Lack of suppression by ribavirin of HIV viraemia.
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Adult↗
Biomedical subjects
S K Gill
Publications and source records attributed to S K Gill.
Attitudes and experiences of human immunodeficiency virus-positive patients to surgery and surgeons.
The issues regarding screening and identification of patients at risk for human immunodeficiency virus (HIV) infection before surgery continue to be discussed, and there is a need for information regarding attitudes of both surgeons and patients to this issue. A population of HIV-positive patients attending a genitourinary medicine clinic were given an anonymous questionnaire to review their experiences of attending for operation. Of 174 patients who replied, 52 had undergone a total of 65 procedures. In all but three of the operations, the HIV status was made known to the surgeon.
Adult↗
Transmission of HIV-1 infection by oroanal intercourse.
We report the cases of two homosexual men, one of whom is believed to have been infected with HIV-1 during oroanal intercourse with the other, his only current sexual partner. Both patients had sero-conversion illnesses with similar symptoms and signs, and of similar duration. The practise of oroanal intercourse is known to be associated with the transmission of enteric infections and has been implicated in the epidemiology of Kaposi's sarcoma. These well-documented cases indicate that HIV-1 may also be transmitted by this route and supports a cautious approach to recommendations regarding "safer" sex.
Adult↗
T cell responses to peptides covering the gag p24 region of HIV-1 occur in HIV-1 seronegative individuals.
We demonstrate that peptides (16 amino acids long) covering the sequence of the HIV-1 core protein p24 induce significant proliferation in peripheral blood mononuclear cells (PBMC) of several (greater than 50%) healthy seronegative volunteers as well as seronegative homosexual men. The nature of this response was characterized and compared with those of HIV-infected patients. Several peptides induced responses; however, the most frequent responses in both seropositive and seronegative individuals were noted to the following peptides: 1 and 2 (aa 133-157); 6 and 7 (aa 183-207); 15 (aa 273-287); and 17 and 18 (aa 293-317). The response pattern was related to the disease stage of the patients; seronegative individuals as well as asymptomatic seropositive individuals (CDC II/III) responded to low concentrations of several peptides, but symptomatic patients (CDC IV) only responded to high concentrations of a few peptides. Cell separation studies of PBMC from healthy volunteers showed that the responding cells were CD4+ and expressed the CD45RO differentiation antigen. Furthermore, cord-blood mononuclear cells with less than 5% of CD45RO T cells did not proliferative to any of the peptides. Finally, CD4+ T cell lines specific for both peptides and p24 protein were successfully established from the PBMC of seronegative individuals confirming the data obtained with freshly isolated cells. These studies therefore suggest that the CD4+ cell response to p24 is not strictly disease related, instead, the response may be due to priming of the host with cross-reactive antigens.
Amino Acid Sequence↗
No effect of zidovudine on hepatitis B virus replication in homosexual men with symptomatic HIV-1 infection.
Zidovudine triphosphate inhibits the hepatitis B virus (HBV) DNA polymerase (DNAp) in vitro. Serial measurements of serum HBV DNAp activity and HBV DNA were made in 14 consecutive male homosexual patients starting zidovudine for symptomatic HIV-1 infection. Median duration of treatment was 15 weeks (range 2-72). In the 13 patients with detectable DNAp/DNA pre-treatment, no significant change in either measure of viral replication was observed during the first 16 weeks of treatment compared with the 13 weeks prior to treatment. The lack of response may be due to the opposing effect of immunosuppression, or to a failure of in vivo activity.
Adult↗
Multiple prostatic abscesses presenting with urethral discharge.
Prostatic abscess has become less common, is now usually related to urinary tract infection, and is a rare cause of urethral discharge. The case is described of a man with prostatic abscesses caused by Staphylococcus aureus possibly related to recent skin abrasions. Transrectal ultrasound was used to make the diagnosis and to facilitate repeated drainage with a successful outcome.
Abscess↗
Alcohol consumption--a risk factor for hemorrhagic and non-hemorrhagic stroke.
PURPOSE: The risks of alcohol consumption and its association with stroke were studied in 621 patients with stroke and 573 control subjects using case-control methods. PATIENTS AND METHODS: Patients with stroke were subdivided into 193 with subarachnoid hemorrhage, 91 with intracerebral hemorrhage, and 337 with cerebral infarction. Data on recent alcohol consumption were obtained by questionnaire in patients with stroke and compared with data from an occupational screening survey in control subjects. RESULTS: Relative risks, adjusted for confounding variables, exhibited J-shaped associations with increasing levels of alcohol consumption classified into four categories--abstainer, 1 to 90 g, 100 to 390 g, and greater than or equal to 400 g weekly). The individual risks were 1, 0.7, 0.5, and 1.3 for subarachnoid hemorrhage; 1.0, 0.6, 0.5., and 2.5 for intracerebral hemorrhage, and 1.0, 0.6, 0.7, and 2.4 for cerebral infarction for men and women combined. CONCLUSIONS: The results suggest that low levels of alcohol consumption may have some protective effect upon the cerebral vasculature, whereas heavy consumption predisposes to both hemorrhagic and non-hemorrhagic stroke.
