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Biomedical subjects

S Kalra

Publications and source records attributed to S Kalra.

At least 55 records · Page 3Linked to original sources
PubMed1995

Rapid onset of tolerance to the bronchoprotective effect of salmeterol.

INTRODUCTION: Twice-daily inhaled salmeterol for 4 weeks produces marked reduction in its acute bronchoprotective effect against methacholine. This investigation examined the onset of this effect over 5 days, and also assessed cross-tolerance with salbutamol. SUBJECTS AND METHODS: Ten asthmatic volunteers who were able to withhold beta 2-agonist therapy for 4 weeks before and during the study participated in a double-blind, crossover, placebo-controlled study with two random-order treatment periods: inhaled salmeterol, 50 micrograms twice a day for seven doses, and placebo in similar fashion. Methacholine inhalation tests were done 1 h after doses 1, 3, 5, and 7, and then 24 h after the last dose of the study inhaler 10 minutes after 200 micrograms of salbutamol. RESULTS: Baseline FEV1 value before doses 3, 5, and 7 of salmeterol (ie, 12 h after salmeterol) was significantly higher than all other (n = 7) values. Twenty-four hours after the last dose of salmeterol, the FEV1 was no different from that during the placebo period. The geometric mean methacholine concentration causing a 20% fall in FEV1 (PC20) after the first dose of salmeterol (6.1 mg/mL) was statistically similar to the value achieved 10 min after salbutamol after the placebo period (8.3 mg/mL), and these were significantly (analysis of variance, p < 0.00005) larger than the second, third, and fourth salmeterol days (3.4 mg/mL, 2.6 mg/mL, 1.9 mg/mL, respectively). The methacholine PC20 10 min after salbutamol measured after the salmeterol period was significantly lower than after placebo (2.3 mg/mL vs 8.3 mg/mL; p < 0.001). CONCLUSIONS: Tolerance to the acute bronchoprotective effect of salmeterol was significant after the first two doses and progressively increased to the seventh dose. Tolerance to the acute bronchoprotective effect of salbutamol was significant after regular use of salmeterol for seven doses.

Adrenergic beta-Agonists↗
PubMed1993

Double-blind trial of steroid tapering in acute asthma.

It is customary to tail off the dose of oral steroids after treatment of an acute exacerbation of asthma; the main reason for this practice is to avoid rebound asthma. We have carried out a randomised double-blind study to find out whether a tapering course of oral prednisolone has any advantage over an abruptly terminated course of prednisolone for an episode of acute asthma requiring hospital admission. We studied 35 patients admitted to hospital with acute asthma; their mean peak expiratory flow rate (PEFR) on admission was 173 L/min and their mean age was 32 years (range 18-55); all were using inhaled steroids on discharge (mean dose 908 micrograms daily). Each patient received 40 mg enteric-coated prednisolone daily for 10 days followed by a tapering course of either prednisolone 5 mg tablets (active taper) or identical placebo tablets (placebo taper), reducing from 7 tablets on day 11 to no tablets by day 18. The primary outcome measure was the PEFR on waking. Both groups responded well to treatment by day 10 (mean morning PEFR: active taper group 396 L/min, placebo taper group 391 L/min). There was no further significant change in PEFR in either group during the 7 days of active or placebo tapering or during the following 10 days (repeated measures analysis of variance, active vs placebo, p = 0.82). The groups were also similar in terms of secondary outcome measures--symptom scores, PEFR after morning bronchodilator treatment, evening PEFR, and treatment failures. This study suggests that steroid tapering is unnecessary in acute asthma; a personal asthma management plan with a reserve course of prednisolone may be more appropriate.

Acute Disease↗
PubMed1993

An outbreak of haemonchosis associated with anthelmintic resistance in sheep.

An outbreak of haemonchosis associated with anthelmintic resistance was recorded in a flock of 150 crossbred lambs. Closantel and ivermectin were 100% effective against Haemonchus contortus while fenbendazole and morantel reduced faecal egg counts by 87 and 29%, respectively. Levamisole showed an efficacy of 95%. At double the recommended dose (10 mg kg-1), fenbendazole had an efficacy of 99% against H. contortus infection. This appears to be the first report of an outbreak of haemonchosis associated with fenbendazole and morantel resistance in a strain of H. contortus in sheep.

Animals↗
PubMed1993

Concentrations of the domestic house dust mite allergen Der p I after treatment with solidified benzyl benzoate (Acarosan) or liquid nitrogen.

