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Ganesan K, Duraisamy S, Meena SK, Yenigalla N, Swaminathan VV, Uppuluri R, Raj R. Genital Graft-versus-Host Disease in Children: An Underdiagnosed and Undertreated Entity. Transplant Cell Ther 2024; 30:228.e1-228.e5. [PMID: 37926190 DOI: 10.1016/j.jtct.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/09/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
Genital graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication, especially in the pediatric population. We report our data on children with genital manifestations of GVHD and their unique clinical features. The study included children up to age 18 years who underwent hematopoietic stem cell transplantation (HSCT) over a 20-year period from February 2002 to February 2022. A total of 1035 children underwent HSCT during the study period. Genital GVHD was documented in 164 children (15.8%). Among these 164 children, 23 (14%) were age <2 years, 98 (59.8%) were age 2 to 10 years, and 43 (26.2%) were age ≥10 years. The conditioning regimen was myeloablative in 122 children (74.4%) and reduced intensity in 42 children (25.6%). Donor type was matched related donor in 62 (37.8%), matched unrelated donor in 44 (26.8%), and haploidentical in 34 (20.7%). Peripheral blood stem cells (PBSCs) were used in 78.7% of the children (n = 129), and sex mismatch was noted in 31.1% of genital GVHD cases (51 of 164). The overall incidence of chronic oral GVHD was 33% (342 of 1035), and of these, 47.9% (164 of 342) also had genital GVHD. Patients with genital GVHD ultimately may require surgical management; 21.5% (22 of 103) of boys with genital GVHD ultimately required circumcision for phimosis, and 1 female patient developed hematocolpos necessitating surgical management. Our case series highlights the significant association between chronic oral GVHD and genital GVHD. Given the strong association between oral GVHD and genital GVHD in children, it is imperative to examine the genital area in all children on follow-up for chronic GVHD. Donor-recipient sex mismatch and use of PBSC grafts predispose to chronic genital GVHD. Early identification and treatment of genital GVHD may help prevent complications, including scarring and phimosis.
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Affiliation(s)
- Kavitha Ganesan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India.
| | - Suresh Duraisamy
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Satish Kumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Navyasri Yenigalla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | | | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
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Ganesan K, Duraisamy SR, Chakraborty S, Meena SK, Venkateswaran V, Uppuluri R, Raj R. Allogeneic hematopoietic stem cell transplantation in relapsed/refractory Hodgkin lymphoma in children: A prospective, single arm study from India. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ganesan K, Duraisamy SR, Chakraborty S, Meena SK, Venkateswaran V, Uppuluri R, Raj R. Pulse dexamethasone and lenalidomide in Rosai Dorfman disease: Efficacy and tolerability of an oral combination chemotherapy regimen for symptomatic and recurrent disease. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.033] [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: 11/26/2022] Open
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Ganesan K, Duraisamy SR, Chakraborty S, Meena SK, Venkateswaran V, Uppuluri R, Raj R. A novel risk stratification based therapy relevant to India for children with E beta thalassemia. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Swaminathan VV, Uppuluri R, Meena SK, Varla H, Chandar R, Ramakrishnan B, Jayakumar I, Raj R. Treosulfan-Based Conditioning in Matched Family, Unrelated and Haploidentical Hematopoietic Stem Cell Transplantation for Genetic Hemophagocytic Lymphohistiocytosis: Experience and Outcomes over 10 Years from India. Indian J Hematol Blood Transfus 2022; 38:84-91. [PMID: 35125715 PMCID: PMC8804033 DOI: 10.1007/s12288-021-01422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
We aimed to analyze data in children with primary hemophagocytic lymphohistiocytosis (HLH) who underwent hematopoietic stem cell transplantation (HSCT). We performed a retrospective study where children up to 18 years, with primary HLH and who underwent HSCT from January 2011 to December 2019, were included. Twenty-five children with genetic HLH underwent HSCT, including variants (Griscelli syndrome (GS2) 7, Chediak-Higashi syndrome (CHS) 2, XIAP mutation 2). Donors were matched family 8 (32%), umbilical cord blood unit 3 (12%), matched unrelated 2 (8%), haploidentical HSCT 12 (48%), (TCR alpha/beta depletion 2 and post-transplant cyclophosphamide 10). With treosulfan-based conditioning, engraftment was achieved in 23/25 (92%) transplants (100% in haplo-HSCT), with sustained complete chimerism in 87%. Disease-free survival was noted in 2/3 children with stable mixed chimerism. Graft-versus-host disease (GVHD) of grade I/II was noted in 6 (24%), grade III in 3 (13%); chronic limited skin GVHD in 2 (12%) children. Overall survival was 72% (87.5% in matched donor, 66.7% in the haplo-HSCT), 71% in GS2, 50% in CHS, 100% in XIAP. HSCT is curative in primary HLH with acceptable disease-free survival with mixed chimerism. Haplo-HSCT is a viable option for those without matched family or unrelated donors.
