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Nila S, Dutta E, Prakash SS, Korula S, Oommen AM. Patient and caregiver perspectives of select non-communicable diseases in India: A scoping review. PLoS One 2024; 19:e0296643. [PMID: 38180969 PMCID: PMC10769076 DOI: 10.1371/journal.pone.0296643] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported measures of encounters in healthcare settings and consideration of their preferences could provide valuable inputs to improve healthcare quality. Although there are increasing reports of user experiences regarding health care in India in recent times, there is a lack of evidence from Indian healthcare settings on the care provided for patients with chronic diseases. METHODS We selected diabetes mellitus and cancer as representatives of two common conditions requiring different care pathways. We conducted a scoping review of studies reporting experiences or preferences of patients/caregivers for these conditions, in PubMed, Global Index Medicus and grey literature, from the year 2000 onwards. Both published and emergent themes were derived from the data and summarised as a narrative synthesis. RESULTS Of 95 included studies (49 diabetes, 46 cancer), 73% (65) were exclusively quantitative surveys, 79% included only patients (75), and 59.5% (44) were conducted in government centres. Studies were concentrated in a few states in India, with the underrepresentation of vulnerable population groups and representative studies. There was a lack of standardised tools and comprehensive approaches for assessing experiences and preferences of patients and caregivers, concerning diabetes and cancers in India. The commonest type of care assessed was therapeutic (74), with 14 cancer studies on diagnosis and nine on palliative care. Repeated visits to crowded centres, drug refill issues, unavailability of specific services in government facilities, and expensive private care characterised diabetes care, while cancer care involved delayed diagnosis and treatment, communication, and pain management issues. CONCLUSIONS There is a need for robust approaches and standardised tools to measure responsiveness of the healthcare system to patient needs, across geographical and population subgroups in India. Health system reforms are needed to improve access to high-quality care for treatment and palliation of cancer and management of chronic diseases such as diabetes.
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Affiliation(s)
- Sindhu Nila
- KEM Hospital Research Centre, Rasta Peth, Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Eliza Dutta
- Indian Institute of Public Health, Shillong, Pasteur Hills, Lawmali, Shillong, Meghalaya, India
| | - S. S. Prakash
- Department of Biochemistry, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Anu Mary Oommen
- Department of Community Health, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Yoganathan S, Bhasin H, Garg D, Malik P, Saini AG, Chandran M, Korula S, Arunachal G, Danda S, Thomas M, Oommen SP, Sharma S. Childhood Neurological Disorders With Hyperhomocystinemia: A Case-Based Review. Pediatr Neurol 2023; 146:26-30. [PMID: 37413720 DOI: 10.1016/j.pediatrneurol.2023.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
Hyperhomocysteinemia is a rare neurometabolic syndrome with diverse manifestations in the pediatric age group, thereby posing a diagnostic challenge. Biochemical testing is imperative to guide plan of evaluation, which may include appropriate genetic testing, in inherited disorders. Through this case-based approach, we demonstrate the heterogeneity of clinical presentation, biochemical and genetic evaluation, and treatment strategies that may reverse this condition among children.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Himani Bhasin
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
| | - Divyani Garg
- Department of Neurosciences, Neo Hospital, Noida, India
| | - Prateek Malik
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mahalakshmi Chandran
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gautham Arunachal
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maya Thomas
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel Philip Oommen
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suvasini Sharma
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College, New Delhi, India.
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Harriet G, Korula S, Rebekah G, Kapoor N, Cherian KE, Jose A, Mathai S, Paul TV. Bone Mineral Density and Serum Bone Turnover Markers among Post-Menarchal Girls from Rural South India. Indian J Endocrinol Metab 2023; 27:242-248. [PMID: 37583403 PMCID: PMC10424113 DOI: 10.4103/ijem.ijem_111_22] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 08/17/2023] Open
Abstract
Background The data on the bone mineral density (BMD) and bone turnover markers (BTMs) in Indian adolescents are limited. Objectives To assess BMD at lumbar spine (LS, L1-L4) and femoral neck (FN) in South Indian post-menarchal girls and correlate it with dietary calcium intake (mg/day), physical activity score and post-menarchal years. The study also assessed serum BTMs and their correlation with chronological age in the study population. Methods This cross-sectional study included apparently healthy post-menarchal adolescent girls aged 12-16 years randomly selected from the community. Participants with vitamin D deficiency were excluded. The data on calcium intake and physical activity were obtained using validated questionnaires. All participants were evaluated with serum calcium, 25-hydroxy vitamin D, parathyroid hormone, N-terminal propeptide of type 1 collagen (P1NP) and Beta-CrossLaps (CTx) and BMD at LS and FN using dual X-ray absorptiometry (DXA). Statistical Analysis EpiData version 3.1 was used for the data entry. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Continuous variables were expressed as mean ± SD. Pearson's correlation coefficient (r) was calculated, and two-tailed Kendall's tau-b test was used for assessing correlation of all nonparametric measures. Results A total of 103 participants were screened, and data from 77 were analysed. There was a significant positive correlation of BMD at LS with chronological age (r: +0.235, P = 0.036), but not at FN. Positive correlation of BMD with increase in post-menarchal years was also noted at LS (r: +0.276, P = 0.015). There was no significant association of BMD with calcium intake and physical activity scores at both sites. There was a significant negative correlation of serum BTMs with age CTx (r: -0.596, P = 0.0001) and P1NP (r: -0.505, P = 0.0001). Conclusion This study provides insight into the reference BMD range at LS spine and FN in South Indian rural post-menarchal adolescent girls. BMD positively correlated, whereas BTMs negatively correlated with age. The study also provides the first Indian reference range for serum BTMs in this age group.
