Publications by authors named "Lokesh Saini"

139 Publications

Evaluation of a Customized 3D Printed ORGAN-Hand Orthotic Device for Unilateral Cerebral Palsy: a Pilot Study.

Indian J Pediatr 2021 Jul 5. Epub 2021 Jul 5.

Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

To achieve intensive activity-based and goal-directed rehabilitation for unilateral cerebral palsy (UCP), several static and functional upper limb orthoses have been used but with limited robust evidence-base. The current pilot study evaluated the feasibility and efficacy of a customized 3D-printed orthotic device in children with UCP. The attainment of a prespecified goal and Shriners Hospital Upper Extremity Evaluation (SHUEE) at 3 and 6 mo were the efficacy measures. Of the 14 screened children, 5 (median age: 7.9 y; 3 boys) were included. The 3-mo follow-up could be completed for 3 children while 6-mo follow-up could be completed for 1 child. Rest could not be assessed due to pandemic restrictions. Although none attained set goals till the last follow-up, all 3 children (at 3-mo follow-up) showed improvement in SHUEE scores without any significant safety concerns. Further studies on 3D-printed orthosis in UCP are the need of the hour.
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http://dx.doi.org/10.1007/s12098-021-03859-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256949PMC
July 2021

Impact of COVID-19 pandemic on sleep in children and adolescents: a systematic review and meta-analysis.

Sleep Med 2021 Jun 11;84:259-267. Epub 2021 Jun 11.

Department of Cardiology, Amcare Hospital, Zirakpur, Punjab, India.

Objective: This systematic review and meta-analysis were conducted to study the prevalence and pattern of sleep disturbances in children and adolescents during the COVID-19 pandemic.

Methods: MEDLINE, EMBASE, and Web of Science were searched for original studies describing sleep abnormalities in children and adolescents with or without pre-existing neurobehavioral disorders during the COVID-19 pandemic. The pooled estimates for various sleep abnormalities were calculated using a random-effect model.

Results: Of 371 articles screened, 16 studies were included. Among these, five studies were in preschool children, two were in children with pre-existing neurobehavioral disorders and the remaining were in school going children and adolescents. The outcome measures used for sleep were markedly heterogeneous across the studies. The pooled prevalence of any sleep disturbance in children during the pandemic was 54%(95%CI:50-57%). Interestingly, the prevalence in pre-school children was lower than pre-pandemic times (RR = 0.87; 95% CI:0.58-1.30) but this was not statistically significant. The pooled prevalence of children not meeting sleep recommendation was 49% (95%CI: 39-58%).

Conclusion: The prevalence of sleep problems in children and adolescents during the COVID-19 pandemic is alarming. Pre-school children had a trend towards relatively fewer sleep disturbances due to home confinement measures in comparison with pre-pandemic times. Sleep duration recommendations were not met in nearly half of healthy children. However, these conclusions need to be seen in light of limited literature on the topic, few included studies done in heterogenous populations, and dubious quality of inferences drawn from these studies which were predominantly online surveys.

Prospero Registration Id: CRD42020213788.
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http://dx.doi.org/10.1016/j.sleep.2021.06.002DOI Listing
June 2021

Effectiveness and Safety of Nitrazepam in Children with Resistant West Syndrome.

Indian J Pediatr 2021 Jun 24. Epub 2021 Jun 24.

Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India.

Objectives: To study the effectiveness, tolerability, and safety of oral nitrazepam in children with resistant West syndrome (WS).

Methods: This prospective observational study was conducted at a tertiary care hospital in North India from January 2019 to October 2020. Children with WS resistant to standard therapy were enrolled within 7 d of initiation of nitrazepam and prospectively followed-up for cessation of spasms and adverse events.

Results: Forty-one children with resistant WS initiated on nitrazepam therapy were evaluated. The median age at onset of spasms was 6 mo (Q1, Q3: 4, 8). There was a preponderance of male gender (71%) and structural causes (78%). More than half of the enrolled children had failed four or more antiseizure medications (ASM) for epileptic spasms. The study participants had a long lead-time-to-treatment (LTTT) for the initial standard therapy (median: 2 mo; Q1, Q3: 1, 5) and nitrazepam (median: 11 mo; Q1, Q3: 8, 16). Nitrazepam was instituted as monotherapy in 7 (17%) children and as an adjunct in the rest. Twenty-one (51%) children achieved persistent cessation of epileptic spasms. However, the electroclinical response was observed in 17 (42%) children. Drowsiness, sialorrhea, and decreased appetite were the most commonly observed adverse events. Most adverse events were mild to moderate in severity and did not require dose reduction or change of medication. There was no significant difference between the responders and nonresponders in terms of LTTT, age at onset, or etiology.

