Vijai Williams

Shaikh Khalifa Medical City

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Muralidharan Jayashree

Post Graduate Institute of Medical Education and Research

Karthi Nallasamy

Post Graduate Institute of Medical Education and Research

Suresh Kumar Angurana

Post Graduate Institute of Medical Education and Research

Arun Bansal

Post Graduate Institute of Medical Education and Research

Arun Baranwal

Post Graduate Institute of Medical Education and Research

Amit Rawat

Post Graduate Institute of Medical Education and Research

Sunit Singhi

Biogen (United States)

Rajalakshmi Iyer

All India Institute of Medical Sciences Rishikesh

Pratibha Singhi

Post Graduate Institute of Medical Education and Research

Javed Ismail

Shaikh Khalifa Medical City

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Post Graduate Institute of Medical Education and Research

Creative Commons

Institute of Post Graduate Medical Education and Research

All India Institute of Medical Sciences

Institute of Medical Sciences

All India Institute of Medical Sciences Raipur

St.John's Medical College Hospital

All India Institute of Medical Sciences Bhopal

Medanta The Medicity

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Dengue guidelines – Is it time for an update?

JOURNAL OF PEDIATRIC CRITICAL CARE (2021)

Vijai Williams

10.4103/jpcc.jpcc_77_21

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Probiotics do have a role to play in treating critically ill children

Acta Paediatrica (2018)

Vijai Williams Suresh Kumar Angurana

None.

10.1111/apa.14510

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Citations (4)

What the Mind Does Not Know, the Eyes Do Not See!

Clinical Pediatrics (2019)

Rajalakshmi Iyer Vijai Williams Karthi Nallasamy Muralidharan Jayashree Arun Baranwal

10.1177/0009922819864589

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Time of Pediatric Intensive Care Unit Admission and Mortality: A Systematic Review and Meta-Analysis

Journal of Pediatric Intensive Care (2019)

Vijai Williams Nishant Jaiswal Anil Chauhan Pranita Pradhan Muralidharan Jayashree

Abstract The aim of this study was to determine the association between the time of admission (day, night, and/or weekends) and mortality among critically ill children admitted to a pediatric intensive care unit (PICU). Electronic databases that were searched include PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Ovid, and Cochrane Library since inception till June 15, 2018. The article included observational studies reporting inhospital mortality and the time of admission to PICU limited to patients aged younger than 18 years. Meta-analysis was performed by a frequentist approach with both fixed and random effect models. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the quality of evidence. Ten studies met our inclusion criteria. Five studies comparing weekday with weekend admissions showed better odds of survival on weekdays (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.60–0.99). Pooled data of four studies showed that odds of mortality were similar between day and night admissions (OR: 0.93; 95% CI: 0.77–1.13). Similarly, three studies comparing admission during off-hours versus regular hours did not show better odds of survival during regular hours (OR: 0.77; 95% CI: 0.57–1.05). Heterogeneity was significant due to variable sample sizes and time period. Inconsistency in adjusting for confounders across the included studies precluded us from analyzing the adjusted risk of mortality. Weekday admissions to PICU were associated with lesser odds of mortality. No significant differences in the odds of mortality were found between admissions during day versus night or between admission during regular hours and that during off-hours. However, the evidence is of low quality and requires larger prospective studies.

Odds

CINAHL

10.1055/s-0039-3399581

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Citations (15)

Management of isolated thyroid swellings: a prospective six year study of fine needle aspiration cytology in diagnosis.

BMJ (1990)

Eleri Cusick C A Macintosh Z H Krukowski Vijai Williams S. W. B. Ewen

OBJECTIVE--To audit the accuracy and impact on the frequency of operation of fine needle aspiration cytology of isolated thyroid swellings. DESIGN--Prospective analysis over six years of cytological predictions compared with histological findings. SETTING--Thyroid clinic serving the Grampian region. PATIENTS--395 Consecutive patients presenting with an isolated thyroid swelling, 307 of whom underwent surgical excision. Analysis was confined to a subgroup of 283 patients with satisfactory aspirates who were operated on. RESULTS--The positive predictive value of aspiration cytology for detecting malignant disease was 100% and the sensitivity 83%. The sensitivity for the detection of neoplasia (frank malignancy together with follicular adenomas) was 76%. The specificity was 58% and the overall accuracy 69%. Recalculation of data in previous papers with strict criteria showed the accuracy of aspiration cytology to be variable and lower than is widely accepted. Since the introduction of aspiration cytology 21% fewer operations for isolated thyroid swellings have been performed. CONCLUSIONS--As a basis of selection for surgical excision of isolated thyroid swellings according to prediction of neoplasia fine needle aspiration cytology is less reliable than is widely accepted. It is an adjunct to management rather than a definitive test, and negative cytological results do not exclude neoplastic disease. Further study should take account of the implications of repeated clinic attendances for review and aspiration as these may culminate in delayed surgical treatment.

