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ABSTRACT: Bilateral anotia or microtia is known to be associated with multiple order malformations. The authors report a young infant who presented with failure to thrive and recurrent respiratory tract infections.The patient had bilaterally absent pinnae; instead small skin tags were present. He also had asymmetric crying facies and clinical evidence of hypothyroidism in the form of hoarse voice, constipation and generalized hypotonia. Thyroid function tests confirmed the diagnosis of hypothyroidism.
Indian Journal of Pediatrics. 01/2004;
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ABSTRACT: To examine the etiological factors, clinical features, treatment modalities and outcome of acute respiratory failure in children.
This hospital-based prospective observational study was conducted over 15 months. Fifty children with acute respiratory failure, diagnosed by serial arterial blood gas analysis, were consecutively enrolled. Ventilation therapy was initiated when the FiO2 requirement went above 0.6.
Pulmonary diseases accounted for majority (68%) of cases, followed by nervous system (12%); and cardiovascular and skeletal muscle system diseases (10%, each). Bronchopneumonia was the commonest cause of acute respiratory failure (11 cases). The majority of cases were in the age group 1 month to < 1 year (26 cases). The commonest signs were altered depth and pattern of respiration (100%), chest wall retractions (88%), flaring of alae nasae (88%), tachypnea (84%), tachycardia (82%), and irritability (64%). Cyanosis was noticed in only 26 (52%) cases. Thirty-six (72%) children required ventilation therapy. The overall mortality was 58%. The mortality was high (55.9% to 66.7%), irrespective of the primary system involved. Significantly higher mortality was associated with co-existent malnutrition (p<0.001), Type I failure (p=0.039) and ventilation therapy (p<0.0001).
Acute respiratory failure has varied etiology and clinical manifestations, and a high mortality. Its outcome is independent of age of the child and the primary system involved. Malnutrition and Type I failure are factors associated with a poor outcome.
The Indian Journal of Pediatrics 11/2003; 70(11):865-9. · 0.52 Impact Factor
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ABSTRACT: The increasing prevalence of HIV infection in urban India together with limited financial resources necessitates judicious HIV testing. This prospective study was undertaken to determine the utility of selective screening for HIV infection based on five clinical risk factors reported in African children. The study was conducted at the Departments of Paediatrics and Microbiology, LTMG Hospital, Bombay, India between September 1998 and 2000. The children were enrolled after taking informed consent from their parents. The HIV seroprevalence rate was determined in children (aged 1 month to 12 years) consecutively admitted with severe malnutrition, serious pyogenic infections (pneumonia, pyogenic meningitis, septicaemia), disseminated tuberculosis, chronic diarrhoea and oral candidiasis, present either singly or in combination. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of a total 204 children (110 male, 94 female) screened, 24 (11.8 per cent) were diagnosed as HIV-infected. The HIV seropositive rate was highest in children having oral candidiasis (40.6 per cent), followed by chronic diarrhoea (18.2 per cent), disseminated tuberculosis (16.2 per cent), severe malnutrition (14.4 per cent), and serious pyogenic infections (11.2 per cent). Only the presence of oral candidiasis was a significant independent risk factor for predicting HIV infection (p < 0.0001). However, as the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increased significantly (p < 0.001). Our study shows that clinically-directed selective screening does have a practical role in diagnosing HIV infection in a resource-poor setting.
Journal of Tropical Pediatrics 06/2002; 48(3):149-55. · 1.39 Impact Factor
