Publications by authors named "Bhavna Dhingra"

36 Publications

Poor adherence to TB diagnosis guidelines among under-five children with severe acute malnutrition in central India: A missed window of opportunity?

PLoS One 2021 12;16(3):e0248192. Epub 2021 Mar 12.

All India Institute of Medical Sciences (AIIMS), Bhopal, India.

Background: In India, under-five children with Severe Acute Malnutrition (SAM) are referred to Nutritional Rehabilitation Centers (NRCs). NRCs screen the causes of SAM including tuberculosis (TB). The national TB programme recommends upfront testing with a rapid molecular test if TB is suspected in children.

Objective: We estimated the yield of and adherence to the TB diagnostic guidelines (clinical assessment and assessment for microbiological confirmation) among under-five children with SAM admitted at NRCs (six in district Sagar and four in district Sheopur) of Madhya Pradesh, India in 2017. We also explored the challenges in screening from the health care providers' perspective.

Methods: It was an explanatory mixed method study. The NRC records were reviewed This was followed by three key informant interviews and three focus group discussions among staff of NRC and TB programme. Manual descriptive thematic analysis was performed.

Results: Of 3230, a total of 2665(83%) children underwent Mantoux test, 2438(75%) underwent physical examination, 2277(70%) were asked about the symptoms suggestive of TB, 1220(38%) underwent chest radiograph and 485(15%) were asked for recent contact with TB. A total of 547(17%) underwent assessment for microbiological confirmation. Of 547, a total of 229 gastric aspirate specimens underwent rapid molecular test (24% positive) and 318 underwent sputum microscopy (44% positive). A total of 223 were diagnosed as TB (195 microbiologically and 28 clinically confirmed) and 209 were initiated on anti-TB treatment. The treatment outcome was favourable (cure or treatment completed) for 70(31%) and not recorded for 121(54%). The main perceived challenges in screening for TB were poor team skills, lack of diagnostic facilities and poor understanding of the guidelines due to inadequate training.

Conclusion: Though NRCs provided a unique window of opportunity for the screening and management of TB among under-five children with SAM, the utilization of this opportunity remained suboptimal.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248192PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954324PMC
March 2021

Coeliac disease presenting atypically: A much wider spectrum.

Trop Doct 2021 Feb 11:49475521991348. Epub 2021 Feb 11.

Director Professor, Genetic division, Department of Pediatrics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.

Atypical coeliac disease in young children is frequently missed when it presents atypically as non-gastrointestinal presentations to different specialties. There was a greater delay (54 months) in establishing the diagnosis in those with atypical coeliac disease (p < 0.001). No difference was observed in the mode of delivery or duration of breast feeding, but significant difference was observed between gestational age at birth (p < 0.001). Most cases showed stunted growth and underweight. Irritability, anaemia, rickets, dermatitis herpetiformis, alopecia and intussusception were other common predictors of atypical coeliac disease. Because of a myriad spectrum of non-gastrointestinal symptoms, at any age with diverse presentation, a high index of suspicion is therefore required.
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http://dx.doi.org/10.1177/0049475521991348DOI Listing
February 2021

Pneumococcal vaccination in persons living with HIV: Pneumococcal conjugate, polysaccharide or both?

EClinicalMedicine 2020 Dec 29;29-30:100593. Epub 2020 Nov 29.

Department of Pediatrics and Clinical Microbiology, All India Institute of Medical Sciences, Bhopal 462020, India.

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http://dx.doi.org/10.1016/j.eclinm.2020.100593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708955PMC
December 2020

Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease.

Indian J Pediatr 2020 Nov 11. Epub 2020 Nov 11.

Department of Pathology & Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India.

Objectives: There is sparsity of studies evaluating blood pressure in children with sickle cell disease (SCD), which have shown inconsistent results. Few of the studies have documented lower office blood pressure (BP) in SCD patients, whereas, others have shown presence of masked hypertension and abnormal ambulatory blood BP monitoring (ABPM). Thus, the present study was conducted to examine 24 h ABPM parameters and renal dysfunction in children with SCD and compare them with healthy controls.

Methods: A cross-sectional study was conducted on 56 children (30 children having SCD and 26 controls). ABPM and evaluation of renal functions including serum creatinine, serum urea, urinary creatinine, urinary protein and specific gravity was performed.

