Malnutrition: A Risk Factor in Childhood Acute Lymphoblastic Leukemia

Background: Malnutrition is an adverse prognostic factor in the outcome of children with standard risk acute lymphoblastic leukemia due to a significantly higher rate of bone marrow relapse in the malnourished patients. The event free survival of children with acute lymphoblastic leukemia in developed countries has increased substantially in the last two decades as treatment with intensive protocols has brought the estimated probability of event free survival at 5 years close to 75%. Although the prognosis of acute lymphoblastic leukemia has also been improved in underdeveloped countries, the figures for event free survival are lower, even when aggressive protocols are used. Unfavorable socioeconomic factors could contribute to this observation. Patients and Method: A retrospective study was done on cases of childhood acute Lymphoblastic Leukemia admitted to the Pediatrics Oncology Ward in AL-Kadhimiyia Teaching Hospital over a period of one year from 1st of June 2007 to end of May 2008.Fifty five patients were collected .Informations were taken from the case sheets of the patients and their records in the Pediatric Oncology Clinic. Weight and height were recorded, Using charts of height for age (Ht/Age) and the Z score = -1.28 (10th percentile), the patients were divided into two groups, malnourished and well nourished. Results: Of the studied group, 28 patients (51%) were between 1-10 years. Thirty two patients (58.2%) were males and 23 (41.8%) were females, with male to female ratio of 1.39:1. Thirty Six (65.45%) patients were below 10th percentile (with Z score below – 1.28) i.e. malnourished, and 19 (34.55%) patients above 10th percentile (Z score above – 1.28) i.e. well nourished. Of the malnourished patients, 26(81.2%) patients achieved complete remission, while in comparison to well nourished patients, 16(84.2%) patients achieved complete remission. The result is statistically not significant (p. value > 0.05). During follow up, of the 42(82.3%) patients that achieved complete remission, 12(28.57%) relapsed, 9(34.62%) of them were malnourished. Death occurred in 7 (16.67%) patients, 6 (23.08%) of them were malnourished. Three patients (7.14%) discontinue treatment, 1(3.84%) of them was malnourished. Twenty (47.62%) patients remained with continuous complete remission, 10 (38.46%) patients were malnourished and another 10(62.5%) were well nourished. Using the Chi square, the results were statistically not significant (p. value> 0.05). Conclusion: From this study, it was concluded that malnutrition in children with acute lymphoblastic leukemia is considered an important risk factor. Although malnourished children achieved complete remission but a high percentage of them relapsed or died

Childhood Idiopathic Thrombocytopenic Purpura: A Retrospective Analysis Of Clinical Features And Response To Treatment

Background : A retrospective study was done in the Pediatric ward /AL-Kadhimiyia Teaching Hospital on cases diagnosed as idiopathic thrombocytopenic Purpura admitted since the first of January1992 – the end of December 2004. Aim of the study : The objective of this paper is to review the natural history of idiopathic thrombocytopenic Purpura , presenting feature and response to treatment. Patients and methods : The review included age ,sex , clinical presentation , physical finding , complications , investigation ,treatment and course of the diseases . Results: total number of the patients were 65, peak age was between (2 -5) years, 40 cases (61.53%). Females were affected more than Males with male: female ratio of 1: 2.09 .There was no seasonal variation and all of the cases were preceded by viral upper respiratory tract infection .The main presentation was petechiae and ecchymosis, were found in all of them (100%) followed by epistaxis, 43 cases (66.15 %). In the majority the platelet count was < 20.000 X 10 9 /L, 32 cases (49.23 %) and the hemoglobin level was between 10 – 11gm /dl in most of them, 43 cases (66.15%). Steroid was the first line treatment, response occur within 2 – 3 weeks in the majority, 51 cases (78.46%). Chronic idiopathic thrombocytopenic Purpura occurred in 3 cases only (4.61%).Splenectomy was done in 2 of them (66.66%). No mortality detected. Conclusion : Idiopathic thrombocytopenic purpura is a mild disease with complete recovery in the majority of patient

A study of the effect of Nigella sativa (black seeds) on methotrexate-induced hepatotoxicity in rabbits

Background: To evaluate the effectiveness of Nigella sativa (NS) in the prevention of hepatotoxicity of large doses of methotrexate (MTX) (IP) in rabbits.Methods: Three groups of male rabbits, six in each were used. Oral dosing was administered as a paste; formula 1 was prepared by mixing 2 g flour with water; formula 2 contained flour and NS and water. Group 1 was fed with formula 1 daily and injected with 2 ml/kg normal saline IP. Group 2 was given formula 1 daily with 20 mg/kg MTX IP. Group 3 was fed with formula 2 daily + MTX 20 mg/kg IP. Injections were given weekly for 5 weeks, and then the animals were sacrificed at day 39. Liver enzymes, malondialdehyde (MDA), glutathione (GSH), and histopathology of the liver were evaluated.Results: Liver enzymes, serum, and liver MDA were significantly increased by MTX. MTX + NS treatment significantly reduced the rise in liver enzymes, MDA in serum with little effect on liver MDA. Serum aspartate aminotransferase, alkaline phosphatase, and bilirubin were reduced from 82.8±18.04 U/L, 4.9±2.0 kind and king unit/100 ml and 0.74±0.1 mg/dl to 56.1±7.5, 2.0±0.6 and 0.27±0.1 respectively. Unexpectedly, serum and liver GSH were slightly increased by MTX. Treatment with MTX + NS further increased these levels. Histologically, portal and lobular sinusoidal dilatation, lymphocytic infiltration, and hepatocyte hydropic degeneration were seen in all rabbits on MTX, which disappeared in three rabbits on NS + MTX.Conclusion: NS is hepatoprotective against MTX induced hepatotoxicity

