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Li CK, Kurkure P, Arora RS, Chen BW, Kirgizov K, Okamoto Y, Seksarn P, Tang Y, Yoo KH, Agarwal B, Chan GC, Dalvi R, Hori H, Khan MS, Yu A, Nakagawara A. Current Challenges of Asian National Children's Cancer Study Groups on Behalf of Asian Pediatric Hematology and Oncology Group. JCO Glob Oncol 2023; 9:e2300153. [PMID: 37656946 PMCID: PMC10581612 DOI: 10.1200/go.23.00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
In Asia, a few countries have a long and established history of collaborative clinical trials successfully formed national children's cancer study groups, but many still do not have such groups. The process of forming national children's cancer groups is fraught with many hurdles, which varies among the countries. One of the basic requirements for running clinical trials is an affordable health care system in which most of the children with cancer can receive the proposed treatment. The health insurance coverage for children with cancer varies from <20% to as high as 100% among Asian countries, and the operation of clinical trials must also be adjusted accordingly. Shortage of research personnel is common, including medical, nursing, research coordinators, and data managers. The establishment of the Asian Pediatric Hematology and Oncology Group aims to provide a good platform for promotion of international clinical trials in the Asian countries.
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Affiliation(s)
- Chi-kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Purna Kurkure
- Division of Pediatric Hemato Oncology & BMT, SRCC Children's Hospital Haji Ali, Mumbai, India
| | - Ramandeep Singh Arora
- Pediatric Oncology Disease Management Group, Max Super Specialty Hospital, New Delhi, India
| | - Bow Wen Chen
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Kirill Kirgizov
- N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Yasuhiro Okamoto
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka Kagoshima, Japan
| | - Panya Seksarn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yongmin Tang
- Department of Hematology-Oncology, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bharat Agarwal
- Department of Pediatric Hematology & Oncology, B J Wadia Hospital for Children, Parel, Mumbai, India
| | - Godfrey C.F. Chan
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Rashmi Dalvi
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Bombay, India
| | - Hiroki Hori
- Graduate School of Medicine, Mie University in Tsu, Tsu, Japan
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Kingdom of Saudi Arabia
| | - Alice Yu
- Institute of Stem Cell & Translational Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Akira Nakagawara
- Saga International Carbon Particle Beam Radiation Cancer Therapy Center, Saga HIMAT Foundation, Harakoga-Machi, Saga, Japan
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Major A, Palese M, Ermis E, James A, Villarroel M, Klussmann FA, Hessissen L, Geel J, Khan MS, Dalvi R, Sullivan M, Kearns P, Frazier AL, Pritchard-Jones K, Nakagawara A, Rodriguez-Galindo C, Volchenboum SL. Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage. JCO Glob Oncol 2022; 8:e2100266. [PMID: 35157510 PMCID: PMC8853619 DOI: 10.1200/go.21.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer. Local stakeholder engagement is necessary to collaborate with global pediatric cancer trial groups.![]()
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Affiliation(s)
- Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Monica Palese
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Ebru Ermis
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Anthony James
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Milena Villarroel
- Grupo de América Latina de Oncología Pediátrica (GALOP), Hospital Luis Calvo Mackenna, National Pediatric Cancer Program (PINDA), Santiago, Chile
| | - Federico Antillon Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Laila Hessissen
- Pediatric Hematology and Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Saudi Arabia
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
| | | | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Sniderman ER, Graetz DE, Agulnik A, Ranadive R, Vedaraju Y, Chen Y, Devidas M, Chantada GL, Hessissen L, Dalvi R, Pritchard‐Jones K, Rodriguez‐Galindo C, Moreira DC, Bolous NS, Haidar CE, Bihannic L, Sa da Bandeira D, Wang JX, Li D, Graca F, Vasilyeva A, Lesmana H. Impact of the COVID‐19 pandemic on pediatric oncology providers globally: A mixed‐methods study. Cancer 2022; 128:1493-1502. [PMID: 35067925 PMCID: PMC9015299 DOI: 10.1002/cncr.34090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide. Methods A 60‐item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery. Results The survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID‐19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID‐19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing. Conclusions COVID‐19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high‐quality care. This mixed‐methods study reveals the impact that the coronavirus disease 2019 (COVID‐19) pandemic has had on pediatric oncology providers globally, and it highlights the importance of implementing strategies to protect the health care workforce during challenging situations.
