Publications by authors named "Anmol Bhatia"

74 Publications

Role of computed tomography for diagnosis of foreign body aspiration in children.

Pediatr Int 2021 May;63(5):612-613

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1111/ped.14578DOI Listing
May 2021

Chest MRI as an emerging modality in the evaluation of empyema in children with specific indications: Pilot study.

Pediatr Pulmonol 2021 May 8. Epub 2021 May 8.

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: To assess the diagnostic role of chest magnetic resonance imaging (MRI) for evaluating empyema in children with specific indications.

Methods: Nineteen children (5-16 years) with a diagnosis of empyema were enrolled in this prospective study from January 2018 to February 2020. MRI and multidetector computed tomography (MDCT) of the chest was performed within 48 h of each other. Two pediatric radiologists independently evaluated the MRI and CT images for the presence of fluid and air in the pleural cavity, septations within the fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Kappa test of agreement was used to determine the agreement between the MRI and MDCT findings. Chance-corrected kappa statistics were used for calculating the interobserver variation.

Results: The kappa test showed almost perfect agreement (κ = 1) between MRI and MDCT for detecting fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Septations within the fluid were detected in 16 (84.2%) patients on MRI, and in 14 (73.7%) patients on MDCT. Almost perfect agreement (κ = 0.81-1.00) was seen for all the findings on CT and MRI between the two radiologists, except for pleural thickening for which a strong agreement (κ = 0.642) was observed.

Conclusion: MRI is comparable to MDCT for the detection of various findings in children with empyema. MRI may be considered in lieu of CT, as a problem-solving tool and as a radiation-reducing endeavor in children with empyema, specifically, only where CT is required for preoperative planning and evaluation of complications.
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http://dx.doi.org/10.1002/ppul.25457DOI Listing
May 2021

Comparison of unenhanced and contrast-enhanced 3 T magnetic resonance portovenography in children with extra hepatic portal venous obstruction.

Abdom Radiol (NY) 2021 Mar 30. Epub 2021 Mar 30.

Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Purpose: To evaluate role of 3-T magnetic resonance portovenography (MRPV) in children with extra hepatic portal venous obstruction (EHPVO) and compare unenhanced and contrast-enhanced sequences.

Methods: 20 Children with EHPVO underwent MRPV using unenhanced [T2, T1 pre-contrast, Balanced turbo field echo (BTFE)] and contrast-enhanced (CE) modified DIXON (mDIXON) sequences. The images were evaluated for the patency of abdominal veins, hepatic and splenic parenchyma by two radiologists for interobserver agreement.

Results: BTFE and post-contrast mDIXON sequences performed best for evaluation of abdominal veins. Concordance between the BTFE and CE sequences was good to very good for both the radiologists for splenic vein (SV) evaluation. The concordance between the two sequences for evaluation of superior mesenteric vein and its confluence with the SV was less remarkable and varied from fair to good, while the interobserver agreement was very good to perfect. The interobserver agreement between the BTFE and CE sequence for the evaluation of left renal vein was very good, while that for IVC was perfect. The agreement between BTFE and CE sequence was perfect for the evaluation of right and middle hepatic veins, while the interobserver agreement was good to perfect. The interobserver agreement was poor for evaluation of hepatic parenchyma on BTFE sequence as compared to CE sequence, and moderate for splenic parenchyma.

Conclusion: BTFE sequence is the single best unenhanced MR pulse sequence to detect all the vascular structures in children with EHPVO. CE-MRI is not superior to BTFE sequence and should be used at the discretion of the radiologist.
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http://dx.doi.org/10.1007/s00261-021-03064-1DOI Listing
March 2021

Diagnostic utility of MDCT in evaluation of persistent stridor in children: Large airway causes and benefit of additional findings.

Pediatr Pulmonol 2021 Jul 31;56(7):2169-2176. Epub 2021 Mar 31.

Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Objectives: To assess the diagnostic utility of MDCT in the evaluation of persistent stridor in children for the underlying large airway causes and benefit of additional findings.