The Relationship Between Helicobacter Pylori Infection And Childhood Idiopathic Thrombocytopenic Purpura

Background: Idiopathic thrombocytopenic purpura , a disorder characterized by autoantibody mediated platelets destruction causing decreased number of circulating platelets manifest as bleeding tendency. Since the discovery of Helicobacter pylori (H. pylori ) several studies have been published concerning a hypothetical role of this bacteria in idiopathic thrombocytopenic purpura. Aim of the study: Evaluate the pathogenic correlation between H.pylori infection and idiopathic thrombocytopenic purpura. Patients and Method: A cross sectional study was done on 30 cases of idiopathic thrombocytopenic purpura admitted to the Pediatric Hemato-Oncology unit in ALKadhimiyia Teaching Hospital and 20 cases of sex and age matched healthy children as a control to determine the relation between H. pylori infection and idiopathic thrombocytopenic purpura. The peak age for idiopathic thrombocytopenic purpura was between ( 6-10 years) of age, (43.33%). Male : female ratio equal to 2:1 . ELIZA test was used to measure the serum IgG antibody titer against H. pylori , 5 cases of idiopathic thrombocytopenic purpura was found to be positive for H.pylori (16.67%)while the test was negative in all of the control group (100%) , Results: a result which is statistically highly s i g n i f i c a n t , p - value<0.05. Of the positive cases 3 (60%) was chronic idiopathic thrombocytopenic purpura and two cases (40%) was acute idiopathic thrombocytopenic purpura. Patients with positive test were older than those with negative test. The mean platelet count was less in the positive than those with negative test. A weak inverse correlation was found between platelet count and H.pylori serum antibody titer( r- value equal to - 0.13437). The test was sensitive in (20%) and specific in (100%) of cases. Conclusion: H. pylori infection may play a role in the initiation of idiopathic thrombocytopenic purpura and eradication of H.pylori infection can cure idiopathic thrombocytopenic purpura specially in chronic and resistant cases. The ELIZA test can be used as a screening test to detect H.pylori infection in children with idiopathic thrombocytopenic purpura

Temperature Effects on Growth of the Biocontrol Agent Pantoea Agglomerans (an Oval Isolate From Iraqi Soils)

The growth response of the biocontrol agent Pantoea agglomerans to changes in temperature was determined in vitro in nutrient yeast extract-sucrose medium. The minimum temperature at which P. agglomerans was able to grow was 4°C and the maximum temperature was 42°C. This study defines the range of environmental condition (Temperature) over which the bacteria may be developed for biocontrol of postharvest diseases

Effect of some anticancer drugs on the growth of children with Acute Lymphoblastic Leukemia in Iraq

Acute Lymphoblastic Leukemia (ALL) is the most common type of leukemia in children. It represents about 75% of all leukemia types in children less than 15 years old and peak incidence at (2-5) years old. The study was designed to evaluate the effect of chemotherapeutic regimens used for Iraqi children with ALL by assessing anthropometric parameters, oxidative state markers, and metabolic state. This prospective randomized clinical study was carried out on (30) newly diagnosed children with ALL (6 months – 8 years old) in Iraq. According to the FAB-classification, the patients grouped as L1 group (n=16) and L2 group (n=14). A healthy children (n=14) were involved and considered as a control group to compare their normal data with these of patients groups. The IGF-I, albumin, total serum protein, BMI, TAS, and LDH were determined at baseline, 1st, 2nd, and 3rd months of the treatment regimen. The results showed that the mean level of serum IGF-I in both patient groups was significantly lower than that of control children at baseline, and it is increased significantly after receiving treatment while no significance difference between patients of both groups. Serum albumin, total serum protein, and BMI showed no significant differences in both patient groups when compared with the control group at baseline and after receiving treatment, also, between patients of both groups. TAS showed a significant reduction at baseline and after receiving treatment of both patients’ groups when compared with the control children, and there was a significant difference between patients of both groups. For LDH, there was a significant elevation in the mean level at baseline for both patients’ groups when compared with the control children, while after receiving treatment a significant reduction noticed in both groups when compared with control children and no significance difference between patients of both groups. These results can give indication for the effect of chemotherapy on the growth and nutrition of ALL children through their effects on IGF-I, which has a direct effect on GH and the reduction in the levels of total proteins and albumin, which may affect BMI, while the reduction in TAS during chemotherapy treatment may result in disruption of cells metabolism which will affect the normal body homeostasis. Keywords: ALL, Growth, IGF-I, Chemotherapy

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Managing Portfolio Risk Using Multivariate Extreme Value Methods

This paper provides a strategy for portfolio risk management by inferring extreme movements in financial markets. The core of the provided strategy is a statistical model for the joint tail distribution that attempts to capture accurately the data generating process through an extremal modelling for the univariate margins and the multivariate dependence structure. It takes into account the asymmetric behavior of extreme negative and positive returns, the heterogeneous temporal and cross-sectional lead-lag extremal dependencies among the portfolio constituents. The strategy facilitates scenario generation for future returns, estimation of portfolio profit-and-loss distribution and calculation of risk measures, and hence, enabling us to answer several questions of economic interest. We illustrate the usefulness of our proposal by an application to stock market returns for the G5 economies

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely