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Biomedical subjects

M Lewis

Publications and source records attributed to M Lewis.

At least 271 records · Page 15Linked to original sources
PubMed1992

[Wake up time, thrombocyte aggregation and the risk of acute coronary heart disease. The TRIMM (Trigger and Mechanisms of Myocardial Infarct) Study Group].

A circadian variation in the incidence of acute coronary artery disease (CAD) was observed, but the correlation to possible triggering external factors and pathophysiologic mechanisms is unclear. In the "Trigger and Mechanisms of Myocardial Infarction" (TRIMM) Study, 573 patients (61 +/- 10 years; 74% male) underwent a systematic interview within 2 weeks after myocardial infarction. From 8.00 to 11.00 a.m. (peak) the relative risk of myocardial infarction was 1.9 (1.6-2.3). After statistical adjustment for individual wake-time the relative risk during the initial 3 hours after awakening was 2.7 (2.2-3.3). In 24 hour studies at platelet aggregability in 10 patients with CAD the threshold concentration of ADP (from 4.8 +/- 0.8 to 2.6 +/- 0.4 mumol, p less than 0.02) and epinephrine (from 7.3 +/- 2.3 to 1.8 +/- 0.9 mumol, p less than 0.02) decreased significantly between 6.00 and 9.00 a.m. indicating an increase of aggregability. The temporal coincidence of clinical events and physiological changes suggests a causal relationship. Further possible important factors in increasing the risk of CAD during the morning include the increase of blood pressure enhancing the risk of plaque rupture and of coronary tone at the same time of day. These results are important in determining the acute mechanisms of CAD and in improving its prevention.

Aged↗
PubMed1992

General practitioner training in ENT in the Trent Region.

A questionnaire was designed and posted to 220 general practitioners in the Trent Region. The questionnaire looked at the individual's undergraduate and postgraduate training. The results indicate that there is a great demand among final year vocational trainees and principals in general practice for an increase in the amount of formal postgraduate training in ENT. Nearly 85% of those questioned welcomed the opportunity of further training, primarily through attending courses, lectures or consultant clinics. Only 13% requested a formal attachment as an SHO on an ENT unit. Just over one in three of the respondents had received formal postgraduate training during their trainee years but even in this group 75% felt they would benefit from further training. Even at an undergraduate level, approximately half of the respondents commented that they had not received or undertaken examination of the ear, nose and throat in adults or children.

Adult↗
PubMed1992

Prenatal exposure to heavy metals: effect on childhood cognitive skills and health status.

Prenatal exposure to seven heavy metals (cadmium, chromium, cobalt, lead, mercury, nickel, and silver) was determined for amniotic fluid taken from 92 pregnant women undergoing amniocentesis at approximately 16 to 18 weeks' gestation. Follow-up assessment of their children's cognitive skills and health status was conducted when the children were approximately 3 years of age. The presence of these metals co-occurred in amniotic fluid. A prenatal toxic risk score was derived which was a weighted score reflecting the presence of the various metals in amniotic fluid. The toxic risk score was negatively related to performance on the McCarthy Scales of Children's Abilities and positively related to the number of child illnesses reported. These results suggest the need for further prospective research on the adverse effects of prenatal exposure to various metals in combination.

Adult↗
PubMed1992

Differences in shame and pride as a function of children's gender and task difficulty.

3-year-old children were presented with easy and difficult tasks and their emotional responses of shame and pride were observed. No shame was shown when subjects succeeded on the tasks and no pride was shown when they failed. Significantly more shame was shown when subjects failed easy tasks than when they failed difficult tasks, and significantly more pride was shown when subjects succeeded on difficult than on easy tasks. While there were no sex differences in task failures, girls showed more shame than boys. There were no sex differences in pride when subjects succeeded.

Achievement↗
PubMed1991

Screening for Down's syndrome based on individual risk.

