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Sedky M, Gohar S, Ahmed S, Zaky I, Salama A, Hassanein O, Maher E, ElHaddad A. Pediatric pulmonary multisystem langerhans cell histiocytosis: does lung lesion severity affect the outcome? Orphanet J Rare Dis 2023; 18:361. [PMID: 37978394 PMCID: PMC10655418 DOI: 10.1186/s13023-023-02970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The pediatric pulmonary multisystem Langerhans cell histiocytosis (PPM LCH) is associated with either low risk or high risk organ(s). The nodulo-cystic lung lesions although pathognomonic, yet are very variable in severity and remain a source of controversy in certifying pulmonary LCH diagnosis. The study aimed to examine the prognostic value of clinical respiratory manifestations and radiological lung lesions severity. This is through associating a CT chest triad of bilateral, extensive and diffuse lesions. It is a retrospective study of 350 LCH patients who received systemic treatment at Children's Cancer Hospital Egypt during the period from 2007 to 2020. RESULTS Sixty-seven patients (67/350-19.1%) had PPM LCH at presentation. Severe lung lesions were present in 24 of them. The median follow-up period was 61 months (IQR: 3.4-8.3). The 5-year overall survival (OS) and event free survival (EFS) was 89% and 56.6% respectively. The EFS, for severe radiological lesions triad was 38% ± 20.7 versus 66% ± 16.2 for non-severe lesions triad p 0.002, while for presence of chest X-ray changes 27% ± 22.344 versus absence of chest X ray changes 66% ± 14.7 p 0.001, for clinical respiratory manifestations 13% ± 13.9 versus none 62% ± 22.9 p < 0.001, for RO- with severe lung lesions 47% ± 30.4 versus RO- without severe lung lesions 69% ± 5.9 p 0.04. There was a tendency for the independent prognostic impact of severe lung involvement; aHR = 1.7 (95% CI 0.92-3.13, p = 0.09). CONCLUSION Although the lung is a low -risk organ per se in LCH, our study demonstrates a non negligeable prognostic impact of severe lung involvement in the risk stratification of pediatric LCH. This warrants further study and external validation.
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Affiliation(s)
- Mohamed Sedky
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt.
- Department of Pediatrics, National Research Centre, Cairo, Egypt.
| | - Seham Gohar
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaky
- Department of Radiology, Children Cancer Hospital Egypt 57357 (11617), Cairo, Egypt
- Department of Radiology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Asmaa Salama
- Department of Pathology, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
- Department of Pathology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Omayma Hassanein
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Eslam Maher
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Alaa ElHaddad
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
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2
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Soliman R, Oke J, Sidhom I, Bhakta N, Bolous NS, Tarek N, Ahmed S, Abdelrahman H, Moussa E, Zamzam M, Fawzy M, Zekri W, Hafez H, Sedky M, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Eweida W, Abouelnaga S, Elhaddad A, Heneghan C. Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence. EClinicalMedicine 2023; 55:101729. [PMID: 36386036 PMCID: PMC9646894 DOI: 10.1016/j.eclinm.2022.101729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. METHODS Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. FINDINGS For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. INTERPRETATION Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy. FUNDING Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.
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Affiliation(s)
- Ranin Soliman
- Department of Continuing Education, University of Oxford, UK
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
- Corresponding author. Department for Continuing Education, Kellogg College, University of Oxford, UK; Health Economics and Value Unit, Children's Cancer Hospital 57357–Egypt (CCHE), Cairo, Egypt.
