Search PubMed⌕ Search

Biomedical subjects

R H Merchant

Publications and source records attributed to R H Merchant.

At least 37 records · Page 2Linked to original sources
PubMed1994

Color Doppler evaluation of uteroplacentofetal circulation in management of high risk pregnancies.

The study group consisted of 75 high risk singleton pregnancies in whom color duplex Doppler evaluation of the uteroplacental circulation was determined and correlated with perinatal outcome. Uterine, umbilical and middle cerebral artery flow velocity waveforms (FVW) were analysed and the resistance index (RI), pulsatility index (PI) and the systolic/diastolic (S/D) ratios measured. On the basis of the FVW the uteroplacentofetal blood flow was classified as normal, increased resistance to flow, absent end diastolic flow (AEDF), and reversed end diastolic flow (REDF). Ultrasound biometry was simultaneously performed for all fetuses, while non stress testing was performed as and when indicated. Of the 75 fetuses studied 33 (44%) had abnormal FVWs and only 30.3% of these had an uncomplicated outcome as compared to 81% of those with normal flows. The mortality in cases with abnormal flows was 43% as compared to 7% in those with normal flows. There were 40 growth retarded fetuses in the study group of which 30 (75%) had abnormal umbilical artery FVWs. Of the 18 fetuses with AEDF or REDF, all (n = 7) in whom timely obstetric intervention was not done died in utero, irrespective of fetal weight and gestational age, however 75% of these with weight > 1000 g survived when delivered by cesarean section.

Female↗
PubMed1994

Cord blood cortisol levels and respiratory distress syndrome.

Cord blood cortisol levels were analyzed in 121 neonates, using a "Coat a Count" RIA kit. Forty two appropriate for gestation age (AGA) preterms < 34 weeks who had not received antenatal dexamethasone constituted Group A, 32 AGA preterms < 34 weeks gestation who had received dexamethasone antenatally comprised Group B, while Group C consisted of 47 term normal neonates. Cortisol levels were compared in these 3 groups and correlated to the development of respiratory distress syndrome (RDS). It was observed tht preterms (Groups A and B) had significantly (p < 0.005) lower levels (8.45 +/- 6.31 micrograms/dl) compared to term neonates (11.67 +/- 4.68 micrograms/dl). Antenatal dexamethasone therapy did not significantly alter cortisol levels within the group of preterms. There was a significant difference (p < 0.02) in cortisol levels between those preterms who developed RDS (5.41 +/- 4.91 micrograms/dl) and those who did not (9.58 +/- 6.45 micrograms/dl). Preterms (Grous A and B) who did not develop RDS had cortisol levels comparable to term neonates. There was a significant reduction in the incidence of RDS (p < 0.05) in preterms who had received antenatal dexamethasone. Cord blood cortisol levels < or = 7 micrograms/dl had a positive predictive accuracy of 36.59% and negative predictive accuracy of 93.75% in predicting onset of RDS.

Case-Control Studies↗
PubMed1993

Maternal heart disease and perinatal outcome.

Between January 1991 and August 1992, 62 singleton pregnancies with heart disease were managed at the Wadia Maternity Hospital, Bombay. In 51 (82.3%), the heart disease was of rheumatic origin, while in 11 (17.7%), the disease was nonrheumatic. Thirteen cases of rheumatic disease (25.4%) were graded as Class III or IV, as per New York Heart Association (NYHA) classification. Six cases with rheumatic disease had closed mitral commisurotomy done, while none had a prosthetic heart valve. There was no maternal mortality. The average birth weight of neonates born to mothers with Class III or IV rheumatic heart disease was significantly lower (p < 0.05) than the average noted in singleton, normal, uncomplicated, non high risk pregnancies, during this period. There was also a significant difference (p < 0.05) in birth weight between infants born to mothers with NYHA Class I or II and Class III or IV symptoms. No infant had a congenital heart disease. Our findings suggest that though the presence of maternal heart disease did not affect the perinatal outcome, all infants born to mothers with NYHA Class III or IV had intrauterine growth retardation.

Adult↗
PubMed1993

Symptomatic atrial septal defect in infancy.

Isolated ostium secundum atrial septal defect (OS-ASD) may rarely lead to severe symptoms in infancy. Over a period of four years, 12 infants admitted to our hospital with severe congestive heart failure had an isolated OS-ASD. Their echocardiographic findings, clinical course, and outcome were outlined. All 12 infants had atypical findings including a holosystolic murmur parasternally and absence of wide fixed splitting of the second heart sound, and none were clinically suspected to have an ASD. M-mode echocardiography in all infants showed a greater than normal diastolic right ventricular internal diameter in the absence of pulmonary hypertension, indicating an increased right ventricular distensibility. Ten out of 12 infants responded well to medical decongestive treatment, and none developed pulmonary hypertension. Two infants who failed to improve with drugs, successfully underwent surgical closure, while two other infants revealed clinical and echocardiographic evidence of spontaneous closure.

Echocardiography↗
PubMed1993

Proptosis: management of 22 patients.

