Acute-onset unexplained hypoxemia persisting despite 100% oxygen has a limited differential diagn... more Acute-onset unexplained hypoxemia persisting despite 100% oxygen has a limited differential diagnosis but poses a challenging diagnostic dilemma. Methemoglobinemia, a hemolytic condition, may lead to significant complications if it goes undiagnosed during the critical golden hour of an emergency department (ED) presentation. This case report presents the clinical details of a 30-month-old child with acute intravascular hemolysis evident by severe pallor and hemoglobinuria and severe hypoxia documented on pulse oximetry. During the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) of the primary survey, "exposure" revealed the parent's deliberate fastening of a mothball around the waist of the baby on the advice of a traditional healer, which was identified as the source of naphthalene toxicity. The swift intervention was undertaken for hypoxic respiratory compromise with 100% oxygen just after triage, and the naphthalene ball with the tied cloth was removed. Arterial blood gas and co-oximetry analysis confirmed the diagnosis of methemoglobinemia, and other laboratory tests suggested severe hemolytic anaemia as well as hemoglobinuria favouring intravascular hemolysis. With the exclusion of other common differentials for hemolytic anaemia, including sickle cell crisis, autoimmune hemolytic anaemia, hemolytic uremic syndrome, and G6PD deficiency, naphthalene exposure was considered the culprit for both hemolysis and methemoglobinemia. After obtaining the history of another similar episode of anaemia six months ago requiring blood transfusion, we retrospected on similar mothball exposure, but parents denied that, saying they were using the mothball only for the last 10 days on the advice of a local healer with intent to get rid of some evil power and sickness in their child. After analyzing the old records of prior hospitalization and getting assured of a normal report of G6PD level, intravenous methylene blue was administered. But in view of an inadequate response, a single blood volume exchange transfusion was performed during the ED stay only, which resulted in a notable reduction in subsequent methemoglobin levels and an improvement of the child's clinical condition by the second day. The child was discharged by the third day with no distress and no further episodes of hemoglobinuria, with detailed parental counselling and follow-up advice. This case underscores the imperative need for timely recognition and effective management of methemoglobinemia in the paediatric population while emphasizing the potential hazards associated with naphthalene exposure. Further comprehensive investigations are warranted to elucidate optimal treatment strategies and explore long-term outcomes in similar clinical scenarios.
While congenital heart disease is not uncommon, cyanotic congenital heart disease (CCHD) accounts... more While congenital heart disease is not uncommon, cyanotic congenital heart disease (CCHD) accounts for a minor fraction of them. However, when cyanosis is present, it usually indicates a severe or critical illness. Tetralogy of Fallot (TOF) is one of the common CCHDs, representing 7-10% of all congenital cardiac malformations. Double-outlet right ventricle (DORV) is another CCHD similar to the TOF and associated with decreased pulmonary flow, ventricular septal defect (VSD), and aorta receiving blood from both ventricles. Reduced oxygen arterial saturation and increased viscosity by polycythemia induce focal cerebral ischemia, often in the area supplied by the middle cerebral artery leading to brain abscess. Brain abscesses require craniotomy, which is a major surgery. These patients also often show features of sepsis and increased intracranial pressure. The presence of CCHD further complicates the situation, making perioperative management even more challenging. There are studies in the literature on the management of similar cases, and they report successful management in most of them. However, not all such cases need intensive postoperative management. We present four pediatric cases who had either TOF or DORV and had to undergo craniotomy for brain abscess or ventriculoperitoneal shunt placement. We describe case management and highlight the critical features and cases that require prolonged postoperative critical care management.
Pediatric Review: International Journal of Pediatric Research, 2019
Bile acid synthesis disorders (BASD) are rare inborn errors of metabolism and its presentation in... more Bile acid synthesis disorders (BASD) are rare inborn errors of metabolism and its presentation includes-neonatal cholestasis, neurologic disease or deficiency of fat-soluble-vitamins. 1 The trait features of these diseases are failure to produce normal bile acids, which leads to accumulation of unusual bile acids and bile acid intermediaries in liver and blood. Pathophysiological manifestations are due to deficiency of bile acids in gastrointestinal tract and accumulation of bile acid intermediates. Delay in initiating treatment can result in progressive chronic liver disease and liver failure. Bile acid therapy can lead to remarkable clinical response, if disorder is recognized earlier and liver transplant can be averted. Here we present an infant with cholestatic jaundice with chronic liver disease and subdural hematoma who was diagnosed to have 5 beta reductase deficiency.
