Recurrence In Children Research Articles

Dental RECUR Randomized Trial to Prevent Caries Recurrence in Children

The purpose of this study was to determine the efficacy of a dental nurse–delivered intervention—the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)—in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child’s general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child’s future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group’s mean dmft was 6.8, and the control group’s was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing–informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

Relationship between Serum Sodium Levels and Febrile Seizure Recurrence in Children.

Relationship between Serum Sodium Levels and Febrile Seizure Recurrence in Children.

Çocuklarda kasık fıtığı onarımında açık teknik ve perkütan internal ring sütürizasyon tekniğinin karşılaştırılması

Objective: Laparoscopic inguinal hernia surgery has recently been a preferred surgical approach among pediatric surgeons. The aim of this study is to compare open and laparoscopic inguinal hernia repair techniques in terms of complications and recurrences in children. Method: Patients whose inguinal hernias were operated with laparoscopic percutaneous internal ring suturing technique and open high ligation technique were included in the study. Dermographic data, surgical details and postoperative complications of the patients were reviewed retrospectively. Results: A total of 246 patients were included in the study. Among them 113 patients underwent laparoscopic inguinal hernia repair and 133 patients open inguinal hernia repair. The mean age of patients in the laparoscopic group was 27.7 months (1-192 months) and the mean age of patients in the open surgery group was 27.5 months (1-156 months). Diagnostic laparoscopy was performed in 104 patients who underwent open surgery, and the contralateral inguinal hernia repair was performed in 33 of the patients after hernia was detected on the contralateral side. Recurrence was observed in 2.6% (n=3) of the patients who underwent laparoscopic surgery and 3.7%(n=5) of the patients undergoing open surgery. In 2 of the patients who underwent laparos- copic surgery had hematomas that resolved without intervention and 1 had hydrocele. On the other hand 4 of the patients who underwent open surgery had iatrogenic undescended testis and 1 had hydrocele. The follow-up periods of the patients who underwent laparoscopic or open surgery were 13.2, and 74 months, respectively. Conclusion: Laparoscopic inguinal hernia repair has results comparable to open repair in terms of recurrence and complications. The advantage of the laparoscopic method can be considered as the ability to evaluate the contralateral side in all cases without increase in the risk of recur- rence and complications, and the ability to operate without scarring , but with good cosmetic results.

Embelezamento, mídia e construção do corpo em narrativas de crianças

Este artigo nasce de uma pesquisa de doutorado cujo foco recai sobre a produção da imagem corporal de crianças na faixa etária entre 6 e 12 anos, pertencentes a diferentes realidades sociais e econômicas, frequentadoras de salões de beleza no Distrito Federal. Trata-se de uma etnografia, com abordagem antropológica da infância, a partir de uma perspectiva interseccional com marcadores sociais de diferença, tais como classe e raça. Apresentam-se dados que revelam a recorrência de crianças frequentadoras de salões assistindo a vídeos veiculados no YouTube protagonizados por outras crianças, as quais produzem o embelezamento de suas imagens corporais (maquiagem, cortes de cabelo, adornos). A partir da análise dos diálogos das crianças espectadoras desses vídeos, buscar-se-á refletir sobre como tais conteúdos audiovisuais reverberam nos processos de produção de suas autoimagens e subjetividades. O artigo convida a pensar como as crianças protagonistas e espectadoras dos vídeos estão, a todo instante, negociando com um mercado estético e cosmético a cada dia mais globalizado e sendo atravessadas por ele.

