Search PubMed⌕ Search

Biomedical subjects

M Shahmanesh

Publications and source records attributed to M Shahmanesh.

At least 37 records · Page 2Linked to original sources
PubMed1998

The clinical load of HIV and AIDS for genitourinary physicians.

We aimed to investigate the extent of genitourinary medicine (GUM) involvement in the clinical management of HIV. A questionnaire survey was conducted on GUM consultants in the UK and the Irish Republic. Clinics were divided into teaching hospitals (THs) undertaking both undergraduate and postgraduate training in GUM, non-teaching training (NTT) centres undertaking specialist training only and non-teaching (NT) centres. Information was obtained on 241 of the 250 consultants on the Royal College of Physician's GUM Committee's records from 117 GUM clinics (including all THs and NTT centres). Four (1 TH and 2 NTT centres) GUM clinics did not see HIV-positive patients, 62 saw 10-99 patients, 18 reported 100-999 and 4 with over 1000 patients attending in 1996. Thirty-five per cent of the 55 THs and NTT centres had over 100 HIV patients. Consultants were involved in the outpatient care of HIV patients in 99.5% and GUM trainees in 85.5% clinics. Overall 47 clinics have their own inpatient HIV beds and 176 consultants (73%) had full (100) or significant (76) input to inpatient HIV management. Only 29% of THs and 12.5% of NTT centres had none or minor input into HIV care. HIV inpatient on-call commitment by the GUM trainees was reported by 64% of training centres. GUM services provide a major input into outpatient and inpatient care of HIV-infected patients in the UK.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Thermosensory threshold: a sensitive test of HIV associated peripheral neuropathy?

The purpose of the study was to assess the prevalence of thermosensory abnormalities in patients infected with HIV infection. Using a Thermo Sensory Analyser, we assessed thermosensory threshold for warm sensation (WS) and cold sensation (CS) of the forearm and foot in 40 controls and 75 HIV positive patients, including five patients with clinically evident peripheral neuropathy, three with AIDS-related dementia and 20 with AIDS. We found that thermosensory threshold is a reproducible test. The 95th centile for normal WS of the forearm was 1.4 degrees C above and CS 0.9 degrees C below the baseline temperature of 32 degrees C, and for WS of the foot was 5.3 degrees C and CS 4.4 degrees C respectively. The median WS of the foot for controls was 1.4 (IQR 0.7-2.8) degrees C, for asymptomatic HIV positive patients was 1.9 (1.1-4.2) degrees C, for patients with AIDS was 3.5 (1.6-5.7) degrees C and for those with peripheral neuropathy was 5.4 (1.7-14.9) degrees C (P< 0.05 compared to controls). A higher threshold was also evident for CS in patients with advanced HIV disease. These findings suggest that thermosensory testing is a sensitive tool in detecting early, small nerve fibre disease before the onset of clinically evident peripheral neuropathy.

AIDS Dementia Complex↗
PubMed1998

Serum kynurenine-to-tryptophan ratio increases with progressive disease in HIV-infected patients.

An alternative pathway of Trp metabolism involves the conversion of Trp to kynurenine by indoleamine-2,3-dioxygenase, which leads to synthesis of the neurotoxin, quinolinic acid. This study explores the relationship of indoleamine-2,3-dioxygenase activity with stages of HIV infection. Sera from 206 HIV-positive and 72 seronegative subjects were analyzed for Trp and kynurenine. The kynurenine-to-Trp (KT) ratio was calculated. The mean KT ratio of seronegative controls was 36.6 +/- 10.9, and the median ratio was 34.9. The upper limit of the seronegative KT ratio, defined as mean + 2 SD, was 58.4. Patients with HIV infection showed a reciprocal relationship between the KT ratio, the CD4 count, and the stage of the disease. The median KT ratios for asymptomatic and AIDS patients were 50.5 and 117.0, respectively. This study shows that the serum Trp concentration is markedly decreased and that the kynurenine concentration is increased with immune stimulation in HIV infection. This may lead to changes in quinolinic acid and explain some of the pathogenesis of AIDS dementia.

AIDS Dementia Complex↗
PubMed1997

Hepatitis B markers in heterosexual patients attending two genitourinary medicine clinics in the West Midlands.

