Biomedical subjects
G M Scott
Publications and source records attributed to G M Scott.
Restriction fragment length polymorphism analysis rules out cross-infection among renal patients with tuberculosis.
A cluster of five cases of tuberculosis occurred on a renal unit in 1993. The initial impression was that this was an outbreak, and cross-infection was suspected. Restriction fragment length polymorphism analysis was carried out on the strains of Mycobacterium tuberculosis isolated from these cases, using a DNA probe directed against the insertion sequence IS6110. DNA fingerprints obtained by this method differed for all the strains tested, ruling out cross-infection as a cause of the outbreak. This technique is a useful adjunct to standard epidemiological investigations in outbreaks of tuberculosis.
Transmission of tuberculosis by patients with HIV infection.
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A nosocomial outbreak due to non-encapsulated Haemophilus influenzae: analysis of plasmids coding for antibiotic resistance.
An outbreak of infections with non-encapsulated Haemophilus influenzae, resistant to ampicillin, chloramphenicol, sulphonamide and tetracycline involved 13 elderly patients and three nurses on acute admission and care of the elderly wards. Thirty-two isolates were found to be indistinguishable on analysis of biotype, antibiogram, serotype and major outer membrane proteins (MOMP). Plasmids could not be identified in the original isolates but after mating with a Rec A H. influenzae recipient, the resultant transconjugates were found to harbour either a 72 kilobase pair (kB) plasmid coding for resistance to chloramphenicol, ampicillin, sulphonamide and tetracycline or a 65 kB plasmid coding for resistance to chloramphenicol, ampicillin and sulphonamide. Both plasmids yielded virtually indistinguishable restriction digest patterns. This suggests that the tetracycline resistance gene (Tc gene) is a non-essential component of one basic plasmid responsible for the multiple antibiotic resistances seen in the strains recovered during the outbreak. This illustrates the value of plasmid profiles to compare strains of non-encapsulated H. influenzae, and suggests that plasmid restriction enzyme analysis is critical.
Audit of infection in continuous ambulatory peritoneal dialysis.
The major cause of failure of continuous ambulatory peritoneal dialysis is peritoneal or exit site infection with Staphylococcus aureus. From 1989-1992, eradication of nasal and perineal carriage, continued use of an occlusive dressing to the exit site, improved aseptic technique for dressing changes by the patient and avoidance of wetting of the dressing were used in an attempt to reduce staphylococcal infections. By comparison with the 3-year period prior to intervention, a significant increase in the life of the catheters was achieved (removed at 1 year, 13 vs. 28%, P < 0.001) with a reduction in episodes of peritonitis due to S. aureus. The study was not prospectively controlled but there did not appear to be any other factor to account for the sudden and consistent improvement observed.
Reducing the loss of implants following penile prosthetic surgery.
OBJECTIVE: To assess the factors associated with loss of implant following penile prosthetic surgery and to make alterations in the management of patients to prevent this from occurring. PATIENTS AND METHODS: A retrospective analysis was carried out of the factors associated with post-operative infection and erosion in 188 patients who underwent implantation of penile prostheses. A prospective study was then established in which 62 patients were managed by a set protocol designed to counteract the factors identified as being contributory to loss of implants in the retrospective review. RESULTS: In the retrospective study nine (4.8%) patients lost a prosthesis due to erosion. Erosion was noted to be more common with one type of implant which has since been modified. Infection was the cause of prosthesis loss in 12.2% of patients in the retrospective review. The new protocol resulted in a significantly reduced infection rate in penile prostheses to 1.6% (P < 0.05). CONCLUSION: With attention to simple antiseptic prophylaxis, antibiotic penetration and continuing audit, a significant improvement in the loss of penile prostheses can be achieved along with a reduction in the amount of antibiotics prescribed.
Penicillin-resistant pneumococcal meningitis.
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Use of laryngoscope and esophageal stethoscope to visually direct intraoperative insertion of pediatric transesophageal echocardiographic probe in infants and small children.
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New drug treatments for HIV infection and AIDS. A review following the Seventh International Conference on AIDS, Florence 16-21 June 1991.
