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Biomedical subjects

J Faoagali

Publications and source records attributed to J Faoagali.

At least 19 recordsLinked to original sources
PubMed2001

Telepathology.

The development of a Queensland-wide videoconferencing network provided an opportunity to develop telepathology. In 1999, weekly videoconferences began with remote laboratories and clinical staff in four peripheral hospitals and the Royal Brisbane Hospital and in 2000 biweekly videoconference pathology grand rounds started across Queensland with up to six sites, from Cairns to the Gold Coast, joining in or presenting. The average number of sites connected was 3.0 in 1998, 3.5 in 1999, 4.4 in 2000 and 4.5 in 2001. Problems included the complexity of the system, timing and need for bookings, coordination of presenters and presentations, and the time needed to organize sessions, set up linkages, advertise sessions and attend the telepathology conference. Successful meetings have been associated with well prepared cases, time for discussion, attendance by all sites, timeliness of cases and responses, and the presence of experts to respond to questions, as well as effective linkages and trouble-free hardware. Future needs include better infrastructure and trained staff to coordinate the linkages and presentations. Telepathology has an important part to play in the provision of cost-effective medical care in Queensland.

Computer Terminals↗
PubMed2000

Hepatitis G virus genotypes in Australia, Papua New Guinea and the Solomon Islands: a possible new Pacific type identified.

BACKGROUND: Hepatitis G Virus (HGV)/GB Virus-C (GBV-C) is a newly discovered RNA virus. Nucleotide sequence comparison and phylogenetic studies of the 5' untranslated region (5'UTR) within the viral genome have identified at least three different types which have provisionally been classified as type 1 (West African origin), type 2 (North American origin) and type 3 (Asian origin). METHODS AND RESULTS: The products of RT-PCR were sequenced by using blood donors and patients infected with HGV/GBV-C in Australia, Papua New Guinea and the Solomon Islands to investigate the genotype distribution in this area of the world. All the Australian isolates showed strong sequence homology with type 2, while the Papua New Guinea and Solomon Islands sequences were more closely related, but differ from type 3, which has previously been reported from isolates studied within Asia. CONCLUSIONS: Phylogenetic analysis suggests that these latter sequences are either a new HGV/GBV-C Pacific type or a subtype of the Asian type RNA virus. Isolates homologous with type 1 were not identified in these population groups.

Australia↗
PubMed1999

Isolation of beta-lactamase positive vancomycin resistant Enterococcus faecalis; first case in Australia.

An increasing number of clinical isolates of vancomycin resistant enterococci (VRE) have been reported in the literature since 1988. Only a few cases of beta-lactamase producing VRE have been described worldwide. This article reports the first case of beta-lactamase positive VRE in Australia. This strain of Enterococcus faecalis was isolated from a patient with non-Hodgkin's lymphoma who subsequently underwent a bone marrow transplant. Screening of all ward contacts did not detect any further case of beta-lactamase producing VRE. With the development of multiple antibiotic resistance in enterococci, additional infection surveillance protocols have been implemented in the hospital. These include routine screening of 'at risk' patients, instigating relevant infection control measures for management of VRE positive patients and controlling the usage of vancomycin in order to limit the development of resistant isolates.

Adult↗
PubMed1998

Burn wound excision and massive blood transfusion did not affect perioperative vancomycin levels.

INTRODUCTION: The effect of burns surgery that requires intraoperative transfusion of five or more units of blood on serum vancomycin levels was assessed. METHODS: Serum vancomycin levels were measured 10 min and 6 h after vancomycin administration with surgery being performed in the interval. The following day the same dose of vancomycin was given and serum vancomycin levels measured at the same times without intervening surgery. RESULTS: Thirteen operations involving nine patients who required a mean blood transfusion of 9.2 units were studied. There was very little difference between 10-min levels, 6-h levels and the change over interval (absolute and percentage) on the day of surgery and the following day. The recorded serum levels were often at the lower end of the desired range, especially in patients who underwent the larger operations. This was the case on both day of surgery and the control day. CONCLUSIONS: Large volume blood loss and replacement during burns surgery did not significantly affect perioperative vancomycin levels. 1998 Elsevier Science Ltd for ISBI.

Adolescent↗
PubMed1998

Exposure to GB virus type C or hepatitis G virus in selected Australian adult and children populations.

