Effect of Sickle Cell Crises Prevention Guide for Children on Parents Knowledge and Reported Practices

Sickle cell anemia (SCA) is a global health concern associated with high childhood morbidity and mortality. The major associated complication is sickle cell crisis which cause frequent hospital admission. Therefore, the purpose of this study was to examine the effect of sickle cell crises prevention guide for children on parents’ knowledge and reported practices. The study was conducted at Hematology & oncology unit of Pediatric department at Menoufia University Hospital and Health insurance hospital for children.  A quazi experimental design was used. A convenient sample of parents with sickle cell children in the above mentioned settings were selected (34 parents) from January to November 2018. One tool was used for data collection consists of 4-sections questionnaire to assess parents' knowledge and practice. The results of this study revealed that there were knowledge deficit between parents' about sickle cell disease, approximately two thirds of parents (64.7%) had improved on post intervention for reported practices of crisis prevention than pre intervention. Also, 79.4% of parents didn’t use social and cultural practices in prevention of sickle cell crises post intervention. Therefore, there was a highly statistical significance differences between pre and post intervention. Conclusion, implementing sickle cell prevention guide improve parents’ knowledge and reported practices for prevention of crises to promote children recovery. Recommendation, ensure that sickle cell booklets are made available to hospitals for parents in order to remind themselves on treatment and prevention of sickle cell crises. Keywords: Sickle cell crisis, knowledge, Practice DOI: 10.7176/JHMN/64-07 Publication date:July 31st 201

Glucose metabolism abnormalities among pediatric acute lymphoblastic leukemia survivors: Assessment and relation to body mass index and waist to hip ratio

AbstractBackgroundAs survival rates of pediatric acute lymphoblastic leukemia (ALL) improve, attention is turning to side and late effects of therapy including glucose metabolism abnormalities.ObjectiveTo asses the presence of abnormal glucose metabolism in pediatric ALL survivors and its possible relation to body mass index (BMI), waist to hip ratio and treatment related factors.Subjects and methodsRetrospective study with a prospective follow-up of 12 ALL survivors who had been off chemotherapy for >9months was done. Fifteen healthy sex and age matched children were involved as controls. Body mass index (BMI) waist to hip ratio (WHR), and Oral glucose tolerance test (OGTT) were performed with assessment of glycated hemoglobin (Hb A1C) and insulin sensitivity indices.ResultsAt study time the mean BMI, WHR, all components of the OGTT (except the 2h post load glucose), all indices of insulin sensitivity and the mean Hb A1C% were significantly higher compared to those of the controls. Two survivors (16.6%) developed transient hyperglycemia during therapy, one (8.3%) had pre-diabetes, seven (58.3%) had a risk level of Hb A1C but no one had diabetes mellitus (DM) or insulin resistance (IR). At study time the two survivors with transient hyperglycemia during therapy had a significantly high WHR compared to the remainders. WHR of the survivors at study time correlated significantly with fasting plasma glucose and area of insulin under the curve (AUC). The 2h post-prandial plasma glucose correlated with the duration after therapy completion.ConclusionsWHR may play a better role than BMI in the prediction of insulin resistance in those patients. Hb A1C may increase earlier than other indices of glucose tolerance

Serum cystatin C and microalbuminuria in children with immune thrombocytopenia under short course of corticosteroids

Background: Corticosteroids are the universally accepted first line therapy for moderate and severe immune thrombocytopenia (ITP). Objectives: We investigated the effect of a short course prednisolone on serum cystatin C and the appearance of microalbuminuria as markers for renal injury in a group of ITP children. Methods: The study involved 33 (19 males, 14 females) newly diagnosed ITP children divided into two groups; group I included 15 children with no or mild bleeding treated according to “watch and wait” policy; group II included 18 children of moderate or severe bleeding treated by oral prednisolone. Fifteen healthy, age and sex matched children were enrolled as a control group. Blood urea, serum creatinine, estimated glomerular filtration rate (eGFR) by Schwartz formula, serum cystatin C (by ELISA) and urinary albumin concentration (by immunoturbidimetric assay) were determined. Results: The baseline investigations were comparable in the three groups and were within the reference ranges. Corticosteroids of 12 mg/kg cumulative dose had induced significant increments in serum creatinine [from 0.62 ± 0.16 to 0.84 ± 0.12 mg/dL, p < 0.0001] cystatin C [from 750.83 ± 108.1 to 2300.55 ± 991.94 ng/ml, p < 0.0001] and decreased eGFR [from 116.69 ± 40.87 to 79.76 ± 24.48 ml/min/1.73 m2, p = 0.001] without change in urinary albumin concentration or induction of microalbuminuria in paired analysis. Conclusion: Although not accompanied by microalbuminuria, steroid induced cystatin C elevation could be attributed in part to impaired GFR. Large population follow up studies are recommended to investigate the reversibility of this effect

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality