bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient satisfaction with bilateral bone-anchored hearing aids: the Birmingham experience
Authors: Dutt Sunil N. , McDermott Ann-Louise , Burrell Stuart P. , Cooper Huw R. , Reid Andrew P. , Proops David W.
Published: October 2002

The Birmingham bone-anchored hearing aid (BAHA) programme has fitted more than 300 patients with unilateral bone-anchored hearing aids since 1988. Some of the patients who benefited well with unilateral aids and who had used bilateral conventional aids previously applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients. Subjective analysis in the form of validated comprehensive questionnaires was undertaken.

The Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire developed to evaluate any otorhinolaryngological surgery and therapy was administered. The results revealed that the use of bilateral bone-anchored hearing aids significantly enhanced general well being (patient benefit) and improved the patient’s state of health (quality of life). The Chung and Stephens questionnaire which addresses specific issues related to binaural hearing was used. Our preliminary results are encouraging and are comparable to the experience of the Nijmegen BAHA group.
Skin reactivity to vasomotor agents in non-eosinophilic and eosinophilic non-allergic rhinitis
Authors: Milošević Dušanka , Janošević Ljiljana , Janošević Slobodanka , Invanković Zoran , Dergenc Ranko
Published: October 2002

The aim of this prospective study was to examine skin reactivity to four vasomotor agents and to determine whether non-eosinophilic rhinitis patients differ from patients with eosinophilic rhinitis. Nasal cytology enabled us to classify 74 rhinitis patients into a non-eosinophilic (n = 63) and an eosinophilic group (n = 11). Skin reactivity to intradermal tests with papaverine, metacholine, histamine and compound 48/80 was measured. No significant difference for papaverine, metacholine, histamine and compound 48/80, singly, was found between the non-eosinophilic and eosinophilic group. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, was greater in the eosinophilic (91 per cent) then in the non-eosinophilic group (78 per cent) but intergroup difference was not significant. These findings suggest that pathologic skin reactivity to vasomotor agents is a feature of non-eosinophilic as well as eosinophilic non-allergic rhinitis patients and indicate that no difference is noticed in the skin reactivity between these groups.
Nasal septal clip (Çiǧdem clip)
Authors: Doǧru Harun , Uygur Kemal , Tüz Mustafa
Published: October 2002

We report the use of a nasal septal clip. We believe that this instrument is more easily inserted and removed when compared with the classical nasal packs.
Nasal septal abscess: an unusual complication of acute spheno-ethmoiditis
Authors: Pang Kenny Peter , Sethi Dharambir S.
Published: October 2002

Nasal septal abscess complicating acute sinusitis is rare. There have been very few reports in the literature of this condition. We present a 12-year old-male with a nasal septal abscess complicating acute pansinusitis.
Evaluation of individually ventilated cage systems for laboratory rodents: cage environment and animal health aspects
Authors: Höglund A. U. , Renström A.
Published: October 2002

The use of individually ventilated cage (IVC) systems has become an attractive housing regime of laboratory rodents. The benefits of IVC systems are, reportedly, a high degree of containment combined with relative ease of handling, and a high degree of protection from allergenes.

In the present study we tested whether two IVC systems (BioZone VentiRack, IVC1 and Techniplast SealSafe, IVC2S), in which we held mature male NMRI mice, were constructed to maintain a constant differential pressure, positive or negative, during a prolonged period of time. We also measured ammonia (NH3) concentrations after about 2 weeks of use, and CO2 build-up during a 60 min simulated power failure situation. In addition, animal weight development and bite-wound frequency were recorded (Renström et al. 2000).

From the present study it is concluded that the IVC1 air handling system provides a more uniform and balanced differential pressure than the IVC2S. Both systems effectively scavenge NH3 when bedding material is not soaked by urine. Although the IVCs are dependent on the continual function of the fans to work properly, it seems unlikely that CO2 concentrations increase to hazardous levels, as a result of a one hour power failure, with the type of cages used in this study. Differences in weight development and bite-wound occurrence were noted between the two IVC systems. Causes for these differences could not be established and need more investigation.
Undergraduate and postgraduate students' responses to mandatory courses (FELASA category C) in laboratory animal science
Authors: Carlsson Hans-Erik , Hagelin Joakim , Höglund A. Urban , Hau Jann
Published: October 2002

The results from the analysis of the course evaluations from FELASA category C compulsory courses in laboratory animal science at Uppsala University showed that the students realize that theoretical knowledge of the subject and practical skills are of great importance to the success of their future research involving animal experiments. All the subjects and elements of the course, in particular the practicals on animal handling and procedures using live anaesthetized animals, were fully appreciated by the students.
Excretion of corticosteroid metabolites in urine and faeces of rats
Authors: Bamberg E. , Palme R. , Meingassner J. G.
Published: October 2002

