Outcome of iron reduction therapy in ex-thalassemics.

There is limited data on iron reduction therapy (IRT) after successful allogeneic haematopoietic stem cell transplantation (aHSCT) for patients with thalassemia major (TM). We present the long term outcome of IRT in 149 patients with TM who underwent aHSCT during January, 2001-December, 2012. The median age was 7 years (range:1-18) and 92 (61.7%) belonged to Pesaro class 3 with a median ferritin at aHSCT of 2480ng/ml (range:866-8921). IRT was reinitiated post-aHSCT at a median of 14 months (range:5-53) post aHSCT with phlebotomy alone in 10 (6.7%) patients or iron chelation alone in 60 (40.3%) patients while 79 (53%) were treated with the combination. Reduction in serum ferritin/month [absolute quantity (ng/ml/month) was as follows: 87 (range:33-195), 130 (range:17-1012) and 147 (range:27.7-1427) in the phlebotomy, chelation and combination therapy groups, respectively (p = 0.038). With a median follow up of 80 months (range:37-182), target ferritin level of <300ng/ml was achieved in 59(40%) while a level <500ng/ml was achieved in 88 patients (59%) in a median duration of 41 months of IRT (range: 3-136). Patients in class III risk category and higher starting serum ferritin levels (>2500ng/ml) were associated with delayed responses to IRT. Our data shows that IRT may be needed for very long periods in ex-thalassaemics to achieve target ferritin levels and should therefore be carefully planned and initiated as soon as possible after aHSCT. A combination of phlebotomy and iron chelators is more effective in reducing iron overload.

Comprehensive evaluation of microalgal based dairy effluent treatment process for clean water generation and other value added products.

The current study demonstrates a comprehensive investigation on clean water generation from raw dairy wastewater (RDW) using a robust microalgal strain, Ascochloris sp. ADW007 and its growth, biomass, and lipid productivities in outdoor conditions. Microalgal treatment studies were conducted in column photobioreactor (CPB) and flat-pate photobioreactor (FPB), where the volumetric algal biomass productivity in RDW was significantly increased in both CPB (0.284 ± 0.0017 g/L/d) and FPB (0.292 ± 0.0121 g/L/d) as compared to synthetic mediums viz., BG11 and TAP, respectively, with enhanced lipid content. Maximum lipid accumulation of 33.40% was obtained within 7 d growth. The volumetric and areal lipid productivities in CPB and FPB were 94 mg/L/d and 5.597 g/m2/d, and 98 mg/L/d and 9.754 g/m2/d, respectively. Chemiflocculation, filtration, and centrifugation techniques were employed for harvesting microalgal biomass. Among the flocculants, 0.08% (w/v) FeCl3 harvested >99% of algal cells within 5 min, while 0.03% (w/v) cetyl trimethyl ammonium bromide and 0.125% (w/v) sodium hydroxide harvested >96% of the cells in 30 and 60 min. After microalgal treatment, >80% of clean and odorless water was obtained with reduction in 94-96% of COD, 72-80% of nitrate and 80-97% of total phosphate, respectively. Highlights Utilization of 100% raw dairy wastewater without any treatment. Production of clean and odorless water for recycle and reuse. COD, nitrate and total phosphate reduction by 94-96%, 72-80%, and 80-97% after treatment. Microalgal treatment studies in simple column and flat-plate photobioreactors. Biomass and lipid production as other value added by-products.

Single Versus Dual Platform Analysis for Hematopoietic Stem Cell Enumeration Using ISHAGE Protocol.

Hematopoietic stem cell transplantation is curative therapy in benign and malignant diseases. Adequate stem cell dose is one of the most important marker of engraftment. Several methods have been developed to enumerate CD34+ cells. We present our data on 147 samples analysis. There was a clear linear correlation between two methods. Both methods were effective. Both single vs dual platform analysis yield similar results. Single platform analysis is easier to perform. In terms of cost reduction dual platform analysis is better.

Skin manifestations associated with mantle cell lymphoma: a case report.

Mantle cell lymphoma (MCL) is a distinct non-Hodgkin's lymphoma type that commonly affects extra nodal sites. The most often affected sites are bone marrow, gastrointestinal tract and Waldeyer's ring, being the skin rarely involved. We report a case of 56 year-old man with MCL, exhibiting multiple large maculopapular skin rashes and skin ulcers. Histopathological examination had not shown direct infiltration by any atypical cells. He had significant improvement of skin lesions with combination chemotherapy and debridement. Awareness of skin manifestations of MCL is crucial for dermatologists and haematologists to establish the early diagnosis and timely administration of appropriate treatment.

Vincristine induced cranial neuropathy.

Neuropathy is a well known side effect of vincristine, however cranial nerve toxicities are reported less frequently which can involve any cranial nerve in mostly bilateral pattern. As many patients have primary tumors or metastatic lesions in sites that could cause the clinician to overlook this reversible cause of neurologic dysfunction, the potential for misdiagnosis is high. Here, along with review of literature we describe three cases on vincristine who developed cranial neuropathy while on treatment.

Piperacillin-tazobactum plus amikacin versus ceftazidime plus amikacin as empirical therapy for Fever in neutropenic patients with hematological malignancies.

Infections are one of the main cause of death in cancer patients particularly when granulocytopenia is present. A number of drugs have been used for the treatment of neutropenic patients with fever. Most published literature has shown piperacillin-tazobactum in combination with amikacin to be significantly more effective than ceftazidime plus amikacin in empirical treatment of febrile episodes in patients with neutropenia. In view of the reported literature we have tried this combination in our febrile neutropenic patients with haematological malignancies at PGIMS Rohtak. It was an open randomized trial. Patients were divided into two groups of 20 each. In the first group (group A) piperacillin-tazobactum (4 + 0.5 g 6 hourly) with single daily dose of amikacin 20 mg/kg was given. In the second group (group B) ceftazidime 40 mg/kg every 8 hourly with single daily dose of amikacin 20 mg/kg was given. The most common site of infection was blood followed by urinary tract, respiratory tract and oral cavity. 13 (65%) patients in group A and 12 (60%) patient in group B showed clinical success. In our study however in our patients a better response was seen in patients with piperacillin-tazobactum + amikacin (65% vs. 60%). So it is recommended that piperacillin-tazobactum + amikacin should be given in febrile neutropenic patients with haematological malignancies.

Cefepime versus ceftazidime as empirical therapy for fever in neutropenic patients with haematological malignancies.

An open randomized comparative study was conducted to evaluate the efficacy of Cefepime (2 gm iv. 8 hr.) vs. ceftazidime (2 gm iv. every 8 hr.) in empirical therapy of febrile neutropenic patients. A total of 40 eligible febrile episodes were randomized to be treated with study regimen. Twenty febrile episodes were treated with cefepime and 20 were treated with ceftazidime. The two groups were comparable in terms of age, sex, height, underlying neoplasm, number of pretherapy neutrophils, duration of neutropenia. The overall therapeutic success rate of cetepime group (60%) was comparable to that of ceftazidime group (55%). The results of this study suggest that cefepime is an effective and safe agent in empirical therapy of febrile episode in neutropenic patient and its efficacy is comparable with that of ceftazidime.