137 results on '"Sethi, Sidharth Kumar"'
Search Results
2. Artificial intelligence in early detection and prediction of pediatric/neonatal acute kidney injury: current status and future directions.
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Raina R, Nada A, Shah R, Aly H, Kadatane S, Abitbol C, Aggarwal M, Koyner J, Neyra J, and Sethi SK
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- Humans, Infant, Newborn, Infant, Child, Risk Assessment methods, Child, Preschool, Machine Learning, Acute Kidney Injury diagnosis, Acute Kidney Injury blood, Acute Kidney Injury urine, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Early Diagnosis, Artificial Intelligence
- Abstract
Acute kidney injury (AKI) has a significant impact on the short-term and long-term clinical outcomes of pediatric and neonatal patients, and it is imperative in these populations to mitigate the pathways leading to AKI and be prepared for early diagnosis and treatment intervention of established AKI. Recently, artificial intelligence (AI) has provided more advent predictive models for early detection/prediction of AKI utilizing machine learning (ML). By providing strong detail and evidence from risk scores and electronic alerts, this review outlines a comprehensive and holistic insight into the current state of AI in AKI in pediatric/neonatal patients. In the pediatric population, AI models including XGBoost, logistic regression, support vector machines, decision trees, naïve Bayes, and risk stratification scores (Renal Angina Index (RAI), Nephrotoxic Injury Negated by Just-in-time Action (NINJA)) have shown success in predicting AKI using variables like serum creatinine, urine output, and electronic health record (EHR) alerts. Similarly, in the neonatal population, using the "Baby NINJA" model showed a decrease in nephrotoxic medication exposure by 42%, the rate of AKI by 78%, and the number of days with AKI by 68%. Furthermore, the "STARZ" risk stratification AI model showed a predictive ability of AKI within 7 days of NICU admission of AUC 0.93 and AUC of 0.96 in the validation and derivation cohorts, respectively. Many studies have reported the superiority of using biomarkers to predict AKI in pediatric patients and neonates as well. Future directions include the application of AI along with biomarkers (NGAL, CysC, OPN, IL-18, B2M, etc.) in a Labelbox configuration to create a more robust and accurate model for predicting and detecting pediatric/neonatal AKI., (© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2024
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3. Cobalamin C Deficiency: An Uncommon Cause of Hemolytic Uremic Syndrome.
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Singh K, Pandey M, Uttam R, and Sethi SK
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- Humans, Male, Female, Infant, Hemolytic-Uremic Syndrome complications, Hemolytic-Uremic Syndrome diagnosis, Vitamin B 12 Deficiency complications, Vitamin B 12 Deficiency diagnosis
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- 2024
4. Voice of a caregiver: call for action for multidisciplinary teams in the care for children with atypical hemolytic uremic syndrome.
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Burke L, Sethi SK, Boyer O, Licht C, McCulloch M, Shah R, Luyckx VA, and Raina R
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- Humans, Child, Caregivers psychology, Patient Care Team organization & administration, Atypical Hemolytic Uremic Syndrome therapy, Atypical Hemolytic Uremic Syndrome diagnosis
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- 2024
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5. What came first, atypical hemolytic uremic syndrome or malignant hypertension: a clinical dilemma.
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Sethi SK, S S, Nair A, Soni K, Bihari Bansal S, Rana AS, and Raina R
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- Humans, Atypical Hemolytic Uremic Syndrome diagnosis, Hypertension, Malignant complications, Hypertension, Malignant diagnosis
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- 2024
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6. Using artificial intelligence to predict mortality in AKI patients: a systematic review/meta-analysis.
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Raina R, Shah R, Nemer P, Fehlmen J, Nemer L, Murra A, Tibrewal A, Sethi SK, Neyra JA, and Koyner J
- Abstract
Background: Acute kidney injury (AKI) is associated with increased morbidity/mortality. With artificial intelligence (AI), more dynamic models for mortality prediction in AKI patients have been developed using machine learning (ML) algorithms. The performance of various ML models was reviewed in terms of their ability to predict in-hospital mortality for AKI patients., Methods: A literature search was conducted through PubMed, Embase and Web of Science databases. Included studies contained variables regarding the efficacy of the AI model [the AUC, accuracy, sensitivity, specificity, negative predictive value and positive predictive value]. Only original studies that consisted of cross-sectional studies, prospective and retrospective studies were included, while reviews and self-reported outcomes were excluded. There was no restriction on time and geographic location., Results: Eight studies with 37 032 AKI patients were included, with a mean age of 65.3 years. The in-hospital mortality was 18.0% in the derivation and 15.8% in the validation cohorts. The pooled [95% confidence interval (CI)] AUC was observed to be highest for the broad learning system (BLS) model [0.852 (0.820-0.883)] and elastic net final (ENF) model [0.852 (0.813-0.891)], and lowest for proposed clinical model (PCM) [0.765 (0.716-0.814)]. The pooled (95% CI) AUC of BLS and ENF did not differ significantly from other models except PCM [Delong's test P = .022]. PCM exhibited the highest negative predictive value, which supports this model's use as a possible rule-out tool., Conclusion: Our results show that BLS and ENF models are equally effective as other ML models in predicting in-hospital mortality, with variability across all models. Additional studies are needed., Competing Interests: J.A.N. is supported by grants from NIDDK (R01DK128208, R01DK133539, U01DK12998 and P30 DK079337). J.K. has National Institutes of Health funding regarding AI-ML AKI (R01DK126933). All other authors disclose no conflicts of interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
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- 2024
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7. Point-of-Care Ultrasound (POCUS) Training Curriculum for Pediatric Nephrology: PCRRT-ICONIC Group Recommendations.
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Sethi SK, Mahan J, Hu J, Koratala A, Soni K, Singh Y, Abitbol C, DeFreitas M, Reisinger N, Argaiz ER, Yap HK, Badeli H, Kalra M, VanGeest J, Nair N, Raynor J, Alhasan KA, McCulloch M, Bunchman T, Sharma V, and Raina R
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- Humans, Child, Curriculum, Ultrasonography methods, Point-of-Care Systems, Nephrology education, Pediatrics education
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- 2024
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8. Dialysis disequilibrium syndrome in a child with uncal herniation: successful management.
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Sethi SK, Raina R, Nair A, Mannava A, Sharma V, and Bansal SB
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- Humans, Male, Hernia, Umbilical complications, Syndrome, Treatment Outcome, Adolescent, Renal Dialysis
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- 2024
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9. Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.
