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Biomedical subjects

N M Robinson

Publications and source records attributed to N M Robinson.

At least 37 records · Page 2Linked to original sources
PubMed1992

The solubility of antibiotic and corticosteroid combinations.

The use of collagen shields soaked in various combinations of medications has been advocated to enhance drug delivery to the cornea. Recently, severe corneal toxicity associated with aggregate formation in mixtures of gentamicin and methylprednisolone prompted our study of the effect of drug concentration, pH, and temperature on the solubility of several antibiotic and corticosteroid formulations commonly used to treat ocular disease. Selected combinations of cefazolin, vancomycin, tobramycin, gentamicin, methylprednisolone, and dexamethasone were evaluated. Mixtures of tobramycin and vancomycin produced no precipitates, but many spheroid aggregates were seen when methylprednisolone and gentamicin were combined. Although the effects of precipitate formation on drug bioavailability and toxicity have not been fully determined, until such information is available, the use of combinations of drugs that remain in solution during administration is recommended.

Anti-Bacterial Agents↗
PubMed1991

Infectious crystalline keratopathy caused by Candida albicans.

Two patients developed corneal opacities resembling infectious crystalline keratopathy. Predisposing factors included a recent corneal transplant with suture replacement in one patient and postradiation keratoconjunctivitis with disposable therapeutic contact-lens wear in the other patient. Both patients were using a topically applied corticosteroid and an aminoglycoside antimicrobial. Smears of corneal scrapings showed numerous yeasts without inflammatory cells. Culturing yielded Candida albicans and Staphylococcus haemolyticus in the first case and C. albicans and S. epidermidis in the second case. Combined antifungal and antimicrobial therapy, with initial withdrawal of corticosteroid use, was effective. The microbial cause of pauci-inflammatory keratitis includes not only viridans streptococci and other bacteria but fungi as well.

Aged↗
PubMed1988

Fungal keratitis in contact lens wearers.

In a retrospective review from 1972 through 1987 of patients with microbial keratitis, fungal infection occurred in four (4%) of 90 cosmetic or aphakic contact lens wearers and in four (27%) of 15 patients using a therapeutic soft contact lens. Predisposing factors included improper lens care by the refractive lens wearers and a chronic epithelial defect with topical corticosteroid use among the therapeutic lens wearers. The responsible organisms in the refractive lens group were Fusarium solani (two patients) and Cephalosporium and Paecilomyces (one patient each), and in the therapeutic lens group Candida (three patients) and Aspergillus (one patient). Filamentous fungi were more likely to be associated with cosmetic or aphakic lens wear, whereas yeasts were more frequently found with therapeutic lens use.

Adult↗
PubMed1988

Comparison of acridine orange and Gram stains in bacterial keratitis.

We assessed the comparative sensitivities of acridine orange and Gram stains in the examination of corneal scrapings using an experimental model of Pseudomonas aeruginosa keratitis. Acridine orange was more sensitive than Gram stain, requiring concentrations of about 10(4) colony-forming units/mg of corneal tissue compared to approximately 10(5) colony-forming units/mg. Our clinical experience with 21 consecutive cases of suspected microbial keratitis showed a similar diagnostic accuracy of acridine orange and Gram stain. Acridine orange accurately predicted culture results in 15 of 21 specimens (71%) compared to a diagnostic accuracy of 62% (13 of 21 specimens) for Gram stain.

Acridine Orange↗
PubMed1986

Conjunctival cytology of adult chlamydial conjunctivitis.

We assessed the diagnostic value of ocular cytologic examination by reviewing Giemsa-stained smears of conjunctival scrapings. Of 387 patients with a clinical diagnosis of adult chlamydial conjunctivitis, intracytoplasmic inclusions were found in 30 (8%). Both polymorphonuclear leukocytes and lymphocytes were common; the predominant cell type was not useful to differentiate chlamydial from adenoviral conjunctivitis. More sensitive cytologic features included the presence of plasma cells, Leber cells, blastoid cells, and multinucleated cells. Giemsa-stained conjunctival cytologic examination can provide a useful method to support the clinical diagnosis and to direct further laboratory testing.

Adenoviridae Infections↗
PubMed1986

Rapid diagnosis of Acanthamoeba keratitis using calcofluor white.

