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Biomedical subjects

H P Sachdev

Publications and source records attributed to H P Sachdev.

At least 19 recordsLinked to original sources
PubMed2001

Effect of gestational zinc deficiency on pregnancy outcomes: summary of observation studies and zinc supplementation trials.

The lack of a valid indicator precludes a true estimate of zinc deficiency in pregnancy in various populations. However, it is possible that mild to moderate deficiency (as assessed by available indicators) may be common in the developing world. Animal experiments indicate that zinc deficiency can result in adverse maternal and fetal consequences. Human data, particularly from prenatal zinc supplementation trials, has failed to document a consistent maternal or infant benefit on evaluated outcome measures including pregnancy induced hypertension, preterm/post-term labour, premature rupture of membranes, maternal infection, postpartum haemorrhage, perinatal mortality, congenital malformations and fetal growth and gestation. Preliminary data suggest a beneficial effect of prenatal zinc supplementation on infants' neurobehavioural development and immune function (evaluated by diarrhoeal and ARI morbidity incidence in the first year of life). Future research should focus on these functional consequences and congenital malformations (with adequate sample sizes), and simultaneously address the safety issue, particularly in relation to micronutrient interactions. In the light of the currently available information, routine zinc supplementation can not be advocated to improve pregnancy outcome.

Animals↗
PubMed2001

Improving antibiotic and bronchodilator prescription in children presenting with difficult breathing: experience from an urban hospital in India.

OBJECTIVE: To evaluate the relative frequency of other conditions that share a clinical overlap with pneumonia as defined by the WHO case management algorithm and to determine the possibility of refining the antibiotic and bronchodilator prescription on the basis of simple clinical features. DESIGN: Prospective observational. SETTING: Urban tertiary care center. METHODS: Two hundred children, between the ages of 6 months to 5 years, presenting with difficult breathing (as defined by WHO algorithm) were prospectively evaluated for the diagnosis and the need for bronchodilator and antibiotic therapy (clinician s diagnosis). An additional independent blinded evaluation of the chest X-rays was done by a radiologist after the study (radiologist-aided diagnosis). On the basis of reliable predictors (sensitivity > 70% and specificity > 70%) of antibiotic and bronchodilator prescription, irrespective of the exact diagnostic category, two viable modifications of WHO case management algorithm emerged, which were compared by paired proportion test. RESULTS: Acute asthma was the predominant condition (46% or 54%), pneumonia alone was rare (10%), co-existence of pneumonia with wheeze (bronchospasm) was more frequent (22% or 15%) and often diagnoses not related to the respiratory system were documented (18% or 17%). All the subjects in whom a preceding history of cough was not elicited had non-respiratory illnesses. An audible wheeze was appreciated in only 44 of the 150 cases (29.3%) with an auscultable wheeze. The two alternatives represented a significant (p < 0.0001) improvement over the WHO algorithm preventing inappropriate usage of both antibiotics and bronchodilators, primarily by restricting over-prescription of the former (14% and 26.5% for proposed algorithms 1 and 2, respectively) and under-utilization of the latter (40%). The performance of the alternative algorithms for the radiologist-aided diagnosis was marginally better for over-prescription of antibiotics (16.2% and 30.9% for proposed algorithms 1 and 2, respectively). CONCLUSION: It is feasible to amalgamate simple clinical features (history of: (i) previous similar episode of cough and difficult breathing, and (ii) fever) in the WHO case management algorithm to significantly refine the antibiotic (95% CI range 7% to 33%) and bronchodilator (35%; 95% CI 27% to 43%) prescription.

Algorithms↗
PubMed2000

Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness between the ages of one week to two months.

OBJECTIVE: To evaluate the utility of the WHO/UNICEF algoritham for integrated management of childhood illness (IMCI) between the ages of 1 week to 2 months. DESIGN: Prospective observational. SETTING: The Outpatient Department and Emergency Room of a medical college hospital. METHODS: 129 infants presenting to Outpatient Department (n=70) or Emergency Room (n=59) were assessed and classified as per 'IMCI' algorithm and treatment required was identified. A detailed evaluation with all relevant investigations was also done for these subjects. The final diagnoses made and therapies instituted on this basis served as 'gold standard'. The diagnostic and therapeutic agreement between 'gold standard and the 'IMCI' was computed. RESULTS: More than one illness was present in 97(75.2%) of subjects as per 'gold standard' (mean 2.1). Subjects having any referral criteria as per 'IMCI' algorithm had a greater (p=0.002) co-existence of illnesses (mean 2.3 vs. 1.8 illnesses per child, respectively. IMCI algorithm covered majority (81-84%) of the recorded diagnoses either partly (40-41%) or fully (40-44%). The referral criteria proved quite sensitive (86-87%) in predicting hospitalization but had a lower specificity (53-58%). a total agreement with IMCI was found in 60-66% cases. The mismatch (34-40%) was more commonly of overdiagnosis (21-23%) rather than underdiagnosis (15-21%). The sensitivity of the algorithm to identify serious bacterial infection was high (96.1-96.5%) while the specificity was relatively low (51. 8-59.7%). Upper respiratory infection (URI)emerged as an important cause resulting in unnecessary referrals (13 out of 21 cases). Of the 43 cases identified as diarrhea by the algorithm, 6 had breast fed stools, which do not require any therapy. The 'IMCI' algorithm had a provision for preventive services of immunization and breastfeeding counseling (18% possibility of availing missed opportunities in both). CONCLUSION: There is a sound scientific basis for adopting IMCI approach even in young infants as there is a need to improve the specificity of referral criteria. Two important conditions identified for possible refinement are URI and breast fed stools

Algorithms↗
PubMed1999

Comparative study of autonomic nervous system activity in malnourished and normal children in India.

