- Pediatric Pulmonary
Clinical Associate Professor, Pediatrics - Pulmonary Medicine
Board Certification: Sleep Medicine, American Board of Pediatrics (2009)
Board Certification: Pediatric Pulmonary, American Board of Pediatrics (2004)
Fellowship:Children's Hospital of Philadelphia (2001) PA
Residency:University of Kansas School of Medicine (1998) KS
Medical Education:PtBD Sharma Post Graduate Institute of Medical Education and Research (1993) India
- Independent Studies (5)
Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
2018; 14 (7): 1187–92
STUDY OBJECTIVES: A major component of pediatric acute-onset neuropsychiatric syndrome (PANS) is disruption of sleep. These disturbances have been reported in the acute phase of diagnosis but it is unknown if these sleep disruptions persist, especially in patients with chronic static symptoms. This retrospective chart review sought to review polysomnography (PSG) tests of patients in whom PANS has been clinically diagnosed in order to assess sleep architecture, periodic limb movements, and presence of rapid eye movement (REM) sleep without atonia (RSWA) after a chronic static course of symptoms, which were refractory to immunomodulatory interventions.METHODS: Patients were retrospectively identified through the PANS clinic at our institution and had to have fully completed a PSG study and be younger than 18 years. PSG with video were reviewed and scored based on established criteria.RESULTS: We identified 9 patients who met inclusion criteria. The median time from presentation to PSG was 4 years. This study identified PSG-measured periodic limb movement index (PLMI) > 5 events/h in REM sleep in 7 of 9 patients. Two patients with elevated PLMI also demonstrated RSWA, although neither fit a clinical diagnosis of REM sleep behavior disorder. This cohort also demonstrated increased onset of REM sleep (median 134 minutes), insomnia (median total sleep time of 389 minutes), and decreased sleep efficiency (77%).CONCLUSIONS: This study identifies continued sleep disturbances in patients with refractory PANS symptoms several years after diagnosis and treatment. Continued sleep disturbances after presentation and treatment in patients with chronic static PANS may be a contributing factor in prolonged symptomatology of this disease process.
View details for DOI 10.5664/jcsm.7222
View details for PubMedID 29991427
Sleep medicine: pediatric polysomnography revisited
CURRENT OPINION IN PEDIATRICS
2015; 27 (3): 325-328
Sleep medicine is an increasingly well subscribed component of pediatric medicine. While knowledge has increased significantly in the past five decades, whether the most widely used tool to assess sleep-disordered breathing possesses demonstrable clinical utility remains unknown. The absence of certainty surrounding the impact of polysomnography (PSG) testing on clinical outcomes, superimposed on the cost and inconvenience of PSG testing, prompts a call to reassess the current normative stance toward PSG testing.The present study argues for the use of the following: endpoints that have known clinical significance; readily available data provided by parents; and data derived from a randomized, placebo-controlled trial to determine the merits of PSG testing in the context of obstructive sleep apnea.By rationalizing the use PSG testing, cost, inconvenience, and parental anxiety can be decreased without compromising care.
View details for DOI 10.1097/MOP.0000000000000219
View details for Web of Science ID 000354214800010
View details for PubMedID 25944311
Pulmonary nocardiosis in an immunocompetent patient with cystic fibrosis.
Case reports in pulmonology
2015; 2015: 984171-?
Nocardia spp. are bacteria of low virulence that cause infection classically in immunocompromised hosts with the lungs as the primary site of infection in the majority of cases. Patients with cystic fibrosis have pulmonary disease characterized by frequent and progressive bacterial infections. Reports of Nocardia spp. isolation in CF are rare in the literature and may represent colonization or active infection, the significance and optimal treatment of which are unknown. We report the second case to date of Nocardia transvalensis pulmonary infection in an immunocompetent patient with CF and the first in a child under the age of eighteen.
View details for DOI 10.1155/2015/984171
View details for PubMedID 25960909
View details for PubMedCentralID PMC4414227