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Affiliation(s)
- Gibeah Harriet
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Sophy Korula
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - Arun Jose
- Department of Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - Sarah Mathai
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Thomas V. Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
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Joy P, Madhuri V, Palocaren T, Das S, Susan Cleave Abraham S, Korula S, Koshy B, Jose J, Chandran M, Danda S. Case report of a rare purine synthesis disorder due to 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase (AICAR) deficiency. Brain Dev 2022; 44:645-649. [PMID: 35637059 DOI: 10.1016/j.braindev.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/05/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AICA (5-aminoimidazole-4-carboxamide) ribosiduria is an inborn error in purine biosynthesis caused due to biallelic pathogenic variants in the 5-aminoimidazole-4-carboxamide ribonucleotide-formyltransferase/imp cyclohydrolase (ATIC) gene located on chromosome 2q35. ATIC codes for a bifunctional enzyme, AICAR transformylase and inosine monophosphate (IMP) cyclohydrolase, which catalyse the last two steps of de novo purine synthesis. This disorder has been previously reported in only 4 cases worldwide, and herein, we report the first from India. CASE REPORT The proband presented with global developmental delay, developmental hip dysplasia (DDH), acyanotic heart disease and nystagmoid eye movements. Whole exome sequencing (WES) identified compound heterozygous pathogenic variants in the ATIC. A novel splice site variant; c.1321-2A > G and a previously reported missense variant; c.1277A > G (p.Lys426Arg) were identified. Segregation analysis of parents showed the father to be a heterozygous carrier for the splice site variant and the mother, a heterozygous carrier for the missense variant. CONCLUSION This case of a rare genetic disorder of purine biosynthesis of ATIC deficiency is the first case reported from India. Early diagnosis lead to early interventional therapy and genetic counselling.
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Affiliation(s)
- Praisy Joy
- Department of Clinical Genetics, Christian Medical College, Vellore, India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
| | - Thomas Palocaren
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
| | - Sweta Das
- Department of Clinical Genetics, Christian Medical College, Vellore, India
| | | | - Sophy Korula
- Department of Paediatric Endocrinology, Christian Medical College, Vellore, India
| | - Beena Koshy
- Department of Developmental Paediatrics, Christian Medical College, Vellore, India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, India
| | | | - Sumita Danda
- Department of Clinical Genetics, Christian Medical College, Vellore, India.
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Ravichandran L, Varghese D, R P, S AH, Korula S, Thomas N, Chapla A. Allele-specific and multiplex PCR based tools for cost-effective and comprehensive genetic testing in Congenital Adrenal Hyperplasia. MethodsX 2022; 9:101748. [PMID: 35756349 PMCID: PMC9213767 DOI: 10.1016/j.mex.2022.101748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital Adrenal Hyperplasia (CAH) is an autosomal recessive disorder due to enzyme defects in adrenal steroidogenesis. Several genes code for these enzymes, out of which mutations in the CYP21A2 gene resulting in 21 hydroxylase deficiency, contribute to the most common form of CAH. However, pseudogene imposed challenges complicate genotyping CYP21A2 gene, and there is also a lack of comprehensive molecular investigations in other genetic forms of CAH in India. Here, we describe a cost-effective, highly specific, and sensitive Allele Specific PCR (ASPCR) assay designed and optimized in-house to screen eight common pathogenic mutations in the CYP21A2 gene. We have also established and utilized a multiplex PCR assay for target enrichment and Next-generation sequencing (NGS) of CYP11B1, CYP17A1, POR, and CYP19A1 genes. Following preliminary amplification of the functional gene CYP21A2, ASPCR based genotyping of eight common mutations - P30L, I2G, 8BPdel, I172N, E6CLUS (I235N, V236E, M238K) V281L, Q318X, and R356W was carried out. These results were further validated using Sanger and Next-generation sequencing. Once optimized to be specific and sensitive, the advantage of ASPCR in CYP21A2 genotyping extends to provide genetic screening for both adult and paediatric subjects and carrier testing at a low cost and less time. Furthermore, multiplex PCR coupled NGS has shown to be cost-effective and robust for parallel multigene sequencing in CAH.
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Chapla A, Johnson J, Korula S, Mohan N, Ahmed A, Varghese D, Rangasamy P, Ravichandran L, Jebasingh F, Kumar Agrawal K, Somasundaram N, Hesarghatta Shyamasunder A, Mathai S, Simon A, Jha S, Chowdry S, Venkatesan R, Raghupathy P, Thomas N. WFS1 Gene-associated Diabetes Phenotypes and Identification of a Founder Mutation in Southern India. J Clin Endocrinol Metab 2022; 107:1328-1336. [PMID: 35018440 DOI: 10.1210/clinem/dgac002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Wolfram syndrome (WFS) is a rare autosomal recessive disorder characterized by juvenile-onset diabetes, diabetes insipidus, optic atrophy, deafness, and progressive neurodegeneration. However, due to the progressive nature of the disease and a lack of complete clinical manifestations, a confirmed diagnosis of WFS at the time of onset of diabetes is a challenge. OBJECTIVE With WFS1 rare heterozygous variants reported in diabetes, there is a need for comprehensive genetic screening strategies for the early diagnosis of WFS and delineating the phenotypic spectrum associated with the WFS1 gene variants in young-onset diabetes. METHODS This case series of 11 patients who were positive for WFS1 variants were identified with next-generation sequencing (NGS)-based screening of 17 genemonogenic diabetes panel. These results were further confirmed with Sanger sequencing. RESULTS 9 out of 11 patients were homozygous for pathogenic/likely pathogenic variants in the WFS1 gene. Interestingly, 3 of these probands were positive for the novel WFS1 (NM_006005.3): c.1107_1108insA (p.Ala370Serfs*173) variant, and haplotype analysis suggested a founder effect in 3 families from Southern India. Additionally, we identified 2 patients with young-onset diabetes who were heterozygous for a likely pathogenic variant or a variant of uncertain significance in the WFS1 gene. CONCLUSION These results project the need for NGS-based parallel multigene testing as a tool for early diagnosis of WFS and identify heterozygous WFS1 variants implicated in young-onset diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Simon
- Christian Medical College Vellore, India
| | - Sujeet Jha
- Max Super Speciality Hospital, New Delhi, India
| | - Subhankar Chowdry
- Institute of Post-Graduate Medical Education and Research, Kolkotta, India
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Korula S, Beryl S, Kamath V, Mathew SS, Joseph V. Turner Syndrome and Craniopharyngioma. Indian J Pediatr 2022; 89:181-183. [PMID: 34843061 DOI: 10.1007/s12098-021-03990-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
Turner syndrome (TS) affects nearly 1 in 2000 live births (1) and craniopharyngioma, a benign brain tumor, has been reported to occur at an incidence of 1.3 per million (2). These rare disorders are not known to coexist. The authors report a patient with incidental suprasellar mass who was diagnosed with both craniopharyngioma and TS, a rare association.
