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Bhagwati AM, Singhi S, Ramachandran B, Ramakrishnan N, Gopalakrishnan R, Kamat VN, Nagaraja P, Prayag S, Todi SK, Rajagopalan RE. Guidelines for the Prevention of Infections Associated with the Use of Vascular Catheters in Indian Intensive Care Units. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Mathew J, Singhi S, Ray P, Chadha M, Gautam V, Ravi Kumar B, Nilsson A. Community Acquired Pneumonia Etiology Study (CAPES): Experience of over 4000 cases from a single centre in India. Int J Infect Dis 2018. [PMCID: PMC7129591 DOI: 10.1016/j.ijid.2018.04.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Mathew J, Keerthivasan S, Agarwal A, Sarkar S, Ratho R, Gautam V, Singhi S, Dutta S, Nilsson A. Prospective study of timing and pattern of bacteria and viruses in the nasopharyngeal microbiome in a birth cohort. Int J Infect Dis 2018. [PMCID: PMC7129185 DOI: 10.1016/j.ijid.2018.04.4155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Singhi S, Sullivan S, Singhi R. 0526 Monitoring Of Long Term Compliance Of Positive Airway Pressure By A Dedicated Sleep Team In Patients With Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Singhi
- Carolina Cardiology Associates, Rock Hill, SC
| | - S Sullivan
- Carolina Cardiology Associates, Rock Hill, SC
| | - R Singhi
- Department of Endocrinology, University of South Carolina School of Medicine, Columbia, SC
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Dhochak N, Jayashree M, Singhi S. A randomized controlled trial of one bag vs. two bag system of fluid delivery in children with diabetic ketoacidosis: Experience from a developing country. J Crit Care 2017; 43:340-345. [PMID: 29066219 DOI: 10.1016/j.jcrc.2017.09.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/16/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare one vs. two bag system with respect to blood glucose variability (BGV), time for resolution of acidosis and incidence of hypoglycemia, hypokalemia, and cerebral edema in children with diabetic ketoacidosis (DKA). MATERIAL AND METHODS In an open labelled randomized controlled trial, thirty consecutive patients ≤12years with DKA were randomized to either one (n=15) or two bag (n=15) system of intravenous fluid delivery. The two bags had similar electrolyte but differing dextrose concentration (none vs. 12.5%) and changing the rate of fluid, delivered different dextrose concentrations. BGV was primary outcome while hypoglycemia (blood glucose, BG<50mg/dL), hypokalemia (serum potassium<3.5mEq/L), time to resolution of acidosis and cerebral edema were secondary outcomes. RESULTS The one and two bag systems had similar BGV parameters; median hourly absolute BG change (mg/dL) [44 (30-74.5) vs. 36 (31-49); p=0.54], mean of standard deviation of BG measurements [65.1 (25.1) vs. 65.5 (26.8); p=0.96] and median number of undesirable events (hourly blood sugar change ≥50mg/dL) [4.5 (1.75-6.0) vs. 5.0 (3.0-8.0); p=0.31]. The incidence of hypoglycemia [42.9% (n=6) vs. 26.7% (n=4); p=0.45] and hypokalemia [64% (n=9) vs. 67% (n=10); p=0.23], and mean (SD) time to resolution of acidosis [20.3 (14.8) and 20.3 (7.0); p=0.59] were similar in both the groups. None had cerebral edema. CONCLUSIONS The one and two bag systems were similar to each other with respect to BGV, incidence of complications and time to resolution of acidosis.
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Affiliation(s)
- N Dhochak
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - M Jayashree
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - S Singhi
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Biswal M, Kumar A, Sharma N, Bhalla A, Singhi S, Sethi S. Genetic diversity of Orientia tsutsugamushi strains from patients in North India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chakrabarti A, Rudramurthy S, Kale P, Hariprasath P, Dhaliwal M, Singhi S, Rao K. Epidemiological study of a large cluster of fungaemia cases due to Kodamaea ohmeri in an Indian tertiary care centre. Clin Microbiol Infect 2014; 20:O83-9. [DOI: 10.1111/1469-0691.12337] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/03/2013] [Accepted: 07/12/2013] [Indexed: 11/27/2022]
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Bhagwati AM, Singhi S, Ramachandran B, Ramakrishnan N, Gopalakrishnan R, Kamat VN, Nagaraja P, Prayag S, Todi S. Guidelines for the Prevention of Infections Associated with the Use of Vascular Catheters in Indian Intensive Care Units. Indian J Crit Care Med 2013. [DOI: 10.5005/ijccm-17-5-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Singh MK, Sachdeva N, Singhi S, Attri SV, Jayashree M, Bhalla AK. Vitamin D levels during and after resolution of ketoacidosis in children with new onset Type 1 diabetes. Diabet Med 2013; 30:829-34. [PMID: 23692346 DOI: 10.1111/dme.12200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2013] [Indexed: 12/13/2022]
Abstract
AIM To study the effect of ketoacidosis on measured 25-hydroxyvitamin D3 in children with new onset Type 1 diabetes. METHODS Measurement of pH and bicarbonate levels was carried out in children with newly diagnosed Type 1 diabetes at presentation with ketoacidosis. 25-hydroxyvitamin D3 estimation was carried out at presentation (timepoint 1) and 1 month later (timepoint 2). There was no significant difference in the mean (±sd) 25-hydroxyvitamin D3 levels [35.39 (±25.79) vs 39.63 (±48.03) nmol/L; P = 0.661) at the two timepoints in the study. RESULTS Correlation analysis revealed a positive correlation between bicarbonate levels and timepoint 1, i.e. the lower the bicarbonate levels, the lower were the timepoint 1 levels and vice versa (correlation coefficient 0.538, P = 0.001). Timepoint 2 levels also showed a positive correlation with serum bicarbonate levels with a correlation coefficient of 0.379 (P = 0.032). None of the variables other than bicarbonate,.(age, gender, BMI, pH or time), was found to have the predictive ability for timepoint1 levels. Similarly for predicting timepoint 2 levels, BMI was found to have independent predictive ability in addition to bicarbonate. CONCLUSIONS Severe ketoacidosis, as judged by bicarbonate but not pH, may transiently lower 25-hydroxyvitamin D3 levels in children with new onset Type 1 diabetes. Persistence of low 25-hydroxyvitamin D3 levels after resolution of ketoacidosis suggests a state of permanent vitamin D deficiency in our patient population.
