Who attends primary care services prior to attendance at genitourinary services and what level of care have they received?

OBJECTIVE: To determine the proportion of patients initially attending primary care services and describe the care received prior to attending genitourinary medicine (GUM) clinics. METHOD: A cross-sectional survey of 1000 new patients attending GUM services in Cornwall between June and December 2006. Patients were asked during consultation whether they had attended primary care before coming and what examination, investigation and management had been carried out there. RESULTS: 35% (348/1000) of patients had attended primary care initially. Genital examination had been carried out in primary care on 60% (111/185) female and 58% (93/159) male patients (p = 0.78). Chlamydia testing had been carried out in 27% (46/171) female and 6% (8/139) male patients (p<0.005). 33% (100/301) patients seen in primary care had been offered treatment. 74% (68/92) patients with genital warts had been correctly diagnosed in primary care and 9% (8/92) of these offered treatment. CONCLUSIONS: The majority of these patients, including those given a diagnosis and/or offered treatment in primary care, had not had a chlamydia test or any other investigations. With the potential "fall out" of patients between primary care and GUM services, this may represent a missed opportunity to detect and appropriately manage sexually transmitted infections.

Mycoplasma genitalium is associated with symptomatic urethritis.

In order to further investigate the epidemiology of Mycoplasma genitalium, 680 men attending departments of genitourinary medicine in Bristol, Bath and Truro were studied. M. genitalium was detected in 36 men (5.3%) and was present at all three clinics. Clinically, both urethritis and the presence of a urethral discharge and/or dysuria, but not penile irritation were independently associated with the detection of M. genitalium, the former being with the strongest association (odds ratio [OR] 10.76, 95% confidence interval [CI] [3.10-37.29], P < 0.0001; OR 3.01, 95% CI [1.28-7.05], P = 0.011 and OR 1.28, 95% CI [0.61-2.69], P = 0.51, respectively). In men with urethritis, those with a discharge and/or dysuria were more likely to have M. genitalium detected (OR 2.61, 95% CI [1.09-6.25], P = 0.032). We found no association with younger age or a recent change of sexual partner. In conclusion, M. genitalium is associated with symptomatic urethritis.

CT appearances of HIV-related lipodystrophy syndrome.

Highly active antiretroviral therapy in HIV-1 infected patients is associated with a lipodystrophy syndrome, characterized by wasting of peripheral fat, central adiposity, hyperlipidaemia and insulin resistance. The CT findings are presented and the differential diagnosis is discussed.

Influence of neurons on lipopolysaccharide-stimulated production of nitric oxide and tumor necrosis factor-alpha by cultured glia.

Cerebral inflammation often originates in a region where neuronal death occurs and thereafter slowly spreads outward. This study aimed to elucidate the roles of neurons in modulating the production of inflammatory factors stimulated by the bacterial endotoxin lipopolysaccharide (LPS). Culturing neurons with mixed glia reduced nitrite and tumor necrosis factor-alpha (TNF-alpha) production compared to cultures with only mixed glia, and shifted the dose-response curve to the right. The decreased nitrite and TNF-alpha production were not due to the cytotoxicity of LPS. Immunocytochemical analysis of glia-neuron co-cultures revealed the morphological changes in the activated microglia. Culturing PC12 cells with rat mixed-glia also reduced nitrite production. The influence of neurons on glial inflammation was partly due to the cell-cell contacts between neurons and glia via neural cell adhesion molecules (NCAM) because NCAM significantly reduced LPS-stimulated nitrite production. These results demonstrate that neurons reduce the production of inflammatory factors by glia. Since cerebral inflammation is important in many neurological disorders, this study might provide insight about the role of glia-neuron interactions in inflammatory responses in the brain.

Managing STIs identified after testing outside genitourinary medicine departments: one model of care.

OBJECTIVES: To develop a local strategy for managing cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) which have been identified in the departments of obstetrics and gynaecology (O&G). METHODS: Weekly notification from the local microbiology laboratory to genitourinary medicine (GUM) departments of all positive CT and GC results generated by tests performed in the two local O&G departments. Direct contact made by GUM departments to index patients identified and "fast track" appointments made. Data recorded for future audit include numbers attending, details of health adviser input, and success of contact tracing. RESULTS: Over 18 months, 294 women were identified and 231 (78%) attended GUM departments; 142 (48%) had received antibiotics before attending GUM departments and of these, 58 (41%) had risked reinfection by an untreated partner and 48 (20%) were found on screening to have a previously undiagnosed genital infection. Over 90% were interviewed by a health adviser. Appropriate follow up was achieved in 87% of index cases. Of the contacts, 194 were treated--150 in the local GUM department. Of these 150 men, 99 (66%) had an identifiable genital infection and 84% of those with CT/non-gonococcal urethritis were asymptomatic. There have been no complaints either formal or informal, by women managed by this system. CONCLUSIONS: GUM clinics are the ideal setting to achieve successful treatment of patients with sexually acquired infections, which must include notification and treatment of their partners if reinfection is to be avoided. For patients with infections diagnosed on other settings, such as O&G, a system of direct notification of results to GUM departments by an agreed protocol can be highly successful. For such a system to work, close cooperation and trust between departments is essential.

