H Vyas

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Roleoflabour intheestablishment offunctional residual capacity atbirth

G272 Intensive care admissions in children with down syndrome: trends in incidence and outcome

Archives of Disease in Childhood, 2020

prevalence of coeliac disease (CD). Recent meta-analysis estimates prevalence at 5.8%. The DS Med... more prevalence of coeliac disease (CD). Recent meta-analysis estimates prevalence at 5.8%. The DS Medical Interest Group (DSMIG), does not recommend routine screening, despite guidance from the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). HLA-DQ haplotyping for CD has been offered for the last 3 years. Method Children with DS identified from Support Needs System (SNS). In 2016, families were invited for HLA DQ haplotyping for DQ2.2 2.5& 8 (and coeliac serology). Subsequently, families invited though discussions in clinic. Children with positive typing are offered coeliac serology every 3 years (or sooner if symptomatic). Results 35 (17 female/18 male) DS children were identified. (1 child excluded as already diagnosed). 28 (76%) children have been tested. 12 (39%) had negative haplotypes, excluding them from life-long screening. 16 (57%), tested positive (table 1). Mean age at testing was 7 years.

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Hormonal abnormalities of the pancreas and gut in cystic fibrosis

Gastroenterology

We have investigated the effect of cystic fibrosis on alimentary hormones in 10 children by measu... more We have investigated the effect of cystic fibrosis on alimentary hormones in 10 children by measuring the pancreatic and gut hormone rsponse to a milk drink. Plasma insulin and gastric inhibitory peptide were both significantly reduced (P &amp;amp;amp;amp;lt; 0.05 and P &amp;amp;amp;amp;lt; 0.005, respectively, at 15 min) in the patients with cystic fibrosis, compared with controls, even though the early glucose rise was greater in the former group (P &amp;amp;amp;amp;lt; 0.05 at 15 min). Fasting levels of pancreatic polypeptide were significantly lower in the fibrocystic children (P &amp;amp;amp;amp;lt; 0.01), and the normal response to milk was completely abolished in these patients (P &amp;amp;amp;amp;lt; 0.001). Fasting plasma enteroglucagon concentrations were grossly abolished in the cystic fibrosis patients (P &amp;amp;amp;amp;lt; 0.001) and these remained elevated throughout the test. No significant differences were seen in basal or postmilk responses of plasma glucagon, gastrin, secretin, vasoactive intestinal peptide, or motilin in cystic fibrosis. It would thus appear that the pancreatic polypeptide cell is more susceptible to the effects of the disease process than the beta or alpha cell in cystic fibrosis. Some aspects of the abnormalities in the gastrointestinal endocrine system were similar to those seen in celiac disease and tropical sprue and may, therefore, effect a similar hormonal response in these patients with cystic fibrosis to those with mucosal damage.

Management of intracranial hypertension and cerebral oedema

Current Paediatrics

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P157 Individual patterns of inhaler use and health outcomes in adolescents with asthma: Abstract P157 Table 1

Thorax

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313 An international study of survival of children with cystic fibrosis after the first episode of invasive mechanical ventilation

Journal of Cystic Fibrosis, 2015

The outcome of cystic fibrosis (CF) patients who require invasive mechanical ventilation (IMV) is... more The outcome of cystic fibrosis (CF) patients who require invasive mechanical ventilation (IMV) is generally considered to be poor, although limited data are available. Objectives To determine a current estimate of survival in the UK, Ireland, Australia and New Zealand amongst children with CF requiring IMV, in a setting where both CF services and intensive care are well resourced. Methods Analysis of data from two clinical databases collected on Paediatric Intensive Care Unit (PICU) admissions in the UK and Ireland (PICANet database) and Australia and New Zealand (ANZPIC database). The primary outcome was survival at discharge from PICU of patients after their first episode of IMV. Results There were 139 CF admissions to intensive care in the PICANet study population. The survival to discharge for these patients was 121/139 (87.1%; 95% Confidence Interval: 80.5 to 91.7%). There were 84 CF admissions to intensive care in the ANZPIC study population. The survival to discharge for these patients was 79/84 (94.0%; 95% CI 86.8 to 97.4%). Survival was better for younger age groups (log-rank test p Conclusion The survival at discharge from paediatric intensive care for non-transplant admissions that required mechanical ventilation in patients with CF is better than previously reported. IMV should not be withheld solely due to a diagnosis of CF.