Conclusions: Nitrazepam is a safe and feasible treatment alternative in children with resistant WS resulting in persistent cessation of spasms and electroclinical response in nearly half of patients.
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http://dx.doi.org/10.1007/s12098-021-03823-4DOI Listing
June 2021

Thick corpus callosum: An underrecognised but important diagnostic clue.

Trop Doct 2021 Jun 24:494755211026281. Epub 2021 Jun 24.

Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Neurofibromatoses are inherited tumour-suppressive disorders that are characterised by multiple neoplastic and non-neoplastic tumours. Neurofibromatosis type 1 is a common disorder with multiple neurofibromas with widespread complications. We here report a seven-year old boy presenting with first episode of seizure and multiple café-au-lait macules but neuroimaging revealed corpus callosal changes without any focal areas of signal intensities.
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http://dx.doi.org/10.1177/00494755211026281DOI Listing
June 2021

Randomized trial of high-dose pyridoxine in combination with standard hormonal therapy in West syndrome.

Seizure 2021 May 29;91:75-80. Epub 2021 May 29.

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

Objective: To determine whether high-dose, oral pyridoxine in combination with standard adrenocorticotropic hormone (ACTH) therapy has superior effectiveness than ACTH therapy alone in increasing cessation of epileptic spasms for children with West syndrome.

Methods: This study was an open-label, randomized controlled trial with masked endpoint assessments. Eligible children with West syndrome, age ranged 3-18 months, were randomized into the intervention (n = 43) and the standard arm (n = 37) of therapy. The intervention group received oral pyridoxine at 100-300 mg/kg/day in addition to standard therapy of intramuscular ACTH at 150 IU/m/day. Primary effectiveness outcome was a complete cessation of spasms at two weeks and sustained till six weeks.

Results: Comparison of effectiveness measures between intervention and standard groups were : complete cessation of epileptic spasms (48.8% vs 58.3%; group difference -9.6%; 95% confidence interval [CI] -30% to 12.3%; p = 0.4), median EEG scores (Q1-Q3) by Jeavons Score at six weeks [3 (1-5) vs 3 (1-5); p = 0.6], median motor scores (Q1-Q3) by DASII (Development Assessment Scales for Indian Infants) at 12 weeks [35 (29-49) vs 42 (34.3-63.8), p = 0.04], and median mental scores (Q1-Q3) by DASII at 12 weeks [35 (29.5-46) vs 41.5 (31.3-60), p = 0.02]. Adverse events were comparable in both arms.

Conclusions: There was no evidence to suggest the superiority of high-dose pyridoxine in combination with ACTH versus ACTH alone for the treatment of West syndrome, considering the limitations of the study design.
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http://dx.doi.org/10.1016/j.seizure.2021.05.012DOI Listing
May 2021

Monozygotic twins with development delay and a characteristic electroencephalographic pattern: Just look at the face.

J Paediatr Child Health 2021 Jun;57(6):960-961

Genetic Metabolic Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1111/jpc.1_15262DOI Listing
June 2021

An Infant with Motor Delay and Deafness Due to Usher Syndrome.

Indian J Pediatr 2021 Aug 31;88(8):827. Epub 2021 May 31.

Pediatric Neurology Unit, 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/s12098-021-03799-1DOI Listing
August 2021

Financial Burden in Families of Children with West Syndrome.

Indian J Pediatr 2021 May 26. Epub 2021 May 26.

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

Objective: To evaluate the illness-related expenditure by families of children with West syndrome (WS) during the first year of illness and to explore the potential determinants of the financial drain.

Methods: This cross-sectional study was conducted at a tertiary care hospital between July 2018 and June 2020. Eighty-five children with WS who presented within one year from the onset of epileptic spasms were included. The details of the treatment costs (direct medical and nonmedical) incurred during the first year from the onset of epileptic spasms were noted from a parental interview and case record review. Unit cost was fixed for drugs and specific services. Total cost was estimated by multiplying the unit cost by the number of times a drug or service was availed. The determinants of the financial burden were also explored.

