Publications by authors named "Narendra Kumar Bagri"

22 Publications

  • Page 1 of 1

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

Macrophage Activation Syndrome in Children: Diagnosis and Management.

Indian Pediatr 2021 Mar 26. Epub 2021 Mar 26.

Department of Pediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust and Translational Health Sciences, University of Bristol, Bristol, UK.

Macrophage activation syndrome is a severe yet under-recognized complication encountered in pediatric rheumatology. It manifests as secondary hemophagocytic lymphohistiocytosis leading to a hyper-inflammatory state resulting from an underlying cytokine storm. If unchecked, it may lead to multiorgan failure and mortality. Early diagnosis and timely initiation of specific therapy is pivotal for a successful outcome. This review outlines the key clinical and laboratory features and management of macrophage activation syndrome.
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March 2021

Communicating Calf Swelling in Systemic-Onset Juvenile Idiopathic Arthritis.

J Clin Rheumatol 2020 08 22. Epub 2020 Aug 22.

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.0000000000001528DOI Listing
August 2020

Role of Serum MRP8/14 in Predicting Response to Methotrexate in Children With Juvenile Idiopathic Arthritis.

J Clin Rheumatol 2020 Jun 9. Epub 2020 Jun 9.

From the Departments of *Pediatrics †Biochemistry ‡Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.

Objective: Nearly 40% of children with juvenile idiopathic arthritis (JIA) might not respond to first-line disease-modifying antirheumatic drugs (DMARDs) including methotrexate (MTX). Hence, there is a need for a biomarker that can predict MTX response and help in tailoring initial therapy. Our objective was to study the role of serum myeloid-related protein (MRP) 8/14, and other inflammatory cytokines, as predictors of response to MTX among children with JIA.

Methods: We did a longitudinal follow-up study among children diagnosed with JIA at our institute. All MTX-naive children with JIA requiring DMARDs were eligible for this study; those who either took corticosteroids or DMARDs for more than 6 weeks at time of presentation were excluded. The demographic and clinical information was collected using a pretested semistructured questionnaire, and selected biomarkers were collected at baseline and again at 3 months. Response at 3 months was assessed using the American College of Rheumatology (ACR) criteria; responders were children who achieved ACR50, whereas those failing to achieve ACR30 were classified as nonresponders. Multivariate binary logistic regression was done to assess determinants of being a responder.

Results: We enrolled 69 children (36 boys) with JIA, of which 48 (69.5%) were responders. The baseline value of serum MRP8/14 was significantly higher in responders (median, 144.34 [interquartile range, 88.54-188.34] ng/mL) compared with the nonresponders (median, 95.34 [interquartile range, 76.54-130.28] ng/mL), p = 0.047. Being a responder was significantly associated with baseline serum MRP8/14 with adjusted odds ratio of 1.01 (95% confidence interval, 1.00-1.02).

Conclusions: The baseline levels of MRP8/14 were significantly raised in children meeting ACR50 at follow-up and suggest a prognostic value in predicting response to MTX.
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http://dx.doi.org/10.1097/RHU.0000000000001406DOI Listing
June 2020

Hemophagocytic Lymphohistiocytosis: manifestation of an untamed immune system.

Indian J Pediatr 2020 07 26;87(7):493-494. Epub 2020 May 26.

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

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http://dx.doi.org/10.1007/s12098-020-03348-2DOI Listing
July 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

Cryopyrin-associated periodic fever syndrome in children: A case-based review.

Int J Rheum Dis 2020 Feb 19;23(2):262-270. Epub 2019 Dec 19.

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

Cryopyrin-associated periodic fever syndrome (CAPS) represents an increasingly recognized disease group entity, with varied presentations. CAPS includes 3 clinical entities, namely, familial cold-induced autoinflammatory syndrome (FCAS; MIM #120100), Muckle-Wells syndrome (MWS; MIM #191900) and chronic inflammatory neurologic cutaneous and articular syndrome (CINCA; MIM #607115); which share several overlapping clinical features. These patients often present with early-onset episodes of fever and rash, and variable systemic signs and symptoms, making it a great mimicker of other systemic autoimmune diseases. The episodes are transient and related to exposure to cold temperature and worsen in the winter season. We hereby present a case presenting with recurrent seasonal fever and rash, diagnosed as FCAS/ MWS overlap based on clinical signs and symptoms and positive testing for NLRP3 gene mutation. We also discuss the clinical presentation and complications of CAPS, chiefly FCAS and MWS, along with the previously described pediatric cases of CAPS. We tried to review the complexities of management of such patients, including the genetic diagnosis and the role of biological therapy. Based on the review of the literature, given the evident broad spectrum of symptoms and signs, use of next-generation sequencing can help in prompt diagnosis and early initiation of biological agents, which may play a great role in reducing the complications that these patients may experience in the long run.
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http://dx.doi.org/10.1111/1756-185X.13772DOI Listing
February 2020

Successful use of tocilizumab in amyloidosis secondary to systemic juvenile idiopathic arthritis.