1. OBJECTIVE--To evaluate the status of clinical development of zidovudine and new drugs for the treatment of Human Immunodeficiency Virus (HIV) infections. 2. METHOD--A critical review of the clinical trial reports and assessment of the design and methodology of the therapeutic trials. Evaluation of the drugs being tested and of the specific difficulties in testing drugs in AIDS. 3. CONCLUSIONS--Drugs are being tested in a unique climate of public opinion characterised by (1) fast track criteria for regulatory approval (2) parallel track (compassionate release) of new drugs before adequate determination of safety and efficacy (3) resistance to the use of placebos in controlled trials.
Outbreaks of multiresistant Haemophilus influenzae infection.
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Predicting deterioration of treated tuberculosis by corticosteroid reserve and C-reactive protein.
Eighteen patients with recently diagnosed pulmonary tuberculosis were studied for factors which could predict, at the outset, reactions to treatment. Abnormally low corticosteroid responses to tetracosactrin were seen in some but not all of the patients who deteriorated while on treatment. Those who deteriorated transiently or died had pre-treatment C-reactive protein (CRP) concentrations above 20 mg/l, which then persisted. As previously observed, those who responded unfavourably were older, had extensive disease and presented with hypoalbuminaemia and hyponatraemia.
Emission of viable bacteria in the exhaust flue from a waste incinerator.
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Assessment of the Axicare human milk pasteuriser (CM80).
The performance of the Axicare human milk pasteurizer was evaluated under different load conditions. The design criteria for pasteurisation specified that milk should be held at 63 degrees C for 30 min. The holding time at this temperature was insufficient if bottles of milk frozen at -20 degrees C were placed into the machine as directed, after the water-bath preheating phase. However, if the machine was loaded with frozen bottles before the whole cycle was commenced, adequate thawing and warming to holding temperature was achieved in sufficient time for satisfactory pasteurization. The pasteurizer gave consistent and adequate temperature and time conditions. The seals on three types of bottles tested tended to leak during the pasteurization cycle but no method of avoiding this problem was established.
Immune status in tuberculosis and response to treatment.
Thirty hospitalized patients with newly diagnosed tuberculosis were studied prospectively with a range of in vitro and in vivo tests of immune function. Responses were compared with those of healthy controls matched for age, sex, ethnic group and diet. A series of metabolic and immunologic abnormalities was found, including evidence of undernutrition, anaemia, neutrophil leucocytosis, monocytosis, lymphopenia, hyperglobulinaemia and raised erythrocyte sedimentation rate. Some patients had accelerated, others diminished, cutaneous tuberculin hypersensitivity, and some had diminished mononuclear cell proliferative and lymphokine responses to tuberculin (purified protein derivative, PPD). The patients were not uniform in their responsiveness, but could be arranged within a spectrum which showed a relationship to crude bacillary excretion and response to treatment. 27% of patients were characterized by hypersensitivity, with normal in vitro cellular responses and skin tests to PPD, scanty bacillary excretion and rapid bacteriologic sputum conversion to negative cultures with treatment. In contrast, 30% of patients were relatively anergic with negative skin tests, reduced or absent in vitro cellular reactivity to PPD, moderate or heavy bacillary excretion and later (greater than 4 weeks) bacteriologic sputum conversion. The remainder of the patients fell between these two groups. There were no correlations between cellular immunity on the one hand, and radiological extent of disease, levels of serum immunoglobulins, peripheral white cell counts or ESR on the other. In those patients followed throughout treatment, all the abnormalities with the exceptions of arm muscle circumference and serum albumin, reverted to the normal ranges established in the control group.
Cross-infection between animals and man: possible feline transmission of Staphylococcus aureus infection in humans?
An outbreak of epidemic methicillin-resistant Staphylococcus aureus occurred on a rehabilitation geriatric ward. Intensive screening of patients and staff revealed an unusually high carriage rate in the nursing staff (38%), thought to be related to a ward cat which was heavily colonized from the environment. Infection control measures and removal of the cat led to rapid resolution of the outbreak.
Herpes simplex virus and facial palsy.
An 8-year-old boy developed acute herpes simplex virus stomatitis followed by transient facial palsy. The possible relationship between this virus and Bell's palsy is discussed.
An outbreak of group A streptococcal skin infection: control by source isolation and teicoplanin therapy.
Streptococcus pyogenes is a potential cause of serious infections in plastic surgery and burns units. We report an outbreak of this organism in one such unit, which was successfully managed by closing the ward, and treating infected patients with a new antibiotic, teicoplanin.