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PubMed2004

Heart disease: the greatest 'risk' factor of them all.

By the turn of the last century, flying in the face of over a hundred years of research and clinical observation to the contrary, medicine abandoned the link between infection and atherogenesis; not because it was ever proven wrong, but because it did not fit in with the trends of a medical establishment convinced that chronic disease such as heart disease must be multifactorial, degenerative and non-infectious. Yet it was the very inability of 'established' risk factors such as hypercholesterolemia, hypertension and smoking to completely explain the incidence and trends in cardiovascular disease that resulted in historically repeated calls to search out an infectious cause, a search that began more than a century ago. Today, half of US heart attack victims have acceptable cholesterol levels and 25% or more have none of the "risk factors" associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection. Even the case of the traditionalist's latest 2003 JAMA assault to 'debunk' what they call the "50% risk factor myth" falls woefully short under scrutiny. In one group 30% died of heart disease with a cholesterol of at least 240 mg/dl, a condition which also existed in 21% who did not die during the same period. And the overlap was obvious throughout the so-called risk categories. Under such scrutiny, lead author Greenland conceded that if obesity, inactivity and elevated cholesteriol in the elderly are included, just about everyone has a risk factor and he likened the dilemma of people who do or do not wind up with heart disease akin to the susceptibility of people who are exposed to tuberculosis but do not get the disease. In Infections and Atherosclerosis: New Clues from an old Hypothesis? Nieto stressed the need to extend the possible role of infectious agents beyond the three infections which have in recent years been the focus of research: Cytomegalovirus (CMV) Chlamydia pneumoniae and Helicobactor pylori. Mycobacterial disease shares interesting connections to heart disease. Not only is tuberculosis the only microorganism to depend on cholesterol for its pathogenesis but CDC maps for cardiovascular disease bear a striking similarity to those of State and regional TB case rates. Ellis, Hektoen, Osler, McCallum, Swartz, Livingston and Alexander-Jackson all saw clinical and laboratory evidence of a causative relationship between the mycobacteria and heart disease. And Xu showed that proteins of mycobacterial origin actually led to experimental atherosclerosis in laboratory animals Furthermore present day markers suggested as indicators for heart disease susceptibility such as C-Reactive Protein (CRP), interleukin-6 and homocysteine are all similarly elevated in tuberculosis. It therefore behooves us to explore the link between heart disease and typical and atypical tuberculosis.

Comorbidity↗
PubMedDate not supplied

Epidemic spread of adenovirus type 4-associated acute respiratory disease between U.S. Army installations.

A large outbreak of adenovirus type 4-associated acute respiratory disease (ARD) occurred at Fort Jackson, South Carolina, in 1997. A laboratory-based ARD surveillance program was initiated at Fort Gordon, Georgia, where advanced individual training was heavily populated with Fort Jackson soldiers. Adenovirus type 4 was isolated from 50% of 147 trainees hospitalized with ARD. Most (88%) introduced cases were in trainees from Fort Jackson.

Adenovirus Infections, Human↗
PubMed2003

Suspected pediatric ingestions: effectiveness of immunoassay screens vs. gas chromatography/mass spectroscopy in the detection of drugs and chemicals.

Rapid and accurate analytical testing can be of great value when determining treatment for pediatric patients suspected of ingesting an unknown chemical. Though often overlooked, gas chromatography/mass spectroscopy (GC/MS) can be a valuable resource in emergency toxicology testing. In a recent 24-month period (July 1999-June 2001), the Analytical Toxicology Laboratory at the University of Mississippi Medical Center, Jackson, MS, compared the results of GC/MS analysis to results obtained by immunoassay testing. The laboratory tested 139 urine samples referred for STAT toxicology testing from the hospital's Pediatric Emergency Department. All samples were tested in parallel using an immunoassay technique (EMIT) and GC/MS. With analysis by immunoassay, 17.3% of the samples were positive for a drug of abuse. The number of positive drug classes ranged from 0 to 2 per sample (mean 0.17 +/- 0.43) using immunoassay. With analysis by GC/MS, drugs were detected in 88.5% of the samples. The number of drugs detected ranged from 0 to 11 per sample (mean 2.2 +/- 1.8) with GC/MS. A total of 64 different pharmaceuticals were identified by GC/MS. This study shows that analysis by GC/MS offers the clinician a more comprehensive view into the exposure of the pediatric patient presenting with an unknown chemical ingestion.

Administration, Oral↗
PubMed1991

Intestinal stasis and rupture in rabbits.

During one year 23 of 110 New Zealand white, adult male laboratory rabbits died. The pathological findings included intestinal stasis, intestinal blockage, acute intestinal rupture and intestinal rupture with peritonitis. These changes were considered to represent stages in an intestinal stasis and rupture syndrome. Another group of 20 comparable rabbits remained unaffected.

Animals↗
PubMed2005

Plate number requirements for establishing method suitability.

Establishing the suitability of an analytical system has become a routine requirement in the testing of modern pharmaceuticals. Acceptable parameters that illustrate the system is performing as intended and in an equivalent manner to the original validation are often set at the time of method validation and transferred with the method to the production laboratory. For chromatographic methods, these parameters include--but are not limited to--resolution, tailing, and plate number specifications. Transferring methods is often a seamless transition from research to quality control. However, far too often the quality group receives arguably "overzealous" and strict requirements for the method. More specifically, chromatographic methods get issued with plate number specifications that far exceed the minimum number required to achieve sufficient resolution of the analytes. Presented here is a discussion of the setting of realistic plate number specifications that still maintain the minimum resolution of the chromatographic critical pair.