Stress enhances the production of corticosteroids by the adrenal cortex, resulting in the increased excretion of their metabolites in urine and faeces. An intraperitoneal injection of radioactive corticosterone was applied to adult, male Sprague-Dawley rats to monitor the route and delay of excreted metabolites in urine and faeces. Peak concentrations appeared in urine after 3.2 ± 1.9 h and in faeces after 16.7 ± 4.3 h. Altogether about 20% of the recovered metabolites were found in urine and about 80% in faeces. Using high-performance liquid chromatography (HPLC), several peaks of radioactive metabolites were found. Some metabolites were detected by enzyme immunoassay (EIA) using two different antibodies (corticosterone, 11β-OH-aetiocholanolone). There was a marked diurnal variation with low levels of faecal corticosterone metabolites in the evening and higher values in the morning. This diurnal variation was influenced neither by the intraperitoneal injection of isotonic saline nor by ACTH. However, the administration of dexamethasone eliminated the morning peak for 2 days.
The impact of the introduction of the ethical review process for research using animals in the UK: implementation of policy
Authors: Purchase Iain F. H. , Nedeva Maria
Published: October 2002

Nearly all establishments in the UK regulated under the Animals (Scientific Procedures) Act 1986 had introduced an ethical review process (ERP) within 9 months of its formal requirement, although quite a high proportion of more junior staff were not familiar with it. A significant proportion of those questioned believed that the ERP has improved the quality (particularly the ethical quality) of project licences. A smaller proportion of respondents believed that the ERP has had a beneficial impact on animal work and training. Nearly all the respondents viewed animal care and accommodation as good or excellent.
The effect of daily disturbance on the breeding performance of mice
Authors: Peters Alan G. , Bywater Peter M. , Festing Michael F. W.
Published: October 2002

The United Kingdom Home Office Code of Practice for the housing and care of breeding animals requires that, ' the general well-being of all animals must be checked at least once daily'. However, excessive daily disturbance of rodent breeding colonies could be counter-productive to animal welfare if it increases pre-weaning mortality. An experiment involving 100 breeding cages of BALB/c mice compared daily inspection of the mouse cages, but without disturbing the mice within the nest, with daily inspection in which every individual was studied even if this involved removing the cage lid and disturbing the nest. No statistically significant differences were found between the two groups in breeding performance or pre-weaning mortality, though the disturbed group produced marginally fewer offspring and had slightly higher mortality. Average weaning weight did not differ between the groups, but sexual dimorphism at weaning was significantly increased in the disturbed group. It is concluded that there are unlikely to be any welfare benefits in an inspection regimen that involves disturbance of breeding mice, provided the cage is inspected daily.
Oral buprenorphine and aspirin analgesia in rats undergoing liver transplantation
Authors: Jablonski P. , Howden B. O.
Published: October 2002

The objective of this study was to establish effective postoperative analgesia for Dark Agouti rats undergoing liver transplantation with minimal additional stress due to handling and no adverse effect on transplant outcome. Oral administration of buprenorphine (0.5 mg/kg/dose) or aspirin (100 mg/kg/dose) in raspberry-flavoured gelatine were compared to controls receiving no treatment or plain gelatine. The drugs were presented five times: immediately on recovery from anaesthesia and at 12 h intervals thereafter. All rats underwent right nephrectomy and replacement of their liver by an arterialized liver isograft preserved optimally for 24 h. All groups had reversible hepatic damage, lost weight and demonstrated severely reduced dark cycle activity after surgery. Neither treatment appeared to ameliorate the loss of body weight that probably reflected hepatic insufficiency during the first week as well as pain and surgical stress. In the second week, when liver function was 'normal', rats began to regain weight at the pre-transplant rate. Aspirin treatment significantly increased activity during the first and second dark cycles after surgery, whereas buprenorphine significantly increased activity during the second dark cycle only. Neither drug had any apparent adverse effects on the rats or on graft function. Postoperative oral administration of aspirin should be incorporated into future programmes of liver transplantation in rodents. More effective treatment in the immediate postoperative period may require oral administration of analgesia prior to surgery or a single subcutaneous injection of an analgesic agent on completion of surgery in addition to postoperative oral administration of aspirin.
Assessment of the postoperative discomfort of intra-auricularly hypophysectomized rats
Authors: Hansen Axel Kornerup , Christoffersen Lene B. , Hejgaard Katharina C. , Thon Rikke , Velschow Sten
Published: October 2002

Rats subjected to hypophysectomy make up one of the largest groups of experimental animals in Europe, since there is a legal demand for batch testing of industrially produced growth hormones. To describe the clinical performance of rats having undergone hypophysectomy, animals were examined postoperatively by monitoring behaviour, body temperature and food intake. Behavioural changes were observed in rats that had only been anaesthetized, as well as in sham-operated rats, while no behavioural deviations could be shown in hypophysectomized rats. On the first day after surgery all rats had declining body temperature and food intake; and this change was not reversed by treatment with carprofen, buprenorphine or oxytetracycline. The mortality rate in rats treated with buprenorphine was increased, as was the mortality rate in rats hypophysectomized when weighing more than 100 g. As there seemed to be no differences whether methohexital or a combination of fentanyl, fluanison and midazolam was used, the latter anaesthesia is recommended due to its analgesic potential. For post-surgical analgesic treatment, carprofen is recommended rather than buprenorphine. At best, the use of hypophysectomized rats should be replaced in industrial batch testing by an existing in vitro method.
Validation of transrectal ultrasonographic volumetry for orthotopic prostate tumours in mice
Authors: Kraaij R. , van Weerden W. M. , de Ridder C. M. A. , Gussenhoven E. J. , Honkoop J. , Nasu Y. , Bangma C. H.
Published: October 2002

