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Biomedical subjects

G Gill

Publications and source records attributed to G Gill.

At least 55 records · Page 3Linked to original sources
PubMed1999

Intraarterial catheter-directed thrombolysis: urokinase versus tissue plasminogen activator.

The purpose of this study was to evaluate the differences between tissue plasminogen activator (TPA) and urokinase (UK) in the management of ischemic limbs. A total of 58 limbs (24 in the TPA group and 34 in the UK group) in 53 patients were studied prospectively. The two groups were based on the surgeon's preference for lytic agent. The dose regimen for UK was 150,000 IU/hr over 1/2 to 2 hr followed by a continuous infusion of 50,000 IU/hr. TPA was given as a 5-mg bolus followed by 1 mg/hr. Both groups received heparin at a rate of 400 IU/hr through the side arm of the arterial sheath. There was no significant difference in efficacy between UK and TPA, but TPA acted faster and had a higher incidence of bleeding complications.

Aged↗
PubMed1999

Brittle diabetes characterised by recurrent hypoglycaemia.

There is little information on the clinical characteristics of "brittle" Type 1 (insulin-dependent) diabetic patients with predominantly hypoglycaemic instability. From a total cohort of 381 brittle diabetic patients from various parts of the United Kingdom, 64 (17%) had life-disrupting instability due to recurrent hospital admissions with hypoglycaemia. Compared to brittle patients with recurrent ketoacidosis (DKA), who comprised 59% of the total, those with recurrent hypoglycaemia were characterised by older mean age (34 +/- 20 v 22 +/- 11 y, p < 0.001), and more equal sex distribution (53% v 71% female, p < 0.05). Patients with "mixed brittleness" (24% of total) were intermediate between the other groups, in terms of both age and female predominance. Physicians in charge of patients with hypoglycaemic brittle diabetes considered psychosocial factors to be frequent underlying causes, though organic conditions such as lost hypoglycaemic warnings and alcohol abuse were also mentioned. Factitious insulin overdose was diagnosed in 3 patients. We conclude that hypoglycaemic brittle diabetes is a small but important sub-group of the overall brittle syndrome. It differs in age and sex distribution from the more common syndrome of recurrent DKA.

Adolescent↗
PubMed1999

Characteristics of insulin requiring diabetes in rural northern Ethiopia--a possible link with malnutrition?

We have examined 100 consecutive insulin-treated diabetic patients from the Diabetic Clinic at Mekelle Hospital in Tigray, Northern Ethiopia; an area of low socio-economic status recently affected by severe famine. The study was conducted over a six month period (1997). Mean age of onset of diabetes was 27 +/- 10 y (SD) and there was a male excess (3.1:1.0). Body Mass index (BMI) at diagnosis was very low at 15.8 +/- 2.8. Because of erratic insulin supply 48 (48%) had interrupted insulin treatment in the past for a mean duration of 9 +/- 12 weeks (range 1-78). Despite this, only 2 (4%) developed ketoacidosis (DKA). The patients thus have features suggestive of malnutrition-related diabetes mellitus (MRDM) possibly of the "malnutrition-modulated" (MMDM) type in view of the apparent absence of overt exocrine pancreatic disease. The famine in this area 10 years previously may be of relevance to the aetiology of diabetes in these patients.

Adult↗
PubMed1998

Impact of age and cranial irradiation on radiographic skeletal pathology in children with acute lymphoblastic leukemia.

BACKGROUND: Symptomatic osteopenia is a common form of morbidity in children with acute lymphoblastic leukemia (ALL) before, during, and after treatment. A causal role for corticosteroids has been proposed, but other investigators have suggested that cranial irradiation is an important factor contributing to this disorder. PROCEDURE: In this study of children with ALL, all of whom received steroids, skeletal morbidity was assessed radiographically by an observer who was blinded to the ages of the children, their risk categorization (and related treatment), and the timing of the assessments with respect to the administration of therapy. DISCUSSION: Skeletal morbidity was most prevalent in older subjects who had been given cranial radiotherapy. However, there was no difference in the frequency of fractures in two groups of younger children (< or = 9 years of age), one irradiated and the other not. CONCLUSIONS: It is likely that corticosteroid therapy plays an important part in the pathogenesis of this disorder. The role played by cranial irradiation is much less certain.

Age Factors↗
PubMed1998

A cellular repressor of E1A-stimulated genes that inhibits activation by E2F.

The adenovirus E1A protein both activates and represses gene expression to promote cellular proliferation and inhibit differentiation. Here we report the identification and characterization of a cellular protein that antagonizes transcriptional activation and cellular transformation by E1A. This protein, termed CREG for cellular repressor of E1A-stimulated genes, shares limited sequence similarity with E1A and binds both the general transcription factor TBP and the tumor suppressor pRb in vitro. In transfection assays, CREG represses transcription and antagonizes 12SE1A-mediated activation of both the adenovirus E2 and cellular hsp70 promoters. CREG also antagonizes E1A-mediated transformation, as expression of CREG reduces the efficiency with which E1A and the oncogene ras cooperate to transform primary cells. Binding sites for E2F, a key transcriptional regulator of cell cycle progression, were found to be required for repression of the adenovirus E2 promoter by CREG, and CREG was shown to inhibit activation by E2F. Since both the adenovirus E1A protein and transcriptional activation by E2F function to promote cellular proliferation, the results presented here suggest that CREG activity may contribute to the transcriptional control of cell growth and differentiation.

