Amar Taksande
@dmimsu.edu.in
Professor and Head of Department, Department of Paediatrics
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha
EDUCATION
MBBS, Nagpur University, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram
MD (Paediatrics ), Nagpur University, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram
Fellowship in Pediatric Cardiology, Innova Children Heart Hospital, Hyderabad (2009-10).
Visiting Fellowship: Royal College of Pediatric and Child Health (RCPCH), United Kingdom (2011-12).
RESEARCH INTERESTS
Pediatric cardiology,
Neonatology
Maternal and child health
Infectious Diseases
Pediatric reserach
Scopus Publications
Scopus Publications
Nilesh Darvhekar, Mahaveer Singh Lakra, Revat J Meshram, and Amar Taksande
Medknow
Abstract Introduction: Rickettsial disease has nowadays emerging as one of the most common causes of exanthematous fever with rash with high mortality and morbidity. Rickettsial fever cases are being reported from all over India. Objectives: The study aims to evaluate prevalence, demographic and clinical details of the cases of rickettsial infection in central India and to assess the significance of Rathi Goodman Aghai (RGA) score and Weil Felix test in diagnosis of rickettsial infection. Materials and Methods: It was a retrospective, analytical comparative study. Patients between age group of 2 months to 18 years from endemic area presenting with fever of more than 4 days duration and/or typical rash (maculopapular/necrotic) with eschar and supporting laboratory test were included in the study. Patients’ demographic and clinical data were analyzed by the software STATA software. and Chi square test. Results: The most common age group affected was between 1 and 5 years (38.09%). 76.19% of patients were from rural area. All the patients 21 (100%) presented with fever. The most common complication was meningoencephalitis (42.85%). Rathi Aghai score was positive in 90.47% of the patients. Weil Felix test was positive in 85.71% cases, out of which 33.33% of patients had OXK strain. The sensitivity and specificity of RGA score was found to be 94.44% and 33.33%, respectively, with positive predictive value of 89.47%. Conclusion: RGA score is a good tool for diagnosis of rickettsial infection with sensitivity and specificity of 94.44% and 33.33%, respectively.
Ashwini Lakra, Mahaveer Singh Lakra, Amar Taksande, Ishani Arora, and Heena Sudhir Bhandekar
Medknow
Abstract The basic signs and symptoms in clinical practice are losing its glory nowadays due to final jumping at diagnosis and due to the easy availability of sophisticated investigations and handy literature. The level of teaching has also gone down in medical colleges, and these clinical signs are not taught and not illustrated, as everyone feels that these are outdated. Although this case looks very simple, it carries lots of importance. A preterm baby who was suffering from respiratory distress and was doing well suddenly desaturated and deteriorated while on ventilator. We worked out the possible causes of displacement, obstruction, pneumothorax, equipment failure, and suspected pneumothorax. Immediately, bedside transillumination test (which is nowadays thought to be outdated) was performed, and a chest drain was put in urgently without waiting for the X-ray and lung ultrasound. Chest drainage was put in immediately, and the baby started improving immediately. and later on, an X-ray was taken, which was suggestive of improving pneumothorax. The present article highlights the importance of elicitation of proper signs and symptoms, the importance of performing illumination tests in newborns, along with the significance of clinical teaching.
