Kamran Afzal - Academia.edu (original) (raw)
Papers by Kamran Afzal
PubMed, Apr 1, 2015
The recent report by Shamim, et al. [1] brings out the most common and continued problem encounte... more The recent report by Shamim, et al. [1] brings out the most common and continued problem encountered in pediatric intensive care units. Research has proved that using isotonic fluids as maintenance fluids in sick children results in fewer hyponatremic episodes compared to hypotonic fluids [2,3]. However, there are few issues:
Coryneforms have emerged as important pathogens causing severe human infections in immunosuppress... more Coryneforms have emerged as important pathogens causing severe human infections in immunosuppressed patients. However, it is increasingly being perceived that the pathogenic potential of Coryneform bacteria is being underestimated and it is not limited to merely this group of patients. These organisms are reported to cause serious infections such as bacteremia, valvular endocarditis, neurosurgical shunt infections, meningitis, brain abscess, peritonitis, osteomyelitis, septic arthritis, pneumonia, empyema and urinary tract infections. The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh, INDIA for a period of eight months from August 2007 to March 2008. All the patients in the study were divided into two groups: (i) Immunocompromised (ii) Immunocompetent. Direct microscopic examination was done by Gram staining, followed by culture. All the isolated Coryneform species were subjected to antimicrobial susceptibility testing using Kirby bauer disc diffusion method on Mueller Hinton agar incorporated with 5% sheep blood. A total of 2508 samples (68.6%) showed growth on culture. Coryneforms were isolated and considered as pathogens in 5.5% samples. Monomicrobial infection of Corynebcaterium species was more common (69.1%) with surgical site infection (27.3%) as the commonest presentation. Coryneforms isolates from the immunocompetent patients accounted for 98(70.5%) isolates, whereas 41(29.5%) isolates were from patients with an immunocompromised status. C. minutissimum was the commonest Coryneform isolated in both the groups. The other Coryneform species isolated were C. jeikium, Microbacterium species, C. xerosis, C. striatum, C. urealyticum, C. afermentans, C. amycolatum and C. ulcerans. Alarmingly widespread antibiotic resistance was observed among most of the Coryneforms. The average sensitivity of the-lactam antimicrobials being just 55% and the aminoglycosides even less than 50% (48%). Only 67(47.5%) strains were sensitive to flouroquinolones. Linezolid was the only antimicrobial to which all the Coryneform isolates included in this study were uniformly sensitive. This study highlights the need for maintaining a high degree of suspicion as far as Coryneform infections are concerned. They should not be dismissed as skin commensals in immunocompetent patients without determining their clinical relevance. Sensitizing clinicians about these emerging pathogens and their multidrug resistant nature is also essential.
PubMed, Jun 1, 2004
This prospective study was carried out in the pediatric ward and outpatient department of a terti... more This prospective study was carried out in the pediatric ward and outpatient department of a tertiary care centre to estimate the prevalence of HIV seropositivity in children with tuberculosis. Two hundred and fifty consecutive children below 12 years of age with (pulmonary and extrapulmonary) tuberculosis diagnosed between March 1999 and July 2000 were screened for HIV infection. A patient was labeled as HIV positive if two consecutive ELISA tests were found positive using different antigen/principle. Supplemental western blot test was also done. Parents of seropositive children were also screened for HIV infection and tuberculosis. Total 5 cases were HIV positive giving a seroprevalence of 2%. All the five patients had disseminated tuberculosis. We suggest regular screening of children with disseminated/miliary tuberculosis for HIV co-infection.
