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Biomedical subjects

D Coakley

Publications and source records attributed to D Coakley.

At least 109 records · Page 6Linked to original sources
PubMed1989

Effect of age on adherence of Branhamella catarrhalis to buccal epithelial cells.

The role of adherence in the pathogenicity of Branhamella catarrhalis in lower respiratory tract infection in the elderly was investigated. Differential adherence of this organism to buccal epithelial cells of elderly inpatients, outpatients, and young controls was measured. The mean number of bacteria adherent per cell was 36.9 +/- 11.2, 40.2 +/- 6.1 and 16.5 +/- 12.8 for inpatient and outpatient elderly and young controls respectively (significantly different p less than 0.01, Student's t test). This significantly higher level of adherence in the elderly subjects suggests that increased adherence may contribute to the incidence of respiratory tract infection due to B. catarrhalis seen in this group.

Adult↗
PubMed1989

Serum hypomagnesaemia in an elderly day-hospital population.

Serum magnesium concentration was measured in 223 elderly patients attending a day-hospital. Patients with medical conditions or receiving medication (other than digoxin/diuretics) which could affect magnesium levels were strictly excluded from the study. All patients were living in the community and were medically stable. Ninety-five patients were on no therapy whilst 107 were on diuretic therapy. In spite of strict exclusion criteria, 10.3% of patients on no therapy had serum magnesium levels below normal. There were 61 patients receiving a combination of frusemide and amiloride and 11.9% of these patients had below normal levels of serum magnesium. We conclude that there is a significant prevalence of unexpected hypomagnesaemia among Dublin inner city day hospital elderly patients. Significant serum hypomagnesaemia may still occur in patients on potassium/magnesium sparing diuretics.

Aged↗
PubMed1989

A double-blind evaluation of captopril in elderly hypertensives.

To establish the role of angiotensin converting enzyme inhibitors in the management of hypertension in the elderly, 16 patients were treated with captopril in a randomized double-blind placebo-controlled cross-over study. Clinic blood pressure, ambulatory blood pressure, renal function and mental performance, with emphasis on mood and psychological well-being, were assessed. Twelve patients, aged 73 (+/- 4.4) years, completed the study. The doses of captopril used were 50 mg (11 patients) and 25 mg (one patient) twice daily for 4 weeks. Mean (+/- s.e.m.) clinic sitting blood pressure during captopril therapy was significantly lower than during administration of placebo (172 +/- 4.5/83 +/- 25 versus 188 +/- 4.4/89 +/- 3.4 mmHg; P less than 0.001/P less than 0.05). Mean ambulatory blood pressure was also significantly lower on captopril treatment than during administration of placebo (166 +/- 5.3/87 +/- 1.6 versus 179 +/- 5.1/94 +/- 2.4 mmHg; P less than 0.02/P less than 0.02) and this effect was sustained over the dosing interval. Renal blood flow and mental performance were unaltered by treatment. Gastrointestinal discomfort occurred in two patients, one of whom was withdrawn and cough developed in one patient. We conclude that captopril is effective as monotherapy in lowering blood pressure in the elderly.

Aged↗
PubMed1989

Screening for dementia and delirium using an adapted Folstein Mini-Mental State Examination.

An adapted Folstein Mini-Mental State Examination was applied to 244 consecutive admissions to an acute geriatric medical unit to determine the prevalence of cognitive impairment. At a cut-off point of 23/30, 109 (44%) were rated as normal and 44 (19%) were unable to perform the test. Of the 85 (36%) who scored less than 23, 63 were suffering from dementia, nine were delirious, and 12 had normal cognitive function, a false positive rate of 14%. The most common dementia was senile dementia of the Alzheimer type. Cognitive impairment was not noted by the admitting doctor in 57% of affected cases. The need for increased awareness of cognitive impairment in the elderly is emphasized, and the more widespread use of formal mental test scores is recommended.

Cognition Disorders↗
PubMed1988

The antihypertensive efficacy of verapamil in the elderly evaluated by ambulatory blood pressure measurement.

To assess the efficacy, tolerability and pharmacokinetics of verapamil in the elderly, ten patients with blood pressure greater than 160/90 mmHg were studied in a randomized double-blind placebo-controlled cross-over trial. Nine patients aged 75 (+/- 4.9) years completed the study. After titration, doses of verapamil varying from 40 to 120 mg (40 mg in four, 80 mg in one and 120 mg in four patients) twice daily for six weeks were taken. Mean (+/- SEM) clinic lying blood pressure was reduced on verapamil from 187 +/- 6.8/100 +/- 4.1 to 167 +/- 4.6/86 +/- 3.1 mmHg, [P less than 0.001). Mean ambulatory blood pressure was reduced from 174 +/- 1.4/95 +/- 1.0 to 169 +/- 1.3/90 +/- 0.8 mmHg, (P less than 0.01). Lying heart rate was significantly reduced but glomerular filtration rate, renal blood flow and mental function, were not altered by treatment. The mean plasma half-life of verapamil was 6.9 +/- 1.1 hours. Side effects were minimal. We conclude that verapamil is an effective blood pressure lowering agent in the elderly.

Aged↗
PubMed1979

Minute eye movement during sleep.

