Biomedical subjects

D M Wood

Publications and source records attributed to D M Wood.

At least 19 recordsLinked to original sources

PubMed2006

Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. METHODS: Data were retrieved from electronic records for patients admitted with AECOPD with lower respiratory tract infection in 2001-2. The patients were grouped according to blood glucose quartile (group 1, <6 mmol/l (n = 69); group 2, 6.0-6.9 mmol/l (n = 69); group 3, 7.0-8.9 mmol/l (n = 75); and group 4, >9.0 mmol/l (n = 71)). RESULTS: The relative risk (RR) of death or long inpatient stay was significantly increased in group 3 (RR 1.46, 95% CI 1.05 to 2.02, p = 0.02) and group 4 (RR 1.97, 95% CI 1.33 to 2.92, p < 0.0001) compared with group 1. For each 1 mmol/l increase in blood glucose the absolute risk of adverse outcomes increased by 15% (95% CI 4 to 27), p = 0.006. The risk of adverse outcomes increased with increasing hyperglycaemia independent of age, sex, a previous diagnosis of diabetes, and COPD severity. Isolation of multiple pathogens and Staphylococcus aureus from sputum also increased with increasing blood glucose. CONCLUSION: Increasing blood glucose concentrations are associated with adverse clinical outcomes in patients with AECOPD. Tight control of blood glucose reduces mortality in patients in intensive care or following myocardial infarction. A prospective study is now required to determine whether control of blood glucose can also improve outcomes from AECOPD.

Acute Disease↗

PubMed2006

Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis.

BACKGROUND: Lower respiratory tract infection with Pseudomonas aeruginosa (P. aeruginosa) occurs in most people with cystic fibrosis. Once chronic infection is established, P. aeruginosa is virtually impossible to eradicate and is associated with increased mortality and morbidity. Early infection may be easier to eradicate. OBJECTIVES: To determine whether antibiotic treatment of early P. aeruginosa infection in children and adults with cystic fibrosis eradicates the organism and improves clinical and microbiological outcome. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: May 2004 SELECTION CRITERIA: We included randomised controlled trials of people with cystic fibrosis, in whom P. aeruginosa had recently been isolated from respiratory secretions. We compared combinations of inhaled, oral or intravenous antibiotics with placebo or usual treatment (or both) or other combinations of inhaled, oral or intravenous antibiotics. We excluded non-randomised trials, cross-over trials, and those utilising historical controls. DATA COLLECTION AND ANALYSIS: Both authors independently assessed selected trials, assessed methodological quality and extracted data. MAIN RESULTS: The search identified 15 trials. Three trials (69 participants) were eligible for inclusion. There is evidence from two randomised controlled trials, of questionable methodological quality, that treatment of early P. aeruginosa infection with inhaled tobramycin results in microbiological eradication of the organism from respiratory secretions more often than placebo and that this effect may persist for up to 12 months, however incomplete data from one of the trials precludes an accurate analysis. One randomised controlled trial of oral ciprofloxacin and nebulised colisitin versus usual treatment was identified. This trial was of poor methodological quality. The results suggested treatment of early infection results in microbiological eradication of P. aeruginosa more often than usual treatment, after two years, RR 0.24 (95% CI 0.06 to 0.96). There is insufficient evidence to determine whether antibiotic strategies for the eradication of early P. aeruginosa decrease mortality or morbidity, improve quality of life, or are associated with adverse effects compared to placebo or standard treatment. AUTHORS' CONCLUSIONS: From the three trials included in this review, there is some evidence that antibiotic treatment of early P. aeruginosa results in short-term eradication but it remains uncertain whether there is clinical benefit to people with cystic fibrosis.

Anti-Bacterial Agents↗

PubMed2006

Influence of pacing strategy on oxygen uptake during treadmill middle-distance running.

