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Objective To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. Methods This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancerdirected therapy in them. Children?15 y on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. Results One hundred twenty-two children (median age 8 y; range 1–15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0–48 d) and no increased toxicities. All-cause mortality rate was 7.4% (n=9) and COVID-19 related mortality rate was 4.9% (n=6). One hundred-ffteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. Conclusions COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.
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@#Myxedema coma is associated with decreased mental status and hyponatremia among patients with diagnosed or undiagnosed hypothyroidism. The diagnosis is challenging in the absence of universally accepted diagnostic criteria, but should be considered as a differential even in cases with competing established diagnoses. All patients should receive intensive care level treatment. Even with optimal treatment, mortality is very high.
Assuntos
Mixedema , ComaRESUMO
Justification: Children with cancer need to be immunized against the common vaccine-preventable diseases after completion andsometimes during ongoing treatment of cancer. However, the immunization schedule for these children needs to be altered due todisease and treatment related immune-suppression. Consequently, there are many guidelines/practice statements from around theworld to address this issue, however, there is no such comprehensive guideline from India catering to the need of Indian children withcancer. Process: A guideline was drafted after reviewing the available literature. The draft guideline was discussed and modified in ameeting attended by pediatric oncologists from the PHO chapter and vaccine experts from the ACVIP of the IAP. Subsequently, themodified draft was reviewed and recommendations were finalized.Objective: To review the current evidence and generate a nationallyrelevant guideline for immunization of children receiving chemotherapy for cancer. Recommendations: Live vaccines arecontraindicated during and up to 6 months after end of chemotherapy. Non-live vaccines are also best given after 6 months from the endof treatment for durable immunity. Annual inactivated influenza vaccine is the only vaccine recommended for all children duringchemotherapy whereas hepatitis B vaccine is recommended only for previously unimmunised children with risk of transfusion associatedtransmission of infection. Post-treatment re-immunization/catch-up schedule largely depends on the pre-chemotherapy immunizationstatus. Sibling immunization should continue uninterrupted except for oral polio vaccine which needs to be substituted by the injectablevaccine. Inactivated influenza vaccine is recommended and varicella vaccine is encouraged for all contacts including siblings
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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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Olanzapine is an atypical antipsychotic which is efficacious in the treatment of schizophrenia. The adverse effect profile for olanzapine is benign except for higher rates of metabolic events. Orthostatic hypotension is less commonly reported with olanzapine as compared to first-generation and few atypical antipsychotics. We report a case where olanzapine, in a dose dependent fashion, caused transient postural hypotension.