Browsing by Author "Om P. Mishra"

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Acute Kidney Injury in Children with Diabetic Ketoacidosis: Risk Factors and Outcome
(Springer, 2021) Om P. Mishra; Rajniti Prasad
[No abstract available]
Acute kidney injury in children with plasmodium falciparum malaria: Determinants for mortality
(Multimed Inc., 2016) Rajniti Prasad; Om P. Mishra
Background: Acute kidney injury (AKI) in P. falciparum malaria infection is an important morbidity in children. The purpose of the present study was done to observe the renal involvement, associated morbidities and outcome. ♦ Methods: Out of 156 patients with severe P. falciparum malaria, diagnosed on the basis of compatible clinical presentations and positive malarial parasites in the peripheral blood smear and/or histidine rich protein 2 antigen, 31 had AKI at presentation andwere analyzed. ♦ Results: Of 31 (19.9%) patients with AKI, 4 were classified at risk, 11 injury, and 16 failure stage, as per pRIFLE criteria (pediatric version of RIFLE [R = risk, I = injury, F = failure, L = loss E = end-stage kidney disease]). Mean age of children with AKI was 7.7 ± 3.2 years. A significantly higher proportion of patients with AKI had hypoglycemia (41.9%), pulmonary edema (32.2%), and disseminated intravascular coagulation (DIC) (29.0%) compared to those without AKI (18.4%, 4.8%, and 3.2%, respectively). Twelve patients (38.7%) required peritoneal dialysis (PD), 8 (25.8%) died, and all were in failure stage. The non-survivors had significantly higher blood urea (p = 0.005) and serum creatinine levels (p = 0.042), lower glomerular filtration rate (p < 0.001), longer duration of illness (p = 0.003), and oliguria/anuria (p = 0.001) than survivors at admission. On logistic regression analysis, the disseminated intravascular coagulation (DIC), jaundice and parasite density (≥ 3+) were found to be significant factors contributing to mortality in children with AKI. ♦ Conclusions: Acute kidney injury in falciparum malaria is one of the severe systemic complications. Duration of illness and presence of comorbidities adversely affected the outcome. © 2016 International Society for Peritoneal Dialysis.
Antioxidant status of children with idiopathic nephrotic syndrome
(2011) Om P. Mishra; Aditya K. Gupta; Rajniti Prasad; Ziledar Ali; Ram S. Upadhyay; Surendra P. Mishra; Narendra K. Tiwary; Franz S. Schaefer
The production of free radicals can cause renal injury and play an important role in the pathogenesis of idiopathic nephrotic syndrome. Markers of reactive oxygen species (ROS) were evaluated in 48 patients with active nephrotic syndrome (ANS) and 30 age- and gender-matched healthy children. Plasma malondialdehyde (MDA), protein carbonyl, nitrite, copper, zinc, selenium, ascorbic acid, and superoxide dismutase (SOD) levels were estimated in patients with ANS and controls. Measurements were repeated in 39 cases after achievement of remission, and in 10 other children who were in remission of >6 months' duration. Plasma MDA and nitrite levels were significantly higher and selenium was lower in ANS patients compared with controls. Plasma protein carbonyl, copper ascorbic acid, zinc, and superoxide dismutase levels were comparable in ANS patients and controls. Plasma copper level was significantly higher in active cases than in the remission and long-term remission groups. Selenium value showed a rise and then normalized in long-term remission. Among different sub-groups of ANS, no significant differences were found in the levels of various parameters, except plasma selenium, which was significantly lower in first-attack nephrotic syndrome (FANS) in comparison to infrequently relapsing nephrotic syndrome (IRNS) and frequently relapsing nephrotic syndrome (FRNS) patients. Thus, we observed evidence of oxidative stress and impaired antioxidant defense during acute nephrotic syndrome. Antioxidant status recovered completely only during long-term remission. © 2010 IPNA.
