GONORRHEA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Gonorrhea: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83963-8 1. Gonorrhea-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on gonorrhea. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON GONORRHEA............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Gonorrhea...................................................................................... 8 E-Journals: PubMed Central ....................................................................................................... 63 The National Library of Medicine: PubMed ................................................................................ 65 CHAPTER 2. NUTRITION AND GONORRHEA ................................................................................... 85 Overview...................................................................................................................................... 85 Finding Nutrition Studies on Gonorrhea .................................................................................... 85 Federal Resources on Nutrition ................................................................................................... 86 Additional Web Resources ........................................................................................................... 87 CHAPTER 3. ALTERNATIVE MEDICINE AND GONORRHEA ............................................................ 89 Overview...................................................................................................................................... 89 National Center for Complementary and Alternative Medicine.................................................. 89 Additional Web Resources ........................................................................................................... 93 General References ....................................................................................................................... 95 CHAPTER 4. DISSERTATIONS ON GONORRHEA .............................................................................. 97 Overview...................................................................................................................................... 97 Dissertations on Gonorrhea ......................................................................................................... 97 Keeping Current .......................................................................................................................... 98 CHAPTER 5. PATENTS ON GONORRHEA ......................................................................................... 99 Overview...................................................................................................................................... 99 Patents on Gonorrhea .................................................................................................................. 99 Patent Applications on Gonorrhea............................................................................................. 117 Keeping Current ........................................................................................................................ 118 CHAPTER 6. BOOKS ON GONORRHEA ........................................................................................... 119 Overview.................................................................................................................................... 119 Book Summaries: Federal Agencies............................................................................................ 119 Book Summaries: Online Booksellers......................................................................................... 124 The National Library of Medicine Book Index ........................................................................... 125 Chapters on Gonorrhea .............................................................................................................. 127 CHAPTER 7. MULTIMEDIA ON GONORRHEA ................................................................................ 131 Overview.................................................................................................................................... 131 Video Recordings ....................................................................................................................... 131 Audio Recordings....................................................................................................................... 131 Bibliography: Multimedia on Gonorrhea ................................................................................... 132 CHAPTER 8. PERIODICALS AND NEWS ON GONORRHEA ............................................................. 135 Overview.................................................................................................................................... 135 News Services and Press Releases.............................................................................................. 135 Academic Periodicals covering Gonorrhea................................................................................. 138 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 141 Overview.................................................................................................................................... 141 U.S. Pharmacopeia..................................................................................................................... 141 Commercial Databases ............................................................................................................... 143 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 147 Overview.................................................................................................................................... 147 NIH Guidelines.......................................................................................................................... 147 NIH Databases........................................................................................................................... 149 Other Commercial Databases..................................................................................................... 152 APPENDIX B. PATIENT RESOURCES ............................................................................................... 155
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Overview.................................................................................................................................... 155 Patient Guideline Sources.......................................................................................................... 155 Finding Associations.................................................................................................................. 162 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 165 Overview.................................................................................................................................... 165 Preparation................................................................................................................................. 165 Finding a Local Medical Library................................................................................................ 165 Medical Libraries in the U.S. and Canada ................................................................................. 165 ONLINE GLOSSARIES................................................................................................................ 171 Online Dictionary Directories ................................................................................................... 174 GONORRHEA DICTIONARY.................................................................................................... 177 INDEX .............................................................................................................................................. 239
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with gonorrhea is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about gonorrhea, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to gonorrhea, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on gonorrhea. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to gonorrhea, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on gonorrhea. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON GONORRHEA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on gonorrhea.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gonorrhea, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “gonorrhea” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Periurethral Abscess: Complication of UTI Source: Geriatrics. 52(8): 86-88. August 1997. Contact: Available from Avanstar Communications. 131 West First Street, Duluth, MN 55802-2065. (888) 527-7008 or (218) 723-9477. Fax (218) 723-9437. Summary: Periurethral abscess is a rare, life threatening infection of the male urethra and periurethral tissues. Periurethral abscess usually results as a consequence of foreign bodies, urethral stricture disease, or urinary extravasation (urine passage or escape into the tissues). In this article, the authors report the case of an older patient with a chronic Foley catheter who developed periurethral abscess and bacteremia as a complication of urinary tract infection (UTI). The authors also review the literature on the pathogenesis, clinical presentation, diagnosis, and treatment of this disease. When periurethral abscess
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develops, rapid diagnosis, therapy with intravenous antibiotics, and immediate evaluation for the necessity of surgical intervention are essential to decrease morbidity. Risk factors for periurethral abscess include urethral stricture disease, obstruction of the urinary flow, previous periurethral abscess, gonorrhea, recent UTI, diabetes mellitus, trauma (or surgery) involving the urethra, or chronic indwelling Foley catheter. Therapy for periurethral abscess consists of surgical drainage and appropriate antibiotic coverage. Although the overall incidence of periurethral abscesses has been decreasing as a result of improved treatment for UTIs, the increasing prevalence of Foley catheters in older male patients may lead to an escalation in the incidence of the disease. The authors stress that increased vigilance by physicians is needed for patients with chronic Foley catheters who have symptomatic UTIs. 2 tables. 18 references. •
The Urgent Need for a Vaginal Microbicide in the Prevention of HIV Transmission Source: American Journal of Public Health; Vol. 84, No. 6, June 1994. Contact: University of California Berkeley, University Health Services, 2222 Bancroft Way, Berkeley, CA, 94720, (510) 642-2000, http://www.uhs.berkeley.edu. Summary: This article points to the need for methods a woman can use to prevent the transmission of HIV when she cannot compel her partner to use a condom. The author cites a paper on the prevention of cervical gonorrhea with the use of nonoxynol-9 as an example of the work that is being done to address this gap in HIV prevention. The key question in prevention research for women has been: can an acceptable, effective, and potentially cheap microbicidal agent be developed for vaginal use that will kill HIV but not damage the epithelium of the reproductive tract for either partner? The female condom is a welcome choice for women that should slow HIV transmission, but it cannot be used without the man's knowledge. Chemical methods that can be controlled by women are likely to have a powerful effect on the spread of HIV. Although effective microbicides have been demonstrated in vitro, none is currently available or undergoing efficacy testing in humans. The author believes that the Food and Drug Administration (FDA) should accelerate the review process, or, at the very least, allow the labeling of a vaginal microbicide as protection for HIV.
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What Everyone Should Know About STD's Source: Diabetes Self-Management. 17(1): 30, 32-34, 36. January-February 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article provides people who have diabetes with information on sexually transmitted diseases (STDs). People who have diabetes are not believed to be at a higher risk for STDs than the general population. The infectious agents that cause STDs are typically passed from one person to another during sexual contact. Although STDs are most prevalent among adolescents and young adults, they can affect people of all backgrounds and economic levels. Many STDs initially cause no symptoms, so a person who is infected may be able to pass the disease on to a sex partner without realizing he or she is doing so. Therefore, safe sex practices must be used at all times. Some of the most common STDs in North America are gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, genital warts, and molluscum contagiosum. Acquired immune deficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV), is perhaps the most feared STD. Although many people live for some time with the virus, it is ultimately fatal. HIV is carried in body fluid, and the primary mode of transmission is through unprotected sexual contact with someone who has the virus.
Studies
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The article discusses the symptoms, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, genital warts, and molluscum contagiosum. In addition, the article outlines ways people can reduce the risk of developing an STD and identifies sources of information about STDs. •
Oral Manifestations of Selected Sexually Related Conditions Source: Dermatologic Clinics. 14(2): 303-314. April 1996. Summary: This article, from a series on disorders affecting the oral cavity, outlines the oral manifestations of selected sexually related conditions. The authors review the clinical manifestations, diagnosis, and treatment of selected diseases and conditions of sexual origin that may affect the oropharynx. Conditions include fellatio syndrome, traumatic lesions of the lingual frenum, oropharyngeal gonorrhea, oropharyngeal chlamydial infections, oropharyngeal trichomonal infection, condyloma acuminatum, oropharyngeal syphilis, the clinical manifestations of primary syphilis, and intraoral molluscum contagiosum. The authors conclude that considerable recent interest in the incubation period of various infections and improved community surveillance programs combine to ascribe infection to specific incidents. It is prudent for health care personnel to acknowledge the presence of many sexually transmitted diseases in the oropharynx and consider them in the differential diagnosis of many well-established conditions. 13 figures. 70 references. (AA-M).
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Vulvar Squamous Cell Carcinoma Source: Seminars in Dermatology. 15(1):51-59; March 1996. Summary: This journal article for health professionals presents an overview of vulvar squamous cell carcinoma. The epidemiological aspects and risk factors of squamous cell carcinoma of the vulva are examined. Risk factors include a history of human papilloma virus infection and gonorrhea, smoking, vulvar intraepithelial neoplasia, and vulvar dystrophies. The clinical presentation of vulvar cancer is described, including pruritus, the presence of a vulvar mass, local discomfort, discharge and bleeding, and groin mass. Guidelines for pretreatment assessment are provided, and surgical staging for vulvar cancer is explained. Options for treating vulvar carcinoma are presented, including the standard procedure of en bloc dissection of vulva and regional lymph nodes, the less mutilating separate groin incision approach, and radiotherapy. The current approach to managing vulvar cancer patients is discussed in terms of distinctive algorithms for decision making in situations involving early lateralized lesions; early centralized lesions; advanced disease caused by local extension; and advanced disease caused by clinically positive, enlarged, or fixed inguinal nodes. In addition, data on recurrences and survival rates are provided. 103 references, 4 figures, and 2 tables.
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AIDS and Heterosexual Anal Intercourse Source: Archives of Sexual Behavior; Vol. 20, No. 3, 1991. Contact: Mariposa Education and Research Foundation, 3123 Schweitzer Dr, Topanga, CA, 90290, (818) 704-4812. Plenum Publishing Corporation, Plenum Medical Book Company, 233 Spring St, New York, NY, 10013-1578, (888) 640-7378, http://www.wkap.nl. Summary: This paper examines the phenomenon of anal intercourse. Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and
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health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggests that heterosexual anal intercourse is far more common than generally realized, with more than 10 percent of American women and their male sexual partners engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, bolster survey data. Considerably more heterosexuals engage in anal intercourse than do homosexual or bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women that is higher than that for unprotected vaginal intercourse, just as receptive anal intercourse carries a very high risk for men. Infection with HIV is increasingly documented in women engaging in anal coitus with infected males in the United States, Europe, and Latin America. •
Sexually Transmitted Diseases Treatment Guidelines 2002 Source: MMWR Morbidity and Mortality Weekly Report Recommendations and Reports May 10 2002;51(RR-6):1-84. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This report for health professionals provides guidelines and recommendations for the most effective treatment regimens, screening procedures, and prevention strategies for sexually transmitted diseases (STDs), which infect an estimated 15 million people each year in the United States. Some of the significant new recommendations and guidelines include (1) an expanded recommendation for chlamydia screening among women; (2) recommendations for alternative treatments for gonorrhea due to increasing drug resistance in California; (3) recommendations for health care providers to focus on risk assessment and counseling in addition to the clinical aspects of STD control, screening, and treatment; (4) findings from recent studies regarding the use of the spermicide Nonoxynol-9 (N-9); (5) expanded risk assessment and screening among gay and bisexual men; (6) new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); and (7) a revised approach to the management of victims of sexual assault. The report also includes recommendations for screening and/or treatment of the following infections: epididymitis, pelvic inflammatory disease (PID), syphilis, trichomoniasis, human papillomavirus infection (HPV), hepatitis C, bacterial vaginosis, vulvovaginal candidiasis and scabies.
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Introduction to STD Treatment Guidelines Source: The Provider; Vol. 19, No. 2. Contact: US Department of Health and Human Services, Public Health Service, Indian Health Service, Office of Human Resources, Clinical Support Center, 1616 E Indian School Rd, Ste 375, Phoenix, AZ, 85016, (602) 640-2140. Summary: This special issues of a journal lists the criteria for diagnosis of common sexually transmitted diseases (STDs) and discusses management strategies. It provides background information, clinical symptoms, and the latest Centers for Disease Control and Prevention (CDC) treatment recommendations. In addition, management of patients and their sex partners is discussed. When treating the following infections, HIV-positive patients are treated the same as HIV-negative: cervicitis, Urethritis,
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Trichomoniasis, and chlamydia. Other infections require more aggressive therapy for HIV-positive patients, including pelvic inflammatory disease (PID), herpes, and syphilis. Gonorrhea and papillomavirus infections are also examined. •
Prevalence of HIV - Related Risk Behaviors and STDs Among Incarcerated Adolescents Source: Journal of Adolescent Health; Vol. 17, no. 3, Sept. 1995. Contact: Blue Ridge Hospital, Department of Psychiatric Medicine, Division of Mental Health Services Research, Division-Box 16, University of Virginia, Charlottesville, VA, 22901. Summary: This study was designed to determine the HIV-related risk behaviors and sexually transmitted diseases (STDs) in a population of incarcerated adolescents, in order to strategically target education and prevention efforts. The approach was a single point-in-time prevalence study of HIV risk behaviors and STD history, based on an analysis of intake medical records of 1,215 incarcerated youth. The incarcerated adolescents reported high rates of risk behaviors for HIV infection and STDs, with 75 percent reporting three or more sex partners, 25 percent never using condoms, and 19 percent having a current diagnosis of at least one STD. Significantly more females than males reported a history of STDs and had higher rates of current diagnoses of chlamydia/non-gonococcal urethritis, trichomonas, and gonorrhea. Ethnic/racial and gender differences were found in risk behaviors for STDs, with African American males reporting higher numbers of sex partners, higher rates of STDs, and higher rates of condom use.
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Urethritis and Cervicitis Source: Australian Family Physician. 28(4): 333-338. April 1999. Contact: Available from Royal Australian College of General Practitioners. 1 Palmerston Cr, South Melbourne VIC 3205. 0392141414. Fax 0392141400. E-mail:
[email protected]. Summary: With sexually transmitted diseases (STDs) no longer on the decline, it is prudent to assume that all cases of nonspecific urethritis and cervicitis are caused by sexually transmitted infection. Specific infections of the urethra and cervix due to chlamydia and other non gonococcal organisms are common and, because they are often not apparent clinically, are underdiagnosed. This article provides a realistic approach to the management of urethritis and cervicitis by encouraging the performance of investigations and the instigation of treatment at the first consultation. The author stresses that a knowledge of the patient's sexual history combined with a working knowledge of the new DNA based technologies should provide for the early assessment of and intervention with patients who are at risk of at least one STD infection. In women, urethritis and cervicitis are commonly asymptomatic but may present with dysuria (painful urination), discharge, postcoital (after sexual intercourse) bleeding, and intermenstrual bleeding. In men, symptoms are more common and may include dysuria, discharge, and urinary urgency. As up to 10 percent of cases with gonorrhea may be missed if microscopy alone forms the basis of diagnosis, a urethral swab should ideally be cultured for N. gonorrhoeae. Antimicrobial regimens (drug therapy) should cover the potential coexisting infection with chlamydia and other as yet undiagnosed non gonococcal infections. All patients at risk of one STD infection should be considered at risk of other STDs. 1 figure. 3 tables. 6 references.
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Federally Funded Research on Gonorrhea The U.S. Government supports a variety of research studies relating to gonorrhea. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to gonorrhea. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore gonorrhea. The following is typical of the type of information found when searching the CRISP database for gonorrhea: •
Project Title: ADOLESCENTS TRANSMISSION
IN
THE
DRUG
CULTURE
AND
STD
Principal Investigator & Institution: Rothenberg, Richard B.; Professor; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ALCOHOL OUTLETS, BROKEN WINDOWS, GONORRHEA AND HIV RISK Principal Investigator & Institution: Cohen, Deborah; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): The 1992 Civil Unrest in Los Angeles resulted in the burning of more than 600 buildings and the closure of 221 alcohol outlets. These events serve as a natural experiment to test the influence of community institutions, [both alcohol outlets and community-based organizations-(CBOs)] on HIV risk in a longitudinal, ecological study. We propose to use longitudinal data of gonorrhea and HIV rates and neighborhood conditions to determine 1) if gonorrhea rates dropped in local neighborhoods where alcohol outlets were closed, 2) if there is an association between changes in neighborhood deterioration (or reconstruction) and changes in rates of gonorrhea, and 3) if there is an association between changes in alcohol outlets, neighborhood deterioration and changes in AIDS case rates at the census tract level. In addition, we propose to conduct a qualitative study of the efforts both prior to and since 1992 of CBOs to prevent the relicensure of alcohol outlets to assist in the interpretation of our quantitative study. Data on gonorrhea and HIV will be obtained from the LA County Department of Health Services. Addresses of destroyed buildings will be obtained from the Arson Section of the LA Fire Department. We have already obtained
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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addresses of alcohol licenses that were surrendered in 1992, as well as existing alcohol licenses on an annual basis. All data will be geocoded to the level of the census tract and will be merged with data from the 1990 and 2000 US Census. Spatio-temporal modeling will be employed to determine whether changes in the community institutions (alcohol outlets) and neighborhood rehabilitation (or deterioration) are associated with GC and HIV rates, after controlling for a number of variables, including age, gender, race, socioeconomic status and preexisting rates of GC and HIV. The findings will inform future HIV prevention interventions and provide guidance to CBOs as to whether control of alcohol outlets and neighborhood development may enhance the prevention of HIV transmission. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: AN EDUCATIONAL INTERVENTION FOR OLDER CRACK USERS Principal Investigator & Institution: Johnson, Wendell A.; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This proposed planning initiative is designed to: 1) increase our understanding and knowledge of HIV risks factors which are specific to middle-aged and older African American male and female users of crack cocaine, and; 2) demonstrate the effectiveness of an age- specific outreach intervention designed to gain access to target group members, increase AIDS knowledge and health risk (e.g. HIV; STD) awareness, assist clients in assessing individual health risk, and promote drug free living. Utilizing a pre-post test intervention design, we will recruit and collect baseline data on three groups of persons: (1) middle aged and older sexually active men (aged >50) for whom crack cocaine is the primary drug of choice (n=40); (2) middle aged and older sexually active women (aged >50) for whom crack cocaine is the primary drug of choice (n=40), and; (3) sexual partners; individuals who have engaged in a sexual act with members in groups 1 or 2 (n=80). Serologic testing for HIV and syphilis, and urine or vaginal swab for testing gonorrhea and chlamydia will be conducted on all study participants. We will conduct one post intervention assessment (including biologic test) in month 9 with Groups 1 and 2 only. These data will be used to describe and compare demographic, serologic, and HIV risk characteristics of older crack cocaine users and their sexual partners; measure and evaluate intervention impact and exposure. In parallel with these quantitative assessments, the qualitative, ethnographic component will consistent of ongoing direct observation augmented by 2 ethnographic interviews per week during the first year of the study and subsequent diminution to 1 interview per week until the conclusion of the study or until redundancy is reached. The ethnographic interviews will be held with selected study participants, their contacts, and other key informants (e.g. landlords, shopkeepers, persons involved in drugs in these neighborhoods, etc.). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANALYSIS OF M. CATARRHALIS LOS: ROLE IN IMMUNITY Principal Investigator & Institution: Campagnari, Anthony A.; Professor; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 28-FEB-2006 Summary: Moraxella catarrhalis, a human mucosal pathogen, is a prominent cause of otitis media in young children and lower respiratory tract infections in adults with COPD. The significant financial burden on the health care system in this country, has
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Gonorrhea
stimulated research studies aimed at identifying possible vaccine components expressed on the bacterial surface. Recent studies have focused on components of the bacterial outer membrane, as these structures would most likely be available for interaction with the host immune response. However, it is clear that little is known about the virulence factors and the host immune response to M. catarrhalis. One prominent bacterial surface component, implicated as a potential virulence factor, is the lipooligosaccharide (LOS). Structural studies have shown that this major glycolipid is relatively conserved among clinical isolates obtained from adults. There have been three LOS serotypes reported using polyclonal rabbit sera for detection. In addition, a comparison of M. catarrhalis LOS has shown that this structure has oligosaccharide epitopes which share homology with the LOS of 9other important Gram-negative human pathogens, including Neisseria meningitis, Neisseria gonorrhea and Haemophilus influenzae. The LOPS epitopes shared by M. catarrhalis and these other important pathogens have been implicated as potential virulence factors involved in various mechanisms of pathogenesis including adherence and invasion of mucosal cells, serum resistance and resistance to opsonophagocytosis. In addition, recent studies have shown that antibodies to M. catarrhalis LOS elicit bactericidal activity, suggesting that this molecule may be an important component of a multifactorial vaccine. Despite these data, there is very little known about the role of M. catarrhalis LOS in colonization of infection, and there are no studies reported which characterize the genes and gene products of this important bacterial component. In this proposal, we will clone and sequence genes involved in the biosynthesis and assembly of LOS and we will construct specific isogenic mutants in these genes. These LOS mutants will be evaluated in various biologic assays to begin to understand the role of this molecule in pathogenesis. Also, we will perform a detailed analysis of the human antibody response to LOS in both children and adults which will provide insight into the host-pathogen relationship. The data obtained from these studies will provide critical information to our understanding of the steps involved in the pathogenesis of M. catarrhalis infections which will lead to new insight into strategies designed to prevent disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ASSEMBLY AND STRUCTURE OF TYPE IV PILI Principal Investigator & Institution: Tainer, John A.; Professor; Scripps Research Institute Tpc7 La Jolla, Ca 92037 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 31-JAN-2005 Summary: This renewal aims to characterize structure-function relationships for type IV pili fibers, which key virulence factors for pathogenic Gram-negative bacteria. Structural analyses for type IV pilin subunits will be integrated with electron microscopy (EM), fiber diffraction, and small angle x-ray scattering (SAXS) structures of native fibers via objective Fourier correlation methods. These proposed studies, which span atomic to subcellular resolutions, will focus upon type IV pili from Neisseria gonorrhoeae, the causative agent of gonorrhea. Successful methods and results on gonococcal pili will allow complementary structural and mutational studies on pili from Pseudomonas aeruginosa, the causative agent on deadly opportunistic nosocomial infections, and Vibrio cholerae, the causative agent of cholera, to define conserved and variable aspects of type IV pili. Key questions concerning pilus structure-function relationships will be addressed including whether the N. gonorrhoeae pilin fold is representative of all type IV pilins, how extreme antigenic variation avoids disrupting the pilin fold and fiber assembly, the nature and significance of post-translational modifications, structural changes associated with fiber formation, species-specific conservation of surface regions
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acting in target cell recognition and accessory protein binding, the structural chemistry controlling bundling, structural characteristics of immunodominant regions, and optimal approaches to the design of cross- species vaccines. Structural results and hypotheses will be experimentally tested by quantitative correlations among diffraction and electron microscopy results and by mutational analyses. The proposed integrated multi-disciplinary studies provide innovation in determining challenging fiber-forming protein structures and in bridging the huge resolution gap between protein crystal structures and EM image reconstructions of subcellular organelles. Overall, these structural and mutational results will promote integration of ongoing biochemical, immunobiological, genetic, and functional studies to decipher the structural chemistry governing pilus actions in pathogenicity: host cell surface attachment, twitching motility, bacteriophage absorption, modulation of transformation efficiency and toleration of extreme sequence variability while retaining structural integrity and flexibility. This understanding of pilus structure-function relationships has long-term potential applications for drug and vaccine design against major bacterial diseases now showing increasing antibiotic resistance and threats to public health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BLOCKING INFECTIOUS ENTRY OF STD PATHOGENS Principal Investigator & Institution: Cone, Richard A.; Professor; Biophysics & Biophysical Chem; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: This Program Project will study entry paths used by STD pathogens, develop and test human monoclonal antibodies as microbicides for blocking pathogen entry, and characterize how antibodies are deployed and function in preventing infectious entry of pathogens in the female reproductive tract. Project 1. Mucosal entry paths used by STD pathogens will investigate entry paths that topical microbicides must blocks: (a) Cell vectors, such as HIV-infected leukocytes, may penetrate genital epithelial and carry HIV directly to target cells in the lymph nodes. (b) Microtrauma that occurs during consensual intercourse, increasing the risk that pathogens will contact target cells. (c) Upper tract exposure. Uterine peristalis causes uptake of vaginal fluids that may expose the upper reproductive tract to STD pathogens. Project 2. Blocking STD pathogen entry with mucosal antibodies will develop monoclonal human antibodies as highly potent and specific microbicides. Pharmacokinetics of a "plantibody" against HSV-2 (a human monoclonal produced in corn for large scale, inexpensive production) will be determined in mouse and rabbit vaginas. New human monoclonals will be developed against HPV, and against leukocyte cell vectors for HIV. Protective efficacy will be tested in vitro and in SCID mouse models. Using mouse monoclonals to identify adhesins and host receptors, human monoclonals against chlamydia and gonorrhea will be generated and tested in mice. Monoclonals will also be tested for their ability to markedly reduce a commensal bacterium in the mouse vagina. Project 3. Uptake of Ig by vaginal epithelial cells will investigate how cervico-vaginal epithelial cells (in tissue culture and in vivo_ deploy Ig in the vaginal epithelium, and the effects of physiological modulators (hormones, cytokines) on Ig uptake, storage and release. Human monoclonals identified in Project 2 will be applied to explants of human genital tissues and immortalized epithelial cell lines, to determine whether monoclonals that have been taken up by epithelial cells are effective for blocking HIV, HSV-2, and chlamydia infections, and for blocking adhesions and transepithelial migration of leukocytes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Gonorrhea
•
Project Title: CLINICAL EPIDEMIOLOGY OF MYCOPLASMA GENITALIUM Principal Investigator & Institution: Totten, Patricia A.; Professor; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2007 Summary: Large proportions of the major reproductive tract inflammatory syndromes remain idiopathic, not attributable to the major sexually transmitted pathogens such as Chlamydia trachomatis or Neisseria gonorrhoeae. Where effective STD control programs exist, most urethritis in men and endocervicitis or mucopurulent cervicitis (MPC) in women is no longer attributable to gonococcal or chlamydial infection. This is equally true for most upper genital tract complications of urethritis (epididymitis) or endocervicitis (endometritis, salpingitis and perinatal and puerperal morbidity). Mycoplasma genitalium, a fastidious bacterium discovered in 1981, now detectable by PCR, has been significantly associated with nongonococcal urethritis (NGU) in men in 11 of 11 studies over the past decade using PCR, including our own recent study which demonstrated M. genitalium in 27 (22%) of 211 men with and 5 (4%) of 117 without NGU (OR 6.5; 95% CI 2.1- 19.9). Recognition of M. genitalium as a pathogen in the male raises the important question of its role as a pathogen in the female, both in nonpregnant and in pregnant women. Since initial submission of this proposal in February 2000, we have completed two retrospective cross- sectional studies involving women. In a random sample of female STD clinic patients, we demonstrated endocervical M. genitalium infection in 24 (13%) of 191 with MPC vs. 27 (6%) of 453 without MPC (OR adjusted for cervical pathogens 3.0; 95% CI 1.6-5.8). This study also detected M. genitalium in 10 (14.3%) of 70 women with history of spontaneous miscarriage at < 20 weeks gestation vs. 41 (7.2%) of 570 without this history (adj OR=2.5; 95% CI 1.1-5.6). A cross-sectional study of 115 Kenyan women with suspected PID demonstrated M. genitalium in endometrial biopsies from 7 (12%) of 58 women with endometritis vs. 0 of 57 without endometritis (p=0.01). In our studies of male urethritis, MPC, and endometritis, associations of M. genitalium with disease were similar to, or stronger than, the associations with chlamydial infection. These data support our proposed studies as the next logical step in clinical epidemiologic studies of this pathogen. Our three specific aims are to (1) define the role of M. genitalium in acute salpingitis in women undergoing laparoscopy in Nairobi Kenya; (2) define the association of M. genitalium with abnormal pregnancy outcomes including preterm delivery of a low birthweight infant, using data and clinical specimens already available from 2500 women prospectively followed to term at University of Washington hospitals (including 625 with gestation <37 weeks); and (3) determine (a) risk factors for M. genitalium infection in a population-based sample of young women participating in Wave 3 of the National Longitudinal Study of Adolescent Health, and in a sample of higher risk women attending the Seattle STD clinic, and (b) concordance of M. genitalium infection in these women and their sex partners. M genitalium may represent an important new pathogen in the female reproductive tract. Studies of its association with salpingitis and pregnancy morbidity are essential. Future studies should also address whether, similar to gonorrhea and chlamydial infection, it facilitates transmission of HIV infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CONTINUATION OF CHINESE HEALTH AND FAMILY BEHAVIOR Principal Investigator & Institution: Parish, William L.; Director; National Opinion Research Center 1155 E 60Th St Chicago, Il 60637 Timing: Fiscal Year 2003; Project Start 15-JAN-1998; Project End 30-APR-2005
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Summary: (provided by applicant): This study examines the correlates of sexual behavior and sexually transmitted diseases, employing three new data sets from China. (1) Population-based sample. With oversampling of cities and coastal areas that have more varied sexual behavior and greater risks for sexually transmitted diseases (STDs), this nationally representative sample provides data on 3,825 adults age 20-64. This sample allows comparisons to other countries, and of major regional, cohort, and other differences in sexual behavior and disease patterns. (2) Clinic sample. This parallel set of interviews of 845 patients from 16 clinics in 5 cities provides larger sample sizes for the analysis of STDs. Besides being analyzed in its own right, when used with comparable observations from the population sample, the clinic sample makes possible a form of case-control analysis to help delve further into risky sexual behaviors and sexually transmitted diseases. (3) Biomarkers. Based on 4,277 urine specimens from the population and clinic samples, these data provide information on current infections for chlamydia, gonorrhea, and trichomonas. With use of the latest lab techniques, these biomarker data provide both an additional check on the validity of the survey data and material for identifying major risk groups in transitional societies. This proposal is for an additional two years of time for the analysis of these data sets, and for producing a public-use data set that includes direct linkages to comparable U.S. data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONTROL OF TRICHOMONIASIS -A PARADIGM FOR STD CONTROL Principal Investigator & Institution: Schwebke, Jane R.; Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-APR-2007 Summary: (provided by applicant): Trichomonas vaginalis is a protozoan sexually transmitted disease (STD), which causes vaginitis and urethritis. Complications associated with this infection include preterm birth and HIV acquisition. Despite the availability of generally effective single dose, affordable antibiotic therapy, this infection remains extremely prevalent worldwide. At a time when bacterial STDs such as gonorrhea and chlamydia have decreased, rates of trichomoniasis have remained constant. Contributors to this continued infection rate may include less sensitive diagnostic tests, especially in males, lack of systematic partner notification and treatment methods, and possibly, decreased susceptibility to metronidazole. In fact, the most effective means of partner notification for STDs in general has not been well studied. We propose to investigate three different methods of partner notification for trichomoniasis via a randomized study design (including partner referral, partner delivered medication and medication delivered by a field worker), determining relative effectiveness rates based on recurrent infection in the female. The role of stigma as a barrier to partner notification and treatment will also be evaluated. The information gained from this study will have broad applicability for control of other STDs such as gonorrhea and chlamydia. In addition, we will utilize specimens from the study to improve diagnostic methods for T. vaginalis, to examine strain differences using PFGE, and to examine the prevalence of resistance strains and their potential contribution to treatment failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--HUMAN CHALLENGE FACILITY Principal Investigator & Institution: Cohen, Myron S.; Professor of Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599
14
Gonorrhea
Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2002 Summary: The Human Challenge Core is available to assess the infectiousness of Neisseria gonorrhoeae isogenic mutants developed in this application, or mutants generated by investigators at other CRCs. Specifically, we will examine the requirements for heme and hemoglobin receptors, and requirement for opa proteins. In addition, the Core will test gonococcal isolates that have already been developed as part of the CRC Program. Specifically, mutants less likely to resist the microbicidal action of the neutrophil inflammatory response have been generated. The Core can also support vaccine research, if a vaccine with adequate immunogenicity is developed. Core facilities include the Microbiology laboratory in the Division of Infectious Disease, and the patient care areas of the General research Center. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CR3 GONORRHEA
IN
CELL
ACTIVATION
AND
PHAGOCYTOSIS
OF
Principal Investigator & Institution: Ingalls, Robin R.; Assistant Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 01-AUG-1997; Project End 31-JUL-2002 Summary: Neisseria gonorrhoeae (GC) is one of the most common sexually transmitted pathogens in the United States, Infection with GC usually remains localized to the lower genital tract, although certain strains are capable of dissemination. During infection of the urogenital tract with GC, bacteria encounter macrophages in the endometrium and other tissues. Here, surface antigens on the gonococcus trigger the local and systemic humoral immune response that results in the release of cytokines, prostaglandin, and other inflammatory mediators. Although previous efforts have focused on defining immunologic responses to protein antigens, studies would suggest that when phagocytes encounter Gram- negative bacteria, the subsequent cytokine response is due to the interactions of bacterial lipopolysaccharides (LPS) with macrophage receptors. In addition, the activation and fixation of complement by GC plays a major role in bacterial interactions with both professional and non-professional phagocytes. The goal of this proposal is to analyze the nature of the interaction between GC and the mammalian receptors likely to be activated in response to bacterial invasion. Efforts to characterize mammalian receptors for GC will focus on the leukocyte CD11/CD18 integrins. This family of adhesion receptors includes CD11b/CD18 (CR3) and CD11c/CD18 (CR4) which are phagocytic receptors for iC3b and opsonized bacteria, as well as signaling receptors for LPS. The focus of this proposal is to identify the molecular mechanisms involved in phagocytosis and LPS signal transduction using CR3- and CR4-transfected fibroblast cell lines. Because native phagocytes express multiple binding proteins on their surface, they have not been a useful tool for the study of a single receptor class. Furthermore, unlike monocytic lines, transfected fibroblast lines can be genetically manipulated in order to identify genes involved in phagocytosis and LPS signaling. Four Specific Aim are proposed. First, we will define the individual roles of the complement receptors CR3 and CR4 in phagocytosis and cell activation by GC and gonococcal LOS. The role of the complement receptors will be compared to that of CD14, a well- characterized LPS receptor on macrophages. Second, using differential display we will identify and characterize phagocytosis inducible genes from established wild type (phagocytosing) and cytoplasmic deletion mutant (non-phagocytosing) CR3transfected CHO line. Finally, we will use somatic cell mutagenesis techniques to generate phagocytosis mutants in the CR3- transfected CHO line. Complementation
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analysis can then be used to identify genes essential for phagocytosis in human monocytes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEVELOPMENT OF A URINE PCR ASSAY FOR HPV DNA DETECTION Principal Investigator & Institution: Hagensee, Michael E.; Associate Professor of Clinical Medicine; Medicine; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 05-APR-2000; Project End 31-MAR-2002 Summary: Human papillomavirus (HPV) is the most common virally sexually transmitted disease, and high-risk types of HPV have been implicated in over 90% of cervical cancers worldwide. Current preventative me measures of cervical cancer include routine Pap smear evaluation, which appears to be effective. Current preventative measures for cervical cancer include routine Pap smear evaluation, which appear to be effective. However, a small but significant proportion (>10%) of females in the United States have either never had a Pap smear or (>30%) do not have them on a routine basis. This may be due, in part, to the invasiveness and discomfort of the requirement pelvic examination. Although HPV cannot be routinely grown in the laboratory, its DNA can be deleted by amplification techniques such as PCR. Detection of HPV DNA from cervical swab or cervical lavage specimens has been used as an epidemiological tool to determine the prevalence rates of HPV infection. These procedures also require a pelvic examination that limits its widespread applicability. A method that is equally sensitive and efficient but does not require a pelvic examination to detect HPV infection will be able to identify more women at risk for cervical cancer and greatly aid in epidemiologic surveys. The recent advances in the diagnosis of gonorrhea and chlamydia infection by screening urine using amplification techniques demonstrate the feasibility of diagnosis a cervical infection by a urine test. Preliminary date have demonstrated the ability to detect HPV DNA in urine specimens from women at high risk for HPV infection. For these reasons, we hypothesize that a urine PCR test for the detection of HPV DNA will reflect the state of infection for the cervic. The goal of this proposal is to fully develop and validate a urine PCR test for HPV DNA detection that can be utilized for epidemiologic screening purposes. We propose to initially develop the urine PCR assay for HPV DNA detection by studying 20 women with no detectable HPV DNA in their urine. The ability to detect beta-globin DNA (internal control for the presence of cells) and known amounts of clon4ed HPV DNA spiked into these urine specimens will be measured and optimized. Next, urine will be obtained from 50 women previously tested to have HPV DNA detected in cervical/vaginal swabs. The extraction method by the initial experiments will be verified by testing these known HPV positive "field" specimens. Finally, utilizing the conditions optimized in specific aims #1 and verified in specific aim #2, a cohort of 250 women at high-risk and 250 women at low-risk for HPV infection will be enrolled. Paired urine and cervicovaginal swabs will be obtained and the ability to detect any HPV DNA, any high-risk HPV DNA and type-specific HPV DNA will be compared. A validated urine test for HPV DNA detection could be used to better define the epidemiology of HPV, to explore the natural history of HPV infection, and to identify women at higher risk for cervical cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Gonorrhea
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Project Title: DOUCHING AND REPRODUCTIVE TRACT INFECTIONS Principal Investigator & Institution: Funkhouser, Ellen M.; Epidemiology & Interntl Health; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Douching is a common practice among American women, especially in the South, among Black women, and among women who are less educated. Douching has been associated with many adverse health events including pelvic inflammatory disease and ectopic pregnancy, and to a much less well established degree, sexually transmitted diseases (STDs). The proposed project is a cross-sectional study of reproductive tract infections and douching practices in Jefferson County, AL. Women attending the County STD clinic and 2 County Family Planning Clinics will be interviewed prior to examination regarding douching practices and history of sexual activities, pregnancies, contraceptive practices, and STDs. Presence of infections and pH of vaginal secretions will be ascertained from appropriate tests. Cases will be women presenting with syphilis, gonorrhea, trichomonas, chlamydia , or bacterial vaginosis. Over a 29 month period 4,370 women, 1,400 from the STD clinic and 2,970 from the Family Planning Clinics, will be interviewed. This should provide about 935 STD cases, 577 cases of bacterial vaginosis without an STD, and 2,858 women with no infections. Douching practices among women with and without a reproductive tract infections will be compared. Logistic regression analysis will be used to assess the following: 1) whether douching is associated with increased risks of STDs or bacterial vaginosis; 2) whether douching is associated with vaginal pH; 3) whether there is a dose-response relationship regarding frequency of douching; and 4) whether the risk differs according to preparation used. We believe the similarities in socioeconomic status of women attending the clinics will be substantial making douching practices potentially one of the most distinguishing characteristics of women with and without an infection. Furthermore, the findings will be readily generalizable to a population that historically and currently has some of the highest STD rates in the nation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DOUCHING, VAGINAL MICROBIOLOGY, AND PID Principal Investigator & Institution: Ness, Roberta B.; Professor and Chair; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2003 Summary: Pelvic inflammatory disease is a major or cause of reproductive morbidity worldwide. Its sequelae include tubal infertility, chronic pelvic pain, recurrent PID and ectopic pregnancy. Douching is a common and possibly modifiable potential risk factor for PID, but a handful of previous studies examining this association are retrospective and conflicting. At the same time, compelling data suggest that douching may alter the vaginal microenvironment, thereby predisposing to bacterial vaginosis and perhaps, resultant PID, but this has not been fully tested. We propose to conduct a large, multicenter, prospective cohort study to examine the independent association between douching and PID and to study the effect of douching on vaginal microbiology. We will enroll 1800 women at high risk for acquiring sexually transmitted infections. Half will be women who report douching consistently at least once per month over the past six months; half will be women who report never douching in the past six months. Enrolled women will be evaluated at baseline by interview for behavioral characteristics related to douching and STD risk and by lower genital tract microbiology for N. gonorrhoea, C.
