A Novel Firefly Algorithm for Optimal Linear Phase FIR Filter Design

Optimal digital filter design in digital signal processing has thrown a growing influence on communication systems. FIR filter design involves multi-parameter optimization, on which the existing optimization algorithms do not work efficiently. For which different optimization techniques can be utilized to determine the impulse response coefficient of a filter and try to meet the ideal frequency response characteristics. In this paper, FIR low pass, high pass, band pass and band stop filters have been designed using a new meta-heuristic search method, called firefly algorithm. Firefly Algorithm is inspired by the flash pattern and characteristics of fireflies. The performance of the designed filters has been compared with that obtained by real coded genetic algorithm (RGA), standard PSO and differential evolution (DE) optimization techniques. Differential evolution (DE) is already one of the most powerful stochastic real-parameter optimization algorithms in current use. Here the firefly algorithm (FA) technique has proven a significant advantage. For the problem at hand, the simulation of designing FIR filters has been done and the simulation results demonstrate that Firefly algorithm is better than other relevant algorithms, not only in the convergence speed but also in the performance of the designed filter.

Effect of surfactants on phosphatase level of fresh water fish Labeo rohita

Alterations in the activity of enzymes Acid phosphatase (E.C.3.1.3.2) and Alkaline phosphatase (EC 3.1.3.1) in organs such as liver, gills and muscle of rohu following its exposure to surfactants viz. CTAB, SDS and Triton X-100 were analyzed. Different levels of exposure were given depending on the LC50 value of the surfactant used. Also, the influence of age and weight of the organisms was tested simultaneously. The activity of ACP in the tissues of fish exposed to all the three surfactants showed marked enhancement after exposure; the effect being highest in the liver followed by gill and muscle. Activity levels of ALP in different tissues of the fish exposed to the surfactants also showed an increase. Maximum increase was found in the liver followed by muscle, and gill. The increase in the levels of these enzymes indicates a stressful condition of the fish.

Availability of services for subjects of sexual assault in genitourinary medicine clinics

The aim of this study is to gain an understanding of the services available to subjects of sexual assault at genitourinary medicine (GU medicine) clinics throughout the United Kingdom, and to determine whether these services are adequate. By means of a questionnaire, consultants in 106 clinics provided information on the number of patients who reported sexual assault and the services available to them. The study found a marked regional variation in attendances by subjects of sexual assault. However, only a minority of clinics kept accurate data (36.7% regarding female victims and 37.75% regarding male victims). The number of subjects who were aged under 16 years was disproportionately high (under 16s: 6.9% of female victims and 1.2% male victims; 16 and over: 1.3% of female victims and 0.14% of male victims). This survey highlights deficiencies in services that need to be addressed by clinics, management and the speciality.

The IL-10 -1082G polymorphism is associated with clearance of HPV infection

The role of cytokines in protecting against human papillomavirus (HPV) and HPV-associated disease is not fully understood. We compared the frequency of the interleukin (IL)-10 polymorphism (G allele) at position --1082 and the distribution of GG/GA/AA genotypes among 116 HPV-positive women, grouped according to their cervical cytological profiles, with 119 HPV-negative controls with normal smears. No difference was observed in genotype frequency between the groups. Among women in the HPV-positive, smear-normal group, who were re-tested for HPV after 12 months, there was a significant inverse association between presence of at least one variant G allele (high activity) and HPV persistence (OR per G allele = 0.082 [95% CI 0.009-0.73], P= 0.001; after controlling for ethnicity). This association remained significant after controlling for age, smoking and hormonal contraception (OR = 0.028 [95% CI 0.001-0.66], P= 0.001). This preliminary study suggests that higher levels of IL-10 may prevent cervical neoplasia through their role in eliminating HPV.

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

OBJECTIVES

Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics.

METHODS

In a cross sectional study adolescents within 5 years of menarche, < or =17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) concentrations were measured.

RESULTS

Among 102 adolescents, 59.8% (61) had a high vaginal pH (>4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of Depo-Provera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (<12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024).

CONCLUSIONS

Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.

Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics

OBJECTIVE

To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections.

METHODS

Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV.

