Publications by authors named "Pankaj C Vaidya"

37 Publications

Isolated Pulmonary Presentation of Childhood Goodpasture Disease.

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

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

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http://dx.doi.org/10.1007/s12098-021-03723-7DOI Listing
June 2021

Comparison of performances of loop-mediated isothermal amplification, XPERT MTB/RIF and BACTEC MGIT in the diagnosis of childhood tuberculosis.

J Paediatr Child Health 2021 06 15;57(6):847-853. Epub 2021 Mar 15.

Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Aim: Key to the successful management of paediatric pulmonary tuberculosis (PTB) lies in the early detection and proper treatment. We evaluated the performances of modern diagnostic tests: loop-mediated isothermal amplification (LAMP-IS6110), Xpert MTB/RIF (Cepheid) and mycobacteria growth indicator tube (BACTEC MGIT 960 culture) against a modified version of international consensus diagnostic definition (i.e. composite reference standard (CRS)).

Methods: A cross-sectional analytical study was conducted in a tertiary care hospital in North India from July 2016 to December 2017 involving 100 children <14 years with suspected PTB. Respiratory specimens (sputum, gastric lavage and/or bronchoalveolar lavage) were collected and subjected to LAMP-IS6110, Xpert MTB/RIF and BACTEC MGIT 960 culture assay.

Results: Fifty-five children had confirmed and probable TB according to the CRS (prevalence = 58.5%). The sensitivity of BACTEC MGIT 960 culture, Xpert MTB/RIF and LAMP-IS6110 assay was 14%, 9.1% and 10.91%, respectively, when compared against the predefined CRS. The specificity for all these tests was 100%. When compared with BACTEC MGIT 960 culture as the gold standard, the LAMP-IS6110 assay and Xpert MTB/RIF assay had the sensitivity of 85.71% (95% CI: 42.13-99.64%) and 71.43% (95% CI: 29.04-96.33%), respectively. The specificity of both assays was 100%.

Conclusions: We noted that LAMP-IS6110 performed better than Xpert MTB/RIF (Cepheid) in terms of sensitivity when compared against BACTEC MGIT 960 culture as reference standard, though specificity of both the tests was comparable. The diagnostic performance of BACTEC MGIT 960 culture was better than LAMP-IS6110 and Xpert MTB/RIF in paediatric PTB, when compared against CRS.
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http://dx.doi.org/10.1111/jpc.15334DOI Listing
June 2021

Fibrosing Mediastinitis Associated With Tuberculosis in Children.

Pediatr Infect Dis J 2021 Apr;40(4):e166-e169

From the Pediatric Pulmonology Unit, Department of Pediatrics, Advanced Pediatrics Centre.

Two children developed fibrosing mediastinitis following past tuberculosis disease. Both were microbiologically negative for tuberculosis at presentation. One was treated with steroids and supportive therapy, but developed active tuberculosis with complications. He ultimately succumbed to healthcare-associated infection. The other recovered with steroids, administered along with antituberculosis treatment.
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http://dx.doi.org/10.1097/INF.0000000000003049DOI Listing
April 2021

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

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

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

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

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

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

Department of Pediatric Surgery, PGIMER, Chandigarh, India.

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

Coronavirus disease 2019 in children: Clinical & epidemiological implications.

Indian J Med Res 2020 Jul & Aug;152(1 & 2):21-40

Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India.

Despite the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there are limited data emerging in children. This review provides an update on clinical features, diagnosis, epidemiology, management and prevention of coronavirus disease 2019 (COVID-19) in children. Specific characteristics noted in children and their implications in disease management as well as transmission control are highlighted. Besides respiratory symptoms, gastrointestinal and atypical features such as chilblains, neurological symptoms and multisystem inflammation are also reported. Younger infants and those with comorbidity were found to be at risk of severe illness. Infected pregnant women and neonates were reported to have good prognosis. It is possible to manage the children with mild disease at home, with strict infection prevention control measures; severely affected require respiratory support and intensive care management. There are anecdotal reports of using antiviral and immunomodulatory drugs, benefit of which needs to be confirmed in clinical trials. A significant percentage of asymptomatic infection in children has epidemiological implication as these may act as links in transmission chain in the community. There is a need for systematic data on extra-pulmonary manifestations and atypical features, risk factors of severity, role of imaging and biomarkers, testing and management strategies and trials with antivirals and immunomodulatory drugs in children. The psychosocial effects of quarantine, closure of schools, lack of play activities and impact of lockdown need to be addressed. Understanding the biological basis for the profound age-dependent differential outcome of COVID-19 infection is important. Elucidating the protective mechanisms in children may aid in developing novel treatment strategies.
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http://dx.doi.org/10.4103/ijmr.IJMR_977_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853265PMC
September 2020

Vitamin D Deficiency: Prevalence and Association with Intrathoracic Tuberculosis in Indian Children.

