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Biomedical subjects

B Speed

Publications and source records attributed to B Speed.

14 recordsLinked to original sources
PubMed2000

Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group.

A prospective population-based study was conducted in Australia and New Zealand during 1994-1997 to elucidate the epidemiology of cryptococcosis due to Cryptococcus neoformans var. neoformans (CNVN) and C. neoformans var. gattii (CNVG) and to relate clinical manifestations to host immune status and cryptococcal variety. The mean annual incidence per 10(6) population was 6.6 in Australia and 2.2 in New Zealand. Of 312 episodes, CNVN caused 265 (85%; 98% of the episodes in immunocompromised hosts) and CNVG caused 47 (15%; 44% of the episodes in immunocompetent hosts). The incidence of AIDS-associated cases in Australia declined annually (P<.001). Aborigines in rural or semirural locations (P<.001) and immunocompetent males (P<.001) were at increased risk of CNVG infection. Cryptococcomas in lung or brain were more common in immunocompetent hosts (P< or =.03) in whom there was an association only between lung cryptococcomas and CNVG. An AIDS-associated genetic profile of CNVN serotype A was confirmed by random amplification of polymorphic DNA analysis. Resistance to antifungal drugs was uncommon. The epidemiology of CNVN infection has changed substantially. Clinical manifestations of disease are influenced more strongly by host immune status than by cryptococcal variety.

AIDS-Related Opportunistic Infections↗
PubMed1999

Tuberculosis infection and homelessness in Melbourne, Australia, 1995-1996.

OBJECTIVE: To describe tuberculosis infection among persons experiencing homelessness in inner Melbourne, Australia. DESIGN: Homeless people were surveyed during late 1995 and early 1996. In stage one of the study 284 homeless people from crisis and long-term accommodation sites were recruited by means of stratified, systematic, random sampling. In stage two a convenience sample of 100 homeless people from squats and the streets were recruited. Participants completed a questionnaire and Mantoux testing was performed. RESULTS: A past history of tuberculosis was reported by 3%. Thirty-seven per cent had a Mantoux > or =10 mm; 21% > or =15 mm; and 11% > or =20 mm. A Mantoux > or =15 mm was independently associated with being aged > or =40 years, coming from the accommodated sample, overseas birth, and a past history of tuberculosis. Using logistic regression modelling, a Mantoux > or =15 mm was predicted by being aged > or =40 years, overseas birth, and past history of tuberculosis. CONCLUSION: Mantoux test results suggest that this group of homeless people had a high prevalence of infection with the tubercle bacillus. Many aspects of the physical and social circumstances of homeless people predispose to reactivation and have the potential to enhance rapid spread should latent infection become active disease.

Adolescent↗
PubMed1998

Health indicators and risks among people experiencing homelessness in Melbourne, 1995-1996.

During the study's first stage, 284 homeless people from crisis and long-term accommodation sites were surveyed using stratified, systematic sampling. The second stage involved a survey of a convenience sample of 100 homeless people from squats and the streets. Participants completed a questionnaire, Mantoux testing was performed and blood taken for gamma-interferon assay, liver and renal function tests. The group's health status was poor, with 72% experiencing medical conditions in the preceding two years and 77% symptoms in the month prior to interview. Bronchitis, asthma and gastroenteritis were the most commonly reported conditions; productive and persistent coughing, shortness of breath and wheezing the commonest symptoms. Twenty-one per cent had Mantoux reactions 15 mm or greater, 28% a raised GGT and 19% a raised ALT. Seventy-seven per cent smoked, 74% were current drinkers, 28% had injected drugs at some time in their lives and 14% were regularly injecting drugs. Forty-four per cent had experienced mental illness, 49% of whom reported depression and 15% schizophrenia. Homeless people in Melbourne have poor health status and engage in behaviours that place their health at risk. The high number of respiratory and gastro-intestinal complaints, the high level of cigarette smoking and injecting drug use (IDU) and the proportion likely to be infected with Mycobacterium tuberculosis (MTb) are all issues with important health consequences. Participants recruited from the street had significantly poorer health and engaged in more risk behaviours than those from accommodation sites; those from the accommodated sample were more likely to be infected with Mtb.

Adolescent↗
PubMed1998

A methodology for sampling and accessing homeless individuals in Melbourne, 1995-96.

