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Sharma P, Bhatia P, Singh M, Das R, Attri SV, Ghara N, Prasada LH, Trehan A. Genomics of iron refractory iron deficiency anemia phenotype reveals a spectrum of novel pathogenic biallelic and monoallelic TMPRSS6 variants and rare overlapping disorders. Gene 2024; 895:147981. [PMID: 37951373 DOI: 10.1016/j.gene.2023.147981] [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: 09/16/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
The study highlights genomic findings in a series of 13 IRIDA phenotype cases. All had microcytic hypochromic anemia with suboptimal oral iron response to two different oral iron preparations at 4-6 weeks and low-normal ferritin, low transferrin saturation, and inappropriately high hepcidin. Targeted NGS on a 26-gene iron panel revealed pathogenic TMPRSS6 variants in 5/13 (38 %) cases. In addition, 2 (15 %) cases revealed rare SMAD4 and TBXAS1 gene variants that can present with refractory anemia but were consistent with diagnosis of hereditary hemorrhagic telangiectasia and Ghosal hematodiaphyseal dysplasia respectively.
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Affiliation(s)
- Pankaj Sharma
- Pediatric Haematology Oncology Unit, Chandigarh, India
| | | | - Minu Singh
- Pediatric Haematology Oncology Unit, Chandigarh, India
| | - Reena Das
- Department of Haematology - Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Laboratory - Department of Pediatrics, Chandigarh, India
| | - Niharendu Ghara
- Department of Pediatric Haematology and Oncology- Tata Medical Center Kolkata, India
| | - L Harsha Prasada
- Department of Pediatrics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, India
| | - Amita Trehan
- Pediatric Haematology Oncology Unit, Chandigarh, India.
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Devarajalu P, Kumar J, Dutta S, Attri SV, Kabeerdoss J. Gut microbiota of preterm infants in the neonatal intensive care unit: a study from a tertiary care center in northern India. Front Microbiol 2024; 15:1329926. [PMID: 38389529 PMCID: PMC10881769 DOI: 10.3389/fmicb.2024.1329926] [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] [Received: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Disruptions of the gut microbiota of preterm infants admitted to the neonatal intensive care unit (NICU) during the first 2 weeks of life are of critical importance. These infants are prone to various complications, including necrotizing enterocolitis (NEC) and sepsis. Studying the gut microbiota will improve outcomes in preterm infants. In the present study, we examined the gut microbiota of preterm infants admitted to the NICU in the first month of life. Methods Neonates admitted to the NICU were recruited, and stool samples were collected weekly from the seventh day of the infant's life until the 30th day of life. DNA was extracted using a DNeasy Powersoil DNA isolation kit. 16S rRNA gene sequencing targeting the V3-V4 region was performed using the MiSeq platform. Sequenced reads were processed on DADA2 pipeline to obtain an amplicon sequence variant (ASV) table. All bioinformatic and statistical analyses were performed using different packages in the R statistical framework. Results Fourteen preterm infants were recruited, and 48 samples were collected. Alpha diversity metrics, observed ASV count, and Shannon index were found to have no differences in any clinical variables. Permutational multivariate analysis of variance (PERMANOVA) showed discrimination of neonates by gestational age and administration of probiotics. Differential abundance analysis showed a decreased abundance of Bifidobacterium Breve in extremely preterm infants (gestational age <28 weeks) compared to moderate preterm infants (gestational age 29-32 weeks). Supplementation with probiotics decreased Acinetobacter and increased Bifidobacterium in the gut of preterm neonates regardless of gestational age. Conclusion Gestational age and probiotic supplementation alter the gut microbiota of preterm infants admitted to the NICU.
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Affiliation(s)
- Prabavathi Devarajalu
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jogender Kumar
- Newborn Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Newborn Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jayakanthan Kabeerdoss
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Basu S, Barman P, Das J, Kabeerdoss J, Attri SV, Mahajan R, Vignesh P, Rawat A. Expanding the clinical and immunological phenotype of prolidase deficiency: A case report. Pediatr Dermatol 2024; 41:115-118. [PMID: 37574707 DOI: 10.1111/pde.15413] [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: 05/11/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
Prolidase deficiency (PD) is a rare autosomal recessive disorder associated with recurrent infections, immune dysregulation, and autoimmunity. PD is characterized by persistent dermatitis, skin fragility, and non-healing ulcerations on the lower limbs as its main dermatologic characteristics. Herein, we report a boy with PD due to a novel variant in PEPD who had abnormal facies, cognitive impairment, corneal opacity, recurrent infections, and persistent non-healing leg ulcers. Th17 lymphocyte counts and phosphorylated-STAT5 expression following IL-2 stimulation were reduced in our patient as compared to healthy control.
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Affiliation(s)
- Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jhumki Das
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayakanthan Kabeerdoss
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bansal A, Suri V, Sikka P, Attri SV, Varma N, Saini SS, Goyal A, Malhotra P. B12 Deficiency is the Commonest Cause of Anaemia During Pregnancy in Northern India: Study from a Tertiary Care Institute. Indian J Hematol Blood Transfus 2024; 40:78-82. [PMID: 38312179 PMCID: PMC10830963 DOI: 10.1007/s12288-023-01682-x] [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] [Received: 08/01/2022] [Accepted: 07/27/2023] [Indexed: 02/06/2024] Open
Abstract
Iron deficiency anemia is considered the leading cause of anemia during pregnancy; however, there is a lack of comprehensive studies on the etiological factors of anemia in pregnant women. The objective of this study was to systematically investigate the causes of anemia in pregnancy. Five hundred women with hemoglobin levels < 11 g/dl between 6 and 40 weeks of pregnancy underwent a complete hemogram, iron studies, serum folate, serum B12, serum copper, and serum zinc level assessments using standard methods. The median age of the patients was 26 years (range 24-29 years). The majority of patients were in the third trimester (449/500, 89.8%). Among the patients, 325 (65%) had vitamin B12 deficiency, with 159 (31.8%) having isolated B12 deficiency and 142 (28.4%) having combined B12 and iron deficiency. Isolated iron deficiency anemia was present in 74 patients (14.8%). Additionally, 28 patients (5.6%) had beta-thalassemia minor, and anemia of chronic disease was found in 17.2% (86) of the patients. Vitamin B12 deficiency was the most common cause of anemia, followed by combined B12 and iron deficiency. Further studies in diverse populations are warranted as they have broader implications for nutrient supplementation during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01682-x.
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Affiliation(s)
- Ankita Bansal
- Department of Obstetrics and Gynaecology, Sankalp Hospital, Ambikapur, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | | | - Neelam Varma
- Department of Haematology, PGIMER, Chandigarh, India
| | | | - Akshaya Goyal
- Department of Ophthalmology, Sankalp Hospital, Ambikapur, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, PGIMER, Chandigarh, 160012 India
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Rana A, Attri SV, Singh S, Kaur R. Otolith microchemistry of freshwater indigenous minor carp (Bangana dero) as a biomonitoring tool to trace heavy metals in River Sutlej, Ropar Wetland (Ramsar site), Punjab, India. Environ Monit Assess 2023; 195:1286. [PMID: 37815645 DOI: 10.1007/s10661-023-11927-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
The elemental composition of the fish otolith may represent a permanent record of the environmental condition the fish inhabited. Fish otolith grows incrementally from the core to a marginal region that acts as a repository of trace metal signatures. The present study explores the potential application of otolith microchemistry of the benthopelagic indigenous minor carp Bangana dero sampled from the Ropar wetland on River Sutlej, Punjab. The concentration of sixteen metals was evaluated in the otolith (n = 42) and water (n = 48) for the post-monsoon and pre-monsoon season from 2020 to 2022 using inductively coupled plasma mass spectrometry (ICP-MS) followed by element detection in the core and marginal region of whole otolith, using energy-dispersive mass spectroscopy (EDS). All the heavy metals exhibited an increase in metal concentrations in fish otolith than water during the post-monsoon season. By indices approach, the otolith was found to have a high bioaccumulation factor for Se in the post-monsoon and Hg in the pre-monsoon. Certain trace metals like As and Hg exhibited fluctuations in their core and marginal region. Thus, trace metal patterns in the otolith could act as a potential tool for monitoring the seasonal changes of metals in water bodies. The EFHg, EFSe and EFAs in the fish otolith predicted its anthropogenic source, while the remaining studied elements showed ambient water origin. Thus, using the otoliths of Bangana dero as a long-term monitoring tool in the future may be helpful for environmental assessments and the reconstruction of historical exposure for safeguarding of water bodies.
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Affiliation(s)
- Anjali Rana
- Department of Zoology, Panjab University, Chandigarh, India
| | | | | | - Ravneet Kaur
- Department of Zoology, Panjab University, Chandigarh, India.
