Browsing by Author "Y, Ramesh Bhat"
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Publication Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates(Nepal Paediatric Society (JNPS), 2021) Y, Ramesh Bhat; George, Juanitha; Lewis, Leslie; Purkayastha, JayashreeAbstract: Introduction: Low birth weight (LBW) neonates comprising of preterm and small for gestational age (SGA) are at risk of hypoglycemia. Hypoglycemia as such in LBW neonates is not well characterized. We aimed to study the blood glucose levels of these neonates and characterise the hypoglycemia. Methods: Blood glucose levels in singleton neonates with birth weight between 1500 gm and 2499 gm were studied prospectively. Glucose levels were assessed at six hour intervals in the first 48 hours of life and extended if indicated. Glucose level ≤ 45 mg/dL in the first 24 hours and < 50 mg/dL thereafter was considered hypoglycaemia. Results: A total of 320 among 3822 neonates satisfied inclusion criteria; 104 had at least one low glucose reading with an incidence of hypoglycaemia of 32.5%. Preterm neonates constituted 158 (49.4%) and SGA 76 (23.8%). Mean blood glucose values were lowest in the first hour of life (60.1 ± 17.2 mg/dL). Incidence of hypoglycemia was highest within one hour of life followed by day two of life (16.3% and 11.6% respectively). About 86 (82.6%) neonates were asymptomatic. Overall, 75% of neonates had a single episode of hypoglycemia and 25% had a recurrence. Hypoglycaemia was noted in 31.8% of neonates born to diabetic mothers, mostly in the first hour (57.1%). Other risk factors for hypoglycemia included intrapartum fluids, birth weight < 2000 g and polycythemia. Conclusions: About a third of LBW neonates had hypoglycemia; mostly on the first hour and day one of life. Asymptomatic nature of hypoglycaemia in the large majority and recurrent hypoglycemia in 25% cases warrants glucose monitoring in this subgroup.Publication Clinical and Immunological Spectrum of Systemic Lupus Erythematosus in Children(Nepal Paediatric Society (JNPS), 2020) Kini, Sandesh; Y, Ramesh Bhat; Thunga, Chennakeshava; Shashidhara, Sowmya; Anand, AkshathaAbstract: Introduction: Systemic Lupus Erythematosus (SLE) is an auto immune disorder affecting mainly adolescent females and young women of reproductive age. The disease is characterised by widespread inflammation of blood vessels and connective tissues due to the presence of anti-nuclear antibodies (ANA). There are limited number of studies from South India on paediatric lupus. Our objectives were to study the clinical and immunological features of childhood SLE along with treatment modalities and its outcome at the end of one year follow up. The correlation between various auto-antibodies and systemic involvement was also assessed. Methods: This was a retrospective observational study carried out in paediatric unit at a tertiary care centre in South India. Data was obtained through patient’s medical records. From April 2003 to April 2019, 32 children were diagnosed to have SLE as per the American college of Rheumatology 1997 criteria. Results: The study population included 32 children fulfilling the criteria. Female to male ratio was 4.3:1. The mean age at diagnosis was 11.52 years. The most common clinical manifestations were renal (87.5%) followed by haematological (81.3%), musculoskeletal (59.4%), mucocutaneous (53.1%) and nervous system (31.3%) involvement. All patients were positive for anti-nuclear antibodies. Anti-double stranded DNA (78.1%) was the most common auto-antibody profile followed by anti-ribosomal p protein (37.5%) and anti-nucleosome antibody (37.5%). During the follow up, 13 (40.6%) children attained complete remission, 10 (31.2%) went into partial remission and nine (28.1%) had persisting active disease. Conclusion: The clinical spectrum and outcome of paediatric SLE depends upon the age of presentation and number of organ systems involved at the time of diagnosis. Our study throws light on various aspects of SLE in children from developing countries like India.Publication Clonidine Toxicity: One or More Tablets can be Dangerous in Toddlers(Nepal Paediatric Society (JNPS), 2019) Kini, Sandesh; Y, Ramesh Bhat; Kousika, Phalguna; Thunga, ChennakeshavaAbstract: Clonidine was a popular anti-hypertensive drug during the 1970s but is less commonly used now. In children clonidine is used to treat attention deficit hyperactive disorder (ADHD). We report a toddler who accidentally ingested 0.3 mg of