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Biomedical subjects

S Noble

Publications and source records attributed to S Noble.

At least 19 recordsLinked to original sources
PubMed2006

Differences in weaning practice, food and nutrient intake between breast- and formula-fed 4-month-old infants in England.

BACKGROUND: Breastfed infants may grow more slowly in the second half of infancy than formula-fed infants, differences in weaning practice may contribute. METHODS: Dietary intakes of 4-month-old infants have been investigated cross-sectionally. Diet was assessed using a structured 1-day un-weighed dietary record in 852 white singletons (72% of those invited) from a random sub-sample of infants taking part in Avon Longitudinal Study of Parents and Children. Nutrient intakes of formula-fed infants were compared by sex and with UK reference values. Estimated mean energy and nutrient intakes, mean bodyweight and daily quantities of food consumed were compared by weaning practice. RESULTS: In formula-fed infants mean energy intakes and intakes of most nutrients were adequate. There were significant differences in intakes of most nutrients by weaning practice; however, mean energy intake and body weight of breastfed infants was similar to formula-fed infants. Infants given formula milk were less likely to consume vegetables and fruit, and more likely to consume commercial infant drinks, compared with infants who were breastfed. In breastfed infants breast milk intake was lower if solids were given (905 g versus 818 g; P = 0.01); however, nutrient intake was not compromised. In formula-fed infants milk intake was not different in those having solids compared to those having milk only (810 g versus 795 g; P = 0.649). CONCLUSIONS: Differences in weaning practice and patterns of food consumption were seen between breast- and formula-fed infants, these may contribute to later growth differences.

Bottle Feeding↗
PubMed2005

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer.

Primary systemic therapy (PST) for operable breast cancer enables the identification of in vivo biological markers that predict response to treatment. A total of 118 patients with T2-4 N0-1 M0 primary breast cancer received six cycles of anthracycline-based PST. Clinical and radiological response was assessed before and after treatment using UICC criteria. A grading system to score pathological response was devised. Diagnostic biopsies and postchemotherapy surgical specimens were stained for oestrogen (ER) and progesterone (PgR) receptor, HER-2 and cell proliferation (Ki-67). Clinical, radiological and pathological response rates were 78, 72 and 38%, respectively. There was a strong correlation between ER and PgR staining (P < 0.0001). Higher Ki-67 proliferation indices were associated with PgR- tumours (median 28.3%, PgR+ 22.9%; P = 0.042). There was no relationship between HER-2 and other biological markers. No single pretreatment or postchemotherapy biological parameter predicted response by any modality of assessment. In all, 10 tumours changed hormone receptor classification after chemotherapy (three ER, seven PgR); HER-2 staining changed in nine cases. Median Ki-67 index was 24.9% before and 18.1% after treatment (P = 0.02); the median reduction in Ki-67 index after treatment was 21.2%. Tumours displaying >75% reduction in Ki-67 after chemotherapy were more likely to achieve a pathological response (77.8 vs 26.7%, P = 0.004).

Adult↗
PubMed2005

The perioperative challenge of nephrogenic diabetes insipidus: a multidisciplinary approach.

Nephrogenic Diabetes Insipidus (NDI) is characterised by the inability of the kidneys to concentrate urine in response to arginine vasopressin (AVP). Such patients typically experience polyuria and polydipsia because of this inability to autoregulate their water balance. This provides a perioperative challenge that could lead to a life-threatening situation. This article documents a patient with NDI who underwent an elective bowel re-anastomosis. Two peak serum sodium values were attained. The first when the patient was retaining sodium due to an inappropriate fluid regimen and the second due to hypovolaemia. The literature is reviewed and principles for NDI perioperative management are proposed.

Anastomosis, Surgical↗
PubMed2001

Food and nutrient intake in a cohort of 8-month-old infants in the south-west of England in 1993.

