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Rajvanshi N, Kumar P, Goyal JP. Evaluation of Chronic Cough in Children Using Management Algorithm: A Prospective Cohort Study. Indian J Pediatr 2024; 91:337-343. [PMID: 37289310 DOI: 10.1007/s12098-023-04632-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the use of a standardized evaluation algorithm [American College of Chest Physician (ACCP) 2006] in children with chronic cough. METHODS In this prospective cohort study, children with chronic cough were evaluated as per the ACCP 2006 diagnostic algorithm. All children were followed regularly at an interval of 2-4 wk. The study's endpoint was for the patient being cough free for four weeks either following treatment or naturally. RESULTS The mean age of the 87 studied children (52 male, 35 female) was 11.9±3 y. Forty children (45.9%) had specific cough pointers on history and examination. Radiograph showed abnormalities in 12 (13.8%) children, and spirometry showed a reversible obstructive pattern on spirometry in 6 (6.9%) among 47 (54%) children without specific cough pointers. After a detailed evaluation, 16 (18.3%) children had no remarkable findings and were reviewed after two weeks. Spontaneous resolution of cough occurred in 6 children. A trial of inhalational corticosteroids (ICS) (9 children) or antibiotics (1 child) was given to the rest of the ten children. Specific underlying diagnoses could be established in 80 (91.9%) children. The most common etiology identified in the study was asthma and asthma-like illnesses (n = 52; 59.8%), followed by upper airway cough syndrome (n = 13; 14.9%) and tuberculosis (n = 9; 10.4%). Eighty-four (96.5%) children had complete resolution of cough during follow-up. The mean time to resolution in the study was 33.6±16.8 d. CONCLUSIONS This study demonstrated that the ACCP 2006 algorithm is effective in establishing the underlying etiology and managing children with chronic cough.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Mittal J, Rajvanshi N, Suvarna K, Kumar P, Goyal JP. Association of vitamin D with disease severity in infants with bronchiolitis. Eur J Pediatr 2024:10.1007/s00431-024-05513-7. [PMID: 38530447 DOI: 10.1007/s00431-024-05513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024]
Abstract
Vitamin D's role in immune system regulation and its contribution to host defenses against respiratory infections may have implications for bronchiolitis pathophysiology. This cross-sectional study aimed to determine the association between the clinical severity of bronchiolitis and serum vitamin D levels in infants. Infants aged 1 month to 12 months, diagnosed with bronchiolitis, and healthy controls attending routine immunization were enrolled. Baseline characteristics were recorded, including clinical details, bronchiolitis severity, and course during hospital stay. Bronchiolitis severity score (BSS) was used to score the severity. A 1-2 ml serum sample was obtained for vitamin D levels estimation. The median age of cases (n = 64; 65.6% male) was 5 [3, 8] months, and that of the control group (n = 30) was 3 [2, 9] months. No statistically significant differences were observed between the two groups in age, gender, weight, mode of delivery, family history of atopy/asthma, feeding pattern, smoke exposure, and daily vitamin D supplementation. The median vitamin D levels were not significantly different between the groups (p = 0.68). Among infants with bronchiolitis, 62.5% had vitamin D insufficiency (≤ 20 ng/ml). A significantly higher median BSS indicates that infants with vitamin D insufficiency exhibited more severe disease (p = 0.019). Although a negative correlation between BSS and vitamin D levels was noted, it did not reach statistical significance [rs = (-)0.17; p = 0.16]. CONCLUSION Infants with Vitamin D insufficiency experienced more severe bronchiolitis with elevated BSS scores. It highlights the potential role of vitamin D deficiency in severe bronchiolitis. WHAT IS KNOWN • Vitamin D level is low in infants with bronchiolitis. WHAT IS NEW • Infant with low vitamin D level experienced more severe bronchiolitis.
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Affiliation(s)
- Jashan Mittal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kkomal Suvarna
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Verma H, Verma PK, Rajvanshi N, Bhat NK. Loeys-Dietz syndrome and Goldenhar syndrome unveiled together. BMJ Case Rep 2024; 17:e256740. [PMID: 38471700 DOI: 10.1136/bcr-2023-256740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Haemifacial microsomia is an asymmetrical congenital tissue malformation developed from the first and second branchial arches with or without multi-system involvement. Alternatively recognised as Goldenhar syndrome or oculoauriculovertebral spectrum (OAVS), it is an aetiologically heterogeneous group of disorders showing dominant trends in inheritable form.We present a case of a boy in early childhood with concomitant craniofacial features of craniofacial microsomia with Loeys-Dietz syndrome. He had a unilateral hypoplastic face, asymmetrical ear malformations and multiple preauricular tags with epibulbar dermoid (features suggestive of Goldenhar syndrome). On detailed clinical evaluation, he met Beighton's criteria and was diagnosed with arterial tortuosity. Further molecular testing confirmed the diagnosis of Loeys-Dietz syndrome type II.Loeys-Dietz syndrome is characterised by aortic root enlargement or type A dissection with or without other vascular malformations and facial midline defects. Molecular testing is required to establish the diagnosis because of overlapping features with other connective tissue disorders.
