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Kale D, Vyas AK, Bhatt GC, Yadav AK, Singh AK, Nema S, Biswas D. Th2-predominant immune response underlies the pathogenesis of Dengue. Cytokine 2024; 177:156562. [PMID: 38430693 DOI: 10.1016/j.cyto.2024.156562] [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] [Received: 09/05/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Dengue is a rapidly emerging pandemic-prone disease, whose manifestations range from asymptomatic infection to life-threatening complications like Dengue Hemorrhagic Fever and Dengue Shock Syndrome. This study investigates and compares the immune response in clinically defined cohorts of Dengue with and without warning signs, with the aim of identifying immunological correlates of clinical disease and potential markers of disease severity. METHODS Blood samples, collected from study participants fulfilling the WHO definition of Dengue with and without warning signs and healthy volunteers, were analyzed using flow cell-based fluorometric methods for cytokines and chemokines. Gene expression analysis, using RT-PCR, was conducted on T helper cell subset-specific transcription factors and cytokines. Demographic details, virological markers, serotype distribution, and hematological parameters were also investigated in all the subjects. RESULTS The 35 participants recruited in the study, included 11 healthy volunteers and 12 patients each fulfilling the WHO criteria of Dengue with and without warning signs. While the demographic characteristics and serotype distribution was similar in Dengue with and without warning signs cohorts of the disease, platelet counts and Aspartate Aminotransferase (AST) levels changed significantly between Dengue with and without warning signs patients. Plasma cytokine analysis showed up-regulation of IL-4, IL-10, IP-10, and MCP-1 in Dengue patients compared to healthy volunteers. Disease severity was associated with elevated levels of IL-10, IP-10, IL-4, MCP-1, and MIP-1α. IL-8 and MIP-1α were significantly up-regulated in Dengue with warning sign compared to Dengue without warning signs cases. Transcription factor analysis indicated increased expression of RORα, FoxP3, and GATA3 in Dengue patients. mRNA expression of TGFβ and IL-4 was also elevated in Dengue patients. A positive correlation between mRNA expression of IL-4 and plasma IL-4 was observed. CONCLUSION The study reveals a Th2-predominant immune response in all Dengue patients, regardless of disease severity, with overexpression of IL-8 and MIP-1α being observed in patients with warning signs.
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Affiliation(s)
- Dipesh Kale
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ashish Kumar Vyas
- Amrita Medical Research Institute, Amrita Institute of Medical Sciences, Faridabad, Haryana, India
| | - Girish Chandra Bhatt
- Department of Paediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ashvini Kumar Yadav
- Regional Virology Laboratory, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anirudh K Singh
- School of Sciences, SAM Global University, Raisen, Madhya Pradesh, India
| | - Shashwati Nema
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India; Regional Virology Laboratory, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Debasis Biswas
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India; Regional Virology Laboratory, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
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Puthukara A, Kumar A, Bhatt GC, Maheshwari M, Pakhare AP, Malik S, Raina R. Performance of home-based and ambulatory blood pressure monitoring in obese children and their correlation with end organ damage. Am J Hypertens 2024:hpae049. [PMID: 38661395 DOI: 10.1093/ajh/hpae049] [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] [Received: 11/21/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The increasing prevalence of childhood obesity has led to a corresponding increase in hypertension among children, necessitating early identification of subclinical target organ damage for accurate cardiovascular risk assessment. However, in the pediatric population, there is a paucity of literature comparing ambulatory and home blood pressure monitoring, and this knowledge gap is exacerbated by limited access to ambulatory blood pressure monitoring (ABPM) facilities, particularly in developing countries, where pediatricians often resort to home blood BP monitoring as the preferred option. METHOD In this cross-sectional study with 60 obese children (aged 5-18 years) at a tertiary health care in central India, we aimed to comprehensively characterize blood pressure profiles, including office, ambulatory and home and investigated their correlations with indicators of end-organ damage. RESULT Among 60 children, 26 (43.3%) participants were found to be hypertensive based on 24 Hr ABPM evaluation. Masked hypertension and white coat hypertension (WCH) were observed in 21.6% and 13.3% respectively. Surprisingly, 20% of participants were identified as hypertensive through 7-day home BP monitoring (HBPM). A notable discordance of 36.6% was between HBPM and ABPM results. Moreover, 26.7% of the children had end-organ damage, with higher odds associated with night-time systolic ambulatory hypertension in the adjusted regression model (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001). CONCLUSION The study highlights 24-hour ABPM's vital role in classifying hypertensive status, especially in high-risk children. The diagnostic performance of HBPM shows poor sensitivity in detecting MH and lower specificity in identifying WCH compared to ABPM. This limitation translates to missed opportunities for early preventive interventions.
