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CONTEXT: Steady improvement in childhood cancer outcomes has led to a growing number of survivors, many of who develop long-term sequelae. There is limited data about these sequelae (including those related to fertility) on childhood cancer survivors from India. AIMS: We undertook a prospective pilot study on childhood cancer survivors from India to assess their gonadal function and fertility. SUBJECTS AND METHODS: A pediatric oncologist and a reproductive medicine specialist assessed 21 childhood cancer survivors. The risk of infertility was established using disease and treatment variables. Current status of puberty, sexuality, and fertility were assessed using clinical and biochemical parameters. Outcomes were correlated with risk group of infertility. Information was also ascertained on counseling with regards to risk of infertility. RESULTS: The cohort included 21 survivors (71% males) with a median age of 18 years who were off treatment for a median age of 7 years. Ten (48%) survivors were at low risk for infertility, 9 (43%) at medium risk and 2 (9%) at high risk. Gonadal dysfunction was seen in 3 (14%) survivors: 0/10 (0%) low risk, 1/9 (11%) medium risk, and 2/2 (100%) high risk. None of the survivors, who are at high risk or medium risk of infertility, received any counseling before treatment. CONCLUSIONS: This prospective pilot study of a cohort of childhood cancer survivors from India demonstrates a deficiency in the information provided and counseling of patients/families at the time of diagnosis with regards to the risk of infertility. Fertility outcomes of childhood cancer survivors were congruent with recognized risk groups for infertility. Future action points have been identified.
RESUMO
OBJECTIVE: To report computed tomographic (CT) scan ratings of various aspects of brain morphology of a large representative sample of patients with a first episode of schizophrenic psychosis and to compare these ratings with those from a previously reported sample of patients with chronic schizophrenia. METHODS: A brain CT scan was performed on 114 patients with a diagnosis of first episode of schizophrenia or schizophreniform psychosis. Ratings on sulcal and ventricular enlargement and sylvian fissure were obtained using the Computed Tomographic Rating Scale for Schizophrenia. The influence of age, sex, age of onset, duration of illness and clinical psychopathology on CT ratings was assessed using bivariate correlations and multiple regression analyses. The CT ratings were also compared with those from a sample of patients with chronic schizophrenia. RESULTS: First-episode patients showed a modest enlargement of sulci and ventricles and a reversed asymmetry of the sylvian fissure. Age was the only independent predictor of these regional changes. Clinical symptoms, sex or duration of untreated psychosis showed no relation to CT ratings. A comparison of first-episode patients with chronically ill patients, with the effect of age covaried, revealed the sylvian fissure was significantly larger (right and left sides) in the chronically ill patients. CONCLUSIONS: Patients with a first episode of schizophrenic psychosis showed evidence of morphological changes generally associated with chronic schizophrenia. Such changes are not likely related to sex, clinical symptoms or duration of untreated psychosis, but are influenced by age. Changes in the ventricles and sulcal size are unlikely to be progressive, suggesting a neurodevelopmental origin, whereas changes in the area of the sylvian fissure may be of a more degenerative nature.