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Biomedical subjects

M Reid

Publications and source records attributed to M Reid.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between birth weight and urea kinetics in children.

OBJECTIVE: To explore the effect of birth weight on urea kinetics in young healthy children. DESIGN: Observational study. SETTING: Tertiary center for treatment of malnutrition. SUBJECTS: A total of 17 male children, 6-24 months old, who had recovered from malnutrition. INTERVENTIONS: Urea kinetics were measured using stable isotope methodology with [(15)N(15)N]-urea over 36 h. RESULTS: Birth weight was negatively related to urea hydrolysis after controlling for the intake of protein (adjusted R (2 ) = 0.91, P = 0.001) and separately for energy intake (adjusted R (2) = 0.95, P = 0.001), age (adjusted R (2) = 0.90, P = 0.001) and rate of weight gain (adjusted R (2) = 0.91, P = 0.001). There was a tendency for higher urea production in the children with lower birth weight after controlling for nitrogen intake (adjusted R (2) = 0.93, P = 0.099), and separately for age (adjusted R (2) = 0.94, P = 0.06) and rate of weight gain (adjusted (R (2) = 0.92, P = 0.096). Urea excretion was not significantly related to birth weight. CONCLUSIONS: The salvaging of urea nitrogen following urea hydrolysis contributed significantly more to the nitrogen economy in children with lower birth weight compared to those with higher birth weight. This may be as a result of reductive adaptation in the children with lower birth weight as a consequence of inappropriate prenatal nutrition and growth.

Adaptation, Physiological↗
PubMed2006

Acquired C1 esterase inhibitor deficiency: An atypical first presentation intra-operatively.

We report a case of airway difficulties encountered as a result of blistering, oedema and bleeding from the oropharyngeal mucosa of an 85-year-old female undergoing an elective excision of a submandibular neck lump. This led to a delay in extubation by several hours. The patient was subsequently found to have an acquired form of C1 esterase inhibitor deficiency considered to be consequent of haematological malignancy.

Aged, 80 and over↗
PubMed2006

Laparoscopic cholecystectomy for chronic cholecystitis in Jamaican patients with sickle cell disease: preliminary experience.

Laparoscopic cholecystectomy, with its advantages of reduced postoperative pain and shorter hospitalization is the accepted standard of care for patients with symptomatic cholelithiasis. A retrospective study was done to assess the outcome of laparoscopic cholecystectomy in patients with sickle cell disease, a group known for its high postoperative morbidity. The study sample comprised of patients seen at the University Hospital of the West Indies during the period 1999 to 2004. Twelve patients were females and four were males. Their mean age was 28.5 years (range 13-43 years). Fifteen underwent elective cholecystectomy for recurrent episodes of cholecystitis while one patient required an emergency procedure. All patients underwent endoscopic retrograde cholangiopancreatography, which successfully removed common bile duct stones which were present in 25% of the cases. There were four conversions to open cholecystectomy as a result of obscure anatomy due to scarring and adhesions. The duration of surgery ranged from 70-150 minutes. Six patients developed postoperative complications, four of whom had acute chest syndrome. This resulted in death in one patient. The mean postoperative hospitalization period was 5.5 days. This report indicates that patients with sickle cell disease remain a high risk group with the potential for significant morbidity even when subjected to minimal access surgery.

Adolescent↗
PubMed2005

Cross-linking of dried paracetamol alginate granules Part 1. The effect of the cross-linking process variables.

This paper reports on the cross-linking of dried (<5% moisture) paracetamol alginate granules with calcium chloride solutions. The effect of calcium concentration, temperature of the treatment solution, stirring speed and time used during cross-linking of granules on water uptake by the granules during cross-linking and physical properties of the cross-linked and dried granules were studied. A full factorial study of these factors each at two levels was used (CaCl2.2H2O: 20, 100 mg/ml; temperature: 25, 45 degrees C; stirrer speed: 25, 240 rpm; time: 1.5 and 5.5 min) to treat dried stock granules (size: 0.8-1.0 mm) containing the model drug paracetamol and sodium alginate powder (1:1) which were prepared using conventional aqueous granulation under low shear. In addition to SEM and photomicrography, the physical properties studied were water uptake during cross-linking, yield, aggregation behaviour, moisture content, drug content, early stage drug release [over 10 s (R10) and the next 50 s (R50)] and calcium and sodium content of the unwashed cross-linked granules. Dry granules were successfully cross-linked. The treatment factors significantly affected most of the response variables. The variables most affected were water uptake (78-254%), drug entrapment (58-86%), early release (R10: 1.2-6.4% and R50: 3.0-12.2%), granule aggregation (0-70%), calcium (6.02-12.4%) and sodium content (1.2-6.44%). SEM photographs suggest that low calcium treated granules were less porous in nature compared to high calcium treated granules. Low shear drug alginate granules can be cross-linked in dried state. The properties of the cross-linked granules can be modified by altering the treatment process.