RESULTS

Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6-0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05).

CONCLUSIONS

Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age.

A major lung cancer susceptibility locus maps to chromosome 6q23-25

Lung cancer is a major cause of death in the United States and other countries. The risk of lung cancer is greatly increased by cigarette smoking and by certain occupational exposures, but familial factors also clearly play a major role. To identify susceptibility genes for familial lung cancer, we conducted a genomewide linkage analysis of 52 extended pedigrees ascertained through probands with lung cancer who had several first-degree relatives with the same disease. Multipoint linkage analysis, under a simple autosomal dominant model, of all 52 families with three or more individuals affected by lung, throat, or laryngeal cancer, yielded a maximum heterogeneity LOD score (HLOD) of 2.79 at 155 cM on chromosome 6q (marker D6S2436). A subset of 38 pedigrees with four or more affected individuals yielded a multipoint HLOD of 3.47 at 155 cM. Analysis of a further subset of 23 multigenerational pedigrees with five or more affected individuals yielded a multipoint HLOD score of 4.26 at the same position. The 14 families with only three affected relatives yielded negative LOD scores in this region. A predivided samples test for heterogeneity comparing the LOD scores from the 23 multigenerational families with those from the remaining families was significant (P=.007). The 1-HLOD multipoint support interval from the multigenerational families extends from C6S1848 at 146 cM to 164 cM near D6S1035, overlapping a genomic region that is deleted in sporadic lung cancers as well as numerous other cancer types. Parametric linkage and variance-components analysis that incorporated effects of age and personal smoking also supported linkage in this region, but with somewhat diminished support. These results localize a major susceptibility locus influencing lung cancer risk to 6q23-25.

Levels of the DNA adduct, N7-methyldeoxyguanosine, are associated with increased risk of failure of treatment of cervical intraepithelial neoplasia

OBJECTIVE

To determine whether exposure to methylating agents was a risk factor for treatment failure in women undergoing colposcopic examination.

METHODS

Nine hundred fifty-eight women attending for colposcopic examination after abnormal cervical smear test results were recruited into the study cohort. Information on demographic factors, smoking and other risk factors was obtained and a pre-treatment biopsy was taken and stored at -70 degrees C. After follow-up, cases who had treatment failure of cervical intraepithelial neoplasia (CIN) within 2 years following treatment were identified (n = 77) and matched to women with no treatment failure of CIN in this time period (controls, n = 154). DNA was extracted from the pre-treatment biopsies and levels of N7-methyl-deoxyguanosine (N7-MedG), a marker of exposure to methylating agents, were quantified as the ring-opened form of the base damage by a validated immunoslotblot assay.

RESULTS

Sufficient DNA for N7-MedG analysis was extracted from 61 subjects corresponding to 20 matched case control pairs. N7-MedG was detected in cervical DNA with levels ranging from non-detected (<0.1 micromol/mol dG) to 4.83 micromol/mol dG. N7-MedG levels were significantly higher in cases (geometric mean 0.99 micromol/mol dG) than controls (0.33 micromol/mol dG; P = 0.01). There were no associations between N7-MedG levels and HPV or smoking status. Log N7-MedG content, after adjustment for HPV status at time of treatment, was found to be significantly associated with increased risk of treatment failure (OR 5.74, 95% CI 1.05-31.23).

CONCLUSIONS

The association between pre-treatment levels of DNA damage induced by methylating agents and subsequent treatment failure implicates methylating agent exposure as a causative factor in treatment failure.

An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester

BACKGROUND

In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester.

METHODS

Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission.

RESULTS

The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet.

CONCLUSIONS

These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region.

Chronic prostatitis/chronic pelvic pain syndrome: national survey of genitourinary medicine clinics

We sought to determine current practice in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CPPS) in genitourinary medicine departments in the UK, using a detailed questionnaire survey. Evaluable responses were received from 147 (69%) clinics. Seventy-nine (54%) clinics reported seeing >10 new CPPS patients per year. A broad range of investigations was reported to be used in the diagnosis of CPPS. Whilst 89 (61%) clinics reported using the four-glass test in diagnosis, 46 (32%) reported using the test in >90% of patients with CPPS, and 42 (29%) reported never using the test. In the treatment, doxycycline or ciprofloxacin were reported to be first line treatment by 98% clinics, mostly in 4-6 week courses; however, great variation was recorded in second-line choices and use of non-antibiotic approaches. This survey demonstrates that patients with CPPS are regularly diagnosed and managed in genitourinary clinics in the UK, with wide variations in diagnostic and treatment practices.

