Devendra Mishra | University of Delhi (original) (raw)

Papers by Devendra Mishra

Journal of Epilepsy Research, 2021

Background and Purpose: To compare the rates of clinically relevant information provided by elect... more Background and Purpose: To compare the rates of clinically relevant information provided by electroencephalogram (EEG) and magnetic resonance imaging (MRI) brain in first afebrile seizure (FAS) in children.Methods: In this prospective randomized controlled trial, neurologically normal children between the age of 2 and 14 years, presenting with first episode of unprovoked, afebrile generalized or partial seizures, were included. Enrolled patients were randomized into two groups. After stabilization, initial workup and management, group I-patients underwent an EEG followed by MRI, whereas group II-patients underwent an initial MRI brain followed by an EEG. The patients were followed up after results of both the investigations and then every 3 months for seizure recurrence. The primary outcome was the proportion of investigations, providing clinically relevant information. The secondary outcomes were to determine the etiological diagnosis of FAS and record adverse events associated wit...

Indian Pediatrics, 2020

The study aimed to explore the perception and knowledge-gain of undergraduate medical students du... more The study aimed to explore the perception and knowledge-gain of undergraduate medical students during the Medical Council of India-mandated one month foundation course in August, 2019. A total of 129 consenting students who underwent the foundation course were enrolled and their feedback collected using an email-based structured questionnaire. A majority (>60%) had positive attitudes towards various aspects of the course, with good scores obtained in the post-test by the majority of the students. The information reported will assist in the planning of future foundation course programs.

PLoS medicine, 2018

Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and ... more Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% S...

Human vaccines & immunotherapeutics, Jan 16, 2017

Varicella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost ... more Varicella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost 30% of Indian adolescents lack protective antibodies against varicella, emphasising the need of routine varicella immunization. The Oka VZV is a well-established, safe and efficacious vaccine strain that is highly immunogenic and produces lifelong protective immunity. The present multicentric, open label, randomized, controlled Phase II/III study, compared the Bio Pox™ (indigenous investigational vaccine) with a licensed vaccine, Varivax™, for its safety and immunogenicity profile in 252 healthy subjects in the age group of 1-12 years (cohort I: 6-12 years, II:1-6 years) in three tertiary medical institutions. Antibodies were measured by VZV Glycoprotein Enzyme Linked Immunoassay (IgG ELISA) kit. Seroconversion percentage in children having pre-vaccination anti VZV IgG titer <10 mIU/mL (<5 gp ELISA units/mL) were 80% for Bio Pox™ and 77% for Varivax™ (p = 0.692). The seroconversion...

Indian Pediatrics, 2010

L amotrigine, a newer antiepileptic drug (AED), may be used add-on drug for both generalized and ... more L amotrigine, a newer antiepileptic drug (AED), may be used add-on drug for both generalized and partial seizures, and also as the first-line drug for partial seizures [1,2]. The drug has shown to be effective for refractory partial and generalized seizures in children, with a low incidence of side-effects [3-5]. In India, the drug has been in clinical use since 2002, but scant data are available about the clinical use of lamotrigine in Indian children [6]. We ascertained the effectiveness and safety of lamotrigine as an addon drug for epilepsy in Indian children. METHODS The study was conducted from January to October 2009 at the Pediatric Neurology Clinic of a tertiarycare hospital attached to a medical college in North India. All children under 14 years (except one patient of 16 years), attending the Clinic and already receiving lamotrigine were retrospectively enrolled (n=14), after written informed consent. Children started on lamotrigine therapy between January to April 2009 were also enrolled prospectively (n=6). Decision regarding starting lamotrigine in patients not responding to the first-line AEDs was taken by a clinician not directly involved with the study. All data were entered in a pre-tested structured proforma. Neuroimaging (CT and/or MRI) and electroencephalography were available for most children. All children at the clinic undergo a comprehensive evaluation and management by a team consisting of developmental pediatricians, speech therapist, occupational-and physiotherapists, child psychologists and special educators. No additional investigations were done as part of the study. Seizure type and frequency during the study were recorded using a seizure log filled by the parents or caretakers. Information about previous seizures was obtained from records available with the parents.

