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Biomedical subjects

S Singhi

Publications and source records attributed to S Singhi.

At least 37 records · Page 2Linked to original sources
PubMed1999

Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma.

To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15 mg/kg) and placebo at half-hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 microg) at half-hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.

Administration, Inhalation↗
PubMed1999

Phlegmonous inflammation of gastrointestinal tract autopsy study of three cases.

Three cases of Phlegmonous inflammation of gastrointestinal tract detected at necropsy are described. Predisposing factors were seen in all three cases. These were chronic alcoholism with submissive hepatic necrosis (HbsAg and HbcAg positive) in Case 1, Indian Childhood cirrhosis in Case 2 and acute on chronic Budd Chiari syndrome in Case 3. In case 1 and 3 the inflammation was limited to the large intestine where as in Case 2 it was seen both in the stomach and large intestine. In two of the three cases blood culture grew Staphylococcus aureus (Case 1) and gram negative organisms (Case 2).

Adult↗
PubMed1998

Respiratory rates of Indian infants under 2 months of age.

There are few data from developing countries, including India, on the normal range of the respiratory rate (RR) recorded by observation. To determine the normal range of RR in infants up to 8 weeks of age and to define tachypnoea, we studied 100 healthy infants, 50 of normal birthweight and 50 of low birthweight) at 1, 2, 4, 6 and 8 weeks of age. The RR was recorded by observation and auscultation simultaneously for 60 seconds on each visit when the baby was either asleep or awake and content. The median RRs ranged between 42 and 43 breaths/min in infants of normal birthweight and 40 and 44 breaths/min. in low birthweight infants. Inter-age variability up to 8 weeks of age was very slight and statistically insignificant. Only 2-10% of the infants at any given age had a RR > or = 60/min. At all ages, RR by observation was higher than that by auscultation (p < 0.001). Neither birthweight nor gender significantly influenced the RR. When awake, infants had significantly higher RRs than when asleep. The RR extrapolated from a 15-second breath count was significantly lower (p < 0.05-0.01), whereas results from 30-second counts were similar to 60-second counts. Our data endorse the use of a RR > or = 60 breaths/min. counted for 1 minute as a cut-off to define tachypnoea in infants < 2 months of age.

Auscultation↗
PubMed1998

Refractory status epilepticus in children: role of continuous diazepam infusion.

To determine efficacy of continuous diazepam infusion in the treatment of refractory status epilepticus in a retrospective study, we analyzed data of 62 children admitted consecutively to our Pediatric Intensive Care Unit with a diagnosis of refractory status epilepticus. The unit followed a standard treatment protocol for diazepam infusion; if it failed, thiopental infusion was used. The mean age of patients was 2.80 years (range, 1.5 to 11.5 yr). Thirty-six patients (60%) had acute infections of the central nervous system and 10 (16%) had idiopathic epilepsy. Diazepam infusion was used in 57 patients. This treatment controlled seizures in 86% of patients (49/57), on average within 40 minutes (median, 30 min; range, 10-120 min), at a mean infusion rate of 0.017 mg/kg/min (range, 0.01-0.03 mg/kg/min). The mean total duration of infusion was 68 hours (range, 12-220 hr). Diazepam infusion was associated with hypotension in one patient, respiratory depression requiring ventilatory support in 12% of patients (6/49), and death in 14% of patients (7/49). Thiopental infusion was used in nine patients, including eight in whom diazepam infusion had failed. Thiopental infusion controlled seizures in all nine patients, but all of them needed mechanical ventilation, and seven needed vasopressor support for hypotension; four patients (44%) died. We conclude that continuous diazepam infusion is a reasonably effective modality to control refractory status epilepticus in children and is associated with reduced need for ventilatory and vasopressor support.

Anticonvulsants↗
PubMed1998

Respiratory symptoms in Indian children exposed to different cooking fuels.

