Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials.

Background: Ultrasound therapy is one of the preferred conservative treatments for patients with plantar fasciitis. This study aims to evaluate the effectiveness of therapeutic ultrasound in decreasing pain intensity and improving functional disability in patients with plantar fasciitis. Methods: Five randomised control trials (RCT) were selected based on an electronic search in PubMed, Trip Database and PEDro. To be included in the systematic review, the study should be an RCT which investigated the effectiveness of therapeutic ultrasound conducted in patients with plantar fasciitis with pain intensity and functional disability as outcome measures. Only studies published in peer-reviewed journals written in the English language were included. The quality of the selected studies was measured by the PEDro scale. Results: All the included studies showed that ultrasound therapy is beneficial in reducing pain score and improving functional disability, except one study did not recommend using ultrasound therapy for plantar fasciitis. Moreover, regarding another outcome measure, two studies found that ultrasound therapy reduces thickness and tenderness in plantar fasciitis and improves static and dynamic balance. Conclusion: After reviewing the five studies, this systematic review support using ultrasound therapy to decrease pain and improve functional disability in patients with plantar fasciitis. Study Registration: https://osf.io/xftzy/.

Pattern of Antibiotic Use Among Children With Acute Respiratory Infections in Saudi Arabia: Clinical Assessment.

OBJECTIVES: This study aimed to evaluate the common clinical diagnoses and treatment management of acute respiratory infections (ARIs) in children and determine when antibiotics are recommended and prescribed. METHODS: A retrospective review of medical charts was carried out at King Salman Bin Abdulaziz Medical City (KSAMC) Hospital to assess pediatric patients diagnosed with ARIs aged 0-14 years, excluding those requiring antibiotics for conditions other than ARIs. Data, including demographic diagnoses and treatment management, were extracted using consecutive sampling, and statistical analyses were conducted using Jamovi software. RESULTS: A total of 285 pediatric patients were included, with a median age of 3 (IQR = 1-6) years and a male predominance of 59.2%. Bronchopneumonia was the most common respiratory disease, diagnosed in 39.1% of participants. The median durations for illness and hospital admission were four and three days, respectively. Clinical evaluations showed an average respiratory rate of 28±10.5 breaths per minute and a mean oxygen saturation of 96.4±3.46% through pulse oximetry. The use of antibiotics was commonly prescribed in ARI patients only when accompanied by certain bacterial infections (46.32%). CONCLUSIONS: ARIs are a common viral health issue among children, emphasizing that not all ARIs in children are caused by bacteria and that antibiotics should only be used when there is a bacterial infection present. Enhanced diagnostic precision, patient awareness, and provider education are the global community's recommendations to prevent the presence of antibiotic resistance and the irrational use of antibiotics.

Stability, Rheological Behavior, and pH Responsiveness of CTAB/HCl Acidic Emulsion: Experimental Investigation.

Cetyltrimethylammonium bromide (CTAB) surfactant was proven to be a reliable emulsifier for creating stable emulsions used for drilling, well stimulation, and EOR. The presence of acids like HCl during such operations may lead to the formation of acidic emulsions. No previous comprehensive investigations have been done to study the performance of CTAB-based acidic emulsions. This paper, therefore, presents experimental investigations of the stability, rheological behavior, and pH responsiveness of a CTAB/HCl-based acidic emulsion. The effects of temperature, pH, and CTAB concentration on the emulsion stability and rheology have been investigated using a bottle test and a TA Instrument DHR1 rheometer. Viscosity and flow sweep were analyzed for the steady state at a shear range of 2.5-250 s-1. For the dynamic tests, the storage modulus (G') and loss modulus (G″) were observed by applying the oscillation test at the range of shear frequency from 0.1 to 100 rad/s. The results revealed that the emulsion exhibits steady rheological behaviors ranging from Newtonian to shear-dependent (psedosteady), depending on the temperature and CTAB concentration. The tendency of the emulsion to exhibit a solid-like behavior is also dependent on CTAB concentration, temperature, and pH. However, the pH responsiveness of the emulsion is more significantly observed within the acidic range of the pH.

Discussing sexuality with patients with neurological diseases: A survey among neurologists working in Saudi Arabia.

