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Biomedical subjects

G R Scott

Publications and source records attributed to G R Scott.

At least 19 recordsLinked to original sources
PubMed2005

Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh.

Epididymo-orchitis among men younger than 35 years is mainly caused by chlamydial infection. National guidelines for the management of this condition have been published. The aim of this study was to audit the management of epididymo-orchitis in a major teaching hospital. To this end we performed a retrospective study of patients with epididymo-orchitis admitted to the Department of Urology in the Western General Hospital, Edinburgh between 1998 and 2003. Case-notes of 108 cases of epididymo-orchitis were reviewed. The diagnosis was established by ultrasound in 94% of cases. Patients were not tested routinely for chlamydial infection and the majority of men younger than 35 years were treated inappropriately with ciprofloxacin. The management of patients younger than 35 years was not in accordance with the recommendations of national guidelines. Chlamydia trachomatis is sexually transmissible and is not responsive to ciprofloxacin. As a result of this audit, each patient will be tested for chlamydial infection and men younger than 35 years will be treated with ofloxacin. Sexual partners of patients with chlamydial infection will be treated in the department of genitourinary medicine.

Adult↗
PubMed2004

What is the role of scrotal ultrasound scans in genitourinary medicine?

The objective of the study was to review the indications for scrotal ultrasound scans and to assess the impact on patient management. We therefore performed a retrospective analysis. Case notes of all males referred for a scrotal ultrasound between April 1998 and March 2001 were studied. Data were extracted for the following: age, presenting complaints, physical findings on examination, results of a full sexual screen, treatment, ultrasound result and the designation of the person requesting the scan. All data were tabulated and summated using 'Windows Excel' software. One hundred and fifteen men were referred for an ultrasound in this period of time. None had an ultrasound more than once. Of these, 25 subjects could not be included as they either failed to attend for their scan (n=8) or their notes could not be traced (n=17). Twelve subjects were excluded as they did not fit the selection criteria (n=12). Median age was 30 years (Range 19-61 years). The commonest reason for referral was testicular pain (n=43) followed by testicular lump (n=19). The commonest abnormality on examination was an inflamed epididymis (n=18). Forty-two of the ultrasound scans were normal. A testicular mass was detected in only five of the 78 patients (6.4%), of which one was a malignancy (1.2%). A direct referral to a urologist for further management was made in only nine patients. Scrotal ultrasound for pain has limited impact on patient management apart from reassuring a worried patient. However, it remains an important investigation in the management of a suspected testicular lump.

Adult↗
PubMed2001

Infection of the CD45RA+ (naive) subset of peripheral CD8+ lymphocytes by human immunodeficiency virus type 1 in vivo.

To investigate the mechanism and functional significance of infection of CD8+ lymphocytes by human immunodeficiency virus type 1 (HIV-1) in vivo, we determined frequencies of infection, proviral conformation, and genetic relationships between HIV-1 variants infecting naive (CD45RA+) and memory (CD45RO+) peripheral blood CD4+ and CD8+ lymphocytes. Infection of CD3+ CD8+ CD45RA+ cells was detected in 9 of 16 study subjects at frequencies ranging from 30 to 1,400 proviral copies/10(6) cells, more frequently than CD3+ CD8+ lymphocytes expressing the RO isoform of CD45 (n = 2, 70 and 260 copies /10(6) cells). In agreement with previous studies, there was no evidence for a similar preferential infection of CD4+ naive lymphocytes. Proviral sequences in both CD4+ and CD8+ lymphocyte subsets were complete, as assessed by quantitation using primers from the long terminal repeat region spanning the tRNA primer binding site. In six of the seven study subjects investigated, variants infecting CD8+ lymphocytes were partially or completely genetically distinct in the V3 region from those recovered from CD4+ lymphocytes and showed a greater degree of compartmentalization than observed between naive and memory subsets of CD4+ lymphocytes. In two study subjects, arginine substitutions at position 306, associated with use of the chemokine coreceptor CXCR4, were preferentially found in CD4 lymphocytes. These population differences may have originated through different times of infection rather than necessarily indicating a difference in their biological properties. The preferential distribution of HIV-1 in naive CD8+ lymphocytes indeed suggests that infection occurred early in T-lymphocyte ontogeny, such as during maturation in the thymus. Destruction of cells destined to become CD8+ lymphocytes may be a major factor in the decline in CD8+ lymphocyte frequencies and function on disease progression and may contribute directly to the observed immunodeficiency in AIDS.

