Biomedical subjects
M Darling
Publications and source records attributed to M Darling.
Sun awareness and behaviour in healthcare professionals and the general public.
The knowledge, attitudes and behaviour of healthcare professionals and the general public towards issues of sun awareness were assessed in this questionnaire-based study. The findings indicated that junior doctors and nurses were no different from the general public when it came to seeking a tan or experiencing sunburn. The increased level of knowledge in doctors was not sufficient to have changed their behaviour and the medical profession should be targeted in education campaigns at an early stage in career development.
Case 1: small bowel obstruction due to metastatic lung cancer.
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Low-dose aspirin not for pre-eclampsia.
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Maternal and neonatal hyponatraemia: a comparison of Hartmanns solution with 5% dextrose for the delivery of oxytocin in labour.
We performed a randomised controlled trial to compare the effect on neonatal and maternal serum sodium of using oxytocin in Hartmanns solution compared to the standard 5% Dextrose regimen for induction or augmentation in labour. We found significantly decreased maternal and neonatal serum sodium concentrations in the 5% Dextrose group compared to the Hartmanns group.
Plasma HVA in adults with mental retardation and stereotyped behavior: biochemical evidence for a dopamine deficiency model.
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CLASP: millstone or milestone?
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Novel polyalkenoate (glass-ionomer) dental cements based on zinc silicate glasses.
Powdered zinc silicate glasses were investigated for cement formation with aqueous poly(acrylic acid). Alkali metal zinc silicate glasses and calcium zinc silicate glasses gave polyalkenoate cements which were hydrolytically unstable, whilst alumino-zinc-silicate glasses gave hydrolytically stable cements with short setting times (under 10 min) and high compressive strengths (above 90 MPa). The aluminium to silicon ratio was not important in determining the cement forming ability of the glass. The ability to form a cement was, instead, determined largely by the network connectivity of the glass.
Ambulatory blood pressure measurement in pregnancy.
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Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and pre-eclampsia.
OBJECTIVE: To determine the behaviour of the coagulation variables antithrombin III (ATIII), protein C, thrombin/antithrombin III (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre-eclamptic pregnancies. DESIGN: Longitudinal and cross-sectional observational study. SETTING: Antenatal clinic and maternity hospital. SUBJECTS: Thirty-six primigravid normotensive caucasian patients, four of whom subsequently developed pre-eclampsia, and 12 patients with established pre-eclampsia. MAIN OUTCOME MEASURES: Plasma levels of PAI-1, PAI-2 and t-PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques. RESULTS: PAI-1 and PAI-2 antigen levels rose progressively throughout normal pregnancy. Among the established pre-eclamptic group compared with matched normal pregnancies, the PAI-2 antigen level was significantly lower (48.5 +/- 22.8 versus 183.5 +/- 37.4; P < 0.001), the PAI-1 antigen level was significantly higher (122 +/- 34.4 versus 79.2 +/- 19.7; P < 0.001), ATIII activity was significantly lower (87.8 +/- 27.1 versus 110.9 +/- 19.3; P < 0.001) and TATIII complex levels were significantly higher (16.9 +/- 6.4 versus 10.2 +/- 5.9; P < 0.001). Among the four initially normotensive patients who subsequently developed pre-eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation. CONCLUSION: Significantly elevated levels of PAI-1 and fibronectin occurring early in pregnancies that subsequently develop pre-eclampsia suggest that these variables may have predictive values. PAI-2 would seem to be a marker of placental function in pre-eclampsia while increased t-PA and TATIII complex levels reflect the severity of the condition.
Accelerated folate breakdown in pregnancy.
During pregnancy there is an increased requirement for folate. We studied pregnant women to determine whether the increased requirement might be due to enhanced catabolism of the vitamin. Six normal pregnant women provided 24 h urine samples during each trimester and postpartum while taking a defined diet. The urines were assayed for the folate breakdown products p-amino-benzoylglutamate (pABGlu) and its acetylated derivative p-acetamidobenzoylglutamate (apBGlu) by high-pressure liquid chromatography. Mean concentration of excreted apABGlu rose significantly in the second trimester but returned to baseline postpartum. This increased rate of folate catabolism produces an extra demand for dietary folate of about 200-300 micrograms per day in pregnant women, a considerably greater value than recent recommendations.
Folate metabolism in pregnancy.
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Twenty-four-hour ambulatory blood pressure measurement in a primigravid population.
