Determining fever in children: the search for an ideal thermometer.

Body temperature measurement is most commonly taken to confirm the presence or absence of fever. Many decisions concerning the investigation and treatment of children are based on the results of temperature measurement alone. Determining the presence of fever in young children is particularly important.

Attitudes and awareness of female genital mutilation: a questionnaire-based study in a Kenyan hospital.

There are considerable efforts in Kenya to increase awareness of the issues and health risks associated with female genital mutilation (FGM) through educational programmes. The Kenyan government formally outlawed FGM in 2001. This questionnaire-based study aimed to explore attitudes and awareness of FGM in Kenya with particular reference to the law, health complications and educational programmes.

Validation of a non-mercury digital auscultatory device with manual pressure registration (PMS Mandaus).

Objective: To assess the clinical accuracy of a non-mercury digital auscultatory device (PMS Mandaus) with manual pressure registration in an adult population.

Methods: The accuracy of the device was assessed by predefined criteria (European Society of Hypertension protocol) in 33 study participants recruited from among patients and staff in a teaching hospital. A series of same-arm sequential blood pressure measurements were taken: first, two observers taking simultaneous mercury readings, followed by a reading with the device.

Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons.

Background: This is a "proof of concept study" to test the hypothesis that pulsed radiofrequency, PRF, produces cell stress at the primary afferent level without signs of overt thermal damage. We assumed that cell stress would result in impairment of normal function, and used the expression of activating transcription factor 3, ATF3, as an indicator of cellular "stress".

Methods: PRF (20 ms of 500-kHz RF pulses, delivered at a rate of 2 Hz; maximum temperature 42 degrees C) was delivered either to the sciatic nerve of adult rats in mid thigh, or to the L4 anterior primary ramus just distal to the intervertebral foramen.

Development of a real-time probe-based PCR assay for the diagnosis of Pneumocystis pneumonia.

This paper describes the development of a rapid probe-based real-time polymerase chain reaction assay (PCR) for the diagnosis of Pneumocystis pneumonia. To develop the PCR, primers and fluorescent resonance energy transfer probes were designed after sequencing products obtained using previously published primers. This gave results that were concordant with conventional cytological staining techniques, but were available within 2 h instead of greater than 24 h.

Exploration of peptide motifs for potent non-viral gene delivery highly selective for dividing cells.

Background: The immunogenicity of viral DNA vectors is an important problem for gene therapy. The use of peptide motifs for gene delivery would largely overcome this problem, and provide a simple, safe and powerful approach for non-viral gene therapy.

Methods: We explored the functional properties of two motifs: the (Lys)(16) motif (for binding and condensing DNA, and probably also nuclear translocation of plasmids) and the fusogenic peptide motif of influenza virus (for acid-dependent endocytic escape of peptide/DNA particles).

A remarkable permeability of canalicular tight junctions might facilitate retrograde, non-viral gene delivery to the liver via the bile duct.

Aims: To establish the extent of retrograde bile duct infusion at an ultrastructural level, as a preliminary step before evaluating the efficacy of gene delivery to the rat liver via a branch of the bile duct.

Methods: The extent of retrograde infusion into the biliary tree was established by light and electron microscopy, following infusion of 10 nm gold particles into the right lateral lobe. Canalicular permeability was further assessed by the infusion of a 67 kDa protein.

Origins and properties of Mycobacterium tuberculosis isolates in London.

Using similarities of IS6110 banding patterns, isolates of Mycobacterium tuberculosis from a population-based study in London were assigned to 12 large groups termed 'superfamilies' (sfams). Analysis of patient data showed a marked geographical association in the distribution of these sfams. In particular, isolates from patients born in Europe were from different sfams than those born elsewhere, indicating that there had been relatively little transmission of tuberculosis in London from immigrant communities into the endogenous population.

Prevalence of hepatitis C in an ethnically diverse HIV-1-infected cohort in south London.

Objectives: There is limited information on the prevalence of and risk factors for hepatitis C virus (HCV) infection among HIV-1-infected patients in the UK. Our objective was to determine the prevalence of HCV infection among an ethnically diverse cohort of HIV-infected patients in south London, and to extrapolate from these data the number of co-infected patients in the UK.

Methods: A total of 1017 HIV-1-infected patients who had attended King's College Hospital HIV clinic between September 2000 and August 2002 were screened for HCV antibody using a commercial enzyme-linked immunosorbent assay (ELISA).

Melanogenesis: a photoprotective response to DNA damage?

Exposure to ultra violet radiation (UVR) is associated with significant long-term deleterious effects such as skin cancer. A well-recognised short-term consequence of UVR is increased skin pigmentation. Pigmentation, whether constitutive or facultative, has widely been viewed as photoprotective, largely because darkly pigmented skin is at a lower risk of photocarcinogenesis than fair skin.

Long-term effects of tibolone on the endometrium as assessed by bleeding episodes, transvaginal scan and endometrial biopsy.

