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Biomedical subjects

A R Mackenzie

Publications and source records attributed to A R Mackenzie.

At least 19 recordsLinked to original sources
PubMed1999

Epidemiology and outcome of HIV infection in North-East Scotland (1985-1997).

OBJECTIVE: to assess the epidemiology of HIV infection in North-East Scotland. METHODS: retrospective casenote review of all HIV-infected patients who have had contact with the Infection Unit in Aberdeen. RESULTS: one hundred and forty-two HIV-infected patients were treated between April 1985 and December 1997. The risk behaviour related to the acquisition of the HIV infection was: 56 (39%) homosexually infected, 45 (32%) heterosexually-infected, 34 (24%) injecting drug users (IDUs), and seven (5%) blood products or not known. Sixteen of the 45 (36%) heterosexually-infected patients were native to Africa and 16 of the 34 (31%) IDUs were prisoners in Peterhead prison at the time of referral. Fifty-two (37%) of the cohort continue to attend the Infection Unit, 41 (29%) have relocated, 40 (28%) have died and nine (6%) have been lost to follow-up. The ratio of heterosexual:homosexual men:IDUs changed significantly between the first 7 years (12:21:25) and the second 6 years (33:35:9) of the review, with significantly more patients being infected through heterosexual contact and fewer infected by IDU in the second period-P<0.001. The median AIDS survival was 17 months. Survival was significantly longer in those patients who took anti-retroviral therapy (median = 20 months) than in the patients who opted not to take anti-retroviral therapy (median = 11 months)-P<0.01. CONCLUSIONS: Although homosexual contact represents the commonest risk group for HIV infection in this region, the number of heterosexually-infected patients has increased significantly in the last 5 years. Temporary residents account for one-third of the HIV-infected population cared for in NE Scotland. Almost half of those lost to follow-up have returned to Africa or been released from prison. The introduction of anti-retroviral therapy has resulted in a dramatic improvement in AIDS survival in our cohort as it has done elsewhere.

Africa↗
PubMed1999

Duration of intravenous therapy and hospital stay according to choice of empirical antimicrobial treatment for community-acquired respiratory infection.

A review of patients admitted to medical wards with respiratory infection was undertaken to look for differences in duration of intravenous (IV) therapy and length of patient stay based on the class of IV antimicrobial used in treatment. Data was analysed from 231 patients with community-acquired respiratory infection who were treated empirically for at least 24 h with either an IV cephalosporin (146 patients) or an IV penicillin or macrolide (85 patients). The severity of illness and indication for IV treatment was similar in each group. Those treated with a cephalosporin received IV therapy for a significantly longer period (mean = 4.44 days, SD = 2.6) than those given a penicillin or macrolide (mean = 3.3 days, SD = 1.8): P < 0.001. Patient stay was significantly longer in the cephalosporin group (mean = 11.6 days, SD = 10.4) than the penicillin/macrolide group (mean = 9.4 days, SD = 6.3): P = 0.04. These differences are most readily accounted for by the absence from the hospital formulary of a third generation oral cephalosporin, a drug that might be regarded as an obvious form of follow-on therapy in patients treated empirically with an injectable cephalosporin.

Anti-Bacterial Agents↗
PubMed1999

Assessment of the efficacy, safety and quality of gentamicin use in Aberdeen Royal Infirmary.

Fifty-five patients who received od gentamicin were studied. The protocol for od gentamicin was followed in 23/55 (48%). Cure rates were 22/23 (96%) when the protocol was followed and 24/32 (75%) when not followed (P = 0.06). Toxicity was more common in those in whom the protocol was not followed (9/32; 28%) than in those in whom it was followed (1/23; 4%) (P< 0.05). The number needed to treat with the protocol to produce one additional cure was 4.84 (95% CI 2.64 to 28.66) and the number needed to treat to prevent one case of toxicity was 3.61 (95% CI 2.16 to 10.99).

Adolescent↗
PubMed1998

The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards.