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Affiliation(s)
- Sophy Korula
- Pediatric Unit 1, Christian Medical College Hospital, Vellore, Tamil Nadu,, 632004, India.
| | - Shafini Beryl
- Pediatric Unit 1, Christian Medical College Hospital, Vellore, Tamil Nadu,, 632004, India
| | - Vandana Kamath
- Department of Cytogenetics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sherin Susheel Mathew
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Vivek Joseph
- Neurosurgery Unit 3, Department of neurological sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Korula S, Yoganathan S, Peter J, Chandran M, Christudass CS, Danda S. Late Onset Multiple Acyl-CoA Dehydrogenase Deficiency: A Rare Treatable Neurometabolic Disorder. Ann Indian Acad Neurol 2022; 25:983-985. [PMID: 36561017 PMCID: PMC9764879 DOI: 10.4103/aian.aian_370_22] [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: 04/23/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sophy Korula
- Paediatric Endocrinology and Metabolism Division, Paediatric Unit-1, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence: Dr. Sophy Korula, Paediatric Endocrinology and Metabolism Division, Paediatric Unit-1, Christian Medical College, Vellore - 632004, Tamil Nadu, India. E-mail:
| | - Sangeetha Yoganathan
- Department of Neurological Sciences, Paediatric Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyanthi Peter
- Department of Paediatrics, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu, India
| | - Mahalakshmi Chandran
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sumita Danda
- Department of Medical Genetics, Clinical Genetics Unit, Christian Medical College, Vellore, Tamil Nadu, India
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Korula S, Ravichandran L, Paul PG, Johnson J, Chapla A, Santhanam S, Simon A, Mathai S. Genetic Heterogeneity and Challenges in the Management of Permanent Neonatal Diabetes Mellitus: A Single-Centre Study from South India. Indian J Endocrinol Metab 2022; 26:79-86. [PMID: 35662751 PMCID: PMC9162257 DOI: 10.4103/ijem.ijem_429_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/02/2021] [Revised: 12/16/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022] Open
Abstract
Aim and Objectives 1. To study the clinical outcome, growth and glycaemic control, 2. To study the frequency and type of genetic mutations. Methods This is a retrospective study with a review of data of medical records from 2008 till date. Results Twelve patients (six males) with neonatal diabetes mellitus (NDM) were identified. Median (interquartile range - (IQR)) age at diagnosis was 72 (31-95) days with a history of consanguinity in 75%. The median birth weight (range) was 2345 (900-3300) g. Follow-up data were available for eight patients with a median age at (IQR) follow-up of 3.3 (3-5.3) years. At follow-up, the mean annual HbA1c was 8.2% at a mean insulin dose of 1.1 U/kg/d. One patient with Wolcott-Rallison syndrome (WRS) and 21α-hydroxylase deficiency had poor growth and intellectual difficulty. The rest demonstrated satisfactory growth with an increase of mean weight centile from 2nd to 13th, height centile from 6.5th to 20th and normal neuro-cognitive development. Eleven patients underwent genetic testing with a molecular diagnosis in 54% (6/11): EIF2AK3 (n = 2) and one each in INS, PDX1, IL2RA and FOXP3. None had variants in ABCC8 or KCNJ11. One with immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome underwent haematopoietic stem cell transplant (HSCT) and later succumbed. Conclusion Our study demonstrates good clinical outcomes among NDM patients without immune dysfunction. Molecular diagnosis was attained only in around half of the patients (54%) with a great genetic heterogeneity.
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Affiliation(s)
- Sophy Korula
- Department of Paediatrics, Paediatric Unit-1, Paediatric Endocrinology and Metabolism Division, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Lavanya Ravichandran
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Praveen G. Paul
- Department of Paediatrics, Paediatric Unit-1, Paediatric Endocrinology and Metabolism Division, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Jabasteen Johnson
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Aaron Chapla
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anna Simon
- Department of Paediatrics, Paediatric Unit-1, Paediatric Endocrinology and Metabolism Division, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sarah Mathai
- Department of Paediatrics, Paediatric Unit-1, Paediatric Endocrinology and Metabolism Division, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Korula S, Mercy A. A treatable cause of neuroregression. CHRISMED J Health Res 2022. [DOI: 10.4103/cjhr.cjhr_40_22] [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: 03/19/2023] Open
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Ravichandran L, Korula S, Asha HS, Varghese D, Parthiban R, Johnson J, Ishwarya J, Shetty S, Cherian KE, Jebasingh F, Kapoor N, Pachat D, Mathai S, Simon A, Rajaratnam S, Paul TV, Thomas N, Chapla A. Allele-specific PCR and Next-generation sequencing based genetic screening for Congenital Adrenal Hyperplasia in India. Eur J Med Genet 2021; 64:104369. [PMID: 34718183 DOI: 10.1016/j.ejmg.2021.104369] [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: 08/10/2021] [Revised: 10/06/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
Genetic screening of Congenital Adrenal Hyperplasia (CAH) is known to be challenging due to the complexities in CYP21A2 genotyping and has not been the first-tier diagnostic tool in routine clinical practice. Also, with the advent of massive parallel sequencing technology, there is a need for investigating its utility in screening extended panel of genes implicated in CAH. In this study, we have established and utilized an Allele-Specific Polymerase Chain Reaction (ASPCR) based approach for screening eight common mutations in CYP21A2 gene followed by targeted Next Generation Sequencing (NGS) of CYP21A2, CYP11B1, CYP17A1, POR, and CYP19A1 genes in 72 clinically diagnosed CAH subjects from India. Through these investigations, 88.7% of the subjects with 21 hydroxylase deficiency were positive for eight CYP21A2 mutations with ASPCR. The targeted NGS assay was sensitive to pick up all the mutations identified by ASPCR. Utilizing NGS in subjects negative for ASPCR, five study subjects were homozygous positive for other CYP21A2 variants: one with a novel c.1274G>T, three with c.1451G>C and one with c.143A>G variant. One subject was compound heterozygous for c.955C>T and c.1042G>A variants identified using ASPCR and NGS. One subject suspected for a Simple Virilizing (SV) 21 hydroxylase deficiency was positive for a CYP19A1:c.1142A>T variant. CYP11B1 variants (c.1201-1G>A, c.1200+1del, c.412C>T, c.1024C>T, c.1012dup, c.623G>A) were identified in all six subjects suspected for 11 beta-hydroxylase deficiency. The overall mutation positivity was 97.2%. Our results suggest that ASPCR followed by targeted NGS is a cost-effective and comprehensive strategy for screening common CYP21A2 mutations and the CAH panel of genes in a clinical setting.
