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Biomedical subjects

M W McKendrick

Publications and source records attributed to M W McKendrick.

At least 19 recordsLinked to original sources
PubMed2005

The European Union of Medical Specialties core training curriculum in infectious diseases: overview of national systems and distribution of specialists.

The European Union of Medical Specialities (UEMS) Section of Infectious Diseases agreed on an infectious disease training programme in 1999, which was updated in 2002. Although the provision of infection services throughout Europe is not uniform, with variation in the roles of infectious disease physicians and microbiologists, there are, nonetheless, physicians with a predominant responsibility for clinical infectious diseases (and tropical medicine) in most countries. However, infectious diseases is formally recognised as a specific discipline by most, but not yet all, European countries. There has been consensus from national representatives to the UEMS on the content of the published curriculum. There are clear areas of overlap in training between different infection disciplines, and exploration of possible areas for closer liaison and collaboration between them has been initiated. The increased movement of medical staff within Europe will place greater demands on those responsible for training, monitoring and quality assurance. The Board and Section of Infectious Diseases have established core training programmes with a generic logbook to assist those countries without a written curriculum or record book and facilitate the development of common standards of training. The duration of training varies across Europe; 4 years is the UEMS standard, or longer if the training is combined with general internal medicine. The numbers of infection specialists (infectious diseases and microbiology) per million population show considerable variation. The UEMS Sections have recognised the importance of working closely with European specialist societies involved with training. The Section for Infectious Diseases has, in partnership with the ESCMID, established a Board for the accreditation of continuing medical education/continuing professional development.

Communicable Disease Control↗
PubMed2003

Prospective study of factors influencing the persistence of symptoms in hospitalised patients with acute infection.

Sequential patients, aged 18-50, admitted to an Infectious Diseases Unit of a large teaching hospital with an acute infection, completed validated psychometric questionnaires on admission and were followed up at three monthly intervals for 12 months. 34% of patients available for follow-up remained symptomatic at 3 months, but by 6 months and for the rest of the study, only about 20% of patients available for follow-up remained symptomatic. Symptoms resembled those of the initial infection at 3 months, but for the remainder of the study, most patients complained of nonspecific symptoms of tiredness and lassitude. Patients symptomatic at 3 and 6 months (S+) had significantly higher depression scores on admission compared with nonsymptomatic group (S-) (P<.05). Stepwise logistic regression revealed that case level depression on admission was predictive of a 13-fold increase in the chance of remaining symptomatic at 6 months. These associations were lost by 12 months. In conclusion, this study has supported the hypothesis that psychopathology occurring at the time of an acute infection can lead to persistent symptoms that at least in the short term resemble those of the acute illness. This relationship breaks down after 6 months, when symptoms become less specific and may be conditioned by exhausting and distressing social situations other than acute illness.

Acute Disease↗
PubMed2003

Increased rectal mucosal expression of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome.

BACKGROUND AND AIMS: Chronic bowel disturbances resembling irritable bowel syndrome (IBS) develop in approximately 25% of patients after an episode of infectious diarrhoea. Although we have previously shown that psychosocial factors operating at the time of, or prior to, the acute illness appear to predict the development of post-infectious IBS (PI-IBS), our finding of an increased inflammatory cell number in the rectum persisting for at least three months after the acute infection suggested that there is also an organic component involved in the development of PI-IBS. To evaluate this further, we measured expressions of interleukin 1beta (IL-1beta) and its receptor antagonist (IL-1ra) in these patients to provide additional evidence that the pathogenesis of PI-IBS is underpinned by an inflammatory process. METHODS: Sequential rectal biopsy samples were prospectively obtained during and three months after acute gastroenteritis, from eight patients who developed post-infectious IBS (INF-IBS) and seven patients who returned to normal bowel habits after acute gastroenteritis (infection controls, INF-CON). Eighteen healthy volunteers who had not suffered from gastroenteritis in the preceding two years served as normal controls (NOR-CON). IL-1beta and IL-1ra gene expressions were assayed by reverse transcriptase-polymerase chain reaction, and their levels of expression were quantitated by optical densitometry after electrophoresis on agarose gel. RESULTS: INF-IBS patients exhibited significantly greater expression of IL-1beta mRNA in rectal biopsies than INF-CON patients both during and three months after acute gastroenteritis. Moreover, IL-1beta mRNA expression had increased in biopsies taken from INF-IBS patients at three months after the acute infection but no consistent change was observed in INF-CON patients. IL-1beta mRNA expression of INF-IBS patients at three months post gastroenteritis was significantly greater than NOR-CON whereas that of INF-CON patients was not significantly different from NOR-CON. Despite these differential changes in IL-1beta mRNA expression, no significant changes were observed in IL-1ra mRNA expression among the three groups. CONCLUSIONS: These findings indicate that those patients who develop IBS post infection exhibit greater IL-1beta mRNA expression, both during and after the infection, compared with individuals who do not develop PI-IBS. We conclude that such patients may be susceptible to inflammatory stimuli, and that inflammation may play a role in the pathogenesis of PI-IBS.

Acute Disease↗
PubMed2002

Liver abscess in adults: ten years experience in a UK centre.