RECURRENCE OF INTESTINAL INTUSSUSCEPTION IN CHILDREN

Purpose. To evaluate outcomes in care of children with intestinal intussusception and to analyze the cause of recurrences of the disease. Material and methods. 196 children with intestinal intussusception were taken into the study. In 2009-2019, they all had standard examination, including ultrasound, radiography, laparoscopy and histological examination of the removed tissues. Results and discussions. 32 patients out of 196 children had a disease relapse. It developed after conservative desinvagination. These relapses developed: in 8 children because of the sagging of ileum mucosa into the cecum; in 4 patients- Mechelen diverticulum; in 6 - tumors of the ileocecal angle; in 8 children - hyperplasia of the lymph nodes of the mesentery. In 6 children the cause of intussusception recurrence was not defined. Conservative and laparoscopic desinvagination was not successful in any of cases with returned intussusception. Conclusion. 1) In most cases, intussusception recurrence in children was caused by mechanical factors: sagging of the ileum mucous into the cecum, Mechelen diverticulum, tumors of the ileocecal angle. 2) In case of intussusception recurrence, diagnostic laparotomy and revision of the abdominal cavity are recommended.

Hydroxyurea Therapy to Prevent Incident Stroke Among Children with Sickle Cell Anaemia in Jamaica: The Extend Trial

Hydroxyurea Therapy to Prevent Incident Stroke Among Children with Sickle Cell Anaemia in Jamaica: The Extend Trial

Post-transplant recurrence of steroid resistant nephrotic syndrome in children: the Italian experience

BackgroundSteroid resistant nephrotic syndrome (SRNS) is a frequent cause of end stage renal disease in children and post-transplant disease recurrence is a major cause of graft loss.MethodsWe identified all children with SRNS who underwent renal transplantation in Italy, between 2005 and 2017. Data were retrospectively collected for the presence of a causative gene mutation, sex, histology, duration of pre-transplant dialysis, age at onset and transplant, HLA matching, recurrence, therapy for recurrence, and graft survival.Results101 patients underwent a first and 22 a second renal transplant. After a median follow-up of 58.5 months, the disease recurred on the first renal transplant in 53.3% of patients with a non-genetic and none with a genetic SRNS. Age at transplant > 9 years and the presence of at least one HLA-AB match were independent risk factors for recurrence. Duration of dialysis was longer in children with relapse, but did not reach statistical significance. Overall, 24% of patients lost the first graft, with recurrence representing the commonest cause. Among 22 patients who underwent a second transplant, 5 suffered of SRNS recurrence. SRNS relapsed in 5/9 (55%) patients with disease recurrence in their first transplant and 2 of them lost the second graft.ConclusionsAbsence of a causative mutation represents the major risk factor for post-transplant recurrence in children with SRNS, while transplant can be curative in genetic SRNS. A prolonged time spent on dialysis before transplantation has no protective effect on the risk of relapse and should not be encouraged. Retransplantation represents a second chance after graft loss for recurrence.

An Ambispective Cohort Study to Assess Seizure Recurrences in Children with Calcified Parenchymal Neurocysticercosis.

Calcified neurocysticercosis (NCC), previously thought to be a dead end, is an important risk factor for seizure recurrences. We studied the pattern of seizure recurrences and associated radiological findings in children with calcified NCC. In this ambispective cohort study, we enrolled children (age 1-15 years) with calcified NCC attending the pediatric NCC clinic between January 2017 and December 2017. Retrospective data were collected from the hospital records, and all enrolled children were prospectively followed up till June 2018. The study group divided into two groups: 1) children first presenting with calcified granuloma and 2) children presented with ring-enhancing lesion (REL) and transformed into the calcified lesion during follow-up imaging. During the study period (January 2017-December 2017), 520 children with NCC were screened and 128 with calcified NCC were enrolled. The mean age was 10.8 ± 3.2 years, and 63% were boys. Among 128 children, 40 (31%) had calcified granuloma and 88 (69%) had REL transformed to calcified granuloma. Sixty-one (49%) children had seizure recurrence: 22 (58%) within calcified granuloma group and 39 (45%) within REL transformed to calcified granuloma group (P = 0.18). Seizure recurrence was associated with the presence of perilesional edema (PE) in 35 (57.4%) children on computed tomography scan. The median interval between two seizure recurrences was 30 (17-56) months, and the median antiepileptic drug-free interval was 17 (12-22) months. The total duration of continued seizures was 42 (26-58) months, slightly longer in children with REL transformed to calcified granuloma group (42, 95% CI: 18-66 months) in comparison to calcified granuloma group (35, 95% CI: 10-60 months, P = 0.32). To conclude, children with calcified NCC have seizure recurrences over a prolonged period. Seizure recurrences are intermittent and may be interspersed with a prolonged period of quiescence in between. The presence of PE and contrast enhancement around the lesion during seizure recurrence suggests lesion reactivation.