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Affiliation(s)
- Elizabeth R. Sniderman
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Asya Agulnik
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Radhikesh Ranadive
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Yuvanesh Vedaraju
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Yichen Chen
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Guillermo L. Chantada
- Department of Pediatric Hematology and Oncology Fundacion Perez Scremini‐Hospital Pereira Rossell Montevideo Uruguay
- Department of Pediatric Hematology and Oncology Hospital Sant Joan de Deu Barcelona Spain
| | - Laila Hessissen
- Department of Pediatric Hematology and Oncology Mohammed V University Rabat Morocco
| | - Rashmi Dalvi
- Department of Pediatrics Bombay Hospital Institute of Medical Sciences Bombay India
| | - Kathy Pritchard‐Jones
- Great Ormond Street Institute of Child Health University College London London England
| | | | - Daniel C. Moreira
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
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Mukkada S, Bhakta N, Chantada GL, Chen Y, Vedaraju Y, Faughnan L, Homsi MR, Muniz-Talavera H, Ranadive R, Metzger M, Friedrich P, Agulnik A, Jeha S, Lam C, Dalvi R, Hessissen L, Moreira DC, Santana VM, Sullivan M, Bouffet E, Caniza MA, Devidas M, Pritchard-Jones K, Rodriguez-Galindo C. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol 2021; 22:1416-1426. [PMID: 34454651 PMCID: PMC8389979 DOI: 10.1016/s1470-2045(21)00454-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents with cancer. METHODS We did a cohort study with data from 131 institutions in 45 countries. We created the Global Registry of COVID-19 in Childhood Cancer to capture de-identified data pertaining to laboratory-confirmed SARS-CoV-2 infections in children and adolescents (<19 years) with cancer or having received a haematopoietic stem-cell transplantation. There were no centre-specific exclusion criteria. The registry was disseminated through professional networks through email and conferences and health-care providers were invited to submit all qualifying cases. Data for demographics, oncological diagnosis, clinical course, and cancer therapy details were collected. Primary outcomes were disease severity and modification to cancer-directed therapy. The registry remains open to data collection. FINDINGS Of 1520 submitted episodes, 1500 patients were included in the study between April 15, 2020, and Feb 1, 2021. 1319 patients had complete 30-day follow-up. 259 (19·9%) of 1301 patients had a severe or critical infection, and 50 (3·8%) of 1319 died with the cause attributed to COVID-19 infection. Modifications to cancer-directed therapy occurred in 609 (55·8%) of 1092 patients receiving active oncological treatment. Multivariable analysis revealed several factors associated with severe or critical illness, including World Bank low-income or lower-middle-income (odds ratio [OR] 5·8 [95% CI 3·8-8·8]; p<0·0001) and upper-middle-income (1·6 [1·2-2·2]; p=0·0024) country status; age 15-18 years (1·6 [1·1-2·2]; p=0·013); absolute lymphocyte count of 300 or less cells per mm3 (2·5 [1·8-3·4]; p<0·0001), absolute neutrophil count of 500 or less cells per mm3 (1·8 [1·3-2·4]; p=0·0001), and intensive treatment (1·8 [1·3-2·3]; p=0·0005). Factors associated with treatment modification included upper-middle-income country status (OR 0·5 [95% CI 0·3-0·7]; p=0·0004), primary diagnosis of other haematological malignancies (0·5 [0·3-0·8]; p=0·0088), the presence of one of more COVID-19 symptoms at the time of presentation (1·8 [1·3-2·4]; p=0·0002), and the presence of one or more comorbidities (1·6 [1·1-2·3]; p=0·020). INTERPRETATION In this global cohort of children and adolescents with cancer and COVID-19, severe and critical illness occurred in one fifth of patients and deaths occurred in a higher proportion than is reported in the literature in the general paediatric population. Additionally, we found that variables associated with treatment modification were not the same as those associated with greater disease severity. These data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness. FUNDING American Lebanese Syrian Associated Charities and the National Cancer Institute.
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Affiliation(s)
- Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Guillermo L Chantada
- Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yuvanesh Vedaraju
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lane Faughnan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Maysam R Homsi
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Hilmarie Muniz-Talavera
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Radhikesh Ranadive
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Monika Metzger
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Catherine Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rashmi Dalvi
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Laila Hessissen
- Department of Pediatric Hematology and Oncology, Mohammed V University, Rabat, Morocco
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Victor M Santana
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Miguela A Caniza
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Moreira DC, Sniderman E, Mukkada S, Chantada G, Bhakta N, Foster W, Avula M, Homsi MR, Faughnan L, Happ B, Andujar A, Sonnenfelt J, Dalvi R, Frazier AL, Hessissen L, Kearns PR, Luna‐Fineman S, Moreno A, Saghir Khan M, Sullivan M, Devidas M, Santana V, Caniza M, Pritchard‐Jones K, Rodriguez‐Galindo C. The Global COVID-19 Observatory and Resource Center for Childhood Cancer: A response for the pediatric oncology community by SIOP and St. Jude Global. Pediatr Blood Cancer 2021; 68:e28962. [PMID: 33629507 PMCID: PMC7994967 DOI: 10.1002/pbc.28962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic quickly led to an abundance of publications and recommendations, despite a paucity of information on how COVID-19 affects children with cancer. This created a dire need for a trusted resource with curated information and a space for the pediatric oncology community to share experiences. The Global COVID-19 Observatory and Resource Center for Childhood Cancer was developed, launched, and maintained by the International Society of Pediatric Oncology and St. Jude Children's Research Hospital. The three components (Resource Library, Global Registry, and Collaboration Space) complement each other, establishing a mechanism to generate and transfer knowledge rapidly throughout the community.
