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Krishnan C, Geeta MG, Shabina MPB, Rajesh TV, Raj A, Ajithkumar VT. Elizabethkingia meningosepticum infections with varied presentations and different antimicrobial susceptibility - A case series. Trop Doct 2023; 53:509-511. [PMID: 37287262 DOI: 10.1177/00494755231180004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report three sporadic infections by Elizabethkingia meningosepticum from Government Medical College Kozhikode in Kerala state, South India over a period of three years. Two cases were commenced in the community in immunocompromised children beyond the newborn period, but both recovered promptly. Another was a hospital-acquired meningitis in a newborn baby who developed neurologic sequelae. In contrast to widespread antimicrobial resistance exhibited by this pathogen, there was good susceptibility to commonly used antimicrobials such as ampicillin, cefotaxime, piperacillin, ciprofloxacin, and vancomycin. Whilst ß lactam antibiotics are found effective in the treatment of Elizabethkingia septicaemia of children, piperacillin-tazobactam, vancomycin combination seems effective empiric choice of antibiotics for neonatal meningitis due to Elizabethkingia; there is a need for guidelines for the management of this infection, especially in neonatal meningitis.
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Affiliation(s)
- Chakkiyar Krishnan
- Additional Professor, Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | | | | | - Thaliyil Veettil Rajesh
- Additional Professor, Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | - Aishwarya Raj
- Senior Resident, Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
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Hridya RV, Geeta MG, Geetha P, Ajithkumar VT, Riyaz A. Opioids for Pediatric Pain Management. Indian Pediatr 2022; 59:114-116. [PMID: 35193989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the efficacy and adverse effects of opioids in management of pain in children. METHODS A descriptive study was conducted in children aged below 15 years with moderate to severe pain, and response to opioids and adverse effects were assessed at 24, 48 and 72 hours after administration. RESULTS 100 children (68% males) with median (IQR) age of 6.5 (3.5,10) years were studied. 81% (n=81) children with moderate pain and 78.9% (n=15) with severe pain responded to opioids in 72 hours. Among children with severe pain of non-malignant origin, 80% (n=8) responded in 48 hours compared to 11.1% (n=1) with malignancy and this difference was statistically significant at 24 hours (P=0.005). Of children with severe pain 73.7% (n=14) developed adverse reactions compared to 30.9% (n=25) with moderate pain. CONCLUSIONS Children with moderate-severe pain, either of malignant or non-malignant origin could be managed effectively with opioids without severe adverse effects.
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Affiliation(s)
- R V Hridya
- Institute of Maternal and Child Health, Government Medical College, Calicut, Kerala. Correspondence to: Dr RV Hridya, Senior Resident, Department of Pediatrics, Government Medical College, Calicut, Kerala.
| | - M G Geeta
- Institute of Maternal and Child Health, Government Medical College, Calicut, Kerala
| | - P Geetha
- Institute of Maternal and Child Health, Government Medical College, Calicut, Kerala
| | - V T Ajithkumar
- Institute of Maternal and Child Health, Government Medical College, Calicut, Kerala
| | - A Riyaz
- Institute of Maternal and Child Health, Government Medical College, Calicut, Kerala
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Sunny MP, Krishnan C, Abdulla PS, Geeta MG. Congenital syphilis: Need for intensification of antenatal screening and clinician awareness. Trop Doct 2021; 52:202-204. [PMID: 34459298 DOI: 10.1177/00494755211041297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital syphilis occurs due to trans-placental transmission of Treponema pallidum or rarely, intrapartum contact with infectious lesions. Even though preventable, congenital syphilis occurs sporadically in India, owing to lack of antenatal screening as well as the lack of awareness among clinicians about the burden of syphilis in the community. Since a significant overlap of clinical manifestations exists with many systemic diseases, awareness among clinicians is crucial for an early diagnosis. Renomegaly, nephrotic syndrome and nephritis can all be the signs of renal involvement in congenital syphilis, which can provide clues of the diagnosis. Direct invasion by spirochetes, hypersensitivity reactions and immune complex deposition in glomeruli contribute to the pathogenesis. We report a case of congenital syphilis characterised by delayed diagnosis with renal as well as cutaneous manifestations from missed maternal syphilis during the antenatal period and owing to the lack of antenatal screening.
