Biomedical subjects

Savithiri Ratnapalan

Publications and source records attributed to Savithiri Ratnapalan.

10 recordsLinked to original sources

PubMed2006

Cardiac perforation 6 weeks after percutaneous atrial septal defect repair using an Amplatzer septal occluder.

A 14-year-old boy presented to the emergency department unaccompanied by his parents with a decreased level of consciousness, bradycardia, and hypotension after a syncopal episode. The patient's electronic chart revealed a percutaneous closure of a secundum atrial septal defect using an Amplatzer septal occluder (AGA Medical, Golden Valley, MN) 6 weeks before this presentation. An urgent echocardiogram revealed a moderate pericardial effusion, and 320 mL of fresh blood was evacuated by subxiphoid pericardiocentesis. The child underwent surgical exploration and was found to have a perforation in the superior-posterior aspect of the right atrium, which was corrected. The septal occluder was extracted, and the atrial septal defect was closed with a pericardial patch. This case illustrates a rare but life-threatening complication of percutaneous closure of atrial septal defect using an Amplatzer septal occluder and the importance of timely access to patient records when available history and physical examination are limited.

Adolescent↗

PubMed2006

The attitude of physicians toward cold remedies for upper respiratory infection in infants and children: a questionnaire survey.

Over-the-counter cold remedies are widely used for symptomatic relief of upper respiratory tract infections. The safety of these drugs is not well established in infants and their efficacy is questionable. Our aim was to study the attitude of family physicians and pediatricians toward the use of cold remedies in infants and children. A questionnaire was sent to 400 family physicians and 100 pediatricians randomly selected across Ontario. The overall response rate was 53.2%. Sixteen percent of family physicians recommended cold remedies for infants 0 to 6 months of age compared to 4% of the pediatricians (P = 0.01). For infants 6 to 12 months of age, the difference between pediatricians and family physicians persisted (14% and 38% of, respectively; P < 0.001). Despite that cold remedies are not proven to be effective and some safety issues are associated with their use in the pediatric age group, physicians still recommend them. Continuing medical education programs should address the issue.

Attitude of Health Personnel↗

PubMed2006

Corticosteroid treatment of refractory Kawasaki disease.

OBJECTIVE: To review the indications for corticosteroids in patients with Kawasaki disease (KD) treated by pediatric rheumatologists in Canada and to determine their efficacy on fever in patients with refractory KD. METHODS: All practicing pediatric rheumatologists in Canada identified KD patients treated with corticosteroids and completed a standard data form that included demographics, clinical and laboratory features, imaging studies, and therapeutic interventions, by chart review. RESULTS: Thirty-two patients with KD (14 female; 18 male: mean age 4.6 years) were treated with corticosteroids. Corticosteroids were used in 26 patients (81%) for persistent fever despite treatment with intravenous immunoglobulin (IVIG) (refractory KD), 5 patients (19%) for congestive heart failure, and 1 patient for persistent acute phase symptoms other than fever. The 26 patients with refractory KD are the primary subject of this report. Twenty-two patients (85%) had rapid, sustained resolution of fever after corticosteroids. There were no serious reported adverse effects. Eight patients (31%) treated with corticosteroids developed coronary artery (CA) aneurysms and 9 (35%) developed CA dilatations without aneurysms. Of those who developed CA aneurysm, 4 had aneurysms detected prior to IV methylprednisolone (MP) on echocardiograms performed on days 6-27 (mean day 13) of illness. The remaining 4 patients had CA aneurysm detected after IVMP therapy, on echocardiograms performed on days 13-49 (mean day 23) of illness, 1-25 days (mean 9 days) after IVMP. In patients with one year or more of followup, 46% had resolution of CA abnormalities. CONCLUSION: Corticosteroids are effective in the treatment of fever in most patients with IVIG-refractory KD. A multicenter prospective study is needed to determine the effect of corticosteroids on CA outcome in patients with refractory KD.

Child↗

PubMed2004

Physicians' perceptions of teratogenic risk associated with radiography and CT during early pregnancy.

