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Biomedical subjects

N J Shaw

Publications and source records attributed to N J Shaw.

At least 73 records · Page 4Linked to original sources
PubMed1999

Outcome predictors in pregnant opiate and polydrug users.

A retrospective case note study of 93 women was performed in order to assess the effect of maternal factors on neonatal outcome in a group of women attending a specialist clinic for pregnant drug users. There were no significant differences in outcome for chaotic drug users compared with non-chaotic drug users, or for cocaine users compared with non-cocaine using drug users. Women who reduced their methadone dose during pregnancy delivered babies of significantly higher birth weight than those whose methadone dose remained the same or increased (median 3027 g, range 1780-3629 g vs 2645 g, range 580-3720 g). Women who abused benzodiazepines during pregnancy produced babies of significantly lower birth weight than those women who did not use benzodiazepines (median 2100 g, range 580-3520 g vs 2767 g, range 1530-3720 g). The results of this study give healthcare staff evidence to use in encouraging drug-using women to avoid benzodiazepines during pregnancy and to reduce their methadone dosage. The treatment received from a specialist clinic may mitigate against some of the other recognised effects of drug use during pregnancy.

Benzodiazepines↗
PubMed1999

Outcome of congenital lung abnormalities detected antenatally.

To determine the outcome of congenital lung abnormalities, data were collected retrospectively between January 1991 and December 1996 on any foetus found to have a lung lesion on antenatal ultrasound. A total of 23 foetuses had lung lesions on antenatal ultrasound. In two foetuses the antenatal ultrasound showed bilateral enlarged "bright" echogenic lungs with evidence of hydrops. Both pregnancies were terminated and tracheal atresia was confirmed. In 15 foetuses the antenatal ultrasound appearance was of a unilateral "bright" echogenic lung. There was one case of bronchial atresia and two cases of congenital lobar emphysema, which all had surgery. In nine cases there was a reduction in the size of the lesion on serial antenatal ultrasounds and no lesion was detected after birth. In three cases a small lesion was present after birth on chest radiography. In six foetuses the antenatal ultrasound appearance was of unilateral cystic or mixed cystic and echogenic lung lesions. Two pregnancies were terminated; both had congenital cystic adenomatoid malformation. Four pregnancies were continued and three infants had surgery soon after birth and were confirmed to have had congenital cystic adenomatoid malformation. One infant has been managed conservatively. In conclusion, a definitive diagnosis cannot usually be made antenatally. A large lesion on initial scan does not necessarily predict a poor outcome. The natural history of small asymptomatic postnatal lesions is unknown and a long-term prospective study is needed to determine the outcome of these lesions.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1999

Detection of infectious Cryptosporidium parvum oocysts in surface and filter backwash water samples by immunomagnetic separation and integrated cell culture-PCR.

A new strategy for the detection of infectious Cryptosporidium parvum oocysts in water samples, which combines immunomagnetic separation (IMS) for recovery of oocysts with in vitro cell culturing and PCR (CC-PCR), was field tested with a total of 122 raw source water samples and 121 filter backwash water grab samples obtained from 25 sites in the United States. In addition, samples were processed by Percoll-sucrose flotation and oocysts were detected by an immunofluorescence assay (IFA) as a baseline method. Samples of different water quality were seeded with viable C. parvum to evaluate oocyst recovery efficiencies and the performance of the CC-PCR protocol. Mean method oocyst recoveries, including concentration of seeded 10-liter samples, from raw water were 26.1% for IMS and 16.6% for flotation, while recoveries from seeded filter backwash water were 9.1 and 5.8%, respectively. There was full agreement between IFA oocyst counts of IMS-purified seeded samples and CC-PCR results. In natural samples, CC-PCR detected infectious C. parvum in 4.9% (6) of the raw water samples and 7.4% (9) of the filter backwash water samples, while IFA detected oocysts in 13.1% (16) of the raw water samples and 5.8% (7) of the filter backwash water samples. All CC-PCR products were confirmed by cloning and DNA sequence analysis and were greater than 98% homologous to the C. parvum KSU-1 hsp70 gene product. DNA sequence analysis also revealed reproducible nucleotide substitutions among the hsp70 fragments, suggesting that several different strains of infectious C. parvum were detected.

