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Biomedical subjects

Ira Shah

Publications and source records attributed to Ira Shah.

16 recordsLinked to original sources
PubMed2006

Is elective caesarian section really essential for prevention of mother to child transmission of HIV in the era of antiretroviral therapy and abstinence of breast feeding?

AIM: To determine whether vaginal delivery along with antiretroviral therapy and avoidance of breast feeding is safe in preventing mother to child transmission (MTCT) of HIV. SETTING: Pediatric & Perinatal HIV clinic, B.J. Wadia Hospital for children, Mumbai. STUDY DESIGN: Retrospective analysis. METHODS AND MATERIALS: 222 HIV-infected pregnant women were treated with zidovudine from 14 weeks of gestation onwards. 174 women underwent an elective caesarian section whereas 48 women delivered spontaneously vaginally. All infants were treated with zidovudine for 6 weeks and breast feeding was withheld. The HIV status of infants was determined at 18 months by ELISA test. RESULTS: Of the 174 infants delivered through LSCS delivery, two were HIV infected whereas 172 (98.9%) were HIV uninfected. Of the 48 infants delivered vaginally, 47 (97.9%) were HIV negative and one child was HIV infected. Thus, elective caesarean section was not statistically better as compared to vaginal delivery (p = 0.8696) suggesting that vaginal delivery was as effective as caesarean section for prevention of MTCT of HIV when added with antiretroviral therapy and no breast feeding. CONCLUSION: Vaginal delivery along with antiretroviral therapy in mother and baby and avoidance of breast feeding is equivalent to that of an elective LSCS delivery for prevention of mother-to-child transmission of HIV. Surgical intervention may thus not be required in these women.

Anti-HIV Agents↗
PubMed2006

Antiphospholipid syndrome in a human immunodeficiency virus 1-infected child.

High prevalence of anticardiolipin antibodies and antiphospholipid antibodies has been reported in human immunodeficiency virus (HIV)-infected patients. A full blown clinical picture of antiphospholipid syndrome (APLS) is rare and rarely reported, even in HIV-infected adults and has never been reported in HIV-infected children. We report an HIV-infected child with left sided choreoathetosis associated with APLS.

Antibodies, Anticardiolipin↗
PubMed2006

Correlation of CD4 count, CD4% and HIV viral load with clinical manifestations of HIV in infected Indian children.

AIM: To correlate the absolute CD4 count, CD4% and HIV viral load with different clinical manifestations of HIV in antiretroviral-naive children. SETTING: The paediatric and perinatal HIV clinic in a tertiary care hospital over a period of 4 years, from January 1999 to December 2003. MATERIALS AND METHODS: A total of 92 highly active antiretroviral-naive, HIV-1-infected children were enrolled in a cross-sectional study. The clinical manifestations, age, sex and CDC classification of each patient were determined. CD4 count, CD4% and HIV-1 viral load were estimated at presentation and correlated with various clinical manifestations of HIV disease. RESULTS: CD4% was higher in infants (p < 0.001) and lower in children over 5 years of age (p = 0.01). Boys had a higher absolute CD4 count than girls (769 +/- 517 vs 532 +/- 430 cells/mm3, p = 0.02). Patients with lymphadenopathy (n = 43) had a high CD4 count (840 +/- 487 cells/mm3, p = 0.01) whereas patients with HIV cardiomyopathy (n = 4) had low CD4 counts (mean 182 cells/mm3, p = 0.04). In patients with failure to thrive (n = 29), the CD4% was low (14 +/- 9%, p = 0.02) and HIV-1 viral load was high (mean 4.5 x 10(5) copies/ml, p = 0.03). CD4 count, CD4% and HIV viral load did not correlate with the stage of the disease as per the CDC classification. CONCLUSION: HIV viral load, CD4 cell count and CD4% vary with age and disease complications in HIV-infected children. However, CD4 count, CD4% and viral load did not correlate with CDC classification.

AIDS-Related Opportunistic Infections↗
PubMed2006

Efficacy of HIV PCR techniques to diagnose HIV in infants born to HIV infected mothers--an Indian perspective.

AIM: To determine the efficiency of HIV DNA PCR (qualitative) and HIV RNA PCR (quantitative) to detect or rule out HIV infection in infants born to HIV infected mothers. SETTING: Pediatric and perinatal HIV clinic in a tertiary pediatric hospital. STUDY DESIGN: Prospective study METHODS AND MATERIALS: 52 infants born to HIV positive mother were tested for HIV infection by HIV DNA PCR or HIV-1 viral load from 1.5 to 7 months of age. Their HIV status was confirmed by an HIV ELISA test at 18 months of age. RESULTS: Of the 36 patients tested by HIV DNA PCR test, 15 patients (41.8%) had a positive test and 21 patients (58.2%) had a negative test. 12 patients (80%) had a false positive test (80%) and no patient had a false negative test. Sensitivity of HIV DNA test 100% with specificity of 53.9%. Of the 18 patients tested by HIV viral load, 17 patients (94.4%) had a negative test and 1 patient (5.6%) had a positive test. No patient had a false negative or false positive test. Sensitivity and specificity of HIV viral load was 100%, which was statistically significant (p=0.0004). CONCLUSION: HIV-RNA PCR (quantitative) is highly specific and sensitive test for diagnosing and excluding perinatal HIV infection in children in India.