BACKGROUND: Various methods of killing the house dust mite to reduce exposure to allergen are being promoted even though complete data on their effects on allergen concentrations are not available. A study was designed to measure the concentrations of the main house dust mite allergen Der pI in homes treated with either solidified benzyl benzoate (Acarosan) or liquid nitrogen. METHODS: Der pI concentrations were measured in dust collected from mattresses, bedroom carpets, and living room carpets in 10 houses treated with Acarosan and 10 houses treated with liquid nitrogen. Samples were collected before the treatment (in July 1990) and three and six months afterwards (October 1990 and January 1991). Forty untreated houses were concurrently sampled as controls. RESULTS: Der pI concentrations were similar in the three groups at baseline. No significant fall was seen in either of the two treated groups three or six months after treatment. Concentrations in the control houses increased significantly--twofold to threefold in dust sampled from mattresses and bedroom carpets between baseline and October 1990. This increase was not seen in either of the treated groups of houses, but there was no significant difference in the Derp pI concentrations in these houses and the control houses from any site at any time point. CONCLUSIONS: Neither Acarosan nor liquid nitrogen reduced the concentrations of Der pI for as long as six months after application. A small effect was probably present as the rise seen in control houses in the three month samples was not found in the treated houses. This effect, however, is likely to be of little clinical importance and also to be transient as the trend was lost by six months.

Allergens↗
PubMed1993

Pulmonary diffusion abnormalities in heart transplant recipients. Relationship to cytomegalovirus infection.

Lung function of patients with heart failure is characterized by a variety of changes proposed as being due to passive congestion, secondary pulmonary fibrosis, and/or recurrent pulmonary emboli. A diffusion impairment thought to be due to cyclosporine has also been noted in patients following heart transplantation. Similar changes of unclear origin have been observed in renal transplant recipients. The objective of this study was to determine the extent to which lung function changes are reversible by cardiac transplantation and relate changes to the status of the recipients lung in the presence of possible vascular, iatrogenic, immune, or infectious injury. We analyzed the data of 22 patients who underwent lung function testing before and after heart transplantation and correlated changes to hemodynamic change, episodes of rejection, concentration of cyclosporine, and cytomegalovirus infection. Despite excellent graft function, the carbon monoxide transfer factor deteriorated to a mean of 57 percent of predicted postoperatively. The fall in diffusion factor did not correlate with episodes of cardiac rejection, cyclosporine levels, or hemodynamic status. In those patients who had serologic evidence of cytomegalovirus infection, the reduction in transfer factor was greater compared to those without infection despite a normal chest radiograph. The effects of cardiopulmonary bypass were unlikely to have been responsible for the abnormalities as lung function was assessed at a mean of 14 months after surgery. In heart transplant recipients, a change in diffusion capacity may represent an additional marker for cytomegalovirus infection and reflect infectious/immune injury late following surgery.

Cyclosporine↗
PubMed1993

The management of cryptogenic fibrosing alveolitis in three regions of the United Kingdom.

The case notes of 200 patients with cryptogenic fibrosing alveolitis, from three regions in the United Kingdom, were reviewed, in order to determine how physicians manage this uncommon condition. In the majority of cases (119), the diagnosis was based solely on clinical grounds, with no attempt at histological confirmation of the diagnosis. Transbronchial biopsy was attempted in 66 patients, but was unhelpful in confirming a diagnosis of pulmonary fibrosis in 30% of these patients. Thirty five patients underwent bronchoalveolar lavage, and 15 had an open lung biopsy. Of the 132 patients treated, 110 received prednisolone alone, and the rest a combination of other immunosuppressive agents. The doses and duration of therapy varied considerably. These results suggest that, in the late 1980s, there were wide variations of practice in the management of cryptogenic fibrosing alveolitis in the United Kingdom. This is likely to reflect a paucity of information on the optimum management of this uncommon condition.

Adult↗
PubMed1992

Absence of seasonal variation in concentrations of the house dust mite allergen Der p1 in south Manchester homes.

