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Biomedical subjects

B G Loftus

Publications and source records attributed to B G Loftus.

At least 19 recordsLinked to original sources
PubMed2005

Medical graduates of the National University of Ireland in 1978: who and where are they?

To inform debate on medical manpower planning and aspects of medical education, we gathered data on graduates of three Irish medical schools in 1978. Twenty six years later, four of the 236 graduates had died and seven were untraceable. All but one of the remainder were in clinical practice and in a wide range of disciplines. A third were overseas. The implications of these findings are briefly discussed.

Career Choice↗
PubMed2002

Management of bronchiolitis: current practices in Ireland.

To establish current practice for hospital-based treatment of uncomplicated respiratory syncytial virus (RSV) infection in the Republic of Ireland. A questionnaire was sent to all consultant general paediatricians in the Republic of Ireland. The questionnaire described a clinical scenario and this was followed by a list of management questions. The scenario was of a 3-month-old infant with uncomplicated but moderately severe RSV infection requiring hospitalization. Seventy-three questionnaires were sent. 63/73 (86%) of the questionnaires were returned. With respect to management of this case almost all (61/63) the paediatricians felt that oxygen therapy was necessary (oxygen saturation described in the case was 90%). With respect to bronchodilator therapy, ipratropium bromide (38/63--60%) was chosen much more frequently than salbutamol (15/63--24%). Chest physiotherapy would have been prescribed by 8/63--13% of paediatricians. Oral steroids were infrequently chosen (1/63--2%) but nebulised steroids were selected in 7/63 (11%) cases. The routine use of RSV monoclonal antibody, palivizumab, for RSV prophylaxis was reported by 49% (31/63) of paediatricians. Prematurity with bronchopulmonary dysplasia was considered an indication for its administration by all of these but only 23% considered prematurity alone to be an indication. The management of infants with RSV bronchiolitis varies greatly among consultant paediatricians in Ireland. Evidence based guidelines may be of value in establishing a more uniform national treatment approach.

Albuterol↗
PubMed1997

Coeliac disease in Galway, Ireland 1971-1990.

Recent studies have reported changes in the incidence of coeliac disease and in its presentation. We carried out a retrospective study looking at the incidence and clinical features of coeliac disease in Galway children over a 20 year period. The study period was divided in two parts. (I) Patients diagnosed between 1971 and 1980 and (II) between 1981 and 1990. Comparison was made between demographic and clinical data in these two periods. There were 97 cases of coeliac disease diagnosed in children resident in Galway over the 20 year period. 71 patients were diagnosed in period I and 26 in period II. The median age at diagnosis in period I was 1.41 years and 4.95 years in period II. There were more females diagnosed in period I. Growth data, histology and enzyme levels were similar in both groups. Diarrhoea and vomiting were the major presenting symptoms in both periods but more patients presented with wasting or abdominal protuberance in the latter period. Our data support the concept that coeliac disease in childhood is declining, and is presenting at a later age.

Adolescent↗
PubMed1996

Massive thymic hemorrhage in a neonate: an entity revisited.

The authors describe a case of early neonatal death of a full-term infant who had respiratory distress and anemia after fetal distress during labor. Postmortem examination disclosed mediastinal compression by a large fresh hemorrhage into the left lobe of the thymus. Massive thymic hemorrhage is an extremely rare but sometimes lethal occurrence; it may represent a manifestation of early-onset hemorrhagic disease of the newborn.

Anemia, Neonatal↗
PubMed1993

Randomized trial of umbilical arterial catheter position: clinical outcome.

In order to determine if umbilical arterial catheter position affects the incidence of necrotizing enterocolitis, clinical outcome was analysed in 308 infants whose umbilical arterial catheter had been randomly allocated to a high (n = 162) or a low (n = 146) position. Necrotizing enterocolitis was classified as suspected or confirmed; all renal, lower limb and local catheter complications were also recorded. High umbilical arterial catheters were in place for longer than low catheters, provided more samples and were removed as an emergency less often. Lower limb blanching and cyanosis were more common with low catheters. Eleven cases of confirmed necrotizing enterocolitis occurred in the "high" group and nine in the "low" group. One case of fatal aortic thrombosis was encountered in the high group. Positioning umbilical arterial catheters in a high position allowed longer functional use and did not increase the incidence of necrotizing enterocolitis.

