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Biomedical subjects

T Butler

Publications and source records attributed to T Butler.

At least 37 records · Page 2Linked to original sources
PubMed1999

Mantoux positivity among prison inmates--New South Wales, 1996.

OBJECTIVES: To determine the prevalence of Mantoux positivity in a prison population; identify risk factors associated with tuberculosis infection; and assess the risk of tuberculosis transmission in a correctional system. METHOD: Cross sectional random sample (between May and August 1996) of inmates stratified by sex, age and Aboriginality. Participants were 789 adult inmates (657 male and 132 female) from 27 New South Wales (NSW) correctional centres (24 male and 3 female). RESULTS: Of the 789 inmates (657 male and 132 female) included in the survey, 639 were given a Tuberculin skin test (Mantoux). Eighty-four (13%) were Mantoux positive. A higher proportion of male inmates were Mantoux positive compared with females (14% vs. 8%, p = 0.08). Significant independent predictors of Mantoux positivity were: being male, aged over 25 years, Aboriginal, born overseas and resident at a jail where there had been a recent tuberculosis outbreak. CONCLUSION: Screening of inmates in NSW prisons based on the principle of risk stratification is appropriate. IMPLICATIONS: While the risk of tuberculosis transmission in NSW jails is currently considered low, continued surveillance is recommended.

Adolescent↗
PubMed1999

Seroprevalence of markers for hepatitis B, C and G in male and female prisoners--NSW, 1996.

OBJECTIVES: 1. Establish the prevalence of markers for hepatitis B (HBV), C (HCV) and G (HGV) in a sample of male and female inmates. 2. Examine exposure to multiple viruses. 3. Compare risk factors for HGV infection with known risk factors for HBV and HCV. DESIGN: Cross-sectional random sample stratified by sex, age and Aboriginality. Inmates were screened for three hepatitis markers. Participants were 789 inmates (657 male, 132 female) in 27 correctional centres in New South Wales, 1996. RESULTS: Overall detection of each of the three screening markers was 35% for HBV, 39% for HCV and 10% for HGV. Exposure rates were higher in female prisoners than males. Increased rates of anti-HBc were observed in Aboriginal inmates compared with non-Aboriginals (54% cf. 27%); anti-HCV and HGV-RNA were comparable between the two groups (36% cf. 41% and 9% cf. 10%). Markers were significantly higher in female injecting drug users (IDU), particularly HCV (90% cf. 66%). Thirty-five per cent of inmates were unaware of their HCV status. For HBV, 72% did not self-report past or present exposure despite serological evidence to the contrary. The multivariate analysis identified Aboriginality, long-term injecting and injecting while in prison as risk factors for HBV. HCV risk factors were female sex, non-Aboriginality, institutionalisation and IDU-associated behaviours. For HGV, female sex and previous imprisonment were significant risk factors but IDU was not. CONCLUSIONS: Blood-borne hepatitis viruses are common in prison inmates, particularly females (HBV, HCV and HGV), Aboriginals (HBV) and IDU (HBV and HCV). Infection can be related to a number of risk factors, which appear similar for HBV and HCV, but distinct from HGV.

Adolescent↗
PubMed1999

Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included patients with multidrug resistance.

To compare clinical and bacteriological efficacies of azithromycin and ciprofloxacin for typhoid fever, 123 adults with fever and signs of uncomplicated typhoid fever were entered into a randomized trial. Cultures of blood were positive for Salmonella typhi in 59 patients and for S. paratyphi A in 3 cases; stool cultures were positive for S. typhi in 11 cases and for S. paratyphi A in 1 case. Multiple-drug resistance (MDR; resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole) was present in isolates of 21 of 64 patients with positive cultures. Of these 64 patients, 36 received 1 g of azithromycin orally once on the first day, followed by 500 mg given orally once daily on the next 6 days; 28 patients received 500 mg of ciprofloxacin orally twice daily for 7 days. Blood cultures were repeated on days 4 and 10 after the start of therapy, and stool cultures were done on days 4, 10, and 28 after the start of therapy. All patients in both groups improved during therapy and were cured. Defervescence (maximum daily temperatures of </=38 degrees C) occurred at the following times [mean +/- standard deviation (range)] after the start of therapy: 3.8 +/- 1.1 (2 to 7) days with azithromycin and 3.3 +/- 1.0 (1 to 5) days with ciprofloxacin. No relapses were detected. Cultures of blood and stool during and after therapy were negative in all cases, except for one patient treated with azithromycin who had a positive blood culture on day 4. These results indicated that azithromycin and ciprofloxacin were similarly effective, both clinically and bacteriologically, against typhoid fever caused by both sensitive organisms and MDR S. typhi.

