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Biomedical subjects

N J Beeching

Publications and source records attributed to N J Beeching.

At least 73 records · Page 4Linked to original sources
PubMed1996

Tuberculin testing in two Liverpool social clubs: the effects of a tuberculosis outbreak on background positivity.

BACKGROUND: Tuberculin testing remains the standard method for assessing infection due to tuberculosis in the UK. However, there are no data on the incidence of tuberculin positivity among the general adult population in the UK and consequently interpretation of Heaf test results is often difficult. METHODS: During the investigation of an outbreak of tuberculosis in a Liverpool social club 198 members were interviewed and Heaf tested and 171 members of a second social club in Liverpool were similarly screened as a control group. Comparisons between the results from the two populations provided both an estimate of baseline Heaf test positivity in indigenous white adults from a British inner city population, and a measure of the effect on this baseline of recent exposure to tuberculosis. RESULTS: In both club populations the proportion of positive Heaf tests increased with age. Independent of age, the tuberculosis exposed population had a higher proportion of positive Heaf grade results (40.9%) than those in the control group (26.9%). Multivariate analysis confirmed both the differences in Heaf results between clubs and between age groups but identified no other behavioural or medical factors which affected Heaf test results. CONCLUSIONS: Heaf test positivity increases with age at least up to 54 years, and recent exposure to tuberculosis increases the proportion of positive Heaf tests in each age group. Interpretation of positive Heaf tests when assessing the effects of a tuberculosis outbreak should take account of background levels of Heaf positivity.

Adolescent↗
PubMed1995

The prevalence and clinical features of multi-drug resistant Salmonella typhi infections in Baluchistan, Pakistan.

Between January and July 1994, a prospective study of bacteraemia in 692 patients with fever without localizing signs was undertaken at the Quetta Military Hospital in Baluchistan, Pakistan. Salmonella spp. were isolated from 76 (11%) of the patients; 62 had S. typhi and 14 had S. paratyphi A. Significantly more isolations of S. typhi were made in the hot dry months of May and June than in the earlier months. Although multi-drug resistance (to chloramphenicol ampicillin and cotrimoxazole) was detected in 43 (69%) of the S. typhi isolates, it was not found in any of the S. paratyphi A. Defervescence of patients with chloramphenicol-sensitive S. typhi took 7-10 days of chloramphenicol therapy. In contrast, most (91%) of the patients infected with multi-drug resistant S. typhi who were treated with fluoroquinolones achieved defervescence in 1-3 days; the remainder took 4-6 days.

Adolescent↗
PubMed1995

Salivary sampling for hepatitis B surface antigen carriage: a sensitive technique suitable for epidemiological studies.

Vertical transmission from mothers to infants of hepatitis B infection result in a high incidence of carriage in children with long-term consequences, and is the focus of current immunization strategies. The use of saliva for hepatitis B surface antigen (HBsAg) screening in a country with an intermediate to high prevalence of chronic carriage was investigated. We recruited 88 Thai women with known HBsAg status (44 positive, 44 negative) who were attending an antenatal clinic. The collection of saliva was acceptable to all patients. Aspects of technique regarding collection and handling in a tropical setting are discussed. Comparing the detection of HBsAg in saliva to serum using a commercially available serological test kit without modification, the sensitivity was 92.0% (95% CI 84.8-99.5) and the specificity was 86.8% (95% CI 76.0-97.6). Population acceptability and safety advantages along with a high sensitivity strongly support the use of salivary sampling for epidemiological surveillance of hepatitis B virus.

Adolescent↗
PubMed1995

An estimate of the prevalence of drug misuse in Liverpool and a spatial analysis of known addiction.