Results: The median monthly per-capita income of the enrolled families (n = 85) was INR 3000 (Q1, Q3, 2000, 6000). The median cost of treatment over one year was INR 27035 (Q1, Q3, 17,894, 39,591). Median direct medical and nonmedical expenses amounted to INR 18802 (Q1, Q3, 12,179, 25,580) and INR 6550 (Q1, Q3, 3500, 15,000), respectively. Seven families had catastrophic healthcare expenditure. Parental education and choice of first-line treatment were important determinants driving healthcare expenses. The age at onset of epileptic spasms, etiology, treatment lag, the initial response to treatment, and relapse following initial response did not significantly influence the illness-related expenditure by the families.

Conclusion: WS imposes a substantial financial burden on the families and indirectly on the healthcare system.
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http://dx.doi.org/10.1007/s12098-021-03761-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149262PMC
May 2021

Monozygotic twins with development delay and a characteristic electroencephalographic pattern: Just look at the face.

J Paediatr Child Health 2021 May 10. Epub 2021 May 10.

Genetic Metabolic Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1111/jpc.15262DOI Listing
May 2021

Prediction of Neurodevelopmental Outcomes in SARS-CoV-2 Infections.

Pediatr Neurol 2021 07 16;120. Epub 2021 Apr 16.

Research Unit iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria.

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http://dx.doi.org/10.1016/j.pediatrneurol.2021.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050400PMC
July 2021

CNS autoimmunity in children: An unwanted wrinkle in a smooth narrative.

Med J Armed Forces India 2021 Apr 24;77(2):138-146. Epub 2021 Mar 24.

Associate Professor, Department of Pediatrics, Armed Forces Medical College, Pune, India.

The emerging paradigm of childhood autoimmune neurological disorders has exploded in recent times due to reliable diagnostic methods and their ease of availability, well-defined diagnostic criteria, and universal awareness about these disorders. The most important aspect of these disorders is a considerable recovery in response to early targeted immunotherapy. If left untreated and/or ill-treated, these can lead to mortality or lifelong morbidity. Autoantibodies can target any part of the central nervous system (CNS), ranging from superficial structures like myelin to deep intracellular ion channels like voltage-gated potassium channels, resulting in contrasting and at times overlapping symptomatology. Though neuroimaging characteristics and serological tests confirm these disorders' diagnosis, it is essential to suspect them clinically and start management before the reports are available for minimizing morbidity and mortality. In the pediatric age group, several metabolic conditions, like mitochondrial disorders and enzyme deficiencies like HMG-CoA-lyase deficiency, can develop neuroimaging patterns similar to those seen in childhood CNS autoimmune disorders and may also show a favorable response to steroids in acute phases. Hence, the clinician must suspect and work up the index patient appropriately. Here, we briefly discuss the pathophysiology, clinical clues, and potential therapeutic targets related to pediatric CNS autoimmune disorders.
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http://dx.doi.org/10.1016/j.mjafi.2021.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042506PMC
April 2021

Long-term epilepsy control, motor function, cognition, sleep and quality of life in children with West syndrome.

Epilepsy Res 2021 Jul 2;173:106629. Epub 2021 Apr 2.

Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India. Electronic address:

Purpose: To assess epilepsy, motor function, cognitive, sleep, and quality of life outcomes and their predictors in a follow-up cohort with West syndrome (WS) at ≥5 years of age.

Methods: Cross-sectional evaluation in a follow-up cohort of WS (aged 5-14 years), between July 2018 and December 2019, was performed at a tertiary-care referral center in Northern India. 164 children were assessed in-person for epilepsy severity, functional status (gross motor and hand function), social quotient, behavioral comorbidities, sleep problems, and quality of life (QoL) using Early Childhood Epilepsy Severity Scale, Gross Motor Function Classification System, Manual Ability Classification System, Vineland Social Maturity Scale, Diagnostic and Statistical Manual of Mental disorders-5 criteria, Children's Sleep Habits Questionnaire, and PedsQL-Epilepsy module respectively. Furthermore, 238 children with the inability to visit the hospital were assessed through telephonic interview along with retrospective case record review for epilepsy control, gross and fine motor measures.