Behavioral problems in Indian children with epilepsy
(Springer India, 2017) Om P. Mishra; Aishvarya Upadhyay; Rajniti Prasad; Shashi K. Upadhyay; Satya K. Piplani
Objective: To assess prevalence of behavioral problems in children with epilepsy. Methods: This was a cross-sectional study of children with epilepsy, and normal controls enrolled between July 2013 to June 2015. Child Behavior Checklist (CBCL) was used as a tool to assess the behavior based on parents reported observation. Results: There were 60 children with epilepsy in 2-5 years and 80 in 6-14 years age groups, and 74 and 83 unaffected controls, respectively. Mean CBCL scores for most of the domains in children of both age groups were significantly higher than controls. Clinical range abnormalities were mainly detected in externalizing domain (23.3%) in 2-5 years, and in both internalizing (21.2%) and externalizing (45%) domains in children of 6-14 years. Younger age of onset, frequency of seizures and duration of disease had significant correlation with behavioral problems in both the age groups. Antiepileptic drug polytherapy was significantly associated with internalizing problems in older children. Conclusion: Age at onset, frequency of seizures and duration of disease were found to be significantly associated with occurrence of behavioral problems. © 2017, Indian Academy of Pediatrics.
Behavioural abnormalities in children with nephrotic syndrome
(Oxford University Press, 2010) Om P. Mishra; Biswanath Basu; Shashi K. Upadhyay; Rajniti Prasad; Franz Schaefer
Background. Glucocorticoid therapy in children with nephrotic syndrome can lead to many adverse effects including behavioural problems. The present study was undertaken to assess the changes in individual behaviour among different sub-groups of patients with idiopathic nephrotic syndrome (INS) and also to find out the relationship, if any, between different behavioural problems with cumulative dose of steroid therapy.Methods. This was a prospective hospital-based study. We assessed behavioural patterns in 131 children and adolescents with steroid-responsive INS aged 1.5-15 years. Fifty healthy children matched for age and gender were included to serve as controls. The Achenbach Child Behaviour Checklist was used to assess individual behaviour. Patients were sub-grouped according to age (1.5-5 and 6-15 years) and disease status (first attack before and after 12-week prednisolone, infrequent relapser, frequent relapser/steroid-dependent).Results. All groups had significantly elevated mean behavioural abnormality scores for dimensions assessed in both age groups, except rule-breaking behaviour. Besides sleep problems, frequent relapsers/steroid-dependent patients exhibited maximum scores in comparison to first attack and infrequent relapsers in the 1.5- to 5-year age group. Total and individual behavioural scores showed close associations with cumulative prednisolone dose in both groups.Conclusions. It is evident that nephrotic syndrome patients should be given due consideration in clinical practice for behavioural abnormalities especially after steroid therapy. © The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Behavioural abnormalities in children with new-onset nephrotic syndrome receiving corticosteroid therapy: results of a prospective longitudinal study
(Springer Verlag, 2016) Aishvarya Upadhyay; Om P. Mishra; Rajniti Prasad; Shashi K. Upadhyay; Franz Schaefer
Background: Corticosteroid therapy can cause behavioural abnormalities in children with nephrotic syndrome. The objective of this study was to explore the timing of the appearance of abnormalities in their first episode. Methods: Forty-five children with a first episode of idiopathic nephrotic syndrome (30 aged 2–5 and 15 aged 6–14 years) were assessed for behavioural problems using the Child Behaviour Checklist (CBCL) before, and after 6 and 12 weeks of oral steroid treatment. Sixty healthy children were included as controls. Results: In both age groups, marked abnormalities of externalising behaviour were noticed, specifically in the domains of aggressive behaviour and attention problems. Clinical range or borderline externalising abnormalities were present in 73 % of the younger children and 60 % of the schoolchildren after 6 weeks of treatment. In the schoolchildren, abnormal internalising behaviour was also noted at 6 weeks, in 40 % at borderline level and in 20 % within the clinical range. Elevated scores were observed for the anxious/depressed and withdrawn/depressed domains. Most changes persisted at the 12-week observation. Conclusions: Children of both age groups showed significant attention problems and aggressive and abnormal externalising behaviour within 6 weeks of starting treatment. Parents should be informed and counselled about this potential adverse effect of steroid therapy. © 2015, IPNA.