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Affiliation(s)
- Athira Puthukara
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
| | - Amber Kumar
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
| | - Mahesh Maheshwari
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
| | - Abhijit P Pakhare
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Shikha Malik
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
| | - Rupesh Raina
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, All India Institute of Medical Sciences (AIIMS), Bhopal, M.P, India
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio
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Kumar S, Goyal A, Atlani M, Malik S, Pakhare A, Maheshwari M, Kumar A, Raina R, Bhatt GC. Obstructive sleep apnea and ambulatory blood pressure abnormalities in children with chronic kidney disease. Blood Press Monit 2023; 28:129-133. [PMID: 37141920 DOI: 10.1097/mbp.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and hypertension are common complications in children with chronic kidney disease (CKD). Progression of CKD can aggravate OSA and hypertension whereas worsening sleep apnea can make hypertension difficult to treat in CKD patients. We, therefore, conducted a prospective study to evaluate the association between OSA and hypertension in pediatric patients with CKD. METHOD In this prospective observational study consecutive children with CKD stage 3-5 (nondialysis dependent) underwent overnight polysomnography and 24-h ambulatory blood pressure monitoring (ABPM). The detailed clinical features and investigations were recorded in a prestructured performa. RESULTS Twenty-two children completed overnight polysomnography and 24-h ABPM was performed within 48 h of performing polysomnography. The median (IQR) age of the study population was 11 (8.5-15.5) years, with an age range of 5-18 years. Moderate-severe OSA defined as apnea-hypopnea index (AHI ≥5) was seen in 14 (63.6%) children, periodic limb movement syndrome in 20 (91%) and poor sleep efficacy in 9 (40.9%) children. Ambulatory blood pressure was abnormal in 15 (68.2%) children with CKD. Of them, 4 (18.2%) had ambulatory hypertension, 9 (40.9%) had severe ambulatory hypertension and 2 (9.1%) had masked hypertension. A statistically significant correlation of sleep efficiency with nighttime DBP SD score/Z score (SDS/Z) (r = -0.47; P = 0.02); estimated glomerular filtration rate with SBP loads (r = -0.61; P < 0.012); DBP loads (r = -0.63; P < ) and BMI with SBP load (r = 0.46; P = 0.012) was found. CONCLUSION Our preliminary findings suggest that ambulatory blood pressure abnormalities, OSA, periodic limb movement syndrome and poor sleep efficiency are highly prevalent in children with CKD stages 3-5.
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Affiliation(s)
- Suryendru Kumar
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics
| | | | | | - Shikha Malik
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mahesh Maheshwari
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics
| | - Amber Kumar
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
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Bhatt GC, Patel B, Das RR, Malik S, Bitzan M, Mishra NR. Efficacy and safety of levamisole in childhood nephrotic syndrome: A meta-analysis. Indian J Pharmacol 2023; 55:43-52. [PMID: 36960520 DOI: 10.4103/ijp.ijp_673_21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Present evidence regarding the efficacy and safety of levamisole in childhood nephrotic syndrome (NS), particularly the steroid-sensitive NS (SSNS), is limited. We searched relevant databases such as PubMed/MEDLINE, Embase, Google Scholar, and Cochrane CENTRAL till June 30, 2020. We included 12 studies for evidence synthesis (5 were clinical trials that included 326 children). The proportion of children without relapses at 6-12 months was higher in the levamisole group as compared to steroids (relative risk [RR]: 5.9 [95% Confidence interval (CI): 0.13-264.8], I2 = 85%). Levamisole as compared to the control increased the proportion of children without relapses at 6-12 months (RR: 3.55 [95% CI: 2.19-5.75], I2 = 0%). The GRADE evidence was of "very-low certainty" except for the comparison of levamisole with control, the latter being of "moderate certainty." To conclude, levamisole given to children with SSNS is beneficial in preventing relapses and achieving remission as compared to placebo or low-dose steroids. Good-quality trials are needed to provide a robust evidence in this regard. PROSPERO Registration number: CRD42018086247.