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Kumar M, Patel K, Chinnapparaj S, Sharma T, Aggarwal A, Singla N, Karthigeyan M, Singh A, Sahoo SK, Tripathi M, Takkar A, Gupta T, Pal A, Attri SV, Bansal YS, Ratho RK, Gupta SK, Khullar M, Vashishta RK, Mukherjee KK, Grover VK, Prasad R, Chatterjee A, Gowda H, Bhagat H. Dysregulated Genes and Signaling Pathways in the Formation and Rupture of Intracranial Aneurysm. Transl Stroke Res 2023:10.1007/s12975-023-01178-w. [PMID: 37644376 DOI: 10.1007/s12975-023-01178-w] [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] [Received: 09/19/2022] [Revised: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
Intracranial aneurysm (IA) has the potential to rupture. Despite scientific advances, we are still not in a position to screen patients for IA and identify those at risk of rupture. It is critical to comprehend the molecular basis of disease to facilitate the development of novel diagnostic strategies. We used transcriptomics to identify the dysregulated genes and understand their role in the disease biology. In particular, RNA-Seq was performed in tissue samples of controls, unruptured IA, and ruptured IA. Dysregulated genes (DGs) were identified and analyzed to understand the functional aspects of molecules. Subsequently, candidate genes were validated at both transcript and protein level. There were 314 DGs in patients with unruptured IA when compared to control samples. Out of these, SPARC and OSM were validated as candidate molecules in unruptured IA. PI3K-AKT signaling pathway was found to be an important pathway for the formation of IA. Similarly, 301 DGs were identified in the samples of ruptured IA when compared with unruptured IAs. CTSL was found to be a key candidate molecule which along with Hippo signaling pathway may be involved in the rupture of IA. We conclude that activation of PI3K-AKT signaling pathway by OSM along with up-regulation of SPARC is important for the formation of IA. Further, regulation of Hippo pathway through PI3K-AKT signaling results in the down-regulation of YAP1 gene. This along with up-regulation of CTSL leads to further weakening of aneurysm wall and its subsequent rupture.
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Affiliation(s)
- Munish Kumar
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Patel
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Shobia Chinnapparaj
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanavi Sharma
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Apinderpreet Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushanta Kumar Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogender Singh Bansal
- Department of Forensic Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Kanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil K Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Khullar
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Vashishta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan Kumar Mukherjee
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Kumar Grover
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajendra Prasad
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Chatterjee
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Harsha Gowda
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Hemant Bhagat
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Saini AG, Singanamalla B, Gunasekaran PK, Didwal G, Attri SV. Knowledge and experiences of healthcare workers in managing children with neurometabolic disorders in a developing country: a cross-sectional study. J Trop Pediatr 2023; 69:fmad023. [PMID: 37616068 DOI: 10.1093/tropej/fmad023] [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] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To evaluate the knowledge and experiences of healthcare workers in the management of neurometabolic disorders. METHODS A cross-sectional study was carried out among the 132 participants of a continued medical education program conducted in the Department of Pediatrics at a tertiary-care teaching hospital. A questionnaire-based feedback form was circulated among the participants, and their responses were analyzed. RESULTS Ninety-three responses were analyzed. The most common pediatric illnesses identified were infections (91%), nutritional (91%), birth-related injuries (44.4%) and metabolic disorders (44.4%). Consanguinity (81.5%) and genetic heterogeneity (42.4%) were recognized as most important causes of neurometabolic disorders. Important steps identified for prevention were prenatal testing (65.6%) and newborn screening at birth (61%); while for improving the diagnosis were routine availability of metabolic investigations (65.3%) and screening at birth (46.6%). Most respondents (58.7%) expressed discomfort in managing a case with inherited metabolic defect due to a lack of knowledge (46.8%) and diagnostic facilities (44.6%). Despite access to testing in the majority, a high cost of testing was noticed for biochemical and genetic investigations. The majority of participants (73%) considered some of the inherited metabolic disorders as treatable. Dietary substitution (89.3%), enzyme replacement (69%), cofactor replacement (53.6%), gene therapy (35.7%) and regular dialysis (16.7%) were considered the treatment options. CONCLUSION In spite of growing awareness of inherited metabolic disorders, there are still gaps in knowledge among healthcare workers. It is challenging to diagnose and manage these disorders. Cost-reduction of diagnostic tests, routine newborn screening and increased educational activities are key challenges to be addressed.
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Affiliation(s)
- Arushi Gahlot Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | - Gunjan Didwal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Dhir N, Jain A, Sharma AR, Sharma S, Mahendru D, Patial A, Malik D, Prakash A, Attri SV, Bhattacharyya S, Das Radotra B, Medhi B. Rat BM-MSCs secretome alone and in combination with stiripentol and ISRIB, ameliorated microglial activation and apoptosis in experimental stroke. Behav Brain Res 2023; 449:114471. [PMID: 37146724 DOI: 10.1016/j.bbr.2023.114471] [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] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Stroke, a devastating neurological emergency, is the leading cause of worldwide mortality and functional disability. Combining novel neuroprotective drugs offers a way to improve the stroke intervention outcomes. In the present era, the combination therapy has been proposed as a plausible strategy to target multiple mechanisms and enhance the treatment efficacy to rescue stroke induced behavioral abnormalities and neuropathological damage. In the current study, we have investigated the neuroprotective effect of stiripentol (STP) and trans integrated stress response inhibitor (ISRIB) alone and in combination with rat bone marrow derived mesenchymal stem cells (BM-MSCs) secretome in an experimental model of stroke. MATERIALS & METHODS Stroke was induced in male Wistar rats (n=92) by temporary middle cerebral artery occlusion (MCAO). Three investigational agents were selected including STP (350mg/kg; i.p.), trans ISRIB (2.5mg/kg; i.p.) and rat BM-MSCs secretome (100µg/kg; i.v). Treatment was administered at 3 hrs post MCAO, in four doses with a 12 hrs interval. Post MCAO, neurological deficits, brain infarct, brain edema, BBB permeability, motor functional and memory deficits were assessed. Molecular parameters: oxidative stress, pro inflammatory cytokines, synaptic protein markers, apoptotic protein markers and histopathological damage were assessed. RESULTS STP and trans ISRIB, alone and in combination with rat BM-MSCs secretome, significantly improved neurological, motor function and memory deficits along with significant reduction in pyknotic neurons in the brain of post MCAO rats. These results were correlating with significant reduction in pro-inflammatory cytokines, microglial activation and apoptotic markers in the brain of drug treated post MCAO rats. CONCLUSION STP and trans ISRIB, alone and in combination with rat BM-MSCs secretome, might be considered as potential neuroprotective agents in the acute ischemic stroke (AIS) management. DATA AVAILABILITY STATEMENT Data will be made available on reasonable request.
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Affiliation(s)
- Neha Dhir
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ashish Jain
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Amit Raj Sharma
- Department of Neurology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Sunil Sharma
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Dhruv Mahendru
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ajay Patial
- Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Deepti Malik
- Department of Biochemistry, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
| | - Ajay Prakash
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Savita Verma Attri
- Department of Biochemistry, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
| | - Shalmoli Bhattacharyya
- Department of Biophysics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Bishan Das Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Reddy R, Dayal D, Sachdeva N, Attri SV, Gupta VK. Combination therapy with lansoprazole and cholecalciferol is associated with a slower decline in residual beta-cell function and lower insulin requirements in children with recent onset type 1 diabetes: results of a pilot study. einstein (São Paulo) 2022; 20:eAO0149. [DOI: 10.31744/einstein_journal/2022ao0149] [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] [Received: 04/28/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
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Tyagi R, Verma S, Dash N, Rohit MK, Sankhyan N, Attri SV. Folate Deficiency: A Possible Association with Congenital Heart Defects. Indian J Pediatr 2022; 89:1013-1015. [PMID: 35175552 DOI: 10.1007/s12098-022-04125-z] [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: 08/10/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
Congenital heart defects continue to remain a major cause of serious morbidity and mortality, especially in the developing world. This study was planned to get some insight into the role of modifiable nutritional elements in structural CHD etiology. This cross-sectional, observational study was conducted at a hospital in Northern India from January 2017 to December 2017. Infants < 6 mo with structural CHD as cases and those without structural heart disease were enrolled as controls. Blood samples were collected from mother-child pairs and tested for serum folate, vitamin B12, and homocysteine. It was found that 46.7% infant-mother pairs, out of 45 in the cases group had folate deficiency, whereas in the control group, only 20% had folate deficiency, which was statistically significant (p = 0.013). Baby (0-6 mo) with congenital heart defects (CHD) and their mothers are more likely to have low folate levels compared to those not having CHD.
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Affiliation(s)
- Reva Tyagi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160036, India
| | - Sanjay Verma
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160036, India.
| | - Nabaneeta Dash
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160036, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160036, India
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Patial A, Saini AG, Kaur R, Kapoor S, Sharda S, Kumar P, Singhi S, Singhi P, Dwivedi I, Malik VS, Tageja M, Didwal G, Kaur G, Varughese B, Attri SV. Detection of IEMs by Mass Spectrometry Techniques in High-Risk Children: A Pilot Study. Indian J Pediatr 2022; 89:885-893. [PMID: 35713767 DOI: 10.1007/s12098-022-04207-y] [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: 09/11/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the incidence and types of inborn errors of metabolism (IEMs) in high-risk children using mass spectrometry techniques. METHODS Children considered high-risk for IEM were screened for metabolic diseases during a 3-y period. Dried blood spots and urine samples were analyzed by tandem mass spectrometry (LC-MS/MS) and gas chromatograph-mass spectrometry (GCMS). Samples with abnormal amino acids were confirmed by high-performance liquid chromatography (HPLC). RESULTS Eight hundred and twenty-two suspected cases were evaluated; of which, 87 possible cases of IEMs were identified. Homocystinuria (n = 51) was the most common IEM detected followed by biotinidase deficiency (n = 7), glutaric aciduria type 1 (n = 7), and carnitine uptake defect (n = 6). Overall, there were 45 (51.7%) cases of organic acidemia, 31 cases (35.6%) of amino acid defect, 9 (10.3%) cases of fatty-acid oxidation disorders, and 2 (2.3%) cases of probable mitochondrial disorder. CONCLUSION IEMs are common in India, with a hospital-based incidence of 1 in approximately 6642 among high-risk children. Screening of high-risk children by mass spectrometry techniques is a valuable strategy for early diagnosis of IEMs where universal newborn screening is not yet available.
