Immunoglobulin G subclass responses to Helicobacter pylori vary with age in populations with different levels of risk of gastric carcinoma.
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Adolescent↗
Biomedical subjects
A Dale
Publications and source records attributed to A Dale.
Early Helicobacter pylori colonisation: the association with growth faltering in The Gambia.
BACKGROUND: Helicobacter pylori is one of the commonest causes of chronic infection of mankind, yet the natural history of acute infection is poorly understood. Some studies suggest that gastric colonisation with H pylori is associated with suboptimal nutrition and growth in childhood. AIMS: To describe the clinical features of early H pylori colonisation and assess its role in the development of infant malnutrition and growth faltering. METHODS: Two consecutive prospective longitudinal cohort studies were conducted at the Medical Research Council Laboratories in a rural community in The Gambia, West Africa. The first birth cohort of 125 infants was followed by a second of 65 children from the same community. H pylori colonisation was detected by sequential 13C urea breath tests, and infant growth was monitored by serial measurements. RESULTS: Children with early H pylori colonisation became significantly lighter, shorter, and thinner than their peers in late infancy. The association was found in both cohorts. No socioeconomic or demographic confounding variables were identified to explain this, and the weight deficit was no longer detectable when the children were aged 5-8 years. CONCLUSIONS: Results suggest that H pylori colonisation in early infancy predisposes to the development of malnutrition and growth faltering, although the effect did not persist into later childhood.
Breath Tests↗
Time To Pregnancy and occupational lead exposure.
BACKGROUND: Lead exposure is known to be harmful to the male reproductive system, including impairment of fertility. However, it is unclear whether currently existing low levels of exposure have this effect. AIMS: To study retrospectively current workers in lead using industries (battery manufacture, smelting, etc), and in non-lead using control industries, in four European countries, with Time To Pregnancy as the outcome variable, as part of the EU funded Asclepios Project. METHODS: Exposure assessment was mainly by blood lead values, which were available from the late 1970s, supplemented by imputed values where necessary. Three exposure models were studied: (1) short term (recent) exposure; (2) total duration of work in a lead using industry; and (3) cumulative exposure. A Cox proportional hazards model with discrete ties was used for the statistical analysis, with covariates for both partners. RESULTS: A total of 1104 subjects took part, of whom 638 were occupationally exposed to lead at the relevant time. Blood lead levels were mainly less than 50 microg/dl. No consistent association of Time To Pregnancy with lead exposure was found in any of the exposure models, although reduced fertility was observed in one category each in models (2) and (3). CONCLUSIONS: This basically negative result is unlikely to be due to the misclassification of key variables, to insufficient statistical power, or to bias, for example, response bias. If any impairment of male reproductive function exists at the levels of occupational lead exposure now current, it does not appear to reduce biological fertility.
Cross-Sectional Studies↗
Sperm count and chromatin structure in men exposed to inorganic lead: lowest adverse effect levels.
OBJECTIVES: To obtain knowledge on male reproductive toxicity of inorganic lead at current European exposure levels and to establish lowest adverse effect levels, if any. METHODS: A cross sectional survey of the semen of 503 men employed by 10 companies was conducted in the United Kingdom, Italy, and Belgium. The mean blood lead concentration was 31.0 microg/dl (range 4.6-64.5) in 362 workers exposed to lead and 4.4 microg/dl (range below the detection limit of 19.8) in 141 reference workers. Semen volume and sperm concentration were determined in a fresh semen sample according to an agreed protocol subject to quality assurance. The sperm chromatin structure assay (SCSA) was performed at a centralised laboratory. Extraneous determinants including centre, period of sexual abstinence, and age were taken into account in the statistical analysis. If appropriate, possible thresholds were examined by iterative threshold slope linear regression. RESULTS: The median sperm concentration was reduced by 49% in men with blood lead concentration above 50 microg/dl. There was no indication of a linear trend of lower sperm concentration with increasing blood lead values, but threshold slope least square regression identified a blood lead concentration of 44 microg/dl (beta=-0.037, F=4.35, p=0.038) as a likely threshold. Abnormal sperm chromatin structure was not related to blood lead concentration, but some indications of deterioration of sperm chromatin was found in men with the highest concentrations of lead within spermatozoa. Biological monitoring data did not indicate long term effects of lead on semen quantity or sperm chromatin. CONCLUSION: Adverse effects of lead on sperm concentration and susceptibility to acid induced denaturation of sperm chromatin are unlikely at blood lead concentrations below 45 microg/dl. Effects of low level exposure to lead on other measures of testicular function cannot be ruled out.