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Affiliation(s)
- Henuka Verma
- Pediatrics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
- Pediatrics, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | - Prashant Kumar Verma
- Pediatrics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Nikhil Rajvanshi
- Pediatrics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
- Pediatrics, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | - Nowneet Kumar Bhat
- Pediatrics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
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Prabha R, Bhakat R, Mohan K, Rajvanshi N, Chacham S, Mohan L. Distinctive Clinico-electrographic and Radiological Profile of Childhood and Adolescent Seizures. Curr Pediatr Rev 2024; 20:357-364. [PMID: 37157210 DOI: 10.2174/1573396320666230508150342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
AIM Electroencephalogram (EEG) is specific, but not sensitive, for the diagnosis of epilepsy. This study aimed to correlate the clinico-electrographic and radiological features of seizure disorders in children attending a tertiary care centre in northern India. METHODS Children aged between one to 18 years with seizure episodes were included. Clinical details, including historical as well as physical findings, were evaluated along with EEG and neuroimaging (Magnetic resonance imaging). Details were noted on pre-designed proforma. Variables were analysed by using appropriate statistical methods. RESULTS A total of 110 children with seizures were enrolled in the study. Male to female ratio was 1.6: 1, and the mean age of the study children was 8 years. The majority of the children were symptomatic for more than one year. The most common seizure type was Generalised Tonic Clonic Seizure (GTCS), and Hypoxic-ischemic Encephalopathy (HIE) sequelae was the most commonly attributed etiology, followed by neurocysticercosis. EEG and neuroimaging findings were found to correlate well with seizure semiology from history. The incidence of febrile seizures was 10% in this study, with nearly three-fourths of them being simple febrile seizures. CONCLUSION Microcephaly and developmental delay were the most distinctive clinical correlates in children with seizures. There was a fair agreement between the types of seizures described in history and depicted on EEG with Cohen's kappa of 0.4. Also, there was a significant association between the type of seizures on EEG and the duration of symptoms.
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Affiliation(s)
- Rashmie Prabha
- Department of Pediatrics, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Rahul Bhakat
- Department of Pediatrics, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Kriti Mohan
- Department of Pediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Latika Mohan
- Department of Physiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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Doreswamy C, Prabhakaran K, Rajvanshi N, Saini L, Garg PK, Kumar P, Goyal JP. Vascular Ring Masquerading as Breath-Holding Spell. Indian J Pediatr 2023; 90:1265. [PMID: 37477861 DOI: 10.1007/s12098-023-04760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Affiliation(s)
- C Doreswamy
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kalyana Prabhakaran
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Kumar P, Rajvanshi N. Multisystem Inflammatory Syndrome in Children (MIS-C): Does it have a Long-Term Impact? Indian J Pediatr 2023; 90:967-968. [PMID: 37548843 DOI: 10.1007/s12098-023-04799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Rajvanshi N, Kumar P, Goyal JP. Utility of systemic immune-inflammation Index as a serum biomarker to differentiate between complicated and simple para-pneumonic effusion. Monaldi Arch Chest Dis 2023. [PMID: 37675918 DOI: 10.4081/monaldi.2023.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
The systemic immune-inflammation index (SII) is a novel inflammatory biomarker. Simple and complicated para-pneumonic effusion (PPE) are two significant complications of pneumonia. We evaluated the efficacy of the systemic immune inflammation index (SII) to differentiate between the two. Records of all children up to 18 years of age admitted between April 2019 and September 2022 and diagnosed with Simple or complicated PPE were retrospectively evaluated. SII and other biomarkers were compared between both groups. ROC with the Youden index was used to estimate the discriminative value of SII. Fifty children were enrolled with a median (IQR) age of 81.5 (36.7, 133.5) months; 31 (62%) were male. Thirty-one (62%) had complicated PPE, and 19 (38%) had simple PPE. SII was significantly higher in complicated PPE (p=0.007). Good areas under the curve (AUCs) were found for CRP (0.771) and SII (0.736) to differentiate complicated from simple PPE. The best cut-off value for SII to differentiate complicated PPE from simple PPE was 1557×103µL, with a sensitivity of 82.4% and specificity of 57.6%. SII can be used as a screening tool to differentiate between complicated and simple PPE at the time of presentation.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur.
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur.
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Rajvanshi N, Kalyana PB, Kumar P, Goyal JP. Does urinary NT-proBNP have a role in predicting bronchiolitis severity? Pediatr Pulmonol 2023; 58:2462-2463. [PMID: 37378465 DOI: 10.1002/ppul.26566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Jagdish P Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
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Semwal P, Bolia R, Rajvanshi N, Phulware RH, Bhat NK. Gastric outlet obstruction due to cytomegalovirus infection in an immunocompetent child. Indian J Gastroenterol 2023; 42:577-579. [PMID: 36201095 DOI: 10.1007/s12664-022-01243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Pooja Semwal
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh, 249 203, India
| | - Rishi Bolia
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh, 249 203, India.
| | - Nikhil Rajvanshi
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh, 249 203, India
| | - Ravi Hari Phulware
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, 249 203, India
| | - Nowneet Kumar Bhat
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh, 249 203, India
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Rajvanshi N, Chacham S, Ks A, Semwal P, Nandolia KK, Rohilla J, Saini L, Saxena S, Basu S. Magnetic resonance imaging brain yield in developmental delay: A developing country perspective. Res Dev Disabil 2023; 138:104518. [PMID: 37148576 DOI: 10.1016/j.ridd.2023.104518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 03/26/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Developmental delay (DD) is an important neuro-morbidity in children affecting the quality of life. MRI plays a crucial role by delineating the underlying structural, metabolic, and genetic abnormalities. AIM To determine the yield of MRI brain in delineating the various underlying abnormalities and etiological factors in children with DD and to correlate these findings with the clinical presentation. METHODS This cross-sectional study enrolled 50 children with the developmental delay between 6 months to 6 years of age. OUTCOMES AND RESULTS The mean age was 31.32 ± 20.56 months. The sensitivity of MRI was 72%. 81.3% of the children with microcephaly had abnormal MRI. The most common underlying etiology was hypoxic-ischemic encephalopathy (42%), followed by congenital/developmental defects and metabolic diseases (10% each). The most commonly involved region of the cerebral cortex was the occipital lobe (44%) because of the high occurrence of coexisting hypoglycemic brain injury, which is extremely common in developing countries and rare in developed countries, with 80% of them having visual abnormalities. Frontal lobe involvement was significantly more in children with abnormal motor findings and behavioral changes. Cortical grey matter abnormalities were significantly more in children with seizures. CONCLUSION AND IMPLICATIONS It is to be emphasized that children with developmental delays should be evaluated with MRI whenever possible. Apart from hypoxic-ischemic encephalopathy, other etiologies should also be looked for.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Swathi Chacham
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aswanth Ks
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Pooja Semwal
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Khanak K Nandolia
- Department of Radio-Diagnosis & Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Jitendra Rohilla
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan 34200, India.