PubMed, Sep 1, 2000
Objective: To compare the safety and efficacy of a hyposmolar oral rehydration solution (H-ORS) (... more Objective: To compare the safety and efficacy of a hyposmolar oral rehydration solution (H-ORS) (245 mmol/liter) with the World Health Organization oral rehydration solution (WHO ORS) in cholera and acute non-cholera diarrhea. Design: Controlled clinical trial. Setting: Diarrhea training and treatment unit. Methods: Thirty-five culture proven cholera and 135 acute non-cholera diarrheal patients randomly received H-ORS or WHO-ORS. Intake and output were measured every 4 hours. Results: Analysis of the total cases revealed rehydration phase (p=0.048, 95% CI 0.64-0.99) and overall (p=0.046, 95% CI 0.70-0.99) frequency of stools to be significantly less in the H-ORS group. In the severely malnourished, the rehydration phase (p=0.032, 95% CI 0.55-97), maintenance phase (p=0.035, 95% CI 0.51-0.97) and overall (p=0.011; 0.95% CI 0.55-0.93) stool frequency were significantly decreased in the H-ORS group. The amount of ORS consumed in the maintenance phase of the cholera cases was significantly (p=0.04, 95% CI 0.44-0.98) less in the H-ORS group. All other parameters, despite showing a decreasing trend, were statistically comparable in the cholera, non-cholera and total cases. The amount of intravenous fluid needed was significantly more in the noncholera and total cases on H-ORS. In the non-breastfed cases, under two years of age, the total duration of diarrhea was significantly decreased (p=0.03; 95% CI 11.07-11.45) but the need for intravenous fluids significantly increased (p=0.02; 95% CI 109.8-112.1) in the H-ORS group. The proportion of children vomiting, the weight gain, urine passed in 24 hours, serum sodium, caloric intake and failure rate were comparable. Conclusions: H-ORS is as safe and effective as the WHO-ORS and may have some additional benefits in malnourished children.
Journal of Pediatric Gastroenterology and Nutrition, Aug 1, 1998
PubMed, 2013
Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recog... more Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies, the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis and intervention.
Current Pediatric Research, 2016
Malaria is associated with severe neurological complication especially by Plasmodium falciparum. ... more Malaria is associated with severe neurological complication especially by Plasmodium falciparum. We report a case of acute malaria in a seven year old boy presenting with features of psychosis as the primary presenting complaint, with absence of fever or concomitant drug intake before arrival. Peripheral blood smear of patient subsequently revealed Plasmodium vivax [ring and trophozoite stage] as he was investigated further when febrile spikes appeared. Malaria is associated with severe neurological complications especially by P. falciparum. We report a case of acute malaria in a seven year old boy presenting with features of psychosis as the initial presenting complaint, without history of fever or concomitant drug intake before arrival. Peripheral blood smear revealed P. vivax [ring and trophozoite stage].
Coryneforms have emerged as important pathogens causing severe human infections in immunosuppress... more Coryneforms have emerged as important pathogens causing severe human infections in immunosuppressed patients. However, it is increasingly being perceived that the pathogenic potential of Coryneform bacteria is being underestimated and it is not limited to merely this group of patients. These organisms are reported to cause serious infections such as bacteremia, valvular endocarditis, neurosurgical shunt infections, meningitis, brain abscess, peritonitis, osteomyelitis, septic arthritis, pneumonia, empyema and urinary tract infections. The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh, INDIA for a period of eight months from August 2007 to March 2008. All the patients in the study were divided into two groups: (i) Immunocompromised (ii) Immunocompetent. Direct microscopic examination was done by Gram staining, followed by culture. All the isolated Coryneform species were subjected to antimicrobial susceptibility testing using Kirby bauer disc diffusion method on Mueller Hinton agar incorporated with 5% sheep blood. A total of 2508 samples (68.6%) showed growth on culture. Coryneforms were isolated and considered as pathogens in 5.5% samples. Monomicrobial infection of Corynebcaterium species was more common (69.1%) with surgical site infection (27.3%) as the commonest presentation. Coryneforms isolates from the immunocompetent patients accounted for 98(70.5%) isolates, whereas 41(29.5%) isolates were from patients with an immunocompromised status. C. minutissimum was the commonest Coryneform isolated in both the groups. The other Coryneform species isolated were C. jeikium, Microbacterium species, C. xerosis, C. striatum, C. urealyticum, C. afermentans, C. amycolatum and C. ulcerans. Alarmingly widespread antibiotic resistance was observed among most of the Coryneforms. The average sensitivity of the-lactam antimicrobials being just 55% and the aminoglycosides even less than 50% (48%). Only 67(47.5%) strains were sensitive to flouroquinolones. Linezolid was the only antimicrobial to which all the Coryneform isolates included in this study were uniformly sensitive. This study highlights the need for maintaining a high degree of suspicion as far as Coryneform infections are concerned. They should not be dismissed as skin commensals in immunocompetent patients without determining their clinical relevance. Sensitizing clinicians about these emerging pathogens and their multidrug resistant nature is also essential.
Indian Journal of Pediatrics, Nov 1, 2004
Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in ... more Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age. Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. <1, 1-4, 5-9 and 10-14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA. Results: Overall 4.35% (95%CI, 2.44-6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1-4 year age category. In the <1, 5-9 and 10-14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577). Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44-6.25). The prevalence progressively increases and peaks in the 1-4 years age group. It is least in 10-14 years age group.
