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Objective: Linear growth is best estimated by serial anthropometric data or height velocity (HV). In the absence of recent data on growth velocity, we undertook to establish normative data in apparently healthy North Indian children. Materials and Methods: Prospective longitudinal study in a representative sample of 7710 apparently healthy children, aged 3-17 years from different regions of Delhi. Height was measured at baseline and at 12 months while pubertal examination was performed at baseline in a subset of children. Results: The data on HV and puberty were available in 5635 participants (73.08%; 2341 boys and 3294 girls) and 1553 participants (622 boys; and 931 girls), respectively. The mean peak height velocity (PHV) was 7.82 ± 2.60 cm in boys seen at 12-12.9 years and 6.63 ± 1.81 cm in girls at 10-10.9 years Although late maturing boys had a greater HV than early or normal maturers, it did not vary with the age of pubertal maturation in girls. HV correlated with parental height in prepubertal boys, girls, and pubertal boys (P < 0.01) while no correlation was seen in girls. Conclusions: The study presents normal height velocities in North Indian children. A secular trend was observed in achieving PHV in both boys and girls. [ABSTRACT FROM AUTHOR]

Adolescence is a critical time for peak bone mass accrual. During puberty the skeletal growth results in the process of bone modeling, remodeling and longitudinal growth which leads to considerable changes in the levels of bone formation and resorption markers. The study was aimed to analyze the levels of bone markers, bone density and their relation to puberty amongst our population. Eighty four healthy boys with a mean age of 14.36+1.97 years (range 11-18 yrs) were evaluated. The bone metabolism markers measured by ELISA were serum osteocalcin (BGP), bone-specific alkaline phosphatase (BALP), carboxyterminal propeptide of type I collagen (CICP), deoxypyridinoline (DPD). Bone density at forearm and calcaneum were measured by Dual Energy X-ray Absorptiometry. Bone formation and resorption markers were raised during all stages of puberty, peaking at stage 3 and declining gradually from stages 4 and 5 onwards whereas the mean bone density continued to increase even beyond stage 3 of puberty. We observed a positive correlation between age, height and weight and bone density. Significant inverse correlations were seen between bone formation markers and bone density at both sites. No correlation was observed between bone density and bone resorption markers. During puberty bone mineral density increases significantly. Though significant positive correlation was observed between age, height and weight, bone density, age and weight remain the best predictors of bone mineral density at distal forearm and calcaneum. [ABSTRACT FROM AUTHOR]

A seven-year field study examined the interactive effect of bed planting (BP) and conventional tillage (CT) with three water regimes and eight nitrogen management options on soil respiration (SR), soil microbial biomass carbon (SMBC) and dehydrogenase activity (DHA) under a maize-wheat sequence. The BP method significantly increased the soil dehydrogenase activity (52.48%) and respiration (72.02%) over CT. Supra-optimal water regime in combination with 120 kg N ha-1 as urea supported the least DHA in both tillage systems. The application of urea at 120 kg N ha-1 depressed the DHA in BP (29%) and CT (30%) over their respective control. In BP and CT, input of 120 kg N ha-1 as organics enhanced SR at supra-optimal water regime. Under BP, the substitution of green manure at 30 kg N ha-1 increased DHA (93%), SR (36.4%) and SMBC (24.6%) over control at sub-optimal water regime. 120 kg N ha-1 as organics recorded the maximum SMBC at the optimal water regime in BP (65% higher than control), but at sub-optimal water regime (30% higher than control) under CT. An increased soil respiration and DHA with corresponding increase in the SMBC was recorded in BP, whereas in CT, DHA declined with an increase in the SMBC. [ABSTRACT FROM AUTHOR]

Background: We assessed referral patterns of children with hematological malignancies (HM) in North India. Materials and Methods: The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptomdiagnosis), and number of contacts were compared between high- and standard-risk disease group. Results: Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1-6), 37 days (IQR 13-55), and 38 days (IQR 15-60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay. Conclusions: Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective. [ABSTRACT FROM AUTHOR]

Genetic polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene have been associated with the development of acute leukemias and various malignancies. We conducted a case–control study in 95 north Indian children with acute lymphoblastic leukemia (ALL) and 255 controls, to investigate the role of MTHFR C677T and A1298C polymorphisms as risk factors in the development of ALL. PCR-RFLP on genomic DNA was carried out to determine C677T and A1298C genotypes. The frequency of MTHFR C677T for the T allele was found to be 23.2% among patients and 18.2% among controls. The frequency of the C allele in MTHFR A1298C was 44.2% among cases and 48.2% in controls. Patients showed a higher frequency of heterozygosity for the MTHFR C677T polymorphism as compared to controls (40% vs 27.8%; OR = 1.73, 95% CI 1.02–2.91, p = 0.02), and the A1298C polymorphism did not show any difference in genotype frequency between cases and controls. MTHFR 677CC/1298AC genotype frequencies showed a statistically significant difference between cases and controls (OR = 0.58, 95% CI 0.34–1.01, p = 0.04). In conclusion, our study in north Indian controls and patients with pediatric ALL showed increased frequency for MTHFR C677T in the heterozygous state and no significant difference in the frequency of A1298C genotype between the two groups. [ABSTRACT FROM AUTHOR]

