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Papers by Dr Arpita Khemka

Research paper thumbnail of Clinico-laboratory profile, outcome, and risk factors for pediatric intensive care admission among hospitalized COVID-19–infected children from Eastern India

Journal of pediatric critical care, 2022

Background: Children had been affected less by COVID-19 than adults. But as the pandemic progress... more Background: Children had been affected less by COVID-19 than adults. But as the pandemic progressed more cases of severe pediatric COVID infection were reported. Aim of this study is to describe the clinical characteristics, laboratory parameters, treatments, and predictors of pediatric intensive care unit (PICU) admission among hospitalized children with SARS-CoV-2 infection. Subjects and Methods: This was a retrospective, observational study performed in a tertiary care COVID referral hospital among hospitalized children aged from 1 month to 12 years, from May 2020 to March 2021. Children treated in the pediatric ward were compared with those admitted in the PICU to assess predictors of intensive care admission. Results: Out of 447 hospitalized patients with confirmed COVID-19 infection, 92 (20.58%) required admission in the PICU. Mean age of the study population was 44.58 (16.77–72.39) months. Thirty-eight patients (8.50%) fulfilled multisystem inflammatory syndrome in children (MIS-C) diagnostic criteria. Invasive mechanical ventilation and inotropic support were needed for 28.26% and 36.96% of PICU-admitted patients, respectively. The mortality rate was 1.57%. Independent risk factors for PICU admission were infant age group, longer duration of fever (>5 days), shortness of breath, presence of shock, underlying comorbidities and higher pediatric early warning score (PEWS ≥5), poor Glasgow coma scale (GCS <7), MIS-C, elevated C-reactive protein (CRP >50 mg/L), neutrophil–lymphocyte ratio (NLR ≥4.5), and hypoalbuminemia (<2.5 g/dL). Conclusions: Clinical factors such as infancy, prolonged fever, respiratory distress at admission, shock, higher PEWS, poor GCS, and comorbidities indicate at risk for severe disease. Simple laboratory parameters such as CRP, NLR ≥4.5, and albumin may be considered as screening at admission to predict need of PICU care.

Research paper thumbnail of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis: Not a Rare Entity in Pediatric Age Group

Journal of Tropical Pediatrics, 2021

Background Our goal was to study the demographic, clinical and laboratory profile and outcome of ... more Background Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group. Methods We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients. Results Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycl...

Research paper thumbnail of Predictors of Severity of Scrub Typhus in Children Requiring Pediatric Intensive Care Admission

Journal of Pediatric Intensive Care, 2021

Objective of our study was to determine the clinical characteristics and laboratory profile of sc... more Objective of our study was to determine the clinical characteristics and laboratory profile of scrub typhus patients requiring pediatric intensive care admission and to find out risk factors for the severity of illness. This was a cross-sectional observational study conducted on 1-month to 12-year-old children admitted with scrub typhus in a tertiary care pediatric intensive care unit (PICU). Relevant demographic, clinical, laboratory, treatment, and outcome-related data were documented. The severity of the disease was measured in the form of multiple organ dysfunction syndrome (MODS). With further correlation, and univariate and multivariate analyses, factors associated with severe disease were identified. During the study period, out of 586 PICU admission, 62 patients (10.6%) were diagnosed with scrub typhus. The mean age was 63.85 ± 52.78 months, where infants constituted 32.3% of the total population. Fever was present in 100% of the cases. Common indications of PICU admission w...

Research paper thumbnail of Plasma Exchange in Refractory Acute Disseminated Encephalomyelitis Associated with COVID-19: Technical Challenges in a Developing Country

Journal of Pediatric Neurology, 2021

Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diag... more Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diagnostic and therapeutic challenges in pediatric population. Immune-mediated ADS of childhood responds well to steroid and intravenous immunoglobulin (IVIg) and in refractory cases with plasma exchange. Novel coronavirus disease 2019 (COVID-19) coinfection in such cases imposes technical challenges in management. An 11-year-old girl with quadriparesis and loss of vision and a magnetic resonance imaging (MRI) brain showing acute demyelinating encephalomyelitis (ADEM) and cerebrospinal fluid examination being noncontributory responded well with plasma exchange after failing steroid and IVIg is described. Coinfection with COVID-19 mandating personal protection in a temperate country imposed technical challenges in her management.