Understanding and managing acute fluid and electrolyte disturbances

Current Paediatrics, 2003

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Dyspnoea in the competitive paediatric athlete

Paediatrics and Child Health, 2012

Adolescent athletes are participating in sport in highly competitive environments. Dyspnoea assoc... more Adolescent athletes are participating in sport in highly competitive environments. Dyspnoea associated with exercise is a common reason they are referred to paediatricians and respiratory specialists. The presentation with dyspnoea in adolescent athletes needs teasing out on history, examination and investigations from numerous conditions including exerciseinduced bronchoconstriction, exercise-induced asthma (where exercise is a trigger for exacerbation of pre-existing asthma), vocal cord dysfunction, laryngeal dysfunction and physiological limitation to exercise. Exercise-induced bronchoconstriction is diagnosed by evaluating the magnitude of fall in FeV1 post exercise. This bronchoconstriction can be completely ameliorated by short acting beta agonists given prior to exertion. Their use is permitted by the WADA but there are concerns over tachyphylaxis with long-term use. Warm up before strenuous exercise can also help in limiting the degree of bronchoconstriction. Athletes with pre-existing atopic asthma benefit from inhaled corticosteroids and leukotriene receptor antagonists. Exercise associated upper airways obstruction maybe due to abnormal adduction of vocal cords or prolapse of the arytaenoid (subglottic) region. There may be psychological overlay. Diagnosis is by flexible nasoendoscopy and assessing the flow volume loops. Management is by reassurance and speech therapy. Exercise-induced hyperventilation and physiological limitations to exercise may also lead to perception of dyspnoea. Absence of cardiopulmonary abnormalities during exercise points towards these diagnosis.

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Inhaled beta-2 agonists for treating non-specific chronic cough in children

Reviews, 1996

The pathophysiology of so called &#39;cough variant asthma&#39; has not received a great ... more The pathophysiology of so called &#39;cough variant asthma&#39; 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 To determine the effectiveness of inhaled ss2 agonists in non-specific chronic cough in children over the age of 2 years. 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 &quot;Grey literature&quot; including theses, internal reports, non-peer reviewed journals were sought. 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 for trials of salbutamol versus placebo were extracted by both reviewers and entered into the Cochrane Collaboration software program Review Manager, version 4.2 In children presenting with isolated chronic cough there was no significant difference between salbutamol treated group and placebo group. Salbutamol was no different from placebo in reducing the frequency of cough measured objectively or scored subjectively.

Sedation in critically ill children

Current Paediatrics, 2000

 Sedation issues in critically ill children  Assessment of sedation  Targeting sedation  Drug... more  Sedation issues in critically ill children  Assessment of sedation  Targeting sedation  Drugs  Upsides  Downsides  Known unknowns  Baby SPICE Case  13 year old boy  Relapsed ALL  Respiratory failure post-BMT  SIMV 6 mls/kg  PEEP 12  FiO2 0.75  Cardiovascular failure  Dobutamine 5 mcg/kg/min  Noradrenaline 0.2 mcg/kg/min  ARF-CVVHD  Sedation/analgesia/muscle relaxation  Fentanyl 2 mcg/kg/hr  Dexmedetomidine 1.0 mcg/kg/hr  Midazolam 150 mcg/kg/hr  Propofol 1 mg/kg/hr  Pancuronium .15 mg/kg 1-3 hourly/prn  Frequent episodes of desaturation associated with movement  Episodes of hypotension with sedation boluses  Parents extremely upset that he is not adequately sedated and distressed  Ideas?  Issues  Is sedation optimum?  Are there better drugs?  Adverse effects  Metabolism  Potential for idiosyncratic effects  Role of delirium

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Comparison of oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children (PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial

Thorax, 2007

To ascertain whether therapeutic equivalence exists for the treatment of paediatric community acq... more To ascertain whether therapeutic equivalence exists for the treatment of paediatric community acquired pneumonia by the oral and intravenous (IV) routes. Methods: A multicentre pragmatic randomised controlled non-blinded equivalence trial was undertaken in eight paediatric centres in England (district general and tertiary hospitals). Equivalence was defined as no more than a 20% difference between treatments of the proportion meeting the primary outcome measure at any time. 246 children who required admission to hospital and had fever, respiratory symptoms or signs and radiologically confirmed pneumonia were included in the study. Exclusion criteria were wheeze, oxygen saturations ,85% in air, shock requiring .20 ml/kg fluid resuscitation, immunodeficiency, pleural effusion at presentation requiring drainage, chronic lung condition (excluding asthma), penicillin allergy and age ,6 months. The patients were randomised to receive oral amoxicillin for 7 days (n = 126) or IV benzyl penicillin (n = 120). Children in the IV group were changed to oral amoxicillin after a median of six IV doses and received 7 days of antibiotics in total. The predefined primary outcome measure was time for the temperature to be ,38˚C for 24 continuous hours and oxygen requirement to cease. Secondary outcomes were time in hospital, complications, duration of oxygen requirement and time to resolution of illness. Results: Oral amoxicillin and IV benzyl penicillin were shown to be equivalent. Median time for temperature to settle was 1.3 days in both groups (p,0.001 for equivalence). Three children in the oral group were changed to IV antibiotics and seven children in the IV group were changed to different IV antibiotics. Median time to complete resolution of symptoms was 9 days in both groups. Conclusion: Oral amoxicillin is effective for most children admitted to hospital with pneumonia (all but those with the most severe disease who were excluded from this study). Prior to this study, the British Thoracic Society guidelines on childhood pneumonia could not draw on evidence to address this issue. This will spare children and their families the trauma and pain of cannulation, and children will spend less time in hospital.

