No abstract available.
Female ; Humans ; Pectoralis Muscles/*diagnostic imaging ; Trigger Points/*diagnostic imaging ; Ultrasonography

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

PURPOSE: The p38 mitogen-activated protein kinase (MAPKs) play a crucial role in the production of pro-inflammatory cytokines and over-expression of it increase cytokines which promote cancer. Among four isoforms, p38α has been well studied in head and neck squamous cell carcinoma (HNSCC) and other cancers as a therapeutic target. p38δ has recently emerged as a potential disease-specific drug target. Elevated serum p38α level in HNSCC was reported earlier from our lab. This study aims to estimate the levels of p38 MAPK-isoforms in the serum of HNSCC and design peptide inhibitor targeting the same. MATERIALS AND METHODS: Levels of p38 MAPK isoforms in the serum of HNSCC and healthy controls were quantified by surface plasmon resonance technology. The peptide inhibitor for p38 MAPK was designed by molecular modeling using Grid-based Ligand Docking with Energetics tools and compared with known specific inhibitors. RESULTS: We have observed highly elevated levels of all four isoforms of p38 MAPK in serum of HNSCC patients compared to the control group. Further, serum p38α, p38β, and p38δ levels were down regulated after therapy in follow-up patients, while p38γ showed no response to the therapy. Present study screened designed peptide WFYH as a specific inhibitor against p38δ. The specific inhibitor of p38δ was found to have no effect on p38α due to great structural difference at ATP binding pocket. CONCLUSION: In this study, first time estimated the levels of p38 MAPK isoforms in the serum of HNSCC. It can be concluded that p38 MAPK isoforms can be a diagnostic and prognostic marker for HNSCC and p38δ as a therapeutic target.
Adenosine Triphosphate ; Carcinoma, Squamous Cell* ; Cytokines ; Epithelial Cells* ; Follow-Up Studies ; Head* ; Humans ; Models, Molecular ; Neck* ; p38 Mitogen-Activated Protein Kinases ; Protein Isoforms* ; Protein Kinases ; Surface Plasmon Resonance