PubMed Health⌕ Search

Biomedical subjects

Sunit C Singhi

Publications and source records attributed to Sunit C Singhi.

At least 19 recordsLinked to original sources
PubMed2006

Hyperglycemic hyperosmolar nonketotic syndrome.

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) was infrequently diagnosed till recently. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus (T2 DM) and its incidence is likely to go up, given global increase in incidence of childhood obesity, increased insulin resistance, and T2 DM. The syndrome is characterized by severe hyperglycemia, a marked increase in serum osmolality and dehydration without accumulation of beta -hydroxybutyric or acetoacetic ketoacids. Significant ketogenesis is restrained by the ability of the pancreas to secrete small amount of insulin. Prolonged phase of osmotic diuresis leads to severe depletion of body water, which excees that of sodium, resulting in hypertonic dehydration. These children, usually obese adolescents with T2 DM, present with signs of severe dehydration and depressed mental status but continue to have increased rather than decreased urine output and are at increased risk of developing rhabdomyolysis and malignant hyperthermia. Emergency treatment is directed at restoration of the intravascular volume, followed by correction of deficits of fluid and electrolyte (Na+, K+, Ca++, Mg++, PO4++), hyperglycemia and serum hyperosmolarity, and a thorough search for conditions that may lead to this metabolic decompensation and their treatment. Use of iso-osomolar isotonic fluid (0.9% saline) until hemodynamic stabilization initially, followed by 0.45% saline with insulin infusion at the rate of 0.1 units/kg/hour, addition of 5% dextrose in fluids and reduction of insulin infusion once the blood glucose is 250 to 300 mg/dl is generally recommended. However, evidence-based guidelines about composition and tonicity of fluids and electrolyte solutions for early resuscitation and rehydration, the rate of infusion-rapid vs slow, and insulin dose-low vs normal, in treatment of HHNS in children are awaited. Careful monitoring of glucose levels and ensuring adequate hydration in patients 'at risk' of HHNS, including those receiving medications that interfere with the secretion or effectiveness of insulin should decrease the risk of HHNS.

Child↗
PubMed2006

Penicillin and gentamicin therapy vs amoxicillin/clavulanate in severe hypoxemic pneumonia.

OBJECTIVE: To compare the efficacy of sequential injectable crystalline penicillin (C.pen) and gentamicin combination followed by oral amoxicillin with sequential IV and oral amoxicillin-clavulanate (amox-clav) in treatment of severe or very severe hypoxemic pneumonia. METHODS: Children aged 2-59 months with WHO-defined severe or very severe pneumonia with hypoxemia (SpO2 < 90%) were included in the study. Patients with fever > 10 days, bacterial meningitis, prior antibiotic therapy > 24 hours, stridor, heart disease and allergy to any of the study drugs were excluded. They were randomly allocated to two groups--Group A and Group B. Group A received C. pen and gentamicin intravenously (IV), followed by oral amoxicillin and group B got amox-clav IV, followed by oral amox-clav. Minimum duration of IV therapy was 3 days and total 7 days. Respiratory rate, oxygen saturation and chest wall indrawing were monitored 6 hourly. RESULTS: 71 patients were included. There were two (5.2%) blood cultures positive in group A and three (9%) in group B. Organisms isolated were S. pneumoniae (n=3) and H. influenzae-b (n=2). There was only one treatment failure in each of the groups. One was due to penicillin resistant H. influenzae -b and the other was due to worsening of pneumonia. The mean time taken for normalization of tachypnea, hypoxia, chest wall indrawing and inability to feed was similar (P-N.S). Mean duration of IV therapy in group A was 76+/-25 hrs and group B was 75+/-24 hrs (p>0.1). CONCLUSION: In children of 2-59 months, sequential injectable C. pen and gentamicin combination, followed by oral amoxicillin or sequential IV and oral amox-clav were equally effective for the treatment of severe or very severe hypoxemic community acquired pneumonia.

Administration, Oral↗
PubMed2006

Serum cortisol levels in children with acute bacterial and aseptic meningitis.

