There is a huge lacunae in the delivery of palliative care services and hence an urgent need to inculcate targeted curriculum to provide focused skills and training for the pediatric postgraduates.

Acute lymphoblastic leukemia (ALL) presented with bone pain and leukopenia is a well-recognized complex. Bone and joint pain are seen as presenting symptoms in 25% of patients with acute leukemia, but generalized osteopenia and vertebral complications are less common. Back pain due to vertebral changes as an early feature has been infrequently reported. We report a case of a 9-year-old female child who presented with back pain for 3 weeks. Blood counts and peripheral smear were normal. X-ray of the spine showed wedge-shaped deformity in L3–L5 vertebrae. Magnetic resonance imaging of the spine confirmed the lytic lesions of L3–L5 vertebrae. Infective etiological evaluation was normal. Bone marrow aspiration revealed pre-B-cell lymphoblastic leukemia. She was started on ALL protocol and pain subsided within a week, and remodeling of the bony lesions could be seen 2 months later. This case highlights that spinal involvement may be a presenting feature despite normal peripheral blood counts.

Context:Acute lymphoblastic leukemia (ALL) ranks first among pediatric malignancies. 8–12% of ALL present with pancytopenia and 2% with hypocellular marrow a. Diagnosis of ALL in the background of pancytopenia and aplastic bone marrow is difficult.Aims:This study was aimed to compare the clinicopathologic, genetic, and outcome of paediatric ALL patients with and without pancytopenia.Settings and Design:This is a retrospective cross-sectional study.Subjects and Methods:The study included all ALL patients presenting with pancytopenia. The control group included equal number of randomly selected patients with ALL without pancytopenia treated during the same period. Ethics committee approved this study. The demographic, laboratory, and treatment-related details were retrieved from the records and entered in an Excel sheet.Statistical Analysis Used:Data was analyzed with Chi-square test with IBM SPSS statistics 16 software.Results:Diagnosis by peripheral smear is significantly lower (P = 0.015) in comparison with the control group. There is no significant difference in diagnosis between the groups by bone marrow aspirate (P = 0.731) and biopsy (P = 0.849). The diagnosis of leukemia is misdiagnosed as hypo cellular/aplastic marrow in 10% of the pancytopenic patients. Flow cytometry yielded the diagnosis in all the pancytopenic patients. Though cytogenetic abnormalities are more common in pancytopenic group, it is not statistically significant (P = 0.106). There is no significant difference in treatment outcome between the groups (P = 0.0827%).Conclusions:Clinical expertise is highly essential to evaluate a case of pancytopenia to diagnose leukemia. Pancytopenia is an obstacle in the diagnosis of ALL without immunophenotyping. There is no significant difference in the outcome between the two groups.

IntroductionThe extracellular matrix protein hyaluronan acid plays an active in role in tumor cell proliferation and invasion. Hyaluronan acid receptors, namely CD168 or the receptor for hyaluronan acid-mediated motility (RHAMM) and CD44 have been implicated in promoting malignancy. There is a lacuna in data on the expression of the receptor in pediatric leukemias.MethodsPediatric patients with acute leukemia who were diagnosed, treated and followed up in our center were enrolled. The bone marrow biopsies performed prior to treatment were subjected to immunohistochemical staining (54 biopsies: acute lymphoblastic leukemia – 45, acute myeloid leukemia – 9). Blast counts were carried out at diagnosis, end of the induction phase and end of chemotherapy, the minimal residual disease was assessed and follow up details were collected. Positivity was correlated with initial blast count, post-induction blast count, minimal residual disease and patient survival.ResultsThere was no correlation between the initial blast count and the percentage of blasts with RHAMM expression. The positive correlation between percentage of blasts expressing RHAMM and the post-induction blast count was moderate in acute myeloid leukemia (0.74) and mild in acute lymphoblastic leukemia (0.48). There was a statistically significant difference in RHAMM expression between the two minimal residual disease risk groups (p-value = 0.012) with a negative prognostic effect of RHAMM expression. Moreover, a negative prognostic effect of RHAMM expression was noted when patient survival was considered.ConclusionThis study shows that blasts in acute myeloid leukemia show more RHAMM positivity than those of acute lymphoblastic leukemia indicating the aggressive nature of this type of leukemia. In acute leukemias, patients with high percentages of RHAMM-positive blasts had more post-induction blasts, blasts in minimal residual disease and poorer prognosis.

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.