Can We Predict Relapses in Children with Idiopathic Steroid-Sensitive Nephrotic Syndrome?
(Oxford University Press, 2013) Om P. Mishra; Abhishek Abhinay; Rabindra N. Mishra; Rajniti Prasad; Martin Pohl
The objective of the present study was to find out the predictors of relapse. One hundred fifty children with a first episode of idiopathic nephrotic syndrome were followed for 12 months after initial treatment. Sixty-one (40.7%) children had no relapse, and 89 (59.3%) had relapses. A significantly higher proportion of children with disease onset between 1 and 3 years were relapsers in comparison with those with disease onset at 4-6 (p<0.03) and 7-13 (p<0.001) years. Risk of relapse was 2.99 times higher in this 1-3 year age-group as compared with patients aged >6 years (p=0.001). Children responding between 1 and 2 weeks after start of treatment had a 0.423 times lesser risk of relapse than those who responded after 4 weeks (p=0.023). Relapsers had significantly higher incidence of infection at relapse than at other time points (p<0.001). Onset of disease in younger age and delayed response to prednisolone therapy were found as significant predictors for relapse. © The Author [2013].
Cerebrospinal Fluid Leucine-Rich Alpha-2 Glycoprotein (LRG) Levels in Children with Acute Bacterial Meningitis
(Springer, 2022) Kushal Talukder; Rajniti Prasad; Abhisek Abhinay; Ankur Singh; Ragini Srivastava; Om P. Mishra; Tej Bali Singh
This study evaluated the diagnostic role of cerebrospinal fluid leucine-rich alpha-2 glycoprotein (CSF LRG) concentration in children with acute bacterial meningitis, and its role in differentiation from aseptic meningitis. CSF LRG concentration was measured by ELISA Kit of 50 children with bacterial meningitis, 16 aseptic meningitis, and 20 children with normal CSF; control. CSF LRG was significantly elevated (p < 0.001) in bacterial meningitis with a sensitivity, specificity, PPV, and NPV of 96%, 100%, 100%, and 90.9%, respectively at a cutoff of 110.0 ng/mL, based on ROC curve. At the same cutoff value, CSF LRG has sensitivity, specificity, PPV, and NPV of 96%, 75%, 92.3%, and 85.7%, respectively in differentiating bacterial from aseptic meningitis. However, sensitivity, specificity, PPV, and NPV at 139.9 ng/mL for differentiating between definite and probable bacterial meningitis were 88%, 75%, 79.1%, and 84.9%, respectively. CSF LRG should be used as a diagnostic biomarker for bacterial meningitis. © 2021, Dr. K C Chaudhuri Foundation.
Chronic Kidney Disease in Children: Magnitude of Problem and Challenges
(Springer India, 2017) Om P. Mishra; Rajniti Prasad
[No abstract available]
Coagulation status and platelet functions in children with severe falciparum malaria and their correlation of outcome
(2009) Rajniti Prasad; B.K. Das; Rahul Pengoria; Om P. Mishra; Jyoti Shukla; Tej B. Singh
This study was undertaken to observe the changes in coagulation and platelet profile, and findings were correlated with their outcome. Forty consecutive children with severe falciparum malaria were studied for their coagulation status, i.e. prothrombin time (PT), activated thromboplastin time (APTT), thrombin time (TT) and anti-thrombin-III (AT-III), platelet profile (platelet count, platelet aggregation with adenine diphosphate (ADP) and ADR and PF3 availability). Derangements in the coagulation profile in the form of increased PT, APTT and/or TT were seen in 47.5, 35 and 62.5% cases, respectively, but bleeding was seen in only six cases. Thrombocytopenia was found in 34 patients. Platelet aggregation with ADP and ADR revealed hypoaggregation in 95.3 and 97.5% cases, respectively, and were statistically significant. Platelet factor-3 availability was also significantly prolonged. Patients with prolonged PT, PF-3 and hypoaggregation with adrenaline had 1.4, 1.7 and 1.45 times higher risk of mortality. © The Author [2009]. Published by Oxford University Press. All rights reserved.