Indian Journal of Pediatrics
![Research paper thumbnail of Incidence, Risk Factors, and Outcomes of Neonatal Acute Kidney Injury: Protocol of a Multicentric Prospective Cohort Study [The Indian Iconic Neonatal Kidney Educational Registry]](https://attachments.academia-assets.com/82824053/thumbnails/1.jpg)
](Frontiers in Pediatrics, 2021
Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is s... more Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries. Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily p...
Indian Journal of Nephrology, 2004
Introduction: This study was performed in a tertiary level teaching hospital to evaluate the role... more Introduction: This study was performed in a tertiary level teaching hospital to evaluate the role of renal ultrasound (US) and serum levels of C-reactive protein (CRP) in differentiating upper from lower urinary tract infections (UTI). Subjects & Methods: A total of 75 children upto 12 years of age, with symptomatic culture positive first episode of UTI were compared with 30 age and sex matched, healthy children. Patients were categorized into upper (UUTI) and lower UTI (LUTI) based on clinical and laboratory parameters. There were 34 cases with UUTI and 41 with LUTI. Serum CRP and renal US were performed in all cases. Results: Levels of CRP were significantly higher in patients of upper UTI (13.9 ± 8 ìg/mL) than those with lower UTI (1.2 ± 2.3 ìg/mL), P<0.001. Follow up estimation showed a mean decline in CRP of 21ìg/mL in upper UTI within 1-2 weeks of antibiotic therapy. On US mean volume of larger kidney in patients of upper UTI (184.4 ± 55.8%) was more than those with lower U...
International Journal of Approximate Reasoning, 2021
Emerging viruses causing Acute Encephalitis Syndrome (AES) can be more damaging due to irreversib... more Emerging viruses causing Acute Encephalitis Syndrome (AES) can be more damaging due to irreversible brain damage, irrespective of the identical medical characteristics created by all agents. We report two cases of acute encephalitis syndrome caused by Japanese encephalitis virus from a usually under-reported geographic region of India. Both patients were managed conservatively with favourable outcome in one of them.There should be considerable effort to identify the particular causative agent that triggers AES, bearing in mind the various clinical manifestations of Japanese encephalitis virus. Although there is no significant impact on management, it is possible to prevent transmission to healthy contacts and the community through vector control and vaccination.
Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part ofthe ... more Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part ofthe normal human oral and upper respiratory tract flora. Although traditionally believed to be anorganism of low virulence, Stomatococcus mucilaginosus has been reported to be anopportunistic pathogen in immunocompromised patients. We describe what we believe is the firstreported case of Stomatococcus mucilaginosus meningitis in a healthy child. The isolate wasmultidrug-resistant, susceptible only to vancomycin. The patient was treated successfully withvancomycin after initial trials with amikacin and cefotaxime.
INDIAN PEDIATRICS 76 VOLUME 43__JANUARY 17, 2006 Familial Radial Dyplasia with Renal Ectopia malr... more INDIAN PEDIATRICS 76 VOLUME 43__JANUARY 17, 2006 Familial Radial Dyplasia with Renal Ectopia malrotated and fused to the lower pole of left kidney. Intravenous pyelography revealed hydronephrotic changes of ectopic right kidney. Hemogram, renal functions, serum electrolytes, EKG, and echocardiography were normal. The baby was diagnosed as a case of bilateral radial club hands with right crossed fused renal ectopia and hydro-nephrosis.
The statistics could have been extended to see how many children will be harmed if used hypotonic... more The statistics could have been extended to see how many children will be harmed if used hypotonic fluids compared to reduced volume isotonic fluids. The number needed to harm in this trial (to cause hyponatremia), if using hypotonic fluids, would be 1 in 4 at 24 hours (95% CI 1.9-15.2) and 48 hours (95% CI 1.9-11.8), which is higher compared to an earlier study [2]. The absolute risk increases by 30 percent if hypotonic fluids are used. However, the earlier trial used the same volume of fluids in both the participant groups which points towards a need of reduced volume rather than standard volume maintenance fluids apart from employing isotonic fluids, to reduce hyponatremia.
