Nikhil shah - Academia.edu (original) (raw)

Papers by Nikhil shah

Research paper thumbnail of A comparison of bone age assessments using automated and manual methods in children of Indian ethnicity

Research paper thumbnail of Prevalence of nephropathy in Indian children and youth with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism, 2022

Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased ... more Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. Methods This cross-sectional study included 319 children and youth (2.6–21 years) with T1D having disease duration of at least 2 years. Demographic data and laboratory findings were obtained using standard questionnaires and protocols. Diagnosis of diabetic nephropathy was based on albuminuria on two occasions within a period of 3 months. Results The prevalence of DN in our study subjects was 13.4%. 7.5% subjects were known cases of diabetic nephropathy on treatment with enalapril. Hypertension was found in 14.3% subjects with DN in contrast to 4.1% without DN (p<0.05). Duration of diabetes and estimated glucose disposal rate were the important predictors of DN. Interestingly, of the 43 children with DN, 11.3% (n=8) were under ...

Research paper thumbnail of Rare association of Beckwith-Wiedemann syndrome with Hirschsprung’s disease in an infant with hypoglycemia

BMJ Case Reports, 2020

Hypoglycaemic due to congenital hyperinsulinism in Beckwith-Wiedemann syndrome is commonly seen. ... more Hypoglycaemic due to congenital hyperinsulinism in Beckwith-Wiedemann syndrome is commonly seen. It is usually transient and is managed by enteral feeds, high glucose-containing intravenous fluids and medications like diazoxide. We describe a case of an infant with genetically proven Beckwith-Wiedemann syndrome with prolonged hyperinsulinemic hypoglycaemia. Despite treatment with high glucose-containing intravenous fluids, diazoxide and octreotide, her hypoglycaemia persisted. In addition to this, she also developed features of intestinal obstruction, which further complicated the management of hypoglycaemia. She underwent a rectal biopsy for this, which was highly suggestive of Hirschprung’s disease. Following surgery, her abdominal distension and feed intolerance were settled and sugar control was improved. We present a rare association of Hirschsprung’s disease with Beckwith-Wiedemann syndrome. To the best of our knowledge, this association has not been previously reported and th...

Research paper thumbnail of Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes

Journal of Pediatric Endocrinology and Metabolism, 2020

Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which wa... more Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BMI) patterns of children with type 1 diabetes (T1DM) from different socio-economic (SE) classes. Methods This observational study included 77 children and youth (5–20 years) with T1DM having disease duration of ≥6 months. Demographic data and investigations were recorded at two time points (post lockdown when the children came for follow up, pre lockdown data from medical records). Results Glycemic control improved (pre lockdown HbA1C 79.4±19.2 vs. post lockdown Hba1C 74.5±16.9 mmol/mol, p<0.05) and there was weight gain post lockdown (pre lockdown weight z-score −0.4±0.8 vs. post lockdown weight z-score −0.2±0.8, p<0.05) without any ...

Research paper thumbnail of Precocious Puberty

The Bombay Hospital journal, 2020

Research paper thumbnail of DXA and pQCT derived parameters in Indian children with beta thalassemia major - A case controlled study