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Sethi SK, Luyckx V, Bunchman T, Nair A, Bansal SB, Pember B, Soni K, Savita, Yadav DK, Sharma V, Alhasan K, and Raina R
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- Adolescent, Child, Humans, Cohort Studies, Iatrogenic Disease, Prospective Studies, Quality Improvement, Renal Dialysis adverse effects, Renal Dialysis methods, Syndrome, Urea, Kidney Failure, Chronic complications, Uremia therapy, Uremia complications
- Abstract
Background: Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment., Design: Prospective observational quality improvement initiative cohort study., Setting and Participants: A prospective single-center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023., Quality Improvement Plan: A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%-30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome., Measures: Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long-term outcomes were assessed at the 1-year follow-up including adherence to dialysis, renal transplantation, death, and loss to follow-up., Results: The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long-term outcomes showed 88% adherence to dialysis and 38% renal transplantation., Limitations: This study is characterized by a single-center design, nonrandomized approach, and limited sample size., Conclusions: Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome., (© 2024 International Society for Hemodialysis.)
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- 2024
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10. NEPHRO-ZEBRA-a neonate with severe jaundice, persistent thrombocytopenia & recurrent acute kidney injury later in childhood: Joining the dots!
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Sethi SK, Yadav SP, Moideen A, and Raina R
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- Humans, Infant, Newborn, Male, Female, Jaundice etiology, Jaundice, Neonatal therapy, Jaundice, Neonatal diagnosis, Acute Kidney Injury therapy, Acute Kidney Injury diagnosis, Recurrence, Thrombocytopenia
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- 2024
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11. Assessment of South Asian Pediatric Acute Kidney Injury: Epidemiology and Risk Factors (ASPIRE)-a prospective study on "severe dialysis dependent pediatric AKI".
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Sethi SK, Raina R, Sawan A, Asim S, Khant AK, Matnani M, Ganesan K, Lohia S, Sinha R, Rumana J, Haque SS, Kalra S, Safdar R, Prasad G, Ijaz I, Ashruf OS, Nair A, S S, Soni K, Shrestha D, Yadav S, Abeyagunawardena A, Luyckx VA, Alhasan KA, and Sultana A
- Abstract
Background: Pediatric acute kidney injury (AKI) is a global health concern with an associated mortality risk disproportionately pronounced in resource-limited settings. There is a pertinent need to understand the epidemiology of pediatric AKI in vulnerable populations. Here, we proposed a prospective study to investigate the epidemiology and associated risk factors of "severe dialysis dependent AKI" in children among South Asian nations which would be the first and largest of its kind., Methods: The ASPIRE study (part of PCRRT-ICONIC Foundation initiative) is a multi-center, prospective observational study conducted in South Asian countries. All children and adolescents ≤ 18 years of age who required dialysis for AKI in any of the collaborating medical centers were enrolled. Data collection was performed until one of the following endpoints was observed: (1) discharge, (2) death, and (3) discharge against medical advice., Results: From 2019 to 2022, a total of 308 children with severe AKI were enrolled. The mean age was 6.17 years (63% males). Secondary AKI was more prevalent than primary AKI (67.2%), which predominantly occurred due to infections, dehydration, and nephrotoxins. Common causes of primary AKI were glomerulonephritis, hemolytic uremic syndrome, lupus nephritis, and obstructive uropathy. Shock, need for ventilation, and coagulopathy were commonly seen in children with severe AKI who needed dialysis. The foremost kidney replacement therapy used was peritoneal dialysis (60.7%). The mortality rate was 32.1%., Conclusions: Common causes of AKI in children in South Asia are preventable. Mortality is high among these children suffering from "severe dialysis dependent AKI." Targeted interventions to prevent and identify AKI early and initiate supportive care in less-resourced nations are needed., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2024
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12. Use of furosemide in preterm neonates with acute kidney injury is associated with increased mortality: results from the TINKER registry.
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Raina R, Sethi SK, Agrawal G, Wazir S, Bajaj N, Gupta NP, Tibrewal A, Vadhera A, Mirgunde S, Balachandran B, Sahoo J, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Soni K, Alhasan K, McCulloch M, and Bunchman T
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- Infant, Newborn, Humans, Diuretics adverse effects, Gestational Age, Kidney, Retrospective Studies, Furosemide adverse effects, Acute Kidney Injury diagnosis
- Abstract
Background: Diuretics are commonly used in neonatal AKI with the rationale to decrease positive fluid balance in critically sick neonates. The patterns of furosemide use vary among hospitals, which necessitates the need for a well-designed study., Methods: The TINKER (The Indian Iconic Neonatal Kidney Educational Registry) study provides a database, spanning 14 centres across India since August 2018. Admitted neonates (≤ 28 days) receiving intravenous fluids for at least 48 h were included. Neonatal KDIGO criteria were used for the AKI diagnosis. Detailed clinical and laboratory parameters were collected, including the indications of furosemide use, detailed dosing, and the duration of furosemide use (in days)., Results: A total of 600 neonates with AKI were included. Furosemide was used in 8.8% of the neonates (53/600). Common indications of furosemide use were significant cardiac disease, fluid overload, oliguria, BPD, RDS, hypertension, and hyperkalemia. The odds of mortality was higher in neonates < 37 weeks gestational age with AKI who received furosemide compared to those who did not receive furosemide 3.78 [(1.60-8.94); p = 0.003; univariate analysis] and [3.30 (1.11-9.82); p = 0.03]; multivariate logistic regression]., Conclusions: In preterm neonates with AKI, mortality was independently associated with furosemide treatment. The furosemide usage rates were higher in neonates with associated co-morbidities, i.e. significant cardiac diseases or surgical interventions. Sicker babies needed more resuscitation at birth, and died early, and hence needed shorter furosemide courses. Thus, survival probability was higher in neonates treated with long furosemide courses vs. short courses., (© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2024
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13. Concurrent use of continuous kidney replacement therapy during extracorporeal membrane oxygenation: what pediatric nephrologists need to know-PCRRT-ICONIC practice points.
