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Aneja S.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Jain P.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Jain P.,BLK Super Speciality Hospital
Indian Journal of Pediatrics | Year: 2014

Refractory epilepsy, estimated to affect 10–20 % children with epilepsy, can have profound effect on the education, social and cognitive functioning and recreational activities of the child. The definitions are still evolving. A detailed clinical evaluation may reveal an accurate syndromic and etiological diagnosis. The recent advances in neuroimaging and electrophysiology have revolutionized the management of children with refractory epilepsy and supplement the clinical evaluation. Genetic and metabolic evaluation may be indicated in selected cases. The rational use of anti-epileptic drugs, epilepsy surgery and dietary therapies are the mainstay in the management. Various experimental treatment options and pharmacogenetics offer hope for future. © 2014, Dr. K C Chaudhuri Foundation.


Chellamuthu P.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Sharma S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Jain P.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Jain P.,BLK Super Speciality Hospital | And 3 more authors.
Epilepsy Research | Year: 2014

Objectives: This study aimed to test the hypothesis that high-dose prednisolone (4. mg/kg/day) may be more efficacious than usual-dose (2. mg/kg/day) prednisolone for spasm resolution at 14-days in children with infantile spasms. Methods: This was a randomized, open-label-trial conducted at a tertiary-level-hospital from February-2012 to March-2013. Children aged 3-months to 2-years presenting with infantile spasms in clusters (at least 1 cluster/day) with hypsarrhythmia or its variants on EEG were enrolled. The study participants were randomized to receive either high-dose prednisolone (4. mg/kg/day) or the usual-dose (2. mg/kg/day) prednisolone. The primary outcome measure was the proportion of children who achieved spasm freedom for 48-h at day-14 after treatment initiation as per parental reports in both the groups. The adverse effects were also monitored. The study was registered with the clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT01575639). Results: Sixty-three children were randomized into the two groups with comparable baseline characteristics. The proportion of children with spasm cessation on day-14 was significantly higher in the high-dose group as compared to the usual-dose group (51.6% vs. 25%, p= 0.03). The absolute risk reduction was 26.6% (95% confidence interval 11.5-41.7%) with number needed to treat being 4. The adverse effects were comparable in both the groups. Conclusions: High-dose prednisolone (4. mg/kg/d) was more effective than low-dose prednisolone (2. mg/kg/d) in achieving spasm cessation at 14-days (as per parental reports) in children with infantile spasms. © 2014 Elsevier B.V.


Chhapola V.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Kanwal S.K.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Brar R.,ESI Corporation
Annals of Clinical Biochemistry | Year: 2015

Background and objectives: To carry out a cross-sectional survey of the medical literature on laboratory research papers published later than 2012 and available in the common search engines (PubMed, Google Scholar) on the quality of statistical reporting of method comparison studies using Bland–Altman (B-A) analysis. Methods:Fifty clinical studies were identified which had undertaken method comparison of laboratory analytes using B-A. The reporting of B-A was evaluated using a predesigned checklist with following six items:(1) correct representation of x-axis on B-A plot,(2) representation and correct definition of limits of agreement (LOA),(3) reporting of confidence interval (CI) of LOA, (4) comparison of LOA with a priori defined clinical criteria,(5) evaluation of the pattern of the relationship between difference (y-axis) and average (x-axis) and (6) measures of repeatability. Results and interpretation: The x-axis and LOA were presented correctly in 94%, comparison with a priori clinical criteria in 74%, CI reporting in 6%,evaluation of pattern in 28% and repeatability assessment in 38% of studies. Conclusions: There is incomplete reporting of B-A in published clinical studies. Despite its simplicity, B-A appears not to be completely understood by researchers, reviewers and editors of journals. There appear to be differences in the reporting of B-A between laboratory medicine journals and other clinical journals. A uniform reporting of B-A method will enhance the generalizability of results. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


PubMed | University of Verona, BL Kapur BLK Super Speciality Hospital, World Health Organization, Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital and All India Institute of Medical Sciences
Type: | Journal: Epilepsy research | Year: 2016

