Biomedical subjects
D McGovern
Publications and source records attributed to D McGovern.
Diagnosis and eradication of Helicobacter pylori in patients with duodenal ulceration in the community.
OBJECTIVE: To determine the value of Helicobacter pylori (Hp) serology in diagnosis of active Hp infection in patients with documented duodenal ulcer (DU) and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. DESIGN OF STUDY: Prospective, single-blinded, randomised trial. METHODS: One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test (UBT). Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs (OCM) or tinidazole 500 mgs (OCT). Eradication was confirmed by a repeat UBT. RESULTS: Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT (100%) had a significantly better eradication rate than OCM (87.8%), p = 0.023. There was no difference in side effects. CONCLUSION: (1) Positive Hp serology in patients with DU does not always mean active infection and (2) for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp.
The efficacy of methotrexate for maintaining remission in inflammatory bowel disease.
BACKGROUND: The management of patients with inflammatory bowel disease who are resistant to or intolerant of azathioprine remains a challenge. Low-dose methotrexate has been shown to be effective in inducing remission in Crohn's disease. AIM: This review was conducted because there are limited long-term follow-up data during and after stopping treatment. There are also limited data on the use of methotrexate in ulcerative colitis. METHODS: The study was a retrospective review of clinical notes. Remission was defined as minimal bowel symptoms without the need for oral steroids for 3 months. Relapse was defined as bowel symptoms that required steroid treatment or surgery. RESULTS: Seventy patients were reviewed; 48 had Crohn's disease and 22 had ulcerative colitis. The mean duration of treatment was 17.1 months; the mean maintenance dose was 20 mg weekly. Remission was achieved in 34 of 55 patients who completed more than 3 months of treatment (62%). Life-table analysis showed that the chances of remaining in remission at 12, 24 and 36 months (if treatment was continued) were 90%, 73% and 51%, respectively. The chances of remaining in remission after stopping treatment at 6, 12 and 18 months were 42%, 21% and 16%, respectively. The dose of methotrexate (mg/kg) was associated with the induction of remission (P=0.02). Treatment was equally effective for Crohn's disease and ulcerative colitis. CONCLUSIONS: Maintenance methotrexate treatment gives acceptable remission rates for treatment periods up to 3 years. After stopping treatment, relapse is frequent and occurs early (usually within 1 year).
Drug and alcohol problems amongst individuals with severe mental health problems in an inner city area of the UK.
BACKGROUND: The extent and impact of drug and alcohol use among those with severe mental health problems has been well documented in the US. However, little is known of the nature of this problem in the UK, particularly in community treatment settings. This paper outlines findings from a large-scale survey conducted across community-based Mental Health and Substance Misuse services, which aimed to ascertain the prevalence of drug and alcohol problems among those with severe mental health problems. METHOD: An assessment instrument was completed by keyworkers for each of their clients, which included mental health diagnosis and an adapted version of the Clinician Rating Scales for Alcohol and Drug Use. RESULTS: From a sample of 3079 clients across services, 1369 clients were identified with a severe mental illness diagnosis. According to their key-workers, 24% of these clients (324/1369) had used alcohol and/or drugs problematically during the past year. These individuals were most likely to have a diagnosis within the schizophrenia cluster, were mainly white males in their mid-30s, and tended to be located within Mental Health services in Assertive Outreach teams and to be higher utilisers of crises/emergency services. CONCLUSIONS: It can be concluded that similar to other studies in inner city areas of the UK, problem substance use is common amongst those with severe mental health problems within Northern Birmingham.
Review article: the genetics of inflammatory bowel disease.
Recent epidemiological, clinical and molecular studies have provided strong evidence that inherited predisposition is important in the pathogenesis of chronic inflammatory bowel diseases. The model most consistent with the epidemiological data suggests that Crohn's disease and ulcerative colitis are related polygenic diseases, sharing some but not all susceptibility genes. Investigators throughout the world have applied the complementary techniques of genome-wide scanning and candidate gene analysis. Four areas of linkage have been widely replicated on chromosomes 16 (IBD1), 12 (IBD2), 6 (IBD3-the HLA region), and most recently on chromosome 14. Fine mapping of these regions is underway. Of the 'positional' candidate genes, most attention has centred on the genes of the major histocompatibility complex. Genes within this region may determine disease susceptibility, behaviour, complications and response to therapy. Hope continues that studies of inflammatory bowel disease genetics will provide fresh insight into disease pathogenesis and soon deliver clinical applications.
Neuropsychological functioning in first-episode psychosis--evidence of specific deficits.