Leishmania plasma membrane Mg2+-ATPase is a H+/K+-antiporter involved in glucose symport. Studies with sealed ghosts and vesicles of opposite polarity

Experiments from other laboratories conducted with Leishmania donovani promastigote cells had earlier indicated that the plasma membrane Mg2+-ATPase of the parasite is an extrusion pump for H+. Taking advantage of the pellicular microtubular structure of the plasma membrane of the organism, we report procedures for obtaining sealed ghost and sealed everted vesicle of defined polarity. Rapid influx of H+ into everted vesicles was found to be dependent on the simultaneous presence of ATP (1 mm) and Mg2+ (1 mm). Excellent correspondence between rate of H+ entry and the enzyme activity clearly demonstrated the Mg2+-ATPase to be a true H+ pump. H+ entry into everted vesicle was strongly inhibited by SCH28080 (IC50 = approximately 40 microm) and by omeprazole (IC50 = approximately 50 microm), both of which are characteristic inhibitors of mammalian gastric H+,K+-ATPase. H+ influx was completely insensitive to ouabain (250 microm), the typical inhibitor of Na+,K+-ATPase. Mg2+-ATPase activity could be partially stimulated with K+ (20 mm) that was inhibitable (>85%) with SCH28080 (50 microm). ATP-dependent rapid efflux of 86Rb+ from preloaded vesicles was completely inhibited by preincubation with omeprazole (150 microm) and by 5,5'-dithiobis-(2-nitrobenzoic acid) (1 mm), an inhibitor of the enzyme. Assuming Rb+ to be a true surrogate for K+, an ATP-dependent, electroneutral stoichiometric exchange of H+ and K+(1:1) was established. Rapid and 10-fold active accumulation of [U-(14)C]2-deoxyglucose in sealed ghosts could be observed when an artificial pH gradient (interior alkaline) was imposed. Rapid efflux of [U-(14)C]d-glucose from preloaded everted vesicles could also be initiated by activating the enzyme, with ATP. Taken together, the plasma membrane Mg2+-ATPase has been identified as an electroneutral H+/K+ antiporter with some properties reminiscent of the gastric H+,K+-ATPase. This enzyme is possibly involved in active accumulation of glucose via a H+-glucose symport system and in K+ accumulation.

Distribution of HIV-1 subtypes in female sex workers of Calcutta, India

BACKGROUND & OBJECTIVES

Different routes for the transmission of HIV-1 in India have been reported and the majority of infections occurred through heterosexual route of transmission. In order to understand the dynamics of HIV-1 transmission, a systematic study was undertaken to determine the viral subtypes circulating among the female sex workers in Calcutta, India.

METHODS

Peptide enzyme immunoassay (PEIA), heteroduplex mobility assay (HMA) and DNA sequence analysis were used to ascertain the HIV-1 subtypes.

RESULTS

V3 serotyping of 52 HIV-1 seropositive samples identified 33 (60%) to be subtype C. A DNA fragment within C2-V3/C2-V5 regions of HIV-1 gp120 was amplified directly from the lymphocyte DNA to avoid any bias in selecting viral variants and used in HMA. Of the 40 samples analyzed, 38 (95%) belonged to subtype C and 2 were found to be non-typable. Further analysis of these 38 samples revealed that 26 (68%) had maximum homology to the C3-Indian reference strain (IND868), 11 (29%) were most homologous to C2-Zambian strain (ZM18) and 1 (3%) showed close resemblance to C1-Malawi strain (MA959). Nucleotide sequence of 11 subsamples encompassing about 325 base pairs was aligned for the Indian and other geographically distinct isolates. On distance and parsimony trees, most of the samples (8/11) clustered together as subtype C.

