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Biomedical subjects

A K Pramanik

Publications and source records attributed to A K Pramanik.

At least 19 recordsLinked to original sources
PubMed1999

Congenital chylothorax in neonatal thyrotoxicosis.

We report a patient with congenital chylothorax who also had neonatal thyrotoxicosis secondary to maternal Graves' disease. Fetal tachycardia with hydrops was detected at 28 weeks' gestational age. The fetus responded to antithyroid medication in utero but had persistent bilateral pleural effusion. At birth, he had respiratory distress due to massive pleural effusion. Cytologic studies of pleural fluid were consistent with chylothorax. To the best of our knowledge, the association of congenital chylothorax with fetal (neonatal) thyrotoxicosis, has not been reported previously.

Adult↗
PubMed1997

Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome.

OBJECTIVE: To compare the relative safety and efficacy of Infasurf (calf lung surfactant extract; ONY, Inc, Amherst, NY, IND #27169) versus Survanta (Beractant, Ross Laboratories, Columbus, OH) in reducing the acute severity of respiratory distress syndrome (RDS) when given at birth and to infants with established RDS. DESIGN: A prospective, randomized, double-blind, multicenter clinical trial. SETTING: Thirteen neonatal intensive care units participated in the treatment arm: seven of these concurrently participated in the prevention arm. PATIENTS: The treatment arm enrolled infants of </=2000 g birth weight with established RDS, and the prevention arm enrolled infants of </=29 weeks' gestation with birth weights <1250 g. INTERVENTION: Infants were randomly assigned to receive Infasurf (n = 303, treatment arm; n = 180, prevention arm) or Survanta (n = 305, treatment arm; n = 194, prevention arm) in accordance with the Survanta package insert instructions. OUTCOME MEASURES: We projected a 25% reduction between groups in the need for a third dose of surfactant for infants with established RDS, and a 25% reduction in the need for a second dose of surfactant for infants who received prophylactic surfactant. Secondary outcomes included the severity of RDS measured by inspired oxygen concentrations and mean airway pressure, air leaks, complications associated with surfactant administration, and survival to 36 weeks' postmenstrual age without the need for oxygen supplementation. RESULTS: In the treatment arm, there was no difference between groups in the number of infants requiring more than two doses of surfactant. The interval between doses was significantly longer for Infasurf, suggesting an increased duration of treatment effect. The inspired oxygen concentration and mean airway pressure were lower in the Infasurf infants during the first 48 hours in the treatment arm. In the prevention arm, there were no differences with respect to the number of surfactant doses. The dosing intervals were longer for Infasurf infants after the second dose. No difference in inspired oxygen or mean airway pressure was noted during the first 72 hours. There were no significant differences in the incidence of air leaks, complications associated with dosing, complications of prematurity, mortality, or survival without chronic lung disease in the prevention or treatment arm. CONCLUSIONS: Infants treated with Infasurf have a modest benefit in the acute phase of RDS. Infasurf seems to produce a longer duration of effect than Survanta.

Age Factors↗
PubMed1994

Comparison of the effect of three doses of a synthetic surfactant on the alveolar-arterial oxygen gradient in infants weighing > or = 1250 grams with respiratory distress syndrome. American Exosurf Neonatal Study Group II.

The effect of a 50% increment or decrement in the recommended 5 ml/kg dose of a commercially available surfactant (Exosurf Neonatal) on the alveolar-arterial oxygen gradient was investigated in a multicenter, double-blind, placebo-controlled rescue trial conducted at 15 hospitals in the United States. Two doses of three different volumes (2.5, 5.0, and 7.5 ml/kg) were compared with two 5.0 ml/kg doses of air in 281 infants weighing > or = 1250 gm who had respiratory distress syndrome requiring mechanical ventilation and an arterial/alveolar oxygen ratio < 0.22. The first dose was given between 2 and 24 hours of age, and the second dose was given 12 hours later to all infants who still required mechanical ventilation. Infants were stratified at entry by gender and the magnitude of the arterial/alveolar oxygen ratio. The air placebo arm of the study was terminated early when reductions in mortality rates were proved in another rescue trial of this surfactant in infants with the same birth weights. For the first 48 hours, administration of a 2.5 ml/kg dose of surfactant provided less improvement in the alveolar-arterial oxygen gradient than doses of 5.0 and 7.5 ml/kg, which were equivalent. Similar results were observed in mean airway pressure (p < 0.05). There were no significant differences among the three dosage groups in mortality rate, air leak, bronchopulmonary dysplasia, and other complications of prematurity. There were no pulmonary hemorrhages in any group. Reflux of surfactant occurred more frequently in the 5.0 and 7.5 ml/kg groups. These results indicate that more sustained improvements in oxygenation are provided, with equal safety, by the standard two 5.0 ml/kg rescue doses of this surfactant than by the 2.5 ml/kg dose. No further benefit is gained from two larger doses given 12 hours apart.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1993