The oxygen uptake (VO2) attained during a constant speed 800-m pace trial on a treadmill is less than the maximal VO2 (VO2max) in male middle-distance runners with a high VO2max (i.e., > 65 ml x kg (-1) x min (-1)). We therefore investigated whether the VO2 attained was influenced by the pacing strategy adopted. Eight male middle-distance runners (age 25.8 +/- 3.3 years; height 1.78 +/- 0.10 m; mass 67.8 +/- 4.7 kg) with a personal best 800-m time of 112.0 +/- 3.3 s volunteered to participate. Subjects undertook a speed ramped progressive test to determine VO2max and three 800-m pace runs to exhaustion all in a randomised order. The three 800-m pace runs included constant speed, acceleration, and race simulation runs. Oxygen uptake was determined throughout each test using 15-s Douglas bag collections. Following the application of a 30-s rolling average, the highest VO2 during the progressive test (i.e., VO2max) and the highest VO2 during the 800-m pace runs (i.e., VO2peak) were compared. For the eight runners, VO2max was 67.2 +/- 4.3 ml x kg (-1) x min (-1) x VO2peak was 60.1 +/- 5.1 ml x kg (-1) x min (-1), 61.1 +/- 5.2 ml x kg (-1) x min (-1), and 62.2 +/- 4.9 ml x kg (-1) x min (-1), yielding values of 89.3 +/- 2.4 %, 90.8 +/- 2.8 %, and 92.5 +/- 3.1 % VO2max for the constant speed, acceleration and race simulation runs, respectively. Across runs, repeated measures ANOVA revealed a significant effect (p = 0.048). Trend analysis identified a significant linear trend (p = 0.025) with the % VO2max attained being higher for the acceleration run than the constant speed run, and higher still for the race simulation run. These results demonstrate that in middle-distance runners a) pacing strategy influences the VO2 attained, with a race simulation run elevating the VO2 attained compared with other pacing strategies, and b) regardless of pacing strategy the VO2 attained in an 800-m pace run on a treadmill is less than VO2max.

Acceleration↗

PubMed2006

Should all patients with unexplained anaemia be screened for chronic lead poisoning?

The global prevalence of lead poisoning is declining. However, the prevalence of lead poisoning in patients with either microcytic or normocytic anaemia is unknown. Blood samples from anaemic patients residing in south-east London without an obvious cause for anaemia had their blood lead concentration (BLC) analysed. A batch of 988 samples was analysed for BLC using atomic absorption spectroscopy. Median haemoglobin was 10.3 g/dL (range: 4.2-10.9) in females, 10.6 g/dL (range: 5.2-11.4) in males and 10.7 g/dL (range: 6.7-10.9) in children. Median BLC was 2.63 microg/dL (0.21-24.0 microg/dL; 95th centile 7.54 microg/dL). Fifteen samples (1.5%) had a BLC > 10.0 microg/dL, five samples (1%) > 15.0 microg/dL and one sample (0.1%) > 20.0 micrg/L. In the 106 children, median BLC was 2.34 microg/dL (0.5-14.5 microg/dL; 95th centile 6.12 microg/ dL). Only one child (14.5 microg/L) had a BLC > 10.0 pg/dL. There was a poor correlation between haemoglobin and BLC (r2 = 0.08). Routine screening for lead poisoning cannot be justified in all patients with unexplained anaemia, unless there is a history or clinical features to suggest lead toxicity. Additionally, we have shown that in this former high-risk area for lead exposure, there is a low point prevalence of significant lead poisoning, even in an anaemic population.

Adolescent↗

PubMed2005

The oxygen uptake response of sprint- vs. endurance-trained runners to severe intensity running.

We compared the oxygen uptake (VO2) response of sprint- and endurance-trained runners for an exhaustive square wave run lasting approximately 2 minutes. Six sprinters and six middle- and long-distance runners each performed two exhaustive square wave runs lasting approximately 2 min and two exhaustive ramp tests. VO2 was determined breath-by-breath (QP9000; Morgan Medical, Rainham, UK) and averaged across the two repeats of each test; for the square wave test, the averaged VO2 response (excluding the first 15 s) was then modelled using a monoexponential function. Both VO2peak for the ramp test (67.5+/-3.3 vs. 54.5+/-8.5 mlxkg(-1)xmin(-1); P= 0.006) and the asymptotic VO2 for the square wave run (59.6+/-2.7 vs. 50.7+/-4.6 mlxkg(-1)xmin(-1); P= 0.002) were higher for the endurance than for the sprint group. However, as a percentage of VO2peak, this asymptotic VO2 did not differ between the groups (90.1+/-3.2% (endurance) vs. 96.2+/-9.0% (sprint); P= 0.145). Across all 12 subjects, the %VO2peak attained in the square wave run was negatively correlated with VO2peak (Pearson's r= -0.811, P= 0.001). We conclude that VO2max is more important than training history as a determinant of the %VO2max attained in exhaustive square wave running lasting approximately 2 min.

Adult↗

PubMed2005

Measuring plasma salicylate concentrations in all patients with drug overdose or altered consciousness: is it necessary?

BACKGROUND: Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. METHODS: A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas' Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate overdose, and documentation of clinical features of salicylate toxicity recorded. RESULTS: In total, 722 patient episodes were identified, of which 596 case notes were available and appropriate for inclusion in this study. Plasma salicylate concentrations (range 15-428 mg/l) were detectable in 50 patients (three notes not available), of whom 38 had given a positive history. The history of salicylate poisoning had a sensitivity of 81% (95% confidence interval (CI) 67 to 91%) and the predictive value of a negative history of salicylate ingestion in not detecting salicylate concentrations was 98% (95% CI 97 to 99%). Insufficient information on clinical features of salicylate toxicity was recorded in 569 patients (including 35 patients who had a history of salicylate ingestion). CONCLUSION: History of salicylate ingestion has a high sensitivity and negative predictive value with respect to the detection of plasma salicylate concentrations. However, current practice indicates that insufficient information is obtained from patients about the clinical features of toxicity. Routine measurement of plasma salicylate concentrations is not required unless there is (a) a positive history of ingestion of salicylates or (b) a reduced level of consciousness or other reason limiting the validity of the history obtained, together with clinical features consistent with salicylate poisoning.

Consciousness↗

PubMed2005

New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea.

Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available. Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is <6 mmol x L(-1), and if there are no symptoms of upper respiratory tract infection.

Algorithms↗

PubMed2005

"Pack year" smoking histories: what about patients who use loose tobacco?

Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods for measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64% were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked, based on the weight of tobacco in ready made cigarettes; 12.5 g or half an ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a questionnaire it was found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked.

Female↗

PubMed2005

Metaraminol (Aramine) in the management of a significant amlodipine overdose.

OBJECTIVE: To report a patient with a significant amlodipine self-poisoning who failed to clinically respond to conventional treatment and was managed with metaraminol (Aramine). PATIENT: A 43-year old male presenting after ingestion of 560 mg amlodipine, who failed to respond clinically to treatment with fluid resuscitation, calcium salts, glucagon and norepinephrine/epinephrine inotropic support. MAIN RESULTS: Following a loading bolus of 2 mg and intravenous infusion (83 microg/min) of metaraminol (Aramine) there was improvement in his blood pressure, cardiac output and urine output. CONCLUSIONS: This is the first case report of the beneficial use of metaraminol (aramine) in the management of significant amlodipine poisoning unresponsive to conventional therapy.

Adrenergic alpha-Agonists↗

PubMed2004

The VO2 response for an exhaustive treadmill run at 800-m pace: a breath-by-breath analysis.

Recent research in which data were averaged over 10 or 30 s suggests that the VO(2) response of aerobically fit individuals plateaus below VO(2 max) in an exhaustive square-wave run lasting approximately 2 min. To investigate this phenomenon we examined the breath-by-breath VO(2) response of trained runners to an exhaustive treadmill run at 800 m pace. Eight male competitive runners completed two treadmill tests on separate days: a ramp test to exhaustion and an exhaustive square-wave run at 800-m pace. For the ramp test, the breath-by-breath data were smoothed with a 15-s moving average and the highest of the smoothed values was taken as VO(2 peak) [mean (SD): 68.9 (5.6) ml kg(-1) min(-1)]. For the square-wave, the breath-by-breath data were interpolated to give one value per second and modelled using a monoexponential function. Following a delay of 11.2 (1.5) s, VO(2) increased quickly [phase-2 time constant of 10.7 (2.7) s] towards an asymptote that represented just 85 (6)% of VO(2 peak) from the ramp test. Expressed in ml kg(-1) min(-1), this asymptote was independent of VO(2 peak) (r=0.04, P=0.94). However, as a percentage of VO(2 peak) it was negatively correlated with VO(2 peak) itself (r=-0.96, P<0.001). It is concluded that in an exhaustive square-wave treadmill run lasting approximately 2 min the VO(2) of aerobically fit runners increases quickly to plateau at a level that is lower than, but independent of, VO(2max).

