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Biomedical subjects

S Singhi

Publications and source records attributed to S Singhi.

At least 55 records · Page 3Linked to original sources
PubMed1995

Changing pattern of childhood poisoning (1970-1989): experience of a large north Indian hospital.

The epidemiology of acute poisoning in children aged 0-15 years hospitalized between 1970-1989 was retrospectively investigated. Two hundred and seventeen children were admitted during this period with 134 in 1980-1989 vs 83 in 1970-1979. Two distinct patterns were observed: accidental poisoning in under 11's and adult pattern and self poisoning in children over 11's. More children belonged to urban areas (72.3%) as compared to rural areas. In both decades more than half of children belonged to middle income group followed by lower income group and least to upper income group. The overall mortality was low (12.5%), with majority of deaths (78%) occurring in older children. The incidence of kerosene ingestion was noticed to have dropped by more than half between 1980-1989 as compared to 1970-1979 (14.9% vs 42%). The study highlights the unacceptable high rate of preventable accidental poisoning in young children and suicide and parasuicide in older children (11-15 years age group).

Adolescent↗
PubMed1995

Water electrolyte homeostasis in acute bronchiolitis.

Children with acute bronchiolitis frequently require hospitalization and parenteral fluid therapy. Water retention due to impaired renal water excretion has been described in several pulmonary conditions in children. We studied 20 infants (3.6 +/- 2.9 months), hospitalized consecutively for acute bronchiolitis for water and electrolyte changes during the acute stage and compared them to those on recovery. Serum sodium and plasma osmolality, urinary sodium and osmolality were measured in all infants. Ten infants each were assigned alternatively to study body water compartment or renal water handling (water load excretion and free water excretion capacity) on the day of hospitalization and after recovery. Mean ( +/- SD) value of serum sodium of the infants at admission was 132.7 +/- 7.2 mEq/L which increased to 137.1 +/- 5.4 mEq/L on recovery (p < 0.05). Plasma osmolality changed from 284 +/- 14 mOsm/kg at admission to 294 +/- 10 mOsm/kg at recovery (p < 0.05). There was a significant decrease in urinary sodium from 54 +/- 39 mEq/L to 20 +/- 18 mEq/L and urinary osmolality from 415 +/- 213 mOsm/kg to 252 +/- 204 mOsm/kg at admission and at recovery, respectively. All 10 infants showed significant increase in total body water (mean +/- SD; 22.8 +/- 7.5 ml/kg) at admission as compared to that at recovery. The total body water (TBW) excess was mainly in extracellular water compartment (16.3 +/- 3.6 ml/kg). Seven of 10 infants had significant impairment in renal water excretion. Increase in maximum free water clearance of these 7 infants on recovery was 0.69 +/- 0.27 ml/min, i.e., 15 times more than that at admission. It is concluded that bronchiolitis of infancy is characterized by water retention which is caused by impaired renal water excretion. In the management of severe bronchiolitis careful attention to fluid therapy is mandatory; liberal fluid therapy may lead to water intoxication.

Bronchiolitis↗
PubMed1995

Functional and behavioral responses as marker of illness, and outcome in infants under 2 months.

Value of abnormal findings on 11 functional and behavioral items were studied for identification of serious illness, presence of bacteremia and prediction of the outcome (recovery or death) in infants upto 2 months of age. All the items were graded on a 3 point scale (0, 1 and 2) in the ascending order of severity. A total of 116 infants who were being evaluated for suspected sepsis were enrolled. The assessment was completed before detailed history and physical examination. Significant associations were observed between presence of serious illness and six items by lambda2-test and/or Pearson's correlation and multiple stepwise regression analysis. These were decreased activity, abnormal quality of cry, presence of pallor, fast breathing, decreased consolability, and consciousness level. The sensitivity of six item model was > 90% and negative predictive value >95%. The negative predictive value of several individual items was also above 90%. Consciousness level was the most important predictor of the outcome followed by poor feeding, hydration, color, consolability and abnormal expression (combined multiple R = 0.51). A total score of 7 or more on above six items had a sensitivity of 80%, and negative predictive value of 97% for death. In conclusion, behavior and functional responses (as mentioned above) were fairly useful in predicting the outcome and/or the severity of the illness. These items may be combined to develop a scale to help in therapeutic decision making.