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Affiliation(s)
- Venkateswaran Vellaichamy Swaminathan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Satish Kumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Harika Varla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Rumesh Chandar
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | | | - Indira Jayakumar
- Department of Pediatric Critical Care, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
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Meena SK, Chandar R, Varla H, Swaminathan VV, Uppuluri R, Jayakumar I, Ramakrishnan B, Raj R. Treatment free remission in pediatric CML. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Varla H, Meena SK, Chandar R, Swaminathan VV, Uppuluri R, Jayakumar I, Lakshmanan V, Raj R. Extracorporeal photopheresis in the management of graft versus host disease in children– Single centre experience from India. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Varla H, Meena SK, Chandar R, Swaminathan VV, Uppuluri R, Jayakumar I, Raj R. Improved outcomes in immunosuppressive therapy in children with severe aplastic anemia with the addition of Eltrombopag. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Meena SK, Chandar R, Varla H, Swaminathan VV, Uppuluri R, Jayakumar I, Ramakrishnan B, Raj R. Tacrolimus offers an effective GVHD prophylaxis with a tolerable toxicity profile in pediatric hematopoietic stem cell transplantation. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Varla H, Meena SK, Chandar R, Swaminathan VV, Uppuluri R, Jayakumar I, Lakshmanan V, Raj R. Haematopoietic stem cell transplantation in rare transfusion dependant haematological conditions –A single center experience. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.121] [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: 11/25/2022] Open
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Varla H, Meena SK, Chandar R, Swaminathan VV, Uppuluri R, Jayakumar I, Lakshmanan V, Raj R. The outcome of children with graft failure post hematopoietic stem cell transplantation- Experience from a tertiary referral center in southern India. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.032] [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: 11/25/2022] Open
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Singh A, Saini I, Meena SK, Gera R. Demographic and Clinical Profile of Mortality Cases of COVID-19 in Children in New Delhi. Indian J Pediatr 2021; 88:610. [PMID: 33689110 PMCID: PMC7944241 DOI: 10.1007/s12098-021-03687-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Amitabh Singh
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Isha Saini
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Satish Kumar Meena
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Rani Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
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Ganesan B, Fong KNK, Meena SK, Prasad P, Tong RKY. Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study. Eur Rev Med Pharmacol Sci 2021; 25:3614-3622. [PMID: 34002837 DOI: 10.26355/eurrev_202105_25845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown. MATERIALS AND METHODS Online cross-sectional survey was conducted between April 2020 and May 2020. RESULTS 114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing. CONCLUSIONS The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.
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Affiliation(s)
- B Ganesan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR.