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Affiliation(s)
- Ajay Patial
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajdeep Kaur
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Seema Kapoor
- Division of Genetics, Genetic & Metabolic Lab, Lok Nayak Hospital & Maulana Azad Medical College, New Delhi, India
| | | | - Praveen Kumar
- Department of Pediatrics, Neonatal Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit Singhi
- Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Haryana, Gurgaon, India
| | - Pratibha Singhi
- Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Haryana, Gurgaon, India
| | - Isha Dwivedi
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vivek Singh Malik
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Mini Tageja
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gunjan Didwal
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gursimran Kaur
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bijo Varughese
- Division of Genetics, Genetic & Metabolic Lab, Lok Nayak Hospital & Maulana Azad Medical College, New Delhi, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Gupta S, Dayal D, Rohit MK, Gawalkar AA, Raj KM, Attri SV, Sachdeva N, Kaur H. Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study. J Pediatr Endocrinol Metab 2022; 35:1059-1068. [PMID: 35822711 DOI: 10.1515/jpem-2021-0693] [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: 11/18/2021] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Growth hormone deficiency (GHD) in adults is associated with an increased risk of cardiovascular morbidity and mortality. Although children with GHD are also believed to have a similar cardiovascular disease (CVD) risk beginning at an early age, the available data in children is scarce. We aimed to determine the various CVD risk parameters in children with isolated GHD (IGHD). METHODS A cross-sectional case-control study was conducted at a tertiary care centre in North India comparing various auxological, biochemical, and echocardiographic parameters between 20 IGHD children aged 5-15 years and their age and sex-matched healthy controls. RESULTS The mean age of children with IGHD and controls was similar (10.5 ± 2.6 yr vs. 9.9 ± 2.7 yr, p=0.48). Children with IGHD had significantly higher waist-hip-ratio (p=0.01), total cholesterol (p=0.02), non-high-density lipoprotein-cholesterol (p=0.02), serum homocysteine (p<0.001), C-reactive protein (CRP) (p=0.01) and pro-brain natriuretic peptide (pro-BNP) (p=0.04) levels as compared to healthy controls. Left ventricular mass (LVM) and interventricular septal thickness were significantly lower (p=0.04; p=0.02) in IGHD children. Correlation analysis showed that pro-BNP and CRP levels had negative correlation (p<0.001, r=-0.70; and p=0.04, r=-0.44, respectively) and LVM had a positive correlation (p=0.02, r=0.53) with height SDS among IGHD children. CONCLUSIONS Children with IGHD showed abnormalities in several biochemical and cardiac parameters that may be associated with an increased CVD risk in later life. More extensive studies, including younger children with IGHD, are needed to determine the lower ages at which the CVD risk is detectable.
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Affiliation(s)
- Saniya Gupta
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Manish Raj
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harvinder Kaur
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Kumar K, Singh M, Mathew JL, Vaidya PC, Verma Attri S. Serum Periostin Level in Children with Asthma. Indian J Pediatr 2022; 90:438-442. [PMID: 35838943 PMCID: PMC9284492 DOI: 10.1007/s12098-022-04282-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the average serum periostin level in children with asthma between 6 and 16 y of age, and to find out if the levels correlated with markers of eosinophilic inflammation, asthma control, and severity. METHODS Children under follow-up at a tertiary care centre were enrolled. Children with conditions causing elevated serum periostin other than asthma, or history of systemic steroid use in the past 6 mo were excluded. Serum total IgE and periostin were estimated by ELISA. RESULTS The median (IQR) serum periostin level was 52.6 (45.4, 58.3) ng/mL. Levels did not vary with age, gender, duration of symptoms, positive family history, or history of exacerbations in the last 6 mo. There was no significant correlation with anthropometric parameters or their z scores, or markers of eosinophilic inflammation in blood including serum total IgE, eosinophil percentage or absolute eosinophil count. There was no difference in median periostin levels of children with different asthma symptom control or asthma severity. CONCLUSIONS In a group of 26 Indian children with physician-diagnosed asthma, serum periostin showed no significant correlation to markers of eosinophilic inflammation.
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Affiliation(s)
- Ketan Kumar
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Meenu Singh
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Joseph L Mathew
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj C Vaidya
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Munikoty V, Sodhi KS, Bhatia A, Bhatia P, Verma Attri S, Rohit MK, Trehan A, Khandelwal N, Bansal D. Estimation of iron overload with T2*MRI in children treated for hematological malignancies. Pediatr Hematol Oncol 2022; 40:315-325. [PMID: 35833695 DOI: 10.1080/08880018.2022.2098436] [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: 01/19/2023]
Abstract
Iron overload may contribute to long-term complications in childhood cancer survivors. There are limited reports of assessment of tissue iron overload in childhood leukemia by magnetic resonance imaging (MRI). A cross-sectional, observational study in children treated for hematological malignancy was undertaken. Patients ≥6 months from the end of therapy who had received ≥5 red-cell transfusions were included. Iron overload was estimated by serum ferritin (SF) and T2*MRI. Forty-five survivors were enrolled among 431 treated for hematological malignancies. The median age at diagnosis was 7-years. A median of 8 red-cell units was transfused. The median duration from the end of treatment was 15 months. An elevated SF (>1,000 ng/ml), elevated liver iron concentration (LIC) and myocardial iron concentration (MIC) were observed in 5 (11.1%), 20 (45.4%), and 2 (4.5%) patients, respectively. All survivors with SF >1,000 ng/ml had elevated LIC. The LIC correlated with SF (p < 0.001). MIC lacked correlation with SF or LIC. Factors including the number of red-cell units transfused and duration from the last transfusion were associated with elevated SF (p = 0.001, 0.002) and elevated LIC (p = 0.012, 0.005) in multiple linear regression. SF >595 ng/ml predicted elevated LIC with a sensitivity of 85% and specificity of 91.6% (AUC 91.2%). A cutoff >9 units of red cell transfusions had poor sensitivity and specificity of 70% and 75% (AUC 76.6%) to predict abnormal LIC. SF >600 ng/ml is a robust tool to predict iron overload, and T2*MRI should be considered in childhood cancer survivors with SF exceeding 600 ng/ml.
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Affiliation(s)
- Vinay Munikoty
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Bhatia
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj K Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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Kasudhan KS, Patil AN, Jandial A, Khadwal A, Prakash G, Jain A, Bhurani D, Ahmed R, Agrawal N, Singh R, Sachdeva MUS, Varma N, Das R, Verma Attri S, Malhotra S, Majhail NS, Malhotra P, Lad DP. Post-transplant cyclophosphamide pharmacokinetics and haploidentical hematopoietic cell transplantation outcomes: an exploratory study. Leuk Lymphoma 2022; 63:2679-2685. [DOI: 10.1080/10428194.2022.2087067] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kripa Shanker Kasudhan
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amol N. Patil
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Reema Singh
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet S. Majhail
- Blood and Marrow Transplant Program, Department of Hematology-Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh P. Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Kasudhan KS, Patil AN, Jandial A, Khadwal A, Prakash G, Jain A, Bhurani D, Ahmed R, Agrawal N, Singh R, Singh Sachdeva MU, Varma N, Das R, Attri SV, Malhotra S, Majhail NS, Malhotra P, Lad DP. Post-Transplant Cyclophosphamide Pharmacometabolomics and Haploidentical Hematopoietic Cell Transplantation Outcomes. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00554-1] [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: 10/18/2022]
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17
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Saini AG, Chatterjee D, Bhagwat C, Vyas S, Attri SV. Leigh syndrome in an infant: autopsy and histopathology findings. Autops Case Rep 2021; 11:e2021334. [PMID: 34805005 PMCID: PMC8597803 DOI: 10.4322/acr.2021.334] [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] [Received: 06/27/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
Leigh syndrome is an inherited neurodegenerative disorder of infancy that typically manifests between 3 and 12 months of age. The common neurological manifestations are developmental delay or regression, progressive cognitive decline, dystonia, ataxia, brainstem dysfunction, epileptic seizures, and respiratory dysfunction. Although the disorder is clinically and genetically heterogeneous, the histopathological and radiological features characteristically show focal and bilaterally symmetrical, necrotic lesions in the basal ganglia and brainstem. The syndrome has a characteristic histopathological signature that helps in clinching the diagnosis. We discuss these unique findings on autopsy and radiology in a young infant who succumbed to a subacute, progressive neurological illness suggestive of Leigh syndrome. Our case highlights that Leigh syndrome should be considered in the differential diagnosis of infantile-onset, subacute neuroregression with dystonia and seizures, a high anion gap metabolic acidosis, normal ketones, elevated lactates in blood, brain, and urine, and bilateral basal ganglia involvement.
