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Biomedical subjects

S K Kabra

Publications and source records attributed to S K Kabra.

At least 19 recordsLinked to original sources
PubMed2003

Etiology of acute lower respiratory tract infection.

OBJECTIVE: To identify pathogens responsible for acute severe lower respiratory tract infection (ALRTI) in under five children by non-invasive methods. METHOD: 95 children hospitalized with acute severe lower respiratory tract infection were investigated for identification of viruses, bacteria, chlamydia or mycoplasma by nasopharyngeal aspirates, blood culture and serology. RESULT: Etiological agents could be identified in 94% of the patients. Viruses from NP aspirate could be isolated in 36 (38%), bacterial isolates from blood cultures in 15 (16%); mycoplasma was identified in 23 (24%) and chlamydia in 10 (11%) by serological tests; mixed infections were present in 8 (8%) patients. CONCLUSION: Noninvasive methods can be useful in identifying etiological agents in severe ALRTI.

Child, Preschool↗
PubMed2003

Long-term management of asthma.

Long-term management of asthma includes identification and avoidance of precipitating factors of asthma, pharmacotherapy and home management plan. Common precipitating factors include viral upper respiratory infections, exposure to smoke, dust, cold food and cold air. Avoidance of common precipitating factors has been shown to help in better control of asthma. Pharmacotherapy is the main stay of treatment of asthma. Commonly used drugs for better control of asthma are long and short acting bronchodilators, mast cell stabilizers, inhaled steroids, theophylline and steroid sparing agents. After assessment of severity most appropriate medications are selected. For mild episodic asthma the medications are short acting beta agonists as and when required. For mild persistent asthma: as and when required bronchodilators along with a daily maintenance treatment in form of low dose inhaled steroids or cromolyn or oral theophylline or leukotriene antagonists are required. Moderate persistent asthma should be treated with inhaled steroids along with long acting beta agonists for symptom control. For severe persistent asthma the recommended treatment includes inhaled steroids, long acting beta agonists with or without theophylline. If symptoms are not well controlled, a minimal dose of oral prednisolone preferably on alternate days may be needed in few patients. Patients should be followed up every 8-12 weeks. On each follow up visit patients should be examined by a doctor, compliance to medications should be checked and actual inhalation technique is observed. Depending on the assessment, medications may be decreased or stepped up. For exercise induced bronchoconstriction: cromolyn, short or long acting beta agonists or leukotriene antagonists may be used. In children with seasonal asthma, maintenance treatment according to assessed severity should be started 2 weeks in advance and continued throughout the season. These patients should be reassessed after discontinuing the treatment. Parents should be given a written plan for management of acute exacerbation at home.

Administration, Inhalation↗
PubMed2003

Cefprozil: a review.

Cefprozil is a novel third generation, broad-spectrum oral cephalosporin with activity against a spectrum of aerobic gram-negative and positive bacteria, as well as certain anaerobes. The beta-lactamase stability of cefprozil may exceed that of other oral cephalosporins for some important pathogens. Cefprozil may be a suitable alternative to several other commonly used beta-lactams and cephalosporins in the treatment of mild to moderate upper and lower respiratory tract infections including sinusitis, otitis media, pharyngitis/tonsillitis, secondary bacterial infection of acute bronchitis, and acute bacterial exacerbations of chronic bronchitis, and skin and skin structure infections in children. Available data indicate the safety of cefprozil in both pediatric and adult population.

Bronchitis↗
PubMed2003

Severe acute respiratory syndrome (SARS).

Several cases of life threatening respiratory disease with no identifiable cause were reported from Guangdong Province, China; these were soon followed by reports from many other countries. The disease was named as severe acute respiratory syndrome (SARS). A novel coronavirus, isolated from the respiratory secretions of patients, has been implicated in the causation of SARS. The modes of transmission include droplet spread, close contact, and Fomites; shedding of virus from respiratory tract is the primary mode of transmission. SARS clinically presents with high-grade fever, chills and rigors, myalgia, headache, cough with or without sputum production, dyspnea, and dizziness. Chest radiographs reveal unilateral or bilateral, predominantly peripheral, areas of consolidation progressing with in a short time of bilateral patchy consolidation. Preliminary reports suggest a milder illness in young children. The case definition of probable SARS cases, laboratory investigations and precautions for prevention of spread are discussed.