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Abstract
18F-Fluoro-deoxyglucose–positron emission tomography/computed tomography findings in a case presenting with pyomyositis are presented in this report.
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Affiliation(s)
- C N B Harisankar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sasidaran K, Singhi S, Jaishree M, Bansal A. Emergence of carbapenem resistance in Gram-negative nosocomial bloodstream infections among critically ill children? A single-center experience. Crit Care 2012. [PMCID: PMC3504889 DOI: 10.1186/cc11775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sasidaran K, Jaishree M, Singhi S. Do we still accept central venous pressure measurements to assess preload responsiveness in children with septic shock? A single-center experience. Crit Care 2012. [PMCID: PMC3504888 DOI: 10.1186/cc11774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pinto PS, Tekes A, Singhi S, Northington FJ, Parkinson C, Huisman TAGM. White-gray matter echogenicity ratio and resistive index: sonographic bedside markers of cerebral hypoxic-ischemic injury/edema? J Perinatol 2012; 32:448-53. [PMID: 21869766 PMCID: PMC4000312 DOI: 10.1038/jp.2011.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Head ultrasonography (HUS) is a reliable and easy to perform bedside imaging technique that can give valuable information about degree of brain injury/edema after perinatal asphyxia in term neonates. The goals of our study were to determine whether semiquantitative markers such as standardized white matter/gray matter (WM/GM) echogenicity ratio and resistive index (RI) value measured by HUS differs between asphyxiated term neonates and healthy controls. STUDY DESIGN Thirty-one carefully selected term neonates who suffered from perinatal hypoxic-ischemic encephalopathy (HIE) were included in the study. The ratio of the WM/GM echogenicity of the cingulate gyrus was calculated. In addition, the RI value was measured in the anterior cerebral artery. US scalars were compared with 11 healthy neonates. RESULT WM/GM ratio is significantly increased and RI value significantly decreased in asphyxiated term neonates compared with healthy subjects. CONCLUSION WM/GM ratio and RI value allows discriminating between asphyxiated neonates and healthy subjects. These US scalars may serve as valuable, easy to acquire semiquantitative bedside markers of brain HIE, when magnetic resonance imaging is unavailable or cannot be performed in the acute setting.
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Affiliation(s)
- PS Pinto
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A Tekes
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA,Neuro Intensive Care Nursery Program, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - S Singhi
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - FJ Northington
- Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Neuro Intensive Care Nursery Program, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - C Parkinson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Neuro Intensive Care Nursery Program, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - TAGM Huisman
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA,Neuro Intensive Care Nursery Program, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Sasidaran K, Jaishree M, Singhi S, Manoj R. Transthoracic echocardiographic assessment of IVC diameter variability to determine fluid responsiveness in children with septic shock: a pilot study. Crit Care 2012. [PMCID: PMC3504887 DOI: 10.1186/cc11773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mathew PJ, Mathew JL, Singhi S. Knowledge, attitude and practice of pediatric critical care nurses towards pain: survey in a developing country setting. J Postgrad Med 2012; 57:196-200. [PMID: 21941056 DOI: 10.4103/0022-3859.85203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Nurses' knowledge, sensitivity and attitudes about pain in children and its management affect their response and therefore management of pediatric pain. Children in critical care units undergo more painful procedures than those in general wards. AIMS To study the knowledge, attitude and practice of nursing personnel catering to critically ill children in a developing country. SETTINGS AND DESIGN Prospective questionnaire-based survey. MATERIALS AND METHODS The survey was carried out in a tertiary care teaching hospital on nursing personnel in three pediatric/neonatal intensive care units. The domains studied were: i. Training and experience, ii. Knowledge of pediatric pain, iii. Individual attitude towards pain in children, iv. Personal practice(s) for pain alleviation, v. Pain assessment, and vi. Non-pharmacological measures adopted. STATISTICAL ANALYSIS Descriptive statistics and logistic regression. RESULTS Of the 81 nursing personnel working in the three critical care units, 56 (69.1%) responded to the questionnaire. Only one-third of them had received formal training in pediatric nursing. Fifty percent of the respondents felt that infants perceive less pain than adults. Training in pediatric nursing was a significant contributing factor in the domain of knowledge (P=0.03). Restraint and distraction were the common modalities employed to facilitate painful procedures. Scientific approaches like eutectic mixture of local anesthetic and the judicious use of sedatives were not adopted routinely. Observing a child's face and posture were widely used parameters to assess pain (83%). None of the three critical care areas used a scoring system to assess pain. CONCLUSIONS There are several lacunae in the knowledge and practice of nurses in developing countries which need to be improved by training.
