Code of practice on managing tuberculosis is satisfactory.
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Child↗
Biomedical subjects
C Skinner
Publications and source records attributed to C Skinner.
Chromosomal DNA restriction endonuclease digestion patterns of beta-lactamase-producing Enterococcus faecalis isolates collected from a single hospital over a 7-year period.
Twenty-three beta-lactamase (beta-lac)-producing, highly gentamicin-resistant Enterococcus faecalis isolates collected over a 7-year period from the same hospital were examined by pulsed-field gel electrophoresis of SmaI-digested genomic DNA. The beta-lac+ isolates appeared to form a single clonal group, which had been previously designated the mid-Atlantic pattern. Eleven variations of the mid-Atlantic clone, differing by one to six bands, were identified; some of the changes were likely due to plasmid bands. However, a number of isolates had indistinguishable patterns, including some recovered over a 4-year period. There was a surprising lack of movement of the beta-lac determinant to other strains, although this trait was transferable in vitro by conjugation. We conclude that a single clone (the mid-Atlantic clone) of beta-lac+ E. faecalis has remained endemic in this hospital for at least 7 years. The reason(s) for the apparent lack of spread to other strains of E. faecalis is unknown.
Anti-Bacterial Agents↗
Hepatotoxicity of antituberculosis drugs.
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Age Factors↗
Mineral-cholesterol concentrations of the aortic aneurysmatic wall.
Mineralogical investigations were performed on specimens from the aneurysmatic wall of ascending and descending thoracic and abdominal aortas collected intraoperatively from 10 patients (8 male, 2 female) aged 40-80 years. Scanning electron microscopy with energy dispersive x-ray analyses (microprobe-SEM/EDXA), and atomic absorption spectroscopy (AAS) showed incipient mineral and cholesterol depositions in the tissues of the patients when compared with the normal aorta of the young individual. Grains and crystals of cholesterol, and spherulitic mineralization, probably apatitic, were detected. It is suggested that localized cations imbalance precedes mineralization and is the potential co-factor of aortic wall pathology and aneurysm formation.
Adult↗
HIV positive patients first presenting with an AIDS defining illness: characteristics and survival.
OBJECTIVES: To study the presentation and survival of patients who present with their first diagnosis of being HIV positive at the same time as their AIDS defining illness. DESIGN: Retrospective study of patients presenting with AIDS between 1991 and 1993. SETTING: Department of genitourinary medicine, St Mary's Hospital, London. MAIN OUTCOME MEASURES: AIDS defining illness at presentation and survival after diagnosis of AIDS. RESULTS: Between January 1991 and December 1993, 97 out of 436 patients (22%) presented with their first AIDS defining illness coincident with their first positive result of an HIV test (group B). The remaining 339 patients (78%) had tested positive for HIV-1 infection within the previous eight years and had consequently been followed up in clinics before developing their first AIDS defining illness (group A). The two groups of patients did not differ in age and sex distribution, risk factors for HIV-1 infection, nationality, country of origin, or haematological variables determined at the time of the AIDS defining illness. However, the defining illnesses differed between the two groups. Illnesses associated with severe immunodeficiency (the wasting syndrome, cryptosporidiosis, and cytomegalovirus infection) were seen almost exclusively in group A whereas extrapulmonary tuberculosis and Pneumocystis carinii pneumonia were more common in group B. The survival of patients in group B after the onset of AIDS was significantly longer than that of patients in group A as determined by Kaplan-Meier log rank analysis (P = 0.0026). CONCLUSIONS: Subjects who are HIV positive and present late are a challenge to the control of the spread of HIV infection because they progress from asymptomatic HIV infection to AIDS without receiving health care. The finding that presentation with an AIDS defining illness coincident with a positive result in an HIV test did not have a detrimental effect on survival gives insights into the effects of medical intervention on disease progression after a diagnosis of AIDS.
AIDS Serodiagnosis↗
Safety and activity of saquinavir in HIV infection.
We evaluated saquinavir, an orally active, selective inhibitor of HIV proteinase, in a randomised, double-blind, dose-ranging study in 49 zidovudine-naive HIV-positive patients with few or no symptoms and CD4 cell counts of 500 or less. The study was designed to assess the antiviral activity and tolerability of saquinavir. Patients were randomised to receive 25, 75, 200, or 600 mg of saquinavir three times daily for 16 weeks. No serious adverse events occurred. CD4 cell counts showed a trend indicative of a dose response in favour of the 600 mg dosage, the maximum increase being seen around week 4. In none of the 8 patients with positive plasma viraemia at baseline did cultures become negative after treatment; peripheral blood mononuclear cell and plasma-viral load by culture and DNA and RNA PCR all showed a trend towards reduction at higher doses of saquinovir. Saquinavir was well tolerated in this group of previously untreated patients with few or no symptoms; this study shows that an HIV-proteinase inhibitor is active in HIV-infected patients.
