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N J Snell

Publications and source records attributed to N J Snell.

16 recordsLinked to original sources
PubMed1990

Economic and long-term benefits of ribavirin therapy on respiratory syncytial virus infection.

Ribavirin is a broad-spectrum antiviral agent. Administered as an aerosol, it has been shown to be clinically effective in improving the signs and symptoms of viral bronchiolitis in infancy, particularly cases due to respiratory syncytial virus (RSV). This paper reviews the evidence for economic and/or long-term clinical benefits from using ribavirin in the acute illness. There are data to suggest that use of ribavirin may lead to a reduction in therapeutic interventions and duration of hospital stay, with associated savings in hospital costs. Ribavirin reduces the production of RSV-specific IgE, and (in vitro) inhibits the release of inflammatory mediators from mast cells, suggesting that there could be beneficial effects on the incidence of postbronchiolitis wheezing. Confirmatory studies are in progress.

Administration, Inhalation↗
PubMed1990

In vitro and in vivo effects of ribavirin on human respiratory epithelium.

The effects of ribavirin, a broad spectrum antiviral agent, on the structure and function of normal human nasal epithelium have been studied in vitro, as has also the in vivo effect of treatment with nebulised ribavirin on nasal mucociliary clearance of saccharin in four patients. Ciliary beat frequency was measured by a photometric technique, and changes in epithelial and ciliary ultrastructure were assessed by transmission electron microscopy. Ribavirin solution at the recommended concentration of 20 mg/ml had no adverse effects on ciliary activity in vitro; at concentrations of 50 mg/ml and above it slowed ciliary beating significantly and at 60 mg/ml caused ciliostasis associated with epithelial disruption. Nasal inhalation of ribavirin at 60 mg/ml for up to 20 minutes, however, did not slow nasal mucociliary clearance, nor did it adversely affect the ciliary beating or structure of nasal ciliated epithelium examined in vitro immediately after inhalation.

Aged↗
PubMed1989

Randomised controlled trial comparing prednisolone alone with cyclophosphamide and low dose prednisolone in combination in cryptogenic fibrosing alveolitis.

In a randomised, controlled study alternate day prednisolone with an initial high dose phase ("prednisolone only series") has been compared with cyclophosphamide plus alternate day low dose prednisolone ("cyclophosphamide-prednisolone series") in 43 patients with previously untreated fibrosing alveolitis (five patients had received prednisolone in minimal dosage). In the prednisolone only series prednisolone 60 mg daily was given for one month and then reduced by 5 mg a week to 20 mg on alternate days or the minimum dose to maintain early improvement. Patients in the cyclophosphamide-prednisolone series received 100, 110, or 120 mg cyclophosphamide daily (depending on body weight) plus 20 mg prednisolone on alternate days. Treatment was continued indefinitely, or changed to the alternative regimen if the patient deteriorated, failed to improve, or developed drug toxicity. For response to treatment (as judged by change in breathlessness score, radiographic appearance, and lung function) patients were classified as improved, stable, or deteriorating. Deaths from cryptogenic fibrosing alveolitis were also analysed. Improvement had occurred at one or more assessments in seven of the 22 patients in the prednisolone only series and in five of the 21 patients in the cyclophosphamide-prednisolone series. At three years, however, only two of the 22 patients in the prednisolone only series were still improved and three stable, compared with one and seven of the 21 patients in the cyclophosphamide-prednisolone series (three of the seven had stopped treatment because of toxicity). Life table analysis suggested better survival in patients in the cyclophosphamide-prednisolone series but this was not significant. At three years 10 of 22 patients in the prednisolone only series had died compared with three of 21 patients in the cyclophosphamide-prednisolone series. With death or failure of first treatment regimen as outcome there was a significant advantage to the patients having cyclophosphamide-prednisolone. This advantage was explained in part by the better lung volumes in this group on admission. After allowance had been made for total lung capacity (TLC), no other factor was predictive of outcome. Analyses of subgroups according to TLC on admission showed that patients with a TLC below 60% predicted did badly and those with a TLC of 80% or more predicted did well with both regimens. Patients with an initial TLC of 60-79% predicted did better with the cyclophosphamide-prednisolone regimen. Side effects were uncommon in both series and those due to cyclophosphamide resolved when treatment was stopped. The combination of cyclophosphamide with prednisolone may be an alternative to prednisolone alone with an initial high dose phase. Many patients, however, failed to respond to either treatment.

Adult↗
PubMed1979

A comparison of Mantoux and tuberculin Tine testing in a chest unit.

Simultaneous Mantoux (10 T.U.) and Tuberculin Tine tests were performed on 393 in-patients on a chest unit. The results were read by the same observer between 48 and 72 hours later. The overall agreement between the tests was 78%; this rose to 90% if patients categorised as 'doubtful' reactors were reclassified as positive. Where one test was 'doubtful' the other was more than 3 times as likely to be positive as negative. It is suggested that the 'doubtful' category by abandoned for both tests and readings in this range be reclassified as positive. In patients expected on clinical grounds to be positive reactors, over one-third were negative to both tests; in those expected to be negative over one-fifth were positive. The Tine test is convenient and gives results which seem to correlate well with the Mantoux test, although neither test appears to be highly specific.

Adult↗
PubMed1979

Tuberculin reactivity as a predictor of survival time in inoperable bronchial carcinoma.

One hundred and two patients with inoperable bronchial carcinoma who had tuberculin tests at the time of diagnosis were followed up to see if there was any correlation between their degree of tuberculin reactivity and their subsequent survival time. There was a significant difference in survival between positive and negative tuberculin reactors (Log Rank Test P less than 0.05), the former having a median survival time almost twice that of the latter. This did not appear to be related to clinical differences between the groups at the time of testing, and other possible explanations are discussed. Tuberculin testing may be useful in helping to assess prognosis in patients with inoperable bronchial tumours.

Aged↗
PubMedDate not supplied

Pediatric tuberculosis in immigrants to the United Kingdom from the Indian sub-continent.

Tuberculosis (TB) is now an uncommon disease in the United Kingdom (U.K.) and its overall incidence is declining. However, the incidence of TB in immigrants from India, Pakistan, and Bangladesh (the Indian sub-continent, ISC) is much higher than in the native white population or immigrant groups from other areas, and this is so even for children of ISC ethnic origin born in the U.K. The clinical pattern of the disease also differs, extrapulmonary involvement being commoner in ISC patients than white patients. The epidemiology and management of TB in pediatric patients of ISC origin is reviewed and reasons for differences from other ethnic groups in the U.K. are discussed.

Adolescent↗