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Singh R.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
British journal of anaesthesia | Year: 2011

Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. A prospective, randomized, double-blind controlled study in 50 ASA I-II children (34 boys and 16 girls) aged 1-6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 μg kg1 (MB) or clonidine 2 μg kg1 (CB) in bupivacaine 0.2% (1.25 ml kg1) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P<0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P<0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P=0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. Caudal clonidine 2 μg kg1 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 μg kg1 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery. Source


Aneja S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Jain P.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
Indian Journal of Pediatrics | Year: 2014

Refractory epilepsy, estimated to affect 10–20 % children with epilepsy, can have profound effect on the education, social and cognitive functioning and recreational activities of the child. The definitions are still evolving. A detailed clinical evaluation may reveal an accurate syndromic and etiological diagnosis. The recent advances in neuroimaging and electrophysiology have revolutionized the management of children with refractory epilepsy and supplement the clinical evaluation. Genetic and metabolic evaluation may be indicated in selected cases. The rational use of anti-epileptic drugs, epilepsy surgery and dietary therapies are the mainstay in the management. Various experimental treatment options and pharmacogenetics offer hope for future. © 2014, Dr. K C Chaudhuri Foundation. Source


Chhapola V.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Kanwal S.K.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Brar R.,ESI Inc.
Annals of Clinical Biochemistry | Year: 2015

Background and objectives: To carry out a cross-sectional survey of the medical literature on laboratory research papers published later than 2012 and available in the common search engines (PubMed, Google Scholar) on the quality of statistical reporting of method comparison studies using Bland–Altman (B-A) analysis. Methods:Fifty clinical studies were identified which had undertaken method comparison of laboratory analytes using B-A. The reporting of B-A was evaluated using a predesigned checklist with following six items:(1) correct representation of x-axis on B-A plot,(2) representation and correct definition of limits of agreement (LOA),(3) reporting of confidence interval (CI) of LOA, (4) comparison of LOA with a priori defined clinical criteria,(5) evaluation of the pattern of the relationship between difference (y-axis) and average (x-axis) and (6) measures of repeatability. Results and interpretation: The x-axis and LOA were presented correctly in 94%, comparison with a priori clinical criteria in 74%, CI reporting in 6%,evaluation of pattern in 28% and repeatability assessment in 38% of studies. Conclusions: There is incomplete reporting of B-A in published clinical studies. Despite its simplicity, B-A appears not to be completely understood by researchers, reviewers and editors of journals. There appear to be differences in the reporting of B-A between laboratory medicine journals and other clinical journals. A uniform reporting of B-A method will enhance the generalizability of results. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav. Source


Singh V.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Singhal K.K.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
Indian Journal of Pediatrics | Year: 2015

Bronchoscopes have markedly improved the diagnosis as well as therapy in pediatric pulmonary disorders. Two types of bronchoscopes are available; flexible and rigid, with their own advantages and disadvantages. Depending on the clinical need and availability of skills, choice is made between the two. Typically, rigid scopes are largely used by the surgeons (pediatric or otolayngologists) while flexible bronchoscope stays in the domain of the pediatric pulmonologist and intensivists. Rigid scopes may be more versatile than flexible bronchoscopes in removing the foreign bodies from the airway. Flexible bronchoscopes on the other hand can even be introduced through an endotracheal tube. At times, use of both scopes may be required in a given patient for optimal results. Bronchoscopes give us a means to visualize the inside of the airway, which can be very informative for assessing various pathologies affecting the airways. Apart from the visualization of the parts of the airway tree and their structure as well as patency, it can also be used to take tissue biopsy specimens, collect secretions from the airways and bronchoalveolar lavage which can also get cellular elements from the distal alveoli. In the past few decades, more and more instruments are being used for expanding the utility of flexible bronchoscope for interventions ranging from bronchial toilet, foreign body removal, airway stenting and lasers or cryotherapy for airway lesions. The perinatologists have opened up more vistas and thrown newer challenges for using fiberoptic bronchoscopy (FB) for in utero tracheal occlusion in cases with diaphragmatic hernia. The vast applications of this tool makes it very relevant to pulmonary investigations and therapeutics. © 2015, Dr. K C Chaudhuri Foundation. Source


Kauser H.,Hamdard University | Jain P.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Sharma S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Aneja S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
Indian Journal of Pediatrics | Year: 2015

The classical phenotype of Miller Fisher syndrome is characterized by ophthalmoplegia, ataxia and areflexia. However, less extensive forms have been described. The authors report a 14-y-old boy with positive anti-GQ1b antibodies with unusual clinical findings. He presented with headache, double vision and vomiting for 7 d. Examination revealed complete opththalmoplegia, right lower-motor-neuron facial palsy, no limb weakness or cerebellar signs and normal fundus. CSF examination and MRI brain were normal. Electrophysiological studies showed normal limb nerve conduction studies, low CMAP amplitude of right facial nerve, abnormal blink reflex and negative repetitive-nerve-stimulation test. Anti-GQ1b antibodies were positive. The child was managed conservatively with gradual complete recovery. The patients with positive anti-GQ1b antibodies who do not demonstrate the full complement of the Miller Fisher syndrome triad have been reported previously. However, unilateral facial palsy has not been reported previously. This report further expands the phenotypic spectrum of anti-GQ1b syndrome. © 2014, Dr. K C Chaudhuri Foundation. Source

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