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Biomedical subjects

I N Bruce

Publications and source records attributed to I N Bruce.

41 records · Page 3Linked to original sources
PubMed1995

An audit of ANCA in routine clinical practice.

We have reviewed the medical records of 301/327 consecutive patients in whom anti-neutrophil cytoplasmic antibodies (ANCA) were detected by the Regional Immunology Laboratory in Northern Ireland between January 1988 and October 1991 (45 months). We have collected data for each patient regarding age, sex, smoking habit, area of residence, and details of any other autoantibody activity. Clinical diagnosis was established, with the number of organ systems involved and the evidence for that involvement (symptomatic, biochemical, radiological, and histological). Diagnoses were divided into four groups according to their recognised vasculitic features and these were related to the pattern of immunofluorescence and maximum ANCA titre detected. The most frequent diagnosis was rheumatoid arthritis (18.2% of patients) and the connective tissue disorders as a whole accounted for 27.9% of patients. ANCA were also detected in a wide range of clinical conditions which are not associated with vasculitis and these patients were an important source of 'false-positives'. The positive predictive value (PPV) of ANCA of all patterns and titres for vasculitic conditions was 27%, however, the detection of a classical ANCA pattern at high titre (> or = 1:640) was associated with an increased PPV of 75%. The coexistence of an antinuclear antibody (ANA) reduces the PPV of both classical and perinuclear ANCA, although perinuclear ANCA with antimyeloperoxidase specificity had an improved PPV. We conclude that ANCA testing should not be used as the only screening investigation for vasculitis but should be included in a rational investigative scheme. The interpretation of a positive ANCA result must take into account the presence of other autoantibodies and the full range of non-vasculitic conditions when the clinical situation is not typical of vasculitis.

Aged↗
PubMed1993

Trends in the prevalence of asthma and dyspnoea in first year university students, 1972-89.

The prevalence of asthma and dyspnoeic symptoms were studied in undergraduates from Ireland, north and south, entering Queen's University Belfast in the years 1972, 1978, 1983, 1986 and 1989. The records of students' compulsory entry medical examination, including responses to questions on dyspnoeic symptoms in a health screening questionnaire, were reviewed. Between 1972 and 1989, the 12-month period prevalence of asthma increased from 1.3% to 2.84% (p < 0.001). This increase was not accounted for by the changes in the sex, or socioeconomic structure of the student body. In non-asthmatics the prevalence of dyspnoea rose from 5.49% to 8.30% (p < 0.01). In students with diagnosed asthma, the proportion with dyspnoeic symptoms did not significantly increase (p = 0.167). There was a greater than two-fold increase in the prevalence of diagnosed asthma in this population between 1972 and 1989. The prevalence of asthma was higher in rural than in urban students. There was also an increased reporting of dyspnoea in non-asthmatics, the significance of which is unclear.

Adolescent↗
PubMedDate not supplied

Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review.

OBJECTIVE: To review the evidence on the clinical effectiveness of etanercept and infliximab for the treatment of active and progressive psoriatic arthritis (PsA) in patients with an inadequate response to standard treatment (including DMARD therapy). METHODS: A systematic review was conducted. The literature search covered a range of 13 medical databases and submissions were provided by the manufacturers of etanercept and infliximab. Randomised controlled trials (RCTs) of etanercept or infliximab that reported outcomes of disease activity in PsA were reviewed. RESULTS: There were two good quality double-blind, placebo-controlled RCTs each for etanercept and infliximab. The results demonstrated that after initial treatment (12 weeks for etanercept and 14 or 16 weeks for infliximab) both drugs had statistically significant beneficial effects compared with placebo on ACR 20, 50 and 70, PsARC and HAQ scores. Efficacy was not dependent upon concomitant methotrexate. Results at 24 weeks indicated that the response to treatment is maintained. Effects on psoriasis were beneficial, particularly with infliximab. Uncontrolled radiographic assessment data at one year indicated a beneficial effect of both etanercept and infliximab on the progression of joint disease. CONCLUSION: Our review indicates that both etanercept and infliximab are efficacious in the treatment of PsA with beneficial effects on both joint and psoriasis symptoms and on functional status. There are limited data indicating that etanercept and infliximab can delay joint disease progression. Further long-term data are required to confirm and consolidate the evidence base for both drugs.

Antibodies, Monoclonal↗
PubMedDate not supplied

Detection and modification of risk factors for coronary artery disease in patients with systemic lupus erythematosus: a quality improvement study.

OBJECTIVE: To assess the detection and control of risk factors for atherosclerosis in patients with SLE who subsequently develop acute coronary events. METHODS: Patients followed at the University of Toronto Lupus Clinic who developed a myocardial infarction (MI) or acute coronary insufficiency (ACI) and who had 2 years of follow-up prior to their event were identified and their case notes reviewed. The management of potentially reversible risk factors in this cohort was assessed. RESULTS: Twenty-four patients (18 female, 6 male) were studied. The mean age at the coronary event was 50 years and the mean duration of SLE was 13.5 years. Nineteen patients had MI and 5 had ACI. Risk factors identified were hypertension (16), obesity/Cushing's (19), smoking (16), hypercholesterolaemia (11), steroid use (22), hyperglycaemia (4) and cardiac involvement with SLE (4). In the two years prior to the event, hypertension and cardiac involvement were appropriately managed in almost all cases. Sixty percent had attempts made to reduce or stop their steroid therapy. Two of four cases with hyperglycaemia and 5 of 11 patients with hypercholesterolaemia had no appropriate action noted. No smoking advice was recorded, while one obese patient had weight reduction advice recorded. CONCLUSION: SLE patients who develop coronary events have potentially reversible risk factors prior to the event. Rheumatologists perform well when optimizing the control of SLE, minimizing the steroid dose and managing hypertension. Other risk factors are less favorably managed. Physicians managing lupus patients need to play a primary role in screening for and managing cardiac risk factors.

Adult↗