1
|
Gupta P, Dabas A, Seth A, Bhatia VL, Khadgawat R, Kumar P, Balasubramanian S, Khadilkar V, Mallikarjuna HB, Godbole T, Krishnamurthy S, Goyal JP, Bhakhri BK, Ahmad A, Angadi K, Basavaraja GV, Parekh BJ, Kurpad A, Marwaha RK, Shah D, Munns C, Sachdev HPS. Erratum. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2467-8] [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: 11/05/2022]
|
2
|
Gupta P, Dabas A, Seth A, Bhatia VL, Khadgawat R, Kumar P, Balasubramanian S, Khadilkar V, Mallikarjuna HB, Godbole T, Krishnamurthy S, Goyal JP, Bhakhri BK, Ahmad A, Angadi K, Basavaraj GV, Parekh BJ, Kurpad A, Marwaha RK, Shah D, Munns C, Sachdev HPS. Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets. Indian Pediatr 2022; 59:142-158. [PMID: 34969941] [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: 06/14/2023]
Abstract
JUSTIFICATION The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India. OBJECTIVES To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children. PROCESS A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members. RECOMMENDATIONS The group reiterates the serum 25-hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12-20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400-600 IU/day, respectively) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids.
Collapse
Affiliation(s)
- Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences, New Delhi. Correspondence to: Dr Piyush Gupta, Professor and Head, Department of Pediatrics, University College of Medical Sciences, and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi 110095, India.
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College, New Delhi
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi
| | - Vijay Lakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi
| | | | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra
| | | | | | | | | | - Bhanu Kiran Bhakhri
- Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, NOIDA
| | - Ayesha Ahmad
- Aligarh Muslim University, Aligarh, Uttar Pradesh
| | | | - G V Basavaraj
- Indira Gandhi Institute of Child Health, Bengluru, Karnataka
| | | | - Anura Kurpad
- Indian Council of Medical Research Expert Committee on Nutrient Requirements of Indians and Scientific Committee, Food Safety and Standards Authority of India, New Delhi
| | - R K Marwaha
- Society of Endocrine Health Care for Elderly Adolescents and Children (SEHEAC), New Delhi
| | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences, New Delhi
| | - Craig Munns
- Department of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia and Pediatric Bone and Mineral Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - H P S Sachdev
- Department of Pediatric and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi
| |
Collapse
|
3
|
Sahoo T, Naseem S, Ahluwalia J, Marwaha RK, Trehan A, Bansal D. Inherited Bleeding Disorders in North Indian Children: 14 years' Experience from a Tertiary Care Center. Indian J Hematol Blood Transfus 2019; 36:330-336. [PMID: 32425385 DOI: 10.1007/s12288-019-01233-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/15/2019] [Indexed: 01/19/2023] Open
Abstract
Inherited bleeding disorders are not uncommon in pediatric practice: most of them being chronic, require lifelong replacement therapy. To frame a management policy, it is essential to assess the load and pattern of bleeding disorders in the local population. However, there is paucity of data reporting the clinical spectrum of coagulation and platelet function disorders in Indian children. Hence to find out the exact burden and clinico-investigational profile of these patients we conducted this study. In this retrospective case review, detailed clinical information was extracted from case records in 426 children with a suspected diagnosis of hereditary bleeding disorder registered in the Pediatric Hematology clinic of a tertiary referral centre over a period of 14 years (1998-2011) and pooled for analysis. In our cohort prevalence of hemophilia A, hemophilia B, platelet function disorders, von Willebrand disease and other rare factor deficiencies were 72%, 11%, 7%, 4% and 4% respectively. Common clinical spectrum included skin bleeds, arthropathy, mucosal bleeds. 10% had deeper tissue bleeding and 16% received replacement therapy at the first visit. Nearly 3/4th of cases were lost for follow up after the initial visit. Hemophilia A was the commonest inherited bleeding disorder in our population. Skin bleeds and arthropathy were common clinical presentations. Factor replacement therapy was restricted to a minority. There is an urgent need for establishing centres of excellence with administrative commitment for factor replacement therapy for comprehensive management of such children in resource-limited countries.
Collapse
Affiliation(s)
- Tanushree Sahoo
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Shano Naseem
- 2Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Jasmina Ahluwalia
- 2Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - R K Marwaha
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Amita Trehan
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Deepak Bansal
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| |
Collapse
|
4
|
Rashid A, Bhat JA, Ganie MA, Wani IA, Bhat MH, Shah ZA, Masoodi SR, Marwaha RK. Evaluation of serum anti-nuclear antibody among women with PCOS: a hospital based single center cross sectional study. Gynecol Endocrinol 2018; 34:965-969. [PMID: 29734859 DOI: 10.1080/09513590.2018.1469613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Polycystic ovary syndrome (PCOS), a major endocrinopathy is associated with barrage of metabolic aberrations. Reports in literature on association of PCOS and autoimmunity are conflicting. We aim to evaluate serum levels of anti-nuclear antibody (ANA) among Indian women with PCOS. In this hospital-based single center cross-sectional study, women qualifying a diagnosis of PCOS by Rotterdam criteria 2003 were recruited. Eighty-nine eligible women who consented were enrolled. All these women along with 87 age-matched, healthy controls underwent, clinical (menstrual history, anthropometry, hirsutism scoring), biochemical, hormonal assessment and serum ANA estimation. OGTT after overnight (8-12 h) fast with 75 g oral glucose load was done for 1 h, 2 h glucose and insulin measurements. The mean age of cases and controls was comparable (22.67 ± 5.53 vs. 22.84 ± 3.64 years). The prevalence of ANA positivity was significantly higher among women with PCOS (18.4% vs. 2.29%; p < .001). Though significant correlation was observed between ANA positivity and clinical signs of hyperandrogenism and plasma glucose, no significant correlation was noted between ANA status and other hormonal parameters. Higher prevalence of ANA positivity among women with PCOS, being a marker of autoimmunity, suggests a possible role of autoimmunity in causation of PCOS and needs further elucidation.
Collapse
Affiliation(s)
- Aafia Rashid
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - Javaid Ahmad Bhat
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - Mohd Ashraf Ganie
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - Imtiyaz Ahmad Wani
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - Moomin Hussain Bhat
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - Zaffar Amin Shah
- b Department of Immunology and Molecular Medicine , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K, India
| | - Shariq R Masoodi
- a Department of Endocrinology , Sheri-Kashmir Institute of Medical Sciences Srinagar , J&K , India
| | - R K Marwaha
- c International Life Science Institute India , New Delhi , Delhi , India
| |
Collapse
|
5
|
Sharma M, Sachdeva MUS, Bose P, Varma N, Varma S, Marwaha RK, Malhotra P. Haematological profile of patients with mixed-phenotype acute leukaemia from a tertiary care centre of north India. Indian J Med Res 2017. [PMID: 28639598 PMCID: PMC5501054 DOI: 10.4103/ijmr.ijmr_324_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background & objectives: Mixed-phenotype acute leukaemia (MPAL) is a rare neoplasm with no definite treatment protocols and a distinctly poor outcome. Advancement in polychromatic flow cytometry has made its identification easier. This prospective study was designed to identify cases of MPAL and study their clinical presentation and haematological profile in a tertiary care hospital in north India. Methods: Ethylenediaminetetraacetic acid (EDTA)-anticoagulated bone marrow aspirate samples of patients diagnosed as acute leukaemia (AL) on the basis of morphology were utilized for immunophenotyping. A comprehensive panel of fluorochrome-labelled monoclonal antibodies targeting myeloid, B-cell, T-cell and immaturity markers was utilized. The patients diagnosed to have MPAL, on the basis of the World Health Organization 2008 classification, were selected for further analyses. Results: There were 15 (2.99%) patients with MPAL of the total 501 cases of AL. Seven were children, all males and mean age of 5.08±3.88 yr. Eight were adults, male:female=6:2 and mean age of 21.43±5.74 yr. Eight were diagnosed as B/myeloid and seven were T/myeloid. No association was observed between age and immunophenotype of MPAL. On morphology, 11 were diagnosed as AML and four as ALL, and no specific morphology of blasts was predictive of a MPAL. Interpretation & conclusions: MPAL appeared to be a rare neoplasm (2.99% of AL cases). A comprehensive primary panel of monoclonal antibodies should be used to identify this neoplasm known to have a poor outcome.