| | - Sudhir Saxena
- Department of Radio-Diagnosis & Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
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Uppaluri PB, Rajvanshi N, Yadav T, Kumar P, Goyal JP. Pneumomediastinum with Subcutaneous Emphysema as an Initial Presentation of Bronchial Asthma. Indian J Pediatr 2023:10.1007/s12098-023-04605-w. [PMID: 37085630 DOI: 10.1007/s12098-023-04605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Pradeep Babu Uppaluri
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Goyal JP, Rajvanshi N. Periostin: A Novel Biomarker for Asthma. Indian J Pediatr 2023; 90:427-428. [PMID: 36882661 DOI: 10.1007/s12098-023-04511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Rajvanshi N, Prabhakaran K, Kumar P, Goyal JP. A Trial of Intranasal Corticosteroids to Treat Childhood OSA Syndrome: Is It Ineffective? Chest 2023; 163:e149. [PMID: 36894275 DOI: 10.1016/j.chest.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 03/09/2023] Open
Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kalyana Prabhakaran
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Rajvanshi N, Natarajan V, Sahai R, Kumar M, Sharawat IK, Bolia R. Recurrent pneumothorax in a child. J Paediatr Child Health 2021; 57:738-740. [PMID: 32757340 DOI: 10.1111/jpc.15015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nikhil Rajvanshi
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Vivekanand Natarajan
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Rishabh Sahai
- Pathology, All India Institute of Medical sciences, Rishikesh, India
| | - Manish Kumar
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Indar Kumar Sharawat
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Rishi Bolia
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
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Rajvanshi N, Bhakat R, Saxena S, Rohilla J, Basu S, Nandolia KK, Agrawal S, Bhat NK, Chacham S. Magnetic Resonance Spectroscopy in Children With Developmental Delay: Time to Look Beyond Conventional Magnetic Resonance Imaging (MRI). J Child Neurol 2021; 36:440-446. [PMID: 33305985 DOI: 10.1177/0883073820978006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Developmental delay (DD) is an important long-term neuromorbidity owing to various insults to the developing brain and neuroimaging plays a key role in evaluating these children. Magnetic resonance spectroscopy (MRS) is the only noninvasive method to determine the levels of various metabolites in the brain which aids in delineating the underlying abnormalities. A total of 48 children aged between 6 months to 6 years with developmental delay were included and evaluated with neuroimaging in our study. Sensitivity of MRS in children with DD and DD plus (DD along with seizures, abnormal motor findings, behavior, brainstem evoked response audiometry, visual assessment, and microcephaly) was 81.2% and 89.6% respectively. 86.6% of children with microcephaly had abnormal MRS. MRS detected abnormalities in two-thirds of children with normal magnetic resonance imaging (MRI). Children with behavioral abnormalities had significantly lower N-acetyl aspartate (NAA)-creatine and NAA-choline ratios on MRS. Thus, MRS is additive to MRI in delineating the underlying pathophysiology in children with DD.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rahul Bhakat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudhir Saxena
- Department of Radio-Diagnosis & Imaging, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jitendra Rohilla
- Department of Psychiatry, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Khanak Kumar Nandolia
- Department of Radio-Diagnosis & Imaging, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sonam Agrawal
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Verma H, Rajvanshi N, Rathaur VK, Pathania M, Bhat NK. Poncet's Disease: A Case Report. J Trop Pediatr 2021; 67:6031233. [PMID: 33306806 DOI: 10.1093/tropej/fmaa116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). It spreads from one person to the another through the air while coughing, spitting, speaking or sneezing. TB most commonly affects lungs but it can affect any organ system. Diagnosis of TB is made on the basis of microbiological evidence of MTB on microscopic examination, cultures and chest X-rays. Poncet's disease is a separate entity in which joints are involved in the form of joint pain and swelling without any microbiological evidence of MTB. It usually occurs in the background setting of pulmonary TB. This case focuses on importance of considering Poncet's disease in the differential diagnosis of paediatric polyarticular arthritis in TB endemic regions or if there is a history suggestive of TB exposure and infection.
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Affiliation(s)
- Henuka Verma
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Vyas Kumar Rathaur
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
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Rajvanshi N, Paul V, Verma PK, Mammen K. Gross hematuria: A rare presentation of disseminated tuberculosis. Indian J Tuberc 2020; 67:564-566. [PMID: 33077059 DOI: 10.1016/j.ijtb.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Vinod Paul
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Prashant Kumar Verma
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Kim Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Rajvanshi N, Chacham S, Chegondi M, Goyal JP, Singh S. Pulmonary Hemosiderosis in a Child With Systemic Lupus Erythematosus: A Rare Presentation. Cureus 2020; 12:e7890. [PMID: 32489744 PMCID: PMC7255548 DOI: 10.7759/cureus.7890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Pulmonary hemorrhage is an uncommon manifestation in children and is often associated with systemic lupus erythematosus. We report a case of an adolescent girl who presented to our hospital with recurrent episodes of fever, cough, and breathlessness. Later on, she was diagnosed with pulmonary hemosiderosis as a manifestation of systemic lupus erythematosus. She was started on immunosuppressive therapy initially with prednisolone and subsequently with azathioprine and hydroxychloroquine, which improved the clinical status of the child.
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Affiliation(s)
- Nikhil Rajvanshi
- Pediatrics, All India Institute of Medical Sciences, Rishikesh, IND
| | - Swathi Chacham
- Pediatrics, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Jagdish P Goyal
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, IND
| | - Surjit Singh
- Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Kumar M, Rajvanshi N. Immune thrombocytopenic purpura in a child with mucopolysaccharidoses. J Appl Hematol 2020. [DOI: 10.4103/joah.joah_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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