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1.  Sudden unexplained death in a patient with HIV and MDR-TB 
PMCID: PMC3112980
2.  John William Nicholson 
BMJ : British Medical Journal  2002;325(7366):716.
PMCID: PMC1124238
3.  Antibacterial activity in bovine lactoferrin-derived peptides. 
Several peptides sharing high sequence homology with lactoferricin B (Lf-cin B) were generated from bovine lactoferrin (Lf) with recombinant chymosin. Two peptides were copurified, one identical to Lf-cin B and another differing from Lf-cin B by the inclusion of a C-terminal alanine (lactoferricin). Two other peptides were copurified from chymosin-hydrolyzed Lf, one differing from Lf-cin B by the inclusion of C-terminal alanyl-leucine and the other being a heterodimer linked by a disulfide bond. These peptides were isolated in a single step from chymosin-hydrolyzed Lf by membrane ion-exchange chromatography and were purified by reverse-phase high-pressure liquid chromatography (HPLC). They were characterized by N-terminal Edman sequencing, mass spectrometry, and antibacterial activity determination. Pure lactoferricin, prepared from pepsin-hydrolyzed Lf, was purified by standard chromatography techniques. This peptide was analyzed against a number of gram-positive and gram-negative bacteria before and after reduction of its disulfide bond or cleavage after its single methionine residue and was found to inhibit the growth of all the test bacteria at a concentration of 8 microM or less. Subfragments of lactoferricin were isolated from reduced and cleaved peptide by reverse-phase HPLC. Subfragment 1 (residues 1 to 10) was active against most of the test microorganisms at concentrations of 10 to 50 microM. Subfragment 2 (residues 11 to 26) was active against only a few microorganisms at concentrations up to 100 microM. These antibacterial studies indicate that the activity of lactoferricin is mainly, but not wholly, due to its N-terminal region.
PMCID: PMC163659  PMID: 8980754
5.  Midwife managed delivery unit: a randomised controlled comparison with consultant led care. 
BMJ : British Medical Journal  1994;309(6966):1400-1404.
OBJECTIVE--To examine whether intrapartum care and delivery of low risk women in a midwife managed delivery unit differs from that in a consultant led labour ward. DESIGN--Pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives unit and the labour ward. SETTING--Aberdeen Maternity Hospital, Grampian. SUBJECTS--2844 low risk women, as defined by existing booking criteria for general practitioner units in Grampian. 1900 women were randomised to the midwives unit and 944 to the labour ward. MAIN OUTCOME MEASURES--Maternal and perinatal morbidity. RESULTS--Of the women randomised to the midwives unit, 647 (34%) were transferred to the labour ward antepartum, 303 (16%) were transferred intrapartum, and 80 (4%) were lost to follow up. 870 women (46%) were delivered in the midwives unit. Primigravid women (255/596, 43%) were significantly more likely to be transferred intrapartum than multi-gravid women (48/577, 8%). Significant differences between the midwives unit and labour ward were found in monitoring, fetal distress, analgesia, mobility, and use of episiotomy. There were no significant differences in mode of delivery or fetal outcome. CONCLUSIONS--Midwife managed intrapartum care for low risk women results in more mobility and less intervention with no increase in neonatal morbidity. However, the high rate of transfer shows that antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour.
PMCID: PMC2541316  PMID: 7819846
7.  Intermittent local prophylaxis against recurrent vaginal candidosis. 
Genitourinary Medicine  1988;64(5):335-338.
Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised.
PMCID: PMC1194255  PMID: 3060424
8.  Vaginal candidosis: relation between yeast counts and symptoms and clinical signs in non-pregnant women. 
Genitourinary Medicine  1988;64(5):331-334.
Of 277 non-pregnant women, 67 (24%) harboured Candida albicans in the genital tract. Of 56 women yielding C albicans who had no other infection diagnosed, 14 were symptomless and 10 had no clinical signs of vulval redness, vaginitis, or discharge. Symptoms and signs tended to be more severe in women with higher yeast counts. Of 22 women with moderate or severe symptoms (pruritus with or without discharge) and signs, 15 had yeast counts of more than 10(3) colony forming units (cfu)/ml, whereas six of nine women with no symptoms or signs had counts of fewer than 10(3) cfu/ml.