Background: Neurological diseases frequently affect sexual activity, and the resulting sexual dysfunction can cause much distress for patients. However, despite the importance of such complaints, neurologists frequently do not ask patients about their sexual symptoms or how their neurological illness and medications are affecting their sexual health. This study aimed to identify these difficulties as well as potential obstructions to conversations for addressing sexual dysfunction in patients with neurological diseases. Methods: This cross-sectional study was performed by sending invitation letters and questionnaires to registered neurologists in Saudi Arabia. The questionnaire was constructed to determine the possibility of discussing sexual activities and function with patients with neurological diseases and the possible obstacles neurologists face in this regard. Statistical analyses were performed using the Statistical Package of Social Sciences (SPSS) program version 25, and p-values of <0.05 were considered statistically significant. Results: A total of 258 of 750 neurologists (34.4%) returned the survey, of which 252 had completed the entire survey; therefore, their responses were considered suitable for further analysis. The majority of the respondents (63.1%) seldom discussed sexuality with their patients, more than half of the participants never discussed sexuality with female patients, and patients aged 60 years or older. The most commonly reported barriers were the lack of spontaneous communication by patients regarding their sexual problems (82.1%), insufficient consultation time (60.7%), and barriers based on language/culture/religion (53.6%). The majority of the respondents (61.9%) expressed the need for training on discussing sexuality as a measure that may enhance the discussion of sexual life with patients. Most of the respondents (92.9%) considered the patients responsible for bringing up problems in their sexual functioning during a patient interview. Conclusion: Sexual dysfunction is rarely discussed with patients showing neurological diseases, particularly with female patients. This is due to the patient's inability to articulate their sexual problems freely as well as a lack of consultation time. Training on discussing sexuality may enhance the discussion of sexual life with patients.

The Burden of Surgical Site Infection at Hospital Universiti Sains Malaysia and Related Postoperative Outcomes: A Prospective Surveillance Study.

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients. Surgical site infections result in longer hospital stays, hospital readmissions, and higher death and morbidity rates. The current study was designed to highlight the importance of such surveillance studies in a Malaysian surgical population with a motive to evaluate and revise concurrent infection control and prevention policies by exploring the burden of surgical site infection and identifying its associated risk factors for future considerations. In this prospective observational cohort study, a total of 216 patients admitted to a surgical ward were identified and studied. Of these 216 patients, 142 elective procedures and 74 emergency procedures were included in the study, of which 13 patients (9.2%) undergoing elective procedures and 15 (20.3%) patients undergoing emergency procedures were SSI positive (OR: 2.5, p = 0.02). Among surgical site infections, 21 were superficial and 7 were deep incisional SSI. No case of organ/space SSI was identified. The time taken for SSIs to develop ranged from 2-17 days with a median of 6 days. Risk factors such as presence of comorbidities (p = 0.011), major co-existing medical diagnosis ≥2 (p = 0.02), and pre-existing infection (p = 0.027) were statistically significant. SSI-positive patients experienced an increase in the post-operative length of hospital stay. In the current population, it was seen that identifying patients who were at high risk of malnutrition via MUST and the NNIS risk index will help clinicians in identifying high risk patients and in managing their patients appropriately. Identifying patients who were at high risk of malnutrition will also improve postoperative outcomes considerably.

Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19.

Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P <0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.

A Novel ZnO Nanoparticles Enhanced Surfactant Based Viscoelastic Fluid Systems for Fracturing under High Temperature and High Shear Rate Conditions: Synthesis, Rheometric Analysis, and Fluid Model Derivation.

