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Biomedical subjects

L Cotter

Publications and source records attributed to L Cotter.

At least 19 recordsLinked to original sources
PubMed2006

Antimicrobial resistance profiling and fla-typing of Irish thermophillic Campylobacter spp. of human and poultry origin.

AIMS: To determine the genetic relationship between a random collection of Irish human and poultry Campylobacter isolates and to determine the frequency of antibiotic resistance. METHODS AND RESULTS: Sixty-six Campylobacter isolates (34 human and 32 poultry) were typed by restriction fragment length polymorphism of flagellin-A (flaA) PCR products (flaA-RFLP) and by sequencing of the short variable region of flaA (flaA-SVR). FlaA-RFLP identified 58 distinct profiles, while flaA-SVR identified 28 different alleles. The highest level of antibiotic resistance was found for ampicillin (48.5%) followed by nalidixic acid (42.2%) and ciprofloxacin (31.8%). In general, poultry isolates displayed a higher incidence of resistance to the antimicrobials tested than the human isolates. CONCLUSIONS: A high level of genetic diversity existed among the Campylobacter strains confirming the weak clonality of this species. There was no relationship between antimicrobial resistance and specific genotypes determined by flaA typing suggesting that resistance was due to pressures of antimicrobial therapy. SIGNIFICANCE AND IMPACT OF THE STUDY: This study emphasizes the need for increased surveillance of antimicrobial susceptibility among Campylobacter isolates in Ireland and the implementation of more stringent control policies relating to the use of antimicrobials in the poultry industry.

Animals↗
PubMed2006

Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction.

BACKGROUND: The extent to which depression impairs health-related quality of life (HRQoL) in the physically ill has not been clearly established. AIMS: To quantify the adverse influence of depression and anxiety, assessed at the time of first myocardial infarction and 6 months later, on the physical aspect of HRQoL 12 months after the infarction. METHOD: In all, 260 in-patients, admitted following first myocardial infarction, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF-36 assessment before discharge and at 6- and 12-month follow-up. RESULTS: Depression and anxiety 6 months after myocardial infarction predicted subsequent impairment in the physical aspects of HRQoL (attributable adjusted R(2)=9%, P<0.0005). These negative effects of depression and anxiety on outcome were mediated by feelings of fatigue. Depression and anxiety present before myocardial infarction did not predict HRQoL 12 months after myocardial infarction. CONCLUSIONS: Detection and treatment of depression and anxiety following myocardial infarction improve the patient's health-related quality of life.

Age Factors↗
PubMed2004

Factors influencing consumption of pork and poultry in the Irish market.

Comparisons of Irish consumers' beliefs about pork and poultry in the framework of Fishbein and Ajzen's Theory of Reasoned Action (TRA) showed that poultry is viewed as the tastier, healthier and less expensive of the two meats while pork is viewed as the safer meat. The influence of attitudes and important others on intention to consume these meats was explored and the findings support the basic structure of the TRA model. In this study, both attitudes towards poultry and pork consumption and the influence of important others influenced intention to consume pork and poultry, but attitude was of greater importance. For poultry, health, eating enjoyment, safety and price were most important determinants of attitude with environment and animal welfare less so. In the case of pork, health, eating enjoyment, safety and animal welfare were most important determinants of attitude with environment and price less so. Furthermore, doctor's advice influenced the subject norm for both poultry and pork, which in turn influenced intention to consume, while dietician's advice only influenced the subject norm for pork.

Adult↗
PubMed2004

The risk factors for depression in first myocardial infarction patients.

BACKGROUND: Depression affects outcome following myocardial infarction but the risk factors for such depression have been little studied. This study considered whether the causes of depression occurring before and after myocardial infarction were similar to those of depression in the general population. METHOD: Consecutive patients admitted to hospital following their first myocardial infarction were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry to detect psychiatric disorders and the Life Events and Difficulties Schedule to assess recent stress. Participants completed the Hospital Anxiety and Depression Scale (HADS) at entry to the study and 1 year later and the risk factors associated with a high score at both times were assessed. RESULTS: Of 314 (88% of eligible) patients who were recruited, 199 (63%) were male and 63 (20%) had depressive disorders. Logistic regression identified the following as independently associated with depressive disorder that had been present for at least I month before the myocardial infarction: younger age, female sex, past psychiatric history, social isolation, having marked non-health difficulties and lack of a close confidant. At follow-up 269/298 (90%) responded; of 189 participants not depressed at first assessment, 39 (21%) became depressed by the 1 year follow-up. Logistic regression identified frequent angina as the only significant predictor of raised HADS scores at 12 months. CONCLUSIONS: Depression developing during the year following myocardial infarction does not have the same risk factors as that which precedes myocardial infarction. Further clarification of the mechanisms linking depression to poor outcome may require separation consideration of pre- and post-myocardial infarction depression, and its risk factors.