OBJECTIVE: The objective of our study was to determine family physicians' and obstetricians' perceptions of the risk of major fetal malformations associated with exposure to radiation from radiography and CT during early pregnancy. MATERIALS AND METHODS: Structured questionnaires were sent to 400 family physicians and 100 obstetricians selected randomly across Ontario, Canada. The physicians were informed about the 1-3% baseline risk for major malformations and were asked about their perceptions of the risk to the fetus associated with an abdominal radiograph and an abdominal CT scan during early pregnancy and whether they would recommend a therapeutic abortion after such exposure. RESULTS: Fifty-five percent (218/400) of the family physicians and 69% (69/100) of the obstetricians responded to our questionnaire. Forty-four percent of family physicians estimated the risk associated with an abdominal radiograph to be 5% or greater, and 61% estimated the risk associated with an abdominal CT scan to be 5% or greater. Eleven percent of obstetricians estimated the risk associated with radiographs to be 5% or greater (p < 0.001), and 34% estimated the risk associated with CT scans to be 5% or greater (p < 0.001). Among family physicians, 1% recommended an abortion if the fetus was exposed to radiation from radiography and 6% after exposure to radiation from CT. None of the obstetricians recommended an abortion after exposure to radiation from an abdominal radiograph, but 5% recommended an abortion after exposure to radiation from an abdominal CT scan in early pregnancy. CONCLUSION: Our survey shows that physicians who care for pregnant women perceive the teratogenic risk associated with an abdominal radiograph and an abdominal CT scan to be unrealistically high during early pregnancy. This misperception could lead to increased anxiety among pregnant women seeking counseling and to unnecessary terminations of otherwise wanted pregnancies. This perception of high teratogenic risk associated with radiation could also lead to a delay in needed care of pregnant women.

Abnormalities, Radiation-Induced↗

PubMed2004

Tattoos and MRI.

Explore the source record for details and available documents.

Adolescent↗

PubMed2004

Pediatric resident education and needs assessment in clinical pharmacology.

OBJECTIVE: To identify perceived and unperceived educational needs of residents to organize a seminar series in clinical pharmacology. METHOD: All pediatric residents (48) and all attending general pediatric staff (20) were sent structured questionnaires with potential seminar topics. Data from previous pharmacy chart audits and complaints lodged with patient care representatives were analyzed as the environmental scans. RESULTS: There was a 75% response rate from both residents and staff. The responses were very similar and the only significant difference was the response to a seminar on correcting electrolyte imbalances which the residents favoured (p = 0.005). The environmental scans identified pain management as one of the main areas needing improvement. CONCLUSION: Perceived learning needs of residents are similar but not identical to those identified by the faculty. Environmental scanning can be used to identify unperceived learning needs.

Chi-Square Distribution↗

PubMed2003

Digoxin-carvedilol interactions in children.

Digoxin is often coadministered with carvedilol in children with severe ventricular failure. In eight children (age 2 weeks to 8 years), the oral clearance of digoxin decreased by half with carvedilol, and two of them had digoxin toxicity. Carvedilol increases serum concentrations of digoxin in children, and its dose may need to be reduced to avoid toxicity.

Carbazoles↗

PubMed2003

Measuring a toddler's mouthful: toxicologic considerations.

The volume of a toddler's mouthful needs to be defined to estimate poisoning risk. We calculated a toddler's mouthful in 66 healthy children (1.5-4.5 years old) by measuring apple juice remaining in a cup after sipping. Mean volume was 9.3 mL (range, 3.5-29; 95% confidence interval, 8-11), twofold larger than commonly quoted values.

Child, Preschool↗

PubMed2003

Ionizing radiation during pregnancy.

QUESTION: One of my patients had a computed tomography scan of her abdomen a week ago and has just found out she is 7 weeks pregnant. What should I tell her about the pregnancy and the risk to her fetus? ANSWER: Your patient is not at increased risk of miscarriage or major congenital fetal malformations due to radiation exposure. Her risk is similar to that of the general population (ie, 1% to 3%).

Adult↗

PubMed2002

Taking ACE inhibitors during pregnancy. Is it safe?

QUESTION: A pregnant patient is taking enalapril for primary hypertension. How safe are angiotension-converting enzyme inhibitors (ACEI) during pregnancy? ANSWER: Evidence of whether ACEIs cause problems during the first trimester of pregnancy is reassuring. There is evidence that they cause severe renal and other problems during the second and third trimesters, however. These drugs should be avoided during pregnancy.

Abnormalities, Drug-Induced↗