Collapse
Affiliation(s)
- Manupriya Sharma
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Parveen Bose
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - R K Marwaha
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
6
|
Nikbakht M, Jha AK, Malekzadeh K, Askari M, Mohammadi S, Marwaha RK, Kaul D, Kaur J. Aberrant promoter hypermethylation of selected apoptotic genes in childhood acute lymphoblastic leukemia among North Indian population. Exp Oncol 2017; 39:57-64. [PMID: 28361856] [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: 06/07/2023]
Abstract
UNLABELLED Promoter hypermethylation mediates gene silencing in many neoplasms. Acute leukemia has been reported to harbor multiple genes aberrantly silenced by hypermethylation. AIM In present study, we investigated the prevalence of hypermethylation of caspase-8 (CASP8), TMS1 and DAPK genes in correlation with clinicopathological factors in childhood acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS A case-control study has been conducted based on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls. Methylation specific polymerase chain reaction (PCR) and bisulfite sequencing PCR was performed to analyze the methylation status of these genes. Reverse transcription PCR and real time PCR was carried out to determine changes in the mRNA expression level of the genes due to hypermethylation. RESULTS Hypermethylation of the 5´CpG islands of the CASP8, TMS1 and DAPK gene promoters was found in 3.2, 6.4, and 13.6% of 125 childhood ALL samples from north Indian population, respectively. There were significant differences in pattern of hypermethylation of TMS1 (p = 0.045) and DAPK (p < 0.001) between patients and healthy controls. Down-regulation of mRNA expression was found in cases in which CASP8, TMS1 and DAPK were hypermethylated. CONCLUSIONS The present study indicated the impact of hypermethylation-mediated inactivation of CASP8, TMS1 and DAPK genes, which is associated with risk of childhood ALL. This abnormality occurs in leukemogenesis and it may be used as a biomarker and for predicting the prognosis of ALL.
Collapse
Affiliation(s)
- M Nikbakht
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran 1411713131, Iran
| | - A K Jha
- Department of Biotechnology, IMS Engineering College, Ghaziabad (U.P.) 160012, India
| | - K Malekzadeh
- Molecular Medicine Research Center (MMRC); Hormozgan University of Medical Science (HUMS); Bandar Abbass 7919915519, Iran
| | - M Askari
- Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - S Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran 14176-13151, Iran
| | - R K Marwaha
- Advanced Pediatrics Center, PGIMER, Chandigarh 160014, India
| | - D Kaul
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160014, India
| | - J Kaur
- Department of Biotechnology, Panjab University, Chandigarh 160014, India
| |
Collapse
|
7
|
Sharma M, Sachdeva MUS, Varma N, Varma S, Marwaha RK. Characterization of immunophenotypic aberrancies in adult and childhood acute lymphoblastic leukemia: A study from Northern India. J Cancer Res Ther 2017; 12:620-6. [PMID: 27461621 DOI: 10.4103/0973-1482.147716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Identification of aberrant antigen expression is important in characterizing neoplastic population among non.neoplastic bone marrow counterparts and further in the detection of minimal residual disease. (MRD). Flow cytometry (FCM) is an important tool in identifying aberrant phenotypes. Incidence of aberrant phenotypes varies considerably in independent studies and its association with prognostic factors is still debatable. AIM To identify the prevalence of aberrant phenotypes on immunophenotyping in a large series of de novo acute lymphoblastic leukemia (ALL) and to evaluate any association with initial clinical and hematological features. MATERIALS AND METHODS In the current study, 303 patients of de novo ALL were included from the Department of Hematology, PGIMER, Chandigarh during the time period (July 2010 to June 2012). The immunophenotype of all cases of ALL was studied using FCM. RESULTS Aberrant myeloid antigen expression was seen in 42.5% cases. Most frequent aberrant myeloid antigen was CD13 (32.2% cases), followed by CD33 (27.2% cases) and CD117 (18.5% cases). The expression of CD117 was relatively frequent in comparison to earlier reports which describe its rare expression. Adult T- ALL showed higher expression of CD33 and CD117 than pediatric T-ALL (P = 0.032 and 0.043, respectively). Myeloid antigen expression in ALL was associated with lower WBC count (P < 0.05) and lower number of peripheral blasts (P < 0.05). Expression of CD34 was higher in My + ALL group (P < 0.05) than My- ALL group. CONCLUSION In summary, CD117 is a relatively frequently expressed myeloid marker contrary to earlier reports which describes its rare expression. Pediatric and adult ALL cases with low blast count and CD34 positivity are more likely to express aberrant myeloid markers. Current study also supports that myeloid antigen expression in both adult and pediatric ALL is not associated with adverse presenting clinical and biological features.
Collapse
Affiliation(s)
- Manupriya Sharma
- Department of Pathology, Dr Rajendra Prasad Government Medical College Kangra at Tanda (Himachal Pradesh); Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Marwaha
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Abstract
The study included 57 patients with visceral leishmaniasis. The average duration of symptoms was 3.8 ± 3.55 months and pancytopenia was the commonest haematological abnormality. The parasite load directly correlated with the degree of anaemia at presentation (P=0.03). Splenic regression took 9.58 ±4.5 days and haematological parameters recovered in 14.5±9.07 days. There were five deaths over the five-year study duration. Leishmaniasis was not the first diagnosis in 14 patients, of whom eight were residents of non-endemic regions. Diagnosis was achieved in 13.5 days in these patients, compared to 4.5 days in patients where leishmaniasis was suspected at the outset.
Collapse
Affiliation(s)
- A Sud
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | | | |
Collapse
|
9
|
Marwaha RK, Yenamandra VK, Sreenivas V, Sahay R, Baruah MP, Desai A, Kurvilla S, Joseph S, Unnikrishnan AG, Lakshmy R, Apoorva C, Sharma VK, Sethuraman G. Regional and seasonal variations in ultraviolet B irradiation and vitamin D synthesis in India. Osteoporos Int 2016; 27:1611-1617. [PMID: 26630977 DOI: 10.1007/s00198-015-3427-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Evaluation of ultraviolet B index (UVBI) and its impact on vitamin D synthesis is important. We observed the maximum UVBI between 11 am and 1 pm. There was no increase in serum 25(OH)D levels following sun exposure during winter as the UVBI was significantly low, emphasizing the need for vitamin D supplementation during these months. INTRODUCTION The amount of vitamin D3 synthesizing UVB irradiation (290-320 nm) reaching the earth's surface at different altitudes and seasons in different parts of India and it's impact on vitamin D synthesis has not been well studied. METHODS The hourly UVB index (UVBI) from 10 am to 3 pm everyday for 12 months was measured by a solar meter in 4 different zones (North, Northeast, West and South) of the country. To study the impact of sun light exposure on vitamin D synthesis during winter, healthy school children aged 10-15 years were exposed to sunlight for a period of 30 min per day, between 11 am to 12 noon with 10 % body surface area, for 4 weeks. The main outcome measures were serum 25(OH)D, PTH, calcium, phosphate, and alkaline phosphatase levels before and after sun exposure. RESULTS The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. The highest UVBI was recorded from the North zone (4.5 ± 2.7 μW/Cm(2)), while the least was recorded in the Northeast zone (2.1 ± 1.2 μW/Cm(2)). UVBI readings in the Northeast zone were consistently low throughout the year, while all the other three zones showed significant seasonal fluctuations. Surprisingly, we observed a significant decrease in serum 25(OH)D levels from baseline (6.3 ± 4.6 to 5.1 ± 2.7 ng/mL; p < 0.001) despite sun exposure. CONCLUSION The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. No increase in the serum 25(OH)D levels was observed following sun exposure in winter, emphasizing the need for vitamin D supplementation during these months.
Collapse
Affiliation(s)
- R K Marwaha
- International Life Sciences Institute, New Delhi, India
| | - V K Yenamandra
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - A Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim Goa, India
| | - S Kurvilla
- Christian Fellowship Hospital, Oddanchatram, Dindigul, India
| | - S Joseph
- Christian Fellowship Hospital, Oddanchatram, Dindigul, India
| | | | - R Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - C Apoorva
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| |
Collapse
|
10
|
Mohapatra S, Bansal D, Bhalla AK, Verma Attri S, Sachdeva N, Trehan A, Marwaha RK. Is there an increased risk of metabolic syndrome among childhood acute lymphoblastic leukemia survivors? A developing country experience. Pediatr Hematol Oncol 2016; 33:136-49. [PMID: 26984439 DOI: 10.3109/08880018.2016.1152335] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Data on metabolic syndrome (MS) in survivors of childhood acute lymphoblastic leukemia (ALL) from developing countries are lacking. The purpose of this single-center, uncontrolled, observational study was to assess the frequency of MS in our survivors. The survivors of ALL ≤15 years at diagnosis, who had completed therapy ≥2 years earlier, were enrolled. Anthropometric measurements (weight, height, waist circumference), biochemistry (glucose, insulin, triglycerides, high-density lipoprotein [HDL], thyroid function tests, C-reactive protein [CRP], magnesium), measurement of blood pressure, and Tanner staging were performed. MS was defined by International Diabetes Federation (IDF) and the National Cholesterol Education Program Third Adult Treatment Panel guidelines (NCEP ATP III) criteria, modified by Cook et al. (Arch Pediatr Adolesc Med. 2003;157:821-827) and Ford et al. (Diabetes Care. 2005;28:878-881). The median age of 76 survivors was 11.9 years (interquartile range [IQR]: 9.6-13.5). Twenty-four (32%) survivors were obese or overweight. The prevalence of insulin resistance (17%), hypertension (7%), hypertriglyceridemia (20%), and low HDL (37%) was comparable to the prevalence in children/adolescents in historical population-based studies from India. The prevalence of MS ranged from 1.3% to 5.2%, as per different defining criteria. Cranial radiotherapy, age at diagnosis, sex, or socioeconomic status were not risk factors for MS. The prevalence of MS in survivors of childhood ALL, at a median duration of 3 years from completion of chemotherapy, was comparable to the reference population. The prevalence of being obese or overweight was, however, greater than historical controls.