Adult↗

PubMed2004

Molecular identification of two species of myiasis-causing Cuterebra by multiplex PCR and RFLP.

The myiasis-causing flies Cuterebra grisea (Coquillet) and Cuterebra fontinella (Clark) (Diptera: Oestridae) are normally parasites of mice, predominantly of the genus Peromyscus. The morphological similarities of these species and the existence of intermediate morphotypes bearing characters of both species make the identification of adults problematic; furthermore the identification of larvae is apparently not possible. This study presents two molecular approaches to discriminate between these species using specific band patterns: (i) species-specific primers designed in the cytochrome oxidase II (COII) region used in multiplex polymerase chain reaction (PCR) and (ii) restriction fragment length polymorphism (RFLP) on amplified segments of cytochrome oxidase I (COI) gene. Both methods were tested on Cuterebra larvae and on adult museum specimens. The two techniques showed a clear difference between C. grisea and C. fontinella, although species-specific primers were more successful than RFLP for degraded DNA. No intraspecific variation in RFLP and species-specific amplifications were detected for the two species of Cuterebra. The results exhibit discrepancies between molecular and morphological identification, suggesting that some of the adults were misidentified.

Animals↗

PubMed2004

The advantages and disadvantages of a 'herbal' medicine in a patient with diabetes mellitus: a case report.

BACKGROUND: Patient-initiated alternative treatments in the management of chronic conditions are common and increasing in the United Kingdom. To date, there have been no reports of herbal medicine use alone in the management of diabetes mellitus. We report here the case of a man who attained excellent glycaemic control using a 'herbal' medicine and reveal how important it was to identify the products of active constituents. CASE REPORT: A 48-year-old man attending our clinic in Tooting, South London with known Type 2 diabetes, with evidence of both micro- and macro-vascular diabetes-related complications, was poorly controlled despite a drug regimen consisting of oral metformin and twice daily insulin. He went to India for at least 1 year and on returning to the clinic had excellent glycaemic control off all diabetic medication. While away he had started himself on a regimen of three different 'herbal' balls. Samples of blood were found to contain chlorpropamide in a therapeutic concentration; chlorpropamide was also found in one of the balls. He has been counselled on the potential risks associated with chlorpropamide and his treatment reverted to a more conventional treatment regimen. CONCLUSIONS: General practitioners and hospital physicians should be alert to those patients returning from abroad on effective 'herbal' medications that these may in fact contain an active ingredient.

Chlorpropamide↗

PubMed2004

Phytoestrogens are potent inhibitors of estrogen sulfation: implications for breast cancer risk and treatment.

We investigated the ability of 37 flavonoids and flavonoid sulfoconjugates, including some abundant dietary constituents, to act as substrates and/or inhibitors of the sulfotransferase and sulfatase enzymes that interconvert active estrogens and inactive estrogen sulfates in human tissues. The enzymes studied include estrogen sulfotransferase, the thermostable phenolsulfotransferase that acts on a range of substrates including estrogens; steroid sulfatase; and two related enzymes, monoamine phenolsulfotransferase and arylsulfatase A. Several dietary flavonoids, including the soy isoflavones genistein and daidzein, were sulfated by these human sulfotransferases. Many flavonoids were potent inhibitors of thermostable phenolsulfotransferase. Genistein and equol were potent mixed inhibitors of hepatic estrogen sulfotransferase, with inhibitory constant values of 500 nM and 400 nM, respectively. Monoamine phenolsulfotransferase activity was relatively unaffected by flavonoids, but this enzyme was mainly responsible for the sulfation of flavonoids at concentrations greater than 1 micro M. Of the compounds tested, only daidzein 4,7-bisulfate, a trace metabolite in humans, significantly inhibited steroid sulfatase in the micromolar concentration range. Hence, dietary flavonoids may be able to influence the bioavailability of endogenous estrogens, and disrupt endocrine balance, by increasing the ratio of active estrogens to inactive estrogen sulfates in human tissues.

