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Biomedical subjects

S Wainer

Publications and source records attributed to S Wainer.

11 recordsLinked to original sources
PubMed1997

Prospective study of fluconazole therapy in systemic neonatal fungal infection.

BACKGROUND: Standard neonatal systemic antifungal therapy with amphotericin B and flucytosine can be associated with toxicity, drug resistance and the need for prolonged venous access. There is consequently a need for alternative treatment options. OBJECTIVES: To assess the efficacy and safety of fluconazole in the treatment of systemic neonatal fungal infections. METHOD: Open, nonrandomized evaluation of fluconazole treatment in 20 consecutively enrolled neonates with systemic fungal infection. RESULTS: Clinical and microbiologic cure was achieved in 12 of 19 (63%) of infants treated. One additional infant received prior amphotericin B therapy and is included for assessment of side effects. One infant with Torulopsis glabrata infection failed treatment. Six infants died of Gram-negative bacterial infection and other intercurrent medical problems. CONCLUSION: Fluconazole appeared to be safe and effective for treatment of systemic candidal infection in the neonate although more data are required in very low birth weight infants.

Antifungal Agents↗
PubMed1996

Fluconazole vs. amphotericin B for the treatment of neonatal fungal septicemia: a prospective randomized trial.

OBJECTIVE: Fungal septicemia is a devastating disease in the neonate, especially in the low birth weight preterm infant who is especially vulnerable to disseminated fungal sepsis. The objective of this study was to compare the efficacy, safety and overall convenience of fluconazole vs. amphotericin B for the treatment of disseminated fungal sepsis in neonates. DESIGN: A prospective, randomized, collaborative study conducted at two South African neonatal units. SUBJECTS: Twenty-four infants with proven fungal septicemia were treated from June, 1992, to June, 1993. Twelve received fluconazole, 11 received amphotericin B and 1 was excluded. Assessment of hepatic, renal and hematologic functions were performed before, during and after treatment. The two groups were comparable at the time of enrollment into the study. RESULTS: Infants receiving amphotericin B had significantly higher values of total and direct bilirubin and alkaline phosphatase values at the end of treatment, while the fluconazole group showed a significant increase in the platelet count. The cumulative total numbers of days receiving intravenous therapy for the administration of antifungal drugs were 57 for the fluconazole group and 162 for the amphotericin group; no central lines were needed in the fluconazole group, whereas 3 babies given amphotericin B had central catheters for a cumulative total of 27 days. The case fatality rate was 33% in the fluconazole group and 45% in the amphotericin B group; there was still proof of fungal septicemia at the time of death in 1 patient given amphotericin B and 2 given fluconazole. CONCLUSION: Fluconazole showed fewer side effects than amphotericin B and was more convenient to use.

Administration, Oral↗
PubMed1994

Prevalence of hyaline membrane disease in black and white low-birth-weight infants.

Previous studies in South Africa and elsewhere have suggested that there are ethnic differences in the prevalence of hyaline membrane disease (HMD). This study compared the prevalence of HMD between black and white infants with birth weights of 1,000-1,749 g. A cohort of black and one of white low-birth-weight infants were enrolled at Baragwanath and Johannesburg Hospitals respectively. Black infants were found to have a higher rate of intra-uterine growth retardation. When compared according to either birth weight or gestational age categories, black infants had a significantly lower prevalence of HMD. For example, between 29 and 34 weeks' gestation 36.2% of black and 62.5% of white infants developed HMD (P < 0.001). The reasons for these differences are not clear, however, and require further study.

Black People↗
PubMed1993

Drip 'flagging'.

Explore the source record for details and available documents.

Cross Infection↗
PubMed1993

Attitudes of mothers, doctors, and nurses toward neonatal intensive care in a developing society.

