Publications by authors named "Manisha Jana"

136 Publications

Central airway abnormalities - More than meets the eye.

Lung India 2021 May-Jun;38(3):280-283

Department of Medicine, AIIMS, New Delhi, India.

Central airway abnormalities are the most overlooked part of the respiratory system during high-resolution computed tomography thorax specifically when these are subtle and read by less experienced eyes. In this article, we have tried to emphasize the importance to include central airways in reporting checklist. Systematically, analysis of airways can give important clues and narrow down the differentials and clinch the diagnosis in some cases like in our index one.
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http://dx.doi.org/10.4103/lungindia.lungindia_87_21DOI Listing
May 2021

Cystic Lung Disease in Tuberculosis.

Indian J Pediatr 2021 Apr 17. Epub 2021 Apr 17.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-021-03751-3DOI Listing
April 2021

Role of Imaging in Childhood Arthritis.

J Clin Rheumatol 2021 Apr 9. Epub 2021 Apr 9.

From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India.

Abstract: Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.
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http://dx.doi.org/10.1097/RHU.0000000000001735DOI Listing
April 2021

Neuroblastoma With Opsoclonus-Myoclonus-Ataxia Syndrome: Role of Chemotherapy in the Management: Experience From a Tertiary Care Center in a Resource-limited Setting.

J Pediatr Hematol Oncol 2021 Mar 23. Epub 2021 Mar 23.

Departments of Pediatric Surgery Pediatrics Radiodiagnosis Department of Medical Oncology, BRAIRCH, AIIMS, New Delhi, India.

Children with neuroblastoma (NB) and opsoclonus-myoclonus-ataxia syndrome (OMAS) have a favorable oncologic outcome and overall survival. In contrast, despite intensive multidrug immunomodulation, the neurologic outcome is complicated by the relapsing nature of the neurologic symptoms and long-term neurobehavioral sequelae. Being associated with low-risk NB, there exists an ambiguity in the current literature regarding the administration of chemotherapy in these children. We reviewed our archives for children with NB-OMAS over a 22-year (January 1996 to January 2018) period. Eighteen children (10 female) with a median age at diagnosis of 23 months had NB-OMAS and were included. They had stage 1 (9/18; 50%), 2 (1/18; 5.5%), 3 (7/18; 39%), and 4 (1/18; 5.5%) disease according to the International Neuroblastoma Staging System. Multimodality therapy included surgery (16/18; 89%), chemotherapy (11/18; 61%), and immunomodulatory therapy (10/18; 55%). Complete oncologic remission was achieved in all children. Relapse of OMAS and presence of neurologic sequelae were observed in 1 (5.5%) and 5 (28%) cases, respectively. Presence of neurologic sequelae was significantly associated with low-tumor stage (P=0.036) and treatment without chemotherapy (P=0.003). Chemotherapy administration was the only variable significantly predicting a favorable neurologic outcome (95% confidence interval: 0.26-1.40, P=0.01). To conclude, our study including a limited cohort of patients highlights a favorable neurologic outcome associated with chemotherapy administration in children with NB-OMAS. However, further studies with larger sample size need to be conducted before drawing any definite conclusions.
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http://dx.doi.org/10.1097/MPH.0000000000002131DOI Listing
March 2021

Spine radiograph in dysplasias: A pictorial essay.

Indian J Radiol Imaging 2020 Oct-Dec;30(4):436-447. Epub 2021 Jan 13.

Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Spine radiograph is an essential component of a skeletal survey. It provides important diagnostic clues to various types of skeletal dysplasia. In some conditions, a spine radiograph alone may be diagnostic and characteristic; but mostly, it yields more value as a part of the complete skeletal survey. In this article we will discuss about a few common lethal and non-lethal skeletal dysplasias and their characteristic imaging findings; primarily focusing on the spine radiograph.
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http://dx.doi.org/10.4103/ijri.IJRI_395_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954163PMC
January 2021

Multiple giant venous malformations.

J Vasc Surg Venous Lymphat Disord 2021 03;9(2):508-509

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

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http://dx.doi.org/10.1016/j.jvsv.2020.06.010DOI Listing
March 2021

Outcome of Children with Stage IV Wilms Tumor - Our Experience of 15 Years.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):372-377. Epub 2020 Oct 27.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Context: Stage IV Wilms tumor is associated with poor prognosis, and recent changes in management have been suggested based on genetic markers and response to chemotherapy in this subgroup of patients.

