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Biomedical subjects

U Forsum

Publications and source records attributed to U Forsum.

At least 55 records · Page 3Linked to original sources
PubMed1995

Decentralized diagnostics of beta haemolytic streptococci group A--introduction of a developmental model for microbiological consultation in primary health care.

OBJECTIVE: To define and evaluate forms for introduction of decentralized diagnosis in primary care. DESIGN: The study was divided into three phases. Intervention I. An intensive course on microbiological diagnostics in cases of tonsillitis with information about rapid EIA-based test kits for beta haemolytic streptococci group A. Intervention II. External quality assurance of the decentralized test. Evaluation. Recording of changes in work practice and attitude regarding decentralized diagnosis by means of a questionnaire. PARTICIPANTS: Thirty-three GPs and 36 laboratory technicians from 37 primary health care centres (PHC) in the county of Ostergötland, Sweden. RESULTS: Thirty-one of the responding GPs (94%) considered that the information gained from quality assurance was useful. Twenty-nine GPs (88%) reported that they had changed their clinical practice to some extent, and 26 of the responding laboratory technicians (72%) reported that they had changed method after the interventions. CONCLUSION: Uniform acceptance was not achieved, but a large number of GPs and PHC laboratory technicians did conform to a rational-empirical strategy for change in clinical practice.

Family Practice↗
PubMed1994

Possible errors in diagnosis of bacterial sinusitis in tracheal intubated patients.

Bacterial sinusitis is recognized as a complication of prolonged nasotracheal intubation. Verification of the diagnosis, however, requires culture findings from a "true" sample from the maxillary antrum. A "true" antral sample can only be obtained after passing either the nasal or oral mucosae with their rich aerobic and anaerobic bacterial flora. No properly controlled study has been made into the problem of contaminated samples in bacterial sinusitis complicating prolonged nasotracheal intubation. The design of the study was a case series in an intensive care unit. The patients had either had endotracheal tube or tracheal cannula for seven days or were septic, having an endothracheal tube or a tracheal cannula and therefore due to an investigation of infection foci. Antral cultures obtained via the canine fossa were compared with oral cultures to exclude the contribution of oral bacterial contamination and thereby to improve the reliability of diagnosis based on culture results. The contamination rate was lowered significantly from 67% to 5% when an area of free bone was prepared in the canine fossa thus avoiding instrument contact with the oral mucosa. A high contamination risk can be dealt with by adjusting the technique of sampling thereby increasing the culture reliability.

Adolescent↗
PubMed1993

E-selectin involvement in in vitro adhesion of blood dendritic cells to human umbilical cord endothelial cells.

Peripheral blood dendritic cells (BDC) are potent antigen-presenting lymphoid cells. In the present study, we have examined the in vitro adhesion of BDC to human umbilical cord venous endothelial cells (HUVEC) and studied the expression of CD molecules and oligosaccharide haptens on BDC and endothelial cells. Immunohistochemistry showed that BDC were strongly positive for antibodies against HLA-DR, CD11c, CD18, CD44 and CD54, and moderately positive for anti-CD11a, CD31, CD43 and CD58. In addition, BDC were moderately positive for anti-Sialyl Lewis a and strongly positive for anti-Sialyl Lewis x and CD77 (Gal alpha 1-4Gal beta 1-4Glc) Non-stimulated HUVEC were positive for anti-CD29, CD31 and CD77. An in vitro adhesion assay showed that only a small percentage of radiolabelled BDC bound to non-stimulated HUVEC (16.9 +/- 5.9%, mean +/- SD). Stimulation of the HUVEC with IL-1 for 4 h produced a significant increase (P < 0.002) in the percentage of radiolabelled BDC that bound to HUVEC (42.3 +/- 7.1%). Preincubation of HUVEC with antibodies against E-selectin (10 micrograms/ml) significantly inhibited (P < 0.02) the binding of radiolabelled BDC to activated HUVEC (32.2 +/- 1.3%) whereas preincubation of BDC with antibodies against CD54, CD18, CD11b, CD11c and Sialyl Lewis x did not produce any significant inhibition. Preincubation of BDC with Sialyl Lewis a antibody and with isotype-matched control antibodies did not affect the increased binding of BDC to IL-1-activated HUVEC. Thus, E-selectin seems to be involved in adhesion of BDC to IL-1-stimulated HUVEC.

Cell Adhesion↗
PubMed1993

Serum antibody responses against shigella lipopolysaccharides and invasion plasmid-coded antigens in shigella infected Swedish patients.

