PubMed Health⌕ Search

Biomedical subjects

S A Deshpande

Publications and source records attributed to S A Deshpande.

14 recordsLinked to original sources
PubMed2005

Renal ultrasonography not required in babies with isolated minor ear anomalies.

AIM: To determine whether infants with isolated minor anomalies of the external ear are at increased risk of renal malformations. METHODS: Consecutive infants with isolated minor anomalies of the external ear (preauricular skin tags, preauricular sinuses, ear pits, and misshapen pinnae) were offered renal ultrasonography by experienced sonographers over a 41 month period. The prevalence of renal anomalies in such infants was compared with that detected on routine fetal scanning during the same period. RESULTS: Ninety six of 13 136 liveborn infants (7.3/1000, 95% confidence interval (CI) 5.9 to 8.9) were noted to have isolated minor ear anomalies on routine neonatal examination, with preauricular skin tags being the most common (85%). Ninety one (95%) infants underwent renal sonography at a mean (SD) age of 40 (19.6) days. Only one infant (1.1%, 95% CI 0.03 to 5.9) had transient unilateral pyelectasia. During the same period, non-syndromic renal anomalies were found in 0.64% (95% CI 0.52 to 0.73) of infants, a prevalence no different from that of infants with minor ear anomalies (p = 0.44). CONCLUSIONS: Routine renal imaging is not warranted in infants with such minor external ear anomalies unless accompanied by other systemic malformations.

Abnormalities, Multiple↗
PubMed2004

Ethnic differences in the rates of BCG vaccination.

An audit of the selective neonatal BCG immunisation programme showed that only 51% of eligible infants received the vaccination. Infants of Indian subcontinental origin (ISC) were significantly more likely to have been vaccinated than non-ISC infants (ISC 70% v non-ISC 29%). Greater awareness of the eligibility of non-ISC infants for BCG as well as simplification of the eligibility criteria are needed to help increase BCG vaccination rates.

BCG Vaccine↗
PubMed2003

The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area.

AIMS: To describe the clinical and health economic impact of respiratory syncytial virus (RSV) disease in children under 2 years of age. METHODS: Hospitalised children less than 2 years of age with a respiratory illness were studied over three consecutive RSV seasons (1996-99). RESULTS: The rates (per 1000 infants under 1 year of age) of hospitalisations from bronchiolitis and RSV illness were 30.8 and 24.4 respectively. The rates of death, intensive care admission, and need for ventilatory assistance during RSV related hospitalisation were 0.2%, 2.7%, and 1.5% respectively. From a cohort of 841 preterm infants, 6.3% had an RSV related hospitalisation during the study period, with the rate rising to 9.2% among those who were either born before 36 weeks gestation and were under 6 months of age at the onset of the RSV seasons, or were less than 2 years of age with chronic lung disease needing home oxygen therapy. Eight of 25 children on home oxygen therapy had RSV related rehospitalisation. Need for assisted ventilation during the neonatal period and discharge home on oxygen therapy were significantly associated with the risk of subsequent RSV related hospitalisation in preterm infants less than 6 months of age. The direct health authority cost of all RSV hospitalisations was pound 542 203, while the currently recommended immunoprophylaxis for the high risk infants would have cost pound 652 960. CONCLUSIONS: Preterm infants receiving assisted ventilation and those on home oxygen therapy are particularly at risk of RSV related hospitalisation. Serious adverse outcomes are however uncommon even among these high risk infants.

Bronchiolitis, Viral↗
PubMed2001

Foot length, an accurate predictor of nasotracheal tube length in neonates.

BACKGROUND: Existing guidelines for optimal positioning of endotracheal tubes in neonates are based on scanty data and relate to measurements that are either non-linear or poorly reproducible in sick infants. Foot length can be measured simply and rapidly and is related to a number of external body measurements. OBJECTIVES: To evaluate the relation of foot length to nasotracheal length in direct measurements at post mortem examinations, and then compare its clinical relevance with traditional weight based estimates in a randomised controlled trial. METHODS: The dimensions of the upper airway were measured at autopsy in 39 infants with median (range) postmenstrual age and birth weight of 32 (24-43) weeks and 1630 (640-3530) g. The regression equations with 95% prediction intervals were calculated to estimate the optimal nasotracheal length from foot length. In a randomised trial, 59 neonates were nasally intubated according to foot length and body weight based estimates to assess the achievement of "optimal" and "satisfactory" tube placements. RESULTS: In the direct measurements of the airway at autopsy, foot length was a better predictor of nasotracheal distances (r(2) = 0.79) than body weight, gestational age, and head circumference (r(2) = 0.67, 0.58, and 0.60 respectively). Measurement of foot length was easy and highly reproducible. In the randomised controlled trial, there were no significant differences between the foot length and body weight based estimates in the rates of optimal (44% v 56%) and satisfactory (83% v 72%) endotracheal tube placements. CONCLUSIONS: Foot length is a reliable and reproducible predictor of nasotracheal tube length and is at least as accurate as the conventional weight based estimation. This method may be particularly valuable in sick unstable infants.

