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Biomedical subjects

N R Shah

Publications and source records attributed to N R Shah.

At least 19 recordsLinked to original sources
PubMed2001

Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and l-asparaginase, maintenance chemotherapy, and transplantation: Children's Cancer Group Study CCG-5912.

PURPOSE: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparaginase (DECAL) for recurrent non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). PATIENTS AND METHODS: Ninety-seven children with recurrent NHL (n = 68) or HD (n = 29) were enrolled. Treatment consisted of two cycles of DECAL, then bone marrow transplantation or up to four cycles of ifosfamide, mesna, and etoposide alternating with DECAL maintenance therapy. RESULTS: After two cycles of DECAL induction therapy, complete response (CR) or partial response (PR) was reported in 19 (65.5%; 10 CRs and nine PRs) of 29 patients with HD and 29 (41.6%; 23 CRs and six PRs) of 68 patients with NHL. When only 24 patients with HD and 58 patients with NHL who were assessable for response were considered, the response rates were 79.2% (19 of 24 patients) and 50.0% (29 of 58 patients), respectively. Five-year event-free survival was 26% +/- 9% and 23% +/- 5% in patients with HD and NHL, respectively. Five-year survival was 31% +/- 14% and 30% +/- 6%, respectively. Although median time to treatment failure was significantly longer in patients with HD (EFS, P =.002; survival, P =.011), this difference did not translate into a higher long-term survival. Grade 3 or 4 toxic effects were observed during induction in 70 (72%) of 97 patients and during maintenance in 45 (70%) of 64 courses of DECAL therapy. Pancytopenia and systemic infections in particular were frequently observed. Other toxic effects were uncommon. Although not a formal part of the therapy or the study design, 42 patients who responded to therapy who underwent bone marrow transplant did not show any benefit from this approach. CONCLUSION: DECAL is an effective and tolerable salvage regimen for treating patients with recurrent NHL and HD.

Adolescent↗
PubMed2000

A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery.

We have attempted to quantify the most up-to-date estimate of the association between cigarette smoking by the mother and preterm delivery. Studies were selected for inclusion in this review if they were prospective, reported data stratified across at least two levels of maternal smoking, and defined preterm delivery on the basis of gestational age. In a meta-analysis we combined results from multiple studies that reported on preterm delivery and maternal smoking during pregnancy. Pooled odds ratios were computed for various strata of smoking intensity with the Mantel-Haenszel fixed-effects model. Twenty studies met all inclusion criteria and were included in meta-analysis. The pooled point estimate from 20 prospective studies on any maternal smoking versus no maternal smoking was 1.27 (95% confidence interval, 1.21-1.33). Subgroup analyses stratifying maternal smoking on number of cigarettes per day suggest a dose-response relationship at low to moderate levels of smoking, which was not further increased at high levels of smoking. A nonsignificant level of publication bias appears to exist in the smoking-preterm delivery literature. Cigarette smoking is a preventable risk factor that is associated with preterm delivery. Consistent results across many study populations and research designs and evidence of a dose-response relationship support its causal role in preterm delivery.

Case-Control Studies↗
PubMed2000

Parental smoking and alcohol consumption and risk of neuroblastoma.

Previous studies and animal evidence have suggested a relationship between parental tobacco or alcohol use and the risk of some childhood cancers, including neuroblastoma. A case-control study was conducted to investigate the relationship between parental tobacco smoking, alcohol consumption, and risk of neuroblastoma. Cases were children diagnosed with neuroblastoma over the period 1992-1994 at Children's Cancer Group and Pediatric Oncology Group institutions throughout the United States and Canada. One matched control was selected using random-digit dialing. Information on parental smoking and drinking history was obtained from 504 case and 504 control parents by telephone interview. Overall, there was no consistent pattern of association with parental smoking and alcohol consumption. For example, both maternal smoking and drinking during the period from 1 month before pregnancy through breastfeeding had adjusted odds ratios (ORs) of 1.1 [95% confidence interval (CI), 0.8-1.4]. There was no association with paternal smoking (OR, 1.2; 95% CI, 0.8-1.6) or paternal drinking 1 month before conception (OR, 1.0; 95% CI, 0.7-1.4). There was no consistent increase in risk by the amount of smoking or drinking during any time period relative to pregnancy. There was no suggestion of an increased risk when only one parent smoked. Smoking or drinking among both parents did not jointly increase the risk of neuroblastoma in their offspring. The child's age at diagnosis, stage, or MYCN oncogene amplification status did not materially alter the OR estimates. It is concluded that the results from this study do not indicate any evidence for a relationship between neuroblastoma and parental tobacco or alcohol use.

Adolescent↗
PubMed1994

Total quality management in action: pharmacy system changes to decrease medication incidents and increase clinical services.

During a monitoring of risk management indicators (incident report analysis), a trend of increasing medication incidents was noted from 1987 to 1990. The medication ordering process was tracked using a flow chart, and, using an interdisciplinary team, the transcription system was targeted for corrective action. A "roving pharmacist" system was devised, with a resultant 63% decrease in the reported medication incident rate from 1990 to 1993.

Hospital Bed Capacity, 300 to 499↗
PubMed1991

Epidemiologic features of pain in pediatric cancer patients: a co-operative community-based study. North Central Cancer Treatment Group and Mayo Clinic).