Results: 402 children with WS (75 % boys) with regular follow-up were studied and the majority (80 %) had underlying structural etiology. The median age (interquartile range) of the cohort was 92 (78-107) months. Of these, 60 % had evolved to Lennox-Gastaut syndrome (LGS). The following long-term outcomes were observed: ongoing epilepsy (261/402), unfavorable motor status (130/402), moderate to profound intellectual disability (111/164), autistic spectrum disorder (42/164), attention-deficit hyperactivity disorder (18/164), poor sleep (135/164), and impaired QoL (115/164). Non-structural etiology (odds ratio [OR] = 3.8, 95 % confidence interval [CI]: 2.1-5.5, p=<0·0001) and older age (>5 months) at the onset of epileptic spasms (OR = 2·9, 95 % CI: 1.5-5.0, p=<0·0001) were associated with enduring seizure freedom for more than two years.

Conclusion: The present study revealed a preponderance of structural etiology and a high rate of transition to LGS. Early age at onset of spasms (before five months) and structural etiology were the predictors of unfavorable long-term epilepsy outcome. QoL was impaired in more than two-thirds of patients and it correlated significantly with cognitive, sleep, motor, and behavioral outcomes. However, the results of our study should be interpreted in the context of significant attrition of the original cohort.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106629DOI Listing
July 2021

Kluver-Bucy syndrome: A rare aftermath of tubercular meningitis.

Indian J Tuberc 2021 04 26;68(2):281-282. Epub 2020 Aug 26.

Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address:

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http://dx.doi.org/10.1016/j.ijtb.2020.08.008DOI Listing
April 2021

Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study.

J Pediatr Endocrinol Metab 2021 May 12;34(5):573-581. Epub 2021 Apr 12.

Pediatric Neurology Unit, Department of Pediatrics,APC, PGIMER, Chandigarh, India.

Objectives: Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures.

Methods: In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]D), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels.

Results: A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04-10.77) years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤-2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was -2.3 (95% confidence interval [CI] = -1.8, -2.8), and at the femoral neck was -2.5 (95% CI = -2, -2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)D levels were deficient in all. Mean serum osteocalcin levels were 0.68 ± 0.38 ng/mL (n=54), serum osteopontin levels were 8.6 ± 4.6 pg/mL (n=54) and serum Ntx levels were 891 ± 476 nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9 (6-34) months vs. 7.8 (4.8-13.4) months]; p=0.04).

Conclusions: Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.
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http://dx.doi.org/10.1515/jpem-2020-0680DOI Listing
May 2021

Flexible bronchoscopy during the COVID-19 pandemic: A concise clinical review and practical recommendations.

Lung India 2021 Mar;38(Supplement):S48-S52

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Bronchoscopy is an extremely useful diagnostic and therapeutic procedure that finds an invaluable place in Pulmonology practice. Due to aerosol generation, bronchoscopy carries a high risk of infection transmission to health care workers and other patients. This fact is even more important in the present times of COVID-19 pandemic owing to its droplet- (and possibly aerosol-) mediated spread. With this background, a working group extracted literature through electronic search of PubMed and Google Scholar databases. All relevant documents were comprehensively reviewed and consensus recommendations formulated based on the level of available evidence. Where evidence was insufficient, Usual Practice Points were formulated based on expert opinion. This resultant document attempts to present clinical recommendations for performing flexible bronchoscopy in COVID-19 suspect/confirmed patients. It outlines important general considerations for bronchoscopy in these cases, provides an algorithmic approach to patient selection for bronchoscopy during these extraordinary times, and enlists critical do's and don'ts that should be followed before, during, and after the procedure. To conclude, flexible bronchoscopy must be cautiously performed amid the COVID-19 crisis. Judicious case selection and meticulous contact and airborne precautions are important to minimise infection transmission.
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http://dx.doi.org/10.4103/lungindia.lungindia_357_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104346PMC
March 2021

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

J Child Neurol 2021 Jul 23;36(8):655-663. Epub 2021 Feb 23.

Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objective: To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome.

Methods: Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM).

Results: We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up.

Conclusion: The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.
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http://dx.doi.org/10.1177/0883073821991291DOI Listing
July 2021

Status of the practice of sleep medicine in India during the COVID-19 pandemic.

J Clin Sleep Med 2021 06;17(6):1229-1235

Department of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India.

Study Objectives: Like other medical branches, the practice of sleep medicine has been affected by the COVID-19 pandemic; however, the actual impact is not known. This study was planned to assess the status of the practice of sleep medicine in India during the COVID-19 pandemic and lockdown.

