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  1. Article: Assessment of the Endotracheal Tube Tip Position by Bedside Ultrasound in a Pediatric Intensive Care Unit: A Cross-sectional Study.

    Subramani, Seenivasan / Parameswaran, Narayanan / Ananthkrishnan, Ramesh / Abraham, Shilpa / Chidambaram, Muthu / Rameshkumar, Ramachandran / Subramanian, Mahadevan

    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

    2023  Volume 26, Issue 11, Page(s) 1218–1224

    Abstract: Introduction: The chest X-ray (CXR) is the standard of practice to assess the tip of the endotracheal tube (ETT) in ventilated children. In many hospitals, it takes hours to get a bedside CXR, and it has radiation exposure. The objective of this study ... ...

    Abstract Introduction: The chest X-ray (CXR) is the standard of practice to assess the tip of the endotracheal tube (ETT) in ventilated children. In many hospitals, it takes hours to get a bedside CXR, and it has radiation exposure. The objective of this study was to find the utility of bedside ultrasound (USG), in assessing the ETT tip position in a Pediatric Intensive Care Unit (PICU).
    Methods: It was a prospective study conducted in the PICU of a tertiary care center involving 135 children aged from 1 month to 60 months, requiring endotracheal intubation. In this study, the authors compared the position of the ETT tip by the CXR (gold standard) and USG. The CXR was taken in children to assess the correct position of the tip of ETT. The USG was used to measure the distance between the tip of ETT and the arch of the aorta, thrice in the same patient. The mean of the three USG readings was compared with the distance between the tip of the ETT and carina in CXR.
    Results: The reliability of three USG readings was tested by absolute agreement coefficient in intraclass correlation (ICC), 0.986 (95% CI: 0.981-0.989). The sensitivity and specificity of the USG in identifying the correct position of the ETT tip in children when compared to CXR were 98.10% (95% CI: 93.297-99.71%) and 50.0% (95% CI: 31.30-68.70%), respectively.
    Conclusion: In ventilated children <60 months of age, identifying the tip of ETTs by bedside the USG has good sensitivity (98.10%) but poor specificity (50.0%).
    How to cite this article: Subramani S, Parameswaran N, Ananthkrishnan R, Abraham S, Chidambaram M, Rameshkumar R,
    Language English
    Publishing date 2023-02-25
    Publishing country India
    Document type Case Reports
    ZDB-ID 2121263-6
    ISSN 1998-359X ; 0972-5229
    ISSN (online) 1998-359X
    ISSN 0972-5229
    DOI 10.5005/jp-journals-10071-24355
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Splenic stiffness and platelet count to predict varices needing treatment in pediatric extrahepatic portal vein obstruction.

    Vadlapudi, Srinivas Srinidhi / Jagadisan, Barath / Ananthkrishnan, Ramesh / Narayanaswamy, Sunil

    Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

    2020  Volume 39, Issue 6, Page(s) 576–583

    Abstract: Background: Surveillance endoscopy to detect varices needing treatment (VNT) is important to prevent bleeding and morbidity in portal hypertension. In adult and pediatric cirrhosis, platelet count and liver stiffness measurement (LSM) are useful in ... ...

    Abstract Background: Surveillance endoscopy to detect varices needing treatment (VNT) is important to prevent bleeding and morbidity in portal hypertension. In adult and pediatric cirrhosis, platelet count and liver stiffness measurement (LSM) are useful in selecting patients for endoscopy. Such recommendations do not exist for extrahepatic portal vein obstruction (EHPVO). Splenic stiffness measurement (SSM) has been studied in adult and pediatric EHPVO with conflicting results and methodological errors. This study evaluates the role of platelet counts and SSM to predict VNT and bleeding in pediatric EHPVO while comparing LSM and SSM between pediatric EHPVO and controls.
    Methods: One hundred and seven children (55 with EHPVO and 52 controls) were recruited. Clinical, biochemical, hematological, and radiographic parameters of all children were noted. All children with EHPVO underwent endoscopy.
    Results: Of the 55 children with EHPVO, 48 (87.3%) had VNT. There was no difference in the platelet counts (85,000/mm
    Conclusion: SSM is higher in EHPVO bleeders but SSM and platelet counts are unreliable to predict VNT in pediatric EHPVO. Surveillance endoscopies may be needed in all pediatric EHPVO until better screening strategies are available.
    Trial registration: Not applicable.
    MeSH term(s) Child ; Constriction, Pathologic ; Elasticity ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/etiology ; Esophageal and Gastric Varices/pathology ; Esophageal and Gastric Varices/therapy ; Female ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/pathology ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Hypertension, Portal/complications ; Hypertension, Portal/pathology ; Male ; Platelet Count ; Portal Vein/pathology ; Spleen/pathology
    Language English
    Publishing date 2020-11-24
    Publishing country India
    Document type Journal Article
    ZDB-ID 632595-6
    ISSN 0975-0711 ; 0254-8860
    ISSN (online) 0975-0711
    ISSN 0254-8860
    DOI 10.1007/s12664-020-01099-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

    Ahuja, Shashi / Jalwaniya, Shilpa / Parameswaran, Sreejith / Sarkar, Sonali / Ananthkrishnan, Ramesh / Gochhait, Debasis

    Annals of the National Academy of Medical Sciences (India)

    2022  Volume 58, Issue 04, Page(s) 189–196

    Abstract: Objectives: The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about ... ...

    Abstract Objectives: The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis.
    Aim: To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study.
    Materials and Methods: Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed.
    Results: Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification.
    Conclusion: The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.
    Keywords chronic kidney disease ; renal dialysis ; impression cytology ; conjunctival keratinization ; squamous metaplasia ; calcification
    Language English
    Publishing date 2022-10-01
    Publisher Thieme Medical and Scientific Publishers Pvt. Ltd.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 632986-x
    ISSN 2454-5635 ; 0379-038X
    ISSN (online) 2454-5635
    ISSN 0379-038X
    DOI 10.1055/s-0042-1757736
    Database Thieme publisher's database

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