Orthotopic human prostate tumour models in athymic nude mice are regarded as being most suitable for fundamental and pre-clinical research on prostate cancer. The anatomic localization of the tumour in the pelvis, however, provides little possibility for monitoring tumour growth or regression. To assess time-related changes in orthotopic tumour volume, we applied transrectal ultrasonography (TRUS) to the murine prostate. This technique has the advantages of allowing accurate monitoring of tumours during therapeutic manipulations and a reduction of animal use due to a reduction of sacrificing endpoints. To validate the TRUS method, the mouse prostate reconstitution model, RM-9, and the prostate-specific antigen (PSA) producing human prostate cancer xenograft PC-346 were used. Volumetric calliper measurements were performed with a 30 MHz ultrasound probe designed for intra-arterial use in humans. Tumour weight, determined at various time-points, was found to be closely related to actual tumour weight ( R = 0.99) and, in the PC-346 model, to the level of PSA in the plasma. Furthermore, the interobserver variation for TRUS was low for tumours above 50 mg. Thus, TRUS for murine prostate tumours proves to be an accurate, reproducible and sensitive method.
Mediating the cultural boundaries between medicine, nursing and management - the central challenge in hospital reform
Authors: Degeling P. , Kennedy J. , Hill M.
Published: October 2002

This paper documents the resilience of medical and nursing profession-based subcultures and the extent of the differences between them. Against this background, we assess the capacity and willingness of medical and nursing managers to promote changes that will extend the accountability of clinicians and engender more evidence-based, financially driven and output-oriented approaches to service delivery.
Cervical cytology screening for sexually-active teenagers
Authors: Acladious N N , Mandal D
Published: October 2002

Our aim was to determine the value of cervical cytology for sexuallyactive teenagers attending genitourinary medicine (GUM) clinics. This is a retrospective review of 57,093 women who had cervical cytology reported at the Royal Bolton Hospital (RBH) during the period 1 April 1994 to 31 March 1996. The results were subdivided into 2 age groups; ≤19 years and ≥20 years. Cervical cytology abnormalities within each age group were analysed and compared with the national figures for cervical cytology screening. The results were also subdivided according to their source of referral; general practitioners (GP), GUM and gynaecology. The data from each group were analysed in the same manner as before. The results of the cervical cytology screening from the RBH for major cytological abnormalities (moderate dyskaryosis and above), for the 2 age groups, were comparable and not significantly different (2.1% for each age group, P=0.909 ) and these figures were within the range of the national figures for cervical cytology screening (1.1%-3.4%). Subdivision of the data by source of referral demonstrated that the percentage of major abnormalities in smears performed at GUM clinics was higher than the national figure for all age groups (41/1000 for the younger age group and 37/1000 for the older age group, 12/1000 for the national figures). In conclusion, cervical cytology screening should be offered to sexually-active teenagers attending GUM clinics.
The presence of HPV types 6/11, 16/18, 31/33/51 in Bowenoid papulosis demonstrated by DNA in situ hybridization
Authors: Salvatore Pala , Irina Poleva , Amina Vocaturo
Published: October 2002

Bowenoid papulosis (BP) is an unusual dermatosis with variable clinical presentation: multiple, generally small, round, papules, isolated or confluent, with smooth or papillomatous surface, sometimes with desquamation. The colour is variable from rose, reddish-purple to brown. These papules are localized mostly on the genital mucosa or perigenital skin of young adults. The aetiopathogenesis of the disorder is not well defined, but it may be linked to human papillomavirus (HPV) infection. We report a case of BP with some particular aspects: (1) misdiagnosis of the disease for 2 years; (2) contemporaneous presence of different types of HPV.
Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya
Authors: Ayisi John G , Van Eijk Anna M , Kuile Feiko O Ter , Kolczak Margarette S , Otieno Juliana A , Misore Ambrose O
Published: October 2002

Our objective was to evaluate HIV prevalence and identify risk factors for HIV infection among women attending the antenatal clinic (ANC) at a large public hospital in Kisumu town, western Kenya. Between June 1996 and November 1997, in the context of a study to determine the effect of placental malaria on mother-to-child transmission of HIV in western Kenya, HIV-1 antibody testing was offered to women with a singleton uncomplicated pregnancy of 32 weeks' gestation attending the ANC. Women were interviewed using a structured questionnaire and had a fingerstick blood sample collected for haemoglobin (Hb), malaria smears, and HIV antibody testing. Overall HIV seroprevalence was 26.1% (743/2844) (95% confidence interval (CI): 24.5-27.7) and in bivariate evaluation was significantly associated with anaemia (Hb< 11 g/dl) (risk ratio (RR) 1.8), malarial parasitaemia (RR 1.6), fever (axillary temperature 37.5 C at screening) (RR 1.6), a history of being treated for either vaginal discharge (RR 1.5) or tuberculosis (RR 1.6), reported alcohol consumption (RR 1.6), being an unmarried multigravida (RR 2.2) or a history of the most recent child having died (RR 2.0). Poisson regression analysis for all women identified 5 significant factors independently associated with HIV seropositivity: anaemia (adjusted RR 1.7; 95% CI 1.3-2.0), malarial parasitaemia (adjusted RR 1.7; 95% CI 1.4-2.0), a history of being treated for vaginal discharge (adjusted RR 1.5; 95% CI 1.1-2.0), fever (adjusted RR 2.0; 95% CI 1.3-3.2) and reported alcohol consumption (adjusted RR 1.6; 95% CI 1.1-2.5). Multigravidae women whose most recent child had died were also more likely to be HIV seropositive (adjusted RR 1.9; 95% CI 1.7- 2.8). Only 5.5% (156/2844) of the women had none of these risk factors, of whom 12% (18/156) were HIV(+). Even though the model containing the 5 identified factors fitted the data well (goodness-of-fit xi2=18.41, P =0.10), its collective capacity to predict HIV infection was poor; while 74% of the truly positive women were correctly predicted positive by the model, 52% of the truly negative women were misclassified. Among pregnant women attending the ANC in western Kenya, we were unable to identify a subgroup at risk of HIV infection using non-serological information, indicating that wherever possible universal access to voluntary HIV counselling and testing would be preferable to targeted screening.
'Get it on' in the Millennium
Authors: Riddell L A , Kuchimanchi U , Cope J , Rooney G , Sherrard J
Published: October 2002