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Affiliation(s)
- Lavanya Ravichandran
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatric Endocrinology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - H S Asha
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Deny Varghese
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Parthiban R
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Jabasteen Johnson
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Janani Ishwarya
- Department of Biochemistry, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Sahana Shetty
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Felix Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Divya Pachat
- Department of Clinical Genetics, Aster MIMS, Calicut, Kerala, India
| | - Sarah Mathai
- Department of Paediatric Endocrinology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Anna Simon
- Department of Paediatric Endocrinology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Simon Rajaratnam
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Thomas V Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Aaron Chapla
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
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Abraham SSC, Yoganathan S, Koshy B, Oommen SP, Simon A, Mathai S, Korula S, Mathew L, Sathishkumar D, Jasper A, George R, Danda S. Phenotypic variability of a TREX1 variant in Aicardi-Goutieres type 1 patients from the Indian subcontinent. Eur J Med Genet 2021; 64:104291. [PMID: 34303877 DOI: 10.1016/j.ejmg.2021.104291] [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: 10/09/2020] [Revised: 06/18/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Aicardi-Goutieres Syndrome (AGS) is a heterogeneous genetic syndrome, manifesting early as encephalopathy and is associated with abnormal neurologic findings, hepatosplenomegaly, elevated liver enzymes, thrombocytopenia and intracranial calcification. The most severe neonatal type, AGS1, is caused by biallelic disease-causing variants in TREX1. In this study, we describe four patients with TREX1-related AGS1 whose phenotype overlaps with intra-uterine infections and neonatal lupus. Exome sequencing identified a previously reported TREX1 variant, c.223dup (NM_016381.5; p. Glu75GlyfsTer82) in all the four patients belonging to the Indian subcontinent. The functional consequence of the disease-causing variant was predicted by using a new combination of bioinformatics softwares. The recurrence of this pathogenic variant indicates a possible founder effect in TREX1 for AGS1 in this population. The phenotypic variability in those with this founder mutation can mimic intrauterine infections and neonatal lupus, thereby leading to misdiagnosis warranting a targeted genetic testing approach to be a part of the diagnostic workup to obtain a definite, early and cost-effective diagnosis in patients from Indian subcontinent with early onset encephalopathy.
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Affiliation(s)
| | - Sangeetha Yoganathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Beena Koshy
- Department of Developmental Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel Philip Oommen
- Department of Developmental Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna Simon
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sarah Mathai
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lydia Mathew
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anitha Jasper
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Renu George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sumita Danda
- Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India.
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Paul PG, Rebekah G, Korula S, Kumar M, Bondu JD, Palany R, Simon A, Mathai S. Optimizing Cord Blood Thyroid Stimulating Hormone Cutoff for Screening of Congenital Hypothyroidism-Experience from Screening 164,000 Newborns in a Tertiary Hospital in India. Indian J Endocrinol Metab 2021; 25:348-353. [PMID: 35136744 PMCID: PMC8793950 DOI: 10.4103/ijem.ijem_220_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/24/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In our institution, we have an ongoing newborn thyroid screening (NBS) program since July 2001. In the initial 9 months, we used cord blood thyroid-stimulating hormone (TSH) (CBTSH) cutoff of 20 mIU/L and thereafter the cutoff was increased to 25 mIU/L. Our objective was to evaluate whether a CBTSH cutoff of 25 mIU/L is sensitive and cost-effective in NBS of congenital hypothyroidism (CH). MATERIALS AND METHODS All in-born babies are screened and those with CBTSH ≥25 mIU/L are recalled for confirmatory TSH/T4/FT4 tests. CH is confirmed with elevated TSH and low T4/FT4. Those with CBTSH 20-24.99 mIU/L were recalled for confirmatory tests in initial period of our NBS and prospectively between January and August 2017. Statistical analysis was done to derive positive predictive value and sensitivity to diagnose CH for each CBTSH between 20 and 30 mIU/L. RESULTS A total of 164,163 neonates were screened from July 2001 to August 2017. Of the 2352 babies with CBTSH ≥25-30 mIU/L, 1763 returned for retesting and 5 confirmed as CH (4 gland-in-situ and 1 absent uptake on nuclear scan). Of the 14,742 screened during the study period, 195 of the 293 babies with CBTSH 20-24.99 mIU/L returned for retesting and none diagnosed as CH. A CBTSH of 25 mIU/L has 99.2% sensitivity and 97.5% specificity. A lower screen TSH cutoff 20 mIU/L would result in recall of additional 300 babies/year with no definite improvement in sensitivity. CONCLUSIONS Our data justify the continuation of using screen TSH cutoff of 25 mIU/L while using cord blood for NBS in our population. With a diverse and large population, it is important that we use feasible regional screen cutoffs for optimal use of our resources.
