Plasma Interferon-gamma and IL-4, Immunoglobulin Classes and Nitric Oxide in Nigerians with Acute Leukaemia

Acute leukaemia are usually rapidly progressive with death often occurring in a few weeks to a few months in untreated patients as a result of abnormal hematopoietic function as well as impaired immune response. The risk of relapse which remains in 20% of patients in remission calls for more research on acute leukaemia. This study therefore, evaluated the plasma levels of nitric oxide (NO), interleukin-4 (IL-4), interferon-gamma (IFN-γ) and immunoglobulin classes (IgA, IgG, IgM, IgE) in twenty-five (25) patients with acute leukaemia (AL) and twenty-five (25) apparently healthy controls. The mean levels of plasma IgA, IgG and IgM were not significantly elevated in leukaemia patients compared with control. However, the mean plasma levels of IgE, NO, IL-4 and IFN-γ were significantly elevated in leukaemia patients compared with controls. It could therefore be concluded from this study that humoural immunity is not depressed in acute leukaemia patients

Acute leukaemia

Acute leukaemia manifests itself into two different types being Acute Lymphocytic Leukaemia (ALL) and Acute Myelogenous Leukaemia (AML) depending on the type of leukocyte being affected. ALL raises a lot of concern since it is the most common type of leukaemia found in children while CML is the most common type of leukaemia in the United States. This study shows the epidemiology, the etiology, such as chromosomal aberrations and gene mutations and the clinical presentations consisting of both signs and symptoms. It also includes how these types of leukaemia are diagnosed as well as their pathophysiology which comprises detailed description of the alterations in various cellular mechanisms. Finally, the treatment involving both chemotherapy and stem cell therapy, amongst others, has also been discussed.peer-reviewe

Increased risk of venous thromboembolism in patients with acute leukaemia

Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML

The development and usability evaluation of the symptom management module in the support system APP for parents of children with acute leukaemia

