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1.
Indian J Cancer ; 58(2): 185-189, 2021.
Article in English | MEDLINE | ID: mdl-33402576

ABSTRACT

BACKGROUND: Early diagnosis of sepsis in children with febrile neutropenia remains difficult owing to non-specific clinical and laboratory signs of infection. There is a need to assess the utility of inflammatory markers in clinical risk assessment for their ability to discriminate between low-risk and high-risk neutropenic patients since presently there is insufficient data to recommend their routine use. METHODS: This is a prospective study of children on therapy admitted with febrile neutropenia and sampled for serum procalcitonin (PCT), interleukin-6 (IL-6), and interleukin-8 (IL-8) at admission. The febrile neutropenia episodes were categorized into two groups - Group I: no focus of infection and Group II: clinically/microbiologically documented infection. Statistical analyses for comparison were performed using Z-test and receiver operating curves at various cut-off levels. RESULTS: A total of 46 episodes of febrile neutropenia in 33 children were analyzed. In total, 76% were categorized as group I and 24% as group II. The mean value of PCT in group II was higher (28.07 ng/mL) than group I (1.03 ng/mL) though there was no significant statistical difference. At a cut-off level of 2 ng/mL for PCT, sensitivity of 63%, specificity of 91%, positive predictive values (PPV) of 70%, and negative predictive value (NPV) of 88% were observed. There was no significant difference in the IL-6 and IL-8 levels between both the groups. However, at an optimal cut-off value of 50 pg/mL, IL-6 had an NPV of 80% and at a cut-off level of 130 pg/mL, IL-8 had an NPV of 73%, however, with low sensitivity and specificity. CONCLUSION: IL-6, IL-8, and PCT can be utilized to define a group of patients with a low risk of sepsis in view of their favorable NPV. The use of these biomarkers together can facilitate early discharge from the hospital, and the use of oral antimicrobial therapy, in turn, reducing the cost of supportive therapy in a developing country.


Subject(s)
Biomarkers/blood , Febrile Neutropenia/complications , Infections/diagnosis , Interleukin-6/blood , Interleukin-8/blood , Neoplasms/complications , Procalcitonin/blood , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infections/blood , Infections/etiology , Male , Prognosis , Prospective Studies , ROC Curve
2.
J Pediatr Hematol Oncol ; 42(7): e655-e658, 2020 10.
Article in English | MEDLINE | ID: mdl-31613844

ABSTRACT

Rosette-forming glioneuronal tumor is a rare World Health Organization grade I neoplasm, primarily involving the posterior fossa. Most cases have been reported in young adults. Although maximal surgical resection is advocated, a precise treatment modality is yet to be established. We describe an unusual presentation of rosette-forming glioneuronal tumor occurring in the optic pathway in a child. As the site of the tumor was not amenable to resection, he underwent radiotherapy and is currently well on follow-up.


Subject(s)
Nervous System Diseases/pathology , Optic Nerve Neoplasms/pathology , Rosette Formation/statistics & numerical data , Child , Humans , Male , Nervous System Diseases/complications , Nervous System Diseases/radiotherapy , Optic Nerve Neoplasms/complications , Optic Nerve Neoplasms/radiotherapy , Prognosis , Radiotherapy/methods
3.
J Oncol Pharm Pract ; 26(5): 1103-1109, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31653180

ABSTRACT

OBJECTIVE: The present study was conducted to evaluate the pattern of occurrence of adverse drug reactions and drug-drug interaction in a pediatric oncology unit of a tertiary care hospital. METHODS: A prospective, observational study was conducted in the Department of Pediatric Oncology, Sri Ramachandra Medical College and Hospital, India. Patients were monitored actively for the occurrences of any adverse drug reaction during the study period. Patient's demographic details, clinical, and treatment data were collected for drug-drug interaction analysis. The detected adverse drug reaction was assessed for causality, severity, and preventability. Drug-drug interaction identified was rated based on their level of urgency and the nature of actions necessary to respond to an interaction. RESULTS: Of 176 patients, 118 were detected for the occurrence of various adverse drug reaction. The majority of the cases were suffering with acute lymphocytic leukemia (67.9%). Vincristine was noted for a maximum number of adverse drug reaction in cytotoxic drugs. Rash is the most frequently occurred reaction. Assessment of causality showed that the majority of cases are "probable" (60.16%). In evaluating the severity of adverse drug reactions, 57.6% reactions were moderately severe and 74.5% of the reactions were preventable. Upon assessing the drug-drug interaction, 38.13% of the prescription needs to be monitored and 10 drug-drug interactions were under the risk category of "X." The majority of the adverse drug reaction was moderately severe in nature and those were preventable. CONCLUSION: Since pediatrics are vulnerable population, they must have a thorough surveillance system for adverse drug reaction and drug-drug interaction; thereby, a positive impact on the medication-use system and improved patient care can be achieved.


