The significance of symptomatic and asymptomatic infections in pregnancy.
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Biomedical subjects
Publications and source records attributed to W Brumfitt.
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Periurethral bacterial colonization was studied in two groups of women by taking samples with a polystyrene sponge. Just over half (56 per cent) of 81 sexually-active women attending a family planning clinic were not colonized in the periurethral area; subjects who were colonized usually showed large numbers of a single bacterial species. On the other hand, all 38 patients who were attending a clinic because of recurrent urinary infections were colonized in the periurethral area; most of these yielded a heavy growth, and more than one bacterial species was usually isolated. Gram-positive cocci predominated as the colonizing flora in both groups, a finding which is in marked contrast to the predominant aetiological agents in urinary infections, namely Gram-negative bacilli. We therefore conclude that colonization of the periurethral area is not the decisive event in the initiation of a urinary infection.
The incidence of primary resistance to rifampicin in Mycobacterium tuberculosis has been analysed in countries where rifampicin is restricted to use for treating tuberculosis and in countries where its use is not restricted. There is no evidence that rifampicin-resistant M tuberculosis strains are more common where the use of the drug is unrestricted. Resistance to rifampicin is less common than is resistance to streptomycin or to isoniazid. We can thus see no danger of producing resistant strains of M tuberculosis if rifampicin therapy is used for short periods for non-tuberculosis infections. The problem of resistance mutants arising in the non-tuberculous species being treated is overcome by combining rifampicin with trimethoprim.
A detailed pharmacokinetic study of cefuroxime has been carried out. Levels of cefuroxime were determined in the blood, sputum, saliva, and urine of 23 patients receiving parenteral cefuroxime eight hourly for chest infections. Profiles were obtained after the first dose and on the final (fifth) day of treatment. Antibiotic levels in the sputum reached 0.8 mg/l within one hour of the first injection, and were maintained close to this value for six hours. There was a build-up by the fifth day, mean cefuroxime concentrations at this time reaching 1.8 mg/l. This concentration was maintained for a prolonged period. Salivary concentrations were detectable but low (maximum mean value was 0.6 mg/l). Concentrations of antibiotic were significantly higher in the serum than those observed after the same doses in volunteers. In the patients there was no build-up in serum levels between the first and fifth days. The data obtained explain the clinical efficacy of cefuroxime in the treatment of lower respiratory infections, and suggest that a 12-hour schedule may be feasible.
Twenty-three hospital in-patients with severe lower respiratory tract infections were treated with cefuroxime sodium. The drug was given intramuscularly in a dose of either 750 mg or 1000 mg at 8-hourly intervals for 5 days. Of the 21 patients who could be assessed, the response to treatment was highly satisfactory and there were no treatment failures. Eight patients had failed to respond to a course of oral antibiotics before being seen. Most of the patients were elderly and all were very ill. The sputum became mucoid in all but 1 patient. There was no change in tests of liver or renal function. Cefuroxime appears to be an effective and well-tolerated drug for the treatment of patients with severe chest infections.
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The ureases of Proteus mirabilis, Proteus vulgaris, and Proteus rettgeri are inducible by urea. Induction is increased when both urea and acetohydroxamic acid, an inhibitor of urease, are present during bacterial growth. Acetohydroxamic acid alone does not cause induction, but, by preventing the hydrolysis of urea, it minimizes pH increases and allows induction to occur much more effectively. The ureases of Proteus morganii and other bacterial genera are not inducible by this method. The relevance of our findings to the formation and management of infection stones is discussed.
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366 specimens of serum from children and adults without liver disease were screened for antibody to hepatitis A virus (anti-HAV) by means of radioimmunoassay. 56% were born in London, 26% came to London from various parts of the United Kingdom and the remainder (18%) from various parts of the world. The prevalence of antibody was related to increasing age, ranging from 7% in children under ten years of age to 77% in adults aged 50 years or more. The prevalence of anti-HAV was significantly higher in females, in the lower socio-economic class and in those not indigenous to London. In comparison to other urban populations such as those of the United States and Western Europe, the prevalence of anti-HAV was similar in terms of the overall prevalence and age distribution. By contrast, these findings were entirely different from the countries of Eastern Europe and the Middle East where the overall prevalence was higher but the anti-HAV was equal in all ages. Thus, the findings presented indicate that hepatitis A virus infection is common in London and also shows a clear relationship to advancing age, lower socioeconomic class and the country of origin.
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