| | - Jason Oke
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Nickhill Bhakta
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nancy S. Bolous
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Menoufia University, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatrics Department, National Research Centre, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Beni-suef University, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
- Chief Executive Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Carl Heneghan
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Alsaffar MM, Hasan M, McStay GP, Sedky M. Digital DNA lifecycle security and privacy: an overview. Brief Bioinform 2022; 23:6518049. [PMID: 35106557 DOI: 10.1093/bib/bbab607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
Abstract
DNA sequencing technologies have advanced significantly in the last few years leading to advancements in biomedical research which has improved personalised medicine and the discovery of new treatments for diseases. Sequencing technology advancement has also reduced the cost of DNA sequencing, which has led to the rise of direct-to-consumer (DTC) sequencing, e.g. 23andme.com, ancestry.co.uk, etc. In the meantime, concerns have emerged over privacy and security in collecting, handling, analysing and sharing DNA and genomic data. DNA data are unique and can be used to identify individuals. Moreover, those data provide information on people's current disease status and disposition, e.g. mental health or susceptibility for developing cancer. DNA privacy violation does not only affect the owner but also affects their close consanguinity due to its hereditary nature. This article introduces and defines the term 'digital DNA life cycle' and presents an overview of privacy and security threats and their mitigation techniques for predigital DNA and throughout the digital DNA life cycle. It covers DNA sequencing hardware, software and DNA sequence pipeline in addition to common privacy attacks and their countermeasures when DNA digital data are stored, queried or shared. Likewise, the article examines DTC genomic sequencing privacy and security.
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Affiliation(s)
- Muhalb M Alsaffar
- Department of Computing, AI and Robotics, School of Digital, Technologies and Arts, Staffordshire University, College Road, ST4 2DE, Staffordshire, United Kingdom
| | | | - Gavin P McStay
- Department of Biological Sciences, School of Health, Science and Wellbeing, Staffordshire University, College Road, Stoke-on-Trent, Staffordshire, ST4 2DE, United Kingdom
| | - Mohamed Sedky
- Department of Computing, AI and Robotics, School of Digital, Technologies and Arts, Staffordshire University, College Road, ST4 2DE, Staffordshire, United Kingdom
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Hafez HA, Ragab I, Sedky M, Shams M, Youssef A, Refaat A, Habib E, Sidhom I. Patterns, risk factors and outcome predictors of posterior reversible encephalopathy syndrome in pediatric cancer patients. Leuk Lymphoma 2020; 62:462-468. [PMID: 33063564 DOI: 10.1080/10428194.2020.1832658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to assess the clinical and radiological patterns and outcome predictors of posterior reversible encephalopathy syndrome (PRES) in pediatric cancer patients. A retrospective study included patients who developed PRES during their treatment at the Children's Cancer Hospital Egypt. A total of 50 patients developed PRES. Leukemia and lymphoma were the commonest diagnoses (64%). Regarding the MRI findings, occipital affection was the most common (92%), followed by frontal and temporal lobes involvement in 32% and 22% respectively and advanced PRES was described in 8 patients. Of the whole patients, 80% had complete clinical resolution and 60% showed complete radiological resolution at 2 weeks' evaluation and 2 patients died out of PRES. Unfavorable outcome was associated with those who had motor dysfunction, status epilepticus at presentation, frontal lobe and thalamic affection and atypical PRES. PRES might present in atypical sites with poor outcome including death.
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Affiliation(s)
- Hanafy A Hafez
- Department of Pediatric Oncology, National Cancer institute, Cairo University, Cairo, Egypt.,Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Iman Ragab
- Pediatric Department, Hematology-Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Mohamed Sedky
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Marwa Shams
- Pediatric Department, Hematology-Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Ayda Youssef
- Radiology Department, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Amal Refaat
- Radiology Department, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Elsaeed Habib
