Publications by authors named "Joseph L Mathew"

182 Publications

Normal FeNO: What Do We Know?

Indian J Pediatr 2021 Jun 7. Epub 2021 Jun 7.

Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India.

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http://dx.doi.org/10.1007/s12098-021-03819-0DOI Listing
June 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

Getting trustworthy guidelines into the hands of decision-makers and supporting their consideration of contextual factors for implementation globally: recommendation mapping of COVID-19 guidelines.

J Clin Epidemiol 2021 Apr 6. Epub 2021 Apr 6.

Department of Health Research Methods, Evidence, and Impact, World Health Organization Collaborating Center for Infectious Diseases, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada. Electronic address:

Published research on COVID-19 is increasing rapidly and integrated in guidelines. The trustworthiness of guidelines can vary depending on the methods used to assemble and evaluate the evidence, the completeness and transparency of reporting on the process undertaken and how conflicts of interest are addressed. With a global consortium of partners and collaborators, we have created a catalogue of COVID-19 recommendations as our direct response to the increased need for structured access to high quality guidance in the field. The COVID19 map of recommendations and gateway to contextualization (https://covid19.recmap.org) is a living project: emerging guideline literature is added on an ongoing basis, allowing granular access to individual recommendations. Building on prior work on mapping recommendations for the World Health Organization tuberculosis guidelines, a novel feature of this map is the self-directed contextualization of the recommendations using the GRADE-Adolopment approach to adopt, adapt or synthesize de novo recommendations for context specific questions. Through our map, stakeholders access the evidence underpinning a recommendation, select what needs to be contextualized and go through the steps of development of adapted recommendations. This one-stop shop portal of evidence-informed recommendations, built with intuitive functionalities, easy to navigate and with a support team ready to guide users across the maps, represents a long-needed tool for decision-makers, guideline developers and the public at large.
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http://dx.doi.org/10.1016/j.jclinepi.2021.03.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022513PMC
April 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

Pulmonary Hydatid Cyst Diagnosed by Flexible Fiberoptic Bronchoscopy.

J Bronchology Interv Pulmonol 2021 Apr;28(2):150-152

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

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http://dx.doi.org/10.1097/LBR.0000000000000742DOI Listing
April 2021

Isolated Pulmonary Presentation of Childhood Goodpasture Disease.

Indian J Pediatr 2021 06 22;88(6):605-606. Epub 2021 Mar 22.

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

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http://dx.doi.org/10.1007/s12098-021-03723-7DOI Listing
June 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

Clinical Profile, Hospital Course and Outcome of Children with COVID-19.

Indian J Pediatr 2021 Feb 13. Epub 2021 Feb 13.

Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic.

Methods: This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included.

Results: Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d.

Conclusions: In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.
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http://dx.doi.org/10.1007/s12098-020-03572-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881747PMC
February 2021

Active toxoplasmosis presenting with polymyositis and pleural effusion in a child.

J Paediatr Child Health 2021 Feb 11. Epub 2021 Feb 11.

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

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http://dx.doi.org/10.1111/jpc.15390DOI Listing
February 2021

Consistency of recommendations and methodological quality of guidelines for the diagnosis and treatment of COVID-19.

J Evid Based Med 2021 Feb 9;14(1):40-55. Epub 2021 Feb 9.

School of Public Health, Lanzhou University, Lanzhou, China.

Objective: Since the beginning of the COVID-19 epidemic, a large number of guidelines on diagnosis and treatment of COVID-19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID-19 and analyze the consistency of the recommendations of these guidelines.

Methods: We searched for guidelines on diagnosis and/or treatment of COVID-19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID-19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID-19 across the included guidelines.

Results: A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X-rays, lung ultrasound, RT-PCR, and routine blood tests were the most commonly recommended methods for COVID-19 diagnosis. Thirty guidelines were on the treatment of COVID-19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy.

