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Background: In endemic regions of several countries, the prevalence of leprosy has not come down to the level of elimination. On the contrary, new cases are being detected in large numbers. Clinically, it is frequently noted that despite completion of multibacillary multidrug therapy for 12 months, the lesions remain active, especially in cases with high bacteriological indices. Aim: The present study focused on finding out the viable number of Mycobacterium leprae during the 12-month regimen of multibacillary multidrug therapy, at six and 12 months intervals and, attempting to determine their role in disease transmission. Methods: Seventy eight cases of multibacillary leprosy cases were recruited from leprosy patients registered at The Leprosy Mission hospitals at Shahdara (Delhi), Naini (Uttar Pradesh) and Champa (Chhattisgarh), respectively. Slit skin smears were collected from these patients which were transported to the laboratory for further processing. Ribonucleic acid was extracted by TRIzol method. Total Ribonucleic acid was used for real-time reverse transcription-polymerase chain reaction (two-step reactions). A standard sample with a known copy number was run along with unknown samples for a reverse transcription-polymerase chain reaction. Patients were further assessed for their clinical and molecular parameters during 6th month and 12th month of therapy. Results: All 78 new cases showed the presence of a viable load of bacilli at the time of recruitment, but we were able to follow up only on 36 of these patients for one year. Among these, using three different genes, 20/36 for esxA, 22/36 for hsp18 and 24/36 for 16S rRNA cases showed viability of M. leprae at the time of completion of 12 months of multidrug therapy treatment. All these positive patients were histopathologically active and had bacillary indexes ranging between 3+ and 4+. Patients with a high copy number of the Mycobacterium leprae gene, even after completion of treatment as per WHO recommended fixed-dose multidrug therapy, indicated the presence of live bacilli. Limitations: Follow up for one year was difficult, especially in Delhi because of the migratory nature of the population. Patients who defaulted for scheduled sampling were not included in the study. Conclusion: The presence of a viable load of bacilli even after completion of therapy may be one of the reasons for relapse and continued transmission of leprosy in the community
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Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.
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Background: In neuropsychological assessment, the time taken by a subject or patient to respond tostimulus provides valuable information about processing in central and peripheral nervous system. Reactiontime is a simple and inexpensive method commonly used in cognitive and sport physiology to assess thesensory-motor performance of an individual.Objective: To compare and validate the baseline values of simple reaction time obtained using the PC 1000Hz reaction timer with Biopac® MP 36.Materials and Methods: 50 healthy subjects (32 males and 18 females) with age of 22.78±3.90 yrs andBMI of 24.820±3.59 kg/m2 participated. Visual (VRT) and auditory (ART) reaction time were estimated usingPC 1000 Hz reaction timer and Biopac® MP 36 separately for minimum of three trials each.Results: There was no significant difference found in ART and VRT values of the subjects estimated by PC1000 Hz and Biopac® MP 36. A strong significant (P<0.01) correlation was found in ART (r=0.92) and VRT(r=0.94) in between the devices. Bland Altman plot also showed that variations for VRT and ART were withinthe acceptable range.Conclusion: The present validation study recommend that the assessment of simple reaction time forauditory and visual stimulus by PC 1000 Hz reaction timer is reliable one and compared with other techniquesit has more advantages such as portable in nature and simplicity to use either in laboratory or in fieldoriented study for the evaluation of psychomotor and cognitive function.
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Background: Application of basic science knowledge to clinical practice is the aim of first year undergraduate dental curriculum. To bring in application of basic science theory to the clinical dental application, a case based learning (CBL) approach has been tried among first year dental students. Materials and methods: Randomized control trial was conducted by grouping first year undergraduate dental students (N= 73) into traditional group (N=35) and CBL group (N=38). Conventional lecture was given to traditional group and case based lecture and small group discussion for CBL group facilitated by faculty. Pre and post tests were administered for both the groups. Perceptions on CBL approach were collected using a questionnaire. Results were analyzed using paired and unpaired ‘t’ test. Results: Test scores were expressed in mean ± SD. deviation. Post-tests scores of traditional - (7.5 ±1.6) and CBL (7.7±1.9) groups were significantly higher than pretest scores of traditional - (5.7 ± 1.4) and CBL (4.9 ± 1.7) groups. Attitude score showed positive perceptions for most of the parameters. Conclusion: The first time CBL approach for Physiology concept provoked interest among dental students. Participants felt the method involved them in active learning and they recommended this approach to other sessions as well. Recall of factual knowledge did not improve significantly over traditional method, but was equally effective.