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Affiliation(s)
- Praveen G. Paul
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Joseph D. Bondu
- Department of Clinical Biochemistry, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Raghupathy Palany
- Department of Paediatric Endocrinology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Anna Simon
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sarah Mathai
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Ravichandran L, Korula S, Asha HS, Varghese D, Parthiban R, Jabasteen J, Jebasingh F, Kapoor N, Cherian KE, Mathai S, Simon A, Paul TV, Thomas N, Chapla A. Comprehensive and Cost-Effective Strategy for Genetic Screening of Congenital Adrenal Hyperplasia (CAH) in India. J Endocr Soc 2021. [PMCID: PMC8090757 DOI: 10.1210/jendso/bvab048.1020] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: With substantial challenges in molecular analysis of 21 hydroxylase deficiency and lack of studies in extended panel of genes implicated in CAH, genetic diagnosis is largely unavailable and unaffordable in India. Therefore, we aim to develop a cost-effective screening strategy in CAH using Allele Specific PCR and Targeted Next-Generation Sequencing (NGS). Methods: Long range PCR and restriction digestion were utilized to specifically amplify the CYP21A2 gene whereas multiplex PCR was used to amplify CYP11B1, CYP17A1, CYP19A1 and POR genes. In house developed Allele Specific PCR (ASPCR) for 8 hotspot mutations in CYP21A2 gene and targeted NGS for five genes was carried out. The results were validated using Sanger sequencing and MLPA. Results: Of the 50 patients suspected for 21 hydroxylase deficiency, 64% (n=32) were of Salt Wasting phenotype (SW), 30% (n=15) with Simple Virilizing (SV) phenotype and 6% (n=3) of the study population were suspected for non-classical (NC) CAH. The mutation positive rate of ASPCR was 86% (n=43). Seven patients carried more than two biallelic mutations indicating smaller gene conversions. The predominant mutation identified among the study subjects was I2G splice variant in SW phenotype (38%) and I172N in the SV phenotype (41%). Based on the Long range PCR amplification and restriction digestion we identified one patient with large gene conversion and one patient with large 30kb deletion. These results were confirmed with MLPA.
Additionally, utilizing the Targeted NGS we identified five patients with CYP21A2 variants (two patients with novel variants c.1274G>T, c.17_18delTG and two other variants in three patients - c.1451G>C, c.143A>G). We also identified a CYP19A1:c.1142A>T gene variant in a patient who was initially suspected for 21 hydroxylase deficiency. Out of six patients with 11 beta hydroxylase deficiency four patients were positive for homozygous CYP11B1 variants (c.1201-1G>A, c.1200 + 1delG, c.412C>T) and two patients with compound heterozygous variants (c.1024C>T and c.1012dupC, c.623G>A and c.412C>T).
Discussion: Utilizing the novel allele specific PCR followed by NGS we identified a total of 96% (48/50) of 21 hydroxylase deficiency patients with homozygous or compound heterozygous mutations and 2% (2/50) were positive for single heterozygous variant in CYP21A2 gene. ASPCR followed by multigene targeted NGS assay for genetic screening in CAH has shown to be a sensitive and specific strategy established in a clinical setting. To best of our knowledge this is the most cost-effective and comprehensive multigene screening carried out in India.
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Affiliation(s)
| | - Sophy Korula
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - H S Asha
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Deny Varghese
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - R Parthiban
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - J Jabasteen
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Felix Jebasingh
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Nitin Kapoor
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | | | - Sarah Mathai
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Anna Simon
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Thomas V Paul
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Nihal Thomas
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
| | - Aaron Chapla
- CHRISTIAN MEDICAL COLLEGE HOSP, DODD MEMORIAL LIBRARY, Vellore, India
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Barney AM, Danda S, Abraham A, Fouzia NA, Gowdra A, Abraham SSC, Sony M, Das S, Korula S, Mathai S, Simon A, Kumar S. Clinicogenetic Profile, Treatment Modalities, and Mortality Predictors of Gaucher Disease: A 15-Year Retrospective Study. Public Health Genomics 2021; 24:139-148. [PMID: 33823526 DOI: 10.1159/000514507] [Citation(s) in RCA: 2] [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] [Received: 09/03/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder, in which biallelic pathogenic variants in the Glucosidase beta acid (GBA) gene result in defective functioning of glucosylceramidase that causes deposition of glucocerebroside in cells. GD has 3 major types namely, non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). Definite treatment options are limited and expensive. They succumb early to the disease, if untreated. There is paucity of studies from the Indian subcontinent, which elicit the factors resulting in their premature mortality. MATERIALS AND METHODS A retrospective study was carried out in a tertiary care setting of South India to assess the clinical profile, mutation spectrum, and various management strategies (only supportive therapy, enzyme replacement therapy [ERT], substrate reduction therapy [SRT] haematopoietic stem cell transplant [HSCT]), and mortality predictors of patients with GD from 2004 to 2019. A Kaplan-Meier survival curve was plotted. In silico predictions were performed for novel variants. RESULTS There were 60 patients with all types of GD seen over the study period of 15 years. Their median age at diagnosis was 2 years. The median follow-up was for 5 years (interquartile range [IQR] = 2-8). The overall mortality rate was 35%; however, it was only 10% in those receiving definite treatment. Mortality was higher (47.5%) by more than 4 folds in those only on supportive therapy. The median survival from the time of diagnosis was 6.3 years (IQR = 3.5-10.8) in the definite treatment group and 3.5 years (IQR = 1-5) in those on supportive therapy. The Kaplan-Meier survival analysis showed significant (p value 0.001) mortality difference between these groups. The multiple logistic regression analysis found the neuronopathic type (OR = 5) and only supportive therapy (OR = 6.3) to be the independent risk factors for premature mortality. CONCLUSION GD is a rare disease with a high mortality rate, if left untreated. ERT and SRT are the definitive treatments which increase the survival. In resource-limited settings like India, with higher prevalence of the neuronopathic type, HSCT may be a more suitable definitive treatment option, due to its one-time intervention and cost, assuming similar efficacy to ERT. However, the efficacy and safety of HSCT in GD needs to be established further by substantial patient numbers undergoing it.
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Affiliation(s)
- Anitha M Barney
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Aby Abraham
- Department of Clinical Haematology, Christian Medical College, Vellore, India
| | - N A Fouzia
- Department of Clinical Haematology, Christian Medical College, Vellore, India
| | - Aruna Gowdra
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | | | - Mohan Sony
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Sweta Das
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Sophy Korula
- Department of Child Health, Christian Medical College, Vellore, India
| | - Sarah Mathai
- Department of Child Health, Christian Medical College, Vellore, India
| | - Anna Simon
- Department of Child Health, Christian Medical College, Vellore, India
| | - Sathish Kumar
- Department of Child Health, Christian Medical College, Vellore, India
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Sarkar S, Chacko SR, Korula S, Simon A, Mathai S, Chacko G, Chacko AG. Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas. Acta Neurochir (Wien) 2021; 163:499-509. [PMID: 33078364 DOI: 10.1007/s00701-020-04591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas. METHODS This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5-127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed. RESULTS Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011). CONCLUSIONS Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up.