Smoke emission from fuels is an important source of indoor air pollution. Children spend considerable time indoors. It is therefore important to determine whether air contaminants from indoor air sources affect incidence of respiratory illness, cause symptoms and changes in pulmonary function status in them. Two hundred children in the age group of 7-15 were selected randomly. They were stratified according to the fuel used in their homes and respiratory symptoms were inquired from them according to a questionnaire recommended by the American Thoracic Society. The most symptomatic children were those whose households used kerosene (52%) and mixed fuels (46%) although different symptoms were present in varying extent in all 4 groups of children. Cough, cold, congestion or phlegm for one week or more occurred more frequently with mixed fuel use followed by kerosene. The present study thus showed that mixed fuel and kerosene fuel had worst effects on respiratory system in children whose households used these fuels.

Adolescent↗
PubMed1997

Acute mercury vapour poisoning in an infant.

Mercury vapour inhalation is a rare cause of acute toxic injury to the lungs and is often fatal in infants. A 5 month-old girl with mercury vapour poisoning who developed chemical pneumonitis with bilateral pneumothoraces is reported. She was managed successfully in an intensive care unit with respiratory support, without chelation therapy.

Female↗
PubMed1997

Electrolyte disturbances due to ouabain sensitive sodium potassium pump in erythrocytes of children with sepsis.

The possible mechanism of hyponatraemia in septicaemic children was studied by measuring the intracellular red cell sodium in relation to ouabain sensitive Na(+)-K(+) pump by flame photometry. Hyponatraemia and hyperkalaemia were observed in most of the patients. There was a marked elevation in serum sodium levels and a significant reduction in serum potassium levels on recovery following therapy. The alteration in the distribution of electrolytes between plasma and erythrocytes resulted in significantly high levels of sodium and low levels of potassium within the erythrocytes of septicaemic patients which normalized on recovery. The ouabain sensitive sodium efflux rate and ouabain sensitive efflux rate constant were significantly decreased in the membranes of erythrocytes of septicaemic patients which also normalized on recovery. Our findings suggest that it is the intrinsic alterations in the transport capacity of Na(+)-K+ pump which could account for the rise in intracellular erythrocyte sodium and fall in intracellular potassium contents in septicaemic children.

Child↗
PubMed1997

Does candiduria predict candidaemia?

Isolation of Candida from blood is the gold standard for the diagnosis of candidaemia, but because of rather low sensitivity and difficulty in collection of large amounts of blood from children, alternative methods are required. We evaluated the reliability of candiduria as an indicator of systemic candidosis. Blood and suprapubic sample of urine were cultured on the same day from 91 children of paediatric intensive care unit who were clinically suspected to have disseminated candidosis. Candida was isolated from blood in 41.8 per cent patients, from urine in 50.5 per cent patients and both from blood and urine in 27.5 per cent patients. C tropicalis was the commonest yeast isolated from blood (55.3%) and urine (58.7%). The sensitivity and specificity of urine culture for predicting candidaemia were 65.8 and 60.4 per cent respectively, positive predictive value was 54.3 per cent and negative predictive value 71.1 per cent. Urine microscopy had comparable sensitivity (52.6%), specificity (75.5%), positive (60.6%) and negative (70.0%) predictive values. Therefore, candiduria is not a reliable indicator of candidaemia. However, the isolation of non-albicans Candida species from urine was better indicator for candidaemia compared to isolation of C. albicans as 59.5 per cent patients with non-albicans Candida species in urine had candidaemia compared to 33.3 per cent with C. albicans.

Candida↗
PubMed1996

Hypokalemia in a pediatric intensive care unit.