Cognitive and behaviour dysfunction of children with neurocysticercosis: A cross-sectional study
(Oxford University Press, 2014) Rajniti Prasad; Shambhavi; Om P. Mishra; Shashi K. Upadhyay; Tej B. Singh; Utpal Kant Singh
Eighty-three confirmed cases of neurocysticercosis diagnosed as per modified delBrutto criteria were enrolled in the study (Group-I) to observe cognitive and behavioural changes. Controls consisted of two groups: children with idiopathic generalized tonic-clonic seizure (Group-II) and normal children with non-specific cough (Group-III). Cases and controls were subjected to cognitive and behaviour assessment. There was significant difference in the intelligence quotient (IQ) of cases in domains of visual perception, immediate recall, analysis synthesis and reasoning, verbal ability, memory and spatial ability. In the age group of 6-18 years, cases had significantly more behaviour problems than control without seizure, in domains of anxious depressed, withdrawn depressed, somatic problems, social problems and rule-breaking behaviour. Neurocysticercosis causes decline in cognitive function and behaviours in older children, which should be recognized early for appropriate management and to avoid undue parental anxiety. © The Author [2014].
Congenital Anomalies of the Kidney and Urinary Tract: Challenges and Future Prospects
(Springer, 2020) Om P. Mishra; Rajniti Prasad
[No abstract available]
Desfechos de crianças com síndrome nefrótica idiopática córtico-resistente: um estudo observacional de centro único; [Outcomes of children with idiopathic steroid resistant nephrotic syndrome: a single centre observational study]
(Sociedade Brasileira de Nefrologia, 2023) Om P. Mishra; Minketan Sidar; Vineeta V. Batra; Rajniti Prasad; Ankur Singh; Abhishek Abhinay; Akash Mishra; Ashish K. Yadav
Introduction: Idiopathic steroid resistant nephrotic syndrome (SRNS) has variable outcomes in children. The primary objective of the present study was to assess the cumulative remission rate and the secondary objectives were to assess factors affecting the remission status, kidney function survival, and adverse effects of medications. Methods: One hundred fourteen patients with SRNS were included. Calcineurin inhibitor-based treatment protocol along with prednisolone and angiotensin-converting enzyme inhibitor were used, and patients were followed over 5 years. Results: Median age was 4.5 years; 53.5% of cases were between 1 to 5 years of age. Sixty-two patients (54.4%) were at initial stage and 52 (45.6%) were at a late SRNS stage. Median eGFRcr was 83.5 mL/min/1.73m2 at presentation. Of the 110 patients, 63 (57.3%) achieved remission [complete remission 30 (27.3%), partial remission 33 (30%)], and 47 (42.7%) had no remission. Kidney function survival was 87.3% and 14 cases (12.7%) had progression to CKD (G3-8, G4-3, G5-1, and G5D-2). Median duration of follow up was 36 months (IQR 24, 60). Age of onset, cyclosporine/tacrolimus, eGFRcr, and histopathology (MCD/FSGS) did not affect remission. Similarly, remission status in addition to age of onset, drug protocol, and histopathology did not significantly affect kidney function during a period of 5 years. Hypertension, cushingoid facies, short stature, cataract, and obesity were observed in 37.7, 29.8, 25.5, 17.5, and 0.7% of cases, respectively. Conclusion: About half of the cases achieved remission. Age of onset of disease, cyclosporine/tacrolimus use, and histopathological lesion neither affected remission status nor short-term kidney function survival in SRNS. © 2023 The Author(s).
Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy
(2012) Jyoti Agrawal; Gauri S. Shah; Prakash Poudel; Nirmal Baral; Ajay Agrawal; Om P. Mishra
Background: Perinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE) is a common problem causing multi organ dysfunction including myocardial involvement which can affect the outcome. Objective: To evaluate the myocardial dysfunction in neonates having HIE by electrocardiographic(ECG) and cardiac enzymes (CK Total, CK-MB and Troponin I) and find out the relationship with HIE and outcome. Design/Methods: This was a hospital based prospective study. Sixty term neonates who had suffered perinatal asphyxia and developed HIE were enrolled. Myocardial involvement was assessed by clinical, ECG, and CK Total, CK-MB and Troponin I measurements. Results: Of 60 cases, 13(21.7%) were in mild, 27(45%) in moderate and 20(33.3%) belonged to severe,HIE. ECG was abnormal in 46 (76.7%); of these 19 (41.3%) had grade I, 13 (28.2%) grades II and III each and 1 (2.1%) with grade IV changes. Serum levels of CK Total, CK- MB and Troponin I were raised in 54 (90%), 52 (86.6%) and 48 (80%) neonates, respectively. ECG changes and enzymatic levels showed increasing abnormalities with severity of HIE, and the differences among different grades were significant (p = 0.002, 0.02, <0.001 and 0.004, respectively). Nineteen (32%) cases died during hospital stay. The non- survivors had high proportion of abnormal ECG (p = 0.024), raised levels of CK-MB (p = 0.018) and Troponin I (p = 0.008) in comparison to survivors. Conclusions: Abnormal ECG and cardiac enzymes levels are found in HIE and can lead to poor outcome due to myocardial damage Early detection can help in better management and survival of these neonates. © 2012 Agarwal et al.; licensee BioMed Central Ltd.
Evaluation of Xpert MTB/RIF Assay for Diagnosis of Tuberculosis in Children
(Oxford University Press, 2019) Arghya Das; Shampa Anupurba; Om P. Mishra; Tuhina Banerjee; Rajneesh Tripathi
Introduction Childhood tuberculosis (TB) is now a global priority. With the advent of Xpert MTB/RIF, more TB cases in children are being reported. This study was undertaken to evaluate the performance of Xpert in diagnosis of pulmonary and extra-pulmonary TB in children. Methods Specimens from 171 suspected TB cases in children aged <15 years were tested with Xpert, culture and smear microscopy in the Department of Microbiology, Institute of Medical Sciences, India. Results The specimens included 106 gastric aspirates, 51 cerebrospinal fluids, 8 induced sputum and 6 lymph node aspirates. Xpert detected Mycobacterium tuberculosis in 19 cases (14 pulmonary and 5 extra-pulmonary), 7 of which were rifampicin-resistant. Sensitivity, specificity, positive predictive value and negative predictive value of Xpert compared with culture were 88.89, 98.04, 84.21 and 98.68%, respectively. The sensitivity was 100% in children aged 1-5 years and 6-10 years and in gastric aspirates. Conclusion Xpert is an efficient diagnostic tool in childhood tuberculosis. © 2018 The Author(s).
