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Bhattad S, Mohite RS, Singh N, Kotecha U, Jhawar P, Ramprakash S, Commondoor R, Jayaram A, Rayabarapu P, Kumar H, Unni J, Cyril G, Kumar S, Pachat D, Jakka S, Makam A, Porta F, Ginigeri C. Profile of 208 patients with inborn errors of immunity at a tertiary care center in South India. Clin Exp Med 2023; 23:5399-5412. [PMID: 37898571 DOI: 10.1007/s10238-023-01225-8] [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] [Received: 06/01/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
Primary immune deficiencies or inborn errors of immunity (IEI) are a heterogeneous group of disorders that predispose affected individuals to infections, allergy, autoimmunity, autoinflammation and malignancies. IEIs are increasingly being recognized in the Indian subcontinent. Two hundred and eight patients diagnosed with an IEI during February 2017 to November 2021 at a tertiary care center in South India were included in the study. The clinical features, laboratory findings including microbiologic and genetic data, and treatment and outcome details were analyzed. The diagnosis of IEI was confirmed in a total of 208 patients (198 kindreds) based on relevant immunological tests and/or genetic tests. The male-to-female ratio was 1.8:1. Of the 208 patients, 72 (34.6%) were < 1 yr, 112 (53.8%) were 1-18 years, and 24 (11.5%) were above 18 years. The most common IEI in our cohort was SCID (17.7%) followed by CGD (12.9%) and CVID (9.1%). We also had a significant proportion of patients with DOCK8 deficiency (7.2%), LAD (6.2%) and six patients (2.8%) with autoinflammatory diseases. Autoimmunity was noted in forty-six (22%) patients. Molecular testing was performed in 152 patients by exome sequencing on the NGS platform, and a genetic variant was reported in 132 cases. Twenty-nine children underwent 34 HSCT, and 135 patients remain on supportive therapy such as immunoglobulin replacement and/or antimicrobial prophylaxis. Fifty-nine (28.3%) patients died during the study period, and infections were the predominant cause of mortality. Seven families underwent prenatal testing in the subsequent pregnancy. We describe the profile of 208 patients with IEI, and to the best of our knowledge, this represents the largest data on IEI from the Indian subcontinent reported so far.
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Affiliation(s)
- Sagar Bhattad
- Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bengaluru, India.
| | - Rachna S Mohite
- Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bengaluru, India
| | - Neha Singh
- Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bengaluru, India
| | | | - Prerna Jhawar
- Department of Fetal Medicine, Rainbow Hospital, Bengaluru, India
| | - Stalin Ramprakash
- Pediatric Hemato-Oncology and BMT Unit, Aster CMI Hospital, Bengaluru, India
| | - Raghuram Commondoor
- Pediatric Hemato-Oncology and BMT Unit, Aster CMI Hospital, Bengaluru, India
| | | | | | - Harish Kumar
- Pediatric Intensive Care Unit, Aster CMI Hospital, Bengaluru, India
| | | | | | | | | | | | | | - Fulvio Porta
- Onco-Hematology and Bone Marrow Transplantation (BMT) Unit, Ospedale Dei Bambini, Brescia, Italy
| | - Chetan Ginigeri
- Pediatric Intensive Care Unit, Aster CMI Hospital, Bengaluru, India
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Mohite RS, Vidya MN, Kaur T, Furtado S, Raghuram CP, Ramprakash S. Miliaria Crystallina Type Rash as an Unusual Presentation of Acute Graft Versus Host Disease (GVHD) After Hematopoietic Stem Cell Transplant'. Indian J Dermatol 2023; 68:727. [PMID: 38371549 PMCID: PMC10868965 DOI: 10.4103/ijd.ijd_118_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Rachna Shanbhag Mohite
- From the Department of Pediatrics, Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, Aster CMI Hospital, Karnataka, India E-mail:
| | - M N Vidya
- Department of Pathology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Tripti Kaur
- Department of Pathology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Shireen Furtado
- Department of Dermatology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - C P Raghuram
- From the Department of Pediatrics, Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, Aster CMI Hospital, Karnataka, India E-mail:
| | - Stalin Ramprakash
- From the Department of Pediatrics, Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, Aster CMI Hospital, Karnataka, India E-mail:
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Agarwal RK, Dhanya R, Sedai A, Ankita K, Parmar L, Ramprakash S, Sandeep, Trivedi D, Shah V, Bhat N, Reddy M, R N, Faulkner L. Bone Marrow Quality Index: A Predictor of Acute Graft-versus-Host Disease in Hematopoietic Stem Cell Transplantation for Thalassemia. Transplant Cell Ther 2023; 29:711.e1-711.e6. [PMID: 37481242 DOI: 10.1016/j.jtct.2023.07.014] [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] [Received: 03/25/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