Bone, 2021

Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases in... more Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases incidence of non-traumatic fractures. Few studies have assessed prevalence of fractures and bone health in underprivileged children with BTM. Our objectives were to 1) determine prevalence of fractures in underprivileged Indian children with BTM, 2) assess size corrected bone density and bone geometry using Dual x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT) in these children and healthy controls 3) determine predictors of fractures in children with BTM 4) compare differences in bone density between children with BMT with and without fractures. Bone mineral content and areal bone mineral density (aBMD) of lumbar spine and whole body and vertebral fracture assessment (VFA) was performed by DXA in 334 children (3-18 years, 167 BTM + 167 controls). Volumetric BMD (vBMD) and bone geometry were assessed by pQCT (subset, 70 BTM, 70 healthy) at distal radius. Children with BTM had higher prevalence of vertebral and long bone fractures (p < 0.05). DXA aBMD was lower in children with BTM (p < 0.05), whereas, lumbar spine bone mineral apparent density (LSBMAD) was higher (p > 0.05). Children with BTM had lower total distal radial vBMD, cortical vBMD and strength strain index (SSI) at 66% site whereas, distal radial trabecular vBMD at 4% was higher (p < 0.05). On height adjustment, children with BTM had lower muscle area and cortical thickness and higher marrow area (p < 0.05) at 66% site. Age, body size, total body less head (TBLH) aBMD and strength strain index (SSI) were important predictors of fractures in children with BTM. Thus, children with BTM had higher prevalence of non-traumatic fractures. Despite lower areal and volumetric densities, they had higher LSBMAD and trabecular densities which may be attributed to erythroid hyperplasia and iron deposition due to inadequate transfusion and chelation. As LSBMAD is raised in these children, it is unlikely to identify BTM subjects at risk of fracture; VFA thus maybe useful in identifying asymptomatic vertebral fractures.

Research paper thumbnail of Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis

BMJ Case Reports, 2020

Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, patho... more Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of acidosis, the gastrointestinal symptoms persisted for which an ultrasonography of the abdomen was performed. It revealed an ileo-ileal intussusception, which was confirmed by a CT scan. He underwent an exploratory laparotomy. After reduction of the intussusception, a Meckel diverticulum was found as the lead point that was then resected. We present a case of a child with type 1 diabetes having an intussusception due to Meckel diverticulum, which was probably made worse by the decreased intestinal motility due to hyperglycaemia. Intussusception should thus be suspected in patients with diabetic ketoacidosis if the pain is persistent despite co...

Research paper thumbnail of Evaluation of Children and Adolescents with Obesity

Indian Journal of Pediatrics, 2021

Childhood overweight and obesity in Indian children and adolescents is a relatively new but wides... more Childhood overweight and obesity in Indian children and adolescents is a relatively new but widespread epidemic. Hence, it is necessary to evaluate and identify these children to prevent long-term complications. The most important evaluation to identify and assess obesity-related risks in these children involves anthropometric assessment and using appropriate growth charts. Overweight and obesity are defined using weight-for-length or -height parameters (World Health Organization 2006 charts) in Indian children less than 5 y and body mass index (Indian Academy of Pediatric 2015 charts) in Indian children aged 5–18 y. Waist circumference is another important predictor of pediatric obesity-related comorbidities and is also a component to define metabolic syndrome. Tall and obese children usually have primary obesity, and short and obese children require further evaluation for endocrine disease or syndromic causes. The presence of developmental delay, hearing or vision impairment, genital and digit abnormalities or dysmorphism should warrant a genetic evaluation. It is important to document social and dietary history as well as time spent in physical activity and usage of electronic screen. Finally, comorbidities associated with childhood obesity are common, which can result in long-term complications; hence, these comorbidities should be screened and managed to prevent long-term cardiometabolic risks.

Research paper thumbnail of Prevalence of metabolic syndrome and predictors of metabolic risk in Indian children, adolescents and youth with type 1 diabetes mellitus

Endocrine, 2021

Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as... more Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as the general population. Several environmental factors such as lifestyle, exogenous insulin therapy (over-insulinization) and genetic/familial factors are thought to underlie the phenotype of 'double diabetes' (co-existence of MS components in patients with T1D). To determine the prevalence of overweight/obesity and MS and to identify its predictors in Indian children, adolescents and young adults with T1D. This cross-sectional study included 355 children and youth aged 6–23 years with T1D. Demographic data were obtained from patients using questionnaires. Anthropometry, blood pressure, sexual maturity rating, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance (IR) was calculated using estimated glucose disposal rate (eGDR) and MS was diagnosed using the international diabetes federation (IDF) consensus definition 2017. The prevalence of overweight/obesity and MS in our study was 15.5% and 4.5%, respectively. Abnormal HDL-cholesterol was the most common component of MS (55.6%) among children with T1D. Age, gender, body mass index (BMI) and eGDR were identified as significant predictors of the likelihood of MS. We found a similar prevalence of MS in children with T1D as compared to other healthy children, which emphasises the need for monitoring of eGDR to determine IR in these children.

Research paper thumbnail of Long-term follow-up of a child with Wolcott-Rallison syndrome

BMJ Case Reports, 2021

Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (D... more Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (DM) in consanguineous families, has a poor prognosis, with a mean survival of 5.8 years. Majority of children with WRS succumb to the disease in the first decade of life. We present the long-term follow-up of an 8-year-2-month-old girl with genetically proven WRS who was born to a non-consanguineous parentage. She is on basal bolus regimen of insulin therapy for DM. In addition, she was noted to have features of skeletal dysplasia at 3 years and 3 months of age, which has led to her short stature. Surprisingly, she has had no episodes of hepatitis or liver dysfunction so far, which is frequently seen in children with WRS. To the best of our knowledge, she is the oldest surviving patient with WRS reported in India and South Asia.

Research paper thumbnail of Low bone mineral density on DXA and slipped capital femoral epiphysis as rare presentation in a child with Rubinstein-Taybi syndrome

BMJ Case Reports, 2021

We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epi... more We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epiphysis (SCFE). She underwent bilateral arthroscopy with implant fixation for the SCFE and the symptoms resolved. This was followed by fracture of the femur after minor trauma. Dual energy X-ray absorptiometry (DXA) scan done to evaluate her bone health revealed a low bone mineral density (BMD). Our case highlights the finding of low BMD on DXA and rare association of SCFE in a child with RTS. The conundrum in this case is whether this child can be labelled to have osteoporosis as defined by the criteria given by the International Society for Clinical Densitometry guidelines.

Research paper thumbnail of Rare association of septic arthritis with neonatal diabetes in a patient with PDX-1 mutation

Indian Journal of Child Health, 2020

Research paper thumbnail of Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus

Pediatric Diabetes, 2020

BACKGROUND Children with type 1 diabetes having dyslipidemia are at increased risk of developing ... more BACKGROUND Children with type 1 diabetes having dyslipidemia are at increased risk of developing premature atherosclerosis and cardiovascular disease. The present study aims to determine the prevalence of dyslipidemia and its predictors in poorly controlled Indian children with type 1 diabetes. METHODS The cross sectional study included 235 children and youth (3-18 years) with type 1 diabetes having disease duration of at least 1 year. Demographic data and laboratory findings were obtained from patients' records. RESULTS The prevalence of dyslipidemia in our study was 47.2% with abnormal LDL cholesterol being the most common lipid abnormality. Poor glycemic control and higher TSH values were important predictors of likelihood of dyslipidemia and hypertriglyceridemia. Despite a low percentage of overweight and obese children in our study, body fat percentage was a significant predictor of likelihood of high total cholesterol and abnormal HDL. Interestingly, 28 children under the age of 10 years were found to have dyslipidemia which constitutes 11.9% of the total study group. CONCLUSIONS We found a high prevalence of dyslipidemia in children with type 1 diabetes including children under age of 10 years which emphasize the need for early screening and regular monitoring of lipid profile in these children. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Distortion of dual energy X-ray images by faecal masses in a child with type 1 diabetes

BMJ Case Reports, 2020

Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to... more Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lumps, leading to falsely elevated BMD and an error in interpretation of the DXA scans. Our case suggests that DXA software may not, at times, differentiate between bone and other high-attenuating material within the regions of interest. Thus, DXA images should also be visually examined and verified with the numeric data before report preparation in these patients.

Research paper thumbnail of Author response for "Prevalence of Dyslipidemia in Indian Children with Poorly Controlled Type 1 Diabetes Mellitus

Research paper thumbnail of The presence of physician champions improved Kangaroo mother care in rural western India

Acta paediatrica (Oslo, Norway : 1992), Jan 25, 2016

This study determined the effect of physician champions on the two main components of Kangaroo mo... more This study determined the effect of physician champions on the two main components of Kangaroo mother care (KMC): skin-to-skin care and breastfeeding. KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between 5 January 2011 and 7 October 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. In comparison to when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% Confidence Interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53% to 82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environmen...