Fibroblast Growth Factor 23 Level and Cardiovascular Parameters in Children with Chronic Kidney Disease
(Springer, 2022) Gaurav Singh; Om P. Mishra; Abhishek Abhinay; Vikas Agarwal; Surendra P. Mishra; Amitnandan D. Dwivedi; Ankur Singh; Rajniti Prasad; Rabindra N. Mishra
Objective: To find out the serum fibroblast growth factor 23 (FGF-23) levels in different grades of CKD, and the prevalence of abnormal left ventricular mass index (LVMI), carotid intima–medial thickness (cIMT), and central pulse wave velocity (cPWV) and the risk factors including FGF-23 for these abnormalities. Methods: Fifty-nine patients of CKD with G2 to G5, aged 2–18 y were included. The LVMI, cIMT, and cPWV were measured using standard techniques, and serum intact FGF-23 levels were estimated at enrollment. Results: Median FGF-23 levels were significantly raised in all the grades of CKD than controls (p < 0.001), and also in G4 and G5 in comparison to G2&3 and in G5D than G5. Increased LVMI in 42 (71.2%), elevated cIMT in 30 (57.7%), and cPWV in 14 (26.9%) patients were found. The FGF-23 showed significant negative correlation with eGFRcr and positive with serum iPTH, phosphate and alkaline phosphatase levels, but had no correlations with LVMI, cIMT SDS, and cPWV SDS. Only systolic BP SDS (odds ratio 1.5, 95% CI 1.008–2.231, p = 0.046) was observed as a significant predictor for increased cIMT, while no variables had any association with abnormal LVMI and cPWV. Conclusions: Serum FGF-23 showed higher levels with increasing grades of CKD, but no significant association with cardiovascular parameters. Systolic BP SDS was found as a significant risk factor for increased cIMT in children with CKD. © 2021, Dr. K C Chaudhuri Foundation.
Focal segmental glomerulosclerosis in primary Sjögren’s syndrome: a rare presentation
(Springer Science and Business Media Deutschland GmbH, 2024) Om P. Mishra; Ankur Singh; Rajniti Prasad
[No abstract available]
Galactose treatment in focal and segmental glomerulosclerosis
(Springer Verlag, 2014) Om P. Mishra; Arun K. Singh
[No abstract available]
Lymphocyte adenosine deaminase activity in children with idiopathic nephrotic syndrome
(2005) Om P. Mishra; Jayant Ghosh; Ziledar Ali; Malay Sen; Rajniti Prasad
Adenosine deaminase (ADA) activity, as a marker of cell-mediated immunity, was evaluated in the serum (S-ADA) and lymphocytes (L-ADA) of 47 children with idiopathic nephrotic syndrome, and 23 healthy controls. The mean S-ADA and L-ADA levels were significantly raised in active nephrotic syndrome (ANS) and in its sub-groups in comparison with controls. The ADA activity was significantly more elevated in relapsers than for the first attack of nephrotic patients, and the frequent relapsers had the highest enzymatic levels both in serum as well as lymphocytes. A significant positive correlation was found between serum and lymphocyte ADA levels (r=0.736, p<0.01). In remission, the S-ADA showed a significant fall in comparison with their corresponding ANS value (p <0.001) and reached the level of controls. The mean L-ADA also showed reduction but the difference was statistically insignificant and the value was significantly raised, when compared with controls. The enzyme activity in serum and lymphocytes normalized in the long-term remission group. Thus, ADA activity was abnormal in ANS cases, and L-ADA demonstrated change both in active as well as remission stage of the disease. © IPNA 2005.
Managing Children With Renal Diseases During the COVID-19 Pandemic
(Springer, 2020) Anil Vasudevan; Mukta Mantan; Sriram Krishnamurthy; Priya Pais; Georgie Mathew; Pankaj Hari; Madhuri Kanitkar; Sanjeev Gulati; Arvind Bagga; Om P. Mishra
The Coronavirus outbreak is a rapidly evolving pandemic, placing unprecedented strain on health-care systems. COVID-19 presents challenges for management of children with renal diseases, especially those receiving long-term immunosuppressive medications, including renal transplant recipients and those with chronic kidney disease and acute kidney injury requiring dialysis. Our preparedness for managing this vulnerable group of children is the need of the hour. The purpose of this article is to provide guidance to caregivers and health care personnel involved in management of children with renal diseases and to ensure patient well-being, while protecting staff from infection. © 2020, Indian Academy of Pediatrics.