Biomedical subjects
Publications and source records attributed to D T Evans.
The author explains the pitfalls that can make the treatment of STDs difficult in general practice. In this, the second section of his article, he describes the treatment of bacterial vaginosis, chlamydia, syphilis, gonorrhoea and Hepatitis B and C and other STDs.
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Infection with Neisseria gonorrhoeae was cleared in 61 men and 26 women at all sites (except in the pharynx of one male bisexual patient with urethral and pharyngeal gonorrhoea) after treatment with aztreonam as a single 1 g intramuscular injection. Aztreonam was well tolerated with no adverse effects. This monobactam antibiotic was effective against both penicillin sensitive and resistant strains.
Sex hormones are possible determinants of systemic lupus erythematosus (SLE). Hence treatment with tamoxifen, which competes for oestrogen receptors, was assessed in 11 female patients with stable SLE in a double-blind crossover trial. The indices used included clinical signs of SLE, renal function, leucocyte counts, serum antinuclear and anti-DNA activity, and serum levels of complement and immune complexes. No patient improved on tamoxifen and two deteriorated. Significant side effects were encountered. The trial yielded no evidence that tamoxifen had an ameliorative effect on clinical or laboratory indices of activity of SLE.
A woman with cancer of the cervix had over a 4-week period three anesthetics with halogenated anesthetic agents, halothane, enflurane and halothane. 1 day after the third halothane anesthetic she developed fever and jaundice with biochemical evidence of severe hepatitis. Liver biopsy 10 days after the onset of jaundice showed features of acute hepatitis with bridging necrosis and piecemeal necrosis. A second biopsy after 10 months showed quiescent cirrhosis with residual piecemeal necrosis. The case is reported as a further example of halothane hepatitis evolving to cirrhosis of the liver.
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A 44-year-old nurse with a 12-year history of systemic lupus erythematosus developed a schizophrenia-like psychosis due to cerebral lupus. Prednisolone in doses up to 200 mg daily was ineffective. Levels of immune complexes by the Raji cell assay were greatly increased in serum and cerebrospinal fluid. Plasma exchange was performed on 4 occasions over 4 days. Three days later, there was a marked and sustained improvement in the mental state, the psychosis resolved and tests of psychological function and electroencephalographic abnormalities improved. There was a corresponding decrease in levels of immune complexes and in titres of anti-neuronal antibody. Five months later, several serological indices had risen to pre-plasmaphaeresis levels except for the level of immune complexes. The patient remained in clinical remission. This case provides further evidence that high levels of circulating immune complexes may be a determinant of cerebral lupus and that plasmaphaeresis may be of lasting benefit in this disease.
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This article on false positive serological reactions for syphilis reviews the rapid developments which have taken place in the serodiagnosis of syphilis in recent years since the advent of the AIDS epidemic. An overview of non-specific and specific treponemal serological tests in relation to acute and chronic biological false positive reactions is followed by closer consideration of syphilis serology in the context of HIV infection, pregnancy and other conditions which may produce false positive reactions.
Myths and fears are intimately associated with issues of sex, sexuality and sexual health. Many myths and fears, present in both the education and clinical settings, prevent health carers from maximizing the potential for wholeness and wellness, for both themselves and their clients. In order for nurses, midwives and health visitors to take their role in therapeutic communication around the sex issues seriously, these myths must be dispelled and the fears overcome. Many of the hindrances to communication are shrouded in other people's taboos and morals, and hidden within the languages of clinical terminology and silence. This leads numerous clinicians and educators to an incommensurate fear of dealing with the sexual issues of life. This article argues that this is an example of institutionalized erotophobia (fear of sex), which results in a barrier to genuine, therapeutic, communication. For the sake of brevity, 'sex' will refer to sex, sexuality and sexual health. Likewise, unless a clear distinction is being made, 'nurse' will include midwives and health visitors.
The state of education and service provision relating to young people and sex, sexualities, and sexual health is currently a major national challenge. Nurses working in the compulsory education sector are at the direct interchange between clients and their obvious experiential and academic needs, and attitudes and systems that frequently seem to fail them. From concerned parents and members of the public, through the teaching and nursing professions, to the UK Government, the message is the same: something must be done to improve the current status quo. The problem lies in the different beliefs about what to do and how to do it. School nurses are in a prime position to improve sexual health education and services for young people. However, it is unreasonable to expect school nurses, who are frequently overburdened with task-oriented jobs, to be effective with an additional remit for sexual health education without adequate support, resources and effective professional training. This article explores the role of school nurses as it develops to encompass numerous aspects of sexual health care. In order to enhance and promote these changes in line with client needs the article examines the strengths, weaknesses, opportunities and threats (SWOT analysis) of this changing role.