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trachomatis, bacterial vaginosis, and concentrations of lactobacillus, anaerobes and facultative bacteria. During 3-4.5 years of follow-up, serial interviews will be completed and self-obtained vaginal swabs assessed for lactobacilli and other vaginal bacteria. The primary outcome of PID (symptomatic endometritis), will be compared between the douching and non-douching groups. We will also compare the following: 1) gonococcal or chlamydial cervicitis at baseline, 2) bacterial vaginosis and semi-quantitative lactobacilli concentration at baseline, 3) change during follow-up in the concentration of lactobacilli (hydrogen-peroxide producing and non-producing), as well as anaerobic and facultative bacteria. Given the paucity of information regarding the relationship between douching and reproductive outcomes, the proposed study is imperative in order to direct future public health recommendations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DRUG COUNSELING
ABUSE,
DEPRESSION
AND
RESPONSES
TO
HIV
Principal Investigator & Institution: Marmor, Michael; Environmental Medicine; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005 Summary: (provided by applicant) The long-term objective of this research is to reduce the incidence of infection with human immunodeficiency virus type 1 (HIV) in industrialized countries by developing methods to identify and treat high-risk individuals whose response to HIV testing and counseling is hindered by psychopathology. The project's specific aims are (1) to describe the distribution of psychopathologies among persons undergoing HIV testing and counseling, and (2) to test the hypotheses that high-risk, HIV-seronegative persons with mild-to-moderate depression will be more likely to adopt protective behavior changes when provided with pharmacotherapy for their depression than when treated with placebo. The study design to achieve specific aim 2 will be a randomized, double-blinded clinical trial of bupropion hydrochloride versus placebo administered for a total of 7 months. The study population will be initially high-risk, HIV-seronegative men who have sex with men (MSM). Individuals who are ineligible or decline entry into the clinical trial will be entered into an observational study. The primary outcome measure of the clinical trial will be self-reported numbers of partners in unprotected receptive anal intercourse. Secondary outcomes will be substances used and frequency of substance use by selfreport and toxicology; (c) new infections with sexually transmitted infections including gonorrhea, syphilis, Kaposi's sarcoma-associated herpesvirus, and hepatitis C virus (HCV) and HIV; and (d) measures of psychological factors that have been shown to be, or are thought to be, associated with HIV incidence rates, including measures of selfefficacy, self-esteem, stage of change, and depression. Enrollment data from the observational study will be combined with enrollment data from the clinical trial to provide a description of the distribution of psychopathologies and substance abuse among high-risk MSM. Longitudinal data form the observational study will be used to assess the associations of psychopathologies, substances used and frequency of substance use with adverse outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECOLOGICAL RISK FOR STDS IN ADOLESCENTS AND YOUNG ADULTS Principal Investigator & Institution: Ellen, Jonathan M.; Associate Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218
18
Gonorrhea
Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): Public health surveillance programs often compare the geographic clustering of sexually transmitted diseases (STDs) with demographic and social features of neighborhoods to determine STD risk factors. The findings shape STD prevention and control strategies. Our research suggests that these strategies are important but may have limited success because they infer individual-level risk factors for STDs from associations between residential neighborhood demographics and rates of disease. Many adolescents and young adults who should be at high risk for STDs on the basis of the demographic composition and social ecology of their residential neighborhood are not infected, while other individuals who should be at low risk for STDs on the basis of the demographic composition and social ecology of their residential neighborhood, are infected. A goal of the proposed study is to address shortcomings of past ecologic research. The specific aims are: (1) to determine whether sex partner selection patterns, within and between neighborhoods, are associated with adolescents' and young adults' risk for STDs in Baltimore and whether these patterns change over time; (2) to determine whether the collective efficacy and social capital of neighborhoods are associated with the prevalence of disease in part due to the availability of high STD risk sex partners; and (3) to determine whether age differences in normative social behavior account for the extent to which individuals do or do not have sex with someone who engages in similar risk behaviors (assortative and disassortative sexual mixing, respectively). The proposed study will conduct interviews and collect urine specimens for gonorrhea and chlamydia infection testing among a household sample of 960 sexually experienced adolescents and young adults residing in core (high STD prevalence) and non-core (low STD prevalence) census block groups within Baltimore City. Interviews will be conducted in the respondent's household at baseline and one year later using audio computer-assisted self-interviewing. Urine specimens will be tested using ligase chain reaction. We will also interview locatable sex partners. In addition, we will conduct a qualitative sub-study, which will provide formative data for survey development and explanatory data to supplement survey findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECONOMIC IMPACT OF HIV PREVENTION ON STDS Principal Investigator & Institution: Johnson-Masotti, Ana P.; Assistant Professor; Psychiatry and Behavioral Med; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: Sexual risk reduction interventions to prevent the transmission of HIV also have beneficial effects on other social health concerns, such as non-HIV STDS and unintended pregnancy. Most prior studies of the cost-effectiveness of HIV prevention interventions focus only on the impact of the intervention on HIV outcomes. Studies that neglect the impact of these interventions on other STDs and unintended pregnancies may underestimate the economic benefits of sexual behavior change. Furthermore, little is known regarding the cost-effectiveness of HIV prevention interventions viewed as STD (or unintended pregnancy) prevention programs. This application seeks funding to conduct a cost-effectiveness analysis of a community-level sexual behavior risk reduction intervention that was implemented at multiple locations in the U.S. The intervention targets low-income, predominantly African- American adolescents living in urban housing developments. This analysis will allow us to: 1) estimate the number of HIV and STD infections and the number of unintended pregnancies prevented by the intervention, as well as associated savings in medical care
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costs and lost economic productivity; 2) evaluate the cost-effectiveness of the intervention with regard to HIV (measured by the cost per HIV case averted), STDs (measured by the cost per chlamydia, gonorrhea, syphilis, HPV, or HBV case averted), and unintended pregnancies (measured by the cost per unintended pregnancy prevented); 3) compare the cost-effectiveness of this intervention with other HIV, STD, and unintended pregnancy prevention interventions; and 4) determine how much difference the addition of non-HIV STDs and unintended pregnancy outcomes make to the estimated HIV prevention cost-effectiveness of the intervention. The proposed, more inclusive, approach to estimating the cost-effectiveness of HIV prevention should produce more accurate estimate for use in policy analyses and resource allocation decision-making. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECTOPY, HORMONAL CONTRACEPTION AND STD'S IN ADOLESCENTS Principal Investigator & Institution: Peralta, Ligia; Director of Adolescent Medicine; Pediatrics; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 20-SEP-2000; Project End 30-JUN-2005 Summary: Adolescents are at high risk for sexually transmitted diseases (STDs), which can have serious consequences for their future health and fertility, and which can increase their vulnerability to HIV infection. Cervical ectopy and use of oral contraceptives (OC), both common in adolescence, are risk factors for chlamydia, the most common inflammatory STD. Standardized, reliable measurements of ectopy have not been employed across studies. The independent risk of OC use stratified by ectopy has not been well studied. The association among Depot Medroxy Progesterone Acetate (DMPA), a contraceptive widely used among adolescents, ectopy and STD acquisition has not been reported. The aims of this proposal are to study prospectively: 1) the natural history of cervical ectopy and the transformation zone (T zone) in sexually active adolescents, 2) the impact of DMPA and a combined estrogen-progestins (OC) over time on cervical ectopy/T zone; 3) the relation between the size of the area of ectopy/T zone and STD acquisition, including chlamydia, gonorrhea, trichomonas and HPV; and 4) the risk of STDs in OC users compared to DMPA users stratified by the extent of cervical ectopy/T zone. Design: This is a 5 year prospective study on 500 inner-city sexually active nonparous females aged 12-18, some of whom will initiate DMPA or OC. They will be recruited consecutively from the Adolescent, Pediatric and community-based OB/Gyn Clinics of the University of Maryland, Baltimore, where the study will be conducted. Participants will be seen every 6 months for medical/sexual history, complete physical and pelvic examinations, and specimen collection of STDs. Cervicography will be used to determine the areas of ectopy and T zone, measured by computerized planimetry. This is an innovative reliable, sensitive and standardized method of measurement. Behavioral data will be collected anonymously by audio assisted computer interview (A-CASI). Interim follow up visits (every 3 months) will include behavioral risk by ACASI, medical history and incidence of STDs by urine screening and from the City STD registry. Summary. This proposal will 1) use a standardized measure of ectopy in young nonparous adolescents before and during hormonal contraceptive use; 2) address the relation between STDs and OCs, especially those OCs containing new progestins; 3) be one of the few studies to examine the association among DMPA, STDs and ectopy in adolescents; 4) recruit a difficult cohort with one of the highest rates of STDs, especially chlamydia infection. The team of researchers has expertise on STDs, adolescent health, and cervical anatomy. They have
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Gonorrhea
collaborated on the preliminary study and have experience in planning, implementing and managing successful longitudinal studies on high-risk youth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EMPOWERING WOMEN DRUG USERS TO REDUCE HIV RISK Principal Investigator & Institution: Gollub, Erica L.; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 20-JUN-2001; Project End 31-MAY-2004 Summary: (provided by applicant): Despite more than 15 years of behavioral intervention research seeking to reduce HIV risk behaviors among drug-using persons, drug-using women, across drug categories, remain at very high risk of HIV infection through unsafe sex. Available epidemiological data suggest that women drug users are at the highest risk of HIV infection relative to other risk groups in the US. State-of-theart HIV counseling and testing (CT) prevention approaches are insufficient to address women's risk. The proposed project uses a woman-specific prevention approach, already tested for feasibility and short-term behavior change on diverse cultural groups. The intervention (BESTBET) seeks to respond to the public health emergency among drug-using women by addressing the concrete realities of economic and emotional dependence on an often-risky sex partner, which provide the foundation of women's HIV risk. Based on Body Empowerment Theory, the proposed intervention provides interactive, skills-based learning, and offers a range of new protection technologies to women, including the female condom. Guided by an Advisory Board of national experts on drug-using women, and sexual behavior, the study seeks to empower women by creating a sense of control over one's body and health, increased community and peer support for new norms, and greater usage of healthful community resources (drug -related, medical, social). Group intervention sessions lead by trained "near-peer" counselors will focus on risk-reduction for sexual and drug-related HIV risk, and on combined drug-sex risk behavior. This 3-year, randomized controlled trial will recruit 240 out-of-treatment drug-using women in West Philadelphia. Both arms will first receive an enhanced HIV CT module composed of 2 short individualized counseling sessions. The study will test the effects of adding a multiple-group session model administered over 5 weeks, with 2 boosters, in the form of 'reunion sessions," against a control condition receiving only the CT module. Follow-up assessments for behavioral outcomes (via audio-assisted computer interview) and biological/serological outcomes (incidence of gonorrhea, Chlamydia and Trichomonas, HIV and syphilis) will occur at 6month intervals over 12 months. Treatment of incident infections will provide for valid measures of STD incidence. A strong relationship with community organizations will be sought, including: community input into the study throughout, training of community group leaders in study techniques and technologies, the distribution of women's "sexual risk reduction kits," and adoption of study activities by community groups by the time of study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENDOMETRIAL INFECTION BY NEISSERIA GONORRHOEAE Principal Investigator & Institution: Timmerman, Michelle M.; Microbiology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 31-OCT-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The pathogenesis of gonococcal infection of human endometrium is relatively undescribed even though the endometrium is a site of
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bacterial persistence. Endometrial infection can progress to pelvic inflammatory disease. The human and bacterial factors involved in initial interactions are uncertain. Whether gonococci invade, traverse, or merely attach to endometrial cells is unknown. The types of endometrial cells infected have not been delineated. In this proposal, I plan to elucidate the nature of the molecular interactions between the gonococcus and human endometrial epithelia. Based on my preliminary studies, I hypothesize that gonococci are internalized by both receptor-mediated endocytosis and macropinocytosis. In order to resolve this hypothesis I propose the following specific aims: 1. Development of a primary human endometrial epithelial cell culture system. 2. Characterization of initial interactions between N. gonorrhoeae and primary endometrial epithelial cells. 3. Characterization of the endometrial receptor(s) for N. ganorrhoeae and the gonococcal ligand for these receptor(s). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EPIDEMIOLOGY Principal Investigator & Institution: Zheng, Xiwen; Natl Ctr for Aids Prevention and Control Prevention and Control (Ncaids) Beijing, Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2006 Summary: The purpose of the Epidemiology Project (Project 1) is to establish HIV incidence and risk factors for HIV infection in three regions of China in order to establish a foundation for conducting clinical trials of HIV prevention and therapeutic interventions. The three specific aims of Project 1 are: Aim 1: To estimate the prevalence and incidence of HIV-1 infection and selected sexually transmitted diseases over time in: a) former plasma donors (FPDs), their stable sexual partners, and their children in rural areas of Shanxi province; b) injection drug users (IDUs) and their stable sexual partners in rural areas of Yunnan Province; and c) female sex workers (FSWs) in Kunming, Yunnan Province; Aim 2: To determine risk factors for HIV infection in the above population, and to recruit participants from these populations for participation in cohort studies in preparation for vaccine, behavioral and therapeutic intervention studies; and Aim 3: TO estimate the prevalence and incidence of HIV-1 infection, HHV8 infection and co-infection with HIV-1 and HHV8 in high risk minority population in Xinjiang Province, and to determine factors that are independently associated with co- infection with HIV-1 and HHV8. Strategies for recruitment and retention of study subjects will vary by study populations. About 1680 FPDs and 900 spouses will be recruited from 12 villages in Shanxi. About 600 HIV-FPDs or HIV-spouses will be followed in year 3 and 5. About 960 IDUs and 400 spouses will be recruited from 48 villages in Yunnan. About 504 HIV-IDUs and some 250 HIV-spouse will be followed at 6, 12, 18, 24 and 30 months after baseline. About 1000 FSWs will be recruited in hotels, entertainment establishments, and in the streets of Kunming City, Yunnan. FSWs will e followed for 2 years with 3 months interval contract and 6-month interval for assessment. About 250 subjects each will be recruited from Kelkez, Kazak, Ughur and Han ethnic groups and followed annually in Urumi, Xinjiang Four biologic indicators (HIV, gonorrhea, chlamydia, and syphilis) will be used cross all 4 study populations. HHV8 will be additionally used in study of minorities in Xinjiang. Our FPD and IDU studies will provide a subject of subjects (HIV positive) for the behavioral intervention study planned in Project 2. In collaboration with Project 4, we will seek to provide clinical care for HIV infected persons identified over the course of recruitment. We will provide clinical specimens for key research initiatives described in Projects 3 and 4. Planning for field trials or candidate HIV vaccines will link Projects 1 and 5. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FUNCTION OF GONOCOCCAL ANAEROBICALLY INDUCED PROTEINS Principal Investigator & Institution: Clark, Virginia L.; Associate Professor; Microbiology and Immunology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-FEB-1977; Project End 28-FEB-2008 Summary: (provided by applicant): Neisseria gonorrhoeae is the etiologic agent of gonorrhea, one of the most prevalent infectious diseases in the U.S. Complications of gonorrhea include pelvic inflammatory disease (PID), the leading cause of sterility in females in this country. Despite the ability to effectively treat gonorrhea with antibiotics, the incidence of this disease remains high, suggesting that the most likely means of controlling the epidemic in the U.S. will be by vaccination. Elimination of gonorrhea will require an understanding of the host immune response to and pathogenesis of N. gonorrhoeae. One of the central themes of microbial pathogenesis is that the pathogen may express virulence determinants in vivo that are not expressed in vitro. We have been investigating the regulation of gonococcal gene expression by anaerobiosis, an environmental condition that this pathogen is likely to encounter in vivo in females. We have identified two anaerobically induced genes, ani A and norB, that are induced anaerobically and encode nitrite reductase and nitric oxide reductase, respectively. Both of these proteins are required for anaerobic growth and their presence means that gonococci can both produce and degrade nitric oxide (NO), an important modulator of the host innate immune response. We propose 1) to perform genetic and biochemical analyses of anaerobically regulated genes; 2) to determine the role of anaerobically induced and repressed genes in gonococcal invasion via the lutropin receptor; 3) to determine steady state NO concentrations during gonococcal denitrification and the effect of environmental parameters; and 4) to determine if gonococcal production/degradation of NO and/or steady-state NO levels down regulate cytokine expression and activation of soluble guanylyl cyclase. The successful completion of these aims should provide important new information on the function of the denitrification pathway and its role in pathogenesis. In addition, significant new insights into the mechanism of gonococcal suppression of the innate immune response may be attained. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETIC DETERMINANTS FOR GONOCOCCAL TRANSCYTOSIS Principal Investigator & Institution: So, Magdalene Y.; Chair; Molecular Microbiology and Immunology; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: N. gonorrhoeae (GC) infects the mucosal epithelium of the human urogenital tract. It adheres to and invades epithelial cells in a multistep manner. Several bacterial ligands and their cognate epithelial cell receptors have been identified, and the initial events in adhesion and invasion are beginning to be understood. GC next traverses the epithelial cell and exits into the subepithelial matrix. This is a slow process requiring 36 48 hours, and the molecular mechanisms underlying it are unknown. We are interested in GC transcellular trafficking, or transcytosis, and have taken a genetic approach to study the process. We first adapted the polarized T84 epithelial cell system as a model epithelial barrier to study GC transcytosis. We then used this system to screen a random bank of mTn-generated GC mutants for fast-trafficking mutants. Four mutants with mTn insertions in three genetic loci were identified in this initial screen. Backcrosses of
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these mutations show that the fast- trafficking phenotype segregated with the mTn insertion. These mutants do not adhere to or invade cells more quickly, nor do they affect the integrity of the epithelial barrier. These mutants are therefore aberrant in the transcellular trafficking process, not in the initial steps of colonization. Preliminary studies indicate that the loci are likely to play a regulatory role in transcytosis. One mutant is deregulated in its growth within two types of human epithelial cells; its extracellular growth in liquid medium is normal. In this grant application, we propose to further characterize these three loci in order to elucidate their role in GC transcellular trafficking. We also propose to screen the rest of the GC mutant bank for additional fasttrafficking mutants and to characterize their mutated genes. Such studies should shed light on the genetic regulation of the transcytosis process, and hopefully guide the design of novel pharmacologic agents against intracellular GC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLOBAL NETWORK FOR WOMEN'S & CHILDREN'S HEALTH RESEARCH Principal Investigator & Institution: Goldenberg, Robert L.; Professor; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 03-SEP-2001; Project End 30-APR-2006 Summary: We will develop a University of Alabama at Birmingham-Aga Khan University multidisciplinary research team with its major goal the reduction of infection-related perinatal mortality in Pakistan. To accomplish this goal, we will continue to build the UAB-AKU research relationship around a series of studies on perinatal infection and pregnancy outcome. The first study will characterize two populations of Pakistani pregnant women. A cohort study consisting of 1500 urban and later 1500 rural women will be performed in which data will be collected near midpregnancy on infections such as bacterial vaginosis, gonorrhea and chlamydia, and on various pregnancy-associated cervicovaginal and serum markers of infections. These data will be correlated with pregnancy outcome. We will also collect psychosocial, nutritional, medical and dental data and correlate these results with bacterial infection of the vagina, the infection markers and with pregnancy outcome. The goal of this study is 1) to determine the current pregnancy outcomes in two Pakistani populations, 2) to determine the prevalence of vaginal infections and markers of infection in these two populations, and 3) to determine the prevalence of various psychosocial, nutritional, medical and dental factors associated with vaginal infection, markers of infection and adverse pregnancy outcomes. Upon completion of the urban cohort study, women identified as high risk for perinatal death because of a previous perinatal death will be invited to participate in a randomized trial of prenatal and perinatal antibiotics to reduce infection-related perinatal mortality. In this study, women who have had a previous stillbirth or a neonatal death will be randomized to one week of treatment with metronidazole and erythromycin or placebos in the late second trimester, with a repeat course of antibiotics or placebo in labor. The primary endpoint will be perinatal mortality. Our second attempt to decrease infection-related mortality will be in a randomized trial of an intrapartum and infant chlorhexidine wash versus placebo washes with saline. With the completion of these projects, not only will we have answered some very important questions related to infections and pregnancy outcome, but AKU, in partnership with UAB, will have developed superb rural and urban pregnancy-related research infrastructures tightly linked to their developing maternity health care systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INTERFACES
GLYCOLIPID
TRANSFER--REGULATION
BY
MEMBRANE
Principal Investigator & Institution: Brown, Rhoderick E.; Professor; Hormel Institute; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-MAY-1992; Project End 30-NOV-2001 Summary: The long-term goal of this project is to define the structural parameters of glycosphingolipids that promote formation of membrane domains and to determine the impact of glycosphingolipid membrane organization on the functional regulation of a protein that catalyzes the intermembrane transfer of glycolipids, i.e. glycolipid transfer protein. The ability of glycosphingolipids to organize into domains in biological membranes is postulated to be a key feature, not only in their own intracellular sorting and trafficking, but also in the sorting and trafficking of proteins with glycosylphosphatidylinositol covalent anchors. The processes by which glycosphingolipid-enriched domains are formed and maintained are not well understood and may involve specific proteins that can bind and transfer glycosphingolipids between membrane surfaces. By using model membrane systems that provide distinct yet complementary information about lipid-lipid and lipid- protein interactions, the following specific aims will be addressed: (1) to determine the structural features of glycolipids that modulate their mixing interactions with phospholipids and sterols, and to define the physical nature of the lamellar environment that is produced by glycolipid-lipid interactions using monolayer and calorimetric approaches; (2) to ascertain the role that glycolipid lateral organization plays in regulating the activity of glycolipid transfer protein by using monolayer and fluorescence techniques; and (3) to overexpress glycolipid transfer protein using molecular biological approaches and provide a foundation for future investigations of site- directed mutagenized forms of glycolipid transfer protein. Achieving these aims will be of fundamental importance in developing ways to control glycosphingolipid availability and accessibility at the cell surface. Such manipulations could be key to preventing infection by certain bacteria (N. gonorrhea, pathogenic E. coli, and cholera) and viruses (rotaviruses and HIV) as well as lead to better ways to target drugs to the surfaces of tumor cells that express oncogenically-related glycosphingolipids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GONOCOCCAL FUR REGULON--LINK TO PATHOGENESIS Principal Investigator & Institution: Genco, Caroline A.; Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 15-JUL-2001; Project End 30-JUN-2006 Summary: (provided by the applicant): In most Gram-negative pathogens, genes involved in iron acquisition and virulence are transcriptionally regulated by the availability of iron through the ferric uptake regulator protein, Fur. The etiological agent of the sexually transmitted disease gonorrhea, Neisseria gonorrhoeae, produces a number of iron regulated proteins which are utilized for iron transport and expression of these proteins is thought to be under the control of Fur; however, the role of Fur in controlling expression of iron transport genes or virulence factors in N. gonorrhoeae is not well defined. This application proposes to further our understanding of the regulation of genes involved in iron transport and virulence by the transcriptional regulator protein Fur, and to define the role of the Fur-regulon in N. gonorrhoeae pathogenesis. Our hypothesis is that Fur controls the expression of a number of genes in addition to iron transport genes that are required for the virulence of N. gonorrhoeae.
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The specific aims of this proposal are as follows: Aim 1.To identify the minimal essential gonococcal nucleotide sequence for Fur binding and characterize the interactions of gonococcal Fur with iron-regulated promoters. Aim 2.To isolate and characterize ironindependent mutants of gonococcal Fur. Aim 3. To define the Fur regulon in N gonorrhoeae. Aim 4.To define the role of the gonococcal Fur regulon in pathogenesis. These studies are based on the premise that gonococcal Fur binds to a unique and specific array of DNA sequences within the promoter regions of a number of Furregulated genes. This allows gonococcal Fur to function as a general global regulator controlling the expression of numerous genes in Neisseria. The intracellular iron concentration and the variability and extension of sequences targeted by Fur may cause a wide range of responses. Therefore, there may be many genes that are regulated by Fur that are unidentified. The results obtained in these studies will enable us to define the binding of gonococcal Fur to gonococcal Fur-regulated promoters, to identify additional genes which are regulated by Fur in N. gonorrhoeae, to define the mechanisms of Fur mediated regulation, and to correlate this with the pathogenic potential of N gonorrhoeae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GONOCOCCAL INFECTION AND GENE EXPRESSION IN FEMALE MICE Principal Investigator & Institution: Jerse, Ann E.; Associate Professor; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: (Adapted from the applicant's abstract): Neisseria gonorrhoeae has a serious impact on women=s health due to the frequency with which this pathogen infects the upper reproductive tract, and the resultant serious complications (e.g., chronic pelvic pain, involuntary infertility and ectopic pregnancy). Current models for studying gonococcal pathogenesis are limited in their ability to sufficiently mimic the intricate balance of host factors in the female reproductive tract. Therefore, the long-term objectives of this proposal are to further develop a female mouse model of gonorrhea for studying the adaptation of N. gonorrhoeae to the host in terms of phase and antigenic variation of surface molecules and gene expression in vivo. The specific aims designed to achieve this objective are to: i. further characterize experimental infection of estradiol-treated mice for use as a research tool for studying specific aspects of gonococcal genital tract infection; ii. identify the host factor(s) that play a role in the selection for gonococcal opacity (Opa) protein expression during experimental infection and to test the capacity of an Opa-specific immune response to drive antigenic variation of Opa phenotype in vivo; iii. identify gonococcal genes that are induced during experimental murine infection using reporter gene fusions. The proposed experiments designed to address these aims are: i.) the susceptibility of estradiol- treated outbred (SLC:ddY) and inbred (BALB/6) mice to N. gonorrhoeae will be characterized with regard to duration of infection and degree of inflammation. Upper reproductive tract infection will be assessed in terms of bacterial interactions with the murine endometrium; ii.) host factors that select for Opa-positive gonococci in vivo will be studied by monitoring Opa protein expression in neutrophil-depleted mice, complement-deficient mice and inbred mice that uniformly do not produce inflammation in response to infection. The PI will compare the Opa phenotype of vaginal isolates from unimmunized mice and from mice immunized with a single purified Opa protein antigenic variant to determine if an Opa-specific immune response decreases the number of gonococci expressing the homologous Opa protein in vivo; iii.)
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expression of a gonococcal catalase-reporter gene fusion will be measured during murine infection and in neutrophil adherence assays to study the regulation of gonococcal catalase in response to inflammation. A transcriptional gene fusion bank using the green fluorescent reporter gene will be constructed and screened for promoters that are expressed during experimental murine infection; genes identified under these conditions will be cloned for further study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GONOCOCCAL PILUS ANTIGENIC VARIATION IN HOST CELLS Principal Investigator & Institution: Criss, Alison K.; Microbiology and Immunology; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): The sexually transmitted disease gonorrhea has remained in the human population for thousands of years, owing in part to the inability of infected individuals to develop long-term immunity to the bacterium that causes this disease, Neisseria gonorrhoeae (Gc). Gc evades immune system surveillance by constantly changing its arsenal of surface-exposed antigens. Changes in pilin, the major subunit of type IV pili, arise from a DNA recombination-based process called antigenic variation (Av). In pilin Av, new DNA sequence is transferred into the pilin expression locus, pilE, from incomplete pilin copies (pilS) found elsewhere in the Gc chromosome. Although a great deal is currently understood about the mechanism of pilin Av, the capacity of Gc to undergo this process upon encountering host cells has not previously been investigated. Therefore, the importance of pilin Av in progession of gonorrheal disease remains unknown. The goal of this proposal is to examine pilin Av in Gc during infection of polarized epithelial cells and peripheral blood neutrophils (PMN), both of which play key roles in disease pathogenesis. First, I will establish parameters for infection of epithelial cells and PMN by Gc, with a focus on determining whether type IV pili are necessary for adherence, internalization, survival, and exit of Gc from these cells. Second, I will calculate the frequency of pilin Av for Gc encountering epithelial cells and PMN. Finally, I will use a genetic approach to examine whether pilin Av is essential to the ability of Gc to reside within epithelial cells and PMN or to crosspolarized epithelial monolayers. The results obtained from these studies will provide crucial insight into how pilin Av contributes to the ability of this pathogen to establish productive infections in host cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HIV AND STIS IN YOUNG ADULTS: A NETWORK APPROACH Principal Investigator & Institution: Morris, W M.; Professor; Ctr/Studs/Demography & Ecology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2004 Summary: (Adapted from Applicant's Abstract) This proposal seeks funding to support analyses of the biomarkers for sexually transmitted infections (STIs) that will be collected in the forthcoming wave (Survey 2000) of the National Longitudinal Study of Adolescent Health (Add Health). The central aim of Survey 2000 is to document the health status of young adults (18-26 years old), and to provide data that make it possible to analyze the relationships between social context, behavior, and health outcomes. Specimens will be tested for four STIs in Survey 2000: Chlamydia trachomatis (Ct), Neisseria gonorrhea (GC), Trichomonas vaginalis (Tv), and human immunodeficiency virus (HIV). The analyses proposed in this project will focus on three interrelated STI
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topics: 1) basic descriptive work on STI prevalence; 2) the development of multiple imputation strategies for missing behavioral and biomarker data; 3) the measurement and analysis of epidemiologically relevant aspects of network location and structure; and 4) multivariate analyses of individual STI risk that explicitly integrate measures of network exposure. The prevalence analyses will provide the first detailed population based estimates of STIs in this age group. Gonorrhea and chlamydia are reportable, and their prevalence is estimated to peak during the age range of the Survey 2000 sample. Trichomoniasis is not reportable, but it is thought to peak during a similar age range. Prevalence of HIV among young adults is not well established. The size of the Survey 2000 sample (N=19,500) will make it possible to estimate prevalence of each of these STIs for detailed race, sex, region, and other subgroups for the first time. All prevalence analyses will implement existing statistical corrections for the sensitivity and specificity of the tests. We estimate that the biomarker collection will have a non-response rate of about 15%. We will therefore develop multiple imputation strategies for the missing data. Comparable strategies have been developed successfully for the NHANES III. There is a wealth of both cross-sectional and longitudinal data in Add Health that can be used to construct an effective imputation scheme. We will produce a public use data set containing the imputed variables, and instructions on the use of existing statistical software for implementing a multiple imputation analysis, available electronically through the Add Health project website. The network and multivariate analyses that comprise the third and fourth foci of this project will take advantage of the unique local network data that will be collected on respondents' sexual partners. STIs travel through networks of sexual partnerships, and Survey 2000 will provide the first nationally representative data on local networks for this highly active age group. Local network data consist simply of respondent reports about their partners, rather than tracing and enrolment of the partners themselves. While relatively simple to collect, these data provide a rich source of information on network exposure, mixing, and concurrent partnerships that can be incorporated into traditional epidemiological models of infection risk. The goal of these analyses will be to identify the relative contribution of individual attributes and network exposure to the risk of infection, and to establish the implications for prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV AND THE SEXUAL NETWORKS OF IDUS AND DRUG-USING MSM Principal Investigator & Institution: Ouellet, Lawrence J.; Epidemiology and Biostatistics; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Preventing the sexual transmission of HIV is essential if the United States is to further reduce HIV incidence. Among drug-using populations, however, the sexual transmission of HIV is understudied. The proposed five-year study focuses on injection drug users (IDUs) and drug-using men who have sex with men (MSM) to examine the sexual diffusion of HIV within and across drugusing population subgroups and to non-drug using and non-MSM populations. Our approach combines 1) behavioral epidemiology, 2) two-types of social network analyses with strong geographic mapping components [including the ability to link geographic location with local socio-economic and health data], 3) mathematical modeling, and 4) and biologic testing for HIV, hepatitis B (HBV) and C (HCV), syphilis, chlamydia and gonorrhea. The study proposes a cross sectional survey of 2500 IDUs and about 562 of their non-injecting sex partners, and 3000 MSM and about 450 of their female sex
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partners. Participants will be recruited through respondent-driven sampling (RDS) [1-3] at six racially and ethnically diverse sites across Chicago. As a feature of RDS, sampling weights will be calculated to adjust for unequal probabilities of selection based on variations in network size, strength of in-group affiliation and recruitment effectiveness, and the data will be post-stratified so the results can be generalized to the population of IDUs and drug-using MSM. HIV specimens from participants with newly diagnosed infections will be tested using the serologic testing algorithm for recent HIV seroconversion (STARHS), and HIV incidence computed from the results. HIV genotyping and phenotyping, RNA viral load testing, and cellular immune panels will be used to characterize newly diagnosed infections by drug resistance, infectiousness, and immune system suppression. Test results for other STIs will be used to better characterize the potential for future diffusion of HIV or increased vulnerability to infection with HIV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV RISK REDUCTION AMONG YOUNG INCARCERATED FEMALES Principal Investigator & Institution: Robertson, Angela A.; None; Mississippi State University P. O. Box 6156 Mississippi State, Ms 39762 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): This study is a longitudinal analysis of STD/HIV exposure among adolescent female offenders in Mississippi, a population that is disproportionately African American, and at higher risk than adolescents in general due to their propensity to engage in a variety of risk-taking behaviors, earlier onset of sexual behaviors, and the greater prevalence of mental disorders, substance abuse disorders, maltreatment, and family dysfunction. Based on social cognitive theory and Fisher and Fisher's (1992) IMB (Information, Motivation, and Behavioral skills) model, we request funding to evaluate a drug abuse related HIV risk reduction intervention and to compare outcomes against a STD/HIV information and health education control condition. Approximately 400 females committed to the state reformatory/training school for girls will be recruited for participation. The research design will consist of alternating cohort/waves of about 36 subjects each. One treatment condition will be administered at a time with a washout period between cohort/waves. Over a three-year period, one half of subjects will get 18 hours of HIV prevention and one half will get 18 hours of Health Education. Before and after the intervention, subjects' social competency skills and health knowledge will be measured. Before intervention and at 6-month and 12-month follow-up, self-report measures of alcohol and drug use, sexual risk behaviors, and impulsivity will be collected. Measures of condom attitudes, self-efficacy, sexual decision-making, and attitudes towards HIV prevention will be collected four times. Urine tests for the detection of 2 STDs (chlamydia and gonorrhea) will also be performed before intervention and at 6-month and 12- month follow-up. Multivariate data analyses will compare the experimental program against the Health Education control condition to evaluate the impact of the prevention program on lowering sexual risk behavior. It is hypothesized that the HIV prevention intervention will produce more favorable attitudes towards condoms and HIV prevention, more consistent use of condoms, and lower risk behavior post intervention and through the one-year follow-up period than the Health Education control condition. It is also hypothesized that the incidence of chlamydia and gonorrhea infection during the follow-up period will be lower for participants of HIV prevention than participants in the control group. The
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results will be useful to juvenile justice administrators and others that work with this high-risk population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV RISK-REDUCTION WITH DRUG-USING YOUTH Principal Investigator & Institution: Pilowsky, Daniel J.; Assistant Professor; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Recent research on the prevalence of HIV infection among illicit drug users has shown that crack smokers have an unexpectedly high HIV seroprevalence. Interventions aimed at reducing sexual risk behavior among young adult crack smokers and other non-injection drug users (NIDUs) are urgently needed. We propose a randomized controlled trial of an innovative HIV risk-reduction coeducational intervention (COPE-Network), which incorporates cognitive-behavioral skills building and social influencing approaches. The primary aim is to reduce sexual risks associated with HIV seroconversion. To achieve this aim, we will recruit young sexually active 11W negative NIDUs (18-30 year old) in Harlem, New York City. We plan to enroll 300 NIDUs aged 18 to 30 into a randomized trial with two arms (COPENetwork versus a control condition; 150 index persons in each condition), as well as members of their sex/drug personal networks. The aims of the study are: (1) To assess the efficacy of the intervention on the primary sexual risk behavior outcomes (VEE, a weighted sexual risk index, and other measures such as proportion of condom-protected acts, and number of sex partners) among index subjects; (2) To assess the efficacy of the intervention on the primary sexual risk behavior outcomes among network subjects; (3) To explore associations between high risk sexual behaviors and risk configuration (the context in which high risk behaviors occur) among index and control subjects. Risk configurations will be assessed by considering the proportion of personal network members engaging in high-risk sexual behavior and illicit drug use; and (4) To gather descriptive epidemiological data on the prevalence and incidence of gonorrheal and Chlamydia infections among the index NIDUs enrolled in the clinical trial. Additionally, these data will be used to provide corollary evidence of an intervention effect by analyzing correlations with self-reported measures of sexual behavior. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HIV SEXUAL RISK-REDUCTION FOR AFRICAN-AMERICAN COUPLES Principal Investigator & Institution: Wingood, Gina M.; Associate Professor; Behavioral Scis & Hlth Educ; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2007 Summary: The broad objective of this Interactive proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases among African American HIV serodiscordant heterosexual couple. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia, Wingood in Atlanta, and Wyatt in Los Angeles) to use a common protocol to implement a randomized controlled trial. While most HIV/STD risk-reduction interventions Are conducted at the individual level, a couple-based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant (200 per site) recruited from community-based organizations (CBOs), health departments, and HIV clinics. The couples will be randomized to one of two
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interventions: an 89-session HIV/STD sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants' previous HIV/STD risk-reduction research with inner-city African-American populations. The primary biological outcome is sexually transmitted disease (chlamydia, gonorrhea, and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate of condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio computer-assisted self- interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and 6- and 12-month follow-up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, analyze will test (a) the effects of the intervention on STD incidence, sexual behavior, and mediators of sexual behavior, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history. The findings will contribute significantly to the field of HIV/STD risk reduction by developing and testing an intervention with African American couples that can be offered to HIV clinics and CBOs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RECRUITS
HIV/AIDS
PREVENTION
AMONG
ANGOLAN
MILITARY
Principal Investigator & Institution: Bing, Eric G.; Director, Collaborative Alcohol; None; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (Provided by applicant): HIV/AIDS has had a devastating impact on subSaharan Africa. With just 8 percent of the world's population, sub-Saharan Africa accounts for 70 percent of all the world's 36.1 million HIV/AIDS cases. Despite the high HIV prevalence rates of as much as 35 percent in neighboring countries, the reported HIV prevalence rate for Angola is reported to be only 3 percent. This relatively low rate may be due to the on-going civil war that has restricted population mobility. Therefore, there is at present a window of opportunity to save Angola from the devastation that AIDS has wrought on other areas of the sub-continent. Our international team of Angolan and American researchers proposes to test the effectiveness of a multi-session HIV/STD prevention intervention on reducing high-risk sexual behaviors and the incidence of sexually transmitted diseases among Angolan military recruits. Our 3 specific aims are: (1) To test the effectiveness of a cognitive-behaviorally focused intervention designed to reduce high-risk sexual behaviors and the incidence of STDs (such as HIV, chlamydia, gonorrhea, and syphilis) immediately following and at 3 and 6 months post-intervention; (2) To determine the degree to which the individual components of the intervention (information about HIV/STDs, motivation to reduce risk of infection, and skills at condom use) produce a reduction in high-risk sexual behaviors and the incidence of STDS; and, (3) To determine if predisposing factors such as sociodemographic and personal characteristics, psychiatric symptoms and disorders, alcohol use and history of STDs moderate the effect of the intervention on sexual risk taking and STD incidence. We will conduct the intervention in the Cabinda Province of Angola. Though Cabinda is the smallest Angolan province, 45 percent of all the country's AIDS cases have been reported there. To better understand the context of HIV
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prevention for the Angolan military, in Phase 1 we will conduct 5 focus groups with new recruits (2 groups), experienced soldiers, military sergeants, and HIV-positive soldiers. We will use the information gained in the focus groups to modify the content of the instruments to be used in a survey and the proposed intervention. In Phase 2, we will pilot test the survey instrument with 100 soldiers as well as the intervention. The proposed intervention, Salva Vida (Save Life), will consist of 4 sessions (1 session each week) and 1 booster session 6 weeks after the final session. In Phase 3, we will test the intervention with a total of 400 military men, with 200 being assigned to the intervention and 200 to the control condition, which will have a general health promotion focus. If this intervention is effective among military recruits in Angola, it may have applicability to many developing nations throughout the world battling HIV with scarce resources and little hope of treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV/INFECTIOUS DISEASE TEST/TREATMENT IN SUBSTANCE ABUSE Principal Investigator & Institution: Lally, Michelle A.; Miriam Hospital Providence, Ri 02906 Timing: Fiscal Year 2001; Project Start 25-SEP-2000; Project End 31-AUG-2005 Summary: (Applicant's Abstract) Phase I of the proposed project will examine barriers to comprehensive HIV and other infectious disease testing and follow-up care among substance abusers at a short term (detox) substance abuse treatment center. In Phase II an intervention that includes comprehensive testing, counseling, medical deferral, and practical strategies to overcome barriers to follow up care will be designed and pilot tested. During Phase III, the intervention will be evaluated against the standard of care of offering HIV testing done through a randomized controlled trial. Three hundred and forty-four participants will be randomized to receive either the comprehensive testing and facilitated referral intervention which will offer testing for HIV, hepatitis B and C, and the STDs gonorrhea and chlamydia (and trichomonas for women only) or standard of care HIV testing alone and referral for further hepatitis and STD testing. Primary endpoints will be the number of tests performed, the number of test results received, and the degree of follow up medical care obtained for the two groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HIV/STD NETWORK PREVENTION TRIAL IN NORTHERN VIETNAM Principal Investigator & Institution: Go, Vivian F.; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (Provided by applicant): Current HIV prevention interventions have been predominantly influenced by several cognitive theories. While individual-level theory has been successful in guiding small and intensive group interventions, their effectiveness may be limited in contexts where targeted behaviors are constrained by complex social and environmental factors, especially in developing countries or among communities engaging in illicit behaviors. Community-norm change models that focus on influencing social or peer norms may be more effective in reaching those at highest risk and least likely to volunteer for individually-based interventions. However, there are few studies that evaluated the efficacy of such interventions in developing countries. This study is a randomized controlled trial of a peer educator, network-oriented
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intervention for injecting drug users (IDUs) and their sexual partners in northern Vietnam. IDUs account for over 88 percent of all reported HIV infections, making them and their drug-using and sexual partners a critical target for HIV prevention efforts. IDU is increasing rapidly in Vietnam, accompanied by an increase in commercial sex work. The potential exists for an explosive shift of transmission dynamics from the core group of IDUs to the general population, as was seen in Thailand. This shift could be mediated by sexual and drug network members as a bridge population to susceptibles in other settings. Current low HIV and STD rates in the general population highlight the need to implement appropriate and effective behavioral interventions in the complex social and ethnographic environment surrounding IDUs and their peer networks. To accomplish this trial, we will: 1) conduct ethnographic research to culturally adapt our peer educator, network oriented intervention and to determine the acceptability of this intervention; 2) enroll and interview a cohort of 400 indexes and three of their sexual/injecting network members (total n = 1600) to determine baseline sexual, drug and biologic (chlamydia, gonorrhea, HBV and HCV) characteristics; 3) randomize index participants to a 6-session network-oriented peer-led intervention or an attention control condition. After randomization, participants will be followed for a minimum of 15 and maximum of 24 months at 6-month intervals. Follow-up visits will consist of a behavioral survey and donation of biological specimens; and 4) compare sexual and drug behavioral risks and HIV VCT uptake among the indexes who receive the intervention and their network members to index IDUs who received the attention controlled sessions and their network members. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV/STD RISK BEHAVIORS IN METHAMPHETAMINE USER NETWORKS Principal Investigator & Institution: Shoptaw, Steven; Associate Research Psychologist; Psychiatry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The proposed study will launch a multidisciplinary effort to examine the diffusion of HIV and sexually transmitted diseases (STDs including gonorrhea, chlamydia, and syphilis) in drug users in L.A. County to identify the individual level factors, partner-level factors, and environmental factors that promote the spread of these diseases. L.A. County is the second largest epicenter of AIDS cases in the nation, yet injection drug use (IDU) accounts for only a minority (13%) of cases, while the majority of cases involve MSM (70%). Recent, disproportionate increases of HIV infection for women and people of color in L.A. County imply the virus is moving from relatively contained groups into larger segments. This 5-year study proposes to establish a representative cohort of individuals thought to represent the behavioral "bridges" for these pathogens to enter the larger population: drug using MSM (n=240), drug using MSM/W (n=240) a comparison group of non-drug using MSM/W (n=240), and the male (n=288) and female (n=192) sexual partners of these individuals (total=1,200). Assessments will be collected at baseline, 6- and 12-months after enrollment. Data collected will address these study aims: (1) Measure associations between drug involvement (methamphetamine user, other drug user, non-drug user), IDU status, sexual risk behavior (MSM, MSM/W, WSM), and HIV/STDs; (2) Evaluate the types of sexual partnerships and dynamics of the partnerships of these individuals and how these are associated with HIV/STD transmission; and (3) Apply mathematical models to the data on partnerships to study how the incidence of HIV/STDs reflect the
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size and interconnectedness of the sexual networks of each of the groups and to determine the impact of sexual network structure in future transmission of HIV in L.A. within and beyond MSM and heterosexual drug using groups. The study will use methods of behavioral epidemiology, ethnography, viral analysis of HIV, and mathematical modeling to yield a comprehensive set of information to predict the spread of HIV and STDs from sexual networks of high HIV prevalence (drug using MSM) to those of low prevalence (heterosexuals). Outcomes from the proposed cohort study of IDU and non-lDU methamphetamine-using MSM and MSM/W and their sexual partners should provide evidence to guide policy and prevention efforts in response to the spread of HIV and STDs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV/STD RISK REDUCTION AMONG AFRICAN AMERICAN COUPLES Principal Investigator & Institution: Wyatt, Gail E.; Associate Professor; Psychiatry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2007 Summary: The broad objective of this Interactive proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases among African American HIV serodiscordant heterosexual couples. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia, Wingood in Atlanta, and Wyatt in Los Angeles) to use a common protocol to implement a randomized controlled trial. While most HIV/STD risk-reduction interventions are conducted at the individual level, a couple-based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant couples (200 per site) recruited from community-based organizations (CBOs), health departments, and HIV clinics. The couplers will be randomized to one or two interventions: an 8-session HIV/STD sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants' previous HIV/STD risk-reduction research with inner-city African American populations. The primary biological outcome is sexually transmitted diseases (chlamydia, gonorrhea and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate on condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio computer-assisted self- interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month followup. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, the analyses will test (a) the effects of the intervention on STD incidence, sexual behavior, and mediators of sexual behavior; and (b) whether the intervention's effects are different depending on key moderator variables, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, ethnic identity, relationship satisfaction and substance abuse history. The findings will contribute significantly to the field of HIV/STD risk reduction by developing and testing an intervention with African American couples that can be offered to HIV clinics and CBOs.
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Gonorrhea
Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV/STD RISK REDUCTION FOR AFRICAN AMERICAN COUPLES Principal Investigator & Institution: El-Bassel, Nabila; Associate Professor; None; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, Ny 10027 Timing: Fiscal Year 2002; Project Start 10-APR-2002; Project End 31-JAN-2007 Summary: (provided by applicant): The broad objective of this proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases among African American HIV serodiscordant heterosexual couples. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia, Wingood in Atlanta, and Wyatt in Los Angeles) to use a common protocol to implement a randomized controlled trial. While most HIV/STI risk-reduction interventions are conducted at the individual level, a couple-based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant couples (200 per site) recruited from communitybased organizations (CBOs), health departments, and HIV clinics. The couples will be randomized to one of two interventions: an 8-session HIV/STI sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants? previous HIV/STI risk-reduction research with inner-city African American populations. The primary biological outcome is sexually transmitted infections (Chlamydia, gonorrhea, and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate of condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio Computer-Assisted Self-Interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, analyses will test (a) the effects of the intervention on STI incidence, sexual behavior, and mediators of sexual behavior; and (b) whether the intervention?s effects are different depending on key moderator variables, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history, ethnic identity and relationship satisfaction. The findings will contribute significantly to the field of HIV/STI risk reduction by developing and testing an intervention with African American couples that can be offered to HIV clinics and CBOs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: HIV/STD RISK REDUCTION FOR AFRICAN AMERICAN COUPLES Principal Investigator & Institution: Jemmott, John B.; Professor; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2007 Summary: The broad objective of this Interactive proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases (STDs) among African American HIV serodiscordant heterosexual couples. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia,
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Wingood in Atlanta, and Wyatt in Los Angeles to use a common protocol to implement a randomized controlled trial. While most HIV/STD risk- reduction interventions are conducted at the individual level, a couple- based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant couples (200 per site) recruited from community-based organizations (CBOs), health departments, and HIV clinics. The couples will be randomized to one of two interventions: an 8-session HIV/STD sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants' previous HIV/STD risk-reduction research with inner-city African American populations. The primary biological outcome is STDs (chlamydia, gonorrhea, and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate of condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio computer-assisted self- interviewing (ACASI) will be used to collected data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, analyses will test (a) the effects of the intervention on STD incidence, sexual behavior, and (b) whether the intervention's effects are different depending on key moderator variables, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history. The findings will contribute significantly to the field of HIV/STD risk reduction by developing and testing an intervention with African American couplers that can be offered to HIV clinics and CBOs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HUMAN PAPILLOMAVIRUS AS A RISK FACTOR FOR HIV INFECTION Principal Investigator & Institution: Chin-Hong, Peter V.; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Human papillomaviruses (HPV) are common sexually transmitted agents throughout the world. The causal association between HPV and anogenital cancer is generally accepted. What has not been well studied is the role of HPV as a risk factor for the acquisition of HIV. Sexually transmitted diseases (STDs) such as gonorrhea and chancroid have been shown to be cofactors for HIV acquisition. Very little information is available regarding the role of HPV infection and anal intraepithelial neoplasia (AIN) or cervical intraepithelial neoplasia (CIN) in facilitating HIV infection. HPV- associated AIN and CIN can enhance susceptibility to HIV infection because of increased microvasculature and bleeding. These lesions are also rich in CD4+ lymphocytes and dendritic cells that are mucosal targets of HIV infection. The specific aims of this study are to: 1) examine the role of AIN and CIN as cofactors for HIV acquisition, 2) examine the association of HPV infection with HIV acquisition, and its role in predicting AIN and CIN, and 3) identify specific bioimmunologic markers of AIN or CIN that predict HIV acquisition. A primary aim of this research is to support the career development of the applicant who is pursuing a career in patient-oriented research through the combination of direct mentoring, supervised study and clinical
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Gonorrhea
activities at the General Clinical Research Center and the AIDS Research Institute. The proposed research plan is a case-control study of 140 incident HIV cases that will be identified over 4 years from the ongoing Options Project, an NIAID-funded study of women and men with primary HIV infection (PHI). The referent group will be 140 men and women referred to the Options Project because of possible PHI but found to be HIV -negative. All participants will undergo anal HPV testing, high-resolution anoscopy (HRA) and anal cytology. Women will also undergo the same procedures as well as cervical PAP smears and colposcopy. To control for potential confounding, self reports regarding sexual behavior, drug use, STD history and laboratory data for STDs will be collected and included in statistical models of the effects of HPV-associated findings on HIV acquisition. The proposed research is the first to use HRA and cervical colposcopy to examine AIN and CIN as independent risk factors for HIV transmission. If HPVassociated epithelial abnormalities are risk factors for HIV infection, then identification of such lesions may improve assessment of HIV transmission risk and could direct future interventions for HIV prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNITY TO STDS IN THE HUMAN MALE GENITAL TRACT Principal Investigator & Institution: Anderson, Deborah J.; Director; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-SEP-2000; Project End 31-MAY-2005 Summary: Sexually transmitted diseases (STDs) cause extensive morbidity and are epidemic in many developing countries and in certain segments of the US population. Little is known about immune defense mechanisms of the male urogenital tract that normally limit STD infections or that can be induced to protect against transmission of STD pathogens. Such information would facilitate the development of vaccines and other strategies to prevent STDs. This Program Project application addresses several aspects of this important research area. Three research projects and two service cores (Administrative and Clinical) are proposed. Project 1 (Dr. Anderson, PI) will investigate humoral and cellular acquired immune responses in the male genital tract and their regulation. A special focus of this project will be the molecular definition and functional studies of immunoregulatory molecules and changes in their expression during infection. It is hypothesized that the male urogenital tract is an inductive site for local humoral immunity, but that cellular immune responses are tightly regulated. Project 2 (Dr. Quayle, PI) addresses the role of epithelial defensins (HD-5, HBD-1 and HBD- 2) in early host-pathogen interactions in the male urogenital tract. This project will characterize expression patterns and secreted forms of defensins in normal men and men with STDs, their activity against STD pathogens, and the role of defensins in leukocyte recruitment to the mucosa. Project 3 (Dr. Toribara, PI) will investigate mucin expression at various sites in the male genital tract, and address the hypothesis that mucins play an important role in mucosal immune defense. Investigators workings on Projects 1 (acquired immunity) and 2 (defensins) will collaborate with investigators working on Project 3 (mucins) to define functional interactions between classic immunological mediators (cytokines, immunoglobulins, lymphocytes, defensins) and mucins present in the male genital tract. The Administrative Core will provide infrastructure support for the program. The Clinical Core, codirected by Drs. J. Pudney and P. Rice (PI of the Boston STD-CRC), will provide five services: 1) a male genital tract tissue bank for studies on cellular distribution and expression of defense molecules in different regions of the male genital tract; 2) immortalized epithelial cell lines from prostate, urethra and seminal vesicles and STD organisms for in vitro studies of effects
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of infection on gene regulation of defense and immunoregulatory molecules; 3) urethral and prostatic secretions from men with specific STDs and controls for studies on regulation of defense mechanisms by natural infections in vivo; 4) a PCR service for screening tissues and clinical samples for specific STD pathogens; and 5) database and statistical support. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNOCHEMISTRY OF GONOCOCCAL LIPOPOLYSACCHARIDE Principal Investigator & Institution: Griffiss, John M.; Associate Professor; Northern California Institute Res & Educ San Francisco, Ca 941211545 Timing: Fiscal Year 2001; Project Start 01-MAR-1984; Project End 29-FEB-2004 Summary: This project continues studies of how lipooligosaccharide (LOS) mimicry of human glycosphingolipids (GSL) enables the transmission of Neisseria gonorrhoeae in order to find ways to prevent it. LOS are outer membrane glycolipids that have a glycose moiety that consists of proximal Basal Region and three short distal chains, termed alpha beta and gamma. Many alpha chain oligosaccharides are structurally identical to those of lacto- (Lac-R), globo- (Pk (Gb3) and P1), paraglobo- (lacto-Nneotetraose (LNnT)), and gangliosyl (Ga1NAcbeta1 yields 3LNnT) series GSL. LOS are involved in attachment to and invasion of epithelial cells and in evasion of immune clearance mechanisms. Gonococci shed during gonorrhoea make larger LOS. The higher Mr LOS made by MS11mkC - a strain used in human experimentation -have polylactosamine structures. Polylactosaminylation explains the higher Mr molecules of this variant, but not those of others. Some serum resistant (serr) gonococcal strains extend the LOS beta chain to form an alpha-lactose that is parallel to the beta-lactose of the alpha chain, and meningococci can extend the gamma chain. We will structure higher Mr LOS made by clinical isolates; LOS made by serr strains, and LOS that appear to have higher order (Gb4 and P1) globosyl oligosaccharides that are isobaric (same Mr) with paraglobosyl and gangliosyl LOS, respectively. We particularly want to know whether higher Mr LOS have parallel GSL-like antennae that could cross-link epithelial cell receptors. We will continue to rely on mass spectrometric techniques. We know little about gonococcal LOS lipoidal moieties. This information is needed because the lipoidal moiety influences the conformation of the glycose moiety in ways that affects the latter's ability to bind glycoproteins, including antibodies. Available structural information from degraded LOS leaves known O-acyl lipoidal moiety heterogeneity unexplored. We will develop methods that allow us to structure intact LOS without prior degradation. MAbs have been used extensively in studies of gonococcal pathogenesis as surrogates for glycose structures; however, we do not have mAbs that discriminate among known glycose structures, much less for those that have yet to be found. We want to expand our library of mAbs to include additional specificities. These mAbs will be necessary for complete studies of the role of LOS in pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMPACT OF SOCIAL NETWORKS ON SYPHILIS TRANSMISSION Principal Investigator & Institution: Rompalo, Anne M.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from the Applicant's Abstract): The investigators propose to examine the role of social context and social influence on syphilis transmission in Baltimore. Currently, Baltimore has the Nation's highest rates for newly acquired
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primary and secondary syphilis. The goals of this study are, first, to examine the social context of syphilis risk through the assessment of social and sexual network characteristics. In collaboration with he Baltimore City Health Department (BCHD), the investigators will recruit between 400 and 1200 patients who present to the BCHD Sexually transmitted Diseases (STD) clinics for evaluation and treatment of primary and/or secondary stage syphilis. The investigators will collect specimens from these patients' syphilis lesions for restriction fragment length polymorphism (RFLP) analysis, and conduct social and sexual network interviews with these syphilis patients and their social/sexual network members. Using Geographic Information System (GIS), the investigators will map the social and sexual networks. This will allow us to track and compare possible syphilis transmission through both network types and to examine social structural factors, especially drug use, which may be associated with disease transmission and risk behaviors. Social context data will be confirmed by biologicallybased strain typing. The investigators propose to apply the RFLP technique in collaboration with Dr. Sheila Lukehart at the University of Washington to determine the prevalence of and factors associated with genetic clustering of syphilis in Baltimore over time. The investigators will determine if different RFLP profiles exist m Baltimore, use GIS to plot their spatial distribution and evaluate the relationship of social networks to clusters of infections. This will be the first time that a biological marker of transmission will serve to validate epidemiological defined transmission groups and thus improve our ability to delineate the sexual, social and personal network characteristics associated with syphilis transmission. The investigators are currently funded to examine the role of social context on gonorrhea transmission. As a second goal of this study will be to compare the social context of syphilis risk to that of gonorrhea risk and to determine and compare the role of drug use and other social factors in the social context of both sexually transmitted diseases. Thus, the investigators propose to compare the efficacy of detecting early infectious (primary and secondary stage) syphilis cases by interviewing and screening social network members of early syphilis index cases compared to that of standard sexual partner notification techniques. The proposed project seeks five years of support to map, analyze and compare syphilis cases within social and sexual networks. Data collected in this proposal data may be applied to modify current methods of syphilis contact tracing and develop more effective future preventive and intervention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IN VITRO ANTI-HIV1 CAP ACTIVITY Principal Investigator & Institution: Jiang, Shibo; Associate Member; New York Blood Center 310 E 67Th St New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 26-SEP-2001; Project End 31-JUL-2005 Description (provided by applicant): Sexual transmission is the major mode of human immunodeficiency virus type 1 (HIV-1) infection worldwide. There is an urgent need to develop safe, topically applied microbicides that can efficiently reduce sexually transmitted infection by HIV-1. The applicant?s previous studies demonstrate that cellulose acetate phthalate (CAP), an inactive pharmaceutical excipient commonly used for the coating of enteric tablets and capsules has potent inhibitory activity against infection by HIV-1, herpesviruses (HSV), simian immunodeficiency virus (SlV), and several non-viral sexually transmitted disease (STD) pathogens, including N. gonorrhea, C. trachomatis, T vaginalis, and Haemophilus ducreyi, but has no effect on Lactobacilli, essential components of the normal vaginal flora. CAP has no significant in vitro and in vivo toxicity and has proven to be safe for human use. In addition, it is inexpensive.
