Treatment outcomes of pediatrics acute myeloid leukemia (AML) and associated factors in the country's tertiary referral hospital, Ethiopia.

BACKGROUND: Pediatric Acute Myeloid Leukemia (AML) is a major cause of morbidity and mortality in children with cancer in Africa and other developing continents. Systemic chemotherapy and effective supportive care have significantly contributed to increased survival rates of pediatric AML in developed countries reaching approximately 70%. There is a paucity of contextual data regarding overall and event-free survival outcomes in children with acute myeloid leukemia in developing countries and most centers in Africa provide palliative care. The objective of this study was to assess the overall survival, event-free survival, and associated factors in pediatric AML patients treated in Ethiopia. METHODS: This retrospective study was conducted on Pediatric AML patients treated at Tikur Anbessa Hospital between January 1, 2015, and May 30, 2022. The socio-demographic profile of patients, the clinical characteristics, the biochemical and morphological subtypes of AML were analyzed using SPSS version 25. The Kaplan-Meier survival curve was used to estimate the probabilities of overall and event-free survival. Statistical significance was set at p < 0.05. RESULTS: A total of 92 children with AML were included in this study. The median age at diagnosis was 7 years (interquartile range: 5-10 years) with a slight male predominance. The median duration of symptoms was one month. Neutropenic fever (56, 86.2%) was the most common complication during treatment. About 29.3% of the patients succumbed to early death. The corresponding 1-year and 3-year OS probabilities were 28.2% and 23% respectively. The median event-free survival time for all pediatric AML patients was one-month (95% CI: 0.77-1.23). The determinants of poorer survival outcomes were FAB subtype, type of protocol used, and signs of CNS involvement (p < 0.05). CONCLUSION: The survival rates of children from AML were low in the study setting. More than 25% of AML patients succumbed to early death, and febrile neutropenia was the most common complication. Effective supportive and therapeutic measures should be taken to manage febrile neutropenia and to prevent early death in AML patients.

Patterns and treatment outcomes of primary bone tumors in children treated at tertiary referral hospital, Ethiopia.

BACKGROUND: Bone tumors account for approximately 6% of all cancers in children. Malignant bone tumors, commonly occurring in children and adolescents, are associated with high mortality and morbidity. The overall survival of children with primary malignant bone tumors is affected by the stage of disease, time of diagnosis, and treatment response. Despite advanced treatment modalities with chemotherapy, surgery, and radiotherapy, bone tumor is the third leading cause of death in children with malignancy. Patients with metastatic disease at diagnosis have poor outcomes compared to localized disease at presentation. The 5-year Overall Survival and event-free survival in children with primary malignant bone tumors were 85.2% and 69.2%. The study aimed to assess the clinicopathological profile and treatment outcomes of children with primary malignant bone tumors in our setup. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted on 95 children who met the inclusion criteria through structured questionnaire. The collected data were analyzed using a statistical package for social sciences (SPSS) version 25. P-value < 0.05 was considered to be statistically significant. Kaplan Meier survival estimate was used for overall and event-free survival analysis. RESULTS: A total of ninety-five patients met the study inclusion criteria and the median age at diagnosis with primary malignant bone tumors was 10 years, with an interquartile range of 8-12 years. The duration of the illness from the onset of symptoms to the oncologic treatment center ranges from three weeks to 2 years with a mean duration of five months. Swelling was the commonest presenting symptom accounting for 95.8% (n = 91). Lower extremity was the commonest primary site of involvement accounting for 55.8% (n = 53) of children with primary malignant bone tumors. Osteosarcoma was the commonest malignant bone tumor constituted 66.3% (n = 63), followed by Ewing sarcoma at 33.7% (n = 32). About 41.2% (n = 39) of children had metastatic disease at presentation and the lung was the commonest site of distant metastasis. The Kaplan Meier survival estimate analysis showed the 1-year and 5-year overall survival probabilities for all pediatric primary malignant bone tumor patients were 65% (95% CI: 0.3-0.56) and 38% (95% CI:0.19-0.47) respectively. The 1-year and 5-year event-free survival probabilities were 55% (95% CI: 0.32-0.73) and 33% (95% CI: 0.10-0.59). The stage of the disease at presentation had a significant association with the outcome (p = 0.023). CONCLUSION: Our study showed the mean duration of the illness from the onset of symptoms to the oncologic treatment center was 5 months ranging from 3 weeks to 2 years. More than one-third of the presented with metastatic disease at presentation. The 1-year and 5-year overall survival (OS) probabilities of children with primary malignant bone tumors were low in our setup compared to other studies.