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Affiliation(s)
- Arushi Gahlot Saini
- Postgraduate Institute of Medical Education and Research, Department of Pediatrics, Chandigarh, India
| | - Debjyoti Chatterjee
- Postgraduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Chandana Bhagwat
- Postgraduate Institute of Medical Education and Research, Department of Pediatrics, Chandigarh, India
| | - Sameer Vyas
- Postgraduate Institute of Medical Education and Research, Department of Radiodiagnosis and Imaging, Chandigarh, India
| | - Savita Verma Attri
- Postgraduate Institute of Medical Education and Research, Department of Pediatrics, Chandigarh, India
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18
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Williams V, Jayashree M, Nallasamy K, Dayal D, Rawat A, Attri SV. Serial urinary neutrophil gelatinase associated lipocalin in pediatric diabetic ketoacidosis with acute kidney injury. Clin Diabetes Endocrinol 2021; 7:20. [PMID: 34719396 PMCID: PMC8559408 DOI: 10.1186/s40842-021-00133-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) due to Diabetic Ketoacidosis (DKA) is rather common. Novel biomarkers to diagnose AKI are being increasingly used in different settings. The use of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) in predicting persistent AKI in pediatric DKA cases is still not thoroughly investigated. METHODS This was a secondary analysis of Saline versus Plasma-Lyte in Ketoacidosis (SPinK) trial data; 66 children (> 1 month-12 years) with DKA, defined by the International Society for Pediatric and Adolescent Diabetes (ISPAD), were analyzed. Children with cerebral edema, chronic kidney disease and those who received pre-referral fluids and/or insulin were excluded. uNGAL and urine NGAL-creatinine ratio (uNCR) at 0 and 24 h were measured in all. Persistent AKI was defined as a composite outcome of continuance of AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3 beyond 48 h from AKI onset, progression of AKI from either KDIGO stage 0 or 1 to a worse stage, need of renal replacement therapy or death. MAIN OUTCOMES Thirty-five (53%) children had AKI at admission; 32 (91.4%) resolved within 48 h. uNGAL was significantly higher in the AKI group at admission [79.8 ± 27.2 vs 54.6 ± 22.0, p = 0.0002] and at 24 h [61.4 ± 28.3 vs 20.2 ± 14.5, p = 0.0003]. Similar trend was observed with uNCR at admission [6.7 ± 3.7 vs 4.1 ± 2.6, p = 0.002] and at 24 h [6.3 ± 2.5 vs 1.2 ± 1.0, p = 0.01]. Furthermore, uNGAL at admission showed a moderate positive linear correlation with serum creatinine. Additionally, elevated uNGAL at 0 and 24 h correlated with corresponding KDIGO stages. Admission uNGAL >88 ng/ml and uNCR of >11.3 ng/mg had a sensitivity of 66% and 67%, specificity of 76% and 95%, and Area under the receiver operating characteristic curve (AUC) of 0.78 and 0.89 respectively for predicting persistent AKI at 48 h. CONCLUSIONS Majority of AKI resolved with fluid therapy. While uNGAL and uNCR both correlated with serum creatinine and AKI stages, serial uNCR was a better predictor of persistent AKI than uNGAL alone. However, feasibility of routine uNGAL measurement to predict persistent AKI in DKA needs further elucidation. TRIAL REGISTRATION This was a secondary analysis of the data of SPinK trial [CTRI/2018/05/014042 ( ctri.nic.in )].
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Intensive Care, Department of Critical Care, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Devi Dayal
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Rawat
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Division of Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Singanamalla B, Saini AG, Attri SV, Suthar R, Mukhopadhyay K. Carbonic Anhydrase-VA Deficiency: A Close Mimicker of Urea Cycle Disorders. Ann Indian Acad Neurol 2021; 24:820-821. [PMID: 35002167 PMCID: PMC8680920 DOI: 10.4103/aian.aian_563_20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/24/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bhanudeep Singanamalla
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanya Mukhopadhyay
- Neonatology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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20
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Kaur R, Paria P, Saini AG, Suthar R, Bhatia V, Attri SV. Metabolic epilepsy in hyperprolinemia type II due to a novel nonsense ALDH4A1 gene variant. Metab Brain Dis 2021; 36:1413-1417. [PMID: 34037900 DOI: 10.1007/s11011-021-00757-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Hyperprolinemia type II (HPII) is a rare autosomal recessive disorder of proline degradation pathway due to deficiency of delta-1-pyrroline-5-carboxylate dehydrogenase. Pathogenic variants in the ALDH4A1 gene are responsible for this disorder. We here describe an 11-month-old infant with recurrent seizures refractory to multiple antiepileptic drugs. She was hospitalized in view of acute-onset encephalopathy, exacerbation of generalized seizures following an upper respiratory infection. Laboratory investigation revealed significantly elevated proline levels in dried blood spots. DNA sample of the child was subjected to a targeted next-generation sequencing gene panel for hyperprolinemias. We detected a novel nonsense homozygous variant in the ALDH4A1 gene in the child and the heterozygous variant of the same in both the parents. Based on the location of the variant i.e. in the last exon, truncated protein is expected to be expressed by skipping nonsense-mediated decay and such point-nonsense variants could be an ideal target for readthrough drugs to correct genetic defects.
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Affiliation(s)
- Rajdeep Kaur
- Pediatric Biochemistry Unit, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Pradip Paria
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, PGIMER, Chandigarh, India.
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21
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Dileep Satya K, Attri SV, Sharawat IK, Vaidya PC, Mehra N, Patial A, Sankhyan N, Singhi PD. Plasma and Urinary Amino Acid Profile in Children with Infantile Tremor Syndrome. J Trop Pediatr 2021; 67:6344872. [PMID: 34363080 DOI: 10.1093/tropej/fmab063] [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: 11/14/2022]
Abstract
BACKGROUND Infantile Tremor Syndrome (ITS) is a disorder of infancy, and characterized by developmental delay and/or regression, pallor, skin hyperpigmentation and hypopigmented hair. It is commonly seen in infants in whom exclusive breastfeeding is given inappropriately for longer durations than recommended. ITS is predominantly reported from the Indian subcontinent and in children from a lower socioeconomic background. It is a clinical diagnosis and vitamin B12 deficiency is the most commonly accepted etiology of this entity. OBJECTIVES The primary objectives of study were to compare the plasma and urine amino acid levels among children with ITS spectrum with those of healthy children. The secondary objectives were to compare the plasma and urine amino acid levels among children with ITS and Pre-ITS. STUDY DESIGN This cross-sectional, observational study was carried out at a tertiary care hospital in North India. PARTICIPANTS A total of 50 children aged < 36 months with ITS/Pre-ITS were enrolled. Children with Pre-ITS and ITS were compared with healthy age-matched study subjects. RESULTS Thirty-nine (78%) cases and twelve (24%) healthy children had low serum vitamin B12 levels. Folate levels were normal in all the controls, while only one case had folate deficiency. There were significant differences (p < 0.05) in the values of 32 amino acids in plasma. Among 44 urinary amino acids, levels of 30 amino acids were significantly different in the cases compared with the controls (p < 0.05). CONCLUSIONS Several changes in amino acids in the children suffering from ITS were observed. These changes may be a reflection of the metabolic derangements in ITS.
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Affiliation(s)
- K Dileep Satya
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Savita Verma Attri
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Rishikesh 249203, India
| | - Pankaj C Vaidya
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Nancy Mehra
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Ajay Patial
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Naveen Sankhyan
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Pratibha D Singhi
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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22
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Dhir N, Attri SV, Pattanaik S, Kumar MP, Gill NK, Patial A, Rathore N, Saha L, Mohindra S. Aneurysmal Subarachnoid Hemorrhage: Impact on Phenytoin Permeability across the Blood-Brain Barrier. Neurol India 2021; 68:588-592. [PMID: 32643669 DOI: 10.4103/0028-3886.288987] [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: 11/04/2022]
Abstract
Background Phenytoin (PHT) is a routinely prescribed prophylactic antiepileptic following aneurysmal subarachnoid hemorrhage (aSAH). However, its prophylactic use in aSAH is controversial as emerging evidence suggests worsening of the neurological and functional outcomes. In addition, there is profound damage to the blood-brain barrier (BBB) in aSAH, posing uncertainty about the permeability of PHT across BBB in these patients. This pilot study was designed to evaluate the alteration in PHT permeability across BBB in aSAH patients. Materials and Methods For conducting the study, 20 patients (control n = 10; aSAH (grade 3 or 4) n = 10) were recruited from a tertiary care hospital. The patients undergoing cranial surgery for pathology with intracerebral mass lesions on MRI were chosen as control for aSAH group. Both groups were administered PHT loading dose (20 mg/kg), infused in 5% dextrose, at a rate not more than 50 mg/min, followed by a maintenance dose (5 mg/kg). Quantification of PHT concentration was performed in brain tissue, plasma, and cerebrospinal fluid (CSF) by LC-MS/MS. Results The median PHT concentration in brain was found to be significantly decreased (64.8%) in aSAH group (3.78 μg/g) as compared to control (10.73 μg/g), P = 0.010. Similarly, median PHT brain concentration as fraction of plasma was significantly decreased in aSAH group (36.72%) compared to that of control (89.55%), P = 0.003. There was no significant difference in PHT concentration in plasma, CSF, and CSF as a fraction of plasma between both the groups. Conclusion There is a definite decrease in the penetration of PHT to the brain in patients with grade 3 and 4 aSAH.