Thyroid disease

Thyroid Nodules

10.1136/bmj.301.6747.318

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Citations (90)

Pediatric Diabetes and Diabetic Ketoacidosis After COVID-19: Challenges Faced and Lessons Learnt

Pediatric Health Medicine and Therapeutics (2023)

Ashish Agarwal Deepankar Bansal Karthi Nallasamy Muralidharan Jayashree Vijai Williams

Abstract: The coronavirus disease (COVID-19) pandemic affected the management and follow-up of several chronic ailments, including pediatric type 1 diabetes mellitus (T1DM). Restricted access to healthcare and fear of contracting the virus during medical facility visits resulted in poor compliance, irregular follow-up visits, treatment, and delayed diagnosis of complications in pediatric diabetes such as diabetic ketoacidosis (DKA). As such, the incidence of complicated DKA in resource-limited settings is high due to delayed presentation, poor compliance with therapy, and associated comorbidities such as malnutrition and sepsis. The pandemic had only added to the woes. The increased surge in DKA, in the face of limited resources, prompted clinicians to find alternative solutions to manage these children effectively. In this narrative review, we discuss the key challenges faced globally while caring for children with T1DM and DKA during the COVID-19 pandemic, and the lessons learned thereof. Keywords: SARS-CoV-2, COVID-19, diabetes, ketoacidosis, pediatrics

Diabetic ketoacidosis

Pandemic

Ketoacidosis

10.2147/phmt.s384104

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Citations (5)

Congenital bathing trunk nevus with meningomyelocele

Indian Dermatology Online Journal (2019)

Vijai Williams Vichithra Mohandoss Namita Ravikumar Karthi Nallasamy

Sir, A 3-day-old female neonate, first born to non-consanguineous parents with unsupervised antenatal period was brought with paucity of movements of the lower limbs and a black skin lesion with ulcerated mass protruding through the midline in the lower back noted since birth. She did not have urinary dribbling or retention. At the time of presentation, child was noted to have elevated hyperpigmented lesion with thick hair measuring 15 × 10 cm involving entire posterior torso suggestive of congenital bathing trunk nevus surrounding the meningomyelocele as shown in Figure 1. Initial screening in form of the ultrasound of cranium was normal. Child underwent meningomyelocele repair. Currently child is asymptomatic; and, magnetic resonance imaging (MRI) brain has been planned on follow up.Figure 1: Hyperpigmented giant hairy nevus surrounding the meningomyelocele with satellite lesion noted over buttock areaCongenital bathing trunk nevus is a rare lesion with female preponderance and an incidence of one in 2–5 lakh births. Though named congenital as it is noticed soon after birth, it is not hereditary and occurs due to somatic mutations in NRAS (chromosome 1p13) and BRAF gene.[1] A strong association exists between congenital giant melanocytic nevus, neurofibromas, lipomas, and neural tube defects (NTD).[2] Congenital nevus is said to be giant when it covers >2% of body surface area or 5 cm in neonates or 20 cm in adults. Lesions may be small in infants and grow proportionately as the body grows. It can occur anywhere on the body with predilection over trunk and is associated with pigmented satellite lesions. It may be flat or raised, hypo- or hyperpigmented, and color may change over time with majority (95%) being associated with thick hair in the lesion. Age of presentation varies; adult presentation is seen when they develop multiple nodules (lipoma, neurofibroma) or when it ulcerates (sclerotic variant of melanoma) while adolescents and girls present for cosmetic reasons. Neurocutaneous melanosis (NCM) and malignant melanoma are the two most important complications.[3] NCM is characterized by proliferation of melanocytes present in the meninges of brain and spinal cord and present as headache, seizures, movement abnormalities, and brain tumors. Risk of malignant melanoma is 2–5 times higher and occurs in the first 5–10 years of life.[4] High-risk lesions for malignant transformation include those with size >20 cm, satellite lesions and multiple (>3) lesions. Bathing trunk nevus needs continuous follow-up to monitor for signs of malignant transformation. Surgical excision of high-risk lesions is best performed in early childhood.[5] Many non-surgical procedures have been tried and each has its own limitations. Serial excision with tissue expansion is the mainstay of treatment of bathing trunk nevus. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Congenital melanocytic nevus

10.4103/idoj.idoj_256_18

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Clinico-laboratory profile, intensive care needs, treatment details, and outcome of Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): A systematic review and Meta-analysis

medRxiv (Cold Spring Harbor Laboratory) (2020)

