Adhi Arya

Bio: Adhi Arya is an academic researcher from Government Medical College, Thiruvananthapuram. The author has contributed to research in topics: Glasgow Coma Scale & Mortality rate. The author has an hindex of 3, co-authored 9 publications receiving 16 citations.

Clinical predictors of hospital admission in acute lower respiratory tract infection in 2 months to 2-year-old children.

Abstract: Background and objective Acute lower respiratory tract infections (ALRI) are a common cause of paediatric emergency visits in young children. We studied risk factors for hospitalization and developed a clinical score for predicting hospitalization among 2 months to 2-year-old children with ALRI. Methods We conducted this prospective cohort study in the paediatric emergency department of a tertiary-care teaching hospital in India. Consecutive children, aged 2 months to 2 years with ALRI were enrolled from 15 December 2011 to 14 December 2012. A total of 26 a priori identified, putative risk factors were studied among enrolled children. We determined independent predictors of hospital admission (primary outcome) through multi-variable logistic regression analysis and assimilated them into a clinical risk score using regression coefficients. Results A total of 240 children (130 admissions) with ALRI were enrolled. Eleven clinical risk factors, which displayed association with hospital admission on univariate analysis (P 37.8°C (score of 3), SpO2 < 92% at room air (score of 4), GCS < 15 (score of 6). Area under the receiver operator characteristic curve was 0.80 (95% CI: 0.75–0.85, P < 0.001). Conclusion Five clinical risk factors—tachypnoea, chest retractions, fever > 37.8°C, SpO2 < 92% and GCS < 15—independently predicted hospital admission in infants with ALRI. A novel clinical score predicting hospital admission is presented.

Stroke in Pediatric Diabetic Ketoacidosis: Case Series.

Abstract: Diabetic ketoacidosis (DKA) can present with various neurological complications, but stroke is rare. Here, we present three children with recent-onset diabetes with DKA, two of them had deep coma not responding to standard DKA regimen and the third one had seventh nerve palsy noted after recovering from coma. Computed tomography scan of head showed hemorrhage in the area of midbrain in one patient and infarcts in two patients. In any child of DKA with severe neurological impairment, possibility of stroke should be entertained.

An atypical case of parotid gland swelling and arthritis in a child.

Abstract: BACKGROUND Early onset sarcoidosis is a rarely reported disease in children. CASE CHARACTERISTICS 2½-year-old girl with chronic enlargement of bilateral parotid glands and polyarthritis. OBSERVATION Biopsy of salivary gland revealed non-caseating granuloma. OUTCOME Polyarthritis and salivary gland swelling resolved completely after starting oral corticosteroids. MESSAGE Sarcoidosis is an important differential diagnosis in young children with joint and salivary gland involvement.

Laryngoscope Bulb - An Unusual Foreign Body in Nasopharynx

Abstract: To the Editor:We report a case of a four-year-old boy admitted in pediatric emergency with the diagnosis of tubercular meningitis with raised intracranial tension. He required intubation for low Glasgow coma scale (E2M2V2). During endotracheal intubation, the light source of laryngoscope became nonfunctional. On inspection, the laryngoscope bulb was found to be dislodged. Child was intubated immediately with another laryngoscope. The position of bulb was found to be in nasopharynx on lateral X-ray neck (Fig. 1a). However, on direct laryngoscopy, the bulb could not be located by ENTsurgeons. A repeat X-ray showed displacement of the bulb into stomach (Fig. 1b). Gastroenterology opined for a conservative approach. Repeat X-ray after three days depicted displacement of bulb in ileocecal region. Unfortunately, the child expired 5 d later due to primary disease. This case highlights the importance of proper checking of instruments before any procedure and, emphasises the need of rapid sequence intubation and proper sedation while performing elective endotracheal intubation [1]. Use of laryngoscope with fibreoptic illumination is another option to completely circumvent this complication [2]. However, it is costly and therefore, not recommended in routine practice. The case also alerts us on prompt reporting and management of this rare but potentially dangerous situation, if such an incident happens.

Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review.

Abstract: Background Pneumonia is the leading infectious cause of death among children less than 5 years of age. Predictive tools, commonly referred to as risk scores, can be employed to identify high-risk children early for targeted management to prevent adverse outcomes. This systematic review was conducted to identify pediatric pneumonia risk scores developed, validated and implemented in low-resource settings. Methods We searched CAB Direct, Cochrane Reviews, Embase, PubMed, Scopus and Web of Science for studies that developed formal risk scores to predict treatment failure or mortality among children less than 5 years of age diagnosed with a respiratory infection or pneumonia in low-resource settings. Data abstracted from articles included location and study design, sample size, age, diagnosis, score features and model discrimination. Results Three pediatric pneumonia risk scores predicted mortality specifically, and 2 treatment failure. Scores developed using World Health Organization-recommended variables for pneumonia assessment demonstrated better predictive fit than scores developed using alternative features. Scores developed using routinely collected healthcare data performed similarly well as those developed using clinical trial data. No score has been implemented in low-resource settings. Conclusions While pediatric pneumonia-specific risk scores have been developed and validated, it is yet unclear if implementation is feasible, what impact, if any, implemented scores may have on child outcomes, or how broadly scores may be generalized. To increase the feasibility of implementation, future research should focus on developing scores based on routinely collected data.

Case Report: Successful Mechanical Thrombectomy in a Newborn With Basilar Artery Occlusion

Abstract: Background Neonatal stroke remains a rare condition that has not yet been assessed in the field of endovascular treatment. Case We present the first case report of a successful mechanical thrombectomy in a newborn with a basilar occlusion the treatment was 14 hours after birth. Complete reperfusion of the basilar artery was achieved after the two thrombectomy maneuvers with stent retrievers. Imaging follow-up proved patency of the target vessel and at day 30, the patient showed no neurologic deficits. Conclusions Mechanical thrombectomy appears to be technically feasible and can be an individual option in selected cases to treat stroke in neonates with proven persistent proximal cerebral artery occlusion.

The Problematic 2014 American Academy of Pediatrics Bronchiolitis Guidelines.

Abstract: The 2014 American Academy of Pediatrics bronchiolitis guidelines do not adequately serve the needs and clinical realities of front-line clinicians caring for undifferentiated wheezing infants and children. This article describes the clinical challenges of evaluating and managing a heterogene

Clinical study of lower respiratory tract infections in children attending a tertiary care hospital

Abstract: Acute respiratory tract infections are one of the leading causes of morbidity and mortality among children in both developed and developing countries. WHO estimated burden of respiratory tract infections in 2010, estimates four and half million deaths due to respiratory tract infections among children every year. In India, 1.2 million deaths have been reported among children due to RTI among 5.9 million deaths globally. India has the ABSTRACT