Amar Taksande
Korean Pediatric Society
Mahaveer Singh Lakra, Bhavana Lakhkar, and Amar Taksande
Medknow
Amar Taksande, , Patel Zeeshan Jameel, Rupesh Rao, Bharati Taksande, Sachin Damke, , , , and
Negah Scientific Publisher
Objectives: The exact prevalence of cardiac anomalies in diagnosed cases of echogenic foci is still unknown, as various studies have been carried out across multiple populations with different methodologies. Objectives: The primary objective of this study was to determine the precise prevalence of cardiac anomalies found in cases with intracardiac echogenic foci. Methods: The authors manually searched the electronic databases (Cochrane Library, PubMed, EMBASE, Scopus, Web of Science). Two reviewers independently did data extraction and quality control; a third reviewer resolved any raised conflicts. The data were analyzed by comprehensive meta-analysis software version 2. Risk of bias assessment and strobe checklist were used for quality assessment. Results: Out of 531 articles identified, 32 studies met the inclusion criteria and were included in the meta-analysis with a total sample size of 7568. The pooled prevalence of cardiac anomalies in the fetuses with intracardiac echogenic foci was 4.8% (95% CI, 3.6%-6.4%). Subgroup analysis was done according to the geographical distribution of cases, maternal age, gestational age, year of publication, risk of bias, and ultrasonography operator. Conclusions: The current study represents the first and only meta-analysis concerning the prevalence of cardiac anomaly in fetuses diagnosed with intracardiac echogenic focus (ICEF). This study supports a definitive relationship between ICEF and underlying congenital heart disease. We recommend increased training of individuals performing this ultrasonography to improve early detection, ultimately enhancing the care given to infants immediately post-birth.
Ashwini Lakra, Heena Sudhir Bhandekar, Ishani Arora, Mahaveer Singh Lakra, and Amar Taksande
Medknow
Kshitij Aviraj and Amar Taksande
Pan African Medical Journal
Iyer Lavanya Ramakrishnan and Amar Taksande
Pan African Medical Journal
Keya Rani Lahiri, Raghvendra Singh, Mohini Apte, Mahantesh Patil, Amar Taksande, Rafael Varona, Godhuli Chatterjee, Manish Verma, Sandrine Brette, and Marcos III Perez
Springer Science and Business Media LLC
Abstract Background Childhood diarrhea remains a major disease burden, particularly in developing countries, and is a leading cause of death in children aged < 5 years, worldwide. Treatment of acute diarrhea now includes probiotics to potentially reduce the duration and severity of the illness. This phase 3, randomized, placebo-controlled, double-blind study assessed the efficacy and safety of four strains (O/C, N/R, SIN, T) of Bacillus clausii probiotic (Enterogermina®) plus oral rehydration therapy (ORT) and zinc, versus placebo plus ORT and zinc, in infants and children in India with acute moderate diarrhea. Methods Patients aged 6 months to 5 years with acute moderate diarrhea (WHO 2005 definition) of < 48 h’ duration were randomly assigned to receive one mini bottle of either polyantibiotic-resistant B. clausii (oral suspension of 2 billion spores per 5 mL bottle) or matching placebo twice daily (morning and evening) for 5 days. Exclusion criteria included known hypersensitivity to B. clausii or excipients in the study treatment, or to other probiotics. Patients were admitted to hospital from Day 1 and discharged ≥6 h after diarrhea resolution, or a maximum of 5 days. The primary endpoint was duration of acute diarrhea from randomization to recovery. Secondary endpoints included frequency of stools, diapers with stools, or dehydration status. Results In total, 457 patients were randomized; 454 were treated. Similar proportions of patients showed recovery from diarrhea over the 120 h after randomization (97.0% in the B. clausii group [n = 227]; 98.0% on placebo [n = 227]). Median time to recovery was also similar: 42.83 (95% CI: 40.90–44.90) hours for B. clausii and 42.13 (95% CI: 39.80–43.87) hours for placebo. However, no statistically significant difference was observed between groups (hazard ratio = 0.93 [95% CI: 0.77–1.13]; p = 0.6968); nor were there statistically significant differences between groups for the secondary endpoints. Treatment with B. clausii was well tolerated with incidence of adverse events (9.7%) similar to that for placebo (12.3%). Conclusions No significant difference in efficacy between B. clausii and placebo was demonstrated. Sample size may have been inadequate to allow detection of a between-group difference in efficacy, given the mild/moderate severity (only ~ 20% of patients had nausea/vomiting or abdominal pains) and short duration of disease among subjects, the relatively late start of treatment (most were already on Day 2 of their disease episode when study treatment started) and the effectiveness of the standard of care with ORT and zinc in both treatment groups. Trial registration CTRI number CTRI/2018/10/016053. Registered on 17 October 2018. EudraCT number 2016-005165-31. Registered 14 May 2020 (retrospectively registered).