Collapse
Affiliation(s)
- Sonali Mohapatra
- a Hematology-Oncology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Deepak Bansal
- a Hematology-Oncology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - A K Bhalla
- b Growth and Anthropology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Savita Verma Attri
- c Biochemistry Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Naresh Sachdeva
- d Department of Endocrinology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Amita Trehan
- a Hematology-Oncology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - R K Marwaha
- a Hematology-Oncology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| |
Collapse
|
11
|
Kumar M, Updesh Singh Sachdeva M, Naseem S, Ahluwalia J, Das R, Varma N, Marwaha RK. Bone marrow infiltration in Langerhan's cell histiocytosis - An unusual but important determinant for staging and treatment. Int J Hematol Oncol Stem Cell Res 2015; 9:193-7. [PMID: 26865930 PMCID: PMC4748689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Langerhans' cell histiocytosis (LCH) is a reactive proliferative disease of unknown pathogenesis characterized by proliferation of Langerhans cells. Involvement of bone marrow (BM), liver and lung are related to high risk factors and poor survival. The aim of this report is to highlight the clinical and haematological findings of 5 cases of LCH with BM infiltration which may help to predict involvement of BM. CASE SERIES Five cases of Langerhan's cell histiocytosis with bone marrow infiltration were retrieved from archives of Department of Hematology, PGIMER and Chandigarh for review and further analysis. Male to female ratio was 3:2 with mean age of 9.4 months. Two out of 5 patients had obvious skull swelling; however, radiography of the skull revealed lytic lesion of skull in 4 cases and 2 had skin rashes. Hepatomegaly was present in 4 cases and 2 of whom also had lymphadenopathy and splenomegaly. All patients had anaemia at the time of presentation. Bone marrow aspiration and trephine biopsy in all 5 cases revealed infiltration by large histiocytes with abundant cytoplasm and coffee bean shaped nucleus. Nodules of these Langerhans cells with admixture of eosinophils were seen on trephine biopsy. Immunohistochemistry showed positivity for CD1a stain. CONCLUSION BM evaluation is important in LCH patients to categorize disease which further determines the type of therapy to be given. Clinical details may help to predict the BM involvement; however, demonstration of CD1a positive cells in marrow is most important tool to diagnose marrow infiltration by LCH.
Collapse
Affiliation(s)
- Mahendra Kumar
- Assistant Professor, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh, India
| | - Man Updesh Singh Sachdeva
- Associate Professor, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Assistant Professor, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Additional Professor, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Professor, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Professor and Head, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Marwaha
- Professor, Department of Pediatrics (Hematology-Oncology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
12
|
Varma N, Naseem S, Binota J, Varma S, Malhotra P, Marwaha RK. A Study of Incidence of Recurrent Genetic Translocations in Adult and Pediatric Acute Lymphoblastic Leukemia (ALL) Patients in North India. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Totadri S, Bansal D, Bhatia P, Attri SV, Trehan A, Marwaha RK. The deferiprone and deferasirox combination is efficacious in iron overloaded patients with β-thalassemia major: A prospective, single center, open-label study. Pediatr Blood Cancer 2015; 62:1592-6. [PMID: 25820920 DOI: 10.1002/pbc.25533] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND The high cost, coupled with the need for continuous infusion, renders Desferrioxamine (DFO), a non-feasible option for iron-chelation in a large majority of patients with β-thalassemia major in developing countries. Monotherapy with deferiprone (DFP) or deferasirox (DFX) may not always attain optimal control, particularly in heavily iron-loaded patients. Combination of DFP and DFX is a potential alternative. PROCEDURE A prospective, single-center, open-label, uncontrolled study was conducted to evaluate the safety and efficacy of the combination in patients with β-thalassemia major. Patients who had received either DFP or DFX for >1 year and a serum ferritin >2,000 μg/L were enrolled. Blood counts, liver/renal functions, and serum ferritin were monitored during the 1-year study period. Facilities for cardiac T2*-MRI were unavailable. RESULTS Thirty-six patients with a mean age of 13 ± 6.9 years (range: 4-29) and a ferritin of 6,768 ± 4,145 μg/L formed the study cohort. Eight (22%) patients had transient gastrointestinal adverse effects. DFX was discontinued in one patient for persistent abdominal pain/diarrhea. Eight (22%) had joint symptoms; DFP was discontinued in two. Four (11%) patients had elevation in AST/ALT levels, managed with temporary interruption of DFX. Nine (25%) had an inconsistent elevation of creatinine to >33% of baseline; no intervention was done. One had transient proteinuria. None had neutropenia. At the end of 1 year, the serum ferritin reduced by a mean value of 3,275.3 ± 618.2 μg/L (P < 0.001). CONCLUSIONS The oral combination was found to be safe, efficacious, and a feasible option in patients with suboptimal response to monotherapy.
Collapse
Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita V Attri
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Marwaha
- Department of Pediatrics, Hematology-Oncology Unit and Biochemistry, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
14
|
Marwaha RK, Sreenivas V, Talwar D, Yenamandra VK, Challa A, Lakshmy R, Sharma VK, Sethuraman G. Impact of solar ultraviolet B radiation (290-320 nm) on vitamin D synthesis in children with type IV and V skin. Br J Dermatol 2015; 173:604-6. [PMID: 25939893 DOI: 10.1111/bjd.13887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- R K Marwaha
- Department of Endocrinology, International Life Sciences Institute (ILSI, India), New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - D Talwar
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Yenamandra
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - A Challa
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - R Lakshmy
- Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Sethuraman G, Sreenivas V, Yenamandra VK, Gupta N, Sharma VK, Marwaha RK, Bhari N, Irshad M, Kabra M, Thulkar S. Threshold levels of 25-hydroxyvitamin D and parathyroid hormone for impaired bone health in children with congenital ichthyosis and type IV and V skin. Br J Dermatol 2014; 172:208-14. [PMID: 24864027 DOI: 10.1111/bjd.13131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with congenital ichthyosis, especially those with darker skin types, are at increased risk of developing vitamin D deficiency and rickets. The relationships between 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and bone health have not been studied previously, in ichthyosis. OBJECTIVES To determine the threshold levels of 25(OH)D and PTH for impaired bone health in children with congenital ichthyosis. METHODS In this cross-sectional study, 119 children with ichthyosis and 168 controls were recruited. Serum 25(OH)D, PTH, calcium, phosphate and alkaline phosphatase (ALP) were measured. Radiological screening for rickets was carried out only in children with ichthyosis. RESULTS Forty-seven children with ichthyosis had either clinical or radiological evidence of rickets. The correlation between serum 25(OH)D and PTH showed that a serum level of 25(OH)D 8 ng mL(-1) was associated with a significant increase in PTH. The correlation between PTH and ALP showed that a serum PTH level of 75 pg mL(-1) was associated with a significant increase in ALP levels. Of the different clinical phenotypes of ichthyosis, both autosomal recessive congenital ichthyosis (ARCI) and epidermolytic ichthyosis (EI) were found to have significantly increased PTH, ALP and radiological rickets scores compared with common ichthyosis. CONCLUSIONS Serum levels of 25(OH)D ≤ 8 ng mL(-1) and PTH ≥ 75 pg mL(-1) significantly increases the risk for development of rickets [odds ratio (OR) 2·8; 95% confidence interval (CI) 1·05-7·40; P = 0·04] in ichthyosis. Among the different types, patients with ARCI (OR 4·83; 95% CI 1·74-13·45; P < 0·01) and EI (OR 5·71; 95% CI 1·74-18·79; P < 0·01) are at an increased risk of developing rickets.
Collapse
Affiliation(s)
- G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Singleton B, Bansal D, Varma N, Das R, Naseem S, Saikia UN, Malhotra P, Varma S, Marwaha RK, King MJ, Ahmed M. Homozygosity mapping reveals founder SEC23B-Y462C mutations in Indian congenital dyserythropoietic anemia type II. Clin Genet 2014; 88:195-7. [PMID: 25418799 DOI: 10.1111/cge.12527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/06/2014] [Accepted: 10/14/2014] [Indexed: 01/25/2023]
Affiliation(s)
- B Singleton
- Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - D Bansal
- Pediatric Haematology-Oncology Unit, Department of Paediatrics, Advanced Paediatrics Centre, PGIMER, Chandigarh, India
| | - N Varma
- Department of Haematology, PGIMER, Chandigarh, India
| | - R Das
- Department of Haematology, PGIMER, Chandigarh, India
| | - S Naseem
- Department of Haematology, PGIMER, Chandigarh, India
| | - U N Saikia
- Department of Histopathology, PGIMER, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - S Varma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - R K Marwaha
- Pediatric Haematology-Oncology Unit, Department of Paediatrics, Advanced Paediatrics Centre, PGIMER, Chandigarh, India
| | - M-J King
- Membrane Biochemistry, International Blood Group Reference Laboratory, NHSBT, Bristol, UK
| | - M Ahmed
- Department of Haematological Medicine, Leukaemia Genomics and Bone Marrow Failure Group, Kings College Hospital, London, UK
| |
Collapse
|
17
|
Fadel S, Aly A, Massoud S, Kedr W, Farhod A, Srinivasan A, Satish G, Scott JX, Rao SM, Chidambaram B, Chandrashekar S, Chintagumpala M, He X, Ma J, Trehan A, Salunke P, Singla N, Kumar N, Radotra BD, Bansal D, Marwaha RK, Chinnaswamy G, Prasad M, Dhamankar V, Vora T, Gupta T, Moiyadi A, Sridhar E, Jalali R, Banavali S, Kurkure P, Kaur K, Kakkar A, Purkait S, Suri V, Sharma M, Mallick S, Jhulka PK, Suri A, Sharma BS, Sarkar C, Giron AV, Castellanos M, Valverde P, Garrido C, Letona T, Antillon F, Bartel U, Yuan X, Wang C, Adesina A, Lau C, Jiang M, Ma J. NEURO-ONCOLOGY IN DEVELOPING COUNTRIES. Neuro Oncol 2014; 16:i97-i98. [PMCID: PMC4046291 DOI: 10.1093/neuonc/nou075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
|
18
|
Sharma P, Das R, Trehan A, Bansal D, Chhabra S, Kaur J, Marwaha RK, Varma N, Garewal G. Impact of iron deficiency on hemoglobin A2% in obligate β-thalassemia heterozygotes. Int J Lab Hematol 2014; 37:105-11. [PMID: 24754744 DOI: 10.1111/ijlh.12246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The potential impact of concomitant iron deficiency on hemoglobin A2 (HbA2)-based identification of β-thalassemia trait (βTT) is a worrisome issue for screening laboratories. This is especially true for resource-constrained settings where iron deficiency is widespread and molecular confirmatory tests for borderline low HbA2 values may be unavailable. METHODS Obligate βTT carrier individuals (n = 752) were identified during screening studies on the parents of thalassemia major patients. HbA2%, complete blood counts and serum iron, ferritin and transferrin saturation were studied. Iron-deficient individuals (n = 135) with normal range HbA2% were taken as controls. RESULTS Concomitant iron deficiency (defined as ferritin ≤15 ng/mL and/or transferrin saturation ≤15%) was present in 20.7% (156/752) βTT cases, that is, 33.3% females (122/366) and 8.8% males with βTT (34/386). Mean HbA2 in iron-replete βTT was 5.4 ± 0.8 (range 3.1-7.9) and in iron-deficient βTT was 5.4 ± 0.9 (range 3.3-7.6). HbA2 < 4.0% was found in 23/752 (3.1%) βTT: 13/595 iron-replete (2.2%) and 10/157 (6.4%) iron-deficient βTT individuals. However, five of the 10 iron-deficient βTT cases carried the silent CAP+1 (A>C) β-thalassemia allele accounting for the borderline HbA2%. On a separate analysis, all five severely anemic βTT (Hb < 80 g/L) and 16/17 βTT with severe hypoferritinemia (<5 ng/mL) had HbA2 > 4.5%. The single case with serum ferritin 4.8 ng/mL and HbA2 3.3% showed a CAP+1 (A>C) mutation. CONCLUSIONS Iron deficiency was prevalent among north Indian βTT individuals, especially women. After adjusting for other causes of low HbA2 in βTT, iron deficiency, even when very severe, was very unlikely to interfere significantly with HbA2-based identification of βTT.
Collapse
Affiliation(s)
- P Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Trehan A, Sharma N, Das R, Bansal D, Marwaha RK. Clinicoinvestigational and demographic profile of children with thalassemia major. Indian J Hematol Blood Transfus 2014; 31:121-6. [PMID: 25548457 DOI: 10.1007/s12288-014-0388-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 08/16/2013] [Accepted: 04/03/2014] [Indexed: 10/25/2022] Open
Abstract
There are an estimated 200 million carriers of the β-thalassemia gene worldwide, 20 million being in India. The mean prevalence in India is 3.3 %. Objective To evaluate the clinico-investigational profile and the demographic characteristics of patients with thalassemia major (TM). Methods This was a retrospective analysis of the clinico-demographic profile at presentation of patients of TM diagnosed in the Paediatric Hematology Clinic of our hospital. Results The clinical profile of 964 patients of TM was analyzed. The mean age at presentation of untransfused children was 13.2 ± 9.7 months. Nearly 2/3(rd) children presented before 1 year of age. Almost 40 % had symptoms for 3 months prior to presentation. The manifestations at presentation included pallor and failure to thrive. About 40 % presented with severe anemia, with a hemoglobin of <5.0 gm/dl. A large number received blood transfusions prior to establishment of the diagnosis. Half of the families had ancestors who hailed originally from Pakistan. Approximately 50 % belonged to the Khatri/Arora castes. The parental literacy rate was about 90 %. Conclusions Thalassemia needs greater public awareness and prevention strategies in our country. Some communities are at high risk as compared to others. Education programs and compulsory antenatal screening appear to be the order of the day.
Collapse
Affiliation(s)
- Amita Trehan
- Division of Pediatric Hematology Oncology, Advanced Pediatric Centre & Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012
| | - Nivedita Sharma
- Division of Pediatric Hematology Oncology, Advanced Pediatric Centre & Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012
| | - Reena Das
- Division of Pediatric Hematology Oncology, Advanced Pediatric Centre & Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012
| | - Deepak Bansal
- Division of Pediatric Hematology Oncology, Advanced Pediatric Centre & Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012
| | - R K Marwaha
- Division of Pediatric Hematology Oncology, Advanced Pediatric Centre & Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012
| |
Collapse
|
20
|
Das A, Bansal D, Das R, Trehan A, Marwaha RK. Hereditary spherocytosis in children: Profile and post-splenectomy outcome. Indian Pediatr 2014; 51:139-41. [DOI: 10.1007/s13312-014-0348-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
21
|
Garg MK, Tandon N, Marwaha RK, Menon AS, Mahalle N. The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol (Oxf) 2014; 80:41-6. [PMID: 23682759 DOI: 10.1111/cen.12248] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Vitamin D deficiency (VDD) is a global problem. Not all patients with VDD have clinical manifestations or secondary hyperparathyroidism. We studied the interaction between serum 25-hydroxy vitamin D (25OHD), parathormone (PTH) and bone mineral density (BMD) in Indian adolescents and adults. DESIGN Population survey. PATIENTS A total of 1829 adolescents and 1346 adults aged 50 years and above were analysed in this study. MEASUREMENTS Serum biochemistry, 25OHD, PTH and BMD were estimated. Subjects were grouped according to quartiles of serum PTH. VDD was defined as severe (25OHD ≤ 5 ng/ml), moderate (25OHD ≤ 10 ng/ml) and mild (25OHD ≤ 20 ng/ml) and secondary hyperparathyroidism (SHPT) when serum PTH levels >65 pg/ml. RESULTS Only 30-40% of subjects with moderate and severe VDD, respectively, had SHPT. BMD decreased from Quartile 1 to Quartile 4 of PTH at all sites among adolescents and adults, with only a marginal decline in serum 25OHD levels between these quartiles. Further, within each PTH quartile, there was no difference in BMD according to categories of VDD. Analysing BMD in the different PTH quartiles, the PTH cut-offs beyond which BMD showed a significant decline, was 35 pg/ml in adolescents and 53 pg/ml in adults. CONCLUSIONS Less than half of the subjects with VDD have SHPT. BMD levels start to decline at PTH values currently considered to be normal. These data suggest the need to redefine SHPT in different age groups keeping in mind the relationship between PTH and BMD. This may also influence the decision to supplement subjects with VDD.