OBJECTIVE: To examine the frequency, severity, risk factors and mortality of hypokalemia, and efficacy of therapy used for its correction. DESIGN: Descriptive, retrospective analysis. SAMPLE: 290 patient records admitted consecutively to a Pediatric Intensive Care Unit (PICU) over a period of one year. RESULTS: Forty three (14.8%) patients had 54 episodes of hypokalemia. Predisposing factors included the nature of primary disease (renal disease 19%, septicemia 19%, acute diarrhea 14%, heart disease with congestive failure, and meningoencephalitis 12% each), malnutrition (weight for age less than 80% in 72%) and therapy with drugs (diuretics, corticosteroids and antiasthma drugs). For correction of hpokalemia all the patients received 4-6 mEq potassium per 100 ml of intravenous fluids (slow correction). Seven patients (9 episodes), with ECG changes of hpokalemia, also received infusion of 0.3 mEq potassium/kg/hour till ECG became normal (rapid correction). Normal potassium level was achieved in all nine episodes where rapid correction was given, and in 40 of 45 episodes which received slow correction. The overall mortality among patients with hypokalemia (25.6%, 11/43) was significantly higher than that among the remaining PICU patients (10.9%, 27/247; odd's ratio 2.34; 95% confidence interval 1.3-4.2) (p < 0.05). All the patients receiving rapid correction survived. CONCLUSIONS: Hypokalemia is a common problem among PICU patients. Early detection through regular monitoring and rapid correction may help in improving the outcome.

Age Distribution↗
PubMed1995

Composition of postnatal weight loss & subsequent weight gain in preterm infants.

To investigate the changes in body composition corresponding to postnatal weight loss and regaining of birth weight, total body water (TBW) and extracellular water (ECW) were measured at birth, on the day of maximum weight loss and on regaining of birth weight in 23 preterm appropriate for gestational age (AGA) infants (mean +/- SD birth weight 1902 +/- 242 g, gestational age 236 +/- 7 days). Intracellular water (ICW) was determined by the difference between TBW and ECW and body solids by the difference between TBW and body weight. Almost 90 per cent of early postnatal weight loss of 132 +/- 38 g (6.9% of birth weight) was because of loss of body water (117 +/- 30 ml; 7.9% of TBW at birth). ECW loss (mean +/- SD 106 +/- 35 ml) accounted for 90 per cent of the TBW loss. Of the subsequent weight gain (134 +/- 40 g) till regaining of birth weight, 48 per cent (64 +/- 28 ml) was TBW and 52 per cent (70 +/- 13 g) body solids. The major gain in body water was in ICW (47 +/- 21 ml). A gradual decrease in TBW and ECW, and a gain in ICW and body solids per kg body weight was observed throughout the study period. These findings favour the concept that in preterm (31-36 wk) infants (i) postnatal weight loss is primarily a reflection of ECW loss and subsequent weight gain is because of cellular growth, (ii) postnatal loss of ECW continues even when weight gain and accumulation of body solids has started.

Birth Weight↗
PubMed1995

Effect of intrauterine growth retardation on postnatal changes in body composition of preterm infants.

To find the effect of intrauterine growth retardation on postnatal changes in body composition, we studied nine preterm small for date (SFD) and 9 gestation matched appropriate for gestational age (AGA) infants (mean +/- SD birth weight - SFD : 1431 +/- 16I g, AGA : 1904 +/- 223 g, gestational age - SFD; 237 +/- 9 days, AGA : 236 +/- 7 days). Total body water (TBW) and extracellular water (ECW) were measured at birth, on the day of maximum weight loss and on regaining of birth weight. Body solids were calculated from the difference between TBW and body weight. SFD infants had significantly less postnatal weight loss (64 +/- 19 g) than AGA infants (135 +/- 49 g; P < 0.01) and showed a significant gain in body solids (19 +/- 12 g) during this period which was not seen in AGA infants (-4 +/- 14 g; P < 0.05). The subsequent weight gain occurred at similar rates in SFD (16 +/- 4 g/day) and AGA (18 +/- 6 g/day) infants, but a significantly higher ratio of the weight gain consisted of solids in SFD as compared to AGA infants (P < 0.05). Per unit of body weight, SFD infants had significantly less body solids (213 +/- 12 g/kg) than AGA infants (228 +/- 18 g/kg; P < 0.05) at birth, but by the time birth weight was regained the two groups of infants had similar probody solids (SFD: 248 +/- 7 g/kg, AGA : 255 +/- 12 g/kg). These results suggest that in SFD infants catch-up growth starts early, during the period of apparent weight loss.

Body Composition↗