Biomedical subjects

Sara Shepherd

Publications and source records attributed to Sara Shepherd.

4 recordsLinked to original sources

PubMed2006

Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease.

RATIONALE: The clinical features and outcome of macrolide-resistant Mycobacterium avium complex (MAC) lung disease are not known. OBJECTIVES: Characterize patients, treatment, and isolates in macrolide-resistant MAC lung disease. METHODS: Retrospective chart review, susceptibility testing, molecular fingerprinting, and DNA sequence analyses of resistant MAC isolates. MEASUREMENTS AND MAIN RESULTS: We identified 51 patients over a 15-yr period with clarithromycin-resistant MAC (minimum inhibitory concentration (MIC)>or=32 microg/ml) lung disease at a single referral center. Twenty-four (47%) patients had nodular disease with bronchiectasis and 27 (53%) had upper lobe cavitary disease. Most patients (77%) had M. intracellulare. Sequencing of the 23S r-RNA gene showed 49 of 51 isolates (96%) with the expected mutation in adenine 2058 or 2059. Risk factors for resistance included macrolide monotherapy or combination with a quinolone only (39/51 or 76%). Macrolide resistance developed in 12 of 303 (4.0%) patients started on the American Thoracic Society-recommended two companion drugs, with no risk difference in clarithromycin versus azithromycin and daily versus intermittent therapy. Sputum conversion with macrolide-resistant MAC occurred in 11 of 14 (79%) patients who received more than 6 mo of injectable aminoglycoside therapy and lung resection, compared with 2 of 37 (5%) who did not. The 1-yr mortality in patients who remained culture positive was 34% (13/38) compared with 0% (0/13) of patients who became culture negative (converted). CONCLUSIONS: Macrolide resistance rarely occurs in patients also receiving ethambutol and a rifamycin. Macrolide-resistant MAC lung disease requires aggressive drug and surgical therapy for cure.

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PubMed2005

Ethambutol ocular toxicity in treatment regimens for Mycobacterium avium complex lung disease.

Ethambutol (EMB) is an important component of multidrug treatment regimens for Mycobacterium avium complex lung disease. Ocular toxicity is the most important potential EMB toxicity, especially in the elderly population with M. avium complex lung disease. Two hundred twenty-nine patients with M. avium complex lung disease, 55% women and 53% with nodular/bronchiectatic disease, received a mean of 16.1 +/- 10.8 months of multidrug therapy that included EMB. Fifty patients (22%) were known to have preexisting ocular disease. While on EMB, 97 (42%) patients consulted an opthalmologist and 24 (10%) stopped EMB at least temporarily. Eight of 139 patients (6%) on daily therapy were diagnosed with EMB ocular toxicity, whereas 0 of 90 patients on intermittent therapy had EMB ocular toxicity (p = 0.05). All patients with EMB ocular toxicity developed symptoms between outpatient clinic appointments; none were diagnosed with routine visual acuity and color vision testing. All patients with EMB ocular disease returned to baseline ocular status after discontinuation of EMB. Intermittent EBM administration was associated with less ocular toxicity than daily EMB administration in this patient population.

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PubMed2005

Agroterrorism workshop: engaging community preparedness.

INTRODUCTION: Agroterrorism is the deliberate tampering with and/or contamination of the food supply with the intent of adversely affecting the social, economic, physical, and psychological well-being of society. Testimony before the Government Affairs Committee of the U.S. Senate has suggested that agriculture is an area that has received comparatively little attention with regard to terrorism. METHODS: In February of 2004, the NIOSH Southwest Center for Agricultural Health, Injury Prevention, and Education developed a workshop on agroterrorism designed to engage local community leaders in a process to prepare for and respond to a terrorist event involving the food supply. The workshop was an effective collaboration between NIOSH Ag Centers, the state department of health (Texas), a school of public health, and the Texas Agricultural Research and Extension Centers in five urban and rural locations with substantial agricultural production. In order to reach a diverse and geographically widespread audience, the workshop was conducted by synchronous two-way interactive televideo (9 geographic sites). The audience of 155 participants was comprised of numerous stakeholders. The workshop format involved separate modules addressing food and fiber, livestock and poultry, food distribution, and emergency preparedness, with participants developing priorities for future consideration within their communities to address all phases of an event from preparedness to follow-up debriefing. There were 13 additional individuals (for a total of 168) who participated in the workshop subsequently through use of a video. RESULTS: Workshop evaluation components included pre- and post-workshop objective assessment of factual information presented (tests), and follow-up for implementation of priorities developed by conference participants. Statistically significant improvement was noted in knowledge acquisition. The six-month follow-up demonstrated implementation of preparedness planning priorities. CONCLUSIONS: This is an effective method of reaching a geographically widespread and diverse audience of community members who will be on the front lines of an agroterrorism event. An attempt was made to enhance communication and collaboration among involved groups for effectively detecting and addressing such an event. This workshop can serve as a model for use in other communities.

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PubMedDate not supplied

Asbestos burden in cases of mesothelioma from individuals from various regions of the United States.

Mesothelioma is a rare tumor that is considered an asbestos marker disease. It occurs in individuals following a longer latency period from first exposure than other asbestos-related diseases. The tumor also occurs in individuals with a wide range of exposures, including individuals with lower level or secondary exposures. In the present study lung tissue from 54 individuals with a pathological diagnosis of mesothelioma was evaluated for ferruginous body and uncoated asbestos fiber content. The data were compared with an earlier study of mesothelioma cases from the northwestern United States. Tissue was prepared via a digestion procedure, with the collected digestate reviewed by light microscopy for quantification of asbestos bodies and analytical transmission electron microscopy for determination of uncoated fiber burden. Twenty-seven cases in the present study had over 1000 ferruginous bodies per gram of dry tissue. The data suggest that amosite provides a more likely stimulus for ferruginous coating than the other forms of asbestos. All individuals were found to have asbestos fibers in their lung tissue. Amosite was the most commonly found fiber, with anthophyllite being the second most commonly found type of asbestos. The finding of tremolite in the tissue most often was associated with the finding of anthophyllite. A limited number of asbestos fibers of each type would have been seen in the light microscope, with the least detected being chrysotile. The majority of all fiber types were found as short fibers (< 8 mum), although some longer fibers were represented in each type of asbestos. The majority of the individuals were found to have mixed types of asbestos in their lungs.

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