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Biomedical subjects

P A Cooper

Publications and source records attributed to P A Cooper.

At least 19 recordsLinked to original sources
PubMed1998

Angiogenesis in the hollow fiber tumor model influences drug delivery to tumor cells: implications for anticancer drug screening programs.

The National Cancer Institute uses the hollow fiber assay as part of its screening program for anticancer drug discovery. Angiogenesis to hollow fibers implanted s.c. has not been reported, thereby raising concerns about the efficiency of drug delivery and its subsequent effects on chemosensitivity. By extending postimplantation times beyond the 6-day period presently used, extensive vascular networks develop, resulting in both increased delivery and chemosensitivity to doxorubicin. This study suggests that present protocols used to evaluate compounds may produce false negative results, and additional studies to determine the predictive value of the assay are required.

Adenocarcinoma↗
PubMed1998

Monitoring utilisation, quality & effectiveness of free antenatal care in an informal settlement in Gauteng.

The aim of this study was to monitor utilisation, quality and effectiveness of free antenatal care from a review of clinic records. Starting randomly, 197 clinic records from four clinics were reviewed. Antenatal care was initiated at the end of the second trimester or in the third trimester, in an inadequate quantity (64% had made less than three visits). Teenagers were significantly more likely to attend only once than the older age groups (Chi-square = 12.5, df = 6, p = 0.05). Standard tasks such as age, weight, blood pressure, foetal heart monitoring, estimated gestational age and urine test results were recorded correctly. However, the effectiveness of care was difficult to assess due to incomplete records and the lack of blood test results. It was concluded that the provision of a free antenatal care service does not automatically increase utilisation; timing and quantity of care obtained were inadequate; and improvements in record keeping are essential for assessing the quality and effectiveness of care.

Adolescent↗
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↗
PubMed1997

Outcome of very low birth weight infants at 12 to 18 months of age in Soweto, South Africa.

OBJECTIVE: To describe the long-term outcome of very low birth weight infants growing up in poor socioeconomic conditions in Soweto, South Africa. METHODS: A stratified sample of infants weighing < 1500 g surviving to hospital discharge was enrolled. Group 1 consisted of 49 infants 1000 to 1499 g who required mechanical ventilation; group 2 consisted of 39 infants 1000 to 1499 g who did not require mechanical ventilation; and group 3 consisted of 25 infants < 1000 g (such infants are not routinely ventilated). Growth and neurological status were recorded at follow-up visits at 3, 6, and 12 months' corrected age and the infants were evaluated further using the Bayley scales of infant development between 12 and 18 months. RESULTS: Fifteen infants died during the period between hospital discharge and 1 year corrected age, and 12 others were lost to follow-up. Although some catch-up growth was noted in the early months, all group means for weight and length were below the 25th percentile at 1 year. Cerebral palsy was diagnosed in nine infants (8 from group 1). Periventricular leukomalacia and/or porencephaly was diagnosed in eight of the nine infants during their initial hospital stay and was also the strongest negative predictor of the Bayley scores. Higher maternal education and better intrauterine growth were associated with higher Bayley scores. CONCLUSIONS: Mortality after hospital discharge in this study cohort was extremely high. However, despite marked differences in socioeconomic conditions and tertiary care facilities, the handicap rates were comparable with recent studies from developed countries, and some of the predictors of handicap, eg, periventricular leukomalacia and porencephaly, were also similar.

Cerebral Palsy↗
PubMed1997

Effects of suboptimal intra-uterine growth on preterm infants between 30 and 32 weeks' gestation.

OBJECTIVE: To investigate the affects of suboptimal intra-uterine growth on the outcome of low-birth-weight (LBW) infants. DESIGN: Prospective observational study. SETTING: Neonatal unit of a tertiary care hospital. PATIENTS: A total of 104 LBW infants with a gestation of 30-32 weeks were selected from a larger cohort that had previously been studied to ascertain the prevalence of respiratory distress syndrome (RDS) and periventricular-intraventricular haemorrhage (PV-IVH). OUTCOME MEASURES: Multivariate analysis was used to examine the association between RDS, PV-IVH and death, and the adequacy of intra-uterine growth. RESULTS: Infants with a higher birth weight ratio or birth weight > or = 25th percentile had an increased risk of developing RDS, particularly where ventilatory support was required. However, PV-IVH was associated with immediate perinatal events and not with intra-uterine growth. Mortality was not affected by intra-uterine growth, since those < 25th percentile. In spite of being at lower risk for RDS, showed a trend towards more infection-related deaths. CONCLUSIONS: The 'intra-uterine stress' experienced by infants with suboptimal intra-uterine growth appears to protect partially against RDS, but confers no overall advantage in terms of survival.