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Affiliation(s)
- Daniel C. Moreira
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Elizabeth Sniderman
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Sheena Mukkada
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Guillermo Chantada
- Fundacion Perez Scremini‐Hospital Pereira RossellMontevideoUruguay
- Hospital Sant Joan de DéuBarcelonaSpain
| | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Whitney Foster
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Meghana Avula
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Maysam R. Homsi
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lane Faughnan
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Brooke Happ
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Allyson Andujar
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jason Sonnenfelt
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's HospitalMumbaiIndia
| | - A. Lindsay Frazier
- Dana‐Farber/Boston Children's Hospital Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | | | - Pamela R. Kearns
- NIHR Birmingham Biomedical Research CentreInstitute of Cancer and Genomic Sciences and Birmingham Children's HospitalBirminghamUK
| | | | | | | | - Michael Sullivan
- University of Melbourne and Royal Children's HospitalMelbourneAustralia
| | - Meenakshi Devidas
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Victor Santana
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Miguela Caniza
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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6
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Graetz D, Agulnik A, Ranadive R, Vedaraju Y, Chen Y, Chantada G, Metzger ML, Mukkada S, Force LM, Friedrich P, Lam C, Sniderman E, Bhakta N, Hessissen L, Dalvi R, Devidas M, Pritchard-Jones K, Rodriguez-Galindo C, Moreira DC. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Health 2021; 5:332-340. [PMID: 33675698 PMCID: PMC7929816 DOI: 10.1016/s2352-4642(21)00031-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
Background Although mortality due to COVID-19 has been reportedly low among children with cancer, changes in health-care services due to the pandemic have affected cancer care delivery. This study aimed to assess the effect of the COVID-19 pandemic on childhood cancer care worldwide. Methods A cross-sectional survey was distributed to paediatric oncology providers worldwide from June 22 to Aug 21, 2020, through the St Jude Global Alliance and International Society for Paediatric Oncology listservs and regional networks. The survey included 60 questions to assess institution characteristics, the number of patients diagnosed with COVID-19, disruptions to cancer care (eg, service closures and treatment abandonment), adaptations to care, and resources (including availability of clinical staff and personal protective equipment). Surveys were included for analysis if respondents answered at least two thirds of the items, and the responses were analysed at the institutional level. Findings Responses from 311 health-care professionals at 213 institutions in 79 countries from all WHO regions were included in the analysis. 187 (88%) of 213 centres had the capacity to test for SARS-CoV-2 and a median of two (range 0–350) infections per institutution were reported in children with cancer. 15 (7%) centres reported complete closure of paediatric haematology-oncology services (median 10 days, range 1–75 days). Overall, 2% (5 of 213) of centres were no longer evaluating new cases of suspected cancer, while 43% (90 of 208) of the remaining centers described a decrease in newly diagnosed paediatric cancer cases. 73 (34%) centres reported increased treatment abandonment (ie, failure to initiate cancer therapy or a delay in care of 4 weeks or longer). Changes to cancer care delivery included: reduced surgical care (153 [72%]), blood product shortages (127 [60%]), chemotherapy modifications (121 [57%]), and interruptions to radiotherapy (43 [28%] of 155 institutions that provided radiotherapy before the pandemic). The decreased number of new cancer diagnoses did not vary based on country income status (p=0·14). However, unavailability of chemotherapy agents (p=0·022), treatment abandonment (p<0·0001), and interruptions in radiotherapy (p<0·0001) were more frequent in low-income and middle-income countries than in high-income countries. These findings did not vary based on institutional or national numbers of COVID-19 cases. Hospitals reported using new or adapted checklists (146 [69%] of 213), processes for communication with patients and families (134 [63%]), and guidelines for essential services (119 [56%]) as a result of the pandemic. Interpretation The COVID-19 pandemic has considerably affected paediatric oncology services worldwide, posing substantial disruptions to cancer diagnosis and management, particularly in low-income and middle-income countries. This study emphasises the urgency of an equitably distributed robust global response to support paediatric oncology care during this pandemic and future public health emergencies. Funding American Lebanese Syrian Associated Charities. Translation For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Dylan Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Radhikesh Ranadive
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yuvanesh Vedaraju
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guillermo Chantada
- Department of Pediatric Hematology and Oncology, Fundacion Perez Scremini-Hospital Pereira Rossell, Montevideo, Uruguay; Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monika L Metzger
