A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae ty... more A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae type b is reported in a one-year old previously healthy child who had apparently no other associated medical condition. The organism was isolated from both the pleural fluid aspirate and blood of the patient with pneumonia. She was successfully treated with parenteral ampicillin and chloramphenicol alongwith intercostal chest tube drainage. The case is notable because it adds to the existing disease spectrum of invasive Hib diseases and brings awareness to the existing burden of the disease in Asia. In addition, it reflects the urgent need to include Hib vaccine in the current immunization program in India.
An 11-year-old Indian girl presented to an outpatient clinic with fever, cough and cold and progr... more An 11-year-old Indian girl presented to an outpatient clinic with fever, cough and cold and progressive shortness of breath for 10 days. Her mother reported that she was always short of breath, first noticed when she was a toddler but did not seek any evaluation or treatment. Mother noticed that during these couple of days prior to admission, the child's dypnoea and purplish discoloration of lips had increased. She had a persistent, low grade fever and her cough was intermittent and increased at night. She denied chest pain. She was born to a non-consanguineous mother and father, requiring no delivery room interventions and had normal APGAR scores at birth. Mother was not receiving any medications in the antenatal period. Postnatal history was insignificant. There was no family history of connective tissue disorders in the family. She had a past medical history significant for intermittent palpitations, fatigue and bluish discoloration of lips on exertion. At presentation, she was febrile (38.2 0 C), dyspneic, cyanotic, tachypneic and tachycardic with blood pressure at the 50% for height, age and gender. Saturations were 85% on room air in the right index finger. Weight of the child was between 15-25 percentile per (World Health Organization) standards; height was between 85-95 percentile and the BMI was between third and fifth percentile.
This study aimed to determine the post-ictal prolactin (PL) response in different types of seizur... more This study aimed to determine the post-ictal prolactin (PL) response in different types of seizures and seizure-like events in children, and correlate with the post-ictal duration. Patients were divided into group I (generalized tonic-clonic seizures, complex partial seizures or simple partial seizures), group II (febrile convulsions) and group III (conditions mimicking seizures). Group IV consisted of 25 controls. Blood was collected within 2 hours of the seizure and PL levels assayed. PL levels were significantly high only within group I; highest and baseline levels were attained within 10 minutes and by 100 minutes respectively. The sensitivity and specificity of elevated PL for epileptic seizures were 64 percent and 98 percent respectively. It is concluded that a high prolactin level within 100 minutes of a seizure is suggestive that a generalized or complex partial seizure has occurred.
We describe case report of a 45 days old male baby with neonatal lupus erythematosus, who present... more We describe case report of a 45 days old male baby with neonatal lupus erythematosus, who presented with 3rd degree congenital heart block and depigmented skin lesions on face and upper part of body. Diagnosis of the baby was confirmed by anti nuclear levels and skin biopsy.
Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unila... more Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unilateral lung agenesis is more common (Aggarwal et al., 2002). Accumulation of bronchial secretions and products of inflammation are chief determinants that determine the degree of respiratory distress
An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica sero... more An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 mg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83RPhe and Asp87RAsn in gyrA and Ser80RIle in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.
International Journal of Clinical Pediatrics, Jun 17, 2013
Elmer This is an open-access article distributed under the terms of the Creative Commons Attribut... more Elmer This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
International Journal of Medicine and Public Health, 2014
Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurit... more Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurity, oxygen administration, and various other factors, which are yet to be identifi ed. Aims: The aim was to fi nd incidence of ROP and risk factors for causation in babies weighing <1800 g; and in the babies weighing between 1501 and 1800 g. Design: Prospective study. Materials and Methods: Neonates weighing ≤1800 g taking birth in our institution from January 2011 to January 2012 for a span of 1 year; were included in the study. The data were analyzed to determine risk factors for ROP causation. Information was collected using the standardized performa which included the maternal risk factors as well. Infants were classifi ed by ophthalmologic examination fi ndings using ICROP revisited. Statistics: Qualitative data were analyzed using Pearson's Chi-square test with Yates correction or Fisher's exact test and possible risk factors were analyzed by univariate analysis and multivariate analysis. Results: A total of 278 subjects was included in the study. Incidence of ROP in babies ≤1800 g was found to be 13.67% (38/278). Incidence of ROP in babies weighing between 1501 and 1800 g was 11.64% (17/146). Twenty-one risk factors were signifi cant on univariate analysis in babies weighing ≤1800 g and 18 risk factors in the babies weighing between 1501 and 1800 g. Multiple gestations (P < 0.01), blood transfusion (P < 0.01), antepartum hemorrhage (P < 0.01), pregnancy-induced hypertension (P < 0.01), mechanical ventilation (MV) (P < 0.01), and APGAR at 1 min (P < 0.01) were found to be independently signifi cant for ROP causation on logistic regression analysis in babies weighing ≤1800 g and MV (P < 0.01) and resuscitation (P < 0.01) were signifi cant for babies weighing 1501-1800 g. Conclusion: It should be considered to incorporate screening of babies ≤1800 g uniformly in developing nations. It is recommended that further studies be done taking representative population of babies in different sites with adequate follow-up.
