Advanced Pediatric Center

Chandigarh, India

Advanced Pediatric Center

Chandigarh, India

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Kulkarni K.P.,University of Alberta | Kulkarni K.P.,Advanced Pediatric Center | Arora R.S.,Alder Hey Hospital | Marwaha R.K.,Advanced Pediatric Center
Journal of Pediatric Hematology/Oncology | Year: 2011

The outcome of childhood acute lymphoblastic leukemia in India has been inferior to more than 80% cure rates in developed nations. This study was done to analyze the outcome of acute lymphoblastic leukemia in India over 4 decades. There has been a gradual improvement in survival rates of up to >70% in some centers along with a decline in relapse and mortality. However, these Results cannot be generalized to the entire nation. There is a crying need to address treatment abandonment, take quality improvement, educational and financial initiatives; cooperative research into risk factors and disease biology, and the implementation of risk stratification along with the assessment of response to therapy. Copyright © 2011 by Lippincott Williams & Wilkins.


Kulkarni K.P.,University of Alberta | Kulkarni K.P.,Advanced Pediatric Center | Marwaha R.K.,Advanced Pediatric Center
Pediatric Hematology and Oncology | Year: 2011

Cure rates of childhood malignancies are inferior in India as compared to developed nations. There is paucity of data addressing outcome of childhood acute myeloid leukemia (AML) from India. Hence, this study was designed to assess the outcome of childhood AML in India over the last 2 decades, identify shortcomings and suggest remedial measures. A comprehensive search to identify studies addressing outcome of childhood AML from India was carried out. International Society of Paediatric Oncology annual meeting abstracts were searched to identify unpublished data. Clinicodemographic and outcome data were extracted from these abstracts. Outcomes of <500 patients have been published to date, with predominantly small single-center series from 5 cities. Several AML protocols with modifications to suit the logistics in India have been used. Administration of chemotherapy (standard as well as oral and outpatient based) with manageable toxicity has been deemed feasible. Survival outcomes are modest (23% to 53.8%) except for AML M3 (over 80%), with high early-death rates, relapse, along with abandonment. Few series have identified prognostic parameters and disease burden at diagnosis, and used cytogenetics (for risk stratification) or bone marrow transplant (BMT). There is a need for assessment of risk factors in Indian patients; administration of adequate and appropriate therapy, both upfront and after relapse; improvement in supportive care; and national data management infrastructure with updating/monitoring of registries along with better financial and social support initiatives. These multimodal and additive remedial measures could significantly improve outcome of childhood AML in India by reducing mortality, relapse, and abandonment. © 2011 Informa Healthcare USA, Inc.


Although, a slight male preponderance has been reported in childhood acute lymphoblastic leukemia (ALL) from several developed nations, several Indian studies suggest a skewed gender ratio in ALL. To assess the gender ratio at presentation in ALL in India, we used a three-prong approach: (i) center audit, (ii) systematic review of published studies on ALL in India, and (iii) assessment of population based registry data. Data on gender at presentation in ALL were extracted from these multiple sources. In our center audit, we observed a significantly higher of male:female (M:F) ratio of 3.16:1 (P = .046) in ALL as compared to world literature. In the systematic review of all ALL studies from India, 367 articles were identified and reviewed. A total of 4230 and 1843 boys and girls in these studies were assessed and the M:F ratio was 2.503:1; much higher than the world ratio but not significantly different (P = .10). Population-based data obtained from the National Cancer Registry Program also depicted a male preponderance, especially from large cities in India in a consistent manner since 1984. There is also significant (P = .025) interregional variation in the gender ratio in India. Our study clearly demonstrates a consistent male preponderance in childhood ALL in India along with significant interregional variations over the last three decades. There is a clear need of prospective nationwide multicenter assessment of high-resolution data to confirm this important observation and assess its implications, especially on the health care system. © 2013 Informa Healthcare USA, Inc.


Marwaha R.K.,Advanced Pediatric Center | Kulkarni K.P.,Advanced Pediatric Center | Bansal D.,Advanced Pediatric Center | Trehan A.,Advanced Pediatric Center
Annals of Hematology | Year: 2010

Acute lymphoblastic leukemia (ALL) often presents with osteoarthritic manifestations which may lead to misdiagnosis with juvenile rheumatoid arthritis (JRA). This study was designed to identify ALL patients with initial diagnosis of JRA, compare their clinicolaboratory characteristics and outcome with other ALL patients treated at our center. Case records of 762 patients with ALL were analyzed. Information regarding the clinical-demographic profile, therapy and outcome were recorded. Of the children, 49 (6.4%) had initial presentation mimicking JRA. Asymmetric oligoarthritis was the most common pattern of joint involvement. Majority presented with fever, pallor, arthritis, night pain, and bone pain. None of the routine prognostic factors including age, gender, lymphadenopathy, hepatosplenomegaly, total leukocytes count (TLC), and platelet count were significantly associated with relapse/death. The mean symptom-presentation interval (SPI), hemoglobin was significantly higher whilst the TLC was significantly lower in these patients compared to other ALL patients. The 5 year overall-survival was better than other patients with ALL (p=0.06, by logrank test). Significantly longer SPI in these patients underscores the need for prompt and early investigations to rule out ALL in patients of JRA with atypical features and pointers of ALL. Children with ALL-mimicking JRA may belong to a subgroup of ALL with a better prognosis. © Springer-Verlag 2009.