Results: Spot urinary protein to creatinine ratio was found to be higher in patients with SCD (63.3%) as compared to controls (p < 0.001). Proteinuria was observed in 1/4th of the SCD patients less than ten years of age. Masked hypertension was present in 2 (6.6%) patients, ambulatory hypertension in 4 (13.3%), ambulatory pre-hypertension in 1 (3.3%) and abnormal dipping in 60%. A statistically significant correlation of BMI for age Z-score and standard deviation score (SDS/Z) of 24 h systolic BP (r = 0.56, p = 0.002); estimated glomerular filtration rate (eGFR) with 24 h diastolic BP SDS (r = -0.52; p = 0.038) and age with e GFR (r = 0.54; p = 0.025) was found in the present study.

Conclusions: The present study corroborates that ABPM abnormalities (ambulatory hypertension, non-dipping pattern, ambulatory prehypertension) and early onset proteinuria are significant findings in patients with SCD. This underscores the importance of regular screening for proteinuria and ABPM in routine care, for early detection and prevention of progressive renal damage in SCD.
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http://dx.doi.org/10.1007/s12098-020-03558-8DOI Listing
November 2020

Updated Pediatric Tuberculosis Guidelines: Authors' Reply.

Indian Pediatr 2019 08;56(8):692-693

Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India.

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August 2019

Recurrent episodes of pneumonia in a toddler: Don't forget chronic granulomatous disease.

J Family Med Prim Care 2019 Mar;8(3):1260-1262

Department of Pediatrics, AIIMS Bhopal, Bhopal, Madhya Pradesh, India.

A 4-year-old boy presented with community acquired pneumonia, hepatosplenomegaly and bilateral cervical lymphadenopathy. The peripheral blood film showed significant monocytosis and bone marrow examination revealed multiple histiocytic granulomas. Presence of CD 68 positive granulomas supported by cytological findings enabled us to make a diagnosis of chronic granulomatous disease.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_29_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482805PMC
March 2019

50 Years Ago in The Journal of Pediatrics: Acrodermatitis Enteropathica: Defective Metabolism of Unsaturated Fatty Acids.

J Pediatr 2019 May;208:155

Department of Pediatrics, University College of Medical Sciences, Delhi, India.

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http://dx.doi.org/10.1016/j.jpeds.2018.11.007DOI Listing
May 2019

Where do mothers take their children for pneumonia care? Findings from three Indian states.

PLoS One 2019 15;14(4):e0214331. Epub 2019 Apr 15.

Samarth, Chennai, Tamilnadu, India.

Childhood pneumonia accounts for 17% of IMR in India, posing a major health burden. With cultural beliefs influencing care seeking behaviour and disparities existing in health infrastructure across the country, an understanding of the underlying issues merits exploration. Study assessed prevalence of probable pneumonia and examined care seeking behaviour of mothers in three states, Madhya Pradesh (MP), Uttar Pradesh (UP) and Tamil Nadu (TN). This mixed methods study involved a household survey and qualitative interviews with mothers in three districts from each state. Households with children aged 2-59 months were screened to identify those with probable pneumonia; sub-sample of mothers participated in qualitative interviews. Care seeking behaviour was explored in the context of recognition of symptoms, nature of first care provided, time when care was sought outside the home and choice of health provider. Overall 17,442 children from 13,544 households were screened, of which 729 (MP), 752 (UP) and 713 (TN) children respectively, were identified with probable pneumonia; 72 mothers participated in the qualitative interviews. Three months period prevalence was estimated in study districts at 22.2%-MP 13.3%-UP and 8.4%-TN. Most mothers in MP and UP were not perceptive to severity of illness; type of care sought was often inappropriate, delayed, with home remedies and visits to unqualified care providers being their first response. In contrast, in TN, use of home remedies was minimal, going to untrained care providers, non-existent and more than 90% mothers sought appropriate care. Private doctors were the preferred choice among all mothers but utilization of government care was highest in TN (20%). Community health workers were underutilized, with less than 10% mothers consulting them. Need for educating mothers about appropriate care seeking and development of good health infrastructure as essential to attainment of better child health indices are advocated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214331PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464169PMC
December 2019

What is New in Management of Pediatric Tuberculosis ?

Indian Pediatr 2019 Mar;56(3):213-220

Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India. Correspondence to: Dr Bhavna Dhingra, Additional Professor, Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India.