Methods: This was an online questionnaire-based descriptive study. A 25-item questionnaire was developed to assess the functioning of sleep laboratories, use of telemedicine, and positive airway pressure therapy during the COVID-19 pandemic in India. The questionnaire was sent to the sleep physicians of 2 major sleep medicine societies of India. Responses were analyzed.

Results: In this study, the response rate was 64.6%. During this pandemic, 72% of physicians reported that they had closed sleep laboratory, whereas 24% reported shifting to home sleep apnea testing. Only half of the sleep physicians confirmed awareness of the disinfection guidelines proposed by the American Academy of Sleep Medicine to prevent COVID-19 infection in the sleep laboratory. However, almost all of them reported taking preventive measures like the use of protective gear. Sixty-one percent of physicians advised mitigating strategies as a temporary measure to their patients of obstructive sleep apnea. A total of 58.6% opined that auto-positive airway pressure might be used for uncomplicated obstructive sleep apnea without diagnostic polysomnography during the pandemic. Eighty-four percent of physicians reported that they were continuing their services through a telemedicine facility. Physicians reported that consultations for insomnia and circadian rhythm sleep disorders increased during the pandemic.

Conclusions: Sleep laboratories were reportedly closed during the COVID-19 pandemic, and most of the sleep physicians were providing services through telemedicine. The majority reported that auto-positive airway pressure without diagnostic polysomnography could be an effective option for uncomplicated obstructive sleep apnea. Consultation for insomnia and circadian rhythm sleep disorders reportedly increased during the lockdown.
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http://dx.doi.org/10.5664/jcsm.9172DOI Listing
June 2021

Efficacy and Safety of Phenobarbitone as First-Line Treatment for Neonatal Seizure: A Systematic Review and Meta-Analysis.

J Trop Pediatr 2021 01;67(1)

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

Background And Objective: Phenobarbitone is used as a first-line drug for neonatal seizures. However, its poor short- and long-term safety profile is concerning. We aim to systematically synthesize the data on the efficacy and safety of phenobarbitone as a first-line agent and compare it against other anti-epileptic drugs (AEDs) in neonates.

Methods: Using keywords related to the study population (neonatal seizure) and intervention (phenobarbitone), we searched CENTRAL, Embase, PubMed and Web of Science until 15 December 2020. Randomized controlled trials (RCTs) comparing phenobarbitone with any other AED as first-line therapy for seizure control in the neonates were considered eligible. The random-effect meta-analysis was done using RevMan 5.3 software.

Results: We screened through 443 records and identified nine eligible studies (719 participants). Five RCTs comparing phenobarbitone with levetiracetam did not find any difference in seizure control with the first dose [risk ratio (RR) 1.43, 95% CI 0.79-2.57] or adverse effects (RR 4.66; 95% CI 0.33-65.83). Two trials comparing phenobarbitone and phenytoin also did not find any difference in seizure control with the first dose (RR 2.09; 95% CI 0.31-14.03) and other outcomes. Only one RCT compared phenobarbitone and lorazepam and found lorazepam to be more efficacious in seizure control with the first dose (RR 0.71; 95% CI 0.53-0.94). Three trials compared neurodevelopmental outcomes, in which levetiracetam was better in two, whereas one did not find any difference.

Conclusion: Phenobarbitone is at least as efficacious and safe as other drugs like phenytoin and levetiracetam. The data over the long-term neurodevelopmental outcome are lacking. The existing evidence is insufficient to recommend other drugs over phenobarbitone.
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http://dx.doi.org/10.1093/tropej/fmab008DOI Listing
January 2021

Development Assessment Scale for Indian Infants: A Systematic Review and Perspective on Dwindling Cutoffs.

Indian J Pediatr 2021 Feb 8. Epub 2021 Feb 8.

Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India.

The Developmental Assessment Scale for Indian Infants (DASII) remains the mainstay in India for diagnostic confirmation and validation of upcoming screening tools for development in infants and toddlers. This is an Indian adaptation of Bayley Scales of Infant Development which is the globally accepted gold standard. However, the DASII cutoff points used for categorizing development and distinguishing normal from abnormal development are not in agreement across different studies conducted over the last two decades in India. This is probably due to a lack of mention of cutoff points in the DASII manual and existing literature. The current systematic review summarizes the heterogeneity in literature for interpretation of DASII and its cutoff points. Also, a perspective on the ideal cutoff points is presented.
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http://dx.doi.org/10.1007/s12098-021-03671-2DOI Listing
February 2021

'Leads' that lead: A patient with tachypnoea, tachycardia, hypotension and an uncommon ECG finding.

