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Biomedical subjects

C Keane

Publications and source records attributed to C Keane.

At least 19 recordsLinked to original sources
PubMed2005

Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000.

In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.

Adult↗
PubMed2005

Impact of the European Antimicrobial Resistance Surveillance System on the development of a national programme to monitor resistance in Staphylococcus aureus and Streptococcus pneumoniae in Ireland, 1999-2003.

Presented here is the 5-year impact of a national antimicrobial resistance surveillance system in Ireland, which was introduced in accordance with the European Antimicrobial Resistance Surveillance System (EARSS). Participation in EARSS began in Ireland in 1999. Initially, 12 laboratories serving a mix of general and tertiary hospitals participated, but by 2003, participation had increased to 28 laboratories with a population coverage of 89%. During 1999-2003, 4,146 episodes of Staphylococcus aureus bacteraemia were reported, and methicillin resistance was detected in 1,709 (41.2%) of these isolates. Over the same period, 1,245 invasive (blood or cerebrospinal fluid) episodes of Streptococcus pneumoniae infection were reported, and 160 (12.9%) isolates were found to be non-susceptible to penicillin, with 23 (1.8%) demonstrating high-level penicillin resistance. By 2003, most Irish hospitals were participating in EARSS, which has been a catalyst for the development of a national antimicrobial resistance surveillance programme.

Drug Resistance, Bacterial↗
PubMed2001

Perceived outcomes of public health privatization: a national survey of local health department directors.

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.

Administrative Personnel↗
PubMed2001

Privatization and the scope of public health: a national survey of local health department directors.

OBJECTIVES: This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. METHODS: A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. RESULTS: Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. CONCLUSIONS: Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments.

Administrative Personnel↗
PubMed1999

Factors associated with prolonged symptoms and severe disease due to Clostridium difficile.

OBJECTIVE: toxigenic Clostridium difficile is responsible for a spectrum of disease severity ranging from mild diarrhoea to fulminant colitis. This study attempts to determine the proportion of patients in each category of severity and evaluate the risk factors for a more prolonged and complicated course. DESIGN: prospective cohort study. SETTING: university teaching hospital. SUBJECTS: all patients with symptomatic C. difficile infection during 4 months of an outbreak (January-April 1995); n=73; median age 74 years (range 17-91). MEASUREMENTS: incidence of C. difficile-associated disease (CDAD); severity of disease; percentage of patients in each category of severity; risk factors for severe disease/prolonged symptoms (univariate and multivariable analyses). RESULTS: the incidence of CDAD was 0.93%. Of the cases identified, 18 (24.7%) had mild, self-limiting disease; 26 (35.6%) had moderately severe disease; 23 (31.5%) had prolonged symptoms and six (8.2%) had a complicated course. Although CDAD was more common in older patients (P < 0.001), increasing age was not a risk factor for severity. Significant risk factors for severe CDAD included low Barthel and abbreviated mental test scores (P < 0.01, P < 0.001 respectively) and recent endoscopy (P=0.03). Logistic regression analysis revealed the following independent predictors of severe CDAD: endoscopy [odds ratios (OR) 4.0, P=0.03] and cognitive impairment (OR 11.0, P < 0.01). A trend towards significance was noted for nasogastric tube insertion (OR 3.1, P=0.08). Complications of infection included dehydration, malnutrition and faecal incontinence (which was statistically significantly associated with more severe disease; P < 0.01). CONCLUSION: risk factors for severity of CDAD include functional disability, cognitive impairment, and recent endoscopy. Anticipation of severe CDAD may limit morbidity and mortality.

Adolescent↗
PubMed1999

Tissue culture adherence and haemagglutination characteristics of Moraxella (Branhamella) catarrhalis.

