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Biomedical subjects

M A Kingston

Publications and source records attributed to M A Kingston.

13 recordsLinked to original sources
PubMed2004

Audit of the management of early syphilis at North Manchester General Hospital.

The city of Manchester has seen a sustained increase in reported cases of early (infectious) syphilis since the late 1990s. We audited the management of patients presenting with early syphilis to North Manchester General Hospital, with reference to the UK national guidelines. Between January 1999 and December 2001 72 cases of early syphilis were identified. Most (90%) occurred in men who have sex with men, 50% of whom were HIV-positive. Serology and polymerase chain reaction testing of lesions were useful diagnostic tests. Treatment regimens followed the national guidelines in 63% of cases, with adherence to the guidelines improving as the outbreak continued. The majority of patients were treated with intramuscular penicillin (78%), with only three discontinuing this treatment due to side effects. Only 4% of sexual contacts identified were traced and screened, an indication of high levels of both anonymous sex and partner change in this group.

Administration, Oral↗
PubMed2004

Training in genitourinary medicine from the specialist registrar's point of view: opportunities and facilities available across the UK and plans for future working.

In recent years training for specialist registrars (SpRs) in GU medicine has undergone a number of changes. In addition, the speciality in general is undergoing modernization and change and issues of workforce planning and consultant job availability have been of particular importance to SpRs. In March 2003 a postal survey of SpRs in the UK was undertaken to evaluate training, future career plans and working patterns. A 59% (69/117) response rate was achieved and overall most SpRs expressed satisfaction with their training. However, a number of concerns were raised with aspects of training, which are discussed in this paper. Nearly half of SpRs will consider working part time in the future and almost two-thirds are interested in job sharing. This is the first survey of its kind in GU medicine and the results are informative to all involved with SpR training programmes and workforce planning in the speciality.

Education, Medical, Graduate↗
PubMed2004

Genitourinary medicine: an opportunity to reduce unwanted pregnancy.

We sought to investigate contraceptive use in women attending a genitourinary medicine (GUM) clinic, and to assess the need for a contraceptive service in this setting. Female attendees at Nottingham GUM clinic were invited to complete an anonymous questionnaire regarding past and present contraceptive use and whether a contraceptive service within GUM would be utilized. Four hundred and eighty-nine questionnaires were analysed. The majority had previously used condoms (89.8%) or the combined oral contraceptive pill (COCP) (74.6%), and 46.6% and 37.4%, respectively were currently using these methods. Contraception was frequently used for the dual aims of avoiding both pregnancy and infection (48.5%). General practitioners (GPs) and family planning clinics were most frequently cited as sources of regular contraceptive advice, 58.1% and 47.2% respectively, and emergency contraception 50.8% and 37.3%, respectively. If a contraceptive service was available within GUM 56.9% of respondents indicated they would use it.

Adolescent↗
PubMed2003

Use of PCR in the diagnosis of early syphilis in the United Kingdom.

OBJECTIVES: To evaluate a Treponema pallidum polymerase chain reaction (PCR) test in the laboratory diagnosis of early syphilis in the United Kingdom. SUBJECTS AND SETTING: Men and women attending genitourinary medicine clinics in England. METHODS: A trial PCR service was offered for the analysis of swabs of ano-genital or oral ulcers suspected to be syphilitic in origin. Clinical details, results of treponemal serology, and other relevant laboratory tests carried out by the sending laboratories were obtained retrospectively by questionnaire. RESULTS: Data from 98 patients, representing 100 episodes of ulceration, were analysed. The majority of patients (70) attended clinics in the Greater Manchester area. Eighty six patients were male and 58 were men who have sex with men (MSM), of whom 24 were HIV positive. PCR results agreed with the clinical diagnosis for 95 patients; samples from 26 patients were PCR positive and serologically diagnosed as primary (18) or secondary (8) syphilis, whereas 70 patients had PCR negative samples and were not diagnosed as having active syphilis. These data include two HIV positive patients who were PCR positive 12 and 21 days before their treponemal seroconversion. One positive PCR result was not supported by positive treponemal serology (this patient coincidentally received a 10 day course of co-amoxiclav 1 week after sampling). Three patients had negative PCR results but positive syphilis serology. The sensitivity, specificity, positive and negative predictive value for primary syphilis were 94.7%, 98.6%, 94.7%, and 98.6%, respectively, and for secondary syphilis these were 80.0%, 98.6%, 88.9%, and 97.2%, respectively. CONCLUSION: PCR is a sensitive and specific test for T pallidum, and an important adjunct to dark ground microscopy and treponemal serology in diagnosing infectious syphilis in the United Kingdom.

DNA, Bacterial↗
PubMed2003

'Shelf life' of Trichomonas vaginalis.

