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Banerjee A, Babu R, Jayaraman D, Chilukuri S. Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour. BMJ Case Rep 2024; 17:e260600. [PMID: 38642931 PMCID: PMC11033631 DOI: 10.1136/bcr-2024-260600] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
Bilateral Wilms tumour (BWT) is a surgically challenging condition. Virtual reality (VR) reconstruction aids surgeons to foresee the anatomy ahead of Nephron Sparing Surgery (NSS). Three-dimensional (3D) visualisation improves the anatomical orientation of surgeons performing NSS. We herewith report a case of BWT where VR planning and 3D printing were used to aid NSS. Conventional imaging is often found to be inadequate while assessing the tumour-organ-vascular anatomy. Advances like VR and 3D printing help surgeons plan better for complex surgeries like bilateral NSS. Next-generation extended reality tools will likely aid robotic-assisted precision NSS and improve patient outcomes.
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Affiliation(s)
- Avijit Banerjee
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ramesh Babu
- Pediatric Urology, Sri Ramachandra University Medical College, Chennai, India
| | - Dhaarani Jayaraman
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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Sengottaiyan J, Jayaraman D, Kumar S, Shanmugam SG, Scott JX. Autoimmune Hemolytic Anemia as Paraneoplastic Phenomenon in Hodgkins Lymphoma in Children - A Rare Occurrence. EJIFCC 2024; 35:52-54. [PMID: 38706732 PMCID: PMC11063785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Jagadhesswari Sengottaiyan
- Postgraduate, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Dhaarani Jayaraman
- Department of Pediatric Hematology and Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Sujith Kumar
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Sri Gayathri Shanmugam
- Department of Laboratory Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Julius Xavier Scott
- Department of Pediatric Hematology and Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Bollineni P, Suman FR, Jayaraman D, Subramani N, Gaddam S. Isolated Prothrombin Deficiency: A Case Report of a Rare Coagulation Disorder and Review of Literature. Cureus 2024; 16:e55940. [PMID: 38601422 PMCID: PMC11005078 DOI: 10.7759/cureus.55940] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Congenital prothrombin deficiency is a rare hemorrhagic disorder, frequent in areas with high degrees of consanguinity as it is autosomal recessive in nature. Clinical manifestations are highly variable, ranging from mild episodes of bleeding to severe hemorrhages. Here, we report a child with isolated prothrombin deficiency who presented with a history of pain and soreness in the prepuce associated with bleeding. Laboratory evaluation showed an altered coagulation profile with a prothrombin activity level of 29.8%, indicative of factor-II deficiency. This case highlights the importance of coagulation screening in all patients before even minor invasive procedures and the role of a detailed coagulation profile in confirming a diagnosis in the case of abnormal screening tests.
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Affiliation(s)
- Pranathi Bollineni
- Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Febe Renjitha Suman
- Pathology and Laboratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Dhaarani Jayaraman
- Pediatric Hematology, Oncology, and Bone Marrow Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Nivedha Subramani
- Pediatric Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sudeep Gaddam
- Pediatric Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Gopalakrishnan M, Ramanathan A, Jayaraman D, Shanmugam SG, Xavier Scott J. Malignancy-Associated Secondary Hemophagocytic Lymphohistiocytosis Mimicking an Infection: A Case Report and Review of the Literature. Cureus 2024; 16:e56738. [PMID: 38650799 PMCID: PMC11033213 DOI: 10.7759/cureus.56738] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hematological disorder of immune dysregulation associated with significant challenges in diagnosis and management. Described as primary HLH secondary to genetic defects or more commonly secondary to infections, it can also occur secondary to malignancy, i.e., malignancy-associated hemophagocytic lymphohistiocytosis (M-HLH). A five-year-old male child presented with left cervical adenopathy and a high-spiking fever for two weeks. He had pallor, anasarca, multiple enlarged and matted cervical lymph nodes, respiratory distress, and hepatomegaly. He had continuous high-grade fever spikes (maximum 105 °F), not touching baseline despite broad-spectrum antibiotics. The CBC revealed anemia with thrombocytopenia. Liver function tests showed mild transaminitis and hypoalbuminemia. The HLH workup showed elevated ferritin, low fibrinogen, and elevated triglycerides. Lymph node biopsy showed intermediate to large atypical monomorphic lymphocyte cells with ALK, CD30, CD5, CD3, CD45, and BCL-2 (weak positive) positivity and Ki-67-95%, suggestive of anaplastic large cell lymphoma (ALCL). The bone marrow aspiration showed reactive marrow with hemophagocytosis. The patient was started on dexamethasone and chemotherapy per the Children's Oncology Group's (COG) ALCL protocol. He showed remarkable clinical improvement and went into remission after the induction phase. Malignancy associated with HLH can mimic infection, as in our patient with high-spiking fever, consolidation, and mediastinal adenopathy. A high index of suspicion is necessary to arrive at an appropriate, early diagnosis, and workup for malignancy is to be considered when an infectious etiology is not identified after thorough evaluation.
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Affiliation(s)
| | - Arunalini Ramanathan
- Pediatrics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, IND
| | - Dhaarani Jayaraman
- Pediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, IND
| | - Sri Gayathri Shanmugam
- Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, IND
| | - Julius Xavier Scott
- Pediatric Haematology and Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, IND
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Kartik P, Liu JF, Sudarsan RT, Srinivasan A, Jayaraman D, Sivaprakasam P, John R, Uppuluri R, Scott JX, Jalali R, Dandapani M. Evaluation of Pathway to Diagnosis of Pediatric Brain Tumors in Tamil Nadu, India. JCO Glob Oncol 2024; 10:e2300214. [PMID: 38386953 PMCID: PMC10898677 DOI: 10.1200/go.23.00214] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Delayed diagnosis and poor awareness are significant barriers to the early intervention of pediatric brain tumors. This multicenter observational study aimed to evaluate the baseline routes and time to diagnosis for pediatric brain tumors in Tamil Nadu (TN), with the goal of promoting early diagnosis and timely referrals in the future. METHODS A standard proforma was used to retrospectively collect information on demographics, diagnosis, referral pathways, and symptoms of incident pediatric brain tumor cases between January 2018 and October 2020 across eight tertiary hospitals in TN. Dates of symptom onset, first presentation of health care, and diagnosis were used to calculate total diagnostic interval (TDI), patient interval (PI), and diagnostic interval (DI). RESULTS A total of 144 cases (mean age, 6.64 years; range, 0-15.1 years) were included in the analysis. Among those, 94% (135/144) were from city/district areas, 40% (55/144) were self-referred, and 90% (129/144) had one to three health care professional visits before diagnosis. Median TDI, PI, and DI were 3.5 (IQR, 1-9.3), 0.6 (IQR, 0.1-4.6), and 0.6 (IQR, 0-3.3) weeks, respectively. Low-grade gliomas had the longest median TDI (6.6 weeks), followed by medulloblastomas (4.6 weeks) and high-grade gliomas (3.3 weeks). Average number of symptoms recorded was 1.7 at symptom onset and 1.9 at diagnosis. CONCLUSION Although there are some similarities with data from the United Kingdom, many low-grade and optic pathway tumors were unaccounted for in our study. DIs were relatively short, which suggests that infrastructure may not be a problem in this cohort. Increased training and establishment of proper cancer registries, combined with proper referral pathways, could enhance early diagnosis for these children.
