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Article: Cardiac findings in multisystem inflammatory syndrome in children: Short term follow up in a large Indian series.

Shah, Sejal Suresh / Naidu, Praveen Kumar K / Selvam, Sumithra / Shetty, Rakshay / Bhat, Chandrika S / Maheshwari, Sunita

Annals of pediatric cardiology

2023 Volume 16, Issue 2, Page(s) 94–101

Abstract: Background: We present a large Indian series of Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) infection. The aim of the study is to present the incidence and pattern of cardiac involvement in ... ...

Abstract	Background: We present a large Indian series of Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) infection. The aim of the study is to present the incidence and pattern of cardiac involvement in children with MIS-C and their short-term follow-up. Methods and results: Consecutive 144 children younger than 18 years of age diagnosed with MIS-C referred for cardiac evaluation between June 1 and November 30, 2021, were included and were followed up till February 2022. In addition to the demographics, details of COVID-19 infection, and biomarkers, their cardiovascular assessment (echocardiogram and electrocardiogram) was documented at baseline and on follow-up. The median age of children with MIS-C was 60 (24-104) months. Abnormal cardiac imaging was noted in 59% of children. Ventricular dysfunction was noted in 13.9% and coronary abnormalities were noted in 25.7% of children. The median duration when the first cardiac abnormality was reported was 7 (5-10) days. The distribution of age categories between children with and without cardiac abnormality was comparable. Children with cardiac abnormalities were followed up for a median duration of 47 (30-58) days. Complete resolution was documented in 92% of children after a median duration of 20 (9-38) days. There were no readmissions or deaths during follow-up. Conclusion: Cardiac involvement in children with MIS-C is frequent with coronary abnormalities and ventricular dysfunction being the most common manifestations. Most children exhibit complete clinical and myocardial recovery with appropriate anti-inflammatory therapy. Studies on long-term outcome of these children are needed.
Language	English
Publishing date	2023-08-16
Publishing country	India
Document type	Journal Article
ZDB-ID	2430956-4
ISSN	0974-5149 ; 0974-2069
ISSN (online)	0974-5149
ISSN	0974-2069
DOI	10.4103/apc.apc_121_22
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Article ; Online: Anakinra in Refractory Multisystem Inflammatory Syndrome in Children (MIS-C).

Bhat, Chandrika S / Shetty, Rakshay / Ramesh, Deepak / Banu, Afreen / Ramanan, Athimalaipet V

Indian pediatrics

2021 Volume 58, Issue 10, Page(s) 994–996

MeSH term(s)	COVID-19/complications ; Child ; Humans ; Ichthyosiform Erythroderma, Congenital ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome
Chemical Substances	Interleukin 1 Receptor Antagonist Protein
Language	English
Publishing date	2021-10-12
Publishing country	India
Document type	Journal Article
ZDB-ID	402594-5
ISSN	0974-7559 ; 0019-6061
ISSN (online)	0974-7559
ISSN	0019-6061
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Article ; Online: Hyperinflammatory Syndrome in Children Associated With COVID-19: Need for Awareness.

Bhat, Chandrika S / Gupta, Latika / Balasubramanian, S / Singh, Surjit / Ramanan, Athimalaipet V

Indian pediatrics

2020 Volume 57, Issue 10, Page(s) 929–935

Abstract: The pandemic of COVID-19 initially appeared to cause only a mild illness in children. However, it is now apparent that a small percentage of children can develop a hyperinflammatory syndrome labeled as Pediatric inflammatory multisystem syndrome - ... ...

Abstract	The pandemic of COVID-19 initially appeared to cause only a mild illness in children. However, it is now apparent that a small percentage of children can develop a hyperinflammatory syndrome labeled as Pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS). Features of this newly recognized condition may include persistent fever, evidence of inflammation, and single or multi-organ dysfunction in the absence of other known infections. Some of these children may share features of Kawasaki disease, toxic shock syndrome or cytokine storm syndrome. They can deteriorate rapidly and may need intensive care support as well. The PCR test is more often negative; although, most of the children have antibodies to SARS-CoV-2. Although the pathogenesis is not clearly known, immune-mediated injury has been implicated. We herein provide current information on this condition, in order to raise awareness amongst pediatricians.
MeSH term(s)	Adolescent ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; Coronavirus Infections ; Female ; Humans ; Infant ; Infant, Newborn ; Macrophage Activation Syndrome ; Male ; Mucocutaneous Lymph Node Syndrome ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	India
Document type	Journal Article
ZDB-ID	402594-5
ISSN	0974-7559 ; 0019-6061
ISSN (online)	0974-7559
ISSN	0019-6061
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Article: Hyperinflammatory Syndrome in Children Associated With COVID-19: Need for Awareness