Methods: All consecutive pediatric patients who underwent MDCT for the evaluation of persistent stridor from December 2018 to February 2020 were included. Two pediatric radiologists independently reviewed MDCT studies for the presence of abnormalities at six large airway levels: (1) nasopharynx, (2) oropharynx, (3) glottis, (4) subglottis, (5) trachea, and (6) mainstem bronchi. In addition, studies were evaluated for the presence of non-airway abnormalities. Interobserver agreement between two reviewers was evaluated with kappa statistics.

Results: There were a total of 40 pediatric patients (age range: 1 day-4 years. MDCT detected large airway abnormalities in 20 (50%) out of 40 patients, including 4 (20%) in nasopharynx, 4 (20%) in glottis, 4 (20%) in trachea, 3 (15%) in subglottis, 3 (15%) in mainstem bronchi, and 2 (10%) in oropharynx. Non-airway abnormalities were seen in 13 (32.5%) children, including 9 (69%) in the lungs, 3 (23%) in the soft tissue, and 1 (8%) in the bone. The remaining 7 (17.5%) studies were normal. There was excellent interobserver agreement seen for detecting large airway and non-airway abnormalities (k > 0.90).

Conclusion: MDCT has high diagnostic utility in diagnosing large airway causes of persistent stridor in children. It can also provide additional information regarding non-airway abnormalities. Therefore, MDCT has the potential to be utilized as a noninvasive problem-solving imaging modality in pediatric patients with persistent stridor.
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http://dx.doi.org/10.1002/ppul.25382DOI Listing
July 2021

Fibrosing Mediastinitis Associated With Tuberculosis in Children.

Pediatr Infect Dis J 2021 Apr;40(4):e166-e169

From the Pediatric Pulmonology Unit, Department of Pediatrics, Advanced Pediatrics Centre.

Two children developed fibrosing mediastinitis following past tuberculosis disease. Both were microbiologically negative for tuberculosis at presentation. One was treated with steroids and supportive therapy, but developed active tuberculosis with complications. He ultimately succumbed to healthcare-associated infection. The other recovered with steroids, administered along with antituberculosis treatment.
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http://dx.doi.org/10.1097/INF.0000000000003049DOI Listing
April 2021

Comparison of Elastography Point Quantification with Transient Elastography in Patients with Chronic Viral Hepatitis and Nonalcoholic Fatty Liver Disease: A Pilot Study.

J Clin Exp Hepatol 2021 Jan-Feb;11(1):21-29. Epub 2020 Jul 2.

Departments of Radiodiagnosis and Imaging, Chandigarh, 160012, India.

Aims: The objective of this study was to compare diagnostic accuracy of elastography point quantification (ElastPQ) with transient elastography (TE) and liver histology for measuring liver stiffness in patients with chronic viral hepatitis (CVH) and nonalcoholic fatty liver disease (NAFLD).

Methods: Thirty-two patients with chronic liver disease (CVH and NAFLD) were evaluated by ElastPQ and TE within 7 days of liver biopsy. Within the CVH group, subgroup analysis was carried out in patients with end-stage renal disease (ESRD) and without ESRD. Area under the receiver operating characteristic (AUROC) curves were calculated for ElastPQ and TE.

Results: There were 15 patients with CVH and 17 patients with NAFLD. In the CVH group, there were 8 patients with ESRD and 7 patients without ESRD. Taking liver histopathology as the gold standard, liver stiffness measurement by ElastPQ (ρ = 0.826; < 0.0001) and TE (ρ = 0.649;  < 0.0001) correlated significantly with the stage of fibrosis. AUROCs of ElastPQ and TE for the diagnosis of any fibrosis (F ≥ 1), significant fibrosis (F ≥ 2), and advanced fibrosis (F ≥ 3) were 0.907, 0.959, 0.926 and 0.870, 0.770, 0.881, respectively, in both CVH and NAFLD groups. However, the accuracy of both these techniques was poor in patients with CVH and ESRD (AUROCs for ElastPQ and TE of 0.667 and 0.167 for the diagnosis of significant fibrosis, respectively, and 0.429 and 0.143 for the diagnosis of advanced fibrosis, respectively). The diagnostic accuracy of both ElastPQ and TE for detecting significant fibrosis was excellent in patients with NAFLD (AUROC of 1.000 and 0.936, respectively). ElastPQ was superior to TE in the diagnosis of significant fibrosis in the combined analysis ( = 0.0149) and in the CVH group ( = 0.0391), while both modalities were comparable in patients of the NAFLD group ( = 0.2539).

