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Biomedical subjects

M P Kelly

Publications and source records attributed to M P Kelly.

At least 19 recordsLinked to original sources
PubMed1998

Chronic carbon monoxide exposure: a clinical syndrome detected by neuropsychological tests.

Chronic exposure to carbon monoxide produces a clinical syndrome that is often overlooked because of obscure symptomatology, a range of presentations, and lack of awareness of the problem. To help physicians recognize and treat the chronic carbon monoxide exposure syndrome, the authors present its objective symptomatology, an approach to diagnosis emphasizing neuropsychological tests, a treatment protocol, and theoretical considerations for the mechanism of hyperbaric oxygen's therapeutic action. For elucidation, eight patients treated in the hyperbaric chamber at a tertiary care facility are described. Diagnosis can be facilitated by recognizing the syndrome based on the patient's history, as well as physical and neuropsychological examinations, with emphasis on identifying potential sources of carbon monoxide exposure. The evaluation and treatment protocols presented, though still experimental, show promise for improving functional, cognitive, and psychiatric capacities.

Adult↗
PubMed1998

Trophic implications of altered body composition observed in or near the nails of hemodialysis patients.

In the absence of biochemically determined nutrient status, renal nutrition specialists have been left to assume that hemodialysis (HD) patients with a stable body weight and acceptable macronutrient intakes had adequate micronutrient stores. However, at the University of California Renal Center, using physical examination and laboratory studies, approximately one in three HD patients were found to have micronutrient imbalance. The Nutrition Physical Examination (NPE), an advanced practice, nutrition-focused, physical examination, can be a timely, cost-effective strategy in assessing nutrient status. Trophic changes that have been identified in and around the nails of HD patients suggestive of protein, vitamin, or mineral imbalance include (1) Beau's lines (zinc); (2) koilonychia (iron, copper, zinc, protein); (3) leukonychia (zinc); (4) pale nail beds (iron); (5) Muehrcke's lines (protein); (6) splinter hemorrhages (V-C); (7) onycholysis (iron, niacin); and (8) chronic paronychia (zinc). While these lesions are not pathognomonic of nutrient deficiency, they do provide valuable direction in diagnostic reasoning essential to problem-solving potential maladaptive alterations in the stimulus and function of micronutrients and their enzyme systems.

Body Composition↗
PubMed1997

Use of dietetic-specific nutritional diagnostic codes in clinical reasoning relevant to the nutritional management of core clinical outcome indicators in hemodialysis patients.

The Health Care Financing Agency (HCFA) has recommended conscientious monitoring of four core outcome indicators (anemia, albumin, treatment adequacy, and hypertension) by the end stage renal disease (ESRD) health care team. Dietetic-specific nutritional diagnostic categories (D-S NDCs) can be a powerful tool in guiding renal nutrition specialists through the clinical reasoning required to diagnose and clinically correct nutrition-related problems in hemodialysis (HD) patients. The purpose of this article is to portray one clinician's dual use of D-S NDCs to identify the nutritional problem responsible for poor performance and determine nutritionally treatable causes. Although four indicator-specific sets of D-S NDCs commonly used in the nutritional assessment of anemia, albumin, treatment adequacy and hypertension were identified and referenced, seven codes were consistently repeated. These D-S NDCs were (1) altered nutritional biochemistry integrity; (2) absence of/limited nutritional service; (3) deficit in nutrition knowledge; (4) imbalance of nutrient/fluid; (5) nutrition misinformation; (6) toxicity of nutrient/nutrient end-product; and (7) possibility of developing a specific disease. Thus, in ESRD, use of D-S NDCs shows the implicit role of the registered dietitian in disease prevention, management of altered nutrient disposition, and patient education.

Dietetics↗
PubMed1997

Tissue expression of components of the renin-angiotensin system in experimental post-infarction heart failure in rats: effects of heart failure and angiotensin-converting enzyme inhibitor treatment.

