1
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Lin JJ, Evans EM, Praxedes K, Agrawal AK, Winestone LE. Financial assistance and other financial coping strategies after a pediatric cancer diagnosis. Pediatr Blood Cancer 2024; 71:e30890. [PMID: 38302828 DOI: 10.1002/pbc.30890] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/24/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Families experience financial burden and household material hardship (HMH) after a pediatric cancer diagnosis. This study investigates types of financial assistance and other financial coping strategies (FCS) adopted by families during the first year after diagnosis. METHODS Retrospective survey of caregivers of pediatric patients diagnosed with cancer from 2015 to 2019. The survey collected data on demographics, diagnosis, income, HMH, and private, hospital, and government assistance received and other FCS adopted after diagnosis. Bivariate and multivariable logistic regressions were used to analyze FCS by income. Subgroup analysis of families experiencing HMH was used to identify predictors of receiving government assistance. RESULTS Of 156 respondents, 52% were low-to-middle income, 29% had public insurance, and 22% had non-English language preference. Low-to-middle-income families were more likely to incur debt (odds ratio [OR] 6.24, p < .001) and reduce consumption (OR 2.16, p = .03) than high-income families, and this association persisted in multivariable analysis. Among families with housing, food, and energy insecurity, 40%, 70%, and 39%, respectively, received hospital or government assistance specific to the experienced hardship. In subgroup analysis of families with HMH, after adjusting for income and other confounders, non-English language preference was associated with lower odds of receiving government assistance. CONCLUSIONS After a pediatric cancer diagnosis, low-to-middle-income families are more likely to incur debt than high-income families. Most families experiencing food insecurity received some food assistance, while housing and energy assistance were less common. Future studies should investigate methods to equitably improve access to financial assistance and minimize long-term financial consequences.
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Affiliation(s)
- Jackie J Lin
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Erica M Evans
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
| | - Kathleen Praxedes
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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2
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Giang S, Agrawal AK, Oates A. Daratumumab therapy in a pediatric case of C3 nephritic factor-positive proliferative glomerulonephritis with monoclonal IgG deposits. CEN Case Rep 2024:10.1007/s13730-024-00868-0. [PMID: 38517598 DOI: 10.1007/s13730-024-00868-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/13/2024] [Indexed: 03/24/2024] Open
Abstract
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is an exceedingly rare cause of glomerulonephritis among children for which prognosis is generally poor, with low incidence of remission and high rates of recurrence after transplant. While there are more cases reported in the adult literature, substantial differences in pediatric vs. adult PGNMID render it essential that we further characterize pediatric cases to optimize management. We report the case of a 12-year-old male presenting initially with edema and hypertension who was subsequently diagnosed with IgG3/Kappa-dominant PGNMID. In the absence of any proven therapy and though without a detectable clone, he was empirically treated with daratumumab with positive effect to date. This is the first reported case of daratumumab monotherapy in pediatric PGNMID, as well as the first PGNMID case to detect presence of C3 nephritic factor.
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Affiliation(s)
- Sophia Giang
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Mailstop: 3214, San Francisco, CA, 94143, USA.
| | - Anurag K Agrawal
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Mailstop: 3214, San Francisco, CA, 94143, USA
| | - Aris Oates
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Mailstop: 3214, San Francisco, CA, 94143, USA
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3
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Levine A, Winn PA, Fogel AH, Lelkes E, McPoland P, Agrawal AK, Bogetz JF. Barriers to Pediatric Palliative Care: Trainee and Faculty Perspectives Across Two Academic Centers. J Palliat Med 2023; 26:1348-1356. [PMID: 37318791 PMCID: PMC10623063 DOI: 10.1089/jpm.2022.0580] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/16/2023] Open
Abstract
Objective: Barriers to palliative care for children with serious illness include system constraints and vastly different training and attitudes toward palliative care. This study aimed to explore trainee and faculty physician perceptions of barriers to palliative care across two pediatric centers to (1) examine differences between trainees and faculty and (2) compare these data with previous studies. Methods: A mixed-methods study was conducted in fall 2021 among pediatric trainees and faculty physicians at three pediatric hospitals in two pediatric centers in the western United States. Surveys were distributed through hospital listservs and analyzed descriptively and through inductive thematic analysis. Results: There were a total of 268 participants: 50 trainees and 218 faculty physicians. Of the trainees, 46% (23) were fellows and 54% (27) were pediatric residents. Trainees and faculty reported the same four most common barriers, which were consistent with previous studies: family not ready to acknowledge an incurable condition (64% trainees and 45% faculty); family preference for more life-sustaining therapies than staff (52% and 39%); uncertain prognosis (48% and 38%); and parent discomfort with possibility of hastening death (44% and 30%). Other barriers commonly reported included time constraints, staff shortages, and conflict among family about treatment goals. Language barriers and cultural differences were also cited. Conclusions: This study examining palliative care across two pediatric centers suggests that providers' perceptions of family preferences and understanding of illness persist as barriers to the delivery of pediatric palliative care services. Future research should examine family-centered and culturally mindful interventions to better elucidate family perspectives on their child's illness to align care.
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Affiliation(s)
- Alyssa Levine
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Phoebe A. Winn
- Divisions of Emergency Medicine and Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Alexis H. Fogel
- Divisions of Emergency Medicine and Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Efrat Lelkes
- Division of Pediatric Critical Care, Benioff Children's Hospital San Francisco, University of California, San Francisco, San Francisco, California, USA
| | - Paula McPoland
- Division of Pediatric Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Anurag K. Agrawal
- Divisions of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Jori F. Bogetz
- Division of Pediatric Bioethics and Palliative Care, Department of Pediatrics, Center for Clinical and Translational Research, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington, USA
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4
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Evans EM, Lin J, Sanchez-Alvarez J, Agrawal AK, Winestone LE. Disparities in household material hardship, financial toxicity, and income loss in pediatric cancer. Pediatr Blood Cancer 2023:e30496. [PMID: 37394628 DOI: 10.1002/pbc.30496] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. METHODS Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change. RESULTS Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity. CONCLUSION HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH.
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Affiliation(s)
- Erica M Evans
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Jackie Lin
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jacklyn Sanchez-Alvarez
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
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5
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Marinoff AE, Aaronson K, Agrawal AK, Braun BS, Golden C, Huang BJ, Michlitsch J, Southworth E, Thrall A, Vo KT, Stieglitz E. Venetoclax in combination with chemotherapy as treatment for pediatric advanced hematologic malignancies. Pediatr Blood Cancer 2023; 70:e30335. [PMID: 37036306 PMCID: PMC10133180 DOI: 10.1002/pbc.30335] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Venetoclax is frequently used as salvage treatment in pediatric, adolescent, and young adult (AYA) patients with advanced hematologic malignancies. However, more data are needed from real-world studies to guide the safe and appropriate use of venetoclax in this population. PROCEDURE We retrospectively reviewed the medical records of all patients diagnosed with hematologic malignancies less than 30 years of age treated with venetoclax outside of clinical trials at the University of California San Francisco Benioff Children's Hospitals from 2016 to 2022. RESULTS We identified 13 patients (acute myeloid leukemia, n = 8; B-acute lymphoblastic leukemia, n = 3; myelodysplastic syndrome, n = 2) aged 4 months to 27 years. A median of 3 prior lines of therapy weregiven (range 0-5). All patients received venetoclax in combination with either a hypomethylating agent or conventional chemotherapy. Three (23%) patients achieved complete remission (CR); two (15%) achieved partial remission (PR); 3 (23%) had stable disease (SD), and five (42%) had progressive disease. Median survival and time to progression from venetoclax initiation was 9 months (range 2.5-52 months) and 3 months (range 2 weeks to 7.5 months), respectively. Six patients (46%) developed grade 3 or higher infections while receiving venetoclax, including bacteremia due to atypical organisms, invasive pulmonary infections with Aspergillus, cytomegalovirus (CMV) viremia, skin infections, and encephalitis with bacterial brain abscesses. CONCLUSIONS Venetoclax in combination with hypomethylating agents or cytotoxic chemotherapy was effective in a subset of pediatric/AYA patients with advanced hematologic malignancies, but multiple severe infections were observed, particularly among patients who received venetoclax in combination with chemotherapy. Prospective studies will be required to determine the optimal dose and duration of venetoclax in this population.
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Affiliation(s)
- Amanda E Marinoff
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Kathryn Aaronson
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Anurag K Agrawal
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin S Braun
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Carla Golden
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin J Huang
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Michlitsch
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Erica Southworth
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Allyson Thrall
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Kieuhoa T Vo
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
| | - Elliot Stieglitz
- Department of Pediatrics, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA
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6
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Martell HJ, Shah AT, Lee AG, Tanasa B, Leung SG, Spillinger A, Liu HY, Behroozfard I, Dinh P, Ventura MVP, Hazard FK, Rangaswami A, Spunt SL, Lacayo NJ, Cooney T, Michlitsch JG, Agrawal AK, Breese MR, Sweet-Cordero A. Abstract 1509: Longitudinal profiling of high-risk pediatric malignancies using a multiomics approach. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
For many pediatric cancer patients, commonly used gene-panel sequencing tests yield few actionable results, partly due to the complex genomic alterations present. We hypothesized that an unbiased approach, combining whole-genome (WGS) and RNA sequencing (RNAseq), could overcome this and lead to a more comprehensive understanding of these diseases. While prior studies have evaluated WGS and RNAseq in pediatric cancers, few focused primarily on metastatic or relapsed disease. We also placed special focus on longitudinal profiling of patients, including with additional deep sequencing, to capture tumor evolution at the primary and metastatic sites, and to quantify the utility of resampling.
