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Biomedical subjects

J M Puliyel

Publications and source records attributed to J M Puliyel.

At least 19 recordsLinked to original sources
PubMed2006

Audit of nurse-led-training for epipen in a District General Hospital.

BACKGROUND: A community-based study in the London Borough of Hounslow, which included patients in our District General Hospital (DGH) Paediatric Department, found that most families who had been prescribed adrenaline auto-injectors could not use them properly. This prompted the establishment of a new protocol for doctors and an Allergy Clinic where one nurse was responsible for training all patients. AIM: This audit was done to reassess this service 3 years after the changes were made. METHODS: 68 of the 81 (83%) patients followed up in our District General Hospital Nurse led Allergy Clinic agreed to participate. They were compared with the District General Hospital sub-group of the previous study. RESULTS: We found that most patients now reported they were trained to use the devise, had written instructions, were able to demonstrate competence on a dummy and would appropriately call an ambulance. This was significantly better than the previous situation. CONCLUSION: The study shows that training can be improved in a DGH setting with the strategy of protocolised prescribing and a Nurse led Allergy Clinic.

Case-Control Studies↗
PubMed2005

Not by bread alone project: a 2-year follow-up report.

BACKGROUND: We have previously reported the developmental gains achieved, after introducing a simple programme of structured play to stimulate children in an orphanage. It was envisaged that the caregivers could continue the programme. However, the enthusiasm of the caregivers waned over the year the programme was entrusted to them. After 1 year, a full time play therapist was recruited to rejuvenate the play programme. METHODS: Children's development was assessed using the Indian adaptation of the Bayley Scales of Infant Development. The first assessment was done when the play therapist joined. Subsequently, three-monthly assessments were done and the scores achieved were recorded. RESULTS: The initial mean motor and mental scores, when the play therapist joined, were 66.14 and 56.95, respectively (similar to the pre-intervention scores of the pilot study reported in an earlier paper). The scores improved to 81.84 and 78.25 within 3 months of restarting the play programme. CONCLUSION: The schedule of the 'Not by Bread Alone' project can accelerate the motor and mental development of children in orphanages. However, it requires a highly motivated and dedicated person to sustain this programme over long periods.

Attitude to Health↗
PubMed2004

Play in orphanages.

OBJECTIVES: This paper attempts to validate the programme of structured play lasting 90 minutes a day, for use in orphanages, to check if it can be replicated in other orphanages, with similar results. METHODS: A 2-week workshop on the structured play scheme was conducted at the Missionaries of Charity Orphanage in Delhi, the venue of the original project. 15 MOC sisters from 6 centers attended the workshop. The authors selected the MOC orphanage at Chandigarh to track the benefits of the programme. The development quotient of all the residents between the ages of 6 months - 3 years was assessed by a pediatric-clinical-psychologist using the Development Assessment Scale for Indian Infants (DAS II) scale. A reassessment of all these children was done again 3 months after initiating the programme of structured play here. RESULTS: The mean motor and mental scores at the orphanage in Chandigarh before the start of the intervention were 57.9 and 58.2 respectively. Post intervention assessments showed a rise of 23 points in both the scores. CONCLUSION: The development of children in orphanages rises dramatically after initiating a programme of play. The pre-intervention development scores is similar to that in a pilot study and the benefits after play was also similar. The play programme can be easily replicated in other orphanages with similar results.

Caregivers↗
PubMed2003

Community based retrospective study of sex in infant mortality in India.

OBJECTIVE: To determine whether the imbalance in the sex ratio in India can be explained by less favourable treatment of girls in infancy. DESIGN: Analysis of results of verbal autopsy reports over a five year period. SETTING: Community health project in urban India. MAIN OUTCOME MEASURES: Deaths from all causes in infants aged less than 1 year. RESULTS: The sex ratio at birth was 869 females per 1000 males. The mean infant mortality was 1.3 times higher in females than in males (72 v 55 per 1000). Diarrhoea was responsible for 22% of deaths overall, though twice as many girls died from diarrhoea. There were no significant differences in the numbers of deaths from causes such as birth asphyxia, septicaemia, prematurity, and congenital anomalies. In 10% of deaths there was no preceding illness and no satisfactory cause was found. Three out of every four such deaths were in girls. CONCLUSIONS: The excess number of unexplained deaths and deaths due to treatable conditions such as diarrhoeal disease in girls may be because girls are regarded and treated less favourably in India.