Bone marrow (BM) continues to be the preferred source of stem cells in allogenic transplantation for nonmalignant disorders. Granulocyte colony-stimulating factor (G-CSF)-primed BM is associated with low rates of acute graft-versus-host disease (aGVHD) and allows reduced collection volumes while ensuring speedy engraftment. However, variability in BM harvest quality is a concern. This study evaluated the utility of a novel indicator, the Bone Marrow Quality Index (BMQI), to predict aGVHD. We analyzed 184 consecutive first matched related donor bone marrow transplants for thalassemia using G-CSF-primed bone marrow over 6 years from March 2017 to April 2023 across 2 centers in India. BMQI was defined as the ratio of the G-CSF-primed BM WBC count to the peripheral blood WBC count within 24 hours of harvest. European Society for Blood and Marrow Transplantation criteria were used to grade aGVHD. The log-rank test was used to assess the impact of BMQI on aGVHD. The chi-square test was used to compare categorical data, and the Wilcoxon rank-sum test was used to compare the numerical data. A Cox proportional hazards model was used to investigate the association of BMQI vis-à-vis other factors on aGVHD. Of the 184 patients studied, 19 had a BMQI <.9, 18 had a BMQI between .9 and 1, and the remaining 147 had a BMQI >1. The rate of aGVHD grade II-IV was 37% in patients with a BMQI <.9 , 22% in those with BMQI .9 to 1, and 12% in those with BMQI >1 (P = .018). Patients with BMQI <.9 had a 3.1-fold greater chance (95% confidence interval [CI], .9 to 10.6) and those with BMQI .9 to 1 had a 2-fold greater chance (95% CI, .5 to 6.6) of developing aGVHD grade II-IV. BMQI was the significant predictor associated with aGVHD hazard (P = .014). BMQI appears to be the most relevant and controllable predictor of aGVHD. It is a novel, informative, and very simple indicator that could influence aGVHD prophylaxis decision making. Our indicator is accurately measurable, inexpensive, precise, and timely; furthermore, it does not involve any sophisticated equipment and thus may be widely applicable. Prior knowledge of poor BM quality may help intensify prophylaxis and monitoring for aGVHD, as well as trigger a review of collection procedures.
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Affiliation(s)
- Rajat Kumar Agarwal
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India.
| | | | - Amit Sedai
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Kumari Ankita
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Lalith Parmar
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Stalin Ramprakash
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Sandeep
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Deepa Trivedi
- Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Vaibhav Shah
- Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Neema Bhat
- Sankalp-BMJH Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Mohan Reddy
- Sankalp-BMJH Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Nithya R
- Sankalp India Foundation, Bangalore, India
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India; Cure2Children Foundation, Florence, Italy
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Marangu-Boore D, Kambuni F, Onyinkwa M, Ramprakash S, C.P. R, Eley B, Bhattad S. Genetically confirmed chronic granulomatous disease in a Kenyan child: case report. Front Immunol 2023; 14:1172848. [PMID: 37275907 PMCID: PMC10233338 DOI: 10.3389/fimmu.2023.1172848] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction We report the first case of genetically confirmed chronic granulomatous disease (CGD) in a Kenyan child. Clinical findings A 7-month-old male infant, the only child of non-consanguineous parents, presented with cough, fever, fast breathing, oral thrush, and axillary lymphadenopathy ipsilateral to the Calmette-Guérin bacillus scar. He had been hospitalized 5 weeks prior for severe pneumonia. Plain chest radiography showed bilateral patchy airspace opacification; chest computed tomography revealed multiple large lung nodules and left axillary lymphadenopathy. HIV ELISA was negative; tuberculin skin test was positive; lymph node biopsy macroscopically revealed caseous granulomas seen on histology; isoniazid- and rifampicin-susceptible Mycobacterium tuberculosis complex isolate was detected on the Hain test. First-line anti-tuberculous drugs were added to his empiric treatment comprising piperacillin-tazobactam, amikacin, cotrimoxazole, and fluconazole. He was discharged after 10 days based on clinical resolution. Diagnoses interventions and outcome An inborn error of immunity (IEI) was considered given the recurrent fevers and atypical lung nodules. Genetic analysis revealed a hemizygous pathogenic variant on CYBB in keeping with X-linked CGD. The child's fevers recurred 2 weeks post-discharge but completely resolved on prophylactic itraconazole and cotrimoxazole. He underwent a successful haplo-identical hematopoietic stem cell transplantation at an experienced center in India with his father as the donor and is currently doing well on post-transplant follow-up. Conclusion Genetic testing is relatively accessible and cost-effective for the diagnosis of IEI in low-and-middle-income countries. Expert multi-disciplinary collaboration is key for successful outcomes.
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Affiliation(s)
- Diana Marangu-Boore
- Paediatric Pulmonology Division, Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Fred Kambuni
- Paediatric Surgery Division, The Nairobi Hospital, Nairobi, Kenya
| | - Mary Onyinkwa
- Radiology Department, The Nairobi Hospital, Nairobi, Kenya
| | - Stalin Ramprakash
- Pediatric Hemat-oncology and Bone Marrow Transplant (BMT), Department of Pediatrics, Aster CMI Hospital, Bangalore, India
| | - Raghuram C.P.
