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Biomedical subjects

P Nalini

Publications and source records attributed to P Nalini.

At least 19 recordsLinked to original sources

Long-term outcome in coma.

OBJECTIVE: To assess the relationship between Modified Glasgow Coma Scale, its components, brain stem reflexes and long term functional outcome in children with acute non-traumatic coma. METHOD: MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The children were followed up regularly and functional outcome was assessed at the end of 9 months. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis. RESULTS: Higher total MGCS score and verbal response score had a significant positive correlation with better functional outcome as measured by GOS and intelligence quotient. There was no association between the language function and the initial MGCS, its components and brain stem reflexes. Lower verbal response (P = 0.005) was the only factor that was found to be individually associated with poorer long term GOS score and intelligence quotient by multivariate linear regression analysis. CONCLUSION: In the long term prediction of outcome in acute non-traumatic coma, MGCS is not useful. However, verbal response, a component of MGCS, correlates well with long term functional outcome and intelligence quotient.

Acute Disease↗

Helicobacter pylori and recurrent pain abdomen.

OBJECTIVE: Pain abdomen is a common problem in childhood. Many factors i.e., organic changes in the gut, psychological and environment contribute to recurrent pain abdomen (RAP) in children. Helicobacter pylori infects children very early in childhood and stays indefinitely in the gut without its eradication. It may be responsible for pain abdomen and peptic ulcers in children. This study was done to assess the HP status in children with RAP diagnosed and evaluate the effects of eradication of HP infection in them. METHODS: 76 children were included in the study. RESULT: Out of 76 children studied 14.8% had evidence of a secondary cause for pain abdomen and responded to appropriate therapy. 65.45% of children who had undergone UGIE, had evidence of HP infection in the upper gastrointestinal tract. Most of these children responded to HP eradication therapy by becoming free of abdominal pain after the eradication therapy with OCA or OMA regimen. We could not do repeated endoscopies in all of them to prove the eradication due to parents' refusal and this is the main drawback of this study. CONCLUSION: However, in view of clinical response to HP eradication therapy in almost all the cases, we strongly advocate this therapy for those children with RAP, in whom HP infection of the upper gastrointestinal tract can be established beyond doubt.

Abdominal Pain↗

Inhalational anthrax with acute respiratory distress syndrome.

A 10-year-old boy presented with facial swelling, thick exudates in the nasal cavities with membranes covering the nasopharynx, shock and respiratory distress. X-ray of the paranasal sinuses showed opacification of both maxillary sinuses. Nasal diphtheria was suspected but culture of the membranes grew Bacillus anthracis. Chest X-ray showed mediastinal widening and extensive pulmonary infiltrates compatible with respiratory anthrax.

Anthrax↗

Increased protein glycation in non-diabetic pediatric nephrotic syndrome: possible role of lipid peroxidation.

BACKGROUND: Malondialdehyde (MDA), ascorbic acid and reduced glutathione (GSH) have been reported to play a possible role in glycation of proteins. This study was performed to evaluate this correlation in nephrotic syndrome patients by comparing the levels of fructosamine with MDA, ascorbic acid and GSH. METHODS: Fifteen children with nephrotic syndrome during relapse and 10 age- and sex-matched healthy controls were enrolled for this study. Whole blood GSH, plasma MDA, total ascorbic acid and fasting glucose were analyzed in both the groups. Partial correlation analysis was performed to predict the independent association of MDA, ascorbic acid and GSH on fructosamine. RESULTS: Plasma MDA and fructosamine levels were found to be increased in nephrotic syndrome patients when compared with controls. Plasma ascorbic acid and whole blood GSH were decreased in nephrotic group vs. healthy controls. Partial correlation analysis showed a significant positive correlation between fructosamine and MDA. CONCLUSIONS: Present data point to a possible involvement of MDA in the glycation of protein in non-diabetic nephrotic syndrome patients, and provide support for the potential use of an antioxidant therapy in these patients.

Ascorbic Acid↗

Role of Glasgow Coma Scale in pediatric nontraumatic coma.

OBJECTIVE: To assess the relationship between Modified Glasgow Coma Scale (MGCS), its components and survival in children with acute coma. DESIGN: Prospective observational study. SETTING: Tertiary care referral hospital. PATIENTS: Consecutive children (n = 270) with acute nontraumatic coma between 2 months to 12 years. METHODOLOGY: MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis. MAIN OUTCOME MEASURE: Survival. RESULTS: Total score (Spearman rank correlation coefficient IRI = O.577, ocular response (IRI = O.641), motor response (IRI = O.729), verbal response (lRI = 0.608), brain stem response (lRI = O.843) were all found to be associated with adverse outcome. Multivariate regression analysis revealed that ocular response and motor response were individually predictive of short-term outcome. CONCLUSION: A score incorporating the brain stem reflexes, ocular response and motor response in the assessment and prognostication of comatose patients needs to be evaluated.

Child↗

Qualitative tuberculin response in the diagnosis of tuberculosis in apparently healthy schoolchildren.