Research paper thumbnail of Report on Kangaroo Care Practices in a Tertiary Level NICU in Western India-Scope for Improvement

Research paper thumbnail of Comparison of bone age assessments by Gruelich-Pyle, Gilsanz-Ratib, and Tanner Whitehouse methods in healthy Indian children

Indian Journal of Endocrinology and Metabolism, 2021

There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-... more There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-Ratib (GR), and Tanner Whitehouse-3 (TW-3) methods. Although GP atlas is the most widely used, there are concerns about its accuracy in children of different ethnicities, making the use of the TW-3 method an attractive option in Indian children. 1) To assess the relationship of BA with chronological age (CA) as assessed by different methods (GP, GR, and TW-3) in healthy Indian children 2) To assess which of the three methods of BA assessment is more suitable in Indian children. X-rays of 851 children (438 boys and 413 girls, aged 2-16.5 years) were analyzed by four independent observers using three different methods of BA estimation (GP, GR, and TW-3). Mean BAs were converted to Z-scores. For purpose of deciding which method of BA was most suitable in our cohort, a test of proportions and root mean square (RMS) deviations were computed. Using the test of proportions, the TW-3 method was most suitable overall (P < 0.05). TW-3 method was again most applicable in prepubertal boys (P < 0.05), in prepubertal girls (although not significant, P > 0.1), and pubertal girls (P < 0.05). However, in pubertal boys, the GR atlas method was most suitable (P < 0.05). The same results were obtained when root mean square (RMS) deviations were computed. Interestingly, BA was underestimated in Indian boys irrespective of the method used. In Indian girls, however, the BA was underestimated till the pubertal growth spurt, after which there was rapid advancement of BA. Among the three methods (GP, GR, and TW-3), the BAs estimated by the TW-3 method were closest to CAs. Hence, it seems reasonable to recommend the use of the TW-3 method for BA estimation in the Indian population till an Indian standard bone age atlas is developed.

Research paper thumbnail of A comparison of bone age assessments using automated and manual methods in children of Indian ethnicity

Research paper thumbnail of Prevalence of nephropathy in Indian children and youth with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism, 2022

Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased ... more Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. Methods This cross-sectional study included 319 children and youth (2.6–21 years) with T1D having disease duration of at least 2 years. Demographic data and laboratory findings were obtained using standard questionnaires and protocols. Diagnosis of diabetic nephropathy was based on albuminuria on two occasions within a period of 3 months. Results The prevalence of DN in our study subjects was 13.4%. 7.5% subjects were known cases of diabetic nephropathy on treatment with enalapril. Hypertension was found in 14.3% subjects with DN in contrast to 4.1% without DN (p<0.05). Duration of diabetes and estimated glucose disposal rate were the important predictors of DN. Interestingly, of the 43 children with DN, 11.3% (n=8) were under ...

Research paper thumbnail of Rare association of Beckwith-Wiedemann syndrome with Hirschsprung’s disease in an infant with hypoglycemia

BMJ Case Reports, 2020

Hypoglycaemic due to congenital hyperinsulinism in Beckwith-Wiedemann syndrome is commonly seen. ... more Hypoglycaemic due to congenital hyperinsulinism in Beckwith-Wiedemann syndrome is commonly seen. It is usually transient and is managed by enteral feeds, high glucose-containing intravenous fluids and medications like diazoxide. We describe a case of an infant with genetically proven Beckwith-Wiedemann syndrome with prolonged hyperinsulinemic hypoglycaemia. Despite treatment with high glucose-containing intravenous fluids, diazoxide and octreotide, her hypoglycaemia persisted. In addition to this, she also developed features of intestinal obstruction, which further complicated the management of hypoglycaemia. She underwent a rectal biopsy for this, which was highly suggestive of Hirschprung’s disease. Following surgery, her abdominal distension and feed intolerance were settled and sugar control was improved. We present a rare association of Hirschsprung’s disease with Beckwith-Wiedemann syndrome. To the best of our knowledge, this association has not been previously reported and th...

