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Biomedical subjects

Tejinder Singh

Publications and source records attributed to Tejinder Singh.

15 recordsLinked to original sources
PubMed2006

Persistent splenomegaly in an adult female with homozygous sickle cell anemia.

Sickle cell anemia (SCA) is associated with repeated episodes of erythrostasis in the spleen, which lead to thrombosis and infarction of the spleen resulting in "autosplenectomy" which is usually complete by 8 years of age. We present a case of a 22-year-old female who presented with complaints of fever, bone pain and joint swelling. On examination she had pallor, icterus and moderate splenomegaly. Her hemoglobin was 7.5 g/dl. Peripheral smear showed many sickled red cells. Slide test for sickling was positive with 2% sodium metabisulphite. Hemoglobin electrophoresis revealed a single band in the hemoglobin S, D, and G region. No band was seen in the HbA & HbA(2) region. HbF level was 0%. USG showed an enlarged spleen with few defined hypoechoeic lesion. We present this case because of rarity of association of homozygous SCA with splenomegaly in this age group, the confusion that echogenic lesions in spleen can create and to emphasize the risk of sequestration crises, which remains in such cases.

Adult↗
PubMed2006

Parvovirus B-19 induced acute pure red cell aplasia in patients with chronic lymphocytic leukemia and neurofibromatosis type-1.

Parvovirus B19 induced pure red cell aplasia (PRCA) has been previously reported in a variety of settings. We present two cases, an adult patient with chronic lymphocytic leukemia (CLL) and a child with neurofibromatosis type-1 (NF-1), where the abrupt appearance of severe anemia raised ominous clinical suspicions. Evidence of recent parvovirus B19 infection in association with the selective erythroid precursor deficiency in marrow helped exclude other etiologies. We emphasize the importance of bearing this infectious agent in mind, even when there are associated disorders (such as CLL) that may independently cause PRCA. An association of NF-1 with acute PRCA has not been described in indexed English literature in the past.

Acute Disease↗
PubMed2004

A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women.

BACKGROUND: Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia. However, 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective. OBJECTIVE: We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation. DESIGN: In a prospective, partially randomized study, 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid, and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly. One hundred women in each group completed the study. Changes in hemoglobin, iron indicators, pregnancy outcomes, and birth weight were compared between the 2 groups. RESULTS: Hemoglobin and iron indicators improved significantly with both treatments. The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment. No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed. Systemic side effects were more common in the parenteral iron group, whereas gastrointestinal side effects were more common in the oral iron group. CONCLUSIONS: The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who cannot tolerate oral administration of iron. However, intramuscular administration of iron is appropriate only in hospital settings well equipped to treat anaphylactic crises.

Administration, Oral↗
PubMed2004

Gamna Gandy bodies of spleen seen in CML: a causal association--a case report.

Gamna Gandy bodies are usually seen in spleen in cases of chronic venous congestion. We present a case of CML showing gamna gandy bodies. These may have occurred as a part of evolving portal hypertension which maybe due to antileukemic therapy or CML per se or due to a combination of both factors.

Antineoplastic Agents↗
PubMed2004

A randomized placebo-controlled trial of iron supplementation in breastfed young infants initiated on complementary feeding: effect on haematological status.

To combat iron deficiency manifesting around six months of age, iron-fortified complementary feeding has been recommended. In developing countries, in view of the poor bioavailability of iron from predominantly cereal-based diets and the high cost of fortification, medicinal iron supplementation is an alternative intervention. This double-blind randomized placebo-controlled trial was conducted from April 1999 to March 2000 in the Out-patient Department of a tertiary hospital in New Delhi, India, to evaluate the haematological effects of medicinal iron supplementation to breastfed young infants initiated on complementary feeding. One hundred healthy non-low birth-weight, predominantly breastfed infants aged 4-6 months were randomized into two groups to receive either iron (2 mg/kg/day) (IS group; n=49) or placebo drops (P group; n=51) beginning with the initiation of home-based non-fortified complementary feeding. Haematological parameters and anthropometry of mothers and infants were measured at baseline and repeated for infants after four and eight weeks of recruitment. Seventy-one subjects (35 in the IS group and the 36 in P group) came for the first follow-up, and of these, 43 (19 in the IS group and 24 in the P group) reported for the second visit. The adjusted (for maternal and baseline infant ferritin) serum ferritin levels were significantly higher in the IS group at both the follow-ups (p=0.006). The adjusted (for maternal ferritin and baseline infant ferritin) change in haemoglobin was significantly higher only at the second follow-up (0.7 g/dL; 95% confidence interval [CI] 0.3-1.0 g/dL). The adjusted rise in haemoglobin was higher in initially anaemic infants (at second follow-up by 1 g/dL; 95% CI 0.5-1.6 g/dL). Medicinal iron supplementation, at the time of initiating complementary feeding, to breastfed young infants resulted in an elevation of serum ferritin and haemoglobin. The response was higher in initially anaemic infants. From a programmatic perspective, evidence needs to be generated on the relative merits of selective (anaemic) versus general supplementation and daily versus weekly supplementation.