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, Division of Pediatric Nephrology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhupeshwari Patel
- Department of Pediatrics, Division of Pediatric Nephrology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shikha Malik
- Department of Pediatrics, Division of Pediatric Nephrology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Martin Bitzan
- McGill University Health Centre, Montreal, Canada; Department of Pediatrics, Kidney Centre of Excellence, Al Jalila Children's Hospital, Dubai, United Arab Emirates
| | - Nihar Ranjan Mishra
- Department of Pediatrics, All India Institute of Medical Sciences, Kalyani, West Bengal, India
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Tripathi AK, Pilania RK, Bhatt GC, Atlani M, Kumar A, Malik S. Acute kidney injury following multisystem inflammatory syndrome associated with SARS-CoV-2 infection in children: a systematic review and meta-analysis. Pediatr Nephrol 2023; 38:357-370. [PMID: 35943577 PMCID: PMC9362633 DOI: 10.1007/s00467-022-05701-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Multisystem inflammatory syndrome (MIS-C) is a rare paediatric hyper-inflammatory disorder that occurs following SARS-CoV-2 infection. Acute kidney injury (AKI) occurs in approximately one-quarter to one-third of the patients with MIS-C and is associated with poor prognosis in critically ill children. This systematic review is aimed to evaluate the incidence of AKI, mortality, and the need for kidney replacement therapy (KRT) in patients with MIS-C. METHODS We searched databases from Medline, EMBASE, Cochrane Register, and Google Scholar from December 2019 to December 2021 with our search strategy. Studies meeting the following criteria were included in this systematic review: (1) articles on AKI in MIS-C; (2) studies providing AKI in MIS-C and COVID-19 infection separately; (3) studies reporting outcomes such as mortality, KRT, serum creatinine; length of hospital/ICU stay. QUALITY ASSESSMENT The quality of the included studies was independently assessed by using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool for cohort studies and case series. STATISTICAL ANALYSIS Outcomes and their 95% confidence intervals (CI) were reported if a meta-analysis of these outcomes was conducted. Heterogeneity was reported using I2 statistics, and heterogeneity ≥ 50% was considered high. We used Baujat's plot for the contribution of each study toward overall heterogeneity. In sensitivity analysis, the summary estimates were assessed by repeating meta-analysis after omitting one study at a time. Forest plots were used for reporting outcomes in each study and with their 95% CI. All statistical tests were performed using R software version 4.0.3. RESULTS A total of 24 studies were included in this systematic review and of these, 11 were included in the meta-analysis. The pooled proportion of patients with MIS-C developing AKI was 20% (95% CI: 14-28%, I2 = 80%). Pooled proportion of death in children with MIS-C was 4% (95% CI: 1-14%; I2 = 93%). The odds of death in patients with AKI were 4.68 times higher than in patients without AKI (95% CI: 1.06-20.7%; I2 = 17%). The overall pooled proportion of MIS-C-induced AKI patients requiring KRT was 15% (95% CI: 4-42%; I2 = 91%). CONCLUSION Approximately one-fifth of children with MIS-C develop AKI which is associated with higher odds of death. PROSPERO registration: CRD42022306170 A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anchal Kumar Tripathi
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
| | - Rakesh Kumar Pilania
- Advanced Pediatrics Centre, Division of Clinical Immunology and Rheumatology, Post Graduate Institute of Medical Sciences (PGI), Chandigarh, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India.
| | - Mahendra Atlani
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, MP India
| | - Amber Kumar
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
| | - Shikha Malik
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
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Atlani MK, Pilania RK, Bhatt GC. Outcomes following peritoneal dialysis for COVID-19-induced AKI: A literature review. Perit Dial Int 2022; 42:554-561. [PMID: 35938619 DOI: 10.1177/08968608221115000] [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: 11/17/2022] Open
Abstract
Acute kidney injury (AKI) has been shown to be associated with significant morbidity and mortality in patients with severe COVID-19 disease. Due to increasing number of cases in pandemic, there is a significant shortage of medical facilities and equipment in relation to patient load. In low resource settings where access to intermittent haemodialysis (HD) or continuous kidney replacement therapy (CKRT) is limited, peritoneal dialysis (PD) may play a vital role in the management of COVID-19-induced AKI. A literature search using Medline/PubMed, Embase, Google Scholar and Cochrane register was performed using following search strategy: (((COVID 19) OR (SARS-CoV-2)) AND (((acute kidney injury) OR (acute renal failure)) OR (acute renal dysfunction))) AND (peritoneal dialysis). Search strategy yielded total 79 articles. After going through titles and abstracts, full text of 15 articles was obtained. Finally, six studies were included in the review after exclusion of 10 studies. Five studies were single centre and one study was multicentric; four studies were conducted in the United States and one in the United Kingdom; PD catheter placement was done by surgeons in three studies and by nephrologist in one study. The mortality reported in the studies varied from 43% to as high as 63%.
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Affiliation(s)
| | - Rakesh Kumar Pilania
- Pediatric Allergy Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Sciences (PGIMER), Chandigarh
| | - Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Bhopal
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Nair N, Kalra R, Chandra Bhatt G, Narang A, Kumar G, Raina R. The Effect and Prevalence of Comorbidities in Adolescents With CKD and Obesity. Adv Chronic Kidney Dis 2022; 29:251-262. [PMID: 36084972 DOI: 10.1053/j.ackd.2022.03.003] [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] [Received: 01/29/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022]
Abstract
Adolescent obesity and CKD are both significant public health issues independently. When seen as comorbid conditions, they can cause deleterious health outcomes that put them on the fast track to necessitate dialysis or transplantation. This paper analyzes the effects of various biomarkers and comorbidities seen in the intersection of obesity and CKD in the adolescent population. We illustrate the estimated prevalence of these biomarkers and comorbidities through a review of the literature, available treatment, and obesity-related glomerulopathies. We found significant prevalence of the biomarkers, microalbuminuria (9.42% ± 9.31% and interquartile range [IQR] of 9.5%), hypertension (23.60% ± 22.5% and IQR of 9.5%), low high-density lipoprotein (14.34% ± 5.46% and IQR of 5%), hyperfiltration (3.12% ± 5.16% and IQR of 4%), and lower estimated glomerular filtration rate 4.59 ± 2.75 and IQR of 3%. Identification of prevalent biomarkers and their manifestations can serve to inform clinicians what to look for in daily setting and help elucidate the magnitude of this growing issue. Additionally, pertinent treatment options from pharmacotherapy to bariatric surgery are outlined to provide care providers with the full spectrum of treatment options for obesity in adolescent populations.
