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Biomedical subjects

T J David

Publications and source records attributed to T J David.

At least 55 records · Page 3Linked to original sources
PubMed1997

Adult height in patients with childhood onset atopic dermatitis.

Cross sectional studies have reported impaired growth in children with atopic dermatitis. If this growth impairment is irreversible, it would be expected to adversely influence final height attainment. The standing heights and other anthropometric parameters were assessed in 35 adults with onset of atopic dermatitis before 5 years of age and a control group of 35 adults with adult onset contact dermatitis or psoriasis. There was no significant difference in the standing height SD score, mid-parental height SD score, sitting height SD score, subischial leg length SD score, nor body mass index between the atopic dermatitis and control groups. The standing height SD score was not significantly different among: (a) patients with atopic dermatitis affecting less than 50% of their body surface area and those with greater than 50% affected; (b) patients using the four different potency topical corticosteroids; and (c) patients with atopic dermatitis without asthma and those with coexisting asthma. It is concluded that short stature is not a feature of our group of adult patients with onset of atopic dermatitis before 5 years of age, continuing into adulthood, and severe enough to require specialist care. This suggests that if growth impairment occurs in childhood, it is likely to be temporary and reversible.

Administration, Topical↗
PubMed1995

Clinical evaluation of meropenem versus ceftazidime for the treatment of Pseudomonas spp. infections in cystic fibrosis patients.

Cystic fibrosis patients (children and young adults) with Pseudomonas spp. chest infections were treated with meropenem or ceftazidime. This study was the first to investigate the use of meropenem in cystic fibrosis. Meropenem was well tolerated with only transient elevations of serum transaminases. No patient experienced nausea and vomiting, even when meropenem was administered as a bolus injection. This allowed home therapy to be used. Meropenem appeared to be at least as active as ceftazidime even at the low doses used. Patients showed a greater improvement in respiratory function on meropenem than ceftazidime. Only one patient (out of 60 courses) failed to respond to meropenem (98% success rate) compared with two failures out of 21 episodes with ceftazidime (90% success rate). There was little emergence of resistance to meropenem even though some patients were treated up to eight times over a 2 year period.

Adolescent↗
PubMed1995

Pyridoxine in atopic dermatitis.

A previous study has reported benefit when pyridoxine hydrochloride was given to patients with atopic dermatitis. To investigate this in children, we performed a randomized, double-blind, parallel-group, placebo-controlled trial. Forty-eight children with moderate or severe atopic dermatitis were recruited and, of those who completed the study, 19 received pyridoxine hydrochloride 50 mg once daily for 4 weeks and 22 received placebo. Disease activity was monitored by clinical severity scores measuring the extent and degrees of erythema recorded by the investigator and symptom scores (daytime itch and nocturnal sleep disturbance) recorded by parents. There was no statistically significant difference between the two groups at the end of treatment. We have been unable to demonstrate clinical benefit from pyridoxine supplementation in children with atopic dermatitis.

Adolescent↗
PubMed1995

Adrenal function following topical steroid treatment in children with atopic dermatitis.

Adrenal suppression is a potential complication of topical corticosteroid treatment in atopic dermatitis. We used a low-dose adrenocorticotrophic hormone (ACTH) test (500 ng/1.73 m2) to detect subtle changes in adrenal glucocorticoid function in 14 prepubertal children with moderate or severe atopic dermatitis affecting 16-90% (median 58%) of the body surface area. All had received regular treatment with mild potency BNF (British National Formulary) classification topical corticosteroid ointments (hydrocortisone 48.7-223.2 mg/m2 body surface area/day; median 134.2) for 3-10 years (median 6.5 years). Nine children had also intermittently used moderate potency preparations. However, none had been treated with corticosteroids by any other route in the preceding 6 months. Fourteen prepubertal children with constitutional short stature, without atopic disease, served as controls. The basal, peak, increment and area-under-curve in plasma cortisol concentrations in children with atopic dermatitis were not significantly different from controls, indicating normal adrenal sensitivity to low-dose ACTH. However, the peak in plasma cortisol occurred earlier in children with atopic dermatitis (median 17.5 min) than in controls (median 25 min) (P = 0.02). In addition, there was a significant inverse relationship between time to peak and extent of atopic dermatitis (rs = -0.52; P < 0.05), but not topical steroid treatment dose or score in children with atopic dermatitis. These findings indicate accelerated adrenal responsiveness to ACTH in children with atopic dermatitis, which is independent of treatment. Mild to moderately potent topical corticosteroid ointments in these doses did not suppress adrenal glucocorticoid function in this sample of children with atopic dermatitis.

Administration, Topical↗
PubMed1995

Increasing dose regimen in children with reactions to ceftazidime.