CD4 Lymphocyte Count↗
Fourth national morbidity study.
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Chronic Disease↗
Molecular analysis of G1B and G3A IFN gamma mutants reveals that defects in CIITA or RFX result in defective class II MHC and Ii gene induction.
Class II major histocompatibility complex (MHC) genes and the invariant (Ii) gene are inducible by interferon-gamma (IFN gamma) but not by interferon-alpha and interferon-beta. The promoter regions of these genes contain three regulatory elements that mediate constitutive and IFN gamma-induced expressions; however, none of the DNA-binding proteins that interact with these elements are regulated by IFN gamma. Recently, a gene coding for a transactivator (CIITA) of class II MHC genes that complements a HLA-DR-negative immunodeficiency has been isolated. Using one IFN gamma mutant cell line (G3A) that is selectively defective in HLA-DR and Ii induction, four lines of evidence are presented to show that CIITA mediates the IFN gamma induction of HLA-DR and Ii genes. Analysis of another mutant line, G1B, indicates that the lack of DRA and Ii gene induction by IFN gamma is correlated with the lack of RFX DNA binding activity, thus providing the link between RFX and an IFN gamma response.
Antigens, Differentiation, B-Lymphocyte↗
Differential RNA fingerprinting as a tool in the analysis of spermatozoal gene expression.
The apparent decline in human male fertility and the concomitant increase in testicular pathology have prompted discussion of the underlying molecular mechanisms which may underpin these observations. While monitoring the expression of protamine-2 genes in the human ejaculate, we found a representative complement of sperm mRNAs following sequence-independent amplification of reverse-transcribed cDNAs with the polymerase chain reaction (RT-PCR). The revelation of unique sperm-derived PCR products using this method suggests that it should now be possible to investigate gene expression in human spermatogenesis by differential RNA fingerprinting of ejaculate spermatozoa. The identification of molecular markers and the corresponding genes associated with male infertility will be considerably enhanced by these investigations while obviating the requirement for invasive biopsy.
Base Sequence↗
Intravenous immunoglobulin: implications for use in the neurological patient.
The efficacy of intravenous immunoglobulin (IVIG) in the treatment of the autoimmune disease, idiopathic thrombocytopenic purpura (ITP), has been well documented in the literature. This has encouraged researchers to examine possible therapeutic uses of IVIG in other immune-mediated disorders. Recent clinical reports have suggested that IVIG may have a role in the treatment of neurological disorders with a possible immunopathogenic etiology. Intravenous immunoglobulin, a blood product which contains immunoglobulin G and a trace amount of immunoglobulin A, is believed to work as an immunomodulating agent. However, its mechanism of action is not well understood. Nurses involved with the administration of IVIG must be well informed about the manufacturing and regulation, proper dose and administration, adverse effects, appropriate assessments and related patient education.
Antibody Formation↗
Combined 17 alpha-hydroxylase/17,20-lyase deficiency caused by heterozygous stop codons in the cytochrome P450 17 alpha-hydroxylase gene.
OBJECTIVE: To determine the genetic defect underlying congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency in a genetic female. DESIGN: Blood samples were used as a source of genomic DNA. A library of size selected genomic DNA sequences was prepared. In addition, portions of the 17 alpha-hydroxylase gene were amplified by the polymerase chain reaction and the gene products sequenced. PATIENTS: Samples were obtained from a patient with sexual infantilism, lack of secondary sexual characteristics and hypertension. Streak gonads were found on laparoscopy. RESULTS: Two point mutations were found, one in exon 3 and one in exon 4 which generate premature stop codons at codons 194 and 239 in place of glutamate and arginine respectively. The mutation in exon 3 has not previously been reported in patients with 17 alpha-hydroxylase deficiency. CONCLUSION: The protein product of these defective genes could be expected to be severely truncated with no catalytic activity. This is in keeping with the complete lack of cortisol and sex steroid output in this patient. The polymerase chain reaction provides faster access to gene sequence information than previous procedures based on library screening prior to sequencing.