clonidine and developed respiratory failure with hypotension requiring ventilatory support and inotropes but recovered completely within one week. In any case scenario, when a previously healthy child presents with sudden onset respiratory failure, we should keep a high index of suspicion of clonidine use by anyone at home and its easy accessibility to the child.Publication Hypothyroidism Causing Precocious Puberty and Ovarian Torsion(Nepal Paediatric Society (JNPS), 2019) Kini, Sandesh; Y, Ramesh Bhat; Kousika, Phalguna; Thunga, Chennakeshava; Handattu, Koushik; Karegowda, Lakshmikanth HalegubbiAbstract: Hypothyroidism in children causes delayed puberty. However longstanding untreated hypothyroidism can lead to precocious puberty which may be secondary to hyperprolactinemia or increased levels of thyroid stimulating hormone (TSH), enhancing the sensitivity of ovaries to circulating gonadotropins. Here we report a seven and half years old girl with hypothyroidism presenting with precocious puberty and multicystic ovaries which responded well to thyroid hormone supplementation but subsequently developed left ovarian torsion requiring surgical intervention.Publication Large Bleeding Tonsillar Mass in a Child - Rare Presentation of Non-Hodgkin Lymphoma(Nepal Paediatric Society (JNPS), 2020) Y, Ramesh Bhat; Patil, Anand KumarAbstract: Tonsillar malignancy is the underlying etiology of only a very small percentage of paediatric unilateral tonsillar enlargements. Further, because of rarity of tonsillar malignancy in children, the diagnosis may be delayed. Authors describe a large bleeding tonsillar mass in a child who remained undiagnosed for two months but finally diagnosed with non-Hodgkin lymphoma at the institution.Publication Spectrum of Influenza B Viral Infection in Indian Children: A Tertiary Centre Experience Authors(Nepal Paediatric Society (JNPS), 2018) Kini, Sandesh; Y, Ramesh Bhat; Handattu, Koushik; Kousika, Phalguna; Thunga, ChennakeshavaAbstract: Introduction: Influenza viral infection in children can range from subclinical illness to multi system involvement. The morbidity associated with influenza B viral infection is often overlooked. India being the second most populous country, accounts for 20% of global childhood deaths from respiratory infections. There is paucity of data on the clinical features and complications of influenza B viral infections in children from the Indian subcontinent. Our objective was to study the clinical profile, seasonality, complications and outcome associated with Influenza B viral infection in children < 18 years of age. Material and Methods: We conducted a retrospective observational study at a tertiary care hospital in South India. Children less than 18 years of age admitted to our paediatric unit were included in the study. We reviewed the case sheets of 56 patients who tested positive for influenza B virus during the study period and recorded their clinical and laboratory data. Throat swab obtained from cases were tested by RT-PCR. The illness was classified as upper respiratory tract infection, pneumonia and severe pneumonia. Outcome measures analysed were- mortality, need for oxygen supplementation or assisted ventilation, duration of oxygen support, duration of ICU/ hospital stay and time for defervescence following initiation of oseltamivir therapy. Results: The mean age of the study population was 6.98 years. Majority of the affected children were > 5 years of age in the school going category with a male to female ratio of 3:2. The diagnosis based on clinical and radiological findings included upper respiratory tract infection (URTI) in 44 (78.5%) cases followed by pneumonia in 11(19.6%) and severe pneumonia in one (1.7%) child. The peak incidence was in the month of March. Malnutrition was the most common risk factor affecting 22 (39.3%) cases followed by history of asthma in eight (14.3%). Three children required oxygen supplementation at admission. The median duration of hospital stay was seven days. The median duration for defervescence following initiation of oseltamivir therapy was 24 hours. Mortality was recorded in one infant who died of acute respiratory distress syndrome. Conclusions: Influenza B virus should be screened in all children having underlying high risk medical condition, presenting with pneumonia or upper respiratory tract infection. Oseltamivir therapy should be initiated early in the management of influenza B viral infections to prevent complications.