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Biomedical subjects

J Akhter

Publications and source records attributed to J Akhter.

16 recordsLinked to original sources
PubMed1992

Non-invasive evaluation of cardiac abnormalities in heat stroke pilgrims.

Serial electrocardiograms as well as echocardiographic studies of 51 pilgrims suffering from acute heat stroke (mean rectal temperature 41.6 degrees C) were performed. All patients were examined immediately after cooling and 24 h later whenever possible. Regional wall motion abnormalities were detected in 9 cases (17.6%) while pericardial effusion was observed in 13 cases (25%) and asymmetrical septal hypertrophy was detected in 8 cases (15.6%). Other cardiac abnormalities included right ventricular dilatation and increased in left ventricular internal dimensions in 4 cases (7.8%), respectively. Thirteen cases (25.5%) had normal echocardiographic findings. Forty (78%) patients had sinus tachycardia while 8 cases (15.7%) showed atrial fibrillation with uncontrolled ventricular rate, and 3 (5.8%) had sinus bradycardia. Heat stroke electrocardiograms showed tracings demonstrating ST segment depression, compatible with ischaemia in 9 cases, while in 6 cases there were nonspecific T wave changes, whereas in another 4 cases the tracings demonstrated different conduction abnormalities. The collected data were analysed and compared to those of 43 control patients. The adverse effects of heat stroke on the heart are multifactorial requiring the utmost attention and understanding, as they reflect the patient's cardiovascular status.

Aged↗
PubMed1991

Latex agglutination and hemagglutination tests for the rapid identification of methicillin sensitive and methicillin resistant Staphylococcus aureus.

Ten latex agglutination (LA) and hemagglutination (HA) kits for the identification of Staphylococcus aureus were compared with reference methods for their reliability and performance. The ten commercial kits consisted of Accu-Staph, Bacto-Staph, Hemastaph, Staphaurex, Staph-Latex, Staphylochrome, Staphyloslide, Staph-Rapid, Sero-Stat and Veri-Staph. The conventional methods included slide coagulase test, tube coagulase test (4 hr, 24 hr), thermonuclease and growth on mannitol salt agar (MSA). A total of 583 clinical isolates of staphylococci were used and all the kits correlated well with the conventional methods (93.1-99.4% sensitivity) in their ability to identify both methicillin sensitive (MSSA) and methicillin resistant S. aureus (MRSA). Although all were rapid, easy to perform and simple to interpret, Staphaurex and Staphyloslide gave the best sensitivities and specificities.

Agglutination Tests↗
PubMed1989

The efficacy and safety of home nebulizer therapy for children with asthma.

We evaluated the efficacy and safety of nebulized beta-agonists used in the homes of 22 children with asthma. Patients served as their own controls for the comparison of asthma-related variables between periods of 12 months before and 12 months after the initiation of home nebulizer therapy. Significant reductions in the numbers of emergency department visits, hospital admissions, and short courses of prednisone therapy occurred when home nebulizer therapy was provided. The younger the patients, the more frequently improvement occurred. After the initiation of home nebulizer therapy there was no change in the severity of illness when patients presented to the emergency department or in the number of episodes of respiratory failure. Home nebulizer therapy for children with asthma appears safe and reduces the need for hospital care and short courses of prednisone therapy.

Adolescent↗
PubMed1989

Persistent peripheral airway obstruction in children with severe asthma.

We reviewed pulmonary function data on 447 children with the diagnosis of asthma, who were studied in our laboratory over a 6-year interval. We found 19 with evidence of consistent airway obstruction. Two patients who had obvious causes for persistent obstruction were excluded. Seven of the remaining 17 patients consented to further studies. In six of the seven patients studied, flow rates at low lung volumes were severely depressed and remained unchanged after 2 weeks of vigorous "inpatient" therapy. No clinical benefit was apparent. One patient had relentlessly worse disease and died of his asthma. The autopsy revealed changes characteristic of asthma. We conclude that some children with severe asthma have persistent and severe peripheral airway obstruction. These findings challenge the current paradigm that asthma in children is a completely "reversible" illness. Long-term follow-up of children with persistent chronic obstruction may clarify the question of childhood origin of adult lung disease.

Adolescent↗
PubMed1988

Respiratory failure from asthma. A marker for children with high morbidity and mortality.

During a seven-year interval, 78 children had documented episodes of respiratory failure from asthma, defined as arterial hypoxemia, hypercapnia, or use of mechanical ventilatory support or intravenous isoproterenol hydrochloride. During 407 patient-years of follow-up (5.2 years per patient), these 78 children had 227 episodes of respiratory failure (2.9 episodes per patient). Fifty-three patients (68%) have had two or more of such episodes. Second episodes usually followed the initial episodes within two years, but some were delayed for over six years. Seven of the 78 children died, and two others have incurred hypoxic brain damage, compared with two deaths among 2892 children with asthma--seen at this hospital during that interval--but without a documented previous episode of respiratory failure. We conclude that children whose asthma has caused even one episode of respiratory failure constitute a special group of asthmatic patients, members of which are at high risk for repeated episodes of respiratory failure and its catastrophic complications. This recognition allows special attention to be focused on them in designing both clinical and research strategies.