BACKGROUND: House dust mite numbers and the concentration of its main allergen, Der p1, depend on ambient temperature and humidity and have been reported to show a seasonal variation in homes in the United States. A study was designed to find out whether Der p1 concentrations vary with the seasons in dust collected from homes in north west England. METHODS: The concentration of Der p1 was measured in dust, collected every three months from April 1990 to April 1991, from mattresses and from bedroom and living room carpets in 40 houses in the south Manchester area. Twenty four hour recordings of indoor relative humidity were made in 20 houses during the sampling day. RESULTS: Mean concentrations of Der p1 from all three sources rose two to three fold in October. This was in contrast to the 1000 fold variation in concentrations of Der p1 present between houses within each season's sample and less than the 10 fold change considered to be of clinical importance. The autumn increase was paralleled by a rise in humidity. There was no statistical correlation, however, between Der p1 concentrations and relative humidity, house type, ventilation, or double glazing. CONCLUSIONS: The results suggest that seasonal variations in exposure to Der p1 exposure in north west England are small and unlikely to be of major clinical importance. The temperature and humidity data showed that the indoor environment remained relatively constant and conducive to mite growth throughout the year.

Allergens↗
PubMed1992

An unusual cause of bilateral diaphragmatic paralysis.

In a patient who had a sudden onset of bilateral diaphragmatic paralysis after forceful neck manipulation complete, though gradual, recovery in lung function and transdiaphragmatic pressures was seen over three years. This is a previously unrecognised risk of neck osteopathy.

Aged↗
PubMed1991

Altered fetal growth: antenatal diagnosis by symphysis-fundal height in India and comparison with western charts.

Antenatal identification of altered fetal growth is a significant problem in spite of the availability of sophisticated technology. The present study was undertaken to generate symphysis-fundal height curves locally for an Indian population and to assess their value in predicting altered fetal growth. The measurements were found to have a high sensitivity of 80.8% and specificity of 93.5% in detection of small for date babies and a sensitivity and specificity of 72.2% and 95.2%, respectively in detection of fetal macrosomia. The locally generated symphysis-fundal height charts have been compared with the western charts and the differences stressed. It is concluded that symphysis-fundal height curves should be locally generated for best results.

Anthropometry↗
PubMed1990

Management of cyclical menorrhagia with prostaglandin synthetase inhibitor.

A well controlled double blind prospective trial was undertaken to determine the efficacy of mefenamic acid in the treatment of menorrhagia. Eighty patients who had unexplained cyclical menorrhagia with secretory endometrium received mefenamic acid orally in a dose of 500 mg 8 hourly or a placebo tablet thrice daily starting from day-one of the cycle for 5 days or till cessation of menses. Mefenamic acid administration caused a statistically significant reduction in the number of days of bleeding from 9.7 +/- 3.1 days before treatment to 4.1 +/- 0.6 days after treatment. It also brought about significant reduction in the amount of bleeding in terms of number of pads used per day, that is from 15.2 +/- 3.1 before treatment to 6.5 +/- 0.02 after treatment. Eighty-six percent patients in the treatment group had control of menorrhagia with the drug compared to 20% in the control group without drugs and this difference was statistically significant. Mefenamic acid proved to be a potent and efficacious agent in the control of unexplained menorrhagia.

Adult↗
PubMed1988

Median cleft lip with bimanual hexadactyly and bilateral accessory toes. Report of two cases in the same family.

The present paper presents two brothers with a median upper lip cleft, associated with postaxial hexadactyly of both hands and feet. Very few similar cases have previously been reported in the literature by various workers. The similarity between the cases reported in the literature and the two cases presented here indicates the existence of a median cleft lip-hexadactyly-syndrome.

Child↗
PubMed1988

Use of visual analogue scales for assessment of the severity of asthma.

Use of visual analogue scales (VAS) can provide reliable assessment of dyspnea. In order to determine if VAS can be used for clinical assessment of asthma we administered the scale to 40 stable asthmatics and found a good correlation (r = -0.72) with the peak expiratory flow rate (PEFR) readings expressed as per cent of predicted normal. The scales were also used to assess severity in 12 acutely ill asthmatics. Values of VAS and PEFR were recorded at the time of admission and twice daily thereafter till discharge from the hospital. The correlation of the two parameters was less than that obtained in stable asthmatics, but graphic parallelism was remarkable.

Adolescent↗
PubMed1988

Single dose kinetics of rifampicin and isoniazid in well-nourished and malnourished patients of tuberculosis.

A single dose kinetics of isoniazid and rifampicin alone, and combination was studied in well-nourished and malnourished patients of tuberculosis. The elimination half-life of isoniazid was significantly increased when administered in combination with rifampicin in well-nourished and malnourished patients, while no significant difference was observed in any of the pharmacokinetic parameters of rifampicin in combination with isoniazid or alone in both groups of patients. Results are discussed on the basis of pharmacokinetic drug interaction.

Acetylation↗