Tuberculosis continues to haunt mankind since its discovery more than a century ago. Although commendable advancements have been made in the diagnosis as well as treatment, especially in the last couple of decades, the healthcare burden of this disease worldwide is immense. Continuously evolving medical science has provided recent changes in national guidelines along with discovery of newer anti-tubercular drugs after many decades. In view of WHO declaring tuberculosis as a global health emergency and strong commitment being reflected by Government of India whereby National Strategic Plan aims to eliminate tuberculosis by 2025, it is high time that we work collectively on the goal of tuberculosis elimination. This article sums up the updates on newer anti-tubercular drugs as well as the recent changes adopted in Revised National Tuberculosis Control Program.
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March 2019

Obstructive Sleep Apnea in Children with Nocturnal Enuresis.

Indian Pediatr 2018 05;55(5):433-434

Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India.

There is increasing evidence on the association of monosymptomatic nocturnal enuresis (MNE) with obstructive sleep apnea. In this communication, we share our experience of four patients with Primary monosymptomatic nocturnal enuresis (PMNE) with positive Sleep-related breathing disorder (SRBD) score who underwent detailed polysomnography, and were either refractory to desmopressin treatment or relapsed on discontinuation of desmopressin.
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May 2018

Congenital Hypotransferrinemia, an Unusual Cause of Iron Deficiency Anemia: Report of Two Cases.

Indian J Hematol Blood Transfus 2017 Sep 16;33(3):402-404. Epub 2016 Nov 16.

Department of Haematology, AIIMS, New Delhi, India.

Hereditary hypotransferrinemia is a very rare cause of iron deficiency anemia in childhood characterized by microcytic hypochromic anemia refractory to iron therapy and concomitant iron overload. Regular plasma infusion to replace the deficient transferrin molecule is the therapeutic option. We report two cases; both presented with refractory anemia requiring blood transfusions and responded to monthly fresh frozen plasma replacement.
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http://dx.doi.org/10.1007/s12288-016-0746-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544637PMC
September 2017

Efficacy and Safety of Combined Oral Chelation With Deferiprone and Deferasirox in Children With β-Thalassemia Major: An Experience From North India.

J Pediatr Hematol Oncol 2017 04;39(3):209-213

*Department of Pediatrics, Division of Hematology and Oncology, Kalawati Saran Children's Hospital and Lady Hardinge Medical College Departments of †Pathology ‡Ophthalmology, Lady Hardinge Medical College, New Delhi.

Objective: A combination of desferrioxamine with either deferiprone (DFP) or deferasirox (DFX) for patients with β-thalassemia major who do not achieve negative iron balance with monotherapy has been studied widely. However, poor compliance resulting from the need for parentral administration of desferrioxamine and its cost necessicitates combining 2 oral chelators.

Methods: A prospective study was conducted in patients with transfusion-dependent β-thalassemia major in a tertiary care center over 2 years. Patients on either DFP or DFX who were not improving on monotherapy over a long period and persistently maintaining serum ferritin >2500 µg/L were enrolled. Efficacy was assessed by serum ferritin levels assessed at 12 months and 2 years. Complete blood counts and liver and kidney function tests were monitored to assess the safety of the combination of drugs.

Results: In total, 33 patients with a mean age of 12.67 years (7.5 to 17.5 y) and a mean ferritin of 4835.2394±1443.85 µg/L formed the study cohort.In total, 28 patients completed the 1-year study period; and 12 patients completed 2 years. Mean serum ferritin reduction at 1 and 2 years was 34.99%±18.13% (range, -34.36% to 56.17%) and 44.67%±13.78% (range, 22.17% to 62.74%), respectively. The combination therapy was well tolerated.

Conclusions: Combined oral chelation with DFP and DFX has better efficacy than either drug used alone. The combination of drugs was well tolerated and no new adverse effects were observed.
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http://dx.doi.org/10.1097/MPH.0000000000000780DOI Listing
April 2017

A clinically suspected case of Anaphylactoid reaction to vitamin K injection in a child - a case report and review of literature.

Indian J Pharmacol 2016 Jul-Aug;48(4):455-457

Department of Pharmacology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India.

Vitamin K is commonly indicated in pediatric patients with coagulopathies. Its commercial preparations are available in the market since long. Minor complications are very well-known, but life-threatening events are rarely reported in children. We present a case of 8-year-old child who developed life-threatening event following intravenous Vitamin K injection. She was survived after cardiopulmonary resuscitation. The reaction was most probably due to anaphylactoid reaction to Vitamin K.
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http://dx.doi.org/10.4103/0253-7613.186216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980939PMC
June 2017

Interviews for academic positions: Applicants' perspective.