Tropical pyomyositis (TP) is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. It has been reported frequently from Africa and Latin America. However, there are only a few cases reported in children from India. Between January 2002 and December 2011, 40 children with TP were admitted to our hospital, and their retrospective review formed the study material. TP is not an uncommon disease in children in Northern India, especially during rainy seasons. Most of the patients were admitted with short history of fever, pain and localized swelling. Pus drainage was done in 87.5% cases, with the amount of pus varying from 5 to 2000 ml. The pus grew methicillin-sensitive Staphylococcus aureus (MSSA) in 42.5% cases, whereas initial blood cultures were sterile. All received antibiotics along with surgical drainage, and recovered. It is important for health professionals to have a high index of suspicion and familiarity with this imminently treatable disease entity. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Blood donor screening can help predict prevalence of coeliac disease in population. Methods: Between December 2010 and June 2011, healthy blood donors were screened using anti-tissue glutaminase antibodies. Those positive underwent duodenoscopy. Their age, gender, body mass index and haemoglobin and histological changes were recorded. Results: Of the 1610 blood donors screened, 1581 (98.2%) were males. The mean age of donors was 31.51±9.66 years and the mean body mass index was 22.12±4.24kg/m2. Nine (0.56%) men were seropositive. Endoscopic features included reduced fold height (9), scalloping (8), grooving (7) and mosaic mucosal pattern (3). Eight had Marsh IIIa changes whilst one had IIIb change. The prevalence of coeliac disease was 1:179 (0.56%, 95% confidence interval 1/366–1/91, 0.27–1.1%). None of the 9 patients had any symptoms. Their mean haemoglobin and body-mass index was similar to rest of the cohort. Conclusion: The prevalence of coeliac disease amongst apparently healthy blood donors was 1:179 (0.56%). [Copyright &y& Elsevier]

Background There is a paucity of data for DEL phenotype in the Indian population. Ours is a tertiary care Regional Blood Transfusion Centre in north India collecting more than 50,000 blood units out of which 8–9% are RhD negative donors. Aim To determine the frequency of DEL phenotype in RhD negative blood donor population at our centre. Material and Methods A total of 200 RhD-negative blood donor samples were included in this study which was conducted over a period of 4 months (October 2013 to January 2014). All these blood samples were tested for extended Rh typing including C, E, c and e antigens and also for adsorption elution testing. The heat elution method at 56 °C in water bath for 10 minutes was utilized. The eluate and the last wash supernatant were used for indirect antiglobulin test against O RhD positive and O RhD negative cells by gel technique using the LISS Coombs' AHG gel cards (Biorad, Morat, Switzerland). Those donor samples which were found positive on adsorption elution testing were also further investigated by gel technique for Direct Antiglobulin test (DAT), Weak D testing and Auto Control test. Results Out of the total 200 Rh D negative donor samples tested, 3 (1.5%) samples were found to give positive result and, thus, were the DEL phenotypes. It was found that 20 (10%) donor samples were positive for C antigen, 5 (2.5%) for E antigen, 200 (100%) for c antigen and 200 (100%) for e antigen. Among the DEL negative (= 197), 193 (98%) were E antigen negative and only 4 (2%) were E antigen positive, whereas among the DEL positive samples (= 3), 2 (66.6%) were E antigen negative and 1 (33.3%) was E antigen positive. The C antigen positivity was only in 2 (66.6%) individuals in the DEL positive group and 178 (90.3%) in the DEL negative samples. All the three samples which were found to be positive as DEL phenotype also gave negative result for DAT, Weak D testing and Auto Control. Conclusion The frequency of DEL phenotype in north Indian RhD negative donor population is 1.5%. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although automated cell separators have undergone a lot of technical refinements, attention has been focused on the quality of platelet concentrates than on donor safety. We planned this prospective study to look into donor safety aspect by studying adverse events in normal healthy plateletpheresis donors. Study design and methods: The study included 500 healthy, first-time (n =301) and repeat (n =199) plateletpheresis donors after informed consent. The plateletpheresis procedures were performed on Trima Accel (5.1 version, GAMBRO BCT) and Amicus (3.2 version FENWAL) cell separators. The adverse events during procedure were recorded and classified according to their nature. The pre and post procedure hematological and biochemical profiles of these donors were also assessed with the help of automated cell counter and analyser respectively. Results: A total of 18% (n =90) adverse events were recorded in 500 plateletpheresis donors, of which 9% of were hypocalcaemia in nature followed by hematoma (7.4%), vasovagal reaction (0.8%) and kit related adverse events in (0.8%). There was significant post procedure drop in Hb, Hct, platelet count of the donors (p <0.0001) whereas WBC count showed a statistically significant rise (p <0.0001). Divalent cations (iCa+, TCa+, TMg+) also showed a statistically significant decline after donation (p <0.0001). However there were no statistically significance difference between adverse events in Trima Accel (5.1 version, GAMBRO BCT) and Amicus (3.2 version FENWAL) cell separators. Conclusion: Donor reactions can adversely affect the voluntary donor recruitment strategies to increase the public awareness regarding constant need for blood and blood products. Commonly observed adverse events in plateletpheresis donors were hypocalcemia, hematoma formation and vasovagal reactions which can be prevented by pre-donation education of the donors and change of machine configuration. Nevertheless, more prospective studies on this aspect are required in order to establish guidelines for donor safety in apheresis and also to help in assessing donor suitability, especially given the present trend of double product apheresis collections. [Copyright &y& Elsevier]