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Force
- Department of Health Metrics Sciences, and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Division of Pediatric Hematology and Oncology, Seattle Children's Hospital, Seattle, WA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Catherine Lam
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elizabeth Sniderman
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laila Hessissen
- Department of Pediatric Haematology and Oncology Center, Mohammed V University, Rabat, Morocco
| | - Rashmi Dalvi
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Bombay, India
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, London, England
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
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7
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Salama M, Ataman-Millhouse L, Braham M, Berjeb K, Khrouf M, Rodrigues JK, Reis FM, Silva TC, Sánchez F, Romero S, Smitz J, Vásquez L, Vega M, Sobral F, Terrado G, Lombardi MG, Scarella A, Bourlon MT, Verduzco-Aguirre H, Sánchez AM, Adiga SK, Tholeti P, Udupa KS, Mahajan N, Patil M, Dalvi R, Venter C, Demetriou G, Geel J, Quintana R, Rodriguez G, Quintana T, Viale L, Fraguglia M, Coirini M, Remolina-Bonilla YA, Noguera JAR, Velásquez JC, Suarez A, Arango GD, Pineda JID, Aldecoa MDC, Javed M, Al Sufyan H, Daniels N, Oranye BC, Ogunmokun AA, Onwuzurigbo KI, Okereke CJ, Whesu TC, Woodruff TK. Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic. J Assist Reprod Genet 2020; 37:1567-1577. [PMID: 32594284 PMCID: PMC7320246 DOI: 10.1007/s10815-020-01821-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.
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Affiliation(s)
- M. Salama
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - L. Ataman-Millhouse
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - M. Braham
- Aziza Othmana Hospital of Tunis, Tunis, Tunisia
| | - K. Berjeb
- Aziza Othmana Hospital of Tunis, Tunis, Tunisia
| | - M. Khrouf
- FERTILLA, Clinique la Rose, Tunis, Tunisia
| | - J. K. Rodrigues
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - F. M. Reis
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - T. Cury- Silva
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - F. Sánchez
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S. Romero
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Smitz
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L. Vásquez
- Unidad de Oncología Pediátrica, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - M. Vega
- Panama Fertility, Sistema Nacional de Investigadores, Panama City, Panama
| | - F. Sobral
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - G. Terrado
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | | | - A. Scarella
- Centro de Reproduccion Humana, Facultad de Medicina, Universidad de Valparaiso, Valparaiso, Chile
| | - M. T. Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - H. Verduzco-Aguirre
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A. M. Sánchez
- Instituto Nacional de Perinatología Isidro Espinoza de los Reyes, Mexico City, Mexico
| | - S. K. Adiga
- Fertility Preservation Centre, Department of Clinical Embryology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - P. Tholeti
- Fertility Preservation Centre, Department of Clinical Embryology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - K. S. Udupa
- Department of Medical Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - N. Mahajan
- Mother and Child Hospital, New Delhi, India
| | - M. Patil
- Dr. Patil’s Fertility and Endoscopy Clinic, Bangalore, India
| | - R. Dalvi
- Hospital Institute of Medical Sciences & SRCC children’s Hospital, Mumbai, India
| | - C. Venter
- Vitalab Fertility Centre, Johannesburg, South Africa
| | - G. Demetriou
- Department Medical Oncology, University of Witwatersrand, Johannesburg, South Africa
| | - J. Geel
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | | | | | | - L. Viale
- Procrearte, Buenos Aires, Argentina
| | | | - M. Coirini
- Hospital de Niños Victor J. Vilela. Rosario, Santa Fe, Argentina
| | | | | | | | - A. Suarez
- Instituto Nacional de Cancerología, Bogota, Colombia
| | | | - J. I. D. Pineda
- Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala City, Guatemala
| | - M. D. C. Aldecoa
- Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala City, Guatemala
| | - M. Javed
- Thuriah Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - H. Al Sufyan
- Thuriah Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - N. Daniels
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | - B. C. Oranye
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | - A. A. Ogunmokun
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | | | | | - T. C. Whesu
- Kingswill Specialist Hospital, Lagos, Nigeria
| | - T. K. Woodruff
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
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8
