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Fiskus W, Rao R, Balusu R, Ganguly S, Tao J, Sotomayor E, Mudunuru U, Smith JE, Hembruff SL, Atadja P, Marquez VE, Bhalla K. Editor's Note: Superior Efficacy of a Combined Epigenetic Therapy against Human Mantle Cell Lymphoma Cells. Clin Cancer Res 2024; 30:1994. [PMID: 38690597 DOI: 10.1158/1078-0432.ccr-24-0856] [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: 05/02/2024]
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2
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Acharya R, Bhalla K, Gathwala G. A Rare Mutation in TRRAP Gene and the Expanded New Phenotype. Indian J Pediatr 2024:10.1007/s12098-024-05115-z. [PMID: 38565765 DOI: 10.1007/s12098-024-05115-z] [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: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Rohan Acharya
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
| | - Kapil Bhalla
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Geeta Gathwala
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Garg D, Bhalla K, Nanda S, Gupta A, Mehra S. Vitamin D status in children with community acquired pneumonia and its association with severity: a hospital-based study. Minerva Pediatr (Torino) 2024; 76:227-235. [PMID: 33845559 DOI: 10.23736/s2724-5276.21.06036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND International and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. This study was undertaken to evaluate the prevalence of vitamin D deficiency in pneumonia in children, and to assess its relationship with the severity. METHODS Study group included children aged between 2 months to 5 years of age admitted as inpatients who presented with clinical features of pneumonia as per WHO Classification. Detailed clinical assessment and physical examination was done at the time of admission and patients were enrolled and relevant findings were noted in prestructured proforma. Vitamin D levels <30 nmol/L (<12 ng/mL) were defined as deficient, 30-50 nmol/L (12-20 ng/mL) as insufficient, and >125 nmol/L (>50 ng/mL) as sufficient. Outcomes of the patients admitted were recorded in terms of duration of hospitalization, Intensive Care Unit (ICU) stay, oxygen requirement, antibiotic need and duration, need for upgradation of antibiotics, nebulization need with drugs used, ventilator need and other parameters. Statistical analysis was performed using statistical package for social sciences software (SPSS Inc., Chicago, IL, USA). A P value of <0.05 was considered statistically significant. RESULTS Out of 101 patients, 100% presented with fever, cough and fast breathing, 42.6% with grunting, 41 (40.5%) with noisy breathing, 5.7% with bluish discoloration, and 4.3% with apnea. Forty-one (40.5%) patients had crepitation, 53 (52.4%) patients had rhonchi, while 7 (6%) presented with bronchial breathing. Chest radiography features at admission helped to differentiate between presumed viral and presumed bacterial infection. Vitamin D deficient patients had significantly longer duration of hospital stay as compared to vitamin D sufficient group (P<0.001). The need for upgradation of antibiotics between the three groups were found to be significant (P<0.001). This showed that vitamin D deficiency is directly proportional to the need of upgradation of antibiotics. Bacterial pneumonia presents mostly as alveolar infiltrates and/or pleural effusion while viral pneumonia presents as interstitial infiltrates and/or hyperinflation. Cases with presumed bacterial pneumonia (based on X-ray, 38 out of 48, 79.1%) were more often vitamin D deficient as compared to case with presumed viral pneumonia (32 out of 52, 61.5%, P=0.05). CONCLUSIONS Vitamin D is widely prevalent in Indian children with pneumonia. Vitamin D deficient patients needed a longer duration of hospitalization, more upgradation of antibiotics, and PICU admissions; moreover, it had more CPAP requirement, longer duration of PICU stay and longer duration of CPAP requirements as compared to vitamin D sufficient group.
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Affiliation(s)
- Deepali Garg
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Kapil Bhalla
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India -
| | - Sanjiv Nanda
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Ashish Gupta
- Department of Anesthesiology, Paras Hospital, Gurgaon, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
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Jain R, Acharya R, Kumud, Bhalla K, Yadav D, Jain N, Jakhar S. Serum Resistin as a Potential Mortality Predictor in Neonatal Sepsis. Cureus 2024; 16:e55289. [PMID: 38562275 PMCID: PMC10984556 DOI: 10.7759/cureus.55289] [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: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Aim The aim of this study was to investigate the utility of serum resistin levels as a prognostic indicator for mortality in neonates diagnosed with sepsis. Methodology This one-year prospective study at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, India, included 151 neonates categorized into two groups based on blood culture results: group 1 (n=86) included those with culture-negative, probable sepsis and group 2 (n=65) included those with culture-positive, proven sepsis. Blood samples obtained pre-treatment underwent comprehensive analysis, including complete blood count, C-reactive protein assessment, micro-erythrocyte sedimentation rate, and resistin level measurement via enzyme-linked immunosorbent assay. The comparison between groups was conducted using either the Student t-test or the Mann-Whitney U test, while correlations were assessed using the Spearman correlation. These analyses were employed to identify the optimal resistin cut-off for distinguishing patients with sepsis. A p-value of <0.05 was considered statistically significant. Results This study with 151 neonates diagnosed with sepsis found a significant association (p < 0.05) between elevated serum resistin levels and increased mortality risk. Multivariate analysis confirmed an independent predictive role of resistin. Elevated resistin levels correlate with higher chances of requiring mechanical ventilation and prolonged hospital stays. These findings highlight serum resistin's potential as a prognostic tool for the early identification of high-risk neonatal sepsis patients. Conclusion This study highlights the link between elevated serum resistin levels and increased mortality risk in neonatal sepsis, supported by strong multivariate analysis, indicating an independent predictive role. Additionally, resistin correlates with higher chances of mechanical ventilation and prolonged hospitalization, suggesting its potential as a prognostic marker for early identification of high-risk neonatal sepsis cases.
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Affiliation(s)
- Rashika Jain
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Rohan Acharya
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Kumud
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Kapil Bhalla
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Dinkar Yadav
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Naman Jain
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
| | - Sunisha Jakhar
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, IND
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Bansal E, Mehra S, Bhalla K. Congenital tuberculosis causing hydrops fetalis: A case report and review of literature. J Family Med Prim Care 2023; 12:3412-3414. [PMID: 38361858 PMCID: PMC10866244 DOI: 10.4103/jfmpc.jfmpc_959_23] [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: 06/12/2023] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 02/17/2024] Open
Abstract
Tuberculosis (TB) is an infectious disease of which congenital TB is a rare form even in TB-endemic countries such as India. There are very few case reports of the same in the literature. Though the incidence rate of congenital TB is low, mortality rates are very high. Here, we report a case of a 2-day-old neonate who presented to Pediatrics Accident and Emergency with complaints of fast breathing and swelling all over the body. The baby had swelling all over the body and subcutaneous edema suggestive of hydrops fetalis. She was investigated and subsequently diagnosed to have congenital TB for which appropriate treatment was started. The baby is still on regular follow-up with no active complaints.
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Affiliation(s)
- Eshita Bansal
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Bataller A, Loghavi S, Gerstein Y, Bazinet A, Sasaki K, Chien KS, Hammond D, Montalban-Bravo G, Borthakur G, Short N, Issa GC, Kadia TM, Daver N, Tang G, Quesada A, Patel KP, Ravandi F, Fiskus W, Mill CP, Kantarjian HM, Bhalla K, Garcia-Manero G, Oran B, DiNardo CD. Characteristics and clinical outcomes of patients with myeloid malignancies and DDX41 variants. Am J Hematol 2023; 98:1780-1790. [PMID: 37665752 DOI: 10.1002/ajh.27070] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
DDX41 is the most frequently mutated gene in myeloid neoplasms associated with germline predisposition including myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). We analyzed 3795 patients with myeloid neoplasms and identified 151 (4%) with DDX41 variants and a diagnosis of AML (n = 96), MDS (n = 52), and chronic myelomonocytic leukemia (n = 3). The most frequent DDX41 variants were the somatic variant p.R525H, followed by the germline variants p.M1I and p.D140fs. Most neoplasms had a normal karyotype (59%) and the most frequent co-mutations were TP53 (16%) and ASXL1 (15%). 30% of patients had no concomitant mutations besides DDX41 mutation. Patients with myeloid malignancies and DDX41 variants responded well to therapy, with an overall response rate for patients with treatment naïve AML and MDS of 87% and 84%, respectively. The median overall survival (mOS) of patients with treatment-naïve AML or MDS was 49 and 71 months, respectively. Patients with AML treated with low-intensity regimens including venetoclax had an improved survival (2-year OS 91% vs. 60%, p = .02) and lower cumulative incidence of relapse compared to those treated without venetoclax (10% vs. 56%, p = .03). In the 33% of patients receiving hematopoietic stem cell transplantation, the 2-year OS was 80% and 85% for AML and MDS, respectively.
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Affiliation(s)
- Alex Bataller
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanam Loghavi
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yoheved Gerstein
- Department of Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre Bazinet
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly S Chien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Danielle Hammond
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guilin Tang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andres Quesada
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keyur P Patel
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Warren Fiskus
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cristopher P Mill
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Vishal V, Sachdeva A, Bhalla K, Dureja A, Tarte S. Exploring the Involvement of Cytokines in Pediatric Patients Afflicted by Simple Febrile Seizures: A Case-Control Study. Cureus 2023; 15:e48083. [PMID: 38046507 PMCID: PMC10689979 DOI: 10.7759/cureus.48083] [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: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
AIM Most children under six with seizures experience febrile seizures (FS), which occur with a temperature of 38°C or higher and no apparent infectious or metabolic causes. FS has a multifaceted etiology, involving genetic and environmental factors. This study aimed to explore the connection between the cytokine system (part of the immune system related to inflammation) and FS to uncover potential relationships. METHOD This research was carried out on 50 patients experiencing FS and 25 patients experiencing only fever served as cases and controls, respectively. The patient's blood was obtained under sterile circumstances from the antecubital/femoral vein as soon as feasible following the commencement of seizures. The complete hemogram analysis was done using the Mindray BC-5800 auto hematology analyzer (Mindray Medical International Limited, Shenzhen, China). RESULT The cases group had significantly higher interleukin-4 (IL-4) concentrations (292.85 pg/mL) than controls (81.04 pg/mL), indicating a statistically significant difference (p<0.05), respectively. In the current research, case participants had a significantly lower mean level of interleukin-6 (IL-6) than control participants. The average IL-6 concentration in cases was 28.00 pg/mL, whereas in controls was 93.09pg/mL. Patients with FS have an important function for the cytokine network to perform. CONCLUSION The findings showed a significant difference in cytokine concentrations between patients with FS and control subjects, highlighting a potential link between the cytokine system and FS. Additionally, lower levels of IL-6 in case participants suggest a complex role of cytokines in FS, emphasizing the importance of the cytokine network in this condition.