Subject(s)
Antineoplastic Agents/adverse effects , Drug-Related Side Effects and Adverse Reactions/epidemiology , Adolescent , Child , Child, Preschool , Drug Interactions , Exanthema/chemically induced , Female , Humans , India/epidemiology , Infant , Male , Prospective Studies , Tertiary Care Centers , Vincristine/adverse effects
4.
Indian J Med Paediatr Oncol ; 38(1): 4-9, 2017.
Article in English | MEDLINE | ID: mdl-28469329

ABSTRACT

CONTEXT: Life-saving cancer therapy is costly and may result in financial burden for these families. Financial costs for treating childhood cancer care are traditionally assessed based on the amount spent for diagnostic tests, hospitalization, and chemotherapy. The financial costs for travel, accommodation, out-of-pocket expenses for food, phone bills, and loss of income due to reduction or termination of parental employment are hidden nonmedical expenses that are rarely accounted for. Studies on the financial implications of pediatric cancer treatment are based on the Western model of healthcare with good government/state insurance coverage and hence literature on lifestyle implications for families in developing nations with limited resources is still scarce. AIMS: The aim of this study is to find out the details of out-of-pocket expenses incurred by the families during their treatment of cancer children and its implications on their quality of life. Settings and Design: This study was conducted in a tertiary care center for pediatric malignancies for over 1-year period. SUBJECTS AND METHODS: About seventy families whose children were diagnosed with acute leukemia and undergoing treatment at our center were asked to fill a questionnaire detailing their out-of-pocket expenses. RESULTS: Nonmedical expenses accounts for about 46% of their monthly household income of parents from rural areas and 22% of their household income from urban areas. On an average, a family from rural area spends four times the normal amount spent on home for their daily food expenditure. Thirty-eight percent of families have borrowed money from money lenders with an average interest rate of about 12.5% which pushes them to a state of debt for the next few years. CONCLUSIONS: Out-of-pocket expenses contribute a significant proportion to the financial burden of the families with childhood malignancies and these invisible expenses should be recognized and provide adequate support to lessen the burden of this economic impact.

5.
J Pediatr Hematol Oncol ; 38(8): 622-626, 2016 11.
Article in English | MEDLINE | ID: mdl-27769080

ABSTRACT

BACKGROUND: The first counseling or the exchange between the physician and the parent(s) of children with cancer is of vital importance as it sets the tone for the rest of the treatment. The goal of our study was to find out the preferences among parents of Indian children with cancer regarding communication and breaking of bad news when fully informed about the diagnosis. MATERIALS AND METHODS: A sample of 60 parents who had been counseled within 3 months from diagnosis were interviewed with a prepared questionnaire directed at eliciting their experiences with the physicians who broke the bad news to them and also suggestions to improve the exchange. RESULTS: Sixty parents of children diagnosed with cancer participated in the study. All parents agreed on the importance of first counseling and asked for a second round of counseling to reinforce concepts learned during the first counseling. An overall 83% of parents wanted a comparison with another child having the same diagnosis, 57% wanted immediate or extended family to be present, and 92% did not want support staff to be present during counseling. In all, 68% of parents did not want to reveal the diagnosis to the child, 77% wanted as much information about the disease as possible, including estimated cost of treatment, and 90% wanted access to other information services and information about other centers where treatment was available. CONCLUSIONS: Parents have preferences about the ways in which information is presented to them during the first counseling. Knowing these preferences will help physicians to better their ability to interact with parents in the future during first counseling and help them decide a culturally appropriate course of action.