Conclusions: The methodological quality of currently available diagnosis and treatment guidelines for COVID-19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID-19 are RT-PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID-19 yet, supportive therapy is at the moment the most important treatment option.
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http://dx.doi.org/10.1111/jebm.12419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013412PMC
February 2021

Demographics of Vaccine Hesitancy in Chandigarh, India.

Front Med (Lausanne) 2020 15;7:585579. Epub 2021 Jan 15.

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

The impact of vaccine hesitancy on childhood immunization in low- and middle-income countries remains largely uncharacterized. This study describes the sociodemographic patterns of vaccine hesitancy in Chandigarh, India. Mothers of children <5 years old were sampled from a two-stage cluster, systematic sample based on Anganwadi child care centers in Chandigarh. Vaccine hesitancy was measured using a 10-item Vaccine Hesitancy Scale, which was dichotomized. A multivariable logistic regression assessed the association between socioeconomic factors and vaccine hesitancy score. Among 305 mothers, >97% of mothers thought childhood vaccines were important, effective, and were a good way to protect against disease. However, many preferred their child to receive fewer co-administered vaccines (69%), and were concerned about side effects (39%). Compared to the "other caste" group, scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy (95% CI: 1.52, 7.99). Those with a high school education had 0.10 times the odds of vaccine hesitancy compared to those with less education (95% CI: 0.02, 0.61). Finally, those having more antenatal care visits were less vaccine hesitant (≥4 vs. <4 visits OR: 0.028, 95% CI: 0.1, 0.76). As India adds more vaccines to its Universal Immunization Program, consideration should be given to addressing maternal concerns about vaccination, in particular about adverse events and co-administration of multiple vaccines.
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http://dx.doi.org/10.3389/fmed.2020.585579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844137PMC
January 2021

Comparison of respiratory pathogen colonization and antimicrobial susceptibility in people with cystic fibrosis bronchiectasis versus non-cystic fibrosis bronchiectasis: a protocol for a systematic review.

Syst Rev 2021 01 4;10(1). Epub 2021 Jan 4.

Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Background: Both cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis are characterized by permanent bronchial dilation, impaired mucociliary clearance, and development of chronic colonization and infection. Although the major airway microbiota in both CF and non-CF bronchiectasis may be similar, there are some differences in clinical and microbiologic features. There may also be differences in antibiotic susceptibility patterns between the CF and non-CF populations. Therefore, analysis and comparison of the microbiota and antibiotic susceptibility pattern in CF bronchiectasis versus non-CF bronchiectasis would help to improve the management of both conditions.

Methods: Two authors will independently search the electronic databases PubMed, EMBASE, the Cochrane Library, and LIVIVO, for studies reporting bacterial colonization of the respiratory tract in adults and children diagnosed with bronchiectasis in either CF or non-CF. We will include studies examining any respiratory tract specimen, using conventional bacterial culture or other specialized techniques such as molecular methods. We will also examine the antimicrobial susceptibility patterns in people with CF bronchiectasis versus non-CF bronchiectasis. The authors will independently assess the risk of bias in each included study using the Newcastle Ottawa Scale (NOS). We will present the data with descriptive statistics and provide pooled estimates of outcomes, wherever it is feasible to perform meta-analysis. Heterogeneity in studies will be explored by visual inspection of forest plots as well as using the Higgins and Thompson I method. We will contact the corresponding authors of studies where data is/are missing and try to obtain the missing data. We will undertake sensitivity analysis to explore the impact of study quality and subgroup analysis based on pre-set criteria. We will prepare a summary of findings' table and assess the confidence in the evidence using the GRADE methodology.

Discussion: To date, there are no locally applicable evidence-based guidelines for antimicrobial treatment of non-CF bronchiectasis patients. In general, treatment is based on extrapolation of evidence in people with CF bronchiectasis. An insight into the microbiota and antimicrobial susceptibility patterns in the two conditions would facilitate appropriate rather than empiric antimicrobial therapy and hopefully reduce the burden of antimicrobial resistance created by rampant usage of antibiotics.

