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Biomedical subjects

P Edgar

Publications and source records attributed to P Edgar.

13 recordsLinked to original sources
PubMed1998

Ciprofloxacin as a therapeutic modality in pediatric burn wound infections: efficacious or contraindicated?

BACKGROUND: Food and Drug Administration regulations state that ciprofloxacin hydrochloride may cause arthropathies. For this reason, such therapy is contraindicated in the pediatric population. However, several studies in children with cystic fibrosis have found the drug to be efficacious. Our hypothesis was that ciprofloxacin treatment is justified in the case of multiresistant organisms in burn populations. DESIGN: During a 4-year period (January 1, 1993, to December 31, 1997) we treated 56 of our pediatric burn patients with ciprofloxacin when cultures proved resistant to other antibiotics. The burn area was 65% of the total body surface area. The average patient age was 8.4 years. Of the 56 patients who received ciprofloxacin, 50 received the recommended dose. Biopsy specimens were assessed for quantitative bacteriology and antibiotic sensitivity. Radiologic review was conducted to examine for arthropathy. RESULTS: All patients showed unequivocal reduction in quantitative bacterial counts, and susceptibility to ciprofloxacin remained stable without the development of resistance. Of the 56 patients treated, 42 had a major reduction in their quantitative wound biopsies from 10(6) to less than 100 colonies per gram of tissue, while the remaining 14 were observed to have a 2- to 3-log decrease. No arthropathy was detected in any of the 56 patients receiving ciprofloxacin. Review of the patients' charts showed no documented adverse events associated with the use of ciprofloxacin. All patients survived their thermal injury and the complications associated with it without any untoward problems or complications of arthropathy. CONCLUSION: On the basis of these data, ciprofloxacin therapy in the treatment of immunosuppressed pediatric burn patients is efficacious and does not cause arthropathy.

Adolescent↗
PubMed1997

Containment of a multiresistant Serratia marcescens outbreak.

A 3-year-old male from Bolivia who sustained a full-thickness 80 per cent TBSA burn complicated by smoke inhalation on the 28 March 1995 was admitted to our burn centre on 6 April 1995. On 11 April the patient's wounds were colonized with a Serratia marcescens sensitive only to ciprofloxacin and imipenem. Sputum cultures revealed the same phenotypic S. marcescens. Two patients who were admitted days later had the same phenotypic S. marcescens. Their TBSA burns ranged from 54 to 80 per cent. Both were injured in early April. Sputum and wound cultures were also positive for S. marcescens. Precautionary measures were instituted immediately. All potential reservoirs were cultured. Cultures were negative for S. marcescens. Patient therapy was maintained via strict isolation. The first patient died on 17 May. The two remaining patients survived and were discharged colonized with S. marcescens. However, the biotype of the initial S. marcescens was different from the latter two. Early recognition of a multiresistant S. marcescens resulted in negating the spread of this agent to other patients.

Adolescent↗
PubMed1995

The effects of the 3-hydroxy, 3-methylglutaryl coenzyme A reductase inhibitor pravastatin on bile composition and nucleation of cholesterol crystals in cholesterol gallstone disease.

3-hydroxy,3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors reduce biliary cholesterol saturation index (CSI) in duodenal bile in hypercholesterolemic patients and might be useful for gallstone dissolution. However, preliminary data suggest that these drugs are not effective in this respect. We therefore studied 33 patients with radiolucent gallstones in an opacifying gallbladder who were scheduled for elective cholecystectomy. Patients were treated with 40 mg pravastatin day-1 or placebo during the 3 weeks before surgery. Six patients could not be evaluated. Baseline characteristics (age, sex, body mass index, serum cholesterol, and the solitary/multiple gallstone ratio) were similar in both groups. Serum cholesterol fell by 39% in the pravastatin group (P < .001) and remained unchanged in the placebo group. Biliary cholesterol (9.5 +/- 1.3 vs. 14.3 +/- 1.5 mmol/L, P = .026), and phospholipid concentrations (24.8 +/- 3.9 vs. 36.7 +/- 3.9 mmol/L, P = .043) were lower in the pravastatin group. Although bile salt concentrations were lower in the pravastatin group (114 +/- 21 vs. 152 +/- 15 mmol/L), this difference was not significant. CSI was not different between both groups (142 +/- 27% [pravastatin] vs. 113 +/- 6% [placebo], P = NS). Cholesterol crystals were present in fresh bile in 7 of 13 patients in the pravastatin group and in 11 of 14 controls (P = NS). Nucleation time was comparable between the 2 groups (13 +/- 3 vs. 9 +/- 3 days, P = NS). Bile salt species and molecular species of phospholipids determined with high-performance liquid chromatography did not differ either between both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile↗
PubMed1993

Time-to-contact judgment in the locomotion of adults and preschool children.