Indian Pediatrics, 2021

G lobally, injuries and violence are major public health problems. Children are at a higher risk ... more G lobally, injuries and violence are major public health problems. Children are at a higher risk for injuries due to their physical and psychological attributes. Their small body size and the softness of tissues lead to greater vulnerability for severe impact. Children's risk perception is limited, making them more susceptible to involvement in road accidents, drowning, burns, and poisoning. Psychological characteristics of children like impulsiveness, curiosity, experimentation, an inadequate judgment of distance/speed, and low levels of concentration make them vulnerable to injuries [1].

International Journal of Contemporary Pediatrics, 2021

Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 d... more Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted ...

Indian Pediatrics, 2010

Pediatricians are usually the first point of contact of children with the health system. Studies ... more Pediatricians are usually the first point of contact of children with the health system. Studies worldwide have shown that there is insufficient knowledge about child abuse recognition and management among health workers. Presently no uniform guidelines exist in India for pediatricians regarding the appropriate response to child abuse. Process: As part of the Child Rights and Protection Programme (CRPP) under IAP VISION 2007 of Indian Academy of Pediatrics, a 'Training of Trainers (TOT) Workshop on Child Rights and Protection' was held in Mumbai in January 2007. It was attended by participants from all over the country. The workshop recommended 'developing country-specific teaching and training material'. A Task force of IAP CRPP was formed and it developed a module for 'Training of Trainers Workshops for Pediatricians'. A National Consultative Meet was held in October, 2007 at New Delhi, where the program was discussed and ratified. Objectives: To train pediatricians to: recognize and respond to child abuse; engage in a multidisciplinary networking mode to deal with child abuse; and, document, record and report instances of child abuse. Recommendations: Guidelines for recognition and management of child abuse are presented. All pediatricians should assess suspected harm with the same thoroughness and attention as they would do with a life threatening condition. Poor management after disclosure can increase psychological damage. Pediatrician should believe, support, reassure, treat and ensure rehabilitation of victims of child abuse, keeping the best interest of the child as the primary goal.

Archives of Disease in Childhood, 2001

Indian Journal of Child Health, 2014

Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta i... more Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta is rare with involvement of aortic root being very uncommon. The diagnosis depends on a combination of clinical criteria, including persistent fever and bacteraemia and echocardiographic confirmation. Because of the rarity of aortic root abscess in children, there is no consensus on a treatment strategy. We describe a 10-year-old male who presented with fever, abdominal pain and headache, and was found to have disseminated tuberculosis and aortic root abscess with mycotic aneurysm. Due to the presence of evidence of tuberculosis elsewhere in the body (multiple tuberculomas in brain, granulomas in liver, lichen scrofulosorum over abdomen), therapy with antituberculous drugs was started to which the patient responded partially, but later died suddenly at home.

Journal of Epilepsy Research, 2019

Background and Purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indi... more Background and Purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indian children. This research was conducted to study the clinico-etiological profiles and short-term outcomes of children aged 1 month to 12 years with convulsive RSE, at a public hospital. Methods: The study was conducted between 1st April 2016 and 28th February 2017 after receiving clearance from an Institutional Ethics Committee. All children (aged 1 month to 12 years) who presented to the pediatrics department of a tertiary-care public hospital with convulsive status epilepticus (SE), or who developed SE during their hospital stay, were enrolled. All patients were investigated and managed according to a standard protocol. Outcomes were assessed based on the Glasgow Outcome Scale. Details of children who progressed to RSE were compared to those without RSE. Results: Fifty children (28 males) with CSE were enrolled, of which 20 (40%) progressed to RSE. Central nervous system (CNS) infection was the most common etiology (53% in SE and 55% in RSE, p > 0.05). Non-compliance with anti-epileptic drugs was the second most common etiology. The overall mortality rate was 38%, and although the odds of death in RSE (50%) were higher than in SE (30%), this difference was not statistically significant (p = 0.15). The odds of having a poor outcome was six times higher in children with RSE as compared to those with SE (odds ratio, 6.0; 95% confidence interval, 1.6-22.3; p = 0.005). Conclusions: When managing CNS infections, pediatricians need to be aware of the high risk of developing RSE. In addition, the possibility of RSE should be considered and managed promptly in an intensive-care setting, to reduce the mortality and morbidity of this severe neurological condition.