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Griscelli syndrome (GS) is a rare autosomal recessive immunodeficiency disorder in which the affected children present with characteristic silvery‑white hairs. The hair microscopy of these children is characteristic and is helpful in differentiating GS from Chediak–Higashi syndrome which also presents with immunodeficiency and silver hairs. We report a 17‑month‑old boy with GS type 2 who presented with severe anemia. Bone marrow examination of the child suggested parvovirus B19 as the cause of severe anemia, which was later confirmed by DNA polymerase chain reaction
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Objective: To evaluate pre-treatment undernutrition, and folate and B12 deficiency in children with acute lymphoblastic leukemia, and their correlation with complications and outcome of induction chemotherapy. Design: Observational study. Setting: Tertiary care teaching hospital in Northern India. Participants: 50 children with acute lymphoblastic leukemia. Procedure: Children were assessed for nutritional status (Weight for age Z-score, serum albumin, folate and B12) at presentation, and were followed-up during induction for bone marrow response, counts and outcome. Folate and B12 were repeated twice at monthly intervals after induction. Univariate and multivariate analyses were done to determine the association of nutritional parameters with the outcome variables. Results: Baseline undernutrition was observed in 66%, hypoalbuminemia in 32.6%, folate deficiency in 41.3% and B12 deficiency in 36.9% of included children. Significant decline in folate levels was noted on serial assays during chemotherapy (P=0.001). Folate deficient children had higher risk for delayed marrow recovery and counts on day 14 (P=0.007 and P=0.001). Hypoalbuminemia (P=0.04), B12 deficiency (P=0.001) and folate (P=0.03) deficiency were associated with toxic deaths during induction. Conclusion: Baseline nutritional deficiencies negatively influence the outcome and occurrence of complications during induction chemotherapy in children with acute lymphoblastic leukemia.
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Context: This study was done to assess the Serial peripheral blood and bone marrow changes in patients of Acute Lymphoblastic Leukemia on chemotherapy. Aims:To assess the therapy related serial bone marrow changes in patients of Acute Lymphoblastic Leukemia. Settings and Design: Prospective study, carried out in Lymphoma- Leukemia Lab, Department of Pathology, K.G.M.U from March 2011 to March 2012. A total of 60 cases were studied Materials and Methods: History, complete hemogram, bone marrow examination at pretherapy (Day-0), intratherapy (Day-14), and end of induction chemotherapy (Day-28) were done. Peripheral blood smears were evaluated at regular interval to assess clearance of blast cells. Statistical analysis used:The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. The values were represented in Number (%) and Mean ± SD. The following Statistical formulas were used: Mean, standard deviation, Chi square test, Paired “t” test, Student ‘t’ test, Level of signifi cance P Results: Incidence of ALL-L1 (46.7%) and ALL-L2 (53.3%) was equal. ALL-L2 patients had poor survival.Day 0 (D-0) bone marrow was hypercellular with fl ooding of marrow by leukemic cells. High levels of tumor load at D‘0’ were associated with poor survival. 14th day of Induction phase showed signifi cant decrease in hemoglobin and TLC as compared to D ‘0’ parameters. D28 showed marrow regeneration. Cellularity, Blast%, and Leukemic Index showed signifi cant drop from day ‘0’ to day 14 due to myelosupression, whereas regeneration refl ected by increased cellularity as per day 28 marrow. Lymphocytosis (>20%) at end of induction chemotherapy had better survival and longer remission.Risk of mortality was directly proportional to blast clearance and was a major independent prognostic factor for achievement of complete remission. Conclusions: A bone marrow examination at the end of induction chemotherapy provides information whether patient has achieved remission with regeneration of cells or still has residual leukemia. If the patient is in remission, maintenance treatment is started and if not more intensive chemotherapy or bone marrow transplantation may be embarked upon.
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Background & objectives: Leukaemia and lymphoma are common paediatric haematological malignancies acquiring human parvovirus B19 (B19) infection. In some studies anaemia has been found in children with acute lymphoblastic leukaemia (ALL) during maintenance therapy and rarely in lymphoma. We studied frequency of B19 infection and its implications in new onset acute leukaemia (mostly ALL) and lymphoma in children. Methods: Seventy serum samples from 35 children (age <12 yr, 29 males) newly diagnosed with haematological malignancies (on induction therapy) were collected together with 34 controls (solid tumours). Children were examined clinically and for anti-B19 IgM antibodies by quantitative ELISA and B19 DNA by PCR (VP1-VP2) and nested-PCR (VP1 unique). Bone marrow aspirates were examined histopathologically, whenever possible. Results: Of the 35 children, 22 had acute leukaemia while 13 had lymphoma. B19 infection was seen in six (17.1%) of 35 children (5 ALL, 1 NHL), two at diagnosis and four during follow up compared to none in the control. Among five B19 IgM positive ALL (n=18) children, two had B19 genome and two had giant pronormoblasts (lantern cells; but one lacked B19 DNA). Of the 70 serum samples tested, eight (11.4%) had anti-B19 IgM as two children had persistent B19 infection and one showed atypical maculopapular rashes (lower limbs) while 12 (34.3%) had anti-B19 IgG antibodies. B19 infected children had unexplained anaemia (80%), required more blood transfusions (6.6 ± 4.8 Units vs 3.0 ± 2.6 Units) besides induction chemotherapy was delayed (60%) and required longer duration of therapy (29.2 ± 20 vs 6.3 ± 7.8 days) (P<0.02). Five children (2 ALL, 2 AML, 1 NHL) died but none were infected with B19. Interpretation & conclusions: B19 infection should be considered in children with ALL as it frequently caused unexplained anaemia and delay in induction chemotherapy.