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Affiliation(s)
- Prerna Kartik
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jo-Fen Liu
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | | | - Dhaarani Jayaraman
- Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | | | - Rikki John
- Christian Medical College, Vellore, India
| | | | | | - Rakesh Jalali
- Kanchi Kamakoti Childs Trust Hospital, Chennai, India
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
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Jayaraman D, Sneha LM, Jeyarani G, Somayajula A, Kothandam BT, Scott JX, Gadekar A. Experience with Generic Pegylated L-asparaginase in Children with Acute Lymphoblastic Leukemia from a Tertiary Care Oncology Center in South India. South Asian J Cancer 2023; 12:371-377. [PMID: 38130281 PMCID: PMC10733070 DOI: 10.1055/s-0042-1759785] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Dhaarani JayaramanBackground Acute lymphoblastic leukemia (ALL) is a common type of leukemia in children. The innovator pegylated L-asparaginase has several advantages over native L-asparaginase; however, its use in India is limited due to availability and cost. Therefore, a generic pegylated L-asparaginase can be considered as an alternative to the innovator molecule. Methods A retrospective study was conducted to assess the outcome (minimal residual disease [MRD]) and toxicity of a generic pegylated L-asparaginase (Hamsyl) at the end of induction therapy. Results Eighty-eight (80.7%) and 21 (19.3%) patients had received generic pegylated L-asparaginase and conventional asparaginase, respectively, as a part of their treatment protocol. Nearly 82% of patients had B-type ALL. Eight-one percent of children had a white blood cell count of fewer than 50,000/mm 3 . At the end of induction, 80.7% (88) of children were minimal residual disease (MRD)-negative, and at the end of augmented consolidation therapy, 20.2% were MRD-negative. Ten percent of patients exhibited allergic reactions. Two children had pancreatitis, and one child had central venous thrombosis. Conclusion The generic pegylated L-asparaginase (Hamsyl) was effective and safe for use in pediatric ALL.
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Affiliation(s)
- Dhaarani Jayaraman
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Latha M. Sneha
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Gracelin Jeyarani
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Alekhya Somayajula
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Balaji Thiruvengadam Kothandam
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - A Gadekar
- Emcure Pharma, Pune, Maharashtra, India
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Jayaraman D, Koneru SH, Shanmugam SG, Venkatraman P, Scott JX. Chai Disease Mimicking Autoimmune Lymphoproliferative Syndrome. Indian J Pediatr 2023:10.1007/s12098-023-04593-x. [PMID: 37085631 DOI: 10.1007/s12098-023-04593-x] [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] [Received: 10/06/2022] [Accepted: 03/28/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Dhaarani Jayaraman
- Department of Pediatric Hematology & Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India.
| | - Shree Hasitha Koneru
- Department of Pediatric Hematology & Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India
| | - Sri Gayathri Shanmugam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India
| | - Padmasani Venkatraman
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatric Hematology & Oncology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India
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Jayaraman D, S R AK, G MS, Sen P, R K, P P, Suman FR, Scott JX, Palaniappan N. Hyphaema unmasking the underlying haemophilia-A. Pediatr Blood Cancer 2023; 70:e30104. [PMID: 36519556 DOI: 10.1002/pbc.30104] [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] [Received: 10/16/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Dhaarani Jayaraman
- Department of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Monicka Shree G
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Parveen Sen
- Vitreoretina Department, Sankara Nethralaya, Chennai, India
| | - Kannan R
- Department of Anaesthesiology, Sankara Nethralaya, Chennai, India
| | - Preethi P
- Vitreoretina Department, Sankara Nethrayala, Chennai, India
| | - Febe Renjitha Suman
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Julius Xavier Scott
- Department of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Arunachalam NT, Jayaraman D, Kancharla A, T.K S, Kumari S, Pulimi R, Scott JX. Boon or Bane? - Disseminated BCGosis complicated by robust immune reconstitution in a child with Severe combined immunodeficiency during transplant – A case report. Pediatric Hematology Oncology Journal 2023. [DOI: 10.1016/j.phoj.2023.01.003] [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: 01/28/2023] Open
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Sneha LM, Mangam NGR, Scott JX, Manokaran RK, Deveram S, Jayaraman D. Ataxia-telangiectasia after hepatoblastoma: The reverse chronology. Pediatr Blood Cancer 2022; 69:e29778. [PMID: 35561060 DOI: 10.1002/pbc.29778] [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] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Latha M Sneha
- Division of Pediatric Hemato Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Naga Geetha Rani Mangam
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ranjith Kumar Manokaran
- Division of Pediatric Neurology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sowmya Deveram
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Dhaarani Jayaraman
- Division of Pediatric Hemato Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Vij M, Sivasankaran M, Jayaraman D, Sankaranarayanan S, Kumar V, Munirathnam D, Scott J. CARMIL2 Immunodeficiency with Epstein Barr Virus Associated Smooth Muscle Tumor (EBV-SMT). Report of a Case with Comprehensive Review of Literature. Fetal Pediatr Pathol 2022; 41:1023-1034. [PMID: 34738861 DOI: 10.1080/15513815.2021.2000533] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Primary immunodeficiency (PID) having defects related to lymphocyte cytotoxic pathway or T-cell dysfunction are well known for developing opportunistic infections and Epstein-Barr virus (EBV)-associated diseases. CARMIL2 deficiency is a recently described combined immunodeficiency (CID) disorder characterized by defective CD28-mediated T cell co-stimulation, altered cytoskeletal dynamics, susceptibility to various infections and Epstein Barr Virus smooth muscle tumor (EBV-SMT). Case report: We report a homozygous CARMIL2 pathogenic variant presenting with recurrent infections and EBV associated smooth muscle tumor (SMT) in a child. Conclusion: The present study reports that EBV SMT may occur in a child with CARMIL2 deficiency.
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Affiliation(s)
- Mukul Vij
- Department of Pathology, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Meena Sivasankaran
- Paediatric Hematology and Oncology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | - Dhaarani Jayaraman
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Vimal Kumar
- Department of Paediatric Haematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Deenadayalan Munirathnam
- Department of Paediatric Haematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Julius Scott
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Gupta N, Magatha LS, Jayaraman D, Scott JX, Antony SB, Koshy T. Mercaptopurine induced myelosuppression in a child with a NUDT15 rs116855232 homozygous variant. J Oncol Pharm Pract 2022:10781552221137709. [DOI: 10.1177/10781552221137709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Mercaptopurine (6-MP) is the backbone of the consolidation and maintenance therapy for paediatric acute lymphoblastic leukaemia (ALL). Nevertheless, it can cause critical myelosuppression. Predicting adverse reactions to 6-MP often involves the investigation of pharmacogenetic variants; in particular thiopurine S-methyltransferase ( TPMT) and nudix hydrolase 15 ( NUDT15). Lately, NUDT15 variants have been shown to play a significant pharmacogenetic role in predicting 6-MP intolerance in children of Asian descent. Case Report We present a six-year-old male child of Indian origin with persistent cytopenia after treatment. This prompted targeted sequencing of the genes TPMT and NUD15. The results revealed two copies of the variant of NUD15 rs116855232, that is, NUDT15*2 genotype. Management and Outcome Since the NUDT15*2 allele classified the patient as a poor metabolizer, he was restarted on a low dose of 6-MP, which he tolerated. Discussion Individuals with the NUDT15*2allele (*2/*2 genotype) are poor metabolizers of thiopurines which results in an adverse reaction to 6-MP. About 3.5% of Indians show variations in the TPMT gene as compared to 19.4% variations observed in NUDT15, which makes the latter a more reliable disease marker.
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Affiliation(s)
- Navya Gupta
- Pediatic Hemato-oncology Unit, Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Latha Sneha Magatha
- Pediatic Hemato-oncology Unit, Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Dhaarani Jayaraman
- Pediatic Hemato-oncology Unit, Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Julius Xavier Scott
- Pediatic Hemato-oncology Unit, Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Sharon Benita Antony
- Department of Human Genetics, Sri Ramachandra Faculty of Biomedical Science and Technology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Teena Koshy
- Department of Human Genetics, Sri Ramachandra Faculty of Biomedical Science and Technology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
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More M, Jayaraman D, Babu R, Rajasekaran B, Jaison J, Scott JX. Renal Primitive Neuroectodermal Tumor Mimicking Wilms' Tumor in a Young Boy: A Case Report of a Rare Entity with Review of the Literature. J Indian Assoc Pediatr Surg 2022; 27:775-777. [PMID: 36714469 PMCID: PMC9878518 DOI: 10.4103/jiaps.jiaps_50_22] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Primary renal primitive neuroectodermal tumors (PNET) are an extremely rare entity. The tumor is very aggressive presenting with metastasis and carries a dismal prognosis. We describe the case of renal PNET in an 11-year-old boy with a solid cystic lesion in the right kidney with a thrombus in the inferior vena cava and lung nodules, mimicking Wilms' tumor.