Natl Med J India 2015 Nov-Dec;28(6):312

Department of Paediatrics All India Institute of Medical Sciences Bhopal Madhya Pradesh,

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July 2016

Nephrotic Syndrome Associated with Multicystic Kidney Disease with Concomitant Cerebral Venous Thrombosis.

Indian J Pediatr 2016 Nov 4;83(11):1358. Epub 2016 Jun 4.

Department of Pediatrics, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, 462020, India.

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http://dx.doi.org/10.1007/s12098-016-2145-8DOI Listing
November 2016

Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India.

PLoS One 2016 18;11(5):e0155808. Epub 2016 May 18.

Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India.

Objective: To study the prevalence of primary monosymptopomatic nocturnal enuresis (PMNE) in children aged 5-10 year and to find its association with sleep disordered breathing (SDB) by using a 22 item pediatric sleep related breathing disorder (SRBD) scale.

Methods: This was a school based cross sectional epidemiological study from July 2015 to November 2015. A questionnaire seeking information on socio-demographic variables, nocturnal enuresis (NE) frequency, school performance and a validated 22 item pediatric sleep related breathing disorder scale (SRBDs) was distributed to 1820 pupils in three primary schools.

Results: A total of 1528(83.95%) questionnaires were retrieved. Out of 1528 forms, 182(11.9%) forms were incomplete for requested information and hence 1346 (73.9%) questionnaires were finally analyzed. The prevalence of NE was found to be 12.7% (95% CI; 11-14.6), whereas prevalence of primary nocturnal enuresis (PMNE) was 8.2% (95% CI; 7.1-10.1). SRBD scale score >0.33 (adjusted OR: 2.87; 95%CI: 1.67-4.92), paternal history of enuresis in childhood (adjusted OR:4.96; 95% CI: 2.36-10.45), and inappropriate toilet training (adjusted OR: 1.64; 95% CI: 1.01-2.66) were independently associated with PMNE.

Conclusion: Sleep disordered breathing, inappropriate toilet training and a history of childhood NE in father were found to be significant risk factors for PMNE in the present study. Thus, these findings suggest that it is imperative to rule out SDB in PMNE patients as they may require different therapeutic interventions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155808PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871538PMC
July 2017

Neurological Complications and Cataract in a Child With Thalassemia Major Treated With Deferiprone.

J Pediatr Hematol Oncol 2015 Oct;37(7):e433-4

*Department of Pediatrics, Division of Hematology and Oncology, Division of Neurology, Kalawati Saran Children's Hospital and Lady Hardinge Medical College †Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India.

The oral iron chelator deferiprone is associated with various side effects including agranulocytosis, arthropathy, and deranged liver function tests. Rarely, neurological and visual side effects have been reported with high doses. The authors describe rare neurological manifestations of cerebellar ataxia, hypertonia, and bilateral cataract in an 11-year-old boy with thalassemia major on recommended therapeutic doses of deferiprone. The neurological abnormalities resolved with stoppage of deferiprone. Central nervous system toxicity and lenticular opacities may be attributed to the low molecular weight of deferiprone and its ability to cross the blood-brain and blood-ocular barrier, respectively. Clinicians should be alert to the possibility of neurological abnormalities that may occur during deferiprone therapy.
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http://dx.doi.org/10.1097/MPH.0000000000000391DOI Listing
October 2015

Pediatric lupus: varied haematological picture and presentation.

Indian J Hematol Blood Transfus 2015 Mar 14;31(1):68-70. Epub 2014 Mar 14.

Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, 110001 India.

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease characterized by periods of increased disease activity caused by inflammation of blood vessels and connective tissue. Pediatric patients with SLE have a more severe clinical course when compared with adults. Patients commonly present with rash, fever, and arthritis, although the presentation may be unpredictable. Hematological findings are more predominant in children than adults. Thirty-nine percent of children with SLE will develop hematological abnormalities, one of the American Rheumatic Association criteria for classifying the disease. In our case series we found varied hematological picture and presentation. We present here four case reports of SLE cases with interesting hematological features. Our first case is a 13 month old female child who was initially diagnosed as Evans syndrome and 2 years later diagnosed as SLE. Second case is a 3 year old male child who had SLE with warm antibody AIHA. Third case is a 6 year old female child who presented with AIHA and was diagnosed with SLE 6 years later. Fourth case is a 6 year old female child diagnosed as SLE with aplastic anemia. Hematological findings should be carefully assessed and treated in order to decrease disease related morbidity.
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http://dx.doi.org/10.1007/s12288-014-0357-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275535PMC
March 2015

T-acute lymphoblastic leukemia in a young adult complicated with unusual findings: an interesting case.

