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Biomedical subjects

E Barrett

Publications and source records attributed to E Barrett.

At least 37 records · Page 2Linked to original sources
PubMed1998

Low frequency of recent parvovirus infection in a population-based cohort of patients with early inflammatory polyarthritis.

OBJECTIVE: To determine the contribution of human parvovirus B19 infection in explaining the incidence of early inflammatory polyarthritis (IP) in a population. SETTING: The Norfolk Arthritis Register (NOAR) is a community-based programme aiming to ascertain all new cases of IP arising in a population that lead to attendance at primary care. SUBJECTS: 147 newly ascertained subjects with IP with a disease duration of less than 16 weeks. METHODS: Full clinical appraisal of all subjects who were followed up for three years. B19 IgM assayed with a third generation antibody capture enzyme immunoassay. RESULTS: Only four (2.7%) patients had evidence of recent B19 infection, only one of whom did not satisfy criteria for rheumatoid arthritis (RA). CONCLUSION: B19 infection does not explain more than a small proportion of either RA or undifferentiated IP cases occurring in the population.

Adolescent↗
PubMed1997

Morbid jealousy as a variant of obsessive-compulsive disorder.

OBJECTIVE: To present a representative case vignette and review several previous reports, and to then suggest that a percentage of those with morbid jealousy may have a variant of obsessive-compulsive disorder (OCD). CLINICAL PICTURE: A patient presented volunteering a diagnosis of depression and anxiety following recent work and marital stresses, before describing recent jealousy and harassment of his wife over an earlier relationship. Obsessional thinking patterns and compulsive behaviours are described, and it is proposed that the picture supports a diagnosis of obsessive-compulsive disorder. TREATMENT AND OUTCOME: The patient was treated as if he had an obsessive-compulsive disorder, and reported dissipation of his concerns after cognitive-behavioural intervention. CONCLUSIONS: The proposition is an important one as a diagnosis of morbid jealousy often invites therapeutic pessimism, and as managements effective for OCD (both drug and behavioural) may well be helpful.

Anxiety Disorders↗
PubMed1996

A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study.

OBJECTIVE: To produce a practical algorithm to predict which patients with early rheumatoid arthritis will develop radiological erosions. DESIGN: Primary care based prospective cohort study. SETTING: All general practices in the Norwich Health Authority, Norfolk. SUBJECTS: 175 patients notified to the Norfolk Arthritis Register were visited by a metrologist soon after they had presented to their general practitioners with inflammatory polyarthritis, and again after a further 12 months. All the patients satisfied the American Rheumatism Association's 1987 criteria for rheumatoid arthritis and were seen by a metrologist within six months of the onset of symptoms. The study population was randomly split into a prediction sample (n = 105) for generating the algorithm and a validation sample (n = 70) for testing it. MAIN OUTCOME MEASURES: Predictor variables measured at baseline included rheumatoid factor status, swelling of specific joint areas, duration of morning stiffness, nodules, disability score, age, sex, and disease duration when the patient first presented. The outcome variable was the presence of radiological erosions in the hands or feet, or both, after 12 months. RESULTS: A simple algorithm based on a combination of three variables--a positive rheumatoid factor test, swelling of at least two large joints, and a disease duration of more than three months--was best able to predict erosions. When the accuracy of this algorithm was tested with the validation sample, the erosion status of 79% of patients was predicted correctly. CONCLUSIONS: A simple algorithm based on three easily measured items of information can predict which patients are at high risk and which are at low risk of developing radiological erosions.

Adult↗
PubMed1996

Outbreaks of gastroenteritis in elderly nursing homes and retirement facilities associated with human caliciviruses.

