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Biomedical subjects

A Hashmi

Publications and source records attributed to A Hashmi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Reproducibility of plasma catecholamine metabolites in normal subjects.

BACKGROUND: Plasma homovanillic acid (HVA) and methoxy-hydroxy-phenylglycol (MHPG) are often used in repeated measurement designs to assess dopamine and norepinephrine metabolism in clinical research. However, only limited data on the reproducibility of these metabolites are currently available. METHODS: Plasma HVA and MHPG were measured in normal volunteers on five nonconsecutive mornings under fasting conditions and restricted smoking and physical activity. RESULTS: Intraclass correlation coefficients (ICC) for plasma HVA and MHPG across 5 days were determined to be 0.85 and 0.79, respectively. ICC improved to 0.90 for HVA and 0.91 for MHPG when the average of the first 2 days was examined against the average of the last 2 days. CONCLUSIONS: Results suggested that under controlled conditions plasma HVA and MHPG measurements have good reproducibility.

Adult↗
PubMed1998

Total anomalous pulmonary venous connections and consideration of the Fontan or one-ventricle repair.

There is now a considerable literature that babies with right atrial isomerism have a poor outcome. The reasons for this are complex and multifactorial, but may be related at least in part to intrinsically small and abnormal pulmonary veins. We reviewed a series of consecutive patients seen at a single institution and found that babies with right atrial isomerism, severe pulmonary outflow tract obstruction or atresia, and total anomalous obstructed pulmonary veins had a grim outlook, especially those requiring operation in the neonatal period. Others have reported a similarly concerning outcome.

Fontan Procedure↗
PubMed1998

Management and outcomes of right atrial isomerism: a 26-year experience.

OBJECTIVES: We sought to determine, in a large series of patients with right atrial isomerism, factors associated with mortality. BACKGROUND: Right atrial isomerism is associated with complex congenital heart disease and high morbidity and mortality. METHOD: All data from patients diagnosed with right atrial isomerism between January 1970 and March 1996 were reviewed. RESULTS: A total of 91 consecutive patients (54 male) were identified. Most patients (89%) presented within the first month of life, 62% at birth. Cardiac abnormalities included common atrioventricular (AV) valve (81%), ventricular hypoplasia or single ventricle (73%), abnormal ventriculoarterial connections (96%), pulmonary outflow tract obstruction (84%), anomalous pulmonary venous drainage (87%) and pulmonary vein obstruction (30%). The overall mortality rate was 69%. No interventions were planned or performed in 24%, 95% of whom died. The mortality rate for patients requiring their first cardiovascular operation in the neonatal period was 75% versus 51% for those with later first operations (p < 0.05). The surgical mortality rate for patients undergoing pulmonary vein repair was 95%. Overall survival estimates were 71% at 1 month, 49% at 1 year and 35% at 5 years. Independent risk factors for decreased time to death included the absence of pulmonary outflow obstruction (relative risk [RR] 2.23, p < 0.03), presence of major AV valve anomaly (RR 5.23, p < 0.03) and obstructed pulmonary veins (RR 5.43, p < 0.0001). CONCLUSIONS: Right atrial isomerism continues to have an associated high mortality despite surgical innovations. Management of pulmonary vein obstruction remains a serious problem and is associated with high mortality.

Female↗
PubMed1998

Transoesophageal echocardiographic assessment of obstruction to the pulmonary venous pathway in children with Mustard or Senning repair.

The morphology and mechanism of obstruction to the pulmonary venous pathway in patients following either Mustard or Senning repair of complete transposition was assessed using transoesophageal echocardiography. Seven patients underwent catheterization and complete transoesophageal study in both transverse and longitudinal planes, followed by balloon dilation of the obstructed venous pathway in five of seven under transoesophageal echocardiography guidance. A complete scan of both systemic and venous pathway was obtained in all patients. Four patients with a Mustard repair were found to have a 'tubular' baffle, with stenosis resulting from a discrete wedge of tissue arising from the atrial free wall in association with fibrous adhesions to the baffle. In the three patients with a Senning repair the intra-atrial baffle showed a characteristic 'peaked' appearance, with stenosis of the venous pathway stenosis related directly to contracture of the patch used to augment the atrial free wall. The mechanism of obstruction appears to be inherent to the different surgical techniques. Indwelling transoesophageal echocardiography provided immediate haemodynamic and morphologic assessment of the efficacy of dilation of the obstructed venous pathway.

Adolescent↗
PubMed1998

Anomalous origin of one pulmonary artery from the ascending aorta: 36 years' experience from one centre.