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Vellaichamy Swaminathan V, Ravichandran N, Ramanan KM, Meena SK, Varla H, Ramakrishnan B, Jayakumar I, Uppuluri R, Raj R. Augmented immunosuppression and PTCY-based haploidentical hematopoietic stem cell transplantation for thalassemia major. Pediatr Transplant 2021; 25:e13893. [PMID: 33111490 DOI: 10.1111/petr.13893] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/03/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
Alternate donor HSCT for thalassemia major from a matched unrelated donor or haploidentical family donor is a feasible therapeutic option in children with no matched family donor. Aggressive pretransplant immunosuppression, reduced toxicity conditioning, and PTCY result in excellent thalassemia-free survival. We describe here our experience in this cohort. We performed a retrospective analysis of the data on children who underwent a haploidentical HSCT for thalassemia major with PTCY at our center from August 2017 to August 2019. All children received pretransplant immune suppression for 6 weeks with fludarabine and dexamethasone, hypertransfusion and chelation with intravenous desferrioxamine. Conditioning included thiotepa, fludarabine, rabbit ATG, and cyclophosphamide, and GvHD prophylaxis included PTCY with tacrolimus. Twenty children were included and nineteen children engrafted. Acute hypertension occurred in five children, bacterial infection in eight children and viral respiratory infection in three children. Three children suffered from graft rejection. Reactivation of viruses namely CMV, adenovirus, and BK virus was seen in 60% of children. Grades 1-2 acute GvHD of the skin in four children (20%) and limited chronic GvHD of the skin in four children (20%). Immune cytopenia was documented in three children (15%). Haploidentical HSCT offers a therapeutic option for children with thalassemia major with no suitably matched family or unrelated donors. Our reduced toxicity regimen with PTCY offers a DFS of 75% and OS of 95% with low transplant-related mortality of 5%.
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Affiliation(s)
| | - Nikila Ravichandran
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Kesavan Melarcode Ramanan
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Satish Kumar Meena
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Harika Varla
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | | | - Indra Jayakumar
- Department of Pediatric Intensive Care, Apollo Cancer Institutes, Chennai, India
| | - Ramya Uppuluri
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
| | - Revathi Raj
- Department of Paediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Cancer Institutes, Chennai, India
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Ganesan B, Gowda T, Al-Jumaily A, Fong KNK, Meena SK, Tong RKY. Ambient assisted living technologies for older adults with cognitive and physical impairments: a review. Eur Rev Med Pharmacol Sci 2020; 23:10470-10481. [PMID: 31841201 DOI: 10.26355/eurrev_201912_19686] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The global number of people over the age of 60 years is expected to increase from 970 million to 2.1 billion in 2050 and 3.1 billion in 2100. About 80% of the aging population will be in the developing countries. Aging population may suffer from various physical, cognitive, and social problems, due to aging process such as impairment of physical related functions (decreased mobility and walking speed, falls, frailty, decreased walking speed, difficulties in basic, and instrumental activities of daily living), cognitive related functions (memory-related issues), sensory functions (hearing loss, cataracts and refractive errors, presbyopia, decreased vestibular function), behavioural and psychological disorders, social isolation issues, and poor quality of life. Over the period of the last few decades, emerging technologies such as internet of things (IoT), artificial intelligence (AI), sensors, cloud computing, wireless communication technologies, and assistive robotics have given the vision to develop various ambient or active assisted living (AAL) approaches for supporting an elderly people to live safely and independently in their living environment and participate in their daily and community activities, as well as supporting them to maintain their physical, mental health, and quality of their life. The aim of this paper is to review the use of Ambient or Active Assisted Living for older adults with physical, cognitive impairments, and their social participation.
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Affiliation(s)
- B Ganesan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, SAR.
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Varla H, Meena SK, Ravichandran N, Ramanan KM, Swaminathan VV, Satheesan R, Raj R, Uppuluri R. Langerhan Cell Histiocytosis – Unusual sites and innovative interventions. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
OBJECTIVE We conducted a study to find a relationship between main weather parameters with admission of positive dengue cases in a tertiary hospital. METHODS Retrospective analysis was undertaken to identify epidemiological trend of dengue in 2016 from paediatric wards of a tertiary hospital in New Delhi. Data were collected on patient particulars and daily weather from January to December 2016. RESULTS A total of 266 confirmed cases of dengue were considered. Relative humidity (RH) was associated with burden of positive dengue cases. On week-wise analysis, each surge of dengue admission was preceded by heavy rain 4-6 weeks earlier. Monthly averaged daily temperature range and RH were noted to have strong correlations with dengue burden, keeping an interval of 2 months in between. CONCLUSIONS Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.
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Affiliation(s)
- Manas Pratim Roy
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi 29, India
| | - Ratan Gupta
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi 29, India
| | - Nidhi Chopra
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi 29, India
| | - Satish Kumar Meena
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi 29, India
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