Adult↗
Ganciclovir for lumbosacral polyradiculopathy in AIDS.
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Acquired Immunodeficiency Syndrome↗
Clinical aspects of HIV and AIDS.
The main messages from the Conference this year were that our management of opportunistic infections is improving with increasing therapeutic options available and better guidelines as to when to start treatment and prophylaxis. Since the first cases of the epidemic were reported in 1981 new drugs have been licensed, e.g. ganciclovir, fluxconazole and inhaled pentamidine. These have been developed, stimulated by the need for new agents to treat the increasing number of unusual infections. While the range of infections may not now be increasing so fast, the search for more effective, less toxic, agents continues.
Acquired Immunodeficiency Syndrome↗
Cigarette smoking. A risk factor for hemorrhagic and nonhemorrhagic stroke.
Cigarette smoking habit was studied in 621 patients with stroke and in 573 control subjects using case control methods. There was an excess of smokers among the stroke group when compared with control subjects. Relative risks of cigarette smokers compared with nonsmokers, after adjustment for the possible confounding variables for subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction, were 4.5, 1.8, and 3.2 for men and 2.5, 1.3, and 2.3 for women, respectively. For all subtypes of stroke combined, the increased relative risk was related to the daily intake of cigarettes, the heaviest smokers having a higher relative risk than that for light smokers. The estimated increase in relative risk among smokers was 1.5 for each 10 cigarettes smoked daily in both men and women. We conclude that cigarette smoke may be an important preventable factor for both hemorrhagic and nonhemorrhagic stroke.
Cerebral Hemorrhage↗
Type-specific concordance in young diabetic monozygotic twins.
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Adolescent↗
Wind-chill and the seasonal variation of cerebrovascular disease.
The hospital admission rates for patients with specific types of stroke were examined for seasonal variation and correlation with meteorological factors. A seasonal variation in admission rates was found for subarachnoid haemorrhage, thrombo-embolic brain infarction and ill-defined cerebrovascular disease. Overall this seasonality was more strongly associated with the computed chilling effect of the atmosphere than with changes in temperature, humidity or wind speed alone. No seasonal variation was observed for admission rates of intracerebral haemorrhage, transient ischaemic attack or occlusion of precerebral arteries. Intracerebral haemorrhage admission rates exhibited a decrease with time. This evidence suggests that seasonal variation in admission rates exists only for certain pathological types of stroke and this is strongly associated with changes in the chilling effect of the atmosphere.
Adult↗
A community case-control study of alcohol consumption in stroke.
This study examines the hypothesis that there may be a clinically important association between alcohol intake and stroke. Alcohol consumption and the haematological and biochemical markers of alcohol intake were studied in hospital admissions for stroke and compared with community based control subjects from an occupational screening survey. In males, moderate to heavy alcohol consumption (greater than 30 units per week) was associated with an increased relative risk of stroke. Light drinking (less than 30 units per week) was associated with reduced relative risk when compared to teetotallers. The relative risk of stroke in moderate and heavy consumers of alcohol compared with teetotallers was elevated 1.8 times. Similar patterns of risk were present for increasing levels of aspartate transaminase and uric acid. Relative risk was increased for all levels of gamma-glutamyl transferase above the lowest. There was a decrease in relative risk associated with increasing levels of mean erythrocyte cell volume though this did not achieve statistical significance. There were few heavy drinkers among the female cases or controls. We conclude that high alcohol intake may be a significant preventable risk factor particularly among male strokes.
Adult↗
Long term mortality after a single treatment course with X-rays in patients treated for ankylosing spondylitis.
Mortality up to 1 January 1983 has been studied in 14,106 patients with ankylosing spondylitis given a single course of X-ray treatment during 1935-54. For neoplasms other than leukaemia or colon cancer, mortality was 28% greater than that of members of the general population of England and Wales, and this increase is likely to have been a direct consequence of the treatment. The proportional increase reached a maximum of 71% between 10.0 and 12.4 years after irradiation and then declined. There was only a 7% increase in mortality from these tumours more than 25.0 years after irradiation and only for cancer of the oesophagus was the relative risk significantly raised in this period. Neither the magnitude of the relative risk, nor its temporal pattern following treatment, were greatly influenced by the age of the patient at first treatment. For leukaemia there was a threefold increase in mortality that is also likely to have been due to the radiotherapy. The relative risk was at its highest between 2.5 and 4.9 years after the treatment and then declined, but the increase did not disappear completely, and the risk was still nearly twice that of the general population more than 25.0 years after treatment. There was some evidence that the risks of acute myeloid, acute lymphatic, and chronic myeloid leukaemia were all increased, but no evidence of any increase in chronic lymphatic leukaemia. The relative risk appeared to be greatest for acute myeloid leukaemia. For colon cancer, which is associated with spondylitis through a common association with ulcerative colitis, mortality was increased by 30%. For non-neoplastic conditions there was a 51% increase in mortality that was likely to be associated with the disease itself rather than its treatment. The increase was apparent for a wide range of diseases and was not confined to diseases that have been associated clinically with ankylosing spondylitis.
