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Biomedical subjects

G C Turner

Publications and source records attributed to G C Turner.

At least 19 recordsLinked to original sources

Delta infection and drug abuse in Merseyside.

Delta agent is a small RNA virus which depends on hepatitis B virus for replication. Infection with delta virus in Britain and other countries in Northern Europe and North America is largely confined to drug abusers and their social contacts. In Merseyside, between 1982 and 1987, we found evidence of delta virus infection in 10 (4.4%) of 224 cases of acute hepatitis B in drug abusers. Among carriers of hepatitis B surface antigen (HBsAg) with a history of drug abuse, however, the proportion with delta antibody rose from 10% in 1984 to 30.8% in 1987. Among all HBsAg carriers identified in 1986 and 1987, delta antibody was detected in 11 (32.4%) of 34 with a history of drug abuse but in only 3 (1.6%) of 183 in whom drug abuse was not admitted. Long-term delta infection in these carriers is often associated with development of chronic active hepatitis and represents a major problem not only in countries where hepatitis B and delta virus infections are endemic but also potentially among drug abusers in Britain. Control of delta virus infection depends on social action to curb drug abuse and on the use of hepatitis B vaccine where appropriate to prevent hepatitis B in those at risk. In order to monitor the prevalence of delta virus infection in the community, priority should be given to testing for delta antibody HBsAg carriers with a history of drug abuse.

Adult

Urine screening for leucocytes and bacteria by dipstick and reflectance spectrophotometry.

In order to develop a rapid and reliable method for screening large numbers of urines for leucocytes and bacteria a dipstick method was used with colorimetric reading of colour changes with a reflectance spectrophotometer. One thousand consecutive urine specimens were tested by that method using a single dipstick for leucocyte esterase, nitrite, blood and protein in parallel with routine methods for enumeration of leucocytes by microscopy and quantitative culture for bacteria. Results of the four dipstick tests taken together had predictive values of 83.7% for a positive test for evidence of infection and 97.2% for a negative result. The false negative rate was 1%. Of the 191 urines with a significant bacteriuria (greater than 10(5) organisms/ml), 10 were false negatives by dipstick testing, representing 5% of all infected urines. Elimination of the need for culture on specimens that were negative by all four tests would reduce the workload by 36%.

Bacteriuria

HTLV-III antibody and T-cell subset ratios in haemophiliacs and their spouses.

44% of 63 British patients with either haemophilia A or B were HTLV-III antibody positive (HTLV-VIII+). HTLV-III+ was more frequent in high factor VIII concentrate users and 75% of severely affected haemophilia A patients were HTLV-III+. All eight patients who were exposed to factor IX concentrate were HTLV-III-. 17 haemophilia A patients who received only British made factor VIII concentrate (average 12,000 units/year) were HTLV-III-. Two of 63 patients had evidence of a pre-AIDS type symptom complex and both were HTLV-III+. Information from a cohort of 21 Liverpool haemophiliacs suggests that HTLV-III was first introduced into this country in 1981. OKT4/T8 ratios were abnormal in 52% of 21 patients studied but this finding was not confined to either HTLV-III+ or HTLV-III- individuals. The spouses of 14 HTLV-III+ haemophiliacs were all HTLV-III-.

Adolescent

Threat to the PHLS.

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Diagnostic Services

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Liverpool from 1977 to 1982.

After the 1976 outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections had been controlled, less than 1 per cent of cases of gonorrhoea in Liverpool in 1977 and 1978 were caused by PPNG. Thereafter the steady increase in PPNG infections to 5.6 per cent of all cases in 1982 was associated with marked changes in epidemiological pattern, plasmids and auxotypes. In 1976 nearly all PPNG infections were acquired by young black males living in the inner city from women frequenting clubs; the PPNG were all of the African 3.2 megadalton (MD) plasmid type and of arginine-requiring auxotype. Between 1977 and 1982 female patients were increasingly ship girl prostitutes associating with seamen who constituted more than 50 per cent of the male patients. These men and other travellers introduced PPNG into Liverpool from the Far East and West Africa. In 1978 PPNG of the Asian type with 4.4 MD plasmid with or without 24.5 MD transfer plasmids were isolated in Liverpool where in 1979 all PPNG carried 4.4 MD and 24.5 MD plasmids. In 1982 strains of the 'new' African type with 3.2 and 24.5 MD plasmids were isolated as were PPNG of the Asian type that had been acquired in West Africa. Auxotyping of the 1982 isolates showed that none were arginine-requiring but three other types were identified: proline-requiring: proline-arginine-requiring; non-requiring. For the control of PPNG, a strategy based on constant vigilance, appropriate diagnostic procedures, rapidly effective treatment and determined contact tracing is needed.

Adolescent

e-Antigen: a link between immune response and infectivity in hepatitis B?

In a study of the distribution of e-antigen and anti-e in subjects whose blood was positive for hepatitis B surface antigen (HBsAg), patients with acute hepatitis B who were tested during the incubation period were all e-antigen-positive but after the onset of illness e-antigen was detected in only 11%. Persistence, and in some instances reappearance of e-antigen in those who became long-term carriers of HBsAg was associated with high titres of HBsAg. There was a high incidence of e-antigen in those conditions in which cell-mediated immunity may be depressed, including Down's syndrome and chronic renal failure. The majority of HBsAg carries identified as sources of infection were e-antigen-positive. A postive reaction for e-antigen is evidently associated with a defective immune response to hepatitis B virus infection which permits continued replication of virus in liver cells accompanied by high titres of HBsAg, numerous Dane particles and detectable DNA polymerase in the blood with consequently a greater likelihood of transmitting infection. Although it cannot be assumed that anti-e positive carriers of HBsAg are not infective, it may be necessary, in the assessment of passive or active immunization for the control of hepatitis B, to take into account the e-antigen/antibody status of possible sources of infection.

DNA-Directed DNA Polymerase

Epidemiology and treatment of gonorrhoea caused by penicillinase-producing strains in Liverpool.

The epidemiological features are described of an outbreak of gonorrhoea caused by penicillinase-producing strains of gonococci in 76 patients in Liverpool between February and November 1976. Initially infections were confined to a socially deprived inner city area with a large immigrant population, and subsequent spread of infection remained circumscribed. The characteristics of those patients acquiring these infections were similar to those infected by gonococci of diminished sensitivity to benzylpenicillin, and showed a strong association with adverse social factors. A comparison of the clinical features of patients harbouring sensitive, less sensitive, and penicillinase-producing strains showed severe symptoms and signs in men and a greater involvement of multiple sites in women infected with penicillinase-producing gonococci. Treatment with penicillins failed. Tetracycline was satisfactory in men but was less so in women in whom gonococci persisted in the rectum. Cefuroxime and spectinomycin were effective.

Black or African American

Subtypes of hepatitis B antigen among patients and symptomless carriers.

A study of the distribution of subtypes ad and ay among sera from hepatitis B antigen-positive subjects in North West England and North Wales revealed a marked contrast between symptomless carriers among whom ad predominated and patients with acute hepatitis the majority of whom were ay. Those with hepatitis associated with drug addiction or other forms of "needle transmission" were almost all of subtype ay. On the other hand in cases of "sporadic" hepatitis without evidence of parenteral exposure subtypes ad and ay are about equally distributed. These findings are similar to those reported from other countries in Northern Europe and North America. Although geographical and social factors clearly affect the distribution of the two subtypes it is suggested that the virus of subtype ay may be more readily transmitted than subtype ad by parenteral routes involving small amounts of blood.

Acute Disease

Hepatitis.

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Alcoholic Beverages