BACKGROUND: The epidemiology and disease association for the GB virus type C (GBV-C) or hepatitis G virus (HGV) are poorly understood. STUDY DESIGN AND METHODS: This study describes the exposure rates to GBV-C/HGV in diverse Australian population groups by testing for current infection and evidence of past infection with a reverse transcriptase polymerase chain reaction and an anti-E2 enzyme-linked immunosorbent assay, respectively. Subjects included volunteer blood donors, hepatitis C antibody (anti-HCV)-positive donors, children, hemodialysis patients, pregnant women attending a prenatal clinic, injecting drug users (IVDUs), and adult hemophiliacs. RESULTS: Combined GBV-C RNA and E2 antibody prevalence was 6.5 percent (6/93) in children, 13.3 percent (75/565) in blood donors, 14 percent (14/99) in pregnant women, 22.5 percent (18/80) in hemodialysis patients, 80 percent (56/70) in anti-HCV-positive donors, 88.6 percent (31/35) in IVDUs, and 85.7 percent (54/63) in adult hemophiliacs. Children had the lowest antibody rate, 1.1 percent, whereas the rate was 10.8 percent for blood donors and rose to 45.7 percent for IVDUs, 57.1 percent for anti-HCV-positive donors, and 74.6 percent for hemophiliacs. In contrast, current infection rates were comparable for children, blood donors, and pregnant women (5.4, 2.6, and 6%, respectively), rising to 11.1 percent for hemophiliacs, 24.3 percent for anti-HCV-positive donors, and 48.6 percent for IVDUs. Ten of 12 blood donors had persistent viremia, while 2 had recent infections, 1 with apparent resolution. CONCLUSION: Exposure to GBV-C can commence at an early age, although ongoing exposure may also occur among adults with no apparent risk factors. GBV-C RNA positivity was not associated with abnormal plasma alanine aminotransferase levels among blood donors.

Adult↗
PubMed1997

Does tea tree oil have a place in the topical treatment of burns?

Burnaid is a sorbalene-based cream containing 40 mg/g of tea tree oil and 1 mg/g of triclosan. This investigation was carried out to determine the effect of Burnaid, a commercial tea tree oil preparation, against Enterococcus faecalis (ATCC29212), Staphylococcus aureus (ATCC29213), Escherichia coli (ATCC25922), and Pseudomonas aeruginosa (ATCC27853), with the activity of the base product in the commercial preparation. The organisms were suspended in sterile saline (0.5 McFarland Standard) and inoculated onto horse blood agar (E. faecalis and S. aureus) or Mueller-Hinton agar (E. coli and P. aeruginosa). One hundred microliters of Burnaid unsterilized, Burnaid sterilized and the base product (Tinasolve) were placed in duplicate in wells cut into the agar plates. Sterility and inactivation cultures were also performed on the samples. None of the samples were found to be contaminated with bacteria prior to testing. Only S. aureus and E. coli showed zones of growth inhibition around the Burnaid and Tinasolve. Zones of growth inhibition (22 mm) were similar for the active product (Burnaid) and the base (Tinasolve). There was no activity against E. faecalis or P. aeruginosa. In view of our findings and literature indicating the cytotoxicity of tea tree oil against human fibroblasts and epithelial cells, it is recommended that this product should not be used on burn wounds.

Anti-Infective Agents, Local↗
PubMed1997

Silvazine (silver sulfadiazine and chlorhexidine) activity against 200 clinical isolates.

The study was undertaken to examine the in vitro efficacy of Silvazine against micro-organisms commonly found in burn wounds. Two hundred non-replicative sequential clinical isolates were collected over a 2-month period. These comprised 50 Staphylococcus aureus (methicillin sensitive), 50 Staphylococcus aureus (methicillin resistant), 50 coagulase negative staphylococci and 50 Pseudomonas aeruginosa. As there is no standard test method, the method chosen was a pour plate overlay of micro-organisms placed on a Mueller Hinton base containing duplicate wells of 0.1 ml Silvazine. Plates were incubated at 35 degrees C for up to 48 h prior to examination. All organisms tested showed zones of growth inhibition. The mean diameters of the zones of growth inhibition were similar within genera. S. aureus 19.7 +/- 1.6 mm, MRSA 16.9 +/- 1.6 mm, P.aeruginosa 15.3 +/- 1.1 mm and coagulase negative staphylococci 20.8 +/- 2.1 mm. There was no bacterial regrowth within the zones of growth inhibition following long-term plate storage. In vitro testing of Silvazine has confirmed its efficiency against common burn wound isolates.

