1
|
Yanamandra U, Boddu R, Kumar A, Mishra K, Pramanik S, Kapoor R. Experience with Central Venous Access Devices in Hematology Practice from Resource Constraint Settings. Indian J Hematol Blood Transfus 2024; 40:353-355. [PMID: 38708171 PMCID: PMC11065810 DOI: 10.1007/s12288-023-01700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/03/2023] [Indexed: 05/07/2024] Open
Affiliation(s)
- Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, 411040 India
| | - Revanth Boddu
- Department of Hematology and Stem Cell Transplant, Army Hospital Research and Referral, Delhi, 110010 India
| | - Abhinav Kumar
- Department of Internal Medicine, Armed Forces Medical College, Pune, 411040 India
| | - Kundan Mishra
- Department of Hematology, Command Hospital, Central Command, Lucknow, 226002 India
| | - Suman Pramanik
- Department of Hematology, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - Rajan Kapoor
- Department of Hematology, Command Hospital, Central Command, Lucknow, 226002 India
| |
Collapse
|
2
|
Bhattachar S, Malhotra VK, Yanamandra U, Singh S, Sikri G, Patrikar S, Kotwal A. Ibuprofen Compared to Acetazolamide for the Prevention of Acute Mountain Sickness: A Randomized Placebo-Controlled Trial. Cureus 2024; 16:e55998. [PMID: 38606209 PMCID: PMC11007448 DOI: 10.7759/cureus.55998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Acetazolamide is recommended for the prevention of acute mountain sickness (AMS); however, its use is limited in some areas because of side effects. Previous studies report ibuprofen to be similar to or slightly inferior to acetazolamide. This randomized, triple-blinded, parallel-group, placebo-controlled trial was designed to compare ibuprofen with acetazolamide for the prevention of AMS. METHODS Four hundred forty-three healthy Asian Indian men with a mean age of 29 (range: 20-49) years were randomized into three groups A, B, and P at 350m (SL). Acetazolamide (A): 85 mg; ibuprofen (B): 600 mg; or placebo (P): calcium carbonate was administered thrice daily, starting one day prior and continuing for three days after arrival at 3500m (HA). Participants were evaluated for AMS using the Lake Louise Questionnaire and for pulse, BP, SpO2, and respiratory rate twice daily for the first two days during rest and once a day for days three to six at HA. RESULTS Of the 443 participants recruited at SL, 139 could not be airlifted due to logistical limitations, and 304 were available for follow-up at HA. Among these, 254 had ascended as per protocol. By intent to treat (IT) (N = 304; A = 99, B = 102, P = 103), the incidence of AMS (LLQS>/=3) was 12%, 5%, and 13%, and the incidence of severe AMS was 1%, 2%, and 6%, in groups A, B, and P, respectively. Using per protocol analysis (PP) (N = 254; A = 83, B = 87, P = 84), the incidence of AMS was 12%, 6%, and 13% in groups A, B, and P, respectively. The relative risk for developing AMS vs. placebo was A-0.96 (CI:0.46-2.0, p=0.91), B-0.39 (CI:0.14-1.04, p=0.06), A-0.94 (CI:0.42-2.1, p=0.88), and B-0.45 (0.16-1.24, p=0.12) by IT and PP, respectively. CONCLUSION Ibuprofen is effective in males for the prevention of AMS with rapid ascent to 3500 m-rest for the first two days. Acetazolamide was superior to ibuprofen in the prevention of moderate-to-severe AMS.
Collapse
Affiliation(s)
- Srinivasa Bhattachar
- Physiology, High Altitude Medical Research Centre, Leh, IND
- Space and Environmental Physiology, Institute of Aerospace Medicine, Bengaluru, IND
| | - Vineet K Malhotra
- Space and Environmental Physiology, Institute of Aerospace Medicine, Bengaluru, IND
| | | | | | - Gaurav Sikri
- Physiology, Armed Forces Medical Services, New Delhi, IND
| | - Seema Patrikar
- Community Medicine, Armed Forces Medical College, Pune, IND
| | - Atul Kotwal
- Community Medicine, National Health Systems Resource Centre, New Delhi, IND
| |
Collapse
|
3
|
Yanamandra U, Khadwal A, Gupta S, Thomas T, Lad D, Taneja N, Prakash G, Varma N, Varma S, Malhotra P. Diarrheal woes in transplantation from real world settings with special focus on clostridium difficile infection. Med J Armed Forces India 2023; 79:679-683. [PMID: 37981921 PMCID: PMC10654365 DOI: 10.1016/j.mjafi.2023.09.001] [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: 06/09/2023] [Accepted: 09/01/2023] [Indexed: 11/21/2023] Open
Abstract
Background Diarrhea is the major cause of discomfort and morbidity of patients undergoing hematopoietic stem cell transplant (HSCT). The cause of diarrhea may be infective or non-infective. Methods This is a prospective single center observational study from North India conducted over a period of approximately 4 years among 105 patients who underwent HSCT (autologous-72, allogeneic-33). The objective of the study was to identify the overall incidence and characteristics of diarrhea in HSCT in the real world, to evaluate any differences among allogeneic or autologous transplants, incidence of C Difficile among diarrheal patients, and antimicrobial usage among these patients. Results Diarrhea was present in 89 of 105 patients (84.7%). The mean diarrheal duration was of 8.39±4.57 days (range: 1-24 days). There was non statistical difference between the incidence of diarrhea amongst allogeneic and autologous transplants (78.9% Vs 87.5%). Out of 89 patients with diarrhea, 13 were CDTA positive. We could isolate Clostridium difficile in culture in only 7.6% of patients with CDTA positivity. Metronidazole was the antibiotic of choice for diarrhea in our post-transplant settings. Metronidazole was prescribed for a median duration of 8 days (Range: 3-18 days). Seventeen patients received oral vancomycin with a median duration of 8 days (Range: 5-14 days). Conclusion We conclude by saying that diarrhea was a common post-transplant morbidity. Clostridium difficile is not common in patients with the diarrhea post hematopoietic stem cell transplant. All cases of diarrhea need not be infective particularly in allogeneic settings.
Collapse
Affiliation(s)
- Uday Yanamandra
- Professor, Department of Medicine & Hematology, Armed Forces Medical College, Pune, India
| | - Alka Khadwal
- Professor (Hemat & BMT), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Setu Gupta
- Resident, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Timmy Thomas
- Nursing Officer, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepesh Lad
- Associate Professor (Hemat & BMT), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Taneja
- Professor (Microbiology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Prakash
- Professor (Hemat & BMT), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Varma
- Professor (Hematopath), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subhash Varma
- Professor (Hemat & BMT), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Professor & Head (Medical Oncology & Clinical Hematology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
4
|
Nair V, Yanamandra U, Nazneen P. Hematopoietic cell transplantation landscape in India. Med J Armed Forces India 2023; 79:621-630. [PMID: 37981919 PMCID: PMC10654369 DOI: 10.1016/j.mjafi.2023.09.002] [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: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 11/21/2023] Open
Abstract
Hematopoietic cell transplantation (HCT), commonly known as Bone marrow transplantation (BMT), is a medical procedure used to treat various conditions, including blood cancers, genetic disorders, and certain autoimmune diseases. The procedure involves replacing damaged or diseased bone marrow with healthy stem cells to promote the production of new, healthy blood cells. In India, HCT has been performed for several years in specialized medical centers. India has a growing healthcare infrastructure, and many hospitals are equipped to perform these procedures. Though there are studies on HCTs done at individual transplant centers in India, a comprehensive analysis of the current landscape of HCT in the country is lacking. HCT in India has seen major advances both in the quantity and quality of HCT centers. This review article has attempted to cover the gaps of HCT in India, including its status in the Armed Forces HCT centers.
Collapse
Affiliation(s)
- Velu Nair
- Chief Consultant & Head (Hematology & BMT), Apollo Cancer Center, Gandhinagar, Gujarat, India
- Former Dean, Armed Forces Medical College, Pune & DGMS (Army), Delhi Cantt, India
| | - Uday Yanamandra
- Professor, Department of Hematology & Stem Cell Transplant, Armed Forces Medical College, Pune, India
| | - P.S. Nazneen
- Assistant Divisional Medical Officer & Chief Physician, Divisional Railway Hospital, Ponmalai, Trichy, India
| |
Collapse
|
5
|
Ahuja A, Yanamandra U, Kapoor R, Chatterjee T. Unusual infection in a haploidentical transplant of Wiskott - Aldrich syndrome. Med J Armed Forces India 2023; 79:729-731. [PMID: 37981929 PMCID: PMC10654363 DOI: 10.1016/j.mjafi.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/09/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Ankur Ahuja
- Associate Professor, Department of Pathology, Armed Forces Medical College, Pune, India
| | - Uday Yanamandra
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Rajan Kapoor
- Professor & HoD (Hematology), Army Hospital (Research & Referral), Delhi, India
| | - Tathagata Chatterjee
- Ex-Professor & Head, (Lab Sciences), Army Hospital (Research & Referral), Delhi, India
| |
Collapse
|
6
|
Kumar R, Kapoor R, Sharma S, Pramanik SK, Yanamandra U, Mishra K, Khera S, Sharma A, Das S, Verma T, Singh J, Nair V. Bone marrow transplant: A two-decade single centre hematology experience. Med J Armed Forces India 2023; 79:657-664. [PMID: 37981920 PMCID: PMC10654354 DOI: 10.1016/j.mjafi.2023.09.005] [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: 08/11/2023] [Accepted: 09/05/2023] [Indexed: 11/21/2023] Open
Abstract
Background Bone Marrow Transplant (BMT) is a curative form of therapy for many hematological disorders in both the adult and pediatric patients. The availability of BMT in the AFMS at AHRR for the last 02 decades has been a game changer for the patients. Methods We reviewed our BMT data since the inception of the program till Feb 2023. Results Over 700 patients with more than 23 different types of hematological disorders have undergone this procedure 58%% patients underwent an Autologous BMT and 42% an allogenic BMT. Autologous BMT for Multiple Myeloma and Allogenic BMT for Aplastic Anemia and Acute Leukemias have been the most common indications. 73% patients were adults, and 27% patients were of the pediatric age group. The male: female ratio was 2:1. The spectrum of allogenic Hematopoietic Stem Cell Transplant (HSCT) has expanded from Matched Sibling Donor (MSD) transplants to Matched Unrelated Donor (MUD) Transplants and Haploidentical Donor Transplants. 93% of our Allogenic BMT patients underwent a MSD BMT, 1% MUD BMT and 06% Haploidentical BMT. Today no patient with a malignant hematological disorder requiring a BMT is denied the procedure due to the lack of an HLA donor due to the availability of haploidentical BMT. Conclusion The evolution of a BMT program has a long learning curve and the expanded pool of eligible donors has led to a situation of "transplant for all". Haploidentical HSCT for nonmalignant hematological disorders is an unmet need. CART cell therapy and Cellular therapies need to be prioritized for future inclusion.
