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2.
Indian Pediatr ; 58(7): 611-616, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34315832

RESUMO

OBJECTIVE: To assess the efficacy and safety of thalidomide in children with transfusion-dependent thalassemia. METHODS: This prospective, single center, open-label study enrolled children aged 12-18 years, and who received thalidomide for a duration of 6 months at a starting dose of 2-3 mg/kg/day. Efficacy was assessed by reduction in transfusion requirement and rate of fall of hemoglobin. Efficacy was classified as major, moderate and minimal/no response depending on the reduction in transfusion requirement. Safety was assessed by adverse effects related to thalidomide. RESULTS: 37 children [mean (SD) age, 14.7 (1.8) years were included. Rate of fall of hemoglobin reduced from a mean of 1.0 (0.24) g/week pre-thalidomide therapy to 0.58 (0.26) g/week after 6 months of thalidomide (P<0.001). 19 children (51.3%) had major response and 12 (32.4%) had moderate response. In 13.5% and 32.4% children response was observed within the first and second month of therapy, respectively. 15 (40.5%) children remained transfusion - free for a median (IQR) time of 6 (3-10) weeks of thalidomide therapy. Mean serum ferritin (SD) decreased from 1758.9 (835.1) to 1549.6(1016.9) (P<0.001). Mean HbF (SD) showed an increase from 2.95(2.6) to 49.2(33.3) (P<0.001). In 32 children, 47 adverse events were observed. Common adverse events were constipation and neutropenia (mostly mild). CONCLUSIONS: Thalidomide resulted in major/moderate response in majority of children with transfusion-dependent thalassemia with satisfactory adverse effect profile.


Assuntos
Talassemia , Talassemia beta , Adolescente , Criança , Hemoglobinas , Humanos , Estudos Prospectivos , Talassemia/tratamento farmacológico , Talidomida/efeitos adversos
3.
Pediatr Blood Cancer ; 68(10): e29219, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34291860

RESUMO

BACKGROUND: Hodgkin lymphoma (HL) in childhood is an eminently curable disease. Excellent outcomes can be achieved even in resource-limited settings and increasingly, the focus is on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with or without low-dose radiotherapy (RT). Many developing countries continue to use ABVD (adriamycin, bleomycin, vinblastin, and dacarbazine)-based regimen owing to limited acute toxicity, cost, and ease of delivery. We report outcomes of children with early-stage HL using limited cycles of ABVD-based treatment in the first prospective multicentric collaborative study from India InPOG-HL-15-01. METHODS: Children <18 years with biopsy-proven HL were enrolled. Patients with stages I and IIA with or without bulky disease were classified as having early-stage disease. Patients were planned to receive four cycles of ABVD subject to satisfactory early response assessment (ERA) scheduled after two cycles of chemotherapy. RT was limited to patients with bulky disease or those with suboptimal ERA. RESULTS: Four hundred ten patients were enrolled over 30 months from 27 centers. One hundred thirty-four were classified as having early-stage disease. Fifty-three (40%) of these had bulky disease. One hundred ten (83%) of this cohort achieved complete or very good partial ERA. Fifty-four (40%) received RT. At a median of 52 months since diagnosis, 5-year event-free survival (EFS) and overall survival (OS) is 94% and 95.5%, respectively. Treatment-related mortality and abandonment were <1%. CONCLUSION: Limited cycles of ABVD with RT to selected patients is a very effective option for patients with early-stage disease in resource-limited settings.