Naseem S.,Advanced Pediatric Center
Indian Journal of Hematology and Blood Transfusion | Year: 2010

Visceral Leishmaniasis (VL) or Kala Azar is a chronic infectious disease caused by parasites of the Leishmania donovani complex that can cause various hematologic manifestations. It is characterized by fever, enlargement of liver and spleen, weight loss, pancytopenia and hypergammaglobinemia. It is endemic in the Indian subcontinent, mainly seen in the states of Bihar and West Bengal. Patients with VL can present to the haematologist for various haematological problems prior to receiving the diagnosis of VL. Anaemia is the most common haematological manifestation of VL. VL may also be associated with leucopenia, thrombocytopenia, pancytopenia, hemophagocytosis and disseminated intravascular coagulation. Hematological improvement is noted within a week and complete hematological response occurs in 4-6 weeks of treatment. Relapses are rare and increased risk of being diagnosed with hematolymphoid malignancies on long term follow up is not noted. © 2010 Indian Society of Haematology & Transfusion Medicine.


Marwaha R.K.,Advanced Pediatric Center | Kulkarni K.P.,Advanced Pediatric Center | Bansal D.,Advanced Pediatric Center | Trehan A.,Advanced Pediatric Center
Leukemia and Lymphoma | Year: 2010

This study was designed to analyze the spectrum of central nervous system (CNS) disease at diagnosis, traumatic lumbar puncture (TLP), role of cranial irradiation, prognostic parameters, and survival outcome in patients with CNS involvement amongst 747 patients with acute lymphoblastic leukemia managed at our center. Twenty-five and six patients had CNS disease and TLP, respectively. Patients with CNS involvement had significantly higher mean presenting leukocyte count (p0.021) and incidence of hyperleukocytosis (p0.01) compared to those without it. The outcome was poor with three patients in continuous complete-remission, nine relapsers, eight deaths, and eight therapy defaulters. Three patients did not opt for therapy. CNS involvement was significantly associated with inferior survival by log-rank (p0.03) analysis but not by Cox-multivariate (p0.145) analysis. CNS involvement is a high-risk indicator. Poor outcome in our cohort indicates the need for the revaluation of our treatment protocols with the inclusion of risk-stratified systemic therapy, categorization of CNS involvement into CNS1/CNS2/CNS3, and appropriate use of intrathecal therapy. © 2010 Informa Healthcare USA, Inc.


Garge S.,Advanced Pediatric Center | Rao K.L.N.,Advanced Pediatric Center | Bawa M.,Advanced Pediatric Center
Journal of Pediatric Surgery | Year: 2013

Purpose The morbidity and mortality associated with esophageal atresia with or without a fistula make it a challenging congenital abnormality for the pediatric surgeon. Anatomic factors like inter-pouch gap and origin of fistula are not taken into consideration in various prognostic classifications. The preoperative evaluation of these cases with computerized tomography (CT) has been used by various investigators to delineate these factors. We reviewed these studies to evaluate the usefulness of this investigation in the intra operative and post operative period. Materials and Methods A literature search was done on all peer-reviewed articles published on preoperative computed tomography (CT) in cases of tracheoesophageal fistula using the PUBMED and MEDLINE search engines. Key words included tracheoesophageal fistula, computerized tomography, virtual bronchoscopy, and 3D computerized tomography reconstruction. Further, additional articles were selected from the list of references obtained from the retrieved publications. A total of 8 articles were selected for analysis. Results In most of the studies, comprising 96 patients, observations noted in preoperative CT were confirmed during surgery. © 2013 Elsevier Inc.


Marwaha R.K.,Advanced Pediatric Center | Kulkarni K.P.,Advanced Pediatric Center | Bansal D.,Advanced Pediatric Center | Trehan A.,Advanced Pediatric Center
Journal of Pediatric Hematology/Oncology | Year: 2010

The outcome of acute lymphoblastic leukemia (ALL) in developing countries is inferior compared with the resource-rich nations. This descriptive study was designed to determine the pattern of deaths in children with ALL treated at a single center and identify the problem areas in management. Case records of 532 patients with AlL were analyzed. Information regarding the clinical-demographic profile, therapy, and course of illness were recorded. One hundred twenty-eight (24.0%) deaths were recorded. Sepsis (53.3%) and bleeding (15.7%) were the most common causes of mortality. The mortality rate fell significantly during the induction and remission phases of the therapy in 2 consecutive time periods between 1990 to 1997 and 1998 to 20The factors associated with an increased risk of death were longer symptom diagnosis interval (P = 0.049), bulk disease (P = 0.008), mediastinal adenopathy (P = 0.001), higher total leukocyte count (P = 0.001), and lower platelet count (P = 0.007) at presentation as compared with the survivors. Multivariate analysis showed that longer symptom diagnosis interval (P = 0.001), mediastinal adenopathy (P=0.006), lower platelet count (P=0.001), and higher total leukocyte count significantly influenced death. The estimated median time to death for the induction and remission deaths were 0.5 and 17 months, respectively. A high mortality rate necessitates the reappraisal of our treatment protocols. Many deaths should be avoidable by the provision of adequate supportive care, close supervision during and after chemotherapy, and appropriate antibiotic and antifungal therapy. Copyright © 2010 by Lippincott Williams & Wilkins.


Kulkarni K.P.,Advanced Pediatric Center | Marwaha R.K.,Advanced Pediatric Center
Asian Pacific Journal of Cancer Prevention | Year: 2010

Abandonment of therapy is cited as an important factor contributory to inferior survival outcome in developing nations. In this communication we describe the pattern of therapy abandonment and its impact on survival of childhood acute lymphoblastic leukemia at a large tertiary care center in Northern India and discuss remedial measures.


Sahu J.K.,Advanced Pediatric Center
Indian Journal of Pediatrics | Year: 2014

Infantile spasms constitute significant burden of refractory epilepsy in children. The first line treatment choice varies at different centres. The author presents concise evidence based update on medical management of infantile spasms. © 2014, Dr. K C Chaudhuri Foundation.

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