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Raina R, Nair N, Pelletier J, Nied M, Whitham T, Doshi K, Beck T, Dantes G, Sethi SK, Kim YH, Bunchman T, Alhasan K, Lima L, Guzzo I, Fuhrman D, and Paden M
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Extracorporeal membrane oxygenation (ECMO) provides temporary cardiorespiratory support for neonatal, pediatric, and adult patients when traditional management has failed. This lifesaving therapy has intrinsic risks, including the development of a robust inflammatory response, acute kidney injury (AKI), fluid overload (FO), and blood loss via consumption and coagulopathy. Continuous kidney replacement therapy (CKRT) has been proposed to reduce these side effects by mitigating the host inflammatory response and controlling FO, improving outcomes in patients requiring ECMO. The Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup and the International Collaboration of Nephrologists and Intensivists for Critical Care Children (ICONIC) met to highlight current practice standards for ECMO use within the pediatric population. This review discusses ECMO modalities, the pathophysiology of inflammation during an ECMO run, its adverse effects, various anticoagulation strategies, and the technical aspects and outcomes of implementing CKRT during ECMO in neonatal and pediatric populations. Consensus practice points and guidelines are summarized. ECMO should be utilized in patients with severe acute respiratory failure despite the use of conventional treatment modalities. The Extracorporeal Life Support Organization (ELSO) offers guidelines for ECMO initiation and management while maintaining a clinical registry of over 195,000 patients to assess outcomes and complications. Monitoring and preventing fluid overload during ECMO and CKRT are imperative to reduce mortality risk. Clinical evidence, resources, and experience of the nephrologist and healthcare team should guide the selection of ECMO circuit., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2024
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14. The Case | Neonatal seizures and tubular dysfunction in childhood: joining the dots!
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Sethi SK, Hu J, and Raina R
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- Humans, Infant, Newborn, Seizures etiology
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- 2024
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15. Kidney transplants in small children: Weighing the pros and cons.
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Alhasan KA, Sethi SK, and Broering DC
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- Child, Humans, Decision Making, Surveys and Questionnaires, Kidney Transplantation
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- 2024
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16. An Adolescent with Tuberous Sclerosis and Hypocalcemia and a Renal Mass.
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Sethi SK, Nataraj SA, Sankhyan N, Rana A, Nair A, and Bansal SB
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Competing Interests: There are no conflicts of interest.
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- 2024
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17. Sudden Spurt in Pediatric Patients with AKI in Uzbekistan: A Call for International Drug Quality Control and Pharmaceutical Legislation.
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Murtalibova N, Sethi SK, Raina R, Mamatkulov B, and Mustakimov A
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- Humans, Child, Uzbekistan epidemiology, Legislation, Pharmacy, Pharmaceutical Preparations, Drug and Narcotic Control, Acute Kidney Injury epidemiology
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- 2023
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18. Renal Transplantation in Patients With Tuberculosis: A Single-center Experience From an Endemic Region.
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Gadde AB, Jha PK, Bansal SB, Rana A, Jain M, Bansal D, Yadav DK, Mahapatra AK, Sethi SK, and Kher V
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Background: Despite being a common infection in end-stage kidney disease patients, there are no evidence-based guidelines to suggest the ideal time of transplantation in patients on antitubercular therapy (ATT). This study aimed to examine the outcome of transplantation in patients while on ATT compared with those without tuberculosis (TB)., Methods: This was a retrospective study. Renal transplant recipients transplanted while on ATT were compared with a 1:1 matched group (for age, sex, diabetic status, and type of induction agent) of patients without TB at the time of transplant. Patient outcomes included relapse of TB and graft and patient survival., Results: There were 71 patients in each group. The mean duration for which ATT was given pretransplant was 3.8 ± 2.47 mo. The average total duration of ATT received was 12.27 ± 1.25 mo. Mortality in both the groups was similar (8.4% in the TB group versus 4.5% in the non-TB group; P = 0.49). None of the surviving patients had recurrence of TB during the follow-up. Death-censored graft survival (98.5% in the TB group versus 97% in the non-TB group; P = 1) and biopsy-proven acute rejection rates (9.86% in the TB group versus 8.45% in the non-TB group; P = 1) were also similar in both the groups., Conclusions: Successful transplantation in patients with end-stage kidney disease on ATT is possible without any deleterious effect on patient and graft survival and no risk of disease recurrence. Multicentric prospective studies are needed., (Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
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- 2023
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19. Correction: A child with chronic kidney disease and hepatic dysfunction: Questions.
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, and Raina R
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- 2023
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20. A child with chronic kidney disease and hepatic dysfunction: Questions.
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, and Raina R
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- Child, Humans, Liver Diseases complications, Liver Diseases diagnosis, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis
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- 2023
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21. Correction: A child with chronic kidney disease and hepatic dysfunction: Answers.
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, and Raina R
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- 2023
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22. A child with chronic kidney disease and hepatic dysfunction: Answers.
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, and Raina R
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- Child, Humans, Liver Diseases complications, Liver Diseases diagnosis, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis
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- 2023
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23. Atypical Hemolytic-Uremic Syndrome: Genetic Basis, Clinical Manifestations, and a Multidisciplinary Approach to Management.
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Yerigeri K, Kadatane S, Mongan K, Boyer O, Burke LLG, Sethi SK, Licht C, and Raina R
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Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy (TMA) defined by the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury. Microthrombi develop in the glomerular capillaries secondary to endothelial damage and exert shear stress on red blood cells, consume platelets, and contribute to renal dysfunction and failure. Per current understanding of pathophysiology, HUS is classified into infectious, secondary, and atypical disease. The most common etiology is infectious sequelae of Shiga toxin-producing Escherichia coli (STEC); other causative organisms include shigella and salmonella. Secondary HUS arises from cancer, chemotherapy, solid organ and hematopoietic stem cell transplant, pregnancy, or autoimmune disorders. Primary atypical hemolytic-uremic syndrome (aHUS) is associated with genetic mutations in complement and complement regulatory proteins. Under physiologic conditions, complement regulators keep the alternative complement system continuously active at low levels. In times of inflammation, mutations in complement-related proteins lead to uncontrolled complement activity. The hyperactive inflammatory state leads to glomerular endothelial damage, activation of the coagulation cascade, and TMA findings. Atypical hemolytic-uremic syndrome is a rare disorder with a prevalence of 2.21 to 9.4 per million people aged 20 years or younger; children between the ages of 0 and 4 are most affected. Multidisciplinary health care is necessary for timely management of its extra-renal manifestations. These include vascular disease of the heart, brain, and skin, pulmonary hypertension and hemorrhage, and pregnancy complications. Adequate screening is required to monitor for sequelae. First-line treatment is the monoclonal antibody eculizumab, but several organ systems may require specialized interventions and coordination of care with sub-specialists., Competing Interests: Prof. Dr. Olivia Boyer reports personal fees from Alexion, during the conduct of the study; personal fees from Alnylam, CSL/Vifor, and Purespring, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2023 Yerigeri et al.)
