Showing papers by "Atul Gupta published in 2016"

Assessment of corticosteroid response in pediatric patients with severe asthma by using a multidomain approach

Abstract: Background There is no agreed upon definition of systemic corticosteroid response in asthmatic children. Moreover, pediatric severe therapy-resistant asthma (STRA) is heterogeneous, and thus response to steroids is unlikely to be uniform in all patients. Objective We sought to evaluate the utility of a multidomain approach incorporating symptoms, lung function, and inflammation to determine steroid responsiveness in pediatric patients with STRA. Methods Eighty-two children (median age, 12 years) with STRA received a clinically indicated dose of intramuscular steroid. Changes in 4 separate domains were assessed 4 weeks after intramuscular triamcinolone acetonide: normalization of (1) symptoms (Asthma Control Test score, >19/25 or 50% increase), (2) spirometric results (FEV 1 ≥80% of predicted value or ≥15% increase), (3) fraction of exhaled nitric oxide levels ( Results Twenty-three (43%) of 54 children had a symptom response, 29 (54%) of 54 had a lung function response, 28 (52%) of 54 had a fraction of exhaled nitric oxide response, and 29 (54%) of 54 had a sputum eosinophil response. Although a similar proportion of children responded to systemic corticosteroids in each domain, there were no reliable predictors of a response pattern. Seven (13%) of 54 were complete responders (response in all domains), 8 (15%) of 54 were nonresponders (no response in any domain), and 39 (72%) of 54 were partial responders (response in ≥1 domain). Conclusions A multidomain evaluation of systemic steroid responsiveness using pragmatic clinical assessments confirms childhood STRA is heterogeneous and that a complete response in symptoms and inflammatory and physiologic parameters is rare. Individual response patterns to systemic steroids might be useful in guiding the choice of add-on therapies in each child as a step toward achieving personalized medicine.

Comparative Study of Single-incision Laparoscopic Cholecystectomy with Four-port Conventional Laparoscopic Cholecystectomy: A Single-center Experience

Abstract: Aims and objective: To assess the feasibility of singleincision laparoscopic cholecystectomy (SILC) with conventional laparoscopic instruments and to compare it with four-port conventional laparoscopic cholecystectomy (LC) regarding various intraoperative and postoperative factors. Materials and methods: This is a prospective randomized controlled study carried out at Santosh Medical College and Hospitals, Ghaziabad from March 2014 to September 2015. This study included 60 patients with cholelithiasis who were divided into two groups of 30 patients each. Group I was offered four-port conventional LC and group II underwent SILC. Results and observations: Cholelithiasis was commonly seen in young females. Single-incision laparoscopic cholecystectomy took more operating time than conventional LC due to more operative difficulty. Outcome of SILC was 79.6% (23 of 30). However, postoperative complications and pain (measured by visual analog scale scoring system) were almost the same in both groups. Cosmetic outcome was better in SILC group. Conclusion: Single-incision laparoscopic cholecystectomy has no added advantage over conventional LC, but it can be performed in selected patients for better cosmetic results.

Prevalence & pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi - NCR.

Abstract: Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio - economic status population. Two part questionnaire was used as main tool. Through part one 1522 elderly were screened for respiratory disease. Respiratory disease was confirmed & diagnosed by part two of questionnaire, physical examination & necessary investigations. Prevalence of respiratory diseases was 18.8% in this study. Prevalence of respiratory diseases was almost double in elderly males as compared to females. COPD was most prevalent respiratory disease followed by Bronchial asthma.

Poor agreement between haemoglobin oxygen saturation measured by pulse oximetry and arterialized earlobe blood gas in ambulatory paediatric sickle cell patients

Abstract: Background: Evidence suggests poor agreement between pulse oximetry SpO 2 and arterial blood gas (ABG) SaO 2 in measuring Hb O 2 saturation in sickle cell disease (SCD) (Blaisdell, Arch Pediatr Adoles Med 2000). Earlobe blood gas co-oximetry (EBG) is an easily performed painless method of measuring SaO 2 , with good agreement with ABG (Zavorsky, Respir Physiol Neurobiol 2007). Aims: To investigate the agreement between SpO 2 and SaO 2 measured by EBG in SCD children. Methods: We reviewed records of SCD patients attending a regional paediatric respiratory clinic, and calculated agreement between paired EBG and SpO 2 measurements. Results: We identified 39 paired SaO 2 and SpO 2 readings from 33 patients (52% male, median age 10y). In 9 cases (23%), difference was >±2%. SaO 2 was lower than SpO 2 in one-third and greater in two-thirds. Of 17 hypoxaemic measurements (SpO 2 2 2 92.1%, P=0.02). Figure 1: Bland-Altman plot showing mean EBG and SpO2 O 2 saturations and differences. Unbroken line: mean difference (-0.7%). Broken line: agreement limits (-5.6 to +4.3%). Shaded region: accepted error range (±2%) Conclusion: This study suggests that SpO 2 as a measure of Hb O 2 saturation is inaccurate in a proportion of ambulatory SCD children. EBG should be used more widely to accurately detect changes in arterial Hb O 2 saturation in SCD children.

G488 Pulse oximetry is an unreliable measure of haemoglobin oxygen saturation as calculated by earlobe blood gas co-oximetry in ambulatory paediatric sickle cell disease patients

Abstract: Aim Accurate measurement of Hb saturation is essential in the care of children with sickle cell disease (SCD). The gold standard of Hb saturation measurement is by ABG with co-oximetry. Minute-by-minute changes are detected with pulse oximetry (SpO2). SpO2 shows good correlation to ABG co-oximetry in well patients with normal Hb. SCD patients represent a different population: previous small studies have shown discrepancies in calculated ABG and SpO2 Hb saturations. SpO2 may be falsely low due to high carboxyhaemoglobin and metahaemaglobin levels following heme catabolism, or high due to hyperbilirubinaemia. Both occur in acute and chronic haemolysis. With treatment decisions in acute and ambulatory settings driven by bedside SpO2, inaccuracies can result in mismanagement. Earlobe blood gas (EBG) co-oximetry is an alternative better tolerated method of measuring Hb O2 saturation in arterialised capillary blood (SaO2), with good correlation to ABG measurements. We sought to investigate the correlation between SpO2 and SaO2 measured by EBG co-oximetry in ambulatory SCD children. Methods We retrospectively reviewed paediatric SCD patients attending a UK tertiary sickle-respiratory clinic from February 2012–August 2015, and who had simultaneous EBG and SpO2 measurements. Positive difference results from SpO2 value greater than EBG SaO2. Results We identified 39 simultaneous paired SaO2 and SpO2 readings from 33 patients (52% male, median age 10years, range: 5–17). Mean difference between readings was –0.7% (Figure 1 and 2). In 23% of cases, difference was >±2%. SaO2 was overestimated in one-third and underestimated in two-thirds. Of 17 hypoxaemic measurements (SpO2 Conclusion Pulse oximetry as a measure of Hb oxygen saturation was inaccurate in a significant proportion of ambulatory SCD children. SpO2 tended to be lower than actual SaO2 as measured with EBG, with SpO2≥94% more likely to predict true result than SpO2