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Li CK, Dalvi R, Yonemori K, Ariffin H, Lyu CJ, Farid M, Gonzales-Santos JRN, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori FA, Jezdic S, Stark DP, Douillard JY, Saloustros E, Mountzios G. Care of adolescents and young adults with cancer in Asia: results of an ESMO/SIOPE/SIOP Asia survey. ESMO Open 2019; 4:e000467. [PMID: 31231565 PMCID: PMC6555609 DOI: 10.1136/esmoopen-2018-000467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Adolescents and young adults (AYAs) with cancer require dedicated management encompassing both adult and paediatric cancer services. Following a European survey, the European Society for Medical Oncology, the European Society for Paediatric Oncology and the Asian continental branch of International Society of Paediatric Oncology undertook a similar survey to assess AYA cancer care across Asia. Methods A link to the online survey was sent to healthcare professionals (HCPs) in Asia interested in AYA cancer care. Questions covered the demographics and training of HCPs, their understanding of AYA definition, availability and access to specialised AYA services, the support and advice offered during and after treatment, and factors of treatment non-compliance. Results We received 268 responses from 22 Asian countries. There was a striking variation in the definition of AYA (median lower age 15 years, median higher age 29 years). The majority of the respondents (78%) did not have access to specialised cancer services and 73% were not aware of any research initiatives for AYA. Over two-thirds (69%) had the option to refer their patients for psychological and/or nutritional support and most advised their patients on a healthy lifestyle. Even so, 46% did not ask about smokeless tobacco habits and only half referred smokers to a smoking cessation service. Furthermore, 29% did not promote human papillomavirus vaccination for girls and 17% did not promote hepatitis B virus vaccination for high-risk individuals. In terms of funding, 69% reported governmental insurance coverage, although 65% reported that patients self-paid, at least partially. Almost half (47%) reported treatment non-compliance or abandonment as an issue, attributed to financial and family problems (72%), loss of follow-up (74%) and seeking of alternative treatments (77%). Conclusions Lack of access to and suboptimal delivery of AYA-specialised cancer care services across Asia pose major challenges and require specific interventions.
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Affiliation(s)
- Chi Kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Rashmi Dalvi
- Department of Pediatrics and Hematology-Oncology, Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Kan Yonemori
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hany Ariffin
- Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chuhl Joo Lyu
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Julieta Rita N Gonzales-Santos
- Department of Paediatrics, De La Salle University Medical and Health Sciences Institute, Dasmarinas, Cavite, Philippines
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Stefan Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - Laurence Brugieres
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anne Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Samira Essiaf
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | | | - Svetlana Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Daniel P Stark
- Department of Oncology, Leeds Institute of Medical Research at St James's, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jean-Yves Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | | | - Giannis Mountzios
- 2nd Department of Oncology, Henry Dunant Hospital Center, Athens, Greece
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9
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Dalvi R, Li CK, Yonemori K, Ariffin H, Lyu C, Farid M, Gonzales-Santos J, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori F, Jezdic S, Stark D, Douillard JY, Saloustros E, Mountzios G. Adolescents and young adults with cancer care in Asia: The joint ESMO/SIOPE/SIOP ASIA survey. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy442.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Gupta S, Parab P, Kerkar R, Mahantshetty U, Maheshwari A, Sastri S, Engineer R, Hawaldar R, Ghosh J, Gulia S, Godbole S, Kumar N, Malliga J, Dalvi R, Kembhavi Y, Gaikar M, Ranade R, Tongaonkar H, Badwe R, Shrivastava S. Neoadjuvant chemotherapy followed by surgery (NACT-surgery) versus concurrent cisplatin and radiation therapy (CTRT) in patients with stage IB2 to IIB squamous carcinoma of cervix: A randomized controlled trial (RCT). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Gupta S, Parab P, Kerkar R, Mahantshetty U, Maheshwari A, Sastri S, Engineer R, Hawaldar R, Ghosh J, Gulia S, Godbole S, Kumar N, Malliga J, Dalvi R, Kembhavi Y, Gaikar M, Ranade R, Tongaonkar H, Badwe R, Shrivastava S. Neoadjuvant chemotherapy followed by surgery (NACT-surgery) versus concurrent cisplatin and radiation therapy (CTRT) in patients with stage IB2 to IIB squamous carcinoma of cervix: A randomized controlled trial (RCT). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Manglani M, Sharma R, Rathod N, Bansal S, Sharma S, Gabhale Y, Dalvi R, Balasubramanian P, Pandey S, Shah N, Fernandes S, Jadhav V, Khandkar O, Kulkarni N, Kamat P, Kamble P, Kaushik P. Hematopoietic stem cell transplantation in a public hospital – Our experience. Pediatric Hematology Oncology Journal 2016. [DOI: 10.1016/j.phoj.2016.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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13