Communicable Diseases, Emerging↗
PubMed2003

Clinical profile and frequency of delta f508 mutation in Indian children with cystic fibrosis.

OBJECTIVE: To document clinical profile of cystic fibrosis (CF) in Indian children and the prevalence of delta F508 mutation in these patients. DESIGN: Observational study. SETTING: Pediatric chest clinic in an urban tertiary care center in north India. PERIOD OF STUDY: July 1995 to June 2002. METHODS: Clinical features of 120 children diagnosed as CF by quantitative pilocarpine iontophoresis were recorded. A polymerase chain reaction based test for identification of delta F 508 mutation was performed on all children. RESULTS: Out of 3500 new cases registered in Pediatric Chest Clinic during this period 120, (3.5%) children were diagnosed as CF. Origin of parents of patients traced from almost all the States of north India. Family history suggestive of CF was present in 41 (34%) and consanguinity in 19 (61%) patients. Common clinical manifestations at the time of presentation included recurrent or persistent pneumonia in 118 (98%), failure to thrive in 108 (90%), malabsorption in 96 (80%), history of meconium ileus in 10 (8%), and rectal prolapse was present in 16 (13%). History of salt craving, salty taste on kissing and skin rashes was present in 5 patients each. 49(41%) patients were severely malnourished. Nasal polyposis was present in 5 (4%) patients. Examination of chest revealed evidence of hyperinflation in 100 (83%), kyphosis 20 (17%), crepitations 110 (92%), wheezing 40 (25%) and bronchial breathing in 20 (17%) patients. Average clinical CF scores were 51 (95%; CI 20-80). 48 (40%) patients had a CF score of LT40. Pseudomonas spp was cultured from respiratory secretions of 51 (42%), Staphylococcus spp in 18 (15%), Klebsiella spp in 8 (7%) and Hemophilus influenzae in 2 (2%) patients. Delta F508 mutation was positive in 45 chromosomes out of 240 tested. Patients originated from Pakistan had more frequency of delta F508 mutations. CONCLUSIONS: Cystic fibrosis does occur in Indian children; clinical features are classical. Diagnosis is often delayed and the disease is advanced in most patients at the time of diagnosis. Frequency of Delta F508 mutation is 19% i.e., less than that seen in Caucasian population. There is need to create awareness about occurrence of CF in Indian children.

Child↗
PubMed2002

Nasopharyngeal carriage of Haemophilus influenzae.

OBJECTIVE: Nasopharyngeal colonization of Haemophilus influenzae (H. influenzae) in young children may be important in developing countries. METHOD: In this study, we screened school going children for carriage of H. influenzae. A total of 44 H. influenzae isolates out of a collection of 162 were characterized for biotypes, capsular serotypes and antibiotic resistance. RESULTS: A significant proportion of H. influenzae (25/44) isolates were serotype b. High antibiotic resistance was observed against commonly administered antibiotics like ampicillin (79%), chloramphenicol (20%), trimethoprim sulfamethoxazole (84%) and erythromycin (95%). Comparison of antibiotic resistance profile of nasopharyngeal isolates was observed to be correlated with those of H. influenzae from disease. CONCLUSION: Multidrug resistant nasopharyngeal H. influenzae in young healthy children may act as reservoir. Monitoring of antibiotic resistance among nasopharyngeal H. influenzae as a surrogate for invasive H. influenzae seems an attractive option.

Age Distribution↗
PubMed2002

Blount's disease: a lesser known cause of bowlegs mandating early differentiation from physiological bowing.

We present a 16-month-old child, with progressively increasing bowing of legs, having a normal serum calcium, phosphorus and alkaline phosphatase level; lower limb radiographs revealed bilateral medial tibial metaphyseal beaking. Based on these findings, a diagnosis of Blount's disease (infantile tibia vara) was made and an orthotic management program was instituted for the child.