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Affiliation(s)
- Nikhil Nair
- Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Riti Kalra
- Department of Biology, Case Western Reserve University, Cleveland, OH
| | | | - Aarushi Narang
- Department of Pediatrics, ISN-SRC Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Gurinder Kumar
- Department of Pediatrics, The Metrohealth System, Cleveland, OH
| | - Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH; Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.
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Bhatt GC, Sethi SK, Mehta I, Nair N, Chakraborty R, Sharma B, Singh S, Kumar N, Gulati K, Raina R. Literature Review of the Efficacy of High-Volume Hemofiltration in Critically Ill Pediatric Patients. Blood Purif 2022; 51:649-659. [PMID: 35468595 DOI: 10.1159/000520519] [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] [Received: 07/10/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric sepsis is a significant public health issue. This condition is exacerbated by rising serum creatinine and inflammatory cytokines that lead to deleterious effects upon the body. The current standard of care involves the use of continuous kidney replacement therapy to remove harmful cytokines until the body returns to homeostasis. In order to promote faster clearance and reduced stay in the ICU, high-volume hemofiltration (HVHF) has shown promise. However, there is a paucity of studies to fully elucidate its benefits. METHODS A literature search was done using PubMed/ MEDLINE and Embase. The literature was reviewed by two independent reviewers, who independently assessed the quality of randomized controlled trials by using the Cochrane risk of bias tool for RCTs and Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized controlled trials. Data were combined from studies with a similar design. RESULTS The primary endpoint of all-cause mortality was found to be reduced by 40% across all of the pooled studies. For secondary endpoints, significant reductions of serum creatinine were found. Additionally, duration of ICU stays and treatment course was found to be significantly shorter in HVHF patients than the current standard of care. The rate of adverse effects was analyzed, and there was no difference in the proportion of patients developing hypokalemia, hyperkalemia, hypernatremia, or hyponatremia. The proportion of patients developing hyperglycemia was higher in patients undergoing HVHF, whereas the proportions of patients developing bleeding were significantly less in patients undergoing HVHF. One study reported a total number of adverse events between the two groups which were significantly lesser in patients undergoing HVHF. CONCLUSION HVHF shows promise as a modality to treat pediatric patients with sepsis. In order to confirm the benefits of this modality, future studies need significantly more patients for analysis.
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Sidharth Kumar Sethi
- Department of Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Ira Mehta
- Department of Chemistry, Lake Ridge Academy, North Ridgeville, Ohio, USA
| | - Nikhil Nair
- Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ronith Chakraborty
- Department of Internal Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Bhavya Sharma
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Siddhartha Singh
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Nikhita Kumar
- Department of Biochemistry & Molecular Biology, University of Albany, Albany, New York, USA
| | - Kabir Gulati
- Department of Chemistry, University School, Hunting Valley, Ohio, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA.,Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
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Priyanka, Bhatt GC, Kumar A, Takkar B. Crystalline keratopathy in nephropathic cystinosis. Sudan J Paediatr 2020; 19:169-170. [PMID: 31969748 DOI: 10.24911/sjp.106-1550747830] [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: 11/11/2022]
Affiliation(s)
- Priyanka
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Amber Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India.,Smt Kanuri Santhamma centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Bhatt GC, Das RR, Chaudhary B, Satapathy AK, Malik S. Peritoneal dialysis for the prevention of fluid overload in infants after cardiac surgery - A systematic review and meta-analysis. Saudi J Kidney Dis Transpl 2020; 30:1222-1235. [PMID: 31929269 DOI: 10.4103/1319-2442.275466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective is to compare peritoneal dialysis with standard care therapy for the prevention of fluid overload in infants after cardiac surgery. We searched published literature through the major database up to December 2017. Randomized controlled trials (RCTs), quasi-randomized trials, and observational studies were included in the study. The primary outcome measures were as follows: all-cause mortality and duration of hospitalization. Of the 392-citation retrieved, full text of 7 was finally assessed for eligibility. Of these, a total of five studies (RCTs = 3, and observational studies = 2) were included. There was no significant difference between the prophylactic PD and the standard therapy group for any of the primary outcomes. The present systematic review shows that prophylactic PD is not beneficial compared to standard care in infants postcardiac surgery for congenital heart disease. The GRADE evidence generated was of "very low quality."
