Search PubMed⌕ Search

Biomedical subjects

S E Day

Publications and source records attributed to S E Day.

11 recordsLinked to original sources
PubMed2000

A prospective social and molecular investigation of gonococcal transmission.

BACKGROUND: Gonorrhoea is a common infectious disease, poorly controlled despite effective treatments. Tracing chains of transmission is difficult, because sexual partners are commonly difficult or impossible to identify. We assess the use of gonococcal opa-typing in identifying transmission links not revealed through interview. METHODS: Epidemiological data and gonococcal isolates were collected prospectively from patients at two UK clinics in London and Sheffield. Social and epidemiological data were combined with molecular typing of gonococcal isolates by a new methodology based on the polymorphisms of the opa gene. FINDINGS: In London, interview data and opa-typing on samples from 215 cases showed a diverse population with few links. In Sheffield, interview data identified links between 51 (43%) of 120 cases, whereas opa-typing suggested a more connected population: 95 (79%) of cases had shared profiles. There was a highly significant correlation between the two distributions with epidemiological clusters appearing as a subset of the opa clusters. Two large opa clusters, of 18 and 43 cases, accounted for 50% of local cases of gonorrhoea. Discordance between epidemiological and opa-typing data was observed at highly connected points in the sexual network. INTERPRETATION: Opa-typing is a more powerful tool for epidemiological investigation of gonorrhoea transmission than earlier methods. Opa-typing can link infections that would otherwise remain unlinked, and may aid interventions to control endemic disease.

Adolescent↗
PubMed1998

Liquid ventilation.

For decades, the fluid-filled lung has been a valuable research model for understanding normal and abnormal pulmonary physiology. It has lagged behind, however, as a useful therapeutic tool. Recently, the potential applications of perflubron's physicochemical and biologic properties have been realized. In animal models of several types of hypoxic respiratory failure, perflubron's efficacy in improving gas exchange and compliance has been demonstrated. Preliminary clinical studies of PLV in neonates who have RDS and CDH, and in children and adults who have ARDS have shown promise. Pivotal prospective, controlled studies have yet to be completed.

Adult↗
PubMed1997

Inhaled nitric oxide reduces the utilization of extracorporeal membrane oxygenation in persistent pulmonary hypertension of the newborn.

OBJECTIVE: To determine if the use of inhaled nitric oxide therapy reduces the need for extracorporeal membrane oxygenation (ECMO) in persistent pulmonary hypertension of the newborn. DESIGN: A matched cohort study with retrospective data extraction. SETTING: Pediatric and neonatal intensive care units at a medical school-affiliated children's hospital serving as a regional referral center for respiratory failure. PATIENTS: Records of all neonates transferred for rescue therapy for persistent pulmonary hypertension during the study period were analyzed, with inclusion in the study based on defined gas exchange parameters, and with exclusion from the study based on the presence of congenital heart disease, diaphragmatic hernia, or lethal chromosomal abnormality. Assignment to cohorts was based on availability of inhaled nitric oxide therapy: group 1 patients were admitted when inhaled nitric oxide was unavailable; group 2 patients were admitted when inhaled nitric oxide was available. INTERVENTIONS: Standard criteria (alveolar-arterial oxygen tension gradient of > 600 torr [> 80 kPa], or oxygenation index of > 40) were used to trigger initial evaluation for ECMO when these criteria were met for 2 hrs, and ECMO was initiated if these criteria continued to be met for 12 hrs, or if cardiovascular instability occurred. Ventilator management in all patients was directed to improve arterial oxygenation, such that ECMO criteria were no longer met. Patients in group 2 only were treated with inhaled nitric oxide after meeting ECMO evaluation criteria, and they continued to receive inhaled nitric oxide if a quantifiable improvement in gas exchange occurred. MEASUREMENTS AND MAIN RESULTS: Fifty patients qualified for inclusion in the analysis (29 patients in group 1, and 21 patients in group 2). In group 1, 21 (72%) patients met ECMO criteria, and 16 (76%) patients required ECMO therapy. In group 2, 16 (76%) patients met ECMO criteria, 15 patients received inhaled nitric oxide therapy, and only four (25%) patients required ECMO therapy (p = .003 compared with group 1). Treatment with inhaled nitric oxide resulted in an initial increase in PaO2, without adverse effects, in all of the treated patients. The reduction in ECMO utilization in group 2 was achieved with a higher rate of complication-free survival (survival without oxygen, requirement at 28 days, p = .018; survival without intracranial hemorrhage, p = .048), and a lower hospital cost per survivor (p = .021), compared with group 1 patients. CONCLUSION: In neonates with persistent pulmonary hypertension, therapy with inhaled nitric oxide reliably and safely improves oxygenation, thereby resulting in a decreased need for ECMO therapy, improved patient outcome, and lower hospital costs.

Administration, Inhalation↗
PubMed1993

Intra-transport stabilization and management of the pediatric patient.

During the period of interhospital transfer, a critically ill child is at risk from the disease, the therapy, and the transfer itself. This risk can be minimized by good communication between the referring and receiving caretakers, careful evaluation and management, anticipation of complications, and a well-equipped and well-trained transport team providing a level of care as close as possible to that available at the receiving critical care unit.

Airway Obstruction↗
PubMed1993

Treating measles: the appropriateness of admission to a Wisconsin children's hospital.

