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Biomedical subjects

M Cox

Publications and source records attributed to M Cox.

At least 37 records · Page 2Linked to original sources
PubMed2001

Loss of visual acuity is the main reason why reading addition increases after the age of sixty.

PURPOSE: To determine why the reading addition increases after the age of 55 to 60 years when accommodation is zero. METHODS: Distance and near visual acuities, arm length, habitual near working distance, reading addition, and pupil diameter were measured in 44 subjects aged >60 years (mean, 72.9 +/- 5.7). Reading addition values were attained using three techniques: least-plus addition using both N-notation text and MN-READ text and the cross-cylinder technique. RESULTS: The mean dioptric working distance was 2.75 +/- 0.40 D. The reading addition found using N-notation text (+2.21 +/- 0.38 D) was significantly lower than that measured using MN-READ text (+2.48 +/- 0.49 D) or the cross-cylinder method (+2.53 +/- 0.44 D). The reading addition was positively correlated with the dioptric working distance (r = 0.47, p < 0.01), and decreasing habitual working distance was associated with poorer visual acuity (r = -0.42, p < 0.01). CONCLUSIONS: Our results suggest that decreases in near visual acuity after 60 years of age lead to a reduction in habitual working distance, which increases text angular subtense. In turn, the reduced working distance requires a greater reading addition. Increases in depth of field associated with both suprathreshold text (N-notation) and lower visual acuity lead to reading additions being less than the dioptric working distance.

Accommodation, Ocular↗
PubMed2001

An aggressive neuroendocrine tumour in a man with AIDS.

Pancreatic neuroendocrine tumours (PETs), though rare, are usually slow growing tumours with a relatively good prognosis. We describe a case of an aggressive malignant neuroendocrine tumour of the pancreas occurring in an AIDS patient, which has not been reported previously.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Eighteenth and nineteenth century dental restoration, treatment and consequences in a British nobleman.

This paper examines unusual eighteenth and nineteenth century dental treatment and its consequences, in a nobleman excavated from beneath St. Nicholas' Church, Sevenoaks, Kent, UK in the early 1990s. This rare archaeological case exhibits erosion of dental enamel on the labial surface of all the anterior dentition. A programme of historical research suggests that this might be attributed to the application of an acid-based dental tincture or the use of an abrasive substance to whiten the teeth. Palliative treatment for the consequence of this application was prescribed by Dr Robert Blake of Dublin. Further, it bears witness to three dental restorations, two of gold and one tin. The two gold (foil) fillings are an occlusal in the upper-right second molar and a cervical on the labial surface of the upper left canine. The tin filling is an occlusal in the upper left second molar. Excavation of the carious tissue appears to have been undertaken using a spoon shaped implement.

Dental Caries↗
PubMed2000

Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction.

BACKGROUND: Endoscopic sphincterotomy for biliary-type pain after cholecystectomy remains controversial despite evidence of efficacy in some patients with a high sphincter of Oddi (SO) basal pressure (SO stenosis). AIM: To evaluate the effects of sphincterotomy in patients randomised on the basis of results from endoscopic biliary manometry. METHODS: Endoscopic biliary manometry was performed in 81 patients with biliary-type pain after cholecystectomy who had a dilated bile duct on retrograde cholangiography, transient increases in liver enzymes after episodes of pain, or positive responses to challenge with morphine/neostigmine. The manometric record was categorised as SO stenosis, SO dyskinesia, or normal, after which the patient was randomised in each category to sphincterotomy or to a sham procedure in a prospective double blind study. Symptoms were assessed at intervals of three months for 24 months by an independent observer, and the effects of sphincterotomy on sphincter function were monitored by repeat manometry after three and 24 months. RESULTS: In the SO stenosis group, symptoms improved in 11 of 13 patients treated by sphincterotomy and in five of 13 subjected to a sham procedure (p = 0.041). When manometric records were categorised as dyskinesia or normal, results from sphincterotomy and sham procedures did not differ. Complications were rare, but included mild pancreatitis in seven patients (14 episodes) and a collection in the right upper quadrant, presumably related to a minor perforation. At three months, the endoscopic incision was extended in 19 patients because of manometric evidence of incomplete division of the sphincter. CONCLUSION: In patients with presumed SO dysfunction, endoscopic sphincterotomy is helpful in those with manometric features of SO stenosis.

Adult↗
PubMed2000

Clinical performance of the levonorgestrel intra-uterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report.

Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 692 Levonorgestrel Intra-uterine Systems (LNG IUS). This study was undertaken to determine the performance of the LNG IUS in British women in routine clinical use. The 12 months cumulative life-table event rates were: pregnancy 0.6, expulsion 4.5. The continuation rate was 70.6. Removals were also required for side effects, which may be due to absorbed levonorgestrel, the removal rate being 7.4. Positive effects include effective contraception and considerably reduced quantity of bleeding for most participants. A need was identified to counsel women about the early bleeding problems, including the possibility of oligomenorrhoea or amenorrhoea. This is considered to be very important as it will help women to persevere so that they can enjoy the longer-term benefits.

Abortion, Spontaneous↗
PubMed2000

Clinical performance of the Nova-T380 IUD in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report.

Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 572 Nova-T380 intra-uterine contraceptive devices (IUDs). The Nova-T (and formerly the identical Novagard) IUDs have copper with a surface area of 200 mm(2). The device used in this study, the Nova-T380, has copper with a surface area of 380 mm(2). The purpose of the study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with other published results, in the clinical setting of British general practice and family planning clinics. The 12-month cumulative life-table event rates were: pregnancy 0.8, expulsion 5.6, removal for bleeding or bleeding and pain 11.0. The continuation rate was 73.4. The pregnancy rate at 12 months showed good contraceptive performance. The increased surface area of copper was not associated with a reduced pregnancy rate, but as this was not a direct comparative study with the Nova-T, the influence of the increased area of copper must remain somewhat uncertain. This study found the discontinuation rate for bleeding problems and pain with bleeding to be higher than in other published studies. Other event rates were consistent with other published studies.

Adolescent↗
PubMed2000

New strategies in the management of acute coronary syndromes.

Advances in the understanding of acute coronary syndromes have occurred rapidly in the last 5 years and have dramatically changed the way patients are evaluated, diagnosed, and managed. Medical advances, such as antiplatelet and antithrombin agents and growing databases on interventional outcomes have created a new world of therapeutic options for the spectrum of ischemic heart disease. As more options become available, nurses are under increasing pressure to stay abreast of what these options have to offer patients, and which patients benefit most from each therapeutic approach. The purpose of this article is to review the newest therapies for acute coronary syndromes, including GP IIb/IIIa inhibitors, low molecular weight heparins, and direct thrombin inhibitors, and discuss indications and contraindications for each of these therapies. Changes in diagnostic approach using troponin T and I are also presented.

Acute Disease↗
PubMed1999

Public preferences regarding rabies-prevention policies in the UK.

The current 6-month quarantine system for all cats and dogs entering the UK has kept the UK rabies-free since 1922. However, pressure is mounting for a change to a system of vaccination, microchip identification and serological testing. In response to the increasing controversy surrounding the quarantine system, the UK government recently set up an independent review panel to assess the alternatives. This paper quantifies public preferences for the current policy and three alternative rabies-prevention measures. A survey was used not only to assess the overall preferences for rabies-prevention policies but also to assess the importance of policy attributes and socio-economic characteristics in determining policy preferences. We interviewed a sample of pet-owners in North Yorkshire. The results showed that the existing system was the single most-preferred policy option. However, a large proportion of the sample preferred the vaccination-based policies. A logistic-regression model and ordered probit models were used to find that safety and animal welfare were the most-important factors determining policy preferences. The respondents' awareness of the rabies-policy review, a desire to take a pet abroad, the amount of foreign travel, occupation and previous experience of quarantine were all important factors in policy choice. Socio-economic characteristics such as income, pets owned and the number of children were not significant determinants of policy preference.

Animals↗
PubMed1999

Early use of inhaled nedocromil sodium in children following an acute episode of asthma.

