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Biomedical subjects

N McKay

Publications and source records attributed to N McKay.

8 recordsLinked to original sources
PubMed2006

A case of dextrocardiac ventricular fibrillation arrest.

Successful defibrillation of a patient with dextrocardia using conventional anterolateral paddle positions raises doubts about the necessity to place paddles in the exact recommended positions. Evidence found relates either to volunteers in a laboratory setting or to defibrillation of atrial arrhythmias. The conclusion is that there is no published difference either in transthoracic impedance or in success of defibrillation between anteroposterior and anterolateral paddle positions. In the absence of any evidence for an ideal apical paddle position in the standard anterolateral defibrillation of ventricular arrhythmias, the emphasis in ALS and resuscitation guidelines on "correct" positioning seems misplaced, and, by adding unnecessary information, may hinder learning the skill of defibrillation. Early defibrillation is crucial to successful recovery from cardiac arrest and anything that delays cardioversion should be avoided. The limited evidence suggests that the exact position of the paddles does not matter. The time taken to find the "correct" position is time wasted and it may instead be preferable to teach people merely to place the apical paddle to the left of the nipple in the midaxillary line.

Dextrocardia↗
PubMed2006

Pseudo myocardial infarction.

The case is presented of a 66 year old woman who attended the emergency department with severe abdominal pain subsequent to a bout of coughing, following a week's history of productive cough. She was known to have chronic obstructive pulmonary disease and was also on warfarin for recurrent deep vein thromboses. She had no history of ischaemic heart disease. She was found to have a rectus sheath haematoma and an international normalised ratio of 7.7, and admission was arranged for coagulation control and analgesia. However, a routine electrocardiograph (ECG) demonstrated an ST elevation pattern consistent with an acute inferior infarction. Subsequent ECGs showed no ST elevation, although the axis and chest lead QRS morphology remained the same throughout the first 12 hours. Over the next three days, R wave progression decreased in the chest leads. Troponin I at admission and 24 hours later were both <0.2 ng/ml. ECG changes compatible with acute myocardial infarction have been reported in association with a number of non-cardiac presentations; however, to our knowledge, it has never been reported in relation to a rectus sheath haematoma. We speculated on the possible mechanism of such "pseudo myocardial infarction" and the importance of treating the patient, not the ECG.

Aged↗
PubMed2005

Rabies: a review of UK management.

Rabies is endemic worldwide, and causes approximately 30 000 deaths per year. In the past 20 years, 12 deaths have occurred in the UK, although all but one case were contracted overseas. We have reviewed the current literature regarding the management of possible rabies exposure in the setting of a UK emergency department. The article offers an overview of rabies, including pathology, risk assessment, and current treatment, including both pre-exposure and post-exposure prophylaxis. We have also included a form online, which allows the correct information to be obtained and recorded prior to seeking advice from the local virology services.

Diagnosis, Differential↗
PubMed1991

A new robust index for measuring isokinetic trunk flexion and extension. Outcome from a regional study.

The purpose of this study was 1) to provide normative data for isokinetic trunk strength as measured by peak torque, best work repetition, and a new composite variable, "muscle performance index"; and 2) to examine the effects of protocol velocity, subject age, gender, height, and weight on these measurements. A significant decrease in peak torque of extension for females (P less than 0.0001) was seen as protocol velocity increased, but no differences were seen in males. A statistically significant amount (0.5-0.7) of the variance in isokinetic measurements was explained by subject age, height, and weight. Multivariant analysis of covariance showed the effects of these variances to be significant on all measurements except for the muscle performance index, which was unaffected by protocol velocity and remained stable without adjustments for subject age, weight, or height.

Adult↗
PubMed1986

Lacticacidaemia due to pyruvate dehydrogenase deficiency, with evidence of protein polymorphism in the alpha-subunit of the enzyme.

In three infants with neonatal lacticacidaemia, a deficiency in the E1 (pyruvate dehydrogenase) component of the pyruvate dehydrogenase complex was demonstrated in skin fibroblast cultures. Residual activities of the pyruvate dehydrogenase complex in the activated state were 1.6%, 3.9% and 18.8% of control values, respectively. Immunoprecipitation of extracts of cultures skin fibroblasts grown on 35S-methionine with anti-pyruvate dehydrogenase complex antibody revealed an abnormality in the E1 alpha-component of these three patients when visualised after sodium dodecyl sulphate/polyacrylamide gel electrophoresis. This component appeared to have a slightly lower molecular weight than did this protein from control cell strains. Cell strains from other patients with a deficiency of the pyruvate dehydrogenase complex did not exhibit this defect. Three patients also showed dysmorphism and developmental abnormalities of the central nervous system.

Animals↗
PubMed1985

Defective intramitochondrial NADH oxidation in skin fibroblasts from an infant with fatal neonatal lacticacidemia.

A small-for-gestational-age female infant born at term developed severe lactic acidosis and died on day 13 of life. Two previous sibs had also died of overwhelming lactic acidosis in the neonatal period. The lactate-to-pyruvate and 3-hydroxybutyrate-to-acetoacetate ratios were elevated at 136 and 42 to one, respectively. The activities of the pyruvate dehydrogenase complex and pyruvate carboxylase in cultured skin fibroblasts were normal but a defect in respiration was indicated by the low rates of conversion of 1-[14C]pyruvate, glutamate, and lactate to 14CO2 in these cells. Skin fibroblast cultures also displayed an elevated lactate-to-pyruvate ratio (72:1) when incubated with glucose as substrate compared to control cell cultures (20:1). When mitochondrial preparations of skin fibroblasts (prepared by digitonin extraction) were tested for their ability to synthesize ATP from a variety of substrates, it was found that those of the patient made adequate amounts of ATP with either succinate or ascorbate/tetramethyl-phenylenediamine as substrate but not with the NAD-linked substrates pyruvate, isocitrate, and palmitoyl carnitine. We propose that this is indicative of a defect in the respiratory chain between NADH and coenzyme Q, for the first time demonstrable in cultured skin fibroblasts.

Acidosis↗