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Affiliation(s)
- Neha Dhir
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Smita Pattanaik
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Praveen Kumar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navjit Kaur Gill
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Patial
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Rathore
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lekha Saha
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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23
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Saini AG, Attri SV. Cholestatic Jaundice in Sulphite Oxidase Deficiency - An Unusual Association: Correspondence. Indian J Pediatr 2021; 88:628-629. [PMID: 33205359 DOI: 10.1007/s12098-020-03560-0] [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: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Arushi Gahlot Saini
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Savita Verma Attri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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24
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Malik VS, Ravindra K, Rattan P, Dayal D, Attri SV. Environmental exposure to urinary Bisphenol-A in North Indian children aged between 6 and 16 years and its association with body mass index. Environ Sci Pollut Res Int 2021; 28:29085-29095. [PMID: 33550552 DOI: 10.1007/s11356-021-12555-z] [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] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
This study investigates the effect of environmental risk factors among North Indian children aged between 6 and 16 years associated with body mass index by comparing fasting and non-fasting urine Bisphenol-A, urine creatinine, and serum thyroid levels with other potential confounding factors. A total of 301 children were enrolled, and term fasting and non-fasting were used based on the sample collection, either first morning or random. Children were grouped into obese, non-obese, and underweight categories based on age- and gender-specific Centre for Disease Control (CDC) 2000 growth chart and grouped according to their body mass index. The overall mean ± SD (standard deviation) of age (years) was 10.45±2.39 (boys age 10.38±2.38 and girls age 10.45±2.40). Urinary Bisphenol-A concentration (ng/mL ± SD) was higher among obese (2.40±4.70) than non-obese (1.30±1.67) and underweight (1.84±3.46) category children. Higher levels of fasting urinary Bisphenol-A (≥2 ng/mL) and thyroid-stimulating hormone (TSH) (≥12.7 μg/dL) were associated with obesity than those of non-fasting children. Being non-fasting among girls at quartile 4 (obese, >2.1800 ng/mL; underweight, >2.1325 ng/mL) had higher odds (obese adjusted odds ratio (aOR) 7.72 (95% CI 0.08-1368.52), underweight adjusted odds ratio (aOR) 12.45 (95% CI 1.55-171.24)] than fasting children. We recommend awareness programs and policy guidelines by engaging teachers and parents for the physical assessment of the presence of Bisphenol-A in food packaging materials to reduce the potential exposure to other chemical migrations sources. Graphical abstract.
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Affiliation(s)
- Vivek Singh Malik
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Preety Rattan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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25
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Suthar R, Reddy BVC, Malviya M, Sirari T, Attri SV, Patial A, Tageja M, Didwal G, Khandelwal NK, Saini AG, Saini L, Sahu JK, Dayal D, Sankhyan N. Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study. J Pediatr Endocrinol Metab 2021; 34:573-581. [PMID: 33838091 DOI: 10.1515/jpem-2020-0680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 07/19/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures. METHODS In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]2D3), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels. RESULTS A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04-10.77) years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤-2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was -2.3 (95% confidence interval [CI] = -1.8, -2.8), and at the femoral neck was -2.5 (95% CI = -2, -2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)2D3 levels were deficient in all. Mean serum osteocalcin levels were 0.68 ± 0.38 ng/mL (n=54), serum osteopontin levels were 8.6 ± 4.6 pg/mL (n=54) and serum Ntx levels were 891 ± 476 nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9 (6-34) months vs. 7.8 (4.8-13.4) months]; p=0.04). CONCLUSIONS Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.
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Affiliation(s)
- Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - B V Chaithanya Reddy
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Manisha Malviya
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Titiksha Sirari
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Ajay Patial
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Minni Tageja
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Gunjan Didwal
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | | | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Devi Dayal
- Pediatric Endocrinology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
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26
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Sharma P, Bhatia P, Singh M, Das R, Jain R, Bansal D, Attri SV, Trehan A. A case series highlighting structured hematological, biochemical and molecular approach to clinical oral iron refractoriness in children: A pressing need for a 3-tier system for classification of variants in TMPRSS6 gene. Blood Cells Mol Dis 2021; 89:102569. [PMID: 33930800 DOI: 10.1016/j.bcmd.2021.102569] [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] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
In current study, we discuss clinical oral iron refractoriness cases and highlight need for a classification system to define TMPRSS6 gene variants. Out of 231 cases of microcytic hypochromic anemia screened (Sept 2019-Dec 2020), 17 cases (7.35%) with unexplained iron refractoriness (URIDA) phenotype were enrolled after ruling out secondary causes and compliance related issues. 11 (65%) had absent/negligible response (0-0.4 g/dl Hb rise) while 6 (35%) partial (0.5-0.9 g/dl Hb rise) response to initial iron trial at 4-8 weeks. Of these 17 cases, inappropriate hepcidin levels (normal-high) were noted in 11/15 (73%) tested. TSAT/Hepcidin ratio was low in 13/15 (87%). Genetic analysis of TMPRSS6 gene by NGS revealed variations in 15/17 (88%) cases. 10/15 cases with variations harbored a common splice site INDEL that was noted to be pathogenic SNP (MAF-0.19) on case-control association study in combination with other known missense SNPs with an odds ratio of 6.38 and relative risk 2.66 (p- < 0.01).
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Affiliation(s)
- Pankaj Sharma
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India
| | - Prateek Bhatia
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India
| | - Minu Singh
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India
| | - Reena Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India
| | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India
| | - Savita Verma Attri
- Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatric Centre, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, India.
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27
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Parameswaran P, Vaidya PC, Attri SV, Angurana SK, Vignesh P, Singh M. Vitamin D Deficiency: Prevalence and Association with Intrathoracic Tuberculosis in Indian Children. Indian J Pediatr 2021; 88:276. [PMID: 32468388 DOI: 10.1007/s12098-020-03350-8] [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] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Priyatharshini Parameswaran
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pankaj C Vaidya
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Savita Verma Attri
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pandiarajan Vignesh
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Meenu Singh
- Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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28
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Kaur R, Attri SV, Saini AG, Sankhyan N. A high frequency and geographical distribution of MMACHC R132* mutation in children with cobalamin C defect. Amino Acids 2021; 53:253-264. [PMID: 33515116 DOI: 10.1007/s00726-021-02942-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/19/2020] [Indexed: 12/16/2022]
Abstract
Cobalamin C defect is caused by pathogenic variants in the MMACHC gene leading to impaired conversion of dietary vitamin B12 into methylcobalamin and adenosylcobalamin. Variants in the MMACHC gene cause accumulation of methylmalonic acid and homocysteine along with decreased methionine synthesis. The spectrum of MMACHC gene variants differs in various populations. A total of 19 North Indian children (age 0-18 years) with elevated methylmalonic acid and homocysteine were included in the study, and their DNA samples were subjected to Sanger sequencing of coding exons with flanking intronic regions of MMACHC gene. The genetic analysis resulted in the identification of a common pathogenic nonsense mutation, c.394C > T (R132*) in 85.7% of the unrelated cases with suspected cobalamin C defect. Two other known mutations c.347T > C (7%) and c.316G > A were also detected. Plasma homocysteine was significantly elevated (> 100 µmol/L) in 75% of the cases and methionine was decreased in 81% of the cases. Propionyl (C3)-carnitine, the primary marker for cobalamin C defect, was found to be elevated in only 43.75% of cases. However, the secondary markers such as C3/C2 and C3/C16 ratios were elevated in 87.5% and 100% of the cases, respectively. Neurological manifestations were the most common in our cohort. Our findings of the high frequency of a single MMACHC R132* mutation in cases with combined homocystinuria and methylmalonic aciduria may be proven helpful in designing a cost-effective and time-saving diagnostic strategy for resource-constraint settings. Since the R132* mutation is located near the last exon-exon junction, this is a potential target for the read-through therapeutics.