BACKGROUND: Current guidelines on the treatment of childhood asthma recommend the introduction of an anti-inflammatory drug in children who have persistent symptoms and require regular treatment with a bronchodilator. The efficacy and safety of inhaled nedocromil sodium (Tilade Mint aerosol) administered using a Fisonair spacer at a dose of 4 mg three times daily was compared with placebo in the treatment of asthmatic children aged 6-12 years who are symptomatic and recovering from an acute exacerbation of asthma. METHODS: A group comparative, double blind, placebo controlled trial was performed in children who were recovering from an acute episode of asthma following treatment in the emergency department of the hospital or in children referred from their general practitioner following a wheezing episode and documented evidence of at least two previous episodes of wheezing. A two week baseline period on existing bronchodilator treatment was followed by a 12 week treatment period on either nedocromil sodium (2 mg/puff) or placebo. Both treatments were administered using a Fisonair spacer at a dose of two puffs three times daily. Changes from baseline values in daytime asthma and night time asthma symptom scores, usage of rescue bronchodilators, mean peak expiratory flow (PEF) recorded twice daily on diary cards, patients' opinion of treatment, and withdrawals due to treatment failure were measured during the primary treatment period (last six weeks of treatment). RESULTS: One hundred and forty two children aged 6-12 years entered the baseline period. Sixty three were withdrawn due to failure to meet the entry criteria (18) or the criteria for asthma symptom severity (15) or reversibility (9), because they developed uncontrolled asthma (2), because they took disallowed treatment (2), or for other non-trial related reasons (17). Seventy nine patients (46 boys) of mean age 8. 8 years entered the treatment period. There were significant differences in the changes from baseline values during the last six weeks of treatment in favour of nedocromil sodium compared with placebo in the primary variables of daytime asthma and night time asthma, morning and evening PEF, and the usage of rescue inhaled bronchodilators; 53% of patients reported nedocromil sodium to be very or moderately effective compared with 44% placebo. Improvement in asthma symptoms, PEF, and reduction in use of rescue bronchodilators did not reach statistical significance until after six weeks of treatment. Twenty two patients were withdrawn or dropped out during the treatment phase, 12 due to uncontrolled asthma or persistence of asthma symptoms, four due to suspected adverse drug reactions (nedocromil sodium 3 (headaches 2, angio-oedema/urticaria 1), placebo 1(persistent cough)), and six due to non-treatment related reasons. Seventy one adverse events were reported by 27 patients in the nedocromil group and 75 by 30 patients in the placebo group. CONCLUSIONS: Asthma symptoms, use of bronchodilators, and lung function can be improved significantly in children recovering from an acute exacerbation of asthma or wheeze and currently receiving treatment with bronchodilators alone by the addition of inhaled nedocromil sodium at a dose of 4 mg three times daily administered using a Fisonair holding chamber.

Acute Disease↗
PubMed1999

Rheumatology. Part 3: The role of surgery.

Surgery can relieve the pain of some patients with rheumatoid arthritis. Caring for RA patients undergoing surgery is a multidisciplinary task. Nurses have a major role to play in pre-operative, peri-operative and postoperative care.

Arthritis, Rheumatoid↗
PubMed1999

Recovery of human skeletal elements from a recent UK murder inquiry: preservational signatures.

Factors that control bone preservation are not fully understood but generally include those that reflect "natural" taphonomic or diagenetic processes and also those reflecting anthropogenic activity. The aim of this paper is to examine whether the survival of skeletal elements from a recent UK serial murder investigation (n = 12) and three archaeological cemetery sites from England (n = 112, 95, 182; Roman to early-medieval), share a similar recovery signature. Examination of this data demonstrates that even when clear evidence of traumatic and perimortem dismemberment exists within an assemblage, the distribution of missing elements can be almost identical to archaeological material buried in normal attrition cemeteries. Given that these preservational signatures are so similar, it is concluded that careful observation of bone surfaces is necessary to confidently interpret bone loss, particularly where dismemberment and/or element excision is suggested by the non-anatomical position of the skeleton within the grave. Where postmortem excision of bone is suspected, careful examination of contiguous bone surfaces, both macroscopic and microscopic, is suggested to detect fine cutmark lesions indicative of anthropogenic excision. Without this evidence other preservational factors must be considered both taphonomic and diagenetic.

Adolescent↗
PubMed1998

Association of malaria parasite population structure, HLA, and immunological antagonism.

Host-parasite coevolution has been likened to a molecular arms race, with particular parasite genes evolving to evade specific host defenses. Study of the variants of an antigenic epitope of Plasmodium falciparum that induces a cytotoxic T cell response supports this view. In African children with malaria, the variants present are influenced by the presence of a human leukocyte antigen (HLA) type that restricts the immune response to this epitope. The distribution of parasite variants may be further influenced by the ability of cohabiting parasite strains to facilitate each other's survival by down-regulating cellular immune responses, using altered peptide ligand antagonism.

Alleles↗
PubMed1998

The criminality of former "special educational provision" permanently "excluded from school" adolescents as young adults (16-23): costs and practical implications.

An analysis of police records of the criminal "careers" of a complete cohort (1990-95) of 227 "excluded from school" adolescents who had been in "special educational provision" found that 63% had a criminal conviction as young adults (16-23 years). However there was evidence of "missed opportunities" as 26% of the offenders were not convicted until over 18-years-old. Averaging 7.4 offences each, 29% had a conviction for violence, 29% had been to prison and a further 27% are currently on bail for alleged offences. Home Office-based predictions show that 42% are highly likely to re-commit their most serious offence within 2 years. Based upon Audit Commission and Department of Health estimates, these 143 young adults cost a minimum of pound 4.16 million pounds. However, 10% of excluded adolescents who were also "ex child care" had a significantly lower crime rate than the others (41% vs. 70%), which suggests that with targeted support, such as under the 1989 Children Act, effective intervention is possible in a significant number of cases.

Adolescent↗