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Biomedical subjects

S Forsythe

Publications and source records attributed to S Forsythe.

At least 19 recordsLinked to original sources
PubMed2006

Retrospective utility of bronchoscopy after hematopoietic stem cell transplant.

Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is thought to be the procedure of choice to evaluate pulmonary infiltrates in hematopoietic stem cell transplant (HSCT) recipients. We retrospectively reviewed 91 bronchoscopies performed on 190 in-patient HSCT recipients admitted or treated for pneumonia from January 1994 to December 2004. These yielded a diagnosis 49% of the time with an overall survival of 35 days post-bronchoscopy. We were unable to detect any survival benefit from an addition to the treatment regimen after a positive result from analysis of the BAL fluid or transbronchial biopsy. The most common bacteria isolated was Pseudomonas that was often resistant to the patient's current antibiotics, suggesting that in lieu of this diagnostic procedure, changes to better cover resistant Gram-negative bacteria are reasonable. Although transbronchial biopsies provided an additional diagnosis in one out of 21 biopsies performed, six of the seven complications in our series were directly related to the transbronchial biopsy. With approximately a 50% yield from a bronchoscopy, additional treatment given after only 20% of all bronchoscopies, and no detectable survival benefit with a bronchoscopy that yielded a diagnosis, the utility of a bronchoscopy in this patient population is questioned by these data.

Adolescent↗
PubMed1999

Etiology of acute lower respiratory tract infection in Central Australian Aboriginal children.

BACKGROUND: Aboriginal children in central Australia have attack rates for acute lower respiratory tract infection (ALRI) that are similar to those in developing countries. Although mortality rates are much lower than in developing countries, morbidity is high and ALRI is still the leading cause of hospitalization. However, there are no data on the etiology of ALRI in this population. METHODS: We prospectively studied 322 cases of ALRI in 280 Aboriginal children admitted to the hospital. Blood, urine and nasopharyngeal aspirate samples were examined for evidence of bacterial, viral and chlamydial infection. RESULTS: The combination of blood culture, viral studies and chlamydial serology provided at least 1 etiologic agent in 170 of 322 (52.5%) cases. Assays for pneumolysin immune complex and pneumolysin antibody increased etiologic diagnosis to 219 (68.0%). Blood cultures were positive in 6% but pneumolysin immune complex and pneumolysin antibody studies were positive in one-third of cases. Evidence of viral infection was present in 155 (48%) of cases compared with 12% in controls (P < 001). There were only 7 possible cases and 2 definite cases of Chlamydia trachomatis and 3 cases of Chlamydia pneumoniae. Coinfection was common in these children. CONCLUSION: These findings have implications for both standard treatment protocols and vaccine strategies. The high rate of coinfection may make it difficult to develop simple clinical predictors of bacterial infection. In the setting of a developed country with efficient patient evacuation services, management algorithms that focus on disease severity and need for hospital referral will be most useful to health staff in remote communities. Pneumococcal conjugate vaccines will be required to reduce the high attack rate of pneumococcal disease.

Australia↗
PubMed1998

Near-fatal heat stroke during the 1995 heat wave in Chicago.

BACKGROUND: In July 1995, Chicago sustained a heat wave that resulted in more than 600 excess deaths, 3300 excess emergency department visits, and a substantial number of intensive care unit admissions for near-fatal heat stroke. OBJECTIVE: To describe the clinical features of patients admitted to an intensive care unit with near-fatal classic heat stroke. Patients were followed for 1 year to assess delayed functional outcome and mortality. DESIGN: Observational study. SETTING: Intensive care units in the Chicago area. PATIENTS: 58 patients admitted to the hospital from 12 July to 20 July 1995 who met the case definition of classic heat stroke. MEASUREMENTS: The data collection tool was designed to compile demographic and survival data and to permit analysis of organ system function by abstracting data on physical examination findings, electrocardiography and echocardiography results, fluid resuscitation, radiography results, and laboratory findings. Data on functional status at discharge and at 1 year were collected by using a modified Stanford Health Assessment Questionnaire. RESULTS: Patients experienced multiorgan dysfunction with neurologic impairment (100%), moderate to severe renal insufficiency (53%), disseminated intravascular coagulation (45%), and the acute respiratory distress syndrome (10%). Fifty-seven percent of patients had evidence of infection on admission. In-hospital mortality was 21%. Most survivors recovered near-normal renal, hematologic, and respiratory status, but disability persisted, resulting in moderate to severe functional impairment in 33% of patients at hospital discharge. At 1 year, no patient had improved functional status, and an additional 28% of patients had died. CONCLUSIONS: Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.