OBJECTIVE: To investigate food and nutrient intakes in 8-month-old infants. DESIGN: Prospective study. SETTING: Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), south-west England. SUBJECTS: A total of 1131 singleton Caucasian infants (82% of those invited) from a 10% random sample of ALSPAC, known as Children in Focus (CIF). METHODS: Diet was assessed using a structured 3-day unweighed dietary record. Food and nutrient intakes were compared with intakes from the 6--9 month age group of a British infant feeding survey, which formed part of the National Diet and Nutrition Survey (NDNS). Nutrient intakes were compared with dietary reference values (DRV). RESULTS: Intakes of energy and most nutrients were very similar between CIF and NDNS. The main difference was in the type of fat eaten resulting in a higher polyunsaturated to saturated fatty acid ratio in CIF (0.34) compared with NDNS (0.21). Other differences included the much lower calcium and iodine intakes in CIF compared with the NDNS. Differences in the proportion of consumers of formula and cow's milk accounted for most of the nutrient differences. Energy intakes were similar to the estimated average requirements (EAR), however, breastfed infants were slightly below and non-breastfed were slightly above the EAR. Mean intakes of zinc and vitamin D were below the Reference Nutrient Intakes. CONCLUSIONS: The diets of 8-month-old infants in this study were adequate in most nutrients. Breastfed infants had slightly lower energy intakes than non-breastfed infants.

Body Weight↗
PubMed2001

Maternal employment and the initiation of breastfeeding.

UNLABELLED: This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population-based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10,530 full-term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) "any" plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with "any" plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding. CONCLUSION: Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding.

Adult↗
PubMed2001

Zoledronic acid.

Zoledronic acid (zoledronate) is a new generation bisphosphonate that inhibits osteoclast bone resorption. It was much more potent than other bisphosphonates at inhibiting 1,25-dihydroxyvitamin D3-induced hypercalcaemia in a rat model and calcium release in vitro. A single 5-minute intravenous infusion of zoledronic acid (4 or 8 mg) was significantly more effective than a 2-hour infusion of pamidronic acid (pamidronic acid disodium, pamidronate disodium) [90 mg] in normalising serum calcium levels in patients with hypercalcaemia of malignancy and resulted in a significantly longer median time to relapse (pooled analysis from 2 randomised, double-blind, parallel-group trials). There were no differences in tolerability between zoledronic acid and pamidronic acid in comparative trials; the most common events in pivotal trials were fever, anaemia, nausea, constipation and dyspnoea. Fever, hypophosphataemia and hypocalcaemia were the most common events in a small phase I trial.

Animals↗
PubMed2001

Alendronate: an update of its use in osteoporosis.

UNLABELLED: Alendronate (alendronic acid) is a nitrogen-containing bisphosphonate which binds to bone surfaces and inhibits bone resorption by osteoclasts. Oral alendronate 5 or 10 mg/day produces sustained increases in bone mineral density (BMD) in postmenopausal women with or without osteoporosis, in men with primary osteoporosis and in both men and women with or without osteoporosis receiving systemic corticosteroid therapy. Histomorphometric analyses have found that alendronate does not appear to impair bone quality. Alendronate reduced the risk of radiographic vertebral fracture, clinical vertebral fracture or hip fracture by 47 to 56% in postmenopausal women who had > or = 1 existing vertebral fracture and in those with no existing vertebral fractures but who had osteoporosis. In a number of comparative trials in postmenopausal women with osteoporosis, alendronate 10 mg/day was found to be more effective at inducing sustained increases in BMD than intranasal calcitonin, and at least as effective as conjugated estrogens and raloxifene. Alendronate 70 mg administered once weekly and 35 mg twice weekly are as effective at increasing BMD as 10 mg/day in this patient group. In clinical trials, alendronate was generally well tolerated when taken as recommended. Adverse events tended to be transient and associated with the upper GI tract, most commonly including abdominal pain, nausea, dyspepsia, acid regurgitation and musculoskeletal pain. No statistically significant differences between alendronate 10 mg/day and placebo have been found in the incidence of upper GI adverse events in large clinical trials. However, postmarketing surveillance reported a low incidence of adverse events related to the oesophagus. Specific instructions aimed at reducing the risk of upper GI adverse events have been provided by the manufacturer. CONCLUSIONS: Alendronate is effective and generally well tolerated in the treatment of women or men with primary (including postmenopausal) or corticosteroid-induced osteoporosis and in the prevention of osteoporosis in postmenopausal women. The drug has been associated with upper GI tract adverse events, although the extent to which alendronate is responsible for these events has not been clearly established. Alendronate should be considered a treatment of choice in postmenopausal women with osteoporosis. Alendronate is also a suitable treatment option for primary osteoporosis in men and for corticosteroid-induced osteoporosis in both men and women.

