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Biomedical subjects

M Reid

Publications and source records attributed to M Reid.

At least 91 records · Page 5Linked to original sources
PubMed1998

Microalbuminuria, renal function and waist:hip ratio in black hypertensive Jamaicans.

OBJECTIVE: To investigate the relationship between blood pressure (BP), renal haemodynamics, anthropometric measures of obesity and urinary albumin excretion in hypertension and in a control group. METHODS: Urinary albumin, BP and anthropometric measurements were carried out in patients attending the hypertension clinic of the University Hospital of the West Indies. A randomised stratified sample was then selected for renal haemodynamic assessment. A normoalbuminuric control group without hypertension or diabetes was also selected. Renal haemodynamics was assessed by measuring glomerular filtration rate using 51-chromium edetic acid (51Cr-EDTA) and renal blood flow using 125-iodohippurate (125-PAH). RESULTS: Urinary albumin excretion was positively and significantly correlated with systolic pressure (beta = 0.011, P < 0.003, R = 0.22), current body weight (beta = 0.014, P < 0.04, R = 0.15) and the presence of diabetes (beta = 0.9, P < 0.001, R = 0.3). In the sample selected for renal haemodynamics, patients with microalbuminuria had lower age-adjusted corrected renal blood flow (P < 0.006), effective renal plasma flow (P < 0.006) and higher filtration fraction (P < 0.006) when compared with patients without microalbuminuria. Glomerular filtration rate in patients with microalbuminuria was not different from those without. Urinary albumin excretion was positively and significantly correlated with systolic pressure (beta = 0.016, P < 0.003, R = 0.40) and inversely related to corrected renal blood flow (beta = -1.13, P < 0.0002, R = 0.46). Waist:hip ratio was inversely related to corrected renal blood flow (beta = -1.74, P < 0.02, adjusted R = 0.48). CONCLUSION: Systolic BP, diabetes and body weight were significant predictors of albuminuria in our patients. Microalbuminuria and body fat distribution as assessed by waist:hip ratio were important determinants of renal haemodynamics in this population.

Albuminuria↗
PubMed1998

Pain after vasectomy.

We studied the influence of the timing of injection of bupivacaine into the vas deferens on the intensity and duration of scrotal pain following vasectomy. Forty-two patients undergoing vasectomy under general anaesthesia were randomly allocated to have the operation performed on either the left or the right side first. On the first side to be operated upon, 5 ml bupivacaine 0.5% was infiltrated along the line of the scrotal incision. The vas deferens was identified and 1 ml bupivacaine 0.5% was injected into its lumen, with 0.5 ml directed proximally and 0.5 ml directed distally. After completion of the procedure on that side, the operation continued on the other side. On this occasion, the same dose of bupivacaine was injected into the vas deferens after division and ligation, and subcutaneously along the scrotal incision after skin closure. Median [interquartile range] visual analogue pain scores on the first side to be operated upon were significantly lower than on the second side on day 1 (7 [1.5-19] vs. 11 [2.5-47]) (p < 0.01) and day 7 (0 [0-8.5] vs. 0 [0-18.8]) (p < 0.05) postoperatively. The median [interquartile range] duration of postoperative discomfort was less on the first side operated upon than on the second (3 [1-7] vs. 6 [2-7]) (p < 0.01). Although statistically significant differences occurred between the treatment groups, the actual differences were small and may not be clinically significant.

Adult↗
PubMed1998

Health status and health care costs for publicly funded patients with schizophrenia started on clozapine.

OBJECTIVE: The study examined the effect of clozapine treatment on the health care costs and health status of people with schizophrenia who are supported by public funds. METHODS: Thirty-three patients with schizophrenia hospitalized in a state facility were interviewed within one week of starting clozapine and six months later. Health status was assessed with four clinical rating scales measuring severity of psychopathology, negative symptoms, depression, and quality of life. Cost and health care utilization data were collected for the six months before and after initiation of clozapine. RESULTS: Only 52 percent of the subjects stayed on clozapine for six months. Subjects who continued on clozapine were more likely to be discharged within six months than those who did not continue. Six months after clozapine was started, health care costs showed a sayings of $11,464 per person, even after adjustment for pretreatment costs, and health status was improved. CONCLUSIONS: For subjects who continued on clozapine for six months, clozapine treatment was associated with reduced days of psychiatric hospital care, reduced overall costs despite increased outpatient treatment and residential costs, and improved health status.

Adult↗
PubMed1997

Human D(IIIa) erythrocytes: RhD protein is associated with multiple dispersed amino acid variations.

