BMD Z-scores were similar among ALL survivors and controls. It was reassuring that there was no detrimental impact of the disease or its treatment on BMD. Future studies are required to determine the best possible ways to target the modifiable risk factors (diet, vitamin D) to optimize bone health.

It is possible to ascertain the diagnosis in most of the cases of intellectual disability using a judicious and sequential battery of tests.

Objective To describe the prevalence of obesity and sarcopenia among survivors of childhood acute lymphoblastic leukemia (ALL) using DEXA scan, and study associated risk factors. Methods This case control study was conducted between July, 2013 and June, 2014 at a tertiary care cancer centre in India. Study participants included 65 survivors of childhood ALL who were <18 years of age at diagnosis, treated between years 1996 and 2008, and were at least two years since completion of therapy. The controls included 50 matched siblings. Dual energy X -ray absorptiometry (DEXA) was used to study the body composition (body fat percentage, BF% and lean body mass, LBM) of the participants and controls. McCarthys body fat reference data were applied and logistic regression analysis was used to study various risk factors. Results At a median (range) follow-up of 5 (7.217.2) years, BF% (DEXA) identified a significantly higher prevalence of obesity of 21.5% (14/65) and sarcopenic obesity (14%) among survivors as compared to the controls (0/50, P <0.001), while the prevalence of sarcopenia as detected by LBM was similar at 60% (39/65) and 56% (28/50), respectively. On multivariate analysis, age at evaluation, high-risk disease and cranial irradiation were independently associated with high likelihood of obesity, while none of the factors predicted sarcopenia. Conclusion High prevalence of obesity and sarcopenic obesity were observed among survivors of childhood ALL.

Anti-N-methyl-D-aspartate receptor encephalitis is a well characterized immune-mediated encephalitis. It is increasingly being recognized as one of the common causes of encephalitis, but is frequently misdiagnosed especially in resource-constrained settings. With a simple test available to diagnose the disorder and prospects of good recovery following early immunotherapy, the disorder should be kept as a differential diagnosis in patients presenting with unexplained behavioral/psychiatric symptoms and progressive encephalopathy with movement disorders.

AC(S)x4 had a significant relation with beginning of CIA in patients >40 (P-0.033) but there was no relation between various protocols, including AC(S)x4 and duration of amenorrhea in treated patients (including <40 and/or >40 years) by Kruskal-Wallis test. Twenty-three out of 237 patients (9.7%) did not have amenorrhea while 90.3% had (60.6% after three cycles and 77.9% after four cycles). Of these patients CIA (duration of amenorrhea more than 3 months), was detected in 86.8% of patients. Adriamucin + CTX are the drugs used in the first four cycles of AC, AC-Taxotere and AC-Taxol protocols including 66.6% of patients. This means that Adria + CTX could be responsible for at least 66.6% of CIA of our patients. Like other studies, duration of CIA was longer in patients over 40 in Iranian patients. AC protocol caused about 66.6% of CIA in this study. Further studies are needed to determine the

Acquired amegakaryocytic thrombocytopenia is an unusual hematological disorder characterized by thrombocytopenia along with markedly diminished megakaryocytes in the bone marrow. There is no uniform consensus on the treatment and the case reports in pediatric age group are few. The authors report a child with this condition who responded to cyclosporine alone.

Introduction: Rhabdomyosarcoma (RMS) arising in the female genital tract is rare accounting for 3.5% of all RMS cases. Approximately half these occur in the vagina, a site that has been associated with a favorable prognosis. Optimal loco-regional treatment for patients with vaginal RMS remains controversial since wide local excision is mutilating and often not done. Two cases of vaginal RMS are reported who underwent chemotherapy and local control with brachytherapy. Methods: Retrospective chart review was done between 2011 and 2015. During this interval, out of 31 cases of pediatric RMS managed at our institution, 2 had vaginal RMS. Their management and outcome is detailed below. Results - Case Materials: Two patients, both aged 2 years at the time of diagnosis, presented with grape-like mass protruding from vaginal orifice and bleeding for 1-2 months. Characteristic MRI features were of a heterogeneously enhancing polypoidal soft tissue mass filling vaginal lumen and protruding out of introitus confirming Botryoidal RMS. Biopsy and histopathology was suggestive of embryonal RMS (IHC positive for desmin, myogenin and focally for myo-D1). Tumor in both the patients was staged as Stage1 Group 3 (low risk). They were started on neo-adjuvant chemotherapy as per IRS-? Protocol with 3 weekly cycles of vincristine, dactinomycin and cyclophosphamide for 33 weeks. They had near complete regression of tumor and received brachytherapy for residual thickening of the vaginal wall. They have been followed up for 24 months and 57 months respectively from presentation, and are disease free. They are on close surveillance with periodic examination under anesthesia and imaging. One patient developed post radiation vaginal synechiae requiring vaginal dilatation. Conclusion: In patients with non-resected vaginal RMS, good outcome can be achieved by the use of brachytherapy for local control.

This case report describes a right-sided borderline ovarian tumour diagnosed unexpectedly following suspected torsion in the third trimester of pregnancy. The patient had had a right mucinous cystadenoma and left serous cystadenoma in her previous pregnancy and underwent bilateral ovarian cystectomy at the time of her first elective caesarean section. The management of borderline ovarian tumours is generally difficult in younger women of reproductive age and is made more complex by pregnancy. The authors share the challenges of managing this condition in pregnancy together with a review of the literature.