Bhat, Chandrika S / Gupta, Latika / Balasubramanian, S / Singh, Surjit / Ramanan, Athimalaipet V

Indian Pediatr

Abstract	The pandemic of COVID-19 initially appeared to cause only a mild illness in children. However, it is now apparent that a small percentage of children can develop a hyperinflammatory syndrome labeled as Pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS). Features of this newly recognized condition may include persistent fever, evidence of inflammation, and single or multi-organ dysfunction in the absence of other known infections. Some of these children may share features of Kawasaki disease, toxic shock syndrome or cytokine storm syndrome. They can deteriorate rapidly and may need intensive care support as well. The PCR test is more often negative; although, most of the children have antibodies to SARS-CoV-2. Although the pathogenesis is not clearly known, immune-mediated injury has been implicated. We herein provide current information on this condition, in order to raise awareness amongst pediatricians.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #656489
Database	COVID19

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Article ; Online: Artificial intelligence for interpretation of segments of whole body MRI in CNO: pilot study comparing radiologists versus machine learning algorithm.

Bhat, Chandrika S / Chopra, Mark / Andronikou, Savvas / Paul, Suvadip / Wener-Fligner, Zach / Merkoulovitch, Anna / Holjar-Erlic, Izidora / Menegotto, Flavia / Simpson, Ewan / Grier, David / Ramanan, Athimalaipet V

Pediatric rheumatology online journal

2020 Volume 18, Issue 1, Page(s) 47

Abstract: Background: To initiate the development of a machine learning algorithm capable of comparing segments of pre and post pamidronate whole body MRI scans to assess treatment response and to compare the results of this algorithm with the analysis of a panel ...

Abstract	Background: To initiate the development of a machine learning algorithm capable of comparing segments of pre and post pamidronate whole body MRI scans to assess treatment response and to compare the results of this algorithm with the analysis of a panel of paediatric radiologists. Methods: Whole body MRI of patients under the age of 16 diagnosed with CNO and treated with pamidronate at a tertiary referral paediatric hospital in United Kingdom between 2005 and 2017 were reviewed. Pre and post pamidronate images of the commonest sites of involvement (distal femur and proximal tibia) were manually selected (n = 45). A machine learning algorithm was developed and tested to assess treatment effectiveness by comparing pre and post pamidronate scans. The results of this algorithm were compared with the results of a panel of radiologists (ground truth). Results: When tested initially the machine algorithm predicted 4/7 (57.1%) examples correctly in the multi class model, and 5/7 (71.4%) correctly in the binary group. However when compared to the ground truth, the machine model was able to classify only 33.3% of the samples correctly but had a sensitivity of 100% in detecting improvement or worsening of disease. Conclusion: The machine learning could detect new lesions or resolution of a lesion with good sensitivity but failed to classify stable disease accurately. However, further validation on larger datasets are required to improve the specificity and accuracy of the machine model.
MeSH term(s)	Adolescent ; Artificial Intelligence ; Bone Density Conservation Agents/therapeutic use ; Chronic Disease ; Disease Progression ; Femur/diagnostic imaging ; Humans ; Image Interpretation, Computer-Assisted/methods ; Machine Learning ; Magnetic Resonance Imaging ; Osteitis/diagnostic imaging ; Osteitis/drug therapy ; Pamidronate/therapeutic use ; Pilot Projects ; Radiologists ; Sensitivity and Specificity ; Support Vector Machine ; Tibia/diagnostic imaging ; Treatment Outcome ; Whole Body Imaging
Chemical Substances	Bone Density Conservation Agents ; Pamidronate (OYY3447OMC)
Language	English
Publishing date	2020-06-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-020-00442-9
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Article ; Online: Chronic non bacterial osteitis- a multicentre study.

Bhat, Chandrika S / Anderson, Catriona / Harbinson, Aoibhinn / McCann, Liza J / Roderick, Marion / Finn, Adam / Davidson, Joyce E / Ramanan, Athimalaipet V

Pediatric rheumatology online journal

2018 Volume 16, Issue 1, Page(s) 74

Abstract: Objective: To understand the demographics, clinical features and treatment outcomes of Chronic Non-bacterial Osteitis (CNO) from three tertiary paediatric rheumatology services in the United Kingdom.: Methods: Children less than 18 years of age ... ...