As a partial D antigen of the Rh blood group system, the D category IIIa phenotype occurs mainly in Blacks, but its molecular basis has not been defined. Here we describe studies of the D category D(IIIa) and VS+ red blood cells (RBC) from two unrelated probands by Southern blot, cDNA PCR, and nucleotide sequencing. Rh haplotyping by Sph I restriction fragment length polymorphisms indicated that the two probands carried Dce/dCe and Dce/DcE genotypes, respectively. Sequence analysis of Rh cDNAs showed that their erythroid cells expressed both D and CE transcripts. Nevertheless, the D transcripts were found to contain four nucleotide changes scattered in three exons: nt455 A-to-C (exon 3), nt602 C-to-G (exon 4), nt 654 C-to-G (exon 5), and nt667 T-to-G (exon 5). These variations resulted in the following amino acid substitutions characteristic of RhCE polypeptides: 152 Asn-to-Thr, 201 Thr-to-Arg, 218 Ile-to-Met, and 223 Phe-to-Val. The 152Thr and 223Val residues were predicted to reside in proximity to the third and fourth extracellular loops, respectively. Together, these results establish a correlation of the four amino acid changes in the RhD protein with the expression of D(IIIa) as a partial D antigen on the RBC membrane. Since the varied nucleotides identified in D(IIIa) all pre-exist in CE, they are likely to have originated from CE by templated micro-conversion event(s). The identification of a specific nt736 C-to-G transversion in CE in the two probands suggests that 245Val may involve the expression of VS antigen.

Amino Acids↗
PubMed1997

Relative effects of carbohydrates and protein on satiety -- a review of methodology.

There is some evidence that the effects of carbohydrates and protein may differ with respect to satiety. This may depend in part on the different methods of preparing these nutrients for administration. Additional factors such as timing, different delays, differential metabolism and expectations of ingested foods may contribute to different outcomes of experiments investigating the satiating effects of macronutrients. Here, studies of the relative satiating effects of carbohydrates and protein are discussed followed by a methodological discussion of the reviewed studies. Finally, suggestions for methodological improvements are given which should allow future studies to investigate more clearly the mechanisms underlying satiety.

Animals↗
PubMed1997

Urea kinetics varies in Jamaican women and men in relation to adiposity, lean body mass and protein intake.

OBJECTIVE: We have measured urea kinetics in normal adult men and women of different body composition to determine whether adiposity is associated with differences in the rate of urea production or endogenous urea hydrolysis. DESIGN: Urea kinetics were determined from the excretion of [15N15N]urea in urine over a period of 48 h following a single oral dose of [15N15N]urea, in nine lean and nine obese women and in seven light and seven heavy males while they were consuming their habitual diets. Urinary 5-L-oxoproline was measured as an index of glycine metabolic status. SETTING: The studies were carried out in the research ward of the Tropical Metabolism Research Unit, University of the West Indies. RESULTS: Successful studies were completed in eight obese and five lean women and in six heavy and five light men. When compared with lean women, in obese women the rate of urea production and hydrolysis was significantly greater and this difference could not be accounted for by the greater fat-free mass alone, and was in part associated directly with the increase in fat mass. The rate of urea production and hydrolysis was greater in heavy men than in light men, a difference which was attributed to an increase in dietary protein. In obese women and heavy men there was a significantly higher rate of excretion of 5-L-oxoproline in urine when compared with lean women and lean men respectively. CONCLUSION: This paper highlights the difficulty in identifying an appropriate reference with which to express results in people of different body composition. In obese women urea production and the hydrolysis of urea are increased, in part related to the increased fat-free mass, but also related to the increased fat mass itself. In obese women and men on high protein diets the greater rate of hydrolysis urea may be a reflection of an increased demand for the synthesis of non-essential amino acids, especially glycine.

Adult↗
PubMed1997

Oesophageal ECG in a child for burns surgery.

Continuous monitoring of heart rate and rhythm are regarded as minimal standards of monitoring during anaesthesia. However, when the thoracic area is exposed for surgery as for debridement of burns and split skin grafting then placement of surface electrodes for electrocardiographic (ECG) monitoring is not possible. We report the intraoperative use of an old technique, oesophageal ECG (OesECG) in a child presenting for major burns surgery. The positioning of the probe, electrical safety and P-QRS morphology, are discussed.

Burns↗
PubMed1997

The KEL24 and KEL14 alleles of the Kell blood group system.

BACKGROUND: The Kell blood group system consists of at least 21 antigens, which may be classified into five sets of alleles and at least 10 independently expressed antigens. The molecular basis of four of the five sets of alleles has been described; point mutations in KEL leading to amino acid substitutions characterize the alleles. In this study, the point mutation associated with the remaining allele, KEL14/KEL24, was determined. STUDY DESIGN AND METHODS: The 19 exons of KEL were amplified from genomic DNA by a polymerase chain reaction (PCR) procedure. The PCR products were sequenced. DNA sequences from unrelated KEL:14,24 and KEL:-14,24 individuals were compared to the DNA sequence of the common KEL:14,-24 phenotype. RESULTS: DNA from the KEL:14,24 person yielded both G and C at nt 659, indicating an Arg and Pro polymorphism in amino acid residue 180 of Kell protein. DNA from the KEL:-14,24 person had a G659C mutation in exon 6, indicating an Arg180Pro substitution. The G659C change introduces an Hae III restriction enzyme site, which was used to confirm the base mutations by restriction fragment length polymorphism analysis of the PCR products. CONCLUSION: A G659C mutation, predicting an Arg180Pro change in Kell protein, is associated with the KEL14/KEL24 allele.