Indian pediatrics, Jan 8, 2016

We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary care ho... more We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary care hospital in New Delhi, India. Clinical and biochemical work-up for etiology, and electroencephalography were performed in all infants. Developmental assessment was done 3-month after discharge. 72% had generalized seizures, and fever was the commonest co-morbidity (57.3%). 68% had provoked seizures, mainly due to hypocalcemia (34.3%) or neuro-infections (29.3%). Seven (9.3%) infants died during hospital stay; mostly those with neuro-infections. 13 (20.3%) infants had developmental delay.

Indian Pediatrics, 2015

Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for n... more Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for neurodevelopmental delay, but scant Indian data are available. Objective: To evaluate the neurodevelopmental status of children with CHD. Methods: We enrolled consecutive children aged 6-30 months with echocardiographically-confirmed CHD between June 2013 and January 2014. Children with clinically recognizable genetic syndromes or disorders; visual and/or hearing deficits, and microcephaly; and post-cardiac surgery children were excluded. Development was assessed by Developmental Assessment Scale for Indian Infants (DASII) and Developmental delay defined as Development Quotient (DQ) <70 in either the mental or motor scale. Results: 75 children (53 males) with CHD were enrolled. Acyanotic CHD was seen in 51 children (VSD in 47%), and Tetralogy of Fallot was the commonest cyanotic CHD (25%). Developmental delay was seen in 25% of these children, more in the motor domain (48%) than in mental (12%). Mean motor and mental DQ in acyanotic CHD was 77 and 84, respectively; and 65 and 85, respectively in cyanotic CHD. Mean motor DQ was significantly less than mental DQ in both acyanotic and cyanotic CHD children (P=0.048). Conclusion: Children with CHD are at an increased risk for developmental delay. Periodic surveillance, screening and evaluation should be instituted in them for early identification and appropriate interventions to enhance later academic, behavioral, psycho-social and adaptive function.

Oxford Medical Case Reports, 2014

Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitt... more Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sandfly Phlebotomus argentipes. The protozoa is obliged intracellularly and causes a wide spectrum of clinical syndromes: VL ('kala azar'), cutaneous leishmaniasis and mucocutaneous leishmaniasis (espundia). Kala azar is the most aggressive form and if untreated causes high mortality. Here, we describe a case of VL that presented to us with high-grade fever and found to have Roth spots that were resolved after 15 days of therapy.

Indian Pediatrics, 2015

Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant h... more Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant had classic Kawasaki disease with transient coronary artery dilatation. Observations: Recurrence of incomplete Kawasaki disease after two years of initial diagnosis. Outcome: The index episode of Kawasaki disease was resistant to single infusion of immunoglobulin, while repeat episode responded within 24 hours of institution of therapy. Message: Early recognition of recurrent Kawasaki disease requires a high index of suspicion.

Journal of clinical and diagnostic research : JCDR, 2014

Kawasaki disease (KD), is the leading cause of acquired heart disease in children in the develope... more Kawasaki disease (KD), is the leading cause of acquired heart disease in children in the developed world. The use of aspirin and intravenous immunoglobulin as the initial therapy in KD is the standard of care, as they reduce the incidence of coronary artery aneurysms, the major cardiac morbidity from this disease. The place of corticosteroids in the initial therapy is; however, controversial. We describe the course of a one-year-old child with Kawasaki disease who was treated with aspirin and corticosteroids as the initial therapy, and discuss pertinent issues.

