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Biomedical subjects

S Ferry

Publications and source records attributed to S Ferry.

At least 19 recordsLinked to original sources
PubMed1995

Number of children as a risk factor for low back pain in men and women.

OBJECTIVE: To estimate the influence of the number of liveborn children on the risk of low back pain. METHODS: The study design was a cross-sectional population-based survey. The 4,501 respondents to a postal survey were asked to provide data on the occurrence of low back pain and on any children they had. Data on some potential confounding variables were also obtained. RESULTS: There was an increased risk of low back pain in those who were married compared with those who were unmarried, among both men (odds ratio 1.7) and women (odds ratio 1.6). Among married individuals, there was a linear trend of increasing risk with increasing numbers of children. CONCLUSION: The risk of low back pain is related more to childrearing than to childbearing, although this effect might be partially mediated by unknown confounders associated with increasing family size.

Adolescent↗
PubMed1995

Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners.

BACKGROUND: Recent guidelines recommend that patients with obvious acute myocardial infarction receive thrombolysis, unless contraindicated, within 60-90 minutes of summoning assistance. If this target is to be achieved, an increasing number of general practitioners are likely to be involved in the administration of thrombolytic agents. AIM: This study aimed to assess the practicality and safety of thrombolysis with anistreplase when given by general practitioners. METHOD: An observational study was conducted in 805 general practices throughout the United Kingdom. Between March 1991 and September 1992, a total of 3383 patients with a clinical diagnosis of myocardial infarction were recruited--888 by 344 general practitioners who wished to include anistreplase in their management of myocardial infarction ('user' group) and 2495 by 776 general practitioners who did not wish to use anistreplase but who were willing to provide information about their cases ('comparison' group). RESULTS: More than half the patients were seen within two hours of onset of symptoms. A high frequency of contra-indications to thrombolysis, diagnostic uncertainty, and other, mainly practical, reasons limited the number of occasions on which anistreplase was administered. Thus, only 310 patients were given anistreplase in the community. The general practitioners in the study used anistreplase safely. Their diagnostic accuracy was high (of the 310 patients given anistreplase 69% had a definite, possible or probably myocardial infarction, 4% a definite non-cardiac diagnosis), the number of patients given anistreplase in spite of a documented contraindication was small (seven patients), and the doctors appeared to be aware of potential bleeding problems associated with thrombolysis. In all cases, the complications of acute myocardial infarction appeared to be managed appropriately. CONCLUSION: General practitioners can use anistreplase both appropriately and safely in the early management of acute myocardial infarction. Recognized contraindications to thrombolysis and practicalities of diagnosis and drug administration may, however, limit the number of occasions on which anistreplase is used.

Adult↗
PubMed1994

Effect of cardiopulmonary bypass on plasma concentrations of diltiazem and its two active metabolites.

Diltiazem is often used to prevent myocardial ischaemia during the perioperative period of coronary artery bypass surgery. The purpose of this study was to investigate the effect of cardiopulmonary bypass (CPB) on plasma concentrations of diltiazem and of its two main and active metabolites (N-monodemethyldiltiazem (N-desmethyldiltiazem) and desacetyldiltiazem). The patients were administered their usual treatment during the preoperative days. The last dose was administered immediately before anaesthesia. At the onset of CPB, a significant decrease in the plasma concentrations of diltiazem and its metabolites was observed, whereas the variation was slight and not significant when the plasma concentrations were corrected for haemodilution. These results confirm that the decrease observed at the initiation of the bypass procedure can be ascribed to the haemodilution induced by the CPB. During CPB, the concentrations of diltiazem and its metabolites remained constant suggesting that the rate of metabolism and excretion of the drug was altered during the bypass procedure. At the end of CPB, there was no increase of drug plasma concentrations suggesting that no redistribution of diltiazem from tissues to plasma occurred. Furthermore, this study shows that only 33% of subjects have therapeutic levels of diltiazem before anaesthesia, and that all subjects have subtherapeutic levels during and after the CPB. These results suggest that a higher chronic oral dose of the drug should be given in patients undergoing cardiac surgery with CPB.

