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1.  Thyrotoxicosis of a rare aetiology 
Postgraduate Medical Journal  2000;76(902):799-800.
doi:10.1136/pmj.76.902.799a
PMCID: PMC1741831  PMID: 11085778
2.  Occupational risk factors for ill health in Gulf veterans of the United Kingdom 
OBJECTIVES—To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for.
DESIGN—A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure.
SETTING—Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991.
PARTICIPANTS—3297 Gulf veterans.
MAIN RESULTS—In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004 ; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health.
CONCLUSIONS—Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans.


Keywords: military; Gulf veterans; rank
doi:10.1136/jech.54.11.834
PMCID: PMC1731581  PMID: 11027197
3.  Re: Gynaecological effects of tamoxifen 
doi:10.1136/jcp.53.6.484-a
PMCID: PMC1731212  PMID: 10911811
4.  Does location of vertebral deformity within the spine influence back pain and disability? 
Annals of the Rheumatic Diseases  2000;59(5):368-371.
OBJECTIVE—Vertebral deformity is associated with back pain and disability. The aim of this analysis was to determine whether location within the spine influences the strength of association between vertebral deformity, back pain and disability.
METHODS—Men and women aged 50 years and over were recruited from population registers in 30 European centres. Subjects were invited for an interviewer administered questionnaire, and for lateral spinal radiographs. The questionnaire included questions about back pain, general health and functional ability. The spinal radiographs were evaluated morphometrically and vertebral deformity defined according to the McCloskey-Kanis method.
RESULTS—756 (11.7%) men and 885 (11.8%) women had evidence of one or more vertebral deformities. Among women with a single deformity, after adjusting for age and centre, those with a lumbar deformity were more likely than those with a thoracic deformity to report back pain, both currently (OR=1.4; 95% CI 1.0, 2.0) and in the past year (OR=1.5; 95% CI 1.0, 2.3). No association was observed in men. Among women with two deformities, those with adjacent deformities were more likely than those with non-adjacent deformities to report poor general health (OR=2.2; 95%CI 0.9, 5.6), impaired functional ability (OR=1.9; 95%CI 0.8, 4.7) and current back pain (OR=2.1; 95%CI 0.9, 4.9), though none of these associations were statistically significant. By contrast, among men, non-adjacent deformities were associated with impaired functional ability compared with those with adjacent deformities.
CONCLUSION—Location within the spine influences the strength of association between self reported health factors and vertebral deformity.


