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Biomedical subjects

A Mindel

Publications and source records attributed to A Mindel.

At least 73 records · Page 4Linked to original sources
PubMed1993

The effect of suppressive oral acyclovir on the psychological morbidity associated with recurrent genital herpes.

OBJECTIVES: To assess the psychological impact of recurrent genital herpes and to determine if longterm acyclovir has any impact on this morbidity. SETTING AND SUBJECTS: Patients with frequently recurring genital herpes attending a department of genitourinary medicine who were considered suitable for longterm acyclovir. METHODS: Patients completed an 80 item, self-administered psychological questionnaire before starting acyclovir and every three months for one year. Treatment was then stopped and three months later a further questionnaire was completed. The questionnaire consisted of the General Health Questionnaire (GHQ); the Hospital Anxiety and Depression Questionnaire (HADQ); Illness Attitude Scales and Illness Concern. Data were analysed by McNemar's test for changes in proportions and by Wilcoxon's test for changes in scores. RESULTS: 102 patients were recruited: 55 men, and 47 women. Eighty two (80%) patients completed three months treatment, 75 (74%) six months, 64 (63%) nine months and 61 (60%) a year. Fifty (49%) of the original 102 patients completed the three months post treatment follow up. At first visit 63% (64/102) were designated as GHQ "cases". Within three months this decreased to 26% (21/82). McNemar's test showed that 67% (34/51) of the patients who were initially classified as GHQ "cases" became "noncases" after three months (p < 0.0001). There was a significant decrease in the proportion of HAD anxiety cases from visit one to visit two (p < 0.0001) and a decrease in illness concern scores from visit one to visit two (p < 0.0001). All these decreases were maintained throughout the years treatment with acyclovir. CONCLUSIONS: There is a substantial morbidity associated with frequently recurring genital herpes. However, acyclovir suppression significantly reduces illness concern and anxiety and is a useful addition to the treatment of this infection.

Acyclovir↗
PubMed1991

Anal human papillomavirus infection: a comparative study of cytology, colposcopy and DNA hybridisation as methods of detection.

OBJECTIVE: To compare anal cytology, colposcopy and DNA hybridisation as methods of detecting anal HPV infection. SUBJECTS AND DESIGN: Patients attending: (1) a genitourinary medicine (GUM) clinic with ano-genital warts; (2) a surgical out-patient department with anal fissure or haemorrhoids were examined for evidence of anal HPV infection. RESULTS: Considering GUM clinic attenders, 17% (38/225) and 40% (90/225) had perianal or anal canal warts respectively. Colposcopic examination revealed anal acetowhite lesions without warts in 28% (63/225). Cytological evidence of HPV infection was found in 98%, 83%, and 90% of patients with anal canal warts, perianal warts and acetowhite lesions respectively. Anal intraepithelial neoplasia (AIN) was documented in 22% of patients with anal canal warts compared with 6% with perianal warts (p less than 0.01). HPV DNA was detected from the anal brushings of 71%, 50%, 32%, and 29% of patients with anal canal warts, perianal warts, acetowhite lesions and a normal anal examination respectively. HPV type 6/11 was detected in the majority of HPV positive samples. Considering surgical out-patient attenders with no history or signs of anal warts, 25% showed cytological evidence of anal HPV infection and HPV DNA was detected from anal brushings in 3% (2/71). CONCLUSION: Anal examination with the colposcope is a useful method for detecting subclinical HPV infection. Anal cytology may prove helpful for detecting AIN, however, since koilocytosis was rarely seen, the specificity of the cytological criteria for anal HPV infection in the absence of AIN is uncertain. DNA analysis of anal brushings proved only moderately sensitive.

Adult↗
PubMed1991

Is it meaningful to treat patients with recurrent herpetic infections?

The introduction of acyclovir a safe and efficacious antiviral agent has revolutionised the treatment of recurrent orolabial and genital herpes. The treatment of each recurrence with topical or oral acyclovir is of limited benefit. However, long term suppression with oral acyclovir is highly effective. Patients should be considered for therapy on the basis of the frequency and severity of recurrence, and any associated psychosexual morbidity. Treatment should be commenced at a dose of 200 mg qds. Subsequent reduction in dose may be possible. Treatment should continue for 1 year then be stopped in order to ascertain if the frequency of recurrence still warrants suppression. The reasons for failure to respond to long term suppression or relapse include malabsorption and the emergence of drug resistant strains.

Acyclovir↗
PubMed1991

Cutaneous herpes simplex infection.

Cutaneous Herpes simplex infections occur either as a result of direct inoculation or in conjunction with primary genital or orolabial herpes. Lesions can occur anywhere on the body. However, when they occur in conjunction with genital herpes the commonest sites are the buttock, thigh and fingers. Cutaneous lesions may recur. In immunosuppressed patients recurrences may lead to 2 serious mucocutaneous complications; chronic progressive mucocutaneous herpes where lesions spread locally to leave large non-healing ulcers; or acute mucocutaneous dissemination where the infection disseminates widely over the skin. In dermatological conditions, especially atopic eczema, widespread cutaneous dissemination (Kaposi's varicelliform eruption) may occur. This usually occurs in association with primary herpes although recurrences do sometimes occur.