Calcofluor white (CFW) is a chemofluorescent dye with an affinity for the polysaccharide polymers of amebic cysts. Using CFW staining with fluorescent microscopy, we demonstrated amebic cysts in corneal scrapings and keratectomy specimens from four patients with culture-proved Acanthamoeba keratitis and from one in whom CFW was the only positive laboratory test. Calcofluor white staining is simple, rapid, and highly reliable in the diagnosis of Acanthamoeba keratitis.

Adolescent↗
PubMed1986

Improved detection of oculomycoses using induced fluorescence with cellufluor.

Cellufluor, a fluorochrome with affinity for chitin and cellulose, was retrospectively compared to gram and giemsa stains for detection of human oculomycoses. From culture-proven specimens, this chemofluorescent stain detected hyphae or yeasts on 50% of smears previously considered negative. Cellufluor is a useful adjunct in the detection and confirmation of fungal elements from ocular specimens.

Evaluation Studies as Topic↗
PubMed1986

Effectiveness of the Denver Developmental Screening Test with biologically vulnerable infants.

The Denver Developmental Screening Test (DDST) was initially developed specifically to identify children with mental retardation. However, its use in screening low birth weight and other biologically at-risk infants for motor problems is widespread. In view of the absence of biologically vulnerable children in the DDST standardization sample, and the limited validational support available for its use with children under 30 months of age, the purpose of this study was to investigate the effectiveness of the DDST in screening 62 Neonatal Intensive Care Unit graduates during infancy. Categorical results (Normal, Questionable, Abnormal), obtained in the home setting by DDST, were compared with results of Neonatal Intensive Care Unit Follow-up Clinic evaluations. There was a marked underselection of the DDST's categorical results in identifying those infants with suspect or abnormal findings on the more detailed clinic evaluations. However, the effectiveness of the screeners' clinical impression ratings (based on observations made during administration of the DDST) in identifying infants with positive criterion results was encouraging. These findings suggest that, although the DDST's categorical results may be of limited value in screening biologically vulnerable infants, administration of the DDST may provide a useful framework for more systematically observing and documenting significant qualitative aspects of an infant's developmental status, particularly for the screener who is less experienced in neuromotor assessment. These observations need to be defined further, and validated.

Developmental Disabilities↗
PubMed1985

Antifungal sensitivity testing for equine keratomycosis.

We evaluated 31 fungal specimens obtained from equine corneas over a 10-year period, 1973 to 1983. More than half were received in late summer and early autumn, and the number tended to increase in frequency during the 1980s. These isolates included 13 different genera and 20 different species. The prevalent genus was Aspergillus (35%). On the basis of examinations for tube-dilution minimal inhibitory concentrations and minimal fungicidal concentrations of 16 fungal isolates, the imidazole antibiotics such as miconazole and ketoconazole consistently showed the lowest geometric mean titers for filamentous fungi. Because fungal sensitivities varied considerably among different species in vitro sensitivity testing is suggested as an aid in the determination of optimal therapy.

Animals↗
PubMed1985

Neuromotor development of graduates of the neonatal intensive care unit: patterns encountered in the first two years of life.

The neurodevelopmental course of 219 Neonatal Intensive Care Unit graduates followed prospectively over 2 years was determined on retrospective chart review. Mild neuromotor abnormalities during the first year were identified in 50%, three-quarters of which proved transient with normal development at 2 years of age. Moderate abnormalities were identified in 7%, half of which proved transient. Severe neuromotor abnormalities were identified in 20%, two-thirds of whom had cerebral palsy at 2 years. Persistent noncerebral palsy neuromotor abnormalities remained in one-third of those in the severe abnormality group, one-half of those in the moderate abnormality group, and one-quarter of those in the mild abnormality group. As birthweight decreased, the incidence of always normal development and transient neuromotor abnormalities decreased while the incidence of persistent neuromotor abnormalities increased. Small for gestational age infants demonstrated a slightly higher incidence of persistent abnormalities than their appropriate for gestational age counterparts. No significant sex differences were observed.

Birth Weight↗
PubMed1984

Predictive validity of the "Movement Assessment of Infants".

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washington's Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.

Cerebral Palsy↗
PubMed1983

Mortality in infants discharged from a neonatal intensive care unit.