PMCID: PMC1194254  PMID: 3060423
9.  Non-invasive assessment of early cardiac involvement in systemic sclerosis. 
Postgraduate Medical Journal  1985;61(718):679-684.
Twenty-eight patients with wide spectrum organ involvement of progressive systemic sclerosis but without signs or symptoms suggestive of cardiac involvement were studied by non-invasive cardiac techniques. The 12-lead electrocardiogram showed abnormalities in 6 patients: one had abnormal T waves and 5 had complete or incomplete right bundle branch block. Twenty-four hour ambulatory electrocardiography demonstrated higher average heart rates than in similar aged controls (82 +/- 9 vs 74 +/- 9 beats/min, P less than 0.05). In one patient a short run of ventricular tachycardia was recorded. No other significant arrhythmia was documented. Echocardiographic measurements were within normal ranges but small pericardial effusions were observed in two patients (7%). Resting first pass radionuclide angiography, utilizing 12 mCi of technetium 99m were performed in 23 patients. Seven patients (30%) had abnormal wall motion (diffuse hypokinesia), with a significant decrease in ejection fraction in comparison to those with normal wall motion (44 +/- 6% vs 60 +/- 6% P less than 0.01). Those with abnormal wall motion had suffered the disease longer than those with normal wall motion (13 +/- 4 vs 9.5 +/- 7 y). In conclusion, the heart is involved in half of the patients in this series; non-invasive cardiac assessment is useful in disclosing the early cardiac involvement and may influence long-term management.
PMCID: PMC2418349  PMID: 4034457
10.  The role of echocardiography in the investigation of focal cerebral ischaemia. 
Postgraduate Medical Journal  1984;60(700):116-119.
One-hundred and ten patients referred for echocardiography to exclude a cardiac source of cerebral emboli were prospectively studied. Four patients with known cardiac abnormalities, for which they were receiving inadequate anticoagulation, were excluded from the study, and 18 patients were subsequently found to have a non-embolic cause for their cerebral pathology. Twenty-eight patients with a normal clinical examination, chest X-ray and electrocardiogram, and 27 patients with hypertension alone had echocardiograms which did not reveal a cardiac source of embolus. Of the remaining group of 33 patients, six were found to have a probable cardiac source of embolus and nine had abnormalities which may be associated with cerebral emboli. Echocardiography may not be indicated in patients with a normal clinical examination, chest X-ray and electrocardiogram, and in patients with hypertension alone. However, if these patients are excluded echocardiography gives a high yield of positive findings which may be of practical importance in the management of the patient.
PMCID: PMC2417699  PMID: 6709541
11.  Preterm labour in association with Neisseria gonorrhoeae: case reports. 
We describe two cases of spontaneous rupture of the membranes, followed by premature labour at 32 and 34 weeks' gestation, in association with gonococcal infection.
PMCID: PMC1046451  PMID: 6704696
12.  Effect of beta blockade on exercise response after cardiac transplantation. 
British Heart Journal  1983;49(6):584-588.
Six cardiac transplant recipients underwent maximal exercise testing before and after the administration of intravenous propranolol to assess the effect of beta blockade on their exercise heart rate response and exercise capacity. Before propranolol the patients were capable of a mean of 6.8 minutes of exercise and heart rate increased from a resting value of 102 +/- 25 a minute to 138 +/- 34 at peak exercise--a mean increase of 35%. All tests were terminated because of tiredness or muscle weakness. After one hour's rest, intravenous propranolol (0.2 mg/kg over 10 minutes) was administered with a reduction in resting heart rate from 109 +/- 28 a minute to 83 +/- 16. During the repeat exercise test the patients were capable of a mean of 4.5 minutes of exercise and all tests were terminated by extreme exhaustion and/or unsteadiness requiring immediate cessation of the treadmill. Heart rate increased from a resting value of 83 +/- 16 a minute to 96 +/- 18 at peak exercise. The exercise capability of the denervated heart is conspicuously reduced by beta blockade, presumably because of its reliance on circulating catecholamines.
PMCID: PMC481354  PMID: 6342635
13.  The respiratory response to pregnancy. 
Postgraduate Medical Journal  1979;55(643):318-324.