Objective: The objective was to evaluate the outcomes of children with Stage IV Wilms tumor who were managed with the AIIMS-WT-99 protocol.

Materials And Methods: All the children with Stage IV Wilms tumor who were managed by us from October 2000 to December 2012 were included in the study. All the patients who had received primary treatment elsewhere were excluded from the study. All patients were managed as per the AIIMS-WT-99 protocol. After appropriate investigations, tumors that were deemed resectable underwent an upfront surgery. Unresectable and inoperable tumors received chemotherapy after cytological confirmation of the diagnosis. Chemotherapy was administered as per the NWTS-5 study. Pulmonary and flank radiotherapy was advised to all patients. Patients with poor response to chemotherapy or with recurrence were managed with an alternative chemotherapy regimen. The outcomes that were assessed the 4-year overall survival (OS) and the 4-year event-free survival (EFS).

Statistical Analysis Used: Kaplan-Meier survival estimates.

Results: During the study period, 219 patients with Wilms tumor were treated. Of these, 36 (16.4%) had Stage IV disease, and they formed the study group. The 4-year OS was 48% with a mean survival time of 59 months limited to 115 months (95% confidence interval: 41.3-75.9 months). The 4-year EFS was 42.4%. Patients with liver metastases had a poor outcome, whereas patients with good response to chemotherapy had a good outcome.

Conclusion: Stage IV Wilms had a poor prognosis, and the survival rates in the index study are lower than those quoted in the literature. Although the exact reason for this poor result eludes us, these patients may benefit from the intensification of chemotherapy.
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http://dx.doi.org/10.4103/jiaps.JIAPS_168_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815034PMC
October 2020

Primary Pulmonary Tumors in Pediatric Population: Imaging Markers for Predicting Histology.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):363-367. Epub 2020 Oct 27.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The objective of the study was to review the imaging features of proven pediatric primary lung tumors, with a purpose of detecting key distinguishing features among the various entities.

Materials And Methods: We retrospectively reviewed multidetector computed tomography (CT) images of 17 pediatric patients with primary lung tumors. For each examination, various CT image descriptors were used to characterize the pulmonary nodules/masses; including location, size, number, morphology, cavitation, calcification, intense enhancement, airway involvement, chest wall/pleural involvement, mediastinal/vascular involvement, and nodal enlargement.

Results: The age of the patients ranged from 2 to 18 years (mean age of 9.5 years). Approximately 35.3% of tumors were benign and 64.7% were aggressive/malignant. Nine distinct histopathologic tumor entities were found. Common tumor types were recurrent respiratory papillomatosis (4) and inflammatory myofibroblastic tumor (4) with two endobronchial tumors including carcinoid and mucoepidermoid carcinomas. Besides invasion and nodal enlargement, large size and central location ( < 0.05) were predictors of aggressiveness/malignancy. Multiple lesions and cavitation ( < 0.05), on the other hand, were frequent in benign lesions.

Conclusion: On imaging, location and morphological markers can allow diagnosis in majority of the tumors.
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http://dx.doi.org/10.4103/jiaps.JIAPS_156_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815042PMC
October 2020

Cystic biliary atresia with congenital absence of portal vein.

BMJ Case Rep 2021 Jan 18;14(1). Epub 2021 Jan 18.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.

A 126-day female child presented with jaundice since day 7 of life. She was icteric and had hepatosplenomegaly. Radiological investigations revealed three extrahepatic and multiple intrahepatic biliary cysts, absent gall bladder and portal vein. These findings were confirmed on laparotomy. To the best of our knowledge, this is the first report of cystic biliary atresia associated with congenital absence of portal vein.
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http://dx.doi.org/10.1136/bcr-2020-239205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813356PMC
January 2021

'Mass-Like' Appearance of Pulmonary Mucormycosis in Chronic Granulomatous Disease: An Imaging Observation.

Indian J Pediatr 2021 Apr 5;88(4):388-389. Epub 2021 Jan 5.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-020-03594-4DOI Listing
April 2021

'Lip-to-Tip' study: comparison of three methods to determine optimal insertion length of endotracheal tube in neonates.