Serum antibody responses to shigella lipopolysaccharide (LPS) and invasion plasmid-coded antigens (Ipa) were studied in 74 Swedish patients with culture verified bacillary dysentery using class-specific enzyme immunoassay (EIA). Anti-LPS responses were found in 80% and 79% serum samples, respectively, from S. flexneri and S. sonnei infected patients and anti-Ipa responses in 60% and 43%, respectively. The mean anti-Ipa IgG antibody titres in S. flexneri infected patients remained high for 4-6 months after onset while the anti-LPS IgG antibody titres had dropped to normal levels. The specificity of EIA for shigella Ipa was 90% and for S. dysenteriae, S. flexneri and S. sonnei LPSs it varied between 84% and 90%. No close correlations between the anti-LPS and anti-Ipa antibody responses were observed indicating that they may be differently regulated. The dynamics of the serum antibody responses indicates that an anti-LPS response is a good indicator of a recent shigella infection and an anti-Ipa IgG response a good indicator of a previous infection.

Adult↗
PubMed1992

Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study.

OBJECTIVE: The purpose of this study was to evaluate the effect of metronidazole treatment on the incidence of postoperative pelvic inflammatory disease after first-trimester abortion in women with bacterial vaginosis. STUDY DESIGN: A double-blind, randomized, multicenter study was conducted on 231 women undergoing first-trimester legal abortion and fulfilling the criteria for bacterial vaginosis. The women were randomized to either metronidazole 500 mg three times daily for 10 days or placebo. Treatment was started at the outpatient visit the week before the operation. RESULTS: Among the 174 women who could be evaluated, pelvic inflammatory disease developed in 14 after the abortion. In the treatment group there were three infections (3.8%) compared with 11 (12.2%) in the placebo group (p less than 0.05). CONCLUSION: These data suggest that patients with bacterial vaginosis should be treated in conjunction with first-trimester abortion because treatment with metronidazole reduces the postoperative infection rate more than three times.

Abortion, Induced↗
PubMed1992

Titres of class-specific antibodies against Shigella and Salmonella lipopolysaccharide antigens in colostrum and breast milk of Costa Rican, Swedish and Vietnamese mothers.

Enzyme immunoassays (EIA) were used to estimate titres of class-specific antibodies against purified and chemically defined phenol-water-extracted lipopolysaccharide (LPS) antigens of Salmonella serogroup B (BO), Shigella dysenteriae type I, Plesiomonas shigelloides (the same O-antigen as Shigella sonnei) and Shigella flexneri Y. Titres in colostrum and breast milk of Swedish, Vietnamese and Costa Rican mothers from various socioeconomic conditions were compared. The antibodies were mainly of the IgA isotype. IgM antibodies were also present, but only very low concentrations of IgG were found. In Costa Rican mothers, the IgA antibody titres were significantly higher (P less than 0.05) in women of low and middle socioeconomical conditions than were those in mothers of high socioeconomical level. The low titres in the last group were comparable to those found in Swedish mothers. The IgA antibody titres found in Vietnamese mothers were similar to those of Costa Rican mothers from the low and middle socioeconomic conditions, being highest against S. flexneri Y LPS. The IgM antibody titres were also highest in Vietnamese mothers, immediately followed by the Costa Rican mothers of low socioeconomic conditions. The low IgM titres in the Costa Rican women of high socioeconomic level were comparable to those seen in Swedish mothers. The results suggest that, in Costa Rica and Vietnam, S. flexneri is the most prevalent Shigella sp. causing infection and that Salmonella serogroup B infections are rare in all three countries. The results also show that the antibody repertoire in colostrum and breast milk varies. Furthermore, in addition to the prevalence of a specific micro-organism in a determined geographical area, such differences may be associated mainly with exposure to certain pathogens in particular socioeconomic conditions.

Adult↗
PubMed1992

Safety and immunogenicity of the live oral auxotrophic Shigella flexneri SFL124 in volunteers.

The live, aromatic dependent Shigella flexneri Y vaccine strain SFL124, with a deleted aroD gene, was tested for safety and immunogenicity in 21 healthy adult volunteers. A single dose of 2 x 10(9) live bacteria was given orally to ten volunteers, whereas 11 received three doses every other day. The vaccine was excreted for 4.2 days and was well tolerated by 90.5% of the vaccinees. Only 2 of 21 (9.5%) after the first dose had a self-limiting diarrhoea lasting 1 day; of volunteers given one dose only 3 of 10 showed anti-lipopolysaccharide (LPS) and anti-invasion plasmid coded antigen (Ipa) responses in serum. A faecal antibody response to LPS and Ipa was seen in six and three persons, respectively. Volunteers given three doses reacted with serum anti-LPS (9/11) and anti-Ipa (5/11) antibody responses. In stool, anti-LPS and anti-Ipa responses were detected in nine and eight volunteers, respectively. A booster dose of 2 x 10(9) bacteria given to six volunteers in the three-dose group 9-10 months later elicited high stool sIgA responses, indicating a strong mucosal memory, and was accompanied by a short excretion period of SFL124 (1.8 versus 4.2 days, p less than 0.05). The vaccination also elicited antibody-secreting cell (ASC) responses against LPS in peripheral blood: the three doses of the vaccine resulted in a stronger response than did the single dose, while the booster dose elicited only a limited ASC response. Volunteers previously exposed to shigellae exhibited stronger anti-Ipa responses in serum and stool suggestive of an immunological memory to the Ipa. The results indicate that SFL124 is a safe live vaccine strain inducing specific immune responses against LPS and Ipa with a mucosal immune memory lasting for at least 9 months.

