Madhulika Kabra

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (241)486.12 Total impact

  • Genetics in medicine: official journal of the American College of Medical Genetics 10/2014; · 3.92 Impact Factor
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    ABSTRACT: Mucopolysaccharidosis IV A (Morquio syndrome A, MPS IVA) is a lysosomal storage disease caused by the deficiency of N-acetylgalactosamine-6-sulfatase (GALNS). The mutation spectrum in this condition is yet to be determined in Indians. We aimed to analyze the mutations in the GALNS gene in Asian Indians with MPS IVA. All the exons and the adjacent intronic regions of the gene were amplified and sequenced in sixty-eight unrelated Indian families. We identified 136 mutant alleles comprising of 40 different mutations. We report twenty-two novel mutations that comprise of seventeen missense (p.Asn32Thr, p.Leu36Arg, p.Pro52Leu, p.Pro77Ser, p.Cys79Arg, p.His142Pro, p.Tyr191Asp, p.Asn204Thr, p.Gly188Ser, p.Phe216Ser, p.Trp230Cys, p.Ala291Ser, p.Gly317Arg, p.His329Pro, p.Arg386Ser, p.Glu450Gly, p.Cys501Ser), three splice-site variants (c.120 + 1G > C, c.1003-3C > G, c.1139 + 1G > A), one nonsense mutation (p.Gln414*) and one frameshift mutation (p.Pro420Leufs*440). Eighteen mutations have been reported earlier. Among these p.Ser287Leu (8.82%), p.Phe216Ser (7.35%), p.Asn32Thr (6.61%) and p.Ala291Ser (5.88%) were the most frequent mutations in Indian patients but were rare in the mutational profiles reported in other populations. These results indicate that the Indian patients may have a distinct mutation spectrum compared to those of other populations. Mutant alleles in exon 1, 7 and 8 accounted for 44.8% of the mutations, and sequencing of these exons initially may be a cost-effective approach in Asian Indian patients. This is the largest study on molecular analysis of patients with MPS IVA reported in the literature, and the first report from India
    American Journal of Medical Genetics Part A 09/2014; · 2.30 Impact Factor
  • Neerja Gupta, Madhulika Kabra, Seema Kapoor
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    ABSTRACT: Early detection and prevention of birth defects is necessary to further reduce neonatal morbidity and mortality. A birth defect registry or surveillance system is necessary to assess the exact magnitude, profile and modifiable risk factors for birth defects. We review the existing efforts and suggest possible options for addressing this important issue. Connecting birth defects registry with the pre-existing programs such as National Neonatal Perinatal Database could be one of the option.
    Indian pediatrics. 09/2014; 51(9):693-6.
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    ABSTRACT: AbstractBackground
    Vaccine 08/2014; 32, Supplement 1:A104-A109. · 3.49 Impact Factor
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    ABSTRACT: Iodine deficiency (ID) is an endemic health problem in Kangra District, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. Iodine nutrition status amongst neonates can be assessed by estimating Thyroid Stimulating Hormone (TSH). The present study was conducted with an objective to assess the iodine nutrition status amongst Neonates in Kangra district, HP. All of the hospitals in the district which provide obstetric services were enlisted, of which three were selected for this survey. A total of 613 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. WHO (2007) reported that that a < 3% frequency of TSH concentrations above 5mIU/L in samples collected 3-4 days after birth indicates iodine sufficiency in a population. In our study we found that 73.4% of the neonates had TSH levels of more than 5mlU/l, thus indicating ID in the population studied. Iodine deficiency continues to be a public health problem in Kangra district, Himachal Pradesh.
    Journal of Trace Elements in Medicine and Biology 07/2014; · 1.96 Impact Factor
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    ABSTRACT: Iodine deficiency disorder (IDD) is a public health problem in Uttarakhand state.
    Indian journal of endocrinology and metabolism. 05/2014; 18(3):419-21.