Collapse
Affiliation(s)
- M K Garg
- Department of Endocrinology and Metabolism, Command Hospital (Southern Command), Pune, Maharashtra, India
| | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND High prevalence of vitamin D deficiency (VDD) has been reported throughout the India for all age groups. Increased awareness about VDD among treating physicians has led to increased prescriptions of vitamin D preparations. Based on our experience of varied clinical and radiological response with different vitamin D formulations, we decided to assess cholecalciferol content of commonly available vitamin D formulations. MATERIALS AND METHODS We measured cholecalciferol content of 14 commercial preparations (two in the form of tablets and 12 as sachet) available in Indian market. Lab analysis was carried out in Shriram Institute for Industrial Research by high-performance liquid chromatography. RESULTS Of the total 14 samples analyzed only 4 (28.57%) were found to be within the acceptable ranges from -90 to +125% as defined by Indian Pharmacopia while 5 (35.7%) had higher and 5 (35.7%) had lower than the acceptable range. The percentage variation in cholecalciferol content as observed from the printed ranged widely from -91% to +65%. CONCLUSIONS Our study shows a high degree of variability in cholecalciferol content of commercial preparations available in the Indian pharmaceutical market. This variation has many clinical implications as it may lead both, under treatment as well as vitamin D toxicity.
Collapse
Affiliation(s)
- Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Ramot
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - K M Chacko
- Shri Ram Institute of Industrial Research, New Delhi, India
| | - R K Marwaha
- Shri Ram Institute of Industrial Research, New Delhi, India
| |
Collapse
|
23
|
Khadgawat R, Marwaha RK, Garg MK, Ramot R, Oberoi AK, Sreenivas V, Gahlot M, Mehan N, Mathur P, Gupta N. Impact of vitamin D fortified milk supplementation on vitamin D status of healthy school children aged 10-14 years. Osteoporos Int 2013; 24:2335-43. [PMID: 23460234 DOI: 10.1007/s00198-013-2306-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/31/2013] [Indexed: 12/31/2022]
Abstract
UNLABELLED Vitamin D deficiency is a major public health problem, needing immediate attention. We studied the effect of vitamin D fortification of milk in school children. Our results show that fortification of milk is safe and effective strategy to deal with widespread vitamin D deficiency. INTRODUCTION Vitamin D deficiency among school children and adolescents is a well-documented major public health problem, needing immediate attention. To assess the effect of vitamin D fortified milk on serum 25 hydroxy vitamin D [S.25(OH)D] levels, we carried out a prospective double-blind randomized control trial in apparently healthy school children, aged 10-14 years. METHODS Of 776 subjects recruited out of 796 who consented, 713 (boys-300; girls-413) completed the study. Subjects were randomized into three groups. Group A (n = 237) received 200 ml of unfortified milk per day while group B (n = 243) and group C (n = 233) received 200 ml of milk fortified with 600 IU (15 μg) and 1,000 IU (25 μg) of vitamin D per day for 12 weeks. Serum calcium, phosphate, alkaline phosphatase, S.25(OH)D, and urinary calcium/creatinine ratio were estimated at baseline and after supplementation. RESULTS Hypovitaminosis D [25(OH)D < 20 ng/ml] was observed in 92.3 % subjects with mean S.25(OH)D level of 11.69 ± 5.36 ng/ml. There was no significant difference in S.25(OH)D levels among the three groups at baseline. The mean percentage change in S.25(OH)D level in groups B (137.97 %) and C (177.29 %.) were significantly greater than group A (-5.25 %). The percentage of subjects having S.25(OH)D levels >20 ng/ml following supplementation were 5.9 % in group A, 69.95 % in group B, and 81.11 % in group C in comparison to 6.32 %, 4.9 % and 12 %, respectively, at baseline. CONCLUSION Fortification of milk with vitamin D is an effective and safe strategy in improving S.25(OH)D levels in children aged 10-14 years.
Collapse
Affiliation(s)
- R Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Aggarwal R, Bansal D, Bansal F, Nanda N, Ray P, Trehan A, Marwaha RK. Interleukin-5, interleukin-6, interleukin-8 and tumour necrosis factor-alpha levels obtained within 24-h of admission do not predict high-risk infection in children with febrile neutropenia. Indian J Med Microbiol 2013; 31:226-9. [DOI: 10.4103/0255-0857.115624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
Narayanan KR, Bansal D, Walia R, Sachdeva N, Bhansali A, Varma N, Marwaha RK. Growth failure in children with chronic myeloid leukemia receiving imatinib is due to disruption of GH/IGF-1 axis. Pediatr Blood Cancer 2013; 60:1148-53. [PMID: 23322583 DOI: 10.1002/pbc.24397] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/17/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND The frontline treatment for chronic myeloid leukemia (CML) is tyrosine kinase inhibitor therapy. There is increasing evidence that imatinib results in growth failure in children; etiology is unclear. PROCEDURE The cross-sectional study was conducted from January 2011 to June 2012 in a pediatric oncology unit. Patients with chronic-phase CML, receiving imatinib for more than 6 months were enrolled. Growth hormone (GH): Insulin like growth factor-1 (IGF-1) axis was evaluated by GH stimulation test by insulin tolerance and clonidine stimulation test, among other hormonal assays. RESULTS Eighteen patients with a median age of 12.9 years (range 6.5-17) completed the study. The mean duration of imatinib therapy was 43.7 ± 32.8 months. The height-for-age z-scores at the start of imatinib and at enrollment were -1.07 ± 0.88 and -1.8 ± 0.98, respectively (P < 0.001). Seven (39%) patients were GH deficient and lacked a sufficient response to either of the two stimulation tests. Majority, 16 (89%) patients had IGF-1 z-scores less than the mean. IGFBP-3 levels were below the mean in all patients. Every patient had deficiency of either GH, or IGF-1, or both. Bone age was delayed in 7 (39%). CONCLUSIONS This study demonstrates that imatinib results in growth failure in children with CML by disturbing the GH:IGF-1 axis. GH stimulation test and serum IGF-1 levels should be performed in children on treatment with imatinib who have growth retardation. Future studies should evaluate the role of recombinant GH therapy for ameliorating the adverse effect on growth.
Collapse
Affiliation(s)
- Karthik R Narayanan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | |
Collapse
|
26
|
Verma S, Singhi SC, Marwaha RK, Singhi P, Singh S, Singh M. Tropical pyomyositis in children: 10 years experience of a tertiary care hospital in northern India. J Trop Pediatr 2013; 59:243-5. [PMID: 23407284 DOI: 10.1093/tropej/fmt005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tropical pyomyositis (TP) is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. It has been reported frequently from Africa and Latin America. However, there are only a few cases reported in children from India. Between January 2002 and December 2011, 40 children with TP were admitted to our hospital, and their retrospective review formed the study material. TP is not an uncommon disease in children in Northern India, especially during rainy seasons. Most of the patients were admitted with short history of fever, pain and localized swelling. Pus drainage was done in 87.5% cases, with the amount of pus varying from 5 to 2000 ml. The pus grew methicillin-sensitive Staphylococcus aureus (MSSA) in 42.5% cases, whereas initial blood cultures were sterile. All received antibiotics along with surgical drainage, and recovered. It is important for health professionals to have a high index of suspicion and familiarity with this imminently treatable disease entity.
Collapse
Affiliation(s)
- Sanjay Verma
- Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. A systematic approach with relevant clinical history and examination along with appropriate laboratory investigations aid in reaching the diagnosis promptly. Indication and administration of blood products including fresh frozen plasma, cryoprecipitate, random donor and single donor apheresis platelets is elaborated. Management of hemophilia, Von Willebrand disease, disseminated intravascular coagulation and bleeding in cyanotic congenital heart disease, among other causes is outlined. Role of antifibrinolytic therapy, desmopressin and recombinant factor VIIa is briefly described. The review outlines the approach to a bleeding child in the emergency room. Practical points in history, examination, investigations and management are discussed. Management in resource constraint setting of developing countries is addressed.
Collapse
Affiliation(s)
- Deepak Bansal
- Hematology -Oncology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
28
|
Abstract
Febrile neutropenia is a common emergency encountered in children receiving chemotherapy for a malignancy. Left untreated, it can lead to serious morbidity and mortality. Febrile neutropenia is suspected in any patient on chemotherapy who presents with fever. Prompt evaluation and management by the primary contact pediatrician is essential for a successful outcome. A detailed history and physical examination is warranted to identify source of infection, although two thirds of them may not have localizing symptoms or signs. Risk stratification is valuable in categorizing the severity and guiding therapy. Initial stabilization, prompt initiation of appropriate antibiotics and adequate supportive care are the cornerstone of treatment. Knowledge of the locally prevailing bacteriological profile and antimicrobial susceptibility data is crucial for each hospital/unit to frame and periodically modify guidelines for the choice of antimicrobials. Delay in initiating antimicrobials significantly worsens the outcome. Education of the family as well as the members of the treating unit is important in this regard. Pro-active steps must be taken to reduce incidence of hospital acquired sepsis. Diagnosis and management in relevance to the emergency room is reviewed and institutional practice is shared.