1. It has been suggested that local tissue renin-angiotensin systems may be activated in heart failure and that effects on such systems may, at least partially, explain the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in this syndrome. To investigate these hypotheses, we examined expression of renin-angiotensin system components in several tissues in a rodent model of post-myocardial infarction (MI) heart failure, and analysed whether such expression is modified by ACE inhibitor treatment. 2. Four groups of rats (n = 8 - 12 per group) were studied 30 days after surgery: (A) sham-operated rats with no treatment, (B) rats with post-MI heart failure induced by ligation of the left coronary artery, (C) sham-operated rats treated with the ACE inhibitor perindopril (1.5 mg day-1 kg-1), and (D) rats as per B, but treated with perindopril. Expression of renin, angiotensinogen, ACE and angiotensin subtype 1 receptor was assessed by quantification of their respective mRNAs by Northern blotting. 3. Renal renin mRNA increased 2-fold in animals with MI (group B) compared with controls (group A) (P < 0.05) and between 50 and 100-fold after ACE inhibitor treatment (P < 0.001). No change in renin gene expression was found in any extra-renal site either following MI or after ACE inhibitor treatment. Hepatic angiotensinogen mRNA level was similar in all groups, but kidney angiotensinogen mRNA level was increased 1.6-fold (P < 0.01) in the groups receiving perindopril. ACE mRNA level in the lung was not affected by ACE inhibitor treatment but decreased by 50% following MI (groups B and D, P < 0.01). This was associated with a similar (50%, P < 0.01) fall in lung ACE activity and was correlated with the severity of heart failure. Angiotensin subtype 1 receptor mRNA level was not affected in any tissue by either MI or ACE inhibitor treatment. 4. We did not find a systematic activation of tissue renin-angiotensin systems, as assessed by steady-state mRNA levels of key components of the system in experimental post-MI heart failure, or a major effect of ACE inhibitor treatment on expression of these components. However, we observed tissue-specific changes in expression of selected components of the renin-angiotensin system in the kidney and the lung in post-MI heart failure and after ACE inhibitor treatment, which may be of relevance to the pathophysiology of the syndrome and the effects of ACE inhibition.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Substance abuse, traumatic brain injury and neuropsychological outcome.

The neuropsychological performance of 119 patients with severe closed traumatic brain injury (TBI) who had received toxicology screens at the time of trauma centre admission was examined. Three groups were created: normal screen, positive alcohol screen, or positive abused drugs screen (with or without the presence of alcohol). The admitting Glasgow Coma Scale (GCS) score was significantly lower in the positive alcohol screen group than the normal screen group, while the three groups did not differ in length of post-traumatic amnesia (PTA) or years of education. Neuropsychological assessment was conducted during inpatient rehabilitation, following resolution of PTA. Normal screen patients obtained significantly better scores than the abused-drugs patients on the Full Scale IQ (FIQ) and Verbal IQ (VIQ) indices of the Wechsler Adult Intelligence Scale-Revised and the Verbal Memory, General Memory, Attention-Concentration, and Delayed Recall indices of the Wechsler Memory Scale-Revised. Normal screen patients also scored significantly higher than positive alcohol screen patients on FIQ and VIQ indices and all five indices from the Wechsler Memory Scale-Revised. These data suggest the existence of an additive effect of substance abuse on neuropsychological outcome in TBI. Findings have potential implications for both acute management and rehabilitation of TBI.

Adult↗
PubMed1997

Discontinuous Percoll gradient preparation for donor insemination: determinants for success.

The use of cryopreserved donor spermatozoa for insemination has become necessary to decrease the risk from sexually transmitted infectious diseases. Lower fecundity rates have been reported with this practice. Efforts have been applied to increase success, including identification of those sperm characteristics which correlate with increased fecundity. Data from in-vitro fertilization have revealed sperm morphology, motility and zona pellucida binding as important sperm parameters. Discontinuous Percoll gradient preparation yields a high concentration of motile spermatozoa. Using this preparation for thawed donor spermatozoa, we have identified post-preparation motility and progression as factors associated with increased fecundity. Consideration should be given to screening sperm donors with a freeze-thaw Percoll gradient preparation prior to acceptance into a donor bank.

Adult↗
PubMed1997

Activity and expression of Na(+)-H+ exchanger isoforms 1 and 3 in kidney proximal tubules of hypertensive rats.

