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Biomedical subjects

J Cox

Publications and source records attributed to J Cox.

At least 163 records · Page 9Linked to original sources
PubMed1992

Improving the diet of under fives in a deprived inner city practice.

This paper reports the introduction of a programme of dietary education to a selected group of young mothers living in a deprived inner city area. The programme was devised by a general practitioner and practice health visitors in collaboration with two hospital dietitians. A diary was used to provide data on diet, food choice, shopping habits, eating together, and planning and frequency of meals. These were included in a list of twelve 'desirable' food groups and three organisational skills, thus providing an individual syllabus for teaching, and a means of assessing the intervention. At the start of the study milk, fruit, vegetables and protein containing iron were common dietary omissions. However, the results show that these foods were an established part of the children's diets following the intervention. The dietary diaries provided a successful means of analysis, and the teaching programme is continuing in this practice. The limitations of such a small study are acknowledged, and a long-term controlled study is suggested.

Adult↗
PubMed1992

Ambulatory blood pressure monitoring in elderly patients with isolated systolic hypertension.

OBJECTIVES: This study compared clinic and ambulatory blood pressure measurement and the reproducibility of these measurements in older patients with isolated systolic hypertension (ISH). PATIENTS: Eighty-seven patients aged greater than or equal to 60 years with ISH on clinic measurement were followed in the placebo run-in phase of the Syst-Eur trial. METHODS: Clinic blood pressure was defined as the mean of two blood pressure readings on each of three clinic visits (six readings in total). Ambulatory blood pressure was measured over 24 h using non-invasive ambulatory blood pressure monitors. RESULTS: Daytime ambulatory systolic pressure was, on average, 21 mmHg lower than the clinic blood pressure, whereas diastolic pressure was, on average, similar with both techniques of measurement. In the 42 patients who had repeat measurements, clinic blood pressure levels nad the amplitude of the diurnal blood pressure profile (fitted by Fourier analysis) were equally reproducible. However, both were less reproducible than ambulatory blood pressure levels. The repeatability coefficients, expressed as per cent of near maximum variation (four times the standard deviation of a given measurement), were 52% and 45% for the clinic systolic and diastolic pressures, 56% and 42% for the amplitude of the diurnal profile, and 29% and 26% for mean 24-h pressures. CONCLUSIONS: In older patients with ISH, clinic and ambulatory systolic blood pressure measurements may differ largely: the prognostic significance of this difference remains to be elucidated. Furthermore, in these patients the level of pressure is more reproducible by daytime ambulatory blood pressure measurement than by clinic measurement.

Aged↗
PubMed1992

[SYST-EUR: a multicenter trial of treatment of systolic hypertension in aged subjects. An initial report].

Syst-Eur is a multicentre placebo-controlled outcome trial, designed by the European Working Party on High Blood Pressure in the Elderly (EWPHE), to investigate the effect of antihypertensive treatment on the incidence of stroke in elderly patients with isolated systolic hypertension (ISH). Eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mmHg with a diastolic blood pressure less than 95 mmHg. The present paper in an interim report on the first 316 patients randomized into this trial. The placebo (N = 170) and active treatment (N = 146) groups were similar at randomization with respect to age (73 +/- 8 years; mean +/- standard deviation), sitting blood pressure (178 +/- 12/85 +/- 7 mmHg), percentage men (34%) and percentage of patients with cardiovascular complications (29%). After randomization blood pressure fell more (p < 0.001) on active treatment than in the placebo group (19 +/- 20/6 +/- 10 mmHg versus 7 +/- 19/1 +/- 10 mmHg for the sitting blood pressure). This first interim report on the Syst-Eur trial demonstrates that a multinational trial in elderly patients with ISH is feasible and that a significant blood pressure difference between the 2 treatment groups can be achieved and maintained. New centres are being recruited in order to randomize a total of 3,000 patients.

Aged↗
PubMed1991

Disseminated toxoplasmosis in a severely immunodeficient patient: demonstration of cysts in bone marrow smears.

