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Biomedical subjects

J Muir

Publications and source records attributed to J Muir.

At least 19 recordsLinked to original sources
PubMed1992

Lifestyle advice in general practice: rates recalled by patients.

OBJECTIVE: To document how often patients with varying cardiovascular risk levels reported receiving lifestyle advice from general practice. DESIGN: Cross sectional descriptive survey by postal questionnaire. SETTING: 5 general practices in Bedfordshire. SUBJECTS: 4941 people aged 35-64 years who had consulted a general practitioner at least once during the 12 months before completing the questionnaire and who subsequently attended for a health check as part of the OXCHECK trial. MAIN OUTCOME MEASURES: Report of having received advice from a general practitioner or practice nurse about smoking, alcohol consumption, exercise, or diet during the 12 months before completing the questionnaire. Cardiovascular risk assessed by a nurse during structured health check. RESULTS: The overall reported rate of advice was 27% for smoking, 4.5% for exercise, 12% for diet, and 3% for alcohol consumption. Those with unhealthy behaviour profile or at increased cardiovascular risk received more advice--for example, 47% of smokers with a history of cardiovascular disease received advice on smoking. Among those at increased risk, men were more likely than women to receive advice about exercise (11% v 4%, p = 0.04) and alcohol consumption (10% v 4%, p = 0.007), while women received more advice about weight (17% v 23%, p < 0.001). The rate of receiving advice was unaffected by age, marital status, or social class. CONCLUSION: The low rate of lifestyle advice reported by patients implies that more preventive advice could be provided in primary care.

Adult↗
PubMed1992

Choosing the preventive workload in general practice: practical application of the Coronary Prevention Group guidelines and Dundee coronary risk-disk.

OBJECTIVE: To determine the workload implications for general practice of the Coronary Prevention Group and British Heart Foundation action plan for preventing heart disease. DESIGN: Computer simulation of plan, including calculation of Dundee risk scores, with data from OXCHECK trial. SUBJECTS: 4759 patients aged 35-64 who had health checks during 1989-91. MAIN OUTCOME MEASURE: Effect of using different risk scores as thresholds on workload and coverage of patients at known risk. Thresholds of 6-20 were used for cholesterol screening (nearset) and 4-16 for special care (preset). RESULTS: On the basis of workload a nearset of 8 and preset of 12 would be reasonable. This implies cholesterol measurement in 1794 (37.7%) patients and special care in 1074 (22.6%). However, many patients with single risk factors were not allocated to special care at these thresholds: 11 (37.9%) patients with cholesterol concentrations > or = 10 mmol/l, 21 (33.9%) with systolic pressure > or = 180 mm Hg, and 213 (40.7%) heavy smokers (> 20 cigarettes/day) were missed. The distribution of scores was similar in those at established clinical risk, those with family history of heart disease, and others. CONCLUSION: The guidelines may help to make best use of resources within specific age-sex groups but sound protocols for unifactorial risk assessment and modification remain essential.

Adolescent↗
PubMed1992

Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy.

BACKGROUND: Amitriptyline reduces the pain caused by peripheral-nerve disease, but treatment is often limited by side effects related to the drug's many pharmacologic actions. Selective agents might be safer and more effective. METHODS: We carried out two randomized, double-blind, crossover studies in patients with painful diabetic neuropathy, comparing amitriptyline with the relatively selective blocker of norepinephrine reuptake desipramine in 38 patients, and comparing the selective blocker of serotonin reuptake fluoxetine with placebo in 46 patients. Fifty-seven patients were randomly assigned to a study as well as to the order of treatment, permitting comparison among all three drugs and placebo as the first treatment. The patients rated the degree of pain present each day using verbal descriptors, and they also assessed the extent of pain relief globally at the end of each treatment period. RESULTS: After individual dose titration, the mean daily doses of the drugs were as follows: amitriptyline, 105 mg; desipramine, 111 mg; and fluoxetine, 40 mg. There was moderate or greater relief of pain in 28 of the 38 patients (74 percent) who received amitriptyline, 23 of the 38 patients (61 percent) who received desipramine, 22 of the 46 patients (48 percent) who received fluoxetine, and 19 of the 46 patients (41 percent) who received placebo. The differences in responses between amitriptyline and desipramine and between fluoxetine and placebo were not statistically significant, but both amitriptyline and desipramine were superior to placebo. Amitriptyline and desipramine were as effective in patients who were not depressed as in depressed patients, but fluoxetine was effective only in depressed patients. CONCLUSIONS: Desipramine relieves pain caused by diabetic neuropathy with efficacy similar to that of amitriptyline, offering an alternative for patients unable to tolerate the latter. Blockade of norepinephrine reuptake is likely to mediate the analgesic effect of these antidepressant drugs in diabetic neuropathy. Fluoxetine, which blocks serotonin uptake, is no more effective than placebo for the relief of pain.