Information on the relationship between autonomic functions and malnutrition in children is scant. In the present study, autonomic function tests were conducted in 30 normal subjects and 30 malnourished children aged between 5 and 10 years. The tests performed included tests for parasympathetic functions (resting heart rate, standing-to-lying ratio, lying-to-standing ratio and Valsalva ratio) and tests to assess sympathetic function (hand grip test, galvanic skin resistance). The malnourished children had significantly lower mean weights-for-age (-2.6 Z vs -1.5 Z; p = 0.001), heights-for-age (-2.5 Z vs -1.5 Z; p = 0.001) and weights-for-height (-1.6 Z vs -0.8 Z; p = 0.001). Parasympathetic function tests evaluated were significantly affected in malnourished children. Resting heart rate was significantly higher in the malnourished group (90.6 vs 82.5/min; p = 0.001). The other parasympathetic function tests had significantly lower mean values than in the control group, namely, standing-to-lying ratio (1.25 vs 1.32; p = 0.026), lying-to-standing ratio (1.23 vs 1.29; p = 0.021) and Valsalva ratio (1.26 vs 1.28; p = 0.037). Of the sympathetic function tests conducted, there were no differences between the two groups for hand grip test but galvanic skin resistance was significantly higher in the malnourished subjects (190.1 vs 149.73; p = 0.001). It is concluded that autonomic nervous system function is significantly compromised in malnourished children.

Autonomic Nervous System↗
PubMed1999

Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness between the age of two months to five years.

OBJECTIVE: To evaluate the utility of the "WHO/UNICEF algorithm for integrated management of childhood illness (IMCI) between the age of 2 months to 5 years. DESIGN: Prospective observational. SETTING: The Outpatient Department and Emergency Room of a medical college hospital. METHODS: 203 children presenting to Outpatient Department (n=101) or Emergency Room (n=102) were assessed and classified as per 'IMCI' algorithm and treatment required was identified. A detailed evaluation with all relevant investigations was also done for these subjects. The final diagnoses made and therapies instituted on this basis served as 'gold standard'. The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed. RESULTS: More than one illness was present in 135 (66.5%) of subjects as per 'gold standard'. The mean (SD) numbers of morbidities as per the gold standard and IMCI- low and high malaria risks were 2.1 (1.1), 1.8 (1.0) and 2.2 (1.1), respectively. Subjects having any referral criteria as per IMCI module had a greater co-existence of illnesses (mean 2.6 vs. 1.6 illnesses per child, respectively). The referral criteria proved useful in predicting hospitalization and a combination of hospitalization and observation; their sensitivity and specificity were 81% and 69% and 74% and 85%, respectively. IMCI algorithms covered majority (92%) of the recorded illnesses. A total agreement with IMCI (malaria low risk) was found in 129 (64%) cases while in 43 (22%) cases, there was partial agreement. Corresponding figures for vertical (split IMCI) program were 93 (46%; p<0.001) and 41 (25%). The difference was primarily due to underdiagnoses (30%). Diagnostic discordance of IMCI algorithm and gold standard was evident for the cough category due to underdiagnosis of bronchial asthma and bronchiolitis and an overdiagnosis of pneumonia whereas the discordance for fever was due to an overdiagnosis of malaria. Identical results were found for broad treatment categories. The IMCI algorithm had a provision for preventive services of immunization (16.3% possibility of availing missed opportunities) and feeding advice. CONCLUSIONS: There is a sound scientific basis for adopting the IMCI approach since: (i) co-existence of morbidities is frequent; (ii) severe illness is assessed with good sensitivity and specificity; and (iii) the IMCI algorithm is diagnostically and therapeutically superior to the vertical disease specific algorithms. The generic IMCI algorithm needs adaptation to reflect the regional morbidity profile.

Child Health Services↗
PubMed1997

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

Age Distribution↗
PubMed1997

Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma.

