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Chalipat S, Kulkarni V, Malwade S, Shah P, Bijaspur P. Silvery Gray Hair Syndrome With Hemophagocytic Lymphohistiocytosis: A Case Report. Cureus 2024; 16:e55649. [PMID: 38586648 PMCID: PMC10996885 DOI: 10.7759/cureus.55649] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Griscelli syndrome (GS) is a rare autosomal recessive disorder, which has been classified into three subtypes based on clinical and genetic differences. GS subtype 2 is commonly associated with hemophagocytic lymphohistiocytosis (HLH) and recurrent infections due to immunodeficiency. In this study, we describe a four-month-old boy with genetically proven GS2, with neurological and immunological manifestations. He presented with fever, refusal of feeds, drowsiness, and multiple episodes of seizures. Examination revealed hypopigmented skin, silvery gray hair, and organomegaly. The child developed features of HLH, fulfilling clinical and laboratory criteria. Neuroimaging findings were in concordance with HLH of the central nervous system. Microscopic examination of the hair showed clumps of melanin pigment along the hair shaft. All findings were in favor of GS type 2, complicated with HLH, which was later confirmed with a homozygous deletion of the RAB27A gene on exome sequencing. Unfortunately, the baby succumbed to death due to severe sepsis and multiorgan dysfunction. The silvery gray hair, with typical hair microscopic findings, and association with HLH are strong indicators for this potentially fatal condition and aid in prompt diagnosis and initiation of treatment. Hematopoietic stem cell transplantation is the only lifesaving treatment option.
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Affiliation(s)
- Shiji Chalipat
- Pediatrics, Dr. D.Y. Patil Medical College Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Vishwanath Kulkarni
- Pediatrics, Dr. D.Y. Patil Medical College Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D.Y. Patil Medical College Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Priyanka Shah
- Pediatrics, Dr. D.Y. Patil Medical College Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Prasad Bijaspur
- Pediatrics, Dr. D.Y. Patil Medical College Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
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2
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Chalipat S, Madala JS, Chavan S, Malwade S, Baviskar S. Critical Illness Polyneuropathy in a Child: A Case Report. Cureus 2024; 16:e56703. [PMID: 38646376 PMCID: PMC11032641 DOI: 10.7759/cureus.56703] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Critical illness polyneuropathy (CIP) and myopathy (CIM) are underreported conditions in critically ill children with prolonged intensive care unit stays and mechanical ventilation. We report a case of a 10-year-old boy with pneumococcal meningoencephalitis with severe sepsis and multiorgan dysfunction. The child required prolonged ventilation, sedation, and inotropic support. He had repeated extubation failures and the development of quadriparesis with areflexia. Electrophysiology studies were consistent with CIP with acute motor and sensory axonal polyneuropathy and elevated muscle enzymes. He was treated with supportive measures and physiotherapy along with management of the underlying condition. He recovered slowly over 68 days with a good recovery with a modified Rankin's scale score of 4 on discharge. There is a need to pay attention to all critically ill children and should have a high index of suspicion for the development of CIP/CIM which can have an impact on course and outcome.
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Affiliation(s)
- Shiji Chalipat
- Pediatric Neurology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Jyothsna Sree Madala
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Shilpa Baviskar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
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3
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Premkumar V, Jadhav R, Malwade S, Kale S. Severe Acute Malnutrition Presenting With Scurvy: A Case Report. Cureus 2024; 16:e54506. [PMID: 38516488 PMCID: PMC10955419 DOI: 10.7759/cureus.54506] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Scurvy is a disease caused by a lack of vitamin C. It is a nutritional deficiency that is associated with multiple severe conditions. Although developed countries report these cases rarely now due to advancements in food and nutritional supplements, they are still prevalent in developing countries, albeit rare, because of poor nutritional status. Due to the lower prevalence of scurvy, diagnosis is delayed in the majority of cases and sometimes missed completely, which results in serious complications and unnecessary workups. Here, we present a rare case of a four-year-old female child with severe acute malnutrition (SAM) presenting with scurvy. The initial clinical signs showed SAM. X-ray and MRI of the left femur and knee were done to further evaluate the orthopedic parameters. Clinical presentation and radiographic imaging confirmed all the signs of scurvy. The patient was started on the Formula 75 (F-75) diet to address the severe malnutrition, and steady weight gain was observed.