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Affiliation(s)
- Rajdeep Kaur
- Pediatric Biochemistry Unit, Department of Pediatrics, PGIMER, Chandigarh, 160012, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, PGIMER, Chandigarh, 160012, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
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29
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Raj KM, Baranwal AK, Attri SV, Jayashree M, Kumar-M P, Patial A, Saini AG. Thiamine Status in Children with Septic Shock from a Developing Country: A Prospective Case-Control Study. J Trop Pediatr 2021; 67:6056050. [PMID: 33381852 DOI: 10.1093/tropej/fmaa107] [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: 12/12/2022]
Abstract
OBJECTIVE Mitochondrial dysfunction is central to sepsis-induced multi-organ dysfunction. Thiamine deficiency may contribute to mitochondrial dysfunction and thus high mortality. Study was planned to assess thiamine status in children with septic shock in comparison to healthy controls from a developing country and to study the effect of thiamine levels on its outcome. METHODS A prospective case-control study (April 2017 to May 2018) enrolling consecutive children with septic shock as 'cases' (n = 76), their healthy siblings (n = 51) and apparently healthy children from immunization clinic (n = 35) as 'controls'. Whole blood total thiamine (WBTT) level was measured on days 1, 10 and 1-month post-discharge. Outcome parameters were acute care area free days on days 14 and 28, and mortality. RESULTS WBTT [nMol/l; median (interquartile range, IQR)] was significantly lower on day 1 in cases compared with sibling controls [23.1 (21.8-26.3) vs. 36.9 (33.6-40.5); p < 0.001]. It fell further on day 10 [20.8 (18.1-21.1); p < 0.02]. Levels rose significantly 1-month post-discharge [35.5 (31.2-36.6)] and became comparable to sibling controls (p = 0.4). Immunization clinic controls also had lower WBTT [42.3 (40.1-45.9)], but was significantly higher than sibling controls and cases at 1-month post-discharge (p < 0.001). Survivors and non-survivors of septic shock were similar. WBTT levels did not correlate with any of the severity indicators of septic shock or its outcomes. CONCLUSIONS WBTT was significantly low in all children, and fell further during septic shock. Observed severe deficiency might have precluded any further association of thiamine levels with severity of septic shock and its outcome. Data obtained may inform trials on metabolic resuscitation in paediatric septic shock in developing countries. Lay summaryThiamine deficiency may contribute to high mortality in paediatric septic shock as thiamine is an essential factor for functioning of mitochondria, the powerhouse of the cells. This prospective case-control study was conducted to assess thiamine status in children with septic shock in comparison with healthy controls in a developing country. Consecutive children with fluid-refractory septic shock were enrolled as 'cases'. Their apparently healthy siblings, and apparently healthy children from immunization clinic, were enrolled as 'controls'. The whole blood total thiamine (WBTT) level was measured on days 1, 10 and 1 month after hospital discharge. Seventy-six children were enrolled as cases, 51 children as sibling controls and 35 children as immunization clinic controls. WBTT was significantly lower on day 1 in cases as compared with their sibling controls. It fell further on day 10. The level rose significantly after a month of discharge and became comparable to sibling controls. Immunization clinic controls also had lower WBTT but was significantly higher compared with sibling controls and cases at 1-month post-discharge. Survivors and non-survivors of septic shock had similar WBTT levels. Observed severe deficiency might have precluded any further association of thiamine levels with septic shock outcome.
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Affiliation(s)
- Kumar Manish Raj
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun K Baranwal
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Patial
- Pediatric Biochemistry Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Division of Pediatric Neurology, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30
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Malik VS, Ravindra K, Attri SV, Bhadada SK, Singh M. Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. Environ Sci Pollut Res Int 2020; 27:42115-42123. [PMID: 32710359 PMCID: PMC7380664 DOI: 10.1007/s11356-020-10132-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/14/2020] [Indexed: 05/07/2023]
Abstract
Globally, both obesity and underweight are severe health risks for various diseases. The current study systematically examined the emerging evidence to identify an association between body mass index (BMI) and COVID-19 disease outcome. Online literature databases (e.g., Google Scholar, PubMed, MEDLINE, EMBASE, Scopus, Medrixv and BioRixv) were screened following standard search strategy having the appropriate keyword such as "Obesity", "Underweight", "BMI", "Body Mass Index", "2019-nCov", "COVID-19, "novel coronavirus", "coronavirus disease". Studies published till 20th April 2020 were included without language restriction. These studies include case reports, case series, cohort, and any other which reported BMI, overweight/obesity or underweight, and its complication with COVID-19 disease. This study observed COVID-19 infection among BMI < 25 kg/m2 with prevalence of 0.60 (95%CI: 0.34-0.86, I2 = - 76.77) as compared to the 0.34 (95%CI: 0.23-0.44, I2 = 53.45% heterogeneity) having BMI > 25 kg/m2. The results of the current study show that BMI plays a significant role in COVID-19 severity in all age groups, especially the older individuals. A panel of doctors and nursing staff should review COVID-19 patients with higher BMI with other co-morbidities (diabetes and hypertension), and they should be given increased vigilance, priority in testing, and treatment to control the associated co-morbidities. Further, the COVID-19 patients whose illness entered 7-10 days, age > 50 years, and elevated CRP levels should be given additional medical considerations. Our finding showed that the population and patients with high BMI have moderate to high risk of medical complications with COVID-19, and hence, their health status should be monitored more frequently including monitoring of blood pressure and blood glucose.
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Affiliation(s)
- Vivek Singh Malik
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Meenu Singh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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31
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Lad DP, Malhotra P, Patil AN, Nampoothiri RV, Kasudhan KS, Khadwal A, Prakash G, Jain A, Malhotra S, Varma N, Attri SV, Varma S. Long-term outcomes of innovator versus generic melphalan formulation in autologous hematopoietic cell transplantation for multiple myeloma. Hematol Oncol Stem Cell Ther 2020; 14:114-118. [PMID: 32622756 DOI: 10.1016/j.hemonc.2020.06.002] [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] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most data on autologous hematopoietic cell transplantation (auto-HCT) in myeloma are based on the use of innovator formulation of melphalan. Comparative bioequivalence and efficacy studies of generic melphalan are lacking. METHODS In this retrospective study, we report long-term outcomes of auto-HCT in myeloma using innovator (Alkeran, Aspen Pharma; n = 41) and generic melphalan (Alkacel, Celon Labs, India; n = 55) formulations. All consecutive patients at a single center from the period 2011-2018 were included. RESULTS The median follow-up in the innovator and generic groups was 61.7 and 32.5 months, respectively. Both groups were matched for age, sex, stage, and myeloma response. There were significantly more patients in the innovator melphalan group who were administered melphalan at a reduced dose at physician discretion (26.8% vs. 3.6%, p = .001). There were significantly more patients with grade 3 or higher mucositis (68.3% vs. 38.1%, p < .0001) and grade 3 or higher diarrhea (85.4% vs. 50.1%, p < .0001) in the innovator group. The median duration of hospital stay was significantly longer in the innovator group (19 days vs. 15.5 days, p < .0001). There were significantly more patients in the generic group who received standard maintenance (94.5% vs. 34.1%, p < .0001). Despite the differences in the melphalan dose and post-transplant strategies, the 4-year progression-free survival and overall survival were not significantly different in the two groups (58% vs. 63%, p = .7, 71% vs. 72%, p = .4, respectively). CONCLUSION Long-term efficacy comparison is helpful in the absence of postmarketing bioequivalence studies of generic melphalan.
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Affiliation(s)
- Deepesh P Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amol N Patil
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram V Nampoothiri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kripa Shanker Kasudhan
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kesavan S, Dhawan S, Saini L, Attri SV, Vyas S, Sankhyan N. Reversible Basal Ganglia Changes and Metabolic Crisis in Infantile Tremor Syndrome. Indian J Pediatr 2020; 87:464-465. [PMID: 31781955 DOI: 10.1007/s12098-019-03111-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/23/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Shivan Kesavan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sumeet Dhawan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Affiliation(s)
- Priyanka Madaan
- From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India
| | - Lokesh Saini
- From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India
| | - Sameer Vyas
- From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India
| | - Savita Verma Attri
- From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India
| | - Jitendra Kumar Sahu
- From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India.
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Affiliation(s)
- Sumeet R Dhawan
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sameer Vyas
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Palanisamy S, Dutta S, Attri SV, Sundaram V. Serum C-Reactive Protein Levels in Healthy Neonates in Different Gestational and Postnatal Ages. J Trop Pediatr 2019; 65:481-490. [PMID: 30649556 DOI: 10.1093/tropej/fmy079] [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: 11/14/2022]
Abstract
There is paucity of normative data on serum C-reactive protein (CRP) in neonates. In Part I of study, we compared CRP in healthy neonates (from 28°/7 weeks to 416/7 weeks of gestation) between various gestational and postnatal age groups in first week. We planned recruitment of 50 participants each in 'term', 'late preterm' and 'moderate-to-very preterm' groups, equally divided in '24-95 h' and '96-168 h' postnatal age sub-groups. In Part II of study, we assayed CRP weekly in moderate-to-very preterm neonates until day 28 to evaluate its trend. Among 154 subjects, term neonates had higher CRP, with highest values among term infants aged 24-95 h. Barring postnatal age, maternal/perinatal factors did not affect CRP levels. CRP did not change significantly over 28 days in moderate-to-very preterm neonates. In conclusion, serum CRP in healthy neonates is highest among term infants aged 24-95 h and does not vary significantly in the first month of life among moderate-to-very preterm infants.
