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Biomedical subjects

P Garner

Publications and source records attributed to P Garner.

At least 127 records · Page 7Linked to original sources
PubMed1992

Epidemiological study of abdominal tuberculosis among Indian migrants and the indigenous population of Leicester, 1972-1989.

A retrospective, epidemiological study of abdominal tuberculosis in the city of Leicester from 1972 to 1989 is reported. Potential cases were identified from hospital medical records and endoscopy lists, in addition to the county notification register. The city population of 280,000 included over 75,000 South Asians. There were 146 cases among South Asians and six in Europeans, four of whom were British. The standardised incidence of abdominal tuberculosis in South Asians decreased significantly from 22.3 cases/10(5)/year during the 1970s to 9.2 cases/10(5)/year in the 1980s (chi 2 = 42, p < 0.001). The incidence during the 1980s was 10.7/10(5)/year in Hindus, 8.7/10(5)/year in Sikhs, and 4.6/10(5)/year in Muslims. The relative risk to Hindus was 2.3 fold greater, and for Sikhs 1.9 fold greater, than that for Muslims, a finding similar to that in pulmonary tuberculosis. The standardised incidence in Europeans was 0.2/10(5)/year and they had significantly less abdominal tuberculosis than South Asians (Z = 8.6, p < 0.001 and relative risk = 46). The standardised mortality ratio was significantly increased in Europeans (standardised mortality ratio = 755, 95% confidence interval 90-2730, chi 2 = 11.4, p < 0.001), but not in South Asians (standardised mortality ratio = 68, 95% confidence interval 20-160). Resection rates were similar between the two ethnic groups. Abdominal tuberculosis still occurs among migrants, and clinicians should remain alert to this in South Asians.

Adolescent↗
PubMed1992

The population dynamics in mosquitoes and humans of two Plasmodium vivax polymorphs distinguished by different circumsporozoite protein repeat regions.

The population dynamics of two Plasmodium vivax polymorphs were studied over a two-year period in a village in a hyperendemic area of Papua New Guinea in both the mosquito and human populations. Strains of P. vivax were distinguished by different circumsporozoite (CS) protein repeats, the VK210 (classic) and the VK247 (variant) polymorphs. In 1986, 34% of P. vivax CS protein-positive mosquitoes were of the VK247 type. Although the proportion of P. vivax sporozoite antigen-positive mosquitoes compared with all sporozoite-positive mosquitoes did not change from 1986 to 1987, the proportion of P. vivax-positive mosquitoes of the VK247 polymorph decreased significantly from 34% to 11% (5 of 45) in 1987. In 1986, 61% (47 of 77) of humans tested had IgGs that recognized the VK247 CS repeat, while only 26% (22 of 84) had IgGs that recognized the VK210 CS repeat. The observed fluctuation in the proportion of the two P. vivax CS protein polymorphs recorded in the mosquito population from 1986 to 1987 is consistent with a hypothesis of selection by humoral immune pressure on the VK247 strain.

Adolescent↗
PubMed1991

Ineffectiveness of amodiaquine against Plasmodium falciparum malaria in symptomatic young children living in an endemic malarious area of Papua New Guinea.

The standard in vivo 7-day test of drug resistance was conducted on 83 children with symptomatic P. falciparum infection, using a full 3-day course of amodiaquine. All children were living in an endemic malarious area of the East Sepik Province of Papua New Guinea. Analysis of blood amodiaquine levels by an ELISA method showed increased blood amodiaquine concentration with progressive days of treatment. By day 7 of the study period parasites had cleared in 68 (82 per cent) of the children while 15 (18 per cent) had persistence or recrudescence of P. falciparum. Of these 15 resistant cases, four were R1 resistant (early recrudescence), seven were R2, and four were R3. This is a higher proportion of R2/R3 resistance than has usually been reported in Papua New Guinea. In vivo amodiaquine resistance declined significantly with increasing age of the child. Resistance was found to be more common in children with low weight for age: this possible association requires further investigation in the study area, which has one of the highest rates of malnutrition in Papua New Guinea.