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Affiliation(s)
- Miloni More
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhaarani Jayaraman
- Department of Pediatrics, Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Banukeerthana Rajasekaran
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jensy Jaison
- Department of Radio Diagnosis, Sri Ramachandra Institute of Higher Education an Research, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatrics, Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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14
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Iswarya PS, Jayaraman D, Rajan XJ, Prabaharan K. Disseminated Cytomegalovirus Infection in a Child with Langerhans Cell Histiocytosis. J Glob Infect Dis 2022; 14:170-172. [PMID: 36636307 PMCID: PMC9831206 DOI: 10.4103/jgid.jgid_15_22] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/18/2022] [Accepted: 03/19/2022] [Indexed: 11/06/2022] Open
Abstract
Cytomegalovirus (CMV) reactivation is well known in post-transplant immunocompromised children. However, the incidence in non-transplant patients is significantly less, and only scarce case reports are available in the literature regarding CMV disease in children with solid tumors. We present a 3-year-old male child with multisystem refractory Langerhans cell histiocytosis, who had very high CMV viremia and disseminated CMV infection with secondary hemophagocytic lymphohistiocytosis and was successfully treated without organ damage and sequelae. Although routine screening is not recommended, CMV viremia/disease needs to be considered in non-transplant immunocompromised children with multisystem involvement with unexplained cytopenia.
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Affiliation(s)
- Polina Siri Iswarya
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhaarani Jayaraman
- Department of Pediatrics, Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Dhaarani Jayaraman, Department of Pediatrics, Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, No. 1, Ramachandra Nagar, Porur, Chennai - 600 116, Tamil Nadu, India. E-mail:
| | - X. Joshua Rajan
- Department of Pediatrics, Division of Pediatric Intensive Care, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Krithika Prabaharan
- Department of Pediatrics, Division of Pediatric Intensive Care, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Jayaraman D, John A, Bose JC, Venkitaraman B, Shalini S, Murali A. Successful Outcome of Metastatic Pancreatoblastoma in an Adolescent: A Case Report and Review of the Literature. J Indian Assoc Pediatr Surg 2022; 27:747-750. [PMID: 36714488 PMCID: PMC9878534 DOI: 10.4103/jiaps.jiaps_4_22] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/13/2022] [Accepted: 04/30/2022] [Indexed: 11/12/2022] Open
Abstract
Pancreatoblastoma, an orphan disease, is the most common malignant epithelial neoplasm of the pancreas in children. With vague clinical features, diagnosis is made by radiological suggestions and histopathology. The presence of metastatic disease and inoperable/incomplete excision remains the poor prognostic markers. We present a rare instance of an adolescent who has survived metastatic pancreatoblastoma after neoadjuvant chemoreduction/complete surgical excision.
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Affiliation(s)
- Dhaarani Jayaraman
- Department of Pediatrics, Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arockia John
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jagadesh Chandra Bose
- Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Balasubramanian Venkitaraman
- Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sai Shalini
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arunan Murali
- Department of Radio Diagnosis, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Devi Padmanaban P, Jayaraman D, Shanmugam SG, Geminiganesan S. Nephrotic Syndrome and Hodgkins Lymphoma - an Unusual Association. EJIFCC 2022; 33:262-267. [PMID: 36447800 PMCID: PMC9644090] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND An association between nephrotic syndrome and extrarenal neoplasia was described for the first time in 1922. The reported incidence of nephrotic syndrome in Hodgkin lymphoma is less than 1%. CLINICAL DESCRIPTION We present a 13 year old boy who was admitted with complaints of abdominal pain, vomiting and loose stools for 2 months. He had a history of significant weight loss of 5kg in a couple of months.On examination, he had bilateral pedal oedema and right cervical lymphadenopathy. Cervical lymph node biopsy revealed nodular sclerosis type of Hodgkin lymphoma. He also had hypoalbuminemia, massive proteinuria and hypercholesterolemia.Secondary nephrotic syndrome due to Hodgkin's lymphoma was made as a clinical diagnosis. MANAGEMENT AND OUTCOME He had been started on chemotherapy (with Prednisolone, Vincristine, Doxorubicin, Etoposide) for stage 3B Hodgkin lymphoma. He tolerated the chemotherapy well. Though he had symptomatic edema, managed conservatively as the urine output was adequate. On follow up, he attained spontaneous remission of nephrotic syndrome. CONCLUSION Overt proteinuria might be the manifestation of paraneoplastic syndrome in children with Hodgkin lymphoma and with the management of the primary disease, proteinuria resolves spontaneously.
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Affiliation(s)
- Priyanka Devi Padmanaban
- Department of Paediatric Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhaarani Jayaraman
- Department of Paediatric Medicine and Division of Paediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sri Gayathri Shanmugam
- Department of Paediatric Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sangeetha Geminiganesan
- Department of Paediatric Medicine and Division of Paediatric Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Sneha LM, Shanmugam R, Scott JX, Jayaraman D. Clinical Profile of COVID-Positive Cancer Children across Three COVID Waves: A Tertiary Care Center's Experience. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1750203] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Latha M. Sneha
- Division of Pediatric Hemato-Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Reshma Shanmugam
- Department of Pediatric Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Division of Pediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhaarani Jayaraman
- Division of Pediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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18
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Raj R, Uppuluri R, Parambil B, Dhariwal N, Totadri S, Mathew LG, Radhakrishnan V, Charan A, Yadav SP, Mahajan A, Mudaliar S, Sharma R, Manglani M, Kharya G, Verma N, Arora R, Ghara N, Ks R, Radhakrishnan N, Iyer N, Mehta P, Singh A, Patel S, John J, Bhat S, Badiger S, Siddaiahgari S, Kakkar S, Scott J, Jayaraman D, Srinivasan A, Krishnan Y, Sonamani N, Misra R, Bafna V, Seth R, Kutty PK, Kanakia S, Rao V, Prakash A, Bharadwaj V, Chinnasamy G. Outcomes of COVID-19 in children with cancer – Report from the Indian Pediatric Oncology Group (InPOG) COVID-19 registry in India. Pediatric Hematology Oncology Journal 2022. [PMCID: PMC8920536 DOI: 10.1016/j.phoj.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Methods Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Results A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.
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Shruthi T, Ravindran D, Mugunthan RR, Jayaraman D. Severe diabetic ketoacidosis and autoimmune pancreatitis with SIRS in an adolescent with LRBA deficiency – A rare complication of a common primary immunodeficiency disease. J Family Med Prim Care 2022; 11:1552-1554. [PMID: 35516664 PMCID: PMC9067192 DOI: 10.4103/jfmpc.jfmpc_1220_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Common variable immunodeficiency is the most common primary immunodeficiency disorder. Lipopolysaccharide (LPS)-responsive beige-like anchor protein (LRBA) deficiency is categorized as a common variable immunodeficiency associated with autoimmune manifestations and inflammatory bowel diseases. We report a rare case, an adolescent presenting with severe diabetic ketoacidosis (DKA) and acute pancreatitis with multiorgan dysfunction with common variable immunodeficiency (CVID) with homozygous LRBA mutation.
