Prevalence and determinants of depression among caregivers of children with leukaemia in Iraq

Background: Depression in caregivers of leukaemic children is usually overlooked and hence missed, as doctors mostly focused on patient’s evaluation and condition. Early attention to symptoms of depression may help to prevent the devel-opment of a more serious depression over time.Aims: This study was conducted to estimate the prevalence, assess severity and identify determinants of depressive dis-order among caregivers of children with leukaemia in Baghdad, Iraq, 2014. Methods: This cross sectional study was conducted on a convenience sample of caregivers of 250 leukaemia children aged <15 years admitted to Child Welfare Teaching Hospital, Baghdad, Iraq. Socio-demographic variables were collected and the presence of depressive disorder was assessed using the Arabic Version of Beck Depression Inventory II (BDI-II); those with a score of >16 were considered depressed. Results: The prevalence of depression was 72% (95% CI: 66–77.5%); classified to 18.9% having borderline clinical depres-sion, 36.7% moderate depression, 27.8% severe depression and 16.7% extreme depression. Presence of depression was sig-nificantly higher among younger age caregivers, disease duration of >12 months and frequent hospital admission. Conclusions: The high prevalence of depression among care givers of leukaemia patients urge health care professionals to pay more attention to the psychological aspects of the families of leukaemia patients and ensure referring them for psychiatric support.

Contexte : La dépression chez les aidants d’enfants leucémiques est souvent négligée et donc non diagnostiquée, les médecins se concentrant la plupart du temps sur l’évaluation et l’état des patients. Une attention précoce accordée aux symptômes de la dépression pourrait permettre de prévenir le développement d’un stade plus avancé de cette affection.Objectifs : La présente étude a été conduite dans le but d’estimer la prévalence, d’évaluer la sévérité et d’identifier les déterminants des troubles dépressifs chez les aidants d’enfants atteints de leucémie à Bagdad (Iraq) en 2014. Méthodes : La présente étude transversale a été réalisée sur un échantillon de commodité de 250 aidants d’enfants leucémiques âgés de moins de 15 ans admis au Centre hospitalier universitaire pour la protection de l’enfance à Bagdad. Les variables socio-démographiques ont été recueillies et la présence de troubles dépressifs a été évaluée à l’aide de la version arabe de l’Inventaire de dépression de Beck II (BDI-II). Les répondants ayant un score supérieur à 16 étaient considérés comme dépressifs. Résultats : La prévalence de la dépression était de 72 % (IC à 95 % : 66 %-77,5 %), parmi lesquels 18,9 % ont été diagnostiqués en dépression clinique limite, 36,7 % en dépression modérée, 27,8 % en dépression sévère et 16,7 % en dépression extrême. La présence de cette affection était significativement plus élevée parmi les aidants plus jeunes ; elle durait généralement plus de 12 mois et nécessitait des hospitalisations fréquentes. Conclusions : La prévalence élevée de la dépression parmi les aidants de patients leucémiques doit inciter les professionnels de la santé à accorder une attention plus soutenue à l’état psychologique des familles des patients et à s’assurer qu’elles soient orientées en vue de bénéficier d’un soutien psychiatrique.

Pesticide exposure as a risk factor for lymphoproliferative disorders in adults

في ضوء الاستعمال الواسع النطاق لمبيدات الهوام في مصر، ومع ازدياد معدلات ابيضاض الدم واللمفوما، استهدف الباحثون تقييم التعرض لمبيدات الهوام مع متغرات متنوعة باعتبارها عوامل اختطار منتقاة لاضطرابات التكاثر اللمفاوي [الابيضاض واللمفوما اللاهودجكينية]، وأجرى الباحثون دراسة استعادية ترتكز على المستشفى للحالات والشواهد في عامي 2011 - 2012، شملت 130 حالة من البالغين المصابين باضطرابات التكاثر اللمفاوي ممن يراجعون العيادات الخارجية في المنوفية، مصر، مع 130 من الشواهد من المرضى الآخرين الذين يماثلون الحالات من حيث الجنس والعمر. واتضح للباحثين أن كلا من السوابق الأسرية للإصابة بالسرطان، والتعرض للأشعة السينية، والتدخين، واستخدام أصبغة الشعر ليست من عوامل اختطار الإصابة باضطرابات التكاثر اللمفاوي، وذلك وفق التحليل الوحيد المتغايرات. أما سوابق التعرض لمبيدات الهوام والعدوى بفيروس الالتهاب الكبدي سي فكانت من عوامل الاختطار المهمة التي يعتد بها إحصائيا لاضطرابات التكاثر اللمفاوي وفق التحليل المتعدد المتغايرات [معدل الأرجحية 2.24 ، بفاصلة ثقة 95 % مع تراوح النتائج بين 1.22 و 4.11 بالنسبة للتعرض لمبيدات الهوام ومعدل الأرجحية 2.67 بفاصلة ثقة 95 % مع تراوح النتائج بين 1.50 و 4.80 بالنسبة للعدوى بفيروس الالتهاب الكبدي سي]. وكان الاختطار ذا أهمية يعتد بها إحصائيا بالنسبة للمفوما اللاهودجكينية، ولكنه ليس كذلك بالنسبة للابيضاض اللمفاوي المزمن

ABSTRACT In view of the widespread use of pesticides in Egypt and the increasing incidence of leukaemia and lymphoma we aimed to assess pesticide exposure and other selected variables as risk factors for lymphoproliferative disorders (leukaemia and non-Hodgkin lymphoma). In a hospital-based, retrospective, case–control study in 2011–2012, adult cases of lymphoproliferative disorders (n = 130) were recruited from outpatient clinics in Menoufia, Egypt, while controls (n = 130) were age- and sex-matched fracture patients. Family history of cancer, exposure to X-rays, smoking and use of hair dyes were not risk factors for lymphoproliferative disorders in univariate analysis. History of exposure to pesticides and HCV infection were significant risk factors for lymphoproliferative disorders in multivariate analysis (OR = 2.24; 95% CI: 1.22–4.11 and OR = 2.67; 95% CI: 1.50–4.80 respectively). The risk was significant for cases of non-Hodgkin lymphoma but not chronic lymphocytic leukaemia.