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Affiliation(s)
- P J Mathew
- Department of Anesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
BACKGROUND Acute poisoning in children is a medical emergency and preventable cause of morbidity and mortality. Knowledge about the nature, magnitude, outcome and predictors of outcome is necessary for management and allocation of scant resources. METHODS This is a retrospective study conducted in the Pediatric Intensive Care Unit (PICU) of an urban multi speciality teaching and referral hospital in North India from January 1993 to June 2008 to determine the epidemiology, clinical profile, outcome and predictors of outcome in children with acute poisoning. Data of 225 children with acute poisoning was retrieved from case records with respect to demographic profile, time to presentation, PRISM score, clinical features, investigations, therapeutic measures, complications and outcome in terms of survival or death. Survivors and non-survivors were compared to determine the predictors of mortality. RESULTS Acute poisoning constituted 3.9% of total PICU admissions; almost all (96.9%) were accidental. The mean age of study patient's was 3.3 ± 3.1 (range 0.10-12) years with majority (61.3%) being toddlers (1-3 years). In the overall cohort, kerosene (27.1%) and prescription drugs (26.7%) were the most common causative agents followed by organophosphates (16.0%), corrosives (7.6%), carbamates (4.9%) and aluminum phosphide (4.9%). However the trends of the three 5-year interval (1993 till the end of 1997, 1998 till the end of 2002 and 2003 till the end of June 2008) revealed a significant decrease in kerosene, aluminum phosphide and iron with increase in organophosphate compound poisoning. Ninety nine (44%) patients required supplemental oxygen, of which nearly half (n = 42; 42.4%) needed mechanical ventilation. Twenty (8.9%) died; cause of death being iron poisoning in five; aluminum phosphide in four; organophosphates in three and one each because of kerosene, diesel, carbamate, corrosive, sewing machine lubricant, isoniazid, salicylate and maduramycin poisoning. There has been a significant decrease in the mortality over the years. The non-survivors were older, had a higher PRISM score and hypotension at admission and higher need for oxygen and ventilation. On multiple logistic regression analysis hypotension at admission was the most significant predictor of death (adjusted odds ratio: 5.59; 95% confidence interval: 1.38-22.63; p = 0.016). CONCLUSION Acute poisoning in children over the past 15 years has shown a changing trend with significant decrease in kerosene, iron and aluminum phosphide and an increase in organophosphate and prescription drugs. The overall mortality has decreased significantly. Hypotension at admission was the most significant predictor of death.
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Affiliation(s)
- M Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Meoded A, Singhi S, Poretti A, Eran A, Tekes A, Huisman TAGM. Tectorial membrane injury: frequently overlooked in pediatric traumatic head injury. AJNR Am J Neuroradiol 2011; 32:1806-11. [PMID: 21852371 DOI: 10.3174/ajnr.a2606] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
REHs and tectorial membrane injuries are rare complications of pediatric head and neck injuries. We aim to describe the neuroimaging findings in pediatric REHs, to summarize the mechanism of injury, and to correlate the imaging findings with the clinical presentation. We retrospectively evaluated CT and/or MR imaging studies of 10 children with traumatic REH. Most patients were involved in MVAs. The tectorial membrane was injured in 70% of patients, and REHs were medium to large in 80%. None of the patients had a focal spinal cord or brain stem injury, craniocervical junction dislocation, or vertebral fractures. Tectorial membrane disruption was diagnosed in most patients without craniocervical junction-related symptoms. Tectorial membrane lesions and REHs were seen in young children who sustained high-speed head and neck injuries. Clinical symptoms may be minimal or misleading. The radiologist should be aware of these injuries in children. MR imaging appears to be more sensitive than CT.
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Affiliation(s)
- A Meoded
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Poretti A, Singhi S, Huisman TAGM, Meoded A, Jallo G, Ozturk A, Boltshauser E, Tekes A. Tecto-cerebellar dysraphism with occipital encephalocele: not a distinct disorder, but part of the Joubert syndrome spectrum? Neuropediatrics 2011; 42:170-4. [PMID: 21932183 DOI: 10.1055/s-0031-1287763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) findings in a 4-year-old child with occipital encephalocele, cerebellar vermis hypogenesis, and tectal malformation are presented. The neuroimaging findings are reminiscent of tectocerebellar dysraphism with an occipital encephalocele (TCD-OE). Additionally, elongated, thickened, and horizontally orientated superior cerebellar peduncles, an abnormally deepened interpeduncular fossa, subependymal heterotopia, and focal cortical dysplasia were noted. Color-coded fractional anisotropy (FA) maps revealed an absence of the decussation of the superior cerebellar peduncles. These findings are highly suggestive of Joubert syndrome and related disorders (JSRD). Our report and the review of the published cases suggest that TCD-OE is not a nosological entity, but may represent the structural manifestation of heterogeneous disorders such as the JSRD spectrum. DTI may be very helpful to differentiate between similar midbrain-hindbrain malformations.
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Affiliation(s)
- A Poretti
- Division of Pediatric Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Singhi S, Ishman S, Oaks J, Huisman T. Inferior pontine segmentation abnormality in a child with sensorineural deafness: DTI analysis of fiber tracts. J Neuroradiol 2011; 38:62-5. [DOI: 10.1016/j.neurad.2010.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 03/20/2010] [Accepted: 03/25/2010] [Indexed: 11/30/2022]
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Taneja N, Chander B, Singh G, Pahil S, Singhi S, Sharma S. P29.38 Hospital acquired diarrhoea in paediatric patients: a prospective case-controlled study in a tertiary care referral hospital in North India. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhattacharya S, Khurana S, Bhatti HS, Singhi S, Malla N. Polyparasitism: Fasciolopsis buski, Ascaris lumbricoides and discussion Hookworm coinfection in a child. Trop Gastroenterol 2010; 31:126-127. [PMID: 20862994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- S Bhattacharya
- Department of Parasitology and Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
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Singhi S. Effective Adjuvant Therapies for Meningitis. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.2230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chakrabarti A, Chatterjee SS, Das A, Panda N, Shivaprakash MR, Kaur A, Varma SC, Singhi S, Bhansali A, Sakhuja V. Invasive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J 2009; 85:573-81. [DOI: 10.1136/pgmj.2008.076463] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sinha A, Jayashree M, Singhi S. Aerosolized L-epinephrine vs budesonide for post extubation stridor: a randomized controlled trial. Indian Pediatr 2009; 47:317-22. [PMID: 19736368 DOI: 10.1007/s13312-010-0060-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/24/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation stridor. STUDY DESIGN Randomized controlled trial. SETTING Pediatric intensive care unit (PICU) of a tertiary teaching and referral hospital. SUBJECTS Sixty two patients with a stridor score ?4 following extubation. INTERVENTION Patients were randomized to receive either aerosolized L-epinephrine (n=32) or budesonide (n =30). Respiratory rate, heart rate, stridor score, blood pressure and oxygen saturation were recorded from 0 min to 24 hours. OUTCOME MEASURES Stridor score remaining at >4, need for renebulization and reintubation between 20 min to 24 hours were primary outcome measures. Tachycardia (HR > normal for age), hypertension (BP >95th centile for age) and hypoxia (SpO2 < 92% for 5 min) were secondary outcome measures. RESULTS Both drugs showed a significant and comparable decline in the median (95% CI) stridor scores from baseline to 60 min [4 (4.10-4.50) to 2.00 (1.46-2.67) for budesonide vs 4 (4.12-5.00) to 2.00 (1.31 -2.75) for epinephrine]. At 2 hours, the stridor scores were significantly lower in the epinephrine as compared to budesonide group [0.00 (0.69-1.81) vs 3.00(1.75-3.32); P =0.02)]. However, the proportion of patients with stridor score >4 at any time between 20 min to 24 hrs (53.3% vs 53.1%; P=0.99), need for renebulization (40% vs 43.8%; P=0.76) and reintubation (20% vs 25%, P=0.638), and adverse effects were similar in both groups. CONCLUSIONS Both aerosolized L-epinephrine and budesonide were equally effective in their initial therapeutic response in post-extubation stridor. However, epinephrine showed a more sustained effect.
