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Biomedical subjects

M S Wright

Publications and source records attributed to M S Wright.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Single dose cefazolin prophylaxis for postcesarean infections: before vs. after cord clamping.

The objective of this study was to test the hypothesis that 1 g of cefazolin administered preoperatively is no more effective than the same dose administered after cord clamping in preventing postcesarean infectious morbidity. Ninety consecutive laboring subjects undergoing cesarean delivery at > or = 37 weeks gestation were randomized by computer to receive 1 g of cefazolin intravenously preoperatively or after cord clamping in a double-blinded, placebo-controlled study. The 2 groups were compared for differences in maternal and neonatal demographics, and intrapartum and operative characteristics associated with postcesarean infection. Primary maternal outcome variables were endometritis or wound infection. Secondary outcomes included intra-abdominal abscess formation, septic pelvic thrombophlebitis, pneumonia, or urinary tract infection. Neonatal outcomes included sepsis screens, sepsis, pneumonia, and meningitis. Subjects were followed 6 weeks postoperatively for late complications. Subjects receiving cefazolin preoperatively or after cord clamping had similar maternal and neonatal demographics, and intrapartum and operative characteristics. One patient in the former group experienced both endometritis and wound infection. In the latter group, 2 wound infections and 1 case of endometritis occurred (P = 0.35). There were no secondary maternal infections. Two infants treated for pneumonia and 2 other infants readmitted with febrile illnesses were born to mothers receiving cefazolin preoperatively. Overall, 8 neonates were evaluated for suspected sepsis and all had negative studies. Six of these infants' mothers received cefazolin preoperatively (P = 0.28). In conclusion, 1 gram of cefazolin preoperatively is no more effective than the same dose administered after cord clamping in preventing postcesarean infectious morbidity, but is associated with a trend toward increased suspected sepsis in the newborn. However, this trend may be related to differences between the study groups' risk factors for infection.

Bacterial Infections↗
PubMedDate not supplied

The incidence and effects of motion sickness among medical attendants during transport.

Motion sickness is a common and often debilitating problem. The purpose of this study was to determine the incidence and effects of the motion sickness syndromes, the Nausea and Sopite Syndromes, among medical transport personnel. Members of the Transport Teams of the University of North Carolina Hospitals completed a questionnaire to identify a history of susceptibility to motion sickness. An additional questionnaire evaluated each individual for symptoms of motion sickness during transport. The Digit Span Test portion of the Mini-Mental Status Examination (DST-MMSE) was used to evaluate cognitive function after transport. Control data on each subject were obtained by testing during nontransport shifts. The Nausea Syndrome was observed during transport in 46% of subjects; 65% experienced symptoms consistent with the Sopite Syndrome. Pretransport surveys were predictive of the Nausea Syndrome, but not of the Sopite Syndrome. The Nausea Syndrome was related to subjective assessments of the severity of motion experienced; the Sopite Syndrome did not correlate with the severity of motion. The DST-MMSE scores after transport were significantly lower than scores during nontransport periods in 85% of personnel. We conclude that transport personnel are susceptible to motion sickness manifested by both the Nausea Syndrome and the Sopite Syndrome. The presence of motion sickness is associated with a significant decline in performance on tests of attention and concentration.

Air Ambulances↗
PubMedDate not supplied

Anticomplement and the indirect antiglobulin test.

We used 140 IgG complement-fixing blood group alloantibodies of 17 different specificities in tests to determine whether anticomplement antibodies are still necessary in antiglobulin reagents to be used in indirect antiglobulin tests. Anti-Rh and other IgG noncomplement fixing antibodies were excluded from the study. A polyspecific antiglobulin reagent that contained anti-IgG and anticomplement antibodies, and an anti-IgG reagent containing the same level of anti-IgG as the polyspecific one, were compared. Titrations with some of the antibodies were repeated with only the polyspecific reagent. With each antibody, studies were done with complement activation blocked, and compared with results in which it was allowed to proceed. We found that 42.9% of the antibodies were detected at a higher dilution, and 64.3% of them were detected with a higher titer score, when the poly-specific antiglobulin serum containing anticomplement antibodies was used. We conclude that anticomplement antibodies are indeed still essential for the correct performance of indirect antiglobulin tests.

Antibody Specificity↗
PubMedDate not supplied

Emerging intestinal protozoa: a diagnostic dilemma.

Increasing isolation of Cryptosporidium, Cyclospora, and microsporidia from immunocompromised patients with severe diarrhea has prompted study of these organisms. Only recently recognized as human pathogens, they have also been associated with several waterborne outbreaks of diarrhea in immunocompetent individuals. Cryptosporidium and Cyclospora have been shown to be transmitted through fecally contaminated food and water. The mode of transmission for microsporidia is still unclear. While the life cycle and pathogenesis of Cryptosporidium are beginning to be understood, the microsporidia and Cyclospora are less well elucidated. The laboratory diagnosis of these protozoa is difficult. The routine ova and parasites screen does not include screening for them. Many microscopic methods, including wet mounts, modified acid-fast and trichrome stains, and immunofluorescence methods have been shown to be effective screening methods in the hands of experienced microscopists. Enzyme immunoassay and polymerase chain reaction methods also show promise. The proper identification of these pathogens rests with well-trained laboratory personnel. As appropriate treatment differs for each genus, communication between the laboratory and the physician is vital to the recovery of the patient.

Animals↗
PubMedDate not supplied

Waterborne transmission of Cryptosporidium, Cyclospora and Giardia.

Waterborne transmission of Cryptosporidium, Cyclospora, and Giardia has been associated with numerous recent outbreaks of diarrheal disease. Epidemiologic evidence shows that many community-acquired infections originate from public water sources. Drinking water, even when chlorinated and filtered, has been implicated in several outbreaks. Cryptosporidium and Cyclospora are resistant to chlorine. Giardia cysts are not killed immediately by chlorine and are less susceptible than most other organisms. Swimming pools and other recreational waters have also been implicated as transmission sources. All 3 organisms pose a challenge to the water industry, as they are difficult to detect in water when small numbers of cysts or oocysts are present. Small numbers of these organisms can cause disease; therefore, the clinical laboratory must be vigilant in screening, identifying, and reporting outbreaks of illness due to these protozoa.

Animals↗
PubMedDate not supplied

Drug-induced hemolytic anemias: increasing complications to therapeutic interventions.

There are recent reports of severe drug-induced immune hemolysis caused by several different classes of drugs. Second and third generation cephalosporins, diclofenac, fludarabine, carboplatin, and beta-lactamase inhibitors are among the drugs associated with severe or fatal hemolysis. Studies on patients who exhibit hemolysis after ingesting these drugs indicate that the four classical mechanisms of drug-induced hemolytic anemia may overlap. These studies appear to support the unified theory for induction of drug-induced immune hemolytic anemia.

Adult↗
PubMedDate not supplied

Laboratory investigation of autoimmune hemolytic anemias.

The investigation of suspected autoimmune hemolytic anemias includes not only the laboratory investigation but also the patient's presenting symptoms and a complete medical history. A drug history is especially important if drug-induced hemolytic anemia is suspected. The patient's direct antiglobulin test results, both polyspecific and monospecific, guide the remainder of the workup. Serum and eluate testing may include untreated reagent red cells with and without the presence of unbound drug(s) and drug-treated reagent red cells. If autoantibodies are demonstrable in the serum, removal of those autoantibodies and subsequent testing for underlying alloantibodies is essential in the provision of safe blood for transfusion.

Anemia, Hemolytic, Autoimmune↗