Animals↗
PubMed1999

Growth in Sotos syndrome.

Although there are several reports on infant and childhood growth in patients with Sotos syndrome, there is little information on the final height achieved and puberty. Growth data on 40 patients (20 female and 20 male) aged 2-31 years were collected. These showed that patients with Sotos syndrome are excessively tall at birth, during infancy, and during childhood. Disproportionately long limbs constitute much of the increase in stature. However, the combination of advanced bone age and early onset of menarche led to a mean (SD) final height of 172.9 (5.7) cm in women. This is within the normal range for the population. Most of the men also attained a final height (mean, 184.3 cm; SD, 6.0) within the normal range, although exceptions were more likely in men than in women. Therefore, these results show that most patients with Sotos syndrome do not require intervention to limit their adult height.

Acromegaly↗
PubMed1999

Individualised pulse oximetry limits in neonatal intensive care.

AIM: To determine whether individualised limits for arterial oxyhaemaglobin saturation by pulse oximetry (SpO(2)) are more effective for detecting hypoxia and hyperoxia in sick newborn infants than setting fixed limits. METHODS: Six hundred and ninety two simultaneous measurements of SpO(2) and partial pressure of oxygen in arterial blood (PaO(2)) were made in 95 infants. The sensitivity and specificity for predicting hypoxia and hyperoxia using various fixed SpO(2) limits and also individualised SpO(2) limits, calculated using a standard equation, were determined and compared. RESULTS: None of the fixed limits for SpO(2) was both sensitive and specific for predicting hypoxia and/or hyperoxia. There was no difference between these and individualised limits. CONCLUSION: Individualised SpO(2) limits are no more effective than fixed SpO(2) limits for predicting hypoxia and/or hyperoxia in sick newborn infants. SpO(2) monitoring is not an ideal method for assessing PaO(2).

Female↗
PubMed1999

Neonatal and pediatric outcome of infants born to mothers with antiphospholipid syndrome.

OBJECTIVE: To determine any adverse outcome to infants born to mothers with Antiphospholipid Syndrome (APS). DESIGN: Case control study with retrospective data collection and prospective pediatric review. SETTING: Regional Recurrent Miscarriage Clinic based at a University Teaching Hospital. PARTICIPANTS: Infants (n = 62) of mothers with APS, compared to 124 index cases randomly selected from the delivery register, matched for gestation and sex who delivered between 1992 and 1997. RESULTS: Sixty two infants born to 55 women with APS were reviewed to study the neonatal outcome. The prematurity rate for the group was 10%, compared to 8.5% for the total hospital population over the same period of time. Twenty-one percent (21%) had birth weights less than or equal to the 10th centile, which was not statistically significant compared to matched controls. The presence of dual parameter positivity (lupus anticoagulant and anticardiolipin antibody) for APS is clearly associated with a higher incidence of growth restriction. All children were normal on neurodevelopmental and physical examination at pediatric review. CONCLUSIONS: There was a low rate of preterm delivery. Although the incidence of growth restriction of 21% is higher than expected it was not statistically significant. There were no developmental abnormalities on follow-up of these children.

Adult↗
PubMed1999

Chronic lung disease and survival in 4 tertiary neonatal units.