Research paper thumbnail of Clinicopathological profile and outcome of COVID-19 infection among children and newborn admitted to a dedicated COVID hospital in West Bengal, India

International Journal Of Community Medicine And Public Health, 2020

Background: Aim of the study was to assess the clinicopathological profile and outcome of COVID 1... more Background: Aim of the study was to assess the clinicopathological profile and outcome of COVID 19 infection in children and newborn in a dedicated COVID tertiary care center.Methods: A retrospective study of a cohort of 105 children (1 month-12 years.) and 128 newborns admitted from 7th July to 7th August 2020. All the admitted children were COVID 19 positive and newborns were delivered from mother with COVID positive status. We collected data from medical records regarding epidemiology, clinical features, comorbidities, investigational report, treatment and outcome of the study population.Results: The median age of 105 children was 3 years with IQR (11 months-6 years) with almost equal sex distribution with higher disease prevalence and severity in younger age group. The mean duration of stay is 10.11 days (SD: 4.93). 35 (33.3%) children were asymptomatic, whereas 53 (50.5%) mildly symptomatic, 8 (7.6%) moderate disease severity, 9 (8.6%) critically ill at time of admission. Fever...

Research paper thumbnail of An Unusual Etiology of Cerebellar Ataxia

Child Neurology Open, 2020

Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as... more Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub typhus. Scrub typhus very rarely presents itself with CNS manifestations. Here, we present the case of a 7-year-old girl from the Hooghly district in West Bengal, who presented to us with the history of fever, cerebellar signs, and sudden onset of visual loss. She was ultimately diagnosed with scrub typhus cerebellitis.

Research paper thumbnail of Clinico-laboratory profile, outcome, and risk factors for pediatric intensive care admission among hospitalized COVID-19–infected children from Eastern India

Journal of pediatric critical care, 2022

Background: Children had been affected less by COVID-19 than adults. But as the pandemic progress... more Background: Children had been affected less by COVID-19 than adults. But as the pandemic progressed more cases of severe pediatric COVID infection were reported. Aim of this study is to describe the clinical characteristics, laboratory parameters, treatments, and predictors of pediatric intensive care unit (PICU) admission among hospitalized children with SARS-CoV-2 infection. Subjects and Methods: This was a retrospective, observational study performed in a tertiary care COVID referral hospital among hospitalized children aged from 1 month to 12 years, from May 2020 to March 2021. Children treated in the pediatric ward were compared with those admitted in the PICU to assess predictors of intensive care admission. Results: Out of 447 hospitalized patients with confirmed COVID-19 infection, 92 (20.58%) required admission in the PICU. Mean age of the study population was 44.58 (16.77–72.39) months. Thirty-eight patients (8.50%) fulfilled multisystem inflammatory syndrome in children (MIS-C) diagnostic criteria. Invasive mechanical ventilation and inotropic support were needed for 28.26% and 36.96% of PICU-admitted patients, respectively. The mortality rate was 1.57%. Independent risk factors for PICU admission were infant age group, longer duration of fever (>5 days), shortness of breath, presence of shock, underlying comorbidities and higher pediatric early warning score (PEWS ≥5), poor Glasgow coma scale (GCS <7), MIS-C, elevated C-reactive protein (CRP >50 mg/L), neutrophil–lymphocyte ratio (NLR ≥4.5), and hypoalbuminemia (<2.5 g/dL). Conclusions: Clinical factors such as infancy, prolonged fever, respiratory distress at admission, shock, higher PEWS, poor GCS, and comorbidities indicate at risk for severe disease. Simple laboratory parameters such as CRP, NLR ≥4.5, and albumin may be considered as screening at admission to predict need of PICU care.