The haemagglutination and tissue culture adherence properties of 20 isolates of Moraxella catarrhalis obtained from the sputum of elderly patients with lower respiratory tract infections were compared with those of 20 isolates of M. catarrhalis obtained from the nasopharynx of elderly persons colonised by the organism. Eighty percent of isolates from the infected group as opposed to 5% of isolates from the colonised group haemagglutinated human erythrocytes (P < 0.001), indicating that the haemagglutinin might be a marker of pathogenicity for M. catarrhalis. There was a significant difference in the adherence to HEp-2 cells of isolates from the infected group in comparison to isolates from the colonised group (P = 0.03). Haemagglutination and tissue culture adherence properties were unrelated, indicating that separate adhesin systems are involved. The adherence of M. catarrhalis to HEp-2 cells was unaffected following pronase and trypsin treatment, however, sodium periodate pre-treatment of the bacteria significantly reduced the tissue culture adherence index, indicating that the adhesin by which the bacteria bind to HEp-2 cells may have a carbohydrate moiety. Transmission electron microscopy studies revealed that adherence of M. catarrhalis to HEp-2 cells was mediated by trypsin-resistant 'tack-/spicule-like' structures protruding from the surface of the bacteria.

Aged↗
PubMed1999

Transmission electron microscopy studies of Moraxella (Branhamella) catarrhalis.

A trypsin-sensitive 200-kDa protein has been reported to be exclusively associated with haemagglutinating isolates of Moraxella (Branhamella) catarrhalis. Transmission electron microscopy studies revealed that haemagglutination by M. catarrhalis to both human and rabbit erythrocytes was mediated by a trypsin-sensitive outer fibrillar coat. This fibrillar layer was absent on non-haemagglutinating isolates examined. Immuno-electron microscopy, using a polyclonal antiserum containing antibodies to the 200-kDa protein as a probe, showed that the 200-kDa protein is present on the outer fibrillar layer of the bacterium. These findings suggest that the haemagglutinin of M. catarrhalis is a 200-kDa protein present on the outer fibrillar coat.

Animals↗
PubMed1998

Spectrum of gestational exposure to illicit drugs and other xenobiotic agents in newborn infants by meconium analysis.

OBJECTIVE: To detect the spectrum of gestational exposure to illicit drugs and other xenobiotic agents in neonates by meconium analysis. METHOD: Meconium was collected from 98 neonates and analyzed for illicit drugs and other xenobiotic agents by high-performance liquid chromatography and gas chromatography/mass spectrometry. RESULTS: Eighty-one (82.7%) infants tested positive for xenobiotic agents, and each infant had from 1 to 9 drugs present. These included local anesthetics (30%) such as lidocaine and mepivacaine; food additives (25%) such as ionol (butylated hydroxytoluene); illicit drugs (11%), especially cocaine and morphine; analgesics (10%) such as meperidine; and fewer (< 10%) other drugs such as antihistamines, antidepressants, adrenergics, anticonvulsants, cough medications, analeptics, hypnosedatives, and cardiotonics. CONCLUSION: We demonstrated substantial exposure of neonates to xenobiotic agents, ranging from exposure to food additives, prescribed or over-the-counter medications, and drugs of abuse.

Chromatography, High Pressure Liquid↗
PubMed1998

Community-acquired Clostridium difficile infection.

Clostridium difficile-associated disease (CDAD) is primarily a nosocomial condition. Community-acquired disease has been reported but the incidence is felt to be low and the rate of disease resulting in hospitalization is reported as negligible. We recently experienced a 6-month outbreak of CDAD (January to June 1995): 139 patients were involved and four deaths were attributable to pseudomembranous colitis. Early in the outbreak period we were aware that many new admissions presented with C. difficile cytotoxin B positive diarrhoea: in some cases this was the sole reason for hospitalization. This observation forms the basis of this report.

Adult↗
PubMed1998

Simultaneous outbreaks of two strains of toxigenic Clostridium difficile in a general hospital.