We assembled a cohort of 191 high-risk pediatric oncology patients, including solid tumors, CNS tumors, and leukemias/lymphomas. We have representation of patients with relapsed/refractory disease (68), metastatic disease at diagnosis (10), rare diagnoses (19), prior cancer history, and estimated overall survival <50%. We characterized 280 samples with WGS (tumor ~60X; germline ~30X) and/or RNAseq (tumor, polyA selected, ≥20 million reads), including multiple samples taken from 85 patients at different time points (diagnosis, resection, relapse, etc.). Variants (SNVs), structural rearrangements (SVs), mutational signatures, and copy-number alterations (CNAs) were identified using WGS. RNAseq was used to profile gene expression outliers, gene fusions, and expression of variants identified by WGS. The integrated results were used to prioritize potentially actionable variants for each patient. For 20 patients (44 samples), we performed targeted deep sequencing of the DNA (~500X) to profile tumor evolution that cannot be captured by WGS.
Multiple sampling from the same patient identified drastic spatial and temporal differences in the genomes and transcriptomes of these tumors. Using the Jaccard index as a measure of concordance between samples shows dynamic changes between samples collected at different time points across multiple modalities (range 0-1, 1 is identical); SNVs ranged from 0.01-0.79, SVs 0.01-0.73, major CNAs 0.07-0.99, minor CNAs 0.38-0.99, up expression outliers 0.12-0.56, down expression outliers 0.04-0.54, and fusions 0-1. Potentially biologically significant differences in therapy-induced mutations by platinum agents were also observed, highlighting the impact of therapy on tumor evolution. Clonal architectures were extracted from deep resequencing and show extensive spatial, temporal, and metastatic heterogeneity in these rare and highly aggressive malignancies that is not captured by WGS alone. Identifying clinically relevant evolution remains a challenge in most patients, but our results suggest that resampling of pediatric tumors at relapse or metastasis will be important for the effectiveness of targeted therapies in the future.
Citation Format: Henry J. Martell, Avanthi T. Shah, Alex G. Lee, Bogdan Tanasa, Stanley G. Leung, Aviv Spillinger, Heng-Yi Liu, Inge Behroozfard, Phuong Dinh, María V. Pons Ventura, Florette K. Hazard, Arun Rangaswami, Sheri L. Spunt, Norman J. Lacayo, Tabitha Cooney, Jennifer G. Michlitsch, Anurag K. Agrawal, Marcus R. Breese, Alejandro Sweet-Cordero. Longitudinal profiling of high-risk pediatric malignancies using a multiomics approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1509.
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Affiliation(s)
- Henry J. Martell
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Avanthi T. Shah
- 2University of Texas Southwestern Medical Center, Dallas, TX
| | - Alex G. Lee
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Bogdan Tanasa
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Stanley G. Leung
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Aviv Spillinger
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Heng-Yi Liu
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Inge Behroozfard
- 1UCSF - University of California San Francisco, San Francisco, CA
| | - Phuong Dinh
- 1UCSF - University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Marcus R. Breese
- 1UCSF - University of California San Francisco, San Francisco, CA
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7
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Hall AG, Winestone LE, Sullivan EM, Wu Q, Lamble AJ, Walters MC, Aguayo-Hiraldo P, Conde LB, Coker TR, Dornsife D, Keating AK, Merino DM, Ramsey B, Park JR, Agrawal AK. Access to Chimeric Antigen Receptor T Cell Clinical Trials in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult Acute Lymphobastic Leukemia Patients. Transplant Cell Ther 2023:S2666-6367(23)01198-3. [PMID: 36966871 DOI: 10.1016/j.jtct.2023.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is a promising approach to improve survival for children and adults with relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL), but these clinical trials might not be equally accessible to patients of low socioeconomic status (SES) or to patients from racial or ethnic minority groups. We sought to describe the sociodemographic characteristics of pediatric and adolescent and young adult (AYA) patients enrolled in CAR-T clinical trials and to compare these characteristics to those of other patients with r/r B-ALL. We conducted a multicenter retrospective cohort study at 5 pediatric consortium sites to compare the sociodemographic characteristics of patients treated and enrolled in CAR-T trials at their home institution, other patients with r/r B-ALL treated at these sites, and patients referred from an external hospital for CAR-T trials. The patients were age 0 to 27 years with r/r B-ALL treated at 1 of the consortium sites between 2012 and 2018. Clinical and demographic data were collected from the electronic health record. We calculated distance from home to treating institution and assigned SES scores based on census tract. Among the 337 patients treated for r/r B-ALL, 112 were referred from an external hospital to a consortium site and enrolled in a CAR-T trial and 225 were treated primarily at a consortium site, with 34% enrolled in a CAR-T trial. Patients treated primarily at a consortium site had similar characteristics regardless of trial enrollment. Lower proportions of Hispanic patients (37% versus 56%; P = .03), patients whose preferred language was Spanish (8% versus 22%; P = .006), and publicly insured patients (38% versus 65%; P = .001) were referred from an external hospital than were treated primarily at a consortium site and enrolled in a CAR-T trial. Patients who are Hispanic, Spanish-speaking, or publicly insured are underrepresented in referrals from external hospitals to CAR-T centers. External provider implicit bias also may influence referral of these patients. Establishing partnerships between CAR-T centers and external hospital sites may improve provider familiarity, patient referral, and patient access to CAR-T clinical trials.
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Affiliation(s)
- Anurekha G Hall
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Lena E Winestone
- Division of Pediatric Allergy, Immunology, and Blood & Marrow Transplantation, UCSF Benioff Children's Hospitals, San Francisco, California
| | - Erin M Sullivan
- Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington
| | - Qian Wu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Adam J Lamble
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Mark C Walters
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California; USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lourdes Baez Conde
- USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Tumaini R Coker
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington
| | | | - Amy K Keating
- Pediatric Blood and Marrow Transplantation, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Bonnie Ramsey
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Julie R Park
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Anurag K Agrawal
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
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8
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Martell HJ, Shah AT, Lee AG, Tanasa B, Leung SG, Spillinger A, Liu HY, Behroozfard I, Dinh P, Ventura MVP, Hazard FK, Rangaswami A, Spunt SL, Lacayo NJ, Cooney T, Michlitsch JG, Agrawal AK, Breese MR, Sweet-Cordero EA. Abstract 54: Integrative analysis of whole-genome and RNA sequencing in high-risk pediatric malignancies. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The use of sequencing-based assays for clinical management of pediatric cancer patients has become increasingly common. However, for many pediatric patients, gene panel based sequencing tests yield few actionable results. Given the complex genomic alterations present in many pediatric cancers, especially high-risk solid tumors, we hypothesized that an unbiased approach might reveal more actionable findings and lead to a more comprehensive understanding of these diseases. To accomplish this, we integrated whole-genome sequencing (WGS) with RNAseq in the analysis of a pediatric oncology cohort, with a focus on longitudinal cases to capture potential tumor evolution in metastatic or treated cases.
Our cohort consists of 269 high-risk pediatric oncology patients, including patients with relapsed/refractory disease, metastatic disease at diagnosis, prior cancer history, a rare diagnosis, or an estimated overall survival <50%. Solid tumors, CNS tumors, and leukemia/lymphomas are all represented. In total, 391 samples were characterized using WGS (tumor ~60X; germline ~30X) and/or RNAseq (tumor, polyA selected, ≥20 million reads). For 85 of these patients, multiple samples were collected at different time points (diagnosis, resection, relapse, etc.) to identify changes in the cancer over time. If panel testing was performed as part of their clinical care, a comparison to the integrated WGS/RNA analysis was made. WGS was used to identify variants (SNVs), structural rearrangements (SVs), mutational signatures, and copy-number alterations (CNAs). RNAseq was used to identify gene expression outliers, gene fusions, and confirm the expression of variants identified using WGS. The combination of WGS and RNAseq was then used to identify and prioritize potentially actionable variants for each patient.
Our results show that the integration of WGS and RNAseq can provide more and higher-quality actionable information than either modality alone, whilst also capturing the majority of actionable variants detected by panel sequencing. RNAseq identified not only druggable fusions and expression outliers, but also many rare and novel fusions. WGS provided fusion validation but highlighted the limitations of WGS alone in identifying fusions resulting from complex SVs. Conversely, WGS was adept at capturing genome-wide patterns of CNAs and loss of heterozygosity that are missed by gene-centric panels. Further RNAseq integration enabled prioritization of expressed SNVs as well as CNAs and SVs that significantly alter gene expression. We also used WGS to extract mutational signatures and tracked their evolution across longitudinal samples. We found potentially biologically significant differences in therapy-induced mutations caused by platinum and alkylating agents. Our unbiased approach has enabled further discovery that advances our understanding of these rare and highly aggressive malignancies.
Citation Format: Henry J. Martell, Avanthi Tayi Shah, Alex G. Lee, Bogdan Tanasa, Stanley G. Leung, Aviv Spillinger, Heng-Yi Liu, Inge Behroozfard, Phuong Dinh, Maria V. Pons Ventura, Florette K. Hazard, Arun Rangaswami, Sheri L. Spunt, Norman J. Lacayo, Tabitha Cooney, Jennifer G. Michlitsch, Anurag K. Agrawal, Marcus R. Breese, E. Alejandro Sweet-Cordero. Integrative analysis of whole-genome and RNA sequencing in high-risk pediatric malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 54.
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Affiliation(s)
| | | | - Alex G. Lee
- 1University of California San Francisco, San Francisco, CA
| | - Bogdan Tanasa
- 1University of California San Francisco, San Francisco, CA
| | | | | | - Heng-Yi Liu
- 1University of California San Francisco, San Francisco, CA
| | | | - Phuong Dinh
- 1University of California San Francisco, San Francisco, CA
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9
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Wintering A, Smith S, Fuh B, Rangaswami A, Dahl G, Chien M, Gruber TA, Dang J, Li LS, Lenzen A, Savelli S, Dvorak CC, Agrawal AK, Stieglitz E. Therapy-related myeloid neoplasms resembling juvenile myelomonocytic leukemia: a case series and review of the literature. Pediatr Blood Cancer 2022; 69:e29499. [PMID: 34939322 PMCID: PMC8957526 DOI: 10.1002/pbc.29499] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022]
Abstract
Therapy-related myeloid neoplasms (t-MN) are a distinct subgroup of myeloid malignancies with a poor prognosis that include cases of therapy-related myelodysplastic syndrome (t-MDS), therapy-related myeloproliferative neoplasms (t-MPN) and therapy-related acute myeloid leukemia (t-AML). Here, we report a series of patients with clinical features consistent with juvenile myelomonocytic leukemia (JMML), an overlap syndrome of MDS and myeloproliferative neoplasms that developed after treatment for another malignancy.
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Affiliation(s)
- Astrid Wintering
- Department of Pediatrics, UCSF Benioff Children’s Hospital San Francisco, University of California San Francisco, San Francisco, CA 94158, USA
| | - Stephen Smith
- Department of Pediatrics, UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, USA
| | - Beng Fuh
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA
| | - Arun Rangaswami
- Department of Pediatrics, UCSF Benioff Children’s Hospital San Francisco, University of California San Francisco, San Francisco, CA 94158, USA
| | - Gary Dahl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - May Chien
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Tanja A. Gruber
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Jinjun Dang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Loretta S. Li
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Alicia Lenzen
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Stephanie Savelli
- Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USA
| | - Christopher C. Dvorak
- Department of Pediatrics, UCSF Benioff Children’s Hospital San Francisco, University of California San Francisco, San Francisco, CA 94158, USA,Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94158, USA
| | - Anurag K. Agrawal
- Department of Pediatrics, UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, USA
| | - Elliot Stieglitz
- Department of Pediatrics, UCSF Benioff Children’s Hospital San Francisco, University of California San Francisco, San Francisco, CA 94158, USA,Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94158, USA
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Cooper-Sood JB, Hagar W, Marsh A, Hoppe C, Agrawal AK. Adjuvant low-dose ketamine for paediatric and young adult sickle cell vaso-occlusive episodes in the emergency department. Br J Haematol 2022; 198:207-209. [PMID: 35396855 DOI: 10.1111/bjh.18201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- J Bryan Cooper-Sood
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ward Hagar
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Anne Marsh
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Carolyn Hoppe
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Anurag K Agrawal
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
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11
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Dessie AS, Lanning M, Nichols T, Delgado EM, Hart LS, Agrawal AK. Patient Outcomes With Febrile Neutropenia Based on Time to Antibiotics in the Emergency Department. Pediatr Emerg Care 2022; 38:e259-e263. [PMID: 32941363 DOI: 10.1097/pec.0000000000002241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although bacteremia in pediatric oncology patients with febrile neutropenia (FN) is not uncommon, sepsis and mortality are rare. Because of the lack of clinically meaningful decision tools to identify high-risk patients with bacteremia, time to antibiotic administration (TTA) is increasingly considered an important quality and safety measure in the emergency department. Because little evidence exists suggesting that this benchmark is beneficial, we sought to determine whether TTA of 60 minutes or less is associated with improved outcomes. METHODS We retrospectively reviewed patients presenting to a pediatric emergency department with FN from November 2013 to June 2016. Clinical outcomes including mortality, pediatric intensive care unit admission, imaging, fluid resuscitation of 40 mL/kg or greater in the first 24 hours, and length of stay were compared between TTA of 60 minutes or less and more than 60 minutes. RESULTS One hundred seventy-nine episodes of FN were analyzed. The median TTA was 76 minutes (interquartile range, 58-105). The incidence of bacteremia was higher in patients with TTA of more than 60 minutes (12% vs 2%, P = 0.04), but without impact on mortality, pediatric intensive care unit admission, fluid resuscitation, or median length of stay. The median TTA was not different for those who were and were not bacteremic (91 vs 73 minutes, P = 0.11). CONCLUSIONS Time to antibiotic administration of more than 60 minutes did not increase mortality in pediatric oncology patients with FN. Our study adds to the existing literature that TTA of 60 minutes or less does not seem to improve outcomes in pediatric FN. Further larger studies are required to confirm these findings and determine which features predispose pediatric FN patients to morbidity and mortality.
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Affiliation(s)
| | - Miranda Lanning
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Tristan Nichols
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | | | - Anurag K Agrawal
- Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
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12
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Yu H, Chen A, Chen E, Long LS, Agrawal AK. Low-dose Ketamine Infusion for Pediatric Hematology/Oncology Patients: Case Series and Literature Review. J Pediatr Hematol Oncol 2022; 44:e188-e193. [PMID: 34486547 DOI: 10.1097/mph.0000000000002290] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
Management of refractory pain in pediatric sickle cell disease (SCD) and oncology is reliant on opioids though high opioid dosing increases side effects and tachyphylaxis. We introduced low-dose ketamine infusion (LDKI) to our inpatient unit to determine if LDKI was tolerable. We subsequently hypothesized that LDKI would improve pain scores. We reviewed inpatients from LDKI initiation in March 2014 through October 2017, with the day before LDKI initiation compared with the day of LDKI initiation and 2 subsequent days. For patients with SCD, the LDKI admission was compared with up to 3 admissions in the prior year for a vaso-occlusive event. Nineteen patients (12 oncology, 7 SCD) with a median age of 14.6 years received LDKI for a median of 6 days at a median initial dose of 0.06 mg/kg/h (1.1 µg/kg/min). There was no change in pain scores or opioid utilization when comparing the day before LDKI initiation with subsequent days. No patient discontinued LDKI because of intolerability. For patients with SCD, there was a median 32% reduction in cumulative pain scores when comparing the LDKI admission with prior admissions. LDKI is well tolerated for refractory pediatric cancer-related and sickle cell-related pain.
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Affiliation(s)
| | - Allen Chen
- University of California Berkeley, Berkeley, CA
| | - Eric Chen
- University of California Berkeley, Berkeley, CA
| | | | - Anurag K Agrawal
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland
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13
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Agrawal AK, Jain S, Sandey KK, Sahu C, Kartikyen S. A study of centrifugal pressing of curd for paneer production. IJDS 2021. [DOI: 10.33785/ijds.2021.v74i05.016] [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: 11/23/2022]
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14
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Chaturvedi RK, Shukla S, Seth K, Agrawal AK. Corrigendum to "Zuckerkandl's organ improves long-term survival and function of neural stem cell's derived dopaminergic neurons in parkinsonian rats" [Experimental Neurology Volume 210, Issue 2, April 2008, Pages 608-623]. Exp Neurol 2021; 346:113859. [PMID: 34521510 DOI: 10.1016/j.expneurol.2021.113859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R K Chaturvedi
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Post Box-80, M.G. Marg, Lucknow 226,001, India
| | - S Shukla
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Post Box-80, M.G. Marg, Lucknow 226,001, India
| | - K Seth
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Post Box-80, M.G. Marg, Lucknow 226,001, India
| | - A K Agrawal
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Post Box-80, M.G. Marg, Lucknow 226,001, India.
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15
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Nik-Ahd M, Agrawal AK, Zimel M. Diagnosis and management of pediatric primary bone tumors in the emergency department. Pediatr Emerg Med Pract 2021; 18:1-20. [PMID: 34196516] [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: 06/13/2023]
Abstract
Musculoskeletal pain is a common chief complaint of children in the emergency department. Although nonspecific and typically benign, musculoskeletal pain should be investigated thoroughly with consideration for an underlying bone tumor, especially when it is a recurrent visit for pain. This issue reviews the specific signs, symptoms, and unique presentations the emergency clinician should know when evaluating a pediatric patient with musculoskeletal pain. Additionally, assessment of relevant radiographic findings to assist in differentiating bone tumors and guide further management are discussed.
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Affiliation(s)
- Mahnoosh Nik-Ahd
- Pediatric Emergency Medicine Fellow, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Anurag K Agrawal
- Associate Professor, Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Melissa Zimel
- Assistant Professor, Division of Orthopaedic Surgical Oncology, Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
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16
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Hilk K, Agrawal AK, Cadenas N, Roman S, Srivastava PS, Yen K, Lodish MB. Bilateral Pheochromocytoma Due to Von Hippel Lindau With Adrenal-Sparing Adrenalectomy in a Child. J Endocr Soc 2021. [PMCID: PMC8090151 DOI: 10.1210/jendso/bvab048.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: More than 40% of pediatric pheochromocytoma or paragangliomas have associated underlying genetic germline mutation. (1) Clinical Case: We present an 8-year-old male who arrived the emergency department with hypertension to 170/115. MRI of the abdomen revealed bilateral well demarcated adrenal masses with central necrosis. Urine metanephrines showed elevated normetanephrine of 15244 µg/24 hr (reference range, 58 - 670 µg/24 hr) and normal urine metanephrines. Urinary vanillylmandelic acid was mildly elevated 35 mg/gCr and homovanillic acid was normal. MIBG scan revealed increased radiotracer activity correlating to the bilateral adrenal masses without evidence of metastasis. Diagnosis of bilateral pheochromocytomas was made. Genetic testing revealed a novel, heterozygous, pathogenic variant of VHL tumor suppressor gene, consistent with Von Hippel-Lindau syndrome. Perioperative blockade was achieved with prazosin, amlodipine, and metoprolol. Due to low likelihood of metastasis in pheochromocytomas due to VHL, adrenal sparing bilateral adrenalectomy was attempted and resulted in 15% sparing of left adrenal gland vs radial bilateral adrenalectomy. (2) Clinical Lessons: 1. Endocrine etiologies of hypertension, although rare, are important causes of hypertension in the pediatric population. 2. Genetic testing prior to surgical intervention could determine surgical course and preservation of adrenals. 3. A multidisciplinary approach to care and referral to a center with experienced surgery, oncology, nephrology, endocrinology, anesthesiology, critical care and genetics is crucial to maximizing outcomes with pheochromocytoma. Reference: 1. NGS in PPGL (NGSnPPGL) Study Group, Toledo RA, Burnichon N, Cascon A, Benn DE, Bayley JP, Welander J, Tops CM, Firth H, Dwight T, Ercolino T, Mannelli M, Opocher G, Clifton-Bligh R, Gimm O, Maher ER, Robledo M, Gimenez-Roqueplo AP, Dahia PL. Consensus Statement on next-generation-sequencing-based diagnostic testing of hereditary phaeochromocytomas and paragangliomas. Nat Rev Endocrinol. 2017 Apr;13(4):233–247. 2. King KS, Prodanov T, Kantorovich V, Fojo T, Hewitt JK, Zacharin M, Wesley R, Lodish M, Raygada M, Gimenez-Roqueplo AP, McCormack S, Eisenhofer G, Milosevic D, Kebebew E, Stratakis CA, Pacak K. Metastatic pheochromocytoma/paraganglioma related to primary tumor development in childhood or adolescence: significant link to SDHB mutations. J Clin Oncol. 2011 Nov 1;29(31):4137–42.
