Nutritional status in children with acute lymphoblastic leukemia, and its correlation with severe infection.

BACKGROUND: Undernutrition is a common childhood problem in India which may contribute to higher risk of infection and lower survival rate in children with acute lymphoblastic leukemia (ALL). METHODS: In our study, we retrospectively included patients of age group 1-15 years who were treated for ALL and survived induction. Data on weight, height and serum albumin levels recorded at the time of diagnosis of the patients were used in this study. For defining acute undernutrition we used weight-for-height, weight-for-age criteria for children ≤5 years and body mass index for age >5 years. We correlated nutritional status of the patients with severe infection and mortality percentage. RESULTS: There were 101 patients with male:female ratio of 2.4:1. Forty-four children were ≤5 years and 57 children were >5 years of age. It was found that 74 children had B-cell ALL and 17 children had T-cell ALL; 54 patients were stratified as high-risk and 47 as standard-risk. In all, 52.5% patients had acute undernutrition at diagnosis. In ALL patients with acute undernutrition, severe infection was found to be 10.8% higher than ALL patients with normal nutrition which was statistically insignificant. Male children and children with serum albumin level <3.5 g/dL in the acute undernutrition group had higher risk of infection. Mortality percentage of patients with baseline acute undernutrition was found to be higher by 11% than normal nutrition group (P-value = 0.21). CONCLUSION: Our study highlights the magnitude of undernutrition at diagnosis in ALL patients in a tertiary care centre. It also correlates nutritional status with severe infection and mortality in follow-up.

Profile of renal diseases in North-East Indian children.

The pattern of kidney diseases varies in different places due to differences in genetic status, socioeconomic status, access to health care, and presence of background infection. In spite of nephrology as a specialty since 1970s, there are still limited data regarding the spectrum of renal diseases in India. Our study was conducted in a tertiary care institute and referral center in northeast India. It provides insight into profile of renal diseases in hospitalized children. It is a cross-sectional study conducted in a government medical college in Assam. All children who were admitted in this department during one year period were examined for the presence of renal disease on the basis of history, clinical examination, and laboratory investigation. Of total admission, 7.17% of children had renal diseases. Nephrotic syndrome was the most common renal disease followed by glomerulonephritis in this study. Acute post infectious glomerulonephritis was the most common cause of glomerulonephritis. Septicemia was the most common cause of AKI. We have seen that a huge burden of pediatric morbidity is due to renal diseases. Majority of the renal diseases are curable with proper and adequate treatment. A large pool of renal diseases are still due to infective etiology and thus preventable.

Severe hyperlipidemia in a case of acute lymphoblastic leukemia.

Severe hyperlipidemia (>1000 mg/dL) at initial presentation of acute lymphoblastic leukemia (ALL) is rare. Cases of hyperlipidemia during therapy for childhood ALL where they were secondary to L-asparaginase or steroids have been described. This is a case report of a one-and-half-year-old boy who presented to us with fever, abdominal distension, severe pallor, and hepatosplenomegaly. Although his investigations were suggestive of ALL, the initial blood samples were found to be grossly lipemic. The lipid profile was abnormal, showing severe hypertriglyceridemia (serum triglycerides 1552 mg/dL). High-density lipoprotein and low-density lipoprotein levels were low, but there were raised very low-density lipoprotein level and serum lactate dehydrogenase (18117 U/L). The patient was started on induction of remission with careful monitoring of biochemical parameters. Abnormal lipid levels declined gradually with normalization of the levels at the end of one week of chemotherapy. No further complications were encountered during the course of induction of remission.

Interleukin-6 and Interleukin-8 Levels Correlate With the Severity of Aplastic Anemia in Children.

AIM: The aim of this study was to evaluate the levels of interleukin (IL)-6 and IL-8 in patients with aplastic anemia and its correlation with severity of the disease. MATERIALS AND METHODS: IL-6 and IL-8 levels were measured in 40 patients with aplastic anemia in the age group of 4 to 14 years. A total of 40 healthy children served as controls. Quantitative estimation of IL-6 and IL-8 was performed using a solid-phase sandwich ELISA kit. Results were presented as IL-6 and IL-8 concentrations in pg/mL. Patients received immunosuppressive therapy per the British Committee for Standards in Haematology Guidelines 2009. RESULTS: Mean age of the patients was 9.78±2.74 years. IL-6 level of patients was elevated compared with controls (193.48±352.3 vs. 4.58±3.39; P<0.001). IL-8 levels were also significantly elevated in patients compared with controls (15.58±18.0 vs. 1.85±0.95; P<0.001). IL levels were also assessed in relation to severity of the disease. Levels were the highest in patients with very severe aplastic anemia (724.33±519.42), followed by severe aplastic anemia (80.51±66.28 pg/mL), and non-severe aplastic anemia (6.01±1.89). Differences were statistically significant. A similar trend was also observed for IL-8 levels, where the levels were 41.02±24.23, 11.34±8.0, and 1.67±0.71 for very severe aplastic anemia, severe aplastic anemia, and non-severe aplastic anemia, respectively. The differences were again statistically significant. IL levels were also correlated with the treatment outcome. Responders had lower levels compared with nonresponders, but the difference was not statistically significant (186.36±322.45 vs. 198.74±368.10). Levels of ILs decreased in responders, but were not comparable with that of controls 6 months after therapy. CONCLUSIONS: High levels of IL-6 and IL-8 were observed in children with aplastic anemia. Increased levels showed correlation with disease severity and therefore appear to play an important role in aplastic anemia. However, levels had no significant correlation with the treatment outcome.