A randomized, placebo-controlled, double-blinded, single-centre, phase IV trial to assess the efficacy and safety of OM-85 in children suffering from recurrent respiratory tract infections

BackgroundOver many years, OM-85, a lysate of 21 common bacterial respiratory pathogens, has been demonstrated to prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in the prevention of respiratory tract infections (RTIs) in children. This study was planned to further contribute to the evaluation of the role played by OM-85 in prevention of recurrent RTIs in children.MethodsThis study was a randomized (3:3:1), placebo-controlled, double-blind, single-centre, phase IV trial carried out in Italy to assess the efficacy of OM-85 (Broncho-Vaxom®; Vifor Pharma; Meyrin 2/Geneva, Switzerland) in reducing the number of new RTI episodes in 288 children aged 1 to 6 years with a history of recurrent RTIs and to compare the efficacy of the standard 3-month regimen with that of administration of OM-85 for 6 months during a 6-month study period.ResultsThe number of RTIs and of children who experienced at least one RTI were significantly lower among patients receiving OM-85 for 3 months than among those given placebo (33% vs 65.1%, p < 0.0001). Differences were statistically significant for upper RTIs (i.e., common cold/viral pharyngitis and acute otitis media; p < 0.0001 and p = 0.006, respectively). Days of absence from day-care for children and working days lost by parents were significantly lower in the group with children treated with OM-85 for 3 months than in the placebo group (p = 0.007 and p = 0.004, respectively). No difference was seen between children who received OM-85 for 3 and those who received OM-85 for 6 months. The prevalence of atopy as well as the history of recurrent wheezing and age of the study child did not influence the results. Benefit was maximally evident among children with a history of frequent recurrences. OM-85 was well tolerated and safe, even in children who received an influenza vaccination.ConclusionsThe use of OM-85 for 3 months in 3 series of 10 consecutive days each time reduces the risk of recurrent RTIs in children, with a favourable safety profile. The greater effect observed in children prone to several respiratory episodes than in non-prone children seems to indicate that this lysate should be administered especially to children with a proven high susceptibility to RTIs.

Particularities and Efficacy of Extracorporeal Shock Wave Lithotripsy in Children

Background: Extracorporeal shock wave lithotripsy (ESWL) was first introduced in paediatric population in 1986. Given the more frequent recurrence in children, compared to adults, urinary stones treatments should require minimal invasive treatment methods. In this study, we aimed to evaluate the profile of the young patient with lithiasis who can benefit from ESWL, analysing the experience of 2 clinical departments. Materials and Methods: We have retrospectively reviewed the medical records of 54 children who underwent ESWL for urolithiasis. ESWL success rate was defined as stone-free status or the presence of clinically insignificant residual fragments. Data were analysed using the STATA 14.2. Results: In our study, the incidence of renal-ureteral calculi is significantly higher in girls (68.5%), compared to boys (31.5%). In total, 83.3% of patients showed a favourable outcome after treatment and the remaining 16.7% showed minimal complications. The presence of complications and remaining calculi was correlated to children age. The overall stone free rate was 88.9%. For calculus of 8.5 mm, only one ESWL session is recommended. Conclusions: The high percentage of cases with favourable outcome indicate that ESWL treatment is effective, considering the minimal cost, minimal invasiveness, repeatability and no need for general anaesthesia.

Recurrent deep vein thrombosis in children with malignant blood diseases: literature review

Venous thromboembolism is not a rare complication in children with cancer. Despite the advantages of the treatment of venous thromboembolism there is still a probability of venous thromboembolism recurrence. In adult patients with cancer venous thromboembolism recurrence an influence on the lower survival rate. In children with cancer venous thromboembolism recurrence is a rare complication, but it can significantly reduce the quality of life. Risk factors of venous thromboembolism recurrence in children with cancer are not properly investigated.

