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2.  Predictors of ratio of placental weight to fetal weight in multiethnic community. 
BMJ : British Medical Journal  1995;310(6977):436-439.
OBJECTIVE--To determine whether placental ratio is influenced by maternal ethnic origin, obesity, hypertension, and haematological indices of iron deficiency anaemia. DESIGN--Observational study. SETTING--District general hospital in Birmingham. SUBJECTS--692 healthy nulliparous pregnant women, of whom 367 were European, 213 Asian, 99 Afro-Caribbean, and 13 of other or undocumented ethnic origin. MAIN OUTCOME MEASURES--Placental ratio and maternal body mass index, blood pressure, and haematological indices. RESULTS--Though birth weight and placental weight were lower in Asian women than in other groups, mean placental ratio was similar in Asian (19.5% (SD 3.3%)), European (20.0% (4.0%)), and Afro-Caribbean women (20.4% (5.3%)). Gestational age at birth was the main predictor of placental ratio in the univariate analysis (r = -0.34, P < 0.001) and multivariate analysis. The only other significant predictor of placental ratio in multivariate analysis was maternal body mass index, which was positively associated with placental ratio (r = 0.1, P = 0.01). Mean (SD) placental ratio was not significantly higher in women who developed gestational hypertension (20.4% (4.5%)) and pre-eclampsia (23.3% (7.3%)) than in normal women (19.8% (3.8%)). No evidence of a relation between placental ratio and first antenatal visit haemoglobin concentration or mean cell volume was detected, and placental ratio was not associated with change in mean cell volume during pregnancy or with third trimester serum ferritin concentration. CONCLUSIONS--These data do not support the proposed association between poor maternal nutrition and increased placental ratio. The association between high placental ratio and adult hypertension may be confounded by genetic and environmental factors associated with maternal obesity (and possibly maternal hypertension).
PMCID: PMC2548818  PMID: 7873949
3.  Cutanous lesions in multiple myeloma. 
British Medical Journal  1972;4(5835):275-276.
PMCID: PMC1788827  PMID: 5083891
4.  Blood pressure measurement at screening and in general practice. 
British Heart Journal  1977;39(1):7-12.
As part of an epidemiological study of hypertension, an analysis was made of the general practitioner records of all attenders at a screening survey. A blood pressure recording, made before screening, was found in 37-9 per cent of cases. The pressures obtained correlated well with those obtained by the screening unit, though the practitioners' readings tended to be lower. Further cases of hypertension were found, not diagnosed by the screening unit; the estimate made of the prevalence of hypertension at the survey could be corrected by inclusion of these cases. Chest pain, headaches, lightheadedness, and dizziness were common reasons for blood pressure measurement in general practice, but these symptoms were not associated with a rise in the blood pressure; symptoms were not helpful in the diagnosis of hypertension. Some form of screening programme is necessary to detect cases of hypertension. This could be carried out by general practitioners.
PMCID: PMC483186  PMID: 831740
5.  Aetiology 
BMJ : British Medical Journal  2000;320(7227):104-107.
