Browsing by Author "Aggarwal, Priyanka"
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Publication Alterations in Bone Turnover during Chemotherapy in Children with Acute Lymphoblastic Leukemia(Georg Thieme Verlag, 2021) Gupta, Vineeta; Dash, Shalini; Aggarwal, Priyanka; Singh, Surya KumarBackground Disturbances of bone metabolism frequently occur in children with acute lymphoblastic leukemia (ALL), leading to increased risk of osteopenia and osteoporosis at diagnosis, during and after completion of chemotherapy. The present study was performed to evaluate alteration in bone mineral metabolism in children with ALL during chemotherapy. Method Fifty newly diagnosed patients with ALL in the age group of 2 to 14 years were included. Relapsed and refractory cases were excluded. Enrolled children were stratified into standard and high risk according to National Cancer Institute criteria. Quantitative analysis of bone resorptive marker carboxyl-terminal telopeptide of human type 1 collagen (ICTP) was assessed at baseline and 3 months after chemotherapy by the sandwich enzyme-linked immunosorbent assay technique. Results Of 50 patients enrolled, 21 were standard and 29 were high risk. The mean age was 7.75 � 4.0 years and the male-to-female ratio was 3.5:1. ICTP levels were analyzed in 44 patients, of which 37 (84%) showed significantly increased levels. The mean ICTP level in patients at diagnosis and controls was 1.78 � 1.39 and 0.96 � 0.32 ?g/L, respectively (p = 0.001). The mean ICTP level at 3 months after chemotherapy increased to 3.55 � 1.40 ?g/L (p = 0.000). It was significantly increased in males (p = 0.000) and in B cell ALL group (p = 0.000) in comparison to females and T cell group. Both standard and high risk groups were equally affected (p = 0.000). On multivariate analysis, no single risk factor could be identified. Conclusion The marker of bone resorption (ICTP) in children with ALL was increased at diagnosis, which further increased during chemotherapy. The disease itself and the intensive chemotherapy both contributed to the increased levels. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication Approach to Acute Respiratory Illness in Children with Hematological Malignancy: A Prospective Study Evaluating Utility of CT Scan(Georg Thieme Verlag, 2022) Aggarwal, Priyanka; Raipa, Tapish; Kumar, Ishan; Verma, Ashish; Shukla, Ram Chandra; Gupta, VineetaIntroduction Various pulmonary complications can occur in children with hematological malignancies including both infection and malignant disease infiltration of pulmonary parenchyma. Objectives To assess the role of CT scan in determining the etiology of acute pulmonary complications in children with hematological malignancies. Materials and Methods All children < 17 years with newly diagnosed hematological malignancy with respiratory symptoms (Group A) along with children who developed fever with persistent respiratory symptoms as well as worsening chest radiographs during treatment (Group B) and underwent CECT thorax, from February 2019 to July 2020 were enrolled. The final diagnosis was made on the basis of clinical history, laboratory as well as radiological investigations and treatment response. Results Thirty-seven children with mean age of 7.5 � 3.5 years and male to female ratio of 1.3:1 who underwent CECT thorax were included in our study. For newly diagnosed cases, i.e., Group A (n = 8), the most common cause of respiratory symptoms as identified on CECT thorax was pulmonary tumoral infiltration (n = 5) followed by tuberculosis (n = 3). However, in Group B (n = 29) the cause of persistent respiratory symptoms was identified as infection (n = 17) followed by leukemic infiltration (n = 12). Thus, chest CT could accurately identify pulmonary tuberculosis, fungal pneumonia, bacterial infection, and pulmonary tumoral infiltrates. Conclusion CT scan can be used as an adjunctive tool for prompt diagnosis and management of pulmonary complications in children with persistent respiratory symptoms as they are often non-specific. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Bone Mineral Metabolism during Chemotherapy in Childhood Acute Lymphoblastic Leukemia(Lippincott Williams and Wilkins, 2021) Maddheshiya, Sonal; Singh, Surya K.; Kumar, Ishan; Aggarwal, Priyanka; Gupta, VineetaObjective: The aim of this study was to evaluate levels of vitamin D, bone mineral density (BMD), and radiograph features at diagnosis and after 6 months of chemotherapy in patients with acute lymphoblastic leukemia (ALL). Vitamin D levels were also correlated with BMD and radiograph features. Materials and Methods: 25-Hydroxy vitamin D [25(OH)D] levels, BMD, and radiograph features were assessed in 50 newly diagnosed patients of ALL in the age group of 2 to 14 years. A total of 30 age-matched and sex-matched children were recruited as controls. Vitamin D deficiency was defined as 25(OH)D <10 ng/mL, Vitamin D insufficiency as 10 to 29 ng/mL, and Vitamin D sufficiency as =30 ng/mL. Enzyme immunoassay (EIA) was used for the quantitative measurement of 25(OH)D levels in plasma and a LUNAR DPX NT bone densitometer was used for the assessment of BMD. Results: The mean age of the patients was 6.3 years, with a male:female ratio of 1.38:1. The mean 25(OH)D levels were 31.90�16.90 ng/mL in patients at diagnosis against 41.63�20.50 ng/mL in controls (P=0.02). Levels were 18.50�11.10 ng/mL postchemotherapy (P=0.00). Female sex was a risk factor for deficient 25(OH)D levels. There was a significant decrease in BMD postchemotherapy in the age groups of 5 to 10 and above 10 years at the femoral neck. Osteopenic changes were observed in more number of patients after 6 months of chemotherapy. There was a significant correlation between vitamin D levels, BMD, and osteopenic changes. Conclusions: Vitamin D deficiency was common among ALL patients, which worsened after chemotherapy. This had a significant correlation with BMD and osteopenic changes in radiograph. � 2021 Lippincott Williams and Wilkins. All rights reserved.Publication Child with Intellectual Disability and Seizures(Springer, 2022) Kumar, Ishan; Ranjan, Manoj; Singh, Ankur; Aggarwal, Priyanka; Verma, Ashish[No abstract available]Publication Comparison of the effects of calcium channel blockers plus iron chelation therapy versus chelation therapy only on iron overload in children and young adults with transfusion-dependent thalassemia: A randomized double-blind placebo-controlled trial(John Wiley and Sons Inc, 2022) Gupta, Vineeta; Kumar, Ishan; Raj, Vibhesh; Aggarwal, Priyanka; Agrawal, VikasBackground: Myocardial iron deposition is a significant cause of morbidity and mortality in patients with transfusion-dependent thalassemia (TDT). Amlodipine, L-type calcium channel blocker with regular chelation therapy may reduce myocardial iron overload. Lack of randomized trials prompted this study to assess the effect of calcium channel blocker (amlodipine) in combination with iron chelation therapy on iron overload in patients with TDT. Methods: Sixty-four eligible patients were randomized to receive either amlodipine and chelation (group A) or chelation alone (group B) in double-blind placebo-controlled trial. Myocardial iron concentration (MIC) using T2* magnetic resonance imaging (MRI), liver iron concentration (LIC), left ventricular ejection fraction (LVEF), and serum ferritin were measured at baseline and 12�months. Results: In the amlodipine group, mean cardiac T2* value significantly increased from 18.11 � 8.47 to 22.15 � 7.61 (p�=.002) at 12�months, whereas in control group, there was a nonsignificant increase (p�=.62) in cardiac T2* value from 19.50 � 8.84 to 20.03 � 9.07. There was a significant decrease in MRI-derived MIC in the amlodipine group compared to control group (1.93 � 1.61 to 1.29 � 0.90, p�=.01). Changes in the LVEF (p�=.45), MRI-derived LIC (p�=.09), and serum ferritin (p�=.81) were not significant between the two groups. Conclusion: Amlodipine is safe and when combined with chelation therapy appears to be more effective in reducing cardiac iron overload than chelation only in children and young adults with TDT. � 2022 Wiley Periodicals LLC.Publication Complications in Transfusion-Dependent Thalassemia(Springer, 2022) Gupta, Vineeta; Aggarwal, Priyanka[No abstract available]Publication COVID-19 Infection in Children with Cancer: Not A Gloomy Picture(Lippincott Williams and Wilkins, 2022) Gupta, Vineeta; Saurabh, Vidya K.; Sidar, Minketan; Aggarwal, Priyanka[No abstract available]Publication CT-Based Definition and Structured Reporting of Abdominal Lymph Node Stations(Georg Thieme Verlag, 2022) Kumar, Ishan; Sharma, Srishti; Prakash, Adity; Aggarwal, Priyanka; Shukla, Ram C.; Verma, AshishBackground Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Dutch-beta thalassemia: A rare mutation from India(Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics, 2022) Sanghvi, Nirali; Aggarwal, Priyanka; Singh, Vineeta; Gupta, VineetaBackground: The Dutch I ?