Browsing by Author "Kumar, Sandeep"
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Publication A Five Year Profile of Clinical, Epidemiological and Radiological Characteristics of H1N1 Influenza in Children Admitted to Tertiary Care Center in South India(Nepal Paediatric Society (JNPS), 2023) Kumar, Sandeep; Athota, Mahesh Choudary; Kini, Pushpa; Aroor, Shrikiran; Mundkur, Suneel; Bhat Y, Ramesh; Moras, Karen JaniceAbstract: Introduction: Influenza viruses are common etiological agents of acute respiratory illness in children. Clinical presentation varies from flu like illness to severe respiratory and multi organ involvement. This study is done to describe the clinical profile and outcome of hospitalized children diagnosed with H1N1 influenza. Methods: A retrospective descriptive study was done at a tertiary care hospital in South India. It included children with swine flu diagnosed by RT-PCR assay of nasopharyngeal swab during the study period of five years. Data included clinical features, radiological findings, laboratory parameters, clinical course, complications and outcome. Results: There were 118 children with H1N1 Influenza. Median age was 4.35 years (IQR 0.8 - 10.7) with male:female ratio of 0.8:1. Fever was the commonest symptom present in 113 children (95.7%) followed by cough in 103 (87.2%) and nasal discharge (39.8%). Lower respiratory tract signs were present in 38 (27.9%) of the children. Co-morbid illness included malnutrition (33%), pre-existing wheeze (9.3%) and anaemia (6.8%). Anaemia was the common laboratory (36%) followed by thrombocytopenia (21.2%) and leucopenia (18.6%). Interstitial pattern was the commonest radiological finding (27.9%). Complications included secondary bacterial infection (27.1%), severe respiratory distress (16.2%), septic shock and MODS (5.9%), pleural effusion (3.4%), ARDS (2.5%), pneumothorax (1.7%) and PAH (1.7%). Mortality was observed in 5 (4.2%) children. Conclusion: The presence of co-morbid illness is a risk factor for severity of illness. Malnutrition and anaemia were risk factors for hospitalization and mortality.Publication Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit(Nepal Paediatric Society (JNPS), 2018) Aroor, Shrikiran; Kumar, Sandeep; Kini, Pushpa; Mundkur, SuneelAbstract: Introduction: Research on critically ill children admitted to the intensive care unit has shown the usefulness of Paediatric Index of Mortality 2 (PIM2) score at admission to predict outcome. This study was conducted to estimate PIM2 score in children admitted to Paediatric Intensive Care Unit and its correlation with clinical outcome. Methods: This prospective observational study was conducted in children of age group one month to 18 years admitted to the paediatric intensive care unit of a tertiary care hospital. Data including demographics, diagnostic categories, duration of hospital stay, predicted death rate (PDR) measured by PIM2 score was compared between survivors and non survivors. Logistic regression analysis was performed to arrive at a risk adjusted relationship between the different predictor variables and the probability of death. Results: Consecutive 130 children admitted to PICU during the study period were enrolled. The mean PDR (%) of the total study population was 22.4 ± 10.60. The mean PDR in survivors was 12.4 ± 7.80 while the PDR in non survivors was 44.2 ± 12.62 (p value < 0.001). Children with PDR < 1% had a mortality rate of 2.4% when compared to 71.4% in children with PDR > 5% (p value < 0.001). PDR by PIM2 score and the presence of hypo-albuminemia remained significant even after adjusting for age in multivariate logistic regression analysis. Conclusion: PDR measured by PIM2 score differentiated well between survivors and non survivors in PICU. The predicted death rate was less than the observed death rate. PIM2 score is a useful tool to assess the severity of illness and predict outcome.Publication Clinico-radiological Profile and Outcome of Children with Viral Pneumonia admitted to Paediatric Intensive Care Unit in the pre COVID 19 period(Nepal Paediatric Society (JNPS), 2022) Aroor, Shrikiran; Mundkur, Suneel; Kumar, SandeepAbstract: Introduction: Viruses are common etiological agents of severe acute respiratory illness in under five