Abstract	Objective: To understand the demographics, clinical features and treatment outcomes of Chronic Non-bacterial Osteitis (CNO) from three tertiary paediatric rheumatology services in the United Kingdom. Methods: Children less than 18 years of age diagnosed with CNO between 2001 to 2016 from one tertiary service and between 2001 to 2017 from two tertiary services were included. Clinical notes were reviewed and all pertinent data were collected on a pre-defined proforma. One hundred and thirty one patients were included in the study. The Bristol diagnostic criteria were applied retrospectively. Results: Retrospective analysis of the data showed that the disease was more common in girls than boys (2.5:1), median age at onset of symptoms was 9.5 years (IQR 8 to 11 years). Bone pain was the predominant symptom in 118/129 (91.4%) followed by swelling in 50/102 (49.01%). Raised inflammatory markers were present in 39.68% of the patients. Whole body Magnetic Resonance Imaging (MRI) was a useful diagnostic tool. Metaphyses of long bones were most often involved and the distal tibial metaphyses 65/131 (49.6%) was the most common site. Non-steroidal anti-inflammatory drugs were used as first line (81.67%) followed by bisphosphonates (61.79%). Treatment was escalated to a TNF blocker when response to bisphosphonates was suboptimal. The disease was in remission in 82.4% of the patients during the last follow up. Conclusion: Our multicentre study describes features and outcomes of CNO in a large number of patients in the United Kingdom. Significance and innovation: Raised inflammatory markers were present in 39.68% of our patients. Whole body MRI is useful for diagnosis and also determining response to treatment. A greater number of lesions were detected on radiological imaging compared to clinical assessment. Metaphyses of long bones were most often involved and the distal tibial metaphyses (49.6%) were the most common site. Non-steroidal anti-inflammatory drugs were used as first line (81.67%) followed by bisphosphonates (61.79%). There was no difference in number of medications used for management in unifocal versus multifocal disease. TNF blockers were used with good effect in our cohort.
MeSH term(s)	Adolescent ; Bone and Bones/pathology ; Child ; Child, Preschool ; Chronic Disease ; Female ; Humans ; Male ; Osteitis/diagnosis ; Osteitis/drug therapy ; Osteomyelitis/diagnosis ; Osteomyelitis/drug therapy ; Retrospective Studies ; United Kingdom
Language	English
Publishing date	2018-11-22
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-018-0290-5
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Article ; Online: Unusual presentation of immature teratoma of the neck: A rare case report.

Shetty, K Jayaprakash / Kishan Prasad, H L / Rai, Sandeep / Kumar, Y Sunil / Bhat, Shubha / Sajjan, Netra / Rao, Chandrika

Journal of cancer research and therapeutics

2015 Volume 11, Issue 3, Page(s) 647

Abstract: Cervical region teratoma is a rare disease, accounting for 3-5% of all teratomas in the children. Teratomas of the head and neck due to their obscure origin, unpredictable behavior, and often manifest as a clinical surprise. Airway obstruction is the ... ...

Abstract	Cervical region teratoma is a rare disease, accounting for 3-5% of all teratomas in the children. Teratomas of the head and neck due to their obscure origin, unpredictable behavior, and often manifest as a clinical surprise. Airway obstruction is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of the neck masses that could obstruct the airway. We present a case of 4-month-old female child at age of 4 th month with right submandibular region swelling. Computed tomography neck showed ill-defined, multiloculated cystic lesion with enhancing thick septations in the right side of the neck. Excision biopsy revealed Grade I--immature teratoma--cervical region. On 1-year of close follow-up, no evidence of local recurrence or metastasis was seen. Unlike adults, teratomas in children are often congenital and very rarely turn malignant. The treating consultant should be aware of their natural history, clinical features, pathology, and principles of management.
MeSH term(s)	Female ; Head and Neck Neoplasms/diagnostic imaging ; Head and Neck Neoplasms/pathology ; Humans ; Infant ; Radiography ; Teratoma/diagnostic imaging ; Teratoma/pathology
Language	English
Publishing date	2015-07
Publishing country	India
Document type	Case Reports ; Letter
ZDB-ID	2187633-2
ISSN	1998-4138 ; 0973-1482
ISSN (online)	1998-4138
ISSN	0973-1482
DOI	10.4103/0973-1482.137994
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Article: Relationship between neurological outcome and early oxidative changes in erythrocytes in head injury patients.

Nayak, Chandrika / Nayak, Dinesh / Bhat, Surekha / Raja, Annaswamy / Rao, Anjali

Clinical chemistry and laboratory medicine

2007 Volume 45, Issue 5, Page(s) 629–633

Abstract: Background: Experimental data indicate that destructive oxidative events reach their peak within the first 24 h after trauma in head injury (HI) and that brain damage occurring due to this impact can be the cause of death or irreversible permanent ... ...

