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1.  You're not going to give me the umbrella, are you? 
BMJ : British Medical Journal  2006;333(7582):1287-1288.
The “umbrella test” is a longstanding urban myth that still bothers men who present for testing at sexual health clinics
doi:10.1136/bmj.39043.717245.F7
PMCID: PMC1761162  PMID: 17185709
2.  STI services in the United Kingdom: how shall we cope? 
Sexually Transmitted Infections  2003;79(6):435-438.
doi:10.1136/sti.79.6.435
PMCID: PMC1744770  PMID: 14663115
3.  Obituary 
doi:10.1136/sti.76.1.6
PMCID: PMC1760573
6.  Tine testing in HIV positive patients. 
Thorax  1993;48(8):831-834.
BACKGROUND--The incidence of tuberculosis is increased in HIV positive patients. Purified protein derivative (PPD, tuberculin) testing has not been performed routinely on patients infected with HIV in the UK and its usefulness in diagnosing tuberculosis in these patients is unclear. METHODS--198 HIV positive patients were Tine tested and a CD4+ lymphocyte count and chest radiograph were performed. Of the 179 male patients 164 were homosexual or bisexual, 11 were injecting drug users (IDUs), and four were both homosexual and IDUs. Of 19 women 14 were heterosexual and five were IDUs. Patients assessed their own skin reactions at 72 hours, recording the grade on a card which was returned by post. Patients with a grade 0 reaction were requested to have a second test one month later. RESULTS--Details were available on 168 of the 198 patients. Grade 0 reactions occurred in 89 of the 168 patients, requiring a second Tine test, and 73 completed Tine 2 results were received. Of 57 patients with CD4+ lymphocyte counts below 200/mm3, low grade PPD reactivity was seen in 18 on Tine 1 and nine on Tine 2. No history of BCG immunisation of tuberculosis was found in 33 Tine positive patients. Two patients treated for tuberculosis in the previous six months were PPD positive with CD4+ counts of 60/mm3 and 4/mm3 respectively. CONCLUSIONS--PPD reactivity may be maintained despite a CD4+ count of 100/mm3 or less when there is a history of tuberculosis or BCG immunisation.
PMCID: PMC464715  PMID: 8105557
7.  AIDS in Africans living in London. 
Genitourinary Medicine  1995;71(6):358-362.
OBJECTIVES--To investigate the presentation of HIV infection and AIDS amongst Africans diagnosed with AIDS living in London. METHODS--Identification of all AIDS cases of African origin attending four HIV specialist centres in South London--Guy's, King's, St George's and St Thomas' Hospitals--up to March 1994, by retrospective review of case notes of all HIV positive patients. RESULTS--Of 86 patients (53 women, 33 men) studied, 59 (69%) were from Uganda. The most frequent AIDS-defining diagnoses were: Pneumocystis carinii pneumonia (PCP) 21%, tuberculosis (TB) 20% (extrapulmonary TB 14%, pulmonary TB 6%), cerebral toxoplasmosis 14%, oesophageal candida 13%, cryptococcal meningitis 11%, wasting 6%, herpes simplex infection > 1 month 5%, Kaposi's sarcoma 5%, other 6%. Cytomegalovirus retinitis was diagnosed in one case. Late presentation was common; 70% were diagnosed HIV positive when admitted to hospital. The diagnosis of AIDS was coincident with a first positive HIV test result in 61%. The mean CD4 counts at both HIV and AIDS diagnoses were similar in both men and women: 87 x 10(6)/l and 74 x 10(6)/l in men and 99 x 10(6)/l and 93 x 10(6)/l in women respectively. Overall, TB 21 (24%) (extrapulmonary TB 12, pulmonary TB 9) was either the AIDS-defining diagnosis or was detected within three months of this event. Sixty-two per cent of TB cases were diagnosed within twelve months of entry to the UK compared to 34% of all other AIDS cases. The prevalence of STD was very low; genital herpes was the commonest STD: 17% of the women, 9% men; 28% of the men and 11% of the women tested had a positive TPHA test. In cases known to be HIV-positive prior to an AIDS diagnosis, 41% took prophylaxis for PCP and 45% had taken zidovudine (ZDV). Forty two of the study participants had 89 children: 59 of these children had mothers in the study. Overall, 37 (42%) of the children had lost at least one parent at the time of data assessment. CONCLUSIONS--PCP and TB were the most common initial AIDS-defining diagnoses. The majority of TB cases were diagnosed within 12 months of entry to the UK. An AIDS-defining diagnosis was the first manifestation of HIV-related illness in the majority of patients. Because of late presentation to medical services, access to treatments for HIV infection and prophylaxis against opportunistic infections was limited. Extending the role of clinics and staff into the community might facilitate both earlier presentation and access to services. Future provision of local services will need to be sensitive to the requirements of individuals from different cultures and backgrounds.