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Affiliation(s)
- Minu P Sunny
- Junior Resident, Department of Pediatrics, Government Medical College Kozhikode, Kozhikode, India
| | - C Krishnan
- Additional Professor, Department of Pediatrics, Government Medical College Kozhikode, Kozhikode, India
| | - Pr Sabeel Abdulla
- Assistant Professor, Department of Pediatrics, Government Medical College Kozhikode, Kozhikode, India
| | - M G Geeta
- Professor, Department of Pediatrics, Government Medical College Kozhikode, Kozhikode, India
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Rajith KR, Medha M, Geeta MG, Krishnakumar P. A Curious Case of Attempted Hanging in a 7-Year-Old Girl. Indian J Pediatr 2021; 88:602. [PMID: 33772431 DOI: 10.1007/s12098-021-03745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K Ravindren Rajith
- Department of Child and Adolescent Psychiatry, Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala, India
| | - Murali Medha
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | - M G Geeta
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | - Padinharath Krishnakumar
- Department of Child and Adolescent Psychiatry, Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala, India.
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Jayakrishnan MP, Krishnakumar P, Geeta MG, George B. Changing Trends of Accidental Poisoning in Children over the Last Two Decades. Indian J Community Med 2021; 46:350-351. [PMID: 34321766 PMCID: PMC8281846 DOI: 10.4103/ijcm.ijcm_723_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Padinharath Krishnakumar
- Department of Child Development Services, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
| | | | - Biju George
- Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
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Jayakrishnan MP, Geeta MG, Krishnakumar P, Gireeshan VK, George B, Prathiksha P, Arunkumar G, Anitha PM. Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children. Indian Pediatr 2020; 57:1029-1032. [PMID: 32788427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy. METHODS The data collection was done prospectively from January, 2018 to May, 2019 with retrospective data from June, 2016 to December, 2017. The study cohort consisted of 58 children <12 years of age with Shigella encephalopathy admitted to the pediatric intensive care unit. Shigella encephalopathy was confirmed if culture or real time polymerase chain reaction (PCR) of a stool sample or rectal swab was positive, with temporal association of diarrhea with seizures, altered sensorium or both. Association of mortality with risk factors was tested using chi square test, and the strength of association was estimated in terms of relative risk (RR) and 95% CI. RESULTS Seizures and altered sensorium were the predominant neurological symptoms. Shock occurred in 32 (55%) children, while blood in stools was a feature in only 6 (10%) children. S. sonnei was the commonest species identified on stool culture (19;33%). On univariate analysis, prolonged seizures, shock, prolonged altered sensorium, multi-organ dysfunction, lymphocytopenia at admission and need for mechanical ventilation were significantly associated with mortality. On multivariate regression, delayed presentation (presentation to the hospital 48 hours after the onset of symptoms) and prolonged altered sensorium (>12 hours) were found to be independently associated with mortality. CONCLUSION Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes.
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Affiliation(s)
- Machinary Puthenpurayil Jayakrishnan
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India. Correspondence to: Dr Machinary Puthenpurayil Jayakrishnan, Additional Professor of Pediatrics, Government Medical College, Kozhikode, Kerala, India.
| | | | | | - V K Gireeshan
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | - Biju George
- Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
| | - P Prathiksha
- Manipal Institute of Virology, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka, India
| | - Govindakarnavar Arunkumar
- Manipal Institute of Virology, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka, India
| | - P M Anitha
- Department of Microbiology, Government Medical College, Kozhikode, Kerala, India
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Abstract
This study was conducted to analyse the clinical characteristics of measles in infants and to compare them with those in older children. Clinical and sociodemographic details of all hospitalised children with suspected measles were recorded and confirmed cases were analysed further. Twenty-four infants and 34 children aged >1 year were included. Most infants were boys and 15 (62.5%) of them were aged <9 months. Early onset of rash (within three days of fever in 62.5% of cases) occurred in infants. The complications of measles in infants included bronchopneumonia (n = 17, 71%), acute diarrhoea (n = 8, 33%), meningitis (n = 1, 4%) and staphylococcal sepsis (n = 2, 8%). The number of infants with complications was significantly high (88% and 65%; P = 0.05). Measles in infants can have atypical presentations, a greater risk for complications and may occur before they are due to receive the conventional first dose of measles vaccine.
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Affiliation(s)
- T G Sindhu
- 1 Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - M G Geeta
- 2 Additional Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - P Krishnakumar
- 3 Additional Professor of Paediatrics and Director, Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala, India
| | - S Sabitha
- 1 Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - K K Ajina
- 4 Junior Resident, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
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Abstract
The present study evaluated the perceptions and practice of 92 final year pediatric residents with regard to breaking bad news. Only 16% of residents had received any training in communication skills. Majority (65%) of the residents were not comfortable while breaking bad news.