doi:10.1136/ard.59.5.368
PMCID: PMC1753132  PMID: 10784519
5.  A rare cause of right-sided abdominal pain in a young woman 
Postgraduate Medical Journal  2000;76(891):43-44.
doi:10.1136/pmj.76.891.43
PMCID: PMC1741458  PMID: 10622784
10.  Spontaneous rupture of malarial spleen: two case reports and review of literature 
Critical Care  2000;4(5):309-313.
Malaria has long been among the most common diseases in the southeast Anatolia region of Turkey. In 1992, 18676 cases were diagnosed in Turkey, and Diyarbakir city had the highest incidence (4168 cases), followed by SanliUrfa city (3578 cases). Malaria was especially common during 1994 and 1995, with 84 345 and 82 094 cases being diagnosed in these years, respectively. Spontaneous rupture of malarial spleen is rare. We saw two cases during 1998, which are reported herein. Both patients were male, and were receiving chloroquine treatment for an acute attack of malaria. One of the patients had developed abdominal pain and palpitations, followed by fainting. The other patient had abdominal pain and fever. Explorative laparotomy revealed an enlarged spleen in both patients. Splenectomy was performed in both patients. We have identified 15 episodes of spontaneous rupture of the spleen in the English language literature published since 1961. Because of increased travel to endemic areas and resistance to antimalarial drugs, malaria is a major medical problem that is becoming increasingly important to surgeons worldwide. Malaria is a particularly important problem in the southeast Anatolia region of Turkey. Prophylactic precautions should be taken by tourists who travel to this region, especially during the summer.
PMCID: PMC29048  PMID: 11056757
malaria; prophylactic precautions; ruptured spleen
11.  New Advances in the Diagnosis of Typhoid and Detection of Typhoid Carriers 
For effective management of typhoid, diagnosis of the disease must be done with speed and accuracy. Development of such a test would require antigens that are specific for typhoid diagnosis. Attempts at finding the specific antigen have been carried out throughout the years. The finding of such an antigen can lead to carrier detection as well. Candidate antigens have been used in the development of antigen or antibody detection tests with variation in sensitivity and specificity. Further characterization and understanding of the candidate antigens combined with use of innovative technologies will allow for the ideal test for typhoid and typhoid carriers to be within reach.
PMCID: PMC3438001  PMID: 22977383
New advances; typhoid diagnosis; typhoid carriers; typhoid antigent
12.  Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study 
BMJ : British Medical Journal  2000;320(7246):1363-1367.
Objectives
To explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect.
Design
Cross sectional study of Gulf war veterans followed for six to eight years after deployment.
Setting
UK armed forces.
Participants
Military personnel who served in the Gulf and who still had their vaccine records.
Main outcome measures
Multisymptom illness as classified by the Centers for Disease Control and Prevention; fatigue; psychological distress; post-traumatic stress reaction; health perception; and physical functioning.
Results
The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).
Conclusion
Among veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the “stress” of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.
PMCID: PMC27378  PMID: 10818024
13.  Laparoscopic Cholecystectomy in Patients with Bilharzial Portal Hypertension 
Objective:
The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in patients with bilharzial portal hypertension.
Methods:
Patients who had gallstones and bilharzia had ultrasonographic assessment of peri-portal fibrosis, endoscopy, hemagglutination and rectal snip. Operating time, blood loss, hospital stay, time of return to work and operative mortality were recorded. Follow-up was two weeks, six weeks and six months after discharge.
Results:
Twenty-five out of 450 patients, who had laparoscopic cholecystectomy, suffered from bilharzial portal hypertension. Ten patients had grade 1 varices, 10 had grade 2 varices, and 5 had grade 3 esophageal varices. All patients had varying degrees of peri-portal fibrosis as shown by ultrasound. Rectal snip showed schistosoma mansoni in 5 patients, and a hemagglutination test was positive in all. Two patients had conversion to open cholecystectomy. Mean operating time was 1 hour and 15 minutes. Average blood loss was 50 cc. Mean hospital stay for 23 patients was 48 hours. Average time of return to work was 2 weeks in 23 patients and 6 weeks in the 2 patients who had conversion. Twenty-two patients benefited from the operation. There was no mortality in this series.
Conclusions:
Laparoscopic cholecystectomy in patients with bilharzial portal hypertension is feasible and has low morbidity.
PMCID: PMC3015381  PMID: 10917123
Laparoscopic Cholecystectomy; Bilharzia; Portal Hypertension
15.  Split-Intron Retroviral Vectors: Enhanced Expression with Improved Safety 
Journal of Virology  2000;74(5):2365-2371.
The inclusion of retrovirus-derived introns within retrovirus-based expression vectors leads to a fraction of the resulting transcripts being spliced. Such splicing has been shown to markedly improve expression (W. J. Krall et al., Gene Ther. 3:37–48, 1996). One way to improve upon this still further might involve the use of more efficient introns instead of those from the provirus. Currently, however, incorporation of such introns remains self-defeating since they are removed in the nucleus of the producer cell. In the past, elaborate ways to overcome this problem have included the use of alphaviruses to make the vector transcripts within the cytoplasm, thus avoiding the nuclear splicing machinery during vector production (K. J. Li and H. Garoff, Proc. Natl. Acad. Sci. USA 95:3650–3654, 1998). We now present a novel design for the inclusion of introns within a retroviral vector. In essence, this is achieved by exploiting the retroviral replication process to copy not only the U3 promoter but also a synthetic splice donor to the 5′-long-terminal-repeat position during reverse transcription. Once copied, synthesized transcripts then contain a splice donor at their 5′ end capable of interacting with a consensus splice acceptor engineered downstream of the packaging signal. Upon transduction, we demonstrate these vectors to produce enhanced expression from near fully spliced (and thus packaging signal minus) transcripts. The unique design of these high titer and high-expression retroviral vectors may be of use in a number of gene therapy applications.
PMCID: PMC111718  PMID: 10666267

Results 1-15 (15)