Predictive Value of MRI in Diagnosing Brain AVM Recurrence after Angiographically Documented Exclusion in Children.

MRI is routinely performed following brain AVM after treatment in children. Our aim was to determine the predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence in children, compared with conventional angiography and the role of 3D rotational angiography-MR imaging fusion in these cases. We included all pediatric patients with brain AVMs during an 18-year period with angiographically documented obliteration after treatment. Patients underwent 3T MR imaging, including contrast-enhanced MR imaging, TOF-MRA, and conventional angiography, with a subset undergoing 3D rotational angiography. The predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence were determined. CTA sections reconstructed from 3D rotational angiography were coregistered with and fused to 3D-T1WI for analysis. Thirty-nine children (10.8 ± 3.9 years of age; range, 2-17 years; male/female ratio, 19:20; mean Spetzler-Martin grade, 1.9 ± 0.6) met the inclusion criteria. Of these, 13 had angiographically confirmed brain AVM recurrence, 8 following surgery and 5 following embolization. Sensitivity, specificity, and positive and negative predictive values for recurrence were the following: contrast-enhanced MR imaging: 84.6%, 38.5%, 40.7%, 81.8%; TOF-MRA: 50.0%, 96.1%, 85.7%, 79.3%; both: 75.0%, 90.9%, 85.7%, 83.3%. 3D rotational angiography-MR imaging fused images confirmed or excluded recurrence in all available cases (13/13). Embolization-only treatment was a significant predictor of recurrence (OR = 32.4, P = .006). MR imaging features predictive of recurrence included a tuft of vessels on TOF-MRA and nodular juxtamural/linear enhancement with a draining vein on contrast-enhanced MR imaging. MR imaging is useful for surveillance after brain AVM treatment in children, but conventional angiography is required for definitive diagnosis of recurrence. TOF-MRA and contrast-enhanced MR imaging provide complementary information for determining brain AVM recurrence and should be interpreted in conjunction. 3D rotational angiography-MR imaging fusion increases the diagnostic confidence regarding brain AVM recurrence and is therefore suited for intraoperative neuronavigation.

Influence of zinc deficiency on one year recurrence in children with nephrotic syndrome

Introduction: Relapses in children with steroid sensitive nephrotic syndrome (SSNS) are common and sometimes triggered by various infections. Low zinc levels have been described in children with nephrotic states. It is supposed to that zinc deficiency might lead to dysregulation of immune system and an increased risk of infection. Objectives: This study sought to examine whether the plasma level of zinc in nephrotic patients is related to the number of relapses in these patients. Patients and Methods: Forty-three children aged 1-10 years were entered in this study. Baseline data including age, serum zinc level, number of relapses during one year was recorded. The t test and chi-square tests were used to compare the mean values and proportions respectively with significant P value (P &lt; 0.05). Results: Forty-three children with storied sensitive nephrotic syndrome enrolled in this study. Twenty-three (53.5%) of them were male and 20 (46.5%) were female. Around 74.4 % of patients experienced relapses of nephrotic syndrome in one-year period. There was a significant relation between zinc deficiency and recurrence rate. Conclusion: Zinc deficiency is common in children suffering from nephrotic syndrome and is related to recurrence of relapses in these patients.

Rate and factors for scabies recurrence in children in Saudi Arabia: a retrospective study

