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Biomedical subjects

A H Knight

Publications and source records attributed to A H Knight.

At least 19 recordsLinked to original sources
PubMed2002

Current methods of transfer of young people with Type 1 diabetes to adult services.

AIMS: To determine the efficacy and patient perception of various transfer procedures from paediatric to adult diabetes services. METHODS: Comparison between four districts in the Oxford Region employing different transfer methods, by retrospective study of case records and interviews of patients recently transferred from paediatric diabetes clinics. The main outcome measures were age at transfer, clinic attendance rates, HbA1c measurements and questionnaire responses. RESULTS: Two hundred and twenty-nine subjects (57% males) > 18 years old in 1998 and diagnosed with Type 1 diabetes < 16 years of age between 1985 and 1995, identified from the regional diabetes register. The notes audit was completed for 222 (97%) and 164 (72%) were interviewed by a single research nurse. Mean age at transfer was 17.9 years (range 13.3-22.4 years). Few young people were lost to follow-up at the point of transfer. There was a high rate of clinic attendance (at least 6 monthly) 2 years pretransfer (94%), but this declined to 57% 2 years post-transfer (P < 0.0005). There was large interdistrict variation in clinic attendance 2 years post-transfer (29% to 71%); higher rates were seen in districts where young people had the opportunity to meet the adult diabetes consultant prior to transfer. The importance of this opportunity was confirmed by questionnaire responses on interview. CONCLUSIONS: Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.

Adolescent↗
PubMed1986

A district screening and treatment service for diabetic retinopathy.

A District Screening and Treatment Service for diabetic retinopathy using diabetic clinic staff is described. From 1978 to 1984 a total of 1195 diabetics entered the screening programme in a district with a population of 136 700. From 1982, when laser treatment became available locally, the average number of patients from the district requiring treatment for the first time per year was 14.0 for proliferative retinopathy and 11.3 for maculopathy. The laser was also used to treat patients from two other districts and the results of treatment from all three districts are reported. Regression of new vessels was achieved in 86% of 72 patients with proliferative retinopathy but 12 of these were also seen at the regional eye centre. Visual acuity was the same or better in 79% of the 104 eyes in 76 patients treated for maculopathy. Effective treatment can be given by a trained hospital practitioner at district level. This reduces demands on the regional centre but good liaison is necessary for difficult cases.

Adolescent↗
PubMed1983

Prevention of deterioration of renal and sensory-nerve function by more intensive management of insulin-dependent diabetic patients. A two-year randomised prospective study.

74 insulin-dependent diabetic patients with background retinopathy were randomised to continue with usual diabetic care (group U) or to a more intensive programme (group A) using ultralente insulin as basal cover and soluble insulin at mealtimes. Group A attended the clinic more frequently, received closer dietary supervision, and were taught home blood glucose monitoring. Group A had a significantly lower mean glycosylated haemoglobin level during the study, although the mean level also fell in group U towards the end of year 2. Renal and sensory-nerve function were significantly better preserved in group A than in group U. Significant improvements were also seen in low-density-lipoprotein-cholesterol and whole-blood low-shear viscosity. The rate of progression of retinopathy was similar in both groups. It appears that a modest improvement in diabetic control, obtainable in most clinics, has been associated with a reduction in the progression of diabetic tissue damage.

Blood Glucose↗
PubMed1981

Unsuspected hypoglycaemia, haemoglobin A1 and diabetic control.

Control of diabetes in a group of 82 insulin-treated diabetics was assessed by in-patient 24-hour plasma glucose profiles and haemoglobin A1 (HbA1) estimation. Thirty-two of these patients (39 per cent) had hypoglycaemia (plasma glucose less than or equal to 2 mmol/l) which was rarely associated with symptoms. Twenty-seven (61 per cent) of 44 patients who took a series of out-patient pre-prandial capillary blood samples over a three-day period had hypoglycaemia. Conventional measurements of diabetic control including fasting plasma glucose and HbA1, were lower in patients with hypoglycaemia than in those without. Rebound hyperglycaemia following hypoglycaemia was not seen and its absence was not due to diabetic autonomic neuropathy. Cortisol/creatinine ratios in early morning urine samples were similar in patients with and without nocturnal hypoglycaemia, consistent with the absence or rebound hyperglycaemia. Diabetic retinopathy was less prevalent in patients with hypoglycaemia, possibly reflecting better long-term diabetic control in this group. HbA1 concentration reflects overall blood glucose control in diabetes but near-normal levels must be interpreted with caution since they may be associated with recurrent hypoglycaemia.

Adult↗
PubMed1980

Blood glucose monitors: a laboratory and patient assessment.

The four blood glucose monitors available in the United Kingdom were compared by asking the opinions of 24 patients who used each monitor for two weeks, by correlating their blood glucose results with those obtained in the laboratory, and by having the monitors examined by an electronics engineer. Of the battery-operated monitors, patients preferred the Hypocount (15) to the Glucochek (9). The mains-operated units were less popular, with little to choose between Eyetone and Reflomat. Under field conditions the blood glucose results obtained with the Glucochek correlated poorly with the standard reference method. In contrast the Hypocount, Eyetone, and Reflomat machines produced good correlations. Poor results with the Glucochek were mainly due to faulty timing systems. The patients' preference for the Hypocount was supported by tests of performance under laboratory conditions and by the electronics engineer's report.