BACKGROUND: The objective of this study was to determine the prevalence and distribution of opiate and cocaine misuse in the City of Liverpool in 1991. The databases included residents of the city using opiates or cocaine, who were known to the Drug Dependency Units or the Infectious Diseases Unit, or who were arrested for possession of drugs in 1991. METHODS: A three-sample log-linear capture-recapture method was applied to databases containing details of drug users with City of Liverpool postcodes, to determine the prevalence of drug misuse in 1991. Linear regression analysis was performed to correlate the prevalence of known drug misuse with indices of material deprivation in each electoral ward. RESULTS: Data on 1427 individuals were analysed, producing an estimate of the drug-using population of 2344 [95 per cent confidence interval (CI) = 1972-2716] and a period prevalence of 5.2 per 1000 [95 per cent CI = (4.5-6.0) per 1000]. In the 15-29 year age group, the prevalence of drug abuse was 16.9 per 1000 [95 per cent CI = (13.9-19.9) per 1000]. There was a negative interdependence between the police and Drug Dependency Unit databases with attenders at the Unit being 7.2 (95 per cent CI = 4.6-11.4) times less likely to be arrested for possession than non-attenders. There was a strong correlation between the distribution of known drug use and material deprivation, as measured by the Townsend index (r = 0.75; p < 0.001). CONCLUSIONS: The capture-recapture method allows the prevalence of drug misuse to be estimated and provides more meaningful information than is available from the notification system. The study suggests that people in contact with drug services are less likely to commit crimes of possession of class A drugs than those not in contact with drug services. There is a strong association between drug abuse and deprivation, and therefore the purchasing of services for drug misusers should be focused on areas of deprivation.

Adolescent↗
PubMed1993

Aseptic arthritis associated with herpes zoster.

Arthritis associated with herpes zoster is rarely reported. We describe the clinical features of an immunocompromised 54-year-old woman who developed sterile arthritis of a knee in association with acute ipsilateral zoster of the L1/L2 dermatomes.

Arthritis, Infectious↗
PubMed1993

The effects of indomethacin and naproxen on zidovudine pharmacokinetics.

The effects of indomethacin and naproxen on zidovudine (ZDV) pharmacokinetics were studied in six patients with the acquired immunodeficiency syndrome (AIDS), AIDS related complex (ARC) or asymptomatic HIV disease using a placebo-controlled crossover design. Indomethacin 25 mg twice daily or naproxen 250 mg twice daily did not alter ZDV pharmacokinetics compared with placebo. The mean AUC value for the glucuronidated metabolite, GZDV, was reduced from 26.6 +/- 11.7 mumol l-1 h in the presence of placebo to 20.9 +/- 8.3 mumol l-1 h (95% C.I. of the difference 1.39-9.98; P < 0.05) following treatment with naproxen 250 mg twice daily for 3 days. The small decrease in plasma GZDV in the naproxen phase reflects an increase in clearance of ZDV to other metabolites and/or a decrease in the formation clearance to GZDV and/or an increase in the clearance of GZDV. A decrease in formation clearance to GZDV would be consistent with the results of in vitro studies reported previously. No significant increase in ZDV concentration in the presence of naproxen may reflect a lower sensitivity of parent drug measurements to selective inhibition of parallel pathways of metabolism. The clinical significance of these findings is unknown but toxicity may be increased if a decreased formation of GZDV is accompanied by shunting of metabolism to 3'-amino-3'-deoxythymidine which is alleged to be cytotoxic.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Albendazole is effective treatment for chronic strongyloidiasis.

A total of 301 British ex-Far East prisoners of war, many of whom worked on the Thai-Burma Railway during World War II, consecutively attended The Liverpool School of Tropical Medicine for clinical review between January 1987 and August 1990. Fifty-two (17%) were found to have chronic strongyloidiasis. Diagnostic criteria included any of the following: characteristic larva currens rash, positive Strongyloides serology, and positive stool examination. Forty-seven were evaluable 6 months, after therapy with albendazole 400 mg twice daily for 3 days, which resulted in a 75% cure rate. Cure was defined as disappearance of the rash, if present, negative serology and negative stool examination. Patients who had more than one positive diagnostic feature were only considered cured if both or all had disappeared or become negative. All 12 of the patients in whom initial treatment failed were given a second course of albendazole: three further cures were obtained in eight evaluable patients. The overall cure rate was 81%. The only side-effects recorded were mild nausea and diarrhoea in one patient. We suggest that albendazole should be the treatment of choice for chronic strongyloidiasis.