The minute eye movements of 4 sleeping subjects were studied with a piezo-electric strain-gauge transducer. The frequency and amplitude of ocular microtremor activity diminished during sleep. Activity increased after auditory stimulation and with the appearance of a K complex in the EEG. The ocular microtremor activity also increased with the onset of rapid eye movement (REM). Low amplitude 'micronystagmoid' movements were observed at intervals throughout sleep. In contrast to the changes observed during sleep, ocular microtremor activity did not diminish during hypnosis. The transducer was far more sensitive than the conventional EOG recording system.

Acoustic Stimulation↗
PubMed1977

The ocular microtremor record and the prognosis of the unconscious patient.

Ocular microtremor was recorded in 41 healthy subjects and 70 unconscious patients. Abnormalities of frequency and pattern were found in all the unconscious patients, the degree of abnormality being related to outcome. The ocular microtremor record is a potential aid to prognosis in the unconscious patient.

Adolescent↗
PubMed1977

The ocular microtremor record as a potential procedure for establishing brain death.

The normal ocular microtremor possesses certain characteristics. Abnormal records are found in unconscious patients. Six patients with clinical manifestations of brain death showed complete absence of ocular microtremor when it was recorded shortly before death. A seventh patient who had taken an overdose of barbiturates had a virtually flat record which gradually improved as her coma lightened. The ocular microtremor record is proposed as a potential monitor of brain stem viability or death.

Adult↗
PubMedDate not supplied

Efficacy and safety of adefovir dipivoxil with antiretroviral therapy: a randomized controlled trial.

CONTEXT: Adefovir dipivoxil is a nucleotide analog that has demonstrated effective antiretroviral activity against human immunodeficiency virus (HIV) with once-daily administration. OBJECTIVE: To determine if adefovir confers antiretroviral or immunologic benefit when added to stable antiretroviral therapy. DESIGN: Multicenter, 24-week, randomized, double-blind, placebo-controlled study. Enrollment was conducted from June 3, 1996, through May 6, 1997. SETTING: Thirty-three US HIV treatment centers. PARTICIPANTS: Of 1171 patients screened, 442 patients infected with HIV receiving stable antiretroviral therapy for at least 8 weeks with plasma HIV RNA greater than 2500 copies/mL and CD4+ cell count above 0.20 x 10(9)/L were randomized. INTERVENTION: Patients were randomized to receive either a single 120-mg/d dose of adefovir dipivoxil (n = 219) or an indistinguishable placebo (n = 223). All patients received L-carnitine, 500 mg/d. Open-label adefovir was offered after 24 weeks and was continued until the end of the study. MAIN OUTCOME MEASURES: Changes in HIV RNA from baseline, based on area under the curve and CD4+ cell levels, adverse events, and effect of baseline genotypic resistance on response to adefovir. RESULTS: Patients assigned to adefovir demonstrated a 0.4-log10 decline from baseline in HIV RNA compared with no change in the placebo group (P<.001), which continued through 48 weeks. CD4+ cell counts did not change. During the initial 24 weeks, elevated hepatic enzyme levels (P<.001), gastrointestinal tract complaints (P<.001), and weight loss (P<.001) were associated with use of adefovir. Between 24 weeks and 48 weeks elevations in serum creatinine occurred in 60% of patients, usually returning to baseline after discontinuation of adefovir. Patients with lamivudine or lamivudine and zidovudine resistance mutations demonstrated anti-HIV effects with adefovir (P< or =.01 vs placebo group). CONCLUSIONS: This study suggests that once-daily adefovir therapy reduces HIV RNA and is active against isolates resistant to lamivudine or lamivudine and zidovudine. Nephrotoxicity occurred when treatment extended beyond 24 weeks but was reversible.

Adenine↗
PubMedDate not supplied

Compliance of external hip protector use amongst elderly day hospital attenders.

BACKGROUND: When worn external Hip Protectors (EHP) reduce hip fracture but poor compliance results in reduced efficacy. AIMS: We determined the compliance with EHP therapy among a group of elderly people attending a day hospital. METHODS: Forty-five patients or their care-givers were interviewed a mean (sd) 334 (150) days after they had been given EHP. RESULTS: There were 12 men and 33 women with mean age of 80 (7) years. Only ten (22%) were still wearing EHP properly. Those who were compliant were given their EHP more recently than those who were not (277 (118) days vs 403 (159), p = 0.0062) and were more likely to feel safer when wearing them (p = 00.017, chi2= 5.68). Reasons for non-compliance included exclusive outdoor wear, discomfort and inconvenience. CONCLUSIONS: Hip protector compliance was poor in this small study of elderly individuals attending a day hospital. Better patient education may improve compliance though this needs to be determined.

Activities of Daily Living↗
PubMedDate not supplied

Distinguishing between patients with depression or very mild Alzheimer's disease using the Delayed-Word-Recall test.

The present study investigated the accuracy of an extended version of the Delayed Word Recall (DWR) test in distinguishing patients with very mild Alzheimer's disease (AD) (Mini Mental State Examination score > or = 23) from community-dwelling depressed/dysthymic patients. The DWR test was administered to 26 non-depressed patients who, at the time of DWR administration or on follow-up, fulfilled NINCDS/ADRDA criteria for probable AD, and to 20 age-matched non-dementing patients with a diagnosis of major depression (n = 12) or dysthymia (n = 8) according to DSM-III-R criteria. Sensitivity and specificity were, respectively, 96 and 100% for DWR free recall, and 92 and 100% for DWR recognition. In this study both DWR free recall and recognition measures were highly sensitive and specific in distinguishing very-mild-AD patients from depressed/dysthymic patients. The investigation of more severely depressed patients is warranted.

Aged↗