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Thus, the applicant believes that CAP is an ideal candidate for rapid development as a microbicide applicable to prevention of sexual transmission of HIV-1 in both developing and developed countries. So far, the anti-HIV-l activity of CAP and its formulations have been evaluated using laboratory-adapted HIV-1 isolates. In order to bring CAP towards clinical application, it is critical to determine whether CAP (a) is also effective in blocking the infection of different target cells by distinct primary HIV-1 isolates, including cell-free and cell-associated viruses, and (b) inactivates the infectivity of these isolates. The specific aims of this Project are: 1) to evaluate the inhibitory activity of CAP on in vitro infection by primary HIV-1 strains with distinct genotypes and phenotypes; 2) to assess the virucidal activity of CAP and its formulations against primary HIV-1 isolates; 3) to determine the effect of CAP on in vitro cell-to-cell transmission of HIV-1; 4) to evaluate the efficacy and bio-compatibility of CAP in human genital and rectal tissue models of HIV-1 transmission; 5) to study the mechanism of action of CAP against infection by primary HIV-1 isolates. The goal of the proposed research is the rigorous and comprehensive pre-clinical evaluation of CAP and its formulations in order to expedite its transfer into human clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INCREASED ACCESS TO EMERGENCY CONTRACEPTIVE PILLS Principal Investigator & Institution: Raymond, Elizabeth G.; Family Health International Box 13950 Research Triangle Park, Nc 27709 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2005 Summary: (provided by applicant): Emergency contraceptive pills (ECPs) can substantially reduce the chance of unintended pregnancy after unprotected intercourse. However, over the longer term, broad availability of this method could affect women's use of other contraceptive methods, which could in turn have either beneficial or adverse consequences on the risk of pregnancy and sexually transmitted infections (STIs). Data on this issue are needed to inform policies and practices regarding provision of ECPs to women. The primary purpose of the proposed randomized trial is to evaluate the impact of maximally increased access to ECPs on pregnancy and STI rates. Secondary research aims are (1) to determine what contraceptive or STIprevention behaviors ore influenced by ready access to ECPs. and (2) to examine determinants of these behaviors. The trial will be conducted in young, primarily minority women, a population with a disproportionately high risk of these two outcomes. Sexually active women who are using barrier methods of contraception, oral contraceptive pills, or no contraception will be enrolled at two clinics in Indiana and California. Each woman will be randomly assigned to one of two groups. In the standard care group, women will be counseled about ECPs and invited to come to the clinic to obtain them (at usual clinic charges) when necessary. In the advance provision group, women will be given a supply of ECPs free of charge to keep at home in case of need. The two groups will be monitored over the following year. The primary analysis will compare the two groups for: 1. the 12-month incidence of pregnancy, and 2. the combined 12-month incidence of three STIs: cervical gonorrhea infection, cervical chlamydia infection and vaginal trichomoniasis. In addition, we will also compare behaviors in the two groups, specifically use of condoms, other contraceptive methods, and ECPs, and also motivating or deterrent determinants of these behaviors using a modified Health Behavior framework. These secondary analyses should help explain the primary biologic outcomes and should be useful in the development of counseling messages and service protocols in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INTERVENTIONS FOR STDS IN HIGH SCHOOLS Principal Investigator & Institution: Gaydos, Charlotte A.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003 Summary: Description (Adapted from application): Sexually active adolescents are at increased risk for sexually transmitted diseases (STDs). The introduction of DNA tests, which utilize non-invasive samples such as urine, have greatly increased the number of STD infections detected, thus the tools to biologically monitor (biomarkers) interventions, which previously have been measured by self-report, are now available clearly documenting high prevalences of infections with C. trachomatis, N. gonnorrhoeae, and T. vaginalis Sequelae of these asymptomatic infections are serious and costly. Interventions to reduce exposure to these agents by changing sexual risk behaviors are greatly needed. In this study, a successful safe-sex intervention "Focus on Kids" will be modified for use in high schools, and administered during lunch periods to approximately 1,350 ninth grade adolescents in five inner-city schools with School Based Health Centers (SBHC). Students, sexually active or not, will be invited to participate in this intervention study which will be advertised broadly at the beginning of the school year. Sexually active students participating in the intervention will be actively enrolled in the biomarker portion of the study in the SBHC and undergo screening for chlamydia, gonorrhea and trichomonas twice a year. Symptomatic students would also be screened as per clinical protocol. Baseline and self-reported behavior changes resulting from the intervention will be evaluated by questionnaire at the beginning and end of the intervention, and at 6- months and at 12-months following completion of the intervention. All students found to be infected will be treated appropriately. Self-reported behavior changes, both short and long-term, will be correlated with biomarker results. The relationship of clinical and demographic variables to biomarkers will be determined, and the relationship and effect of sexual mixing patterns on prevalence of STDS will also be determined. This multi-disciplinary and cooperative study encompassing behavioral, interventional, epidemiological, and biological sciences will evaluate a behavioral approach to STD prevention and control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LACTOFERRIN RECEPTOR AND GONOCOCCAL PATHOGENESIS Principal Investigator & Institution: Sparling, Philip F.; Professor; Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-JUL-1988; Project End 31-MAR-2004 Summary: Description (adapted from the applicant's abstract) The PI proposes studies of the structure, function and genetics of the gonococcal lactoferrin (LF) receptor. Principal questions include the frequency of expression in fresh clinical isolates of the two proteins (LbpB and LbpA) that make up the receptor. We will address whether gonococci expressing the LF receptor are better equipped to attach to eukaryotic cells, and to cause urethral infection in human volunteers. The protein domains in LbpB and LbpA that bind LF will be analyzed, as will the functional contribution of LbpB to the various functions of the LF receptor. We will test whether there is high frequency variation in expression of LbpB, and the genetic basis for frequent deletions in lbpb and lbpa. Antibodies will be raised against LbpB and LbpA to assess the potential of these antigens as components of a vaccine for gonorrhea, and to assist in studies of structure and function of the proteins. The studies are important for better understanding gonococcal pathogenesis and vaccine development, and also other mucosal pathogens
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including meningococci that infect similar mucosal surfaces and that make comparable receptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LIPOOLIGOSACCHARIDE BIOSYNTHESIS IN NEISSERIACEAE Principal Investigator & Institution: Stein, Daniel C.; Professor; Cell Biology & Molecular Gen; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2001; Project Start 30-SEP-1988; Project End 31-MAY-2005 Summary: Description (adapted from the applicant's abstract): Neisseria gonorrhoeae is responsible for over 1 million cases of gonorrhea each year in the United States and the total health care costs associated with treating gonorrhea, and complications that arise from infections caused by this organism exceed 1 billion dollars per year. An effective vaccine would dramatically reduce the associated health care costs. This proposal focuses on elucidating the genetic mechanisms responsible for the expression of one of the organism's principal surface antigens, lipooligosaccharide (LOS). In the work to be described, I will identify by gene cloning and genetic complementation techniques, genes required for the LOS biosynthesis. I will characterize these genes by DNA sequence analysis, define the biochemical properties of the gene products and determine their role in the biosynthetic process. Since the gonococcus can vary its LOS, depending on the host and the local environment, studies on the genetic regulation of its synthesis are warranted. Stable LOS-producing strains are needed to allow us to dissect the role of LOS in the disease process. I will construct a series of genetically defined LOS mutants that express defined LOS structures. These strains will also allow us to study the interaction of the expression of this molecule with other cell surface components. Understanding how the expression of LOS is regulated will allow us to design experiments to test the role of each cell surface component in the disease process. By understanding the relationship between disease and the expression of a specific surface component, we can design vaccines that can prevent the disease in specific demographic groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEASURING HIV RISK IN A CLINIC POPULATION Principal Investigator & Institution: Rogers, Susan M.; Senior Scientist; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, Nc 27709 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: (Adapted from Applicant's Abstract): Primary prevention of HIV is as important today as it was in the early years of the AIDS epidemic. Evaluating behavioral interventions has been difficult because self-reported measures of sensitive and illegal behaviors associated with HIV are vulnerable to nontrivial levels of reporting bias. The proposed research seeks to improve the investigators' understanding of bias in selfreported measures in a population at very high risk for HIV, namely STD clinic patients. Data from recent population-based surveys have found that respondents assigned to a new audio computer-assisted self-interview (ACASI) system are more likely to report engaging in a range of sexual behaviors and illicit drug use than respondents assigned to interviewer administered questionnaires (IAQs) or paper and pencil selfadministered questionnaires. However, a pilot study of ACASI in a small sample of STD clinic patients, found limited mode effect for even the most sensitive items. Further examination of the data indicate that reporting patterns of new patients are different from that of repeat patients. From these data, the investigators hypothesize that (1)
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interview mode effect for sensitive measures of sex and drug use will be more pronounced among new patients than repeaters, but (2) mode effect for measures of prescribed behaviors (i.e., condom use) will be more pronounced among repeaters. The investigators propose two phases of research. In phase 1 they will conduct an experiment to improve understanding of the patient roles, expectations, and perceptions that may mold interview mode differences. They will also conduct a feasibility study of a new touch screen ACASI system for use in a clinic population with low levels of education. They will also conduct a laboratory experiment to define the performance characteristics of a new DNA-based assay to detect sperm in vaginal fluid. While Phase 1 findings may be interesting in and of themselves, they have been designed to guide the implementation and evaluation of a large Phase 2 clinic-based study. In Phase 2, they will collect data and biologic specimens (vaginal swabs and urine) from 1800 STD clinic patients, half of whom will be new patients and half will be repeaters. Depending on Phase 1 findings, half of respondents will be randomly assigned to either touch screen ACASI or standard keyboard ACASI; the other half will be assigned to IAQs. The data from this study will be used to estimate interview mode effects on prevalence estimates of HIV risk-associated behaviors. They will use the new sperm assay plus urine-based assays for gonorrhea and chlamydial infection to validate measures of recent unprotected intercourse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANISMS FOR PRETERM BIRTH IN AFRICAN-AMERICAN WOMEN Principal Investigator & Institution: Gennaro, Susan; Professor, Director of Doctoral and Post; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Nationally, 11% of pregnant women experience a spontaneous preterm delivery every year but only 40-50% of preterm labors end in preterm delivery. The mechanism for preterm delivery remains poorly understood especially among African-American women and especially in early preterm labor (prior to 34 weeks gestation). In our earlier federally funded work, mothers of preterm infants compared to mothers of term infants had significantly poorer immune function (diminished lymphocyteproliferation in response to concanavalin A, pokeweed mitogen, and phytohemagglutinin) at delivery, and 1, 2 and 4 months postpartum. However, it is not known if this altered immune response was present prior to preterm delivery. Infection is also purported to be a causative factor in preterm birth and recent work by one of our research team linking increases in cervicovaginal cytokines with vaginal infections in non pregnant women underscores the need to examine the relationship between local and systemic cellular immune response to birth outcomes. This study will compare stress (perception of stress, CRH), infection (chlamydia, gonorrhea, bacterial vaginosis), health behaviors (smoking, nutrition) and immune response (cervicovaginal and serum IL-1, IL-6 and TNF-alpha) between three groups of African-American women: 20 experiencing a normal pregnancy and term delivery, 20 women presenting between 24-34 weeks of gestation in preterm labor delivering at term and 20 women presenting between 24-34 weeks of gestation in preterm labor who deliver before 34 weeks gestation. The study will provide us with necessary preliminary data to support a major grant submission, allow us to standardize laboratory procedures and inform the methodology of the larger study by providing data on the correlation between serum, cervical, and vaginal cytokine levels. It will also provide preliminary data to identify those factors that best differentiate African American women who
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experience preterm labor but deliver at term from those who deliver experience preterm labor and deliver prematurely from those who never labor prematurely and who deliver at term. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANISMS OF GONOCOCCAL PILIN ANTIGENIC/PHASE VARIATION Principal Investigator & Institution: Seifert, H. Steven.; Professor; Microbiology and Immunology; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 01-MAY-1994; Project End 31-JAN-2003 Summary: (Adapted from the applicant's abstract): Neisseria gonorrhoeae (Gc) is an obligate human pathogen that is the causative agent of the sexually transmitted disease gonorrhea. All freshly isolated Gc express pili on their cell surfaces; and the expression of the pilus is required for infection in human volunteers. The most unique characteristic of Gc pili is the large number of possible pilus antigenic types that a single organism can produce. This antigenic variation process occurs by recombination between one of several silent pilin gene copies and the singular expressed gene (that encodes the major subunit of the pilus, pilin), resulting in multiple sequence changes in the expressed gene and protein. This system of pilin antigenic variation provides a large mosaic of antigenic types in a Gc population, and allows continual reinfection of the high risk portion of the human population that transmits Gc into the general population. Much of our understanding about the mechanisms that produce and control pilin antigenic variation has been obtained by determining the types of sequence changes that occur when an antigenic switch occurs. For each antigenic switch, a portion of one of 19 silent pilin gene copies is transferred to the pilE locus in a nonreciprocal fashion. The investigators have isolated a number of cis and trans-acting mutation that disrupt the process of pilin antigenic variation and predict molecular mechanisms that promote the high frequency transfer of variable pilin sequences. They will continue to isolate and characterize genes, proteins, and cis-acting DNA sequences that are required for pilin antigenic variation to test between different hypotheses about how pilin antigenic variation is mediated. They will also explore the possibility that pilin antigenic variation is regulated during human infection. Through these investigations, this project will continue to define the molecular mechanism used to allow these high frequency recombination reactions that are of critical importance to the pathogenesis of gonorrhea. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MOLECULAR EPIDEMIOLOGY OF N. GONORRHOEAE Principal Investigator & Institution: Viscidi, Raphael P.; Associate Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2007 Summary: Gonorrhea is a common bacterial infection that is transmitted primarily by sexual contact. Gonococcal infections have an epidemiological pattern characterized by the concentration of infections in social or geographically defined communities termed "core groups". These "core groups" have been proposed as reservoirs for the continued transmission of infections within communities, and therefore, understanding the biological nature of the constituent organisms is important for public health control strategies. We propose to examine the molecular evolution of Neisseria gonorrhea within a community over time and in relation to epidemiological information pertaining to the host individuals. This is a collaborative effort between two experts in infectious
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disease and epidemiology of gonorrhea and a population geneticist. Two molecular typing methods will be used to characterize gonococcal isolates: por gene sequencing and multi-locus sequence typing (MLST) scheme, in which alleles at six housekeeping genes are characterized by sequencing approximately 500 bp internal fragments of the genes. The study has three main objectives The first is to determine temporal trends in the population genetic structure of N. gonorrhea over a 20-year period in a high prevalence community, Baltimore, MD. The second is to correlate changes in population genetic parameters with epidemiological information pertaining to the host individual's residence in a "core" or "peripheral" region. Our major hypothesis is that higher levels of genetic diversity, more intense selection pressure on the por gene, a positive growth rate, and a higher recombination rate relative to the peripheral population will characterize the population genetic structure of N. gonorrhea in the core. The third aim is to determine whether gender, age, or disseminated versus local infection influences the population genetic structure of N. gonorrhea. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR TARGETS IN PEPTIDOGLYCAN SYNTHESIS Principal Investigator & Institution: Davies, Christopher; Assistant Professor; Biochem and Molecular Biology; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2007 Summary: (provided by applicant): The murein sacculus is a mesh of cross-linked peptidoglycan strands that confers rigidity to the bacterial cell wall. Beta-lactam antibiotics, which target the essential transpeptidases (penicillin-binding proteins or PBPs) that cross-link the peptidoglycan strands, are important compounds in the treatment of bacterial diseases. Unfortunately, the emergence of multiple mechanisms of antibiotic resistance threatens to make these and other antibiotics obsolete in the treatment of bacterial infections. Along with other pathogenic bacteria, antibiotic resistance in Neisseria gonorrhoeae is a growing problem. Penicillin and tetracycline, once the antibiotics of choice for treatment of gonococcal infections, are no longer be used due to the emergence of resistant strains. Moreover, increasing numbers of strains are now resistant to the fluoroquinolones, one of the two antibiotics current recommended in the treatment of gonorrhea. Clearly there is an urgent need to develop new antimicrobials directed both against well-known molecular targets, such as PBPs, but also against novel targets. In this proposal we describe structural and biochemical studies of three enzymes involved in peptidoglycan metabolism: a D-Dcarboxypeptidase from E. coli (PBP 5) that serves as a model system for elucidating PBP function, an essential transpeptidase (PBP 2) from N. gonorrhoeae that is the lethal target of current beta-lactam antibiotics, and a lytic transglycosylase, MltA, also from N. gonorrhoeae, that serves as the lynchpin of the cell wall synthesizing complex. Each of these proteins has been selected to address one or more of the following aims: (a) to understand the biology of peptidoglycan synthesis, (b) to explore their interactions with antibiotics, (c) to elucidate the molecular basis for antibiotic resistance and (d) to examine their potential as targets for drug development. Studies on PBP 5 will elucidate the mechanism by which this enzyme hydrolyzes substrate and will provide a better understanding of PBP-antibiotic interactions in general. The molecular basis for antibiotic resistance in PBP 2 will be investigated by structural studies of the native enzyme and of a mutant isolated from a penicillin-resistant strain. The role of MltA as part of a multienzyme complex mediating peptidoglycan synthesis as well as its suitability as a novel target for antimicrobials will be examined by solving its crystal
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structure. These studies will provide a framework for future studies aimed at structurebased drug design and will provide substantial insight into the mechanisms of peptidoglycan synthesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MUCOSAL VACCINES AGAINST GONORRHEA Principal Investigator & Institution: Russell, Michael W.; Research Professor of Microbiology; Microbiology and Immunology; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2004 Summary: (Adapted from Applicant's Abstract) The objective of this proposal is to evaluate the use of a newly discovered, highly conserved outer-membrane protein antigen of Neisseria gonorrhoeae, designated NspA, as a potential candidate vaccine against gonorrhea, when administered by mucosal routes designed to induce high levels of antibodies in the genital tract. This will be accomplished by exploiting a novel technology, developed in this laboratory, for fusing bacterial protein antigens to the A2 subunit of cholera toxin (CT) and co-expressing the fusion protein with the nontoxic binding (B) subunit of CT, to form chimeric immunogens of the form NspA-CTA2/B, in which the toxic A1 subunit of CT has been replaced by the desired antigen. Chemical conjugates of NspA and CTB will also be evaluated. Alternative constructs will utilize type II heat-labile enterotoxins of Escherichia coli, which have different binding properties. Immunogens of this type have previously been shown to induce strong mucosa and circulating antibody responses when administered by mucosal routes. Specific IgA and IgG antibody responses in the genital tract (and other mucosal sites) and in the serum will be determined in mice immunized with these constructs as applied by intranasal or intragastric routes. Specific antibody secreting cells, specific T cells and the cytokines secreted by T cells will also be evaluated to assess the immune response in detail. A newly described mouse model of genital tract colonization by N. gonorrhoeae will be used to determine the ability of NspA-CTA2/B chimeric proteins and other constructs to elicit protective immunity against gonococcal infection. Potential mechanisms by which the expected IgA and IgG antibodies to NspA may be effective in protection against gonococcal infection of the genital tract will be examined by developing monoclonal IgA and IgG antibodies from mice mucosally immunized with NspA-CTA2/B constructs, and testing their ability to inhibit gonococcal adherence to and invasion of epithelial cells in culture, and to suppress genital colonization of mice with N. gonorrhoeae. The successful accomplishment of these objectives should provide a basis for further considering NspA as a component of a vaccine against gonorrhea, and for proposing trials designed to evaluate human genital tract immune responses to NspA-CTA2/B chimeric proteins. The information gained about genital tract immunity and the techniques used may also be applicable to other sexually transmitted diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NATURAL HISTORY OF HPV--INFECTION TO NEOPLASIA Principal Investigator & Institution: Moscicki, Anna-Barbara B.; Professor; Pediatrics; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-JUL-1990; Project End 31-AUG-2005 Summary: (Adapted from investigator's abstract): The long term goal of this renewal is to better understand local and systemic immune responses to human papillomavirus (HPV) infection in its natural setting of the cervix early in its course as well as in states
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of persistence or clearance. The first aim of the study is to examine the local immune response in the natural history of cervical HPV infection in young women by comparing changes in the local cervical cytokine milieu, specifically interferon (IFN)-gamma, interleukin (IL)-12, IL-2, IL-10 and IL-4, in association: a) persistence, b) clearance of initial and/or c) secondary infections, and d) development of SIL. The second aim is to examine systemic response to HPV specifically cytotoxic T cell response to HPV 16 infections in association with the four HPV states described above. Four groups of women will be recruited for the study: 1) women with a long history of persistent HPV infection, 2) women with secondary HPV type infections, 3) adolescent and young women with evidence of initial HPV infection, 4) women with a long history of persistent HPV negativity (control group). Examinations for women from the first three groups seen every 4 months will include samples for: HPV DNA, cytology, cervical cell cytokine analysis using RT-PCR, C. trachomatis, N. gonorrhea, herpes simplex virus, bacterial vaginosis, and peripheral blood CTL assays on women with HPV 16 infection. The control group (HPV negative) will have similar examinations every 6 months and have HPV serology to virus-like particles (VLP) to characterize HPV exposure not defined by repeated HPV testing. The understanding of both local and systemic immune responses to initial and subsequent HPV infections may be key in vaccine or therapeutic developments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ONCOGENIC HUMAN PAPILLOMAVIRUSES & PROSTATE CANCER RISK Principal Investigator & Institution: Stanford, Janet L.; Head, Prostate Cancer Research Program; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2001; Project Start 10-SEP-2001; Project End 31-AUG-2003 Summary: Prostate cancer is the most frequent cause of cancer in men, yet few risk factors for this disease have been identified. Some prior studies suggest that sexual behavior and associated exposure to sexually transmitted agents enhance risk In particular, number of sexual partners, age at first intercourse, sexual frequency, history of gonorrhea and syphilis, and serologic evidence of syphilis and oncogenic subtypes of human papillomavirus (HPV) have been associated with risk of prostate cancer, but results have not been confirmed. In a recent study of risk factors for prostate cancer in men under age 65 years, we found a significant increase in risk with increasing number of female sexual partners (trend p <0.001), which we hypothesize is related to prior exposure to I-IPV-16 or -18. To test this hypothesis, we propose a population-based casecontrol study that will analyze stored serum from histologically confirmed prostate cancer cases (n=648) diagnosed during 1993-1996 and ascertained by the Seattle-Puget Sound SEER registry and from control men (n--571) without a history of prostate cancer and frequency matched on age to cancer cases. Virus-like particle ELISA serologic assays will be used to detect BPV-16 and -18. Detailed data on known and suspected risk factors for prostate cancer will be available from in-person interviews. Unconditional logistic regression will be used to estimate relative risks associated with HPV- 16/-18 infection, controlling for potential confounding factors. Clinical data on prostate cancer cases will be utilized to assess whether associations with HPV differ according to disease aggressiveness. Results from this study will provide insight on whether or not these oncogenic HPV subtypes play a role in prostate cancer etiology. If there is an association, the results will have important public health implications since both the exposure and the disease are common.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ORAL ACQUISITION OF HIV INFECTION Principal Investigator & Institution: Shafer, Kimberly P.; Assistant Adjunct Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 15-APR-1999; Project End 31-MAR-2004 Summary: Although the number of case reports and epidemiologic evidence of orogenital transmission of HIV infection has increased in recent years, little is known about biological, behavioral or social risk factors that may be associated with this mode of transmission. We propose to identify risk factors for oral acquisition of HIV infection using a case-control study design. By using a uniform method of identifying recent seroconverters (dual or "detuned" enzyme immunoassay) who report only receptive oral sex as a mode of transmission, a uniform oral and periodontal exam, sexually transmitted disease screening, and standardized questionnaires, to measure biological, behavioral and sociodemographic data, we will study a question of great concern to communities at risk of HIV infection. The Specific Aims of this proposal are: 1. To assess whether host oral environment including signs and symptoms of periodontal disease (e.g. gingival bleeding or loss of attachment), and/or oral health practices are associated with increased odds of oral acquisition of HIV infection. 2. To assess which specific orogenital sexual practices and oral exposure to ejaculatory fluids (such as swallowing or not swallowing semen) are associated with increased or decreased odds of oral acquisition of HIV. 3. To assess whether comorbid conditions documented within the seroconversion period (e.g. sexually transmitted disease such as gonorrhea, chlamydia and other viral infections such as HSV-1 or 2) are associated with increased or decreased odds of oral acquisition of HIV. 4. To assess whether non-injecting substance use which may modify the oral or naso-pharyngeal mucosa and/or sexual behavior is associated with increased or decreased odds of oral acquisition of HIV. The case-control design cannot estimate infectivity or the rate of oral HIV infection, but is the only feasible way to study factors which may influence the risk of oral infection. Identification of the cofactors for orogenital HIV acquisition will provide us with the kind of data that can be used by AIDS prevention programs and by members of AIDS risk groups themselves so that the risk for HIV transmission can be lowered even further. For this reason, this study addresses a crucial public health goal, one that is long overdue for careful epidemiological study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PENICILLIN-RESISTANT NEISSERIA GONORRHOEAE (CMRNG) Principal Investigator & Institution: Nicholas, Robert A.; Pharmacology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-APR-1996; Project End 31-MAY-2006 Summary: Antibiotic resistance in Neisseria gonorrhoeae remains a very important problem. Penicillin and tetracycline, which were once the antibiotics of choice for treatment of gonococcal infections, are no longer used due to the preponderance of strains resistant to these agents. Resistance to currently recommended antibiotics is also increasing. My laboratory is interested in the mechanisms of chromosomally-mediated antibiotic resistance in the gonococcus, especially those that promote high- level resistance and subsequent treatment failure. Intermediate- level chromosomallymediated resistance to penicillin and tetracycline is due to three resistance loci. These
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include the penA gene encoding altered forms of penicillin-binding protein 2 (PBP 2), the mtr loci conferring resistance to hydrophobic agents, and the penB gene, which decreases outer membrane permeability. The genes involved in mediating high-level penicillin resistance, however, have been difficult to identify. Our work during the last funding period has identified two resistance genes, ponA and penC, which together mediate high- level penicillin resistance, and a third gene, tetGC, which confers highlevel tetracycline resistance. This proposal outlines experiments to clone and characterize the penC and tetGC genes and to elucidate the mechanisms by which they increase resistance. In addition, we propose experiments that follow up on our structure/function studies of the penB gene product, porin IB, to understand how mutations in this protein increase both penicillin and tetracycline resistance. We also propose studies to complete our work on the crystal structure of penicillin- binding protein 2 (PBP 2), an essential penicillin target, and several mutant forms that display a lower affinity for beta- lactam antibiotics. In addition, we will engage in new structural studies of wild-type and mutant forms of porin IB to explicate in molecular detail how mutations in this protein decrease antibiotic permeability. The combination of genetic, biochemical, biophysical, and structural approaches outlined in this proposal will provide important insight into the mechanisms by which this important human pathogen becomes resistant to antibiotics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PID IN IUD VS INJECTABLE CONTRACEPTIVE USERS PILOT STUDY Principal Investigator & Institution: Feldblum, Paul J.; Family Health International Box 13950 Research Triangle Park, Nc 27709 Timing: Fiscal Year 2001; Project Start 22-SEP-2000; Project End 31-DEC-2003 Summary: (Adapted from applicant's description): The applicant proposes a Pilot Study to assess the feasibility of a randomized controlled trial comparing the incidence of pelvic inflammatory disease (PID) in users of copper intrauterine devices (IUDs) to the incidence in users of injectable depotmedroxyprogesterone acetate (DMPA). If indicated by the Pilot Study, the applicant will propose a larger Main Clinical Trial to measure and compare the PID risks of the IUD and DMPA more accurately. Pilot Study specific aims are: to determine the feasibility of enrolling and randomly assigning family planning acceptors to IUD or DMPA use; to collect information on the suitability of our four participating sites for a subsequent Main Clinical Trial, including: baseline prevalence of cervical gonorrhea and chlamydia among 100 study participants randomized to IUD or DMPA use; baseline prevalence of cervical gonorrhea and chlamydia among 100 non-participating IUD and DMPA users at each study site, to increase the precision of the estimates; cumulative probability of PID among Pilot Study participants during follow-up; adequacy of clinic facilities and staff, especially with regard to the diagnosis of PID. Women at each site who are willing to initiate either IUD or DMPA use and are medically eligible for both will be approached. Each woman will be counseled and screened as envisioned for the Main Trial. Eligible women will receive the assigned method according to computer-generated random assignment cards in sealed opaque envelopes. Participants will be followed for up to twelve months each with visits scheduled at two weeks, one, three, six, nine and twelve months after enrollment. PID will be diagnosed according to two separate standards: a sensitive one designed to ascertain the maximum number of cases accepting some over-treatment; and a specific one that is more congruent with U.S. clinical definition and practice. Criteria for determining the feasibility of the Main Clinical Trial include: The applicant
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must succeed in randomizing, enrolling and following close to 400 women combined within nine months. The applicant must detect evidence of moderate STD prevalence and PID incidence in the cohorts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTION OF INFERTILITY IN WOMEN WITH SUBCLINICAL PID Principal Investigator & Institution: Wiesenfeld, Harold C.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2003; Project Start 01-MAY-1998; Project End 31-JAN-2008 Summary: (provided by applicant): The broad, long-term goals of this study are to evaluate whether longer course antibiotic therapy for women at-risk for subclinical PID prevents subsequent infertility better than currently used short course antibiotic regimens for lower genital tract infections. Subclinical pelvic inflammatory disease (PID) is an important yet overlooked cause of infertility, responsible for more cases of postinfectious tubal infertility than acute PID. Subclinical PID is present in 25% of women with gonorrhea or chlamydia, and one in seven women with bacterial vaginosis, despite the absence of symptoms of acute PID. Most importantly, there is a doubling in infertility among women with subclinical PID compared to women without PID. Current treatment strategies for cervicitis and vaginitis do not address ongoing upper genital tract inflammation. Our hypothesis is that the preservation of fertility is greater among women with subclinical PID treated with a long-course antibiotic regimen compared to women receiving standard single-dose regimens for uncomplicated lower genital tract infections. The proposed application describes a randomized, double-blind, comparative phase III clinical trial studying a novel treatment regimen that incorporates azithromycin, an antimicrobial with potent immunomodulatory properties, on fertility outcomes in women at-risk for post-infectious fallopian tube damage. The specific aims are to 1) compare fertility rate of women with subclinical PID receiving two weeks of broad-spectrum antibiotic therapy with the fertility rate of women with subclinical PID receiving single-dose antibiotic regimen, 2) determine whether the resolution of endometritis is more common in women treated with the enhanced antimicrobial regimens utilized for acute PID compared to currently recommended single-dose regimens for lower genital tract infections, 3) characterize the inflammatory response in the lower genital tract in women with and without subclinical PID, and 4) evaluate whether women with subclinical PID have evidence of fallopian tube inflammation. During this study, very real public health questions will be asked and answered which will affect the way that lower genital tract infections are routinely managed, potentially enhancing fertility among American women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: REDUCING HIV RISK IN FEMALE TEENS: A TAILORED APPROACH Principal Investigator & Institution: Diclemente, Ralph J.; Professor and Chairperson; Behavioral Scis & Hlth Educ; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAY-2005 Summary: The search for effective HIV interventions tailored to African American female adolescents remains a public health priority. A subgroup at considerable risk of HIV are African American adolescent females being treated for STDs. Thus, there is an
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urgent need for efficacious, cost-effective interventions that can be used in public health STD clinics to reduce female adolescents' HIV risk. The proposed study uses a Phase III randomized, controlled trial design, to evaluate the efficacy of an HIV intervention plus standard-of-care counseling compared with standard-of-care counseling only. A random sample of 960 females, 15-19 years of age, will be recruited at the Fulton County Department of Health and Wellness (FCDHW) STD Program following receipt of STD treatment and standard-of-care counseling. Eligible teens, at baseline, will complete an audio computer-assisted interview (ACASI) and provide a urine specimen that will be analyzed using nucleic acid amplification assays to detect STDs (chlamydia, gonorrhea, and trichomoniasis). The interview, derived from Social Cognitive Theory and the Theory of Gender and Power, will measure HIV risk behaviors, sociodemographics, culturally- and gender-relevant factors associated with risk and preventive practices, and other theoretically-relevant mediators of HIV risk behaviors. After 40 adolescents complete baseline assessments, they will be re- contacted and asked to return to the FCDHW (we expect 80 percent will return). Returning teens will be randomized to either an HIV intervention or a control condition. Adolescents in the control condition will view a video about the importance of nutrition. Those assigned to the HIV intervention will participate in a culturally-relevant and gender-tailored intervention implemented by FCDHW health educators, assisted by peer educators, over three consecutive Saturdays. The HIV intervention will emphasize enhancing: (a) gender and ethnic pride, (b) HIV prevention knowledge, (c) self-efficacy for condom use, negotiation skills, and refusal skills, (d) norms supportive of abstaining from sex and using condoms if engaging in sexual behavior, and (e) building healthy relationships. All adolescents will return at 4-, 8- and 12-months post-intervention to complete an ACASI interview, similar to the baseline interview, and provide a urine specimen for STD assay. Immediately following their completion of the 4- and 8-month follow-up assessments, adolescents in the HIV intervention will also participate in booster sessions designed to reinforce prevention messages and prevent relapse to risk behaviors. An intent-to-treat analysis, controlling for baseline assessments, will determine the efficacy of the HIV intervention plus the standard-of-care counseling, relative to standard-ofcare STD counseling only, in reducing HIV sexual risk behaviors and incident STDs over a 12-month follow-up period. Secondary analyses will evaluate the impact of the intervention condition, relative to the control condition, on hypothesized mediators of HIV-preventive behavior, and, evaluate the cost-effectiveness of the intervention condition, relative to the control condition, with respect to increasing random use and averting incident STDs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REDUCING YOUTH DRUG RELATED HIV/STD RISK IN THAILAND Principal Investigator & Institution: Celentano, David D.; Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Methamphetamine (MA), a central nervous system stimulant, has become the leading drug of abuse in Thailand over the past three years. The United Nations' Drug Control Program reported that the most significant increase of illicit drug use worldwide in the1990s was in the consumption of amphetamine-type stimulants (ATS). The WHO estimates more than 35 million regular users of MA worldwide, making it the second most commonly used illicit drug after marijuana. With recent drought and subsequent reduced poppy production in Burma, the Burmese military junta in power has responded to declining foreign reserves by encouraging the
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production and shipment of massive quantities of methamphetamine into Thailand during the past two years. These mobile factories are very difficult to locate and the MA tablets are easily concealed and smuggled, resulting in easy access and low price in Thailand. There are a range of social and medical consequences of MA abuse: poor performance in schools among students; anxiety; convulsion; brain damage; MA psychosis, characterized by violent behavior, repetitive activity, memory loss and paranoia; and acquiring HIV and other blood-borne infections from administering MA by injection. In Thailand, youth are the leading age group initiating MA use. A recent Thai national survey estimated that 12.4 percent of students between 12 and 20 years used illicit drugs in 1999, of whom 57 percent reportedly have used MA. Thus, there is a compelling public health need to address the issue of MA abuse among adolescents and young adults in northern Thailand. Preventing escalation of drug use practices, particularly with respect to route of drug administration, may prove effective in preventing the spread of HIV among those who have not yet begun injecting; HIV prevalence among injectors in northern Thailand is currently over 30 percent. In response to this public health emergency, we are proposing a randomized, controlled peer-outreach intervention trial targeting methamphetamine users (n=258) and their drug and sexual networks (n=1032) in northern Thailand. We will adapt Latkin's intervention that has been demonstrated effective in the USA in reducing HIV-related risk behaviors among IDUs. The primary study endpoint would be reduction in transition to injection drug use among MA users who currently deny any history of injection. The primary objective of this RCT is to assess the efficacy of a peer educator intervention versus HIV voluntary counseling and testing (VCT) on transition to injection drug use among MA users and their peer networks. The intervention addresses reduction of HIV risk behaviors. A series of behavioral measures for HIV risk, level of MA abuse (including overdose and psychiatric morbidity) and injection use among the index and network members will be used to evaluate the efficacy of the intervention. Secondary objectives include: (1) To compare the incidence of sexually transmitted infections (C trachomatis, N gonorrhea, and, for women, T vaginalis) and Hepatitis C Virus in each study condition; (2) To compare changes in HIV and sexual risk behaviors in each study condition for index participants and network members; and (3) To compare perceived changes in substance use network norms for drug and sexual risk practices in each study condition. This study builds on an active NIDA study (DA11133) of our Thai collaboration, is an appropriate extension of our work on HIV and drug use epidemiology and is responsive to a public health problem of central concern to our host country. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RELATIONSHIP BETWEEN SUBSTANCE ABUSE AND SEXUAL BEHAVIOR Principal Investigator & Institution: Grossman, Michael; Distinguished Professor; National Bureau of Economic Research Cambridge, Ma 02138 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-FEB-2004 Summary: This proposal focuses on two aspects of the relationship between substance use and sexual behavior among teenagers and young adults. The first involves evaluating the extent to which the relationship between the use of such substances as marijuana, cocaine, and alcohol and various aspects of sexual behavior are causal. That is, does the use, of marijuana, cocaine and alcohol cause young people to initiate sexual intercourse at an earlier age, to be more likely to engage in sexual intercourse in the past month or past year, to be less likely to use condoms or other methods of birth control, to
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have had more sexual partners. or to have experienced an unplanned pregnancy? The second involves an investigation of the effects of state and local policies that attempt to reduce substance use on the outcomes just mentioned and on the incidence of sexually transmitted diseases (STDs), including acquired Immunodeficiency syndrome (AIDS). Examples of these policy variables are the prices of cocaine and marijuana (which depend on resources allocated to criminal justice), penalties imposed on users of these substances for possession, public spending for drug prevention, the price of alcohol (which depends on the rate at which it is taxed), and statutes pertaining to alcohol sales, advertising, and server liability. Five one individual-level panels, one individual-level survey of different teenagers pooled over five years, and two time series of state or city cross sections will be employed: the original National Longitudinal Survey of Youth (NLSY), the young adult sample of the NLSY, the new NLSY97, National Education Longitudinal Study of 1988 (NELS88), the National Longitudinal Study of Adolescent Health (Add Health), the Youth Risk Behavior Survey (YRBS), and two data series from the Centers for Disease Control and Prevention's (CDC) Sexually Transmitted Disease Surveillance Reporting System. Some specific questions to be addressed include: What are the effects of marijuana, cocaine, and alcohol use on a variety of indicators of sexual behavior and risky sex when these effects are obtained by multivariate statistical procedures such as instrumental variables and fixed effects that account for reverse causality and unmeasured variables'? How do these effects differ by gender, race, and age (teenagers versus young adults)? What are the effects of illegal drug and alcohol regulatory variables on sexual behavior, risky sex, and incidence rates of AIDS, chlamydia, and gonorrhea? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLES GONORRHOEAE
OF
PILIN
GLYCAN
IN
PATHOGENESIS
OF
N.