Anemia, Iron-Deficiency↗
PubMed2004

Hemophagocytic syndrome in malaria and kala-azar.

Hemophagocytic syndrome is a clinicopathological entity characterized by systemic proliferation of cells of the monocyte-macrophage-histiocytic lineage associated with fever, cytopenias, hepatosplenomegaly, lymphadenopathy and coagulopathy. Two forms of the syndrome have been described-familial hemophagocytic lymphohistiocytosis (FHL) of infants and reactive hemophagocytosis syndrome (RHS) encountered at any age. The underlying diseases are heterogenous which include, systemic lupus erythematosus and infections- bacterial, viral, fungal and parasitic. Mechanisms of RHS remain unclear, but cytokines may play a role. Risk factors associated with death are worsening anemia, thrombocytopenia during treatment, presence of DIC, and increase in serum ferritin and â-2 microglobulin and jaundice. We discuss the peripheral blood and bone marrow findings in 14 cases RHS with associated Kala-Azar (9 cases) and malaria (plasmodium vivax-2, plasmodium falciparum-3 cases). Three patients of Kala-azar expired- two due to hemorrhagic shock and one as a result of antimony related myocarditis.

Adolescent↗
PubMed2004

Histomorphology of multiple myeloma on bone marrow biopsy.

In a retrospective study, 49 bone marrow biopsies (BMB) of patients with multiple myeloma (MM) were studied for its role in diagnosis and to determine histological parameters of prognostic significance. Sections were analyzed by 2 observers and classified according to: 1. Cytological grading according to differentiation of the neoplastic cells as plasmacytic, pleomorphic and plasmablastic. 2. Volume of infiltration: quantitating the percentage of myeloma cells in the biopsy. 3. Pattern of neoplastic infiltration. The overall marrow cellularity, presence of marrow fibrosis, micro-osteolesions and normal haematopoeisis were also studied. The bone marrow biopsy (BMB) was diagnostic for myeloma in five cases, where the aspirates were hypocellular: four had early myeloma and one had extensive marrow fibrosis. The pattern of infiltration was interstitial in 19 cases (39%), nodular in 19 cases (39%), and diffuse in 11 cases (22%). In majority of the cases (49%), the cell type was plasmacytic (24 cases), plasmablastic in 10 cases and pleomorphic in 15 cases. All cases of poorly differentiated cell type (plasmablastic) had a diffuse or nodular pattern of infiltration, whereas majority of the well-differentiated cell type had an interstitial pattern. The plasma cell burden in biopsy i.e the volume of infiltration was <10% in 8 cases, <50% in 19 cases and >50% in 22 cases and was used for histological staging of MM. Fibrosis was present in 30% of cases. Follow up was available in 11 cases, and cases with poorly differentiated myeloma, diffuse pattern of infiltration and dense fibrosis had survival less than one year. Cases of well differentiated myeloma, interstitial pattern of infiltration and plasma cell load less than 20% with absence of fibrosis had a more than 5-year survival. Different series have quoted that all these histological parameters provide valuable prognostic information, wherever other modalities like beta 2 microglobulin and IL-6 levels, etc are not available. The effects of therapy can also be monitored by sequential biopsies.

Adult↗
PubMed2004

Acute fulminant visceral leishmaniasis in children--a report of two cases.

Kala-azar usually presents in older children and young adults with insidious onset of fever, splenomegaly and pancytopenia. Characteristic L.D. bodies in bone marrow or splenic aspirates are diagnostic of kala-azar. We report two cases of visceral leishmaniasis in children-1 1/2 and 10 year old with unusual presentation and fulminant course. In case 1 a female presented with fever, jaundice and bleeding manifestations. Peripheral smear revealed L.D. bodies in neutrophils as well as monocytes. The liver function tests were deranged. The child died within three days due to respiratory arrest. Case 2 was a boy who presented with fever and altered sensorium with deranged liver function tests. The patient expired within three days due to hepatic encephalopathy. Thus, it is important to consider the diagnosis of Kala-azar even when the presenting complaints are atypical and institute diagnostic and therapeutic measures early to prevent mortality.

Animals↗
PubMed2003

Right-sided diaphragmatic hernia masquerading as staphylococcal pneumonia.

A 9-month-old infant who was diagnosed to have right-sided diaphragmatic hernia with no other associated anomalies, is being reported here. He had presented with cough for one month and respiratory difficulty for one-week duration and history of bilious vomiting two days prior to admission. His chest X-ray showed multiple lucent shadows in the right lower zone in A-P and lateral views, with not very well defined diaphragm on the same side. A diagnosis of staphylococcal pneumonia was considered but with clinical and radiological picture, a right-sided diaphragmatic hernia was strongly suspected which was confirmed by doing fluoroscopy and CT-scan of the chest. He underwent a successful correction of the defect. So radiological finding of pleural effusion with displacement of mediastinum to the left and the presence of bowel gas high in the right upper quadrant should alert the possibility of a right-sided Bochdalek hernia.

Diagnosis, Differential↗
PubMed2002

Quantification of coronary risk score.

OBJECTIVE: To quantify the coronary risk score in children and/or grandchildren of patients with coronary artery disease (CAD). METHODS: One hundred and fifty children with positive family history of CAD (cases) and age and sex matched children with no such history (controls) were enrolled in the study. Fasting blood sugar, serum cholesterol and triglycerides were estimated on all children and a risk score was calculated using Nora's scheme. RESULT: The cases and controls were similar with respect to mean age, six distribution, mean weight and mean height. None of the child was hypertensive. Mean serum levels of triglycerides were 164.7 m/dl and 105.7 mg% respectively in cases and controls (p < 0.005). Prevalence of hypertriglyceridemia was three times more in cases (p < 0.001). Cases had a significantly higher risk scores (p < 0.00001) and this was mainly attributable to higher biochemical risk (P < 0.0006). CONCLUSION: Children and grand children with a positive family history of CAD had significantly higher risk scores for future CAD. The increased risk was mainly due to biochemical derangements.

Case-Control Studies↗
PubMedDate not supplied

Prevalence of Helicobacter pylori infection in children with recurrent abdominal pain.

The present study was performed to study the prevalence of Helicobacter pylori (H. pylori) infection in children with recurrent abdominal pain (RAP). Children above 3 years of age of both sexes attending the OPD of a teaching hospital, with complaints of at least three discrete episodes of abdominal pain of sufficient severity to interrupt normal daily activities, occurring over a period of one month or more and with out identifiable cause of pain were enrolled in the study. The subjects were divided into 3 age groups of 3-5 years, 5-8 years and 8-12 years. Thirty normal controls from each age group were also enrolled. Detailed history was taken and thorough physical examination was done. Estimation of haemoglobin and specific IgG antibodies to H. pylori by Immunocomb II was done. Upper gastrointestinal endoscopy was performed with a fibreoptic pediatric sized endoscope in RAP cases after obtaining informed parental consent. Multiple biopsy samples were taken and subjected to Rapid Urease Test (RUT), Gram's Staining, Culture and histology. Data obtained were analyzed, using Fisher's Z Test, Students t-test or Chi Square as applicable. Sixty-eight cases and 90 controls were enrolled, the number in various age groups being comparable (p >0.05). Seropositivity rate was significantly more in cases (60.3%) compared to controls (10%) (p <0.001) even among various age groups (<0.01). Prevalence increased with advancing age from 3.3% to 16.7% in controls, but not among cases. Seropositivity rates among males and females were comparable both among cases and controls. Incidence of malnutrition, stunting and anemia were similar irrespective of serological status. Total duration of illness, frequency, duration of each episode, and location of pain were also comparable. Among 10 seropositive children who underwent upper gastrointestinal endoscopy 80% showed one or more abnormalities, while the single seronegative child had no abnormal finding. Half the seropositive cases had gastritis, hyperemia or erosion on gross examination. Histopathological evidence of gastritis was present in 40%, but culture was negative in all. There is a significant association of H. pylori infection and RAP. But studies involving larger number of children undergoing endoscopy is required for definite evidence of a 'cause and effect'.

Abdominal Pain↗