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Biomedical subjects

H Vyas

Publications and source records attributed to H Vyas.

At least 19 recordsLinked to original sources
PubMed2006

Respiratory outcome in late childhood after neonatal continuous negative pressure ventilation.

BACKGROUND: The outcome in late childhood for children entered into a randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard respiratory management for the treatment of neonatal respiratory distress was studied. In the original trial, there were advantages in the duration of oxygen and the prevalence of chronic lung disease for those assigned to receive CNEP. AIM: To determine whether the above differences had persisted into childhood. METHODS: Outpatient evaluation of children by a paediatrician using Spirometry (Vitalograph Spirometer 2120, Ennis, Ireland) and MicroRint (Micro Medical, Rochester, Kent, UK) techniques independently of the original trial. Parents completed questionnaires about their child's respiratory history and social-demographic information. RESULTS: 133 (65%) survivors were evaluated at 9.6-14.9 years of age. The group examined were representative of the original cohort and no significant baseline differences were observed between children evaluated who had been allocated to CNEP or standard treatments. We compared Rint (before and after bronchodilator) and forced expiratory flow, volume and vital capacity between the two study groups; none were significant. Children in the standard group had received paediatric intensive care more often (p = 0.19) and were more likely to be receiving inhaled drugs for asthma (p = 0.19; all not significant). CONCLUSIONS: No important differences were found at follow-up in late childhood in respiratory outcomes for children treated with neonatal CNEP or standard treatment. Caution should be exercised, as the original trial was not powered to show these differences, but there seems to be no long-term detriment in respiratory outcomes for children treated with CNEP in the neonatal period.

Adolescent↗
PubMed2005

Inhaled beta2-agonists for treating non-specific chronic cough in children.

BACKGROUND: The pathophysiology of so called 'cough variant asthma' has not received a great deal of research interest and opinion lies divided as to whether it is really asthma or not. The proponents of cough variant asthma suggest a therapeutic trial of medications usually used to treat asthma OBJECTIVES: To determine the effectiveness of inhaled ss2 agonists in non-specific chronic cough in children over the age of 2 years. SEARCH STRATEGY: The Cochrane Airways Group database (including MEDLINE, EMBASE and CINAHL) and the Cochrane Controlled Trials Register (CCRT) were searched. Additional searching included hand searching of medical journals through the Cochrane Collaboration, references, references of references listed in primary sources and personal communication with authors. In addition "Grey literature" including theses, internal reports, non-peer reviewed journals were sought. SELECTION CRITERIA: All randomised (randomised and quasi-randomised) controlled clinical trials in which inhaled ss2 agonists were given for chronic cough in children over 2 years of age were included. Two reviewers independently assessed articles for inclusion and methodological quality. DATA COLLECTION AND ANALYSIS: Data for trials of salbutamol versus placebo were extracted by both reviewers and entered into the Cochrane Collaboration software program Review Manager, version 4.2 MAIN RESULTS: In children presenting with isolated chronic cough there was no significant difference between salbutamol treated group and placebo group. AUTHORS' CONCLUSIONS: Salbutamol was no different from placebo in reducing the frequency of cough measured objectively or scored subjectively.

Administration, Inhalation↗
PubMed2003

Interpretation of heart rate variability via detrended fluctuation analysis and alphabeta filter.

Detrended fluctuation analysis (DFA), suitable for the analysis of nonstationary time series, has confirmed the existence of persistent long-range correlations in healthy heart rate variability data. In this paper, we present the incorporation of the alphabeta filter to DFA to determine patterns in the power-law behavior that can be found in these correlations. Well-known simulated scenarios and real data involving normal and pathological circumstances were used to evaluate this process. The results presented here suggest the existence of evolving patterns, not always following a uniform power-law behavior, that cannot be described by scaling exponents estimated using a linear procedure over two predefined ranges. Instead, the power law is observed to have a continuous variation with segment length. We also show that the study of these patterns, avoiding initial assumptions about the nature of the data, may confer advantages to DFA by revealing more clearly abnormal physiological conditions detected in congestive heart failure patients related to the existence of dominant characteristic scales.