Rheumatol Int 2020 Jan 4;40(1):153-159. Epub 2019 Jul 4.

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

Amyloidosis secondary to juvenile idiopathic arthritis is a known complication of poorly controlled systemic juvenile idiopathic arthritis (SJIA), occurring in 1-2% of the patients. The IL-6 inhibitor tocilizumab is effective in controlling systemic signs and symptoms of sJIA and may be of therapeutic benefit in secondary amyloidosis. Herein, we report the clinical timeline of a 10-year boy with sJIA and secondary amyloidosis, who showed a sustained improvement of systemic symptoms and a reduction in proteinuria with tocilizumab. Compared to the data on adult patients affected with the secondary amyloidosis, there are very few reports on therapeutic options for the children affected with SJIA and secondary amyloidosis in the paediatric population. While doing a systematic literature search for writing this review, we could only retrieve nine case reports and one case series of the children affected with SJIA and secondary amyloidosis, including five cases which were treated with tocilizumab. We also looked into the clinical and biochemical response to various agents that have been used in the previous cases, including tocilizumab. The available literature and the present case report suggest that tocilizumab may be considered as a safe and effective option to treat SJIA-related secondary amyloidosis.
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http://dx.doi.org/10.1007/s00296-019-04363-zDOI Listing
January 2020

Cyclosporine for Systemic Onset Juvenile Idiopathic Arthritis: Current Stand and Future Directions.

Indian J Pediatr 2019 07 1;86(7):576-577. Epub 2019 Jun 1.

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

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http://dx.doi.org/10.1007/s12098-019-02985-6DOI Listing
July 2019

Juvenile dermatomyositis with IgA nephropathy: case-based review.

Rheumatol Int 2019 Mar 14;39(3):577-581. Epub 2018 Dec 14.

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

Juvenile dermatomyositis (JDM) is the most common childhood idiopathic inflammatory myopathy (IIM). It is characterized by the classic skin rash in the form of Gottron papules and heliotrope rash, and symmetric proximal muscle weakness. Renal involvement in JDM is rare which includes acute kidney injury and glomerulonephritis. We report a 10-year-old boy with juvenile dermatomyositis and IgA nephropathy. Child responded dramatically to the conventional therapy with steroids and methotrexate for the primary disease, and did not require any additional treatment for his renal disease. Child's primary disease is in remission and has normal urinalysis with normal renal function at 6-month follow-up. We reviewed the literature and found 11 cases of IIMs with renal involvement. Four patients (one JDM, two polymyositis, and one dermatomyositis) had IgA nephropathy out of which three patients responded to the conventional therapy of primary disease and only one patient with polymyositis needed hiking immunosuppression targeted for renal condition. Therapy targeting the underlying disorder is usually sufficient in patients with JDM and secondary IgA nephropathy.
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http://dx.doi.org/10.1007/s00296-018-4229-4DOI Listing
March 2019

Intra-articular Corticosteroid Administration.

Indian Pediatr 2018 07;55(7):612

Division of Pediatric Rheumatology, Department of Pediatrics, AlIMS, New Delhi, India.

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July 2018

Starry Sky Calcifications.

J Clin Rheumatol 2018 Apr;24(3):150-151

From the Division of Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

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http://dx.doi.org/10.1097/RHU.0000000000000643DOI Listing
April 2018

Juvenile systemic sclerosis: experience from a tertiary care center from India.

Rheumatol Int 2017 Oct 22;37(10):1687-1691. Epub 2017 Aug 22.