Catheterization↗
PubMed1993

Childhood asthma, can admissions be avoided?

Since admissions with asthma continue to increase and account for considerable morbidity, we chose to prospectively study asthma admissions over a one year period to assess the severity of patients' asthma, their need for treatment available only in hospital, and to assess the adequacy of their prehospital treatment. A study proforma was completed soon after the admission of each child. Data gathered between the 1st January and 31st December 1990 are presented. There were 105 children admitted, two-thirds of those were boys and just over half were aged less than 5 years. Eighty-seven children had a previous diagnosis of asthma. Overall the attacks were not severe, only 10 patients were treated with intravenous medication and 18 children required continuous oxygen. Sixteen patients required hospitalisation for more than 48 hours, the remainder were discharged within 2 days. Suboptimal prehospital care was identified in a third of patients, inappropriate management of the acute attack, failure of adequate prophylactic medication and non-compliance with prescribed regimes were common. In our hospital, admissions with acute severe asthma have declined in 1990, attention to simple treatment schedules may further reduce hospitalisation.

Adolescent↗
PubMed1992

Paediatric asthma admissions in Galway 1985-89.

The past 15 years has seen a worldwide increase in asthma admissions in children. The aim of our project was to study patterns of admission in our unit over the years 1985 to 1989. The study was retrospective, information was obtained from the ward admission register. Data were gathered on the age and sex of patients and the month of admission. Over the five year period there was a doubling in the number of admissions, in each year there was a male predominance. Just over half the children were aged one to four years. There was a marked seasonal variation in admission trends with a peak in September. When seasonal trends were analysed for age specific groups there was also an apparent peak in May for children aged one to four. Our data indicated that increasing hospitalisation because of asthma has also occurred in Galway. In common with several previous studies we have shown a marked seasonable variability with a peak of admissions in the autumn. Our study emphasizes the importance of preschool children in accounting for a disproportionate number of admissions.

Age Factors↗
PubMed1990

Placebo controlled trial of systemic corticosteroids in acute childhood asthma.

In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p less than 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p less than 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p less than 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.

Acute Disease↗
PubMed1989

Once or twice daily theophylline in childhood asthma.

We conducted a randomized, single-blind, crossover trial to compare two sustained release theophylline preparations. Fifty-nine chronic asthmatics, aged 7-14 years, were randomly allocated to receive Slophyllin (SP) twice daily followed by Uniphyllin (UP) taken as a single dose at bedtime, or UP followed by SP. Two 4-week periods on therapeutic doses of each preparation were compared. Thirty-six patients completed the study. Eight were non-compliant, seven defaulted and eight withdrew because of theophylline related side-effects (seven on UP). Symptom scores, beta-agonist usage, compliance by pill counts, evening peak flow rates and maximal expiratory flow-volume curves were similar on both treatments. Blood levels of theophylline at 11 am and morning peak flow rates were significantly higher on UP. UP may be more helpful for patients with early morning symptoms, but is associated with an increased frequency of severe side effects.

Adolescent↗
PubMed1988

IgG subclass deficiency in asthma.

Total immunoglobulin G (IgG) and subclasses were measured in serum samples from 82 children with chronic asthma, aged 1.5 to 6.3 years, and 76 controls. Concentrations of IgG1, IgG2, IgG3, and total IgG were significantly lower in asthmatic children aged 1 to 5, and IgG2 concentrations were also significantly lower in asthmatic children over 5 years of age. Twenty eight asthmatic children had at least one value in the deficient range, and 26 had IgG2 deficiency alone or in combination. Five children had IgG2 and IgA deficiency. These 28 children were significantly younger and fewer had raised IgE concentrations than the remainder. IgG subclass deficiency, which may reflect delayed maturation of the immune system, is common in young asthmatic children, and may have a role in the pathogenesis of the disease.