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Koneru SH, Jayaraman D, Scott JX, Suman FR, Shanmugam SG, Kannan K, Thomas S. Therapy related acute myeloid leukemia single centre experience. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.161] [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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21
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HasithaKoneru S, Jayaraman D, Scott J, Janarthananan M. Rheumatological manifestations in primary immunodeficiency disorders. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.087] [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: 11/29/2022] Open
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22
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Narasimhan S, Jayaraman D, Scott J, Venkatraman P. Seemingly malignant –Autoimmune lymphoproliferative syndrome with rare genetic mutation. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.088] [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: 10/18/2022] Open
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23
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Balaji BS, Jayaraman D, Shruthi. T, Scott J, Pulimi R, Kumari S. Still not obsolete–BCGOSIS in a child with severe combined immunodeficiency. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.089] [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: 10/18/2022] Open
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24
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Janani R, Latha M, Arul J, Jayaraman D, Scott J, Sundaram S, Rajeswaran R. Unusual sites of Rosai Dorfman disease in children: Case series from a tertiary care paediatric hemato-oncology centre. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.179] [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: 10/18/2022] Open
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25
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Somayajula A, Jayaraman D, Arul J, Shruthi T, Palraj K, Murali A, Murali S, Ayub II, Scott J. An immunocompromised boy with multiple osteolytic lesions: Infection or malignancy? Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.082] [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: 10/18/2022] Open
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26
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Sneha LM, Tatapudi V, Scott JX, Suman FR, Gayathri SS, Jayaraman D. SARS-CoV-2 At diagnosis of acute lymphoblastic leukemia-Case series. To worry about COVID or leukemia? A developing country's perspective. Pediatr Blood Cancer 2021; 68:e29124. [PMID: 34003567 PMCID: PMC8209874 DOI: 10.1002/pbc.29124] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Latha M. Sneha
- Division of Pediatric Hematology and OncologyDepartment of Pediatrics, Sri Ramachandra Institute of Higher Education and ResearchChennaiIndia
| | - Vahnita Tatapudi
- Division of Pediatric Hematology and OncologyDepartment of Pediatrics, Sri Ramachandra Institute of Higher Education and ResearchChennaiIndia
| | - Julius Xavier Scott
- Division of Pediatric Hematology and OncologyDepartment of Pediatrics, Sri Ramachandra Institute of Higher Education and ResearchChennaiIndia
| | - Febi Renjitha Suman
- Department of PathologySri Ramachandra Institute of Higher Education and ResearchChennaiIndia
| | - S. Sri Gayathri
- Department of PathologySri Ramachandra Institute of Higher Education and ResearchChennaiIndia
| | - Dhaarani Jayaraman
- Division of Pediatric Hematology and OncologyDepartment of Pediatrics, Sri Ramachandra Institute of Higher Education and ResearchChennaiIndia
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Jayaraman D, Bhurat R, Rathinasamy J, Shanmugam SG, Scott JX, Sivaraman RP, Sneha LM. A Journey Across Oceans With a Heavy Heart: Rare Presentation of a Pediatric Malignancy. JACC Case Rep 2021; 3:1221-1226. [PMID: 34401764 PMCID: PMC8353567 DOI: 10.1016/j.jaccas.2021.03.027] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 11/24/2022]
Abstract
Myeloid sarcoma, due to extramedullary deposition of myeloblasts, is one of the rare presentations in acute myeloid leukemia. We present an extremely rare case of a 5-year-old boy with cardiac myeloid sarcoma. Noninvasive mode of diagnosis, timely initiation of chemotherapy and meticulous supportive care are the keys to successful outcome. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Dhaarani Jayaraman
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Rishab Bhurat
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Jebaraj Rathinasamy
- Division of Paediatric Cardiology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Sri Gayathri Shanmugam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Rajakumar Padur Sivaraman
- Division of Pediatric Intensive Care, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Latha M Sneha
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
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Jeyarani G, Jayaraman D, Menon G, Harshavardhaan JKG, Rajendiran S, Murali A. Telangiectatic Osteosarcoma in a Young Child – A Case Report and Review of the Literature. J Orthop Case Rep 2021; 11:72-75. [PMID: 35437480 PMCID: PMC9009463 DOI: 10.13107/jocr.2021.v11.i06.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteosarcoma (OS) is one of the most common primary malignant bone tumors in children and adolescents. OS incidence varies significantly with age and peak incidence is in adolescent age group. Telangiectatic osteosarcoma (TOS) is an unusual variant of OS, forming 3–10% of all OSs. Only few case reports of this rare variant of OS are described in the literature. Case Report: We report a 6-year-girl who presented with fracture of the left proximal humerus after a trivial trauma. X-ray left shoulder showed osteolytic lesions in the left proximal humerus with fracture of proximal humerus. Open biopsy from the left proximal humerus osteolytic lesion suggested clusters of highly atypical cells like osteoid material and focal areas of hemorrhage and necrosis suggestive of TOS. The child was started on chemotherapy followed by limb-salvage surgery with wide resection of the tumor in the left proximal humerus. She completed her adjuvant chemotherapy and is currently doing well for the past 4 years. Conclusion: OS occurs more frequently in adolescents around the knee in the metaphyses. The most common histologic type is osteoblastic/fibroblastic or chondroblastic type. Very few cases have been reported in <5 years age group and it’s relatively rare in 5–10-year-old children. Rare histologic variants, especially telangiectatic variant, are more common in younger children and occur more in upper limbs. Imaging reveals mainly osteolytic lesions, unlike in conventional OS. This case highlights the utmost role of histopathology in the diagnosis of the bone tumors which would guide the management appropriately.
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Mahalingam H, Ramasundaram M, Rajendiran S, Jayaraman D. Mesenchymal Hamartoma of the Chest Wall in an Infant - A Benign Entity Masquerading as Malignancy. J Indian Assoc Pediatr Surg 2021; 26:184-187. [PMID: 34321791 PMCID: PMC8286021 DOI: 10.4103/jiaps.jiaps_84_20] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/09/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Mesenchymal hamartoma of the chest wall is a rare tumor-like lesion encountered in neonates and infants. Although typically benign with no metastatic potential, it has alarming imaging and pathological features that mimic malignancy. We describe the imaging, surgical, and pathological features of this rare entity in a 1-month-old infant.
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Affiliation(s)
- Harshavardhan Mahalingam
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Madhu Ramasundaram
- Department of Pediatric Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Swaminathan Rajendiran
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Dhaarani Jayaraman
- Department of Hematoncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Janarthanan M, John A, Jayaraman D, Gunabooshanam B. Secondary antiphospholipid syndrome in an adolescent girl with sjögren syndrome. Indian J Rheumatol 2021. [DOI: 10.4103/injr.injr_255_20] [Citation(s) in RCA: 1] [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: 11/04/2022] Open
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31
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Saravanam PK, Gajendran A, Dinakaran N, Jayaraman D. Oropharyngeal Kimura's disease: a diagnostic dilemma and therapeutic challenge. BMJ Case Rep 2020; 13:13/10/e236366. [PMID: 33127696 DOI: 10.1136/bcr-2020-236366] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
Kimura's disease is a chronic inflammatory disorder involving subcutaneous tissue and locoregional lymph nodes of head and neck region, characterised by angiolymphoid proliferation. It is typically associated with peripheral eosinophilia, increased serum IgE and lymphadenopathy. Diagnosis is usually based on histopathological examination. Though various treatment modalities have been put forward, surgical management remains the first line of treatment, followed by systemic steroids application. This case report discusses the diagnostic dilemma and therapeutic management of a rare clinical presentation and management of oropharyngeal Kimura's disease in a young immunocompetent woman.
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Affiliation(s)
| | - Aishwarya Gajendran
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Nethra Dinakaran
- Otorhinolaryngology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Dhaarani Jayaraman
- Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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32
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Jayaraman D, Scott JX, Lalitha, John A. Quality of life of parents of children with cancer- An observational study from a tertiary care center in South India. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.002] [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] Open
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33
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Jayaraman D, Scott JX, John A, Chandra Bose J, K S, S R, Shalini S. Unusual abdominal tumour in childhood – case report of pancreatoblastoma with metastasis. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.110] [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: 11/15/2022] Open
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34
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Jayaraman D, Mohan M, Shanmugam S, Scott J. Disease in disguise – An unusual cause of leukocytosis in an infant – A case report and review of the literature. J Appl Hematol 2020. [DOI: 10.4103/joah.joah_85_20] [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: 11/04/2022] Open
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35
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Gracelin Jeyarani S, Jayaraman D, Scott JX, Latha M, Priyathersini, Gayathri S. “All that glitters is not gold”a case series of rare causes of lymphadenopathy. Pediatric Hematology Oncology Journal 2019. [DOI: 10.1016/j.phoj.2019.08.078] [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: 11/28/2022] Open
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36
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Patel S, Swaminathan VV, Mythili V, Venkatadesikalu M, Sivasankaran M, Jayaraman D, Balasubramaniam R, Uppuluri R, Raj R. Quality Matters–Hematopoietic Stem Cell Transplantation versus Transfusion and Chelation in Thalassemia Major. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1441-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Patel S, Swaminathan VV, Mythili VS, Venkatadesikalu MS, Sivasankaran M, Jayaraman D, Balasubramaniam R, Uppuluri R, Raj R. Quality Matters - Hematopoietic Stem Cell Transplantation versus Transfusion and Chelation in Thalassemia Major. Indian Pediatr 2018; 55:1056-1058. [PMID: 30745477] [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: 06/09/2023]
Abstract
OBJECTIVE To compare quality of life of children with thalassemia major who have undergone stem cell transplantation with those on regular transfusion. METHODS The study included 40 children who underwent transplantation and 40 children and 20 adults on regular transfusion and iron chelation therapy. The quality of life assessment was done using the Pediatric Quality of Life Inventory 4.0 Generic Core Scale. RESULTS The mean total summary score, psychosocial summary score and physical score was 92, 91 and 92.8, respectively in transplant group and 83, 82.7 and 83.6, respectively in children in transfusion group. The adult group on transfusion showed overall poorer scores of 74.9, 76 and 73.9, respectively. The average scores in all domains were significantly (P<0.05) lower and drop steeply in second decade in transfusion group. CONCLUSIONS Allogeneic stem cell transplantation improves quality of life in thalassemia major.