BackgroundDespite the fact that several scabies outbreaks emerged in schools in Saudi Arabia in 2018, no study has investigated the risk of scabies recurrence among children in Saudi Arabia. This study aimed to estimate the rate of scabies recurrence and identify factors that were associated with an increased risk of recurrence among children.MethodsThis is a multi-center retrospective study of children (age < 14 years) who were diagnosed between May 20, 2015 and September 12, 2018 with one or multiple recurrent scabies at the Ministry of National Guard Health Affairs (MNGHA) hospitals and clinics in Saudi Arabia. Data were obtained from an electronic health system, BestCare database.ResultsA sample of 264 children analyzed (mean age of 6.7 years) resulted in a cumulative number of 316 scabies diagnoses in which 86 (27.2%) experienced scabies recurrence (at least once). Independent factors associated with a high risk of scabies recurrence: older children (adjusted hazard ratio [aHR], 1.036; 95% CI, 1.002–1.072; P = 0.039), female gender (aHR, 1.734; 95% CI, 1.329–2.262; P = 0.001), Western region of Saudi Arabia (aHR, 1.548; 95% CI, 1.115–2.151; P = 0.009), and 2nd tertile season [May to August] (aHR, 2.368; 95% CI, 1.706–3.288; P = 0.001).ConclusionsThe study demonstrated that the recurrence rate of scabies among children is high. Older children, the female gender, the Western region of Saudi Arabia, and the seasonality were independently associated with an increased risk of scabies recurrence. High temperature and low humidity should be explored as leading factors for scabies infestations in Saudi Arabia. Findings derived from this study may be useful for clinicians and governments in optimizing clinical management of scabies cases and contacts.

Anaphylaxis admissions in pediatric intensive care units: Follow-up and risk of recurrence.

Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow-up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis. We conducted a telephone survey of 166 children (≤18years) hospitalized from 2003 to 2013. In all, 106 (64%) completed the survey (boys, 59%; mean age [SD]: 15.3years [5.5]). The main index triggers were drugs (45%) and foods (37%). The mean duration follow-up was of 7.7years (SD: 2.4). Thirty-eight (36%) children experienced 399 new allergic reactions during a follow-up period of 282 patient-years (incidence rate: 1.4/100patients/y; 95% CI: 0.64-2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100patients/y; 95% CI non-calculable). Food was the trigger for 79% of recurrent reactions and drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (P<10-4 ), asthma (P<0.005), atopic dermatitis (P<0.05) than those without. 31% of the 50 children with food allergy did not see an allergist, 23% had no adrenaline auto-injector, and 26% lacked a school individual healthcare plan. Following a PICU admission for anaphylaxis, recurrence is high in children with food allergy compared with drug allergy. Allergic comorbidities increase the risk. Medical follow-up has to be improved for these at-risk children.

Impact of OM-85 Given during Two Consecutive Years to Children with a History of Recurrent Respiratory Tract Infections: A Retrospective Study.

In otherwise healthy infants and young children, respiratory tract infections (RTIs) are extremely common. Clinical data have shown that OM-85 could prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in clinical practice. In addition, an unsolved problem is the efficacy of OM-85 when it is administered for two consecutive years. Moreover, another open question is the safety of OM-85 when co-administered with the influenza vaccine. In order to solve these unanswered issues, 200 children aged three to six years with a history of recurrent RTIs, defined as at least six documented episodes of acute RTI in a single year, who had received OM-85 (Broncho-Vaxom®; OM Pharma, a Vifor Pharma Group Company, Geneva, Switzerland) for two consecutive years (3.5 mg once a day for 10 days for 3 months of each year) were selected and matched based on age, sex, and period of evaluation with children with recurrent RTIs who did not receive OM-85. In the group of children treated with OM-85, the number of patients who did not experience any new episode of RTI, as well as the number of RTIs, wheezing episodes, medical visits, and prescribed antibiotic courses, were significantly lower than that in the group not treated with OM-85. The results were similar in the first and second year of OM-85 administration. A minority of patients showed mild adverse events, and the safety profile was overall good, including in the 49 children who received the influenza vaccination within one month from the beginning of the first cycle of OM-85. Our data suggest that OM-85 can effectively and safely reduce the risk of new infective episodes in children with recurrent RTIs and that a second yearly course of lysate administration can be useful to maintain protection, particularly when the diagnosis of recurrent RTIs is made in younger children for whom it is likely that definitive maturation of the immune system still requires a long time.

Multidimensional Analysis of Urinary Stone Diseases in Pediatric Patients.

