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Biomedical subjects

D Isaacs

Publications and source records attributed to D Isaacs.

At least 19 recordsLinked to original sources
PubMed1992

Immunization status of casualty attenders: risk factors for non-compliance and attitudes to 'on the spot' immunization.

Outbreaks of vaccine preventable infections have focused attention on 'missed opportunities' for immunizing children. The immunization status of 520 consecutive children attending Casualty during a 10 day period was studied. Only 70% of children had received their diphtheria, tetanus, pertussis (DTP) and poliomyelitis immunization at the appropriate time, 13% had completed the schedule later than recommended and 17% had immunizations overdue by 4 weeks or more. For measles (mumps/rubella) vaccine (MM or MMR) 75% were up to date, 10% were given late and 15% were overdue. A subset of 171 families was interviewed to evaluate factors affecting compliance. Families possessing a Social Security 'Health Care Card', whose father was unemployed, who spoke poor English or who had lived in Australia for 5 years or less were significantly more likely (P < 0.02) to be inadequately immunized. There were 84 children whose immunization was overdue and who were well enough to be immunized. The parents of 70 (83%) of these 84 said that they would agree to 'on the spot' immunization if it were available; 14 (17%) parents refused, the commonest reason for refusal being that the parents felt that the child was too sick at the time to be immunized.

Child↗
PubMed1992

Sinusitis-induced subdural empyema.

Over a 17 year period, 1975-91, 10 children were managed who had sinusitis-induced subdural or extradural empyema. Their ages ranged from 6 to 14 years, with a mean of 11 years. All presented with worsening headaches, fever, vomiting, all had neurological abnormalities, and all had symptoms or signs suggestive of sinusitis. Initial computed tomography gave normal results in five cases and the empyema was diagnosed on the second or third scan. All patients had symptoms for at least one to two weeks before the diagnosis was made. Streptococcus milleri was the organism most frequently implicated. Medical treatment was started in all cases on admission, but all required surgical intervention before resolution.

Adolescent↗
PubMed1992

Reduced use of surface cultures for suspected neonatal sepsis and surveillance.

Data on infection in a neonatal unit were collected prospectively for seven years. After the first four years, the number of surface cultures obtained from neonates with suspected sepsis and for surveillance was reduced. Rates of systemic infection (sepsis and meningitis) were not significantly different in the four years before and the three years after this change. Reduction in surface culture information made no observable difference to detection of colonisation in neonates with early onset sepsis (within first 48 hours of life) nor to antibiotic choice in late onset sepsis. Decisions concerning the length of antibiotic course in suspected infection were not adversely affected. Reduction in the number of surface cultures led to considerable saving of time, effort, and cost while appearing safe in terms of clinical practice and outcome.

Anti-Bacterial Agents↗
PubMed1992

Immunogenicity and safety of PRP-T conjugate vaccine given according to the British accelerated immunisation schedule.

The immunogenicity and safety of a new Haemophilus influenzae type b conjugate vaccine, PRP-T, was studied in 107 infants from the Oxford district. The vaccine was given concurrently with diphtheria, pertussis, tetanus, and polio vaccines at 2, 3, and 4 months of age. Symptoms after immunisation were recorded by a parent. Sera were obtained before the first immunisation and at 5 months of age and the antibodies were measured by both radioimmunoassay and enzyme linked immunosorbent assay (ELISA). No serious adverse reactions were observed and there was no increase in the incidence of expected minor side effects. By radioimmunoassay, the geometric mean titre of serum anticapsular antibody increased from 0.09 micrograms/ml before immunisation to 5.01 micrograms/ml after three immunisations. Ninety eight per cent of children had antibody concentrations consistent with protection (greater than or equal to 0.15 micrograms/ml). IgG antibody concentrations measured by ELISA correlated well with total antibody concentrations measured by radioimmunoassay (r = 0.864). These results provide encouragement that routine immunisation against H influenzae type b at 2, 3, and 4 months of age, could prevent most cases of disease in children in the UK.

Age Factors↗
PubMed1992

Familial asplenia.

Explore the source record for details and available documents.

Bacterial Infections↗
PubMed1991

Retropharyngeal abscess.

Of 31 children with retropharyngeal abscess treated at this hospital between 1954 and 1990, 17 (55%) were 12 months old or less and 10 (32%) less than 6 months. Three of these 10 children were neonates, only one of whom had a predisposing congenital lesion. Fourteen children (45%) had a preceding upper respiratory illness and four (13%) had a prior history of pharyngeal trauma or ingestion of a foreign body. In children less than 1 year old the clinical presentation was usually classical with fever, neck swelling, stridor, and pharyngeal swelling. Significantly fewer children over 1 year had neck swelling and no child over 3 years old had stridor. A lateral radiograph of the neck, when performed, had a sensitivity of 88% in diagnosis. Bacteria isolated included pure growths of Staphylococcus aureus (25%), klebsiella species (13%), group A streptococcus (8%), and a mixture of Gram negative and anaerobic organisms (38%). There were two deaths. In six cases (24%) the abscess recurred necessitating further surgical drainage.

Abscess↗
PubMed1991

Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus.

Hospital acquired infections with respiratory syncytial virus are a major problem. The virus is spread predominantly by infected nasal secretions and we investigated whether we could reduce its incidence by cohorting babies on each ward into designated areas and encouraging staff and parents to wash their hands. We examined the incidence of hospital acquired infection due to respiratory syncytial virus in all children less than 2 years old and in those with congenital heart disease. In 1986-7, before any intervention, 18 (4.2%) of 425 hospitalised children less than 2 years old developed hospital acquired infection due to respiratory syncytial virus. In 1987-8, after intervention, five (0.6%) of 840 children developed hospital acquired infection but there were fewer ward admissions with community acquired infections due to the virus. In 1988-9, when there were more community acquired infections than 1986-7, six (1.1%) of 552 children developed hospital acquired infection. In 1986-7, eight (34.8%) of 23 children less than 2 years old with congenital heart disease developed hospital acquired infection due to respiratory syncytial virus; all eight were among 11 children with congenital heart disease hospitalised for more than 14 days. In 1987-8, one (3.3%) of 30 children with congenital heart disease developed hospital acquired infection due to respiratory syncytial virus and in 1988-9 there was one (2.1%) case out of 47 children with congenital heart disease. Handwashing and cohorting significantly reduce the incidence of nosocomial respiratory syncytial virus infection.

Cohort Studies↗