Conclusion: ElastPQ may be equally accurate as Fibroscan, and large prospective studies are required to validate the same.
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http://dx.doi.org/10.1016/j.jceh.2020.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897856PMC
July 2020

Prospective Evaluation of Free-Breathing Fast T2-Weighted MultiVane XD Sequence at 3-T MRI for Large Airway Assessment in Pediatric Patients.

AJR Am J Roentgenol 2021 04 3;216(4):1074-1080. Epub 2021 Feb 3.

Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.

The purpose of our study was to prospectively evaluate the technical feasibility of the free-breathing fast T2-weighted MultiVane XD sequence (sequence with non-Cartesian k-space filling using radial rectangular blades) at 3-T MRI for large airway assessment in pediatric patients. Forty consecutive pediatric patients (23 boys and 17 girls; age range, 5-15 years) referred for MRI examination for indications not related to neck, chest, or large airway disorders were enrolled in this prospective research study. All children underwent MRI in three planes using a free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI. The MR images were assessed by two pediatric radiologists independently for visualization of the large airways at six levels. The quality of the MR images was assessed and graded. Interobserver agreement between two radiologists was assessed using the kappa test, McNemar test, and intraclass correlation coefficients. High-quality MR images of the large airways were obtained in at least one plane in 38 MRI examinations (95.0%) by reviewer 1 and 37 MRI examinations (92.5%) by reviewer 2. Best-quality MR images with the least artifacts were seen in the sagittal plane followed by the coronal plane and the axial plane. The kappa test of agreement showed almost-perfect agreement between the two radiologists for MR image quality in the sagittal (κ = 1), coronal (κ = 0.96), and axial (κ = 0.81) planes. The McNemar test and intraclass correlation coefficients revealed similar results. The free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI is a technically feasible and promising new MRI technique for evaluating the large airways of pediatric patients in daily clinical practice.
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http://dx.doi.org/10.2214/AJR.20.23225DOI Listing
April 2021

Lung ultrasound as a non-invasive tool for respiratory distress syndrome.

Acta Paediatr 2021 05 27;110(5):1682. Epub 2021 Jan 27.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/apa.15739DOI Listing
May 2021

Outcome of percutaneous drainage in patients with pancreatic necrosis having organ failure.

HPB (Oxford) 2020 Nov 21. Epub 2020 Nov 21.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address:

Background: Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.

Methods: We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.

Results: Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis <50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.

Conclusion: PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.
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http://dx.doi.org/10.1016/j.hpb.2020.10.021DOI Listing
November 2020

Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute.

J Anaesthesiol Clin Pharmacol 2020 Apr-Jun;36(2):156-161. Epub 2020 Jun 15.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background And Aims: The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events.

Material And Methods: A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care.

Results: A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty-two percent children received one sedative drug, 60% children were administered two drugs, and 5% children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8% patients without the requirement of a repeat scan. Twelve (5%) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death.

Conclusions: The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.
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http://dx.doi.org/10.4103/joacp.JOACP_16_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480298PMC
June 2020

Response to letter to editor: Natural history of pancreatic fluid collections: are children different from adults?

Pancreatology 2020 Sep 5;20(6):1253-1254. Epub 2020 Aug 5.

Division of Paediatric Radiology, Institute of Medical Education & Research, Chandigarh, 160012, India.

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http://dx.doi.org/10.1016/j.pan.2020.07.404DOI Listing
September 2020

Ataxia as Forme Fruste of Opsoclonus Myoclonus Ataxia Syndrome.

Ann Indian Acad Neurol 2020 May-Jun;23(3):415-417. Epub 2020 Jun 10.

Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/aian.AIAN_111_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313590PMC
June 2020

Role of Transthoracic Lung Ultrasonography in Acute Pancreatitis.

Pancreas 2020 May/Jun;49(5):e47-e48

Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarh, India Department of RadiodiagnosisPostgraduate Institute of Medical Education and ResearchChandigarh, India Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarh, India Division of Surgical GastroenterologyDepartment of SurgeryPostgraduate Institute of Medical Education and ResearchChandigarh, India.

