Justification: In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the... more
Justification: In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. Process: Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among pediatric nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. Objectives: To revise and formulate recommendations for management of steroid sensitive nephrotic syndrome. Recommendations: The need for adequate cortico-steroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a pediatric nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with long-term, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on basis of current best practice, are aimed to familiarize physicians regarding management of children with steroid sensitive nephrotic syndrome.
Research Interests:
Research Interests:
BackgroundYoga nidra practice in novices is known to improve sleep. Its effect on objective parameters on sleep and on cognitive performance is not well known. The aim of the study was to study the effect of yoga nidra practice on... more
BackgroundYoga nidra practice in novices is known to improve sleep. Its effect on objective parameters on sleep and on cognitive performance is not well known. The aim of the study was to study the effect of yoga nidra practice on cognition and night time sleep using objective parameters.Methods41 healthy volunteers were enrolled and baseline sleep diary collected. Subjects underwent overnight polysomnography and cognition testing battery comprising of Motor praxis test (MPT), emotion recognition task (ERT), digital symbol substitution task (DSST), visual object learning task (VOLT), abstract matching (AIM), line orientation task (LOT), matrix reasoning task (MRT), fractal-2-back test (NBACK), psychomotor vigilance task (PVT-10 min) and balloon analog risk task (BART). Yoga nidra was practiced for two weeks after training. Cognition testing battery was done at baseline and at one and two weeks of practice to compare. The cognitive tasks were further analysed using Python library and...
Research Interests:
Research Interests:
Background: Seroprevalence of COVID-19 antibody production in a person can be dependent on many physiological and demographic aspects such as previous infection, age, sex, body mass index, and also status of vaccination. It is of immense... more
Background: Seroprevalence of COVID-19 antibody production in a person can be dependent on many physiological and demographic aspects such as previous infection, age, sex, body mass index, and also status of vaccination. It is of immense value to know about demographic aspect of COVID-19 antibody production so as to know about vulnerable population and suggest preventive measures. Aims and Objectives: The present study was aimed to determine effect of demographic variables COVID-19 antibody production in population of urban area. Materials and Methods: In this study, a total of 2454 subjects were screened for COVID-19 neutralizing antibody by ELISA technique. Subjects more than 18-year-old were selected for the study. We used cluster sampling method for data collection. A pre-structured questionnaire was administered after informed consent and 5 mL venous blood was collected in plain bulb for testing. Results: The prevalence of neutralizing antibody was found to be 93.9%. Female had...
Research Interests:
Research Interests:
Introduction: Levamisole, a synthetic imidazothiazole derivative has been used as a steroid sparing agent in children with Frequently Relapsing Nephrotic Syndrome (FRNS) and Steroid Dependent Idiopathic Nephrotic Syndrome (SDNS).... more
Introduction: Levamisole, a synthetic imidazothiazole derivative has been used as a steroid sparing agent in children with Frequently Relapsing Nephrotic Syndrome (FRNS) and Steroid Dependent Idiopathic Nephrotic Syndrome (SDNS). Levamisole has been essentially considered a safe drug with minimal toxicity. We conducted this study to re-examine the safety of Levamisole in children with nephrotic syndrome and to describe the clinical profile of these children. Materials and Methods: Records of children with idiopathic nephrotic syndrome between June 2014 and December 2016 were reviewed. We identified frequently relapsing or steroid dependent children between 1-18 years of age who had received Levamisole for at least six months or in whom Levamisole was started but had to be withdrawn due to some adverse events in the first 6 months. Results: 21 children were started on Levamisole in the study period. 13 (61.90%) were FRNS and remaining had a steroid dependent course. Levamisole had to be withdrawn in one child at 1 month 13 days after initiation when the child developed severe headache. Levamisole also had to be discontinued in a 9 years old girl at 13 months after initiation of therapy due to polyarticular arthralgia involving both the small and large joints. Conclusions: The use of Levamisole warrants caution in children with Nephrotic Syndrome and its efficacy needs to be balanced against its potential side effects.
