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Biomedical subjects

E J Carter

Publications and source records attributed to E J Carter.

At least 19 recordsLinked to original sources
PubMed2006

Characteristics of HIV infected patients cared for at "academic model for the prevention and treatment of HIV/AIDS" clinics in western Kenya.

BACKGROUND: With the new initiatives to treat large numbers of HIV infected individuals in sub-Saharan Africa, policy makers require accurate estimates of the numbers and characteristics of patients likely to seek treatment in these countries. OBJECTIVE: To describe characteristics of adults receiving care in two Kenyan public HIV clinics. DESIGN: Cross-sectional cohort analysis of data extracted from an electronic medical records system. SETTING: Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's second national referral (urban) hospital and a nearby rural health center. SUBJECTS: Adult patients presenting for care at HIV clinics. MAIN OUTCOME MEASURES: Gender and inter-clinic stratified comparisons of demographic, clinical, and treatment data. RESULTS: In the first nineteen months, 790 adults visited the urban clinic and 294 the rural clinic. Mean age was 36 +/- 9 (SD) years. Two-thirds were women; a quarter had spouses who had died of acquired immune deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple sexual partners, rare condom use) and constitutional symptoms (fatigue, weight loss, cough, fever, chills) were common. Rural patients had more symptoms and less prior and current tuberculosis. Men more commonly presented with symptoms than women. The cohort CD4 count was low (223 +/- 197 mm3), with men having significantly lower CD4 count than women (185 +/- 175 vs. 242 +/- 205 p = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent (most often men) had received prior antiretroviral drug therapy, (7% in urban and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were sicker and more often received antiretroviral drugs. CONCLUSIONS: Patients presenting to two Kenyan HIV clinics were predominantly female, ill and naive to retroviral therapy with substantial differences by clinic site and gender. Behavioural risk factors for HIV/AIDS were common. A thorough understanding of clinical and behavioural characteristics can help target prevention and treatment strategies.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status.

The overlapping epidemiology of human immunodeficiency virus (HIV) infection and tuberculosis (TB) and the catastrophic consequences of the interactions between the two epidemics have led to increased morbidity and mortality due to HIV-associated TB. While effective therapy is available for both conditions, there are major challenges in the concurrent treatment of HIV and TB co-infection. This review examines the interactions between HIV and TB infections and reviews the current status of highly active antiretroviral therapy (HAART) in patients with co-infection. Specific questions relating to optimal timing of concurrent HAART, challenges to concurrent HAART, optimal regimens and future considerations are discussed.

Adult↗
PubMed2004

Analyzing Mycobacterium tuberculosis proteomes for candidate vaccine epitopes.

Secreted antigens of Mycobacterium tuberculosis (Mtb) induce strong T cell responses and interferon-gamma (IFN-gamma) secretion, both of which are integral in the defense against Mtb. We used web-based tools (SignaIP and Prosite) to identify putative secreted proteins from Mtb genomes CDC 1551 and H37Rv. We then used EpiMatrix, a proprietary pattern-matching algorithm, to do a preliminary analysis of these proteins for regions that contained a high number of class II MHC binding motif matches. The use of bioinformatics tools reduced the number of potential epitopes to be screened to 5% of the 1.3 million overlapping peptides. Peripheral blood mononuclear cells (PBMC) were obtained from healthy, asymptomatic tuberculin skin test-positive donors. Of the 17 highest-ranking peptide candidates that could be synthesized for this preliminary in vitro evaluation, 15 (88%) stimulated IFN-gamma response, and eight (47%) stimulated lymphocyte proliferation in vitro. IFN-gamma ELISpot assays were therefore a more sensitive test for T cell response to these peptides than were proliferation assays. One highly promiscuous epitope (MT2281-26-J, WRRRPLSSALLSFGLLLGGLPL) induced IFN-gamma secretion in PBMC from 11 of 25 Mtb immune subjects (44%). Overall, 15 epitopes, and MT2281-26-J in particular, are candidates for inclusion in a multi-epitope TB vaccine. These findings support the systematic application of bioinformatics tools to whole genomes when used in combination with in vitro methods for screening and confirming epitopes.