Birth Weight↗
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↗
PubMed1996

Factors associated with poor prognosis in very-low-birth-weight infants.

OBJECTIVE: To evaluate predictors of poor outcome, including the CRIB (Clinical Risk Index for Babies) score, in a local population of very-low-birth-weight (VLBW) infants, in order to provide guidelines for selection of these babies for expensive tertiary care. SUBJECTS: Two hundred and thirty-one neonates born at less than 31 weeks' gestation and/or weighing between 1001 g and 1500 g, enrolled prospectively as part of a multicentre study evaluating the CRIB score. DESIGN: Univariate analysis (chi-square/t-tests) and multivariate analysis (stepwise logistic regression) on the above sample to determine predictors of poor outcome. SETTING: Neonatal Unit, Johannesburg Hospital. OUTCOME MEASURES: Death or impairment (namely oxygen therapy > 28 days, grade 3 or 4 intraventricular haemorrhage, or ventricular enlargement). RESULTS: Poor outcome was predicted by birth weight, lowest oxygen requirement in the first 12 hours (which are two components of the CRIB score), and maximum partial arterial carbon dioxide pressure (PaCO2) in the first 72 hours. Other factors, including the full CRIB score, were not predictive of outcome. CONCLUSIONS: One method of selection of infants for expensive tertiary care is on the basis of predicted outcome. Birth weight remains a reasonable basis for this selection, but the inclusion of other factors, such as oxygen requirement, would improve accuracy. The CRIB score was not a suitable means to select infants in the local context, but may be of value in international comparisons.

Apgar Score↗
PubMed1994

SHINE: Strategic Health Informatics Networks for Europe.

The mission of SHINE is to construct an open systems framework for the development of regional community healthcare telematic services that support and add to the strategic business objectives of European healthcare providers and purchasers. This framework will contain a Methodology, that identifies healthcare business processes and develops a supporting IT strategy, and the Open Health Environment. This consists of an architecture and information standards that are 'open' and will be available to any organisation wishing to construct SHINE conform regional healthcare telematic services. Results are: generic models, e.g., regional healthcare business networks, IT strategies; demonstrable, e.g., pilot demonstrators, application and service prototypes; reports, e.g., SHINE Methodology, pilot specifications & evaluations; proposals, e.g., service/interface specifications, standards conformance.

Community Health Planning↗
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↗
PubMed1994

Periventricular-intraventricular haemorrhage in low-birth-weight infants at Baragwanath Hospital.

The prevalence of periventricular-intraventricular haemorrhage (PV-IVH) among very-low-birth-weight infants at Baragwanath Hospital has not been well documented. In this prospective study, a total of 282 live-born infants with birth weights of 1,000-1,749 g were studied over a 4 1/2-month period. Every infant had at least one cranial ultrasound examination at 7-10 days of age, while one-third of non-ventilated and all ventilated infants had ultrasound examinations on days 3, 7 and 14. Where possible, all infants had a follow-up ultrasound scan at 40 weeks' post-conceptional age. The overall prevalence of PV-IVH was 53% for infants weighing less than 1,500 g at birth and 52% for infants born at less than 35 weeks' gestation, but only 12% had either grade III or grade IV haemorrhages. The prevalence and severity of PV-IVH increased with both decreasing birth weight and decreasing gestational age and was also predicted by the need for active resuscitation at birth, mechanical ventilation and the development of pneumothorax. A total of 93% of infants without PV-IVH survived, but survival decreased with increasing grade of PV-IVH. Germinal matrix cysts were noted on follow-up in 55% of surviving infants with grade I PV-IVH. Very-low-birth-weight infants at Baragwanath Hospital therefore seem to have a higher prevalence of PV-IVH when compared with reported figures, but this is due mainly to an increase in smaller haemorrhages.

Cerebral Hemorrhage↗
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↗