RÉSUMÉ Étant donné l'utilisation largement répandue des pesticides en Égypte et l'incidence croissante de la leucémie et du lymphome, nous avons tenté d'évaluer l'exposition aux pesticides et d'autres variables sélectionnées en tant que facteurs de risque des maladies lymphoprolifératives (leucémie et lymphome non-hodgkinien). Dans une étude cas-témoins rétrospective menée en milieu hospitalier en 2011–2012, des adultes atteints de maladies lymphoprolifératives (n = 130) ont été recrutés dans des services de consultations externes à Menoufia (Égypte), tandis que les témoins appariés pour l'âge et le sexe (n = 130) recrutés souffraient de fractures. Des antécédents familiaux de cancer, d'exposition aux rayons-X, de consommation de tabac et d'utilisation de teintures capillaires ne constituaient pas des facteurs de risque des maladies lymphoprolifératives selon une analyse univariée. Des antécédents d'exposition aux pesticides et d'infection par le virus de l'hépatite C étaient des facteurs de risque importants de certaines maladies lymphoprolifératives à l'analyse multivariée (OR = 2,24 ; IC à 95 % : 1,22–4,11 etOR = 2,67 ; IC à 95 % : 1,50–4,80 respectivement). Le risque était significatif pour les cas de lymphome non-hodgkinien mais non significatif pour la leucémie lymphocytaire chronique.

High incidence of hepatitis B infection after treatment for paediatric cancer at a teaching hospital in Baghdad

This study estimated the incidence of viral hepatitis in children treated for cancer, to identify variables that could affect this Incidence and to assess the role of hepatitis B virus [HBV] vaccination In preventing infection. Between September 2007 and June 2008, 256 children in the haemato-oncology unit at the Children's Welfare Teaching Hospital, Baghdad, were studied prospectively. Demographic and clinical data and vaccination history were recorded. Patients were tested for HBV at the time of diagnosis [all were negative] and after starting chemotherapy. On admission to the unit, 231 patients [90.2%] were revaccinated. At reassessment after treatment for cancer, HBV infection was found in 70 patients [27.3%]. The variables that significantly increased the risk for HBV infection were a diagnosis of leukaemia and receiving more than 3 units of blood. A higher number of HBV vaccinations in hospital reduced the risk for HBV infection. The high rate of acquisition of HBV infection found in this study indicates the need for better screening of blood products and adherence to aseptic techniques In management of this group of patients

Etiological profile of pancytopenia in adults in Marrakesh, Morocco

This retrospective study evaluated the frequency of different causes of pancytopenia in all adult patients with pancytopenia presenting to the Department of Haematology of Mohamed VI Hospital, Marrakesh from 1 January 2008 to 31 December 2010. A total of 118 cases of pancytopenia were found [average of 39 cases per year]. The mean age of patients was 52 years [range 18-82 years] and 52.5% were male. The main clinical signs were pallor [100%], asthenia [100%] and fever [30.5%]. Mean haemoglobin was 6.5 g/dL [range 2.9-9.2 g/dL], mean white blood cell count was 2360/mm[3] [range 840-3360/mm[3]] and platelet count 66 000/mm[3] [range 3000-123 000/mm[3]]. Bone marrow aspiration was performed in 112 patients; megaloblastosis was found in 32.2% and marrow blasts in 23.7%. Anaemia due to vitamin B[12] deficiency [32.2%], acute leukaemia [23.7%] and aplastic anaemia [15.2%] were the main causes of pancytopenia. Given the incidence of acute leukemia among our cases, patients presenting with pancytopenia require urgent diagnosis and treatment

[Cytological features of acute leukaemia in the central region of Tunisia]

In Tunisia, because of an absence of population registry, data on acute leukaemia are scarce. We studied the epidemiological and cytological characteristic of 193 patients with acute leukaemia. Haemograms were carried out and slides for peripheral blood and bone marrow were prepared for each patient. The age range of the patients was 10 months to 83 years with a predominance of males [ratio: 1.27]. As regards type of leukaemia, 40.4% had acute lymphoblastic leukaemia, 51.8% had acute myeloblastic leukemia and 7.8% were unclassified. Diagnosis was made at less than 10 years in 31.6% of cases and 72% of these were the lymphoblastic type. Anaemia [Hb < 11 g/dL was found in 85% of cases, thrombocytopenia [platelets < 100 000/mm3] in 80.5% and hyperleukocytosis [WBC > 100 000/mm3] in 14.5% of cases with blasts in peripheral blood in 92% of cases

Induction of leukaemia in chloramphenicol-treated toads

Chloramphenicol has been associated with the development of aplastic anaemia. As it is still widely used in Egypt, we studied its effect on 100 Egyptian toads [Bufo regularis] given a dose of chloramphenicol of 5 mg/40 g body weight for 12 weeks. We found it induced numerous, severe ultrastructural changes in almost all types of leukocytes. These changes were similar to those induced by the chemical carcinogen 7,12-dimethylbenz[a]anthracene in 100 toads used as the carcinogen control group, and similar to those in leukocytes reported in humans with leukaemia. We recommend regulations be applied on the use of this antibiotic in countries where it is still widely used