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Biomedical subjects

P Stubbs

Publications and source records attributed to P Stubbs.

14 recordsLinked to original sources
PubMed2001

Point-of-care testing: a cardiologist's view.

The rationale for point-of-care testing is that more rapid provision of biochemical test results performed at the patients bedside will equate with better outcomes. For this to be the case, a number of conditions must be satisfied, and in particular the choice of appropriate markers, an adequate turnaround time (TAT), and an accurate measurement. Point-of-care testing of cardiac markers was found to reduce TAT from 72 (central laboratory) to 20 min thus allowing to decrease total hospital stay.

Biomarkers↗
PubMed1998

Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes.

AIMS: Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline concentrations were a risk factor for an adverse outcome in patients admitted with acute coronary syndromes. METHODS AND RESULTS: Five hundred and nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The prognostic significance of a baseline lipoprotein(a) concentration of > or = 30 mg x dl(-1) or lower for subsequent cardiac death was assessed in patients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of > or =30 mg x dl(-1) was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29.8% vs 18.6%, Log rank P=0.04). In a multivariate regression model a baseline lipoprotein(a) concentration of > or = 30 mg x dl(-1) retained its significance as an independent predictor of cardiac death (P=0.037). In patients with unstable angina, baseline concentrations of > or = 7.9 mg x dl(-1) were found to be significant predictors of cardiac death in univariate (P=0.021) and multivariate (P=0.035) regression models. CONCLUSION: Baseline lipoprotein(a) concentrations in patients admitted with acute coronary syndromes are associated with an increased risk of cardiac death. For patients with myocardial infarction a concentration of > or = 30 mg x dl(-1) appears appropriate as a risk discriminator; for patients admitted with unstable angina, however, much lower concentrations of lipoprotein(a) appear to be prognostically important.

Acute Disease↗
PubMed1998

The cardiac troponins: uses in routine clinical practice. Experiences from GUSTO and other clinical trials.

Recent advances in pharmacological and mechanical approaches to acute coronary syndromes have led to rapid changes in the management of patients admitted with acute coronary syndromes. These changes have been mirrored by the appearance of newer highly specific biochemical markers of myocardial damage particularly the cardiac troponins. When new biochemical markers become available it is the responsibility of the clinical chemist to evaluate them critically in terms of sensitivity, specificity, efficiency and analyzer precision, in the rigid setting of quality control that laboratories practise, and to compare them with other markers. When the data are shown to Clinical Cardiologists with supporting statements such as 'useful management tool' and 'can be used for early diagnosis of Myocardial Infarction', a different set of questions may need to be answered. The 'So what?' response is most frequent and is the most important hurdle that these newer biochemical markers have to overcome to convince physicians to change their current practice. This presentation will review the results of studies that have examined the potential clinical usefulness of the cardiac troponins with respect to diagnosis and risk stratification of patients admitted with suspected acute coronary syndromes. Any troponin variable that survives the 'so what' question has one further major hurdle to overcome. This is the requirement to inform physicians what different therapeutic strategies they should follow if the variable is present. Available clinical trial evidence about differing management options for patients according to their troponin status will be reviewed and outline management algorithms will be presented. Many questions remain unanswered and these will be included at the time points where they may be relevant.

Algorithms↗
PubMed1997

Are what people know about their epilepsy and what they want from an epilepsy service related?

This study set out to investigate the level of knowledge about epilepsy in general and in relation to the patients' own condition, in patients attending a tertiary referral epilepsy outpatient clinic. It also sought to investigate patient satisfaction with the service and whether knowledge acquired about epilepsy related to that satisfaction. Seventy out of 94 patients responded to the Epilepsy Knowledge Profile Questionnaires (general and personal knowledge of epilepsy) and a questionnaire assessing service satisfaction. Patients were found to know more about epilepsy in general than about their own condition. In particular some patients were unable to give accurate indications of their drug regimes. Over 91% were satisfied with the serviced they received but this bore no relation to information they had acquired or wanted about epilepsy. Multidisciplinary services were requested by a sizeable percentage of patients but especially access to a specialist nurse in epilepsy. The study highlights the need for clinicians to check patients' knowledge about their condition and for further work to clarify the source of patients' satisfaction with service delivery.

Adolescent↗
PubMed1997

A prospective study of the role of lipoprotein(a) in the pathogenesis of unstable angina.