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bharat Chaudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Kumar Satapathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shikha Malik
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Bhatt GC, Gogia P, Bitzan M, Das RR. Theophylline and aminophylline for prevention of acute kidney injury in neonates and children: a systematic review. Arch Dis Child 2019; 104:670-679. [PMID: 30798259 DOI: 10.1136/archdischild-2018-315805] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of theophylline or aminophylline for prevention of acute kidney injury (AKI) in neonates and children. DESIGN Systematic review and meta-analysis with application of Grading of Recommendations, Assessment, Development and Evaluation system. DATA SOURCES PubMed/MEDLINE, Embase, Google Scholar and Cochrane renal group were searched from 1970 to May 2018. ELIGIBILITY CRITERIA Randomised clinical trials and quasi-randomised trials comparing the efficacy and safety of prophylactic theophylline or aminophylline for prevention of AKI in neonates and children were included. The primary outcomes were: incidence of AKI, serum creatinine levels and all-cause mortality. RESULTS A total of nine trials were included in the qualitative synthesis. Six trials including 436 term neonates with birth asphyxia who received a single dose of theophylline were finally included in the meta-analysis. The pooled estimate showed 60% reduction in the incidence of AKI in neonates with severe birth asphyxia (RR: 0.40; 95% CI 0.3 to 0.54; heterogeneity: I2=0%) (moderate quality evidence), decrease in serum creatinine over days 2-5 (very low to low quality evidence) without significant difference in all-cause mortality (RR: 0.88; 95% CI 0.52 to 1.50; heterogeneity: I2=0%) (very low-quality evidence). A significant difference in the negative fluid balance, increase in GFR and decrease in urinary β2 microglobulin was seen in favour of theophylline. CONCLUSION AND RELEVANCE A single dose of prophylactic theophylline helps in prevention of AKI/severe renal dysfunction in term neonates with severe birth asphyxia (moderate quality evidence) without increasing the risk of complications and without affecting all-cause mortality (very low-quality evidence). TRIAL REGISTRATION NUMBER CRD 42017073600.
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Priya Gogia
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Martin Bitzan
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Jain S, Bhatt GC, Goya A, Gupta V, Dhingra B. Obstructive Sleep Apnea in Children with Nocturnal Enuresis. Indian Pediatr 2018; 55:433-434. [PMID: 29845962] [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: 06/08/2023]
Abstract
There is increasing evidence on the association of monosymptomatic nocturnal enuresis (MNE) with obstructive sleep apnea. In this communication, we share our experience of four patients with Primary monosymptomatic nocturnal enuresis (PMNE) with positive Sleep-related breathing disorder (SRBD) score who underwent detailed polysomnography, and were either refractory to desmopressin treatment or relapsed on discontinuation of desmopressin.
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Affiliation(s)
- Shikha Jain
- Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Abhishek Goya
- Department of Pulmonology and Sleep Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Vikas Gupta
- Department of ENT, AIIMS, Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra
- Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India
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Bhatt GC, Das RR. Early versus late initiation of renal replacement therapy in patients with acute kidney injury-a systematic review & meta-analysis of randomized controlled trials. BMC Nephrol 2017; 18:78. [PMID: 28245793 PMCID: PMC5331682 DOI: 10.1186/s12882-017-0486-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in the critically ill patients and associated with a substantial morbidity and mortality. Severe AKI may be associated with up to 60% hospital mortality. Over the years, renal replacement therapy (RRT) has emerged as the mainstay of the treatment for AKI. However, the exact timing of initiation of RRT for better patient outcome is still debatable with conflicting data from randomized controlled trials. Thus, a systematic review and meta-analysis was performed to assess the impact of “early” versus “late” initiation of RRT. Methods All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched from 1970 to October 2016. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the effect of “early/prophylactic” RRT versus “late/as and when required” RRT were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing early initiation of RRT or prophylactic RRT with late or as and when required RRT were included. The primary outcome measures were all cause mortality and dialysis dependence on day 90. The secondary outcome measures were: length of ICU stay, length of hospital stay, recovery of renal function and adverse events. Results Of the 547 citation retrieved, full text of 44 articles was assessed for eligibility. Of these a total of 10 RCTs with 1,636 participants were included. All the trials were open label; six trials have unclear or high risk of bias for allocation concealment while four trials have low risk of bias for allocation concealment. There was a variable definition of early versus late in different studies. Thus, the definition of early or late was taken according to individual study definition. Compared to late RRT, there was no significant benefit of early RRT on day 30 mortality [6 studies; 1301 participants; RR, 0.92;95% CI: 0.76, 1.12); day 60 mortality [3 trials;1075 participants; RR, 0.94; 95% CI: 0.78, 1.14)]; day 90 mortality [3 trials; 555 participants; RR,0.94;95% CI: 0.67, 1.33)]; overall ICU or hospital mortality; dialysis dependence on day 90 [3 trials; (RR, 1.06; 95% CI:0.53, 2.12)]. There was no significant difference between length of ICU or hospital stay or recovery of renal functions. A subgroup analysis based on modality of RRT or mixed medical and surgical vs. surgical or based on severity of illness showed no difference in outcome measure. The trials with high or unclear risk of bias for allocation concealment showed benefit of early RRT (RR, 0.74; 95% CI: 0.59, 0.91) while the trials with low risk of bias for allocation concealment showed no difference in the mortality (RR, 1.02; 95% CI: 0.89, 1.17). Grade evidence generated for most of the outcomes was “low quality”. Conclusion This updated meta-analysis showed no added benefit of early initiation of RRT for patients with AKI. The grade evidence generated was of “low quality” and there was a high heterogeneity in the included trials. PROSPERO registration number CRD42016043092. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0486-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Room no.18, OPD Block, Bhopal, Madhya Pradesh, 462024, India.
