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Biomedical subjects

B A Kirk

Publications and source records attributed to B A Kirk.

8 recordsLinked to original sources
PubMed2001

Analysis of 44,279 blood glucose estimations in relation to outcomes in 80 pregnant diabetic women.

A retrospective study was conducted to assess glycaemic control in relation to pregnancy outcomes in pre-existing and gestational diabetics. Computerised blood glucose records from 47 pre-existing diabetic patients and 33 gestational diabetics were collected prospectively and then analysed retrospectively in relation to pregnancy outcomes. There were two spontaneous miscarriages from the pre-existing diabetic cohort. A total of 44,279 individual blood glucose estimations were made. The mean fasting glucose for pre-existing diabetic patients fell significantly throughout pregnancy, being 7.7+/-2.1, 7.2+/-3.1 and 6.5+/-2.4 mmol/l, respectively, for trimesters 1,2 and 3 (P<0.01). The mean post-prandial glucose for each trimester were 8.9+/-2.0, 8.6+/-1.6 and 8.2+/-1.2 mmol/l (P<0.01). The HbAlc for pre-existing diabetic patients for each trimester was 7.5+/-1.4%, 6.1+/-1.0% and 5.9+/-0.7%, respectively. Gestational diabetic patients had a mean fasting glucose of 5.6+/-1.5 mmol/l and a mean post-prandial glucose of 8.0+/-2.1 mmol/l during trimester 3. Home glucose monitoring correlated reasonably well with first trimester HbA1c (r2=0.43, P<0.001), but this relationship became less valid as pregnancy progressed. The mean gestation at delivery was 37 weeks, although 30% of women were delivered between 34 and 37 weeks and 8% delivered before 34 weeks. Labour was induced in 49% of patients and the overall caesarean section rate was 58%. The mean birth weight for pre-existing diabetic patients was 3479 g (1410-5000 g) and for women with gestational diabetes was 3605 g (1890-5920 g). For pre-existing diabetic patients HbA1c did not correlate with birth weight; however, home blood glucose data from trimester 2 did correlate (r2=0.15, P <0.005) and there appeared to be stronger relationship with trimester 3 data (r2=0.24, P <0.005). There was no association between trimester 3 glucose data and birth weight in the gestational cohort. The babies born to pre-existing diabetic mothers had a high incidence of admission to a neonatal unit and over 50% of the babies had proven hypoglycaemia. Our present computerised system for home blood glucose monitoring has shown that for pre-existing diabetes patients but not gestational diabetic patients, glycaemic control in the second and third trimester influences birth weight. The current degree of glycaemic control in the mothers did not prevent a high rate of neonatal hypoglycaemia.

Journal Article↗
PubMed1997

Arthritic temporomandibular joint: correlation of macromolecular contrast-enhanced MR imaging parameters and histopathologic findings.

PURPOSE: To assess the utility of macromolecular contrast material-enhanced magnetic resonance (MR) imaging parameters for determining the histopathologic severity of temporomandibular joint (TMJ) arthritis. MATERIALS AND METHODS: Ovalbumin was used to induce arthritis in the TMJs of 10 previously sensitized adult white rabbits. Five rabbits composed the sham-treated control group. Dynamic spin-echo imaging was performed immediately before and for 30 minutes after injection of macromolecular contrast medium. Histologic specimens of TMJ were assessed quantitatively for arthritis. Changes in MR signal intensity were derived from the synovial and subsynovial tissues of the TMJ, and plasma volume (PV) and permeability surface area product (PS) were calculated. These MR parameters and the arthritic scores were compared between sham-treated and antigen-challenged TMJs. The relationships between MR parameters and histopathologic indexes were also determined. RESULTS: Arthritic TMJs showed marked enhancement of the synovial and subsynovial tissues over the imaging period. PS and all histopathologic indexes of arthritis were significantly greater (P < .005) in antigen-challenged than in sham-treated TMJs. PS demonstrated strong positive relationships with all histologic parameters of arthritis, indicating its utility for assessing the severity of joint inflammation. CONCLUSION: Macromolecular contrast-enhanced MR imaging enables quantification of PS and PV in inflamed joints. This technique may provide insights into the pathogenesis of joint inflammation and noninvasive monitoring of disease severity and treatment response in arthritis.

Albumins↗
PubMed1997

Effects of prenatal testosterone on sexual behavior, reproductive morphology and LH secretion in the female rat.