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Affiliation(s)
- Varsha Premkumar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Renuka Jadhav
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Shivani Kale
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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4
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Khot N, Joshi S, Malwade S, Chavan S, Mane SV, Agarkhedkar S, Arora A. A Comprehensive Echocardiographic Assessment of Neonatal Right Ventricular Function in Neonatal Intensive Care Unit Babies. Cureus 2023; 15:e37166. [PMID: 37153277 PMCID: PMC10162581 DOI: 10.7759/cureus.37166] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The right ventricle (RV) in the fetus is the predominant chamber, accounting for about 60% of the total cardiac output. The majority of the RV outflow volume is diverted from the pulmonary artery via the ductus arteriosus to the descending aorta. After birth, the RV undergoes extensive structural and functional modifications. The RV undergoes an improper transition from fetal to neonatal circulation in sick neonatal intensive care unit (NICU) babies. Functional echocardiography is now commonly being used in most NICUs as it is a noninvasive and bedside investigation that gives an immediate evaluation of hemodynamics and can be taken into consideration as an extension of clinical assessment to study a critically unwell neonate. Therefore, a study of RV functions in NICU neonates will help in better understanding the neonatal cardiopulmonary response to different diseases. Thus, this study aimed to assess RV functions in neonates getting admitted to the NICU of a tertiary care institute. Methodology This observational, cross-sectional study was approved by the Research & Recognition Committee of Dr. D. Y. Patil Vidyapeeth, Pune. In total, 35 cases of term neonates admitted to the NICU at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune who fulfilled the inclusion criteria were enrolled in this study after obtaining consent from their parents. Two-dimensional echocardiography was performed by a trained pediatric cardiologist, and the findings were substantiated by a neonatologist trained in echocardiography. Results Our study found a strong association between tricuspid inflow velocity and neonates with sepsis. Similarly, a significant association was observed between abnormal tricuspid Inflow velocity (E/A and E/E') and neonates requiring inotropic support. Conclusions Data on the normal values of different echocardiographic parameters of the systolic and diastolic function of the RV during the neonatal phase of life are currently limited. Our data offer preliminary insights into this topic. Early echocardiography and intervention are advisable, especially in neonates with sepsis and requiring inotropic support.
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Affiliation(s)
- Nikita Khot
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Santosh Joshi
- Pediatric Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Shailaja V Mane
- Pediatric Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sharad Agarkhedkar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Amodini Arora
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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5
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Kartikeswar G, Parikh T, Randive B, Kinikar A, Rajput U, Valvi C, Vaidya U, Malwade S, Agarkhedkar S, Kadam A, Smith R, Westercamp M, Schumacher C, Mave V, Robinson M, Gupta A, Milstone A, Manabe Y, Johnson J. Bloodstream infections in neonates with central venous catheters in three tertiary neonatal intensive care units in Pune, India. J Neonatal Perinatal Med 2023; 16:507-516. [PMID: 37718859 PMCID: PMC10875914 DOI: 10.3233/npm-221110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. RESULTS During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). CONCLUSIONS We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.
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Affiliation(s)
- G.A.P. Kartikeswar
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - T.B. Parikh
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - B. Randive
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A. Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U.C. Rajput
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - C. Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U. Vaidya
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - S. Malwade
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - S. Agarkhedkar
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - A. Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R.M. Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Westercamp
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C. Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V. Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M.L. Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A.M. Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y.C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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6
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Lohiya N, Chalipat S, Lohiya N, Malwade S. Neurocognitive, behavioral and socio-adaptive functioning assessment in a case of Coffin-Siris syndrome: A holistic approach/perspective beyond the identification of the disorder. J Pediatr Rehabil Med 2022; 15:529-532. [PMID: 35754295 DOI: 10.3233/prm-210050] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Coffin-Siris syndrome (CSS) is a rare genetic disorder characterized by the presence of particular facies, congenital malformations, intellectual developmental disorder, behavioral issues, and speech and language impairment. Thorough neuropsychological assessments in the case of CSS have been reported infrequently, and its subdomains are poorly defined. A detailed description of the clinical, neurocognitive, behavioral, socio-adaptive sequelae of the patient with CSS is provided. RESULTS The clinical diagnosis in the patient was confirmed by genetic analysis, which identified the presence of mutation of ARID1B gene; the parents' Sanger sequencing reported normal. The neuropsychological assessments revealed borderline intellectual functioning (IQ-75, verbal > performance) with a mild socio-adaptive deficit score of 64 as suggested by the adaptive scale. The behavioral profile reported that the child had significant difficulties in the attention subdomain with concern in social and thought subdomains. The child met the profile for mild severity of Autism Spectrum Disorder and did not meet the criteria for Attention Deficit Hyperactivity Disorder. In addition, the child had scholastic difficulties in reading and mathematical skills. CONCLUSION Neurocognitive, behavioral, socio-adaptive functioning and comorbidity assessment in order to provide holistic management of such children after thorough evaluation is essential for their overall functioning.