Indian J Pediatr 2021 03 28;88(3):276. Epub 2020 May 28.

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

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http://dx.doi.org/10.1007/s12098-020-03350-8DOI Listing
March 2021

Loop-mediated isothermal amplification (LAMP) in the respiratory specimens for the diagnosis of pediatric pulmonary tuberculosis: A pilot study.

J Infect Chemother 2020 Aug 12;26(8):823-830. Epub 2020 May 12.

Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. Electronic address:

Background: Loop-mediated isothermal amplification (LAMP) assay is a novel molecular diagnostic technique that can be used for the diagnosis of tuberculosis (TB). It is most suited for developing countries as it is rapid, inexpensive, highly sensitive, requiring minimal infrastructure, training and manpower. Studies in pediatric TB are lacking. We evaluated LAMP in the diagnosis of pediatric pulmonary TB.

Methodology: This was a cross-sectional analytical study conducted at a tertiary care teaching hospital in North India from July 2014 to June 2015 involving 60 children with suspected pulmonary TB. Respiratory specimens (sputum, gastric lavage, bronchoalveolar lavage and/or endotracheal aspirates) were collected and subjected to BACTEC MGIT 960 culture, IS6110 PCR, and LAMP assay targeting IS6110 gene of Mycobacterium tuberculosis.

Results: Thirty seven children had confirmed and probable TB according to the composite reference standard (CRS). Among all the 3 tests used for diagnosis of Pulmonary TB, LAMP had highest sensitivity (37.8%) followed by PCR (27%), and culture (21.6%) when compared against the predefined CRS. Culture had maximum specificity of 100%; and PCR, and LAMP had specificity of 95-96%. The sensitivity, specificity, PPV, and NPV of LAMP against culture as reference standard were 75%, 72.4%, 42.9%, and 91.3% respectively. Similarly sensitivity, specificity, PPV, and NPV of PCR against culture as reference standard were 75%, 86.2%, 60%, and 86.2% respectively. On combining LAMP with culture, sensitivity increased to 45.7% (7.8% increase, p = 0.04).

Conclusion: We noted that LAMP had highest sensitivity when compared to culture and PCR and comparable specificity.
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http://dx.doi.org/10.1016/j.jiac.2020.03.019DOI Listing
August 2020

Trace Element Status in Children with Infantile Tremor Syndrome: An Inductively Coupled Plasma-Mass Spectrometry Based Study.

Indian J Pediatr 2020 03 29;87(3):221-223. Epub 2020 Jan 29.

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

The primary objective of the study was to compare the trace element status in children with infantile tremor syndrome (ITS) with healthy controls. Blood counts, serum vitamin B12, plasma homocysteine, plasma ferritin and trace elements - magnesium, zinc and selenium were compared. Twenty-six children (11 with tremors, 14 boys, mean age 11.5 ± 3.5 mo) and 19 controls were enrolled for this study. Low vitamin B12 levels (67% vs. 5%) and elevated plasma homocysteine 96% vs. 26%) was significantly more (P < 0.001) in cases. Eight controls had hypoferritinemia, while none with ITS had it (p < 0.001). None of the children in either group had low serum levels of zinc or magnesium. Low levels of selenium were seen in six cases and five controls. This study did not show any association between the studied nutrients/ trace elements and ITS while, it showed a strong association of ITS with vitamin B12 deficiency supporting that it is a Neurocutaneous Infantile B-12 deficiency (NIB) syndrome.
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http://dx.doi.org/10.1007/s12098-019-03176-zDOI Listing
March 2020

Infantile Tremor Syndrome or a Neurocutaneous Infantile B12 Deficiency (NIB) Syndrome?

Indian J Pediatr 2020 03 27;87(3):179-184. Epub 2020 Jan 27.

Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education andResearch, Chandigarh, India.

Objectives: To prospectively study the clinical and developmental profile; hematological profile and the B-12 status using multiple parameters in children with Infantile tremor syndrome (ITS).