Adult↗
Functional imaging of neural responses to expectancy and experience of monetary gains and losses.
Neural responses accompanying anticipation and experience of monetary gains and losses were monitored by functional magnetic resonance imaging. Trials comprised an initial "prospect" (expectancy) phase, when a set of three monetary amounts was displayed, and a subsequent "outcome" phase, when one of these amounts was awarded. Hemodynamic responses in the sublenticular extended amygdala (SLEA) and orbital gyrus tracked the expected values of the prospects, and responses to the highest value set of outcomes increased monotonically with monetary value in the nucleus accumbens, SLEA, and hypothalamus. Responses to prospects and outcomes were generally, but not always, seen in the same regions. The overlap of the observed activations with those seen previously in response to tactile stimuli, gustatory stimuli, and euphoria-inducing drugs is consistent with a contribution of common circuitry to the processing of diverse rewards.
Adult↗
Ambulatory blood pressure in patients with mesangial proliferative glomerulonephritis.
Twenty-four-hour ambulatory blood pressure was measured in seven normotensive and 10 hypertensive patients with biopsy proven mesangial proliferative glomerulonephritis (MPG). In normotensive patients, the nocturnal blood pressure variation was seen with a nightly drop in blood pressure while in hypertensive patients with MPG, 24-h blood pressure level was increased both at day- and night-time, but a nocturnal change in blood pressure was also observed in these patients. The pattern of blood pressure variation was not, however, different from the normotensive patients. None of the hypertensive patients with MPG was a so-called non-dipper, showing the same level of blood pressure both at day- and night-time. The hypertensive patients had a rapid increase in blood pressure in the early morning hours from 06.00 to 09.00 h, followed by a relatively abrupt decrease in blood pressure in the evening hours. The patients with high blood pressure were treated with antihypertensive drugs; all patients started with captopril 25 mg once a day, later increasing to twice daily. If the correction of the high blood pressure was not achieved with this drug, amlodipine 5 or 10 mg was added with or without furosemide. Most of the patients needed more than one drug. In all patients, a normal 24-h ambulatory blood pressure could be obtained. The lack of nightly non-dippers in the present hypertensive patients may be explained by a relatively short history of renal disease and the presence of normal or moderately reduced glomerular filtration rate. The abrupt rise in blood pressure during the early morning hours may be due to activation of the renin-angiotensin or sympathetic nervous system in the hypertensive patients with MPG.
Adult↗
Unusual presentation of mastoid eosinophilic granuloma in a young patient.
Eosinophilic granuloma is a well-recognized form of Langerhans cell histiocytosis, most commonly involving the skull bones, usually with an excellent prognosis. Recurrent and difficult to recognize osteolytic lesions of the skull are encountered only rarely. A patient with recurrent eosinophilic granuloma of the skull is reported. In spite of appropriate multimodality treatment, there were several recurrences, most recently with involvement of the mastoid process. Imaging studies revealed extensive involvement of surrounding structures with expansion of the tumor into the middle cranial fossa and slight pressure on the antero-medial portion of the temporal lobe of the brain. Despite extensive involvement, the patient had no complaints. Because of the rarity of such silent and unpredictable lesions, a systematic approach with regular CT and MRI follow-up is suggested.
Child↗
Adherence to highly active antiretroviral therapy in the real world: experience of twelve English HIV units.
In order to describe how human immunodeficiency virus (HIV) clinics in and around London are trying to optimize their patients' adherence to highly active antiretroviral therapy (HAART), we performed a survey of practice and policy in the clinics using a postal questionnaire. Clinics were also asked to review up to 10 randomly selected case notes of patients receiving HAART and complete a questionnaire on each about how adherence was encouraged and assessed. Twelve clinics took part in the project and surveyed the notes of 89 patients. The results show that several clinics define adequate adherence as taking more than 95% of prescribed doses although there was no uniform definition across the participating units. Adherence was encouraged through simplifying HAART regimens, providing dose-dispensing boxes and alarms, arranging early follow-up for patients starting treatment, and offering continuing support through specific health care workers. Adequate discussion and provision of written information was seen as an important aid to adherence but the case note survey showed evidence of deficiencies in this area in approximately 40% of patients. Assessed levels of adherence were less than 95% in 27% of patients. The main reasons for suboptimal adherence were found to be lack of motivation to take treatment by the patients, high pill burden, and drug side effects although there were several other contributing factors. This study shows that the HIV units take HAART adherence seriously but there are several deficiencies in putting policy into practice.