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Affiliation(s)
- A Sinha
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr 2009; 46:577-583. [PMID: 19430087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 08/28/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine occurrence of hyponatremia in critically ill children receiving conventional maintenance fluids (0.18% saline in 5% dextrose) and its relationship with electrolyte free water (EFW), sodium intake and natriuresis. DESIGN Prospective observational study. SETTING Pediatric Intensive Care Unit of a tertiary care teaching hospital. SUBJECTS Thirty eight patients, 3 months-12 years, consecutively admitted to PICU over 30 days. Main outcome measure was occurrence of hyponatremia (serum sodium < 130 mEq/L). Serum and urinary sodium, and osmolality were measured, and type and volume of intravenous fluids and total urine output were recorded 12 hourly. Daily intake of sodium and EFW, urinary sodium excretion and net balance of fluid and sodium were estimated from above. Data of hyponatremic and non-hyponatremic patients was compared using ANOVA, Mann-Whitney U, and Chi-square tests. RESULTS Fourteen episodes of hyponatremia were recorded in 12 patients over 397 patient days (3.5 episodes/100 patient days). Their mean (SD) serum sodium dropped from 139 (9.3) at admission to 128 (1.0) mEq/L, over a median interval of 3.5 days (range 1-15 days). Net fluid and sodium balance in hyponatremic patients did not differ significantly from non-hyponatremic patients. Within the hyponatremic group, sodium intake, urinary sodium and sodium balance were similar before and after the occurrence of hyponatremia, while total fluid (P=0.009) and EFW intake (P=0.001) were lower in the days preceding hyponatremia. CONCLUSIONS Fluid and sodium balance, magnitude of natriuresis and EFW intake alone did not explain occurrence of hyponatremia in critically ill children; contribution of other mechanisms needs to be studied.
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Affiliation(s)
- S Singhi
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Gupta M, Prinja S, Shekher S, Chakarborti A, Singh A, Singhi S, Kumar R. Feasibility of Pneumonia and Meningitis Surveillance in a District of Northern India. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Goyal R, Vashishta RK, Singhi S, Gill M. Extraventricular unusual glioma in a child with extensive myxoid change resembling chordoid glioma. J Clin Pathol 2007; 60:1294-5. [PMID: 17965223 DOI: 10.1136/jcp.2005.033548] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sankar J, Singhi P, Bansal A, Ray P, Singhi S. Role of dexamethasone and oral glycerol in reducing hearing and neurological sequelae in children with bacterial meningitis. Indian Pediatr 2007; 44:649-656. [PMID: 17921553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the efficacy of dexamethasone and oral glycerol in reducing hearing and neurological sequelae in children with acute bacterial meningitis (ABM). DESIGN Prospective double blind, placebo controlled randomized study. SETTING Pediatric services of a tertiary care teaching and referral hospital. SUBJECTS Children 2 months to 12 years with a diagnosis of acute bacterial meningitis admitted between June 2002 to September 2003. INTERVENTION Subjects were assigned randomly to receive dexamethasone, glycerol, dexamethasone+glycerol or placebo. Neurological and hearing impairment was assessed at discharge and after 1 month. RESULTS 58 children (48 boys, 10 girls), mean age 50.2 +/- 41.0 months, were studied. Twelve patients received dexamethasone, 13 glycerol, 20 dexamethasone + glycerol and 13 placebo. Bacterial etiology was ascertained in 24 patients: Streptococcus pneumoniae-10, H influenzae b-7, Staph. aureus-5 and others-2. Three (5.2%) children died during hospital stay and 55 survived. Seven (12%) patients had neurological sequelae (3 in glycerol, 3 in dexamethasone+glycerol, 1 in placebo group, P = 0.29), and 10 patients (17%) had hearing sequelae (2 in glycerol, 3 in dexamethasone, 2 dexamethasone + glycerol and 3 in placebo group, P = 0.68). CONCLUSION No significant difference was seen in neurological or hearing outcome with use of either glycerol or dexamethasone in children with acute bacterial meningitis.