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    ABSTRACT: Background Congenital Ichthyosis especially in darker skin types is at increased risk of developing vitamin D deficiency and rickets. The relationships between 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and bone health have not been studied previously, in ichthyosis.Objective To determine the threshold levels of 25(OH)D and PTH for impaired bone health in children with congenital IchthyosisMethods In this cross sectional study,119 children with Ichthyosis and 168 controls were recruited. Serum 25(OH)D, PTH, calcium, phosphate and alkaline phosphatase(ALP) were measured. Radiological screening for rickets was carried out only in Ichythoses children.Results47 (41%) children with ichthyosis had either clinical or radiological evidence of rickets. Correlation between serum 25(OH)D and PTH showed a serum level of 25(OH)D 8ng/mL, was associated with significant increase in PTH. Correlation between PTH and ALP showed that a serum PTH level of 75 pg/mL was associated with a significant increase in ALP levels. Of the different clinical phenotypes of ichthyosis, both autosomal recessive congenital ichthyosis (ARCI) and epidermolytic ichthyosis (EI) were found to have significantly increased PTH, ALP and radiological rickets scores as compared to common ichthyosis.Conclusions Serum levels of 25(OH)D ≤ 8 ng/mL and PTH (≥ 75 pg/mL) significantly increases the risk for development of rickets (OR = 2.8; 95% CI = 1.05 – 7.40;P = 0.04) in ichthyosis. Among the different types, ARCI (OR 4.83; 95% CI 1.74 – 13.45; p < 0.01) and EI (OR 5.71; 95% CI 1.74 – 18.79; p < 0.01) are at an increased risk of developing rickets.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2014; · 3.76 Impact Factor
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    ABSTRACT: Iodine deficiency (ID) is an endemic health problem in Kangra District, Himachal Pradesh (HP). ID in pregnant mothers leads to neonatal hypothyroidism (NH), mental retardation, deaf mutism, squint, dwarfism, spastic dysplasia, neurological defects and congenital anomalies. NH can be assessed by estimating the thyroid stimulating hormone (TSH) in cord blood samples. The present study was conducted with an objective to assess the prevalence of NH in district Kangra, HP. In district Kangra, all the hospitals providing obstetric services were enlisted. Three hospitals conducting more than 100 deliveries per year were selected randomly. A total of 613 umbilical cord blood samples of neonates were collected on filter papers and analyzed for TSH. TSH was estimated by enzyme-linked immunosorbent assay method. Neonates with TSH levels ⩾20 mIU/l were recalled for reassessment of TSH for confirmation of NH. Prevalence of NH was found to be 4.4%. This finding suggests the need for the implementation of a neonatal screening program for early detection of children with ID.European Journal of Clinical Nutrition advance online publication, 23 April 2014; doi:10.1038/ejcn.2014.71.
    European journal of clinical nutrition 04/2014; · 3.07 Impact Factor
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    ABSTRACT: Osteogenesis imperfecta (OI) is a condition of decreased bone density with heterogeneous etiologies. Most of the cases are inherited in an autosomal dominant fashion and are caused by mutations in the COL1A1 or COL1A2 genes. Since these two genes are very large, there are no data about mutations in Indian patients with OI. We selected 35 Indian patients who were clinically diagnosed with OI and all exons of both the genes were sequenced. Mutations in COL1A1 (14 cases, 6 novel) and COL1A2 (11 cases, 7 novel) were identified in 25 patients. A total of 55 polymorphisms were identified in both the genes with eight novel variants in the coding region, and nine novel variants in the non-coding regions. No mutation was detected in 10 patients. Six of them were from consanguineous families, with one or two similarly affected siblings suggesting possible autosomal recessive inheritance. If we exclude families with consanguinity, mutations were identified in 25 out of 29 families giving 86% mutation detection rate. Mutations in COL1A1 accounted for 56% of the cases and COL1A2 44%, which is similar to the reported rate worldwide. © 2014 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part A 03/2014; · 2.30 Impact Factor
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    ABSTRACT: Fungal infections, especially in immunocompetent children are uncommon causes of fever of unknown origin. A 5-year-old boy with prolonged fever and no evidence of immunosuppression. Ultrasound-guided retroperitoneal lymph node biopsy showed granulomas and intracytoplamic fungal yeasts; staining charactristics were suggestive of cryptococci. Clinical and radiological improvement was seen after treatment with amphoterecin-B. Disseminated fungal infection should be suspected as a cause of pyrexia of unknown origin after ruling out the commoner causes. Biopsy from enlarged lymph node or organomegaly may yield the diagnosis when non-invasive tests fail.