Neuropsychological impairment is ubiquitous in schizophrenia even at the first presentation of psychotic symptoms. We sought to elucidate the nature of the neuropsychological profile at the onset of the illness by examining the neuropsychological functioning of 40 patients experiencing their first episode of psychosis and 22 matched controls. All participants completed a battery of neuropsychological tasks designed to assess attention, verbal learning/memory, non-verbal memory, spatial ability, psychomotor speed, and executive function. First-episode patients showed significant impairment on tasks of executive function, including those requiring the ability to form and initiate a strategy, to inhibit prepotent responses, and to shift cognitive set, and also on tasks of verbal fluency. Memory impairments were seen on verbal learning and delayed non-verbal memory only. Impairment on tasks of psychomotor speed suggests that there may be a significant amount of cognitive slowing even at the first onset of psychosis. We suggest that our patients may be experiencing difficulty in specific aspects of executive functions, including the ability to form and execute a strategy, and these difficulties may be mediating the deficits observed on tasks of verbal learning.
Intensive case management for severe psychotic illness.
Explore the source record for details and available documents.
Long-term follow-up of young Afro-Caribbean Britons and white Britons with a first admission diagnosis of schizophrenia.
In this follow-up study, a group of black and white patients were followed up between 4 years 9 months and 10 years after a first admission with a clinical diagnosis of schizophrenia. It was possible to trace 98% of the sample, and historical, clinical and social data were obtained from case notes and interviews with patients and informants. There was no evidence of greater misdiagnosis in black patients, but their outcome was poorer in terms of readmissions and allocation to schizophrenic catego classes on follow-up (almost significant at 5% level). On follow-up, no differences were found in physical treatments and after-care arrangements or contacts with services. However, more black patients were readmitted on forensic sections and from prison, and more were treated in secure units. Explanations for the increased contact with penal and forensic services are discussed. The poorer clinical outcome found in black patients was associated with four factors apparent before first admission; living alone, unemployment, conviction and imprisonment.
A follow-up of second generation Afro-Caribbeans and white British with a first admission diagnosis of schizophrenia: attitudes to mental illness and psychiatric services of patients and relatives.
A sample of second generation Afro-Caribbeans and white British with a diagnosis of schizophrenia, and their relatives, were interviewed 5-10 years after first admission. There was no difference between Afro-Caribbeans and whites on measures of satisfaction, conceptualization about illness and attitudes to different types of treatment and management. However black relatives were more likely to attribute causation of illness to substance use and to view services as racist. Most black patients and relatives thought that black day centres would be beneficial.
Vitamin-D-fortified liquid milk--a highly effective method of vitamin D administration for house-bound and institutionalised elderly.
The aim of the study was to assess the efficacy and acceptability of vitamin-D-fortified liquid milk in the management of hypovitaminosis D in an elderly institutionalised population. The design was a single-blind randomised controlled study. In phase I, patients were encouraged to drink an increased quantity of either fortified or unsupplemented milk for 3 months. In phase II, patients were continued on either fortified or on unsupplemented milk which was given as part of the everyday diet for a further 6 months with no extra encouragement of any patient to take additional amounts. Ninety-eight patients (mean age 84 years) from extended care wards at the Department of Medicine for the Elderly, St. James's Hospital, Dublin, Ireland, participated in the study. Seventy-eight patients completed phase I, and 62 completed phase II. A general biochemical screen and 25-hydroxy vitamin D measurements were performed at entry and repeated 3 and 9 months later. The average milk intake per patient in phase I was 454 ml/day in the unsupplemented group and 359 ml/day in the fortified milk group. In phase II, the average daily milk intake per patient was 235 ml in the unsupplemented milk group and 140 ml in the fortified milk group. Seventy-four patients (94%) of the total who completed phase I had serum vitamin D baseline levels below the normal range. In the fortified milk group, mean vitamin D levels rose from 2.4 to 14.80 ng/ml (p < 0.001) at the end of phase I and remained significantly elevated at 10.2 ng/ml (p < 0.001) at the end of phase II.(ABSTRACT TRUNCATED AT 250 WORDS)
Second generation Afro-Caribbeans and young whites with a first admission diagnosis of schizophrenia.
A study of young Afro-Caribbeans and whites diagnosed as suffering from schizophrenia on a first admission suggests that the over-representation of Afro-Caribbeans with this diagnosis is not explained by mis-diagnosis. The Afro-Caribbeans were more likely to live alone and to be in contact with the police or prison services before admission. They were also more likely to be admitted compulsorily, especially on forensic orders. They were less likely to make and maintain voluntary contact with the services. There was little difference in the physical treatment given to both groups but the Afro-Caribbeans were more likely to be re-admitted in subsequent years and one third of the Afro-Caribbean males were treated at some time in forensic units. Results are discussed with reference to previous literature and some recommendations made.
First psychiatric admission rates of first and second generation Afro Caribbeans.
Explore the source record for details and available documents.
The compulsory detention of males of different ethnic groups, with special reference to offender patients.
Compulsory detention rates of white, West Indian and Asian males under Part IV and Part V (offenders) of the 1959 Mental Health Act were compared: British-born West Indians and Asians were differentiated from migrants. Rates for Asians were similar to those for whites, but West Indians were significantly over-represented amongst compulsory detentions, especially as offender patients. A high total number of admissions and diagnostic differences accounted for the excess of West Indians admitted under Part IV, but not Part V.