Anti-Infective Agents, Local↗
PubMed1997

Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients.

OBJECTIVE: To compare the degree of bacterial circuit colonization, frequency of ventilator-associated pneumonia (VAP), character of respiratory secretions, rewarming of hypothermic patients, disposable costs, and air flow resistance in intensive care patients ventilated using either a heat and moisture exchanger (HME) or hot water (HW) humidifier circuit. DESIGN: A prospective, randomized blinded trial of patients in the intensive care unit undergoing mechanical ventilation. SETTING: A metropolitan teaching hospital. PATIENTS: One hundred sixteen patients undergoing mechanical ventilation for a minimum period of 48 hrs were enrolled. INTERVENTIONS: Patients were randomized to three ventilation groups using a) an HW circuit with a 2-day circuit change (n = 41); or b) a bacterial-viral filtering HME in the circuit, with either a 2-day (n = 42); or c) a 4-day circuit change (n = 33). MEASUREMENTS AND MAIN RESULTS: Circuit colonization was assessed using quantitative culture of washings taken from the circuit tubing and semiquantitative culture of swabs from the Y connectors. Sixty-seven percent of HW circuits became contaminated compared with 12% in the two HME groups (p < .0001). Median colony counts were lower in the HME groups (p < .0001). If circuits at first circuit change were contaminated in the HW group, 89% of subsequent circuit changes became contaminated compared with 0% and 25% for the 2- and 4-day HME groups, respectively. The frequency of VAP, the time to resolution of admission hypothermia, and the volume and fluidity of secretions were similar for all groups. The resistance of the HME after 24 hrs of use was < 0.025 cm H2O/L at gas flows of 40 L/min. HME use resulted in a cost reduction of $1.48 (Australian)/day. CONCLUSIONS: Circuits with a bacterial-viral filtering HME are less readily colonized by bacteria. Contamination is a random event. Humidification technique has no influence on the frequency rate of VAP, the effectiveness of rewarming, nor the character of the respiratory secretions. Breathing resistance is generally low and disposable costs are reduced when an HME is used.

APACHE↗
PubMed1996

An ELISA for the detection of antibody to the core antigen of hepatitis C virus: use in diagnosis and analysis of indeterminate samples.

AIMS: In order to examine more carefully the natural history of hepatitis C virus infection and to determine a role for anti-core in the discrimination of indeterminate samples, a solid phase ELISA to detect antibody of the immunoglobulin G class to the hepatitis C virus core antigen was developed using purified protein expressed in Escherichia coli from a major portion of the core antigen coding region. METHODS/RESULTS: In a study which examined 651 samples submitted for routine testing by a commercial ELISA (Ortho), only 11 samples showed discrepant results; of these, 10 were Ortho ELISA positive, anti-core negative and one was Ortho ELISA negative anticore positive. Supplemental tests showed that 5/10 of these samples were anti-HCV negative by RIBA and the reciprocal 5 were negative for anti-C22 but positive for anti-C100 and anti-C33. The Ortho ELISA negative, anticore positive sample was weakly positive for anti-C22. The anti-core ELISA was then used to examine 67 indeterminate samples from the blood bank; 11/11 samples which were HCV-RNA positive were anti-core positive and 7/56 samples which were HCV-RNA negative were anti-core positive. The anti-core titre was then examined in two groups of indeterminate samples; group 1, polymerase chain reaction-positive, anti-core positive and group 2, polymerase chain reaction-negative, anti-core positive. The geometric mean anti-core titres in these groups were 1 x 10(-3.6) and 1 x 10(-2.3), respectively. Thus in this group of indeterminate samples, all samples (except one) with an anti-core titre > or = 1/200 were polymerase chain reaction-positive, confirming a close correlation between anti-core levels and hepatitis C viraemia. Anti-core was detected with equal efficiency in patients infected with genotypes which differed to that used to express the recombinant core antigen.

Antibody Specificity↗
PubMed1995

Comparison of the immediate, residual, and cumulative antibacterial effects of Novaderm R,* Novascrub R,* Betadine Surgical Scrub, Hibiclens, and liquid soap.