The hypothesis of Lee (1976)--that approach and deceleration toward a surface can be controlled through the rate of change of the optic variable tau--was examined for natural human locomotion. In Experiment 1, 12 adults were asked to perform locomotor tasks that required running at speed and then decelerating so that either the hand or head made a controlled contact with a door. In Experiment 2, 12 preschool children performed a relay-running task that required similar control. In Experiment 3, 12 children and 12 adults ran with a stick as an extension to their arm length and performed the same task. The results supported Lee's hypothesis for the initial phase of approach, but subjects switched to a separate adjustment phase 2 to 3 arm lengths from the target. Children did not adopt an appropriate tau strategy for collision avoidance and appeared unable to modify their approach strategy to allow for a hand-held stick.

Acceleration↗
PubMed1989

Enzyme linked immunosorbent assay for measuring antithrombin III.

A competitive ELISA for the measurement of antithrombin III antigen was developed using a pure preparation of antithrombin. This two step immunoassay requires only one antibody binding step and avoids the binding of anti-antithrombin antibody to the solid phase. Plasma samples measured by this ELISA correlated well with measurements taken with immune electrophoresis measurements (r = 0.933); the ELISA was also shown to be both sensitive and precise.

Antithrombin III↗
PubMedDate not supplied

Much ado about nothing: methicillin-resistant Staphylococcus aureus.

The pathogenic methicillin-resistant Staphylococcus aureus (MRSA) has received a voluminous amount of notoriety. The four major reasons are its morbidity, mortality rate, cost of treatment, and constant appearance in intensive care units. Both Staphylococcus aureus and S. epidermidis (MRSE) account for 82% of our gram-positive wound isolates, whereas the gram-negative account for 34% of all isolates. Therefore we compared the morbidity, mortality rate, and cost factors related to MRSA-MRSE and gram-negative infections for a 4-year period, assessing more than 214 documented infections. Morbidity and mortality rates were minor for MRSA. Pseudomonas aeruginosa and Escherichia coli accounted for 57.5% of the total gram-negative isolates. Gram-negative antimicrobial therapy usually requires two therapeutic drugs, which increases morbidity and costs, whereas the staphylococci usually can be treated by one antimicrobial. During this period there were 47 gram-negative infections requiring 10 to 15 additional days of hospital stay, with a daily antibiotic cost of $293.40. Costs for MRSA or MRSE are 28% less. Therefore our preoccupation with MRSA or MRSE infections is unwarranted and unsubstantiated.

Adolescent↗
PubMedDate not supplied

Alternate antimicrobial therapy for vancomycin-resistant enterococci burn wound infections.

Survival after a major thermal burn is precarious and fraught with difficult complications associated with hypermetabolism, gut or respiratory dysfunction, and infection. Clinicians must be cognizant of a new threat to the patient with burn injuries--the emergence of vancomycin-resistant enterococci (VRE). In an analysis of 31 clinical isolates obtained during acute burn hospitalization, an optimal antimicrobial therapy for VRE has been identified. All VRE cultures were inoculated to the MicroScan Gram-Positive Breakpoint Combo Panel #8 (Dade Microscan, Inc, Sacramento, Calif), which speciates the enterococci, provides antimicrobial susceptibility patterns (including vancomycin) and a biotype, and examines streptomycin and gentamicin synergy. Eleven (35.5%) of the 31 isolates were identified as E faecium and 20 (64.5%) as E faecalis. All isolates were susceptible to chloramphenicol and tetracycline, whereas only half were sensitive to gentamicin synergy screen. All other antimicrobials screened against VRE were either ineffective or of limited effect. Our preliminary data supports the initiation of chloramphenicol therapy when a VRE burn wound infection is encountered or suspected.

Anti-Bacterial Agents↗