Over the Christmas and New Year period the Health Education Authority launched a sexual health promotion campaign aimed at increasing the awareness of and reducing the incidence of sexually transmitted infections (STIs) and unwanted pregnancy. We undertook a study to assess the effect of this campaign locally in 2 genitourinary medicine (GUM) clinics. From our study we concluded the following: (1) Although rarely performed, it is possible to assess the effectiveness of health promotion campaigns. (2) Genitourinary medicine clinics provide a good forum for the assessment of such campaigns. (3) The information obtained from such assessments can be valuable for effective targeting of future campaigns.
HIV in cervical cancer
Authors: Wallace S V F , Carlin E M
Published: October 2002

Women are an increasing proportion of the HIV-infected population. In addition, compared with their HIV-negative counterparts, they have a greater incidence of both cervical intraepithelial neoplasia (CIN) and invasive cervical cancer, which tends to be more progressive and aggressive. The development of invasive cervical carcinoma in an HIV-infected woman is an AIDS-defining diagnosis. However, what is not clear is whether women who are identified with cervical carcinoma should be offered screening for HIV infection. This review addresses these issues and provides a cost-effectiveness assessment.
Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy
Authors: Vergis Emanuel N , Paterson David L , Wagener Marilyn M , Swindells Susan , Singh Nina
Published: October 2002

Metabolic complications are being increasingly recognized among HIV-infected patients treated with potent combination antiretroviral therapies. We sought to assess the association of dyslipidaemia with adherence to protease inhibitor (PI) therapy and with the markers of clinical response to antiretroviral therapy (CD4 count, HIV RNA viral level) through a prospective, cross-sectional cohort study. Fifty-six HIV-infected patients who were already on, or who were started on PI-containing antiretroviral therapy were monitored for the development of dyslipidaemias. Therapy with PI-containing antiretroviral therapy was significantly associated with elevated serum triglyceride level (>250 mg/dl) (52% vs 8%, P=0.001). Patients with an adherence rate of at least 80% to a PI-containing regimen were significantly more likely to have elevated low density lipoprotein (LDL) cholesterol level as compared to patients with an adherence rate of <80% (79% vs 26%, P=0.03). Patients with an adherence rate of at least 80% to a PI-containing regimen were also significantly more likely to have severe hypertriglyceridaemia (>800 mg/dl) as compared to patients with an adherence rate of <80% (21% vs 4%, P=0.04). Viral load at the last study visit did not correlate with total cholesterol ( r=-0.39, P=0.30), LDL cholesterol ( r=0.57, P=0.30), or triglyceride level ( r=0.55, P=0.20). However, there was a significant correlation between the last viral load and high density lipoprotein (HDL) cholesterol ( r=0.79, P=0.035), i.e. lower viral load was associated with higher HDL cholesterol level. In conclusion, dyslipidaemia in patients with HIV infection was significantly associated with adherence to PI-containing antiretroviral therapy. Patients who are adherent to PI-containing regimens at least 80% of the time warrant close monitoring for the development of dyslipidaemia.
High-Risk Behaviours in Men from Bogotá, Colombia and the Spread of HIV
Authors: Míguez-Burbano M J , Page J B , Angarita I , Rodriguez N , Baum M K , Burbano X , Shor-Posner G
Published: October 2002

Our objective was to identify sexual behaviours related to risk of HIV infection. A cluster survey of sexually experienced men from diverse socio-demographic settings in Bogotá, Colombia was carried out using a standardized self-administered questionnaire. A high response rate (96%) resulted in the enrolment of 553 men. Most participants 129/442 reported having intercourse with women and 51/111 reported having sex with other men. Most respondents (90%) engaged in high-risk sexual practices; only 2% knew their HIV-1 serostatus. Consistent condom use was reported by 20% of those who practised anal sex, and was even lower (5%) among men who had sex with women during menses. Heterosexuals exhibited a higher degree of risky sexual patterns than homosexual/bisexuals (P=0.01). In conclusion, high-risk sexual practices are prevalent among men in Bogotá, particularly heterosexuals, attesting to the urgent need for effective and specific interventions to prevent HIV transmission.
Prevalence of abnormal adrenocortical function in human immunodeficiency virus infection by low-dose cosyntropin test
Authors: González-González José Gerardo , de la Garza-Hernández Natalia Eloisa , Garza-Morán Ricardo Aarón , Rivera-Morales Irma Matilde , Montes-Villarreal Juan , Valenzuela-Rendón Jorge , Villarreal-Pérez Jesús Zacarías
Published: October 2002

