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Biomedical subjects

A E Brown

Publications and source records attributed to A E Brown.

At least 19 recordsLinked to original sources
PubMed1998

The BAOMS United Kingdom survey of facial injuries part 1: aetiology and the association with alcohol consumption. British Association of Oral and Maxillofacial Surgeons.

OBJECTIVE: To determine the age and sex distribution, timing, causes, geographical location, and nature of facial injuries in the UK and to determine the association of these factors with alcohol consumption by the patient or any other involved person. DESIGN: A 12-section proforma was completed on all patients with facial injuries covering their age and sex, time and day of injury and presentation, the cause and type of injury and where it occurred, the treatment the patient received, any other injuries, and alcohol consumption by the patient and any other involved person. The total attendances for the study week and the catchment population for each A&E department were recorded. SETTING: 163 of the A&E departments in the UK served by 137 of the UK's oral and maxillofacial departments. SUBJECTS: All patients who presented with facial injuries to these 163 A&E departments in England, Scotland, Wales and Northern Ireland over the study week from 09.00 hours on Friday 12 September 1997 to 08.59 hours on Friday 19th September 1997. RESULTS: 6114 patients with facial injuries presented over the week, out of a total of 152,692 A&E attendances. The male:female ratio was 68:32. This rose to 79:21 in assault cases. The mean age of all patients was 25.3 years, of males 23.2 years, and of females 29.8 years. Forty per cent of the facial injuries were caused by falls. A large proportion of these happened to the under-5 age group in the home. Eleven per cent of all falls were associated with alcohol consumption. Twenty-four per cent of the facial injuries were caused by assault. The commonest sites for assault were the street followed by public drinking establishments. More women than men were assaulted at home. Fifty-five per cent of assaults were related to alcohol consumption. Eight per cent of assaults were with bottles or glasses. Five per cent of the facial injuries occurred in road traffic accidents (RTAs). Fifteen per cent of RTA victims had consumed alcohol. The 15-25 age group suffered the greatest number of facial injuries caused by assault and RTAs and had the highest number associated with alcohol consumption. At least 22% of all the facial injuries in all age groups were related to alcohol consumption within 4 hours of the injury. In the over 15 age groups, alcohol consumption was associated with 90% of facial injuries occurring in bars, 45% on the street, and 25% in the home. Assault, RTA and alcohol consumption conveyed an increased risk of serious facial injury. CONCLUSIONS: Campaigns should be instituted to educate young people about the link between excessive alcohol consumption, assault, road traffic accidents and serious facial injury.

Accidental Falls↗
PubMed1998

An investigation of vancomycin-resistant Enterococcus faecium within the pediatric service of a large urban medical center.

BACKGROUND: Between 1990 to 1992 and 1993 to 1995 there was a >5-fold increase (16.7% to 89.8%) in vancomycin-resistant Enterococcus faecium isolates as a percentage of all isolates of vancomycin-resistant enterococci on the pediatric units of The New York Hospital-Cornell Medical Center (NYH-CMC). A molecular epidemiologic investigation was undertaken to determine the extent to which this increase was associated with the spread of a vanA-containing clone of vancomycin-resistant E. faecium that had been previously defined in adults hospitalized at NYH-CMC or with the spread of another vanA clone that had been defined in children hospitalized on the pediatric service at Memorial Sloan-Kettering Cancer Center, which shares a common pediatric intensive care unit and pediatric house staff with NYH-CMC. METHODS: Molecular genotyping of vancomycin-resistant E. faecium isolates obtained from pediatric patients from 1993 to 1995 was performed by pulsed field gel electrophoresis of chromosomal SmaI digests. Southern hybridization was performed using vanA- and vanB-specific probes. Medical records of patients were reviewed for pertinent clinical and demographic information. RESULTS: A single vanB clone of vancomycin-resistant E. faecium was responsible for 17 (77.3%) of 22 isolates in the neonatal intensive care unit (NICU) of NYH-CMC. Two other vanB strains of vancomycin-resistant E. faecium and 2 vanA strains were identified among the 5 remaining NICU isolates. Vancomycin-resistant E. faecium isolates from the other pediatric units represented a heterogeneous population of primarily vanA strains, but vanA clonal strains previously identified from patients on adult services at NYH-CMC and from children hospitalized at Memorial Sloan-Kettering Cancer Center were not detected. CONCLUSION: A newly identified vanB clone was responsible for the increase in vancomycin-resistant E. faecium isolates in the NICU of NYH-CMC. The increase of vancomycin-resistant E. faecium among children hospitalized at NYH-CMC was unrelated to the spread of vancomycin-resistant E. faecium among adults in the same hospital or among children at an affiliated facility cared for by the same house staff and sharing a common pediatric intensive care unit.