4.
Indian Pediatr ; 58(7): 635-638, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-33772533

RESUMO

OBJECTIVES: To assess pubertal development and its determinants in adolescents with transfusion-dependent thalassemia (TDT). METHODS: In this cross-sectional study from a tertiary teaching hospital in Delhi, records of adolescents aged 17-19 years with TDT on regular transfusion at thalassemia day-care centre were reviewed. Pubertal development and its determinants were assessed. RESULTS: Records of 58 (33 male) adolescents with TDT were reviewed. Among them, 42 (72.4%) had normal/delayed onset with spontaneous progression of puberty, while 16 (27.6%) had pubertal arrest/failure and received hormonal replacement therapy (HRT). Short stature was observed in all adolescents on HRT. Amongst other endocrinopathies, only hypoparathyroidism was found to be significantly higher in the HRT group. On multivariate analysis, serum ferritin (OR-1.005, 95% CI 1.002, 1.009) was observed to be the only significant determinant of pubertal arrest/failure. CONCLUSIONS: A significant proportion of adolescents with TDT continue to have pubertal arrest/failure. High systemic iron load is the key determinant for this.


Assuntos
Doenças do Sistema Endócrino , Talassemia , Talassemia beta , Adolescente , Transfusão de Sangue , Estudos Transversais , Humanos , Masculino , Puberdade , Talassemia/epidemiologia , Talassemia/terapia
6.
Indian Pediatr ; 57(9): 854-856, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32999115

RESUMO

Immune Thrombocytopenia is the commonest cause of thrombocytopenia in young children. A thorough history, examination and peripheral smear evaluation is central to diagnosis. The recent American Society of Hematology guidelines 2019, has shed light on diagnosis and management based on latest available literature. We, herein, delineate the important aspects of these guidelines.

7.
Indian J Hematol Blood Transfus ; 36(3): 498-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32647424

RESUMO

Methotrexate (MTX) forms the backbone of maintenance cycles in childhood acute lymphoblastic leukemia (ALL) chemotherapy, including interim maintenance. There is sufficient published data describing toxicities of high dose MTX (HD-MTX), but toxicities with escalating doses of MTX (Capizzi regimen) is not well documented. Capizzi regimen is thought to be relatively safe; we contend that even low escalating doses of MTX have significant toxicities. Our study intends to characterise such events with Capizzi MTX in comparison to that seen with HD-MTX. The retrospective study was conducted at a tertiary care centre of North India. We looked for the presence of six main toxicities: febrile neutropenia, thrombocytopenia, mucositis, hepatic toxicity, renal toxicity and skin toxicity from the clinical records of children with newly diagnosed acute lymphoblastic leukemia and lymphoma (intermediate and high risk disease), treated at our centre from November 2013 to July 2018. Intermediate risk ALL (IR-ALL) received Capizzi MTX, whereas high risk ALL (HR-ALL/T-NHL), received HD-MTX. Both these regimens do not use L-asparaginase. A total of 237 cycles of Capizzi escalating MTX and 151 cycles of HD-MTX (B cell: 3 gm/m2 and T cell ALL/T-NHL: 5 gm/m2) during interim maintenance were studied in 93 children. Fifty-four (54) children were of IR (all B cell ALL) and 39 of HR-ALL (21 B-ALL, 18 T-ALL/T-NHL). The combined incidence of toxicities, were similar between the two groups: 68/237 cycles (28.7%) of Capizzi MTX and 45/151 cycles (29.8%) of HD-MTX (P = 0.815). However, mucositis was more commonly witnessed in the later group at 22/151 cycle (14.6%) versus 13/237 cycles (5.5%) in Capizzi MTX (P = 0.002). Nephrotoxicity and skin toxicity was seen only in the HD-MTX group. There was no difference in the severity of toxicity, graded using NCI CTCAE v 5.0, between the two groups. There was no mortality directly attributable to methotrexate toxicity (Grade V toxicity). Serum MTX levels were available in 69/151 (45.7%) cycles of HD-MTX and showed no association with toxicity in this group. Also, there was no difference in the incidence of combined toxicities between groups with (19/69 cycles) or without (26/82 cycles) available serum MTX levels in the HR group (P = 0.577). Male gender, lower baseline ANC and lower BMI had significant association with toxicity. Methotrexate related toxicity is common with both Capizzi and HD-MTX schedule in childhood ALL with a correlation of lower BMI, baseline ANC and male gender. However, it is possible to administer Capizzi as well as HD-MTX in lower middle income countries, with manageable toxicity. Further studies will be required to substantiate our findings and determine the predictors of such events.

