Indian pediatrics最新文献

{"title":"Recurrent Acute Liver Failure and Early Chronic Liver Disease in an Infant with CALFAN Syndrome.","authors":"Aswanth Ks, Sailen Kumar Bana, Akanksha Singh, Neelam Mohan","doi":"10.1007/s13312-026-00436-y","DOIUrl":"https://doi.org/10.1007/s13312-026-00436-y","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up Outcomes of 100 Children with Frequently Relapsing and Steroid Dependent Nephrotic Syndrome Treated with Oral Cyclophosphamide: A Retrospective Cohort Study.","authors":"Sangeetha Bharathy Cn, Ramachandran Ramge Sivakumar, Bobbity Deepthi, Sudarsan Krishnasamy, Darshan Rangaswamy, Sriram Krishnamurthy","doi":"10.1007/s13312-026-00435-z","DOIUrl":"https://doi.org/10.1007/s13312-026-00435-z","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective was to estimate the proportion of children with frequently relapsing nephrotic syndrome (FRNS) and steroid-dependent nephrotic syndrome (SDNS) responding to oral cyclophosphamide, while secondary objectives were to document adverse effects, evaluate relapse-free survival following therapy, and assess outcomes at the last follow-up.</p><p><strong>Methods: </strong>In this retrospective cohort study, 100 children aged 1-18 years with FRNS or SDNS who received oral cyclophosphamide (cumulative dose ≤168 mg/kg) between 2010 and 2023 at a pediatric nephrology clinic were included. Demographic characteristics, previous treatments, adverse effects, and relapse patterns were retrieved from medical records. Response was defined as being relapse-free and off steroids for ≥6 months after completion of cyclophosphamide therapy, while sustained remission was defined as absence of relapse for ≥2 years.</p><p><strong>Results: </strong>The median (q1, q3) age at onset of nephrotic syndrome was 4 (2.5, 6) years, and oral cyclophosphamide was initiated at 8 (7, 10) years. The response rate to oral cyclophosphamide was 67%, with a median (q1, q3) relapse-free interval of 9.1 (3.9, 24.7) months. Adverse effects occurred in 28%, most commonly nail discoloration (28 cases), followed by transient leukopenia (4 cases). During follow-up, 56% required an alternative steroid-sparing agent. At a median (q1, q3) follow-up of 72.5 (25.5, 107.25) months, 28% achieved sustained remission, while 69% had infrequent relapses.</p><p><strong>Conclusion: </strong>Oral cyclophosphamide is effective in children with FRNS and SDNS, inducing sustained remission in a significant proportion and suggesting a prolonged therapeutic effect. However, many children require additional immunosuppressive therapy during follow-up.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Severe Acute Kidney Injury by Positive Renal Angina Index and Cystatin C in Children with Septic Shock: A Diagnostic Accuracy Study.","authors":"Anilkumar J S, Daisy Khera, Aliza Mittal, Jitendra Meena, Bharat Choudhary, Siyaram Didel, Kuldeep Singh, Mithu Banerjee, Nisha Toteja, Prem Prakash Sharma","doi":"10.1007/s13312-026-00431-3","DOIUrl":"https://doi.org/10.1007/s13312-026-00431-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive performance of Renal Angina Index (RAI) for the development of severe acute kidney injury (AKI) in children with septic shock and to compare its performance with serum and urine cystatin C.</p><p><strong>Methods: </strong>This diagnostic accuracy study enrolled 60 consecutive children admitted to the Pediatric Intensive Care Unit (PICU) with septic shock. The primary outcome was the proportion of children with positive RAI who developed severe AKI within seven days of admission. Secondary outcomes included comparing the performance of RAI with serum and urine cystatin C for early prediction of severe AKI, and evaluating its predictive ability for the need for renal replacement therapy (RRT), mechanical ventilation (MV), and 28-day mortality.</p><p><strong>Results: </strong>Renal angina index was positive in 29 (48.3%) patients. Positive RAI showed a sensitivity of 81.8% and specificity of 92.6%, with an area under the receiver operating characteristic curve (AUROC) of 0.81(95% CI, 0.69-0.90) for predicting severe AKI. The AUROCs of serum and urine cystatin C were 0.89 (95% CI, 0.86-0.99) and 0.72 (95% CI, 0.60-0.84), respectively. The combination of RAI and serum cystatin C yielded an AUROC of 0.99 (95% CI, 0.98-1.00). The AUROCs of RAI for predicting need for RRT, MV, and mortality were 0.84 (95% CI, 0.71-0.96), 0.73 (95% CI, 0.59-0.86) and 0.74 (95% CI, 0.58-0.89), respectively.