We report an outbreak of Clostridium difficile-associated disease (CDAD) in a large Dublin hospital. From January to June 1995, inclusive, 139 patients were affected; the mean age of cases was 68.8 +/- 19 years. Clinical information is available for 73 cases identified during the first four months of the outbreak. The majority of patients presented with abrupt onset of watery diarrhoea; however, 19.2% presented with an unexplained pyrexia following a course of antimicrobial therapy and 5.5% presented with a surgical acute abdomen. Twenty patients (27.4%) experienced relapsing disease and seven (9.6%) patients died. Seventy-six percent of cases received a cephalosporin prior to the onset of disease, the highest relative risks occurring with third-generation agents; however, 9.6% of patients affected had not been exposed to antimicrobial therapy in the preceding eight weeks. Pyrolysis mass spectrometry identified two clusters of isolates, representing two strains of C. difficile. There was marked spatial clustering of these strains, with each confined to a separate area of the hospital. Infection control measures and an antibiotic policy were introduced. Throughout the outbreak period the use of the most frequently used cephalosporin in the hospital increased; this was accompanied paradoxically by a reduction in the number of new cases of CDAD.

Aged↗
PubMed1998

Maintenance of mobility in residents of an Alzheimer special care facility.

The cognitive and functional decline of demented residents in a specialized Alzheimer's facility was compared to that of demented residents living in a traditional nursing home. All residents met DSM-III-R criteria for dementia. The evaluation consisted of a clinical interview with patients and collateral assessments of cognition, general health, problem behaviors, depression, and a broad range of activities of daily living (ADLs) including mobility. Residents were evaluated at baseline and 6-month intervals over 18 months. Similar rates of decline were found in cognition and overall ADLs in both groups. However, the most striking finding was preserved mobility in residents of the Alzheimer's facility. This finding suggests that specialized facilities do not halt or slow the overall progression of cognitive and functional decline seen in Alzheimer's disease; however, residents of such facilities may show slower decline in mobility.

Accidental Falls↗
PubMed1998

Timing of surgery for fulminating pseudomembranous colitis.

BACKGROUND: With increasing antibiotic usage Clostridium difficile colitis is becoming more common. Surgery for fulminating C. difficile colitis, however, is rare because of the effectiveness of specific anticlostridial chemotherapy. Surgical outcome in five patients with fulminating C. difficile colitis involved in a recent outbreak of this disease is reported. METHODS: Five of 138 patients developed fulminating C. difficile colitis unresponsive to medical therapy. All patients had antibiotics in the preceding period. Indications for operation in those who underwent surgery were systemic toxicity with a pyrexia, marked leukocytosis and abdominal signs leading to progressive organ failure, despite appropriate anticlostridial antibiotic therapy. RESULTS: At operation all patients had a markedly oedematous colon with normal serosa but with acute mucosal colitis. All underwent subtotal abdominal colectomy and ileostomy. Progressive organ failure persisted in four, leading to death, giving a mortality rate of four in five in the operated group in comparison with 3.8 per cent (five of 133 patients) in those treated medically. CONCLUSIONS: These results indicate that this increasingly common disease frequently leads to a fatal outcome in patients requiring surgery and implies that earlier surgical consultation may be necessary to improve survival in patients with fulminating C. difficile colitis unresponsive to antibiotic therapy.

Abdomen, Acute↗
PubMed1998

A community-based study of the epidemiology of Helicobacter pylori infection and associated asymptomatic gastroduodenal pathology.

OBJECTIVES: To document the epidemiology of Helicobacter pylori infection in a normal population, to assess asymptomatic H. pylori positive individuals for the presence of gastroduodenal disease, and to compare the macroscopic and microscopic findings at endoscopy in this group with those of patients presenting with dyspepsia. DESIGN/METHODS: Serum was collected from blood donors and assessed for the presence of anti-H. pylori IgG antibodies. A randomly selected group of asymptomatic blood donors and dyspeptic patients underwent endoscopy. RESULTS: The seroprevalence of H. pylori in 1000 subjects was 43.0%. The prevalence of infection increased from 29% in 18-30 year olds to 62% in 46-60 year olds (P < 0.01). The infection was more prevalent in individuals from social classes IV and V (50.0%) than social classes I and II (36.9%) (P < 0.01). There was no difference between the H. pylori positive asymptomatic individuals (n = 37) and matched dyspeptic patients (n = 29) at endoscopy with regard to duodenal ulcer (13.5% vs. 17.2%) or gastroduodenal erosions (24.3% vs. 20.7%) while 5.4% of the former had gastro-oesophageal reflux compared to 27.6% of the latter. Overall, 56.8% of the H. pylori positive asymptomatic group had a normal macroscopic endoscopy compared with 31% of the dyspeptic group. Histology of the gastric mucosa did not reveal any significant differences between the two groups. In H.pylori negative asymptomatic individuals (n = 13) 92.3% had a normal endoscopy (7.7% had grade I gastro-oesophageal reflux) compared with 61.5% of a matched dyspeptic group (n = 13). CONCLUSION: H.pylori infection, symptomatic and asymptomatic, is associated with significant pathology, and screening for the infection may be indicated for the prevention of gastroduodenal diseases.

