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Biomedical subjects

John Ferguson

Publications and source records attributed to John Ferguson.

14 recordsLinked to original sources
PubMed2006

Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation.

OBJECTIVES: We aimed to characterise and quantify the incidence of common infectious agents in acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring ventilation, with a focus on respiratory viruses. DESIGN: An epidemiological study conducted over 3 years. SETTING: A 12-bed intensive care unit (ICU). PARTICIPANTS: ICU patients over 45 years of age with a primary diagnosis of COPD exacerbation requiring non-invasive ventilation (NIV) or ventilation via endotracheal tube (ETT). MATERIALS AND METHODS: Nasopharyngeal aspirates (NPA) and posterior pharyngeal swabs (PS) were tested for viruses with immunofluorescence assay (IFA), virus culture (VC) and polymerase chain reaction (PCR). Paired virus and atypical pneumonia serology assays were taken. Blood, sputum and endotracheal aspirates were cultured for bacteria. RESULTS: 107 episodes in 105 patients were recorded. Twenty-three (21%) died within 28[Symbol: see text]days. A probable infectious aetiology was found in 69 patient episodes (64%). A virus was identified in 46 cases (43%), being the sole organism in 35 cases (33%) and part of a mixed infection in 11 cases (10%). A probable bacterial aetiology was found in 25 cases (23%). There was no statistically significant difference in clinical characteristics or outcomes between the group with virus infections and that without. CONCLUSION: Forty-six (43%) of the patients with COPD exacerbation requiring mechanical ventilation had a probable viral pathogen. Prodromal, clinical and outcome parameters did not distinguish virus from non-virus illness. PCR was the most sensitive whilst virus culture was the least of virus assays.

Aged↗
PubMed2006

Low-level fluoroquinolone resistance among Campylobacter jejuni isolates in Australia.

BACKGROUND: Ciprofloxacin-resistant Campylobacter jejuni isolates obtained from infected patients in Australia have not been detected in studies of isolates from specific geographic areas. The Australian government has prohibited the use of fluoroquinolone in food-producing animals. To assess the impact of this policy, we have examined the antimicrobial susceptibility of isolates from 5 Australian states. METHODS: We conducted a period-prevalence survey of the susceptibility of C. jejuni isolates to 10 antimicrobial agents. C. jejuni isolates obtained from 585 patients from 5 Australian states (Queensland, South Australia, Tasmania, Victoria, and Western Australia) were identified by means of notifiable disease databases and were systematically selected from September 2001 to August 2002. RESULTS: Among locally acquired infections, only 2% of isolates (range, 0%-8% in different states) were resistant to ciprofloxacin. The locally acquired isolates also exhibited resistance to sulfisoxazole (55%), ampicillin (46%), roxithromycin (38%), tetracycline (7%), nalidixic acid (6%), chloramphenicol (3%), erythromycin (3%), gentamicin (2%), and kanamycin (0.2%). Treatment with antimicrobial agents in the 4 weeks before onset was not associated with ciprofloxacin resistance. CONCLUSIONS: The very low level of ciprofloxacin resistance in C. jejuni isolates likely reflects the success of Australia's policy of restricting use of fluoroquinolones in food-producing animals.

Australia↗
PubMed2006

Growth kinetics and competition between Methanosarcina and Methanosaeta in mesophilic anaerobic digestion.

Methanosarcina species with a high maximum specific growth rate (mumax) and high half-saturation coefficient (KS) and Methanosaeta species with a low mumax and low KS are the only known aceticlastic methanogens. Because of Methanosaeta's low KS, the low acetate concentrations in conventional, mesophilic anaerobic digestion yield Methanosaeta dominance. However, Methanosarcina absorbs increases in acetate more efficiently and thus promotes more stable digestion. This paper tests the hypothesis that decreasing digester feeding frequencies can increase Methanosarcina predominance. Two acetate-fed reactors were established at a 17-day solids retention time. One reactor was fed hourly, and one was fed once daily. Microscopic and molecular methods were used to verify that the hourly fed reactor enriched for Methanosaeta, while the daily fed reactor enriched for Methanosarcina. Growth and substrate-use kinetics were measured for each reactor. A digester overload condition was simulated, and the Methanosarcina-enriched reactor was found to perform better than the Methanosaeta-enriched reactor. These findings indicate that Methanosarcina dominance can be achieved with infrequent feedings, leading to more stable digestion.