Adolescent↗
PubMed1997

Use of SSU rDNA group-I intron to distinguish Monilinia fructicola from M. laxa and M. fructigena.

Monilinia fructicola, M. laxa and M. fructigena are the causal agents of brown rot of pome and stone fruits. M. fructicola is not present in Europe and is classed as a quarantine pathogen in EU countries. A 418-bp group-I intron has been located in the small subunit (SSU) rDNA gene of M. fructicola which is absent from M. laxa and M. fructigena. PCR primers specific to the 3'-region of the intron together with the SSU rDNA primer NS5 were able to amplify a 444-bp product from M. fructicola and fruit tissue infected with M. fructicola but not from the other two species. This allows for the rapid and sensitive detection of this pathogen in planta.

Ascomycota↗
PubMed1997

Importance of the C-1 substituent in classical cannabinoids to CB2 receptor selectivity: synthesis and characterization of a series of O,2-propano-delta 8-tetrahydrocannabinol analogs.

The separation of the mood-altering effects of cannabinoids from their therapeutic effects has been long sought. Results reported here for a series of C-9 analogs of the cyclic ether O,2-propano-delta 8-tetrahydrocannabinol (O,2-propano-delta 8-THC) point to the C-1 position in classical cannabinoids as a position for which CB2 subtype selectivity occurs within the cannabinoid receptors. O,2-Propano-11-delta 8-THC, O,2-propano delta 9,11-THC, O,2-propano-9-oxo-11-nor-hexahydrocannabinol (O,2-propano-9-oxo-11-nor-HHC), and O,2-propano-9 alpha- and O,2-propano-9 beta-OH-11-nor-HHC were synthesized and evaluated in radioligand displacement assays for affinity at the CB1 and CB2 receptors and in the mouse vas deferens in vitro assay and the mouse tetrad in vivo assay for cannabinoid activity. Evaluation of binding affinity at the CB1 and CB2 receptors revealed that each compound possesses a modest increased affinity for the CB2 receptor. Analogs which contained an oxygen attached to C-9 (i.e., oxo and hydroxy derivatives) showed the highest affinity and selectivity for CB2 (for O,2-propano-9-oxo-11-nor-HHC, Ki(CB1) = 90 nM, Ki(CB2) = 23 nM, selectivity ratio 3.9; for O,2-propano-9 beta-OH-11-nor-HHC, Ki(CB1) = 26 nM, Ki(CB2) = 5.8 nM, selectivity ratio 4.5). Each compound was found to produce a dose-dependent inhibition of electrically-evoked contractions of the mouse isolated vas deferens when administered at submicromolar concentrations. This inhibition could readily be prevented by the selective CB1 cannabinoid receptor antagonist SR-141716A. The analogs exhibited unique in vivo profiles with O,2-propano-delta 9,11-THC exhibiting antinociception with reduced activity in three other in vivo measures and O,2-propano-9 beta-OH-HHC exhibiting lack of dose responsiveness in all measures. The CB2 selectivities in the O,2-propano analogs may be due to differences in solvation/desolvation that occur when the ligands enter the CB1 vs CB2 binding site. Alternatively, the CB2 selectivities may be a results of an amino acid change from a hydrogen bond-accepting residue in CB1 to a hydrogen bond-donating residue in CB2.

Animals↗
PubMed1997

Prophylactic efficacy of persistent anthelmintics against challenge with drug-resistant and susceptible Ostertagia circumcincta.