Amar Taksande
Academy of Family Physicians of Malaysia
Mahaveer Lakra, Amar Taksande, Bhavana Lakhkar, Sachin Damke, and Ashwini Lakra
Nepal Journals Online (JOL)
The SARS COVID-19 virus has arisen as a major hazard to mankind, posing harm to the whole world population. During the second COVID wave, mucormycosis has emerged as one of the deadliest and most devastating illnesses. Mucormycosis is strongly associated with diabetes, prolonged use of steroids, prolonged hospitalisation and immunocompromised states. Children have also been affected by this badly. Hyperbaric oxygen therapy is a non-invasive, cost-effective and painless therapy where 100% oxygen is given to patients under high atmospheric pressure in small tents or chambers. It helps in tissue regeneration and angiogenesis. Hyperbaric oxygen has proved to be effective in the treatment of oculo-rhino-cerebral mucormycosis. Various studies have proved its role in the management of mucormycosis and acute respiratory distress syndrome associated with COVID-19 infection. The advantages of hyperbaric oxygen are same in children as in adults with minimum side effects. Hyperbaric oxygen therapy can be one of the good adjunctive therapies in the management of mucormycosis. It is found to be safe in the treatment of COVID-19 infection, but data is still limited on its use and further studies are needed. This article is all about its use, its efficacy, and future perspectives in the management of mucormycosis and COVID-19 in view of the arrival of the third COVID wave in developing countries like India.
Matthew M. Heeney, Miguel R. Abboud, Jessie Githanga, Baba P. D. Inusa, Julie Kanter, Alan D. Michelson, Videlis Nduba, Victor Musiime, Mohini Apte, Adlette Inati,et al.
American Society of Hematology
Abstract The phase 3 HESTIA3 study assessed the efficacy and safety of the reversible P2Y12 inhibitor ticagrelor vs placebo in preventing vaso-occlusive crises in pediatric patients with sickle cell disease (SCD). Patients aged 2 to 17 years were randomly assigned 1:1 to receive weight-based doses of ticagrelor or matching placebo. The primary end point was the rate of vaso-occlusive crises, a composite of painful crises and/or acute chest syndrome (ACS). Key secondary end points included number and duration of painful crises, number of ACS events, and number of vaso-occlusive crises requiring hospitalization or emergency department visits. Exploratory end points included the effect of ticagrelor on platelet activation. In total, 193 patients (ticagrelor, n = 101; placebo, n = 92) underwent randomization at 53 sites across 16 countries. The study was terminated 4 months before planned completion for lack of efficacy. Median ticagrelor exposure duration was 296.5 days. The primary end point was not met: estimated yearly incidence of vaso-occlusive crises was 2.74 in the ticagrelor group and 2.60 in the placebo group (rate ratio, 1.06; 95% confidence interval, 0.75-1.50; P = .7597). There was no evidence of efficacy for ticagrelor vs placebo across secondary end points. Median platelet inhibition with ticagrelor at 6 months was 34.9% predose and 55.7% at 2 hours’ postdose. Nine patients (9%) in the ticagrelor group and eight patients (9%) in the placebo group had at least one bleeding event. In conclusion, no reduction of vaso-occlusive crises was seen with ticagrelor vs placebo in these pediatric patients with SCD. This trial was registered at www.clinicaltrials.gov as #NCT03615924.