DNA, Viral↗
PubMed2005

Adverse effects of antiretroviral therapy in HIV-1 infected children.

The aim of this prospective study was to determine the adverse effects of antiretroviral therapy in HIV-1 infected children and factors associated with adverse effects. The study was performed in a pediatric and perinatal HIV clinic in a tertiary general hospital. Forty-three HIV positive children from the age group of 5 months to 14 years were started on antiretroviral therapy ART. Thirteen patients (30%) had adverse effects related to the ART. Seven patients (16%) had hepatotoxicity, 5 patients (12%) had raised serum amylase without symptomatic pancreatitis, 5 patients (12%) had zidovudine AZT induced anemia, 4 patients (9%) had Nevirapine NVP induced rash, 1 patient (2%) had Didanosine ddI induced pain in abdomen, 1 patient (2%) had Stavudine d4T induced angioedema, and 1 patient (2%) had hepatic steatosis. Five patients (71%) with hepatotoxicity responded to dose adjustment of ART whereas in 2 patients (29%), the elevated liver enzymes resolved on its own. Two patients (40%) with AZT induced anemia required omission of AZT and remaining 3 patients (60%) responded to dosage adjustment. ddI induced abdominal pain, d4T induced angioedema and hepatic steatosis resolved on omitting the respective antiretroviral drug. NVP induced rash and raised serum amylase subsided without any intervention. Hepatotoxicity was seen at higher viral load (Mean = 118608 copies/ml) whereas elevated serum amylase was seen at lower viral load (mean = 37631 copies/ml), which was statistically significant (p < 0.0001). NVP induced rash was seen in early weeks of therapy, serum amylase abnormalities were seen at a mean interval of 0.9 years after starting therapy, hepatotoxicity was seen at a mean interval of 1.7 years and AZT induced anemia was seen at a mean interval of 2.0 years after starting therapy. Adverse effects with antiretroviral drugs in HIV-infected children are quite common. Hepatotoxicity is the commonest adverse effect noted followed by elevated serum amylase and zidovudine induced anemia. Hepatotoxicity is seen at higher viral load as compared to other adverse effects. Most of the adverse effects are reversible on dosage modification or omitting the offending drug.

Adolescent↗
PubMed2005

Age related clinical manifestations of HIV infection in Indian children.

AIM: To determine the various clinical manifestations of HIV infection in children as per the age. SETTING: Pediatric and Perinatal HIV clinic in a tertiary pediatric hospital over a period of 7 years. STUDY DESIGN: Retrospective and prospective analysis. METHODS AND MATERIALS: Clinical manifestations of 317 HIV infected children were noted and commonest clinical symptoms were determined. The various clinical manifestations as per age were analysed. RESULTS: The mean age of presentation of HIV infection was 4.5+/-2.9 years. Predominant mode of transmission was vertical (83 per cent). Most of the children (75 per cent) were in Class B or C on presentation. There was no significant difference in the clinical symptoms and mode of transmission of HIV. The predominant clinical features seen were hepato-splenomegaly (51.1 per cent), lymphadenopathy (48.6 per cent) and tuberculosis (43.4 per cent). Patients with vertical transmission presented at an early mean age of 4.1+/-2.7 years as compared to those who acquired it by other means, which was statistically significant. PCP pneumonia was the earliest manifestation in toddlers and hepatosplenomegaly, lymphadenopathy, chronic diarrhea was seen in pre-schoolers. Systemic organ dysfunction due to HIV was seen in older children. CONCLUSIONS: Hepatosplenomegaly, lymphadenopathy and opportunistic infections together in a child may be suggestive of HIV infection. High suspicion and early diagnosis will lead to early management and decrease in the incidence of HIV related morbidity.

Child↗
PubMed2005

Progressive multifocal leukoencephalopathy (PML) presenting as intractable dystonia in an HIV-infected child.

Progressive multifocal leukoencephalopathy (PML) has been described in adult immunocompromised patients and has a progressive downhill course. Though dementia and motor disturbances have been described, intractable dystonia is a very unusual manifestation. In children, PML is very rare and often misdiagnosed as other central nervous system (CNS) encephalopathy. No definitive treatment is available.

Brain↗
PubMed2005

Aplastic anemia in an HIV infected child.

Hematologic manifestations of HIV in children are common and include anemia, neutropenia, lymphocytopenia, thrombocytopenia that may occur due to many reasons. However, aplastic anemia due to HIV infection is rare and even more so in children. Though anemia is seen with advanced disease and associated with poor prognosis it is treated with various therapeutic modalities. Our patient with aplastic anemia due to HIV infection responded to antiretroviral therapy.