Adult↗
PubMed1998

Protecting paradise: tourism and AIDS in the Dominican Republic.

This study summarizes results from six data collection instruments administered to tourists, hotel workers, and commercial sex workers (CSWs) in the Dominican Republic (D.R.). The objective of this study was to assess: 1. how HIV/AIDS may affect tourism; 2. how tourists are likely to react to prevention campaigns; and 3. how tourism may affect the spread of HIV/AIDS. It was found that an overwhelming proportion of tourists did not consider the prevalence of HIV to be a factor when making their travel plans, and that most did not consider themselves at greater risk of becoming infected while on holiday than when they were at home. This study determined that the spread of HIV/AIDS was unlikely to affect the demand for tourism services in the D.R. The study also found that most tourists would respond positively to an HIV/AIDS prevention campaign and would not be discouraged from visiting the D.R. because of such campaigns. Those most receptive to prevention efforts were also those who felt they were at highest risk, according to study data. Finally, it was determined that while most tourists probably do not engage in high risk activities, there were some male and female tourists who do engage in sexual encounters with multiple Dominican CSWs and hotel employees. These encounters represent a risk to the health and economic development of the D.R., as well as to tourists and their other sexual partners. Based on these findings, it is recommended that in order to minimize the potential social and economic impact of HIV/AIDS in the D.R., prevention messages need to reach a number of groups which have not yet been adequately targeted. These groups include tourists, with a special emphasis on 'sex tourists', and hotel employees, with a special emphasis on entertainment staff.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Evolution of socioeconomic impact assessments of HIV/AIDS.

OBJECTIVE: The objective of this paper is to describe how and why socioeconomic impact assessments, as applied to HIV/AIDS in developing countries, have evolved over time and to discuss the direction that this field should be taking in the future. DESIGN: This paper involves a review of existing literature and incorporates the experience of AIDSCAP/Family Health International, the AIDS and Economics Network (AEN) and other organizations working in this field. RESULTS: Socioeconomic impact methodologies have become more rigorous over the last 10 years. Concurrently, they have been applied to achieve a new understanding of the impact of AIDS on the economy. The results have been successfully utilized because they are often compelling; to inform, sensitize and mobilize policymakers. At the same time, however, demand is growing for socioeconomic impact assessments to continue to evolve to meet the needs of policymakers in developing countries. CONCLUSION: The tools that have been used in the past for performing socioeconomic impact assessments will have to change significantly to reflect the needs of policymakers for more specific, policy-oriented analyses. Existing economic impact assessments in the field of HIV/AIDS will need to be replaced by more targeted economic research intended to encourage the development of appropriate workplace policies, mitigate the impact of HIV/ AIDS on families, and address critical treatment issues.

Anti-HIV Agents↗
PubMed1998

Cost of providing sexually transmitted disease services in Bangkok.

OBJECTIVE: The main purpose of this study was to assess the economic costs of sexually transmitted disease (STD) treatment and to identify opportunities for sustaining Bangkok's STD clinics. DESIGN: A cost analysis was used to assess the resources required to provide (i) STD services, (ii) additional services at STD clinics during the evening, and (iii) outreach activities with commercial sex workers. The cost analysis included a review of opportunities to increase sustainability through cost recovery and institutional restructuring. RESULTS: The study revealed that the cost of providing services does differ significantly across the five clinics analysed, with recurrent costs of day-clinic STD care varying from US$13-37 per patient reached. An analysis of expanded evening hours at STD clinics suggested that an investment of US$62 000 per year allowed an additional 2000 patients to receive STD treatment and that evening hours appear to offer greater convenience to patients. It was also found that outreach activities initiated by the STD clinics and carried out in brothels have been used inexpensively (US$0.20 per woman reached) to reach commercial sex workers with critical information on STDs, including HIV. An analysis of opportunities for cost recovery at public STD clinics indicated that although some resources can be recovered, government support will continue to be required. The cost recovery option believed to be most feasible for promoting sustainability was a proposed charge of US$2-4 for STD clinic attenders. This charge was projected to allow each clinic to recover between 11% and 22% of their recurrent costs. CONCLUSION: This study concluded that there are numerous opportunities for promoting the financial sustainability of STD services at public clinics. It was also concluded that the existing outreach program is extremely inexpensive and is reaching people who are in need of the services that are being offered. However, this study was not able to determine if it would be worthwhile to reopen public STD clinics during evening hours.

