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Biomedical subjects

R Pownall

Publications and source records attributed to R Pownall.

At least 19 recordsLinked to original sources
PubMed1991

A dose ranging study of ibuprofen suspension as an antipyretic.

A double blind trial was conducted to determine the dose of ibuprofen suspension, which is effective in reducing the body temperature. The principal measure of efficacy was a reduction in axillary temperature of 1 degree C or more three hours after dosing. A second objective of the trial was to compare the incidence and severity of side effects and the palatability of a range of ibuprofen doses. Ninety three children were included in the analysis. All four doses of ibuprofen studied (0.625 mg/kg-5 mg/kg) were associated with temperature reduction and only the lowest dose failed to satisfy the principal measure of efficacy. The influence of dose on the magnitude of the body temperature reduction was significant and the 5 mg/kg dose achieved the largest mean reduction in body temperature (2 degrees C). The tolerability and palatability of all doses studied were excellent. These findings suggest that ibuprofen is a good alternative to paracetamol as an antipyretic.

Child, Preschool↗
PubMed1989

Benefits of early anti-inflammatory medication following acute ankle injury.

A total of 122 patients presenting with acute ankle injuries within 6 h of injury were entered into a double-blind study. Treatment consisted of a standardized regimen of physiotherapy and elastic support for all patients, who were then randomized into two groups. One group received immediate ibuprofen (2400 mg/day) while the other group received placebo medication for 48 h, followed by ibuprofen (2400 mg/day) from the 3rd day onwards, i.e. delayed antiinflammatory treatment. Assessments were made by means of a daily diary and also by clinical and radiological examination. The immediate treatment group demonstrated more rapid recovery by day 7 in terms of regression of swelling (P less than 0.01) and clinician's impression of severity (P less than 0.05). This group also tended to consider their ankle more able to bear weight at this stage (P = 0.05). In comparison with an earlier study, in which the only active treatment was an elastic support, a greater percentage of patients recovered earlier in the present study. The incidence of side-effects was low. Immediate high-dose ibuprofen is therefore recommended as treatment for moderate to severe acute ankle injuries.

Acute Disease↗
PubMed1989

Circadian rhythm of serum cytidine deaminase in patients with rheumatoid arthritis during rest and exercise.

Circadian rhythm of serum cytidine deaminase and C reactive protein was assessed in 11 inpatients with rheumatoid arthritis who were crossed between 24 hours of bed rest and 24 hours of normal ward activity. Blood was taken at six hourly intervals and the results analysed by fitting sine waves with an assumed period of 24 hours to the measured concentrations. Cytidine deaminase after activity, but not at rest, showed circadian variation, with a 24 hour mean level of 17.4 units (normal 3-13 units) and an amplitude of 1.1 units. The circadian variation, defined as the curve's peak to trough difference as a percentage of the 24 hour mean, was 12.3% and occurred at 1208 hours. C reactive protein showed no significant circadian rhythm, in keeping with published findings. The timing of the peak in serum cytidine deaminase concentrations after a period of morning physiotherapy, but not during the bedrest morning, suggests that exercise accounts for the circadian rhythm, probably by increasing the lymphatic clearance from inflamed joints.

Adult↗
PubMed1989

Clinical benefits of early cold therapy in accident and emergency following ankle sprain.

One hundred and forty-three patients presenting with ankle sprains within 24 h of injury were entered into a double blind study. Treatment consisted of a standardized regime of high dose non-steroidal anti-inflammatory medication and an elastic support for all patients, who were then randomly allocated to two groups. One group received immediate cold therapy, the other received simulated therapy. Assessments made at 7 days showed a trend in favour of the group receiving cold therapy, although this did not reach significance. It is concluded that cold therapy together with compression may have a beneficial effect but that a single application in the accident and emergency department is not justified when a background therapy of non-steroidal anti-inflammatory medication is given.

Adolescent↗
PubMed1985

The absorption of beta-adrenoceptor antagonists in rat in-situ small intestine; the effect of lipophilicity.

Intestinal absorption characteristics of eleven beta-adrenoceptor antagonists were measured by monitoring their disappearance from in-situ intestinal loops in the anaesthetized rat. All have basic pKa values of around 9.5 (with the exception of sotalol) but show a wide range of lipophilic character (octanol-water log P values from -0.79 to 3.65). The results show two types of absorption behaviour, indicating different mechanisms for 'hydrophilic' and 'lipophilic' beta-adrenoceptor antagonists. The four most hydrophilic molecules (sotalol, atenolol, nadolol and practolol) show virtually identical absorption rate constants. Absorption is slow and relative rates in jejunum (mean pH 6.5) and ileum (mean pH 7.3) are not consistent with pH-partition (jejunum greater than or equal to ileum). The more lipophilic members of the series (pindolol, timolol, metoprolol, oxprenolol, alprenolol and propranolol) are all absorbed much more rapidly. Absorption rate constant rises rapidly with log P and the expected pH effects are seen (ileum greater than jejunum). Acebutolol shows anomalously slow absorption for its log P value.

Adrenergic beta-Antagonists↗
PubMed1983

Detection of renal allograft rejection by computer.

