Survivors of MB are at risk of SNs both within and outside the CNS. A significant proportion of SNs occur in areas of exit RT dose. Studies are needed to determine whether the use of proton therapy, which has no exit RT dose, is associated with a lower incidence of SNs.
Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare acquired bleeding disorder secondary to development of antibodies against prothrombin protein, in the presence of antiphospholipid antibodies. We describe the case of a 13-year-old girl who presented with severe menorrhagia and symptomatic anemia. Labs indicated anemia, thrombocytopenia, elevated PT and aPTT, high-titer inhibitor on mixing studies, positive ANA and anti-dsDNA antibodies, along with a triple-positive antiphospholipid antibody panel. Given additional systemic manifestations, systemic lupus erythematosus was diagnosed. High dose steroids and hydroxychloroquine subsequently started. Her clinical course was complicated by femoral deep venous thrombosis and post renal biopsy retroperitoneal hematoma. Further workup revealed low prothrombin level and the diagnosis of lupus anticoagulant hypoprothrombinemia syndrome. In view of suboptimal response to initial immunosuppressive therapy, rituximab was added to her regimen, leading to an improvement in clinical symptoms and resolution of hypoprothrombinemia. She remains recurrence free 5 years from the event.
Objective: Detecting the prevalence of human cytomegalovirus (CMV) coinfection in HIV-infected individuals attending a tertiary care hospital in Delhi by using 3 laboratory tests namely pp65 antigenemia assay, CMV DNA polymerase chain reaction (PCR), and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) for anti-CMV antibody. Design: HIV seropositive patients with CD4 count 100 cells/mm 3 were included as cases and HIV-negative healthy individuals as controls. Blood samples were collected from all participants and 3 tests were performed. Methods: pp65 antigenemia assay and IgM ELISA were performed by commercially available kits; PCR was performed by an in-house nested PCR method. Results: In all, 7.1%, 5.7%, and 2.9% were positive for pp65 antigenemia, CMV DNA, and IgM antibody against CMV, respectively. On the basis of pp65 and/or PCR positivity, it can be said that active CMV coinfection was present in 8.57% of the cases. Conclusion: In the postantiretroviral therapy (ART) era, CMV coinfection in HIV-infected patients has significantly declined.
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