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Biomedical subjects

Sandeep B Bavdekar

Publications and source records attributed to Sandeep B Bavdekar.

14 recordsLinked to original sources
PubMed2006

Prediction of weight of Indian children aged upto two years based on foot-length: implications for emergency areas.

BACKGROUND: Children presenting in critical care department might receive improper drug doses, as their weight and length cannot be determined while they are being resuscitated. AIMS: To determine if there is a correlation between foot-length and weight, length and surface area and to compare the drug doses calculated as per predicted weight (determined on the basis of foot-length) with those calculated on the basis of actual weight. MATERIAL AND METHODS: Weight, length and foot-length of children aged up to 24 months were determined in the prospective study. Analysis was done using simple linear regression analysis and by determination of coefficient of determination. The dosages of emergency medications (epinephrine, atropine, Ringers lactate and diazepam) were calculated on the basis of actual weight and dosages given in standard text and were then compared with dosages likely to be administered on the basis of weight predicted by foot-length measurement. RESULTS: Five hundred subjects were enrolled in the study that demonstrated a significant linear relationship between foot-length and body weight (r2 = 0.88), total length (r2 = 0.88), and body surface area (r2 = 0.84). The weight could be predicted on the basis of the following formula Weight (kg)= [1.35 x foot-length (cm)] -5.15. The doses of drugs calculated on the basis of weight predicted from foot length were exceeded the standard dose by 2.35 to 2.40%. CONCLUSIONS: In children aged up to 2 years, foot-length can be used to predict weight and calculate doses of emergency drugs.

Body Height↗
PubMed2005

Anticonvulsant hypersensitivity syndrome: a review.

Anticonvulsant hypersensitivity syndrome (AHS), characterised by fever, rash and internal organ involvement, is a rare, but potentially fatal adverse event that occurs most commonly with first-line aromatic anticonvulsants, but can also occur with non-aromatic anticonvulsants such as lamotrigine and valproic acid. AHS can begin anywhere from 1 to 12 weeks after commencement of therapy and has been estimated to occur at a frequency of 1/1000 to 1/10,000 exposures. Its true incidence, however, remains unknown due to under-reporting. The disease has protean manifestations mimicking several other conditions, and the diagnosis is thus difficult. Several hypotheses have been put forward to explain the pathogenesis of AHS. These include accumulation of toxic metabolites, graft versus host disease, antibody production and viral infections. The one based on toxic metabolites has found the greatest acceptance, perhaps due to the fact that it can be proven by an in vitro test; the lymphocyte toxicity assay. Discontinuation of the offending agent with supportive, symptomatic therapy forms the mainstay of management of AHS. In addition, counselling of both the patient and first degree relatives for susceptibility to AHS is an important aspect of management. In the last decade, several new anticonvulsants have been introduced for epilepsy. In addition, for resource-poor countries, inexpensive and effective first-line drugs such as phenytoin and phenobarbitone will continue to remain important treatment options. Thus, the problem of AHS will continue, and attempts should be made to further understand the molecular basis of and individual susceptibility to AHS. Adverse event monitoring programs must also actively seek AHS reports to estimate its true incidence.

Anticonvulsants↗
PubMed2005

Evaluation of an Internet delivered pediatric diagnosis support system (ISABEL) in a tertiary care center in India.

BACKGROUND: Young graduates manning the emergency rooms in public hospitals often need guidance in diagnosing critically ill patients due to their limited clinical experience. Textbooks, manuals and several websites are of limited assistance, as they do not generate patient-specific advice. ISABEL diagnostic tool, an Internet-delivered pediatric diagnosis support system that provides such information has not been evaluated in developing countries. AIM: To study the sensitivity of the ISABEL diagnostic tool. MATERIAL AND METHOD: Records of patients admitted in the pediatric intensive care unit in a metropolitan hospital in India during January 2000-July 2002 were retrieved. Resident medical officers wrote key clinical and laboratory findings on the basis of admission notes and results of investigations carried out within 30 min of admission. The list of diagnoses generated by the diagnostic tool at the ISABEL site after submission of these terms was entered in a performa. The presence of final diagnosis in the list generated by the ISABEL was the outcome measure studied. RESULTS: Records of 200 subjects (boys 111, girls 89, aged 28 days-12 years) were analyzed. Congenital heart disease, respiratory tract infections, meningitis, tetanus and septicemia were the most frequently encountered diagnoses. The diagnostic tool missed 27 diagnoses (such as septicemia, tuberculosis and seizures) in 39 subjects providing a sensitivity of 80.5%. CONCLUSION: Even without any training offered to the users, ISABEL provided a reasonable sensitivity of 80.5%. The tool holds promise of being useful in the developing countries.

Child↗
PubMed2005

Clinically directed selective screening for HIV infection in hospitalized children.