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Nampoothiri RV, Kasudhan KS, Patil AN, Malhotra P, Khadwal A, Prakash G, Jain A, Malhotra S, Verma Attri S, Varma N, Varma S, Lad DP. Impact of frailty, melphalan pharmacokinetics, and pharmacogenetics on outcomes post autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 2019; 54:2088-2095. [DOI: 10.1038/s41409-019-0631-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/22/2019] [Accepted: 07/13/2019] [Indexed: 12/27/2022]
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Dhawan SR, Saini L, Verma Attri S, Kumar A, Sankhyan N. Owl's Eye Sign in a Reversible Etiology of Spastic Quadriparesis. Neuropediatrics 2019; 50:135-136. [PMID: 30453355 DOI: 10.1055/s-0038-1675627] [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] [Indexed: 10/27/2022]
Affiliation(s)
- Sumeet R Dhawan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
| | | | | | - Renu Suthar
- Pediatric Neurology Unit Department of Pediatrics
| | - Savita Verma Attri
- Department of Pediatrics Postgraduate Institute of Medical Education and Research Chandigarh, India
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Giridhar S, Kumar J, Attri SV, Dutta S, Kumar P. Intramuscular Followed by Oral Vitamin A Supplementation in Neonates with Birth Weight from 750 to 1250 g: A Randomized Controlled Trial. Indian J Clin Biochem 2019; 35:197-204. [PMID: 32226251 DOI: 10.1007/s12291-018-0807-1] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/24/2018] [Indexed: 01/09/2023]
Abstract
Multiple intramuscular (IM) injections of vitamin A have been shown to decrease bronchopulmonary dysplasia in very low birth weight (VLBW) neonates. However, this regime is neither practical nor popular. Oral vitamin A has failed to achieve adequate plasma levels. We aimed to investigate if a schedule of initial IM followed by oral supplementation can reduce vitamin A deficiency. This was a blinded, randomized controlled trial, conducted in a level III neonatal unit. Neonates with birth weight from 750 to 1250 g, were enrolled at the age of 24-96 h of life. They were randomly allocated to vitamin A supplementation (VAS) (n = 61) or placebo group (n = 59). VAS group received vitamin A 5000 IU IM on alternate days till establishment of adequate enteral feeds, followed by oral 10,000 IU daily for 28 days. The primary outcome was incidence of vitamin A deficiency (plasma retinol < 200 μg/L) on day 28. A total of 120 neonates with mean (SD) gestation age and birth weight of 31 (2.4) weeks and 1065 (141) g, respectively were enrolled. More than 90% of cases were vitamin A deficient at the baseline. The proportion of vitamin A deficient infants on day 28 of study was significantly lower in VAS group compared to placebo group (4% vs. 61%, p < 0.001). The median (1st-3rd quartile) plasma retinol levels (μg/L) were significantly higher in VAS group compared to placebo [489 (295,627) vs. 184 (156,240), p < 0.001]. We conclude that the IM followed by oral VAS significantly reduced the incidence of vitamin A deficiency in VLBW infants.
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Affiliation(s)
- S Giridhar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Jogender Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Savita Verma Attri
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Vaishnavi K, Bansal D, Trehan A, Jain R, Attri SV. Improving the safety of high-dose methotrexate for children with hematologic cancers in settings without access to MTX levels using extended hydration and additional leucovorin. Pediatr Blood Cancer 2018; 65:e27241. [PMID: 29768710 DOI: 10.1002/pbc.27241] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/23/2018] [Revised: 03/12/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A lack of access to methotrexate levels is common in low- and middle-income countries (LMIC), relevant for 80% of children with cancer worldwide. We evaluated whether high-dose methotrexate (HD-MTX) can be administered safely with extended hydration and leucovorin rescue, with monitoring of serum creatinine and urine pH. METHODS The prospective study was conducted at a single centre in Chandigarh, India in 2015. Patients with B-cell acute lymphoblastic leukemia (ALL) or with T-cell ALL or non-Hodgkin lymphoma (T-NHL) were administered 3 and 5 gm/m2 of MTX (24 hr infusion), respectively. Six doses of leucovorin (15 mg/m2 /dose), instead of recommended three (for optimally reduced levels) at standard timing (42 hr from start of HD-MTX) were administered. Hydration (125 ml/m2 /hr) was continued for 72 hr, instead of the recommended 30 hr. Hydration fluid consisted of 0.45% sodium chloride, 5% dextrose, 7.5% sodium bicarbonate (50 mmol/l) and potassium chloride (20 mmol/l). Serum creatinine and urine pH were measured at baseline, 24 and 48 hr. The volume of hydration was increased (200 ml/m2 /hr) for a serum creatinine > 1.25 times the baseline. RESULTS The study included 100 cycles of HD-MTX in 53 patients: B-ALL 25 patients (51 cycles), T-ALL 16 patients (28 cycles), T-NHL 10 patients (18 cycles), and relapsed ALL 2 patients (3 cycles). The mean age was 6.8 ± 3.2 years. Patients were underweight in 15 (15%) cycles. Patients in 23% of cycles had a rise in creatinine to >1.25 times the baseline. Toxicities (NCI CTCAE v4.0) included mucositis (32%), diarrhoea (10%), and febrile neutropenia (9%). One patient died from dengue shock syndrome. CONCLUSIONS It is safe to administer 3 or 5 gm/m2 of MTX (24 hr infusion) without measuring MTX levels, with extended hydration, additional doses of leucovorin, and monitoring of serum creatinine and urine pH.
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Affiliation(s)
- Kalthi Vaishnavi
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Biochemistry Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Chylothorax is an uncommon complication in children. Although surgery and trauma are the most common causes encountered, hematological as well as solid malignancies can present with chylothorax. This study aimed to describe the presentation and management of malignant chylothorax in children. This is a case series from a pediatric hematology-oncology unit. Chylothorax was diagnosed by demonstrating high triglyceride content in the pleural fluid and a low cholesterol concentration in relation to the serum cholesterol. Cytology for malignant cells and investigations for tuberculosis were performed in all patients. Initial management included placement of an intercostal tube and administration of a fat-free diet with the addition of medium-chain triglycerides. Appropriate treatment of the underlying malignancy was initiated simultaneously. Three children with diagnoses of Stage IV neuroblastoma, lymphoblastic lymphoma, and Hodgkin lymphoma developed chylothorax. Malignant cytology was positive in the patient with T-NHL. All patients were found to have associated hypoproteinemia and hypoalbuminemia. The chylothorax resolved with conservative measures in two patients. It remained intractable in the child with T-NHL, in whom the lymphoma was refractory to chemotherapy. Chylothorax is a rare but challenging complication that can accompany childhood malignancies. Surgical interventions, radiotherapy, and pleurodesis are alternatives if the chylothorax is refractory to medical management.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Pediatric Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Pediatric Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Pediatric Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Pediatric Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Balachandran B, Mukhopadhyay K, Sachdeva N, Walia R, Attri SV. Randomised controlled trial of diazoxide for small for gestational age neonates with hyperinsulinaemic hypoglycaemia provided early hypoglycaemic control without adverse effects. Acta Paediatr 2018; 107:990-995. [PMID: 29385640 DOI: 10.1111/apa.14252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Received: 12/28/2016] [Revised: 11/08/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
Abstract
AIM Hyperinsulinaemic hypoglycaemia (HH) is a very common cause of hypoglycaemia in small for gestational age (SGA) neonates. We compared using early oral diazoxide or a placebo for this patient group. METHODS This was a randomised, double-blind, placebo-controlled trial that focused on SGA neonates born at at least 32 weeks of gestation with HH during the first five days of life. Neonates with severe perinatal asphyxia, sepsis or contraindications for oral feeds were excluded. The primary outcome was the hours taken to achieve hypoglycaemic control, with a glucose infusion rate of ≤4 mg/kg/min. The secondary outcomes were the duration of intravenous fluids, sepsis episodes, time to achieve full feeds and mortality. RESULTS We screened 490 neonates and 30 neonates were eligible for randomisation and completed the trial. Half received diazoxide and half received a placebo. The median time to achieve hypoglycaemia control (40 vs 71.5 hours, p = 0.015), the total duration of intravenous fluids (114 vs 164 hours, p = 0.04) and time to achieve full feeds (74 vs 124 hours, p = 0.02) were significantly lower in the diazoxide group, with no adverse effects attributed to the drug. CONCLUSION Using oral diazoxide for SGA neonates with HH provided early hypoglycaemic control with no apparent adverse effects.
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Affiliation(s)
- Binesh Balachandran
- Neonatal Unit; Department of Pediatrics; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Kanya Mukhopadhyay
- Neonatal Unit; Department of Pediatrics; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Naresh Sachdeva
- Department of Endocrinology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Rama Walia
- Department of Endocrinology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Savita Verma Attri
- Neonatal Unit; Department of Pediatrics; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
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Munikoty V, Bansal D, Sodhi KS, Bhatia A, Bhatia P, Attri SV, Rohit MK, Trehan A, Khandelwal N. Serum Ferritin Versus T2*Mri For Estimation Of Iron Overload In Children Treated For Hematological Malignancies. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.015] [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: 11/16/2022] Open
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Dayal D, Verma Attri S, Kumar Bhalla A, Kumar R. Response to low dose indomethacin in two children with nephrogenic diabetes insipidus. Pediatr Endocrinol Diabetes Metab 2017; 20:178-81. [PMID: 26615585 DOI: 10.18544/pedm-20.04.0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/13/2022]
Abstract
Two children with nephrogenic diabetes insipidus (NDI) were treated with oral indomethacin (0.75-1.2 mg/kg/day) three times a day for a mean duration of 3 yrs. Remission occurred in both patients in terms of achieving a normal fluid balance and body growth and the drug was withdrawn in one patient after 2 yrs. The treatment was well tolerated and no side effects were noted. The mean duration of follow-up was 6.5 yrs. These long-term observations of a favourable response to low dose indomethacin in 2 children with NDI need to be tested on larger number of patients.