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Affiliation(s)
- Vaibhav Vishal
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ashuma Sachdeva
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Kapil Bhalla
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ankanksha Dureja
- Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Sagar Tarte
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Jia Y, Han L, Ramage CL, Wang Z, Weng CC, Yang L, Colla S, Ma H, Zhang W, Andreeff M, Daver N, Jain N, Pemmaraju N, Bhalla K, Mustjoki S, Zhang P, Zheng G, Zhou D, Zhang Q, Konopleva M. Co-targeting BCL-XL and BCL-2 by PROTAC 753B eliminates leukemia cells and enhances efficacy of chemotherapy by targeting senescent cells. Haematologica 2023; 108:2626-2638. [PMID: 37078252 PMCID: PMC10542840 DOI: 10.3324/haematol.2022.281915] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
BCL-XL and BCL-2 are key anti-apoptotic proteins and validated cancer targets. 753B is a novel BCL-XL/BCL-2 proteolysis targeting chimera (PROTAC) that targets both BCL-XL and BCL-2 to the von Hippel-Lindau (VHL) E3 ligase, leading to BCLX L/BCL-2 ubiquitination and degradation selectively in cells expressing VHL. Because platelets lack VHL expression, 753B spares on-target platelet toxicity caused by the first-generation dual BCL-XL/BCL-2 inhibitor navitoclax (ABT-263). Here, we report pre-clinical single-agent activity of 753B against different leukemia subsets. 753B effectively reduced cell viability and induced dose-dependent degradation of BCL-XL and BCL-2 in a subset of hematopoietic cell lines, acute myeloid leukemia (AML) primary samples, and in vivo patient-derived xenograft AML models. We further demonstrated the senolytic activity of 753B, which enhanced the efficacy of chemotherapy by targeting chemotherapy-induced cellular senescence. These results provide a pre-clinical rationale for the utility of 753B in AML therapy, and suggest that 753B could produce an added therapeutic benefit by overcoming cellular senescence-induced chemoresistance when combined with chemotherapy.
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Affiliation(s)
- Yannan Jia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Lina Han
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cassandra L Ramage
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhe Wang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Connie C Weng
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Yang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simona Colla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Helen Ma
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Weiguo Zhang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, University of Helsinki and Helsinki University Hospital Comprehensive Cancer center, Helsinki, Finland; Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland; iCAN Digital Precision Cancer Medicine Flagship, Helsinki
| | - Peiyi Zhang
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL
| | - Guangrong Zheng
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL
| | - Daohong Zhou
- Department of Biochemistry and Structural Biology and Center for Innovative Drug Discovery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Qi Zhang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Richard-Carpentier G, Rausch CR, Sasaki K, Hammond D, Morita K, Takahashi K, Tang G, Kanagal-Shamanna R, Bhalla K, Dinardo CD, Borthakur G, Pemmaraju N, Shpall EJ, Alousi A, Daver NG, Garcia-Manero G, Konopleva MY, Ravandi F, Kantarjian HM, Kadia TM. Characteristics and clinical outcomes of patients with acute myeloid leukemia with inv(3)(q21q26.2) or t(3;3)(q21;q26.2). Haematologica 2023; 108:2331-2342. [PMID: 36951163 PMCID: PMC10483357 DOI: 10.3324/haematol.2022.282030] [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: 10/18/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
Acute myeloid leukemia (AML) with inv(3)(q21q26.2)/t(3;3)(q21;q26.2) has a very poor prognosis. Determinants of clinical outcomes and optimal treatment remain uncertain. We retrospectively reviewed 108 cases of AML with inv(3)/t(3;3) and evaluated clinicopathological characteristics and clinical outcomes: 53 newly diagnosed (ND) AML and 55 relapsed/refractory (R/R) AML. Median age was 55 years. White blood cell (WBC) count ≥20x109/L and platelet count ≥140x109/L was observed in 25% and 32% of ND patients, respectively. Anomalies involving chromosome 7 were identified in 56% of patients. The most frequently mutated genes were SF3B1, PTPN11, NRAS, KRAS and ASXL1. In ND patients, the composite complete remission (CRc) rate was 46% overall; 46% with high-intensity treatments and 47% with lowintensity treatments. The 30-day mortality was 14% and 0%, with high- and low-intensity treatment, respectively. In R/R patients, the CRc rate was 14%. Venetoclax based-regimens were associated with a CRc rate of 33%. The 3-year overall survival (OS) was 8.8% and 7.1% in ND and R/R patients, respectively. The 3-year cumulative incidence of relapse was 81.7% overall. Older age, high WBC, high peripheral blast count, secondary AML and KRAS, ASXL1, DNMT3A mutations were associated with worse OS in univariable analyses. The 5-year OS rates were 44% and 6% with or without hematopoietic stem cell transplantation in CR1, respectively. AML with inv(3)/t(3;3) is associated with low CR rates, very high risk of relapse and dismal long-term survival. Intensive chemotherapy and hy pomethylating agents provide similar rates of remission and patients achieving CR benefit from hematopoietic stem cell transplantation in first CR.
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Affiliation(s)
- Guillaume Richard-Carpentier
- Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | - Caitlin R Rausch
- Division of Pharmacy, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Koji Sasaki
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Danielle Hammond
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Kiyomi Morita
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Koichi Takahashi
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Kapil Bhalla
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Courtney D Dinardo
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Naveen Pemmaraju
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Naval G Daver
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Guillermo Garcia-Manero
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Marina Y Konopleva
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Hagop M Kantarjian
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, Division of Cancer Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas.
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Bansal E, Mehra S, Bhalla K. Improvement of quality of life in a family of a child with asthma after using the Written Asthma Action Plan (WAAP). J Family Med Prim Care 2023; 12:1336-1341. [PMID: 37649773 PMCID: PMC10465022 DOI: 10.4103/jfmpc.jfmpc_1828_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 09/01/2023] Open
Abstract
Background Asthma is a common childhood disease that leads to impairment of quality of life (QOL) of both the children affected by the disease and their caregivers. Management of asthma includes pharmacotherapy along with education about asthma and its self-management, which is most often given verbally. There is limited evidence regarding the benefits of using a written asthma action plan (WAAP) that has been improved using pictorial representation. Objective The study aimed to assess the effectiveness of a WAAP in improving the QOL of children with bronchial asthma and also of their caregivers. It also educates the patients and families about various triggers and danger signs of an acute attack of asthma. Methods This was an interventional study with the aim of improving the quality of asthma management. Children of age group 7-17 years in whom the diagnosis of asthma was made and those parents and children who could read and answer the questionnaire (mini-PAQLQ and PACQLQ) were included in the study. Subjects were randomized into Case and Control groups. The intervention was to give the randomly selected patients (Case group) an individualized WAAP along with standard asthma care to both groups. Both groups were followed up to assess and record variations in the quality of life. Results The P value was highly significant in the following parameters post-intervention: missed doses of controller medication (P value = 0.001), need for rescue medication (<0.001), ACT score (0.001), total PAQLQ (<0.001), and PACQLQ (<0.001) score. Though statistical significance was not established, improvement was also observed in the number of unscheduled OPD visits (P value = 0.082) and hospitalization events (P value = 0.554). Conclusion On being provided with the WAAP, the frequency of acute asthma events, treatment compliance, and QOL improved. There was a significant increase in the primary outcomes-PAQLQ and PACQLQ scores. Significant improvement in the secondary outcomes-number of missed school days, missed doses of controller medication, need for rescue medication, and ACT score was also observed.
