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Sharma J, Arora RS, Trehan A, Bakhshi S, Hazarika M, Verma N, Malhotra P, Tripathi R, Majhi I, Lowe J, William J, Bagai P, Guilmoto C, Arora R. Diagnosis interval is the largest contributor to time to diagnosis and treatment for childhood cancer patients in India results of the InPOG-ACC-16-02 study. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mishra R, Kapur A, Goyal A, Gauba K, Trehan A. Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia. Eur Arch Paediatr Dent 2021; 23:281-287. [PMID: 34843095 DOI: 10.1007/s40368-021-00679-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC). METHODS A cohort of 43 patients, aged 3-12 years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports. RESULTS A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant. CONCLUSION Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.
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Affiliation(s)
- R Mishra
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Trehan
- Unit of Hematology and Oncology, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Madan R, Dey T, Goyal S, Bansal D, Trehan A, Peters N, Chatterjee D, Ballari N, Khosla D. PO-1436 Burden of pediatric oncology in radiotherapy department:A tertiary care center experience from India. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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King RJ, Schuett K, Tiede C, Jankowski V, John V, Trehan A, Simmons K, Ponnambalam S, Storey RF, Fishwick CWG, McPherson MJ, Tomlinson DC, Ajjan RA. Fibrinogen interaction with complement C3: a potential therapeutic target to reduce thrombosis risk. Haematologica 2021; 106:1616-1623. [PMID: 32354869 PMCID: PMC8168514 DOI: 10.3324/haematol.2019.239558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 12/03/2022] Open
Abstract
Complement C3 binds fibrinogen and compromises fibrin clot lysis, thereby enhancing the risk of thrombosis. We investigated the role of the fibrinogen-C3 interaction as a novel therapeutic target to reduce thrombosis risk by analyzing: (i) consistency in the fibrinolytic properties of C3; (ii) binding sites between fibrinogen and C3; and (iii) modulation of fibrin clot lysis by manipulating fibrinogen-C3 interactions. Purified fibrinogen and C3 from the same individuals (n=24) were used to assess inter-individual variability in the anti-fibrinolytic effects of C3. Microarray screening and molecular modeling evaluated C3 and fibrinogen interaction sites. Novel synthetic conformational proteins, termed affimers, were used to modulate the C3-fibrinogen interaction and fibrinolysis. C3 purified from patients with type 1 diabetes showed enhanced prolongation of fibrinolysis compared with healthy control protein (195±105 and 522±166 s, respectively; P=0.04), with consistent effects but a wider range (5-51% and 5-18% lysis prolongation, respectively). Peptide microarray screening identified two potential C3-fibrinogen interaction sites within the fibrinogen β chain (residues 424-433 and 435-445). One fibrinogen-binding affimer that was isolated displayed sequence identity with C3 in an exposed area of the protein. This affimer abolished C3- induced prolongation of fibrinolysis (728±25.1 s to 632±23.7 s; P=0.005) and showed binding to fibrinogen in the same region that is involved in C3-fibrinogen interactions. Moreover, it shortened plasma clot lysis of patients with diabetes, cardiovascular disease or controls by 7-11%. C3 binds fibrinogen -chain and disruption of the fibrinogen-C3 interaction using affimer proteins enhances fibrinolysis, which represents a potential novel tool to reduce thrombosis in high-risk individuals.
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Affiliation(s)
- Rhodri J King
- Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Katharina Schuett
- Department of Internal Medicine I, University Hospital RWTH Aachen, Germany
| | - Christian Tiede
- Bioscreening Technology Group,School of Molecular and Cellular Biology, University of Leeds, UK
| | - Vera Jankowski
- Institute for Molecular and Cardiovascular Research, Aachen University, Germany
| | - Vicky John
- Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Abhi Trehan
- Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, UK
| | | | | | | | | | - Michael J McPherson
- Bioscreening Technology Group, School of Molecular and Cellular Biology, University of Leeds, UK
| | - Darren C Tomlinson
- Bioscreening Technology Group, School of Molecular and Cellular Biology, University of Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, UK
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Totadri S, Mahajan A, Gupta V, Das A, Meena J, Singh M, Mohammed S, Aggarwal P, Tuladhar S, Seth R, Naseem S, Varma N, Trehan A, Bansal D. PS1178 TREATMENT AND OUTCOME OF CHRONIC MYELOID LEUKEMIA IN CHILDREN AND ADOLESCENTS: THE INDIAN PEDIATRIC ONCOLOGY GROUP-CML-16–01 MULTICENTRIC STUDY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000562996.37394.c4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Totadri S, Thipparapu S, Aggarwal R, Sharma M, Jain R, Trehan A, Malhotra P, Bansal D. Imatinib induced hypogammaglobulinemia in children with chronic myeloid leukemia. Pediatric Hematology Oncology Journal 2019. [DOI: 10.1016/j.phoj.2019.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Schutt KA, King RA, Tiede C, Jankowski V, John V, Trehan A, Simmons K, Ponnambalam S, Fishwick CWG, McPherson MJ, Tomlinson DC, Ajjan RA. 5068A novel methodology to improve prolonged clot lysis in diabetes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K A Schutt
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - R A King
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - C Tiede
- University of Leeds, Bioscreening Technology Group in the School of Molecular and Cellular Biology, Leeds, United Kingdom
| | - V Jankowski
- RWTH Aachen University, Institute for Molecular Cardiovascular Research (IMCAR), Aachen, Germany
| | - V John
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - A Trehan
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - K Simmons
- University of Leeds, School of Chemistry, Leeds, United Kingdom
| | - S Ponnambalam
- University of Leeds, School of Molecular & Cellular Biology, Leeds, United Kingdom
| | - C W G Fishwick
- University of Leeds, School of Chemistry, Leeds, United Kingdom
| | - M J McPherson
- University of Leeds, Bioscreening Technology Group in the School of Molecular and Cellular Biology, Leeds, United Kingdom
| | - D C Tomlinson
- University of Leeds, Bioscreening Technology Group in the School of Molecular and Cellular Biology, Leeds, United Kingdom
| | - R A Ajjan
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
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Peyam S, Trehan A, Jain R, Bansal D, Varma N. Acute Myeloid Leukemia: Incremental Improvement In Outcome In A Developing Country. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bhatia P, Singh M, Shandilya J, Varma N, Sachdeva M, Trehan A, Bansal D, Jain R, Totadri S. Flowcytometric expression of LAIR-1 inhibitory immune-receptor in pediatric acute lymphoblastic leukemia cases does not correlate with standard risk factors and minimal residual disease. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Totadri S, Trehan A, Srinivasan R, Bansal D, Bhatia P. Do traumatic lumbar punctures lead to greater relapses in acute lymphoblastic leukemia? Experience at a university hospital in India. Indian J Cancer 2016; 52:300-3. [PMID: 26905118 DOI: 10.4103/0019-509x.176722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the impact of traumatic lumbar puncture (TLP) at diagnosis of relapse in childhood acute lymphoblastic leukemia (ALL). Risk factors associated with TLP were assessed. MATERIALS AND METHODS A retrospective analysis was performed from the records of children with ALL who were treated from January 2010 to December 2012. RESULTS A total of 311 patients with median age of 5 years (range: 1-13) were treated for ALL. The cerebrospinal fluid analysis obtained from first LP revealed 275: Central nervous system 1 (CNS 1) (no blasts); 8: CNS 3 (blasts positive); and 28: TLP. Twenty-eight (9%) patients relapsed. Twelve (3.9%) had a CNS relapse. A TLP at diagnosis was not associated with an increased risk of systemic or CNS relapse (P = 0.298, 0.295). Three years event-free survival of patients with TLP and without atraumatic LP (ATLP) at diagnosis was 56 ± 5.2% and 51.8 ± 12.4%, (P = 0.520). Three years overall survival with TLP and ATLP was 73.3 ± 3.5% and 70.4 ± 12.5%, respectively, (P = 0.963). Median platelet count in patients with TLP was significantly lower than those without TLP (10,000/μL and 28,000/μL, P < 0.001). A receiver operating characteristic curve was constructed for predicting the risk of TLP based on platelet count. Area under the curve was 0.74 ± 0.05 (95% confidence interval 0.64-0.84). Platelet count < 23.5 × 109/L at the time of LP had 75% sensitivity and 64.4% specificity in predicting a TLP. CONCLUSIONS Low platelet counts are significantly associated with risk of TLP. Traumatic LP at diagnosis was not associated with an increased risk of relapse.
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Affiliation(s)
| | - A Trehan
- Department of Pediatrics, Hematology/Oncology Unit, Advanced Pediatric Center, Chandigarh, India
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Abstract
The study included 57 patients with visceral leishmaniasis. The average duration of symptoms was 3.8 ± 3.55 months and pancytopenia was the commonest haematological abnormality. The parasite load directly correlated with the degree of anaemia at presentation (P=0.03). Splenic regression took 9.58 ±4.5 days and haematological parameters recovered in 14.5±9.07 days. There were five deaths over the five-year study duration. Leishmaniasis was not the first diagnosis in 14 patients, of whom eight were residents of non-endemic regions. Diagnosis was achieved in 13.5 days in these patients, compared to 4.5 days in patients where leishmaniasis was suspected at the outset.
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Affiliation(s)
- A Sud
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Trehan A, Prabhu V, Bansal D. The impact of weight for age on survival in acute lymphoblastic leukemia: Report from a tertiary care center in North India. Indian J Cancer 2016; 52:203-6. [PMID: 26853405 DOI: 10.4103/0019-509x.175835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Undernutrition is considered to have a negative impact on survival in children with malignancies. The objective of this retrospective analysis was to evaluate the morbidity pattern and outcome of therapy in undernourished (UN) children with acute lymphoblastic leukemia. METHODS A retrospective analysis of impact of weight for age was performed in children treated for ALL. The IAP & CDC criteria for undernutrition were used in the two different time periods of analysis. RESULTS There were two cohorts in the study: Between 1995 and 2005, 360 children were evaluated where the weight for age was classified using the Indian Academy of Pediatrics criteria for undernourishment (Group A). Group B of the study included 373 children treated from 2007 to 2011, who were graded as per the Centers for Disease Control criteria for weight for age. In Group A, 35% of the children were malnourished at presentation. The morbidity and supportive care needed in the well-nourished and UN group were similar. The event-free survival and mortality were similar in both groups. Analysis of Group B showed an overall survival of 62.6% with a greater survival in children with a weight of ≥10th centile for age compared to children at the <10th centile, (P = 0.026) with a higher mortality (P = 0.011) in the UN group. CONCLUSION Our data have yielded conflicting results. The older cohort did not show a significant difference in survival using malnutrition as a risk factor. However, in the subsequent cohort, a difference in survival was noted. This could be due to the reason that different criteria for classification of undernutrition were applied in the two groups. This analysis lays the foundation for a future prospective analysis to evaluate nutrition as an independent risk factor nutrition as an independent risk factor in the outcome of childhood malignancies.
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Affiliation(s)
- A Trehan
- Pediatric Hematology-Oncology Unit, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND Multidrug resistant (MDR) pathogens are becoming a major problem worldwide, more so in the immunocompromised hosts resulting in the urgent need of antibiotic stewardship. PURPOSE To analyze the organisms isolated and the drug resistance pattern in a pediatric oncology unit. RESULTS Data pertaining to infections with 128 positive cultures in patients with febrile neutropenia over a period of 1-year are presented. The unit antibiotic policy is decided depending on the sensitivity of the prevailing common organisms. We isolated Gram-negative organisms in 56% cases. Escherichia coli and Klebseilla were the most frequent lactose fermenting Gram-negative Bacilli and Pseudomonas and Acinetobacter the nonfermenting Gram-negative Bacilli. Only 20-30% of the Gram-negative organisms cultured were sensitive to a 3rd/4th generation cephalosporin. The combination of a beta-lactam/inhibitor covered 2/3rd of Gram-negative organisms. About 80% of the organisms were sensitive to carbapenems. There was no colistin resistance. About 44% of our cultures grew a Gram-positive bacterial organism and included coagulase negative Staphylococcus. We had an incidence of methicillin resistant Staphylococcus aureus to be 30%. About 30% of the enterococci isolated in our unit were vancomycin-resistant enterococci. About 23% of patients with a positive bacterial culture died. CONCLUSIONS Infections in pediatric cancer patient's account for about 15-20% of the deaths in developing countries as these patients are at a high risk for developing MDR infections. Resistance rates among Gram-positive and Gram-negative organisms have increased worldwide. Every unit needs a rational antibiotic policy. Antibiotic de-escalation and judicious decrease in the duration of antibiotics needs to be practiced.
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Affiliation(s)
- A Trehan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Fadel S, Aly A, Massoud S, Kedr W, Farhod A, Srinivasan A, Satish G, Scott JX, Rao SM, Chidambaram B, Chandrashekar S, Chintagumpala M, He X, Ma J, Trehan A, Salunke P, Singla N, Kumar N, Radotra BD, Bansal D, Marwaha RK, Chinnaswamy G, Prasad M, Dhamankar V, Vora T, Gupta T, Moiyadi A, Sridhar E, Jalali R, Banavali S, Kurkure P, Kaur K, Kakkar A, Purkait S, Suri V, Sharma M, Mallick S, Jhulka PK, Suri A, Sharma BS, Sarkar C, Giron AV, Castellanos M, Valverde P, Garrido C, Letona T, Antillon F, Bartel U, Yuan X, Wang C, Adesina A, Lau C, Jiang M, Ma J. NEURO-ONCOLOGY IN DEVELOPING COUNTRIES. Neuro Oncol 2014; 16:i97-i98. [PMCID: PMC4046291 DOI: 10.1093/neuonc/nou075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
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Trehan A, Trehan AK. Laparoscopic management of a dermoid cyst containing a tooth-bearing mandible-like structure and possible chronic adnexal torsion. J OBSTET GYNAECOL 2014; 34:656-7. [DOI: 10.3109/01443615.2014.915296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sharma P, Das R, Trehan A, Bansal D, Chhabra S, Kaur J, Marwaha RK, Varma N, Garewal G. Impact of iron deficiency on hemoglobin A2% in obligate β-thalassemia heterozygotes. Int J Lab Hematol 2014; 37:105-11. [PMID: 24754744 DOI: 10.1111/ijlh.12246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The potential impact of concomitant iron deficiency on hemoglobin A2 (HbA2)-based identification of β-thalassemia trait (βTT) is a worrisome issue for screening laboratories. This is especially true for resource-constrained settings where iron deficiency is widespread and molecular confirmatory tests for borderline low HbA2 values may be unavailable. METHODS Obligate βTT carrier individuals (n = 752) were identified during screening studies on the parents of thalassemia major patients. HbA2%, complete blood counts and serum iron, ferritin and transferrin saturation were studied. Iron-deficient individuals (n = 135) with normal range HbA2% were taken as controls. RESULTS Concomitant iron deficiency (defined as ferritin ≤15 ng/mL and/or transferrin saturation ≤15%) was present in 20.7% (156/752) βTT cases, that is, 33.3% females (122/366) and 8.8% males with βTT (34/386). Mean HbA2 in iron-replete βTT was 5.4 ± 0.8 (range 3.1-7.9) and in iron-deficient βTT was 5.4 ± 0.9 (range 3.3-7.6). HbA2 < 4.0% was found in 23/752 (3.1%) βTT: 13/595 iron-replete (2.2%) and 10/157 (6.4%) iron-deficient βTT individuals. However, five of the 10 iron-deficient βTT cases carried the silent CAP+1 (A>C) β-thalassemia allele accounting for the borderline HbA2%. On a separate analysis, all five severely anemic βTT (Hb < 80 g/L) and 16/17 βTT with severe hypoferritinemia (<5 ng/mL) had HbA2 > 4.5%. The single case with serum ferritin 4.8 ng/mL and HbA2 3.3% showed a CAP+1 (A>C) mutation. CONCLUSIONS Iron deficiency was prevalent among north Indian βTT individuals, especially women. After adjusting for other causes of low HbA2 in βTT, iron deficiency, even when very severe, was very unlikely to interfere significantly with HbA2-based identification of βTT.