PMCID: PMC1117365  PMID: 10625270
6.  A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. 
BACKGROUND: The management of atrial fibrillation (AF) has changed substantially in recent years, especially with a greater appreciation of the prophylactic role of antithrombotic therapy against stroke. There is therefore a need for further information on the prevalence of AF in Britain, the prevalence of (and contraindications to) anticoagulant treatment, and the factors that influence doctors' decisions in treating AF, including the investigation of patients with this arrhythmia. AIM: To investigate the prevalence, clinical features and management of patients with AF in a general practice setting. METHOD: Cross-sectional survey of patients using treatment prescriptions and clinical records in two general practices from the west of Birmingham (serving a patient population of 16,519) where 4522 subjects (27.4%) were aged > or = 50 years. RESULTS: One hundred and eleven (2.4%) patients who were aged > or = 50 years were found to be in AF (42 males; mean age 76.6, SD 9.1); 77.5% were Caucasian, 2.7% Afro-Caribbean, 0.9% Asian, and 0.9% mixed race; in 20 cases there was no information on ethnicity. Of the AF patients, 5.4% were aged 50-60 years, 16.2% aged 61-70 years, 20.7% aged 71-75 years, 20.7% aged 76-80 years, 24.3% aged 81-85 years, and 12.6% aged > 85 years old, with female patients being significantly older than males. Eighty-one patients (73%) had chronic AF, while 30 patients (27%) had paroxysmal AF. The most common associated factors were hypertension (36.9%) and ischaemic heart disease (28.8%), with no obvious cause for AF in six patients. Cardiac failure was associated with AF in 34 patients (30.6%), and stroke had occurred in 29 patients (18%). Only 20 patients (18%) had had an echocardiogram, 26 (23.4%) a chest X-ray, and 58 (52.3%) thyroid function test. Only 30.6% had ever presented to hospital practice. Warfarin was prescribed to 40 patients (36%), with anticoagulation intensity monitoring by the general practitioner (GP) in three cases (7.5%), by a hospital clinic in 30 (75%), and by both GP and hospital in seven cases (17.5%). Of those not anticoagulated (n = 71), only 12 patients (16.9%) had contraindications to warfarin therapy. Patients treated with warfarin were younger than those who were not prescribed warfarin (71.3 versus 79.6 years, P < 0.001). Aspirin was being prescribed for 21 patients (18.9%), primarily for previous myocardial infarction. Only five patients (4.5%) had ever had attempted cardioversion. CONCLUSION: Atrial fibrillation is a common arrhythmia in general practice, and is commonly associated with hypertension, ischaemic heart disease and heart failure. There is a suboptimal application of standard investigations and use of antithrombotic therapy or attempted cardioversion; and few patients have presented to hospital practice. Guidelines on the management of this common arrhythmia in general practice are required.
PMCID: PMC1313001  PMID: 9219403
7.  Hypertension in aortic valve disease and its response to valve replacement. 
Postgraduate Medical Journal  1992;68(797):180-185.
We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement. In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure greater than 160 systolic and or greater than 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively. The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size. Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.
PMCID: PMC2399236  PMID: 1589375
8.  Alcohol and blood pressure: the INTERSALT study. 
BMJ : British Medical Journal  1994;308(6939):1263-1267.
OBJECTIVES--To assess the relation between alcohol intake and blood pressure in men and women and in men at younger and older ages; to examine the influence of amount and pattern of alcohol consumption, as well as of acute effects, taking into account body mass index, smoking, and urinary sodium and potassium excretion. DESIGN--Subjects reported alcohol consumption for each of seven days before standardised blood pressure measurement, and whether they had consumed any alcohol in the 24 hours before measurement. SETTING--50 centres worldwide. SUBJECTS--4844 men and 4837 women aged 20-59. MAIN OUTCOME MEASURES--Effect of alcohol on blood pressure estimated by taking a weighted average of regression coefficients from centres. Acute effect assessed by examining mean differences in blood pressure of non-drinkers and of heavy drinkers who had and had not consumed alcohol in the 24 hours before measurement. Effect of pattern of consumption assessed by examining mean differences in blood pressure of non-drinkers compared with drinkers (i) whose intake was concentrated in fewer days or who were drinking more frequently, and (ii) whose alcohol intake varied little over the seven days or varied more substantially, as indicated by the standard deviation of daily consumption. RESULTS--Of the 48 centres in which some people reported consuming at least 300 ml/week of alcohol, 35 had positive regression coefficients linking heavy alcohol consumption to blood pressure. Overall, alcohol consumption was associated with blood pressure, significantly at the highest intake. After account was taken of key confounders, men who drank 300-499 ml alcohol/week had systolic/diastolic blood pressure on average 2.7/1.6 mmHg higher than non-drinkers, and men who drank > or = 500 ml alcohol/week had pressures of 4.6/3.0 mmHg higher. For women, heavy drinkers (> or = 300 ml/week) had blood pressures higher by 3.9/3.1 mmHg than non-drinkers. Heavy drinking and blood pressure were strongly associated in both sexes, and in men at both younger (20-39 years) and older (40-59 years) ages. In men who were heavy drinkers, episodic drinkers (those with great variation in daily alcohol consumption) had greater differences in blood pressure compared with non-drinkers than did regular drinkers of relatively constant amounts. CONCLUSION--The significant relation of heavy drinking (3-4 or more drinks/day) to blood pressure, observed in both men and women, and in younger and older men, was independent of and added to the effect on blood pressure of body mass index and urinary excretion of sodium and potassium. The findings indicate the usefulness of targeting those at high risk as well as the general population to reduce the adverse effects of alcohol on blood pressure.