Objectives:Urinary tract stones are less common in children than in adults. Determining the etiology is the most important step to achieve successful treatment and prevent future recurrence. The aim of this study was to investigate the clinical characteristics and possible risk factors for urinary stone disease in pediatric patients.Methods:The data of 126 patients with urinary stone disease who were treated in a pediatric nephrology clinic between 2000 and 2014 were analyzed retrospectively. A total 126 patients were enrolled in the study: 70 (55%) male and 56 (45%) female patients were included. The complaints, age of diagnosis, family histories, and stone location were examined. Direct urine microscopic examination, complete urinalysis, and urine culture were performed for all of the patients. Calcium, uric acid, oxalate, citrate, magnesium, and cystine levels were measured in urine collected in a 24-hour period. Serum electrolyte, blood urea nitrogen, creatinine, calcium, phosphorus, uric acid, and albumin levels were measured. Urinary ultrasound was performed. Stone analysis was conducted using the X-ray diffraction method. The mean age of the patients was 55 months (range: 1-162 months) at presentation.Results:In all, 34% of the patients had a family history of urinary stone disease. The rate of previous urinary tract infection was 26%. It was determined that 34% of the patients had been taking vitamin D and 5% had been taking a high dose. Metabolic risk factors determined were: hypercalciuria in 41%, hypocitraturia in 30%, hyperoxaluria in 14%, hyperuricosuria in 10%, and cystinuria in 5%. Among the group, 81% of the patients had kidney stones, 6.5% had ureter stones, and 2.5% had bladder stones. Furthermore, it was determined that 45% of the stones were composed of calcium oxalate, 35% had calcium phosphate stones, 14.2% had uric acid stones, and 13.3% had cystine stones. In 52% of the cases, extracorporeal shock wave lithotripsy was performed, and 71% underwent surgical treatment.Conclusion:Metabolic evaluation and stone analysis should be performed to prevent future recurrences in children with urinary stone disease and lifelong follow-up should be emphasized.

A study protocol on comparative randomised controlled trial of Homoeopathy -vs- allopathy in acute otitis media and its recurrence in Children

Background: Acute otitis media (AOM) is one of the most common acute infections in children, and injudicious prescription of antibiotics may lead to increase of antibiotic-resistant cases. Homoeopathic treatment may provide a safer and more effective treatment. Objective: Earlier, a pilot study conducted by the Central Council for Research in Homoeopathy (CCRH) on eighty patients at a single centre showed non-inferiority results. This study shall be undertaken to substantiate the earlier findings. Methods: This will be an open-label, non-inferiority, randomised controlled (parallel arm) trial to be conducted on children in the age group of 2–12 years, suffering from AOM. The trial will include 240 children; each participant shall be randomly selected to receive either individualised homoeopathic medicine or symptomatic allopathic medicine. In case a child does not have ≥50% improvement with assigned treatment on day 3, he/she shall be given antibiotics. Children shall be treated/followed up for a period of 1 year to check recurrence, if any, in both the groups. The primary outcomes are changes in the Tympanic Membrane Examination Scale and Acute Otitis Media-Severity of Symptoms scale, time to improvement in pain through the Facial Pain Scale-Revised between the groups and recurrence (number of episodes, intensity and duration) of AOM between the groups at 1 year. Discussion: The study will consolidate the findings observed during a pilot study conducted by the CCRH at Jaipur, India. It is proposed to compare the role of individualised homoeopathy over allopathy in the treatment of AOM and to assess its role in controlling the recurrence.

Frequency of Cytogenetic Findings and its Effect on the Outcome of Pediatric Acute Lymphoblastic Leukemia.