Recent evidence suggests that 10 µg cosyntropin test has higher sensitivity for detecting hypothalamus-hypophysis-adrenal axis (HHA-A) dysfunction. Our objective was to determine prevalence of glucocorticoid insufficiency with the 10 µg cosyntropin test and the level of the HHA-A defect. One hundred and four HIV-infected patients underwent the 10 µg cosyntropin test. In abnormal and borderline respondents, insulin-induced hypoglycaemia test and human corticotropin releasing hormone test were used to confirm and localize the level of the HHA-A defect. Thirty-two patients with HIV infection and 72 with AIDS were identified. Prevalence of glucocorticoid insufficiency by the 10 µg cosyntropin test was 21.2%. By clinical categories, the frequency in AIDS and HIV infection patients was 26.4% and 9.4%, respectively. Confirmed glucocorticoid insufficiency by insulin-induced hypoglycaemia test was found in 16 out of 19 cases. Twelve cases had primary glucocorticoid insufficiency, 7 had secondary glucocorticoid insufficiency and 3 were false positive. In conclusion, adrenocortical dysfunction occurs in approximately 20% of the cases with HIV disease. Clinical findings commonly occurring in HIV disease as well as adrenocortical insufficiency are not reliable indicators for performing adrenocortical laboratory assessment. Our results suggest screening all AIDS patients with the 10 µg cosyntropin test.
Recurrent hypersensitivity to Combivir
Authors: Winston Alan , McLean Ken
Published: October 2002

The non-nucleoside reverse transcriptase inhibitors (NNRTIs) are commonly used in combination antiretroviral therapy and are associated with hypersensitivity reactions on induction therapy. We report a case of recurrent hypersensitivity associated with Combivir, when there was a delay in determining the cause as the NNRTIs were considered to be the more likely cause.
Psychosocial determinants of sexual activity and condom use intention among youth in Addis Ababa, Ethiopia
Authors: Taffa N , Klepp K I , Sundby J , Bjune G
Published: October 2002

Determinants of sexual activity and intentions for condom use were examined guided by the Attitude, Social influences, and Self-efficacy (ASE) model as a theoretical framework. A total of 561 in and out-of-school youth (15–24 years) in Addis Ababa completed a self-administered questionnaire. A third of them reported sexual intercourse in the past and half of the sexually active used condoms during recent intercourse. Being out-of-school, male, aged 20–24 years, alcohol use and khat (amphetamine-like substance) consumption predicted the likelihood of engagement in sexual activity. Of these variables, however, male sex was more associated with reported condom use during recent sexual intercourse. Self-efficacy, skills, and barriers predicted 23% of the variance in intentions to use condoms. Self-efficacy was also associated with past condom use. Psychosocial constructs predicted more variations in condom use intention for males than for females. In general, self-efficacy was found to be the strongest predictor of the constructs, whereas attitude and social influences were the weakest. The study implies that HIV/AIDS prevention programmes for young people in Ethiopia need to emphasize building assertive communication skills in sexual negotiations and condom use. Minimizing the gender gap in sexual relationships forms the cornerstone for such educational strategies.
Colposcopy services provided by Genito-Urinary Medicine Clinics in the United Kingdom-British Society for Colposcopy and Cervical Pathology/National Co-ordinating Network Survey, 1993
Authors: Shen R N , Hicks D A , Cruickshank M E
Published: October 2002

Postal questionnaires were circulated to all Genito-Urinary Medicine (GUM) clinics in the UK (in parallel with questionnaires circulated to gynaecologists) on behalf of British Society for Colposcopy and Cervical Pathology (BSCCP) and National Co-ordinating Network (NCN) to audit colposcopy services. Information was sought on colposcopy workload, referral criteria, treatment method and followup, waiting times, staffing and training. A similar but less comprehensive survey of colposcopy services in GUM was undertaken in 1990 enabling direct comparison of some but not all aspects of the service in the last 3 to 4 years 1. One hundred and forty-two GUM Clinics replied. Of those who replied, 70 (49.3%) clinics provided a colposcopy service; an increase from 60 to 70 clinics since 1990. However, only 66 clinics provided detailed inform ation for analysis. Forty-six out of 66 (69.7%) clinics performed treatment for some or all of their patients and the most frequent methods of treatment used were loop excision and cold coagulation. One hundred and seventy-two (range 8-1982) patients were seen per annum with a m ean of 7 (range 1- 68) colposcopy sessions per month. Sixty-four per cent of these sessions were undertaken by consultants, 14% by training grades and the rest by Clinical Assistants and Associate Specialists. Fifty-three per cent of all patients with abnormal smears were colposcoped within 2 weeks and the maximum waiting period was less than 8 weeks for all severe dyskaryosis/malignant cells cytology reports; 1.6% of clinics admitted to having cases of invasive cervical cancer following previous treatment of cervical intraepithelial neoplasia (CIN) and 96% of clinics had a protocol in place for defaulters. The default rate was 12% both for new and follow-up patients. Thirty out of 70 (43%) clinics were com puterized and 50/66 (75.8%) of clinics collected accurate statistics.
Risk factors for HIV in pregnant women
Authors: Smith Nathaniel H , Hwang Lu-Yu
Published: October 2002