- Pediatric Hemat-oncology and Bone Marrow Transplant (BMT), Department of Pediatrics, Aster CMI Hospital, Bangalore, India
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Sagar Bhattad
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, Aster CMI Hospital, Bangalore, India
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Suresh T, Jayakumar K, Selvakumar G, Ramprakash S. Experimental Investigation on Improvement of Machinability of SS 304 Through Multipass Cutting in WEDM. Arab J Sci Eng 2022. [DOI: 10.1007/s13369-022-07508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Marwah P, Ramprakash S, Prasad T R S, Gizhlaryan M, Trivedi D, Shah V, Chitaliya A, Elizabeth S, Agarwal RK, Dhanya R, Faulkner L. Is it safe and efficacious to remove central lines in pediatric bone marrow transplant patients with platelets less than 20,000/μl? eJHaem 2022; 3:154-158. [PMID: 35846206 PMCID: PMC9175805 DOI: 10.1002/jha2.379] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
Background Patients with tunneled central venous lines (CVL) may develop bloodstream infections which at times are difficult to control without line removal. Concomitant severe thrombocytopenia with platelet transfusion refractoriness is often considered a major contraindication to any procedure involving a major blood vessel. There is very little literature on the clinical risks of tunneled central line removal in febrile pancytopenia patients. Procedure We analyzed complications and outcomes in all our patients, a total of 52, who underwent CVL removal with platelets <20,000/μl. Results CVL removal was done on a median day of 17.5 with 47 of the 52 patients never having achieved platelets engraftment prior to line removal. No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. All patients had time to hemostasis within 5 min of catheter removal. Removal of CVL under local anesthesia remained complication‐free even at platelet counts less than 20,000/ul. A total of 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days. We found no difference in defervescence when comparing those whose antibiotic therapy was changed/escalated versus those in whom it was not. Conclusion Our findings suggest that central lines can be safely removed with platelet counts less than 20,000/ul and that this may result in enhanced bloodstream infection control. This might be particularly relevant to neutropenic patients in this day and age of multidrug‐resistant organism emergence and paucity of new effective antibiotics.
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Affiliation(s)
- Priya Marwah
- Department of Pediatrics Mahatma Gandhi University of Medical Sciences and Technology Jaipur India
| | - Stalin Ramprakash
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Sai Prasad T R
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | | | - Deepa Trivedi
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | - Vaibhav Shah
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | | | - Sandeep Elizabeth
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Rajat Kumar Agarwal
- Sankalp India Foundation Bangalore India
- Jagriti InnoHealth Platforms Pvt. Ltd. Bangalore India
| | | | - Lawrence Faulkner
- Sankalp India Foundation Bangalore India
- Cure2Children Foundation Florence Italy
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Nagabushana D, Chandrasekhar S, Ramprakash S, Avathi Venkatesha G, Helavar RV. Cyclosporine-induced Leukoencephalopathy Precipitated Following Interaction with Ciprofloxacin. J Pediatr Neurosci 2022; 16:161-162. [PMID: 35018187 PMCID: PMC8706601 DOI: 10.4103/jpn.jpn_130_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 11/04/2022] Open
Abstract
A bone marrow transplant recipient on cyclosporine initiated on ciprofloxacin for a renal abscess presented with encephalopathy, right hemiparesis, and multiorgan dysfunction. Imaging revealed white matter signal changes characteristic of cyclosporine leukoencephalopathy. This case illustrates the potential drug interaction of cyclosporine with ciprofloxacin and the need to exercise caution while prescribing antibiotics with cyclosporine.