Autopsy↗
PubMed2003

Triage score for severity of illness.

OBJECTIVE: To evolve a triage scoring system for severity of illness based on clinical variables related to systemic inflammatory response syndrome (SIRS). DESIGN: Prospective study in a tertiary-care hospital. METHODS: Consecutive pediatric patients admitted to the ward or pediatric intensive care unit (PICU) were studied. The respiratory rate, heart rate, capillary refill time, oxygen saturation (SpO2), systolic blood pressure and temperature were noted, Sensorium level was assessed on AVPU score. Variables were based on SIRS criteria and criteria mentioned in Advanced Pediatric Life Support (APLS). Each study variable was scored as 0 or 1 (normal or abnormal) and total score for each child obtained. The survival at discharge was correlated with the study variables and the total score. Another score based on the magnitudes of the coefficients in multiple logistic regression analysis was computed and the correlation between this score and mortality was also studied. ROC curve analysis was performed to see the overall predictive ability of the score as well as a cut off at which maximum discrimination occurred. RESULTS: Of 1099 children studied, 44 died. Of the seven variables, only five variables were abnormal in the study subjects. Except heart rate and respiratory rate, all other variables and age showed significant association with survival status (P < 0.01). The mortality increased with increase in the number of abnormal variables: 0.4% 2.2% 6.1% 15.3% 19.4% and 29.4%for scores of 0,1,2,3,4 and 5 respectively and the linear trend was significant (P < 0.01). Mortality also increased with a decrease in age (P < 0.01). Children with a score of 2 or more (2 or more abnormal clinical variables) had significantly higher mortality as compared to those with no abnormal clinical variables (score = 0). Based on the regression coefficients, the maximum possible score was 9.8. Regression based score was found to predict survival status well. The area under the ROC curve was 0.887, indicating that overall 88.7% of the subjects could be predicted correctly. Maximum discrimination was observed at a score of 2.5 (sensitivity 84.1% specificity 82.2%). CONCLUSION: For triage scoring, any child with 2 or more abnormal clinical variables should be taken as serious that might lead to death. With a more detailed scoring, score of 2.5 can be taken as cut-off to select children who possibly need admission and closer observation.

Child↗
PubMed2002

The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India.

AIMS: To compare the vitamin D status of 34 children, 9-24 months old, living in an area of Delhi renowned for high levels of atmospheric pollution (Mori Gate), with a comparable age matched group of children from a less polluted (Gurgaon) area of the city. METHODS: Serum concentrations of calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Haze scores, regarded as a surrogate marker of solar UVB radiation reaching ground level, were measured in both areas. RESULTS: Mean 25(OH)D of children in the Mori Gate area was 12.4 (7) ng/ml, compared with 27.1 (7) ng/ml in children living in the Gurgaon area (p < 0.001). The median ALP (p < 0.05) and mean PTH (p < 0.001) concentrations were higher in children living in the Mori Gate area than in the Gurgaon area. The mean haze score in the Mori Gate area (2.1 (0.5)) was significantly lower (p < 0.05) than in the Gurgaon area (2.7 (0.4)), indicating less solar UVB reaching the ground in Mori Gate. CONCLUSION: We suggest that children living in areas of high atmospheric pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements.

Air Pollution↗
PubMed2001

Ultrasonographic femur-tibial length ratio: a marker of Down syndrome from the late second trimester.