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- 2023
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24. A survey on nutritional management of critically ill children on continuous renal replacement therapy.
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Raina R, Sethi SK, Soundararajan A, Brown AM, Kusumi K, VanGeest J, and Bunchman T
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- Humans, Child, Renal Replacement Therapy adverse effects, Renal Replacement Therapy methods, Critical Illness therapy, Nutritional Status, Continuous Renal Replacement Therapy
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We conducted a survey of pediatric nephrologists to examine the knowledge and current practices of and identify challenges in the nutritional management of critically ill children during continuous renal replacement therapy (CRRT). Although it is known that there is a significant effect on nutrition during CRRT, there seems to be a lack of knowledge as well as variability in the practices of nutritional management in these patients, as indicated by our survey results. The heterogeneity of our survey results highlights the need to establish clinical practice guidelines and develop consensus around optimal nutritional management in pediatric patients requiring CRRT. The results as well as the known effects of CRRT on metabolism should be considered during the development of guidelines in critically ill children on CRRT. Our survey findings also highlight the need for further research in the assessment of nutrition, determination of energy needs and caloric dosing, specific nutrient needs, and management., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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25. Switching from continuous veno-venous hemodiafiltration to intermittent sustained low-efficiency daily hemodiafiltration (SLED-f) in pediatric acute kidney injury: A prospective cohort study.
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Sethi SK, Raina R, Bansal SB, Soundararajan A, Dhaliwal M, Raghunathan V, Kalra M, Soni K, Mahato SK, Vadhera A, Yadav DK, and Bunchman T
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- Humans, Child, Renal Dialysis, Prospective Studies, Critical Illness therapy, Continuous Renal Replacement Therapy, Hemodiafiltration, Acute Kidney Injury therapy
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Introduction: Continuous kidney replacement therapy (CKRT) is the preferred modality in critically ill children with acute kidney injury. Upon improvement, intermittent hemodialysis is usually initiated as a step-down therapy, which can be associated with several adverse events. Hybrid therapies such as Sustained low-efficiency daily dialysis with pre-filter replacement (SLED-f) combines the slow sustained features of a continuous treatment, ensuring hemodynamic stability, with similar solute clearance along with the cost effectiveness of conventional intermittent hemodialysis. We examined the feasibility of using SLED-f as a transition step-down therapy after CKRT in critically ill pediatric patients with acute kidney injury., Methods: A prospective cohort study was conducted in children admitted to our tertiary care pediatric intensive care units with multi-organ dysfunction syndrome including acute kidney injury who received CKRT for management. Those patients receiving fewer than two inotropes to maintain perfusion and failed a diuretic challenge were switched to SLED-f., Results: Eleven patients underwent 105 SLED-f sessions (mean of 9.55 +/- 4.90 sessions per patient), as a part of step-down therapy from continuous hemodiafiltration. All (100%) our patients had sepsis associated acute kidney injury with multiorgan dysfunction and required ventilation. During SLED-f, urea reduction ratio was 64.1 +/- 5.3%, Kt/V was 1.13 +/- 0.1, and beta-2 microglobulin reduction was 42.5 +/-4%. Incidence of hypotension and requirement of escalation of inotropes during SLED-f was 18.18%. Filter clotting occurred twice in one patient., Conclusion: SLED-f is a safe and effective modality for use as a transition therapy between CKRT and intermittent hemodialysis in children in the PICU., (© 2023 International Society for Hemodialysis.)
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- 2023
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26. Pharmacokinetics in Critically Ill Children with Acute Kidney Injury.
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Raina M, Ashraf A, Soundararajan A, Mandal AK, and Sethi SK
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- Adult, Humans, Child, Critical Illness, Renal Replacement Therapy adverse effects, Acute Kidney Injury therapy
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Acute kidney injury (AKI) is a commonly encountered comorbidity in critically ill children. The coexistence of AKI disturbs drug pharmacokinetics and pharmacodynamics, leading to clinically significant consequences. This can complicate an already critical clinical scenario by causing potential underdosing or overdosing giving way to possible therapeutic failures and adverse reactions. Current available studies offer little guidance to help maneuver such complex dosing regimens and decision-making in pediatric patients as most of them are done on heterogeneous groups of adult populations. Though there are some studies on drug dosing during continuous renal replacement therapy (CRRT), their utility is in question because of the recent advances in CRRT technology. Our review aims to discuss the principles of pharmacokinetics pertinent for honing the existing practices of drug dosing in critically ill children with AKI, and the various complexities and intricate challenges involved. This in turn will provide a framework to help enable caretakers to tailor dosing regimens in complex clinical setups with further ease and precision., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2023
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27. Diagnosing Etiology by Urine Microscopy in Sudden Spurt of Acute Kidney Injury Cases: Going Back to the Basics.
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Murtalibova N, Sethi SK, Tojiboev J, Soni K, and Raina R
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- 2023
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28. The effects of COVID-19 on pediatric and adult solid organ transplant recipients and the emergence of telehealth.
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Raina R, Shah R, Marks SD, Johnson JN, Nied M, Bhatt GC, Bonham CA, Datla N, Sethi SK, and Bartosh SM
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- Adult, Child, Humans, Pandemics, SARS-CoV-2, Transplant Recipients, COVID-19 epidemiology, Organ Transplantation adverse effects, Telemedicine
- Abstract
Background: The SARS-CoV-2 pandemic and corresponding acute respiratory syndrome have affected all populations and led to millions of deaths worldwide. The pandemic disproportionately affected immunocompromised and immunosuppressed adult patients who had received solid organ transplants (SOTs). With the onset of the pandemic, transplant societies across the world recommended reducing SOT activities to avoid exposing immunosuppressed recipients. Due to the risk of COVID-19-related outcomes, SOT providers adapted the way they deliver care to their patients, leading to a reliance on telehealth. Telehealth has helped organ transplant programs continue treatment regimens while protecting patients and physicians from COVID-19 transmission. This review highlights the adverse effects of COVID-19 on transplant activities and summarizes the increased role of telehealth in the management of solid organ transplant recipients (SOTRs) in both pediatric and adult populations., Methods: A comprehensive systematic review and meta-analysis were conducted to accentuate the outcomes of COVID-19 and analyze the efficacy of telehealth on transplant activities. This in-depth examination summarizes extensive data on the clinical detriments of COVID-19 in transplant recipients, advantages, disadvantages, patient/physician perspectives, and effectiveness in transplant treatment plans via telehealth., Results: COVID-19 has caused an increase in mortality, morbidity, hospitalization, and ICU admission in SOTRs. Telehealth efficacy and benefits to both patients and physicians have increasingly been reported., Conclusions: Developing effective systems of telehealth delivery has become a top priority for healthcare providers during the COVID-19 pandemic. Further research is necessary to validate the effectiveness of telehealth in other settings., (© 2023 Wiley Periodicals LLC.)