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Ghoraani B, Dalvi R, Gizurarson S, Das M, Ha A, Suszko A, Krishnan S, Chauhan VS. Localized rotational activation in the left atrium during human atrial fibrillation: relationship to complex fractionated atrial electrograms and low-voltage zones. Heart Rhythm 2013; 10:1830-8. [PMID: 24016695 DOI: 10.1016/j.hrthm.2013.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In humans, the existence of rotors or reentrant sources maintaining atrial fibrillation (AF) and the underlying electroanatomic substrate has not been well defined. OBJECTIVE Our aim was to determine the prevalence of localized rotational activation (RotA) in the left atrium (LA) during human AF and whether complex fractionated atrial electrograms (CFAEs) or low-voltage areas colocalize with RotA sites. METHODS We prospectively studied 32 patients (mean age 57 ± 8 years; 88% with persistent AF) undergoing AF catheter ablation. Bipolar electrograms were recorded for 2.5 seconds during AF using a roving 20-pole circular catheter in the LA. RotA was defined as sequential temporal activation of bipoles around the circular catheter. Bipolar electrogram fractionation index and bipolar voltage were used to define CFAEs and low-voltage areas, respectively. RESULTS In 21 (66%) patients, 47 RotA sites were identified. Few (9%) lasted 2.5 seconds (cycle length 183 ± 6 ms), while the majority (91%) were nonsustained (duration 610 ± 288 ms; cycle length 149 ± 11 ms). RotA was most common in the pulmonary vein antrum (71%) and posterior LA (25%). CFAEs were recorded from 18% ± 12% of LA area, and most (92% ± 7%) were not associated with RotA sites. However, 85% of RotA sites contained CFAEs. Very low voltage (<0.1 mV) areas comprised 12% ± 10% of LA area and were present in 23% of RotA sites. CONCLUSIONS In patients with predominantly persistent AF, localized RotA is commonly present but tends to be transient (<1 second). Although most CFAEs do not colocalize with RotA sites, the high prevalence of CFAEs and very low voltages within RotA sites may indicate slow conduction in diseased myocardium necessary for their maintenance.
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Affiliation(s)
- B Ghoraani
- Department of Engineering, Rochester Institute of Technology, Rochester, New York
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14
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Pigge FC, Dalvi R. Metal-mediated dearomatization leading to 2-azaspiro[4.5]decanes via tandem nucleophilic aromatic addition–Horner–Wadsworth–Emmons olefination–oxidative demetalation sequences. Tetrahedron 2008. [DOI: 10.1016/j.tet.2008.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Gupta SK, Pal AK, Sahu NP, Dalvi R, Kumar V, Mukherjee SC. Microbial levan in the diet of Labeo rohita Hamilton juveniles: effect on non-specific immunity and histopathological changes after challenge with Aeromonas hydrophila. J Fish Dis 2008; 31:649-657. [PMID: 18786027 DOI: 10.1111/j.1365-2761.2008.00939.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 60-day feeding trial was conducted to study the immuno-protective effect of microbial levan on Labeo rohita juveniles challenged with Aeromonas hydrophila. Six purified diets were prepared with different levels of microbial levan: control (no levan), T1 (Basal + 0.25%), T2 (Basal + 0.50%), T3 (Basal + 0.75%), T4 (Basal + 1%) and T5 (Basal + 1.25%), fed to six groups of fish in triplicate. Among the treatment groups the haemoglobin content and total leucocyte count were increased with a dietary supplementation of levan at 1% or more. An increasing trend for total erythrocyte count was observed with increasing level of dietary levan. Lower levan-supplemented groups showed a higher albumin/globulin ratio. As the levan supplementation was increased, there was a gradual increase in serum lysozyme activity and respiratory burst activity [nitroblue tetrazolium (NBT) assay] reduction values. The highest lysozyme activity and NBT were observed in the T5 group although this was similar to the T4 group (P > 0.05). No significant histo-architectural changes were associated with dietary levan levels. After challenge with A. hydrophila, moderately degenerated hepatocytes, oedema and leucocytic infiltration in parenchymatous tissues, and extensive haemorrhage and haemosiderosis in the kidney were observed in the control group. However, the T5 group supplemented with 1.25% levan showed infiltrating leucocytes in the liver while the kidney showed only moderate degeneration of renal tubules. The relative survival per cent of juveniles after challenge with A. hydrophila was the highest in the T5 group followed by T4. This suggests that microbial levan at 1.25% can be used as dietary immunostimulant for L. rohita juveniles.
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Affiliation(s)
- S K Gupta
- Department of Fish Nutrition and Biochemistry, Central Institute of Fisheries Education, Mumbai, India.
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16
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Pigge FC, Coniglio JJ, Dalvi R. Exploiting Phosphonate Chemistry in Metal-Mediated Dearomatization: Stereoselective Construction of Functionalized Spirolactams from Arene Ruthenium Complexes. J Am Chem Soc 2006; 128:3498-9. [PMID: 16536505 DOI: 10.1021/ja058342y] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arene ruthenium complexes possessing beta-amido phosphonate side chains participate in intramolecular spirocyclization reactions to deliver stable cyclohexadienyl ruthenium adducts. Spirocyclization is accomplished via a tandem two-step sequence that involves stereoselective nucleophilic aromatic addition to the ipso position of the coordinated arene, followed by intermolecular Horner-Wadsworth-Emmons olefination. The resulting eta5-cyclohexadienyl complexes can then be diastereoselectively converted to metal-free azaspiro[4.5]decane derivatives upon oxidative demetalation in the presence of suitable nucleophiles. An asymmetric spirocyclization was demonstrated through application of this procedure to a beta-amido phosphonate prepared from (S)-(-)-alpha-methyl benzylamine. The expected spirolactam product was obtained as a single enantiomer.