To explore the existing evidence for anti-convulsant drugs and their routes of administration in treating acute seizures in children and adults when intravenous access is not available.All major databases including Medline via Ovid, PubMed, Cochrane CENTRAL, Embase, and Google Scholar were searched till May 2015. Randomized and quasi-randomized controlled trials comparing two anti-convulsant drugs (at least one comparator being administered through non-intravenous route) for treatment of acute seizures were included.Primary outcome measure was proportion of children with clinical seizure cessation within 10min of drug administration. Secondary outcome measures were time taken to clinical seizure cessation from the time of admission and from the time of drug administration, and incidence of significant adverse effects.Out of the 19,165 citations, 26 studies were finally included. Regarding the primary outcome measure, the quality of evidence was moderate for following 3 comparisons: buccal midazolam being superior to per-rectal diazepam (RR 1.14; 95% CI, 1.06-1.24), intra-nasal lorazepam being same as intravenous lorazepam (RR 1.04; 95% CI, 0.89-1.22) and intramuscular paraldehyde (RR 1.22; 95% CI, 0.99-1.52). The quality of evidence was very-low for 1 comparison: per-rectal lorazepam being superior to per-rectal diazepam (RR 3.17; 95% CI, 1.63-6.14). The quality of evidence was low for following 2 comparisons: sub-lingual lorazepam being inferior to rectal diazepam (RR 0.71; 95% CI, 0.62-0.81), and intranasal midazolam being superior to per-rectal diazepam (RR 1.14; 95% CI, 1.05-1.25). The rest of the comparisons did not show any difference, but the quality of evidence was low to very low. The time to seizure cessation after drug administration was lower in the intravenous group. However, time to seizure cessation after presentation (includes time for drug administration) was lower in the non-intravenous group. Significant adverse effects were infrequently reported and when present, were similar in both the groups.When intravenous access is not available, non-intravenous routes of administration of benzodiazepines should be considered for the control of acute seizures in children/adults. The preference may be guided by availability, expertise and social preference. [PROSPERO No: CRD42015019012].


Chhapola V.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Kanwal S.K.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Shafi O.M.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Kumar V.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital
Indian Journal of Pediatrics | Year: 2014

Objective: To predict factors causing altered sensorium at admission in children with diabetic ketoacidosis (DKA).Methods: This retrospective study was done on 139 children with DKA who presented to Pediatric Emergency of a tertiary care hospital between January 2008 and November 2012. The case records were reviewed and information regarding personal details, clinical features, biochemical parameters and outcome was recorded. Statistical analyses were performed in small STATA version 12. Variables associated with altered sensorium in bivariate analysis (P < 0.05) were selected for inclusion in the multivariable logistic regression model.Results: Mean age was 8.04 ± 4.1 y; Male: Female ratio 0.75:1. The newly diagnosed diabetics were 54.6 % whereas rest were known diabetics. Eighty one percent children in severe DKA, 63 % moderate DKA and 18 % mild DKA had altered sensorium at admission. Univariate analysis revealed significant P values (P < 0.05) for pH and degree of dehydration. Results of final multivariate logistic regression revealed significant P values for pH (for pH 7.1–7.2, AOR-5.47, 95 % CI-1.24–24.1, P = 0.025 and for pH <7.1, AOR-14.19, 95 % CI - 4.13–48.7, P = 0.001) using pH >7.2 as the reference category.Conclusions: Alteration in sensorium in children at initial admission with DKA is associated to low blood pH. ROC curve suggested good discrimination of pH for prediction of altered sensorium. The exact pathophysiologic mechanism of how low pH alters sensorium in DKA is still unknown and requires further studies. © 2014, Dr. K C Chaudhuri Foundation.


Sharma S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Jain P.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital | Aneja S.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
International Journal of Epilepsy | Year: 2014

We report the characteristic EEG findings of an infant with lissencephaly who presented with infantile spasms. © 2014.