Alleles↗
PubMed1997

Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants.

AIMS: To improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity. METHODS: A prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student's t test, the Mann-Whitney U test, the chi 2 test and logistic regression. RESULTS: There was an excess of sicker babies in group A, as measured by initial disease severity (P < 0.01), but mean total energy intakes were significantly higher (P < 0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay. CONCLUSION: Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in discharge, but did not decrease pulmonary morbidity or shorten hospital stay.

Bacterial Infections↗
PubMed1997

Use of GUM services and information and views held by first time service users in a large UK city: implications for information provision.

The aim of this study was to examine the relationship between information and views held by service users before obtaining help from a genitourinary medicine (GUM) service and the accessibility and use of the service, and to determine potential intervention measures for change. A structured questionnaire was completed by 292 first-time GUM service users in a large UK city in 1994. Overall 94 (57.7%) of 163 male service users and 59 (48.4%) of 122 female service users had some information about the service before seeking help, although this difference was not significant. Only 92 (31.5%) knew the service was open-access. The main source of information was through general practitioners (GPs), with personal contact as the second most common information source. Two hundred and fifteen (73.6%) used the service within 2 weeks of needing help and 104 (35.6%) of these felt there was delay, but reporting delay was not associated with having information about the service. The majority indicated feeling nervous and/or embarrassed about using the service. Female service users were significantly more likely to feel nervous or embarrassed than male service were (P < 0.05). Service users were significantly more likely to feel nervous when they had no information about the service than if they knew something about the service (P < 0.01). Most service users regarded the service as dealing with sexually transmitted infections (STIs), and most intended to use the service for this reason. However, whilst many service users indicated knowledge about non-STI services, including HIV counselling and testing, relatively few intended to use these services. Most service users (269, 92.1%) were in favour of increased availability information about GUM clinics mainly through written media but also through GPs. The results of this study show a clear need to project increased awareness and information about this GUM service so as to encourage use of the range of services available and promote more positive feelings about using the service. Information in written media as well as through other health professionals may be of benefit. Further work is needed to study the effect of information provision in influencing the large number of potential service users to make use of sexual health services.

Counseling↗
PubMed1997

A new experimental model: the vascular pedicled cutaneous flap over the mid-dorsum of the rat.

The cutaneous vascular anatomy of the mid-dorsum in the rat and its role in flap design was studied in the rat. The investigation consisted of anatomic dissection, methylene blue injection into the axial artery, and flap harvesting in live animals. Dissection and injection revealed that the mid-dorsum of the rat derives its blood supply largely from the 10th intercostal artery, here referred to as the middle dorsal artery, which originates from the lateral aspect of the thoracic aorta. The cutaneous vascular territory of the middle dorsal artery was defined as follows: the medial border, midline of the dorsum; the lateral border, midaxillary line; the cephalic border, a line joining the medial and lateral borders midway between the level of the axilla proximally and 1 cm above the base of the rib cage distally; and the caudal border, a line drawn midway between the latter point proximally and the anterior superior iliac spine distally. Both unilateral and bilateral vascular pedicled island cutaneous flaps were harvested in living rats based on and exceeding the vascular territory delimited by methylene blue injection. Flaps limited to this territory with intact middle dorsal arteries showed total survival, while oversized flaps underwent partial necrosis peripherally. Because of its simplicity, reliability, and consistent vascularity, this flap has potential applications in the study of flap hemodynamics.

Animals↗
PubMed1996

Randomised, controlled trial of efficacy of midwife-managed care.

BACKGROUND: Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction. METHODS: We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat. FINDINGS: Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]). INTERPRETATION: We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.

Adult↗
PubMed1996

A new low-incidence antigen in the Kell blood group system: VLAN (KEL25).

A multilaboratory investigation has identified a new low-incidence antigen "VLAN' on the red cells of a blood donor. The VLAN antigen is destroyed by 2-aminoethylisothiouronium bromide treatment of the donor's red cells suggesting an association with the Kell system. Monoclonal antibody-specific immobilization of erythrocyte antigen analysis with anti-VLAN and with several mouse monoclonal antibodies directed at epitopes on the Kell glycoprotein gave positive results, indicating that the VLAN antigen is located on the Kell glycoprotein. The VLAN red blood cells have the common Kell phenotype: KEL:-1,2,-3,4,5,-6,7,-10,11,12,13,14,-17,18,19,-21,22,-23,-24. Additional serologic data indicate that the VLAN antigen is not part of any other ISBT blood group system, collection or series. A family study showed that the VLAN antigen is inherited since the red cells of two sisters and one niece of the propositus are also VLAN+. The ISBT Working Party on Terminology for Red Cell Surface Antigens has assigned VLAN to the Kell blood group system as KEL25 (number for computer listings 006025).

Antigens↗