Adult↗
PubMed2003

Warning note on a blood gas report leading to diagnosis of acetaminophen overdose.

OBJECTIVE: To report a case of acetaminophen toxicity diagnosed after a warning note of "interfering substances" on the blood gas report, leading to early and successful treatment. DESIGN: Case report. SETTING: Tertiary-care pediatric intensive care unit. PATIENT: A 14-yr-old boy admitted unconscious with lactic academia and hyperglycemia. INTERVENTIONS: Routine investigations. MEASUREMENTS AND MAIN RESULTS: His initial investigations revealed hyperglycemia and lactic acidosis. An annotation of "interfering substances" on the blood gas report prompted us to investigate for toxic substances, and an acetaminophen overdose was confirmed. CONCLUSIONS: A persistent warning note on the blood gas report of a sick child with elevated lactate and glucose should alert the clinician to the possibility of an acetaminophen overdose.

Acetaminophen↗
PubMed2000

Early infantile pertussis; increasingly prevalent and potentially fatal.

UNLABELLED: We report nine cases of severe early pertussis in infants less than 7 weeks of age. Clinical features at this age are atypical and may be confused with more common illnesses such as bronchiolitis. All were very difficult to manage. Ventilation was required for apnoeas in five cases, seizures in two or respiratory failure in two. Complications included hypotension in seven cases, pulmonary hypertension in one, pneumothoraces in two, seizures in five and co-infection in five. Two cases were referred for extracorporeal membrane oxygenation and six died. Infection was confirmed either at post mortem or by culture from pernasal swabs. The mother or other close family members were symptomatic at the time and thought to be the source of infection. CONCLUSION: The nine cases suggest a significant resurgence of the infection, which may be fatal in early life. If reporting continues to increase, the immunisation schedule will need to be reviewed and secondary transmission prevented where possible, to protect this vulnerable pre-immunisation group.

England↗
PubMed1992

Chronic granulomatous disease with renal stones.

A case of chronic granulomatous disease with hydronephrosis and renal calculi is presented. This is to our knowledge the first such case to be reported. The calculi were successfully ablated by extracorporeal shockwave lithotripsy.

Child↗
PubMed1991

Acute purulent pericarditis in Omani children.

A total of eight children admitted to the Royal Hospital, Muscat with purulent pericardial effusions were analysed. Six of the cases were in children less than 2 years of age. Five of the eight children had positive blood cultures: Haemophilus influenzae was cultured from two patients, Streptococcus pneumoniae from one patient, E. coli from one patient and Streptococcus viridans from the remaining child. In three children both blood and pericardial cultures were sterile; two of these children had received prior antibiotics. In our experience early diagnosis by cross-sectional echocardiography followed by adequate surgical drainage and parenteral administration of broad spectrum antibiotics helped prevent the high morbidity and mortality usually reported in this condition in developing countries.

Acute Disease↗
PubMed1990

A comparison of enteric coated microspheres with enteric coated tablet pancreatic enzyme preparations in cystic fibrosis. A controlled study.

A comparative study of the efficacy of pH sensitive enteric coated microspheres (ECM) with an enteric coated tablet (ECT) pancreatic enzyme preparation was carried out in 20 children with cystic fibrosis in a double-blind double-placebo crossover manner. Steatorrhoea was assessed by 3 day faecal fat analysis and dosage of medication, stool frequency and consistency; abdominal pain and appetite were documented by a patient-kept diary card. ECM controlled steatorrhoea (11.8 +/- 9.2 g vs 23.2 +/- 18.9 g, P less than 0.02), stool frequency (1.7 +/- 0.6 vs 2.1 +/- 0.9, P less than 0.01) and abdominal pain (8.8 +/- 13.8 vs 23.4 +/- 24.1, P less than 0.05) significantly better than ECT. Out of 20 patients 17 preferred ECM to ECT (P less than 0.00036). ECM preparations should allow more satisfactory dietary management of patients with cystic fibrosis with longterm beneficial effect.

