Use of Psychoactive Substance and its Associated Factors among School Adolescents in Rupandehi District of Nepal.

BACKGROUND: Psychoactive substance use among adolescents has been identified as an important health issue in Nepal. Therefore, this study examined the psychoactive substance use and factors associated with its use among adolescent students in the Rupandehi district of Nepal. METHODS: A school-based cross-sectional study was conducted from December 2017 to July 2018 with 460 school students aged between 15 to 19 years across sampled public and private schools in the Rupandehi district of Nepal. Structured interview schedule was used to collect information on psychoactive substance use. The generalized estimating equation was used to identify the factors associated with the use of psychoactive substances. RESULTS: Over a quarter (27.4%) of school-going adolescents used at least one type of psychoactive substance. Commonly used psychoactive substance included tobacco products (59.3%) followed by cannabis (55.6%), marijuana (35.8%), hashish (23.5%), alcohol (22.2%), heroin (18.5%), nitrogen tablets (14.8%), sulfa (13.6%) and opium (13.6%), respectively. Being male (AOR=2.0, 95% CI: 1.19-3.36), having peers (AOR=1.8, 95% CI: 1.13-3.03) or family members (AOR=2.2, 95% CI: 1.40-3.54) that used psychoactive substances and father's education level (AOR=2.5, 95% CI: 1.05-5.78) were significantly associated with the psychoactive substance use. CONCLUSIONS: This study identified that over a quarter of school-going adolescents reported the use of at least one illegal psychoactive substance. This study provided details on the extent of behaviours, and can be used to develop a comprehensive prevention and control program. Such programs should address the socio-cultural factors that enable substance use and address gaps in knowledge to prevent and control of psychoactive substance use.

Safety and feasibility of granulocyte colony-stimulating factor (G-CSF) primed bone marrow (BM) using three days of G-CSF priming as stem cell source for pediatric allogeneic BM transplantation.

There are limited data on the optimal dosing and schedule of G-CSF priming prior to BM harvest. We evaluated the safety and efficacy of three days of G-CSF of primed BM from related pediatric donors. Forty-five children were treated. All donors received 5 µg/kg per day of G-CSF as a single subcutaneous injection for three consecutive days prior to the BM harvest. The median age of the donors was seven yr (range, 0.8-18) and no donor experienced major adverse events related to G-CSF administration. The median age for the recipients was five yr (0.3-16 yr). Thirty-five patients had non-malignant disorders. The median dose of nucleated (TNC) and CD34+, CD3 cells infused per recipient weight was 5.4 × 10(8) /kg (range, 0.61-17), 4.7 × 10(6) /kg (range, 1.6-19), and 43.8 × 10(6) /kg (range, 1.8-95), respectively. All patients achieved neutrophil and platelets engraftment, at a median of 15 (range, 10-22) and 23 days (range, 13-111), respectively. At a median follow up of 60 months (range 12-100), the estimated five yr overall and EFS was 91% and 80%, respectively. Collection of BM following three days of G-CSF priming from pediatric donors is safe and results in high TNC and CD34+ cell yield.

GCSF with or without chemotherapy compared to Plerixafor with GCSF as salvage mobilization regimen in patients with multiple myeloma and lymphoma: collection effectiveness and cost effectiveness analysis.

INTRODUCTION: Plerixafor is a novel mobilizing agent of peripheral blood stem cells (PBSCs) in lymphoma and multiple myeloma (MM) patients whose cells mobilize poorly. Due to the substantial cost associated with its use, we aimed to compare the effectiveness and cost effectiveness of Plerixafor + GCSF (PG) versus GCSF ± Chemotherapy (GC) as salvage mobilization regimens. METHODS: The charts of consecutive lymphoma and MM patients who had undergone at least one previous attempt of PBSCs mobilization that failed or resulted in an insufficient cell dose for transplant between 2007 and 2010 were retrospectively reviewed. Patients identified received salvage mobilization with GC (prior to 2009) or PG after Plerixafor's FDA approval. Data collected included demographics, medical histories, apheresis yields and transplant outcome. The cost effectiveness analysis was from the perspective of the Jordanian Ministry of Health. The incremental cost effectiveness ratio (ICER) was calculated by dividing the difference in cost by the difference in effectiveness for the two regimens. RESULTS: Five patients received GC and twelve received PG. A minimum CD34+ cell dose of 2 × 10(6) cells/kg was collected from 8 patients (67%) in the PG group compared to 3 (60%) in the GC group (p=0.79). The average costs were US$8570 and US$25,700 for the GC group and the PG group, respectively. The ICER was US$244,714 per successful stem cell collection. CONCLUSION: Salvage Plerixafor use showed a non-significant improvement in PBSCs collection with a significant increase in cost. Prospective comparative effectiveness studies are warranted to inform the optimal salvage mobilization regimen. To our knowledge, this is the first study from the Middle East to describe the effectiveness and cost effectiveness of Plerixafor.

Risk adopted allogeneic hematopoietic stem cell transplantation using a reduced intensity regimen for children with thalassemia major.

BACKGROUND: Patients with thalassemia in developing countries have limited access to safe transfusions, regular medical care and chelation therapy. Although allogeneic hematopoietic stem cell transplantation (HSCT) can offer a curative approach, there are limited data on the use of this procedure in developing countries. PROCEDURE: Forty-four patients underwent a risk adopted HSCT from matched related family donor in Jordan. Thirty-one patients (7 Class 1 and 24 Class 2) underwent myeloablative conditioning (MAC) with busulfan (16 mg/kg), cyclophosphamide (200 mg/kg) and antithymocyte globulin (ATG). Thirteen patients all with Class 3, seven with hepatitis C received reduced intensity conditioning (RIC) with busulfan (8 mg/kg), fludarabine (175 mg/m(2)), total lymphoid irradiation (500 cGy) and ATG. RESULTS: All patients had initial neutrophil and platelet engraftment. Secondary graft failure was observed in 2 (6%) patients receiving myeloablative HSCT and 3 (23%) patients receiving RIC. At a median follow up of 64 months (13-108), 43 of 44 patients are alive. The 5-year probability of overall survival (OS) was 97.8% for all patients, 96.8% for patients received MAC and 100% for patients received RIC. The 5-year probability of thalassemia-free survival was 86.4% for all patients, 90.3% and 77% for patients who received MAC and RIC, respectively. CONCLUSION: Implementing a risk-adopted therapy in patient with thalassemia in Jordan can result in an excellent thalassemia free and OS, especially in those at highest risk.