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Aakanksha Singh,Sandeep Grover,Pankaj Malhotra,Subhash C. Varma 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.2
Agranulocytosis as a side effect of clozapine has been reported to be associated with initial phases of treatment, i.e., first six months. Agranulocytosis with clozapine during the initial phases of treatment has been linked to genetic vulnerability in the form of variations in the human leukocyte-antigen haplotypes. However, there is limited literature on late onset agranulocytosis with clozapine and this has very rarely been linked to human leukocyte-antigen haplotypes vulnerability. In this report we review the existing data on late onset agranulocytosis with clozapine and describe the case of a young man, who developed agranulocytosis with clozapine after 35 months of treatment and was found to have genetic vulnerability in form of being positive for HLA DR4. This case highlights underlying autoimmune immune mechanism in clozapine-induced agranulocytosis and the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with genetic vulnerability to develop this condition.
Karthik Bommannan,Man Updesh Singh Sachdeva,Pankaj Malhotra,Narender Kumar,Prashant Sharma,Shano Naseem,Jasmina Ahluwalia,Reena Das,Neelam Varma,Gaurav Prakash,Alka Khadwal,Radhika Srinivasan,Subhash 대한혈액학회 2016 Blood Research Vol.51 No.1
BackgroundPlasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×109/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma.MethodsClinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively.ResultsBetween January 2007 and December 2014, ten PPCL and four SPCL patients were inves-tigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months.ConclusionWe highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to un-mask possible significant effects on pathogenesis.
Karthik Bommannan,Man Updesh Singh Sachdeva,Pankaj Malhotra,Narender Kumar,Prashant Sharma,Shano Naseem,Jasmina Ahluwalia,Reena Das,Neelam Varma,Gaurav Prakash,Alka Khadwal,Radhika Srinivasan,Subhash 대한혈액학회 2016 Blood Research Vol.51 No.1
BackgroundPlasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×109/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma.MethodsClinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively.ResultsBetween January 2007 and December 2014, ten PPCL and four SPCL patients were inves-tigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months.ConclusionWe highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to un-mask possible significant effects on pathogenesis.
Primary pyomyositis in North India: a clinical, microbiological, and outcome study
( Susheel Kumar ),( Ashish Bhalla ),( Rajveer Singh ),( Navneet Sharma ),( Aman Sharma ),( Vikas Gautam ),( Surjit Singh ),( Subhash Varma ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.2
Background/Aims: Pyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis. Methods: This study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent. Results: Sixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality. Conclusions: Primary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.