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Biomedical subjects

J S Bingham

Publications and source records attributed to J S Bingham.

At least 37 records · Page 2Linked to original sources
PubMed1999

Sexually transmitted infections in Estonia.

Estonia, one of the Baltic countries, regained its independence in 1991, after the collapse of the USSR. This process led to great changes in every sphere of life--in politics, in the economy and in medicine. The service providing care for sexually transmitted infections (STIs) was involved in the process of these changes, too. However, freedom was followed not only by great happiness, but also by social destabilization and transformation of the old moral norms, the most evident features of which were the dramatic rise in crime, a sexual revolution and public prostitution. These 2 great simultaneous transformations in the STI care system and public mores led to the rapid increase of STIs in Estonia in the first half of the 1990s. Now some stabilization, and even a fall in incidence has occurred.

Delivery of Health Care↗
PubMed1998

Persistence of Pseudomonas aeruginosa strains in respiratory infection in AIDS patients.

OBJECTIVES: To establish the clinical pattern of Pseudomonas aeruginosa respiratory infections in HIV-seropositive patients and to determine whether repeated isolation of the organism represents reinfection or recurrence and to assess whether common source, nosocomial infection occurred. DESIGN AND METHODS: Evaluation of the clinical pattern of P. aeruginosa respiratory infections by case note review and epidemiological characterization of P. aeruginosa by serotype determination and Xbal DNA macrorestriction analysis. Serum sensitivity testing of strains was performed to further define phenotypic characteristics of the isolated organisms. RESULTS: Seventy-three per cent (29 out of 40) of individuals had P. aeruginosa isolated on two or more occasions in the setting of clinical respiratory infection. Overall, 85% had evidence of P. aeruginosa to within 2 months of study completion or death. Epidemiological characterization revealed persistence of unique single strains in 93% of individuals where multiple isolates were available for testing, whereas only two patients harboured a common strain. The serotype distribution of strains was similar to that reported from non-HIV-positive patients. CONCLUSIONS: Once established, eradication of P. aeruginosa from the respiratory tract of HIV-seropositive individuals with advanced immunosuppression is problematic and a chronic infective state appears common. There was no evidence of nosocomial transmission. Serotype loss and development of sensitivity to normal human serum were both observed and were highly correlated. This represents truncation of O-antigenic lipopolysaccharide on the cell surface of P. aeruginosa and may reflect progression to phenotypes commonly associated with chronic infection in other clinical settings such as cystic fibrosis.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Radioactively labelled diethylene triamine penta acetate lung scan in Pneumocystis carinii pneumonia and asymptomatic HIV-positive patients.

The objective of this study is to establish normal ranges for the assessment of lung permeability, using 99mTc DTPA (diethylene triamine penta acetate) aerosol by measuring the half-time of transfer from the lung in asymptomatic HIV-positive patients. Also to audit the use of the test in the clinical management of outpatients with symptoms suggestive of Pneumocystis carinii pneumonia (PCP). A retrospective analysis of data from outpatients' notes for the audit of symptomatic patients, and prospective acquisition of 'normal' data for HIV-positive asymptomatic patients who were non-smokers and smokers was performed. Over a period of 8 years, DTPA scans were performed on 400 asymptomatic HIV-positive patients (121 non-smokers and 279 smokers) and 188 symptomatic HIV-positive patients with symptoms suggestive of PCP. A biphasic curve of transfer of 99mTc DTPA with a half-time of less than 4 min, was considered diagnostic of PCP. The mean half-times (+/-SEM) for asymptomatic non-smokers was 61.4 +/- 3 min and for smokers was 21.9 +/- 0.8 min. In the symptomatic patients, 106 were treated for PCP and in 97 (91.5%) of these, the transfer was biphasic. Of the remaining 82 patients with respiratory pathology other than PCP, 71 (86.6%) had normal scans. The results show that smokers may have abnormal baseline scans 16/ 279 (5.7%) and therefore a baseline scan before symptoms should be recorded or a higher false positive rate can be expected. The test is however highly sensitive for the detection of PCP and allows the attending physician to initiate PCP treatment without delay.

