Tuberculosis clinical grand round.
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Child↗
Biomedical subjects
R Lodha
Publications and source records attributed to R Lodha.
Recurrent pneumonia in children: clinical profile and underlying causes.
AIM: To study the clinical profile and describe the predisposing causes of recurrent pneumonia in Indian children. METHODS: The clinical details and the investigations of children presenting with recurrent pneumonia to the paediatric chest clinic services of a tertiary care centre in northern India were reviewed. RESULTS: Seventy children (44M, 26F) presented with recurrent pneumonia over a period of 5 y. Based on the clinical features and the results of the investigations, underlying illness could be identified in 59 children (84%). The most frequent underlying cause for recurrent pneumonia was recurrent aspiration (24.2%), followed by immunodeficiency (15.7%), asthma (14.2%) and structural anomalies (8.6%). CONCLUSION: The underlying cause of recurrent pneumonia was identified in more than 80% of children. Recurrent aspirations were the most common cause.
Child↗
An indigenously developed method for sweat collection and estimation of chloride for diagnosis of cystic fibrosis.
An indigenously developed method for sweat collection and titration method for estimation of chloride was validated. The mean difference in estimated chloride value from the known strength of saline in 50 samples was -1.04 +/- 4.13 mEq/L (95% CI: -0.07 to 2.28). The mean difference in the estimated chloride values between two observers when the test was performed on known strengths of saline solution was -2.5 +/- 4.24 mEq/L (95% CI: -3.67 to 1.33). The inter observer variability between two observers when the test was performed on sweat samples obtained from 50 individuals was -1.12 +/- 4.34 mEq/L (95% CI: -2.23 to 0.8 ). Sweat weight of more than 100 mg could be collected in first attempt in 602 of 757 (80%) patient with an average sweat weight of 230 mg. This inexpensive method of sweat collection and chloride estimation has acceptable accuracy and repeatability and can be used in resource poor setting for making a diagnosis of cystic fibrosis.
Cystic Fibrosis↗
Nosocomial infections in pediatric intensive care units.
Nosocomial infections are a significant problem in pediatric intensive care units. While Indian estimates are not available, western PICUs report incidence of 6-8%. The common nosocomial infections in PICU are bloodstream infections (20-30% of all infections), lower respiratory tract infections (20-35%), and urinary tract infections (15-20%); there may be some differences in their incidence in different PICUs. The risk of nosocomial infections depends on the host characteristics, the number of interventions, invasive procedures, asepsis of techniques, the duration of stay in the PICU and inappropriate use of antimicrobials. Most often the child had endogenous flora, which may be altered because of hospitalization, are responsible for the infections. The common pathogens involved are Staphylococcus aureus, coagulase negative staphylococci, E. coli Pseudomonas aeruginosa, Klebsiella, enterococci, and candida. Nosocomial pneumonias predominantly occur in mechanically ventilated children. There is no consensus on the optimal approach for their diagnosis. Bloodstream infections are usually attributable to the use of central venous lines; use of TPN and use of femoral site for insertion increase the risk. Urinary tract infections occur mostly after catheterization and can lead to secondary bacteremia. The diagnostic criteria have been discussed in the review. With proper preventive strategies, the nosocomial infection rates can be reduced by up to 50%; handwashing, judicious use of interventions, and proper asepsis during procedures remain the most important practices.
Adolescent↗
Upper respiratory tract infections.
Acute respiratory infections accounts for 20-40% of outpatient and 12-35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis are S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus and S. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10-14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.
Anti-Bacterial Agents↗
Efficacy of a home-made spacer with acute exacerbation of bronchial asthma: a randomized controlled trial.
Metered dose inhaler (MDI) with spacer is the preferred method for administration of aerosolized medications in pediatric asthma. The expense of commercial spacers limits their use and indigenous alternatives have therefore been developed. Information on the clinical efficacy of home-made spacers is limited. This study was conducted to compare the efficacy of a valve-less home-made spacer with a commercial spacer in delivering salbutamol via MDI in acute asthma. Asthmatic children aged 5-15 years who presented with an acute exacerbation to the pediatric chest clinic of a tertiary care hospital were enrolled in a single blinded randomized parallel group study. The study patients received 10 puffs of salbutamol (100 microg/puff) via MDI-home-made spacer or MDI-commercial spacer. Pre and post inhalation measurements of peak expiratory flow rate (PEFR), oxygen saturation (SaO2), respiratory rate (RR), pulse rate (PR) were made and compared. Sixty children were enrolled in the study, 31 were administered salbutamol via the home-made spacer and 29 via the commercial spacer. The median increase in PEFR was similar in both the groups (20.8% vs 22.2%, p=0.4), clinical improvement being satisfactory in all patients. The valve-less home-made spacer is equally efficacious and cheaper than the commercial spacer in administering bronchodilators in acute exacerbations of asthma. Further studies on the efficacy of home-made spacer in delivery of inhaled steroids are needed.