Singh R.,Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital
British journal of anaesthesia | Year: 2011

Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. A prospective, randomized, double-blind controlled study in 50 ASA I-II children (34 boys and 16 girls) aged 1-6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 μg kg1 (MB) or clonidine 2 μg kg1 (CB) in bupivacaine 0.2% (1.25 ml kg1) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P<0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P<0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P=0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. Caudal clonidine 2 μg kg1 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 μg kg1 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.


Nirupam N.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Pemde H.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Chandra J.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital
Indian Journal of Hematology and Blood Transfusion | Year: 2014

Spontaneous spinal epidural hematoma (SSEH) is a rare complication in patients of haemophilia. We report the case of a 9-year-old boy with severe haemophilia B who presented with acute abdomen of 5 days duration. Acute onset of neck/back pain,walking impairment and urinary retention has usually been described as symptom complex in SSEH. The hematoma was identified by magnetic resonance imaging of the spinal column. Our case calls attention to recognition of abdominal pain (with no other localizing features) as initial symptom of SSEH and prompt evaluation and management before more overt symptoms of spinal cord compression becomes evident. © 2013, Indian Society of Haematology & Transfusion Medicine.


Singh V.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital | Singhal K.K.,Lady Hardinge Medical College And Associated Kalawati Saran Childrens Hospital
Indian Journal of Pediatrics | Year: 2015

Bronchoscopes have markedly improved the diagnosis as well as therapy in pediatric pulmonary disorders. Two types of bronchoscopes are available; flexible and rigid, with their own advantages and disadvantages. Depending on the clinical need and availability of skills, choice is made between the two. Typically, rigid scopes are largely used by the surgeons (pediatric or otolayngologists) while flexible bronchoscope stays in the domain of the pediatric pulmonologist and intensivists. Rigid scopes may be more versatile than flexible bronchoscopes in removing the foreign bodies from the airway. Flexible bronchoscopes on the other hand can even be introduced through an endotracheal tube. At times, use of both scopes may be required in a given patient for optimal results. Bronchoscopes give us a means to visualize the inside of the airway, which can be very informative for assessing various pathologies affecting the airways. Apart from the visualization of the parts of the airway tree and their structure as well as patency, it can also be used to take tissue biopsy specimens, collect secretions from the airways and bronchoalveolar lavage which can also get cellular elements from the distal alveoli. In the past few decades, more and more instruments are being used for expanding the utility of flexible bronchoscope for interventions ranging from bronchial toilet, foreign body removal, airway stenting and lasers or cryotherapy for airway lesions. The perinatologists have opened up more vistas and thrown newer challenges for using fiberoptic bronchoscopy (FB) for in utero tracheal occlusion in cases with diaphragmatic hernia. The vast applications of this tool makes it very relevant to pulmonary investigations and therapeutics. © 2015, Dr. K C Chaudhuri Foundation.


PubMed | Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital and BL Kapur Super Speciality Hospital
Type: Journal Article | Journal: Annals of Indian Academy of Neurology | Year: 2016

The modified Atkins diet (MAD) has been used predominantly in older children, adolescents, and adults. There is a paucity of data on the use of the MAD in refractory epilepsy in young children.This study was planned to evaluate the efficacy and tolerability of the MAD in refractory epilepsy in young children.This study recruited children aged 9 months to 3 years with refractory seizures. Children received MAD for 6-month with the on-going anticonvulsant medications being continued unchanged. Reduction in seizure frequency was the primary outcome measure. Adverse effects were also studied.Thirty-one children with daily seizures were studied with a median age of 18-month (range 9-30 months). West syndrome was the most common epilepsy syndrome (26, 86.6%). Twenty-one children remained on diet at 3 months and 13 at 6 months. The children who achieved >50% seizure reduction were 17 (54.8%) at 3 months and 9 (29%) at 6 months. Refusal to eat was a significant problem seen in eight children. Three children discontinued the diet due to adverse effects.The MAD was found to be feasible, effective, and well-tolerated.

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