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Affiliation(s)
- Kelly Hilk
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Anurag K Agrawal
- University of California of San Francisco, San Francisco, CA, USA
| | - Nicola Cadenas
- University of California San Francisco, San Francisco, CA, USA
| | - Sanziana Roman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Kevin Yen
- University of California San Francisco, San Francisco, CA, USA
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Agrawal AK, Michlitsch J, Golden C, Hastings CA, Raphael R, Feusner JH. Nelarabine in Pediatric and Young Adult T-Cell Acute Lymphoblastic Leukemia-Clearly Beneficial? J Clin Oncol 2021; 39:694. [PMID: 33444071 DOI: 10.1200/jco.20.02973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anurag K Agrawal
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Jennifer Michlitsch
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Carla Golden
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Caroline A Hastings
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Robert Raphael
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - James H Feusner
- Anurag K. Agrawal, MD, Jennifer Michlitsch, MD, Carla Golden, MD, Caroline A. Hastings, MD, Robert Raphael, MD, and James H. Feusner, MD, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
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18
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Sridhar S, Agrawal AK, Ferrerosa L, Lee B, Singh P. 194. Antibiotic-resistant bloodstream infections in pediatric oncology patients on levofloxacin prophylaxis. Open Forum Infect Dis 2020. [PMCID: PMC7778287 DOI: 10.1093/ofid/ofaa439.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Sunita Sridhar
- UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | | | | | - Brian Lee
- UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | - Prachi Singh
- UCSF Benioff Chidlrens Hospital Oakland, Orinda, California
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19
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Yu H, Cohler Peretz CA, Matsunaga A, Agrawal AK. Vaginal Bleeding and Otorrhea in a 6-year-old Girl. Pediatr Rev 2020; 41:648-651. [PMID: 33262156 DOI: 10.1542/pir.2019-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Cheryl A Cohler Peretz
- Department of Hematology/Oncology, University of California at San Francisco Benioff Children's Hospital Oakland, Oakland, CA
| | - Alison Matsunaga
- Department of Hematology/Oncology, University of California at San Francisco Benioff Children's Hospital Oakland, Oakland, CA
| | - Anurag K Agrawal
- Department of Hematology/Oncology, University of California at San Francisco Benioff Children's Hospital Oakland, Oakland, CA
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20
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Slone JS, Slone AK, Wally O, Semetsa P, Raletshegwana M, Alisanski S, Force LM, Chinyundo K, Margolin J, Agrawal AK, Anderson AR, Scheurer ME, Mehta PS. Establishing a Pediatric Hematology-Oncology Program in Botswana. J Glob Oncol 2019; 4:1-9. [PMID: 30241278 PMCID: PMC6223487 DOI: 10.1200/jgo.17.00095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/03/2023] Open
Abstract
Purpose Annually, 300,000 children are diagnosed with cancer, and the majority of these children live in low- and middle-income countries (LMICs). Currently, there is incomplete information on pediatric cancer incidence, diagnosis distribution, and treatment outcomes in Africa. Since 2007, a pediatric hematology-oncology program has been operating in Botswana through a partnership between the Botswana government, Baylor College of Medicine, and Texas Children’s Hospital. Methods To better understand patient characteristics and outcomes at Botswana’s only pediatric cancer program, a hospital-based data base—the Botswana Pediatric Oncology Database—was established in 2014. Children younger than 18 years of age at the time of diagnosis who presented between 2008 and 2015 were included. Data for this study were extracted in February 2016. Results Of the 240 potential enrollees, 185 (77%) children met eligibility for this study. The median age was 6.4 years, and 50.8% were male. Leukemia was the most common malignancy representing 18.9% of the cohort and 88.1% of the total cohort had a histopathologic diagnosis. HIV seropositivity was confirmed in 13.5%. The 2-year overall survival of all pediatric cancer diagnoses was 52.4%. Abandonment of treatment occurred in 3.8% of patients. Conclusion In the first 9 years of the program, capacity has been developed through a longstanding partnership between Botswana and Baylor College of Medicine/Texas Children’s Hospital that has led to children receiving care for cancer and blood disorders. Although continued improvements are necessary, outcomes to date indicate that children with cancer in Botswana can be successfully diagnosed and treated.
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Affiliation(s)
- Jeremy S Slone
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Amanda K Slone
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Oaitse Wally
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Pearl Semetsa
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Mpho Raletshegwana
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Susan Alisanski
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Lisa M Force
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Kamusisi Chinyundo
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Judith Margolin
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Anurag K Agrawal
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Alan R Anderson
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Michael E Scheurer
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Parth S Mehta
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
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21
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Agrawal AK, Singh B, Kashyap YS, Shukla M, Manjunath BS, Gadkari SC. Gamma-irradiation-induced micro-structural variations in flame-retardant polyurethane foam using synchrotron X-ray micro-tomography. J Synchrotron Radiat 2019; 26:1797-1807. [PMID: 31490172 DOI: 10.1107/s1600577519009792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Flame-retardant polyurethane foams are potential packing materials for the transport casks of highly active nuclear materials for shock absorption and insulation purposes. Exposure of high doses of gamma radiation causes cross-linking and chain sectioning of macromolecules in this polymer foam, which leads to reorganization of their cellular microstructure and thereby variations in physico-mechanical properties. In this study, in-house-developed flame-retardant rigid polyurethane foam samples were exposed to gamma irradiation doses in the 0-20 kGy range and synchrotron radiation X-ray micro-computed tomography (SR-µCT) imaging was employed for the analysis of radiation-induced morphological variations in their cellular microstructure. Qualitative and quantitative analysis of SR-µCT images has revealed significant variations in the average cell size, shape, wall thickness, orientations and spatial anisotropy of the cellular microstructure in polyurethane foam.
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Affiliation(s)
- A K Agrawal
- Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - B Singh
- Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Y S Kashyap
- Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - M Shukla
- Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - B S Manjunath
- Reactor Technology Division, Bhabha Atomic Research Centre, Mumbai, India
| | - S C Gadkari
- Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, India
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22
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Sharma R, Sharma SD, Sarkar PS, Singh B, Agrawal AK, Datta D. Phantom-Based Feasibility Studies on Phase-Contrast Mammography at Indian Synchrotron Facility Indus-2. J Med Phys 2019; 44:39-48. [PMID: 30983770 PMCID: PMC6438051 DOI: 10.4103/jmp.jmp_98_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/21/2022] Open
Abstract
Introduction: Use of synchrotron radiation (SR) X-ray source in medical imaging has shown great potential for improving soft-tissue image contrast such as the breast. The present study demonstrates quantitative X-ray phase-contrast imaging (XPCI) technique derived from propagation-dependent phase change observed in the breast tissue-equivalent test materials. Materials and Methods: Indian synchrotron facility (Indus-2, Raja Ramanna Centre of Advanced Technology [RRCAT]) was used to carry out phantom feasibility study on phase-contrast mammography. Different phantoms and samples, including locally fabricated breast tissue-equivalent phantoms were used to perform absorption and phase mode imaging using 12 and 16 keV SR X-ray beam. Edge-enhancement index (EEI) and edge enhancement to noise ratio (EE/N) were measured for all the images. Absorbed dose to air values were calculated for 12 and 16 keV SR X-ray beam using the measured SR X-ray photon flux at the object plane and by applying the standard radiation dosimetry formalism. Results and Conclusion: It was observed in case of all the phantoms and test samples that EEI and EE/N values are relatively higher for images taken in the phase mode. The absorbed dose to air at imaging plane was found to be 75.59 mGy and 28.9 mGy for 12 and 16 keV SR energies, respectively. However, these dose values can be optimized by reducing the image acquisition time without compromising the image quality when clinical samples are imaged. This work demonstrates the feasibility of XPCI in mammography using 12 and 16 keV SR X-ray beams.
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Affiliation(s)
- Reena Sharma
- Division of Radiological Physics and Advisory, Bhabha Atomic Research Centre, CT and CRS, Mumbai, Maharashtra, India.,Department of Atomic Energy, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S D Sharma
- Division of Radiological Physics and Advisory, Bhabha Atomic Research Centre, CT and CRS, Mumbai, Maharashtra, India.,Department of Atomic Energy, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - P S Sarkar
- Department of Atomic Energy, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Division of Technical Physics, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, India
| | - B Singh
- Division of Technical Physics, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, India
| | - A K Agrawal
- Division of Technical Physics, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, India
| | - D Datta
- Division of Radiological Physics and Advisory, Bhabha Atomic Research Centre, CT and CRS, Mumbai, Maharashtra, India.,Department of Atomic Energy, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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23
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Fatima A, Venkatesh AS, Mukherjee R, Agrawal AK, Singh B, Sarkar PS, Kashyap Y, Shripathi T. 3D spatial distribution of ore mineral phases using high resolution synchrotron micro-computed tomography (μCT) combined with optical microscopy. Appl Radiat Isot 2019; 148:49-59. [PMID: 30921617 DOI: 10.1016/j.apradiso.2019.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/24/2022]
Abstract
Ore minerals in dolomites and Graphite Mica Schist (GMS) were studied by synchrotron radiation micro-computed tomography (SR-μCT) and optical microscopy. High resolution μCT images of ore minerals were obtained at Imaging Beamline (BL-4), Indus-2 synchrotron radiation source for the comprehensive volume characterization of minerals. Optical microscopy was used for mineral identification, mineral/rock characterization and quantification of ore mineral assemblages was also confirmed by XRD. 3D images from SR-μCT have shown spatial distribution of major minerals and crystals of different minerals in the volume of samples. The results obtained shows that the GMS and dolomitic hosted rocks mined from region near Udaipur, Rajasthan contains sulfide mineral phases. SR-μCT facilitates visualization of the association of the various metallic minerals with the host rock. The presence of economically important metallic minerals galena, sphalerite and pyrite found in the samples through SR-μCT has implications on exploration and processing of ores.
