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Article: Ochoa Syndrome - Neurogenic Bladder with an Inverted Smile.

Govindarajan, Varun / Hanumanna, Anil Kumar / Kumari, Vijayakumar Krishna / Kariyappa, Mallesh

2022 Volume 32, Issue 4, Page(s) 384–386

Abstract: Ochoa or urofacial syndrome is a rare autosomal recessive syndrome with around 150 cases reported in the medical literature comprising of neurogenic bladder and facial abnormalities, culminating in obstructive uropathy and chronic kidney disease. We ... ...

Abstract	Ochoa or urofacial syndrome is a rare autosomal recessive syndrome with around 150 cases reported in the medical literature comprising of neurogenic bladder and facial abnormalities, culminating in obstructive uropathy and chronic kidney disease. We report a 5-year-old boy presenting to us with Stage IV chronic kidney disease with bilateral hydroureteronephrosis secondary to chronic urinary incontinence. His peculiar facial expression with a grimace while smiling suggested the diagnosis of Ochoa syndrome. He was managed conservatively for neurogenic bladder and is under follow-up. We wish to highlight this unique syndrome and the simplicity in making this syndromic diagnosis, just by appreciating abnormal facial expressions.
Language	English
Publishing date	2022-05-20
Publishing country	India
Document type	Case Reports
ZDB-ID	2134388-3
ISSN	1998-3662 ; 0971-4065
ISSN (online)	1998-3662
ISSN	0971-4065
DOI	10.4103/ijn.ijn_235_21
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Article ; Online: Enteritis: a window to the diagnosis of systemic lupus erythematosus in an adolescent girl: case report.

Patel, Ashray / Krishnapura Lakshminarayana, Shilpa / Kumble, Dhanalakshmi / Kariyappa, Mallesh / Ramkumar, Gautham / Anilkumar, H / Bhattad, Sagar

Paediatrics and international child health

2024 Volume 44, Issue 1, Page(s) 42–47

Abstract: Background: Enteritis is one of the rare systemic manifestations in childhood-onset systemic lupus erythematosus and its diagnosis is very challenging. This is a rare case of an adolescent girl with recurrent non-specific gastro-intestinal symptoms ... ...

Abstract	Background: Enteritis is one of the rare systemic manifestations in childhood-onset systemic lupus erythematosus and its diagnosis is very challenging. This is a rare case of an adolescent girl with recurrent non-specific gastro-intestinal symptoms which were later diagnosed to be owing to lupus enteritis, the only presenting manifestation of an active flare. Case report: A 15-year-old girl was admitted with recurrent episodes of abdominal pain, vomiting and loose stools. She had diffuse abdominal tenderness. Abdominal ultrasonography demonstrated moderate ascites. A contrast-enhanced abdominal computerised tomography scan revealed thickening of the small bowel wall. On colonoscopy, there were rectal erosions, and microscopic examination of the biopsy specimens demonstrated mild inflammation. Non-specific enteritis was diagnosed and she was given antibiotics and supportive care. She was re-admitted 6months later with abdominal pain. An abdominal contrast-enhanced computerised tomography scan revealed thickening of the bowel wall and the target sign and comb sign in the small intestine. The anti-nuclear antibody was positive. Renal biopsy demonstrated grade 2 lupus nephritis. Lupus enteritis was diagnosed and the case satisfied the 2019 EULAR-ACR criteria and SLICC criteria. She was treated with methylprednisolone, cyclophosphamide and hydroxychloroquine. She improved with treatment and has remained asymptomatic during follow-up. Conclusion: This case emphasises the need for healthcare providers to be alert to the possibility of lupus enteritis. It also highlights the importance of close follow-up of cases who have non-specific gastro-intestinal symptoms. Lupus enteritis should be considered in the differential diagnosis of recurrent non-specific gastro-intestinal symptoms in children, especially adolescents, to ensure timely diagnosis and treatment.
MeSH term(s)	Adolescent ; Female ; Humans ; Abdominal Pain/complications ; Cyclophosphamide ; Enteritis/diagnosis ; Enteritis/etiology ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/pathology ; Lupus Nephritis/complications
Chemical Substances	Cyclophosphamide (8N3DW7272P)
Language	English
Publishing date	2024-01-07
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2649065-1
ISSN	2046-9055 ; 2046-9047
ISSN (online)	2046-9055
ISSN	2046-9047
DOI	10.1080/20469047.2023.2299581
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Article: Quality Improvement Study With Low-Cost Strategies to Reduce Neonatal Admission Hypothermia.