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http://dx.doi.org/10.1097/MPA.0000000000001556DOI Listing
May 2021

Role of Granulocyte Colony Stimulating Factor on the Short-Term Outcome of Children with Acute on Chronic Liver Failure.

J Clin Exp Hepatol 2020 May-Jun;10(3):201-210. Epub 2019 Oct 23.

Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.

Background: Acute-on-chronic liver failure (ACLF) results in very high mortality in children. We aimed to evaluate the role of granulocyte colony-stimulating factor (GCSF) on short-term outcome of children with ACLF in a nontransplant unit.

Methods: Children (aged > 1 year) diagnosed with ACLF over a 15 month period were randomised. Group A was given GCSF therapy along with standard medical care (SMC - details in supplementary data) and group B was given only SMC. The outcome was evaluated as survival at 30 and 60 days of therapy.

Result: Thirty-one children with ACLF were enrolled, with a mean age of 6.92 ± 4.3yrs. A total of 15 patients were randomised to group A and 16 to group B. The overall mortality was 54.83%. The intervention group showed survival rates of 80%, 66.67% and 53.3%, whereas the control group had survival rates of 43.75%, 37.5% and 37.5% at 14, 30 and 60 days, respectively. A significant survival benefit was noted on day 14 (p = 0.043) of therapy in group A with significant difference in Child-Turcotte-Pugh (CTP) and pediatric end-stage liver disease (PELD) scores in the two groups. After an initial rise in group A, the granulocyte counts fell to become comparable in the two groups by day 30 and 60, indicating that the effect of GCSF therapy wears off over time. There was no significant difference in the overall survival, median/mean CTP, PELD and MCS (Modified Cliff sequential organ failure assesment (SOFA)) scores on day 30 and 60. Mean (%) CD 34 + cells level showed a rise on day 7 in group A but was statistically insignificant.

Conclusion: The present study shows that GCSF therapy at 5 mcg/kg/day for 5 days seems to be ineffective in improving the survival outcome on day 30 and 60 of therapy. Studies with larger number of children enrolled and longer duration of therapy are required. (CTRI/2017/11/010420).
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http://dx.doi.org/10.1016/j.jceh.2019.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212291PMC
October 2019

Abdominal tuberculosis in children: A real-world experience of 218 cases from an endemic region.

JGH Open 2020 Apr 20;4(2):215-220. Epub 2019 Aug 20.

Department of Microbiology Post Graduate Institute of Medical Education and Research Chandigarh India.

Background And Aim: Abdominal tuberculosis (ATB) in children poses a diagnostic challenge because of its nonspecific clinical features, which often delay the diagnosis. Our aim was to present our real-world experience and provide an insight into the presentation, pattern of distribution, and diagnosis of the disease.

Methods: A retrospective review was conducted of case records of all children ≤12 years of age diagnosed with ATB from January 2007 to January 2018. Clinical details and investigations were recorded and analyzed.

Results: A total of 218 children (110 boys), with a median age of 10 (0.25-12) years, were included. There was a median delay of 4 (0.5-36) months in establishing the diagnosis. Abdominal pain, fever, and loss of weight were the most common presenting features, with the triad of symptoms present in 54%. Multiple intra-abdominal sites were involved in 118 (54%) patients, with a combination of the gastrointestinal tract (I) and abdominal lymph nodes (L) being the most common (53/118). Among children with single-site involvement ( = 100), the most commonly involved was L in 39 (39%), followed by I in 35(35%). Loss of weight was more common in children with involvement of multiple sites (85/118 60/100, = 0.03). Overall, a confirmed diagnosis was possible in 94 participants (43.1%). Suggestive imaging had the highest diagnostic yield of 85%. Nine (4.1%) patients needed surgical management.

Conclusion: A triad of abdominal pain, fever, and weight loss is suggestive of ATB. Multiple intra-abdominal sites are frequently involved. Microbiological confirmation is possible in only one-third of the cases.
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http://dx.doi.org/10.1002/jgh3.12245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144780PMC
April 2020

Role of noninvasive tools for prediction of clinically evident portal hypertension in children.