Amino Acid Sequence↗
PubMed1998

Co-infection with Mycobacterium tuberculosis and HIV in high risk clinical care setting in Rhode Island.

We assessed the extent to which co-infection with HIV and Mycobacterium tuberculosis (Mtb) was diagnosed at several high risk clinical care sites from 1992 to 1994 to determine whether surveillance for co-infection was performed. Information on PPD skin testing, HIV status, and HIV risk exposures was extracted from records at HIV clinics in Rhode Island and a large database (HIV sites) and from records at the state TB clinic and the Rhode Island Health Department (TB sites). At the HIV sites, 34 of 1,408 HIV infected subjects were newly diagnosed with Mtb infection in the study period. At the TB sites, 16 of 1,389 subjects with newly diagnosed Mtb infection or disease were identified as HIV infected. Eighty per cent of the records reviewed for this study were incomplete. Hispanic subjects were at higher risk of being identified as co-infected at the HIV sites. At the TB sites, US-born subjects were at higher risk of being identified as co-infected Recommendations for high risk individuals include yearly tuberculosis skin testing. Adherence to these guidelines in selected high-risk clinical care sites in Rhode Island was substandard during the study period; the importance of Mtb screening was demonstrated in this study. Identification of groups that are at higher risk of having HIV and Mtb co-infection identified may enable health care providers to improve testing and prevention of tuberculosis at high risk clinical care settings.

AIDS-Related Opportunistic Infections↗
PubMed1997

Standardization of gastric aspirate technique improves yield in the diagnosis of tuberculosis in children.

BACKGROUND: The diagnosis of tuberculous disease in children remains a difficult one, based on epidemiologic investigation, Mantoux skin testing and suggestive radiologic findings. Because children with pulmonary tuberculosis are unable to produce sputum, gastric aspirates remain the procedure of choice for microbiologic confirmation of tuberculous disease; however, yield is frequently low. OBJECTIVES: To evaluate the effect of a standardized gastric aspirate collection protocol on diagnostic culture yield. METHODS: The gastric aspirate culture yield for Mycobacterium tuberculosis in 13 historical control children with clinically confirmed tuberculosis from 1979 to 1994 was compared with the yield in 8 children with tuberculous disease after institution of a standardized gastric aspirate collection protocol involving physician education, strict timing of collection, base neutralization of aspirate specimens and expedited processing. RESULTS: Retrospective survey of gastric aspirate results in Rhode Island from 1979 to 1994 revealed that only 1 of 13 cases (8%) of pediatric pulmonary tuberculosis were confirmed in this manner. During a 12-month period after institution of a protocol, gastric aspirates yielded positive cultures in 4 of 8 children (50%) with pulmonary tuberculosis, a yield that compares favorably with the sensitivities of 20 to 52% published in the literature. CONCLUSIONS: Attention to the technique of gastric aspirate collection, and expedited processing in particular, appears to improve the yield of this diagnostic procedure for pediatric tuberculosis.

Child↗
PubMed1996

Substance-misuse: the front line at the police station - an opportunity for intervention.

The Brighton project, 'Get It While You Can', has two ex-drug addict project workers visiting prisoners in police custody cells. They provide information about harm reduction and service provision within the Brighton area. They are also able to provide on-going support to the detainees after they have left the police station and to help them successfully access agencies in the town and further afield.

Journal Article↗
PubMed1994

A standard experimental 'chemical burn'.

To establish a standard method for producing experimental cutaneous injuries caused by contact with corrosive liquids, we modified an apparatus and method recommended by Walker and Mason in 1967 to produce experimental thermal burns. The resulting procedure proved to be safe, reproducible, humane and efficient and can be used with a wide variety of corrosive liquids.

Animals↗
PubMed1994

Epidermal lipids and the natural history of hydrofluoric acid (HF) injury.