J Family Med Prim Care 2020 Nov 30;9(11):5787-5789. Epub 2020 Nov 30.

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

This case is being reported to draw the attention of non-cardiac practicing physicians including pulmonologists, intensivists, and, as a matter of fact all primary care and emergency clinicians, towards a relatively uncommon ECG finding that could be the potential lead in suspecting the diagnosis of a commonly encountered, often fatal medical condition. Together with a high clinical index of suspicion, this alone could guide the decision-making process for further work-up and specific therapy.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1073_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842422PMC
November 2020

Orbital Apex Syndrome: A Clinico-anatomical Diagnosis.

J Pediatr Neurosci 2020 Jul-Sep;15(3):336-337. Epub 2020 Nov 6.

Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

An 8-month-old girl presented with fever, restricted left eye movements and increasing proptosis for 8 days. On examination she had left orbital cellulitis, relative afferent pupillary defect and ophthalmoplegia. Contrast-enhanced magnetic resonance imaging (MRI) brain with orbits revealed orbital apex syndrome (OAS) with cavernous sinus thrombosis. Orbital apex is located posteriorly in the orbit and characterised by involvement of cranial nerves II, III, IV, VI and ophthalmic division of Vth nerve. The close clinico-anatomical differentials of OAS are cavernous sinus and superior orbital fissure syndrome. The current case was treated successfully with intravenous antibiotics and anticoagulation therapy.
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http://dx.doi.org/10.4103/jpn.JPN_114_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847102PMC
November 2020

Psychological Morbidity among People in Quarantine.

J Neurosci Rural Pract 2021 Jan 29;12(1):67-70. Epub 2021 Jan 29.

Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

 This study aimed to evaluate psychological distress of persons in quarantine and compare the same with a group of persons, who are currently in lockdown.  Forty-four persons in quarantine and 45 subjects currently in lockdown were evaluated on Depression Anxiety Stress Scale II.  About three-fourth (77.3%) of the participants in the quarantine group and one-third (37.8%) in the comparator group had depression. About one fourth (22.7%) in the quarantine group and one-third (35.6%) in the lockdown group had anxiety.  The present study suggests that lockdown and being in quarantine are associated with significantly higher psychiatric morbidity, especially anxiety.
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http://dx.doi.org/10.1055/s-0040-1718855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846334PMC
January 2021

Child with predominant midline stereotypies and infrequent seizures.

BMJ Case Rep 2021 Jan 20;14(1). Epub 2021 Jan 20.

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

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http://dx.doi.org/10.1136/bcr-2020-238764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818796PMC
January 2021

Acute Flaccid Myelitis: Are We Vigilant Enough?

Indian Pediatr 2021 01;58(1):93

Pediatric Neurology Division, Department of Pediatrics, Advanced Pediatric Centre, PGIMER, Chandigarh, India.

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January 2021

Hypertensive Emergency with Medullary and Spinal Hemorrhage in Turner Syndrome.

Indian J Pediatr 2021 Jan 14. Epub 2021 Jan 14.

Division of Pediatric Critical Care, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India.

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http://dx.doi.org/10.1007/s12098-020-03646-9DOI Listing
January 2021

Retrieval of a tracheobronchial blood clot with a Yankauer suction catheter in complete airway obstruction.

Acute Crit Care 2021 Feb 13;36(1):78-80. Epub 2021 Jan 13.

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, India.

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http://dx.doi.org/10.4266/acc.2020.00675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940101PMC
February 2021

Acute Flaccid Myelitis Surveillance During the COVID-19 Pandemic.

Pediatr Neurol 2021 03 3;116. Epub 2020 Dec 3.

Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

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http://dx.doi.org/10.1016/j.pediatrneurol.2020.11.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711197PMC
March 2021

Home-Videos for Neurodevelopmental Follow-Up of High-Risk Infants during COVID-19 Pandemic: A Simple and Inexpensive Tool.

J Trop Pediatr 2021 01;67(1)

Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz 8036, Österreich.

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http://dx.doi.org/10.1093/tropej/fmaa088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798623PMC
January 2021

Neurological Manifestations of COVID-19 in Children: Time to Be More Vigilant.

Pediatr Neurol 2021 02 17;115:28. Epub 2020 Nov 17.

Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

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http://dx.doi.org/10.1016/j.pediatrneurol.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670227PMC
February 2021
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