Eur J Gastroenterol Hepatol 2020 08;32(8):931-937

Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Noninvasive tools (NITs) for predicting varices in children with portal hypertension (PHTN) are infrequently used.

Methods: Eighty-five consecutive, treatment-naïve children with PHTN and 97 controls were enrolled study from July 2017 to November 2018. Each case was evaluated by esophagogastroduodenoscopy (EGD) and various NITs: platelet spleen size Z (PSZ), clinical prediction rule (CPR), King's variceal prediction rule (KVaPS), Splenic stiffness (SSM) and liver stiffness measurement (LSM) by point shear wave elastrography (pSWE).

Results: Had PHTN due to extra hepatic portal vein obstruction (EHPVO) and 70% due to cirrhosis [chronic liver disease (CLD)]. Sixty-five percent of PHTN cases had varices. Children with varices had lower platelet counts, lower albumin and larger spleens. SSM and LSM were significantly higher in cases as compared with controls. SSM was significantly higher in cases with varices than those without. SSM and LSM, at cutoffs of 3.8 and 3.2 kPa, respectively, discriminated PHTN cases from controls with an area under the curve (AUROC) of 0.67 (0.59-0.74). Both SSM and LSM predicted varices in CLD, but in EHPVO, only SSM predicted varices. SSM of 5.2 and 12.8 kPa, in CLD and EHPVO subgroups, respectively, had AUROC of 0.73 and 0.94 for variceal prediction. Blood-based NITs performed better in the CLD subgroup: aspartate aminotransferase platelet ratio index, CPR and KVPS predicted severity of PHTN with AUROC of 0.81, 0.92 and 0.93, respectively.

Conclusions: Blood-based NITs outperform elastography for prediction of PHTN/varices in children with CLD. SSM by pSWE is a better predictor of varices than LSM, especially in the EHPVO subgroup.
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http://dx.doi.org/10.1097/MEG.0000000000001716DOI Listing
August 2020

Paediatric acute pancreatitis: Clinical profile and natural history of collections.

Pancreatology 2020 Jun 13;20(4):659-664. Epub 2020 Mar 13.

Division of Paediatric Radiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.

Background & Aims: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes.

Methods: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed.

Results: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children.

Conclusions: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's.
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http://dx.doi.org/10.1016/j.pan.2020.03.007DOI Listing
June 2020

Ascites: an unusual presentation of eosinophilic gastroenteritis in a child.

Trop Doct 2020 Jul 16;50(3):277-279. Epub 2020 Mar 16.

Professor and Head, Division of Paediatric Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.

Eosinophilic ascites, owing to serosal involvement, is a very rare manifestation of eosinophilic gastroenteritis in children, especially when it occurs with muscular involvement in the absence of mucosal disease, which may be confirmed by endoscopic ultrasonography. An 11-year-old girl, presenting with massive eosinophilic ascites and colicky abdominal pain with peripheral eosinophilia, raised IgE levels and positive skin prick test, had such investigation which confirmed the presence of muscle layer thickening of both stomach and small bowel. She responded well to steroids and montelukast.
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http://dx.doi.org/10.1177/0049475520911230DOI Listing
July 2020

Chylothorax in a Child with Nephrotic Syndrome.

Indian J Nephrol 2020 Jan-Feb;30(1):32-34. Epub 2019 Sep 17.

Division of Pediatric Nephrology, Department of Pediatrics, PGIMER, Chandigarh, India.

Chylothorax is an uncommon presentation of venous thrombosis in nephrotic syndrome. We present a case of an 8-year-old boy with nephrotic syndrome who presented with prolonged respiratory difficulty and dry cough. A detailed evaluation revealed left chylothorax secondary to thrombosis of the left brachiocephalic vein. He improved with conservative management including anticoagulation therapy, intercostal chest tube drainage, and dietary modification. This case highlights the need to consider venous thrombosis as a cause of chylothorax in patients with nephrotic syndrome to institute appropriate treatment.
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http://dx.doi.org/10.4103/ijn.IJN_24_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977379PMC
September 2019

Fusion Image-Guided and Ultrasound-Guided Fine Needle Aspiration in Patients With Suspected Hepatic Metastases.