Amino Acid Sequence↗
PubMed1999

Infrequent detection of TT virus infection in intravenous drug users, prostitutes, and homosexual men.

TT virus (TTV), a recently discovered DNA virus, has been implicated as a cause of non-A to non-C posttransfusion hepatitis. The frequency of TTV in persons considered at high risk for sexual and parenteral infection was investigated (52 prostitutes, 81 homosexual men, 65 intravenous drug users) to assess its mode of transmission. TTV DNA was assayed by polymerase chain reaction using primers from conserved regions in the N22 clone. Viremia frequency was 4.5%-13.0% in study subjects, not significantly different from that in low-risk controls (2 [4.5%] of 44). The frequency of TTV viremia increased significantly with age (P=.018) but was not associated with human immunodeficiency virus coinfection. The low frequency of infection detected in both risk groups suggests that spread by sexual contact or by intravenous drug use is relatively inefficient and unlikely to account for the high prevalence of TTV observed worldwide.

Adult↗
PubMed1999

Historical disclosure of rape by women attending genitourinary medicine clinics.

In a previous internal audit of women attending the department of genitourinary medicine following rape, we noted that data from diagnostic coding seemed to underestimate the problem and that anecdotally, a number of women had been seen with concerns relating to historical assault. We therefore decided to record attendance following rape prospectively. Between 1 June 1996 and 31 May 1997 staff at the Department of Genitourinary Medicine (GUM) at the Royal Infirmary of Edinburgh completed a data collection form for every female patient aged >15 years who attended the clinic and spontaneously disclosed a history of rape, either recent or historical. Seventy-five women attending GUM disclosed a history of rape. Sixty-six per cent were aged <25 years. Thirty women presented more than 12 months after the incidence, of whom 50% presented to the health adviser requesting HIV antibody testing. The incidence of sexually transmitted infections was low and in no case could be specifically attributed to the rape. None of the 38 HIV antibody tests performed were positive. A number of women present to GUM a long time after an incident of rape, most commonly due to concerns about HIV. They may have endured a great deal of mental anguish before summoning up the courage to seek help. This can have a substantial effect on workload, especially for health advisers.

Adolescent↗
PubMed1999

Antiretroviral therapy in HIV infection: are we using resources appropriately and cost effectively?

The provision of antiretroviral therapy to HIV-positive patients attending the Department of Genitourinary Medicine at the Royal Infirmary of Edinburgh was assessed, to examine whether clinicians were offering treatment in line with the departmental protocol. A total of 195 patients attended in 1998, of whom 169 fulfilled the protocol criteria for treatment. Although only 115 of these were on therapy, no patient who fulfilled treatment criteria and wished to be treated was denied treatment. Of the 26 patients not fulfilling any treatment criteria, 9 had transferred in from another unit already on treatment. The remaining 17 were not on treatment.

Anti-HIV Agents↗
PubMed1998

Global eradication of rinderpest. Yea or nay?

Rinderpest is a scourge continuing to change the course of history. The German "Rinderpest" in English fails to convey the spectre of Death, Despair and Desolation long associated with the disease. Although the causal morbillivirus cross-protects against other morbillivirus, there is only one rinderpest serotype which is both immuno-suppressive and immunogenic. Safe vaccines induce lifelong protection in cattle. Transmission follows close contact between sick and healthy artiodactyls. Infectious periods are short and deaths may be curtailed by liberal fluid replacement therapy. Carriers do not exist. In other words rinderpest is a prime candidate for eradication. Why has it not happened? The major obstacle is "man's inhumanity to man". Rinderpest thrives in a milieu of armed conflict and fleeing refugee masses. Until world peace is secured, the "Nays" win the argument.

Animals↗
PubMed1998

Sexual transmission of GB virus C/hepatitis G virus.

