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Biomedical subjects

R Munro

Publications and source records attributed to R Munro.

At least 55 records · Page 3Linked to original sources
PubMed1996

An evaluation of the in vitro activity of piperacillin/tazobactam.

Tazobactam is a new, irreversible inhibitor of bacterial beta-lactamases of staphylococci, plasmid-mediated beta-lactamases of the TEM and SHV types found in Escherichia coli and Klebsiella species and beta-lactamases of anerobes such as Bacteroides species. Its combination with piperacillin, a broad spectrum ureido-penicillin, would be expected to improve the activity of piperacillin against staphylococci, TEM and SHV beta-lactamase producing Gram negative bacteria and anerobes. Minimal inhibitory concentrations (MIC) of piperacillin/tazobactam were determined for 1952 individual patient isolates of Gram positive and negative bacteria causing significant infections and compared with MIC values for cefotaxime, ceftazidime, ciprofloxacin, imipenem, ticarcillin/clavulanic acid. MICs were determined by agar dilution (NCCLS 1990 and 1992). Piperacillin/tazobactam had excellent activity against methicillin susceptible staphylococci, Streptococcus pneumoniae, Haemophilus influenzae, enterococci and organisms of the Bacteroides fragilis group. It was also active against the majority of Enterobacteriaceae and Pseudomonas aeruginosa isolates tested. It was not active against extended spectrum beta-lactamase (ESBL) producing Klebsiella species and some high level TEM and SHV beta-lactamase producing E. coli and Klebsiella species. Activity against Gram negative organisms capable of producing chromosomally mediated beta-lactamases was good, since in most organisms tested, the enzymes were not induced in sufficient quantities to cause antibiotic resistance. However some Enterobacter species were derepressed hyperproducing mutants; these isolates showed resistance to piperacillin/tazobactam since tazobactam does not inhibit these Class I beta lactamases. Activity was superior to ticarcillin/clavulanic acid for Gram negative rods. Imipenem was the most active agent against ESBL producing Klebsiella species. Piperacillin/tazobactam has a suitable spectrum of activity in vitro to suggest its use in monotherapy of mixed anerobic infections, mixed respiratory infections such as aspiration pneumonia and, in combination with an aminoglycoside, it would provide Gram positive as well as Gram negative cover of febrile episodes in immunosuppressed patients.

Bacteroides fragilis↗
PubMed1996

Is rheumatoid arthritis becoming a milder disease? Or are we starting second-line therapy in patients with milder disease?

The aim of the study was to see whether rheumatoid arthritis (RA) is becoming a milder disease. Information on the initial disease activity and patient function (modified Health Assessment Questionnaire-HAQ) was collected in all RA patients enrolled into studies of sulphasalazine since 1980 in two Glasgow teaching hospitals. Patients (352) were enrolled in trials in the decade 1980-1989, and were compared to 374 patients enrolled in 1990-1994. Patients recruited in the 1980s were significantly younger, but had a similar disease duration to the 1990s patients. The 1980s patients had more active disease as measured by erythrocyte sedimentation rate (61 vs 44, P < 0.0001) and C-reactive protein (40 vs 26, P < 0.0001), and significantly worse function (HAQ 2.3 vs 1.9, P < 0.001). The response to sulphasalazine was very similar in the two cohorts, in terms of the percentage of patients remaining on therapy for 6 months, and the percentage improvement in measures of disease activity. Patients with milder disease were enrolled into the more recent trials of sulphasalazine. This may be because RA is becoming a milder disease, but other possible explanations are discussed.

Adult↗
PubMed1996

Unusual complications of cervical spine surgery for cervical myelopathy in rheumatoid arthritis.

Cervical myelopathy is a recognized complication of rheumatoid arthritis and other inflammatory arthropathies. In a significant proportion of patients, surgical stabilization of the cervical spine offers the best opportunity for improvement of symptoms and long-term survival. We report two cases that illustrate some potential complications of cervical spine surgery and which also emphasize the need for vigilance when caring for patients in this group.

Arthritis, Rheumatoid↗
PubMed1996

Meningococcal disease in urban south western Sydney, 1990-1994.

