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Sweeney EL, Al-Shehri SS, Cowley DM, Liley HG, Bansal N, Charles BG, Shaw PN, Duley JA, Knox CL. The effect of breastmilk and saliva combinations on the in vitro growth of oral pathogenic and commensal microorganisms. Sci Rep 2018; 8:15112. [PMID: 30310099 PMCID: PMC6181944 DOI: 10.1038/s41598-018-33519-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/24/2018] [Indexed: 01/12/2023] Open
Abstract
Neonates are exposed to microbes in utero and at birth, thereby establishing their microbiota (healthy microbial colonisers). Previously, we reported significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies after first discovering a primal metabolic mechanism that occurs when breastmilk (containing the enzyme xanthine oxidase) and neonatal saliva (containing highly elevated concentrations of the substrates for xanthine oxidase: xanthine and hypoxanthine). The interaction of neonatal saliva and breast milk releases antibacterial compounds including hydrogen peroxide, and regulates the growth of bacteria. Using a novel in vitro experimental approach, the current study compared the effects of this unique metabolic pathway on a range of bacterial species and determined the period of time that microbial growth was affected. We demonstrated that microbial growth was inhibited predominately, immediately and for up to 24 hr following breastmilk and saliva mixing; however, some microorganisms were able to recover and continue to grow following exposure to these micromolar amounts of hydrogen peroxide. Interestingly, growth inhibition was independent of whether the organisms possessed a catalase enzyme. This study further confirms that this is one mechanism that contributes to the significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies.
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Affiliation(s)
- E L Sweeney
- The Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, 4059, Australia.
| | - S S Al-Shehri
- School of Applied Medical Science, Taif University, Taif, 21974, Saudi Arabia
| | - D M Cowley
- Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - H G Liley
- Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - N Bansal
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia.,School of Agriculture and Food Science, The University of Queensland, St Lucia, 4072, Australia
| | - B G Charles
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia
| | - P N Shaw
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia
| | - J A Duley
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia.,Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - C L Knox
- The Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, 4059, Australia
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Davey PG, Cowley DM, Geddes AM, Terry J. Clinical evaluation of beta 2-microglobulin, muramidase, and alanine aminopeptidase as markers of gentamicin nephrotoxicity. Contrib Nephrol 2015; 42:100-6. [PMID: 6152413 DOI: 10.1159/000409967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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3
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Morgan TJ, Vellaichamy M, Cowley DM, Weier SL, Venkatesh B, Jonest MA. Equivalent Metabolic Acidosis with Four Colloids and Saline on Ex Vivo Haemodilution. Anaesth Intensive Care 2009; 37:407-14. [DOI: 10.1177/0310057x0903700304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately −13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 ≥0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was −0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.
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Affiliation(s)
- T. J. Morgan
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care Unit, Mater Adult Hospital, Mater Health Services
| | - M. Vellaichamy
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care Unit, Toowoomba General Hospital, Toowoomba
| | - D. M. Cowley
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Chemical Pathology, Mater Health Services Pathology, Mater Health Services
| | - S. L. Weier
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Mater Health service Pathology, Mater Health Services
| | - B. Venkatesh
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care, Intensive Care Units, Princess Alexandra and Wesley Hospitals, University of Queensland
| | - M. A. Jonest
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Queensland Clinical Trials Centre, University of Queensland, Princess Alexandra Hospital
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Jeske YWA, McGown IN, Harris M, Bowling FG, Choong CSY, Cowley DM, Cotterill AM. 21-hydroxylase genotyping in Australasian patients with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab 2009; 22:127-41. [PMID: 19449670 DOI: 10.1515/jpem.2009.22.2.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mutations in CYP21 (21-hydroxylase) lead to congenital adrenal hyperplasia (CAH). We genotyped 26 probands with CAH by PCR-sequencing the entire CYP21 gene. 25/26 had homozygous or compound heterozygous mutations. The frequencies of mutations were similar to other populations with deletion/hybrid, I2 G splice and I172N the most common. Five patients with a I172N allele predicting simple-virilising CAH had a salt-wasting phenotype. Two other probands also had a more severe phenotype than predicted by genotype. Two families had both non-classic and salt-wasting phenotypes arising from combinations of three deleterious alleles. Two novel CYP21 alleles were detected: D106N and a large deletion encompassing CYP21 and adjacent pseudogene. Two rare CYP21 alleles were also found. Three of these four novel/rare alleles were only detected as a result of sequencing the entire CYP21 gene. Entire CYP21 sequencing will increase the number of mutations detected in CAH, and in combination with functional studies should contribute a greater understanding of phenotype-genotype correlations.
