Biomedical subjects
M Soman
Publications and source records attributed to M Soman.
Risk factors for early neonatal sepsis.
The authors undertook a case-control study of 113 cases of neonatal sepsis and 347 randomly selected controls. All cases and controls were selected from the 1980 and 1981 Washington State birth certificates. The increased risk for males (odds ratio (OR) = 1.75, p = 0.012) and the large risk associated with low birth weight (OR = 99.1, p less than 0.001 if less than 1,500 g and OR = 5.17, p less than 0.001 if 1,500-2,500 g) are consistent with past studies. The relationship of maternal age (OR = 2.00, p = 0.01 if less than or equal to 20 years and OR = 1.74, p = 0.05 if greater than 30) parallels the overall risk of many pregnancy-related complications in these age groups. Interpretation of the elevated risk associated with amniocentesis is hampered by small numbers but is provocative. The strong association of an Apgar score of 6 or less at five minutes (OR = 36.25, p less than 0.001) with neonatal sepsis suggests the possibility of routine sepsis evaluation in such neonates born in areas with high incidence rates of early neonatal sepsis. We found no previous reports associating either abruptio placentae (OR = 12.70, p = 0.028) or preeclampsia (OR = 6.43, p = 0.017) with neonatal sepsis.
A possible case of carbamazepine-induced pancreatitis.
At least 25 different drugs have been implicated in drug-induced pancreatitis. For some drugs the evidence is strong, but for many a contradictory or incomplete association exists between their administration and the occurrence of pancreatitis. To our knowledge, carbamazepine has not been associated with pancreatitis. We report a case of a 73-year-old female on carbamazepine 200 mg bid for partial complex seizures who developed nausea, fatigue, anorexia, malaise, headache, and increased thirst. After carbamazepine discontinuation, the patient noted an almost immediate decrease in all symptoms. Her seizures are now treated successfully with phenytoin.
Characteristics and management of febrile young children seen in a university family practice.
A cohort of 311 children registered with the University of Washington Family Medical Center was retrospectively identified and followed until the age of 2 years. Analysis of all encounters for which a temperature of 37.7 degrees C (100 degrees F) or above was noted revealed 438 such encounters among 189 patients. Only 30 encounters involved patients aged under 3 months, and in 74 percent of the encounters the temperature was below 38.9 degrees C (102 degrees F). The most common diagnoses were otitis media (34 percent), upper respiratory tract infection (19 percent), fever without a source (14 percent), and acute gastroenteritis (7 percent). While antibiotic usage, follow-up, and laboratory utilization all increased with increasing temperature, the latter was unrelated to a child's age. Laboratory evaluation of children considered at high risk for occult illness did not adhere to published guidelines. A more aggressive laboratory approach is recommended for such children, as is follow-up contact. Further studies to evaluate the risk of occult illnesses in febrile children seen in family medicine settings would be helpful in refining and improving management strategies in these settings.
Treatment plan for acute and chronic adrenergic poisoning crisis utilizing sympatholytic effects of the B1-B2 receptor site blocker propranolol (Inderal) in concert with diazepam and urine acidification.
In a large series of patients who have abused a variety of commercially available "amphetamine-like" agents as well as "street drugs" with CNS stimulant activity, the specific lytic effects of propranolol (Inderal) were utilized to reverse the dangerous hyperkinetic cardiovascular and frightening CNS phenomena noted in these non-comatose individuals. Presented here is a logical and clinically proven mode of therapy by which the authors have consistently, successfully, and safely managed such patients in "adrenergic crisis" by judicious titration of electrolytes, propranolol, and diazepam.