PMCID: PMC1196104  PMID: 8566973
8.  Pulmonary deposition of nebulised pentamidine isethionate: effect of nebuliser type, dose, and volume of fill. 
Thorax  1990;45(6):460-464.
An estimate of the absolute pulmonary deposition of nebulised pentamidine isethionate was obtained in nine patients with AIDS. Two nebuliser systems were compared, System 22 Mizer (Medic-Aid) and Respirgard II (Marquest), with 50 and 150 mg doses of pentamidine in a 3 ml solution driven by an air flow of 6 l/min with the patient in the sitting position. The 50 mg pentamidine dose was repeated with a 6 ml fill with both devices. The nebuliser cloud was labelled with technetium-99m human serum albumin (Ventocol) and lung deposition was measured with a gamma camera. Of the two nebulisers studied, System 22 Mizer delivered more drug to the lungs as a whole and to each individual lung region, including the peripheral and upper zones. For the 50 mg dose the mean (SEM) total pulmonary deposition with the 3 and the 6 ml fill respectively was 2.63 (0.34) and 3.71 (0.41) mg for the System 22 Mizer and 1.37 (0.26) and 1.45 (0.18) mg for the Respirgard II. For the 150 mg dose the System 22 Mizer delivered 7.16 (1.02) mg and the Respirgard II 4.34 (0.57) mg. Increasing the volume of fill from 3 to 6 ml increased pulmonary deposition with System 22 Mizer, and this was related to an increase in nebuliser output. Neither pulmonary deposition nor nebuliser output was increased by using a 6 ml solution in the Respirgard II. Increasing the volume of fill prolonged the time required for nebulisation with both nebulisers. The System 22 Mizer produced more nonpulmonary (gastric and oropharyngeal) deposition of drug, more frequent local adverse effects (cough, burning in the throat, and a metallic taste), and small reductions in lung function, particularly with the 150 mg pentamidine dose. Thus nebuliser type, volume of fill, and nebuliser dose affect the pulmonary deposition of pentamidine. A 300 mg dose of pentamidine via a Respirgard II is generally recommended as providing effective prophylaxis; our results suggest that similar pulmonary deposition can be produced with System 22 Mizer and 150 mg pentamidine. A clinical trial would be needed to show whether this regimen provides similar prophylactic benefit.
PMCID: PMC462530  PMID: 2392791
10.  The proton motive force drives the outer membrane transport of cobalamin in Escherichia coli. 
Journal of Bacteriology  1993;175(10):3146-3150.
Cells of Escherichia coli pump cobalamin (vitamin B12) across their outer membranes into the periplasmic space, and it was concluded previously that this process is potentiated by the proton motive force of the inner membrane. The novelty of such an energy coupling mechanism and its relevance to other outer membrane transport processes have required confirmation of this conclusion by studies with cells in which cobalamin transport is limited to the outer membrane. Accordingly, I have examined the effects of cyanide and of 2,4-dinitrophenol on cobalamin uptake in btuC and atp mutants, which lack inner membrane cobalamin transport and the membrane-bound ATP synthase, respectively. Dinitrophenol eliminated cobalamin transport in all strains, but cyanide inhibited this process only in atp and btuC atp mutant cells, providing conclusive evidence that cobalamin transport across the outer membrane requires specifically the proton motive force of the inner membrane. The coupling of metabolic energy to outer membrane cobalamin transport requires the TonB protein and is stimulated by the ExbB protein. I show here that the tolQ gene product can partly replace the function of the ExbB protein. Cells with mutations in both exbB and tolQ had no measurable cobalamin transport and thus had a phenotype that was essentially the same as TonB-. I conclude that the ExbB protein is a normal component of the energy coupling system for the transport of cobalamin across the outer membrane.