Age Factors↗
PubMed1991

Serological evaluation of the macrofilaricidal effects of diethylcarbamazine treatment in bancroftian filariasis.

An Mr 200,000 phosphorylcholine-containing antigen (PC-Ag) of predominantly adult worm origin was found in the sera of humans infected with Wuchereria bancrofti. This paper describes results of a longitudinal study of changes in levels of PC-Ag in response to diethylcarbamazine (DEC) therapy as measured by two-site immunoradiometric assay (IRMA) and Western blotting. One hundred thirty-two residents of a bancroftian filariasis-endemic area of Papua New Guinea (PNG) were treated with a 72 mg/kg dose of DEC. A macrofilaricidal effect was seen with this dose of DEC as 34% of the treated subjects had localized side effects and long-term decreases in microfilariae (mf) counts were observed 12 months after treatment. The PC-Ag levels were reduced to 72%, 52%, and 51% of pretreatment values at 21 days and at six and 12 months after treatment. These decreases, observed by IRMA, were specifically associated with loss of the Mr 200,000 PC-Ag detected by immunoadsorption and Western blotting. From drug treatment data, the maximum half-life of PC-Ag in circulation was calculated to be 50 days, assuming a first-order decay process. This maximum half-life indicates that persistent antigenemia observed in the majority of treated subjects could only result from the survival of adult worms. In the absence of methods to directly demonstrate W. bancrofti adult worms, detection of serum PC-Ag levels provides a sensitive indirect measure of the dynamics of adult worm populations. This serological measurement may be useful in optimizing the macrofilaricidal and therapeutic effects of DEC and in assessing the macrofilaricidal action of new antifilarial drugs and immunological interventions.

Adolescent↗
PubMed1991

The cost of rural health services in Papua New Guinea.

In 1988 a countrywide study was conducted on the costs of rural health services in Papua New Guinea. 16% of all health centres and subcentres were surveyed. Information was collected on physical facilities, recurrent costs, staff time allocation, service outputs and quality of services. Wide variation was found in the costs of rural health facilities overall, and significant differences were found between the costs and outputs of health centres and subcentres. Average levels of service output were found to be similar at church and government facilities but average levels of utilization by the population were higher at church facilities. Despite government policy on extension of preventive health care, a strong emphasis was found on curative care. Many facilities were found to have significant excess bed capacity. Recurrent financing for transportation and maintenance was found to be inadequate.

Cost Allocation↗
PubMed1990

The prevalence of naturally acquired multiple infections of Wuchereria bancrofti and human malarias in anophelines.

Malaria and filaria infection rates were determined for anopheline mosquitoes collected whilst biting and resting in village houses in Papua New Guinea. The number of anophelines infected with both parasites was greater than expected from the infection rates of each parasite and this difference was significant in resting collections. The excess of multiply infected mosquitoes is probably a result of a vector population composed of individuals with differing numbers of opportunities to become infected. Malaria-positive Anopheles punctulatus from resting catches had a significantly greater number of Stage 3 Wuchereria bancrofti larvae than malaria-negative mosquitoes. However, multiply infected mosquitoes appear to suffer greater mortality than non-infected or singly infected mosquitoes when the filarial worm reaches the third stage. Any potential increase in transmission resulting from multiple infections is thereby offset by a greater mortality rate in these mosquitoes.

Animals↗
PubMed1990

Specimen transport audit.

A specimen transport audit was performed at a routine and reference laboratory. Over the survey period (1986-89) the percentage of specimens received and assessed as hazardous (inadequately packed, misidentified, or contaminated by leakage) fell significantly from 12.0 to 2.8%. Specimen transport audit identified technical and logistical faults associated with sample transmission. It is concluded that no type of hazard should exceed 0.5% of samples, with the total being less than 1% of specimens received. Specimen transport audit is an additional laboratory performance indicator.