Bacteremia↗
PubMed1994

Validity of clinical signs for the identification of pneumonia in children.

In a prospective study to determine simplified clinical signs predictive of pneumonia in children between 2 months and 5 years of age, and to test the validity of the signs recommended by the World Health Organization, clinical findings were correlated with X-ray evidence of pneumonia in 854 children, 400 with pneumonia and 454 with upper respiratory infections (no pneumonia). A respiratory rate of > or = 50/min in infants 2-6 months of age, > or = 40/min in children 7-35 months, and > or = 35/min in children > or = 36 months was the best discriminator of radiological evidence of pneumonia. Use of a respiratory rate of > or = 50/min instead of > or = 40/min resulted in a 14%, 19% and 32% loss of sensitivity with little gain in specificity in the age groups 7-11 months, 12-35 months and > or = 36 months, respectively. The age-specific respiratory rate (recommended by WHO) and/or chest indrawing, history of rapid or difficult breathing and/or chest indrawing, and nasal flaring were also sensitive and specific indicators of pneumonia in almost all the age groups studied.

Age Factors↗
PubMed1994

Changes in body water compartments in children with acute meningitis.

Changes in body water and electrolytes were studied in 30 children, 2 months to 5 years old, with acute meningitis. Total body water (TBW), extracellular water (ECW) and urinary and serum sodium and osmolality were estimated on the day of hospitalization (Day 1) and after recovery/Day 10. Thirty age- and sex-matched children served as their controls. The TBW (683 +/- 63 (mean +/- SD) ml/kg) as well as ECW (311 +/- 76 ml/kg) was significantly higher in children with meningitis on Day 1 than in the controls (TBW 642 +/- 49 ml/kg, ECW 271 +/- 62 ml/kg) (P < 0.01), whereas the values after recovery (TBW 643 +/- 48 ml/kg, ECW 272 +/- 63 ml/kg) were similar to those of controls. Thus on the average a child with acute meningitis had excess body water, all of which was in the ECW compartment. The mean ECW excess was 33 +/- 32 ml/kg. Twenty-four of 27 surviving children had higher TBW and ECW at the time of admission compared with the values after recovery. On multiple regression analysis, the only significant determinant of ECW excess was severity of the illness (partial r2 = 0.62). The ECW excess was 70 +/- 8 ml/kg in severely ill, 50 +/- 32 ml/kg in moderately ill and only 12 +/- 18 ml/kg in mildly ill children (P < 0.01). Those who had complications or sequelae had much higher ECW (49 +/- 26 ml/kg) than those who recovered completely (17 +/- 27 ml/kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

Clinical signs of pneumonia in infants under 2 months.

To determine clinical signs that can predict pneumonia (confirmed by radiography) in infants under 2 months of age, 101 infants with pneumonia and 150 with an upper respiratory infection (but not pneumonia) were studied. Ten infants with pneumonia and 15 with an upper respiratory infection did not have the cough and/or difficult (or rapid) breathing that are recommended as 'entry criteria' by the World Health Organisation (WHO). The remaining infants met WHO entry criteria; in them sensitivity and specificity of respiratory rate > or = 60/min and/or severe chest indrawing to diagnose pneumonia was 85% and 97% respectively. Addition of four non-specific signs (stopped feeding well, looked sick, temperature < or = 38 degrees C, and abdominal distension) to respiratory rate > or = 60/min and/or chest indrawing for case identification resulted in a 7% gain in sensitivity but 22% loss of specificity. Addition of nasal flaring improved the sensitivity by 6% without loss of specificity. However, the non-specific signs were the only clue to diagnosis in five infants weighing < or = 2500 g. At age < 7 days, a weight < or = 2500 g and cyanosis were associated with significantly higher risk of mortality. These findings support the use of a respiratory rate > or = 60/min and/or chest indrawing for identification of pneumonia, and suggest addition of nasal flaring to the criteria for case identification in infants under 2 months with cough and/or difficult or rapid breathing.

Body Weight↗
PubMed1994

Predictors of serious bacterial infection in infants up to 8 weeks of age.