Eleven outbreaks of acute gastroenteritis, eight of which were in nursing homes or retirement facilities, were reported in virginia during the winter of 1993-1994. Serum samples (four outbreaks) and stool samples (two outbreaks) from involved people were tested for human calicivirus (HuCV) infection by enzyme immune assays (EIAs) using recombinant Norwalk virus (rNV) and Mexico virus (rMX) capsid antigens and reverse transcription-polymerase chain reaction (RT-PCR). Of the 31 pairs of acute and convalescent serum specimens tested, 24 had a fourfold or more titer increase to rMX and 4 responded to rNV. In all four outbreaks, the geometric mean titers (GMTs) against rMX were significantly higher than those against rNV in the convalescent, but not in the acute phase of illness. The antibody response to rMX among these patients was also higher than to rNV (summary mean 32-fold increase vs. 0.7-fold increase, respectively, P < .001). Antigen was detected in 5 of 21 stool specimens tested by the rMX EIA, RNA in 12 of 17 stool specimens tested by RT-PCR, and small round structured virus (SRSV) particles in 12 of 21 by electron microscopy (EM); none were positive by the rNV EIA. Sequence analysis of the RT-PCR-amplified products from the viral RNA polymerase region revealed 92-93% amino acid identity with Snow Mountain agent (SMA), 86% with MX, 58-59% with NV, and 31-32% with Sapporo HuCV, suggesting that these viruses belong to the SMA HuCV genogroup.

Aged↗
PubMed1995

Slow component of O2 uptake during heavy exercise: adaptation to endurance training.

Seven untrained male subjects [age 25.6 +/- 1.5 (SE) yr, peak O2 uptake (VO2) 3.20 +/- 0.19 l/min] trained on a cycle ergometer 4 days/wk for 6 wk, with the absolute training workload held constant for the duration of training. Before and at the end of each week of training, the subjects performed 20 min of constant-power exercise at a power designed to elicit a pronounced slow component of VO2 (end-exercise VO2-VO2 at minute 3 of exercise) in the pretraining session. An additional 20-min exercise bout was performed after training at this same absolute power output during which epinephrine (Epi) was infused at a rate of 100 ng.kg-1.min-1 between minutes 10 and 20. After 2 wk of training, significant decreases in VO2 slow component, end-exercise VO2, blood lactate ([La-] and glucose concentrations, plasma Epi ([Epi]) and norepinephrine concentrations, ventilation (VE), and heart rate (HR) were observed (P < 0.05). Although the rapid attenuation of the VO2 slow component coincided temporally with reductions in plasma [Epi], blood [La-], and VE, the infusion of Epi after training significantly increased plasma [Epi] (delta 2.22 ng/ml), blood [La-] (delta 2.4 mmol/l) and VE (delta 10.0 l/min) without any change in exercise VO2. We therefore conclude that diminution of the VO2 slow component with training is attributable to factors other than the reduction in plasma [Epi], blood [La-] and VE.

Adaptation, Physiological↗
PubMed1992

Lactic acidosis: effect of treatment on intracellular pH and energetics in living rat heart.

Systemic acidemia may impair cardiac contractility and predispose to arrhythmias. Moreover, bicarbonate treatment may further depress cardiac performance and increase mortality. Whether changes in myocardial intracellular pH or energy metabolism underlie this diminished performance has not been clarified in the in vivo setting. Thus we investigated the effect of lactic acidosis and two proposed treatments on myocardial energetics and intracellular pH in anesthetized living rats. A previously validated 31P-labeled nuclear magnetic resonance (31P-NMR) spectroscopic technique using saturating pulses was used to follow myocardial intracellular pH, phosphocreatine (PCr), ATP, and inorganic phosphate (Pi). After obtaining baseline values, we infused lactic acid to achieve a level greater than 5 mM. We then added an infusion of either bicarbonate (n = 7) or saline (n = 5). During lactic acid infusion, arterial pH declined (from 7.27 to 7.07, P less than 0.0001), but myocardial intracellular pH did not change (7.13 vs. 7.07, P not significant). The ratio of PCr to Pi, however, decreased with acidemia (from 3.13 to 2.24, P = 0.004), suggesting impaired energy metabolism. Compared with saline, bicarbonate infusion restored systemic pH (from 7.08 to 7.29), but myocardial pH was unaltered. In addition, PCr/Pi declined further following bicarbonate treatment (1.41 vs. 2.42, P = 0.08) but not following saline. Thus, despite reversal of systemic acidemia, bicarbonate treatment was associated with more severe impairment of energy metabolism than saline. This suggests a mechanism for previously reported adverse cardiac effects of bicarbonate treatment.

Acidosis, Lactic↗
PubMed1991

Personality and coping style as influences on alcohol intake and cigarette smoking during pregnancy.