</p><p><strong>Conclusion: </strong>Renal angina index has good accuracy for predicting severe AKI within seven days of admission in children presenting with septic shock. RAI combined with serum cystatin C provides better predictability for severe AKI.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic Closure of Bronchopleural Fistula Using Silver Nitrate in a Child with Post-Tubercular Lung Sequelae and Necrotizing Pneumonia.","authors":"Kamal Kumar Singhal, Aysha Dilsha M, Vikas Yadav, Pratap S Yadav, Soumya Tiwari","doi":"10.1007/s13312-026-00430-4","DOIUrl":"https://doi.org/10.1007/s13312-026-00430-4","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Guideline on Prioritized Issues for the Management of Empyema Thoracis in Children.","authors":"Joseph L Mathew, Dipti Aggarwal, Sanjay Bafna, Kanchankumar Bhagyawant, Sonia Bhatt, Pallab Chatterjee, N S Chithambaram, Rashmi Ranjan Das, Hema Mittal, Sarika Gupta, Pawan Kalyan, Rashmi Kapoor, Hardeep Kaur, Jasmeet Kaur, Satnam Kaur, Suhas P Kulkarni, Amber Kumar, Ketan Kumar, Soumi Kundu, Pravakar Mishra, Pramod Paharia, Madhu S Pujar, Sanjeev Singh Rawat, Mounika Reddy, S Vinaykumar, Narayan Santuka, Sachin Singh, Somu Sivabalan, Shetanshu Srivastava, Anshula Tayal, Lovely Jain, Davinder Kaur, Meenakshi Malik, Abhishek Purohit, Meenakshi Sachdeva, Nabaneeta Dash, Prema Menon, Archana Angrup, Anmol Bhatia, Vasant Khalatkar, Yogesh N Parikh","doi":"10.1007/s13312-026-00439-9","DOIUrl":"10.1007/s13312-026-00439-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Justification: &lt;/strong&gt;The lack of clarity in the management of pediatric empyema thoracis necessitates evidence-based guidance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an evidence-based guideline on high-priority issues in pediatric empyema management (laboratory investigations, antibiotic therapy, intrapleural fibrinolytic therapy, surgical intervention, and follow-up).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Process: &lt;/strong&gt;The guideline was developed using contemporary methodology, viz. establishing a Steering Group; setting up an Evidence-Based Guideline Development Group (EBGDG); collating formal declarations of interest and managing conflicts; identifying and prioritizing questions; evidence synthesis; critical appraisal using GRADE methodology; translating evidence to recommendation statements; external peer review; and finalization of the guideline document.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations: &lt;/strong&gt;The dominant pathogen causing empyema in Indian children is Staphylococcus aureus, followed by Streptococcus pneumoniae. Therefore, the empirical antibiotics (pending culture reports) should preferably be the combination of Cloxacillin and Ceftriaxone (conditional recommendation, very low certainty of evidence). On the issue of intrapleural fibrinolytic therapy (IPFT) vs. no IPFT as the initial modality, pediatricians could use either option (in addition to oxygen, appropriate antibiotics, and effective pleural pus drainage) as the limited evidence did not show significant differences for critical outcomes (conditional recommendation, very low certainty of evidence). However, IPFT is recommended as the initial modality of therapy compared to Video-Assisted Thoracoscopic Surgery (VATS), on account of comparable efficacy, moderate savings, enhanced equity, stakeholder acceptability, and feasibility in diverse settings (conditional recommendation, very low certainty of evidence). The EBGDG does not recommend any particular intrapleural fibrinolytic agent over another due to a lack of comparative evidence (conditional recommendation, no evidence). The superiority of early initiation of IPFT (i.e. as the initial management, or at presentation), compared to late(r) instillation is not established in the absence of any evidence (conditional recommendation, no evidence). No recommendation can be made regarding the use of initial intrapleural fibrinolytic