Aged↗
PubMed1992

Acute gastroenteritis: effect on nutritional status.

Anthropometric measurements were performed on admission and at four weeks post discharge on 25 adults referred to hospital with acute gastroenteritis. There was a significant change in weight (P < 0.001) and mid-arm circumference (P < 0.05), but no change in skinfold thickness, arm muscle area or arm fat area. The results suggest that weight change during acute gastroenteritis is more a consequence of dehydration than of malnutrition.

Acute Disease↗
PubMed1991

Survey of "do not resuscitate" orders in a district general hospital.

OBJECTIVE: To evaluate the local use of written "Do not resuscitate" orders to designate inpatients unsuitable for cardiopulmonary resuscitation in the event of cardiac arrest. DESIGN: Point prevalence questionnaire survey of inpatients' medical and nursing records. SETTING: 10 acute medical and six acute surgical wards of a district general hospital. PARTICIPANTS: Questionnaires were filled in anonymously by nurses and doctors working on the wards surveyed. MAIN OUTCOME MEASURES: Responses to questionnaire items concerning details about each patient, written orders not to resuscitate in the medical case notes and nursing records, whether prognosis had been discussed with patients' relatives, whether a "crash call" was perceived as appropriate for each patient, and whether the "crash team" would be called in the event of arrest. RESULTS: Information was obtained on 297 (93.7%) of 317 eligible patients. Prognosis had been discussed with the relatives of 32 of 88 patients perceived by doctors as unsuitable for resuscitation. Of these 88 patients, 24 had orders not to resuscitate in their medical notes, and only eight of these had similar orders in their nursing notes. CONCLUSIONS: In the absence of guidelines on decisions about resuscitation, orders not to resuscitate are rarely included in the notes of patients for whom cardiopulmonary resuscitation is thought to be inappropriate. Elective decisions not to resuscitate are not effectively communicated to nurses. There should be more discussion of patients' suitability for resuscitation between doctors, nurses, patients, and patients' relatives. Suitability for resuscitation should be reviewed on every consultant ward round.

Age Factors↗
PubMed1991

Autonomic neuropathy is common in human immunodeficiency virus infection.

We prospectively evaluated autonomic nervous system function in 17 consecutive ambulant patients with HIV infection [mean age (S.D.) 34.5 (5.5) years] and 17 controls matched for sex and age [31.2 (7.4) years]. A questionnaire was administered, and neurological examination and standard bedside autonomic function tests were performed. Eleven of 17 HIV-infected individuals (64.7%) had symptoms suggestive of autonomic dysfunction, particularly urogenital problems. Thirteen of 17 (76.5%) had autonomic neuropathy (one or more abnormal tests), including nine of 11 symptomatic individuals. Only two controls had any autonomic symptoms, and all had normal tests. Autonomic dysfunction is common in those with HIV infection and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Early anti-HBs antibody response to accelerated and to conventional hepatitis B vaccination regimens in healthy persons.

A significantly higher prevalence of a protective concentration of anti-HBs was achieved at 1 and 2 months among 132 healthy medical students who received an accelerated vaccination schedule with a recombinant hepatitis B vaccine (Engerix-B) than among 120 medical students who received a conventional regimen. With the accelerated schedule, however, 60% students at 1 month and 27% at 2 months were still unprotected (anti-HBs titre less than 10.0 IU/l). Additional passive immunisation should therefore continue to be offered if the accelerated schedule is adopted for post-exposure prophylaxis.

Adult↗