Acetaminophen↗
PubMed2005

Divergent mechanisms of cis9, trans11-and trans10, cis12-conjugated linoleic acid affecting insulin resistance and inflammation in apolipoprotein E knockout mice: a proteomics approach.

Conjugated linoleic acids (CLA) affect atherogenesis, but mechanisms are not well understood. We explored how two isomers of CLA, cis9, trans11-CLA and trans10, cis12-CLA, affected lipid and glucose metabolism, as well as hepatic protein expression, in apolipoprotein E knockout mice. After 12 wk of intervention, plasma triglyceride, NEFA, and glucose concentrations were significantly higher in the trans10, cis12-CLA group, whereas plasma triglyceride, NEFA, glucose, and insulin concentrations were significantly lower in the cis9, trans11-CLA group, compared with control mice consuming linoleic acid. Proteomics identified significant up- or down-regulation of 113 liver cytosolic proteins by either CLA isomer. Principal component analysis revealed that the treatment effect of cis9, trans11-CLA was mainly explained by the up-regulation of different posttranslational forms of heat shock protein 70 kD. In contrast, the treatment effect of trans10, cis12-CLA was mainly explained by up-regulation of key enzymes in the gluconeogenic, beta-oxidation, and ketogenesic pathways. Correlation analysis again emphasized the divergent effects of both CLA isomers on different pathways, but also revealed a linkage between insulin resistance and increased levels of hepatic serotransferrin. Thus, our systems biology approach provided novel insights into the mechanisms by which individual CLA isomers differentially affect pathways related to atherogenesis, such as insulin resistance and inflammation.

Animal Feed↗
PubMed2005

Patients strategies for managing medication for chronic heart failure.

OBJECTIVES: To explore patients views of the management of medication of chronic heart failure (CHF); to explore in what circumstances they have difficulties in managing medication. DESIGN: Qualitative analysis of in-depth interviews using a constant comparative approach. PARTICIPANTS: Patients attending an outpatients clinic with a primary diagnosis of CHF due to left ventricular systolic dysfunction, NYHA Class II or III symptoms, and a history of hospital admission for heart failure. RESULTS: 50 patients were recruited, average age 67.1 years with ranges between 41 and 80 years. 26 were classified as NYHA Class II and 24 Class III. Patients reported developing routines and back up strategies to help with the complex task of medication-taking. They also described circumstances in which they were more likely not to take medication. CONCLUSIONS: This study demonstrates, with a large sample of respondents, the complexities of medication-taking and the difficulties of maintaining constant medication over a long period of time. The study provides examples of patients' strategies for so doing. Health care professionals should recognise that concordance may vary but explore ways in which they can help patients establish routines.

Adult↗
PubMed2005

Oesophageal foreign bodies at the University Hospital of the West Indies.

A retrospective study was conducted of 97 patients with oesophageal foreign bodies (EFB). The patients were admitted to assess characteristics of EFB, modes of presentation and radiological and endoscopic findings. The patients were from the University Hospital of the West Indies and most (42%) were over the fourth decade of life. The commonest EFB were bones. A negative radiological finding was not a reliable means to select patients for endoscopy. Oesophagoscopy is a reliable method in the treatment of EFB impaction. There were no major complications or deaths.

Bone and Bones↗
PubMed2005

A clinical audit of the quality of care of hypertension in general practice.

Clinical audits monitor the use of particular interventions, or the care received by patients, against agreed standards. Any departures from "best practice" can then be examined, and causes can be determined and acted upon. The Ministry of Health (MOH), Jamaica, has recently published standards of care for hypertension. The medical records of a convenience sample of 125 hypertensive patients being managed by five current family medicine residents in their respective primary care practices were audited Initial results showed limited adherence to the MOH recommended hypertension management guidelines. The same practices were re-audited after an interval of six months, during which time the physicians were sensitized to the results of the preliminary audit. Marked improvements were noted in the second audit. Assessment for co-risk factors for hypertension-related diseases improved: nutritional advice (33% to 74%), smoking and alcohol intake history (40% to 65%) and history taking of physical activity (30% to 47%). Assessment for target organ damage also improved: fundoscopy done (11% to 54%), foot examination done (30% to 58%) and yearly electrolytes done (28% to 62%). There are clear gaps between current practice and standards that exist internationally and locally for management of hypertension. The MOH needs to disseminate and educate general practitioners about the standards of care guidelines.