OBJECTIVE: To determine if personality and coping style are central determinants of drinking and smoking at risk to fetal health during pregnancy. DESIGN, SETTING AND PARTICIPANTS: A sample of 99 women recently confined at a Sydney obstetric hospital received a semi-structured interview and completed a number of questionnaires. MEASURES: Alcohol and cigarette consumption over designated intervals since conception were assessed by interview. Questionnaires assessed maternal anxiety and postnatal depression, as well as coping strategies and personality characteristics such as impulsiveness. RESULTS: After confirmation of pregnancy, two-thirds of those previously drinking ceased while only one-third of those who had been smokers then abstained, with intake levels showing a similar pattern of a relatively greater decrease in alcohol than cigarette consumption over the course of the pregnancy. Personality and coping style differences were not demonstrated between the following contrasting groups: (a) smokers v. non-smokers prior to confirmation of pregnancy; (b) on-going drinkers v. relative abstainers during pregnancy; and (c) excessive smokers and drinkers before pregnancy v. all other subjects. Comparison of drinkers and non-drinkers before pregnancy suggested less "mature" coping styles for the latter, an unexpected finding. CONCLUSION: There was little support for the hypothesis that drinking and smoking at risk to health (before and during pregnancy) are determined by the individual's personality and general coping repertoires.

Adaptation, Psychological↗
PubMed1991

NMR determination of myocardial pH in vivo: separation of tissue inorganic phosphate from blood 2,3-DPG.

Phosphorus NMR can measure myocardial tissue pH from the chemical shift of inorganic phosphate (Pi) in isolated buffer-perfused hearts, but in vivo the Pi peak originating from the myocardium is obscured by the resonance of 2,3-diphosphoglycerate (DPG) in the blood, making pH difficult to determine. Taking advantage of the fact that most of the interfering DPG is within the cardiac chambers and is rapidly flowing out of the sensitive volume of our coil, we developed a pulse sequence which would separate myocardial Pi signal from interfering DPG. We tested this method on a flow phantom and in living rat heart, using exogenous glycerol phosphate as a blood-pool marker. The results indicated that signal from moving and nonmoving substances could be separated, and derived values for myocardial pH and PCr/Pi ratio were consistent with previous estimates. This method should be useful for studying myocardial acid-base physiology with NMR.

2,3-Diphosphoglycerate↗
PubMed1991

Thromboblastic hyperthyroidism: sensitive monoclonal TSH assay demonstrates suppressed immunoreactive TSH.

We describe a case of frank clinical hyperthyroidism due to hydatidiform mole. This is thought to be due to human chorionic gonadotrophin (hCG) or a closely related molecule produced by the tumour. hCG can cross-react with TSH in older TSH radioimmunoassays causing falsely elevated TSH levels. We demonstrate this does not occur with a chemiluminescent immunometric (monoclonal) TSH assay despite circulating hCG levels greater than 10(6) u/L.

Adult↗
PubMed1991

Effect of diabetes on Na(+)-H+ exchange by single isolated hepatocytes.

We used the fluorescent dye 2',7'-bis-(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF) to examine intracellular pH (pHi) regulation in single hepatocytes isolated from control rats and rats with either spontaneous or drug-induced diabetes mellitus (DM). In the absence of CO2-HCO3-, both control and DM cells recovered from cellular acid loads applied by the NH4+ prepulse technique. Because the pHi recovery was blocked by either Na+ withdrawal or ethylisopropylamiloride in both control and DM cells, it was presumably mediated by Na(+)-H+ exchange. In the control cells, the pHi threshold above which the rate of change of pHi (dpHi/dt) was zero was 7.06, and the slope of the dpHi/dt-pHi relationship was -0.030 s-1. In the DM cells, the pHi threshold was 7.22 and the slope was -0.017 s-1. Thus, at pHi values below approximately 6.9, the pHi recovery was slower in the DM cells. Inasmuch as we observed no difference in the cellular buffering power between control and DM cells, diabetes inhibits Na(+)-H+ exchange within this low pHi range. At pHi values above approximately 6.9, however, Na(+)-H+ exchange was apparently stimulated by diabetes. Thus diabetes induces two distinct alterations of Na(+)-H+ exchange, an alkaline shift in pHi threshold and decrease in slope. Treatment of diabetic rats with insulin for 48 h restored both Na(+)-H+ exchange parameters to normal. On the other hand, insulin added in vitro to DM cells for 2-5 h shifted the threshold toward the control value without affecting the slope, thus leading to a further inhibition of Na(+)-H+ exchange over the entire pHi range.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Audit of hyperthyroxinaemia and thyrotoxicosis using a sensitive TSH assay.

