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Biomedical subjects

G R Sethi

Publications and source records attributed to G R Sethi.

At least 19 recordsLinked to original sources
PubMed2001

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of two cases with fine-needle aspiration cytology.

Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease is a rare but well-defined histiocytic proliferative disorder. There are only few reports or small series of cases on the fine-needle aspiration (FNA) cytologic features of this entity. Our first case was a 14-yr-old girl who presented with low-grade fever and neck swellings of 2 mo duration. FNA smears from the submandibular and cervical lymph nodes showed numerous histiocytes with evidence of lymphophagocytosis (emperipolesis) against a background of reactive lymphoid cells. The FNA cytodiagnosis was Rosai-Dorfman disease. The patient was put on steroids, with improvement. The second patient was a 3(1/2)-yr-old girl who presented with fever and left cervical lymphadenopathy. The initial FNA smear from an outside laboratory was reported as reactive hyperplasia. A repeat FNA smear showed numerous histiocytes with evidence of emperipolesis, mild nuclear enlargement and multilobation/multinucleation in a few histiocytes, and reactive lymphoid cells. The cytodiagnosis was Rosai-Dorfman disease. Review of the initial smear showed the Rosai-Dorfman (RD) cells, but in smaller number. We conclude that FNA cytology is a useful tool in the diagnosis of SHML, but the diagnosis may be missed at initial stages when characteristic cytomorphologic features are not well-developed.

Adolescent↗
PubMed2000

Bronchiectasis: causes and management.

Bronchiectasis is a condition representing abnormal and permanent dilatation and distortion of medium sized bronchi, usually accompanied by destruction of the airway wall. Post inflammatory bronchiectasis remains very common in the developing countries as a sequel to pulmonary tuberculosis, whooping cough, and severe measles (among other causes). Cystic fibrosis is the most common cause of generalized bronchiectasis in developed countries. Symptoms primarily are chronic cough and expectoration of foul smelling sputum. Bronchography was, until recently, the investigation of choice for the diagnosis of bronchiectasis and the gold standard against which the current best imaging technique HRCT (high resolution computed tomography) has been compared. Treatment includes prompt attention to acute exacerbations, management of airway secretions and control of airway hyperreactivity. Treatment is aimed at the non progression of the disease and complete cure if possible. The role of surgical therapy has evolved from early curative resection for all patients to a more palliative approach. Patients with advanced generalized bronchiectasis should be considered for lung transplantation.

Anti-Bacterial Agents↗
PubMed1998

Indoor air quality and acute lower respiratory infection in Indian urban slums.

The present prospective study was conducted at two urban slums of Delhi, Kusumpur Pahari and Kathputly Colony, in the peak winter season from November 1994 through February 1995. We studied 642 infants to determine the incidence of acute lower respiratory infection (ALRI) and its relationship to indoor air pollution due to fuel used for cooking (wood or kerosene). In Kusumpur Pahari, there were 317 children (142 wood and 175 kerosene), including 64 controls and 78 cases of ALRI in the wood fuel group and 81 controls and 94 ALRI cases in the kerosene group (p > 0.05). Out of 316 children in Kathputly Colony (174 wood and 142 kerosene), there were 33 and 45 ALRI cases in the wood and kerosene groups, respectively (p < 0.05). Controls were children without ALRI and were used as controls in different groups. The demographic data and risk factors, namely, nutritional and immunization status, were comparable in ALRI cases and controls in both study areas. Pneumonia was the most common ailment in all the groups. Bronchiolitis was reported in 22.5% of the wood group and 27.1% of the kerosene group in Kathputly Colony versus 13.7% in the wood group and 12.1% in the kerosene group in Kusumpur Colony. Only one case of croup was reported from Kusumpur Pahari among wood users. The duration of illness was longer in the Kusumpur Pahari due to poor compliance, feeding, and child rearing habits. In conclusion, a higher incidence of ALRI was reported in kerosene users in Kathputly Colony, a high pollution area; however, the reasons for the differences observed need further elucidation.

Acute Disease↗
PubMed1997

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

Age Distribution↗
PubMed1997

Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma.

OBJECTIVE: To compare the relative efficacy of jet nebulizer and metered dose inhaler (MDI) with spacer for the administration of aerosolized salbutamol in an acute exacerbation of bronchial asthma. DESIGN: Randomized prospective study. SETTING: Emergency Room. METHODS: In 60 subjects with acute asthma aged between 1 to 12 years, clinical and laboratory assessment of severity at recruitment included heart rate, respiratory rate, pulsus paradoxus, arterial blood gas analysis (all cases) and peak expiratory flow rate (wherever possible). The subjects were randomized into two equal groups to receive aerosolized salbutamol either via nebulizer (Group I) or MDI-spacer (Group II) as per the Consensus Guidelines. The response to therapy was sequentially assessed after 20, 40 and 60 minutes of institution of therapy. RESULTS: A significantly (p < 0.02) greater number of subjects in Group II presented with severe dyspnea and intercostal muscle retraction (subjective assessment). However, the objectively evaluable outcome parameters were comparable (p > 0.05) in both groups at presentation. All the outcome measures showed a significant (p < 0.05) improvement with time in both the groups. The recovery parameters were comparable (p > 0.05) at different time periods in the two groups. CONCLUSION: MDI-spacer is as effective as a nebulizer for the aerosolized administration of salbutamol in an acute exacerbation of asthma in children. However, for developing countries, distinct advantages (economic and power requirement) argue strongly for utilization of MDI-spacer in preference to nebulizer.

Acute Disease↗
PubMed1994

Clinical predictors of hospitalization in an acute attack of bronchial asthma.

The present study was undertaken to identify the clinical predictors of hospitalization in an acute attack of bronchial asthma in subjects aged 2-12 years. Seventy five children with an acute attack of bronchial asthma were evaluated. A detailed clinical history and examination was recorded and baseline investigations sent before starting therapy. All subjects were treated with injection adrenaline (two doses) and those who did not respond were hospitalized. Twenty subjects who were hospitalized were compared with 32 cases who were discharged and did not have a relapse on follow up. After multivariate analysis, the factors independently predictive of hospitalization were, pulsus paradoxus (> 10 mm Hg; OR = 1.02), younger age (below 5 years, OR = 0.98) and severe accessory muscle use (OR = 89.6). Presence of any 2 of these 3 clinical predictors has a high sensitivity (90%) and specificity (96%). The investigative variables significant after multivariate analysis were low pH (OR = 0.00) and polymorphonuclear leucocytosis (> 70%) on peripheral smear (OR = 1.12). The sensitivity of this model was similar (90%) but specificity was lower (90.6%). The addition of investigative variables to clinical model did not improve the predictability. It is concluded that it is possible to identify at presentation, children with acute bronchial asthma who require hospitalization and clinical variables are sufficient for this purpose.

Acute Disease↗
PubMed1989

Typhoid fever. Unusual hepatic manifestations.

Four cases of typhoid fever with unusual hepatic manifestations are described. Two cases had hepatitis and two had hepatic abscess. These complications are documented for the first time in the pediatric age group. Awareness of these rare manifestations may be helpful in avoiding unnecessary morbidity and mortality.

Child↗
PubMed1988

BCG vaccination.

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Adolescent↗