Research paper thumbnail of Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes

Journal of Pediatric Endocrinology and Metabolism, 2020

Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which wa... more Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BMI) patterns of children with type 1 diabetes (T1DM) from different socio-economic (SE) classes. Methods This observational study included 77 children and youth (5–20 years) with T1DM having disease duration of ≥6 months. Demographic data and investigations were recorded at two time points (post lockdown when the children came for follow up, pre lockdown data from medical records). Results Glycemic control improved (pre lockdown HbA1C 79.4±19.2 vs. post lockdown Hba1C 74.5±16.9 mmol/mol, p<0.05) and there was weight gain post lockdown (pre lockdown weight z-score −0.4±0.8 vs. post lockdown weight z-score −0.2±0.8, p<0.05) without any ...

Research paper thumbnail of Precocious Puberty

The Bombay Hospital journal, 2020

Research paper thumbnail of DXA and pQCT derived parameters in Indian children with beta thalassemia major - A case controlled study

Bone, 2021

Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases in... more Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases incidence of non-traumatic fractures. Few studies have assessed prevalence of fractures and bone health in underprivileged children with BTM. Our objectives were to 1) determine prevalence of fractures in underprivileged Indian children with BTM, 2) assess size corrected bone density and bone geometry using Dual x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT) in these children and healthy controls 3) determine predictors of fractures in children with BTM 4) compare differences in bone density between children with BMT with and without fractures. Bone mineral content and areal bone mineral density (aBMD) of lumbar spine and whole body and vertebral fracture assessment (VFA) was performed by DXA in 334 children (3-18 years, 167 BTM + 167 controls). Volumetric BMD (vBMD) and bone geometry were assessed by pQCT (subset, 70 BTM, 70 healthy) at distal radius. Children with BTM had higher prevalence of vertebral and long bone fractures (p < 0.05). DXA aBMD was lower in children with BTM (p < 0.05), whereas, lumbar spine bone mineral apparent density (LSBMAD) was higher (p > 0.05). Children with BTM had lower total distal radial vBMD, cortical vBMD and strength strain index (SSI) at 66% site whereas, distal radial trabecular vBMD at 4% was higher (p < 0.05). On height adjustment, children with BTM had lower muscle area and cortical thickness and higher marrow area (p < 0.05) at 66% site. Age, body size, total body less head (TBLH) aBMD and strength strain index (SSI) were important predictors of fractures in children with BTM. Thus, children with BTM had higher prevalence of non-traumatic fractures. Despite lower areal and volumetric densities, they had higher LSBMAD and trabecular densities which may be attributed to erythroid hyperplasia and iron deposition due to inadequate transfusion and chelation. As LSBMAD is raised in these children, it is unlikely to identify BTM subjects at risk of fracture; VFA thus maybe useful in identifying asymptomatic vertebral fractures.

Research paper thumbnail of Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis

BMJ Case Reports, 2020

Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, patho... more Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of acidosis, the gastrointestinal symptoms persisted for which an ultrasonography of the abdomen was performed. It revealed an ileo-ileal intussusception, which was confirmed by a CT scan. He underwent an exploratory laparotomy. After reduction of the intussusception, a Meckel diverticulum was found as the lead point that was then resected. We present a case of a child with type 1 diabetes having an intussusception due to Meckel diverticulum, which was probably made worse by the decreased intestinal motility due to hyperglycaemia. Intussusception should thus be suspected in patients with diabetic ketoacidosis if the pain is persistent despite co...