BACKGROUND: There has been a sustained increase in incidence of meningococcal disease throughout Australia since 1987. In south western Sydney the incidence is higher than the national rate and a cluster of cases occurred in 1991 resulting in a widespread vaccination programme. AIMS: To investigate the clinical demographics of patients with meningococcal disease treated in south western Sydney, and to differentiate meningococcal strains to understand better the epidemiology in this urban setting. In addition, to investigate whether delays in diagnosis of meningococcal disease and institution of appropriate treatment were occurring. METHODS: Retrospective classification of notified cases as meningitis, septicaemia, meningitis/septicaemia, and other syndromes. Clinical information recorded to establish patterns of disease, delays in diagnosis and appropriate treatment, and outcome. Microbiological classification of organisms isolated by serogroup, serotype and subtype. RESULTS: Meningococcal disease primarily affects young children in winter months in south western Sydney, with a secondary peak of incidence in the 15-20 year old age group. 20.7% presented with meningitis only, 22.4% with septicaemia only, and 53.4% with meningitis/septicaemia. There was a delay in diagnosis and institution of appropriate treatment of more than two hours in 21/58 (36.2%) patients including three of the six who died. No patient had received a parenteral antibiotic prior to coming to hospital -18.9% had received an oral antibiotic. The use of antibiotics before diagnostic lumbar puncture decreased the number of positive CSF cultures. However, in all but one patient with negative cultures there was other microbiological evidence of meningococcal disease. The mortality rate was highest (30.8%) in patients with septicaemia only, 6.5% in patients with meningitis/septicaemia and 0% in patients with meningitis only. Serogroup C was the predominant organism in all age groups. The predominant serotype was 2b (80% of serogroup C isolates). Subtypes were more variable but P1.2 occurred in 66.7% of serogroup C strains. CONCLUSIONS: There is a need for more education in our Health Area to improve the time taken to diagnose and institute appropriate treatment. The predominance of serogroup C is unusual in urban Australia where national data show serogroup B organisms predominate. Meningococci of phenotype C:2b:P1.2 have continued to cause disease in our Health Area for the past five years. This phenotype is uncommon in other areas of Australia.

Adolescent↗
PubMed1995

Isolation of a parapoxvirus from a grey seal (Halichoerus grypus).

A grey seal (Halichoerus grypus) developed cutaneous pocks which progressed to involve the skin extensively, necessitating euthanasia. Macroscopically and histologically the lesions resembled previous descriptions of parapoxvirus infections of seals and virus particles were observed in preparations of a scab and a skin lesion. Suspensions of the scab and skin lesion were prepared and inoculated on to monolayer cultures of grey seal kidney cells. After 25 days in culture and three passages, cytopathic effects were observed and parapoxvirus particles were detected by electron microscopy in the supernatant fluid. Both isolates were adapted to cultures of fetal lamb muscle cells and shown to be antigenically related to orf virus.

Animals↗
PubMed1995

Necrotising enteritis in suckled calves.

Necrotising enteritis is a newly recognised disease affecting two to three-month-old suckled calves in Scotland. A cohort of 10 calves from an affected herd was closely monitored from birth until the risk period was over, and one case occurred. In addition, all the cases of dysentery in suckled calves reported to SAV Veterinary Services, St Boswells, from April to August of 1992 were investigated and a further five outbreaks of necrotising enteritis were identified. The clinical pathology, gross and histological findings and results of microbiological investigations are described. No aetiological agent was identified and although the condition bore a superficial resemblance to mucosal disease the histological changes were distinct from those of mucosal disease and no bovine viral diarrhoea virus antigen was detected.

Animals↗
PubMed1995

Relative changes in blood flow with functional electrical stimulation during exercise of the paralyzed lower limbs.

Eight spinal cord injured (SCI) patients performed three sets of exercise with two conditions, 60% and 80% of VO2peak, with an arm crank ergometer. Functional neuromuscular stimulation was used to induce static leg contractions in two of the above sets of exercise. The three exercise sets were performed with no functional neuromuscular stimulation (NOS); with functional neuromuscular stimulation at 40 milliamperes; and with functional neuromuscular stimulation at 80 milliamperes (HIS). The lower limb blood flow was estimated by a photoelectric plethysmograph. Results showed that the lower limb blood flow was consistently reduced across both functional neuromuscular stimulation levels (17.4% from NOS to LOS; 13.8% from LOS to HIS; and 28.8% from NOS to HIS), and work loads (15.3% from rest to 60% VO2peak; 38.0% from 60% VO2peak to 80% VO2peak; and 47.5% from rest to 80% VO2peak). Rate-pressure product was decreased by 8.3% between NOS and HIS at 60% VO2peak (15.7 +/- 3.4 to 14.4 +/- 3.8), by 6.8% between NOS and HIS at 80% VO2peak (18.9 +/- 53 to 17.6 +/- 4.8), and by 12.4% between LOS and HIS at 80% VO2peak (20.1 +/- 6.7 to 17.6 +/- 4.8). These data indicate that in SCI (a) functional neuromuscular stimulation-induced contractions of the lower limb muscles can increase blood flow and thus reduce venous blood pooling in the paralyzed muscles, and (b) such improvements are associated with a reduced rate pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

European brown hare syndrome in England.