An observational prospective study reported that newborn babies with Down syndrome (DS) had short upper limbs that reach up to their pelvis. The shortening was most marked in the forearm (the middle segment of the upper limb) and this relative shortening resulted in an alteration of the proximal to middle segment length ratio. This study assumes that there is a similar alteration in the ratio of the lower limb. We propose to study the proximal to middle segment ratio in the lower limb in normal fetuses at different gestational ages. Against these norms we propose to study the ratio in fetuses with DS to see at what stage in intrauterine life the altered ratio becomes evident. We also propose to take postnatal measurements of upper and middle segments of both upper and lower limbs of babies born with DS and compare them with normal babies. Fetal femoral and tibial lengths were measured by routine antenatal ultrasound scans at a General hospital with 6000 deliveries a year. All babies delivered were examined for phenotypical evidence of DS. The in utero measurements recorded of babies born with DS were compared with the measurements in normal babies. Postnatal measurements of the arm and forearm, and the thigh and leg of babies with DS were taken soon after birth. These were compared with a control group of 20 consecutive normal babies born over 2 days. There were 3690 readings of 3075 normal fetuses and 8 measurements of 7 Down fetuses. The leg, the upper arm, and arm of newborns with DS were significantly shorter than controls (p<0.01). The upper limb reached up to the pelvis in infants with DS and not up to mid thigh as in normal babies. The forearm was shorter than the arm in infants with DS. This is a reversal of the ratio seen in controls. The ratio of femoral to tibial length remains near constant at 1.1 after 13 weeks' gestation in normal fetuses. It rises from 1.2 to 1.4 from 22 weeks' to 38 weeks' gestation in fetuses with DS. The mean standard deviation score of fetuses with DS was 4.53 compared with norms (SD 1.7, p<0.01). Conclusions of this study are: (1) short upper limbs (reaching only up to the pelvis) is a clinical feature of DS at birth; and (2) after 20 weeks' gestation, the ratio of femoral-tibial length can be a marker of DS in utero.

Adult↗
PubMed2001

Prediction of mortality by application of PRISM score in intensive care unit.

OBJECTIVE: Prediction of mortality by application of Pediatric Risk of Mortality (PRISM) score in Pediatric Intensive Care Unit (PICU) patients under Indian circumstances. DESIGN: Prospective study. SETTING: PICU of a tertiary care multi-specialty hospital. METHODS: 100 sick pediatric patients admitted consecutively in PICU were taken for this study. PRISM score was calculated. Hospital outcome was recorded as (died/survived). The predicted death was calculated by the formula: RESULTS: Of 100 patients, 18 died and 82 survived. By PRISM score 49 children had the score of 1-9. The expected death in this group was 10.3% (n = 5.03) and the observed death was 8.2% (n = 4). Among 45 children with the score of 10-19, the expected mortality was 21.2% (n = 9.6) and observed was 24.4% (n = 11). There were 3 patients with the score of 20-29, the expected mortality in this group was 39.3% (n = 1.18) and observed mortality 33.3% (n = 1). There were 3 patients with score > or = 30, observed death 66.3% (n = 2) and expected mortality was 74.7% (n = 2.24). There was no significant difference between expected and observed mortality in any group. (p > 0.5). ROC analysis showed area under the curve of 72%. CONCLUSION: PRISM score has good predictive value in assessing the probability of mortality in relation to children admitted to a PICU under Indian circumstances.

Cause of Death↗
PubMed2000

A simple strategy to improve first breath oxygen delivery by self inflating bag.

The text book of Pediatric Advanced Life Support of the American Heart Association recommends that a reservoir is used with a self inflating bag valve device. The figure in the book suggests that if such a device is connected to an oxygen supply, the oxygen will fill the bag first and then go on to fill the reservoir. However the valve structure of the self-inflating device does not permit active entry of oxygen into the bag, unless the bag is deflated and allowed to reinflate, drawing oxygen from the reservoir. We did this study to test the concentration of oxygen delivered in the first few breaths with the help of a Miniox-III oxygen monitor probe (MSA Medical Products, Pittsburgh, PA 15230) inserted into a self inflating bag (AMBU). Twenty-one percent oxygen is delivered with first breath and it rose to 42 and 58% with the second and third inflations, respectively. Eighty percent oxygen was achieved after eight reinflation cycles. We developed a formula to calculate the concentration of oxygen in the bag after each inflation effort, assuming that there was no passive diffusion of oxygen. We suggest that compressing the bag 8-12 times prior to putting the mask to the face of the patient will allow 80% oxygen to be delivered with first breath.

Humans↗