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17
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Joy P, Yoganathan S, Korula S, Abraham SSC, Barney AM, Walter VM, Gibikote S, Danda S. Ghosal hematodiaphyseal dysplasia and response to corticosteroid therapy. Am J Med Genet A 2020; 185:596-599. [PMID: 33185009 DOI: 10.1002/ajmg.a.61961] [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] [Received: 05/09/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Praisy Joy
- Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sangeetha Yoganathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Pediatric Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anitha M Barney
- Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vrisha Madhuri Walter
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sumita Danda
- Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
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18
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Korula S, Danda S, Paul PG, Mathai S, Simon A. Hepatic Glycogenoses Among Children-Clinical and Biochemical Characterization: Single-Center Study. J Clin Exp Hepatol 2020; 10:222-227. [PMID: 32405178 PMCID: PMC7212290 DOI: 10.1016/j.jceh.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/08/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Glycogen storage disease (GSD) is typified by early morning seizures. Absence of this results in delayed diagnosis, especially the non-GSD 1 group. Data are limited to few patients with unclear outcome. OBJECTIVES 1. Study the common presentation and types of GSD. 2. Study the clinical and biochemical outcome. 3. Review genetic mutations. METHODS Observational study from May 2016-April 2019 at metabolic clinic at our center. RESULTS Total of 30 patients were diagnosed with GSD. Ten were excluded-Fanconi-Bickel (3) and <4 months follow-up (7). Data were analyzed for 20 patients (16 males). Mean age at presentation was 4.3 yrs. All had hepatomegaly, 90% had short stature, and 40% had early morning seizures. Mean follow-up was 22 months. There was a statistically significant improvement in metabolic parameters on treatment (mean)-fasting glucose from 50.4 to 79.5 mg/dl, SGPT from 416 to 199 U/L. Lipid profile showed reduction in triglycerides (318-225 mg/dl) but minimal increase in cholesterol (178-188 mg/dl). Mean weight centile improved from 14.1 to 20.3 and height centile from 2.3 to 7.9. Genetic testing confirmed types VI (3), III (3), IXa (1), IXc (1), and Ia (1). Liver biopsy confirmed GSD in 15/20. All were managed with uncooked corn starch. In addition, omega-3 fatty acid was used in 8/20 and high protein diet in 2 with GSD type III. CONCLUSION Awareness of GSD needs to improve among pediatricians and hepatologists. The most common symptoms are asymptomatic hepatomegaly and short stature. Dietary therapy with uncooked corn starch remains mainstay of treatment. Mixed hyperlipidemia is difficult to control despite good metabolic improvement. Role of omega-3 fatty acid needs to be explored further. Genetic mutation analysis can assist with tailoring treatment and should get precedence over liver biopsy.
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Affiliation(s)
- Sophy Korula
- Paediatric Endocrinology and Metabolism Unit, Christian Medical College and Hospital, Vellore, India
| | - Sumita Danda
- Clinical Genetics Department, Christian Medical College and Hospital, Vellore, India
| | - Praveen G. Paul
- Paediatric Endocrinology and Metabolism Unit, Christian Medical College and Hospital, Vellore, India
| | - Sarah Mathai
- Paediatric Endocrinology and Metabolism Unit, Christian Medical College and Hospital, Vellore, India
| | - Anna Simon
- Paediatric Endocrinology and Metabolism Unit, Christian Medical College and Hospital, Vellore, India
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19
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Srinivas R, Jacob TJK, Raj PM, Korula S, Mathew LG. Paediatric mucormycosis: tailoring surgical strategies to compliment antifungal chemotherapy. Different strokes for different folks. Trop Doct 2020; 50:87-90. [PMID: 31928201 DOI: 10.1177/0049475519874270] [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
Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.
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Affiliation(s)
- Rohith Srinivas
- Department of Paediatric Surgery, Christian Medical College, Vellore, India
| | - Tarun John K Jacob
- Department of Paediatric Surgery, Christian Medical College, Vellore, India
| | - Promila Mohan Raj
- Lecturer, Department of Microbiology, Christian Medical College, Vellore, India
| | - Sophy Korula
- Department of Paediatric Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - Leni G Mathew
- Professor and Head, Department of Paediatric Haematology and Oncology, Christian Medical College and Hospital, Vellore, India
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20
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Thomas AM, Korula S, Thomas L, Sridhar S, Mathai J, Hephzibah J. Neonatal Cholestasis Syndrome: Aetiological Spectrum and Outcome Analysis- Single Center Study. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/42699.13261] [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: 11/24/2022]
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21
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Korula S, Chapla A, Priyambada L, Mathai S, Simon A. Sirolimus therapy for congenital hyperinsulinism in an infant with a novel homozygous KCNJ11 mutation. J Pediatr Endocrinol Metab 2018; 31:87-89. [PMID: 29176012 DOI: 10.1515/jpem-2017-0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/21/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Congenital hyperinsulinism results in refractory hypoglycemia. If a therapy with diazoxide has been unresponsive this has been treated by subtotal pancreatectomy in the past. This therapeutic option poses an increased risk of developing diabetes at a later stage. There have been a few case reports on the use of sirolimus in such situations in the recent past. CASE PRESENTATION Our patient was started on sirolimus very early, on day 29 of life and at the age of 14 months is doing well on sirolimus therapy. His growth and development have been good and he has not had any major complications so far. Genetic testing showed a novel KCNJ11 homozygous mutation on next generation sequencing and the parents were heterozygous carriers. CONCLUSIONS We report the successful use of sirolimus in the management of diazoxide unresponsive congenital hyperinsulinism with diffuse pancreatic involvement. We believe this is the youngest patient to be initiated on sirolimus so far.