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Affiliation(s)
- Eshita Bansal
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Zhang X, Zhao X, Fiskus W, Lin J, Lwin T, Rao R, Zhang Y, Chan JC, Fu K, Marquez VE, Chen-Kiang S, Moscinski LC, Seto E, Dalton WS, Wright KL, Sotomayor E, Bhalla K, Tao J. Retraction Notice to: Coordinated Silencing of MYC-Mediated miR-29 by HDAC3 and EZH2 as a Therapeutic Target of Histone Modification in Aggressive B-Cell Lymphomas. Cancer Cell 2023; 41:1198. [PMID: 37311416 DOI: 10.1016/j.ccell.2023.05.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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12
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Collins M, Thomsen A, Gartin A, Sandoval GJ, Adam A, Reilly S, Delestre L, Penard-Lacronique V, Fiskus W, Bhalla K, de Botton S, Agresta S, Piel J, Hentemann M. Abstract 2122: The dual BRM/BRG1 (SMARCA2/4) inhibitor FHD-286 induces differentiation in preclinical models of AML. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2122] [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: 04/07/2023]
Abstract
Abstract
The BRG1/BRM-associated factors (BAF) complex (also known as mSWI/SNF) is a critical regulator of the chromatin landscape of the genome. By controlling chromatin accessibility, BAF regulates lineage-specific transcriptional programs, including those important for AML blast cell growth and survival. FHD-286 is a highly potent inhibitor of the BAF catalytic subunits BRM and BRG1 (SMARCA2/4), which demonstrates strong tumor growth inhibition in several AML CDX and PDX models. FHD-286 is being developed for the treatment of relapsed/refractory AML and MDS (see Foghorn website for current status).Investigation of FHD-286 in a broad panel of AML cell lines showed that BAF inhibition affects hematopoietic transcriptional programs important for blast cell self-renewal and identity, agnostic of mutational background. Similarly, FHD-286 demonstrated broad efficacy in ex vivo treatment of AML patient-derived samples from diverse genetic backgrounds, including those with difficult to treat mutational profiles, including mtNPM1, FLT3 ITD, and Inv(3) with EVI1 overexpression. Interestingly, while higher concentrations (≥90 nM) of FHD-286 predominantly induced cytoreduction, lower concentrations (≤30 nM) predominantly led to differentiation-like responses. To investigate this differentiation effect, we performed immunophenotyping of cell lines and primary AML samples following prolonged treatment with FHD-286. Extended treatment (7+ days) with relevant concentrations (5-20 nM) of FHD-286 led to time- and dose-dependent upregulation of the myeloid differentiation marker CD11b, and acquisition of monocyte/metamyelocyte morphology. CD11b+ cells expressed lower levels of the hematopoietic transcription factor PU.1, as well as proliferation and survival proteins Ki67, Myc and BCL2. Additionally, primary patient samples showed a loss of CD34 positivity in blasts and GMP-like cells after 7 days of ex vivo treatment, indicating a decrease in stemness in these populations. Finally, upregulation of CD11b coincided with decreased BRG1 protein, suggesting that immature blasts are characterized by high levels of BRG1. These results suggest that BAF functions to drive transcriptional programs required to maintain AML cells in an undifferentiated state, and that FHD-286 may inhibit AML cell growth by overcoming this differentiation block. Expanding on these findings, we have also demonstrated synergistic activity with multiple combination partners, including cytarabine and decitabine, in vitro. Elaboration of this in both CDX and PDX in vivo models also shows significant survival benefit in difficult to treat mutational backgrounds. Taken together, these findings suggest that FHD-286 is able to target blast progenitor populations that are heavily BRM/BRG1-dependent, and that combination with standard of care agents can achieve profound, mutationally agnostic antitumor activity in AML.
Citation Format: Mike Collins, Astrid Thomsen, Ashley Gartin, Gabriel J. Sandoval, Ammar Adam, Sarah Reilly, Laure Delestre, Virginie Penard-Lacronique, Warren Fiskus, Kapil Bhalla, Stephane de Botton, Sam Agresta, Jessica Piel, Murphy Hentemann. The dual BRM/BRG1 (SMARCA2/4) inhibitor FHD-286 induces differentiation in preclinical models of AML [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2122.
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13
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Issa GC, Bidikian A, Venugopal S, Konopleva M, DiNardo CD, Kadia TM, Borthakur G, Jabbour E, Pemmaraju N, Yilmaz M, Short NJ, Maiti A, Sasaki K, Masarova L, Pierce S, Takahashi K, Tang G, Loghavi S, Patel K, Andreeff M, Bhalla K, Garcia-Manero G, Ravandi F, Kantarjian H, Daver N. Clinical outcomes associated with NPM1 mutations in patients with relapsed or refractory AML. Blood Adv 2023; 7:933-942. [PMID: 36322818 PMCID: PMC10027507 DOI: 10.1182/bloodadvances.2022008316] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 06/24/2022] [Revised: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Mutations in Nucleophosmin 1 (NPM1) are associated with a favorable prognosis in newly diagnosed acute myeloid leukemia (AML), however, their prognostic impact in relapsed/refractory (R/R) settings are unknown. In a retrospective analysis, we identified 206 patients (12%) with mutated NPM1 (NPM1c) and compared their outcomes to 1516 patients (88%) with NPM1 wild-type (NPM1wt). NPM1c was associated with higher rates of complete remission or complete remission with incomplete count recovery compared with NPM1wt following each line of salvage therapy (first salvage, 56% vs 37%; P < .0001; second salvage, 33% vs 22%; P = .02; third salvage, 24% vs 14%; P = .02). However, NPM1 mutations had no impact on relapse-free survival (RFS) and overall survival (OS) with each salvage therapy with a median OS following salvage 1, 2 or 3 therapies in NPM1c vs NPM1wt of 7.8 vs 6.0; 5.3 vs 4.1; and 3.5 vs 3.6 months, respectively. Notably, the addition of venetoclax to salvage regimens in patients with NPM1c improved RFS and OS (median RFS, 15.8 vs 4.6 months; P = .05; median OS, 14.7 vs 5.9 months; P = .02). In conclusion, NPM1 mutational status has a minimal impact on prognosis in relapsed or refractory AML; therefore, novel treatment strategies are required to improve outcomes in this entity.
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Affiliation(s)
- Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aram Bidikian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sangeetha Venugopal
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abhishek Maiti
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lucia Masarova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keyur Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Venugopal S, DiNardo CD, Loghavi S, Qiao W, Ravandi F, Konopleva M, Kadia T, Bhalla K, Jabbour E, Issa GC, Macaron W, Daver N, Borthakur G, Montalban-Bravo G, Yilmaz M, Patel KP, Kanagal-Shamanna R, Chien K, Maiti A, Kantarjian H, Short NJ. Differential prognostic impact of RUNX1 mutations according to frontline therapy in patients with acute myeloid leukemia. Am J Hematol 2022; 97:1560-1567. [PMID: 36087091 DOI: 10.1002/ajh.26724] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 01/31/2023]
Abstract
RUNX1-mutated (mRUNX1) acute myeloid leukemia (AML) has historically been associated with poor outcomes in the setting of conventional chemotherapy. The prognostic impact of mRUNX1 AML is not well-established in the current era of lower-intensity treatment regimens incorporating venetoclax. We retrospectively analyzed 907 patients with newly diagnosed AML, including 137 patients with mRUNX1 AML, who underwent first-line therapy with intensive chemotherapy (IC), low-intensity therapy without venetoclax (LIT without VEN), or LIT with VEN. When stratified by RUNX1 status, there was no statistically significant difference in outcomes between mRUNX1 and wild-type (wtRUNX1) AML, regardless of therapy received. However, among patients who received LIT with VEN, there was a trend towards superior overall survival (OS) in those with mRUNX1 AML (median OS for mRUNX1 vs. wtRUNX1: 25.1 vs. 11.3 months; 2-year OS 54% vs. 33%; p = 0.12). In patients without another adverse-risk cyto-molecular feature, the presence of mRUNX1 conferred inferior OS in patients who received IC (p = 0.02) or LIT without VEN (p = 0.003) but not in those who received LIT with VEN (mRUNX1 vs. wtRUNX1: 25.1 vs. 30.0 months; 2-year OS 59% vs. 54%; p = 0.86). A multivariate analysis showed possible interaction between RUNX1 mutation status and treatment, suggesting a differential prognostic impact of RUNX1 mutations when patients received IC versus LIT with VEN. In summary, the prognostic impact of mRUNX1 AML may be treatment-dependent, and the presence of RUNX1 mutations may not impact clinical outcomes when venetoclax-based regimens are used.
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Affiliation(s)
- Sangeetha Venugopal
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney D DiNardo
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanam Loghavi
- Departments of Hematopathology, and, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marina Konopleva
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan Kadia
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kapil Bhalla
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elias Jabbour
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ghayas C Issa
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Walid Macaron
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naval Daver
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gautam Borthakur
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Musa Yilmaz
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keyur P Patel
- Departments of Hematopathology, and, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rashmi Kanagal-Shamanna
- Departments of Hematopathology, and, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly Chien
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abhishek Maiti
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop Kantarjian
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas J Short
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Rivera D, Kim K, Kanagal-Shamanna R, Borthakur G, Montalban-Bravo G, Daver N, Dinardo C, Short NJ, Yilmaz M, Pemmaraju N, Takahashi K, Jabbour EJ, Pierce S, Konopleva M, Bhalla K, Garcia-Manero G, Ravandi F, Kantarjian H, Kadia TM. Implications of RAS mutational status in subsets of patients with newly diagnosed acute myeloid leukemia across therapy subtypes. Am J Hematol 2022; 97:1599-1606. [PMID: 36117258 DOI: 10.1002/ajh.26731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Abstract
Activating mutations in RAS have been reported in about 10-15% of patients with AML; previous studies have not identified a prognostic significance. However, RAS mutations have emerged as a potential resistance mechanism to treatment with inhibitors of FLT3, IDH, and BCL2. We aimed to determine the characteristics and outcomes of patients with RAS-mutated (RAS-mut) AML across therapy subsets of 1410 patients newly diagnosed (ND AML). RAS-mut was observed in 273 (20%) patients. Overall, patients with RAS-mut AML had an estimated 3-year survival rate of 38% vs. 28% in those with RAS wild type (RAS-wt), p = .01. Among patients with RAS-mut, favorable karyotype and concomitant NPM1 mutations were associated with a higher CR/CRi rate, OR 23.2 (95% CI: 2.7-192.7; p < .001) and OR 2.8 (95% CI: 1.1-6.9; p = .02), respectively, while secondary and treated secondary (ts)-AML were associated with low response rates, OR 0.34 (95% CI: 0.1-0.9; p = .04) and OR 0.22 (95% CI: 0.09-0.5; p = .001), respectively. Intensive chemotherapy was associated with high response rates OR 5.9 (95% CI: 2.9-12.2; p < .001). Better median OS was observed among those with favorable karyotype, HR 0.28 (95% CI: 0.1-0.6; p = .002), and those treated with intensive chemotherapy, HR 0.42 (95% CI: 0.2-0.6 p < .001). Conversely, ts- AML and co-occurrence of mutations in TP53 were associated with poor median OS; HR 2.3 (95% CI: 1.4-3.9; p = .001) and HR 1.7 (95% CI: 0.9-3.1; p = .06), respectively. The addition of venetoclax was associated with a non-significant improvement in CR/CRi and OS.