Adolescent↗
Lung function tests in asthma: which indices are better for assessment of severity?
Pulmonary function tests are objective evidence of the severity of asthma. A cross-sectional study was carried out to determine the sensitivity of various pulmonary function indices in picking up clinically diagnosed mild and severe asthma. Three groups, each with 60 subjects between 5 and 15 years all of either sex, with mild asthma, severe asthma, and without asthma, respectively, were studied. Pulmonary function tests were performed using a portable spirometer. FEV1 and FVC could differentiate mild asthma from non-asthmatic children in 38 (63 per cent) and 35 (58 per cent), respectively. FEF25% and FEF75% could identify 46 (77 per cent), and 47 (78 per cent) of mild asthmatic children. In children with severe asthma, FEV1, FVC, FEF25%, and FEF75% were abnormal in 54 (90 per cent), 48 (80 per cent), 58 (97 per cent) and 56 (94 per cent), respectively. Peak expiratory flow rate was abnormal in 77 per cent of mild and 87 per cent of severe asthmatics. The FEV1/FVC ratio showed no significant difference between asthmatics and non-asthmatics. It is concluded that FEF25% and FEF75% are better indices for assessment of severity of asthma than FEV1 and FVC. The ratio FEV1/FVC is not useful.
Adolescent↗
Hepatitis B in India: a review of disease epidemiology.
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Age Distribution↗
Chronic obstructive pulmonary disease in children.
Chronic obstructive pulmonary disease is not a well defined entity in children. A child presenting with chronic cough and wheezing should be investigated for asthma, recurrent aspiration airway compressions, chronic infection, cystic fibrosis and immune deficiency. If a specific cause is not identified; search should be made for environmental factors such as passive smoking, air pollution and irritants. The therapeutic option for patients with chronic productive cough without specific etiology include control of environmental factors, bronchodilators and chest physiotherapy.
Asthma↗
Acute respiratory distress syndrome: experience at a tertiary care hospital.
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Child↗
Risk factors for severe acute lower respiratory tract infection in under-five children.
BACKGROUND: Acute lower respiratory infection (ALRTI) is the leading cause of death in children below five years of age. Identification of modifiable risk factors of severe ALRTI may help in reducing the burden of disease. METHODS: A hospital based case control study was undertaken to determine risk factors associated with severe lower respiratory tract infection (LRTI) in under-five children. A case definition of severe ALRTI as given by World Health Organization (WHO) was used for cases. Healthy children attending Pediatrics out patient department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. RESULTS: 512 children including 201 cases and 311 controls were enrolled in the study. On stepwise logistic regression analysis it was found that lack of breastfeeding (OR: 1.64; 95 percent CI: 1.23-2.17); upper respiratory infection in mother (OR: 6.53; 95 percent CI: 2.73-15.63); upper respiratory infection in siblings (OR: 24; 95 percent CI: 7.8-74.4); severe malnutrition (OR: 1.85; 95 percent CI: 1.14-3.0); cooking fuel other than liquid petroleum gas (OR: 2.5; 95 percent CI: 1.51-4.16); inappropriate immunization for age (OR: 2.85; 95 percent CI 1.59-5.0) and history of LRTI in the family (OR 5.15, 95 percent CI 3.0-8.8) were the significant contributors of ALRTI in children under five years. Sex of the child, age of the parents, education of the parents, number of children at home, anemia, inadequate caloric intake, type of housing were not documented to be significant risk factors of ALRTI. CONCLUSION: Lack of breast-feeding, upper respiratory infection in mother, upper respiratory infection in siblings, severe malnutrition, cooking fuel other than liquid petroleum gas, inappropriate immunization for age and history of LRTI in the family were the significant risk factors associated with ALRTI
Breast Feeding↗
Pneumonia.
Pneumonia is the leading cause of mortality and a common cause of morbidity in children below five years of age. Commonly, pneumonia is caused by bacterial agents. The diagnosis of pneumonia is usually made on clinical features. A child with tachypnea with no chest in-drawing or difficulty in feeding is labeled as pneumonia. Presence of chest in-drawing, difficulty in speech, feeding or cyanosis classifies a child as suffering from severe or very severe pneumonia. Factors that may help in selection of appropriate antibiotics include: knowledge of etiological agents, sensitivity of pathogens to antibiotics, severity of the disease, immune status, nutritional status, previous antimicrobial usages, history of hospitalization, duration of illness, associated complications and cost and safety of antibiotics. For selection of antibiotics pneumonia can be classified in two major categories (a) community acquired, without risk factors, and (b) pneumonia with risk factors. Both these can be further classified as non severe and severe illness. A community acquired pneumonia in a child between 2 months -60 months without risk factors for resistant or atypical organism may be treated with amoxicillin. The alternative to amoxicillin includes oral cephalosporins and cotrimoxazole. In pneumonia with presence of risk factors the antibiotics are decided on basis of individual patients characteristics. A child with non-severe pneumonia should be treated with oral cefuroxime or amoxicillin clavulinic acid for a period of 7-14 days.