The clinical features and management of 22 cases with proptosis is highlighted. Proptosis was unilateral in fifteen and bilateral in seven cases. The common etiologic factors were neoplasms, infections and bleeding diatheses. Of the ten cases with neoplasms as many as 7 expired, whereas of nine cases due to infections only one expired and one developed phthisis bulbi. All three patients with proptosis due to bleeds recovered completely without sequelae. Orbital CT scan was done in fourteen and ultrasound in eight cases, while in five cases both investigations were done. As neoplasms are a frequent cause of proptosis in children and there is a high mortality in this group, a thorough systemic examination and hematological profile is essential to arrive at a speedy diagnosis. CT and USG are useful imaging modalities of the orbit, the latter being particularly useful for follow up of the lesion.

Child↗
PubMed1992

Prophylactic theophylline infusion for prevention of apnea of prematurity.

To assess if there was any advantage in the prophylactic use of theophylline to prevent apnea in preterms, we treated 56 preterms (Group A) < 34 weeks gestation with theophylline infusion and compared these with 25 age and weight matched preterms (Group B) who received no therapy. Aminophylline (25 mg/ml) was infused from admission in all neonates (group A) at rates ranging 0.2 to 0.38 mg/kg/h and blood levels estimated on an Abbots TDX analyser by Fluorescence Polarization Immunoassay, after 5 days infusion. All neonates (Groups A + B) were monitored on a Corometric 505 neonatal monitor. In Group A, 1/48 developed primary apnea while in Group B, 4-21 had primary apnea (p < 0.05). Serum theophylline ranged from 2.3 to 39.5 micrograms/ml with a mean of 12.7 micrograms/ml. The mean serum level of theophylline in 4 cases who exhibited clinical evidences of toxicity was 30.1 micrograms/ml. A statistically significant difference (p < 0.05) was noted in birth weight and serum level inspite of similar infusion rates of theophylline. A linear correlation r = 0.65 was noted between serum level and infusion rate. Multivariate regression analysis, between birth weight and gestational age to serum level, showed a linear correlationship only between birth weight and serum level (r = 0.45).

Aminophylline↗
PubMed1992

Congenital factor XIII deficiency.

Clinical and hematological data of 9 cases with factor XIII deficiency is highlighted. The age at first bleed ranged from 3 days of life to 1 year. Seven of these 9 cases had bleeding from the umbilicus, 3 had recurrent subcutaneous and muscle hematomas, while 4 cases had CNS bleeds of which 3 expired. Routine coagulogram was normal, while clot solubility in 5 molar urea solution was abnormal in all cases. Factor XIII assay was not done in any. Patients were treated with plasma transfusion during episodes of bleeding. No patient received plasma transfusion as prophylactic therapy. The cumulative Indian data so far documented, inclusive of this series, shows a very high incidence of CNS bleeds (33%) in patients with this inherited coagulation disorder.

Cerebral Hemorrhage↗
PubMed1992

Hematocrit and whole blood viscosity in newborns: analysis of 100 cases.

Hematocrit (Hct) and whole blood viscosity was studied at a mean age of ten hours in 100 neonates. Group A (n = 25), were term normal newborns, Group B (n = 25) were preterms, Group C (n = 20) were term small for gestation (SGA) and Group D (n = 30) had perinatal hypoxia. Blood viscosity was estimated in all cases at shear rates 94.5, 51.2, 20.4 and 8.1 and intergroup variability in viscosity compared at shear rate 51.2. The mean hematocrit (Hct) (59.4%) and viscosity (8.2 cps) was higher in Group A as compared to other groups, but the difference was not significant (p greater than 0.05). The upper limit of viscosity in Group C (11.9 cps) was higher than in all other groups but this difference was also not significant (p greater than 0.05). With decrease in shear rates a reciprocal increase in viscosity was noted in all four groups. Seventeen neonates (17%) had polycythemia of which eight (47.5%) were SGA. Twelve per cent preterms were polycythemic. Only 3% of neonates had hyperviscosity. The mean Hct and viscosity of the 17 cases with polycythemia was 70.9 and 9.21 cps, respectively, which was significantly higher than mean Hct and viscosity of Group A (p less than 0.05). Partial exchange transfusions were done in five neonates with Hct greater than 75%, of which only one had hyperviscosity. Post-exchange viscosity was not estimated. Whereas, three neonates with polycythemia were symptomatic, none of these had hyperviscosity. A linear correlation between Hct and viscosity was observed (r = 0.67).

Blood Viscosity↗
PubMed1992

Neonatal gastrointestinal perforations.

Fourteen neonates presented with clinical and radiological evidence of gastrointestinal perforation, of which 13 were treated by operative intervention. No infant was formula fed, had rectal bleeding or radiological evidence of pneumatosis intestinalis. Operative findings revealed localized perforation in ten of which three were gastric, two distal ileal, three cecal and two in sigmoid colon. Gangrene with extensive perforation of jejunum, ascending colon and transverse colon were seen in one each. Blood cultures were positive in four, one grew E. coli and three Klebsiella while peritoneal cultures were positive in six, one grew E. coli and five Klebsiella. Ten neonates survived and are being followed up. Three of the four cases who died had white blood cell count greater than 25 x 109/L and grew Klebsiella on peritoneal culture. Factors predisposing to gastrointestinal perforations in neonates are discussed, emphasis is made on the cautious use of umbilical, gastric and rectal catheters, and the need for early surgical intervention.

Female↗