Acetates↗
PubMed2005

The culture factor.

Explore the source record for details and available documents.

Hospital Administration↗
PubMed2004

Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects.

OBJECTIVE: To compare treatment outcomes of open foot wounds with significant soft tissue defects using either negative pressure wound therapy (NPWT) or standard wet-to-moist saline-soaked gauze dressings. SUBJECTS: : Forty-seven subjects with open wounds with significant soft tissue defects. DESIGN: A retrospective analysis of sequentially selected records of patients treated with NPWT or standard wet-to-moist dressings. RESULTS: Risk of complications, subsequent foot surgeries, and hospital readmissions (secondary outcomes) were all reduced by 70% or more for the patients treated with NPWT. Length of stay during readmissions tended to be shorter; rates of wound cavity filling and wound healing (primary outcomes) tended to be greater with NPWT, although the differences were not statistically significant. CONCLUSION: Patients included in the study treated with NPWT had fewer foot-related complications, less additional foot surgery, and fewer readmissions for the study foot than did patients treated with standard therapy. Further research using randomized clinical trials is needed to confirm the findings of the current study's data. CLINICAL RELEVANCE: Wound cavity filling time and time to complete closure were similar in both study groups, despite the fact that patients receiving NPWT were older, had larger wounds, and had poorer nutrition. NPWT may be an effective modality for the healing of open wounds with significant defects and for reducing subsequent care.

Adolescent↗
PubMed2003

Fluoroquinolone resistance in Campylobacter absent from isolates, Australia.

Fluoroquinolone resistance was detected in 12 of 370 Australian human Campylobacter isolates; 10 of these were travel-associated, and for 2 isolates travel status was unknown. No resistance was found in isolates known to be locally acquired. In Australia, fluoroquinolones have not been licensed for use in food production animals, a policy that may have relevance for countries with fluoroquinolone-resistant Campylobacter.

Australia↗
PubMed2003

Antibiotic resistance in Campylobacter jejuni isolated from humans in the Hunter Region, New South Wales.

Campylobacter is a common cause of bacterial gastroenteritis in Australia. Antibiotic resistance among Campylobacter is an emerging problem in Europe and the United States of America. Monitoring may detect emerging resistance. Since there is no epidemiologically validated subtyping system for Campylobacter, antimicrobial resistance patterns may prove useful as an epidemiological marker. Campylobacter isolates from residents of the Hunter region were differentiated by PCR into two categories: C. jejuni and non-C. jejuni. Minimal inhibitory concentrations (MIC) were determined for 10 antibiotics using the National Committee for Clinical Laboratory Standards (NCCLS) agar dilution methodology. Risk factor information including travel history were obtained as part of a case-control study by conducting telephone interviews with infected individuals. Sixty-four per cent, 3.4 per cent, 3.4 per cent and 11.2 per cent of C. jejuni isolates were resistant to ampicillin (at MIC > 8 mg/L), erythromycin (> 8 mg/L), nalidixic acid (> 32 mg/L) and tetracycline (> 8 mg/L), respectively. A diverse pattern of antibiotic resistance ('resistotypes') was detected with some change occurring over time. Several possible clusters of Campylobacter infections were identified based on resistotype. Of seven infections acquired during overseas travel, 57 per cent (4/7) were resistant to more than one antibiotic class compared to 10 per cent (14/144) of locally-acquired isolates (p=0.004, Fisher exact). The potential usefulness of resistotyping as an epidemiological marker is worthy of further exploration.

Anti-Infective Agents↗
PubMed2002

Non-antiarrhythmic drugs prolonging the QT interval: considerable use in seven countries.