Adolescent↗
PubMed1990

Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test.

Fifteen Omani infants, ranging between 2 and 4 months of age, with acute lead encephalopathy underwent plain skeletal radiology. X-rays in all 15 infants revealed dense metaphyseal bands in long bones. These were best seen around the knee joint. Six infants had evidence of multiple lead lines indicating previous episodes of exposure to lead while four infants also had lead lines in the axial skeleton. We suggest that any young infant presenting with an unexplained encephalopathy should undergo an X-ray of the knee and that the presence of dense metaphyseal bands strongly supports the diagnosis of lead poisoning. A plain X-ray of the knee is a cheap, widely available investigation which can be rapidly obtained.

Bone and Bones↗
PubMed1988

Randomized trial of artificial surfactant (ALEC) given at birth to babies from 23 to 34 weeks gestation.

Artificial surfactant (ALEC) composed of dipalmitoylphosphatidylcholine and unsaturated phosphatidylglycerol in a ratio of 7:3 (w/w) and a dose of 50-100 mg was suspended in 1 ml of cold saline and used at birth as a prophylaxis against the respiratory distress syndrome and its complications in a two centre randomized prospective trial involving 341 babies from 23 to 34 weeks gestation regardless of their antenatal problems. The surfactant had little effect in babies above 29 weeks gestation and was most beneficial in babies under 30 weeks gestation (67 controls and 69 surfactant treated babies). In this subgroup the artificial surfactant significantly reduced the inspired oxygen and peak ventilator pressure requirements during the first 96 h, the incidence of intraventricular haemorrhages from 40% to 19% (P less than 0.01), the overall mortality from 36% to 17% (P less than 0.02), the mortality due to RDS from 31% to 9% (P less than 0.01), the need for more than 28 days oxygen from 37% to 21% (P = 0.05) and the use of pancuronium in ventilated babies from 52% to 27% (P less than 0.01). There were no apparent side effects. This protein free, artificial surfactant should be a useful addition to the therapy of babies under 30 weeks gestation to reduce the severity of their RDS and the incidence of serious complications.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1988

Transcutaneous oxygen monitoring beyond the neonatal period.

Transcutaneous O2 (PtcO2) tensions were compared with PaO2 measurements in 57 infants and children (age range 2 wk to 15.5 yr) using electrode temperatures of 43 degrees and 44 degrees C. At both temperatures, the relationships between PtcO2 and PaO2 were linear over the whole range of data (PaO2 39.75 to 120 torr) although mean PtcO2/PaO2 fell from 44 degrees to 43 degrees C. Skin stripping by repeated applications of adhesive tape immediately before electrode placement did not improve these relationships. In an additional 20 children with a mean age of 2.4 yr (range 0.08 to 15.85) who were being investigated for sleep-disordered breathing, the mean PaO2/PtcO2 ratio of 1.22 at 44 degrees C was used as a correction factor during air calibration for PtcO2. This resulted in a mean PtcO2/PaO2 of 0.99 (range 0.83 to 1.15) provided blood flow is not impaired. Extending the monitoring period from 4 to 8 h between site changes did not result in any burns or persisting erythema. In hemodynamically stable infants and children, and at electrode temperatures of 44 degrees C and 43 degrees C, PtcO2 is linearly related to PaO2 over a wide range of PaO2 values. At an electrode temperature of 44 degrees C, PtcO2 can be arterialized effectively by allowing for transepidermal O2 loss during air calibration; at this electrode temperature, intervals between site changes can be extended safely up to 8 h.

Adolescent↗
PubMed1988

Arterialisation of transcutaneous oxygen and carbon dioxide.

We compared previously calculated global correction factors for oxygen and carbon dioxide arterial/transcutaneous ratios with individual in vivo calibrations from the first arterial sample. In infants beyond the neonatal period and older children in vivo calibration confers little benefit over the use of a global calibration correction factor for transcutaneous carbon dioxide, and may reduce the precision with which arterial oxygen can be estimated from transcutaneous oxygen.

Arteries↗