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Bhatt GC, Jain S, Das RR. Zinc supplementation as an adjunct to standard therapy in childhood nephrotic syndrome - a systematic review. World J Clin Pediatr 2016; 5:383-390. [PMID: 27872827 PMCID: PMC5099591 DOI: 10.5409/wjcp.v5.i4.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/27/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the role of zinc as add on treatment to the “recommended treatment” of nephrotic syndrome (NS) in children.
METHODS All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched till 31st December 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the role of zinc in childhood NS were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing zinc vs placebo was included. Effect of zinc was studied in both steroid sensitive and steroid dependent/frequent relapsing NS. The primary outcome measure was the risk of relapse in 12 mo. The secondary outcome measures were mean relapse rate per patient in 12 mo, mean relapse rate per patient in 6 mo, risk of infection associated relapse in 12 mo, cumulative dose of steroids in two groups, mean length of time to next relapse, adverse effects of therapy, and change in serum zinc levels.
RESULTS Of 54 citations retrieved, a total of 6 RCTs were included. Zinc was used at a dose of 10-20 mg/d, for the duration that varied from 6-12 mo. Compared to placebo, zinc reduced the frequency of relapses, induced sustained remission/no relapse, reduced the proportion of infection episodes associated with relapse with a mild adverse event in the form of metallic taste. The GRADE evidence generated was of “very low-quality”.
CONCLUSION Zinc may be a useful additive in the treatment of childhood NS. The evidence generated mostly was of “very low-quality”. We need more good quality RCTs in different country setting as well different subgroups of children before any firm recommendation can be made.
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Choudhary B, Patil R, Bhatt GC, Pakhare AP, Goyal A, P A, Dhingra B, Tamaria KC. Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India. PLoS One 2016; 11:e0155808. [PMID: 27191620 PMCID: PMC4871538 DOI: 10.1371/journal.pone.0155808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To study the prevalence of primary monosymptopomatic nocturnal enuresis (PMNE) in children aged 5-10 year and to find its association with sleep disordered breathing (SDB) by using a 22 item pediatric sleep related breathing disorder (SRBD) scale. METHODS This was a school based cross sectional epidemiological study from July 2015 to November 2015. A questionnaire seeking information on socio-demographic variables, nocturnal enuresis (NE) frequency, school performance and a validated 22 item pediatric sleep related breathing disorder scale (SRBDs) was distributed to 1820 pupils in three primary schools. RESULTS A total of 1528(83.95%) questionnaires were retrieved. Out of 1528 forms, 182(11.9%) forms were incomplete for requested information and hence 1346 (73.9%) questionnaires were finally analyzed. The prevalence of NE was found to be 12.7% (95% CI; 11-14.6), whereas prevalence of primary nocturnal enuresis (PMNE) was 8.2% (95% CI; 7.1-10.1). SRBD scale score >0.33 (adjusted OR: 2.87; 95%CI: 1.67-4.92), paternal history of enuresis in childhood (adjusted OR:4.96; 95% CI: 2.36-10.45), and inappropriate toilet training (adjusted OR: 1.64; 95% CI: 1.01-2.66) were independently associated with PMNE. CONCLUSION Sleep disordered breathing, inappropriate toilet training and a history of childhood NE in father were found to be significant risk factors for PMNE in the present study. Thus, these findings suggest that it is imperative to rule out SDB in PMNE patients as they may require different therapeutic interventions.
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Affiliation(s)
- Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Rajesh Patil
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Abhijit P Pakhare
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Abhishek Goyal
- Department of Pulmonology and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Aswin P
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Bhavna Dhingra
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - K C Tamaria
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
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Abstract
Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.