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Affiliation(s)
- P Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Aggarwal R, Bansal D, Bansal F, Nanda N, Ray P, Trehan A, Marwaha RK. Interleukin-5, interleukin-6, interleukin-8 and tumour necrosis factor-alpha levels obtained within 24-h of admission do not predict high-risk infection in children with febrile neutropenia. Indian J Med Microbiol 2013; 31:226-9. [DOI: 10.4103/0255-0857.115624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhatia P, Binota J, Varma N, Das R, Bansal D, Trehan A, Marwaha RK, Malhotra P, Varma S. Clinico-hematological, immunophenotyping, and molecular transcript profile of BCR–ABL-positive B cell acute lymphoblastic leukemias. J Hematop 2012. [DOI: 10.1007/s12308-012-0171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bhatia P, Binota J, Varma N, Bansal D, Trehan A, Marwaha RK, Malhotra P, Varma S. Incidence of common chimeric fusion transcripts in B-cell acute lymphoblastic leukemia: an Indian perspective. Acta Haematol 2012; 128:17-9. [PMID: 22572394 DOI: 10.1159/000338260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/13/2012] [Indexed: 12/17/2022]
Affiliation(s)
- P Bhatia
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Satyanarayana S, Kalghatgi AT, Muralidhar A, Prasad RS, Jawed KZ, Trehan A. FINE NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODES IN HIV INFECTED PATIENTS. Med J Armed Forces India 2011; 58:33-7. [PMID: 27365657 DOI: 10.1016/s0377-1237(02)80010-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Lymphadenopathy is the commonest presentation in HIV positive individuals. Fine needle aspiration cytology of 196 HIV positive patients was studied during six monthly review. 75% paients in this study who were asymptomatic were detected to have lymphadenopathy during the surveillance. 82% had lymph nodes smaller than 1cm size. Lymphadenopathy at more than one site was observed in 46.8% cases. Commonest opportunistic infection noticed was tuberculosis (TB) in 34.2%. Cyto-morphologically reactive pattern with Add fast bacilli (AFB) positivity was observed in 16.4% of TB cases. In 2.9% cases AFB were detected even in the tissue fluid. Negative images of AFB were observed in the macrophages in 3 cases. TB was detected with equal frequency in both asymptomatic and symptomatic groups. Axillary nodes pose problem due to deeper location. False positives were a case of dermatopathic lymphadenopathy and a case of Kimura's disease. False negatives include two cases of TB lymphadenitis. Pathogens should be looked for irrespective of cyto-morphology. Biopsy should be done to confirm cases of lymphomas. Fine needle aspiration cytology should be included in the protocol of six monthly review of HIV infected cases.
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Affiliation(s)
| | - A T Kalghatgi
- Reader, Department of Microbiology, Armed Forces Medical College, Pune-411 040
| | - A Muralidhar
- Classified Specialist (Medicine & Immunology),Bangalore - 560 007
| | - R S Prasad
- Senior Adviser (Pathology), Delhi Cantt - 110 010
| | - K Z Jawed
- Classified Specialist (Pathology), Base Hospital, Delhi Cantt - 110 010
| | - A Trehan
- Graded Specialist (Pathology), Command Hospital (Air Force), Bangalore - 560 007
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Ali A, Trehan A, Ullah Z, Aqil M, Sultana Y. Matrix type transdermal therapeutic systems of glibenclamide: Formulation, ex vivo and in vivo characterization. Drug Discov Ther 2011; 5:53-9. [PMID: 22466096 DOI: 10.5582/ddt.v5.1.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Matrix type transdermal therapeutic systems (TTS) of glibenclamide were formulated using polymers Eudragit RL 100, ethyl cellulose, PVP K-30, and polyvinyl acetate, and citral was used as the penetration enhancer. The polymer films were formulated with Eudragit RL 100 and PVP K-30 in different ratios and subsequently subjected to ex vivo studies (drug permeation through rat skin) followed by interaction studies, skin irritation studies, accelerated stability analysis, and in vivo studies (determination of blood glucose level in rabbits). The drug content of the formulations was found to be 99.1-99.2%. The cumulative percentages of drug permeated through rat skin from the three selected formulations in 48 h were 95.3%, 98.8%, and 99%, respectively. A plot between cumulative percent of drug permeated and square root of time exhibited linear curves, which suggests the Higuchian matrix mechanism of drug release. The formulation containing Eudragit RL 100 and PVP K-30 showed better improvement in hypoglycemic activity in rabbits (56.2-60.8% reduction in blood glucose level, p < 0.05). There were fewer fluctuations in blood glucose level as compared to oral therapy due to controlled release of the active pharmaceutical ingredient, and no interaction was found between the drug and excipients of the formulation. Accelerated stability analysis showed that the formulation was stable up to 5.5 years, with negligible skin irritation. The formulation precluded severe hypoglycemic reactions (side effect of sulfonylureas) and was effective for management of diabetes mellitus up to 48 h, with a single TTS.
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Affiliation(s)
- A Ali
- Department of Pharmaceutics, Faculty of Pharmacy, Hamdard University, New Delhi, India
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Abstract
BACKGROUND Relapse of disease is documented in 15-20% of children with acute lymphoblastic leukemia (ALL). Although testicular relapse is rare with modern risk-adapted treatment protocols, earlier, the testes were a frequently encountered site of relapse and were designated as "drug sanctuaries". PURPOSE This descriptive study was designed to assess the pattern of testicular relapse and to identify high-risk factors. MATERIALS AND METHODS Data obtained from case records of 407 boys with ALL were analyzed. Fine needle aspiration cytology was carried out in children presenting with painless enlargement of testi(e)s. Bone marrow aspiration and cerebrospinal fluid examination were performed concomitantly to confirm or exclude disease at these sites. RESULTS Testicular relapse was documented in 30 boys. It was isolated in 17 patients and associated with bone marrow and/or central nervous system relapse in 13. At relapse, nine boys were over the age of 10 years. The majority were very early and early relapsers. Hyperleucocytosis was documented in five of 30 and seven of 137 relapsers and nonrelapsers, respectively (P = 0.04). Twelve of the 30 boys with testicular relapse were treated with testicular irradiation, reinduction and maintenance therapy. The estimated median overall survival was 33 months. CONCLUSION Testicular relapse, which depends on the therapy administered, may manifest several months/years after completion of treatment. The high incidence of testicular relapse in our series implicates the need of revaluation of our protocol and incorporation of high/intermediate dose methotrexate therapy upfront.