Adolescent↗
PubMed2005

Intramuscular midazolam vs intravenous diazepam for acute seizures.

OBJECTIVE: To determine effectiveness of intramuscular midazolam to control acute seizures in children as compared to intravenous diazepam. METHODS: 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study. Patients who already had an intravenous access present were treated intravenous diazepam. Patients without an i.v. access at the time of convulsions were randomised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures. Time interval from administration of drug to cessation of seizures was compared. Effectiveness of i.m. midazolam in various age groups, types of convulsions and etiology of convulsions was analyzed. Side effects of both drugs were evaluated. RESULTS: The mean interval to cessation of convulsions with i.m. midazolam was 97.22 seconds whereas in diazepam group without prior i.v. access it was 250.35 seconds and in diazepam group with prior i.v. access it was 119.4 seconds. i.m. midazolam acted faster in all age groups and in patients with febrile convulsions, which was statistically significant. i.m. midazolam was equally effective in various types of convulsions be it GTC or focal convulsions. 7 patients (10.8%) had thrombophlebitis associated with i.v. diazepam administration whereas none of the patients in the midazolam group had any side effects, which was statistically significant. CONCLUSION: i.m. midazolam is an effective agent for controlling acute convulsions in children especially in children with febrile convulsions. It has relatively no side effects as compared to Intravenous diazepam and can be used as a first line agent for treatment of acute convulsions in patients with difficult intravenous access.

Anticonvulsants↗
PubMed2005

Cardiac dysfunction in HIV infected children: a pilot study.

Twenty six perinatally acquired HAART naive HIV positive children asymptomatic for cardiac disease in age group of 1-9 years were evaluated for cardiac abnormalities by echocardiography. All children were classified according to the revised CDC classification for HIV infection in children. 20 (76.9 percent) patients had evidence of cardiac abnormalities on echocardiography. 18 (69.2 percent) patients in category B had statistically significant abnormal echocardiographic finding . The commonest echocardiographic abnormalities seen were left ventricular dilatation in 10 (38.5 percent) and left ventricular hypertrophy in 10 (38.5 percent) patients. Echocardiographic abnormalities are present even in HIV-infected children who are asymptomatic for cardiac dysfunction.

Child↗
PubMed2004

Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome.

An alarming rise of dengue has been seen in Mumbai during the post-monsoon season. We undertook this prospective study in the pediatric wards and pediatric intensive care unit of B. J. Wadia Hospital for Children between 27 August 2003 and 10 October 2003 to determine the clinical features, laboratory abnormalities, and outcome of children affected with dengue and to determine the predictive markers for dengue shock syndrome. Fifty-one suspected dengue cases were tested for positivity of dengue by determination of dengue IgM antibodies by ELISA test. These positive cases were analysed for common clinical features, laboratory derangements, and outcome. Patients were subdivided into three subgroups: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) as per WHO classification. Predictive markers for DSS were also determined. Thirty-nine patients had a positive dengue IgM titre, 20 patients had DHF, 18 patients had DSS, and one patient had DF The mean age of presentation was 4.9 years. Fever, hepatomegaly, vomiting, bleeding tendencies, erythematous rash, thrombocytopenia, elevated liver enzymes, and deranged PT and PTT were the predominant clinical and laboratory features. Predictive markers for DSS were younger age at onset, altered sensorium, paralytic ileus, and significantly deranged PT. Patients with DSS also had a longer recovery period and required more supportive management in the form of component therapy and ionotropic support. All three patients who died belonged to the DSS subgroup with case fatality rate for DSS being 16.6 per cent. None of the patients in the DHF or DF subgroup died. Endemicity of dengue fever is on the rise in Mumbai with increased incidence among children. Appropriate investigations, strict monitoring and prompt supportive management can reduce mortality in dengue. Predictive markers of DSS can reduce the mortality if promptly treated. Also prevention of transmission by mosquito control and maintaining water sanitation is required to effectively control this epidemic.

Analysis of Variance↗
PubMed2004

A bedside dipstick method to detect Plasmodium falciparum.

We conducted this study to determine efficacy of Parasight-F (an HRP-II antigen dipstick method to detect P. Falciparum) in children. A total of 30 children were enrolled in the age group of 2 months to 12 years whose peripheral smear showed asexual forms of Plasmodium falciparum. All patients were tested for presence of HRP-II antigen of Plasmodium falciparum in their blood by the Parasight-F dipstick test by either an EDTA sample or a finger prick blood sample. The sensitivity of Parasight-F was 83.3 % However, the sensitivity of Parasight-F to detect Plasmodium Falciparum in case of mixed Plasmodium (Vivax + Falciparum) infection was only 25 %. Also, all patients less than 6 months of age had a negative Parasight-F test. Parasitic index, prior treatment with antimalarials or severity of Falciparum malaria have no effect on the sensitivity of Parasight-F test. We conclude that Parasight-F is an effective tool for diagnosis of Plasmoduim falciparum malaria in children.

Animals↗