There is a huge lacunae in the delivery of palliative care services and hence an urgent need to inculcate targeted curriculum to provide focused skills and training for the pediatric postgraduates.

Acute lymphoblastic leukemia (ALL) presented with bone pain and leukopenia is a well-recognized complex. Bone and joint pain are seen as presenting symptoms in 25% of patients with acute leukemia, but generalized osteopenia and vertebral complications are less common. Back pain due to vertebral changes as an early feature has been infrequently reported. We report a case of a 9-year-old female child who presented with back pain for 3 weeks. Blood counts and peripheral smear were normal. X-ray of the spine showed wedge-shaped deformity in L3–L5 vertebrae. Magnetic resonance imaging of the spine confirmed the lytic lesions of L3–L5 vertebrae. Infective etiological evaluation was normal. Bone marrow aspiration revealed pre-B-cell lymphoblastic leukemia. She was started on ALL protocol and pain subsided within a week, and remodeling of the bony lesions could be seen 2 months later. This case highlights that spinal involvement may be a presenting feature despite normal peripheral blood counts.

Clinical Presentation: Afro-Caribbean female, age 59, with a comorbidity of hypertension presented with acute painless right-sided vision loss. Brain MRI revealed numerous scattered T2/FLAIR hyperintense foci throughout the periventricular, deep, and subcortical white matter, which were favored to represent chronic microvascular ischemic changes. CTA of the head and neck demonstrated mild atherosclerotic calcification of the cavernous segment of the left internal carotid artery without significant stenosis, mild noncalcified atherosclerotic plaque at the right carotid bifurcation, and mild irregularity and narrowing of the mid basilar artery. Cardiac Imaging: Transthoracic Echocardiography (TTE) demonstrated severe concentric left ventricular hypertrophy, left ventricle ejection fraction 60-65%, and a mobile, intracavitary mass measuring 1.60cm x 1.59cm. Repeat TTE estimated the mass to be 1.8cm x 1.2cm in the region of the posteromedial papillary muscle. Transesophageal Echocardiography (TEE) redemonstrated a mobile left ventricular mass measuring 2.0cm x 1.8cm along the inferior wall of the interventricular septum. Left heart catheterization demonstrated nonobstructive coronary artery disease with a 30% stenosis of the proximal Right Coronary and Distal Circumflex. Patient underwent surgical removal of the cardiac mass, biopsy-proven to be a Papillary Fibroelastoma (PFE). Discussion: PFEs account for 7.9% of all primary benign cardiac tumors and are the most common valvular tumor. More than 80% of these tumors are attached on the aortic or mitral valve, unlike in this patient where it was attached to the left ventricular trabeculae without involvement of the mitral valve or sub-valvular apparatus. The classic appearance of PFEs on TTE is pedunculated and often compared to a sea anemone but appeared homogenous in nature with central vacuolization in this case. This made characterizing the mass as a thrombus or cardiac tumor challenging.

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Objectives:The health care scenario in India is experiencing an increase in the number of children affected with cancer and the number of pediatric oncologists available to treat these children are few and the awareness of childhood cancer is decimally low. Hence, the purpose of this study was to determine the attitude of post-graduate students of general pediatrics towards childhood cancer and to assess their interest in pursuing pediatric oncology as a specialty in their carrier.Materials and Methods:The study was conducted among 188 post-graduates hailing from various Medical colleges all over South India who were attending a 2 day workshop at Chennai. The survey was a 10 point questionnaire pertaining to their previous training, competence, interest toward the field of hematooncology. The data were analyzed by SPSS 18.V software.Results:Among the post-graduates, 74.7% of them reported that they did not have a pediatric oncology unit in their institution. 63.3% reported that they never been posted in pediatric oncology clinical postings before. 62% were not interested in pursuing pediatric oncology as a sub-specialty at all. 45.3% felt that pediatric oncology was too depressing to take as a specialty. 46.7% felt that late diagnosis and referral was the main factor which contributed to the failure of effective treatment of childhood cancers. 52.7% had never attended a class on pediatric oncology. 61.3% felt that they did not have sufficient knowledge to suspect and refer a child with cancer. 92% felt that there was a need to improve pediatric oncology teaching in their curriculum. 56.7% felt that the best way to imprint awareness on childhood malignancies was to improve pediatric oncology teaching in their medical curriculum.Conclusion:The results show that majority of post-graduates in pediatrics were not interested in pursuing pediatric oncology as a sub-specialty. The main reasons may be lack of specialized Pediatric oncology units in the majority of the medical institutions, lack of opportunity of these post-graduates to attend clinical postings and theory classes. They thus lack sufficient information in this field and hence do not want to take up a career in pediatric oncology.