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Affiliation(s)
- F Christopher Pigge
- Department of Chemistry, University of Iowa, 305 Chemistry Building, Iowa City, Iowa 52242, USA.
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17
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Vyas J, Dalvi R, Agarwal B, Gangal S. Study on ALL-1 gene alterations in Indian childhood acute leukemias: non-isotopic Southern blotting and molecular cytogenetics. Leuk Res 2003; 27:915-23. [PMID: 12860012 DOI: 10.1016/s0145-2126(03)00030-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We carried out this study to detect ALL-1 gene alterations in Indian childhood leukemias (n-84) using non-radioactive Southern blotting and FISH techniques. 18 (21.4%) patients showed altered ALL-1 gene. All 18 patients with altered ALL-1 gene did not have high WBC count and or typical CD10-/19+ phenotype. 4/18 were infants, while 14 were of 1-12 years of age. 13/18 children were boys. 14/18 expired within 1 year. Karyotyping detected abnormal chromosome 11 only in 4/43 patients and Classical t(4:11) in one AML patient but combination of Painting FISH and LS-FISH confirmed ALL-1 gene alteration in 17/18 cases. In addition, FISH identified nine translocations and multiple copies of ALL-1 gene in three cases which conventional cytogenetics had failed to detect. Our result indicates that a combination of Southern blotting, cytogenetic and FISH techniques are useful to identify ALL-1 gene alterations in childhood leukemias.
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Affiliation(s)
- Jaya Vyas
- Department of Pediatric Hematology and Oncology, Research Society of Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai 400012, India.
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18
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Ganguly BB, Dalvi R, Mehta AV. Translocation (3;12) (p21-pter; q24.1-qter) and phenylketonuria. Cytobios 2002; 106:63-70. [PMID: 11478664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Cytogenetic karyotyping in mental retardation associated with physical dysmorphism has been regarded as the primary key for the classification of syndromes and other genetic disorders for the predisposition of neoplasia and other fatal diseases. Giemsa-banding of metaphase chromosomes in lymphocytes is a traditional and routine process for the identification of the chromosomal counterpart which can provide a clue for molecular investigation in the subject. An 8-year-old girl showed a diploid karyotype 46, XX, t(3;12) (p21-pter, q24.1-qter) in peripheral blood lymphocyte culture. Biochemical examination of urine labelled her as a case of phenylketonuria. The maternal karyotyping was similar and confirmed the maternal transmission of the translocation.
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Affiliation(s)
- B B Ganguly
- Centre for Research in Mental Retardation, Malad, Mumbai, India
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19
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Ganguly BB, Dalvi R, Mehta AV. Pericentric inversion in human chromosome 8 and spherocytosis. Cytobios 2001; 102:119-26. [PMID: 10885509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A cytogenetic study of a patient revealed a pericentric inversion in chromosome 8, and spherocytes in 10% of cells, in a routine blood smear. The critical portion which affected the expression of spherocytosis appeared to be localized at 8p22-8q21. The mother's karyotyping showed the transmission of the inversion to the child.
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Affiliation(s)
- B B Ganguly
- Centre for Research in Mental Retardation, Malad, Mumbai, India
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20
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Agarwal BR, Bhalla K, Dalvi R, Currimbhoy ZE, Mehta KP. Myelofibrosis secondary to SLE and its reversal on steroid therapy. Indian Pediatr 1995; 32:1207-10. [PMID: 8772871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- B R Agarwal
- Department of Pediatrics, Institute of Child Health and Research Centre, Parel, Bombay
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21
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Agarwal BR, Gulvady A, Bhalla K, Dalvi R, Currimbhoy ZE. Treatment of aplastic anemia in children with high dose methyl prednisolone. Indian Pediatr 1995; 32:1061-5. [PMID: 8984042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Severe aplastic anemia (SAA) in children has been previously treated with high dose methyl prednisolone (HDMP) with favorable results. We reviewed our experience with intravenous HDMP. Seven children with a diagnosis of SAA confirmed on bone marrow biopsy were treated with 300 mg/kg total dose of intravenous HDMP over a 4 week period. Patients were closely monitored for response and side effects. HDMP was well tolerated except for hyperglycemia in one case. Six of the seven patients showed no response to HDMP. This observation is in stark contrast with previous trials on use of HDMP in SAA. It is concluded that HDMP should be reserved only for patients with milder bone marrow hypoplasia.