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

Juvenile systemic sclerosis (JSSc) is a rare disorder with paucity of information on its treatment and longterm  outcome. Herein, we are sharing our experience with this rare entity. Case records of children, diagnosed to have systemic sclerosis attending Pediatric Rheumatology Clinic at All India Institute of Medical Sciences, New Delhi from January 1998 to June 2016 were reviewed. The demographic, clinical, laboratory, treatment and outcome details were recorded. Disease outcome was classified arbitrarily as controlled, partly controlled or non-responsive/progressive based on: (A) ability to perform activities of daily life (ADL) and (B) presence or absence of musculoskeletal symptoms, skin changes (ulceration/progressive digital pitting/gangrene), and visceral organ involvement (dyspahgia, cardiopulmonary symptoms). Controlled: ability to perform ADL and absence of B features for at least 6 months. Partly controlled: inability to perform ADL or any of the B features. Non-responsive/progressive disease: presence of both A and any of B features. Thirty-two children (21, girls) diagnosed as systemic sclerosis for whom follow-up of more than 6 months was available were included for this retrospective analysis. Mean (SD) age at presentation was 112.79 (30.05) months, while the median (IQR) delay in diagnosis was 28.5 (9-47.25) months. Of the 32 children 17 (53.12%) had diffuse systemic sclerosis (dSSc), 5 (15.62%) had limited systemic sclerosis (lSSc) and 10 (31.25%) had sclerosis with overlap syndrome. The common clinical features apart from sclerosis/induration proximal to metacarpophalangeal joint were Raynauds phenomenon (n = 22, 68.7%), skin rash (n = 20, 62%), arthritis or arthralgia (n = 16, 50%), and muscular weakness (n = 10, 31.2%). Among those for whom data regarding investigations were available; ANA was positive in 50% (12/24), whereas Anti Scl70 was positive in one out three cases. Treatment regimen included naproxen, methotrexate, calcium channel blockers with or without steroids. HCQ was added in children with skin rash or in children with partial control. Median (IQR) follow-up period was 19.75 (12-31.75) months. With the above treatment protocol, 19 (59.3%) children achieved disease control on treatment, 8 (26.6%) had partial control while 5 (16.6%) showed no response or progressive disease. Esophageal dysmotility and intertitial lung disease (ILD) were documented in three children each. Complication (cataract and herpes zoster) related to immunosuppressive therapy were observed in two children. There was no mortality during the study period. Juvenile Sclerosis though rare is associated with significant morbidities and lacks a curative treatment but a reasonable quality of life to perform daily activities can be achieved using methotrexate and steroid-based immuosuppressive therapy.
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http://dx.doi.org/10.1007/s00296-017-3793-3DOI Listing
October 2017

Efficacy of Oral Zinc Supplementation in Radiologically Confirmed Pneumonia: Secondary Analysis of a Randomized Controlled Trial.

J Trop Pediatr 2018 04;64(2):110-117

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

Objective: To evaluate the effect of zinc as an adjuvant therapy in radiologically confirmed pneumonia in children 2-24 months of age.

Patients And Methods: We analyzed data of 212 children with pneumonia for whom chest X-ray films were available at enrollment and at least two radiologists agreed on the diagnosis of pneumonia. We compared the time to recovery in the two groups (n = 121, zinc group and n = 91, placebo group) using a Cox proportional hazards regression model.

Results: Time to recovery was similar in both groups [median interquartile range: zinc, 84 h (64, 140 h); placebo, 85 h (65, 140 h)]. The absolute risk reduction for treatment failure was 5.2% (95% confidence interval: -4.8, 15.1) with zinc supplementation.

Conclusion: There was no significant beneficial effect of zinc on the duration of recovery or risk of treatment failure in children with radiologically confirmed pneumonia.
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http://dx.doi.org/10.1093/tropej/fmx036DOI Listing
April 2018

Zinc supplementation for neonatal hyperbilirubinemia: a randomized controlled trial.

Indian Pediatr 2014 May;51(5):375-8

Departments of Pediatrics and *Botany, Banaras Hindu University, Varanasi, India Correspondence to: Dr Ashok Kumar, Neonatal Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India.

Objective: To determine the efficacy of oral zinc for treatment of idiopathic neonatal hyperbilirubinemia in near-term and term (35-41 weeks) neonates.

Design: Randomized placebo-controlled trial.

Setting: Tertiary-care teaching hospital.

Participants: Eighty newborns with idiopathic neonatal hyperbilirubinemia.

Intervention: Neonates were randomized to receive either oral zinc sulfate (10 mg/d) or placebo for 7 days.

Main Outcome Measures: Primary: total serum bilirubin levels at 48 (±12) h, 96 (±12) h and 144 (±12) h after intervention. Secondary: duration of phototherapy, and serum zinc and copper levels.

Results: Baseline mean (SD) total serum bilirubin levels were 14.8 (3.8) and 14.4 (3.5) mg/dL in zinc and placebo groups, respectively. No significant differences were observed in total bilirubin levels between the two groups after the intervention. Mean (SD) total serum bilirubin levels in zinc and placebo groups were 13.9 (2.5) vs. 13.4 (1.9) mg/dL (mean difference 0.566; 95% CI -0.535, 1.668, P=0.038) at 48 h, 13.1 (2.7) vs. 12.8 (2.3) mg/dL (mean difference 0.234; 95% CI -1.011, 1.479, P =0.708) at 96 h and 8.0 (2.0) vs. 8.6 (1.2) mg/dL (mean difference -0.569, 95% CI -1.382, 0.242, P=0.166) at 144 h. Although the mean duration of phototherapy in the zinc group was less by 21.3 h (95% CI 11.6, 30.9, P=0.052), the difference was not significant. Post-intervention, serum zinc levels were significantly higher in the zinc-supplemented group while serum copper levels were comparable between the two groups.