Adolescent↗
PubMed1997

p55 Tumor necrosis factor receptor fusion protein in the treatment of patients with severe sepsis and septic shock. A randomized controlled multicenter trial. Ro 45-2081 Study Group.

OBJECTIVE: To evaluate the safety and efficacy of p55 tumor necrosis factor receptor fusion protein, a recombinant chimeric protein of human p55 (type I) tumor necrosis factor receptor (CD120a) extracellular domain and IgG1 sequences (referred to as p55-IgG), in the treatment of patients with severe sepsis or septic shock. DESIGN: Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial. SETTING: Forty-four community and university-affiliated hospitals in the United States and Europe. PATIENTS: There were 498 patients enrolled in this clinical trial. INTERVENTION: Patients prospectively stratified within each site into refractory shock or severe sepsis groups were randomized to receive a single infusion of p55-IgG, 0.083 mg/kg, 0.042 mg/kg, or 0.008 mg/kg, or placebo. Patients received standard aggressive medical/surgical care during the 28-day postinfusion period. OUTCOME MEASURE: Twenty-eight-day all-cause mortality. RESULTS: The distribution of variables describing demographics, organ system dysfunction or failure, infecting microorganisms, predicted mortality, plasma interleukin 6 levels, and plasma tumor necrosis factor alpha (TNF-alpha) levels were similar among patients in the p55-IgG and placebo treatment arms. A planned interim analysis was performed after 201 patients were enrolled. Because a statistically nonsignificant trend toward increased mortality was present in patients who had received 0.008 mg/kg, this treatment arm was discontinued, and the study continued with 3 arms. Among all infused patients, there was a statistically nonsignificant trend toward reduced 28-day all-cause mortality in those who received p55-IgG compared with placebo-treated patients (5% reduction, 0.042 mg/kg vs placebo; 15% reduction, 0.083 mg/kg vs placebo; P=.30). However, in patients with severe sepsis and early septic shock (n=247), therapy with p55-IgG, 0.083 mg/kg, was associated with a 36% reduction in 28-day all-cause mortality compared with placebo (P=.07): 20 (23%) of 87 patients died among those treated with p55-IgG, 0.083 mg/kg; 30 (37%) of 82 among those treated with p55-IgG, 0.042 mg/kg; and 28 (36%) of 78 in the placebo group. A prospectively planned logistic regression analysis to assess treatment effect on 28-day all-cause mortality by means of predicted mortality and serum interleukin 6 levels as continuous covariates demonstrated a significant improvement in outcome for the patients with severe sepsis treated with p55-IgG, 0.083 mg/kg, compared with placebo (P=.01). Serious adverse events, including death and the development of new organ system dysfunction, were reported in 65% of patients infused with placebo, with no increased frequency (56%) present in the 2 p55-IgG treatment arms. There were no reports of immediate hypersensitivity reactions caused by p55-IgG. CONCLUSIONS: In this dose-finding study, there was no decrease in mortality between placebo and p55-IgG in all infused patients. In the prospectively defined population of patients with severe sepsis who received p55-IgG, 0.083 mg/kg, there was a trend toward reduced mortality at day 28 that became significant when predicted mortality and plasma interleukin 6 levels were included in a logistic regression analysis.

APACHE↗
PubMed1997

Faecal pollution of ocean swimming pools and stormwater outlets in eastern Sydney.

We determined the levels of faecal contamination over a three-year period from 1991 to 1993 at selected ocean swimming pools and stormwater outlets to assess whether these levels represented a threat to public health. Three popular ocean swimming pools and three nearby stormwater outlets located in Sydney's eastern suburbs were included in the analysis. The ocean swimming pools consistently had elevated levels of faecal coliform bacteria; the highest microbe levels were observed in a pool used largely by children. Faecal coliform bacteria counts in the ocean pools at times reach levels likely to be associated with illness in bathers. Stormwater outlets at three locations had reducing counts over the three-year period. An improved system of sampling, testing and risk communication appears to be needed to reduce potential health risks to users of these popular ocean pools.

Colony Count, Microbial↗
PubMed1997

Comparison of clinical features and pathologic findings in fatal cases of typhoid fever during the initial and later stages of the disease.

This study was undertaken to correlate the clinical features and pathologic changes noted during the initial and later stages of fatal typhoid illness. Five cases who died during the initial stage of the illness (< 2 weeks from onset) had altered mental status, tachypnea, and tachycardia. Three had shock and elevation of serum creatinine values. Autopsies of all five revealed hyperplastic Peyer's patches, features of adult respiratory distress syndrome, and megakaryocytosis. Five other cases died during the later stage of the illness (> or = 2 weeks after onset). They had a left shift in peripheral blood leukocyte count. Autopsies revealed deep ileal ulcerations with or without perforation and peritonitis and intercurrent pneumonia. Three of them had disseminated intravascular coagulation. Further studies are warranted to understand the mediators of shock and tissue injuries during the initial period of the illness.