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Affiliation(s)
- B R Agarwal
- Department of Pediatrics Hematology and Oncology, B.J. Wadia Hospital for Children, Bombay
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22
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Joshi NC, Dalvi R, Merchant RH. Symptomatic atrial septal defect in infancy. Indian Pediatr 1993; 30:1079-83. [PMID: 8125592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Isolated ostium secundum atrial septal defect (OS-ASD) may rarely lead to severe symptoms in infancy. Over a period of four years, 12 infants admitted to our hospital with severe congestive heart failure had an isolated OS-ASD. Their echocardiographic findings, clinical course, and outcome were outlined. All 12 infants had atypical findings including a holosystolic murmur parasternally and absence of wide fixed splitting of the second heart sound, and none were clinically suspected to have an ASD. M-mode echocardiography in all infants showed a greater than normal diastolic right ventricular internal diameter in the absence of pulmonary hypertension, indicating an increased right ventricular distensibility. Ten out of 12 infants responded well to medical decongestive treatment, and none developed pulmonary hypertension. Two infants who failed to improve with drugs, successfully underwent surgical closure, while two other infants revealed clinical and echocardiographic evidence of spontaneous closure.
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Affiliation(s)
- N C Joshi
- Cardiology Clinic, B.J. Wadia Hospital for Children, Parel, Bombay
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23
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Dalvi R, Birewar N, Lokeshwar MR, Fernandez AR. Spontaneous regression of bilateral retrobulbar masses in a newborn? Neuroblastoma. Indian Pediatr 1991; 28:286-9. [PMID: 1937706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R Dalvi
- Department of Pediatrics, LTMG Hospital, Sion, Bombay
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24
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Dalvi R, Rao S, Rangnekar J, Fernandez A. Exchange transfusions in neonatal sepsis. Indian Pediatr 1991; 28:39-43. [PMID: 2055609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Between October, 1987 and October, 1988, 53 neonates with severe or unresponsive sepsis were subjected to therapeutic exchange transfusions (ET) using 170 ml/kg of citrated blood less than 24 hours old. The procedure was repeated up to a maximum of 4 times. The success of therapy was adjudged by resolution of sclerema and/or improvement in clinical features. There were 32 low birth-weight (LBW) and 21 non-LBW infants and 51/53 subjects had sclerema. The mean time for recovery following ET was 19.6 +/- 12.4 h (range: 1-48 h). The overall survival was 77.4% and the survival rates for LBW and non-LBW infants were 73.6 and 68.2%, respectively, however, the difference was not statistically significant. No significant or fatal complications occurred during ET. The effects of other associated problems on outcome studied by multiple regression analysis showed that neurologic problems were associated with a poor chance for survival despite ET. Exchange transfusion may thus be an effective and safe therapeutic modality for severe neonatal sepsis.
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Affiliation(s)
- R Dalvi
- Department of Neonatology, LTM Medical College, Bombay
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Dalvi R, Dalvi BV, Birewar N, Chari G, Fernandez AR. Mortality determinants and prediction of outcome in high risk newborns. Indian Pediatr 1990; 27:571-5. [PMID: 2253992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to determine independent patient-related predictors of mortality in high risk newborns admitted at our centre. The study population comprised 100 consecutive newborns each, from the premature unit (PU) and sick baby care unit (SBCU), respectively. Thirteen high risk factors (variables) for each of the two units, were entered into a multivariate regression analysis. Variables with independent predictive value for poor outcome (i.e., death) in PU were, weight less than 1 kg, hyaline membrane disease, neurologic problems, and intravenous therapy. High risk factors in SBCU included, blood gas abnormality, bleeding phenomena, recurrent convulsions, apnea, and congenital anomalies. Identification of these factors guided us in defining priority areas for improvement in our system of neonatal care. Also, based on these variables a simple predictive score for outcome was constructed. The prediction equation and the score were cross-validated by applying them to a 'test-set' of 100 newborns each for PU and SBCU. Results showed a comparable sensitivity, specificity and error rate.
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Affiliation(s)
- R Dalvi
- Department of Pediatrics, LTM General Hospital, Sion, Bombay
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Merchant RH, Dalvi R, Vidwans A. Infant of the diabetic mother. Indian Pediatr 1990; 27:373-9. [PMID: 2210824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R H Merchant
- Division of Neonatology, Bai Jerbai Wadia Hospital for Children, Parel, Bombay
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Affiliation(s)
- R Dalvi
- Department of Neonatology, L.T.M.G. Hospital, Sion, Bombay
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Dalvi R. Studies on binding of berenil to microsomal protein and its significance with respect to microsomal metabolism of trypanocidal drug. Indian J Exp Biol 1988; 26:464-6. [PMID: 3192287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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