PMCID: PMC204637  PMID: 8387997
11.  The association between sexually transmitted diseases and inflammatory cervical cytology. 
Genitourinary Medicine  1992;68(5):305-306.
OBJECTIVES--To assess the significance of inflammatory changes as a marker of sexually transmitted diseases and their use as a diagnostic aid. METHODS--363 patients attending a department of genito urinary medicine were examined prospectively. All underwent cervical cytology and full STD screening. Cervical cytology was assessed for evidence of the presence or absence of inflammatory changes. RESULTS--There was no significant association between inflammatory cytology and cervical ectropion or dyskaryosis. Infections with Chlamydia trachomatis and Trichomonas vaginalis were significantly associated with inflammatory changes but there was no significant association with chlamydia alone, and 91.1% of T. vaginalis infections were detected on cytology. CONCLUSION--The presence of inflammatory changes on cervical cytology seems a poor indicator of sexually transmitted diseases.
PMCID: PMC1195983  PMID: 1427801
12.  Over the counter treatment for candidiasis. 
BMJ : British Medical Journal  1992;304(6843):1648.
PMCID: PMC1882385  PMID: 1633516
14.  Interdependence of calcium and cobalamin binding by wild-type and mutant BtuB protein in the outer membrane of Escherichia coli. 
Journal of Bacteriology  1990;172(9):4919-4926.
The binding of calcium and cobalamin to outer membranes from cells of Escherichia coli that contained amplified levels of wild-type or mutant btuB was studied. The mutant (BBam50) had an aspartyl-prolyl dipeptide inserted after the original 50th amino acid residue of the mature BtuB protein, which is within a region that shows extensive homology with the ferric siderophore receptors. This insertion resulted in cleavage of the BtuB in two places. The larger form retained the insertion but had lost 11 amino acid residues from the amino terminus. The smaller form was cut at the insertion site. Both the wild-type protein and the larger form of mutant BtuB showed calcium-dependent cobalamin binding with the same affinity for cobalamin, although the mutant had a much lower affinity for calcium. The smaller form of the mutant BtuB protein had a greatly reduced affinity for cobalamin, which was probably the result of inactivation of the cobalamin-dependent calcium-binding site. Cobalamin-dependent calcium binding was measured in wild-type BtuB preparations and was found to have the same corrinoid specificity and response to various corrinoid concentrations as shown previously for cobalamin binding. The results are consistent with a role for calcium in the cobalamin pump of the outer membrane of E. coli and show that a conserved part of the BtuB protein is required for the cobalamin-dependent binding of calcium.
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PMCID: PMC213146  PMID: 2168369
15.  Use of the Cytobrush for concurrent endocervical cytology and chlamydia sampling. 
Genitourinary Medicine  1990;66(3):205-207.
In 899 women attending a genitourinary medicine clinic Chlamydia trachomatis was tested for using both a Cytobrush and a conventional swab. In 425 cases, the Cytobrush was used for concurrent cytology and chlamydia sampling. Both methods were equally effective in the detection of chlamydia, and, in addition, the Cytobrush gave a higher yield of inclusion bodies per sample. The use of the same instrument for both cytology and chlamydia screening may represent a saving in time and money.
PMCID: PMC1194504  PMID: 2370065
16.  Parvovirus infection and anaemia in a patient with AIDS: case report. 
Genitourinary Medicine  1990;66(2):95-96.
Opportunistic infections such as Pneumocystis carinii pneumonia are well-recognised in patients with the acquired immune deficiency syndrome (AIDS). Anaemia due to a variety of causes also occurs in AIDS. Persistent infection with parvovirus (B19) causing severe anaemia has been reported in patients with leukaemia and congenital immunodeficiency. A case is now reported of parvovirus infection and anaemia, in an adult with AIDS, which responded dramatically to immunoglobulin therapy.
PMCID: PMC1194470  PMID: 2160424
17.  Point mutations in a conserved region (TonB box) of Escherichia coli outer membrane protein BtuB affect vitamin B12 transport. 
Journal of Bacteriology  1989;171(12):6526-6533.