The effect of an intravenous (i.v.)-to-oral switch policy on antibiotic prescribing in general medical wards was examined. Three audits, each of 2 months' duration, were carried out to examine the duration of i.v. therapy and length of patient stay. The first audit (S1) was performed before the introduction of switch guidelines, the second (S2) after guidelines had been placed in patient case-notes and the third (S3) after the guidelines had been introduced into the drug charts. The duration of i.v. therapy was significantly shorter in the S3 group (mean = 3.7 days) than in the S2 or S1 groups (mean 4.4 and 4.35 days, respectively) (P < 0.05). There was no significant difference in the length of patient stay between the three audit periods but the stay was significantly shorter in 81 switched patients (mean duration = 8.9 days) than in matched controls (mean duration = 12.6 days) (P = 0.01). Fewer patients with respiratory infection were treated for > 24 h with i.v. antimicrobials in the S3 audit period (75/549) than in the S2 (85/372) and S1 audits (83/326) (P < 0.01). The introduction of switch guidelines to drug charts reduces the length of i.v. therapy. Switched patients spend less time in hospital than their matched controls.

Administration, Oral↗
PubMed1998

Spinal epidural abscess: the importance of early diagnosis and treatment.

OBJECTIVES: To remind clinicians of the dangers of delayed diagnosis and the importance of early treatment of spinal epidural abscess. METHODS: A review of the literature on spinal epidural abscess and a comparison of the published literature with local experience. RESULTS: Imaging with MRI or CT enables early diagnosis of spinal epidural abcess and optimal therapy is surgical evacuation combined with 6-12 weeks (median 8 weeks) of antimicrobial chemotherapy. Clinical features are fever, pain, and focal neurological signs and may be associated with preceding and pre-existing bone or joint disease. The commonest aetiological organism is S aureus. CONCLUSION: Early diagnosis and appropriate early antimicrobial chemotherapy with surgery is associated with an excellent prognosis.

Abscess↗
PubMed1998

Raw egg ingestion and salmonellosis in body builders.

Four patients with Salmonella enteritidis infection are reported. All were body builders who regularly consumed substantial quantities of raw eggs. They presented with a severe febrile illness and diarrhoea--presumably reflecting a large bacterial inoculum. Advice regarding the potential hazards of raw egg ingestion has been repeatedly issued by the Department of Health--but this report highlights the fact that this practice continues in spite of this. The epidemiology of S. enteritidis infection in relation to raw egg ingestion is discussed.

Adult↗
PubMed1996

Salmonella Dublin infection in Queensland dairy cattle.

OBJECTIVE: To investigate the presence of Salmonella Dublin in Queensland cattle. DESIGN: An epidemiological study using diagnostic laboratory information and farm records. PROCEDURE: Outbreaks of gastroenteritis or pneumonia in calves, and abortions and enteritis in cows were routinely investigated for the presence of salmonellae. Where S Dublin was isolated, attempts were made to gather further epidemiological information. RESULTS: Prior to 1983 only two outbreaks of S Dublin have been recorded in Queensland dairy cattle. In 1983 S Dublin abortions were diagnosed in dairy heifers introduced from southern Australia to south-east Queensland. Sampling indicated that at least 10% of the 500 introduced heifers were faecal excretors of S Dublin. On 3 of the 7 farms from which S Dublin was recorded, infection spread to other cattle that were in contact. From February 1985 to February 1996, 29 outbreaks of S Dublin in cattle occurred on 29 farms (28 in south east Queensland and 1 in north Queensland). Calves were primarily affected. Continuing outbreaks were confirmed on only 4 of these 29 farms. On 15 farms S Dublin infections were associated with the purchase of infected calves or cows, while another farm adjoined 2 previously infected farms. No source of S Dublin was evident for the other 13 farms, where histories were often inadequate. CONCLUSION: There has been a marked increase in S Dublin outbreaks in Queensland dairy cattle since 1983. Introduction of S Dublin carrier and aborting dairy heifers from southern Australia, where S Dublin is not uncommon, was associated with the initial outbreaks.

Animals↗
PubMed1995

Translumbar amputation: the longest survivor--a case update.

BACKGROUND: Translumbar amputation, known also as hemicorporectomy, was first described by Kredel but was not performed until 10 years later in 1960. It appears that 44 such operations have been reported but probably several others remain unpublished. METHODS: The operation has been performed in 44 reported patients over the past 30 years in more or less the same fashion. Most have been done as a one-stage procedure, but the author favors laparotomy and maturation of urinary and fecal diversions before doing the amputation about two weeks later. RESULTS: Overhydration caused the death of the first three patients. This problem was avoided in the Memorial Sloan-Kettering patients by careful monitoring of central venous pressure. There were no operative deaths, but 8 of the 44 patients died within a month. Survival of cancer patients has not been good, but those with benign lesions have survived fairly well. CONCLUSION: This case is remarkable in that, despite a rapidly advancing cancer of the bladder, the patient lived for over 28 years. It is gratifying to see that other surgeons and patients have not abandoned this most radical of all operations when no other therapy can preserve life.

