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Viswanathan V.,Kanchi Kamakoti Childs Trust Hospital
Indian journal of pediatrics | Year: 2014

Management of epilepsies in children has improved considerably over the last decade, all over the world due to the advances seen in the understanding of the patho-physiology of epileptogenesis, availability of both structural and functional imaging studies along with better quality EEG/video-EEG recordings and the availability of a plethora of newer anti-epileptic drugs which are tailormade to act on specific pathways. In spite of this, there is still a long way to go before one is able to be absolutely rational about which drug to use for which type of epilepsy. There have been a lot of advances in the area of epilepsy surgery and is certainly gaining ground for specific cases. Better understanding of the genetic basis of epilepsies will hopefully lead to a more rational treatment plan in the future. Also, a lot of work needs to be done to dispel various misunderstandings and myths about epilepsy which still exists in our country.


Balasubramanian S.,Kanchi Kamakoti CHILDS Trust Hospital | Ramachandran B.,Kanchi Kamakoti CHILDS Trust Hospital | Amperayani S.,Kanchi Kamakoti CHILDS Trust Hospital
Archives of Disease in Childhood | Year: 2012

Dengue is a vector-borne viral infection of global importance. Several pathogenetic mechanisms such as immune enhancement and selection pressure have been proposed and febrile, critical and recovery phases have been identified. A new classification proposed by WHO has recently been introduced where definitions have been changed to 'probable dengue', 'dengue with warning signs' and 'severe dengue'. The majority of dengue viral infections are self-limiting, but complications have high morbidity and mortality. The diagnosis of dengue viral infection is essentially clinical, although confirmation requires laboratory tests including serology, NS1 antigen detection, PCR and viral cultures. There are no specific anti-dengue drugs and treatment is basically supportive and consists of early recognition of complications and appropriate fluid therapy. A number of candidate vaccines are under development.


Balasubramanian S.,Kanchi Kamakoti CHILDS Trust Hospital | Dhanalakshmi K.,Kanchi Kamakoti CHILDS Trust Hospital | Amperayani S.,Kanchi Kamakoti CHILDS Trust Hospital
Indian Pediatrics | Year: 2013

Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency. © 2013 Indian Academy of Pediatrics.


Balasubramanian S.,Kanchi Kamakoti CHILDS Trust Hospital | Ganesh R.,Kanchi Kamakoti CHILDS Trust Hospital | Kumar J.R.,Kanchi Kamakoti CHILDS Trust Hospital
Indian Pediatrics | Year: 2012

During a 5 year period, 33 children (22 males) were diagnosed to have infectious mononucleosis (M:F::2:1; age 9 mo-15 y). The common clinical features observed were fever (100%), lymphadenopathy (84%) hepatosplenomegaly (81%), tonsillar enlargement (45%), neck swelling (30%), upper respiratory symptoms (21%), epitrochlear node enlargement (20%), vomiting and diarrhea (1%). Ten children had complications; upper airway obstruction and hemophagocytic lymphohistocytosis occurred in four each and septic shock in two. EBV associated infectious mononucleosis in hospitalized children was found to affect mainly preschool children and had a favorable prognosis.


Radhika R.,Kanchi Kamakoti CHILDS Trust Hospital
Indian Journal of Practical Pediatrics | Year: 2015

Point of care testing (POCT) is near-patient testing wherein diagnostic tests are performed near the patient. Specimen drawn from the patient is tested immediately and results are displayed instantly on the point of care device. Point of care testing evolved due to the need for a high-quality, efficient, timely laboratory testing at a reasonable cost. In an emergency situation, with an urgent need for rapid diagnosis and therapy, this provides a lot of supplemental information and is invaluable in patient management. POCT is accomplished at the bedside through the use of transportable, portable devices and test kits. Quantity of sample required is very minimal and results are obtained in a very short period of time at or near the location of the patient. Although only a limited number of investigations can be performed using a POCT and errors are prone to occur, newer tests are increasingly becoming available and it has been found to improve patient care. © Indian Academy of Pediatrics.