Eur J Pediatr 2021 May 3;180(5):1459-1466. Epub 2021 Jan 3.

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

The aim of this prospective observational study was to compare the incidence of endotracheal tube (ETT) malposition using weight-based (Tochen), gestation-based (Kempley), and nasotragal length (NTL) methods in deceased neonates and fresh stillbirths. We enrolled deceased neonates and fresh stillbirths within 2 ± 1 h of death or delivery, respectively; without hydrops, tracheostomy or major congenital anomalies affecting face, neck, or thorax. Each enrolled subject was intubated orotracheally, with lip-to-tip distance determined by three methods in random succession. Chest X-ray was acquired after each insertion. The primary outcome was proportion of malpositioned ETTs on chest X-ray (defined as ETT tip not lying between upper border of T1 and lower border of T2 vertebrae), assessed by two experts masked to the methods used. The proportion of malpositioned tubes was not significantly different with any of the three methods: (weight 27/50 (54%), gestation 35/50 (70%), and NTL 35/50 (70%), p value 0.055). The malpositioned tubes were too far in (87/150; 58%) than too far out (10/150; 6.7%).Conclusions: None of the currently recommended methods accurately predicts optimal ETT length in neonates. There is an urgent need for newer bedside modalities for estimating ETT position in neonates. What is known? • NRP guidelines recommend gestation-based and nasotragal length (NTL) methods to estimate initial ETT depth in neonates. Weight-based (Tochen) method is still widely used in neonatal units for ETT depth estimation. Evidence till date has not proven superiority of one method over the other. What is new? • All three methods for ETT depth estimation (Tochen, gestation-based, and NTL) resulted in high rates of ETT malposition in neonates. Formulae, devised from this study based on linear regression models, did not perform well for estimation of optimal ETT position.
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http://dx.doi.org/10.1007/s00431-020-03919-7DOI Listing
May 2021

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children.

Pediatr Pulmonol 2020 12 14;55(12):3457-3464. Epub 2020 Oct 14.

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

Rationale: The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established.

Objectives: To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy.

Methods: In an observational cohort study, children aged 1-18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end-expiration (DTe) and end-inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre- and post-extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated.

Measurements And Main Results: Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10), and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04) per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79% [1.03, 2.87]) than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri-extubation DTe and DTF) in extubation success versus failure.

Conclusions: The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.
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http://dx.doi.org/10.1002/ppul.25076DOI Listing
December 2020

Isolated Asternia: An Extremely Rare Entity.

J Indian Assoc Pediatr Surg 2020 Jul-Aug;25(4):254-255. Epub 2020 Jun 24.

Department of Radiodiagnosis, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_223_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478271PMC
June 2020

Novel Use of Ultrasound in Evaluation of Adenoid Hypertrophy in Children.

Indian J Pediatr 2020 11 10;87(11):885-886. Epub 2020 Sep 10.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-020-03487-6DOI Listing
November 2020

High Resolution Transthoracic Ultrasound in Evaluation of Pediatric Mediastinal Lymphadenopathy.

Indian J Pediatr 2021 Jan 2;88(1):105. Epub 2020 Sep 2.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-020-03485-8DOI Listing
January 2021

Ultrasound Imaging of Renal Cysts in Children.

J Ultrasound Med 2021 Mar 14;40(3):621-635. Epub 2020 Aug 14.

Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Renal cysts can be focal or diffuse and unilateral or bilateral. In childhood, most renal cysts are due to hereditary diseases rather than simple cysts or acquired cystic diseases, unlike adults. Inherited cystic diseases can be ciliopathies due to a primary ciliary defect (as in polycystic kidney diseases and nephronophthisis). Acquired causes include obstructive cystic dysplasia, dyselectrolytemia, and acquired cysts in renal replacement therapy. The final diagnosis requires a multispecialty approach, including radiology, pathology, and genetics. Imaging is a very important component in treating patients with cystic renal diseases. This article discusses the ultrasound findings of cystic renal diseases in children, along with a brief discussion of other imaging modalities and a suggested ultrasound reporting format.
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http://dx.doi.org/10.1002/jum.15435DOI Listing
March 2021

Fibroscan as a non-invasive predictor of hepatic steatosis in women with polycystic ovary syndrome.

