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F Drobniewski

Publications and source records attributed to F Drobniewski.

At least 55 records · Page 3Linked to original sources
PubMed1998

Multiple drug resistant tuberculosis: aetiology, diagnosis and outcome.

Tuberculosis is an increasing problem worldwide both in terms of disease burden and resistance to conventional antibiotic therapy. Studies of outbreaks involving resistant strains have highlighted the need for both improved infection control and the rapid provision of accurate susceptibility data. Each patient should undergo a risk assessment for possible resistance and those in whom risk factors exist should be investigated by means of rapid molecular techniques or other phenotypic methods, so that appropriate management can be instituted with minimal delay. The ultimate outcome will vary according to whether the patient is immunosuppressed, the time taken to make a diagnosis, the severity of disease as well as the degree of resistance. The prognosis can be improved when adequate antibiotic therapy is started as soon as resistance is suspected. Adjuncts to conventional treatment, such as surgery and perhaps immunotherapy may be considered when response to antimicrobial chemotherapy has been suboptimal.

HIV Infections↗
PubMed1998

Simultaneous genotyping and species identification using hybridization pattern recognition analysis of generic Mycobacterium DNA arrays.

High-density oligonucleotide arrays can be used to rapidly examine large amounts of DNA sequence in a high throughput manner. An array designed to determine the specific nucleotide sequence of 705 bp of the rpoB gene of Mycobacterium tuberculosis accurately detected rifampin resistance associated with mutations of 44 clinical isolates of M. tuberculosis. The nucleotide sequence diversity in 121 Mycobacterial isolates (comprised of 10 species) was examined by both conventional dideoxynucleotide sequencing of the rpoB and 16S genes and by analysis of the rpoB oligonucleotide array hybridization patterns. Species identification for each of the isolates was similar irrespective of whether 16S sequence, rpoB sequence, or the pattern of rpoB hybridization was used. However, for several species, the number of alleles in the 16S and rpoB gene sequences provided discordant estimates of the genetic diversity within a species. In addition to confirming the array's intended utility for sequencing the region of M. tuberculosis that confers rifampin resistance, this work demonstrates that this array can identify the species of nontuberculous Mycobacteria. This demonstrates the general point that DNA microarrays that sequence important genomic regions (such as drug resistance or pathogenicity islands) can simultaneously identify species and provide some insight into the organism's population structure.

Alleles↗
PubMed1998

Antituberculosis drug resistance surveillance in Kenya, 1995.

SETTING: Twenty-two of the 42 administrative districts in Kenya. OBJECTIVE: To determine the prevalence of drug resistance in newly diagnosed patients with pulmonary tuberculosis, to determine possible risk factors associated with resistance, and to establish standard routine surveillance of drug resistance. DESIGN: Cross-sectional study. METHODS: Sputum samples from newly diagnosed patients with smear-positive pulmonary tuberculosis were analysed using standard procedures. RESULTS: Of 638 patients, 85% were culture positive for Mycobacterium tuberculosis. Of 491 patients tested for susceptibility to isoniazid, streptomycin, rifampicin and ethambutol, 90.8% had fully sensitive strains and 9.2% had a strain resistant to one or more drugs. Of 445 patients with no history of previous chemotherapy, 6.3% had a resistant strain. Of 46 patients with a history of previous chemotherapy, 37% had a resistant strain. No resistance to either rifampicin or ethambutol was detected. There was a strong association between previous chemotherapy and resistance. Resistance was not associated with age or sex. High concordance between Kenya's results and those of the Mycobacterium Reference Unit in the UK on both drug-sensitive and drug-resistant strains indicates that clinically significant and comparable data can be obtained from laboratories employing unsophisticated and inexpensive standard procedures. CONCLUSION: Rates of initial drug resistance are still low in Kenya. The increase in acquired resistance to isoniazid requires monitoring.

Adult↗
PubMed1997

Enteropathy in Zambians with HIV related diarrhoea: regression modelling of potential determinants of mucosal damage.

