Biomedical subjects
Publications and source records attributed to B T Goh.
The aim of this study was to assess the prevalence of otological symptoms in patients with chlamydial conjunctivitis. We report four cases of chlamydial conjunctivitis, in association with otitis media, that were investigated by an otologist.
The Department of Health provided two recurrent targeted funding of 5 million pounds sterlings and 3 million pounds sterlings for genitourinary (GU) medicine services in 2003 in response to the increasing waiting times for appointments. The British Association for Sexual Health and HIV conducted a survey to find out if the clinics continued to receive their full allocation, if not, the reasons for it, and the workload change from 2002 to 2004. Out of a total of 91 responders, 78 were from acute trusts and 13 from primary care trusts (PCTs). Of the acute trusts and PCTs, respectively, 67.9% and 76.9% received the full allocation; overall 30.8% did not receive their full allocation. In all, 86% of clinics had increases in their workload and of the 26 clinics with shortfall of funds, 24 (92.3%) still managed to increase the workload. This survey showed that the funding and other measures have increased the workload capacity, and also highlights the continuing problem of many clinics in not receiving their full allocation. Such clinics should be targeted for early review by Medical Foundation for AIDS and Sexual Health with involvement of the Special Health Authorities and PCTs in the current national review of GU services.
The introduction of digital camera and phone camera without having to develop images by a third party has simplified photography for everyday use. Digital imaging by patients can assist the assessment of medical conditions. We describe four male patients attending our department in whom digital imaging initiated by the patients was deemed to be helpful in supporting the diagnosis and assessing the severity of Peyronie's disease.
The majority of cases of chlamydial conjunctivitis are thought to result from autoinoculation by the patient of infected genital secretions from themselves or their sexual partners. We noted that some patients had developed symptoms following direct ejaculation into the affected eye. We describe four cases of chlamydial conjunctivitis following ejaculation of semen directly into the eye, which have not been previously described. In only one case was chlamydia detected in the genital tract. In three cases, there was no evidence of genital chlamydial infection; the sources of the eye infection being either from infected genital material of their sexual partners transferred by hands to the eyes, or more likely from direct ejaculate inoculation. It is likely that this mode of transmission is underestimated as a history of ejaculation into the conjunctiva is not normally asked for.
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
OBJECTIVES: To evaluate the use of dark ground microscopy (DGM) and treponemal serological tests in the diagnosis of primary (PS) and secondary (SS) syphilis. METHODS: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002. Data were collected on demographics, results of treponemal serology and DGM. RESULTS: 50 individuals had PS and 36 individuals had SS. DGM was performed in 31/50 (62%) of PS cases and this was positive in 97%. In 17 (34%) cases of PS, treponemal EIA was negative initially. DGM was performed on 13 of these, all of which were positive. Therefore, EIA had a sensitivity of 57% when compared to DGM. In 27 patients where EIA-IgM was performed, this was positive in 22 (81%), of which 12 were EIA negative on initial screening. All SS cases had positive EIA. DGM was performed in 19/36 (52%) of SS cases and was positive in 16/19--that is, a sensitivity of 84% when compared to EIA. The major reason why DGM was not performed in the cases of PS was that herpes was the presumed diagnosis and in SS the rash was attributed to other causes. CONCLUSIONS: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.
OBJECTIVES: To describe the epidemiology, presentation, and diagnosis of early syphilis in 103 homosexual men in east London. METHODS: A retrospective study using data from KC60 returns, the Health Protection Agency (HPA) enhanced surveillance forms and case notes. RESULTS: 40 cases of primary (PS), 40 of secondary (SS) and 23 of early latent syphilis were identified, 33% co-infected with HIV. 41% had concurrent sexually transmitted infections (STIs). Pain featured in 35% of PS and itch in 13% of rashes. Dark ground microscopy (DGM), performed in 44 of the symptomatic cases, was positive in 37 (84%) allowing early management. Initial syphilis serology was negative in 15/40 (37%) cases of PS. 51% and 49% opted for parenteral and oral treatment, respectively. In 53/103 (51%) cases oral sex was the only risk factor. 86% of infections were UK acquired. Only 4% of contacts were seen. CONCLUSION: This outbreak, reflecting the resurgence of syphilis across the United Kingdom, highlights several important points. Painful chancres and itchy rash are common presentations. DGM is a highly sensitive diagnostic tool. Initial negative serological screening tests are common in PS and sero-surveillance for 3 months is recommended. The high prevalence of concomitant STIs indicates ongoing unprotected sexual intercourse. Oral sex is a significant risk factor and is a distinctly "unsafe" practice. Conventional partner notification is ineffective. Other methods of screening of the at-risk homosexual population are warranted. Continued education is required to reduce STI acquisition in homosexual men.
We report the case of a man with proven chlamydial conjunctivitis and urethritis who was found to have asymptomatic chronic penile oedema secondary to masturbation.
OBJECTIVES: To determine the safety and efficacy of imiquimod (Aldara) 5% cream in the treatment of prepuce-associated warts in uncircumcised males. METHODS: An open-label study in six UK medical centres with 35 uncircumcised males with prepuce-associated warts treated with imiquimod 5% cream three times per week for up to 16 weeks. Other anogenital warts were also treated. RESULTS: Three times weekly application of imiquimod was found to be safe, with erythema as the most commonly reported local skin reaction. Forty per cent of patients had complete clearance of anogenital warts within 16 weeks. CONCLUSIONS: Imiquimod cream at a dosing regimen of three times per week, is effective and has an acceptable safety profile in the treatment of prepuce associated warts and other external anogenital warts in uncircumcised males.
OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs) and mode of presentation in patients originating from Bangladesh and resident in the United Kingdom in comparison with non-Bangladeshi patients attending an inner London genitourinary medicine (GUM) clinic. METHODS: A retrospective, cross sectional study with comparator group was carried out at an open access GUM clinic in east London. 104 consecutive newly attending Bangladeshi men were compared with 199 consecutive newly attending non-Bangladeshi men and 115 consecutive newly attending Bangladeshi women were compared with 218 consecutive newly attending non-Bangladeshi women. Any diagnosed sexually transmitted infections, sexual history characteristics, reasons for presentation, and referral patterns were noted. RESULTS: Bangladeshi men (28.8% compared with 7.5%; p<0.0001) and women (42.7% compared with 12.8%; p<0.0001) were more likely to be referred by their general practitioners or other medical services. Bangladeshi men were more likely to present with sexual dysfunction (12.5% compared with 2.5%; p=0.001). The prevalence of STIs was broadly similar across the study groups; however, syphilis was significantly more common in the Bangladeshi men (10.9% compared with 4%; p=0.04) and nongonococcal urethritis (NGU) in the control men (35% compared with 20.2%; p=0.02). Bacterial vaginosis was an infrequent diagnosis in the Bangladeshi women (3.5% compared with 22.4%; p<0.0001). CONCLUSIONS: STI prevalence in Bangladeshis attending GUM services is similar to other populations although patterns of presentation and referral do show variation. Bangladeshi men are more likely to access GUM clinics for psychosexual services. The presence of STIs in Bangladeshis particularly those imported from Bangladesh provides an opportunity for HIV transmission between the United Kingdom and Bangladesh.
OBJECTIVE: To determine prevalence of hepatitis B virus (HBV) serological markers in Chinese residents in the United Kingdom. METHOD: Retrospective case-controlled study between January 1997 and June 2000 in two genitourinary medicine (GUM) clinics. RESULTS: 117 Chinese and 234 non-Chinese controls were studied. Baseline characteristics except marital status showed no difference. Overall prevalence of HBV serological markers was 35.8% in Chinese, controls 5.5% (p<0.001). Hepatitis B surface antigen (HBsAg) positive carrier rate was 12.8% in Chinese, controls 0.4% (p<0.001); 1.7% of Chinese patients were also hepatitis B e antigen (HBeAg) positive, none in controls. Natural immunity was acquired in 23.0% of Chinese, controls 5.1% (p<0.001). Prevalence of HBV serological markers in UK born Chinese was 6.7%, non-UK born Chinese 40.1% (p<0.011). Only 7.6% of Chinese had a history of previous HBV vaccination. CONCLUSIONS: Prevalence of HBV serological markers among Chinese patients attending two GUM clinics in London was high and only a minority of Chinese had immunisation against HBV. Although the prevalence of HBV markers in UK born Chinese was lower than non-UK born Chinese, they may be at continuous risk of HBV infection. Non-UK born Chinese patients attending GUM services in the United Kingdom should be targeted for screening and vaccination to reduce HBV transmission.
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The aim of the study was to determine the frequency of structural lesions diagnosed on magnetic resonance imaging (MRI) in a sample of patients with trigeminal neuralgia (TN) and to compare history and clinical features between the groups with and without structural lesions. Clinical records and MRI findings of 42 consecutive patients diagnosed with TN at the National Dental Centre, Singapore, and who underwent routine MRI examinations at diagnostic workup between April 1997 and March 1999 were retrospectively studied. Of these, 6 (14.3%; 95% confidence interval, 0 to 28.8%) were diagnosed with an associated structural lesion. Mean age of the group with structural lesions was 53.3 years (standard deviation, 10.9 years) at presentation, there was female predominance (M:F = 1:2), and all (100.0%) gave a typical pain history and had unilateral involvement of a single division of the trigeminal nerve. Two patients (33.3%) had other cranial nerve abnormalities. Three patients (50.0%) had complete, 2 patients (33.3%) had partial, and 1 patient (16.7%) had poor response to medical therapy. None of these variables was statistically different from the group without structural lesions (cranial nerve abnormalities were not compared). In conclusion, the frequency of structural lesions associated with TN in our sample was relatively high. It is not possible to reliably identify high risk patients for selective MRI indication on the basis of history and clinical features. It may be prudent to consider routine MRI for all patients with TN to exclude structural lesions.
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We examined the feasibility of intraoperative conscious sedation employing patient-controlled analgesia with alfentanil (PCA-alfentanil) in 20 adult outpatients undergoing third molar surgery under local anaesthesia. A loading dose of intravenous alfentanil 15 mg/kg was administered immediately before local anaesthetic administration using 2% lignocaine with 1:80,000 adrenaline. This was followed by a background alfentanil infusion of 0.05 mg/kg/min. On demand alfentanil doses were 4 mg/kg with lockout intervals of 3 minutes. All patients were mildly sedated, easily aroused verbally and co-operative throughout the surgery. None experienced any cardiovascular or respiratory complications related to PCA-alfentanil. Immediate postoperative complications included nausea, vomiting and pruritus. High patient comfort and acceptance scores suggest that the use of PCA-alfentanil can be a useful adjunct to local anaesthesia in adult outpatients undergoing third molar surgery.
Odontoameloblastoma is a very rare odontogenic tumour that is similar to ameloblastoma in its locally aggressive behaviour. Its clinical presentation, however, often mimics the more innocuous odontoma, and hence the recognition of its aggressive nature is commonly only ascertained after its histopathologic diagnosis following enucleation. This paper presents a case of odontoameloblastoma. Some of the difficulties that may be encountered in the diagnosis and treatment planning of odontoameloblastomas are discussed.
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