Uptake of cobalamins and iron chelates in Escherichia coli K-12 is dependent on specific outer membrane transport proteins and the energy-coupling function provided by the TonB protein. The btuB product is the outer membrane receptor for cobalamins, bacteriophage BF23, and the E colicins. A short sequence near the amino terminus of mature BtuB, previously called the TonB box, is conserved in all tonB-dependent receptors and colicins and is the site of the btuB451 mutation (Leu-8----Pro), which prevents energy-coupled cobalamin uptake. This phenotype is partially suppressed by certain mutations in tonB. To examine the role of individual amino acids in the TonB box of BtuB, more than 30 amino acid substitutions in residues 6 to 13 were generated by doped oligonucleotide-directed mutagenesis. Many of the mutations affecting each amino acid did not impair transport activity, although some substitutions reduced cobalamin uptake and the Leu-8----Pro and Val-10----Gly alleles were completely inactive. To test whether the btuB451 mutation affects only cobalamin transport, a hybrid gene was constructed which encodes the signal sequence and first 39 residues of BtuB fused to the bulk of the ferrienterobactin receptor FepA (residues 26 to 723). This hybrid protein conferred all FepA functions but no BtuB functions. The presence of the btuB451 mutation in this fusion gene eliminated all of its tonB-coupled reactions, showing that the TonB box of FepA could be replaced by that from BtuB. These results suggest that the TonB-box region of BtuB is involved in active transport in a manner dependent not on the identity of specific side chains but on the local secondary structure.
PMCID: PMC210543  PMID: 2687240
18.  Mothers with HIV. 
BMJ : British Medical Journal  1989;299(6703):806-807.
PMCID: PMC1837682  PMID: 2510840
19.  Urinary tract infections in men. 
BMJ : British Medical Journal  1989;299(6692):184.
PMCID: PMC1837037  PMID: 2504370
20.  Women and HIV. 
BMJ : British Medical Journal  1989;298(6670):342-343.
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PMCID: PMC1835736  PMID: 2493927
22.  Prophylaxis against infection in Singaporean prostitutes. 
Genitourinary Medicine  1988;64(1):52-53.
One hundred prostitutes were interviewed about the prophylactic measures they took against infection. The use of contraceptive diaphragms and clandestine antibiotics correlated significantly with fewer gonococcal infections.
PMCID: PMC1194148  PMID: 3346026
23.  Penicillin treatment for gonorrhoea in relation to early syphilis in prostitutes. 
Genitourinary Medicine  1988;64(1):7-9.
A retrospective study of prostitutes in Singapore showed that they had received less antigonorrhoeal treatment with penicillin derivatives during the three month period before early syphilis was diagnosed than in other three month periods when they had not developed syphilis. This suggests that penicillin derivatives in doses sufficient to treat gonorrhoea will abort coincidental early syphilis.
PMCID: PMC1194137  PMID: 3346033
24.  Cryotherapy compared with trichloroacetic acid in treating genital warts. 
Genitourinary Medicine  1987;63(6):390-392.
In an observer blind comparative study, 130 men with penile warts were randomly allocated to treatment with either cryotherapy or trichloroacetic acid (TCAA). There was no significant difference in response to treatment, side effects, or recurrence rates between the two treatments. Warts resolved in 81% of patients treated with TCAA compared with 88% of those treated with cryotherapy. Early recurrence occurred in 36% of patients treated with TCAA and in 39% of those treated with cryotherapy.
PMCID: PMC1194123  PMID: 3323028
25.  Treatment of CMV retinitis in an AIDS patient. 
We present a case of cytomegalovirus (CMV) retinitis in an AIDS patient who survived for 10 months after the start of his ocular problems. The retinitis responded to dihydroxy propoxy methyl guanine (DHPG) but relapsed four to six weeks after each course of treatment with progressive retinal destruction. One relapse was therefore treated with trisodium phosphoformate hexahydrate (Foscarnet). There are few reports of the use of this drug in the treatment of CMV retinitis with AIDS, but it appeared to be less effective in our patient than DHPG, possibly because of poor penetration of the blood-ocular barrier. A final course of outpatient maintenance therapy with DHPG failed to prevent a preterminal relapse of the retinitis. Fundus photographs demonstrated the resolution and relapse of the retinitis associated with each course of treatment. Maintenance therapy with DHPG would appear to be necessary to prevent relapse, but the logistics of this are difficult, and the effective dosage of DHPG is as yet uncertain.
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PMCID: PMC1041317  PMID: 2825756

Results 1-25 (35)