The Indian Journal of Pediatrics, 2014

Journal of Epilepsy Research, 2021

Background and Purpose: To compare the rates of clinically relevant information provided by elect... more Background and Purpose: To compare the rates of clinically relevant information provided by electroencephalogram (EEG) and magnetic resonance imaging (MRI) brain in first afebrile seizure (FAS) in children.Methods: In this prospective randomized controlled trial, neurologically normal children between the age of 2 and 14 years, presenting with first episode of unprovoked, afebrile generalized or partial seizures, were included. Enrolled patients were randomized into two groups. After stabilization, initial workup and management, group I-patients underwent an EEG followed by MRI, whereas group II-patients underwent an initial MRI brain followed by an EEG. The patients were followed up after results of both the investigations and then every 3 months for seizure recurrence. The primary outcome was the proportion of investigations, providing clinically relevant information. The secondary outcomes were to determine the etiological diagnosis of FAS and record adverse events associated wit...

Indian Pediatrics, 2020

The study aimed to explore the perception and knowledge-gain of undergraduate medical students du... more The study aimed to explore the perception and knowledge-gain of undergraduate medical students during the Medical Council of India-mandated one month foundation course in August, 2019. A total of 129 consenting students who underwent the foundation course were enrolled and their feedback collected using an email-based structured questionnaire. A majority (>60%) had positive attitudes towards various aspects of the course, with good scores obtained in the post-test by the majority of the students. The information reported will assist in the planning of future foundation course programs.

PLoS medicine, 2018

Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and ... more Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% S...

Human vaccines & immunotherapeutics, Jan 16, 2017

Varicella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost ... more Varicella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost 30% of Indian adolescents lack protective antibodies against varicella, emphasising the need of routine varicella immunization. The Oka VZV is a well-established, safe and efficacious vaccine strain that is highly immunogenic and produces lifelong protective immunity. The present multicentric, open label, randomized, controlled Phase II/III study, compared the Bio Pox™ (indigenous investigational vaccine) with a licensed vaccine, Varivax™, for its safety and immunogenicity profile in 252 healthy subjects in the age group of 1-12 years (cohort I: 6-12 years, II:1-6 years) in three tertiary medical institutions. Antibodies were measured by VZV Glycoprotein Enzyme Linked Immunoassay (IgG ELISA) kit. Seroconversion percentage in children having pre-vaccination anti VZV IgG titer <10 mIU/mL (<5 gp ELISA units/mL) were 80% for Bio Pox™ and 77% for Varivax™ (p = 0.692). The seroconversion...

Indian Pediatrics, 2010

L amotrigine, a newer antiepileptic drug (AED), may be used add-on drug for both generalized and ... more L amotrigine, a newer antiepileptic drug (AED), may be used add-on drug for both generalized and partial seizures, and also as the first-line drug for partial seizures [1,2]. The drug has shown to be effective for refractory partial and generalized seizures in children, with a low incidence of side-effects [3-5]. In India, the drug has been in clinical use since 2002, but scant data are available about the clinical use of lamotrigine in Indian children [6]. We ascertained the effectiveness and safety of lamotrigine as an addon drug for epilepsy in Indian children. METHODS The study was conducted from January to October 2009 at the Pediatric Neurology Clinic of a tertiarycare hospital attached to a medical college in North India. All children under 14 years (except one patient of 16 years), attending the Clinic and already receiving lamotrigine were retrospectively enrolled (n=14), after written informed consent. Children started on lamotrigine therapy between January to April 2009 were also enrolled prospectively (n=6). Decision regarding starting lamotrigine in patients not responding to the first-line AEDs was taken by a clinician not directly involved with the study. All data were entered in a pre-tested structured proforma. Neuroimaging (CT and/or MRI) and electroencephalography were available for most children. All children at the clinic undergo a comprehensive evaluation and management by a team consisting of developmental pediatricians, speech therapist, occupational-and physiotherapists, child psychologists and special educators. No additional investigations were done as part of the study. Seizure type and frequency during the study were recorded using a seizure log filled by the parents or caretakers. Information about previous seizures was obtained from records available with the parents.