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Abstract
The strong ion gap (SIG) is under evaluation as a scanning tool for unmeasured ions. SIG is calculated by subtracting [buffer base], which is ([A-]+[HCO3-), from the apparent strong ion difference, which is ([Na+]+[K+]+[Ca++]+[Mg++]-[Cl-]-[L-lactate]). A- is the negative charge on albumin and phosphate. We compared the pH stability of the SIG with that of the anion gap (AG). In normal and hypoalbuminaemic hyperlactaemic blood, PCO2 was reduced stepwise in vitro from >200 mmHg to <20 mmHg, with serial blood gas and electrolyte analyses, and [albumin] and [phosphate] measurement on completion. Respective [haemoglobin], [albumin], [phosphate] and [lactate] in normal blood were 156 (0.9) g/l, 44 (2) g/l, 1.14 (0.06) mmol/l and 1.7 (0.8) mEq/l, and in hypoalbuminaemic blood 116 (0.9) g/l, 24 (2) g/l, 0.78 (0.06) mmol/l and 8.5 (0.5) mEq/l. pH increased from < 6.85 to > 7.55, causing significant falls in [Na+] and elevations in [Cl-]. Initial and final SIG values did not differ, showing no correlation with pH. Mean SIG was 0.5 +/- 1.5 mEq/l. AG values were directly correlated with pH (normal: R2 = 0.51, hypoalbuminaemic: R2 = 0.65). Final AG values significantly exceeded initial values (normal blood: 15.9 (1.7) mEq/l versus 8.9 (1.8) mEq/l, P < 0.01; hypoalbuminaemic blood: 16.5 (0.8) mEq/l versus 11.8 (2.0) mEq/l, P < 0.05). We conclude that, unlike the AG, the SIG is not affected by severe respiratory acidosis and alkalosis, enhancing its utility in acid-base disturbances.
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Affiliation(s)
- T J Morgan
- Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
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Jeske YWA, McGown IN, Cowley DM, Oley C, Thomsett MJ, Choong CSY, Cotterill AM. Androgen receptor genotyping in a large Australasian cohort with androgen insensitivity syndrome; identification of four novel mutations. J Pediatr Endocrinol Metab 2007; 20:893-908. [PMID: 17937062 DOI: 10.1515/jpem.2007.20.8.893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We genotyped the androgen receptor (AR) gene in 31 Australasian patients with androgen insensitivity syndrome (AIS). The entire coding region of AR was examined including analysis of polymorphic CAG and GGN repeats in all patients. AR defects were found in 66.7% (6/9) of patients with complete AIS (CAIS) and 13.6% (3/22) of patients with partial AIS (PAIS). A novel deletion (N858delG) leading to a premature stop codon was found in CAIS patient P1. CAIS patient P2 has a novel deletion (N2676delGAGT) resulting in a stop at codon 787. These mutations would result in inactivation of AR protein. A novel insertion of a cysteine residue in the first zinc finger of the AR DNA-binding domain (N2045_2047dupCTG) was found in CAIS patient P3. PAIS patient P4 has a novel amino acid substitution (Arg760Ser) in the AR ligand binding domain, which may impair ligand binding. Five patients were found to have previously reported AR mutations and no mutations were identified in the remaining patients.
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Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of 17 hydroxyprogesterone (17OHP) determination in dried filter paper blood samples from patients with congenital adrenal hyperplasia caused by 21-hydroxylase deficiency. It was hypothesized that these home samples would enhance patient treatment. STUDY DESIGN Results of 17OHP determination in simultaneously collected venous and dried filter paper blood samples were compared to establish assay reliability. Thereafter, parents mailed dried filter paper blood samples collected before each hydrocortisone dose. RESULTS The 17OHP levels in wet and dried blood samples correlated well (r = 0.98). Results did not change when stored for 2 weeks under various conditions. Blood sampling at different times of the day provided insights into the patterns of 17OHP secretion and identified times of inadequate adrenal suppression. Dose adjustments were then made considering the time of day when adrenal suppression was inadequate. CONCLUSION Home monitoring of 17OHP is a reliable and practical approach for assessing adrenal steroid activity in patients with congenital adrenal hyperplasia. Considering the time of day of 17OHP elevations also facilitates hydrocortisone dosing adjustment.