Methods: In this observational study (NCT02762682) (July 2015 through December 2016) children (and their mothers) with a clinical diagnosis of ITS were evaluated clinically; and development was assessed by CAPUTE scales. A complete blood count (CBC); peripheral blood smear examination; markers of vitamin B12 status (serum B12, homocysteine, folate); acylcarnitines [using Tandem mass spectrometry (TMS)] and urine methylmalonic acid (MMA) [Gas chromatography mass spectrometry (GCMS)] were estimated. A control group of children and their mothers were sampled for comparison.

Results: A total of 286 individuals were enrolled for this study. One-hundred-ten children with ITS were screened and 92 (20 with tremors; age 12.7 ± 5 mo, 61 boys) children and their mothers were enrolled. Fifty-one children and their mothers were enrolled as controls. The median clinical linguistic & auditory milestone-developmental quotient (CLAM-DQ) was 32 (IQR 20.6-45.5) and median cognitive adaptive test-developmental quotient (CAT-DQ) was 36.2 (IQR 18.7-49.0). All babies except 9 (ovo-veg) had vegetarian mothers. Head circumference below 2 SD (WHO standards) was seen in 84% and below 3 SD in 58%. The CBC findings were; Hb- 8.3 ± 1.6 g/dl, Thrombocytopenia-29 (32%), mean corpuscular volume (MCV)- 92.2 ± 13.4, MCV- more than 95 fL-38(42%), Red cell distribution width (RDW)- 21.6 ± 6.5, and macrocytes on peripheral smear in 68%. In 89 (97%) out of 92 children had laboratory features of deficient B12 status. Two-thirds of the mothers also had evidence of B12 deficiency.

Conclusions: ITS is, in all likelihood is a consequence of vitamin B12 defeciency. It has a significant impact on head growth and development of affected infants.
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http://dx.doi.org/10.1007/s12098-019-03117-wDOI Listing
March 2020

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

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

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

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

Antitubercular therapy-induced psychosis.

Neurology 2019 12;93(23):1012-1013

From the Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre (B.S., L.S., P.M., P.C.V., J.K.S.), and Department of Radiodiagnosis (P.S.), Post Graduate Institute of Medical Education & Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India.

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http://dx.doi.org/10.1212/WNL.0000000000008578DOI Listing
December 2019

An Infant with Interstitial Lung Disease.

Indian Pediatr 2019 02;56(2):135-140

Department of Histopathology; Postgraduate Institute of Medical Education and Research, Chandigarh, India. Correspondence to: Dr Uma Nahar, Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.

Interstitial lung disease in infants, unlike older children and adults, has diverse etiology, including infective, metabolic, autoimmune, genetic, malignant and idiopathic causes. Clinical recognition of the interstitial pattern of lung involvement is important as the etiology and management is entirely different from that of recurrent or chronic lung parenchymal pathologies. We discuss the clinical and pathological findings of an infant with interstitial pneumonia, who succumbed to hospital-acquired sepsis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096988PMC
February 2019

Tuberculosis Burden among Household Pediatric Contacts of Adult Tuberculosis Patients: Correspondence.

Indian J Pediatr 2019 07 11;86(7):667-668. Epub 2019 Feb 11.

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

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http://dx.doi.org/10.1007/s12098-019-02874-yDOI Listing
July 2019

Clinico-epidemiological profile and predictors of outcome in children with diphtheria: a study from northern India.

Trop Doct 2019 Apr 12;49(2):96-101. Epub 2019 Jan 12.

3 Professor, Department of Pediatrics (Emergency and Critical Care), PGIMER, Chandigarh, India.

Diphtheria, a vaccine preventable disease in children, is still being reported from India. Details of 99 children with a clinical diagnosis of diphtheria admitted to a paediatric tertiary care teaching and referral hospital between January 2008 and December 2015 were collected retrospectively and analysed. The median (interquartile range [IQR]) age of the study group was 7.0 years (IQR = 5.0-8.0 years). Nearly two-thirds were unimmunised. Clinical features included fever (97%), dysphagia (82%), sore throat (67%), bull neck (54%), stridor (40%), neuropathy (27%) and nasal discharge (14%). Throat swab for Albert stain was positive in only 21% of cases and C. diphtheriae was isolated in only 28%. Complications included airway compromise (61.7%) followed by myocarditis (35.4%), acute kidney injury (22.3%), thrombocytopenia (25.3%) and neuropathy (27.3%). In all, 66% survived, 23% died and 11% opted for discontinuity of care owing to unfavourable prognoses. On multivariable logistic regression analysis, shorter duration of symptoms before presentation to our hospital was an independent predictor of unfavourable outcome (adjusted odds ratio = 0.88, 95% confidence interval = 0.79-0.99, P = 0.03).
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http://dx.doi.org/10.1177/0049475518823657DOI Listing
April 2019

A Child with Tuberculous Meningitis Complicated by Cortical Venous and Cerebral Sino-Venous Thrombosis.