Arylsulfotransferase↗

PubMed2003

The VO2 response to exhaustive square wave exercise: influence of exercise intensity and mode.

We investigated the oxygen uptake ( VO(2)) response to exhaustive square wave exercise of approximately 2, 5 and 8 min duration in cycling and running. Nine males completed a ramp test and three square wave tests on a motorised treadmill and the same four tests on a cycle ergometer, throughout which gas exchange was assessed (Douglas bag method). The peak VO(2) from the ramp test was higher for running than for cycling [mean (SD): 58.4 (2.8) vs. 55.9 (3.7) ml.kg(-1).min(-1); P=0.04]. However VO(2max) (defined as the highest VO(2) achieved in any of the four tests) did not differ between running and cycling [60.0 (2.9) vs. 58.5 (3.3) ml.kg(-1).min(-1); P=0.15]. The peak VO(2) was similar ( P>0.1) for the 5 and 8 min square wave tests [98.5 (1.8) and 99.2 (2.3) % VO(2max) for running; 97.0 (4.2) and 97.5 (2.0) % VO(2max) for cycling] but lower ( P<0.001) for the 2-min test [91.8 (2.5) and 89.9 (5.5) % VO(2max) for running and cycling respectively]. VO(2) increased over the final two 30-s collection periods of the 2-min test for cycling [Delta VO(2)=0.18 (0.15) l.min(-1); P<0.01] but not running [Delta VO(2)=0.00 (0.09) l.min(-1); P=0.98]. We conclude that in the aerobically fit the peak VO(2) for square wave running or cycling at an intensity severe enough to result in exhaustion in approximately 2 min is below VO(2max). In running, VO(2) plateaus at this sub-maximal rate.

Adult↗

PubMed2003

Effects of dichloroacetate on VO2 and intramuscular 31P metabolite kinetics during high-intensity exercise in humans.

Traditional control theories of muscle O2 consumption are based on an "inertial" feedback system operating through features of the ATP splitting (e.g., [ADP] feedback, where brackets denote concentration). More recently, however, it has been suggested that feedforward mechanisms (with respect to ATP utilization) may play an important role by controlling the rate of substrate provision to the electron transport chain. This has been achieved by activation of the pyruvate dehydrogenase complex via dichloroacetate (DCA) infusion before exercise. To investigate these suggestions, six men performed repeated, high-intensity, constant-load quadriceps exercise in the bore of an magnetic resonance spectrometer with each of prior DCA or saline control intravenous infusions. O2 uptake (Vo2) was measured breath by breath (by use of a turbine and mass spectrometer) simultaneously with intramuscular phosphocreatine (PCr) concentration ([PCr]), [Pi], [ATP], and pH (by 31P-MRS) and arterialized-venous blood sampling. DCA had no effect on the time constant (tau) of either Vo2 increase or PCr breakdown [tauVo2 45.5 +/- 7.9 vs. 44.3 +/- 8.2 s (means +/- SD; control vs. DCA); tauPCr 44.8 +/- 6.6 vs. 46.4 +/- 7.5 s; with 95% confidence intervals averaging < +/-2 s]. DCA, however, resulted in significant (P < 0.05) reductions in 1). end-exercise [lactate] (-1.0 +/- 0.9 mM), intramuscular acidification (pH, +0.08 +/- 0.06 units), and [Pi] (-1.7 +/- 2.1 mM); 2). the amplitude of the fundamental components for [PCr] (-1.9 +/- 1.6 mM) and Vo2 (-0.1 +/- 0.07 l/min, or 8%); and 3). the amplitude of the Vo2 slow component. Thus, although the DCA infusion lessened the buildup of potential fatigue metabolites and reduced both the aerobic and anaerobic components of the energy transfer during exercise, it did not enhance either tauVo2 or tau[PCr], suggesting that feedback, rather than feedforward, control mechanisms dominate during high-intensity exercise.