INTERPRETATION & CONCLUSIONS

Subtype C was the major circulating HIV-1 strain in this geographical region, although variation within this subtype was also noticed. DNA sequence analysis was found to be the best method in determining the nature of the HIV-1 subtype followed by HMA and peptide enzyme immunoassay. These findings may have important implications for the design of effective vaccines in India and emphasizes the need for constant monitoring of the HIV-1 subtypes in different parts of India.

Cervical cytology screening for sexually-active teenagers

Our aim was to determine the value of cervical cytology for sexually-active teenagers attending genitourinary medicine (GUM) clinics. This is a retrospective review of 57,093 women who had cervical cytology reported at the Royal Bolton Hospital (RBH) during the period 1 April 1994 to 31 March 1996. The results were subdivided into 2 age groups; < or = 19 years and > or = 20 years. Cervical cytology abnormalities within each age group were analysed and compared with the national figures for cervical cytology screening. The results were also subdivided according to their source of referral; general practitioners (GP), GUM and gynaecology. The data from each group were analysed in the same manner as before. The results of the cervical cytology screening from the RBH for major cytological abnormalities (moderate dyskaryosis and above), for the 2 age groups, were comparable and not significantly different (2.1% for each age group, P=0.909) and these figures were within the range of the national figures for cervical cytology screening (1.1%-3.4%). Subdivision of the data by source of referral demonstrated that the percentage of major abnormalities in smears performed at GUM clinics was higher than the national figure for all age groups (41/1000 for the younger age group and 37/1000 for the older age group, 12/1000 for the national figures). In conclusion, cervical cytology screening should be offered to sexually-active teenagers attending GUM clinics.

Manganese selectivity of pmr1, the yeast secretory pathway ion pump, is defined by residue gln783 in transmembrane segment 6. Residue Asp778 is essential for cation transport

We have solubilized and purified the histidine-tagged yeast secretory pathway/Golgi ion pump Pmr1 to near homogeneity in one step, using nickel affinity chromatography. The purified pump demonstrates both Ca(2+)- and Mn(2+)-dependent ATP hydrolysis and phosphoenzyme intermediate formation in forward (ATP) and reverse (P(i)) directions. This preparation has allowed us to examine, in detail, the properties of mutations D778A and Q783A in transmembrane segment M6 of Pmr1. In phenotypic screens of Ca(2+) chelator and Mn(2+) toxicity reported separately (Wei, Y., Chen, J., Rosas, G., Tompkins, D.A., Holt, P.A., and Rao, R. (2000) J. Biol. Chem. 275, XXXX-XXXX), D778A was a loss-of-function mutant apparently defective for transport of both Ca(2+) and Mn(2+), whereas mutant Q783A displayed a differential sensitivity consistent with the selective loss of Mn(2+) transport. We show that mutant D778A is devoid of cation-dependent ATP hydrolytic activity and phosphoenzyme formation from ATP. However, reverse phosphorylation from P(i) is preserved but is insensitive to inhibition by Ca(2+) or Mn(2+) ions, which is evidence for a specific inability to bind cations in this mutant. We also show that Ca(2+) can activate ATP hydrolysis in the purified Q783A mutant, with a half-maximal concentration of 0.06 micrometer, essentially identical to that of wild type (0.07 micrometer). Mn(2+) activation of ATP hydrolysis was half-maximal at 0.02 micrometer in wild type, establishing a normal selectivity profile of Mn(2+) > Ca(2+). Strikingly, Mn(2+)-ATPase in the Q783A mutant was nearly abolished, even at concentrations of up to 10 micrometer. These results were confirmed in assays of phosphoenzyme intermediates. Molecular modeling of the packing between helices M4 and M6 suggests that residue Gln(783) in M6 may form a critical hydrophobic interaction with Val(335) in M4, such that the Ala substitution modifies the packing or tilt of the helices and thus the ion pore. The data emphasize the critical role of transmembrane segment M6 in defining the cation binding pocket of P-type ATPases.