Annals of Tropical Medicine and Public Health, 2013
An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oligu... more An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oliguria. He had hypertension. Urine microscopy showed hematuria and glomerular casts. Renal functions were deranged and had low complement C3 level. Chest X-ray showed plural effusion and ultrasonography abdomen showed mild ascitis. The immunoglobulin (Ig)M and IgG enzyme-linked immunosorbent essay for dengue virus were positive. Diagnosis of dengue hemorrhagic fever with acute glomerulonephritis was made. He was managed with maintenance fluid, antihypertensive medicine and supportive care. He recovered gradually and was discharged 12 days after admission.
Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unila... more Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unilateral lung agenesis is more common (Aggarwal et al., 2002). Accumulation of bronchial secretions and products of inflammation are chief determinants that determine the degree of respiratory distress (Krivchenya et al., 2000). Anomalies frequently associated with pulmonary agenesis may include any organ system viz, cardiovascular, skeletal, gastrointestinal and genitourinary systems (Krivchenya, 2000; Nazir et al., 2006; Kaya and Dilmen, 1989; Lucaya and Strife 2002). These are more commonly found in association with right pulmonary agenesis. Vascular aberrations and genitourinary system malformations have also been noted with the presence of right pulmonary agenesis. Left pulmonary agenesis is often an isolated anomaly; associated with usually no congenital defects (Maltz and Nadas, 1968). In our case; despite left pulmonary agenesis, there was evidence of atrial septal, ventricular sept...
The study was conducted after taking Institutional Ethics Committee approval and patients were en... more The study was conducted after taking Institutional Ethics Committee approval and patients were enrolled after taking ABSTRACT Objective: The aim of this study is to assess the utilization of the pediatric risk of mortality-(PRISM)-III score to predict mortality in critically sick children and determination of mortality risk factors in a tertiary care pediatric unit. Materials and Methods: In this cross-sectional descriptive study, 100 children admitted during an 18-month period were enrolled in the study. PRISM-III score and mortality risk were calculated. Follow-up was noted as death or survival. Results: Of 100 patients, 27 died and 73 survived. The 47% of the patients were males. The PRISM-III score was 0-9 in 75%, 10-19 in 15% and 20-29 in 8%, ≥30 in 2% of patients. PRISM-III score showed an increase of mortality from 8% in 0-9 score patients to 100% in ≥20 score. PRISM-III score was significantly associated with study variables such as duration of hospital stay, mental status (Glasgow Coma scale <8), and blood pH <7.28 (p<0001). Conclusion: PRISM-III score showed good predictive value (94.5%) and adequate discriminatory capacity (area under receiver operating characteristics curve 90.8%), and thus constitutes a useful tool for the assessment of prognosis for pediatric patients.
A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae ty... more A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae type b is reported in a one-year old previously healthy child who had apparently no other associated medical condition. The organism was isolated from both the pleural fluid aspirate and blood of the patient with pneumonia. She was successfully treated with parenteral ampicillin and chloramphenicol alongwith intercostal chest tube drainage. The case is notable because it adds to the existing disease spectrum of invasive Hib diseases and brings awareness to the existing burden of the disease in Asia. In addition, it reflects the urgent need to include Hib vaccine in the current immunization program in India.
Journal of clinical and diagnostic research : JCDR, 2016
Ebstein's anomaly is a rare congenital heart disorder and has a varied clinical course, with ... more Ebstein's anomaly is a rare congenital heart disorder and has a varied clinical course, with detection as late as the seventh decade. We hereby describe an 11-year-old child in whom Ebstein's anomaly was diagnosed. The most common presentation in early second decade is due to an arrhythmia; however, the present case report is about a patient who presented with acute congestive heart failure due to decompensation from an acute upper respiratory tract infection, which is a rather uncommon presentation.
Epidermal nevi syndrome (ENS) is a multisystem neurodermatological disorder in which epidermal ne... more Epidermal nevi syndrome (ENS) is a multisystem neurodermatological disorder in which epidermal nevi may be associated with neurological, skeletal, ocular and other cutaneous anomalies as well as malignancies with potentially devastating consequences. Most cases are sporadic though occasionally autosomal dominant transmission has been documented. The objective of the present communication is to sensitize regarding the presence of the entity.