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Affiliation(s)
- Nirali Lohiya
- Dr. D Y Patil Medical College and Hospital, Pune, Maharashtra, India.,Division of Developmental & Behavioral Pediatrics, Silver Lining Pediatric Super speciality center, Nagpur, Maharashtra, India
| | - Shiji Chalipat
- Dr. D Y Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Nikhil Lohiya
- Dr. D Y Patil Medical College and Hospital, Pune, Maharashtra, India.,Division of Growth & Endocrinology, Silver Lining Pediatric Super speciality center, Nagpur, Maharashtra, India
| | - Sudhir Malwade
- Department of Pediatrics, Dr. D Y Patil Medical College and Hospital, Pune, Maharashtra, India
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Gangadharan A, Malwade S, Nayak M, Agarkhedkar S. Self-regressing scalp arteriovenous malformation in a neonate. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_32_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: 11/04/2022] Open
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8
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Gangadharan A, Malwade S, Nayak M, Agarkhedkar S. Fulminant late-onset sepsis due to elizabethkingia meningoseptica in term newborns. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_8_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: 11/04/2022] Open
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9
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Shukla D, Chalipat S, Chavan S, Agarkhedkar S, Malwade S, Kulkarni V. Etiological spectrum and predictors of intractability in early-onset epilepsy (3 months–2 years): A cross-sectional observational study. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_100_21] [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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10
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Johnson J, Robinson ML, Rajput UC, Valvi C, Kinikar A, Parikh TB, Vaidya U, Malwade S, Agarkhedkar S, Randive B, Kadam A, Smith RM, Westercamp M, Mave V, Gupta A, Milstone AM, Manabe YC. High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India. Clin Infect Dis 2021; 73:271-280. [PMID: 32421763 PMCID: PMC8282256 DOI: 10.1093/cid/ciaa554] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/17/2019] [Accepted: 05/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC). METHODS We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0-2 and late-onset BSI on DOL 3 or later. RESULTS From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non-low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001). CONCLUSIONS In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.
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Affiliation(s)
- Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Uday C Rajput
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Chhaya Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Tushar B Parikh
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - Umesh Vaidya
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - Sudhir Malwade
- Department of Pediatrics, Dr D. Y. Patil Medical College, Pune, India
| | | | - Bharat Randive
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Abhay Kadam
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rachel M Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Vidya Mave
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron M Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Chaturvedi S, Tillu G, Kale A, Pendse A, Kulkarni A, Ambike D, Krishnan M, Gaikwad M, Mulay M, Prabhudesai M, Nanal N, Tillu N, Jog P, Jamadar S, Kadam S, Singh SK, Komarajju S, Agarkhedkar S, Malwade S, Patwardhan B. Protocol for Infant Massage in Home Settings: An e-Delphi Approach for Consensus Guidance Integrating Traditional Wisdom with Modern Medicine. J Trop Pediatr 2021; 67:6313136. [PMID: 34213538 DOI: 10.1093/tropej/fmab043] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Infant massage is a highly prevalent traditional practice in India and other parts of Asia. Clear guidance on safe and effective uses of infant massage is lacking especially in the contemporary times when the traditional knowledge is on the verge of extinction and preparations may differ from in the past. This paper presents a consensus guidance in the form of a standardized protocol for routine massage of infants in home settings. Furthermore, a feasible method to develop an integrative protocol involving traditional and modern medicine experts is described. A modified e-Delphi method was used to develop the protocol. A group of seventeen experts, including academicians and practitioners from disciplines as modern paediatrics, Ayurveda paediatrics, Physiotherapy and Naturopathy participated in three rounds of a Delphi study to evolve the consensus guidance. The present protocol for massage of infants born beyond 34 weeks of gestation and weighing above 1.8 kg is recommended for use by care givers. This provides guidance on the preparation for infant massage such as when to begin massaging the infant, checking fitness of the infant for massage, the appropriate time, environment, person and substance for infant massage and a detailed description of the procedure for infant massage. Paediatricians, obstetricians and other child care practitioners can use this protocol to guide care givers on how to peform infant massage.