Sexual differentiation of many brain structures and functions is dependent on levels of testosterone (T) or its metabolites during certain 'sensitive' developmental periods. If T is present during these perinatal periods, masculinization and defeminization of sexual behavior occur; also, reproductive physiology, and central nervous system morphology and function are altered. The purpose of the present study was to characterize the influence of T at specific prenatal developmental intervals on offspring reproductive morphology, physiology, locomotor activity and sexual behavior during postnatal development. To avoid complications induced by endogenous testicular activity, only females were examined. Free T was used because of its relative short half-life, so that the effects induced by its administration on a specific gestational day (GD) could be evaluated. Pregnant rats received a single subcutaneous injection of either sesame oil (controls) or 5 mg of T on GD 16, 17, 18, 19, 20, 21, or 22. Female offspring of pregnant rats exposed to T displayed significant alterations in morphology and behavior. The anogenital distance, measured at 25 days postbirth, was significantly increased if T was administered on GD 16, 17 or 18. T treatment on GD 16 or each day thereafter through GD 20 significantly delayed the normal occurrence of vaginal opening (controls at 37.5 days vs. T treatment which ranged from 38.5 to 41.4 days). Abnormal vaginal morphology (enlarged clitoris) was also observed when T was injected during a similar prenatal interval (i.e. GD 16 to GD 22). Furthermore, prenatal T treatment on GD 18 (and each day thereafter), until GD 22 significantly decreased lordotic behavior compared to control values. However, exposure to T, on any prenatal GD did not alter the animals' ability to exhibit an induced luteinizing hormone (LH) surge. These results suggest that the onset for altered reproductive morphology occurs at least as early as GD 16, whereas the onset of sexual behavior sensitivity occurs precisely at GD 18, and that the normal pattern of adult LH release in females is not altered by prenatal androgen treatment using this specific paradigm.

Animals↗
PubMed1996

Is macrosomia associated with poor glycaemic control in diabetic pregnancy?

The study aimed to determine the influence of glucose control during pregnancy on the incidence of macrosomia in the infants of mothers with insulin-dependent diabetes. The prevalence of macrosomia was determined in pregnancies of all such women attending the City Hospital Nottingham, between July 1987 and July 1993, where it is policy for diabetic patients to aim during pregnancy for preprandial capillary glucose levels of less than 6.0 mmol I-1, and postprandial glucose levels of less than 8.0 mmol I-1. Macrosomia was defined as a birthweight greater than 90th centile using a computer model which takes into account all the major determinants of birthweight. Twelve of 29 infants were macrosomic, which is greater than expected (p < 0.01). During pregnancy there was no difference in mean seven point glucose profiles between those mothers with normal weight babies and those with macrosomia, but fructosamine levels at booking were significantly higher in the latter 2.5 (1.9-2.9) vs 2.2 (1.2-3.0); p < 0.05. These data confirm other studies and suggest that the incidence of macrosomia may be reduced by tighter control of diabetes at conception and in the first trimester, but to a lesser extent during later pregnancy.

Blood Glucose↗
PubMed1996

Mapping abnormal synovial vascular permeability in temporomandibular joint arthritis in the rabbit using MRI.

An automated method for two-dimensional spatial depiction (mapping) of quantitative physiological tissue characteristics derived from contrast-enhanced MRI was applied to a model of inflammatory disease represented by antigen-induced arthritis of the temporomandibular joint in the rabbit. Specifically, an established two-compartment kinetic model of unidirectional mass transport was implemented on a pixel-by-pixel basis to generate maps of tissue permeability surface area product (PS) and fractional blood volume (BV) based on dynamic MRI intensity data after administration of albumin-(Gd-DTPA)30, a prototype macromolecular contrast medium designed for blood pool enhancement. Maps of PS and BV in a disease model of induced arthritis clearly depicted zones of increased permeability (up to approximately 200 microliters/cc/h-compared to 25 microliters/cc/h in normal tissues).

Animals↗
PubMed1996

Effect of long-term glycemic control on cognitive function.

OBJECTIVE: To investigate the relationship between recurrent hypoglycemia and cognitive impairment in insulin-dependent diabetic patients. RESEARCH DESIGN AND METHODS: Seventy patients who were diagnosed as diabetic at age 18 years or older, were under 55 years old, and had no condition likely to affect cognitive abilities were recruited from a diabetic register. Patients were interviewed to obtain information on the frequency of major and minor hypoglycemia. Their cognitive abilities were assessed on tests of premorbid intelligence, current intelligence, reaction time, concentration, memory, and information processing. RESULTS: There was a significant correlation between the apparent decline in intelligence, expressed as the discrepancy between the estimated premorbid and the actual performance intelligence quotient, and the frequency of major hypoglycemic attacks (rs = -0.30; P < 0.01). Comparison of patients with and without recurrent hypoglycemia showed few significant differences in cognitive ability. CONCLUSIONS: Results support previous work that suggests that major hypoglycemic attacks have a significant effect on some aspects of cognitive function, but the clinical importance of this finding remains to be determined.

Adult↗
PubMed1991

Perceived needs of general practitioners and practice nurses for the care of diabetic patients.

This study compared the aims and needs of General Practitioners (GPs) and practice nurses who wished to improve the service they provided for non-insulin-treated diabetic patients. Contact was made with 242 GPs in 110 practices in Central and North Nottingham, and a questionnaire was sent to the 149 (62%) who requested one. Completed questionnaires were returned by 110 (74%) of these, and by 48 (80% of 60) of their practice nurses. Only 19 GPs ran a specific diabetic clinic, but nearly all (95%) wanted to improve the service they provided for diabetes care. In doing so, many wished for involvement of opticians, chiropodists, and dietitians, and all wished to involve the practice nurse. The need for involvement of hospital-based diabetes specialist nurses was perceived by only 37% GPs. More than two-thirds (69%) of practice nurses wanted more input into the care of diabetes. Both GPs and practice nurses felt that the role of the practice nurse should include screening for complications, although there was some disagreement about the extent of this involvement. GPs envisaged that patient education would be a major problem in establishing a diabetes service, but only 58% identified education as a task that could be accomplished by the practice nurse.

Attitude of Health Personnel↗