Indian J Med Res 2020 04;151(4):333-341

Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Background & Objectives: There is limited data on non-alcoholic fatty liver disease (NAFLD) among Indian women with polycystic ovary syndrome (PCOS), and there are no data on the utility of fibroscan in its assessment. The objective of this study was thus to investigate the frequency of hepatic steatosis in young women with PCOS and evaluate the utility of transient elastography (TE) in its assessment.

Methods: Seventy women diagnosed with PCOS and 60 apparently healthy women (controls) were enrolled in this pilot study. These women were evaluated for clinical, biochemical and hormonal parameters, transabdominal ultrasonography, dual-energy X-ray absorptiometry and fibroscan assessing liver stiffness measure (LSM) and controlled attenuation parameter (CAP). Other indices such as liver fat score (LFS), lipid accumulation product (LAP), fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index, hepatic steatosis index (HIS) scores were also calculated. The main outcome measures were the presence of NAFLD in women with PCOS and its correlation with CAP and LSM on TE.

Results: Women with PCOS had higher frequency (38.57 vs. 6.67%) of hepatic steatosis than control women as determined by abdominal sonography. The aminotransferases were higher in PCOS group (14.28 vs. 1.7%, P=0.03) even after adjusting for body mass index implying higher non-alcoholic steatohepatitis among young PCOS patients. PCOS women had significantly higher CAP on TE compared to controls (210 vs. 196). CAP had a significant correlation with LFS, LAP and HIS.

Interpretation & Conclusions: NAFLD is common in young women with PCOS, and fibroscan using TE may be considered as a promising non-invasive diagnostic modality in its early detection.
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http://dx.doi.org/10.4103/ijmr.IJMR_610_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371053PMC
April 2020

Unusual cause of seizure in a child: Intracranial calcified metastasis of osteosarcoma.

Indian J Cancer 2020 Apr-Jun;57(2):209-211

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

Intracranial parenchymal calcification has both benign and malignant etiologies. Calcifications by malignant etiologies are comparatively rare. Malignant calcification has numerous causes. Calcified brain metastasis from osteosarcoma is one such cause. We present histopathologically confirmed intracranial calcified metastasis in a 10 year old girl. This girl had received treatment for primary osteosarcoma of the left femur with pulmonary metastases. Radiological imaging with Positron emission tomography-computed tomography revealed an intracranial calcified lesion in the frontal lobe and she was successfully operated for the same. The malignant causes of intracranial calcifications are reviewed and radiological differential diagnoses of malignant intracranial calcifications are discussed in this case report. Prior history, strong clinical suspicion, and radiological imaging are needed to arrive at the diagnosis of intracranial calcified metastasis from primary osteosarcoma of the appendicular skeleton.
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http://dx.doi.org/10.4103/ijc.IJC_796_18DOI Listing
November 2020

Bi-allelic loss-of-function novel variants in LTBP3-related skeletal dysplasia: Report of first patient from India.

Am J Med Genet A 2020 08 20;182(8):1944-1946. Epub 2020 May 20.

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

Dental anomalies and short stature (DASS) has been recently identified as a distinct entity, associated with bi-allelic hypomorphic variants in LTBP3 gene. Only 20 individuals from nine families have been previously reported, with a consistent phenotype of short stature, brachyolmia, and amelogenesis imperfecta. We report the first case from India, with novel radiographic and molecular findings in LTBP3 gene, thereby expanding the phenotypic spectrum of DASS.
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http://dx.doi.org/10.1002/ajmg.a.61629DOI Listing
August 2020

Thoracic Manifestations of Primary Immunodeficiency Disorders.