Collapse
Affiliation(s)
- Sapna Oberoi
- Hematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | | | | |
Collapse
|
29
|
Naseem S, Varma N, Marwaha RK, Agarwal P. T-lineage acute lymphoblastic leukemia and parvovirus infection in a child with neurofibromastosis-1. INDIAN J PATHOL MICR 2013; 56:446-8. [DOI: 10.4103/0377-4929.125366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Abstract
Superior Vena Cava Syndrome (SVCS) refers to signs and symptoms caused by obstruction of the superior vena cava. Superior mediastinal syndrome (SMS) is the term used when SVCS coexists with obstruction of trachea. In children, a mediastinal pathology causing SVCS generally results in SMS as well, due to the limited chest volume. Hence, the two terms are often used interchangeably in children. SMS is a medical emergency that can be challenging, albeit often rewarding to manage. The common causes in a patient presenting to pediatric emergency room include non-Hodgkin lymphoma and acute lymphoblastic leukemia. Patients with SMS are at a very high risk for adverse cardio-respiratory events in case they are administered any kind of anesthetic agents, anxiolytics or sedatives. Investigations, including tissue diagnosis are desirable, though not mandatory, before initiating emergency management. The patient's clinical condition should dictate the speed, requirement and sequence of investigations and the specific treatment. The least invasive procedure should be performed to confirm the diagnosis. As the most common cause of SMS in children is lymphoma/leukemia, the administration of systemic steroids is often the front line therapy. Diagnosis, monitoring and management of SMS in relevance to the pediatric emergency room are outlined.
Collapse
Affiliation(s)
- Richa Jain
- Department of Pediatrics, Pediatric Hematology Oncology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | | |
Collapse
|
31
|
Bhatia P, Binota J, Varma N, Das R, Bansal D, Trehan A, Marwaha RK, Malhotra P, Varma S. Clinico-hematological, immunophenotyping, and molecular transcript profile of BCR–ABL-positive B cell acute lymphoblastic leukemias. J Hematop 2012. [DOI: 10.1007/s12308-012-0171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
32
|
Marwaha RK, Kulkarni KP. Hematuria and renal involvement at presentation in acute lymphoblastic leukemia. Saudi J Kidney Dis Transpl 2012; 23:1088-9. [PMID: 22982933 DOI: 10.4103/1319-2442.100965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
33
|
Bansal D, Shava U, Varma N, Trehan A, Marwaha RK. Imatinib has adverse effect on growth in children with chronic myeloid leukemia. Pediatr Blood Cancer 2012; 59:481-4. [PMID: 22052850 DOI: 10.1002/pbc.23389] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/14/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-term adverse effects of Imatinib in children with chronic myeloid leukemia (CML) are uncertain. The aim was to study the effect of imatinib on growth in children with CML. PROCEDURE Children ≤13 years of age at diagnosis were enrolled retrospectively, from 2004 to 2011, from a single center in India. Patients who received imatinib for >1 year were included for growth assessment. Height standard deviation scores (SDS) were derived from WHO-AnthroPlus, a global growth monitoring tool. RESULTS Thirty-four children received imatinib. Twenty children fulfilled the criteria for assessment of growth. Median age was 10 years (range: 2-13). Of 20 children, 13 were prepubertal at commencement of imatinib. The mean duration of imatinib in 20 children was 61.3 ± 16.2 months (range: 31-83). No patient was treated with a second-generation tyrosine kinase inhibitor or a stem cell transplant. Highly significant reduction in height SDS's was observed (P = 0.002 at 5th year). Children who started imatinib therapy after the onset of puberty were immune to this adverse effect (P = 0.448 and 0.003 at 5th year of treatment for pubertal and prepubertal children, respectively). The 5-year survival probability of 33 children who received imatinib in chronic phase was 80% with a median survival time of 60 months (mean: 70.2; 95% CI: 60-80.5). CONCLUSIONS Growth retardation is a significant adverse effect of imatinib in children with CML. The failure to gain appropriate height was most discernible when imatinib was initiated in the prepubertal period. Etiology and remedial measures need to be investigated.
Collapse
Affiliation(s)
- Deepak Bansal
- Advanced Pediatric Center, Pediatric Hematology-Oncology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | |
Collapse
|
34
|
Bhatia P, Binota J, Varma N, Bansal D, Trehan A, Marwaha RK, Malhotra P, Varma S. Incidence of common chimeric fusion transcripts in B-cell acute lymphoblastic leukemia: an Indian perspective. Acta Haematol 2012; 128:17-9. [PMID: 22572394 DOI: 10.1159/000338260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/13/2012] [Indexed: 12/17/2022]
Affiliation(s)
- P Bhatia
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Bansal D, Trehan A, Gupta MK, Varma N, Marwaha RK. Serodiagnosis of celiac disease in children referred for evaluation of anemia: a pediatric hematology unit's experience. INDIAN J PATHOL MICR 2012; 54:756-60. [PMID: 22234104 DOI: 10.4103/0377-4929.91488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Children presenting with typical clinical features of celiac disease (CD) are diagnosed relatively easily, however, diagnosis remains challenging and is often delayed when they present with 'difficult to treat anemia' without overt gastrointestinal manifestations. Index study was undertaken to report profile of patients referred to pediatric hematology unit with 'difficult anemia' who subsequently were diagnosed with CD. MATERIALS AND METHODS The records of 83 patients (1988-2008) with CD were scrutinized retrospectively who had presented with predominant hematological manifestations. RESULTS CD was confirmed histologically in 31 (37%), while 52 (63%) were diagnosed by serology alone. The mean age at diagnosis was 8.0 ± 2.8 years. The mean duration of symptom-diagnosis interval was 40.9 ± 30.6 months. Eighty-one (98%) children had anemia (Hb < 11 g/dl) and 55 (66%) had received iron supplements without discernible benefit. Thirty-nine (47%) patients received a blood transfusion. Thirty-six (43%) patients did not have diarrhea. Majority of the patients had either a microcytic-hypochromic (48%) or dimorphic (43%) anemia. Twenty-four (33%) had thrombocytosis, while 5 (7%) had thrombocytopenia. Mean duration of follow-up for patients on roll in the clinic for more than six months was 17.7 ± 20.9 months. CONCLUSION Pediatricians and hematologists need to be aware of the extra-intestinal manifestations of CD. Prolonged duration of symptoms and a diagnosis at a relatively older age is striking in children presenting with predominantly hematological manifestations. Investigations for CD are recommended in children presenting with iron deficiency anemia refractory to hematinics or who have coexisting growth retardation. Necessity for biopsy in overtly symptomatic cases is discussed.
Collapse
Affiliation(s)
- Deepak Bansal
- Pediatric Hematology-Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | |
Collapse
|
36
|
Bhakhri BK, Vaidya PC, Trehan A, Marwaha RK, Garewal G. Iron deficiency anemia in children presenting with lymphoreticular malignancies and the effect of induction therapy. Pediatr Hematol Oncol 2012; 29:148-53. [PMID: 22376018 DOI: 10.3109/08880018.2011.627979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is scant information regarding iron deficiency in children with malignant disorders. Serum iron status of children with lymphoreticular malignancies (LRMs) at onset and at the end of induction therapy, compared to the normal population, was evaluated. Prospective cohort study conducted between July 2002 and March 2004. Previously untreated children recently diagnosed with LRM were studied. Age-matched controls were enrolled from follow-up and growth monitoring clinics. Hematological (complete blood counts and red cell indices) parameters and markers of iron status (serum iron, serum ferritin, total iron binding capacity) were estimated at presentation and at the end of remission induction therapy, that is, 5 weeks after initial evaluation. Bone marrow iron store were only assessed in cases. Thirty-five children (31 with acute lymphoid leukemia, 2 with acute myeloid leukemia, and 2 with non-Hodgkin lymphoma; 27 boys and 8 girls; 2 to 12 years of age) were evaluated in the study cohort. Anemia was documented in 80% of children with LRM. Iron deficiency was an important etiological factor. In the majority of cases therapy resulted in significant improvement towards normalization of deranged hematological parameters. This phenomenon could be attributed to enhanced quantity and quality of erythropoietic activity and red cell transfusions. The observation suggests that therapeutic iron supplements are not indicated in the majority of children on therapy for malignant disorders. Various hematological and body iron status parameters should be assessed on a case-by-case basis.
