Treatment results and prognostic factors of pediatric neuroblastoma: a retrospective study

<p>Abstract</p> <p>Background</p> <p>We conducted a retrospective analysis to investigate treatment results and prognostic factors of pediatric neuroblastoma patients.</p> <p>Methods</p> <p>This retrospective study was carried out analyzing the medical records of patients with the pathological diagnosis of neuroblastoma seen at South Egypt Cancer Institute, Assiut University during the period from January 2001 and January 2010. After induction chemotherapy, response according to international neuoblastoma response criteria was assessed. Radiotherapy to patients with residual primary tumor was applied. Overall and event free survival (OAS and EFS) rates were estimated using Graphed prism program. The Log-rank test was used to examine differences in OAS and EFS rates. Cox-regression multivariate analysis was done to determine the independent prognostic factors affecting survival rates.</p> <p>Results</p> <p>Fifty three cases were analyzed. The median follow-up duration was 32 months and ranged from 2 to 84 months. The 3-year OAS and EFS rates were 39.4% and 29.3% respectively. Poor prognostic factors included age >1 year of age, N-MYC amplification, and high risk group. The majority of patients (68%) presented in high risk group, where treatment outcome was poor, as only 21% of patients survived for 3 year.</p> <p>Conclusion</p> <p>Multivariate analysis confirmed only the association between survival and risk group. However, in univariate analysis, local radiation therapy resulted in significant survival improvement. Therefore, radiotherapy should be given to patients with residual tumor evident after induction chemotherapy and surgery. Future attempts to improve OAS in high risk group patients with aggressive chemotherapy and bone marrow transplantation should be considered.</p

Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt

A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a per-formance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other dis-tricts in Egypt

The value of YKL-40 in ischemic heart disease patients

Introduction Atherosclerotic coronary artery disease is considered to be the most common cause of myocardial ischemia. YKL-40, a chitin-binding acute phase glycoprotein, has been found to be expressed by macrophages in atherosclerotic plaques. The YKL-40 could potentially be a new useful biomarker to monitor severity and predict early diagnosis of acute coronary syndrome (ACS) in ischemic heart disease (IHD) patients. Aim The aim of this study was to measure the level of serum YKL-40 in IHD patients and to clarify its role as a potentially beneficial diagnostic marker in those patients. Patients and methods Serum YKL-40 was measured in 60 IHD patients and 30 healthy controls. According to chest pain analysis, ECG changes, and cardiac enzymes, the IHD patients were categorized into patients with stable angina and patients with ACS. Results The median level of YKL-40 (pg/ml) was significantly elevated in patients with IHD compared with the control group (2080 (575.5–5974.6) vs 522.6 (133.2–769.5), respectively; P<0.001). The median level of YKL-40 was also significantly higher in patients with ACS compared with patients with stable angina (2436 (576–5975) vs 1015 (675–1822), respectively; P˂0.001). There was a positive correlation between YKL-40 levels and high-sensitivity C-reactive protein (mg/dl) in all studied groups of IHD patients. However, no significant correlation was detected between YKL-40 and age, systolic or diastolic blood pressure, and lipid profile in patients with IHD. Conclusion YKL-40 might play an important role as a diagnostic and prognostic marker in patients with IHD and in patients with ACS

Critically ill systemic lupus erythematosus patients referred to the intensive care unit of Fayoum University Hospital: Frequency, complications and outcome

Aim of the work: To determine the frequency of critical complications of systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU), study the risk factors and outcome. Patients and methods: Fifty SLE patients consequently admitted to the ICU were prospectively studied. The SLE Disease Activity Index (SLEDAI) was assessed. Results: The mean age of the patients was 29.3 ± 8.7 years; they were 42 females (84%) and disease duration of 4.9 ± 3.4 years. The overall mortality was 24% (12 patients) and tended to be higher in males (37.5% vs 21.5%). The commonest causes of death were infection (p < 0.001) and pulmonary complications (p = 0.04) in all non-survivors. Metabolic acidosis was significantly increased in deceased patients (75%) compared to survivors (23.7%) (p = 0.003). Cardiac and CNS complications were significantly increased in non-survivors (p = 0.04 and p = 0.03 respectively). Acute renal failure was significantly more frequent in mortality case 9/12 compared to survivors (28.9%) (p = 0.007) as well as abnormal arterial blood gases (100% vs 57.9%; p = 0.005). The SLEDAI was significantly increased in non-survivors (41.8 ± 8.2) compared to survivors (21.4 ± 5.1) (p = 0.001). There was a significant correlation between mortality and SLEDAI (r = 0.58, p = 0.001) and inversely with the pH (r = −0.38, p = 0.01). On multiple regression, only increasing SLEDAI was a significant predictor of mortality (β0.26, OR 1.29, 95%CI 1.12–1.49; p < 0.0001). Mortality prediction by SLEDAI showed at a cut-off of 28.5; sensitivity 84% and specificity 90% (p = 0.001). Conclusion: SLE patients admitted to the ICU are at an increased risk of mortality especially those with high disease activity. The main causes of mortality were infection, respiratory, cardiac and neurological complications. Keywords: Systemic lupus erythematosus, Intensive care unit, Mortality rate, Critical complication

Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt

A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a per-formance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other dis-tricts in Egypt

The Antidiabetic Effects and Modes of Action of the <i>Balanites aegyptiaca</i> Fruit and Seed Aqueous Extracts in NA/STZ-Induced Diabetic Rats

Diabetes mellitus (DM) is a chronic metabolic disorder that threatens human health. Medicinal plants have been a source of wide varieties of pharmacologically active constituents and used extensively as crude extracts or as pure compounds for treating various disease conditions. Thus, the aim of this study is to assess the anti-hyperglycemic and anti-hyperlipidemic effects and the modes of action of the aqueous extracts of the fruits and seeds of Balanites aegyptiaca (B. aegyptiaca) in nicotinamide (NA)/streptozotocin (STZ)-induced diabetic rats. Gas chromatography–mass spectrometry analysis indicated that 3,4,6-tri-O-methyl-d-glucose and 9,12-octadecadienoic acid (Z,Z)- were the major components of the B. aegyptiaca fruit and seed extracts, respectively. A single intraperitoneal injection of STZ (60 mg/kg body weight (b.w.)) 15 min after intraperitoneal NA injection (60 mg/kg b.w.) was administered to induce type 2 DM. After induction was established, the diabetic rats were treated with the B. aegyptiaca fruit and seed aqueous extracts (200 mg/kg b.w./day) via oral gavage for 4 weeks. As a result of the treatments with the B. aegyptiaca fruit and seed extracts, the treated diabetic-treated rats exhibited a significant improvement in the deleterious effects on oral glucose tolerance; serum insulin, and C-peptide levels; liver glycogen content; liver glucose-6-phosphatase and glycogen phosphorylase activities; serum lipid profile; serum free fatty acid level; liver lipid peroxidation; glutathione content and anti-oxidant enzyme (glutathione peroxidase, glutathione-S-transferase, and superoxide dismutase) activities; and the mRNA expression of the adipose tissue expression of the insulin receptor β-subunit. Moreover, the treatment with fruit and seed extracts also produced a remarkable improvement of the pancreatic islet architecture and integrity and increased the islet size and islet cell number. In conclusion, the B. aegyptiaca fruit and seed aqueous extracts exhibit potential anti-hyperglycemic and anti-hyperlipidemic effects, which may be mediated by increasing the serum insulin levels, decreasing insulin resistance, and enhancing the anti-oxidant defense system in diabetic rats