Subject(s)
Counseling/statistics & numerical data , Neoplasms/psychology , Parents/psychology , Professional-Family Relations , Adult , Child , Family , Female , Humans , Information Dissemination , Male , Physicians , Surveys and Questionnaires
6.
J Pediatr Hematol Oncol ; 38(6): 473-5, 2016 08.
Article in English | MEDLINE | ID: mdl-27164530

ABSTRACT

Paraneoplastic neurological syndromes (PNS) are rare, remote effects of cancer that are usually caused by an altered immune response to the tumor and not due to the tumor mass, metastasis, infection, ischemia, or metabolic derangements. PNSs can affect any area of the central, the peripheral, and the autonomic nervous systems. These are rare in lymphomas compared with solid tumors attributed to their presentation even in late stages and the absence of onconeural antibodies. We present a child with stage IIB Hodgkin lymphoma who presented with dual PNS, achalasia cardia, and Holmes Adie pupil occurring synchronously with the cancer.


Subject(s)
Adie Syndrome/etiology , Esophageal Achalasia/etiology , Hodgkin Disease/complications , Paraneoplastic Syndromes, Nervous System/etiology , Child , Fluorodeoxyglucose F18 , Humans , Male , Positron-Emission Tomography
8.
Natl J Maxillofac Surg ; 3(2): 187-9, 2012 Jul.
Article in English | MEDLINE | ID: mdl-23833495

ABSTRACT

Primary Non Hodgkin s Lymphoma (NHL) usually arises within the lymphnodes, but 20-30% account for extra nodal sites. Oral cavity, as a primary extra nodal site for NHL, is relatively rare and diverse in presentation, response to therapy and prognosis. We report a 14 year old adolescent girl who presented with multiple gingival swellings, the most prominent one being in the right anterior maxilla. Gingival biopsy showed NHL- diffuse large B cell type. Child was completely cured with chemotherapy and now she is in complete remission and under regular follow up.

9.
Pediatr Blood Cancer ; 50(1): 134-7, 2008 Jan.
Article in English | MEDLINE | ID: mdl-16514617

ABSTRACT

Tumors of the salivary gland are very uncommon in children. Sialoblastoma is a rare, aggressive, blastomatous, and potentially malignant congenital tumor. Distant metastases are rare. We present a case of sialoblastoma with lung metastases that developed in a 4-year-old girl adjacent to a congenital nevus in the left cheek. The tumor was inoperable at diagnosis but the largest of the pulmonary metastases was removed surgically. The patient responded well to chemotherapy and underwent surgical excision of the primary tumor, followed by three more courses of chemotherapy.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lung Neoplasms/secondary , Parotid Neoplasms/pathology , Pneumonectomy , Child, Preschool , Facial Neoplasms/pathology , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Neoplasms, Multiple Primary/pathology , Nevus, Pigmented/pathology , Parotid Neoplasms/therapy , Skin Neoplasms/pathology
10.
J Paediatr Child Health ; 43(10): 713-5, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17854459

ABSTRACT

A 5-year-old boy was vaccinated with the Oka strain of varicella zoster virus vaccine before cord blood transplant for chronic granulomatous disease in 2005. In 2006, he developed herpes zoster on his left arm. DNA from the vesicular rash confirmed the Oka vaccine strain of varicella zoster virus caused this complication. He responded well to 10 days of aciclovir treatment.


Subject(s)
Chickenpox Vaccine/adverse effects , Fetal Blood/transplantation , Herpes Zoster/chemically induced , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Child, Preschool , Granulomatous Disease, Chronic/therapy , Herpes Zoster/drug therapy , Humans , Male
11.
J Trop Pediatr ; 50(3): 185-6, 2004 06.
Article in English | MEDLINE | ID: mdl-15233199

ABSTRACT

Rickets is a paradoxical complication of osteopetrosis resulting from the inability of the osteoclasts to maintain a normal calcium-phosphorus balance in the extracellular fluid. Detection of rickets in a child with osteopetrosis is necessary, because treatment of the rickets with vitamin D leads to improvement in activity, decrease in irritability, improvement of appetite, and protects against recurrent respiratory tract infections. If bone marrow transplantation is feasible, then for better results, rickets should be completely treated prior to the transplantation.


Subject(s)
Osteopetrosis/complications , Rickets/etiology , Bone Marrow Transplantation , Calcitriol/therapeutic use , Humans , Infant , Male , Osteopetrosis/therapy , Prednisolone/therapeutic use , Rickets/diagnosis , Rickets/therapy
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