Adolescent↗
PubMed1977

Elevation of serum alkaline phosphatase activity and related enzymes in diabetes mellitus.

Of 101 consecutive hospitalised diabetic patients, 29 had elevated serum enzyme activities attributable to recognized clinical entities; 17% of the remainder had raised alkaline phosphatase (AP) activity, 15% had raised aspartate aminotransferase (GOT) activity, and 12% raised lactate dehydrogenase (LDH) activity in serum. Ketoacidosis and death within 3 months were commoner among patients with elevated serum enzyme activities than among those with normal enzymes. Study of 200 consecutive new untreated diabetics when first seen at an out-patient clinic revealed 15 with clinically explainable abnormal serum enzyme activities. Of the remainder, 11% had raised AP activity, 12% raised GOT activity, and 21% raised LDH activity in serum; these patients tended to have higher blood sugar concentrations than the subjects with normal serum enzymes. These abnormalities seem to be an intrinsic feature of diabetes mellitus which do not relate to duration, complications, or treatment of the disease. They do not seem to be directly related to hepatic involvement.

Adolescent↗
PubMed1977

Influence of the level of nitrate nutrition on ion uptake and assimilation, organic Acid accumulation, and cation-anion balance in whole tomato plants.

Tomato plants (Lycopersicon esculentum L. var. Ailsa Craig) were grown in water culture in nutrient solution in a series of 10 increasing levels of nitrate nutrition. Using whole plant data derived from analytical and yield data of individual plant parts, the fate of anion charge arising from increased NO(3) assimilation was followed in its distribution between organic anion accumulation in the plant and OH(-) efflux into the nutrient solution as calculated by excess anion over cation uptake. With increasing NO(3) nutrition the bulk of the anion charge appeared as organic anion accumulation in the plants. OH(-) efflux at a maximum accounted for only 20% of the anion charge shift. The major organic anion accumulated in response to nitrate assimilation was malate. The increase in organic anion accumulation was paralleled by an increase in cation concentration (K(+), Ca(2+), Mg(2+), Na(+)). Total inorganic anion levels (NO(3) (-), SO(4) (2-), H(2)PO(4) (-), Cl(-)) were relatively constant. The effect of increasing NO(3) nutrition in stimulating organic anion accumulation was much more pronounced in the tops than in the roots.It is suggested that increasing the level of NO(3) nutrition to tomato plants stimulates cation uptake and translocation as counter-ions are required to accompany NO(3) (-) ions to the upper plant parts, the major site of NO(3) reduction. On NO(3) reduction, the resulting stoichiometric accumulation of organic anions is balanced by the cations originally accompanying NO(3) (-) ions. Organic anions and cations are largely retained in the upper plant parts. The results suggest that only a small fraction of the total K absorbed by the roots can be translocated downward from the leaves to the roots in the phloem sap. The possible extent of K recirculation is thus low.

Journal Article↗
PubMed1975

The microbial flora of the vagina and its relationship to bacteriuria in diabetic and non-diabetic women.

The vaginal and urinary flora have been studied in 57 diabetic and 33 non-diabetic patients. In both populations, no correlation was found between urogenital symptoms and colonisation of the vagina. There was no greater prevalence of potentially pathogenic organisms in diabetic patients, even when control was poor. However, although not statistically significant, group B streptococci were isolated more frequently from poorly controlled diabetics. Bacteriuria was not significantly more common in diabetics. Gram-negative bacilli were found in the vagina significantly more often in bacteriuric patients; the prevalence of such organisms being four-fold greater after the menopause.

Adult↗
PubMed1975

Epilepsy and pregnancy: a study of 153 pregnancies in 59 patients.

The relation of epilepsy with gestation was studied in 59 patients through 153 pregnancies. In patients with idiopathic epilepsy, 45 per cent had more frequent fits during pregnancy, 50 per cent were unchanged, and 5 per cent were improved. The results in patients with symptomatic epilepsy were similar. Patients with a high frequency of fits in the pregestational state are likely to have an increased number when pregnant. Two cases of status epilepticus were treated successfully without interruption of pregnancy. Fourteen patients had true gestational epilepsy, 4 of whom had underlying organic disorders. Congenital heart disease occurred in 2 per cent and cleft lip or cleft lip and palate in 1 per cent of infants, all of these mothers on antiepileptic therapy. The rate was 4 and 10 times the rate in 69,000 consecutive births in the same area. Prompt control of repeated seizures during pregnancy is imperative, folic acid should be given , accumulation of water prevented, and patients who have their first fit during pregnancy should be investigated.

Anemia↗
PubMed1973

Significance of hyperamylasaemia and abdominal pain in diabetic ketoacidosis.

An analysis of 35 consecutive episodes of diabetic ketoacidosis confirmed the frequent high levels of serum amylase in this condition. Serum amylase was raised during 21 episodes (60%), and in six instances (17%) the peak level exceeded 1,000 Somogyi units per 100 ml. Hyperamylasaemia was more often found when the initial blood sugar exceeded 500 mg/100 ml, or when the onset of the episode had been relatively acute (less than 48 hours). There was no conclusive evidence in any patient to support a diagnosis of acute pancreatitis and other explanations for the hyperamylasaemia are discussed. Even grossly raised amylase levels were not associated with increased mortality or morbidity.

Abdomen↗