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Affiliation(s)
- H H Bode
- Sydney Children's Hospital and School of Paediatrics, University of New South Wales, Australia
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Affiliation(s)
- D M Cowley
- Mater Misericordiae Hospital, South Brisbane, Queensland, Australia
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Cowley DM. Paget's disease of bone: why not use less expensive skull films? Geriatrics (Basel) 1996; 51:11. [PMID: 8707064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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McIntyre HD, Mitchell CA, Bowler SD, Armstrong JG, Wooler JA, Cowley DM. Measuring the systemic effects of inhaled beclomethasone: timed morning urine collections compared with 24 hour specimens. Thorax 1995; 50:1280-4. [PMID: 8553302 PMCID: PMC1021352 DOI: 10.1136/thx.50.12.1280] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inhaled glucocorticoid therapy has systemic effects including hypothalamic-pituitary-adrenal (HPA) suppression. The optimal test for detecting these effects has not been defined. METHODS Timed urine collections and 09.00 hour plasma cortisol levels were obtained from 12 normal volunteers receiving inhaled placebo, beclomethasone (BDP) 800 or 2000 micrograms/day. The 24 hour urine samples were collected as follows: first hour after waking (hour 1), the next two hours after waking (hours 2 and 3), remainder of day, and overnight, with results expressed as urine cortisol/creatinine (UCC) ratios and as hourly cortisol output in the timed collections. Twenty four hour urinary cortisol excretion was also calculated. Medication was blinded and given in random order with a washout period of at least 11 days between each treatment arm. RESULTS None of the UCC ratios changed with BDP 800 micrograms/day. UCC ratios at hour 1, hour 2 and 3, and overnight, and 24 hour urinary free cortisol excretion were reduced after BDP 2000 micrograms/day, whilst remainder of day UCC ratio and the plasma cortisol level did not change significantly. Cortisol output showed similar changes. In a follow up study BDP 1400 micrograms/day also reduced UCC ratios for the first two hours after waking. CONCLUSIONS UCC ratios are as sensitive as the more cumbersome 24 hour urinary free cortisol excretion, and more sensitive than single morning plasma cortisol measurements, in detecting the effects of inhaled beclomethasone on the HPA axis.
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Affiliation(s)
- H D McIntyre
- Department of Endocrinology, Mater Misericordiae Adult Hospital, South Brisbane, Queensland, Australia
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12
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Abstract
We describe a case of 2 siblings aged 2 1/2 and 3 1/2 yrs accidentally poisoned by ethylene glycol ingestion. We found estimating the level of ethylene glycol in plasma by calculation of osmolar gap too insensitive to be of value and advocate the availability of a specific method. In our study only one of the 2 children had a toxic level of ethylene glycol but assay by conventional assay and by proton magnetic resonance spectroscopy (1HMRS) of toxic metabolites viz glycolate, glyoxylate and oxalate showed both to be excreting grossly elevated levels. This indicates the desirability of assaying the toxic metabolites of the glycol as well as the parent compound in assessing ingestions.
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Affiliation(s)
- E A De Leacy
- Pathology Department, Mater Misericordiae Hospital, South Brisbane, Australia
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Voroteliak V, Cowley DM, Florin TH. Improved colorimetric determination of urinary thiosulfate to study intermediate sulfur metabolism in humans. Clin Chem 1993; 39:2533-4. [PMID: 8252731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Voroteliak V, Cowley DM, Florin TH. Improved colorimetric determination of urinary thiosulfate to study intermediate sulfur metabolism in humans. Clin Chem 1993. [DOI: 10.1093/clinchem/39.12.2533] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Cowley DM. Night sweats. Hosp Pract (Off Ed) 1993; 28:16. [PMID: 8408355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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De Leacy EA, Cowley DM. Variability of glucose tolerance test in pregnancy diminished by use of a glucose polymer. Clin Chem 1992; 38:1388-9. [PMID: 1623616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- V M Ellis
- Douglass Laboratories Pty Ltd, Ryde, N.S.W., Australia
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Abstract
We describe 2 patients presenting with severe chronic hyponatremia in whom clinical and biochemical features strongly suggested the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both, however, were proven to have a primary pituitary deficiency of corticotropin. Their short synacthen tests were only mildly abnormal but associated with low basal ACTH levels. The diagnosis of ACTH deficiency was made more convincingly by their dramatic response to glucocorticoid replacement therapy. In patients in whom no cause for SIADH can be found, a trial of maintenance cortisol therapy is warranted to exclude this eminently treatable condition.