    Indian pediatrics 03/2014; 51(3):225-6. · 1.04 Impact Factor
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    ABSTRACT: Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). According to WHO, if more than 3 % of the neonates have TSH levels of 5 mlU/l and more in a population, it indicates presence of iodine deficiency (ID). Iodine deficiency is an endemic health problem in Solan district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. The aim is to determine iodine nutrition status of neonates of Solan district. In Solan district, six hospitals/community health centers providing obstetric services and conducting more than 100 deliveries per annum were identified and enlisted. Two hospitals were selected keeping in view of operational feasibility. A total of 683 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. It was found that 63.2 % of the neonates had TSH levels of more than 5 mlU/l indicating iodine deficiency in the Solan district. Iodine deficiency was a public health problem in Solan district, HP.
    Journal of Community Health 02/2014; · 1.28 Impact Factor
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    ABSTRACT: Causal association of gallbladder stones with gallbladder cancer (GBC) is not yet well established. To study the frequency of occurrence of preneoplastic histological lesions and loss of heterozygosity (LOH) of tumor suppressor genes in patients with gallstones. All consecutive patients with gallstones undergoing cholecystectomy from 2007-2011 were included prospectively. Histological examination of the gallbladder specimens was done for preneoplastic lesions. LOH at 8 loci, that is 3p12, 3p14.2, 5q21, 9p21, 9q, 13q, 17p13, and 18q for tumor suppressor genes (DUTT1, FHIT, APC, p16, FCMD, RB1, p53, and DCC genes) that are associated with GBC was tested from microdissected preneoplastic lesions using microsatellite markers. These LOH were also tested in 30 GBC specimens. Of the 350 gallbladder specimens from gallstone patients, hyperplasia was found in 32%, metaplasia in 47.8%, dysplasia in 15.7%, and carcinoma in situ in 0.6%. Hyperplasia, metaplasia, and dysplasia alone were found in 11.7%, 24.6%, and 1.4% of patients, respectively. A combination of hyperplasia and dysplasia, metaplasia and dysplasia, and hyperplasia, metaplasia, and dysplasia was found in 3.4%, 6.3%, and 4.3% of patients, respectively. LOH was present in 2.1% to 47.8% of all the preneoplastic lesions at different loci. Fractional allelic loss was significantly higher in those with dysplasia compared with other preneoplastic lesions (0.31 vs 0.22; P = 0.042). No preneoplastic lesion or LOH was found in normal gallbladders. Patients with gallstones had a high frequency of preneoplastic lesions and accumulation of LOH at various tumor suppressor genes, suggesting a possible causal association of gallstones with GBC.
    Annals of surgery 01/2014; · 7.90 Impact Factor
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    ABSTRACT: Bardet-Biedl syndrome (BBS), a ciliopathy disorder with pleiotropic effect manifests primarily as retinal degeneration along with renal insufficiency, polydactyly and obesity. In the current study, we have performed homozygosity mapping using NspI 250K affymetrix gene chip followed by mutation screening of the candidate genes located in the homozygous blocks. These regions are prioritized based on the block length and candidature of the genes in BBS and other ciliopathies. Gene alterations in known BBS (22) and other ciliopathy genes like ALMS1 (2) were seen in 24 of the 30 families (80%). Mutations in BBS3 gene, inclusive of a novel recurrent mutation (p.I91T) accounted for 18 % of the identified variations. Disease associated polymorphisms p.S70N (BBS2), rs1545 and rs1547 (BBS6) were also observed. This is the first study in Indian BBS patients and homozygosity mapping has proved to be an effective tool in prioritizing the candidate genes in consanguineous pedigrees. The study reveals a different mutations profile in the ciliopathy genes in Indian population and implication of novel loci / genes in 20% of the study group.