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt.,Pediatric Department, Hematology-Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Iman Sidhom
- Department of Pediatric Oncology, National Cancer institute, Cairo University, Cairo, Egypt.,Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt
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5
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Soliman RM, Elhaddad A, Oke J, Eweida W, Sidhom I, Ahmed S, Abdelrahman H, Moussa E, Fawzy M, Zamzam M, Zekri W, Hafez H, Sedky M, Abdalla A, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Fouad H, Tarek N, Abouelnaga S, Heneghan C. Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt. Int J Cancer 2020; 148:1562-1574. [PMID: 32997796 DOI: 10.1002/ijc.33321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022]
Abstract
Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P < .001) and by calendar periods from 69.6% to 74.2% (P < .0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P < .001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
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Affiliation(s)
- Ranin M Soliman
- Department of Continuing Education, University of Oxford, Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Menoufia University, Al Minufya, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Department, National Research Centre, Giza, Egypt
| | - Amr Abdalla
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Department of Paediatric Oncology, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Beni-Suef University, Beni-Suef, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Heba Fouad
- World Health Organization, Non-communicable Diseases Surveillance Unit, Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Chief Executive Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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Abdelaal AHK, Sedky M, Gohar S, Zaki I, Salama A, Hassanain O, El Ghoneimy AM. Skeletal involvement in children with Langerhans cell histiocytosis: healing, complications, and functional outcome. SICOT J 2020; 6:28. [PMID: 32672151 PMCID: PMC7364762 DOI: 10.1051/sicotj/2020024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Skeletal involvement in children with Langerhans cell histiocytosis (LCH) is a common feature of the disease. Several options for the treatment of these skeletal lesions have been reported. We describe our experience in the treatment of skeletal involvement of LCH in this retrospective case series study, entailing anatomic distribution, pattern of healing, skeletal deformities, and functional outcome of skeletal LCH. Methods: A retrospective analysis was conducted for patients diagnosed with LCH and having skeletal lesions in the period between 2007 and 2015. Out of a total of 229 cases, 191 (83.4%) had skeletal involvement. Bone healing was divided into partial and complete based on the size of lesion and cortical changes in plain radiograph. Skeletal deformities were serially measured. Time to pain control, resumption of weight bearing, and the final functional status of the patient were reviewed. Results: The mean age at presentation was 4.4 years (3 m–14.8 y) and the mean follow-up period was 53.3 months (0.2–120.7). After screening of skeletal and extra-skeletal lesions, 59 patients (31%) had M-S (Multisystem) LCH and 132 (69%) had S-S (Single system) LCH. Unifocal bone lesions were found in 81 (42.5%) patients, and multifocal bone lesions in 110 patients (57.5%). Single or multiple bone lesions were found in the craniofacial bones in 152 patients (79.5%), femur in 19 patients, (10%), ribs in 18 patients (9.4%), spine in 15 patients (8.1%), pelvis in 14 patients (7.3%), scapula in 8 patients (4.1%), humerus in 6 (3.1%), clavicle in 6 patients (3.1%), tibia in 3 patients (1.5%), radius in 3 patients (1.5%), and the ulna in 2 patients (1%) patients. No lesions were found in the fibula, hand, or foot. Out of all skeletal lesions, 179 (93.7%) patients were treated either medically or conservatively and 12 patients (6.2%) were treated surgically. The mean time to complete healing was 5.2 months (2–12). Skeletal complications included: pathologic fractures (9 vertebra plana, 5 long bone, 1 iliac bone), deformities (9 thoracolumbar kyphosis, 2 cervical spine subluxations, 2 coxa vara deformity of the proximal femur and one flattening of iliac bone). Conclusion: Non-operative treatment can lead to adequate bone healing in few months period. Partial or complete remodeling of bone deformities can be observed without surgical correction. However, surgical intervention might be indicated when cervical spine affection may lead to instability and subsequent neurological affection. Functional impairment is rarely caused by skeletal lesions in LCH.
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Affiliation(s)
- Ahmed H K Abdelaal
- Consultant of Musculoskeletal Tumor Surgery, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Sohag University, 82524 Sohag, Egypt
| | - Mohamed Sedky
- Professor of Pediatrics, Pediatric Department National Research Centre, Consultant of Pediatric Oncology Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Seham Gohar
- Consultant of Pediatric Oncology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Iman Zaki
- Professor of Radiodiagnosis National Cancer Institute NCI, Cairo University Head of Medical Imaging Department, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Asmaa Salama
- Professor of Pathology National Cancer Institute NCI, Cairo University Consultant of Pathology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Omayma Hassanain
- Clinical Research Senior Supervisor, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Ahmed M El Ghoneimy
- Head of Musculoskeletal Tumor Surgery Unit, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, 12613 Giza, Egypt
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Alshammari N, Alshammari T, Sedky M, Champion J, Bauer C. OpenSHS: Open Smart Home Simulator. Sensors (Basel) 2017; 17:s17051003. [PMID: 28468330 PMCID: PMC5469526 DOI: 10.3390/s17051003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 12/03/2022]
Abstract
This paper develops a new hybrid, open-source, cross-platform 3D smart home simulator, OpenSHS, for dataset generation. OpenSHS offers an opportunity for researchers in the field of the Internet of Things (IoT) and machine learning to test and evaluate their models. Following a hybrid approach, OpenSHS combines advantages from both interactive and model-based approaches. This approach reduces the time and efforts required to generate simulated smart home datasets. We have designed a replication algorithm for extending and expanding a dataset. A small sample dataset produced, by OpenSHS, can be extended without affecting the logical order of the events. The replication provides a solution for generating large representative smart home datasets. We have built an extensible library of smart devices that facilitates the simulation of current and future smart home environments. Our tool divides the dataset generation process into three distinct phases: first design: the researcher designs the initial virtual environment by building the home, importing smart devices and creating contexts; second, simulation: the participant simulates his/her context-specific events; and third, aggregation: the researcher applies the replication algorithm to generate the final dataset. We conducted a study to assess the ease of use of our tool on the System Usability Scale (SUS).
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Affiliation(s)
- Nasser Alshammari
- Staffordshire University, College Road, ST4 2DE Stoke-on-Trent, UK.
- College of Information and Computer Science, Aljouf University, Sakaka 72388, Saudi Arabia.
| | - Talal Alshammari
- Staffordshire University, College Road, ST4 2DE Stoke-on-Trent, UK.
- College of Computer Science and Engineering, University of Hail, Hail 53962, Saudi Arabia.
| | - Mohamed Sedky
- Staffordshire University, College Road, ST4 2DE Stoke-on-Trent, UK.
| | - Justin Champion
- Staffordshire University, College Road, ST4 2DE Stoke-on-Trent, UK.
| | - Carolin Bauer
- Staffordshire University, College Road, ST4 2DE Stoke-on-Trent, UK.
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Abdel Rahman H, Sedky M, Hamoda A, Raafat T, Youssef A, Omar W, Hassanein O, Moussa E. Role of FDG-PET scan in the management of pediatric mature B cell non-Hodgkin's lymphoma. CCHE experience. J Egypt Natl Canc Inst 2016; 28:95-9. [PMID: 27133974 DOI: 10.1016/j.jnci.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/26/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022] Open
Abstract
AIM OF WORK To evaluate the sensitivity (Se), specificity (Sp), and predictive values (PV) of PET scan during management of pediatric mature B cell non-Hodgkin's lymphoma (NHL) in comparison with conventional computed tomography (CT) scan. PATIENTS AND METHODS A retrospective study enrolled on pediatric NHL patients at Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to the end of June 2013. RESULTS For 115 pediatric patients diagnosed with mature B cell NHL, 152 PET and 152 CT scans were done simultaneously. Median age was 5.7years. They were 85 males (74%) and 30 females (26%). One hundred twenty six scans (82.9%) were done for 100 (87%) Burkitt lymphoma (BL) patients, while 26 scans (17.1%) were done for 15 (13.0%) patients with diffuse large B cell NHL (DLBC). Nineteen examination (12.5%) were done before starting chemotherapy (group 1), 107 (70.3%) at time of evaluation (group 2), and 26 (17.1%) during follow up (group C). Overall sensitivity was 91.6% for PET and 70.0% for conventional CT (p=0.02). Specificity was 84.1% for PET and 58.9% for CT (p<0.001). Positive predictive value (PPV) for PET was 50%, while was 22% for CT scan (p<0.001). Negative predictive value (NPV) for PET was 98%, and 92% for CT (p=0.01). CONCLUSION PET scan is significantly more sensitive than conventional CT in the management of aggressive pediatric mature B cell NHL. PET negativity is an excellent indicator of tumor response.