Adrenal Hyperplasia, Congenital↗
Life-threatening right ventricular thrombosis in association with phospholipid antibodies.
An 18 year old man presented with cough and dyspnoea caused by pulmonary infarction. A large friable mass of organising thrombus in an anatomically normal right ventricle was identified as an embolic source. The acute illness was associated with raised titres of anticardiolipin antibodies, one of the antiphospholipid group. This thrombus recurred after surgical removal but subsequently was dissipated after treatment with oral corticosteroids and long-term oral anticoagulation.
Adolescent↗
Genetic analysis of the steroid 21-hydroxylase gene following in vitro amplification of genomic DNA.
The 5' end of the steroid 21-hydroxylase B gene encompassing putative control regions and the first 3 exons, has been selectively amplified in vitro from a number of patients with congenital adrenal hyperplasia caused by a deficiency of this enzyme. Sequence analysis has revealed a number of isolated instances of gene conversion to the 21-hydroxylase A sequence. One mutation, a C to G transversion at the 3' end of the second intron, thought to lead to incorrect splicing of the mRNA, was found in 11 subjects all with the classical form of the disease.
Adrenal Hyperplasia, Congenital↗
Unusual spinal tuberculosis after adequate chemotherapy for lymph node tuberculosis in an immunocompetent man.
A 35 year old man developed paraplegia due to an epidural mass 15 months after completion of a full chemotherapy course for pulmonary and lymph node Mycobacterium bovis infection. His cellular immune function was normal after treatment. It is suggested that the lesion was a granulomatous healing response rather than bacteriological recurrence.
Adult↗
A multipurpose teaching workstation using expert systems, CD ROM and interactive laserdisc.
This demonstration shows a multipurpose workstation used in a clinical teaching application which combines currently available software suitable for clinical diagnosis and teaching. The medical software includes QMR, Scientific American Medicine, the Slice of Life and generic video laserdisc authoring software developed at the University of Ottawa. The system allows a clinical instructor either in an individual or in a small group teaching setting on a ward or in a classroom, to access high quality differential diagnosis information via QMR, which is then supplemented by the text components of Scientific American Medicine on CD ROM, with video laserdisc of the appropriate anatomy, imagery and pathology provided by one of the various laserdiscs. The generic authoring software allows the instructor or students to construct subject related tutorial or testing modules either with or without video laserdisc support. The workstation uses DESQview as the multitasking environment to control the various resources. This program allows easy transfer from one application to another and allows for marking and pasting of text material into a study document. DESQview can also be used to script a specific learning sequence. The demonstration will show the interaction required to study a specific clinical problem and how this can be made into a meaningful multimedia experience with hardcopy for study purposes.
CD-ROM↗
Improved porcine renal preservation with a simple extracellular solution--PBS140.
In this prospective randomized trial a porcine model of renal autotransplantation was used to compare quality of preservation, as reflected by detailed analysis of posttransplant renal function, following 24-hr cold storage in phosphate-buffered sucrose (PBS140), hyperosmolar citrate (HOC), and University of Wisconsin (UW) preservation solutions. There were 6 deaths with primary nonfunction: 3 of 5 HOC, 2 of 5 UW, but only 1 of 5 PBS140. Analysis of the whole group and separate analysis of the survivors demonstrated significantly better renal function following preservation with PBS140 when compared with both HOC and UW, with a lower peak serum creatinine (P = 0.02) and improved loop of Henle function (P = 0.02). The animals in the PBS140 group also demonstrated a more rapid return to normal creatinine, higher GFR, improved tubular function, and higher effective renal plasma flow, with figures approaching statistical significance (P = 0.06-0.07). The proposal of UW as a universal storage medium prompted this study, and its results suggest the need for a clinical comparison of renal preservation using UW and PBS140 in a prospective randomized trial.
Adenosine↗
The case for samples of anonymized records from the 1991 census.
"The census of population represents a rich source of social data. Other countries have released samples of anonymized records from their censuses to the research community for secondary analysis. So far this has not been done in Britain. The areas of research which might be expected to benefit from such microdata are outlined, and support is drawn from considering experience overseas. However, it is essential to protect the confidentiality of the data. The paper therefore considers the risks, both real and perceived, of identification of individuals from census microdata. The conclusion of the paper is that the potential benefits from census microdata are large and that the risks in terms of disclosure are very small. The authors therefore argue that the Office of Population Censuses and Surveys and the General Register Office of Scotland should release samples of anonymized records from the 1991 census for secondary analysis."
Censuses↗