Worldwide, the number of childbearing women infected with the human immunodeficiency virus HIV is rising. Early intervention can improve care for these women and reduce HIV transmission to their children. However, for intervention strategies to be effective, childbearing women at risk must be identified. HIV prevalence and risk factors vary widely from one region to another, and strategies for HIV testing must be tailored to local conditions. In this review, published data on HIV risk factors in pregnant women are presented by region, and implications for regional strategies for HIV testing in pregnant women are discussed.
Musculoskeletal disorders: genitourinary medicine perspective
Authors: Tayal Sarup C , Watson Peter
Published: October 2002

Summary: The association of musculoskeletal disorders and genitourinary symptoms is reviewed. Reactive arthritis, Sjogren's syndrome and rheumatoid arthritis can present with a variety of genitourinary symptoms. Similarly sexually transmitted diseases including gonorrhoea, syphilis, HIV and other viral infections can affect the musculoskeletal system. Reiter's syndrome may be a consequence of a sexually transmitted infection although its presentation can suggest that also in postdysenteric cases. The fact that conditions may present to various medical specialties requires doctors outside departments of GUM to allow their patients an opportunity and the time to discuss sexual matters.
Key issues in outcomes measurement
Authors: Long Andrew F
Published: October 2002

Summary: Exploring and monitoring outcomes within routine clinical practice is central to high quality patient care. It is however a complex and challenging task. Multiple interests in outcomes information are apparent and different perspectives on what counts as an 'effective' intervention or 'successful' outcome. The paper provides insight into ways to explore and monitor the desired outcomes of key participants to the health care process. In particular, it outlines the approach of the outcomes grid, and applies this to services for genitourinary medicine.
Parvovirus B19 infection in AIDS patients
Authors: Kerr J. R. , Kane D. , Crowley B. , Leonard N. , O'Briain S. , Coyle P. V. , Mulcahy F.
Published: October 2002

Summary: Bone marrow of 61 HIV-1-infected patients and 23 control patients was examined to determine the incidence of B19 infection and its clinical impact in HIV1-infected persons. Of the 61 HIV-infected patients studied, ages ranged from 22-47 years with a mean of 33.2 years. There was a man : woman ratio of 3.8 : 1.With regard to staging of HIV disease at the time of bone marrow sampling, 52 patients were CDC group 4, 5 patients were CDC group 3, and 4 patients were CDC group 2. Control patients, were not known to be HIV-1-infected, and had one of the following conditions: lymphoma, leukaemia, thrombocytopenia, thrombocytosis, anaemia, multiple myeloma, raised serum IgM. Thirteen of 61 HIV-infected patients and 0 of 23 control patients were positive for B19 DNA in bone marrow (two-tailed P value=0.016). Within the HIV-infected group, the average haemoglobin among persons testing B19 DNA positive (n=13) was 11.1 g/dl, compared with 11.5 g/dl among persons testing B19 DNA negative (n=48). In conclusion, B19 persistence may be common and frequently subclinical in AIDS patients.
Cryptosporidiosis in patients with AIDS
Authors: Stuart Rhonda L , Hellard Margaret E , Jolley Damien , Spelman Denis , Hoy Jennifer , Stevenson Elaine M , Yates Maria T , Ryan Norbert J , Fairley Christopher K
Published: October 2002

Cases of cryptosporidiosis in patients with the acquired immunodeficiency syndrome (AIDS) residing in Melbourne over a 6-year period (1990-1995) are described. During this period 85 cases occurred, while 979 new AIDS diagnoses were notified. Over this period temporal clustering in cryptosporidial detection was evident ( P =0.007), but the pattern was not statistically associated with the season, rainfall ( P =0.88), mean average maximal temperature ( P =0.15) or mean average minimal temperature. Further studies should identify these risk factors and provide an opportunity to prevent this devastating disease.
HIV seroprevalence amongst pregnant women in northeastern Zaire
Authors: Wannan Gary J , Cutting William A M , Fischer Philip R
Published: October 2002

To assess the seroprevalence of HIV in pregnant women in northeastern Zaire and factors that correlate with seropositivity, sequential blood sampling and interviews were performed on 700 women at antenatal clinics in northeastern Zaire. The seroprevalence of the 3 clinics surveyed varied from 0.3%-5.5%, rates being higher in more urban areas. Seropositivity was associated with greater < education ( P 0.001) and having a partner whose job involved travelling < ( P 0.001). No correlation was found with marital status, age, or gravidity. Women in northeastern Zaire are at a greater risk of being infected with HIV if they are well educated or have a husband who travels due to his work. Health education on HIV should be particularly directed at women who are well educated and at men who have 'mobile' jobs.
Decrease in CD4 lymphocyte counts with rest; implications for the monitoring of HIV infection
Authors: Campbell P J , Aurelius S , Blowes G , Harvey D
Published: October 2002