Collapse
Affiliation(s)
- Rajiv Kumar
- Senior Advisor (Medicine) & Clinical Hematologist, Army Hospital (R&R), New Delhi, India
| | - Rajan Kapoor
- Consultant (Medicine) & Clinical Hematologist, Army Hospital (R&R), New Delhi, India
| | | | | | - Uday Yanamandra
- Professor (Medicine) & Clinical Hematologist, Armed Forces Medical College, Pune, India
| | - Kundan Mishra
- Senior Advisor (Medicine) & Clinical Hematologist, Command Hospital (CC), Lucknow, India
| | - Sanjeev Khera
- Classified Specialist (Pediatrics) & Pediatric Hematoncologist, Army Hospital (R&R), New Delhi, India
| | - Ajay Sharma
- Consultant (Medicine) & Clinical Hematologist, Paras Hospital, Panchkula, India
| | - S. Das
- Consultant (Medicine) & Clinical Hematologist, Jaypee Hospital, Noida, India
| | - Tarun Verma
- Consultant (Medicine) & Clinical Hematologist, Yashoda Hospital, Ghaziabad, India
| | - Jasjit Singh
- Consultant (Medicine) & Clinical Hematologist, Sir Ganga Ram Hospital, New Delhi, India
| | - Velu Nair
- Group Head Medical Services, Chief Consultant – Hemato -Oncology & Bone Marrow Transplant, Apollo-CBCC, Ahmedabad, India
| |
Collapse
|
7
|
Kapoor R, Yanamandra U, Kumar R, Pramanik SK. Successful T replete haploidentical HSCT with post-transplant cyclophosphamide in two patients with Wiskott-Aldrich syndrome. Med J Armed Forces India 2023; 79:722-725. [PMID: 37981926 PMCID: PMC10654355 DOI: 10.1016/j.mjafi.2023.08.015] [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: 08/06/2023] [Accepted: 08/27/2023] [Indexed: 11/21/2023] Open
Abstract
We describe two young patients with Wiskott-Aldrich Syndrome (WAS) who were treated by T-replete hematopoietic stem cell transplantation (HSCT) from the HLA haploidentical father according to a modified Baltimore protocol. Whereas similar protocols have been successfully used in various malignant and non-malignant diseases, this is the first report for this particular disease. The data being presented pertains to the report about two successful haploidentical transplants with post transplant cyclophosphamide (PTCY) after busulfan-based conditioning.
Collapse
Affiliation(s)
- Rajan Kapoor
- Professor & Head (Hematology), Army Hospital (Research & Referral), Delhi Cantt, India
| | - Uday Yanamandra
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Rajiv Kumar
- Senior Advisor (Medicine) & Clinical Hematologist, Army Hospital (R&R), New Delhi, India
| | | |
Collapse
|
8
|
Singh C, Karunakaran P, Yanamandra U, Jindal N, Kumar SR, Saini N, Jandial A, Jain A, Lad D, Prakash G, Khadwal A, Kumar N, Naseem S, Ahluwalia J, Varma N, Varma S, Malhotra P. Factors associated with thrombo-hemorrhagic deaths in patients with Acute Promyelocytic leukemia treated with Arsenic Trioxide and all-trans retinoic acid. Leuk Res 2023; 134:107392. [PMID: 37774447 DOI: 10.1016/j.leukres.2023.107392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Acute Promyelocytic Leukemia (APL) is associated with excellent long-term outcomes. However, early mortality due to coagulopathy remains a challenge. In this study we examined the bleeding and thrombotic manifestations, as well as incidence of Early Death secondary to thrombosis/hemorrhage (ED-TH) in patients with APL. Early death (ED) was defined as death occurring within 30 days of induction therapy. Two-hundred forty-eight patients were included in the study. Overall, 57 patients had evidence of a major bleed/thrombosis at presentation or during induction therapy, including 44 patients with a major bleed, 8 patients with thrombosis and 5 patients with both evidence of thrombosis and a major bleed. Forty patients (16.1%) had ED, of which 21 had ED-TH. The cumulative incidence of death due to thrombo-hemorrhagic complications at 30 days was 8.4%. On univariate analysis, increasing Prothrombin time (PT)(p-<0.001), white blood cell count (p < 0.001) and activated Partial thromboplastin time (aPTT) (p < 0.001) were statistically significantly associated with increased risk of ED-TH. However, on multivariate analysis, only increasing PT (p-0.025) and aPTT (p-0.041) were significantly associated with increased risk of ED-TH.
Collapse
Affiliation(s)
- Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parathan Karunakaran
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Armed Forces Medical College, Pune, India
| | - Nishant Jindal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; BMT Unit, Department of Medical Oncology, ACTREC-Tata Memorial Centre, Navi Mumbai, India
| | - Saloni Rani Kumar
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Government Medical College and Hospital, Chandigarh, India
| | - Neha Saini
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
9
|
Yanamandra U, Reddy Gorla AK, Agrawal K, Mittal BR, Prakash G, Khadwal AR, Varma N, Varma S, Malhotra P. Prognostic significance of extramedullary disease (EMD) detected on pre-transplant 18F-FDG PET/CT in patients with multiple myeloma: Results of PIPET-M trial. Med J Armed Forces India 2023; 79:672-678. [PMID: 37981939 PMCID: PMC10654356 DOI: 10.1016/j.mjafi.2023.08.007] [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: 06/18/2023] [Accepted: 08/11/2023] [Indexed: 11/21/2023] Open
Abstract
Background It is difficult to prognosticate the post-Autologous Stem Cell Transplant (ASCT) responses in multiple myeloma (MM) with the currently available prognostication models. 18F-FDGPET/CT has numerous advantages to prognosticate the post-transplant responses by assessing extramedullary disease (EMD) in addition to the extent of active disease. We aimed at identifying the prognostic value of EMD in predicting progression-free survival (PFS) and overall survival (OS). Methods This is a single centre prospective study from western India during a study period of 2014-2022 (with a median follow-up of patients of 6 years). All ASCT patients underwent 18F-FDG-PET/CT as part of pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. EMD on PET/CT was correlated with pre-transplant biochemical markers and post-ASCT survival/ progression (as defined by revised IMWG criteria). Statistical analysis was done using SPSS ver. 20. Results Patients with pre-ASCT EMD had a hazard-ratio for post-transplant all-cause mortality of 5.46 (p-0.045). Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). The 6-year median OS in patients with and without EMD were 57.1%, and 80.6% respectively. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. Conclusion EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and is significantly correlated with pre-transplant higher β2M and LDH levels. Thus, EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role.
Collapse
Affiliation(s)
- Uday Yanamandra
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Arun Kumar Reddy Gorla
- Junior Consultant, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanhaiyalal Agrawal
- Associate Professor (Nuclear Medicine), All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Bhagwant Rai Mittal
- Professor (Nuclear Medicine), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Prakash
- Professor (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Alka Rani Khadwal
- Professor (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Varma
- Ex-Professor & Head (Hematology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subhash Varma
- Ex-Dean, Ex-Professor & Head (Internal Medicine), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Professor & Head (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
10
|
Khurana H, Muthusamy B, Yanamandra U, Garapati K, Premdeep H, Subramanian S, Pandey A. Whole Exome Sequencing Reveals Novel Variants in Unexplained Erythrocytosis. OMICS 2023; 27:299-304. [PMID: 37428608 PMCID: PMC10357103 DOI: 10.1089/omi.2023.0059] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Erythrocytosis is characterized by an increase in red cells in peripheral blood. Polycythemia vera, the commonest primary erythrocytosis, results from pathogenic variants in JAK2 in ∼98% of cases. Although some variants have been reported in JAK2-negative polycythemia, the causal genetic variants remain unidentified in ∼80% of cases. To discover genetic variants in unexplained erythrocytosis, we performed whole exome sequencing in 27 patients with JAK2-negative polycythemia after excluding the presence of any mutations in genes previously associated with erythrocytosis (EPOR, VHL, PHD2, EPAS1, HBA, and HBB). We found that the majority of patients (25/27) had variants in genes involved in epigenetic processes, including TET2 and ASXL1 or in genes related to hematopoietic signaling such as MPL and GFIB. Based on computational analysis, we believe that variants identified in 11 patients in this study could be pathogenic although functional studies will be required for confirmation. To our knowledge, this is the largest study reporting novel variants in individuals with unexplained erythrocytosis. Our results suggest that genes involved in epigenetic processes and hematopoietic signaling pathways are likely associated with unexplained erythrocytosis in individuals lacking JAK2 mutations. With very few previous studies targeting JAK2-negative polycythemia patients to identify underlying variants, this study opens a new avenue in evaluating and managing JAK2-negative polycythemia.
Collapse
Affiliation(s)
- Harshit Khurana
- Command Hospital (Air Force), Bangalore, India
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | | | - Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Kishore Garapati
- Institute of Bioinformatics, International Technology Park, Bangalore, India
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Manipal Academy of Higher Education, Manipal, India
| | | | | | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
11
|
Singh C, Yanamandra U, Karunakaran P, Jindal N, Kumar SR, Saini N, Jandial A, Jain A, Das C, Lad D, Prakash G, Khadwal A, Naseem S, Das R, Varma N, Varma S, Malhotra P. Long-term real-world outcomes of patients with acute promyelocytic leukaemia treated with arsenic trioxide and all-trans retinoic acid without chemotherapy-a retrospective, single-centre study. Br J Haematol 2023; 201:249-255. [PMID: 36529704 DOI: 10.1111/bjh.18618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) form the backbone of the treatment of acute promyelocytic leukaemia (APL), with the addition of chemotherapy for high-risk patients. We describe our experience of treating patients with APL of all risk classes with ATO and ATRA without chemotherapeutic agents. Patients received induction with ATO and ATRA followed by three cycles of consolidation with ATO and ATRA (each 1 month apart) after achieving morphological remission. Patients with intermediate- and high-risk disease received a further 2 years of maintenance with ATRA, 6-mercaptopurine and methotrexate. A total of 206 patients were included in the study. The majority of the patients were intermediate risk (51.9%), followed by high risk (43.2%). Differentiation syndrome was seen in 41 patients (19.9%). Overall, 25 patients (12.1%) died within 7 days of initiating therapy. Seven patients relapsed during follow-up. The mean (SD) estimated 5-year event-free survival (EFS) and overall survival (OS) in the entire cohort was 79% [5.8%] and 80% [5.8%] respectively. After excluding patients who died within 7 days of therapy initiation, the mean (SD) estimated 5-year EFS and OS was 90% [5.8%] and 93% [3.9%] respectively. Our study shows that treatment of all risk classes of APL with ATO and ATRA without chemotherapy is associated with excellent long-term outcomes in the real-world setting.