Age Factors↗
PubMed2004

Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction.

OBJECTIVE: To assess the role of depression and lack of social support before myocardial infarction (MI) in determining outcome in a large representative sample of patients admitted after MI in the UK. DESIGN: Prospective cohort design. PATIENTS: 1034 consecutive patients were screened 3-4 days after MI. MAIN OUTCOME MEASURES: Mortality and further cardiac events over one year after an MI. RESULTS: At 12 months' follow up mortality and further cardiac events were assessed in 583 of 654 eligible patients (90% response); 140 of 589 for whom baseline data were collected (23.8%) were depressed before their MI. Patients who were depressed before their MI were not more likely to die (mortality 5.2% v 5.0% of non-depressed patients) or suffer further cardiac events (cardiac events rate 20.7% v 20.3% of non-depressed patients). After controlling for demographic factors and severity of MI, the absence of a close confidant predicted further cardiac events (hazard ratio 0.57, p = 0.022). CONCLUSION: Lack of a close confidant but not depression before MI was associated with adverse outcome after MI in this sample. This association may be mediated by unhealthy behaviours and lack of compliance with medical recommendations, but it is also compatible with difficulties in early life leading to heart disease.

Age Factors↗
PubMed2001

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort study.

OBJECTIVE: To assess the clinical efficacy and accuracy of an emergency department based six hour rule-out protocol for myocardial damage. DESIGN: Diagnostic cohort study. SETTING: Emergency department of an inner city university hospital. PARTICIPANTS: 383 consecutive patients aged over 25 years with chest pain of less than 12 hours' duration who were at low to moderate risk of acute myocardial infarction. INTERVENTION: Serial measurements of creatine kinase MB mass and continuous ST segment monitoring for six hours with 12 leads. MAIN OUTCOME MEASURE: Performance of the diagnostic test against a gold standard consisting of either a 48 hour measurement of troponin T concentration or screening for myocardial infarction according to the World Health Organization's criteria. RESULTS: Outcome of the gold standard test was available for 292 patients. On the diagnostic test for the protocol, 53 patients had positive results and 239 patients had negative results. There were 18 false positive results and one false negative result. Sensitivity was 97.2% (95% confidence interval 95.0% to 99.0%), specificity 93.0% (90.0% to 96.0%), the negative predictive value 99.6%, and the positive predictive value 66.0%. The positive likelihood ratio was 13.9 and the negative likelihood ratio 0.03. CONCLUSIONS: The six hour rule-out protocol for myocardial infarction is accurate and efficacious. It can be used in patients presenting to emergency departments with chest pain indicating a low to moderate risk of myocardial infarction.

Adult↗
PubMed2001

Left cervical aortic arch associated with pseudocoarctation and aortic and mitral regurgitation: one-stage surgical repair.

Cervical aortic arch is rare with a prevalence of less than 1/10000 live births (Pediatr Cardiol 10 (1989) 205); but may occur with other cardiovascular congenital abnormalities. We report pseudocoarctation of a left-sided cervical aortic arch with an aberrant right subclavian artery and aortic and mitral regurgitation, corrected by an anterior mediastinal shunt from ascending to descending aorta and aortic and mitral valve replacements, as a one-stage procedure.

Adult↗
PubMed2001

A minimal serpin promoter with high activity in haematopoietic progenitors and activated T cells.

INTRODUCTION: The serine protease inhibitor Serpin 2A is highly expressed in ex vivo bipotent granulocyte/macrophage progenitor cells and in cultured myeloid stem cells. The gene undergoes rapid down-regulation as these cells are induced to differentiate, and constitutive expression in cultured myeloid stem cells retards maturation. Serpin 2A is also expressed in T cells as a consequence of activation. We now report analysis of the upstream regulatory elements that control Serpin 2A transcription. MATERIALS AND METHODS: Using primer extension and rapid amplification of cDNA ends the transcription start site of the Serpin 2A gene was mapped, and a 1.2 Kb genomic upstream fragment cloned and sequenced. Promoter activity and protein binding of deletion and site-directed mutant constructs were analysed by transient transfection and by electrophoretic mobility shift assays. RESULTS: A minimal promoter fragment was identified with high activity dependent on NF-kappa and Moloney murine leukaemia enhancer factor LVa binding sites in both myeloid stem cells and activated T cells. NF-kappa was shown to be the main DNA binding protein in T cells, whereas that in haematopoietic stem cells appears to be novel. CONCLUSION: Serpin 2A promoter activity in T cells is due predominantly to NF-kappa binding to its consensus site. Activity in haematopoietic stem cells appears to be mediated by a novel protein, which recognises the NF-kappa consensus only in the context of flanking sequences. This concise regulatory element may be of potential value in gene therapeutic applications.