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Affiliation(s)
- Shikha Jain
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS) , Bhopal, Madhya Pradesh, India
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Abstract
Enteroviruses (EVs) have emerged as one of the important etiological agents as a causative organism for encephalitis, especially in children and adults. After the first report of EV encephalitis cases in 1950s, there have been increasing reports of regular outbreaks of EV encephalitis worldwide. Enteroviruses are RNA viruses of the family Picornaviridae that consists of more than 100 serotypes, which are characterized by a single positive-strand genomic RNA. The clinical features are pleomorphic and can be accompanied by mucocutaneous manifestations or isolated encephalitis only. The incidence of encephalitis in EV infection is reported to be about 3% and is associated with high mortality and morbidity. A number of newer therapeutic agents have been used in EV encephalitis with variable results. This review will focus on clinical features, pathophysiology, and newer treatment modality in EV encephalitis.
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Abstract
Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2½-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies.
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Affiliation(s)
- Shikha Jain
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra Bhan
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Patel B, Sharma T, Bhatt GC, Dhingra Bhan B. Enterobius vermicularis: an unusual cause of recurrent urinary tract infestation in a 7-year-old girl: case report and review of the literature. Trop Doct 2015; 45:132-4. [PMID: 25586573 DOI: 10.1177/0049475514566872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Enterobius vermicularis, the pinworm, is one of the most prevalent intestinal parasites in the world. Ectopic infestations in the genital or urinary tracts rarely occur and chronic enterobiasis of the urinary tract has rarely been reported. Here we present such a case in a 7-year-old girl presenting with fever, pain in the abdomen, vomiting and burning micturition. Ultrasonography and micturating cystourethrogram (MCU) studies were normal. The ova were demonstrated from both the patient's urine and stool specimen. This child was treated successfully with Albendazole and Ivermectin.
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Affiliation(s)
| | - Tanya Sharma
- Senior Resident, Department of Pediatrics, AIIMS Bhopal, MP
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Abstract
Isolated cold abscess of the thigh without active tuberculosis elsewhere in the body is a rare entity, and only a few cases have been reported in the literature. We report a case of isolated cold abscess of the thigh following DPT vaccination in an immunocompetent child. The association with DPT vaccination is intriguing and requires further research.
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Affiliation(s)
- Juhi Sharma
- Consultant Pathologist, Department of Pathology, Subharati Medical College, Meerut, Uttar Pradesh, India
| | - Tanya Sharma
- Senior Resident, Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Girish Chandra Bhatt
- Assistant Professor, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Ruchika Bhargava
- Assistant Professor, Department of Pathology, LLRM Medical College, Meerut, Uttar Pradesh, India
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Bhatt GC, Dewan V, Dewan T, Yadav TP. Pseudotumour cerebri with multiple cranial nerve palsies in enteric fever. Indian J Pediatr 2014; 81:196-7. [PMID: 23334586 DOI: 10.1007/s12098-013-0965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 01/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, PGIMER and Associated Dr RML Hospital, New Delhi, India
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Pongener I, Nandan D, Bhatt GC, Dewan V. Hydrocephalus due to aqueductal stenosis in a case of mumps meningoencephalitis: A rare complication. J Pediatr Neurosci 2013; 8:179-80. [PMID: 24082949 PMCID: PMC3783738 DOI: 10.4103/1817-1745.117871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Imkongkumzuk Pongener
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Abstract
Tuberculous liver abscess without active pulmonary or miliary tuberculosis or other clinical evidence of tuberculosis, is very rare. A 3-year-old immunocompetent boy with isolated tuberculous liver abscess recovered completely on systemic anti-tuberculous drugs.
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Affiliation(s)
- Devki Nandan
- Postgraduate Institute of Medical Education and Research and Associated Dr RML Hospital, New Delhi, India
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, PGIMER and Associated Dr. RML Hospital, New Delhi, India
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Abstract
Summary Acute glomerulonephritis occurring during the course of enteric fever is a rare entity and only a few cases have been reported in the published literature. We describe two interesting cases of acute glomerulonephritis occurring in twin siblings.
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Affiliation(s)
| | - Devki Nandan
- Department of Pediatrics, PGIMER & Associated Dr RML Hospital, New Delhi, India
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Nandan D, Bhatt GC, Dewan V, Pongener I. Complete right lung agenesis with dextrocardia: an unusual cause of respiratory distress. J Clin Imaging Sci 2013; 2:81. [PMID: 23393637 PMCID: PMC3551508 DOI: 10.4103/2156-7514.105140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/20/2012] [Indexed: 11/25/2022] Open
Abstract
Pulmonary agenesis, defined as complete absence of bronchus, parenchyma, and vessels is a very rare condition. Herein, we report a 4-month-old infant who presented with fever, cough, and respiratory distress and was misdiagnosed in a peripheral hospital as a case of pneumonia. The child was, later diagnosed as having right lung agenesis with dextrocardia.
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Affiliation(s)
- Devki Nandan
- Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India
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Bhatt GC, Sharma T. Hand, foot and mouth disease in Odisha. Indian Pediatr 2013; 50:250. [DOI: 10.1007/s13312-013-0048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Isolated tuberculous liver abscess (TLA) without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare and only few cases have been reported in the literature. We report two cases of isolated TLA in immunocompetent children, treated successfully by percutaneous aspiration followed by systemic antituberculous drugs.