    Clinical Genetics 01/2014; · 4.25 Impact Factor
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    ABSTRACT: Background Sulfatides, the most abundant glycosphingolipids, are a major component of myelin. They are degraded by the combined action of sphingolipid activator protein and arylsulfatase A. Deficiency of either of these two causes metachromatic leukodystrophy (MLD). On the basis of age of onset this entity is divided into late infantile, juvenile and adult subtypes. Late infantile form, the commonest subtype, can have peripheral neuropathy as the initial manifestation. The other two usually manifests peripheral neuropathy later in the disease course. Case An 1.5 year old girl with preexisting isolated motor delay presented with acute onset ascending flaccid quadriparesis, ptosis and respiratory failure. Ptosis and respiratory failure responded completely to intravenous immunoglobulin whereas quadriparesis showed minimal improvement. Nerve biopsy revealed metachromatic granules with demyelination and serum arylsulfatase A levels were undetectable. Conclusion The severity and nature of the disease coupled with the response to immunotherapy makes this case unusual. This case represents either an atypical presentation of MLD with coincidental response to immunotherapy or an episode of immune mediated neuropathy in a case of MLD as they already have diseased nerves.
    Pediatric Neurology 01/2014; · 1.42 Impact Factor
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    ABSTRACT: This cross sectional study assessed the prevalence of behavioral comorbidity and its association with epilepsy-related factors in children and adolescents with epilepsy. One hundred consecutive patients with active epilepsy, aged 6–16 years, were screened for behavioral comorbidity using the Child Behavior Checklist and those who qualified as having behavioral comorbidity were compared with those who did not have it. Behavioral comorbidity was found in 43 of 100 participants. Being treated with antiepileptic drug polytherapy (odds ratio 6.3, 95% confidence interval 1.4–17.3, p = 0.01) independently predicted behavioral comorbidity in the patients studied. The demonstrated high frequency of behavioral comorbidity in children with epilepsy suggests that pediatrician and pediatric neurologists should be sensitive to this fact in order to identify behavioral comorbidity in children with epilepsy.
    Journal of Clinical Neuroscience 01/2014; · 1.25 Impact Factor
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    ABSTRACT: Background Post licensure studies have identified an increased risk of intussusception following vaccination with currently licensed rotavirus vaccines, raising safety concerns generic to all rotavirus vaccines. We describe the surveillance for intussusception in a phase III clinical trial with an oral monovalent rotavirus vaccine developed from the neonatal 116E strain. Methods Using broad screening criteria and active surveillance, the incidence of intussusception between 6 weeks and 2 years of age was measured in 4532 children who received three doses of vaccine and 2267 children who received a placebo in the clinical trial. Possible intussusceptions were evaluated with a screening ultrasonogram. An independent intussusception case adjudication committee reviewed all intussusceptions and graded them on Brighton Collaboration criteria for diagnostic certainty. Results We identified twenty-three intussusceptions on ultrasound from 1361 evaluated sentinel events. Eleven were of level 1 diagnostic certainty as determined by the independent intussusception case adjudication committee. None required surgical intervention, and the earliest identified intussusception was at 36 days following the third dose in a placebo recipient. Among vaccine recipients the first event of intussusception occurred 112 days after the third dose. The incidence of ultrasound-diagnosed intussusception was 200/100,000 child-years (95% CI, 120, 320) among those receiving the vaccine and 141/100,000 child-years (95% CI, 50, 310) among those receiving the placebo. The incidence rate of confirmed intussusception among vaccine recipients was 94/100,000 child-years (95% CI, 41, 185) and 71/100,000 child-years (95% CI, 15, 206) among those receiving the placebo. Conclusion In this licensure study, 23 cases of intussusception were identified through an active surveillance system, but there was no temporal association with rotavirus vaccination. The use of active surveillance with broad criteria intended for ensuring safety of children participating in a trial, identified several transient intussusceptions that were of doubtful clinical significance.
