Varinder Singh

• MD (Paeds), Hony FRCPCH
• Director Professor Retired at Lady Hardinge Medical College

To explore the stakeholders’ perspectives on barriers and facilitators influencing childhood cancer care delivery in India. A nationwide survey was conducted across 26 states and 4 Union Territories, involving childhood cancer physicians from tertiary and secondary hospitals, state nodal officers (SNOs) for the National Programme for Control of Non...

Alloimmunisation is a significant problem that can considerably complicate the management of transfusion dependent β-thalassemia patients. Extended prophylactic red cell matching/Better match approach has been proposed to reduce the risk of alloimmunisation. There is limited literature on efficacy of Better Match Approach in preventing alloimmunisa...

Introduction Childhood tuberculous meningitis (TBM) is a devastating disease. The long-standing WHO recommendation for treatment is 2 months of intensive phase with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 10 months of isoniazid and rifampicin. In 2022, WHO released a conditional recommendation that 6 months o...

Background: Objectives were to identify discriminatory spectral patterns of cough consistent with common respiratory sounds, through machine learning, to assist diagnosis. Methods: Spectral analysis of cough recordings of 50 children each with crackles alone, wheezing alone and absence of crackles and wheezing. Identification of unique features thr...

Background With the increased availability of licensed vaccines for respiratory viruses such as severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus (RSV), and influenza virus, a better understanding of the viral aetiology of severe acute respiratory infections (SARI) among children could help in optimising the use of these...

Paediatric Abdominal Tuberculosis

Paediatric Intrathoracic Tuberculosis

Paediatric Osteoarticular Tuberculosis

Paediatric Lymph Node Tuberculosis

Paediatric Tubercular Meningitis

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle ag...

Context Children with human immunodeficiency virus (HIV) infection frequently present with opportunistic infections of the lung that may be associated with high mortality rate. There is no study, to the best of our knowledge, correlating specific radiographic patterns of chest infections with CD4 levels of immunity in HIV-infected children of India...

Tracheal agenesis is a rare and life-threatening airway malformation, and currently, there is no curative treatment available. The described case involves a preterm male newborn at 30 weeks of gestational age who could not be intubated during resuscitation, despite multiple attempts. However, the baby could be ventilated after oesophageal intubatio...

Background Thalidomide has been demonstrated to induce global gene expression hereby increasing the proliferation of erythroid cells. Recent studies have revealed encouraging data regarding the efficacy and safety of thalidomide in both transfusion dependent (TDT) and non-transfusion dependent (NTDT) thalassemia. However, the optimal dose of thalid...

Frequent imaging manifestations of pulmonary tuberculosis are airspace or interstitial nodules with or without tree-in-bud nodules, consolidation, cavitation, ground glass opacity, miliary nodules, lymphadenopathy and pleural effusion. It is unusual to encounter cystic changes in patients with pulmonary tuberculosis, and these findings should be di...

Objectives: The objectives of this study were to study the spectrum of neurological complications in children with lymphoreticular malignancy (acute lymphoblastic leukemia, Hodgkin, and non-Hodgkin lymphoma) at diagnosis and during treatment and to determine the etiology of these complications. Materials and methods: In this descriptive cohort s...

Anemia coexisting with Gaucher disease (GD) is often associated with non-hemolytic processes. Few cases of GD with autoimmune hemolytic anemia have been reported. However, literature on GD with concomitant nonimmune hemolytic anemia is scarce. A 1-year 6-month-old male child presented in 2018 with complaints of palpable mass in left upper abdomen,...

Objectives: To evaluate the incidence of laboratory-confirmed pertussis (LCP) among infants hospitalized with acute respiratory infections (ARIs) and meeting the Centers for Disease Control and Prevention (CDC)-recommended clinical case definition. Methods: An investigator-initiated active surveillance for clinically suspected cases (CSCs) of pe...

Background: Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at seco...

NTDT

Background: Foreign Body Aspiration (FBA) is a common issue in pediatric emergencies, with regional variations. Various cultures and foods, parents' and physicians' inadequate experience, and lack of bronchoscopy equipment are some attributable factors in the regional variation of FBA. Aim: To more accurately represent the demographic characteri...

Background Cutaneous tuberculosis (TB) is a rare disease seen by the pediatrician on an outpatient basis. It has a varied presentation and is classified on the basis of the source of infection and host's immune response to mycobacteria. Lupus vulgaris (LV) is a paucibacillary manifestation of cutaneous TB. It can mimic other infectious skin disease...

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality...

Background Hypermanganesemia with dystonia 1 and 2 (HMNDYT1 and 2) are rare, inherited disorders of manganese transport. Objectives We aimed to describe clinical, laboratory features, and outcomes among children with HMNDYT. Methods We conducted a retrospective multicenter study involving tertiary centers across India. We enrolled children betwee...

Aim: Covid-19 has presented an unprecedented challenge to health services and has significantly affected the management of non-Covid illnesses, like thalassemia. The present study documents the impact of Covid-associated restrictions and disruptions on working of the pediatric thalassemia day care centre (TDCC), and measures taken by TDCC and bloo...

This case report is about a 13 years old boy who was diagnosed to have sputum negative pulmonary tuberculosis. Anti-tuberculosis treatment (ATT) was continued for it and he initially showed improvement but later transitioned into a slowly progressive persistent pneumonia. In this scenario, most appropriate approach is to work the patient up for per...

The present study explored the association between daily ambient air pollution and daily emergency room (ER) visits due to acute respiratory symptoms in children of Delhi. The daily counts of ER visits (ERV) of children (≤15 years) having acute respiratory symptoms were obtained from two hospitals of Delhi for 21 months. Simultaneously, data on dai...

Objective To detail clinical profile and outcome in children infected with SARS-CoV-2.Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (< 18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed.Re...

Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs are not fully met by either programme. In this narrative review article, we use the World Health...

The Government of India has developed a National Strategic Plan for tuberculosis (TB) elimination by 2025, five years ahead of the global target set by the World Health Organization (WHO). For achieving these targets there has been a paradigm shift in the diagnostic and treatment strategies of TB at all ages. This update summarizes the specific cha...

Background Data on the relation between the increase in ambient air pollution and acute respiratory illness in children are scarce. The present study aimed to explore the association between daily ambient air pollution and daily emergency room (ER) visits due to acute respiratory symptoms in children of Delhi. Methods In this epidemiological study...

Background Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-of-cost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of...

Childhood tuberculosis does not get the attention it deserves, both in the general child health services and the TB specific services. The difficulty in identification of the organism due to lack of proper sample as well as lower sensitivity of the smear, made it harder to detect cases with ease in the community. Newer diagnostic methods like cartr...

A preterm 32-week neonate presented on the 14th day of life with respiratory distress and cyanosis. the respiratory distress worsened progressively, which was managed with continuous positive airway pressure support. the neonate had blood-tinged oral secretions on the 39th day of life, for which bronchoscopy was performed, whose findings were sugge...

A preterm 32-week neonate presented on the 14th day of life with respiratory distress and cyanosis. The respiratory distress worsened progressively, which was managed with continuous positive airway pressure support. The neonate had blood-tinged oral secretions on the 39th day of life, for which bronchoscopy was performed, whose findings were sugge...

Background Diagnosis of tuberculosis (TB) in infants is challenging due to non-specific clinical presentations of the disease in this age-group and low sensitivity of widely available TB diagnostic tools, which in turn delays prompt access to TB treatment. Upfront access to Xpert/MTB RIF (Xpert) testing, a highly sensitive and specific rapid diagno...

Supplementary information. Table A: Confirmatory DST for RR-TB cases diagnosed on Xpert under the project Table B: Mortality Data (Mortality status of notified TB and DR TB cases). (DOCX)

The WHO Integrated Management of Childhood Illnesses-HIV (IMCI-HIV) algorithm and its regional adaptation have shown variable performance in clinically identifying HIV-infected children with lack of validation in low prevalence areas. Addition of certain ‘parental factors’ (proxy indicators of parental HIV) may improve its utility. In this study, c...

Background Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic test...

Supporting data file- compiled sheet till 30 Jun16_23-1-18.xlsb. (XLSB)

Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential componen...

