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Biomedical subjects

P Iqbal

Publications and source records attributed to P Iqbal.

11 recordsLinked to original sources
PubMed2006

Twenty four hour ambulatory blood pressure monitoring: a new tool for determining cardiovascular prognosis.

Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important part in the management of subjects with suspected and confirmed disorders of blood pressure regulation. This article reviews the prognostic significance of various aspects of the 24-H ABPM and describes the authors experience in Chesterfield. Over the course of 12 month period from 1 August 2002, 1264 subjects had 24-ABPM. A total of 1187 (93.91%) subjects were included in this study, with mean age of 59.30 years and male:female ratio was 46%: 54 %. Fifty two (4.38%) of the subjects had all of the seven features associated with an adverse prognosis. Only 82 (6.90%) subjects had none of the seven adverse prognostic features with the remainder having one or more adverse prognostic features.

Blood Pressure↗
PubMed2004

Rhabdomyolysis induced by a single dose of a statin.

Statins have been shown to cause myotoxicity and rhabdomyolysis. In most cases rhabdomyolysis occurs following the use of these drugs for at least one week. A case of rhabdomyolysis after just a single dose of simvastatin is reported.

Dyspnea↗
PubMed2000

The effect of pregnancy on bone density and bone turnover.

During pregnancy, the mother adapts to meet the calcium demands of the fetus. The effect of this adaptation on the maternal skeleton is not fully understood. Our objectives were to evaluate changes in bone mineral density (BMD) and bone turnover during pregnancy. We studied 16 women longitudinally, with baseline measurements before pregnancy; then at 16, 26, and 36 weeks of pregnancy; and postpartum. We measured total-body BMD and biochemical markers of bone resorption (urinary pyridinium crosslinks and telopeptides of type I collagen) and bone formation (serum bone alkaline phosphatase, propeptides of type I procollagen [PINP] and osteocalcin). We also measured parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and human placental lactogen. Postpartum, BMD increased in the arms (2.8%, P < 0.01) and legs (1.9%, P < 0.01) but decreased in the pelvis (-3.2%, P < 0.05) and spine (-4.6%, P < 0.01) compared with prepregnancy values. All biochemical markers, with the exception of osteocalcin concentration, increased during pregnancy. The change in IGF-I at 36 weeks was related to the change in biochemical markers (e.g., PINP, r = 0.72, P = 0.002). Pregnancy is a high-bone-turnover state. IGF-I levels may be an important determinant of bone turnover during pregnancy. Elevated bone turnover may explain trabecular bone loss during pregnancy.

Adult↗
PubMed1997

Antihypertensive therapy and orthostatic responses in elderly hospital in-patients.

The study aim was to determine the association between use of antihypertensive drugs and orthostatic hypotension on prolonged standing in an elderly in-patient population. Hospital in-patients aged > 60 years had manually and automatically determined blood pressure (BP) measurements recorded in the supine position. On standing a total of nine measurements were taken over 10 min, six measurements were taken using a mercury sphygmomanometer and three by an automatic monitor. Seventy-four patients of mean age 73 +/- 7 years were studied; 52 (70%) were taking > or = 1 antihypertensive drug and 22 (30%) none. On standing, manually determined systolic BP (SBP) fell to a similar extent in the group of patients taking antihypertensive therapy compared to those not taking such treatment (at 9 min standing: -6 +/- 16 vs -10 +/- 15 mm Hg, respectively) and the frequency of orthostatic hypotension (SBP fall > or = 20 mm Hg) was similar in both groups [at 9 min: 9 (17%) vs 5 (23%)]. Automatically determined measurements also revealed similar orthostatic SBP responses in both treated and non-treated groups (at 8 min: -3 +/- 18 vs -6 +/- 13 mm Hg, respectively) and a similar frequency of orthostatic hypotension. No significant change in standing compared to supine diastolic BP (DBP) measured manually or automatically was seen in either group. Even in the subgroup of patients taking > or = 2 antihypertensive drugs the orthostatichypotension. BP response and the frequency of orthostatic hypotension was similar to that in the non-treated group. In conclusion no association was found between use of antihypertensive therapy and orthostatic hypotension in an elderly in-patient population.