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Affiliation(s)
| | - Devki Nandan
- Department of Pediatrics, PGIMER & Associated Dr RML Hospital, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
We herein report an 18-months-old child who presented with high-grade fever, cough, and breathlessness along with tachypnoea and diminished air entry on the left side of the chest, in which a diagnosis of left-sided pleural effusion was made. Salmonella typhi was isolated from the pleural tap culture. The patient had uneventful recovery with appropriate antibiotic therapy. Empyema thoracic as a complication is extremely rare in the absence of an underlying co-morbid illness, is even more uncommon in a child, and is even rarer to find with Salmonella typhi species. After reviewing the available literature we could find only five cases of empyema thoracic due to Salmonella typhi in children with the age range of 9–13 years. We are reporting this case as the youngest child reported with this complication.
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Affiliation(s)
- Devki Nandan
- Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India.
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Bhatt GC, Bondre VP, Sapkal GN, Sharma T, Kumar S, Gore MM, Kushwaha KP, Rathi AK. Changing clinico-laboratory profile of encephalitis patients in the eastern Uttar Pradesh region of India. Trop Doct 2012; 42:106-8. [PMID: 22431829 DOI: 10.1258/td.2011.110391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A cross-sectional study was done on 100 consecutive paediatric patients presenting with acute encephalitis syndrome. The clinico-laboratory features of all patients were recorded in a prestructured performa. Cerebrospinal fluid and serum samples were tested for: Japanese encephalitis (JE) virus; Chandipura virus; coxsackie virus; dengue virus; enterovirus 76; and West Nile virus. Twenty-two (22.0%) patients were confirmed JE cases and 17% had parasitic or bacteriological aetiology. The remaining 61 cases (61.0%) in which no viral aetiological agent was found were grouped as non-JE cases. Peripheral vascular failure, splenomegaly and hypotonia were distinguishing clinical features found in the non-JE patients. A high mortality of 26.5% was seen in patients with confirmed or presumptive viral encephalitis (22/83). A fatal outcome was independently associated with peripheral vascular failure and pallor at the time of admission. Early recognition of these signs may help clinicians to manage these cases.
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Abstract
Although acute glomerulonephritis is a rare complication of Plasmodium falciparum malaria, it has not been reported in connection with Plasmodium vivax. We report a case of complicated P. vivax malaria presenting as acute glomerulonephritis. A three-year-old boy presented with high grade fever, a seven-day history of the progressive swelling of his body and a one-day history of vomiting. An examination revealed hypertension (>95th percentile), pallor and hepatosplenomegaly. Investigations showed a platelet count 80,000/mm3 with haematuria [20–30 red blood cells/high power field with more than 80% dysmorphic red blood cells]. A peripheral smear showed the presence of trophozoites of P. vivax. The patient was diagnosed as having P. vivax causing acute glomerulonephritis and was treated successfully with antimalarials and enalapril. With the changing epidemiological pattern of malaria, especially in endemic areas, unusual complications such as acute glomerulonephritis may sometimes present in cases of P. vivax malaria.
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Affiliation(s)
| | - Devki Nandan
- PGIMER & Associated Dr RML Hospital, New Delhi, India
| | - Vivek Dewan
- PGIMER & Associated Dr RML Hospital, New Delhi, India
| | - Soumya Dey
- PGIMER & Associated Dr RML Hospital, New Delhi, India
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Bhatt GC, Sharma T. Author reply. J Pediatr Neurosci 2012; 7:241-2. [PMID: 23560025 PMCID: PMC3611927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India,Address for correspondence: Dr. Girish Chandra Bhatt, 20/19, 3rd floor, Old Rajendra Nagar, New Delhi - 110 060, India. E-mail:
| | - Tanya Sharma
- Department of Pathology, University College of Medical Sciences and associated Guru Teg Bahadur Hospital, New Delhi, India
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Midala TA, Lege-Oguntoye L, Werblinska B, Bhatt GC. In-vivo sensitivity of Plasmodium falciparum to chloroquine in Zaria, Nigeria. J Trop Med Hyg 1988; 91:9-11. [PMID: 3279222] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 33 children with confirmed Plasmodium falciparum malaria, the WHO Extended Field Test was employed to test the sensitivity of the parasite to chloroquine in Zaria urban area. No evidence of resistance to the drug was found. In 82% of the patients parasitaemia had disappeared within 3 days, while the remaining 18% were parasite negative on day 4 or 5. The mean parasite clearance time was calculated as 3.45 +/- 1.23 days. The results suggest that chloroquine sensitivity of P. falciparum may be decreased in this part of Nigeria.
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Affiliation(s)
- T A Midala
- Department of Pharmacology, Ahmadu Bello University, Zaria, Nigeria
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