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- 2023
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29. Patterns in the Economic Burden of Acute Kidney Injury in Hospitalized Children, 2019-2021.
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Raina R, Soundararajan A, Menassa N, Pandya A, Nemer C, Tibrewal A, and Sethi SK
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- Child, Humans, Financial Stress, Hospitalization, Length of Stay, Child, Hospitalized, Acute Kidney Injury epidemiology
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- 2023
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30. Point-of-care ultrasound in pediatric nephrology.
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Sethi SK, Raina R, Koratala A, Rad AH, Vadhera A, and Badeli H
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- Humans, Child, Ultrasonography, Point-of-Care Testing, Echocardiography, Point-of-Care Systems, Nephrology
- Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances., (© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2023
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31. Common Prognostic Biomarkers and Outcomes in Patients with COVID-19 Infection in Saudi Arabia.
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Abujabal M, Shalaby MA, Abdullah L, Albanna AS, Elzoghby M, Alahmadi GG, Sethi SK, Temsah MH, Aljamaan F, Alhasan K, and Kari JA
- Abstract
Background: COVID-19 is a respiratory disease that eventually became a pandemic, with 300 million people infected around the world. Alongside the improvement in COVID-19 management and vaccine development, identifying biomarkers for COVID-19 has recently been reported to help in early prediction and managing severe cases, which might improve outcomes. Our study aimed to find out if there is any correlation between clinical severity and elevated hematological and biochemical markers in COVID-19 patients and its effect on the outcome. Methods: We have collected retrospective data on socio-demographics, medical history, biomarkers, and disease outcomes from five hospitals and health institutions in the Kingdom of Saudi Arabia. Results: Pneumonia was the most common presentation of COVID-19 in our cohort. The presence of abnormal inflammatory biomarkers (D-dimer, CRP, troponin, LDH, ferritin, and t white blood cells) was significantly associated with unstable COVID-19 disease. In addition, patients with evidence of severe respiratory disease, particularly those who required mechanical ventilation, had higher biomarkers when compared to those with stable respiratory conditions ( p < 0.001). Conclusion: Identifying biomarkers predicts outcomes for COVID-19 patients and may significantly help in their management.
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- 2023
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32. Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery.
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Abhay P, Sharma R, Bhan A, Raina M, Vadhera A, Akole R, Mir FA, Bajpai P, Misri A, Srivastava S, Prakash V, Mondal T, Soundararajan A, Tibrewal A, Bansal SB, and Sethi SK
- Abstract
Introduction: There is a need to index important clinical characteristics in pediatric cardiac surgery that can be obtained early in the postoperative period and accurately predict postoperative outcomes., Methodology: A prospective cohort study was conducted in the pediatric cardiac ICU and ward on all children aged <18 years undergoing cardiac surgery for congenital heart disease from September 2018 to October 2020. The vasoactive-ventilation-renal (VVR) score was analyzed to predict outcomes of cardiac surgeries with a comparison of postoperative variables., Results: A total of 199 children underwent cardiac surgery during the study period. The median (interquartile range) age was 2 (0.8-5) years, and the median weight was 9.3 (6-16) kg. The most common diagnoses were ventricular septal defect (46.2%) and tetralogy of Fallot (37.2%). At the 48th h, area under the curve (AUC) (95% CI) values were higher for the VVR score than those for other clinical scores measured. Similarly, at the 48th h, AUC (95% CI) values were higher for the VVR score than those for the other clinical scores measured for the length of stay and mechanical ventilation., Discussion: The VVR score at 48 h postoperation was found to best correlate with prolonged pediatric intensive care unit (PICU) stay, length of hospitalization, and ventilation duration, with the greatest AUC-receiver operating characteristic (0.715, 0.723, and 0.843, respectively). The 48-h VVR score correlates well with prolonged ICU, hospital stay, and ventilation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Abhay, Sharma, Bhan, Raina, Vadhera, Akole, Mir, Bajpai, Misri, Srivastava, Prakash, Mondal, Soundararajan, Tibrewal, Bansal and Sethi.)
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- 2023
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33. Complement Inhibition in Severe S. pneumoniae-Associated Hemolytic Uremic Syndrome.
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Sethi SK, Raina R, Dhaliwal M, Raghunathan V, Bansal SB, Taneja S, and Bagga A
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- Humans, Complement System Proteins, Hemolytic-Uremic Syndrome drug therapy, Pneumonia
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- 2023
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34. Patient outcome in antibody-positive systemic vasculitis treated with therapeutic plasma exchange.
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Tiwari AK, Setya D, Tanna D, Arora D, Aggarwal G, Gupta R, Bansal SB, and Sethi SK
- Abstract
Background: Therapeutic plasma exchange (TPE) has been advocated as an adjunct to steroids and cytotoxic drugs in treating patients suffering from vasculitis and presenting with active disease, but we still have insufficient evidence on its effectiveness in improving the clinical response, especially in India. This study was planned to study the clinical outcome in severe vasculitic presentations treated with TPE as an adjunctive therapy., Materials and Methods: A retrospective analysis of TPE procedures performed from July 2013 to July 2017 in the department of transfusion medicine at a large tertiary care hospital was done. All consecutive patients admitted with new diagnosis of systemic vasculitis presenting with active disease and severe presentations such as advanced renal failure or severe respiratory abnormalities or life-threatening vasculitis affecting the gastrointestinal tract, neurological and musculoskeletal system; who needed TPE for removal of preformed antibodies, were included in the study., Results: There were a total of 31 patients in whom TPE was performed for severe systemic vasculitis; 26 adults and five pediatric. Six patients tested positive for perinuclear fluorescence, 13 for cytoplasmic fluorescence (cANCA), two for atypical antineutrophil cytoplasmic autoantibody, seven for anti-glomerular basement membrane antibodies, two for antinuclear antibodies (ANA), and one patient tested positive for ANA as well as cANCA before the augmentation of TPE. Out of 31, seven patients showed no clinical improvement and succumbed to the disease. At the end of desired number of procedures, 19 tested negative and five tested weak positive for their respective antibodies., Conclusion: Favorable clinical outcomes were observed with TPE in patients with antibody-positive systemic vasculitis., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Asian Journal of Transfusion Science.)