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Affiliation(s)
- E A De Leacy
- Mater Misericordiae Public Hospital, South Brisbane
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de Leacy EA, Cowley DM, Brown JM, McWhinney BC, Chalmers AH. Effect of oral citrate on calcium absorption after an oral load of calcium phosphate. Clin Chem 1989. [DOI: 10.1093/clinchem/35.7.1541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E A de Leacy
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
| | - D M Cowley
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
| | - J M Brown
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
| | - B C McWhinney
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
| | - A H Chalmers
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
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Abstract
Abstract
Fifty consecutive pregnant patients referred for a glucose-tolerance test were classified on the basis of increasing (n = 20) or decreasing (n = 28) hematocrit after an oral 75-g glucose load. (The hematocrit did not change in the other two patients.) Patients with increasing hematocrit, a response previously seen in patients with the dumping syndrome, showed significantly flatter increases in glucose concentrations in plasma after the load. The mean decrease in the concentration of phosphate in plasma, measured as an index of glucose uptake by cells, was significantly less (P less than 0.05) 2 h after the load in the group with flatter glucose responses, suggesting that the flat response is ascribable to poor glucose absorption rather than to an exaggerated insulin response. These results indicate that the oral glucose-tolerance test stresses the pancreatic islets differently in different pregnant subjects, owing to individual variations in the gastrointestinal handling of the glucose load. Consequently, patients may give a "normal" result who might otherwise become hyperglycemic after normal meals. We suggest that alternative screening procedures be investigated to assess pregnant patients postprandially.
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Affiliation(s)
- E A de Leacy
- Department of Pathology, Mater Misericordiae Public Hospital, South Brisbane, Queensland, Australia
| | - D M Cowley
- Department of Pathology, Mater Misericordiae Public Hospital, South Brisbane, Queensland, Australia
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de Leacy EA, Cowley DM, Brown JM, McWhinney BC, Chalmers AH. Effect of oral citrate on calcium absorption after an oral load of calcium phosphate. Clin Chem 1989; 35:1541. [PMID: 2758607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E A de Leacy
- Dept. of Pathol., Misericordiae Public Hospital, South Brisbane, Queensland, Australia
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de Leacy EA, Cowley DM. Evidence that the oral glucose-tolerance test does not provide a uniform stimulus to pancreatic islets in pregnancy. Clin Chem 1989; 35:1482-5. [PMID: 2667802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fifty consecutive pregnant patients referred for a glucose-tolerance test were classified on the basis of increasing (n = 20) or decreasing (n = 28) hematocrit after an oral 75-g glucose load. (The hematocrit did not change in the other two patients.) Patients with increasing hematocrit, a response previously seen in patients with the dumping syndrome, showed significantly flatter increases in glucose concentrations in plasma after the load. The mean decrease in the concentration of phosphate in plasma, measured as an index of glucose uptake by cells, was significantly less (P less than 0.05) 2 h after the load in the group with flatter glucose responses, suggesting that the flat response is ascribable to poor glucose absorption rather than to an exaggerated insulin response. These results indicate that the oral glucose-tolerance test stresses the pancreatic islets differently in different pregnant subjects, owing to individual variations in the gastrointestinal handling of the glucose load. Consequently, patients may give a "normal" result who might otherwise become hyperglycemic after normal meals. We suggest that alternative screening procedures be investigated to assess pregnant patients postprandially.
