Ebor Jacob James - Academia.edu (original) (raw)

Papers by Ebor Jacob James

Journal of Clinical and Experimental Hepatology

International Journal of Contemporary Pediatrics

Double aortic arch is a rare congenital disorder. Symptoms arises due to compression of trachea o... more Double aortic arch is a rare congenital disorder. Symptoms arises due to compression of trachea or esophagus. Its presentation varies from asymptomatic cases to life threatening respiratory distress. Clinical diagnosis is often difficult due to presence of wide verities of symptoms. We described a three-month-old child presented with wheezing and severe respiratory distress and found to have double aortic arch.

Journal of Clinical and Experimental Hepatology

Frontiers in Pediatrics

IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-i... more IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.Materials and MethodsWe conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed o...

Indian Journal of Critical Care Medicine

Background: To describe the clinical profile, risk factors, and outcomes that are associated with... more Background: To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods: A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results: Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions: The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC).

Indian Pediatrics, 2021

Objectives: To compare the clinical profile, treatment, and outcomes of PCR-positive and PCR-nega... more Objectives: To compare the clinical profile, treatment, and outcomes of PCR-positive and PCR-negative antibody-positive critically ill children with multisystem inflammatory syndrome (MIS-C). Methods: This retrospective observational study was done at a tertiary care coronavirus disease 19 (COVID-19) pediatric intensive care unit in India. The baseline characteristics, clinical profile, treatment, and outcomes in seventeen critically ill children diagnosed with MIS-C were analyzed from 1 July to 31 October, 2020. Results: Sixteen out of 17 children presented with hypotensive shock and respiratory distress. Mean (SD) age of PCR-negative antibody-positive and PCR-positive children was 11 (4.4) and 5 (3.7) years, respectively (P=0.007). The former group had significantly higher mean (SD) D-dimer levels [16,651 (14859) ng/mL vs 3082 (2591) ng/mL; P=0.02]. All received intensive care management and steroid therapy; 7 children received intravenous immunoglobulin. 14 children survived and 3 died. Conclusions: The outcome of children with MIS-C was good if recognized early and received intensive care.

Journal of Pediatric Critical Care, 2020

Background: Pediatric (especially preadolescent) asphyxiation secondary to near hanging is a seld... more Background: Pediatric (especially preadolescent) asphyxiation secondary to near hanging is a seldom reported entity and tends to be predominantly accidental in nature. Objective: The objective of the study was to assess and report the course during the intensive care unit (ICU) stay and the unique problems that are pertinent to pediatric near-hanging injuries. Methodology: A 10-year retrospective analysis (2009–2019) was conducted after obtaining ethical approval. Results: Eleven patients presented to our pediatric ICU over the past 10 years, with pediatric asphyxiation secondary to near hanging. Among these children, most of them had saree swing as the mode of hanging; this subgroup had a higher morbidity and mortality. They tend to have higher markers of myocardial ischemia (high troponin T and creatine kinase). About half of the patients required fluid boluses, inotropic requirement, and ventilation at admission. Patients with pulmonary edema tended to have low oxygen saturation (SpO2), even without respiratory distress at admission, and higher ventilator and inotropic requirement. Only half of the patient population admitted were discharged with good neurological outcome (Glasgow Coma Scale: 15/15 at discharge). Conclusion: The nature of complications secondary to hanging necessitates ICU monitoring, with pediatric ENT and anesthesia backup. The presence of low SpO2at admission in this setting should alert the clinician to possibility of pulmonary edema. Parents should be made aware that saree swing can lead to accidental asphyxiation. It is important to raise awareness to prevent this entity as it is associated with poor outcome.

Indian Journal of Medical Microbiology, 2019

Burkholderia cepacia complex (Bcc) is a group of aerobic, non-fermenting Gram-negative bacilli (N... more Burkholderia cepacia complex (Bcc) is a group of aerobic, non-fermenting Gram-negative bacilli (NFGNB) comprising at least 20 species that are phenotypically similar and genetically distinct. [1,2] It is widely distributed in the environment and isolated from water, soil, vegetables and fruits. [3-5] Although an organism of low virulence, it is known to colonise and cause necrotising pneumonia in patients with cystic fibrosis and chronic granulomatous disease. [6] In the past two decades, Bcc has emerged as an important nosocomial pathogen in immunocompromised patients and caused several outbreaks, especially in intensive care units (ICUs). [4] The spectrum of infections caused by Bcc is bloodstream infections, pneumonia, urinary tract infections, septic arthritis and peritonitis. [6,7] Its ability to grow in nutrient-poor water and survive in disinfectants accounts for Bcc outbreaks in hospitals. Like other NFGNB, Bcc is also a multidrug-resistant organism, intrinsically resistant to polymyxins, aminoglycosides, first-and second-generation cephalosporins and antipseudomonal penicillins. [8] Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia are the three most important NFGNB that cause hospital-acquired Purpose: Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India. Materials and Methods: Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis. Results: Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures. Conclusion: This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.