Asthma↗
PubMed1987

Transcutaneous oxygen measurement in paediatric respiratory disease.

We have measured simultaneous arterial (Pao2) and transcutaneous oxygen tension (tcPo2) in 13 children, aged 8 months to 10 years, with respiratory disease. A Radiometer TCM2 transcutaneous oxygen monitor was used. At an electrode temperature of 44 degrees C the regression equation was tcPo2 = 0.9 Pao2 -10 and at 44.5 degrees C tcPo2 = 0.9 Pao2 -8. The 95% confidence limits were +/- 13 torr at both temperatures. We also studied the usefulness of the method in monitoring trends in oxygenation in individual patients. In six children paired observations were made on five or more occasions and in these tcPo2 followed changes in Pao2 accurately. We conclude that this technique is not sufficiently reliable for predicting arterial values, but in individual patients it accurately reflects trends in oxygenation.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Long-term, placebo-controlled trial of ketotifen in the management of preschool children with asthma.

Forty-seven children with chronic asthma, aged 2 to 6 years, completed a double-blind, placebo-controlled, crossover trial of ketotifen, 1 mg twice daily, in the prophylaxis of asthma. The study period covered two 24-week periods preceded by a 4-week run-in and separated by a 4-week washout. When symptoms, concomitant medication, frequency of acute exacerbations, and parental and physician preferences were analyzed, there were no significant differences between active and placebo treatments. The results suggest that ketotifen has no place in the management of young children with frequent asthma.

Asthma↗
PubMed1987

Abnormalities of lung mechanics in young asthmatic children.

Measurements of total compliance of the respiratory system by the weighted spirometer technique and of the functional residual capacity by helium gas dilution were attempted in 86 asthmatic children aged 2.2-7.9 years. In all but six of the 86 children reliable measurements could be obtained. Significantly raised functional residual capacity was detected in children with asthma of all degrees of severity. The compliance of the respiratory system was significantly abnormal (reduced) only in children who had symptoms at the time of measurement or who had chronic persistent asthma. The results indicate that these measurements are well tolerated in young asthmatic children. Further work needs to be undertaken to assess the value of this technique in following the response to treatment.

Asthma↗
PubMed1986

Clinical and immunological characteristics of pre-school asthma.

Ninety-two children, sixty-two boys and thirty girls, aged 18 months to 6 years with frequent asthma were studied. Nine were born prematurely and two were ventilated in the neonatal period; two had been admitted to hospital with acute bronchiolitis. Most had an early onset of symptoms, forty-two developing asthma in infancy. Although overall growth was normal, 63% had some chest deformity. Half had past or present eczema and just over half had chronic rhinitis. Upper respiratory infection appeared to be an important precipitant of attacks in all, and 88% had exercise-induced asthma. The majority were atopic, 74% had elevated serum IgE levels, skin-prick tests were positive in 61 of 77 tested and half had eosinophilia. However, allergic factors were clearly identified as causing asthma attacks in only 24%. Immunoglobulin deficiencies were found in thirteen and defective yeast opsonization in eighteen; these children showed no other obvious differences from the remainder. Eighty-two children were followed up and after 1 year fifty-one were receiving inhaled steroids. Measurement of serum immunoglobulin, eosinophil count and skin-prick testing had little influence on management.

Asthma↗
PubMed1986

Response to bronchodilators assessed by lung mechanics.

Abnormalities of compliance and functional residual capacity were shown in eight young children aged 2-8 years with asthma during an acute attack. In a randomised, placebo controlled study treatment with bronchodilator (salbutamol) was associated with a significant improvement in compliance and lessening of hyperinflation as shown by a reduction in functional residual capacity.

Acute Disease↗
PubMed1985

Home nebulisers.

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Acute Disease↗