A methodology for sampling homeless populations in inner Melbourne was developed to study their health status and prevalence of tuberculosis. This paper describes the design, development and implementation of the project. The results of health status and tuberculosis analysis are published elsewhere. Involvement and interaction with local service providers and agencies to homeless people was central to the project throughout. A definitional construct of homelessness was developed, drawn from local and overseas literature and contemporary local experience. The study's aim was to obtain a representative sample of homeless individuals in various levels of accommodation and a convenience sample of those who were unaccommodated (streets and parks). A comprehensive sampling frame of accommodation options was constructed from available databases, and systematic sampling applied to produce a sample of 396 beds, from which 284 participants were enrolled. Convenience sampling of unaccommodated homeless individuals produced 100 participants. All agreed to undergo a comprehensive questionnaire, blood and Mantoux testing, the latter being completed successfully in 94%. Commonsense, cultural sensitivity and a non-threatening approach were critical to the success of the project and the security of the field workers. The methods described attempt to address recognised difficulties of sampling from homeless populations and should be reproducible both in the future and elsewhere. Potential for selection bias remains the main threat to validity, which the described methodology combined with adequate resources should help to address.

Health Surveys↗
PubMed1996

Clinical management of fungal infections.

Fungal infections require clinical and microbiological diagnosis for optimal therapy. Superficial mycoses often respond to topical agents but newer, less toxic drugs are available for systemic treatment when required. For invasive mycoses, amphotericin B remains the gold standard, with triozoles as the preferred oral agents.

Antifungal Agents↗
PubMed1996

A review of antifungal agents.

A vigorous approach to the management of fungal related diseases has been precipitated by a number of issues; HIV/AIDS being one of the most prominent. In line with this there have been a number of new developments that all practitioners should know about. This article reviews the appropriate use of all agents currently available for antifungal treatments. The second part of this article (appearing in the June issue) will look at the clinical applications of these treatment options.

AIDS-Related Opportunistic Infections↗
PubMed1995

Clinical and host differences between infections with the two varieties of Cryptococcus neoformans.

A population-based register of cases of cryptococcosis in patients treated in Victoria, Australia, over a 10-year period was established for studying the epidemiologic and clinical features of infection with Cryptococcus neoformans and its two varieties, gattii and neoformans. One hundred thirty-three cases of cryptococcosis were entered on the register; the incidence was 3.0 cases per 1 million population per year, a rate that increased to 5.0 cases per 1 million population per year over the decade as a result of the AIDS epidemic. There was a distinct association between immune status and C. neoformans variety: all C. neoformans variety gattii infections occurred in healthy hosts and 90% of C. neoformans variety neoformans infections occurred in immunosuppressed hosts. Meningitis was the commonest manifestation, with focal CNS and pulmonary lesions occurring primarily in healthy hosts with C. neoformans variety gattii infection; isolation of C. neoformans from blood and urine was associated with immunosuppression and C. neoformans variety neoformans infection. The mortality among patients with C. neoformans variety neoformans infection was high, while none of those patients with C. neoformans variety gattii died but often had neurological sequelae that required surgery and prolonged therapy. These findings appear to be related to variety-specific interactions between host and parasite and warrant further epidemiologic and immunologic study.

Adolescent↗
PubMed1990

Reactive haemophagocytic syndrome in human immunodeficiency virus infection.

The reactive or virus-associated haemophagocytic syndrome (RHS) has been described in association with several different infections and is regarded as clinically and pathologically distinct from malignant histiocytosis. A case is described of this syndrome in a 30-year-old HIV-antibody positive homosexual male who presented with fever, pancytopenia, lymphadenopathy, and massive splenomegaly. The fever and haematological abnormalities resolved following splenectomy, and the patient remains well after 12 months. Prominent histiocytic haemophagocytosis was seen in both the spleen and an abdominal lymph node. Exhaustive tests failed to demonstrate any infectious agent other than human immunodeficiency virus, indicating this to be a case of this syndrome occurring in association with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Agranulocytosis after ranitidine administration.

A patient who developed agranulocytosis and streptococcal septicaemia while taking ranitidine is reported. We believe this to be the first published Australian case, and in view of the wide clinical usage of this drug, clinicians should be alerted to this possible complication.

Adult↗
PubMed1984

How really real is real?

This paper takes issue with a number of family therapists who appear to hold that reality is entirely constructed out of our beliefs and that different views of reality can only be discriminated between on the basis of their usefulness for a particular purpose. Rather this paper argues for a co-constructivist position, that is, that the knower's beliefs and constructs are in an interpenetrating relationship with reality and that different views of reality can be discriminated between on the basis of their adequacy in describing that reality and that it is this adequacy that will determine their usefulness. These issues are not just of theoretical interest but have important implications for the practice of therapy.

Adolescent↗