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Affiliation(s)
- Divya Nagabushana
- Department of Neurology, People Tree Hospitals, Bengaluru, Karnataka, India
| | | | - Stalin Ramprakash
- Department of Pediatrics, People Tree Hospitals, Bengaluru, Karnataka, India
| | | | - Rajesh V Helavar
- Department of Diagnostic and Interventional Radiology, Columbia Asia Hospitals, Bengaluru, Karnataka, India
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Dhanya R, Agarwal RK, Ramprakash S, Trivedi D, Shah V, Bhat N, Reddy M, Elizabeth S, Batool A, Khalid S, Faulkner L. Do weekly surveillance cultures contribute to antibiotic stewardship and correlate with outcome of HSCT in children - a multicentre real-world experience of 5 years from Indian subcontinent? Transplant Cell Ther 2021; 28:170.e1-170.e7. [PMID: 34936930 DOI: 10.1016/j.jtct.2021.12.008] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The utility of weekly rectal swab surveillance cultures (RSSC) as a resource to identify gut colonisation with Extended Spectrum Beta-Lactamase (ESBL)-producing E Coli or Klebsiella pneumoniae carbapenemase (KPC) producing organisms, to guide empirical antibiotic therapy in HSCT patients continues to be a subject of interest. There is urgency to assess and justify modifications to empirical antibiotics based upon regional epidemiology and patient groups. OBJECTIVE To study the utility of weekly rectal swab surveillance cultures (RSSC) to guide empirical antibiotics therapy and the impact of gut colonisation on transplant outcomes. STUDY DESIGN This is a retrospective analysis of 317 successive first transplants done in three pediatric bone marrow transplant centres in Indian sub-continent, mainly for hemoglobinopathies, between April 2016 and April 2021. Transplantation, infection control and febrile neutropenia management protocols are identical among the three centres. First line antibiotics were chosen based on RCCS reports i.e. meropenem and high dose meropenem with colistin for ESBL and carbapenemase resistant colonisation respectively for first half of the study and no adjustment was made in the second half. Clinical response to antibiotics, long term outcomes, antibiotic-resistant bacteraemia and acute GVHD were analysed. Log-rank test, Chi-squared test and Wilcoxon test were used to compare data using R Statistical software. RESULTS Of all 871 weekly RSSC done, 162 were positive for ESBL- or KPC-resistant organism. RCCS were ESBL-positive in 106 patients (33%) and KPC-positive in 10 patients (3%). Within 97 ESBL-positive patients for whom antimicrobial susceptibility testing (AST) report was available, only 22 (25%) demonstrated clinical resistance of Pip-Taz. Within the 10 KPC-positive patients' clinical resistance was observed only in 4 (40%) to Pip-Taz and 3 (30%) to meropenem. For ESBL-positive RSSC where 1st line empirical antibiotics were used, 66% of the patients responded clinically. Even within the 15 who were resistant to 1st line empirical antibiotics (Pip-Taz) on RSSC reports, 67% responded to Pip-Taz clinically. Within these patients 27 (56%) never needed any carbapenems. Using Pip-Taz empirically in ESBL-positive patients did not prolong meropenem use within 100 days of transplantation (p=0.18). For KPC-positive RSSC where 1st line empirical antibiotics were used, all patients clinically responded, including 4 who were resistant to Pip-Taz and 3 patients who were meropenem resistant on RCCS. Comparing patients who were ESBL-positive, KPC-positive and neither, no statistically significant difference was seen in overall survival (p=0.95), disease free survival (p=0.45), transplant related mortality (p=0.97), rejection (p=0.68) and rate of acute GVHD grade II-IV (p=0.78). Comparing the ESBL-positive patients who did and did not get higher-level empirical antibiotics, no statistical difference was seen in overall survival (p=0.32), disease free survival (p=0.64), transplant related mortality (p=0.65), rejection (p=0.46), acute GVHD grade II-IV (p=0.26) or antibiotic resistant bacteraemia (p=0.3). CONCLUSIONS In context of transplantation for non-malignant HSCTs, empiric antibiotic choice based on rectal swab surveillance cultures is not justified, even in regions with a high prevalence of antimicrobial resistance. Antimicrobial susceptibility testing (AST) reports in surveillance cultures did not correlate with in-vivo clinical response. Colonisation reported on weekly surveillance rectal swab cultures showed no correlation with clinical outcomes.
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Affiliation(s)
| | - Rajat Kumar Agarwal
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms, Bangalore, India.
| | - Stalin Ramprakash
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Deepa Trivedi
- Sankalp India Foundation, Bangalore, India; Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Vaibhav Shah
- Sankalp India Foundation, Bangalore, India; Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Neema Bhat
- Sankalp India Foundation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Mohan Reddy
- Sankalp India Foundation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Sandeep Elizabeth
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Aliya Batool
- Dr Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Sadaf Khalid
- Dr Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India; Cure2Children Foundation, Florence, Italy
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Mehta P, Ramprakash S, Raghuram CP, Trivedi D, Dhanya R, Agarwal RK, Faulkner L. Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. Ann Hematol 2021; 100:2071-2078. [PMID: 34148110 DOI: 10.1007/s00277-021-04571-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/28/2020] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
ABO incompatibility is not a barrier to allogeneic stem cell transplant but may result in acute hemolytic reactions. As stem cell product manipulation is cumbersome, we are reporting the effectiveness and safety of donor-type red cell infusion as a method of reducing acute hemolytic reaction while using marrow as stem cell source. In major ABO-mismatched bone marrow transplants, manipulation of marrow product requires expertise and expensive equipment, which may not be readily available to transplant centers in low- and middle-income regions. The aim behind our study is to report a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. We retrospectively analyzed 303 consecutive allogeneic bone marrow transplants (BMTs) for beta thalassemia major, between August 2015 and March 2020, with either major (n = 41) or bidirectional (n = 14) mismatches. When isohemagglutinin titers were 1:32 or higher, donor-type packed red blood cell was divided into 4 aliquots, irradiated and administered over 4 days at incremental volumes. Patients were observed for hemolytic reaction, and if no reaction, bone marrow was infused without manipulation. Out of 55 patients, 20 received donor-type blood infusion. Twelve patients showed evidence of mild hemolysis. None developed severe hemolytic or anaphylactic reaction. Titers were rechecked in 14 patients and all had reduction in titers, except for one. Our experience demonstrated that donor-type PRBC infusion is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even with bone marrow as graft source.