A 30-year-old woman was treated with unrelated HLA-compatible bone marrow transplantation for acute myeloid leukemia. Examination of her bone marrow smears because of fever and pancytopenia revealed the presence of Toxoplasma cysts. Although Toxoplasma cysts are rarely found in the bone marrow, bone marrow examination in the immunocompromised patient offers rapid diagnosis of systemic toxoplasmosis.

Adult↗
PubMed1991

Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project.

Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer's disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from "severe dementia". Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. A pilot study has demonstrated the feasibility of the trial. The main study is in progress.

Aged↗
PubMed1991

Cardiovascular manifestations of Lyme disease.

Although the cardiac manifestations of Lyme disease may be diverse, in general they are treatable with currently available therapies. A high index of suspicion is required to make a diagnosis, especially for patients who may lack a suggestive history of tick exposure or residence in an endemic region. Lyme disease-related heart block may require pacemaker insertion and supportive care. The efficacy of antibiotics in the therapy of acute and chronic cardiac Lyme disease will require further study. Serologic testing and cardiac histopathology are the most precise methods of diagnosis. There is a need to develop more sensitive and specific diagnostic tests for Lyme disease and for Lyme carditis in particular.

Administration, Oral↗
PubMed1991

Ambulatory blood pressure monitoring in the evaluation of drug efficacy.

Conventional clinic measurement of blood pressure is influenced by many factors that make the technique unsuitable for the assessment of antihypertensive drug efficacy. The major drawback of conventional measurement is that it cannot indicate the duration of drug effect or the influence of antihypertensive drugs on nocturnal blood pressure. Noninvasive 24-hour ambulatory blood pressure measurement has a number of advantages over conventional measurement: it provides a profile of blood pressure over the 24-hour period; it detects white coat responders; it is free of regression to the mean and the placebo response, thereby making it possible to consider efficacy studies which need not have a placebo phase; it enables considerably more observations than is possible with clinic measurement by increasing the power of studies, which may reduce significantly the numbers of patients needed for antihypertensive drug studies. Twenty-four-hour ambulatory blood pressure measurement offers the opportunity to study antihypertensive drugs in fewer patients with greater accuracy than is possible with conventional clinic measurement and should be a mandatory requirement for such studies.

Ambulatory Care↗
PubMed1991

Development of an enzyme immunoassay for the detection of Clostridium novyi type B alpha toxin.

Clostridium novyi type B alpha toxin was purified to homogeneity and shown to have a molecular weight of 200 kD by SDS polyacrylamide gel electrophoresis. The toxin was toxoided and used to produce a pair of non-interfering monoclonal antibodies. Their specificity was confirmed by immunoblotting and bioassay. The monoclonal antibodies were used to develop an enzyme immunoassay which was more sensitive than bioassay, and permitted less than 1 ng/ml toxin to be detected in a rapid 10 min assay format. Use of the assay can eliminate the requirement for in vivo testing of novyi toxin and toxoid, provided measurements of biological activity are not required. Because of its speed and sensitivity, the assay can be used to monitor toxin production during fermentation and as an alternative to bioassay to measure antigen content during toxoiding and vaccine formulation.

Animals↗
PubMed1991

Using new electronic information products to fund others.

Small medical libraries can, with a planned approach, respond positively to extra user demands generated by new information products, such as CD-ROM databases, by taking the initiative to raise, through fee-based services, income which can be used to fund other products.

Budgets↗
PubMed1991

Twenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: the Allied Irish Bank Study.