Surfactant replacement therapy for pulmonary diseases.

Surfactant therapy has clearly been a meaningful addition to the therapeutic armamentarium in the management of premature infants with RDS. Pediatricians and others involved in the care of newborn infants should familiarize themselves with the various surfactant preparations, the indications for their use, the techniques of administration, and the possible side effects. All such care provides should also be skilled in endotracheal intubation and ventilation of neonates; recognition of the clinical and radiographic signs of RDS; and have the appropriate equipment to monitor cardiopulmonary status, oxygenation, and ventilation in these infants until transport to a tertiary care facility can be accomplished. In addition to the two current FDA-approved surfactants, several other surfactants are in various stages of evaluation. When administered to infants with established RDS, both natural and synthetic surfactants have clearly been shown to improve survival, decrease requirements for ventilatory support, and reduce the incidence of air leak complications. Although by no means conclusively demonstrated, certain infants, particularly those delivered at < 30 week gestation, may benefit from immediate treatment in the delivery room. It should be emphasized that, except under extenuating but controlled circumstances and except in the hands of an experienced physician, surfactant treatment should not be viewed as an integral part of neonatal resuscitation. Adequate treatment requires the administration of a minimum of two surfactant doses, although some infants may benefit from additional doses or treatment with an alternative preparation. Massive pulmonary hemorrhage, although rare, is observed with prophylactic and rescue treatment protocols and may result from hemorrhagic pulmonary edema due to a hemodynamically significant PDA. Currently there are no data to recommend the use of one surfactant preparation over another. The short- and long-term benefits may be similar with different products. Therefore, we must await results of trials with then necessary power (large number of subjects) and unbiased design to discern any clinically relevant differences. Results of studies directly comparing the relative efficacy of Survanta and Exosurf, conducted under the auspices of the National Institutes of Health, are expected in 1993. Multicenter trials comparing prophylactic and rescue administration of Exosurf versus CLSE and Survanta versus CLSE are currently underway. It is encouraging to note that follow-up studies up to 2 years of age do not reveal an increase in physical or neurodevelopmental handicaps, BPD, or other problems in preterm infants who received surfactant preparations either for prophylaxis or rescue therapy. Results of long-term follow-up studies, however, are not yet available.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchopulmonary Dysplasia↗
PubMed1993

Solid-phase extraction and GC/MS quantitation of cocaine, ecgonine methyl ester, benzoylecgonine, and cocaethylene from meconium, whole blood, and plasma.

A selective solid-phase extraction technique has been applied to the analysis of cocaine and selected cocaine metabolites in meconium, whole blood, and plasma. This technique uses a mixed-mode Bond Elut Certify column that utilizes the characteristics of hydrophobic and polar interactions and ion exchange chromatography. Following extraction, cocaine, ecgonine methyl ester, benzoylecgonine, and cocaethylene were identified and quantitated using GC/MS. Linear quantitative response curves have been generated for the metabolites over a concentration range of 0-1000 ng/g for meconium and 0-1000 ng/mL for whole blood and plasma. The overall extraction efficiencies, depending on the metabolite, were between 58.1 and 99.7% for meconium, 95.6 and 124.0% for blood, and 86.9 and 128.9% for plasma. Linear regression analyses of the standard curve for the four analytes exhibited correlation coefficients ranging from 0.850 to 0.946 for meconium, 0.939 to 0.993 for whole blood, and 0.981 to 0.996 for plasma. Because of its capability to detect cocaethylene in meconium, blood, and plasma, the procedure can be used to determine if drug exposure occurred during the latter stages of gestation and if it involved only cocaine or a combination of cocaine and ethanol.