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Affiliation(s)
- Pallavi Mehta
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India. .,Hemato-Oncology and Stem Cell Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India.
| | - Stalin Ramprakash
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - C P Raghuram
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - Deepa Trivedi
- Care Institute of Medical Sciences, Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad, India
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Vignesh P, Rawat A, Kumrah R, Singh A, Gummadi A, Sharma M, Kaur A, Nameirakpam J, Jindal A, Suri D, Gupta A, Khadwal A, Saikia B, Minz RW, Sharma K, Desai M, Taur P, Gowri V, Pandrowala A, Dalvi A, Jodhawat N, Kambli P, Madkaikar MR, Bhattad S, Ramprakash S, Cp R, Jayaram A, Sivasankaran M, Munirathnam D, Balaji S, Rajendran A, Aggarwal A, Singh K, Na F, George B, Mehta A, Lashkari HP, Uppuluri R, Raj R, Bartakke S, Gupta K, Sreedharanunni S, Ogura Y, Kato T, Imai K, Chan KW, Leung D, Ohara O, Nonoyama S, Hershfield M, Lau YL, Singh S. Clinical, Immunological, and Molecular Features of Severe Combined Immune Deficiency: A Multi-Institutional Experience From India. Front Immunol 2021; 11:619146. [PMID: 33628209 PMCID: PMC7897653 DOI: 10.3389/fimmu.2020.619146] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background Severe Combined Immune Deficiency (SCID) is an inherited defect in lymphocyte development and function that results in life-threatening opportunistic infections in early infancy. Data on SCID from developing countries are scarce. Objective To describe clinical and laboratory features of SCID diagnosed at immunology centers across India. Methods A detailed case proforma in an Excel format was prepared by one of the authors (PV) and was sent to centers in India that care for patients with primary immunodeficiency diseases. We collated clinical, laboratory, and molecular details of patients with clinical profile suggestive of SCID and their outcomes. Twelve (12) centers provided necessary details which were then compiled and analyzed. Diagnosis of SCID/combined immune deficiency (CID) was based on 2018 European Society for Immunodeficiencies working definition for SCID. Results We obtained data on 277 children; 254 were categorized as SCID and 23 as CID. Male-female ratio was 196:81. Median (inter-quartile range) age of onset of clinical symptoms and diagnosis was 2.5 months (1, 5) and 5 months (3.5, 8), respectively. Molecular diagnosis was obtained in 162 patients - IL2RG (36), RAG1 (26), ADA (19), RAG2 (17), JAK3 (15), DCLRE1C (13), IL7RA (9), PNP (3), RFXAP (3), CIITA (2), RFXANK (2), NHEJ1 (2), CD3E (2), CD3D (2), RFX5 (2), ZAP70 (2), STK4 (1), CORO1A (1), STIM1 (1), PRKDC (1), AK2 (1), DOCK2 (1), and SP100 (1). Only 23 children (8.3%) received hematopoietic stem cell transplantation (HSCT). Of these, 11 are doing well post-HSCT. Mortality was recorded in 210 children (75.8%). Conclusion We document an exponential rise in number of cases diagnosed to have SCID over the last 10 years, probably as a result of increasing awareness and improvement in diagnostic facilities at various centers in India. We suspect that these numbers are just the tip of the iceberg. Majority of patients with SCID in India are probably not being recognized and diagnosed at present. Newborn screening for SCID is the need of the hour. Easy access to pediatric HSCT services would ensure that these patients are offered HSCT at an early age.
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Affiliation(s)
- Pandiarajan Vignesh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Kumrah
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankita Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjani Gummadi
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhubala Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anit Kaur
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Johnson Nameirakpam
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Bone Marrow Transplantation Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Biman Saikia
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Walker Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaushal Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Desai
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Prasad Taur
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Vijaya Gowri
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Ambreen Pandrowala
- Bone Marrow Transplantation Unit, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Aparna Dalvi
- ICMR-National Institute of Immunohematology, Mumbai, India
| | - Neha Jodhawat
- ICMR-National Institute of Immunohematology, Mumbai, India
| | | | | | - Sagar Bhattad
- Pediatric Immunology and Rheumatology, Aster CMI hospital, Bengaluru, India
| | - Stalin Ramprakash
- Pediatric Hemat-oncology and BMT Unit, Aster CMI Hospital, Bengaluru, India
| | - Raghuram Cp
- Pediatric Hemat-oncology and BMT Unit, Aster CMI Hospital, Bengaluru, India
| | | | | | | | - Sarath Balaji
- Institute of Child Health, Madras Medical College, Chennai, India
| | - Aruna Rajendran
- Institute of Child Health, Madras Medical College, Chennai, India
| | - Amita Aggarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Komal Singh
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Fouzia Na
- Christian Medical College, Vellore, India
| | | | | | | | | | | | | | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yumi Ogura
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Tamaki Kato
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Kohsuke Imai
- Department of Pediatrics, National Defense Medical College, Saitama, Japan.,Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koon Wing Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Daniel Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | | | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bhattad S, Raghuram CP, Porta F, Ramprakash S. Successful Haploidentical Transplant Using Post-Transplant Cyclophosphamide in a Child with Chronic Granulomatous Disease-First Report from the Indian Subcontinent. J Clin Immunol 2021; 41:820-824. [PMID: 33471233 DOI: 10.1007/s10875-020-00951-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sagar Bhattad
- Division of Pediatric Immunology and Rheumatology, Department of Pediatrics, Aster CMI Hospital, Bangalore, India
| | | | - Fulvio Porta
- Pediatric Oncohematology and Bone Marrow Transplant (BMT) Unit, Children's Hospital, Spedali Civili, Brescia, Italy
| | - Stalin Ramprakash
- Division of Pediatric Bone Marrow Transplant, Department of Pediatrics, Aster CMI Hospital, Bangalore, India.
