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Biomedical subjects

P Clarke

Publications and source records attributed to P Clarke.

At least 145 records · Page 8Linked to original sources
PubMed1985

Amiodarone. The dilemma of hyperthyroxinaemia and the treatment of thyrotoxicosis.

The use of amiodarone, a drug which is prescribed increasingly as an anti-anginal and anti-arrhythmic agent, necessitates a high index of suspicion for the development of thyroid disorders, especially thyrotoxicosis. Two cases, which illustrate the diagnostic dilemma of hyperthyroxinaemia and the poor response to antithyroid medication, are described. During amiodarone therapy, the clinical features of thyrotoxicosis may be masked or atypical, and the choice of therapy is complicated by a delayed response to thioamide drugs and possible contraindication for beta-blocking agents which necessitates the use of glucocorticoid drugs in some patients.

Aged↗
PubMed1985

Responsiveness to oral diazepam in the elderly: relationship to total and free plasma concentrations.

The immediate and residual response to single doses of oral diazepam 10 mg was measured in 11 young and 12 elderly healthy volunteers using postural sway, digit symbol substitution scores and subjective ratings. The effect on postural sway was markedly accentuated in the older volunteers, but the difference between groups in the effect on the other measures used did not achieve significance. The corresponding plasma total diazepam concentrations were lower in the older subjects beyond 0.5 h post dose and the concentrations of plasma desmethyldiazepam did not differ between the groups. Diazepam plasma protein binding was significantly reduced in the elderly subjects, but the plasma free (unbound) diazepam concentrations did not exceed those in the young group. There was poor correlation between the responses measured and the concentrations of either total diazepam, desmethyldiazepam or free diazepam. The results suggest the occurrence of a non-uniform effect of age on different aspects of benzodiazepine response, and that where an accentuated effect occurs the mechanisms are substantially pharmacodynamic.

Adult↗
PubMed1984

Seven years experience of home management in pregnancy in women with insulin-dependent diabetes.

Fifty-eight of a consecutive series of 75 pregnancies in women with insulin-dependent diabetes went into the third trimester. Diabetes was managed by home blood glucose monitoring and women were not routinely admitted at any stage before delivery. The mean number of in-patient days before delivery was 15 for the whole series but has been reduced to 9 during the past four years. Each woman performed an average of 171 blood glucose measurements during her pregnancy. Mean blood glucose (including post-prandial levels) fell significantly from 7.9 mmol/l in the first trimester to 7.3 in the second and 6.4 in the third. Mean percentage of haemoglobin A1 was within the normal range in the second and third trimesters. The cesarean section rate was high at 66% but there were no perinatal deaths. Three infants had congenital abnormalities. We conclude that home blood glucose monitoring is a safe and effective way of managing pregnant diabetic women as out-patients. The cost of meters and sticks is repaid many times over in the saving of hospital costs. In addition, home blood glucose monitoring is popular with the patients and many choose to continue it after delivery.

Blood Glucose↗
PubMed1982

Insulin-induced hypoglycaemia in an accident and emergency department: the tip of an iceberg?

In one year a prospective survey in a large accident and emergency department identified 204 admissions of adults with severe hypoglycaemia, 200 in insulin-treated patients. Ninety-six had one admission while 34 others were admitted on 104 occasions. Of the 130 patients, 111 attended diabetic clinics in Nottingham, forming 9% of a known clinic population of 1229 on insulin treatment. Since many other episodes of hypoglycaemia were presumably treated outside hospital, 9% a year is a minimum estimate of the incidence of severe hypoglycaemia in our area. The mean insulin dose was 1.2 units/kilogram/day for those admitted twice or more and 0.9 U/kg/day for those admitted once; these doses were significantly higher than those of an age-matched clinic population. A year after the latest admission with hypoglycaemia, the mean insulin dose in the group with two or more admissions had fallen to 0.8 U/kg/day, suggesting that over-treatment had been an important causal factor. A similarly high incidence has been reported in other studies, and we believe that it is due mainly to the inadequacy of conventional subcutaneous insulin treatment.

Adolescent↗
PubMed1982

The nucleotide sequence of the araC regulatory gene in Salmonella typhimurium LT2.

The nucleotide sequence of the araC regulatory gene of Salmonella typhimurium LT2 has been determined. This sequence and the predicted araC translational product are compared to their counterparts in Escherichia coli. The two genes code for similar products although the S. typhimurium protein is eleven amino acids shorter than the E. coli protein. The predicted amino acid sequences are 92% conserved and the DNA sequences are 82% conserved for the common regions of the two genes.

Amino Acid Sequence↗
PubMed1981

The patient is the expert: a technique for teaching interviewing skills.

Aspects of a teaching development intended to encourage patient-centredness in medical interviewing is discussed. Patients are asked by their local general practitioner to volunteer their time in order to be interviewed by medical students and then to stay on afterwards to discuss their impressions of the students' behaviour. It is argued that this approach to teaching interviewing skills enables students to examine the assumptions they make about the patient and to become aware of their difficulties in discussing sensitive issues.

Education, Medical, Undergraduate↗
PubMed1981

Cardiovascular, sedative and anticholinergic effects of amitriptyline and zimelidine in young and elderly volunteers.

Single doses of amitriptyline (50 mg) and zimelidine (100 mg) were administered orally to 4 young and 4 elderly healthy volunteers (aged 21--26 and 68--75 respectively) in a comparative study of the two drugs. Systolic time intervals, supine and standing blood pressure, salivary flow and indices of sedation were measured at regular intervals up to 6 hours post dose. No conclusive changes in the QS2 interval, left ventricular ejection time (LVETc) LVET index, pre-ejection period (PEPc), resting heart rate, or blood pressures were observed with either drug. Salivary flow was reduced by about 40% at 3.5 hours and 50% at 5.5 hours after ingestion of amitriptyline. No change in salivary flow was observed after zimelidine (significant difference between treatments; P less than 0.01 at 3.5 and 5.5 hours). Subjective drowsiness as measured by visual analogue ratings was significantly greater for amitriptyline at 3.5 hours (P less than 0.01). Postural sway was also increased by amitriptyline but not zimelidine (difference between treatments significant at 3.5 and 5.5 hours; P less than 0.01 and 0.05 respectively). Auditory reaction time increased with amitriptyline, the difference between treatments achieving significance at 5.5 hours. No differences in response to either drug between young and elderly volunteers were demonstrable in these small groups, although variability was greater in the older group. Possible implications of these findings for the treatment of depression in the elderly are discussed.

Adult↗
PubMed1980

Sex differences in the inheritance of some anthropometric characters in twins.

Biometrical genetical techniques have been applied to the analysis of certain anthropometric characters measured in 134 pairs of adult twins. After allowing for assortative mating it appears that there is a family environment (E2) component for variation in height larger than previously reported. "Fatness" traits - weight, ponderal index, and skinfold thickness - all show higher heritabilities in males and substantial E2 components in females, and reasons for this are discussed. The same is true for cephalic index and forearm length but the reason for these differences is not so obvious. Head length shows a much higher heritability than head breadth. A larger sample of DZ opposite-sex pairs would allow more powerful discrimination, but the variety of patterns of variation revealed by the model-fitting approach used here justify its use over more traditional techniques.

Anthropometry↗