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Affiliation(s)
- Hany Abdel Rahman
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt.
| | - Mohamed Sedky
- Department of Pediatrics, National Research Centre and Children Cancer Hospital, Egypt
| | - Asmaa Hamoda
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Tarek Raafat
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Ayda Youssef
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Walid Omar
- Department of Nuclear Medicine, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Omneya Hassanein
- Department of Clinical Research, Children Cancer Hospital, Egypt
| | - Emad Moussa
- Department of Medical Oncology, Menoufiah University and Children Cancer Hospital, Egypt
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Zekri W, Sedky M, Khalifa M. The impact of homocysteine level on methotrexate induced neurotoxicity in children treated with St. Jude total XV acute lymphoblastic leukemia protocol. Int J Cancer Ther Oncol 2016. [DOI: 10.14319/ijcto.41.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rahman HA, Sedky M, Mohsen I, Taha H, Loaye I, Zaghloul MS, El Wakeel M, Labib RM. Corrigendum to “Outcome of pediatric parameningeal rhabdomyosarcoma. The Children Cancer Hospital, Egypt experience” [J Egypt Natl Cancer Instit 2013;25:79–86]. J Egypt Natl Canc Inst 2016. [DOI: 10.1016/j.jnci.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abdel Rahman H, Moussa E, Sedky M. Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience. Int J Cancer Ther Oncol 2015. [DOI: 10.14319/ijcto.32.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sedky M, Mekki Y, Mialou V, Bleyzac N, Girard S, Salama E, Abdel Rahman H, Bertrand Y. Cytomegalovirus infection in pediatric allogenic hematopoietic stem cell transplantation. A single center experience. Pediatr Hematol Oncol 2014; 31:743-53. [PMID: 24308761 DOI: 10.3109/08880018.2013.859188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a retrospective analysis of Cytomegalovirus (CMV) infection: incidence, recurrence, resistance, and subsequent disease of 81 children who underwent allogenic hematopoietic stem cell transplantation (HSCT). The recipient and/or donor's CMV serology was positive prior to transplant [recipient (R+) and/or donor (D+)]. CMV was monitored by RT-PCR starting from the first week post transplant. Forty patients showed CMV infection (49, 5%). Of them 10 manifested CMV disease leading to four deaths. In univariate analysis, factors associated with CMV infection were CMV R+ P < .01, CMV R+/D+ pair P < .01, nonbone marrow (BM) stem cell source P < .05, nonirradiation conditioning regimen P < .05, Antithymocyte globulin (ATG) P < .01. Factors associated with CMV resistance were: >1 HLA allele mismatch P < .05, CMV R +/D-pair P < .01, CMV D-P < .01, non-BM P < .05, nongenoidentical transplant P < .01. CMV disease was influenced by >1 HLA allele mismatch (P < .001), non-BM (P < .01). On multivariate analysis, CMV R+/D- (P < .05), corticosteroids ≥2 mg/kg P < .01, ATG P < .01 and non-BM (P < .05) were independent factors for CMV infection. CMV R+ transplant is associated with more CMV infection and resistance to preemptive treatment. Prolonged immune suppression (IS) worsens outcome of CMV infection and should be shortened whenever possible.
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Affiliation(s)
- M Sedky
- Pediatric Department, National Research Center , Cairo , Egypt
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Rahman HA, Sedky M, Mohsen I, Taha H, Loaye I, Zaghloul MS, Wakeel ME, Labib RM. Outcome of pediatric parameningeal rhabdomyosarcoma. The Children Cancer Hospital, Egypt, experience. J Egypt Natl Canc Inst 2013; 25:79-86. [DOI: 10.1016/j.jnci.2013.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/13/2013] [Accepted: 01/13/2013] [Indexed: 11/30/2022] Open
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Al-Tonbary Y, Sarhan MM, El-Ashry RA, Salama E, Sedky M, Fouda A. Comparative study of two mechlorethamine, vincristine, procarbazine, and prednisone derived chemotherapeutic protocols for the management of pediatric Hodgkin lymphoma (HL): single-center 5-year experience. Leuk Lymphoma 2010; 51:656-63. [DOI: 10.3109/10428191003624249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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