Subramanian Mahadevan
Jawaharlal Institute of Postgraduate Medical Education and Research
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Archives of Disease in Childhood | 2005
Subramanian Mahadevan; Patrick McKiernan; Paul W. Davies; Deirdre Kelly
Aim: To identify the clinical and biochemical risk factors associated with outcome of paracetamol induced significant hepatotoxicity in children. Methods: Retrospective case notes review of those with paracetamol overdose admitted from 1992 to 2002. Patients were analysed in two groups: group I recovered after conservative treatment and group II developed progressive liver dysfunction and were listed for liver transplantation. Results: Of 51 patients (6 males, 45 females, aged 0.8–16.1 years), 6 (aged <7 years) received cumulative multiple doses, and 45 a single large overdose (median 345 mg/kg, range 91–645). The median (range) interval to hospital at presentation post-ingestion was 24 hours (4–65) and 44 hours (24–96) respectively in groups I and II. Patients received standard supportive treatment including N-acetylcysteine. All children in group I survived. In group II, 6/11 underwent orthotopic liver transplantation (OLT) and 2/6 survived; 5/11 died awaiting OLT. Cerebral oedema was the main cause of death. Children who presented late to hospital for treatment and those with progressive hepatotoxicity with prothrombin time >100 seconds, hypoglycaemia, serum creatinine >200 μmol/l, acidosis (pH <7.3), and who developed encephalopathy grade III, had a poor prognosis or died. Although hepatic transaminase levels were markedly raised in both groups, there was no correlation with necessity for liver transplantation or death. Conclusion: Accidental or incidental paracetamol overdose in children may be associated with toxic liver damage leading to fulminant liver failure. Delayed presentation and/or delay in treatment, and hepatic encephalopathy ⩾grade III were significant risk factors, implying poor prognosis and need for OLT. Prompt identification of high risk patients, referral to a specialised unit for management, and consideration for liver transplantation is essential.
Indian Journal of Pediatrics | 2001
Sashi Sahai; Subramanian Mahadevan; S. Srinivasan; Reba Kanungo
Objective: To identify causative bacteria from cerebrospinal fluid (CSF) of children with miningits and analyse various clinical and laboratory parameters.Methods: Over a 20 month period, September 1994 to April 1996, one hundred episodes of acute bacterial meningitis in children aged 1 month–12 years were studied in a tertiary urban hospital in South India. Organisms were isolated from the cerebrospinal fluid (CSF) in 35% of cases. Among infants and children, the two major pathogens wereH. influenzae (17%) andS.pneumoniae (12%).Results: The illness at presentation was mild in 13% and severe in 36% of cases. The association of subdural effusion in children with Salmonella Gp B meningitis merits attention. The overall case fatality rate was 25%.S.pneumoniae had a higher case fatality rate than Salmonella Gp B andH.influenzae (50% vs 17% vs 12%). All the three infants below 3 months of age withS.pneumoniae meningitis died. On analysis of selected clinical and laboratory features by discriminant analysis, CSF culture was the significant (P=0.02) variable in relation to outcome. In pneumococcal meningitis, CSF WBC count was a highly significant variable in relation to outcome (Wilk’s Lambda 0.15, F=24.64, P=0.0002).Conclusion: Prevention of infections due toH.influenzae andS.pneumoniae should be given higher priority.
Journal of Tropical Pediatrics | 2008
Vrinda Nair; Subramanian Mahadevan
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorder with a prevalence of 8-12%. Even though psychostimulants remain the treatment of choice, its cost and availability in developing countries limits the usage of the drug. In view of free availability and low cost, a Randomized controlled study was carried out using two second line drugs (clonidine and carbamazepine) in a tertiary care hospital, Pondicherry, South India. OBJECTIVE To compare the efficacy of clonidine and carbamazepine in children with ADHD. METHOD With approval of ethics committee, a prospective, Double-blind, Randomized controlled study of clonidine and carbamazepine was conducted with 50 children with ADHD (age group 4-12 years), over a period of 2 years (2005-07) in a tertiary care hospital, Pondicherry, South India. RESULTS Clonidine was effective in improving the hyperactivity and impulsivity symptoms in children with ADHD as compared to carbamazepine. Statistical significant improvement was not noted with respect to inattention symptoms and other comorbid conditions. CONCLUSION Clonidine can be a safer and cheaper alternative in treatment of children with ADHD, with a predominant effect on their hyperactivity and impulsivity symptoms.
Indian Journal of Pediatrics | 2005
B. Mahadevan; Subramanian Mahadevan; V. Tiroumourougane Serane; R. Narasimhan
Objective: To study tuberculin reactivity in childhood tuberculous meningitis both in clinical and histopathological (HP) context.Methodology: Children with tuberculous meningitis (TBM) were given tuberculin test by Mantoux technique, which was read at the end of 72 hours after the placement of skin test. Histopathological examination of the punch biopsy specimen of the tuberculin test site was performed and histopathological grading of the tuberculin reaction was compared with clinical reaction and clinical parameters.Results: Of the 50 children studied, 68% of them were malnourished and 42% had BCG scar. Tuberculin test was positive in 22 (44%) cases. Spearman analysis showed negative correlation between stage of TBM and the size of tuberculin reaction. BCG status did not affect the size of tuberculin reaction. Histopathological grade of the tuberculin reaction was found to be directly proportional to the size of the tuberculin reaction and it was not affected by the stage of TBM.Conclusion: Tuberculin positivity is low in TBM irrespective of the nutritional status. At least some degree of inflammatory reaction can be seen at the site of tuberculin administration. In tuberculin negative cases, varying grades of cellular response in the absence of clinical induration can be seen in histopathology.