The respiratory response to pregnancy appears to be largely mediated by the action of progesterone and, perhaps to a lesser extent, oestrogens, at least in the first and second trimesters. The mechanical effects of the gravid uterus cause relatively little change in pulmonary mechanics, although finer changes in airways function require further investigation. Dyspnoea during pregnancy is also probably hormone-mediated but the exact temporal relationship between hormone status, functional change and the development of symptoms is not yet clearly defined.
PMCID: PMC2425453  PMID: 382162
18.  Effect of intravenous propranolol on QT interval. A new method of assessment. 
British Heart Journal  1980;43(1):1-6.
Changes in the QT and QTc intervals were studied in 16 patients by atrial pacing at rates of 100, 130, and 150 beats/minute. In all patients the measured QT shortened when the atrial paced rate was increased, but when corrected for heart rate the QTc lengthened. Intravenously administered propranolol produced a bradycardia and a lengthening of the QT interval in 15 of the 16 patients studied. When the QT interval was corrected for heart rate using Bazett's formula the QTc was shortened in 13 patients, unchanged in one, and lengthened in two. However, when the QT interval was measured at identical atrial paced rates the QT of the 15 patients studied was lengthened in 10 and unchanged in five. In none was the QT interval shortened. These results show firstly that Bazett's formula is unsuitable for correction of QT interval changes induced by atrial pacing, and secondly that, though intravenously administered propranolol usally produces a shortening of the QTc, when its effect is assessed directly by using an identical atrial paced rate the QT interval usually lengthens, or may remain unchanged, but never shortens. It is suggested that the formal assessment of drug induced QT interval changes should be made at identical atrial paced rates.
PMCID: PMC482234  PMID: 7356855
19.  Effect of simultaneous oral and vaginal treatment on the rate of cure and relapse in vaginal candidosis. 
One hundred patients with vulvovaginal candidosis were entered in a double-blind trial to compare the effect of six days' local treatment with clotrimazole with that of the same treatment plus 10 days' oral treatment with nystatin. No significant differences were detected in the rate of cure or relapse between the treatment groups. The cure rate was lowest and the relapse rate highest in patients in whom vaginal candidosis had last been diagnosed during the preceding 12 months.
PMCID: PMC1045682  PMID: 389354
20.  Epidemiological investigation of patients with vulvovaginal candidosis. Application of a resistogram method for strain differentiation of Candida albicans. 
The resistogram method was applied to 420 isolates of Candida albicans obtained from 30 selected patients undergoing treatment for vulvovaginitis. Of these, 16 patients each harboured a particular strain of C. albicans which persisted in the mouth or intestinal tract or both. In three of these patients, this strain persisted in the genital tract, and, in eight patients, it later recolonised the genital tract. Fourteen patients harboured more than one strain of C. albicans: one failed to respond to treatment and continued to harbour the same strain in the genital tract; in five the original strain later recolonised the genital tract and a second strain remained confined to the mouth or intestinal tract or both; and in three a second strain, present in the intestinal tract, later colonised the genital tract. Each of the male partners of seven patients harboured a strain of C. albicans that was identical to the strain, or to one of the strains, that had been isolated from his female partner.
PMCID: PMC1045681  PMID: 389353
21.  Longitudinal respiratory studies in older people 
Thorax  1978;33(5):547-554.
Milne, J S (1978).Thorax, 33, 547-554. Longitudinal respiratory studies in older people. A random sample of older people in Edinburgh (215 men, 272 women aged 62-90 years) was examined with the MRC questionnaire on respiratory symptoms. The FEV1 and FVC were recorded. Spirograms were repeated after one and five years and the questions after five years, the sample by then having been reduced to 133 men and 148 women.
After five years 7% of the surviving men and women had developed persistent cough and phlegm. This syndrome had disappeared in 12% of men and 2% of women. Dyspnoea had increased beyond grade 2 in 13% of men and 7% of women and had lessened only in 6% of women.
One-quarter of male and one-seventh of female cigarette smokers had given up smoking, mostly in the first year. Nearly all who stopped were symptomless before and after. In those men who stopped smoking before the study began symptom prevalence was similar to that in those who continued smoking.
