Publications by authors named "Suvir Singh"

15 Publications

  • Page 1 of 1

Considerations for Peripheral Blood Stem Cell Apheresis in a Low Body Weight Infant.

J Pediatr Hematol Oncol 2021 Dec 30. Epub 2021 Dec 30.

Departments of Clinical Hematology and Stem Cell Transplantation Pediatric Oncology Pediatric Critical Care Transfusion Medicine and Immunohematology, Ludhiana, Punjab, India.

Introduction: Peripheral blood stem cell (PBSC) apheresis in infants (<10 kg body weight) requires specific precautions to prevent periprocedural complications.

Case Report: A 9 month old child was diagnosed with high-risk neuroblastoma and planned for autologous stem cell transplantation after induction chemotherapy. We illustrate the precautions and technical details observed while performing PBSC collection in this patient.

Discussion: Use of continuous flow devices, priming of apheresis circuits, appropriate flow rates and continuous monitoring can help to mitigate several procedure related complications.

Conclusions: PBSC apheresis in infants (<10 Kg) is safe and feasible with appropriate precautions detailed above.
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http://dx.doi.org/10.1097/MPH.0000000000002380DOI Listing
December 2021

Management of Amyloid Cardiomyopathy in Resource-Constrained Settings: Challenges and Opportunities.

JACC CardioOncol 2021 Oct 19;3(4):611-613. Epub 2021 Oct 19.

Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.1016/j.jaccao.2021.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543086PMC
October 2021

Not all thrombocytopenic bleeding is the same: Response to Singh

Authors:
Suvir Singh

J Family Med Prim Care 2021 Aug 27;10(8):3165-3166. Epub 2021 Aug 27.

Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/jfmpc.jfmpc_457_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483134PMC
August 2021

Thrombocytopenia in COVID-19: Focused Summary of Current Understanding of Mechanisms and Clinical Implications.

J Pediatr Hematol Oncol 2021 10;43(7):243-248

Medical Oncology, Dayanand Medical College, Ludhiana, Punjab, India.

Thrombocytopenia is noted in corona virus disease-2019 (COVID-19) with a prevalence of 5% to 41%, and has been observed to be associated with inferior outcomes. The pathogenesis of thrombocytopenia in COVID-19 is unique and differs from other viral syndromes in terms of clinical presentation and causative mechanisms. Platelets act as both targets and the initial defense against severe acute respiratory syndrome-coronavirus 2 and work in concert with the underlying thrombophilic mechanisms to modulate the final disease phenotype. Understanding these mechanisms may possibly allow targeting of a key component of COVID-19 pathogenesis. We provide a focused review of the current mechanisms implicated in development of thrombocytopenia in COVID-19 and therapeutic implications of the same.
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http://dx.doi.org/10.1097/MPH.0000000000002264DOI Listing
October 2021

Cross-sectional Survey of Anticoagulant Use among Specialist Physicians with a Focus on Direct Anticoagulants.

Int J Appl Basic Med Res 2021 Jul-Sep;11(3):177-181. Epub 2021 Jul 19.

Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India.

Introduction: Direct oral anticoagulants (DOACs) have been available for clinical use since 2010 and offer the advantages of a lower bleeding risk with similar efficacy compared to Vitamin K antagonists (VKAs). However, no data is available on practice patterns anticoagulation usage and determinants of the same among physicians in India.

Methods: A cross-sectional survey was conducted using Google Forms comprising of 24 questions in 4 categories on baseline information, practice details, knowledge, and outlook.

Results: A total of 412 physicians were contacted, of which complete responses were received from 50 (12%). Majority had a subspecialist (58%) or a specialist (32%) qualification, with 54% working in a medical college. VKAs were the preferred first-line agent for 46%, with the most common perceived disadvantage being need of regular monitoring. The absence of regular blood testing was the most prominent advantage attributed to novel oral anticoagulants (NOACs) by 76% participants. Equivalent number of participants perceived efficacy to be similar in both groups, and 86% indicated NOACs to have better safety. Most participants responded to knowledge-based questions correctly and cited high costs of DOACs as the most common barrier to clinical use (78%).