OBJECTIVE: To determine the prevalence of hepatitis B virus (HBV) infection in heterosexual patients attending two genitourinary medicine (GUM) clinics in the West Midlands and to examine whether heterosexual activity is a risk factor for acquiring HBV infection with the view to extend HBV vaccination policies to cover this group. DESIGN: HBV markers were determined in the GUM study group and compared with that of the control groups. Responses to a questionnaire were used to examine sexual behaviour patterns that may be related to heterosexual acquisition of HBV infection. SETTING: The West Midlands, UK April 1992-January 1993. SUBJECTS: 788 male patients and 688 female patients attending GUM clinics were compared with 498 male blood donors and 563 females attending antenatal clinics for the seroprevalence of HBV markers. Potential risk factors related to heterosexual activity were assessed in 1436 patients in the study group. MAIN OUTCOME MEASURES: Prevalence of HBV markers in the GUM study group and the controls. The possible use of the risk factors examined as predictors for acquiring HBV infection. RESULTS: The seroprevalence of hepatitis B core antibody (anti-HBc) in GUM patients was 1.9% and 0.5% in the control group. In the study groups the prevalence of anti-HBc from Birmingham was 3.2% while that from Coventry was 0.8%. The low seroprevalence of HBV prevented a multiple logistic analysis. A limited regression analysis showed that being non-white (p < 0.001) and duration of sexual activity (p = 0.013) were risk factors for HBV infection. However, these two factors were poor predictors of the risk to exposure to HBV infection. CONCLUSION: The prevalence of HBV infection in heterosexual patients in the West Midlands is very low and does not provide any indications to broaden HBV vaccination into heterosexual patients attending GUM clinics. Risk factors were poor predictors of the exposure to HBV infection. This is partially due to the low prevalence of HBV infection in this study. Further studies are required before definitive conclusions are made regarding the potential predictive value of risk factors.

Adult↗
PubMed1997

Women with recurrent vaginal candidosis have normal peripheral blood B and T lymphocyte subset levels.

OBJECTIVE: To compare the B and T lymphocyte subset levels of otherwise healthy women suffering from frequently recurrent vaginal candidosis with a healthy control group. SUBJECTS: 26 unselected otherwise healthy women of reproductive age with at least four attacks of vaginal candidosis in the past year and more than three vaginal isolates of a moderate or heavy growth of Candida albicans. Controls were 26 patients or clinical and laboratory staff (asymptomatic for genital infection) matched for time of day and age within 5 years. Only three patients accepted an HIV test. All proved HIV negative. No controls were tested. MAIN OUTCOME MEASURES: T lymphocyte subsets (CD4 and 8) and B lymphocytes (CD 19) as estimated from the total lymphocyte count and flow cytometry. RESULTS: No statistically significant difference between patients and controls. CONCLUSION: No significant difference was found between patients and controls in levels of lymphocyte subsets.

Adult↗
PubMed1996

Sexual behaviour in travellers abroad attending an inner-city genitourinary medicine clinic.

OBJECTIVE: To investigate frequency of sexual encounters with new partners abroad in patients attending a genitourinary clinic (GUM). METHODS: In a case series 464 attenders at a genitourinary medicine clinic completed an anonymous self-administered questionnaire, if they had been abroad recently, enquiring about sexual behaviour abroad. RESULTS: 28.4% of subjects admitted to sex with a new partner abroad with only 41.7 per cent consistently using condoms. There were no significant differences in condom use for gender, ethnicity or type of visit and relationship. Twenty-nine per cent of those admitting to sex abroad had more than one partner. The risk of multiple partners was not associated with gender, ethnicity, type of visit (holiday or business) or type of relationship (heterosexual or homosexual). The first partner abroad for 63% of men and 62.5% of women was of a nationality other than that of United Kingdom residents. Non-Caucasians and homosexuals were significantly more likely to have first partners abroad from outside the UK than Caucasians and heterosexuals respectively. CONCLUSION: The occurrence of casual sex abroad in GUM attenders suggests that further research is needed to establish targetable risk factors for this type of behaviour amendable to change through health promotion.

Adolescent↗
PubMed1996

Urethral lymphocyte isolation in non-gonococcal urethritis.

