Veterinary nursing examinations.
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Animal Technicians↗
Biomedical subjects
P A James
Publications and source records attributed to P A James.
Multiple drug resistant tuberculosis: a story of success.
This is a study of an international student with multiple drug resistant tuberculosis. The prolonged history of his prediagnosis treatment, his final diagnosis, supportive treatment, and pronounced cure are highlighted against a backdrop of a rigorous maritime environment.
Adult↗
Beta-lactam susceptibility of Haemophilus influenzae strains showing reduced susceptibility to cefuroxime.
Minimum inhibitory concentrations of 13 beta-lactam antibiotics (ampicillin, amoxycillin, amoxycillin/clavulanate, imipenem, cefazolin, cefadroxil, cefaclor, cefuroxime, cefotaxime, cefepime, cefpirome, cefpodoxime and cefixime), were determined for 76 strains of beta-lactamase negative Haemophilus influenzae, isolated over a five year period (1985-1990) that gave reduced zones to cefuroxime on disc testing when compared to the control strain H. influenzae NCTC 11931. MIC90 values for all antibiotics (except imipenem) were approximately ten times higher than the MIC90 values for a susceptible control group. Increased resistance was not associated with any particular biotype, although three biotype III strains were highly resistant to imipenem. More than 50% of strains with reduced susceptibility to beta-lactam antibiotics were isolated from patients with chronic respiratory disease. Published data on the sputum concentration of each antibiotic were compared to the MIC90 values obtained for the susceptible and resistant strains.
Anti-Bacterial Agents↗
Laboratory aspects of infective endocarditis.
The clinical laboratory has a major role in both the diagnosis and treatment of cases of infective endocarditis. Patients often present with vague non-specific symptoms, which complicates the initial diagnosis. Blood cultures are by far the most important specimens. Laboratories should be aware of isolation problems associated with certain organisms. If initial blood cultures are negative then serological tests for non-bacterial causes should be considered. Staphylococci and streptococci account for > 90% of cases, and appropriate antimicrobial chemotherapy for the majority of strains is well established. The laboratory role is to identify the infecting organism, to establish the in-vitro activity of the proposed antibiotic therapy by determining minimum inhibitory concentrations and minimum bactericidal concentrations of antibiotics, singly and in combination against the patient's own organism, and to measure the bactericidal activity of antibiotics in the patient's serum to assess potential clinical efficacy. Laboratory aspects of diagnosis, treatment and therapeutic monitoring are discussed.
Anti-Bacterial Agents↗
Incidence of penicillin tolerance among blood culture isolates of Streptococcus sanguis, 1987-88.
Laboratories that reported isolations of Streptococcus sanguis from blood cultures to the Communicable Disease Surveillance Centre (CDSC) Colindale were requested to submit strains to Bath Public Health Laboratory to allow the prevalence of penicillin tolerance within different biotypes of this species to be studied. One hundred and fifty one Streptococcus spp were received from 78 United Kingdom laboratories in one year. Strains were identified using the API 20 Strep, and minimum inhibitory concentrations (MICs) of penicillin were determined using the spiral gradient plate method. Penicillin tolerance was detected by spraying beta-lactamase over inoculated gradient plates, reincubating for 48 hours and counting the number of surviving organisms represented by colonies. There were 57 different API identification profiles encountered in the survey. Most S sanguis I/1 strains were penicillin tolerant, most S sanguis II strains were non-tolerant. The overall geometric mean MIC of penicillin was considerably lower for S sanguis I/1 than for all other biotypes. The distribution of biotypes and the geometric mean MIC of penicillin for each biotype were not significantly different for infective endocarditis strains than for all strains tested, suggesting little or no association between penicillin tolerance and the seeding of endocardium. When the reactions obtained using API 20 Strep were compared with a recent taxonomic study of viridans streptococci, 22 of 38 S sanguis I/1 strains could be reclassified as S gordonii; all these strains were penicillin tolerant. Such reclassification would allow likely penicillin tolerant strains to be predicted.
Blood↗
Soft tissue abscess caused by Mycobacterium fortuitum.
Mycobacterium fortuitum is an environmental organism which rarely causes disease. We report the case of a young man in whom this organism caused a soft tissue abscess. The laboratory findings and subsequent management of the case are described.
Abscess↗
A bacteriological study of the effect on the environment of using a one- or two-trolley system in theatre.
In a survey of 53 hospitals, 62% still had a transfer zone in theatre, involving the use of two trolleys. Reluctance to use one trolley without patient transfer was probably because of concerns about excessive bacterial contamination of the theatre. In an attempt to see if these concerns were justified, air in the operating theatre was sampled for bacterial content, as were the surfaces and wheels of trolleys and the floor in the theatre, anaesthetic room and at the 'red line' in the transfer zone. Samples were taken during the first and second cases on the list of each session in one plenum-ventilated theatre over a four-week period, alternating each week between a one- and two-trolley system. Using one trolley did not significantly influence the bacterial counts in the theatre and anaesthetic room. There were significant differences between counts from the trolley wheels and from the floor of the transfer zone, with counts being higher for one trolley than two. These differences were greatly diminished after the trolleys were washed half way through the study. We conclude that there is no deleterious effect on the environment of the operating theatre, the most sensitive area, if only one trolley is used. If it is considered desirable to decrease the contamination of less important areas when using a one-trolley system, trolleys should be washed regularly, particularly the wheels.
