Clinical Spectrum of Advanced Neuroblastoma

Background: To analyze the spectrum of neuroblastoma and burden of high risk malignancy on the public sector tertiary center.Methods: In this descriptive study, 70 patients with neuroblastoma were enrolled. Data regarding their age, sex, type (infantile <547 days or 18 months or more than 18 months), staging and clinical features, bone and bone marrow involvement, course of therapy and outcome was analyzed . The staging was done on the basis of bilateral bone marrow biopsy and imaging CT Scans, MRI neck chest and abdomen and bone scans. Patients were treated with conventional vincristine, cyclophosphamide, doxorubicin, etoposide and carboplatin for 6-8 courses 2-3 weeks apart depending upon the age whether 18 months or older group. Evaluation was done after 2-4 courses to see the response and options for surgery by doing imaging in the form of MRI or CT scans.Results: Total 70 patients with age ranging from< 1 year to 15 years (median age of 3 yrs) were included. M: F Ratio was 1.8:1. Non-infantile type (70%), stage IV (79%) and adrenal mass (47%) were the commonest presentations. Bone and bone marrow involvement was seen in 53% and 70% , respectively. Thirty out of seventy (43%) successfully completed the chemotherapy, 12/70(17%) abandoned treatment, 17/70 (24%) expired due to progressive disease and infections, 7/70(10%) were put on palliative treatment at presentation 4/70(6%) relapsed and given palliation therapy.Conclusion: In resource limited settings, neuroblastoma stage IV is a challenging malignancy to deal with. There is intense need of increased capacity building to diagnose them early and implementation of effective infection control measures with better survival options in these patients

Diagnostic issues and clinical spectrum of childhood degenerative brain diseases

To find out the spectrum of clinical presentation and typesof neurodegenerative disorders of childhoodin tertiary care child neurology centre of Pakistan. To find out the role of brain imaging in the diagnosis of degenerative brain disorders in children. Methods: It will bea retrospective, descriptive study conducted at department of paediatric neurology,The Children’s Hospital, Institute of child health, Lahore, Pakistanfrom January 1st,2004 to December 31,2013 (10 years). A total of 22,737 patients were admitted in the Paediatric Neurology department in the above said period. Out of them 366 children fulfilled the inclusion criteria. History, clinical examination and relevant investigations were evaluated from the files manually and proformas were filled. Results: Male to female ratio was 1.43:1 with 78% incidence of consanguinity. Age range was twenty five months to eighteen years. Metachromatic leukodystrophy was the predominant type(21%) followed by adrenoleukodystrophy(1%) and cerebral atrophy (9.5%)and 3% of each Alexander disease, Hellervordenspatz disease, one case each of multiple sclerosis and ataxia telangiectasia. Conclusion: Degenerative brain diseases are common entity in paediatric population. Commonest presentation is regression of mile stones with variable presentation. General pediatriciansmust be aware of their clinical presentation look into it when dealing with children having regression of milestones to diagnosethem earlier.Because of limited diagnostic modalities, brain imaging has significant valve. Facilities for molecular genetics and enzymes should have been available. Regional diagnostics laboratories should have been established and more research is required in this area

Perception of healthcare workers regarding the psychological impact of COVID-19 on their children

Background and Objective: Pandemics like COVID-19 adversely affect children&rsquo;s behavior and psychological development by disrupting routine life activities. Children of healthcare workers are exposed additionally due to the fear of parental exposure to the virus. The objective of this study was to assess the perception of frontline healthcare workers (HCWs) regarding the psychological impact of the COVID-19 pandemic on their children. We also sought to identify the difference of the psychological impact on children of the male and female healthcare workers.Methods: A survey questionnaire was developed comprising 10 questions about the perception of HCWs regarding the psychological impact of COVID-19 on their children. It was distributed both online and face to face among 150 healthcare professionals, working in training and non-training posts in 4 public and 5 nongovernment hospitals of Pakistan. The mean and standard deviation were calculated for each survey item using Statistical Package for the Social Sciences 26.0. Results: The response rate was 71.3% and majority (64.2%) of the healthcare professionals were &ge;30 years of age. Ninety-two HCWs (85.98%) either agreed or strongly agreed that the parental separation from their kids for long hours during the pandemic had a negative psychological impact on their children. There was a significant difference in perceived psychological impact of COVID-19 on the children of male and female HCWs, with a mean survey score of 2.29 &plusmn; 1.82 and 1.69 &plusmn; 0.79, respectively (t = 2.29, p-value = 0.024).Conclusion: Children of the healthcare workers experience more stress and anxiety because of long duty hours and working in high-risk settings. Continuous psychological support and counseling services may be adopted formally to prevent unforeseen adverse events or any long-term negative impact on their physical and mental health.</p