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Affiliation(s)
- K P Kulkarni
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Chandigarh, India
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Marwaha RK, Kulkarni KP, Bansal D, Trehan A. Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation. Indian J Pediatr 2010; 77:779-83. [PMID: 20589462 DOI: 10.1007/s12098-010-0119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/23/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the prognostic impact of overt testicular disease (OTD) at diagnosis and role of testicular irradiation in the same. METHODS Data of 579 boys treated at our center over 16 years was reviewed. RESULTS Fourteen (2.4%) males had OTD. 10 (71.4%) of these had high-risk disease. Patients with OTD, had a significantly higher incidence of mediastinal-adenopathy (p=0.001), hyperleucocytosis (p=0.004) and CNS disease at presentation (p<0.0001) compared to patients in continuous complete remission (CCR). 4 of the 11 patients with OTD, who opted for therapy, had relapse; 2 are in CCR. Although, survival in patients with OTD was inferior (p=0.183) compared to patients without OTD, it was not an independent prognostic factor (p=0.47). In the entire study cohort, symptom-diagnosis interval (p=0.006), white cell (p=0.001) and platelet count (p=0.001) at presentation were significantly associated with survival (Cox multivariate regression analysis). CONCLUSIONS OTD was not an independent prognostic factor, despite association with high-risk features. Survival outcome was inferior. The observations indicate the need of revaluation of the present protocol with incorporation of intermediate dose and subsequently high-dose methotrexate (after assessment for toxicity and tolerance), risk-stratified therapy and plausibly omission of testicular irradiation.
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Affiliation(s)
- R K Marwaha
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Chandigarh, India.
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25
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Gautam V, Ray P, Puri GD, Sharma K, Vandamme P, Madhup SK, Das A, Malhotra P, Trehan A, Garg RK, Rana S, Koushal V, Kumar A. Investigation of Burkholderia cepacia complex in septicaemic patients in a tertiary care hospital, India. Nepal Med Coll J 2009; 11:222-224. [PMID: 20635597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Burkholderia cepacia complex (BCC) is being increasingly recognized as an important pathogen of humans. During the year 2007-8, 39 putative BCC isolates were obtained from 21 cases and subjected to recA PCR RFLP. Twenty-four isolates were confirmed as Burkholderia cenocepacia IIIA (nineteen isolates, recA PCR RFLP type G and five isolates, recA PCR RFLP type I), six were confirmed as B. cepacia (recA PCR RFLP type E). BCC were isolated from inpatients of different wards of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh with increased isolation from children admitted to different wards of Advanced Pediatric Centre (11/21 cases). BCC isolates are often resistant to most commonly used antibiotics and an early use of effective antimicrobial therapy can decrease morbidity and mortality.
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Affiliation(s)
- V Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012 India
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26
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Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Pattern of relapsed disease in childhood all: experience from a single tertiary care center in North India. Pediatr Hematol Oncol 2009; 26:398-406. [PMID: 19657989 DOI: 10.3109/08880010902900734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study was designed to determine the pattern of relapsed disease and identify problem areas in management. Relapse occurred in 111 (23.9%) of the boys and 16 (13.0%) of the girls. The majority relapsed while on chemotherapy. Isolated relapse in the marrow and in the CNS was seen in 51 (40.8%) and 24 (18.9%) patients, respectively. Isolated testicular relapse was seen in 17 (15.3%) of the 111 boys who suffered a relapse. Age and TLC at initial presentation and gender in relapsers and nonrelapsers were compared. Multivariate regression analysis showed that gender (p = .03) and TLC (p = .001) were significant predictors of relapse. Relapse of disease while on chemotherapy and high incidence of CNS and testicular relapse indicate the need for reappraisal of treatment protocols.
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Affiliation(s)
- K P Kulkarni
- Division of Pediatric Hematology-Oncology Advanced Pediatric Center, PGIMER, Chandigarh, India
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Abstract
BACKGROUND Survival of children with ALL, in developing nations has not kept pace with cure rates in developed countries. Our study was designed to assess survival data and identify risk factors. PROCEDURE Data of 762 patients with ALL were analyzed. Information regarding the clinical-demographic profile, therapy and course of illness were recorded. Status and duration at last follow-up were utilized to generate Kaplan-Meier survival curves. RESULTS The mean age was 5.7 +/- 0.23 years (M/F, 3.2:1). Parents of 230 (30.2%) patients opted for no therapy. There were 68 and 60 deaths in induction and remission phases respectively. Besides these, 111 children either defaulted therapy or were lost to follow up. Relapsed disease was documented in 125 cases. The 5-year OS and EFS was 46% and 43% respectively. Survival analysis, using the Cox multivariate regression, for gender (P = 0.659, CI: 0.852-1.161), age (P = 0.943, CI: 0.725-1.225), symptom-diagnosis interval (P = 0.002, CI: 1.116-1.668), WCC (P < 0.001, CI: 1.353-1.814) and platelet count (P = 0.001, CI: 0.546-0.849) was performed. Bulk disease (P = 0.049, CI: 0.428-0.986), mediastinal adenopathy (P = 0.045, CI: 1.040-3.697), WCC (P = 0.016, CI: 1.395-2.691), platelet count (P = 0.031, CI: 0.431-0.967) and administration of 2 intensification blocks (P = 0.012, CI: 0.624-0.940) were found to be significant predictors of outcome by multivariate analysis. CONCLUSIONS The management of ALL requires financial resources and access to quality supportive care. One third of our patients opted for no therapy. The other problem areas were a high proportion of therapy defaulters, lost to follow up and infection related deaths during induction and remission phases. The introduction of remedial measures for resolving the difficulties identified would hopefully improve cure rates in ALL in developing nations.