The diagnosis of Trichomonas vaginalis (TV) infection in women may be made by observing motile trichomonads in wet-mount preparations of vaginal discharge. The duration for which these organisms can be identified in such samples is unknown. We sought to assess this by performing wet-mount microscopy on samples from female patients immediately, and then in positive samples, every 10 minutes until motile trichomonads could no longer be identified. Of the 65 wet-mount specimens positive for TV, a cumulative total of 13 (20%) samples had become negative by 10 minutes, 23 (35%) samples by 30 minutes and 51 samples (78%) by two hours, with the remainder exceeding two hours. We conclude that one-fifth of wet-mount vaginal preparations initially positive for motile TV become negative within 10 minutes of the initial, immediate reading. In order to maximize the sensitivity of this widely used test it is recommended that all specimens be examined immediately after they are taken.

Animals↗
PubMed2001

Penile fracture.

A wide range of patients present to genitourinary medicine (GUM) clinics with diverse conditions, many of which may not be infective. One such condition, albeit rare, is penile fracture. This is a traumatic rupture of the corpus cavernosum usually associated with blunt trauma to the erect penis. Prognosis and management issues are discussed.

Adult↗
PubMed2001

The investigation of patients with HIV infection: 10 years of progress.

The past decade has seen great advances in the management of patients with HIV infection. The introduction of highly active antiretroviral therapy (HAART) has resulted in a decrease in opportunistic infections but the development of new clinical entities such as lipodystrophy and immune reconstitution illnesses. The use of investigations such as lipid profiles and dual energy X-ray absorptiometry (DEXA) scanning to assess lipodystrophy have been necessitated by these changes in the epidemic. Technological advances have resulted in new techniques such as viral resistance assays and single photon emission computed tomography (SPECT) scanning. The appropriate use of these investigations is subject to ongoing assessment.

Absorptiometry, Photon↗
PubMed2000

Glucose sensor with improved haemocompatibilty.

A new biocompatible copolymer has been synthesised and used in an electrochemical enzyme-based glucose sensor. The copolymer incorporates three segments including a monomer with an electrically neutral phosphorylcholine head group that is able to reject protein adsorption and two segments that increase the affinity to polyurethane substrate. Peel and solution circulation tests showed that this material has high attachment to polyurethane. With the new copolymer as the outermost layer and the polyurethane as the diffusion-limiting membrane, the sensor showed extended linearity up to 50 mM glucose and stable output in bovine serum for 70 h. During in vivo tests, the sensor exhibited a steady current signal and a rapid transient response when the glucose concentration was raised. These results imply that the haemocompatibility of the glucose sensor coated with the new copolymer has been improved, which is crucial for a sensor used for clinical real-time monitoring. The material may also be suitable for application to other implantable devices.

Animals↗
PubMed1995

Role of metabolic acidosis on cardiac mechanical performance during severe acute hypoxia and reoxygenation is small and transient.

OBJECTIVE: The aim was to determine whether the metabolic acidosis that develops during severe acute myocardial hypoxia improves or impairs the recovery of cardiac mechanical function during reoxygenation. METHODS: Isolated rat hearts performed external work against a model of the rat systemic vascular impedance. Four groups of 10 hearts were used for mechanical studies. In these experiments, the hearts were subjected to normoxic ventilation for 15 min, hypoxic ventilation for 20 min, and reoxygenation for 60 min. The perfusate pH was either allowed to drift downward due to metabolic acidosis, or it was corrected to 7.4 as hypoxia or reoxygenation began. Mechanical performance was assessed by measuring heart rate and model "aortic" pressure and flow and by computing left ventricular mean, pulsatile, and total hydraulic power output and stroke work. A further four groups of 10 hearts were used for biochemical studies. In these experiments, myocardial high energy phosphates and calcium content were measured at the end of the period of hypoxia. RESULTS: When no attempt was made to regulate the perfusate pH, it drifted downward from 7.40(SEM 0.01) to 7.33(0.01) during hypoxia and then to 7.25(0.02) during reoxygenation. All mechanical variables measured and computed were severely depressed by hypoxia, whether the pH was regulated or not. Left ventricular total hydraulic hydraulic power output decreased to less than 10% of the control value in all experiment groups and recovered to 86.7-91.2% of the control value after 60 min of reoxygenation. Mechanical recovery was most rapid when the correction of acidosis was delayed until reoxygenation was begun. After 5 min of reoxygenation, it had recovered to 65.5% of the control value compared with a 37.0% recovery when the pH was allowed to drift and 34.9% when the pH was corrected to 7.4 during hypoxia. However, the differences in power output became non-significant after 10 min of reoxygenation. Myocardial creatine phosphate and adenosine triphosphate concentrations were decreased by hypoxia whether the pH was corrected (63.0% and 26.9% relative to the control), or not (68.9% and 35.0% relative to the control) (not statistically significant), but total cell calcium was not affected. CONCLUSIONS: In the isolated rat heart, correction of the moderate metabolic acidosis that developed during severe acute myocardial hypoxia improved the rate of mechanical recovery, but the effect was small and not sustained.

Acidosis↗