UNLABELLED: Anomalous origin of one pulmonary artery from the ascending aorta is an uncommon lesion with an uncertain outcome. We reviewed 16 consecutive children (9 males) presenting with this lesion over a 36 year period at a single institution. Median age at presentation was 2 days (range, birth to 3.2 years). The anomalous pulmonary was the right in 12 and the left in 4, all originating from the proximal ascending aorta, with no patient having stenosis at the origin of the anomalous pulmonary artery. Associated cardiac anomalies were noted in 9 patients. No intervention was attempted in 2 patients: one was deemed inoperable due to complex associated lesions and pulmonary vascular obstructive disease, while the other one died before repair. Surgical intervention was attempted in 14 patients, with 3 intraoperative deaths (21%). Of 11 operative survivors, 8 developed pulmonary arterial stenosis graded severe in 2, moderate in 1 and mild in 5. Patients with severe stenosis required surgical angioplasty, 1 after unsuccessful dilation combined with placement of an endovascular stent. One patient with moderate, and one with mild, stenosis underwent successful transcatheter balloon dilation. The remaining 4 patients with mild stenosis remain unchanged during follow-up. One patient had biopsy evidence of pulmonary vascular obstructive disease at 3.3 years of age. There were no late deaths, giving a total mortality of 25% (4/16). CONCLUSION: While early diagnosis and repair of anomalous origin of one pulmonary artery from the ascending aorta is necessary, restenosis of the site of repair is common.

Aorta↗
PubMed1997

Surfactant therapy improves pulmonary function in infants with Pneumocystis carinii pneumonia and acquired immunodeficiency syndrome.

Pneumocystis carinii pneumonia (PCP) is an important cause of acute respiratory failure in HIV-infected children. PCP may initiate acute respiratory distress syndrome (ARDS) by adversely affecting surfactant physiology. We report improved pulmonary function following administration of bovine lipid extract surfactant to two infants with AIDS-related PCP/ARDS.

AIDS-Related Opportunistic Infections↗
PubMed1997

The effect of insoles in therapeutic footwear--a finite element approach.

Current practice in the prevention of recurrence of neuropathic foot ulcers is to prescribe accommodative in-shoe orthoses or insoles which reduce plantar pressure levels at locations of bony prominences, particularly under the metatarsal heads. To date, design of these orthoses has largely been a trial and error process. There is little quantitative information available regarding the effects of thickness and the influence of soft tissue characteristics on the cushioning effect of such interventions. The current paper investigated alterations in pressure under the second metatarsal head as a function of insole thickness and tissue thickness. Both experimental and quasi-static plane strain finite element approaches were employed. The orthoses chosen reduced plantar pressure by a maximum of approximately 30% and were more effective (on a percentage basis) in the setting of reduced sub-metatarsal tissue thickness. Peak normal stresses predicted by the FE models were, on average, within 5.9% of experimentally measured values for the normal tissue case and 8.1% for the reduced tissue case. The techniques presented represent a promising approach to understanding plantar cushioning and the principles involved in the design of therapeutic footwear for insensate feet.

Equipment Design↗
PubMed1997

Systolic function of the univentricular heart: comparison of the Simpson's rule with acoustic quantification.

BACKGROUND: Acoustic quantification (AQ) is a new method of obtaining real-time information about systolic ventricular function. This method establishes a ;blood-tissue interface' and computes an intraventricular blood volume in real time to derive a beat to beat instantaneous ejection fraction. AQ assessment of systolic function has been reported previously in patients with normal cardiotypes and varying degrees of myocardial dysfunction. OBJECTIVE: To determine the potential utility of AQ in patients with abnormal ventricular morphology, in whom systolic function may be difficult to measure by traditional methods. PATIENTS AND DESIGN: Seventeen children (nine females) ranging in age from five days to 18 years (mean 6.9 years) with univentricular left ventricle heart morphology underwent a prospective and comparative echocardiographic study of ventricular function with the use of AQ and manual planimetry (single plane Simpson's rule). Imaging was done during steady state without sedation. Routine scan planes were performed, followed by repeat scanning of the univentricle from the apical four-chamber view in the AQ mode. Subsequently, manual planimetry using Simpson's rule was performed from an online graphical analysis package to measure systolic and diastolic frames from the conventional replay images. These data were used to calculate ejection fraction using standards previously established. The results were then compared with real-time AQ results. SETTING: Tertiary care referral center. RESULTS: Scan time for the combined standard and AQ imaging averaged 45 mins (range 35 to 65 mins). Measured ejection fraction by AQ and manual planimetry were 44 +/- 11% and 46 +/- 10%, respectively. Statistical analysis by repeated measures ANOVA with Bonferroni/Dunn correction (F = 0.6, df = 1,32, P = 0.44) demonstrated significant agreement between AQ and manual planimetry with an intraclass correlation coefficient of 0.93. Bland-Altman analysis was used to provide a graphic display of the clinical significance of differences in the comparison of the two methods of measurement. CONCLUSIONS: These findings support the use of AQ for continuous online determination of indexes of systolic function for patients with univentricular left ventricle morphology. The variability in the morphology inherently present within this group of patients results in a wider variability of determined ejection fraction. Particular attention must be directed to the technical aspects of image acquisition and AQ application to ensure accuracy.

Adolescent↗