Patterns and Clinico-Radiological Characteristics of Primary Liver Masses in Children Treated at a Tertiary Referral Hospital, in Ethiopia.

Background: Liver masses are a cause of morbidity and mortality in children worldwide. Although the patterns and clinical-radiological characteristics of primary liver masses have been studied in developed countries, few studies have been conducted in developing countries. Studying the patterns of liver mass in children helps to improve the outcome of liver masses and to design preventive strategies if the identified risk factors are preventable. Material and Method: A hospital-based cross-sectional study was conducted on children who met the inclusion criteria, using a self-administered structured questionnaire. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Statistical significance was set at P < 0.05. Descriptive and logistic regression analyses were used to assess the determinant factors. Results: A total of 74 children were included, with most patients being males (60.8%). More than one-third (n = 27) of the participants were between 1 and 4 years of age and the mean age at diagnosis of the liver mass was 4.6 years. The duration of illness at presentation to Tikur Anbessa Specialized Hospital was between 4 and 8 weeks, in 42% of the patients. The most common presenting symptom was abdominal swelling, accounting for 70.3% (n = 52) of the patients. Benign hepatic mass lesions accounted for 57.5% (n = 42), and 43.2% (n = 32) were malignant liver masses. Most lesions were solitary and involved the right lobe of the liver. The common benign hepatic masses were pyogenic liver abscesses (38.1%), and the most common malignant hepatic masses were hepatoblastomas (78.1%). Conclusion: Pyogenic liver abscess was the most common benign hepatic mass and hepatoblastoma was the most common malignant hepatic mass in our study. Most lesions were solitary and involved the right lobe. Understanding the patterns of liver masses will help in the early diagnosis and improve treatment outcomes in children with liver masses.

Hypercalcemia in a 5-Year-Old Child with Disseminated Tuberculosis: Case Report and Literature Review.

In tuberculous patient, abnormal extrarenal production of 1.25-dihydroxyvitamin D3 by activated macrophages results in hypercalcemia. High calcium level associated with tuberculosis is frequent in adults with active pulmonary tuberculosis even though most patients are asymptomatic, while hypercalcemia in children due to disseminated tuberculosis is rare. Here, we described a case of a 5-year-old who presented with cough and right anterior chest swelling of two-month duration with an Erythrocyte Sedimentation Rate of 144mm/hour, and a high serum ionized calcium level of 1.46millimol/L. With the epidemiologically prevalence, clinical and radiological imaging findings the diagnosis of disseminated tuberculosis to lung, pleura, lymph node, liver and bone was made, and the child was started with the anti-tuberculosis treatment, hypercalcemia was attributed to the disseminated tuberculosis precipitated by high calcium meal intake and excessive sun exposure. Tuberculosis can be complicated with hypercalcemia; care must be taken in supplementing vitamin D and high calcium meals especially in high sun exposure geographic areas.

Transient Leukoerythroblastic Reaction in a Newborn with Rh-Incompatibility and Hemolysis: Case Report and Literature Review.

Leukoerythroblastosis is rarely encountered in clinical practice and is characterized by the presence of leukocytosis and erythroid and myeloid blast cells in peripheral blood. The most common causes of leukoerythroblastosis in early childhood are viral infection, juvenile myelomonocytic leukemia, and osteopetrosis. To the best of our knowledge, leukoerythroblastic reactions associated with hemolysis have not been previously reported in newborns. Here, we report a 24-hour-old female term newborn diagnosed with a leukoerythroblastic reaction, severe anemia, and neonatal hyperbilirubinemia secondary to Rh incompatibility based on presentation, laboratory determination, and peripheral morphology. A high index of clinical suspicion is required to avoid life-threatening complications among health professionals in the neonatal care unit.

Isolated renal hydatid cyst in a ten-year-old female child: A rare case report.

Hydatid cyst is a zoonotic disease caused by CestodaEchinococcus, especially Echinococcus granulosus. Isolated renal hydatidosis is an extremely rare clinical condition associated with nonspecific symptoms and physical findings. Diagnosis can be difficult and depends on imaging findings and histologic examination of excised tissue specimens. Here, we report a case of an isolated right renal hydatid cyst in a 10-year-old girl who presented with progressively worsening right flank pain. Diagnosis was established using multimodal imaging after which she underwent a successful cystectomy, had a smooth post-operative course, and was discharged with improvement and a continuation of albendazole.