Abstract	Background: Experimental data indicate that destructive oxidative events reach their peak within the first 24 h after trauma in head injury (HI) and that brain damage occurring due to this impact can be the cause of death or irreversible permanent disabilities in affected patients. Methods: Venous blood samples were obtained from 50 HI patients within 24 h of trauma onset and from 30 age- and sex-matched normal controls (NC). Patients were divided into three different neurological outcome groups: those who died within 10 days of trauma (D), and those with severe neurological deficits (SD) or mild/no neurological deficits (MD) at 90 days after trauma. Early oxidative changes in erythrocytes were assessed by estimating an indicator of lipid peroxidative damage - thiobarbituric acid-reactive substances (TBARS) - and antioxidants [reduced glutathione (GSH) levels and superoxide dismutase (SOD) activity]. Results: In the D group, erythrocyte TBARS levels were significantly higher compared to the NC, SD and MD groups (p<0.001); GSH levels were significantly lower compared to the NC (p<0.001) and MD (p<0.01) groups and SOD activity was significantly higher than in the NC (p<0.01) and MD (p<0.01) groups. In the SD group, TBARS levels were significantly higher than in the NC (p<0.001) and MD (p<0.05) groups; GSH levels were significantly lower than in the NC (p<0.001) and MD (p<0.01) groups and SOD activity was higher compared to the NC and MD (p<0.01) groups. In the MD group, TBARS levels were significantly higher and GSH levels significantly lower compared to the NC group (p<0.001). However, we did not observe any significant change in SOD activity compared to the NC group. Conclusions: These findings indicate that early oxidative changes may reflect the severity of neurological insult and provide an early indication of patient outcome in traumatic HI.
MeSH term(s)	Adult ; Antioxidants/analysis ; Case-Control Studies ; Craniocerebral Trauma/blood ; Craniocerebral Trauma/complications ; Craniocerebral Trauma/diagnosis ; Craniocerebral Trauma/mortality ; Erythrocytes/metabolism ; Female ; Glutathione/blood ; Humans ; Lipid Peroxidation ; Male ; Nervous System Diseases/diagnosis ; Nervous System Diseases/etiology ; Oxidation-Reduction ; Predictive Value of Tests ; Severity of Illness Index ; Superoxide Dismutase/blood ; Thiobarbituric Acid Reactive Substances/analysis
Chemical Substances	Antioxidants ; Thiobarbituric Acid Reactive Substances ; Superoxide Dismutase (EC 1.15.1.1) ; Glutathione (GAN16C9B8O)
Language	English
Publishing date	2007
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/CCLM.2007.123
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Article ; Online: Multi-centre national audit of juvenile localised scleroderma: describing current UK practice in disease assessment and management.

Pediatric rheumatology online journal

2018 Volume 16, Issue 1, Page(s) 80

Abstract: Objective: To describe current United Kingdom practice in assessment and management of patients with juvenile localised scleroderma (JLS) compared to Paediatric Rheumatology European Society (PRES) scleroderma working party recommendations.: Methods: ...

Abstract	Objective: To describe current United Kingdom practice in assessment and management of patients with juvenile localised scleroderma (JLS) compared to Paediatric Rheumatology European Society (PRES) scleroderma working party recommendations. Methods: Patients were included if they were diagnosed with JLS and were under the care of paediatric rheumatology between 04/2015-04/2016. Retrospective data was collected in eleven UK centres using a standardised proforma and collated centrally. Results: 149 patients were included with a median age of 12.5 years. The outcome measures recommended by the PRES scleroderma working party were not utilised widely. The localised scleroderma cutaneous assessment tool was only used in 37.6% of patients. Screening for extracutaneous manifestations did not meet recommendations that patients with head involvement have regular screening for uveitis and baseline magnetic resonance imaging (MRI) brain: only 38.5% of these patients were ever screened for uveitis; 71.2% had a MRI brain. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) or biologics was widely used (96.0%). In keeping with the recommendations, 95.5% of patients were treated with methotrexate as first-line therapy. 82.6% received systemic corticosteroids and 34.2% of patients required two or more DMARDs/biologics, highlighting the significant treatment burden. Second-line treatment was mycophenolate mofetil in 89.5%. Conclusion: There is wide variation in assessment and screening of patients with JLS but a consistent approach to systemic treatment within UK paediatric rheumatology. Improved awareness of PRES recommendations is required to ensure standardised care. As recommendations are based on low level evidence and consensus opinion, further studies are needed to better define outcome measures and treatment regimens for JLS.
MeSH term(s)	Adolescent ; Antirheumatic Agents/therapeutic use ; Child ; Clinical Audit ; Female ; Glucocorticoids/therapeutic use ; Humans ; Male ; Mass Screening/statistics & numerical data ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Scleroderma, Localized/diagnosis ; Scleroderma, Localized/drug therapy ; Societies, Medical ; United Kingdom
Chemical Substances	Antirheumatic Agents ; Glucocorticoids
Language	English
Publishing date	2018-12-18
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-018-0295-0
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