Pratik, Pi Pragyan / Lakshminarayana, Shilpa Krishnapura / Devadas, Sahana / Kommalur, Anitha / Sajjan, Sushma Veeranna / Kariyappa, Mallesh

Cureus

2023 Volume 15, Issue 6, Page(s) e40301

Abstract: Background Admission hypothermia is still an underappreciated major challenge for new-born survival in low-resource settings. The WHO recommends skin-to-skin contact as the simplest and safest way for maintaining the body temperature even during ... ...

Abstract	Background Admission hypothermia is still an underappreciated major challenge for new-born survival in low-resource settings. The WHO recommends skin-to-skin contact as the simplest and safest way for maintaining the body temperature even during transportation. Quality improvement initiatives for hospitalised new-borns have shown benefits like a reduction in neonatal morbidity and mortality. This study was undertaken in a resource-constrained public hospital in southern India with an aim to reduce neonatal hypothermia at admission to <20%. Method It was a prospective, quality improvement study undertaken over 20 weeks. All neonates born in the selected delivery room (DR), requiring transportation to the neonatal intensive care unit, were included. The primary outcome indicators were the mean axillary temperature of neonates measured upon arrival at the neonatal intensive care unit and the percentage of neonates with hypothermia at admission. Improving the thermoregulatory practices and ambient DR temperature to >25˚C, transportation by the kangaroo method, and a portable infant warmer (PIW) were implemented in three successive Plan-Do-Study-Act (PDSA) cycles. Result In the third PDSA cycle, the mean admission temperature (36.51˚C ±0.82) was significantly (p<0.0001) higher when compared with the baseline phase (35.41˚C ±1.09), and there was a significant (p<0.001) reduction in hypothermia (33.33%). The aim was achieved in the last two weeks of the third cycle with a reduction in hypothermia to 17.6%. Conclusion Implementation of appropriate thermoregulatory practices and low-cost strategies like the kangaroo method and PIW using quality improvement methodology significantly reduced admission hypothermia.
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.40301
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Article ; Online: Acute Leukoencephalopathy with Restricted Diffusion in an Infant with Severe COVID-19 and Dengue Coinfection Progressing to West Syndrome.

Kariyappa, Mallesh / Govindarajan, Varun / Kommalur, Anitha

Journal of tropical pediatrics

2021 Volume 67, Issue 2

Abstract: COVID-19 pandemic is increasingly being recognized in infants and some develop cytokine storm mediated tissue damage. We report 5-month-old infant presenting with fever, refusal of feeds, developing altered sensorium and convulsions during the hospital ... ...

Abstract	COVID-19 pandemic is increasingly being recognized in infants and some develop cytokine storm mediated tissue damage. We report 5-month-old infant presenting with fever, refusal of feeds, developing altered sensorium and convulsions during the hospital course, tested positive for SARS-CoV2 RT-PCR in second week of illness. Her serology was also Dengue positive. She had features of cytokine storm and her MRI Brain suggested acute demyelinating encephalomyelitis (ADEM). She was treated with high-dose methylprednisolone followed oral prednisolone, under antibiotics cover. Infant improved gradually over 3 weeks duration following a stormy hospital course. On follow-up, infant showed delayed motor milestones with epileptic spasms and hysparrhthymia on EEG, progressing to develop secondary West syndrome. Features of acute encephalopathy, hypercytokinemia and restricted diffusion on DWI-MRI, with post-encephalopathic epilepsy, pointed to a differential of ADEM-acute leukoencephalopathy with restricted diffusion (ALERD) as the primary diagnosis; establishing ALERD as a possible neurological complication of COVID-19 infection in infants. Timeline of events. There is a demonstrable fall in the inflammatory markers with clinical improvement following the start of intravenous methylprednisolone. Epileptic spasms and developmental delay with hypsarrhthymia noted on follow-up, suggestive of secondary West syndrome.
MeSH term(s)	COVID-19 ; Coinfection ; Dengue ; Female ; Humans ; Infant ; Leukoencephalopathies ; Pandemics ; RNA, Viral ; SARS-CoV-2 ; Spasms, Infantile/diagnosis ; Spasms, Infantile/drug therapy ; Spasms, Infantile/etiology
Chemical Substances	RNA, Viral
Language	English
Publishing date	2021-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	800065-7
ISSN	1465-3664 ; 0449-3281 ; 0142-6338
ISSN (online)	1465-3664
ISSN	0449-3281 ; 0142-6338
DOI	10.1093/tropej/fmab026
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Article: A Study of the Clinical Profile and Respiratory Index of Severity in Children (RISC) Score in Infants Admitted With Acute Respiratory Infections at a Tertiary Care Hospital.

