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Biomedical subjects

E Blair

Publications and source records attributed to E Blair.

At least 37 records · Page 2Linked to original sources
PubMed1998

Adverse outcome after multiple pregnancy.

There is increasing interest in the outcomes of multiple pregnancies as their numbers rise, mainly owing to advances in fertility-enhancing techniques. In addition, the numbers of multiple births surviving the perinatal period is increasing with the increasing survival of very tiny babies. In order to investigate these outcomes or to evaluate procedures that may improve them, it is important to consider a number of methodological issues that affect the comparability of data both between and within populations. How a birth and a multiple birth are defined, data sources, whether multiple pregnancies or individual births are being counted and the identification of multiple gestations by zygosity and chorionicity will all affect the reported outcome rates. In light of this, perinatal mortality and neurodevelopmental disabilities are examined as adverse outcomes of multiple pregnancies.

Abortion, Spontaneous↗
PubMed1998

What constitutes cerebral palsy?

Cerebral palsy (CP) is a term of convenience applied to a group of motor disorders of central origin defined by clinical description. It is not a diagnosis in that its application infers nothing about pathology, aetiology, or prognosis. It is an umbrella term covering a wide range of cerebral disorders which result in childhood motor impairment. The precise inclusion criteria vary with the objectives for using the term. For meaningful comparison of rates of CP, as performed by and between CP registers, it is important that the rates should be generated using the same criteria. As generally understood there must be motor impairment, and this impairment must stem from a malfunction of the brain (rather than spinal cord or muscles). Furthermore, the brain malfunction must be non-progressive and it must be manifest early in life. For the purposes of comparisons of rates across time even when the condition meets all the above criteria, it must not historically have been excluded from the category of CP. This paper addresses the problem of standardizing the inclusion criteria for selecting people included on CP registers with particular reference to this last criterion.

Cerebral Palsy↗
PubMed1997

Mucopolysaccharidosis type VII associated with hydrops fetalis: histopathological and ultrastructural features with genetic implications.

A case of mucopolysaccharidosis type VII (MPS VII, beta glucuronidase deficiency) causing fatal hydrops fetalis in the third trimester is presented. The diagnosis was suspected on histopathological examination by the presence of foam cells in many of the viscera and foamy change in the placental Hofbauer cells. Electron microscopy showed empty cytoplasmic inclusion bodies within macrophages and in the Hofbauer cells. Enzyme assay of cultured fibroblasts showed markedly deficient beta glucuronidase activity, thus confirming the diagnosis. A detailed and thorough histopathological examination of hydrops fetalis cases is important to detect subtle features of inherited metabolic disorders. Use of a structured necropsy protocol is recommended for cases of non-immune hydrops. Electron microscopy is a useful adjunct to light microscopy in cases where an inherited metabolic disorder is suspected. Precise necropsy diagnosis is important as there are implications for genetic counselling and possible prenatal diagnosis in subsequent pregnancies.

Fatal Outcome↗
PubMed1996

[Motor deficiencies in children: for a nosologic clarification in epidemiological studies].

In order to clarify the epidemiological research on childhood motor deficiency in France there is a need to better differenciate the two terms used to define this pathology: the French term "infirmité motrice cérébrale" (IMC) and the English term "cerebral palsy" (CP). The distinction between IMC and CP is highlighted on the basis of clinical examples. IMC recovers motor deficiencies which are quite similar, however, it can be very difficult to control the variations in its use. CP has the advantage of a greater exhaustivity as well as a greater reproductibility for epidemiological records. Recently a study was conducted for measuring the prevalence of childhood deficiencies in France, and the results were expressed either as IMC or as CP. When using the CP definition the prevalence rate in France was found to be close to that of foreign studies (1.9 per thousand). In studies with etiological purposes involving several countries, a preliminary agreement on the definition of the clinical groups is absolutely necessary.

Adolescent↗
PubMed1996

Effectiveness of five days of therapy with cefuroxime axetil suspension for treatment of acute otitis media.

BACKGROUND: In recent years there has been considerable interest in reducing the duration of antibiotic treatment regimens in patients with common bacterial infections. We conducted two independent, investigator-blinded, multicenter, randomized clinical trials, one of which included microbiologic evaluation of middle ear fluid obtained by tympanocentesis, comparing the efficacy and safety of 5 or 10 days of treatment with cefuroxime axetil suspension (CAE) with that of 10 days of treatment with amoxicillin/clavulanate suspension (AMX/CL) in children with acute otitis media. METHODS: A total of 719 pediatric patients from the ages of 3 months to 12 years were enrolled in the 2 studies. Patients received CAE for either 5 or 10 days at 30 mg/kg/day in 2 divided doses (n = 242 and 235, respectively) or AMX/CL for 10 days at 40 mg/kg/day in 3 divided doses (n = 242). Patients in the CAE (5 days) group received placebo on Days 6 through 10. In the study that included tympanocentesis, bacteriologic assessments were based on middle ear fluid cultures obtained pretreatment and, when possible, after treatment in patients with an unsatisfactory clinical outcome. RESULTS: Organisms were isolated from the pretreatment middle ear fluid specimens of 177 of 244 (73%) patients undergoing tympanocentesis, with the primary pathogens being Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis (37, 35 and 12% of isolates, respectively). Pathogens were eradicated or presumed to be eradicated in 92% (24 of 26), 84% (32 of 38) and 95% (36 of 38) of bacteriologically evaluable patients treated with CAE for 5 or 10 days or with AMX/CL, respectively. A satisfactory clinical outcome (cure or improvement) occurred in 69% (101 of 147), 70% (121 of 173) and 74% (131 of 177) of clinically evaluable patients treated with CAE (5 days), CAE (10 days) or AMX/CL, respectively. Treatment with AMX/CL was associated with a significantly higher incidence of drug-related adverse events than was treatment with CAE for either 5 or 10 days (P < 0.001), primarily reflecting a higher incidence of drug-related gastrointestinal adverse events (34% vs. 17 and 12%, respectively; P < 0.001), particularly diarrhea. CONCLUSIONS: Treatment with CAE given twice daily for 5 days is equivalent to treatment for 10 days either with the same regimen of CAE or with AMX/CL given three times daily in pediatric patients with acute otitis media.

