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Biomedical subjects

M J Painter

Publications and source records attributed to M J Painter.

At least 19 recordsLinked to original sources
PubMed1994

Hepatitis B outbreak in a drug trials unit: investigation and recommendations.

In autumn 1990 three young men developed acute hepatitis B. They belonged to a group of 24 young male volunteers who had taken part in a trial in a residential unit for drug trials in July and August 1990. A further case of acute hepatitis B and a carrier of hepatitis B e antigen (HBeAg) were detected by serological testing of the volunteers. Volunteers, in two groups of twelve, had occupied the unit at different times during the trial. The four cases occurred in the group that contained the HBeAg positive carrier. The carrier had also taken part in two trials on the unit in 1989. He was HBeAg positive then, but transmission of hepatitis B virus (HBV) did not occur. Although blood samples were taken in each of the three trials, intravenous cannulas were used only in the 1990 trial. It is likely that HBV was transmitted by blood to blood contact between volunteers when blood was sampled through cannulas during the trial. This outbreak might have been prevented. If an infection control policy had been applied to avoid hazardous practices, and volunteers had been screened for HBV before entry and the carrier excluded (as recommended by the Association of Independent Clinical Research Contractors), the outbreak would not have occurred. Volunteers for drug trials in residential units should be screened for HBV, human immune deficiency virus (HIV) and hepatitis C virus (HCV), and those found to be infected should not be accepted.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1994

Neonatal phenobarbital and phenytoin binding profiles.

Phenobarbital and phenytoin binding profiles were determined in 27 neonates. Binding of both drugs decreased compared with that in older subjects. In vitro binding of both agents correlated significantly with total protein and albumin concentrations. In vivo binding at 0.5 hours correlated significantly with birthweight and gestational age. Phenobarbital, but not phenytoin, binding decreased when three other therapeutic agents were concomitantly administered. Bilirubin concentrations, free fatty-acid concentrations, and pH values encountered in this population did not significantly influence binding. An in vitro binding profile accurately predicted in vivo free fractions (percent drug unbound) and plasma concentrations of both drugs.

Birth Weight↗
PubMed1991

Neonatal seizures: diagnosis and treatment.

Neonatal seizures are a frequent problem encountered in neonatal nurseries, but their significance is controversial. Some investigators regard newborn seizures as simply epiphenomena and reflective of brain injury, whereas others note associated metabolic and physiologic aberrations suggesting that seizures per se are injurious to the central nervous system. The proper approach to the treatment of neonatal seizures depends on the etiology because treatment differs if seizures are of metabolic, toxic, or structural origin. Most studies reporting the efficacy of anticonvulsant agents neither define the seizure characteristics being treated nor use electroencephalographic documentation of seizure activity. The choice of anticonvulsants has been based on tradition rather than on the proven superiority of one agent over another. Although several anticonvulsants are available, phenobarbital remains the drug most frequently chosen as the initial agent in treatment. The important pharmacologic considerations of anticonvulsants include route of administration, ability to achieve therapeutically efficacious and predictable plasma levels rapidly, drug distribution, the availability and affinity of receptor sites, protein-binding characteristics, effects on brain growth, and cardiovascular toxicities. At the present time, critical questions remain regarding the effects of both seizures and anticonvulsants on the developing central nervous system.

Electroencephalography↗
PubMed1991

Destructive brain lesions of presumed fetal onset: antepartum causes of cerebral palsy.

Antepartum events have been associated with fetal brain injury and may contribute to later neurological sequelae. However, children with these injuries may be asymptomatic or exhibit few clinical signs during the neonatal period. Six neonates are presented with destructive brain lesions of fetal onset based on radiological and neurophysiological studies at birth. No intrapartum difficulties were noted in any of the cases. Two maternal histories were significant for either placental bleeding or toxemia during the second or third trimesters of pregnancy. Fetal porencephaly from presumed intraventricular hemorrhage was documented by serial abdominal sonography for these two children. No causes could be assigned for the remaining four patients with destructive brain lesions. All six children had normal results on neurological examinations at birth, although four neonates later presented with isolated seizures at 8 to 30 hours of life which resolved after administration of anti-epileptic medication. In all cases initial neonatal electroencephalographic records showed abnormalities consisting of major background asymmetries or seizures. Initial documentation of cerebral lesions was made by fetal sonography (two patients) and computed tomography scan (four patients) during the initial 30 hours of life, timing the lesions to the antepartum period. Cerebral palsy has been documented in all children; one child had resolution of her deficits by 6 months of age. Better surveillance of events during the antepartum period may help identify specific pathophysiological conditions that contribute to cerebral palsy. Neurophysiological and imaging studies should be used during the immediate new-born period for neonates believed to have cerebral lesions based on maternal sonography or isolated seizures.