AIMS: A pilot feasibility study to investigate the local immune response in patients with non-gonococcal urethritis (NGU). METHODS: Urethral lymphocytes were extracted from first void urine (FVU) of patients with non-gonococcal urethritis and gonorrhoea using magnetic beads coated with antibody against either the pan-T cell marker CD2 or to CD4. The CD2+ and CD4+ lymphocyte content of FVU were compared between chlamydia-positive and chlamydia-negative and between first and subsequent attacks of NGU. RESULTS: Median CD2+ lymphocyte content of FVU was significantly higher in cases of gonorrhoea and chlamydia-positive urethritis than in chlamydia-negative NGU. Median CD2+ lymphocyte content of FVU in chlamydia-negative NGU was 15.6 x 10(4), (n = 14 range 3.2-111) which was significantly lower than in chlamydia positive NGU (35.2 x 10(4), n = 18, range 7.4-390 p = 0.037) and gonorrhoea (67.7 x 10(4), n = 8 range 13-501, p = 0.019). Comparing the first with subsequent attacks of NGU, CD2+ cell numbers were greater in those presenting with their first episode of chlamydia-negative NGU (21.8 x 10(4), range 5.6-111) compared with those who had experienced NGU before (12.3 x 10(4), range 3.2-20.4, p = 0.033), but not in those presenting with chlamydia-positive NGU. There was no difference in CD4+ cells between any of the groups. CONCLUSION: The lower total lymphocyte content of subsequent attacks of chlamydia-negative NGU compared with the first attack chlamydia-positive and negative NGU suggests that a different aetiology may be operating in some of these patients. Sufficient lymphocytes can be isolated from the urethra in patients with NGU for studies of lymphocyte subsets to be carried out.

CD4 Lymphocyte Count↗
PubMed1995

The treatment of bacterial vaginosis with a 3 day course of 2% clindamycin cream: results of a multicentre, double blind, placebo controlled trial. B V Investigators Group.

OBJECTIVE: To evaluate the efficacy and safety of a 3 day course of intravaginal clindamycin 2% cream for the treatment of bacterial vaginosis. DESIGN: A prospective, randomised, double-blind placebo controlled study. SETTING: Departments of genitourinary medicine at Birmingham, Nottingham, Liverpool, Swansea, Leeds, Walsall, Stoke Mandeville, Southampton, Plymouth, Bishop's Stortford and Glasgow. SUBJECTS: Pre-menopausal women aged 18 years and over, who had symptomatic bacterial vaginosis were randomly allocated to receive either clindamycin 2% cream 5 grams (107 patients) or matching placebo cream (114 patients), daily for three days. Response to therapy was assessed at 7 days (Visit 2) and 28 days (Visit 3). RESULTS: 221 patients with symptomatic bacterial vaginosis were enrolled to the study and of these 141 (63.8%) completed the study. On the "intent-to-treat" (ITT) analysis, 75% of the clindamycin group were classified as "success" or "improved" at visit 2 compared with 13% of the placebo group (p < 0.001). At Visit 3, 41% of the clindamycin group were classified as either "success" or "improved" versus 4% in the placebo group (p < 0.001). Of the 80 patients who were recorded "success" or "improved" at visit 2, 20 (25%) were reported to have a "recurrence" of BV at Visit 3. The meta-analysis on those who were evaluable at Visit 2 and 3 also showed that clindamycin cream 2% was an effective treatment for bacterial vaginosis, and the differences between the clindamycin group and the placebo group were statistically significant. CONCLUSION: We conclude that a 3 day course of clindamycin 2% cream is an effective, and well tolerated treatment for bacterial vaginosis.

Administration, Intravaginal↗
PubMed1995

Response to influenza immunisation in asymptomatic HIV infected men.

OBJECTIVE: This study aimed to determine if patients with HIV infection can develop a significant antibody response to influenza immunisation, and whether such immunisation is detrimental to the progression of their HIV illness. DESIGN: Prospective, non-randomised study. METHODS: The titres of antibody response to influenza immunisation were determined in 44 asymptomatic HIV positive men and compared with 16 HIV presumed seronegative controls. The magnitude of response were correlated with patients' CD4 lymphocyte counts. The rate of CD4 lymphocyte count decline over a median of 12 months before and after immunisation were also evaluated. RESULTS: Thirty-two of the 44 HIV positive subjects (73%) were able to mount a four-fold or greater response to at least one of the influenza strains, and 14 of them (32%) did so to all four strains. In comparison, 15 of the 16 controls (93.5%) had a four-fold or greater response to at least one, and six of them (38%) to all influenza strains, which was not significantly different from the HIV positive group. The magnitude of increase in antibody titre was not significantly different between the two groups either. CD4 lymphocyte count change for a median of 12 months after immunisation was not different from a median of 12 months before immunisation. CONCLUSIONS: Asymptomatic HIV infected patients are able to mount antibody response to influenza immunisation, which appears to be safe in respect to HIV illness progression in the short term.

Adolescent↗
PubMed1993

Chemotactic activity of urethral secretions in men with urethritis and the effect of treatment.

