Treatment outcome of childhood Hodgkin lymphoma after chemotherapy alone

To find the outcome of Hodgkin lymphoma treatment in children without radiotherapy using chemotherapy as a single treatment modality. Descriptive retrospective study. This study was conducted at the Pediatric Oncology Department, Children's Hospital and Institute of Child Health, Multan from January, 2006 to January, 2014. All newly diagnosed children with Hodgkin lymphoma up to the age of 15 years were included in the study. Diagnosis was made on history, clinical examination and lymph node biopsy for histopathology and immunohistochemical staining. X-Ray chest. CT scan of the abdomen, bone scan and bone marrow biopsy were done for staging the disease. Chemotherapy was given to all children according to UKCCSG [United Kingdom Childhood Cancer Study Group] protocol for treatment of Hodgkin lymphoma. Response to treatment was noted after completion of chemotherapy. Among 60 children with Hodgkin lymphoma. 55[92%] were male with M: F = 1 1.5:1.Age range at presentation was 3.5-15 years with mean of 8.5 years. Cervical lymphadenopathy was noted in 52[87%] and mediastinal lymphadenopathy in 8[13%] patients. Stage I, II, III and IV were found in 13[22%], 4[7%], 34[56%] and 9[15%] respectively. Mixed cellularity [MC] was the most common histopathological type, found in 43[72%] patients, followed by nodular sclerosis[NS] in 13[22%] and lymphocyte predominant [LP] in 3[5%].Lymphocyte depleted[LD] type was found in only one patient. On immunohistochemical staining CD30 was positive in all patients. So far, 53 [88%] children have completed their treatment and showed complete response to chemotherapy alone, 4[7%] got relapse and 3[5%] expired during treatment. Most of the children with Hodgkin lymphoma show complete response to the chemotherapy alone and can be treated without radiotherapy. However more patients and long-term follow up is needed for making definite conclusions

Treatment outcome in childhood steroid resistant nephrotic syndrome with different therapeutic regimens

To determine the efficacy of different treatment strategies in children with steroid resistant nephrotic syndrome [SRNS] and to find the impact of histopathological lesions on the treatment outcome. Retrospective observational. This study was conducted at Paediatric Nephrology Department, the Children's Hospital and the Institute of Child Health, Multan from January, 2006 to July, 2014. Medical record of 77 patients with SRNS was reviewed. For the purpose of treatment patients were divided into two groups depending upon the initial renal function tests [RFTs]. Group 1 included patients with normal RFTs. They received cyclosporine A [CsA], mycophenolate mofetil [MMF], combined CsA and MMF, and intravenous methylprednisolone [MP] pulses as step 1, 2, 3, and 4 respectively. Group 2 included patients with deranged RFTs and they were given either MMF, or MP pulses. Long-term follow up was done ranging from 1-5 years. Treatment outcome with different therapeutic regimens was determined. The role of histopathology in predicting final outcome was also evaluated. In group 1, 44/61[72%] patients achieved complete remission with successive treatment steps1-4.Two [3.4%] patients were partial responders whilst 15[24.6%] patients failed to respond to all treatment regimens. Out of the 16 patients in group 2, only 02 [12.5%] achieved remission. Patients with focal segmental glomerulosclerosis [FSGS] were least likely to respond to treatment [12/28; 42.8%],followed by mesangioproliferative glomerulonephritis [MesPGN][15/23;65.2%], and minimal change disease [MCD][14/18;77.8%]. SRNS patients with normal initial RFTs are much more likely to respond to immunosuppressives than those with deranged RFTs at presentation. FSGS is more difficult lesion to treat compared with non-FSGS lesions

Causes of short stature identified in children presenting at a tertiary care hospital in Multan Pakistan

To determine the frequency of common causes of short stature in children presenting to the Children's Hospital and the Institute of Child Health, Multan. This cross sectional study was done in Pediatric Endocrinology department, the Children's Hospital and the Institute of Child Health, Multan, from March to September, 2011. One hundred and sixty nine children with short stature presenting to the outpatient department meeting inclusion criteria were recruited after taking an informed consent. The detailed history, physical examination including anthropometric measurements and relevant investigations were recorded. Causes of short stature [outcome variable] were recorded on a predesigned proforma for final analysis. The common causes of short stature identified were; familial short stature [FSS] 36 cases [21.3%], hypothyroidism 29[17.2%], growth hormone deficiency [GHD] 18[10.7%], insulin dependent diabetes mellitus [IDDM] 16[9.5%] and constitutional delayed growth and maturation [CDGM] 11[6.5%] cases. This was followed by primary malnutrition 8[4.7%], celiac disease 6[3.6%], Turner syndrome 5[3%] cases and unknown syndromes 4[2.4%] followed by other rare causes. Common causes of short stature identified in this study were endocrine diseases followed by normal variant short stature [NVSS], while nonendocrine causes were the least

Primary duodenal Burkitt lymphoma in a paediatric patient, presenting as a protein-losing enteropathy