Research Interests:
In this paper, we present a new mathematical model for pandemics that have asymptomatic patients, called SUTRA. The acronym stands for Susceptible, Undetected, Tested (positive), and Removed Approach. There are several novel features of... more
In this paper, we present a new mathematical model for pandemics that have asymptomatic patients, called SUTRA. The acronym stands for Susceptible, Undetected, Tested (positive), and Removed Approach. There are several novel features of our proposed model. First, whereas previous papers have divided the patient population into Asymptomatic and Infected, we have explicitly accounted for the fact that, due to contact tracing and other such protocols, some fraction of asymptomatic patients could also be detected; in addition, there would also be large numbers of undetected asymptomatic patients. Second, we have explicitly taken into account the spatial spread of a pandemic over time, through a parameter called “reach.” Third, we present numerically stable methods for estimating the parameters in our model. We have applied our model to predict the progression of the COVID-19 pandemic in several countries. Where data on the number of recovered patients is available, we predict the number...
Research Interests:
Research Interests:
Background Economic evaluations of health technology help to decide which interventions are to be continued and which are to be terminated. In the Armed Forces, the provision of efficient medical services requires meticulous planning for... more
Background Economic evaluations of health technology help to decide which interventions are to be continued and which are to be terminated. In the Armed Forces, the provision of efficient medical services requires meticulous planning for optimal utilization of scarce resources. We report a cost analysis of telemedicine and air transportation of casualties, and attempt to identify the strengths, weaknesses, opportunities and threats of telemedicine services. Methods The costs incurred in telemedicine were compared with the cost of air evacuation. A qualitative assessment of telemedicine was undertaken through in-depth interviews with the hospital authorities and focused group discussions with medical officers and paramedical staff. Results 34.2% of casualties could successfully be stabilized on-site using available healthcare resources with the peripheral hospitals. 18 casualties were managed at the periphery on-site by teleconsultations each year, averting air-transportation efforts. Estimated cost savings achieved in the initial management of casualty by teleconsultation was Rs. 146,111 per case. The strengths of telemedicine are knowledge updation, faster decision making, improved pre-hospital care and improved confidence in case management. Conclusion The reduction in air efforts and remote management of casualties make a substantive case for scaling up telemedicine interventions.
Research Interests:
Research Interests:
Research Interests:
Unfavourable decisions and rejections on submitted manuscripts are not uncommon in scholarly publications. Rejection in a particular journal need not be viewed as end of all hopes for aspiring authors. Substantial number of rejected... more
Unfavourable decisions and rejections on submitted manuscripts are not uncommon in scholarly publications. Rejection in a particular journal need not be viewed as end of all hopes for aspiring authors. Substantial number of rejected manuscripts find their final place in one or the other journal after suitable revision. As an author, it is extremely important to be familiar with common reasons for unfavourable decision/rejection in order to prevent them or to find solutions.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
IntroductionIn last few years, several studies have revealed the remarkable stability of extracellular microRNAs (miRNAs) circulating in the blood or excreted in the urine and underscored their key importance as biomarkers of certain... more
IntroductionIn last few years, several studies have revealed the remarkable stability of extracellular microRNAs (miRNAs) circulating in the blood or excreted in the urine and underscored their key importance as biomarkers of certain diseases. Since miRNA in urinary sediment is relatively stable and easily quantified, it has the potential to be developed as a biomarker for disease diagnosis and monitoring. Identification of serum and urinary levels of certain miRNAs may assist in the diagnosis and assessment of disease activity in patients with nephrotic syndrome (NS). The global expression profile of miRNAs in childhood NS in Indian population remains unknown. Hence, further research is warranted in this area. This study seeks to prospectively evaluate whether a multipronged multiomics approach concentrating on microRNA expression profiles in children with NS vis-a-vis normal healthy children is discriminant enough to predict steroid responsiveness in childhood NS.Methods and analy...
Research Interests:
Research Interests:
In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing... more
In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among pediatric nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. To revise and formulate recommendations for management of steroid sensitive nephrotic syndrome. The need for adequate cortico-steroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a pediatric nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with long-term, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, includi...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Bed wetting or nocturnal enuresis is a common problem among children. It is either monosymptomatic or may be associated with a voiding disorder. Many factors may contribute towards enuresis such as developmental delay, heredity,... more
Bed wetting or nocturnal enuresis is a common problem among children. It is either monosymptomatic or may be associated with a voiding disorder. Many factors may contribute towards enuresis such as developmental delay, heredity, inappropriate nocturnal anti diuretic hormone secretion and reduced bladder capacity. Any child presenting with bed-wetting should be evaluated for any underlying bladder dysfunction before labeling as monosymptomatic enuresis. The evaluation consists of structured bowel and bladder history, detailed clinical examination, frequency volume record and appropriate investigations. The frequency volume diary is an indispensible component of evaluation and helps in establishing diagnosis and tailoring therapy. The treatment of monosymptomatic enuresis consists of positive psychological support, alarms and medication (desmopressin/ anticholinergics/ imiprammine). Children with features of underlying bladder dysfunction, anatomical anomalies and neurological disorde...