Splenic infarction is extremely rare in children with enteric fever. We present a unique case of ... more Splenic infarction is extremely rare in children with enteric fever. We present a unique case of culture proven enteric fever who presented with prolonged fever and left hypochondrial pain. Ultrasonography showed hypo echoic areas consistent with the diagnosis of a splenic infarction. A prolonged antibiotic cover of ceftriaxone resulted in recovery. Please download Vol. 19 (2013): (December) Malaysian Journal of Paediatrics and Child Health from here
PG Textbook of Pediatrics: Systemic Disorders and Social Pediatrics (Volume 3)
PubMed, Apr 1, 2015
The recent report by Shamim, et al. [1] brings out the most common and continued problem encounte... more The recent report by Shamim, et al. [1] brings out the most common and continued problem encountered in pediatric intensive care units. Research has proved that using isotonic fluids as maintenance fluids in sick children results in fewer hyponatremic episodes compared to hypotonic fluids [2,3]. However, there are few issues:
Coryneforms have emerged as important pathogens causing severe human infections in immunosuppress... more Coryneforms have emerged as important pathogens causing severe human infections in immunosuppressed patients. However, it is increasingly being perceived that the pathogenic potential of Coryneform bacteria is being underestimated and it is not limited to merely this group of patients. These organisms are reported to cause serious infections such as bacteremia, valvular endocarditis, neurosurgical shunt infections, meningitis, brain abscess, peritonitis, osteomyelitis, septic arthritis, pneumonia, empyema and urinary tract infections. The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh, INDIA for a period of eight months from August 2007 to March 2008. All the patients in the study were divided into two groups: (i) Immunocompromised (ii) Immunocompetent. Direct microscopic examination was done by Gram staining, followed by culture. All the isolated Coryneform species were subjected to antimicrobial susceptibility testing using Kirby bauer disc diffusion method on Mueller Hinton agar incorporated with 5% sheep blood. A total of 2508 samples (68.6%) showed growth on culture. Coryneforms were isolated and considered as pathogens in 5.5% samples. Monomicrobial infection of Corynebcaterium species was more common (69.1%) with surgical site infection (27.3%) as the commonest presentation. Coryneforms isolates from the immunocompetent patients accounted for 98(70.5%) isolates, whereas 41(29.5%) isolates were from patients with an immunocompromised status. C. minutissimum was the commonest Coryneform isolated in both the groups. The other Coryneform species isolated were C. jeikium, Microbacterium species, C. xerosis, C. striatum, C. urealyticum, C. afermentans, C. amycolatum and C. ulcerans. Alarmingly widespread antibiotic resistance was observed among most of the Coryneforms. The average sensitivity of the-lactam antimicrobials being just 55% and the aminoglycosides even less than 50% (48%). Only 67(47.5%) strains were sensitive to flouroquinolones. Linezolid was the only antimicrobial to which all the Coryneform isolates included in this study were uniformly sensitive. This study highlights the need for maintaining a high degree of suspicion as far as Coryneform infections are concerned. They should not be dismissed as skin commensals in immunocompetent patients without determining their clinical relevance. Sensitizing clinicians about these emerging pathogens and their multidrug resistant nature is also essential.
PubMed, Jun 1, 2004
This prospective study was carried out in the pediatric ward and outpatient department of a terti... more This prospective study was carried out in the pediatric ward and outpatient department of a tertiary care centre to estimate the prevalence of HIV seropositivity in children with tuberculosis. Two hundred and fifty consecutive children below 12 years of age with (pulmonary and extrapulmonary) tuberculosis diagnosed between March 1999 and July 2000 were screened for HIV infection. A patient was labeled as HIV positive if two consecutive ELISA tests were found positive using different antigen/principle. Supplemental western blot test was also done. Parents of seropositive children were also screened for HIV infection and tuberculosis. Total 5 cases were HIV positive giving a seroprevalence of 2%. All the five patients had disseminated tuberculosis. We suggest regular screening of children with disseminated/miliary tuberculosis for HIV co-infection.