Conclusions: Our survey indicates VKAs as the preferred first-line agents despite perceived disadvantages. Among specialist physicians, high drug costs and not lack of knowledge or familiarity appear to be predominant factors precluding more frequent use of NOACs.
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http://dx.doi.org/10.4103/ijabmr.ijabmr_135_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360223PMC
July 2021

Mitigation of in-hospital risk of coronavirus disease 2019: Experience from a haematology-oncology and stem cell transplant setting.

Natl Med J India 2021 Jan-Feb;34(1):10-14

Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.

Background: . Coronavirus disease 2019 (Covid-19) was first described in December 2019 and has evolved into an ongoing global pandemic. Cancer patients on chemotherapy are immunocompromised and are at the highest risk of Covid-19-related complications. We describe our experience with the management of haematology-oncology and stem cell transplant (SCT) patients receiving curative chemotherapy in a hospital with a high influx of Covid-19 patients.

Methods: . We did a prospective observational study at a 99-bedded cancer centre of a tertiary care teaching hospital from April 2020 to September 2020. Preventive measures taken were categorized as follows: (i) staff: screening, mandatory use of personal protective equipment (PPE), risk stratification of potential exposure and testing and isolation as needed; (ii) patients: mandatory viral polymerase chain reaction testing, segregation of positive and untested patients and testing of family members; and (iii) environment: mandatory regular cleaning, visitor restriction, telemedicine services and reassignment of priority to clinic visits. Treatment of the underlying conditions was continued with added precautions.

Results: . A total of 54 patients were included in the analysis, including 48 with haematological malignancies and 6 for stem cell therapy. Preventive measures were universally applied, and chemotherapy with a curative intent was initiated as per protocol. Three patients were detected to have Covid-19 infection before admission and one after the institution of chemotherapy. Nine patients died after the first cycle of chemotherapy, 2 due to severe Covid-19-related illness and 7 due to complications of chemotherapy or disease progression.

Conclusions: . In the wake of the Covid-19 pandemic, treatment for haematological malignancies must continue while balancing the risk of Covid-19 infections. Our report emphasizes the effectiveness of measures such as hand hygiene, social isolation, patient segregation, use of masks and PPE and universal pre-treatment testing for Covid-19 in reducing the risk of infection in a high-risk clinical setting.
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http://dx.doi.org/10.4103/0970-258X.315901DOI Listing
August 2021

Physician schedules and patient safety: Critical appraisal.

Natl Med J India 2020 Nov-Dec;33(6):359-361

Hero DMC Heart Institute, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/0970-258X.321146DOI Listing
September 2021

Real world data on clinical profile, management and outcomes of venous thromboembolism from a tertiary care centre in India.

Indian Heart J 2021 May-Jun;73(3):336-341. Epub 2021 Feb 17.

Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India. Electronic address:

Objectives: Venous thromboembolism (VTE) is a major cause of mortality and morbidity worldwide. This study describes a real-world scenario of VTE presenting to a tertiary care hospital in India.

Methods: All patients presenting with acute VTE or associated complications from January 2017 to January 2020 were included in the study.

Results: A total of 330 patient admissions related to VTE were included over 3 years, of which 303 had an acute episode of VTE. The median age was 50 years (IQR 38-64); 30% of patients were younger than 40 years of age. Only 24% of patients had provoked VTE with recent surgery (56%) and malignancy (16%) being the commonest risk factors. VTE manifested as isolated DVT (56%), isolated pulmonary embolism (PE; 19.1%), combined DVT/PE (22.4%), and upper limb DVT (2.3%). Patients with PE (n = 126) were classified as low-risk (15%), intermediate-risk (55%) and high-risk (29%). Reperfusion therapy was performed for 15.7% of patients with intermediate-risk and 75.6% with high-risk PE. In-hospital mortality for the entire cohort was 8.9%; 35% for high-risk PE and 11% for intermediate-risk PE. On multivariate analysis, the presence of active malignancy (OR = 5.8; 95% CI: 1.1-30.8, p = 0.038) and high-risk PE (OR = 4.8; 95% CI: 1.6-14.9, p = 0.006) were found to be independent predictors of mortality.