The chemotactic activity of urethral exudate and the effect of treatment were assessed in 67 patients with nongonococcal urethritis (NGU) or gonorrhea. All samples demonstrated chemotactic activity related to the number of neutrophils seen on Gram's staining of the urethral smear. Chemotactic activity decreased after treatment in patients with Chlamydia-positive NGU (mean +/- SE, 21.1 +/- 2.7 cells/high-power field [hpf] before treatment; 8.7 +/- 2.2 after treatment; P < .004) and gonorrhea (25.6 +/- 5.2 cells/hpf before treatment; 1.6 +/- 0.7 after treatment; P < .015). Chemotactic activity increased again in Chlamydia-positive NGU patients to 21.0 +/- 3.3 cells/hpf (P < .05) 2-3 weeks after cessation of therapy in the absence of demonstrable infection or further intercourse. There was no significant decrease in chemotactic activity after therapy in the Chlamydia-negative NGU or persistent urethritis groups. These data suggest a previously unrecognized persistent chemotactic stimulus in urethral exudate from patients with urethritis.

Chemotaxis, Leukocyte↗
PubMed1992

T-lymphocyte responses to Pneumocystis carinii in healthy and HIV-positive individuals.

Pneumocystis carinii pneumonia (PCP) is a well-recognized cause of morbidity in patients with impaired T-cell function. In this study of cellular immunity to P. carinii, peripheral blood mononuclear cells from 25 HIV antibody-positive (HIV+) patients and 11 healthy individuals were stimulated in vitro with P. carinii antigen. The responding T-cell blasts were cocultured with autologous P. carinii antigen-pulsed macrophages to measure P. carinii-specific cytolytic T-lymphocyte activity (CTL). T-cell blasts from two healthy donors were used to generate P. carinii-specific clones by limiting dilution. T cells from HIV+ patients proliferated less to P. carinii antigen than T cells from healthy volunteers. In contrast, the level of specific cytotoxicity was identical in all groups when equal numbers of CTLs were used. Within the group of symptomatic patients, CTL activity was higher in those with a history of PCP (p = 0.033). Pneumocystis carinii antigen-specific T-cell clones proved to be CD4+ and MHC class II restricted; six of eight clones tested showed P. carinii-specific cytolytic activity. Cell-mediated immune response to P. carinii in healthy individuals include CD4+, class II MHC-restricted T cells with P. carinii-specific cytotoxicity. There is an increasing loss of P. carinii-specific proliferative responses in HIV+ patients as disease progresses, but a cytotoxic response is still detected in the absence of proliferation.

Adolescent↗
PubMed1991

The value of serum TPHA titres in selecting patients for lumbar puncture.

Between January 1981 and December 1989, 258 patients with positive syphilis serology underwent lumbar puncture. Nine patients had long-standing neurosyphilis and had lumbar punctures performed during the course of their follow-up. Of the remaining 249 only 12 demonstrated the presence of TPHA in the CSF. The serum TPHA titre for eight of these 12 patients, and seven of the nine (two having no titre reported) known neurosyphilis patients at the time of original diagnosis, was 1 in 5120 or more. The four remaining newly found CSF positive patients had serum TPHA titres of 1 in 2560. We suggest that a serum TPHA titre of 1 in 2560 or greater should be considered as a criterion when selecting patients for lumbar puncture, especially when there are no clinical signs or symptoms.

Adult↗
PubMed1990

Flat condylomata of the penis presenting as patchy balanoposthitis.

Fifty patients presenting with either primary or recurrent patchy balanoposthitis which became aceto-white after the application of 5% acetic acid underwent biopsy. Microbiological screening, including Grocott staining of the biopsy material for fungal hyphae was performed. Forty nine biopsies showed marked koilocytosis suggestive of human papilloma virus (HPV) infection, and of these, only three showed fungal hyphae. This study suggests that HPV may be associated with some cases of patchy balanoposthitis.

Adolescent↗
PubMed1990

The usefulness of the HIV-CHEK assay as a simple, rapid and sensitive screening test for HIV infection.

The purpose of this study was to evaluate the usefulness of the HIV-CHEK kit for human immunodeficiency virus (HIV) antibody testing. A comparison with the Serodia-HIV test was made on 42 fresh serum samples. Both tests accurately identified the 11 true positive serum samples, while there was one false positive with the Serodia-HIV and 3 were difficult to interpret using the HIV-CHEK. To assess the sensitivity of the HIV-CHEK assay, a comparison with other tests was made using serial titrations of stored known HIV-positive frozen serum samples. Here the HIV-CHEK demonstrated a poor sensitivity compared to the others. In conclusion, although we found the HIV-CHEK to be simple and quick, the difficulty with interpretation of some specimens and the apparent poor sensitivity on frozen samples makes it difficult to recommend this kit in its present form as a principal initial screening test for HIV antibody.

AIDS Serodiagnosis↗