Indian J Hematol Blood Transfus 2013 Jun 13;29(2):77-9. Epub 2011 Dec 13.

Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.

A young adult diagnosed as T-acute lymphoblastic leukemia presented with unusual complications during chemotherapy. He was diagnosed to have tubercular splenic abscess and had neurologic complaints like vincristine- induced peripheral neuropathy and focal neurologic deficit complicating the course of chemotherapy. Cases of hepatosplenic tuberculosis presenting as abscesses during prolonged neutropenia in patients with acute leukemia during or after chemotherapy are rare but reported. Vincristine induced neuropathy is reported to be higher in Indian children possibly due to co-existent malnutrition. The focal lesions in the brain were intriguing as regards to the symptomatology and exact etiology especially with the limitation of imaging in such patients. This case highlights the difficulty in the course of chemotherapy due to the rare complications encountered.
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http://dx.doi.org/10.1007/s12288-011-0128-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636358PMC
June 2013

Inflammatory myofibroblastic tumor: an unusual mimicker of childhood intrathoracic tuberculosis.

J Pediatr Hematol Oncol 2014 Oct;36(7):e426-9

Departments of *Pediatrics ‡Radiodiagnosis, Lady Hardinge Medical College †Department of Pediatric Surgery, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi §Department of Pathology, University College of Medical Sciences and Guru Teg Bhadhur Hospital, Delhi, India.

Inflammatory myofibroblastic tumors are rare lesions of uncertain etiology that are often difficult to diagnose because of their myriad clinical presentations. Not uncommon, they mimic persistent pneumonia. We report a 4-year-old girl who presented with prolonged pyrexia, weight loss, severe anemia, hepatosplenomegaly, and nonresolving pneumonia. Initial investigations including flexible bronchoscopy and bronchial washing for usual causes of persistent pneumonia, such as tuberculosis and other infections, were negative. Chest computed tomography revealed a well-defined lesion involving the lingula and left upper lobe with extension into the subpleural space. Pleural tap and biopsy was also noncontributory. Thoracoscopic biopsy was suggestive of an inflammatory myofibroblastic tumor. As the lesion was encasing the major vessels, it was considered inoperable. The patient did not respond to steroid therapy and etoricoxib and later succumbed to the illness. This uncommon tumor should be considered in the differential diagnosis of children who presented with unresolving consolidation with pyrexia.
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http://dx.doi.org/10.1097/MPH.0000000000000019DOI Listing
October 2014

Neurological paraneoplastic syndrome as presentation of leukemia.

J Pediatr Hematol Oncol 2013 Jul;35(5):e214-6

Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India.

Acute disseminated encephalomyelitis (ADEM) has been reported in acute leukemia and after stem cell transplantation, but ADEM as a presenting feature in pediatric acute lymphoblastic leukemia is rare. We report an 8-year-old child with acute lymphoblastic leukemia who presented with features of ADEM. The diagnosis was confirmed by neuroimaging and the lesions disappeared with chemotherapy.
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http://dx.doi.org/10.1097/MPH.0b013e318290bc75DOI Listing
July 2013

Alloimmunisation in thalassaemics: a comparison between recipients of usual matched and partial better matched blood. An evaluation at a tertiary care centre in India.

Blood Transfus 2014 Jan 6;12 Suppl 1:s100-4. Epub 2013 Feb 6.

Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.

Background: There is an ongoing controversy regarding provision of usually matched blood (i.e. matched for ABO-D antigens) or phenotypically matched blood (also matched for Rh and Kell antigens) for multiply transfused thalassaemics, especially in developing countries. A pilot study conducted at our centre revealed an alloimmunisation rate of 3.79% with Rh and Kell alloantibodies accounting for 90% of all antibodies. The present cross-sectional study was conducted to assess the impact of a policy of partial better matching (for Rh cDE and Kell antigens) of blood on alloimmunisation in thalassaemics.