PMCID: PMC2540174  PMID: 7802765
9.  Hypertension. 
Postgraduate Medical Journal  1991;67(785):230-246.
PMCID: PMC2399022  PMID: 2062770
12.  Bilateral dislocation of the shoulders due to nocturnal hypoglycaemia. 
Postgraduate Medical Journal  1988;64(752):450-452.
A young insulin-dependent diabetic awoke with apparently spontaneous bilateral anterior dislocation of his shoulders. The most likely explanation was nocturnal hypoglycaemia. Similar case reports describing this complication have not been discovered.
PMCID: PMC2428863  PMID: 3211824
14.  'Neutropenia' in black west Indians. 
Postgraduate Medical Journal  1987;63(738):257-261.
A prospective case control study routine haematological parameters was conducted in 294 healthy Black and White age/sex-matched subjects. The most important finding relevant to clinical practice was a reduction of total white cell count in Blacks due mainly to reduced neutrophil numbers. Twenty-one percent of sickle negative Blacks had white cell counts below the lowest value seen in Whites. The haemoglobin concentration, erythrocyte mean cell volume and monocyte count were also significantly lower amongst Blacks though lymphocyte counts were higher. The racial differences in haemoglobin and white count were not accounted for by differences in smoking and drinking habits. They were also found when Blacks with sickle cell trait were compared to age/sex-matched Whites and in others taking the oral contraceptive pill. Awareness of racial group should aid interpretation of routine tests and avoid unnecessary investigation of normal 'neutropenic' Blacks.
PMCID: PMC2428154  PMID: 3684833
16.  Pseudo-phaeochromocytoma due to alcohol withdrawal. 
Postgraduate Medical Journal  1985;61(718):721-723.
Alcohol withdrawal hypertension is a common clinical problem which often goes unrecognized. We report a case in which the symptoms and signs of withdrawal with a marked elevation in blood pressure mimicked the features of a phaeochromocytoma. Despite a positive phentolamine test no further evidence for phaeochromocytoma was found and both blood pressure and symptoms settled as the features of alcohol withdrawal abated.
PMCID: PMC2418363  PMID: 4034462
17.  Clinical evaluation of the Infrasonde D4000 blood pressure monitor. 
Postgraduate Medical Journal  1985;61(714):321-323.
Choosing a blood pressure machine from their ever increasing number is often difficult due to lack of performance data. We have evaluated a new automated non-invasive blood pressure recorder, the Infrasonde D4000. In comparison with the Hawksley random zero mercury sphygmomanometer the Infrasonde showed less variability for both systolic and diastolic readings. However, it was found to record significantly lower mean systolic and diastolic pressures.
PMCID: PMC2418217  PMID: 4022862
18.  The frequency, characteristics and prognosis of epileptic seizures at the onset of stroke. 
In a series of 230 patients admitted to hospital with a stroke, the frequency and significance of epileptic seizures at onset was assessed. Thirteen (5.7%) suffered single or multiple witnessed seizures at the onset of their stroke. Seizures were evenly distributed among all pathological stroke sub-types but were restricted to lesions in the carotid artery territory. They indicated a poorer prognosis over the first 2 days. Six of the 13 presenting with stroke and seizures had prior seizures and, if they survived, continued to have fits. The five patients surviving with stroke and a first seizure were all fit-free after 30 months follow-up.
PMCID: PMC1031543  PMID: 3346694
19.  Ethnic differences in peak expiratory flow rate in Birmingham factory workers. 
Postgraduate Medical Journal  1983;59(696):671-673.
Among 698 Birmingham factory workers, Asian men (n = 75) tended to have lower peak expiratory flow rates (PEFR) than black (n = 156) or white (n = 138) men when age, height and smoking habits were accounted for. This trend reached statistical significance in Asian females (n = 20), despite a small sample size. There were no significant differences in PEFR between blacks and whites of either sex.
PMCID: PMC2417654  PMID: 6647185
20.  The Birmingham blood pressure school study. 
Postgraduate Medical Journal  1983;59(696):627-629.
Four-hundred and twenty-eight school leavers of 3 ethnic groups (white, black and Asian) were screened for blood pressure, resting pulse rate and general anthropometric characteristics. Asian pupils were both shorter and lighter than the other two groups whilst black males were heavier and taller. There was no significant difference in the mean systolic or diastolic blood pressure between the 3 groups, although the black pupils had a stronger family history of hypertension, particularly on the mother's side. These observations differ in some respects from other ethnic blood pressure studies and establish values for the local population.