Collapse
Affiliation(s)
- Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Armed Forces Medical College, Pune, India
| | - Parathan Karunakaran
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | - Nishant Jindal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- BMT Unit, Department of Medical Oncology, ACTREC-Tata Memorial Centre, Navi Mumbai, India
| | - Saloni Rani Kumar
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Government Medical College and Hospital, Chandigarh, India
| | - Neha Saini
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Das
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
12
|
Yanamandra U, Yadav N, Pramanik S, Kapoor R, Mishra K, Khurana H, Sharma S, Das S. Supplemental Pioglitazone to Patients of CML with Suboptimal TKI Response: A Pragmatic Pilot Study. Indian J Hematol Blood Transfus 2023; 39:71-76. [PMID: 36699425 PMCID: PMC9868211 DOI: 10.1007/s12288-022-01561-x] [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: 03/03/2022] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have improved outcomes of chronic myeloid leukemia (CML). However, 20-30% of patients require second-line TKIs following suboptimal response. The cost and adverse events limit their use in resource-constraint settings. We conducted a pilot study to ascertain the benefit of adding pioglitazone to TKIs with suboptimal response in real-world resource-constraint settings. In this pragmatic pilot study from 01 Jan 2017 to 31 July 2021, CML patients from a tertiary care center in North India with sub-optimal response to TKIs were additionally given pioglitazone after ruling out imatinib resistance mutation (n - 31). Pioglitazone was stopped if there was disease progression on follow-up, and second-line TKI was started. The data were analyzed with the intention-to-treat principle using JMP Ver.15.1.1. The median age of the study population was 54y (27-82), who were followed up for a median duration of 1023.5d (59-1117). Pioglitazone showed the benefit of one-log reduction in BCR-ABL in 89.7% of the study participants. 1y, 2y and 3y-PFS were 92.57%, 76.5%, and 68.3% respectively. During follow-up period, the disease progressed in 38.7%, of which two succumbed. No adverse events to Pioglitazone were documented. This study proved that adding Pioglitazone to the existing TKI regime in CML with sub-optimal response can benefit. The addition of Pioglitazone was well tolerated. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12288-022-01561-x.
Collapse
Affiliation(s)
- Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, 411040 India
| | - Naveen Yadav
- Department of Internal Medicine, Armed Forces Medical College, Pune, 411040 India
| | - Suman Pramanik
- Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010 India
| | - Rajan Kapoor
- Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010 India
| | - Kundan Mishra
- Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010 India
| | - Harshit Khurana
- Department of Hematology and Bone Marrow Transplantation, Command Hospital (Southern Command), Pune, 411040 India
| | - Sanjeevan Sharma
- Department of Internal Medicine, Command Hospital (Central Command), Lucknow, 226002 India
| | - Satyaranjan Das
- Department of Hematology and Bone Marrow Transplantation, Command Hospital (Southern Command), Pune, 411040 India
| |
Collapse
|
13
|
Singh C, Wadhera S, Yanamandra U, Karunakaran P, Jindal N, Kumar SR, Saini N, Jandial A, Jain A, Das C, Prakash G, Khadwal A, Naseem S, Das R, Varma N, Varma S, Malhotra P, Lad D. High-dose hydroxyurea with differentiating agents for treating ultra-high-risk acute promyelocytic leukemia in resource-challenged settings. Acta Oncol 2022; 61:1512-1514. [PMID: 36579788 DOI: 10.1080/0284186x.2022.2162347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarthak Wadhera
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parathan Karunakaran
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishant Jindal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saloni Rani Kumar
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Saini
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Das
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
14
|
Boddu R, Duddugunta V, Bahl R, Mishra K, Yanamandra U, Pramanik S. 217P Role of copper levels in patients with myelodysplastic syndromes. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.252] [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: 12/07/2022] Open
|
15
|
Yanamandra U, Rajagopal S, Aggarwal B, Kaur P, Singh A, Aggarwal N, Sai Kumar PB, Duhan G, Sahu R, Menon AS. Sweetness and positivity together aren't a happy ending: Case controlled study amongst severe COVID-19 for impact of diabetes mellitus on survival. Med J Armed Forces India 2022:S0377-1237(22)00093-4. [PMID: 36034073 PMCID: PMC9393750 DOI: 10.1016/j.mjafi.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background India is the epicenter of diabetes mellitus (DM). The relationship between COVID and DM in age/gender-matched non-diabetics has not been studied yet. The role of DM in predicting the disease severity and outcome in COVID patients might provide new insight for effective management. Methods We conducted a prospective comparative study at a COVID care center from 25th April-31st May 2021. Among 357 severe-COVID patients screened, all consecutive diabetes (n-113) and age/gender-matched non-diabetes (n-113) patients were recruited. All diabetics and non-diabetics at admission were subjected to high resolution computed tomography (HRCT) chest and inflammatory markers (C-reactive protein (CRP), D-dimer, ferritin, interleukin-6 (IL-6), lactate dehydrogenase (LDH), Neutrophil-Lymphocyte Ratio (NLR)) before starting anti- COVID therapy. Statistical analysis was done using JMP 15·0 ver·3·0·0. Results The prevalence of DM among the screened population (n-357) was 38·37%. The mean age of the study population was 61y with male preponderance (57%). There was no statistical difference in the HRCT-score or inflammatory markers in the two groups except for higher NLR (p-0·0283) in diabetics. Diabetics had significantly inferior overall survival (OS) (p-0·0251) with a 15d-OS of diabetics vs. non-diabetics being 58·87%, 72·67%, and 30d-OS of diabetics vs. non-diabetics being 46·76%, 64·61%, respectively. The duration of the hospital stay was not statistically different in the two groups (p-0·2). Conclusion The mortality is significantly higher in severe-COVID patients with DM when compared to age/gender-matched non-diabetics. There was no significant difference in most inflammatory markers/CT at admission between the two groups.
Collapse
Affiliation(s)
- Uday Yanamandra
- Professor, Dept of Medicine, Armed Forces Medical College, Pune, India
| | - Srinath Rajagopal
- Professor, Dept of Medicine, Armed Forces Medical College, Pune, India
| | | | - Praneet Kaur
- Medical Officer, 42 Wing Air Force, C/o 99 APO, India
| | - Anurag Singh
- Medical Officer 12 Wing Air Force, C/o 56 APO, India
| | | | - Pavan B Sai Kumar
- Fleet Medical Officer, INS Virbahu, C/o Fleet Mail Office Visakhapatnam, India
| | - Gaytri Duhan
- Fleet Medical Officer, INS Aditya, C/o Fleet Mail Office, Mumbai, India
| | - Rajesh Sahu
- Associate Professor, Dept of Community Medicine, Armed Forces Medical College, Pune, India
| | - A S Menon
- Professor & Head, Dept of Medicine, Armed Forces Medical College, Pune, India
| |
Collapse
|
16
|
Nair V, Singh S, Ashraf MZ, Yanamandra U, Sharma V, Prabhakar A, Ahmad R, Chatterjee T, Behera V, Guleria V, Patrikar S, Gupta S, Vishnoi MG, Rigvardhan, Kalshetty K, Sharma P, Bajaj N, Khaling TD, Wankhede TS, Bhattachar S, Datta R, Ganguli LP. Epidemiology and pathophysiology of vascular thrombosis in acclimatized lowlanders at high altitude: A prospective longitudinal study. Lancet Reg Health Southeast Asia 2022; 3:100016. [PMID: 37384264 PMCID: PMC10306047 DOI: 10.1016/j.lansea.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Previous literature suggests that thrombosis is more common in lowlanders sojourning at high altitude (HA) compared to near-sea-level. Though the pathophysiology is partly understood, little is known of its epidemiology. To elucidate this, an observational prospective longitudinal study was conducted in healthy soldiers sojourning for months at HA. METHODS A total of 960 healthy male subjects were screened in the plains, of which 750 ascended, to altitudes above 15,000ft (4,472m). Clinical examination, haemogram, coagulogram, markers of inflammation and endothelial dysfunction, were studied at three time points during ascent and descent. The diagnosis of thrombosis was confirmed radiologically in all cases where a thrombotic event was suspected clinically. Subjects developing thrombosis at HA were labelled as Index Cases (ICs) and compared to a nested cohort of the healthy subjects (comparison group,(CG)) matched for altitude of stay. FINDINGS Twelve and three subjects, developed venous (incidence: 5,926/105 person-years) and arterial (incidence: 1,482/105 person-years) thrombosis at HA, respectively. The ICs had enhanced coagulation (FVIIa: p<0.001; FXa: p<0.001) and decreased levels of natural anticoagulants (thrombomodulin, p=0.016; tissue factor pathway inhibitor [TFPI]: p<0.001) and a trend to dampened fibrinolysis (tissue plasminogen activator tPA; p=0.078) compared to CG. ICs also exhibited statistically significant increase in the levels of endothelial dysfunction and inflammation markers (vascular cell adhesion molecule-1[VCAM-1], intercellular adhesion molecule-1 [ICAM-1], vascular endothelial growth factor receptor 3 [VEGFR-3], P-Selectin, CD40 ligand, soluble C-reactive protein and myeloperoxidase: p<0.001). INTERPRETATION The incidence of thrombosis in healthy subjects at HA was higher than that reported in literature at near sea-level. This was associated with inflammation, endothelial dysfunction, a prothrombotic state and dampened fibrinolysis. FUNDING Research grants from the Armed Forces Medical Research Committee, Office of the Director General of Armed Forces Medical Services (DGAFMS) & Defence Research and Development Organization (DRDO), Ministry of Defence, India.