OBJECTIVE: A large number of children with measles were hospitalized at a children's hospital during a metropolitan measles outbreak. In this study we addressed the appropriateness of those admissions. METHODS: Charts of all 634 patients with a diagnosis of measles who were treated between August 1989 and April 1990 were reviewed. Determination of the appropriateness of hospital admission was based on severity of illness and presence of severe complications of measles. RESULTS: Of 564 patients with clinical measles or serologic evidence of recent infection, 252 were inpatients (median age 1.5 years) and 312 were outpatients (median age 2.1 years). Fifty-nine (23.4%) of the inpatients had been inappropriately admitted. Inpatients were significantly more likely than outpatients to have physiologic instability or a clinical complication. Children 15 months of age or younger were more likely to be hospitalized, as were children evaluated in the first 3 months of the outbreak period, even if admission was not appropriate on the basis of physiologic instability or complications. CONCLUSIONS: Younger patients with measles and patients evaluated earlier in the epidemic were more likely to be admitted to the hospital even when admission was inappropriate as assessed by degree of physiologic instability or presence of complications.

Age Factors↗
PubMed1993

Measles severity and serum retinol (vitamin A) concentration among children in the United States.

BACKGROUND: Studies in developing countries have shown that children with measles have low serum retinol concentrations and that lower retinol levels are associated with measles-related mortality. Vitamin A therapy has been shown to reduce mortality among African children with acute measles. OBJECTIVES: To determine whether serum retinol concentration is low among children with measles in the United States and to determine whether retinol concentration is associated with illness severity. SETTING: Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990. PATIENTS: One hundred fourteen patients < or = 5 years of age evaluated for serologically confirmed measles with serum obtained within 5 days following rash onset. METHODS: Serum retinol concentration was determined by high-performance liquid chromatography. Clinical data were collected by hospital record review. A modified Pediatric Risk of Mortality (PRISM) score was used to assess physiologic instability as a measure of illness severity. RESULTS: Retinol concentrations ranged from 0.25 to 1.18 mumol/L (median 0.58 mumol/L); 82 (72%) patients had low retinol concentration (< or = 0.70 mumol/L). Median retinol concentrations were lower among hospitalized patients (0.56 vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02) but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher modified PRISM scores, reflecting greater physiologic instability, were associated with lower retinol concentration (beta coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associated with lower retinol concentration (beta coefficient -.0144, P = .025) even after controlling for hospitalization, presence of complications, race, age, receipt of Aid to Families With Dependent Children, gender, and interval from rash onset until serum was collected. CONCLUSIONS: Among these children with measles in an urban United States community, retinol concentrations were depressed, and the degree of depression was associated with illness severity. Vitamin A therapy should be considered for children with measles in the United States who require hospitalization.

Child, Preschool↗
PubMed1992

Transport of critically ill patients in need of extracorporeal life support.

In the past 10 years, we have seen tremendous growth in the use of ECMO for neonatal cardiopulmonary failure, and new indications are being recognized for the use of ECMO and other forms of ECLS in older children and adults. The number of medical centers providing ECLS is and will always be limited, so services are needed to transport critically ill patients to ECLS centers. Transport teams should be thoroughly familiar with the pathophysiology of cardiac and respiratory failure. They should be equipped to continue the monitoring and treatment initiated at the referring center, to maintain that level of care during transfer, and to treat complications of the diseases or of the therapy itself. The responsibilities of the referring centers are to acquaint themselves with ECLS programs in their geographic areas and with transport services available. Early communication with complete and accurate information is essential. Developing a program for ECLS during transport is a huge undertaking that should be considered seriously. Not every ECLS center has the resources to embark on such a program. Timely referral should make such complex transfers unnecessary for most patients.

Adult↗
PubMed1984

Immunocytochemical labelling of Bacteroides nodosus pili using an immunogold technique.

An immunogold labelling technique was used to label the pili of the bacterium Bacteroides nodosus. The labelling was distinct and highly specific, and individual pili could be recognised beneath the gold probe. The labelling of somatic antigens could be distinguished from that of pilus antigens. Furthermore, labelling of fragments of cytoplasm released by cell lysis and trapped in the pili could be distinguished from pilus labelling. An antiserum that had been raised against strain 80200 (serotype N) labelled pili of strain 215 (serotype B). Double labelling experiments with this antiserum and the antiserum against strain 215 (serotype B) showed that both antisera label the same pili bundles. The ease of detection of the immunocytochemical reaction should enable this technique to be used as a routine screen for pilus antigens. It also possesses the potential for much wider applications for immunolabelling other antigens, such as viruses, that can be obtained in suspension.

Bacteroides↗
PubMed1979

Circadian rhythmicity in rat intestinal villus length and cell number.

Circadian rhythmicity has been reported in various small intestinal digestive-absorptive functions and in the mitotic activity of intestinal crypt cells. These functional activity rhythms and perhaps the mitotic rhythms are cued by the feeding schedule. We now report that circadian rhythms also occurred in both the villus height and cell number in rats maintained on morning or afternoon feeding schedules for 7 days. Villus width was constant. In afternoon-fed rats both villus height and cell number were 50% greater just before feeding than 12 h later. The amplitudes of the two rhythms in the morning fed rats were decreased, the general shape of the cycles were changed and the average number of cells was increased. These changes between morning and afternoon feeding are attributed to incomplete phase shifting due to an insufficient adaptation span for the morning fed rats. We conclude that circadian rhythms occurring in villus height and cell number are affected by the feeding schedule. Similarities to some previously reported functional rhythms suggest that fluctuations in cell number and/or villus length might be related to the functional changes.

Animals↗