Adolescent↗
PubMed1998

Globality and constructions of world health.

Explorations of the social construction of health and illness reveal that popular and professional discourses on health and disease implicitly contain underlying images of how societies can or should be structured. Globality, which is a notion that refers to the consciousness of the world as a single place, suggests that these images of world structure are now salient. This article describes four current discourses of "work health" and discusses them in terms of their underlying ideal images of world order. The four images of the world are defined in terms of four elemental points of reference: individuals, societies, the system of societies, and humankind. These ideal images have either a gemeinschaft (community) or gesellschaft (society) orientation. An anthropology of globality can refine and extend our understandings of discourses of world health. Sensitivity to these discourses and their world-oriented ideological roots should help to demystify the notion of world health.

Anthropology↗
PubMed1997

Cutaneous mucormycosis due to Absidia corymbifera occurring after bone marrow transplantation.

Mucormycosis is an uncommon severe life-threatening fungal infection in the immunocompromised host caused by fungi belonging to the order Mucorales, most commonly Rhizopus arrhizus (R. oryzae). We report a patient who developed a severe right atrial catheter exit site infection with Absidia corymbifera. The catheter was removed and necrotic tissue debrided. With liposomal amphotericin B and G-CSF, the infection subsided. He remains well 8 months later.

Amphotericin B↗
PubMed1997

A 200 kDa protein is associated with haemagglutinating isolates of Moraxella (Branhamella) catarrhalis.

Moraxella catarrhalis adheres to human erythrocytes by means of a proteinaceous, trypsin sensitive, heat modifiable haemagglutinin. A 200 kDa protein was found to be associated with haemagglutinating isolates of M. catarrhalis. This protein was present on all haemagglutinating isolates (n = 17), but was absent on the non-haemagglutinating isolates (n = 23) examined. This protein demonstrated heat-modifiable properties in sodium dodecyl sulfate and was degraded by trypsin. Immunoblot assays with polyclonal antiserum indicated that the 200 kDa protein was associated exclusively with haemagglutinating isolates and antibodies to this protein did not recognise epitopes on non-haemagglutinating isolates. This protein, which appears to be a surface expressed protein may be a haemagglutinin of M. catarrhalis.

Bacterial Proteins↗
PubMed1997

Studies on haemagglutination and serum resistance status of strains of Moraxella catarrhalis isolated from the elderly.

A total of 40 strains of Moraxella catarrhalis, isolated from the sputum of elderly persons with respiratory tract infections and from nasopharyngeal swabs from healthy elderly, were examined for haemagglutination of human red blood cells and resistance to bactericidal activity in normal human serum (NHS). 15 of 20 strains isolated from the infected elderly and 3 of 20 strains isolated from the healthy elderly showed haemagglutinating properties (p < 0.001). Similarly, 13 of 20 strains from the infected group and 2 of 20 strains from the healthy group were found to be resistant to the bactericidal activity of NHS (p < 0.001). Strains of M. catarrhalis which were associated with respiratory tract infections in the elderly, in contrast to strains colonizing the healthy elderly, were found to be predominantly haemagglutinating for human red blood cells and resistant to complement killing in NHS.

Adult↗