Sandeep Kanwal

Followers

Following

Co-author

Public Views

Uploads

Papers by Sandeep Kanwal

Comparison of Two New Generation Pulse Oximeters with Arterial Oxygen Saturation in Critically Ill Children: Correspondence

Indian Journal of Pediatrics, May 14, 2015

Download

Congenital Central Hypoventilation Syndrome with PHOX2B Gene Mutation: Are We Missing the Diagnosis?

Indian Journal of Pediatrics, Jul 25, 2012

Congenital Central Hypoventilation Syndrome is a rare disorder of autonomic and central nervous s... more Congenital Central Hypoventilation Syndrome is a rare disorder of autonomic and central nervous system dysfunction with impaired control of breathing. The authors report a 37-d-old girl infant with recurrent apnea requiring repeated mechanical ventilation with no evidence of neuromuscular, cardiac or lung disease. A mutation analysis of PHOX2B gene revealed 25 polyalanine repeat expansion mutation on chromosome 4p12. This article aims at raising awareness among pediatricians about molecular basis and availability of confirmatory genetic testing for diagnosis and to help with prognosis in this disorder.

Download

Viswas chhapola, Sandeep Kumar Kanwal, pallavi Joshi, Virendra Kumar Use of liquid heparin for blood gas sampling in PICU: A comparative study of effects of varying volumes of heparin on blood gas parameters accepted by Indian J Critic Care Med 2013, 17(6): 350-56

Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study

Cureus, 2021

The aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk... more The aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk Indian women in active labor and its association with early-onset neonatal sepsis (EONS) and puerperal sepsis. Methods The study was conducted prospectively from October 2018 to March 2020 in a tertiary hospital in New Delhi, India. Low-risk pregnant women (N=920) in active labor with intact membranes were recruited. High vaginal swabs were collected, cultured by standard methods to detect aerobic bacteria. The primary outcomes were the development of puerperal sepsis and EONS. Results In a total of 920 low-risk subjects, vaginal colonization was found in 484 (52.6%), coagulase-negative Staphylococcus being the predominant colonizer (13.2%) followed by Escherichia coli (8.9%). Multigravida women were at 1.4 times higher risk of colonization than primigravida (odds ratio [OR] 1.399; 95% CI 1.064, 1.84). Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination (OR 0.34; 95% CI 0.241, 0.481). The incidence of colonization increased with progressive vaginal examinations (p<0.001). None of the colonized women and their neonates developed puerperal sepsis or EONS, respectively. Conclusion Vaginal colonization of aerobic bacteria in active labor is not associated with an increased risk of puerperal sepsis or EONS.

Download

Predictors of poor outcome in children with steroid sensitive nephrotic syndrome

Nefrología (English Edition), 2018

Background and objective: Nearly 50% of the children with steroid sensitive nephrotic syndrome (S... more Background and objective: Nearly 50% of the children with steroid sensitive nephrotic syndrome (SSNS) have a frequently relapsing (FR) or steroid dependent (SD) course, experiencing steroid toxicities and complications of immunosuppression. The study aimed to compare parameters between children with infrequent relapsing (IFR) and FR/SD nephrotic syndrome and to identify the factors associated with a FR/SD course. Methods: A retrospective analysis of medical records from 2009 to 2014, of children with SSNS attending the pediatric nephrology clinic in a tertiary care medical college and hospital. Results: Out of 325 children (226 males) with SSNS, 213 were IFR and 112 were FRNS/SDNS. The median age of onset was 34 (IQR 24-48) months. The median time to the first relapse was 4 (IQR 3-7) months and 6 (IQR 4-12) months in FR/SD and IFR group respectively. Multivariate logistic regression analysis showed "adequate treatment (≥12 weeks) of the first episode" (odds ratio 0.56, 95% CI 0.34-0.91; p value = 0.02) and "shorter median time to the first relapse"

format_quoteFirst relapse occurring within 5.5 months predicts FR/SD course, underlining the need for early intervention.format_quote

Download

Chondrodysplasia Punctata with Severe Airway Stenosis

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2018

Chondrodysplasia punctata (CDP) is a group of skeletal dysplasias characterized primarily by punc... more Chondrodysplasia punctata (CDP) is a group of skeletal dysplasias characterized primarily by punctate calcifications in cartilage. It is a rare disease with an incidence of 1:100,000 live births. Extensive airway involvement with calcification of tracheal, bronchial, and thyroid cartilage in CDP is an infrequent finding. We aim to report a case of CDP with characteristic radiological features and severe airway involvement.