Analysis of Variance↗
PubMed2000

Effect of oral antibiotics on intestinal production of propionic acid.

BACKGROUND: Propionic acid derived from colonic bacterial fermentation contributes substantially to overall propionate load in children with disorders of propionate metabolism, and its reduction is important for adequate metabolic control. AIMS: To evaluate the in vitro and in vivo effects of antibiotic treatment on propionate production by colonic bacteria, and plasma propionate concentrations in a child with propionic acidaemia. METHODS: In vitro fermentation techniques were used to study the effects of addition of antibiotics (metronidazole, clindamycin, erythromycin, and vancomycin) on net faecal production of short chain fatty acids including propionic acid. Courses of oral antibiotics of 7 days duration were used to assess the in vivo effects on faecal propionate production and metabolic control including plasma propionate concentrations. RESULTS: Metronidazole produced the largest and most consistent reduction (77-84%) in the production in vitro of propionate from faecal homogenates. Oral administration of metronidazole reduced faecal propionate production by 43% within 24 hours of treatment; a 7 day course virtually eliminated it for the next 3 weeks. These reductions were accompanied by substantially lowered plasma propionate concentrations during the same period. CONCLUSIONS: Intermittent courses of oral metronidazole might be as effective as continuous treatment in reducing gut propionate production in children with disorders of propionate metabolism.

Amino Acid Metabolism, Inborn Errors↗
PubMed1999

Measures of executive functioning as predictors of functional ability and social integration in a rehabilitation sample.

OBJECTIVE: To examine the utility of executive function tests in predicting rehabilitation outcome. DESIGN: A prospective, descriptive study of the value of neuropsychologic and motor functioning measures in the prediction of functional outcome 6 months after acute rehabilitation. SETTING: A Midwestern, urban, university-affiliated rehabilitation hospital. PATIENTS: Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury units. Age of the participants ranged from 17 to 73. MAIN OUTCOME MEASURES: Community Integration Questionnaire (CIQ), Disability Rating Scale (DRS), SF-36 Health Survey. RESULTS: Canonical correlation analyses indicated that measures of executive functioning and verbal memory were strongly related to measures of functional outcome 6 months after rehabilitation, as measured by the DRS and the CIQ. In contrast, perceived health status as measured by the SF-36 was highly related to estimated premorbid IQ and modestly related to visuospatial impairment. CONCLUSIONS: Executive functioning, verbal memory, and estimated premorbid intelligence predict functional dependence after discharge from rehabilitation beyond information regarding basic sensory and motor skills. Moreover, there is a dissociation between measures of functional outcome, such that objective and behaviorally oriented measures of disability (CIQ and DRS) are strongly related to each other; however, they are not related to perceptions of general health status (SF-36).

Adolescent↗
PubMed1998

Executive functioning and predictors of falls in the rehabilitation setting.

OBJECTIVE: To examine the incremental utility of executive function tests in the prediction of inpatient falls. DESIGN: Evaluation of neuropsychologic and medical risk factors for fall was completed at admission. Inpatient falls were tabulated following discharge. SETTING: A freestanding, urban rehabilitation hospital. PATIENTS: Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury wards. Age of the participants ranged from 17 to 73 years old. MAIN OUTCOME MEASURE: Incident reports of inpatient falls. RESULTS: Standard multiple regression analyses indicated that measures of executive functioning sensitive to self-monitoring accounted for unique variance in falls beyond that explained by age and functional motor ability as assessed by the Functional Independence Measure. Visuospatial functioning, although not directly related to falls, was a significant predictor in combination with measures of executive functioning. Together, these variables accounted for 30.3% of the variance in inpatient falls (multiple r = .55; p < .001). CONCLUSION: The findings suggest that the influence of motor and sensory impairments on falls are moderated, in part, by executive functioning. Patients with intact executive functioning are less likely to act in ways that could result in a fall; thus, aggressive fall prevention measures may be unnecessary. In contrast, executive dysfunction may signal the need for intervention, even among patients whose profiles are unremarkable with regard to traditional risk factors for fall.

Accidental Falls↗
PubMed1998

Adverse neonatal effects of maternal labetalol treatment.

Two infants with features of severe beta adrenergic blockade, pericardial effusions, and myocardial hypertrophy were born to mothers receiving long term treatment with oral labetalol for hypertension in pregnancy. Labetalol was implicated in the aetiology of these problems. Pericardial effusion and myocardial hypertrophy have not been associated with labetalol toxicity in neonates.

Adrenergic beta-Agonists↗
PubMed1997

Association between blood lactate and acid-base status and mortality in ventilated babies.