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Affiliation(s)
- Jhuma Sankar
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Patra PK, Jayashree M, Singhi S, Ray P, Saxena AK. Nosocomial pneumonia in a pediatric intensive care unit. Indian Pediatr 2007; 44:511-518. [PMID: 17939179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence, risk factors and etiological agents of NP in a PICU, is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital, to determine the incidence, etiology and risk factors for NP. MATERIALS AND METHODS Patients admitted to the PICU, over a period of 1 year who had endotracheal (ET) intubation, were enrolled consecutively into the study. Demographic details were recorded at the time of inclusion. Diagnosis of NP was based on CDC criteria (1988). Semiquantiative assay of endotracheal aspirate (ETA) with a colony count of > 10(5) cfu/mL was taken as evidence of infection. Colonisation was defined as isolation of organism with <10(5) cfu/mL. Age, nutritional status, number and duration of intubations, duration of mechanical ventilation, sedation, nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis, were subjected to multiple regression analysis to determine the most important predictors of NP. RESULTS The study group comprised of 72 children with a median age of 3.7 years and boys: girls ratio of 1.9:1. Twenty two of 72 (30.5%) developed NP; the predominant isolates from ETA were Acinetobacter anitratus(12), Pseudomonas aeruginosa (5), Klebsiella sp(3) and Staphylococcus aureus and E.coli(1) each. Additionally 18(39%) had evidence of ET colonization, with Acinetobacter sp being the commonest 9(50%). Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP(OR 0.72, 95%CI 0.55-0.94). Overall mortality was 21%(15/72);7(47%)of these deaths were secondary to NP. CONCLUSIONS NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP.
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Affiliation(s)
- P K Patra
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Abstract
Bloodstream infections (BSI) are the commonest cause of nosocomial infections (NI) in PICU. Knowledge about their magnitude, risk factors and outcome are important in devising appropriate prevention and control measures. Our objective was to study the incidence, etiology, risk factors and outcome of primary BSI in PICU. A prospective cohort of 285 patients consecutively admitted to PICU from July 2003-04, having a stay of >48 h, were enrolled and monitored for BSI till discharge from ICU or death. Primary BSI was defined as per CDC criteria 1988. Data of patients with BSI was compared with those without BSI with respect to demographic details, PRISM III, primary diagnosis, nutritional status, device utilization and invasive procedures to identify risk factors for BSI. Variables significant on univariate analysis were subjected to multiple logistic regression analysis. Outcome was measured as length of PICU stay (LOS) and survival or death. There were 116 episodes of primary BSI in 86 (30%) patients; the incidence being 31.2 episodes/1000 patient days. The mean age of the patients with BSI was 3.7 +/- 3.5 years. Predominant isolates were Gram-negative (53.5%); Klebsiella pneumoniae (n = 21) being the commonest. Staphylococcus aureus (n = 18) was the most common Gram-positive organism. Seven of the 9 (77.8%) yeast isolates were Candida tropicalis. Younger age, higher PRISM III, lower hemoglobin, pre-existing infection, higher frequency and duration of device utilization (CVC, urinary catheter, endotracheal tube, mechanical ventilation) were significant risk factors on univariate analysis. On multiple logistic regressions, hemoglobin (OR 1.24, 95% CI 1.1-1.4, p = 0.002) duration of urinary catheter (OR 0.91, 95% CI 0.84-0.98, p = 0.015) and pre-existing infection (OR 0.46, 95% CI 0.23-0.93, p = 0.03) were independent risk factors for primary BSI. The median LOS was significantly longer in patients with BSI compared to those without (16 vs. 7 days, p = 0.0001) 47% of patients with BSI died as compared to 26% deaths in the whole cohort (p = 0.002). Just over half the cases of BSI in our PICU were caused by Gram-negative bacteria. Lower hemoglobin, pre-existing infection and prolonged duration of urinary catheter were independent risk factors identified on multivariate analysis. BSI was associated with significantly higher mortality and longer stay in our PICU.
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Affiliation(s)
- K S Lakshmi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
OBJECTIVE To find the clinical signs that are the best predictors of hypoxemia (SpO2 =92%) in acute asthma in children. METHODS Color of skin, dyspnea (by single breath counting), alertness, respiratory rate, presence of audible wheeze, wheezing on auscultation, accessory muscle use, nasal flaring, pulse rate, systolic and diastolic blood pressure, pulsus paradoxus and oxygen saturation at room air (by pulse oximetry) were recorded at the time of presentation and one hour after presentation after completion of 3 doses of nebulized salbutamol and budesonide. RESULTS Hypoxemia (SpO2 92% pounds sterling) was seen in 45% children at presentation and 14(28.6%) after one hour. The clinical signs that correlated significantly with hypoxemia at both time points were dyspnea assessed by single breath count (OR 3.3, 95% CI 0.9-12.9), accessory muscle use score > or = 3 (OR 3.0, 95% CI 0.9-15.4) and pulsus paradoxus> 10 (OR 3.0, 95% CI 0.7-13.6). In a multiple logistic regression model accessory muscle score > or = 3 and pulsus paradoxus> 10 were identified as independent predictors of hypoxemia (sensitivity 64.3%, specificity 91%). CONCLUSION Physical assessment in a child with acute exacerbation of asthma should at least include accessory muscle use and pulsus paradoxus, since these predict hypoxemia the best.
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Affiliation(s)
- M S Rahnama'i
- Department of General Practice, Maastricht University, The Netherlands
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Jayashree M, Singhi S, Gupta A. Predictors of outcome in children with hydrocarbon poisoning receiving intensive care. Indian Pediatr 2006; 43:715-9. [PMID: 16951435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The retrospective study included 48 children between 8.5 months--10 years, admitted to the PICU of an urban, tertiary care, teaching hospital in northern India from January 1995 to December 2001. Eighteen (38%) patients were hypoxemic on arrival, of which 8 (45%) required mechanical ventilation. Compared to the non-hypoxemic children, the hypoxemic patients were more likely to have received gastric lavage before arrival to our center (Odds Ratio 23.2, 95% CI 2.4 - 560.7) and had higher frequency of severe respiratory distress and leucocytosis (Odds Ratio 8.0, 95% CI 1.79 -38.6). On multiple regression analysis, we could not identify any particular variable that could predict hypoxemia. Secondary pneumonia developed in 16 (33.3%), with the duration of PICU stay being longer in these patients as against those who did not (144 hours vs 72 hours, p <0.05). Two (4.2%) children died and one suffered hypoxic sequelae. Prior lavage, hypoxemia at admission, need for ventilation, secondary sepsis and ventilator related complications were associated with poor outcome.