Chromatography↗
PubMed1992

Neuromyoblastoma in the rat.

We report three tumours arising in the brain stem or adjacent cranial nerves of the Alderly Park rat. Light microscopy with special stains, immunocytochemistry and electron microscopy supported the conclusion that both neuronal and myoid differentiation occurred in all neoplasms. This was shown by the presence in neural cells of axon-like cell processes and in myoblastic cells of striated myofibrils. Although medulloblastomas occur in man and rats the tumours reported here were not related to the cerebellum. We have termed this tumour neuromyoblastoma.

Animals↗
PubMed1993

Detection and quantitation of human immunodeficiency virus type 1 using molecular DNA/RNA technology.

The direct detection and quantitation of human immunodeficiency virus type 1 are becoming increasingly important for diagnosis and viral load determinations in human immunodeficiency virus type 1 infection. Traditional molecular-based assays such as Southern, Northern, and in situ hybridization have had limited application in this area due to the relatively low number of proviral copies per cell, the low percentage of infected cells, and transcriptional dormancy in many of the infected cells. Recent technological advances in polymerase chain reaction assays promise a number of useful applications in the clinical research and clinical laboratory setting.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Emerging infections with community-associated methicillin-resistant Staphylococcus aureus in outpatients at an Army Community Hospital.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection typically occurs in chronically ill patients requiring long-term antimicrobial therapy or hospitalization. However, community-associated MRSA (CA-MRSA) necrotizing soft tissue infections seem to be increasing in incidence. Our aim was to describe the incidence and microbiologic characteristics of CA-MRSA isolates collected at an army community hospital. METHODS: We report a retrospective review of MRSA isolates identified during 1998-2003 at the microbiology laboratory of Moncrief Army Community Hospital that serves a community of approximately 40,000 transient residents yearly in Fort Jackson, South Carolina. We evaluated the incidence of MRSA in our laboratory during 1998-2003. For MRSA isolates from 2003, we evaluated antimicrobial susceptibility patterns. Six selected isolates were evaluated by molecular typing, resistance gene analysis, and toxin analysis. RESULTS: During 1998-2003, 241 (23%) of 1041 S. aureus isolates identified at the hospital microbiology laboratory were resistant to methicillin. Of these 241 MRSA isolates, 223 were cultured from outpatients. The incidence of MRSA in our population increased from 12% of S. aureus isolates in 1998 to 43% in 2003. In 2003, MRSA was cultured from 76 different patients. Isolates of MRSA were often resistant to erythromycin (91%), although resistance to other agents was less common: Ciprofloxacin (14%), levofloxacin (14%), clindamycin (3%), tetracycline (3%), and trimethoprim sulfamethoxazole (1%). No isolates were resistant to vancomycin, gentamicin, nitrofurantoin, or rifampin. Six CA-MRSA isolates were compared by pulsed-field gel electrophoresis (PFGE). Five were PFGE type USA300, and one was PFGE type USA100, based on the U.S. Centers for Disease Control and Prevention (CDC) classification scheme. The five USA300 isolates carried SCCmec type IV, and the USA100 carried SCCmec II. None of the isolates were positive by PCR for genes encoding enterotoxins A-E and H, or toxic shock syndrome toxin (TSST-1), but the five USA300 isolates carried the gene coding for Panton-Valentine leukocidin toxin. CONCLUSIONS: The incidence of MRSA at our institution is increasing. Isolates of MRSA show resistance patterns and microbiologic characteristics consistent with CA-MRSA isolates from the United States. Clinicians should consider the possibility of CA-MRSA in patients with soft-tissue infections who do not respond to initial therapy with beta-lactam antimicrobial agents.

Community-Acquired Infections↗
PubMed2000

The spectrum of chronic inflammatory demyelinating polyneuropathy.

Research criteria for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) were proposed by an Ad Hoc Subcommittee of the American Academy of Neurology (AAN) in 1991, and since then these criteria have been widely used in clinical studies. We have been impressed by the frequent finding of electrophysiological changes of a demyelinating neuropathy in patients whose clinical presentation does not conform to the usually accepted clinical phenotype of CIDP. To determine the clinical spectrum of CIDP, we conducted a retrospective review of patients of the peripheral electrophysiology laboratory of the University of Miami-Jackson Memorial Medical Center. Diagnostic criteria for acquired demyelination of an individual nerve were adapted from the AAN research criteria for the diagnosis of CIDP (1991). Patients were accepted for inclusion when such evidence was demonstrated in at least one motor nerve or at least two sensory nerves. We then reviewed the clinical phenotype and the underlying etiology of the neuropathy in these cases. Eighty-seven patients, 63 male and 24 female, age of onset 4-84 (mean 49.3) years, met these inclusion criteria. Forty-seven patients (54%) had distinct features outside the usual clinical presentation of CIDP. Of these, 15 (17%) had predominantly distal features, 13 (15%) had exclusively sensory polyneuropathy; seven (8%) had markedly asymmetric disease, seven (8%) had associated CNS demyelination, four (5%) had predominant cranial nerve involvement, and one (1%) had only the restless legs syndrome. An associated medical condition that may have been responsible for the acquired demyelinating neuropathy was present in 60% of the patients. We conclude that spectrum of CIDP is broader than would be indicated by the strict application of the AAN research criteria, and that many of the cases meeting more liberal criteria frequently respond to immunosuppressive therapy.

Adolescent↗