Download

$Research paper thumbnail of {"__content__"=>"Hepatomyoencephalopathy Secondary to Poisoning: Report of Three Cases from North India.", "i"=>{"__content__"=>"Cassia occidentalis"}}$

{"__content__"=>"Hepatomyoencephalopathy Secondary to Poisoning: Report of Three Cases from North India.", "i"=>{"__content__"=>"Cassia occidentalis"}}

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2018

is an annual tropical shrub causing toxicity in cattle. However, human case reports of its poison... more is an annual tropical shrub causing toxicity in cattle. However, human case reports of its poisoning are scarce. We, here, report three young children, residents of Western Uttar Pradesh in North India, who presented with lethargy, jaundice, and altered sensorium after consumption of Cassia seeds. The toxidrome was defined as hepatomyoencephalopathy. The children were resuscitated, managed for acute liver failure, and subsequently discharged without sequel. Although few studies have previously documented this association, this is the first such case series documenting a direct causal relationship of Cassia to hepatomyoencephalopathy syndrome. Public and clinician awareness regarding this syndrome mimicking viral encephalitis has the potential to prevent further outbreaks.

Download

Neonatal exchange transfusions at a tertiary care centre in north India: an investigation of historical trends using change-point analysis and statistical process control

International health, Jan 4, 2018

The need for exchange transfusion (ET) as a treatment modality for neonatal hyperbilirubinaemia d... more The need for exchange transfusion (ET) as a treatment modality for neonatal hyperbilirubinaemia declined in developed countries with the advent of effective phototherapy. The trends of ET from India are unknown. Our objective was to investigate the trends of ET in India. Retrospective data (January 2006-December 2016) was collected on total outborn neonatal admissions and ET procedures from a centre in north India. A combination of change-point analysis (CPA) and statistical process control (SPC) was used to investigate the trends of ET. During the study period, a total of 39 217 outborn neonates were admitted and 1575 (4%) underwent 1816 ET procedures. The CPA unravels four critical change points (October 2009, May 2011, September 2011 and November 2014) in ET rates. An SPC chart showed a decline in mean ET rate from 89.3 (upper control limit [UCL] 176.9, lower control limit [LCL] 1.7)/1000 neonatal admissions at the start of the study to 7.7 (UCL 34.6, LCL 0)/1000 at the end of th...

format_quoteThe study concludes with a progressive decline in neonatal ET procedures over 11 years, offering strong evidence for care improvements.format_quote

Download

Novel fructose bisphosphatase 1 gene mutation presenting as recurrent episodes of vomiting in an Indian child

Journal of postgraduate medicine

Fructose-1, 6-bisphosphatase 1 (FBP1) deficiency is an autosomal recessive disorder of gluconeoge... more Fructose-1, 6-bisphosphatase 1 (FBP1) deficiency is an autosomal recessive disorder of gluconeogenesis resulting in severe and recurrent life-threatening episodes of hypoglycemia and lactic acidosis in infancy. We report a 16 month-old girl who presented with recurrent episodes of vomiting, rapid breathing, lactic acidosis, hyperuricemia, and hypertriglyceridemia. Genetic analysis revealed a novel compound heterozygous mutation in FBP1 gene confirming the diagnosis of FBP1 deficiency. The patient was managed with treatment of acute episodes and preventive long-term dietary modifications. Long-term prognosis of FBP1 deficiency is excellent underlining the importance of early recognition of clinical signs, prompt diagnosis, and avoidance of fasting in this disease. FBP1 gene mutations have been described from various ethnic backgrounds, but there is limited data available from Indian population, hence the importance of this case.

Are normative sonographic values of kidney size in children valid and reliable? A systematic review of the methodological quality of ultrasound studies using the Anatomical Quality Assessment (AQUA) tool

Journal of nephrology, 2018

A plethora of research is available on ultrasonographic kidney size standards. We performed a sys... more A plethora of research is available on ultrasonographic kidney size standards. We performed a systematic review of methodological quality of ultrasound studies aimed at developing normative renal parameters in healthy children, by evaluating the risk of bias (ROB) using the 'Anatomical Quality Assessment (AQUA)' tool. We searched Medline, Scopus, CINAHL, and Google Scholar on June 04 2018, and observational studies measuring kidney size by ultrasonography in healthy children (0-18 years) were included. The ROB of each study was evaluated in five domains using a 20 item coding scheme based on AQUA tool framework. Fifty-four studies were included. Domain 1 (subject characteristics) had a high ROB in 63% of studies due to the unclear description of age, sex, and ethnicity. The performance in Domain 2 (study design) was the best with 85% of studies having a prospective design. Methodological characterization (Domain 3) was poor across the studies (< 10% compliance), with subo...