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Affiliation(s)
- Shivani Patel
- Pediatric Hematology and Blood and Marrow Transplantation, Apollo Speciality Cancer Hospital, Chennai, India. Correspondence to: Dr Shivani Patel, Apollo Cancer Institute, 320 - Anna Salai, Teynampet Chennai 600 035, India.
| | | | - V Sr Mythili
- Thalassemia Centre and Blood bank, The Voluntary Health Services Hospital, Chennai, India
| | - M Sr Venkatadesikalu
- Thalassemia Centre and Blood bank, The Voluntary Health Services Hospital, Chennai, India
| | - Meena Sivasankaran
- Pediatric Hematology and Blood and Marrow Transplantation, Apollo Speciality Cancer Hospital, Chennai, India
| | - Dhaarani Jayaraman
- Pediatric Hematology and Blood and Marrow Transplantation, Apollo Speciality Cancer Hospital, Chennai, India
| | | | - Ramya Uppuluri
- Pediatric Hematology and Blood and Marrow Transplantation, Apollo Speciality Cancer Hospital, Chennai, India
| | - Revathi Raj
- Pediatric Hematology and Blood and Marrow Transplantation, Apollo Speciality Cancer Hospital, Chennai, India
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Sivasankaran M, Venkatadesikalu M, Mythili V, Sankaranarayanan S, Jayaraman D, Patel S, Swaminathan VV, Uppuluri R, Raj R. Ushering a New Era in the Management of Hepatitis C in Children with Hematological Disorders. Indian J Hematol Blood Transfus 2018; 34:739-741. [PMID: 30369751 PMCID: PMC6186249 DOI: 10.1007/s12288-018-0981-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
Transfusion-transmitted hepatitis C is a major concern among thalassemia patients. Our aim is to estimate the prevalence of Hepatitis C infection among thalassemia patients and to assess the treatment response, adverse effects of Peg-interferon based regimen and the new direct-acting antiviral drugs. Patients with thalassemia receiving regular blood transfusions with positive anti HCV antibodies during a period from January 2012 to June 2017 were analyzed. Serial HCV viral load and genotype and liver function tests were performed. Peg interferon and Ribavirin were used in patients diagnosed before January 2016 and patients diagnosed after January 2016 were started on the combination of Ledipasvir/Sofosbuvir. Thirty-two patients aged between 2 and 28 years were analyzed. Genotype 1 was the predominant type. Twenty-one patients were initiated on Peg Interferon with Ribavirin, and 14 achieved sustained virological response. All of them had increased blood transfusion requirements with significant compliance issues. All eleven patients started on Ledipasvir and Sofosbuvir including 4 undergoing hematopoietic stem cell transplantation and 7 interferon failures showed sustained viral clearance with good compliance. Ledipasvir/Sofosbuvir combination can be safely used in thalassemia patients and in young children. The cost of therapy is less compared to peg interferon based regimen with good compliance and superior efficacy.
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Affiliation(s)
- Meena Sivasankaran
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
| | - M Venkatadesikalu
- Voluntary Health Services Hospital Thalassemia Center, Chennai, India
| | - V Mythili
- Voluntary Health Services Hospital Thalassemia Center, Chennai, India
| | - Srinivas Sankaranarayanan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
| | - Dhaarani Jayaraman
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
| | - Shivani Patel
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
| | | | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035 India
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Uppuluri R, Jayaraman D, Sivasankaran M, Patel S, Swaminathan VV, Vaidhyanathan L, Kandath S, Raj R. Hematopoietic Stem Cell Transplantation for Primary Immunodeficiency Disorders: Experience from a Referral Center in India. Indian Pediatr 2018; 55:661-664. [PMID: 30218511] [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: 06/08/2023]
Abstract
OBJECTIVE To share experience of over 15 years in hematopoietic stem cell transplantation in children with primary immunodeficiency disorders. DESIGN Medical record review. SETTING A referral center for pediatric hemato-oncological disorders. PARTICIPANTS Children (<18 y) diagnosed to have primary immune deficiencies who underwent hematopoietic stem cell transplantation between 2002 and August 2017. MAIN OUTCOME MEASURES Disease-free survival, morbidity and mortality. RESULTS 85 primary immunodeficiency disorder transplants were performed with engraftment noted in 80 (94%) transplants and an overall survival of 67%. The conditioning regimen was individualized based on the underlying immune defect. Mixed chimerism was noted in 20% children with 56% (9/16) remaining disease-free. Graft versus host disease was noted in 33 (39.2%) children with most seen in children with chronic granulomatous disease. Severe combined immune deficiency transplants were mainly complicated by infections. Immune cytopenias complicated Wiskott Aldrich syndrome and Hemophagocytic lymphohistiocytosis transplants. 29.4% (25/85) children underwent haploidentical transplant in our cohort with a survival of 70% in this group. Infectious complications were the most common cause of death. CONCLUSIONS Primary immunodeficiency disorders are curable in India when transplanted in centers with experienced and trained pediatric transplant physicians and intensivists.
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Affiliation(s)
- Ramya Uppuluri
- Department of Pediatric Haematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India. Correspondence to: Dr Ramya Uppuluri, Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, 320, Padma Complex, Anna Salai, Teynampet, Chennai 600 035, India.
| | - Dhaarani Jayaraman
- Department of Pediatric Haematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Meena Sivasankaran
- Department of Pediatric Haematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Shivani Patel
- Department of Pediatric Haematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | | | - Lakshman Vaidhyanathan
- Department of Haematology and Stem Cell Pheresis, Apollo Cancer Institutes, Chennai, India
| | | | - Revathi Raj
- Department of Pediatric Haematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
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40
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Stouffs K, Stergachis AB, Vanderhasselt T, Dica A, Janssens S, Vandervore L, Gheldof A, Bodamer O, Keymolen K, Seneca S, Liebaers I, Jayaraman D, Hill HE, Partlow JN, Walsh CA, Jansen AC. Expanding the clinical spectrum of biallelic ZNF335 variants. Clin Genet 2018; 94:246-251. [PMID: 29652087 DOI: 10.1111/cge.13260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
ZNF335 plays an essential role in neurogenesis and biallelic variants in ZNF335 have been identified as the cause of severe primary autosomal recessive microcephaly in 2 unrelated families. We describe, herein, 2 additional affected individuals with biallelic ZNF335 variants, 1 individual with a homozygous c.1399 T > C, p.(Cys467Arg) variant, and a second individual with compound heterozygous c.2171_2173delTCT, p.(Phe724del) and c.3998A > G, p.(Glu1333Gly) variants with the latter variant predicted to affect splicing. Whereas the first case presented with early death and a severe phenotype characterized by anterior agyria with prominent extra-axial spaces, absent basal ganglia, and hypoplasia of the brainstem and cerebellum, the second case had a milder clinical presentation with hypomyelination and otherwise preserved brain structures on MRI. Our findings expand the clinical spectrum of ZNF335-associated microcephaly.