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Affiliation(s)
- A Fatima
- UGC-DAE Consortium for Scientific Research, University Campus, Khandwa Road, Indore, India.
| | - A S Venkatesh
- Department of Applied Geology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | - R Mukherjee
- Department of Applied Geology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | - A K Agrawal
- Technical Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - B Singh
- Technical Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - P S Sarkar
- Technical Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - Y Kashyap
- Technical Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - T Shripathi
- UGC-DAE Consortium for Scientific Research, University Campus, Khandwa Road, Indore, India
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24
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Agrawal AK, Robertson S, Litwin L, Tringale E, Treadwell M, Hoppe C, Marsh A. Virtual reality as complementary pain therapy in hospitalized patients with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27525. [PMID: 30362236 DOI: 10.1002/pbc.27525] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 09/16/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Due to incomplete management of vaso-occlusive pain episodes (VOE) in patients with sickle cell disease (SCD), we sought to determine if immersive VR would be feasible for inpatients. Secondarily, we hypothesized that a single VR session would improve the VOE pain experience. PROCEDURES Consecutive patients with SCD eight years and older admitted for VOE were offered one 15-minute VR session, utilizing a relaxing underwater world specifically created for pediatric patients and to minimize potential simulator side effects. Safety and acceptability were evaluated with a brief survey before and after the session. Pain was evaluated utilizing the validated adolescent pediatric pain tool (APPT). Survey data and pain scores were analyzed using Wilcoxon signed-rank test as the data were nonnormally distributed. RESULTS Thirty patients, 21 female, with a median age of 16 years were enrolled, the majority having hemoglobin SS disease. The VR session had no reported side effects; all patients requested VR again in the future. Median pain intensity (pre-VR 7.3 [interquartile range, IQR, 6.1, 8.8], post-VR 5.8 [4.7, 7.9]), number of affected body areas (pre-VR 3.0 [2.0, 7.8], post-VR 2.0 [0, 4.8]), and qualitative measures including sensory, affective, evaluative, and temporal pain domains were all statistically reduced (i.e., P ≤0.01). CONCLUSIONS VR therapy was feasible in a cohort of patients with SCD admitted for VOE. In addition to standard therapies, VR may help reduce the pain experience with SCD VOE. Further study is required to determine the impact of VR therapy on opioid usage and length of stay in hospital.
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Affiliation(s)
| | | | - Liat Litwin
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Erica Tringale
- UCSF Benioff Children's Hospital Oakland, Oakland, California
| | | | - Carolyn Hoppe
- UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Anne Marsh
- UCSF Benioff Children's Hospital Oakland, Oakland, California
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25
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Agrawal AK, Aguilar A, Feusner J. Unifying the diagnosis of isolated central nervous system relapse in acute lymphoblastic leukaemia based on minimal residual disease testing. Br J Haematol 2018; 184:1026-1027. [PMID: 29676465 DOI: 10.1111/bjh.15215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anurag K Agrawal
- Department of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA, USA
| | - Ana Aguilar
- The Haley Center for Children's Cancer and Blood Disorders at Arnold Palmer Hospital, Orlando, FL, USA
| | - James Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA, USA
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26
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El-Mallawany NK, Kamiyango W, Villiera J, Slone JS, Kovarik CL, Campbell LR, Agrawal AK, Dittmer DP, Eason AB, Ahmed S, Schutze GE, Scheurer ME, Kazembe PN, Mehta PS. Proposal of a Risk-Stratification Platform to Address Distinct Clinical Features of Pediatric Kaposi Sarcoma in Lilongwe, Malawi. J Glob Oncol 2017; 4:1-7. [PMID: 29272148 PMCID: PMC6180767 DOI: 10.1200/jgo.17.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Nader Kim El-Mallawany
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - William Kamiyango
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jimmy Villiera
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jeremy S Slone
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Carrie L Kovarik
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Liane R Campbell
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anurag K Agrawal
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Dirk P Dittmer
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anthony B Eason
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Saeed Ahmed
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gordon E Schutze
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael E Scheurer
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter N Kazembe
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Parth S Mehta
- Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, Saeed Ahmed, Gordon E. Schutze, and Parth S. Mehta, Baylor College of Medicine; Nader Kim El-Mallawany, Jeremy S. Slone, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers, Houston, TX; William Kamiyango, Jimmy Villiera, Saeed Ahmed, and Peter N. Kazembe, Baylor College of Medicine Children's Foundation Malawi; William Kamiyango, Jimmy Villiera, and Peter N. Kazembe, Kamuzu Central Hospital, Lilongwe, Malawi; Carrie L. Kovarik, University of Pennsylvania, Philadelphia, PA; Liane R. Campbell, Baylor College of Medicine Children's Foundation Tanzania, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Mbeya, Tanzania; Anurag K. Agrawal, Children's Hospital and Research Center Oakland, Oakland, CA; and Dirk P. Dittmer and Anthony B. Eason, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Kesselheim JC, Agrawal AK, Bhatia N, Cronin A, Jubran R, Kent P, Kersun L, Rao AN, Rose M, Savelli S, Sharma M, Shereck E, Twist CJ, Wang M. Measuring pediatric hematology-oncology fellows' skills in humanism and professionalism: A novel assessment instrument. Pediatr Blood Cancer 2017; 64. [PMID: 27808467 DOI: 10.1002/pbc.26316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Educators in pediatric hematology-oncology lack rigorously developed instruments to assess fellows' skills in humanism and professionalism. PROCEDURE We developed a novel 15-item self-assessment instrument to address this gap in fellowship training. Fellows (N = 122) were asked to assess their skills in five domains: balancing competing demands of fellowship, caring for the dying patient, confronting depression and burnout, responding to challenging relationships with patients, and practicing humanistic medicine. An expert focus group predefined threshold scores on the instrument that could be used as a cutoff to identify fellows who need support. Reliability and feasibility were assessed and concurrent validity was measured using three established instruments: Maslach Burnout Inventory (MBI), Flourishing Scale (FS), and Jefferson Scale of Physician Empathy (JSPE). RESULTS For 90 participating fellows (74%), the self-assessment proved feasible to administer and had high internal consistency reliability (Cronbach's α = 0.81). It was moderately correlated with the FS and MBI (Pearson's r = 0.41 and 0.4, respectively) and weakly correlated with the JSPE (Pearson's r = 0.15). Twenty-eight fellows (31%) were identified as needing support. The self-assessment had a sensitivity of 50% (95% confidence interval [CI]: 31-69) and a specificity of 77% (95% CI: 65-87) for identifying fellows who scored poorly on at least one of the three established scales. CONCLUSIONS We developed a novel assessment instrument for use in pediatric fellowship training. The new scale proved feasible and demonstrated internal consistency reliability. Its moderate correlation with other established instruments shows that the novel assessment instrument provides unique, nonredundant information as compared to existing scales.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Anurag K Agrawal
- Children's Hospital and Research Center Oakland, Oakland, California
| | - Nita Bhatia
- Department of Psychological and Brain Sciences, University of Iowa.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angel Cronin
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rima Jubran
- Children's Hospital of Los Angeles, Los Angeles, California
| | - Paul Kent
- Rush University Medical Center, Chicago, Illinois
| | - Leslie Kersun
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Mukta Sharma
- Children's Mercy Hospital, Kansas City, Missouri
| | - Evan Shereck
- Doernbecker Children's Hospital, Oregon Health Sciences University, Portland, Oregon
| | - Clare J Twist
- Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
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Fatima A, Kataria S, Baghel L, Guruprasad KN, Agrawal AK, Singh B, Sarkar PS, Shripathi T, Kashyap Y. Synchrotron-based phase-sensitive imaging of leaves grown from magneto-primed seeds of soybean. J Synchrotron Radiat 2017; 24:232-239. [PMID: 28009562 DOI: 10.1107/s1600577516015745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
Experiments were conducted to study the effects of static magnetic fields (SMFs) on the venation network of soybean leaves using the synchrotron-based X-ray micro-imaging technique. The seeds of soybean (Glycine max, variety JS-335) were pretreated with different SMFs from 50 to 300 mT in steps of 50 mT for 1 h. The phase-contrast images obtained showed that, as the strength of the SMF increased, the area, width of the midrib, area of the midrib and minor vein of the middle leaflets of third trifoliate leaves also increased up to the SMF strength of 200 mT (1 h) and decreased thereafter. Quantification of the major conducting vein also showed the differences in the major and minor vein structures of the soybean leaves as compared with control leaves. Further, the phase-retrieval technique has been applied to make the segmentation process easy and to quantify the major and minor veins in the venation network. The width and area of midrib enhancement by pre-treatment with SMF implies an enhancement in the uptake of water, which in turn causes an increased rate of photosynthesis and stomatal conductance.