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Affiliation(s)
- M Jayashree
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Jayashree M, Shruthi N, Singhi S. Predictors of outcome in patients with diphtheria receiving intensive care. Indian Pediatr 2006; 43:155-60. [PMID: 16528112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Forty eight patients with a clinical diagnosis of diphtheria, admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care teaching hospital, from December 1994 to 2002, were analyzed retrospectively with respect to demographic details, clinical features, immunization status, complications and mortality. Several variables were compared among the survivors and non-survivors to define the predictors of outcome More than half 27 (56.3%). of the patients were unimmunized. Complications seen were: airway compromise 34 (70.8%), myocarditis 32 (66.6%), renal failure 17 (35.4%) and thrombocytopenia 15 (31.3%). Out of the 48 patients, 21 survived and 27 died (56.3%). The immediate cause of death was myocarditis 23 (85%), airway compromise 3 (11.1%) and septic shock due to nosocomial sepsis(1). Inadequate immunization, hypotension at admission and presence of any complication like airway compromise, myocarditis and renal failure had a significant (P <0.05) adverse effect on outcome; multiple regression analysis ascertained that, development of myocarditis was the only independent predictor of death (Adjusted OR 0.061; 95% CI 0.009-0.397; P = 0.003).
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Affiliation(s)
- M Jayashree
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Ray P, Sharma J, Marak RSK, Singhi S, Taneja N, Garg RK, Sharma M. Chromobacterium violaceum septicaemia from north India. Indian J Med Res 2004; 120:523-6. [PMID: 15654137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Though Chromobacterium violaceum is a common inhabitant of soil and water in tropical and sub-tropical regions, human infections are rare but when they do occur result in high mortality. Since the first case from Malaysia in 1927, about 150 cases have been reported in world literature. Till date 6 cases have been reported from southern and eastern parts of India. We report here a case of C. violaceum septicaemia, probably the first case from north India. The patient, a 6 and a half year old boy was admitted with high fever. The patient had anaemia, neutrophilic leucocytosis and bilateral chest infiltrates. Routine and bacteriological investigations were carried out to establish the aetiological diagnosis. C. violaceum was isolated in pure culture from blood and pus. The patient was successfully treated with ciprofloxacin and amikacin. This is probably the first documented case report of C. violaceum infection from north India and the only Indian case with septicaemia which survived.
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Affiliation(s)
- Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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Singhi S, Bharti B. Response to Duke et Al. Arch Dis Child 2003; 88:364-5; author reply 365. [PMID: 12651774 PMCID: PMC1719536 DOI: 10.1136/adc.88.4.364-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
UNLABELLED Posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible, encephalopathy with transient occipital lobe abnormalities detected on MRI that occur mostly in association with acute hypertension. The clinical presentation includes seizures, headache, altered mental status and blindness. Disturbed autoregulation of cerebral blood flow and endothelial injury are central to the pathogenesis of this disorder. Prompt control of hypertension results in rapid and complete neurological recovery. In this report we discuss the cases of two children with acute onset hypertension of different aetiologies that presented with the characteristic features of posterior leukoencephalopathy syndrome. CONCLUSION Early recognition of this readily treatable condition may obviate the need for extensive and invasive investigations. Despite the alarming lesions on the MRI, prompt control of hypertension carries a uniformly favourable prognosis.
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Affiliation(s)
- P Singhi
- Department of Pediatrics. Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Rao DSVR, Ghosh A, Singhi S, Chakrabarti A. Mannan antigen detection in the diagnosis of patients with invasive candidiasis. Indian J Med Res 2002; 116:13-20. [PMID: 12514973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND & OBJECTIVES With the increase in the incidence of invasive candidiasis (IC) in recent years, there is a need to improve the sensitivity of diagnosis. A conventional technique like blood culture is positive in nearly 50 per cent of cases. To improve the diagnostic efficiency in invasive candidiasis mannan antigen detection holds promise. Hence mannan antigen detection was evaluated in patients with suspected invasive candidiasis in the Paediatric Intensive Care Unit (PICU). METHODS A prospective study, involving 186 consecutive patients admitted to the PICU of the Advanced Paediatric Center at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh between March 1999 and November 1999 were followed up for possible invasive candidiasis. Sixty five children clinically suspected to have sepsis and at risk for developing IC and or who stayed in the hospital more than 5 days were further evaluated for the diagnosis of IC by collecting two blood culture samples 48 h apart and by mannan antigen and anti-mannan antibody detection. Both antigen and antibody were detected by in-house standardized techniques: antibody by whole cell agglutination (WCA) and antigen by sandwich enzyme linked immunosorbent assay (ELISA). RESULTS Twenty of 65 patients (30.7%) were positive by blood culture. Mannan antigen was positive in all 20 patients and significant anti-mannan antibody titre (> or = 128) was present in 12 (60%) patients. Mannan antigen was detected in 15 more patients, who were negative for isolation of Candida from blood. Twelve of these patients had febrile episode not responding to antibacterial therapy but responding to fluconazole/itraconazole therapy indicating that the patients possibly had IC. Mannan concentration was also found to be significantly higher in the patients with Candida isolated from blood. INTERPRETATION & CONCLUSION Thus, the present study confirms the earlier claim that mannan antigen detection possibly improves the diagnostic efficiency of IC.