Surfactant-based viscoelastic (SBVE) fluids are innovative nonpolymeric non-newtonian fluid compositions that have recently gained much attention from the oil industry. SBVE can replace traditional polymeric fracturing fluid composition by mitigating problems arising during and after hydraulic fracturing operations are performed. In this study, SBVE fluid systems which are entangled with worm-like micellar solutions of cationic surfactant: cetrimonium bromide or CTAB and counterion inorganic sodium nitrate salt are synthesized. The salt reagent concentration is optimized by comparing the rheological characteristics of different concentration fluids at 25 °C. The study aims to mitigate the primary issue concerning these SBVE fluids: significant drop in viscosity at high temperature and high shear rate (HTHS) conditions. Hence, the authors synthesized a modified viscoelastic fluid system using ZnO nanoparticle (NPs) additives with a hypothesis of getting fluids with improved rheology. The rheology of optimum fluids of both categories: with (0.6 M NaNO3 concentration fluid) and without (0.8 M NaNO3 concentration fluid) ZnO NPs additives were compared for a range of shear rates from 1 to 500 Sec-1 at different temperatures from 25 °C to 75 °C to visualize modifications in viscosity values after the addition of NPs additives. The rheology in terms of viscosity was higher for the fluid with 1% dispersed ZnO NPs additives at all temperatures for the entire range of shear rate values. Additionally, rheological correlation function models were derived for the synthesized fluids using statistical analysis methods. Subsequently, Herschel-Bulkley models were developed for optimum fluids depending on rheological correlation models. In the last section of the study, the pressure-drop estimation method is described using given group equations for laminar flow in a pipe depending on Herschel-Bulkley-model parameters have been identified for optimum fluids are consistency, flow index and yield stress values.

The Prevalence and Associated Factors of Neck Pain among Ministry of Health Office Workers in Saudi Arabia: A Cross Sectional Study.

(1) Background: Neck pain is the most common type of musculoskeletal problem affecting office workers. Various occupational risk factors have been linked to neck pain. This study aims to assess the prevalence and risk factors of neck pain among office workers at the Ministry of Health in Saudi Arabia. (2) Methods: A cross-sectional study was conducted, and the participants completed an online questionnaire based on the Standardized Nordic questionnaire and Quality of Life Scale Brief Version to evaluate their neck pain and the physical, psychological, social, and environmental factors that might affect their conditions. A descriptive analysis was conducted for the data and a logistic regression was performed to ascertain the effects of biodemographic and occupational factors on the likelihood of having neck pain. (3) Results: A total of 413 subjects (176 females and 237 males) participated in our study with an average age of 33.6 ± 8 years. The prevalence of neck pain in our participants was 64% during a twelve-month period. Females were less likely to suffer neck pain than males (OR = 0.52, 95%CI [0.30,0.87]), and age, BMI, level of education, and profession were not associated with likelihood of having neck pain. However, reduced working hours were associated with a reduction in the likelihood of having neck pain (OR = 0.42, 95%CI [0.33,0.53]). (4) Conclusion: Neck pain affects a large proportion of the office workers at the Ministry of Health, and this pain is significantly associated with long working hours and males. Thus, there is a need for future research that can investigate how associated factors can be managed to reduce the long-term impact of neck pain on workers' lives. Quality improvement approaches might be used to implement effective interventions for the prevention and management of work-related risk factors that can cause neck pain.

Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review.

(1) Background: Pneumocystis jirovecii pneumonia (PCP) has a substantial impact on the morbidity and mortality of patients, especially those with autoimmune disorders, thus requiring optimal dosing strategies of Trimethoprim-Sulfamethoxazole (TMP-SMX). Therefore, to ensure the safety of TMP-SMX, there is a high demand to review current evidence in PCP patients with a focus on dose optimization strategies; (2) Methods: Various databases were searched from January 2000 to December 2021 for articles in English, focusing on the dose optimization of TMP-SMX. The data were collected in a specific form with predefined inclusion and exclusion criteria. The quality of each article was evaluated using a Newcastle-Ottawa Scale (NOS) for retrospective studies, Joanna Briggs Institute (JBI) critical checklist for case reports, and Cochrane bias tool for randomized clinical trials (RCTs); (3) Results: Thirteen studies met the inclusion criteria for final analysis. Of the 13 selected studies, nine were retrospective cohort studies, two case reports, and two randomized controlled trials (RCT). Most of the studies compared the high-dose with low-dose TMP-SMX therapy for PCP. We have found that a low dose of TMP-SMX provides satisfactory outcomes while reducing the mortality rate and PCP-associated adverse events. This strategy reduces the economic burden of illness and enhances patients' compliance to daily regimen plan; (4) Conclusions: The large-scale RCTs and cohort studies are required to improve dosing strategies to prevent initial occurrence of PCP or to prevent recurrence of PCP in immune compromised patients.

Perceived Application and Barriers for Gait Assessment in Physical Therapy Practice in Saudi Arabia.