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Affiliation(s)
- K P Kulkarni
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Chandigarh, India
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Purohit D, Trehan A, Arora V. Development of Room Temperature Stable Formulation of Formoterol Fumarate/Beclomethasone HFA pMDI. Indian J Pharm Sci 2009. [PMCID: PMC2846486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The primary aim of present investigation was to develop and formulate room temperature stable formulation of formoterol fumarate and beclomethasone dipropionate with extra fine part size of hydrofluoroalkane pressurized metered dose inhalers. Particle size distribution of hydrofluoroalkane pressurized metered dose inhalers was evaluated using Twin Stage Glass Impinger and Anderson Cascade Impactor. A tetrafluoroethane and/or heptafluoropropane were evaluated for preparation of hydrofluoroalkane pressurized metered dose inhalers. The fine particle fractions delivered from hydrofluoroalkane propellant suspension pressurized metered dose inhalers can be predicted on the basis of formulation parameters and is dependent of metering chamber of valve and orifice size of actuators. The results presented in investigation showed the importance of formulation excipients with formulation of pressurized metered dose inhalers viz, canister, valve and actuators used in formulations.
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Affiliation(s)
- D. Purohit
- Research & Development Centre (R&D I), Ranbaxy Laboratories Limited, Plot No. 20, Sector 18, Udyog Vihar Industrial Area, Gurgaon-122 015, India,Address for correspondence E-mail:
| | - A. Trehan
- Research & Development Centre (R&D I), Ranbaxy Laboratories Limited, Plot No. 20, Sector 18, Udyog Vihar Industrial Area, Gurgaon-122 015, India
| | - V. Arora
- Research & Development Centre (R&D I), Ranbaxy Laboratories Limited, Plot No. 20, Sector 18, Udyog Vihar Industrial Area, Gurgaon-122 015, India
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Abstract
Acyclovir is an antiviral drug of choice in the treatment of many types of herpes virus infections, including genital herpes simplex infections, herpetic conjunctivitis, herpes simplex encephalitis, etc. The present study describes the degradation behavior of acyclovir under different International Conference on Harmonization recommended stress conditions (hydrolysis, oxidation, photolysis, and thermal decomposition) in order to establish a validated stability-indicating high-performance liquid chromatography method. Acyclovir is found to degrade extensively in acidic conditions and oxidative stress. Mild degradation of the drug occurs in alkaline and neutral conditions. The drug is stable to dry heat. The drug is found to be sufficiently stable after light exposure in a solid state; however, photolytic degradation is observed when the drug is exposed as a solution in water. The major degradation product in acidic hydrolysis and photolysis is identified as guanine through comparison with the standard. Separation of drug and the degradation products under various conditions is successfully achieved on a C-18 column utilizing water-methanol in the ratio of 90:10. The flow rate is 1 mL/min, and the detection wavelength is 252 nm. The method is validated with respect to linearity, precision, accuracy, selectivity, specificity, and robustness. The mean values of slope and correlation coefficient are 39.307 and 0.9998 with relative standard deviation values less than 2%. The recovery of the drug is found to be in the range of 97.34% to 102.35%. From the previous study it is concluded that the stability-indicating method developed for acyclovir can be used for analysis of the drug in various stability samples.
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Affiliation(s)
- V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Abstract
Nowadays, emphasis is being laid to development of controlled release dosage forms. Interest in this technology has increased steadily over the past few years. Although oral administration of drugs is a widely accepted route of drug delivery, bioavailability of drug often varies as a result of gastrointestinal absorption, degradation by first-pass effect, and hostile environment of gastrointestinal tract. Transdermal administration for percutaneous absorption of drug is limited by the impermeable nature of the stratum corneum. Ocular and nasal delivery is also unfavorable because of degradation by enzymes present in eye tissues and nasal mucosa. Hence, the parenteral route is the most viable approach in such cases. Of the various ways of achieving long-term parenteral drug delivery, biodegradable microspheres are one of the better means of controlling the release of drug over a long time. Because of the lipidic nature of liposomes, problems such as limited physical stability and difficulty of freeze-drying are encountered. Similarly, for emulsions, stability on long-term basis and in suspensions, rheological changes during filling, injecting, and storage poses limitation. Also, in all these systems, the release rate cannot be tailored to the needs of the patient. Parenteral controlled-release formulations based on biodegradable microspheres can overcome these problems and can control the release of drug over a predetermined time span, usually in the order of days to weeks to months. Various FDA-approved controlled-release parenteral formulations based on these biodegradable microspheres are available on the market, including Lupron Depot Nutropin Depot and Zoladex. This review covers various molecules encapsulated in biodegradable microspheres for parenteral delivery.
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Affiliation(s)
- V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Sinha VR, Bansal K, Kaushik R, Kumria R, Trehan A. Poly-epsilon-caprolactone microspheres and nanospheres: an overview. Int J Pharm 2004; 278:1-23. [PMID: 15158945 DOI: 10.1016/j.ijpharm.2004.01.044] [Citation(s) in RCA: 672] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Revised: 01/19/2004] [Accepted: 01/27/2004] [Indexed: 11/29/2022]
Abstract
Poly-epsilon-caprolactone (PCL) is a biodegradable, biocompatible and semicrystalline polymer having a very low glass transition temperature. Due to its slow degradation, PCL is ideally suitable for long-term delivery extending over a period of more than one year. This has led to its application in the preparation of different delivery systems in the form of microspheres, nanospheres and implants. Various categories of drugs have been encapsulated in PCL for targeted drug delivery and for controlled drug release. Microspheres of PCL either alone or of PCL copolymers have been prepared to obtain the drug release characteristics. This article reviews the advancements made in PCL-based microspheres and nanospheres with special reference to the method of preparation of these and their suitability in developing effective delivery systems.