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12
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Kambli PM, Bargir UA, Yadav RM, Gupta MR, Dalvi AD, Hule G, Kelkar M, Sawant-Desai S, Setia P, Jodhawat N, Nambiar N, Dhawale A, Gaikwad P, Shinde S, Taur P, Gowri V, Pandrowala A, Gupta A, Joshi V, Sharma M, Arora K, Pilania RK, Chaudhary H, Agarwal A, Katiyar S, Bhattad S, Ramprakash S, Cp R, Jayaram A, Gornale V, Raj R, Uppuluri R, Sivasankaran M, Munirathnam D, Lashkari HP, Kalra M, Sachdeva A, Sharma A, Balaji S, Govindraj GM, Karande S, Nanavati R, Manglani M, Subramanyam G, Sampagar A, Ck I, Gutha P, Kanakia S, Mundada SP, Krishna V, Nampoothiri S, Nemani S, Rawat A, Desai M, Madkaikar M. Clinical and Genetic Spectrum of a Large Cohort of Patients With Leukocyte Adhesion Deficiency Type 1 and 3: A Multicentric Study From India. Front Immunol 2020; 11:612703. [PMID: 33391282 PMCID: PMC7772426 DOI: 10.3389/fimmu.2020.612703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
Leukocyte adhesion deficiency (LAD) syndrome is a group of inborn errors of immunity characterized by a defect in the cascade of the activation and adhesion leading to the failure of leukocyte to migrate to the site of tissue injury. Three different types of LAD have been described. The most common subtype is LAD type 1 (LAD1) caused due to defects in the ITGβ2 gene. LAD type 2 (LAD2) is caused by mutations in the SLC35C1 gene leading to a generalized loss of expression of fucosylated glycans on the cell surface and LAD type 3 (LAD3) is caused by mutations in the FERMT3 gene resulting in platelet function defects along with immunodeficiency. There is a paucity of data available from India on LAD syndromes. The present study is a retrospective analysis of patients with LAD collated from 28 different centers across India. For LAD1, the diagnosis was based on clinical features and flow cytometric expression of CD18 on peripheral blood leukocytes and molecular confirmation by Sanger sequencing. For patients with LAD3 diagnosis was largely based on clinical manifestations and identification of the pathogenic mutation in the FERMT3 gene by next-generation Sequencing. Of the total 132 cases diagnosed with LAD, 127 were LAD1 and 5 were LAD3. The majority of our patients (83%) had CD18 expression less than 2% on neutrophils (LAD1°) and presented within the first three months of life with omphalitis, skin and soft tissue infections, delayed umbilical cord detachment, otitis media, and sepsis. The patients with CD18 expression of more than 30% (LAD1+) presented later in life with skin ulcers being the commonest manifestation. Bleeding manifestations were common in patients with LAD3. Persistent neutrophilic leukocytosis was the characteristic finding in all patients. 35 novel mutations were detected in the ITGβ2 gene, and 4 novel mutations were detected in the FERMT3 gene. The study thus presents one of the largest cohorts of patients from India with LAD, focusing on clinical features, immunological characteristics, and molecular spectrum.