Biochemical studies on the H-2K mutant B6.C-H-2bm10.
The H-2K glycoprotein from the MHC mutant bm10 was analyzed biochemically to determine where primary structural differences distinguished it from the parental standard molecule, Kb. Comparative peptide maps showed differences in two peptides known to be part of the parental CNBr fragment spanning amino acids 139 to 228. Partial sequence analyses of CNBr fragments and tryptic peptides identified two tightly clustered amino acid substitutions at amino acids 165 (Val to Met) and 173 (Lys to unknown). The substitutions in bm10 represent the most carboxy-terminal substitutions characterized in the Kb molecules of the spontaneous, histogenically active H-2 mutants.
Biochemical studies of H-2K antigens from a group of related mutants. I. Identification of a shared mutation in B6-H-2bm5 and B6-H-2bm16.
Structural studies of the H-2 gene products from a group of five closely related but independent C57BL/6H-2 mutant mice were undertaken. Each of the mutants exhibits reciprocal graft rejection with the parent. The group is remarkable, however, because each member of this group can accept skin grafts from any other member. The results of biochemical analysis of the H-2 glycoproteins from two of these related mutants, bm5 and bm16, are presented in this report. Evidence is given that the H-2K molecules from these two mutants are identical to each other based on comparative tryptic peptide mapping profiles with the parent. From partial amino acid sequence analysis, K products of both mutants have at least one common difference from the parental type located at residue number 116. Definitive studies established that in both bm5 and bm16 a tyrosine found in the parent molecule is substituted with a phenylalanine in the mutant. These results show that a biochemical difference between the K products of the two mutants and of the parent can be detected, that the mutants appear to be identical with one another even though they arose independently, and that they differ from the other H-2Kb mutants analyzed.
Biochemical studies of H-2K antigens from a group of related mutants. II. Identification of a shared mutation in B6-H-2bm6, B6.C-H-2bm7, and B6.C-H-2bm9.
In an earlier paper, we presented evidence that two independent mutants of the bg series, B6-H-2bm5 (bm5) and B6-H-2bm16 (bm16) carry identical mutations such that tyrosine at residue number 116 of the H-2Kb molecule from the parent strain C57BL/6Kh is replaced by a phenylalanine in each of the two mutant molecules. In this paper, we demonstrate, using similar techniques, that the independent bg series mutants B6-H-2bm6 (bm6), B6.C-H-2bm7 (bm7), and B6.C-H-2bm9 (bm9), which share biological properties with bm5 and bm16, can be grouped together because they share two identical mutations, one of which is common to bm5 and bm16, a Tyr to Phe interchange at residue number 116. In addition, a second mutation is at residue number 121, where a Cys in the H-2K molecule from B6 is substituted with an Arg in the mutant. Since all of the bg series mutants arose independently and share biological and biochemical characteristics, it is anticipated that study of these mutants could lead to some understanding of the high mutation rate in the Kb molecule.
Sensitivity to ionising radiation of lymphocytes from Huntington's chorea patients compared to controls.
Blood samples were collected from 22 patients with Huntington's chorea and from 22 matched controls. Lymphocytes were separated from aliquots of each sample and cultures set up both from these and from further aliquots of whole blood. After 24 hours, half of each culture was subjected to X irradiation. Seventy-two hours later the percentages of live lymphocytes were estimated for each half of every culture and the viability ratio calculated for each sample. The lymphocytes derived from the patients with Huntington's chorea were found to be more susceptible to X irradiation than were the lymphocytes derived from controls. This was true both for whole blood and separated lymphocyte cultures. This susceptibility was found not to be the result of the main types of medication received by the patients. The small differences between viability ratios from patients and controls and the degree of overlap makes this test unsuitable for the prediction of asymptomatic carriers of the Huntington's chorea gene.
Biochemical studies on the H-2K antigens of the MHC mutant bml.
Biochemical analysis of the H-2K-gene product from the MHC mutant strain bml and from the C57BL/6 parent strain has been carried out in order to characterize the structural differences between parent and mutant K-gene products. Based on comparative tryptic peptide mapping of the cyanogen bromide fragments from these glycoproteins, two peptide differences were localized to the CN-Ia fragment. Partial amino-acid sequence analysis revealed two alterations in the primary structure of Kbml involving substitutions of tyrosine for arginine at position 155, and tyrosine for leucine at position 156. Both of these amino-acid replacements require a minimum of two nucleotide base changes at the nucleic acid level. These changes were the only alterations noted differentiating the Kbml and Kb glycoproteins. However, because our techniques allow us to analyze only 75 to 80 percent of the extra cellular portion of H-2Kb, it is possible there are other undetected changes. Nonetheless, the biochemical data are consistent with the hypothesis that the structural alterations noted in the Kbml mutant glycoprotein are directly related to the observed immunological specificity relative to the parent Kb molecule. Peptide comparisons of the Kb molecules of two C57BL/6 sublines and of the H-2b lymphoblastoid cell line, EL-4, disclosed no difference.