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Affiliation(s)
- Daniel Rivera
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kunhwa Kim
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney Dinardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mehra S, Gupta A, Bhalla K, Nanda S. Recurrent heart failure in a child with underlying dilated cardiomyopathy associated with celiac disease: An unusual presentation. J Family Med Prim Care 2022; 11:5689-5691. [PMID: 36505521 PMCID: PMC9730954 DOI: 10.4103/jfmpc.jfmpc_2499_21] [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: 12/30/2021] [Revised: 02/21/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
Many previous studies have shown that certain cardiovascular conditions (including myocarditis, arrhythmias, and cardiomyopathy) are more prevalent in individuals with celiac disease compared to individuals without the disease. Association of celiac disease with dilated cardiomyopathy (DCMP) is a rare occurrence and a few cases have been reported and even fewer in children. Here, we report an interesting case of a 10-year-old male child who presented to the pediatric emergency in a life-threatening condition with congestive cardiac failure manifested by dyspnea, hepatomegaly, pedal edema, and raised JVP with underlying severe anemia. The diagnosis of DCMP associated with celiac disease was made. The child was advised for strict gluten-free diet and hematinics, and ivabradine was started for managing DCMP. Early diagnosis with screening tests may prevent serious complications and also are essential to prevent progression of the disease.
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Affiliation(s)
- Shuchi Mehra
- Department of Microbiology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Anesthesiology, Paras Hospital, Gurugram, Haryana, India
| | - Kapil Bhalla
- Department of Pediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana,, India,Address for correspondence: Dr. Kapil Bhalla, Department of Pediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India. E-mail:
| | - Sanjiv Nanda
- Department of Pediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana,, India
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Kim K, Bazinet A, Loghavi S, Konopleva M, Bhalla K, Daver N, Khoury JD, Kadia T, Wilson NR, Curry JL, Heberton M, Miller D, Pierce S, Borthakur G, Pemmaraju N. Major Clinical Response in a Patient with Leukemia Cutis Treated with the Bromodomain Inhibitor PLX51107 and Azacitidine. Leuk Res 2022; 119:106884. [DOI: 10.1016/j.leukres.2022.106884] [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] [Received: 02/18/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
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Khanna A, Banoth B, Verma A, Bhalla K, Holla S, Yadav S. Comparative effectiveness of oral dexamethasone vs. oral prednisolone for acute exacerbation of asthma: A randomized control trial. J Family Med Prim Care 2022; 11:1395-1400. [PMID: 35516722 PMCID: PMC9067196 DOI: 10.4103/jfmpc.jfmpc_1210_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/12/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute exacerbation of asthma is a common condition leading to emergency visits. Prednisolone is a commonly prescribed drug in the standard management of acute exacerbation of asthma along with other drugs. This study was planned to see the efficacy of oral dexamethasone when compared with oral prednisolone in the management of acute exacerbation of asthma. Methods: A single-center pilot study in the form of randomized control trial was done by recruiting children aged 2–14 years diagnosed with acute asthma exacerbation with mild to moderate severity. A total of 88 patients received oral dexamethasone (0.3 mg/kg) in two doses 24 h apart, which was compared with 87 patients who received oral prednisolone (1 mg/kg) in two divided doses 12 h apart for 5 days. The patients were assessed at the time of admission (zero hour), at 4th hour, and on the 5th day by various parameters such as respiratory rate, use of accessory muscles, Pediatric Respiratory Assessment Measure (PRAM) score, peak expiratory flow rate (PEFR), 6-h admission stay, and rate of hospital admission. Results: Baseline demographic profile, clinical characteristics, comorbidities, indoor pollution, and use of Metered Dose Inhaler (MDI) among the two study groups were comparable. Six-hour emergency stay and rate of admission were significantly lower in the dexamethasone group (P < 0.05). Improvement in PRAM score, PEFR, use of accessory muscles, and respiratory rate was also better in dexamethasone group at the 4th hour and 5th day (P < 0.05). In addition, oral dexamethasone was shown to have less incidence of vomiting/gastritis than prednisolone (P < 0.05). Conclusion: Oral dexamethasone can be considered a reliable and better option as compared with prednisolone due to its faster action and minimal side effects.
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Zutshi S, Gwasikoti N, Bhalla K, Dalal P. Thrombocytopenia in an Apparently Healthy Neonate: An Unusual Report of Postnatally Acquired Dengue Infection. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/48158.15966] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dengue is one of the commonest viral infections affecting general population in endemic zones every year. However, dengue is usually not reported in newborn period as it is widely believed that infants are protected from serious viral infections in the first 6 months of life by presence of maternal antibodies. Here, a unique case of an apparently healthy newborn with dengue fever is reported where transmission of the infection occurred postnatally. A 10-day-old male child, born to a primigravida mother with normal antenatal history, presented with complaints of fever for four days along with full body macular rash. Examination findings revealed red coloured, pin-point macular rash while rest of general and systemic examination were unremarkable. Routine Sepsis work-up was negative except presence of thrombocytopenia. Keeping in mind the endemicity and season of dengue, NS1 antigen of the baby was tested by a rapid antigen test which was positive, which was further confirmed by IgM ELISA for dengue. However, the mother was asymptomatic and platelet count as well as NS1 antigen and IgM, IgG ELISA for dengue of the mother was negative.
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20
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Verma R, Kumar G, Yadav RK, Chayal V, Kalhan M, Bhalla K, Dhaka R, Agrawal G, Sachdeva A, Satija J, Pankaj, Sagar V. Association of psychosocial factors with aggression among school going rural adolescents in Haryana. J Family Med Prim Care 2021; 10:3720-3724. [PMID: 34934671 PMCID: PMC8653475 DOI: 10.4103/jfmpc.jfmpc_447_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Adolescents are being involved in aggressive activities nowadays. Sometimes, involvement in aggressive activities may be fatal for the victim as well as for the doer. It is a matter of great concern for all including parents, teachers, psychologists, social reformers, and others. A momentary expression of anger sometimes may spoil the future life of the adolescents. Aim and Objectives: To determine the prevalence of aggression and to identify the psychosocial risk factors associated with aggression among school-going adolescents. Methodology: The study recruited 480 school-going rural adolescents from eight government senior secondary schools in the rural block of Beri, district Jhajjar (Haryana). Observations: The mean age of the adolescents was 14.11 ± 1.12 years; 49.4% of the adolescents were found to be aggressive. After applying binary logistic regression, there was a statistically significant relation between aggression and determinants like class, gender, occupation of the father. Conclusion and Recommendations: The study concluded that determinants like age, class of students, gender of the subject, occupation of father found a significant association with aggression. To solve this current situation, parents must give love, attention to their children and must act in an appropriate way in front of them and be role models.
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Affiliation(s)
- Ramesh Verma
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Gopal Kumar
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | | | - Vinod Chayal
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Meenakshi Kalhan
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Pediatrics, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Rohit Dhaka
- Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ginni Agrawal
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Aman Sachdeva
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Jitesh Satija
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Pankaj
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Vidya Sagar
- Department of Community Medicine, Pt B D Sharma PGIMS, Rohtak, Haryana, India
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21
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Gwasikoti N, Bhalla K, Kaushik JS, Ghalaut VS, Kundu ZS. Vitamin D, Bone Mineral Density and Serum IGF-1 Level in Non-ambulatory Children With Cerebral Palsy. Indian Pediatr 2021; 58:836-838. [PMID: 33864451] [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: 06/12/2023]
Abstract
OBJECTIVES To compare serum 25-hydroxy vitamin D (25-OHD) status, bone mineral density and Insulin-like growth factor (IGF-1) level among children with cerebral palsy (CP) aged 1 to 8 years with age- and gender-matched controls. METHODS A cross-sectional study enrolled 30 children in each group: CP with epilepsy, CP without epilepsy, and healthy controls. Bone mineral density (BMD), serum 25-OHD levels, and serum insulin like growth factor (IGF)-1 levels were measured. RESULTS z-scores of BMD [-1.80 (1.03), -2.12 (0.85) vs -1.40 (0.90); P<0.01], 25-OHD levels [19.26 (8.28), 20.59 (8.92) Vs 26.79 (12.76) ng/mL; P<0.01] and IGF-1 levels [20.90 (6.42), 23.37 (8.11) vs 31.77 (11.21) ng/mL; P<0.01] were significantly low among children with CP with epilepsy, CP without epilepsy when compared to controls. CONCLUSIONS Children with CP with or without comorbid epilepsy were prone to vitamin D deficiency, low bone mineral density and growth hormone axis suppression with low IGF-1 levels.
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Affiliation(s)
| | - Kapil Bhalla
- Department of Pediatrics, Pt. BD Sharma PGIMS, Rohtak, Haryana. Correspondence to: Dr Kapil Bhalla, Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124 001, Haryana.