Principal Investigator & Institution: Banerjee, Asesh; Biology; Catholic University of America 620 Michigan Ave Ne Washington, Dc 20064 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: Neisseria gonorrhoeae (gonococcus, GC) not only causes uncomplicated gonorrhea but also complications like pelvic inflammatory disease and disseminated gonococcal infection. Pilus is an important pathogenicity factor of GC and is a polymer of the glycoprotein pilin. Glycans of pilin were proposed to play important role in GC pathogenesis. We have cloned a pilin galactosyl transferase (pgtA), that adds an alpha galactosyl. In most complicated disease strains, pgtA contains a poly-G tract like the other phase-variable genes that are frequently turned on and off to presumably provide GC with selective advantage in different niches of human body. However, in uncomplicated gonorrheal isolates, this poly- G is generally not present in pgtA. Hence, we hypothesize that the poly-G mediated high-frequency phase-variation of pgtA plays an important role in conversion of uncomplicated gonorrhea to more complex systemic diseases. In addition, our High pH Anion Exchange Chromatographic analysis of GC pilin glycans suggests presence of sugars that were not reported before. These observations lead to the hypothesis that GC pilin glycans are considerably more complex than the current models and some of these glycans can be associated with certain disease phenotypes or with particular sites of the human body. To test the stated hypotheses, the following specific aims are proposed: 1) Characterization of GC pilin glycans from selective strains and pilus glycosylation mutants and identification of novel pilin glycosylation genes; and 2) Examination of the role of pilin glycans in GC pathogenesis. These studies will further elucidate the mechanism of gonococcal
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infections. Additionally, glycosylation of many surface proteins, including pilins, of several pathogenic bacteria is being reported. Therefore, the study of the role of pilin glycans in GC pathogenesis is likely to provide important leads into the mechanisms of pathogenesis of other bacteria as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SEXUAL NETWORKS, PARTNER NOTIFICATION AND STD PREVENTION Principal Investigator & Institution: Golden, Matthew R.; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-MAY-2005 Summary: (adapted from applicant's abstract): Epidemiologic research on communicable diseases has evolved from using static models suitable for noncommunicable diseases to using dynamic mathematical models more appropriate for studying the diffusion of infections through populations over time. With the application of deterministic and stochastic models, attention has shifted from analyzing only the risk factors of individuals, to also the interactions between individuals that drive transmission of infection. For sexually transmitted infections (STIs), the focus of research has thus shifted from an initial emphasis on individual sexual risk behaviors to a more comprehensive integration of data including sexual mixing matrices, partnership concurrency, other sex partnership characteristics and ecological factors that influence all of these levels of interaction. Surprisingly little empirical data have been collected on these higher order patterns of sexual interaction, particularly on potential differences in patterns associated with the various STIs that have very different natural histories. The integrated training activities and research proposed will provide Dr. Golden with skills to facilitate his goal of becoming an independent academic investigator as he collects and analyzes such data. The proposed studies include systematic, concurrent analyses of patterns of sexual mixing and sexual network characteristics for important STIs with very dissimilar natural histories: two bacterial STIs (gonorrhea and chlamydial infection) and two viral STIs (newly acquired genital herpes and HIV). Three federally funded studies at the UW already support recruitment of individuals with these infections, allowing the proposed studies to be added with only small additional cost. Mentoring by Dr. Geoff Garnett at Oxford University, and Drs. King Holmes and Martina Morris at the UW will help guide development of data on sexual networks and the use of such data to improve mathematical models designed to assess the potential impact of innovative preventive interventions. Specific aims will be to: 1) define sexual networks associated with gonorrhea and chlamydial infection and use empiric network data in mathematical models of transmission dynamics to evaluate the potential effect of partner notification, counseling and treatment on the prevalence of these two infections; and 2) To define the sexual networks associated with the acquisition of HIV and genital HSV infections, compare them to sexual networks of people with bacterial STI and without STIs, and use empiric network data in mathematical models of transmission dynamics to evaluate the potential effects of behavior and antiviral treatment interventions on the prevalence of these infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SEXUAL RISK REDUCTION AMONG MEN WITH MENTAL ILLNESS Principal Investigator & Institution: Susser, Ezra S.; Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032
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Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: (Applicant's abstract): In this application we propose to advance the work of developing safe and effective prevention services to combat the epidemic of HIV and sexually transmitted infections among men with severe mental illness. We will conduct a randomized clinical trial of a sexual risk reduction intervention among at-risk, innercity men with severe mental illness attending outpatient psychiatric clinics. The intervention is theory-based and preliminary data suggest efficacy. We also propose to gather descriptive epidemiological data on the prevalence and incidence of gonorrhea and chlamydia among the men enrolled in the clinical trial. Such infections impact on the health of the severe mentally ill and place them at greater risk of HIV infection. The data will enable mental health providers to assess the value of incorporating the diagnosis and treatment of sexually transmitted infections into the routine care of men with severe mental illness. The clinical trial will enroll 200 men and follow them for 24 months. The trial is designed to minimize potential biases and accurately assess both short-term and long-term efficacy of the intervention. The primary outcome will be selfreported sexual risk behavior. Trends in the incidence of sexually transmitted infections will be used for corollary evidence of an intervention effect. We will thoroughly examine the implications of the data for service provision and disseminate the results as appropriate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SEXUALLY TRANSMITTED DISEASES COOPERATIVE RESEARCH CENTE Principal Investigator & Institution: Rice, Peter A.; Professor & Chief; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003 Summary: The major objectives of this STD-CRC are directed towards the prevention and control of two major STD pathogens, Chlamydia trachomatis and Neisseria gonorrhoeae in the context of their natural settings-patients infected with these organisms. Five research projects and four service cores (Administrative, Clinical, Laboratory and Statistical) are proposed. In the first project we propose to develop and evaluate an educational intervention to prevent Chlamydia infection among sexually active inner city youths using the populations of two Boston adolescent clinics (Boston Medical Center and Children's Hospital). In the second Project, we propose to use newly developed genetic techniques to identify novel virulence genes and mechanisms focusing particularly on how C. trachomatis regulate their dimorphic life cycle. In the third Project we proposed to examine the role of bacterial LPS (or LOS) receptors, CR3 and CD14, in the host response to genital infections with N. gonorrhoeae and C. trachomatis. We believe that innate immune responses determine the extent of uptake by both professional and non-professional phagocytes of these two pathogens. In the fourth Project we propose to examine the trafficking pathway of N. gonorrhoeae after it enters genital epithelial cells and the effects of the up-regulated asialoglycoprotein receptor in these events. Together with the third project we will also examine the basis upon which these cells produce cytokines in a CD14 independent fashion. In the fifth Project we propose to continue to investigate the immunologic hypothesis that women who resist infection with N. gonorrhoeae when exposed may have protective immunity. We will determine in vivo expression of and the immune response to a group of ironregulated proteins in subjects with gonorrhea, examining also whether women who resist gonococcal infection harbor potentially protective immune responses. Together
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with the fourth Project, we will also examine the regulation of these proteins in the model of urethral epithelial cell infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SEXUALLY TRANSMITTED DISEASES COOPERATIVE RESEARCH CTR Principal Investigator & Institution: Hillier, Sharon L.; Professor; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003 Summary: This Sexually Transmitted Diseases Cooperative Research Center will emphasize prevention of selected STDs and the consequences of STDs. In particular we are stressing STDs which have significant adverse impact on the health of women. With this approach we will identify ways in which the burden of complications associated with STDs that disproportionately result in adverse effects on the reproductive health of women can be reduced. To achieve this goal we will be taking several approaches. Two intervention studies, an indirect and direct approach will be undertaken to prevent acquisition of bacterial vaginosis (BV), chlamydia and herpes and thereby the complications associated with these STDs. In a biologic intervention approach use of a Lactobacillus capsule will be assessed in a double-blinded placebo-controlled trial to prevent infection with BV, C. trachomatis, and other genital infections. By studying the stigma associated with herpes and developing an intervention designed to produce more rational herpes-related decision making we are attempting to prevent acquisition pf HSV. Determining the antimicrobial protective function of secretory leukocyte protease inhibitor (SI PI) will add to our knowledge understanding of the biologic interaction between T. vaginalis and HIV and other STDs; it also may lead to innovative vaginal microbicidal strategies. Determining the molecular mechanisms of gonococcal iron acquisition and the expression and immunogenecity of iron acquisition will provide information relevant to developing gonococcal vaccines based on the human transferrin-binding protein complex and pathogen-targeted antimicrobial interventions targeting the iron-acquisition mechanism of N. gonorrhea. This STD CRC proposal integrates clinical, epidemiological, behavioral and fundamental research into a collaborative effort by investigators from Ob/Gyn, Medicine, Infectious Diseases, Microbiology, Immunology, Behavioral Sciences and Epidemiology that addresses the disproportionate burden of the STD epidemic that affects women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SPORE PEPTIDOGLYCAN SYNTHESIS IN BACILLUS SUBTILIS Principal Investigator & Institution: Popham, David L.; Assistant Professor; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2002 Summary: The incidence of gonorrhea has decreased during the last decade. In stark contrast to this downward trend, the proportion of strains showing drug resistance has increased. Penicillin resistant strains were first reported in 1976 and, since that time, drug resistant Neisseria gonorrhoeae isolates from various parts of the world have been described. Although some quinolones and extended-spectrum cephalosporins are currently proving adequate for a treatment regimen, species vulnerability will likely diminish and antimicrobial resistance is a matter of time. Physiological adaptability and evasion of immune host response contribute to microbial persistence and many of these strategies can be manifested through and by the components of the outer surface
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Hpooligosaccharide (LOS). Foremost, and probably related, are the demonstrable antigenic variations and oligosaccharide (OS) heterogeneity. Transparent to a significant part of these differences is the mAb 2C7, which recognizes an OS epitope that is widely expressed in vivo. A better understanding of the structural features of reactivity for 2C7 may provide an improved basis for gonococcal vaccine development. In this investigation, using several known andone unknown LOS, we are carrying out their structural characterization using simple chemical manipulations and the mass spectrometry techniques of electrospray ionization, collision-induced decomposition tandem mass spectrometry. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STD RISKS AND LATINO ADOLESCENTS' SEXUAL NETWORKS Principal Investigator & Institution: Padian, Nancy S.; Professor; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 29-SEP-2000; Project End 31-JUL-2004 Summary: Recent research has shown that the structure of sexual networks can increase individuals' risks for sexually transmitted diseases (SIDS) and pregnancy. Accordingly, sexual networks are currently being examined in several studies among adolescents. However, there are nonesuch studies specifically targeting Latino/a teens, even though compared to most other ethnic and racial groups, Latino teens are at increased risk for STDs and have the highest rates of pregnancy. This is a particular problem in California, and especially in the Bay Area, where Latinos represent the fastest growing ethnic group. To address this deficiency, we propose a two-year longitudinal study to examine social and sexual networks of Latino/a adolescents, 14-19 years old, from the Mission District of San Francisco. Our project has three specific aims: 1) to measure the size and structure of Latino/a adolescents' social and sexual networks, at baseline and over time, including the association between network structure and membership with reproductive health outcomes (STDs and pregnancy); 11) to identify predictors of membership in high-risk sexual networks among Latino adolescents using factors derived from the Social Cognitive Model of the Development of Ethnic Identity and from Problem Behavior Theory (such as family, peer and community influences as well as independence and desire for achievement); and III) to compare the configuration, properties, and mixing matrices of sexual and social networks of Latino/a adolescents with those of African American adolescents in a contiguous geographic area using data from a parallel, companion study. In order to characterize social and sexual networks, we propose a form of egocentric sampling based on an initial, population- based random sample of index individuals recruited without regard to infection status that then builds on snowball sampling of partners. Our cohort of initial respondents will consist of sexually active teens who have been randomly selected, one or two of their closest friends who also meet eligibility criteria, as well as randomly selected teens who are sexually inactive at baseline, but who become so over the course of the study. The network will be derived from recruitment of two generations of their sexual partners and information about their friends. Participants will be interviewed using state-of-theart interviewing techniques (audio computer-assisted self-interview [ACASI]) and tested for gonorrhea and chlamydia (using ligase chain reaction) and pregnancy by collection of urine specimens. The study will permit detailed examination of the combined influence of epidemiologic, psychosocial, behavioral, and network factors on sexual risk taking, the acquisition of STDS, and likelihood of pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STD-RELATED CARE SEEKING AMONG ADOLESCENTS IN BALTIMORE Principal Investigator & Institution: Cunningham, Shayna D.; International Health; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Delay in seeking screening and obtaining treatment for sexually transmitted diseases (STDs) presents a significant public health problem. Individuals who delay medical care are more likely to transmit the infection to others, are at increased risk for HIV and a have a greater probability of adverse sequelae. One of a few studies that examined adolescents' STD-related care seeking behavior revealed that symptomatic females delayed seeking STD-related care significantly longer than both asymptomatic females and symptomatic males. The objective of this study is to examine the individual, relational and environmental factors associated with STDrelated care seeking behavior among young women ages 15-24 in Baltimore, Maryland. The specific aims are to: 1) explore the factors associated with young women's ability to detect symptoms and the terms they employ to describe these symptoms; 2) determine the types of actions young women typically take to address STD symptoms and the factors that influence young women's STD-related care seeking behavior; and 3) determine the factors that influence young women's decision to discuss STD symptoms and/or diagnoses with their sexual partners. Both qualitative and quantitative methods will be used to answer the study aims. For Aim 1, in-depth interviews will be held with female adolescents who are the partners of males who have tested positive for gonorrhea or chlamydia. For Aims 2 and 3, a longitudinal household based survey among a representative sample of adolescents residing in Baltimore city, Maryland will be conducted. A greater understanding of these processes will assist program planners in the development of more effective prevention and control services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STDS AND THE PATHOGENESIS OF SUBCLINICAL PID Principal Investigator & Institution: Sweet, Richard L.; Professor and Chair; MageeWomen's Hospital of Upmc 300 Halket St Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 30-APR-2003 Summary: Unrecognized pelvic inflammatory disease (PID) may be a major factor in the pathogenesis of tubal factor infertility. This is supported by the presence of serologic evidence of prior sexually transmitted diseases (STD's) in a large proportion of women with tubal factor infertility, yet most of these women do not recall a history of STD's or PID. In addition, many women with lower genital tract infection associated with STD's (gonorrhea, chlamydia, bacterial vaginosis) have histologic evidence of endometritis even though they do not have symptoms of PID. Our hypothesis is that unrecognized PID due to STD's is associated with tubal obstruction. We propose to test this hypothesis in a cohort of 1500 women aged 15-30 with lower genital tract STD associated infection. A group of 200 women with acute symptomatic PID will be evaluated for comparison. Specimens will be obtained from the vagina and cervix for microbiologic analysis and measurement of defensins (neutrophil granule products). An endometrial biopsy will be obtained for histologic and microbiologic analysis. The primary outcome of this study is tubal impatency, therefore all women will undergo a hysterosalpingogram 12 weeks from enrollment. Other outcomes include infertility and ectopic pregnancy formation, which will be determined using regular telephone contact for at least one year to determine the rate of adverse reproductive sequelae. The frequency of tubal impatency
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will be compared between women with acute symptomatic PID, women with unrecognized PID, and uninfected women. The risk of unrecognized PID will be compared between women testing positive for an STD and uninfected women. As the diagnostic accuracy for the diagnosis of PID is currently suboptimal, risk factors for unrecognized PID will be established, a clinical prediction model will be devised, and defensins from the lower genital tract will be evaluated as less-invasive markers of PID. The microbiology and histology of unrecognized PID will be compared to these findings in acute PID, in an effort to understand the pathogenesis of PID. Information obtained from this study will: i) determine the role of unrecognized PID in subsequent tubal damage ii) establish risk factors and predictors of PID iii)improve the understanding of the pathogenesis of PID. Earlier detection of unrecognized PID will enable more timely treatment, with the intent on reducing the rate of tubal impatency and resultant adverse reproductive sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STIS/HIV RISK IN YOUNG ADULTS: A MULTILEVEL APPROACH Principal Investigator & Institution: Upchurch, Dawn M.; Associate Professor; Community Health Sciences; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 09-SEP-2002; Project End 30-JUN-2005 Summary: (provided by applicant): The objectives of this inquiry are to: (i) investigate the sociodemographic correlates of current STI/HIV status and history; (ii) examine the multiple ways that sexual and protective practices influence STI risk; (iii) explore how interpersonal and sexual relationship-specific factors affect these practices; and (iv) assess the ways in which social environments influence individual risk. To attain these objectives, we will analyze data from the National Longitudinal Study of Adolescent Health (Add Health), a three-wave panel survey of a nationally representative sample of over 20,000 adolescents followed through their young adult years. Several sources of data will be used in the proposed research: biomarker indicators of gonorrhea, Chlamydia, trichomoniasis, and HIV; self-reported STI histories; person- and relationship-specific sexual and protective practices; psychosocial and sociodemographic measures; and social and demographic variables for census tracts, counties, and states. The core premise of the investigation is that multiple levels of social context shape individuals' attitudes and beliefs, which in turn affect individuals' relationship experiences and sexual and protective practices, which ultimately affect their risk of STIs. The proposed study has three major components. First, we will compare biomarker and self-report data to assess STI risk. Second, we will assess the relative contributions of four critical sexual and protective practices on STI risk. Third, we will examine the effects of relationship-specific characteristics on the propensity to practice protective behaviors within relationships. The project will use several methods of multilevel modeling (e.g., fixed effects, Generalized Estimating Equations (GEE), random coefficients, classical estimation with covariance matrix adjustments via the "sandwich estimator" tailored for clustering) to account for clustering, and will also explore the effectiveness of alternate definitions of contexts in a study of STI and HIV. Because the study will use a population-based approach that incorporates multiple social contexts, it will be possible to assess the impact of intervention strategies targeted at individuals, relationships, and communities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE LONG-TERM IMPACT OF A NETWORK OUTREACH INTERVENTION Principal Investigator & Institution: Latkin, Carl A.; Professor; Health Policy and Management; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: (Adapted from Applicant's abstract): This is a proposal to evaluate the long term outcomes of the SHIELD study, a network-oriented, experimental HIV prevention intervention for African American injection drug users (IDUs). Based on social influence framework with theories of social diffusion and social identity, the intervention used peers as change agents to introduce safer sex and drug norms to their social networks. The study is designed to empirically examine social processes, such as norm formation and peer influence, hypothesized to explain intervention outcomes. 224 current and former drug users were trained in the 10-session intervention. Index participants were randomly assigned to either a peer outreach or an equal-attention control condition. The indexes and their peer network members were administered pre-intervention and 3month post intervention assessments, which will complete September 1999. Preliminary analysis of 118 participants suggests that indexes in the peer outreach condition reported fewer risk behaviors and more HIV-related discussions at the 3-month followup. We are requesting support to conduct 12-month, 18-month, and 24-month follow-up assessments to determine the long-term effects and diffusion of effects to 934 study participants, as well as non-participating eligible individuals for comparison. In addition to assessing long-term outcomes of the SHIELD study, we seek to identify characteristics of effective peer educators, individuals for whom the intervention was most beneficial, and factors that predict relapse of risk behaviors. We also propose to conduct urine-based screening of 3 sexually transmitted infections (STIs): gonorrhea, chlamydia, and trichomonas. In addition to their health sequelae, STIs are risk factors for HIV infection and transmission, are biological markers of HIV-related sexual behavior, and help validate self-reports of risk behaviors. The data will also used to examine associations between characteristics of sex partners and personal networks to describe sexual mixing patterns of this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TRUCKER TRANSMISSION
NETWORKS,
DRUG
USE,
AND
DISEASE
Principal Investigator & Institution: Apostolopoulos, Yorghos; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): The proposed research is designed to study the sexual and drug networks of US long-haul truckers and their potential role in the acquisition and dissemination of sexually transmitted and blood-borne infections. It builds upon and extends our small-scale studies with truckers, "truck chasers," and other trucker network groups that revealed extensive risk-taking, ranging from IDU to frequently unprotected sex. With primarily male heterosexual truckers at their center, trucker risk networks include such diverse groups as: men who have sex with men including "truck chasers" and sex workers (CB hustlers, "buffaloes"); female sex workers (CB prostitutes, "lot lizards," "traveling ladies," American and Mexican brothel workers, motel sex workers, street walkers/hustlers); female "truck chasers;" drug dealers/pushers/runners and pimps; "polishers," "lumpers," homeless, and hitchhikers; trucking company and truck plaza employees; home setting social and risk contacts; and
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other sexual and drug contacts on the road. Despite demonstrated links between trucking routes and STI/HIV transmission in other parts of the globe, and truckers' potential role as bridges between populations with significant structural equivalence within truck plazas and other highway trucker settings in the US, there exists a research lacuna in the potential public-health repercussions of the constant movement of 3.3 million US. long-haul truckers. A combination of qualitative and quantitative designs and methodologies as well as biological testing are planned to achieve four specific aims: 1) the comprehensive ascertainment of how truckers' work milieu, interpersonal relationships, social network configurations, and home settings influence their drug use and sexual behaviors, placing them at risk for acquisition of STI/HIV and other bloodborne and sexually transmitted infections; 2) the establishment of baseline seroprevalence of HIV, HCV, HBV, syphilis, gonorrhea, and Chlamydia among trucker risk-network members and groups to generate epidemiologic profiles of infection; 3) the analysis of ethnographic results of the core trucker risk-network members and groups as well as baseline seroprevalence, in terms of the influence of higher-order causal levels; and 4) the utilization of ethnographic findings to develop and pilot test both paper-andpencil and computer-assisted personal interview (CAPI) versions of a survey instrument to assess truckers' risk taking, their highway, social and risk networks, and the acquisition of STI/HIV and other blood-borne and sexually transmitted infections. The successful implementation of these aims will be instrumental in generating longoverdue epidemiologic estimates of US. trucker networks' risk-taking via a cohort prospective study and in initiating an assessment process that will lead to risk/infection/disease mapping across trucking routes as well as risk reduction interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TYPE IV SECRETION BY NEISSERIA GONORRHOEAE Principal Investigator & Institution: Dillard, Joseph P.; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Neisseria gonorrhoeae causes the sexually transmitted disease gonorrhea, the more serious infections pelvic inflammatory disease (PID) and disseminated gonococcal infection (DGI). We identified a 57 kb genetic island present in N. gonorrhoeae that shows the characteristics of a pathogenicity island. Several forms of the gonococcal genetic island (GGI) are present among disease isolates, with approximately 80 percent of gonococcal strains carrying some form of the GGI. We identified a peptidoglycan hydrolase (atlA) encoded in the GGI and found that it is involved in the production of an unusual cytotoxin derived from the bacterial cell wall. This peptidoglycan-derived cytotoxin (PG-cytotoxin) is identical to the tracheal cytotoxin of Bordetella pertussis and is an important virulence factor in gonococcal infections. PG-cytotoxin causes the death of ciliated fallopian tube cells in organ culture, induces arthritis in rats, and induces IL-1 and IL-6 in cultured cells. The presence of atlA in the genetic island is significantly correlated with strains that cause DOT. DNA sequencing revealed that the GGI encodes a putative type IV secretion system. Type IV secretion systems include plasmid conjugation systems and virulence factor export systems and some type IV secretion systems carry out both processes. Mutations in the putative type IV secretion genes in the GGI result in loss of DNA secretion. These mutants also show delayed adherence to primary cervical cells and exhibit an unusual microcolony phenotype upon binding to cells. Mutations in atlA result in the same phenotypes as the other type IV secretion mutations as well as showing decreased PG-
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cytotoxin production. Thus AtlA is necessary for type IV secretion and is either directly or indirectly involved in PG-cytotoxin production. These results suggest that the GGI encodes an active type IV secretion system important in interaction of N. gonorrhoeae with the host. The goals of this proposal are contained in two specific aims. 1) We will make mutations designed to affect type IV secretion and test these mutants for secretion of proteins, DNA, and PG-cytotoxin. 2) We will test mutants with defects in secretion for phenotypes relevant to virulence, i.e., epithelial cell adherence and invasion, intracellular survival, and microcolony formation. Overall, these studies are designed to reveal the molecular mechanisms of this novel secretion system and identify previously unrecognized virulence factors important in gonococcal infection which may serve as new targets for chemotherapy or immunoprotection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: URINARY SYMPTOMS IN ADOLESCENT FEMALES: STI OR UTI? Principal Investigator & Institution: Huppert, Jill; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Sexually transmitted infections of the genital tract (STIs) and non-sexually transmitted infections of the urinary tract (UTIs) share common risk factors and presenting symptoms in women of reproductive age. Because adolescents constitute the age group at highest risk for STIs, the CDC recommends annual screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in all sexually active (SA) adolescents, regardless of symptoms. Because the clinical presentations of CT, GC, Trichomonas vaginalis (TV), and UTI may be similar, many experts recommend interim testing for all four infections in SA adolescent females who have urinary symptoms. Despite these recommendations, there are important gaps between ideal and actual clinical practice. The availability of sensitive and specific, noninvasive tests for CT, GC, and TV may increase both routine and symptom-based STI screening of SA adolescents. However, important questions regarding the triage of symptomatic patients remain unanswered. The goal of the proposed study is to elucidate the association between STIs and UTIs in SA adolescent females. It focuses on the three STIs that are highly prevalent, likely to cause urinary symptoms, and detectable on tests of urine or patient-obtained vaginal samples. The study sample will consist of 474 SA adolescent females presenting to a hospital-based teen health center w/urinary symptoms (n=158) and w/o urinary symptoms (n=316). Each subject will be interviewed during the visit by a trained research assistant for chief complaint, genitourinary symptoms, sexual history, and past medical history. Prior to physical examination, each subject will provide a urine sample and a self-collected vaginal swab sample. The urine will be tested by ligase chain reaction for CT and GC and cultured for bacteria; the vaginal sample will be cultured for TV. The CT, GC and TV prevalence rates will be compared in subjects with and without urinary symptoms and in subjects with and without UTI, defined as over 1000 colonies of a single organism. Best subset logistic regression analyses will be performed to identify the variables that identify subjects with urinary symptoms who have CT, GC, and/or TV, and the variable that identify subjects with urinary symptoms who have UTIs. The findings of this study will strengthen the evidence base for symptom-based STI testing of SA adolescent females and will promote care that addresses both individual patient and public health needs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: URINE-BASED POINT-OF-CARE CHLAMYDIA/GONORRHOEA TEST Principal Investigator & Institution: Gerdes, John C.; Vice President of Research & Development; Xtrana, Inc. 717 Yosemite Cir Denver, Co 80220 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2003 Summary: (provided by applicant): During phase I Xtrana/BioPool (formerly Molecular Innovations, Inc.) demonstrated the feasibility of a urine-based diagnostic test that potentially could be performed in the clinic to detect both genital chlamydia and gonorrhea. The strategy involves the release of Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC) ribosomal RNA, capture onto Xtrana/Biopool's XtraBind solid phase bead matrix, followed by direct isothennal amplification using Nucleic Acid Sequence Based Amplification (NASBA). After NASBA, haptenized primers are added so that the amplified product is directly visualized as a blue line immediately following wicking through a lateral flow membrane. The integration of solid phase capture, direct isothermal amplification, and visual lateral flow detection enables device platforms with simple protocols compatible with nucleic acid testing at the point-of-care at reduced cost using only a heat block for instrumentation. Finalized chemistry, device design, prototyping, and manufacturing, followed by clinical validation studies will be performed in phase II. At the conclusion of phase 11, extraction, amplification, and detection chemistry run within the prototype will be completed and its performance characterized utilizing urine specimens. PROPOSED COMMERCIAL APPLICATION: Not Available Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: VAGINAL DOUCHING AS A RISK FACTOR FOR VAGINITIS Principal Investigator & Institution: Hatch, Maureen C.; Director; Community and Preventive Med; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2001 Summary: (Adapted from investigator's abstract) Incident and recurrent vaginitis are highly prevalent health problems in women of reproductive age resulting in significant medical care costs and limitation of work activity. The symptoms of excessive vaginal discharge, malodor and intensive vulvovaginal pruritus can seriously impair women=s productivity and social life. Vaginitis also facilitates HIV transmission. Bacterial vaginosis and candidiasis are the most common causes of vaginitis. However, despite their high prevalence, risk factors for developing these infections remain unclear. The investigators hypothesize that frequent vaginal douching increases the risk of bacterial vaginosis and candidiasis by disturbing the normal vaginal microflora and immunologic defense system. To test this hypothesis, it is proposed to recruit a cohort of 1260 black women seeking treatment at Mount Sinai Hospital's outpatient gynecologic/family planning clinic between January, 1999 and June, 2000. A standardized questionnaire will be used to collect detailed information on douching practices and other risk factors for vaginitis, with particular attention to the three months prior to the clinic visit. In addition to recording clinical symptoms and signs, samples of vaginal discharge will be collected for diagnostic verification using Gram stain with scoring (for bacterial vaginosis) and culture (or Candida albicans). Subjects will also be tested for trichomoniasis (culture), gonorrhea and chlamydia (DNA probe tests); those with symptomatic infections will be excluded. The association between vaginal douching in the previous three months and risk of bacterial vaginosis and between douching and
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candidacies will be examined using multiple logistic regression models to control for confounding variables. In addition, frequency of douching and duration of douching practice will be examined to test a dose-response pattern. The investigators state that the elucidation of the role of douching practices in the etiology of vaginitis will have important public health implications and could make a major contribution to promoting women's health. Further, both douching and vaginitis are very common in minority heterosexual women, among whom the prevalence of AIDS is growing fastest. In the era of the AIDS epidemic, this study will have public health significance beyond vaginitis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “gonorrhea” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for gonorrhea in the PubMed Central database: •
Alteration of gonococcal protein expression in acidic culture. by Pettit RK, Filiatrault MJ, Martin ES.; 1996 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173877
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Comparison of single-dose cefuroxime axetil with ciprofloxacin in treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinaseproducing Neisseria gonorrhoeae strains. by Thorpe EM, Schwebke JR, Hook EW 3rd, Rompalo A, McCormack WM, Mussari KL, Giguere GC, Collins JJ.; 1996 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163620
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Comparison of single-dose oral grepafloxacin with cefixime for treatment of uncomplicated gonorrhea in men. The STD Study Group. by Hook EW 3rd, McCormack WM, Martin D, Jones RB, Bean K, Maroli AN.; 1997 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=164021
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Dose-ranging study of CP-99,219 (trovafloxacin) for treatment of uncomplicated gonorrhea. by Hook EW 3rd, Pinson GB, Blalock CJ, Johnson RB.; 1996 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163403
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Duration of Persistence of Gonococcal DNA Detected by Ligase Chain Reaction in Men and Women following Recommended Therapy for Uncomplicated Gonorrhea. by Bachmann LH, Desmond RA, Stephens J, Hughes A, Hook III EW.; 2002 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=130863
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Experimental Gonococcal Genital Tract Infection and Opacity Protein Expression in Estradiol-Treated Mice. by Jerse AE.; 1999 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96944
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Gonococcal infection in a nonhuman host is determined by human complement C1q. by Nowicki S, Martens MG, Nowicki BJ.; 1995 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173686
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Growth of Neisseria gonorrhoeae in the Female Mouse Genital Tract Does Not Require the Gonococcal Transferrin or Hemoglobin Receptors and May Be Enhanced by Commensal Lactobacilli. by Jerse AE, Crow ET, Bordner AN, Rahman I, Cornelissen CN, Moench TR, Mehrazar K.; 2002 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127891
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Identification of Discrete Domains within Gonococcal Transferrin-Binding Protein A That Are Necessary for Ligand Binding and Iron Uptake Functions. by Boulton IC, Yost MK, Anderson JE, Cornelissen CN.; 2000 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=97808
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Insertion Mutations in pilE Differentially Alter Gonococcal Pilin Antigenic Variation. by Howell-Adams B, Seifert HS.; 1999 Oct 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=103643
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InTray GC Medium Versus Modified Thayer-Martin Agar Plates for Diagnosis of Gonorrhea from Endocervical Specimens. by Beverly A, Bailey-Griffin JR, Schwebke JR.; 2000 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87483
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Lactate Stimulation of Gonococcal Metabolism in Media Containing Glucose: Mechanism, Impact on Pathogenicity, and Wider Implications for Other Pathogens. by Smith H, Yates EA, Cole JA, Parsons NJ.; 2001 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=100028
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Modulation of Gonococcal Piliation by Regulatable Transcription of pilE. by Long CD, Hayes SF, van Putten JP, Harvey HA, Apicella MA, Seifert HS.; 2001 Mar 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95045
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Natural proteoglycan receptor analogs determine the dynamics of Opa adhesinmediated gonococcal infection of Chang epithelial cells. by van Putten JP, Hayes SF, Duensing TD.; 1997 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175725
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Reduced Clinical Efficacy of Pazufloxacin against Gonorrhea Due to High Prevalence of Quinolone-Resistant Isolates with the GyrA Mutation. by Tanaka M, Matsumoto T, Sakumoto M, Takahashi K, Saika T, Kabayashi I, Kumazawa J, Group TP.; 1998 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105501
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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with gonorrhea, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “gonorrhea” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for gonorrhea (hyperlinks lead to article summaries): •
“Broken windows” and the risk of gonorrhea. Author(s): Cohen D, Spear S, Scribner R, Kissinger P, Mason K, Wildgen J. Source: American Journal of Public Health. 2000 February; 90(2): 230-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10667184&dopt=Abstract
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A geographic relation between alcohol availability and gonorrhea rates. Author(s): Scribner RA, Cohen DA, Farley TA. Source: Sexually Transmitted Diseases. 1998 November; 25(10): 544-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9858351&dopt=Abstract
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A randomized trial of ciprofloxacin versus cefixime for treatment of gonorrhea after rapid emergence of gonococcal ciprofloxacin resistance in The Philippines. Author(s): Aplasca De Los Reyes MR, Pato-Mesola V, Klausner JD, Manalastas R, Wi T, Tuazon CU, Dallabetta G, Whittington WL, Holmes KK. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 May 1; 32(9): 1313-8. Epub 2001 April 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11303266&dopt=Abstract
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A randomized trial that compared oral cefixime and intramuscular ceftriaxone for the treatment of gonorrhea in pregnancy. Author(s): Ramus RM, Sheffield JS, Mayfield JA, Wendel GD Jr. Source: American Journal of Obstetrics and Gynecology. 2001 September; 185(3): 629-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11568790&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A sustainable behavioral intervention to increase condom use and reduce gonorrhea among sex workers in Singapore: 2-year follow-up. Author(s): Wong ML, Chan KW, Koh D. Source: Preventive Medicine. 1998 November-December; 27(6): 891-900. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9922072&dopt=Abstract
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A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics. Author(s): Gershman KA, Barrow JC. Source: Sexually Transmitted Diseases. 1996 November-December; 23(6): 481-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8946633&dopt=Abstract
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Acceptability and feasibility of urine screening for Chlamydia and gonorrhea in community organizations: perspectives from Denver and St Louis. Author(s): Bull SS, Jones CA, Granberry-Owens D, Stoner BP, Rietmeijer CA. Source: American Journal of Public Health. 2000 February; 90(2): 285-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10667194&dopt=Abstract
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American Academy of Pediatrics. Committee on Child Abuse and Neglect. Gonorrhea in prepubertal children. Author(s): American Academy of Pediatrics. Committee on Child Abuse and Neglect. Source: Pediatrics. 1998 January; 101(1 Pt 1): 134-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11345976&dopt=Abstract
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An investigation of geographic clustering of repeat cases of gonorrhea and chlamydial infection in San Francisco, 1989-1993: evidence for core groups. Author(s): Ellen JM, Hessol NA, Kohn RP, Bolan GA. Source: The Journal of Infectious Diseases. 1997 June; 175(6): 1519-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9180198&dopt=Abstract
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Antimicrobial susceptibility of Neisseria gonorrhoeae in Cuba (1995-1999): implications for treatment of gonorrhea. Author(s): Llanes R, Sosa J, Guzman D, Llop A, Valdes EA, Martinez I, Palma S, Lantero MI. Source: Sexually Transmitted Diseases. 2003 January; 30(1): 10-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514435&dopt=Abstract
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Assessment of a geographically targeted field intervention on gonorrhea incidence in two New York State counties. Author(s): Han Y, Coles FB, Muse A, Hipp S. Source: Sexually Transmitted Diseases. 1999 May; 26(5): 296-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10333285&dopt=Abstract
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Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for Chlamydia and gonorrhea screening. Author(s): Brodine SK, Shafer MA, Shaffer RA, Boyer CB, Putnam SD, Wignall FS, Thomas RJ, Bales B, Schachter J. Source: The Journal of Infectious Diseases. 1998 October; 178(4): 1202-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806061&dopt=Abstract
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Can risk factor assessment replace universal screening for gonorrhea and Chlamydia in the third trimester? Author(s): Magriples U, Copel JA. Source: American Journal of Perinatology. 2001 December; 18(8): 465-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11733863&dopt=Abstract
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CDC says rates are up for gonorrhea, down for syphilis. Author(s): Vastag B. Source: Jama : the Journal of the American Medical Association. 2001 January 10; 285(2): 155. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11176791&dopt=Abstract
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Chlamydia and gonorrhea screening in San Francisco high schools. Author(s): Kent CK, Branzuela A, Fischer L, Bascom T, Klausner JD. Source: Sexually Transmitted Diseases. 2002 July; 29(7): 373-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12170123&dopt=Abstract
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Chlamydia, gonorrhea, and HIV-1 prevalence among five populations of women in the Czech and Slovak Republics. Author(s): Kacena KA, Dohnal K, Benesova V, Grivna M, Deliopolu J, Tryzna R, Horak J, Gaydos CA, Quinn TC. Source: Sexually Transmitted Diseases. 2001 June; 28(6): 356-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11403195&dopt=Abstract
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Ciprofloxacin for the treatment of uncomplicated gonorrhea infection in adolescents: does the benefit outweigh the risk? Author(s): Burstein GR, Berman SM, Blumer JL, Moran JS. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 October 15; 35(Suppl 2): S191-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353206&dopt=Abstract
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Clinical aspects of diagnosis of gonorrhea and Chlamydia infection in an acute care setting. Author(s): Mehta SD, Rothman RE, Kelen GD, Quinn TC, Zenilman JM. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 February 15; 32(4): 655-9. Epub 2001 Feb 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11181134&dopt=Abstract
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Clinical evaluation of ceftibuten in gonorrhea. A pilot study in Hong Kong. Author(s): Chong LY, Cheung WM, Leung CS, Yu CW, Chan LY. Source: Sexually Transmitted Diseases. 1998 October; 25(9): 464-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9800257&dopt=Abstract
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Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco. Author(s): Bloomfield PJ, Kent C, Campbell D, Hanbrook L, Klausner JD. Source: Sexually Transmitted Diseases. 2002 May; 29(5): 294-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984447&dopt=Abstract
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Comparative trial of azithromycin and ciprofloxacin in the treatment of gonorrhea. Author(s): Gruber F, Brajac I, Jonjic A, Grubisic-Greblo H, Lenkovic M, Stasic A. Source: Journal of Chemotherapy (Florence, Italy). 1997 August; 9(4): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9269606&dopt=Abstract
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Comparison of Neisseria gonorrhoeae isolates from the genital tract and pharynx of two gonorrhea patients. Author(s): Saika T, Nishiyama T, Kanayama A, Kobayashi I, Nakayama H, Tanaka M, Naito S. Source: Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy. 2001 September; 7(3): 175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11810580&dopt=Abstract
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Comparison of single-dose cefuroxime axetil with ciprofloxacin in treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinaseproducing Neisseria gonorrhoeae strains. Author(s): Thorpe EM, Schwebke JR, Hook EW 3rd, Rompalo A, McCormack WM, Mussari KL, Giguere GC, Collins JJ. Source: Antimicrobial Agents and Chemotherapy. 1996 December; 40(12): 2775-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9124839&dopt=Abstract
Studies
69
•
Comparison of single-dose oral grepafloxacin with cefixime for treatment of uncomplicated gonorrhea in men. The STD Study Group. Author(s): Hook EW 3rd, McCormack WM, Martin D, Jones RB, Bean K, Maroli AN. Source: Antimicrobial Agents and Chemotherapy. 1997 August; 41(8): 1843-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9257777&dopt=Abstract
•
Cost-effectiveness of five strategies for gonorrhea and chlamydia control among female and male emergency department patients. Author(s): Mehta SD, Bishai D, Howell MR, Rothman RE, Quinn TC, Zenilman JM. Source: Sexually Transmitted Diseases. 2002 February; 29(2): 83-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818893&dopt=Abstract
•
Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease. A 25-year study from an urban area of central Sweden. Author(s): Kamwendo F, Forslin L, Bodin L, Danielsson D. Source: Sexually Transmitted Diseases. 1996 September-October; 23(5): 384-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8885069&dopt=Abstract
•
Developing a collaborative community, academic, health department partnership for STD prevention: the Gonorrhea Community Action Project in Harlem. Author(s): VanDevanter N, Hennessy M, Howard JM, Bleakley A, Peake M, Millet S, Cohall A, Levine D, Weisfuse I, Fullilove R. Source: Journal of Public Health Management and Practice : Jphmp. 2002 November; 8(6): 62-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463052&dopt=Abstract
•
Disease surveillance in the ED: factors leading to the underreporting of gonorrhea. Author(s): Kirsch TD, Shesser R, Barron M. Source: The American Journal of Emergency Medicine. 1998 March; 16(2): 137-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9517687&dopt=Abstract
•
Dose-ranging study of CP-99,219 (trovafloxacin) for treatment of uncomplicated gonorrhea. Author(s): Hook EW 3rd, Pinson GB, Blalock CJ, Johnson RB. Source: Antimicrobial Agents and Chemotherapy. 1996 July; 40(7): 1720-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8807070&dopt=Abstract
•
Drug treatment of common STDs: part I. Herpes, syphilis, urethritis, chlamydia and gonorrhea. Author(s): Woodward C, Fisher MA. Source: American Family Physician. 1999 October 1; 60(5): 1387-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10524484&dopt=Abstract
70
Gonorrhea
•
Duration of persistence of gonococcal DNA detected by ligase chain reaction in men and women following recommended therapy for uncomplicated gonorrhea. Author(s): Bachmann LH, Desmond RA, Stephens J, Hughes A, Hook EW 3rd. Source: Journal of Clinical Microbiology. 2002 October; 40(10): 3596-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12354851&dopt=Abstract
•
Dynamics and control of the transmission of gonorrhea. Author(s): Yorke JA, Hethcote HW, Nold A. Source: Sexually Transmitted Diseases. 1978 April-June; 5(2): 51-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10328031&dopt=Abstract
•
Early intervention for human immunodeficiency virus in Baltimore Sexually Transmitted Diseases Clinics. Impact on gonorrhea incidence in patients infected with HIV. Author(s): Golden MR, Rompalo AM, Fantry L, Bein M, Perkins T, Hoover DR, Zenilman JM. Source: Sexually Transmitted Diseases. 1996 September-October; 23(5): 370-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8885067&dopt=Abstract
•
Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. Author(s): Roddy RE, Zekeng L, Ryan KA, Tamoufe U, Tweedy KG. Source: Jama : the Journal of the American Medical Association. 2002 March 6; 287(9): 1117-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11879108&dopt=Abstract
•
Empiric treatment of gonorrhea and chlamydia in the ED. Author(s): Wiest DR, Spear SJ, Bartfield JM. Source: The American Journal of Emergency Medicine. 2001 July; 19(4): 274-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11447510&dopt=Abstract
•
Epidemiology of gonorrhea. Author(s): St John RK, Curran JW. Source: Sexually Transmitted Diseases. 1978 April-June; 5(2): 81-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10328039&dopt=Abstract
•
Epidemiology of the reemergence of gonorrhea in Sweden. Author(s): Berglund T, Fredlund H, Giesecke J. Source: Sexually Transmitted Diseases. 2001 February; 28(2): 111-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11234784&dopt=Abstract
Studies
71
•
Evaluation of chlamydia and gonorrhea screening criteria: San Francisco sexually transmitted disease clinic: 1997 to 1998. Author(s): Ciemins EL, Kent CK, Flood J, Klausner JD. Source: Sexually Transmitted Diseases. 2000 March; 27(3): 165-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726651&dopt=Abstract
•
Failure of azithromycin therapy in gonorrhea and discorrelation with laboratory test parameters. Author(s): Tapsall JW, Shultz TR, Limnios EA, Donovan B, Lum G, Mulhall BP. Source: Sexually Transmitted Diseases. 1998 November; 25(10): 505-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9858344&dopt=Abstract
•
Field-delivered therapy increases treatment for chlamydia and gonorrhea. Author(s): Steiner KC, Davila V, Kent CK, Chaw JK, Fischer L, Klausner JD. Source: American Journal of Public Health. 2003 June; 93(6): 882-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773344&dopt=Abstract
•
Fluoroquinolone treatment failure in gonorrhea. Emergence of a Neisseria gonorrhoeae strain with enhanced resistance to fluoroquinolones. Author(s): Deguchi T, Saito I, Tanaka M, Sato K, Deguchi K, Yasuda M, Nakano M, Nishino Y, Kanematsu E, Ozeki S, Kawada Y. Source: Sexually Transmitted Diseases. 1997 May; 24(5): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9153731&dopt=Abstract
•
Fluoroquinolones, gonorrhea, and the CDC STD treatment guidelines. Author(s): Berman SM, Moran JS, Wang SA, Workowski KA. Source: Sexually Transmitted Diseases. 2003 June; 30(6): 528-9; Author Reply 530. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782957&dopt=Abstract
•
Follow-up program for emergency department patients with gonorrhea or chlamydia. Author(s): Kelly JJ, Dalsey WC, McComb J, Njuki F. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2000 December; 7(12): 1437-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11099438&dopt=Abstract
•
Formative research for interventions among adolescents at high risk for gonorrhea and other STDs. Author(s): Welych LR, Laws B, Fiorito AF, Durham TH, Cibula DA, Lane SD. Source: Journal of Public Health Management and Practice : Jphmp. 1998 November; 4(6): 54-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10187078&dopt=Abstract
72
Gonorrhea
•
Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system. Author(s): Becker KM, Glass GE, Brathwaite W, Zenilman JM. Source: American Journal of Epidemiology. 1998 April 1; 147(7): 709-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9554611&dopt=Abstract
•
Gonococcal susceptibility to antimicrobials in Baltimore, 1988-1994. What was the impact of ciprofloxacin as first-line therapy for gonorrhea? Author(s): Zenilman JM. Source: Sexually Transmitted Diseases. 1996 May-June; 23(3): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8724511&dopt=Abstract
•
Gonorrhea among drug users: an Alaskan versus a national sample. Author(s): Paschane DM, Fisher DG, Cagle HH, Fenaughty AM. Source: The American Journal of Drug and Alcohol Abuse. 1998 May; 24(2): 285-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9643466&dopt=Abstract
•
Gonorrhea among men who have sex with men: outbreak caused by a single genotype of erythromycin-resistant Neisseria gonorrhoeae with a single-base pair deletion in the mtrR promoter region. Author(s): Xia M, Whittington WL, Shafer WM, Holmes KK. Source: The Journal of Infectious Diseases. 2000 June; 181(6): 2080-2. Epub 2000 May 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10837198&dopt=Abstract
•
Gonorrhea and chlamydia screening among young women: stage of change, decisional balance, and self-efficacy. Author(s): Banikarim C, Chacko MR, Wiemann CM, Smith PB. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2003 April; 32(4): 288-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667733&dopt=Abstract
•
Gonorrhea in male adolescents and young adults in Newark, New Jersey: implications of risk factors and patient preferences for prevention strategies. Author(s): Mertz KJ, Finelli L, Levine WC, Mognoni RC, Berman SM, Fishbein M, Garnett G, St Louis ME. Source: Sexually Transmitted Diseases. 2000 April; 27(4): 201-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10782741&dopt=Abstract
•
Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Author(s): Fox KK, del Rio C, Holmes KK, Hook EW 3rd, Judson FN, Knapp JS, Procop GW, Wang SA, Whittington WL, Levine WC. Source: American Journal of Public Health. 2001 June; 91(6): 959-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11392941&dopt=Abstract
Studies
73
•
Gonorrhea in the United States, 1981-1996. Demographic and geographic trends. Author(s): Fox KK, Whittington WL, Levine WC, Moran JS, Zaidi AA, Nakashima AK. Source: Sexually Transmitted Diseases. 1998 August; 25(7): 386-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9713920&dopt=Abstract
•
Gonorrhea incidence and HIV testing and counseling among adolescents and young adults seen at a clinic for sexually transmitted diseases. Author(s): Chamot E, Coughlin SS, Farley TA, Rice JC. Source: Aids (London, England). 1999 May 28; 13(8): 971-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10371179&dopt=Abstract
•
Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000. Author(s): Dicker LW, Mosure DJ, Berman SM, Levine WC. Source: Sexually Transmitted Diseases. 2003 May; 30(5): 472-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12916141&dopt=Abstract
•
Gonorrhea surveillance: the missing links. Author(s): Rothenberg R, Potterat JJ. Source: Sexually Transmitted Diseases. 2002 December; 29(12): 806-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466724&dopt=Abstract
•
Gonorrhea, chlamydia and the sexual network: pushing the envelope. Author(s): Zenilman JM. Source: Sexually Transmitted Diseases. 2000 April; 27(4): 224-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10782744&dopt=Abstract
•
Gonorrhea. Author(s): Darville T. Source: Pediatrics in Review / American Academy of Pediatrics. 1999 April; 20(4): 125-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10208085&dopt=Abstract
•
Gonorrhea: a pediatric perspective. Author(s): Sung L, MacDonald NE. Source: Pediatrics in Review / American Academy of Pediatrics. 1998 January; 19(1): 136. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9439164&dopt=Abstract
74
Gonorrhea
•
High HIV seroprevalence associated with gonorrhea: New York City Department of Health, sexually transmitted disease clinics, 1990-1997. Author(s): Torian LV, Makki HA, Menzies IB, Murrill CS, Benson DA, Schween FW, Weisfuse IB. Source: Aids (London, England). 2000 January 28; 14(2): 189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10708290&dopt=Abstract
•
Historical, physical, and laboratory characteristics of female ED patients with positive chlamydia and gonorrhea cultures. Author(s): Stewart DP. Source: The American Journal of Emergency Medicine. 1996 May; 14(3): 336-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8639221&dopt=Abstract
•
HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist. Author(s): Torian LV, Makki HA, Menzies IB, Murrill CS, Weisfuse IB. Source: Sexually Transmitted Diseases. 2002 February; 29(2): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818891&dopt=Abstract
•
Impact of a gonorrhea control program, including selective mass treatment, in female sex workers. Author(s): Holmes KK, Johnson DW, Kvale PA, Halverson CW, Keys TF, Martin DH. Source: The Journal of Infectious Diseases. 1996 October; 174 Suppl 2: S230-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8843253&dopt=Abstract
•
Incidence of gonorrhea in Belgrade, 1988-1994. Author(s): Bjekic M, Vlajinac H, Sipetic S. Source: The Journal of Infection. 1998 July; 37(1): 44-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9733378&dopt=Abstract
•
Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men. Author(s): Page-Shafer K, Graves A, Kent C, Balls JE, Zapitz VM, Klausner JD. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 January 15; 34(2): 173-6. Epub 2001 December 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740704&dopt=Abstract
•
Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic. Author(s): Rietmeijer CA, Patnaik JL, Judson FN, Douglas JM Jr. Source: Sexually Transmitted Diseases. 2003 July; 30(7): 562-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838084&dopt=Abstract
Studies
75
•
Increasing incidence of gonorrhea in Israel associated with countrywide dissemination of a ciprofloxacin-resistant strain. Author(s): Yagupsky P, Schahar A, Peled N, Porat N, Trefler R, Dan M, Keness Y, Block C. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2002 May; 21(5): 368-72. Epub 2002 May 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12072921&dopt=Abstract
•
Index of suspicion. Case 2. Diagnosis: gonorrhea conjunctivitis. Author(s): Brady RC. Source: Pediatrics in Review / American Academy of Pediatrics. 1997 May; 18(5): 175-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9114719&dopt=Abstract
•
Initial and repeated screening for gonorrhea during pregnancy. Author(s): Miller JM Jr, Maupin RT, Mestad RE, Nsuami M. Source: Sexually Transmitted Diseases. 2003 September; 30(9): 728-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972798&dopt=Abstract
•
InTray GC medium versus modified Thayer-Martin agar plates for diagnosis of gonorrhea from endocervical specimens. Author(s): Beverly A, Bailey-Griffin JR, Schwebke JR. Source: Journal of Clinical Microbiology. 2000 October; 38(10): 3825-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11015410&dopt=Abstract
•
Is there a seasonal variation in gonorrhea and chlamydia in adolescents? Author(s): Schroeder B, Tetlow P, Sanfilippo JS, Hertweck SP. Source: Journal of Pediatric and Adolescent Gynecology. 2001 February; 14(1): 25-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11358703&dopt=Abstract
•
Modeling prevention strategies for gonorrhea and Chlamydia using stochastic network simulations. Author(s): Kretzschmar M, van Duynhoven YT, Severijnen AJ. Source: American Journal of Epidemiology. 1996 August 1; 144(3): 306-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8686700&dopt=Abstract
•
NAAT-identified and self-reported gonorrhea and chlamydial infections: different atrisk population subgroups? Author(s): Rogers SM, Miller HG, Miller WC, Zenilman JM, Turner CF. Source: Sexually Transmitted Diseases. 2002 October; 29(10): 588-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370526&dopt=Abstract
76
Gonorrhea
•
Neisseria gonorrhea infections in girls younger than 12 years of age evaluated for vaginitis. Author(s): Shapiro RA, Schubert CJ, Siegel RM. Source: Pediatrics. 1999 December; 104(6): E72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10586006&dopt=Abstract
•
Network methodologies, contact tracing, gonorrhea, and human immunodeficiency virus. Author(s): Friedman SR. Source: Sexually Transmitted Diseases. 1996 November-December; 23(6): 523-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8946641&dopt=Abstract
•
On the need to screen for Chlamydia and gonorrhea infections prior to colposcopy in adolescents. Author(s): Harel Z, Riggs S. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1997 August; 21(2): 87-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9248932&dopt=Abstract
•
Optimal treatment of gonorrhea. Author(s): Rajan VS. Source: Sexually Transmitted Diseases. 1982 January-March; 9(1): 56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10328028&dopt=Abstract
•
Partner notification for HIV and STD in the United States: low coverage for gonorrhea, chlamydial infection, and HIV. Author(s): Golden MR, Hogben M, Handsfield HH, St Lawrence JS, Potterat JJ, Holmes KK. Source: Sexually Transmitted Diseases. 2003 June; 30(6): 490-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782949&dopt=Abstract
•
Partner referral by patients with gonorrhea and chlamydial infection. Case-finding observations. Author(s): van de Laar MJ, Termorshuizen F, van den Hoek A. Source: Sexually Transmitted Diseases. 1997 July; 24(6): 334-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9243740&dopt=Abstract
•
Patterns of chlamydia and gonorrhea infection in sexual networks in Manitoba, Canada. Author(s): Wylie JL, Jolly A. Source: Sexually Transmitted Diseases. 2001 January; 28(1): 14-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11196040&dopt=Abstract
Studies
77
•
Positive screening tests for gonorrhea and chlamydial infection fail to lead consistently to treatment of patients attending a sexually transmitted disease clinic. Author(s): Schwebke JR, Sadler R, Sutton JM, Hook EW 3rd. Source: Sexually Transmitted Diseases. 1997 April; 24(4): 181-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9101628&dopt=Abstract
•
Practice patterns for the elicitation of sexual history, education, and counseling among providers of STD services: results from the gonorrhea community action project (GCAP). Author(s): Bull SS, Rietmeijer C, Fortenberry JD, Stoner B, Malotte K, Vandevanter N, Middlestadt SE, Hook EW 3rd. Source: Sexually Transmitted Diseases. 1999 November; 26(10): 584-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10560723&dopt=Abstract
•
Prevalence and factors associated with gonorrhea and chlamydial infection in at-risk females presenting to an urban emergency department. Author(s): Bachmann LH, Pigott D, Desmond R, Jones M, Lumpkins J, Gala P, Terndrup T, Hook EW 3rd. Source: Sexually Transmitted Diseases. 2003 April; 30(4): 335-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671555&dopt=Abstract
•
Prevalence, incidence, and correlates of chlamydia and gonorrhea among young adult injection drug users. Author(s): Latka M, Ahern J, Garfein RS, Ouellet L, Kerndt P, Morse P, Farshy CE, Des Jarlais DC, Vlahov D; Collaborative Injection Drug User Study Group. Source: Journal of Substance Abuse. 2001; 13(1-2): 73-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11547626&dopt=Abstract
•
Promoting condoms for oral sex: impact on pharyngeal gonorrhea among female brothel-based sex workers. Author(s): Wong ML, Chan RK, Koh D. Source: Sexually Transmitted Diseases. 2002 June; 29(6): 311-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035019&dopt=Abstract
•
Randomized trial of trovafloxacin and ofloxacin for single-dose therapy of gonorrhea. Trovafloxacin Gonorrhea Study Group. Author(s): Jones RB, Schwebke J, Thorpe EM Jr, Dalu ZA, Leone P, Johnson RB. Source: The American Journal of Medicine. 1998 January; 104(1): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9528716&dopt=Abstract
78
Gonorrhea
•
Rapid decrease of endemic gonorrhea in Finland. Author(s): Hiltunen-Back E, Rostila T, Kautiainen H, Paavonen J, Reunala T. Source: Sexually Transmitted Diseases. 1998 April; 25(4): 181-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9564719&dopt=Abstract
•
Re: Condom efficacy against gonorrhea and nongonococcal urethritis. Author(s): Cates WC Jr, Holmes KK. Source: American Journal of Epidemiology. 1996 April 15; 143(8): 843-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8610697&dopt=Abstract
•
Recommendations for screening high school students for chlamydia and gonorrhea in San Francisco. Author(s): Nsuami M. Source: Sexually Transmitted Diseases. 2003 April; 30(4): 367; Author Reply 368. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671561&dopt=Abstract
•
Reduced chlamydial infection and gonorrhea among commercial sex workers in Fukuoka City, Japan. Author(s): Tanaka M, Nakayama H, Sakumoto M, Takahashi K, Nagafuji T, Akazawa K, Kumazawa J. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 1998 September; 5(5): 471-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9781437&dopt=Abstract
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Reduced clinical efficacy of pazufloxacin against gonorrhea due to high prevalence of quinolone-resistant isolates with the GyrA mutation. The Pazufloxacin STD Group. Author(s): Tanaka M, Matsumoto T, Sakumoto M, Takahashi K, Saika T, Kabayashi I, Kumazawa J. Source: Antimicrobial Agents and Chemotherapy. 1998 March; 42(3): 579-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9517935&dopt=Abstract
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Reemergence of gonorrhea in Sweden. Author(s): Berglund T, Fredlund H, Ramstedt K. Source: Sexually Transmitted Diseases. 1999 August; 26(7): 390-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458632&dopt=Abstract
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Relationships of stigma and shame to gonorrhea and HIV screening. Author(s): Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, Malotte CK, Stoner BP. Source: American Journal of Public Health. 2002 March; 92(3): 378-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867314&dopt=Abstract
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Risk factors for and trends in gonorrhea incidence among persons infected with HIV in the United States. Author(s): Do AN, Hanson DL, Dworkin MS, Jones JL; Adult and Adolescent Spectrum of HIV Disease Project. Source: Aids (London, England). 2001 June 15; 15(9): 1149-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11416717&dopt=Abstract
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Risk for anogenital cancer and other cancer among women hospitalized with gonorrhea. Author(s): Johansen C, Mellemkjaer L, Frisch M, Kjaer SK, Gridley G, Olsen JH. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 August; 80(8): 757-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11531621&dopt=Abstract
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Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women. Author(s): Sloan NL, Winikoff B, Haberland N, Coggins C, Elias C. Source: Stud Fam Plann. 2000 March; 31(1): 55-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10765538&dopt=Abstract
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Screening and treatment of sexually transmitted diseases. Part 1: Chlamydia, gonorrhea, and bacterial vaginosis. Author(s): Lahoti S, McClain N, Girardet R, McNeese M, Cheung K. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2000 January-February; 14(1): 34-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141826&dopt=Abstract
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Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention. Author(s): Burstein GR, Waterfield G, Joffe A, Zenilman JM, Quinn TC, Gaydos CA. Source: Sexually Transmitted Diseases. 1998 September; 25(8): 395-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9773430&dopt=Abstract
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Screening women for gonorrhea: demographic screening criteria for general clinical use. Author(s): Mertz KJ, Levine WC, Mosure DJ, Berman SM, Dorian KJ, Hadgu A. Source: American Journal of Public Health. 1997 September; 87(9): 1535-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9314811&dopt=Abstract
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Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Author(s): Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, Shultz M, Sweet RL. Source: Sexually Transmitted Diseases. 2001 June; 28(6): 321-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11403188&dopt=Abstract
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Sexual partner networks in the transmission of sexually transmitted diseases. An analysis of gonorrhea cases in Sheffield, UK. Author(s): Ghani AC, Ison CA, Ward H, Garnett GP, Bell G, Kinghorn GR, Weber J, Day S. Source: Sexually Transmitted Diseases. 1996 November-December; 23(6): 498-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8946636&dopt=Abstract
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Sexually transmitted disease clinic clients at risk for subsequent gonorrhea and chlamydia infections: possible 'core' transmitters. Author(s): Gunn RA, Fitzgerald S, Aral SO. Source: Sexually Transmitted Diseases. 2000 July; 27(6): 343-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907910&dopt=Abstract
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Sexually transmitted diseases in adolescents: focus on gonorrhea, chlamydia, and trichomoniasis--issues and treatment guidelines. Author(s): Patel K. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1998 July-August; 12(4): 211-5; Quiz 216-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9832736&dopt=Abstract
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Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention. Author(s): Lafferty WE, Hughes JP, Handsfield HH. Source: Sexually Transmitted Diseases. 1997 May; 24(5): 272-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9153736&dopt=Abstract
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Sexually transmitted diseases in women. Gonorrhea and syphilis. Author(s): Emmert DH, Kirchner JT. Source: Postgraduate Medicine. 2000 February; 107(2): 181-4, 189-90, 193-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10689416&dopt=Abstract
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Sexually transmitted infections among female sex workers in Kupang, Indonesia: searching for a screening algorithm to detect cervical gonococcal and chlamydial infections. Author(s): Davies SC, Otto B, Partohudoyo S, Chrisnadarmani VA, Neilsen GA, Ciaffi L, Patten J, Samson ET, Sutama IN. Source: Sexually Transmitted Diseases. 2003 September; 30(9): 671-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972788&dopt=Abstract
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Single-dose gatifloxacin compared with ofloxacin for the treatment of uncomplicated gonorrhea: a randomized, double-blind, multicenter trial. Author(s): Stoner BP, Douglas JM Jr, Martin DH, Hook EW 3rd, Leone P, McCormack WM, Mroczkowski TF, Jones R, Yang J, Baumgartner T. Source: Sexually Transmitted Diseases. 2001 March; 28(3): 136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289194&dopt=Abstract
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Slowing the spread of gonorrhea. Author(s): Justesen S. Source: Nursing. 2002 April; 32(4): 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11969006&dopt=Abstract
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Social structure, race, and gonorrhea rates in the southeastern United States. Author(s): Thomas JC, Gaffield ME. Source: Ethn Dis. 2003 Summer; 13(3): 362-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12894961&dopt=Abstract
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Socioeconomic status and self-reported gonorrhea among African American female adolescents. Author(s): Sionean C, DiClemente RJ, Wingood GM, Crosby R, Cobb BK, Harrington K, Davies SL, Hook EW 3rd, Oh MK. Source: Sexually Transmitted Diseases. 2001 April; 28(4): 236-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11318256&dopt=Abstract
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Stroke in a young woman with a history of gonorrhea. Author(s): Solis ST, Ebright JR. Source: Hosp Pract (Off Ed). 1996 June 15; 31(6): 140-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8675537&dopt=Abstract
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Success and failure in gonorrhea control. Author(s): Low N, FitzGerald MR. Source: Dermatologic Clinics. 1998 October; 16(4): 713-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9891670&dopt=Abstract
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Syphilis and gonorrhea. Author(s): Siegel MA. Source: Dent Clin North Am. 1996 April; 40(2): 369-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8641527&dopt=Abstract
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Testing for genital gonorrhea infections in prepubertal girls with suspected sexual abuse. Author(s): Palusci VJ, Reeves MJ. Source: The Pediatric Infectious Disease Journal. 2003 July; 22(7): 618-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867837&dopt=Abstract
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The role of sexual partnership networks in the epidemiology of gonorrhea. Author(s): Ghani AC, Swinton J, Garnett GP. Source: Sexually Transmitted Diseases. 1997 January; 24(1): 45-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9018783&dopt=Abstract
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Treatment failure with the use of ciprofloxacin for gonorrhea correlates with the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae strains in Bangladesh. Author(s): Rahman M, Alam A, Nessa K, Nahar S, Dutta DK, Yasmin L, Monira S, Sultan Z, Khan SA, Albert MJ. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 March 15; 32(6): 884-9. Epub 2001 Mar 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11247712&dopt=Abstract
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Trends in gonorrhea in Canada, 1990-1995. Author(s): Squires S, Doherty J. Source: Can Commun Dis Rep. 1997 June 15; 23(12): 89-95. Review. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9229510&dopt=Abstract
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Trends of gonorrhea and chlamydial infection during 1985-1996 among active-duty soldiers at a United States Army installation. Author(s): Sena AC, Miller WC, Hoffman IF, Chakraborty H, Cohen MS, Jenkins P, McKee KT Jr. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 April; 30(4): 742-8. Epub 2000 March 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10770738&dopt=Abstract
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Unsuspected gonorrhea and chlamydia in patients of an urban adult emergency department: a critical population for STD control intervention. Author(s): Mehta SD, Rothman RE, Kelen GD, Quinn TC, Zenilman JM. Source: Sexually Transmitted Diseases. 2001 January; 28(1): 33-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11196043&dopt=Abstract
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Use of wet mount to predict Chlamydia trachomatis and Neisseria gonorrhea cervicitis in primary care. Author(s): Majeroni BA, Schank JN, Horwitz M, Valenti J. Source: Family Medicine. 1996 September; 28(8): 580-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8884256&dopt=Abstract
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CHAPTER 2. NUTRITION AND GONORRHEA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and gonorrhea.