The aim of this study was determine (a) the causes of hyperthyroxinaemia and (b) the biochemical profile of thyrotoxicosis in a general hospital laboratory for one year using a sensitive TSH assay. Total T4 (TT4) and TSH were measured in all 8,382 samples and TT3, free T4, free T3 and thyroxine binding globulin (TBG) in selected cases. TT4 was elevated in 215 (2.6%). 159 (74%) were due to thyrotoxicosis; 41 (19%) to elevated TBG and 15 (7%) non-thyroidal illness. Thyrotoxicosis (serum TSH less than 0.15m U/1) occurred in 223 (2.7%) of all patients and was diagnosed with high TT4 in 159 (71%), normal due to intercurrent illness. 352 (4%) patients had suppressed TSH while all thyroid hormone values were normal. Thus TT4 may be elevated from causes other than thyrotoxicosis sufficiently frequently to necessitate routine TSH measurements. While Normal TSH measurements nearly always excludes thyrotoxicosis, suppressed values are insufficient to establish a diagnosis or monitor thyroxine replacement therapy.

Humans↗
PubMed1989

Acute effects of insulin-like growth factor I on glucose and amino acid metabolism in the awake fasted rat. Comparison with insulin.

To elucidate the acute metabolic actions of insulin-like growth factor I (IGF-I), we administered a primed (250 micrograms/kg), continuous (5 micrograms/kg.min) infusion of human recombinant (Thr 59) IGF-I or saline to awake, chronically catheterized 24-h fasted rats for 90 min. IGF-I was also infused while maintaining euglycemia (glucose clamp technique) and its effects were compared to those of insulin. IGF-I infusion caused a twofold rise in IGF-I levels and a 75-85% decrease in plasma insulin. When IGF-I alone was given, plasma glucose fell by 30-40 mg/dl (P less than 0.005) due to a transient twofold increase (P less than 0.05) in glucose uptake; hepatic glucose production and plasma FFA levels remained unchanged. IGF-I infusion with maintenance of euglycemia produced a sustained rise in glucose uptake and a marked stimulation of [3-3H]glucose incorporation into tissue glycogen, but still failed to suppress glucose production and FFA levels. IGF-I also produced a generalized 30-40% reduction in plasma amino acids, regardless of whether or not hypoglycemia was prevented. This was associated with a decrease in leucine flux and a decline in the incorporation of [1-14C]leucine into muscle and liver protein (P less than 0.05). When insulin was infused in a dosage that mimicked the rise in glucose uptake seen with IGF-I, nearly identical changes in amino acid metabolism occurred. However, insulin suppressed glucose production by 65% and FFA levels by 40% (P less than 0.001). Furthermore, insulin was less effective than IGF-I in promoting glycogen synthesis. We conclude that (a) IGF-I produces hypoglycemia by selectively enhancing glucose uptake; (b) IGF-I is relatively ineffective in suppressing hepatic glucose production or FFA levels; and (c) IGF-I, like insulin, lowers circulating amino acids by reducing protein breakdown rather than by stimulating protein synthesis. Thus, IGF-I's metabolic actions in fasted rats are readily distinguished from insulin.

Amino Acids↗
PubMed1985

Diabetes enhances activity of alanine transport in liver plasma membrane vesicles.

In the present study plasma membrane vesicles were prepared from livers of control and alloxan-induced diabetic rats and the substrate specificity and kinetic characteristics of alanine transport determined in both groups. Sodium-dependent alanine uptake at physiological alanine concentrations (100 microM) was enhanced threefold in diabetic as compared with control animals (0.31 +/- 0.04 vs. 0.11 +/- 0.01 nmol X mg protein-1 X 10 s-1). This accelerated influx corresponded to a three- to fourfold increase in the Vmax of alanine transport in diabetic versus control group (7.1 +/- 2.1 vs. 1.6 +/- 0.2 nmol X mg protein-1 X 10 s-1, P less than 0.05), whereas the Km of alanine uptake was unchanged (2.8 +/- 1.2 vs. 1.4 +/- 0.1 mM). Other neutral amino acids (20 mM) inhibited alanine transport to a similar degree in both groups. The sodium-dependent influx of glutamine (100 microM) was similar in diabetic and control groups (0.17 +/- 0.03 and 0.14 +/- 0.02 nmol X mg protein-1 X 10 s-1, respectively). The initial velocity of 22Na uptake (80 mM) into vesicles and half-maximal stimulation of alanine transport was achieved at essentially identical sodium concentrations (approximately 40 mM) in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine↗
PubMed1985

Women and abortion: attitudes, social networks, decision-making.