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22
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Morita K, Wang F, Jahn K, Hu T, Tanaka T, Sasaki Y, Kuipers J, Loghavi S, Wang SA, Yan Y, Furudate K, Matthews J, Little L, Gumbs C, Zhang J, Song X, Thompson E, Patel KP, Bueso-Ramos CE, DiNardo CD, Ravandi F, Jabbour E, Andreeff M, Cortes J, Bhalla K, Garcia-Manero G, Kantarjian H, Konopleva M, Nakada D, Navin N, Beerenwinkel N, Futreal PA, Takahashi K. Author Correction: Clonal evolution of acute myeloid leukemia revealed by high-throughput single-cell genomics. Nat Commun 2021; 12:2823. [PMID: 33972555 PMCID: PMC8110810 DOI: 10.1038/s41467-021-23280-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kiyomi Morita
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Feng Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katharina Jahn
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland. .,SIB Swiss Institute of Bioinformatics, Basel, Switzerland.
| | - Tianyuan Hu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tomoyuki Tanaka
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuya Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Kuipers
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuanqing Yan
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ken Furudate
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Jairo Matthews
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Latasha Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Thompson
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daisuke Nakada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas Navin
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland. .,SIB Swiss Institute of Bioinformatics, Basel, Switzerland.
| | - P Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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23
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Sharma S, Bhalla K, Dayal S. Athena: Speciality Certificate Examination case for Paediatrics and Genetics. Clin Exp Dermatol 2021; 47:1595-1596. [PMID: 33904204 DOI: 10.1111/ced.14707] [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] [Received: 03/21/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S Sharma
- Departments of, Dermatology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - K Bhalla
- Departments of, Paediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - S Dayal
- Departments of, Dermatology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
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24
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Ma MCJ, Tadros S, Bouska A, Heavican T, Yang H, Deng Q, Moore D, Akhter A, Hartert K, Jain N, Showell J, Ghosh S, Street L, Davidson M, Carey C, Tobin J, Perumal D, Vose JM, Lunning MA, Sohani AR, Chen BJ, Buckley S, Nastoupil LJ, Davis RE, Westin JR, Fowler NH, Parekh S, Gandhi M, Neelapu S, Stewart D, Bhalla K, Iqbal J, Greiner T, Rodig SJ, Mansoor A, Green MR. Subtype-specific and co-occurring genetic alterations in B-cell non-Hodgkin lymphoma. Haematologica 2021; 107:690-701. [PMID: 33792219 PMCID: PMC8883549 DOI: 10.3324/haematol.2020.274258] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
B-cell non-Hodgkin's lymphoma (B-NHL) encompasses multiple clinically and phenotypically distinct subtypes of malignancy with unique molecular etiologies. Common subtypes of B-NHL such as diffuse large B-cell lymphoma (DLBCL) have been comprehensively interrogated at the genomic level. But rarer subtypes such as mantle cell lymphoma (MCL) remain sparsely characterized. Furthermore, multiple B-NHL subtypes have thus far not been comprehensively compared using the same methodology to identify conserved or subtype-specific patterns of genomic alterations. Here, we employed a large targeted hybrid-capture sequencing approach encompassing 380 genes to interrogate the genomic landscapes of 685 B-NHL tumors at high depth; including DLBCL, MCL, follicular lymphoma (FL), and Burkitt lymphoma (BL). We identified conserved hallmarks of B-NHL that were deregulated in the majority of tumor from each subtype, including the frequent genetic deregulation of the ubiquitin proteasome system (UPS). In addition, we identified subtype-specific patterns of genetic alterations, including clusters of co-occurring mutations and DNA copy number alterations. The cumulative burden of mutations within a single cluster were more discriminatory of B-NHL subtypes than individual mutations, implicating likely patterns of genetic cooperation that contribute to disease etiology. We therefore provide the first cross-sectional analysis of mutations and DNA copy number alterations across major B-NHL subtypes and a framework of co-occurring genetic alterations that deregulate genetic hallmarks and likely cooperate in lymphomagenesis.
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Affiliation(s)
- Man Chun John Ma
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Saber Tadros
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alyssa Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Tayla Heavican
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Haopeng Yang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qing Deng
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dalia Moore
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Ariz Akhter
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB
| | - Keenan Hartert
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Neeraj Jain
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jordan Showell
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sreejoyee Ghosh
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lesley Street
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Marta Davidson
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Christopher Carey
- Northern Institute for Research, Newcastle University, Newcastle upon Tyne, England
| | - Joshua Tobin
- Diamantina Institute, University of Queensland, QLD
| | - Deepak Perumal
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie M Vose
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Matthew A Lunning
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Benjamin J Chen
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Shannon Buckley
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE
| | - Loretta J Nastoupil
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Eric Davis
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R Westin
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan H Fowler
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maher Gandhi
- Diamantina Institute, University of Queensland, QLD
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Douglas Stewart
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Kapil Bhalla
- Department of Pathology, Brigham and Womens Hospital, Boston, MA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Scott J Rodig
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adnan Mansoor
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Michael R Green
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX.
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25
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Mehra S, Bhalla K, Dalal P, Gupta A, Nehra D. Coexistence of disseminated tuberculosis and peripheral deep vein thrombosis in a child with newly diagnosed celiac disease: A rare entity. J Family Med Prim Care 2021; 9:6288-6290. [PMID: 33681081 PMCID: PMC7928094 DOI: 10.4103/jfmpc.jfmpc_1216_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Some case reports have been published suggesting association of celiac disease (CD) with tuberculosis (TB) and with deep vein thrombosis (DVT) but mostly in adult populations and in different patients. We report a 13-year-old girl recently diagnosed with CD presented to pediatric emergency at a tertiary teaching hospital in north India with complaints of generalized weakness, pain and swelling over left lower limb that subsequently was diagnosed to have disseminated TB and left lower limb DVT. She was treated with course of anti-tubercular drugs, short-term anticoagulant therapy, and gluten free diet with positive outcomes over next 3 months. To the best of authors’ knowledge, no previous reports have yet suggested a coexistence of disseminated TB and peripheral deep vein thrombosis and CD in one single pediatric patient.
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Affiliation(s)
- Shuchi Mehra
- Department of Microbiology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Paediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Poonam Dalal
- Department of Paediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Cardiology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Deepak Nehra
- Department of Pharmacology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
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26
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Bannon SA, Routbort MJ, Montalban-Bravo G, Mehta RS, Jelloul FZ, Takahashi K, Daver N, Oran B, Pemmaraju N, Borthakur G, Naqvi K, Issa G, Sasaki K, Alvarado Y, Kadia TM, Konopleva M, Shamanna RK, Khoury JD, Ravandi F, Champlin R, Kantarjian HM, Bhalla K, Garcia-Manero G, Patel KP, DiNardo CD. Next-Generation Sequencing of DDX41 in Myeloid Neoplasms Leads to Increased Detection of Germline Alterations. Front Oncol 2021; 10:582213. [PMID: 33585199 PMCID: PMC7878971 DOI: 10.3389/fonc.2020.582213] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Previously considered rare, inherited hematologic malignancies are increasingly identified. Germline mutations in the RNA helicase DDX41 predispose to increased lifetime risks of myeloid neoplasms with disease often occurring later in life which presents challenges for germline recognition. To improve identification of germline DDX41, individuals presenting with ≥1 DDX41 alteration on an institutional MDS/AML next-generation sequencing based panel with at least one at >40% variant allele frequency were flagged for review and genetic counseling referral. Of 5,801 individuals, 90 (1.5%) had ≥1 DDX41 mutation(s) identified. Thirty-eight (42%) patients with a median age of 66 years were referred for genetic counseling; thirty-one were male (81.5%). Thirty-five (92%) referred patients elected to pursue germline evaluation and in 33/35 (94%) a germline DDX41 variant was confirmed. Twenty-two patients (66%) with germline variants reported antecedent cytopenias, seven (21%) had a prior history of malignancy, and twenty-seven (82%) reported a family history of cancer. Predictive genetic testing for healthy family members under consideration as stem cell transplant donors was successfully performed in 11 family members, taking an average of 15 days. Near-heterozygous DDX41 mutations identified on next-generation sequencing, particularly nonsense/frameshift variants or those at recurrent germline “hot spots” are highly suggestive of a germline mutation. Next-generation sequencing screening is a feasible tool to screen unselected myeloid neoplasms for germline DDX41 mutations, enabling timely and appropriate care.
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Affiliation(s)
- Sarah A Bannon
- Department of Clinical Cancer Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Guillermo Montalban-Bravo
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Rohtesh S Mehta
- Department of Stem Cell Transplantation, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Fatima Zahra Jelloul
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Naval Daver
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Betul Oran
- Department of Stem Cell Transplantation, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Kiran Naqvi
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Ghayas Issa
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Koji Sasaki
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Yesid Alvarado
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Marina Konopleva
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Rashmi Kanagal Shamanna
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Richard Champlin
- Department of Stem Cell Transplantation, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
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27
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Morita K, Wang F, Jahn K, Hu T, Tanaka T, Sasaki Y, Kuipers J, Loghavi S, Wang SA, Yan Y, Furudate K, Matthews J, Little L, Gumbs C, Zhang J, Song X, Thompson E, Patel KP, Bueso-Ramos CE, DiNardo CD, Ravandi F, Jabbour E, Andreeff M, Cortes J, Bhalla K, Garcia-Manero G, Kantarjian H, Konopleva M, Nakada D, Navin N, Beerenwinkel N, Futreal PA, Takahashi K. Publisher Correction: Clonal evolution of acute myeloid leukemia revealed by high-throughput single-cell genomics. Nat Commun 2020; 11:5996. [PMID: 33214561 PMCID: PMC7677309 DOI: 10.1038/s41467-020-19902-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A Correction to this paper has been published: https://doi.org/10.1038/s41467-020-19902-7.