During a period of 2 years we prospectively studied 116 infants up to 8 weeks of age with suspected sepsis. Each infant was assessed clinically before laboratory evaluation for sepsis. Depending upon impression of sepsis, temperature abnormality, micro ESR (mESR), WBC counts and toxic granulations infants were assigned to either high (n = 74) or low (n = 31) risk group for serious bacterial infection (SBI). All infants were kept under observation till the final decision for hospitalization was made. Eighty six per cent of cases in high risk group and 26% of cases in low risk group were hospitalized and treated with antibiotics. SBI was present in 55% of the high risk group infants compared to one (3%) in the low risk group. Culture for bacterial infections were positive in 22 (19%) cases; bacteremia was found in 15 (13%) infants. None of the variables individually predicted the presence of bacteremia or SBI satisfactorily. Presence of two or more criteria out of the three criteria namely impression of sepsis, raised mESR and toxic granulation could identify 93% of infants with bacteremia and 95% of those with SBI and excluded 89% of cases without SBI.

Escherichia coli↗
PubMed1994

Safety and efficacy of a concentrated potassium chloride solution infusion for rapid correction of hypokalemia.

Twenty children with hypokalemia (plasma potassium concentration < or = 3.5 mmol/L) with electrocardiographic (ECG) changes were given an infusion of concentrated solution of potassium chloride (200 mmol/L) at a rate of 0.25 mmol per kg per hour till ECG changes reverted to normal, under close monitoring of vital signs and ECG. The regimen effectively corrected the ECG changes in 1 to 6 hours with a mean increase in serum potassium by 0.75 +/- 0.49 mmol/L. No complications occurred. Controlled infusion of a concentrated solution of potassium chloride at a rate of 0.25 mmol/kg/hour is a safe and effective way to achieve rapid correction of hypokalemia with ECG changes, using minimal fluid volumes.

Child↗
PubMed1994

Hyponatremia in sick children: a marker of serious illness.

To study the association between hyponatremia (serum sodium < or = 130 mEq/L) and the final outcome of the illness, we correlated serum sodium concentration at the time of hospitalization with the length of hospital stay and mortality in a prospective study of 727 sick children aged upto 12 years, who sought emergency care. The mean +/- SE duration of hospital stay (7.7 +/- 0.4 days) among 217 children with serum sodium < or = 130 mEq/L was about 30% longer than that of 510 children with serum sodium > or = 131 mEq/L (5.9 +/- 0.3 days) (p < 0.01). This remained unaffected by the sex and the age group, but was further prolonged in children with hypotonic--euvolemic type of hyponatremia as compared to those with hypovolemic hyponatremia. The mortality rate in 510 children with normal serum sodium concentration (> or = 131 mEq/L) was 5.3%. In contrast, it was 17% in 47 children with serum sodium < 125 mEq/L (Relative Risk 3.2; 95% Confidence Interval 1.6-6.7) and 9.3% in 170 children with serum sodium between 126-130 mEq/L (Relative Risk--1.8; 95% Confidence Interval 1.1-3.7) (p < 0.01). Hyponatremia in acutely ill children at admission indicates a poor prognosis.

Child↗
PubMed1994

Sonography in pyogenic meningitis.

In this prospective study to evaluate usefulness of ultrasonography for early diagnosis and monitoring of complications of acute pyomeningitis, we performed serial sonographic examinations of skull in 50 infants (with open fontanelle) with proven pyomeningitis. One or more abnormal sonographic findings were detected in 32 infants. These were echogenic sulci (26%), ventriculomegaly with some or other complication (26%), brain abscess (20%), ventriculitis (14%), subdural effusion (6%) and cerebral edema (10%), and were detected mostly after the first week of illness. Ultrasonographic findings were in complete agreement with CT scan diagnosis of ventriculomegaly, ventriculitis, solitary brain abscess and cerebral edema. However, sonography missed cases of subdural effusion (2 out of 5), multiple brain abscesses (1 out of 2), and cerebral infarction (all the four), which were detected on CT Scan. Serial sonographic findings were useful in documenting progressive increase in ventricular size in all the 13 infants with ventriculomegaly and monitoring response to anti-edema therapy in 5 infants with cerebral edema. Sonography is a useful tool for diagnosis of complications of pyomeningitis after the first week of illness, and for monitoring the progress of ventriculomegaly.

Acute Disease↗
PubMed1994

Hyponatremia in sick children seeking pediatric emergency care.