Adenosine Triphosphate↗

PubMed2002

Heart rate variability: response following a single bout of interval training.

We investigated the effect of exercise on heart rate variability by analysing the heart rate power spectrum prior to, and 1 and 72 h following, an interval training session. Subjects initially performed a graded test to exhaustion to determine maximal oxygen uptake (VO(2) max) and the running speed at which VO(2) max was first attained (vVO(2) max). The training session was completed on a separate day and comprised six 800 m runs at 1 km x h (-1) below vVO(2) max. Prior to the training session (pre), 1 h following the training session (+ 1h), and 72 h following the training session (+ 72 h), subjects sat quietly in the laboratory for 20 min whilst breathing frequency was maintained at 12 breath x min (-1). Cardiac cycle R-R interval data were collected over the final 5 min of each 20 min period and analysed by means of autoregressive power spectral analysis to determine the high frequency (HF) and low frequency (LF) components of heart rate variability. Heart rate was higher, and the standard deviation of the R-R intervals was lower, at + 1 h than for pre or + 72 h (p < 0.05). The HF and the LF components of heart rate variability were also lower (p < 0.05) for + 1 h than for pre or + 72 h when the data were expressed in ms(2). However, no changes in the LF:HF ratio were observed, and the changes in the HF and LF components disappeared when the data were expressed as a fraction of the total power. Whilst these findings illustrate the importance of controlling the timing of exercise prior to the determination of heart rate variability, the time course of the post-exercise heart rate variability response remains to be quantified.

Adult↗

PubMed2001

Do dietary phytoestrogens influence susceptibility to hormone-dependent cancer by disrupting the metabolism of endogenous oestrogens?

Phytoestrogens are natural constituents of our diets that have been suggested to protect against hormone-dependent breast cancer. Some of the diverse effects of these compounds may be attributed to ligand-dependent differences in their interaction with oestrogen receptor sub-classes. However, phytoestrogens can also inhibit enzymes that are involved in the generation and removal of endogenous steroid hormones. Among the most potent effects of dietary phytoestrogens is their ability to inhibit the sulphotransferases that sulphate both oestrogenic steroids and a variety of environmental chemicals, including dietary pro-carcinogens. Circulating steroid sulphates are thought to be the major source of oestradiol in post-menopausal breast tumours and sulphation is a key step in the activation of some dietary pro-carcinogens. Hence the inhibition of sulphotransferases by dietary phytoestrogens may have complex effects upon human susceptibility to breast cancer.

3-Hydroxysteroid Dehydrogenases↗

PubMed1999

Aspirin usage in a large teaching hospital diabetes clinic setting.

AIM: To document aspirin usage and the prevalence of large and small vessel complications in patients with diabetes mellitus (DM) attending the outpatient diabetes clinics of a large public hospital. METHODS: All patients attending diabetes outpatient clinics at The Royal Melbourne Hospital in Melbourne, Australia were surveyed over a 3-month period. RESULTS: Complete data were available on 629 of 632 (296 male) patients surveyed. Of the 29.3% of patients who were suffering from one or more macrovascular complication (ischaemic heart disease, cerebrovascular disease or peripheral vascular disease), 63% were currently on aspirin treatment. Of those not on aspirin, 65% had no contra-indication to aspirin treatment and a further 19% had only a relative contra-indication of either aspirin or warfarin treatment recorded. CONCLUSIONS: The published recommendations for the use of aspirin in patients with macrovascular disease were generally being followed in this clinic-based population. However, a significant proportion of patients without a contra-indication to treatment were still not receiving aspirin. The lack of clear evidence-based guidelines for aspirin use may be a factor in its under-prescription. This survey suggests clear evidence-based guidelines should be established and disseminated.

Adult↗