AIM: To compare mortality and respiratory morbidity in preterm infants born at 4 United Kingdom centers during 1994 and 1995. METHOD: Collection of CRIB scores, respiratory parameters and mortality rates from unit databases. RESULTS: Mortality in center A was 27% (actual number of deaths 36/135), in center B was 30% (39/130), in center C was 28% (51/182), in center D was 39% (60/156). The rate of chronic lung disease (36 week definition) in center A was 16%, in center B was 12%, in center C was 13%, in center D was 15%. The predicted number of deaths by CRIB scores in center A was 54 (95% confidence intervals 45-63), in center B was 33 (25-41), in center C was 53 (43-63), in center D was 46 (37-56). CONCLUSION: Center A had a lower than predicted mortality. Center D had a higher than predicted mortality. There is an urgent need for a national neonatal database to allow comparison between center and to identify reasons for variation in outcomes.

Birth Weight↗
PubMed1998

Changes in pulmonary artery pressure during the acute phase of respiratory distress syndrome treated with three different types of surfactant.

We studied the changes in acceleration time/right ventricular ejection time ratio (AT/RVET; indicative of changes in pulmonary artery pressure) calculated from Doppler ultrasound examinations performed before and 1, 6, and 12 h after the first and second doses of surfactant following the administration of each of three different surfactants during the acute phase of the respiratory distress syndrome. Maximum fractional inspired oxygen concentration (F(I,O2)) and peak inspiratory pressure (PIP) were recorded during each 4 h period from birth for the first 24 h and subsequently every 24 h until 72 h. Eighty-three infants were studied. Fifty patients weighing > 1 kg received Exosurf (n = 29) or ALEC (n = 21) and 33 weighing < or = 1 kg received Exosurf (n = 22) or Survanta (n = 11). The AT/RVET rose rapidly after administration of all three surfactants. There was no significant difference in the change in AT/RVET between those > 1 kg who received Exosurf and those who received ALEC (a synthetic surfactant). Similarly, there was no difference between those infants < or = 1 kg who received Exosurf and those who received Survanta. The F(I,O2) requirements, but not PIP, were lower in those infants who received Survanta at 12 and 20 h compared with those who received Exosurf. There was no significant difference in the F(I,O2) or PIP requirements between infants > 1 kg who received Exosurf compared with those who received ALEC. The rise in AT/RVET found in this study after administration of ALEC, Exosurf, or Survanta suggests that similar and rapid falls in pulmonary artery pressure occur after all three surfactant administrations, despite the difference in clinical response demonstrated between Exosurf and Survanta.

Acceleration↗
PubMed1998

A common and recurrent 13-bp deletion in the autoimmune regulator gene in British kindreds with autoimmune polyendocrinopathy type 1.

Autoimmune polyendocrinopathy type 1 (APS1) is an autosomal recessive disorder characterized by autoimmune hypoparathyroidism, autoimmune adrenocortical failure, and mucocutaneous candidiasis. Recently, an autoimmune regulator gene (AIRE-1), which is located on chromosome 21q22.3, has been identified, and mutations in European kindreds with APS1 have been described. We used SSCP analysis and direct DNA sequencing to screen the entire 1,635-bp coding region of AIRE-1 in 12 British families with APS1. A 13-bp deletion (964del13) was found to account for 17 of the 24 possible mutant AIRE-1 alleles, in our kindreds. This mutation was found to occur de novo in one affected subject. A common haplotype spanning the AIRE-1 locus was found in chromosomes that carried the 964del13 mutation, suggesting a founder effect in our population. One of 576 normal subjects was also a heterozygous carrier of the 964del13 mutation. Six other point mutations were found in AIRE-1, including two 1-bp deletions, three missense mutations (R15L, L28P, and Y90C), and a nonsense mutation (R257*). The high frequency of the 964del13 allele and the clustering of the other AIRE-1 mutations may allow rapid molecular screening for APS1 in British kindreds. Furthermore, the prevalence of the 964del13 AIRE-1 mutation may have implications in the pathogenesis of the more common autoimmune endocrinopathies in our population.

Alleles↗
PubMed1998

Pulmonary artery pressure: early predictor of chronic lung disease in preterm infants.

