P. Nalini

Acute pulmonary edema as a complication of Anti-snake Venom therapy

Polyvalent Anti-snake Venom (ASV) is a life-saving antivenin for severe envenomation due to snake bite in India. ASV infusion is occasionally associated with severe allergic reactions, i.e. anaphylaxis and death. We report a rare instance of non-cardiogenic pulmonary edema due to ASV infusion in an eleven years old boy.

Perinatal mortality-incidence and effect of various maternal factors, part 1

Of 12,716 consecutive briths, over a period of eleven years, perinatal mortality rate was 80.7, still birth rate 41.4 and early neonatal death rate 39.3. Perinatal mortality was very high in association with previous pregnancy wastages, obstetrical complications like toxemia and antepartum hemorrhage, acute infection and chronic illnesses during pregnancy, abnormal presentation, prolonged sedation and anesthesia. Teenage and elderly mothers, primi and grandmultipara, mothers with anemia and A or O blood group and consangunity also had high perinatal losses. Alcoholism and smoking tend to have adverse effects on fetus but require further studies to be conclusive. A low perinatal mortality rate of 29/1000 in properly booked cases is another highlight of this study.

Helicobacter pylori and Recurrent Pain Abdomen

Objective : Pain abdomen is a common problem in childhood. Many factors i.e., organic changes in the gut, psychological and environment contribute to recurrent pain abdomen (RAP) in children. Helicobacter pylori infects children very early in childhood and stays indefinitely in the gut without its eradication. It may be responsible for pain abdomen and peptic ulcers in children. This study was done to assess the HP status in children with RAP diagnosed and evaluate the effects of eradication of HP infection in them.Methods: 76 children were included in the study.Result: Out of 76 children studied 14.8% had evidence of a secondary cause for pain abdomen and responded to appropriate therapy. 65.45% of children who had undergone UGIE, had evidence of HP infection in the upper gastrointestinal tract. Most of these children responded to HP eradication therapy by becoming free of abdominal pain after the eradication therapy with OCA or OMA regimen. We could not do repeated endoscopies in all of them to prove the eradication due to parents’ refusal and this is the main drawback of this study.Conclusion: However, in view of clinical response to HP eradication therapy in almost all the cases, we strongly advocate this therapy for those children with RAP, in whom HP infection of the upper gastrointestinal tract can be established beyond doubt.

Long-term outcome in coma

Objective:To assess the relationship between Modified Glasgow Coma Scale, its components, brain stem reflexes and long term functional outcome in children with acute non-traumatic coma.Method: MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The children were followed up regularly and functional outcome was assessed at the end of 9 months. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis.Results: Higher total MGCS score and verbal response score had a significant positive correlation with better functional outcome as measured by GOS and intelligence quotient. There was no association between the language function and the initial MGCS, its components and brain stem reflexes. Lower verbal response (P = 0.005) was the only factor that was found to be individually associated with poorer long term GOS score and intelligence quotient by multivariate linear regression analysis.Conclusion: In the long term prediction of outcome in acute non-traumatic coma, MGCS is not useful. However, verbal response, a component of MGCS, correlates well with long term functional outcome and intelligence quotient

Tuberculin reactivity in healthy school children in Pondicherry

Five hundred healthy school children in the age group 5–9 years underwent tuberculin testing. Seventy nine per cent of the study population had a BCG scar. 9.2% children were found to be suffering from malnutrition, using the Quetlets Index and 7.8% were found to be malnourished by weight for age method. 18.6% of the children were tuberculin positive (induration ≥10 mm) and the prevalence of tuberculin positivity increased with age. The numbers of tuberculin reactors or the mean tuberculin reaction were not affected by malnutrition. BCG scar status neither affected the mean tuberculin size nor the number of tuberculin reactors.

A prospective study of bacterial infections in the newborn

Neonatal bacterial infections were identified in 1675 consecutive liveborns in Pondicherry. Babies weighing less than 2000 gm at birth had higher incidence of major infections as compared to higher birth weight babies. Minor infections like pyoderma and conjunctivitis occurred with equal frequency in both the weight groups. Commonest organism isolated from neonates with minor infection wasStaphylococcus pyogenes. In cases of septicemia predominant organisms isolated wereKlebsiella, Salmonella, E. coli andPseudomonas aerugenosa, in descending order of frequency. Antibiotic sensitivity pattern of all the organisms showed high sensitivity to gentamycin (94.2%), chloramphenicol (70.3%) and kanamycin (67.3%) and poor sensitivity to streptomycin, tetracycline, ampicillin and penicillin.

Predictive Value of Tuberculin Induration at 24 h in Healthy Schoolchildren

Tuberculin (1 TU PPD RT23 Tween 80) was administered to 500 healthy schoolchildren, aged 5-9 years. The induration at 24 h was compared with that at 72 h. The mean (standard deviation) induration of the tuberculin reaction at the end of 24,48 and 72 h was 4.5 (6.75), 4.4 (7.11) and 4.0 (6.91) mm, respectively. When the tuberculin reaction was 0-9 mm, a significant difference was noted between the 24- and 72-h reading (p = 0.0001). There was no difference in the size of the tuberculin reaction between the 24- and 72-h readings when the reaction size was > or = 10 mm (p > 0.05). Considering a tuberculin induration of < 10 mm as negative tuberculin reaction for our reference population in South India, the sensitivity, specificity, positive predictive value and the negative predictive value in our study for the 24-h reading were found to be high. The predictive value of 24-h induration was not affected by age. Reading and interpretation of tuberculin test after 24 h needs due consideration in clinical practice.

Churg-Strauss syndrome.

ConclusionOurs is probably the youngest child with C.S.S. reported in literature who is still having bronchial asthma after recovery from the vasculitis phase.