OBJECTIVE: To study serum cortisol levels in acute childhood meningitis with respect to the severity of illness and the outcome. DESIGN: Prospective observational study. SETTING: Pediatric services of a tertiary care teaching and referral hospital. SUBJECTS: A total of 30 consecutive children, 2 months to 12 yrs of age, with suspected bacterial meningitis. METHODS: Serum cortisol levels (by enzyme-linked immunosorbent assay) obtained at admission were correlated with clinical characteristics (including Glasgow Coma Scale and Pediatric Risk of Mortality scores) recorded at admission and with neurologic and hearing status 2 months after discharge using SPSS 10.0. RESULTS: Mean +/- sd serum cortisol was 467 +/- 251 ng/dL in patients with bacterial (n = 16) and 319 +/- 159 ng/dL in aseptic meningitis (n = 14, p = .068). Glasgow coma scale score, systolic blood pressure, age, Pediatric Risk of Mortality, and cerebrospinal fluid protein were significant independent predictors of serum cortisol on stepwise multivariate regression analysis (each had an R change of >5%). Patients with neurologic or hearing sequelae had significantly higher median serum cortisol (450 ng/mL, n = 12) than those without sequelae (300 ng/mL, n = 17; p = .043 by Mann-Whitney U test). On multivariate logistic regression analysis, a serum cortisol of >/=420 ng/mL (odds ratio, 0.022; 95% confidence interval, 0.01-0.43) and systolic blood pressure (odds ratio, 1.35; 95% confidence interval, 1.04-1.74) were significant independent predictors of neurologic and hearing sequelae. CONCLUSION: Low serum cortisol is uncommon in acute bacterial meningitis of nonmeningococcal pathogenesis. Very high levels are likely to be associated with sequelae.

Acute Disease↗
PubMed2005

Non traumatic coma.

OBJECTIVE: To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome. METHODS: 100 consecutive cases of non-traumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome. RESULTS: Etiology of coma in 60% cases was CNS infection (tubercular meningitis-19, encephalitis-18, bacterial meningitis-16, others-7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age < or = 3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho = .32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death. CONCLUSION: CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome.

Child↗
PubMed2005

Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma.

OBJECTIVES: To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children. METHODS: 100 consecutive children, between 2 months to 12 years, with non-traumatic coma, (Glasgow Coma Scale score < 8). Demographic and clinical data was recorded at admission. EEG and CT scan were done within 24 hours of admission. Etiologic diagnosis was assigned on basis of clinical data and relevant laboratory investigations. The outcome was recorded as survived and died. Among survivors it was graded as no disability, or mild, moderate, or severe disability. Odds ratio and/or relative risk (RR) with 95% confidence interval (C I) were calculated. RESULTS: EEG could be done in 60 patients (43 survived; 7 were normal, 8 had mild, 17 moderate and 11 severe disability) CT scan in 93 patients (60 survived; 11 were normal, 14 had mild, 21 moderate and 14 severe disability). A normal/borderline EEG was associated with good outcome (P = 0.001); 11 of 12 survived and of survivors 55% had no or mild disability. Electrocerebral silence on EEG was a predictor of death (OR = 44 -sub .95% Cl - 1.5-7372; P = 0.01). An abnormal EEG was associated with significant increase in risk of disability among survivors (RR = 2.6, 95% Cl = 1.2-5.4, P = 0.03). Among CT abnormalities intracranial bleed suggested increased risk of death (RR = 2.1; 95% Cl - 0.8-5.3; P = 0.058), while, hydrocephalus was associated with better survival (RR = 0.7; 95% CI - 0.5 to 0.96; P = 0.029). However, hydrocephalus when compared with other abnormal CT scan findings, was associated with higher risk of moderate and severe disability among survivors (P = 0.046) CONCLUSION: A normal CT scan and EEG, and some of the specific findings could be helpful in predicting outcome in children with non-traumatic coma. EEG and CT scan should be done at admission in all patients with non-traumatic coma if feasible.

Child↗
PubMed2005

Sodium stibogluconate and polymorphic ventricular tachycardia.

Numerous antimicrobials including pentavalent antimonials are implicated in causing prolong QT-interval and ventricular tachycardia. Torsades de pointes is rarely documented with use of sodium stibogluconate. Here is described a 12-yr-old girl with visceral leishmaniasis, who developed syncopal attacks, prolong QT-interval, polymorphic ventricular tachycardia and torsades de pointes after completing a course of Stibogluconate (20 mg/kg/day for 30 days). Prolong lidocaine infusion and cardioversion were life saving.

Anti-Arrhythmia Agents↗
PubMed2004

Oral itraconazole in treatment of candidemia in a pediatric intensive care unit.