Critical Care Medicine, 2019

Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

World Journal of Surgery, 2019

Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in ... more Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low-and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles. Methods Three global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships. Results GICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second-and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care. Conclusion Worldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children. Defining the need Surgical burden of disease Since the conclusion of the United Nations' Millennium Development Goals (MDGs) and through the ongoing work toward Sustainable Development Goals (SDGs), tremendous progress has been made toward reducing childhood mortality [1, 2]. However, the care of children with surgical diseases remains an underappreciated and underfunded area in health care, despite congenital Collaborating members are listed in the Acknowledgments.

Current Medical Issues, 2017

Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. C... more Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. Children, especially those under 2 years of age and those with comorbid illnesses are particularly vulnerable. A small percentage of individuals with the infection may develop features of severe dengue (SD) which is potentially life threatening. Warning signs often precede the development of SD. The recognition of symptoms of SD fever and optimal fluid management are key factors in the treatment of this illness.

BMJ case reports, Jan 11, 2016

Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressi... more Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbre...

Pediatric Critical Care Medicine, 2014

Pediatric Critical Care Medicine, 2014

Journal of Pediatric Surgery, 2014

We will discuss a new initiative of the American College of Surgeons and the American Pediatric S... more We will discuss a new initiative of the American College of Surgeons and the American Pediatric Surgical Association to prospectively define optimal resource standards for children's surgical care.

Indian Pediatrics, 2011

T he incidence of ventilator-associated pneumonia (VAP) in pediatric patients varies from 5.1%-33... more T he incidence of ventilator-associated pneumonia (VAP) in pediatric patients varies from 5.1%-33.3% [1-3]. Acinetobacter has emerged as a common causative agent of nosocomial infections, particularly VAP [4-6]. Originally thought to be lowgrade pathogen contaminating the hospital environment, with its inherent ability to survive in diverse reservoirs and develop resistance to disinfectants and antimicrobials, it has transformed into an emerging, multidrug-resistant nosocomial pathogen [7]. We report an outbreak, subsequent identification of source and control of VAP caused by carbapenemresistant Acinetobacter baumannii in 6 infants admitted to the pediatric intensive care unit (PICU). METHODS The outbreak occurred between 18th September to 10 th October 2008 at the PICU, which annually admits over 1200 children up to 15 years of age.

Indian Journal of Critical Care Medicine, 2014

Acquired methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing... more Acquired methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing agents and drugs. Although parents may not give any history of toxin ingestion; with the aid of pulse-oximetry and blood gas analysis, we can diagnose methemoglobinemia. Prompt recognition of this condition is required in emergency situations to institute early methylene blue therapy. We report an unusual case of severe toxic methemoglobinemia, which did not respond to methylene blue, but was successfully managed with exchange transfusion.

Journal of Clinical and Experimental Hepatology

International Journal of Contemporary Pediatrics

Double aortic arch is a rare congenital disorder. Symptoms arises due to compression of trachea o... more Double aortic arch is a rare congenital disorder. Symptoms arises due to compression of trachea or esophagus. Its presentation varies from asymptomatic cases to life threatening respiratory distress. Clinical diagnosis is often difficult due to presence of wide verities of symptoms. We described a three-month-old child presented with wheezing and severe respiratory distress and found to have double aortic arch.

Journal of Clinical and Experimental Hepatology

Frontiers in Pediatrics

IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-i... more IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.Materials and MethodsWe conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed o...

Indian Journal of Critical Care Medicine

Background: To describe the clinical profile, risk factors, and outcomes that are associated with... more Background: To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods: A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results: Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions: The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC).

Indian Pediatrics, 2021

Objectives: To compare the clinical profile, treatment, and outcomes of PCR-positive and PCR-nega... more Objectives: To compare the clinical profile, treatment, and outcomes of PCR-positive and PCR-negative antibody-positive critically ill children with multisystem inflammatory syndrome (MIS-C). Methods: This retrospective observational study was done at a tertiary care coronavirus disease 19 (COVID-19) pediatric intensive care unit in India. The baseline characteristics, clinical profile, treatment, and outcomes in seventeen critically ill children diagnosed with MIS-C were analyzed from 1 July to 31 October, 2020. Results: Sixteen out of 17 children presented with hypotensive shock and respiratory distress. Mean (SD) age of PCR-negative antibody-positive and PCR-positive children was 11 (4.4) and 5 (3.7) years, respectively (P=0.007). The former group had significantly higher mean (SD) D-dimer levels [16,651 (14859) ng/mL vs 3082 (2591) ng/mL; P=0.02]. All received intensive care management and steroid therapy; 7 children received intravenous immunoglobulin. 14 children survived and 3 died. Conclusions: The outcome of children with MIS-C was good if recognized early and received intensive care.