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Affiliation(s)
- V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
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Sinha VR, Goyel V, Trehan A. Radioactive microspheres in therapeutics. Pharmazie 2004; 59:419-26. [PMID: 15248454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Microspheres as a drug delivery system hold great promise in reaching the goal of controlled drug delivery as well as site specific delivery. In the last few decades, scientific and technological advancements have been made in the research and development of radiolabeled microspheres. These are used successfully for the treatment of various cancers and tumors. Since response to chemotherapy and external radiotherapy is not so effective and hazardous too, so an alternative to this is internal radiation therapy. These radiolabeled microspheres are very stable and have a proven efficacy in the field of primary as well as metastatic cancers. Radioactive microspheres can be selectively targeted to various tumors without undue radiation to the nontumorous tissues. The radioactive microspheres are injected to halt tumor growth via the blood supply, thereby enabling surgical removal once the tumor size decreases. This review provides an outlook to various aspects of radioactive microspheres and their role in treatment of various tumors and cancers.
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Affiliation(s)
- V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Ahluwalia J, Kumar V, Trehan A, Marwaha RK, Garewal G. The psuedo-Chediak-Higashi anomaly: an unusual staining pattern in an Indian child with acute myeloid leukemia. Pediatr Hematol Oncol 2004; 21:199-202. [PMID: 15202158 DOI: 10.1080/08880010490276881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors describe the psuedo-Chediak-Higashi anomaly in a 12-year-old boy with acute myeloid leukemia (AML-M2). There were large purple granules in the blasts, promyelocytes, and myelocytes. Instead of the previously described patterns, the authors observed a unique rim pattern staining of the granules in both the May-Grunwald-Giemsa and the myeloperoxidase stains. Moreover, many of the granules had central vacuoles with strong myeloperoxidase positivity at the periphery. The bone marrow had a much higher positivity for these mega-granules as compared to the peripheral blood. On remission, these granules were no longer seen. To the best of the authors' knowledge, this pattern of staining has not been previously reported in the literature.
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Affiliation(s)
- J Ahluwalia
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Undifferentiated embryonal sarcoma (UES) of liver is a rare form of liver tumor in children. It may have an atypical presentation leading to delay in diagnosis. The authors report on 3 consecutive children with this condition, each of them presenting in older children who presented with this condition and an initial diagnostic dilemma. One of them presented initially with a solitary cyst, the second with severe abdominal pain, and the third with intermittent fever. Preoperative chemotherapy was successful in shrinking the tumors in 2 children to allow anatomic liver resection with tumor-free margin. Both remain free of recurrence 2 years after completing treatment.
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Affiliation(s)
- S K Chowdhary
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rajagopal R, Khati C, Vasdev V, Trehan A. Scrub typhus: a case report. Indian J Dermatol Venereol Leprol 2003; 69:413-5. [PMID: 17642955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Fever with rash is a common cause for dermatological referral. The causes can range from viral to protozoal, bacterial or spirochaetal. A case of rickettsial fever is reported.
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Affiliation(s)
- R Rajagopal
- Department of Dermatology, 5 Air Force Hospital, C/o 99 APO.
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Abstract
The authors describe an Indian child, who presented in the accelerated phase of the Chédiak-Higashi syndrome. The disease usually presents in early childhood with recurrent skin and mucosal infections. This patient had subtle pigmentary abnormalities and no family history of the disease, which made the clinical diagnosis difficult. The cytopenias, hepatosplenomegaly, lymphohistiocytic infiltrate in the bone marrow, and the characteristic granules in the leucocytes clinched the diagnosis. This case underscores the importance of a bone marrow examination in patients with unusual presentations of rare disorders.
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Affiliation(s)
- J Ahluwalia
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Marwaha RK, Bansal D, Sharma S, Kumar S, Trehan A, Duseja A, Chawla YK. Seroprevalence of hepatitis C and B virus in multiply transfused beta-thalassemics: results from a thalassemic day care unit in north India. Vox Sang 2003; 85:119-20. [PMID: 12925166 DOI: 10.1046/j.1423-0410.2003.00325.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND The incidence of end-stage renal disease (ESRD) in England is increasing. There is a higher incidence of ESRD in British Indo-Asians than in the White population. AIM To determine to what degree the increasing demand for renal replacement therapy in the UK is due to Indo-Asian patients. To study the presentation to renal services of Indo-Asian patients with ESRD and report any inequalities in initial treatment of Indo-Asian patients with ESRD compared to their White counterparts. DESIGN Prospective, inception cohort study. METHODS Consecutive adult patients with ESRD who started renal replacement therapy between 1 April 2000 and 31 December 2001 in all 14 renal units serving an area from North Cheshire to South Cumbria, including Greater Manchester and Lancashire, were recruited and interviewed. RESULTS Of the 578 patients, 9.5% were Indo-Asian. The annual acceptance rate for renal replacement therapy was 342 per million population in Indo-Asians, compared with 91 per million population in the White population ( p < 0.001). Indo-Asian patients with ESRD were younger (median age 51 years vs. 60 yrs, p = 0.006) and more socially deprived (81% vs. 36.5% in the 5th Carstairs quintile, p < 0.001). A greater proportion of Indo-Asian patients with ESRD presented late to specialist renal services (31% vs. 19%, p = 0.03). Once adjusting for their younger age, atherosclerotic renovascular disease and/or hypertensive nephropathy was more prevalent in Indo-Asian patients (OR 4.9; p = 0.03). There was no difference in the initial mode of maintenance dialysis or the perception of choice the patients felt they had, based on their ethnicity. DISCUSSION There is a silent epidemic of ESRD in Indo-Asian patients in the North-West, possibly vascular in aetiology, in which specialist intervention is late. This suggests that Indo-Asian patients should be prioritized for early intervention strategies to reduce the burden of ESRD.
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Affiliation(s)
- A Trehan
- SIRS group, Renal Unit, Manchester Royal Infirmary, Manchester and. Renal Association Standards Subcommittee, Aberdeen, UK.