�- Thalassemia is caused by 12.6 kilo-base (kb) deletion in Hemoglobin subunit beta (HBB) gene causing variable phenotypic presentation depending upon the zygosity of the condition. Case characteristics: An 8 year old female child presented with pallor, icterus and splenomegaly without any previous history of blood transfusion. She was evaluated for the evidence of hemoglobinopathy and was found to have very high HbF and absent HbA levels on High performance liquid chromatography (HPLC). The gene mutation analysis suggested the child to have a rather scarce pathogenic large deletion in HBB gene which has never been reported from India. Message: As this pathogenic variant has been rarely reported and discussed in literature, we hereby present the clinical characteristics associated with it, as demonstrated in our patient. � 2022 Pediatric Hematology Oncology Chapter of Indian Academy of PediatricsPublication Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score�a pilot study(Springer Nature, 2021) Kumar, Ishan; Singh, Shweta; Kumar, Ashok; Aggarwal, Priyanka; Shukla, Ram C.; Verma, AshishAims and objectives: To evaluate the Doppler changes in the intracranial arteries of neonates exposed to perinatal hypoxic insult and compare it with normal neonates. Materials and methods: Color Doppler of bilateral anterior and middle cerebral arteries was performed within 6 h of birth in 26 healthy neonates and 50 neonates who received delivery room resuscitation (DRR) for perinatal depression and had a 5 min Apgar score <7. Comparisons of resistive index (RI) and peak systolic velocity (PSV) were made between the (a) control group (b) patients with low 5 min Apgar score <7 who without clinical features of neonatal encephalopathy at 24 h (c) neonates with perinatal depression with a clinical evidence of disturbed neurological function at 24 h of birth and examination consistent with mild, moderate, or severe encephalopathy using modified Sarnat and Sarnat�s classification. Results: Significantly higher RI was observed in the neonates with to perinatal depression compared to the normal neonates. Significantly higher RI was seen in the patients with clinical features of neonatal encephalopathy (Group C) compared to group B. RI <0.6 and >0.82 was associated with severe neonatal encephalopathy. Differences in PSV were not statistically significant in the various groups. Conclusion: The study presents the changes in early cerebral Doppler parameters observed in neonates with low 5 min Apgar score following DRR compared to the normal neonates. We also present the relations of Doppler parameters with increasing severity of neonatal encephalopathy according to Sarnat classification. � 2020, The Author(s), under exclusive licence to Springer Nature America, Inc.Publication Factors Affecting Short-Term Outcome of Critically Ill Children with Malignancies Admitted in Pediatric Intensive Care Unit: A Retrospective Observational Study(Thieme Medical Publishers, Inc., 2021) Aggarwal, Priyanka; Kumar, Ishan; Rao, Sunil Kumar; Pradhap, K.; Gupta, VineetaIntroduction Pediatric cancer contributes <1% of all malignancies. Childhood cancer survival has improved dramatically with the use of more intensive chemotherapy regimens, better stratification, and improvement in supportive care with enhanced facilities in pediatric intensive care unit (PICU). Objective The aim of this study was to identify the risk factors responsible for poor outcome in critically ill children with malignancies admitted in PICU. Materials and Methods Sixty-four children with a primary diagnosis of malignancy admitted in PICU with disease or treatment related complications were enrolled retrospectively. The short-term outcome, that is, shifting from PICU to ward, was assessed in relation to the presence of febrile neutropenia, organ failure, hepatitis, acute renal failure as well as requirement of inotropes and mechanical ventilation. Death was considered as an adverse outcome in this study. Results The mean age of study population was 6.25 � 3.91 and M:F ratio 2.4:1. The majority of children had hematological malignancies (81.25%), that is, pre-B acute lymphoblastic