Background Childhood cancer is the second cause of death in children. Leukaemia is the most common childhood cancer, accounting for 31% of cancers in children under 14. It has become a global concern for children's health. During the treatment of children with acute leukaemia, symptom management is the most painful thing for children and their parents. The symptom brings pain to children, reduces their quality of life, and affects the disease's prognosis. Moreover, the symptom can lead to the termination of treatment, hospitalization prolongation, and treatment costs increase. Therefore, parents need to participate in the symptom management of their children. The parents of children with acute leukaemia bear the heavy blow of their children’s condition and limited knowledge of leukaemia. They do not have sufficient knowledge for the treatment, care, symptom prevention, recognition, and management of the symptom. Hence, these facts result in an extreme lack of confidence in participating in symptom management of their children. Therefore, symptom management in children with acute leukaemia needs to be highly concerned. With the progress of mobile health technology, more and more information means are applied in chronic disease management. However, few studies focus on symptom management support for parents of children with acute leukaemia. Funded by the National Natural Science Foundation of China, our research team has constructed the framework of the support system APP for parents of children with acute leukaemia. The symptom management module of the support system APP was reserved—this study aimed at the pain points in the symptom management of children with acute leukaemia. By applying mobile health technology, this study constructed the symptom management module in the support system APP for parents of children with acute leukaemia, realized the function of the symptom management module, and finished the usability evaluation of the symptom management module. This study will help improve the effectiveness of symptom management of children with acute leukaemia, enhance parents' symptom management ability, and save medical resources. Objectives This research aims to develop the symptom management module in the support system APP for parents of children with acute leukaemia and evaluate the usability of the symptom management module. Purpose one: To explore the parents’ symptom management needs for children with acute leukaemia; Purpose two: To construct the image-text knowledge base of the symptom management module in the support system APP; Purpose three: To develop the symptom management module in the support system APP; Purpose four: To evaluate the usability of the symptom management module in the support system APP. Methods The study was comprised of 4 parts： Part1: The analysis of parents’ symptom management needs for children with acute leukaemia By the qualitative interview, six healthcare providers of the haematology-oncology department and 14 parents of children with acute leukaemia were interviewed, all from the Children's Hospital of Fudan University and the Children's Hospital of Suzhou University. This study also selected two WeChat groups of the haematology-oncology department of the Children's Hospital of Fudan University and the Children's Hospital of Suzhou University to collect and analyze the chat records of parents of children with acute leukaemia. The content analysis method was used to analyze the data of the interviews and the WeChat group chat records. Hence, the symptoms suitable for parents to manage, the symptom management needs of parents of children with acute leukaemia, and their needs for the symptom management module were deeply understood. Part2: The construction of the image-text knowledge base The clinical manuals, guidelines, scientific literature, and monographs on symptom management of children with acute leukaemia were searched. Combined with the preliminary analysis of symptom management needs in parents of children with acute leukaemia, the framework of the image-text knowledge base was constructed. Then, the symptom management module's preliminary image-text knowledge base was finished. Two researchers and two healthcare providers revised the preliminary image-text knowledge base. Finally, the researcher composed the final image-text knowledge base and reviewed it with two scientific researchers. Part3: The development of the symptom management module in the support system APP Based on the final image-text knowledge base and the analysis of the symptom management needs in parents of children with acute leukaemia, the brainstorming discussion with the multidisciplinary development team was organized to generate the function assumptions of the symptom management module. The multidisciplinary development team included three researchers, two healthcare providers, and two software engineers. By the human-centred concept and the agile development method, the researcher developed the symptom management module with software engineers through five steps: requirement confirmation, interface design, function realization, testing, and disclosure. Part4: The usability evaluation of the symptom management module in the support system APP The formative usability evaluation was implemented during the development of the symptom management module. The formative usability evaluation aimed to find the problems with the module's interface, font, and functions. Then the summarized usability evaluation was implemented when the module was completed. Five researchers, four healthcare providers, and ten parents of children with acute leukaemia were invited to evaluate the usability problems of the symptom management module by typical task analysis, Post-Study System Usability Questionnaire (PSSUQ), and semi-structured interviews. Results Part1: The analysis of symptom management needs in parents of children with acute leukaemia The qualitative study of parents of children with acute leukaemia precipitated: 1) the symptoms that parents participated or wanted to participate in, the preliminary symptom list suitable for parents to participate in (36 physiological symptoms and 5 psychological symptoms); 2) parents’ symptom management needs; 3) the functions of the symptom management module that parents needed. Moreover, the chat records of two WeChat groups were analyzed to supplement the parents’ symptom management needs. The qualitative results of healthcare providers presented: 1) the final symptom list suitable for parents of children with acute leukaemia to participate in (41 physiological symptoms and 6 psychological symptoms); 2) the symptom management-related knowledge that parents need ed to know; 3) the healthcare providers’ suggestion about the functions of the symptom management module. In conclusion, the final symptoms list suitable for parents to participate in (41 physiological symptoms and 6 psychological symptoms) was formed; Symptom management needs of parents of children with acute leukaemia (4 categories and 17 contents); Three main functions of the symptom management module (search function, symptom assessment and response function, and recommendation function). Part2: The construction of the image-text knowledge base The researcher constructed the framework of the image-text knowledge base, which included four categories and 17 contents. According to the framework, the preliminary image-text knowledge base was constructed. After the experts’ review and revision, the final image-text knowledge base was generated, including 41 image-text knowledge articles of physiological symptoms and 6 image-text knowledge articles of psychological symptoms. Part3: The development of symptom management module in the support system APP The functions assumptions of the symptom management module in the support system APP included (1) Active browsing and searching function; (2) Symptom assessment-based recommendation function ; (3) Content-based recommendation function. The functions of the developed symptom management module in support system APP included: (1) Active browsing and searching function: 1)Parents can directly browse the related image-text symptom management knowledge in the symptom management module; 2) Parents can search in the "Search" column, and the related image-text symptom management knowledge will emerge; (2) Symptom assessment-based recommendation function: After filling in the PROMIS (Patient-reported Outcomes Measurement Information System) pediatric self-reported / parent proxy-reported questionnaire in the APP, parents/children will be recommended the related symptom management knowledge according to the score of the PROMIS questionnaire; (3) Content-based recommendation function:1) If parents search for symptom-related information, the relevant image-text symptom management information will scroll in the "Recommended Articles" module in the APP home page; 2) When parents search for information related to chemotherapy drug, side effects related-symptoms of the chemotherapy drug will emerge in the search results; 3) There are physiological symptoms and psychological symptoms in the symptom management module, when it comes to a specific image-text symptom knowledge, the clickable related-symptom links (based on the symptom recommendation rule) are at the bottom of the image-text knowledge page. It will be linked to the other related symptom by clicking. Part4: The usability evaluation of the symptom management module in the support system APP In formative usability evaluation, six fundamental problems of the module interface were found and revised. After the development of the module, the summative usability evaluation was carried out. The scores of the PSSUQ after the test: researchers: 1)system usefulness is 5.2, information quality is 6.0, interface quality is 5.4, and overall evaluation is 6.0; 2) healthcare providers: system usefulness is 5.8, information quality is 6.0, interface quality is 5.9, and overall evaluation is 6.2; 3) parents: system usefulness is 5.8, information quality is 6.0, interface quality is 5.9, and overall evaluation is 6.2. The interview data with parents showed three topics related to usability: 1) " Awareness of symptoms management"; 2) " Advantages and benefits"; 3) " Disadvantages and obstacles." Conclusions Parents of children with acute leukaemia have various needs in symptom management. This study explored the suitable symptoms for parents to participate in (41 physiological and 6 psychological symptoms) and their needs in participation in their children’s symptom management. Based on these findings, the researcher constructed the image-text knowledge base and developed the symptom management module in the support system APP. The usability evaluation showed that the module had good usability and met the symptom management needs of parents of children with acute leukaemia