Aged↗
PubMed1997

Management of urinary incontinence in the elderly.

Urinary incontinence is common in the elderly, affecting 6-8% of people over 64 years in the community and up to 31% in hospital and long-term care. It is possible to establish the diagnosis clinically in most incontinent patients with the likelihood of improving symptoms in the majority. Treatment of patients with urinary incontinence requires attention to general and specific measures. General measures include moderation of fluid intake to about 1.5 litres/day, reduced intake of caffeine-rich drinks, treatment of aggravating conditions such as urinary infection, oestrogen deficiency, increased solute load as in diabetes mellitus and uraemia, and drugs like diuretics, sedatives and antidepressants. Specific measures include pelvic floor exercises, vaginal cones, interferential therapy and oestrogens for patients with stress incontinence. Bladder retraining and anticholinergic drugs are for patients with urge incontinence, and alpha-blockers and 5-alpha reductase inhibitors for patients with overflow incontinence due to prostatic hyperplasia.

Aged↗
PubMed1997

Orthostatic blood pressure changes on prolonged standing in elderly hospital in-patients.

To determine early and delayed orthostatic BP responses in elderly hospitalized patients on prolonged standing, 85 patients, including normotensive and hypertensive persons, both treated and untreated, aged between 60 and 90 years, were studied. Following 10 min rest a series of nine supine BP measurements were undertaken, first with a mercury sphygmomanometer, immediately followed by an automatic oscillometric BP monitor (SpaceLabs 90207), then again by the sphygmomanometer. Patients then stood and the series of BP measurements was repeated, giving a total of nine standing BP determinations at 1 min intervals. Orthostatic BP measurements recorded by both devices were assessed at 1-3 min (early phase), 4-6 min (mid-phase), and 7-9 min (late phase). The orthostatic fall in SBP was greater during the late than early phase when measured by both the sphygmomanometer (-7.5+/-14.9 vs -2.6+/-10.3 mmHg; difference 4.9+/-8.7 mmHg, p<0.001, 95% CI: 3.0, 6.7 mmHg) and the automatic monitor (-3.5+/-16.9 vs 0.5+/-14.5 mmHg, difference 4.0+/-11.6 mmHg; p=0.002, CI: 1.5, 6.5 mmHg). Orthostatic changes in DBP were similar during early and late phases. More patients had systolic orthostatic hypotension (SBP fall > or =20 mmHg on standing) measured by the sphygmomanometer during the late than early phase (19 [22%] vs 6 [7%]; respectively, p=0.009), but not when measured by the monitor (10 [12%] vs 9 [11%], respectively). Many hospitalized elderly patients may exhibit systolic orthostatic hypotension as measured by sphygmomanometry only after prolonged (> or =7 min) standing.

Aged↗
PubMed1996

Differences in orthostatic blood pressure changes measured with an oscillometric blood pressure monitor and a mercury sphygmomanometer.

AIMS: To compare orthostatic blood pressure (BP) changes recorded with the SpaceLabs 90207 BP monitor (SL) and the standard mercury sphygmomanometer (HgS). METHODS: 85 hospital in-patients aged 60-90 years had nine BP measurements recorded by both instruments using the same arm sequential measurement technique in supine and standing position by two observers. Supine BP was taken as the final set of three supine measurements, ie, one made with the SL, and the mean of the two HgS readings immediately before and after the monitor reading. From the SL supine reading was subtracted the three standing SL monitor readings and from the mean of the 2 supine HgS readings was subtracted the six standing measurements taken by the HgS. The orthostatic BP changes recorded by the HgS immediately before and after each SL monitor reading were averaged and compared with the corresponding orthostatic change recorded by the monitor. RESULTS: The monitor underestimated orthostatic SBP changes at all 3 comparisons compared to the HgS; i) -0.9 +/- 14.9 vs 2.7 +/- 10.3 mmHg, p < 0.05; ii) 0.3 +/- 15.4 vs 4.5 +/- 12.1 mmHg, p < 0.05; iii) 3.5 +/- 16.9 vs 7.5 +/- 14.9 mmHg, p < 0.05, respectively. These differences were more pronounced in males than females. Orthostatic hypotension (defined as SBP fall on standing of > or = 20 mmHg) was recorded in males by the monitor in four (8%) and by the HgS in 12 (25%), p < 0.05. Mean orthostatic DBP changes were similarly recorded by the monitor and HgS. On average only 60% and 77% of orthostatic SBP measurements taken by both instruments agreed within 10 and 15 mmHg respectively while 75% and 88% respectively of orthostatic DBP changes agreed within these limits. CONCLUSION: Orthostatic BP falls measured by an automatic oscillometric BP monitor may not be equivalent to those taken with a HgS and their use adds a further variable to the comparison of orthostatic BP changes between studies.