INTRODUCTION: Gait is a major function of independence that determines the quality of life, participation, and restriction. Gait assessment in physical therapy practice is fundamental for assessing musculoskeletal conditions. This study planned to determine the extent and barriers of using gait assessment tools by physical therapists in clinical practice in Saudi Arabia. METHOD: A cross-sectional design was used. A standardized survey was sent through e-mail and social media to physical therapists working in hospitals, clinics, and rehabilitation centers in different Saudi Arabian regions. RESULTS: A total of 320 physical therapists from different regions in Saudi Arabia participated. There was a significant relationship between using gait assessment tools by physical therapists and patient groups (p = 0.002), receiving training (p = 0.001), dealing with patients who suffer from gait problems (p = 0.001), and visiting the gait laboratory (p = 0.001). Physical therapists' use of gait assessment tools for musculoskeletal conditions in clinical practice in Saudi Arabia was limited. The primary barrier preventing physical therapists from using gait assessment methods in clinical practice was a lack of resources, including instruments, space, time, and funds.

Anabolic-androgenic steroids and dietary supplements among resistance trained individuals in western cities of Saudi Arabia.

BACKGROUND: Anabolic-androgenic steroids (AAS) contain testosterone-like androgens and are used as supplements to improve performance, therapeutic measures, appearance, and muscular development. PURPOSE: This study aimed to estimate using anabolic-androgenic steroids (AAS) and good and bad practices about dietary supplements among resistance-trained individuals. It further seeked to determine the use of common drugs and supplements containing anabolic steroids among resistance-trained individuals (who work out at the sports centre) and assess users' knowledge about its side effects. METHODS: A cross-sectional survey was conducted at the sports centres of the western cities of Saudi Arabia. A self-administered questionnaire was used to collect data from 120 male resistance-trained individuals. RESULTS: The majority of the participants (80%) reported that they had not used any hormonal bodybuilding supplement last year, while 20% said they had used such hormonal supplements. Approximately half (52.5%) of participants reported that they always used dietary supplements. A total of 44.2% of participants possessed inadequate knowledge of these products. The main reason behind the use of hormones and supplements was to increase muscle mass. CONCLUSIONS: A minority of resistance-trained individuals in the studied population frequently misused AAS. However, the results cannot be generalised to the whole of Saudi Arabia. AAS consumption can be reduced by enhancing the level of awareness and knowledge of potential adverse health outcomes.

Identification of Tomato black ring virus from tomato plants grown in greenhouses in Saudi Arabia.

A survey was conducted in Al-Kharj governorate, Riyadh region to identify viruses causing variety of virus-like symptoms on tomato plants. A total of 135 samples were collected from symptomatic tomato plants. Symptoms included mottling, deformation, necrosis of leaves and fruits. Eighteen viruses were tested by DAS-ELISA. Tomato black ring virus (TBRV) was the virus of concern as it was not detected in Saudi Arabia before and was detected in 52.6% of the collected samples in this study. RT-PCR was used to confirm detection of TBRV and to sequence the amplified products to determine molecular characteristics of this virus. In the host range test study that was performed using a purified isolate of TBRV, sixteen out of the twenty two tested plants showed symptoms. Brassica oleracea was not infected by this virus. Gel electrophoreses (2% agarose) yielded fragments of 978 bp of coat protein gene of TBRV. Nucleotide sequences of purified RT-PCR products for three TBRV Saudi isolates were deposited in the GenBank with the following accession numbers MT274656, MT274657, and MT274658. These isolates of TBRV indicated a close Phylogenetic relationship of (99-100%) among themselves and with five isolates from Poland (95-98%) but a distant relationship of 85% with isolates from England and Lithuania deposited in the GenBank. This is the first report for detection and molecular characterization of TBRV infecting tomato plants in Saudi Arabia.

Enabling Control over Mechanical Conformity and Luminescence in Molecular Crystals: Interaction Engineering in Action.