Bone Diseases, Developmental↗
PubMed2002

Recurrent pneumonia in children: clinical profile and underlying causes.

AIM: To study the clinical profile and describe the predisposing causes of recurrent pneumonia in Indian children. METHODS: The clinical details and the investigations of children presenting with recurrent pneumonia to the paediatric chest clinic services of a tertiary care centre in northern India were reviewed. RESULTS: Seventy children (44M, 26F) presented with recurrent pneumonia over a period of 5 y. Based on the clinical features and the results of the investigations, underlying illness could be identified in 59 children (84%). The most frequent underlying cause for recurrent pneumonia was recurrent aspiration (24.2%), followed by immunodeficiency (15.7%), asthma (14.2%) and structural anomalies (8.6%). CONCLUSION: The underlying cause of recurrent pneumonia was identified in more than 80% of children. Recurrent aspirations were the most common cause.

Child↗
PubMed2002

Isosporiasis in children.

The clinical, laboratory and therapeutic data of patients with diarrhea in Human immunodeficiency virus (HIV) antibody positive, immunocompromised and immunocompetent individuals were studied especially to look for prevalence of intestinal coccidiosis. During a study period of one decade, Isospora belli were identified in the stool samples of seven children with diarrhea. Diarrhea persisted for a little longer period in HIV-seropositive children compared to sero-negatives but the clinical picture did not differ significantly in either HIV infected or HIV uninfected individuals.

Child↗
PubMed2002

An indigenously developed method for sweat collection and estimation of chloride for diagnosis of cystic fibrosis.

An indigenously developed method for sweat collection and titration method for estimation of chloride was validated. The mean difference in estimated chloride value from the known strength of saline in 50 samples was -1.04 +/- 4.13 mEq/L (95% CI: -0.07 to 2.28). The mean difference in the estimated chloride values between two observers when the test was performed on known strengths of saline solution was -2.5 +/- 4.24 mEq/L (95% CI: -3.67 to 1.33). The inter observer variability between two observers when the test was performed on sweat samples obtained from 50 individuals was -1.12 +/- 4.34 mEq/L (95% CI: -2.23 to 0.8 ). Sweat weight of more than 100 mg could be collected in first attempt in 602 of 757 (80%) patient with an average sweat weight of 230 mg. This inexpensive method of sweat collection and chloride estimation has acceptable accuracy and repeatability and can be used in resource poor setting for making a diagnosis of cystic fibrosis.

Cystic Fibrosis↗
PubMed2002

Tuberculosis in children--what has changed in last 20 years?

Several changes have been observed in the epidemiology, clinical manifestations, diagnostic modalities and treatment of tuberculosis. Emergence of HIV epidemic and drug resistance have posed significant challenges. With increase in number of diseased adults and spread of HIV infection, the infection rates in children are likely to increase. It is estimated that in developing countries the annual risk of tuberculosis infection in children is 2.5%. Nearly 8-20% of the deaths caused by tuberculosis occur in children. Lymph node tuberculosis has increased over last two decades. HIV infected children are at an increased risk of tuberculosis, particularly disseminated disease. In last two decades drug resistant tuberculosis has increased gradually. The rates of drug resistance to any drug varied from 20% to 80% in different geographic regions. Various diagnostic techniques such as improved culture techniques, serodiagnosis, and nucleic acid amplification have been developed and evaluated to improve diagnosis of childhood tuberculosis. Serodiagnosis is an attractive investigation but till date none of the tests have desirable sensitivity and specificity. Tests based on nucleic acid amplification are a promising advance. Relatively less experience in children, need for technical expertise and high cost are limiting factors for their use in children with tuberculosis. Short-course chemotherapy for childhood tuberculosis is well established. Treatment with intermittent regimens is comparable to daily regimens. Directly observed treatment strategy have shown encouraging result.

BCG Vaccine↗
PubMed2002

Phenotypic & genotypic variants of Pseudomonas aeruginosa isolated from children with cystic fibrosis in India.