Research paper thumbnail of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis: Not a Rare Entity in Pediatric Age Group

Journal of Tropical Pediatrics, 2021

Background Our goal was to study the demographic, clinical and laboratory profile and outcome of ... more Background Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group. Methods We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients. Results Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycl...

Research paper thumbnail of Predictors of Severity of Scrub Typhus in Children Requiring Pediatric Intensive Care Admission

Journal of Pediatric Intensive Care, 2021

Objective of our study was to determine the clinical characteristics and laboratory profile of sc... more Objective of our study was to determine the clinical characteristics and laboratory profile of scrub typhus patients requiring pediatric intensive care admission and to find out risk factors for the severity of illness. This was a cross-sectional observational study conducted on 1-month to 12-year-old children admitted with scrub typhus in a tertiary care pediatric intensive care unit (PICU). Relevant demographic, clinical, laboratory, treatment, and outcome-related data were documented. The severity of the disease was measured in the form of multiple organ dysfunction syndrome (MODS). With further correlation, and univariate and multivariate analyses, factors associated with severe disease were identified. During the study period, out of 586 PICU admission, 62 patients (10.6%) were diagnosed with scrub typhus. The mean age was 63.85 ± 52.78 months, where infants constituted 32.3% of the total population. Fever was present in 100% of the cases. Common indications of PICU admission w...

Research paper thumbnail of Plasma Exchange in Refractory Acute Disseminated Encephalomyelitis Associated with COVID-19: Technical Challenges in a Developing Country

Journal of Pediatric Neurology, 2021

Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diag... more Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diagnostic and therapeutic challenges in pediatric population. Immune-mediated ADS of childhood responds well to steroid and intravenous immunoglobulin (IVIg) and in refractory cases with plasma exchange. Novel coronavirus disease 2019 (COVID-19) coinfection in such cases imposes technical challenges in management. An 11-year-old girl with quadriparesis and loss of vision and a magnetic resonance imaging (MRI) brain showing acute demyelinating encephalomyelitis (ADEM) and cerebrospinal fluid examination being noncontributory responded well with plasma exchange after failing steroid and IVIg is described. Coinfection with COVID-19 mandating personal protection in a temperate country imposed technical challenges in her management.

Research paper thumbnail of Clinicopathological profile and outcome of COVID-19 infection among children and newborn admitted to a dedicated COVID hospital in West Bengal, India

International Journal Of Community Medicine And Public Health, 2020

Background: Aim of the study was to assess the clinicopathological profile and outcome of COVID 1... more Background: Aim of the study was to assess the clinicopathological profile and outcome of COVID 19 infection in children and newborn in a dedicated COVID tertiary care center.Methods: A retrospective study of a cohort of 105 children (1 month-12 years.) and 128 newborns admitted from 7th July to 7th August 2020. All the admitted children were COVID 19 positive and newborns were delivered from mother with COVID positive status. We collected data from medical records regarding epidemiology, clinical features, comorbidities, investigational report, treatment and outcome of the study population.Results: The median age of 105 children was 3 years with IQR (11 months-6 years) with almost equal sex distribution with higher disease prevalence and severity in younger age group. The mean duration of stay is 10.11 days (SD: 4.93). 35 (33.3%) children were asymptomatic, whereas 53 (50.5%) mildly symptomatic, 8 (7.6%) moderate disease severity, 9 (8.6%) critically ill at time of admission. Fever...

Research paper thumbnail of An Unusual Etiology of Cerebellar Ataxia

Child Neurology Open, 2020

Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as... more Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub typhus. Scrub typhus very rarely presents itself with CNS manifestations. Here, we present the case of a 7-year-old girl from the Hooghly district in West Bengal, who presented to us with the history of fever, cerebellar signs, and sudden onset of visual loss. She was ultimately diagnosed with scrub typhus cerebellitis.