Acute Disease↗
PubMed1996

Why do aboriginal newborns weigh less? Determinants of birthweight for gestation.

OBJECTIVE: To compare birthweight for gestational age of Aboriginal with Caucasian infants and investigate the origins of their differences. METHODOLOGY: Data pertaining to birthweight, gestational age at delivery and pathological factors were abstracted from birth records of 1301 Western Australian singleton Aboriginal pregnancies dated before 24 weeks by ultrasound fetometry and compared with routinely collected data pertaining to Caucasian births of the same period. RESULTS: Median birthweight for gestation was lower in Aboriginal than in Caucasian infants for deliveries after 35 weeks of gestation, and that of pure-descent lower than that of mixed-descent Aboriginal infants at all gestations. Pathological factors (e.g. diabetes, urogenital infections, alcoholism and leprosy) occurring more commonly in Aboriginal than in Caucasian pregnancies accounted for most of the differences in birthweight for gestation between mixed-descent Aboriginal and Caucasian infants but a discrepancy of almost 180 g remained between pure-descent Aboriginal and Caucasian infants. CONCLUSIONS: Identified pathological factors contribute but do not entirely explain the lower birthweights for gestation observed in Aboriginal infants.

Australia↗
PubMed1996

The undesirable consequences of controlling for birth weight in perinatal epidemiological studies.

OBJECTIVE: To compare the effects of controlling for birth weight with those of controlling for gestational age at delivery in perinatal epidemiological studies using two examples. SETTING: Western Australia. SUBJECTS: Population data: all white births born at 20-46 weeks of gestation in Western Australia during 1985-91 inclusive (n = 147564). Example 1: All Western Australian births from 1980-89 born either at 33-36 weeks inclusive (n = 13607), or born with a birth weight of 2050-2900 g (n = 34107). Example 2: 160 singleton cases of spastic cerebral palsy born to white mothers in Western Australia from 1975-80 and whose gestational age was known, compared with (a) 480 controls individually matched for gender and birth weight and (b) singletons with known gestational age liveborn to white mothers in Western Australia from 1980-81, or 1979-82 if < 30 weeks' gestational age at birth (n = 32031). MEASUREMENTS AND MAIN RESULTS: The risks of cerebral palsy associated with two separate exposures in groups defined by birth weight were compared with those in groups defined by gestational age. The origin of the differences are explained using total population data. The estimates of risk differ when exposure and outcome are both associated with appropriateness of fetal growth. The difference varied with gestational age, being greatest in the moderately preterm (33-36 weeks' gestation). CONCLUSION: Epidemiological studies in which appropriateness of fetal growth is an important variable should be based on gestational age at birth rather than birth weight, whatever the neonatal size or maturity.

Birth Weight↗
PubMed1995

Antenatal antecedents of moderate and severe cerebral palsy.

Aetiological relationships between cerebral palsy, preterm birth, small-for-gestational-age (SGA) birth and selected feto-maternal factors were investigated in a case-control study of all moderate and severe cerebral palsy cases born in Western Australia between 1980 and 1986 (n = 215). Cases were individually matched to three controls of the same gender and plurality born in the same year. Two of the controls were matched to the index cases for gestational age, one of which was also matched for birthweight. Pre-eclampsia and urinary tract infections were not significantly associated with cerebral palsy. The significant association of antepartum haemorrhage with cerebral palsy was accounted for by its associations with preterm birth. Congenital malformations and non-cerebral palsy neurological disorder were significantly associated with cerebral palsy; these associations were only partially accounted for by adjusting for preterm birth and small-for-gestational-age birth. This study shows that some of the risk of cerebral palsy associated with the antenatal antecedents of some common feto-maternal factors is mediated through preterm birth, confirming the importance of interrelationships between antenatal antecedents in the aetiology of some cerebral palsy. Perinatal and post-neonatal causes now account for only around 20% of all cerebral palsy. Future reductions in cerebral palsy incidence may therefore depend on acquiring greater knowledge of inter-relationships between antenatal antecedents.

Case-Control Studies↗
PubMed1995

A study of a dynamic proximal stability splint in the management of children with cerebral palsy.

This paper describes a study of the UPsuit, a proximal stability splint fabricated from Lycra, in the management of children with cerebral palsy. The splint improved posture and reduced involuntary movement immediately. The amount of functional improvement depended on the type and severity of impairments, the subject's attitude, their capacity for purposeful intent and compliance. Compromised lung function and pre-existing hypoactivity were medical contra-indications to UPsuit wear whilst a limited capacity for purposeful intent or a negative attitude restricted benefits. The Upsuit was of great value to one-quarter of subjects, but Lycra splinting may benefit a wider spectrum of persons with cerebral palsy in the form of less intrusive splints applied to the limbs.

Adolescent↗