Live birth following in vitro fertilization in a breast cancer survivor: A case report and review of literature.

The well-being of young cancer survivors is hampered due to the toxic effects of chemotherapy on the ovaries, resulting in infertility. We report a case of a 42-year-old woman with a history of bilateral ductal carcinoma of the breast who underwent radical mastectomy with chemotherapy and radiotherapy was anxious to conceive. In vitro fertilization was performed with donor oocyte; the patient became pregnant and delivered a full term baby with no congenital anomalies. As very few have a background for providing guidance and treatment in this setting, this report highlights the possibility of improving the quality of reproductive life of young survivors by various assisted reproductive techniques, the importance of fertility preservation and a multidisciplinary team approach.

Indian Pediatric Postgraduate's Perspective on Future Career Intentions.

OBJECTIVE: To determine the factors that influence Pediatric residents to pursue a subspecialty career and establish their choice of future workplace. METHODS: The present questionnaire based study was conducted during a National level pediatric post graduate exam refresher course in Chennai, India and involved Pediatric residents from all parts of India. Datas was analysed with the statistical package for social sciences (SPSS, version 18.0). RESULTS: Seventy five respondents participated in the study. Eighty-nine percent of the female students reported that marriage has an influence on whether or not to do sub specialisation and their choice of it while 92% of the male students found it irrelevant. Fifty-one (male - 75%, female - 58%) students pragmatically cited "interest in the subject Pediatrics" when asked for the reason choosing Pediatrics as their future career. Neonatology was the most chosen speciality followed by Critical Care and Cardiology. When asked to indicate the most important factors that is likely to influence their decision whether or not to pursue sub speciality program, the largest proportion of students identified "financial reasons" (31; 41%) followed by "job opportunities" (16; 21%). CONCLUSIONS: Pediatric residents should compulsorily be exposed to all subspecialties during their post-graduation. Adequate career guiding and exposure to various subspecialties will make the residents pursue subjects like Pediatric Nephrology, Hemato-oncology, Developmental Pediatrics and Hepatology which have less takers.

Successful pregnancy following single blastocyst transfer in a renal transplant recipient.

Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients.

Pericentric inversion of chromosome 9 causing infertility and subsequent successful in vitro fertilization.

One of the most common and benign variants of normal human karyotype is pericentric inversion of chromosome 9 (inv[9][p11q13]). Despite being categorized as a normal variant, there are several reports of its association with various disease conditions. Here, we report a 27 year old female, who presented to us with primary infertility. The woman was diagnosed with inv (9)(p11q13) which was acknowledged as the reason for her otherwise unexplained infertility. The couple thereupon underwent in vitro fertilization using donor oocyte resulting in live birth. The clinical significance of this minor chromosomal rearrangement, need for genetic counseling, and subsequent reproductive guidance is highlighted in this report.

Vitamin D insufficiency among children with cancer in India.

BACKGROUND: Vitamin D plays an important role in regulating various homeostatic mechanisms and has yet untapped potential in cancer prevention and prognosis. Only a few studies have been done worldwide in relating the Vitamin D levels in pediatric cancer patients to the general population but none so far in an Indian setting to the best of our knowledge. OBJECTIVE: To compare the Vitamin D levels in a group of children with cancer to that of the general pediatric population and to note differences in the prevalence of Vitamin D insufficiency and make inferences arising from demographic and therapeutic variations. MATERIALS AND METHODS: Vitamin D levels were found by immuno-chemilumino-metric assay in 102 children (51 cases and 51 controls) over a 6 months period. RESULTS: In comparing the Vitamin D levels of children with cancer and controls from a healthy population we found an increased incidence of Vitamin D insufficiency in cancer children (80.39%) when compared to controls (50.98%) and a much lower mean Vitamin D value in cancer children (22.8 ng/ml) when compared to controls (33 ng/dl). It was also found that cancer children above 6 years had a greater chance for developing Vitamin D insufficiency (P = 0.038) as did children suffering from hematological malignancies (P = 0.025). CONCLUSION: Our study showed an increased prevalence of Vitamin D insufficiency in children with cancer and hence we suggest routine measurement of Vitamin D levels in children with cancer and subsequent supplementation.

Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures?

BACKGROUND: Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Children's Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult. OBJECTIVES: The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome. METHODS: This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports. RESULTS: Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes. CONCLUSION: Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings.

Knowledge, attitude, and awareness of childhood cancer among undergraduate medical students in South India.

BACKGROUND: In India roughly 60000 childhood cancer cases are diagnosed annually with only nearly 100 pediatric oncologists. So it's pertinent that the physicians and pediatricians are adequately equipped to recognize and refer them appropriately. Hence this study was conducted to assess the knowledge, attitude and awareness of childhood cancer among undergraduate medical students in South India. MATERIALS AND METHODS: The study was conducted among 240 undergraduate students from all over South India in a undergraduate pediatric clinical training. A 24 point questionnaire was given to assess their understanding of pediatric malignancies and their interest towards pediatric oncology. Statistical analysis was done with SPSS 18.V software. RESULTS: 50% were interested in pursuing pediatrics as their career but 80% of them were not interested in pursuing pediatric oncology as their career. 55% of the students have not encountered any pediatric oncology patients in the ward. 40% did not have any lecture classes on pediatric oncology. 65.5% felt that their knowledge of childhood cancer did not make them competent to suspect and refer appropriately during their practice. 84% supported that there is a need to improve pediatric oncology teaching in their medical curriculum. CONCLUSIONS: The study unambiguously states that the future physicians lack confidence in identifying and managing childhood malignancies and pediatric oncology is far down in their career options. There is a need to reform the undergraduate medical students by increasing their exposure to pediatric oncology to improve their competence levels and interest in pursuing it as a career also.