Air Microbiology↗
Comparison of four methods for the determination of MIC and MBC of penicillin for viridans streptococci and the implications for penicillin tolerance.
Four methods of MIC and MBC determination were examined to compare their reproducibility and ability to detect penicillin tolerance. The MIC and MBC of penicillin were determined for 28 strains of viridans streptococci by a microdilution method, a macrodilution method, a membrane method, and a gradient-plate method using a spiral-plating device. The macrodilution, membrane and gradient plate methods were found to be acceptable for MIC determination with a reproducibility to within one doubling dilution, but only the gradient method gave acceptable reproducibility for MBC determinations. The consequence of these findings with respect to penicillin tolerance is discussed.
Microbial Sensitivity Tests↗
Religion and family medicine.
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Family Practice↗
Lactobacillus endocarditis.
Two cases of endocarditis due to Lactobacillus plantarum and Lactobacillus casei var. rhamnosus are described. Both patients were successfully treated medically. The response of the two isolates to a range of concentrations of penicillin in an apparatus which continuously monitored growth is reported. The strain of L. casei var. rhamnosus was found to be penicillin tolerant. The use of a combination of a penicillin with gentamicin to treat endocarditis due to penicillin tolerant strains of lactobacillus is discussed. The criteria for selecting oral agents to follow intravenous therapy are assessed also.
Adult↗
Comparison of glucokinase in C3H/He and C58 mice that differ in their hepatic activity.
Partially purified preparations of the hepatic glucokinase from C3H/He and C58 inbred mice have been used to explore the molecular basis for the observed twofold difference in activity between the strains. The single codominant gene that appears to regulate activity, the alleles of which are designated Gka and Gkb, respectively, for the two strains, could represent a structural gene change. This now seems unlikely because the mouse enzyme, although showing small differences from rat glucokinase, appeared to be identical in the two strains with respect to thermal stability, electrophoretic mobility in agarose gels, and kinetic properties such as the apparent Km values for MgATP2- and glucose and the unique cooperative interaction with the latter substrate. The enzymes also reacted identically in a range of immunological tests (double-diffusion, immunoelectrophoresis, immune precipitation and immune inhibition assays) and ELISA immune inhibition assays indicated that the twofold difference in activity was due to a similar difference in antigenically active enzyme. Genetic control over the physiologically significant regulation of enzyme amount is therefore probable.
Animals↗
A comparison of glucose metabolism and related hormonal parameters in two strains of mice having differing hepatic glucokinase activities.
Parameters of glucose metabolism in the livers of two inbred strains of mice, C3H/He and C58, which have high- and low-glucokinase activities respectively, have been determined. Unlike insulin concentrations, the plasma glucagon concentrations are similar in the two strains. Certain of the numbers of insulin receptors per hepatocyte cell surface area were higher in starved than fed animals of the same strain but affinities were the same, while only small differences in receptor numbers were found between the strains in starved animals. The difference in glucokinase activity, determined spectrophotometrically and confirmed by measurements of detritiation of [2-3H]glucose by hepatocytes incubated in vitro, does not apparently influence the minimal rate of glucose recycling as measured by the relative loss of 3H and 14C from [2-3H, U-14C]glucose. The development profiles for the two strains show a marked developmental difference arising around 20 days after birth.
Aging↗
Hepatic glucokinase activity and circulating insulin concentrations in two inbred mouse strains.
Hepatic glucokinase activity in the C3H/He strain of mice is about twice that in the C58 strain. Genetic analysis of hybrids and back-crosses indicates control of activity by a single codominant gene. The adaptations of activity that occur when animals of the two strains are starved, fed a carbohydrate-free diet or made streptozotocin-diabetic are similar in the two strains. In almost all the situations tested, plasma insulin concentrations were higher in the C3H/He strain than in the C58 strain. On the assumption that insulin plays some role in the synthesis of glucokinase, the possible association between the plasma insulin concentration and hepatic glucokinase activity in mice in which plasma glucose concentrations are similar is discussed. The twofold difference in glucokinase activity between the two strains is associated with only minor differences in glucose tolerance and insulin response to a glucose load.
Animals↗
Bradykinin analogues containing N alpha-methyl amino acids.
Analogues of bradykinin were synthesized containing single substitutions by N alpha-methyl amino acids in the 1, 4, 5, 5, and 9 positions. [MeArg]Bradykinin possessed 60% of the muscle-contracting activity of the parent compound in a guinea pig ileum assay. The other analogues were very weak agonists (less than 2%) and, disappointingly, failed to show blocking activity except at very high doses.
Animals↗
Low-residue diets and hiatus hernia.
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Adult↗
Structure-taste relationships of aspartic acid amides.
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Amides↗
Using the cooperative extension service in agricultural health education.
In summary, the North Carolina experience of cooperation and health education using the Cooperative Extension Service has been very successful. Agriculture and medicine have found a common ground where responsibilities can be shared. By discovering the special capabilities and contributions of the Cooperative Extension Service, medical professionals may more closely address preventive medicine in an agricultural setting.
Agriculture↗