J Clin Exp Hepatol 2019 Sep-Oct;9(5):547-553. Epub 2019 Jan 25.

Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.

Aim: The aim of this study was to compare the diagnostic adequacy of computed tomography (CT)-ultrasound (US) fusion image-guided fine needle aspiration (FNA) and US-guided FNA in patients with suspected hepatic metastases.

Methods: Thirty consecutive patients of either sex with known or unknown primary malignancy suspected of having liver metastases on both US and CT, whose multiphasic contrast-enhanced computed tomography was performed using a 64-slice or a higher slice CT scanner, and who were referred for percutaneous FNA were included in this prospective study approved by the institutional review board of the study institute. CT-ultrasound fusion image-guided FNA of the largest lesion using electromagnetic tracking and with freehand ultrasound-guided FNA were performed in the same sitting. Value of fitness, which is a rough estimate of how well the fusion has been achieved, was recorded. Diagnostic adequacy of smears was assessed by a scoring system based on cellular material, background blood/clot, degree of cellular degeneration or trauma, and retention of architecture.

Results: The size of the lesions ranged from 1 to 10 cm, and the depth of location of the lesions ranged from 1.4 to 9.3 cm. The fusion fitness values ranged from 1.2 to 10 mm. The scores of the smears did not correlate with lesion size, depth of location, and fusion fitness value. Diagnostic adequacy was seen in 90% and 93.3% of lesions sampled by fusion image guidance and ultrasound guidance, respectively (p = 0.655). All the lesions that yielded inadequate smears by fusion guidance were deep-seated lesions (>5 cm). All the lesions that yielded inadequate smears by ultrasound guidance were small lesions (<3 cm). No complications were encountered in any of the patients.

Conclusion: Fusion image-guided FNA is a safe procedure with a high diagnostic adequacy rate. Fusion image-guided FNA is not better than US-guided FNA for conspicuous hepatic lesions; however, it may be useful in inconspicuous lesions.
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http://dx.doi.org/10.1016/j.jceh.2019.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823694PMC
January 2019

Diagnostic accuracy of 3-T lung magnetic resonance imaging in human immunodeficiency virus-positive children.

Pediatr Radiol 2020 01 13;50(1):38-45. Epub 2019 Sep 13.

Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.

Background: More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis.

Objective: To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard.

Materials And Methods: We included 25 children with confirmed HIV-positive status and pulmonary complaints who were referred for chest CT. All children had 3-T thorax MRI using T2-W turbo spin-echo sequence, steady-state free precession gradient echo sequence, T2-W turbo spin-echo MultiVane XD sequence, and T1-weighted modified Dixon sequences. We evaluated the images for various pulmonary and mediastinal findings and calculated the sensitivity and specificity of 3-T thoracic MRI.

Results: Sensitivity of 3-T MRI was 100% for detecting nodules >4 mm (95% confidence interval [CI] 66.3-100%), pleural effusion (CI 29.2-100%) and lymphadenopathy (CI 81.5-100%). It demonstrated a specificity of 100% for nodules >4 mm (CI 79.4-100%), pleural effusion (CI 84.6-100%) and lymphadenopathy (CI 59-100%). For consolidation/collapse, sensitivity and specificity were 93.8% (CI 69.8-99.8%) and 88.9% (CI 51.8-99.7%), respectively. The sensitivity and specificity for detecting bronchiectasis were 75% (CI 42.8-94.5%) and 100% (CI 75.3-100%), respectively, while for ground-glass opacity, sensitivity and specificity were 75% (CI 34.9-96.8%) and 94.1% (CI 71.3-99.9%), respectively. Nodules <4 mm were not well detected on MRI, with sensitivity of 35% (CI 15.4-59.2%).

Conclusion: Thoracic MRI at 3 T demonstrates a high sensitivity and specificity for detecting nodules >4 mm, effusion and lymphadenopathy in HIV-positive children.
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http://dx.doi.org/10.1007/s00247-019-04523-0DOI Listing
January 2020

Wormian Bones and Dilated Scalp Veins in an Infant With Epilepsy.