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Affiliation(s)
- E A de Leacy
- Department of Pathology, Mater Misericordiae Public Hospital, South Brisbane, Queensland, Australia
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Cowley DM, Brown JM, McWhinney BC, Chalmers AH. Hydroxycarboxylate Malabsorption and Calcium Oxalate Nephrolithiasis. Urolithiasis 1989. [DOI: 10.1007/978-1-4899-0873-5_148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cowley DM, McWhinney BC, Brown JM, Chalmers AH. Effect of citrate on the urinary excretion of calcium and oxalate: relevance to calcium oxalate nephrolithiasis. Clin Chem 1989; 35:23-8. [PMID: 2910576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Studies in 24 recurrent oxalate stone-formers have shown that values for urinary calcium excretion for this group on at-home diets vary significantly (P less than 0.001) more than values for creatinine excretions. By placing stone-formers on controlled in-hospital diets and measuring their calcium excretions, we were able to predict probable outpatient hypercalciuria (greater than 7.5 mmol/day) with a sensitivity of 95% and a specificity of 95%. In this study, the renal loss of calcium during low-calcium diets was proportional to the absorptive hypercalciuria during high-calcium diets. Calcium loading experiments in fasted stone-formers and normal subjects indicated that citrate, at citrate:calcium molar ratios ranging from 0.12 to 1, stimulated urinary calcium excretion more than did calcium carbonate loading alone. In addition, citrate also significantly (P less than 0.05) increased the excretion of urinary oxalate by two normal subjects for a given load of calcium oxalate. Malabsorption of citrate and possibly other hydroxycarboxylic acids may thus predispose to oxalate nephrolithiasis by promoting calcium and oxalate absorption.
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Affiliation(s)
- D M Cowley
- Department of Pathology, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia
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Cowley DM, McWhinney BC, Brown JM, Chalmers AH. Effect of citrate on the urinary excretion of calcium and oxalate: relevance to calcium oxalate nephrolithiasis. Clin Chem 1989. [DOI: 10.1093/clinchem/35.1.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Studies in 24 recurrent oxalate stone-formers have shown that values for urinary calcium excretion for this group on at-home diets vary significantly (P less than 0.001) more than values for creatinine excretions. By placing stone-formers on controlled in-hospital diets and measuring their calcium excretions, we were able to predict probable outpatient hypercalciuria (greater than 7.5 mmol/day) with a sensitivity of 95% and a specificity of 95%. In this study, the renal loss of calcium during low-calcium diets was proportional to the absorptive hypercalciuria during high-calcium diets. Calcium loading experiments in fasted stone-formers and normal subjects indicated that citrate, at citrate:calcium molar ratios ranging from 0.12 to 1, stimulated urinary calcium excretion more than did calcium carbonate loading alone. In addition, citrate also significantly (P less than 0.05) increased the excretion of urinary oxalate by two normal subjects for a given load of calcium oxalate. Malabsorption of citrate and possibly other hydroxycarboxylic acids may thus predispose to oxalate nephrolithiasis by promoting calcium and oxalate absorption.
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Affiliation(s)
- D M Cowley
- Department of Pathology, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia
| | - B C McWhinney
- Department of Pathology, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia
| | - J M Brown
- Department of Pathology, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia
| | - A H Chalmers
- Department of Pathology, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia
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DeLeacy EA, Cowley DM, Wynne JM. False-positive result of a glucose tolerance test. Med J Aust 1988; 149:225-6. [PMID: 3173184 DOI: 10.5694/j.1326-5377.1988.tb120583.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Cowley DM, Pabari M, Sinton TJ, Johnson S, Carroll G, Ryan WE. Pathogenesis of postoperative hyponatraemia following correction of scoliosis in children. Aust N Z J Surg 1988; 58:485-9. [PMID: 3077898 DOI: 10.1111/j.1445-2197.1988.tb06240.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eight paediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium, renin and aldosterone, and urine volume, sodium and osmolality were measured. These patients had an impaired ability to excrete a sodium-free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h postoperation are considered, the sodium-free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P less than 0.01). To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema, it is recommended that no more than 50 ml/kg sodium-free water be given until urine sodium falls and volume increases.