A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae ty... more A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae type b is reported in a one-year old previously healthy child who had apparently no other associated medical condition. The organism was isolated from both the pleural fluid aspirate and blood of the patient with pneumonia. She was successfully treated with parenteral ampicillin and chloramphenicol alongwith intercostal chest tube drainage. The case is notable because it adds to the existing disease spectrum of invasive Hib diseases and brings awareness to the existing burden of the disease in Asia. In addition, it reflects the urgent need to include Hib vaccine in the current immunization program in India.
An 11-year-old Indian girl presented to an outpatient clinic with fever, cough and cold and progr... more An 11-year-old Indian girl presented to an outpatient clinic with fever, cough and cold and progressive shortness of breath for 10 days. Her mother reported that she was always short of breath, first noticed when she was a toddler but did not seek any evaluation or treatment. Mother noticed that during these couple of days prior to admission, the child's dypnoea and purplish discoloration of lips had increased. She had a persistent, low grade fever and her cough was intermittent and increased at night. She denied chest pain. She was born to a non-consanguineous mother and father, requiring no delivery room interventions and had normal APGAR scores at birth. Mother was not receiving any medications in the antenatal period. Postnatal history was insignificant. There was no family history of connective tissue disorders in the family. She had a past medical history significant for intermittent palpitations, fatigue and bluish discoloration of lips on exertion. At presentation, she was febrile (38.2 0 C), dyspneic, cyanotic, tachypneic and tachycardic with blood pressure at the 50% for height, age and gender. Saturations were 85% on room air in the right index finger. Weight of the child was between 15-25 percentile per (World Health Organization) standards; height was between 85-95 percentile and the BMI was between third and fifth percentile.
This study aimed to determine the post-ictal prolactin (PL) response in different types of seizur... more This study aimed to determine the post-ictal prolactin (PL) response in different types of seizures and seizure-like events in children, and correlate with the post-ictal duration. Patients were divided into group I (generalized tonic-clonic seizures, complex partial seizures or simple partial seizures), group II (febrile convulsions) and group III (conditions mimicking seizures). Group IV consisted of 25 controls. Blood was collected within 2 hours of the seizure and PL levels assayed. PL levels were significantly high only within group I; highest and baseline levels were attained within 10 minutes and by 100 minutes respectively. The sensitivity and specificity of elevated PL for epileptic seizures were 64 percent and 98 percent respectively. It is concluded that a high prolactin level within 100 minutes of a seizure is suggestive that a generalized or complex partial seizure has occurred.
We describe case report of a 45 days old male baby with neonatal lupus erythematosus, who present... more We describe case report of a 45 days old male baby with neonatal lupus erythematosus, who presented with 3rd degree congenital heart block and depigmented skin lesions on face and upper part of body. Diagnosis of the baby was confirmed by anti nuclear levels and skin biopsy.
Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unila... more Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unilateral lung agenesis is more common (Aggarwal et al., 2002). Accumulation of bronchial secretions and products of inflammation are chief determinants that determine the degree of respiratory distress
An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica sero... more An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 mg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83RPhe and Asp87RAsn in gyrA and Ser80RIle in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.
International Journal of Clinical Pediatrics, Jun 17, 2013
Elmer This is an open-access article distributed under the terms of the Creative Commons Attribut... more Elmer This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
International Journal of Medicine and Public Health, 2014
Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurit... more Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurity, oxygen administration, and various other factors, which are yet to be identifi ed. Aims: The aim was to fi nd incidence of ROP and risk factors for causation in babies weighing <1800 g; and in the babies weighing between 1501 and 1800 g. Design: Prospective study. Materials and Methods: Neonates weighing ≤1800 g taking birth in our institution from January 2011 to January 2012 for a span of 1 year; were included in the study. The data were analyzed to determine risk factors for ROP causation. Information was collected using the standardized performa which included the maternal risk factors as well. Infants were classifi ed by ophthalmologic examination fi ndings using ICROP revisited. Statistics: Qualitative data were analyzed using Pearson's Chi-square test with Yates correction or Fisher's exact test and possible risk factors were analyzed by univariate analysis and multivariate analysis. Results: A total of 278 subjects was included in the study. Incidence of ROP in babies ≤1800 g was found to be 13.67% (38/278). Incidence of ROP in babies weighing between 1501 and 1800 g was 11.64% (17/146). Twenty-one risk factors were signifi cant on univariate analysis in babies weighing ≤1800 g and 18 risk factors in the babies weighing between 1501 and 1800 g. Multiple gestations (P < 0.01), blood transfusion (P < 0.01), antepartum hemorrhage (P < 0.01), pregnancy-induced hypertension (P < 0.01), mechanical ventilation (MV) (P < 0.01), and APGAR at 1 min (P < 0.01) were found to be independently signifi cant for ROP causation on logistic regression analysis in babies weighing ≤1800 g and MV (P < 0.01) and resuscitation (P < 0.01) were signifi cant for babies weighing 1501-1800 g. Conclusion: It should be considered to incorporate screening of babies ≤1800 g uniformly in developing nations. It is recommended that further studies be done taking representative population of babies in different sites with adequate follow-up.