AIM: To investigate the relation between common acid-base parameters and blood lactate concentrations and their prognostic importance in sick, ventilated neonates. METHODS: Two hundred and seventy eight serial simultaneous measurements of arterial acid-base status and blood lactate concentrations were carried out in 75 mechanically ventilated neonates with indwelling arterial catheters (gestational age and birthweight, median (range) -29 (23-40) weeks, and 1340 (550-4080) g, respectively). RESULTS: There were no correlations between arterial blood lactate and pH and base excess within subjects (r = 0.07 and r = -0.06, respectively) and only weakly positive but clinically irrelevant positive correlations between subjects (r = 0.28 and r = 0.27) in this group. Even in those infants who had not received any bicarbonate before their initial measurements (n = 48), there were no correlations between initial blood lactate concentrations and pH (r = 0.27), base excess (r = 0.17), or serum bicarbonate concentrations (r = -0.18). There was no relation between peak lactate concentration (PLC) and base excess (r = 0.16), and only a weak correlation between peak lactate concentration (PLC) and pH (r = 0.28). Negative base excess was an insensitive indicator of raised lactate concentrations. Only two out of 33 (6%) instances of hyperlactataemia (lactate > 2.5 mmol/l) would have been identified with a base excess < -10 mmol/l as a cutoff. Lower cutoff values of base excess or pH performed no better. Raised lactate concentrations were associated with increased mortality at all levels. While six of 53 (11%) infants with a PLC < 2.5 mmol/l died, this proportion increased to four of 15 (27%) with a PLC between 2.5-5.0 mmol/l, and four of seven (57%) with a PLC > 5.0 mmol/l. Infants showing little rise or a substantial fall in blood lactate fared better than those with persistently raised values. A clinically important increase in blood lactate preceded the development of clinical markers of deterioration and complications in six infants. CONCLUSIONS: Contrary to popular belief, pH or base excess cannot be used as proxy measures for blood lactate concentration, and independent measurement of the latter are needed. Blood lactate concentrations may provide an early warning signal and important prognostic information in ill, ventilated neonates. In this regard, serial measurements of blood lactate are more useful than a single value.

Acid-Base Equilibrium↗
PubMed1996

Verbal learning subtypes in traumatic brain injury: a replication.

Traumatic brain injury (TBI) has been associated with memory impairments, but the severity and qualitative aspects of such impairment do not appear homogeneous across patients. This study sought to replicate an earlier investigation that found distinct verbal learning subtypes in TBI using the California Verbal Learning Test (CVLT). CVLT data from 88 acute rehabilitation inpatients with mild, moderate, and severe traumatic brain injuries were analyzed with multiple cluster analytic techniques. Cluster analyses yielded five learning subtypes, three of which appeared similar to the subtypes previously identified as Active, Disorganized, and Passive subtypes, and two that appeared similar to the Deficient subgroup. Traumatic brain injury appears to be characterized by heterogeneous, but fairly reliable, verbal learning subtypes that can be detected early postinjury.

Adolescent↗
PubMed1996

Reappraisal of ultrasound imaging of neonatal intravascular catheters.

Ultrasonography was successful in localising the tips of neonatal intravascular catheters and showed their precise relation to the cardiac chambers and major aortic branch vessels in 28 infants. Wherever adequate resources and training are available, this technique may provide a cheaper and non-invasive option, as well as giving additional information, than can be obtained from radiography.

Cardiac Catheterization↗
PubMed1996

Measuring blood glucose in neonatal units: how does hemocue compare?

Rapid and reliable determination of blood glucose concentration is essential during the neonatal period to prevent adverse neurodevelopmental outcome from hypoglycaemia. Despite their unreliability, reagent strip methods continue to be used extensively in neonatal nurseries due to their rapidity and convenience. Recently, a new portable laboratory standard technique has been introduced (HemoCue B-Glucose system) for whole blood glucose determination. It is particularly suitable for near-patient testing in neonatal units. This new method, as well as other established methods of whole blood (Yellow Springs Instrument (YSI) and a hexokinase method on Cobas Bio), and plasma (Kodak Ektachem) glucose measurement, were therefore evaluated for their accuracy and concordance of measurements taken in the neonatal period. There were substantial discrepancies among the four methods of glucose measurement with wide limits of agreement between these methods. The glucose concentrations measured by HemoCue and YSI (n = 206), HemoCue and hexokinase (n = 113), HemoCue and plasma glucose on Ektachem (n = 69) and hexokinase and Ektachem (n = 66) were likely to differ by -29 to +61%, -23 to +56%, -36 to +65%, and -19 to +30%, respectively. Even the laboratory methods of blood glucose determination, therefore, can not be used interchangeably. Using a model based approach, the probabilities of "discordant" classification as hypo- or normo-glycaemia were estimated to be 6.8%, 6.5%, and 7.1% between HemoCue and YSI, HemoCue and hexokinase on Cobas Bio, and HemoCue and Ektachem analysers, respectively. In view of these low probabilities of discordant classification with other glucose analysers, the HemoCue system may offer a reasonable compromise between bedside and laboratory blood glucose estimations in neonates.

Blood Glucose↗
PubMed1990

Haemolytic uraemic syndrome with prolonged anuria and cortical calcification: a case report.

An 18-month-old infant presented with haemolytic uraemic syndrome following a prodrome of colitis. Incomplete recovery of renal function occurred after 4 weeks of anuria and was associated with extensive renal cortical calcification. During the recovery phase he had two relapses of colitis, microangiopathic haemolytic anaemia and thrombocytopenia without any deterioration in renal function.

Anuria↗