Adult↗
PubMed1992

Direct gas chromatographic assay of urinary medium-chain fatty acylcarnitines by their thermal decomposition.

We report a gas chromatographic assay for urinary medium-chain acylcarnitines which employs their property of thermal lability, and by circumventing the need for specialised mass spectroscopy is suitable for routine laboratory use. The method produces readily interpreted, uncomplicated chromatograms and has proved to be both sufficiently sensitive and specific to enable detection of octanoylcarnitine in a symptomatic individual with medium-chain CoA dehydrogenase deficiency and in two asymptomatic siblings following administration of a carnitine load.

Acyl-CoA Dehydrogenase↗
PubMed1990

Reviewing diabetes.

Explore the source record for details and available documents.

Diabetes Mellitus↗
PubMed1990

A study of fatigue in systemic lupus erythematosus.

Fifty-nine patients with systemic lupus erythematosus were evaluated by questionnaires, histories, physical examinations and routine laboratory studies in order to better understand their fatigue. The fatigue severity scale (scored from 1 to 7) was used to measure fatigue and yielded a mean score +/- SD of 4.6 +/- 1.5. Fifty-three percent of the patients reported that fatigue was their most disabling symptom. Although perceived as severe, the symptom of fatigue did not correlate significantly with any of the laboratory measures. However, there was a significant correlation between fatigue and the physician's rating of disease activity. Fatigue also correlated significantly with depression which accounted for 21% of the variation in fatigue scores.

Adolescent↗
PubMed1989

Three year follow up of patients with raised blood pressure identified at health checks in general practice.

OBJECTIVE: To assess the extent of three year follow up of blood pressure, weight, and smoking habit in patients with raised blood pressure identified at health checks. DESIGN: Retrospective audit of medical and nursing records. SETTING: Three general practices in Oxfordshire. PATIENTS: 386 of 448 patients with raised blood pressure (diastolic greater than or equal to 90 or systolic greater than or equal to 160 mm Hg) identified from 2935 patients aged 35-64 attending health checks in 1982-4. MEASUREMENTS AND MAIN RESULTS: All records of blood pressure, weight, and smoking habit in the medical record were abstracted for three years after the initial health check. All 42 patients with an initial diastolic blood pressure greater than or equal to 105 mm Hg and 316 of 344 patients with an initial pressure of 90-104 mm Hg had at least one further measurement of their blood pressure. Follow up of smoking habit and of weight was less complete with only half of the 100 smokers and 67 of the 87 obese patients (body mass index greater than or equal to 30) having any documented follow up of these risk factors. Annual follow up in the second and third years occurred in 228/297 (76.8%) and 232/320 (72.5%) in patients with blood pressure greater than 95 mm Hg at the beginning of each year. For patients who smoked annual follow up in these years occurred in fewer than a third and for those who were obese in just over half. On the assumption that those not followed up had not changed, at the end of three years the proportion of patients with diastolic blood pressure greater than or equal to 100 mm Hg had fallen from 61 patients (15.8%) to 31 (8.1%); the proportion of smokers had fallen from 103 (26.7%) to 94 (24.4%); and the proportion of obese patients had fallen from 87 (22.5%) to 79 (20.5%). CONCLUSIONS: These changes were modest and in the absence of a control group cannot be attributed necessarily to health checks. Although the standard of follow up was better than in previously reported studies of the management of hypertension, the results emphasise the need to develop formal protocols for dietary and antismoking interventions and to evaluate formally the effectiveness (and cost effectiveness) of health checks.