Administration, Oral↗
PubMed1992

During HIV-1 infection most blood dendritic cells are not productively infected and can induce allogeneic CD4+ T cells clonal expansion.

We have considered the possibility that antigen-presenting cells of the dendritic cell lineage may be infected in vivo and spread HIV-1 at the time dendritic cells initiate the clonal expansion of antigen-specific T cells. Dendritic cells were isolated from 25 HIV-1-infected subjects (CDC stages II-IV). Fewer dendritic cells were recovered from most infected subjects. Reduced numbers of total non-T cells were also found in these patients, so that preferential loss of dendritic cells did not occur. Dendritic cell function was assessed by stimulatory capacity for allogeneic CD4+ T cells in the mixed leucocyte reaction (MLR). Potent MLR stimulator activity was retained in the dendritic cell-enriched populations from HIV-infected patients. Seven out of nine patients without AIDS (asymptomatic, lymphadenopathy or ARC) and three out of six patients with AIDS had proliferative responses equivalent to those induced by dendritic cells from controls. Dendritic cells from HIV+ subjects were able to initiate the expansion of allogeneic CD4+ T cell clones with cloning efficiency not different from controls and without evidence of cytopathic effect in the expanding CD4+ clones. In situ hybridization of the different mononuclear cell populations with a gag-specific riboprobe demonstrated positive cells in the T cell fractions of 12 of the 15 patients tested. None of the asymptomatic or ARC patients had riboprobe-positive cells in the dendritic cell-enriched populations. Four out of nine patients with AIDS had cells positive for HIV-1 expression in the dendritic cell-enriched fraction. However, the positive cells had the nuclear profile of lymphocytes, and by cytofluorography some residual low-density T cells were present. By limiting dilution and polymerase chain reaction (PCR), CD4+ lymphocytes carried HIV provirus in inocula of 500-5000 cells, while provirus could only be detected in 50,000 cells from the dendritic cell-enriched fraction. The latter signal may be due to the demonstrated levels of T cell contamination. Our data indicate that productive or latent HIV-1 infection of blood dendritic cells in vivo is rare, certainly no greater than in T lymphocytes, and that in vitro dendritic cell preparations from patients can expand CD4+ T cells efficiently and therefore may be able to expand T cells with immunotherapeutic activity.

CD4-Positive T-Lymphocytes↗
PubMed1992

Detection and identification of Mobiluncus species by direct filter hybridization with an oligonucleotide probe complementary to rRNA.

A hybridization assay for direct detection and identification of Mobiluncus species has been developed and tested. A [32P]-labelled synthetic oligonucleotide probe, complementary to a nucleotide sequence in the variable region V8 of Mobiluncus 16S ribosomal RNA, was utilized. One of the advantages of using rRNA as target molecule for the hybridization assays is the copy number of rRNA, which can be as high as 10(4), and that additionally three to six sites on the minus strand of the DNA gene can be utilized. This probe was found to be sensitive and to react with 62 of 68 tested typical or atypical Mobiluncus isolates. It was also specific, and was shown not to react with 96 tested unrelated bacterial species and isolates, including taxonomically closely related species like Actinomyces or Bifidobacterium spp., or with bacteria isolated from the vagina of both healthy persons with an undisturbed flora, as well as from patients suffering from the bacterial vaginosis syndrome (BV).

Bacteroidaceae↗
PubMed1991

Some monoclonal anti-human lymphocyte and class II MHC antigen antibodies do not stain snap frozen Macaca fascicularis lymphocytes or tissue sections.

Experiments were designed to stain snap frozen and fixed Macaca fascicularis peripheral blood mononuclear cell (PBMC) preparations and colon sections assuming that monoclonal mouse anti-human lymphocyte and class II major histocompatibility complex antigen antibodies would cross-react with the monkey counterparts to the human antigens. Most of the monoclonals used in this study did not stain the monkey frozen and fixed tissues in immunoenzymatic protocols despite adequate staining of control human tissues. The fact that snap frozen Macaca fascicularis PBMCs and tissue sections were not always stained is of practical importance for experimental design in Macaca fascicularis using anti-human reagents.