The livers from 50 brown hares (Lepus europaeus) were examined by electron microscopy for calicivirus-like particles typical of the virus of European brown hare syndrome (EBHS). The virus was visible in 23 of the livers which included four taken from hares which died in 1982 and 1985 and which had been stored at -20 degrees C. The clinical histories, post mortem and other findings associated with these 23 hares were similar to those described in cases of European brown hare syndrome in other European countries. The findings were compared with those associated with viral haemorrhagic disease (VHD) of rabbits which, although it did not occur in the United Kingdom until 1992, is also caused by a calicivirus believed to be related to EBHS virus. The finding of the virus in hares which died from the disease in 1982 is the earliest recorded isolation of the organism and predates the description of VHD virus and VHD in China in 1984. A retrospective review of post mortem reports revealed cases of disease between 1976 and 1977 which may have been due to EBHS and it is considered that the disease has occurred sporadically in England for several years. The results from suspected and confirmed cases of EBHS in England between 1976 and 1990 are reported and the epidemiology and emergence of the disease is considered.

Animals↗
PubMed1994

Legionnaires' disease outbreak in south western Sydney, 1992. Clinical aspects.

OBJECTIVES: To document the clinical, laboratory and radiological features of patients with Legionella pneumophila serogroup 1 pneumonia during an outbreak, and probe for any relationship between clinical or laboratory features and outcome. DESIGN AND SETTING: Prospective identification of patients with Legionnaires' disease in an outbreak from 15-26 April 1992 in the South Western Sydney Area Health Service, centred on the Fairfield area. PATIENTS: Twenty-six patients (22 men, four women) were confirmed to have the disease, based on the presence of clinical features of pneumonia, with L. pneumophila serogroup 1 isolated on culture, or evidence of seroconversion. RESULTS: Seventeen patients (65.4%) were culture-positive for L. pneumophila serogroup 1 and nine were diagnosed on serological criteria. A direct fluorescent antibody (DFA) test of sputum performed well as a rapid diagnostic method. Twenty-three patients (89%) presented with hyponatraemia, 14 (54%) with renal impairment and nine of 19 (47%) with elevated serum creatinine phosphokinase levels. Overall mortality was 23% (71% for patients requiring mechanical ventilation). Eleven of 119 patients (10.2%) who did not have Legionnaires' disease showed serological evidence of previous exposure. CONCLUSIONS: The duration of symptoms and severity of biochemical abnormalities at presentation were not related to outcome. The sputum DFA test is useful for rapid diagnosis during outbreaks.

Adult↗
PubMed1994

Lyme disease: a search for a causative agent in ticks in south-eastern Australia.

Attempts were made to identify the causative organism of Lyme disease in Australia from possible tick vectors. Ticks were collected in coastal areas of New South Wales, Australia, from localities associated with putative human infections. The ticks were dissected; a portion of the gut contents was examined for spirochaetes by microscopy, the remaining portion inoculated into culture media. The detection of spirochaetes in culture was performed using microscopy, and immunochemical and molecular (PCR) techniques. Additionally, whole ticks were tested with PCR for spirochaetes. From 1990 to 1992, approximately 12,000 ticks were processed for spirochaetes. No evidence of Borrelia burgdorferi or any other spirochaete was recovered from or detected in likely tick vectors. Some spirochaete-like objects detected in the cultures were shown to be artifacts, probably aggregates of bacterial flagellae. There is no definitive evidence for the existence in Australia of B. burgdorferi the causative agent of true Lyme disease, or for any other tick-borne spirochaete that may be responsible for a local syndrome being reported as Lyme disease.

Animals↗
PubMed1994

Microbiological aspects of an outbreak of Legionnaires' disease in south western Sydney.

In April 1992 an outbreak of Legionnaires' disease occurred in south western Sydney. Twenty four patients were diagnosed as having Legionnaires' disease either on the basis of a positive culture of Legionella pneumophila serogroup I from a respiratory specimen (14 patients) or a four-fold or greater rise in antibody titre or isolated convalescent titre > 1024 with IgM antibodies present (10 patients). This is the largest outbreak in New South Wales since 44 cases of Legionnaires' disease were reported in Wollongong in 1987. Culture and direct immunofluorescent staining (DFA) were performed for early laboratory diagnosis. The DFA test and a set of defined clinical criteria were then used to classify patients as probable cases of Legionnaires' disease for subsequent Public Health investigations. The DFA test had a predictive value for a positive culture of 45.8% and for a negative culture of 97.1%. Its positive predictive value for a definite diagnosis of Legionnaires' disease (either positive culture or seroconversion), however, was 78.3% with a negative predictive valve of 95.1%. During a 27 day period DFA and culture for Legionella species were performed on 198 specimens from 127 patients. Cultures became positive after a mean of 5 days incubation (range 1-11 days). The use of both selective and non-selective media is recommended for optimal recovery of L. pneumophila since some isolates were obtained on only one culture plate. After an initial evaluation of heat decontamination of specimens this process was abandoned, since in 8/63 specimens so treated, L. pneumophila was recovered prior to but not following heat decontamination and was not grown only in heated specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease Outbreaks↗