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Affiliation(s)
- Priyanka Madhav Kambli
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Umair Ahmed Bargir
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Reetika Malik Yadav
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Maya Ravishankar Gupta
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Aparna Dhondi Dalvi
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Gouri Hule
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Madhura Kelkar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Sneha Sawant-Desai
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Priyanka Setia
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Neha Jodhawat
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Nayana Nambiar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Amruta Dhawale
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Pallavi Gaikwad
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Shweta Shinde
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Prasad Taur
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Vijaya Gowri
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Ambreen Pandrowala
- Department of Bone Marrow Transplant, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vibhu Joshi
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhubala Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Arora
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Chaudhary
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Agarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Shobita Katiyar
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Sagar Bhattad
- Department of Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bengaluru, India
| | - Stalin Ramprakash
- Pediatric Hemat-Oncology and Bone Marrow Transplant Unit, Aster CMI Hospital, Bengaluru, India
| | - Raghuram Cp
- Pediatric Hemat-Oncology and Bone Marrow Transplant Unit, Aster CMI Hospital, Bengaluru, India
| | - Ananthvikas Jayaram
- Department of Hematology and Pathology, Neuberg Anand Diagnostic and Research Centre, Bangalore, India
| | - Vinod Gornale
- Department of pediatric, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Teynampet, India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Teynampet, India
| | - Meena Sivasankaran
- Department of Pediatric, Hemato-oncology, Kanchi Kamakoti Childs Trust Hospital, Chennai, India
| | | | - Harsha Prasad Lashkari
- Department of Paediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Manas Kalra
- Department of Pediatric Hematology Oncology BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Anupam Sachdeva
- Department of Pediatric Hematology Oncology BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Avinash Sharma
- Dr. Rajendra Prasad Government Medical College, Tanda, India
| | - Sarath Balaji
- Department of Paediatrics, Institute of Child Health and Hospital for Children, Chennai, India
| | | | - Sunil Karande
- Department of Pediatrics, King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, King Edward Memorial Hospital, Mumbai, India
| | - Mamta Manglani
- Department of Pediatric, Oncology, Hematology & BMT, Comprehensive Thalassemia Care Center and Bone Marrow, Mumbai, India
| | | | - Abhilasha Sampagar
- Department of Pediatrics, KIES Dr. Prabhakar Kore Hospital & Medical Research, Belgaum, India
| | - Indumathi Ck
- Department of Pediatrics, St. John's Medical College, Bengaluru, India
| | - Parinitha Gutha
- Department of Paediatric Haematology and Oncology, Little Stars Children's Hospital, Hyderabad, India
| | - Swati Kanakia
- Department of Hematology-Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Vidya Krishna
- Department of Pediatrics, Sri Ramachandra Medical College, Chennai, India
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Science & Research Center, Cochin, India
| | - Sandeep Nemani
- Nihira Diagnostic Lab, Arihant Galaxy, Ganesh Naga, Sangli, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Desai
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Manisha Madkaikar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
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13
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Marwah P, Soni R, Ramprakash S, Bhat N, Raghuram CP, Agarwal RK, Dhanya R, Sedai A, Kumari A, Parmar L, Faulkner L. Host Vs. Graft Mismatches May Impact on Rejection of Haploidentical Bone Marrow Transplants in Thalassemia Patients Using Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.115] [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: 10/27/2022]
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14
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Ramprakash S, Bhat N, Raghuram CP, Trivedi D, Lavana S, Marwah P, Soni R, Agarwal RK, Dhanya R, Faulkner L. Splenomegaly May Increase Rejection Rates in Matched-Related Transplants for Thalassemia, This Effect Is Mitigated by Additional Immunosuppression. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.170] [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: 10/27/2022]
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15
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Agarwal RK, Sedai A, Ankita K, Parmar L, Dhanya R, Dhimal S, Sriniwas R, Gowda A, Gujjal P, H P, Jain S, Ramaiah JD, Jali S, Tallur NR, Ramprakash S, Faulkner L. Information Technology-Assisted Treatment Planning and Performance Assessment for Severe Thalassemia Care in Low- and Middle-Income Countries: Observational Study. JMIR Med Inform 2019; 7:e9291. [PMID: 30672740 PMCID: PMC6364210 DOI: 10.2196/medinform.9291] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.