Adenoviridae↗
PubMed1998

Hyponatraemia: biochemical and clinical perspectives.

Hyponatraemia is a common bio-chemical abnormality, occurring in about 15% of hospital inpatients. It is often associated with severe illness and relatively poor outcome. Pathophysiologically, hyponatraemia may be spurious, dilutional, depletional or redistributional. Particularly difficult causes and concepts of hyponatraemia are the syndrome of inappropriate antidiuresis and the sick cell syndrome, which are discussed here in detail. Therapy should always be targeted at the underlying disease process. 'Hyponatraemic symptoms' are of doubtful importance, and may be more related to water overload and/or the causative disease, than to hyponatraemia per se. Artificial elevation of plasma sodium by saline infusion carries the risk of induction of osmotic demyelination (central pontine myelinolysis).

Adolescent↗
PubMed1998

Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa.

Noncommunicable diseases (NCDs) such as hypertension, asthma, diabetes and epilepsy are placing an increasing burden on clinical services in developing countries and innovative strategies are therefore needed to optimize existing services. This article describes the design and implementation of a nurse-led NCD service based on clinical protocols in a resource-poor area of South Africa. Diagnostic and treatment protocols were designed and introduced at all primary care clinics in the district, using only essential drugs and appropriate technology; the convenience of management for the patient was highlighted. The protocols enabled the nurses to control the clinical condition of 68% of patients with hypertension, 82% of those with non-insulin-dependent diabetes, and 84% of those with asthma. The management of NCDs of 79% of patients who came from areas served by village or mobile clinics was transferred from the district hospital to such clinics. Patient-reported adherence to treatment increased from 79% to 87% (P = 0.03) over the 2 years that the service was operating. The use of simple protocols and treatment strategies that were responsive to the local situation enabled the majority of patients to receive convenient and appropriate management of their NCD at their local primary care facility.

Adolescent↗
PubMed1998

Evaluating your practice.

In this series you have learnt about research as it applies to researchers in general practice. You have seen how a research question is defined, examined how to search the medical literature to discover what is known about the topic, seen the use of qualitative and quantitative approaches to data collection and had explained to you some of the problems of data collection and analysis. As an active GP you may have found the topics interesting, but who has time for research? This final article in the series is titled 'Evaluating your own practice'. Every day you carry out this activity. Simple items like how long do your patients wait, or is there enough money earned to cover expenses? These are things you have been evaluating for a long time. You are an expert at evaluating many aspects of your practice. What I want to try and do in this brief article is to show you how knowledge of research approaches can help you by making it easier to carry out an evaluation and arrive at more accurate conclusions.

Australia↗
PubMed1997

Nickel-dependent oxidative cross-linking of a protein.

A model protein, ribonuclease A (bovine pancreas), was examined for its ability to coordinate Ni2+ and promote selective oxidation. In the presence of a peracid such as monopersulfate, HSO5-, nickel induced the monomeric RNase A to form dimers, trimers, tetramers, and higher oligomers without producing fragmentation of the polypeptide backbone. Co2+ and to a lesser extent Cu2+ exhibited similar activity. The nickel-dependent reaction appeared to result from a specific association between the protein and Ni2+ that allowed for transient and in situ oxidation of the bound nickel to yield intermolecular tyrosine-tyrosine cross-links. Macrocylic nickel complexes that had previously been shown to promote guanine oxidation were unable to mimic the activity of the free metal salt. Amino acid analysis of the protein dimer confirmed the expected consumption of one tyrosine per polypeptide and formation of dityrosine. The presence of excess tyrosine efficiently inhibited formation of the protein dimer and produced instead a ribonuclease-tyrosine cross-link. In contrast, high concentrations of the hydroxyl radical quenching agent mannitol only partially inhibited ribonuclease dimerization. The polypeptide-mediated activation of nickel and its subsequent reactivity mimic a process that could contribute to the adverse effects of nickel in vivo.

Amino Acids↗
PubMed1997

Painless stress fractures in diabetic neuropathic feet.

We describe two patients with diabetes mellitus and associated neuropathy, who presented with painless foot swelling and no history of trauma. X-Rays revealed recent underlying fractures-in one of a metatarsus, and the other of a proximal phalanx. These were assumed to be 'stress' fractures unassociated with pain because of the severe sensory neuropathy. Though spontaneous fractures in neuropathic feet have been previously described, they almost always occur in association with Charcot joints, and are usually painful. The differential diagnosis of acute swelling in the foot of a diabetic patient with sensory neuropathy should include stress fracture.

Adult↗