Indian J Pediatr 2020 Oct 8;87(10):846-849. Epub 2020 May 8.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

Primary immunodeficiency disorders (PIDD) are a group of disorders presenting with recurrent infections. The authors retrospectively reviewed the imaging records of 24 proven cases of PIDD and correlated the imaging findings with the type of defect. Final diagnoses were categorized in four groups; Group I (humoral immunodeficiency), Group 2 (cell mediated immunodeficiency), Group 3 (phagocytic disorders) and Group 4 (others). Group 3 was the commonest, followed by 1 and 2. Three most common disorders encountered were chronic granulomatous disease (CGD) (7/24), hyper IgE syndrome (5/24) and common variable immunodeficiency (CVID) (4/24). Consolidation (12/24), nodules (10/24), bronchiectasis (9/24) and lymphadenopathy (8/24) were the commonest imaging findings. Although not statistically significant, some definite imaging trends could be established. Presence of consolidation and nodules; with absence of bronchiectasis was the striking finding in Group 3. Group 2 disorders predominantly showed bronchiectasis, whereas presence of consolidation, nodules, bronchiectasis all were very common in Group 1.
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http://dx.doi.org/10.1007/s12098-020-03289-wDOI Listing
October 2020

Utility of MR proton density fat fraction and its correlation with ultrasonography and biochemical markers in nonalcoholic fatty liver disease in overweight adolescents.

J Pediatr Endocrinol Metab 2020 Apr;33(4):473-479

Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.

Background Clinical or biochemical markers that have good correlation with magnetic resonance proton density fat fraction (MR PDFF) can be used as simple tools for the screening for nonalcoholic fatty liver disease (NAFLD) and in determining the degree of fatty infiltration of the liver. The objective of this study was to determine the degree of relationship between MR PDFF and ultrasonography (USG) grades of fatty liver, and clinical and biochemical parameters of adolescents and to determine the sensitivity and specificity of USG for diagnosis of NAFLD. Methods This prospective study included 34 overweight adolescents (mean age, 12.1 ± 1.5 years; range, 10-15.1 years; 10 girls and 24 boys) who underwent both USG and magnetic resonance imaging (MRI). Correlation analysis was performed between MR fat fraction and USG grades of fatty liver, and clinical and biochemical parameters of fatty liver disease. Results MR fat fraction had a moderate positive correlation with serum alanine transaminase (ALT) and aspartate transaminase (AST) (ρ = 0.634, p < 0.001, ρ = 0.516, p = 0.002, respectively) and had a negligible or weak correlation with body mass index (BMI), BMI standard deviation score (SDS), waist circumference (WC), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), serum triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol levels. The sensitivity and specificity of USG in the diagnosis of NAFLD were 81% (95% confidence interval 54%-95%) and 50% (27%-73%), respectively. The MR fat fraction had a moderate positive correlation with ultrasound grades of fatty liver (ρ = 0.487, p = 0.003). Conclusions Serum ALT and AST are potential biochemical markers to assess the degree of hepatic steatosis in NAFLD, which needs validation in further studies. USG can be used as a screening tool for NAFLD, but the diagnosis should be confirmed by estimating the MR fat fraction.
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http://dx.doi.org/10.1515/jpem-2019-0463DOI Listing
April 2020

Zebra Lines From Cyclical Bisphosphonate Therapy.

J Clin Rheumatol 2021 Apr;27(3):e92

From the Departments of Pediatrics.

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http://dx.doi.org/10.1097/RHU.0000000000001269DOI Listing
April 2021

Mimickers of Juvenile Idiopathic Arthritis: Getting Clues From Imaging.

J Clin Rheumatol 2021 Apr;27(3):e113-e115

Division of Pediatric Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1097/RHU.0000000000001288DOI Listing
April 2021

Correlation of Hepatic Artery Resistive Index with Portal Pressure and Serum Nitric Oxide Levels in Patients with Extrahepatic Portal Vein Obstruction.

J Indian Assoc Pediatr Surg 2020 Jan-Feb;25(1):38-42. Epub 2019 Nov 27.

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

Aim: The aim was to study the correlation of hepatic artery resistive index (HARI) with the portal pressure (PP) and its surrogate marker serum nitric oxide (NO) levels and to determine the validity of HARI as noninvasive indirect marker of PP in extrahepatic portal venous obstruction (EHPVO) pre- and postoperatively.

Methods: A prospective study was conducted on 19 patients with EHPVO undergoing proximal lienorenal (LR) shunt or devascularization from February 2016 to January 2018. HARI, calculated from Doppler sonography, and NO were measured preoperatively and 14, 30 and 90 days postoperatively. Intraoperatively, PP was measured before splenectomy, and both PP and NO were measured postshunt.