Pranathi, Bangalore Srinivas / Lakshminarayana, Shilpa Krishnapura / Kumble, Dhanalakshmi / Rangegowda, Ravichandra Kothur / Kariyappa, Mallesh / Chinnappa, Gayathri Devi

Cureus

2023 Volume 15, Issue 8, Page(s) e43100

Abstract: Background Pneumonia is a major infectious cause of mortality in young children worldwide. The Respiratory Index of Severity in Children (RISC) score was designed with the intent to provide an objective mean to quantify the severity of lower respiratory ... ...

Abstract	Background Pneumonia is a major infectious cause of mortality in young children worldwide. The Respiratory Index of Severity in Children (RISC) score was designed with the intent to provide an objective mean to quantify the severity of lower respiratory tract infection in young children based on their risk of mortality. Knowledge about the clinical profile of acute respiratory infections and the scoring system predicting the risk of mortality helps in modifying treatment strategies. This study was undertaken at a resource-limited, tertiary-care public hospital in southern India with the objectives of describing the clinical profile of infants admitted with acute respiratory infections and determining the association of the RISC score with mortality. Method This was a retrospective observational study conducted over six months. Case records of infants admitted with acute respiratory infections were reviewed. The socio-demographic and clinical details of each case were recorded. The RISC score was calculated using clinical parameters which included the history of refusal of feeds, oxygen saturation lower than 90%, chest in-drawing, wheezing, and low weight-for-age. The maximum score was six. Descriptive data was represented using mean, standard deviation, and percentage or proportion. The association between any two categorical variables was analyzed using the chi-square test. The differences between any two continuous variables were analyzed using the independent sample t-test. A p-value of < 0.05 was considered statistically significant. Results A total of 75 infants were admitted with a diagnosis of acute respiratory infection during the study period. Of these, 68 were included in the study. The mean age of infants was 6.69 ± 3.96 months; 58.8% were male, 41 (60%) were exclusively breastfed, and 51 (75%) were up-to-date immunized. Twenty (29.4%) infants had a history of exposure to indoor smoke. The majority (67.6%) had pneumonia. Nine (13.2%) were mechanically ventilated. The mean duration of hospital stay was 8.16 ± 5.45 days. Sixty-three (92.64%) infants recovered and there were five deaths. The presence of less than 90% oxygen saturation (p-value=0.004), a diagnosis of severe pneumonia (p-value <0.001), and the need for mechanical ventilation (p-value <0.001) were significantly associated with mortality. A statistically significant (p-value=0.001) association was observed between the RISC score and mortality. Conclusions Addressable factors like the absence of exclusive breastfeeding, partial-immunization status, exposure to indoor smoke, and malnutrition were observed in infants with acute respiratory infections, which reinforces the importance of protective and preventive strategies for the control of pneumonia. The RISC score was observed to be beneficial in predicting mortality in an infant with acute respiratory infection. Triaging and early identification of infants at risk of mortality using this score could be very helpful in initiating timely treatment to reduce mortality, especially in resource-limited settings.
Language	English
Publishing date	2023-08-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.43100
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Article ; Online: Exploring the Skin Mycobiome in Very Preterm babies during the early neonatal period in a Neonatal Intensive Care Unit of India.

Shah, Pritik A / Govindarajan, Varun / Diggikar, Shivshankar / Rangaiah, Ambica / Devadas, Sahana / Kariyappa, Mallesh

Tropical doctor

2022 Volume 52, Issue 2, Page(s) 362–364

Abstract: The neonatal skin microbiome consists of all the genomes and genetic products of micro-organisms harbouring the skin of babies. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead ...