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Affiliation(s)
- Kiyomi Morita
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Feng Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katharina Jahn
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Tianyuan Hu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tomoyuki Tanaka
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuya Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Kuipers
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuanqing Yan
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ken Furudate
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Jairo Matthews
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Latasha Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Thompson
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daisuke Nakada
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Nicholas Navin
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland. .,SIB Swiss Institute of Bioinformatics, Basel, Switzerland.
| | - P Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Bhalla K, Verma A, Nanda S. Effect of inadvertent steroid use during COVID-19 lockdown in chronic illnesses in children. Trop Doct 2020; 51:127-128. [PMID: 33167800 DOI: 10.1177/0049475520969507] [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: 11/16/2022]
Affiliation(s)
- Kapil Bhalla
- Associate Professor, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
| | - Anjali Verma
- Assistant Professor, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Senior Professor, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
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Lachowiez C, Bannon S, Loghavi S, Wang F, Kanagal‐Shamanna R, Mehta R, Daver N, Borthakur G, Pemmaraju N, Ravandi F, Patel KP, Garcia‐Manero G, Takahashi K, Kantarjian H, Bhalla K, DiNardo CD. Clonal evolution and treatment outcomes in hematopoietic neoplasms arising in patients with germline RUNX1 mutations. Am J Hematol 2020; 95:E313-E315. [PMID: 32804409 DOI: 10.1002/ajh.25965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Curtis Lachowiez
- Division of Cancer Medicine University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Sarah Bannon
- Clinical Cancer Genetics Program University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Sanam Loghavi
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Feng Wang
- Department of Genomic Medicine University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Keyur P. Patel
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | | | - Koichi Takahashi
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Kapil Bhalla
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
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Dhaka R, Verma R, Parmar A, Chayal V, Kalhan M, Bhalla K, Chawla S, Agrawal G, Kumar G, Sachdeva A. Association between the socioeconomic determinants and soil-transmitted helminthiasis among school-going children in a rural area of Haryana. J Family Med Prim Care 2020; 9:3712-3715. [PMID: 33102355 PMCID: PMC7567293 DOI: 10.4103/jfmpc.jfmpc_383_20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 11/05/2022] Open
Abstract
Background: WHO indicates that India has the highest burden of soil-transmitted helminthiasis (STH) in the world, contributing to 25% of the total global cases, with 220 million children aged 1–14 estimated to be at risk. Aim and Objective: To study the association between the socioeconomic factors and STHs among primary school children in a rural area of Haryana. Methodology: The study was conducted among children aged 6–10 years studying in the rural government primary schools in the rural areas of Haryana. A total of 300 children were enrolled from government school. Results: The study found that the prevalence of helminthiasis was 28.7% (86/300) and of these 14.0% children were infected with Ascaris lumbricoides and sex wise association with Helminthic infection was observed as statistically nonsignificant. One third of the (31.39%; 27/86) children were pallor and 5.81% subjects were having Bitot's spot while 13.95% children were having constitutional symptoms such as weakness, 6.97% subjects have fatigue, and 5.81% children have body ache. Discussion: The morbidity can be reduced with appropriate inputs to improve the environmental factors. This may need investment for sanitary latrines, food hygiene, and safe drinking water, anti-helminthic drugs, and health education. Conclusion and Recommendations: The results of the study concluded and recommended that proper implementation of national deworming day and other long-term strategies like sanitation, clean drinking water, adequate sanitation, and also improvement in nutritional status through various nutritional health programmes.
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Affiliation(s)
- Rohit Dhaka
- Department of Community Medicine, ESIC Medical College and Hospital Faridabad, Nalhar, Nuh, India
| | - Ramesh Verma
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Aparna Parmar
- Microbiology, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Vinod Chayal
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Meenakshi Kalhan
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Kapil Bhalla
- Department of Pediatrics, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Suraj Chawla
- Department of Community Medicine, SHKM Government Medical College, Nalhar, Nuh, India
| | - Ginni Agrawal
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Gopal Kumar
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
| | - Aman Sachdeva
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Nalhar, Nuh, India
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31
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Jain N, Hartert K, Tadros S, Fiskus W, Havranek O, Ma MCJ, Bouska A, Heavican T, Kumar D, Deng Q, Moore D, Pak C, Liu CL, Gentles AJ, Hartmann E, Kridel R, Smedby KE, Juliusson G, Rosenquist R, Gascoyne RD, Rosenwald A, Giancotti F, Neelapu SS, Westin J, Vose JM, Lunning MA, Greiner T, Rodig S, Iqbal J, Alizadeh AA, Davis RE, Bhalla K, Green MR. Targetable genetic alterations of TCF4 ( E2-2) drive immunoglobulin expression in diffuse large B cell lymphoma. Sci Transl Med 2020; 11:11/497/eaav5599. [PMID: 31217338 DOI: 10.1126/scitranslmed.aav5599] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/31/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Abstract
The activated B cell (ABC-like) subtype of diffuse large B cell lymphoma (DLBCL) is characterized by chronic activation of signaling initiated by immunoglobulin μ (IgM). By analyzing the DNA copy number profiles of 1000 DLBCL tumors, we identified gains of 18q21.2 as the most frequent genetic alteration in ABC-like DLBCL. Using integrative analysis of matched gene expression profiling data, we found that the TCF4 (E2-2) transcription factor gene was the target of these alterations. Overexpression of TCF4 in ABC-like DLBCL cell lines led to its occupancy on immunoglobulin (IGHM) and MYC gene enhancers and increased expression of these genes at the transcript and protein levels. Inhibition of TCF4 activity with dominant-negative constructs was synthetically lethal to ABC-like DLBCL cell lines harboring TCF4 DNA copy gains, highlighting these gains as an attractive potential therapeutic target. Furthermore, the TCF4 gene was one of the top BRD4-regulated genes in DLBCL cell lines. BET proteolysis-targeting chimera (PROTAC) ARV771 extinguished TCF4, MYC, and IgM expression and killed ABC-like DLBCL cells in vitro. In DLBCL xenograft models, ARV771 treatment reduced tumor growth and prolonged survival. This work highlights a genetic mechanism for promoting immunoglobulin signaling in ABC-like DLBCL and provides a functional rationale for the use of BET inhibitors in this disease.
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Affiliation(s)
- Neeraj Jain
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Keenan Hartert
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Saber Tadros
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Warren Fiskus
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ondrej Havranek
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Man Chun John Ma
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alyssa Bouska
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tayla Heavican
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Dhiraj Kumar
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qing Deng
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dalia Moore
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Christine Pak
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Andrew J Gentles
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Elena Hartmann
- Institute of Pathology, University of Würzburg, Würzburg 97080, Germany.,Comprehensive Cancer Center Mainfranken, Wurzburg 97080, Germany
| | - Robert Kridel
- Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Karin Ekstrom Smedby
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm SE-171 76, Sweden
| | - Gunnar Juliusson
- Department of Laboratory Medicine, Stem Cell Center, Lund University, Lund SE-221 00, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Universitetssjukhuset, Stockholm SE-171 76, Sweden
| | - Randy D Gascoyne
- Center for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg 97080, Germany.,Comprehensive Cancer Center Mainfranken, Wurzburg 97080, Germany
| | - Filippo Giancotti
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jason Westin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Julie M Vose
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Matthew A Lunning
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Timothy Greiner
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Javeed Iqbal
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - R Eric Davis
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kapil Bhalla
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael R Green
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. .,Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Aim To determine the significance of acute disulfiram poisoning in pediatric population. Background Disulfiram poisoning in children is uncommon, can occur in children who have ingested large amount of drug because of careless and unsafe storage. Only few cases have been reported in literature. Although well tolerated by most patients, severe toxic side effects have been also reported including hepatitis, encephalopathy, psychosis, optic, and peripheral neuropathy. Case description This is a case report of disulfiram toxicity in a 4.5-year girl who ingested 4–5 tablets of disulfiram (approximately 1–1.25 g) accidentally and presented with hypoglycemia and encephalopathy. After initial stabilization in emergency room, the child was shifted to intensive care unit (ICU) where the child was managed conservatively. Blood sugars normalized after 8 hours of admission. Magnetic resonance imaging (MRI) brain showed bilateral globus pallidus hyperintensity in T2-weighted (T2W) and diffusion-weighted (DW) images and hypointensity in T1-weighted (T1W) images including diffusion restriction. Conclusion Acute disulfiram poisoning can occur in children who have ingested large amount of drug because of unsafe storage. It can lead to hepatitis, encephalopathy, psychosis, optic, and peripheral neuropathy. Mainstay of treatment is supportive care, airway protection, oxygen, and dextrose-containing intravenous fluid should be given. Clinical significance Acute disulfiram poisoning should be an important differential in diagnosis of any child presenting with idiopathic encephalopathy along with extrapyramidal symptoms with basal ganglia signal changes in MRI of brain in a previously healthy child. How to cite this article Bhalla K, Mittal K, Gupta A, Nehra D. Acute Disulfiram Poisoning in a Child: A Case Report and Review of Literature. Indian J Crit Care Med 2020;24(3):203–205.
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Affiliation(s)
- Kapil Bhalla
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kundan Mittal
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Cardiology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
- Ashish Gupta, Department of Cardiology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, Phone: +91-0124-4010624, e-mail:
| | - Deepak Nehra
- Department of Pharmacology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Abou Dalle I, Kantarjian H, Bannon SA, Kanagal‐Shamanna R, Routbort M, Patel KP, Hu S, Bhalla K, Garcia‐Manero G, DiNardo CD. Successful lenalidomide treatment in high risk myelodysplastic syndrome with germline DDX41 mutation. Am J Hematol 2020; 95:227-229. [PMID: 31400013 DOI: 10.1002/ajh.25610] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Iman Abou Dalle
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sarah A. Bannon
- Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Rashmi Kanagal‐Shamanna
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Mark Routbort
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur P. Patel
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Shimin Hu
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Kapil Bhalla
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Courtney D. DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
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Gupta A, Bhalla K, Dalal P, Mehra S, Bhanot B. Tuberculosis presenting as septic shock in immunocompetent child: An unusual presentation. J Family Med Prim Care 2020; 9:5766-5768. [PMID: 33532429 PMCID: PMC7842424 DOI: 10.4103/jfmpc.jfmpc_1226_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022] Open
Abstract
As per latest Global TB Report (2018), an estimated 2.2 lakh children get tuberculosis (TB) each year in India and illness constitutes a very high global burden. Here we report an unusual case of a child aged 14 years (female), who presented to Emergency with complaints of cough and restlessness for the past 1 day. Working diagnosis of septic shock was kept and child was started on intravenous ionotropes, vasopressors, and an antibiotic. There was no significant history suggestive of TB. Patient was shifted to PICU and managed for shock accordingly. X-ray lung showed single right-sided cavitatory lesion. Bronchoalveolar lavage was positive for acid fast bacilli, confirming the diagnosis of pulmonary TB. The patient was started on antitubercular drug regimen (ATT) for 6 months and showed significant improvement with complete resolution. Literature was searched for association of septic shock in tubercular patients as a presenting complaint, which is a rare entity.