Adolescent↗
PubMed1996

Dietary sources of calcium and the contribution of flour fortification to total calcium intake in the diets of Northumbrian adolescents.

Increased Ca intake by adolescents is desirable. In order to achieve this, information on the current dietary sources of Ca by this age group is essential to enable change to build on existing habits. This paper addresses two issues: first, the dietary sources of Ca for adolescents are reported and, second, the importance of fortification of flour with Ca to present-day Ca intakes was determined. In 1990 the diets of 379 children aged 12 years were assessed using the 3 d dietary diary and interview method. Computerized food tables were used to calculate the contributions of different food groups to total Ca intake. The Ca content of each food was subdivided into naturally occurring Ca and Ca from fortification, and data were analysed to give the daily intake of each. The four most important sources of Ca were milk (25%), beverages (12%), puddings (10%) and bread (9%). Fortification of flour accounted for 13% of total Ca intake. When the contribution of fortification was removed, the proportion of subjects with intakes of Ca below the lower reference nutrient intake (Department of Health, 1991) increased more than fourfold, to 10% of girls and 12% of boys. Milk is contributing less to Ca intake than in the past and increased consumption should be encouraged. Ca fortification of flour remains an important source of Ca. Therefore, unless dietary habits are modified to ensure adequate Ca from other sources, increased consumption of unfortified products from outside the UK will lead to a further reduction in Ca intake.

Adolescent↗
PubMed1996

Minor psychiatric morbidity, its prevalence and outcome in a cohort of civil servants--a seven-year follow-up study.

During the years 1979-1986, a cohort of direct entrant executive officers in the Civil Service were followed up to examine the prevalence and outcome of minor psychiatric morbidity in an occupational setting. All studies using epidemiological standardized research methods agree that prevalence rates are high in occupational settings. As in primary care settings, half of the illness episodes followed a chronic course, which emphasizes the need for early detection and prompt management of these conditions, and for evaluative studies of intervention strategies.

Administrative Personnel↗
PubMed1996

The effect of fluoridation and social class on caries experience in 5-year-old Newcastle children in 1994 compared with results over the previous 18 years.

In 1994, the dental health of 327 5-year-old children who had lived in continuously fluoridated (at 1.0 mg/IF-) Newcastle was compared with the dental health of 335 children of the same age in non-fluoridated (less than 0.1 mg/IF-) south east Northumberland. The caries prevalance in social class groups I + II, III, IV + V children was compared both within and between the two areas. The prevalence of dental caries in the three social groupings I + II, III, and IV + V (and the mean dmft) respectively, was 23 percent (0.59), 39 percent (1.21) and 31 percent (1.17) in the fluoridated area, and 38 percent (1.46), 47 percent (2.04) and 62 percent (2.74) in the non-fluoridated area. Differences between the fluoridated and non-fluoridated areas were observed in all social class groupings but the greatest difference in the percentage of children with decay experience occurred in social groups IV + V. There has been a fall in caries experience in all social groups in both the fluoridated and non-fluoridated areas since a previous survey in 1987. However, this reduction was not enough to obviate the disadvantage of social background. Reduction in caries experience especially amongst social classes I and II has meant that the power of water fluoridation to reduce caries experience has diminished. Refinement of the instruments for classifying socio-economic position has the potential to demonstrate greater degrees of inequality than the crude measures such as occupational class as used in this study.

Child, Preschool↗
PubMed1995

Infection of baboons with simian/human immunodeficiency viruses.