Research paper thumbnail of Evaluation of Children and Adolescents with Obesity

Indian Journal of Pediatrics, 2021

Childhood overweight and obesity in Indian children and adolescents is a relatively new but wides... more Childhood overweight and obesity in Indian children and adolescents is a relatively new but widespread epidemic. Hence, it is necessary to evaluate and identify these children to prevent long-term complications. The most important evaluation to identify and assess obesity-related risks in these children involves anthropometric assessment and using appropriate growth charts. Overweight and obesity are defined using weight-for-length or -height parameters (World Health Organization 2006 charts) in Indian children less than 5 y and body mass index (Indian Academy of Pediatric 2015 charts) in Indian children aged 5–18 y. Waist circumference is another important predictor of pediatric obesity-related comorbidities and is also a component to define metabolic syndrome. Tall and obese children usually have primary obesity, and short and obese children require further evaluation for endocrine disease or syndromic causes. The presence of developmental delay, hearing or vision impairment, genital and digit abnormalities or dysmorphism should warrant a genetic evaluation. It is important to document social and dietary history as well as time spent in physical activity and usage of electronic screen. Finally, comorbidities associated with childhood obesity are common, which can result in long-term complications; hence, these comorbidities should be screened and managed to prevent long-term cardiometabolic risks.

Research paper thumbnail of Prevalence of metabolic syndrome and predictors of metabolic risk in Indian children, adolescents and youth with type 1 diabetes mellitus

Endocrine, 2021

Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as... more Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as the general population. Several environmental factors such as lifestyle, exogenous insulin therapy (over-insulinization) and genetic/familial factors are thought to underlie the phenotype of 'double diabetes' (co-existence of MS components in patients with T1D). To determine the prevalence of overweight/obesity and MS and to identify its predictors in Indian children, adolescents and young adults with T1D. This cross-sectional study included 355 children and youth aged 6–23 years with T1D. Demographic data were obtained from patients using questionnaires. Anthropometry, blood pressure, sexual maturity rating, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance (IR) was calculated using estimated glucose disposal rate (eGDR) and MS was diagnosed using the international diabetes federation (IDF) consensus definition 2017. The prevalence of overweight/obesity and MS in our study was 15.5% and 4.5%, respectively. Abnormal HDL-cholesterol was the most common component of MS (55.6%) among children with T1D. Age, gender, body mass index (BMI) and eGDR were identified as significant predictors of the likelihood of MS. We found a similar prevalence of MS in children with T1D as compared to other healthy children, which emphasises the need for monitoring of eGDR to determine IR in these children.

Research paper thumbnail of Long-term follow-up of a child with Wolcott-Rallison syndrome

BMJ Case Reports, 2021

Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (D... more Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (DM) in consanguineous families, has a poor prognosis, with a mean survival of 5.8 years. Majority of children with WRS succumb to the disease in the first decade of life. We present the long-term follow-up of an 8-year-2-month-old girl with genetically proven WRS who was born to a non-consanguineous parentage. She is on basal bolus regimen of insulin therapy for DM. In addition, she was noted to have features of skeletal dysplasia at 3 years and 3 months of age, which has led to her short stature. Surprisingly, she has had no episodes of hepatitis or liver dysfunction so far, which is frequently seen in children with WRS. To the best of our knowledge, she is the oldest surviving patient with WRS reported in India and South Asia.

Research paper thumbnail of Low bone mineral density on DXA and slipped capital femoral epiphysis as rare presentation in a child with Rubinstein-Taybi syndrome

BMJ Case Reports, 2021

We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epi... more We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epiphysis (SCFE). She underwent bilateral arthroscopy with implant fixation for the SCFE and the symptoms resolved. This was followed by fracture of the femur after minor trauma. Dual energy X-ray absorptiometry (DXA) scan done to evaluate her bone health revealed a low bone mineral density (BMD). Our case highlights the finding of low BMD on DXA and rare association of SCFE in a child with RTS. The conundrum in this case is whether this child can be labelled to have osteoporosis as defined by the criteria given by the International Society for Clinical Densitometry guidelines.