Adult↗
PubMed2001

Valganciclovir.

Valganciclovir is a prodrug of ganciclovir which has been developed for the treatment of cytomegalovirus (CMV) retinitis in patients with AIDS. Oral valganciclovir is rapidly absorbed and hydrolysed to ganciclovir. The oral bioavailability of ganciclovir after oral valganciclovir administration is high. Oral valganciclovir 900 mg provides a daily exposure of ganciclovir comparable to that of intravenous ganciclovir 5 mg/kg. A single, randomised, nonblind study indicated that oral valganciclovir (900mg twice daily for 3 weeks then 900 mg once daily) and intravenous ganciclovir (5 mg/kg twice daily for 3 weeks then 5 mg/kg once daily) were equally effective in the treatment of newly diagnosed CMV retinitis in 160 patients with AIDS. Valganciclovir appears to have a similar tolerability profile to intravenous ganciclovir during induction therapy in patients with AIDS and newly diagnosed CMV retinitis. During maintenance therapy with valganciclovir, the most commonly reported adverse events included neutropenia, anaemia, thrombocytopenia, gastrointestinal (including diarrhoea, nausea, vomiting and abdominal pain), fever, headache, insomnia, peripheral neuropathy, paraesthesia and retinal detachment.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Rasburicase.

Rasburicase (recombinant urate oxidase) is a uricolytic agent which has been developed for the prevention and treatment of chemotherapy-induced hyperuricaemia at a dosage of 0.15 or 0.2 mg/kg/day in patients with haematological malignancies. Significant reductions from baseline in plasma uric acid levels were seen in 3 noncomparative and 1 randomised comparative trial of rasburicase in patients with, or at high risk of, hyperuricaemia. A multicentre, nonblind, randomised trial found that patients who received intravenous rasburicase 0.2 mg/kg/day experienced an average 2.6-fold less exposure to uric acid than those who received oral allopurinol 10 mg/kg/day. There was no evidence of renal insufficiency in 3 noncomparative trials which monitored creatinine levels to assess renal function during chemotherapy and rasburicase treatment. Rasburicase was generally well tolerated in clinical trials, with skin rashes reported in approximately equals 2% of patients. Bronchospasm, nausea and vomiting, and haemolysis occurred less frequently. In all cases the patients had also received chemotherapy prior to the adverse event.

Adolescent↗
PubMed2000

Types of drinks consumed by infants at 4 and 8 months of age: a descriptive study. The ALSPAC Study Team.

OBJECTIVE: To document the type and volume of drinks given to infants and investigate whether giving supplementary drinks leads to reduced milk consumption. DESIGN: Carers were asked to record all drinks consumed by the infants in a 24-hour period at two ages, detailing the types and volume taken. SETTING: The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). SUBJECTS: A randomly chosen population sample of over 1000 infants at 4 and 8 months of age. RESULTS: The different types of milk feed were used to group infants, compare volumes consumed and look at the use of non-milk drinks. The average volume of drinks consumed over 24 hours at 4 months was 861 ml and at 8 months was 662 ml. At 4 months 69.7% consumed infant formula and 43.0% breast milk. The mean volume of milk consumed by those having only formula was 802 ml and for those having only breast milk was estimated at 850 ml. The volumes of milks consumed were slightly lower in the groups who also had supplementary drinks. A quarter of infants were given fruit drinks and 14.6% herbal drinks. Supplementary drinks and solids were more likely to be given to formula-fed than breast-fed infants. At 8 months, formula milk was consumed by 71.4% and breast milk use had decreased (22.9%) but fruit drink use had increased (squash/cordial: 55.8%, fruit juice: 14.9%), with 13.9% of infants having no infant milk at all. More infants were fed formula milk and less were fed cows' milk compared with a nationally representative British study conducted 5 years earlier. CONCLUSIONS: Many infants were given supplementary drinks by 4 months; there is some evidence that this led to a small reduction in milk intake. A minority were not being given infant milks at all by 8 months, contrary to British infant feeding recommendations.