AIDS-Related Opportunistic Infections↗
PubMed1996

Hepatitis B vaccination schedules in genitourinary medicine clinics.

OBJECTIVES: To compare two vaccination schedules in delivering hepatitis B vaccine to at-risk genitourinary medicine clinic attenders. SETTING: Genitourinary medicine clinic of St Thomas' Hospital, London, UK. METHODS: Two vaccination protocols were compared. Between January 1991 and December 1992, individuals had doses of recombinant hepatitis B vaccine at 0, 1 and 6 months (standard). From January until October 1993 doses of vaccine were administered at 0, 1 and 2 months (accelerated), following which timing of a booster dose was made on the basis of hepatitis B surface antibody (anti-HBs) assessment. Case notes were reviewed with regard to compliance rates and anti-HBs levels. RESULTS: Two hundred and fourteen individuals were included (standard 104, accelerated 110). Of the standard group 80.8% and 61.5% attended for the 2nd and 3rd doses respectively compared with 80.0% and 75.5% of the accelerated group (attendance for the 3rd dose chi 2 = 4.19, p < 0.05). For both of these groups compliance was significantly better in those who requested vaccination rather than being offered it opportunistically (chi 2 = 4.86, p < 0.05). Seroconversion rates were not significantly different between the two groups (87.5% versus 83.1%). A significantly higher proportion of the standard group, however, achieved anti-HBs levels greater than 100 i.u./l. CONCLUSIONS: Completion of hepatitis B vaccination was improved by changing to a 0, 1 and 2 month protocol. Levels of anti-HBs achieved in the accelerated group, however, were lower. If it is confirmed that maintaining anti-HBs levels is not important in retaining protection against hepatitis B then the accelerated schedule has clear advantage. If not, the advantages may be nullified by the need, in some, for an early booster.

Adolescent↗
PubMed1995

Adherence of Malassezia isolates to human keratinocytes in vitro--a study of HIV-positive patients with seborrhoeic dermatitis.

Adherence of Malassezia yeast cells to human keratinocytes was assessed by a novel technique using double-sided Sellotape. Although adherence using double-sided Sellotape is still merely a model for in vivo adherence, it approximates to the conditions found on the skin surface. There were no differences in adhesive properties to human keratinocytes between Malassezia strains originating from HIV-positive and HIV-negative patients with seborrhoeic dermatitis, nor was there a relationship between the severity of seborrhoeic dermatitis and in vitro adherence to human keratinocytes.

Adult↗
PubMed1993

Changes in circulating immune complexes during the Jarisch Herxheimer reaction in secondary syphilis.

A cohort of 16 patients with early secondary syphilis were recruited to investigate the role of circulating immune complexes in the pathogenesis of the Jarisch Herxheimer reaction. Eleven of 16 patients had a reaction (68.75%) following initial therapy, characterised by rash potentiation, pyrexia, cardiovascular changes and a number of less specific symptoms. Circulating immune complexes were measured by a standard polyethylene glycol precipitation method and a new sensitive conglutinin binding assay that measured the proportion of IgG, IgM and IgA in complexes, in the first 8 hours after initial therapy. In the latter assay, resting levels of IgG (range 46-700 micrograms/ml) and IgM (range 100-410 micrograms/ml) containing complexes were raised in all patients prior to treatment, but levels were not predictive of those who subsequently had a Jarisch Herxheimer reaction. All patients having a reaction demonstrated a mean fourfold or greater rise in IgG (mean rise 712 micrograms/ml; range 180-1506 micrograms/ml) and IgM (mean rise 804 micrograms/ml; range 200-1120 micrograms/ml) containing complexes between two and eight hours after initial therapy. No such effect was seen in the five patients having no reaction or in a control subject. All these results were confirmed using the polyethylene glycol precipitation method for complex detection.

Adult↗
PubMed1993

Attitudes of medical students to HIV and AIDS.

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.

Acquired Immunodeficiency Syndrome↗