AIMS: Many drugs belonging to different therapeutic classes appear to share a potentially fatal side-effect: ventricular tachyarrhythmias associated with QT prolongation. The aim of this study was to assess the relevance and the magnitude of the problem in seven countries by grouping all nonantiarrhythmic drugs according to the type of evidence on QT prolongation and analysing their sales data. METHODS: We divided all nonantiarrhythmic QT-prolonging agents into the following categories (in increasing order of clinical relevance): group A, drugs with published clinical or preclinical evidence on QT prolongation or with relevant official warnings; group B, drugs with published clinical or preclinical evidence; group C, drugs with published clinical evidence; group D, drug with published clinical evidence on torsades de pointes or ventricular arrhythmias associated with QT prolongation; group E, drugs belonging to group D with official warnings. We retrieved 1998 sales data from community pharmacies in seven countries (Australia, Denmark, England, Germany, Greece, Italy and Sweden). Data for individual agents were expressed as defined daily doses per 1000 inhabitants per day (DDD/1000/day). Overall use in each country was calculated for each drug group. Groups D and E were considered as the most clinically relevant. RESULTS: Among the 102 nonantiarrhythmic agents meeting at least one of the inclusion criteria, 33 drugs had sales data > or =1 DDD/1000/day and 71 drugs had a use > or =0.1 DDD/1000/day in at least one country. Among the 37 nonantiarrhythmic agents with published reports of ventricular arrhythmias associated with QT prolongation, 12 compounds had sales data > or =1 DDD/1000/day. Total consumption in each country ranged: from 51.9 to 94.7 DDD/1000/day for group A; from 51.6 to 92.7 DDD/1000/day for group B; from 37.1 to 76.6 DDD/1000/day for group C; from 12.9 to 29.1 DDD/1000/day for group D; and from 5.8 to 15.3 DDD/1000/day for group E. CONCLUSIONS: In spite of wide variations in the sales of individual agents, the overall extent of use of nonantiarrhythmic QT-prolonging drugs was of the same order of magnitude in all countries. The significant use of drugs belonging to categories D and E should prompt careful risk/benefit assessment of each agent.

Australia↗
PubMed2002

Disease recurrence after liver transplantation in Western Australia.

BACKGROUND AND AIM: Orthotopic liver transplantation (OLT) is now the accepted therapy for end-stage chronic liver disease. Long-term survival is now expected in the majority of patients and, consequently, disease recurrence has emerged as a major concern. Our aim was to document the rate of disease recurrence after liver transplantation for conditions other than hepatitis C, in patients followed up by the Western Australian Liver Transplant Service (WALTS). METHODS: The case notes of all post-OLT patients followed up by WALTS were reviewed. Patients were excluded if survival was less than 3 months post-OLT; OLT was performed for hepatitis C alone or follow up was unavailable. Detection and definition of disease recurrence depended on pretransplant diagnosis, and were based on patient interview, biochemical, immunological and serological tests. Radiological and histological confirmation were obtained where clinically indicated. RESULTS: Eighty-seven patients were identified (89 OLTs performed). The overall rate of recurrence was 10%. Recurrence rates by disease were: primary sclerosing cholangitis (17%), primary biliary cirrhosis (12%), autoimmune hepatitis (17%), hepatitis B (40%) and alcoholic liver disease (4%). Alcohol use relapse after transplantation occurred in 25%. The overall survival post-OLT was 87%, with a mean follow up of 53 months. Survival in patients with recurrent disease was 89%. CONCLUSIONS: Disease recurrence after OLT does occur, but overall, it is relatively uncommon. Recurrence rates vary significantly and depend, in part, on indication for OLT. With medium-term follow up, recurrent disease does not have an effect on mortality.

Adolescent↗
PubMed2002

Acute thrombocytopenia in patients treated with the oral glycoprotein IIb/IIIa inhibitors xemilofiban and orbofiban: evidence for an immune etiology.

Thrombocytopenic episodes occurring in 18,845 patients treated with the GPIIb/IIIa inhibitors xemilofiban and orbofiban ("fibans") were analyzed by a blinded review panel and 73 patients were classified as having "possible fiban-induced thrombocytopenia". When the treatment codes were broken, a significant association between drug exposure and assignment to this group was found (p <0.001). Twenty-eight (82%) of 34 archived serum samples from these patients contained fiban-dependent antibodies specific for GPIIb/IIIa, but no such antibodies were found in 61 drug treated patients not classified as having "possible fiban-induced thrombocytopenia" (p <0.001). We conclude that fiban-dependent antibodies were the major cause of acute, severe thrombocytopenia in patients judged on the basis of clinical findings to have thrombocytopenia "possibly-induced" by xemilofiban and orbofiban. Measurement of drug-dependent antibodies may be helpful in determining the basis for acute thrombocytopenia in fiban-treated patients and possibly for identification of patients at risk to develop thrombocytopenia.

Acute Disease↗