Background & objectives: Mixed-phenotype acute leukaemia (MPAL) is a rare neoplasm with no definite treatment protocols and a distinctly poor outcome. Advancement in polychromatic flow cytometry has made its identification easier. This prospective study was designed to identify cases of MPAL and study their clinical presentation and haematological profile in a tertiary care hospital in north India. Methods: Ethylenediaminetetraacetic acid (EDTA)-anticoagulated bone marrow aspirate samples of patients diagnosed as acute leukaemia (AL) on the basis of morphology were utilized for immunophenotyping. A comprehensive panel of fluorochrome-labelled monoclonal antibodies targeting myeloid, B-cell, T-cell and immaturity markers was utilized. The patients diagnosed to have MPAL, on the basis of the World Health Organization 2008 classification, were selected for further analyses. Results: There were 15 (2.99%) patients with MPAL of the total 501 cases of AL. Seven were children, all males and mean age of 5.08±3.88 yr. Eight were adults, male:female=6:2 and mean age of 21.43±5.74 yr. Eight were diagnosed as B/myeloid and seven were T/myeloid. No association was observed between age and immunophenotype of MPAL. On morphology, 11 were diagnosed as AML and four as ALL, and no specific morphology of blasts was predictive of a MPAL. Interpretation & conclusions: MPAL appeared to be a rare neoplasm (2.99% of AL cases). A comprehensive primary panel of monoclonal antibodies should be used to identify this neoplasm known to have a poor outcome. [ABSTRACT FROM AUTHOR]

Abstract: Background: We present here our experience with therapeutic apheresis (TA) performed for various indications, clinical response and complications in a tertiary care center over last 10years. Study design and methods: Present study is a retrospective analysis of 492 TA procedures performed for 125 patients from January 2000 to December 2009. For each patient: age, gender, weight, clinical indication, pre-procedure hematological profile and ionized calcium levels were recorded. For every procedure following parameters were analyzed: type of venous access (central/peripheral), volume of blood and plasma processed, amount of anticoagulant used, procedure duration, blood flow rate, type of replacement fluid given, response to therapy and adverse reactions. Results: Of 492 TA procedures, 68.8% were performed for neurology, 20.8% hematology–oncology, 9.6% renal and 0.8% for rheumatology patients. Therapeutic plasma exchanges (n =464; 94.3%) and therapeutic cytapheresis (n =28; 6.7%) were performed in 113 and 12 patients, respectively. Majority of patients belonged to ASFA category I and II (n =124; 99.2%). The overall response rate was 84%, with encouraging response in TTP (100%), aHUS (81.8%) and in neurological disorders (88.4%). Adverse events were reported in 52.8% of patients in 14.83% of procedures. Conclusion: Our results of TPE in neurological disorders and in atypical hemolytic uremic syndrome are encouraging and it is a cost effective alternative to IvIg in neurological disorders. Currently, there is a need for establishment of an Indian apheresis registry to understand the scenario of TA across the country and in the expansion of appropriate and applicable indications for TA in our setting. [Copyright &y& Elsevier]

The article discusses research on the presence of the pathogen Burkholderia cepacia complex (BCC) in patients with septicaemic non-cystic fibrosis (CF) in tertiary care hospitals in north India. BCC isolates were identified using standard phenotypic and a molecular recA polymerase chain reaction (PCR) based restriction fragment length polymorphism (RFLP) method. The non-CF BCC isolates showed susceptibility to the drug ceftazidime. The study found that the most prevalent BCC species among the non-CF patients was Burkholderia cenocepacia.