therapy (IPFT) (i.e., at or close to confirmation of empyema) versus IPFT after failure of intercostal chest drain (ICD) alone because of the absence of evidence (conditional recommendation, no evidence). Antibiotic therapy for ≤4 weeks is not suggested in preference to therapy for &gt;4 weeks, despite the absence of direct evidence, owing to greater clinical experience with the latter, as well as its acceptability and feasibility (conditional recommendation, no evidence). Routine use of microbiologic molecular methods in preference to conventional culture techniques is not suggested, on account of greater speci","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"706-719"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Gaps in Pediatric Practice: From Evidence Synthesis to Context-Specific Guidelines.","authors":"Dheeraj Shah","doi":"10.1007/s13312-026-00441-1","DOIUrl":"https://doi.org/10.1007/s13312-026-00441-1","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"63 10","pages":"701-703"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Air We Breathe: Evolving Evidence and the Changing Role of Pediatrics.","authors":"Neelam Mohan","doi":"10.1007/s13312-026-00442-0","DOIUrl":"https://doi.org/10.1007/s13312-026-00442-0","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"63 10","pages":"699-700"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Computed Tomography Scan Versus Thoracic Ultrasonography for Management Decisions in Empyema Thoracis: A Systematic Review.","authors":"Davinder Kaur, Ketan Kumar, Pravakar Mishra, Mounika Reddy, Narayan Santuka, Anshula Tayal, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00367-8","DOIUrl":"10.1007/s13312-026-00367-8","url":null,"abstract":"<p><strong>Context: </strong>Although thoracic ultrasonography (USG) provides valuable information for managing empyema, many clinicians resort to thoracic computed tomography (CT) scans.</p><p><strong>Objective: </strong>This systematic review was conducted to synthesize evidence on the efficacy, safety and cost of thoracic CT scan versus USG for managing childhood empyema.</p><p><strong>Evidence acquisition: </strong>We searched for diagnostic test accuracy studies and observational studies in PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, clinical trial registries and grey literature sources (ProQuest and OpenGrey), without any language restrictions. Two reviewers independently screened studies for inclusion. Studies in children (< 18 years) with confirmed empyema were included. The outcomes evaluated were findings impacting management missed by the other modality, adverse events, concordance, additional findings identified with either modality, and cost. Risk of bias was estimated using study design-specific tools. Certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Only one retrospective study with 13 participants met the inclusion criteria. CT identified one additional case with loculations compared to USG, and one additional lung abscess, although it was not confirmed at surgery. Fibrin strands seen on USG in all 13 cases were not detected by CT. Both modalities detected pulmonary consolidation in 11 patients; although the sites of consolidation differed in some children. There was no comparative data on cost and adverse events. The GRADE evidence certainty was judged as very low.</p><p><strong>Conclusion: </strong>The limited, very low certainty evidence suggested no advantage of CT scan over USG in the management of childhood empyema. Appropriately designed prospective studies can resolve this question.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"757-764"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial Etiology of Empyema Thoracis in Children: A Systematic Review and Meta-Analysis.","authors":"Abhishek Purohit, Rashmi Ranjan Das, Rashmi Kapoor, Pramod Paharia, Sachin Singh, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00386-5","DOIUrl":"10.1007/s13312-026-00386-5","url":null,"abstract":"<p><strong>Context: </strong>Identifying the microbial etiology of empyema is crucial to implement contextually appropriate clinical management and prevention strategies. However, there is no systematic review examining this question.