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Biomedical subjects

F D Johnstone

Publications and source records attributed to F D Johnstone.

At least 19 recordsLinked to original sources
PubMed1992

Survival time after AIDS in pregnancy.

OBJECTIVE: To examine the suggestion, based on theoretical considerations and case reports, that pregnancy decreases survival time after AIDS (acquired immunodeficiency syndrome). DESIGN: A total population study in Edinburgh. SETTING: A city with a moderately high prevalence of human immunodeficiency virus (HIV) infection in women. SUBJECTS: AIDS has been diagnosed in 22 women, five of whom had a pregnancy. MAIN OUTCOME MEASURES: Clinical characteristics, disease presentation, lymphocyte markers, pregnancy outcome, subsequent progress and survival time. RESULTS: Pregnancy was not obviously associated with a difference in clinical findings. The mean survival time for the three women with a pregnancy who died was 24 months and for the 11 women without a pregnancy it was 15 months. (P = 0.63 log rank test). CONCLUSIONS: The clinical presentation, severity of the illness and laboratory findings were not obviously different in pregnancy. All three women who had Pneumocystis carinii pneumonia for the first time in pregnancy survived this initial episode. Survival time was not obviously reduced by the conjunction of pregnancy with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Doppler umbilical artery flow velocity waveforms in diabetic pregnancy.

OBJECTIVE: To assess the effect of uncomplicated diabetes on umbilical artery flow velocity waveforms (FVWs); to investigate the relation between glycaemic control and FVWs and the predictive value of umbilical artery FVWs for antenatal fetal compromise. DESIGN: Prospective descriptive study. SETTING: A large diabetic pregnancy clinic in a teaching hospital. SUBJECTS: 128 pregnancies complicated by diabetes mellitus. 170 non diabetic women with no pre-existing or pregnancy complications. INTERVENTIONS: In diabetic pregnancies, umbilical artery resistance index (RI) Doppler recordings and glycosylated haemoglobin were measured every 2 weeks from 28 weeks. MAIN OUTCOME MEASURES: Umbilical artery RI and antenatal fetal compromise defined as a non reactive, decelerative cardiotocograph and/or a biophysical profile score persistently less than 6 and leading to immediate caesarean section. RESULTS: Uncomplicated diabetic pregnancies had FVW values similar to those in the non-diabetic range. Glycaemic control was unrelated to umbilical artery FVW values. Abnormal umbilical artery RI was found in nine pregnancies, these were more likely to show evidence of fetal compromise and to be associated with birthweights of less than 50th centile. In seven pregnancies there was evidence of fetal compromise, but only three of these pregnancies had abnormal FVW values. CONCLUSIONS: The non-diabetic range of umbilical artery RI values is appropriate for diabetic pregnancies. Long-term glycaemic control, within the range in this study, does not seem to affect umbilical artery RI. Abnormal umbilical artery RI is a significant predictor of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal RI values. Undue reliance should not be placed on normal FVW values in diabetic pregnancies.

Apgar Score↗
PubMed1992

Anticardiolipin antibodies and pregnancy outcome in women with human immunodeficiency virus infection.

Abnormal anticardiolipin antibodies are associated with adverse pregnancy outcome in the general obstetric population. We studied 55 pregnancies in women infected with human immunodeficiency virus type 1 (HIV-1) to examine two hypotheses: that a substantial proportion of these women would have raised anticardiolipin antibodies, and that the affected pregnancies would be more likely to be complicated by preterm delivery and intrauterine growth retardation. Blood was taken at the initial antenatal visit, and was also taken from 15 HIV-seronegative intravenous (IV) drug users and 20 controls with no drug history. The reference for immunoglobulin G class antibodies to cardiolipin was calculated from 50 healthy young adults, and the upper limit of normal was defined as 4 standard deviations above the mean for this reference series. Twenty-four percent of the infected women, but none of the HIV-seronegative IV drug users and none of the control group, had raised anticardiolipin antibodies. There was no statistically significant relationship with birth weight, standardized birth weight, length, gestation, occipitofrontal circumference, or adverse pregnancy outcome. No women gave a history of thromboembolism or recurrent abortion, and in no pregnancy was there clinically apparent thromboembolism. We conclude that abnormal anticardiolipin antibodies provoked by HIV infection are common, but probably have a narrow specificity for cardiolipin, are unrelated to phospholipid antibody syndrome, and cannot explain adverse pregnancy outcome in HIV-infected women.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Can prepregnancy care of diabetic women reduce the risk of abnormal babies?

OBJECTIVE: To see whether a prepregnancy clinic for diabetic women can achieve tight glycaemic control in early pregnancy and so reduce the high incidence of major congenital malformation that occurs in the infants of these women. DESIGN: An analysis of diabetic control in early pregnancy including a record of severe hypoglycaemic episodes in relation to the occurrence of major congenital malformation among the infants. SETTING: A diabetic clinic and a combined diabetic and antenatal clinic of a teaching hospital. PATIENTS: 143 Insulin dependent women attending a prepregnancy clinic and 96 insulin dependent women managed over the same period who had not received specific prepregnancy care. MAIN OUTCOME MEASURE: The incidence of major congenital malformation. RESULTS: Compared with the women who were not given specific prepregnancy care the group who attended the prepregnancy clinic had a lower haemoglobin AI concentration in the first trimester (8.4% v 10.5%), a higher incidence of hypoglycaemia in early pregnancy (38/143 women v 8/96), and fewer infants with congenital abnormalities (2/143 v 10/96; relative risk among women not given specific prepregnancy care 7.4 (95% confidence interval 1.7 to 33.2]. CONCLUSION: Tight control of the maternal blood glucose concentration in the early weeks of pregnancy can be achieved by the prepregnancy clinic approach and is associated with a highly significant reduction in the risk of serious congenital abnormalities in the offspring. Hypoglycaemic episodes do not seem to lead to fetal malformation even when they occur during the period of organogenesis.