Low HIV and high STD among commercial sex workers in a brothel in Bangladesh: scope for prevention of larger epidemic

The present study documents the first systematic assessment of a brothel in Bangladesh in terms of sexually transmitted disease (STD) and human immunodeficiency virus (HIV). A cross sectional study was undertaken on brothel-based commercial sex workers (CSWs) selected systematic random sampling to assess the prevalence of STDs and HIV among CSWs in a brothel setting. Two hundred and ninety-six CSWs were selected from a brothel with a population of 593 women. Following informed consent, endocervical and blood samples were obtained for the diagnosis of genital chlamydia, gonorrhoea, HIV and syphilis respectively. In addition, another 170 consecutive blood samples were collected from the total CSW population for HIV tests. All blood samples for HIV testing were made anonymous by removing patient identifiers before testing. Endocervical specimens were tested by polymerase chain reaction (PCR) for the diagnosis of genital chlamydia and gonorrhoea. Syphilis and HIV infections were diagnosed by serology. One hundred and sixty-nine (57.1%) of the women were Treponema pallidum haemagglutination (TPHA)-positive, 20 (6.8%) of the women were Venereal Disease Research Laboratory (VDRL)-positive at a greater than 1:8 dilution. Eighty-two (28%) of the women were found to be infected either by gonorrhoea or chlamydia. No HIV antibody was found in any of the 466 blood samples. A high prevalence of STDs and low prevalence of HIV in the CSWs in Bangladesh suggest potential for the rapid spread of HIV once it is introduced in this high-risk population. The opportunity to control STD and HIV infection in this population should not be missed, in order to prevent a large epidemic in the future.

Psychological and psychosexual aspects of vulvar vestibulitis

AIMS

To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis.

METHODS

30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion.

RESULTS

Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected.

CONCLUSIONS

When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions.

Is patch testing necessary in vulval vestibulitis?

Allergic contact dermatitis has been suggested as a possible cause of vulval vestibulitis, a condition of unknown aetiology characterized by burning, stinging and dyspareunia, with symptoms localised to the vestibule. To examine this relationship, 30 women with vulval vestibulitis were patch tested using a standard series of contact allergens and a special series relevant to perianal and vulval disorders. Other potential allergens identified by the patients as causing aggravation were also included. There were 5 positive reactions, 4 to nickel and 1 to fragrance mix, though none of these reactions were considered relevant. Our results suggest that allergic contact dermatitis is unlikely to be a primary factor in the development or persistence of vulval vestibulitis. Patch testing patients with vulval vestibulitis cannot routinely be recommended.

The plasma-membrane Ca2+-ATPase of Leishmania donovani is an extrusion pump for Ca2+

Controlled exposure of Leishmania donovani promastigotes to hypotonic shock results in the formation of deflagellated unsealed ghosts of original polarity that largely retain the pellicular microtubular structure associated with plasma membrane of the parasite. Gentle shearing followed by suspension of the purified membrane in appropriate isotonic buffer containing Mg2+ (4mM) results in the formation of sealed everted vesicles. The presence of Mg2+ (4 mM) appears to be essential for efficient sealing and also to prevent leakiness. ATP-dependent Ca2+ accumulation can be demonstrated in these vesicles Km values for Ca2+ and ATP were 125 nM and 0.8 mM respectively. The accumulated Ca2+ reaches a concentration of 1.1 mM. Ca2+ uptake is completely inhibited by vanadate (40 microM) and several thiol-modifying agents. Using 5,5'-dithiobis-(2-nitrobenzoic acid) as the modifying agent, an excellent correlation between loss of enzyme activity and transport capability and their parallel regeneration in the presence of 2 mM dithiothreitol was demonstrated. Using 2'.7-bis(carboxyethyl)-5(6)-carboxyfluorescein as the fluorescent pH probe, it was observed that Ca2+ entry into the vesicles is accompanied by an outward movement of H+ from the vesicles. Taken together, this paper establishes that the high-affinity transmembrane Ca2+-ATPase [Ghosh, Ray, Sarkar and Bhaduri (1990) J. Biol. Chem. 265, 11345-11351; Majumdar, Mukherjee, Ray and Bhaduri (1992) J. Biol. Chem. 267, 18440-18446] is an extrusion pump for Ca2+ in this human pathogen.