Finding Nutrition Studies on Gonorrhea The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “gonorrhea” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “gonorrhea” (or a synonym): •
116 cases of gonococcal arthritis treated with acupuncture. Author(s): Shandan County Hospital of TCM, Gansu Province. Source: Wang, K J-Tradit-Chin-Med. 1996 June; 16(2): 108-11 0254-6272
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Increased adhesiveness and internalization of Neisseria gonorrhoeae and changes in the expression of epithelial gonococcal receptors in the Fallopian tube of copper T and Norplant users. Author(s): Universidad de Santiago de Chile, Facultad de Quimica y Biologia, Casilla 40 Correo 33, Estacion Central, Santiago, Chile. Source: Fernandez, R Nelson, P Delgado, J Aguilera, J Massai, R Velasquez, L Imarai, M Croxatto, H B Cardenas, H Hum-Reprod. 2001 Mar; 16(3): 463-8 0268-1161
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The varied manifestations of disseminated gonococcal infection. Author(s): Veterans Administration Medical Center, Nashville. Source: Alspaugh, J A J-Tenn-Med-Assoc. 1994 November; 87(11): 479-80 0040-3318
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMD®Health: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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CHAPTER 3. ALTERNATIVE MEDICINE AND GONORRHEA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to gonorrhea. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to gonorrhea and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gonorrhea” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to gonorrhea: •
116 cases of gonococcal arthritis treated with acupuncture. Author(s): Wang K. Source: J Tradit Chin Med. 1996 June; 16(2): 108-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389135&dopt=Abstract
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A large outbreak of conjunctivitis caused by a single genotype of Neisseria gonorrhoeae distinct from those causing genital tract infections. Author(s): Mak DB, Smith DW, Harnett GB, Plant AJ. Source: Epidemiology and Infection. 2001 June; 126(3): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11467794&dopt=Abstract
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A one-year survey of Neisseria gonorrhoeae isolated from patients attending an east London genitourinary medicine clinic: antibiotic susceptibility patterns and patients' characteristics. Author(s): Lewis DA, Ison CA, Livermore DM, Chen HY, Hooi AY, Wisdom AR.
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Source: Genitourinary Medicine. 1995 February; 71(1): 13-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7750947&dopt=Abstract •
A prospective study of reiter's syndrome. an interim report on the first 82 cases. Author(s): POPERT AJ, GILL AJ, LAIRD SM. Source: Br J Vener Dis. 1964 September; 40: 160-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14210482&dopt=Abstract
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A targetted intervention research on traditional healer perspectives of sexually transmitted illnesses in urban Zambia. Current research. Author(s): Masauso Nzima M, Romano K, Anyangwe S, Wiseman J, Macwan'gi M, Kendall C, Green EC. Source: Soc Afr Sida. 1996 July; (13): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12179374&dopt=Abstract
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Age at first episode of venereal syphilis in an aboriginal population: an application of survival analysis. Author(s): Mak DB, Holman CD. Source: Aust N Z J Public Health. 1998 October; 22(6): 704-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848968&dopt=Abstract
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AIDS prevention for women: a community-based approach. Author(s): Norr KF, McElmurry BJ, Moeti M, Tlou SD. Source: Nursing Outlook. 1992 November-December; 40(6): 250-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1461755&dopt=Abstract
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Amoxicillin and potassium clavulanate: an antibiotic combination. Mechanism of action, pharmacokinetics, antimicrobial spectrum, clinical efficacy and adverse effects. Author(s): Weber DJ, Tolkoff-Rubin NE, Rubin RH. Source: Pharmacotherapy. 1984 May-June; 4(3): 122-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6739312&dopt=Abstract
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An assessment of care provided by a public sector STD clinic in Cape Town. Author(s): Mathews C, van Rensburg A, Schierhout G, Coetzee N, Lombard CJ, Fehler HG, Ballard RC. Source: International Journal of Std & Aids. 1998 November; 9(11): 689-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9863583&dopt=Abstract
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Anaerobic pelvic infections and developments in hyperbaric oxygen therapy. Author(s): Parker RT, Jones CP.
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Source: American Journal of Obstetrics and Gynecology. 1966 November 1; 96(5): 645-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5921424&dopt=Abstract •
Anal eroticism. Author(s): Marino AW Jr, Mancini HW. Source: The Surgical Clinics of North America. 1978 June; 58(3): 513-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=675464&dopt=Abstract
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Antibacterial activity and beta-lactamase stability of temocillin. Author(s): Jules K, Neu HC. Source: Antimicrobial Agents and Chemotherapy. 1982 September; 22(3): 453-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6982681&dopt=Abstract
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Antigonorrhoeal activity of plants used in Guatemala for the treatment of sexually transmitted diseases. Author(s): Caceres A, Menendez H, Mendez E, Cohobon E, Samayoa BE, Jauregui E, Peralta E, Carrillo G. Source: Journal of Ethnopharmacology. 1995 October; 48(2): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8583798&dopt=Abstract
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Anti-inflammatory and analgesic properties of the stem bark extract of Mitragyna ciliata (Rubiaceae) Aubrev. & Pellegr. Author(s): Dongmo AB, Kamanyi A, Dzikouk G, Nkeh BC, Tan PV, Nguelefack T, Nole T, Bopelet M, Wagner H. Source: Journal of Ethnopharmacology. 2003 January; 84(1): 17-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499071&dopt=Abstract
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Application of high performance liquid chromatography coupled with ultraviolet spectroscopy and electrospray mass spectrometry to the characterisation of ellagitannins from Terminalia macroptera roots. Author(s): Silva O, Gomes ET, Wolfender JL, Marston A, Hostettmann K. Source: Pharmaceutical Research. 2000 November; 17(11): 1396-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205733&dopt=Abstract
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Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi. Author(s): Zachariah R, Harries AD, Nkhoma W, Arendt V, Nchingula D, Chantulo A, Chimtulo F, Kirpach P. Source: Trans R Soc Trop Med Hyg. 2002 May-June; 96(3): 232-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12174768&dopt=Abstract
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Care of the newborn in perinatal units in New Brunswick. Author(s): Malhotra KK. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1986 May 1; 134(9): 1009-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3697868&dopt=Abstract
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Case-control study of non-Hodgkin's lymphoma among women and heterosexual men in the San Francisco Bay Area, California. Author(s): Holly EA, Lele C, Bracci PM, McGrath MS. Source: American Journal of Epidemiology. 1999 August 15; 150(4): 375-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10453814&dopt=Abstract
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Common gynecologic infections. Author(s): Denenberg R. Source: World. 1998 March; (No 83): 3-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11365173&dopt=Abstract
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Community efforts in the reduction of corneal blindness in developing countries. Author(s): Foster A, Gilbert C. Source: Refract Corneal Surg. 1991 November-December; 7(6): 445-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1782160&dopt=Abstract
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Condylomata acuminata in women: the effect of concomitant genital infection on response to treatment. Author(s): Cooper C, Singha HS. Source: Acta Dermato-Venereologica. 1985; 65(2): 150-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2408418&dopt=Abstract
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Consumption by semen loss in India and elsewhere. Author(s): Bottero A. Source: Culture, Medicine and Psychiatry. 1991 September; 15(3): 303-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1935181&dopt=Abstract
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Culture, community medicine and venereal disease. Author(s): White G. Source: The Medical Journal of Australia. 1977 January 1-8; 1(1-2): 17-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=840071&dopt=Abstract
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Dissemination of gonococcal infection is associated with delayed stimulation of complement-dependent neutrophil chemotaxis in vitro. Author(s): Densen P, MacKeen LA, Clark RA.
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Source: Infection and Immunity. 1982 November; 38(2): 563-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6815096&dopt=Abstract •
Divine and rational: the reproductive health of women in ancient Egypt. Author(s): Sullivan R. Source: Obstetrical & Gynecological Survey. 1997 October; 52(10): 635-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9326756&dopt=Abstract
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Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia. Author(s): Joesoef MR, Sumampouw H, Linnan M, Schmid S, Idajadi A, St Louis ME. Source: American Journal of Obstetrics and Gynecology. 1996 January; 174(1 Pt 1): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8571993&dopt=Abstract
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Screening for gonorrhea and syphilis in gay bathhouses in Denver and Los Angeles. Author(s): Merino HI, Judson FN, Bennett D, Schaffnit TR. Source: Public Health Reports (Washington, D.C. : 1974). 1979 July-August; 94(4): 376-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=472098&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMD®Health: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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The following is a specific Web list relating to gonorrhea; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Proctitis Source: Integrative Medicine Communications; www.drkoop.com Prostate Infection Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Integrative Medicine Communications; www.drkoop.com Rectal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Sexually Transmitted Diseases Source: Integrative Medicine Communications; www.drkoop.com STDs Source: Integrative Medicine Communications; www.drkoop.com
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Alternative Therapy Color Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683,00.html Homeopathy Alternative names: homeopathic medicine homeotherapeutics homoeopathy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html
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Chinese Medicine Mianbixie Alternative names: Sevenlobed Yam Rhizome; Rhizoma Dioscoreae Septemlobae Source: Chinese Materia Medica
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Herbs and Supplements Calophyllum Alternative names: Punna, Kamani; Calophyllum sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Corn Silk Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Horsetail Source: Prima Communications, Inc.www.personalhealthzone.com Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com Phyllanthus Alternative names: Phyllanthus niruri Source: Healthnotes, Inc.; www.healthnotes.com Sandalwood Alternative names: Santalum album Source: Healthnotes, Inc.; www.healthnotes.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON GONORRHEA Overview In this chapter, we will give you a bibliography on recent dissertations relating to gonorrhea. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “gonorrhea” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gonorrhea, we have not necessarily excluded nonmedical dissertations in this bibliography.
Dissertations on Gonorrhea ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to gonorrhea. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
Effectiveness of Gonorrhea and Syphilis Education in Selected Los Angeles Area Secondary Schools. by Alkhateeb, Waleed Ahmed, DRPH from University of California, Los Angeles, 1976, 142 pages http://wwwlib.umi.com/dissertations/fullcit/7625173
•
Guidelines for Teaching College Students about Sexually Transmitted Diseases Other Than Syphilis and Gonorrhea. by Whitmore, Robert Hoover, EDD from Columbia University Teachers College, 1978, 245 pages http://wwwlib.umi.com/dissertations/fullcit/7810905
•
Hiv/aids and Five Other Leading Sexually Transmitted Diseases: Knowledge and Behavior Levels of University Freshmen (immune Deficiency, Gonorrhea, Syphilis, Herpes, Genital Warts, Chlamydia) by Roper, Robyn Lynn, EDD from Auburn University, 1994, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9503405
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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. PATENTS ON GONORRHEA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “gonorrhea” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gonorrhea, we have not necessarily excluded nonmedical patents in this bibliography.
Patents on Gonorrhea By performing a patent search focusing on gonorrhea, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on gonorrhea: •
2-Acetyl quinoline thiosemicarbazones useful in treatment of gonorrhea, malaria or bacterial infections Inventor(s): Dobek; Arthur S. (Silver Spring, MD), Gonzalez; Armando (Orlando, FL), Grant; Steven D. (Lander, WY), Klayman; Daniel L. (Chevy Chase, MD), Massie; Samuel P. (Laurel, MD), Morrison; Norman E. (Baltimore, MD), Scovill; John P. (Silver Spring, MD) Assignee(s): The United States of America as represented by the Secretary of the Army (Washington, DC) Patent Number: 4,440,771 Date filed: February 12, 1982 Abstract: This invention relates to the preparation and use of various 2-acetyl quiine thiosemicarbazones which are substituted on the 4-nitrogen atom. These compounds are useful in the treatment of gonorrhea and, in addition, many are useful either in the treatment of malaria or bacterial infections, such as leprosy and meningitis. Excerpt(s): (5) morpholino, dialkyl (preferably one to four carbon atoms in each alkyl group) morpholino. In this disclosure, it is understood that COO alkyl represents the alkyl carboxylic acid ester; for example, COO Et represents the ethyl carboxylic acid ester. While evidence indicates that all of the above-described compounds and their pharmaceutically-acceptable acid addition salts are useful in the treatment of gonorrhea (gonorrhoeae), in addition many of the compounds and salts are useful either in the treatment of malaria or bacterial infections, such as leprosy and meningitis. Such use of the above-described compounds and salts is included in the present invention. Moreover, the above-described compounds per se, and their pharmaceuticallyacceptable acid addition salts, are included in the invention provided that: when R.sub.2 is hydrogen, then R.sub.1 cannot be ethyl, isopropyl, or monochlorophenyl. Web site: http://www.delphion.com/details?pn=US04440771__
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Antigen for trachoma lymphogranuloma venereum (LGV) and non-gonococcal urethritis (NGU) Inventor(s): Caldwell; Harlan D. (Seattle, WA), Kenny; George E. (Seattle, WA), Kuo; Cho-Chou (Seattle, WA) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,118,469 Date filed: April 27, 1976 Abstract: Solubilized antigens of C. trachomatis strain LGV-434 upon analysis using two-dimensional immunoelectrophoresis yielded a single antigen which was found to be consistently precipitated by sera of patients with C. trachomatis infections. This antigen as antigen-antibody complex was employed as an immunogen to prepare a rabbit monospecific antiserum to this component or antigen. This monospecific antiserum demonstrated the presence of the antigen in each of the 15 strains of C. trachomatis organisms and was non-reactive with strains of C. psittaci. The C. trachomatis specific antigen was purified by immunoadsorption chromatography using
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monospecific antiserum as a specific ligand covalently bound to agarose gel columns and the resulting purified antigen employed to detect antibody from the sera of lymphogranuloma venereum patients using counterimmunoelectrophoresis. When the C. trachomatis specific antigen is isotopically labeled and utilized in the highly sensitive radioimmune assay antibody to the antigen should be demonstrated and a serological test based thereon should be applicable for the serological diagnosis of non-gonococcal urethritis (NGU). Excerpt(s): Chlamydia trachomatis organisms are the etiological agents for a number of human ocular-genital diseases, such as ocular trachoma, lymphogranuloma venereum (LGV) and non-gonococcal urethritis (NGU). The most important of these diseases in the United States is NGU. The annual incidence of NGU exceeds that of gonorrhea and it is estimated that there occur more than 2,000,000 cases of NGU yearly in the United States alone. There are 15 different immunotypes of C. trachomatis, 12 of which have been associated with NGU. At present, the only serological test used in the diagnosis of NGU is the microimmunofluoresence test. This test is only available in a limited number of research laboratories throughout the world. This test requires that all 15 strains of C. trachomatis organisms be used as serological test antigen. Accordingly, this test is very laborious, time-consuming, expensive and difficult to perform. There is no commercially available antigen that can be used for serological testing. Ideally, a serological test antigen for NGU, as well as for LGV, would be one that is shared by each of the C. trachomatis strains to which infected individuals make antibody to during the course of infection. Accordingly, it is an object of this invention to prepare an antigen of C. trachomatis useful in the serological testing for LGV and/or NGU. Web site: http://www.delphion.com/details?pn=US04118469__ •
Assay of immunoglobulin A protease and the rapid diagnosis of gonorrhea Inventor(s): Murray; Kittie A. (New York, NY) Assignee(s): Magbon Test Company (Great Neck, NY) Patent Number: 4,582,699 Date filed: December 23, 1981 Abstract: A method for rapid diagnosis of gonorrhea is set forth comprising assay of the enzyme immunoglobulin A protease (IgAP). Immunoassays including radioimmunoassay and enzyme-linked immunoassay with monoclonal antibodies to IgAP are disclosed. A kit for early detection of gonorrhea is given. The assay and kit of the present invention may also be used in the detection of meningitis. Excerpt(s): Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhea. The disease has plagued mankind since ancient history, and although penicillin and related "miracle drugs" have helped control the spread of gonorrhea, it still persists in epidemic proportions. In the United States along 3 million cases of gonorrhea are reported annually and worldwide over 60 million cases are reported each year. A major reason for the rampant spread of gonorrhea is the lack of a rapid method for detection of infection in its early stages. Neisseria gonorrhea may thrive on the genital membranes several days before the obvious symptoms of prurulent discharge become visible, and during this period contact with a non-carrier may result in unwitting transmission of the bacterium. Moreover, many carriers of the disease, especially women, are asymptotic and spread the disease unknowingly. Current diagnostic methods for gonorrhea include preliminary microscopic observation by a
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trained clinician of gram-stained extract from uro-genital membranes followed by incubation of extract on a medium selective by Neisseria gonorrhea. Final chemical tests are made in the laboratory and finally reported to the patient who may then be treated. This diagnostic procedure is a time-consuming process requiring trained personnel and sophisticated instrumentation. Web site: http://www.delphion.com/details?pn=US04582699__ •
Broad spectrum vaccine against gonorrhea Inventor(s): Rothbard; Jonathan (San Francisco, CA), Schoolnik; Gary K. (Palo Alto, CA) Assignee(s): The Board of Trustees of the Leland Stanford Junior University (Stanford, CA) Patent Number: 4,584,195 Date filed: June 21, 1984 Abstract: Vaccines comprising peptide sequences corresponding to immunorecessive determinants in gonorrhea pilus protein are disclosed. The vaccines are effective in protecting human subjects against infection by a wide range of gonorrhea strains by raising antibodies which interfere with the colonization of the epithelium by the infecting bacteria. Excerpt(s): This invention relates to immunization of humans against gonorrheal infection. In particular, it relates to a vaccine useful in protecting humans against a broad spectrum of gonococcus strains. Gonorrhea is a well known, sexually transmitted disease which produces acute suppuration of the mucous membranes of the genital urinary tract and the eye followed by chronic inflammation and fibrosis. It is caused by a gram negative group of cocci Neisseria gonorrhoeae (gonococcus). A single strain of this species is an isolate from a single host (patient) at a particular site. There are, therefore, multitudinous strains of N. gonorrhoeae, each of which has characteristic antigenic determinants assocated with the pili, a fact which renders both diagnosis and immunization difficult. The incidence of the disease has markedly increased since 1955, and has been complicated by the appearance of penicillin resistant strains harboring.beta.-lactamase encoding plasmids, which were first reported in 1976. The infectivity of the organism is extremely high, and it has been estimated that a single sexual encounter with an infected partner results in a 20-30% probability of acquiring the disease. If left untreated, relapses are to be expected, as resistance to re-infection does not appear to develop. The course of the disease involves colonization of the mucous membranes by the bacterium, a process which is mediated by the attachment of the colonizing cell to the surface membrane by means of filamentous structures called pili associated with its cell wall. After attachment, the gonococcus is passed through the epithelium to the submucosal space where it is capable of causing inflammation and fibrosis. The attachment of the gonococci to the epithelial surface can be blocked by antipilus antibody, but the use of pilus immunogens of such antibodies as vaccines has been rendered impractical by the lack of cross-reactivity among strains. Web site: http://www.delphion.com/details?pn=US04584195__
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Determination of lymphocyte reactivity to specific Inventor(s): Levine; Robert A. (31 Pilgrim La., Guilford, CT 06437), Wardlaw; Stephen C. (191 N. Cove Rd., Old Saybrook, CT 06475) Assignee(s): none reported Patent Number: 5,360,719 Date filed: September 30, 1992 Abstract: A patient's blood sample is incubated with an antigen and tested for lymphocyte response, i.e. an activation of lymphocytes and/or a conversion of lymphocytes to lymphoblasts, which indicates prior exposure of the patient to the antigen. A positive response indicates the presence of prior exposure to prior diseases or clinical conditions such as parasitic diseases, tuberculosis, salmonellosis, gonorrhea, fungal infections, rickettsial infections, Lyme disease or allergens. Whole blood from the patient is incubated with the antigen of the disease or condition for which the patient is being tested. After a suitable time, a fluorescent dye or colorant which has an affinity for a discriminant characteristic of the activated lymphocytes or lymphoblasts, such as: intracellular calcium; surface activation antigens such as transferrin receptor; HLA-Dr; Leu-23; and the like. The incubated blood is then drawn into a transparent tube containing a float which concentrates the buffy coat constituent layers upon centrifugation of the blood sample. The concentrated lymphocyte layer is then examined for fluorescence or coloration which is indicative of the presence of the activated lymphocytes or lymphoblasts, and their concentration. The fluorescence or coloration can be qualified and/or quantified by a reader instrument. Excerpt(s): This invention relates to a procedure for determining whether a patient has been previously exposed to certain antigens, and more particularly, to antigens indicative of diseases, infections, allergies or the like maladies. When diagnosing patients for possible illness or the like, the physician will typically perform blood tests to determine the presence or absence of agents in the blood which are indicative of prior exposure to various diseases or other maladies. Traditional tests to determine a patient's previous exposure to antigens, generally infectious agents, have usually relied upon tests for the presence or absence of a circulating humoral antibody directed against the proposed antigen. An example of such tests include blood tests to detect: immunity to Rubella (German measles); and a multitude of other viral and bacterial antigens. The means of detecting the antibody are many and include: latex agglutination in which the agglutination or lack of agglutination of antigen-coated latex particles is observed; enzyme linked immuno substrate assay (ELISA) in which the development of a color is observed either visually or spectrophotometrically; radioimmunoassay in which the measurement of radioactivity is measured; liposome technology in which the presence and intensity (or absence) of a color or fluorescent dye contained in the liposomes is detected; radio immuno sorbant assay (RAST) in which the measurement of radioactivity adherent to a solid substrate is measured; and indirect immunofluorescence in which the immobilized antigen to which the antibody to be detected is allowed to react with the specimen being tested, the antigen being washed to remove non-specifically adherent antibodies, and a fluorescently tagged antibody directed against the class of the antibody being tested for is applied, and the presence or absence of fluorescence is determined; as well as other methodologies. Antibodies, when present, can be titered, and their immune globulin class (of most interest are: IgM, signifying acute exposure; IgG, signifying past exposure; and IgE, signifying an allergic state) can be determined thereby determining the subject's previous exposure to the given antigen. All of the above tests are measurements of the function of a group of
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lymphocytes called B-lymphocytes. In cases, or disease processes: where little or no antibody response is made, the above tests will fail to determine the subject's previous exposure. Many diseases and clinical states, however, may not result in detectable humoral antibodies, i.e., a B-lymphocyte response, but do in fact produce cellular immunity, i.e., a T-lymphocyte response. Examples of such diseases and clinical conditions where the T-lymphocyte response predominates include many parasitic diseases, tuberculosis, salmonellosis, gonorrhea, fungal infections, rickettsial infections, and Lyme disease. As recently reported by Dattwyler et al (New England Journal; of Medicine, Vol. 319, at 1441, 1988) a significant proportion of patients, including some who have received some antibiotic therapy early in the course of the disease, do not produce detectable antibodies to the Lyme disease spirochete, but do have a measurable T-lymphocyte response There are two general ways for determining whether a Tlymphocyte response has taken place in the blood due to prior exposure to diseases, infectious agents, or the like. The first procedure relies on the presence of morphologic cell changes which arise from prior exposure. Previously exposed T-lymphocytes will assume blast-like characteristics when re-exposed to the particular antigens. For example, the T-lymphocytes will develop a larger than normal nucleus and an abundant basophilic cytoplasm. Biochemical changes indicative of activation will also occur, such as increased turnover of membrane phospholipids; increased synthesis of RNA and proteins; changes in intra-cellular Ca++ concentration; expression of surface receptor for T-cell growth factor interleukin-2; and increase in the incorporation 3H-thymidine, as well as other events summarized in a recent article by Chatila, T. et al (New England Medical Journal, Vol. 320, page 696, 1989). Web site: http://www.delphion.com/details?pn=US05360719__ •
Devices and methods for the prevention of transmission of venereal disease and nongonococcal genital infections Inventor(s): Gutnick; Morton (8329 Fairview Rd., Elkins Park, PA 19117) Assignee(s): none reported Patent Number: 4,332,243 Date filed: April 4, 1980 Abstract: A method and devices for the prevention of transmission of venereal diseases and non-gonococcal genital infection which includes methods, such as contraceptive and non-contraceptive creams, jellies, foams, etc., and/or methods involving mechanical birth control devices such as condoms and cervical caps and vaginal diaphragms incorporating medication receptacles functioning to release medication in the form of contraceptive and non-contraceptive creams, jellies, foams, etc. by seepage or wall breaching during intercourse to expose the genital organs involved in intercourse to the medication and thus prevent the transmission of disease organisms. Excerpt(s): The method of, and devices for, the prevention of transmission of venereal disease utilizing contraception devices and associated medication. Attention is directed to my United States issued U.S. Pat. Nos. 3,913,573 (10/21/75) and 3,996,933 (12/14/76) on Intrauterine Contraceptive Devices and 4,102,998 (7/25/78) on a Process for Prevention of Venereal Disease. These patents are directed to intrauterine devices and are effective when utilized and properly inserted and maintained. However, many persons have not or will not seek medical aid for such protection and yet will utilize condoms, contraceptive sponges, diaphragms, vaginal suppositories, contraceptive and non-contraceptive liquids, creams, jellies and foams which can be self applied. The
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incidence of venereal disease is increasing at an alarming rate as sexual morals change in the direction of more sexual promiscuity extending into younger and younger ages. Inasmuch as many persons engaged in sexual activity, whether within the accepted moral codes or without, are still concerned about birth control, a large number of partners in intercourse are willing to utilize mechanical birth control devices such as condoms and diaphragms, and/or contraceptive (and non-contraceptive) liquids, creams, salves, foams, etc. Web site: http://www.delphion.com/details?pn=US04332243__ •
Diagnostic method for gonorrhea by assay of IgA1 fragments Inventor(s): Blake; Milan S. (New York, NY) Assignee(s): Immunogon Associates (Great Neck, NY) Patent Number: 4,795,702 Date filed: February 5, 1986 Abstract: Method for assay of fragments produced by the reaction between the enzyme immunoglobulin A protease and its substrate immunoglobulin A, sub-class 1. IgA1, IgAP and also bacteria which secrete IgAP may be detected. The assay is especially useful in the detection of Neisseria gonorrhea and in the diagnosis of gonorrhea. Excerpt(s): This invention concerns immunoassay of the fragments produced by the enzyme immunoglobulin A protease (IgAP) in the reaction with its substrate immunoglobulin A, sub-class 1 (IgA1). IgA1, IgAP and also bacteria which secrete IgAP may be detected. The assay is especially useful in the detection of Neisseria gonorrhea and in the diagnosis of gonorrhea. IgAP has been the subject of intensive study since its discovery in the human body. It has been found that IgAP is secreted by pathogenic bacteria. The enzyme has been implicated in the diseases caused by these bacteria, namely gonorrhea, meningitis and influenza. The substrate of IgAP is IgA1. IgAP hydrolyzes IgA1 at a highly specific site that differs with the bacterial source of enzyme. IgA1 is naturally secreted in the human body by urogenital membranes. It has been observed that the amount of IgA1 on these membranes rises in response to infection (Mulks, et al., J. Infect. Dis. (1984) 150: 734-44). Although the role of IgAP in pathogenicity is not clear, it has been postulated that this increase in level is a natural defense mechanism of the body to bacteria which secrete IgAP. The study of IgAP and its reaction with IgA1 would be aided by a rapid, simple assay for the enzyme. Current methods are cumbersome and time-consuming. Immunoelectrophoresis is a sophisticated technique which separates reaction products according to size and charge and then identifies them with anti-sera (Plaut, et al (1974) Adv. Exp. Med. Biol., 45: 245249; Male C. J. (1979) Inf. Immun., 26: 254-261). SDS-PAGE analysis of 125I-labeled IgA1 is a sensitive technique, but is also time consuming (Blake, et al. (1979) J. Infect. Dis., 139: 89-92; Blake and Swanson (1978) Inf. Immun., 22: 350-358) Lindahl reports an assay utilizing IgA-binding protein from Group A streptococci which is useful under laboratory conditions but this method is also limited by time and labor requirements (Lindahl, L. (1981) J. Clin. Microbiol., 13: 991-993). Web site: http://www.delphion.com/details?pn=US04795702__
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Germicidal use compounds
of
compositions
containing
certain
quaternary
ammonium
Inventor(s): Saurino; Vincent R. (Boca Raton, FL) Assignee(s): Research Lab Products, Inc. (Palm Beach, FL) Patent Number: 4,321,277 Date filed: February 4, 1980 Abstract: The present invention relates to new and improved germicidal compositions having spermicidal properties comprising of a major amount of a mixture of n-C.sub.12-18 alkyl dimethyl benzyl ammonium halides and n--C.sub.12-14 alkyl dimethyl ethylbenzyl ammonium halides and a minor amount of a wetting agent selected from the group consisting of non-ionic, cationic and/or amphoteric surfactants and mixtures thereof.Spermicidal-germicidal compositions of the present invention possess new, improved and unexpected properties, particularly with respect to being biologically active against a wide range of organism including the venereal type organisms such as Neisseria gonorrhea, Treponema pallidum and other spirochetes, Hemophilus ducreyii, flagellates, such as Trichomonas vaginalis and related organisms. The compositions of the present invention have been found to exhibit spermicidal properties and, therefore, are particularly useful as a contraceptive. They are non-irritating towards vaginal tissues. Excerpt(s): A variety of germicidal compositions are known to the art. A particularly effective such composition, which also is a spermicide, is the subject of U.S. Pat. No. 3,594,468, said composition comprising a mixture of 2-[(2-hydroxy-5-nonyl-benzyl)methyl-amino]ethane sulfonic acid or a salt of said acid and 2{[3-(dimethylaminomethyl)-2-hydroxy-5-nonyl benzyl]methyl-amino}ethane sulfonic acid or a salt of said acid. Compositions of the present invention, which are totally different from the compositions of this patent, are spermicidal and germicidal active materials which are effective against the same range of organisms at generally lower concentrations and possess additional desirable properties such as being milder to inflamed tissues. The present invention relates to biostatic and biocidal compositions. More particularly, it is concerned with compositions which are effective in the inhibiting of (biostatic) and killing of (biocidal) a wide range of gram-positive and gram-negative organisms. The compositions also possess spermicidal properties making them particularly useful as a contraceptive and for controlling, preventing and/or curing infection with venereal disease organisms, e.g., Neisseria gonorrhea and Treponema pallidum. The compositions of this invention may be formulated into a wide range of other end products and uses, among which are germicidal cleaning compositions for hospitals and the like, compositions for the control of mildew, algae and the like, paints which will control microbial corrosion and cosmetics such as shaving creams and skin creams to control staphylocci in lesions. The compositions of the present invention comprise a mixture of components (A) and (B), as hereinafter defined. Web site: http://www.delphion.com/details?pn=US04321277__
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Gonorrhea diagnostic test Inventor(s): Doyle; Ronald J. (Jefferson Town, KY), Keller; Kenneth F. (Anchorage, KY), Schaefer; Robert L. (Louisville, KY) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,298,689 Date filed: September 25, 1978 Abstract: Method of diagnosing Neisseria gonorrhoeae infections utilizing plant lectins which have an affinity for N-acetylglucosamine. Excerpt(s): Current methods for definitively diagnosing Neisseria gonorrhoeae (N.g.) infections are time consuming and expensive. The sugar fermentation test, which is most often used in clinical laboratories, requires an incubation period of 6 to 48 hours after primary isolation. Other tests which have been suggested to increase the speed of testing generally require that the testing laboratory have relatively expensive instrumentation available such as fluorescence microscopes or radioimmunoassay equipment. There is a genuine need for a facile, accurate, reproducible, sensitive, specific, inexpensive test for screening large numbers of people. It has been previously demonstrated that lectins extracted from a variety of plants can be used to selectively agglutinate specific types of red blood cells, bacteria and yeasts. A clinical application of this phenomenon has been utilized in identifying specific red blood cell types. Ottensooser et al. have shown that a lectin isolated from Wisteria floribunda seeds would agglutinate certain Group C streptococcus, but would not affect other serotypes of streptococci, see (Infection and Immunity, Vol. 9, No. 5, 971-973 (1974). These workers even suggested that the laboratory tests might be extended to clinical applications. However, there have been no reports of any clinical applications to determine the presence of any kind of infections in humans. A test has now been discovered for detecting the presence of N.g. infections in humans which meets all of the criteria set forth above, and is well adapted to large population screening. The test comprises a method for the detection of N.g. infections of humans. It has been discovered that plant lectins which possess an affinity for N-acetylglucosamine residues will react specifically with N.g. microorganisms since these microorganisms are characterized by the presence of available N-acetylglucosamine on the cell surface. The resulting reaction can be detected by any of a number of available means. Perhaps the most convenient method of detection is the macroscopic-slide agglutination test the accuracy of which may be enhanced by microscopic examination. It is also possible to label or tag the lectin and detect the presence of a reaction product by detecting the tag without effecting agglutination. For example, the lectin can be tagged with a fluorescein dye, that is, a dye which fluoresces when exposed to ultraviolet light such as fluorescein itself, rhodamine and auramine. These are presently preferred, but other labels, for example, isotopic labels such as.sup.14 C,.sup.125 I,.sup.131 I, and.sup.35 S; or enzyme labels such as peroxidase, B-glucuronidase, B-D-glucosidase, B-D-galactosidase, urease, glucose oxidase plus peroxidase, galactose oxidase plus peroxidase and acid phosphatase may also be employed. With these labels the reaction product is not, strictly speaking, an agglutination product such as is observed when the lectin is contacted with the N.g. microorganisms on a cell growth culture. These procedures are effective in testing exudates resulting from human infection. Web site: http://www.delphion.com/details?pn=US04298689__
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High pH extraction composition and its use to determine a chlamydial, gonococcal or herpes antigen Inventor(s): Gilbert; James H. (Oakland, CA), Greer; Catherine E. (Oakland, CA), Mauck; John C. (Rochester, NY), Pronovost; Allan D. (San Diego, CA), Sullivan; Sheryl S. (Hilton, NY) Assignee(s): Eastman Kodak Company (Rochester, NY) Patent Number: 5,132,205 Date filed: October 7, 1988 Abstract: An extraction composition is useful for lysing chlamydial, gonococcal or herpes organisms and extracting detectable antigen from the organisms. In particular, this composition has a high pH (at least about 8) and comprises an alcoholamine which is effective in extracting antigen. It is particularly useful for extracting either or both of the lipopolysaccharide and major outer membrane protein chlamydial antigens. Excerpt(s): This invention relates to an extraction composition and its use in the determination of chlamydial, gonococcal or herpes organisms. In particular, it relates to a composition useful for the extraction of the appropriate antigen, a method of extraction and a method of determining the antigen. Immunoassays have been used in recent years to detect the presence of infectious diseases. In order for the assay to be useful, it must detect a particular organism with a high degree of reliability. In most cases, this requires the isolation and reaction of antigens peculiar to the organism with corresponding antibodies. For the test to be commercially successful, it also needs to be relatively inexpensive, simple to use and rapid. One such organism which can be detected by immunoassay is Chlamydia trachomatis (herein C. trachomatis) which is one of two microbial species of the genus Chlamydiaceae, order Chlamydiales. There are 15 or more strains of this species which are the causes of a number of human ocular and genital diseases including trachoma, inclusion conjunctivitis, lymphogranuloma venereum, nongonococcal urethritis and proctitis. Infection from C. trachomatis is pervasive in the general population so that it is believed that there are millions of cases each year of nongonococcal urethritis alone. Web site: http://www.delphion.com/details?pn=US05132205__
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Instrument for the detection of Neisseria gonorrhoeae without culture Inventor(s): Mennen; Frederick C. (La Porte, IN) Assignee(s): U.S. Packaging Corporation (La Porte, IN) Patent Number: 4,018,653 Date filed: December 30, 1974 Abstract: A non-culture method and instrument for a rapid presumptive test for gonorrhea in which a specimen of exudate from a suspected case is placed in direct contact with a pledget containing a compound which reacts with Neisseria gonorrhoeae to produce a color change. The pledget, before the test, is in a dry condition and is activated by a wetting agent such as saline, when placed in contact with the pledget. The chemical compound used and incorporated into the pledget is selected from a group consisting of phenylenediamines. The instrument used consists of a flexible tube containing a fluid-filled frangible ampul at one end and the chemically impregnated pledget disposed immediately above same. A separate sterile swab is supplied for
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taking the specimen. The swab containing the specimen is inserted into the flexible tube. The flexible tube is then squeezed at the ampul portion, releasing the wetting agent by breaking the frangible ampul. The wetting agent when thus released activates the reagents in the pledget. A downward pressure of the swab containing the specimen places it in direct contact with the activated pledget. If gonorrhea is present in the specimen on the swab, a distinctive coloration of the specimen takes place within two minutes. Excerpt(s): It is common knowledge that this country and most of the world is undergoing a venereal disease epidemic. In the United States alone the disease has reached pandemic proportions. It is estimated that only one-fifth of the cases are reported and only one-third reach the attention of physicians and Public Health authorities in order to receive treatment. The availability of a simple, rapid and inexpensive test would aid in recognition and control of this disease. The usual clinical evidence of a gonorrheal infection in the male is a purulent discharge from the meatus and urethra of the penis. As routine procedure it is necessary to make a differential diagnosis of the nature of the discharge before antibiotics can be prescribed. As a rule the first test is to determine if the urethritis is gonococcal or non-specific in nature. An object of this invention is therefore to provide a system which will operate directly from the patient and give the clinician or physician a differential diagnostic tool which is time saving, inexpensive and reliable. As a screening test for gonorrhea in public V-D clinics, hospitals, physicians' offices and the Armed Forces, the present device would serve as an inexpensive and accurate differential diagnostic aid to assist the physician or clinic in the choice of drug treatment. The need for a simple and inexpensive diagnostic system that can function in the field, independent of bacteriological and microscopic tests, is therefore well established. One of the difficulties in making a quick and reliable diagnosis of male infection is the initial confusing similarity with urethritis. Web site: http://www.delphion.com/details?pn=US04018653__ •
Intrauterine contraceptive devices and processes Inventor(s): Gutnick; Morton (8329 Fairview Road, Elkins Park, PA 19117) Assignee(s): none reported Patent Number: 3,996,933 Date filed: October 14, 1975 Abstract: An intrauterine contraceptive device comprising an elongated shank having divergent convoluted portions at its distal end, said convoluted portions being generally sinusoidal in nature, said device having incorporated in said shank a permanent magnet and having a substantial portion of its surface covered with a biologically inert, silicone elastomeric material which may contain an analgaesic or anti-fertility agent which is gradually eleased in utero. In a preferred embodiment of the invention, the proximal end, of the shank contains a pair of downwardly extending divergent, resilient legs which tend to prevent inadvertent expulsion of the device. In another preferred embodiment, the lower end of the device is also formed with one or more small refillable containers for certain types of medication which are released gradually into the vagina and the lower end of the uterus over a prolonged period of time for the prevention and cure of such venereal diseases as gonorrhea, syphilis, trichomonas vaginalis and moniliasis.