Systematic Review Registration: The protocol has been registered in PROSPERO on July 26, 2020 (PROSPERO registration number: CRD42020193859 ).
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http://dx.doi.org/10.1186/s13643-020-01557-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780385PMC
January 2021

Flexible through rigid bronchoscopy for airway foreign body: A good marriage of convenience!

Pediatr Pulmonol 2021 02 24;56(2):335-337. Epub 2020 Nov 24.

Department of Pediatric Surgery, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.1002/ppul.25167DOI Listing
February 2021

Vaccination Inequities in India: Current Status and the Way Forward.

Am J Prev Med 2021 01 9;60(1 Suppl 1):S4-S10. Epub 2020 Nov 9.

Department of Pediatrics, Max Super Speciality Hospital, Vaishali, India; Chacha Nehru Bal Chikitsalya, Delhi, India.

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http://dx.doi.org/10.1016/j.amepre.2020.10.005DOI Listing
January 2021

Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades.

Am J Prev Med 2021 01 10;60(1 Suppl 1):S34-S43. Epub 2020 Nov 10.

Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

Introduction: Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination.

Methods: The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models.

Results: The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor.

Conclusions: The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist.

Supplement Information: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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http://dx.doi.org/10.1016/j.amepre.2020.10.001DOI Listing
January 2021

Randomized Controlled Trial Evaluating Levetiracetam as First-line Therapy for Seizures in Neonates: Evidence-based Medicine Viewpoint.

Authors:
Joseph L Mathew

Indian Pediatr 2020 09;57(9):848-851

Department of Pediatrics, PGIMER, Chandigarh, India.

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September 2020

Utility of Xpert MTB/RIF Assay for Diagnosis of Pediatric Tuberculosis Under Programmatic Conditions in India.

J Epidemiol Glob Health 2020 06;10(2):153-156

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

Tuberculosis (TB) diagnosis in children still remains a challenge in developing countries. We analyze the performance of Xpert MTB/RIF assay for the diagnosis of pediatric TB under programmatic conditions. We retrospectively analyzed the performance of Xpert MTB/RIF assay from February 2016 to March 2018. A total 2678 samples from TB suspects below 14 years were received in the laboratory and were frontline tested by Xpert MTB/RIF assay according to the manufacturer's instructions. If sample was sufficient, the smear microscopy and culture were performed as per standard World Health Organization's guidelines. The smears and cultures were performed in 2178 and 588 samples, respectively. Among 2678 samples, 68 were rejected, Xpert MTB/RIF assay was positive in 357/2610 (13.6%) cases, while the smear was positive in 81/2178 (3.3%) cases. The sensitivity of smear and Xpert MTB/RIF when compared with culture was 24.6% (14.1-37.8%) and 81% (68.6-90.1%), respectively. The diagnostic accuracy of Xpert MTB/RIF and smear was 97.1% and 92.2%, respectively. Thirty samples (8.5%) were detected as rifampicin resistance by Xpert MTB/RIF assay. The Xpert MTB/RIF increased the detection rate up to fourfold when compared with smear microscopy. Xpert MTB/RIF assay is the most rapid, sensitive, and specific method for microbiological confirmation and rifampicin resistance detection in pediatric tuberculosis.
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http://dx.doi.org/10.2991/jegh.k.191215.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310775PMC
June 2020

Child Health and Delivery of Care During the COVID-19 Pandemic and Beyond.

Authors:
Joseph L Mathew

Indian J Pediatr 2020 08 9;87(8):579-582. Epub 2020 Jun 9.

Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.1007/s12098-020-03380-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281691PMC
August 2020

Cluster Randomized Trial Evaluating Impact of a Community-based Microfinance Scheme on Childhood Nutritional Status: Evidence-based Medicine Viewpoint.