Aged↗
PubMed1993

Electrophysiologic effects of a potassium channel activator (pinacidil) on repolarization parameters in healthy volunteers: a surface ECG study.

About a quarter to a third of patients receiving pinacidil, a new cyanoguanidine vasodilator, show ECG changes, in particular T-wave modifications that sometimes mimic myocardial ischemia. To investigate these changes, we performed a randomized placebo-controlled trial in 10 carefully selected, healthy subjects who received single oral doses of either pinacidil (25 mg), quinidine (330 mg), and placebo. Quinidine, which induces specific modifications to the surface ECG signal, was used as an internal control. The complete experimental design involved five consecutive administrations of the drugs in random order: pinacidil (twice), quinidine (twice), and placebo (once), separated by a week-long washout period. Electrophysiologic data acquisition and signal analysis were performed with the Lyon vectocardiographic processing system. Pinacidil decreased T-wave amplitude (-0.26 +/- 0.1 mV) significantly as compared with placebo (-0.14 +/- 0.06 mV), but did not change the duration of the T-wave. Although the cardiac rate increased with pinacidil, the QTc interval remained constant. Conversely, quinidine did not modify the RR interval but significantly increased duration of the T-wave (+67 +/- 20 ms) and QTc interval (+53 +/- 13 ms) as compared with placebo (+17 +/- 13 and +18 +/- 11 ms). In addition, no specific ischemic changes to the T-loop were observed with pinacidil. The modifications to the surface ECG signal caused by pinacidil appear to be drug-specific and related to its electrophysiologic properties rather than involving any ischemic mechanism. Such an approach may be useful for describing morphologic ECG changes caused by new drugs and identifying possible underlying electrophysiologic mechanism(s), which should then be confirmed in further studies.

Administration, Oral↗
PubMed1991

Modified high-performance liquid chromatographic method for the determination of ganciclovir in plasma from patients with severe renal impairment.

Using the rapid and sensitive high-performance liquid chromatographic (HPLC) method previously described for the analysis of ganciclovir in plasma, we have observed an interfering peak which co-elutes with the peak of ganciclovir in plasma samples from heart-transplant patients with severe renal insufficiency. A slight modification of this method allows the separation of the two peaks. The modified HPLC method, presented in this paper, is suitable for the accurate determination of ganciclovir in plasma from patients with severe renal impairment.

Chromatography, High Pressure Liquid↗
PubMed1991

High-performance liquid chromatographic determination of ganciclovir in plasma.

A rapid, selective and sensitive isocratic reversed-phase high-performance liquid chromatographic method for the determination of ganciclovir in plasma samples was developed. This method, which was applied to the analysis of plasma ganciclovir from heart transplant patients under ganciclovir therapy for cytomegalovirus infections, represents a suitable analytical tool for drug monitoring and pharmacokinetic investigations.

Chromatography, High Pressure Liquid↗
PubMed1991

Pharmacokinetics of methohexital during cardiovascular surgery with cardiopulmonary bypass.

The pharmacokinetics of methohexital after intravenous bolus administration was studied during cardiovascular surgery with cardiopulmonary bypass. The effect of body temperature (normothermia and hypothermia) during cardiopulmonary bypass on methohexital pharmacokinetics was investigated. The pharmacokinetic data obtained were compared with those from vascular surgery without cardiopulmonary bypass. A marked decrease in plasma methohexital concentrations and therefore in area under curve and a significant increase in clearance and in volume of distribution were observed in the cardiopulmonary bypass groups compared to the vascular surgery group without cardiopulmonary bypass. However, the elimination half-life and the mean residence time were similar in the 2 groups. Furthermore, the study shows that body temperature during cardiopulmonary bypass does not influence methohexital pharmacokinetics.