Download

Intravenous Anti-D immunoglobulin for control of life threatening bleed in dengue hemorrhagic fever with severe thrombocytopenia

Journal of Pediatric Infectious Diseases, 2015

We report an eight-year-old girl with Dengue Hemorrhagic Fever, shock and a life-threatening uppe... more We report an eight-year-old girl with Dengue Hemorrhagic Fever, shock and a life-threatening upper gastrointestinal and pulmonary bleed with refractory thrombocytopenia. She received 6 units of random donor platelets, 1 unit of single donor platelets, 1 unit of packed red cells and 4 units of fresh frozen plasma to control bleeding but had no response. Finally, 36 hour after onset of bleed intravenous Anti-D 75 µg/kg was given and she had a dramatic increase in platelet counts and cessation of all clinical bleed. This case report highlights that intravenous Anti-D can be a treatment option in Dengue Hemorrhagic Fever with severe refractory thrombocytopenia and massive bleeding.

An interrupted time series analysis showed suboptimal improvement in reporting quality of trial abstract

Journal of Clinical Epidemiology, 2016

To assess and compare the immediate and long-term change in reporting quality of randomized contr... more To assess and compare the immediate and long-term change in reporting quality of randomized controlled trial (RCT) abstracts published in Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics before and after the publication of Consolidated Standards of Reporting Trial (CONSORT)-abstract statement. Study had &quot;Interrupted time-series&quot; design. Eligible RCT abstracts were retrieved by PubMed search in two study periods from January 2003 to December 2007 (pre-CONSORT) and January 2010 to December 2014 (post-CONSORT). These abstracts were matched with the CONSORT checklist for abstracts. The primary outcome measure was CONSORT-abstract score defined as number of CONSORT items correctly reported divided by 18 and expressed as percentage. The mean percentage scores were used to compare reporting quality between pre- and post-CONSORT using segmented linear regression. A total of 424 RCT abstracts in pre-CONSORT and 467 in post-CONSORT were analyzed. A significant change in slope of regression line between two time periods (0.151 [confidence interval CI, 0.004-0.298], P = 0.044) was observed. Intercepts did not show a significant difference (-2.39 [CI, 4.93-0.157], P = 0.065). The overall reporting quality of RCT abstracts in the high-impact pediatrics journals was suboptimal (&lt;50%); however, it improved when assessed over a 5-year period, implying slow but gradual adoption of guideline.

Reporting standards for Bland-Altman agreement analysis in laboratory research: a cross-sectional survey of current practice

Annals of clinical biochemistry, Jan 11, 2014

To carry out a cross-sectional survey of the medical literature on laboratory research papers pub... more To carry out a cross-sectional survey of the medical literature on laboratory research papers published later than 2012 and available in the common search engines (PubMed, Google Scholar) on the quality of statistical reporting of method comparison studies using Bland-Altman (B-A) analysis. Fifty clinical studies were identified which had undertaken method comparison of laboratory analytes using B-A. The reporting of B-A was evaluated using a predesigned checklist with following six items: (1) correct representation of x-axis on B-A plot, (2) representation and correct definition of limits of agreement (LOA), (3) reporting of confidence interval (CI) of LOA, (4) comparison of LOA with a priori defined clinical criteria, (5) evaluation of the pattern of the relationship between difference (y-axis) and average (x-axis) and (6) measures of repeatability. The x-axis and LOA were presented correctly in 94%, comparison with a priori clinical criteria in 74%, CI reporting in 6%, evaluation...

format_quoteOnly 6% of studies correctly reported Bland-Altman plot axes and limits of agreement, highlighting significant deficiencies in reporting standards.format_quote

Download

High prenatal and postnatal lead exposure associated lead encephalopathy in an infant

Indian journal of pediatrics, 2011

An 11-month-old child presented with persistent seizures requiring ventilator support. The child ... more An 11-month-old child presented with persistent seizures requiring ventilator support. The child had global developmental delay, was staying in the premises of battery manufacturing unit, had microcytic and hypochromic anemia with basophilic stripling on peripheral smear, lead line on radiograph of the long bones and BLL of 244 μg/dl. The CT scan of the brain revealed cerebral atrophy. The mother also had high BLL and lead line in the radiograph of the long bones. The child was managed with chelation therapy. Given the continuing lead exposure among occupational and general populations in India, this case study highlights the need for prompt environmental preventive actions as well as nutritional and preventive counseling for occupational populations.