Introduction:Acute lymphoblastic leukemia (ALL) is one of the most common cancers in children and accounts for about ⅓ of cancers in children. The annual incidence of ALL is 4 patients per 100,000 children. Their peak age is between 2-5 Year. One of the most important prognostic factors is cytogenetic abnormalities which are very effective in determining treatment policy.Aim:To determine the frequency of cytogenetic findings and its effect on the outcome of children with ALL.Materials and Methods:This retrospective cross-sectional analytical study was conducted on children with ALL who their disease was diagnosed between 2001and 2009. Furthermore, 206 patients with ALL were examined by referring to Clinic of Ali Asghar Hospital in Tehran. Data was collected from medical records and analyzed by SPSS16 software.Results:206 children with ALL were enrolled in the study. The estimated event-free survival rate of all enrolled patients was more than 70%. There was a significant relationship between type of cytogenetic disorder and clinical outcome of patients (P˂0.0001), where the highest mortality was observed in patients with t (9;22) and t (4;11). There was no significant correlation between the sex and age with the clinical outcome of the patient (P = 0.064; p=0.322). There was a statistically significant relationship between mediastinal mass and clinical outcome (P = 0.002), indicating that the presence of cells growth in an involuntary way can be cause of the cancer. A significant association was found between the clinical outcome of patients and radiotherapy (P = 0.043), indicating that radiotherapy is effective in improving cancer.Conclusion:The findings demonstrated that the average survival rate without recurrence in children was at level of the European countries. However, the strong chemotherapy weakened the role of many prognostic factors in ALL patients, but some translocations are prognostic factors in predicting death in patients with ALL. Therefore, patients with this factor need to receive more confident treatment policy. Comprehensive studies are required by focusing on more samples because of low number of relapses and deaths in the present study.

Clinical study on deletion of IKZF1 gene in 93 children with B-cell acute lymphoblastic leukemia

Objective To study the effect of IKZF1 gene deletion on the relapse and prognosis of children with B-cell acute lymphoblastic leukemia (B-ALL) , and provide a theoretical basis for the selection and intensity adjustment of chemotherapy in B-ALL children with IKZF1 gene. Methods From June 2014 to November 2016, a total of 93 children with B-ALL were included in the study. They were newly diagnosed in the Department of Hematology Oncology, Children′s Hospital of Kunming Medical University, and able to provide sufficient bone marrow DNA samples.They were divided into IKZF1 gene deletion group(n=18) and IKZF1 gene non-deletion group (n=75). The incidence of IKZF1 gene deletion was calculated. The gender, age, number of white blood cells count, early treatment response, central nervous system (CNS) classification, minimal residual disease(MRD) grouping, risk grouping, recurrence and survival constituent ratioes were compared between two groups. The 2-year disease-free survival (DFS) and overall survival(OS) rates of the two groups were calculated by Kaplan-Meier method, and the survival curves were plotted. The samples collection of this study were agreed from the guardians, and they signed the informed consent forms. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Kunming Medical University (approval No. CCLG-ALL-2015). Results ① The incidence of IKZF1 gene deletion was 19.4% (18/93). ② There were no significant differences in gender, age, CNS classification, early treatment response and risk grouping between the two groups (P>0.05). The proportion of children with white blood cell count ≥50×109/L and high-risk MRD in the IKZF1 gene deletion group were 38.9% (7/18) and 27.8% (5/18), respectively, which were significantly higher than those of IKZF1 non-deletion group with 13.3% (10/75) and 8.0% (6/75), respectively, and the differences were statistically significant (χ2=4.75, P=0.019; χ2=4.72, P=0.009). The recurrence rate of the IKZF1 gene deletion group was 33.3% (6/18), which was significantly higher than that of the IKZF1 non-deletion group with 9.3%(7/75), and the difference was also statistically significant (χ2=6.95, P=0.008). ③ The 2-year DFS and OS rates in the IKZF1 gene deletion group were (72.7±13.4)% and (81.8±11.6)%, respectively, which were significantly lower than those of IKZF1 non-deletion group with (92.3±3.0)% and (94.4±2.8)%, and the differences were significant (P<0.05). Conclusions Deletion of the IKZF1 gene is one of the high-risk predictors of recurrence in children with B-ALL. It should be used as a risk factor to guide the risk stratification of B-ALL children in order to adjust the intensity of chemotherapy method and improve their prognosis. Key words: Leukemia, B-cell; Gene deletion; Prognosis; Risk factors; IKZF1 gene; Child