OBJECTIVE: To examine efficacy of itraconazole in the treatment of candidemia in critically ill children. METHODS: We studied retrospectively cases of candidemia seen consecutively in our Pediatric Intensive Care Unit (PICU) over three and half years. Candida isolates from those patients included. Candida albicans--19, C. tropicalis--31, C. guillermondii--9, C.krusei--4 and C. glabrata--1. RESULTS: Of the 64 patients, 48 (75%) had symptoms suggestive of septicemia and 16 had no symptoms suggestive of septicemia. No antifungal therapy was given to asymptomatic patients; they recovered from candidemia without development of any sequelae. Of the 48 symptomatic patients 11 died before results of fungal culture became available and antifungal therapy could be started. Thirty seven patients were treated with itraconazole (10 mg/kg/day orally or through gastric tube). Seven (18.9 %) of 37 patients died, 3 within first week of antifungal therapy. Thirty (81%) patients recovered; microbiological cure was noted on average by day 14 (range 4-30 days). The mean +/- SD duration of therapy in patients who responded was 24 +/-7 days (range 21-42 days). None had any major side effect. CONCLUSION: We conclude that oral itraconazole may be effective in treatment of candidemia in children in a PICU where non-C. albicans candida species constituted majority (70%) of all Candida isolates.

Administration, Oral↗
PubMed2004

Candidemia in a pediatric intensive care unit.

OBJECTIVE: To examine the incidence, epidemiology, and clinical characteristics of candidemia in a pediatric intensive care unit. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care unit of a tertiary care teaching and referral hospital in north India. SUBJECTS: All patients with candidemia from March 1993 to December 1996. INTERVENTIONS: Patient-related data were analyzed to study candidemia in relation to reason for fungal culture, underlying medical conditions, predisposing factors, Candida isolates, antimicrobial and antifungal treatment, and deaths. MEASUREMENTS AND MAIN RESULTS: Sixty-four patients with candidemia were identified. The Candida species isolated were Candida tropicalis (48.4%), C. albicans (29.7%), C. guillermondii (14.1%), C. krusei (6.3%), and C. glabrata (1.6%). Thirty-three patients were detected by a high-risk surveillance blood culture, whereas 31 patients were detected while undergoing septic workup. Sixteen (25%) patients were asymptomatic; they recovered without any antifungal therapy and without any sequelae. Of 48 symptomatic patients, 11 died before institution of antifungal therapy; 37 received oral itraconazole (10 mg.kg(-1).day(-1)). Seven (19%) of these 37 patients died. Those who recovered had sterile culture on average by day 14 (range, 4-30) and received the antifungal therapy on average for 24 days (range, 9-42 days). Overall mortality rate was 28.1%, and bivariate analysis showed significant association with Pediatric Risk of Mortality score (p =.0001), presence of symptoms (p =.003), isolation of nonalbicans Candida in general (p =.04) and C. tropicalis specifically (p =.001), and failure to give presumptive antifungal therapy (p =.055). On multivariate analysis, Pediatric Risk of Mortality score and isolation of C. tropicalis were the only significant predictors of mortality. CONCLUSIONS: Nonalbicans Candida accounted for 70% of candidemia in a pediatric intensive care unit. High-risk surveillance blood cultures aided diagnosis in about half the patients. Severity of illness and isolation of C. tropicalis were significant predictors of mortality.

Candida↗
PubMed2004

Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study.

OBJECTIVE: Candida bloodstream infections have shown an increase in hospitalized patients, especially those receiving intensive care. The effectiveness of various azoles, especially itraconazole, in treatment of candidemia has not been fully evaluated. Our objective was to compare the efficacy and safety of enterally administered itraconazole vs. fluconazole in treatment of candidemia. DESIGN: Randomized, double-blind, controlled trial. SETTING: Pediatric intensive care unit of a referral and teaching hospital. SUBJECTS: Forty-three pediatric patients with candidemia, INTERVENTION: Patients received either fluconazole (n = 22) or itraconazole (n = 21), about 10 mg/kg orally or through a gastric tube, and were monitored for clinical and mycological cure (sterile fungal blood culture), blood counts, and liver and renal functions. MEASUREMENTS AND MAIN RESULTS: The clinical characteristics of two groups were comparable. The cure rate was similar in both the groups: itraconazole 17 of 21 (81%) and fluconazole 18 of 22 (82%). Crude mortality rate (itraconazole 9.5% and fluconazole 13.6%) was also comparable in two groups of patients. The frequency of electrolyte disturbance was very low and similar in both the groups. Blood urea, creatinine, liver enzymes, and serum bilirubin were not adversely affected. CONCLUSIONS: Itraconazole was as effective as fluconazole in nosocomial candidiasis in children receiving intensive care and was devoid of serious side effects.

Antifungal Agents↗
PubMed2004

Intensive care needs of children with acute bacterial meningitis: a developing country perspective.