BACKGROUND: Triclosan (Irgasan), an antibacterial active against staphylococci and coliform bacteria, has been formulated for use as a handwash. There has been only one previous report of the use of the glove juice test to determine the immediate, residual, and cumulative effects of a 1% triclosan-based handwash product. There have been no previous studies on the use of 1% triclosan combined with povidone-iodine (PI) in a handwash product. METHODS: The glove juice technique was used to document and compare the immediate, 3-hour residual, and 5-day cumulative effects on the mean log10 bacterial counts of 1% triclosan-based handwash product and 1% triclosan with 5% PI. A standardized surgical handwashing technique was used before sample collection. These results and the identity and type of the aerobic bacteria cultured from the samples were compared with the results of standardized washing and glove juice sampling with 4% weight/volume chlorhexidine gluconate (CHG), 7.5% PI, and a nonantimicrobial liquid soap. RESULTS: All five tested products showed significant log10 reduction from baseline on day 1, hour 0 (p < 0.05). There was no significant difference between the mean log10 bacterial count when 7.5% PI, 4% CHG, and 1% triclosan with 5% PI were compared with each other immediately after washing (p > 0.05). There was a significant difference between 1% triclosan and the liquid soap when they were each compared with 4% CHG, 7.5% PI, and 1% triclosan with 5% PI. There was no statistically significant difference between the 1% triclosan product and the liquid soap (p > 0.20). All products were effective at reducing the immediate bacterial count from the baseline level. All formulations except the liquid soap showed significant cumulative effect (p < 0.05) after multiple washes, with no significant difference between the cumulative effects of the liquid soap and 1% triclosan (p > 0.05). Both products differed significantly (p < 0.05) from the CHG, PI, and triclosan with PI. CHG, PI, and triclosan with PI showed effects significantly different from each other (p < 0.05). CONCLUSIONS: Triclosan combined with PI resulted in the prevention of bacterial regrowth at 3 hours such as occurred when PI alone was used. Triclosan-containing products have a small cumulative effect, although not as great as that produced by CHG. The triclosan-based products did not appear to select for gram-negative bacterial overgrowth, although the study period may have been too short to detect such an effect.

Adolescent↗
PubMed1995

Ventilator circuitry in neonatal intensive care: extending the period between changes from 4 to 7 days. A pilot study.

OBJECTIVE: To determine the effect of increasing the time span between changes of disposable ventilator tubing from 4 to 7 days. DESIGN: A prospective non-randomised study comparing levels of bacterial colonisation amongst babies who had ventilator circuits changed on either the 4th or 7th day. Data was collected sequentially with data collection from the '4-day group' preceding data collection from the '7-day group'. SETTING: A tertiary neonatal intensive care nursery. PATIENTS: All babies requiring ventilation at the time when data collection was possible. Ten babies were included in the first group (4 days) and 33 babies in the second group. INTERVENTIONS: Inspiratory and expiratory lines were swabbed and water from the humidifier trap sampled before the line was changed at either 4 or 7 days. Results of routine endotracheal aspirates, taken before and after the change of circuitry, were noted. MAIN OUTCOME MEASURE: The level of bacterial contamination of ventilator circuits. RESULTS AND CONCLUSIONS: In this small sample, no differences were found in terms of bacterial colonisation of ventilator lines. This has resulted in a change of practice in the hospital and a cost saving of over $15,000.

Equipment Contamination↗
PubMed1992

Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery.

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non-performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Staphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P less than 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.

Cefazolin↗
PubMed1990

Bacterial contamination of contrast media stored after opening.

A barium suspension, iohexol, iopamidol and ioxaglate which were diluted with tapwater and 0.9% NaCl and dextrose saline (4% and 0.18%) were made into aliquots of 10 ml and stored at 4 degrees C, room temperature and 37 degrees C for 8 weeks. Regular handling and bacterial cultures were performed. These studies confirmed that environmental organisms do contaminate these solutions and that they also support viable organisms, but do not become significantly colonized at room temperature or 4 degrees C. The solutions should be stored at room temperature or at 4 degrees C. The diluted barium solution was the contrast medium least contaminated and if it is not contra-indicated for other reasons should be used in preference to low osmolality water soluble contrast media on the basis of its cost, radiological contrast and low microbial contamination rate.

Bacteria↗