    Vaccine. 01/2014; 32:A104–A109.
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    ABSTRACT: This study was undertaken in view of the paucity of data regarding the profile of prothrombotic factors in children with ischemic stroke. Sixty-four children with ischemic stroke were prospectively evaluated for presence of prothrombotic factors over a 2 year period. The blood samples were analyzed for protein C (PC), protein S (PS), activated protein C resistance (APCR), factor V Leiden (FVL), anti-thrombin-III (AT-III), lipoprotein (a) [Lp(a)], lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL) immunoglobulin (Ig) M and IgG, homocysteine, and methylenetetrahydrofolate reductase (MTHFR) at least 3 months after the onset of stroke. At least one prothrombotic factor was identified in 45.3% children (29/64). These included hyperhomocysteinemia (11/64), PC deficiency (9/64), aCL (8/64), PS deficiency (5/64), APCR (3/64), AT-III deficiency (2/64) and LA (1/64). Multiple factors were coexistent in 17.2% (11/64). The prevalence of PC deficiency, PS deficiency and co-existence of multiple abnormalities observed were similar to the published literature. Elevated Lp(a) and APCR were less prevalent. FVL and MTHFR were not seen in any of the study children. Forty-five percent of children had at least one prothrombotic abnormality. Hyperhomocysteinemia, PC deficiency, aCL and PS deficiency were the most frequent prothrombotic abnormalities.
    Journal of Clinical Neuroscience 01/2014; · 1.25 Impact Factor
  • Neerja Gupta, Madhulika Kabra
    The Indian Journal of Medical Research 01/2014; 139(1):4-6. · 2.06 Impact Factor
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    ABSTRACT: Holoprosencephaly (HPE) is the most common forebrain developmental anomaly with a prevalence of 1:16 000 live-births. Possible aetiological agents include environmental factors and genetic defects such as trisomies (13, 18) and deletions (18p, 7q, 2p and 21q). This complex malformation is due to incomplete division of the cerebral hemisphere. The phenotypes of HPE include alobar, semilobar, lobar and midline interhemispheric fusion variants. Craniofacial anomalies occur in 80% of cases. Severely affected babies die in the neonatal period. Here we report an autopsied case of semilobar HPE with pituitary and adrenal agenesis with 21q22 deletion. Additional findings are noted that would help expand the spectrum of 21q22 deletion.
    Case Reports 01/2014; 2014.
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    ABSTRACT: Menkes disease is an X-linked multisystem disorder characterized by early onset of cerebral and cerebellar neurodegeneration, fair skin, hypopigmented sparse hair and connective tissue abnormalities.
    Journal of Pediatric Neurosciences 01/2014; 9(1):11-6.

Publication Stats

1k Citations
486.12 Total Impact Points


  • 1995–2014
    • All India Institute of Medical Sciences
      • Department of Paediatrics
      New Dilli, NCT, India
  • 2013
    • Dayanand Medical College & Hospital
      • Department of Pediatrics
      Ludhiana, Punjab, India
    • Lok Nayak Hospital
      New Dilli, NCT, India
  • 2012–2013
    • Charité Universitätsmedizin Berlin
      • Institute of Medical Genetics and Human Genetics
      Berlin, Land Berlin, Germany
  • 2008–2011
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2010
    • Maulana Azad Medical College
      New Dilli, NCT, India