Adult↗
PubMed2005

Iron deficiency anaemia in Jamaican children, aged 1-5 years, with sickle cell disease.

OBJECTIVE: The aim of this study was to determine, using a combination of measures, the prevalence of iron deficiency anaemia (IDA) in children under five years-of-age who have sickle cell disease (SCD) and attend the Sickle Cell Clinic (SCU) of the Tropical Medicine Research Institute. MATERIALS AND METHODS: Children with homozygous sickle cell anaemia (Hb SS) or doubly heterozygous for Hb S and Hb C (Hb SC) disease who had not received a blood transfusion within three months prior to the iron measurements, were enrolled. The diagnosis of IDA was made if transferrin saturation was less than 16% with serum iron less than 10.7 micromol/l and a low mean corpuscular volume (MCV) for age. RESULTS: Twelve children (8.5%), seven with Hb SS and five with Hb SC had IDA. Adjusting for genotype, children with IDA had significantly higher red blood cell (RBC) counts (4.3 x10(9)/l vs 3.0 x 10(9)/l, p < 0.001) and total iron binding capacity (TIBC) (65.6 micromol/l vs 55.2 micromol/l, p < 0.004) but significantly lower reticulocyte (retic) counts (7.8 % vs 12.2%, p = 0.001) than children without IDA. CONCLUSION: Iron deficiency anaemia is a clinical problem which affects children with SCD in Jamaica. The higher RBC counts in the IDA group may be due to decreased haemolysis and increased red cell survival whilst the lower reticulocyte counts may be due to impaired erythropoiesis. These observations need to be extended by clinical studies to establish improved diagnostic measures for IDA in SCD. Additionally, clinical trials are needed to determine whether treatment of IDA in children with SCD reduces morbidity and is associated with clinical benefits such as improvements in neurocognitive function.

Age Distribution↗
PubMed2004

The impact of induced labour on postpartum blood loss.

It is generally believed that postpartum blood loss is less in patients whose labour is induced with prostaglandins than in patients delivered without induction. However, postpartum blood loss is known to be greater with precipitate labour and labours induced with oxytocin and prostaglandins, unless an oxytocic agent is continued after delivery. A retrospective study was undertaken at the University Hospital of the West Indies to look at the outcome of induced labour during 3 months, October-December 1998. Misoprostol induction was compared to the outcome after oxytocin induction, misoprostol induction plus oxytocin augmentation and those patients who delivered without oxytocics during this same time period. During that period, 524 patients were delivered and 51 (9.7%) were induced with misoprostol, 174 (33.2%) with oxytocin, 21 (4%) misoprostol plus oxytocin and 271 (51.7%) without oxytocic. Seven patients were eliminated from further analysis, as we were unsure of their induction status. Results showed no significant differences between the groups for variables such as maternal age, parity and fetal birth weight. There was a significantly greater mean blood loss at delivery with all induced labour compared with those not induced. For misoprostol 162.5(SD 190) ml, oxytocin (150 (SD 100) ml and for oxytocin plus misoprostol 150 (SD 150) ml, while controls had the lowest mean blood loss 100 (SD 130) ml occurring where no predelivery oxytocic was needed (P<0.03). Postpartum haemorrhage was highest with misoprostol 5.8% versus 4.4% for no oxytocic, 1.1% for oxytocin and 0% for misoprostol plus oxytocin. However, none of these values reached statistical significance. The misoprostol group also had the shortest first stage, 333 minutes versus 557 minutes for oxytocin, 576 minutes when both misoprostol and oxytocin was used and 344 minutes with no oxytocic. Blood loss was also independently directly associated with placental weight (P=0.01) and fetal birth weight (P=0.03), as well as the length of the third stage of labour (P=0.01), but not the length of the first stage of labour. Induction of labour with oxytocic agents is associated with greater blood loss. However, increased blood loss is not due to precipitate labour alone.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

The prevalence of positive anticardiolipin antibody in Jamaican women with spontaneous abortion and the correlation with past clinical history.

One hundred and thirty-eight (138) pregnant women who had spontaneous abortions were screened for immunoglobulin G (IgG) antibodies to cardiolipin (aCL) by enzyme immunoassay (EIA). A total of 85 (61.6%) tested negative, while 53 (38.4%) had positive aCL test results. A review of the patients' hospital notes was conducted and comparisons were made between patients with moderate/high positive (21/138, 15.2%), those with low positive (32/138, 23.1%) and those with negative aCL results (85/138, 61.6%). The variables examined were a history of previous abortions, the number of previous fetal deaths and a past history of medical problems such as thrombosis or high blood pressure. No significant differences were found between the patients with moderate/high positive aCL; low positive aCL; and those with negative aCL test results for any of the clinical variables examined. In conclusion, the prevalence of positive IgG aCL tests was high in this cohort of patients with spontaneous abortion. However, intervention is not necessary in many of these patients who have only a positive aCL test, but none of the clinical conditions of the antiphospholipid syndrome.

