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Biomedical subjects

M Trent

Publications and source records attributed to M Trent.

9 recordsLinked to original sources

A cluster of leptospirosis among abattoir workers.

In early December 1998, the Northern Rivers Public Health Unit (north-eastern New South Wales) was alerted to a possible cluster of leptospirosis cases by the supervising scientist of the Western Pacific Region World Health Organization/Food and Agricultural Organization Collaborating Centre for Reference and Research on Leptospirosis. Investigation revealed a cluster of eight leptospirosis cases diagnosed during October and November 1998. All were employees of a local meat works. Leptospira serovars isolated included pomona and hardjo. Symptoms included headache, fever, muscle pain, sore eyes, abdominal pain, vomiting, jaundice, and rash. Five of the eight cases were hospitalised. The infection could not be traced to any particular source. Unfortunately, records of stock killed during the exposure periods were not available. All cases reported exposure to large volumes of animal urine during the course of their work. Protective clothing provided included an apron, gloves, and rubber boots. All of the patients said they wore rubber boots and seven of the eight wore the apron provided. Only two patients reported wearing gloves, the remainder thought these were too difficult to work in.

Abattoirs↗

Infections in patients managed at home during autologous stem cell transplantation for lymphoma and multiple myeloma.

A group of 51 patients with multiple myeloma, non-Hodgkin's lymphoma or Hodgkin's disease receiving high-dose chemotherapy and autologous peripheral blood stem cell rescue received chemotherapy and clinical care in the peritransplant period at home. This group was compared with 88 cases with the same diagnoses, receiving the peripheral stem cell transplant over the same time period as an inpatient in a high efficiency particulate air filtered bone marrow transplant unit. Patients were treated at home based on choice, geographic accessibility, availability of an educated care giver and a clean home environment, and comprehension of the concepts of infection and aseptic techniques. Febrile neutropenia and sepsis were not increased in the home group and no episodes of septic shock were seen in this group. Patients at home received prophylactic oral ciprofloxacin and roxithromycin during the phase when the absolute neutrophil count was < 1 x 10(9)/l. Fewer gram-negative infections, but no diminution in gram-positive infections or in the rate of fever were seen in patients at home. Empiric therapy with a third generation cephalosporin, teicoplanin and tobramycin was instituted in 31 patients who developed a fever greater than 38.5 degrees C. Of this group of 31, 18 required admission to hospital, 12 because of febrile neutropenia which persisted or was considered unsuitable for management at home due to sepsis. The remaining 13 with febrile neutropenia remained at home throughout, as did the 20 cases not developing neutropenic fever. This study demonstrates the feasibility of managing carefully selected patients in their home environment when at risk from febrile neutropenia or other septic complications following autologous peripheral stem cell support.

Anti-Bacterial Agents↗

Self-reported morbidity of Barmah Forest virus infection on the north coast of New South Wales.

OBJECTIVE: To describe the clinical features and disability associated with Barmah Forest virus (BFV) infection. DESIGN: Retrospective postal survey. SETTING: North Coast Public Health Unit, Lismore, New South Wales, January to October 1995. SUBJECTS: All 84 subjects notified by mandatory laboratory reporting as positive for BFV IgM by enzyme-linked immunosorbent assay. OUTCOME MEASURES: Demographic information, self-reported symptoms, disability and treatment. RESULTS: Response rate was 77%. Peak incidence was in the 30-50 years age group, with almost identical numbers of men and women affected. The most common symptoms were lethargy (89%), joint pain (82%) and rash (68%). These were also generally the first symptoms to appear. Thirty of 54 respondents (56%) reported time off work and 27 of 53 (51%) reported illness lasting more than six months. Those who had a rash were significantly more likely to have recovered by the time of the survey than those who had no rash (odds ratio, 10.3; 95% confidence interval, 1.8-76.6). No treatment led to more than slight relief of symptoms. CONCLUSION: Symptoms of BFV infection appear similar to those of the better-known Ross River virus infection, and clinicians should consider both in patients with symptoms of arboviral disease. The wide distribution and long duration of illness make BFV a potentially significant cause of morbidity in Australia. A possible association between the presence of a rash and improved prognosis needs further investigation.

Activities of Daily Living↗

An outbreak of Norwalk virus gastroenteritis following consumption of oysters.

In August 1996, an outbreak of Norwalk virus gastroenteritis occurred among south-east Queensland and northern New South Wales residents over a four week period. Ninety-two of the 97 cases detected were confirmed as having consumed raw oysters within three days prior to developing the illness. No other food items or beverages were significantly associated with the illness. Environmental investigations indicated the Terranora Broadwater, Tweed Heads as the origin of the contaminated oysters. However, the primary source of Norwalk virus could not be verified. Oysters and other shellfish appear to be a common vehicle for transmission of this virus. This outbreak and the more recent hepatitis A outbreak associated with Wallis Lake oysters, highlight the susceptibility of oysters to environmental contamination and the urgent need for stricter quality control procedures. This report details the epidemiological, microbiological and environmental findings from an outbreak investigation conducted jointly by the Queensland and New South Wales health authorities.

Adolescent↗

Assessing work retention issues.

Within 6 months, a 10-member Nursing Services task force created and administered a literature-based retention survey. Tool development and administration is described. The 33-item tool was completed by 85% of the staff. Responses led to the formation of work groups, charged with addressing dissatisfiers and communicating implementation strategies to the hospital at large.

Adult↗

Familial balanced translocation 4p+/17q- as a suggested cause of primary trisomy-21 Down's syndrome.

A case is presented in which a 4p+/17q- familial balanced reciprocal translocation in the mother produced a son with primary trisomy-21, as well as the structural chromosomal anomaly. A number of similar situations have been reported, suggesting that the two events are related. In practice, this (as well as other direct risks) should be taken into account when counseling those families in which one parent carries a balanced translocation. A hypothesis, based on experiments in Drosophila, has been put forward by Grell to explain the mechanism which links the balanced structural abnormality to an aneuploidy of chromosomes not taking part in the structural change, and this has been extended to similar human situations.

Child, Preschool↗