Brain Diseases↗
PubMed1989

Secondary cases of meningococcal infection among close family and household contacts in England and Wales, 1984-7.

To determine the incidence of secondary meningococcal infection in close family and household contacts of index patients and to review the efficacy of chemoprophylaxis the records of 3256 cases occurring from 1984 through 1987 were examined. Seventeen secondary cases (0.5%) of infection were identified among these groups. The median interval between index and secondary cases was seven weeks. Fourteen secondary cases occurred more than one week after the disease was diagnosed in the index case. Three secondary cases had not received chemoprophylaxis and in another case the infecting strain had acquired resistance to rifampicin. Prophylaxis for the close contacts of 10 out of 11 of the remaining index patients failed to fulfil all the criteria of an optimal regimen. Even after optimal chemoprophylaxis the medical practitioner and the family should be aware of the increased and prolonged risk of secondary meningococcal infection among close contacts of patients with the disease.

Adult↗
PubMed1989

Controversies concerning neonatal seizures.

Five issues are discussed with respect to the diagnosis, etiology, treatment, prognosis, and pathogenesis of neonatal seizures. The presentation of a newborn with seizures represents a true emergency and frequently indicates significant neurologic dysfunction or damage to the immature nervous system. Despite the urgency to establish a diagnosis, several unique aspects of neonatal seizures impede prompt recognition. In addition, several etiologic possibilities may be associated with seizures. The efficacy of antiepileptic drugs and the prediction of outcome of patients with neonatal seizures are controversial. Experimental research in developing animals suggests both a selective vulnerability and resistance of the brains of immature animals subjected to neonatal seizures.

Asphyxia Neonatorum↗
PubMed1988

Fetal heart rate patterns during labor: neurologic and cognitive development at six to nine years of age.

The development of 50 children relative to the fetal heart rate patterns they demonstrated during labor and delivery was prospectively studied. Normal deceleration patterns were recorded for 12 of the children, while 16 were recorded as moderately severe and 22 as severe variable or late deceleration patterns. The parity and socioeconomic status of the mothers and the sexes of the infants were similar among the groups. A statistically significant developmental difference in favor of children with normal fetal heart rate patterns was seen in the first year of life. However, at 6 to 9 years of age the difference in neurologic and cognitive development was no longer evident. These data do not support the hypothesis that brief abnormal fetal heart rate patterns recorded during labor are indicative of irreversible central nervous system injury.

Achievement↗
PubMed1987

Outcome in children with enteroviral meningitis during the first year of life.

The neurologic, psychologic, language, and academic skills were evaluated and compared in children who had had enteroviral meningitis in infancy and their siblings. The study population consisted of 45 children in whom enteroviral meningitis developed between the ages of 4 days and 12 months. Three died of heart failure caused by viral myocarditis. Thirty-three survivors and 31 siblings were comprehensively evaluated with physical and neurologic examinations; hearing, vision, and achievement tests; and tests of cognitive, perceptual-motor, language, memory, and emotional-behavioral functions. The remaining nine survivors of meningitis and eight of their siblings were assessed by telephone interviews and analysis of school and medical records. None of the survivors had major adverse neurologic sequelae. In addition, they performed as well as their siblings on all tests administered. Our study did not demonstrate either overt or covert impairments of neurologic function or development in survivors of infantile enteroviral meningitis.

Child↗
PubMed1986

Neonatal seizures.

