Biomedical subjects
Rachna Seth
Publications and source records attributed to Rachna Seth.
Extraneural cysticercosis - presenting as painless cervical swellings.
Explore the source record for details and available documents.
Autism -- experiences in a tertiary care hospital.
UNLABELLED: Pervasive developmental disorders (PDD) or Autistic Spectrum Disorders (ASD) include Autistic Disorder (commonest), Asperger's syndrome, Childhood Disintegrative Disorders, Rett's syndrome and PDD-NOS (not otherwise specified). OBJECTIVE: Autism is an important cause of social disability and reported more often from the developed world than from the developing countries. The present study was aimed to establish the diagnosis of autism amongst children with derangements of language, communication and behavior; ascertain and treat the co-morbidities; identify underlying cause and create a sensitivity and awareness among various health care professionals. METHODS: Sixty-two of the seventy-five referred patients fulfilled the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder) criteria for autism. Evaluation included a detailed history, clinical examination, IQ assessment, Connor's scoring for hyperactivity and Fragile-X screening. Management of co-morbidities was done. A follow up of these patients was done. Parents' assessment of the child was also done. A registry for autistic children was established at the Department of Pediatrics with other major institutions of Delhi. RESULTS: The male:female ratio was 8:1 and missed diagnosis was common. Professional awareness is merited. Behavioral modification by early intervention and stimulation improved the core symptoms of autism. Important co-morbidities included mental retardation (95%), hyperactivity (53%) and seizures (10%) cases. Control of co-morbidities in these children facilitated child's periodic assessment and implementation of intervention programmes. In the registry initiated 62 patients were enrolled at AIIMS and 6 were identified from other hospitals. CONCLUSION: Autism does occur in Indian children too. Diagnosis is often missed. Capacity building among health professionals by a more structured teaching of developmental disabilities in the medical curriculum is required. The need to attend to co-morbidities and associated symptoms was clear. The initiation of the registry and beginning of networking was important.
Diagnostic criteria for Tuberculous Meningitis.
OBJECTIVE: Tuberculous Meningitis is associated with a high morbidity and mortality if there is a delay in diagnosis. The diagnosis is based on clinical evaluation since the bacteriological diagnosis takes time and has a low yield. This study attempts to validate these criteria in children with TBM. METHODS: Forty-two children clinically suspected to have TBM were enrolled in the study. History, examination, CT scan and CSF findings were utilized to categorize patients into "definite", "highly probable", "probable" and "possible" TBM based on the criteria laid down by Ahuja et al. The validity of these criteria was tested against bacterial isolation and response to treatment. RESULTS: Thirty one children, with complete data, were included for analysis. Using "improvement on therapy as a criterion for definite TBM, we analyzed the sensitivity and specificity of the Ahuja criteria in diagnosing TBM. Using the criteria of "highly probable" TBM, the sensitivity was 65% with a specificity of 75%. When the criteria of "probable" TBM were used, the sensitivity increased to 96% while the specificity dropped to 38%. In an attempt to make these criteria more appropriate for children, we modified the criteria by including mantoux reaction, and family history of exposure in the criteria. The modified criteria gave a sensitivity of 83% and a specificity of 63%. DISCUSSION: A sensitivity of 65% (highly probable group) implies that 35% of TBM patients will be missed, while the probable criteria gave a 63% false positive rate suggesting that the trade-off for a higher sensitivity makes the criteria very unreliable. Our modification of the criteria gave us a reasonable sensitivity of 83% with a higher specificity of 63%. The false positive rate was also reduced to 38%. Thus the modified Ahuja criteria worked better for children with TBM. CONCLUSION: The modified Ahuja criteria are better applicable for use in pediatric patients with TBM . Since the number of patients was small in this study, the study needs to be validated with a larger sample size.
Screening for pre-clinical hypertrophic cardiomyopathy by tissue Doppler imaging.
BACKGROUND: Hypertrophic cardiomyopathy is an autosomal dominant inherited disorder. On a routine clinical basis, genetic analysis is both time consuming and impractical at present. Thus, use of tissue Doppler imaging as a surrogate for genetic screening is an attractive option. METHODS AND RESULTS: Fifty-five first-degree relatives of 15 patients with hypertrophic cardiomyopathy were screened. Of them, two were found to have hypertrophic cardiomyopathy and were included in Group 1, which hence had 17 patients with overt hypertrophic cardiomyopathy. Group 2 had 53 family members who did not manifest any overt echocardiographic abnormality. Twenty healthy volunteers comprised Group 3. Doppler tissue myocardial longitudinal velocities were measured in systole and early diastole and with atrial contraction at the medial mitral annulus, lateral mitral annulus, mid lateral wall and mid interventricular septum. The tissue Doppler characteristics were analyzed for the presence of abnormalities suggestive of subclinical myocardial involvement. Myocardial velocities were highest in the normal control group and lowest in the hypertrophic cardiomyopathy group. The velocities of the relatives without overt hypertrophy were intermediate in range. Of the 53 relatives screened, nine (17%) subjects showed tissue Doppler abnormality in the systolic and early diastolic velocities at the medial and lateral mitral annulus suggestive of a possibility of pre-clinical hypertrophic cardiomyopathy and a carrier state for a hypertrophic cardiomyopathy. Twenty-two of the 53 screened members had a mean early diastolic velocity less than 13.5 cm/s, among this group 9 had an ejection fraction more than 68%. These findings suggest that at least 16.7% of the screened population may carry beta-myosin heavy chain mutation. CONCLUSIONS: Screening for hypertrophic cardiomyopathy is feasible and tissue Doppler imaging is a sensitive and easy means to detect subclinical myocardial involvement in apparently normal family members without overt hypertrophy.