BACKGROUND: The epidemiology and management of liver abscess (LA) have evolved over time. AIM: To examine our experience over 10 years in a UK teaching centre. DESIGN: Retrospective review of patient records. METHODS: We reviewed the records of all patients aged >16 years discharged from Royal Hallamshire Hospital with a diagnosis of LA between April 1988 and December 1999. RESULTS: There were 69 patients with LA (65 pyogenic, 4 amoebic), giving a crude annual incidence rate of 2.3/100,000/year (18.15/100,000 hospital admissions). Median age was 64 years. Single lesions were found in 41 patients, multiple lesions in 28. Pre-admission, patients were symptomatic for a median 14 days, with the most common symptoms and signs being fever and abdominal pain/tenderness. Pathogens were identified in 74% and predisposing aetiology in 92% of those undergoing investigation. Spread of infection to the liver via the portal venous system was the commonest route of infection (46%), most frequently in patients aged >/=60 years (p=0.019). Abdominal ultrasound (US) was diagnostic for LA in >90% of cases. Treatment with anti-microbial therapy plus interventional radiology was optimal. The case fatality rate was 12.3%, mainly from associated underlying pathology. DISCUSSION: LA is commonly associated with underlying gastrointestinal pathology. Seeking out this underlying aetiology is an integral part of management. We recommend US as the first-line diagnostic tool with guided intervention plus antibiotic(s) as first-line treatment. Prognosis depends chiefly on the underlying pathology.

Adolescent↗
PubMed2001

Lung function tests and risk factors for pneumonia in adults with chickenpox.

BACKGROUND: Varicella is 25 times more likely to be complicated by pneumonia in adults than in children. Data on changes in lung function following pneumonia are limited. This study was undertaken to describe the epidemiological factors associated with pneumonia and to investigate lung function up to 1 year following chickenpox. METHODS: Thirty eight consecutive suitable patients admitted to a university hospital were enrolled in the study; 19 had pneumonia and 19 did not. Epidemiological data and density of rash were recorded, spirometric tests were performed, and carbon monoxide transfer factor was measured. RESULTS: Varicella pneumonia was associated with the presence of respiratory symptoms (p=0.006), current smoking (p=0.003), and history of close contact (p=0.009). There was a trend towards patients with pneumonia having a more severe rash. No association was observed between pneumonia and age or sex. Current smokers had a higher mean number of spots than non-smokers (p=0.005). Carbon monoxide transfer factor at hospital discharge was reduced in 27 patients (71%), more markedly in the group with pneumonia (p=0.009). Nine patients (seven with pneumonia) still had a reduced carbon monoxide transfer factor (mean reduction 36%) at 12 months. CONCLUSION: Chickenpox may result in a defect in carbon monoxide transfer factor for at least a year after acute illness.

Adult↗
PubMed2001

A hoarse voice: atypical mycobacterial infection of the larynx.

Myobacterium malmoense is a non-tuberculous mycobacterium that most commonly causes pulmonary infection, particularly in patients with underlying pulmonary disease or immunodeficiency. We describe a case of Mycobacterium malmoense infection of the larynx in a previously well middle-aged woman, which has previously not been reported. The case highlights the importance of considering atypical mycobacterial infection in the differential diagnosis of laryngeal lesions.

Aged↗
PubMed2001

Potential for hepatitis C transmission among non-needle/syringe sharing Sheffield drug injectors through the sharing of drug preparation paraphernalia.

This study aimed to investigate possible means by which hepatitis C virus (HCV) might be transmitted between drug injecting individuals without the sharing of needles and syringes. A questionnaire-based survey of 143 (out of 287) attendees was conducted at an Infectious Diseases Unit-based HCV clinic. Those patients (all of whom were positive for antibodies to HCV) who asked about risk activities and those that admitted to a history of recreational drug injecting were questioned in detail about their past and current drug preparation practices. Ten per cent denied any history of needle and/or syringe sharing and had no other apparent source of their HCV infection, but instead admitted to having shared drug preparation eqiupment. The existence among drug injectors of such practices with the potential to transmit blood borne viruses is important as it may explain how HCV, which is capable of being spread via very small quantities of blood, can be passed between drug injecting individuals who might otherwise never come into contact with another drug injector's blood. Clinical and public health messages regarding the prevention of the spread of HCV may need to be revised and strengthened.

Communicable Disease Control↗
PubMed2000

Parvovirus B19 causing leucopenia and neutropenia in a healthy adult.

A 27-year-old healthy female presented with a prolonged and intermittent febrile illness. She was found to have leucopenia, neutropenia and thrombocytopenia, but a normal haemoglobin. The patient recovered spontaneously and convalescent serology 1 month later was positive for specific parvovirus B19 IgM and IgG. Parvovirus B19 infection was confirmed by detection of viral DNA by dot blot hybridization in a specimen of blood taken during the acute illness. A review of the previously reported cases of parvovirus B19-induced leucopenia in normal adults is presented. Parvovirus B19 should be considered in the differential diagnosis of leucopenia and neutropenia in healthy adults.

Adult↗
PubMed2000

Two simultaneous cases of Cyclospora cayatensis enteritis returning from the Dominican Republic.

According to the "International Passenger Survey," published in 1996 by the Office of Trading Standards, 534,000 British people traveled to the Caribbean area (personal communication, ABTA, 1998). The Dominican Republic, the eastern end of a large Caribbean island, has become in recent years one of the most popular destinations for UK holidaymakers as well as for travelers from many other countries. Cyclospora cayatensis has been firmly identified as a cause of gastroenteritis among international travelers,1 including human immunodeficiency virus (HIV)-positive individuals,2 but it has not been previously reported in the literature in British individuals returning from this increasingly popular vacation destination.

Aged↗