Lymphomas of gastrointestinal system are usually of non-Hodgkin's type. Primary Burkitt lymphoma involving the duodenum is very rare in paediatric population. It may present as protein losing enteropathy in adults which may lead to generalized edema, however in paediatric population these cases are associated with colicky or persistant abdominal pain, weight loss, fever, gut bleeding or obstruction. We report a case of a young male child with primary duodenal Burkitt Lymphoma presenting as protein losing enteropathy

Significance of bone marrow biopsy in diagnosis of pediatric diseases; one year experience at a single pediatric hematology/oncology center

Despite the recent advances in the field of hematology in the form of molecular studies and immunophenotyphing, morphological study of bone marrow remains a corner stone in the diagnosis of pediatric hematological diseases. It is also helpful in the diagnosis of many non-hematological diseases. This study is unique in a sense that bone marrow biopsy procedure and morphology reporting were done by a pediatrician trained in clinical hematology. To describe the indications of bone marrow biopsy and frequency of pediatric hematological and non-hematological diseases on morphological basis. This study was conducted at the Pediatric Hematology/Oncology Department, The Children Hospital and the Institute of Child Health Multan from January 2010 to December 2010. This study was conducted on children whether admitted in hematology / oncology ward or referred from various departments of this hospital. A Performa was filled for each patient including detailed history, clinical examination, base line investigation reports and provisional diagnosis. All bone marrow biopsies were performed from posterior iliac spines according to standard protocol for this procedure. Biopsy samples were stained with Leishman stain for morphological study. Bone marrow biopsy report was issued with detailed morphology, morphological diagnosis and suggestion for further investigations e.g. immunophenotyping. Patients age range was 3 months to 13 years with Male: Female = 1:1. Out of 100 bone marrow biopsy reports, disease distribution was acute lymphoblast leukemia [ALL] 30%, acute myeloid leukemia [AML] 7%, lymphoma infiltration 3%, aplastic anemia 18%, idiopathic thrombocytopenic purpra [ITP] 7%, storage disorders 11%, hemolytic anemia 5%, congenital dyserythropoitic anemia [CDA] 2%, red cell aplasia [RCA] 2%, refractory anemia with excessive blasts [RAEB] 2%, nutritional anemia 3%, malaria 3%, reactive changes 5% and normal morphology 2%.In children, acute leukemia is a leading hematological disease on bone marrow morphology followed by aplastic anemia and various non-hematological diseases. Despite availability of advanced diagnostic facilities, bone marrow biopsy is still a useful diagnostic test in many childhood diseases

Diagnostic usefulness of anti-tissue transglutaminase in celiac disease: correlation with intestinal mucosal biopsy

To describe the clinical value of Anti-tTG [IgA, IgG] in the diagnostic work-up of celiac disease patients. Children with clinical suspicion of celiac disease, presenting in Gastroenterology and Hepatology out patient department, Children's Hospital and The Institute of Child Health, Multan were recruited. It was a descriptive case series, study was conducted from Jan 2007 to Jan 2009, blood samples for Anti-tTGs [IgG, IgA] and duodenal biopsies for histological analysis were taken. Data was analyzed for descriptive analysis. Sixty patients with symptoms suggestive of celiac disease were submitted for Anti-tTGs [IgG, IgA] and duodenal biopsy, 46 patients had histological changes according to the Marsh criteria and 49 had raised Anti-tTGs. A total of 54 patients who had one or both the tests positive, were considered for final analysis. 41 patients showed histological changes of celiac disease on duodenal biopsy and raised Anti-tTGs, 5 patients with histological changes of celiac disease had Anti-tTGs levels within normal limits. Five patients with raised Anti-tTGs levels had nonspecific inflammatory changes [not consistent with celiac disease] and 3 patients with raised Anti-tTGs levels had normal histology of intestinal mucosa. Anti-tTGs [IgA, IgG] is very valuable screening marker in the diagnostic work-up of celiac disease, specially in selecting the patients for duodenal biopsies

Health problems in children of imprisoned mothers

To describe the health problems faced by children who accompanied their mothers in the prison. An observational cross-sectional study. 30 children who accompanied their mothers in women jail Multan were examined from 1 October 2009 to 30 December 2009. The department of preventive and social pediatrics visited the woman jail Multan fortnightly for regular medical checkup and support to the children who were residing with their mothers in the jail. All the information regarding their ailments was recorded on a pre-designed questioner. 17 children were male and 13 were female. Mostly children were between 1 to 5 years. Anemia and malnutrition was common. Other illnesses like ARI, scabies Diarrhea and asthma were also noted in these children. One child was suffering from Epilepsy. 26 children were fully vaccinated and 4 were partially vaccinated .childrens environmental condition was inadequate. The children who accompany their mothers in the prison have to face multiple medical and social problems like anemia, malnutrition, infections, asthma and Immunization. These disorders can be prevented by providing adequate living conditions, avoiding overcrowding, providing sufficient and balanced diet, sterilized water, proper Immunization and proper hand washing