AIM: To determine if pulmonary artery pressure (PAP) in ventilated preterm infants is independently associated with the development of chronic lung disease (CLD) and whether early assessment has any prognostic value. METHODS: Two cohorts (development n = 55; and validation n = 28) of preterm infants were studied at 24 hours of age. PAP was assessed non-invasively using its inverse correlation with the corrected acceleration time to right ventricular ejection time ratio (AT:RVET(c)), calculated from the pulmonary artery Doppler waveform. Clinical and respiratory variables were also collected. Using logistic regression analysis to identify factors independently associated with CLD, a prognostic score was developed to predict CLD. The ability of the score to predict CLD was described using receiver operating characteristic (ROC) curves. RESULTS: Birthweight, inspired oxygen concentration, and AT:RVET(c) were independently predictive of CLD. The area under the ROC curve was 0.96 for the development and 0.89 for the validation cohort. Exclusion of AT:RVET(c) resulted in a reduction to 0.88 and 0.73, respectively. CONCLUSION: PAP is independently associated with CLD. An early assessment of PAP using AT:RVET(c) may permit the early prediction of CLD as part of a multifactorial scoring system.

Blood Pressure↗
PubMed1998

Arterial oxygen saturation profiles in healthy preterm infants.

AIM: To construct a reference range of SpO2 values in healthy preterm infants using a simple data logging device. METHODS: Thirty three healthy preterm infants were monitored for a continuous period of 4 hours at rest using an Ohmeda Biox 3700 E Pulse Oximeter and an electronic data logger (Rustrack Ranger). Stored data were downloaded and saved as individual files on a personal computer. RESULTS: The study group median and 5th and 95th percentiles were used to construct a cumulative frequency curve of time against SpO2 value, representing the normal reference range of SpO2 profiles in healthy preterm infants. CONCLUSION: Comparison of an infant's SpO2 profile against this curve may be more helpful in guiding supplemental oxygen treatment in that individual than a figure for a mean SPO2 and its standard deviation.

Arteries↗
PubMed1997

Conjunctival impression cytology in the preterm infant and it's relation to outcome.

UNLABELLED: The preterm infant is deficient in vitamin A (retinol) and this has been implicated in the pathogenesis of chronic lung disease of prematurity. Conjunctival impression cytology (CIC) has been used in adults to assess retinol status. We aimed to assess the feasibility of performing CIC in the preterm infant and to determine the significance of abnormal CIC findings. CIC samples were collected during routine retinopathy screening, and classified as inadequate, normal, borderline normal or abnormal. Ninety preterm infants were studied. Seventy-four (82%) CIC specimens produced a positive yield, whereas 16 (18%) were inadequate. Of the 74 adequate samples, 61 (82%) were normal or borderline normal and 13 (18%) abnormal. Seventy-three CIC specimens were assessed by a second histopathologist with complete agreement on 64 (88%) samples and disagreement on 9 (12%) samples. Ten sets of conjunctival impressions, taken from both eyes, gave identical results in all adequate samples. Birth weight was significantly lower in this abnormal group. Four infants (32%) in the abnormal group required treatment for retinopathy compared to two (3%) in the normal/borderline normal group, (P < 0.01). CONCLUSION: Conjunctival impression cytology is simple and reproducible technique which maybe easily applied to the preterm infant. Abnormal CIC is associated with retinopathy of prematurity requiring treatment.

Conjunctiva↗
PubMed1997

Reliability of fat-pad sign in radial head/neck fractures of the elbow.

In a prospective study at a single centre between August 1995 and March 1996, 193 patients with elbow injuries were studied. Standard radiographs of the elbows were taken. A total of 181 X-rays were reported by one person concerning the presence or absence of fractures and fat-pad signs. The radiographs were analysed and positive predictive values were calculated for the presence of the fat-pad sign with radial head/neck fractures. The sensitivity for radial head/neck fracture is 85.4 per cent, while the specificity is only 50 per cent. The fat-pad sign must be used cautiously as an indicator of radial head/neck fractures; its absence is a more reliable indicator of the absence of a radial head/ neck fracture.

Adolescent↗