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Excerpt(s): The invention relates to both new and useful improvements in contraceptive devices for human beings and other animals which serve also to prevent and cure venereal and other diseases. It has been known for many years that a foreign object in the uterus will prevent conception. To date, many different types of intrauterine contraceptive devices, also known as IUDs, have been proposed, and several types are in widespread use, but none have been fully satisfactory. Bleeding and pain account for eighty-five per cent of the complications or side effects of intrauterine contraceptive devices. Therefore, any device that would reduce or eliminate bleeding and pain would lead to fewer removals of intrauterine contraceptive devices for "cause," and would allow a greater percentage of patients to "continue to use" the IUDs and would probably also expand the usage of IUDs. Web site: http://www.delphion.com/details?pn=US03996933__ •
Method and analytical device for simultaneous immunoassay Inventor(s): Arcioni; Laura (Monza, IT), Gatti; Guido (Monza, IT) Assignee(s): Boehringer Mannheim Italia S.p.A. (Milan, IT) Patent Number: 5,731,162 Date filed: December 6, 1995 Abstract: The present invention concerns a method and an analytical device for the simultaneous detection of at least two organisms selected from the group consisting of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Mycoplasma (M) from a single specimen. Excerpt(s): This application is a rule 371 continuation of PCT/EP94/01723 filed May 27, 1994. The present invention concerns a method and an analytical device for the simultaneous detection of Chlamydia trachomatis (CT), Neisseria gonorrheae (NG) and Mycoplasma (M) from a single specimen. The diagnosis of the pathogenic agents responsible of sexually transmitted diseases (STD) such as gonorrhea, urethritis and similar illnesses, currently requires a specimen taken from the infection district as well as a separated analysis for each pathogen, the presence of which has to be verified. Web site: http://www.delphion.com/details?pn=US05731162__
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Method of using over the counter swab kit for self detection of gonorrhea in the male using tetramethyl chromogen ampul Inventor(s): Mennen; Frederick C. (506 Clay St., LaPorte, IN 46350) Assignee(s): none reported Patent Number: 4,340,670 Date filed: June 19, 1981 Abstract: An over the counter swab kit for self detection of gonorrhea in the male using an ampul containing 1% N, N, N' N' tetramethyl-p- phenylenediamene or tetramethyl chromogen. The method of taking a sample is also shown in which the open end of a tube is filled with a plug in the form of fibrous material. After a sample is taken of exudate from a male, the 1% solution of tetramethyl chromogen reacts with Neisseria gonorrhea which may be present in the exudate to produce a color change. The plug, before the test, is in a dry condition, the plug is activated only by the tetramethyl
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chromogen which is placed below the plug in the tube and the ampul broken to release its contents. A sufficient amount of 1% tetramethyl chromogen is held within the frangible ampul to wet the plug and this amount is 1/2 the volume than is used in the saline ampul in my companion patent application entitled Over the Counter Swab Kit for Self Detection of Gonorrhea in the Male Using Saline Ampul. This volume is drawn by capillary action through the tip on which the sample of exudate was placed and before the ampul was broken. A purple color is created on the tip in 3 minutes at the site of the bacteria and is a positive test for gonorrhea. A key feature of the kit is the cover which protects the tip before use in self diagnosis is removed to take the specimen of exudate, and is replaced when the kit is inverted and the ampul broken to get the color change to purple in 3 minutes. If the deep purple color does not develop this is a negative test. Excerpt(s): Frederick C. Mennen, application filed Oct. 29, 1971, entitled Method and Instrument for the Detection of Neisseria Gonorrheae Without Culture, now U.S. Pat. No. 3,876,503 granted Apr. 8, 1975. Frederick C. Mennen, application filed Dec. 30, 1974, entitled Instrument for the Detection of Neisseria Gonorrhoeae, Ser. No. 537,593, allowed Oct. 20, 1976, Final Fee Paid Jan. 21, 1977, Now U.S. Pat. No. 4,018,653 granted Apr. 19, 1977. Frederick C. Mennen, application filed Mar. 28, 1975, entitled Apparatus Especially Useful for Detection of Neisseria Gonorrhoeae and the Like in Females, Ser. No. 563,300, granted May 4, 1976, now U.S. Pat. No. 3,954,563. Web site: http://www.delphion.com/details?pn=US04340670__ •
Neisseria gonorrhoeae lectin useful as a vaccine and diagnostic marker and means for producing this lectin Inventor(s): Deal; Carolyn D. (San Diego, CA), Seifert; H. Steven (Del Mar, CA), So; Magdalene Y. H. (Cardiff, CA) Assignee(s): Scripps Clinic and Research Foundation (La Jolla, CA) Patent Number: 4,786,592 Date filed: September 12, 1986 Abstract: A bacterial lectin isolatable from Neisseria gonorrhoeae is disclosed. This lectin binds to gonococcal carbohydrates such as gangliotetraosylceramide, has a relative molecular weight of about 22,400 daltons, and an isolectric pH value in the range of about 6.1 to about 6.4. The disclosed lectin is useful as a constituent of a vaccine against gonorrhea and as a diagnostic means for gonorrhea. A method for isolating this lectin is also disclosed, as well as means for producing it. Excerpt(s): This invention relates to a lectin suitable for use in an inoculum or a vaccine against Neisseria gonorrhoeae, to a vaccine containing the lectin and to a method of diagnosing gonorrhea. More specifically, this invention relates to a Neisseria gonorrhoeae lectin obtainable from gonococci, a method of isolating the lectin, to an inoculum and/or a vaccine prepared therefrom, and to means for producing such lectin. The annual incidence of reported infections by Neisseria gonorrhoeae (N.g.) is estimated to be about two million cases. A gonococcal infection in men usually results in a relatively uncomplicated urogenital infection. Disseminated gonococcal infection is reported to occur in 1 to 3% of those with gonorrhea, but the morbidity of this disease with current therapy is slight. On the other hand, in women infected with gonorrhea, salpingitis occurs in 10 to 20%, and even when adequately treated, may result in recurrent salpingitis, ectopic pregnancy, and infertility. It is estimated that salpingitis
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leads to 1.8 million office visits to private physicians and 220,000 hospitalizations each year in the United States. Web site: http://www.delphion.com/details?pn=US04786592__ •
Process for solubilization of gonococcal antigen Inventor(s): Karkhanis; Yashwant D. (Fanwood, NJ) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 4,330,623 Date filed: February 19, 1980 Abstract: Gonococcal antigens are solubilized by a process involving trypsin-digestion. Excerpt(s): The present invention relates to a process for the solubilization of gonococcal antigens, especially those isolated from the cell surface of Neisseria gonorrhoeae. For example, gonococcal lipopolysaccharides, G.sub.c antigens (a family of polysaccharides. See M. A. Apicella et. al, in Immunobiology of Neisseria gonorrhoeae, proceedings of a conference held in San Francisco, Calif., 1978, American Society for Microbiology, Washington, D.C., p. 108), or the antigenic complex as described in U.S. Patent Application Ser. No. 949,581 filed Oct. 12, 1978, now U.S. Pat. No. 4,220,638. The solubilization of these antigens is essential to their capacity as a vaccine against N. gonorrhoeae for humans. This is because most of these antigens contain water-insoluble determinants such as protein or peptides. In order to inject a vaccine subcutaneously, intravenously or intramuscularly, it is necessary that the antigens which constitute the vaccine be substantially solubilized in a physiologically acceptable medium, for example sterile saline. The solubilization process of the present invention involves trypsin digestion of the antigen. Although trypsin has been used to digest other bacterial antigens, it has not been used to solubilize gonococcal antigens isolated from N. gonorrhoeae. Web site: http://www.delphion.com/details?pn=US04330623__
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Radioimmune assay method for detection of gonorrhea antibodies Inventor(s): Maley; Frank (Delmar, NY) Assignee(s): Research Corporation (New York, NY) Patent Number: 3,974,269 Date filed: July 12, 1974 Abstract: Gonorrhea antibodies in serum are detected by determination of radioactivity of conjugate formed between antibodies and antigens labelled with radioactive isotope. Excerpt(s): This application relates to improvements in the methods of detection disclosed in copending and commonly assigned patent application Ser. No. 385,863 filed on Aug. 6, 1973, the disclosure of which is hereby incorporated by reference. This invention relates generally to methods for screening large number of persons for current or past gonorrhea infection. Gonorrhea is one of the most commonly reported bacterial diseases in man and its persistence as a major health problem has intensified the search for new and better methods of detection. Web site: http://www.delphion.com/details?pn=US03974269__
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Screening method for inflammatory diseases using neutrophil defensins and lactoferrin Inventor(s): Heine; Robert Phillips (Pittsburgh, PA) Assignee(s): University of Pittsburgh (Pittsburgh, PA) Patent Number: 6,174,664 Date filed: May 5, 1999 Abstract: The present invention provides a relatively accurate, rapid and economical method of screening a patient for the presence of inflammatory diseases such as an intraamniotic infection, bacterial meningitis and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. The method of the present invention involves measuring the concentration of neutrophil defensins HNP1-3 and the concentration of lactoferrin, found in a bodily fluid, tissue or a combination thereof, adding these two concentrations together to yield a summed total, and correlating the measured summed total to known summed totals to give an indication of whether the patient is at risk of suffering from inflammatory diseases such as an intraamniotic infection, bacterial meningitis or the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. Excerpt(s): The present invention relates to a method of screening for inflammatory diseases in a patient. More particularly, this invention concerns the method of screening a patient for the presence of inflammatory diseases such as an intraamniotic infection, bacterial meningitis and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis, by utilizing neutrophil defensins and lactoferrin, found in a bodily fluid, a tissue or a combination thereof, to give an indication of whether the patient is at risk of suffering from one or more such inflammatory diseases. The methods of disease detection may be divided into two general types: diagnosis and screening. Diagnosis is the method whereby a physician determines the nature of a disease based upon the patient's signs and symptoms. Screening is the method of suggesting the presence, or the absence, of a particular disease, or class of diseases, in a patient. When a screening test indicates that a patient does not have a disease, in many cases the need for further diagnostic testing has been eliminated. Used in this manner, screening saves money for patients, health insurance companies and government health programs by precluding the unwarranted diagnostic testing of people shown not to suffer from the disease or class of diseases. To be effective in reducing unnecessary diagnostic testing, however, a screening method must be widely used. In order that a screening method is widely used, the screening test should be relatively accurate, quick, and economical to use. In addition, screening provides a way for patients to avoid the cost and discomfort associated with the more invasive procedures often necessary to collect the samples required for diagnostic testing. The following are some of the conventional methods used for screening and diagnosing inflammatory conditions such as an intraamniotic infection, bacterial meningitis, and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. Web site: http://www.delphion.com/details?pn=US06174664__
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Sensitive condom Inventor(s): Mallette; Kermit J. (3923 South Dakota Ave. NE., Washington, DC 200183037) Assignee(s): none reported Patent Number: 5,284,158 Date filed: April 13, 1992 Abstract: An improved condom for human sexual intercourse for improved sensitivity, prevention of pregnancy as well as for providing an effective barrier against transmittal of certain diseases such as spread of HIV for AIDS, gonorrhea, non-specific urethritis, male urinary tract diseases as well as female pregnancy related diseases. The sensitive condom comprises a membrane condom which is reinforced at the head of the penis by latex rubber or polyurethane which prevents osmotic transmission of bodily fluids. A generic spermicide such as nonoxynol 9 is also added at the front end of the condom to deactivate HIV. The packaging includes braille markings for orientation such that it can be donned properly even in the dark. Excerpt(s): This invention relates to an improvement in condom construction and design for increased sensitivity during human sexual intercourse as well as for prevention of certain sexual diseases of the male and the female sex organs. A prior art search was conducted and the following U.S. Patent documents were uncovered arranged in reverse a chronological order. f) U.S. Pat. No. 4,821,742 granted to John Phelps III on Apr. 18, 1989 for, "Contraceptive Device". Web site: http://www.delphion.com/details?pn=US05284158__
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Serological reagent, test slide and method for gonorrheal antibodies Inventor(s): Price; Richard T. (Verona, NJ), Prodell; Rita C. (West Orange, NJ) Assignee(s): Akzona Incorporated (Asheville, NC) Patent Number: 4,066,744 Date filed: January 16, 1976 Abstract: Disclosed are a reagent and test slide used for serological detection of gonorrheal antibodies in human blood serum or synovial fluid. The reagent comprises latex particles having absorbed on their surfaces an inert protein, such as bovine serum albumin and a heat labile antigen derived from Neisseria gonorrhoeae bacteria exhibiting T.sub.1 colonial morphology. The reagent may be employed by several forms, for example, as a liquid suspension of the latex particles, or in the form of a dried deposit of the latex particles. Regardless of the form employed, the reagent is particularly useful as a routine screening test in hospitals and prenatal clinics to detect gonococcal infection in women and also in cases of complicated gonorrhea, e.g., gonorrheal arthritis where infection is not conveniently detectable by present means. The test slide may have dried thereon an absorbing antigen for heterophile antibodies. If desired, diagnosis made by the test of the invention can be subsequently confirmed by conventional more expensive and time consuming means, if this is thought to be desirable. Excerpt(s): Presently, the recognized test procedures for the determination of gonoccocal infection rely upon culture methods which are laborious, time-consuming, and in the case of asymptomatic infections present in females, the accuracy of cultural methods
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may be doubtful (see Pariser et al., Southern Medical Journal. Vol. 63, pages 198-201). Typical procedures are described in the publication "Criteria and Techniques for the Diagnosis of Gonorrhea" published by the United States Public Health Service at the Venereal Disease branch in Atlanta, Georgia. Typically, in males, the presence of gonococcal infection is determined by obtaining urethral cultures which exhibit oxidaseportions colonies of gram-negative diplococci when cultured on Thayer-Martin medium (J. D. Thayer and J. E. Martin, Jr., in Public Health Rep., 79, pages 49-57). In females, gonococcal infection is diagnosed by cervical cultures on Thayer-Martin medium wherein oxidase-positive colonies of gram-negative diplococci appear. In the above culture tests, all cultures are incubated for 18 hours at 37.degree. C. with CO.sub.2 enrichment. The cultural results are frequently confirmed by sugar fermentation studies. Other tests employed include complement fixation wherein the hemolysis of erythrocytes is monitored. This test is time consuming, the accuracy of results is questionable, and standardization of reagents is a problem. Indirect immuno fluorescence is also employed to measure the amount of gonococcal antibody in sera. However, this test requires complex and costly apparatus as well as a skilled operator. Web site: http://www.delphion.com/details?pn=US04066744__ •
Steric hindrance enzyme immunoassay Inventor(s): Castro; Albert (Miami, FL), Monji; Nobuo (Miami Springs, FL) Assignee(s): University of Miami (Coral Gables, FL) Patent Number: 4,323,647 Date filed: October 15, 1980 Abstract: A novel separation technique is described that is particularly useful for effecting separations in enzyme immunoassay procedures. A mixture, in an aqueous liquid vehicle, of (1), ligand-enzyme conjugate, and of (2), the conjugate bound through its ligand moiety to a receptor, is brought into contact with an insoluble, immobilized pseudo-substrate material, to which the enzyme normally binds. Free conjugate binds and becomes insoluble. Bound conjugate remains in the liquid phase. The ligand may be an antigen and the receptor, the antibody to the antigen.This separation technique makes feasible several sensitive immunoassay procedures. The material to be assayed may be, for example, rubella virus; hepatitis B surface antigen; gonorrhea antigen; the antibody to any of the foregoing; a general antibody, i.e., an immunoglobulin; a hormone such as choriomammotropin; a steroid, hapten, or the like. Excerpt(s): This invention relates specifically to a new assay procedure for the detection and measurement of certain biologically active substances, particularly immunochemical substances. This new assay procedure permits rapid qualitative and quantitative determinations to be made in an advantageous manner. The invention also relates to a novel separation technique that is of general utility, and more particularly, to kits useful for assay procedures. There is a continuing need for rapid, accurate qualitative and quantitative determinations of many kinds of biologically active substances at extremely low concentrations, i.e., at physiological concentrations. Today, there is for example a need for determining the presence of drugs or narcotics in body fluids, such as saliva, blood or urine. In addition, in medical diagnosis, it is frequently important to be able to detect and quantify the presence of various substances which are synthesized naturally by the body or ingested. These include hormones, both steroidal and polypeptides, prostaglandins, and toxins, as well as other materials which may be
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involved in body functions. Frequently, there is concern with extremely small amounts and occasionally, with very small differences in concentrations. Web site: http://www.delphion.com/details?pn=US04323647__ •
Test method for the laboratory diagnosis of Gonorrhea and test strain of neisseria gonorrhoeae Inventor(s): Zubrzycki; Leonard J. (Pennsauken, NJ) Assignee(s): Temple University of the Commonwealth System of Higher Education (Philadelphia, PA) Patent Number: 4,446,230 Date filed: October 30, 1981 Abstract: A strain of Neisseria gonorrhoeae ATCC 31953 is described which is abnormal in that it has characteristically poor growth on chocolate agar at a temperature range of about 30.degree. C. to about 37.degree. C. in a CO.sub.2 atmosphere suitable for growth of N. gonorrhoeae. This strain is resistant to nalidixic acid at the 5-10 mcg/ml level and resistant to streptomycin at the 1000 mcg/ml level or greater. N. gonorrhoeae ATCC 31953 is a test strain suitable for use in the method described for the laboratory diagnosis of gonorrhea. The method comprises the steps of (1) applying a non-toxic preparation of a patient's specimen material, directly to a culture of Neisseria gonorrhoeae ATCC 31953, which has abnormal growth characteristics, which is in or on a biological medium suitable for growth of normal Neisseria gonorrhoeae, and observing for the restoration of normal growth to the abnormal growth strain Neisseria gonorrhorae ATCC 31953, in or on the biological medium of step (1), under conditions normal for growth of Neisseria gonorrhoeae. The observence of growth indicates positive detection of N. gonorrhoeae DNA. Excerpt(s): The standard laboratory diagnosis of gonorrhea depends on isolation and subsequent identification of Neisseria gonorrhoeae by colony morphology, microscopic examination, biochemical or serologic tests (Kellog, Jr., et al., Laboratory Diagnosis of Gonorrhea, Cumitech, Amer. Soc. Microbiol., 1976). Although gram stain examination can be used to diagnose gonococcal urethritis, this technique lacks sensitivity in detecting infections of the cervix, rectum or oropharynx. Other diagnostic methods, such as serologic testing or direct fluorescent antibody staining, have not proven useful. Because N. gonorrhoeae loses viability rather quickly, the best procedure for isolating gonococci is to culture a specimen as soon as possible. This requires special facilities since it is necessary to incubate the inoculated culture media at 35.degree. C.-37.degree. C. in a CO.sub.2 atmosphere. When proper facilities are not available, specimens can be sent to a laboratory in Amies' or Stuart's transport medium or in a transport and growth medium such as Transgrow (Martin, Lester, HSMHA Health rep. 86:30, 1971). The latter procedures are not nearly as good as immediate culturing which itself is about 90-95% sensitive in detecting gonococci (Schmaly, Martin, Domescik, J. Am. Med. Assoc. 210:312, 1969; Caldwell, Price, Pazin, Cornelius, Am. J. Obstr. Gynecol. 109:463, 1971). In 1976, a transformation test was reported which could be used to identify a clinical isolate as N. gonorrhoeae and thereby to help diagnose gonorrhea (Janik, Juni, Heym, J. Clin. Microbiol. 4:71; Juni U.S. Pat. No. 3,930,956). A transformation test depends on detecting gonococcal DNA as compared to a culture technique which depends on isolating colonies. In preliminary laboratory studies, the test appeared to be a useable alternative to standard porcedures for identifying colonies of N. gonorrhoeae (Bawdon, Juni, Britt, J. Clin. Microbiol. 5:108, 1977; Sarafian, Young, J. Med. Microbiol. 13:291,
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1980). However, in a field trial, done in collaboration with the Centers for Disease Control, using specimens obtained from clinic patients, the test described was found to be insensitive and nonspecific for the laboratory diagnosis of gonorrhea infections. Web site: http://www.delphion.com/details?pn=US04446230__
Patent Applications on Gonorrhea As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to gonorrhea: •
Method of inhibiting formation of infectious microorganisms Inventor(s): Docherty, John; (Kent, OH) Correspondence: Pamela A. Docherty; Calfee, Halter & Griswold Llp; 1400 Mcdonald Investment Center; 800 Superior Avenue; Cleveland; OH; 44114; US Patent Application Number: 20010020043 Date filed: December 11, 2000 Abstract: The present invention provides a method of inhibiting the formation of pseudorabies particles in a host cell. The method involves administering an effective amount of a poly-hydroxylated stilbene, particularly resveratrol, to a herpes virus infected host cell. The present invention also provides a method of reducing or inhibiting the growth of Neisseria gonorrhea and Neisseria meningiditis in vitro and in vivo. The method comprises administering a composition comprising a therapeutically effective amount of a tri-hydroxylated stilbene to a growth surface which has come into contact or could come into contact with the bacterium. Excerpt(s): This application is a continuation in part of the co-pending, commonly assigned, U.S. patent application Ser. No. 09/145,039; filed Sep. 1, 1998. The present invention relates to methods of inhibiting replication of three pathogenic microorganisms, pseudorabies virus, Neisseria gonorrheae, and Neisseria meningiditis. Pseudorabies virus, a member of the Herpesvirus family, primarily affects swine. Because virus is present in the nasal and oral discharges of infected pigs, infection is usually transmitted between pigs by none to nose contact. Contaminated drinking water and feed buckets may also transmit disease. Clinical symptoms in pigs can vary from undetectable to death. The extent of the symptoms depends on the age and immune status of the animal at the time of infection, the virus dose, route of infection, and strain of virus. Young pigs may be severely affected with a 100% mortality in pigs under 2 weeks of age. Piglets may die suddenly or, prior to death, exhibit symptoms which include fever, loss of appetite, convulsions, and paddling. The severity of clinical signs decreases with age, and older pigs may only experience fever and inappetence of a few days duration. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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This has been a common practice outside the United States prior to December 2000.
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Keeping Current In order to stay informed about patents and patent applications dealing with gonorrhea, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “gonorrhea” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on gonorrhea. You can also use this procedure to view pending patent applications concerning gonorrhea. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON GONORRHEA Overview This chapter provides bibliographic book references relating to gonorrhea. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on gonorrhea include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gonorrhea” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on gonorrhea: •
AIDS: Historic Overview of Syphilis and Its Significance to Contemporary Medical Policy. Medical Library Association's 89th Annual Meeting Contact: Teach'em, Incorporated, 160 E Illinois, Chicago, IL, 60611, (312) 467-0424. Summary: In this sound recording of a session from the Medical Library Association's 89th Annual Meeting, the epidemic of Acquired immunodeficiency syndrome (AIDS), caused by the Human immunodeficiency virus (HIV), is discussed from the viewpoint of the medical historian. He says that the way society reacts to disease shows its deepest cultural, social, and moral values. He discusses the denial that existed in this country for a long time about the real causes of syphilis and gonorrhea. He says that there are many similarities between the way the public reacts to AIDS today and the reaction against syphilis and gonorrhea early in the 20th century. He says that the major public health campaigns used today were developed early in this century. He discusses the distinction made by the public between innocent and guilty victims of Sexually transmitted diseases (STD's). He compares this attitude to the distinction made today between
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Persons with AIDS (PWA's). He describes the effort to lower the STD rates during World War I by closing down the red light districts in 110 cities. Between 40,000 and 60,000 prostitutes were incarcerated in barbed-wire camps throughout the war, but the rate of STD's was not affected. He says that the social policy response to AIDS must be faced in the coming years. It must be decided what is safe and how risks can be compared. He discusses the involvement of the AIDS epidemic in the political process, which led to compulsory HIV testing for marriage-license applicants in Louisiana and Illinois. He concludes his discussion by saying that society needs a deeper medical and cultural understanding of the AIDS epidemic. A question-and-answer period follows the presentation. •
New Pathways to Health: Lessons for Teaching About AIDS and Other STDs (Sexually Transmitted Diseases) - Senior High School Contact: Los Angeles Unified School District, Office of Health Education Programs, 1320 W Third St Rm 34, Los Angeles, CA, 90012, (213) 625-6411. Summary: This AIDS and other sexually transmitted diseases (STD's) instructional guide for teachers of senior high schools provides a framework for AIDS and STD instruction. It is structured to provide students with the facts and critical-thinking skills that will enable them to make informed decisions that will reduce their chances of contracting an STD. It is comprised of 8 lesson plans which constitute teaching objectives, materials, procedures, content, and activities. The lesson plans include information on STD's, the body's defenses against disease, chlamydia, gonorrhea, syphilis, AIDS, genital herpes, reducing the risks of STD's, STD's and the law, and communicating about AIDS and other STD's. Worksheets, factsheets, and a resource list are included.
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Sex: What you don't know can kill you Source: Grand Rapids, MI: Baker Books. 1997. 121 pp. Contact: Available from Baker Books, P.O. Box 6287, Grand Rapids, MI 49516. Summary: This book by an obstetrician/gynecologist is divided in two sections; the first reviews the symptoms and treatments for a number of sexually transmitted diseases; the second examines the various behaviors and risks involved with different methods of sexual fulfillment. The first section covers these diseases, among others: chlamydia, gonorrhea, herpes, hepatitis B, HIV and AIDS, and vaginal infections. The second section discusses sexual acts other than intercourse, the use of condoms, cohabitation as a form of mutual monogamy, how and when to abstain from sex, secondary virginity, celibacy, and personal codes regarding sexual activity.
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Social Diseases Source: The Serious Sides of Sex. Contact: Nevbet Company, 2843 Brownsboro Rd, Louisville, KY, 40206, (502) 897-1664. Summary: This book chapter discusses a dozen Sexually transmitted diseases (STD's), including Acquired immunodeficiency syndrome (AIDS), chancroid, chlamydia, gonorrhea, nonspecific urethritis, syphilis, vaginitis, genital herpes, genital warts, Hepatitis B, pubic lice, and scabies. Symptoms, treatment, diagnosis, and consequences for sexual partners are covered for each. The chapter also looks at public health, education, and ethical, legal, medical and psychological issues involved in STD transmission.
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Crack Contributes to the Spread of AIDS and Other Sexually Transmitted Diseases Source: Drug Abuse - The Crack Ccocaine Epidemic: Health Consequences and Treatment. Contact: US General Accounting Office, Document Distribution Center, 700 4th St NW Rm 1100, Washington, DC, 20548, (202) 512-6000, http://www.gao.gov. Summary: This book chapter examines the possible link between the use of crack cocaine and Acquired immunodeficiency syndrome (AIDS). It says that studies have shown crack users are more likely to engage in risky sexual behaviors, such as having repeated sex with multiple partners or exchanging sex for drugs. A survey of adolescent crack users showed the majority engaged in unprotected intercourse while using crack, and that Sexually transmitted disease (STD's), including Human immunodeficiency virus (HIV) infection, were very common. The chapter cites other studies that show rises in the rates of syphilis and gonorrhea among crack users.
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Sexually Transmissible Diseases Source: Guidelines for Women's Health Care; 1996. Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. Summary: This book chapter reviews the assessment, evaluation, diagnosis, and treatment of sexually transmitted diseases (STDs). The chapter provides an overview and history of the more common STDs followed by guidelines for the treatment of gonorrhea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis, herpes simplex virus, human papillomavirus, bacterial vaginosis, candidal vaginitis, hepatitis B, and HIV.
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Reasonable Reasons to Wait: Family Life and Character Formation; Student Handbook Contact: An Educated Choice, Inc., Teen Choice, 6201 Leesburg Pike Ste 404, Falls Church, VA, 22044, (703) 532-9455. Summary: This guide is the student handbook of an eight unit sexual abstinence and human sexuality curriculum for high school students. The curriculum covers human development, peer pressure, premarital sex, chemical use and abuse, and the freedom associated with sexual self-control and regaining that self-control. The first unit contains exercises and information that support the decision to remain abstinence until marriage. Unit Two reviews the impact that peer pressure and the need for acceptance often has on the adolescent's sexual behavior. The third unit covers the purpose and responsibilities of dating and the benefits of establishing long lasting relationships. Unit four discusses the facts about common sexually transmitted diseases, including HIV, chlamydia, syphilis, genital herpes, and gonorrhea. Unit five emphasizes the importance of building a solid foundation to marriage relationship. The sixth unit covers the elements and purpose of marriage. Unit seven presents the prerequisites for parenting, and the eighth unit contains the basics of human development.
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VD! STD! or What? Some Facts About Sexually Transmitted Diseases. Translated title Contact: Hawaii Department of Health, AIDS/STD Project, AIDS Prevention Project, PO Box 3378, Honolulu, HI, 96816, (808) 735-5303.
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Summary: This monograph gives young people basic information about Sexually transmitted diseases (STD's) so they can protect themselves against them. Descriptions of the symptoms of gonorrhea, syphilis, chlamydia, vaginitis, genital herpes, venereal warts, and Human immunodeficiency virus (HIV) are given. The reader is counseled to know one's sex partner, to use condoms, and to seek treatment if symptoms appear. The location of a local clinic is given. •
Womancare: Sexually Transmitted Diseases Contact: University of Pittsburgh, Magee - Womens Hospital, Health Center, 300 Halket St, Pittsburgh, PA, 15213-3180, (412) 641-1000. Summary: This monograph presents basic information about the spread of Sexually transmitted diseases (STD's) and their prevention with a focus on women and infants as the high-risk group. STD's which can be spread only through sexual contact, such as genital warts, gonorrhea, and syphilis, are covered. Those which can also be transmitted through IV-needle sharing, blood transfusions, or the perinatal route include Acquired immunodeficiency syndrome (AIDS), hepatitis, herpes-virus group infections, plus relevant bacterial, fungal, and parasitic infections. For each disease, the causative agent, symptoms, and diagnosis is described, together with with the respective treatment, if available. Preventive measures include barrier methods of contraception, avoiding casual sexual contacts, and vaccination, in particular for hepatitis.
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Sexually Transmitted Diseases: Problems in Primary Care Contact: Practice Management Information Corporation, 4727 Wilshire Blvd Ste 300, Los Angeles, CA, 90010, (800) 633-7467. Summary: This monograph provides basic and practical information on sexually transmitted diseases (STDs). It is designed for physicians, particularly those practicing family and emergency medicine. The monograph describes how various STDs are spread and exactly what is meant by safe sexual practices. It covers the many types of venereal disease (VD) currently prevalent, as well as non-VD infections that can be spread by sexual contact. Each chapter deals with one type of disease, or groups of closely related diseases or infections. Methods of recognizing, treating, and preventing each disease are covered. The effectiveness and outcome statistics for treatments are discussed, with effectiveness based on current sensitivities of the infecting organism. The type of the organism and its life cycle are described. Chapters on the "classic" STDs include: gonorrhea, syphilis, lymphogranuloma venereum, and chancroid. Other chapters discuss: HIV infection, herpes simplex, cytomegalovirus (CMV), human papilloma virus (HPV), hepatitis, and chlamydia. The monograph also contains information concerning related topics such as management of rape victims and contraception.
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Adolescent Health: State of the Nation, Monograph Number 2: Pregnancy, Sexually Transmitted Diseases, and Related Risk Behaviors Among U.S. Adolescents Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and, Health Promotion, Division of Adolescent and School Health, 3005 Chambelle Tucker Rd, Atlanta, GA, 30341-3724, (770) 448-3252. Summary: This monograph reports on the consequences of early, unprotected sexual intercourse among adolescents. It is designed to provide state and local education and health agencies with information about priority health outcomes among adolescents
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aged 10-24 years. The monograph shows changes over time in the rates of pregnancy, abortion, live births, gonorrhea, and chlamydia. In addition, the national and state profiles include data about live birth rates and trends by age group; live birth rates by race/ethnicity; pregnancy rates (both abortion and live births) by age group; gonorrhea rates and trends by age group and sex; chlamydia cases, rates, and trends by sex; cumulative AIDS case counts by age group and sex; and related risk behaviors for high school students by sex. •
Sexually Transmitted Disease Surveillance 2000 Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for HIV STD and TB Prevention, 1600 Clifton Rd NE MS E06, Atlanta, GA, 30333, (404) 639-8063, http://www.cdc.gov/nchstp/od/nchstp.html. Summary: This report provides policy makers, program managers, health planners, researchers, and others who are concerned with the public health with implications of sexually transmitted diseases (STDs) with statistics and trends of STDs in the United States (US) through 2000. It consists of four sections: (1) a national profile section, which contains figures that provide an overview of STD morbidity in the US and text identifying major findings and trends for selected STDs, including chlamydia, gonorrhea, and syphilis; (2) a special focus profiles section, which highlights trends and distribution of STDs in populations of particular interest for STD and HIV prevention programs in State and local health departments, including women and infants, adolescents and young adults, racial and ethnic minorities, men who have sex with men, persons entering corrections facilities, and persons living in the South; (3) a detailed tables section, which presents statistical information about STDs, including chlamydia, gonorrhea, syphillis, and chancroid at the State, county, city, and national levels; and (4) an appendix, which includes the sources and limitations of the data used to produce the report, tables and figures that demonstrate the progress made toward Healthy People 2010 Priority Area 25, and figures that show progress made by States in converting from hardcopy aggregate reporting to electronic line-listed data submissions.
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Abstinence: Making Responsible Decisions Contact: Macmillan/McGraw-Hill, Glencoe Division, 936 Eastwind Drive, Westerville, OH, 43081. Summary: This study guide covers teen sexuality and promotes sexual abstinence in the prevention of unplanned pregnancies and sexually transmitted diseases (STDs). It discusses making good decisions; various aspects of dating and relationship building; the physical, emotional, and social consequences of having sex as an adolescent; and the transmission, symptoms, possible long-term effects, and treatment of STDs including chlamydia, gonorrhea, syphilis, genital herpes, vaginitis, the human papillomavirus (HPV), parasitic infections, and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).
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On Postponing Sex Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channing-bete.com. Summary: This study guide, for adolescents and educators, promotes sexual abstinence to prevent adolescent pregnancy and sexually transmitted diseases (STDs). It discusses sex and the consequence of practicing sex at an early age; how to deal with social and
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peer pressure and the media; and how to create strong, health relationships. The study guide describes the symptoms and treatment options for several STDs including the human immunodeficiency virus (HIV), genital herpes, gonorrhea, and syphilis. •
Sexually - Transmitted Diseases Contact: Daniel Memorial Institute, Incorporated, 3725 Belfort Rd, Jacksonville, FL, 32216, (904) 448-7612. Summary: This teaching guide enables trainers to teach foster parents about sexually transmitted diseases (STDs) as they may affect the children that they will care for. The first section starts off by looking at long-term effects and general symptoms of STDs. It then provides specific symptoms, long-term effects, and treatment for a number of common STDs, including: chlamydia, genital herpes, genital warts, vaginitis, gonorrhea, syphilis, AIDS, crab lice, Hepatitis, and gastrointestinal STDs. The second section teaches caregivers how to recognize those members of the foster-care population who are at risk for STDs; that group includes infants, abused children, and sexually active youth. The third section gives guidance on dealing with STD-infected children. This section presents detailed information on AIDS, including symptoms; routes of transmission; prevention, such as condom use; and talking with children about AIDS. Myths of casual contact transmission are dispelled.
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Getting There: Taking Charge of Future Dating Relationships Contact: American Home Economics Association, 1555 King St, Alexandria, VA, 223141028, (703) 706-4600. Summary: This teaching guide outlines an approach to teaching students how to manage dating relationships without engaging in sexual intercourse. The realities of early parenthood and dangers of Sexually transmitted diseases (STD's), such as Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS), as well as gonorrhea, syphilis, and Herpes, are discussed.
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What We Told Our Kids About Sex Contact: Harcourt Brace Jovanovich, 111 5th Ave, New York, NY, 10003, (212) 614-3000. Summary: Written for parents, this monograph explains both bodily sexual changes at puberty and sexual intercourse. It also discusses pregnancy and childbirth, (including natural childbirth, Cesarean section, and breech birth), sex outside of marriage, and prostitution. Coverage of Sexually transmitted diseases (STD's) includes herpes, gonorrhea, syphilis, and Acquired immunodeficiency syndrome (AIDS). Contraceptives are reviewed and other forms of sexuality, such as homosexuality, are introduced. Sexrelated crimes are also covered. The monograph closes with a glossary of terms. The material is presented from a morally neutral standpoint and emphasizes the need to provide children with sex information at an early age.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT
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NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “gonorrhea” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “gonorrhea” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “gonorrhea” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Cumitech Four A: A Laboratory Diagnosis of Gonorrhea; ISBN: 9993904260; http://www.amazon.com/exec/obidos/ASIN/9993904260/icongroupinterna
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Gonorrhea by Chelsea House Publications (2003); ISBN: 0791073041; http://www.amazon.com/exec/obidos/ASIN/0791073041/icongroupinterna
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Gonorrhea (SuDoc HE 20.3252:SE 9/3/992/GONO.) by U.S. Dept of Health and Human Services; ISBN: B00010CTUI; http://www.amazon.com/exec/obidos/ASIN/B00010CTUI/icongroupinterna
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Gonorrhea and Syphilis - 1912: A Drugless Treatment of Veneral Diseases by J. H. Tilden, Dr John H. Tilden; ISBN: 1564598756; http://www.amazon.com/exec/obidos/ASIN/1564598756/icongroupinterna
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Gonorrhea and Syphilis: A Drugless Treatment (1993); ISBN: 078730879X; http://www.amazon.com/exec/obidos/ASIN/078730879X/icongroupinterna
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Gonorrhea Transmission Dynamics and Control (1984); ISBN: 3540138706; http://www.amazon.com/exec/obidos/ASIN/3540138706/icongroupinterna
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Gonorrhea Transmission Dynamics and Control (Lecture Notes in Biomathematics, Vol 56) by Herbert W. Hethcote, James A. Yorke; ISBN: 0387138706; http://www.amazon.com/exec/obidos/ASIN/0387138706/icongroupinterna
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Guide for the diagnosis of gonorrhea : using culture & gram - stained smear : (formerly "Criteria and techniques for the diagnosis of gonorrhea") (SuDoc HE 20.7308:G 58) by U.S. Dept of Health and Human Services; ISBN: B0001088CG; http://www.amazon.com/exec/obidos/ASIN/B0001088CG/icongroupinterna
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Protect yourself from the storm hepatitis B, herpes, gonorrhea, genital warts, chlamydia, syphilis, AIDS (SuDoc D 2.9:D 36/2/NO.111) by U.S. Dept of Defense; ISBN: B00010UV0I; http://www.amazon.com/exec/obidos/ASIN/B00010UV0I/icongroupinterna
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Sexually Transmitted Diseases Sourcebook: Basic Information About Herpes, Chlamydia, Gonorrhea, Hepatitis, Nongonoccocal Urethritis, Pelvic Inflammatory Disease, Syphilis, AIDS, and More (Health Reference Series, Vol 26) by Linda M. Ross (Editor), Peter Dresser (Editor) (1997); ISBN: 0780802179; http://www.amazon.com/exec/obidos/ASIN/0780802179/icongroupinterna
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The Official Patient's Sourcebook on Gonorrhea: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 0597832986; http://www.amazon.com/exec/obidos/ASIN/0597832986/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gonorrhea” (or synonyms) into the search box, and select “books only.”
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From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •
20 questions on gonorrhea. Author: United States. Public Health Service.; Year: 1967; [Washington, 1940]
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A compendious and easy method of curing the virulent stillicidium, commonly call'd gonorrhea: with an account of the efficacy of Plummer's alternative pills, in cases of chancres, buboes, hernia veneris, &c. Author: Norman, J. (John),; Year: 1730; London: Sold by E. Withers. and by J. Palmer, bookseller, in Bristol, [1756?]
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A control model for gonorrhea. Author: Reynolds, Gladys H.; Year: 1973; Atlanta, U. S. Center for Disease Control [1973]
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A study of fact and attitude about gonorrhea as demonstrated by questionnaire study. Author: Wann, Marie (di Mario); Year: 1970; [New York, Columbia Univ., 1943]
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Diagnosis and therapy of gonorrhea, January 1969 through June 1972. 189 citations in English. Prepared by P. E. Pothier. Author: National Library of Medicine (U.S.); Year: 1972; [Bethesda, Md.] 1972
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Gonococcal infection: recent advances in pathology, diagnosis and treatment, by Robert V. Storer. with foreword by Kenneth M. Walker. Author: Storer, Robert Vivian.; Year: 1939; London, J. Bale, sons; Danielsson, ltd., 1934
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Gonococcal urethritis in the male, for practitioners, by P. S. Pelouze. Author: Pelouze, Percy Starr,; Year: 1939; Philadelphia and London, W. B. Saunders company, 1928
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Gonorrhea and kindred affections. Gonorrhea in the male, chancroid and verruca acuminata, by George Robertson Livermore; and Gonorrhea in the female, and the infectious granulomata, by Edward Armin Schumann. Author: Livermore, George Robertson,; Year: 1929; New York, Appleton, 1929
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Gonorrhea in the male and female, a book for practitioners, by P. S. Pelouze. Author: Pelouze, Percy Starr,; Year: 1947; Philadelphia and London, W. B. Saunders company, 1931
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Gonorrhea in the male and female; a book for practitioners, by P. S. Pelouze. Author: Pelouze, Percy Starr,; Year: 1949; Philadelphia and London, W. B. Saunders company, 1943
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Gonorrhea. Author: Barrett-Connor, Elizabeth.; Year: 1972; Chicago, Year Book Medical Publishers, 1973
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Minimum standards for the diagnosis, treatment and control of gonorrhea, approved by the Committee on Public Health of the Massachusetts Medical Society and by the Neisserian Medical Society of Massachusetts; prepared by the MassachusettsDepartment of Public Health co-operating with the United States Public Health Service. Author: Massachusetts. Dept. of Public Health.; Year: 1940; [Boston?] 1931
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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Student's manual on venereal disease; facts about syphilis and gonorrhea. Author: Schwartz, William F.; Year: 1968; Washington, American Assn. for Health, Physical Education, and Recreation, 1965
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Survey of male gonorrhea clinics [in] New York City. Author: New York Tuberculosis and Health Association. Social Hygiene Committee.; Year: 1716; New York [1935]
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Syphilis and gonorrhea; a manual for physicians. Author: Canada. Dept. of National Health and Welfare.; Year: 1968; Ottawa, Dept. of National Health and Welfare, 1967]
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Syphilis, gonorrhea and the public health, by Nels A. Nelson. and Gladys L. Crain. Author: Nelson, Nels Albin,; Year: 1948; New York, The Macmillan company, 1938
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The unconquered plague; a popular story of gonorrhea. Author: Wain, Harry,; Year: 1953; New York, International universities press [1947]
Chapters on Gonorrhea In order to find chapters that specifically relate to gonorrhea, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and gonorrhea using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “gonorrhea” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on gonorrhea: •
Oral Bacterial Infections Source: in Eisen, D. and Lynch, D.P. Mouth: Diagnosis and Treatment. St. Louis, MO: Mosby, Inc. 1998. p. 92-107. Contact: Available from Harcourt Health Sciences. Book Order Fulfillment Department, 11830 Westline Industrial Drive, St. Louis, MO 63146-9988. Website: www.mosby.com. PRICE: $79.95 plus shipping and handling. ISBN: 0815131054. Summary: More than 300 different bacteria, including Staphylococcus aureus, coliform bacteria, Kelsiella, and Pseudomonas, reside in the oral cavity and comprise what is regarded as normal oral flora. When a species of bacteria increases in number or when the host defense threshold is exceeded, disease arises. Two of the most common bacterial diseases that afflict humans are dental caries and periodontal disease. This chapter on oral bacterial infections is from a textbook on the mouth that offers information to primary care physicians and to many specialists in medicine and dentistry. Topics include gingivitis and periodontitis, necrotizing gingivostomatitis, tuberculosis, oral cutaneous fistulas, gonorrhea, syphilis, actinomycosis, parulis, and miscellaneous infections, including scarlet fever, diphtheria, tularemia, granuloma inguinale, leprosy, suppurative infection of the salivary glands, and noma. For each condition, the authors describe symptoms, identification, complications, and treatment. The chapter is illustrated with numerous full color photographs of the conditions under discussion. 19 figures. 46 references.
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Oral Ulceration Source: in Lamey, P.J.; Lewis, M.A.O. Clinical Guide to Oral Medicine. 2nd ed. Hampshire, United Kingdom: British Dental Journal (BDJ), Stockton Press. 1997. p. 7-12.
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Contact: Available from British Dental Journal (BDJ). Marketing Department, Stockton Press, Houndsmill, Basingstoke, Hampshire, RG21 6XS, United Kingdom. Telephone +44 (0) 1256 351898. Fax +44(0) 1256 328339. PRICE: $41.00. ISBN: 0904588505. Summary: This chapter on oral ulceration is from a clinical guide to oral medicine. The book is a compilation of pathology photographs designed to improve competence in the recognition of diseases involving the oral and para-oral structures. The book includes summaries of the management of those conditions most frequently seen in practice. The authors note that oral ulceration is probably the oral mucosal condition most frequently seen by general dental and general medical practitioners. It is almost always painful and patients are therefore prompt to seek advice. An important exception to this generalization is the occurrence of oral cancer, which is often painless in its early stages. Definitive diagnosis, involving mucosal biopsy, is therefore mandatory for any persistent area of oral ulceration. The chapter discusses the diagnostic process, traumatic ulceration, recurrent aphthous stomatitis, viral infection, erythema multiforme (StevensJohnson syndrome), myeloproliferative disorders, syphilis and gonorrhea, and squamous cell carcinoma. The authors conclude that if an ulceration fails to respond to treatment or has an unusual appearance, then the presence of an underlying systemic problem, such as myeloproliferative disease or HIV infection, must be considered. Full color photographs illustrate the chapter. 17 figures. •
Ulcerative Conditions Source: in Regezi, J.A. and Sciubba, J.J. Oral Pathology: Clinical Pathologic Correlations. 3rd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 30-82. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522. Fax (800) 874-6418. Website: www.wbsaunders.com. PRICE: $63.95. ISBN: 0721677312. Summary: This chapter on ulcerative conditions is from a pathology textbook that presents current concepts of oral and maxillofacial pathology in order to enhance the reader's diagnostic skills through the use of differential diagnosis strategies. The text offers readers detailed guidance of etiology, pathogenesis, clinical features, histopathology, differential diagnosis, and treatment of oral diseases of the mucosa, submucosa, and bone. This chapter covers reactive lesions, including those associated with bacterial conditions (syphilis, gonorrhea, tuberculosis, leprosy, actinomycosis, and noma) and fungal diseases (deep fungal diseases, subcutaneous fungal diseases such as sporotrichosis, and opportunistic fungal infections such as phycomycosis); conditions associated with immunologic dysfunction, including aphthous ulcers, Behcet's syndrome, Reiter's syndrome, erythema multiforme, lupus erythematosus, drug reactions, contact allergy, Wegener's granulomatosis, midline granuloma, chronic granulomatous disease, cyclic neutropenia; and neoplasms, including squamous cell carcinoma, and carcinoma of the maxillary sinus. 68 figures. 14 tables. 77 references.
•
Bacterial Diseases Source: in Bork, K., et al. Diseases of the Oral Mucosa and the Lips. Orlando, FL: W.B. Saunders Company. 1993. p. 123-151. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 352-3445; http://www.wbsaunders.com. PRICE: $99.00 plus shipping and handling. ISBN: 0721640397.
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Summary: This lengthy chapter, from a textbook on diseases of the oral mucosa and the lips, discusses the etiology, clinical features, histopathology, diagnosis, and differential diagnosis for a variety of bacterial diseases that demonstrate oral manifestations. Diseases covered include impetigo, furuncle and carbuncle (deep staphylococcal infections of the hair follicle), acute bacterial cheilitis with ectropion, chancriform pyoderma, erysipelas, periodontal disease, simple gingivitis, hyperplastic or chronic gingivitis, acute necrotizing ulcerative gingivostomatitis (ANUG), noma (cancrum oris), chronic periodontitis, juvenile periodontitis, periodontal abscess, parodontal pseudocysts, dental sinus tracts, dental infection as a cause of other diseases, nonodontogenic oral abscesses, scarlet fever, diphtheria, cat-scratch disease, gonorrhea, chancroid, syphilis, congenital syphilis, yaws, tuberculosis (including lupus vulcagis), leprosy, actinomycosis, and miscellaneous bacterial infections, including anthrax, brucellosis, listeriosis, glanders, meningococcemia, granuloma inguinale, pertussis, and tularemia. Full-color photographs illustrate the chapter; references are provided for each section. 57 figures. 100 references. (AA-M). •
Cultures: Pinpointing the Cause of Infection Source: in Shaw, M., et al., eds. Everything You Need to Know About Medical Tests. Springhouse, PA: Springhouse Corporation. 1996. p. 617-636. Contact: Available from Springhouse Publishing. Attention: Trade and Textbook Department, 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 3313170 or (215) 646-4670 or (215) 646-4671. Fax (215) 646-8716. PRICE: $24.95 (as of 1995). ISBN: 0874348234. Summary: This section on cultures is from a consumer reference guide to over 400 diagnostic tests. For each test, the book covers the reasons for performing the test; what patients should know before the test; what to expect during and after the test; risk factors associated with the test; the normal results; and what abnormal results mean. Tests in this section include general cultures, including urine culture, stool culture, throat culture, nasopharyngeal culture, sputum culture, blood culture, wound culture, stomach culture, and intestinal culture; and genital cultures, including culture for gonorrhea, for herpes, and for chlamydia.