Research Interests: Algorithms, Pediatrics, Social Support, Adolescent, Medicine, and 15 moreHumans, Child, Behavior Therapy, Enuresis, Female, Male, Differential Diagnosis, Desmopressin, Imipramine, Tolterodine, Nocturnal enuresis, Child preschool, Cholinergic antagonists, Referral and consultation, and Deamino arginine vasopressin
To validate the non-invasive tests that can predict the type of bladder dysfunction normally diagnosed by invasive urodynamics. Children below 12 yrs of age were evaluated prospectively. Non-invasive urodynamic evaluation included... more
To validate the non-invasive tests that can predict the type of bladder dysfunction normally diagnosed by invasive urodynamics. Children below 12 yrs of age were evaluated prospectively. Non-invasive urodynamic evaluation included history, clinical examination, frequency volume charting, ultrasonographic scan, urine analysis and renal function tests. Micturating cystourethrogram was carried out in children with recurrent urinary tract infections. All children underwent invasive urodynamic studies and the significance of association of the parameters of noninvasive assessment with invasive urodynamics was determined. Chi square test using Epi 6 software was used for statistical analysis of data. 41 children underwent invasive urodynamic studies. The commonest disorder was detrusor instability in 28 (68.2%). Dysynergic voiding was noted in 8 (19.5%). The study was normal in 5 (12.1%). Nocturnal enuresis with day time symptoms, holding maneuvers, small frequent voiding pattern (p<0....
Research Interests: Pediatrics, Statistical Analysis, Tropical Medicine, Medicine, Humans, and 15 moreChild, Enuresis, Female, Male, Urodynamics, Urinary tract infection, Renal Function, Urinary System, Reproducibility of Results, Chi Square Test, Minimally Invasive, Predictive value of tests, Positive predictive value, Nino, and Child preschool
This study was carried out to determine the association of recurrent urinary tract infections with functional voiding disorders. Sixty eight children with suspected functional voiding disorders were prospectively evaluated clinically and... more
This study was carried out to determine the association of recurrent urinary tract infections with functional voiding disorders. Sixty eight children with suspected functional voiding disorders were prospectively evaluated clinically and by non-invasive urodynamics. Invasive urodynamics were carried out when indicated. Group I comprised 34 children with symptoms suggestive of functional voiding disorders and recurrent urinary tract infections (mean age 6.3+/-2 yr) and Group II comprised 34 children with symptoms suggestive of functional voiding disorders without recurrent urinary tract infections (mean age 6.7+/-2 yr). The underlying bladder abnormalities in Groups I and II were detrusor instability in 22 (64.7%) and 30 (88.2%), respectively (P>0.05) and dysynergic voiding in 10 (29.4%), and 1 (2.9%), respectively (P<0.05). Children with recurrent urinary tract infections are more likely to have a dysynergic voiding pattern than children presenting with other symptoms of funct...
Research Interests:
Neonatal Lupus Erythematosus (NLE) is an uncommon condition manifesting with congenital complete heart block and occasionally other manifestations like hepatitis. Neonatal Lupus with severe cholestasis with positive anti SS-A/Ro and anti... more
Neonatal Lupus Erythematosus (NLE) is an uncommon condition manifesting with congenital complete heart block and occasionally other manifestations like hepatitis. Neonatal Lupus with severe cholestasis with positive anti SS-A/Ro and anti SS-B/La antinuclear antibodies in the mother and child is being reported.
Research Interests:
Research Interests:
Research Interests:
Among the 2,052 children with renal disease admitted to a Pediatric Department during a period of 10 years, 270 developed chronic renal failure (CRF). Of these 270 patients, 147 (54%) were under 5 yea