Indian Pediatrics, 2021

G lobally, injuries and violence are major public health problems. Children are at a higher risk ... more G lobally, injuries and violence are major public health problems. Children are at a higher risk for injuries due to their physical and psychological attributes. Their small body size and the softness of tissues lead to greater vulnerability for severe impact. Children's risk perception is limited, making them more susceptible to involvement in road accidents, drowning, burns, and poisoning. Psychological characteristics of children like impulsiveness, curiosity, experimentation, an inadequate judgment of distance/speed, and low levels of concentration make them vulnerable to injuries [1].

International Journal of Contemporary Pediatrics, 2021

Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 d... more Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted ...

Indian Pediatrics, 2010

Pediatricians are usually the first point of contact of children with the health system. Studies ... more Pediatricians are usually the first point of contact of children with the health system. Studies worldwide have shown that there is insufficient knowledge about child abuse recognition and management among health workers. Presently no uniform guidelines exist in India for pediatricians regarding the appropriate response to child abuse. Process: As part of the Child Rights and Protection Programme (CRPP) under IAP VISION 2007 of Indian Academy of Pediatrics, a 'Training of Trainers (TOT) Workshop on Child Rights and Protection' was held in Mumbai in January 2007. It was attended by participants from all over the country. The workshop recommended 'developing country-specific teaching and training material'. A Task force of IAP CRPP was formed and it developed a module for 'Training of Trainers Workshops for Pediatricians'. A National Consultative Meet was held in October, 2007 at New Delhi, where the program was discussed and ratified. Objectives: To train pediatricians to: recognize and respond to child abuse; engage in a multidisciplinary networking mode to deal with child abuse; and, document, record and report instances of child abuse. Recommendations: Guidelines for recognition and management of child abuse are presented. All pediatricians should assess suspected harm with the same thoroughness and attention as they would do with a life threatening condition. Poor management after disclosure can increase psychological damage. Pediatrician should believe, support, reassure, treat and ensure rehabilitation of victims of child abuse, keeping the best interest of the child as the primary goal.

Archives of Disease in Childhood, 2001

Indian Journal of Child Health, 2014

Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta i... more Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta is rare with involvement of aortic root being very uncommon. The diagnosis depends on a combination of clinical criteria, including persistent fever and bacteraemia and echocardiographic confirmation. Because of the rarity of aortic root abscess in children, there is no consensus on a treatment strategy. We describe a 10-year-old male who presented with fever, abdominal pain and headache, and was found to have disseminated tuberculosis and aortic root abscess with mycotic aneurysm. Due to the presence of evidence of tuberculosis elsewhere in the body (multiple tuberculomas in brain, granulomas in liver, lichen scrofulosorum over abdomen), therapy with antituberculous drugs was started to which the patient responded partially, but later died suddenly at home.

Journal of Epilepsy Research, 2019

Background and Purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indi... more Background and Purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indian children. This research was conducted to study the clinico-etiological profiles and short-term outcomes of children aged 1 month to 12 years with convulsive RSE, at a public hospital. Methods: The study was conducted between 1st April 2016 and 28th February 2017 after receiving clearance from an Institutional Ethics Committee. All children (aged 1 month to 12 years) who presented to the pediatrics department of a tertiary-care public hospital with convulsive status epilepticus (SE), or who developed SE during their hospital stay, were enrolled. All patients were investigated and managed according to a standard protocol. Outcomes were assessed based on the Glasgow Outcome Scale. Details of children who progressed to RSE were compared to those without RSE. Results: Fifty children (28 males) with CSE were enrolled, of which 20 (40%) progressed to RSE. Central nervous system (CNS) infection was the most common etiology (53% in SE and 55% in RSE, p > 0.05). Non-compliance with anti-epileptic drugs was the second most common etiology. The overall mortality rate was 38%, and although the odds of death in RSE (50%) were higher than in SE (30%), this difference was not statistically significant (p = 0.15). The odds of having a poor outcome was six times higher in children with RSE as compared to those with SE (odds ratio, 6.0; 95% confidence interval, 1.6-22.3; p = 0.005). Conclusions: When managing CNS infections, pediatricians need to be aware of the high risk of developing RSE. In addition, the possibility of RSE should be considered and managed promptly in an intensive-care setting, to reduce the mortality and morbidity of this severe neurological condition.