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Affiliation(s)
- D M Cowley
- Department of Pathology, Mater Misericordiae Public Hospitals, Brisbane, Queensland, Australia
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Chalmers AH, Cowley DM, Brown JM, McWhinney BC. More on citric acid and calcium nephrolithiasis. Clin Chem 1988; 34:793. [PMID: 3359632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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30
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Chalmers AH, Cowley DM, Brown JM, McWhinney BC. More on citric acid and calcium nephrolithiasis. Clin Chem 1988. [DOI: 10.1093/clinchem/34.4.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brown JM, Stratmann G, Cowley DM, Mottram BM, Chalmers AH. The variability and dietary dependence of urinary oxalate excretion in recurrent calcium stone formers. Ann Clin Biochem 1987; 24 ( Pt 4):385-90. [PMID: 3662388 DOI: 10.1177/000456328702400407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Twenty-two recurrent calcium stone formers had 24-h urinary oxalate excretions on their home diets which were significantly greater than those of 30 normal subjects (0.48 +/- 0.23 mmol/d; mean +/- SD compared with 0.31 +/- 0.11; P less than 0.01). The stone formers also demonstrated marked day to day variability in oxalate excretion indicating that a single normal urinary oxalate measurement did not exclude significant hyperoxaluria at other times. On a hospital diet containing 1000 mg calcium per day, urinary oxalate excretion fell significantly from 0.48 +/- 0.23 mmol/d to 0.32 +/- 0.12; P less than 0.01. As the urinary calcium excretion in and out of hospital was similar, it seems unlikely that low calcium intake at home was responsible for the hyperoxaluria. All patients had recurrent symptomatic stone disease and had been advised to avoid foods rich in oxalate. Whilst poor compliance is a possible explanation for the variability in oxalate excretion, we believe it is more likely that there is an inadvertent intake of oxalogenic precursors in their diet. As normal subjects do not demonstrate hyperoxaluria on similar home diets, stone formers may have a metabolic defect in the handling of these precursors.
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Affiliation(s)
- J M Brown
- Department of Medicine, Mater Misericordiae Public Hospitals, Queensland, Australia
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McWhinney BC, Nagel SL, Cowley DM, Brown JM, Chalmers AH. Two-carbon oxalogenesis compared in recurrent calcium oxalate stone formers and normal subjects. Clin Chem 1987; 33:1118-20. [PMID: 3594837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We used a xylitol load to test the two-carbon pathway to oxalate production in humans. Use of this pentose sugar caused a fourfold increase in glycolate excretion, indicating its suitability as a dynamic function test of two-carbon metabolism. However, despite this increase in glycolate excretion in 10 recurrent stone formers and six normal subjects, there was no concomitant increase in oxalate excretion in either group. By comparison, a sucrose load produced no increase in excretion of either glycolate or oxalate. In addition, when we studied four recurrent calcium stone formers on successive diets with various fat content, we found no correlation between high fat intake and increased glycolate or oxalate excretion. In summary, there was no evidence of abnormal fluxes through the two-carbon pathway to oxalate in recurrent stone formers, nor of hyperoxaluria as related to increased intake of sucrose or fat.
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McWhinney BC, Nagel SL, Cowley DM, Brown JM, Chalmers AH. Two-carbon oxalogenesis compared in recurrent calcium oxalate stone formers and normal subjects. Clin Chem 1987. [DOI: 10.1093/clinchem/33.7.1118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We used a xylitol load to test the two-carbon pathway to oxalate production in humans. Use of this pentose sugar caused a fourfold increase in glycolate excretion, indicating its suitability as a dynamic function test of two-carbon metabolism. However, despite this increase in glycolate excretion in 10 recurrent stone formers and six normal subjects, there was no concomitant increase in oxalate excretion in either group. By comparison, a sucrose load produced no increase in excretion of either glycolate or oxalate. In addition, when we studied four recurrent calcium stone formers on successive diets with various fat content, we found no correlation between high fat intake and increased glycolate or oxalate excretion. In summary, there was no evidence of abnormal fluxes through the two-carbon pathway to oxalate in recurrent stone formers, nor of hyperoxaluria as related to increased intake of sucrose or fat.