Conclusions: Oral zinc sulfate, in a dose of 10 mg/day, is not effective in the management of idiopathic neonatal hyperbilirubinemia.
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http://dx.doi.org/10.1007/s13312-014-0420-1DOI Listing
May 2014

Pericardial effusion in children: experience from tertiary care center in northern India.

Indian Pediatr 2014 Mar;51(3):211-3

Division of Pediatric Cardiology, Department of Pediatrics, and *Department of CTVS, PGIMER and Dr. RML Hospital, New Delhi, India. Correspondence to: Dr Dinesh Kumar Yadav, Department of Pediatrics, PGIMER and Dr. RML Hospital, N. Delhi 110 001, India.

Objective: To describe profile and outcome in children with significant pericardial effusion.

Methods: Hospital records of 25 children admitted with significant pericardial effusion during January 2010 to March 2013 were analyzed.

Results: Thirteen (52%) children had tubercular, 6 (24%) had bacterial, 3 viral, 2 recurrent idiopathic and one had malignant pericardial effusion. Only 3 children in our series required surgical drainage.

Conclusion: Echocardiography guided percutaneous pericardiocentesis and pigtail catheter placement was found to be safe and effective.
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http://dx.doi.org/10.1007/s13312-014-0378-zDOI Listing
March 2014

Chédiak-higashi syndrome: a case report.

Indian J Hematol Blood Transfus 2013 Jun 1;29(2):80-3. Epub 2012 Feb 1.

Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005 Uttar Pradesh India.

Chédiak-Higashi syndrome (CHS) is an extremely rare autosomal recessive immunodeficiency disorder. Approximately 200 cases have been reported worldwide. To the best of our knowledge, not more than 10 cases have been reported from India. Herein we are reporting a case of CHS in one-and-half-year-old boy who presented to us in the accelerated phase of disease. Other syndromes presenting with similar clinical features have also been discussed.
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http://dx.doi.org/10.1007/s12288-011-0130-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636352PMC
June 2013

Palatal perforation due to late congenital syphilis.

Indian J Pediatr 2014 Feb 30;81(2):216-7. Epub 2013 Apr 30.

Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India,

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http://dx.doi.org/10.1007/s12098-013-1038-3DOI Listing
February 2014

Neonatal endogenous endophthalmitis: a report of six cases.

Pediatrics 2013 Apr 11;131(4):e1292-7. Epub 2013 Mar 11.

Division of Neonatology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Endogenous endophthalmitis is a rare but potentially blinding complication of neonatal sepsis. Early diagnosis and aggressive treatment are essential to avoid vision loss. Therapeutic options include systemic and intravitreal antibiotics, as well as vitrectomy in selected cases. We report a series of 6 premature very low birth weight neonates who developed endogenous endophthalmitis in our NICU over the past 3 years. Endophthalmitis was part of early-onset sepsis in 2 newborns, both of whom died, and late-onset sepsis in 4 newborns, of which 1 infant died. None of the neonates had any history of previous trauma or intervention to the eye. Maternal screening for congenital infections, including HIV, was negative in all. Causative organisms included Klebsiella pneumoniae (2 cases), Pseudomonas aeruginosa (2 cases), Methicillin-resistant Staphylococcus aureus (1 case), and Candida albicans (1 case). All bacterial isolates showed resistance to first-line antibiotics. Of the 3 survivors, 2 infants had normal vision in the affected eye, and 1 developed phthisis bulbi after corneal perforation and required enucleation. This report draws attention to the emergence of endophthalmitis as a complication of neonatal sepsis in places where, although survival of very low birth weight newborns has increased significantly due to improved care, the burden of infection continues to be high. We emphasize the importance of daily examination of eyes as a part of routine clinical care in septic newborns for early diagnosis of endophthalmitis and prompt intervention in consultation with an ophthalmologist to optimize the outcome.
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http://dx.doi.org/10.1542/peds.2011-3391DOI Listing
April 2013

Tubercular abscess of pons in a child with quadriparesis.

BMJ Case Rep 2010 17;2010. Epub 2010 Mar 17.

Institute of Medical Sciences, Pediatrics, 7FF, Kabir Colony, Bhu, Varanasi, 221005, India.

Tuberculous brain abscess is a rare manifestation of tuberculosis of the central nervous system. We report a case of a 6-year-old girl with a pontine tuberculous abscess, who presented with fever and quadriparesis and recovered completely after stereotactic aspiration and antituberculous treatment with four drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol). Tuberculous abscess was confirmed based on findings of magnetic resonance imaging, a positive tuberculin test, and the presence of acid fast bacilli in smear and culture of abscess aspirate.
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http://dx.doi.org/10.1136/bcr.10.2009.2370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028151PMC
October 2012