Indian J Pediatr 2019 04 9;86(4):371-378. Epub 2019 Jan 9.

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

Stroke is common in tuberculous meningitis. Stroke commonly affects the tubercular zone, comprising the anterior part of the thalamus, caudate and the internal capsule (anterior limb and genu). Stroke, in tuberculous meningitis is predominantly arterial ischemic stroke, and is due to infiltrative, proliferative or necrotizing arteritis. Rarely, aneurysm formation and mycotic aneurysms have also been described. The authors describe the clinical and autopsy findings of a 27-mo-old boy with tuberculous meningitis whose course was complicated by arterial and venous strokes, and nonresponse to adequate and appropriate antitubercular therapy.
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http://dx.doi.org/10.1007/s12098-018-2830-xDOI Listing
April 2019

Childhood allergic bronchopulmonary aspergillosis.

Lung India 2018 Nov-Dec;35(6):499-507

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

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease caused by Aspergillus induced hypersensitivity. It usually occurs in immunocompetent but susceptible patients with bronchial asthma and cystic fibrosis. If ABPA goes undiagnosed and untreated, it may progress to bronchiectasis and/or pulmonary fibrosis with significant morbidity and mortality. ABPA is a well-recognized entity in adults; however, there is lack of literature in children. The aim of the present review is to summarize pathophysiology, diagnostic criteria, clinical features, and treatment of ABPA with emphasis on the pediatric population. A literature search was undertaken through PubMed till April 30, 2018, with keywords "ABPA or allergic bronchopulmonary aspergillosis" with limitation to "title." The relevant published articles related to ABPA in pediatric population were included for the review. The ABPA is very well studied in adults. Recently, it is increasingly being recognized in children. There is lack of separate diagnostic criteria of ABPA for children. Although there are no trials regarding treatment of ABPA in children, steroids and itraconazole are the mainstay of therapy based on studies in adults and observational studies in children. Omalizumab is upcoming therapy, especially in refractory ABPA cases. There is a need to develop the pediatric-specific cutoffs for diagnostic criteria in ABPA. Well-designed trials are required to determine appropriate treatment regimen in children.
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http://dx.doi.org/10.4103/lungindia.lungindia_216_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219146PMC
November 2018

Glucose intolerance in children with cystic fibrosis: a developing country's perspective.

J Pediatr Endocrinol Metab 2018 Oct;31(10):1139-1146

Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India.

Background Cystic fibrosis-related diabetes (CFRD) is a common comorbidity reported in patients with cystic fibrosis (CF). There is a dearth of data on glucose intolerance or CFRD in children with CF from developing countries. So, we planned to study the prevalence of abnormal glucose tolerance (AGT) in children with CF and its relation with the duration and severity of CF. Methods We performed an oral glucose tolerance test (OGTT) on children (2-18 years old) having CF for at least 6 months. Two-hour plasma glucose levels on OGTT were correlated with various disease-related factors. Results Out of the 25 children enrolled, there were 18 boys and seven girls. The mean age and duration of CF were 7.9±4.3 and 3.16±2.5 years, respectively. AGT was observed in 16 (64%) children with CF including three (12%) children with CFRD. Children with a duration of CF of 3 years had significantly higher prevalence (81.8%) of AGT when compared with duration ≤3 years (p-value<0.05). Twelve out of 17 (70.6%) children were colonized with Pseudomonas and 12 out of 15 (80%) children >6 years of age had AGT. There was a positive correlation of 2-h glucose value on OGTT with duration of CF and number of hospitalizations with acute pulmonary exacerbations. Conclusions The majority of children having CF for >3 years and/or age >6 years developed AGT. In our clinical setting, an annual screening with OGTT to detect AGT may be required at an early age and duration of CF.
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http://dx.doi.org/10.1515/jpem-2018-0222DOI Listing
October 2018

Pulmonary Functions in Children Ventilated for Acute Hypoxemic Respiratory Failure.

Pediatr Crit Care Med 2018 09;19(9):e464-e471

Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Objective: To assess pulmonary functions of children who received mechanical ventilation for acute hypoxemic respiratory failure.

Design: Longitudinal study.