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- 2023
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35. Renal Outcomes in Neonates and Infants with Transposition Physiology Undergoing Arterial Switch Procedure.
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Sharma R, Bhan A, Nautiyal A, Mittal A, Akole R, Malhotra N, Ahmad Mir F, Bajpai P, Misri A, Srivastava S, Prakash V, Tibrewal A, Jha PK, Bansal SB, Kher V, Raina R, and Sethi SK
- Subjects
- Infant, Infant, Newborn, Child, Humans, Prospective Studies, Dopamine, Norepinephrine, Arterial Switch Operation adverse effects, Transposition of Great Vessels surgery, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology
- Abstract
Acute kidney injury (AKI) in children with Transposition of Great arteries (TGA) undergoing Arterial Switch operation (ASO) is an important complication in the post-operative period associated with worse outcomes. AKI in children post open cardiac surgery has been well studied, with lesser data in literature pertaining to TGA and its sub-types specifically. This was a prospective, observational study enrolling infants with TGA undergoing ASO at a single center over a span of a decade from January 2010 to December 2020. The infants were followed during the duration of ICU and hospital stay, with documentation of baseline and intraoperative parameters as well as post-operative course. Out of 145 infants enrolled in the study, 83.1% developed AKI with majority (83.9%) having stage 1 AKI. Higher odds of AKI were seen in infants requiring Norepinephrine [odds ratio - 16.76 (95% CI 2.19-128.2), p < 0.001] and those who developed gram-negative infections [2.81 (1.04-7.56), p - 0.036]. Infants with AKI had significantly higher vasoactive-inotropic support at day 1 than those without AKI [16 (12.5-21.50 vs 13 (10.25-15.75), p - 0.014]. Seventeen infants in the AKI group (14%) died as opposed to none in the non-AKI group (p = 0.076). Median hours of ventilator support required were significantly higher in those with AKI than those who did not develop AKI (48 vs 45.5 p = 0.015). The infants with ASO + ASD + PDA (53% of neonates who died) were younger, had less weight at admission, more gram-negative sepsis and need for dopamine, as compared to ASO + VSD + ASD (23.5% of mortality) and ASO + ASD + VSD + aortic arch repair (23.5% of mortality). AKI in infants with TGA undergoing ASO is common and associated with poorer outcomes. In this subpopulation, AKI development is associated most commonly with hemodynamic instability and infections. This is the first study, looking at outcomes of TGA depending on the sub-types of ASO surgeries done in the infants [ASO with ASD + PDA or ASD + VSD or ASD + VSD + Arch Repair]., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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36. Siblings with complement activation, thrombotic microangiopathy and gangrene: Questions.
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Sethi SK, Dhaliwal M, Raghunathan V, Raaj H, Mahato SK, Vadhera A, Dragon-Durey MA, Jha PK, Bansal SB, and Raina R
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- Complement Activation, Complement System Proteins, Humans, Siblings, Gangrene etiology, Thrombotic Microangiopathies etiology
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- 2022
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37. Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study.
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Sethi SK, Wazir S, Sahoo J, Agrawal G, Bajaj N, Gupta NP, Mirgunde S, Balachandran B, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Sultana A, Soni K, Nair N, Sharma D, Khooblall P, Pandey A, Alhasan K, McCulloch M, Bunchman T, Tibrewal A, and Raina R
- Subjects
- Hemorrhage complications, Humans, Infant, Newborn, Kidney, Prospective Studies, Registries, Retrospective Studies, Risk Factors, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Enterocolitis, Necrotizing complications, Heart Diseases complications, Peritoneal Dialysis adverse effects, Water-Electrolyte Imbalance
- Abstract
Background: Acute kidney injury (AKI) is common in neonates admitted to neonatal intensive care units (NICUs). There is a need to have prospective data on the risk factors and outcomes of acute peritoneal dialysis (PD) in neonates. The use of kidney replacement therapy in this population compared to older populations has been associated with worse outcomes (mortality rates 17-24%) along with a longer stay in the NICU and/or hospital., Methods: The following multicentre, prospective study was derived from the TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) database, assessing all admitted neonates ≤28 days who received intravenous fluids for at least 48 h. The following neonates were excluded: death within 48 h, presence of any lethal chromosomal anomaly, requirement of congenital heart surgery within the first 7 days of life and those receiving only routine care in nursery. Demographic data (maternal and neonatal) and daily clinical and laboratory parameters were recorded. AKI was defined according to the Neonatal Kidney Disease: Improving Global Outcomes criteria., Results: Of the included 1600 neonates, a total of 491 (30.7%) had AKI. Of these 491 neonates with AKI, 44 (9%) required PD. Among neonates with AKI, the odds of needing PD was significantly higher among those with significant cardiac disease (odds ratio (95% confidence interval): 4.95 (2.39-10.27); p < 0.001), inotropes usage (4.77 (1.98-11.51); p < 0.001), severe peripartum event (4.37 (1.31-14.57); p = 0.02), requirement of respiratory support in NICU (4.17 (1.00-17.59); p = 0.04), necrotising enterocolitis (3.96 (1.21-13.02); p = 0.03), any grade of intraventricular haemorrhage (3.71 (1.63-8.45); p = 0.001), evidence of fluid overload during the first 12 h in NICU (3.69 (1.27-10.70); p = 0.02) and requirement of resuscitation in the delivery room (2.72 (1.45-5.12); p = 0.001). AKI neonates with PD as compared to those without PD had a significantly lower median (interquartile range) duration of stay in NICU (7 (4-14) vs. 11 (6-21) days; p = 0.004), but significantly higher mortality (31 (70.5%) vs. 50 (3.2%); p < 0.001). This discrepancy is likely attributable to the critical state of the neonates with AKI., Conclusions: This is the largest prospective, multicentre study specifically looking at neonatal AKI and need for dialysis in neonates. AKI was seen in 30.7% of neonates (with the need for acute PD in 9% of the AKI group). The odds of needing acute PD were significantly higher among those with significant cardiac disease, inotropes usage, severe peripartum event, requirement of respiratory support in NICU, necrotising enterocolitis, any grade of intraventricular haemorrhage, evidence of fluid overload more than 10% during the first 12 h in NICU and requirement of resuscitation in the delivery room. AKI neonates with PD as compared to AKI neonates without PD had a significantly higher mortality. There is a need to keep a vigilant watch in neonates with risk factors for the development of AKI and need for PD.