Results: Mean age was 10.58 ± 2.85 years, and male:female ratio was 15:4. LR shunt was done in 16 while three patients required devascularization. There was a significant fall in the HARI (0.06 ± 0.02, = 0.02), NO (14.31 ± 2.66 μmol/l, < 0.001), and PP (11.81 ± 1.03 mmHg, < 0.001) following shunt surgery. However, fall in HARI did not correlate with fall in PP. Preoperative HARI also did not correlate with preshunt/devascularization PP nor with preoperative NO. Postoperatively, HARI did not correlate with NO at 14-, 30-, and 90-day follow-up.

Conclusion: HARI bears no correlation with PP or NO. Hence, it cannot be used as an indirect marker of PP.
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http://dx.doi.org/10.4103/jiaps.JIAPS_244_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910058PMC
November 2019

Life-threatening Hypercalcemia as the First Manifestation of Acute Lymphoblastic Leukemia.

Indian Pediatr 2019 11;56(11):972-974

Department of Pediatrics, AIIMS, New Delhi, India.

Hypercalcemia of malignancy, usually reported in adults in advanced stages, is rare in children. A 4-year-old boy presented with intermittent episodes of severe hypercalcemia, which improved with intravenous hydration therapy, furosemide and bisphosphonates as the initial manifestation of occult acute lymphoblastic leukemia. Pediatricians should rule out hematological malignancy in patients with severe hypercalcemia.
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November 2019

Dual partial arc volumetric-modulated arc therapy: The game changer for accelerated hypofractionated whole-breast radiotherapy with simultaneous integrated tumor cavity boost in early breast cancer - A comparative dosimetric study with single partial arc volumetric-modulated arc therapy.

J Cancer Res Ther 2019 Jul-Sep;15(5):1005-1010

Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India.

Introduction: In a previous study, we demonstrated clinical and dosimetric feasibility of single partial arc volumetric modulated arc therapy (VMAT) for accelerated hypofractionated whole breast radiotherapy with simultaneous integrated boost (SIB) to lumpectomy cavity for early breast cancer. In this dosimetric study, we compared dual partial arcs versus single arc.

Patients And Methods: Fifteen consecutive patients for treatment with hypofractionated accelerated radiotherapy with SIB using VMAT were planned with single partial arc in an earlier study, initial result of which is published elsewhere. The comparative dosimetric plan was created using two partial arcs. Skewness and kurtosis test, Paired Student's t-test, and Wilcoxon signed-rank test were applied for statistical analysis. P < 0.05 was considered statistically significant.

Results: Most planning targets are better achieved with dual arc technique. Coverage of planning target volume (PTV) whole breast (PTV and PTV lumpectomy cavity (PTV) was significantly improved with dual partial arc without significant difference in conformity index and homogeneity index. Dual arc improved dosimetric parameter significantly. Mean dose (D) and maximum dose (D) of whole breast PTV as well as D of PTV; ipsilateral and contralateral lung D, D, 5 Gy volume (V); contralateral lung D, D, V; Heart V and V; D of 5 mm thickness skin; D and D of ribs; and D and D of contralateral breast were improved with dual arc.

Conclusion: This is first of its kind study establishing the advantage of dual partial arcs in the current context. Dual partial arcs improved dosimetry over single partial arc. Significant dose reduction can be achieved for multiple crucial organs at risk.
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http://dx.doi.org/10.4103/jcrt.JCRT_922_17DOI Listing
July 2020

Prevalence and Risk Factors of Allergic Bronchopulmonary Aspergillosis and Aspergillus Sensitization in Children with Poorly Controlled Asthma.

J Trop Pediatr 2020 06;66(3):275-283

Department of Pediatrics, All India Institute of Medical Sciences, 110029 New Delhi, India.

Background: Allergic bronchopulmonary aspergillosis (ABPA) may be a risk factor for poorly controlled asthma in children. The studies regarding prevalence and risk factors of ABPA in children with poorly controlled asthma are limited in number.

Objectives: To determine prevalence and risk factors of ABPA and aspergillus sensitization (AS) in children with poorly controlled asthma.

Methods: In this prospective cross-sectional study from a tertiary care center in India, we enrolled asthmatic children 5-15 years of age with poorly controlled asthma. We did the following investigations: spirometry, skin prick test, serum total immunoglobulin E (IgE), aspergillus-specific IgE and immunoglobulin G, serum precipitin for Aspergillus, absolute eosinophil count, chest X-ray and high-resolution computed tomography of the chest. ABPA and AS were diagnosed as per the recently proposed criteria.