Setting: PICU and Pediatric Pulmonology Clinic of a tertiary care teaching hospital in North India.

Patients: All children, 5-12 years old, ventilated for acute hypoxemic respiratory failure in PICU from July 2012 to June 2013 and survived.

Interventions: The baseline admission variables recorded were as follows: age, sex, duration of illness, primary diagnosis at admission, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices, and duration of PICU stay. The children were followed up twice, at 3 and 9-12 months, after discharge from PICU and evaluated for any residual respiratory symptoms and signs, pulse oximetry, chest radiograph, 6-minute walk test, peak expiratory flow rate, and spirometry. Age, sex, duration of illness, primary diagnosis, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices (PaO2/FIO2 ratio and oxygenation index), and duration of PICU stay were recorded from patient records.

Measurements And Main Results: Twenty-nine children (25 boys and four girls; mean [SD] age, 8.4 [2.4] yr) were followed up at 3.5 (± 1.2) and 10.6 (± 2.7) months after discharge from PICU. Recurrent respiratory symptoms were noted in 37.9% patients (11/29) during first and in none during second follow-up. None had limitation of physical activity or need of supplemental oxygen. Chest examination was normal in all, except one during first follow-up, but 13.8% (4/29) had abnormal chest radiograph during first follow-up. Nearly all children could perform 6-minute walk test although mean distance walked increased significantly from first (352 ± 66.7 m) to second follow-up (401 ± 60.7 m; p = 0.002). Abnormal spirometry was seen in 82.7% (24/29) versus 18.5% (5/27) children during first and second follow-up visits, respectively (p = 0.0001). Most cases had restrictive abnormality (58.6% vs 11.1%; p = 0.002) during first and second follow-up, respectively. There was no correlation between pulmonary functions and lung injury scores, oxygenation indices (PaO2/FIO2 ratio and oxygenation index), and mechanical ventilation parameters.

Conclusions: Significant number of children ventilated for acute hypoxemic respiratory failure had subclinical pulmonary function abnormality, without limiting physical activity, which improved over time. Further research on this topic with a larger sample size and patient categorization according to recent pediatric acute respiratory distress syndrome definition is needed.
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http://dx.doi.org/10.1097/PCC.0000000000001635DOI Listing
September 2018

Drug reaction with eosinophilia and systemic symptoms in a child on multiple antiepileptics.

Turk J Pediatr 2017 ;59(2):197-199

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

Goswami JN, Vaidya PC, Saini AG, De D, Radotra BD, Singhi PD. Drug reaction with eosinophilia and systemic symptoms in a child on multiple antiepileptics. Turk J Pediatr 2017; 59: 197-199. Drug reaction with eosinophilia and systemic symptoms (DRESS) is an adverse drug-reaction that may mimic systemic illnesses and have a fulminant presentation. We describe an 8-year-old girl with epilepsy and exposure to multiple anti-epileptics who presented with fever, extensive maculopapular rash, cervical lymphadenopathy, hepatomegaly, progressive anemia and transaminitis. Infections, autoimmune disorders and hematological or reticuloendothelial malignancies were excluded. Based on the proposed diagnostic criteria, a diagnosis of DRESS was concluded. Her skin biopsy showed atypical findings consistent with erythema multiforme. Suspected anti-epileptic drugs were discontinued. She was administered pulse methyl-prednisolone therapy and broad-spectrum antibiotics along with adequate supportive management. Unfortunately, the child succumbed to nosocomial sepsis. Our case highlights the importance of early suspicion for diagnosis of pediatric DRESS, avoidance of polytherapy and institution of early immunomodulation to improve the outcomes in children in this condition.
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http://dx.doi.org/10.24953/turkjped.2017.02.014DOI Listing
November 2018

Subclavian Artery Pseudoaneurysm Following Lung Abscess in a Child.

Indian J Pediatr 2018 08 15;85(8):695-696. Epub 2017 Dec 15.

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

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http://dx.doi.org/10.1007/s12098-017-2565-0DOI Listing
August 2018

Salmonella typhimurium Meningitis in an Infant Presenting with Recurrent Meningitis.

Indian J Pediatr 2018 07 14;85(7):560-562. Epub 2017 Dec 14.

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

Salmonella typhimurium meningitis in infancy is very uncommon and does not respond to usual duration of empirical antibiotic therapy. A 5-mo-old infant presented with clinical picture of acute pyogenic meningitis and was treated with empirical antibiotic therapy for 14 d. But, 2 wk after the discharge, the child presented again with similar complaints. CSF culture had grown Salmonella typhimurium following which dual antibiotic therapy was given for 6 wk.
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http://dx.doi.org/10.1007/s12098-017-2562-3DOI Listing
July 2018

Pulmonary presentation of Kawasaki disease-A diagnostic challenge.