Animals↗
PubMed2000

Racecadotril.

Racecadotril is an oral enkephalinase inhibitor used in the treatment of acute diarrhoea. It prevents the degradation of endogenous opioids (enkephalins), thereby reducing hypersecretion of water and electrolytes into the intestinal lumen. In a randomised double-blind study in 6 adult volunteers with castor oil-induced diarrhoea, racecadotril significantly reduced stool weight and stool number in comparison with placebo. Similar results have been obtained in treating castor oil-induced diarrhoea in rats. Racecadotril was significantly more effective than placebo in randomised double-blind studies in adults or children with diarrhoea (of infectious origin or in adults with HIV infection). In well controlled trials, racecadotril had efficacy similar to that of loperamide and was generally as effective as loperamide-oxide. Racecadotril had a similar tolerability profile to placebo, and was better tolerated than loperamide, in adults and children with diarrhoea. It caused significantly less constipation after resolution of diarrhoea than loperamide.

Animals↗
PubMed2000

Amprenavir: a review of its clinical potential in patients with HIV infection.

UNLABELLED: The virological/immunological efficacy of amprenavir-containing combination regimens has been evaluated in a small number of clinical trials in patients with HIV infection. Amprenavir plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) was more effective than 2 NRTIs (in treatment-naive patients) or amprenavir monotherapy (in treatment-naive or -experienced patients) in double-blind trials. In the only direct comparison with another protease inhibitor as part of triple therapy, amprenavir was less effective than indinavir in treatment-experienced (protease inhibitor-naive) patients. Amprenavir was as effective as other protease inhibitors when given with abacavir in a small nonblind trial. Amprenavir is generally well tolerated (most events are mild or moderate). GI disturbance and rash are the principal treatment-limiting effects. Preclinical data suggest that amprenavir may have a low potential for metabolic disturbances (e.g. lipodystrophy, fat redistribution); such effects have been infrequent in patients treated to date, but longer term experience is needed. 150V is the major HIV protease substitution associated with amprenavir resistance; this mutation is not seen in isolates from patients receiving other available protease inhibitors. Amprenavir-resistant isolates evaluated to date showed no significant cross-resistance to most other protease inhibitors, although some cross-resistance to ritonavir was noted. Many isolates from patients previously treated with other protease inhibitors are susceptible to amprenavir. Amprenavir offers the convenience of twice-daily administration with no food-timing or fluid restrictions, but this may be offset by the large number and size of the capsules. However, pharmacokinetic data support the use of co-administration of amprenavir and ritonavir at reduced dosages, thereby allowing a reduction in the number of amprenavir capsules. CONCLUSIONS: Amprenavir-containing combination regimens have shown virological efficacy, and have generally been well tolerated, in patients with HIV infection (primarily treatment-naive or protease inhibitor-naive). The limited number of studies available and the absence of well controlled comparisons with other triple therapies limits the conclusions that can be drawn at present. The clinical value of amprenavir for patients with isolates which are resistant to other protease inhibitors but sensitive to amprenavir, and in treatment-experienced patients in general, requires further investigation. Further evaluation of the amprenavir/ritonavir combination is awaited with interest. Like other members of its class, amprenavir has a particular profile of tolerability, resistance and administration characteristics which should be carefully considered in relation to the needs of individual patients.

Animals↗