BACKGROUND: Of 87 consecutive patients with cystic fibrosis treated with 859 courses of intravenous ceftazidime, 15 patients experienced reactions to drugs. OBJECTIVE: To see if by varying the means of administration further courses of treatment with ceftazidime could be tolerated in subjects who had experienced drug reactions. METHODS: Starting with a dose of 1 mg per hour, and doubling the dose every hour, ceftazidime was administered at increasing dosage by continuous infusion, reaching a rate of 150-300 mg/kg/day. Thereafter the full daily dose was given in three divided bolus doses. For patients who tolerated the maximum infusion rate but reacted adversely to bolus doses, the procedure was restarted, and once the normal daily dose rate had been achieved, treatment was completed by continuous intravenous infusion rather than bolus doses. RESULTS: Of the 15 patients, three patients with urticaria and four patients with nonurticarial itchy rash tolerated further courses of ceftazidime without adverse reactions, and two patients have not had further treatment with intravenous antibiotics. The increasing dose regimen was tolerated in five of the remaining six patients, and further courses of treatment were tolerated in the four patients in whom this was required. One patient had recurrent urticaria despite three attempts at using the regimen, and treatment was given with alternative antibiotics. CONCLUSION: A continuous drug infusion regimen of starting at a very low dosage and then increasing the dosage offers the potential for further treatment in some children with cystic fibrosis with adverse reactions to ceftazidime.

Adolescent↗
PubMed1995

Oxygen consumption during sleep in atopic dermatitis.

Measurements of oxygen consumption (VO2) were made during sleep in 10 patients with atopic dermatitis. Two groups of healthy children acted as controls. All subjects were studied in bed in an environmental temperature of 24-26 degrees C, and sleep was confirmed during continuous electroencephalographic monitoring. Mean (SD) values of VO2 in sleeping patients who were not scratching ranged from 4.0 (0.4) to 7.4 (0.7), which was not statistically significantly different from control values which ranged from 3.24 (0.3) to 5.56 (0.4). During scratching (while asleep), which occurred in nine out of 10 patients with atopic dermatitis, the mean values of VO2 ranged from 4.5 (0.04) to 10.4 (2.7), and this was significantly higher than the non-scratching patients and the control values. Scratching during sleep in children with atopic dermatitis is associated with increased VO2.

Adolescent↗
PubMed1995

Controlled trial of a few foods diet in severe atopic dermatitis.

Eighty five children (median age 2.3 years, range 0.3 to 13.3 years) with refractory atopic dermatitis affecting more than 12% of the body surface area, were randomly allocated to receive a few foods diet (eliminating all but five to eight foods) supplemented with either a whey hydrolysate (n = 27) or a casein hydrolysate formula (n = 32), or to remain on their usual diet and act as controls (n = 26), for a six week period. Thirty five patients who received the diet and four controls had to be withdrawn because of non-compliance with the diet or intercurrent illness. The change in dermatitis severity was evaluated by a blinded observer who estimated the extent and severity of the dermatitis, using a skin severity score. After six weeks, there was a significant reduction in all three groups in the percentage of surface area involved (controls, median reduction (MR) = 4.9% (95% confidence interval 1.5%, 11.9%); whey hydrolysate group, MR = 17.8% (8.3%, 23.0%); casein hydrolysate group, MR = 5% (1.6%, 21.2%), and skin severity score (controls, MR = 15.9 (5.0, 22.5); whey hydrolysate group, MR = 21.8 (12.8, 30.2); casein hydrolysate group, MR = 13.5 (3.4, 38.0). Sixteen (73%) of the 22 controls and 15 (58%) of the 24 who received the diet showed a greater than 20% improvement in the skin severity score. This study failed to show benefit from a few foods diet.

Adolescent↗
PubMed1995

Nutritional content of few foods diet in atopic dermatitis.

The nutritional content of a few foods diet, supplemented with a casein hydrolysate formula (n = 24) or a whey hydrolysate formula (n = 21), was studied in 45 children with atopic dermatitis. The six day weighed food inventory record method was used to estimate the mean daily intake of energy, protein, calcium, iron, zinc, folate, and vitamin C on normal diet and on the few foods diet. The diet was associated with a significant reduction in protein and calcium intake in both groups, and in energy intake in the casein hydrolysate group. The median daily volume of hydrolysate milk taken was 10.5 ml/day (range 0-840 ml/day) for the casein hydrolysate group and 267 ml/day (range 0-1300 ml/day) for the whey hydrolysate group. Whey hydrolysate appears to be more palatable than casein hydrolysate, which is a potential advantage in the maintenance of an adequate intake in children on a few foods diet.

Calcium, Dietary↗