Annals of Tropical Medicine and Public Health, 2013
An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oligu... more An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oliguria. He had hypertension. Urine microscopy showed hematuria and glomerular casts. Renal functions were deranged and had low complement C3 level. Chest X-ray showed plural effusion and ultrasonography abdomen showed mild ascitis. The immunoglobulin (Ig)M and IgG enzyme-linked immunosorbent essay for dengue virus were positive. Diagnosis of dengue hemorrhagic fever with acute glomerulonephritis was made. He was managed with maintenance fluid, antihypertensive medicine and supportive care. He recovered gradually and was discharged 12 days after admission.
Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unila... more Background: Pulmonary agenesis is the complete absence of bronchus, parenchyma and vessels. Unilateral lung agenesis is more common (Aggarwal et al., 2002). Accumulation of bronchial secretions and products of inflammation are chief determinants that determine the degree of respiratory distress (Krivchenya et al., 2000). Anomalies frequently associated with pulmonary agenesis may include any organ system viz, cardiovascular, skeletal, gastrointestinal and genitourinary systems (Krivchenya, 2000; Nazir et al., 2006; Kaya and Dilmen, 1989; Lucaya and Strife 2002). These are more commonly found in association with right pulmonary agenesis. Vascular aberrations and genitourinary system malformations have also been noted with the presence of right pulmonary agenesis. Left pulmonary agenesis is often an isolated anomaly; associated with usually no congenital defects (Maltz and Nadas, 1968). In our case; despite left pulmonary agenesis, there was evidence of atrial septal, ventricular sept...
The study was conducted after taking Institutional Ethics Committee approval and patients were en... more The study was conducted after taking Institutional Ethics Committee approval and patients were enrolled after taking ABSTRACT Objective: The aim of this study is to assess the utilization of the pediatric risk of mortality-(PRISM)-III score to predict mortality in critically sick children and determination of mortality risk factors in a tertiary care pediatric unit. Materials and Methods: In this cross-sectional descriptive study, 100 children admitted during an 18-month period were enrolled in the study. PRISM-III score and mortality risk were calculated. Follow-up was noted as death or survival. Results: Of 100 patients, 27 died and 73 survived. The 47% of the patients were males. The PRISM-III score was 0-9 in 75%, 10-19 in 15% and 20-29 in 8%, ≥30 in 2% of patients. PRISM-III score showed an increase of mortality from 8% in 0-9 score patients to 100% in ≥20 score. PRISM-III score was significantly associated with study variables such as duration of hospital stay, mental status (Glasgow Coma scale <8), and blood pH <7.28 (p<0001). Conclusion: PRISM-III score showed good predictive value (94.5%) and adequate discriminatory capacity (area under receiver operating characteristics curve 90.8%), and thus constitutes a useful tool for the assessment of prognosis for pediatric patients.
A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae ty... more A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae type b is reported in a one-year old previously healthy child who had apparently no other associated medical condition. The organism was isolated from both the pleural fluid aspirate and blood of the patient with pneumonia. She was successfully treated with parenteral ampicillin and chloramphenicol alongwith intercostal chest tube drainage. The case is notable because it adds to the existing disease spectrum of invasive Hib diseases and brings awareness to the existing burden of the disease in Asia. In addition, it reflects the urgent need to include Hib vaccine in the current immunization program in India.
Journal of clinical and diagnostic research : JCDR, 2016
Ebstein's anomaly is a rare congenital heart disorder and has a varied clinical course, with ... more Ebstein's anomaly is a rare congenital heart disorder and has a varied clinical course, with detection as late as the seventh decade. We hereby describe an 11-year-old child in whom Ebstein's anomaly was diagnosed. The most common presentation in early second decade is due to an arrhythmia; however, the present case report is about a patient who presented with acute congestive heart failure due to decompensation from an acute upper respiratory tract infection, which is a rather uncommon presentation.
Epidermal nevi syndrome (ENS) is a multisystem neurodermatological disorder in which epidermal ne... more Epidermal nevi syndrome (ENS) is a multisystem neurodermatological disorder in which epidermal nevi may be associated with neurological, skeletal, ocular and other cutaneous anomalies as well as malignancies with potentially devastating consequences. Most cases are sporadic though occasionally autosomal dominant transmission has been documented. The objective of the present communication is to sensitize regarding the presence of the entity.
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