In a three-year period, 3.8% (43) of 1,123 infants discharged from one neonatal intensive care unit (NICU) subsequently died, the vast majority before 1 year of age. Sudden infant death syndrome was responsible for 28% of the deaths, congenital heart disease for 25% of the deaths, chronic lung disease for 16%, and trauma, infections, and chromosomal disorders each accounted for 5% of the deaths. Postdischarge death rates in the three-year study period remained stable, while infant mortality in the NICU decreased from 26.5% to 16.3%. This study suggests that decreasing mortality among infants treated in NICUs is not necessarily reflected in improved postdischarge death rates and that the vast majority of deaths in these infants are currently not preventable.

Adult↗
PubMed1983

Social interaction and developmental competence of preterm and full-term infants during the first year of life.

37 mother-preterm and 42 mother-full-term infant pairs were assessed at 1, 4, 8, and 12 months following hospital discharge. The psychosocial functioning of the families was assessed at 1 and 8 months by interview, infants received developmental assessments at 4 and 12 months, and mother-infant interactions were observed in unstructured and semistructured situations at 4, 8, and 12 months. Significant differences were found in both mothers' and preterm infants' interactive behavior across the first year of life, extending the findings of previous research that had noted differences during early infancy. Additionally, preterms performed significantly below full-terms on measures of cognitive and language development corrected for gestational age. Results are discussed in terms of the persistence of interactive differences in mother-preterm pairs and the possible effects on their relationship and infant developmental outcome.

Affect↗
PubMed1983

Growth and development of infants weighing less than 800 grams at birth.

A prospective study of infants weighing less than 800 g at birth and cared for in a single neonatal intensive care unit between 1977 and 1980 was conducted. Neonatal mortality was 80%; neurodevelopmental outcome was assessed in 16 of the 18 survivors. Mean birth weight for these 16 was 730 g; mean gestational age was 26 weeks. Perinatal asphyxia, respiratory distress, apnea, mechanical ventilation, and chronic pulmonary disease were commonplace. Symptomatic intracranial hemorrhage, seizures, sepsis, or meningitis did not occur in survivors. Of the 16 infants, 13 (81%), including all three with birth weight less than 700 g, were without major CNS handicaps and were developing appropriately at 6 months to 3 years of age. Only one of the 16 had clearly subnormal mental development. None had a major visual or hearing impairment. Apgar scores at one and five minutes were significantly related to outcome; apnea, mechanical ventilation, and chronic pulmonary disease were not. These data suggest that a remarkably hopeful outcome is possible for the few survivors of extremely low birth weight.

Apgar Score↗
PubMed1983

Effects of stress and social support on mothers and premature and full-term infants.

This study examined the relationships of stress and social support to maternal attitudes and early mother-infant interactive behavior. 52 mother-premature infant pairs and 53 mother-full-term infant pairs were seen for structured home interviews at 1 month, and behavioral interactions at 4 months. Maternal life stress, social support, life satisfaction, and satisfaction with parenting were assessed at the 1-month home visit. Although no group differences were found, both stress and support significantly predicted maternal attitudes at 1 month and interactive behavior at 4 months when data were pooled. Mothers with greater stress were less positive in their attitudes and behavior, while mothers with greater support were significantly more positive. Intimate support proved to have the most general positive effects. Additionally, social support moderated the adverse effects of stress on mother's life satisfaction and on several behavioral variables. Maternal social support was further found to have several significant effects on infant interactive behavior. Results are discussed in terms of the ecological significance of social support to parenting and infants' early development.

Adolescent↗
PubMed1982

Hyaline membrane disease, birth weight, and gestational age. Effects on development in the first two years.

Mean mental and motor developmental test scores (Bayley scales) at 4, 12, and 24 months of age were determined for 161 graduates of a neonatal intensive care unit during the period 1977 through 1979. Analysis of variance for our data showed significant effects of hyaline membrane disease (HMD) on mental and motor development at 4 months, but disappearance of these effects at 12 and 24 months of age. Conversely, birth weight was not significantly related to developmental performance at 4 months, but was strongly related to both mental and motor performance at 12 and 24 months of age. Gestational age was significantly related to mental performance at 24 months of age. No relationship was found between HMD and major CNS handicapping conditions; both birth weight and gestational age were highly related to the occurrence of neurologic handicaps. Of the three variables assessed, birth weight was the best predictor of neurodevelopmental outcome.

Birth Weight↗