Amputation, Surgical↗
PubMed1990

P300 and smooth eye pursuit: concordance of abnormalities and relation to clinical features in DSM-III schizophrenia.

Twenty-five DSM-III-diagnosed schizophrenics and 37 normal and age-matched controls were examined using an oddball paradigm for the generation of P300 and smooth eye-pursuit tasks. Results were compared between groups and related to clinical characteristics, including a family history of psychiatric illness. Group differences were found for P300 amplitudes, latencies and eye-tracking. A family history of psychiatric illness was associated with normal eye-tracking in patients. Small P300 amplitudes alone and in combination with long P300 latencies were associated with a family history in controls.

Adult↗
PubMed1990

Disease of geese caused by a new herpesvirus.

A goose flock farmed outdoors in south-eastern Queensland suffered an outbreak of peracute disease with high death rate (97%). Small button ulcers and large plaques overlying lymphocyte aggregates were present on the mucosa of the small intestine of affected birds. Small white foci of necrosis and focal haemorrhages were seen in the livers. Numerous intranuclear inclusion bodies were observed microscopically in hepatocytes and a herpesvirus which grew rapidly in chicken kidney cells was isolated from tissues. Duck virus enteritis (DVE) was suspected but DVE antiserums failed to neutralise the virus. Further serological studies with a limited range of known avian herpesviruses have failed to identify the virus. Experimental transmission resulted in high mortality in geese (100%), lower mortality in ducklings and nil mortality in chickens. Surveillance studies showed no evidence of infection in domestic and wild birds beyond the original farm and the infection appears not to have been established in the area. Wild ducks, which were frequent visitors to the farm dam, were considered the most likely source of the infection.

Animals↗
PubMed1990

Influence of anaesthesia on blood loss in transurethral prostatectomy.

In this study operative blood loss was measured in 177 transurethral prostatectomies performed over a six-year period in one hospital by the author. A comparison was made relative to type of anaesthesia used i.e. general inhalation versus spinal anaesthesia. The two groups were similar in age and physical condition. Their prostates were almost the same size and there was negligible difference in the rate of resection between the two groups. Mean loss and median loss in 113 patients given general anaesthesia were 66.6 and 29.9 ml. In 64 patients who had spinal anaesthesia these losses were 35.6 and 22.2 ml respectively. The findings are in agreement with two of the three previous studies devoted to the relationship between operative blood loss during transurethral prostatectomy and the type of anaesthesia used.

Adult↗
PubMed1989

Investigations into the membrane associated IL-1 like activity on mouse macrophages.

The present study was undertaken to investigate the expression of membrane IL-1 (mIL-1) in mouse macrophages. Membrane IL-1 activity was measured on paraformaldehyde fixed peritoneal macrophages using EL4 6.1 lymphocyte cell line. Acid washing prior to fixation did not remove the mIL-1 activity, indicating that mIL-1 is an integral part of the membrane. Adherence to tissue culture plastic plates was found to be a potent inducer of mIL-1 activity in both resident and C. parvum activated macrophages. Dexamethasone reduced mIL-1 activity induced in vivo by C. parvum and also that induced by adherence in vitro.

Animals↗
PubMed1987

Campylobacter hyointestinalis-associated enteritis in Moluccan rusa deer (Cervus timorensis subsp. Moluccensis).

A morphological and bacteriological study on a Campylobacter hyointestinalis-associated enteritis in adult Moluccan rusa deer is described. Necropsied deer were 2 to 2.5 years of age and had been scouring for 1 to 2 months. There was distension of the ileum and excessive corrugation of the mucosa. Microscopic lesions in the small intestine were confined to the ileum. Stunting and fusion of villi, patchy erosion of epithelium and a predominantly neutrophilic infiltrate were features. The inflammatory reaction in caecum and colon was much less severe. Light and scanning electron-microscopical examination of small and large intestine showed large numbers of Gram-negative curved rods colonizing surface mucus and moderate numbers in close association with gland epithelium. No salmonellae or other enteropathogenic bacteria were isolated on aerobically-incubated media. C. hyointestinalis was isolated from the faeces, ileum, caecum, colon and mesenteric lymph nodes from 2 cases and one farm-collected faecal sample.

Animals↗