Adolescent↗
PubMed1986

Outcomes of emergency room visits for asthma. I. Patient determinants.

To learn how differences among individual patients influence the outcomes of their emergency room (ER) visits for asthma, we matched the results of 1209 sequential ER visits with the records of the 464 children and young adults who visited during a 37-week interval. Most patients visited the ER only once and were unlikely to be admitted. Those patients admitted once were unlikely to be admitted a second time. Only 119 patients (25.6%) made 54.7% of all ER visits and were responsible for 68.5% of admissions; they also accounted for all but eight of 92 relapses. Patients were accordingly stratified into group F, frequent visitors, and group I, infrequent visitors. A separate high-risk category (group HR) was composed of 50 other patients who received especially conservative treatment in the ER owing to prior episodes of severe asthma. HR patients included both frequent and infrequent visitors and had a very high probability of being admitted on any given visit. The patients of group F, each of whom visited the ER at least four times during the 37 weeks initially studied, were also consistently frequent visitors for comparable periods before and after the initial period. Their rate of ER relapses for exceeded their visiting rate, at least in part because some patients tended to relapse on repeated occasions. Patterns of ER use allow differentiation among groups of patients with distinctly different prognoses. These groups are similar to prognostic categories reported by previous authors. Such differences among individual patients must be taken into account when management systems are evaluated or clinical strategies are organized.

Adolescent↗
PubMed1986

Outcomes of emergency room visits for asthma. II. Relationship to admission criteria.

To learn how the outcomes of emergency room (ER) care relate to the decision-making process, criteria for the disposition of asthma in the ER were incorporated into a formal protocol in the form of an algorithm for use by pediatric resident physicians. We compared the application of those criteria with the consequences of 199 decisions to admit patients to the hospital for asthma and of 293 decisions to discharge patients from the ER. For most patients the chance of relapse was significantly raised if they were discharged from the ER when the protocol had specified admission. This was not true, however, for a group of "frequent visitors" (12.7% of all patients) who accounted for 66.3% of all relapses. This finding offers an explanation for previous difficulties in identifying characteristics of visits destined to be followed by relapse. Patients were placed in jeopardy by inappropriate ER discharges only if they were high-risk patients who had experienced prior episodes of respiratory failure. Nearly all admissions involving severe episodes of asthma were also limited to high-risk patients. A variety of criteria supported such admissions. At the other extreme, "avoidable" admissions, in which obstruction resolved within a few hours of admission, occurred equally among all patient strata, and no particular admission criterion could be held at fault for admission of such rapidly remitting cases. The results support the use of explicit, quantitative criteria for guiding ER disposition of asthma, especially specific arrangements for management of ER visits by high-risk patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

High incidence of false positives by a latex agglutination test for the diagnosis of Clostridium difficile associated colitis in compromised patients.

Detection of Clostridium difficile cytotoxin using cell culture assays for the diagnosis of antibiotic-associated colitis has been used for over a decade. Because the methodology is time consuming and cumbersome, a recently introduced commercial latex agglutination (LA) kit has attracted much attention. We compared the sensitivity and specificity of this method with the cytotoxic assay (CTA) using diarrheal stools from 652 patients at a referral tertiary care center. Specimens from 71 (10.9%) patients were found positive with CTA and 98 (15%) by LA. Of these, 67 stools were positive by both methods. Four specimens showed cytotoxicity but were negative by LA. Of the 31 patient specimens that were positive by LA but negative by CTA, 22 were obtained from leukemic bone marrow transplant and four from renal transplant patients [corrected]. Sixteen of these patients had Giardia lamblia (four), Salmonella enteritidis (three), Blastocystis hominis (five), Rotavirus (two), and Shigella boydii (two) in their stools [corrected]. No significant organisms were found in the rest of the LA-positive and CTA-negative specimens.

Bone Marrow Transplantation↗
PubMedDate not supplied

Tracheal obstruction secondary to esophageal achalasia.

A 12-year-old girl presented with cough, emesis, and weight loss of 18-month duration. She was diagnosed as having achalasia of the esophagogastric junction. Flow-volume loops done because of the cough revealed a configuration consistent with variable intrathoracic tracheal obstruction. A barium swallow revealed the cause of obstruction to be massive dilatation of the esophagus. Balloon dilatation of the esophageal sphincter resolved all symptoms and normalized the flow-volume loops. This case illustrates that some pulmonary symptoms in achalasia can be due to direct tracheal obstruction in addition to the usual aspiration of esophageal contents.

Airway Obstruction↗