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Cowley DM, McWhinney BC, Brown JM, Chalmers AH. Chemical factors important to calcium nephrolithiasis: evidence for impaired hydroxycarboxylic acid absorption causing hyperoxaluria. Clin Chem 1987; 33:243-7. [PMID: 3802507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An investigation of variables important to calcium stone formation in urine indicated significantly increased daily excretion of calcium and oxalate and decreased excretion of ascorbate and citrate by recurrent calcium stone formers. In addition, urine volume, sodium, mucopolysaccharide, and protein were also significantly increased. We compared the uptake of citrate and ascorbate from the gut into the blood in normal controls and stone formers. These studies indicated significantly depressed absorption of both these hydroxycarboxylic acids in recurrent calcium stone formers. We also found that concurrent administration of citrate inhibited ascorbate absorption and increased urinary oxalate excretion after an ascorbate load in normal subjects and stone formers. These findings suggest a mechanism that explains hyperoxaluria in stone patients on the basis of a malabsorption of citrate, ascorbate, and possibly other hydroxycarboxylic acids.
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Abstract
The need exists for a fast and accurate method of estimating glomerular filtration rate (GFR). A number of nomograms and formulae which estimate GFR on the basis of a plasma creatinine level have appeared in the literature. We examined some of these nomograms and formulae and showed that when the formula published by Cockcroft and Gault was compared with the GFR as estimated by 51Cr EDTA clearance, the coefficient of correlation was better than 0.94. We also compared creatinine clearance with the Cockcroft and Gault formula, and the Siersbaek-Nielsen nomogram. In each case, the correlation coefficient was less than that for the Cockcroft and Gault-51Cr EDTA comparison. Because of the inherent difficulties in making accurate 24 h urine collections, and problems associated with 51Cr EDTA studies, it is suggested that the formula prediction of GFR is more reliable than a GFR estimate using a 24 h collection.
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Tudehope DI, Mitchell F, Cowley DM. A comparative study of a premature infant formula and preterm breast milk for low birthweight infants. Aust Paediatr J 1986; 22:199-205. [PMID: 3767788 DOI: 10.1111/j.1440-1754.1986.tb00223.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
We have devised a simple, sensitive quantitative method for the determination of serum methemalbumin. The method uses a modified Allen correction to correct the alpha band of methemalbumin at 623 nm for background turbidity. The technique is robust and is more sensitive than Schumm's test.
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Cowley DM, Mottram BM, Haling NB, Sinton TJ. Improved linearity of the calcium-cresolphthalein complexone reaction with sodium acetate. Clin Chem 1986; 32:894-5. [PMID: 3698286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Cowley DM, Mottram BM, Haling NB, Sinton TJ. Improved linearity of the calcium-cresolphthalein complexone reaction with sodium acetate. Clin Chem 1986. [DOI: 10.1093/clinchem/32.5.894a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chalmers AH, Cowley DM, Brown JM. A possible etiological role for ascorbate in calculi formation. Clin Chem 1986; 32:333-6. [PMID: 3943193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Studies of recurrent stone formers indicated that they have significantly increased urinary oxalate and decreased ascorbate excretions. Results of oral and intravenous administration of ascorbate indicate an enhanced production of oxalate from ascorbate in recurrent calcium stone formers as compared with normal persons and that most of this oxalate is generated in the gut.
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Abstract
Abstract
Studies of recurrent stone formers indicated that they have significantly increased urinary oxalate and decreased ascorbate excretions. Results of oral and intravenous administration of ascorbate indicate an enhanced production of oxalate from ascorbate in recurrent calcium stone formers as compared with normal persons and that most of this oxalate is generated in the gut.
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Abstract
A calcium loading test performed on seven of eight children with idiopathic hypercalciuria identified the hyperabsorptive form of hypercalciuria in five and renal hypercalciuria in one. The type of hypercalciuria was not identified in the other patient. Three children presented with hematuria without calculus formation. Chlorothiazide reduced the urinary calcium excretion level in two of six patients to the normal range. The addition of cellulose phosphate to chlorothiazide reduced the urinary calcium excretion level to the normal range in those four patients who showed an incomplete response to chlorothiazide alone. There was clinical improvement with cellulose phosphate in another child whose symptoms did not disappear after chlorothiazide had reduced urinary calcium level to the normal range. Cellulose phosphate is effective in children with recurrent stone formation who have shown inadequate response to chlorothiazide.