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Affiliation(s)
- A Fatima
- UGC-DAE, Consortium for Scientific Research, Indore (MP), India
| | - S Kataria
- School of Life Sciences, DAVV, Khandwa Road, Indore (MP), India
| | - L Baghel
- School of Life Sciences, DAVV, Khandwa Road, Indore (MP), India
| | - K N Guruprasad
- School of Life Sciences, DAVV, Khandwa Road, Indore (MP), India
| | - A K Agrawal
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - B Singh
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - P S Sarkar
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - T Shripathi
- UGC-DAE, Consortium for Scientific Research, Indore (MP), India
| | - Y Kashyap
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
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Agrawal AK, Mat Jais IS, Chew EM, Yam AKT, Tay SC. Biomechanical investigation of 'figure of 8' flexor tendon repair techniques. J Hand Surg Eur Vol 2016; 41:815-21. [PMID: 26936747 DOI: 10.1177/1753193416632640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 12/25/2015] [Indexed: 02/03/2023]
Abstract
This biomechanical study compared the original Al-Qattan repair with other modifications postulated to reduce bulk and friction, thereby potentially improving outcome. A total of 32 cadaveric digits with intact flexor apparatus were used. In each digit, the flexor digitorum profundus and flexor digitorum superficialis tendons were cut cleanly in Zone 2. We tested Al-Qattan's technique along with three modifications using stronger suture material and varying the number of strands across the repair site. Of the four repair techniques, the modified Al-Qattan's technique using two 'figure of 8' 4-0 Fiberwire core sutures (Group 4) had the best balance of ultimate tensile strength (50.9 N), 2 mm gapping force (38 N) and friction. The modified technique provided a stronger repair for early active mobilization and has less friction than the originally described repair.
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Affiliation(s)
- A K Agrawal
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - I S Mat Jais
- Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - E M Chew
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - A K T Yam
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - S C Tay
- Department of Hand Surgery, Singapore General Hospital, Singapore Biomechanics Laboratory, Singapore General Hospital, Singapore
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Sun YC, Qian ZW, Chen J, Yam AK, Agrawal AK, Mat Jais IS, Tay SC. Re: Agrawal AK, Mat Jais IS, Chew EM, Yam AKT, Tay SC. Biomechanical investigation of 'figure of 8' flexor tendon repair techniques. J Hand Surg Eur. 2016, 41: 815-21. J Hand Surg Eur Vol 2016; 41:888-9. [PMID: 27655813 DOI: 10.1177/1753193416666201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Y C Sun
- Department of Hand Surgery, Nantong University, Jiangsu, China
| | - Z W Qian
- Department of Hand Surgery, Nantong University, Jiangsu, China
| | - J Chen
- Department of Hand Surgery, Nantong University, Jiangsu, China
| | - A K Yam
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - A K Agrawal
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - I S Mat Jais
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - S C Tay
- Department of Hand Surgery, Singapore General Hospital, Singapore
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Fatima A, Kataria S, Guruprasad KN, Agrawal AK, Singh B, Sarkar PS, Shripathi T, Kashyap Y, Sinha A. Synchrotron X-ray phase contrast imaging of leaf venation in soybean (Glycine max) after exclusion of solar UV (280-400 nm) radiation. J Synchrotron Radiat 2016; 23:795-801. [PMID: 27140160 DOI: 10.1107/s1600577516003507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
The hydraulic efficiency of a leaf depends on its vascular structure as this is responsible for transport activities. To investigate the effect of exclusion of UVAB and UVB radiation from the solar spectrum on the micro-structure of leaves of soybean (Glycine max, variety JS-335), a field experiment was conducted using synchrotron-based phase contrast imaging (PCI). Plants were grown in specially designed UV exclusion chambers, and wrapped with filters that excluded UVB (280-315 nm) or UVAB (280-400 nm), or transmitted all the ambient solar UV (280-400 nm) radiation (filter control). Qualitative observation of high-resolution X-ray PCI images obtained at 10 keV has shown the differences in major and minor vein structures of the leaves. The mid-rib width of the middle leaflet of third trifoliate leaves, for all treatments, were obtained using quantitative image analysis. The width of the mid-rib of the middle leaflet of third trifoliate leaves of UVB excluded plants was found to be more compared to leaves of filter control plants, which are exposed to ambient UV. The mid-rib or the main conducting vein transports water and sugars to the whole plant; therefore, mid-rib enhancement by the exclusion of solar UV radiation possibly implies enhancement in the leaf area which in turn causes an increased rate of photosynthesis.
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Affiliation(s)
- A Fatima
- UGC-DAE, Consortium for Scientific Research, University Campus, Khandwa Road, Indore (MP), India
| | - S Kataria
- School of Life Sciences, DAVV, Khandwa Road, Indore (MP), India
| | - K N Guruprasad
- School of Life Sciences, DAVV, Khandwa Road, Indore (MP), India
| | - A K Agrawal
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - B Singh
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - P S Sarkar
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - T Shripathi
- UGC-DAE, Consortium for Scientific Research, University Campus, Khandwa Road, Indore (MP), India
| | - Y Kashyap
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - A Sinha
- Neutron and X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
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Agrawal AK, Sarkar PS, Singh B, Kashyap YS, Rao PT, Sinha A. Application of X-ray micro-CT for micro-structural characterization of APCVD deposited SiC coatings on graphite conduit. Appl Radiat Isot 2016; 108:133-142. [PMID: 26722834 DOI: 10.1016/j.apradiso.2015.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
Abstract
SiC coatings are commonly used as oxidation protective materials in high-temperature applications. The operational performance of the coating depends on its microstructure and uniformity. This study explores the feasibility of applying tabletop X-ray micro-CT for the micro-structural characterization of SiC coating. The coating is deposited over the internal surface of pipe structured graphite fuel tube, which is a prototype of potential components of compact high-temperature reactor (CHTR). The coating is deposited using atmospheric pressure chemical vapor deposition (APCVD) and properties such as morphology, porosity, thickness variation are evaluated. Micro-structural differences in the coating caused by substrate distance from precursor inlet in a CVD reactor are also studied. The study finds micro-CT a potential tool for characterization of SiC coating during its future course of engineering. We show that depletion of reactants at larger distances causes development of larger pores in the coating, which affects its morphology, density and thickness.
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Affiliation(s)
- A K Agrawal
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai, India.
| | - P S Sarkar
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - B Singh
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Y S Kashyap
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai, India
| | - P T Rao
- Powder Metallurgy Division, Bhabha Atomic Research Centre, Mumbai, India
| | - A Sinha
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai, India
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33
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Fatima A, Kulkarni VK, Banda NR, Agrawal AK, Singh B, Sarkar PS, Tripathi S, Shripathi T, Kashyap Y, Sinha A. Non-destructive evaluation of teeth restored with different composite resins using synchrotron based micro-imaging. J Xray Sci Technol 2016; 24:119-132. [PMID: 26890899 DOI: 10.3233/xst-160530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Application of high resolution synchrotron micro-imaging in microdefects studies of restored dental samples. OBJECTIVE The purpose of this study was to identify and compare the defects in restorations done by two different resin systems on teeth samples using synchrotron based micro-imaging techniques namely Phase Contrast Imaging (PCI) and micro-computed tomography (MCT). With this aim acquired image quality was also compared with routinely used RVG (Radiovisiograph). METHODS Crowns of human teeth samples were fractured mechanically involving only enamel and dentin, without exposure of pulp chamber and were divided into two groups depending on the restorative composite materials used. Group A samples were restored using a submicron Hybrid composite material and Group B samples were restored using a Nano-Hybrid restorative composite material. Synchrotron based PCI and MCT was performed with the aim of visualization of tooth structure, composite resin and their interface. RESULTS The quantitative and qualitative comparison of phase contrast and absorption contrast images along with MCT on the restored teeth samples shows comparatively large number of voids in Group A samples. CONCLUSIONS Quality assessment of dental restorations using synchrotron based micro-imaging suggests Nano-Hybrid resin restorations (Group B) are better than Group A.
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Affiliation(s)
- A Fatima
- UGC- DAE Consortium for Scientific Research, University Campus, Indore (M.P.), India
| | - V K Kulkarni
- Department of Pedodontics and Preventive Dentistry, Modern Dental College, Indore (M.P.), India
| | - N R Banda
- Department of Pedodontics and Preventive Dentistry, Modern Dental College, Indore (M.P.), India
| | - A K Agrawal
- Neutron & X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - B Singh
- Neutron & X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - P S Sarkar
- Neutron & X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - S Tripathi
- UGC- DAE Consortium for Scientific Research, University Campus, Indore (M.P.), India
| | - T Shripathi
- UGC- DAE Consortium for Scientific Research, University Campus, Indore (M.P.), India
| | - Y Kashyap
- Neutron & X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
| | - A Sinha
- Neutron & X-ray Physics Division, Bhabha Atomic Research Center, Trombay, Mumbai, India
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Agrawal AK, Singh B, Kashyap YS, Shukla M, Sarkar PS, Sinha A. Design, development and first experiments on the X-ray imaging beamline at Indus-2 synchrotron source RRCAT, India. J Synchrotron Radiat 2015; 22:1531-1539. [PMID: 26524319 DOI: 10.1107/s1600577515016276] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
A full-field hard X-ray imaging beamline (BL-4) was designed, developed, installed and commissioned recently at the Indus-2 synchrotron radiation source at RRCAT, Indore, India. The bending-magnet beamline is operated in monochromatic and white beam mode. A variety of imaging techniques are implemented such as high-resolution radiography, propagation- and analyzer-based phase contrast imaging, real-time imaging, absorption and phase contrast tomography etc. First experiments on propagation-based phase contrast imaging and micro-tomography are reported.