8.
J Pediatr Orthop ; 40(6): e473-e478, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501918

RESUMO

BACKGROUND: Arthropathies and bone deformities are well known to occur in patients with thalassemia major and have been attributed to the disease or to its therapy. Before the advent of chelation therapy, these children developed widened diploic space and "hair-on-end" pattern in skull, "cobweb" pattern in the pelvis, and the lack of the normal concave outline in the long bones because of extensive marrow proliferation. After the introduction of iron-chelation therapy, these patients were noted to develop metaphyseal abnormalities and vertebral changes resembling spondylo-metaphyseal dysplasia. Only one study has shown some association of deferiprone (chelating agent) use with distal ulnar changes in these children. Our study was done to describe the skeletal changes and deformities in wrist joints of children with transfusion-dependent thalassemia and correlate them with age, mean pretransfusion hemoglobin level, mean serum ferritin level, and type and duration of chelation therapy in these children. METHODS: A total of 60 children with transfusion-dependent thalassemia from the thalassemia daycare center were examined. These children were divided into 3 groups on the basis of their age (group A: 2 to 6 y, group B: 6 to 10 y, and group C: 10 to 14 y). Detailed history, including treatment history, number of blood transfusions received over the last 1 year, clinical examination, and radiologic assessment of both forearm with wrists were done. RESULTS: The clinical and radiologic differences in radial and ulnar lengths increased significantly with the increasing age of these patients, the ulna being short. There was some correlation between increasing negative ulnar variance and distal radial articular angle with deferiprone consumption. CONCLUSION: Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Terapia por Quelação/efeitos adversos , Deferiprona/efeitos adversos , Quelantes de Ferro/efeitos adversos , Articulação do Punho/efeitos dos fármacos , Talassemia beta/tratamento farmacológico , Adolescente , Transfusão de Sangue , Criança , Pré-Escolar , Feminino , Antebraço/diagnóstico por imagem , Humanos , Artropatias/etiologia , Masculino , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/efeitos dos fármacos , Ulna/diagnóstico por imagem , Ulna/efeitos dos fármacos , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
9.
J Pediatr Hematol Oncol ; 42(3): 193-197, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32209945

RESUMO

BACKGROUND: Febrile neutropenia (FN) is a common life-threatening complication in patients with severe aplastic anemia (SAA). However, few studies have examined the spectrum of infections in FN in patients with SAA, especially in children. Therefore, the current study was planned to study the clinicomicrobiologic profile of FN episodes in these children. MATERIALS AND METHODS: Data of 38 episodes of FN that occurred in 31 children with SAA from November 2015 to April 2017 were collected prospectively and analyzed. RESULTS: FN episodes occurred more frequently (54.8%) in patients on immunosuppressive therapy. Clinically documented infections accounted for 21 (55.26%) episodes, microbiologically documented infections for 15 (39.47%), bacteremia for 13 (34.21%), and invasive fungal diseases for 6 (15.78%) episodes. Among clinically documented infections, the lower respiratory tract was the commonest site in 23.68% episodes, followed by skin and soft tissue infections. No focus of infection could be identified in 12 (31.57%) episodes. Gram-negative bacteria (71.42%) were the predominant isolates (commonest Klebsiella pneumoniae) over Gram-positive bacteria (commonest coagulase-negative Staphylococcus). High prevalence of aminoglycoside, piperacillin-tazobactam, and carbapenem resistance was noted among Gram-negative organisms. Gram-positive organisms showed excellent sensitivity to vancomycin, linezolid, and clindamycin. The overall mortality rate was 42%. CONCLUSIONS: Empirical antimicrobial therapy should include adequate coverage for Gram-negative pathogens. The antimicrobial regimen should be modified according to the results of the culture and sensitivity testing.


