1,721,277 research outputs found
Does current reporting of lung function by the UK Cystic Fibrosis Registry allow a fair comparison of adult centres?
No full textBackground:Outcome data for UK cystic fibrosis centres are publicly available in an annual report, which ranks centres by median FEV1% predicted. We wished to assess whether there are differences in lung function outcomes between adult centres that might imply differing standards of care.Methods:UK Registry data from 4761 subjects at 34 anonymised adult centres were used to calculate mean FEV1% and rate of change of lung function for 2007–13. These measures were used to rank centres and compare outcomes.Results:There are minor differences between centres for mean FEV1% for some years of the study and for rate of change of lung function over the study period. However, rankings are critically dependent on the outcome measure chosen and centre variation becomes negligible once patient population characteristics are taken into account.Conclusions:We have demonstrated that the ranking of centres is biased and any apparent difference in respiratory outcomes is unlikely to be related to differing standards of care between centres
Fetal growth in women with homozygous sickle cell disease: an observational study
No full textOBJECTIVES: To assess fetal growth and whether lower birthweight to mothers with homozygous sickle cell (SS) disease is related to maternal body composition or to clinical events in pregnancy.STUDY DESIGN: A prospective study of 41 pregnant women with SS disease and 41 women with a normal (AA) phenotype attending the antenatal clinic, University Hospital of the West Indies, Kingston, Jamaica. Maternal anthropometry, body composition and fetal sonographic measurements were assessed at 15, 25, and 35 weeks' gestation from December 2005 to April 2008. Birth measurements were performed within 24h of delivery. Differences between maternal genotypes and between their offspring were assessed using 2-sample t-tests. Multiple linear regression was used to control for baby's gender and gestational age at delivery. Fetal growth was compared in SS mothers with and without admission for sickle-related complications including bone pain crisis, acute chest syndrome, pregnancy-induced hypertension and urinary tract infection.RESULTS: Mothers with SS disease had lower weight, body fat, fat mass and lean body mass throughout pregnancy but correlation with birth size did not reach statistical significance. Sonographically, babies of SS mothers had smaller abdominal circumference, femoral length and a lower estimated fetal weight at 35 weeks. Birth measurements confirm lower birthweight, crown-heel length and head circumference but the differences were no longer significant after adjustment for baby gender and gestational age at delivery. Bone pain crisis in pregnancy was associated with a significantly reduced crown-heel length at birth.CONCLUSION: Lower birthweight in babies of mothers with SS disease is largely the result of the lower gestational age. Fetal sonography showed no growth differences by maternal genotype until 35 weeks' gestation and a reduced crown-heel length in offspring of SS mothers was associated with bone pain crises in pregnancy
Long-term outcomes of Fine Needle Diathermy for established corneal neovascularisation
No full textBACKGROUND/AIMS:Corneal neovascularisation (CoNV) can lead to significant ocular comorbidity with reduction in vision and cosmesis. A number of techniques have been described to reduce CoNV, but these can be expensive. Our study aimed to determine the safety, efficacy and long-term outcomes of fine needle diathermy (FND) for CoNV.METHODS:A 5-year retrospective study identified all cases of FND. Indications, intraoperative complications, and postoperative visual acuity, after treatment and retreatments, were documented, along with the procedure time. Evidence of regression and number of retreatments were identified.RESULTS:56 eyes from 52 patients underwent FND for CoNV. The main indications included herpes simplex keratitis (HSK) (53%, n=25) and microbial keratitis/peripheral ulcerative keratitis (13%, n=6). Pretreatment acuity was significantly correlated with extent of CoNV (p=0.044). One complication was noted during the procedure-an intrastromal and subconjunctival haemorrhage (rate 2%). 68.1% of patients demonstrated regression at first follow-up (mean 6.9 weeks), and 89.3% (n=42) showed regression with two or less treatments. Mean post-FND acuity was 0.72 (range -0.2-3.0) vs 0.82 (-0.2-3.0) preprocedure (p=0.08). VA improved in the HSK subgroup (p=0.012). Mean follow-up was 18.9 months (range 1-56 months).CONCLUSIONS:In the largest case series reported, FND appears to be a safe and effective technique in the long term to induce regression of CoNV, with significant improvement in the VA of patients with HSK
Maternal micronutrient supplementation study group. Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation
No full textMultiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation
No full textCompared with iron-folic acid supplementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BM
Growth and living conditions in childhood and hypertension in adult life: a longitudinal study