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Sinton TJ, Cowley DM, Bryant SJ. Reference intervals for calcium, phosphate, and alkaline phosphatase as derived on the basis of multichannel-analyzer profiles. Clin Chem 1986; 32:76-9. [PMID: 3940739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In an attempt to demonstrate a rapid and economical approach to deriving reference intervals, we analyzed data on plasma calcium and phosphate from a multichannel analyzer for more than 20 000 subjects and data on alkaline phosphatase from more than 10 000 subjects. Subjects were selected by the criterion, that their results for constituents other than the one of interest were within current reference intervals. Thus we have been able to include older patients who have diseases that accompany old age, but that do not affect test results. The mean concentrations of calcium and phosphate decreased with increasing age in both sexes, except for an abrupt increase for women about the time of reaching menopause. Similarly, the mean alkaline phosphatase activity increased with age in both sexes, reflecting a skewed frequency distribution. Here also, there was an abrupt increase in the modal value for women near menopause.
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Sinton TJ, Cowley DM, Bryant SJ. Reference intervals for calcium, phosphate, and alkaline phosphatase as derived on the basis of multichannel-analyzer profiles. Clin Chem 1986. [DOI: 10.1093/clinchem/32.1.76] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
In an attempt to demonstrate a rapid and economical approach to deriving reference intervals, we analyzed data on plasma calcium and phosphate from a multichannel analyzer for more than 20 000 subjects and data on alkaline phosphatase from more than 10 000 subjects. Subjects were selected by the criterion, that their results for constituents other than the one of interest were within current reference intervals. Thus we have been able to include older patients who have diseases that accompany old age, but that do not affect test results. The mean concentrations of calcium and phosphate decreased with increasing age in both sexes, except for an abrupt increase for women about the time of reaching menopause. Similarly, the mean alkaline phosphatase activity increased with age in both sexes, reflecting a skewed frequency distribution. Here also, there was an abrupt increase in the modal value for women near menopause.
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Chalmers AH, Cowley DM, McWhinney BC. Stability of ascorbate in urine: relevance to analyses for ascorbate and oxalate. Clin Chem 1985; 31:1703-5. [PMID: 3930094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ascorbate is unstable in urine at room temperature at pH values ranging from 1 to 12. At pH 7 and above, oxalate is generated in amounts directly proportional to the ascorbate concentration. In 12 different urines, adjusted to pH 12 and incubated for 20 h at room temperature, there was a significant correlation between the amount of oxalate formed and the initial ascorbate concentration (r = 0.97, p less than 0.01). The mean (+/- SD) concentration of oxalate (1.32 +/- 0.70 mmol/L) formed during this period approximated the initial ascorbate concentration (1.57 +/- 1.09 mmol/L). Disodium EDTA, 10 mmol/L final concentration, stabilizes ascorbate in urine and inhibits its conversion to oxalate at pH values of 4.4 to 7.0 during a 24-h period. We therefore propose that urine specimens for ascorbate and oxalate analyses be collected with disodium EDTA present such as to give about this final concentration.
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Abstract
Abstract
Ascorbate is unstable in urine at room temperature at pH values ranging from 1 to 12. At pH 7 and above, oxalate is generated in amounts directly proportional to the ascorbate concentration. In 12 different urines, adjusted to pH 12 and incubated for 20 h at room temperature, there was a significant correlation between the amount of oxalate formed and the initial ascorbate concentration (r = 0.97, p less than 0.01). The mean (+/- SD) concentration of oxalate (1.32 +/- 0.70 mmol/L) formed during this period approximated the initial ascorbate concentration (1.57 +/- 1.09 mmol/L). Disodium EDTA, 10 mmol/L final concentration, stabilizes ascorbate in urine and inhibits its conversion to oxalate at pH values of 4.4 to 7.0 during a 24-h period. We therefore propose that urine specimens for ascorbate and oxalate analyses be collected with disodium EDTA present such as to give about this final concentration.
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Chalmers AH, Cowley DM. Stabilization of the reaction mixture used in urinary citrate estimations. Clin Chem 1985. [DOI: 10.1093/clinchem/31.9.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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McWhinney BC, Cowley DM, Chalmers AH. An automated method for measuring plasma citrate without protein precipitation. Clin Chem 1985; 31:1578-9. [PMID: 4028416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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