Introduction: Period-free hormone replacement therapy (HRT) obliterates the need for withdrawal bleeds. There is a need to ensure that, if these preparations are to be used in the long term, they still achieve amenorrhea.

Aims: To assess the bleeding rates and the endometrial status over 10 years in women who were taking tibolone compared to an age-matched control group.

The effectiveness of an acupuncturist working in general practice--an audit.

This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based).

The impact of matching the patient's vocabulary: a randomized control trial.

Background: Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation.

Objective: The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations.

Methods: The study took place in one inner city general practice.

"I want more time with my doctor": a quantitative study of time and the consultation.

Background: Although consultations have increased in length, patients still express dissatisfaction with how much time they spend with their doctor.

Objectives: This study aimed to explore aspects of consultation time and to examine the correlates of patients' desire for more time.

Methods: A quantitative cross-sectional design was used.

Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence.

The present study compared the modelling and control theories of parental influence on children's eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their child's food intake and using food as a tool for controlling behaviour.

Exploratory cluster randomised controlled trial of shared care development for long-term mental illness.

Background: Primary care clinicians have a considerable amount of contact with patients suffering from long-term mental illness. The United Kingdom's National Health Service now requires general practices to contribute more systematically to care for this group of patients.

Aims: To determine the effects of Mental Health Link, a facilitation-based quality improvement programme designed to improve communication between the teams and systems of care within general practice.

Expectant or surgical management of miscarriage: a qualitative study.

Objective: To explore women's reasons for selecting either expectant or surgical management of first trimester miscarriage and to examine the impact of treatment upon them.

Design: A qualitative study using interviews.

Setting: The Early Pregnancy and Gynaecology Assessment Unit at a London hospital.

Nitric oxide: potential role for reducing gastro-enteropathy.

The pathogenesis of non-steroidal anti-inflammatory drug (NSAID)-induced gastroenteropathy may involve a number of key events leading to increased intestinal permeability and inflammation (topical effect) and the development of ulcers (micro-vascular effects of COX-1 inhibition and prostaglandin deficiency). Many strategies have been employed in an attempt to reduce the toxic effects of NSAIDs and these have been targeted at the different pathogenic stages of lesion development. One of the latest in this long chain of damage limitation has been the development of nitric oxide (NO) sequestering NSAIDs (NO-NSAIDs).

BRCA1 : BARD1 induces the formation of conjugated ubiquitin structures, dependent on K6 of ubiquitin, in cells during DNA replication and repair.

The N-terminus of the BRCA1 protein bears a RING finger domain that functions as an E3 ubiquitin ligase in vitro where it is able to catalyse the synthesis of monoubiquitin and polyubiquitin targeted proteins. This activity is greatly increased when BRCA1 is in a complex with its N-terminal binding partner BARD1. In this report we use an immunohistochemical approach to demonstrate the association of cellular BRCA1 with the end product of the ubiquitin conjugation and ligation pathway, conjugated ubiquitin.

The effect of a six-month exercise program on very low-density lipoprotein apolipoprotein B secretion in type 2 diabetes.

The dyslipidemia and insulin resistance of type 2 diabetes can be improved by aerobic exercise. The effect of 6 months supervised exercise on very low-density lipoprotein (VLDL) apolipoprotein B metabolism was investigated in patients with type 2 diabetes. Moderately obese patients (n = 18) were randomized into supervised (n = 9) and unsupervised (n = 9) exercise groups.

HLA class II polymorphisms determine responses to bacterial superantigens.

The excessive immunological response triggered by microbial superantigens has been implicated in the etiology of a wide range of human diseases but has been most clearly defined for the staphylococcal and streptococcal toxic shock syndromes. Because MHC class II presentation of superantigens to T cells is not MHC-restricted, the possibility that HLA polymorphisms could influence superantigenicity, and thus clinical susceptibility to the toxicity of individual superantigens, has received little attention. In this study, we demonstrate that binding of streptococcal and staphylococcal superantigens to HLA class II is influenced by allelic differences in class II.

Drug resistance is uncommon in pregnant women with low viral loads taking zidovudine monotherapy to prevent perinatal HIV transmission.

Zidovudine monotherapy is used to reduce perinatal HIV transmission in women with low viral loads. There are few data on the risk of drug resistance in this select cohort of women. We determined the prevalence of newly acquired mutations conferring reduced sensitivity to zidovudine after exposure during pregnancy, and found that the development of mutations was uncommon and was restricted to women treated before 1998 who had higher baseline viral loads than those currently recommended monotherapy.

Relationship between quality of life and disease severity in atopic dermatitis/eczema syndrome during childhood.

Purpose Of Review: Atopic dermatitis is a chronic relapsing itchy disease that has an effect on children and families' quality of life. The purpose of this review is to give workers in the field an easy-to-read, up-to-date and accessible summary of recent advances in the relationship between quality of life and disease severity in atopic dermatitis/eczema syndrome during childhood. This review, however, concentrates on original articles that have been published since 1 April 2002, and reports a relationship between disease severity and quality of life scores in childhood atopic dermatitis.