Assuntos
Anemia Aplástica/complicações , Antibacterianos/uso terapêutico , Neutropenia Febril/microbiologia , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino
10.
J Pediatr Orthop ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32011549

RESUMO

BACKGROUND: Arthropathies and bone deformities are well known to occur in patients with thalassemia major and have been attributed to the disease or to its therapy. Before the advent of chelation therapy, these children developed widened diploic space and "hair-on-end" pattern in skull, "cobweb" pattern in the pelvis, and the lack of the normal concave outline in the long bones because of extensive marrow proliferation. After the introduction of iron-chelation therapy, these patients were noted to develop metaphyseal abnormalities and vertebral changes resembling spondylo-metaphyseal dysplasia. Only one study has shown some association of deferiprone (chelating agent) use with distal ulnar changes in these children. Our study was done to describe the skeletal changes and deformities in wrist joints of children with transfusion-dependent thalassemia and correlate them with age, mean pretransfusion hemoglobin level, mean serum ferritin level, and type and duration of chelation therapy in these children. METHODS: A total of 60 children with transfusion-dependent thalassemia from the thalassemia daycare center were examined. These children were divided into 3 groups on the basis of their age (group A: 2 to 6 y, group B: 6 to 10 y, and group C: 10 to 14 y). Detailed history, including treatment history, number of blood transfusions received over the last 1 year, clinical examination, and radiologic assessment of both forearm with wrists were done. RESULTS: The clinical and radiologic differences in radial and ulnar lengths increased significantly with the increasing age of these patients, the ulna being short. There was some correlation between increasing negative ulnar variance and distal radial articular angle with deferiprone consumption. CONCLUSION: Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children. LEVEL OF EVIDENCE: Level IV-case series.

11.
Indian Pediatr ; 57(1): 34-38, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31937695

RESUMO

OBJECTIVE: To assess HIV-free survival and nutritional status of HIV-exposed infants. METHODS: This retrospective cohort study was conducted on infants born to woman with HIV infection born at our Institute between January 2011 to March 2016, and followed using current National guidelines. HIV transmission rate, HIV-free survival, and nutritional status were assessed 18 months age. RESULTS: Of the 155 infants, 10 (6.5%) died before 18 months of age. Two of 145 surviving infants were confirmed HIV-positive, the remaining were HIV-negative at 18 months (HIV-free survival 92.3%). Of the 10 infants who died, one was confirmed HIV-positive and three negative; the rest died before their HIV status could be ascertained. HIV infection rate among the 149 infants for whom the test reports were available was 2%. At 18 months age, 14% HIV-uninfected infants were wasted, 28% stunted, and 3% had microcephaly. CONCLUSIONS: Infants born to mothers with HIV managed as per the current National guidelines have a good outcome at 18 months of age.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Estado Nutricional/fisiologia , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Desnutrição , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Retrospectivos
12.
Indian J Pediatr ; 87(3): 217-218, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31925714

RESUMO

Children with acute lymphocytic leukemia (ALL) are at an increased risk of acquiring hepatitis B infection due to repeated exposure to blood products. They have poor response to vaccination due to immunosuppressive effects of malignant disease and chemotherapy; hence necessitating vaccination with increased doses or increased amount of vaccine or both. The authors studied 44 patients (32 boys and 12 girls) given double dose hepatitis B vaccination at 0, 1 and 2 mo during induction and consolidation phase of therapy. Of the thirty patients who completed the study, only 13 (43.34%) developed protective antibody levels (titres >10 mIU/ml) measured 4 wk after the third dose. The authors conclude that with three double dose schedule of Hepatitis B vaccination, response rate is poor. Therefore, for protection from Hepatitis B infection during initial phase of therapy, there is a need to provide passive immunization.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/imunologia , Hepatite B/prevenção & controle , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Vacinação , Adolescente , Criança , Pré-Escolar , Tratamento Farmacológico , Feminino , Anticorpos Anti-Hepatite B/sangue , Humanos , Esquemas de Imunização , Imunização Passiva , Lactente , Masculino
13.
Indian Pediatr ; 56(12): 1041-1048, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31884436