Download

Clinical profile of diabetic ketoacidosis in Indian children

Indian journal of pediatrics, 2012

To study the clinical profile of the Indian children admitted with DKA. This descriptive retrospe... more To study the clinical profile of the Indian children admitted with DKA. This descriptive retrospective study was conducted in pediatric ICU of tertiary level care hospital at Delhi (between Jan 2008 and Jan 2010). The case records of 55 children admitted with DKA were reviewed and information with respect to the personal details, clinical features, laboratory parameters, management and outcome was recorded using a predesigned performa.The data was analyzed using SPSS version 16. The mean age of patients at presentation was 7.4±3.9 y; 27 boys and 28 girls were enrolled. Diabetes was newly diagnosed in 56.4% patients and 43.6% were known cases of diabetes. Polyuria and polydipsia (54.5%), persistent vomiting (52.7%), altered sensorium (50.9%), abdominal pains (47.3%) were common presenting symptoms. Most of the children had dehydration at admission, one fourth being severe. Hypernatremia, hypokalemia, cerebral edema and renal failure were observed in 20%, 14.5%, 14.5% and 7.2% , respe...

Download

Post-diphtheritic neuropathy: a clinical study in paediatric intensive care unit of a developing country

Tropical doctor, 2012

A retrospective study was done on 48 consecutive patients with clinical diagnosis of post-diphthe... more A retrospective study was done on 48 consecutive patients with clinical diagnosis of post-diphtheritic neuropathy admitted to the paediatric intensive care unit of tertiary care hospital in North India between January 2008 and December 2010 to study the clinical profile of post-diphtheritic neuropathy in children. The case records were reviewed and information regarding personal details, clinical features, recovery parameters and outcome was recorded using a predesigned proforma. Median age was 4.25 years. All cases were unimmunized. Median latency period was 15 days. Of the children, 52% had palatal palsy whereas 48% had limb weakness initially. Median duration of progression of weakness was five days. Limb muscle weakness was present in 94%. Respiratory muscles were involved in 85.4% cases and 60.4% required mechanical ventilation, while 14.6% had fatal outcome and 10.4% had hypoxic neurological injury. Boys were affected more. Median duration of latency was shorter; muscle weakne...

A Comparative Study on Reliability of Point of Care Sodium and Potassium Estimation in a Pediatric Intensive Care Unit

The Indian Journal of Pediatrics, 2013

To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point... more To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer. This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software. Mean sodium measured on the BGA was 132.8 ± 12.2 mmol/L where as measured by AA was 141.5 ± 11.1 mmol/L. The mean difference between the two was -8.76 mmol/L (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The difference was statistically significant in all three subgroups of hypernatremia, isonatremia and hyponatremia (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Potassium level in BGA was 3.53 ± 0.81 mmol/L and AA was 4.28 ± 1.05 mmol/L. The mean difference between the BGA and AA was -0.75 mmol/L (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The difference was statistically significant in patients with normokalemia and hyperkalemia (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The difference was non significant in patients with hypokalemia (p = 0.051). Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.

Predictors of Altered Sensorium at Admission in Children with Diabetic Ketoacidosis

The Indian Journal of Pediatrics, 2014

Download

Hyponatremic-Hypertensive Syndrome: Think of Unilateral Renal Artery Stenosis

The Indian Journal of Pediatrics, 2012

Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder, in which hypertension is associ... more Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder, in which hypertension is associated with profound hyponatremia. It is mostly encountered in adults with unilateral renal artery stenosis. Although renovascular hypertension is one of the commonest causes for severe hypertension in children, HHS is rarely reported in childhood. The authors report a 9-y old boy with hypertensive emergency and severe hyponatremia due to unilateral renal artery stenosis who was successfully managed by vascular stenting of the affected vessel. Prompt recognition of this disorder can be life-saving and can subsequently lead to appropriate referral and treatment as in the present case.

Hepatomyoencephalopathy due to Cassia occidentalis Poisoning

The Indian Journal of Pediatrics, 2012

Download

Sandeep Kanwal

Uploads

Papers by Sandeep Kanwal

Log In