Introduction: The first wave of the coronavirus disease 2019 (COVID-19) pandemic created havoc an... more Introduction: The first wave of the coronavirus disease 2019 (COVID-19) pandemic created havoc and confusion in choosing appropriate treatment, as well as prophylaxis, due to its rapid surge, disease novelty, and lack of evidence-based literature. It was even more concerning among the healthcare workers (HCWs), who had to take care of patients, themselves, and their own families. Objective: This online survey-based study targeted finding the various options for COVID-19 precautionary or prophylactic measures opted for by HCWs. Methodology: This was an observational study based on a predesigned questionnaire, which was floated online for three months after institutional ethical approval, just after the first wave of COVID-19 in 2021, targeting HCWs of different cadres (doctors, nurses, paramedics/laboratory technicians, etc.), ages, and sexes and HCWs hailing from across the country. Questions were focused on HCW's adopted measures, the order of preference and its reasons, and concerns related to safety and efficacy. Data was collected through Google Forms (Google, Inc., Mountain View, CA) into an Excel spreadsheet (Microsoft ® Corp., Redmond, WA) and analyzed by the latest Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY) using appropriate statistics. Results: The routine practice of standard precautionary measures (face mask, hand hygiene, and social distancing) and wearing a personal protective equipment (PPE) kit during the care of COVID-19-positive or COVID-19-suspected patients was adopted by the majority of HCWs, i.e., 306/312 (>98%) irrespective of cadre (p = 0.001). After the "routine measures," the most adopted measure by participant HCWs irrespective of profession, age, and gender was the consumption of allopathic drugs (n = 188; 60.26%). Anti-COVID-19 measures in the category of drugs used by healthcare providers (HCPs) were prophylactic allopathic drugs (60.26%), homeopathic drugs (11.86%), and other Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH)/traditional medical system drugs (11.86%). Vitamin C was the most consumed among all of the drugs for COVID-19 prophylaxis purposes. Non-drug measures espoused by the HCPs were physical exercises (46.47%), increased sleep duration (35.89%), change in dietary habits (42.62%), and spiritual measures (19.23%). The fear of COVID-19 imposed on the HCPs the obligation to use all the available preventive measures in spite of the lack of evidence on actual benefits. After the routine infection preventive measures, the most adopted measure by participant HCWs irrespective of profession, age, and gender was the consumption of prophylactic allopathic drugs (>60%), and the most non-drug preventive measures were the initiation of physical exercises and change in dietary habits. Adapting some form of physical exercise was more noted with males than females (p = 0.001), and it significantly increased with HCPs of higher age of >25 and >40 years than younger HCPs (58.6% versus 29.3%; p = 0.016). Females preferred more dietary and nutritional modifications.
The Journal of the Association of Physicians of India, 2017
For a beginner, presenting a research paper at a conference as a podium presentation can be a dau... more For a beginner, presenting a research paper at a conference as a podium presentation can be a daunting task. She is required to choose an appropriate conference for presentation, prepare an abstract, prepare slides and the speech that goes parallel with the slides and train oneself to answer questions posed by the audience. She has also got to overcome the fear of speaking in public and conquer the phobia of encountering a hostile audience ready to shred her paper to pieces. This communication intends to provide useful tips on how to go about preparing and presenting a research paper. Almost every conference has at least one slot reserved for oral or podium presentation of research papers. These podium presentation sessions are important for the presenters, organizers as well as for the attending delegates (Table 1). For the beginners and the recently-initiated, the challenge of organizing all the data and ideas for presentation in less than 10 minutes, might seem overwhelming. Adde...
Diarrhoeal disease is one of the major public health concerns and represents the second most caus... more Diarrhoeal disease is one of the major public health concerns and represents the second most cause of mortality among children below 5 years of age in developing countries. Globally Rotavirus is transmitted by the fecal oral route, causes life intimidating gastroenteritis amongst human and cattle which has enforced the focused efforts to develop vaccines by understanding narrative therapeutic mechanisms of gastrointestinal virus pathogenesis. Rotavirus is the most common and contagious virus that cause diarrhea in infants and viral diarrhea in calves. Therefore worldwide endogenous government health policies and WHO have taken vast preventive and controlling measure to overcome the disease burden of Rotavirus.
Pediatric Review: International Journal of Pediatric Research, 2019
The peroxisomal diseases are genetically determined disorders caused either by the failure to for... more The peroxisomal diseases are genetically determined disorders caused either by the failure to form or maintain the peroxisome or by a defect in the function of a single protein that is normally located in this organelle. It is a heterogeneous group of autosomal recessive disorders characterized by a defect in peroxisome formation and are caused by mutations in one of 13 PEX genes. The defect in peroxisome formation or impaired metabolic pathways result in metabolic abnormalities. Typically in Zellweger spectrum disorders (ZSD) patients accumulate very long chain fatty acids (VLCFAs), phytanic and pristanic acid, C27-bile acid intermediates and pipecolic acid in plasma and have a deficiency of plasmalogens in erythrocytes.These disorders present with a wider range of phenotype than has been recognized in the past and few of them may phenotypically resemble Downs Syndrome.
This study aims to understand how retail and supply chain researches have permeated the sustainab... more This study aims to understand how retail and supply chain researches have permeated the sustainability paradigm. Using a literature review method in two data bases: Scopus and Science Direct, we identified an increase in the studies related to this specific field in the last twenty years. The areas that have recorded a greater concentration in this field are:
Hyperhomocysteinemia is an inborn error of amino acid metabolism (IEM) in which homocysteine accu... more Hyperhomocysteinemia is an inborn error of amino acid metabolism (IEM) in which homocysteine accumulates in the blood and produces a slowly evolving clinical syndrome. (1) Late presentation is rarely seen in paediatric age group. (2) An eight year old male child presented with diffuse left lower limb swelling (below knee upto medial malleolus) with complete longitudinal and transverse thrombosis of popliteal vein and posterior tibial vein this was later diagnosed with Hyperhomocysteinemia.
Creating Posters for Effective Scientific Communication
The Journal of the Association of Physicians of India, 2017
A scientific poster is a summary of one's research that is presented in a visually engaging m... more A scientific poster is a summary of one's research that is presented in a visually engaging manner. Posters are presented as a means of short and quick scientific communications at conferences and scientific meetings. Presenting posters has advantages for the presenters and for conference attendees and organizers. It also plays a part in dissemination of research findings and furthering science. An effective poster is the one that focuses on a single message and conveys it through a concise and artistically attractive manner. This communication intends to provide tips on creating an effective poster to young scientists.
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