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Affiliation(s)
- A K Agrawal
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
| | - B Singh
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
| | - Y S Kashyap
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
| | - M Shukla
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
| | - P S Sarkar
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
| | - Amar Sinha
- Neutron and X-ray Physics Division, Bhabha Atomic Research Centre, Mumbai 85, India
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Slone JS, Agrawal AK, Mehta PS, Mazhani L, Motumise K, Anabwani G, Poplack DG. Reply to "childhood cancer in Africa". Pediatr Blood Cancer 2014; 61:1524. [PMID: 24519963 DOI: 10.1002/pbc.24972] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Jeremy S Slone
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
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Agrawal AK, Bobiński P, Grzebieniak Z, Rudnicki J, Marek G, Kobielak P, Kazanowski M, Agrawal S, Hałoń A. Pseudomyxoma peritonei originating from urachus-case report and review of the literature. ACTA ACUST UNITED AC 2014; 21:e155-65. [PMID: 24523614 DOI: 10.3747/co.21.1695] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pseudomyxoma peritonei (pmp) is a rare clinical condition defined as extensive intraperitoneal spread of mucus associated with a variety of mucinous tumours of varying biologic behavior. Although appendix or ovaries have usually been implicated as the primary site, cases have been reported in association with neoplastic lesions of other sites. Pseudomyxoma peritonei originating from urachal remnants is a unique entity, reported only 18 times in the English literature thus far. Considering the rarity of the lesion, we report the case of a 50-year-old man surgically treated for pmp associated with a low-grade mucinous urachal neoplasm. Unique aspects of case are the low histologic aggressiveness of the causative lesion (reported only twice worldwide) and the early stage of the disease, with a relatively small amount of intraperitoneal free mucin. Review of the literature about pmp in general and a collation of previously reported cases of pmp originating from the urachus are presented and discussed.
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Affiliation(s)
- A K Agrawal
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - P Bobiński
- Department of General Surgery ii , Lower-Silesian Specialised Hospital, Wroclaw, Poland
| | - Z Grzebieniak
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - J Rudnicki
- Wroclaw Medical University, Wroclaw, Poland
| | - G Marek
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - P Kobielak
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - M Kazanowski
- Second Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - S Agrawal
- Wroclaw Medical University, Wroclaw, Poland
| | - A Hałoń
- Division of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
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Abstract
BACKGROUND Kaposi sarcoma (KS) remains the second most frequently diagnosed HIV-related malignancy (HRM) worldwide and most common HRM in sub-Saharan Africa where HIV is most prevalent and human herpesvirus 8 (HHV-8), the precipitating agent for the development of KS, is endemic. The majority of KS patients would likely benefit from systemic chemotherapy in addition to the initiation of antiretroviral therapy (ART). However, as paediatric staging and treatment criteria are not readily available, there are no uniform treatment criteria. OBJECTIVES To describe the efficacy and effectiveness of current treatment options for HIV-associated KS in ART-treated paediatric populations. SEARCH METHODS We used standard Cochrane methods to search electronic databases and conference proceedings with relevant search terms without limits to language. SELECTION CRITERIA Randomised controlled trials, cohort studies, and case-control studies of HIV-infected infants and children <18 years old treated with ART and diagnosed with KS. DATA COLLECTION AND ANALYSIS Abstracts of all studies identified by electronic or bibliographic scanning were examined independently by two authors. We initially identified 920 references and examined 15 in detail for study eligibility. Data were abstracted independently using a standardised abstraction form. MAIN RESULTS After initially screening 920 titles, 15 full-text articles were closely examined by two authors. We identified four cohort studies that met our inclusion criteria for data extraction, coding, and potential meta-analysis.Using the Newcastle-Ottawa Scale and Cochrane risk of bias assessments, all observational studies had cohorts that were representative of average (treated and untreated) HIV-infected children with Kaposi sarcoma. For all outcomes of interest, no study adjusted for any other potential confounders. Two of four observational studies either explicitly described complete follow up of the study participants and/or described the characteristics of the participants lost to follow up.The use of ART together with a chemotherapeutic regimen versus ART alone appears to increase the likelihood of KS remission in HIV-infected children diagnosed with KS, although data are sparse and not adequately adjusted for staging of disease and comorbidities. Additionally, though data are sparse, the use of ART together with a chemotherapeutic regimen versus chemotherapy alone in some analyses appears to increase the likelihood of KS remission and reduce the risk of death in HIV-infected children diagnosed with KS.In this analysis, we found that the quality of evidence was very low due to small sample sizes and a paucity of paediatric literature. AUTHORS' CONCLUSIONS Data describing the efficacy of different treatment options for pediatric KS, to include chemotherapy and ART, are sparse. However, the use of ART together with a chemotherapy regimen may be superior to the use of ART alone or of chemotherapy alone.
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Affiliation(s)
- Andrew Anglemyer
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA, 94105
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Gupta N, Jassal M, Manchanda R, Saxena RK, Sharma B, Sharma S, Agrawal AK. Leaching of plastic polymers by plastic vials used for storing homoeopathic medicines: A preliminary study. Indian J Res Homoeopathy 2014. [DOI: 10.4103/0974-7168.135642] [Citation(s) in RCA: 3] [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: 11/04/2022] Open
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Shukla A, Mohapatra TM, Agrawal AK, Parmar D, Seth K. Salsolinol induced apoptotic changes in neural stem cells: amelioration by neurotrophin support. Neurotoxicology 2013; 35:50-61. [PMID: 23261589 DOI: 10.1016/j.neuro.2012.12.005] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 11/20/2022]
Abstract
Salsolinol (SAL), a catechol isoquinoline has invited considerable attention due to its structural similarity with dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Its high endogenous presence in Parkinsonian brain implicated its possible association with the disease process. SAL is also present in alcohol beverages and certain food materials and can get access to brain especially in conditions of immature or impaired BBB. Besides this, the effect of SAL on neural stem cells (NSCs) which are potential candidates for adult neurogenesis and transplantation mediated rejuvenating attempts for Parkinson's disease (PD) brain has not been known so far. NSCs in both the cases have to overcome suppressive cues of diseased brain for their survival and function. In this study we explored the toxicity of SAL toward NSCs focusing on apoptosis and status of PI3K survival signaling. NSCs cultured from embryonic day 11 rat fetal brain including those differentiated to TH(+ve) colonies, when challenged with SAL (1-100μM), elicited a concentration and time dependent cell death/loss of mitochondrial viability. 10μM SAL on which significant mitochondrial impairment initiated was further used to study mechanism of toxicity. Morphological impairment, enhanced TUNEL positivity, cleaved caspase-3 and decreased Bcl-2:Bax suggested apoptosis. Sal toxicity coincided with reduced pAkt level and its downstream effectors: pCREB, pGSK-3β, Bcl-2 and neurotrophins GDNF, BDNF suggesting repressed PI3K/Akt signaling. Multiple neurotrophic factor support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) potentially protected NSCs against SAL through activating PI3K/Akt pathway. This was confirmed on adding LY294002 the PI3K inhibitor which abolished the protection. We inferred that SAL exerts substantial toxicity toward NSCs. These findings will lead to better understanding of endogenous threats that might affect the fate of transplanted NSCs and their probable antidotes.
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Affiliation(s)
- A Shukla
- Indian Institute of Toxicology Research (CSIR), Developmental Toxicology Division, Mahatma Gandhi Marg, Post Box 80, Lucknow 226 001, India; Department of Microbiology, IMS, Banaras Hindu University, Varanasi 221 005, India
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Agrawal AK, Hsu E, Quirolo K, Neumayr LD, Flori HR. Red blood cell transfusion in pediatric patients with severe chronic anemia: how slow is necessary? Pediatr Blood Cancer 2012; 58:466-8. [PMID: 21793178 DOI: 10.1002/pbc.23238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/19/2011] [Indexed: 11/11/2022]
Abstract
Historic practice recommends slow transfusion for children with chronic anemia and hemoglobin less than 5.0 g/dl due to the theoretical risk of transfusion-associated circulatory overload (TACO). In our pediatric intensive care unit (PICU), we have been utilizing a more liberal transfusion practice in patients without underlying cardiopulmonary disease, and a faster transfusion rate appears safe in this population. Rate of transfusion must be based on multiple factors including convenience, timeliness of procedures and transport to an appropriate care facility, risk of alloimmunization and wastage of blood, stress for the family, and need for PICU monitoring.
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Affiliation(s)
- Anurag K Agrawal
- Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA.
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Agrawal AK, Kammen BF, Guo H, Donthineni R. An unusual presentation of subcutaneous granuloma annulare in association with juvenile-onset diabetes: case report and literature review. Pediatr Dermatol 2012; 29:202-5. [PMID: 22085091 DOI: 10.1111/j.1525-1470.2011.01638.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subcutaneous granuloma annulare (SGA) is a rarely reported subtype of granuloma annulare that occurs almost exclusively in children. The etiology of these lesions is unknown, although a possible relationship to insulin-dependent diabetes mellitus (IDDM) has been proposed in the literature. Here we present an unusual case of SGA on the right forearm in a 3-year-old girl. Unlike the typical lesions noted on the extremities, on magnetic resonance imaging her lesions involved the subcutaneous tissue and adjacent muscles in multiple locations. Histopathologically, the case was consistent with SGA but was unusual in its distribution involving multiple muscles, a finding that has not been previously reported. Weeks after incisional biopsy, she was readmitted with diabetic ketoacidosis (DKA) secondary to IDDM. After treatment of her DKA and control of her glycemia, the forearm SGA vanished, which supported the pathologic diagnosis and alleviated our concerns secondary to the unusual distribution.
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Affiliation(s)
- Anurag K Agrawal
- Children's Hospital and Research Center, Oakland, California 94609, USA.
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Agrawal AK, Saini N, Gildengorin G, Feusner JH. Is routine computed tomographic scanning justified in the first week of persistent febrile neutropenia in children with malignancies? Pediatr Blood Cancer 2011; 57:620-4. [PMID: 21265012 DOI: 10.1002/pbc.22974] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/18/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prolonged febrile neutropenia (FN) remains a common problem in pediatric oncology and often leads to empiric computed tomography (CT) of the sinuses, chest, abdomen, and pelvis. Little evidence is available as to the diagnostic utility of CT in this setting. PROCEDURE We performed a retrospective review of all oncology patients admitted to the hospital from January 2004 through December 2008 for FN who had daily fevers with neutropenia for 4 or more consecutive days prompting CT evaluation. Eligible patient charts were reviewed for symptomatology prior to imaging as well as antibiotic and antifungal regimens throughout therapy. RESULTS Fifty-two patients had 68 unique episodes of prolonged FN that resulted in CT imaging. Positive findings occurred in 18%, 12%, and 25% of initial chest, abdomen, and sinus CTs, respectively. There were no positive findings on initial pelvic CT. Only two of the initial positive CT scans led to a change in management (6.5% of positive scans, 0.8% of all initial scans). These were both scans of the chest. All patients with concern for occult fungal infection had findings on chest CT. Patients with clinically important infections had no statistical difference in days of fever or neutropenia or type of underlying malignancy compared with those without infection. Clinical symptomatology was most helpful for typhlitis. CONCLUSIONS Treatment alteration rarely results from empiric CT imaging in the early days of prolonged FN. We therefore recommend limiting initial empiric CT imaging to the chest only in patients without localizing signs or symptoms and prolonged FN.