Journal of Tropical Pediatrics | 2002
B. Mahadevan; Subramanian Mahadevan; V. Tiroumourougane Serane
The risk factors affecting the outcome in 50 children with tuberculous meningitis were evaluated over a period of 20 months. Five children (10 per cent) had stage 1 disease, 29 (58 per cent) had stage II disease, and 16 (32 per cent) had stage III disease at admission. Seventeen cases (34 per cent) showed complete recovery, five (10 per cent) had mild, 14 (28 per cent) had moderate, and nine (18 per cent) had severe neurological sequelae. Five children (10 per cent) died. Younger age, tonic posturing, papilloedema, focal neurological deficit and stage at presentation were found to affect adversely the prognosis independently in children with tuberculous meningitis.
Indian Journal of Critical Care Medicine | 2013
Sriram Krishnamurthy; Parameswaran Narayanan; Sivaprakasam Prabha; Nivedita Mondal; Subramanian Mahadevan; Niranjan Biswal; S. Srinivasan
Background: Although the term acute renal failure was replaced by acute kidney injury (AKI) recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world. Objectives: The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU) with AKI, aged 1 month to 13 years. Materials and Methods: In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded. Results: The incidence of AKI among 215 patients screened was 54 (25.1%). The common etiologies were infections, [34 (62.9%)], acute glomerulonephritis (7.6%), snake envenomation (5.7%), hemolytic uremic syndrome (3.8%) and congestive cardiac failures (3.8%). Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI. Conclusions: Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%), the condition was associated with adverse outcomes, including high mortality (46.3%) and need for dialysis (27.8%). Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.
Indian Journal of Pediatrics | 1991
Mina Shah; I. C. Verma; Subramanian Mahadevan; Ramesh K. Puri
Two hundred term healthy neonates were examined and 14 anthropometric measurements were taken in the face and ear region. Difference between the sexes was observed in ear length, ear breadth, and philtrum. Significant correlation was found between ear placement and ear length; and outer and inner canthal distances (p<0.001). The paper provides baselines data for facial growth measurements and discusses the utility of these measurements in detecting dysmorphogenesis in neonates.
Indian Journal of Pediatrics | 2003
Shyam Narayan; Subramanian Mahadevan; V. Tiroumourougane Serane
Objective : To evaluate the applicability of Keith Edwards scoring system for the diagnosis of childhood tuberculosis.Methods. One hundred and one children aged 2 months to 12 years who fulfilled the inclusion criteria were evaluated with Keith Edwards score. The diagnosis of tuberculosis by Keith Edwards score and the definitive reference were compared.Results. Among the 65 children diagnosed as having tuberculosis by the definitive reference, 59 had a Keith Edwards score of >7. Four children had a score of >7 but were not suffering from tuberculosis. The sensitivity and specificity of this score have been found to be 91% and 88% respectively.Conclusion. In select population with indicative clinical features, Keith Edwards score can be a definitive guideline for the diagnosis of childhood tuberculosis. However, more studies are required for the validation of this clinical score before it can be used as a definitive diagnostic reference standard for tuberculosis.
Indian Journal of Pediatrics | 1997
Subramanian Mahadevan
The use of TB-ELISA tests as a diagnostic tool offer a lot of scope in early diagnosis of serious forms of childhood tuberculosis. The characteristics of these tests have improved with the availability of purified and recombinant antigens and competition assays using monoclonal antibodies. Lower antibody titres toM. tuberculosis specific antigens in children and the presence of ‘natural exposure’ antibodies make the interpretation of these tests difficult at times. Caution must be exercised in interpreting their results due to problems inherent on currently available methods of TB-immunodiagnosis. The selection of best combination of antigens for serology, prospective clinical trials comparing success rate of serology with the standard different diagnostic procedures are required.
Archives of Disease in Childhood | 2014
Karuppiah Pandi; Sriram Krishnamurthy; Rangan Srinivasaraghavan; Subramanian Mahadevan
Objective To assess the efficacy of combined use of scorpion antivenom (SAV) with prazosin, compared with prazosin alone in children with Mesobuthus tamulus scorpion envenomation. Study design Randomised controlled trial. Setting A tertiary care hospital in south India. Patients 50 children with definite history and/or systemic manifestations of scorpion envenomation were recruited from the paediatric emergency or outpatient department from February 2012 to July 2013. Interventions The children were randomised into two groups. In 25 children, SAV was administrated as a slow intravenous bolus combined with prazosin (group A). Others received prazosin alone (group B). Results were analysed by Student t test and χ2 test. Main outcome measures Time required for resolution of autonomic symptoms, total dose of prazosin, adverse events. Results Children in group A recovered earlier than those in group B (mean difference 9.1 h, 95% CI 6.0 to 12.2). 23 children (92%) in group A were clear of autonomic symptoms within 10 h, compared with 10 children (40%) in group B (mean difference 52%, 95% CI 29% to 75%). The proportion of children deteriorating to clinical grade 3 or 4 was 8% in group A as against 44% in group B (p<0.01). The mean dose of prazosin required was 54 µg/kg versus 130.8 µg/kg in group A and B, respectively (p<0.01). SAV was not associated with severe adverse reactions. Conclusions Usage of SAV led to faster recovery and reduced the incidence of myocardial dysfunction. Combined therapy with SAV and prazosin is beneficial for children with M tamulus scorpion envenomation. Trial registration number: CTRI/2013/09/004002 (Clinical Trials Registry of India).
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Jawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
View shared research outputsJawaharlal Institute of Postgraduate Medical Education and Research
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