Journal of Pediatric Critical Care, 2020

Background: Pediatric (especially preadolescent) asphyxiation secondary to near hanging is a seld... more Background: Pediatric (especially preadolescent) asphyxiation secondary to near hanging is a seldom reported entity and tends to be predominantly accidental in nature. Objective: The objective of the study was to assess and report the course during the intensive care unit (ICU) stay and the unique problems that are pertinent to pediatric near-hanging injuries. Methodology: A 10-year retrospective analysis (2009–2019) was conducted after obtaining ethical approval. Results: Eleven patients presented to our pediatric ICU over the past 10 years, with pediatric asphyxiation secondary to near hanging. Among these children, most of them had saree swing as the mode of hanging; this subgroup had a higher morbidity and mortality. They tend to have higher markers of myocardial ischemia (high troponin T and creatine kinase). About half of the patients required fluid boluses, inotropic requirement, and ventilation at admission. Patients with pulmonary edema tended to have low oxygen saturation (SpO2), even without respiratory distress at admission, and higher ventilator and inotropic requirement. Only half of the patient population admitted were discharged with good neurological outcome (Glasgow Coma Scale: 15/15 at discharge). Conclusion: The nature of complications secondary to hanging necessitates ICU monitoring, with pediatric ENT and anesthesia backup. The presence of low SpO2at admission in this setting should alert the clinician to possibility of pulmonary edema. Parents should be made aware that saree swing can lead to accidental asphyxiation. It is important to raise awareness to prevent this entity as it is associated with poor outcome.

Indian Journal of Medical Microbiology, 2019

Burkholderia cepacia complex (Bcc) is a group of aerobic, non-fermenting Gram-negative bacilli (N... more Burkholderia cepacia complex (Bcc) is a group of aerobic, non-fermenting Gram-negative bacilli (NFGNB) comprising at least 20 species that are phenotypically similar and genetically distinct. [1,2] It is widely distributed in the environment and isolated from water, soil, vegetables and fruits. [3-5] Although an organism of low virulence, it is known to colonise and cause necrotising pneumonia in patients with cystic fibrosis and chronic granulomatous disease. [6] In the past two decades, Bcc has emerged as an important nosocomial pathogen in immunocompromised patients and caused several outbreaks, especially in intensive care units (ICUs). [4] The spectrum of infections caused by Bcc is bloodstream infections, pneumonia, urinary tract infections, septic arthritis and peritonitis. [6,7] Its ability to grow in nutrient-poor water and survive in disinfectants accounts for Bcc outbreaks in hospitals. Like other NFGNB, Bcc is also a multidrug-resistant organism, intrinsically resistant to polymyxins, aminoglycosides, first-and second-generation cephalosporins and antipseudomonal penicillins. [8] Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia are the three most important NFGNB that cause hospital-acquired Purpose: Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India. Materials and Methods: Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis. Results: Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures. Conclusion: This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.

Critical Care Medicine, 2019

Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

World Journal of Surgery, 2019

Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in ... more Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low-and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles. Methods Three global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships. Results GICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second-and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care. Conclusion Worldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children. Defining the need Surgical burden of disease Since the conclusion of the United Nations' Millennium Development Goals (MDGs) and through the ongoing work toward Sustainable Development Goals (SDGs), tremendous progress has been made toward reducing childhood mortality [1, 2]. However, the care of children with surgical diseases remains an underappreciated and underfunded area in health care, despite congenital Collaborating members are listed in the Acknowledgments.

Current Medical Issues, 2017

Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. C... more Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. Children, especially those under 2 years of age and those with comorbid illnesses are particularly vulnerable. A small percentage of individuals with the infection may develop features of severe dengue (SD) which is potentially life threatening. Warning signs often precede the development of SD. The recognition of symptoms of SD fever and optimal fluid management are key factors in the treatment of this illness.

BMJ case reports, Jan 11, 2016

Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressi... more Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbre...

Pediatric Critical Care Medicine, 2014

Pediatric Critical Care Medicine, 2014

Journal of Pediatric Surgery, 2014

We will discuss a new initiative of the American College of Surgeons and the American Pediatric S... more We will discuss a new initiative of the American College of Surgeons and the American Pediatric Surgical Association to prospectively define optimal resource standards for children's surgical care.

Indian Pediatrics, 2011

T he incidence of ventilator-associated pneumonia (VAP) in pediatric patients varies from 5.1%-33... more T he incidence of ventilator-associated pneumonia (VAP) in pediatric patients varies from 5.1%-33.3% [1-3]. Acinetobacter has emerged as a common causative agent of nosocomial infections, particularly VAP [4-6]. Originally thought to be lowgrade pathogen contaminating the hospital environment, with its inherent ability to survive in diverse reservoirs and develop resistance to disinfectants and antimicrobials, it has transformed into an emerging, multidrug-resistant nosocomial pathogen [7]. We report an outbreak, subsequent identification of source and control of VAP caused by carbapenemresistant Acinetobacter baumannii in 6 infants admitted to the pediatric intensive care unit (PICU). METHODS The outbreak occurred between 18th September to 10 th October 2008 at the PICU, which annually admits over 1200 children up to 15 years of age.

Indian Journal of Critical Care Medicine, 2014

Acquired methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing... more Acquired methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing agents and drugs. Although parents may not give any history of toxin ingestion; with the aid of pulse-oximetry and blood gas analysis, we can diagnose methemoglobinemia. Prompt recognition of this condition is required in emergency situations to institute early methylene blue therapy. We report an unusual case of severe toxic methemoglobinemia, which did not respond to methylene blue, but was successfully managed with exchange transfusion.