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Biomedical subjects

E F Dunne

Publications and source records attributed to E F Dunne.

15 recordsLinked to original sources
PubMed2001

Is drinking water in Abidjan, Côte d'Ivoire, safe for infant formula?

OBJECTIVE: To survey knowledge, attitudes, and practices regarding water use and infant feeding in the Koumassi District of Abidjan, Côte d'Ivoire, and to evaluate the microbiologic quality of source and stored drinking water. DESIGN: Random-cluster household survey. METHODS: We randomly selected 20 clusters, each comprising six households with at least 1 child aged < or =3 years. In each household, we administered a questionnaire and collected source and stored drinking water samples and tested these for chlorine levels and for total coliform and fecal bacteria count ( Escherichia coli ). RESULTS: Municipal water was used for drinking in 112 (93%) of 120 households, and in 99 (83%), it was stored for later use. By 1 month of age, 97 (90%) of 108 infants given drinking water were given stored water for drinking. In 8 (66%) of 12 households where children were receiving artificial feeding, formula was prepared from municipal water without additional treatment. Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p <.001), and E. coli was detected in 36 (41%) of 87 stored water samples and 1 (1%) of 108 source water samples ( p <.001). CONCLUSIONS: In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most households, is often contaminated with E. coli, and is given to children at a young age. If replacement feeding is to be more widely used to prevent postnatal transmission of HIV-1, communities using stored water need interventions to make stored water safer.

Chlorine↗
PubMed2000

Emergence of domestically acquired ceftriaxone-resistant Salmonella infections associated with AmpC beta-lactamase.

CONTEXT: Ceftriaxone, an expanded-spectrum cephalosporin, is an antimicrobial agent commonly used to treat severe Salmonella infections, especially in children. Ceftriaxone-resistant Salmonella infections have recently been reported in the United States, but the extent of the problem is unknown. OBJECTIVES: To summarize national surveillance data for ceftriaxone-resistant Salmonella infections in the United States and to describe mechanisms of resistance. DESIGN AND SETTING: Case series and laboratory evaluation of human isolates submitted to the Centers for Disease Control and Prevention from 17 state and community health departments participating in the National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria between 1996 and 1998. PATIENTS: Patients with ceftriaxone-resistant Salmonella infections between 1996 and 1998 were interviewed and isolates with decreased ceftriaxone susceptibility were further characterized. MAIN OUTCOME MEASURES: Exposures and illness outcomes, mechanisms of resistance. RESULTS: The prevalence of ceftriaxone-resistant Salmonella was 0.1% (1 of 1326) in 1996, 0.4% (5 of 1301) in 1997, and 0.5% (7 of 1466) in 1998. Ten (77%) of the 13 patients with ceftriaxone-resistant infections were aged 18 years or younger. The patients lived in 8 states (California, Colorado, Kansas, Massachusetts, Maryland, Minnesota, New York, and Oregon). Nine (82%) of 11 patients interviewed did not take antimicrobial agents and 10 (91%) did not travel outside the United States before illness onset. Twelve of the 15 Salmonella isolates with ceftriaxone minimum inhibitory concentrations of 16 microg/mL or higher were serotype Typhimurium but these isolates had different pulsed-field gel electrophoresis patterns. Thirteen of these 15 isolates collected between 1996 and 1998 were positive for a 631-base pair polymerase chain reaction product obtained by using primers specific for the ampC gene of Citrobacter freundii. CONCLUSIONS: Domestically acquired ceftriaxone-resistant Salmonella has emerged in the United States. Most ceftriaxone-resistant Salmonella isolates had similar AmpC plasmid-mediated resistance.

Adolescent↗
PubMed2000

Ceftriaxone-resistant salmonella infection acquired by a child from cattle.

BACKGROUND: The emergence of resistance to antimicrobial agents within the salmonellae is a worldwide problem that has been associated with the use of antibiotics in livestock. Resistance to ceftriaxone and the fluoroquinolones, which are used to treat invasive salmonella infections, is rare in the United States. We analyzed the molecular characteristics of a ceftriaxone-resistant strain of Salmonella enterica serotype typhimurium isolated from a 12-year-old boy with fever, abdominal pain, and diarrhea. METHODS: We used pulsed-field gel electrophoresis and analysis of plasmids and beta-lactamases to compare the ceftriaxone-resistant S. enterica serotype typhimurium from the child with four isolates of this strain obtained from cattle during a local outbreak of salmonellosis. RESULTS: The ceftriaxone-resistant isolate from the child was indistinguishable from one of the isolates from cattle, which was also resistant to ceftriaxone. Both ceftriaxone-resistant isolates were resistant to 13 antimicrobial agents; all but one of the resistance determinants were on a conjugative plasmid of 160 kb that encoded the functional group 1 beta-lactamase CMY-2. Both ceftriaxone-resistant isolates were closely related to the three other salmonella isolates obtained from cattle, all of which were susceptible to ceftriaxone. CONCLUSIONS: This study provides additional evidence that antibiotic-resistant strains of salmonella in the United States evolve primarily in livestock. Resistance to ceftriaxone, the drug of choice for invasive salmonella disease, is a public health concern, especially with respect to children, since fluoroquinolones, which can also be used to treat this disease, are not approved for use in children.

Animals↗
PubMed2000

Inguinal lymphadenitis caused by Entamoeba histolytica: case report and literature review.