Abortion, Spontaneous↗
PubMed2004

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding.

Postmenopausal bleeding is traditionally investigated with invasive procedures. Recent studies in white populations have suggested that these procedures can be avoided, as ultrasonographic endometrial thickness of < 5 mm is not associated with malignancy. We performed a prospective study in 75 Jamaican Afro-Caribbean women with postmenopausal bleeding to determine whether an endometrial thickness of < 5 mm excluded endometrial cancer. We also examined the aetiology of postmenopausal bleeding and looked for possible risk factors. Double-layer transvaginal ultrasonographic measurement of the endometrial thickness was followed by hysteroscopy, suction curettage and histopathological confirmation. Correlation between imaging and pathology was not reliable. Half the patients with endometrial cancer had an endometrial thickness of between 3 mm and 4 mm. Seventy per cent of the women with endometrial thickness of greater than 5 mm had benign pathology. Additionally, the following characteristics were found to be more strongly associated with women with endometrial cancer: age over 65 years and 5 or more years since menopause. However parity < 2 appeared not to have a significant effect.

Age Factors↗
PubMed2004

Should euthanasia be legal? An international survey of neonatal intensive care units staff.

OBJECTIVE: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. DESIGN: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom); 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively). MAIN OUTCOME MEASURE: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now". RESULTS: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now. CONCLUSIONS: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.

Adult↗
PubMed2004

Discrepancies between clinical and postmortem diagnoses in Jamaica: a study from the University Hospital of the West Indies.

AIMS: It has previously been shown that the low necropsy request rate at the University Hospital of the West Indies (UHWI) in Jamaica (35.3%) results primarily from clinicians' confidence in clinical diagnoses and laboratory investigations. This study aimed to determine the rates of discrepancy between clinical and necropsy diagnoses at the UHWI, because many previous studies from other institutions have shown persistent high rates of discrepancy, despite advances in medical investigative technology over the past several years. METHODS: Data were extracted retrospectively from consecutive necropsies performed at the UHWI over a two year period. The data were analysed to determine the categories and rates of discrepancy, and to determine the relation between discrepancy rates and age, sex, type and number of diagnoses for each patient, hospital service, and length of hospitalisation. RESULTS: Necropsies were performed on 446 patients; 348 were suitable for further analysis. The overall discrepancy rate was 48.4% and the diagnoses with the highest individual discrepancy rates were pneumonia (73.5%), pulmonary thromboembolism (68.3%), and myocardial infarction (66.7%). Males and older patients were more likely to have discrepant diagnoses. There was a high frequency of discrepancies in patients who died within 24 hours of admission, but there was no consistent relation between length of hospitalisation and discrepancy rate. CONCLUSIONS: The high discrepancy rates documented at the UHWI are similar to those reported globally. This study supports previous attestations that the necropsy remains a vital tool for determining diagnostic accuracy, despite modern modalities of clinical investigation and diagnosis.

Adolescent↗
PubMed2004

Effect of the oral contraceptive pill on patients undergoing controlled ovarian hyperstimulation.

This is a retrospective analysis of 89 patients who were undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in the Fertility Management Unit of the Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies. Twenty-eight patients (Group A), who did not receive oral contraceptive pills prior to controlled ovarian hyperstimulation (COH) were compared with 61 patients in Group B treated with oral contraceptive pills for two months prior to undergoing COH assisted reproduction using the long protocol. The number of follicles, oocytes, estimated oestradiol levels on the day of administration of human chorionic gonadotrophin (hCG), pregnancy rates, miscarriage rates and the incidence of patients who developed ovarian hyperstimulation syndrome (OHSS) were the main outcome measures. The mean age and haematocrit were the same in each group. The number of follicles retrieved tended to be higher in Group A than in Group B (median 8 versus 6, p = 0.06) with significantly more oocytes being retrieved in Group A than Group B (p < 0.05). There were no statistically significant differences between the two groups in oestradiol levels, the proportion of patients with polycystic ovarian disease, the proportion of women who developed ovarian hyper-stimulation syndrome or pregnancy outcomes. There was no difference between the groups in measures of clinical severity of OHSS. In a logistic regression model the significant predictors of OHSS were haematocrit and oestradiol levels. There appeared to be no significant clinical benefit in administering oral contraceptive pills for two months to patients prior to COH.

Adult↗