Collapse
Affiliation(s)
- Velu Nair
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Director General Medical Services (Army), India
- Comprehensive Blood & Cancer Center (CBCC), Gandhinagar, Gujarat, India
| | - Surinderpal Singh
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Army College of Medical Sciences, New Delhi, India
| | - Mohammad Zahid Ashraf
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Uday Yanamandra
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- 153 General Hospital, Leh, India
| | - Vivek Sharma
- Department of Imaging & Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiology, Bharati Vidyapeeth Hospital & Medical College, Pune, Maharashtra, India
| | - Amit Prabhakar
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Cardiovascular Research Institute (CVRI), University of California, San Francisco, USA
| | - Rehan Ahmad
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Luchkee Health Pvt Ltd Vasant Kunj, New Delhi, India
| | - Tathagata Chatterjee
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (Research & Referral), New Delhi, India
- Department of Haematology and Stem Cell Transplant, ESIC Med College and Hospital, Faridabad, Haryana, India
| | - Vineet Behera
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Internal Medicine, INHS Asvini, Colaba, Mumbai, India
| | - Vivek Guleria
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
| | - Seema Patrikar
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shivi Gupta
- 403 Field Hospital, C/o 56 APO, India
- Indian Field Hospital, UN Mission, Malakal 71111, South Sudan
| | - Madan Gopal Vishnoi
- 403 Field Hospital, C/o 56 APO, India
- Department of Nuclear Medicine, Command Hospital (Eastern Command), Kolkata, India
| | - Rigvardhan
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
| | - Kiran Kalshetty
- Regimental Medical Officer, 20 Grenadiers c/o 56 APO, India
- Department of Anaesthesiology, 305 Field Hospital, C/o 99 APO, India
| | - Prafull Sharma
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Military Hospital, Jalandhar, Punjab, India
| | - Nitin Bajaj
- Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, Haryana, India
- Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Thyelnai D. Khaling
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
| | - Tanaji Sitaram Wankhede
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Sports Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Srinivasa Bhattachar
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rajat Datta
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
- Director General Armed Forces Medical Services, New Delhi, India
| | - Late Prosenjit Ganguli
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Department of Pathology, Command Hospital (Eastern Command), Kolkata, India
| |
Collapse
|
17
|
Yanamandra U, Saxena P, Srinath R, Sawant A, Singh A, Aggarwal N, Pavan B, Duhan G, Aggarwal B, Kaur P. Assessment of Six-Minute Walk Test Among Discharge-Ready Severe COVID-19 Patients: A Cross-Sectional Study. Cureus 2022; 14:e25108. [PMID: 35733480 PMCID: PMC9205384 DOI: 10.7759/cureus.25108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background Among patients hospitalized for severe pneumonia due to coronavirus disease (COVID-19), clinical stability and normal resting peripheral oxygen saturation (SpO2) levels are widely used as a discharge criterion after recovery. It is unknown whether a test to assess the functional exercise capacity, like a six-minute walk test (6MWT), can add to the appropriateness of discharge criteria. Methods A cross-sectional study was conducted at a tertiary care COVID-19 hospital in India from 01st to 31st May 2021. All patients considered fit for discharge after recovery from "severe" COVID-19 pneumonia were subjected to 6MWT. Fitness for discharge was assessed by clinical stability and resting SpO2 above 93% for three consecutive days. Patients were considered to have failed the 6MWT if there was ≥4% fall in SpO2 or if they could not complete the test. Serum samples were analyzed for levels of C-reactive protein (CRP), interleukin-6 (IL-6), and lactate dehydrogenase (LDH) at the time of discharge. Results Fifty-three discharge-ready patients with a mean age of 54.54 ± 14.35 years with a male preponderance (60.38%) were analyzed. Thirty-three (62.26%) patients failed the 6MWT with a median six-minute walk distance (6MWD) of 270 m (60-360). A total of 45 (84.91%) patients had a fall in SpO2 during the test. The median change in SpO2 (∆SpO2) was 5% ranging from -6% to 8%. Serum LDH was significantly higher among patients who failed the 6MWT with a median LDH of 334 IU/L (38.96-2339) versus 261 IU/L (49.2-494) (p = 0.02). The difference was not significant for CRP or IL-6. There was no statistically significant correlation between the inflammatory markers with either 6MWD or (∆SpO2). Conclusion Two-thirds of the patients considered fit for discharge after recovery from severe COVID-19 pneumonia failed 6MWT, implying reduced functional exercise capacity and exertional hypoxia. Serum LDH levels were higher in these patients but not in other inflammatory markers. None of the inflammatory markers at discharge correlated with 6MWD or ∆SpO2 of 6MWT.
Collapse
|
18
|
Yanamandra U, Shobhit S, Paul D, Aggarwal B, Kaur P, Duhan G, Singh A, Srinath R, Saxena P, Menon AS. Relationship of Computed Tomography Severity Score With Patient Characteristics and Survival in Hypoxemic COVID-19 Patients. Cureus 2022; 14:e22847. [PMID: 35382199 PMCID: PMC8977105 DOI: 10.7759/cureus.22847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background Computed tomography (CT) scans and CT severity scores (CTSS) are widely used to assess the severity and prognosis in coronavirus disease 2019 (COVID-19). CTSS has performed well as a predictor in differentiating severe from non-severe cases. However, it is not known if CTSS performs similarly in hospitalized severe cases with hypoxia at admission. Methods We conducted a retrospective comparative study at a COVID-care center from Western India between 25th April and 31st May 2021, enrolling all consecutive severe COVID-19 patients with hypoxemia (peripheral oxygen saturation < 94%). Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), lactate dehydrogenase (LDH), D-dimer, ferritin, and CT thorax were done within 24h of admission before being initiated on any anti-COVID-19 therapy. CTSS was calculated by visual assessment and categorized into three severity categories and was correlated with laboratory markers and overall survival (OS). Statistical analysis was done using John's Macintosh Project (JMP) 15.0.0 ver. 3.0.0 (Cary, North Carolina). Results The median age of the study population (n-298) was 59 years (24-95) with a male preponderance (61.41%, n=183). The 15 and 30-day survivals were 67.64% and 59.90%, respectively. CTSS did not correlate with age, gender, time from vaccination, symptoms, or comorbidities but had a significant though weak correlation with LDH (p=0.009), D-dimer (p=0.006), and NLR (p=0.019). Comparing demographic and laboratory aspects using CT severity categories, only NLR (p=0.0146) and D-dimer (p=0.0006) had significant differences. The 15d-OS of mild, moderate, and severe CT categories were 88.62%, 70.39%, and 52.62%, respectively, while 30d-OS of three categories were 59.08%, 63.96%, and 49.12%, respectively. Conclusion Among hospitalized severe COVID-19 patients with hypoxemia at admission, CT severity categories correlate well with outcomes but not inflammatory markers at admission.
Collapse
|
19
|
|
20
|
Tewari R, Chatterjee T, Mendonca S, Dogra M, Pramanik SK, Yanamandra U. Monoclonal gammopathy of renal significance: Spectrum of diseases and approach to a case. Saudi J Kidney Dis Transpl 2022; 32:298-306. [PMID: 35017322 DOI: 10.4103/1319-2442.335440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The occurrence of kidney diseases associated with a monoclonal gammopathy in the absence of symptomatic multiple myeloma is increasingly recognized. When the kidney is involved, the monoclonal etiology of these diseases results in clinical and laboratory features distinct from those of other disease, necessitating the nomenclature monoclonal gammopathy of renal significance (MGRS). The detection of these monoclonal diseases involving the kidney is important since they are poorly responsive to conventional immunosuppression and instead require clone-directed therapy. The new International Kidney and Monoclonal research group consensus definition of MGRS includes all proliferative conditions of B cells and/or plasma cells. Renal lesions due to monoclonal immunoglobulins are quite capable of progression with resulting end-stage renal disease development. Hence, these lesions require therapeutic intervention even if they do not satisfy myeloma criteria or the presence of any myeloma defining event. The spectrum of renal lesions that can be observed in a case of MGRS is wide and mirrors the list that may be seen in a case of any plasma cell neoplasm. This includes Ig light chain, heavy chain, and heavy and light chain amyloidosis; immunotactoid glomerulonephritis (GN); monoclonal immunoglobulin deposition disease including light chain, heavy chain, or heavy and light chain disease; light chain proximal tubulopathy; crystal-storing histiocytosis; proliferative GN with monoclonal immunoglobulin deposits; C3 glomerulopathy with monoclonal gammopathy and cast nephropathy. The initial approach after histological assessment is based on presence or absence of monoclonal immunoglobulin deposits. If monoclonality is evident, it is important to distinguish between conditions with deposition of intact immunoglobulin molecule or light chains only. The treatment of MGRS is directed at the underlying neoplastic B-cell or plasma cell clones.
Collapse
Affiliation(s)
- Rohit Tewari
- Department of Pathology, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Tathagat Chatterjee
- Department of Pathology, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Satish Mendonca
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - Manu Dogra
- Department of Pathology, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Suman Kumar Pramanik
- Department of Hematology, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Uday Yanamandra
- Department of Hematology, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| |
Collapse
|
21
|
Srinath R, Yanamandra U, Singh A, Aggarwal N, Kaur P, Aggarwal B, Shobhit S, Duhan G, Paul D, K Bareedu SP, Sahu R, Menon AS. Headache of Wearing PPE; A Survey for Neurological Symptoms with PPE amongst Health Care Workers. Neurol India 2022; 70:122-126. [PMID: 35263864 DOI: 10.4103/0028-3886.338723] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has put the entire medical fraternity into a very challenging and demanding situation. Along with always being at the risk of COVID infection, healthcare workers (HCWs) are also facing neurological problems due to long working hours in personal protective equipment (PPE). These symptoms and their characteristics need to be observed and studied in-depth to understand the problems experienced by HCWs and to design new solutions to overcome such problems. OBJECTIVES This study intends to evaluate the various neurological manifestations among the HCWs wearing PPE for prolonged periods. MATERIALS AND METHODS We conducted a questionnaire-based cross-sectional study at a Covid care center from western India from April 20 to June 01, 2021 by using a self-administered web-based questionnaire. A total of 256 HCWs were surveyed. The de-identified data were analyzed using JMP 15.0.0. RESULTS Among a total of 256 HCWs surveyed for this study, the majority (58.6%) were aged 24-35 years, with a male preponderance (65.62%, n = 168). Participants included doctors (41%), nurses (35%), paramedical staff (22%), and housekeeping staff (1%). The symptoms encountered among the HCWs wearing the PPE were headache, classified further as donning headache in 112 (44.98%), doffing headache in 56 (26.24%), slowed mentation in 48 (21.05%), and excessive sleepiness in 86 (38.74%), which affected their work performance. The age of the HCWs had a significant correlation with all the symptoms. CONCLUSION Headache, slowed mentation, and excessive sleepiness was encountered among the HCWs wearing PPE, which depended upon the duration of PPE usage. The most common symptom was headache, which was of moderate to severe intensity.