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Affiliation(s)
| | - Girish Tillu
- Centre for Complementary and Integrative Health, Savitribai Phule Pune University, Pune, India
| | - Anil Kale
- Department of Kaumarbhritya, Government Ayurved College, Osmanabad, Maharashtra, India
| | - Aruna Pendse
- Sumati Ayurvedic Clinic, Sadashiv Peth, Pune, India
| | | | - Deepali Ambike
- Department of Pediatrics, PCMC's Post Graduate Institute, Y C M Hospital, Pimpri, Pune, India
| | | | - Manoj Gaikwad
- Department of Prasutitantra and Streerog, Government Ayurved College, Nagpur, India
| | - Monica Mulay
- Department of Panchkarma, Tilak Ayurved Mahavidyalay, Pune, India
| | - Murlidhar Prabhudesai
- Shree Dhanvantari Ayurvedic Panchakarma Chikitsalaya, Bhom, Sindhudurg, Maharashtra, India
| | | | | | - Pramod Jog
- Department of Pediatrics, Dr D Y Patil Medical College Hospital and Research Centre, Pune, India
| | | | | | | | | | - Sharad Agarkhedkar
- Department of Pediatrics, Dr D Y Patil Medical College Hospital and Research Centre, Pune, India
| | - Sudhir Malwade
- Department of Pediatrics, Dr D Y Patil Medical College Hospital and Research Centre, Pune, India
| | - Bhushan Patwardhan
- Centre for Complementary and Integrative Health, Savitribai Phule Pune University, Pune, India
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12
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Johnson J, Latif A, Randive B, Kadam A, Rajput U, Kinikar A, Malshe N, Lalwani S, Parikh TB, Vaidya U, Malwade S, Agarkhedkar S, Curless MS, Coffin SE, Smith RM, Westercamp M, Colantuoni E, Robinson ML, Mave V, Gupta A, Manabe YC, Milstone AM. Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India. Front Pediatr 2021; 9:794637. [PMID: 35071137 PMCID: PMC8772032 DOI: 10.3389/fped.2021.794637] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices. Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload. Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03-1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning-continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001). Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.
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Affiliation(s)
- Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Asad Latif
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Bharat Randive
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Abhay Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Uday Rajput
- Department of Pediatrics, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Pediatrics, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Nandini Malshe
- Department of Neonatology, Bharati Vidyapeeth Deemed to Be University Medical College, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed to Be University Medical College, Pune, India
| | - Tushar B Parikh
- Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - Umesh Vaidya
- Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - Sudhir Malwade
- Department of Pediatrics, Dr. D. Y. Patil Medical College, Pune, India
| | | | - Melanie S Curless
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Susan E Coffin
- Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel M Smith
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aaron M Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Karambelkar G, Malwade S, Karambelkar R. Cost-analysis of healthcare in a private-sector neonatal intensive care unit in India. Indian Pediatr 2016; 53:793-795. [DOI: 10.1007/s13312-016-0933-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gupta M, Agarkhedkar S, Malwade S. Ambras syndrome. Med J DY Patil Univ 2015. [DOI: 10.4103/0975-2870.153186] [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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Malwade S, Agarkhedkar S, Joshi H. Persistent pulmonary hypertension and infantile hypertrophic pyloric stenosis in a neonate: Reduced nitric oxide levels could be a common etiological factor. Med J DY Patil Univ 2014. [DOI: 10.4103/0975-2870.140488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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