Ambulatory Care Facilities↗
PubMed1996

Collaborative ring-trial of Dynabeads anti-Salmonella for immunomagnetic separation of stressed Salmonella cells from herbs and spices.

Eight laboratories participated in a Salmonella detection ring-trial which compared selective enrichment by conventional broths with immunomagnetic separation (IMS) using Dynabeads Anti-Salmonella. Laboratories analyzed six types of herbs and spices that were spiked with one of six freeze-dried Salmonella species. Each herb and spice analysis comprised of 12 samples (25 g each) which had been spiked at three different levels, plus a negative control and stored for one week prior to testing. Out of a total 468 samples analyzed, 195 (41.7%) were positive by both methods. Eighteen samples were positive only by IMS enrichment, in comparison with 19 positive samples by conventional enrichment broths and not IMS. These results confirm the potential use of IMS as an alternative to enrichment broths for Salmonella isolation.

Culture Media↗
PubMed1995

An essential role for DsbA in cytochrome c synthesis and formate-dependent nitrite reduction by Escherichia coli K-12.

An Escherichia coli K-12 mutant, isolated on the basis of its inability to catalyze formate-dependent nitrite reduction, was characterized. The mutant was defective in the synthesis of all known c-type cytochromes during anaerobic growth. The mutation was localized by conjugation, transduction, and Southern blotting experiments to the dsbA gene at minute 87 on the E. coli chromosome and was complemented by the wild-type allele. Both DsbA and the recently described DipZ protein were shown to be essential for cytochrome c synthesis, suggesting that they act sequentially in a pathway for cytochrome c assembly in the E. coli periplasm.

Bacterial Proteins↗
PubMed1991

Hippocampal pyramidal cell disarray in schizophrenia as a bilateral phenomenon.

In a continuing quantitative study of hippocampal cell orientation in schizophrenic subjects and nonschizophrenic control subjects, a pattern of right hemispheric cell disorganization in schizophrenic subjects, as robust as that previously described in the left hemisphere, was shown. The study was based on tissue from 11 schizophrenic and seven approximately age-matched control subjects from a Veterans Administration Medical Center. Using a new measuring technique that proved complementary and superior to the method formerly used, we determined the axes of orientation for approximately 10,800 neurons. A significant difference in cell disorganization was found between schizophrenic and control subjects. From separate analyses of the interface zones among the various hippocampal cell sectors, this difference was found to be significant at the interfaces between cornu ammonis zones 1 and 2 and zones 2 and 3. Analysis of the pattern of disorganization numbers suggests a bimodal distribution in which the cell orientation values of one group of schizophrenic subjects overlap those of the nonschizophrenic control group, while the cell orientation values of a second group significantly exceed those of the control population. Although some recent studies have suggested that schizophrenia may be related exclusively to the left hemisphere, the results of this study indicate that schizophrenia-related structural changes involve the right hemisphere as well. Thus, schizophrenia may be a bilateral rather than unilateral disorder.

Adult↗
PubMed1983

Estimation of mixed venous oxygen saturation.

Pulmonary artery oxygen saturation (PA) was measured directly and estimated from venal cavae samples in 175 adults without intracardiac shunts to ascertain which of four formulas (MV1, MV2, MV3, or MV4) best estimated mixed venous oxygen saturation. Because the formula MV1, which favored IVC samples, most closely approximated pulmonary artery saturation, we recommend its use to estimate systemic flow in patients with left-to-right shunts. In addition, a difference between directly measured PA and calculated MV1 of 6% or greater indicates the presence of a left-to-right shunt in 97% of cases.

Adolescent↗