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Affiliation(s)
- D S V Raman Rao
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Abstract
Acute bacterial meningitis (ABM) in children is associated with a high rate of acute complications and mortality, particularly in the developing countries. Most of the deaths occur during first 48 hours of hospitalization. Coma, raised intracranial pressure (ICP), seizures, shock have been identified as significant predictors of death and morbidity. This article reviews issues in critical care with reference to our experience of managing 88 children with ABM in PICU. Attention should first be directed toward basic ABCs of life-support. Children with Glasgow Coma Scale (GSC) score < 8 need intubation and supplemental oxygen. Antibiotics should be started, even without LP (contraindicated if focal neuro-deficit, papilledema, or signs of raised ICP). Raised ICP is present in most of patients; GCS < 8 and high blood pressure are good guides. Mannitol (0.25 gm/Kg) should be used in such patients. If there are signs of (impending) herniation short-term hyperventilation is recommended; prolonged hyperventilation (> 1 hour) must be avoided. Any evidence of poor perfusion, hypovolemia and/or hypotension needs aggressive treatment with normal saline boluses and inotropes, if necessary, to maintain normal blood pressure. Empiric fluid restriction is not justified. Seizures may be controlled with intravenous diazepam or lorazepam. Refractory status epilepticus may be treated with continuous diazepam (0.01-0.06) mg/kg/min) or midazolam infusion. Ventilatory support may be needed early for associated pneumonia, poor respiratory effort and/or coma, and occasionally to reduce work of breathing in shock. Provision of critical care to children with ABM may reduce the mortality significantly as experienced by us.
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Affiliation(s)
- S Singhi
- Pediatric Intensive Care Unit, Department of Pediatrics, Advance Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
Strangulation is a common method of committing murder, though underreported in Indian literature. We managed a girl child, victim of child abuse who later succumbed to its neurological complications. This case report describes the clinical features associated with such injuries and complications which should be anticipated in such cases.
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Affiliation(s)
- V Jain
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wairagkar NS, Shaikh NJ, Ratho RK, Ghosh D, Mahajan RC, Singhi S, Gadkari DA. Isolation of measles virus from cerebrospinal fluid of children with acute encephalopathy without rash. Indian Pediatr 2001; 38:589-95. [PMID: 11418724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine the viral agent involved in cases of acute encephalopathy in children during an outbreak in Northern India. DESIGN Virological and serological studies using serum and cerebrospinal fluid specimens from patients. METHODS Serum and CSF specimens were tested by IgM ELISA for IgM antibodies to variety of viruses like Japanese encephalitis, West Nile, Dengue and Measles. The specimens were inoculated into Vero cell monolayer for virus isolation. The viral strains isolated were identified by indirect immunofluorescence test and qualitative in-vitro neutralization test using polyclonal and monoclonal antibodies to measles. Identity of the isolates was reconfirmed using RT-PCR method. RESULTS Of the 28 specimens tested, 17 had IgM antibodies to measles. Commercial IgM ELISA kits confirmed the serological findings. Vero cell cultures yielded 4 isolates from CSF and 2 from serum specimens of six different patients. Cytopathic effect was typical of measles. Indirect imunofluorescence using polyclonal and monoclonal antibodies to measles HA protein, confirmed the measles etiology. Neutralization tests reconfirmed the measles strain isolation. RT-PCR amplified product was confirmed as measles. CONCLUSION The isolation of measles virus from CSF and serum of children with acute encephalopathy without rash proved the etiological role of measles virus in this outbreak.
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Affiliation(s)
- N S Wairagkar
- National Institute of Virology, 20-A, Ambedkar Road, Pune 411 001, India.
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Chakrabarti A, Singh K, Narang A, Singhi S, Batra R, Rao KL, Ray P, Gopalan S, Das S, Gupta V, Gupta AK, Bose SM, McNeil MM. Outbreak of Pichia anomala infection in the pediatric service of a tertiary-care center in Northern India. J Clin Microbiol 2001; 39:1702-6. [PMID: 11325977 PMCID: PMC88012 DOI: 10.1128/jcm.39.5.1702-1706.2001] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pediatric emergency ward, with subsequent transmission to the premature nursery, pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for dissemination of the fungus. The outbreak could only be controlled after a health education campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk infants was introduced. In a case-control study, we identified a lower gestational age, a very low birth weight (<1,500 g), and a longer duration of hospital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 consecutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these neonates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patient and health care workers' hand isolates), and the results suggested that these isolates were identical. Our study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Salaria M, Singhi S. Enteral nutrition for critically ill patients. Indian Pediatr 2001; 38:256-63. [PMID: 11255301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- M Salaria
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Abstract
Tetanus is an acute neurological disease characterized by muscle rigidity and spasms, autonomic dysfunction and in severe forms requires respiratory and hemodynamic support. Though it is entirely preventable by immunization, it still occurs in developing countries causing significant morbidity and mortality. Intensive care management of tetanus is fraught with problems of ventilator-associated pneumonia, nosocomial sepsis and a variety of other complications. Various treatment protocols have been tried in managing diverse manifestations of severe tetanus but the consensus is yet to emerge. In this review we have discussed the pathophysiology, clinical features and management controversies and suggest on basis of our experience use of high dose diazepam (20-120 mg/kg/day) and vecuronium with mechanical ventilation if required for control of spasms, and early detection of autonomic dysfunction and use of propranolol, in our circumstances.