Three groups of newly-weaned Romney lambs were given either a standard oral dose of albendazole, a controlled-release capsule containing albendazole, or a standard oral dose of moxidectin. At 10, 20, 30 and 40 days after treatment, sub-groups of lambs were given 10,000 infective-stage larvae of either a drug-resistant or a drug-susceptible strain of Ostertagia circumcincta. The recommended oral dose of albendazole removed 32 per cent of the resistant strain and over 99.9 per cent of the susceptible O. circumcincta. The recommended oral dose of moxidectin removed 91 per cent of the resistant strain and over 99.9 per cent of the susceptible parasites. None of the lambs treated with controlled-release capsules was challenged at 20 or 30 days after treatment. Twenty-one days after challenge, samples of faeces were taken to determine the presence of nematode eggs and cultured to establish the proportion of eggs developing to infective-stage larvae (L3). Abomasa were recovered after slaughter and worm burdens determined. In the lambs given controlled-release capsules only the resistant parasites were able to establish, and there were significantly fewer than in the lambs treated orally with albendazole. The proportion of the eggs from resistant parasites which developed to L3 was not reduced by the presence of the capsules. Oral moxidectin provided no protection against the establishment of the resistant strain and viable L3 were recovered after challenge with resistant parasites 10 days after treatment; however, the establishment of susceptible O. circumcincta was reduced by more than 99 per cent. The establishment of the susceptible parasites in the lambs treated with moxidectin increased with time and was not significantly lower than in the other groups by 30 days after treatment.

Administration, Oral↗
PubMed1997

Valve obturation of the nasopharynx.

Complete obturation of the nasopharynx can cause functional problems with breathing and swallowing due to obstruction of the nasal airway. A technique is described whereby a one way valve was incorporated in an obturator to allow normal nasal inspiration whilst maintaining an oropharyngeal seal during swallowing and speech.

Carcinoma, Squamous Cell↗
PubMed1997

Viral RNA in the resolution of human immunodeficiency virus type 1 diagnostic serology.

BACKGROUND: Assays for human immunodeficiency virus (HIV) antibody testing are characterized by very high levels of sensitivity and specificity. Nonetheless, serologic testing of HIV-infected individuals before they produce multispecific HIV antibodies will not detect and confirm those individuals as positive for HIV. This study was carried out to determine whether viral RNA in such specimens is detectable in a quantitative RNA polymerase chain reaction assay. STUDY DESIGN AND METHODS: Study specimens were identified through the United States military HIV testing program. Thirty-five individuals were studied whose HIV type 1 (HIV-1) infection status was serologically inconclusive at initial testing (i.e., reactive on enzyme immunoassay, nondiagnostic or nonreactive on Western blot), but who were documented to be infected (n = 15) or uninfected (n = 20) through the testing of subsequently collected (follow-up) sera. HIV-1 RNA was detected in sera by the use of a commercially available, quantitative, reverse transcriptase-polymerase chain reaction assay. RESULTS: Specimens from 15 individuals subsequently confirmed to be positive for HIV antibody were all positive for HIV-1 RNA. Specimens from 19 of 20 individuals subsequently confirmed to be negative for HIV antibody were negative for HIV-1 RNA. In the one HIV-1 RNA-positive serum from this group, the RNA copy number was low; specimen contamination during prior laboratory testing was suspected. CONCLUSION: Viral RNA was detected in specimens collected for serologic diagnosis of HIV infection in which no special precautions had been taken to preserve the nucleic acid. Such molecular methods potentially add a much needed tool to current HIV testing algorithms.

AIDS Serodiagnosis↗
PubMed1997

1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America.

This is the first in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are internists, pediatricians, and family practitioners. The targeted patients and setting for the fever and neutropenia guideline are hospitalized individuals with neutropenia secondary to cancer chemotherapy. Panel members represented experts in adult and pediatric infectious diseases and oncology. The guidelines are evidence-based. A standard ranking system was used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary, algorithms, and tables highlight the major recommendations. The guideline will be listed on the IDSA home page at http://www.idsociety.org.

Adult↗
PubMed1997

Rapid disease progression without seroconversion following primary human immunodeficiency virus type 1 infection--evidence for highly susceptible human hosts.

A patient is described who rapidly progressed from primary human immunodeficiency virus (HIV) type 1 infection to death without seroconversion but with consistently high plasma viremia. His asymptomatic sex partner had been HIV-1 seropositive for >8 years prior to transmission. Analysis of viral sequences from these subjects and controls confirmed the transmission event. Although the biologic properties of the patient's virus were unremarkable, he had poor functional immune responses to HIV and an HLA haplotype associated with rapid disease progression. The disparity between immune responses and clinical course in this transmission pair, coupled with infection with an unremarkable HIV-1 isolate, underscores the crucial importance of host factors in HIV-1 pathogenesis.

Adult↗
PubMed1997

Human immunodeficiency virus RNA levels in US adults: a comparison based upon race and ethnicity.

Volunteers in a natural history study of human immunodeficiency virus type 1 (HIV-1) at two military medical centers were studied to determine whether plasma HIV-1 RNA levels differ among racial and ethnic groups of US adults infected with HIV-1. Cross-sectional analyses of plasma HIV-1 RNA and CD4 cell counts were done using demographic and clinical data collected during study visits. Age, gender, CD4 cell count, seroconversion status, and use of antiretroviral therapy were studied in 545 military members (46% white, 49% black, and 6% Hispanic). No association was found between HIV-1 RNA levels and race or ethnicity among infected adults for whom access to care and socioeconomic status were not confounding factors.

Adult↗
PubMed1996

The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis.

BACKGROUND: The management of pediatric oncology patients with fever and neutropenia assumes that all patients are at risk for bacteremia, and therefore generally involves hospitalization and broad-spectrum parenteral antibiotics for all patients. The determination of which patients are at low risk for having positive blood cultures and for developing complications related to bacteremia is of potential benefit. METHODS: The records of 161 pediatric patients with neoplastic disease hospitalized for 509 episodes of fever and neutropenia between January 1990 and June 1992 were retrospectively reviewed. Clinical features at initial presentation, clinical and microbiologic documentation of infection, and outcome were analyzed. RESULTS: The only presenting clinical features that correlated with an increased likelihood of having positive blood cultures were chills, hypotension, the requirement for fluid resuscitation (P < 0.001), or a diagnosis of leukemia or lymphoma (P < 0.041). Leukemia patients with relapse admitted for fever and neutropenia were no more likely to have positive blood cultures than those patients in remission. There were ten episodes of fever and neutropenia in which patients were transferred to the intensive care unit (ICU), and two sepsis related deaths. Nine episodes involving ICU management and both deaths were in patients who had persistent fever and an absolute neutrophil count (ANC) of less than 100 after 48 hours of hospitalization (n = 177). Patients with an ANC of less than 100 after 48 hours were twice as likely to have antibiotic changes, 15 times more likely to receive amphotericin B, and were hospitalized twice as long as patients with an ANC of 100 or higher after 48 hours. CONCLUSIONS: Children hospitalized for fever and neutropenia who have persistent fever and an ANC of less than 100 after 48 hours are at high risk for morbidity and are more likely to require antibiotic changes and antifungal therapy. Children who initially lack signs of sepsis, are afebrile, and have an ANC of 100 or higher after 48 hours are at low risk for complications and could be selectively discharged on antimicrobials after a 48-hour period of inpatient hospitalization.

Adolescent↗
PubMed1996

Vitreous hemorrhage as an ophthalmic complication of galactosemia.

A major complication of galactosemia is cataracts. This is usually considered to be the sole ophthalmic feature of this disorder. However, we have encountered vitreous hemorrhage, a very rare ophthalmic finding, in five neonates with galactosemia and have found four probable additional cases in the literature. All of these infants had severe neonatal manifestations of galactosemia and were discovered to have vitreous hemorrhage by ophthalmologic examination initiated by the observation of clouding of the eye or on a routine basis. The infants lost most or all vision from the affected eye. Retinal abnormalities were present in the involved eyes of the five neonates of whom we have direct knowledge. Thus we believe that retinal hemorrhage is the most likely source of the vitreous hemorrhage and that the coagulopathy associated with neonatal disease in galactosemia leads to vitreous hemorrhage. Prompt recognition and therapy for the coagulopathy would likely prevent vitreous hemorrhage in galactosemia.