BACKGROUND & OBJECTIVES: Pseudomonas aeruginosa is the leading cause of morbidity and mortality in patients with cystic fibrosis (CF). With increase in the chronicity of the disease, there is a diversification of the organism into different colony morphological types. The antimicrobial susceptibility of the organism varies with its colony morphology. The present work was carried out to study the different morphotypes of P. aeruginosa isolated from patients of cystic fibrosis. METHODS: We studied 38 children with CF attending the Paediatric Chest Clinic at the All India Institute of Medical Sciences, New Delhi, India during October 2000-January 2001 who were regularly followed up at the clinic. Patients were divided into 2 groups, Group 1 included all patients chronically infected with P. aeruginosa and Group 2 included patients who were infrequently colonized with this organism. Different colony morphological types of P. aeruginosa on culture media were identified. They were characterized by phenotypic methods using antibiograms and genotypic methods using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction and PCR-ribotyping. RESULTS: Fourteen of the 38 patients were colonized at least once with P. aeruginosa. Eight patients belonged to Group 1 and 42 isolates were obtained from these patients. Group 2 had 6 patients and 9 isolates were obtained from them. All patients in Group 1 harboured different colony morphotypes (Types 1-6) while all 6 patients in Group 2 showed a single type of colony morphology (Type 1). The isolates from Group 1 patients showed higher antimicrobial resistance as compared to Group 2 patients. Molecular typing of the isolates revealed 10 ERIC-PCR patterns and 2 PCR-ribotyping patterns among Group 1 and 2 ERIC-PCR and 1 PCR-ribotyping pattern among patients of Group 2. INTERPRETATION & CONCLUSION: The frequency of different morphotypes of P. aeruginosa and antibiotic resistance was higher among Group 1 patients. On molecular typing, more than one genotype was isolated from Group 1 patients while only one genotype was isolated from patients in Group 2. We conclude that at a given time, chronically infected patients can be colonized by phenotypically and genotypically distinct strains of P. aeruginosa which has an implication in the management of these patients.

Adolescent↗
PubMed2001

Risk factors associated with bronchial asthma in school going children of rural Haryana.

Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. 2000 school going children from five schools of Chhainsa and Dayalpur Primary Health Centre area in Ballabgarh Block of Haryana state were screened for presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). 40 children were identified as cases of bronchial asthma. For each child with asthma two age and sex matched non-asthmatic controls were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were passive smoking (OR 3.33, 95% CI 1.85-7.65), pets at home (OR 5.5, 95% CI 1.04-29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17-13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant on statistical analysis. Thus, passive smoking, inadequate ventilation and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in rural children.

Asthma↗
PubMed2001

Nosocomial infections in pediatric intensive care units.

Nosocomial infections are a significant problem in pediatric intensive care units. While Indian estimates are not available, western PICUs report incidence of 6-8%. The common nosocomial infections in PICU are bloodstream infections (20-30% of all infections), lower respiratory tract infections (20-35%), and urinary tract infections (15-20%); there may be some differences in their incidence in different PICUs. The risk of nosocomial infections depends on the host characteristics, the number of interventions, invasive procedures, asepsis of techniques, the duration of stay in the PICU and inappropriate use of antimicrobials. Most often the child had endogenous flora, which may be altered because of hospitalization, are responsible for the infections. The common pathogens involved are Staphylococcus aureus, coagulase negative staphylococci, E. coli Pseudomonas aeruginosa, Klebsiella, enterococci, and candida. Nosocomial pneumonias predominantly occur in mechanically ventilated children. There is no consensus on the optimal approach for their diagnosis. Bloodstream infections are usually attributable to the use of central venous lines; use of TPN and use of femoral site for insertion increase the risk. Urinary tract infections occur mostly after catheterization and can lead to secondary bacteremia. The diagnostic criteria have been discussed in the review. With proper preventive strategies, the nosocomial infection rates can be reduced by up to 50%; handwashing, judicious use of interventions, and proper asepsis during procedures remain the most important practices.

Adolescent↗