BACKGROUND: As HIV infection presents with several manifestations, none of which is specific, several children are subjected to HIV testing. Very few studies have examined the issue of probability of HIV infection with a given clinical manifestation. AIM: To determine the probability of HIV infection when a child is hospitalized with at least one of the selected manifestations. MATERIAL AND METHODS: Children aged 18 mo and above, admitted to a tertiary care center in Mumbai, India with chronic diarrhea, severe malnutrition, persistent cough, generalized lymphadenopathy, oral thrush, hepatomegaly, repeated common infections, generalized dermatitis, chronic parotid swelling, recurrent bacterial infection, disseminated tuberculosis and/ or Pneumocystis carinii pneumonia were enrolled in a prospective study after obtaining informed consent. They were subjected to HIV testing using WHO-UNAIDS strategy II. The data obtained was analyzed using the Statistical Package For Social Sciences (SPSS) software program. RESULTS: Twenty-three (20 PERCENT) of the 115 children enrolled tested positive for HIV. The seropositivity rate for various features ranged from 9.1 PERCENT for chronic diarrhea to 83.3 PERCENT for chronic dermatitis. Oral thrush, generalized dermatitis and generalized lymphadenopathy were the significant independent clinical risk factors for predicting HIV seropositivity. The probability of HIV infection was higher in children who had higher number of risk factors present concomitantly CONCLUSIONS: The probability of HIV infection in a child is dependent upon the nature and number of manifestations present.

Child↗
PubMed2004

Anticonvulsant hypersensitivity syndrome: lymphocyte toxicity assay for the confirmation of diagnosis and risk assessment.

OBJECTIVE: To report a case of anticonvulsant hypersensitivity syndrome (AHS) precipitated by exposure to phenobarbital. CASE SUMMARY: An 11-year-old girl receiving phenobarbital developed fever, exfoliative skin rash, mucous membrane lesions, alopecia, and hepatic inflammation. Investigations ruled out an infectious etiology; an adverse event following phenobarbital administration was considered. Applying the Naranjo probability scale for objective causality assessment showed the adverse reaction was probably due to phenobarbital. The diagnosis was confirmed by in vitro lymphocyte toxicity assay, which demonstrated increased cell death following exposure to phenobarbital, as well as other aromatic anticonvulsants and lamotrigine. DISCUSSION: AHS is a rare, potentially fatal event with multisystem manifestations. It is reported following exposure to aromatic antiepileptics. The mechanism proposed for AHS is accumulation of toxic arene oxide metabolites due to a defect in epoxide hydrolase-mediated detoxification. Despite the difference in chemical structure of lamotrigine, in vitro susceptibility to AHS was demonstrated in our patient. CONCLUSIONS: Although AHS is a rare event, it should be suspected in patients who develop unexplained systemic manifestations following exposure to aromatic antiepileptics. The potential of lamotrigine to cause AHS should be remembered when this drug is used in subjects who have developed AHS on exposure to phenobarbital and other first-line antiepileptic agents.

Anticonvulsants↗
PubMed2004

Recurrent acute transverse myelopathy: association with antiphospholipid antibody syndrome.

A seven-year-old boy presented with a second episode of acute transverse myelopathy. The first episode had responded dramatically to methylprednisolone. The manifestations of the second episode did not respond to methylprednisolone or IVIG. He showed persistently raised levels of antiphospholipid antibodies in the serum. Primary conditions like collagen vascular diseases, malignancy, exposure to drugs and HIV infection, which are known to be associated with the raised titers of these antibodies were ruled out clinically and by investigations. Recurrent transverse myelopathy is a rare event in childhood and reports of its association with Antiphospholipid Antibody Syndrome (APLAS) are scanty. The etiological role for these antibodies remains to be established. However, once the diagnosis is established, it may be prudent to treat the condition with agents and procedures to bring about a decrease in their titers. Long-term therapy to prevent thromboembolic complications of APLAS may also be instituted.

Acute Disease↗
PubMed2003

Neurological complications of rabies vaccines.

The rabies vaccines containing neural elements are used in some countries including India. We report three cases that presented with various neurological complications following the use of these vaccines. The presenting manifestations included those of encephalitis, radiculitis and acute inflammatory demyelinating polyradiculoneuropathy. These neurological complications are highlighted so that scientific evidence compels the community to discontinue the use of the neural tissue rabies vaccines. Newer generation cell culture rabies vaccines should be preferred over the neural tissue rabies vaccines for post-exposure prophylaxis.

Cerebral Ventricles↗
PubMed2003

Neurological manifestations of HIV infection.

Case records of HIV infected patients were analyzed for identifying neurological manifestations. Eight patients (7 males) were identified to have probable HIV encephalopathy (in a period of 24 months) as per the CDC revised classification system. Their ages ranged from one year to ten years. The neurological manifestations noted included-developmental delay (2 cases), seizures (6 cases), acute onset alteration of sensorium (4 cases), aphasia (2 cases), loss of vision (2 cases), focal neurological deficits (6 cases), brisk deep tendon reflexes (7 cases), extensor plantar responses (5 cases) and signs of cerebellar dysfunction (2 cases). Other clinical features included growth failure, microcephaly, fever, lymphadenopathy, hepatomegaly, splenomegaly, pneumonia, otorrhea and oral candidiasis. Cerebrospinal fluid studies were normal. The neuroimaging features included cerebral atrophy and ventricular dilatation, cerebral infarction, basal ganglia calcification and cerebellar atrophy. Childhood HIV infection may have a variety of neurological abnormalities. HIV infection should be suspected in children presenting with unexplained neurological manifestations and growth failure.

Child↗