Conclusion: Our data provides real-world perspectives on the demographic sand management of patients presenting with acute VTE in a referral hospital setting. We observed relatively high mortality for intermediate-risk PE, necessitating better subclassification of this group to identify candidates for more aggressive approaches.
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http://dx.doi.org/10.1016/j.ihj.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322750PMC
October 2021

Clinical and Molecular Attributes of Patients With BCR/ABL1-negative Myeloproliferative Neoplasms in India: Real-world Data and Challenges.

Clin Lymphoma Myeloma Leuk 2021 06 23;21(6):e569-e578. Epub 2021 Feb 23.

Molecular Genetics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Introduction: Classic BCR/ABL1-negative myeloproliferative neoplasms (MPNs) are characterized by clinical and genetic heterogeneity and include 4 distinct constituents. Very little data on clinical presentation and epidemiology of the same is available from the Indian setting.

Patients And Methods: Patients referred to Hematology-Oncology from January 2018 to August 2020 with suspected MPNs were included in the analysis and prospectively followed-up. All patients were initially screened, and only those meeting the updated World Health Organization 2016 criteria were included in the analysis. Epidemiologic, clinical, and molecular characteristics were documented, and patients were followed-up prospectively.

Results: A total of 233 patients were referred for evaluation of MPN, of which 63 were included in the analysis, including 39 males and 24 females. The median age at diagnosis was 57 years (range, 28-82 years), and 38% patients were younger than 50 years of age. The most common presentations were incidental detection in 35 (55.5%), abdominal symptoms in 13 (20%), fatiguability in 7 (11%), and recent vascular events in 6 (9.5%) patients. Final diagnosis was polycythemia vera in 27, essential thrombocytosis (ET) in 21, prefibrotic myelofibrosis in 9, and myelofibrosis in 6 patients. The frequency of driver mutations in polycythemia vera included JAK2 in 75%; in ET, JAK2 in 33%, CALR in 33%, and MPL in 4%; and in prefibrotic myelofibrosis, JAK2 in 66% and CALR in 33%. Aspirin was used for all patients along with risk-adapted cytoreduction with hydroxyurea. Ruxolitinib was reserved for symptoms refractory to hydroxyurea. After a median follow-up of 15 months (interquartile range, 10-28 months) from diagnosis, disease progression was noted in 4 patients. Two patients died at the end of the follow-up period, including 1 with secondary acute myeloid leukemia post myelofibrosis and one with ET and coexistent oral malignancy. The remaining 61 patients are alive and on regular treatment.

Results: This is one of the first systematic descriptions and prospective follow-up of patients with BCR/ABL-negative MPNs from India. Our study indicates a younger median age of presentation and higher proportion of JAK2-unmutated disease across all subtypes. The primary role of bone marrow morphology and supportive role of somatic mutations in differentiating MPN subtypes is indicated.

Conclusions: This study sets the stage for a collaborative registry for defining epidemiologic data and long-term outcomes with MPN in India.
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http://dx.doi.org/10.1016/j.clml.2021.01.017DOI Listing
June 2021

Treatment of Acute Leukemia During COVID-19: Focused Review of Evidence.

Clin Lymphoma Myeloma Leuk 2021 05 12;21(5):289-294. Epub 2021 Jan 12.

Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

The Coronavirus disease-2019 (COVID-19) pandemic is an unprecedented health care crisis and has led to over 1.5 million deaths worldwide. The risk of severe COVID-19 and mortality is markedly raised in patients with cancer, prompting several collaborative groups to issue guidelines to mitigate the risk of infection by delaying or de-escalating immunosuppressive therapy. However, delayed therapy is often not feasible for patients requiring treatment for acute leukemia or stem cell transplantation. We provide a focused review of the recommendations and evidence for managing this high-risk group of patients while minimizing the risk of COVID-19 infection, and provide a small snapshot of treatment data from our center.
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http://dx.doi.org/10.1016/j.clml.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801183PMC
May 2021

Pediatric Subcutaneous Panniculitis-like T-Cell Lymphoma With Hemophagocytosis Showing Complete Resolution With the BFM90 Protocol: Case Report and Review of Literature.