BACKGROUND: AIDS is characterised by small intestinal mucosal damage, but its aetiopathogenesis is poorly understood. Enteric infections in Africa differ from those in northern countries, where protozoan infections have been associated with severe enteropathy in AIDS patients. AIMS: To characterise enteropathy in Zambian AIDS patients compared with local controls, and to assess relative contributions of enteric infection, nutritional impairment, and immune dysfunction. METHODS: Computer aided mucosal morphometry of small intestinal biopsy specimens from 56 HIV infected Zambians with persistent diarrhoea and 26 diarrhoea free controls, followed by regression modelling. RESULTS: Patients with HIV related diarrhoea had reduced villous height and increased crypt depth compared with controls. There was no difference between HIV positive and negative controls. In regression models applied to AIDS mucosal measurements, villous height and crypt depth were related to nutritional parameters and to serum soluble tumour necrosis factor receptor p55 concentration. Crypt depth was also related to lamina propria plasma cell count. Intestinal infection was found in 79%, which consisted predominantly of microsporidia in 34%, Isospora belli in 24%, and Cryptosporidium parvum in 21%, but detection of these enteropathogens was not related to severity of enteropathy. CONCLUSIONS: Nutritional and immune disturbances were associated with enteropathy, accounting for over one third of the variation in mucosal morphometric parameters.

Adolescent↗
PubMed1996

Tuberculosis in Siberia: 1. An epidemiological and microbiological assessment.

SETTING: Siberia, Russian Federation. OBJECTIVE: To assess the situation regarding tuberculosis as a paradigm for the Russian Federation. DESIGN: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994. RESULTS: The downward trend in notifications of tuberculosis throughout Russia reversed in 1990/91, the rate increasing from 34/100,000 to 42.9/100,000 in 1993. Incidence rates are higher in Siberia, varying from approximately 43 to 108/100,000; prevalence is 250-300/100,000. The tuberculosis service is centralized and based on specialized polyclinics and dispensaries. An extensive surveillance system employs regular fluorography and tuberculin testing: half of the cases diagnosed are detected by fluorography, against 1% through contact tracing. Patients are classified principally on clinical and radiological grounds. Bacille Calmette-Guérin immunisation is performed at birth and at age 7, and again at 13, 21, and 28 years if Mantoux test is negative. Microscopy and culture services are organisationally separate, and direct comparison of smear and culture data is not possible. Drug resistance to isoniazid and streptomycin is probably high and resistance to rifampicin low, but data on susceptibility of isolates from new cases are not available. CONCLUSION: Tuberculosis is increasing in Siberia. Homelessness, unemployment and alcoholism are important factors, but concurrent human immunodeficiency virus (HIV) infection appears to be uncommon. Prisons probably form a significant reservoir of infectious cases.

Adult↗
PubMed1996

Tuberculosis in Siberia: 2. Diagnosis, chemoprophylaxis and treatment.

OBJECTIVE: To assess tuberculosis diagnosis, chemoprophylaxis and therapy in Siberia as a paradigm for the Russian Federation. DESIGN: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994. RESULTS: Tuberculosis disease and cure is classified according to a Dispensary Group Register based principally on clinical and radiological criteria. Isoniazid is widely used for chemoprophylaxis and post-therapy and may be linked to high levels of isoniazid resistance. Combination drug therapy is individualized, frequently changed, and given orally, parenterally or intra-bronchially. Galvanization, autotransfusion of ultra-violet irradiated blood, antioxidants and steroids are used as adjunct treatment. Ambulatory treatment is uncommon. Surgical treatments including lobectomy and pneumonectomy are used in 5-10% of patients. CONCLUSION: Tuberculosis is increasing in Siberia. An improved drug supply using short course standardized regimens is required supported by high quality co-ordinated bacteriological services. Surgery retains a useful role, but many adjunct therapies should be abandoned.

Adult↗
PubMed1993

Sex and the nation's health.

The Government's 'Health of the Nation', influenced by the WHO's 'Global Strategy for Health for All by the Year 2000', pledges a reduction in sexually transmitted diseases in general and AIDS in particular. The recommendations are clearly sensible but how do you persuade people to believe and comply with the 'sensible' advice? Failure to consider public health measures involving sexual behaviour without considering how different cultures respond and interpret the advice given is bound to fail. People are individuals and there is a danger in assuming that our values and beliefs are shared by people globally. For a message to succeed it needs to be simple and direct, and portrayed in its cultural context through an appropriate medium. An appreciation that the message however sensible may clash with individual needs (eg the economics of prostitution) and research into these aspects of sexual behaviour will ensure that the message remains effective. Changing the slogans and methods of conveying the message regularly will help to reinforce key points and reduce apathy.

Acquired Immunodeficiency Syndrome↗