Biomedical subjects

A K Dutt

Publications and source records attributed to A K Dutt.

At least 37 records · Page 2Linked to original sources

PubMed1987

Evaluation of the use of an oxygen conservation device in long-term oxygen therapy.

An oxygen-conserving delivery system employing a flow reducing oxygen pendant (OP) cannula was evaluated during home use for oxygen savings, cost reduction, and patient acceptance. Twenty-one male outpatients receiving home oxygen from liquid systems by conventional nasal cannula (NC) were fitted with OP and followed for 1 month. Oxyhemoglobin saturations (SaO2) were successfully maintained with a threefold reduction in mean O2 flow rate from 1.45 to 0.46 L/min. Exercise testing demonstrated no change between the 2 systems in either degree of desaturation or duration of exercise. Because the same benefit was achieved at lower O2 flow with the OP, 14 patients were able to utilize their O2 for longer periods of time without refilling their portable liquid units. Liquid O2 use per patient was reduced from 200 pounds/month with NC to 135 pounds/month with OP. In 12 patients who reported full compliance during the study period; a net savings of $141/month/patient was realized. However, 9 of the 21 patients stopped using the OP before completing the study. Patient evaluations of the OP identified several factors leading to poor compliance, including bulkiness and/or poor fit (16 patients), ear discomfort (8 patients), nasal discomfort (6 patients), and required nasal breathing (6 patients). While significant savings were achieved with OP, problems with patient acceptance may limit its practicality, particularly in continuous use situations. The primary benefit of the OP may be in extending the range of portable oxygen systems.

Aged↗

PubMed1986

Short-course chemotherapy for pleural tuberculosis. Nine years' experience in routine treatment service.

Short-course chemotherapy (SCC) for pulmonary tuberculosis for nine months with isoniazid (INH) and rifampin (RIF) is well established. However, there is still no report on results of such therapy in pleural disease. From January 1976 through December 1984, we treated 201 patients (average age 61.6 years) for pleural tuberculosis, 143 with SCC for nine months of mainly INH and RIF and 58 with conventional therapy (CT) for 18 to 24 months. Findings indicated that SCC with INH and RIF was as effective as in pulmonary tuberculosis. The results were equivalent or even better than CT given for prolonged periods.

Adolescent↗

PubMed1986

Short-course chemotherapy for extrapulmonary tuberculosis. Nine years' experience.

Short-course chemotherapy with isoniazid and rifampin is well established for pulmonary tuberculosis but not yet for extrapulmonary disease. We report our 9-year experience with short-course chemotherapy in treating 350 patients; 402 extrapulmonary sites were involved. Therapy was largely self-administered with careful monitoring by local public health nurses. Administration of drugs was directly supervised in less than 2% of patients. Short-course chemotherapy with isoniazid and rifampin for 9 months was successful in 95% of patients, equivalent to conventional therapy with two to three drugs for 18 to 24 months. It was found that early drainage and complete debridement of necrotic material in bone lesions enhances healing. Short-course chemotherapy has excellent patient acceptance, short duration, fewer doses, and modest toxicity. Our largely twice-weekly regimen has the additional advantages of reduced cost, fewer doses, and ease of supervision when needed.

Adolescent↗

PubMed1985

Theophylline kinetics in chronic obstructive airway disease in the elderly.

Theophylline kinetic studies, serial spirometric function tests, and arterial blood gas determinations were performed in 39 adult men with stable chronic obstructive airway disease (COPD). Subjects were given an intravenous aminophylline loading dose of 5.6 mg/kg and a maintenance dose of 0.9 mg/kg/hr for 6 hours. Elderly (greater than 60 years old) nonsmoking subjects had 36% lower theophylline clearance (Cl) and a 40% longer serum theophylline elimination t1/2 than did middle-aged (less than 60 years old) nonsmoking subjects (mean +/- SE; clearances of 32.6 +/- 3.2 [n = 13] and 50.7 +/- 8.5 ml/kg/hr [n = 8] and t1/2s of 11.0 +/- 0.8 and 7.4 +/- 0.8 hours, respectively). There were also differences in Cl and t1/2 between elderly and middle-aged subjects in both the smoking and nonsmoking groups: elderly group, Cl = 43.6 +/- 3.7 mg/kg/hr and t1/2 = 9.0 +/- 0.7 hours; middle-aged group, Cl = 57.6 +/- 6.0 mg/kg/hr and t1/2 = 6.7 +/- 0.6 hours). There was consistent improvement in spirometric functions in both nonsmoking and smoking elderly subjects: percent changes in forced expiratory volume in 1 second of 19% to 25%; in forced vital capacity of 25% to 31%; in forced expiratory flow at 25% to 75% of vital capacity of 59% to 67%; and in maximum mid-flow time of -25% to -30%, at serum theophylline concentrations of 10 to 13 mg/L (group mean). We conclude that elderly nonsmoking subjects with COPD cleared theophylline more slowly than did middle-aged, nonsmoking subjects with COPD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1985

Isoniazid-induced pure red cell aplasia.