Collapse
Affiliation(s)
- Bhanu Kiran Bhakhri
- Division of Pediatric-Hematology-Oncology, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | |
Collapse
|
37
|
Rana P, Sripathy G, Varshney A, Kumar P, Devi MM, Marwaha RK, Tripathi RP, Khushu S. Phosphorous magnetic resonance spectroscopy-based skeletal muscle bioenergetic studies in subclinical hypothyroidism. J Endocrinol Invest 2012; 35:129-34. [PMID: 21508663 DOI: 10.3275/7676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Subclinical hypothyroidism (sHT) is considered to be a milder form of thyroid dysfunction. Few earlier studies have reported neuromuscular symptoms as well as impaired muscle metabolism in sHT patients. AIM/OBJECTIVE In this study we report our findings on muscle bioenergetics in sHT patients using phosphorous magnetic resonance spectroscopy (31P MRS) and look upon the possibility to use 31P MRS technique as a clinical marker for monitoring muscle function in subclinical thyroid dysfunction. SUBJECTS AND METHODS Seventeen normal subjects, 15 patients with sHT, and 9 patients with hypothyroidism performed plantar flexion exercise while lying supine in 1.5 T magnetic resonance scanner using custom built exercise device. MR Spectroscopy measurements of inorganic phosphate (Pi), phosphocreatine (PCr), and ATP of the calf muscle were taken during rest, at the end of exercise and in the recovery phase. PCr recovery rate constant (kPCr) and oxidative capacity were calculated by monoexponential fit of PCr vs time (t) at the beginning of recovery. RESULTS We observed that changes in some of the phosphometabolites (increased phosphodiester levels and Pi concentration) in sHT patients which were similar to those detected in patients with hypothyroidism. However, our results do not demonstrate impaired muscle oxidative metabolism in sHT patients based upon PCr dynamics as observed in hypothyroid patients. CONCLUSIONS 31P MRS-based PCr recovery rate could be used as a marker for monitoring muscle oxidative metabolism in sub clinical thyroid dysfunction.
Collapse
Affiliation(s)
- P Rana
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Nikbakht M, MalekZadeh K, Kumar Jha A, Askari M, Marwaha RK, Kaul D, Kaur J. Polymorphisms of MTHFR and MTR genes are not related to susceptibility to childhood ALL in North India. Exp Oncol 2012; 34:43-48. [PMID: 22453148] [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: 05/31/2023]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most worldwide common type of childhood cancer. Methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR) participate in folate pathways and are known as critical factors for DNA integrity as well as DNA hypomethylation. The aim of this work is to investigate frequency of MTHFR (677C→T and 1298A→C) and MTR (2756A→G) polymorphisms and their interaction with respect to possible effect on risk of childhood ALL among North Indian population. PROCEDURE A case control study from has been conducted on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls using PCR-RFLP method. RESULTS No statistically significant differences were observed for different genotypes between patients and controls (p>0.05). Significant difference for the risk of ALL in individuals having genotype of MTHFR 677TT (OR=0.61, 95% CI=0.21-1.77) and MTHFR 1298CC (OR=0.56, 95% CI=0.18-1.68) was not observed. The correlation of SNP of MTR gene and risk of ALL was not observed, too. CONCLUSIONS The differences in distribution of possible combined genotypes of MTHFR (677C→T, 1298A→C) and MTR (2756A→G) between ALL patients and controls were statistically insignificant.
Collapse
Affiliation(s)
- M Nikbakht
- Department of Biotechnology, Panjab University (PU), Chandigarh, India
| | | | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Inusha Panigrahi
- Division of Genetics, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | |
Collapse
|
40
|
Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bhadra K, Mithal A. Bone health in healthy Indian population aged 50 years and above. Osteoporos Int 2011; 22:2829-36. [PMID: 21271341 DOI: 10.1007/s00198-010-1507-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/05/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED One thousand six hundred healthy subjects aged more than 50 years, residing in Delhi, were evaluated for bone mineral metabolic parameters. High prevalence of osteoporosis (35.1% subjects) was observed in this population. Bone mineral density (BMD) correlated positively with body mass index (BMI) and negatively with PTH levels. No correlation was observed with serum 25(OH)D levels. INTRODUCTION To assess the bone health status in elderly Indians and compare peripheral DXA (pDXA) with central DXA in evaluation of osteoporosis. METHODS The study involved 1,600 healthy subjects more than 50 years of age residing in Delhi, India, who underwent anthropometric, biochemical, and hormonal evaluation. BMD was measured by DXA at lumbar spine, hip, and distal radius; and by pDXA at forearm and calcaneum. RESULTS Seven hundred ninety-two males and 808 postmenopausal females, with a mean age of 57.67 ± 9.46 years were evaluated. Osteoporosis was present in 35.1% subjects (M-24.6%, F-42.5%) and osteopenia in 49.5% (M-54.3%, F-44.9%). Prevalence of osteoporosis increased with age in females, but not in males. BMD at all sites, except distal radius, was positively correlated with BMI (r=0.037, p=0.14). Total body BMD was negatively correlated with alkaline phosphatase (r= -0.184, p<0.00001) and PTH levels (r= -0.099, p<0.00001), respectively. No significant correlation was observed between serum 25(OH)D levels and BMD at any site. BMD at forearm and calcaneum, measured using pDXA, showed strong positive correlation with BMD measured by central DXA. pDXA had sensitivity of 88%, specificity of 55%, and negative and positive predictive values of 89% and 52%, respectively, at T-score -2.5 at peripheral sites compared to central DXA. CONCLUSIONS A high prevalence of osteoporosis was observed in elderly Indian subjects. pDXA has high negative predictive value, making it a useful tool in population screening for osteoporosis.
Collapse
Affiliation(s)
- R K Marwaha
- Department of Endocrinology and Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bandra K. Vitamin D status in healthy Indians aged 50 years and above. J Assoc Physicians India 2011; 59:706-709. [PMID: 22616336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION There is widespread prevalence of vitamin D deficiency from new-born to infancy, childhood and adult male and females (non-pregnant, pregnant and lactating). However, there is limited information of the vitamin D status in elderly Indians. MATERIAL AND METHODS The study was carried in 1346 healthy subjects more than 50 years of age residing in Delhi, India. These subjects, who were divided in two groups: Group-1 (50-< 65 years) and Group-2 (> or = 65 years), underwent anthropometric, biochemical and hormonal evaluation for vitamin D status Bone mineral density was measured by dual X-ray absorptiometry. RESULTS There were 643 males and 703 females, with a mean age of 58.0 +/- 9.5 years (range 50-84 years). Vitamin D deficiency [VDD, serum 25(OH)D levels < 20 ng/ml) was present in 1228 (91.2%) and Vitamin D insufficiency [VDI, serum 25(OH)D levels 20-< 30 ng/ml] in 92 (6.8%). There was no significant difference in prevalence of either VDD or VDI between two age groups and sexes. Serum 25(OH)D levels were negatively correlated with PTH levels (r -0.027, p <0.00001) and BMI (r -0.128, p 0.05). Prevalence of secondary hyperparathyroidism increased from 14.1% to 43.1% from VDI to severe VDD. PTH levels started rising at vitamin D level < 30 ng/ml. However, more than 50% of subjects with severe VDD had PTH levels within normal range. High prevalence of osteopenia (50.2%) and osteoporosis (31.2%) was observed in this population. CONCLUSION Hypovitaminosis D is universal above the age of 50 years in north India. Absence of a PTH response was observed in more than 50% of individuals with VDD, the cause of which merits further evaluation. Normal bone mass was observed in only 18.6% of study subjects.