Although it is established that infection with GB virus C (GBV-C) or hepatitis G virus (HGV) can be transmitted parenterally, the prevalence of GBV-C/HGV viremia in the general population (2-5%) is relatively high compared with other parenterally borne viruses such as hepatitis C virus. To investigate the possibility of sexual transmission of GBV-C/HGV, we determined the frequency of viremia by the polymerase chain reaction and serological reactivity to the E2 protein by ELISA in samples collected from individuals at risk for sexually transmitted diseases attending a city genitourinary medicine clinic. GBV-C/HGV viremia was detected in 27 of 87 male homosexuals (31%) and 9 of 50 prostitutes (18%), frequencies significantly greater than those in matched controls (2/63) and local blood donors (2.3%). Among nonviremic individuals, a high frequency of serological reactivity to the E2 protein of GBV-C/HGV was also observed in the risk groups (male homosexuals: 14/60; prostitutes: 11/41), although these figures are likely to be underestimates of the frequency of past infection as detectable anti-E2 reactivity may attenuate rapidly over time following resolution of infection. Infection with GBV-C/HGV was more frequent among those coinfected with human immunodeficiency virus type 1. Among male homosexuals from whom retrospective samples were available, evidence for de novo infection was found in 9 of 22 individuals over a mean sampling time of 2.9 years, predicting an annualized incidence of GBV-C/HGV infection of approximately 11% in this group. The high prevalence and incidence of GBV-C/HGV infection in these individuals and prostitutes provides strong evidence for its spread by sexual contact. Further studies are required to investigate the mechanism of its transmission and the clinical significance of acute and persistent infection in these risk groups.

Adolescent↗
PubMed1998

Measurement of cardiac function by transthoracic echocardiography: day to day variability and repeatability in normal Thoroughbred horses.

In order to assess the reliability and repeatability of transthoracic echocardiography for detecting serial changes in cardiac function in horses, day to day variability of a number of echocardiographic indices of ventricular function were studied. The variables investigated were, from 2-dimensional (2-D) and M-mode echocardiography - aortic diameter in systole (Aos), pulmonary artery diameter in systole (Pas), left ventricular internal diameter in systole (LLVIDs) and diastole (LLVIDd), and left ventricular fractional shortening (%FS) and estimated ejection fraction (EF). From pulsed Doppler echocardiography - maximum velocity (Vmax) and acceleration (dv/dtmax) of aortic and pulmonary arterial blood flow, left and right ventricular velocity time integral (AoVTI and PAVTI) and estimated cardiac output (COLV, and CORV), left and right ventricular ejection time (LVET and RVET) and pre-ejection period (LVPEP and RVPEP), and heart rate. Maximum velocity of early rapid right ventricular filling (ETV) and late right ventricular filling due to right atrial contraction (ATV) were measured. Maximum deceleration and time for deceleration of early rapid filling (dv/dtTV and dt TV) were also determined. Seven healthy mature Thoroughbred horses weighing 490-600 kg were studied. The horses' management regimes and environment were standardised and an echocardiographic examination was carried out on each horse at the same time every day for 6 consecutive days. Two statistical measures of repeatability were calculated for each variable: the intraclass correlation coefficient (rI) and the 95% confidence intervals for error free value of a single measurement. In general, the dimensions and indices of cardiac function derived from 2-D and M-mode echocardiography showed better repeatability for individual horses than did the indices derived from Doppler echocardiography. Overall the 95% confidence intervals for an error-free value of all variables derived from Doppler echocardiography were wide. This must be appreciated when attributing serial measured changes of Doppler echocardiographic variables in an individual animal to effects of a treatment or disease.

Analysis of Variance↗
PubMed1998

PCR testing of genital and urine specimens compared with culture for the diagnosis of chlamydial infection in men and women.

Our aim was to determine the number of chlamydial infections detected by Cobas Amplicor CT/NG multiplex polymerase chain reaction (PCR) testing of genital and first-voided urine (FVU) specimens compared with routine culture. Two hundred and eighty-six female and 276 male patients attending the Genito-Urinary Medicine (GUM) Unit at Edinburgh Royal Infirmary were included in the study. Case notes were analysed retrospectively to determine how many infected patients would not have been treated had diagnosis relied on routine culture. Polymerase chain reaction on FVU from women had a sensitivity, specificity, positive and negative predictive value of 91%, 100%, 100% and 99.1%: corresponding values for genital PCR and culture were 96%, 100%, 100%, 99.6% and 65%, 100%, 100%, 96.7% respectively. PCR on FVU from men had a sensitivity, specificity, positive and negative predictive value of 96%, 99.1%, 92.6% and 99.5%: corresponding values for genital PCR and culture were 89%, 99.5%, 95.8%, 98.6% and 48%, 100%, 100%, 94.3% respectively. In both men and women genital PCR and urine PCR were significantly more sensitive than culture. PCR almost doubled the number of patients detected by culture (49 vs 27). Of the 22 cases detected only by PCR 8 would not have received treatment on the basis of clinic treatment policy.

Chi-Square Distribution↗