Rupesh Rao, Amar Taksande, Syed Athhar Saqqaf, Sachin Yedve, and Sneh Kumar
SAGE Publications
Background Neurosonography has been commonly used for screening in neonatal intensive care unit (NICU), for early detection of defects in the central nervous system (CNS) which include findings like intracranial hemorrhage, hydrocephalus, cerebral edema, and other structural abnormalities. Aim To detect the CNS abnormality in critically ill neonates by neurosonography. Materials and Methods This was a cross-sectional study done in the NICU of AVBR Hospital, Sawangi Meghe, Wardha. Neonates were defined as “critically ill” after taking their detailed history and performing a complete physical examination. Following this, the newborns who fulfilled the studies’ inclusion criteria were subjected to neurosonogram. The following factors were considered: gestational age, clinical examination, investigations, neurosonography findings, and outcomes. Results A total of 150 critically ill newborns were subjected to neurosonography, 24 of them had abnormal findings. There was a significant correlation of gestational weeks, mode of delivery, and diagnosis of critically ill neonates with abnormal neurosonography ( P = .000, P = .000, and P = .000). Prematurity was the most common diagnosis followed by meningitis. A total of 16% of the newborns had abnormal results in neurosonography. About 6.67% of these had hydrocephalus, 5.34% had an intraventricular hemorrhage (IVH), 1.34% had periventricular echogenicity, 0.66% had cerebral edema, 0.67% had germinal matrix hemorrhage, and 0.66% had brain abscess. A total of 109 (72.67%) participants in the study had a positive outcome at the time of discharge from NICU; whereas, 27 (18%) unfortunately did not survive. Conclusion Neurosonography is thus a valuable, safe, and effective diagnostic tool used for screening critically ill neonates for abnormalities of the brain.
Babasaheb V. Tandale, Shilpa J. Tomar, Vijay P. Bondre, Gajanan N. Sapkal, Rekha G. Damle, Rahul Narang, Mohiuddin S. Qazi, Padmaja V. Goteti, Manish Jain, Dipty Jain,et al.
Elsevier BV
Richa Chaudhary, Karthikeya Nagula, and Amar Taksande
Georg Thieme Verlag KG
AbstractAltered consciousness is a common problem encountered in the pediatric emergency department. Modified Glasgow coma scale (MGCS) has been widely used in pediatric intensive care units (PICUs) for assessing the level of consciousness in children with various illnesses. To compare utility of alert verbal painful unresponsive (AVPU) scale and MGCS for assessing level of consciousness of critically ill patients admitted to PICU. A prospective observational study was conducted at Acharya Vinoba Bhave Rural Hospital in Maharashtra, India on children above the age of 30 days admitted to the PICU from September 2018 to August 2019, fulfilling the inclusion criteria, after obtaining informed consent from the parents. Level of consciousness of the enrolled patients was assessed using the AVPU scale and MGCS. One-way analysis of variance technique was used for data analysis. A total of 74 children were included in the study. A good correlation was observed between the two scales and mean MGCS score of 13.8 (13–15), 11.3 (11–12), 8.09 (7–9), and 3 corresponded to A, V, P, and U, respectively. AVPU scale was comparable to MGCS in assessing level of consciousness in children admitted to PICU. AVPU can be used for initial evaluation of level of consciousness in children presenting with altered consciousness. More detailed MGCS can be used to assess the improvement over time and to decide further treatment strategy.
Arjun Jaiswal and Amar Taksande
Pan African Medical Journal
Amar Taksande, Yash Dalal, Himanshi Jindal, and Taksande Bharati
Paediatrica Indonesiana - Indonesian Pediatric Society
Background Many studies have been conducted on heart, liver, and endocrine abnormalities in thalassemia; however, studies on pulmonary dysfunction (PD) have been limited. Previous studies on the prevalence of restrictive lung disease (RLD) and obstructive lung disease (OLD) in β-thalassemia major patients have lacked agreement.
 Objective To assess the prevalence of PD in β-thalassemia major patients by systematic review of the literature and meta-analysis.
 Methods We searched Cochrane library, PubMed, Web of Science, MEDLINE, Scopus, and Embase for relevant articles. Articles were selected according to the inclusion criteria and data were extracted. The primary outcome was prevalence of pulmonary dysfunction in β-thalassemia major with 95% confidence interval (95%CI). Subgroup analyses were applied to explore the prevalence in different age groups, regions, and serum ferritin levels. Sensitivity analysis and publication bias assessment were also conducted.