Pediatr Pulmonol 2018 Jan 26;53(1):103-107. Epub 2017 Sep 26.

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

Objectives: Kawasaki disease (KD) is a multisystemic vasculitis with predominant mucocutaneous manifestations. Pulmonary involvement in KD is distinctly uncommon and is not commonly recognized. We describe our experience of managing children with KD wherein the initial presentation was predominantly pulmonary.

Methods: Six hundred and two children have been diagnosed with KD during the period January 1993 to May 2017 in the Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. Data were collected from inpatient records in Allergy Immunology Unit and follow-up files in the Pediatric Rheumatology Clinic.

Results: Of 602 children, 11 (1.83%) had a predominant pulmonary presentation of KD. Mean age at diagnosis of KD was 2.5 years. Fever, cough and respiratory distress were the presenting complaints in all patients. First sign of KD was noted at a mean duration of 14.5 days from the onset of symptoms. Periungual desquamation was the most common clinical sign (72.7%). Persistent fever in spite of antimicrobials, thrombocytosis, and elevated erythrocyte sedimentation rate and C-reactive protein levels pointed toward a diagnosis of KD in our patients. Parenchymal consolidation was evident on chest X-ray in all patients, pleural effusion in six, empyema in three, and pneumothorax in two patients. Coronary artery abnormalities were evident in three patients. Intravenous immunoglobulin was given after a mean period of 22.4 days of onset of fever.

Conclusions: The diagnosis of KD is often delayed in children who have a predominantly pulmonary presentation. This can have adverse clinical consequences.
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http://dx.doi.org/10.1002/ppul.23885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167766PMC
January 2018

Indian Pediatric Postgraduate's Perspective on Future Career Intentions: Correspondence.

Indian J Pediatr 2017 10 5;84(10):806-807. Epub 2017 Jun 5.

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

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http://dx.doi.org/10.1007/s12098-017-2367-4DOI Listing
October 2017

Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child.

J Infect Public Health 2017 Sep - Oct;10(5):674-677. Epub 2017 May 22.

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address:

Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases.
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http://dx.doi.org/10.1016/j.jiph.2017.03.008DOI Listing
May 2018

Necrotizing Fasciitis of Scalp and Neck in Neonates.

APSP J Case Rep 2017 May-Jun;8(3):23. Epub 2017 May 1.

Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.

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http://dx.doi.org/10.21699/ajcr.v8i3.554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423892PMC
May 2017

Infantile Kawasaki disease presenting as acute meningoencephalitis.

Int J Rheum Dis 2017 Dec 9;20(12):2225-2226. Epub 2017 Feb 9.

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

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http://dx.doi.org/10.1111/1756-185X.13014DOI Listing
December 2017

Spinal Dural Arteriovenous Fistula and Cecal Arteriovenous Malformation in a Boy.

APSP J Case Rep 2017 Jan-Feb;8(1). Epub 2017 Jan 5.

Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization.
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http://dx.doi.org/10.21699/ajcr.v8i1.510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253611PMC
January 2017

Recurrent Ventricular Tachycardia and Peripheral Gangrene in a Young Child.

Indian Pediatr 2016 Sep 1;53(9):815-821. Epub 2016 Jul 1.

Departments of Pediatrics, *Histopathology and #Cardiology, PGIMER, Chandigarh, India. Correspondence to: Dr Pankaj C Vaidya, Associate Professor, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160 012, India.

A 10-year-old girl presented with sudden onset recurrent ventricular tachycardia and symmetrical distal peripheral gangrene. She also had pulmonary thromboembolism and cerebral sinus venous thrombosis. Investigations revealed anemia, hemolysis, hypocomplementemia, and elevated IgM anti-beta2 glycoprotein antibody levels. Electrocardiogram and echocardiogram suggested features of a rare cardiac anomaly, which was confirmed at autopsy.
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http://dx.doi.org/10.1007/s13312-016-0937-6DOI Listing
September 2016

Concomitant Scrofuloderma and Tuberculous Osteomyelitis of Mandible.

Indian J Pediatr 2016 Nov 8;83(12-13):1482-1483. Epub 2016 Jun 8.

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

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http://dx.doi.org/10.1007/s12098-016-2143-xDOI Listing
November 2016