BACKGROUND: The ethical allocation of scarce resources is a major challenge for physicians working in the developing world. Guidelines currently employed by health care workers in the developed world may be considered impractical or inappropriate in the "Third World." OBJECTIVE: To gain insight into the attitudes of doctors, nurses, and mothers of recent neonatal intensive care unit (NICU) survivors toward the utilization and withdrawal of life support in the context of a developing society. DESIGN: Descriptive cohort study. PARTICIPANTS: Thirty-three doctors, 20 nurses, and 70 mothers of recent NICU survivors. The cohort of mothers surveyed were predominantly unmarried, poorly educated, and either unemployed or still at school. RESULTS: In response to hypothetical scenarios, mothers exhibited very conservative attitudes toward withdrawal of life support compared to caregivers. Only 2.9% (2/70) of mothers would contemplate any degree of life support withdrawal for infants with probable "moderate" handicap compared with 51.0% (26/51) of the medical staff. One mother (1.4%, 1/70) accepted the concept of withdrawal of life support where extremely poor outcome was anticipated, compared with 85% (45/53) of the caregivers. Doctors and nurses exhibited very utilitarian attitudes toward NICU resource allocation, with emphasis directed toward avoidance of significant handicap. The majority of these caregivers considered the anticipated burden of the handicapped child in the society to be a major factor in the justification of their decision. CONCLUSION: The nonideal conditions under which doctors and nurses work in developing nations mandate resource allocation to be an integral component of NICU care.

Attitude of Health Personnel↗
PubMed1992

Prophylactic miconazole oral gel for the prevention of neonatal fungal rectal colonization and systemic infection.

Prior rectal colonization with fungi may be an important risk factor for development of systemic fungal infection in the neonate. This placebo-controlled study evaluated the benefits of miconazole oral gel in the prevention of fungal rectal colonization and systemic infection in high risk neonates admitted to the Neonatal Intensive Care Unit. Repeated oral application of miconazole gel reduced the overall prevalence of postnatally acquired rectal colonization; a yeast was grown in 19.5% of the weekly rectal swabs in the miconazole-treated group compared with 36.2% in the control group (69 of 354 vs. 146 of 403, P < 0.0001). There was no reduction in the incidence of systemic fungal infection in the two groups although the overall incidence of the infection was low in both groups, at 2.0% vs. 2.6% (6 of 298 vs. 8 of 302, P not significant). No relationship was shown between prior rectal colonization and subsequent systemic fungal infections in either of the two groups. This study does not support the use of prophylactic miconazole oral gel for the prevention of neonatal systemic fungal infections.

Administration, Oral↗
PubMed1991

Congenital contractural arachnodactyly in a black African kindred.

Congenital Contractural Arachnodactyly is an inherited disorder of connective tissue characterised by congenital contractures, arachnodactyly, marfanoid habitus, crumpled auricles and in some kindreds, progressive kyphoscoliosis. An extensive kindred with many affected members is described. The importance of the early recognition of this syndrome is highlighted.

Abnormalities, Multiple↗
PubMed1987

Severe hypervitaminosis A in siblings: evidence of variable tolerance to retinol intake.

A 2-year-old boy had signs and symptoms of chronic hypervitaminosis A. A course of increasing severity led to eventual death. A younger brother later had similar clinical features. Chicken liver spread containing up to 420 IU/g vitamin A was the likely source of intoxication. Markedly elevated circulating retinyl ester levels have persisted in the surviving sibling for 3 subsequent years despite severe restriction of vitamin A intake. A therapeutic trial of the carbohydrate-derived complexing agent 2-hydroxypropyl-beta-cyclodextrin was initiated. Circulating retinyl esters transiently increased during the infusion (from 407 to 4791 micrograms/dL), and urinary total vitamin A excretion, undetectable before infusion, increased to 23 micrograms/dL after infusion. The frequency of hypervitaminotic episodes has decreased somewhat in the 2 years since the infusion, probably related to dietary vitamin A restriction. The occurrence of this syndrome in two brothers, while a sister ingesting the same diet remains completely healthy, suggests an inherited variance in tolerance to vitamin A intake.

2-Hydroxypropyl-beta-cyclodextrin↗