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1378 Apnoea and bradycardia in pre-term babies

Pediatric Research, 1981

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1377 Effects of prolonged and slow-rise inflation pressures on resuscitation of asphyxiated newborn babies

Pediatric Research, 1981

and Bell Labs, N.J. The Bilirubin Hematofluorometer measures albumin-bound bilirubin (AB) and tot... more and Bell Labs, N.J. The Bilirubin Hematofluorometer measures albumin-bound bilirubin (AB) and total blood bilirubin (TB), A risk factor for developing kernicterus is the level of non-AB, The fraction of TB not bound by albumin is defined as TB-AB/TB=llB, In two studies we found that llB increased during PT. In 23 jaundiced preterm infants, mean llB Q,B) increased during 4 to 24 hours o!._ phototherapy (Pre-PT, llB ± S.D, = 0,15 ± 0.10 and Post-PT, llB ± S,D, = 0.24 + 0.11 = P<0,005, by paired t-test), In a study of 17 jaundiced-pre-term infan~, llB was determined serially during 24 hours of continuous PT; llB increased by 0.1 ± 0.1 over Pre-PT

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1213 The Impact Upon Paediatric Intensive Care of Previous Admission to the Neonatal Intensive Care Unit - a 9 Year Study

Pediatric Research, 2010

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Chronic granulomatous disease with renal stones

Pediatric Radiology, 1992

A case of chronic granulomatous disease with hydronephrosis and renal calculi is presented. This ... more

Determinants of the first inspiratory volume and functional residual capacity at birth

Pediatric Pulmonology, 1986

We have investigated the pattern of pressure and volume changes that occur in vaginally delivered... more We have investigated the pattern of pressure and volume changes that occur in vaginally delivered, full-term infants during the onset of spontaneous respiration. Within a few seconds of delivery of the head, simultaneous measurements were made of stomach and esophageal pressure changes together with volume changes determined at the mouth. Values obtained for volume were very similar, but pressure changes were of a greater magnitude than previously reported. A significant correlation has been shown between first inspiratory volume and functional residual capacity (FRC) at the end of the first breath (p less than 0.004). No significant relationship was found between first inspiratory pressure and FRC. However, using a calculated index of inspiratory pressure and time (&amp;amp;amp;amp;amp;amp;quot;inspiratory effort&amp;amp;amp;amp;amp;amp;quot;), a significant relationship of this to FRC was observed (p less than 0.02).

Acute Purulent Pericarditis in Omani Children

Journal of Tropical Pediatrics, 1991

A total of eight children admitted to the Royal Hospital, Muscat with purulent pericardial effusi... more 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.

Lung expansion at birth

The Journal of Pediatrics, 1982

THE FIRST BREATH and the first cry have always had an almost mystical significance, signalling th... more THE FIRST BREATH and the first cry have always had an almost mystical significance, signalling the beginning of a new life. There has been a corresponding interest in the physiologic changes that occur during the adaptation from fetal to extrauterine existence. Some of the questions that have taxed investigators have been resolved, but inevitably their place has been taken by others. We know that the fetus initiates respiratory movements as early as 11 weeks' gestation) As a proportion of term, this age of onset is the same as in the fetal lamb: 0.27 of term. 2 With increasing gestational age these respiratory movements become more frequent, more vigorous, and very much more organized. Toward the end of gestation regular breathing is observed, with respiratory rates of 30 to 70/minute? However, within three days of labor the incidence of fetal breathing movements is greatly reduced; it falls from around 80% to 15% or 30% of the time? The breathing movements can be suppressed by hypoxia 4 and drugs Such as barbiturates? Fetal breathing is stimulated by hypercapnia, 6 although there is evidence that chemoreceptor sensitivity is reduced prior to birth. 7 Maternal smoking will enhance the rate of fetal breathing, but there is a corresponding redaction in fetal movements as perceived by the mother. ~ The majority of fetal breathing movement occurs during rapid eye movement sleep, 2 a

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Intrathoracic pressure and volume changes during the spontaneous onset of respiration in babies born by cesarean section and by vaginal delivery

The Journal of Pediatrics, 1981

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Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant

The Journal of Pediatrics, 1981

Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiate... more Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant Measurements of' thoracic volume, inflation pressure, and intrathoracic pressure have been recorded at the resuscitation of nine newborn babies. The initial inflation pressure was maintained fbr approximately five seconds which produced a twofold increase in inflation volume compared to standard resuscitation techniques and always led to formation of an FRC. When the inflation pressure was increased slowly over three to .five seconds, the apparent opening pressure which occurred universally in square wave inflation was rarely seen.

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