To explain several fortuitous observations, we hypothesized that there is a naturally occurring lipid 'barrier' to HF injury in guinea-pig skin and sought to characterize both the barrier and its role in the natural history of such injuries. Under anaesthesia, the dorsal trunk skin of groups of guinea-pigs was gently clipped of hair, washed with chloroform, soap and water, acetone or nothing (controls), and examined histologically for the presence of neutral lipid. Thereafter, in animal groups similarly washed, 1.5 in x 1.5 in (38 mm x 38 mm) areas were exposed to 40 per cent HF for up to 50 min and: (a) mean percentages of exposed areas with gross necrosis 5 days postinjury plotted on dose-response curves; or (b) less than 4 h after exposure to HF, intra-aortic India ink was injected and skin specimens examined to discern depth of ischaemia and necrosis. In contrast to controls, washing reduced neutral lipid in epidermis and significantly (at P < 0.001) increased susceptibility to injury by HF. With very rare (but interesting) exceptions, HF injury was found to be full thickness in depth with ischaemia and coagulative necrosis. In this study, development of guinea-pig skin necrosis due to HF was typically an 'all-or-nothing' 'barrier-penetration' phenomenon relating as much to the integrity of an epidermal lipid barrier as to the duration and intensity of noxious exposure.

Animals↗
PubMed1994

Tuberculosis during pregnancy. The Rhode Island experience, 1987 to 1991.

Although recent studies have reported otherwise, previous conventional wisdom has held that one-half to two-thirds of pregnant women with tuberculosis are asymptomatic. If true, this has important implications for screening programs. Charts of all patients with culture-proven Mycobacterium tuberculosis in Rhode Island between 1987 and 1991 were reviewed. One-third of women aged 21 to 32 years with culture-proven tuberculosis were pregnant at time of diagnosis (7 pregnant; 15 nonpregnant). Pregnant patients with pulmonary conditions were more likely to be found through routine screening (p = 0.008) and to be asymptomatic (p = 0.008). In addition, pregnant women with pulmonary conditions were more likely to present with unilateral non-cavitary, smear-negative disease (p = 0.02). If routine screening is not performed prenatally with radiographic follow-up of all infected individuals, most pregnant women will not have their conditions diagnosed and, therefore, will not be treated in time to prevent risk to the fetus, the newborn, and the obstetric ward.

Adult↗
PubMed1992

Serotype specificity of vaccine-induced immunity to pertussis.

Two large epidemics of pertussis occurred in Britain during 1977-79 and 1981-83, following a decline in vaccine uptake in the mid-1970s. Serotype 1,3 predominated during both epidemics but serotypes 1,2 and 1,2,3 constituted 32% (243 of 769) of the isolates from unvaccinated children compared with only 10% (9 of 86) of the isolates from vaccinated children (p < 0.005). Whole-cell vaccines, although effective against infection with all serotypes, have a higher efficacy against serotypes 1,2 and 1,2,3 than against serotype 1,3. These data suggest that not only should acellular vaccines contain agglutinogens specific for each serotype but trials should demonstrate efficacy against all three serotypes.

Bordetella pertussis↗
PubMed1990

Location of the three major agglutinogens of Bordetella pertussis by immuno-electronmicroscopy.

When the three serotypes of Bordetella pertussis (types 1,2,3; 1,2 and 1,3) were labelled with agglutinins and protein-A gold, agglutinogen 1 was found on fimbriae and on the cell surface of types 1,2,3 and 1,2 but on the cell surface only of non-fimbriate type 1,3 organisms. In contrast, agglutinogen 2 was located on fimbriae only. Agglutinogen 3 was not labelled. When protein-A gold was replaced by immunoglobulin-G gold, agglutinogen 3 was found on the cell surface only, even of fimbriate bacteria of type 1,2,3. The implications of these findings for acellular vaccines are discussed.

Agglutination Tests↗
PubMed1990

Alveolar hemorrhage with epithelioid hemangioendothelioma. A previously unreported manifestation of a rare tumor.

Epithelial hemangioendothelioma (EH), originally termed intravascular sclerosing bronchioloalveolar tumor (IVBAT), is a rare pulmonary vascular neoplasm usually associated with an indolent but slowly progressive clinical course. We describe a patient with EH who presented with alveolar hemorrhage and died within 8 wk. This report extends the clinical spectrum of epithelial hemangioendothelioma to include this aggressive form. EH should be considered in the differential diagnosis of alveolar hemorrhage syndrome.

Aged↗