Authors:
Joseph L Mathew

Indian Pediatr 2020 05;57(5):459-463

Department of Pediatrics, PGIMER, Chandigarh, India.

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May 2020

Does Normal Saline Have Clinical Effects in Infants with Bronchiolitis?: Evidence-based Medicine Viewpoint.

Authors:
Joseph L Mathew

Indian Pediatr 2020 03;57(3):254-257

Department of Pediatrics, PGIMER, Chandigarh, India.

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March 2020

Epidemiological investigation and containment of a measles outbreak in New York: Critical appraisal and public health implications for India.

Authors:
Joseph L Mathew

Natl Med J India 2019 May-Jun;32(3):153-155

Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/0970-258X.278690DOI Listing
April 2020

Health Technology Assessment in Asia: Food for Thought.

Authors:
Joseph L Mathew

Int J Technol Assess Health Care 2019 ;35(6):413-415

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

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http://dx.doi.org/10.1017/S0266462319000801DOI Listing
August 2020

Tracheal bronchus and disseminated tuberculosis in a 9-year-old girl: incidental finding or association?

BMJ Case Rep 2020 Jan 21;13(1). Epub 2020 Jan 21.

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

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http://dx.doi.org/10.1136/bcr-2019-231988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021106PMC
January 2020

Community-based Randomized Controlled Trial Evaluating Effect of Kangaroo Mother Care on Neonatal and Infant Outcomes: Evidence-based Medicine Viewpoint.

Authors:
Joseph L Mathew

Indian Pediatr 2020 01;57(1):56-60

Department of Pediatrics, PGIMER, Chandigarh, India.

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January 2020

Review of a 7-year record of the bacteriological profile of airway secretions of children with cystic fibrosis in North India.

Indian J Med Microbiol 2019 Apr-Jun;37(2):203-209

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

Background: Cystic fibrosis (CF) is now a recognised entity in India, with prevalence rates between 1/10,000 and 1/50,000. However, no data were available with regard to the profile of respiratory pathogens in the Indian setting.

Materials And Methods: The records of respiratory secretion bacterial cultures of children with CF in a tertiary care hospital in North India from January 2010 to December 2016 were reviewed. Culture data were evaluated; the organisms were noted and their antimicrobial susceptibilities were analysed. The microbiological profile and antimicrobial susceptibility pattern of CF patients were evaluated.

Results: A total of 445 samples from 146 children were processed, of which 246 (55%) samples showed bacterial growth. Mixed infections 48 (19.5%) were common in older children. Children aged 3-6 months (62.5%) showed the highest culture positivity. The most commonly isolated organisms were Pseudomonas aeruginosa (52.6%) and Staphylococcus aureus. Children with initial cultures positive for P. aeruginosa had 55% of their subsequent cultures showing polymicrobial infections. P. aeruginosa was most susceptible to ciprofloxacin (89%) and piperacillin-tazobactum (88%). Among the staphylococcal isolates, 38% were methicillin-resistant S. aureus (MRSA). The percentage of MRSA increased from 66% in 2010 to 75% in 2012, followed by a decline to 24% in 2016.

Conclusions: The pattern of airway colonisation in the Indian setting is different from the Caucasian population, and P. aeruginosa and Burkholderia cepacia complex appear early. Colonisation with P. aeruginosa benefits from therapy. In case of infection, care must be taken while initiating empiric therapy. It should be based on local antibiograms to prevent the emergence of resistant microbes.
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http://dx.doi.org/10.4103/ijmm.IJMM_18_424DOI Listing
April 2020

Liberal vs. Conservative Approach to Timing of Blood Transfusion in Severely Anemic Children: Evidence-based Medicine Viewpoint.

Authors:
Joseph L Mathew

Indian Pediatr 2019 11;56(11):959-963

Department of Pediatrics, PGIMER, Chandigarh, India.

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November 2019