Cocaine↗
PubMed1989

Electron microscopic evaluation of bacterial adherence to polyvinyl chloride endotracheal tubes used in neonates.

Studies in adults suggest a possible association between pulmonary nosocomial infection and bacterial adherence to endotracheal tubes (ETT). Some strains of coagulase-negative Staphylococcus produce a mucoid extracellular material known as slime or glycocalyx that helps bacteria adhere to the surface of biomaterials. We examined by scanning and transmission electron microscope the surface of 29 polyvinyl ETT removed from neonatal patients, and ten unused ETT. Multiple surface irregularities were found in the unused tubes. These irregularities were most prominent in the tip and around the side hole. Amorphous material containing slime-producing bacteria was found on 29 ETT removed from patients. Tubes in place for longer times had greater areas of surface covered; the amorphous material was more concentrated in the areas where surface irregularities were most prominent. No clinical correlation with pulmonary nosocomial infection was established.

Bacteria↗
PubMed1983

Evidence of peroxidative damage to the erythrocyte membrane in iron deficiency.

The mechanism responsible for reduced red blood cell (RBC) survival in iron deficient infants or animals is unknown. To investigate the possible role of membrane peroxidation in iron-deficiency anemia, we studied RBC membrane lipids and proteins of rats fed iron-deficient (2 ppm Fe) and control (50 ppm Fe) diets between 21 and 41 days of age. Thin-layer chromatography of lipids showed that iron-deficient rats' RBC contained a novel phospholipid (1.9% of the total phospholipid) which moved between phosphatidylserine and phosphatidylethanolamine. Detailed studies showed that this PL is a Shiff's base adduct of phosphatidylserine, phosphatidyl-ethanolamine, and malonyldialdehyde, an end product of lipid peroxidation. Polyacrylamide gel electrophoresis of RBC proteins of iron-deficient rats also showed presence of high molecular protein complexes similar to that formed in in vitro malonyldialdehyde-treated RBC. To examine the role of such membrane cross-linking on in vivo RBC survival, we have studied survival of in vitro malonyldialdehyde-treated RBC in rabbits, 51Cr-T 1/2 of 5 microM malonyldialdehyde-treated RBC, which contained about the same amount of phospholipid/malonyldialdehyde adducts, was reduced to 6 days as compared to 11 days of sham-treated RBC. The in vitro study suggests that peroxidative damage results in significant reduction in RBC T 1/2 and may be analogous to decreased RBC survival in iron-deficient infants and animals.

Anemia, Hypochromic↗
PubMed1980

8402 human cell culture--a model for evaluating bilirubin-albumin interactions with drug.

The effect of therapeutic concentration of sulfisuxazole (sulfa) on the bilirubin uptake and viability of 8402 cells in culture was studied. The total bilirubin was kept constant at 24 microM and albumin was added to obtain bilirubin-albumin molar ratio (BAMR) ranging from 0.5 to 2. The effect of sulfa on unbound bilirubin (UB) was measured by the peroxidase assay. Sulfa increased UB at all BAMR's more so at 1.5 and 2.0 (P less than 0.05). Significant increase in bilirubin uptake/cell with a corresponding decrease in cell viability was noted with sulfa at BAMR's greater than 1 (P less than 0.05). The LD50 of these cells was 73-86 nM of UB. A plot of cell viability versus UB for the combined control and sulfa data (r2 = 0.94) confirms that the decrease in cell viability with increasing BAMR is explained by the corresponding rise in UB. Therefore, increase in UB by sulfa leads to toxicity of 8402 cells. Thus, we speculate that they may be used to study the mechanism of bilirubin neurotoxicity induced by similar drugs.

Albumins↗
PubMed1979

Transcutaneous gamma benzene hexachloride absorption and toxicity in infants and children.

A premature, malnourished infant had seizures and abnormal neurological function associated with topical gamma benzene hexachloride (lindane) therapy. The level of gamma benzene hexachloride in his blood was 17 times greater than expected after a single topical application of 1% gamma benzene hexachloride. Significant levels developed in another child's blood after repeated applications of small amounts to areas of dermatitis and excoriations on the skin. The use of topical gamma benzene hexachloride in pediatric patients is reviewed because of increased evidence of unpredictable absorption and toxicity.

Administration, Topical↗