children. Very few studies are available considering the profile of children with viral pneumonia admitted to paediatric intensive care unit (PICU) in our setting. Hence this study was done to describe the clinico- radiological profile and outcome of children diagnosed with viral pneumonia admitted to PICU. Methods: This was a retrospective descriptive study done in the PICU of a tertiary care hospital in South India. The presenting clinical features, blood parameters, chest radiography findings, course during the hospital stay and outcome of children with viral pneumonia (RT- PCR Positive) admitted to PICU were studied. Results: The aetiological profile of 28 children included - Influenza virus - 14 cases, Respiratory Syncytial Virus - 6 cases, Adeno virus - 4 cases, Human Boca virus - 2 cases, Human Rhino Virus - 1 case and Human metapneumo Virus - 1 case. Majority of children (50%) presented with severe respiratory distress. Predominant radiological picture included bilateral interstitial infiltrates followed by patchy alveolar consolidation. Eight children required mechanical ventilation. Complications included septic shock and MODS (n = 5), pneumothorax (n = 2), myocarditis (n = 2), pleural effusion (n = 1), ventilator associated pneumonia (n = 2) and pulmonary artery hypertension (n = 2). Mortality was observed in seven (25%) children. SpO2 / FiO2 ratio < 300, shock at admission, neutrophil leucocyte ratio > 2 and hypoalbuminemia were found to be significant predictors of mortality. Conclusions: Malnutrition and iron deficiency analmia were the common risk factors. Patchy alveolar consolidation is also a common radiological finding along with interstitial infiltrates. Hypoalbuminemia was a common finding among non-survivors.Publication Diffuse Alveolar Haemorrhage in Childhood Systemic Lupus Erythematous With Good Response to Oral Steroid Therapy(Nepal Paediatric Society (JNPS), 2019) Kini, Pushpa Gurudas; Moras, Karen; Kumar, Sandeep; Shetty, DeeptiAbstract: Diffuse alveolar hemorrhage (DAH) is a relatively rare and life threatening complication of systemic lupus erythematosus (SLE) in childhood. We report two distinct cases of SLE presenting with DAH as the sole manifestation of the disease during long term follow up. Both were successfully treated with oral prednisolone.Publication Fibroscan as a Non-invasive Tool for Assessment of Hepatic Fibrosis in Children with Beta Thalassemia Major(Perinatal Society of Nepal (PESON), 2024) Chowdhury, Udita; Mundkur, Suneel; Kumar, Sandeep; Kini, Pushpa; Aroor, Shrikiran; Bhat Y, RameshAbstract: Introduction: Fibroscan is a noninvasive tool for measuring liver fibrosis. This study was done to assess liver fibrosis in thalassemic children and to correlate fibroscan findings with supportive markers of increased iron store such as serum ferritin. Methods: This prospective observational study was conducted in children between five and 18 years of age diagnosed with beta thalassemia major who were on regular blood transfusion. The fibroscan findings of liver were correlated with serum ferritin, liver enzymes, and blood transfusion requirements. Results: Among the 34 children who satisfied the inclusion criteria, 22 children (64%) had no fibrosis, 10 (30%) had mild fibrosis, and two (6%) had moderate fibrosis. Higher mean duration of blood transfusion and greater median ferritin levels (3420 vs 1997 µg / L; p-value 0.006) were observed in children with fibrosis. A greater number of transfusions were significantly associated with a greater degree of hepatic fibrosis which was statistically significant (p < 0.05). No association was observed between liver fibrosis and mean age of the study population, gender, and mean age at first transfusion, AST or ALT levels. Spearman’s correlation coefficient (rho) measured to estimate the degree and direction of the relationship between degrees of fibrosis with ferritin levels was 0.549, indicating a moderately positive relationship between serum ferritin levels and hepatic fibrosis (p-value - 0.0007). Conclusions: Fibroscan is an affordable, noninvasive, and faster alternative tool to estimate liver fibrosis in children with beta thalassemia major and is directly related to serum ferritin levels and transfusion requirements in children.