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Urethritis Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 77-94. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Urethral discharge (the presenting symptom of urethritis, or inflammation of the urethra, the tube that goes from the bladder to the outside of the body) is largely caused by sexually transmitted diseases (STDs). The two most common pathogens causing urethral discharge are gonorrhea and chlamydia. This chapter on urethritis is from a text on common problems in urology (written for the primary care provider). The author develops the differential diagnoses of a segment of STDs: urethritis and urethral discharge. STDs that manifest primarily as genital ulcerations or as cutaneous (skin) lesions are covered in another chapter. The author first reviews the steps for treating any STD, then discusses discharge in males and females; definition of urethritis and urethral discharge; key elements to the patient history; the physical examination and laboratory tests; diagnosis by DNA probes and nucleic acid amplification techniques; classification
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of male urethritis; gonococcal urethritis; Chlamydia trachomatis; management recommendations for Chlamydia and other nongonococcal urethritis; Ureaplasma urealyticum; Mycoplasma genitalium; Trichomonas vaginalis; treatment of recurrent or persistent symptoms of urethritis; other manifestations and complications of urethritis; and controversies, pitfalls to avoid, and emerging trends. A series of patient evaluation and care algorithms is also provided. The author recommends that physicians consider multiple pathogens (disease causing organisms) in each patient with urethritis. Second, it is vital to include the patient's sexual partner in care and educational strategies. And third, physicians are cautioned to maintain adequate followup after treatment in these patients, to ensure eradication of pathogens (and to prevent reinfection or recurrence of symptoms). 3 figures. 4 tables. 35 references.
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CHAPTER 7. MULTIMEDIA ON GONORRHEA Overview In this chapter, we show you how to keep current on multimedia sources of information on gonorrhea. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on gonorrhea is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “gonorrhea” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “gonorrhea” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on gonorrhea: •
Gonorrhea: No Clapping Matter Contact: NIMCO, PO Box 9, Calhoun, KY, 42327-0009, (502) 273-5050. Summary: This video provides information about the sexually transmitted disease (STD), gonorrhea. The video discusses gonorrhea, its prevention, transmission, longterm effects if left untreated, diagnosis, and treatment.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option
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“Sound Recordings.” Type “gonorrhea” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on gonorrhea: •
America Responds to AIDS -- Radio PSA's: New York Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National AIDS Information and Education Program, Bldg 1 Rm 2122, 1600 Clifton Rd NE, Atlanta, GA, 30333, (404) 639-2928. Summary: In this sound recording of a radio public service announcement (PSA), three New Yorkers give warnings about the dangers of contracting Human immunodeficiency virus (HIV) and/or Acquired immunodeficiency syndrome (AIDS) from sexual partners. An AIDS counselor notes that deciding to have sex is potentially exposing oneself to HIV, but that unlike gonorrhea and syphilis, there is no cure for AIDS. A nurse counselor says that even one sexual encounter could lead to infection. A minority AIDS project worker says there is a problem with young people not knowing how to protect themselves against AIDS, and so efforts must be made to inform them. An announcer notes that AIDS affects everyone, and urges listeners to learn the facts about AIDS to protect themselves and their families.
Bibliography: Multimedia on Gonorrhea The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in gonorrhea (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on gonorrhea: •
Diagnosis and treatment of gonorrhea [slide] Source: University of Michigan, Medical Center, Independent Study Unit, Department of Postgraduate Medicine and Health Professions Education; Year: 1974; Format: Slide; Ann Arbor: The University: [for loan or sale by its Medical Center Media Library], c1974
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Gonococcal infections [videorecording] Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1981; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1981
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Gonorrhea: a systemic disease [sound recording] Source: Dept. of Medical Education at the Millard Fillmore Hospital, in cooperation with the School of Medicine State University of New York at Buffalo; Year: 1976; Format: Sound recording; Buffalo: Communications in Learning, 1976
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Gonorrhea [motion picture]: a film for physicians in technicolor Source: produced by Hugh Harman Productions, Inc.; [presented by] Federal Security Agency, United States Public Health Service; Year: 1943; Format: Motion picture; United States: The Service, c1943
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Gonorrhea [slide]. Year: 1986; Format: Slide; [S.l.: s.n., 1986]
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Gonorrhea [slide]. Year: 1989; Format: Slide; New York, N.Y.: Gower Medical Pub., c1989
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Gonorrhea [videorecording] Source: produced and filmed by Health Education Video, Inc; Year: 1989; Format: Videorecording; Bloomington, MN: Health Education Video, [1989]
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Gonorrhea medical training slides [slide]. Year: 1984; Format: Slide; Washington, D.C.: National Audiovisual Center, 1984
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Health is a victory [motion picture]: the story of the fight against gonorrhea Source: presented by the American Social Hygiene Association, with the cooperation of the New York City Department of Health and the New York Hospital; produced by Willard Pictures; Year: 1942; Format: Motion picture; [United States]: The Association, c1942
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Laboratory diagnosis of gonorrhea [slide]. Year: 9999; Format: Slide; [S.l.: s.n., 1986]-
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Syphilis and gonorrhea [filmstrip] Source: Trainex Corporation; Year: 1974; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1974
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Syphilis and gonorrhea [videorecording] Source: Trainex Corporation; Year: 1974; Format: Videorecording; Garden Grove, Calif.: Trainex, c1974
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Venereal diseases [videorecording]: gonorrhea Source: [presented by] CME Productions, Inc., in cooperation with the Infectious Disease Section, Yale University, School of Medicine; Year: 1980; Format: Videorecording; [S.l.]: CME Productions, c1980
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CHAPTER 8. PERIODICALS AND NEWS ON GONORRHEA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover gonorrhea.
News Services and Press Releases One of the simplest ways of tracking press releases on gonorrhea is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “gonorrhea” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to gonorrhea. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “gonorrhea” (or synonyms). The following was recently listed in this archive for gonorrhea: •
Rates of fluoroquinolone-resistant gonorrhea rising in Hawaii and California Source: Reuters Industry Breifing Date: November 21, 2002
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Drug-resistant gonorrhea on the rise in 2 states Source: Reuters Health eLine Date: November 21, 2002
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Gonorrhea test kits recalled due to error potential Source: Reuters Health eLine Date: September 04, 2002
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Abbott recalls gonorrhea test kits because of potentially faulty results Source: Reuters Medical News Date: September 03, 2002
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Abbott recalls gonorrhea test kits Source: Reuters Industry Breifing Date: September 03, 2002
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Gonorrhea rises in some cities, but stable overall Source: Reuters Health eLine Date: March 05, 2002
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Protein helps gonorrhea switch off immune cells Source: Reuters Health eLine Date: February 20, 2002
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Gonorrheal protein suppresses activation and proliferation of CD4+ T cells Source: Reuters Medical News Date: February 19, 2002
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Untreated gonorrhea, chlamydia rife in young adults Source: Reuters Health eLine Date: February 12, 2002
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Many cases of gonorrhea, chlamydia are asymptomatic and go undiagnosed Source: Reuters Medical News Date: February 12, 2002
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LCR assay more sensitive than culture in detecting pharyngeal gonorrhea Source: Reuters Medical News Date: February 06, 2002
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Digene gets FDA clearance for chlamydia, gonorrhea test application Source: Reuters Industry Breifing Date: October 03, 2001
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High level of drug-resistant gonorrhea found in UK Source: Reuters Health eLine Date: August 02, 2001
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Condoms do prevent HIV, gonorrhea: US panel Source: Reuters Health eLine Date: July 20, 2001
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Surging gonorrhea cases reflect unsafe sex in gay and bisexual me Source: Reuters Medical News Date: May 31, 2001
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Gonorrhea on the rise in gay, bisexual me Source: Reuters Health eLine Date: May 31, 2001
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Gatifloxacin safe, effective for treatment of uncomplicated gonorrhea Source: Reuters Industry Breifing Date: March 23, 2001
Periodicals and News
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Antibiotic resistance to gonorrhea on the rise in UK Source: Reuters Health eLine Date: December 08, 2000
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US syphilis rates down, gonorrhea rates up Source: Reuters Health eLine Date: December 05, 2000
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Drug-resistant gonorrhea spreading in the US Source: Reuters Health eLine Date: September 21, 2000
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Gonorrhea infection rate increasing in US after 13-year decline Source: Reuters Medical News Date: June 23, 2000
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US gonorrhea rates rise Source: Reuters Health eLine Date: June 22, 2000
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Increases in beer tax, legal drinking age correlate with reduced gonorrhea rates Source: Reuters Medical News Date: April 28, 2000
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Gonorrhea rates drop when beer tax goes up Source: Reuters Health eLine Date: April 28, 2000
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Digene chlamydia/gonorrhea test approved Source: Reuters Medical News Date: March 08, 2000
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35% rise in London's gonorrhea rate Source: Reuters Health eLine Date: February 21, 2000
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Vaginitis in young girls may indicate gonorrhea Source: Reuters Medical News Date: December 20, 1999
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FDA approves Digene's gonorrhea test for wome Source: Reuters Medical News Date: December 07, 1999
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Nasal vaccine reduces gonococcal colonization in mouse model Source: Reuters Medical News Date: June 03, 1999
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Decrease in prevalence of gonorrhea may contribute to decrease in prevalence of secondary subfertility Source: Reuters Medical News Date: May 26, 1999
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html.
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MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “gonorrhea” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “gonorrhea” (or synonyms). If you know the name of a company that is relevant to gonorrhea, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gonorrhea” (or synonyms).
Academic Periodicals covering Gonorrhea Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to gonorrhea. In addition to these sources, you can search for articles covering gonorrhea that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.”
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If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for gonorrhea. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with gonorrhea. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gonorrhea: Azithromycin •
Systemic - U.S. Brands: Zithromax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202642.html
Cephalosporins •
Systemic - U.S. Brands: Ancef; Ceclor; Ceclor CD; Cedax; Cefadyl; Cefizox; Cefobid; Cefotan; Ceftin; Cefzil; Ceptaz; Claforan; Duricef; Fortaz; Keflex 20; Keftab 20; Kefurox; Kefzol; Mandol; Maxipime; Mefoxin; Monocid; Omnicef; Rocephin; Suprax; Tazicef; Tazidime; Vantin; Velo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202119.html
Ciprofloxacin •
Ophthalmic - U.S. Brands: Ciloxan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202655.html
Doxycycline •
Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203716.html
Fluoroquinolones •
Systemic - U.S. Brands: Avelox; Cipro; Cipro I.V.; Floxin; Floxin I.V.; Levaquin; Maxaquin; Noroxin; Penetrex; Tequin; Zagam http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202656.html
Ofloxacin •
Ophthalmic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202687.html
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Ophthalmic - U.S. Brands: Ocuflox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202687.html
Penicillins and Beta-Lactamase Inhibitors •
Systemic - U.S. Brands: Augmentin; Timentin; Unasyn; Zosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202705.html
Spectinomycin •
Systemic - U.S. Brands: Trobicin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202530.html
Spermicides •
Vaginal - U.S. Brands: Advantage 24; Because; Conceptrol Contraceptive Inserts; Conceptrol Gel; Delfen; Emko; Emko Pre-Fil; Encare; Gynol II Extra Strength Contraceptive Jelly; Gynol II Original Formula Contraceptive Jelly; Koromex Cream; Koromex Crystal Clear Gel; Koromex Fo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202531.html
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Sulfonamides and Trimethoprim •
Systemic - U.S. Brands: Bactrim; Bactrim DS; Bactrim I.V.; Bactrim Pediatric; Cofatrim Forte; Cotrim; Cotrim DS; Cotrim Pediatric; Septra; Septra DS; Septra Grape Suspension; Septra I.V.; Septra Suspension; Sulfatrim; Sulfatrim Pediatric; Sulfatrim S/S; Sulfatrim Suspension; S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202781.html
Tetracyclines •
Systemic - U.S. Brands: Achromycin V; Declomycin; Doryx; Dynacin; Minocin; Monodox; Terramycin; Vibramycin; Vibra-Tabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202552.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
11
These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
12
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “gonorrhea” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “gonorrhea” (or synonyms) into the “For these words:” box. The following is a sample result: •
Increasing Incidence of Gonorrhea - Minnesota, 1994 Source: Morbidity and Mortality Weekly Report; Vol. 44, No. 14, April 14, 1995. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: In the United States, gonorrhea is an important cause of urethritis in men and cervicitis in women; reproductive complications include infertility and ectopic pregnancy. During 1981-1993, the annual incidence rate of gonorrhea in Minnesota declined; the average annual change in the rate of infection was - 8.5 percent (Figure 1). However, in 1994, the incidence rate increased 32 percent (from 56 cases per 100,000 persons in 1993 to 74 cases per 100,000 in 1994). No corresponding increases occurred in rates of other reportable sexually transmitted diseases (STDs), including chlamydial infection and early syphilis. To elucidate possible explanations for the increased rate of gonorrhea in Minnesota in 1994, the Minnesota Department of Health (MDH) analyzed surveillance data for 1994 and compared it with data for 1993. This report presents the findings of the analysis.
•
Gonorrhea Among Men Who Have Sex With Men - Selected Sexually Transmitted Diseases Clinics, 1993 - 1996 Source: Morbidity and Mortality Weekly Report; Vol. 46, No. 38, Sept. 26, 1997. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: This report summarizes the results of a special survey conducted to describe factors associated with gonococcal infection (GC) in men who have sex with men (MSM). The results indicate that the number and proportion of MSM diagnosed with GC has increased in the sexually transmitted disease (STD) clinics of large cities across the United States. The survey also addressed overall gonorrhea and other STD trends and factors that could be associated with GC trends in MSM. MSM comprised five percent of all cases in the Gonococcal Isolate Surveillance Project (GISP) sample in 1993. GISP is a sentinel surveillance project begun in 1987 to monitor antimicrobial resistance
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in Neisseria gonorrhoea. The incidence of gonorrhea among MSM declined substantially during the early 1980s as the HIV epidemic led to substantial reductions in sexual risktaking behaviors. However findings indicate a possible reversal in GC trends among MSM. An increase in high-risk encounters among MSM could explain the increase in GC cases and could enhance HIV transmission in this population. The results of this survey underscore the need to implement safer sex education programs among MSM. •
National Assembly on School-Based Health Care 1998 Conference : Handouts for Session 00A2 : HIV/STDs Testing in SBHCs : School-Linked Chlamydia and Gonorrhea Prevention : Creating Effective Contact: Los Angeles County Department of Health Services, Public Health Programs Disease Control Programs, Sexually Transmitted Disease Program, 2615 S Grand Ave Rm 500, Los Angeles, CA, 90007, (213) 744-3070, http://www.lapublichealth.org/std. Summary: This teaching aid provides statistical information about the sexual behavior of adolescents, including the incidence rates of gonorrhea and chlamydia, and the effectiveness of school-based urine testing for preventing these diseases. The teaching aid provides general information about chlamydia, and statistics about the number of sexually active teens, their average number of partners, and condom use. It describes a high school-based chlamydia and gonorrhea screening project. It shows statistics concerning the number of chlamydia cases found by this screening process in Los Angeles, and compares this data to that of non-school-based testing. It compares the cost of the screening process versus the number of cases missed. The teaching aid discusses the possible disadvantages of urine testing and challenges regarding the implementation of the screening process. Recommendations about how these obstacles can be overcome are given.
The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gonorrhea” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
14 15
Items Found 10979 699 84 852 6 12620
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
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HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “gonorrhea” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
17
The HSTAT URL is http://hstat.nlm.nih.gov/.
18
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 19 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 20 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on gonorrhea can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to gonorrhea. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to gonorrhea. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “gonorrhea”:
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•
Other guides Chlamydia Infections http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html Gonorrhea http://www.nlm.nih.gov/medlineplus/gonorrhea.html Herpes Simplex http://www.nlm.nih.gov/medlineplus/herpessimplex.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Pelvic Inflammatory Disease http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html
Within the health topic page dedicated to gonorrhea, the following was listed: •
General/Overviews Information to Live by: Gonorrhea Source: American Social Health Association http://www.ashastd.org/stdfaqs/gonorrhea.html
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Treatment Facts About Drug-Resistant Gonorrhea Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/fs2k0922a.htm
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Children Gonococcal Infections Source: Nemours Foundation http://kidshealth.org/parent/infections/bacterial_viral/gonococcal.html
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Organizations American Social Health Association http://www.ashastd.org/ National Center for HIV, STD, and TB Prevention, Division of Sexually Transmitted Diseases Source: Centers for Disease Control and Prevention http://www.cdc.gov/nchstp/dstd/dstdp.html National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/
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Prevention/Screening Condoms: Protect Yourself Against STDs and Unwanted Pregnancy Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00463 Right Way to Use a Condom Source: American Social Health Association http://www.ashastd.org/stdfaqs/condom_a.html
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Research Chlamydia Infection among Patients Receiving Treatment for Gonorrhea in Sexually Transmitted Disease Clinics in the United States Source: American College of Physicians http://www.annals.org/cgi/content/full/139/3/I-40
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Statistics Closer Look at Gonorrhea: Tracking the Hidden Epidemics 2000, Trends in STDs in the United States Source: National Center for HIV, STD, and TB Prevention, Division of STD Prevention http://www.cdc.gov/nchstp/od/news/RevBrochure1pdfcloselookgon.htm
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gonorrhea. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
NGU : Nongonococcal Urethritis : Information for Men About a Common Sexual Infection Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: This brochure discusses about nongonococcal urethritis (NGU), an infection of the urethra, which is a sexually transmitted disease (STD). The symptoms of NGU in men include discharge from the penis, painful urination, and burning or itching around the opening of the penis. Women can just as easily contract the same organisms that
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cause NGU, but in women these viruses and bacteria often infect the reproductive tract. NGU can be dangerous if left untreated and can result in permanent damage to the reproductive organs resulting in infertility and problems in pregnancy such as premature delivery, low birth weight, and infections in newborns. Individuals who are sexually active should be tested for gonorrhea and NGU. NGU is treated with antibiotics, and all infected individuals' partners should be treated. To help to prevent NGU, individuals should practice 'outercourse' and/or safer sex with condoms during each sexual encounter, should carry latex condoms with them at all times, should limit their number of partners, and should be tested for STDs. The brochure provides contact information for services from which individuals can learn more about NGU and STDs. •
Low Rate of Concurrent Positive Laboratory Findings of Chlamydia Trachomatis and Neisseria Gonorrhea Among Women Presenting to Massachusetts STD Clinics Contact: Massachusetts Department of Public Health, 150 Tremont St, Boston, MA, 02111, (617) 727-0368. Summary: This brochure presents findings of an analysis of positive laboratory findings of chlamydia and gonorrhea in the same women tested by 15 Massachusetts clinics for sexually transmitted diseases. Of 887 women screened for both infections, 198 (22.3 percent) were found to have positive laboratory findings, with dual infections in 21 (2.4 percent). Findings do not justify dual therapy for all patients presenting to these clinics, although patients should be screened for both diseases.
•
STD: Sexually Transmitted Diseases - AIDS, Cervicitis, Chlamydia, Genital Warts, Gonorrhea, Herpes, PID, Syphilis, Urethritis, Vaginitis Contact: Intermedia, Incorporated, 1300 Dexter Ave, Seattle, WA, 98109, (206) 284-2995. Summary: This brochure presents general information about the warning signs and transmission of Sexually transmitted diseases (STD's) and their prevention and specific characteristics of the individual diseases in this group. Symptoms are not always present with STD's and the only way to know for sure is to have the right tests, and then the right treatment. The brochure contains a chart of the various STD's: Acquired immunodeficiency syndrome (AIDS), cervicitis, chlamydia, genital warts, gonorrhea, Herpes-virus group, pelvic inflammatory disease, syphilis, urethritis, and vaginitis, with pertinent information. For each disease it provides a definition, causative agent, mode of transmission, duration of infection, symptoms, diagnosis, treatment, and consequences if not treated. It lists steps to take when the presence of STD's is suspected.
•
Gonorrhea : Common Disease, Simple Cure Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: This brochure provides general information about the sexually transmitted disease (STD), gonorrhea. The brochure identifies the symptoms of gonorrhea in men and women, such as discharge from the penis/vagina and burning or pain during urination, and discusses the long-term effects of untreated gonorrhea, such as sterility. It discusses treatment, partner notification, and special considerations for pregnant women. The brochure briefly expands on the following prevention tips: practice lowrisk behaviors, limit sex partners, use a condom, be prepared by having condoms and not doing drugs, and see a doctor to be diagnosed immediately. For additional information, the brochure suggests that readers contact the CDC National STD Hotline, their health care provider, or a local health clinic.
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Gonorrhea : What You Need to Know Contact: Education Programs Associates, Health Education Resource Center, 1 W Campbell Ave Ste 45, Campbell, CA, 95008, (408) 374-3720, http://www.cfhc.org. Summary: This brochure, for the general public, discusses the sexually transmitted disease (STD), gonorrhea. The symptoms of gonorrhea include pain during urination, yellow discharge from the penis or vagina, pain or tenderness in the abdomen, and sore throat. Gonorrhea is treated with antibiotic shots or pills. Individuals with gonorrhea need to protect themselves by ensuring that partners are treated, taking all of the prescribed medication even if symptoms disappear, avoiding sex during treatment, reporting any drug side effects or new symptoms immediately to a health care provider, and undergoing follow-up treatment after the antibiotic regimen has been completed. If left untreated, gonorrhea can cause pain and swelling in the sex organs, inability to have children, heart problems, and swelling around the spinal cord. Pregnant women with gonorrhea can infect their infants. To help to prevent STDs, individuals should practice safer sex with condoms and foam during each sexual encounter. The brochure provides contact information for services from which individuals can learn more about gonorrhea.
•
Gonorrhea Contact: National Abstinence Clearinghouse, 801 E 41st St, Sioux Falls, SD, 57105, (888) 577-2966, http://www.abstinence.net. Summary: This brochure, for young adults, provides information on the sexually transmitted disease (STD), gonorrhea. It discusses the history of gonorrhea, its transmission, symptoms, epidemiological data, treatment, prevention, and condom use. The brochure discusses gonorrhea's affect on pregnant women. It provides a phone number and Web address for individuals to access products and resources on abstinence until marriage.
•
What's It Going to Cost You? Gonorrhea Contact: Health Edco, Division of WRS Group, Inc., PO Box 21207, Waco, TX, 767021207, (254) 776-6461. Summary: This brochure, written for adolescents, discusses the sexually transmitted disease (STD), gonorrhea. The following topics are discussed: (1) diagnosis; (2) symptoms; (3) transmission through unprotected oral, vaginal, or anal sex with an infected person; (4) prevention measures such as practicing sexual abstinence, monogamy, or safer sex with condoms; (5) treatment with antibiotics; and (6) the financial costs of treating gonorrhea. In women, untreated gonorrhea can develop into pelvic inflammatory disease (PID) causing scarring in the fallopian tubes or tubal pregnancies, and in men, it can lead to sterility and prostate infections.
•
What Is Gonorrhea? Contact: California Department of Health Services, Office of AIDS, California AIDS Clearinghouse, 1443 N Martel Ave, Los Angeles, CA, 90046-4207, (323) 845-4180, http://www.hivinfo.org/cac/cachouse.shtml. Summary: This fact sheet provides general information about gonorrhea, a sexually transmitted disease (STD). Gonorrhea is spread through unprotected oral, anal, or vaginal intercourse. Women with gonorrhea may experience symptoms such pain and itching of the vulva or in the vagina, vaginal discharge, unusual vaginal or anal
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bleeding, painful urination, or pain during sexual intercourse. Men with gonorrhea may experience pain and swelling in the groin, penile or anal discharge, pain or itching at the head of the penis, and/or pain when urinating. Often individuals have no symptoms. If left untreated, gonorrhea can cause sterility in men and women, as well as pelvic inflammatory disease (PID) in women. Individuals with gonorrhea should see a health care provider immediately, inform their health care provider if they believe that they are pregnant, inform their sex partners, and discuss STDs with their partners. Individuals can help to prevent gonorrhea by practicing safer sex with condoms and getting tested if any symptoms appear. The fact sheet provides contact information for services from which individuals can learn more about STDs and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). •
Gonorrhea ('Clap') Contact: Minnesota Department of Health, AIDS/STD Prevention Services Section, (651) 676-5698, http://health.state.mn.us/divs/dpc/aids-std/aids-std.htm. Summary: This fact sheet, for the general public, discusses the sexually transmitted disease (STD), gonorrhea. It lists the symptoms for men and women; transmission methods (e.g., perinatal transmission); the long-term consequences of untreated gonorrhea; its affect on pregnant women and their infants; prevention measures; and treatment. Contact information is provided for state and national STD services.
•
Gonorrhea ('The Clap') Contact: Kansas Department of Health and Environment, Bureau of Epidemiology and Disease Prevention, HIV-STD Section, 1000 SW Jackson Ste 210, Topeka, KS, 66612-1274, (785) 296-6173, http://www.kdhe.state.ks.us/olrh/download/health_directory.pdf. Summary: This information sheet discusses the sexually transmitted disease (STD) gonorrhea, also known as "the clap," its symptoms, transmission, diagnostic test, treatment, prevention, and complications of the disease. If left untreated, gonorrhea can cause sterility in men and pelvic inflammatory disease (PID), which can lead to infertility and ectopic pregnancy in women.
•
STD Facts: Nongonococcal Urethritis (NGU) (Caused by Various Organisms Other Than Gonorrhea) Contact: Minnesota Department of Health, Infectious Disease Epidemiology Prevention and Control Division, PO Box 9441, Minneapolis, MN, 55440-9441, (612) 676-5414, http://www.health.state.mn.us/divs/dpc/idepc.html. Summary: This information sheet presents an overview of nongonococcal urethritis (NGU), including signs and symptoms, transmission routes and factors, and complications and consequences that may include damage to reproductive organs and eye infection in newborns. Prevention strategies and treatment options are outlined. Sources of additional information are provided.
•
STD Fast Facts : Gonorrhea Contact: Education Training and Research Associates, PO Box 1830, Santa Cruz, CA, 95061-1830, (800) 321-4407, http://www.etr.org. Summary: This pamphlet provides information about the sexually transmitted disease (STD) gonorrhea. It describes gonorrhea, its transmission, the importance of treatment,
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symptoms for men and women, ways to prevent gonorrhea, and what individuals should do if infected. •
What You Need to Know About Gonorrhea Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://cdcnpin.org. Summary: Using a question and answer format, this fact sheet provides information on the transmission, symptoms, diagnosis, treatment, complications, and prevention of gonorrhea. It also provides statistics on the incidence of gonorrhea and information on at-risk populations and the effect of gonorrhea on pregnant women and their babies. Gonorrhea is a common sexually transmitted disease (STD), which is caused by Neisseria gonorrhoeae, a bacterium. It is spread through sexual contact and from mother to child during birth. Symptoms of infection in men can include a burning sensation when urinating and yellowish white discharge from the penis. Symptoms in women may include a painful or burning sensation when urinating and yellow or bloody vaginal discharge; many women who are infected have no symptoms. Several laboratory tests are available to diagnose gonorrhea. Antibiotics can successfully cure uncomplicated gonorrhea in adolescents and adults, and it is important to take all the medication prescribed to cure the infection. Untreated gonorrhea can cause serious and permanent problems including pelvic inflammatory disease (PID)in women and epididymitis in men. In pregnant women, gonorrhea can cause premature delivery or spontaneous abortion; in babies, it can cause blindness, joint infection, and lifethreatening blood infections. Persons with gonorrhea can more easily contract the human immunodeficiency virus (HIV). To prevent infection, individuals should use latex condoms correctly during every sex act, limit their number of partners, practice sexual abstinence, or limit sexual contact to one uninfected partner. The National Guideline Clearinghouse™
The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “gonorrhea” (or synonyms). The following was recently posted: •
2002 national guideline on the management of non-gonococcal urethritis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3030&nbr=2256&a mp;string=gonococcal Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:
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•
Gonorrhea Summary: This booklet discusses the symptoms, diagnosis, treatment, complications, and prevention of gonorrhea -- a highly contagious bacterial infection usually spread through sexual contact. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=105 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gonorrhea. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMD®Health: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to gonorrhea. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with gonorrhea.
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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gonorrhea. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gonorrhea” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gonorrhea”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “gonorrhea” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “gonorrhea” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
22
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
170 Gonorrhea
•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on gonorrhea: •
Basic Guidelines for Gonorrhea Chlamydia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001345.htm Gonococcal arthritis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000453.htm Gonorrhea - female Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000656.htm Gonorrhea - male Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000623.htm
•
Signs & Symptoms for Gonorrhea Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm
172 Gonorrhea
Dyspareunia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Dysuria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Increased urinary frequency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Increased urinary frequency or urgency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Mouth sores Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003059.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Pain on urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Pain or burning on urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Painful intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Painful urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Pruritus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Sexual intercourse, painful Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Skin rash or lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm
Online Glossaries 173
Skin rashes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Sore throat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm Tenesmus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003131.htm Throat, sore Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm Urinary discomfort Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Urinary hesitancy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003143.htm Vaginal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm •
Diagnostics and Tests for Gonorrhea Cervical gram stain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003753.htm Culture of joint aspirate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003742.htm Endocervical culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003754.htm Gram stain of urethral discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003749.htm Joint fluid Gram stain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003743.htm Rectal culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003759.htm Skin lesion aspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003451.htm Throat culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003746.htm Throat swab culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003746.htm Urethral discharge culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003750.htm
174 Gonorrhea
•
Background Topics for Gonorrhea Asymptomatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002217.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Condoms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/004001.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm Reportable disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001929.htm Safer sex behaviors Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm Safer sexual practices Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm Symptomatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002293.htm Testicles Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002334.htm Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
Online Glossaries 175
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
177
GONORRHEA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acid Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.2. [NIH] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actinomycosis: Infections with bacteria of the genus Actinomyces. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
178 Gonorrhea
Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] AFP: Alpha-fetoprotein. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergens: Antigen-type substances (hypersensitivity, immediate). [NIH]
that
produce
immediate
hypersensitivity
Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH]
Dictionary 179
Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amber: A yellowish fossil resin, the gum of several species of coniferous trees, found in the alluvial deposits of northeastern Germany. It is used in molecular biology in the analysis of organic matter fossilized in amber. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonium Compounds: Inorganic and organic compounds that contain the hypothetical radical NH4. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH]
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Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]
Anode: Electrode held at a positive potential with respect to a cathode. [NIH] Anogenital: Pertaining to the anus and external genitals. [EU] Anoscopy: A test to look for fissures, fistulae, and hemorrhoids. The doctor uses a special instrument, called an anoscope, to look into the anus. [NIH] Anthrax: An acute bacterial infection caused by ingestion of bacillus organisms. Carnivores may become infected from ingestion of infected carcasses. It is transmitted to humans by contact with infected animals or contaminated animal products. The most common form in humans is cutaneous anthrax. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-infective: An agent that so acts. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU]
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Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aphthous Stomatitis: Inflammation of the mucous membrane of the mouth. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Auditory nerve: The eight cranial nerve; also called vestibulocochlear nerve or acoustic nerve. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH]
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Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basilar Artery: The artery formed by the union of the right and left vertebral arteries; it runs from the lower to the upper border of the pons, where it bifurcates into the two posterior cerebral arteries. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beer: An alcoholic beverage usually made from malted cereal grain (as barley), flavored with hops, and brewed by slow fermentation. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological Sciences: All of the divisions of the natural sciences dealing with the various
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aspects of the phenomena of life and vital processes. The concept includes anatomy and physiology, biochemistry and biophysics, and the biology of animals, plants, and microorganisms. It should be differentiated from biology, one of its subdivisions, concerned specifically with the origin and life processes of living organisms. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biophysics: The science of physical phenomena and processes in living organisms. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Birth Rate: The number of births in a given population per year or other unit of time. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blennorrhoea: A general term including any inflammatory process of the external eye which gives a mucoid discharge, more exactly, a discharge of mucus. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types,
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yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Brucellosis: Infection caused by bacteria of the genus Brucella mainly involving the reticuloendothelial system. This condition is characterized by fever, weakness, malaise, and weight loss. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buffaloes: Ruminants of the family Bovidae consisting of Bubalus arnee and Syncerus caffer. This concept is differentiated from bison, which refers to Bison bison and Bison bonasus. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]
Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a
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network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carbuncle: An infection of cutaneous and subcutaneous tissue that consists of a cluster of boils. Commonly, the causative agent is Staphylococcus aureus. Carbuncles produce fever, leukocytosis, extreme pain, and prostration. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cat-Scratch Disease: A self-limiting bacterial infection of the regional lymph nodes caused by Afipia felis, a gram-negative bacterium recently identified by the Centers for Disease Control and Prevention and by Bartonella henselae. It usually arises one or more weeks following a feline scratch, with raised inflammatory nodules at the site of the scratch being the primary symptom. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing
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factors, and risk factors. [NIH] Cefixime: A third-generation cephalosporin antibiotic that is stable to hydrolysis by betalactamases. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH] Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervical intraepithelial neoplasia: CIN. A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how much of the cervix contains abnormal cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chancroid: Acute, localized autoinoculable infectious disease usually acquired through
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sexual contact. Caused by Haemophilus ducreyi, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. [NIH] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chimeric Proteins: Proteins in individuals that are derived from genetically different zygotes. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Chlamydia Infections: Infections with bacteria of the genus Chlamydia. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholera Toxin: The enterotoxin from Vibrio cholerae. It is a protein that consists of two major components, the heavy (H) or A peptide and the light (L) or B peptide or choleragenoid. The B peptide anchors the protein to intestinal epithelial cells, while the A peptide, enters the cytoplasm, and activates adenylate cyclase, and production of cAMP. Increased levels of cAMP are thought to modulate release of fluid and electrolytes from intestinal crypt cells. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment
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originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]
Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Coitus: Sexual intercourse. [NIH] Coliphages: Viruses whose host is Escherichia coli. [NIH] Colloidal: Of the nature of a colloid. [EU] Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [NIH] Commensal: 1. Living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. An organism living on or within another, but not causing injury to the host. [EU] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Community Medicine: A branch of medicine concerned with the total health of the individual within the home environment and in the community, and with the application of comprehensive care to the prevention and treatment of illness in the entire community. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1,
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IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementation: The production of a wild-type phenotype when two different mutations are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a
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fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contact Tracing: Identification of those persons (or animals) who have had such an association with an infected person, animal, or contaminated environment as to have had the opportunity to acquire the infection. Contact tracing is a generally accepted method for the control of sexually transmitted diseases. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corrosion: Irreversible destruction of skin tissue. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Counterimmunoelectrophoresis: Immunoelectrophoresis in which immunoprecipitation occurs when antigen at the cathode is caused to migrate in an electric field through a
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suitable medium of diffusion against a stream of antibody migrating from the anode as a result of endosmotic flow. [NIH] Crack Cocaine: The purified, alkaloidal, extra-potent form of cocaine. It is smoked (freebased), injected intravenously, and orally ingested. Use of crack results in alterations in function of the cardiovascular system, the autonomic nervous system, the central nervous system, and the gastrointestinal system. The slang term "crack" was derived from the crackling sound made upon igniting of this form of cocaine for smoking. [NIH] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cutaneous Fistula: An abnormal passage or communication leading from an internal organ to the surface of the body. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized
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subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement
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through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Horizontal: The transmission of infectious disease or pathogens from one individual to another in the same generation. [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [NIH] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a
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molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Design: The molecular designing of drugs for specific purposes (such as DNAbinding, enzyme inhibition, anti-cancer efficacy, etc.) based on knowledge of molecular properties such as activity of functional groups, molecular geometry, and electronic structure, and also on information cataloged on analogous molecules. Drug design is generally computer-assisted molecular modeling and does not include pharmacokinetics, dosage analysis, or drug administration analysis. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges)
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covering the brain and spinal cord; called also pachymeninx. [EU] Dysuria: Painful or difficult urination. [EU] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]
Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]
Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of
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a tooth. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocytosis: Cellular uptake of extracellular materials within membrane-limited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]
Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort
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studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]
Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erysipelas: An acute infection of the skin caused by species of streptococcus. This disease most frequently affects infants, young children, and the elderly. Characteristics include pink-to-red lesions that spread rapidly and are warm to the touch. The commonest site of involvement is the face. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythema Multiforme: A skin and mucous membrane disease characterized by an eruption of macules, papules, nodules, vesicles, and/or bullae with characteristic "bull's-eye" lesions usually occurring on the dorsal aspect of the hands and forearms. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH]
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Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Facial: Of or pertaining to the face. [EU] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral,
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anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Galactose Oxidase: An enzyme that oxidizes galactose in the presence of molecular oxygen to D-galacto-hexodialdose. It is a copper protein. EC 1.1.3.9. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting
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colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Fusion: Fusion of structural genes to analyze protein behavior or fusion of regulatory sequences with structural genes to determine mechanisms of regulation. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Techniques: Chromosomal, biochemical, intracellular, and other methods used in the study of genetics. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glanders: A contagious disease of horses that can be transmitted to humans. It is caused by Pseudomonas mallei and characterized by ulceration of the respiratory mucosa and an eruption of nodules on the skin. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions
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are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Gonorrhoea: Infection due to Neisseria gonorrhoeae transmitted sexually in most cases, but also by contact with infected exudates in neonatal children at birth, or by infants in households with infected inhabitants. It is marked in males by urethritis with pain and purulent discharge, but is commonly asymptomatic in females, although it may extend to produce suppurative salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteraemia occurs in both sexes, resulting in cutaneous lesions, arthritis, and rarely meningitis or endocarditis. Formerly called blennorrhagia and blennorrhoea. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Granuloma Inguinale: Anogenital ulcers caused by Calymmatobacterium granulomatis as
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distinguished from lymphogranuloma inguinale (see lymphogranuloma venereum) caused by Chlamydia trachomatis. Diagnosis is made by demonstration of typical intracellular Donovan bodies in crushed-tissue smears. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]
Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Haemophilus: A genus of Pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gram-negative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH]
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Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes virus: A member of the herpes family of viruses. [NIH] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird
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and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Housekeeping: The care and management of property. [NIH] Human Development: Continuous sequential changes which occur in the physiological and psychological functions during the individual's life. [NIH] Human Experimentation: Moral, legal, ethical, social, and religious aspects of experiments on humans but not the routine conduct of clinical research. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperaemia: An excess of blood in a part; engorgement. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypersensitivity, Immediate: Hypersensitivity reactions which occur within minutes of exposure to challenging antigen due to the release of histamine which follows the antigen-
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antibody reaction and causes smooth muscle contraction and increased vascular permeability. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune Complex Diseases: Group of diseases mediated by the deposition of large soluble complexes of antigen and antibody with resultant damage to tissue. Besides serum sickness and the arthus reaction, evidence supports a pathogenic role for immune complexes in many other systemic immunologic diseases including glomerulonephritis, systemic lupus erythematosus and polyarteritis nodosa. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]
Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH]
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Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impetigo: A common superficial bacterial infection caused by staphylococcus aureus or group A beta-hemolytic streptococci. Characteristics include pustular lesions that rupture and discharge a thin, amber-colored fluid that dries and forms a crust. This condition is commonly located on the face, especially about the mouth and nose. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Ingestion: Taking into the body by mouth [NIH]
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Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inoculum: The spores or tissues of a pathogen that serve to initiate disease in a plant. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interpersonal Relations: The reciprocal interaction of two or more persons. [NIH] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
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Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Isopropyl: A gene mutation inducer. [NIH] Jealousy: An irrational reaction compounded of grief, loss of self-esteem, enmity against the rival and self criticism. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]
Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU]
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Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]
Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Lice: A general name for small, wingless, parasitic insects, previously of the order Phthiraptera. Though exact taxonomy is still controversial, they can be grouped in the orders Anoplura (sucking lice), Mallophaga (biting lice), and Rhynchophthirina (elephant lice). [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligase: An enzyme that repairs single stranded discontinuities in double-stranded DNA molecules in the cell. Purified DNA ligase is used in gene cloning to join DNA molecules together. [NIH] Ligase Chain Reaction: A DNA amplification technique based upon the ligation of oligonucleotide probes. The probes are designed to exactly match two adjacent sequences of a specific target DNA. The chain reaction is repeated in three steps in the presence of excess probe: (1) heat denaturation of double-stranded DNA, (2) annealing of probes to target DNA, and (3) joining of the probes by thermostable DNA ligase. After the reaction is repeated for 20-30 cycles the production of ligated probe is measured. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU]
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Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]
Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphoblasts: Interferon produced predominantly by leucocyte cells. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphogranuloma Venereum: Subacute inflammation of the inguinal lymph glands caused by certain immunotypes of Chlamydia trachomatis. It is a sexually transmitted disease in the U.S. but is more widespread in developing countries. It is distinguished from granuloma venereum (granuloma inguinale), which is caused by Calymmatobacterium granulomatis.
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[NIH]
Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen
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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbicide: Any substance (gels, creams, suppositories, etc.) that can reduce transmission of sexually transmitted infections. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH]
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Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mode of Transmission: Hepatitis A [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Evolution: Multiple rounds of selection, amplification, and mutation leading to molecules with the desired properties. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morals: Standards of conduct as right or wrong. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU]
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Mucopurulent: Containing both mucus and pus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myeloproliferative Disorders: Disorders in which one or more stimuli cause proliferation of hemopoietically active tissue or of tissue which has embryonic hemopoietic potential. [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nalidixic Acid: Synthetic antimicrobial agent used in urinary tract infections. It is active against gram-negative bacteria but has little activity against gram-positive organisms or Pseudomonas. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Natural Childbirth: Psychophysical relaxation techniques that are used to facilitate childbirth. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle Sharing: Usage of a single needle among two or more people for injecting drugs. Needle sharing is a high-risk behavior for contracting infectious disease. [NIH] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neisseria gonorrhoeae: A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of gonorrhea. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH]
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Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonoxynol: Nonionic surfactant mixtures varying in the number of repeating ethoxy (oxy1,2-ethanediyl) groups. They are used as detergents, emulsifiers, wetting agents, defoaming agents, etc. Nonoxynol-9, the compound with 9 repeating ethoxy groups, is a spermatocide, formulated primarily as a component of vaginal foams and creams. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Amplification Techniques: Laboratory techniques that involve the in-vitro synthesis of many copies of DNA or RNA from one orginal template. [NIH]
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Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oligonucleotide Probes: Synthetic or natural oligonucleotides used in hybridization studies in order to identify and study specific nucleic acid fragments, e.g., DNA segments near or within a specific gene locus or gene. The probe hybridizes with a specific mRNA, if present. Conventional techniques used for testing for the hybridization product include dot blot assays, Southern blot assays, and DNA:RNA hybrid-specific antibody tests. Conventional labels for the probe include the radioisotope labels 32P and 125I and the chemical label biotin. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Oncology: The study of cancer. [NIH] Oophoritis: Inflammation of an ovary. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Manifestations: Disorders of the mouth attendant upon non-oral disease or injury. [NIH]
Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH]
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Ornithosis: Infection with Chlamydophila psittaci (formerly Chlamydia psittaci), transmitted to man by inhalation of dust-borne contaminated nasal secretions or excreta of infected birds. This infection results in a febrile illness characterized by pneumonitis and systemic manifestations. [NIH] Oropharynx: Oral part of the pharynx. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Overexpress: An excess of a particular protein on the surface of a cell. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]
Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid)
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disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Penicillin Resistance: Nonsusceptibility of an organism to the action of penicillins. [NIH] Penicillinase: A beta-lactamase preferentially cleaving penicillins. (Dorland, 28th ed) EC 3.5.2.-. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perianal: Located around the anus. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal Abscess: Localized circumscribed purulent area of inflammation in the periodontal tissue. It is a derivative of marginal periodontitis and commonly associated with suprabony and infrabony pockets and interradicular involvements, in contrast to periapical abscess which is attributable to pulp necrosis. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex.
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[NIH]
Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharyngitis: Inflammation of the throat. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH]
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Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain
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pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pledget: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presumptive: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH]
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Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15-
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hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostitution: The practice of indulging in promiscuous sexual relations for money. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]
Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pseudocysts: A collection of enzyme-rich pancreatic fluid and tissue debris arising within areas of necrosis or an obstructed smaller duct. [NIH] Pseudorabies: A highly contagious herpesvirus infection affecting the central nervous system of swine, cattle, dogs, cats, rats, and other animals. [NIH] Psittaci: Causal agent of ornithosis. [NIH]
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Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotomimetic: Psychosis miming. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Public Sector: The area of a nation's economy that is tax-supported and under government control. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyoderma: Any purulent skin disease (Dorland, 27th ed). [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH]
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Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU]
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Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regional lymph node: In oncology, a lymph node that drains lymph from the region around a tumor. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time.