Aged↗
PubMed1996

Validation of the SpaceLabs 90207 automatic non-invasive blood pressure monitor in elderly subjects.

OBJECTIVE: To validate the SpaceLabs 90207 ambulatory blood pressure monitor in the elderly. METHODS: Eighty-five subjects aged 60-90 years were recruited from hospital inpatients. Using the same-arm sequential measurement technique two observers recorded blood pressure with a mercury sphygmomanometer first and then by using the SpaceLabs 90207 ambulatory monitor. This set of blood pressure readings was performed three times with all 85 subjects supine, sitting and standing. Data were analysed according to the British Hypertension Society protocol. RESULTS: Over the blood pressure range tested the SpaceLabs 90207 device recorded diastolic blood pressure (DBP) satisfactorily, achieving grade A in all body postures, but not systolic blood pressure (SBP; supine D, standing C, sitting C). However, at SBP </= 160 mmHg, satisfactory performance was achieved in sitting (B) and standing (B) patients, but not in supine patients (C). With higher blood pressure there was increasing underestimation by the SpaceLabs 90207 device of SBP and DBP compared with those recorded by the mercury sphygmomanometer (supine SBP r = -0.42, P < 0.001; DBP r = -0.21, P = 0.05; sitting SBP r = -0.43, P < 0.001; DBP r = -0.5, P < 0.001; standing SBP r = -0.34, P = 0.002; DBP r = -0.24, P = 0.003). CONCLUSION: The SpaceLabs 90207 blood pressure monitor appears satisfactory for clinical use in elderly subjects over a wide range of DBP levels, but with increasing SBP its performance diminishes, particularly in the very high SBP range.

Journal Article↗
PubMedDate not supplied

Age-related variations in presentation and outcome in Wegener's granulomatosis.

Wegener's granulomatosis (WG) is increasingly being diagnosed in older people. The object of this study was to see whether age influences the clinical presentation and prognosis. In a retrospective open case-note review of 51 patients with a diagnosis of WG based on internationally accepted criteria, 29 patients (56.9%) below 60 years and 22 (43.1%) aged 60 or above were compared. The incidence of limited (10% vs 9.1%) and classical (89.6% vs 90.9%) disease was similar in the two groups, but some clinical features were commoner in the younger cohort at presentation: ear, nose and throat (100% vs 68.1%; p < 0.01), ophthalmic (48.3% vs 18.2%; p = 0.05) and dermatological (51.7% vs 18.2%; p = 0.05). There were no significant differences in the incidence of renal, pulmonary, rheumatological or neurological involvement or in the presence of antineutrophil cytoplasmic antibody. Outcome was significantly worse for the over 60 group despite a similar treatment regimen (prednisolone, cyclophosphamide, and dialysis if required) (six months' survival: 96.5% vs 59.1%; p < 0.01). Renal function at presentation was a significant determinant of prognosis: mean serum creatinine at presentation was 525 mumol/l vs 291 mumol/l respectively in those who died within six months and in those who survived (p = 0.03). Uncontrolled pulmonary vasculitis was the commonest cause of death. In conclusion, the classical presentations of WG are similar in older patients. Disease in the latter is more often restricted to the lungs and the kidneys, and this may cause diagnostic uncertainty. The outcome is worse in older patients, with uncontrolled pulmonary vasculitis the commonest cause of death despite immuno-suppressive treatment. Early diagnosis and treatment may improve outcome.

Adult↗