</p><p><strong>Objective: </strong>This systematic review addressed this knowledge gap by synthesizing evidence on the pathogens identified in children with empyema.</p><p><strong>Evidence acquisition: </strong>PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, major trial registries, and grey literature sources were searched for observational studies in children with empyema. The prevalence of organisms identified in pleural pus, blood, or bronchoalveolar lavage fluid by culture or molecular methods was determined, along with the antimicrobial susceptibility pattern. Risk of bias in the included studies was assessed using the NIH quality assessment tool for observational studies. Meta-analysis was performed using random-effects model, and the certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Out of 8022 citations retrieved, 36 studies were included. In pleural fluid specimens, S. aureus dominated (38.99%, 95% CI 28.97, 49.00; I² 93.5%) followed by S. pneumoniae (31.51%, 95% CI 21.75-41.26; I² 95%). In blood, S. pneumoniae was the most prevalent organism (60.05%, 95% CI 40.78-79.32; I² 93.5%) followed by S. aureus (9.51%, 95% CI 0.0-19.18; I² 73.2%). Amongst the Indian studies, S. aureus dominated both in pleural fluid and blood. Limited data suggested S. aureus and S. pneumoniae susceptibility to vancomycin, cefotaxime, and chloramphenicol. The majority of studies (n = 32) were 'fair' quality, and the GRADE certainty of evidence was 'very low'.</p><p><strong>Conclusion: </strong>Very low certainty evidence suggested that S. aureus and S. pneumoniae are the common causes of empyema in children, with S. aureus dominant in India.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"734-746"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapleural Fibrinolytic Therapy Versus Video-Assisted Thoracoscopic Surgery, as the Initial Treatment Modality, in Children with Empyema Thoracis: A Systematic Review and Meta-Analysis.","authors":"Abhishek Purohit, Pallab Chatterjee, Hema Mittal, Madhu S Pujar, Sanjiv Singh Rawat, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00421-5","DOIUrl":"10.1007/s13312-026-00421-5","url":null,"abstract":"<p><strong>Context: </strong>Intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis as the initial treatment modality. However, some pediatricians prefer video-assisted thoracoscopic surgery (VATS). The optimal strategy is unclear.</p><p><strong>Objective: </strong>This systematic review was undertaken to compare IPFT versus VATS as the initial treatment modality in children with empyema thoracis, to support an evidence-based guideline recommendation.</p><p><strong>Evidence acquisition: </strong>Literature search was conducted in seven electronic databases and four trial registries, seeking randomized controlled trials (RCT) comparing IPFT versus VATS in children with empyema thoracis. The critical outcomes were failure of therapy, need for thoracotomy, clinical outcomes within three months of discharge, and serious adverse events. Other outcomes were mortality, clinical outcomes at ≥ 12mo of discharge and pulmonary function after discharge. Methodological quality was assessed using Cochrane RoB 2 tool. GRADE was used to assess the overall certainty of evidence.</p><p><strong>Results: </strong>Amongst 7,738 citations, five RCTs were included. Failure of therapy (4 studies, n = 235) was comparable between IPFT versus VATS; OR 1.01, 95% CI 0.46, 2.21; I² 9%. Likewise, the need for thoracotomy (3 studies, n = 199) was also comparable; OR 0.24, 95% CI 0.06,1.06; I² 0%; and also, the serious adverse events were similar (4 studies, n = 235); OR 0.67, 95% CI 0.24,1.90; I² 0%. However, IPFT was associated with longer hospital stay, but lower cost. Risk of bias assessment identified concerns related to the randomization process, outcome measurement, and selective reporting in some studies. The overall certainty of evidence was very low.</p><p><strong>Conclusion: </strong>Very low certainty evidence from five RCTs did not identify a clear difference between IPFT and VATS as the initial treatment modality in children with empyema thoracis.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"835-845"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}