Research paper thumbnail of Rare association of septic arthritis with neonatal diabetes in a patient with PDX-1 mutation

Indian Journal of Child Health, 2020

Research paper thumbnail of Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus

Pediatric Diabetes, 2020

BACKGROUND Children with type 1 diabetes having dyslipidemia are at increased risk of developing ... more BACKGROUND Children with type 1 diabetes having dyslipidemia are at increased risk of developing premature atherosclerosis and cardiovascular disease. The present study aims to determine the prevalence of dyslipidemia and its predictors in poorly controlled Indian children with type 1 diabetes. METHODS The cross sectional study included 235 children and youth (3-18 years) with type 1 diabetes having disease duration of at least 1 year. Demographic data and laboratory findings were obtained from patients' records. RESULTS The prevalence of dyslipidemia in our study was 47.2% with abnormal LDL cholesterol being the most common lipid abnormality. Poor glycemic control and higher TSH values were important predictors of likelihood of dyslipidemia and hypertriglyceridemia. Despite a low percentage of overweight and obese children in our study, body fat percentage was a significant predictor of likelihood of high total cholesterol and abnormal HDL. Interestingly, 28 children under the age of 10 years were found to have dyslipidemia which constitutes 11.9% of the total study group. CONCLUSIONS We found a high prevalence of dyslipidemia in children with type 1 diabetes including children under age of 10 years which emphasize the need for early screening and regular monitoring of lipid profile in these children. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Distortion of dual energy X-ray images by faecal masses in a child with type 1 diabetes

BMJ Case Reports, 2020

Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to... more Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lumps, leading to falsely elevated BMD and an error in interpretation of the DXA scans. Our case suggests that DXA software may not, at times, differentiate between bone and other high-attenuating material within the regions of interest. Thus, DXA images should also be visually examined and verified with the numeric data before report preparation in these patients.

Research paper thumbnail of Author response for "Prevalence of Dyslipidemia in Indian Children with Poorly Controlled Type 1 Diabetes Mellitus

Research paper thumbnail of The presence of physician champions improved Kangaroo mother care in rural western India

Acta paediatrica (Oslo, Norway : 1992), Jan 25, 2016

This study determined the effect of physician champions on the two main components of Kangaroo mo... more This study determined the effect of physician champions on the two main components of Kangaroo mother care (KMC): skin-to-skin care and breastfeeding. KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between 5 January 2011 and 7 October 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. In comparison to when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% Confidence Interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53% to 82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environmen...

Research paper thumbnail of Report on Kangaroo Care Practices in a Tertiary Level NICU in Western India-Scope for Improvement

Research paper thumbnail of Comparison of bone age assessments by Gruelich-Pyle, Gilsanz-Ratib, and Tanner Whitehouse methods in healthy Indian children

Indian Journal of Endocrinology and Metabolism, 2021

There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-... more There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-Ratib (GR), and Tanner Whitehouse-3 (TW-3) methods. Although GP atlas is the most widely used, there are concerns about its accuracy in children of different ethnicities, making the use of the TW-3 method an attractive option in Indian children. 1) To assess the relationship of BA with chronological age (CA) as assessed by different methods (GP, GR, and TW-3) in healthy Indian children 2) To assess which of the three methods of BA assessment is more suitable in Indian children. X-rays of 851 children (438 boys and 413 girls, aged 2-16.5 years) were analyzed by four independent observers using three different methods of BA estimation (GP, GR, and TW-3). Mean BAs were converted to Z-scores. For purpose of deciding which method of BA was most suitable in our cohort, a test of proportions and root mean square (RMS) deviations were computed. Using the test of proportions, the TW-3 method was most suitable overall (P < 0.05). TW-3 method was again most applicable in prepubertal boys (P < 0.05), in prepubertal girls (although not significant, P > 0.1), and pubertal girls (P < 0.05). However, in pubertal boys, the GR atlas method was most suitable (P < 0.05). The same results were obtained when root mean square (RMS) deviations were computed. Interestingly, BA was underestimated in Indian boys irrespective of the method used. In Indian girls, however, the BA was underestimated till the pubertal growth spurt, after which there was rapid advancement of BA. Among the three methods (GP, GR, and TW-3), the BAs estimated by the TW-3 method were closest to CAs. Hence, it seems reasonable to recommend the use of the TW-3 method for BA estimation in the Indian population till an Indian standard bone age atlas is developed.