Molecular crystals of π-conjugated molecules are of great interest as the highly ordered dense packing offers superior charge and exciton transport compared with its amorphous counterparts. However, integration into optoelectronic devices remains a major challenge owing to its inherently brittle nature. Herein, control over the mechanical conformity in single crystals of pyridine-appended thiazolothiazole derivatives is reported by modulating the molecular packing through interaction engineering. Two polymorphs were prepared by achieving control over the thermodynamic/kinetic factors of crystallization; one of the polymorphs exhibits elastic bending whereas the other is brittle. The control over the bending ability was achieved by forming co-crystals with hydrogen/halogen bond donors. A seamless extended crisscross pattern with respect to the bend plane through a ditopic hydrogen-bonding motif showed the highest compliance towards mechanical bending, whereas the co-crystals with a layered crisscross arrangement with segregated layers of co-formers exhibit slightly lower bending conformity. These results update the rationale behind the plastic/elastic bending in molecular crystals. The co-crystals of ditopic halogen bond co-assemblies are particularly appealing for waveguiding applications as the co-crystals blend high mechanical flexibility and luminescence properties. The hydrogen bonded co-crystals are non-emissive in nature owing to excited state proton transfer dynamics. The rationale behind the fluorescence properties of these materials was also established from DFT calculations in a quantum mechanics/molecular mechanics (QM/MM) framework.

Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis.

PURPOSE: Allergic fungal rhinosinusitis (AFRS) is a common disorder with a high prevalence and a very high incidence of recurrence. Management includes surgery and medical treatment in the form of local and/or systemic steroids. However, some cases are resistant to the action of steroids and further treatment is warranted. Being an immune-mediated disorder, targeting IgE seems a logical step. Immunotherapy drugs acting on the IgE (e.g. omalizumab) can modify the clinical course of the disease. This study aimed at evaluating the effect of omalizumab on the clinical course of patients undergoing surgery for AFRS. MATERIALS AND METHODS: This is a two-arm prospective, randomized, single blind clinical trial among patients with AFRS. Twenty patients were included and randomly divided into two groups: Group A; 10 patients received a single subcutaneous injection of omalizumab (Xolair ' Novartis) (150 mg) 2 weeks postoperatively. Group B: 10 patients received local steroids nasal sprays (budesonide or mometasone furoate, 100 µg twice daily for 6 months, starting 2 weeks postoperatively. All patients underwent history, examination, CT scan and IgE level estimation and were submitted to endoscopic sinus surgery. They were evaluated at 4 weeks interval for 6 months. RESULTS: In both groups there were highly significant differences between pre/post-operative SNOT-20 scores, TNSS scores, total IgE level and Philpott-Javer staging scores. Comparison between the two study groups at 24 weeks showed a highly significant difference (p = 0.001) between post-operative SNOT 20 and TNSS scores in favour of group A. There was no statistically significant difference between the two study groups as regarding postoperative total IgE or Philpott-Javer scores. There were two recurrences in both arms, but no significant side effects. DISCUSSION: We compared a single post operative injection of omalizumab with twice daily intranasal steroid spray for 6 months. Both treatments were effective, but the omalizumab group showed a more significant clinical and endoscopic response. There were no significant side effects in both arms. This novel approach used a single low dose injection of omalizumab increased the compliance of the patients with minimal complications. Longer follow-up of the patients is ongoing to determine the optimal time for re-injection. The only downside was the higher cost of omalizumab compared to that of local steroids.

Qualitative Analysis of Air Freshener Spray.

Air fresheners contain various chemicals that may or may not be harmful to human health and the environment. These products are widely used in different settings such as homes, schools, offices, and hospitals with ignorance of their real ingredients and their relative health effects. Thus, this preliminary study was carried out to identify the presence of different compounds in spray air fresheners that were not disclosed on the product's label. Four different brands of spray air fresheners were selected randomly from a local store, in which two were of mid-to-high cost and the remaining two of low cost. The samples were analyzed using gas chromatography/mass spectrometry headspace, in which single components of the samples were identified by the mass spectrometry detector. The results were shown as a chromatogram of several peaks, each representing different compounds. The chemicals found in the samples include; lilial, galaxolide, benzenemethanol, musk ketone, butylated hydroxytoluene, and linalool. These chemicals may cause irritation and other health problems. However, none of them were revealed on the product's label. The study concludes that air fresheners need to be free of any toxic or harmful chemicals and include natural ingredients instead.

Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: a systematic review.