leukemia (ALL) (45.3%), non-Hodgkin lymphoma (21.3%), acute myeloid leukemia (12.5%), T ALL (10.9%), and Hodgkin lymphoma (3.1%). Few children also had retinoblastoma (4.7%) and Langerhans cell histiocytosis (1.6%). The mean duration of PICU stay was 3.16 � 2.31 days. Sepsis (37.5%) was the most common indication for PICU admission, followed by metabolic disturbance (26.6%), respiratory failure (17.2%), neurological complaints (15.6%), and anaphylactic shock (3.1%). Children requiring mechanical ventilation (p < 0.001), inotrope support (p < 0.001), having acute renal failure (p = 0.001), and >1 organ failure (p < 0.001) were associated with adverse outcome. The overall survival at the time of discharge from PICU was 64%. Conclusion In the context of low- and middle-income countries, optimal resource utilization by early identification of risk factors for clinical deterioration is required to allow timely admission to PICU and delivery of life-saving therapy to salvageable patients. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication Lipid profile during chemotherapy in children with acute lymphoblastic leukemia(Wolters Kluwer Medknow Publications, 2021) Madan, Dolly; Aggarwal, Priyanka; Jain, Anubha; Gupta, Vineeta[No abstract available]Publication Mandatory Testing for Hemoglobinopathies: Need of the Hour!(Springer, 2023) Gupta, Vineeta; Aggarwal, Priyanka[No abstract available]Publication Rotavirus Gastroenteritis in Eastern Uttar Pradesh, India(Springer, 2021) Gupta, Vineeta; Aggarwal, Priyanka; Kumar, Brajesh; Nair, Nayana P.; Thiyagarajan, Varunkumar; Lingam, RagaviObjective: To identify cases of rotavirus diarrhea in Uttar Pradesh among children less than 5 y of age presenting with acute gastroenteritis, to study the clinical profile of the cases and to identify the rotavirus genotypes. Methods: Any child who is 0�59 mo of age who is admitted to the study facility with diarrhea as the presenting complaint were enrolled into the surveillance after obtaining informed consent. Clinical history and sociodemographic information was recorded for all the patients. Patients with dehydration were treated as per standard protocol. Stool samples were collected for isolation of rotavirus and identification of its genotype. Results: Of the 418 stool specimens collected, rotavirus was isolated in 47 (11.33%) samples. Rotavirus gastroenteritis was most common below the age of two years. A significant difference in the clinical characteristics between children who were positive for rotavirus and those who tested negative were not observed in this study. But patients with rotavirus diarrhea had longer duration of hospital stay (OR 3.31; CI 1.24�8.87). The outcome was similar in the two groups (OR 2.64; CI 0.27�25.89). G3P[8] was the most common type genotype isolated in 13 (28.89%) patients followed by G2P[4] in 7 (15.56%) patients. Thirteen patients (28.89%) had mixed genotype. Conclusion: Rotavirus diarrhea was most common below two years of age. G3P[8] was the most common genotype identified. � 2021, Dr. K C Chaudhuri Foundation.Publication The many faces of intracranial tuberculosis: atypical presentations on MRI�a descriptive observational cohort study(Institute for Ionics, 2023) Kumar, Ishan; Shekhar, Shashank; Yadav, Tanya; Aggarwal, Priyanka; Singh, Pramod Kumar; Shukla, Ram C.; Verma, AshishBackground: Atypical MRI findings of cranial tuberculosis can lead to prolonged delay in diagnosis resulting in high costs to evaluate for alternative diagnoses. The aim of this study was to describe a series of cranial tuberculosis patients with spectrum of MRI features, other than hydrocephalus, parenchymal tuberculomas, and leptomeningeal thickening. The final diagnosis was made based on CSF findings, clinical findings, and/or marked improvement after antitubercular treatment. Results: A total of 39 patients met the inclusion criteria and were diagnosed with vasculitis (n = 15), tubercular abscess (n = 5), miliary tuberculosis (n = 3), tubercular cerebritis (n = 9), sellar and parasellar tuberculosis (n = 7), mass forming tuberculosis (n = 1), choroid plexitis (n = 2), and intraventricular tuberculomas (n = 1). Conclusion: A significant number of patients of cranial tuberculosis can have variable presentations and may be misdiagnosed. This analysis helps to reinvestigate the spectrum of MRI findings. � 2023, The Author(s).