Herpes Simplex↗
PubMed1990

Screening pregnant women for genital herpes.

Neonatal herpes leads to serious morbidity and high mortality. The true incidence is unknown due to under reporting and difficulties in diagnosing the condition, but may be increasing. Mothers with primary disease, at term, present a greater infection risk to their offspring than mothers with recurrent disease, but the exact risks remain unknown. Existing prevention policies are inefficient, time-consuming for the doctor and the patient and, where caesarean section is offered to at-risk mothers, potentially hazardous. Anti-viral therapy offers a rational alternative and requires urgent evaluation.

Acyclovir↗
PubMed1990

Cutaneous herpes simplex infections.

OBJECTIVE: To review the clinical features and natural history of cutaneous herpes simplex infections associated with genital herpes. DESIGN: A retrospective case note study of all patients presenting to James Pringle House with this condition between 1983-1987. SUBJECTS: 123 patients were identified. RESULTS: The commonest sites involved were the buttocks 64/186 (34%), suprapubic area 28/186 (15%) and thigh 14/186 (7.5%). Thirty five of the 123 (28%) patients had more than one anatomical site involved. Genital and extragenital recurrences occurred with similar frequency. DISCUSSION: Extragenital cutaneous herpes simplex is not uncommon. Lesions may occur virtually anywhere on the body. HSV should always be considered in the differential diagnosis of vesiculating skin lesions.

Adult↗
PubMed1990

Treatment of cytomegalovirus retinitis with zidovudine and ganciclovir in patients with AIDS: outcome and toxicity.

Sixteen patients with the Acquired Immunodeficiency Syndrome (AIDS) and cytomegalovirus retinitis were treated with ganciclovir alone (9 patients) or ganciclovir and zidovudine (6 patients). The duration of effective treatment, that is the number of weeks during which there was no deterioration in visual symptoms or retinal appearance, was comparable in both groups. However, six of the seven patients receiving concurrent therapy had to cease treatment temporarily because of bone marrow toxicity compared with one of the nine patients treated with ganciclovir alone. It is concluded that continuous concurrent therapy with oral zidovudine and intravenous ganciclovir is not possible unless unlimited supportive therapy including blood transfusion, is available.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Anal and cervical intraepithelial neoplasia: possible parallel.

This study evaluated prospectively the use of an endoscope in examination of the anal canal for the detection of premalignant lesions. All patients underwent endoscopy and anal epithelial biopsy; the biopsy samples were examined histologically and human papillomavirus (HPV) DNA hybridisation was done. No evidence of anal intraepithelial neoplasia (AIN) was found in 20 control patients with anal fissure or fistula. Of 82 patients with anal HPV infection, 23 had evidence of AIN. The prevalence of AIN was significantly higher among homosexual than among heterosexual men (17 of 28 vs 1 of 26) with anal HPV infection. Of 28 women with anal HPV infection, 10 had cervical intraepithelial neoplasia (CIN); 5 of the 10 also had AIN, whereas no woman had AIN in the absence of CIN. The study shows that AIN occurs and can be diagnosed endoscopically in a manner similar to CIN. Further detailed prospective studies on the natural history of AIN and of groups at risk are required.

Adolescent↗
PubMed1989

Chancroid.

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Chancroid↗
PubMed1989

Primary and secondary syphilis, 20 years' experience. 2. Clinical features.

The notes of 946 patients with primary and 854 with secondary syphilis were retrospectively reviewed. Of the 184 heterosexual men with primary syphilis, 182 (99%) had chancres affecting the penis, compared with 467 (64%) of the 728 homosexual men (p less than 0.0001). Anorectal chancres occurred in 249 (34%) of homosexual men. The commonest features of secondary syphilis included a rash, lymphadenopathy, and mucous patches of the mouth or genital area. Hepatitis, meningitis, other neurological problems, iridocyclitis, and periostitis were all exceptionally rare. The clinical features of primary and secondary syphilis do not appear to have changed in recent years.

Chancre↗
PubMed1989

Suppression of frequently recurring genital herpes: acyclovir v inosine pranobex.

The suppressive action of acyclovir and inosine pranobex was compared in a randomised double blind controlled trial in patients with frequently recurring genital herpes. Fourteen patients received acyclovir and 17 inosine pranobex. Treatment continued for 12 weeks. The time to the first recurrence was significantly longer and the frequency of recurrences significantly less in the recipients of acyclovir. No important side effects were noted. It is concluded that acyclovir is the treatment of choice to suppress often recurring genital herpes.

Acyclovir↗