Ambulatory Care Facilities↗
CMF (cyclophosphamide, methotrexate, 5-fluorouracil) versus cnf (cyclophosphamide, mitoxantrone, 5-fluorouracil) as adjuvant chemotherapy for stage II lymph-node positive breast cancer: a phase III randomized multicenter study.
A multicenter phase III randomized study compared the efficacies of two adjuvant polychemotherapeutic regimens in 145 patients with stage II node-positive breast cancer. The standard chemotherapy combination, CMF (cyclophosphamide, methotrexate, 5-fluorouracil), was administered to 77 women. The experimental protocol, CNF (cyclophosphamide, mitoxantrone, 5-FU), in which mitoxantrone (Novantrone) replaced methotrexate, was given to 68 patients. Follow-up of the 145 patients by six participating hospitals showed no statistically significant difference (p = 0.6) between the two treatment regimens during a median follow-up of 4.5 years in terms of overall survival. There was, however, a significant advantage (p = 0.04) in the disease-free survival for those receiving mitoxantrone (mean survival 4.4 years for CNF versus 2.7 years for CMF). Toxic side effects associated with CNF (particularly alopecia and myelotoxicity) were relatively more frequent but acceptable and did not lead to dose reduction. In light of its association with improved disease-free survival in this study, larger studies should be undertaken on the role of mitoxantrone as adjuvant treatment in stage II breast cancer.
Adult↗
Management of chronic prostatitis in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 2000.
Twenty-two Genitourinary Medicine (GUM) clinics in North Thames participated in a survey of policies and case notes audit of chronic prostatitis managed within the past 2 years, compared with the UK National Guideline. For 32/33 cases notes reviewed (97%) chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/CPPS) were diagnosed. Of these, 14/32 cases (44%) were following non-chlamydial non-gonococcal urethritis (NGU), 1/32 cases (3%) followed Chlamydia trachomatis infection and for 17/32 cases (53%) no predisposing cause was identified. The single case of chronic bacterial prostatitis (CBP) was caused by prostatic infection with Staphylococcus spp. All cases were prescribed antibiotics, initial follow-up appointments coinciding with completion of antibiotics. Fourteen cases (42%) were discharged following GUM clinic management; only 7 of these cases (50%) were asymptomatic, the others having residual problems. Nine cases (27%) were referred to a specialist. Ten cases (30%) defaulted follow-up appointments; 7 of these did not attend their first follow-up appointments.
Adult↗
Antiretroviral resistance testing policy in England's north Thames HIV units: a survey of current practice.
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Anti-HIV Agents↗
[Metformin associated lactic acidosis--case reports and literature review].
BACKGROUND: The use of metformin in the treatment of diabetes mellitus type II is increasing. The drug has several advantageous metabolic effects, and is considered safe if not used in the presence of contraindications, in particular renal failure. MATERIAL AND METHODS: We present a patient with metformin associated lactic acidosis, to remind of a potentially lethal adverse reaction. We also review the literature about incidence and risk, prognosis and treatment of the disease. RESULTS: Our patient was a 72 year old woman with diabetes mellitus type II treated with metformin, who presented with acute renal failure, severe metabolic acidosis and circulatory failure. Treatment with bicarbonate buffer and vasopressors did not improve her condition, only after hemodialysis was her situation stabilised. INTERPRETATION: Metformin associated lactic acidosis must be considered in obscure metabolic acidosis in diabetic patients. The single most important therapeutic approach appears to be immediate hemodialysis.
Acidosis, Lactic↗
Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals.