Collapse
Affiliation(s)
- Rajagopal Srinath
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anurag Singh
- Medical Officer - Armed Forces Medical Services, Chabua, Assam, India
| | - Nupur Aggarwal
- Dental Officer - Armed Forces Medical Services, 1 AFDC, Delhi, India
| | - Praneet Kaur
- Medical Officer - Armed Forces Medical Services, Mohanbari, Assam, India
| | - Bhavya Aggarwal
- Medical Officer - Armed Forces Medical Services, Barrackpore, West Bengal, India
| | - Shivendra Shobhit
- Department of Anesthesia, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Gaytri Duhan
- Medical Officer - Armed Forces Medical Services, INHS Sanjivani, Kochi, Kerala, India
| | - Debashish Paul
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sai Pavan K Bareedu
- Medical Officer - Armed Forces Medical Services, INS Satavahana, Visakhapatnam, Andhra Pradesh, India The Departments and Institutions to which the work is to be Attributed: Department of Internal Medicine, Armed Forces Medical College, Pune - 411040, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anil S Menon
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
22
|
Kumar V, Rai C, Kumari B, Srivastava S, Yanamandra U, Singh J, Ganju L, Varshney R, Garg I. Association of APOA1 gene polymorphisms (G-75A and C+83T) with deep vein -thrombosis: An Indian study. Gene Reports 2021. [DOI: 10.1016/j.genrep.2021.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Mishra K, Kumar S, Sandal R, Jandial A, Sahu KK, Singh K, Ahuja A, Somasundaram V, Kumar R, Kapoor R, Sharma S, Singh J, Yanamandra U, Das S, Chaterjee T, Sharma A, Nair V. Safety and efficacy of splenectomy in immune thrombocytopenia. Am J Blood Res 2021; 11:361-372. [PMID: 34540344 PMCID: PMC8446833] [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] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Immune Thrombocytopenia (ITP) is characterized by low platelet counts. Splenectomy has been in practice for the treatment of ITP since the early 20th century. We aimed to analyze the data of ITP patients from our hospital who underwent splenectomy and further present the long-term outcome and safety profile in these patients. METHOD This study was a single-center, registry based study conducted at a tertiary care hospital in Northern India. Patients aged 18 years or more, who underwent splenectomy after at least one line of therapy, were included in the study. The primary outcome was the overall response rate (ORR) at one month after splenectomy. Secondary outcomes were sustained response, relapse-free survival, factors affecting the ORR, and adverse events after splenectomy. RESULTS Forty-five patients of ITP were included in the study. Thirty-six patients underwent splenectomy in the first half (2001-2010), of the study period. The median age of the patients was 38 (19-56) years. The median duration from diagnosis to splenectomy was 1.76 (0.47-2.58) years. The median number of therapy received before splenectomy was 3 (1-6). The overall response rate (ORR) post-splenectomy at day 30 was 89.2% with 61.8% complete response (CR). The ORR was 88.5% at 1-year, with 48.8% CR. The relapse-free survival (RFS) at 5-years was 57.38% (95% Confidence Interval 40.59-71.02%), There was no effect of duration of disease, age, gender, and prior therapy received, on the ORR at one-month. At one year, the platelet response was significantly better in patients who had a CR at one-month than patients who had a partial response at one month. The relapse-free survival was better in patients who achieved CR after 1-month of splenectomy. During the median follow-up of 5.02 (1 month-20 years) years, there were five cases of overwhelming post-splenectomy infection (OPSI). There was no recorded incidence of perioperative mortality, deep vein thrombosis, or mesenteric thrombosis. DISCUSSION Despite the variation in outcome from different studies, splenectomy gives the best possible long-term treatment-free remission amongst all the available second-line agents. It is also, one of the most financially affordable therapies. Despite advantages, the number of ITP patients undergoing splenectomy has been on the decline and largely attributable to the newer and more effective second-line therapies. There is no pre-surgery variable predicting the ORR after splenectomy. CONCLUSION Splenectomy in ITP offers a long-term sustained response at an economical cost.
Collapse
Affiliation(s)
- Kundan Mishra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
| | - Suman Kumar
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
| | - Rajeev Sandal
- Department of Radiotherapy and Oncology, IGMC ShimlaHimachal Pradesh, India
| | - Aditya Jandial
- Department of Internal Medicine, PGIMERChandigarh, India
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent HospitalWorcester, Massachusetts, USA
| | - Kanwaljeet Singh
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral)Delhi, India
| | - Ankur Ahuja
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral)Delhi, India
| | - Venkatesan Somasundaram
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral)Delhi, India
| | - Rajiv Kumar
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Department of Internal Medicine, Command Hospital (Air Force)Bangaluru, India
| | - Rajan Kapoor
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Department of Internal Medicine, Command Hospital (Eastern Command)Kolkata, India
| | - Sanjeevan Sharma
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Department of Internal Medicine, Command Hospital (Central Command)Lucknow, India
| | - Jasjit Singh
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Dept of Clinical Hematology and Stem Cell Transplant, Sir Ganga Ram HospitalDelhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
| | - Satyaranjan Das
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Department of Internal Medicine, Command Hospital (Southern Command)Pune, India
| | - Tathagat Chaterjee
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral)Delhi, India
| | - Ajay Sharma
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
| | - Velu Nair
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral)Delhi, India
- Group Head-Medical Services and Chief Consultant-Haemato-Oncology & Bone Marrow Transplant, Medical Services & Comprehensive Blood & Cancer Center (CBCC)Ahmedabad, India
| |
Collapse
|
24
|
Yanamandra U, Sharma R, Shankar S, Yadav S, Kapoor R, Pramanik S, Ahuja A, Kumar R, Sharma S, Das S, Chatterjee T, Somasundaram V, Verma T, Mishra K, Singh J, Sharma A, Nair V. Survival Outcomes of Newly Diagnosed Multiple Myeloma at a Tertiary Care Center in North India (IMAGe: 001A Study). JCO Glob Oncol 2021; 7:704-715. [PMID: 33999651 PMCID: PMC8162976 DOI: 10.1200/go.20.00625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The outcomes of patients with myeloma from developing countries are often lacking because of poor record maintenance. Publications from such settings are also limited because of the retrospective nature of the data collection. Information technology can bridge these gaps in developing countries with real-time data maintenance. We present the real-time survival data of the patients with myeloma from a tertiary care center in North India using one such indigenously built software. PATIENTS AND METHODS These are real-time data of all patients with myeloma presenting to a tertiary care center from North India. The patient characteristics (demographics, baseline disease characteristics, risk stratification, and outcomes) were recorded contemporaneously. The survival of the study population was analyzed and grouped based on various disease characteristics at diagnosis. RESULTS The median age of the study population (N = 696) was 65.9 (34.9-94.9) years with male predominance (65%). The median follow-up was 3.7 years (0-18.6 years) with the median overall survival (OS) not achieved. The OS of the study population at 1, 3, and 5 years was 94% (n = 558), 87.5% (n = 394), and 83.1% (n = 267), respectively. Most of the patients presented in advanced stages based on International Staging System (III:70%). On Kaplan-Meier analysis, the presence of weight loss (P = .01), renal dysfunction (P = .047), and anemia at diagnosis (P = .004) had a significant impact on survival. On Cox proportional model univariate analysis, the presence of renal dysfunction, anemia, and weight loss had the significant hazard ratio of 1.68 (1-2.82, P = .049), 3.18 (1.39-7.29, P = .0063), and 2.81 (1.22-6.42, P = .014), respectively, whereas on multivariate analysis of hypercalcemia, renal disease, anemia, and bone disease (CRAB) features, only anemia was found to have a significant hazard ratio of 2.56 (1.01-6.47, P = .046). CONCLUSION The real-world data show OS comparable with the published western literature. Only anemia was found to have significant impact on survival. The use of such software can aid in better data-keeping in resource-constrained settings.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ankur Ahuja
- IMAGe Research Scholar, Manipal Hospital, Delhi, India
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Mishra K, Kumar S, Ninawe S, Bahl R, Meshram A, Singh K, Jandial A, Sahu KK, Sandal R, Khera S, Yanamandra U, Khurana H, Kumar R, Kapoor R, Sharma S, Singh J, Das S, Ahuja A, Somasundaram V, Chaterjee T. The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings. Ther Adv Infect Dis 2021; 8:20499361211036592. [PMID: 34394928 PMCID: PMC8358573 DOI: 10.1177/20499361211036592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days (p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 (p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.
Collapse
Affiliation(s)
- Kundan Mishra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Suman Kumar
- DM (Clinical Hematology), Prof & Head of the Department, Department of Clinical Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010, India
| | - Sandeep Ninawe
- Department of Microbiology, Army Hospital (Research & Referral) Delhi, India
| | - Rajat Bahl
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Ashok Meshram
- Department of Internal Medicine, INHS Asvini, Mumbai, MH, India
| | - Kanwaljeet Singh
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Aditya Jandial
- Department of Internal Medicine, PGIMER, Chandigarh, CH, India
| | - Kamal Kant Sahu
- Hematology & Medical Oncology Fellow (PGY 4), Huntsman Cancer Institute, University of Utah, Salt Lake City, 84112, Utah, USA
| | - Rajeev Sandal
- Department of Radiotherapy and Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjeev Khera
- Department of Pediatrics, Army Hospital (Research & Referral) Delhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Harshit Khurana
- Department of Internal Medicine, Command Hospital (Air Force), Bangaluru, KA, India
| | - Rajiv Kumar
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Rajan Kapoor
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Sanjeevan Sharma
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Jasjit Singh
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Satyaranjan Das
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Ankur Ahuja
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Venkateshan Somasundaram
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Tathagat Chaterjee
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| |
Collapse
|
26
|
Affiliation(s)
| | - Vikram Singh
- Dept of Pathology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Ravi Roy
- Department of ENT and Head and Neck Surgery, Army Hospital Research and Referral, New Delhi, India
| | - Uday Yanamandra
- Department of Clinical Haematology, Army Hospital Research and Referral, New Delhi, India
| |
Collapse
|
27
|
Ganesan P, Jain H, Bagal B, Subramanian PG, George B, Korula A, Mehra N, Kalaiyarasi JP, Bhurani D, Agrawal N, Ahmed R, Kayal S, Bhattacharyya J, Yanamandra U, Kumar S, Philip CC, John MJ, Nadaraj A, Karunamurthy O, Lakshmanan J, Mathews V, Sengar M. Outcomes in adolescent and young adult acute lymphoblastic leukaemia: a report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 2021; 193:e1-e4. [PMID: 33656752 DOI: 10.1111/bjh.17268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Hasmukh Jain
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | | | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | | | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jina Bhattacharyya
- Department of Clinical Hematology, Gauhati Medical College and Hospital, Gauhati, India
| | - Uday Yanamandra
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Suman Kumar
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Chepsy C Philip
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - M Joseph John
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | | | | | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Manju Sengar
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| |
Collapse
|
28
|
Yanamandra U, Vardhan V, Saxena P, Singh P, Gupta A, Mulajkar D, Grewal R, Nair V. Radiographical Spectrum of High-altitude Pulmonary Edema: A Pictorial Essay. Indian J Crit Care Med 2021; 25:668-674. [PMID: 34316147 PMCID: PMC8286401 DOI: 10.5005/jp-journals-10071-23827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background High-altitude pulmonary edema (HAPE) is a common cause of hospitalization in high altitude areas with significant morbidity. The clinical presentation of HAPE can overlap with a broad spectrum of cardiopulmonary diseases. Also, it is associated with varied radiological manifestations mimicking other conditions and often leading to unnecessary and inappropriate treatment. Patients and methods The primary aim of the study was to study the various radiological manifestations of HAPE through real-world chest radiographs. We present six different chest X-ray patterns of HAPE as a pictorial assay, at initial presentation, and after the resolution of symptoms with supplemental oxygen therapy and bed rest alone. Results HAPE can present as bilateral symmetrical perihilar opacities, bilateral symmetrical diffuse opacities, unilateral diffuse opacities, bilateral asymmetrical focal opacities, and even lobar consolidation with lower zone or less commonly upper zonal predilection. These presentations can mimic many common conditions like heart failure, acute respiratory distress syndrome, pulmonary embolism, aspiration pneumonitis, pneumonia, malignancy, and tuberculosis. Conclusion A holistic clinical–radiological correlation coupled with analysis of the temporal course can help high-altitude physicians in differentiating true HAPE from its mimics. How to cite this article Yanamandra U, Vardhan V, Saxena P, Singh P, Gupta A, Mulajkar D, et al. Radiographical Spectrum of High-altitude Pulmonary Edema: A Pictorial Essay. Indian J Crit Care Med 2021;25(6):668–674.