Animals↗
PubMed1991

Clue cells in predicting infections after abdominal hysterectomy.

Seventy women scheduled for abdominal hysterectomy were examined for the presence of clue cells in the vaginal discharge in an attempt to identify a possible risk group for development of postoperative infection. Seven of 20 women (35%) with clue cells developed vaginal cuff infections or wound infections, compared with four of 50 women (8%) without clue cells (P less than .01). Women with bacterial vaginosis, diagnosed by air-dried vaginal smears, are therefore at risk for postoperative infection.

Adult↗
PubMed1990

Treatment of bacterial vaginosis in women with vaginal bleeding complications or discharge and harboring Mobiluncus.

A double-blind study of treatment for bacterial vaginosis (BV), using metronidazole tablets 500 mg 3 times daily for 10 days versus placebo in the same regimen, was performed on 42 outpatients with irregular bleeding episodes or discharge attending a gynecological clinic. All patients had motile rods in wet smears in addition to fulfilling the criteria for BV. Treatment gave a cure rate of 76% versus 5% in the placebo group. Mobiluncus sp. was identified in 81% of these cases before treatment, in 8% of the cured patients and in 50% of those not initially cured at follow-up. Repeated treatments, once or twice, resulted in a 100% cure rate. A 6-month follow-up was carried out on 39 of the 42 patients. There were 7 relapses after 6 months giving a cure rate of 82%. After successful treatment all bleeding disturbances disappeared. We conclude that it is important to treat BV in patients with symptoms other than malodorous discharge.

Adult↗
PubMed1990

Distribution of HLA-DR, HLA-DP, HLA-DQ antigens in liver tissue from patients with primary sclerosing cholangitis.

This study describes the distribution of the major histocompatibility class II antigens HLA-DR, HLA-DP, and HLA-DQ in liver tissue from eight patients with primary sclerosing cholangitis, by means of the immunoperoxidase technique on cut cryostat sections. HLA-DR was expressed on the bile duct epithelium and vascular endothelium from all patients. HLA-DP showed an expression much like HLA-DR on the bile duct epithelium, but the vascular endothelium mostly did not stain for HLA-DP. HLA-DQ was generally more weakly expressed, and only three of the patients expressed HLA-DQ on the bile ducts. None of the hepatocytes expressed any of the MHC class II antigens.

Adult↗
PubMed1989

Immunoblotting of a Staphylococcus aureus DNA library as a tool for isolating potential antigenic proteins.

A Staphylococcus aureus DNA library was created in the lambda vector EMBL4 and expressed in Escherichia coli strain Y1090. Plaques were screened using serum from a S. aureus-infected patient. A number of positive clones that expressed proteins recognised by serum antibodies were further analysed using Western blots of total lysates from cultures infected with the lambda clones. Differences were found between patient and control sera in both the specificity and titre of anti-S. aureus antibodies. Expressed staphylococcal proteins appeared to be stable and were easily distinguishable from E. coli proteins in the Western blot. This method may have applications in specifically selecting clones encoding antigens associated with infection and may be of potential use clinically.

Adult↗
PubMed1989

Mobiluncus and clue cells as predictors of PID after first-trimester abortion.

Women attending our Department for a first-trimester abortion were examined for the presence of Mobiluncus species. C. trachomatis or clue cells in vaginal discharge in an attempt to identify risk groups for development of pelvic inflammatory disease (PID) after first-trimester abortion. A correlation was found between the presence of Mobiluncus and clue cells in vaginal discharge and the incidence of PID after first-trimester abortions. These women were also older than those in whom C. trachomatis was identified. Our study indicates that screening for C. trachomatis and clue cells in vaginal discharge will identify two different risk groups for developing PID after first-trimester abortion.

Abortion, Induced↗
PubMed1989

The influence of cervical dilatation by laminaria tent and with Hegar dilators on the intrauterine microflora and the rate of postabortal pelvic inflammatory disease.

In a prospective study, 519 women were randomly selected for cervical dilatation by laminaria tents or Hegar dilators before scheduled vacuum aspiration. In other 68 women randomly divided into a laminaria group and a control (Hegar) group, placenta, decidua and blood were separately aspirated from the uterine cavity before the vacuum aspiration and cultured for micro-organisms. The rate of postabortal inflammatory disease (PID) was significantly lower after pretreatment with laminaria tent irrespective of patient's age and parity. However, a higher risk of postabortal PID was found in gestational age of 10-12 weeks than of 5-9 weeks. Previous PID and abortion did not increase the risk of postabortal PID. Vaginal/cervical micro-organisms were, irrespective of method for cervical dilatation, identified in two thirds of the patients.

Abortion, Induced↗