 Results A total of 37 studies comprising 1,467 cases were included in this analysis. Pulmonary dysfunction was present in 64.7% (95%CI 57.6 to 71.1) of cases. The pooled prevalence of RLD (44.9%) was higher than that of OLD (7.6%) and diffusion impairment (DI) (35.6%). Subgroup analysis revealed that the region with the highest pooled prevalence of PD was the Americas (75.2%). The highest prevalence of RLD and DI was found in Asia (48.2% and 44.6%, respectively) and that of OLD in Europe (9.7%). Sensitivity analysis showed that the pooled results were robust.
 Conclusion A high prevalence of pulmonary dysfunction, mainly RLD rather than OLD, was detected in β-thalassemia major patients.
Amar Taksande and PatelZeeshan Jameel
Medknow
Amar Taksande, Divya Pujari, Patel Zeeshan Jameel, Bharati Taksande, and Revat Meshram
Baishideng Publishing Group Inc.
BACKGROUND Pulmonary hypertension (PH) has serious short- and long-term consequences. PH is gaining increasing importance in high risk groups such as Down syndrome (DS) as it influences their overall survival and prognosis. Hence, there is a dire need to collate the prevalence rates of PH in order to undertake definitive measures for early diagnosis and management. AIM To determine the prevalence of PH in children with DS. METHODS The authors individually conducted a search of electronic databases manually (Cochrane library, PubMed, EMBASE, Scopus, Web of Science). Data extraction and quality control were independently performed by two reviewers and a third reviewer resolved any conflicts of opinion. The words used in the literature search were “pulmonary hypertension” and “pulmonary arterial hypertension”; “Down syndrome” and “trisomy 21” and “prevalence”. The data were analyzed by Comprehensive Meta-Analysis Software Version 2. Risk of bias assessment and STROBE checklist were used for quality assessment. RESULTS Of 1578 articles identified, 17 were selected for final analysis. The pooled prevalence of PH in these studies was 25.5%. Subgroup analysis was carried out for age, gender, region, year of publication, risk of bias and etiology of PH. CONCLUSION This review highlights the increasing prevalence of PH in children with DS. It is crucial for pediatricians to be aware of this morbid disease and channel their efforts towards earlier diagnosis and successful management. Community-based studies with a larger sample size of children with DS should be carried out to better characterize the epidemiology and underlying etiology of PH in DS.
A. Taksande and R. Rao
Background: Neurosonography has commonly used for screening in a tertiary level hospital with a neonatal intensive care unit (NICU), for early detection of Central Nervous System (CNS) defects like intra-ventricular haemorrhage (IVH), hydrocephalus, cerebral edema or any structural anomalies. in the neonates brain. Aim: To study the detection of Central Nervous System (CNS) abnormality by neurosonography in critically ill neonates. Materials and methods: This was a cross sectional study done in NICU, AVBRH, Sawangi Meghe. By taking detailed maternal history and clinical examination, neonate is described as “critically ill”. These neonates subjected to neurosonogram (NUSG) according to the inclusion and exclusion criteria as per the protocols and various anomalies noted. Gestational age, birth weight, clinical examination, investigation, neurosonography finding and outcome were evaluated. Results: Neurosonography performed in 105 critically ill neonates. Out of that, 21 had abnormal neurosonography finding. There was no significant correlation of birth weight and gestational age of high-risk neonate with abnormal neurosonograpy (p=0.538 & p=0.130). The most frequent clinical manifestation was RDS followed by neonatal seizure. The mean HR,RR, SBP,DBP and SpO2 were 140±19.81, 54.08±13.07, 90.96±8.66, 54.13±8.39 and 94.39±6.93 respectively. There was no statistically significant correlation between the vital parameters and the presence of abnormalities on neurosonography. On neurosonography, 20% of neonates had abnormal findings. About 8.57% of these had hydrocephalus, 6.6% Intraventricular haemorrhage, 1.90% has periventricular echogenicity, 0.95% had cerebral oedema, 0.95% had germinal matrix haemorrhage and 1% had brain abscess. Seventy-two neonates (68.57%) participate had positive outcome at the time of NICU discharge and 19(18.10%) were died. Conclusion: Neurosonography is a useful tool in NICU. It is acceptable and reliable modality to screen critically ill neonates and aid in early detection and management of these ill neonates.