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Affiliation(s)
- Sophy Korula
- Paediatric Endocrinology and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Aaron Chapla
- Molecular Genetics Lab, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Leena Priyambada
- Paediatric Endocrinology and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sarah Mathai
- Paediatric Endocrinology and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anna Simon
- Paediatric Endocrinology and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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22
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Lau YN, Korula S, Chan AK, Heels K, Krass I, Ambler G. Analysis of insulin pump settings in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2016; 17:319-26. [PMID: 25998469 DOI: 10.1111/pedi.12285] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022] Open
Abstract
AIM To characterize current insulin pump settings used in young patients with type 1 diabetes mellitus (T1DM) and to assess their relationship to glycemic control. METHODS This retrospective study included patients aged <18 yr old with T1DM >1 yr using a Medtronic pump device. Pump data including number of blood glucose (BG) tests per day, basal and bolus insulin parameters, carbohydrate ratio (CR), and insulin sensitivity factors (ISFs) were averaged over 14 d for statistical analyses. Anthropometric data and recent glycosylated hemoglobin A1c (HbA1c) were recorded. RESULTS A total of 292 patients (144 males and 148 females) were included in the study. Participants had a median age (interquartile range, IQR) of 12.9 yr (10.0-15.1 yr) and pump duration of 2.8 yr (1.5-4.2 yr). No significant differences in median HbA1c (IQR) were observed in preschool [n = 14; HbA1c 7.8% (7.3-8.3%)], prepubertal [n = 105; HbA1c 8.1% (7.7-8.9%)], and adolescent subjects [n = 173; HbA1c 8.4% (7.7-9.0%)]. Adolescents took significantly fewer boluses and BG tests per day compared with younger children (p < 0.05). Age-specific diurnal variation in basal insulin delivery was noted. Additionally, stronger carbohydrate cover and weaker corrections were used in real-life compared with theoretical 500 and 100 rules, respectively. Lower HbA1c was associated with higher number of daily boluses, greater number of BG tests per day, lower average CR/500 rule ratio, and higher average ISF/100 rule ratio adjusted for age (R(2) = 0.22; p < 0.01). CONCLUSION Insulin pump therapy requires continuous adjustments and glycemic targets are achieved by a minority. We believe this is the first study in pediatric cohort looking at association between CR and ISF with glycemic control.
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Affiliation(s)
- Yu Ning Lau
- Pharmacy Department, University of Sydney, Sydney, Australia
| | - Sophy Korula
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Albert K Chan
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Kristine Heels
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Ines Krass
- Pharmacy Department, University of Sydney, Sydney, Australia
| | - Geoffrey Ambler
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
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Korula S, Owens P, Charlton A, Bhattacharya K. Rare Case of Hepatic Gaucheroma in a Child on Enzyme Replacement Therapy. JIMD Rep 2016; 32:101-104. [PMID: 27334896 DOI: 10.1007/8904_2016_562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We present a 6 year old boy with type I Gaucher treated from 16 months with ERT, developing focal Gaucheroma in the liver at 3.5 years. CASE The subject presented at 13 months of age with anaemia, thrombocytopenia and hepatosplenomegaly. Gaucher disease was confirmed by leucocyte enzyme assay. A homozygous change: c.1193G>A (p.Arg398Gln) in the GBA gene was identified. He had normal neurology with normal saccades. Imiglucerase was administered at 60 IU/kg/fortnight from 15 months as per Australian regulations with good clinical response. At 3.5 years hepatic ultrasound demonstrated a nodular cystic lesion measuring 7 × 5.3 × 5.1 cm in the right lobe of liver, confirmed on MRI. Biopsy demonstrated acellular hyaline necrosis, portal-portal bridging fibrosis and nodules of Gaucher cells. Cystic fluid comprised necrotic debris and Gaucher cells. Further evaluation over 18 months including repeat MRI, biopsy, alpha-fetoprotein monitoring and whole-body FDG-Pet scan demonstrate no malignancy. CONCLUSION GD is the most common lysosomal storage disorder. The aetiology, natural history and optimal management strategy of rare Gaucheroma in paediatric cases has not been defined particularly in regards to malignancy risk.
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Affiliation(s)
- Sophy Korula
- Genetic Metabolic Disorders Service, Children's Hospital at Westmead, Sydney, NSW, 2145, Australia.
| | - Penny Owens
- Genetic Metabolic Disorders Service, Children's Hospital at Westmead, Sydney, NSW, 2145, Australia
| | - Amanda Charlton
- Genetic Metabolic Disorders Service, Children's Hospital at Westmead, Sydney, NSW, 2145, Australia
| | - Kaustuv Bhattacharya
- Genetic Metabolic Disorders Service, Children's Hospital at Westmead, Sydney, NSW, 2145, Australia
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Yu NL, Korula S, Heels K, Krass I, Ambler G. Analysis of insulin pump settings in children and adolescents with type 1 diabetes mellitus. Int J Pediatr Endocrinol 2015. [PMCID: PMC4429095 DOI: 10.1186/1687-9856-2015-s1-p17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Korula S, Srinivasan S, Ambler G, Silink M, Howard N, Cowell C, Benitez-Aguirre P, Craig M, Donaghue K. Graves’ disease in children less than 8 years of age: review of clinical features and treatment outcome. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428259 DOI: 10.1186/1687-9856-2015-s1-p102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
As many as 50% of children will sustain a fracture before 18 years of age, and up to 20% will have two or more fractures. A small proportion of children who experience multiple fractures have osteoporosis, either from a genetic bone disorder (primary osteoporosis) or secondary to another underlying medical condition (secondary osteoporosis). Fracture history, together with bone mineral density assessment and vertebral radiographs, help clinicians to identify children with osteoporosis. Its aetiology can usually be determined through the combination of a detailed medical history and physical examination, laboratory investigations to assess mineral homeostasis, evaluation of secondary causes of osteoporosis and genetic studies to identify the underlying cause of the disorder. Transiliac bone biopsy with histology and histomorphometry should not be overlooked as valuable tools for the investigation of a child with osteoporosis of uncertain aetiology. Optimal management of osteoporosis requires a multidisciplinary team to address physical activity, nutrition, pubertal progression, the management of any underlying medical condition, pharmacotherapy (bisphosphonates) and orthopaedic surgery. This chapter outlines an approach to the evaluation and treatment of children with recurrent fractures and describes three common scenarios involving infants, children with chronic illness and children without chronic illness.