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Jindal P, Bhalla K, Neha ., Nanda S. Henoch Schonlein Purpura as Late Manifestation of Hepatitis A Infection. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/44327.13898] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An uncommon presentation of Hepatitis A Virus (HAV) Infection is cutaneous vasculitis. This report is about a seven-year-old male patient that came to the pediatric emergency with complaints of bilateral swelling of lower limbs and pain in right knee for the last three days. Patient had history of jaundice one month back. On examination, he was febrile and had swelling over right knee with decreased range of movements and multiple palpable purpura over lower extremities and buttocks. Laboratory evaluation showed deranged Liver Function Test (LFT) and positive HAV IgM antibodies. Histopathological examination of skin biopsy was suggestive of leukocytoclastic vasculitis and IgA deposition. Final diagnosis of Henoch Schonlein Purpura (HSP) was established based on clinical findings and skin biopsy findings which are usually sufficient for confirmed diagnosis. Patient was admitted and managed conservatively with oral analgesics. After a few days, patient was discharged in satisfactory condition.
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Gupta A, Bhalla K, Mangla J, Nanda S, Nehra D. Hemoglobinopathy E in 4 siblings of a North Indian family: A hidden malaise of social problem. J Family Med Prim Care 2020; 9:3160-3161. [PMID: 32984192 PMCID: PMC7491792 DOI: 10.4103/jfmpc.jfmpc_135_20] [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: 01/21/2020] [Revised: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 12/03/2022] Open
Abstract
The preference for male child and neglect of girl child for long has resulted in a hazardously poor sex ratio, but bride buying seems to be no solution for it as it has its own inherent consequences on society and public health. This article tries to look at a relationship between a state's poorly kept secret like bride buying and its unseen complications. Here, we report a family of six members, where all 4 children have hemoglobin E disease a relatively rare entity seen in this part of the country. Hemoglobin E (β26 Glu → Lys) is usually seen in northeastern parts of India. This case report has tried to highlight a relatively rare disease afflicting all children of the family due to gene mutations which are rarely seen in Haryana/Punjab.
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Gupta A, Bhalla K, Verma N, Nanda S, Mehra S. Idiopathic autoimmune hemolytic anemia along with concomitant vitamin B12 deficiency in an adolescent girl: A rare occurrence. J Family Med Prim Care 2020; 9:3756-3758. [PMID: 33102365 PMCID: PMC7567204 DOI: 10.4103/jfmpc.jfmpc_401_20] [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: 03/17/2020] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Vitamin B12 deficiency is seen in countries like India mainly because of predominantly vegetarian diet and is a significant health problem. Patients present with various neurological and hematological manifestations of megaloblastic anemia. In this case report, we present a 14-year-old girl child having a history of past blood transfusions and iron deficiency anemia currently presenting with severe anemia due to idiopathic autoimmune hemolytic anemia (AIHA) and later found to have concomitant vitamin B12 deficiency. On investigating, she had vitamin B12 deficiency, raised homocysteine and methylmalonic acid levels, positive Direct Coombs Test (DCT), and negative glucose-6-phoshphatase deficiency and osmotic fragility tests. Thyroid profile and tissue transglutaminase IgA (tTg-IgA) tests were negative. Antinuclear antibodies (ANA) and anti-double stranded DNA antibody (anti-dsDNA) serum immunoglobulin were also normal. Bone marrow showed megaloblastic anemia picture. Although AIHA and vitamin B12 deficiency anemia are not common, clinicians should have a high index of suspicion when patients present with hemolytic picture and severe megaloblastic anemia.
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Dangi S, Gwasikoti N, Bhalla K, Dalal P. Medullary Sponge Kidney in a Paediatric Patient: A Rare Case Report. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/43354.13614] [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: 11/24/2022]
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Babbar N, Bhalla K, Nanda S, Mehra S. Inadvertent Use of Oral Corticosteroids Leading to Iatrogenic Cushing Syndrome in an Infant with Down Syndrome. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/43588.13692] [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: 11/24/2022]
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40
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Bhalla K, Bhardwaj P, Gupta A, Mehra S, Nehra D, Nanda S. Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice. J Family Med Prim Care 2019; 8:3130-3135. [PMID: 31742131 PMCID: PMC6857377 DOI: 10.4103/jfmpc.jfmpc_495_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/24/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 01/02/2023] Open
Abstract
Background and Aims: Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use. Settings and Design: This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital. Methods: All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study. Statistical Analysis Used: Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied. Results: Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years’ age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house. Conclusions: The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.
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Affiliation(s)
- Kapil Bhalla
- Department of Pediatrics, Pt BD Sharma PGIMS, Shimla, Himachal Pradesh, India
| | - Parveen Bhardwaj
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Ashish Gupta
- House Surgeon, Department of Trauma Centre, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Deepak Nehra
- Department of Pharmacology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Pediatrics, Pt BD Sharma PGIMS, Shimla, Himachal Pradesh, India
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Dhaka R, Verma R, Kumar R, Chayal V, Bhalla K, Singh R, Agrawal G, Kumar G. Pattern and determinants of soil-transmitted helminthiasis in a rural area of Haryana: A school-based study. J Family Med Prim Care 2019; 8:1971-1975. [PMID: 31334164 PMCID: PMC6618185 DOI: 10.4103/jfmpc.jfmpc_278_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: In the world, helminthiasis is the major public health problem in school-age children. More than 60 million school-age children live in intensively transmitted areas and they need immediate treatment and preventive interventions. Methodology: The study was conducted in the rural government schools of Block Beri, District Jhajjar (Haryana), India, and the study was descriptive and cross-sectional in design. The study recruited 300 school-going children in the age group of 6–10 years. Results: In this study, the mean age of subjects was 7.68 ± 1.467 years and prevalence of soil-transmitted helminths was 28.7%. The association between practice of hand washing and practice of washing fruits and vegetables with helminthic children were found statistically significant. Conclusion and Recommendation: Impart health education among community through primary care physician about wash hands before eating food and after defecation, washed thoroughly raw and uncooked food before eating.
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Affiliation(s)
- Rohit Dhaka
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Raj Kumar
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Vinod Chayal
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Pediatric, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Ranvir Singh
- Medical Officer, Director General Health Services, Haryana, Jhajjar, India
| | - Ginni Agrawal
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Gopal Kumar
- Department of Community Medicine, Pt BD Sharma PGIMS, Rohtak, Haryana, India
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Nimmanapalli R, Porosnicu M, Nguyen D, Worthington E, O'Bryan E, Perkins C, Bhalla K. Editor's Note: Cotreatment with STI-571 Enhances Tumor Necrosis Factor α-related Apoptosis-inducing Ligand (TRAIL or Apo-2L)-induced Apoptosis of Bcr-Abl-positive Human Acute Leukemia Cells. Clin Cancer Res 2019; 25:4195. [PMID: 31263034 DOI: 10.1158/1078-0432.ccr-19-1602] [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: 11/16/2022]
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Verma R, Bhalla K, Dhankar M, Kumar R, Dhaka R, Agrawal G. Practices and knowledge regarding dengue infection among the rural community of Haryana. J Family Med Prim Care 2019; 8:1752-1754. [PMID: 31198749 PMCID: PMC6559082 DOI: 10.4103/jfmpc.jfmpc_6_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The dengue infection has become a major global public health problem and 40% of the world's population living in an area at risk for dengue and causing nearly 400 million infections every year. There is no specific treatment for dengue, but if there is proper case management then case fatality rates can be below 1%. Aim and Objectives: To study the knowledge and practice about dengue fever in a rural community of Haryana. Methodology: The study recruited 400 adults (15-60 years) and all subjects were selected randomly from survey registers of eight anganwadi centres and data was collected by visiting house to house. Results: The association between demographic variables and knowledge about dengue fever and found out that only caste wise and socio-economic wise were found to be statistically significant rest associations were found to be statistically non-significant. Conclusion and Recommendations: There is a need of hour to make rural people aware of symptoms of DF and different preventive methods through mass media like television, newspapers, internet, social media etc or audio visual aids or through primary care physician
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Affiliation(s)
| | | | | | - Raj Kumar
- Pt B D Sharma PGIMS, Rohtak, Haryana, India
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Abstract
Context: Acute glomerulonephritis (AGN) is a major cause of morbidity in developing countries like India. AGN includes both infectious and non infectious causes leading to immunological insult to the kidney. Aims: This study is an attempt to evaluate the clinical characteristics, complications and outcome of acute glomerulonephritis. Settings and Design: This hospital based descriptive study was conducted at a tertiary care hospital in North India. Materials and Methods: 50 children with AGN were recruited and analyzed over a period of one year. Detailed clinical examination and relevant laboratory investigations were done. Children were followed up for 6 months. Statistical Analysis Used: Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages. Results: 50 patients were enrolled in the study with male to female ratio of 1.72:1. Pharyngitis was the most common predisposing condition (70.2%). 22(40.4%) of patients had developed complications. Of this acute kidney injury with significant pulmonary edema was seen in 16 patients and 6 patients had encephalopathy with seizures. Two patients had to be managed with hemodialysis. 42 patients had positive CRP (>10) and ASO titres were >200 Todd units in all patients. At 6 months’ majority of patients had complete clinical recovery with microscopic hematuria present only in 8 patients, persistent hypertension in 2 patients, 8 patients had proteinuria. These patients are being still followed up. Conclusions: Complications and morbidity is significantly high during the acute phase in AGN. Non infectious causes should also be kept in mind. This study highlights the complications requiring intensive care and need for long term follow up.