Baboons were evaluated for their utility to serve as a model for testing envelope-based vaccines against human immunodeficiency virus type 1 (HIV-1). The ability of HIV-1 strains IIIB, RF, and SF2 to infect baboons was compared with that of simian/human immunodeficiency virus (SHIV) recombinant viruses comprised of either HXB2 or SF2 env, tat, rev, and vpu genes inserted into the SIVmac239 backbone. Both SHIV recombinants replicated in baboon PBMC in vitro, while no evidence of replication was noted for HIV-1 strains (MN, IIIB, SF2). Infection of baboons in vivo correlated with the restriction of infection in vitro. Virus was recovered by cocultivation methods early after SHIV (HXBc2) infection of two baboons with seroconversion profiles that parallel those observed in simian immunodeficiency virus (SIV)mac-infected rhesus monkeys. One of two baboons inoculated with SHIV(SF2) also seroconverted within 4 weeks; however, the kinetics of infection in a second animal appeared much later, with seroconversion to gp120 not evident until 20 weeks and no virus recovery during 32 weeks following infection. Viral DNA was detected in the lymph nodes of the SHIV-inoculated animals by nested polymerase chain reaction (PCR) amplification. Histopathologic changes were evident in lymph nodes, yet no overt clinical disease was observed. When HIV-1 strains (IIIB, RF, and SF2) were inoculated into baboons, virus was not recovered and no seroconversion to the major HIV-1 antigens was observed. However, viral DNA from the lymph nodes of four animals inoculated with HIV-1 strains could be detected by nested PCR, indicating a persistent but diminutive infection of HIV-1. The baboon thus represents a new animal model for testing HIV-1 envelope-based vaccines including the evaluation of new immunogens, dosages, routes, and adjuvants that act in eliciting protective responses.

Animals↗
PubMed1995

Endocrine basis for two types of individual differences in lordosis reflex intensity.

We have identified individual differences in two independent types of lordosis reflex intensity. Overall lordosis reflex intensity, averaged across 9.4 +/- 0.99 days (range = 1-18 days), differs among cycling individuals and is a biomarker for the rate and pattern of reproductive aging. Although estrogen is necessary to permit lordosis reflex responding and manifests individual differences throughout the estrous cycle, it was individual differences in progesterone that correlated negatively with the individual variation in overall lordosis reflex intensity; females with intense overall lordosis reflexes had low progesterone throughout the estrous cycle. Independent of their overall reflex intensity, females also displayed individual variation in lordosis reflex intensity on proestrus. Among females that still maintained a cyclic lordosis reflex, those with intense lordosis reflexes on proestrus had high levels of luteinizing hormone (LH) at lights out. Among females that displayed intense lordosis reflexes throughout the estrous cycle (i.e., had entered constant lordosis), those with intense proestrous lordosis reflexes had low levels of LH at lights out on proestrus. Females who had entered constant lordosis tended to have lower overall progesterone than females who still maintained cyclic patterns of lordosis. Thus, constant lordosis was identified as an important component of the changes of reproductive aging.

Animals↗
PubMed1995

Treatment of typhoid fever: randomized trial of a three-day course of ceftriaxone versus a fourteen-day course of chloramphenicol.

To compare the efficacy of a short course of ceftriaxone with a standard course of chloramphenicol for typhoid fever, a randomized trial was conducted in 46 patients (30 adults and 16 children) who were blood culture-positive for Salmonella typhi or S. paratyphi. Ceftriaxone was given intravenously once a day for three days to 15 adults at a dose of 2 g/day and to eight children at a dose of 50 mg/kg/day. Chloramphenicol was given orally four times a day to an equal number of patients at a dose of 60 mg/kg/day until defervescence, followed by 40 mg/kg/day for a total of 14 days. Clinical cure without complications or relapse occurred in 19 patients (83%) treated with ceftriaxone and in 20 patients (87%) treated with chloramphenicol (P > 0.05). Four patients with clinical failures in the ceftriaxone group included two with fever lasting six days or more, one with altered sensorium, and one with relapse; three patients treated with chloramphenicol developed leukopenia and thrombocytopenia and were switched to amoxicillin therapy. Bacteriologically, blood cultures of all 46 patients were sterile three days after the start of treatment, and remained so through day 15 of follow-up. These results extend previous observations on the efficacy of ceftriaxone in short courses for both adults and children with typhoid fever.

Administration, Oral↗
PubMed1995

Multiple drug classes and hyperosmolarity alter binding of muscarinic drugs to mesothelial cells in vitro.

Mesothelial cells in vitro exhibited binding sites for L-quinuclidinyl[phenyl-4-3H]-benzilate ([3H]-QNB), but not [3H]-N-methylscopolamine (NMS), a cell-impermeable ligand. [3H]-QNB binding demonstrated a biphasic pattern of binding in living cells: a maximum after 15 min at 37 degrees C was followed by a decrease out to 90 min. [3H]-QNB binding was blocked by increasing concentrations of atropine; WIN35428 and GBR12909, dopamine transport inhibitors also decreased binding. Pretreatment of cells for 18 hours with atropine, QNB, or WIN35428 resulted in enhanced [3H]-QNB binding, but coexposure to cycloheximide blocked this increase. Hyperosmolarity caused by NaCl or mannitol decreased binding of [3H]-QNB to living cells. Thus rabbit peritoneal mesothelial cells possess binding sites for [3H]-QNB that are influenced by other drugs and osmolarity.

Animals↗