Adult↗
PubMed1990

Optimized urinary microscopy for assessment of bacteriuria in primary care.

Microscopy of wet-stained urinary sediment as an indicator of bacteriuria was evaluated in 418 consecutive primary care visits in a small community. Delivery of morning urine was encouraged and contributed to bladder incubation times of 4 or more hours in 79% of the visits; the overall culture positivity was about 80%. Bacteria or leukocytes alone or together as minimal requirements were suboptimal microscopy criteria for bacteriuria, whereas a minimum of moderate amounts of bacteria or 5 leukocytes per high-power field (x400) as a cutoff point yielded the best diagnostic accuracy. Optimization of urinary sediment microscopy in this way resulted in a desirable high sensitivity (97%) and efficacy (86%) in acutely symptomatic patients, as well as reasonably high efficacy (79%) in other patients, independent of sex or bladder incubation time. The method's simplicity and speed recommend it for use in primary care, particularly in patients with acute symptoms of urinary tract infection.

Bacteriuria↗
PubMed1989

A controlled study of Dextran 40: effect on cerebral blood flow and metabolic rates in acute head trauma.

A controlled double-blind evaluation of the effects of Dextran 40 at different concentrations on cerebral blood flow (CBF), cerebral oxygen consumption (CMRO2) and cerebral lactate production (CMRLact) was carried out. We studied 40 patients in coma due to recent head injury. Concentrations of Dextran solution were not significantly related to variations in CBF and metabolic rate over the period of infusion. The lack of effect of the Dextran infusion may be explained by the absence of global brain ischemia in these patients at the time of the study. The very low initial CBF values were a consequence of brain metabolic depression and not a sign of global ischaemia. The rheological benefits of treatment with Dextran 40 in head injured patients should preferably be investigated using techniques which permit detection of local changes in CBF and metabolism.

Adolescent↗
PubMed1989

Uricult and Sensicult dipslides for diagnosis of bacteriuria and prediction of drug resistance in primary health care.

Uricult dipslide as an indicator of bacteriuria yielded acceptable results in primary health care (PHC), and readings by local staffs were similar to those by laboratory technicians. Sensicult dipslide detected somewhat fewer bacteriurias and predicted bacterial drug sensitivity better than resistance (predictive values 93% and 50%, respectively). The mean risk of bacterial drug resistance against seven common urinary tract infection (UTI) antibiotics in PHC was 17%. The use of Sensicult for targeting UTI therapy resulted in an average risk of 7% for prescribing drugs to which the organism was resistant. The corresponding risk with Uricult for classification of UTI bacteria by Gram grouping, lactose and catalase reactions, and local guidelines for therapy of different bacterial groups, was also 7%. The latter method is simple, offers qualitative, and thus prognostic information, but can be further improved.

Bacteriuria↗
PubMed1988

A comparative evaluation of the effects of propafenone and lidocaine on early ventricular arrhythmias after acute myocardial infarction.

A double-blind, placebo-controlled trial comparing the antiarrhythmic effects of lidocaine (given intravenously as a bolus injection of 100 mg followed by an infusion of 2 mg min-1) and propafenone (given as a bolus of 105 mg followed by 300 mg orally every 8 h) was conducted in the first 24 h following acute myocardial infarction. Analysis of ventricular arrhythmias was carried out by Holter recordings. The three treatment groups, propafenone (36 patients), lidocaine (28 patients), and placebo (25 patients), did not differ with respect to age, gender, prevalence of previous infarction, delay from the onset of pain to hospitalization, clinical features on entry (the patients with heart failure or malignant arrhythmias were excluded), site of acute myocardial infarction, or CPK peak. A decrease in the number of ventricular premature beats was noted with lidocaine, but was not statistically significant. The analysis of the first 8 h showed trends suggesting that only lidocaine could suppress complex arrhythmias, couplets and ventricular tachycardia. The drugs were well tolerated. Mean plasma concentrations of propafenone and lidocaine were 517 +/- 464 ng ml-1 and 3.84 +/- 1.10 mg l-1, respectively. In conclusion, this study does not favour the use of propafenone as an alternative to lidocaine therapy during the acute phase of myocardial infarction.