Measurement of the CD4 lymphocyte count is widely used as a prognostic marker and guide for the institution of antiretroviral therapy in patients infected with HIV (human immunodeficiency virus). CD4 counts are known to fluctuate with strenuous physical activity and diurnal variation but there is no information on the effects of rest or normal daily activity. We investigated the effects of rest on the absolute CD4 lymphocyte count in 20 healthy laboratory workers. Blood samples were obtained in 20 subjects upon arrival in the laboratory (CD4 0), following 30 and 60 min rest (CD4 30 and CD4 60 respectively) and 8 h into a normal working day (CD4 8). A significant decrease in the CD4 lymphocyte count was observed following 60 min rest; mean CD4 count at 0 min 1060 106/L, mean CD4 count at 60 min 660 106/L ( P =0.0017). These results demonstrate a significant effect of rest on CD4 lymphocyte counts in healthy volunteers. This biological variation may be important in HIV-infected patients and needs to be addressed by further studies.
Sexually transmitted diseases in Estonia: past and present
Authors: Uuskula A , Silm H , Vessin T
Published: October 2002

The present survey covers historical events in Estonia during the era of the USSR regime and the era after independence as regards incidence of sexually transmitted diseases (STDs). The diagnostical methods used as the reporting system are presented. Reasons for the increased incidence of traditional venereal diseases such as gonorrhoea and syphilis are discussed. The importance of migration of prostitutes from Russia is also considered.
HIV/AIDS care giving physicians: their experience and practice patterns
Authors: Heath Katherine V , Bally Gerry , Yip Benita , O'Shaughnessy Michael V , Hogg Robert S
Published: October 2002

To identify associations between HIV-related experience and patterns of service provision, physicians across Canada were solicited by mail to register in a national network of HIV/AIDS care givers. Respondents provided data about: personal, demographic and practice characteristics; the number of HIV-positive patients ever seen; the nature of the HIV-positive client population; and services provided to HIV-positive patients. Univariate techniques provided a demographic and professional profile of participating physicians. Logistic regression was used to identify associations between level of HIV-related experience and the provision of patient services. The 566 registered physicians have provided care to 56,378 HIVinfected persons and represent every province and territory in Canada. Multivariate analysis revealed that highly experienced physicians were more likely to provide all 3 types of services considered, to practise in Montreal, Vancouver or Toronto, and to < be medical specialists (all P 0.001).
Clinical predictors of azole resistance, outcome and survival from oesophageal candidiasis in AIDS patients
Authors: Laing R B S , Brettle R P , Leen C L S
Published: October 2002

Summary: A retrospective review of AIDS-related oesophageal candidiasis was undertaken to identify clinical features helpful in predicting response to azole therapy and patient survival. Patients who had received daily azole prophylaxis against candidiasis were significantly less likely to respond to azole therapy than < those who had not ( P 0.001). Patients who had lost the 2 months before oesophageal candidiasis were less likely to respond to azoles < than the others ( P 0.001). Amongst those who had not received daily azoles, < + patients with a CD4 cell count 25/mm were less likely to respond to azole treatment ( P = 0.05). The median survival beyond oesophageal candidiasis was 18 months. Survival from oesophageal candidiasis was significantly poorer for patients who did not respond to azole therapy but AIDS survival did not differ between azole responders and non-responders. Non-responders who had been taking daily azole prophylaxis had the poorest survival (median = 4 months). > 5% of their body weight in 3
An international survey of patients with genital warts: perceptions regarding treatment and impact on lifestyle
Authors: Maw Raymond D , Reitano Michael , Roy Michel
Published: October 2002

Our aim was to determine country-specific attitudes and perceptions of patients with genital warts and to understand the psychosexual impact of the disease and its treatment. We used a standardized discussion guide to interview patients with genital warts in Canada, France, Germany, the UK, and the USA about their perceptions and concerns regarding the diagnosis, treatment, and psychosexual impact of the disease. Interviews were conducted in person and lasted approximately 30 min. The study group included 80 men and 86 women with genital warts. Forty-seven per cent were currently undergoing treatment. Overall, 49% of the men had first consulted a general or family practitioner, and 52% of the women had first consulted a gynaecologist. Although all the patients eventually consulted a physician about their warts, one-third delayed seeing a doctor because they thought the condition would resolve on its own or that the problem was not serious. Most patients reported that treatment was associated with pain, discomfort, and embarrassment. Sixty per cent of patients experienced a recurrence after initial clearance with treatment. More than 80% stated that they had had little or no involvement in the selection of treatment. Globally, 52% of men and 61% of women were 'quite concerned' or 'very concerned' about having genital warts, although there were significant variations by country. Approximately two-thirds of patients had made lifestyle changes regarding sexual relationships. In addition, two-thirds believed that there were risks associated with having genital warts; the most common risk identified was a link to cancer (cervical and unspecified). A high level of anxiety is associated with the diagnosis and treatment of genital warts. Patients with genital warts require understanding and an acknowledgement of their concerns. A better understanding of the psychosexual aspect of the disease by health-care providers is pivotal to effective disease management and patient counselling.
Paediatric HIV infection in the Republic of Ireland and the need for antenatal screening
Authors: Nourse C , Hayes E , Travers R , Mcconkey S , Butler K M
Published: October 2002