Collapse
Affiliation(s)
- Uday Yanamandra
- Department of Hematology & Stem Cell Transplant, Army Hospital (R&R), New Delhi, India
| | - Vasu Vardhan
- Department of Pulmonology, Base Hospital, New Delhi, India
| | - Puneet Saxena
- Department of Pulmonology, Army Hospital (R&R), New Delhi, India
| | - Priyanka Singh
- Department of Pulmonology, Army Hospital (R&R), New Delhi, India
| | - Amul Gupta
- Department of Radiology, Base Hospital, New Delhi, India
| | - Deepak Mulajkar
- Department of Oncology, Army Hospital (R&R), New Delhi, India
| | - Rajan Grewal
- Ex Director General, Medical Services (Army), Currently, Vice Chancellor, Sikkim Manipal University, Sikkim, Gangtok, India
| | - Velu Nair
- Department of Haemato-Oncology and Bone Marrow Transplant, Apollo CBCC Cancer Care, Ahmedabad, Gujarat, India
| |
Collapse
|
29
|
Joshi A, Sood V, Mendonca S, Dogra M, Batta G, Tiwari R, Yanamandra U. Catastrophic Antiphospholipid Syndrome in Immune Thrombocytopenic Purpura - Beyond Tenuous Concomitance! Indian J Nephrol 2020; 30:424-426. [PMID: 33840964 PMCID: PMC8023023 DOI: 10.4103/ijn.ijn_188_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/05/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
Significance of antiphospholipid antibodies in immune thrombocytopenic purpura is debatable and pose a diagnostic and therapeutic dilemma. Catastrophic antiphospholipid syndrome is a rare life-threatening entity, occurring in patients with antiphospholipid syndrome, usually after a triggering event. We describe an adult lady of chronic immune thrombocytopenic purpura (in remission) with antiphospholipid antibodies, who presented with rapidly progressive renal failure and had primary antiphospholipid syndrome nephropathy. The index manuscript titled exemplifies the fact that although the presence of APLA in ITP is known, however, management in the absence of clinical event remains debatable and may carry a future risk of thrombotic event/s mandating close monitoring with a high index of suspicion.
Collapse
Affiliation(s)
- Arun Joshi
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Vivek Sood
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Satish Mendonca
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Manu Dogra
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Gaurav Batta
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Rohit Tiwari
- Department of Nephro-Pathology, Army Hospital (Research and Referral), New Delhi, India
| | - Uday Yanamandra
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| |
Collapse
|
30
|
Mishra K, Singh G, Bahl R, Yanamandra U. Mysterious overnight disappearance of mediastinal mass. BMJ Case Rep 2020; 13:13/10/e238399. [PMID: 33127711 DOI: 10.1136/bcr-2020-238399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kundan Mishra
- Department of Hematology & Stem Cell Transplant, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Giriraj Singh
- Department of Radio-Diagnosis, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Rajat Bahl
- Department of Hematology & Stem Cell Transplant, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Uday Yanamandra
- Department of Hematology & Stem Cell Transplant, Army Hospital Research and Referral, New Delhi, Delhi, India
| |
Collapse
|
31
|
Affiliation(s)
- Uday Yanamandra
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
| | | | - Rajat Bahl
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
| | | |
Collapse
|
32
|
Mishra K, Pramanik S, Jandial A, Sahu KK, Sandal R, Ahuja A, Yanamandra U, Kumar R, Kapoor R, Verma T, Sharma S, Singh J, Das S, Chatterjee T, Sharma A, Nair V. Real-world experience of eltrombopag in immune thrombocytopenia. Am J Blood Res 2020; 10:240-251. [PMID: 33224568 PMCID: PMC7675127] [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] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
Immune thrombocytopenia (ITP) is characterized by decreased platelet count in the peripheral circulation. The first-line therapy is corticosteroids with 53-80% overall response rate. Eltrombopag has been used as second-line therapy in ITP for over a decade now. The long-term efficacy and safety profile have been widely reported in the western world. However, the data from the resource-constraint settings of the developing world is scarce. We aim to present the real-life experience of efficacy and safety of eltrombopag from the resource-constraint settings. This was a retrospective, single-center study conducted at a tertiary care hospital in Northern India from 2012-2019. On audit of medical records, patients of ITP receiving eltrombopag were screened for inclusion. Patients whose treatment outcomes were not available were excluded. Finally, 53 patients were analyzed using statistical packages of Python v3.7. The patients' median age was 35 years (range 17-78), with 23 (43.4%) being female. The median time to response was 35 days (range 28-50 days) and the cumulative overall response rates (ORR) at day 30, day 60 and day 90 were 41.5%, 69.8%, and 81.1% respectively. A total of 10 patients on eltrombopag relapsed during follow up. The cumulative rate of relapse at one year, three years, and five years were 6.6%, 25.3%, and 47.7%, respectively. There was no significant difference in outcome (response rate or relapse) in any subgroups depending on age, sex, duration of disease, number of prior lines of treatment, splenectomy, or baseline platelet count. Six patients stopped eltrombopag after having a median sustained response for 796 days (range 658-1185), and after a median follow up of 624 days (range 92-1339), they continued to be in remission. Seventeen patients (17/53, 32%) reported one or more adverse events while on eltrombopag therapy. A total of 49 adverse events (n=4, grade ≥3 CTCAEv4) were noted. Anemia was the most frequent adverse event followed by hepatobiliary dysfunction as reflected by deranged AST/ALT or raised bilirubin. The use of eltrombopag among adult ITP patients in resource-constraint settings was well-tolerated and yielded excellent overall response. The benefit was found to be sustained on long-term follow up. However, events like anemia, hepatobiliary, and thrombotic complications merit closer follow up.
Collapse
Affiliation(s)
- Kundan Mishra
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
| | - Suman Pramanik
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
| | - Aditya Jandial
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent HospitalWorcester, Massachusetts, USA
| | - Rajeev Sandal
- Department of Health and Family WelfareHimachal Pradesh, India
| | - Ankur Ahuja
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) DelhiIndia
| | - Uday Yanamandra
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
| | - Rajiv Kumar
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Department of Internal MedicineINHS Asvini, Mumbai, India
| | - Rajan Kapoor
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Department of Internal Medicine, Command Hospital (Eastern Command)Kolkata, India
| | - Tarun Verma
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
| | - Sanjeevan Sharma
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Department of Internal Medicine, Command Hospital (Central Command)Lucknow, India
| | - Jasjit Singh
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Department of Internal Medicine, Command Hospital (Western Command)Chandimandir, India
| | - Satyaranjan Das
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Department of Internal Medicine, Command Hospital (Southern Command)Pune, India
| | - Tathagata Chatterjee
- Dept of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) DelhiIndia
| | - Ajay Sharma
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Dept of Clinical Hematology and Stem Cell Transplant, Sir Ganga Ram HospitalDelhi, India
| | - Velu Nair
- Dept of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) DelhiIndia
- Chief Consultant-Haemato-Oncology & Bone Marrow Transplant, Medical Services & Comprehensive Blood & Cancer Center (CBCC)Ahmedabad, India
| |
Collapse
|
33
|
Yanamandra U, Boddu R, Pramanik S, Mishra K, Kapoor R, Ahuja A, Chatterjee T, Das S. Prevalence and Clinical Characteristics of Post-Thrombotic Syndrome in High-Altitude-Induced Deep Vein Thrombosis: Experience of a Single Tertiary Care Center from Real-World Settings. High Alt Med Biol 2020; 21:319-326. [PMID: 32707006 DOI: 10.1089/ham.2020.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Uday, Yanamandra, Revanth Boddu, Suman Pramanik, Kundan Mishra, Rajan Kapoor, Ankur Ahuja, Tathagata Chatterjee, and Satyaranjan Das. Prevalence and clinical characteristics of post-thrombotic syndrome in high-altitude-induced deep vein thrombosis: experience of a single tertiary care center from real-world settings. High Alt Med Biol. 21:319-326, 2020. Background: Exposure to high altitude (HA) is a recognized predisposing factor for venous thrombosis. Post-thrombotic syndrome (PTS) is a significant late complication, occurring in ∼30%-50% of patients of deep vein thrombosis (DVT). There are not many studies about the characteristics of PTS in patients with HA-DVT. Aim: The aim was to study the epidemiology and clinical characteristics of PTS using a noninvasive Villalta score and identify the risk factors for its development in patients with HA-DVT. Methodology: This is a retrospective single-center observational study (n = 47). The diagnosis of HA-DVT was confirmed using color Doppler ultrasonography at HA. The patients were managed with low molecular weight heparin, followed by vitamin K antagonist therapy till normalization of D-dimer and imaging. The therapeutic target range of >80% was ensured. Villalta scale was used for PTS assessment. JMP 15.0 was used for statistical analysis. Results: All study participants were male with a median age of 34 years, of which 46.81% developed PTS with mean Villalta of 5.29 ± 4.25. The most common symptom was pain (87.23%; n = 41), whereas the most common sign was hyperpigmentation (42.5%; n = 20). On multivariate analysis, the time from onset of DVT and the extent of DVT were related to the development of PTS (degree of freedom [dF] = 5, χ2 = 17.34, p = 0.0039) with a likelihood ratio of 4.95 (p = 0.026) and 4.96 (p = 0.026), respectively. The extent of DVT was associated with the severity of PTS (dF = 5, χ2 = 12.6, p = 0.0273) with a likelihood ratio of 5.24 (p = 0.022). Conclusions: PTS develops in approximately half of the patients with HA-DVT. The extent of DVT is a significant risk factor for both development of PTS and its severity, whereas time to assessment of PTS from the onset of DVT was associated only with the occurrence of PTS.