Indian pediatrics, Jan 8, 2016

We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary care ho... more We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary care hospital in New Delhi, India. Clinical and biochemical work-up for etiology, and electroencephalography were performed in all infants. Developmental assessment was done 3-month after discharge. 72% had generalized seizures, and fever was the commonest co-morbidity (57.3%). 68% had provoked seizures, mainly due to hypocalcemia (34.3%) or neuro-infections (29.3%). Seven (9.3%) infants died during hospital stay; mostly those with neuro-infections. 13 (20.3%) infants had developmental delay.

Indian Pediatrics, 2015

Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for n... more Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for neurodevelopmental delay, but scant Indian data are available. Objective: To evaluate the neurodevelopmental status of children with CHD. Methods: We enrolled consecutive children aged 6-30 months with echocardiographically-confirmed CHD between June 2013 and January 2014. Children with clinically recognizable genetic syndromes or disorders; visual and/or hearing deficits, and microcephaly; and post-cardiac surgery children were excluded. Development was assessed by Developmental Assessment Scale for Indian Infants (DASII) and Developmental delay defined as Development Quotient (DQ) <70 in either the mental or motor scale. Results: 75 children (53 males) with CHD were enrolled. Acyanotic CHD was seen in 51 children (VSD in 47%), and Tetralogy of Fallot was the commonest cyanotic CHD (25%). Developmental delay was seen in 25% of these children, more in the motor domain (48%) than in mental (12%). Mean motor and mental DQ in acyanotic CHD was 77 and 84, respectively; and 65 and 85, respectively in cyanotic CHD. Mean motor DQ was significantly less than mental DQ in both acyanotic and cyanotic CHD children (P=0.048). Conclusion: Children with CHD are at an increased risk for developmental delay. Periodic surveillance, screening and evaluation should be instituted in them for early identification and appropriate interventions to enhance later academic, behavioral, psycho-social and adaptive function.

Oxford Medical Case Reports, 2014

Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitt... more Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sandfly Phlebotomus argentipes. The protozoa is obliged intracellularly and causes a wide spectrum of clinical syndromes: VL ('kala azar'), cutaneous leishmaniasis and mucocutaneous leishmaniasis (espundia). Kala azar is the most aggressive form and if untreated causes high mortality. Here, we describe a case of VL that presented to us with high-grade fever and found to have Roth spots that were resolved after 15 days of therapy.

Indian Pediatrics, 2015

Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant h... more Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant had classic Kawasaki disease with transient coronary artery dilatation. Observations: Recurrence of incomplete Kawasaki disease after two years of initial diagnosis. Outcome: The index episode of Kawasaki disease was resistant to single infusion of immunoglobulin, while repeat episode responded within 24 hours of institution of therapy. Message: Early recognition of recurrent Kawasaki disease requires a high index of suspicion.

Journal of clinical and diagnostic research : JCDR, 2014

Kawasaki disease (KD), is the leading cause of acquired heart disease in children in the develope... more Kawasaki disease (KD), is the leading cause of acquired heart disease in children in the developed world. The use of aspirin and intravenous immunoglobulin as the initial therapy in KD is the standard of care, as they reduce the incidence of coronary artery aneurysms, the major cardiac morbidity from this disease. The place of corticosteroids in the initial therapy is; however, controversial. We describe the course of a one-year-old child with Kawasaki disease who was treated with aspirin and corticosteroids as the initial therapy, and discuss pertinent issues.

The Indian Journal of Pediatrics, 2014