Anti-Arrhythmia Agents↗
PubMed1988

Clinical and bacteriological effects of therapy of urinary tract infection in primary health care: relation to in vitro sensitivity testing.

17 primary health care (PHC) centres participated in a 1-month evaluation of a county urinary tract infection (UTI) management program. A total of 302 patients contributing 355 episodes, dominated by female (93%), lower symptomatic (75%) and Escherichia coli (74%) episodes were studied. In therapeutic failure gram-negative bacteria other than E. coli showed an increased prevalence whereas Staphylococcus saprophyticus was not found. The general pattern of drug resistance was little influenced by UTI history and the mean pretherapy prevalence of resistance to the 7 antibacterial agents studied was low (7%). Drug resistance was increased in failure (mean 24%) also for agents not used for therapy (sulphonamides and nitrofurantoin) but not in early or repeated recurrence. UTI symptoms were eradicated in only two-thirds of bacteriologically cured episodes but in one-third of the failures at the posttreatment control. On average, therapy resulted in 8% bacteriological failure and 12% early recurrence. The bacteriological cure rate was the same irrespective of whether the infecting bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, sensitivity testing of isolates is rarely needed in sporadic or recurrent UTI in PHC but may be relevant in failure. In order to be of prognostic value in uncomplicated UTI high-level breakpoints focusing more on peak urinary drug concentrations need to be studied.

Adolescent↗
PubMed1987

Short-term nalidixic acid plus sodium citrate in acute lower urinary tract infection.

Low-dose nalidixic acid (0.66 g) in combination with 4 g of sodium citrate (NAC) was evaluated in acute lower UTI. In college-age females (n = 24) given NAC every 8 h for 3 days the nalidixic acid (NA) susceptible infecting strain was eradicated in 100% of the patients and recurrence during the 1 month follow-up period occurred in 1 case (5%) classified as relapse. In a following study the corresponding rates in general practice (GP) patients (n = 71) were 90% and 17%, respectively, irrespective of treatment with NAC every 12 h for 3 days or 5 days. The failures observed in GP were due to persistence of (or immediate reinfection by) the original infecting strain (4%) or its NA resistant mutant (6%). Emergence of NA resistance was associated with high age of the patient and a high incidence of NA resistant mutants in the infecting Escherichia coli strain. NA susceptible failure and recurrence during follow-up occurred primarily in younger GP patients. The recurrences were equally often classified as relapse (6 cases) as reinfection (5 cases). About 20% of the patients reported rather innocuous transient side effects of NAC and interruption of medication occurred in 1 case (0.6%).

Adolescent↗
PubMed1987

Urinary tract infection in primary health care in northern Sweden. I. Epidemiology.

During a 12-month study at the primary health care (PHC) centre in Vännäs (population 8,000) 632 encounters by 265 individuals because of suspected urinary tract infection (UTI) or control after treatment resulted in 279 episodes of bacteriuria in 185 patients. Nine per cent of the episodes concerned patients with indwelling catheter or incontinence requiring other aids. Symptoms of lower and higher UTI were recorded in 56 and 12%, respectively, whereas one third of the episodes were associated with vague or no symptoms and discovered mainly at planned treatment controls. The annual incidence of bacteriuria recorded increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised 13% of the episodes, increased after middle age and contributed 40% at greater than or equal to 80 years of age. The risk of recurrence (on average 50% during the year studied) was relatively independent of sex and age. No seasonal variation of UTI was observed except for a peak in late summer due to Staphylococcus saprophyticus confined to females aged 15-64 years and causing 28% of the episodes in August. Although UTI in PHC appears to be similar globally it represents a far more complex patient group than indicated by the UTI drug trials frequently published.

Adolescent↗