Pure red blood cell aplasia (PRCA) is an extremely rare side effect of isoniazid (INH). We have encountered 2 patients who developed anemia caused by PRCA. One was receiving INH preventive therapy and the other was being treated with INH and rifampin. On withdrawal of INH, the anemia responded rapidly. For unexplained anemia during INH therapy, PRCA should be considered as a cause.

Aged↗

PubMed1985

Tuberculosis chemotherapy today.

Effective chemotherapy of tuberculosis not only reduces morbidity and mortality, but it is a powerful mechanism to control further spread of infection. Although conventional therapy for 18-24 months is highly effective, a major disadvantage is non-compliance of patients in completing the full course of therapy. With better understanding of bacteriologic action of many antituberculous drugs, the disease can now be cured in six to nine months of bactericidal chemotherapy. Isoniazid and rifampin for nine months, either given daily throughout or initially for one month followed by twice weekly administration for another eight months, is highly effective for cure of the disease. However, this is not recommended for patients in developing countries due to high frequency of initial isoniazid resistance. Bactericidal therapy with four drugs (streptomycin or ethambutol (25 mg/kg), isoniazid, rifampin and pyrazinamide) daily for two months followed by isoniazid and rifampin daily or twice weekly for another four months is very effective. In suspected or proved isoniazid resistance, the therapy has also proven effective. However, therapy may also be changed during the continuation phase to streptomycin, rifampin and pyrazinamide daily or twice weekly for another four to six months. The treatment of extrapulmonary tuberculosis, alone or when associated with other medical disorders, is the same as for pulmonary tuberculosis. There are several short course regimens available for use in developing countries while keeping in consideration the shortage of major drugs and financial constraints. Modern short course chemotherapy has the potential advantage of success in developing countries by increasing the population of patients completing therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitubercular Agents↗

PubMed1984

Short-course chemotherapy for tuberculosis with mainly twice-weekly isoniazid and rifampin. Community physicians' seven-year experience with mainly outpatients.

The general medical community in the United States has been rather slow in adopting short-course bactericidal chemotherapy for tuberculosis despite the clear demonstration of the advantage by several carefully controlled clinical trials. Reported herein is experience between January 1976 and December 1982 in 1,028 patients with bacteriologically proved pulmonary tuberculosis treated for nine months with isoniazid (300 mg) and rifampin (600 mg) daily for one month followed by twice-weekly isoniazid (900 mg) and rifampin (600 mg) for the other eight months. They were treated by 45 local practitioners and supervised by public health nurses through 60 Arkansas Department of Health chest clinics in the state. Outpatient therapy was mostly self-administered in the routine treatment program. Overall success was achieved in 95 percent of the 751 patients who completed therapy; in 21 (2.8 percent), sputum cultures failed to convert to negative, and 15 (2.1 percent) have had relapse since therapy was stopped. Therapy could not be completed in 26.9 percent due to deaths, drug toxicities, relocation, refusal, etc. Of 21 bacteriologic failures, 18 patients developed isoniazid resistance and were treated with additional two bactericidal drugs. Most of the relapses (nine of 15) occurred within 12 months after chemotherapy was stopped. However, four relapses occurred quite late during follow-up. Only three of 15 patients with relapse showed isoniazid resistance. Side effects of the drugs were encountered in 10.3 percent, but major toxicities occurred in 3.2 percent (hepatitis in 2.6 percent, hematologic effects in 0.6 percent). Clinical surveillance for toxicity is preferred over routine and regular biochemical monitoring. Patient acceptance of the regimen was excellent, and compliance was good. Short-course chemotherapy is effective, with low drug toxicity, reduced cost of drugs, and ease of direct supervision when needed, and is acceptable to patients in routine treatment.

Adolescent↗

PubMed1984

Projecting physician requirements in a two-county region in Ohio.

A methodology for projecting physician requirements in a geographical region is presented. The procedure incorporates variables defining physician workloads, rates of retirement and estimated population changes to determine the future needs for health care practitioners. A case study using data from a two-county region of northeastern Ohio is included to illustrate the applicability of the projection methodology.

Health Planning↗

PubMed1983

Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis.