Adult↗
PubMed1989

Immuno- and bioactive inhibin and inhibin alpha-subunit expression in rat Leydig cell cultures.

The rise in serum immunoactive inhibin levels in male rats following hCG stimulation raised the possibility that Leydig cells may produce inhibin. This study therefore evaluated whether Percoll-purified Leydig cells from adult male rats synthesized and secreted inhibin in vitro as measured by Northern blot analysis, radioimmunoassay and in vitro bioassay. Northern blot analysis demonstrated the presence of alpha-inhibin subunit mRNA in the Leydig cell and inhibin bioactivity was detected in Leydig cell culture media. Levels of immunoactive inhibin increased in culture over 20 h and were directly dependent on the number of Leydig cells in culture. rLH (NIADDK-rLH-I-6) and not rFSH (NIADDK-rFSH-I-6) stimulated immunoactive inhibin levels in a dose-dependent manner. This study demonstrates that Leydig cells express mRNA for the alpha-subunit of inhibin and produce inhibin which is biologically and immunologically active prompting a re-evaluation of our concepts of testicular inhibin production.

Animals↗
PubMed1989

The recovery of circulating progenitor cells after chemotherapy in AML and ALL and its relation to the rate of bone marrow regeneration after aplasia.

Peripheral blood levels of BFU-e, CFU-GM and CFU-mix were studied serially in nine patients with acute leukaemia in remission during the period of recovery that followed induction or consolidation chemotherapy. Following 23 courses of treatment in the nine patients, the values for all three classes of progenitor were found to be higher in ALL than in AML (mean peak CFU-GM levels 5.8 x 10(3)/ml and 0.8 x 10(3)/ml respectively) and the highest levels were observed in patients recovering the most rapidly from bone marrow aplasia. Peak levels of these progenitors correlated best with the rate and extent of platelet recovery and all patients achieving blood levels of greater than 1.0 x 10(3) CFU-GM/ml had recovered greater than 100 x 10(9)/l platelets by 20 d and had peak platelet counts of greater than 400 x 10(9)/l within 40 d following chemotherapy. The peak values for circulating progenitors fell markedly after repeated courses of treatment in three of the five AML patients studied and this is likely to limit useful harvesting of such cells during later consolidation courses in this disease.

Adolescent↗
PubMed1989

The tissue distribution of T lymphocytes expressing different CD45 polypeptides.

The distribution of T lymphocytes expressing the different polypeptides of the leucocyte common antigen (LCA) family detected by CD45R and UCHL1 antibodies has been studied in normal lymphoid tissues. In the thymus most cortical thymocytes express UCHL1 and co-express CD4 and CD8. The more mature membrane CD3+ (mainly medullary) T cells are heterogenous and may express both UCHL1 and CD45R weakly or be restricted to display CD45R or UCHL1 alone. In the medulla both the CD45R+ and UCHL1+ subpopulations contain single positive CD4 and CD8 cells. In tonsils, germinal centre T cells are almost exclusively UCHL1+, CD4+ and a proportion also express HNK-1 (Leu 7) antigen. In the paracortical areas approximately equal numbers of CD45R+ and UCHL1+ cells are found but these separately occupy nests of cells containing one or the other type. Again, both CD45R+ and UCHL1+ cells include single CD4+ and CD8+ lymphocytes. A small proportion (less than 5%) of strongly CD45R+, UCHL1+ double-stained cells are also seen, and these probably represent recently activated lymphocytes. In the gut, small clusters of such strongly double-labelled cells are in the submuscular mucosae while cells of the lamina propria are almost exclusively UCHL1+. Many intra-epithelial lymphocytes are only weakly positive or negative for UCHL1 and appear to be CD45R-. These results are consistent with the view that expression of different CD45 polypeptides identifies successive stages of thymocyte-T-cell maturation and that following their thymic education, unprimed T lymphocytes are CD45R+, while primed memory T cells are UCHL1+. These populations occupy different microenvironments.

Antigens, Differentiation↗