Collapse
Affiliation(s)
- Uday Yanamandra
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Revanth Boddu
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Suman Pramanik
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Kundan Mishra
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Rajan Kapoor
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Ankur Ahuja
- Hematopathology, Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Tathagata Chatterjee
- Hematopathology, Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Satyaranjan Das
- Clinical Hematology, and Department of Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| |
Collapse
|
34
|
Yanamandra U, Bahl R, Mishra K, Kumar S. Letter to the Editor: Portal Vein Thrombosis with Splenic Infarct in β-Thalassemia Minor at High Altitude. High Alt Med Biol 2020; 21:310. [PMID: 32498614 DOI: 10.1089/ham.2020.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Uday Yanamandra
- Department of Hematology, Army Hospital Research and Referral, New Delhi, India
| | - Rajat Bahl
- Department of Hematology, Army Hospital Research and Referral, New Delhi, India
| | - Kundan Mishra
- Department of Hematology, Army Hospital Research and Referral, New Delhi, India
| | - Suman Kumar
- Department of Hematology, Army Hospital Research and Referral, New Delhi, India
| |
Collapse
|
35
|
Khera S, Pramanik SK, Yanamandra U, Mishra K, Kapoor R, Das S. Dapsone: An Old but Effective Therapy in Pediatric Refractory Immune Thrombocytopenia. Indian J Hematol Blood Transfus 2020; 36:690-694. [PMID: 33100711 DOI: 10.1007/s12288-020-01286-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/25/2019] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Abstract
There are no definitive guidelines for management of chronic or refractory immune thrombocytopenia (ITP) in children. Dapsone is an inexpensive and efficacious, yet neglected, therapeutic option for treatment of chronic ITP. We evaluated the efficacy and safety of dapsone in the management of chronic ITP in children. Children with chronic ITP < 14 years with minimum grade 2 bleeds refractory to either splenectomy/rituximab/eltrombopag; who were offered dapsone therapy were retrospectively analyzed. Dapsone intolerance and G6PD deficiency were excluded. Dapsone was started at a dose of 1-2 mg/kg/day. Response to dapsone as per international working group definitions, time to response along with side-effects were noted. Forty-four children enrolled; 29 analyzed. Nineteen were refractory to rituximab, 8 to splenectomy and 6 to eltrombopag. Median age was 9.8 years (3-14) with 16/29 males. Median dapsone dose was 1.59 mg/kg/day (range 1-2.1). Overall response was seen in 21/29 (72%): Complete Response in 7/29 (24%), Partial Response in 14/29 (48%). All responses were sustained for minimum 3 months. Median duration to response was 2.9 months (2-6.6). Median follow up was 28 months (6-73) and relapse rate-21%. Major side effects noted: Methemoglobinemia-01, skin ulceration-02. In three cases dapsone could be tapered and stopped without relapse. Dapsone is an economical and efficacious agent with good safety profile in childhood chronic/refractory ITP.
Collapse
Affiliation(s)
- Sanjeev Khera
- Department of Pediatrics, Army Hospital Research and Referral, Delhi, 110010 India
| | | | - Uday Yanamandra
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
| | - Kundan Mishra
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
| | - Rajan Kapoor
- Department of Hematology, Command Hospital EC, Kolkata, India
| | | |
Collapse
|
36
|
KUMAR VINAY, Garg I, Rai C, Srivastava S, Singh J, Yanamandra U, Panjawani U, Kumar B. High Density Lipoprotein Dysfunctionality in Venous Thromboembolism. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- VINAY KUMAR
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| | - Iti Garg
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| | - Chhavi Rai
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| | - Swati Srivastava
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| | | | | | - Usha Panjawani
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences Defence Research and Development Organisation
| |
Collapse
|
37
|
Yanamandra U, Sharma M, Katoch D, Yanamandra S, Bhattachar SA, Gupta A, Patyal S, Grewal R, Kumar S, Nair V. High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem. Indian J Med Res 2020; 149:778-782. [PMID: 31496531 PMCID: PMC6755783 DOI: 10.4103/ijmr.ijmr_1981_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE. Methods This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy. Results The mean SpO2on ambient air on arrival was 66.92±10.8 per cent for all patients with HAPE. Higher SpO2values were achieved with PRM in comparison to Hudson's mask on day one (86.08±5.15 vs. 77.23±9.09%) and day two (89.94±2.96 vs. 83.39±5.93%). The difference was more pronounced on day one as compared to day two. Interpretation & conclusions Mean SpO2values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO2to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.
Collapse
Affiliation(s)
- Uday Yanamandra
- Department of Medicine, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Manisha Sharma
- Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Deeksha Katoch
- Station Medicare Centre, Air Force Station, Vadodara, India
| | - Sushma Yanamandra
- Department of Medicine, High Altitude Medical Research Centre, Leh, Ladakh, India
| | | | - Amul Gupta
- Department of Radiology, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Sagarika Patyal
- Department of 153 General Hospital, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rajan Grewal
- Department of 153 General Hospital, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Suman Kumar
- Department of Hematology, Army Research & Referral Hospital, New Delhi, India
| | - Velu Nair
- Department of Medicine, Armed Forces Medical College, Pune, India
| |
Collapse
|
38
|
Srivastava S, Garg I, Kumari B, Rai C, Singh Y, Kumar V, Yanamandra U, Singh J, Bansal A, Kumar B. Diagnostic potential of circulating micro RNA hsa-miR-320 in patients of high altitude induced deep vein thrombosis: An Indian study. Gene Reports 2019. [DOI: 10.1016/j.genrep.2019.100550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
39
|
Mishra K, Yanamandra U, Shukla A, Pramanik S, Kapoor R, Das S. Risk stratification of CML-CP in a real-world scenario, comparison of S.H.E. with rate of fall of BCR/ABL. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz427.013] [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: 11/14/2022] Open
|
40
|
Das S, Yanamandra U, Iqbal S, Kapoor R. Multiple myeloma mimicking primary bone tumour. BMJ Case Rep 2019; 12:12/10/e230517. [PMID: 31594784 DOI: 10.1136/bcr-2019-230517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satyaranjan Das
- Department of Hematology and Stem Cell transplant, Army Hospital Research and Referral, New Delhi, India
| | - Uday Yanamandra
- Department of Hematology and Stem Cell transplant, Army Hospital Research and Referral, New Delhi, India
| | - Schezan Iqbal
- Department of Orthopedics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rajan Kapoor
- Department of Hematology and Stem Cell transplant, Army Hospital Research and Referral, New Delhi, India
| |
Collapse
|
41
|
Kumar R, Kapoor R, Singh J, Das S, Sharma A, Yanamandra U, Nair V. Splenic Infarct on Exposure to Extreme High Altitude in Individuals with Sickle Trait: A Single-Center Experience. High Alt Med Biol 2019; 20:215-220. [PMID: 31407926 DOI: 10.1089/ham.2018.0120] [Citation(s) in RCA: 7] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Sickle cell trait (SCT) is a common genetic abnormality in the so-called "sickle belts" in India. Splenic infarction often brings to medical attention an underlying SCT, when appropriately looked for. The hypoxic environment of an extreme high-altitude area (HAA) is conducive for developing a splenic infarct in an SCT individual not a native of these areas. Aims: We studied retrospectively 27 cases who presented with a splenic infarction during the last 4 years. Results: Twenty-five patients (92.5%) were diagnosed to have SCT, and 85% patients had developed splenic infarct on exposure to very HAAs. Clinically, splenomegaly was seen in 33% of patients with splenic infarct at presentation. The mean hemoglobin S was 36.92% in SCT individuals. A thrombus in the splenoportal axis was demonstrated in 22.2% of cases. Splenic rupture was a rare event, seen in only 3.5% of patients. Splenectomy was not required in any of the cases. Splenic abscess was not seen, and antibiotics were not required in any of the cases. We discuss the profile and management of these patients and review the literature on splenic infarction in HAA. Conclusion: SCT is commonly overlooked cause of splenic infarction and conservative management is effective in most of the cases. Splenectomy is required only in the rarest of rare cases. The profile and management of these patients and a review of the literature on splenic infarction in HAA has been discussed.
Collapse
Affiliation(s)
- Rajiv Kumar
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Rajan Kapoor
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Jasjit Singh
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Satyaranjan Das
- Department of Pediatrics and Clinical Hematology, Army Hospital (R&R), New Delhi, India
| | - Ajay Sharma
- Department of Hematology & BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Velu Nair
- General Army Medical Services, IHQ, MOD, New Delhi, India
| |
Collapse
|
42
|
Yanamandra U, Bhattachar SA, Katoch D, Yanamandra S, Shankar S, Kumari VKL, Ayekappam A, Kumar S, Patyal S, Nair V. Anthropometric evaluation of school-going native highlanders (4-19 years of age) from the Leh-Ladakh region in India. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0253/ijamh-2018-0253.xml. [PMID: 31075082 DOI: 10.1515/ijamh-2018-0253] [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: 11/03/2018] [Accepted: 12/11/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The native population of the Ladakh region faces the unique challenges of a high-altitude environment with distinct physiological adaptations in comparison with lowlanders. However, no comprehensive data on standard anthropometric parameters for the school-going children in this populace is available. OBJECTIVES We aimed to study the various anthropometric parameters in the school-going native highlander population and computed measures of central tendency. The nutritional status of the community was also be determined by comparing with World Health Organization (WHO) scores for height for age (HFA), weight for age (WFA) and body mass index (BMI) for age. DESIGN A cross-sectional, descriptive study was devised to assess the anthropometric parameters. We measured height, weight, mid-upper circumference (MUAC), triceps skinfold (TSF) thickness, sub-scapular skinfold (SSF) thickness, waist, hip and abdominal circumference. Statistical analysis was conducted to determine the mean [±2 standard deviation (SD)], median, range, minimum and maximum. The z-scores for HFA, WFA and BMI for age was computed using WHO reference data. SUBJECTS A total of 346 school-going native highlander children (4-19 years of age) were studied. RESULTS Among the study population, the mean height was 141.17 ± 39.08 cm, the mean weight was 38.27 ± 25.40 kg. The gender difference in height, MUAC, sub-scapular skinfold (SSF) thickness, TSF thickness and the abdominal circumference was found to be statistically significant. Of the subjects 23.46% were stunted (i.e. HFA below -2 SD of the WHO standard) and 7.01% were underweight (WFA below -2 SD of the WHO standard). CONCLUSION The nutritional status of the Ladakhi population was assessed by comparison with the WHO reference data. Nomograms for anthropometric data in school-going children (4-19 years of age) of Ladakh were created. These can be used for further studies and planning targeted intervention strategies on this geographically isolated and evolutionary distinct highland population.