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Satyanarayana S, Kalghatgi AT, Malaviya AK, Bhardwaj JR, Muralidhar A, Jawed KZ, Chatterjee T, Trehan A, Sirohi D. Needle necropsy in AIDS. INDIAN J PATHOL MICR 2003; 46:416-9. [PMID: 15025288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
The value of autopsy in understanding the natural course of any disease is beyond any argument. The reluctance of pathologists to perform autopsy in HIV infected cadavers is justified due to the risks involved to the prosector and the morgue attendants. A relative low risk needle necropsy protocol is proposed using fine needle aspiration cytology, tru-cut biopsies and microbiological examination. Diagnosis could be offered in all the forty-four needle necropsies performed. Disseminated tuberculosis in 18/44 (40.9%) cases, disseminated cryptococcosis in 12/44 (27.2%) cases, poly-microbial infections in 27.2% cases and non-Hodgkin's lymphoma in 9% cases were detected in the study. Infectious agents like Histoplasma capsulatum, Isospora belli, tachyzoites of Toxoplasma gondii, Candida sp and Cryptococcus sp could be demonstrated in the samples obtained in the study. Lack of material for study of gross pathology, inaccessibility of deep-seated lesions and risk of needle stick injury to the prosector though low are the limitations of this procedure.
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Srinivas BR, Trehan A, Marwaha RK. Paradoxical embolism through patent foramen ovale causing cerebellar infarction in a young boy. Neurol India 2003; 51:73-4. [PMID: 12865524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A previously healthy young boy who suffered an acute stroke involving superior cerebellar artery circulation is presented here. Echocardiography revealed a patent foramen ovale through which paradoxical embolism had probably occurred. Low dose aspirin was started and surgical closure was planned to prevent further recurrences.
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Affiliation(s)
- K L N Rao
- Department of Paediatric Surgery, Paediatric Medicine and Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Abstract
Diagnostic methods have become increasingly complex and frequently involve the use of agents that must meet the same approval criteria as drugs. The search for diagnostic contrast agents has spread from X-ray to other imaging modalities, especially to magnetic resonance imaging (MRI) and ultrasound. A wide variety of methods have been used to develop microencapsulated agents, from liposomal entrapment to use of biodegradable polymers. Various scientific and technological advancements have been made in the research and development of diagnostic microspheres. Diagnostic microspheres can be used to understand the human body functions in both healthy and sick people. For example, they allow the detection of malignancies vs. benign tissue changes. Diagnostic microspheres give useful clinical information for various diseases, are very stable, and have proven efficacy in the quantitative measurement of blood flow to an organ. This review discusses various aspects of diagnostic microspheres, such as the choice of contrast agents and radioactive molecules, and their applications in blood flow measurements and organ imaging.
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Affiliation(s)
- V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Chakrabarti A, Marhawa RK, Mondal R, Trehan A, Gupta S, Rao Raman DSV, Sethi S, Padhyet AA. Generalized lymphadenopathy caused by Trichosporon asahii in a patient with Job's syndrome. Med Mycol 2002; 40:83-6. [PMID: 11862981 DOI: 10.1080/mmy.40.1.83.86] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Of the six species of Trichosporon known to cause human infections, T. asahii is the main agent of invasive trichosporonosis. We describe an unusual case of generalized lymphadenopathy due to T, asahii in a 10-year-old boy with Job's syndrome (markedly elevated IgE with eosinophilia). The diagnosis was based on the presence of blastic conidia and hyphal elements breaking into arthroconidia in biopsied tissue of the cervical lymph node and isolation of the causal agent T, asahii in pure culture. The patient responded initially to amphotericin B therapy, but the infection recurred within 4 weeks and did not respond to therapy of liposomal amphotericin B and 5-fluorocytosine for 10 days. The patient left the hospital against medical advice.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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44
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Chakrabarti A, Marhawa RK, Mondal R, Trehan A, Gupta S, Rao DSVR, Sethi S, Padhye AA. Generalized lymphadenopathy caused by Trichosporon asahii in a patient with Job's syndrome. Med Mycol 2002. [DOI: 10.1080/714031075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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45
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Bansal D, Marwaha RK, Trehan A, Poddar U, Radotra BD. Portal hypertension secondary to Langerhans cell histiocytosis. Indian J Gastroenterol 2001; 20:201-2. [PMID: 11676337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report two children, aged 2 and 2 1/2 years, with multisystem Langerhans cell histiocytosis (LCH). Both were administered chemotherapy, with apparently good response. However, hepatic fibrosis and portal hypertension were detected 5 and 1 1/2 years after therapy, respectively. The first child died after a bout of hematemesis. Hepatic fibrosis can proceed despite apparently successful chemotherapy in LCH.
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Affiliation(s)
- D Bansal
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, Chandigarh
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46
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Sood M, Trehan A. Turner's syndrome in infancy. Indian Pediatr 2001; 38:559. [PMID: 11359988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- M Sood
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Abstract
The brief communication describes a 2-year-old child who presented with delayed achievement and regression of milestones, seizures of multiple types, exaggerated response to sound, inability to see and bilateral cherry red spots. In addition to these typical manifestations of the late infantile variety of Tay-sachs disease, unilateral ptosis was present. The magnetic resonance imaging of brain revealed abnormalities consistent with an advanced stage of the disease.
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Abstract
Acute hemorrhagic edema of infancy is a laucocytoclastic vasculitis characterized by a triad of fever, large purpuric skin lesions and edema. The presentation is often dramatic. The manifestations are often misinterpreted as a septicemic illness. We report the occurrence of this syndrome in a 1 1/2-year-old-child, highlighting some of the diagnostic and therapeutic problems encountered.
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Affiliation(s)
- S Jayanti
- Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Kakkar N, Vasishta RK, Lamba A, Trehan A, Marwaha RK. Special feature: pathological case of the month. Denouement and discussion: congenital adrenocortical carcinoma. Arch Pediatr Adolesc Med 2000; 154:1267-8. [PMID: 11115315 DOI: 10.1001/archpedi.154.12.1267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- M Sood
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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