OBJECTIVE: To establish the profiles of 24-h non-invasive ambulatory blood pressure measurement (ABPM) during the trimesters of pregnancy and the puerperium in normotensive healthy primigravidae. DESIGN: A prospective study in which 24-h ABPM was performed on five occasions in each subject: in the first trimester between 9 and 16 weeks' gestation; in the second trimester between 18 and 24 weeks; in the third trimester between 26 and 32 weeks and between 33 and 40 weeks; and finally at 6 weeks post partum. METHOD: One hundred and six Caucasian primigravid women who were normotensive at their first booking visit were recruited consecutively from the antenatal clinic and had 24-h ABPM performed with the SpaceLabs 90207 ambulatory system. RESULTS: Of the 106 women recruited, 98 completed 24-h ABPM on four of the five measurement occasions. Four women delivered prematurely before 33 weeks' gestation, thereby missing one ABPM measurement. Changes during pregnancy and the puerperium were assessed against the ABPM performed in the first trimester. There was no difference for daytime or night-time systolic blood pressure between 9 and 33 weeks, but it rose significantly from 33 to 40 weeks. At 6 weeks post partum, systolic blood pressure was not significantly different from the daytime pressure in the first-trimester ABPM but was raised significantly at night. Diastolic blood pressure decreased significantly between 18 and 24 weeks for both daytime and night-time. From 33 to 40 weeks it increased in parallel with systolic blood pressure, and at 6 weeks post partum it was raised significantly compared with first-trimester values for daytime and night-time. The nocturnal fall in blood pressure was preserved throughout pregnancy with a significant difference between daytime and night-time measurements present on all measurement occasions for systolic, diastolic and mean blood pressures and heart rate. There were significant differences between daytime ABPM and clinic blood pressure for both systolic and diastolic blood pressure up to 33 weeks. From 33 weeks until 6 weeks post partum there was no significant difference between daytime ambulatory and clinic blood pressures. CONCLUSION: This study provides reference values for ABPM in healthy primigravidae with generally uncomplicated pregnancies.
Characteristics of bacteriuria in a homogeneous maternity hospital population.
Bacteriuria and urinary tract infection are a common cause of morbidity in pregnancy. Recent evidence has, however, questioned the magnitude of this risk and the effectiveness of therapy in reducing it. To clarify matters, a prospective study on 3123 ante-natal women was carried out. Screening for bacteriuria was carried out by culturing a mid-stream specimen of urine. Treatment was given to all patients with a positive culture and was based on antibiotic sensitivity testing. Repeat culture was performed 1 week after completion of therapy. The prevalence of bacteriuria in our population was 4.74%. Over half of these patients were asymptomatic. 67% of those with bacteriuria at screening were symptomatic or had a past history of urinary tract infection. Escherichia coli was the predominant organism cultured. The most effective antibiotic was Nitrofurantoin, which was sensitive in over 90% of isolates. Late urinary tract infection occurred in 3.52% of patients. There was no increase in maternal or foetal complications amongst those with bacteriuria. We concluded that it might be more cost-effective to confine screening to those patients who are symptomatic or have a past history of urinary tract infection.
Oral care of HIV-infected patients: the knowledge and attitudes of South African dentists.
As the numbers of people with HIV infection and AIDS increase, so will the contribution required from the dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in South Africa to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS, and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to the dental management of infected patients. Only 45 per cent were prepared to be engaged in the continued care of HIV-infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in South Africa.
The use of exercise as a method of aborting migraine.
Exercise, as a method of migraine management has been discussed theoretically and tested empirically. The consensus is that exercise can help to reduce the frequency, intensity and/or duration of migraine attacks. Conversely, there are case studies which, with few exceptions, suggest that periods of exercise can precipitate a migraine headache. The literature concurs, however, that one should not attempt exercise when in the midst of an attack. The present article presents a case study of a woman who found prompt relief from her migraines with strenuous exercise.
Exercise and migraine. A critical review.
Exercise has been frequently discussed as a method of migraine management, but the pathways by which exercise may alter migraines are unclear at present. The purpose of this paper is to provide a theoretical discussion of variables potentially involved in the prophylactic effects of a program of regular exercise. Exercise medicated changes to neurochemical secretory patterns, as well as symptoms commonly associated with, and thought to precipitate migraines will be discussed. Due to the paucity of experimental investigations of exercise and migraine, the bulk of supportive evidence for exercise as a treatment for migraines is gathered from related areas of research.
Clinical application of ambulatory blood pressure measurement in pregnancy.
Eclampsia and pre-eclampsia are the most important obstetric causes of maternal mortality in the Western world. The current definitions of hypertensive disorders in pregnancy rely on arbitrary blood pressure limits based on intermittent clinic readings which are subject to bias and error. Twenty-four-hour ambulatory blood pressure monitoring can overcome many of these deficiencies but has only recently been introduced into antenatal care. Five pregnancy studies using ambulatory blood pressure monitoring are currently underway in Birmingham, Glasgow, Grenoble, Oxford and Dublin. The results so far indicate that ambulatory blood pressure monitoring is an acceptable method of measuring blood pressure in pregnancy. It is also concluded that ambulatory blood pressure monitoring may have several roles in the future antenatal management of hypertension, including modification of existing classification systems, a clinical confirmatory role and a possible predictive role for pre-eclampsia.