Collapse
Affiliation(s)
- R K Marwaha
- Department of Endocrinology and Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Bhatia P, Haldar D, Varma N, Marwaha RK, Varma S. A case series highlighting the relative frequencies of the common, uncommon and atypical/unusual hematological findings on bone marrow examination in cases of visceral leishmaniasis. Mediterr J Hematol Infect Dis 2011; 3:e2011035. [PMID: 22084650 PMCID: PMC3212968 DOI: 10.4084/mjhid.2011.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 06/16/2011] [Accepted: 07/14/2011] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bone marrow aspiration and biopsy still remains as one of the vital tests for confirmation of diagnosis of visceral Leishmaniasis. The aim of the present study is to assess the relative frequency of common, uncommon and atypical hematological findings in cases of Visceral Leishmaniasis. MATERIALS #ENTITYSTARTX00026; METHODS A total of 16 cases of Leishmaniasis diagnosed on Bone marrow examination over a period of two years (2008-2010), were retrieved from the archives and the peripheral blood smear, bone marrow aspiration smears and trephine biopsies were examined for the common, uncommon and atypical features as described in the literature. RESULTS Out of the total of 16 cases, 10 were pediatric and 6 adult cases. The common findings like pancytopenia, peripheral blood monocytosis, increased histiocytes on aspirate smears and granulomas on biopsies were noted in 12/16 (75%), 9/16 (56.25%), 13/16 (81.2%) and 11/16 (69%) cases respectively. Amongst the uncommon findings, hemophagocytosis was noted in 12/16 (75%) cases, plasma cells with inclusions in 6/16 (37.5%) and LD bodies in cells other than histiocytes in 4/16 (25%) cases. The atypical findings included organism aggregates noted in 9/16 (56%) cases, Pelger-Heut cells seen in 4/16 (25%) cases and increased focal vascularity on biopsies in 10/16 (62.5%) cases. The average parasite density (APD) on smears was 3+ and the range of positivity was 1+ to 5+. CONCLUSION The knowledge of these morphological clues can assist us in searching for LD bodies and correctly diagnosing the condition without excessive dependence on unnecessary and sophisticated tests.
Collapse
Affiliation(s)
| | | | | | | | - Subhash Varma
- Department of Internal Medicine. Institute of Medical Education and Research, Chandigarh. India
| |
Collapse
|
43
|
Abstract
A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.
Collapse
Affiliation(s)
- K P Kulkarni
- Department of Pediatrics, Advanced Pediatric Center, PGIMER, Chandigarh, India
| | | | | | | |
Collapse
|
44
|
Abstract
Background: We assessed referral patterns of children with hematological malignancies (HM) in North India. Materials and Methods: The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptom-diagnosis), and number of contacts were compared between high- and standard-risk disease group. Results: Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1–6), 37 days (IQR 13–55), and 38 days (IQR 15–60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay. Conclusions: Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective.
Collapse
Affiliation(s)
- P M Ramesh
- Department of Pediatrics, Govt. TD Medical College, Alappuzha, Kerala, India
| | | | | |
Collapse
|
45
|
Marwaha RK, Khadgawat R, Tandon N, Kanwar R, Narang A, Sastry A, Bhadra K. Reference intervals of serum lipid profile in healthy Indian school children and adolescents. Clin Biochem 2011; 44:760-6. [PMID: 21620812 DOI: 10.1016/j.clinbiochem.2011.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/26/2011] [Accepted: 05/07/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To develop age and sex specific reference intervals of serum lipid parameters in healthy Indian children in the age group of 6-17 years. PARTICIPANTS Study subjects were selected from the schools of Delhi. Children with BMI either in overweight or obese category were excluded to generate reference intervals. The final analysis included 3076 children with BMI in normal range for age. RESULTS The mean±SD, 3rd, 10th, 25th, 50th, 75th, 90th and 97th centile values of lipid parameters are presented. All these parameters were significantly higher in girls than in boys. About 89.2% subjects had total cholesterol in acceptable range while 9.1% had borderline elevated and 1.5% had elevated TC. Optimal serum triglyceride levels were seen in 45.1% subjects while optimal levels of HDL cholesterol were seen in 0.3% subjects only. CONCLUSIONS Reference intervals of serum lipid parameters for healthy Indian children (6-17 years) are presented.
Collapse
Affiliation(s)
- R K Marwaha
- Dept of Endocrinology & Thyroid Research, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
| | | | | | | | | | | | | |
Collapse
|
46
|
Priyambada L, Bhatia V, Krishnani N, Agarwal V, Bhattacharyya A, Jain S, Mishra SK, Marwaha RK. Primary hypothyroidism, precocious puberty and hypothalamic obesity in Langerhans cell histiocytosis. Indian J Pediatr 2011; 78:351-3. [PMID: 21038089 DOI: 10.1007/s12098-010-0271-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 10/06/2010] [Indexed: 12/01/2022]
Abstract
A 5 year old girl presented with central diabetes insipidus and primary hypothyroidism. No clinical or radiological evidence of Langerhans cell histiocytosis (LCH) was present. Absent posterior pituitary bright spot was seen in magnetic resonance imaging of the brain. She subsequently developed severe headache, massive obesity, accelerated growth and thelarche. A repeat MRI of the brain revealed hypothalamic tumor. Hormonal investigations revealed, paradoxically, undetectable growth hormone on a clonidine stimulation test. Langerhans cell histiocytosis was proved on electron microscopy of the thyroid tissue. There needs to be a high degree of suspicion for LCH as an etiology of primary hypothyroidism, especially in the presence of diabetes insipidus. Precocious puberty, accelerated growth despite growth hormone deficiency, hypothalamic obesity may occur in pediatric LCH. CNS lesions may have an evolving course, thus repeat neuroimaging is important.
Collapse
Affiliation(s)
- Leena Priyambada
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Bansal D, Venkateshwaran S, Khandelwal N, Marwaha RK. Quantitative computed tomography is unreliable for measurement of bone mineral density in inadequately chelated adolescent patients with β-thalassemia major: a case-control study. Pediatr Blood Cancer 2011; 56:409-12. [PMID: 21113944 DOI: 10.1002/pbc.22912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Utility of quantitative computed tomography (QCT) for assessment of bone mineral density (BMD) in patients with thalassemia is not fully established. Majority of patients with thalassemia in India receive suboptimal iron chelation. There is paucity of data on BMD in this population. Aim was to assess BMD by lumbar QCT in adolescent patients with transfusion dependent β-thalassemia major and compare with controls. PROCEDURE Study was conducted prospectively, over 15 months. Single energy QCT was performed through first three lumbar vertebrae. RESULTS Forty-five patients were enrolled (age: 10-19 years). Thirty-eight normal siblings of patients with thalassemia patients served as controls. Forty percent patients weighed <3rd percentile, 64% were stunted, and 40% had suboptimal sexual maturity scores. Eighteen (40%) patients were on iron chelation with deferiprone. Mean serum ferritin was 2,800 ± 1,473 ng/ml. Mean BMD (mg/cu mm) of cases and controls was 194.5 ± 27.1 and 170.4 ± 28.84, respectively (P = 0.0002). The mean BMD of patients with ferritin <2,000 ng/ml and those with a higher ferritin was 181.2 ± 14.9 and 196.7 ± 25, respectively (P = 0.07). The finding of increased BMD in patients with thalassemia is in stark contrast to published reports. Patients had several risk factors for low BMD, including growth retardation, delayed puberty, and iron overload. CONCLUSION Single energy QCT of lumbar vertebrae is not reliable for measurement of BMD in inadequately chelated patients with β-thalassemia major. The deposition of iron in bone tissue may result in increased X-ray attenuation values of trabecular bone.
Collapse
Affiliation(s)
- Deepak Bansal
- Hematology/Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
48
|
Marwaha RK, Gopalakrishnan S. Facts of iodine supplementation. J Assoc Physicians India 2011; 59 Suppl:7-10. [PMID: 21818999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- R K Marwaha
- Division of Thyroid Research, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Marg, Timarpur, Delhi-110054, India
| | | |
Collapse
|
49
|
Marwaha RK, Kulkarni KP. Superior vena cava obstruction in childhood acute lymphoblastic leukemia. Indian Pediatr 2011; 48:78-79. [PMID: 21317479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
50
|
Abstract
BACKGROUND Predominant etiologies of febrile neutropenia (FN) during the course of cancer chemotherapy include infections with bacteria, fungi, and viruses. Infection with malarial parasite is a possibility in regions that are endemic for malaria. Over-diagnosis and over-treatment of malaria is increasingly being recognized as a serious concern in malaria endemic regions. Aim was to determine the incidence of malarial infection in episodes of FN in children receiving chemotherapy for malignant disorders. METHODS Children, with malignant disorders, on chemotherapy, who fulfilled the definition of FN were enrolled prospectively. Standard microscopy, quantitative buffy coat, and antigen detection (OptiMAL) were performed in each episode of FN. RESULTS One hundred episodes of FN involving 82 children were investigated. The age ranged from 2 to 13 years (mean: 5.8 ± 2.8). Eighty-one episodes were in children with acute lymphoblastic leukemia, 15 in acute myeloid leukemia, and remaining 4 in other malignancies. Evidence for malaria was not found in any case by any of the three methods. CONCLUSIONS Malaria was not found to be a causative agent for FN in children with various malignant disorders, in a region with low endemicity for malaria. Presumptive administration of antimalarials in children with FN is unjustified. Pediatric oncologists constantly face the challenge of managing febrile illnesses in immunocompromised patients. Those practicing in malaria endemic regions can effectively exploit diagnostic tools for malaria for a rational decision.
Collapse
Affiliation(s)
- Deepak Bansal
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Chandigarh, India.
| | | | | | | |
Collapse
|