Material And Methods: In this cross-sectional study three groups of patients were considered. Group 1 comprised 211 thalassaemics who received usually matched (UM) blood until April 2009. Their rates of alloimmunisation have already been published in a prior study. Group 2 consisted of 46 thalassaemics who were enrolled after April 2009 and have received partially better matched (PBM) blood (matched for ABO, Rh cDE and Kell antigens) since the initiation of transfusion therapy. Group 3 (UM→PBM) comprised the patients from group 1 who, from April 2009, were given partial better matched blood. Antibody screening (using a 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibodies.

Results: None of the thalassaemic patients in group 2 (PBM) developed alloantibodies. Eight thalassaemics in group 3 (UM→PBM) developed new alloantibodies (after April 2009).

Discussion: According to the results of the present study, providing at least partially better matched blood appears to improve the efficacy of transfusion for chronically transfused thalassaemics. Large-scale, comprehensive, multicentre studies need to be carried out to formulate realistic, evidence-based, economically feasible transfusion policies for thalassaemic children based on the red blood cell antigen profile of the population.
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http://dx.doi.org/10.2450/2012.0154-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934288PMC
January 2014

Plasmodium vivax malaria complicated by splenic infarct.

Paediatr Int Child Health 2014 Feb 6;34(1):63-5. Epub 2013 Dec 6.

An 11-year-old girl presented with Plasmodium vivax malaria complicated by shock and acute renal failure. The diagnosis of malaria was based on demonstration of trophozoites of P. vivax in the peripheral blood smear and a positive rapid malarial antigen test for P. vivax but negative for P. falciparum. She responded to parenteral artesunate and supportive care. During the course of her infection, she developed pain in her left hypochondrium. Ultrasonography showed multiple hypo-echoic lesions in the spleen and CT scan revealed multiple splenic infarcts. Management was restricted to close clinical monitoring and analgesia. We consider that this is the first report of splenic infarct complicating the course of childhood P. vivax malaria in the English literature. Physicians should suspect and investigate for this rare complication if a patient with malaria complains of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during the course of malaria infection.
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http://dx.doi.org/10.1179/2046905512Y.0000000029DOI Listing
February 2014

Persistent hyperinsulinemic hypoglycemia of infancy.

J Pediatr Endocrinol Metab 2012 ;25(5-6):591-3

Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.

Congenital hyperinsulinism (CHI) is the most frequent cause of severe, persistent hypoglycemia in infancy and childhood. We report a case of CHI with diffuse pancreatic abnormality diagnosed preoperatively using the 68Ga octreotide (DOTA NOC) positron emission tomography scan. Genetic analysis revealed homozygous ABCC8 splicing mutation. Subtotal (95%) pancreatectomy was done, and the infant remained euglycemic and was discharged on breast feeds. The patient is continuously followed up and is asymptomatic until 9 months.
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http://dx.doi.org/10.1515/jpem-2012-0055DOI Listing
September 2012

Early diagnosis of febrile illness: the need of the hour.

Indian Pediatr 2011 Nov;48(11):845-9

Department of Pediatrics, Maulana Azad Medical College, and Associated Chacha Nehru Bal Chikitsalaya and Lok Nayak Hospital, New Delhi, India.

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http://dx.doi.org/10.1007/s13312-011-0134-6DOI Listing
November 2011

Indian government promises universal availability of free medicines.

Authors:
Bhavna Dhingra

Natl Med J India 2012 Mar-Apr;25(2):125

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September 2012

National rural health mission.

Indian J Pediatr 2011 Dec 10;78(12):1520-6. Epub 2011 Aug 10.

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India.

The health related indices in our country are far from satisfactory and the country still bears an enormous share of the global disease burden. The lack of accessibility, scarce availability and the poor quality of health services and personnel in the remote rural and underdeveloped urban areas have been the major obstacles to the delivery of quality health care services in a vast and culturally diverse country with inter- and intra-regional variations and inequalities. The already over-stretched public health care system has been grappling with the deficiencies in linkage with the collateral health determinants, gross shortage and non utilization of infrastructure, financial and human resources. Revitalizing the existing primary health care infrastructure under the National Rural Health Mission (NRHM) will bring about the long overdue architectural corrections in the health care sector and be able to provide accessible, affordable, accountable, effective and reliable health care especially to the under-privileged sections of the society. NRHM is based on the principles of decentralisation of the health system, empowerment of the community and the panchayati raj institutions. Effective integration of health concerns with other health determinants like sanitation, hygiene and nutrition through district health plan is being made.
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http://dx.doi.org/10.1007/s12098-011-0536-4DOI Listing
December 2011