Amar Taksande, PatelZeeshan Jameel, Bharati Taksande, and Rewat Meshram
Medknow
Red reflex test (RRT) screening is yet to be a part of the neonate's normal examination before discharge from hospital in a majority of low- and middle-income countries. The purpose was this review was to systematically evaluate the diagnostic accuracy of RRT for the detection of ocular abnormalities in newborns. PubMed, EMBASE, Scopus, Web of Science, and Cochrane database of systematic reviews were the data sources. Quality of Diagnostic Accuracy Studies-2 (QUADAS-2) was utilized for quality assessment of bias and applicability. Random effects models were used to summarize sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and respective confidence intervals (CI). The pooled sensitivity, calculated from the meta analysis of 11 studies, was 23% (95% CI: 21–24%) and pooled specificity was 98% (95% CI: 98–98%). The PLR was 32.52 (95% CI: 7.89–134.15), NLR was less than 1 (0.69 [95% CI: 0.55–0.88]), and DOR calculated was 138.48 (95% CI: 23.85–803.97). The area under the curve (AUC) and Q* index for RRT were 0.98 ± 0.02 and 0.95 ± 0.045, respectively. The results of our study justify the conclusion that RRT is a highly sensitive and specific test for the detection of anterior segment abnormalities.
Amar Taksande and Patel Zeeshan Jameel
Bentham Science Publishers Ltd.
Critical congenital heart defects (CCHDs) are serious malformations that remain to be an important cause of neonatal mortality and morbidity. The clinical presentations of CCHD are shock, cyanosis, or respiratory distress, which may be similar to that of other neonatal conditions. Failure to diagnose these conditions early on after birth may result in acute cardiovascular collapse and death. Screening with routine pulse oximetry is efficient in distinguishing newborns with CCHD and other hypoxemic illnesses, which may otherwise be potentially life-threatening. If the cardiovascular system cannot be observed by echocardiography, then treatment with continuous prostaglandin-E1(PGE1) infusion should be started in any newborn whose condition deteriorates in the first few days of life. This review aims to provide a concise summary of the presentation and management of various CCHDs and to emphasize the role of timely diagnosis in the management.
Amar Taksande, Patel Zeeshan Jameel, Divya Pujari, Bharati Taksande, and Revat Meshram
Pan African Medical Journal
Introduction the spectrum of pulmonary complications in sickle cell anemia (SCA) comprises mainly of acute chest syndrome (ACS), pulmonary hypertension (PH) and airway hyper-responsiveness (AHR). This study was conducted to examine the abnormalities in pulmonary function tests (PFTs) seen in children with SCA. Methods electronic databases (Cochrane library, PubMed, EMBASE, Scopus, Web of Science) were used as data sources. Two authors independently reviewed studies. All case-control studies with PFT performed in patients with SCA and normal controls were reviewed. Pulmonary functions were assessed with the help of spirometry, lung volume and gas diffusion findings. Results nine studies with 788 SCA children and 1101 controls were analyzed. For all studies, the pooled mean difference for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow rate (PEFR), total lung capacity (TLC) and carbon mono-oxide diffusing capacity (DLCO) were -12.67, (95% CI: -15.41,-9.94), -11.69, (95% CI: -14.24, -9.14), -1.90, (95% CI: -4.32, 0.52), -3.36 (95% CI: -6.69, -0.02), -7.35, (95% CI: -14.97, -0.27) and -4.68, (95% CI -20.64, -11.29) respectively. FEV1 and FVC and were the only parameters found to be significantly decreased. Conclusion sickle cell anemia was associated with lower FEV1 and FVC, thus, supporting the role of routine monitoring for the progression of lung function decline in children with SCA with ACS. We recommend routine screening and lung function monitoring for early recognition of pulmonary function decline.