Increased activity of the cellular Na(+)-H+ exchangers (NHEs), especially isoform 1 (NHE-1), is a recognized intermediate phenotype of hypertension. NHE activity has been demonstrated to be increased in proximal tubules of the spontaneously hypertensive rat (SHR). However, with the recent cloning of other members of this family of transporters, it is unclear which isoforms may contribute to this increased activity. We have used specific antibodies raised against glutathione-S-transferase fusion proteins of rat NHE-1 and NHE-3 to determine the relative contributions of these isoforms to the NHE activity in freshly isolated and cultured proximal tubule cells from SHR and Wistar-Kyoto (WKY) normotensive control rats. In freshly isolated proximal tubule cells, NHE activity was elevated almost 3-fold in SHR cells (P < .001), and in both rat strains, the contribution from NHE-1 and NHE-3 was approximately equal. Western blots of membranes from these cells showed equal amounts of NHE-1 protein in SHR and WKY cells. However, NHE-3 protein expression was increased 50% in SHR cells (P < .001), and this may account for the elevated activity of this isoform in SHR. The effect of culturing these cells in vitro was then examined. Although total NHE activity in both cell types was decreased during culture, this was mainly due to loss of expression of NHE-3 protein. NHE-1 activity was persistently elevated in the SHR cells in culture. These findings suggest that elevated NHE activity in SHR proximal tubules could be mediated by two mechanisms: (1) increased NHE-1 activity without any increased NHE-1 protein content that persists despite culture and may resemble those changes described for extrarenal tissues and (2) increased NHE-3 activity due to increased expression of NHE-3 protein. Disappearance of NHE-3 during culture implies that our culture conditions did not replicate the in vivo environment and may have removed the factors contributing to the increased NHE-3 expression in SHR cells.

Animals↗
PubMed1996

Evaluating ovarian reserve: follicle stimulating hormone and oestradiol variability during cycle days 2-5.

A prospective measurement of follicle stimulating hormone (FSH) and oestradiol between cycle days 2 and 5 was conducted to investigate the intra- and inter-cycle variability in a healthy population of women with regular menstrual intervals. Daily serum samples were obtained from 44 women for a total of 66 cycles on cycle days 2, 3, 4 and 5. FSH concentrations were consistent on all cycle days measured. Oestradiol concentrations on cycle day 2 were not different from cycle day 3, but concentrations on cycle day 4 and cycle day 5 were statistically different from both cycle day 2 and cycle day 3 by analysis of variance (P < or = 0.05). Evaluation of functional ovarian reserved by cycle day 3 FSH measurement has become the standard in most assisted reproductive technology programmes. The recent change in FSH standardization coupled with the inflexibility of cycle day 3 testing has led to a re-evaluation of testing protocols. Cycle day 3 appears to have emerged as a dictum because most ovulation induction protocols are initiated on cycle day 3, 4 or 5. Flexibility of sampling day can be introduced as suggested by these results. The additional information ascertained from oestradiol testing as applied to evaluation of ovarian reserve warrants further investigation.

Adult↗
PubMed1996

Recently recognised microbial enteropathies and HIV infection.

Persistent diarrhoea and small bowel enteropathy are important features of HIV infection. At least 80% of cases of persistent diarrhoea in patients with HIV/AIDS can be attributed to a specific enteropathogen. The coccidian parasites Cryptosporidium parvum, Isospora belli and Cyclospora and the Microsporidia account for at least 50% of cases of persistent diarrhoea in the industrialised and developing world with major contributions from Mycobacterium avium complex and other bacteria and cytomeglovirus. The intracellular protozoa can be detected on faecal microscopy although confirmation may be required by intestinal mucosal biopsies. Although up to 20% of cases of persistent diarrhoea can not be attributed to a specific infection, the question as to whether HIV infection itself can produce enteropathy remains uncertain. Recent developments in the treatment of persistent diarrhoea in HIV include the use of albendazole for microsporidial diarrhoea and co-trimoxazole for the treatment and eradication of Cyclospora.

HIV Enteropathy↗
PubMed1996

The relationship of vitamin B6 status to median nerve function and carpal tunnel syndrome among active industrial workers.