Abstract	The neonatal skin microbiome consists of all the genomes and genetic products of micro-organisms harbouring the skin of babies. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. Our study was conducted to explore the neonatal skin fungal microbiome of very preterm neonates admitted to Neonatal Intensive Care Unit at a tertiary health care setting using Next Generation Sequencing of the18S rRNA gene. The most abundant genera found in 22/30 samples were
MeSH term(s)	Candida/genetics ; Fungi/genetics ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Newborn, Diseases ; Intensive Care Units, Neonatal ; Mycobiome
Language	English
Publishing date	2022-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	193169-6
ISSN	1758-1133 ; 0049-4755
ISSN (online)	1758-1133
ISSN	0049-4755
DOI	10.1177/00494755221077520
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Article ; Online: Quality improvement initiative to improve the duration of kangaroo mother care for twin preterm neonates born at a tertiary care hospital in resource-limited settings.

Arora, Pihu / Kommalur, Anitha / Devadas, Sahana / Kariyappa, Mallesh / Rao, Suman P N

Journal of paediatrics and child health

2021 Volume 57, Issue 7, Page(s) 1082–1088

Abstract: Aim: Kangaroo mother care (KMC) can be challenging in multiple births and more so in resource-limited settings. This study aims at increasing the mean duration of KMC with early initiation in twin preterm neonates born at a tertiary care hospital using ... ...

Abstract	Aim: Kangaroo mother care (KMC) can be challenging in multiple births and more so in resource-limited settings. This study aims at increasing the mean duration of KMC with early initiation in twin preterm neonates born at a tertiary care hospital using a quality improvement (QI) initiative. Methods: Barriers for poor KMC practice in twin preterm neonates born at the tertiary care hospital were analysed and baseline data were collected over a period of 4 months using a predesigned proforma. A QI team was formed and suggested solutions were prioritised through focus group discussions in the form of Plan-Do-Study-Act (P-D-S-A) cycles. Each cycle was of one-month duration and three cycles were implemented, followed by the sustenance phase studied at 1-month post-implementation. Results: There were a total of 238 twin deliveries in the study period, of which 169 twin pairs were included in the study. At the end of implementation, the average day of initiation of KMC improved from 8th to 3rd day of life and the duration of KMC increased significantly from an average of 2.70 h/infant/day to 7.88 h/infant/day. Conclusion: This QI project focused on the improvement of KMC practice in twin preterm neonates in a tertiary care hospital where results were achieved with maximal utilisation of available hospital resources and low-cost interventions. This study design is generalizable to other hospitals in resource-limited settings where family participatory care can be strengthened to overcome the challenges of KMC in multiple births.
MeSH term(s)	Child ; Humans ; Infant, Newborn ; Kangaroo-Mother Care Method ; Quality Improvement ; Tertiary Care Centers
Language	English
Publishing date	2021-02-26
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1024476-1
ISSN	1440-1754 ; 1034-4810
ISSN (online)	1440-1754
ISSN	1034-4810
DOI	10.1111/jpc.15406
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Article ; Online: Mycobacterium Species on the Cutaneous Microbiome of Very Preterm Neonates.

Shah, Pritik A / Govindarajan, Varun / Rangaiah, Ambica / Diggikar, Shivashankar / Devadas, Sahana / Chunchanur, Sneha K / Shankar, Sathyanarayan Muthur / Das, Subhadeep / Kariyappa, Mallesh

Journal of tropical pediatrics

2022 Volume 68, Issue 2

Abstract: The neonatal skin microbiome consists of all the genomes and genetic products of microorganisms harboring on an infant's skin. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead ... ...

Abstract	The neonatal skin microbiome consists of all the genomes and genetic products of microorganisms harboring on an infant's skin. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. This study was conducted to understand the neonatal skin microbiome of very preterm neonates (under 32 weeks) admitted to the Neonatal Intensive Care Unit(NICU) at a tertiary healthcare setting before and after kangaroo mother care (KMC), using next-generation sequencing (NGS). Skin swabs were collected on two different occasions and analyzed using the NGS technique after amplification via polymerase chain reaction. The results showed relative abundance for Mycobacterium tuberculosis in 83.33% and 66.67% (p = 0.29) and Mycobacteroides abscessus in 100% and 93.33% (p = 0.30) of the very preterm neonates on the skin microbiome before and after KMC, respectively as an incidental finding. The mere presence of these bacilli as commensals or as potential pathogens is alarming due to the risk of early exposure and incidence of tuberculosis from birth. These findings, in our view, are the first findings to be established in such a setting.
MeSH term(s)	Child ; Humans ; Infant, Extremely Premature ; Infant, Newborn ; Intensive Care Units, Neonatal ; Kangaroo-Mother Care Method ; Microbiota ; Mycobacterium
Language	English
Publishing date	2022-02-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	800065-7
ISSN	1465-3664 ; 0449-3281 ; 0142-6338
ISSN (online)	1465-3664
ISSN	0449-3281 ; 0142-6338
DOI	10.1093/tropej/fmac020
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Article ; Online: Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India.