Collapse
Affiliation(s)
- Uday Yanamandra
- Department of Hematology, Army Research and Referral Hospital, New Delhi, India, Phone: +91-8195035551.,Department of Medicine, 153 General Hospital, Leh, India
| | | | - Deeksha Katoch
- Army Hospital (Research and Referral), Dhaula Kuan, New Delhi, India
| | | | - Siddharth Shankar
- Manipal University, Kasturba Medical College Manipal, Internal Medicine, Manipal, Karnataka, India
| | - V K Lalitha Kumari
- Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Angella Ayekappam
- Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Suman Kumar
- Army Hospital (Research and Referral), Dhaula Kuan, New Delhi, India
| | | | - Velu Nair
- Department of Medicine, Armed Forces Medical College, Pune, India
| |
Collapse
|
43
|
Yanamandra U, Malhotra P. Stem Cell Transplantation in Multiple Myeloma: Very Much Alive and Kicking. Indian J Hematol Blood Transfus 2019; 35:205-207. [PMID: 30988553 PMCID: PMC6438993 DOI: 10.1007/s12288-019-01111-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Uday Yanamandra
- Department of Hematology and Stem Cell Transplant, Army Hospital (Research and Referral), Delhi, 110010 India
| | - Pankaj Malhotra
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
| |
Collapse
|
44
|
Affiliation(s)
- Kamal Kant Sahu
- 1 Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
| | - Uday Yanamandra
- 2 Department of Internal Medicine, Clinical Hematology Division, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Malhotra
- 2 Department of Internal Medicine, Clinical Hematology Division, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
45
|
Yanamandra U, Deo P, Sahu KK, Nampoothiri RV, Gupta N, Prabhakaran A, Dhibhar DP, Khadwal A, Prakash G, Sachdeva MUS, Lad D, Varma N, Varma S, Malhotra P. Clinicopathological Profile of Myelomatous Pleural Effusion: Single-center Real-world Experience and Review of Literature. Clinical Lymphoma Myeloma and Leukemia 2019; 19:183-189.e1. [DOI: 10.1016/j.clml.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/25/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022]
|
46
|
Sahu KK, Yanamandra U, Kakkar N, Malhotra P. Rare Presentation of Mucormycosis in Aplastic Anaemia: Isolated Hepatic Mucormycosis. Mycopathologia 2019; 184:347-348. [PMID: 30684143 DOI: 10.1007/s11046-018-0309-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kamal Kant Sahu
- Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, United States
| | - Uday Yanamandra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| |
Collapse
|
47
|
Yanamandra U, Senee H, Yanamadra S, Das SK, Bhattachar SA, Das R, Kumar S, Malhotra P, Varma S, Varma N, Nair V. Erythropoietin and ferritin response in native highlanders aged 4-19 years from the Leh-Ladakh region of India. Br J Haematol 2018; 184:263-268. [PMID: 30474185 DOI: 10.1111/bjh.15553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Abstract
The pivotal role of erythropoietin (EPO) in hypoxic adaptation has led to various studies assessing the EPO and ferritin response in native highlanders from Andes and Tibet. We assessed the relationship between EPO, haemoglobin and ferritin in 335 native highlanders (172 boys and 163 girls, aged 4 to 19 years) from Leh-Ladakh, India, who had no history of travel to lowland areas. Complete blood counts, serum EPO and ferritin levels were measured. We stratified study subjects based on age, gender, pubertal status and analysed the EPO and ferritin levels between the stratified groups respectively. The mean EPO level in boys was lower than girls. The mean ferritin level in boys was significantly higher (P = 0·013) than in girls. There was no significant variation in the EPO and ferritin levels amongst the various age groups in our study. Near normal EPO levels since childhood with a negative correlation with haemoglobin is suggestive of a robust adaptive mechanism to high altitude from the early years of life. Low ferritin levels are indicative of decreased iron stores in these native highlanders.
Collapse
Affiliation(s)
- Uday Yanamandra
- Department of Haematology, Army Hospital (Research & Referral), New Delhi, India
| | | | | | - Subrat K Das
- Regimental Medical Officer, EME School, Vadodara, India
| | | | - Reena Das
- Department of Haematology, PGIMER, Chandigarh, India
| | - Suman Kumar
- Department of Haematology, Army Hospital (Research & Referral), New Delhi, India
| | | | - Subhash Varma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neelam Varma
- Department of Haematology, PGIMER, Chandigarh, India
| | - Velu Nair
- Ex Director General Medical Services, Integrated Headquarters, Ministry of Defence, Delhi, India
| |
Collapse
|
48
|
Yanamandra U, Sahu KK, Karunakaran P, Katoch D, Jain N, Khadwal A, Prakash G, Lad D, Naseem S, Varma N, Varma S, Malhotra P. Adolescent and Young Adult Chronic Myeloid Leukemia in Real-World Settings: Experience from a Tertiary Care Institute in Northern India. J Adolesc Young Adult Oncol 2018; 8:94-97. [PMID: 30383979 DOI: 10.1089/jayao.2018.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The data on adolescent and young adult chronic myeloid leukemia (AYA-CML) from the Indian subcontinent are scarce. We studied characteristics of AYA-CML through a retrospective analysis of 1950 CML patients registered to a tertiary care hospital in Northern India. AYA-CML represented 22.1% of all CML patients, with cumulative overall survival (OS) of 84%, and 1 and 8 years OS of 94.2% and 74.2%, respectively. Of all cases, 8.91% patients had advanced disease at the time of diagnosis, and 13.95% had myelofibrosis in the diagnostic marrow, 79.6% had complete cytogenetic response (CCyR), and 84.5% had major molecular response (MMR). Loss of CCyR and MMR was noted in 37.2% and 28.4%, respectively. The cumulative OS was significantly better in patients on patient assistance program, and they were initiated on therapy within 3 months of symptom onset.
Collapse
Affiliation(s)
- Uday Yanamandra
- 1 Department of Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Kamal Kant Sahu
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Parathan Karunakaran
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Deeksha Katoch
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Nidhi Jain
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Alka Khadwal
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Gaurav Prakash
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Deepesh Lad
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Shano Naseem
- 3 Department of Hematology, PGIMER, Chandigarh, India
| | - Neelam Varma
- 3 Department of Hematology, PGIMER, Chandigarh, India
| | - Subhash Varma
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| |
Collapse
|
49
|
Yanamandra U, Bhattachar SA, Das SK, Yanamandra S, Kumari VKL, Ayekappam A, Kumar S, Malhotra P, Varma S, Varma N, Nair V. Hematological Parameters in Native Highlanders of Ladakh Aged 4-19 Years. Indian J Hematol Blood Transfus 2018; 34:731-738. [PMID: 30369750 DOI: 10.1007/s12288-018-0967-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/07/2018] [Indexed: 11/28/2022] Open
Abstract
Hematological adaptations to high altitude (HA) are long studied but are focused either on lowlanders visiting HA or native highlanders from Andes and Tibet. The literature on native highlanders from the Indian subcontinent or paediatric highlanders is scarce. We aimed at assessing hematological parameters in native highlanders of Ladakh, India, aged 4-19 years and derive nomograms in an age stratified manner specific to these native highlanders. A total of 335 self-reported healthy native highlanders of Ladakh, without any known comorbidities and not on hematinic nor any drugs in the age group of 4-19 years were included in the study. Complete hemogram including red cell indices was measured. R ver 3.4.0 was used to compare the hematological parameters based on gender/age stratification, pubertal and nutritional status. The hematological reference ranges were created for various parameters in the paediatric population. The mean (SD) haemoglobin (Hb) concentration was 14.74 (2.07) gm/dL. The mean hematocrit (Hct) was 40.43 (5.57%) %, mean corpuscular volume (MCV) was 81.87 (7.22) fL, white blood cell (WBC) count was 7596 (2172) cells/μL and platelets was 378.4 (152.8) × 103/μL. Hct and MCV increased with age. Hb concentration, Hct, and MCV in girls was significantly lower than boys. Severely underweight subjects (body mass index < 16) showed significantly higher platelet counts compared to their nourished counterparts. The hematological nomograms for the native paediatric highlanders from Ladakh, India have been reported in this study.
Collapse
Affiliation(s)
- Uday Yanamandra
- 1Department of Hematology, Army Hospital (Research & Referral), Delhi Cantt, India
| | | | | | | | - V K Lalitha Kumari
- 5Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Angella Ayekappam
- 5Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Suman Kumar
- 6Army Hospital (Research & Referral), Delhi, India
| | | | - Subhash Varma
- 7Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neelam Varma
- 8Department of Hematology, PGIMER, Chandigarh, India
| | - Velu Nair
- 9Director General Medical Services (Army), Integrated Headquarters Ministry of Defence, Delhi, India
| |
Collapse
|
50
|
Yanamandra U, Malhotra P, Sahu K, Sushma Y, Saini N, Chauhan P, Gill J, Rikhi D, Khadwal A, Prakash G, Lad D, Suri V, Kumari S, Varma N, Varma S. Variation in Adherence Measures to Imatinib Therapy. J Glob Oncol 2018; 4:1-10. [PMID: 30241224 PMCID: PMC6223484 DOI: 10.1200/jgo.2016.007906] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The introduction of tyrosine kinase inhibitors has transformed the care of patients with chronic myeloid leukemia, with survival approaching that of healthy individuals. Current-day challenges in chronic myeloid leukemia care include adherence to tyrosine kinase inhibitor therapy. We studied adherence from resource-constrained settings and tried to analyze the factors responsible for nonadherence in these individuals. We also correlated adherence to current molecular status. PATIENTS AND METHODS This was a single-center, cross-sectional, observational study from north India. It consisted of a questionnaire-based survey in which a one-to-one interview technique was used by trained nursing staff administering the Modified Morisky Adherence Scale (MMAS-9) questionnaire. Adherence was also measured on the basis of physician's assessment. JMP 13.0.0 was used for statistical analysis. RESULTS A total of 333 patients with a median age of 42 years were included in the study. The median BCR-ABL/ABL ratio (IS) was 0.175 (0.0 to 98.0). The mean MMAS-9 score was 11 ± 2. Adherence was seen in 54.95% on the basis of MMAS-9, whereas physician's assessment reported adherence in 90.39% of patients. Using the χ2 test, no relationship was found between the two assessment techniques. There was a significant relationship between major molecular response status and adherence by physician's assessment and MMAS-9 ( P < .001). Bivariate analysis by logistic fit showed a good relation between the MMAS-9 score and the BCR-ABL/ABL ratio (IS), χ2 (1,220) = 135.45 ( P < .001). On multivariate analysis, enrolment in the Novartis Oncology Access program (a patient assistance program) was significantly associated with adherence ( P = .012). CONCLUSION This study highlights the lack of adherence in real-world settings and the various factors responsible. Such studies are important from a public health services perspective in various settings around the world because they may lead to corrective action being taken at the institutional level.
Collapse
Affiliation(s)
- Uday Yanamandra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pankaj Malhotra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - K.K. Sahu
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Yanamandra Sushma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neha Saini
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pooja Chauhan
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Jasmeen Gill
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepika Rikhi
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Alka Khadwal
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Gaurav Prakash
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepesh Lad
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Vikas Suri
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Savita Kumari
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neelam Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Subhash Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| |
Collapse
|