Case reports and small case series suggest that vitamin B6 deficiency is an important etiologic factor in carpal tunnel syndrome (CTS). This hypothesis has never examined in a randomly selected study population, particularly among active workers. We examined 125 randomly selected active workers from two industrial plants. Each worker completed a self-administered symptom questionnaire and underwent electrodiagnostic testing of the median and ulnar sensory nerves. Laboratory biochemical analyses of vitamin B6 status were also performed using the erythrocyte glutamic pyruvic transaminase assay, and quantification of plasma pyridoxal-5'-phosphate. Measurements of vitamin B6 status were unrelated to self-reported symptoms potentially consistent with CTS, electrophysiologically determined median or ulnar nerve function, and CTS defined on the basis of self-reported symptoms and electrophysiologic measurements. These results suggest that CTS among active industrial workers is unrelated to vitamin B6 status. Furthermore, in our opinion, empiric prescription of vitamin B6 to patients with CTS is unwarranted and potentially hazardous.

Adult↗
PubMed1996

Health education, the health promotion movement, and communication.

This paper explores the debate between health education and health promotion. It is argued that each is located in a different philosophical tradition, The Modern and The Post-Modern. The Health Promotion movement can unintentionally undermine the very basis of prevention. It is argued that a skills-based approach is required. Drawing on the work of Habermas, a model for the effective delivery of the public health education message is outlined.

Adaptation, Psychological↗
PubMed1994

Patients' decision making in major surgery: the case of total colectomy.

Qualitative interview data concerning patients' decision making in major surgery (total colectomy and ileostomy) are reported. Unsurprisingly, these procedures are not recommended lightly by the medical profession and the medical and surgical consensus is that patients should be involved in the decision making which leads to the surgery. Data relating to that involvement are presented. It is argued that the decision making is a process which involves changes in identity and self and that the tensions between identity and self account for some of the emotional and other problems attaching thereto.

Adaptation, Psychological↗
PubMed1994

Traumatic injury in patients with neurologic and psychiatric disease.

Our work and multiple other lines of evidence suggest that patients suffering from neurologic and psychiatric disorders are over-represented in the population suffering traumatic injuries. In addition, a premorbid history of such disorders can impact on the severity of injury, as well as present particular problems in the acute management of this population. Constant vigilance, leading to prompt identification of concurrent neurologic and psychiatric illness in trauma victims, is critical for patient management. The interactions of these disorders and their treatments present complex clinical challenges to the traumatologist and the intensivist.

Critical Care↗
PubMed1993

Wechsler Memory Scale-Revised in closed head injury.

This study was undertaken to determine the ability of the Wechsler Memory Scale-Revised (WMS-R) to differentiate a group of closed head injury patients from a group of controls and determine how injury severity and attentional deficits are associated with WMS-R performance. The relationship of WMS-R performance to everyday memory also was assessed. The head injured group performed more poorly than controls on all five WMS-R indices and exhibited greater impairments on tasks that measure retention. In the original sample only the Visual Memory Index correlated with injury severity; in a larger sample, all four memory indices correlated modestly with injury severity. Patients who performed more poorly on the WMS-R also received poorer ratings on an independent assessment of everyday memory.

Adolescent↗
PubMed1993

The four levels of health promotion: an integrated approach.

Four levels of health promotion are identified: environmental, social, organisational and individual. It is argued that health promotion interventions should not be confined to one level but instead an integrated approach should be adopted, in which the relationships between the four levels and the outcomes at all levels ought to be considered and analysed. It is suggested that these four levels are used as a checklist when health promotion interventions are planned.

Environment↗
PubMed1993

A gene differentially expressed in the kidney of the spontaneously hypertensive rat cosegregates with increased blood pressure.

The role of the kidney in initiating hypertension has been much debated. Here we demonstrate that a recently identified gene of yet unknown function, termed SA, which is differentially expressed in the kidney of the spontaneously hypertensive rat, cosegregates with an increase in blood pressure in F2 rats derived from a cross of the spontaneously hypertensive rat with normotensive Wistar-Kyoto rats, accounting for 28 and 21% of the genetic variability in systolic and diastolic blood pressures, respectively. Further, the genotype at this locus appears to determine the level of expression of the gene in the kidney. The findings provide strong evidence for a primary genetic involvement of the kidney in hypertension.

Aging↗