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Affiliation(s)
- Anurag K Agrawal
- Children's Hospital and Research Center, Oakland, California 94609, USA.
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Agrawal AK, Guo H, Golden C. Siblings presenting with progressive congenital aleukemic leukemia cutis. Pediatr Blood Cancer 2011; 57:338-40. [PMID: 21425444 DOI: 10.1002/pbc.23053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 01/04/2011] [Indexed: 11/07/2022]
Abstract
Congenital leukemia is infrequent, occurring in <1% of pediatric leukemia patients, and mainly of myeloid lineage. Twenty-five to 30% of congenital leukemia cases present with cutaneous leukemic infiltrates. Rarely, infants will have aleukemic leukemia cutis, presenting with leukemic skin lesions but without systemic symptoms or bone marrow involvement. Few cases of congenital aleukemic leukemia cutis have been reported in the literature. The course of disease is variable as cases of spontaneous resolution have been described. Here we present the first report of siblings with progressive congenital aleukemic leukemia cutis, both treated successfully with myeloid leukemia chemotherapy.
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Affiliation(s)
- Anurag K Agrawal
- Children's Hospital and Research Center Oakland, Oakland, California 94609, USA.
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Agrawal AK, Feusner JH. Management of tumour lysis syndrome in children: what is the evidence for prophylactic rasburicase in non-hyperleucocytic leukaemia? Br J Haematol 2011; 153:275-7. [DOI: 10.1111/j.1365-2141.2010.08506.x] [Citation(s) in RCA: 8] [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: 11/27/2022]
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Kaur R, Wadhwa A, Gulati A, Agrawal AK. An unusual phaeoid fungi: Ulocladium, as a cause of chronic allergic fungal sinusitis. Iran J Microbiol 2010; 2:95-7. [PMID: 22347556 PMCID: PMC3279772] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Allergic fungal sinusitis (AFS) has been recognized as an important cause of chronic sinusitis commonly caused by Aspergillus spp. and various dematiaceous fungi like Bipolaris, Alternaria, Curvalaria, and etc. Ulocladium botrytis is a non pathogenic environmental dematiaceous fungi, which has been recently described as a human pathogen. Ulocladium has never been associated with allergic fungal sinusitis but it was identified as an etiological agent of AFS in a 35 year old immunocompetent female patient presenting with chronic nasal obstruction of several months duration to our hospital. The patient underwent FESS and the excised polyps revealed Ulocladium as the causative fungal agent.
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Affiliation(s)
| | - A Wadhwa
- Department of Microbiology,Corresponding author: Dr. Anupriya Wadhwa. Address: 76, Ground Floor, RPS Flats, Sheikh Sarai Phase-1, Malviya Nagar, New Delhi-110017. Tel: +91-9312350269, +91-1126017626. E-mail:
| | - A Gulati
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - AK Agrawal
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
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Choudhary H, Agrawal AK, Malviya R, Yadav SK, Jaliwala YA, Patil UK. Evaluation and optimization of preparative variables for controlled-release floating microspheres of levodopa/carbidopa. Pharmazie 2010; 65:194-198. [PMID: 20383939] [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: 05/29/2023]
Abstract
Levodopa, a prodrug of dopamine, is the first line drug in the treatment of Parkinson's disease. All current levodopa products are formulated in combination with aromatic amino acid decarboxylase inhibitors such as carbidopa or benserazide to prevent the peripheral metabolism of levodopa. The objective of the present investigation was to produce floating microspheres of carbidopa (CD)/levodopa (LD) to enhance their efficacy by increasing their gastric residence time, which is major technique to improve efficacy of narrow absorption window drugs. The microspheres were prepared by the o/w emulsion-solvent diffusion method using polymers hydroxypropylmethyl cellulose K15 M (HPMC K15 M) and ethyl cellulose (EC). The effects of various formulation and process variables on the particle size, in vitro floating behavior, percent drug entrapment, and in vitro drug release were studied. The size and surface morphology of prepared microspheres were characterized by optical and scanning electron microscopy, respectively. In vitro drug release studies were performed and drug release kinetics was evaluated using the linear regression analysis. The prepared microspheres exhibited prolonged drug release (approximately 10h) and remained buoyant for >12 h. Spherical and smooth-surfaced microspheres with encapsulation efficiency ranging from 43% to 80% were obtained. In vitro studies demonstrated diffusion-controlled drug release from the microspheres.
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Affiliation(s)
- H Choudhary
- Nano Carriers Research Laboratory, V. N.S. Institute of Pharmacy, Neelbud, Bhopal (M.P.), India
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Agrawal AK, Gupta PN, Khanna A, Sharma RK, Chandrawanshi HK, Gupta N, Patil UK, Yadav SK. Development and characterization of in situ gel system for nasal insulin delivery. Pharmazie 2010; 65:188-193. [PMID: 20383938] [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: 05/29/2023]
Abstract
The objective of the present study was to develop a thermosensitive in situ gel system based on chitosan and poly vinyl alcohol (PVA) for nasal delivery of insulin. The hydrogel was prepared by mixing chitosan and PVA. The concentration of the components was optimized during formulation development. The prepared hydrogel was characterized for gelation temperature, gelation time, viscosity changes, degree of swelling, in vitro release and in vivo hypoglycemic effect. The prepared hydrogel was liquid at room temperature while underwent thermal transition from solution below or at room temperature to non-flowing hydrogel when incubated at 37 degrees C for approximately 12 minutes with increased viscosity. The in vitro release of insulin from gel network was observed spectrophotometrically which was good enough to maintain blood glucose level for six hour. Furthermore, the formulation when evaluated for their in vivo hypoglycemic effect, demonstrated its ability to reduce glucose level. The observed in vitro and in vivo results indicate that the proposed thermosensitive in situ gelling system has substantial potential as nasal delivery system for insulin.
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Affiliation(s)
- A K Agrawal
- Drug and Vaccine Delivery Research Laboratory, V.N.S. Institute of Pharmacy, Neelbud, Bhopal (M.P.), India
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Singh N, Kayal N, Gupta PK, Agrawal AK. Monitoring the trace metals concentration in rice by flame atomic absorption spectrometer and inductively coupled plasma atomic emission spectrometer. J Environ Sci Eng 2010; 52:33-36. [PMID: 21114104] [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: 05/30/2023]
Abstract
The objective of this study was to monitor the concentration of trace metals in rice. Eight different commercial rice samples were collected from retail market and among these samples Fe, Cd, Cr and Zn metal concentrations were determined by using Flame Atomic Absorption Spectrometer (FAAS) and Inductively Coupled Plasma Atomic Emission Spectrophotometer (ICP-AES). The powdered rice samples were digested by wet chemical method. The analytical results obtained by both the instruments were found comparable. The accuracy of the method has been confirmed by analyzing Certified Reference Material CRM No. 10-b of National Institute for Environmental Studies (NIES). The concentrations of Fe, Cd, Cr and Zn in different brands were found in the range of 15.4 +/- 1.1 to 57.7 +/- 2.5 mg/kg, 0.08 +/- 0.03 to 0.39 +/- 0.05 mg/kg, 0.16 +/- 0.03 to 0.58 +/- 0.08 mg/kg and 7.3 +/- 0.3 to 18.6 +/- 0.5 mg/kg respectively. The standard deviation of the measurements has been calculated for Fe, Cd, Cr and Zn in six replicates of each sample and was found to be less than +/- 3% by the method proposed.
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Affiliation(s)
- Nahar Singh
- Chemical Metrology Section, National Physical Laboratory, Dr K. S. Krishnan Marg, New Delhi-1 10 012, India.
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Abstract
Hematological profile of homozygous sickle cell disease patients attending RHDMC from Central India is presented. Central India has a huge population of sickle cell disease patients. Though predicted SS in the region is 22-44 %, 81 homozygous of sickle cell patients reported during study period of Jan 2003-Dec 2005. The clinical course of these patients is characterized in most of the cases by relatively long period without any symptoms punctuated by acute clinical events. Hematological profile of these 81 patients with age ranging from 6 month to 64 years is presented. There are 44 males and 37 females with an average age of 14.55yrs in males and 18.13 yrs females. Males out number females in pediatric age group where as females with SCD are attending hospital more in reproductive age group. Very few patients are reported after the age of 30 yrs. Average hemoglobin in males is 7.11 ± 2.13 gms/dl and in females 6.75 ± 1.85 gms/dl with parallel low RBC count.Hemoglobin rise is seen after 14 years of age in males and females. Age related rise in MCV is more noted in females after the age of 5 as compared to males. No age or sex related difference was seen in MCHC values. Hb A(2) levels for males is 2.13 ± 0.95% and for females 2.04 ± 0.91 %.Hb F in males is 19.58 + 5.86% and in females is 20.99 + 4.9%. There is no age and sex related difference in Hb F levels. Moderate to severe anemia with high Hb F dominate Central Indian sickle cell disease patient's hematological profile. The hematological profile in Central India is similar to the profile in other parts of India and Saudi Arabia but different from Jamaica and Africa.
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Affiliation(s)
- A V Shrikhande
- Dept. of Pathology, Indira Gandhi Government Medical, Nagpur, India
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