In view of very limited availability of paediatric intensive care (PIC) facilities in developing countries, it is important to define priorities and recognise children who might benefit most from PIC. The objective of this retrospective, descriptive analysis was to identify the clinical indicators for intensive care in children with acute bacterial meningitis (ABM). The study included 220 children aged between 1 month and 12 years with ABM admitted to the paediatric services of an urban, tertiary-care, teaching hospital in northern India from July 1993 to December 1996. Of these, 88 were transferred to the PICU by the primary physician, 59% were comatose (Glasgow coma score <8), 44% had raised intracranial pressure (ICP), 24% were in shock and 42% had respiratory distress/failure. Seizures occurred during their illness in 64 children, 34 of whom had refractory status epilepticus. Endotracheal intubation was needed in 29 and ventilatory support in 19 children. Most of the life support measures were required during the initial 48 hours. Nineteen (22%) children died, 16 of whom were comatose on admission. Multiple system involvement was associated with higher mortality. There were no deaths among the children who were not transferred to the PICU. Children with ABM who have a Glasgow coma score <8, clinical signs of raised ICP, refractory status epilepticus, shock and/or respiratory compromise should be prioritised to receive PIC.

Acute Disease↗
PubMed2003

Celiac crisis.

Celiac crisis is a life-threatening cause of acute diarrhea and multiple metabolic emergencies. It is extremely rare these days. We successfully managed a 5-year old girl with celiac crisis for multiple metabolic problems viz., hyponatremia, hypokalemia, metabolic acidosis, hyperglycemia and polyuria in Pediatric Intensive Care Unit. Steroid therapy was life saving. The case may serve as a reminder of the condition, which presents a difficult therapeutic challenge.

Acidosis↗
PubMed2003

Profile of patients attending pediatric emergency service at Chandigarh.

Profile of children attending in a Pediatric Emergency Unit of an urban teaching hospital over a period of one year was analyzed. The total number of patients seen between September 1999 to August 2000 was 9205; there was a prepondence of boys (73%). The maximum number of patients were seen in the monsoon month of July and August. About half (52.5%) of the patients were infants. Fever (29.5%), breathing difficulty (17.4%) and diarrhea (14.5%) were the most common presenting symptoms. Respiratory and gastrointestinal illnesses were the two commonest pediatric emergencies. About 2% (n-198) patients died within 24 hours of hospitalization; 42.3% deaths were in the age group of 0-28 days. Sepsis was the most common diagnosis in patients who died. This information may help in planning and development of a Pediatric Emergency unit and prioritizing residents, training.

Accidents↗
PubMed2003

Hypo- and hypermagnesemia in an Indian Pediatric Intensive Care Unit.

Data on magnesium disturbances in critically ill children admitted to a Paediatric Intensive Care Unit (PICU) are scarce, especially from developing countries. We have studied occurrence and incidence of hypo- and hypermagnesaemia in children admitted to a PICU and the correlation between such disturbances and the outcome of illness. A total of 100 children (68 boys, 32 girls) aged 6 months to 12 years (mean +/- SD 4.9 + 3.5 years) admitted consecutively to a PICU were studied. At admission and on every alternate day venous blood was obtained for the estimation of serum and RBC-magnesium, serum calcium, sodium, and potassium, and arterial blood for ionized calcium and pH. This was done after ethical approval and informed consent. Hypomagnesaemia and hypermagnesaemia occurred in 60 per cent and 4 per cent of patients, respectively. The incidence of hypomagnesaemia was 30.1, and hypermagnesaemia was two episodes per 100 patient days. The incidence of low RBC-Mg was 17.3 episodes per 100 patient days. Hypomagnesaemia was most common in patients with raised intracranial pressure (63 episodes per 100 patients days). Mortality was nine-fold higher in hypomagnesaemic (30 per cent, 19 of 63) compared with normomagnaesemic (3.3 per cent, one of 30) patients. If Mg and Ca both were low, the mortality rate was 33 per cent (15 of 45 patients) in contrast to nil if both were normal (p < 0.05). We conclude that hypomagnesaemia and low RBC-Mg are a common occurrence in PICU patients and are associated with higher mortality.

Child↗
PubMed2003

One vs. two years of anti-epileptic therapy in children with single small enhancing CT lesions.