Mean values of FEV1 and FVC declined as age increased, the decline being greater in FVC with resulting rise in FEV1%. Five-year differences in FEV1 and FVC were symmetrically distributed with mean differences increasing with age. Mean differences in FEV1 were 280-350 ml in men and 150-230 ml in women. Prediction equations from the first examinations remained usable for clinical work. Mean values of FEV1 and FVC at the first examination were smaller in those who died compared with survivors, whether symptoms were present or not. The prevalence of symptoms was greater in those who died.
PMCID: PMC470935  PMID: 725823
22.  Antibodies to Candida albicans in human cervicovaginal secretions. 
The incidence of IgA and IgG antibodies against Candida albicans was determined in cervicovaginal secretions from 95 non-pregnant women. IgG antibodies were detected in 21.2% of women with vaginal candidosis, in 23.5% of women harbouring yeasts in the vagina without clinical signs of infection, and in 26.6% of women not harbouring yeasts in the vagina. IgA antibodies were found in 6.1% of women with vaginal candidosis, in 5.9% of women harbouring yeasts in the vagina without clinical signs of infection, and in 8.9% of women not harbouring yeasts in the vagina. IgG antibodies against C. albicans were detected in the serum of all 95 women. It is suggested that a proportion of the antibodies found in the secretions was derived from the circulation.
PMCID: PMC1045447  PMID: 342069
23.  Longitudinal survey of ischaemic heart disease in randomly selected sample of older population. 
British Heart Journal  1977;39(8):889-893.
A group of 215 men and 272 women aged 62 to 90 forming a randomly-selected sample of the older population was studied by cardiovascular survey methods and followed for 5 years. The 5-year mortality of 28 per cent was related to age and was higher in men. Ischaemic heart disease was the certified cause of 28 per cent of the deaths. Mortality was greater in those with systolic hypertension. Among electrocardiographic features ST depression, T inversion, and atrial fibrillation increased overall and ischaemic heart disease mortality independently of their association with age. A positive response to an angina and infarct questionnaire was poorly related to subsequent mortality. Re-examination of 72 per cent of 5-year survivors was possible. Systolic and diastolic blood pressures were significantly lower and the frequency of electrocardiographic abnormalities, particularly left axis deviation, left ventricular hypertrophy, and ST and T wave changes, was increased.
PMCID: PMC483337  PMID: 901684
24.  Longitudinal study of heart size in older people. 
British Heart Journal  1976;38(12):1286-1290.
Transverse cardiac diameter and transverse thoracic diameter were measured in a longitudinal study of older men and women at the original examination and after five years. The cardiothoracic ratio overestimated 5-year changes in heart size, because of significant decreases with age in transverse thoracic diameter. A regression equation to predict transverse cardiac diameter from age and weight had been previously computed from the data obtained at the initial examination. This was a satisfactory predictor of recorded 5-year changes except in women of 70 years and over at entry to the study in whom the predicted change was significantly larger than the recorded change. This had resulted from the death during the 5 years of women in that age group with larger transverse cardiac diameters.
PMCID: PMC483169  PMID: 1008971
25.  Thirty-two cases of mesothelioma in Victoria, Australia: a retrospective survey related to occupational asbestos exposure. 
Mesotheliomas have been reported in four states in Australia. Crocidolite has been mined and milled at Wittenoom in West Australia where five cases of mesothelioma were reported after exposure of high intensity. The 32 cases of mesothelioma reported in this paper occurred during a period of 11 years in Victoria; 29 were pleural and three peritoneal. There were 22 autopsies. End occupations were misleading in 66% of cases. Two of the three subjects with peritoneal mesothelioma were siblings, and there was no evidence of occupational or other exposure to asbestos in either. There was a significant prevalence of pulmonary asbestos bodies in the tumour series as compared with an unselected consecutive series of 200 routine autopsies (0.01 greater than P greater than 0.001). The occupational history was as effective a method of assessing 'true' asbestos exposure as the pulmonary asbestos body count. Five cases had had a duration of exposure of one year or less, but they had had heavy exposure. The latent interval before tumour development was 25 years or longer in each case. There was no known exposure to asbestos in five cases (16%). The rare association of mesothelioma with types of asbestos other than crocikolite may not exist and could be explicable on the basis of the proportion (16%) of these tumours arising randomly in the population.
PMCID: PMC1008115  PMID: 1276091

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