[Purpose] The purpose of this review is to compare the effect of McKenzie and stabilization exercises in reducing pain and disability in individuals with chronic nonspecific low back pain. [Methods] A systematic literature review of randomized controlled trials (RCTs) were performed using 6 databases. The quality of reviewed articles were assessed by the risk of bias using the Cochrane collaboration's tool. [Results] A total of 829 articles were found from the databases, of which 10 were finally selected to be included in this review. The overall risk of bias assessment indicated that the risk of bias was low in one study and high in the other nine studies. One study reported reduced pain and two studies reported reduced functional disability in the McKenzie exercise group compared to other exercises. Two studies reported reduced pain and three studies reported reduced functional disability in the stabilization exercise group compared to other exercises. In two studies, the stabilization exercise group was as effective as McKenzie exercise group in reducing pain and functional disability in patients with chronic nonspecific low back pain. [Conclusion] Only two studies compared stabilization and McKenzie exercises in the management of chronic nonspecific low back pain. Therefore, insufficient evidence is available to draw any conclusive comparison on the effects of McKenzie and stabilization exercises in chronic nonspecific low back pain. However, both McKenzie and stabilization exercises was better than conventional exercise programs in reducing functional disability in patients with chronic nonspecific low back pain.

Risk-adapted stratification for optimally intensive treatment assignment of pediatric patients with non-Hodgkin lymphoma is an effective strategy in developing countries.

BACKGROUND: Pediatric patients with non-Hodgkin lymphoma (NHL) in developing countries (DCs) present with greater tumor load even at lower stages and with comorbidities that impact therapy delivery. This causes toxic mortality with "standard" intensive protocols or recurrences with "gentler" treatment. OBJECTIVES: We developed and evaluated a risk stratification schema that guides intensity of therapy. DESIGN/METHODS: Sixty-nine patients were prospectively assigned to five risk groups (A-E; n = 6, 15, 16, 15, and 17) following staging and treated with protocols of risk-stratified intensity. Risk stratification utilized St. Jude stage, disease bulk, and sites involved. RESULTS: Between 2006 and 2011, 69 patients with B-cell NHL were enrolled. Among these, 72.5% were boys with mean age of 6.9 years (±3.33 [SD]; range 2.4-14.2 years). Eighty-seven percent had Burkitt lymphoma, 82.6% had advanced stage (25 [36.2%] stage III; 32 [46.4%] stage IV), and 24.6% were central nervous system positive. Mean lactate dehydrogenase increased progressively across the risk strata. Among these, 0/6, 1/15, 3/16, 2/15, and 7/17 patients relapsed/progressed within each risk stratum. Fifteen patients died; three from treatment-related toxicity. At a median follow-up of 6.2 years, the overall and event-free survival (EFS) for all patients was 78.1 and 75.4%, respectively; EFS was related to risk assignment. The frequency of documented infectious and noninfectious toxicities increased with higher risk group assignment causing prolongation of admissions and potential treatment delays. CONCLUSIONS: Reduction in treatment intensity for an identified subset of patients with NHL is feasible, while high-intensity therapy is required for high-risk groups. This risk stratification system may be a first step toward improving the outcomes in some DCs.

Outcome of pediatric patients with lymphoma following stem cell transplant: a single institution report.

Hematopoietic stem cell transplant (HSCT) is recommended for pediatric patients with relapsed/refractory lymphoma even though the evidence for this is limited. We retrospectively reviewed records of 57 patients (29 Hodgkin lymphoma [HL], 28 non-Hodgkin lymphoma [NHL]) who underwent HSCT between 1995 and 2012. All demonstrated chemoresponsiveness prior to HSCT and 44 patients had a complete response. All underwent myeloablative conditioning, 38 chemotherapy-based and 19 total body irradiation-based. Forty-one patients received autologous and 16 allogeneic HSCT. Twelve (21%) died within 100 days post-HSCT, and 25 patients relapsed at a median of 1.6 months post-HSCT. Three patients developed second malignant neoplasms. Five-year overall survival (OS) was 50.5% and event-free survival (EFS) was 43.4%. Outcomes for HL were significantly better than those for NHL (OS 61.9% vs. 38.7% [p = 0.005] and EFS 60.4% vs. 26% [p = 0.008]). In summary, approximately half of all pediatric patients with lymphoma who failed first-line therapy and demonstrated chemosensitivity to second-line therapy can be salvaged with HSCT.