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Biomedical subjects

J Heptonstall

Publications and source records attributed to J Heptonstall.

45 records · Page 3Linked to original sources
PubMed1991

Outbreaks of hepatitis B virus infection associated with infected surgical staff.

Twelve outbreaks of hepatitis B virus (HBV) infection associated with HBV infected surgical health care workers (11 surgeons; one perfusion technician) were reported between 1975 and 1990 in England, Wales and Northern Ireland. A total of 95 infections was identified. Transmission rates ranged from one to nine per cent but were higher for patients who had undergone major surgical procedures. The number of infections reported under-estimates the total number of patients who will have acquired HBV infection from HBV infected surgeons during this period because subclinical infections will have been missed and other outbreaks may not have been recognised or reported.

Cross Infection↗
PubMed1989

High-level vancomycin-resistant enterococci causing hospital infections.

Nosocomial infection or colonization due to enterococci with high-level resistance to vancomycin (minimal inhibitory concentrations [MICs] between 64 and greater than 2000 mg/L) has occurred in 41 patients with renal disease. These vancomycin-resistant enterococci were cultured from many sources including blood. All but one strain contained one or more plasmids ranging in molecular weight from 1.0 to 40 Megadaltons (MDa). Vancomycin resistance was transferable by conjugation to a susceptible recipient strain of Enterococcus faecalis but this was not always associated with plasmid DNA. The emergence of transferable high-level vancomycin resistance in enterococci causing significant clinical infections is of particular importance since vancomycin is widely regarded as a reserve drug for the management of infections with multi-resistant Gram-positive organisms.

Acute Kidney Injury↗
PubMed1988

Murine typhus infection complicated by dengue haemorrhagic fever.

Murine typhus is endemic in many South East Asian countries but it has not been reported from the island of Borneo. Recently we attended to an English lady who contracted the disease in Brunei. Her clinical course unexpectedly turned stormy in the third week of the illness accompanied by severe thrombocytopenia. She made a complete recovery. Serological studies here and subsequently in England confirmed that she suffered from recent murine typhus infection complicated by dengue haemorrhagic fever.

Adult↗
PubMedDate not supplied

Surgeons who test positive for hepatitis C should be transferred to low risk duties.

HCV-infected surgeons may transmit HCV to patients during exposure-prone procedures. Current UK policy allows HCV-infected surgeons to practise unrestricted unless they have been associated with transmission, and, at present, surgeons are not routinely tested for HCV infection. The overall outcome for patients exposed to an HCV-infected surgeon may be worse than that for patients exposed to a surgeon who is an HBeAg negative carrier of HBV. However, because most acute HCV infections are anicteric, surgeon associated HCV transmission is less likely to be detected by surveillance. Surgeons have been observed to sustain intraoperative injuries in around 5% of procedures. If surgeons were required to report every intraoperative injury and to be tested to determine whether the patient could have been exposed to HCV, compliant surgeons would be tested for HCV at least annually. Investigations of HBV transmission, however, have suggested that patients may be exposed to a surgeon's blood in as many as 1 in 5 procedures, and that much surgeon to patient transmission is the result of inapparent intraoperative exposure, which the surgeon does not recognise. Thus, requiring surgeons to report intraoperative injuries would not identify all those patients who might have been exposed to HCV, and, since no vaccine or prophylaxis is available, could not prevent infection. A more satisfactory alternative is regular testing of surgeons for HCV, coupled with restriction of practice of those found to be infected.

Hepatitis C↗
PubMedDate not supplied

Changes in human nasal mucosa during experimental coronavirus common colds.

Twenty-four adult volunteers were inoculated with nasal drops containing a coronavirus of 229E serotype to determine the differences in the clinical and physiological reactions which occur between clinically infected, sub-clinically infected and non-infected individuals. Thirteen volunteers were clinically infected, 8 had sub-clinical infections and 3 were uninfected. Nasal airway resistance and the temperature of the nasal mucosa increased in all infected subjects both with and without symptoms: the core temperature increased also but to a lesser extent. Mucosal blood flow and nasal secretion increased only in those with symptoms. The albumin content of the nasal secretion increased in the clinically infected, suggesting that it was derived, partially at least, from the circulation. The nasal cycle of variation in airway resistance between the two sides of the nose was observed in all three groups but increased only in those clinically infected.

Adult↗
PubMedDate not supplied

Significant endogenous synthesis of nitrate does not appear to be a feature of influenza A virus infection.

There is much concern about the role of nitrate in the formation of carcinogenic N-nitroso compounds. There has been renewed interest in the endogenous formation of nitrate arising as a host response to infection. This study was designed to investigate whether the large increases in nitrate excretion rate reported (6-15-fold) for certain infectious diseases is also a feature of systemic influenza infections. Volunteers were challenged either with an attenuated strain of influenza A virus or with saline; and excreted nitrate was measured in subsequent 24-h urine samples. Both with and without adjustment for potential confounding by dietary and other factors, it was clear that neither mild nor moderate influenza A virus infection resulted in substantial endogenous nitrate biosynthesis since all the variation in urinary nitrate excretion observed was within the range of normal daily fluctuations. It remains possible that a stronger and more consistent nitrate excretion response might be observed in other infectious illnesses with greater systemic disturbance.

Adult↗