PubMed, Sep 1, 2000
Objective: To compare the safety and efficacy of a hyposmolar oral rehydration solution (H-ORS) (... more Objective: To compare the safety and efficacy of a hyposmolar oral rehydration solution (H-ORS) (245 mmol/liter) with the World Health Organization oral rehydration solution (WHO ORS) in cholera and acute non-cholera diarrhea. Design: Controlled clinical trial. Setting: Diarrhea training and treatment unit. Methods: Thirty-five culture proven cholera and 135 acute non-cholera diarrheal patients randomly received H-ORS or WHO-ORS. Intake and output were measured every 4 hours. Results: Analysis of the total cases revealed rehydration phase (p=0.048, 95% CI 0.64-0.99) and overall (p=0.046, 95% CI 0.70-0.99) frequency of stools to be significantly less in the H-ORS group. In the severely malnourished, the rehydration phase (p=0.032, 95% CI 0.55-97), maintenance phase (p=0.035, 95% CI 0.51-0.97) and overall (p=0.011; 0.95% CI 0.55-0.93) stool frequency were significantly decreased in the H-ORS group. The amount of ORS consumed in the maintenance phase of the cholera cases was significantly (p=0.04, 95% CI 0.44-0.98) less in the H-ORS group. All other parameters, despite showing a decreasing trend, were statistically comparable in the cholera, non-cholera and total cases. The amount of intravenous fluid needed was significantly more in the noncholera and total cases on H-ORS. In the non-breastfed cases, under two years of age, the total duration of diarrhea was significantly decreased (p=0.03; 95% CI 11.07-11.45) but the need for intravenous fluids significantly increased (p=0.02; 95% CI 109.8-112.1) in the H-ORS group. The proportion of children vomiting, the weight gain, urine passed in 24 hours, serum sodium, caloric intake and failure rate were comparable. Conclusions: H-ORS is as safe and effective as the WHO-ORS and may have some additional benefits in malnourished children.
Journal of Pediatric Gastroenterology and Nutrition, Aug 1, 1998
PubMed, 2013
Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recog... more Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies, the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis and intervention.
Current Pediatric Research, 2016
Malaria is associated with severe neurological complication especially by Plasmodium falciparum. ... more Malaria is associated with severe neurological complication especially by Plasmodium falciparum. We report a case of acute malaria in a seven year old boy presenting with features of psychosis as the primary presenting complaint, with absence of fever or concomitant drug intake before arrival. Peripheral blood smear of patient subsequently revealed Plasmodium vivax [ring and trophozoite stage] as he was investigated further when febrile spikes appeared. Malaria is associated with severe neurological complications especially by P. falciparum. We report a case of acute malaria in a seven year old boy presenting with features of psychosis as the initial presenting complaint, without history of fever or concomitant drug intake before arrival. Peripheral blood smear revealed P. vivax [ring and trophozoite stage].
Coryneforms have emerged as important pathogens causing severe human infections in immunosuppress... more Coryneforms have emerged as important pathogens causing severe human infections in immunosuppressed patients. However, it is increasingly being perceived that the pathogenic potential of Coryneform bacteria is being underestimated and it is not limited to merely this group of patients. These organisms are reported to cause serious infections such as bacteremia, valvular endocarditis, neurosurgical shunt infections, meningitis, brain abscess, peritonitis, osteomyelitis, septic arthritis, pneumonia, empyema and urinary tract infections. The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh, INDIA for a period of eight months from August 2007 to March 2008. All the patients in the study were divided into two groups: (i) Immunocompromised (ii) Immunocompetent. Direct microscopic examination was done by Gram staining, followed by culture. All the isolated Coryneform species were subjected to antimicrobial susceptibility testing using Kirby bauer disc diffusion method on Mueller Hinton agar incorporated with 5% sheep blood. A total of 2508 samples (68.6%) showed growth on culture. Coryneforms were isolated and considered as pathogens in 5.5% samples. Monomicrobial infection of Corynebcaterium species was more common (69.1%) with surgical site infection (27.3%) as the commonest presentation. Coryneforms isolates from the immunocompetent patients accounted for 98(70.5%) isolates, whereas 41(29.5%) isolates were from patients with an immunocompromised status. C. minutissimum was the commonest Coryneform isolated in both the groups. The other Coryneform species isolated were C. jeikium, Microbacterium species, C. xerosis, C. striatum, C. urealyticum, C. afermentans, C. amycolatum and C. ulcerans. Alarmingly widespread antibiotic resistance was observed among most of the Coryneforms. The average sensitivity of the-lactam antimicrobials being just 55% and the aminoglycosides even less than 50% (48%). Only 67(47.5%) strains were sensitive to flouroquinolones. Linezolid was the only antimicrobial to which all the Coryneform isolates included in this study were uniformly sensitive. This study highlights the need for maintaining a high degree of suspicion as far as Coryneform infections are concerned. They should not be dismissed as skin commensals in immunocompetent patients without determining their clinical relevance. Sensitizing clinicians about these emerging pathogens and their multidrug resistant nature is also essential.
Indian Journal of Pediatrics, Nov 1, 2004
Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in ... more Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age. Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. <1, 1-4, 5-9 and 10-14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA. Results: Overall 4.35% (95%CI, 2.44-6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1-4 year age category. In the <1, 5-9 and 10-14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577). Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44-6.25). The prevalence progressively increases and peaks in the 1-4 years age group. It is least in 10-14 years age group.