Temporoparietal Brain Hydatid Cyst in an Eight-Year-Old Child: A Rare Case Report.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, which affects children in many different parts of the world. It commonly affects the lungs and the liver of the children. Brain hydatidosis is an extremely rare clinical condition in the pediatric population, presenting with non-specific symptoms and signs. The diagnosis of intracranial hydatid cysts can be established by brain magnetic resonance imaging and histopathological examination of the specimen. Here, we report an 8-year-old female child diagnosed with a temporoparietal brain hydatid cyst. Brain magnetic resonance imaging showed a thin-walled cystic lesion located in the right temporoparietal lobe with significant mass effect and midline shift, with no abnormal wall or solid enhancement, and no surrounding edema. The diagnosis of brain temporoparietal hydatid cyst was made radiologically. The patient was operated on and the cyst was completely removed without rupture. The removed cyst was sent for histopathological examination; the histological sections showed a laminated acellular cyst wall with a nucleated germinal layer and no protoscolices, and the diagnosis of temporoparietal brain hydatid cyst was confirmed. The patient had a smooth postoperative course, started albendazole therapy, and was discharged with improvement.

Laryngeal Leech Infestation: A Rare Cause of Upper Air Way Obstruction in Children.

Laryngeal leech infestation is a rare cause of upper air way obstruction in children. A high index of clinical suspicion of laryngeal leech infestation has to made in child presented with foreign body sensation in the aerodigestive tract, symptoms and signs suggestive of upper air way obstruction especially in areas where drinking water from the streams and ponds is a habit. Here, we report a 9-year-old male child who presented with signs of upper air way obstruction: coughing, shortness of breath, stridor and use of accessory muscles. Direct laryngoscope examination showed a visible black mobile leech through the anterior glottis area having attachment at the anterior commissure and the other at the anterior subglottic area occupying around 75% of glottic opening. The leech adhered to the larynx was grasped cautiously with laryngeal forceps and the leech removed alive. The patient was transferred to ward with stable vital signs. Subsequently patient was decannulated and discharged home.

Bilateral Large Pulmonary Hydatid Cyst: A Rare Presentation in a Young Child from Ethiopia.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, which is endemic in many parts of the world. Hydatid cysts can occur in any organ of the human body and the lung is the most common site in children, primarily related to higher lung tissue elasticity. Bilateral pulmonary hydatid cyst is a rare clinical phenomenon in young children. Here, we report on a 3-year-old boy diagnosed with bilateral pulmonary hydatid cyst after he came with four months history of dry cough and progressive worsening of shortness of breath. Computed tomography of the chest revealed large bilateral thick-walled pulmonary cystic mass lesions, with bilateral perihilar extension and pressure effect on the diaphragm with surrounding atelectatic changes. The patient underwent left posterolateral thoracotomy and cyst excision was done for the left hydatid cyst. Two months after the first surgical cyst excision, right posterolateral thoracotomy and cystectomy was done for the right lung hydatid cyst. He recovered well post-operatively.

Removal of endocrine disrupters from the contaminated environment: public health concerns, treatment strategies and future perspectives - A review.

Endocrine-disrupting compounds (EDCs) are emerging contaminants of concern (ECC) that disturb endocrine hormones and system functionality even at very low concentrations (i.e. µg/L or ng/L levels). Hence, EDCs are found in all components of the environment including surface and groundwater, wastewater, soil, outdoor and indoor air and in the contaminated foods from a variety of sources (run off from agricultural activities, sewage treatment plants, leakage from septic tanks etc.), and the effects are more severe as the majority of EDCs do not have standard regulations. The environmental mobility of EDCs is higher as conventional wastewater treatment does not degrade efficiently and the development of effective and sustainable removal technologies specifically designed for the removal of those emerging micropollutants is essential. Accordingly, EDCs cause various public health diseases such as reproductive abnormalities, obesity, various cancer types, cardiovascular risks, metabolic disorders, epigenetic alterations, autism, etc. This paper reviews the existing and emerging treatment technologies for the removal of phenolic based EDCs, such as natural estrogens (estrone (E1), 17ß-estradiol (E2), estriol (E3)), synthetic estrogen 17α-ethinylestradiol (EE2) and phenolic xenoestrogens (4-nonyl phenols (4-NP) and bisphenol-A (BPA)) from the contaminated environment. These includes advanced oxidation processes (AOP), adsorption processes, membrane based filtration, bioremediation, phytoremediation and other integrated approaches. The sustainability of EDCs removal can be assured through the use of combined processes (i.e. low-cost - biological and adsorption methods with efficient and costly - AOPs) techniques through system integration to achieve better removal efficiency than using a single treatment technique. Besides, the public health concerns and future research perspectives of EDCs are also highlighted.