The results of a study of 517 women seeking abortion are presented regarding attitudes about abortion in general, feelings about the specific decision to have an abortion and the social networks utilized in the decision-making process. Areas of potential conflict related to decision-making are identified along with the implications for social work practice.

Abortion, Induced↗
PubMed1984

Mechanism of improvement in glucose metabolism after chronic glyburide therapy.

The effect of glyburide on glucose metabolism was examined in 10 non-insulin-dependent diabetic subjects (NIDDM) and 7 young, control subjects. After 3 mo of glyburide treatment in NIDDM, fasting plasma glucose declined from 198 to 141 mg/dl (P less than 0.01) without change in fasting insulin levels. Basal hepatic glucose production (HGP) was slightly elevated in NIDDM versus controls (2.35 versus 2.18 mg/kg X min, P = NS) and was positively correlated with the fasting glucose concentration (r = 0.93, P less than 0.001). With chronic glyburide therapy, HGP declined to 1.72 mg/kg X min (P less than 0.01 versus preglyburide) and remained highly correlated with the fasting glucose concentration (r = 0.85, P less than 0.005). Basal glucose clearance in NIDDM was reduced by 48% compared with age-matched controls (1.22 versus 2.32 ml/kg X min, P less than 0.001) and was unchanged after 3 mo of glyburide. Thus, the most important factor responsible for the decline in fasting plasma glucose concentration was an inhibition of hepatic glucose output. The decrease in basal hepatic glucose production and fasting plasma glucose concentration occurred without any change in fasting plasma insulin or C-peptide concentration. Insulin-mediated glucose metabolism (insulin clamp technique) was reduced by 55% in NIDDM (2.91 versus 6.39 mg/kg X min, P less than 0.001). After glyburide, insulin-mediated glucose metabolism increased by 26% to 3.67 mg/kg X min (P less than 0.01). This increase in tissue sensitivity to insulin was unassociated with any change in insulin binding to monocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Microbiological analysis of rock cod (Sebastes spp.) stored under elevated carbon dioxide atmospheres.

The numbers and types of microorganisms on fresh rock cod fillets and fillets stored in air or in a modified atmosphere (MA; 80% CO(2), 20% air) at 4 degrees C were compared. Samples were analyzed after 0, 7, 14, and 21 days of storage. The isolation plates were incubated aerobically, anaerobically, or under MA at 4, 20, or 35 degrees C. After 7 days of storage in air, the fillets were obviously spoiled and had a 3- to 4-log cycle increase in microbial counts. Plate counts increased more slowly on MA-stored fillets. After 21 days, the counts on the latter had increased only 2 log cycles, and the fillets did not seem spoiled. The microbial flora changed greatly during MA storage. Only Lactobacillus spp. (70%) and an Aeromonas sp.-like isolate (30%) were found on plates incubated aerobically at 4 and 20 degrees C, and only Lactobacillus spp. was found on plates incubated aerobically and anaerobically at 35 and at 20 degrees C under MA. Isolation plates incubated at 20 degrees C in air gave the highest counts in the shortest incubation time and the greatest diversity of bacterial types recovered. No Vibrio parahaemolyticus, Staphylococcus aureus, or Clostridium botulinum type E were isolated from the fresh or MA-stored fillets.

Aerobiosis↗
PubMed1983

Group meetings for parents in a children's burns unit.

Thermal injuries in childhood occur mainly in the first three years of life and often lead to hospital admission: most are due to scalds in the home. The distress and anxiety of parents bears on the management of the young sick child in hospital, on his subsequent recovery at home and on the welfare of the whole family. To help parents, a weekly meeting was held with a small group of staff in the Burns Unit at which there was free and open discussion of all problems and worries connected with the child's accident. This paper describes the working of the group and the contribution it made to the care of 149 children admitted with burns and scalds during one year.

Burn Units↗