Single vs multidrug therapy in enteric fever.
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Biomedical subjects
Publications and source records attributed to So Shivbalan.
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Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract and is an important cause of morbidity in children and adolescents. In India Crohn's disease (CD) was considered a rare disease, however, during the last 10 years CD in adults is being reported from several centers especially in Southern India. CD is characterized by transmural granulomatous inflammation involving any part of the gastrointestinal tract in a discontinuous manner. The peak incidence of Crohn's disease occurs during the adolescent and young adult years. The clinical presentation and complications are varied and several extraintestinal manifestations have been recognized. The understanding of the pathophysiology has opened new avenues in the management. The recognition of this problem in children and adolescents by pediatricians is necessary for proper diagnosis and management.
This report is based on observations during the conduct of a study of hypocalcemia in infants and children. In a study of 50 cases, 13 exclusively breast fed infants manifesting with hypocalcemic seizures were confirmed to have vitamin D deficiency. None of the 13 infants had received vitamin D supplementation. All of them had biochemical evidence of hyperparathyroidism and low levels of 25 (OH) Vit D3 and promptly responded to therapy with vitamin D and calcium. All the mothers of these 13 infants had low levels of 25 (OH) Vit D3. Mothers of 5 infants had reported reduced exposure to sunlight due to religious reasons. This report emphasizes the need to supplement Vitamin D in exclusively breast fed infants and also to encourage exposure to sunlight in them and their mothers.
A study was undertaken to analyze the usefulness of radiographic and ultrasonographic findings and area specific hematocrit cut off values in Dengue Hemorrhagic Fever (DHF). Of the 65 cases, 35 were DHF and 30 were Dengue Fever as per the WHO case definition. Among the DHF cases, hemoconcentration (>20%) was detected in 20 cases (57.14%), hypoproteinemia in 11 (31.42%) and clinical evidence of pleural effusion and or ascites in 25 (71.42%). Hemoconcentration based on area specific hematocrit cut off values was observed in 32 cases (91.42%). Ultrasonographic evidence of plasma leakage was seen in 32 cases (91.42%). In detecting plasma leakage, area specific hematocrit cut off values and ultrasonography had the highest sensitivity (91.42%), while ultrasonography had the highest negative predictive value of 84.21%. Clinical evidence of plasma leakage was more frequent than hemoconcentration or hypoproteinuria. Ultrasonography is an ideal non-invasive investigation to detect plasma leakage and area specific hematocrit values are useful as evidence of plasma leakage.
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Crohn's disease is a chronic inflammatory bowel disorder characterized by discontinuous, transmural, granulomatous inflammation involving any location of the gastrointestinal tract. A retrospective analysis of 10 children diagnosed as Crohn's disease (CD) is presented from Chennai, South India. The children were between 5-15 years of age and majority had primary colonic involvement. Complications such as stricture and fistula were identified. These children were managed medically except one who underwent surgery.
Myelofibrosis is a rare hematological condition in infancy. We report a case of a 6-month-old infant who was diagnosed to have myelofibrosis due to Vitamin D deficient rickets. This rare association of myelofibrosis and rickets is discussed here with a review of relevant literature.
Chest physiotherapy (CPT) in children is generally considered as a separate and specialized treatment modality that should be rendered only by a physiotherapist. Actually this is not difficult if one has a proper understanding of the basic concept and principle behind the maneuver. This article aims at making CPT simple, so that it could be incorporated in routine pediatric practice for managing respiratory ailments.
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The MURCS association i.e. MUllerian duct aplasia, Renal aplasia, Cervicothoracic Somite dysplasia is a rare developmental disorder. The authors report a case of MURCS association with supernumerary ribs in a 7-month-old infant who presented with failure to thrive.
A 2-year-old boy presented with low-grade fever and multiple progressive painful swellings over upper dorsal trunk and supraclavicular region with progressive stiffening of skin for the last 2 months. Examination revealed dysmorphic face, proximally placed thumb and bilateral hallux valgus. Hence, a diagnosis of Fibrodysplasia Ossificans Progressiva was entertained.
Esophageal tuberculosis is a rare clinical entity even in adults. Esophageal tuberculosis, can be either primary or secondary, the former is less common as compared to the latter. The authors present a 14-year-old boy, who presented with vomiting, cough, low-grade fever and anorexia for two months. He had a positive mantoux with history of contact to Tuberculosis. Upper GI scopy revealed an irregular ulcer in the mid esophagus and the biopsy was suggestive of tuberculosis. The CT scan of the chest showed consolidation left lower lobe with hilar and mediastinal adenopathy. He responded well to ATT.
OBJECTIVE: To identify the predictive factors for spontaneous bleeding manifestations in Dengue illness in infants and children. METHODS: 60 cases of Dengue viral infection with spontaneous skin and or mucosal bleed were compared with 72 cases without spontaneous bleed. The protean bleeding manifestations in dengue infection were recorded. Various clinical and laboratory parameters were analyzed using univariate and logistic regression analysis. RESULTS AND CONCLUSION: Prothombin time was abnormal only in cases with spontancous bleed. A combination of (a) biphasic pattern of fever, (b) hemoconcentration, (c) platelet count less than 50,000/mm3 and (d) elevated ALT had a sensitivity of 79.2%, specificity of 64.7% with a positive predictive value of 70% and a negative predictive value of 75% in predicting spontaneous bleeding in dengue.
Fiberoptic bronchoscopy (FBS) is an important entry in the armamentarium of procedures listed in management of respiratory problems. It is a simple and a safe procedure. FBS has a great scope for diagnosis as well as therapy in pediatric respiratory illnesses. This article gives a practical overview of FBS in pediatric practice.
An 11-year-old girl presented with acute onset of paraplegia with bowel and bladder incontinence. She had spinal tenderness and a sensory level at mid thoracic region. MRI spine revealed an intradural extramedullary arterio-venous malformation with hemorrhage into the intramedullary region. Hence a diagnosis of spinal arterio-venous malformation was entertained.