In order to determine reference values for ambulatory blood pressure, a sample of 815 healthy bank employees (399 men and 416 women), aged 17-79 years, were investigated. Ambulatory blood pressure was recorded over 24 h, taking measurements at 30-min intervals. Blood pressure was also measured by trained observers in the clinic. Ambulatory blood pressure in the 815 subjects averaged 118/72 mmHg over 24 h, 124/78 mmHg during the day (1000-2259 h) and 106/61 mmHg at night (0100-0659 h). Office blood pressure, measured by an observer, was 4/2 mmHg lower (p less than 0.0001) than daytime ambulatory pressure. The 95th centiles for the daytime ambulatory pressure in men were: 114/88 mmHg for the age group 17-29 years (n = 107); 143/91 mmHg from 30-39 years (n = 123); 150/98 mmHg from 40-49 years (n = 109); and 155/103 mmHg in 50-79 year old men (n = 60); for the corresponding age groups in women, the 95th centiles of the daytime pressure were: 131/83 mmHg (n = 174); 132/85 mmHg (n = 149); 150/94 mmHg (n = 55); and 177/97 mmHg (n = 38).

Adult↗
PubMed1991

Hereditary site-specific colon cancer in a Canadian kindred.

In summary, we have presented a large Canadian kindred exhibiting hereditary large bowel cancer, without polyposis coli, transmitted in an autosomal dominant fashion (Hereditary Site-Specific Colon Cancer). This series serves to emphasize the heritable nature of this and other malignant conditions and the importance of so fundamental a concept as the taking of a complete family history in the identification and management of these conditions. Looking to the future, the reduction of morbidity and mortality from Hereditary Site-Specific Colon Cancer lies in the education of the family and genetic counselling, both commencing in the mid teens the education of physicians and surgeons in the very considerable risk of malignancy in this condition the surveillance of asymptomatic family members including such measures as stool testing for occult blood six monthly augmented by air contrast barium enema and/or colonoscopy at two yearly intervals, commencing at age 25 the creation of national and international registries the identification of reliable biomarkers. We are indeed fortunate to live in a age when technology holds promise for the identification of the oncogenes operative in this and other heritable malignancies. This is the subject of ongoing collaboration between us and our molecular biology colleagues at Memorial University in St. John's and exemplifies, I believe, the very best in the cooperative spirit which may exist between a community hospital and a larger teaching centre.

Adult↗
PubMed1991

Ambulatory blood pressure measurement in the diagnosis and management of hypertension.

Before the diagnostic potential of 24-hour non-invasive BP measurement can be assessed, the accuracy of ambulatory recorders must be established, and normal reference values determined. The accuracy criteria of four ambulatory BP measuring systems (the SpaceLabs 90207, the Novecor DIASYS 200, the Takeda TM-2420 and the Del Mar Avionics Pressurometer IV) have been assessed according to the British Hypertension Society (BHS) protocol, and the Medilog, Suntech Accutracker II and the SpaceLabs 90202 according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI). The SpaceLabs 90202 and 90207, the DIASYS 200 and the Medilog fulfilled the AAMI criteria. The best devices with the BHS grading system are the SpaceLabs 90207 and the DIASYS 200. Normal reference values for daytime, night-time and 24-hour ambulatory BP have been provided by the Allied Irish Bank study of 815 healthy individuals, which showed clear age and sex differences. The mean 24-hour ambulatory pressure for the entire group was 118/72 mm Hg. 24-hour ambulatory BP measurement possesses clear advantages over conventional clinic measurement in evaluating drug efficacy, as it provides many more readings, allowing for the possibility of reducing the number of patients in antihypertensive drug studies and eliminating the need for a placebo-controlled crossover design. It allows assessment of night-time BP, which is important in view of the fact that excessive BP reduction may put patients at risk of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The role of twenty-four-hour ambulatory blood pressure measurement in clinical practice.

Twenty-four-hour ambulatory blood pressure monitoring is passing from research into clinical practice and it is necessary to clarify circumstances for which 24-h ambulatory measurement will be most beneficial. Devices should be accurate and reasonably priced. The operator should be able to interpret 24-h recordings and be familiar with the operation of the equipment. The subject must be capable of complying with the instructions necessary for successful use of the device. In diagnosis, 24-h ambulatory blood pressure measurement is particularly useful in deciding whether subjects with borderline hypertension have a genuinely elevated blood pressure, in identifying white-coat hypertension, in determining dipper status and in diagnosing symptomatic hypotension. In the management of antihypertensive drug treatment, the technique helps the clinician to select the drug best suited to the individual patient in terms of duration of action and suitability for the individual 24-h profile; the technique also identifies any excessive reduction in blood pressure and provides a means of assessing resistant cases of hypertension.