Rifampicin (RFP) and pyrazinamide (PZA) are the primary anti-tubercular drugs with a considerably safe profile. However, none of the drugs are without adverse reactions. They both can lead to a variety of adverse effects including life-threatening anaphylaxis. We report an interesting and possibly the first case of concurrent hypersensitivity to tw...

Biomarkers reflecting the extent of Mycobacterium tuberculosis-induced pathology and normalization during anti-tuberculosis treatment (ATT) would considerably facilitate trials of new treatment regimens and the identification of patients with treatment failure. Therefore, in a cohort of 99 Indian children with intrathoracic tuberculosis (TB), we pe...

Background: Pediatric acute respiratory infections (ARI) are a major cause of hospitalization and deaths worldwide. Data on the contribution of different pathogens to ARI are limited in India. We used the Taqman Array Card (TAC), a real-time reverse transcriptase polymerase chain reaction (rRT-PCR) multipathogen platform, to assess the prevalence o...

Background: Drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) isolates is crucial for the effective treatment of tuberculosis. Data on DST patterns in Mtb isolates in childhood tuberculosis are scanty. Aims: To determine drug resistance patterns in Mtb isolates from a paediatric TB cohort in North India. Methods: 403 childr...

The World Health Organization (WHO) calls for an accurate, rapid, and simple point-of-care (POC) test for the diagnosis of pediatric tuberculosis (TB) in order to make progress “Towards Zero Deaths”. Whereas the sensitivity of a POC test based on detection of Mycobacterium tuberculosis (MTB) is likely to have poor sensitivity (70–80% of children ha...

Background: Tuberculosis (TB) in children is neglected, mainly due to lack of sensitive diagnostic tools. Recently Xpert MTB/RIF assay has revolutionized the diagnostic field, but its usefulness in pediatric TB has not been reported from India and no report is available on its use on long term archived samples. Methods: We recruited 130 pediatric...

Intensified chemotherapy has improved survival rates for ALL/LL patients, but also the incidence and severity of CNS complications. Prompt diagnosis and treatment is essential to prevent mortality and limit long term disability.

Bronchoscopes have markedly improved the diagnosis as well as therapy in pediatric pulmonary disorders. Two types of bronchoscopes are available; flexible and rigid, with their own advantages and disadvantages. Depending on the clinical need and availability of skills, choice is made between the two. Typically, rigid scopes are largely used by the...

Drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) isolates is crucial for the effective treatment of tuberculosis. Data on DST patterns in Mtb isolates in childhood tuberculosis are scanty. To determine drug resistance patterns in Mtb isolates from a paediatric TB cohort in North India. 403 children aged 6 months to14 year with...

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease characterized by periods of increased disease activity caused by inflammation of blood vessels and connective tissue. Pediatric patients with SLE have a more severe clinical course when compared with adults. Patients commonly present with rash, fever, and arthritis, al...

Background & objectives: Deficiency of vitamin D, an immunomodulator agent, is associated with increased susceptibility to tuberculosis in adults, but only limited studies are available in the paediatric age group, especially regarding association of vitamin D with type and outcome of tuberculosis. We conducted this study to determine the baseline...

An 18-mo-old girl was brought with complaints of sudden loss of attained milestones after a febrile illness at 13 mo of age. MRI of the brain showed extensive loss of white matter with rarefaction and cystic degeneration; suggestive of vanishing white matter disease. The patient was found to be compound heterozygote for two mutations in the gene EI...

Background: Micronutrients play an important role in immune function. To our knowledge, there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis. Objective: We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy (ATT). Design: A random...

Thymolipomas are benign neoplasms that usually occur in adults and are rarely described in children. They are usually detected incidentally but can be of massive size and lead to respiratory compromise. A 6-month-old boy presented with respiratory distress and an anterior mediastinal mass which proved to be a thymolipoma. He underwent surgical rese...

Tertiary care hospitals in India. To compare the performance of the QuantiFERON®-TB Gold In-Tube test (QFT-GIT) with that of the tuberculin skin test (TST) in the diagnosis of intrathoracic childhood tuberculosis (TB). Children with intrathoracic TB were enrolled in a randomised controlled trial studying micronutrient supplementation in intrathorac...

Background/objectives: Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and Q...