This prospective study evaluated the frequency, clinical characteristics and causes of hyponatremia (serum sodium < 130 mEq/L) in 727 children upto 12 years of age, who were brought for emergency care, and needed hospitalization. Hyponatremia was found in 29.8% and was more frequent in summer (36%; 123/341) than in winter (24%; 94/386) (p < 0.001). Acute lower respiratory infections (pneumonia) and acute diarrhea each accounted for 20% cases of hyponatremia; others were accounted for by meningitis/encephalitis (12%) septicemia (8%), and renal, heart and liver diseases (6-7% each). Clinical evaluation and concurrent plasma and urinary osmolality and urine sodium suggested that hyponatremia associated with pneumonia, meningitis/encephalitis, septicemia, seizures and miscellaneous diseases was of hypotonic-euvolemic (dilutional) type in more than 80% patients while in all children with acute diarrhea it was of hypovolemic type. The study has shown that hyponatremia occurs frequently in sick children requiring emergency care, especially in summer months, and should receive appropriate attention in the management plan.

Child↗
PubMed1993

Value of serum C-reactive protein concentrations in febrile children without apparent focus.

We examined the value of serum C-reactive protein (CRP) in febrile children without an apparent focus of infection, (i) as a tool to differentiate bacteraemia and bacterial infection from a non-bacterial illness (NBI), and (ii) as an indicator of recovery or complications. Included in the study were 100 children up to the age of 3 years with a temperature of > or = 38.5 degrees C, without an apparent focus. The serum CRP concentration was measured on days 1, 3 and 5 of evaluation and correlated with the final diagnosis and outcome. The serum CRP was 40 mg/l and above in 95% of patients (18/19) with bacteraemia and also in seven of the eight with purulent meningitis, while it was < 40 mg/l in 84% of patients (52/62) with NBI (mean (SD) 22 (28.6) mg/l). The mean serum CRP concentration among six children with a culture-positive urinary tract infection (16.3 (8.3) mg/l) and five with otitis media (9 (5.7) mg/l) was similar to those with NBI. The sensitivity of serum CRP > or = 40 mg/l for diagnosis of bacteraemia was 95% and the positive predictive value 67%. On serial monitoring, a fall in the CRP concentration was a sensitive indicator of recovery from infection and provided the earliest clue to therapeutic response long before a fall in temperature.

Bacteremia↗
PubMed1993

Acute intravascular haemolysis in glucose-6-phosphate dehydrogenase deficiency.

Thirty-five children with G6PD deficiency, who presented with acute intravascular haemolysis, were evaluated to define its aetiology, clinical features and ultimate outcome. All were boys with ages ranging from 6 months to 12 years. Pallor of abrupt onset and passage of cola-coloured urine were universal presenting symptoms. Incriminating factors responsible for haemolysis include hepatitis (7), malaria (4), bacterial sepsis (3) and drug intake (24), with more than one predisposing condition existing in some children. Marked elevations in serum bilirubin, coinciding with intravascular haemolysis, was a feature in all the seven children with hepatitis. Azotaemia was noted in 20 patients, of whom 14 did not have oliguria. All four children with malaria presented with protracted renal failure. Therapy focused on maintaining a high urine output in those without oliguria. A total of 15 peritoneal dialyses and five haemodialyses were required in six patients with acute renal failure, all of whom were oliguric. Supportive therapy consisted of blood transfusions and treatment of the predisposing diseases. Thirty-two children recovered completely while three died, the cause of death being severe anaemia and congestive cardiac failure, malaria with oliguric renal failure and hepatic encephalopathy, respectively.

Acute Disease↗
PubMed1992

Multi-drug-resistant Salmonella typhi--a need for therapeutic reappraisal.

Enteric fever caused by Salmonella typhi resistant to all the standard first-line antibiotics is emerging as a major problem in developing countries. Fifteen such culture-proven cases were treated with ceftriaxone (6), cefotaxime (5) or ciprofloxacin (4). The earliest defervescence occurred with ceftriaxone (mean 3.3 days). Clinical cures were obtained with all three drugs with only one child having a relapse. Ciprofloxacin, by virtue of its cost and an oral route of administration, is the ideal choice in a developing country.

Cefotaxime↗