RESUMO

JUSTIFICATION: Children with cancer need to be immunized against the common vaccine-preventable diseases after completion and sometimes during ongoing treatment of cancer. However, the immunization schedule for these children needs to be altered due to disease and treatment related immune-suppression. Consequently, there are many guidelines/practice statements from around the world to address this issue, however, there is no such comprehensive guideline from India catering to the need of Indian children with cancer. PROCESS: A guideline was drafted after reviewing the available literature. The draft guideline was discussed and modified in a meeting attended by pediatric oncologists from the PHO chapter and vaccine experts from the ACVIP of the IAP. Subsequently, the modified draft was reviewed and recommendations were finalized. OBJECTIVES: To review the current evidence and generate a nationally relevant guideline for immunization of children receiving chemotherapy for cancer. RECOMMENDATIONS: Live vaccines are contraindicated during and up to 6 months after end of chemotherapy. Non-live vaccines are also best given after 6 months from the end of treatment for durable immunity. Annual inactivated influenza vaccine is the only vaccine recommended for all children during chemotherapy whereas hepatitis B vaccine is recommended only for previously unimmunised children with risk of transfusion associated transmission of infection. Post-treatment re-immunization/catch-up schedule largely depends on the pre-chemotherapy immunization status. Sibling immunization should continue uninterrupted except for oral polio vaccine which needs to be substituted by the injectable vaccine. Inactivated influenza vaccine is recommended and varicella vaccine is encouraged for all contacts including siblings.


Assuntos
Esquemas de Imunização , Hospedeiro Imunocomprometido , Neoplasias , Vacinas/administração & dosagem , Criança , Consenso , Humanos , Índia , Oncologia/organização & administração , Neoplasias/tratamento farmacológico , Neoplasias/fisiopatologia , Pediatria/organização & administração , Irmãos , Vacinação , Vacinas/efeitos adversos
14.
Indian J Pediatr ; 86(12): 1085-1086, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31713209
15.
Pediatr Hematol Oncol ; 36(6): 344-351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31514565

RESUMO

Injection vincristine is an important component of therapy for acute lymphoblastic leukemia (ALL). An important adverse effect of vincristine is neurotoxicity. The incidence of this adverse effect is well studied. The present was undertaken to determine the incidence of vincristine-induced neurotoxicity in children with ALL after the induction of remission phase of chemotherapy and to ascertain its correlation with undernutrition, vitamin B12, folate and iron deficiency. Thirty children (1-18 years) with ALL were enrolled at the commencement of chemotherapy. The electrophysiological evaluation was done at baseline and repeated after four doses of vincristine (1.5 mg/m2/dose). Clinical evaluation was done regularly. Anthropometry and serum B12, folate and ferritin levels were assessed at baseline. Twelve children over a 4-week period of observation had peripheral neuropathy clinically. The autonomic system was most commonly involved followed by motor and sensory system respectively. On electrophysiological testing, half of the patients had evidence of neuropathy. Micronutrient deficiencies were present in a significant number of patients-63.3% had a B12 deficiency, 20% were deficient in folate and 43.3% in iron. The incidence of vincristine-induced neuropathy in patients with/without these micro-nutrient deficiencies was not statistically significantly different. Vincristine-induced neuropathy is common in Indian children with ALL. The present study did not find any correlation between the occurrences of vincristine-induced neuropathy and nutritional deficiencies. Larger studies are warranted to evaluate the contribution of micronutrient deficiencies to the development of peripheral neuropathy in childhood ALL.