Ambulatory Care Facilities↗
PubMed1990

The effect of established and gestational diabetes on pregnancy outcome.

OBJECTIVE: To study the prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size. DESIGN: A prospective case-control study with data collected by patient interview and examination of all available records during a 16-months period between 1984 and 1986. SETTING: A large maternity hospital in Kuwait where diabetes in pregnancy is common. SUBJECTS: The cases were a consecutive sample of 731 women, delivered during the study period, recorded in the labour ward register as being diabetic or having abnormal glucose tolerance, the control group was formed from the next woman in the register (provided she was not known to be diabetic). MAIN OUTCOME MEASURES: Type of diabetes followed the WHO classification, with subdivision depending on level of fasting plasma glucose. Type of perinatal death was examined in detail and birthweight centile calculated. RESULTS: Of the 731 cases, 22% were established diabetics, most were treated with oral hypoglycaemic drugs before pregnancy and insulin during pregnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Established diabetics had a perinatal mortality rate nearly four times greater than non diabetics (RR, 3.7, 95% CI 2.6 to 6.4) and for gestational diabetics RR was 2.0 95% CI 1.2 to 3.7). Unexplained deaths were particularly common, both in established diabetics (RR, 18.4, 95% CI 3.9 to 85.7) and in gestational diabetics (RR, 13.4, 95% (CI 2.9 to 61.6). Cases with impaired glucose tolerance had no stillbirths and had a lower perinatal loss than the controls, though this was not statistically significant. Heavier babies were seen in all case groups compared with controls, though the impaired glucose tolerance group had lower birthweights than the other two case groups. CONCLUSIONS: Type 2 diabetes was found to be common, most cases being diagnosed in pregnancy. Under the conditions found in Kuwait, diabetes, in the sense of a raised fasting glucose, is accompanied by a high rate of perinatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fetal macrosomia was also common in both situations. Impaired glucose tolerance, where fasting levels remain normal, does not appear to increase fetal loss, but may be associated with fetal macrosomia. As these women age they are likely to develop overt diabetes in the non-pregnant state, and subsequently to develop serious complications of this disease. Improving glycaemic control, both during preg

Adult↗
PubMed1989

Heartrate variation of umbilical artery Doppler waveforms.

Umbilical artery Doppler waveforms from 20 patients were used to investigate the dependence of resistance index and pulsatility index on beat to beat pulse length over short time periods for individual patients, and on the usefulness of a common normalisation formula. For individual patients the resistance index and pulsatility index were only partially correlated with pulse length. Changes in both indices occurred independently of pulse length. Use of a common normalisation formula resulted in no significant reduction of the coefficient of variation of the resistance index (p greater than 0.1), and a reduction in the coefficient of variation of the pulsatility index of 10% (p greater than 0.001). It is concluded that short term changes in resistance index and pulsatility index cannot be corrected by a common normalisation formula.

Female↗
PubMed1989

The choice of index for umbilical artery Doppler waveforms.

Umbilical artery Doppler waveforms acquired from 211 patients were used to investigate the power of different waveform indices in predicting antenatal fetal compromise. Waveform indices were calculated using a BBC microcomputer. The specificity at 100% sensitivity for detection of antenatal fetal compromise was not significantly different for resistance index, pulsatility index, normalised resistance index and normalised pulsatility index, and was approximately 80%. For the indices of resistance time and downslope the specificity was significantly lower. This similarity in the power of a number of indices in the detection of antenatal fetal compromise suggests that standardisation to one of the simpler indices such as resistance index or pulsatility index could be adopted.

Female↗
PubMed1989

A comparison of fetal abdominal circumference measurements and Doppler ultrasound in the prediction of small-for-dates babies and fetal compromise.

A total of 145 pregnancies clinically suspected of being small-for-dates was studied at presentation with a single measurement of the fetal abdominal circumference and Doppler studies of the umbilical and arcuate arteries. The abdominal circumference measurement gave the best prediction of the small-for-gestational-age (SGA) baby (sensitivity 73%, umbilical artery sensitivity 47%, arcuate artery sensitivity 29%). The umbilical artery measurement gave the best prediction of antenatal fetal compromise; the performance of the tests was compared for a fixed sensitivity of 100% (i.e. all cases of antenatal compromise would be detected), the specificity of the umbilical artery measurement was 77%, abdominal circumference measurement 12% and arcuate artery measurement 2%. In our data, umbilical artery studies were not a sensitive predictor of the SGA baby but they did give an accurate prediction of the potentially compromised SGA fetus.

Abdomen↗
PubMed1989

Neutrophil activation in pregnancy-induced hypertension.

Human neutrophil elastase may be a major mediator of vascular damage and could contribute to the vascular damage seen in women with pregnancy-induced hypertension (PIH). Elevated plasma levels of this substance will reflect neutrophil activation in vivo. To determine neutrophil activation in PIH, we studied 30 normal non-pregnant women, 32 women with normal pregnancies, 19 with mild/moderate PIH and 16 with severe PIH between 28 and 39 weeks gestation. Plasma neutrophil elastase was measured by radioimmunoassay. There was a significantly higher concentration of plasma neutrophil elastase in both mild/moderate and severe PIH than in normotensive pregnancies and this may contribute to the vascular lesion associated with PIH. Concentrations were also significantly higher in normal pregnancy than in non-pregnant women which suggests that neutrophil activation and degranulation are increased in normal pregnancy.

Adult↗