Liver abscesses are the most common manifestation of extraintestinal infection by Entamoeba histolytica. Involvement of other sites, including the peritoneum, pericardium, brain, or genitourinary tract, is unusual. We describe a case of inguinal necrotizing lymphadenitis caused by E histolytica. Our patient responded well to surgical drainage, metronidazole, and paramomycin therapy. A literature review of genitourinary and other uncommon sites of E histolytica infection is included.

Adult↗
PubMed1998

Streptomyces pneumonia in a patient with human immunodeficiency virus infection: case report and review of the literature on invasive streptomyces infections.

Streptomyces species are most widely known for their production of antimicrobial substances and, apart from mycetoma, have rarely been reported as a cause of infection. We describe a patient with early human immunodeficiency virus infection who presented with fever, cough, and nodular pulmonary infiltrates. Open lung biopsy revealed necrotic tissue and a sulfur granule; aerobic bacterial cultures yielded Streptomyces species. The patient was treated successfully with clarithromycin for 6 months. We review the clinical presentation and treatment of invasive streptomyces infections.

AIDS-Related Opportunistic Infections↗
PubMed1984

Myocardial revascularization for patients with an ejection fraction of 0.2 or less. 12 years' results.

From 1969 through December 31, 1981, a total of 232 patients with an ejection fraction of 0.2 or less (normal 0.67) had myocardial revascularization. The in-hospital mortality in these patients decreased from 25 deaths in 82 patients (30%) from 1969 through 1972 to 10 deaths in 150 patients (7%) from 1973 through December 31, 1981. There was a 24% five-year survival for patients in congestive heart failure at the time of operation, a 40% survival at five years for patients successfully treated for failure before operation and a 60% five-year survival for those patients who had never been in failure. These results would appear to be better than those with cardiac transplantation, with neither the restrictions for operation nor the long-term immunotherapy required with cardiac transplantation.

Adult↗
PubMed1978

Disease of the left main coronary artery. Surgical treatment and long-term follow up in 267 patients.

Of 4,196 patients undergoing coronary angiography, 297 (7 percent) had left main coronary arterial narrowing. In 188 (4.5 percent) the narrowing was greater than or equal to 70 percent and in 109 (3 percent) it was between 50 and 69 percent. Three patients (1 percent) died at cardiac catheterization. Saphenous vein bypass graft surgery was performed in 267 patients with an operative mortality of 7 percent: in 179 patients the left main coronary narrowing was greater than or equal to 70 percent (operative mortality 9 percent), and in 88 between 50 and 69 percent (mortality rate 2 percent). There was an average of 2.6 grafts per patient. The course of these patients was followed up for 4 3/4 years. At 1 year there was a 92.2 percent survival rate. The rate of survival at 2, 3 and 4 3/4 years, was 91, 89 and 86 percent, respectively. After saphenous vein bypass graft surgery, 75 percent of patients are angina-free and 22.4 percent are in improved condition. Grafts were studied in 51 patients and 85 percent of 128 grafts were found to be patent. It appears that there is improvement in survival and a reduction of symptoms after saphenous vein bypass graft surgery in patients with left main coronary arterial narrowing.

Adult↗
PubMed1977

Forward angiography in the identification of vegetations in tricuspid endocarditis.

A patient with staphylococcal endocarditis of unknown valvular location and resistant to antibiotic therapy was studied in order to localize the site of infection prior to cardiac surger. The injection of contrast material into the right atrium visualized tricuspid vegetations which were confirmed at surgery. In such situations, forward angiographic studies constitute a safe, simple, and potentially diagnostic procedure which avoids the hazards of advancing a catheter across an infected valve.

Adult↗
PubMed1976

Myocardial revascularization and mitral repair or replacement for mitral insufficiency due to coronary artery disease.

During the past 5 years, 45 patients were operated on for mitral insufficiency due to coronary artery disease. Preoperatively, 33 had angina; 24 were in NYHA Class IV; and 21 were in Class III. The ejection fraction ranged from 0.1 to 0.7 (mean 0.40). The degree of mitral regurgitation ranged from Grade II/VI to Grade V/VI. Mitral repair was performed in 38 (84%) and replacement in seven (16%). At surgery, a ruptured papillary muscle or torn chordae tendineae with a dilated annulus were found in 21 patients and a dilated annulus only in 24. Seventy-six vein grafts and eight internal mammary anastomoses were performed. There were three hospital deaths (7%). Postoperative follow-up of 36 long-term survivors revealed symptomatic improvement in all but one patient. Twenty patients were in NYHA Class I, 15 in Class II, and one in Class III. In eight patients restudied, 17 of 18 vein grafts were patent (94%). Mitral regurgitation decreased from a mean of 2.7 to a mean of 0.6 (P less than 0.001). Average improvement in ejection fraction was 0.14, significant at P less than 0.01. Actuarial studies revealed an 80% survival rate at 5 years.

Aged↗
PubMed1975

Aortic stenosis, angina, and coronary artery disease. Interrelations.

Sixty-nine patients over age 35 with severe valvular aortic stenosis were investigated for concomitant coronary artery disease. Forty (57.9%) had clinical angina pectoris. Sixteen (23.2%) had significant coronary occlusive disease by arteriography. Of those with angina, 13 patients (32.5) had significant coronary arterial obstruction, while in the pain-free group only (10.3%) had occlusive coronary disease. It is concluded that patients with severe aortic stenosis who are free of angina have only a small, but definite, chance of having significant coronary disease.

Aged↗