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Affiliation(s)
- S Singhi
- Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
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Abstract
Neurocysticercosis is a major cause of neurologic illness worldwide. Its manifestations are variable, and somewhat different when it occurs in children. Controversy exists regarding anticysticercal therapy. The clinical, laboratory, and radiographic features of 500 consecutive children with neurocysticercosis were studied; the children were then followed prospectively and their response to albendazole therapy was analyzed. Diagnosis of neurocysticercosis was based primarily on neuroimaging. Computed tomographic (CT) scans, neurocysticercosis serology, chest radiographs, and Mantoux tests were done in all children, and magnetic resonance imaging scans in 10%. All children with multiple lesions, and some randomly allocated children with single, small, enhancing CT lesions received albendazole. CT scans were repeated after 3 to 6 months. There were 272 boys and 228 girls, age range 1 6/12 to 12 6/12 years. Seizures were present in 94.8% of cases; 83.7% had focal seizures. Features of raised intracranial pressure were seen in 30% of patients and focal neurodeficit in 4%. Single lesions were seen in 76% of the children, with perilesional edema in 57.4%. Thirty-four children who had multiple cysts and received albendazole underwent serial CT evaluation. Four showed disappearance of lesions and 22 had reductions in the size or number, to give an overall improvement rate of 76%. Serial CT studies were available on 176 children with single lesions, 90 of whom received albendazole. Improvement (disappearance or reduction in the size of lesions) was observed in 91% (82 of 90) of albendazole-treated children versus 85% (73 of 86) of untreated children. This difference was not significant. No significant side-effects of albendazole were reported. These data indicate that partial seizures and single parenchymal cysts are the most frequent clinical and neuroradiographic manifestations of neurocysticercosis in children. Although albendazole therapy should be considered, especially in children with multiple lesions, many children with isolated neurocysticercosis will improve without antiparasitic therapy.
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Affiliation(s)
- P Singhi
- Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
OBJECTIVE To evaluate the respiratory rate as an indicator of hypoxia in infants < 2 months of age. SETTING Pediatric emergency unit of an urban teaching hospital. SUBJECTS 200 infants < 2 months, with symptom(s) of any acute illness. METHODS Respiratory rate (by observation method), and oxygen saturation (SaO(2)) by means of a pulse oximeter were recorded at admission. Infants were categorised by presence or absence of hypoxia (SaO(2) </= 90%). RESULTS The respiratory rate was >/= 50/min in 120 (60%), >/= 60/min in 101 (50. 5%), and >/= 70/min in 58 (29%) infants. Hypoxia (SaO(2) </= 90%) was seen in 77 (38.5%) infants. Respiratory rate and SaO(2) showed a significant negative correlation (r = -0.39). Respiratory rate >/= 60/min predicted hypoxia with 80% sensitivity and 68% specificity. CONCLUSION These results indicates that a respiratory rate > 60/min is a good predictor of hypoxia in infants under 2 months of age brought to the emergency service of an urban hospital for any symptom(s) of acute illness.
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Affiliation(s)
- V T Rajesh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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47
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Abstract
OBJECTIVE To evaluate the efficacy of aerosolized budesonide therapy (with metered dose inhaler and spacer) early in the emergency room treatment of acute moderate exacerbations of bronchial asthma in children. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING Paediatric Emergency Service of an urban teaching hospital and a tertiary case referral centre. STUDY POPULATION Sixty children between 3 and 12 years of age with an acute moderate exacerbation of asthma. INTERVENTION All patients received humidified oxygen (5-8 L/min by Venturi(R) mask; Hudson Respiratory Care, Temecula, CA, USA), nebulized salbutamol (0.15 mg/kg in 3 mL saline) and were randomized to receive either budesonide (400 microg) or placebo inhalation (MDI and spacer) at half hourly intervals for three doses. If there was an inadequate response or no response to treatment at the end of 2 h, oxygen and salbutamol therapy were continued and the patient was given one of dose intravenous hydrocortisone and was started on an aminophylline infusion. If there was no response at the end of a further 4 h, the patient was hospitalized. INITIAL EVALUATION AND MONITORING: Colour, respiratory rate (RR), heart rate, accessory muscle usage, chest retraction, wheeze, oxygen saturation (by pulse oximetery) and peak expiratory flow rate (PEFR) was recorded at admission and thereafter at hourly intervals for 3 h or until till the child recovered. The need for oxygen therapy after 2 h and need for hospitalization were recorded. MAIN RESULTS Both groups showed a significant improvement in respiratory status at the end of 2 h. However, children in the intervention group showed greater improvements in RR and PEFR (P < 0. 05) and respiratory distress score (P < 0.1). A significantly lower proportion of the intervention group patients required oxygen therapy for more than 2 h (23% vs 50%; P < 0.05) and aminophylline infusion and systemic corticosteroid therapy (7% vs 27%; P < 0.05). None of the children in the budesonide group, in contrast to 23% of those in the placebo group, required hospitalization (P < 0.05). The length of hospital stay (i.e. time taken to recover from acute asthma) was significantly shorter in the intervention group (3.2 +/- 2.5 h) than in the placebo group (7.8 +/- 11.3 h; P < 0.01). CONCLUSION Aerosolized budesonide therapy (with MDI and spacer) together with nebulized salbutamol early in the emergency room treatment of acute moderate exacerbations of asthma helped in early recovery and decreased the need for hospitalization. It may be worthwhile calculating this regimen for home-based early treatment of acute exacerbations.
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Affiliation(s)
- S Singhi
- Paediatric Emergency and Intensive Care Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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48
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Abstract
To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15 mg/kg) and placebo at half-hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 microg) at half-hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.
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49
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Singhi S. Management of shock. Indian Pediatr 1999; 36:265-88. [PMID: 10713840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
MESH Headings
- Child
- Child, Preschool
- Combined Modality Therapy
- Female
- Humans
- Infant
- Male
- Prognosis
- Shock/diagnosis
- Shock/mortality
- Shock/therapy
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/mortality
- Shock, Cardiogenic/therapy
- Shock, Hemorrhagic/diagnosis
- Shock, Hemorrhagic/mortality
- Shock, Hemorrhagic/therapy
- Shock, Septic/diagnosis
- Shock, Septic/mortality
- Shock, Septic/therapy
- Survival Rate
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Affiliation(s)
- S Singhi
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Eeducation and Research, Chandigarh 160 012, India.
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50
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Singh Y, Samujh R, Narasimhan KL, Rao KL, Jayashree M, Singhi S. Amebic abscess of both liver lobes: simultaneous rupture into pleura and stomach. Indian Pediatr 1999; 36:190-2. [PMID: 10713818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Y Singh
- Department of Pediatric Surgery and Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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