Thirty-seven HIV-infected children have been identified in the Republic of Ireland since 1985. Only 12 (32%) of 37 were followed prospectively from birth. Median age at diagnosis was 18 months (4 weeks to 8 years). In 32 (86%) of 37 cases, HIV infection was acquired as a result of transmission from mother to infant with intravenous drug use (IVDU) the most frequent risk factor for maternal acquisition of HIV. Of these 32 children, median maternal age at delivery was 24 (interquartile range (IQR) 23-26) years with median gestation at delivery 40 (IQR 38-40) weeks. Mode of delivery was by vaginal delivery in all 29 (91%) cases where mode of delivery is known. Only 2 infants were breastfed. Seven children have died at a median age of 9 (0.8-9.6) years. As of July 1997, 12 children have AIDS, 14 have symptomatic disease without AIDS and 3 are asymptomatic. Median age at AIDS diagnosis was 2.6 (0.1-6.5) years. Median survival time post-AIDS diagnosis was 6.5 (1.8-8.3) years. Of 29 living children, 24 mothers and 14 fathers are HIV infected and only 14 children live with both parents. Childhood HIV infection has had a significant personal, social and financial impact on both Irish families and society in general. More effective measures to control HIV infection among intravenous drug users are needed. Antenatal detection of HIV-infected mothers is paramount as vertical transmission can be successfully prevented and morbidity and death can be prevented in the infected infant.
An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-seropositive persons
Authors: Smith Nicholas P , Nelson Mark R , Azadian Berge , Gazzard Brian G
Published: October 2002

Staphylococcus aureus is a cause of considerable morbidity and mortality in HIV-seropositive persons. Although methicillin-resistant S. aureus (MRSA) is encountered worldwide and in many areas of medical care, little has been reported on clinical infection with MRSA in patients with HIV. We report on an outbreak of MRSA infection in HIV antibody positive patients, using case reports to describe an outbreak of MRSA infection in HIV-seropositive persons. Six cases of clinical MRSA infection were reported over a 4-week period on patients on an HIV dedicated ward. All cases had previous AIDS diagnoses and low CD4 cell counts (median 8 x 10 6/l; range 0 to 238). Two cases had infected skin lesions and 2 cases had infected indwelling central venous catheters with septicaemia. Two cases had pneumonia, one with concurrent infection at the entry site of a percutaneous endoscopic gastrostomy (PEG) feeding tube. Isolates of MRSA from the 6 cases were compared by pulsed-field gel electrophoresis of Sma 1 chromosomal digests. The resultant banding pattern showed the same strain was responsible for all the infections. A seventh inpatient, the index case, had positive carriage with the same strain of MRSA. To define ongoing MRSA carriage after the outbreak, 29 consecutive ward patients were swabbed for MRSA: all were negative. All patients identified with MRSA infection responded to treatment with intravenous teicoplanin, although carriage was unaltered. Four of the 6 cases died within 7 weeks of diagnosis of MRSA. MRSA can cause severe morbidity in patients with end-stage HIV disease. A small outbreak of MRSA was controlled by simple precautionary measures with no subsequent ongoing transmission of MRSA.
Risk profile of female sex workers who participate in a routine penicillin prophylaxis programme in Surabaya, Indonesia
Authors: Joesoef M R , Kamboji A , Valleroy L A , Linnan M , Idajadi A , Louis M E St , Kuntjoro T M , Barakbah Y
Published: October 2002

We conducted a sexually transmitted disease (STD) prevalence survey of 1867 female sex workers in Surabaya, Indonesia, some of whom reported participation in a routine penicillin prophylaxis programme. In Surabaya, 34% of female sex workers had received a prophylactic penicillin injection programme from the government within 28 days. Sex workers who had received routine prophylaxis injection were more likely to be less educated, to work in brothel complexes, and to have more customers per week than other sex workers. The prevalence rates of syphilis, gonorrhoea, chlamydia, and trichomoniasis were higher among sex workers who received the routine penicillin treatment than among those who had not received antibiotic treatment in the last 28 days. However, after adjustment for age, education, fee per sex act, number of customers, and condom use in the previous 7 days, only trichomoniasis was still significantly different (adjusted odds ratio of 3.2). High-risk women were more likely to participate in the routine penicillin prophylaxis programme. The lack of a demonstrable individual-level protection from this prophylaxis treatment programme in this cross-sectional study appears due to differential uptake of penicillin prophylaxis by women at higher presumptive risk for STD. Randomized clinical trials and mathematical modelling, together with observational data such as presented here, all can contribute to optimal understanding of a complex intervention like mass chemoprophylaxis for STD among female sex workers.
Liaison between gynaecologists, microbiologists and genitourinary medicine clinics in the management of patients with genital chlamydia and gonococcal infections
Authors: Huengsberg M , Mullis D , Gray J , Sawers R S , Radcliffe K W
Published: October 2002

Inadequate treatment and follow-up of women with genital infection with Chlamydia trachomatis and Neisseria gonorrhoeae can cause long-term morbidity1,2. Inadequate contact tracing can predispose to re-infection3. As some women with genital infections present to agencies other than genitourinary medicine (GUM) clinics, improved liaison between these and GUM departments are important in safeguarding proper follow-up and contact tracing4.