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Affiliation(s)
- K Stouffs
- Center for Medical Genetics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - A B Stergachis
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - A Dica
- Pediatric Neurology Clinic, Alexandru Obregia Hospital, Bucharest, Romania
| | - S Janssens
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - L Vandervore
- Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Gheldof
- Center for Medical Genetics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - O Bodamer
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Keymolen
- Center for Medical Genetics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Seneca
- Center for Medical Genetics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - I Liebaers
- Center for Medical Genetics, UZ Brussel, Brussels, Belgium
| | - D Jayaraman
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - H E Hill
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - J N Partlow
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Howard Hughes Medical Institute, Boston Children's Hospital, Boston, Massachusetts
| | - C A Walsh
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Howard Hughes Medical Institute, Boston Children's Hospital, Boston, Massachusetts.,Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, Massachusetts
| | - A C Jansen
- Neurogenetics Research Unit, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, Brussels, Belgium.,Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Brussels, Belgium
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41
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Robinson M, Jayaraman D, Lanser B. P346 Practical dietary recommendations for patients with food protein-induced enterocolitis syndrome (FPIES). Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.005] [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: 11/28/2022]
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42
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Uppuluri R, Subburaj D, Jayaraman D, Swaminathan VV, Mullanfiroze K, Vaidhyanathan L, Raj R. Cytomegalovirus reactivation posthematopoietic stem cell transplantation (HSCT) and type of graft: A step toward rationalizing CMV testing and positively impacting the economics of HSCT in developing countries. Pediatr Blood Cancer 2017; 64. [PMID: 28544502 DOI: 10.1002/pbc.26639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/09/2017] [Accepted: 04/17/2017] [Indexed: 11/06/2022]
Abstract
We aimed to determine a correlation between cytomegalovirus reactivation post hematopoeitic stem cell transplantation (post-HSCT) with the type of graft source, defining children at risk. We analyzed data on children less than 18 years of age undergoing HSCT from 2002 to May 2016 (n = 464). Correlation between reactivation and graft source was analyzed statistically. Reactivation occurred in 3% of children with matched-related donor (MRD) transplants, 33.3% with unrelated peripheral blood stem cells, 17.4% with unrelated cords, and 36.5% (15/41) with mismatched or haploidentical grafts (P = <0.0001). MRD does not warrant weekly PCR, unlike unrelated or haploidentical donors, thus defining protocols for developing countries with limited resources.
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Affiliation(s)
- Ramya Uppuluri
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Divya Subburaj
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Dhaarani Jayaraman
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | | | - Khushnuma Mullanfiroze
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | | | - Revathi Raj
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
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43
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Subburaj D, Uppuluri R, Jayaraman D, Vellaichamyswaminathan V, Kandath S, Raj R. Combating blood stream infections during induction chemotherapy in children with acute myeloid leukemia: Single center results in India. Pediatr Blood Cancer 2017; 64. [PMID: 28332765 DOI: 10.1002/pbc.26517] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 01/31/2023]
Abstract
Optimal management of infectious complication is the biggest challenge in children receiving chemotherapy for acute myeloid leukemia (AML). We have analyzed the data of children undergoing AML induction chemotherapy at our center from 2002 to 2016 and found that Gram-negative infections are more predominant when compared to the published literature. There also has been a surge in multidrug-resistant (MDR) infections over the last 4 years, which has increased the need for supportive care and escalated the cost of care. We have introduced certain novel methods to combat MDR sepsis and decrease mortality rates.
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Affiliation(s)
- Divya Subburaj
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | - Dhaarani Jayaraman
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | | | - Sathishkumar Kandath
- Department of Pediatric Critical Care Group, Apollo Speciality Hospital, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
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44
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Jayaraman D, Mukhopadhyay K, Bhalla AK, Dhaliwal LK. Randomized Controlled Trial on Effect of Intermittent Early Versus Late Kangaroo Mother Care on Human Milk Feeding in Low-Birth-Weight Neonates. J Hum Lact 2017; 33:533-539. [PMID: 28152330 DOI: 10.1177/0890334416685072] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breastfeeding at discharge among sick low-birth-weight (LBW) infants is low despite counseling and intervention like kangaroo mother care (KMC). Research aim: The aim was to study the effects of early initiation of KMC on exclusive human milk feeding, growth, mortality, and morbidities in LBW neonates compared with late initiation of KMC during the hospital stay and postdischarge. METHODS A randomized controlled trial was conducted in level 2 and 3 areas of a tertiary care neonatal unit over 15 months. Inborn neonates weighing 1 to 1.8 kg and hemodynamically stable were randomized to receive either early KMC, initiated within the first 4 days of life, or late KMC (off respiratory support and intravenous fluids). Follow-up was until 1 month postdischarge. Outcomes were proportion of infants achieving exclusive human milk feeding and direct breastfeeding, growth, mortality and morbidities during hospital stay, and postdischarge feeding and KMC practices until 1 month. RESULTS The early KMC group ( n = 80) achieved significantly higher exclusive human milk feeding (86% vs. 45%, p < .001) and direct breastfeeding (49% vs. 30%, p = .021) in hospital and almost exclusive human milk feeding (73% vs. 36%, p < .001) until 1 month postdischarge than the late KMC group ( n = 80). The incidence of apnea (11.9% vs. 20%, p = .027) and recurrent apnea requiring ventilation (8.8% vs. 15%, p = .02) were significantly reduced in the early KMC group. There was no significant difference in mortality, morbidities, and growth during the hospital stay and postdischarge. CONCLUSION Early KMC significantly increased exclusive human milk feeding and direct breastfeeding in LBW infants.
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Affiliation(s)
- Dhaarani Jayaraman
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanya Mukhopadhyay
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar Bhalla