OBJECTIVE: To evaluate the effectiveness of biochemical screening of individual pregnancies for Down's syndrome risk. DESIGN: Retrospective determination of risk. SETTING: Obstetric and cytogenetic services in Tayside, Scotland. SUBJECTS: 3436 pregnant women who had screening for neural tube defects in the second trimester during November 1988 to March 1990 and whose pregnancies were dated by ultrasonography. Three women with pregnancies associated with Down's syndrome reported later in 1990. MAIN OUTCOME MEASURES: Individual risk calculated from age at estimated date of delivery; chorionic gonadotrophin and alpha fetoprotein concentrations in serum samples obtained at precisely determined gestational ages in second trimester. Results of karyotype determination and outcome of pregnancy. RESULTS: During November 1988 to March 1990 karyotypes were determined for 5% of pregnancies for reasons of maternal age and genetic history and one of the eight affected fetuses was detected. Individual risk could not be calculated for 347 pregnancies, but screening on this basis would have detected five of the cases and required screening in 194 out of 3089 (6.3%) pregnancies; all three affected pregnancies reported later in 1990 would also have been detected, giving a success rate of 73% (95% confidence interval 39% to 94%). The age distribution of women according to individual risk suggests that women over 35 would be screened effectively. CONCLUSION: Screening based on individual risk would use resources more effectively than screening based on maternal age and genetic history without affecting detection rates in older women.

Adult↗
PubMed1991

[Prognostic significance of prehospital phase in acute myocardial infarct. Results of the Augsburg Myocardial Infarct Registry, 1985-1988].

Data collected by the Augsburg Infarct Register during 1985-1988 were analysed. There were 3,729 cases of acute myocardial infarct (2,672 men and 1,057 women; mean age 62.8 [25-74] years). Before hospitalization cardiac arrest had occurred in 1,401 persons (38%); resuscitation attempts were made in 494 of them (34%). A doctor witnessed the arrest in 243 persons, 13 of whom survived the subsequent 28 days. But none of 640 persons who had a cardiac arrest when only lay people were present survived the first day: resuscitation had been attempted in 39. 518 persons died before hospitalization without anyone present. In the first hour after infarction 30% died, within 4 hours 38% of the total group. The median pre-hospitalization time was 3.11 (range 1.67-8.05) hours. 42% of the patients first called their doctor, 26% went to him (her). This caused decisive delays. The thrombolysis rate was 24%, if the pre-hospital interval was under 6 hours (mortality rate 6% with, 12% without thrombolysis). The prognosis of acute myocardial infarction could be improved by specific instructions to high-risk patients and their relatives and by widening emergency care provisions.

Adult↗
PubMed1991

Cloning and expression of cDNAs for two distinct murine tumor necrosis factor receptors demonstrate one receptor is species specific.

Complementary DNA clones encoding two distinct tumor necrosis factor receptors were isolated from a mouse macrophage cDNA library. The cDNA for murine tumor necrosis factor receptor type 1 (mTNF-R1) predicts a mature polypeptide of 425 amino acids that is 64% identical to its human counterpart, whereas the cDNA of murine tumor necrosis factor receptor type 2 (mTNF-R2) predicts a mature protein of 452 amino acids that is 62% identical to human tumor necrosis factor receptor type 2. The two murine tumor necrosis factor receptors have limited sequence homology (approximately 20% identity) in their extracellular regions but no apparent similarity in their cytoplasmic portions. Northern (RNA) analysis indicates a single 2.6-kilobase (kb) transcript for mTNF-R1; a 3.6-kb and a more predominant 4.5-kb transcript are observed for mTNF-R2. A human cell line transfected with either mTNF-R1 or mTNF-R2 expression vectors specifically bound 125I-labeled recombinant murine tumor necrosis factor alpha (TNF-alpha). Although mTNF-R1 had a similar affinity for both recombinant murine TNF-alpha and human TNF-alpha, mTNF-R2 showed strong specificity for recombinant murine TNF-alpha. This result suggests that the various activities of human tumor necrosis factor alpha reported in mice or in murine cell lines are probably mediated by mTNF-R1.

Amino Acid Sequence↗
PubMed1991

Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction.