PMCID: PMC2417648  PMID: 6647172
21.  Blood pressure in black, white and Asian factory workers in Birmingham. 
Postgraduate Medical Journal  1983;59(696):622-626.
A screening survey was conducted among factory workers, aged 15-64 years, in Birmingham, England to investigate ethnic differences in blood pressure. One-thousand and forty-nine subjects (784 men, 265 women) were screened, representing 79% of the eligible population. Mean systolic and diastolic blood pressures generally did not differ between men of black West Indian (n = 173), local white (n = 439) or Asian (n = 172) origin, when matched by 10-year age groups. Analysis of covariance using age as the covariate revealed that, overall, Asian men had significantly lower systolic but higher diastolic pressures than the other ethnic groups. The proportion of men arbitrarily defined as hypertensive (greater than or equal to 160 mmHg systolic or greater than or equal to 95 diastolic or blood pressures below this figure whilst receiving antihypertensive therapy) was 26% of West Indians, 22% of whites and 17% of Asians, but these were not significantly different when age was accounted for. Black West Indian women (n = 101) did have higher diastolic pressure than white women (n = 164), but this difference was dependent on body mass index. Overall, systolic pressures in women were not significantly different. These findings differ from those consistently reported from the United States.
PMCID: PMC2417647  PMID: 6647171
22.  Breast cancer in blacks, Asians and whites in Birmingham. 
Postgraduate Medical Journal  1983;59(696):661-663.
A retrospective study was mounted into the frequency of breast cancer in blacks, whites and Asians attending Dudley Road Hospital in the years 1970-1981 inclusive. This figure was compared with the ethnic distribution of the surrounding population and of admissions for all causes. Breast cancer was uncommon in both ethnic minorities compared with whites, but was commoner in blacks than in Asians. These trends are similar to the World Health Organization figures for Britain, Jamaica and India. Differences in parity and breast feeding do not explain the variability of breast cancer in this study.
PMCID: PMC2417640  PMID: 6647182
23.  Lack of difference between malignant and accelerated hypertension. 
The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated. Ninety five patients had bilateral haemorrhages and exudates and papilloedema (grade IV retinopathy) and 31 had bilateral haemorrhages and exudates with no papilloedema (grade III). A further 74 patients had bilateral retinopathy but failed to meet the criteria for grade IV or III and were investigated separately. No overall differences were found in survival when comparing the various grades of retinopathy. Cigarette smoking was significantly commoner only in grade IV patients compared with those with non-malignant hypertension matched for age, sex, and race. In patients with grade III retinopathy excess smoking was not statistically significant. In conclusion, the clinical features and survival rate showed that malignant and accelerated hypertension are one and the same disease.
PMCID: PMC1339207  PMID: 3081084
24.  Ethnic differences in respiratory disease 
Postgraduate Medical Journal  1981;57(674):777-778.
Hospital admission statistics from a district general hospital for patients aged 30-59 years over a 6-year period were analysed. There were 40 034 admissions excluding obstetrics. The overall distribution by place of birth was 9·2% West Indies, 13·5% Asia and 71·9% Northern Europe. This distribution was compared with the distributions for 4 groups of respiratory diseases. There were highly significant differences between these distributions for each diagnostic category. Asthma and respiratory tuberculosis were very much more common amongst Asians whilst West Indians suffered very little carcinoma of bronchus or bronchitis. Data collected from a factory screening showed that cigarette smoking could not account for these differences.
PMCID: PMC2426255
25.  Studies of red cell cation transport in white and black essential hypertensives 
Postgraduate Medical Journal  1981;57(674):769-771.
It has been reported previously in white patients with essential hypertension that red cell sodium pump activity as measured by ouabain-sensitive uptake of the potassium analogue 86Rb from a potassium-free medium, is very significantly greater than in white controls. In a further study of black (West Indian) subjects reported here no similar abnormality was present in black hypertensives when compared with black normotensive individuals. Red cell rubidium uptake was significantly lower in normotensive blacks than in normotensive whites although sodium pump activity was the same. These results may be relevant to observed racial differences in sodium handling and in the pathophysiology of essential hypertension.
PMCID: PMC2426254

Results 1-25 (94)