England↗
PubMed1989

Human host selection by anophelines: no evidence for preferential selection of malaria or microfilariae-infected individuals in a hyperendemic area.

Host selection among humans by Anopheles punctulatus was studied in an area of Papua New Guinea endemic for malaria and filariasis. Blood films were made from the stomach contents of freshly engorged mosquitoes found resting on the walls of houses in which the parasite status of the occupants was known. Engorgement rates on humans were non-random but could not be consistently related to the parasite status of individuals in the houses for either malaria or filaria. In some households, anophelines preferentially fed on parasitaemic individuals while in other households aparasitaemic individuals were significantly more often selected. This finding is believed to reflect the fact that malaria and filarial infections in this endemic area are predominantly asymptomatic. There were no significant differences in axillary temperatures between malaria or microfilariae positive or negative individuals.

Adolescent↗
PubMed1986

A toxicity study of recombinant interferon-gamma given by intravenous infusion to patients with advanced cancer.

Eighteen patients with solid tumours were treated with human recombinant interferon-gamma at escalating dose levels starting at 1 X 10(6) units/m2 per infusion and rising through 3 X 10(6), 6 X 10(6), 9 X 10(6) and 22 X 10(6) to a maximum of 110 X 10(6) units/m2 per infusion. The IV infusions were given three times a week over a 4-week period. Side effects were seen in all patients, but were mild except at the highest dose. Acute dose-related effects included pyrexia, tiredness, thirst, chills and rigors. Chronic dose-related effects included anorexia, lethargy, weakness, disorientation, a trace of proteinuria and minimal rises in liver enzymes. In addition, effects were observed which were not related to dose. These included headache, nausea and vomiting, backache, myalgia, flatulence and a mild, transient reduction in neutrophils and erythrocytes. At the highest dose level dose-limiting toxicity was observed, consisting in severe tiredness and anorexia, hypotension, disorientation and changes on the electrocardiograph. Overall, toxicity was similar to that seen with preparations of interferon-alpha, except that no tolerance to the effects of interferon-gamma was noted. We observed less hepatic and haematological toxicity, but also recorded flatulence, handcramps and electrocardiograph changes, which have not been reported with interferon-alpha. When given according to this regimen, doses of 22 X 10(6) units/m2 per infusion of recombinant interferon-gamma were generally well tolerated by the patients.

Adult↗
PubMed1986

Bone tuberculosis: results and experience in Leicestershire.

Management of tuberculosis falls to the thoracic physician and includes extrapulmonary sites. We have conducted a survey of notification of bone tuberculosis in Leicestershire from 1978 to 1983 inclusive. Eighty-one cases were notified, 75 were traced and 69 confirmed tuberculosis (mean age 40.2 years, 39 male, 54 from the Indian sub-continent (ISC)). Mean length of symptoms was 8.4 months, the commonest being pain and swelling. The diagnosis was established by evidence of bone involvement plus at least one of the following: positive Heaf test (54/56), positive culture at bone sites for Mycobacterium tuberculosis (45/47), or suggestive histology (30/34). There were no resistant organisms. Chemotherapy (mean duration 16.2 months) was well tolerated. Spine was the site most often involved (37 patients, 34 ISC), with abscess formation common (17 patients). Four who presented with spinal cord compression received a mean of 8 months' bed rest, three required decompression and one died. No patient developed new neurological signs on treatment. Fourteen others received an average of 2.3 months' bed rest. In this predominantly ISC immigrant population, spinal tuberculosis is common but does not progress to cord compression on treatment. For those without cord compression the course and outcome were similar whether or not they were treated with bed rest.

Adolescent↗
PubMed1985

Rural health centre use: variation with distance and disease.

Utilisation of a rural health centre in respect to distance and disease is examined. Some deficiencies in health care provision are revealed, and strategies implemented to correct these through aid post-orderlies (APO) inservice, maternal child health (MCH) reorganisation and health education are outlined. This type of survey is easy to conduct, uses data routinely collected and can help plan improvement of health services.

Community Health Centers↗