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Affiliation(s)
- Devi Dayal
- Additional Professor, Pediatric Endocrinology & Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Savita Verma Attri
- Additional Professor, Pediatric Biochemistry, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Anil Kumar Bhalla
- Additional Professor, Child Growth and Anthropology Unit, Department of Pediatrics, Postgraduate Insti- tute of Medical Education and Research, Chandigarh
| | - Rakesh Kumar
- Associate Professor, Pediatric Endocrinology & Diabetes Unit, Department of Pediatrics, Postgraduate Insti- tute of Medical Education and Research, Chandigarh
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Tenneti N, Dayal D, Sharda S, Panigrahi I, Didi M, Attri SV, Sachdeva N, Bhalla AK. Concentrations of leptin, adiponectin and other metabolic parameters in non-obese children with Down syndrome. J Pediatr Endocrinol Metab 2017; 30:831-837. [PMID: 28749784 DOI: 10.1515/jpem-2016-0422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/06/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent data indicates that adults with Down syndrome (DS) are at increased risk for cardiovascular disease (CVD) that significantly contributes to their morbidity and mortality. Although identification of cardiometabolic risk factors during childhood is desirable to design preventive interventions, the data on such risk factors in children with DS is scarce. The aim of this study was to study the cardiometabolic risk factors such as insulin resistance (IR), leptin and adiponectin concentrations, lipid abnormalities and leptin resistance in non-obese children with DS. METHODS This cross-sectional case control study included karyotype confirmed trisomy-21 DS children aged 2-12 years and their matched healthy controls. After detailed anthropometry, weight, height and body mass index (BMI) standard deviation scores (SDSs) were calculated with reference data. Laboratory evaluation included determination of fasting lipid parameters, insulin, glucose, leptin and adiponectin concentrations. The homeostasis model assessment method (HOMA-IR) was used to assess IR and the ratio of leptin to BMI was used as an index of leptin resistance. RESULTS Seventy-seven children (39 with DS and 38 controls) comprised the study cohort. The anthropometric parameters were similar in the two groups. Children with DS showed significantly higher mean leptin concentrations (2.098±1.68 ng/mL vs. 1.44±0.52 ng/mL, p-value: 0.00) and higher indices of leptin resistance (0.127±0.085 vs. 0.09±0.03, p-value: 0.001) as compared to controls. Fasting adiponectin concentrations were lower (20.64±19.87 ng/mL vs. 32.58±34.25 ng/mL, p-value: 0.21) and fasting glucose higher (89.25±8.12 mg/dL vs. 85.71±5.52 mg/dL, p-value: 0.06) in the DS group as compared to the controls but the differences did not reach statistical significance. The concentrations of insulin, various lipid parameters and calculated HOMA-IR values were similar in the two groups. In the DS group, five children were identified to have high (>75th centile) leptin levels and four as impaired fasting glucose as compared to none in the controls. CONCLUSIONS Alterations of several cardiometabolic risk factors, in particular, leptin concentrations and leptin resistance are present in children with DS. The presence of hyperleptinemia without hyperinsulinemia suggests a probable inherent genetic basis for increased leptin resistance in patients with DS. There is a need for larger studies to further understand increased leptin resistance in DS that may contribute to increased CVD related morbidity and mortality in these patients.
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Chandrasekaran S, Patil S, Suthar R, Attri SV, Sahu JK, Sankhyan N, Tageja M, Singhi P. Hyperhomocysteinaemia in children receiving phenytoin and carbamazepine monotherapy: a cross-sectional observational study. Arch Dis Child 2017; 102:346-351. [PMID: 27821519 DOI: 10.1136/archdischild-2016-311436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/15/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Long-term therapy with phenytoin and carbamazepine is known to cause hyperhomocysteinaemia. We evaluated the prevalence of hyperhomocysteinaemia in North Indian children receiving phenytoin or carbamazepine monotherapy for >6 months duration and the effect of folic acid supplementation on plasma homocysteine. METHODS In this cross-sectional observational study we enrolled consecutive children aged 2-12 years with epilepsy who had received phenytoin or carbamazepine monotherapy for >6 months. Plasma total homocysteine, folic acid, vitamin B12 and antiepileptic drug concentrations were measured. Healthy age- and sex-matched controls were recruited. Children with homocysteine >10.4 µmol/L received folic acid supplementation for 1 month and homocysteine and folic acid concentrations were measured after 1 month follow-up. RESULTS A total of 112 children receiving antiepileptic monotherapy for >6 months were enrolled. Hyperhomocysteinaemia was present in 54 children (90%) receiving phenytoin, 45 children (90%) receiving carbamazepine therapy and 17 (34%) controls (p<0.05). Mean plasma homocysteine concentrations were significantly higher (18.9±10.2 vs 9.1±3 µmol/L) and serum folic acid concentrations (10.04±8.5 ng/ml vs 12.6±4.8 p<0.001) and vitamin B12 concentrations (365±155 pg/mL vs 474±332 pg/mL, p=0.02) were significantly lower in the study group compared with the control group. Duration of antiepileptic drug therapy correlated significantly with elevated homocysteine and reduced folic acid concentrations (p<0.05). Supplementation with folic acid for 1 month led to a reduction in plasma homocysteine concentrations in the study group (from 20.9±10.3 µmol/L to 14.2±8.2 µmol/L, p<0.05). CONCLUSIONS Phenytoin or carbamazepine monotherapy for >6 months duration is associated with hyperhomocysteinaemia in 90% of North Indian children. Elevated homocysteine concentrations were normalised in these children with folic acid supplementation.
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Affiliation(s)
- Saravanan Chandrasekaran
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sooraj Patil
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini Tageja
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Chief unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Angurana SK, Attri SV. Is Vitamin D Deficiency Linked to Critical Illness? Indian Pediatr 2017; 54:160-161. [PMID: 28285297] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Attri SV, Singhi P, Wiwattanadittakul N, Goswami JN, Sankhyan N, Salomons GS, Roullett JB, Hodgeman R, Parviz M, Gibson KM, Pearl PL. Incidence and Geographic Distribution of Succinic Semialdehyde Dehydrogenase (SSADH) Deficiency. JIMD Rep 2016; 34:111-115. [PMID: 27815844 DOI: 10.1007/8904_2016_14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/17/2023] Open
Abstract
The incidence of succinic semialdehyde dehydrogenase (SSADH) deficiency, an autosomal recessive inherited disorder of GABA degradation, is unknown. Upon a recent diagnosis of a new family of affected fraternal twins from the Punjabi ethnic group of India, case ascertainment from the literature and our database was done to determine the number of confirmed cases along with their geographic distribution. The probands presented with global developmental delay, infantile onset epilepsy, and a persistent neurodevelopmental disorder upon diagnosis at 10 years of age with intellectual disability, expressive aphasia, and behavioral problems most prominent for hyperactivity. Gamma-hydroxybutyric aciduria and homozygous ALDH5A1 c.608C>T; p.Pro203Leu mutations were confirmed. Identification of all available individual cases with clinical details available including geographic or ethnic origin revealed 182 patients from 40 countries, with the largest number of patients reported from the USA (24%), Turkey (10%), China (7%), Saudi Arabia (6%), and Germany (5%). This study provides an accounting of all published cases of confirmed SSADH deficiency and provides data useful in planning further studies of this rare inborn error of metabolism.
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Affiliation(s)
| | | | | | | | | | - Gajja S Salomons
- Department of Biological Chemistry, Vrje University, Amsterdam, Netherlands
| | - Jean-Baptiste Roullett
- Experimental and Systems Pharmacology, Washington State University, College of Pharmacy, Spokane, WA, USA
| | - Ryan Hodgeman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mahsa Parviz
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Michael Gibson
- Experimental and Systems Pharmacology, Washington State University, College of Pharmacy, Spokane, WA, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Patil S, Dutta S, Attri SV, Ray P, Kumar P. Serial C reactive protein values predict sensitivity of organisms to empirical antibiotics in neonates: a nested case-control study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F557-F560. [PMID: 27129489 DOI: 10.1136/archdischild-2015-309158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/12/2015] [Accepted: 04/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is common clinical practice to repeat serum C reactive protein (CRP) estimation in the first 48 h after starting empirical antibiotics for neonatal sepsis. The change in CRP is believed to indicate whether the empirical antibiotics are appropriate or not, but there is little evidence to support this practice. METHODS This was a nested case-control study on neonates with suspected sepsis (clinical signs+baseline CRP >10 mg/L). We drew samples for serum CRP at baseline and at 24, 36 and 48 h after starting empirical antibiotics and stored them at -20°C. Those with positive blood cultures were enrolled into two groups: those who had received empirical antibiotics to which the organism was sensitive ('sensitive') and those who had received antibiotics to which the organism was resistant ('resistant'). Stored samples of these subjects were assayed for CRP. Repeated CRP values were compared between groups by mixed linear models. We evaluated change in CRP from baseline as a diagnostic test for identifying empirical use of sensitive antibiotics. RESULTS We enrolled 45 and 44 subjects in 'sensitive' and 'resistant' groups, respectively. In the 'resistant' group, median CRP increased with time but decreased in the 'sensitive' group. Decline in CRP by 48 h identified the use of antibiotics to which the organism was sensitive with 89% sensitivity and 80% specificity. CONCLUSIONS Serial CRP values in the first 48 h of antibiotic therapy help to predict whether the causative organism is sensitive to the empirical antibiotics administered.
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Affiliation(s)
- Sandeep Patil
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Suri D, Pandit RA, Saini AG, Dogra S, Gupta A, Rawat A, Dwivedi I, Masih S, Attri SV. A novel splice acceptor site mutation (IVS11 G > A) of PEPD gene causing prolidase deficiency associated with hyperimmunoglobulinemia E. Gene Reports 2016. [DOI: 10.1016/j.genrep.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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