AIM: Lipoprotein(a) is considered to be a risk factor for atherothrombotic diseases. The aim of the study was to examine the potential role of lipoprotein(a) concentrations in patients admitted with unstable angina with particular reference to their cardiac Troponin T concentrations, which identifies a subgroup at high risk of subsequent cardiac events. METHODS AND RESULTS: Consecutive patients admitted with chest pain to a single coronary care unit were studied. One hundred and sixty-seven patients had a final diagnosis of unstable angina, of whom 56 were cardiac Troponin T-positive. Admission lipoprotein(a) concentrations were significantly higher in the cardiac Troponin T-positive unstable angina group as compared to the cardiac Troponin T-negative unstable angina group: median and interquartile ranges 22.25 mg.dl-1 (6.25, 32.0) vs 6.0 mg.dl-1 (2.22, 14.8) respectively) P = 0.0004. A highly significant correlation was also found between the level of cardiac Troponin T at diagnosis and the lipoprotein(a) concentration: rs = 0.2798, P = 0.0001. CONCLUSION: This study provides the first evidence in man of a significant role for lipoprotein(a) in unstable angina. The correlation between lipoprotein(a) concentration and cardiac Troponin T concentration suggests that lipoprotein(a) may be significantly involved in the early failure of plaque rupture stabilization.

Adult↗
PubMed1996

Prognostic significance of admission troponin T concentrations in patients with myocardial infarction.

BACKGROUND: New, highly specific cardiac structural proteins can now be measured. The early presence of one of these proteins, troponin T, has been found to have important prognostic significance in patients with unstable angina pectoris. The prognostic significance of its presence on admission was assessed in patients with myocardial infarction. METHODS AND RESULTS: Two hundred forty patients admitted with myocardial infarction were studied and followed prospectively for a median of 3 years. The prognostic significance of an admission troponin T concentration > or = 0.2 ng/mL for subsequent cardiac death and/or reinfarction was assessed and compared with other variables in a regression model. Any detectable troponin T on admission was associated with a worse prognosis on follow-up. An admission concentration of > or = 0.2 ng/mL was associated with a higher risk of subsequent cardiac death (chi 2, 13.3; P = .0002) and death or nonfatal reinfarction (chi 2, 16; P = .00006). The excess risk was seen primarily in patients with admission ECG ST-segment elevation (cardiac death chi 2, 9.7; P = .001; death or nonfatal reinfarction chi 2, 10.3; P = .001). In a stepwise regression model for cardiac death or nonfatal reinfarction, troponin T was superior to most of the other variables entered in both myocardial infarction subgroups. CONCLUSIONS: The presence of admission troponin T in patients with myocardial infarction defines a subgroup, particularly those with ST-segment elevation, at increased risk of subsequent cardiac events and identifies a group that may benefit from alternative early management strategies.

Biomarkers↗
PubMed1996

Prospective study of the role of cardiac troponin T in patients admitted with unstable angina.

OBJECTIVE: To examine the prognostic significance and role in risk stratification of the biochemical marker troponin T in patients admitted with unstable angina. DESIGN: Single centre, blinded, prospective study of patients admitted with chest pain. SETTING: Coronary care unit of a district general hospital. SUBJECTS: 460 patients admitted with chest pain and followed up for a median of three years. 183 patients had a final diagnosis of unstable angina. MAIN OUTCOME MEASURES: Cardiac death, need for coronary revascularisation, or readmission with non-fatal myocardial infarction as first events. RESULTS: 62 (34%) unstable angina patients were troponin T positive. This group had significantly increased incidence rates of subsequent cardiac death (12 cases (19%) v 14 (12%)), coronary revascularisation (22 (35%) v 26 (21%)), death or revascularisation (33 (53%) v 40 (33%)), and death or non-fatal myocardial infarction (18 (29%) v 21 (17%)) compared with the troponin T negative group. In multiple logistic regression troponin T status was a highly significant predictor for the end points coronary revascularisation and cardiac death or revascularisation as first events. CONCLUSION: Troponin T in the serum of patients with unstable angina identifies a subgroup at higher risk of subsequent cardiac events and its measurement aids in risk factor stratification. The increased risk extends to two years after admission. Prospective randomised trials are required to identify optimum therapeutic strategies for this subgroup.

Angina, Unstable↗
PubMed1995

Efficacy and safety of d-sotalol, a pure class III antiarrhythmic compound, in patients with symptomatic complex ventricular ectopy. Results of a multicenter, randomized, double-blind, placebo-controlled dose-finding study. The d-Sotalol PVC Study Group.