The chronically symptomatic vulva: prevalence in primary health care

OBJECTIVES

To examine within the primary health care setting, the frequency of chronic vulval disorders, their frequency, investigation, management and referral patterns.

METHODS

A questionnaire based survey at general practitioners surrounding a district general hospital.

RESULTS

A total of 79 (72%) GPs replied to the questionnaire. Thirty-six (45%) GPs saw more than one patient per month with recurrent vulval symptoms and ten (13%) GPs saw more than three patients per month. The predominant symptom amongst patients with recurrent vulval symptoms was itching (55%) followed by soreness (26%), burning (14%) and dyspareunia (5%). Topical-antifungals and steroid medications were the commonest treatments prescribed for all women with vulval symptoms.

CONCLUSIONS

Women who have vulval complaints commonly attend their GP for treatment. In many instances women with chronic vulval complaints are inadequately investigated and inappropriately managed.

Bacterial vaginosis in a district genitourinary medicine department: significance of vaginal microbiology and anaerobes

The aim of this study was to correlate the significance of vaginal microbiology, in particular its anaerobic component, to the presence of bacterial vaginosis (BV), and to review the clinical criteria used in the diagnosis of this condition. Ninety-two female patients who received routine STD screening were studied. After routine history, presence and character of vaginal discharge and vaginal pH were noted, an amine test performed, and a wet stain observed microscopically. Routine Gram stain smears and cultures were prepared. BV was diagnosed clinically in 28 (30%) of our sample, and Gardnerella vaginalis was cultured in 41 patients (45%). Both clue cells and anaerobes were closely associated with each other and both mutually exclusive with the presence of lactobacilli on Gram stain (P < 0.001). BV was found to be strongly associated with the presence of clue cells on the wet film, anaerobes and G. vaginalis. In conclusion, bacterial vaginosis is not only strongly associated with the presence of G. vaginalis in the vaginal flora, but more strongly with the presence of anaerobes. The study suggests that the microaerophile G. vaginalis is a commensal organism in a significant proportion of sexually active women. If the aerobic status of the healthy vagina is disrupted, anaerobes (including Gardnerella) will flourish, producing the clinical picture of bacterial vaginosis.

Prevalence of occult human papillomavirus infection, determined by cytology and DNA hybridization, in heterosexual men attending a genitourinary medicine clinic

One hundred and five heterosexual men without evidence of clinical anogenital warts and attending a genitourinary medicine clinic were studied. Three separate specimens for cytology were taken from (i) the distal urethra including the perimeatal area, (ii) the penile shaft and glans penis including the sub-preputial area, and (iii) from the anorectal area using a proctoscope. Pooled specimens of exfoliated cells from these sites were also taken for the detection of human papillomavirus (HPV) by DNA hybridization. Twenty-eight (27%) of the men had cytological evidence suggestive of HPV infection. HPV genome was detected in 21 (20%) of the men by DNA hybridization and 95% of them were carrying HPV 16 genotype either alone or in combination with other genotypes. A total of 42 (40%) of patients had evidence of occult HPV infection using cytology and/or DNA hybridization techniques collectively. None of the epidemiological risk factors were significantly associated with occult HPV infection in this study. The significance of this high incidence of sexually transmissible HPV genomes, mostly HPV16 in the anogenital area of heterosexual men attending genitourinary medicine clinics requires further study.

Comparison of cotton wool swab and cytobrush for detection of chlamydial infection in women attending a genitourinary medicine clinic

Endocervical specimens obtained by cytobrush and conventional cotton wool swabs from 90 women attending a genitourinary medicine clinic were compared for their efficiency in detecting chlamydial infection. Isolation of Chlamydia trachomatis and detection of the chlamydial lipopolysaccharide antigen were attempted on each specimen. Antigen was detected in 18% of cytobrush and 17% of swab specimens. The cytobrush proved less suitable than swabs for isolation because 8 cytobrush specimens (9%) were toxic to the McCoy cells. Toxicity was significantly associated with an infected endocervix (2P = 0.004). Cytobrush therefore appeared to have little advantage over the much cheaper alternative, the cotton wool swab.