Vijai Williams Nabaneeta Dash Renu Suthar Vichithra Mohandoss Nishant Jaiswal

Abstract Objectives To synthesize the current data on clinico-laboratory features, intensive care needs, treatment, and outcome of Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C). Data Sources Articles published in PubMed, Web of Science, Scopus, Google Scholar, and WHO COVID-19 research database, CDC database, and Cochrane COVID-19 study register between 1 st December 2019 to 10 th July 2020. Study Selection Observational studies involving patients ≤21 years with PIMS-TS or MIS-C, that reported the clinico-laboratory features, intensive care needs, treatment, and outcome. Data Extraction The search identified 422 citations and finally 18 studies with 833 participants were included and pooled estimate was calculated for parameters of interest utilising random effect model. Data Synthesis The median age was 9 (8-11) years. Fever, gastrointestinal symptoms, rash, conjunctival injection, and respiratory symptoms were common clinical features. Majority had positive SARS-CoV-2 antibody test and only 1/3 rd had RT-PCR positive. The commonest laboratory abnormalities were elevated CRP, D-dimer, procalcitonin, BNP, fibrinogen, ferritin, troponin, and IL-6; and lymphopenia, hypoalbuminemia, and thrombocytopenia. The cardiovascular complications included shock (65%), myocardial dysfunction (61%), myocarditis (65%), and coronary artery abnormalities (39%). Three-fourth children required admission in PICU for mechanical ventilation (25%) and vasoactive drugs (61%). The common treatment provided was IVIG (82%), steroids (54%), antiplatelet drugs (64%), and anticoagulation (51%). The mortality was low (n=13). Conclusion Fever, gastrointestinal and mucocutaneous symptoms, cardiac dysfunction, shock, and hyperinflammation are common manifestations of PIMS-TS or MIS-C. The short-term outcome is good with supportive intensive care and immunomodulatory treatment.

Procalcitonin

10.1101/2020.10.21.20217034

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Citations (7)

Acute Kidney Injury in Children With Diabetic Ketoacidosis: A Real Concern

Pediatric Critical Care Medicine (2019)

Biraj Parajuli Suresh Kumar Angurana Mullai Baalaaji Vijai Williams

Parajuli, Biraj DM; Kumar Angurana, Suresh DM, FCCP, FIMSA; Baalaaji, Mullai DM; Williams, Vijai DM Author Information

Diabetic ketoacidosis

Ketoacidosis

10.1097/pcc.0000000000001928

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Citations (8)

P0028 / #1687: “VITAMIN K DEFICIENCY BLEEDING (VKDB) IN CHILDREN - INTENSIVE CARE NEEDS AND PREDICTORS OF IN-HOSPITAL MORTALITY, A TEN-YEAR SINGLE CENTER EXPERIENCE

Pediatric Critical Care Medicine (2021)

P Awasthi Muralidharan Jayashree Vijai Williams Karthi Nallasamy Sunit Singhi

Aims & Objectives: Vitamin K deficiency bleeding (VKDB) is a common and preventable cause of spontaneous intracranial hemorrhage (SICH) among infants. It is associated with significant morbidity and mortality. Data regarding VKDB is limited. Methods:Design: Single center retrospective observational study (January 2009- July 2019). Setting: PICU of a tertiary care teaching hospital of North India. Case records of 47 children with VKDB, aged 1 to 12 months, admitted to PICU were analysed. Primary outcome: In-hospital mortality. Variables with respect to demography, clinical features, site of bleed, treatment modality (conservative versus surgical), and PICU needs were compared between survivors and non survivors to determine predictors of outcome. Results: The median (IQR) age of subjects was 6.5 (1.5, 12) monthsMedian (IQR) Glasgow Coma Scale (GCS) at admission was 9 (6, 13); GCS <8 was seen in 22 children (46%) SDH (n=12, 25.5%), and multi(n=9, 19.1%).longer duration of symptoms before hospitalization (OR 0.35; CI:0.27-4.3,p=0.004), need for mechanical ventilation (OR 0.99,CI: 0.95-1.04, p=0.03), shock (OR 2.8; CI: 1.9-4.3, p= 0.02), and vasoactive support (OR2.9, CI; 0.8-10.5,p=0.01)were predictors of poor outcome.On multivariable analysis, shock (OR-2.8; CI: 1.9-4.3, p= 0.02) was an independent predictor of mortality. Age, site of bleed and decompressive craniectomy did not affect outcome. Conclusions: VKDB is common cause of SICH among infants. Longer duration of symptoms prior to hospitalization, need for mechanical ventilation, shock and vasoactive support were poor prognostic factors

Bleed

10.1097/01.pcc.0000738456.25364.03

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