Assuntos
Antineoplásicos Fitogênicos/efeitos adversos , Desnutrição/complicações , Síndromes Neurotóxicas/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Vincristina/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Estudos Prospectivos
16.
Indian Pediatr ; 56(6): 476-480, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31278227

RESUMO

OBJECTIVE: To compare growth, anemia prevalence, and sickness frequency in HIV- exposed uninfected infants on different feeding modes. METHODS: In this retrospective cohort study, 109 HIV-exposed uninfected infants registered at our center were categorized into three groups as per their feeding mode during first 6 months viz. exclusively breast fed (n=50), animal milk fed (n=40) and commercial infant formula fed (n=19). Their anthropometric parameters, hemoglobin and frequency of sickness at the age of 6 months were compared. RESULTS: There were no significant inter-group differences in the weight for age, weight for length, length for age z-scores (P=0.16, 0.37 and 0.12, respectively); proportion of infants with underweight (P=0.63), wasting (P=0.82), or stunting (P=0.82), and mean hemoglobin levels among the 3 groups at 6 month of age. Animal milk fed and formula fed infant had increased risk of sickness compared to exclusively breastfed infants (OR 2.5 and 2.49, respectively; P<0.01). CONCLUSIONS: In circumstances where breastfeeding is not feasible or preferred, animal milk feeding offers a viable alternative to commercial infant feeding formula in HIV exposed infants.


Assuntos
Anemia/prevenção & controle , Aleitamento Materno , Exposição Ambiental , Transtornos do Crescimento/prevenção & controle , Infecções por HIV , Fórmulas Infantis , Leite , Anemia/epidemiologia , Anemia/etiologia , Animais , Búfalos , Bovinos , Feminino , Seguimentos , Cabras , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Lactente , Cuidado do Lactente/métodos , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Magreza/epidemiologia , Magreza/etiologia , Magreza/prevenção & controle
18.
J Trop Pediatr ; 65(1): 29-38, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29506083

RESUMO

The WHO Integrated Management of Childhood Illnesses-HIV (IMCI-HIV) algorithm and its regional adaptation have shown variable performance in clinically identifying HIV-infected children with lack of validation in low prevalence areas. Addition of certain 'parental factors' (proxy indicators of parental HIV) may improve its utility. In this study, children aged 2 months to 5 years were enrolled into Group A (n = 1000, 'suspected symptomatic HIV infected' children as per the IMNCI-HIV algorithm) and group B (n = 50, children newly diagnosed with HIV infection). Parental factors were asked and HIV infection was tested for in Group A. For Group B, retrospective data were collected regarding IMNCI-HIV algorithm signs and parental factors. Utility of individual and various combinations of IMNCI-HIV signs and parental factors to predict HIV status was evaluated. Results showed that incorporating parental factors to IMNCI-HIV algorithm improved its sensitivity and positive predictive value in identifying HIV-infected children while maintaining the same sensitivity.


Assuntos
Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Infecções por HIV/diagnóstico , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Pais , Atenção Primária à Saúde/métodos , Adulto , Algoritmos , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Índia/epidemiologia , Lactente , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Estudos Retrospectivos
19.
Indian J Hematol Blood Transfus ; 34(4): 648-652, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30369735

RESUMO

To determine the efficacy of zoledronic acid (ZA) in thalassemia major associated low bone mineral density. Prospective, open label, single arm trial. Bone mineral density (BMD) at lumbar, hip and forearm region were performed at baseline and after 1 year of therapy. Initial, 9 patients received a first dose of 4 mg. Due to severe adverse effects, further doses for these patients and all new recruited patients were 1 mg once every 3 months for 4 doses. All patients were receiving 500 mg of calcium carbonate twice daily and 0.25 µg alfacalcidol once daily before and during the entire study period. Dual energy X-ray absoptiometry was performed at baseline and after 1 year. Twenty-seven patients with transfusion dependent thalassemia with a median age 19.5 year (15-38 years) were eligible for ZA treatment. Seven patients had bony pains. Four patients developed grade 4 hypocalcemia (3 developed tetany) and 2 developed infusion related toxicity with initial dose of 4 mg. One mg dose was well tolerated. At the end of 1 year, bone pains had completely resolved. There was significant increase in BMD at lumbar (p = 0.002) and forearm regions (p = 0.04) and intertrochantric area (p = 0.041). The % change in BMD at 1 year was +3.7 ± 3.2%. ZA is an efficacious agent in treatment of low BMD in these patients. ZA produces significant adverse reactions at 4 mg dose but 1 mg dose is well tolerated and is efficacious.

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