Ramachandran B.,Kanchi Kamakoti CHILDS Trust Hospital | Balasubramanian S.,Kanchi Kamakoti CHILDS Trust Hospital | Abhishek N.,Kanchi Kamakoti CHILDS Trust Hospital | Ravikumar K.G.,Kanchi Kamakoti CHILDS Trust Hospital | Ramanan A.V.,Bristol Royal Hospital for Children
Indian Pediatrics | Year: 2011

Objective: To describe the epidemiology, clinical features, laboratory findings, outcome and the difficulties in diagnosis and management of children with Hemophagocytic Lymphohistiocytosis (HLH) in a tertiary children's hospital in India. Study Design: Retrospective analysis of case records of all the children with a diagnosis of HLH from December 2006 to December 2008. Setting: Tertiary care children's teaching hospital in Chennai, India. Results: 43 children had a diagnosis of hemophagocytosis, of who only 33 (19 male, mean age 46 months, range 50 days-14 years) met the inclusion criteria based on the HLH-2004 protocol of the Histiocyte Society. The predominant presenting features included prolonged fever and hepatosplenomegaly. CNS symptoms were present in 36%. Anemia (Hb <9gm/dL), and thrombocytopenia (platelets <1,00,000/mm 3) were present in 97% and 72%, respectively. Among the biochemical markers, hyperferritinemia was present in 97%, and hypofibrinogenemia and high LDH in 92%. Bone marrow examination showed hemophagocytosis in 84%. Infectious agents were identified in 42% children, with viruses accounting for 2/3 of them (5 Dengue virus, 3 EBV, 1 CMV, 1 TB and 5 bacterial agents). The mean duration between the onset of symptoms and the diagnosis was 16 days. Corticosteroids were the most commonly used immunomodulatory agents (67%), followed by IVIg (64%). Cyclosporine was used in 33% and Etoposide in 15%. Improvement of laboratory parameters was noticed within 5-7 days of starting treatment. Overall survival rate was 76%. Conclusion: HLH should be considered in the differential diagnosis of children with prolonged fever, hepatosplenomegaly and cytopenia. Prompt recognition and appropriate therapy may result in good outcome, particularly in Infection associated HLH. © 2011 Indian Academy of Pediatrics.


Sathiyasekaran M.,Kanchi Kamakoti CHILDS Trust Hospital
Indian Journal of Practical Pediatrics | Year: 2013

Pediatric feeding disorders are challenging problems encountered commonly in day to day practice. 25% of normal children present with a mild disorder which increases to 80% in children with developmental delay. The etiology is multifactorial comprising of medical, nutritional, behavioral, psychological and environmental causes. Feeding disorders should be conceptualized as a bio-behavioral problem, a continuum between psycho-social and organic factors. The clinical spectrum includes food selectivity, food refusal, excessive meal duration, dysphagia, choking, vomiting and inappropriate mealtime behaviors. Nutritional and cognitive impairment, growth failure, susceptibility to chronic illness and even death may occur as a result of this disorder. Assessment and treatment are best conducted by an interdisciplinary team including a pediatrician, gastroenterologist, nutritionist, behavioral psychologist and occupational and/or speech therapist.


Balasubramaniam C.,Kanchi Kamakoti Childs Trust Hospital
Journal of Craniofacial Surgery | Year: 2014

In pediatric neurosurgery departments in India, craniosynostosis is being increasingly identified and dealt with during the past several years. The management of this problem is well established in units that have a strong pediatric bias, whereas it is still in infancy in certain departments. Some misconceptions exist regarding this condition with reference to clinical, genetic aspects and management-in particular, the surgical indications. The experience gained for more than 2 decades of treating this condition as well as the problems faced in the management of this condition will be discussed. Although the terms craniostenosis and craniosynostosis do not mean quite the same thing, the terms are used interchangeably andwill be done so in this communication. Copyright © 2014 by Mutaz B. Habal, MD.


Ramesh S.,Kanchi Kamakoti Childs Trust Hospital | Jayanthi R.,Kanchi Kamakoti Childs Trust Hospital
Indian Journal of Anaesthesia | Year: 2011

Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children. © 2011.


Suresh N.,Kanchi Kamakoti CHILDS Trust Hospital | Ganesh R.,Kanchi Kamakoti CHILDS Trust Hospital | Sathiyasekaran M.,Kanchi Kamakoti CHILDS Trust Hospital
Indian Pediatrics | Year: 2010

A retrospective analysis of the clinical profile, endoscopic features and management of 22 children (age 18 months-18 years) diagnosed as solitary rectal ulcer syndrome is presented. The majority (81.8%) were ≤ 8 years of age. Rectal bleeding was the presenting feature in all the children. Mucorrhea, constipation, tenesmus and rectal prolapse were observed in 77.3%, 63.6%, 59% and 13.6% children, respectively. Colonoscopy showed classical single rectal ulcer in 68.2% and multiple ulcers in 22.7%. Polypoidal and erosive lesions were documented in 4.5% each. The medical management comprised of bowel training and high fibre diet for all children. The other modalities included oral 5-amino salicylate (59%), sucralfate enema (4.5%) and rectal mesalamine in 9%. 64% children recovered and 13.6 % had recurrence of symptoms. © 2010 Indian Academy of Pediatrics.

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