Browsing by Author "Kini, Sandesh"
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Publication Clinical and Immunological Spectrum of Systemic Lupus Erythematosus in Children(Nepal Paediatric Society (JNPS), 2020) Kini, Sandesh; Y, Ramesh Bhat; Thunga, Chennakeshava; Shashidhara, Sowmya; Anand, AkshathaAbstract: Introduction: Systemic Lupus Erythematosus (SLE) is an auto immune disorder affecting mainly adolescent females and young women of reproductive age. The disease is characterised by widespread inflammation of blood vessels and connective tissues due to the presence of anti-nuclear antibodies (ANA). There are limited number of studies from South India on paediatric lupus. Our objectives were to study the clinical and immunological features of childhood SLE along with treatment modalities and its outcome at the end of one year follow up. The correlation between various auto-antibodies and systemic involvement was also assessed. Methods: This was a retrospective observational study carried out in paediatric unit at a tertiary care centre in South India. Data was obtained through patient’s medical records. From April 2003 to April 2019, 32 children were diagnosed to have SLE as per the American college of Rheumatology 1997 criteria. Results: The study population included 32 children fulfilling the criteria. Female to male ratio was 4.3:1. The mean age at diagnosis was 11.52 years. The most common clinical manifestations were renal (87.5%) followed by haematological (81.3%), musculoskeletal (59.4%), mucocutaneous (53.1%) and nervous system (31.3%) involvement. All patients were positive for anti-nuclear antibodies. Anti-double stranded DNA (78.1%) was the most common auto-antibody profile followed by anti-ribosomal p protein (37.5%) and anti-nucleosome antibody (37.5%). During the follow up, 13 (40.6%) children attained complete remission, 10 (31.2%) went into partial remission and nine (28.1%) had persisting active disease. Conclusion: The clinical spectrum and outcome of paediatric SLE depends upon the age of presentation and number of organ systems involved at the time of diagnosis. Our study throws light on various aspects of SLE in children from developing countries like India.Publication Clonidine Toxicity: One or More Tablets can be Dangerous in Toddlers(Nepal Paediatric Society (JNPS), 2019) Kini, Sandesh; Y, Ramesh Bhat; Kousika, Phalguna; Thunga, ChennakeshavaAbstract: Clonidine was a popular anti-hypertensive drug during the 1970s but is less commonly used now. In children clonidine is used to treat attention deficit hyperactive disorder (ADHD). We report a toddler who accidentally ingested 0.3 mg of clonidine and developed respiratory failure with hypotension requiring ventilatory support and inotropes but recovered completely within one week. In any case scenario, when a previously healthy child presents with sudden onset respiratory failure, we should keep a high index of suspicion of clonidine use by anyone at home and its easy accessibility to the child.Publication Hypothyroidism Causing Precocious Puberty and Ovarian Torsion(Nepal Paediatric Society (JNPS), 2019) Kini, Sandesh; Y, Ramesh Bhat; Kousika, Phalguna; Thunga, Chennakeshava; Handattu, Koushik; Karegowda, Lakshmikanth HalegubbiAbstract: Hypothyroidism in children causes delayed puberty. However longstanding untreated hypothyroidism can lead to precocious puberty which may be secondary to hyperprolactinemia or increased levels of thyroid stimulating hormone (TSH), enhancing the sensitivity of ovaries to circulating gonadotropins. Here we report a seven and half years old girl with hypothyroidism presenting with precocious puberty and multicystic ovaries which responded well to thyroid hormone supplementation but subsequently developed left ovarian torsion requiring surgical intervention.Publication Spectrum of Influenza B Viral Infection in Indian Children: A Tertiary Centre Experience Authors(Nepal Paediatric Society (JNPS), 2018) Kini, Sandesh; Y, Ramesh Bhat; Handattu, Koushik; Kousika, Phalguna; Thunga, ChennakeshavaAbstract: Introduction: Influenza viral infection in children can range from subclinical illness to multi system involvement. The morbidity associated with influenza B viral infection is often overlooked. India being the second most populous country, accounts for 20% of global childhood deaths from respiratory infections. There is paucity of data on the clinical features and complications of influenza B viral infections in children from the Indian subcontinent. Our objective was to study the clinical profile, seasonality, complications and outcome associated with Influenza B viral infection in children < 18 years of age. Material and Methods: We conducted a retrospective observational study at a tertiary care hospital in South India. Children less than 18 years of age admitted to our paediatric unit were included in the study. We reviewed the case sheets of 56 patients who tested positive for influenza B virus during the study period and recorded their clinical and laboratory data. Throat swab obtained from cases were tested by RT-PCR. The illness was classified as upper respiratory tract infection, pneumonia and severe pneumonia. Outcome measures analysed were- mortality, need for oxygen supplementation or assisted ventilation, duration of oxygen support, duration of ICU/ hospital stay and time for defervescence following initiation of oseltamivir therapy. Results: The mean age of the study population was 6.98 years. Majority of the affected children were > 5 years of age in the school going category with a male to female ratio of 3:2. The diagnosis based on clinical and radiological findings included upper respiratory tract infection (URTI) in 44 (78.5%) cases followed by pneumonia in 11(19.6%) and severe pneumonia in one (1.7%) child. The peak incidence was in the month of March. Malnutrition was the most common risk factor affecting 22 (39.3%) cases followed by history of asthma in eight (14.3%). Three children required oxygen supplementation at admission. The median duration of hospital stay was seven days. The median duration for defervescence following initiation of oseltamivir therapy was 24 hours. Mortality was recorded in one infant who died of acute respiratory distress syndrome. Conclusions: Influenza B virus should be screened in all children having underlying high risk medical condition, presenting with pneumonia or upper respiratory tract infection. Oseltamivir therapy should be initiated early in the management of influenza B viral infections to prevent complications.Publication The Efficacy and Safety of Once Daily versus Twice Daily Dosing of Caffeine Citrate in Apnea of prematurity: a Randomised Control Trial(Nepal Paediatric Society (JNPS), 2022) Syed, Farooq; Kini, Sandesh; Majeed, AbdulAbstract: Introduction: Caffeine citrate is widely used for prevention of apnea of prematurity and helps in successful extubation from mechanical ventilation. The optimum caffeine dose in preterm infants with apnea of prematurity has been extensively investigated with varied results. The objective of our study was to compare the efficacy and safety of once versus twice daily maintenance dose of caffeine citrate in premature infants with apnea. Methods: In this study, preterm neonates with gestational age of 28 to 34 weeks, with evidence of apnea of prematurity were included. Both groups received a 20 mg / kg loading dose of caffeine citrate followed by a maintenance dose of 2.5 mg / kg every 12-hour-interval in group 1 and 5 mg / kg every 24-hour-interval in group 2, either orally or by intravenous infusion. Response to treatment, duration to achieve full feeds, possible adverse reactions were evaluated and compared among the two groups. Results: Among two groups, group 1 had early reduction in number of apneic episodes on five consecutive days after loading dose, which was statistically significant. Time taken to establish full feeds following treatment initiation was lower in group 1 compared to group 2 (median: Two vs four days) which was statistically significant. Conclusions: In this study, neonates who received twice daily maintenance dose of caffeine citrate had better outcomes in terms of early reduction in number of apneic episodes and early feed establishment when co.