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Affiliation(s)
- M G Geeta
- Department of Pediatrics, Govt. Medical College, Kozhikode (Calicut), Kerala, India.
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Abstract
OBJECTIVE To study the clinical characteristics and predictors of mortality from snake bite envenomation in children. DESIGN Prospective observational study with a one-group cohort design. SETTING Paediatric intensive care unit of a tertiary care hospital in South India. SUBJECTS The study cohort consisted of 145 children (55 girls and 90 boys) <12 years of age with snake bite envenomation. METHODS Demographic and clinical details were recorded in a semistructured pro forma. Children were treated with polyvalent antisnake venom (ASV) as per WHO protocol. Details of treatment, complications and outcomes were recorded. Univariate analysis was done to identify statistical significance, and those variables found to be significant were analysed using binary logistic regression. RESULTS Russell's viper was the most common offending snake followed by hump-nosed pit viper. Features of haemotoxicity, neurotoxicity and combined haemotoxicity and neurotoxicity occurred in 68 (47%), 39 (26.9%) and 9 (6%) children, respectively. Acute kidney injury (AKI) occurred in 36 (25%) children. The mortality rate was 10.3%. On univariate analysis, nocturnal bites, severe leucocytosis on day 1, AKI, capillary leak syndrome and a need for more than 20 vials of ASV were significantly associated with mortality. On multivariate analysis, only severe leucocytosis on day 1 (OR 35.29; 95% CI 1.37 to 911.89) and AKI (OR 35.05 95% CI 1.74 to 706.93) were found to be independent predictors of mortality. CONCLUSIONS This study has identified two hitherto unrecognised risk factors-severe leucocytosis on day 1 and capillary leak syndrome. These findings need to be taken into consideration when planning management strategies for snake bite envenomation in children.
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Affiliation(s)
| | - M G Geeta
- Government Medical College, Kozhikode, Kerala, India
| | | | - T V Rajesh
- Government Medical College, Kozhikode, Kerala, India
| | - Biju George
- Government Medical College, Kozhikode, Kerala, India
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Jayakrishnan MP, Geeta MG, Krishnan C, Rajesh TV, Riyaz A. Staphylococcal brain abscess associated with maternal breast abscess in young infants. Trop Doct 2015; 46:233-235. [PMID: 26612094 DOI: 10.1177/0049475515617409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M P Jayakrishnan
- Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - M G Geeta
- Additional Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - C Krishnan
- Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - T V Rajesh
- Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - A Riyaz
- Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
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Geeta MG, Krishnakumar P, Riyaz A, Cherian NC, Gopalan AV. Pediatric postgraduate training in India-residents' perspective. Indian J Pediatr 2014; 81:521-2. [PMID: 24363012 DOI: 10.1007/s12098-013-1308-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/11/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M G Geeta
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
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Krishnakumar P, Geeta MG. Child friendly school initiative program. Indian Pediatr 2011; 48:651. [PMID: 21918275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Geeta MG, Krishnakumar P, Rajasree KC, Ashraf TP, Sureshkumar K, Riyaz A. Effectiveness of communication skills training on perceptions and practice of pediatric residents. Indian J Pediatr 2011; 78:979-82. [PMID: 21286864 DOI: 10.1007/s12098-010-0316-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 11/25/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of a structured communication skills training workshop on the perceptions and practice of pediatric residents. METHODS The perceptions and practice of pediatric residents with regard to doctor- patient (parent) communication were evaluated before and 6 weeks after a communication skills training workshop, using a structured questionnaire. RESULTS Twenty pediatric residents participated in the study. They included nine residents who had completed 1 year of pediatric training and 11 residents who had completed 2 years or more of pediatric training. 9 were female residents and 11 were males. Before the intervention, majority of the residents rated themselves poorly on assessment of their perceptions and practice of communication skills. After the workshop there was overall improvement in the communication skills of the residents. CONCLUSIONS Communication skills of pediatric residents are generally inadequate. Structured training programs will help to improve their communication skills. There is a need to incorporate communication skills training in the pediatric postgraduate curriculum.
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Affiliation(s)
- M G Geeta
- Department of Pediatrics, Medical College, Calicut, Kerala 673008, India.