OBJECTIVE: To compare the relative efficacy of jet nebulizer and metered dose inhaler (MDI) with spacer for the administration of aerosolized salbutamol in an acute exacerbation of bronchial asthma. DESIGN: Randomized prospective study. SETTING: Emergency Room. METHODS: In 60 subjects with acute asthma aged between 1 to 12 years, clinical and laboratory assessment of severity at recruitment included heart rate, respiratory rate, pulsus paradoxus, arterial blood gas analysis (all cases) and peak expiratory flow rate (wherever possible). The subjects were randomized into two equal groups to receive aerosolized salbutamol either via nebulizer (Group I) or MDI-spacer (Group II) as per the Consensus Guidelines. The response to therapy was sequentially assessed after 20, 40 and 60 minutes of institution of therapy. RESULTS: A significantly (p < 0.02) greater number of subjects in Group II presented with severe dyspnea and intercostal muscle retraction (subjective assessment). However, the objectively evaluable outcome parameters were comparable (p > 0.05) in both groups at presentation. All the outcome measures showed a significant (p < 0.05) improvement with time in both the groups. The recovery parameters were comparable (p > 0.05) at different time periods in the two groups. CONCLUSION: MDI-spacer is as effective as a nebulizer for the aerosolized administration of salbutamol in an acute exacerbation of asthma in children. However, for developing countries, distinct advantages (economic and power requirement) argue strongly for utilization of MDI-spacer in preference to nebulizer.

Acute Disease↗
PubMed1996

Nutrient intake amongst adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan.

OBJECTIVE: To assess the nutrient intake of adolescent girls belonging to low socio-economic group of rural Rajasthan. DESIGN: Cross-sectional, using probability proportionate to size, cluster sampling method. SETTING: 18 villages of Jaipur district. SUBJECTS: 941 adolescent girls of age 10-18 yr. METHODS: Anthropometric measurements for height, weight, mid-upper arm circumference, triceps skin fold and chest circumference; 24 h recall method to assess nutrient intake. Nutrient intake was compared with Indian Council of Medical Research recommended dietary allowances. RESULTS: The diets were deficient in calories by 26 to 36%, and in proteins by 23 to 32%. Nutritional status as assessed by body mass index revealed that 8.1% of adolescent girls suffered from chronic energy deficiency (CED) grade I, 6.6% grade II CED, and 78.8% grade III CED. About 73.7% of subjects suffered from anemia and 43.6% had signs of vitamin B complex deficiency. CONCLUSIONS: Intervention strategies are needed to improve the dietary intake of adolescent girls so that their requirements of energy, protein, vitamins and minerals are met.

Adolescent↗
PubMed1995

A comprehensive index for longitudinal monitoring of child health status.

The aim of this study was to develop a single comprehensive index of child mortality for longitudinal assessment of health status of children. The need for such a comprehensive index arose from conflicting trends in different child mortality indicators. The data for the study was taken from the Sample Registration System (SRS) reports of the Registrar General of India. SRS is known to provide reliable estimates of births and deaths at the State and the National level. The study included five child mortality indicators, namely, under five mortality rate (U5MR), infant mortality rate, neonatal mortality rate, perinatal mortality rate and still birth rate. These were available for fifteen states of India over the years 1972-1988. To develop this index we modified an earlier method based on factor analysis. Factor analysis of data on various indicators of child mortality revealed two factors which together explained 78% to 93% of the total variation in different years. The first factor was identified as representing mortality after birth and the second as before and during birth. The comprehensive index was obtained as a linear combination of these two factors. The resultant index thus fairly represented all five mortality indicators and provided a comprehensive and reasonably correct picture of child mortality. The lower the magnitude of this index, the better was the child health status. Trends in the index showed that the highest decline in the magnitude was in the state of Kerala followed by Punjab, Andhra Pradesh, Gujarat and Maharashtra in that order. This indicates steady improvement of the child health status over years in these states. In the State of Jammu and Kashmir, the index remained more or less constant over the years though the magnitude was low in the cross-sectional comparison with other states. Thus the comprehensive index developed by using factor analysis of the various mortality indicators can be used for the longitudinal monitoring of child health status in the states of India.

Child↗
PubMed1995

Predictors of exclusive breastfeeding in early infancy: operational implications.

OBJECTIVES: To evaluate the independent predictors of exclusive breastfeeding in early infancy. DESIGN: Cross sectional multivariate comparison of different breastfeeding categories. SETTING: Urban teaching hospital Outpatient Department. SUBJECTS: Mothers of 501 children between the age group of 0-6 months were questioned in detail on a standardized pretested proforma about various sociodemographic, parental, infant, feeding related, antenatal and perinatal characteristics likely to affect breastfeeding practices. Mother's height and weight and infant's weight were also recorded. RESULTS: The exclusive breastfeeding, predominant breastfeeding, bottle feeding, ever breastfed and timely first suckling rates were 44.9%, 67.8%, 31.5%, 99.4% and 10.4%, respectively. Amongst the 29 factors subjected to univariate analyses, 16 clinically relevant or significant (p < 0.1) variables were included for multiple logistic regression models. The significant (p < 0.05) positive independent association for exclusive and partial breastfeeding were (OR) infant's present weight (1.45 to 9.64); breastmilk as first feed (1.53 to 2.22); and lower age of child (1.02 to 1.05). Additional important predictors for exclusive breastfeeding versus total top feeding) were (OR) breastfeeding propagation (1.34 and 2.99); less educated mother (1.09 and 1.23); normal vaginal delivery (1.60) and taller mother (1.21). CONCLUSIONS: Breastfeeding propagation plays a key role in promoting exclusive breastfeeding. Other independent negative predictors represent a high risk subset for whom intensive propagation is desirable since these factors by themselves may not be amenable to intervention.

Breast Feeding↗