Animals↗
PubMed1999

Recurrent prosthetic valve thrombosis: importance of prolonged Doppler echocardiography examination for diagnosis.

In a 9-month period a 52-year-old woman was admitted on 3 occasions with thrombotic obstruction of a Medtronic Hall aortic valve prosthesis. On the first occasion the diagnosis was clinically obvious; on the second occasion prosthetic valve malfunction was detected fortuitously on Doppler echocardiography; on the third occasion the diagnosis was made after prolonged Doppler echocardiographic examination. The patient was treated with thrombolysis, surgical thrombectomy, and aortic valve re-replacement on the 3 occasions, respectively.

Aortic Valve↗
PubMed1998

Motif-dependent DNA analysis of a methicillin-resistant Staphylococcus aureus collection.

Methicillin-resistant Staphylococcus aureus (MRSA) has become a major nosocomial pathogen in recent years. Once introduced into the hospital environment, MRSA can spread rapidly, and its subsequent treatment is often difficult as it may be simultaneously resistant to several antibiotics. A useful strategy both to identify the source of infection and to monitor specific infecting strains would be beneficial, facilitating the implementation of control and preventive measures. In this study, a typing strategy, based on the amplification of a conserved repeat-motif in the bacterial genome, was applied in a hospital setting to analyse an MRSA collection. Using a fluorescent-labelled oligonucleotide primer RW3A, which annealed to several dispersed short-repeat sequences occurring throughout the bacterial genome, DNA amplification fingerprint patterns were produced by polymerase chain reaction (PCR). Thirty-nine MRSA isolates were successfully analysed using conventional agarose gel electrophoresis and GeneScan technology. The latter method provides a finer resolution, making use of capillary electrophoresis in an ABI Prism 310 genetic analyser. The fluorescent detection approach can facilitate the construction of a fingerprint database which can be accessed for comparison of any isolate. Quantitative analysis of all patterns divided the MRSA isolates into four different groups, based on their RW3A fingerprints. Most of the isolates (88%) were assigned to one of three main groups, while the remaining isolates (12%) comprised a fourth, miscellaneous group.

Bacterial Typing Techniques↗
PubMed1997

Investigation of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in an Irish hospital: triplex PCR and DNA amplification fingerprinting.

Methicillin-resistant Staphylococcus aureus (MRSA) is becoming a problematic nosocomial pathogen. A continuing increase in numbers of isolates is reported from Irish hospitals each year. Preventing cross-infection and the further spread of endemic strains requires effective control measures. This necessitates the development of sensitive methods for both detection and genetic identification of MRSA isolates. In this study, 48 MRSA strains isolated in the Cork University Hospital were analysed between January and July 1995 using a one-tube triplex-polymerase chain reaction (PCR), wherein three genes, the methicillin-resistance gene (mecA), femA and the extracellular thermonuclease gene, nuc, were simultaneously amplified. Methicillin-sensitive S. aureus (MSSA) and coagulase-negative staphylococci (CNS) were also tested and the assay was found to be MRSA specific. The genetic relationship among this collection of MRSA isolates was also investigated. A single primer, RW3A, derived from a well-characterized, repetitive sequence found in Mycoplasma pneumoniae produced discriminating DNA fragment arrays with all the study organisms. The patterns were reproducible, even after several passages of the isolates. Quantitative analysis of the patterns divided the collection into two main groups, DAF group I representing 48% of the collection and DAF group II a further 19%. The remaining strains showed unrelated patterns. To fully outline the distribution of MRSA in this area a larger study will be necessary. This paper outlines the applicability of both the identification and fingerprinting techniques to local strains.

Cross Infection↗
PubMed1997

Detection of a small left atrial myxoma: value and limitations of four imaging modalities.

Coronary angiography in a 52-year-old woman with angina-type chest pain showed tumor circulation with feeding arteries arising from the circumflex artery. Transthoracic echocardiography and magnetic resonance imaging both failed to show any intracardiac masses. A sessile mass measuring 1.5 cm in diameter attached to the atrial septum was readily detected by transesophageal echocardiography. Histologic analysis confirmed the tumor to be a myxoma. Coronary angiography may provide the first clue to the presence of a small myxoma. Transesophageal echocardiography is the imaging modality of choice for further evaluation.

Coronary Angiography↗