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakhbir Kaur Dhaliwal
- 2 Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rob D, Špunda R, Lindner J, Šmalcová J, Šmíd O, Kovárník T, Linhart A, Bìlohlávek J, Marinoni MM, Cianchi G, Trapani S, Migliaccio ML, Gucci L, Bonizzoli M, Cramaro A, Cozzolino M, Valente S, Peris A, Grins E, Kort E, Weiland M, Shresta NM, Davidson P, Algotsson L, Fitch S, Marco G, Sturgill J, Lee S, Dickinson M, Boeve T, Khaghani A, Wilton P, Jovinge S, Ahmad AN, Loveridge R, Vlachos S, Patel S, Gelandt E, Morgan L, Butt S, Whitehorne M, Kakar V, Park C, Hayes M, Willars C, Hurst T, Best T, Vercueil A, Auzinger G, Adibelli B, Akovali N, Torgay A, Zeyneloglu P, Pirat A, Kayhan Z, Schmidbauer SS, Herlitz J, Karlsson T, Friberg H, Knafelj R, Radsel P, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Maka M, Ollieuz S, Reychler G, Mosaddegh R, Abbasi S, Talaee S, Zotzmann VZ, Staudacher DS, Wengenmayer TW, Dürschmied DD, Bode CB, Nelskylä A, Nurmi J, Jousi M, Schramko A, Mervaala E, Ristagno G, Skrifvars M, Ozsoy G, Kendirli T, Azapagasi E, Perk O, Gadirova U, Ozcinar E, Cakici M, Baran C, Durdu S, Uysalel A, Dogan M, Ramoglu M, Ucar T, Tutar E, Atalay S, Akar R, Kamps M, Leeuwerink G, Hofmeijer J, Hoiting O, Van der Hoeven J, Hoedemaekers C, Konkayev A, Kuklin V, Kondratyev T, Konkayeva M, Akhatov N, Sovershaev M, Tveita T, Dahl V, Wihersaari L, Skrifvars MB, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Reinikainen M, Lybeck A, Cronberg T, Nielsen N, Friberg H, Rauber M, Steblovnik K, Jazbec A, Noc M, Kalasbail P, Garrett F, Kulstad E, Bergström DJ, Olsson HR, Schmidbauer S, Friberg H, Mandel I, Mikheev S, Podoxenov Y, Suhodolo I, Podoxenov A, Svirko J, Sementsov A, Maslov L, Shipulin V, Vammen LV, Rahbek SR, Secher NS, Povlsen JP, Jessen NJ, Løfgren BL, Granfeldt AG, Grossestreuer A, Perman S, Patel P, Ganley S, Portmann J, Cocchi M, Donnino M, Nassar Y, Fathy S, Gaber A, Mokhtar S, Chia YC, Lewis-Cuthbertson R, Mustafa K, Sabra A, Evans A, Bennett P, Eertmans W, Genbrugge C, Boer W, Dens J, De Deyne C, Jans F, Skorko A, Thomas M, Casadio M, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G, Moon JB, Cho JH, Park CW, Ohk TG, Shin MC, Won MH, Papamichalis P, Zisopoulou V, Dardiotis E, Karagiannis S, Papadopoulos D, Zafeiridis T, Babalis D, Skoura A, Staikos I, Komnos A, Passos SS, Maeda F, Souza LS, Filho AA, Granjeia TAG, Schweller M, Franci D, De Carvalho Filho M, Santos TM, De Azevedo P, Wall R, Welters I, Tansuwannarat P, Sanguanwit P, Langer T, Carbonara M, Caccioppola A, Fusarini CF, Carlesso E, Paradiso E, Battistini M, Cattaneo E, Zadek F, Maiavacca R, Stocchetti N, Pesenti A, Ramos A, Acharta F, Toledo J, Perezlindo M, Lovesio L, Dogliotti A, Lovesio C, Schroten N, Van der Veen B, De Vries MC, Veenstra J, Abulhasan YB, Rachel S, Châtillon-Angle M, Alabdulraheem N, Schiller I, Dendukuri N, Angle M, Frenette C, Lahiri S, Schlick K, Mayer SA, Lyden P, Akatsuka M, Arakawa J, Yamakage M, Rubio J, Mateo-Sidron JAR, Sierra R, Celaya M, Benitez L, Alvarez-Ossorio S, Rubio J, Mateo-Sidron JAR, Sierra R, Fernandez A, Gonzalez O, Engquist H, Rostami E, Enblad P, Toledo J, Ramos A, Acharta F, Canullo L, Nallino J, Dogliotti A, Lovesio C, Perreault M, Talic J, Frenette AJ, Burry L, Bernard F, Williamson DR, Adukauskiene D, Cyziute J, Adukauskaite A, Malciene L, Luca L, Rogobete A, Bedreag O, Papurica M, Sarandan M, Cradigati C, Popovici S, Vernic C, Sandesc D, Avakov V, Shakhova I, Trimmel H, Majdan M, Herzer GH, Sokoloff CS, Albert M, Williamson D, Odier C, Giguère J, Charbonney E, Bernard F, Husti Z, Kaptás T, Fülep Z, Gaál Z, Tusa M, Donnelly J, Aries M, Czosnyka M, Robba C, Liu M, Ercole A, Menon D, Hutchinson P, Smielewski P, López R, Graf J, Montes JM, Kenawi M, Kandil A, Husein K, Samir A, Heijneman J, Huijben J, Abid-Ali F, Stolk M, Van Bommel J, Lingsma H, Van der Jagt M, Cihlar RC, Mancino G, Bertini P, Forfori F, Guarracino F, Pavelescu D, Grintescu I, Mirea L, Alamri S, Tharwat M, Kono N, Okamoto H, Uchino H, Ikegami T, Fukuoka T, Simoes M, Trigo E, Coutinho P, Pimentel J, Franci A, Basagni D, Boddi M, Cozzolino M, Anichini V, Cecchi A, Peris A, Markopoulou D, Venetsanou K, Papanikolaou I, Barkouri T, Chroni D, Alamanos I, Cingolani E, Bocci MG, Pisapia L, Tersali A, Cutuli SL, Fiore V, Palma A, Nardi G, Antonelli M, Coke R, Kwong A, Dwivedi DJ, Xu M, McDonald E, Marshall JC, Fox-Robichaud AE, Charbonney E, Liaw PC, Kuchynska I, Malysh IR, Zgrzheblovska LV, Mestdagh L, Verhoeven EF, Hubloue I, Ruel-laliberte J, Zarychanski R, Lauzier F, Bonaventure PL, Green R, Griesdale D, Fowler R, Kramer A, Zygun D, Walsh T, Stanworth S, Léger C, Turgeon AF, Baron DM, Baron-Stefaniak J, Leitner GC, Ullrich R, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Pérez AG, Silva J, Artemenko V, Bugaev A, Tokar I, Konashevskaya S, Kolesnikova IM, Roitman EV, Kiss TR, Máthé Z, Piros L, Dinya E, Tihanyi E, Smudla A, Fazakas J, Ubbink R, Boekhorst te P, Mik E, Caneva L, Ticozzelli G, Pirrelli S, Passador D, Riccardi F, Ferrari F, Roldi EM, Di Matteo M, Bianchi I, Iotti GA, Zurauskaite G, Voegeli A, Meier M, Koch D, Haubitz S, Kutz A, Bargetzi M, Mueller B, Schuetz P, Von Meijenfeldt G, Van der Laan M, Zeebregts C, Christopher KB, Vernikos P, Melissopoulou T, Kanellopoulou G, Panoutsopoulou M, Xanthis D, Kolovou K, Kypraiou T, Floros J, Broady H, Pritchett C, Marshman M, Jannaway N, Ralph C, Lehane CL, Keyl CK, Zimmer EZ, Trenk DT, Ducloy-Bouthors AS, Jonard MJ, Fourrier F, Piza F, Correa T, Marra A, Guerra J, Rodrigues R, Vilarinho A, Aranda V, Shiramizo S, Lima MR, Kallas E, Cavalcanti AB, Donoso M, Vargas P, Graf J, McCartney J, Ramsay S, McDowall K, Novitzky-Basso I, Wright C, Medic MG, Bielen L, Radonic V, Zlopasa O, Vrdoljak NG, Gasparovic V, Radonic R, Narváez G, Cabestrero D, Rey L, Aroca M, Gallego S, Higuera J, De Pablo R, González LR, Chávez GN, Lucas JH, Alonso DC, Ruiz MA, Valarezo LJ, De Pablo Sánchez R, Real AQ, Wigmore TW, Bendavid I, Cohen J, Avisar I, Serov I, Kagan I, Singer P, Hanison J, Mirza U, Conway D, Takasu A, Tanaka H, Otani N, Ohde S, Ishimatsu S, Coffey F, Dissmann P, Mirza K, Lomax M, Dissmann P, Coffey F, Mirza K, Lomax M, Miner JR, Leto R, Markota AM, Gradišek PG, Aleksejev VA, Sinkovič AS, Romagnoli S, Chelazzi C, Zagli G, Benvenuti F, Mancinelli P, Boninsegni P, Paparella L, Bos AT, Thomas O, Goslar T, Knafelj R, Perreault M, Martone A, Sandu PR, Rosu VA, Capilnean A, Murgoi P, Frenette AJ, Lecavalier A, Jayaraman D, Rico P, Bellemare P, Gelinas C, Williamson D, Nishida T, Kinoshita T, Iwata N, Yamakawa K, Fujimi S, Maggi L, Sposato F, Citterio G, Bonarrigo C, Rocco M, Zani V, De Blasi RA, Alcorn D, Barry L, Riedijk MA, Milstein DM, Caldas J, Panerai R, Camara L, Ferreira G, Bor-Seng-Shu E, Lima M, Galas F, Mian N, Nogueira R, de Oliveira GQ, Almeida J, Jardim J, Robinson TG, Gaioto F, Hajjar LA, Zabolotskikh I, Musaeva T, Saasouh W, Freeman J, Turan A, Saseedharan S, Pathrose E, Poojary S, Messika J, Martin Y, Maquigneau N, Henry-Lagarrigue M, Puechberty C, Stoclin A, Martin-Lefevre L, Blot F, Dreyfuss D, Dechanet A, Hajage D, Ricard J, Almeida E, Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, De Brito C, Cavichio L, Almeida L, Ribeiro U, Osawa E, Boltes R, Battistella L, Hajjar L, Fontela P, Lisboa T, Junior LF, Friedman GF, Abruzzi F, Primo JAP, Filho PM, de Andrade JS, Brenner KM, boeira MS, Leães C, Rodrigues C, Vessozi A, Machado AS, Weiler M, Bryce H, Hudson A, Law T, Reece-Anthony R, Molokhia A, Abtahinezhadmoghaddam F, Cumber