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- 2022
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38. Siblings with complement activation, thrombotic microangiopathy and gangrene: Answers.
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Sethi SK, Dhaliwal M, Raghunathan V, Raaj H, Mahato SK, Vadhera A, Dragon-Durey MA, Jha PK, Bansal SB, and Raina R
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- Complement Activation, Gangrene etiology, Humans, Siblings, Thrombotic Microangiopathies etiology
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- 2022
- Full Text
- View/download PDF
39. Anti-factor H antibody and its role in atypical hemolytic uremic syndrome.
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Raina R, Mangat G, Hong G, Shah R, Nair N, Abboud B, Bagga S, and Sethi SK
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- Antibodies genetics, Antibodies immunology, Blood Proteins genetics, Complement C3b Inactivator Proteins genetics, Complement Factor H antagonists & inhibitors, Complement Factor H genetics, Complement Factor H immunology, Humans, Plasma Exchange, Acute Kidney Injury genetics, Acute Kidney Injury immunology, Acute Kidney Injury therapy, Atypical Hemolytic Uremic Syndrome complications, Atypical Hemolytic Uremic Syndrome genetics, Atypical Hemolytic Uremic Syndrome immunology, Atypical Hemolytic Uremic Syndrome therapy, Complement System Proteins genetics, Complement System Proteins immunology
- Abstract
Atypical hemolytic uremic syndrome (aHUS) an important form of a thrombotic microangiopathy (TMA) that can frequently lead to acute kidney injury (AKI). An important subset of aHUS is the anti-factor H associated aHUS. This variant of aHUS can occur due to deletion of the complement factor H genes, CFHR1 and CFHR3 , along with the presence of anti-factor H antibodies. However, it is a point of interest to note that not all patients with anti-factor H associated aHUS have a CFHR1/R3 deletion. Factor-H has a vital role in the regulation of the complement system, specifically the alternate pathway. Therefore, dysregulation of the complement system can lead to inflammatory or autoimmune diseases. Patients with this disease respond well to treatment with plasma exchange therapy along with Eculizumab and immunosuppressant therapy. Anti-factor H antibody associated aHUS has a certain genetic predilection therefore there is focus on further advancements in the diagnosis and management of this disease. In this article we discuss the baseline characteristics of patients with anti-factor H associated aHUS, their triggers, various treatment modalities and future perspectives., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor C-YY declared a shared parent affiliation with the author RS at the time of review., (Copyright © 2022 Raina, Mangat, Hong, Shah, Nair, Abboud, Bagga and Sethi.)
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- 2022
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40. Familial kidney failure with macro-thrombocytopenia: Answers.
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Sethi SK, Goel S, Vadhera A, Raaj H, Mahato SK, Jha PK, Bansal SB, and Raina R
- Subjects
- Humans, Mutation, Hearing Loss, Sensorineural, Renal Insufficiency etiology, Renal Insufficiency genetics, Thrombocytopenia diagnosis, Thrombocytopenia genetics
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- 2022
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41. Validation of the STARZ neonatal acute kidney injury risk stratification score.
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Sethi SK, Raina R, Rana A, Agrawal G, Tibrewal A, Bajaj N, Gupta NP, Mirgunde S, Sahoo J, Balachandran B, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Soni K, Sharma D, Khooblall A, Khooblall P, Bunchman T, and Wazir S
- Subjects
- Humans, Infant, Newborn, Intensive Care Units, Neonatal, Predictive Value of Tests, ROC Curve, Risk Assessment, Risk Factors, Acute Kidney Injury diagnosis, Acute Kidney Injury etiology
- Abstract
Background: Neonatal acute kidney injury (AKI) is common in neonatal intensive care units (NICU) and leads to worse outcomes. Stratifying neonates into an "at risk" category allows health care providers to objectively recognize opportunities for improvements in quality of care., Methods: The "Neonatal AKI Risk Prediction Scoring" was devised as the "STARZ [Sethi, Tibrewal, Agrawal, Raina, waZir]" Score. The STARZ score was derived from our prior multicentre study analysing risk factors for AKI in neonates admitted to the NICU. This tool includes 10 variables with a total score ranging from 0 to 100 and a cut-off score of 31.5. In the present study, the scoring model has been validated in our multicentre cohort of 744 neonates., Results: In the validation cohort, this scoring model had sensitivity of 82.1%, specificity 91.7%, positive predictive value 81.2%, negative predictive value 92.2% and accuracy 88.8%. Based on the STARZ cut-off score of ≥ 31.5, an area under the receiver operating characteristic (ROC) curve was observed to be 0.932 (95% CI, 0.910-0.954; p < 0.001) signifying that the discriminative power was high. In the validation cohort, the probability of AKI was less than 20% for scores up to 32, 20-40% for scores between 33 and 36, 40-60% for scores between 37 and 43, 60-80% for scores between 44 and 49, and ≥ 80% for scores ≥ 50., Conclusions: To promote the survival of susceptible neonates, early detection and prompt interventional measures based on highly evidenced research is vital. The risk of AKI in admitted neonates can be quantitatively determined by the rapid STARZ scoring system. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
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- 2022
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42. Familial kidney failure with macro-thrombocytopenia: Questions.
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Sethi SK, Goel S, Vadhera A, Raaj H, Mahato SK, Jha P, Bansal S, and Raina R
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- Blood Platelets, Humans, Renal Insufficiency etiology, Renal Insufficiency genetics, Thrombocytopenia diagnosis, Thrombocytopenia genetics
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- 2022
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- View/download PDF
43. A farmer's child with kidney failure.
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Singh DP, Dhaliwal M, Raghunathan V, Vadhera A, Kumar A, Bansal SB, Jha PK, Raina R, and Sethi SK
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- Child, Farmers, Humans, Farmer's Lung, Renal Insufficiency diagnosis, Renal Insufficiency etiology
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- 2022
- Full Text
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44. Editorial: Kidney replacement therapy advances in children.
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Raina R, Sethi SK, Nair N, and Yap HK
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- 2022
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45. STARZ Neonatal AKI Risk Stratification Cut-off Scores for Severe AKI and Need for Dialysis in Neonates.
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Sethi SK, Raina R, Wazir S, Agrawal G, Vadhera A, Nair N, Soni K, and Tibrewal A
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- 2022
- Full Text
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46. Blood filters in children with COVID-19 and acute kidney injury: A review.