A computer program incorporating an adaptation of a statistical method, the multiprocess Kalman filter, was used to detect changes in trends of plasma creatinine and urea concentrations. In 28 recipients of renal allografts a definite deterioration in renal function was identified retrospectively on 32 occasions by an experienced renal physician independently of the statistical analysis. The computer identified 31 of these 32 episodes using creatinine and urea results, and 29 using creatinine alone. Dysfunction was identified by the computer significantly earlier (p less than 0.05) than by the clinician and a median of one day earlier (p less than 0.02) than treatment was actually initiated. The computer identified dysfunction on 11 out of 1259 days when the clinician did not suspect rejection. These 11 episodes may have had a pathological importance, though no clinical diagnosis was made. This computer method is useful for immediate analysis of incoming results and for timing events either prospectively or retrospectively.

Computers↗
PubMed1983

Mathematical and statistical aids to evaluate data from renal patients.

The monitoring of renal patients and the making of many decisions during their management involves consideration of sequences of numerical data. Renal function results after renal transplantation were used as an example of how graphical presentations, simple mathematical transforms, statistical evaluation and adjustments to the data, to take into account other biological and technical sources of error, can all contribute to better understanding. Experience with a statistical technique, the 4-state Kalman filter not often used in the biological sciences, was summarized and its use suggested as a method to quantitate some traditionally subjective decisions about individual patients, for example, the onset of allograft rejection. The method has identified in retrospect and in prospect events after transplantation earlier than did experienced clinicians. Other statistical techniques to set the sensitivity and specificity of monitoring methods, to detect change points and to quantitate rhythmic sequences of clinical data were discussed, with examples, and with increasing access to computers, these can be used more easily by nephrologists, transplant surgeons, and others.

Computers↗
PubMed1982

Circadian variation in disease activity in rheumatoid arthritis.

Disease activity in rheumatoid arthritis as measured by repeated estimation of joint pain, stiffness, articular index, and grip strength was shown to have a circadian rythm, maximal activity being seen between 0200 and 0400 and minimal activity in the early afternoon. This variation in disease activity may be related to circadian alterations in immune and inflammatory responses (such as immune complexes and neutrophil function) dependent on alterations in circulating concentrations of steroids. The circadian variation in disease activity has important implications in assessment of patients, prescription of drugs, and performance of drug trials.

Adult↗
PubMed1982

Time of day of prednisolone administration in rheumatoid arthritis.

Twelve patients with rheumatoid arthritis took low dosage prednisolone, mean 5.6 mg daily, at either 0800 h, 1300 h or 2300 h in a double-blind within-patient controlled trial. Each patient was studied on each of the 3 regimens to assess control of symptoms and side effects and also to examine circadian rhythms in signs and symptoms. For several days during each drug regimen patients collected urine at each micturition and self-assessed their signs and symptoms. Circadian rhythms of finger joint swelling and of grip strength were determined, and were similar on all regimens, with morning peaks of symptoms and signs. Subjective and objective assessments showed no differences in effectiveness between the 3 times of administration of prednisolone. Urinary excretion patterns were similar to those observed in untreated people. The quantity and circadian pattern of 11-hydroxycorticosteroids excreted were similar to those in healthy patients, providing no evidence of adrenal cortical suppression at the dose levels studied, even when this dose was taken in the evening. A single morning dose of prednisolone appears in many patients to be as effective as a single evening dose or divided doses. It is therefore reasonable to initiate therapy with a morning-only regimen, because adrenopituitary suppression should be minimised.

11-Hydroxycorticosteroids↗
PubMed1982

Domiciliary self-measurement in the rheumatoid arthritis and the demonstration of circadian rhythmicity.

Symptoms and signs of rheumatoid arthritis vary within the day and from day to day. Interesting and possibly important observations can be missed when evaluations are based only on outpatient measurements, which are likely to be made at only one time and at infrequent intervals. We have found that patients can measure their own grip strength and finger joint sizes at home, and simultaneously assess overall pain and stiffness on numerical scales. Measurements made by patients were reproducible when made at the same time of day if on the same treatment. The patient's subjective assessment of pain and stiffness is a useful measure of the severity of rheumatoid arthritis. These pain and stiffness ratings were found to be well correlated with the patient's objective measurements of finger joint size and grip strength. Information not otherwise available can be collected by studying patients at home with these self-measurement techniques. These have allowed the demonstration of circadian variations in the signs and symptoms of rheumatoid arthritis and improved the evaluation of drugs studied in clinical trials.

Arthritis, Rheumatoid↗
PubMed1981

Circadian variations in the signs and symptoms of rheumatoid arthritis and in the therapeutic effectiveness of flurbiprofen at different times of day.

1 Seventeen patients with rheumatoid arthritis were studied in a double-blind crossover trial contrasting three different times of administration of twice-daily flurbiprofen. 2 Twelve of these patients were also studied when taking the same dose of flurbiprofen as a split dose four times a day. 3 Symptoms and signs of the disease were self-assessed throughout the day for several days on each regimen and the information was analysed for rhythmicity. 4 Twice a day flurbiprofen may be more effective than four times daily flurbiprofen, and the regimen without an evening dose was the least effective of three twice-daily treatments tested. 5 Circadian rhythms of grip strength and finger joint size were demonstrated, and were similar on all treatment regimens. 6 These rhythms have a similar pattern to those detected during studies of immune responses, and it is suggested that morning stiffness in rheumatoid arthritis is not only the result of nocturnal inactivity, and may respond to appropriately timed medication given to decrease inflammation or to suppress other aspects of the immune response.

Arthritis, Rheumatoid↗