OBJECTIVES: To ascertain current practices in the diagnosis and management of HIV and pregnancy in the North Thames Region. METHODS: Postal survey using a self-completed questionnaire sent to the head of all of the Region's 34 units involved in the care of HIV. The survey asked questions on current policy around HIV and pregnancy in the HIV units and associated antenatal clinics and was linked to a case-note survey of pregnant, HIV-positive women in the last 2 years. RESULTS: Over 50% of the responding antenatal units recommended the HIV test by March 1999. Most HIV units were offering a range of antiretroviral regimens in pregnancy, although a minority (33%) did not offer triple therapy. Elective Caesarean section was the recommended mode of delivery for most women (90%) irrespective of drug therapy or viral load. Most infants were being tested for HIV infection by a combination of PCR, viral culture and antibody testing to 18 months of age. All the infants (19) followed to 6 months of age in the case-note survey were PCR negative. Reporting rates to the National Survey of HIV in Pregnancy were high (87%) but poor for the Drug Exposure Register (33%). CONCLUSIONS: Management of HIV and pregnancy in the North Thames units showed a large amount of consistency with regard to testing policies and management. However, there were a few units that did not offer therapy appropriate for advanced disease despite the recommendations of national bodies and a few units still did not recommend HIV testing to all women.
England↗
Developments in census taking in the last 25 years.
This article looks back at censuses of population conducted since 1971. It identifies some of the most important changes with respect to questions asked, methods of collecting the census and the production of outputs. In particular it discusses the introduction of the ONS Longitudinal Study following the 1971 Census and the Samples of Anonymised Records following the 1991 Census. This article outlines some of the changes being introduced for the 2001 Census, including methods of dealing with under-enumeration and improved access to outputs.
Censuses↗
FP provision in GUM clinics.
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Ambulatory Care Facilities↗
[Kidney biopsies and video conferences].
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Humans↗
Helicobacter pylori colonization in early life.
Helicobacter pylori infection is a major cause of upper gastrointestinal disease throughout the world. Colonization begins in childhood, although little is known about its age of onset, rate, or mode of colonization. Our aim was to identify the age of acquisition of H. pylori colonization in Gambian children. A cohort of 248 Gambian children aged 3 to 45 months was studied at intervals of 3 months for 2 years, using the 13C-urea breath test, specific IgM and specific IgG serology. The prevalence of positive breath tests rose from 19% at 3 months of age to 84% by age 30 months. Elevated specific IgG and IgM antibody levels were associated with positive breath tests, although there was discrepancy between breath test results and serology, particularly IgG serology, during the 1st year of life. Neither IgG nor IgM serology could be validated as reliable diagnostic tools for infant H. pylori colonization compared with the 13C-urea breath test. Reversion to negative breath test, in association with declining specific antibody levels, occurred in 48/248 (20%) of children. On the assumption that the 13C-urea breath test is a reliable index of H. pylori colonization, we conclude that the infection is extremely common from an early age in Gambian children. Transient colonization may occur. Previous studies relying on serodiagnosis may have significantly underestimated the true early prevalence of colonization in the developing world, where the target age for intervention studies is probably early infancy.
Antibodies, Bacterial↗
Interpreting the 13C-urea breath test among a large population of young children from a developing country.
The 13C-urea breath test is a noninvasive tool for the diagnosis of gastric Helicobacter pylori infection. However, it has not been validated in young children from the developing world, where infection is very common. 13C urea breath tests were performed on 1532 occasions on 247 Gambian infants and children aged from 3 to 48 mo. The means and variances of the separate sub-populations of 13C enrichment results contained within the overall dataset were estimated by a Genstat procedure using the EM algorithm, thereby identifying a cut-off value to discriminate positive from negative results. To illustrate the appropriateness of this calculated cut-off value, 13C urea breath tests were performed upon a small group of 14 patients aged 6 to 28 mo undergoing diagnostic upper endoscopy. Fixed gastric antral biopsies were examined to identify H. pylori. Two subpopulations were identified within the large dataset. A cut-off value of 5.47 delta per thousand relative to Pee Dee Belemnite limestone above baseline at 30 min identified 95% of the normally distributed negative sub-population and 99.4% of the log normal distributed positive sub-population. Comparison with endoscopic data confirmed that this cut-off value was appropriate for this population, as 7/7 children without H. pylori on their gastric biopsies had negative urea breath tests, and 6/7 children with gastric H. pylori colonization had positive urea breath tests. These findings confirm the value of the urea breath test as a diagnostic tool in young children from developing countries. They also offer a way to calculate the most appropriate cut-off value for use in different populations and the likelihood that it will correctly assign any value into the appropriate sub-population, without the need for endoscopy.
Breath Tests↗