Adolescent↗
Newer positive inotropic agents in the treatment of chronic cardiac failure. Current status and future directions.
Heart failure is a serious worldwide health problem of major proportions. For many physicians, digitalis (an inotropic agent of limited proportions) and diuretics have proven the standard of treatment for heart failure. Vasodilators have also gained acceptance in recent years. Nevertheless, many patients remain symptomatic and therefore attention has been given to the development of pharmacological agents with mechanisms of action targeted to cardiac and vascular smooth muscle. The newer generation of inotropic agents have clearly been shown to improve the pumping function of the failing heart in patients who remain symptomatic despite digitalis, diuretics and vasodilators, while myocardial oxygen consumption is not enhanced. Several uncontrolled trials with the phosphodiesterase inhibitors enoximone, milrinone and piroximone have concluded that these agents improve exercise capacity and thereby hold promise to enhance quality of life. Large scale controlled trials currently in progress will determine the ultimate efficacy, as well as safety, of these agents. Results to date with several orally active beta-adrenoceptor agonists suggest that their efficacy may be limited by the induction of ventricular arrhythmias.
Animals↗
Stroke and alcohol consumption.
We conducted a retrospective case-control study to investigate a possible association between alcohol intake and stroke. Reported recent alcohol consumption and biochemical and hematologic markers of alcohol intake were examined for 230 patients with stroke (20 to 70 years old) and compared with concurrently collected data on controls matched for age, sex, and race. A single estimate of current intake was used as a measure of alcohol consumption. Among men, the relative risk of stroke (adjusted for hypertension, cigarette smoking, and medication) was lower in light drinkers (those consuming 10 to 90 g of alcohol weekly) than in nondrinkers (relative risk, 0.5), but was four times higher in heavy drinkers (consuming greater than or equal to 300 g weekly) than in nondrinkers. Because very few women in our study drank heavily, we were unable to determine whether heavy alcohol intake influenced the risk of stroke in women. With increasing serum concentrations of the biochemical markers of alcohol intake (aspartate aminotransferase, uric acid, and gamma-glutamyl transferase), we observed similar trends in the relative risk of stroke. Only the erythrocyte mean cell volume did not follow this pattern. We conclude that heavy alcohol consumption is an important and underrecognized independent risk factor for stroke in men, but our data are not adequate to settle the issue for women. Our conclusions are qualified by our reliance on reported recent alcohol consumption as the primary measure of intake.
Adult↗
Reduced platelet function in subarachnoid hemorrhage.
The hypothesis that abnormalities of platelet function may relate to the occurrence or recurrence of subarachnoid hemorrhage (SAH) has been examined. Seventy patients with SAH and 65 control individuals were studied. The adenosine diphosphate (ADP) threshold for secondary platelet aggregation was significantly higher in the SAH group than in the controls. In tests using 4.0 micrograms/ml ADP, the percent platelet aggregation (at 2 minutes) and the maximum rate of platelet aggregation (over 20 seconds) were significantly lower in the SAH patients. There was no difference in total platelet count between the two groups. Platelet adhesiveness was lower in the SAH patients when compared to controls. Circulating microaggregates did not differ between the two groups. The results indicate that reduced platelet function does relate to SAH and may either contribute to aneurysmal rupture in cases of SAH or be a consequence of it.
Adult↗
Diurnal variation of and activity during the onset of stroke.
The diurnal variation in the onset of stroke was examined in 557 consecutive patients aged over 70 years. These included 194 patients with subarachnoid hemorrhage, 118 with intracerebral hemorrhage, and 245 with thromboembolic cerebral infarction. All three types of strokes exhibited a peak incidence between 1000 and 1200 hours. Intracerebral hemorrhages occurred less frequently between 0400 and 0600 hours, but there were no differences between the groups for the other time periods. There was no difference in the time of onset of stroke between normotensive and treated or untreated hypertensive patients. There were more untreated hypertensive patients in the intracerebral hemorrhage group than in the other stroke type groups. Subarachnoid hemorrhage occurred more frequently in the lavatory and during sexual and sporting activity. Intracerebral hemorrhage occurred more commonly during driving or the consumption of alcohol. Cerebral infarction occurred more frequently during sleep or was noticed on waking. No differences were found for the other activities examined. The relationship between diurnal variation in stroke and the known variation in blood pressure is discussed.
Activities of Daily Living↗