No full textObjectives : To examine the interplay between childhood growth and living conditions in the development of hypertension.Design : A longitudinal study of people whose growth between birth and 12 years, and social circumstances during childhood and adult life, were recorded.Setting : Helsinki, Finland.Participants : Eight thousand seven hundred and sixty men and women born in Helsinki University Central Hospital during 1934-44, who attended child welfare clinics in the city and were still resident in Finland in 1971.Main outcome measures : Incidence of hypertension defined by prescription of medication.Results : The 1404 children who later developed hypertension grew differently to other children. Low birthweight and shortness or thinness at birth were followed by rapid compensatory growth in weight and height, and an above-average body mass index (BMI, kg/m2) from the age of 8 years onwards. Some 25% of children with low birthweight but high BMI at 12 years subsequently developed hypertension, compared to 9% of those with high birthweight but low BMI. Growth had large effects on the risk of later hypertension in children living in poor social conditions, but only small effects in children in good living conditions. Living conditions in adult life did not affect the risk of hypertension.Conclusions : Hypertension originates in slow fetal growth followed by rapid compensatory growth in childhood. This path of growth has a greater effect on the risk of disease among children who live in poor social conditions. Living conditions in adult life do not seem to be important.<br/
A case-control study of the locus coeruleus degeneration in Alzheimer’s disease
No full textThe locus coeruleus (LC) is the major source of noradrenaline, which plays a key role in cognition. We aimed to detect the extent of the LC signal attenuation in Alzheimer's disease (AD) patients using a neuromelanin (NM)-sensitive MRI and how it may correlate with inflammatory and autonomic measures. An individually matched case-control study design was employed. 24 patients with AD and 24 age and gender matched controls with no cognitive impairment were recruited. The primary outcome measure was the LC signal intensity indicated by the LC contrast ratio (CR) and measured by the NM-sensitive MRI. Secondary outcome measures included neuropsychometric tests of cognitive state, peripheral inflammatory and autonomic measures. Conditional logistic regression analysis revealed a significant 22% LC-CR reduction in the AD group compared with the control group. However, there was no statistical significance from inflammatory or autonomic measures. This is the largest individually-matched case-control study to visualise the LC degeneration in AD patients. The study revealed significant LC degeneration which holds promise to stratify patients who may benefit from treatment targeting noradrenergic dysfunction.</p
The role of the intrauterine environment in the later development of type 2 diabetes and the metabolic syndrome
No full textLinks between indices of poor fetal growth and either adult type 2 diabetes, the metabolic syndrome, or both are reproducible in many studies and many ethnic groups. It has been proposed that genetic factors, environmental factors, or a mixture of both underlie these links. Studies of monozygotic twins have shown that environmental factors operate independently of the genome. Attention has been focused recently on links with childhood growth, particularly rapid catch-up growth before puberty. Animal models have shown that poor maternal nutrition can lead to glucose intolerance and hypertension in offspring. The molecular mechanisms mediating these links are unclear. The hypothalamic-pituitary-adrenal axis may be involved as may the sympathetic nervous system. It is difficult to calculate what proportions of type 2 diabetes and metabolic syndrome may be caused by early environmental factors. Conversely, it is possible to obtain a low figure
Growth and chronic disease: findings in the Helsinki Birth Cohort
No full textThere is now clear evidence that the pace and pathway of early growth is a major risk factor for the development of a group of chronic diseases that include coronary heart disease, stroke, type 2 diabetes and hypertension. This has led to a new ‘developmental’ model for these disorders. The so-called
‘fetal origins hypothesis’ proposes that the disorders originate through developmental plasticity, whereby malnutrition during fetal life, infancy and early childhood permanently change the structure and function of the body, a phenomenon known as ‘programming’. This paper reviews recent findings in the Helsinki Birth Cohort, which comprises 13 345 men and women born in the city during 1934 - 944. There is also an older cohort comprising 7086 people born during 1924-1933. We review the
paths of pre- and postnatal growth that lead to later disease. Children who later develop coronary heart disease and type 2 diabetes grow slowly during fetal life and infancy but thereafter increase their body mass indices rapidly. Those who later develop stroke grow slowly in fetal life, infancy and during
childhood. We also review how the growth of girls during infancy, childhood and at puberty influences chronic disease in the next generation
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