OBJECTIVE: To compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labour and to evaluate factors in addition to analgesia that may influence maternal satisfaction. DESIGN: A prospective randomised pilot study. SETTING: Birmingham Maternity Hospital. SUBJECTS: 85 primiparous women who requested epidural analgesia in labour and their babies. INTERVENTIONS: Group 1 mothers were treated with bupivacaine conventionally, group 2 mothers with bupivacaine and fentanyl in a more complex way designed to provide satisfactory analgesia but with less troublesome side effects. MAIN OUTCOME MEASURES: Overall maternal satisfaction, maternal perception of epidural analgesia and its side effects, and aspects of mothers' psychological states during labour, quantified using 100 mm visual linear analogue scales; the frequency of normal and operative deliveries; and measurements of neonatal wellbeing. RESULTS: Satisfaction was higher in group 2 mothers (median group difference +3 mm, 95% confidence interval +1 to +5, p = 0.012): this was associated with more normal deliveries (difference between proportions 0.23, 95% confidence interval +0.03 to +0.42); greater self control (median group difference -7 mm, -17 to -2, p = 0.003); and reduced unpleasantness of motor blockade (-10 mm, -19 to -5, p less than 0.001), sensory blockade (-5 mm, -11 to -2, p = 0.002) and shivering (-5 mm, -18 to 0, p = 0.046) at the expense of mild itching (0 mm, 0 to 0, p less than 0.001). Group 1 mothers found restricted movements more unpleasant (-1 mm, -11 to 0, p = 0.006) and were more sleepy (-4 mm, -20 to 0, p = 0.032). The addition of fentanyl to bupivacaine reduced the requirement for local anaesthetic (-33 mg, -55 to -15, p less than 0.001) without compromising analgesia. No adverse effects in neonates were attributed to the use of fentanyl. CONCLUSIONS: The already high maternal satisfaction from conventional epidural analgesia can be improved; epidural fentanyl may be combined with bupivacaine to reduce operative deliveries and confer other advantages that may increase maternal satisfaction. Further investigations should be performed to determine the exact mechanisms of these findings and, in particular, to develop a safe method of delivering such analgesia to women.

Analgesia, Epidural↗
PubMed1991

[Drug interactions in the prescriptions of patients before and after a heart infarct: results of the MONICA Augsburg heart infarct registry].

The prescriptions of 603 patients who had survived acute myocardial infarction (AMI) for at least one year and were registered from 1 Oct 84 to 31 Dec 86 in the Coronary Event Register of the MONICA project Augsburg were analyzed for the presence of drug-drug interactions with the aid of a computerized drug information system (SMA). Prior to AMI, 59% of patients were treated (average of 2 active substance per patient), 100% were treated on release from hospital (4.5 active substances), and 96% one year after AMI (5.8 active substances). Potential drug-drug interactions were found in 18% of patients before AMI, 65% on discharge from hospital, and 66% one year after AMI. While the potential frequency and severity of interactions are minor on average, prescriptions frequently contain several interactions. Calculations show that at least 5-6% of all prescriptions after AMI will produce interactions, so that drug safety for this high-risk patient group can be enhanced by a drug information system. Beta-blockers are the substance group most frequently involved in potential interactions in AMI patients.

Adult↗
PubMed1991

[Population-based heart infarct register in the Augsburg region: possibilities and limitations].

Special procedures were developed to establish the Augsburg Coronary Event Register in accordance with the German data confidentiality laws. Contracts with the 26 hospitals in the study region and the adjacent ares (registration of 95% of all acute myocardial infarctions (AMI)) were specified to ensure their cooperation with the MONICA Project (WHO project Monitoring Trends and Determinants in Cardiovascular Disease). Written consent of the patients, declaring their participation in the project is required. Fatal events with suspected AMI within the study region (4% of male and 7% of female coronary deaths occur outside the region) are selected from the information in the anonymous death certificates provided by the three regional health departments. Each health department allocates an identification (ID) number to each event and sends a questionnaire for cause of death validation (MONICA questionnaire) to the last attending physician and/or the coroner. The register receives this information in anonymous form and links the MONICA questionnaire and the death certificate by means of the ID number. While data confidentiality laws do not impair case finding, they do restrict the validation of the diagnosis and person-based registration. The inclusion of fatal events with insufficient data on cause of death (25% of all registered fatal events) seems prudent to avoid underestimating attack rates and mortality, i.e. the AMI risk for the resident study population.

Cause of Death↗
PubMed1991

Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study.

The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed.

Adult↗
PubMed1991

The low-incidence red cell antigen Wra: genetic studies.

Studies of 91 individuals in three families allowed a genetic-linkage analysis of the gene governing the production of the low-incidence red cell antigen Wra and provided evidence that Wra is not a member of the Scianna, Landsteiner-Wiener, Chido/Rodgers, or XK blood group systems, and that the "WR" locus is excluded from autosomal sites or regions 1p34-p22.1, 1p21-q23, 1q32, 2p25, 3q21, 4q28-q32, 6p24-q12, 9q34.1-q34.2, 13q14.1-q14.2, 14q24.3-q32.1, 14q32.33, 16p13, 16q22.1, and 21q21-q22.1. "WR" is also excluded from within specified genetic distances of chromosomes 8 (GPT), 18 (JK), 19 (C3), 20 (ADA), and 22 (P1) loci, which brings its exclusion to approximately 10 percent (320cM) of the total genetic map of the genome. The possibility that "WR" is pseudoautosomal is deemed to be highly unlikely.

Blood Group Antigens↗