Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Hyperphagia- A Rare Clinical Presentation of Acute Lymphoblastic Leukemia Relapse

Yasir Bashir, Nusrat Bashir, Sajad Geelani, Asif Ahmed*, Manzoor Parry, Shabeer Ahmad, Javid Rasool

Department of pediatrics Sheri-kashmir institute of medical sciences, soura, Srinagar, j&k, India

Abstract: Hyperphagia (also referred to as polyphagia) is a serious eating disorder defined as an extreme unsatisfied drive to consume food and the most common sign that aperson has hyperphagia is obesity. It can be caused commonly by variety of congenital obesity syndromes and rarely by acquired hypothalamic dysfunction.Here we report a clinical manifestation of a child who was a diagnosed case of acute lymphoblastic leukemia and was on maintenance chemotherapy when parents noted her overeating and on evaluation she proved to have central nervous system relapse.

Keywords: hyperphagia, acute lymphoblastic leukemia, relapse

Received October 29, 2014; Revised November 02, 2014; Accepted November 04, 2014

Citation: Yasir Bashir, Nusrat Bashir, Sajad Geelani, Asif Ahmed, Manzoor Parry, Shabeer Ahmad, Javid Rasool, Hyperphagia- A Rare Clinical Presentation of Acute Lymphoblastic Leukemia Relapse. American Journal of Medical Case Reports, 2 (11). 247-249. January 2014. doi:10.12691/ajmcr-2-11-6

1. Case Report

This child was a diagnosed case of standard risk precursor B-lymphoblastic leukemia 2 years back at age of 18 months and was put on standard risk pediatric BFM chemotherapy protocol. Her treatment remained uneventful throughout induction and child was doing well till last few days of 24 month of her treatment, while she was on maintenance phase of her chemotherapy, when parents noted her unsatisfied drive to consume food. For initial 2 weeks they did not give it a strong consideration but lately at around 1 month of this complaint they got worried and sought a medical attention.

On examination the striking finding was that this child was obese (Figure 1) for her age (anthropometry Table 1 & Figure 2) and rest of the examination was normal.

At this point her haemogram and peripheral blood film examination, bone marrow and coagulogram were normal (Table 2).

Fundus examination was also normal and CSF examination (Figure 3) was suggestive of CNS relapse. An MRI examination of brain was performed which was essentially normal except for subtle hypointense lesions in thalamic area brain suggestive of leukemic infiltration (Figure 4). This child was immediately advised to go for possible allogenic stem cell transplantation.

Table 1.

Figure 1. showing that the patient is obese with weight for age of 97 percentile as against expected of (3rd-75th) for her age

Figure 2. showing that the patient is obese with weight for age of 97 percentile as against expected of (3rd-75th) for her age

Figure 3. CSF examination of the patient showing about 80% blasts

Figure 4. Magnetic resonance imaging of the patient with subtle hypointense lesions in the thalamic area of brain.

Table 2.

2. Discussion

ALL presumably arises from malignant transformation of B- or T-progenitor cells. [1] The most common cause of treatment failure in childhood ALL remains relapse which is seen in approximately 15-20% of patients. [2] Relapses can be medullary as well as extramedullary. The extramedullary relapses seen in testes, central nervous system and breast are considered as sanctuary sites for disease persistence. [9] Most ALL relapses occur during treatment or within the first 2 years after treatment completion, although relapses have been reported to occur even after 10 years from diagnosis. [3,4] Relapse may represent preexisting drug-resistant clone, novel clone by mutation [5] or quiescent leukemic cell that harbors an otherwise silent fusion gene and that has escaped eradication during initial therapy. [6] With intensive combination chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT), 30%-50% of all children with relapsed ALL can be cured. [7,8] Thus, most children still die despite aggressive chemo-radiotherapy approaches, including transplantation, and novel salvage regimens are needed.

3. Conclusion

Although very rare, clinician treating leukemia should keep an eye on growth pattern of children, for early detection of CNS relapse.

References

[1]   | Pui CH, Jeha S. New therapeutic strategies for the treatment of acute lymphoblastic leukaemia. Nat Rev Drug Discov 6 (2): 149-65, 2007.
[2]   | LocatelliF, Schrapp M, Bernard ME, and Rutella S.How I treat relapsed childhood acute lymphoblastic leukemia. . October 4, 2012.
[3]   | Gaynon PS, Childhood acute lymphoblastic leukaemia and relapse. Br Haematol; 131 (5): 579-587. 2005.
[4]   | Rizzari C, Valsecchi MG, Arico M, et al Outcome of very late relapse in children with acute lymphoblastic leukemia. Haematologica; 89 (4): 427-434. 2004.
[5]   | Bailey LC, Lange BJ, Rheingold SR, Bunin NJ,Bone-marrow relapse in paediatric acute lymphoblastic leukaemia. Lancet Oncol; 9 (9):873-883. 2008.
[6]   | Ford AM, Fasching K, Panzer, Grumayer ER, Koenig M, Haas OA, Greaves MF Origins of “late” relapse in childhood acute lymphoblastic leukemia with TEL-AML1 fusion genes. Blood; 98 (3): 558-564. 2001.
[7]   | Tallen G, Ratei R, Mann G, et al. Long-term outcome in children with relapsed acute lymphoblastic leukemia after time-point and site-of-relapse stratification and intensified short-course multidrug chemotherapy: results of trial ALL-REZ BFM 90. J Clin Oncol 28 (14): 2339-2347. 2010.
[8]   | Herold R, von Stackelberg A, Hartmann R, Eisenreich B,Henze G. Acute lymphoblastic leukemia-relapse study of the Berlin-Frankfurt-Munster Group (ALL-REZ BFM) experience: early treatment intensity makes the difference. J Clin Oncol; 22 (3): 569-570. author reply 570-561. 2004.
[9]   | Memis A, Killi R, Orguc S, et al Bilateral breast involvement in acute lymphoblastic leukemia: color Doppler sonography findings. AJR (Am J Roentgenol) 165: 1011. 1995.