Breastfeeding patterns and risk of childhood acute lymphoblastic leukaemia.

The risk of childhood acute lymphoblastic leukaemia (ALL) was investigated in relation to breastfeeding patterns in the Northern California Childhood Leukaemia Study. Data collected by self-administered and in-person questionnaires from biological mothers of leukaemia cases (age 0-14 years) in the period 1995-2002 were matched to birth certificate controls on date of birth, sex, Hispanic ethnic status, and maternal race. Ever compared to never breastfeeding was not associated with risk of ALL at ages 1-14 years (odds ratio=0.99; 95% CI=0.64-1.55) and ages 2-5 years (OR=1.49; 95% CI=0.83-2.65). Various measures of breastfeeding duration compared to absence of breastfeeding also had no significant effect on risk. Complimentary feeding characteristics such as type of milk/formula used and age started eating solid foods among breastfed children were not associated with ALL risk. This study provides no evidence that breastfeeding affects the occurrence of childhood ALL

COMPARISON OF CLINICAL, BIOLOGICAL AND EVOLUTIONARY CHARACTERISTICS BETWEEN CHILDHOOD ACUTE LYMPHOBLASTIC AND MYELOID LEUKEMIA IN WESTERN ALGERIA, FROM 2016 TO 2018

Background and Objectives: Haematological malignancies account for approximately 40% of all cancers by the age of 15 years. Acute leukaemia (AL) account for one-third of childhood cancer cases; consisting of Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML). The aim of this work is to describe the epidemiological, clinical, biological and evolutionary characteristics of children with acute leukaemia in the western and south-western region of Algeria. Patients and Methods: A three-year retrospective study was undergone from January 2016 to December 2018 on children with acute leukaemia. The study was conducted at the paediatric oncology department of the anti-cancer -Emir AEK- of Missreghine in Oran. Results: During this period, we identified 135 cases of diagnosed AL. The sex ratio M/F was 1.1. The “two to five-year” age group was the most affected. The prevalence of ALL, AML, and biphenotypic acute leukaemia (BAL) was 60.45%, 23.88%, and 15.57%, respectively. The clinical signs were mainly presented by the tumour syndrome dominated by the presence of lymphadenopathy (63%) and splenomegaly (56.3%). The most frequent abnormal blood abnormalities were anaemia (66.66% in ALL and 28.14% in AML), thrombocytopenia (75.9% in ALL and 24.4% in AML) and leukocytosis (76.3% ALL and 23.7% AML). Conclusion: Paediatric acute leukaemia is a real public health problem that requires special care and attention. This management must involve all epidemiological, clinical and biological aspects for this highly sensitive age group

Representativeness of samples from general practice lists in epidemiological studies: case-control study

Ethical constraints often prevent epidemiological studies from evaluating the impact of non-participation. Particular problems may arise when subjects fail to respond to an approach by researchers or when they cannot be contacted because of inaccurate contact details or a doctor's refusal to give permission for their patient to be approached. If these subjects differ from those subjects who agree or decline to participate then the validity and generalisability of the study may be compromised. We investigated these issues in a case-control study of acute leukaemia in England

Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Group

Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Grou

Some implications of current therapy leukaemia

Improved survival in acute leukaemia follows aggressive combination chemotherapy based on a proper understanding of tumour cell kinetics and principles of modern pharmacology. Such cytoreduction regimens reduce tumour mass to a level at which eradication by immune mechanisms becomes feasible, a fact presently being exploited by immunotherapy programmes. Further improvement is possible by the judicious use of sophisticated support facilities such as laminar flow isolation areas and blood fraction separators, but the cost and expertise of operating such facilities limits availability to a few specialised centres. Logically, patients with acute leukaemia should have the benefit of management in these units.S. Afr. Med. J., 48, 1573 (1974