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Korula S, Ekbote A, Kumar N, Danda S, Agarwal I, Chaturvedi S. Renal manifestations of tuberous sclerosis among children: an Indian experience and review of the literature. Clin Kidney J 2014; 7:134-7. [PMID: 25852861 PMCID: PMC4377768 DOI: 10.1093/ckj/sft162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 03/19/2013] [Accepted: 12/12/2013] [Indexed: 12/01/2022] Open
Abstract
Objective The objective of this study was to describe the renal manifestations in children 0–18 years of age diagnosed with tuberous sclerosis complex (TSC) at a tertiary hospital in South India. Methods Data of children with TSC, who presented to Christian Medical College Vellore Hospital from January 2008 to January 2013, were analysed by a retrospective chart review. The cases were identified from outpatient records and underwent ultrasonography, urine analysis and examination of serum creatinine to recognize renal involvement. Results Twenty-five children with TSC were identified. Two children did not have imaging studies available and were excluded from the analysis. The age of the included children ranged from 5 days to 15 years with a median age of 8 years. Seventy-four per cent (17/23) were males. Ten of the 23 children had evidence of renal involvement (43.5%). Of the 10 children with renal involvement, 6 had angiomyolipoma (60%), 5 had renal cysts (50%) and 1 had suspected renal cell carcinoma. In two children both angiomyolipoma (AML) and cysts were noted. One child was found to have proteinuria. The rest of the children had no evidence of proteinuria and had normal creatinine clearance. Conclusion We conclude that all children with TSC should be screened for renal involvement and regular follow-up should be arranged.
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Affiliation(s)
- Sophy Korula
- Department of Paediatrics , Christian Medical College and Hospital , Vellore , Tamil Nadu , India
| | - Alka Ekbote
- Department of Medical Genetics , Christian Medical College Hospital , Vellore , Tamil Nadu , India
| | - Naresh Kumar
- Department of Paediatrics , Christian Medical College and Hospital , Vellore , Tamil Nadu , India
| | - Sumita Danda
- Department of Medical Genetics , Christian Medical College Hospital , Vellore , Tamil Nadu , India
| | - Indira Agarwal
- Department of Paediatrics , Christian Medical College and Hospital , Vellore , Tamil Nadu , India
| | - Swasti Chaturvedi
- Department of Paediatrics , Christian Medical College and Hospital , Vellore , Tamil Nadu , India
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Varkki S, Tergestina M, Bhonsle VS, Moses PD, Mathai J, Korula S. Isolated pulmonary Langerhans cell histiocytosis. Indian J Pediatr 2013; 80:700-3. [PMID: 23001923 DOI: 10.1007/s12098-012-0866-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 6-y- old boy presenting with recurrent pneumothorax, whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Biopsy of the lesions confirmed pulmonary LCH with Cd1a and S 100 positivity.
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Affiliation(s)
- Sneha Varkki
- Department of Pediatrics, Unit 3, Christian Medical College, Vellore, Tamil Nadu 632004, India
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Basker MM, Mathai S, Korula S, Mammen PM. Eating disorders among adolescents in a tertiary care centre in India. Indian J Pediatr 2013; 80:211-4. [PMID: 22798272 DOI: 10.1007/s12098-012-0819-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To analyse the clinical profile of eating disorders (ED) among adolescent patients living in India. METHODS This is a descriptive study of a series of seven adolescent patients presenting to a tertiary care centre with characteristic clinical features of eating disorder. RESULTS Of the seven adolescents with ED there were 3 boys and 4 girls. Physical examination, psychiatric assessment and investigations confirmed the diagnosis of ED in all seven. Five adolescents were managed with nutritional rehabilitation and family based therapy as inpatients for about 3 wk. One was treated in the outpatient clinic and one was unwilling for treatment. Four patients who had strong family support recovered, 1 had minimal weight gain and 2 were lost to follow up. CONCLUSIONS The characteristic form of adolescent onset ED exists among adolescents living in India. A multidisciplinary approach to treatment is essential for a good outcome. This article was written to sensitize health care professionals, pediatricians in particular about the existence of ED among adolescents living in India and the current acceptable principles of management of this potentially fatal illness.
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Affiliation(s)
- Mona M Basker
- Department of Pediatrics, Christian Medical College, Vellore, Tamilnadu 632004, India.
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Abraham V, Korula S, Afzal L. Evaluation of low dose succinyl choline for insertion of laryngeal mask airway during thiopentone induction: A comparison with atracurium. J Anaesthesiol Clin Pharmacol 2010. [DOI: 10.4103/0970-9185.74777] [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: 11/04/2022] Open
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Puliyel MM, Pillai R, Korula S. Intravenous magnesium sulphate infusion in the management of very severe tetanus in a child: a descriptive case report. J Trop Pediatr 2009; 55:58-9. [PMID: 18701521 DOI: 10.1093/tropej/fmn066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a 7-year-old boy with very severe tetanus treated with continuous infusion of magnesium sulphate for the control of spasms and severe autonomic dysfunction which was refractory to deep sedation and mechanical ventilation. The infusion was not associated with any adverse effects and he made an uneventful recovery. We recommend the use of intravenous magnesium sulphate infusion as an inexpensive and highly effective modality in severe tetanus.
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Affiliation(s)
- Mammen M Puliyel
- Department of Child Health, Christian Medical College Hospital, Vellore, India.
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Abstract
We report on several individuals with bilateral cleft lip and palate, lagophthalmia, megaloblepharon, distichiasis, and ectropion of the lower eyelids, representing in total a distinct craniofacial syndrome. Eight cases (3 from 1 family) in ages ranging from 1-45 years were identified over a 7-year period in the Cleft Palate and Craniofacial Clinic at our center. All cases (3 male, 5 female) presented with bilateral cleft lip and palate and lagophthalmia. Birth weight, growth, and development were normal in all cases, except for one who probably has familial small stature. Five of the 8 cases have distichiasis, and 5 have ectropion in varying degrees; dental findings consisted of hypodontia in 5 and delayed dentition in 1 patient. Hypoplastic nails and clinodactyly were confined to 3 members of 1 family. Clinical evidence in these cases and a review of the literature regarding distichiasis and lagophthalmia, either alone or in combination with ectropion, suggest that this craniofacial syndrome is most likely an autosomal-dominant trait. The 5 non-familial cases probably represent new mutations.
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Affiliation(s)
- S Korula
- Cleft Palate Service, Rancho Los Amigos Medical Center, Downey, California, USA
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