Antihypertensive Agents↗
PubMed1991

A comparison of the twenty-four-hour blood pressure profile in normotensive and hypertensive subjects.

The aim of this study was to assess the relationship between blood pressure measured conventionally ('conventional' pressure) and 24 h ambulatory blood pressure measured with the SpaceLabs 90202 recorder, in a control population with normal blood pressure, and in patients with hypertension. Reference values for 24 h ambulatory blood pressure had been determined previously in a control population of 776 healthy bank employees (396 men and 380 women), aged 17-80 years, and were compared with those from a clinic population which comprised 805 patients referred to a blood pressure clinic for evaluation of hypertension. The clinic population was divided into two groups: 'normotensive' patients, whose conventional blood pressure was less than 160/90 mmHg (n = 168), and 'hypertensive' patients, whose conventional blood pressure was greater than or equal to 160/90 mmHg (n = 637). The clinic population had higher conventional (156/87 versus 119/76 mmHg), daytime (147/90 versus 125/79 mmHg) and night-time (129/75 versus 106/61 mmHg) ambulatory pressures compared with the control population. The clinic 'hypertensive' patients had higher conventional (175/97 versus 136/77 mmHg), daytime (153/93 versus 140/87 mmHg) and night-time (133/78 versus 124/72 mmHg) ambulatory pressures than the clinic normotensive population. Daytime ambulatory pressure was higher than conventional pressure (125/79 versus 119/76 mmHg) in the control population and in the clinic normotensive population (140/87 versus 136/77 mmHg). However, this relationship was reversed in the clinic hypertensive patients (153/93 versus 175/97 mmHg). It is concluded that while conventionally measured blood pressure tends to be lower than ambulatory daytime pressure in normotensive populations, this relationship is reversed in patients with hypertension.

Adult↗
PubMed1990

Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis.

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Acute Disease↗
PubMed1990

The use of stable isotopes and gas chromatography/mass spectrometry in the identification of steroid metabolites in the equine.

Stable isotope gas chromatography/mass spectrometry has been used successfully in the elucidation of structures of urinary steroid metabolites in the horse and in the identification of metabolites isolated from in vivo perfusion and in vitro incubation studies using equine tissue preparations. Deuterium-labeled steroids, testosterone, dehydroepiandrosterone, and 5-androstene-3 beta,17 beta-diol have been synthesized by base-catalyzed isotope exchange methods and the products characterized by gas chromatography/mass spectrometry. [16,16(-2)H2]Dehydroepiandrosterone (plus radiolabeled dehydroepiandrosterone) was perfused into a testicular artery of a pony stallion and was shown to be metabolized into 2H2-labeled testosterone, 4-androstenedione, isomers of 5-androstene-3,17-diol, 19-hydroxytestosterone, and 19-hydroxy-4-androstenedione. In further studies, equine testicular minces have been incubated with 2H2-labeled and radiolabeled dehydroepiandrosterone and 5-androstene-3 beta, 17 beta-diol. The metabolites, whose identity was confirmed by stable isotope gas chromatography/mass spectrometry, proved the interconversion of the two substrates, as well as formation of testosterone and 4-androstenedione. The aromatization of dehydroepiandrosterone was also confirmed, together with the formation of an isomer of 5(10)-estrene-3,17-diol from both substrates showing 19-demethylation without concomitant aromatization. In studies of the feto-placental unit, the allantochorion was shown to aromatize [2H5]testosterone to [2H4]estradiol, the loss of one 2H from the substrate being consistent with aromatization of the A ring. The formation of 6-hydroxyestradiol was also confirmed in this study. The same technique has been valuable in determining the structure of two metabolites of nandrolone isolated from horse urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Allantois↗