J Pediatr Hematol Oncol 2019 08;41(6):478-481

Clinical Haematology and Bone Marrow Transplantation, Christian Medical College, Ludhiana, Punjab.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a distinct subtype of peripheral T-cell lymphoma associated with aggressive clinical behavior. Since its original description, it has continued to be a rare disease, and <200 cases have been reported in literature. We report an 11-year-old boy who presented with SPTCL and hemophagocytic lymphohistiocytosis (HLH) and responded to high-dose multiagent chemotherapy. He presented with steroid refractory erythematous, raised plaques over his face, trunk, and limbs over a period of 15 months treated elsewhere. Repeat evaluation in our center was consistent with SPTCL with features of HLH. He was initiated on therapy with the BFM90 protocol, which led to complete morphologic and biochemical remission. No single-best treatment regimen has been described for SPTCL with HLH in literature, and high-dose chemotherapy has shown good long-term remissions in the literature. The presence of SPTCL with HLH and systemic symptoms should prompt treatment with high-dose multiagent chemotherapy rather than Cyclophosphamide, Vincristine, Adriamycin, Prednisolone-like therapy. BFM90 is one such regimen that is well tolerated, and it can induce significant clinical and biochemical responses.
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http://dx.doi.org/10.1097/MPH.0000000000001434DOI Listing
August 2019

Spinal Epidural Bleed in Hemophilia: A Rare Site of Bleeding With Complete Resolution With Nonsurgical Management.

J Pediatr Hematol Oncol 2019 04;41(3):215-217

Departments of Clinical Hematology and Bone Marrow Transplantation.

Hemophilia A is an inherited bleeding disorder, seen in 1 in 10,000 live births. It is characterized by an increased risk of bleeding, especially involving the musculoskeletal system. Central nervous system bleeding, including brain and spinal cord bleed is rare in the absence of overt trauma, seen in <5% patients. Epidural spinal bleeding in hemophilia is even rarer, and described in <20 patients so far in literature. We describe a young boy who presented with a cervical spine epidural bleed, and was managed conservatively without any sequelae. We also look at the controversies and recent evidence weighing surgical and conservative management of such bleeds.
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http://dx.doi.org/10.1097/MPH.0000000000001335DOI Listing
April 2019

Kite flying: ancient tradition or death trap?

Emerg Med Australas 2014 Oct 10;26(5):478-80. Epub 2014 Sep 10.

Department of Pediatric Surgery, Christian Medical College and Hospital, Ludhiana, India.

Background: Kite flying has been popular in India since ancient times, especially during harvest festivals of Lohri, Basant and Makar Sankranti. It often takes form of a competitive sport and in recent times has been associated with multiple, sometimes fatal injuries. This prognostic study was conducted to try and understand the epidemiology and factors associated with kite flying injuries in the state of Punjab, India.

Methods: Case reports of patients who presented to the ED with trauma as a result of kite flying were reviewed. The study included patients reporting to the Christian Medical College, Ludhiana, between January 2005 and January 2010. Details of the type and mode of injury, and outcomes were recorded.

Results: The highest incidence of injuries occurred during months of the kite flying festivals. The most common mode of injury was fall from heights, associated with traumatic brain injury. The mortality rate in this series was 6.25%.

Conclusions: This study highlights the importance of kite flying injuries as a common mode of injury in children and adolescents. It is an easily preventable mode of injury with simple safety regulations and possibly stronger legislation.
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http://dx.doi.org/10.1111/1742-6723.12270DOI Listing
October 2014

Case report of Aspergillus osteomyelitis of the ribs in an immunocompetent patient.

J Glob Infect Dis 2013 Jul;5(3):118-20

Department of Medicine, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, India.

Aspergillus is a saprophytic fungus which is universally found in the environment. Most people breathe in the spores of Aspergillus every day without development of disease. It commonly affects immunocompromised hosts. There are only few reported cases in an immunocompetent host. It most commonly affects the respiratory system, causing superficial or invasive disease. It also affects the skin, brain and eye in severely immunocompromised patients. Aspergillosis of the bone is extremely rare. Amongst all the reported cases of invasive aspergillosis the incidence of osteomyelitis is less than three percent. In these cases commonly of the spine is reported. We present a case of Aspergillus osteomyelitis of the ribs in an immunocompetent host.
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http://dx.doi.org/10.4103/0974-777X.116875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766334PMC
July 2013
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