Papers by Wilson Carswell
Anaesthesia, 1980
I write from the Milago Hospital, Kampala, Uganda, where I am employed as a general surgeon.
The Lancet, Jun 1, 1993
The World Health Organization (WHO) Global Programme on AIDS (GPA) was initiated February 1987 an... more The World Health Organization (WHO) Global Programme on AIDS (GPA) was initiated February 1987 and became the major recipient of Western support for AIDS prevention. While the WHO/GPA has successfully provided policies and technical assistance available funds were not spent quickly enough or on the right things. Other mechanisms for channeling funds to recipients are needed. Many early programs designed to secure safe blood supplies received the largest proportion of resources even though HIV infection via transfusion was the least common route of spread. Despite models demonstrating that treating sexually transmitted diseases (STD) costs $4-7.50/HIV case prevented in adult populations with 10% HIV prevalences STD treatment is supported less than programs which urge individuals to have fewer sex partners and those which distribute condoms. Even so no global plan exists to supply life-saving commodities such as condoms in countries most in need. Poor management further cripples programs potential scope and effectiveness. This commentary holds that AIDS interventions could be organized under the following separate and distinct groupings: urban STD control; prostitute and client services; condom marketing to entrepreneurs in developing countries; and blood supply security. The supply of commodities must be assured; system administration simplified; small projects supported; and program funds transferred directly to nongovernmental organizations and the private sector. Further those on national AIDS committees who oppose programs for the marginalized or who believe condoms cause promiscuity should not be allowed to delay or veto projects; the overlap between family planning and HIV prevention programs needs to be rationalized; manager must be responsible for programs; and institutions must act quickly and be judged on that basis.
Tropical Doctor, 1977
CHRONIC OSTEOMYELITIS Bone infection may present in the tropics as a tender swollen limb. Soft ti... more CHRONIC OSTEOMYELITIS Bone infection may present in the tropics as a tender swollen limb. Soft tissue infections, such as tropical myositis, trichiniasis and Guinea worm infestation, and venous thrombosis and bone tumours must, if possible, be excluded before considering the inflammatory diseasesof bone. These include acute pyogenic osteomyelitis and its chronic form, the responsible organism usually being the staphylococcus aureus. In neonatal umbilical cord infections, however, streptococci or Gram-negative bacteria may be involved. Other diseases causing similar symptoms include Brodie's abscess, brucellosis, the periostitis of yaws, and infection by salmonellae which for some little understood reason is common in patients with sickle-cell anaemia. The alternative presentation is as a discharging sinus or ulcer with infected bone at the base. These patients have often been exposed to accidental trauma or suffered sepsis after some operative procedure. However, some pyogenic infections, tuberculosis, brucellosis, and fungal infections form abscesses, sinuses, and subsequently ulcerate.
Retrovirology
We present 109 near full-length HIV genomes amplified from blood serum samples obtained during ea... more We present 109 near full-length HIV genomes amplified from blood serum samples obtained during early 1986 from across Uganda, which to our knowledge is the earliest and largest population sample from the initial phase of the HIV epidemic in Africa. Consensus sequences were made from paired-end Illumina reads with a target-capture approach to amplify HIV material following poor success with standard approaches. In comparisons with a smaller ‘intermediate’ genome dataset from 1998 to 1999 and a ‘modern’ genome dataset from 2007 to 2016, the proportion of subtype D was significantly higher initially, dropping from 67% (73/109), to 57% (26/46) to 17% (82/465) respectively (p < 0.0001). Subtype D has previously been shown to have a faster rate of disease progression than other subtypes in East African population studies, and to have a higher propensity to use the CXCR4 co-receptor (“X4 tropism”); associated with a decrease in time to AIDS. Here we find significant differences in predi...
Journal of Hygiene, 1975
SUMMARYGroups of patients with lepromatous and tuberculoid leprosy and hospital staff from six le... more SUMMARYGroups of patients with lepromatous and tuberculoid leprosy and hospital staff from six leprosaria in East Africa and ‘non-contact’ groups of villagers or staff from general hospitals have been skin tested with 10 reagents. These were prepared by ultrasonic disintegration fromM. tuberculosis, M. duvalii, M. cheloneiand 7 other species identified in the Ugandan environment. Comparisons were made of the percentages of positive reactors in each study group for each reagent. The ‘specific’ defect of lepromatous patients was found to apply to a variable extent to six of the species tested, but not toM. tuberculosis, M. aviumorM. ‘A*’. The defect applied most noticeably toM. nonchromogenicumandM. vaccae, suggesting that they are more closely related toM. lepraethan are the other species tested. The reagent Chelonin produced unexpected and anomalous results in the lepromatous group. It is suggested that this was due to an unusually slow clearing of Arthus' reaction.
Journal of Hygiene, 1977
SUMMARYFour hundred and seventy tuberculosis patients were each skin tested with four of a range ... more SUMMARYFour hundred and seventy tuberculosis patients were each skin tested with four of a range of 17 mycobacterial reagents in four countries in all of which tuberculosis and leprosy were endemic. Sixteen of the reagents were new tuberculins prepared from extracts of living mycobacteria disrupted by ultrasonic disintegration and the last was PPD, RT23.The effect that tuberculosis exerted on the delayed-type skin test response to these antigens was assessed by comparing results for tuberculosis patients with those for Tuberculin positive and Tuberculin negative control populations. Tuberculosis patients on Rifampicin therapy showed no difference in their skin test responses to any of the antigens from those patients on other forms of anti-tuberculosis treatment.Amongst the normal population it was found that possession of Tuberculin positivity was associated with an enhanced response to all the other mycobacterial antigens with the exception of A*-in which demonstrated a reciprocal...