Assessment of the Management of Diarrhoea Among Children Under Five in Addis Ababa, Ethiopia.

PURPOSE: Irrational antibiotic use is a worldwide problem. One of the main reasons for excessive use of antibiotics is the failure to follow the clinical guidelines. Inappropriate use of antibiotics for infectious diarrhea is associated with the risk of increasing the development of antimicrobial resistance and the cost of health care. We therefore pursued to assess the appropriateness of the management of diarrhea in children in Addis Ababa. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted in the health centers of Addis Ababa, Ethiopia, between September 2014 and February 2015. Demographic characteristics, signs of dehydration, stool characteristics, drug types and other relevant information have been collected. Data analysis was performed using version 20 of the SPSS. Logistic regression was used to examine the association between dependent and independent variables. Indicators for the appropriateness of diarrhoea management have been established on the basis of the Standard Treatment Guideline and the guidelines of the World Health Organization. RESULTS: A total of 803 medical records of children have been checked. Of this, 54.4% had received inappropriate management. At least one antimicrobial was prescribed to 73.2% of the children who visited the health centres. Oral rehydration solution (ORS) and zinc were prescribed only in 66.7% and 47.5%, respectively. Appropriate management among children diagnosed with dysentery was found to be 6.38 times higher adjusted odds ratios (AOR=6.38 (3.11, 13.63)) than children with watery diarrhea. Although antibiotics are prescribed inappropriately for most children, it is appropriate when the diarrhea is bloody. Appropriate management of diarrhoea among infants aged 2-11 months was 54% less compared to children aged 12-59 months (AOR=0.46 (0.24, 0.90)). CONCLUSION: The magnitude of inadequate antibiotic prescription while managing diarrhoea in our setting was high. On the contrary, a low prescribing rate of ORS and zinc was observed. Our result highlights the need for urgent action to prevent the development of antibiotic-resistant microorganisms. Health-care professionals should have clear information on the risks of inadequate diarrhoea treatment in children under five.

Potential Effect of Hydroxychloroquine in Diabetes Mellitus: A Systematic Review on Preclinical and Clinical Trial Studies.

BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia. It affects millions of people globally. In spite of many antidiabetic drugs that are available, an adequate level of control remains challenging. Hydroxychloroquine is an immunomodulatory drug that has been used for the treatment of malaria and autoimmune diseases. There is an emerging evidence that suggests its beneficial effect against diabetes mellitus. Therefore, this systematic review is aimed at discoursing the role of hydroxychloroquine against diabetes mellitus and its potential mechanisms of actions. METHODS: A systematic and manual searching was carried out to retrieve relevant articles (preclinical and clinical studies) published from January 2014 to July 2019. Electronic databases including PubMed and Scopus as well as clinicaltrials.gov have been searched using different searching terms: "hydroxychloroquine," "diabetes mellitus," "hyperglycemia," and "insulin resistance." The MeSH terms (PubMed) and text words were combined with "AND" or "OR." In addition, manual searching of Google Engine and Google Scholar was conducted. Quality assessment of all the included studies was performed using CAMARADES (preclinical studies) and the Newcastle-Ottawa Scale and Cochrane Collaboration's tools (clinical studies). RESULTS: A total of eighteen studies (three experimental and fifteen clinical studies) were found to be eligible for the present systematic review. Among the included clinical studies (six randomized control trials, five observational studies, and four cohort studies), about 55,776 study participants were involved. Most of these studies showed significant improvement of lipid profile and insulin levels and substantial diminution of hemoglobin A1c, fasting plasma glucose, and postprandial blood glucose levels. Reduction in lysosomal degradation of the internal insulin-insulin receptor complex and enhancement in insulin sensitivity and adiponectin levels are some of the hypothesized mechanisms for the antidiabetic effect of hydroxychloroquine. CONCLUSION: The current review provides preliminary evidence for potential antidiabetic properties of hydroxychloroquine. Though the provided available data were promising, further clinical trials and mechanistic studies are needed to determine its long-term effects.