Neonatal seizures, as distinguished from nonconvulsive abnormal movements, are a significant problem in neonatal intensive care units. Clinical diagnosis without EEG confirmation is difficult. By virtue of brain metabolic and peripheral physiologic effects, seizures may damage the immature brain. The approach to neonatal seizures should be systematic and directed at establishing the primary etiology. On the basis of tradition, phenobarbital is currently the drug of first choice in the treatment of neonatal seizures. A significant number of neonates with seizures have poor outcomes, and both duration of seizure activity and numbers of anticonvulsants required in treatment predict the outcome.

Adrenoleukodystrophy↗
PubMed1986

Biotinidase deficiency: accumulation of lactate in the brain and response to physiologic doses of biotin.

Biotinidase deficiency is the most common cause of late onset, biotin-responsive multiple carboxylase deficiency (MCD). We studied the two oldest known boys with this disorder who had high CSF content of lactate that could have contributed to the clinical disorder. The symptoms of these patients implied that near physiologic, rather than pharmacologic, doses of biotin may be sufficient for treatment.

Amidohydrolases↗
PubMed1985

Cause of hearing loss in the high-risk premature infant.

Bilateral hearing loss occurred in 9.7% of infants who survived despite very low birth weight (less than or equal to 1500 gm), 16.7% of infants who survived neonatal seizures, and 28.6% of infants who survived both low birth weight and neonatal seizures. All neonates received treatment in a single neonatal intensive care unit between 1976 and 1980. Twenty-two of 36 hearing-impaired children were normal physically and mentally, with IQ scores of greater than or equal to 85. Significant neonatal predictors of hearing loss in high-risk premature infants (less than or equal to 36 weeks gestation), as determined by multivariable testing, were prolonged respirator care, high serum bilirubin concentration, and hyponatremia. Exchange transfusions were associated with a decreased risk of hearing loss.

Audiometry, Evoked Response↗
PubMed1985

The epidemiology of meningococcal infections in England and Wales, 1912-1983.

The epidemiology of meningococcal infections that arose in England and Wales during the period 1912-1983 has been reviewed. The outcome of meningococcal disease was dramatically improved when treatment with sulphonamides was introduced. With the emergence of sulphonamide-resistant strains, penicillin has become the drug of choice. Despite modern treatment, however, the mortality ratio during the last 30 years has remained about the same. Prompt diagnosis as well as immediate and effective treatment are cardinal needs. Even so, when infection is overwhelming there is little chance of saving the patient. Immunisation is probably the only effective answer but as yet there is not an effective vaccine to prevent group B infections which predominate in this country.

Age Factors↗
PubMed1985

Intracerebral hemorrhage in the full-term neonatal infant.

Supratentorial intracerebral hemorrhage was diagnosed in 18 full-term neonates, including six with primarily intraparenchymal hemorrhage and 12 with primarily intraventricular hemorrhage. Precipitating or associated factors were hypoxic-ischemic injury in five patients, polycythemia in two, and cranial birth trauma in two. Nine other infants had no identifiable medical risk events. The pathogenesis of intraparenchymal hemorrhage was probably related to hemorrhagic infarction, but the pathogenesis of intraventricular hemorrhage was often unknown. All 17 survivors returned for neurologic and developmental examinations between 1 and 7 years of age. Follow-up assessments were normal in nine children and abnormal in eight. Two had perceptual difficulties, three had moderate-to-severe cognitive deficiencies (two of the three had hemiplegia), and three had severe mental and neurologic handicaps. Eight of nine children with known or suspected hypoxic-ischemic or traumatic insults suffered moderate-to-severe disabilities whereas eight of nine children with no known precipitating cause for their hemorrhage developed normally.

Apgar Score↗
PubMed1984

A comparison of biotypes and serotypes of Campylobacter sp. isolated from patients with enteritis and from animal and environmental sources.

The origin of sporadic campylobacter infections has been investigated by means of a collaborative study. From a total of 1152 cases reported in North West England in 1982, Campylobacter strains isolated during one month in each quarter of the year were biotyped and serotyped. For comparison, 875 strains of Campylobacter isolated from environmental and animal sources were similarly examined. Most strains from human beings were Campylobacter jejuni; about half of them were of three serotypes. Those serotypes commonly found in human infections were frequent among strains isolated from environmental and animal sources.

Adolescent↗