An improved technique for the culture of jerusalem artichoke (Helianthus tuberosus L.) explants for use in the study of xylem differentiation.

An improved technique is described for the culture of explants from Helianthus tuberosus L. (Jerusalem artichoke). No xylem is formed when tuber discs are pre-cultured on a medium containing ßNAA, allowing uninfected discs to be selected for investigation of xylogenesis. Subsequent growth on a medium containing 0.45µM 2,4-D and 9.3µM kinetin stimulates a high proportion (up to 36%) of the cells to differentiate into xylem elements within a relatively short time (between 1 and 3 d after transfer).

The influence of gibberellic acid and abscisic acid on cell and tissue differentiation of bean callus.

Bean callus was induced to form roots (tissue differentiation) and vascular nodules (cell differentiation) by lowering the ratio of auxin to cytokinin in the growth medium. Both types of differentiation were inhibited by the addition of abscisic acid (at concentrations greater than I muM) to induction medium. Initiation of differentiation was inhibited, but its subsequent development was not, and the inhibition was not affected by the addition of gibberellic acid. Addition of gibberellic acid (GA) alone to induction medium stimulated tissue differentiation, although cell differentiation was unaffected (30 muM GA) or inhibited (45 muM GA) and its onset was delayed at both concentrations. Root initiation was also stimulated by gibberellic acid (0.I-45 muM) at an auxin-to-kinin ratio 10 times that normally optimal for cell differentiation. The phenylalanine ammonia lyase (PAL) activity of the calluses was closely correlated with the amount of cell differentiation which had occurred, and measurement of this confirmed that gibberellic acid delayed the initiation of cell differentiation. The increase and subsequent decline of PAL and betaI leads to 3 glucan synthetase activities, normally induced by transfer to induction medium, was abolished by abscisic acid. Addition of gibberellic acid did not affect the betaI leads to 3 glucan synthetase activity.

Correlation of the induction of various enzymes concerned with phenylpropanoid and lignin synthesis during differentiation of bean callus (Phaseolus vulgaris L.).

The activities of phenylalanine ammonia lyase and caffeate-0-methyl transferase in bean callus tissue, during differentiation, were induced in a coordinated manner over a period of 21 days. Neither enzyme activity could be induced to increase when differentiation was repressed by the addition of abscisic acid to the induction medium. The formation of soluble phenols was also increased during the induction of differentiation but it was also increased by the transfer to induction medium of an old callus which could no longer differentiate. PAL activity was more directly correlated with xylogenesis and nodule induction than with the formation of soluble phenols. Peroxidase activity in the callus tissue was always high but the level decreased during the induction of differentiation. A new isoenzyme of peroxidase was induced during callus formation and this was probably a response to the presence of auxins in the medium used to grow the callus.

Quantitative measurement of the course of bean callus differentiation.

Two strains of callus have been isolated from bean hypocotyl and grown on a defined maintenance medium supplemented with 2 mg/l. 2:4-dichlorophenoxyacetic acid (2:4D) and 2% sucrose. Root initiation was observed in one strain and formation of nodules containing xylem and phloem in both strains after transfer to an induction medium supplemented with 1 mg/l. naphthyleneacetic acid, 0-2 mg/l. kinetin and 3% sucrose, after 3 transfers to maintenance medium. The number of nodules per gramme increased 10-fold between 6 and 12 days after transfer, and thereafter remained constant. Phenylalanine ammonia lyase (PAL) activity rose to a maximum value when the rate of nodule formation was greatest, and decreased after the maximum nodule concentration was reached. The final constant value for PAL activity was above that of callus grown on maintenance medium. Beta I leads to 3 glucan synthetase activity rose to a maximum 15 days after transfer, and then fell gradually to a level above that measured in callus on maintenance medium. Callus was transferred from maintenance medium after 3, 4, 5 and 6 transfers. The concentration of nodules after 21 days on induction medium decreased as the callus was kept in culture. No further differentiation could be induced after 6 transfers. The fall in nodule formation was paralleled by a decrease in PAL and betaI leads to 3 glucan synthetase activities measured 21 days after transfer.