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[NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Mucosa: The mucous membrane lining the respiratory tract. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk-Taking: Undertaking a task involving a challenge for achievement or a desirable goal in which there is a lack of certainty or a fear of failure. It may also include the exhibiting of certain behaviors whose outcomes may present a risk to the individual or to those associated with him or her. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Rubella Virus: The type (and only) species of Rubivirus causing acute infection in humans, primarily children and young adults. Humans are the only natural host. A live, attenuated vaccine is available for prophylaxis. [NIH] Safe Sex: Sex behavior that prevents or decreases the spread of sexually transmitted diseases or pregnancy. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH]
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Salmonellosis: Infection by salmonellae. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scabies: A contagious cutaneous inflammation caused by the bite of the mite Sarcoptes scabiei. It is characterized by pruritic papular eruptions and burrows and affects primarily the axillae, elbows, wrists, and genitalia, although it can spread to cover the entire body. [NIH]
Scarlet Fever: Infection with group A streptococci that is characterized by tonsillitis and pharyngitis. An erythematous rash is commonly present. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serologic Tests: Diagnostic procedures involving immunoglobulin reactions. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino
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acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Behavior: Sexual activities of humans. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Education: Education which increases the knowledge of the functional, structural, and behavioral aspects of human reproduction. [NIH] Sexual Abstinence: Refraining from sexual intercourse. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shame: An emotional attitude excited by realization of a shortcoming or impropriety. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or
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cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spermicide: An agent that is destructive to spermatozoa. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and
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cryptogamic plants. [NIH] Sporotrichosis: The commonest and least serious of the deep mycoses, characterized by nodular lesions of the cutaneous and subcutaneous tissues. It is caused by inhalation of contaminated dust or by infection of a wound. [NIH] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Standardize: To compare with or conform to a standard; to establish standards. [EU] Staphylococcal Infections: Infections with bacteria of the genus Staphylococcus. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Staphylococcus aureus: Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. [NIH] Steady state: Dynamic equilibrium. [EU] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between
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the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Streptomycin: O-2-Deoxy-2-(methylamino)-alpha-L-glucopyranosyl-(1-2)-O-5- deoxy-3-Cformyl-alpha-L-lyxofuranosyl-(1-4)-N,N'-bis(aminoiminomethyl)-D-streptamine. Antibiotic substance produced by the soil actinomycete Streptomyces griseus. It acts by inhibiting the initiation and elongation processes during protein synthesis. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppuration: A pathologic process consisting in the formation of pus. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]
Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other
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covariates on the function. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]
Syphilis, Congenital: Syphilis acquired in utero and manifested by any of several characteristic tooth (Hutchinson's teeth) or bone malformations and by active mucocutaneous syphilis at birth or shortly thereafter. Ocular and neurologic changes may also occur. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Tetracycline Resistance: Nonsusceptibility of a microbe (usually a bacterium) to the action of tetracycline, which binds to the 30S ribosomal subunit and prevents the normal binding
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of aminoacyl-tRNA. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]
Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. It is often caused by a bacterium. Tonsillitis may be acute, chronic, or recurrent. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH]
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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]
Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Trachoma: A chronic infection of the conjunctiva and cornea caused by Chlamydia trachomatis. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomonas vaginalis: A species of trichomonas that produces a refractory vaginal
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discharge in females, as well as bladder and urethral infections in males. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tuberculosis, Oral: Tuberculosis of the mouth, tongue, and salivary glands. [NIH] Tularemia: A plague-like disease of rodents, transmissible to man. It is caused by Francisella tularensis and is characterized by fever, chills, headache, backache, and weakness. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urinary urgency: Inability to delay urination. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This
Dictionary 237
includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Verruca: A circumscribed, cutaneous excrescence having a papilliferous surface; a small, circumscribed, epidermal tumor. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrio: A genus of Vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Vibrio cholerae: The etiologic agent of cholera. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH]
238 Gonorrhea
Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Wetting Agents: A surfactant that renders a surface wettable by water or enhances the spreading of water over the surface; used in foods and cosmetics; important in contrast media; also with contact lenses, dentures, and some prostheses. Synonyms: humectants; hydrating agents. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yaws: A systemic non-venereal infection of the tropics caused by Treponema pallidum subspecies pertenue. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
239
INDEX A Abdomen, 159, 177, 184, 202, 207, 208, 210, 230, 231, 234, 238 Aberrant, 23, 177 Abscess, 3, 177, 201, 218 Acatalasia, 177, 185 Acetylcholine, 177, 215 Acetylglucosamine, 107, 177, 201 Acid Phosphatase, 107, 177 Acremonium, 177, 186 Acrylonitrile, 177, 227 Actinomycosis, 127, 128, 129, 177 Acyl, 37, 177 Adaptability, 55, 177 Adaptation, 25, 177 Adenylate Cyclase, 177, 187 Adhesions, 11, 177 Adjustment, 177 Adolescence, 19, 177 Adverse Effect, 55, 90, 178, 229 Aerobic, 178, 213, 214 Affinity, 48, 103, 107, 178 AFP, 7, 178 Agar, 64, 75, 116, 178, 191, 205, 220 Agarose, 101, 178, 205 Aggressiveness, 46, 178 Albumin, 178, 220, 233 Algorithms, 5, 130, 178, 183 Alkaline, 178, 184 Alkaloid, 178, 188 Alleles, 44, 178 Allergens, 103, 178 Alpha-Defensins, 178, 192 Alternative medicine, 138, 179 Amber, 179, 206 Amebiasis, 179, 212 Amino Acid Sequence, 179, 180, 200 Amino Acids, 179, 197, 200, 218, 223, 228, 235 Ammonium Compounds, 106, 179 Amphetamine, 50, 179, 193 Amplification, 15, 30, 33, 34, 35, 50, 62, 67, 74, 79, 179, 209, 213 Ampulla, 179, 198 Anaerobic, 17, 22, 90, 179, 202, 231, 237 Anal, 5, 17, 35, 91, 159, 179, 196, 199, 210 Analgesic, 91, 179 Analogous, 179, 194, 235
Anaphylatoxins, 179, 189 Anaplasia, 179 Anemia, 179, 211 Anions, 178, 180, 208, 229 Annealing, 180, 209 Anode, 180, 191 Anogenital, 35, 79, 180, 201 Anoscopy, 36, 180 Anthrax, 129, 180 Antibacterial, 91, 180, 216, 230 Anticoagulant, 180, 223 Antidepressant, 180, 184 Antigen-Antibody Complex, 100, 180, 188 Antigen-presenting cell, 180, 192 Anti-infective, 180, 187, 204 Antimicrobial, 7, 49, 55, 66, 68, 69, 78, 90, 91, 150, 180, 187, 192, 214 Antiserum, 100, 180 Antiviral, 53, 180, 207 Anus, 179, 180, 181, 184, 218, 226 Anxiety, 51, 181 Aphthous Stomatitis, 128, 181 Applicability, 13, 15, 31, 181 Aqueous, 115, 181, 182, 191, 195, 204, 210 Arachidonic Acid, 181, 222 Arginine, 179, 181, 215, 236 Arterial, 181, 223 Arteries, 181, 182, 183, 190, 212 Arterioles, 181, 183, 184 Aseptic, 181, 216, 231 Aspirate, 173, 181 Aspiration, 173, 181, 198 Assay, 15, 42, 50, 101, 103, 105, 108, 112, 115, 136, 181, 205, 225 Asymptomatic, 7, 40, 57, 67, 114, 136, 174, 177, 179, 181, 201 Atmospheric Pressure, 181, 204 Attenuated, 181, 227 Auditory, 181, 211, 228 Auditory nerve, 181, 211 Autonomic, 177, 181, 191, 219 Autonomic Nervous System, 181, 191 Azithromycin, 49, 68, 71, 142, 181 B Bacillus, 180, 181, 184 Bacteremia, 3, 181 Bacterial Infections, 44, 100, 127, 129, 182 Bacterial Physiology, 177, 182
240 Gonorrhea
Bactericidal, 10, 182, 197 Bacteriophage, 11, 182, 220, 235, 237 Bacteriostatic, 182, 197 Bacterium, 11, 12, 26, 101, 102, 117, 161, 182, 185, 188, 189, 203, 233, 234 Base, 61, 72, 182, 192, 200, 208, 233 Basilar Artery, 182, 211 Basophils, 182, 201, 209 Beer, 137, 182 Benign, 182, 202, 214, 217, 225, 238 Beta-Defensins, 182, 192 Beta-Lactamases, 182, 186 Bile, 182, 204, 210, 231 Biochemical, 11, 22, 41, 44, 48, 104, 116, 178, 182, 183, 200, 201, 208, 228 Biological Markers, 59, 182 Biological response modifier, 182, 207 Biological Sciences, 40, 182 Biological Transport, 183, 193 Biomarkers, 13, 26, 40, 183 Biophysics, 11, 183 Biopsy, 57, 128, 183 Biosynthesis, 10, 41, 181, 183, 228 Biotechnology, 63, 65, 126, 138, 149, 183 Biotransformation, 183 Birth Rate, 123, 183 Bladder, 129, 183, 223, 236 Blastocyst, 183, 189, 195, 220 Blennorrhoea, 183, 201 Blood Coagulation, 183, 184, 234 Blood Glucose, 183, 203 Blood pressure, 183, 213 Blood transfusion, 122, 183 Blood vessel, 183, 185, 196, 198, 203, 210, 234, 237 Body Fluids, 115, 183, 194, 236 Bone Marrow, 183, 205, 210, 213 Bowel, 179, 184, 207, 208, 232 Bowel Movement, 184, 232 Bradykinin, 184, 215, 220 Branch, 115, 169, 184, 188, 195, 210, 211, 218, 224, 230, 234 Breakdown, 184, 193, 199 Broad-spectrum, 49, 184, 186, 216 Bronchiseptica, 184, 219 Brucellosis, 129, 184 Buccal, 184, 210 Buffaloes, 59, 184 Bupropion, 17, 184 C Calcium, 103, 184, 188, 229 Candidiasis, 6, 62, 184
Candidosis, 184 Capillary, 111, 184, 237 Capsules, 38, 185, 199 Carbohydrate, 185, 200, 201, 221, 228 Carbon Dioxide, 185, 199, 220, 227 Carbuncle, 129, 185 Carcinogen, 185, 212 Carcinogenic, 185, 207, 216, 222, 231 Carcinoma, 5, 128, 185 Cardiac, 185, 196, 214, 227, 231 Cardiovascular, 179, 185, 191, 229 Cardiovascular System, 185, 191 Carrier Proteins, 185, 220, 225 Case report, 47, 185 Catalase, 26, 177, 185 Catecholamine, 185, 194, 219 Catheters, 4, 185 Cathode, 180, 185, 190, 195 Cat-Scratch Disease, 129, 185 Causal, 35, 51, 60, 185, 196, 203, 207, 223, 228 Causality, 52, 185 Cefixime, 63, 65, 69, 186 Ceftriaxone, 65, 186 Cefuroxime, 63, 68, 186 Cell Adhesion, 186, 207 Cell Differentiation, 186, 229 Cell Division, 182, 186, 220, 228 Cell membrane, 183, 185, 186, 192, 220 Cell proliferation, 186, 229 Cellobiose, 186 Cellulose, 38, 186, 199, 220 Central Nervous System, 50, 177, 179, 181, 186, 188, 191, 193, 202, 212, 223, 229 Centrifugation, 103, 186 Cephalosporins, 55, 142, 182, 186 Cervical, 4, 12, 15, 19, 35, 39, 42, 46, 48, 60, 81, 104, 115, 173, 186 Cervical intraepithelial neoplasia, 35, 186 Cervix, 7, 45, 57, 116, 174, 186, 188 Chancroid, 35, 120, 122, 123, 126, 129, 186 Cheilitis, 129, 187 Chemotactic Factors, 187, 189 Chemotaxis, 92, 187 Chemotherapy, 61, 68, 69, 78, 91, 187 Chimeric Proteins, 45, 187 Chlamydia Infections, 11, 80, 156, 187 Chlorhexidine, 23, 187 Cholera, 10, 24, 45, 187, 229, 237 Cholera Toxin, 45, 187 Cholesterol, 182, 187, 209, 231 Chromosomal, 179, 187, 200, 220
Index 241
Chromosome, 26, 187, 189, 202, 209, 228 Chronic, 3, 16, 25, 102, 122, 128, 129, 174, 179, 187, 193, 206, 208, 232, 234, 235 Ciprofloxacin, 63, 65, 67, 68, 72, 75, 82, 142, 187 CIS, 43, 187 Clinical trial, 8, 17, 21, 29, 39, 49, 54, 149, 187, 190, 194, 220, 223, 225 Clone, 10, 48, 187 Cloning, 41, 183, 188, 209 Coca, 188 Cocaine, 9, 51, 188, 191 Cofactor, 188, 223, 234 Cohort Studies, 21, 188, 197 Coitus, 6, 188 Coliphages, 182, 188 Colloidal, 178, 188, 195, 229 Colposcopy, 36, 76, 188 Commensal, 11, 64, 188 Communicable disease, 53, 188 Community Medicine, 92, 188 Competency, 28, 188 Complement, 14, 25, 64, 92, 115, 179, 188, 189, 200, 207, 220 Complementary and alternative medicine, 89, 95, 189 Complementary medicine, 89, 189 Complementation, 14, 41, 189 Computational Biology, 149, 189 Conception, 110, 189, 190, 198, 221, 231 Concomitant, 92, 189 Condoms, 7, 28, 39, 50, 51, 77, 104, 120, 122, 136, 157, 158, 159, 160, 161, 174, 189 Condyloma, 5, 189 Cone, 11, 189, 232 Confounding, 36, 46, 63, 189 Congestion, 189, 197 Conjugated, 189 Conjugation, 60, 183, 189 Conjunctiva, 190, 206, 235 Conjunctivitis, 75, 89, 108, 190 Connective Tissue, 184, 189, 190, 198, 199, 210, 219, 223, 228 Consciousness, 179, 190, 194, 227 Consultation, 7, 190 Consumption, 50, 92, 190, 193, 227 Contact Tracing, 38, 76, 190 Contamination, 190, 203 Contraception, 39, 104, 122, 190 Contraceptive, 16, 19, 39, 104, 106, 109, 110, 114, 142, 190 Contraindications, ii, 190
Control group, 28, 30, 33, 34, 35, 46, 190, 220, 222, 225 Convulsion, 51, 190 Cornea, 190, 235 Coronary, 190, 212 Coronary Thrombosis, 190, 212 Corpus, 190, 218, 222 Corrosion, 106, 190 Cortex, 190, 197, 222 Counterimmunoelectrophoresis, 101, 190 Crack Cocaine, 9, 121, 191 Crossing-over, 191, 226 Cross-Sectional Studies, 191, 197 Cryptosporidiosis, 181, 191 Culture Media, 116, 178, 191 Cultured cells, 60, 191 Curative, 191, 234 Cutaneous, 127, 129, 180, 184, 185, 191, 201, 210, 228, 231, 237 Cutaneous Fistula, 127, 191 Cyclic, 128, 177, 191, 202, 215, 222 Cyst, 181, 191 Cysteine, 191, 192 Cytokine, 14, 22, 42, 46, 191 Cytomegalovirus, 122, 191 Cytoplasm, 104, 182, 186, 187, 191, 196, 201, 213 Cytoskeleton, 191, 207 Cytotoxic, 46, 191, 225, 229 D Data Collection, 191, 199 Databases, Bibliographic, 149, 191 Decision Making, 5, 55, 192 Defense Mechanisms, 36, 192, 207 Defensins, 36, 57, 113, 178, 182, 192 Degenerative, 192, 203 Dehydration, 187, 192 Deletion, 14, 72, 192 Delivery of Health Care, 192, 202 Delusions, 192, 217, 224 Denaturation, 192, 209 Dendrites, 192, 215 Dendritic, 35, 192 Dendritic cell, 35, 192 Density, 186, 192, 209, 216 Dental Caries, 127, 192 Depolarization, 192, 229 Detergents, 192, 215 Deuterium, 192, 204 Developed Countries, 39, 192 Developing Countries, 31, 36, 92, 193, 210 Dextroamphetamine, 179, 193, 212
242 Gonorrhea
Diabetes Mellitus, 4, 193, 200, 203 Diagnostic procedure, 99, 102, 138, 193, 228 Diarrhea, 179, 191, 193, 196 Diffusion, 27, 32, 53, 59, 183, 191, 193, 205 Digestion, 112, 182, 184, 193, 207, 210, 231, 237 Digestive tract, 193, 230, 231 Dihydrotestosterone, 193, 226 Dilatation, 193, 222, 237 Dimethyl, 106, 193 Diphtheria, 127, 129, 193 Diploid, 189, 193, 220 Direct, iii, 9, 13, 17, 35, 55, 62, 108, 116, 141, 193, 194, 200, 218, 226 Disease Progression, 193, 237 Disease Transmission, 38, 193 Disease Transmission, Horizontal, 193 Disease Transmission, Vertical, 193 Dissection, 5, 193 Dissociation, 178, 193, 208 Distal, 37, 109, 194, 223 Dopamine, 179, 184, 188, 193, 194, 213 Dorsal, 194, 197, 221 Double-blinded, 17, 55, 194 Douching, 16, 62, 93, 194 Drive, ii, vi, 25, 53, 85, 123, 127, 128, 194 Drug Design, 45, 194 Drug Interactions, 143, 194 Drug Resistance, 6, 28, 55, 194 Drug Tolerance, 194, 234 Duct, 179, 194, 223, 227 Duodenum, 182, 194, 232 Dura mater, 194, 212, 217 Dysuria, 7, 172, 195 E Ectopic, 16, 25, 57, 111, 150, 160, 195 Ectopic Pregnancy, 16, 25, 57, 111, 150, 160, 195 Effector, 177, 188, 195 Efficacy, 4, 11, 17, 18, 28, 29, 31, 33, 34, 38, 39, 50, 51, 54, 64, 72, 78, 90, 126, 194, 195 Ejaculation, 195, 228 Electrolyte, 195, 221 Electrons, 182, 185, 195, 208, 224, 225 Electrophoresis, 195, 205 Embryo, 183, 186, 195, 206, 221, 230 Embryo Transfer, 195, 221 Emergency Medicine, 69, 70, 71, 74, 122, 195 Emergency Treatment, 195 Empiric, 53, 70, 195
Empirical, 53, 195 Emulsion, 195, 199 Enamel, 192, 195 Endemic, 78, 187, 196, 211 Endocarditis, 184, 196, 201 Endocytosis, 21, 196 Endometrial, 12, 21, 57, 196 Endometrium, 14, 20, 25, 196 Endoscope, 188, 196 Endothelium, 196, 215 Endothelium-derived, 196, 215 Endotoxic, 196, 209 Endotoxins, 189, 196 Enteropeptidase, 196, 236 Enterotoxins, 45, 196 Environmental Exposure, 182, 196 Environmental Health, 148, 150, 196 Enzymatic, 184, 189, 192, 196 Eosinophils, 196, 201, 209 Epidemic, 22, 36, 41, 54, 55, 63, 101, 109, 119, 121, 151, 196 Epidemiologic Studies, 12, 182, 196 Epidemiological, 5, 15, 20, 27, 29, 38, 40, 43, 47, 54, 55, 159, 197 Epidermal, 197, 237, 238 Epidermoid carcinoma, 197, 231 Epithelial, 11, 21, 22, 26, 36, 37, 45, 54, 61, 64, 86, 102, 182, 183, 187, 197, 203, 217 Epithelial Cells, 11, 21, 22, 26, 37, 45, 54, 64, 182, 187, 197, 203 Epithelium, 4, 11, 22, 102, 189, 196, 197, 217 Epitope, 56, 197 Erectile, 197, 218 Erysipelas, 129, 197 Erythema, 128, 197 Erythema Multiforme, 128, 197 Erythrocytes, 115, 179, 184, 197, 203, 226 Erythromycin, 23, 72, 181, 197 Escalation, 4, 51, 197 Esophagus, 193, 197, 219, 232 Estradiol, 25, 64, 197 Estrogen, 19, 197 Ethanol, 197, 198 Ethnic Groups, 21, 197 Eukaryotic Cells, 40, 197, 216 Excipient, 38, 198 Exhaustion, 198, 211 Exogenous, 183, 198, 223 Extracellular, 23, 190, 196, 198, 207 Extracellular Matrix, 190, 198, 207 Extraction, 15, 62, 108, 198
Index 243
Extravasation, 3, 198 Exudate, 108, 110, 198 F Facial, 198, 211 Fallopian Tubes, 159, 198 Family Planning, 16, 48, 62, 66, 149, 198 Fat, 181, 184, 198, 209, 232, 233 Fatty acids, 178, 198, 201, 222 Feces, 198, 232 Fermentation, 107, 115, 182, 198 Fertilization in Vitro, 198, 221 Fetoprotein, 178, 198 Fetus, 178, 198, 220, 221, 230, 231, 236 Fibrosis, 102, 198 Fixation, 14, 115, 198 Flagellum, 199, 235 Fluorescence, 24, 103, 107, 115, 199 Focus Groups, 31, 199 Fold, 10, 199 Foramen, 199, 211 Fovea, 199 Fungi, 189, 199, 212, 213, 230, 238 Fungus, 184, 186, 199 G Galactose Oxidase, 107, 199 Gamma Rays, 199, 225 Gangrenous, 199, 229 Gas, 185, 193, 199, 204, 215 Gastrin, 199, 204 Gastrointestinal, 124, 184, 187, 191, 197, 199, 211, 229, 232, 236, 237 Gelatin, 191, 199, 232 Gels, 199, 212 Gene, 10, 22, 25, 37, 41, 43, 44, 48, 126, 178, 182, 183, 200, 208, 209, 216, 226, 228 Gene Expression, 22, 25, 200 Gene Fusion, 25, 200 Genetic Code, 200, 215 Genetic Engineering, 183, 188, 200 Genetic Techniques, 54, 200 Genetics, 40, 189, 200 Genitourinary, 61, 89, 90, 161, 200, 214, 236 Genotype, 72, 89, 200, 219 Gestation, 12, 42, 200, 218, 220, 230 Giardiasis, 200, 212 Gland, 200, 210, 211, 217, 223, 228, 231 Glanders, 129, 200 Glottis, 200, 219 Glucose, 64, 107, 183, 186, 193, 200, 201, 203, 228, 236 Glucose Intolerance, 193, 200
Glycerol, 200, 201, 220 Glycerophospholipids, 200, 220 Glycogen, 187, 201 Glycoprotein, 52, 201, 234 Glycosaminoglycans, 201, 223 Glycosidic, 186, 201, 216 Glycosylation, 52, 201 Gonadal, 201, 231 Gonorrhoea, 16, 37, 62, 151, 201 Governing Board, 201, 221 Grade, 40, 201 Graft, 201, 204 Gram-negative, 10, 24, 106, 115, 184, 185, 186, 187, 196, 201, 202, 214, 216, 237 Gram-Negative Bacteria, 196, 201, 214 Gram-positive, 106, 186, 201, 208, 214, 216, 231, 232 Granule, 57, 201 Granulocytes, 201, 209, 229, 238 Granuloma, 127, 128, 129, 201, 210 Granuloma Inguinale, 127, 129, 201, 210 Groin, 5, 160, 202, 207 Guanylate Cyclase, 202, 215 H Haemophilus, 10, 38, 186, 187, 202 Half-Life, 186, 202 Haploid, 202, 220 Haptens, 178, 202, 225 Headache, 202, 206, 236 Health Behavior, 39, 42, 202 Health Care Costs, 41, 202 Health Education, 28, 120, 133, 159, 202 Health Expenditures, 202 Health Promotion, 30, 31, 33, 34, 35, 122, 202 Health Status, 26, 202 Heme, 14, 202 Hemoglobin, 14, 64, 179, 197, 202, 203 Hemolysis, 115, 203 Hemolytic, 203, 206 Hemorrhoids, 180, 203 Hemostasis, 203, 207, 229 Hepatitis, 5, 6, 17, 27, 31, 51, 115, 120, 121, 122, 124, 125, 203, 213, 237 Hepatitis A, 31, 203, 213 Hepatocytes, 203 Hepatovirus, 203 Hereditary, 203, 219 Heredity, 200, 203 Hernia, 126, 203
244 Gonorrhea
Herpes, 4, 6, 7, 46, 53, 55, 69, 97, 108, 117, 120, 121, 122, 123, 124, 125, 129, 156, 158, 203 Herpes virus, 117, 203 Herpes Zoster, 203 Heterodimers, 203, 207 Heterogeneity, 37, 56, 178, 203 Histology, 58, 203 Homologous, 25, 178, 191, 203, 228, 233 Homosexuality, 124, 204 Hormonal, 19, 204 Hormone, 115, 182, 197, 199, 204, 222, 229, 233 Housekeeping, 44, 204 Human Development, 121, 148, 204 Human Experimentation, 37, 204 Human papillomavirus, 6, 15, 35, 45, 46, 121, 123, 204 Humoral, 14, 36, 103, 204 Humour, 204 Hybrid, 187, 204, 216 Hydrogen, 17, 100, 182, 185, 192, 204, 213, 223 Hydrogen Peroxide, 185, 204 Hydrolysis, 182, 183, 186, 204, 219, 223, 236 Hydrophobic, 48, 192, 200, 204, 209 Hygienic, 194, 204 Hyperaemia, 190, 204 Hyperbaric, 90, 204 Hyperbaric oxygen, 90, 204 Hypersensitivity, 178, 204 Hypersensitivity, Immediate, 178, 204 I Id, 87, 93, 157, 161, 162, 168, 170, 205 Idiopathic, 12, 205 Immune Complex Diseases, 180, 205 Immune function, 42, 205 Immune response, 10, 14, 22, 25, 36, 42, 45, 54, 180, 202, 205, 232, 236, 238 Immune Sera, 205 Immune system, 26, 28, 180, 205, 206, 210, 211, 237, 238 Immunity, 26, 36, 45, 54, 93, 103, 107, 192, 205, 235 Immunization, 102, 205, 228 Immunoassay, 47, 101, 105, 108, 110, 115, 205 Immunodeficiency syndrome, 52, 119, 120, 121, 122, 124, 132, 158, 205 Immunodiffusion, 178, 205
Immunoelectrophoresis, 100, 105, 178, 190, 205 Immunofluorescence, 103, 205 Immunogen, 100, 205 Immunogenic, 205, 209, 225 Immunoglobulin, 101, 105, 115, 180, 205, 213, 228 Immunologic, 14, 54, 62, 128, 187, 205, 225 Immunology, 22, 26, 43, 45, 55, 60, 178, 206 Impairment, 206, 212, 224 Impetigo, 129, 206 Implantation, 189, 206 In situ, 5, 206 In vitro, 4, 11, 22, 36, 38, 92, 117, 195, 206, 228, 234 In vivo, 11, 22, 25, 37, 38, 54, 56, 117, 206 Incision, 5, 206, 207 Incubated, 103, 115, 206 Incubation, 5, 102, 107, 206, 219 Incubation period, 5, 107, 206, 219 Indicative, 103, 125, 206, 218, 237 Induction, 206, 225 Infarction, 190, 206, 212 Infertility, 16, 25, 49, 57, 111, 150, 158, 160, 206, 236 Influenza, 105, 206 Ingestion, 180, 206 Inguinal, 5, 207, 210 Inhalation, 207, 217, 231 Initiation, 207, 232 Inlay, 207, 227 Inner ear, 186, 207 Inoculum, 111, 207 Insight, 10, 26, 45, 46, 48, 207 Integrins, 14, 207 Interferon, 46, 207, 210 Interferon-alpha, 207 Interleukin-2, 104, 207 Interpersonal Relations, 60, 207 Intervention Studies, 21, 55, 207 Intestinal, 129, 178, 187, 191, 196, 207, 208 Intestine, 184, 207, 208, 232 Intracellular, 23, 24, 25, 61, 103, 200, 202, 206, 207, 215, 221, 222, 229 Intraepithelial, 5, 35, 207 Intramuscular, 65, 207 Intravenous, 4, 207 Intrinsic, 178, 207 Invasive, 40, 58, 61, 113, 205, 207 Involuntary, 25, 190, 208, 214, 230 Ionization, 56, 208
Index 245
Ionizing, 196, 208, 225 Ions, 182, 194, 195, 204, 208 Isopropyl, 100, 208 J Jealousy, 208, 217 Joint, 161, 172, 173, 187, 208, 233 K Kb, 60, 148, 208 Keratolytic, 192, 208 Kinetic, 208 L Labile, 45, 114, 188, 208 Lactobacillus, 17, 55, 208 Laparoscopy, 12, 208 Large Intestine, 193, 207, 208, 226, 230 Lavage, 15, 208 Laxative, 178, 208 Least-Squares Analysis, 208, 226 Lectin, 107, 111, 208 Leprosy, 100, 127, 128, 129, 208 Lesion, 172, 173, 201, 208, 236 Lethal, 44, 182, 208 Leucocyte, 209, 210 Leukocytes, 11, 182, 184, 187, 196, 201, 207, 209, 213, 219 Leukocytosis, 185, 209 Library Services, 168, 209 Lice, 120, 124, 209 Life cycle, 54, 122, 199, 209 Ligament, 209, 223 Ligands, 22, 207, 209 Ligase, 18, 56, 61, 64, 70, 209 Ligase Chain Reaction, 18, 56, 61, 64, 70, 209 Ligation, 209 Likelihood Functions, 209, 226 Linear Models, 209, 226 Linkages, 13, 201, 203, 209, 233 Lipid, 24, 200, 209, 210 Lipid A, 24, 209 Lipopolysaccharide, 108, 201, 209 Lipoprotein, 201, 209 Liposome, 103, 210 Liver, 178, 181, 182, 191, 195, 198, 201, 203, 210 Liver cancer, 178, 210 Localized, 14, 177, 186, 192, 193, 199, 206, 210, 218, 220, 236 Locomotion, 199, 210, 220 Logistic Models, 210, 226 Longitudinal Studies, 20, 191, 210 Longitudinal study, 56, 210
Loop, 203, 210 Lupus, 128, 129, 205, 210 Lymph, 11, 186, 196, 204, 210, 226 Lymph node, 11, 186, 210, 226 Lymphatic, 196, 206, 210, 230, 234 Lymphatic system, 210, 230, 234 Lymphoblasts, 103, 210 Lymphocyte, 103, 104, 180, 210, 212 Lymphogranuloma Venereum, 100, 101, 108, 122, 202, 210 Lymphoid, 180, 209, 211 Lymphoma, 92, 211 Lysine, 211, 236 Lytic, 44, 211, 228, 237 M Macrophage, 14, 211 Malaise, 184, 211 Malaria, 100, 211 Malaria, Falciparum, 211 Malaria, Vivax, 211 Malignancy, 211, 217 Malignant, 210, 211, 214, 225, 228 Manic, 211, 224 Manic-depressive psychosis, 211, 224 Manifest, 129, 211 Mastitis, 211, 229 Maxillary, 128, 211, 217 Maxillary Sinus, 128, 211 Meatus, 109, 211 Mediate, 30, 33, 34, 35, 48, 194, 211 Mediator, 207, 211, 229 Medical Records, 7, 212 Medical Staff, 194, 212 Medicament, 212, 232 MEDLINE, 149, 212 Membrane, 10, 24, 37, 45, 48, 62, 102, 104, 108, 114, 181, 186, 189, 190, 192, 196, 197, 198, 201, 212, 213, 214, 216, 217, 218, 220, 221, 227, 229, 233, 235 Memory, 51, 212 Meninges, 186, 194, 212 Meningitis, 10, 100, 101, 105, 113, 201, 212 Mental Disorders, 28, 212, 224 Mental Health, iv, 7, 8, 54, 148, 152, 212, 224 Metabolite, 183, 193, 212 Metastasis, 212 Methamphetamine, 32, 50, 212 Methionine, 193, 212 Metronidazole, 13, 23, 212 MI, 66, 120, 174, 212 Microbe, 212, 233, 234
246 Gonorrhea
Microbicide, 4, 39, 212 Microbiology, 14, 16, 20, 22, 26, 43, 45, 55, 58, 70, 75, 112, 177, 212 Microorganism, 188, 212, 218, 238 Micro-organism, 192, 213, 228 Microscopy, 7, 10, 213 Migration, 11, 213 Miscarriage, 12, 213 Mitochondria, 213, 216 Mobility, 30, 213 Mode of Transmission, 4, 47, 158, 213 Modeling, 9, 27, 33, 58, 75, 194, 213 Modulator, 22, 213 Molecular Evolution, 43, 213 Molecule, 10, 41, 180, 182, 189, 194, 195, 196, 197, 201, 204, 208, 213, 220, 223, 225, 226, 229, 237 Monitor, 40, 150, 213, 215 Monoamine, 179, 193, 213 Monoclonal, 11, 45, 101, 213, 225 Monoclonal antibodies, 11, 101, 213 Monocytes, 15, 209, 213 Mononuclear, 201, 213 Morals, 105, 213 Morphology, 114, 116, 213 Motility, 11, 213, 229 Mucins, 36, 213, 227 Mucocutaneous, 213, 233 Mucopurulent, 12, 214 Mucosa, 36, 45, 47, 128, 129, 210, 214 Mucositis, 214, 234 Mucus, 183, 213, 214 Mutagenesis, 14, 214 Mutagens, 214 Myalgia, 206, 214 Myeloproliferative Disorders, 128, 214 Myocarditis, 193, 214 Myocardium, 212, 214 N Nalidixic Acid, 116, 214 Nasal Mucosa, 206, 214 Nasopharynx, 214 Natural Childbirth, 124, 214 NCI, 1, 147, 187, 214 Necrosis, 206, 212, 214, 218, 223 Needle Sharing, 122, 214 Neonatal, 23, 201, 214 Neoplasia, 5, 35, 214, 215 Neoplasm, 214, 215, 217, 228 Neoplastic, 179, 211, 215 Nerve, 181, 192, 211, 215, 217, 221, 231, 234, 237
Nervous System, 179, 181, 186, 211, 215, 232, 233 Networks, 27, 29, 32, 33, 38, 51, 53, 56, 59, 76, 80, 82, 215 Neural, 198, 204, 215 Neurologic, 215, 233 Neurons, 188, 192, 215, 233 Neutropenia, 128, 215 Neutrophil, 14, 25, 57, 92, 113, 215 Nitric Oxide, 22, 215 Nitrogen, 100, 178, 199, 215 Nonoxynol, 4, 6, 70, 114, 215 Nosocomial, 10, 215 Nuclear, 189, 195, 197, 199, 214, 215, 225 Nuclei, 190, 195, 200, 215, 223 Nucleic acid, 50, 62, 129, 200, 214, 215, 216 Nucleic Acid Amplification Techniques, 129, 215 Nucleus, 104, 181, 182, 191, 192, 196, 197, 199, 213, 216, 223 O Observational study, 17, 216 Ocular, 101, 108, 216, 233 Odds Ratio, 216, 226 Office Visits, 112, 216 Ofloxacin, 77, 81, 142, 216 Oligonucleotide Probes, 209, 216 Oligosaccharides, 37, 216 Oncogenic, 46, 207, 216 Oncology, 216, 226 Oophoritis, 201, 216 Opacity, 25, 64, 192, 216 Ophthalmology, 199, 216 Oral Health, 47, 216 Oral Manifestations, 5, 129, 216 Organ Culture, 60, 216, 234 Organelles, 11, 186, 191, 213, 216, 220 Ornithosis, 217, 223 Oropharynx, 5, 116, 214, 217 Osmosis, 217 Osmotic, 114, 178, 217, 229 Otitis, 9, 217 Otitis Media, 9, 217 Outpatient, 54, 62, 217 Ovaries, 198, 217, 229 Ovary, 197, 216, 217 Overdose, 51, 217 Overexpress, 24, 217 Ovum, 200, 209, 217, 222, 238 P Pachymeningitis, 212, 217 Palliative, 217, 234
Index 247
Pancreas, 183, 217, 236 Pancreatic, 217, 223 Papilloma, 5, 122, 189, 217 Papillomavirus, 7, 217 Paranasal Sinuses, 211, 217 Paranoia, 51, 217 Parasite, 218, 236 Parasitic, 103, 104, 122, 123, 191, 209, 218, 235 Parasitic Diseases, 103, 104, 218 Paroxysmal, 218, 219, 238 Particle, 46, 210, 218, 235 Pathogen, 9, 11, 12, 22, 25, 26, 36, 43, 48, 55, 110, 206, 207, 218 Pathogenesis, 3, 10, 20, 22, 24, 25, 26, 37, 40, 43, 52, 57, 128, 218 Pathologic, 128, 183, 184, 190, 204, 218, 232 Patient Education, 157, 166, 168, 174, 218 Pelvic inflammatory disease, 6, 7, 16, 21, 22, 48, 49, 52, 57, 60, 69, 121, 158, 159, 160, 161, 218 Penicillin, 44, 47, 55, 101, 102, 218 Penicillin Resistance, 48, 218 Penicillinase, 63, 68, 218 Penis, 109, 114, 157, 158, 159, 160, 161, 174, 189, 195, 218, 219 Peptide, 102, 187, 196, 218, 223 Perception, 42, 189, 218 Perianal, 189, 218 Perinatal, 12, 23, 92, 122, 160, 218 Periodontal Abscess, 129, 218 Periodontal disease, 47, 127, 129, 218 Periodontitis, 127, 129, 218 Peripheral blood, 26, 46, 207, 219 Peripheral Nerves, 208, 219 Peritonitis, 201, 219 Peroxidase, 107, 219 Peroxide, 17, 219 Pertussis, 60, 129, 219, 238 Phagocytosis, 14, 219 Phallic, 199, 219 Pharmaceutical Preparations, 186, 197, 199, 219 Pharmacokinetic, 219 Pharmacologic, 23, 202, 219, 235 Pharmacotherapy, 17, 90, 219 Pharyngitis, 219, 228 Pharynx, 68, 206, 214, 217, 219 Phenotype, 23, 25, 60, 182, 189, 219 Phospholipases, 219, 229 Phospholipids, 24, 104, 198, 209, 220 Phosphorus, 184, 220
Physical Examination, 61, 129, 220 Physiologic, 183, 202, 220, 222, 226 Physiology, 182, 183, 220 Pilot study, 41, 68, 220 Placebos, 23, 220 Placenta, 197, 220, 222 Plague, 127, 220, 236 Plants, 91, 107, 178, 183, 185, 188, 192, 200, 208, 213, 220, 228, 231, 235 Plaque, 187, 220 Plasma, 21, 178, 180, 186, 199, 200, 203, 220, 228, 229, 237 Plasma cells, 180, 220 Plasma protein, 178, 220, 229 Plasmid, 60, 220, 237 Plastids, 216, 220 Platelet Activation, 221, 229 Platelet Aggregation, 179, 215, 221 Platelets, 215, 221, 229 Pledget, 108, 221 Polymorphism, 38, 221 Polysaccharide, 178, 180, 186, 221, 223 Posterior, 179, 182, 194, 217, 221 Postsynaptic, 221, 229 Post-translational, 10, 221 Potassium, 90, 221 Potentiation, 221, 229 Practice Guidelines, 152, 161, 221 Precipitating Factors, 185, 221 Pregnancy Outcome, 12, 19, 23, 221 Prenatal, 23, 114, 195, 221 Presumptive, 108, 221 Primary endpoint, 23, 31, 222 Probe, 62, 209, 216, 222 Progeny, 189, 222 Progesterone, 19, 222, 231 Prognostic factor, 222, 232 Progressive, 186, 194, 197, 202, 214, 221, 222 Projection, 192, 222 Promoter, 25, 72, 222 Prophylaxis, 222, 227, 237 Prospective study, 19, 60, 90, 210, 222 Prostaglandin, 14, 222 Prostaglandins A, 222 Prostate, 36, 46, 94, 159, 183, 223, 236 Prostitution, 124, 223 Protease, 55, 101, 105, 223 Protein Binding, 11, 223 Protein C, 11, 55, 108, 178, 179, 182, 209, 223
248 Gonorrhea
Protein S, 11, 126, 136, 183, 197, 200, 223, 232, 233 Proteoglycan, 64, 223 Proteolytic, 188, 196, 223 Protocol, 29, 33, 34, 35, 40, 220, 223 Protons, 204, 208, 223, 224 Protozoa, 189, 212, 223, 230 Proximal, 37, 109, 194, 223 Pruritic, 223, 228 Pruritus, 5, 62, 172, 223 Pseudocysts, 129, 223 Pseudorabies, 117, 223 Psittaci, 100, 217, 223 Psychiatric, 7, 30, 51, 53, 54, 182, 212, 224 Psychiatry, 18, 20, 29, 32, 33, 92, 198, 224 Psychopathology, 17, 224 Psychosis, 51, 224 Psychotomimetic, 179, 193, 224 Puberty, 124, 224 Public Policy, 149, 224 Public Sector, 90, 224 Publishing, 4, 5, 63, 129, 224 Pulse, 213, 224 Purulent, 109, 201, 214, 218, 224, 237 Pustular, 206, 224 Pyoderma, 129, 224 Q Quaternary, 106, 224 Quinolones, 55, 224 R Race, 9, 27, 52, 81, 123, 213, 224 Radiation, 196, 199, 204, 208, 212, 224, 225, 238 Radiation therapy, 204, 225 Radioactive, 112, 202, 204, 206, 208, 213, 215, 216, 225 Radioactivity, 103, 112, 225 Radioimmunoassay, 101, 103, 107, 225 Radioimmunotherapy, 225 Radiotherapy, 5, 225 Random Allocation, 225 Randomization, 32, 225 Randomized, 13, 17, 20, 23, 29, 31, 33, 34, 35, 39, 48, 49, 50, 51, 54, 65, 70, 77, 81, 195, 225 Randomized clinical trial, 54, 225 Rape, 122, 225 Reagent, 114, 225 Reality Testing, 224, 226 Receptor, 14, 21, 22, 40, 54, 64, 103, 104, 115, 177, 180, 189, 194, 225, 226, 229 Recombination, 26, 43, 44, 189, 226
Rectal, 39, 94, 173, 226 Rectum, 6, 116, 181, 184, 193, 199, 208, 223, 226, 232 Recurrence, 130, 211, 226 Red blood cells, 107, 197, 203, 226, 228 Reductase, 22, 226 Refer, 1, 184, 188, 198, 199, 203, 210, 215, 224, 225, 226 Refraction, 226, 230 Refractory, 226, 235 Regimen, 49, 55, 159, 195, 219, 226 Regional lymph node, 5, 185, 226 Regression Analysis, 16, 226 Regulon, 24, 226 Relapse, 50, 59, 226 Relative risk, 46, 226 Relaxation Techniques, 214, 226 Reliability, 108, 226 Remission, 211, 226, 227 Reproduction Techniques, 221, 227 Research Design, 28, 227 Respiration, 185, 213, 227 Respiratory Mucosa, 200, 227 Response rate, 27, 227 Restoration, 116, 227, 238 Resuscitation, 195, 227 Retrospective, 12, 16, 227 Rhinitis, 184, 227, 229 Rigidity, 44, 220, 227 Risk-Taking, 28, 59, 151, 227 Rod, 181, 182, 202, 208, 227 Rubber, 114, 177, 227 Rubella, 103, 115, 227 Rubella Virus, 115, 227 S Safe Sex, 4, 122, 227 Saline, 23, 108, 111, 112, 227 Saliva, 115, 227 Salivary, 127, 191, 227, 236 Salivary glands, 127, 191, 227, 236 Salmonellosis, 103, 104, 228 Salpingitis, 12, 111, 201, 228 Saponins, 228, 231 Sarcoma, 17, 228 Scabies, 6, 120, 228 Scarlet Fever, 127, 129, 228 Schizophrenia, 217, 228 Secretion, 60, 204, 213, 214, 228, 237 Secretory, 55, 178, 228 Segregation, 226, 228 Semen, 47, 92, 195, 223, 228 Seminal vesicles, 36, 228
Index 249
Septicaemia, 228, 229 Sequence Analysis, 41, 228 Sequencing, 44, 60, 228 Serine, 228, 236 Seroconversion, 28, 29, 47, 228 Serologic, 9, 28, 46, 57, 116, 205, 228 Serologic Tests, 116, 228 Serology, 46, 228 Serotonin, 219, 228 Serotypes, 10, 107, 229 Serum, 10, 23, 37, 42, 45, 46, 112, 114, 178, 179, 180, 188, 205, 219, 225, 228, 229 Serum Albumin, 114, 225, 229 Sex Behavior, 174, 229 Sex Characteristics, 177, 224, 229, 233 Sex Education, 151, 229 Sexual Abstinence, 121, 123, 159, 161, 229 Sexual Partners, 6, 9, 21, 27, 32, 46, 52, 56, 57, 82, 120, 132, 229 Shame, 78, 229 Shock, 229, 235 Side effect, 110, 141, 159, 178, 229, 234 Signal Transduction, 14, 229 Signs and Symptoms, 47, 113, 160, 226, 227, 229 Skeleton, 208, 222, 229, 230 Skull, 230, 233 Small intestine, 194, 200, 204, 207, 230, 236 Sneezing, 219, 230 Social Behavior, 18, 230 Social Environment, 58, 230 Solvent, 197, 200, 217, 230 Soma, 230 Somatic, 14, 177, 204, 218, 230 Spasmodic, 219, 230 Specialist, 163, 230 Specificity, 27, 178, 230 Spectrum, 55, 79, 90, 102, 230 Sperm, 42, 142, 187, 230 Spermatozoa, 228, 230 Spermicide, 6, 106, 114, 230 Spinal cord, 159, 186, 187, 195, 212, 215, 217, 219, 230 Spirochete, 104, 230, 233 Spleen, 191, 210, 230 Spontaneous Abortion, 161, 221, 230 Spores, 207, 230 Sporotrichosis, 128, 231 Sputum, 129, 231 Squamous, 5, 128, 197, 231 Squamous cell carcinoma, 5, 128, 197, 231 Squamous cells, 231
Staging, 5, 231 Standardize, 42, 231 Staphylococcal Infections, 129, 231 Staphylococcus, 127, 185, 206, 231 Staphylococcus aureus, 127, 185, 206, 231 Steady state, 22, 231 Sterile, 108, 112, 181, 231 Sterility, 22, 158, 159, 160, 206, 231 Steroid, 115, 228, 231 Stillbirth, 23, 221, 231 Stimulant, 50, 179, 193, 212, 231 Stimulus, 194, 231, 234 Stomach, 129, 193, 197, 199, 204, 208, 219, 230, 231 Stool, 129, 208, 232 Streptococci, 105, 107, 206, 228, 232 Streptococcus, 107, 197, 232 Streptomycin, 116, 232 Stress, 4, 42, 181, 185, 227, 232 Stricture, 3, 232 Styrene, 227, 232 Subacute, 206, 210, 232 Subclinical, 49, 206, 232 Subcutaneous, 128, 185, 199, 231, 232 Subspecies, 230, 232, 238 Substance P, 197, 212, 228, 232 Substrate, 44, 103, 105, 115, 232 Suppositories, 104, 199, 212, 232 Suppression, 22, 28, 232 Suppuration, 102, 232 Suppurative, 127, 199, 201, 232 Surfactant, 215, 232, 238 Survival Analysis, 90, 232 Survival Rate, 5, 233 Sympathomimetic, 179, 193, 194, 212, 233 Symphysis, 223, 233 Symptomatic, 4, 17, 40, 57, 61, 62, 174, 233 Synaptic, 229, 233 Synovial, 114, 233 Synovial Fluid, 114, 233 Synovial Membrane, 233 Syphilis, Congenital, 129, 233 Systemic, 14, 42, 45, 52, 128, 132, 142, 143, 183, 184, 193, 205, 206, 217, 225, 233, 235, 238 Systemic disease, 52, 132, 233 T Tachycardia, 181, 233 Tachypnea, 181, 233 Teichoic Acids, 201, 233 Temporal, 9, 44, 211, 233 Testis, 197, 233
250 Gonorrhea
Testosterone, 226, 233 Tetracycline, 44, 47, 233 Tetracycline Resistance, 48, 233 Therapeutics, 143, 234 Thigh, 202, 234 Thorax, 177, 234 Threshold, 127, 234 Thrombin, 221, 223, 234 Thrombomodulin, 223, 234 Thrombosis, 207, 223, 234 Thymidine, 104, 234 Thymus, 205, 210, 234 Tinnitus, 217, 234 Tissue, 11, 36, 39, 113, 180, 182, 183, 185, 187, 190, 194, 195, 196, 198, 199, 201, 202, 203, 204, 205, 208, 209, 210, 211, 212, 214, 215, 218, 219, 221, 223, 227, 229, 230, 231, 232, 234, 235, 238 Tissue Culture, 11, 234 Tolerance, 177, 200, 234 Tonicity, 203, 234 Tonsillitis, 228, 234 Tooth Preparation, 177, 234 Topical, 11, 187, 197, 204, 234 Toxic, iv, 45, 116, 190, 193, 196, 205, 232, 234, 235 Toxicity, 38, 194, 234 Toxicokinetics, 234 Toxicology, 17, 150, 235 Toxins, 115, 180, 196, 206, 213, 225, 235 Toxoplasmosis, 181, 235 Trachea, 219, 235 Trachoma, 100, 101, 108, 235 Transduction, 229, 235 Transfection, 183, 235 Transfer Factor, 205, 235 Transferases, 201, 235 Transfusion, 235 Translation, 197, 235 Translational, 235 Translocation, 197, 235 Transplantation, 195, 205, 235 Trauma, 4, 202, 214, 234, 235 Treatment Failure, 13, 47, 71, 235 Trees, 179, 227, 235 Triage, 61, 235 Trichomonas, 7, 13, 16, 19, 20, 26, 31, 40, 59, 61, 106, 109, 130, 235, 236 Trichomonas vaginalis, 13, 26, 61, 106, 109, 130, 235, 236 Trichomoniasis, 6, 7, 13, 27, 30, 33, 34, 35, 39, 50, 58, 62, 80, 113, 121, 212, 236
Trypsin, 112, 196, 236, 238 Tuberculosis, 103, 104, 127, 128, 129, 190, 210, 236 Tuberculosis, Oral, 127, 236 Tularemia, 127, 129, 236 Tumor marker, 183, 236 U Ulcer, 236 Ulceration, 127, 128, 200, 236 Unconscious, 192, 205, 236 Ureters, 236 Urethra, 3, 7, 36, 109, 129, 157, 218, 223, 236 Urinary, 3, 7, 61, 102, 114, 172, 173, 186, 187, 200, 214, 236 Urinary tract, 3, 61, 102, 114, 186, 214, 236 Urinary tract infection, 3, 214, 236 Urinary urgency, 7, 236 Urine Testing, 151, 236 Urogenital, 14, 22, 36, 70, 105, 111, 200, 201, 236 Urology, 78, 129, 236 Uterus, 109, 110, 186, 190, 195, 196, 198, 217, 222, 236, 237 V Vaccination, 22, 122, 236 Vaccine, 10, 11, 14, 21, 40, 41, 45, 46, 56, 102, 111, 112, 137, 223, 227, 237 Vacuoles, 196, 216, 237 Vagina, 11, 23, 57, 109, 158, 159, 174, 184, 186, 188, 208, 237, 238 Vaginal Discharge, 62, 159, 161, 236, 237 Vaginitis, 13, 49, 62, 76, 120, 121, 122, 123, 124, 137, 158, 184, 237 Vaginosis, 6, 16, 23, 42, 46, 49, 55, 57, 62, 79, 121, 237 Vascular, 196, 205, 206, 215, 220, 237 Vasodilators, 215, 237 Vector, 218, 235, 237 Vein, 207, 215, 237 Venereal, 90, 92, 104, 106, 109, 110, 115, 122, 127, 133, 214, 233, 237, 238 Venous, 203, 223, 237 Venules, 183, 184, 237 Verruca, 126, 237 Vertebrae, 230, 237 Vertigo, 217, 237 Veterinary Medicine, 149, 237 Vibrio, 10, 187, 237 Vibrio cholerae, 10, 187, 237 Viral, 4, 15, 28, 33, 38, 47, 53, 103, 128, 156, 206, 216, 235, 237, 238
Index 251
Viral Hepatitis, 4, 237 Viral Load, 28, 237 Virulence, 10, 22, 24, 54, 60, 181, 234, 237 Virulent, 126, 237 Viscera, 230, 238 Vitro, 39, 215, 238 Vivo, 22, 25, 238 Volition, 208, 238 Vulva, 5, 159, 238 W Walkers, 59, 238 War, 30, 120, 238 Warts, 4, 97, 120, 122, 124, 125, 158, 204, 238 Wetting Agents, 215, 238
White blood cell, 180, 206, 209, 210, 211, 214, 215, 220, 238 Whooping Cough, 219, 238 Windpipe, 219, 238 Womb, 236, 238 Wound Healing, 207, 238 X X-ray, 10, 185, 199, 215, 225, 238 Y Yaws, 129, 238 Yeasts, 107, 184, 199, 219, 238 Z Zygote, 189, 190, 238 Zymogen, 223, 238
252 Gonorrhea