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Abstract
OBJECTIVE To study the clinical profile, treatment and outcome of tetanus in children treated with intrathecal tetanus immunoglobulin. (TIG) METHODS: Retrospective analysis of hospital records of tetaus cases admitted to the pediatric ICU during the five year period between 1999 to 2004 was done. RESULTS There were 66 cases of tetanus treated with intrathecal TIG. Children below 5 years formed 53% of cases and 47% were above 5 years. Totally unimmunized children constituted 82% of cases and 18% partially immunized children. The portal of entry was otogenic in 58% of cases and injury in30% of cases. The common complications observed included thrombophlebitis, aspiration pneumonia, laryngospasm and autonomic system involvement. There were no complications specific to intrathecal administration of TIG. The mortality due to tetanus was 9%. DISCUSSION Mortality and morbidity due to tetanus was less in the present study compared to other centers where TIG is given intramuscularly. CONCLUSION Intrathecal TIG is effective in the treatment of mild and moderate tetanus. Randomized controlled clinical trials are needed to evaluate the efficacy of intrathecal TIG in the management of severe tetanus.
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Affiliation(s)
- M G Geeta
- Department of Pediatrics, Medical College, Calicut, Kerala, India.
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Krishnakumar P, Geeta MG. Clinical profile of depressive disorder in children. Indian Pediatr 2006; 43:521-6. [PMID: 16820661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The aim of this retrospective study was to evaluate the risk factors, clinical features and co-morbid disorders of depressive disorder in children below the age of 12 years. Children who attended the child guidance clinic between January 2000 and December 2003 formed the subjects for the study. The diagnosis of depressive disorder was based on DSMIV diagnostic criteria for Major Depressive Disorder, Single episode. There were 26 boys and 19 girls. Stress at school and in the family was significantly associated with depressive disorder. Children with depressive disorder had significantly more family members affected with mental illnesses. The clinical features included diminished interest in play and activities, excessive tiredness, low self- esteem, problems with concentration, multiple somatic complaints, behavior symptoms like anger and aggression, recent deterioration in school performance and suicidal behavior. Majority of children had other associated psychiatric disorders which included dysthymic disorder, anxiety disorders, conduct disorder and conversion disorder.
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Affiliation(s)
- P Krishnakumar
- Department of Pediatrics, Institute of Maternal and Child Health, Medical College, Calicut, Kerala, India.
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Abstract
OBJECTIVE To evaluate the effectiveness of an individualized education program for children with scholastic backwardness. METHODS Among the children attending a Child Guidance Clinic for scholastic backwardness, 12 of them who were diagnosed as slow learners based on current level of academic functioning and IQ and 6 children having mild mental retardation were given individualized education for a period of two months. Independent assessors evaluated the academic functioning at the beginning of the training and at the end. RESULTS The results showed that the children had significant improvement in their academic functioning and self esteem after the training. CONCLUSION The present experiment can be a model to set up a resource room in normal schools to provide individualized education to children who are slow learners.
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Affiliation(s)
- P Krishnakumar
- Department of Pediatrics, Medical College, Calicut, India.
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Geeta MG, Krishnakumar P. Television and suicidal behavior. Indian Pediatr 2005; 42:837-8. [PMID: 16141492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Krishnakumar P, Geeta MG, Gopalan AV. Deliberate self-poisoning in children. Indian Pediatr 2005; 42:582-6. [PMID: 15995274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This prospective study was aimed to analyze the nature of and the factors associated with deliberate self-poisoning in children below the age of 12 years. Children referred to the Child Guidance Clinic for evaluation after recovery from the effects of poisoning during the five-year period between 1999 and 2003 formed the subjects of the study. The children were evaluated for stress factors, psychiatric disorders and the nature and mode of deliberate self-poisoning. Deliberate self-poisoning constituted 0.9% of total admissions due to poisoning. There were 10 boys and 2 girls between the ages of 9 and 12 years. Both acute and chronic stress in the family and school were associated with deliberate self-poisoning. Majority of them had psychiatric disorders. Rat poison (zinc phosphide) was the commonest poison used. Two children got the idea from watching TV serials.
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Affiliation(s)
- P Krishnakumar
- Department of Pediatrics, Institute of Maternal and Child Health, Medical College, Calicut, North Kerala, India.
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Geeta MG, Krishna Kumar P. Cholera in Kerala. Indian Pediatr 2005; 42:89. [PMID: 15695877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Geeta MG, Kumar PK. Mumps--need for urgent action. Indian Pediatr 2004; 41:1181-2. [PMID: 15591682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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