BACKGROUND: There is increasing interest in pure class III antiarrhythmic compounds, ie, drugs in which the electrophysiological effect is confined to the propensity for producing an isolated lengthening of action potential duration. d-Sotalol represents the prototype of such pure class III agents. This double-blind, placebo-controlled, randomized dose-finding study evaluated the antiarrhythmic efficacy and safety of d-sotalol in patients with symptomatic chronic ventricular ectopy. METHODS AND RESULTS: A total of 233 patients presenting with > or = 30 premature ventricular contractions (PVCs) per hour during drug-free Holter monitoring randomly received placebo or d-sotalol at dosages of 50, 100, or 200 mg BID. Drug efficacy was assessed by repeat Holter monitoring at the end of double-blind therapy. There was a dose-dependent increase in QT and QTc duration, indicating class III activity. A dose-related decrease in hourly PVC counts was observed, reaching statistical significance for patients receiving 200 mg d-sotalol BID (311 PVCs/h during baseline compared with 135 PVCs/h during active treatment, P < .05). Analysis of the primary efficacy criterion (ie, > or = 75% reduction in total PVCs/h) revealed a significant treatment effect only for the highest d-sotalol dose, with 8 patients (14%) meeting this criterion. Eighteen patients reported side effects, which led to drug discontinuation in 5. One sudden death and one nonfatal cardiac arrest occurred in patients with dilative cardiomyopathy receiving 200 mg d-sotalol BID. No incidence of torsade de pointes was reported. CONCLUSIONS: d-Sotalol exerts dose-dependent class III activity in patients with symptomatic ventricular ectopy. Its PVC-suppressing activity is modest and becomes evident predominantly at dosages of 200 mg administered BID. The observation of drug-associated serious adverse arrhythmic events emphasizes the need for individualized careful dose titration, particularly in patients with advanced organic heart disease.

Adolescent↗
PubMed1995

Lipoprotein (a): a prothrombotic risk factor for coronary artery disease.

New data on the interactions between lipoprotein (a) [Lp(a)] and the coagulation-fibrinolytic system, which emphasize the importance of the activity of lysine-binding sites on apolipoprotein (a) [apo(a)], provide an increasingly strong basis for the role of Lp(a) in thrombosis. Further insights into the genetic control of Lp(a) levels show that inherited factors other than the size of the apo(a) gene are important. The clinical relationship between Lp(a) and coronary heart disease has been more firmly established by two further large prospective cohort studies. The consensus that the concentration of Lp(a) does not predict the outcome of thrombolytic therapy still holds, although Lp(a) does affect endogenous fibrinolysis after myocardial infarction. The effect of Lp(a) on mortality should soon be known.

Animals↗
PubMed1990

Immunoglobulin isotype production by cycling human B lymphocytes in response to recombinant cytokines and anti-IgM.

Actively cycling populations of purified human tonsilar B lymphocytes were examined for their capacity to secrete IgM, IgA, IgE and IgG of all four subclasses in direct response to recombinant cytokines; in some experiments, monoclonal antibody to IgM (anti-mu) was included in order to explore the influence of antigen receptor ligation on immunoglobulin (Ig) production. Enhanced IgM release was seen on culture of the cycling cells with either interleukin-2 (IL-2), IL-4 or interferon-alpha (IFN-alpha). IL-2 and IFN-alpha also augmented IgA production, whereas IL-4 had no effect on this isotype. IL-4 did, however, encourage the production of the IgG subclasses IgG1, IgG2 and IgG3, while IL-2 augmented IgG1 and IgG3 release and IFN-alpha increased IgG1 levels. IgG4 production, and that of IgE, failed to be perturbed by any of the cytokines assayed. Neither IL-1 alpha, IL-1 beta, IL-5 nor IFN-gamma significantly altered the profile of Ig isotype release. When confronted with anti-mu, cycling B cells demonstrated a marked suppression in IgM production. Suppression could not be overcome by the addition to culture of the normally IgM-promoting IL-4. Concomitant with the reduction in IgM levels, an increase in IgG release was observed. This was comprised of elevations in IgG1 and IgG3. Although not influencing IgA release directly, anti-mu was found to promote increased IgA production in co-culture with either IL-2 or IFN-alpha. The findings are discussed in the context of recent findings on Ig isotype control in both human and murine systems.

Antibodies, Anti-Idiotypic↗
PubMedDate not supplied

War trauma, psycho-social projects and social development in Croatia.

This article looks at the ways in which concepts of 'war trauma' and 'post-traumatic stress disorder' are being used within 'psycho-social projects' in Croatia, in the context of the wars of the Yugoslav succession and consequent large-scale forced migration. Psycho-social discourses are addressed critically, both in terms of their internal consistency and problems relating to the wider social and political context. The authors suggest the importance of 'social development projects' as an alternative to those projects which rely on narrow psycho-social interventions.

Croatia↗
PubMedDate not supplied

Ethnicity, forced migration and psychosocial work in Croatia.

This article outlines the development of psycho-social work with refugees and displaced persons in Croatia, in the context of war and large-scale forced migration. The article, which is based upon original research on refugees and displaced persons in Croatia, considers the dominance of ethnicized nationalism within Croatia, examines the role of global agencies and how psychosocial programmes influence aspects of ethnicity. It ends with some recommendations for the development of an anti-nationalistic psychosocial work approach in complex emergencies and wider forms of intervention.

Croatia↗