The duration of anti-epileptic drug (AED) therapy in children with seizures due to single small enhancing CT lesions (SSECTL) is controversial. We sought to determine whether there is any difference in the rate of seizure recurrence after 1 vs. 2 years of AED therapy and to identify the factors predictive of seizure recurrence. A total of 115 consecutive children with seizures and SSECTL were randomly assigned to two groups. Group A received AED(s) for 1 year and Group B for 2 years seizure-free interval. CT scan and EEG were done prior to AED withdrawal and children were followed-up for seizure recurrence for at least 1 year. Association between seizure recurrence and clinical and CT characteristics was analysed. Groups A and B consisted of 55 and 51 children, respectively (nine were lost to follow-up). There were 61 boys and 45 girls; mean age 9.33 years. Most (93 per cent) had focal seizures: 36 per cent complex partial, 22 per cent simple partial, 35 per cent partial with secondary generalization; 21 per cent had status epilepticus. The two groups were comparable in clinical, EEG and CT characteristics. CT scan and EEG prior to AED withdrawal were abnormal in 44 per cent and 33 per cent respectively. Six children, three from each group had seizure recurrence. Significant association was found between seizure recurrence and abnormal CT (persistence/calcification of lesion) and abnormal EEG prior to AED withdrawal (p < 0.01). The relative risk of seizure recurrence in a child with abnormal CT and EEG prior to AED withdrawal was 26.2 (95 per cent confidence interval 3.3-210.2, p = 0.0003). No association was found between seizure recurrence and any of the other variables. There was no difference in seizure recurrence after 1 vs. 2 years of AED therapy. Combination of persistent/calcified CT lesion and abnormal EEG prior to AED withdrawal was the best predictor of seizure recurrence.

Adolescent↗
PubMed2003

Hypocalcaemia in a paediatric intensive care unit.

Data on the incidence of hypocalcaemia in critically ill children admitted to a Paediatric Intensive Care Unit (PICU) is scarce, especially from developing countries. We have studied serum calcium in a prospective cohort of 100 children (68 boys, 32 girls), admitted consecutively to a PICU of a tertiary-care teaching hospital and correlated it with the outcome. Venous blood was obtained for serum calcium, magnesium, sodium, potassium, and arterial blood for ionized calcium and pH at admission and on every alternate day of hospital stay. Hypocalcaemia was present in 35 per cent of patients at admission and occurred in another 13 per cent during hospital stay. The incidence of hypocalcaemia (serum total calcium < 8.5 mg/dl) was 22.4, and ionized hypocalcaemia (serum ionized calcium < 3.2 mg/dl) was 32.4 episodes/100 patient days. Correlation between serum total and ionized calcium levels was not significant (r = 0.25, p = 0.089). Mortality was significantly higher in hypocalcaemic (28.3 per cent) compared with normocalcaemic (7.5 per cent) patients (p < 0.05). We conclude that hypocalcaemia is common in critically ill children admitted to a PICU and is associated with higher mortality.

Child↗
PubMed2003

Acute iron poisoning: management guidelines.

Serum iron level may not be available and fully reliable in management decision and prognostication in our setting. An estimated ingestion of >60 mg/kg elemental iron, onset of symptoms, blood sugar >150 mg/dL, total leukocyte count >15,000 cumm and presence of iron tablets on abdominal radiograph indicates severe toxicity and need for chelation therapy. Appearance of "vin-rose" color urine following a dose of desferrioxamine may be helpful, but is not seen consistently after chelation therapy. Early decontamination of gut (gastric lavage/whole gut irrigation), desferrioxamine infusion (15 mg/kg/hour in saline), and aggressive management of shock, and organ failure preferably in a PICU are mainstay of management, and has improved the outcome. Shock, coagulopathy (prothrombin index <50%), severe acidosis and acute liver failure are poor prognostic indicators. Guardians should be counseled about safe storage of iron tablets made for adults, and general poisoning prevention measures.

Child↗
PubMed2003

Acute iron poisoning: clinical picture, intensive care needs and outcome.

In this retrospective study, we examined the prevalence of acute iron poisoning among children attending Pediatric Emergency service of a teaching hospital, and studied their clinical profile, treatment and outcome to define intensive care needs. During the 5 years' study period of 27125 patient visits to Pediatric Emergency, 337 (1.2%) were for accidental poisoning. Of these 21(7%) patients had iron poisoning; 18 were transferred to PICU. Three patients were asymptomatic, others had vomiting (n =15, 83%), diarrhoea (n =13, 72%), malena (n = 8, 44%), and hemetemesis (n=6, 33%) generally within 6 hours of ingestion. Nine progressed to shock and/or impaired consciousness; two had acute liver failure. Dose of ingested iron and clinical signs were most useful guide to iron toxicity and management decisions; serum iron did not help. Gastric lavage yielded fragments of iron tablets in 10 patients. On desferrioxamine infusion Vin-rose colour urine was not seen in 31% even in presence of high serum iron. Shock responded to normal saline (33 +/- 15 mL/kg) and dopamine (10 +/- 4 microg/kg/min) within 4-24 hours in 7 of 9 patients. Presence of shock or acute liver failure with coagulopathy and/or severe acidosis predicted all the four deaths. Desferrioxamine infusion and supportive care of shock was the mainstay.

Acute Disease↗