Indian Journal of Pediatrics
Frontiers in Pediatrics, 2021
Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is s... more Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries. Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily p...
Indian Journal of Nephrology, 2004
Introduction: This study was performed in a tertiary level teaching hospital to evaluate the role... more Introduction: This study was performed in a tertiary level teaching hospital to evaluate the role of renal ultrasound (US) and serum levels of C-reactive protein (CRP) in differentiating upper from lower urinary tract infections (UTI). Subjects & Methods: A total of 75 children upto 12 years of age, with symptomatic culture positive first episode of UTI were compared with 30 age and sex matched, healthy children. Patients were categorized into upper (UUTI) and lower UTI (LUTI) based on clinical and laboratory parameters. There were 34 cases with UUTI and 41 with LUTI. Serum CRP and renal US were performed in all cases. Results: Levels of CRP were significantly higher in patients of upper UTI (13.9 ± 8 ìg/mL) than those with lower UTI (1.2 ± 2.3 ìg/mL), P<0.001. Follow up estimation showed a mean decline in CRP of 21ìg/mL in upper UTI within 1-2 weeks of antibiotic therapy. On US mean volume of larger kidney in patients of upper UTI (184.4 ± 55.8%) was more than those with lower U...
International Journal of Approximate Reasoning, 2021
Emerging viruses causing Acute Encephalitis Syndrome (AES) can be more damaging due to irreversib... more Emerging viruses causing Acute Encephalitis Syndrome (AES) can be more damaging due to irreversible brain damage, irrespective of the identical medical characteristics created by all agents. We report two cases of acute encephalitis syndrome caused by Japanese encephalitis virus from a usually under-reported geographic region of India. Both patients were managed conservatively with favourable outcome in one of them.There should be considerable effort to identify the particular causative agent that triggers AES, bearing in mind the various clinical manifestations of Japanese encephalitis virus. Although there is no significant impact on management, it is possible to prevent transmission to healthy contacts and the community through vector control and vaccination.
Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part ofthe ... more Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part ofthe normal human oral and upper respiratory tract flora. Although traditionally believed to be anorganism of low virulence, Stomatococcus mucilaginosus has been reported to be anopportunistic pathogen in immunocompromised patients. We describe what we believe is the firstreported case of Stomatococcus mucilaginosus meningitis in a healthy child. The isolate wasmultidrug-resistant, susceptible only to vancomycin. The patient was treated successfully withvancomycin after initial trials with amikacin and cefotaxime.
INDIAN PEDIATRICS 76 VOLUME 43__JANUARY 17, 2006 Familial Radial Dyplasia with Renal Ectopia malr... more INDIAN PEDIATRICS 76 VOLUME 43__JANUARY 17, 2006 Familial Radial Dyplasia with Renal Ectopia malrotated and fused to the lower pole of left kidney. Intravenous pyelography revealed hydronephrotic changes of ectopic right kidney. Hemogram, renal functions, serum electrolytes, EKG, and echocardiography were normal. The baby was diagnosed as a case of bilateral radial club hands with right crossed fused renal ectopia and hydro-nephrosis.
The statistics could have been extended to see how many children will be harmed if used hypotonic... more The statistics could have been extended to see how many children will be harmed if used hypotonic fluids compared to reduced volume isotonic fluids. The number needed to harm in this trial (to cause hyponatremia), if using hypotonic fluids, would be 1 in 4 at 24 hours (95% CI 1.9-15.2) and 48 hours (95% CI 1.9-11.8), which is higher compared to an earlier study [2]. The absolute risk increases by 30 percent if hypotonic fluids are used. However, the earlier trial used the same volume of fluids in both the participant groups which points towards a need of reduced volume rather than standard volume maintenance fluids apart from employing isotonic fluids, to reduce hyponatremia.
Splenic infarction is extremely rare in children with enteric fever. We present a unique case of ... more Splenic infarction is extremely rare in children with enteric fever. We present a unique case of culture proven enteric fever who presented with prolonged fever and left hypochondrial pain. Ultrasonography showed hypo echoic areas consistent with the diagnosis of a splenic infarction. A prolonged antibiotic cover of ceftriaxone resulted in recovery. Please download Vol. 19 (2013): (December) Malaysian Journal of Paediatrics and Child Health from here
PG Textbook of Pediatrics: Systemic Disorders and Social Pediatrics (Volume 3)