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Raina R, Sethi SK, Chakraborty R, Singh S, Teo S, Khooblall A, Montini G, Bunchman T, Topaloglu R, and Yap HK
- Subjects
- Adult, Child, Cytokines metabolism, Endotoxins, Female, Humans, Male, Renal Replacement Therapy methods, Acute Kidney Injury epidemiology, Acute Kidney Injury therapy, COVID-19 therapy
- Abstract
COVID-19 has challenged the global healthcare system through rapid proliferation and lack of existing treatment resulting in over 180 million cases and 3.8 million deaths since December 2019. Although pediatric patients only comprise 1%-2% of diagnosed cases, their incidence of acute kidney injury ranges from 8.2% to 18.2% compared to 49% in adults. Severe infection, initiated by dysregulated host response, can lead to multiorgan failure. In this review, we focus on the use of various blood filters approved for use in pediatric kidney replacement therapy to mitigate adverse effects of severe illness. Therapeutic effects of these blood filters range from cytokine removal (CytoSorb, HA330, HCO/MCO), endotoxin removal (Toraymyxin, CPFA), both cytokine and endotoxin removal (oXiris), and nonspecific removal of proteins (PMMA) that have already been established and can be used to mitigate the various effects of the cytokine storm syndrome in COVID-19., (© 2022 International Society for Apheresis and Japanese Society for Apheresis.)
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- 2022
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47. Pediatric to Adult Transition: Identifying Important Comorbidities and Considerations for Adult and Pediatric Nephrology Health Care Teams.
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Raina R and Sethi SK
- Subjects
- Adult, Child, Comorbidity, Humans, Patient Care Team, Nephrology, Transition to Adult Care
- Published
- 2022
- Full Text
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48. Acute kidney injury in COVID-19 pediatric patients in North America: Analysis of the virtual pediatric systems data.
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Raina R, Mawby I, Chakraborty R, Sethi SK, Mathur K, Mahesh S, and Forbes M
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- Adult, Child, Female, Hospital Mortality, Humans, Intensive Care Units, Male, Retrospective Studies, Risk Factors, SARS-CoV-2, Young Adult, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Acute Kidney Injury therapy, COVID-19 complications, COVID-19 epidemiology
- Abstract
Background: Despite extensive research into acute kidney injury (AKI) in adults, research into the epidemiology, associated risk factors, treatment, and mortality of AKI in pediatric COVID-19 patients is understudied. Advancing understanding of this disease is crucial to further developing treatment and preventative care strategies to reduce morbidity and mortality., Methods: This is a retrospective analysis of 2,546 COVID-19 pediatric patients (age ≤ 21 years) who were admitted the ICU in North America. Analysis of the Virtual Pediatric Systems (VPS) COVID-19 database was conducted between January 1, 2020, and June 30, 2021., Results: Out of a total of 2,546 COVID positive pediatric patients, 10.8% (n = 274) were diagnosed with AKI. Significantly higher continuous and categorical outcomes in the AKI subset compared to the non-AKI cohort included: length of stay at the hospital (LOS) [9.04 (5.11-16.66) vs. 5.09 (2.58-9.94) days], Pediatric Index of Mortality (PIM) 2 probability of death [1.20 (0.86-3.83) vs. 0.96 (0.79-1.72)], PIM 3 probability of death [0.98 (0.72-2.93) vs. 0.78 (0.69-1.26)], mortality [crude OR (95% CI): 5.01 (2.89-8.70)], airway and respiratory support [1.63 (1.27-2.10)], cardio-respiratory support [3.57 (1.55-8.23)], kidney support [12.52 (5.30-29.58)], and vascular access [4.84 (3.70-6.32)]., Conclusions: This is one of the first large scale studies to analyze AKI among pediatric COVID-19 patients admitted to the ICU in North America. Although the course of the COVID-19 virus appears milder in the pediatric population, renal complications may result, increasing the risk of disease complication and mortality., Competing Interests: The authors have declared that no competing interests exist.
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- 2022
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49. Perioperative albuminuria and clinical model to predict acute kidney injury in paediatric cardiac surgery.
- Author
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Nautiyal A, Sethi SK, Sharma R, Raina R, Tibrewal A, Akole R, Gupta A, Bhan A, and Bansal SB
- Subjects
- Albumins, Albuminuria complications, Albuminuria etiology, Biomarkers urine, Child, Female, Humans, Male, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications urine, Acute Kidney Injury diagnosis, Acute Kidney Injury etiology, Acute Kidney Injury urine, Cardiac Surgical Procedures adverse effects
- Abstract
Background: AKI is an important complication post cardiac surgery in children. An early diagnosis can help in mitigating complications and allow for prognostication. Urinary albumin:creatinine ratio (ACR) as a biomarker can provide a cheaper and more accessible AKI risk assessment and prediction. There is a paucity of paediatric literature regarding its utility., Methods: This was a prospective observational study, enrolling all children aged 1 month to 18 years, who underwent cardiac surgery, with use of cardiopulmonary bypass. Cohort was divided into groups < 2 years and ≥ 2 years for analyses to account for differences in physiological albumin excretion with age., Results: Of 143 children enrolled in the study, 36 developed AKI. In both age groups, the post-operative ACR was higher than pre-operative ACR among patients with and without AKI. In the group aged ≥ 2 years, the highest first post-operative ACR tertile (> 75.8 mg/g) predicted post-operative AKI after adjusting for clinical variables (adjusted RR, 11.71; 1.85-16.59). In the group aged < 2 years, the highest first post-operative ACR tertile (> 141.3 mg/g) predicted post-operative AKI in unadjusted analysis but not after adjusting for clinical variables (RR, 2.78; 0.70-6.65). For AKI risk prediction, AUC (95% CI) was highest after combining clinical model and pre-operative ACR for groups aged < 2 years [0.805 (0.713-0.896)] and ≥ 2 years [0.872 (0.772-0.973)]., Conclusions: This study provides evidence for use of albuminuria as a feasible biomarker in AKI prediction in children post cardiac surgery, especially when added to a clinical model. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2021. IPNA.)
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- 2022
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50. Neonatal acute kidney injury risk stratification score: STARZ study.
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Wazir S, Sethi SK, Agarwal G, Tibrewal A, Dhir R, Bajaj N, Gupta NP, Mirgunde S, Sahoo J, Balachandran B, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Soni K, Rana A, Bunchman T, and Raina R
- Subjects
- Creatinine, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Prospective Studies, Risk Assessment, Risk Factors, Acute Kidney Injury
- Abstract
Background: Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures., Methods: The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]., Results: The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%., Conclusions: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit., Impact: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment. With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
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- 2022
- Full Text
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