Female↗
PubMed1996

Combined radial forearm and pharyngeal flap for soft palate reconstruction.

The use of a free vascularised fascio-cutaneous radial forearm flap in combination with a cranially based pharyngeal flap for soft palate reconstruction has not been previously reported. We present the technique and illustrate its use in two cases of total and one case of subtotal soft palate reconstruction. The functional outcome is discussed with particular reference to nasal airway patency, speech and swallowing.

Bone Transplantation↗
PubMed1996

Surveillance for human immunodeficiency virus type 1 group O infections in the United States.

BACKGROUND: Reports that the human immunodeficiency virus type 1 (HIV-1) group O variants are not reliably detected by some commercial diagnostic tests have raised concerns about the sensitivity of existing screening tests, especially with regard to blood safety. Although it is unlikely that these divergent strains are prevalent in North America, systematic, continuous surveillance is needed to monitor the potential spread of HIV variants into that region. STUDY DESIGN AND METHODS: Stored serum samples (n = 1072) from both high- and low-risk population groups at several sites in the United States and Puerto Rico were tested by peptide enzyme immunoassays specific for the prototypic HIV-1 group O strains, MVP5180 and ANT70. RESULTS: None of the 1072 samples examined had peptide reactivity that was consistent with HIV-1 group O infection. CONCLUSION: While no evidence of specific HIV-1 group O (MVP5180 or ANT70) infection was found in this study, the sensitivity of current tests has not been fully evaluated against the wide range of genetic variation of HIV. Therefore, it is important to continue active surveillance for HIV-1 and HIV type 2 strains, to characterize any divergent strains, and to judiciously modify tests to correct for any deficiencies in sensitivity.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Phylogeny and systematics of 18 Colletotrichum species based on ribosomal DNA spacer sequences.

The potential use of the ribosomal DNA internal transcribed spacer (ITS) sequences in understanding the phylogeny and systematics of Colletotrichum species has been evaluated. Sequence data from a limited number of isolates revealed that in Colletotrichum species the ITS 1 region (50.3% variable sites) shows a greater degree of intra- and inter-specific divergence than ITS 2 (12.4% variable sites). Nucleotide sequences of the ITS 1 region from 93 isolates representing 18 Colletotrichum species were determined. Data for 71 of these isolates where molecular and morphological identities concurred were used for phylogenetic analysis. The size of the ITS 1 region varied from 159 to 185 base pairs. Maximum intraspecific divergence was recorded with C. acutatum (5.8%), and C. capsici showed the greatest level of interspecific divergence (8.9-23.3%). Parsimony and distance analyses gave similar tree topologies. The bootstrapped consensus parsimony tree divided the 18 Colletotrichum species into six phylogenetic groups, designated 1-6. These groups, however, are not congruent with species clusterings based on spore shape. For example, the straight cylindrical spored species were represented both in groups 1 and 6; group 6 also included the falcate fusiform spored species C. capsici. The molecular evidence suggests refinement of the species concepts of some of the taxa examined. In group 6, divergence between C. gloeosporioides and C. fuscum (0.6-3.0%) or C. kahawae (0.6-3.0%) or C. fragariae (0.6-4.2%) overlap the divergence (3.6%) within C. gloeosporioides. It is suggested that C. fuscum as well as C. kahawae and C. fragariae fall within the group species C. gloeosporioides. ITS 1 data enabled clear distinction (7.1%) of Colletotrichum isolates from maize and sorghum into C. graminicola and C. sublineolum, respectively (group 2). Species such as C. acutatum, C. coccodes, C. dematium, and C. trichellum can be clearly distinguished based on ITS 1 sequence divergence, but C. destructivum cannot be confidently separated (98% homology) from C. linicola. Colletotrichum dematium f. truncatum is distinct (12.9%) from C. dematium and should probably be called C. truncatum.

Base Sequence↗