Broad-spectrum antimicrobial therapy has revolutionized the management of febrile neutropenia (FN) in cancer patients. In vogue is an effective therapy an an outpatient basis. One thousand three hundred episodes of FN observed in 70 pediatric solid tumors (STs) and 65 cases of hematomalignancy (HM) at a median age of 5.5 years were treated with a protocol using once-a-day injectable ceftriaxone plus amikacin and other oral adjuvant antimicrobial agents. The mean duration of FN in the ST group was 4.0 +/- 1.2 days and in the HM group was 5.0 +/- 2.5 days. The mean duration of antimicrobial cover in the ST group was 5.0 +/- 1.75 days and in the HM group was 6.0 +/- 1.5 days. The overall recrudescence rate was 6% and the mean duration to recrudescence was 4 +/- 1.5 days (range 3-6 days). The objectives of this protocol were cost reduction and utilization of the available inpatient resources optimally by reducing the pressures of hospitalization for febrile neutropenia. We concluded that a selected group of patients with FN can be effectively managed with this regimen on an outpatient basis.

Administration, Oral↗

PubMedDate not supplied

Pediatric hyperfibrotic myelodysplasia: an unusual clinicopathologic entity.

This study is presented to highlight a rare pediatric bone marrow pathology in which features of bone marrow dysplasia coexist with severe fibrosis in a clinical setting of fever, anemia, and organomegaly. Fourteen children (nine males, five females) clinically presented with fever, anemia, and hepatosplenomegaly. Extensive bone marrow fibrosis with dysplastic features was seen in their marrow precursor cells. Peripheral blood smears showed teardrop poikilocytes thrombocytopenia, and occasional blasts. In conclusion, pediatric hyperfibrotic myelodysplasia is a distinct clinicopathologic entity. Myeloproliferative and dysmyelopoietic syndromes are complex disorders that are interrelated and not always easily diagnosed only on morphologic grounds.

Adolescent↗

PubMedDate not supplied

Retinoblastoma: problems and perspectives from India.

This study examined the salient clinical and epidemiological characteristics of retinoblastoma (RB) in India, thereby highlighting the problems encountered there. The epidemiological characteristics of 296 patients with RB over 8 years were evaluated using hospital records and postal follow-ups. Unilateral disease was seen in 61.8% of patients. The overall median age at presentation was 3.5 years (3.5 years for unilateral RB and 1.0 years for bilateral RB). The male/female ratio was 1.4:1. The median duration of symptomatic disease was 8 months. Consanguineous marriage was seen in 17% and family history of RB was noted in 1.7% cases. Also, 2% had a history of other malignancy in the family. Associated congenital malformation was seen in 10.5% of cases. A second malignancy was seen in 0.67% of cases at a mean duration of 4.5 years after completion of therapy. A predominance of advanced-stage disease (74.5% had Reese-Ellsworth group IV and V disease) was seen in our series. Only 43.6% of patients had disease localized to the globe without any infiltration/invasion. The majority of cases had advanced-stage disease at presentation and came from the underprivileged class of society. Patients with bilateral RB presented much earlier than those with unilateral disease. In patients with unilateral RB, higher age at presentation as well as advanced disease may be related to much delay in seeking medical attention. In view of the advanced stage at presentation, there also exist a possibility of difference in the biology of the tumor seen in these patients.

Child↗

PubMedDate not supplied

L-asparaginase (Leunase) induced pancreatitis in childhood acute lymphoblastic leukemia.

A major complication of L-asparaginase therapy in acute lymphoblastic leukemia (ALL) is pancreatitis. Among the 915 cases of ALL seen over last 10 years, 19 (2%) developed pancreatitis. Median age was 5.5 years with a median duration of symptoms of 4 weeks. All cases had raised serum amylase and lipase. Pancreatitis was not related to the dose/duration of L-asparaginase therapy. Ultrasonography can be used as a corroborative investigation for diagnosis along with serum chemistries. Close clinical monitoring of children for early diagnosis of this complication is recommended.

Adolescent↗

PubMedDate not supplied

Strategies for eradication of poliomyelitis--the Indian experience.

Substantial progress has been made towards achieving global eradication of poliomyelitis by the end of the year 2000; the goal set by the World Health Assembly in May 1988. The basic strategies to eradicate polio are: attaining high routine coverage with at least three doses of OPV; conducting national immunization days (NIDs) in polio endemic countries; establishing a sensitive system of acute flaccid paralysis (AFP) surveillance to track wild poliovirus circulation; and conducting "mopping-up" immunization when polio is reduced to focal transmission. By the end of 2000. India was in the midst of the sixth National Immunization Days (NIDs). Surveillance system for Acute Flaccid Paralysis (AFP) continued to achieve the recommended non-polio AFP rate of at least 1 per 100,000 population < 15 years per year (1.88 for week 51 ending 23rd December 2000), the adequate stool specimen collection rate was 83% that met the target of > 80%. Some States in the south and west have started to implement mopping-up immunization campaigns as the end-stage strategy to eliminate the last remaining foci of transmission. While most of India appears to be well placed to eradicate polio by the end of 2000 or shortly thereafter, concerns remain about low coverage in parts of the densely populated northern States of Uttar Pradesh and Bihar where high intensity transmission persists. The Government of India has embarked upon an intensified strategy that relies on extra rounds of NIDs; house-to-house immunization to reach previously missed children; and aggressive mopping-up campaigns including pre-emptive mopping-up in the known reservoirs in Uttar Pradesh and Bihar. Extensive microplanning and supervision of the supplementary immunization activities is critical to achieve the target of polio eradication.

Communicable Disease Control↗

PubMedDate not supplied

Serum protein profile in normal pregnancy and in relation to parity.

Forty pregnant females of third trimester and their twenty non-pregnant controls were screened for Hb%, PCV and serum protein differentials in relation to parity. Paper electrophoresis method revealed significant rise in mean levels of serum alpha 1, alpha 2 and beta-globulins in pregnant females as compared to non-pregnant controls, which may be due to the rise in pregnancy-associated-proteins. Radial immunodiffusion method revealed rise in mean serum IgM level with increasing parity, whereas a decrease in mean serum IgG level was observed which might be due to the placental membrane-transfer and/or decreased IgG synthesis. Haematological investigations revealed decreased Hb% and PCV which may have been caused both due to increased demand of nutrients as well as by haemodilution, associated with water retention during pregnancy.

Adult↗

PubMedDate not supplied

Hemostasis in acquired hemophilia--role of intracavitary instillation of EACA.

An 82 year old man developed antibodies against coagulation factor VIII:C without any apparent cause. Bleeding from the soft tissue cavity could not be controlled by factor VIII:C concentrates, immunosuppression with steroids and intravenous immunoglobulin therapy in the standard dosages. However, a single injection of Epsilon Aminocaproic Acid (EACA) instilled into the cavity under aseptic precautions achieved lasting hemostasis with resultant wound healing.

Aged↗