Journal of Hygiene, 1976
SUMMARYA range of new Tubercul ns prepared from extracts of living organisms belonging to 12 myco... more SUMMARYA range of new Tubercul ns prepared from extracts of living organisms belonging to 12 mycobacterial species has been used to assess the effect of BCG immunization and contact with environmental mycobacteria on Ugandan adults. A total of 2,456 tests were carried out on 562 people, 86% of whom came from three areas selected for special study. These areas were chosen on the basis of occurrence of leprosy andM. ulceransinfection and on data concerning the distribution of environmental mycobacteria. It was found that the effect of BCG was small compared with that previously observed amongst Kenyan schoolchildren, but that the effect of geographical origin was considerable. There was some correlation between the percentages of reactivity to the reagents and the frequency of mycobacteria in the environment.
British Journal of Cancer, 1986
Four Ugandan patients (1 women, 3 men) with generalized Kaposi's sarcoma (KS) were seen in the Ug... more Four Ugandan patients (1 women, 3 men) with generalized Kaposi's sarcoma (KS) were seen in the Uganda Cancer Institute between October 1983 and December 1984. They presented with generalized lymphadenopathy, plaques/nodules on the body, general swelling of the head, oral and visceral involvement and respiratory distress. Initial responses to adriamycin as a single agent or a combination chemotherapy of actinomycin D, vincristine, adriamycin and imidazole carboxamide appeared to be favourable but no sustained response was obtained. Serological tests for human T-lymphotropic virus (HTLV-II) antibodies were positive in all 4 cases.
Tropical doctor, 1990
Conflicting recommendations have been offered about whether HIV+ mothers should breastfeed. Since... more Conflicting recommendations have been offered about whether HIV+ mothers should breastfeed. Since there is a strong precedent for US infant feeding practices to be imitated in developing countries, a model was constructed to estimate infant mortality if the CDC admonition for HIV+ mothers not to breastfeed were upheld in less developed settings. Estimates are given for infant mortality in the presence and absence of breastfeeding across several baseline levels of infant mortality and across several theoretical rates of transmission through breastfeeding. The infant mortality associated with HIV infection acquired through breastfeeding is estimated to be lower than the mortality associated with the diseases of infancy that would result if breastmilk were withheld. The difference in these estimates is greater in areas with high baseline levels of infant mortality.
Injury, 1974
Summary Eighteen cases of damage to the jejunum and ileum by blunt injury of the abdomen are desc... more Summary Eighteen cases of damage to the jejunum and ileum by blunt injury of the abdomen are described. None was caused by road accidents and there were seven deaths.
Health Education Research, 1992
A review of projects run by non-governmental organizations (NGOs) in primarily developing countri... more A review of projects run by non-governmental organizations (NGOs) in primarily developing countries, which have aimed to provide STD/AIDS education and prevention skills to various marginalized groups, reveals that past quantitative and formative research has failed to identify key programmatic factors which lead to more successful project implementation and sustainability. In observations, interviews with field staff, visits to program sites and information drawn from the literature, a variety of methods to reach a wide range of groups such as men who have sex with men, prostitutes, clients of prostitutes, prisoners, street children, migrant workers and refugees are explored. Factors found to facilitate project success include the following: at least one full-time committed staff member; respectful treatment and appropriate motivation of the target group; suitable and sufficient equipment and supplies (particularly condoms); planning ahead for the participation of HIV-positive individuals and ways to meet their needs; focusing on qualitative rather than quantitative evaluation; planning in advance beyond a 9 or 12 month &#39;model&#39;. Despite some evidence that marginalized groups can be successfully motivated to practise safer sex through prevention education, long-term behaviour change still presents major challenges--even when specific conditions are met.
British Journal of Surgery, 1974
Eleven cases of wandering spleen are described of which 8 were in children. Six patients presente... more Eleven cases of wandering spleen are described of which 8 were in children. Six patients presented with a chronic abdominal mass and 5 with acute torsion. In the chronic case the diagnosis may be clarified by the use of radioactive 51 Cr, and the plain abdominal X-ray is of value in chronic and acute presentations. Splenectomy is required for all acute cases but a technique for preservation of the spleen is feasible in the chronic case. The condition may arise from association of splenomegaly and maldevelopment of the dorsal mesogastrium.
AIDS, 1989
Sixty-eight lorry drivers and their assistants were examined for evidence of infection with HIV-1... more Sixty-eight lorry drivers and their assistants were examined for evidence of infection with HIV-1 because of their association and regular contact with prostitutes. Out of a total of 68 drivers, 24 (35.2%) were serologically found to be HIV-1 positive. Epidemiological evidence demonstrated a wide travel history involving seven different countries served by the port of Mombasa. History of other sexually transmitted disorders were significantly higher in HIV-seropositive individuals. The data presented here further support the hypothesis that a major route of heterosexual transmission of HIV in Africa is dissemination through a group such as lorry drivers and their assistants, whose behaviour puts them at risk of acquiring sexually transmitted diseases.
The Lancet. Infectious diseases, Jan 28, 2018
BMJ, 2018
retired surgeon Rickmansworth WD3 1HH, UK Macdonald discusses the challenges of rehabilitating so... more retired surgeon Rickmansworth WD3 1HH, UK Macdonald discusses the challenges of rehabilitating soldiers and veterans. 1 The Defence and National Rehabilitation Centre was recently opened in the United Kingdom. 2 Of the 200 beds for rehabilitation, 80 are reserved for "seriously wounded soldiers." Presently, it seems destined to fill a non-existent need.
Uploads
Papers by Wilson Carswell