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Affiliation(s)
- Kapil Bhalla
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Trauma Centre, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Hota D, Bhalla K, Nanda S, Gupta A, Mehra S. Beneficial effects of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in celiac disease patients. J Family Med Prim Care 2019; 8:823-827. [PMID: 31041208 PMCID: PMC6482799 DOI: 10.4103/jfmpc.jfmpc_56_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Context: In the resource poor country like India it is difficult to get HLA screening and EMA testing in patients with celiac disease in small centres. Aims: To study the effect of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in patients with celiac disease. Settings and Design: This was a prospective study conducted in the department of paediatrics of a tertiary referral hospital in north India in 3 stages viz. on presentation, after 3 months and 6 months of initial presentation. Materials and Methods: 392 patients with symptoms suggestive of celiac disease were screened for IgA tTG levels more than 10 folds of upper limit of normal. 50 cases (who followed up for 6 months regularly) were enrolled in the study. Spectrum of various growth and clinical parameters were also studied. Statistical analysis used: Statistical analysis was performed by the SPSS version 20.0. Data were checked for normality before statistical analysis. p value less than 0.05 was considered statistically significant. Results: 50 cases were enrolled in study. After initiation of gluten free diet, improvements were seen in various growth factors like height (12.71%) and weight (3.47 cm) after 6 months. Serum tTG(IgA) levels decreased to 94.88±55.35 U/mL from baseline level of 202±83.96 U/mL after 6 months. Conclusions: Gluten free diet has major role in improvement in growth parameters as well as anemia. So, early detection of celiac disease is an important step in prevention of morbidity associated with this chronic disease.
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Affiliation(s)
- Dayanand Hota
- Department of Paediatrics, All India Institutes of Medical Sciences, Raipur, Chhattisgarh, India
| | - Kapil Bhalla
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Trauma Centre, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Singh R, Bhalla K, Nanda S, Gupta A, Mehra S. Correlation of spot urinary protein: Creatinine ratio and quantitative proteinuria in pediatric patients with nephrotic syndrome. J Family Med Prim Care 2019; 8:2343-2346. [PMID: 31463254 PMCID: PMC6691425 DOI: 10.4103/jfmpc.jfmpc_403_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Nephrotic Syndrome is the commonest glomerular disease in children and is often characterized by multiple relapses. 24 hour urinary protein excretion is the accepted method used in quantification of proteinuria, but it's a time consuming, inconvenient and cumbersome method and difficult in very young children. Spot urine examination would be a simpler, easy, acceptable, and less time consuming method for detection of proteinuria in children. Aim: To evaluate the utility of protein: Creatinine ratio in random urine samples as a reliable diagnostic tool to quantify proteinuria and to determine the correlation of protein: Creatinine ratio to 24 hour protein excretion which is the gold standard reference method. Materials and Methods: The study was done on forty pediatric patients with nephrotic syndrome admitted in relapse, or presenting for the first time. Nephrotic syndrome was diagnosed on the basis of massive proteinuria (>40 mg/m2/hr), hypoalbuminemia (<25 mg/l) and generalized oedema. Urine protein analysis was done using the sulphosalicylic acid method and creatinine estimation by a modified Jaffe's method. Result: The correation between spot protein and creatinine ratio and 24 hour proteinuria was statistically significant with r = 0.833 (P < 0.01) using Pearsons correlation coefficient. Conclusion: Spot protein creatinine ratio can be used as reliable test for detection of proteinuria in the pediatric age group in pateints with nephrotic syndrome.
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Affiliation(s)
- Richa Singh
- Department of Paediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Paediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Paediatrics, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Trauma Centre, Pt BD Sharma PGIMS, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pt BD Sharma PGIMS, Rohtak, Haryana, India
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Gupta A, Bhalla K, Nanda S, Mehra S, Verma S. Parental knowledge and common practices regarding acute respiratory infections in children admitted in a hospital in rural setting. J Family Med Prim Care 2019; 8:2908-2911. [PMID: 31681665 PMCID: PMC6820399 DOI: 10.4103/jfmpc.jfmpc_510_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022] Open
Abstract
Context: In developing countries, there is paucity of data regarding knowledge and practices of parents regarding acute respiratory infections (ARIs). Aims: The present study was undertaken to study the knowledge and practices of parents for ARIs. Settings and Design: This was a prospective, cross-sectional study conducted over period of 3 months in pediatric ward of a tertiary care teaching hospital. Subjects and Methods: All the children admitted in pediatrics ward with complaints of ARI were included in the study. Statistical Analysis Used: Statistical analysis was carried out by using Statistical Package for Social Sciences software version 20. Results: A total of 1,752 children were enrolled in the study out of which 885 (50.51%) were males and 867 (49.49%) were females. Only 42.6% of parents answered correct answers about the proper use of antibiotics for children with ARI. Most of the caregivers (58.4%) had poor knowledge about incomplete immunization as a risk factor for developing diseases like diphtheria and pertussis. Majority of caregivers (66.3%) practice home remedies by themselves. Conclusion: The knowledge of caregivers/parents regarding symptoms, risk factors, and complications of ARI was adequate. Better awareness is needed for safe use of antibiotics, and caregivers shall be encouraged to minimize indoor air pollution. More awareness is required for discouraging the practice of visiting quacks as it can lead to serious complications in the child.
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Ohanian M, Rozovski U, Kanagal-Shamanna R, Abruzzo LV, Loghavi S, Kadia T, Futreal A, Bhalla K, Zuo Z, Huh YO, Post SM, Ruvolo P, Garcia-Manero G, Andreeff M, Kornblau S, Borthakur G, Hu P, Medeiros LJ, Takahashi K, Hornbaker MJ, Zhang J, Nogueras-González GM, Huang X, Verstovsek S, Estrov Z, Pierce S, Ravandi F, Kantarjian HM, Bueso-Ramos CE, Cortes JE. MYC protein expression is an important prognostic factor in acute myeloid leukemia. Leuk Lymphoma 2019; 60:37-48. [PMID: 29741984 PMCID: PMC6226369 DOI: 10.1080/10428194.2018.1464158] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 02/03/2023]
Abstract
As new drugs targeting MYC show clinical activity in acute myeloid leukemia (AML), understanding MYC expression in AML is of critical importance. We assessed MYC protein expression by immunohistochemistry in bone marrow of patients with untreated AML (n = 265). Overall, 90% of patients demonstrated MYC overexpression and MYC immunopositivity ≤6% was associated with superior complete remission (CR) duration of 23 months versus 12 months for MYC immunopositivity >6% (p = .028). Among 241 patients at higher risk for relapse, including those ≥55 years of age and patients with intermediate- and high-risk AML, MYC immunopositivity ≤6% conferred significantly superior median overall survival (OS) (24 versus 13 months; p = .042), event-free survival (EFS) (14 versus 6 months; p = .048), and relapse-free survival (RFS) (25 versus 12 months; p = .024). The prognostic impact of MYC-immunopositivity was retained on multivariate analysis of OS, EFS, and RFS. We conclude that MYC immunopositivity is an important prognostic factor in patients with untreated AML, particularly those at higher risk for relapse.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Uri Rozovski
- Department of Hematology, Davidoff Cancer Center at Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Lynne V. Abruzzo
- Department of Pathology, Ohio State University, Columbus, OH 43202
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Tapan Kadia
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Yang O. Huh
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Sean M. Post
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Peter Ruvolo
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Michael Andreeff
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Steven Kornblau
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Peter Hu
- School of Health Professions, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Marisa J. Hornbaker
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | | | - Xuelin Huang
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Zeev Estrov
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Hagop M. Kantarjian
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Carlos E. Bueso-Ramos
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Jorge E. Cortes
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
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Bhalla K, Nanda S, Gupta A, Nehra D, Mehra S. DRESS Syndrome: An Unusual Side Effect. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/40069.12584] [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: 11/24/2022]
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Bhalla K, Nehra D, Nanda S, Verma R, Gupta A, Mehra S. Prevalence of bronchial asthma and its associated risk factors in school-going adolescents in Tier-III North Indian City. J Family Med Prim Care 2018; 7:1452-1457. [PMID: 30613541 PMCID: PMC6293925 DOI: 10.4103/jfmpc.jfmpc_117_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/18/2022] Open
Abstract
BACKGROUND Asthma is one of the most common chronic diseases of childhood and a major health problem not only in India but globally. Despite multifold increase in prevalence, there is paucity of data on bronchial asthma from non-metro cities. The objectives were to find prevalence of bronchial asthma and various risk factors that are associated in this age group and determine the extent of under diagnosis. MATERIALS AND METHODS A cross-sectional study involving 927 students from four government and three private schools was conducted using International Study of Asthma and Allergies in Childhood questionnaire. RESULTS Prevalence of bronchial asthma in adolescents was 13.1% (n = 121) of which 10.3% had episodes in the past 1 year. Prevalence was higher among males (8.77%) compared to females (4.33%). About 77.7% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke-producing fuel at home (firewood/cow dung/kerosene; P = 0.032), and with history of smoking among family members (P = 0.035). Among current asthmatics, 72.3% reported cold/rhinitis (54.6% in March-May duration), 63.6% nocturnal dry cough, 50.5% sleep disturbances, and 38.9% speech disturbances in the past 1 year. CONCLUSION The study shows higher prevalence of bronchial asthma in school-going population (11-16 years) compared to other parts of Northern India possibly attributable to rapid industrialization and post harvesting season when the study was carried out. Preventive interventions need to be taken to reduce disease burden at community level.
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Affiliation(s)
- Kapil Bhalla
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Nehra
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Nanda
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Community Medicine, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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