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Affiliation(s)
- Rajat Kumar Agarwal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Amit Sedai
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Kumari Ankita
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Lalith Parmar
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | | | - Sunil Dhimal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India
| | | | - Ashwini Gowda
- Project Samraksha, Rashtrotthana Parishat, Bangalore, India
| | - Pooja Gujjal
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Pushpa H
- Sankalp India Foundation, Bangalore, India.,Indira Gandhi Institute of Child Health, Bangalore, India
| | - Suman Jain
- Thalassemia and Sickle Cell Society, Hyderabad, India
| | | | - Sujata Jali
- Jawaharlal Nehru Medical College, Belgaum, India
| | | | - Stalin Ramprakash
- Sankalp-People Tree Centre for Pediatric Bone Marrow Transplant, People Tree Hospitals, Bangalore, India
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India.,Cure2Children Foundation, Florence, Italy
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Priya G, Remya S, Divya K, Prasad S, Bhat N, Trivedi D, Lavana S, Chitailya A, Agarwal R, Ramprakash S. Safety And Cost Effectiveness Of Removal Of Tunnelled Hickman Line U Nder Local Anaesthesia Vs Short General Anesthesia. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.160] [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: 11/29/2022] Open
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17
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Sandeep, Priya G, Prasad S, Bhat N, Trivedi D, Lavana S, Chitailya A, Agarwal R, Ramprakash S. Patterns of central line infections in two bone marrow transplant units in India among children undergoing allogeneic transplant for thalassaemia. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Bhat N, Ramprakash S, Faulkner L. Dengue Infection: Varying Presentations, Clinical Severity And Hlh In Thalassemia Patients Post Allogeneic Bone Marrow Transplant. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.120] [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: 11/28/2022] Open
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Parmar L, Sedai A, Ankita K, Dhanya R, Agarwal RK, Dhimal S, Shriniwas R, Iyer HV, Gowda A, Gujjal P, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Jali S, Tallur NR, Ramprakash S, Faulkner L. Can inequity in healthcare be bridged in LMICs – Multicentre experience from thalassemia day care centres in India. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Agarwal RK, Sedai A, Ankita K, Parmar L, Dhanya R, Dhimal S, Shriniwas R, Sumithra P, Iyer HV, Gowda A, Gujjal P, Pradeep R, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Sharma H, Jali S, Viragi S, Bobati S, Tallur NR, Ramprakash S, Faulkner L. Multi-institutional, retrospective review of blood transfusion practices and outcomes in a large cohort of thalassemia patients in South India. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ramprakash S, Agarwal R, Dhanya R, Marwah P, Soni R, Yaqub N, Fatima I, Zhara T, Gooneratne L, Williams S, Khalid S, Sen S, Kanwar V, Faulkner L. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ramprakash S, Agarwal RK, Dhanya R, Sedai A, Kumari A, Parmar L, Srinivas R, Kakulamari VR, Marwah P, Soni R, Williams S, Rathnayake W, Sen S, Tulpule S, Faulkner L. Rejection of paternal vs maternal fully matched bone marrow grafts in children with thalassemia. Bone Marrow Transplant 2017; 52:1585-1586. [PMID: 28920948 PMCID: PMC5671933 DOI: 10.1038/bmt.2017.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/09/2022]
Affiliation(s)
- S Ramprakash
- Bone Marrow Transplant Unit, People Tree Hospitals, Bangalore, India
| | | | - R Dhanya
- Sankalp India Foundation, Bangalore, India
| | - A Sedai
- Sankalp India Foundation, Bangalore, India
| | - A Kumari
- Sankalp India Foundation, Bangalore, India
| | - L Parmar
- Sankalp India Foundation, Bangalore, India
| | - R Srinivas
- Sankalp India Foundation, Bangalore, India
| | | | - P Marwah
- Bone Marrow Transplant Unit, South East Asia Institute for Thalassemia, Jaipur, India
| | - R Soni
- Bone Marrow Transplant Unit, South East Asia Institute for Thalassemia, Jaipur, India
| | - S Williams
- Bone Marrow Transplant Unit, Nawaloka Hospital, Colombo, Sri Lanka
| | - W Rathnayake
- Bone Marrow Transplant Unit, Nawaloka Hospital, Colombo, Sri Lanka
| | - S Sen
- Bone Marrow Transplant Unit, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - S Tulpule
- Bone Marrow Transplant Unit, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - L Faulkner
- Cure2Children Foundation, Florence, Italy
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Ramprakash S, Agarwal R, Dhanya R, Marwah P, Soni R, Yaqub N, Fatima I, Gooneratne L, Williams S, Khalid S, Sen S, Faulkner L. Role of G-CSF priming of donor marrow prior to transplant in low risk HLA matched sibling transplant in children with severe thalassemia. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.11.073] [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: 10/18/2022] Open
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Ramprakash S, Fishman D. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain. BMJ Case Rep 2015; 2015:bcr-2015-211850. [PMID: 26430233 DOI: 10.1136/bcr-2015-211850] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.
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Affiliation(s)
- Stalin Ramprakash
- Department of General Paediatrics, Luton and Dunstable Hospital, Luton, UK Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital, London, UK
| | - Daniel Fishman
- Department of Rheumatology, Luton and Dunstable Hospital, Luton, UK
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Muthayya S, Dwarkanath P, Thomas T, Ramprakash S, Mehra R, Mhaskar A, Mhaskar R, Thomas A, Bhat S, Vaz M, Kurpad AV. The effect of fish and omega-3 LCPUFA intake on low birth weight in Indian pregnant women. Eur J Clin Nutr 2007; 63:340-6. [PMID: 17957193 DOI: 10.1038/sj.ejcn.1602933] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and omega-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women. SUBJECTS/METHODS In a prospective cohort study, data on maternal fish intake and omega-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%. RESULTS Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g day(-1) at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg day(-1), respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P<0.001). Women who did not eat fish during the third trimester had a significantly higher risk of LBW (OR: 2.49, P=0.019). Similarly, low EPA intake during the third trimester had an association with a higher risk of LBW (OR: 2.75, P=0.011). CONCLUSIONS Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with omega-3 LCPUFA during pregnancy may have important implications for fetal development in India.
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Affiliation(s)
- S Muthayya
- Division of Nutrition, Maternal and Child Health Unit, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
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