J Pediatr Neurosci 2019 Apr-Jun;14(2):103-104

Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

A three-months boy presented with recurrent seizures. On examination, he was fair, had dilated scalp veins, sparse hypopigmented hair, and was hypotonic. X-ray of the skull showed wormian bones. The child was diagnosed with Menkes disease. The manuscript aims to emphasize dilated scalp veins in diagnosis of Menkes disease.
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http://dx.doi.org/10.4103/jpn.JPN_151_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712920PMC
September 2019

Infantile form of Niemann-Pick disease type C with demyelination: An uncommon feature.

Neurol India 2019 May-Jun;67(3):783-786

Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Demyelination, neurofibrillary tangles, and axonal spheroids are neuropathological features rarely encountered in infantile form of Niemann-Pick disease type C compared to swollen neurons and neuronal loss which are more commonly seen. We describe clinico-pathological findings in an autopsy case of an infant who died of suspected inborn error of metabolism. At autopsy, storage cells of Niemann-Pick type were observed in plenty in spleen and lymph nodes, and sparsely in liver and brain. Preterminally, the child also developed fungal meningitis with minimal boderzone encephalitis. The neuropathological findings are unique and have been illustrated in detail.Congenital anomaly of the urogenital system was an incidental associated finding.
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http://dx.doi.org/10.4103/0028-3886.263230DOI Listing
February 2020

Dancing Eyes.

J Pediatr 2019 11 11;214:231. Epub 2019 Jul 11.

Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1016/j.jpeds.2019.06.035DOI Listing
November 2019

Acute pancreatitis with Cullen's sign presentation in a case of mixed type I and II choledochal cyst.

J Pediatr Surg 2019 Oct 20;54(10):2187-2190. Epub 2019 Jun 20.

Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

A 3 year old girl presented initially with acute severe hemorrhagic pancreatitis diagnosed by clinical features including a positive Cullen's sign and raised serum amylase. A contrast enhanced computed tomography (CECT) scan corroborated the same and also reported a type I choledochal cyst. Magnetic resonance cholangiopancreatography (MRCP) 2 months later reported a type II choledochal cyst and a persistent pseudo pancreatic cyst. Intraoperative features and close perusal of the CECT and MRCP films showed the presence of mixed type I and II choledochal cyst. The case is reported for the presence of Cullen's sign, CECT and MRCP features of a mixed type I and II choledochal cyst and successful surgical outcome. It appears to be only the fifth case of mixed type I and II choledochal cyst in world literature in the pediatric age group, following the 4 previous cases in children reported from Japan.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.06.011DOI Listing
October 2019

First Case Report of Intraventricular Tigecycline in a Neonate With Extensively Drug-resistant Acinetobacter baumannii Ventriculitis.

Pediatr Infect Dis J 2019 08;38(8):e172-e174

Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infections have been increasing as a cause of healthcare-associated infections in the neonatal age group. In this report, we describe a 27-week, 1028 g, preterm neonate with extensively drug-resistant A. baumannii infection complicated by ventriculitis who did not respond to intravenous and intraventricular colistin but did respond after intraventricular tigecycline. This is the first case report describing the use of intraventricular tigecycline in a neonate with ventriculitis.
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http://dx.doi.org/10.1097/INF.0000000000002348DOI Listing
August 2019

Lipomatosis of spinal epidural space, peritoneum, and renal sinus: a rare complication of long-term steroid therapy in a child with nephrotic syndrome.

Childs Nerv Syst 2019 08 2;35(8):1401-1405. Epub 2019 Apr 2.

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Excessive visceral adipose tissue proliferation, resulting in diffuse lipomatosis, is a rare complication of long-term steroid therapy. A 10-year-old boy presented with severe radicular back pain with limitation of lower limb movements. He was diagnosed with steroid-resistant nephrotic syndrome and was on unregulated steroid therapy. Magnetic resonance imaging of the spine showed increased adipose tissue in the epidural space of the lumbo-sacral spine causing clumping of cauda equina nerve roots along with marked proliferation of fat in the renal sinus as well as peritoneum. He was started on pregabalin with tapering of steroids, following which there was a gradual decrease in pain and improvement of activity. Our patient had diffuse lipomatosis involving spinal epidural space, bilateral renal sinus, and peritoneum, secondary to steroid overuse. With the availability of advanced imaging techniques, the condition can be prevented by judicious and proper use of steroids with close follow-up for any untoward complications.
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http://dx.doi.org/10.1007/s00381-019-04141-zDOI Listing
August 2019

Prospective Comparison of MRI and Contrast-Enhanced MDCT for Evaluation of Pediatric Pulmonary Hydatid Disease: Added Diagnostic Value of MRI.