Anti-Bacterial Agents↗
Long-term management of asthma.
Long-term management of asthma includes identification and avoidance of precipitating factors of asthma, pharmacotherapy and home management plan. Common precipitating factors include viral upper respiratory infections, exposure to smoke, dust, cold food and cold air. Avoidance of common precipitating factors has been shown to help in better control of asthma. Pharmacotherapy is the main stay of treatment of asthma. Commonly used drugs for better control of asthma are long and short acting bronchodilators, mast cell stabilizers, inhaled steroids, theophylline and steroid sparing agents. After assessment of severity most appropriate medications are selected. For mild episodic asthma the medications are short acting beta agonists as and when required. For mild persistent asthma: as and when required bronchodilators along with a daily maintenance treatment in form of low dose inhaled steroids or cromolyn or oral theophylline or ketotifen are required. Moderate persistent asthma should be treated with inhaled steroids along with long acting beta agonists for symptom control. For severe persistent asthma the recommended treatment includes inhaled steroids, long acting beta agonists with or without theophylline. If symptoms are not well controlled, a minimal dose of oral prednisolone preferably on alternate days may be needed in few patients. Newer drugs like leukotriene antagonists may find a place in control of exercise-induced bronchoconstriction and mild and moderate persistent asthma. Patients should be followed up every 8-12 weeks. On each follow up visit patients should be examined by a doctor, compliance to medications should be checked and actual inhalation technique is observed. Depending on the assessment, medications may be decreased or stepped up. For exercise induced bronchoconstriction: cromolyn, short or long acting beta agonists may be used. In children with seasonal asthma, maintenance treatment according to assessed severity should be started 2 weeks in advance and continued throughout the season. These patients should be reassessed after discontinuing the treatment. Parents should be given a written plan for management of acute exacerbation at home.
Anti-Asthmatic Agents↗
Diphtheria in urban slums in north India.
We recorded a reappearance of cases of microbiologically confirmed diphtheria in a tertiary care hospital in north India. Poor immunisation coverage, population migrations, and overcrowded urban slums may be contributory factors.
Child↗
Is axillary temperature an appropriate surrogate for core temperature?
The ideal technique for measuring temperature should be rapid, painless, reproducible and accurately reflect the core temperature. While axillary temperature is commonly used because of convenience and safety, there are conflicting reports about its accuracy. To determine whether axillary temperature can act as a surrogate for oral/rectal temperatures, a prospective comparative study was conducted. The axillary and rectal temperatures (Group 1: infants < 1 year age) and axillary and oral temperatures (Group 2: children 6-14 years age) were compared using mercury-in-glass thermometers. Various tests of agreement were applied to the data obtained. Rectal and axillary temperatures for infants agreed well; the mean difference (95% limits of agreement) between the two being 0.6 degree C (-0.3 degree C, 1.4 degrees C). Similarly, the mean difference (95% limits of agreement) between oral and axillary measurements for children aged 6-14 years was observed to be 0.6 degree C (-0.4 degree C, 1.4 degrees C). Axillary temperature appears to be an acceptable alternative to rectal/oral temperature measurements in children.
Adolescent↗
Tetanus in immunized children.
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Child, Preschool↗
Traditional Indian systems of medicine.
INTRODUCTION: A number of traditional systems of medicine exist in India of which Ayurveda is the most popular. Despite being in use for more than 3000 years, few properly designed trials have scientifically examined the clinical potential of Ayurvedic and other medications. METHODS: We reviewed the MEDLINE database to identify clinical trials conducted using traditional Indian medicines. Single case reports were excluded. RESULTS: Ayurvedic preparations have been successfully used for the treatment of bronchial asthma, ischaemic heart disease and hyperlipidaemia. Formulations containing curcumin were reported to reduce inflammation and disability in double-blind clinical trials on patients with rheumatoid arthritis. A number of products are reported to be useful in patients with acute viral hepatitis. A multicentric study by the Indian Council of Medical Research showed that a preparation from Pterocarpus marsupium was effective in reducing levels of blood glucose and glycosylated haemoglobin in patients with non-insulin-dependent diabetes mellitus. In another multicentric trial, patients with fistula-in-ano were randomised to surgery or application of medicated seton (Ksharsootra). Surgical treatment led to a faster cure but recurrence rates were lower with medicated seton. Administration of extract from Bacopa monnieri, to children with mental retardation, was reported to significantly improve short-term and long-term memory. CONCLUSIONS: Evidence-based studies on the efficacy and safety of traditional Indian medicines are limited. The essential ingredient in most formulations is not precisely defined. High quality studies are necessary to evaluate and compare the value of traditional Indian drugs to modern medicine.
Animals↗