The prevalence, etiology, and management of pain in pediatric cancer patients seen at the Mayo Clinic and member institutions of the North Central Cancer Treatment Group were assessed. Participating centers, including both primary care and referral institutions, surveyed all patients seen during a 1-week period (Monday through Friday); procedure-related pain was excluded. Of the 160 children surveyed, 28 reported pain of which 57.8% was related to a side effect of anticancer treatment, 21.1% was unrelated to the malignancy, and 21.1% arose directly from the cancer. Pain intensity assessment was performed by both health-care professional and patient using a variety of measurement tools. Correlation between assessors was close except in young children. The predominance of treatment-related rather than cancer-related pain differs from results in series in adult cancer patients.

Adolescent↗
PubMed1990

Aluminum-induced microcytosis in a child with moderate renal insufficiency.

A child with moderate renal failure, on high doses of aluminum compounds for treatment for hyperphosphatasemia, presented with unexplained microcytosis. The patient also had psychomotor delay. On discontinuation of aluminum, microcytosis reversed in 2 months. Four months later, psychomotor development improved. Children with renal failure, on aluminum supplementation, should be carefully monitored for toxicity. Microcytosis may be a clue to aluminum toxicity in such patients.

Aluminum Hydroxide↗
PubMed1988

Methemoglobinemia and hemolytic anemia associated with Campylobacter jejuni enteritis.

A 7-week-old infant with methemoglobinemia, hemolytic anemia, and inadequate weight gain was found to have a Campylobacter jejuni gastrointestinal tract infection. Known etiologies of methemoglobinemia such as oxidative drug exposure, deficiency of NADH-methemoglobin reductase, and hemoglobin M disorder were excluded. The patient had a twin brother (probably identical) who had neither methemoglobinemia nor stool cultures positive for C. jejuni. The twin essentially served as an experimental control, making other environmental or genetic causes of methemoglobinemia unlikely in the patient. Both the methemoglobinemia and the C. jejuni infection responded to adequate treatment with erythromycin. The association of a C. jejuni infection with methemoglobinemia is discussed in light of previous associations of enteritis and methemoglobinemia in infants.

Anemia, Hemolytic↗
PubMed1988

Severe anemia caused by human parvovirus in a leukemia patient on maintenance chemotherapy.

A 6-year-old boy on maintenance chemotherapy for acute lymphocytic leukemia developed severe hypoplastic anemia during chemotherapy previously well tolerated. The hypoplastic episode persisted for approximately 30 days. Human parvovirus (B19), the etiologic agent of aplastic crisis in persons with underlying hemolytic syndromes, was detected in the patient's serum 25-30 days after onset of hemoglobin decrease, and B19 IgM seroconversion occurred 1 week later. The patient's hypoplastic anemia was presumably caused by prolonged B19 infection resulting from a blunted immune response. An immune response to the B19 infection and resolution of the illness were temporally associated with brief cessation of chemotherapy.

Anemia, Aplastic↗
PubMed1986

The community physician's involvement in clinical trials and home treatment.

The advances in outcome of children with cancer in the last four decades have been remarkable. The improvement, however, has not been uniform. It has recently been shown that the outcome of children with medulloblastoma treated at nonuniversity cancer centers has been less successful than those who were treated at the university cancer centers. Protocol treatment and location of treatment has been correlated with outcome in children with acute lymphocytic leukemia. Cooperative group protocols, used in the clinical setting of pediatric oncologists, with extensive resources and major referral center backup, have improved the prognosis of childhood ALL. Therefore, to improve outcome of pediatric cancer patients a multidisciplinary team at a center with partnership of community physician (CP) would be helpful. The CP can assume an extremely important role in shared management of children with cancer. Major involvement can be anticipated in areas including: chemotherapeutic treatment, immunization, infection surveillance and treatment, detection of disease recurrence, and late effects of cancer treatment. A CP could decrease the financial burden, and help alleviate the anxieties and emotional stresses placed upon the patients and parents. More importantly, the CP can facilitate home terminal care when necessary. These CP-referral center arrangements are of value to the CP, as well, through their educational and psychological benefits.

Cancer Care Facilities↗
PubMed1986

Mixed germ cell tumor of the ovary with pure choriocarcinoma metastasis.

A case report of a 30-month disease-free survival in a ten-year-old girl with ovarian mixed germ cell tumor consisting of dysgerminoma, choriocarcinoma, and immature teratoma with pure choriocarcinoma paraaortic lymph node metastasis is presented. To prevent resistant cell colonies, the noncross-resistant combination of vinblastine-Adriamycin and vinblastine-actinomycin D-cytoxan were added to the initial four courses of vinblastine-cisplatin-bleomycin. There are no previously reported survivals in ovarian mixed germ cell tumors with pure choriocarcinoma metastasis.

Child↗
PubMed1983

Neuroblastoma associated with Beckwith-Wiedemann syndrome.

This report describes an infant with Beckwith-Wiedemann Syndrome (BWS) found to have a thoracic neuroblastoma. Infants with BWS are known to have an increased incidence of tumors (10%). We believe this to be the first report of a malignant neural crest tumor in a child with BWS and also the first case occurring in familial BWS. Usually the malignancies associated with the BWS are intraabdominal; however, this malignancy was located in the chest. It is important to detect malignancy in early stages. Therefore, recommendations for screening children with BWS are discussed.

Beckwith-Wiedemann Syndrome↗