AJR Am J Roentgenol 2019 Feb 19:1-6. Epub 2019 Feb 19.

4 Department of Radiology, Boston Children's Hospital, and Harvard Medical School, Boston, MA.

Objective: The objective of our study was to prospectively investigate the diagnostic accuracy and added value of fast MRI for evaluating pulmonary hydatid disease in children by comparing fast MRI findings with MDCT findings.

Subjects And Methods: Twenty-eight consecutive children (24 boys and four girls; mean age ± SD, 8.93 ± 3.1 years; range, 5-17 years) with clinically suspected pulmonary hydatid disease were enrolled in this prospective research study for the period from October 2012 to July 2018. Fast MRI without contrast material and contrast-enhanced MDCT of the chest were performed within 48 hours of each other in all children. Two pediatric radiologists independently evaluated the lungs for the presence of consolidation, nodule, and mass (solid vs cyst). Cysts were further evaluated for the presence of fluid, air, and an internal membrane. The accuracies of fast MRI and MDCT for detecting pulmonary hydatid disease were obtained and compared. Interobserver agreement was measured with the kappa coefficient.

Results: The accuracy of fast MRI and MDCT for detecting pulmonary hydatid cyst was 92.86%. There was no difference between fast MRI and MDCT for accurately detecting pulmonary hydatid cyst (p < 0.001). Internal membranes were detected in 11 of 28 patients (39.28%) with fast MRI and three of 28 patients (10.71%) with MDCT. Almost perfect interobserver agreement was present between the two independent reviewers (κ = 1).

Conclusion: Fast MRI without contrast material is comparable to contrast-enhanced MDCT for accurately detecting lung cysts in pediatric patients with pulmonary hydatid disease. However, fast MRI provides added diagnostic value by showing internal membranes of cysts, which is specific to pulmonary hydatid disease.
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http://dx.doi.org/10.2214/AJR.18.20928DOI Listing
February 2019

Role of Diagnostic Endoscopic Ultrasound in Idiopathic Acute Pancreatitis and Acute Recurrent Pancreatitis in Children.

Pancreas 2019 03;48(3):350-355

From the Division of Pediatric Gastroenterology, Department of Gastroenterology.

Objectives: Endoscopic ultrasound (EUS) is a minimally invasive pancreatic imaging modality. We evaluated children with idiopathic acute pancreatitis (IAP) and acute recurrent pancreatitis (ARP) for changes of chronicity (Rosemont criteria) and biliary risk factors. Diagnostic yield of simultaneously performed transabdominal ultrasonography (TUS) was compared with EUS.

Methods: This was a prospective observational study. Patients underwent EUS and TUS after 2 months of pancreatitis attack.

Results: Forty-five (18 IAP, 27 ARP) patients underwent EUS and TUS. Mean (standard deviation) age and weight were 9.1 (2.6) years and 32.66 (12.43) kg in IAP, whereas these were 12.2 (3.1) years and 44.84 (15.12) kg in ARP, respectively. Endoscopic ultrasound demonstrated morphological abnormality in 33.3% and 40.7% of IAP and ARP, respectively (P = 0.61), whereas 16.6% and 25.9% were abnormal in TUS. Endoscopic ultrasound showed unequivocal changes of chronicity (11.1% vs 0%) and risk factors only among ARP (25.9% vs 0%; P = 0.03) and demonstrated slightly higher odds ratio (95% confidence interval) as compared with TUS to detect abnormalities in both IAP (2.43 [0.49-14.17], P = 0.28) and ARP (1.94 [0.60-6.47], P = 0.26).

Conclusions: Applying EUS, changes of chronicity and risk factors were noted only in ARP. Endoscopic ultrasound performed better than TUS in detecting chronicity.
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http://dx.doi.org/10.1097/MPA.0000000000001243DOI Listing
March 2019