Results: We enrolled 106 children [boys 72 (67.9%); mean age of 10.2 ± 2.6 years] with poorly controlled asthma. The prevalence of ABPA and AS were 11.3% (95% CI, 5.2-17.5%) and 61.3% (95% CI, 52.0-70.7%), respectively. The presence of brownish sputum was significantly more in ABPA compared with non-ABPA patients (33.3 vs. 4.2%, p = 0.002). The age, gender, allergic rhinitis and gastroesophageal reflux were not significantly different in ABPA compared with non-ABPA patients.

Conclusion: The prevalence of ABPA and AS was 11.3 and 61.3%, respectively in children with poorly controlled asthma. We could not find any risk factors for ABPA except that the presence of brownish sputum was more in children with ABPA. Spirometry parameters were not significantly different in ABPA compared with non-ABPA patients.
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http://dx.doi.org/10.1093/tropej/fmz066DOI Listing
June 2020

Surgical Correction of Pectus Excavatum Using a Rib Graft Strut Following Excision of Costal Cartilages.

J Indian Assoc Pediatr Surg 2019 Oct-Dec;24(4):252-256

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

Background: A number of techniques are described for correction of pectus excavatum (PE). This article describes the experience with an innovative procedure which combines features from the Ravitch and Nuss procedures without using prosthetic material.

Methods: This cross-sectional study included 12 cases of PE from January 2000 to March 2017 managed by excision of deformed costal cartilages and support to the thoracic cage using an autologous free rib graft as a strut. Indication for surgery was Haller's Index above 3.2 with or without respiratory distress. Noncontrast computed tomography scans were done at 6 months after surgery to document the position of the strut and to see the final correction and new Haller's Index, respectively.

Results: The male-to-female ratio was 2:1. Preoperative Haller's Index in all cases was >3.2 (range 3.25-14). The average age at surgery was 5 years and 8 months (range: 7 months-15 years). Mean duration of hospital stay was 11 days (range 5-16 days).The 11 rib was used commonly although in two cases, the 10 rib was used as the 11 rib was considered relatively short. Pericardial effusion requiring strut removal was seen in one case; in another case, removal of the rib was needed because of nonhealing of a delayed dehisced surgical wound. Others had an uneventful postoperative period. The mean postoperative Haller's Index was 2.75 (range 2.0-7).

Conclusion: This modified procedure using an autologous rib strut is technically feasible and reproducible even with limited facilities and gives excellent results.
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http://dx.doi.org/10.4103/jiaps.JIAPS_68_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752060PMC
October 2019

Combination antifungals as an effective means of salvage in paediatric leukaemia patients with invasive fungal infections.

Indian J Med Microbiol 2019 Jan-Mar;37(1):109-112

Department of Pediatrics, Division of Pediatric Oncology, All Institute of Medical Sciences, New Delhi, India.

Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in paediatric leukaemias. Antifungal combinations to treat these patients are being explored. Fourteen children with leukaemias and IFIs were treated with a combination of antifungal agents at our centre. The first antifungal was amphotericin-B in 13 children and voriconazole in one child. In view of no improvement and clinical deterioration, in nine patients, voriconazole was added as the second antifungal agent and in four, it was caspofungin. All patients completed 4-6 weeks of antifungal therapy. The overall mortality attributable to IFI for the cohort was 4/14 (28%).
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http://dx.doi.org/10.4103/ijmm.IJMM_18_157DOI Listing
December 2019

Report of a Novel Homozygous Nonsense Mutation in an Indian Adult Male with Spondylo-meta-epiphyseal Dysplasia, Short Limb-Abnormal Calcification Type.

J Pediatr Genet 2019 Sep 12;8(3):153-156. Epub 2019 Mar 12.

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

Spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type is a rare autosomal recessive disorder causing severe disproportionate short stature along with typical radiological features. We report an adult male patient with typical features and a novel homozygous nonsense mutation c.2422C > T (p.Gln808Ter) in . This is the first report of the disease from India.
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http://dx.doi.org/10.1055/s-0039-1683382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688880PMC
September 2019