SETTING: School-based cross-sectional study. OBJECTIVE: To assess the value of qualitative tuberculin responses (turgid and non-turgid type) in diagnosis of tuberculosis disease in apparently healthy schoolchildren. DESIGN: Qualitative tuberculin responses were assessed in 548 apparently healthy schoolchildren. Tuberculin-positive (> or = 10 mm) children were investigated for evidence of tuberculosis. The relationship between the types of qualitative tuberculin response and occurrence of tuberculosis was studied. RESULTS: Eighty-eight (16.1%) children were found to be tuberculin-positive. Of these, 68 had non-turgid reaction whereas 20 had turgid reaction. Most of the children with a reaction of 5-9 mm had a non-turgid type of tuberculin reaction. Only four children with non-turgid reaction had tuberculosis, while 18 children with turgid reaction had tuberculosis disease (P < 0.0001). A larger tuberculin reaction was found to be associated with a higher occurrence of tuberculosis (P = 0.016 by linear regression method). CONCLUSION: The observations indicate a possible relation between turgid reaction and tuberculosis disease.

Child↗

Social status of the rural girl child in Tamil Nadu.

OBJECTIVE: The social status of the girl child in school age was assessed in a village in Tamil Nadu applying both qualitative and quantitative methods. METHODS: The home milieu was taken as the social context for the study purpose since home is the first societal unit a child comes into contact with. The various issues considered to study the social status were (1) Gender preference in having children (2) Nutrition and health care given to them (3) Importance given to their education (4) Activity pattern in daily life (5) Attitude of the community towards (a) girl child after menarche and (b) marriage. RESULT: In the study village, although there was desire to have sons, a girl child is not ignored. The value of having a girl in the family was appreciated. There was no gender discrimination in giving nutrition and health care. However the workload in girls was found to be marginally higher than in boys. The educational status of girls was lower than that of boys in terms of school enrollment and attendance. But menarche, was not an important cause of the lower educational status of girls. In the sociocultural context of the study village the priority in a girl's life during school going age was marriage. Soon after attaining puberty in a girl's life during school going age was marriage, not education and this perhaps reveals the lesser importance given to a girl's education by the community. CONCLUSION: The need of the hour is to improve her educational status by changing the attitude of the community so that a girl child's priority in her school age is not marriage but education.

Child↗

Predictive value of tuberculin induration at 24 h in healthy schoolchildren.

Tuberculin (1 TU PPD RT23 Tween 80) was administered to 500 healthy schoolchildren, aged 5-9 years. The induration at 24 h was compared with that at 72 h. The mean (standard deviation) induration of the tuberculin reaction at the end of 24,48 and 72 h was 4.5 (6.75), 4.4 (7.11) and 4.0 (6.91) mm, respectively. When the tuberculin reaction was 0-9 mm, a significant difference was noted between the 24- and 72-h reading (p = 0.0001). There was no difference in the size of the tuberculin reaction between the 24- and 72-h readings when the reaction size was > or = 10 mm (p > 0.05). Considering a tuberculin induration of < 10 mm as negative tuberculin reaction for our reference population in South India, the sensitivity, specificity, positive predictive value and the negative predictive value in our study for the 24-h reading were found to be high. The predictive value of 24-h induration was not affected by age. Reading and interpretation of tuberculin test after 24 h needs due consideration in clinical practice.

Child↗

Congenital leukaemia in Down Syndrome--a case report.

A 17 days old male infant, who had features of Down Syndrome, presented with fever, refusal to feed and seizures. He had papular, crusted skin lesions, moderate hepatosplenomegaly and a rapid downhill course. Peripheral blood and bone marrow aspirate showed features of acute leukaemia. Congenital Leukaemia is a rare malignancy associated with a very poor prognosis. Paradoxically, many cases of Congenital Leukaemia, especially in infants with Down Syndrome, show spontaneous remission.

Acute Disease↗

Acute pulmonary edema as a complication of anti-snake venom therapy.

Polyvalent Anti-snake Venom (ASV) is a life-saving antivenin for severe envenomation due to snake bite in India. ASV infusion is occasionally associated with severe allergic reactions, i.e. anaphylaxis and death. We report a rare instance of non-cardiogenic pulmonary edema due to ASV infusion in an eleven years old boy.

Anaphylaxis↗

Tuberculin reactivity in healthy school children in Pondicherry.

Five hundred healthy school children in the age group 5-9 years underwent tuberculin testing. Seventy nine per cent of the study population had a BCG scar. 9.2% children were found to be suffering from malnutrition, using the Quetlet's Index and 7.8% were found to be malnourished by weight for age method. 18.6% of the children were tuberculin positive (induration > or = 10 mm) and the prevalence of tuberculin positivity increased with age. The numbers of tuberculin reactors or the mean tuberculin reaction were not affected by malnutrition. BCG scar status neither affected the mean tuberculin size nor the number of tuberculin reactors.

BCG Vaccine↗

Perinephric abscess due to Aspergillus fumigatus.

Invasive aspergillosis is rare in healthy children. Severe systemic complications due to aspergillosis may be seen in AIDS patients with severe neutropenia and macrophage dysfunction.

AIDS-Related Opportunistic Infections↗

Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.

Age Factors↗