E, Channon L, Wong A, Groome R, Gearon D, Varley J, Wilson A, Reading J, Wong A, Zampieri FG, Bozza FA, Ferez M, Fernandes H, Japiassú A, Verdeal J, Carvalho AC, Knibel M, Salluh JI, Soares M, Gao J, Ahmadnia E, Patel B, McCartney J, MacKay A, Binning S, Wright C, Pugh RJ, Battle C, Hancock C, Harrison W, Szakmany T, Mulders F, Vandenbrande J, Dubois J, Stessel B, Siborgs K, Ramaekers D, Soares M, Silva UV, Homena WS, Fernandes GC, Moraes AP, Brauer L, Lima MF, De Marco F, Bozza FA, Salluh JI, Maric N, Mackovic M, Udiljak N, Bosso CE, Caetano RD, Cardoso AP, Souza OA, Pena R, Mescolotte MM, Souza IA, Mescolotte GM, Bangalore H, Borrows E, Barnes D, Ferreira V, Azevedo L, Alencar G, Andrade A, Bierrenbach A, Buoninsegni LT, Bonizzoli M, Cecci L, Cozzolino M, Peris A, Lindskog J, Rowland K, Sturgess P, Ankuli A, Molokhia A, Rosa R, Tonietto T, Ascoli A, Madeira L, Rutzen W, Falavigna M, Robinson C, Salluh J, Cavalcanti A, Azevedo L, Cremonese R, Da Silva D, Dornelles A, Skrobik Y, Teles J, Ribeiro T, Eugênio C, Teixeira C, Zarei M, Hashemizadeh H, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Lignos M, Crissanthopoulou E, Flevari K, Dimopoulos P, Armaganidis A, Golub JG, Markota AM, Stožer AS, Sinkovič AS, Rüddel H, Ehrlich C, Burghold CM, Hohenstein C, Winning J, Sellami W, Hajjej Z, Bousselmi M, Gharsallah H, Labbene I, Ferjani M, Sattler J, Steinbrunner D, Poppert H, Schneider G, Blobner M, Kanz KG, Schaller SJ, Apap K, Xuereb G, Xuereb G, Apap K, Massa L, Xuereb G, Apap K, Massa L, Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, Roy PM, Gianello P, Hadîrcă L, Ghidirimschi A, Catanoi N, Scurtov N, Bagrinovschi M, Sohn YS, Cho YC, Golovin B, Creciun O, Ghidirimschi A, Bagrinovschi M, Tabbara R, Whitgift JZ, Ishimaru A, Yaguchi A, Akiduki N, Namiki M, Takeda M, Tamminen JN, Reinikainen M, Uusaro A, Taylor CG, Mills ED, Mackay AD, Ponzoni C, Rabello R, Serpa A, Assunção M, Pardini A, Shettino G, Corrêa T, Vidal-Cortés PV, Álvarez-Rocha L, Fernández-Ugidos P, Virgós-Pedreira A, Pérez-Veloso MA, Suárez-Paul IM, Del Río-Carbajo L, Fernández SP, Castro-Iglesias A, Butt A, Alghabban AA, Khurshid SK, Ali ZA, Nizami IN, Salahuddin NS, Alshahrani M, Alsubaie AW, Alshamsy AS, Alkhiliwi BA, Alshammari HK, Alshammari MB, Telmesani NK, Alshammari RB, Asonto LP, Zampieri FG, Damiani LP, Bozza F, Salluh JI, Cavalcanti AB, El Khattate A, Bizrane M, Madani N, Belayachi J, Abouqal R, Ramnarain D, Gouw-Donders B, Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A, Taniguchi LU, Araujo L, Salgado G, Vieira JM, Viana J, Ziviani N, Pessach I, Lipsky A, Nimrod A, O´Connor M, Matot I, Segal E, Kluzik A, Gradys A, Smuszkiewicz P, Trojanowska I, Cybulski M, De Jong A, Sebbane M, Chanques G, Jaber S, Rosa R, Robinson C, Bessel M, Cavalheiro L, Madeira L, Rutzen W, Oliveira R, Maccari J, Falavigna M, Sanchez E, Dutra F, Dietrich C, Balzano P, Rezende J, Teixeira C, Sinha S, Majhi K, Gorlicki JG, Pousset FP, Kelly J, Aron J, Gilbert AC, Urankar NP, Knafelj R, Irazabal M, Bosque M, Manciño J, Kotsopoulos A, Jansen N, Abdo W, Casey ÚM, O’Brien B, Plant R, Doyle B. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3). Crit Care 2017. [PMCID: PMC5374552 DOI: 10.1186/s13054-017-1630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Jayaraman D, Uppuluri R, Swaminathan VV, Sivasankaran M, Patel S, Raj R. Affordable and Safe Health Care for All Children: Lessons Learned from the Use of Peg-asparaginase in a Developing Country. Indian J Med Paediatr Oncol 2017; 38:398-400. [PMID: 29200702 PMCID: PMC5686995 DOI: 10.4103/ijmpo.ijmpo_110_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Peg-asparaginase has widely replaced the use of conventional asparaginase in treatment of children with acute lymphoblastic leukaemia in developed countries. In developing countries like India, with financial constraints being a part of clinical challenge to the treatment of cancers, uniform use of Peg-asparaginase in all children is not practically possible. However, we found by a retrospective analysis of 211 children treated for acute lymphoblastic leukaemia, uniform use of this drug was feasible with indigenous techniques like storing the drug with strict cold chain maintenance and sharing the drug amongst 2 or 3 patients to reduce the burden on each family. We have not found increased rates of infection or any loss of efficacy of the drug due to prolonged storage.
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Affiliation(s)
- Dhaarani Jayaraman
- Department of Paediatric Haematology, Oncology and BMT, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Ramya Uppuluri
- Department of Paediatric Haematology, Oncology and BMT, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | | | - Meena Sivasankaran
- Department of Paediatric Haematology, Oncology and BMT, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Shivani Patel
- Department of Paediatric Haematology, Oncology and BMT, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Revathi Raj
- Department of Paediatric Haematology, Oncology and BMT, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
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Sivasankaran M, Jayaraman D, Patel S, Venkateswaran V, Mythili V, Venkatadesikalu M, Srinivas S, Uppuluri R, Raj R. Ushering a new era in the management of hepatitis C in children with haematological disorders. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.11.131] [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: 10/18/2022] Open
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Jayaraman D, Rabinovitch N. P090 A Case of recurrent angioedema associated with elevated tree pollen counts. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.099] [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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Dayal D, Jayaraman D, Sankhyan N, Singhi P. Acute Painful Neuropathy in a Girl with Type 1 Diabetes: Long Term Follow-Up. J Clin Diagn Res 2016; 10:SD01-2. [PMID: 27437321 DOI: 10.7860/jcdr/2016/19765.7773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/24/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
Acute Painful Diabetic Neuropathy (APDN) is a reversible neuropathy that occurs in patients with diabetes usually after a fast improvement in glycaemic control. The condition is extremely rare in children with Type 1 Diabetes (T1D). We describe a 12-year-old girl T1D who developed APDN shortly after diagnosis of T1D. Neurological examination and nerve conduction studies showed severe asymmetric lower limb sensorimotor neuropathy. She was treated with carbamazepine, benfotiamine (vitamin B1 analogue), and NSAID analgesics and showed complete recovery 9 months after the onset. The treating physicians should recognize and understand this entity in view of the current recommendations for quick achievement of glycaemic targets in T1D, the need to provide relief from severe pain and to lay emphasis on complete recovery.
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Affiliation(s)
- Devi Dayal
- Additional Professor, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Dhaarani Jayaraman
- Senior Resident, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Naveen Sankhyan
- Associate Professor, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Pratibha Singhi
- Professor and Head, Department of Pediatrics, Chief, Pediatric Neurology and Neurodevelopment Unit, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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