Between January 1976 and June 1981, 814 patients with pulmonary tuberculosis were treated for 9 months with isoniazid (INH) and rifampin (RIF), daily for 1 month and twice weekly for the other 8 months. Overall success was achieved in 95% of the 586 patients who completed therapy: in 15 patients (2.9%), sputum cultures failed to convert to negative during therapy, and 10 patients (1.7%) have relapsed since stopping the chemotherapy. Major toxic effects occurred in 22 patients; in 14 during the daily phase and in 8 during the twice-weekly phase. Hepatic toxicity occurred in 13 patients during daily and in 5 during twice-weekly treatment, and it was caused by RIF in 5, INH in 10, and was undetermined in 3. Hematologic abnormalities developed in 4 patients: in 1 during the daily and in 3 during the twice-weekly phase. Minor side effects, which were not life threatening, were encountered in 62 patients: in 35 during the daily and in 27 during the twice-weekly therapy. These were gastrointestinal intolerance in 18, drug fever in 27 (including 11 with "flu-syndrome" during twice-weekly administration), cutaneous rashes in 14, and headache, general malaise, and weakness in 3. These side effects were produced by RIF in 43, by INH in 18, and the responsible drug was not identified in 1. Hypersensitivity reactions to twice-weekly administration of RIF were infrequent. Clinical surveillance for toxicity is preferred over routine and regular biochemical monitoring.

Adolescent↗

PubMed1983

Physiologic effects of oral bronchodilators during rest and exercise in chronic obstructive pulmonary disease.

At rest and during exercise, noninvasive studies of cardiopulmonary physiology in patients with chronic obstructive pulmonary disease (COPD) were carried out to determine the objective benefits of commonly used oral bronchodilator drugs in 15 stable patients without cardiovascular disease or reversible obstruction of airflow. Theophylline, terbutaline, a combination of theophylline and terbutaline, and placebo were given for ten days each in a randomly sequenced double-blind protocol for outpatients. Spirometric values, the ratio of physiologic dead space to tidal volume (VDp/VT), and the alveolar-arterial oxygen pressure difference (P[A-a]O2) were studied at rest on each regimen. During steady-state exercise the changes in VDp/VT and P(A-a)O2, as well as the ventilatory equivalent for oxygen and oxygen pulse, were measured. When compared with placebo, no significant change was noted in the previously mentioned measurements with any regimen, with the exception of a small improvement in the forced expiratory volume in one second, which was significant for all regimens. These findings suggest that commonly used oral bronchodilator drugs in usual doses may have small effects on airflow even in "irreversible" COPD but that the objective effect of these agents on gas exchange during rest and exercise is not significant.

Administration, Oral↗

PubMed1983

Short-course chemotherapy for tuberculosis in children.

Short-course, largely twice-weekly chemotherapy for tuberculosis was introduced in the United States for treatment of adults with pulmonary disease by the Arkansas State Department of Health in 1976. Since 1977, 50 children with tuberculosis have been treated with rifampin, 10 to 20 mg/kg, and isoniazid, 10 to 20 mg/kg daily for one month followed by 10 to 20 mg/kg of rifampin and 20 to 40 mg/kg of isoniazid twice a week for another 8 months. Ages ranged from 4 months to 15 years with a median age of 3 years. A presumptive diagnosis of tuberculosis was made on the basis of 10 mm or more of induration to 5 TU of purified protein derivative and a chest film or other findings compatible with tuberculosis. Three children had extrapulmonary disease (two had cervical adenitis, one had tuberculosis arthritis). Of the 47 children with pulmonary disease, 32 were asymptomatic. The results were excellent. Symptoms cleared in 1 to 2 months. Most pulmonary infiltrates had cleared by 10 months, but hilar adenopathy rarely cleared in less than 2 years. Drug toxicity occurred in only one patient (vomiting of rifampin). This treatment appears to be safe, effective, inexpensive, short and simple enough to ensure cooperation or to allow personnel to administer drugs directly to children from socially disorganized families.

Adolescent↗

PubMed1983

The effect of aminophylline on cardiac rhythm in advanced chronic obstructive pulmonary disease: correlation with serum theophylline levels.

The effect of IV aminophylline on cardiac rhythm of patients with advanced, stable chronic obstructive pulmonary disease (COPD) was evaluated with Holter monitoring in 38 males (average age 62 yrs). Serum levels ranged from 7.4 to 18.6 mg/l. Significant improvement in pulmonary functions and blood gases from baseline measurements were observed. New supraventricular tachycardia was seen only in three (8%) of 38 patients. Sixteen (76%) of the 21 patients with insignificant ventricular ectopy (VE) at baseline remained unchanged during therapy. Of the 17 patients who had significant baseline VE, nine (53%) had increased VE and eight (47%) had decreased VE. No symptomatic arrhythmia was observed. Whereas aminophylline in therapeutic dosage failed to provoke VE in arrhythmia-free COPD patients, the effect of aminophylline on pre-existent VE is variable.

Aged↗

PubMed1982