Damodar, Tina / Singh, Bhagteshwar / Prabhu, Namratha / Marate, Srilatha / Gowda, Vykuntaraju K / Lalitha, A V / Dsouza, Fulton Sebastian / Sajjan, Sushma Veeranna / Kariyappa, Mallesh / Kinhal, Uddhava V / Prathyusha, P V / Desai, Anita / Thennarasu, Kandavel / Solomon, Tom / Ravi, Vasanthapuram / Yadav, Ravi

Emerging infectious diseases

2023 Volume 29, Issue 4, Page(s) 711–722

Abstract: Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, ... ...

Abstract	Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.
MeSH term(s)	Humans ; Child ; Scrub Typhus/complications ; Scrub Typhus/diagnosis ; Scrub Typhus/epidemiology ; Acute Febrile Encephalopathy/diagnosis ; Acute Febrile Encephalopathy/epidemiology ; Acute Febrile Encephalopathy/etiology ; Orientia tsutsugamushi/genetics ; India/epidemiology ; Meningoencephalitis ; Immunoglobulin M
Chemical Substances	Immunoglobulin M
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2904.221157
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Article ; Online: Early congenital syphilis: missed opportunities in a mother owing to many problems during pregnancy - a case report.

Krishnapura Lakshminarayana, Shilpa / Devadas, Sahana / Bharath, K / Kariyappa, Mallesh / Byadarahalli Keshavamurthy, Bindushree / S Bagewadi, Megha / Veeranna Sajjan, Sushma / Vineet, Dadegal / Mohammed, Thanzir

Paediatrics and international child health

2022 Volume 42, Issue 2, Page(s) 89–94

Abstract: Untreated syphilis in pregnancy can result in an adverse outcome for the fetus. A multigravida woman with a previously poor obstetric history of early neonatal death, abortion and stillbirth was admitted in labour in the 7th month of pregnancy. On ... ...

Abstract	Untreated syphilis in pregnancy can result in an adverse outcome for the fetus. A multigravida woman with a previously poor obstetric history of early neonatal death, abortion and stillbirth was admitted in labour in the 7th month of pregnancy. On admission, syphilis screening with the qualitative rapid plasma reagin (RPR) test was negative. The infant had macules on the chest, abdomen and extremities, desquamating bullous skin lesions on the palms and soles, bilateral cataracts, an enlarged liver and spleen, anaemia, thrombocytopenia and conjugated hyperbilirubinaemia. A quantitative RPR test in the infant was positive in a 1:64 dilution and was subsequently positive in the mother in a 1:16 dilution after congenital syphilis was diagnosed. The mother later reported the father's high-risk behaviour and her previous visits to healthcare facilities for genital ulcers. The quantitative RPR test in the father was positive in a 1:32 dilution, and the parents and infant were treated for syphilis. The case demonstrates the importance of timely identification of high-risk pregnant women, early screening, repetition of the non-treponemal test on diluted serum when a routine screening test is negative, proper advice from the laboratory regarding selection of the most appropriate tests, and screening with the treponemal test first (reverse) algorithm utilising an automated enzyme immunoassay/chemiluminescence assay for the initial screening in high-risk cases, even in resource-limited settings to prevent a missed diagnosis.
MeSH term(s)	Female ; Humans ; Immunoglobulin M ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Mothers ; Penicillin G Benzathine ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Reagins ; Syphilis/diagnosis ; Syphilis, Congenital/diagnosis ; Syphilis, Congenital/prevention & control
Chemical Substances	Immunoglobulin M ; Reagins ; Penicillin G Benzathine (RIT82F58GK)
Language	English
Publishing date	2022-04-10
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2649065-1
ISSN	2046-9055 ; 2046-9047
ISSN (online)	2046-9055
ISSN	2046-9047
DOI	10.1080/20469047.2022.2044676
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