PROF SOAD KHALIL AL JAOUNI MD FRCPC Professor of Hematology Professor of Pediatrics Hematology Oncology Department of Pediatrics Hematology Oncology Department of ID: 741420
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Slide1
Natural products can improve the quality of life in Pediatric Hematology/Oncology
PROF. SOAD KHALIL AL JAOUNI, MD, FRCP(C)
Professor of
Hematology
Professor of Pediatrics Hematology/Oncology Department of Pediatrics Hematology/Oncology, Department of Hematology, King Abdulaziz University HospitalFaculty of Medicine, King Abdulaziz University Fellow of the Royal College of Physician & Surgeon in Canada
The 2
nd
International Conference on Quality Medication in Prophetic Medicine
King Faisal Main Auditorium at King
Abdulaziz
University
April 5 – 7, 2016, Jeddah, Kingdom of Saudi Arabia
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Most of childhood cancer are curable with chemotherapy, radiotherapy and surgery.
Health problems that develop during chemotherapy/radiotherapy are common [ mucositis, infection, major cardiac event, organ dysfunction, infertility and learning disability].Recent studies showed that some of the natural productshave good nutritional and medicinal potential.
KAU, SJaouniSlide3
Two controlled studies will be presented from King Abdulaziz University Hospital (A tertiary care medical
center) King Abdulaziz University, Jeddah, KSA A pilot trial of Saudi honey on oral mucositis among pediatric cancer patients (October 2004 to O
ctober 2005)Effect of Phoenix dactylifera palm date (Ajwa) on infection, hospitalization and mortality among Pediatric Cancer patients at King Abdulaziz University Hospital, King Abdulaziz University (January 2008 to September 2015). These studies were approved by Ethical Research Board.
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SJaouniSlide4
A PILOT TRIAL 0F SAUDI HONEY ON ORAL MUCOSITIS AMONG PEDIATRIC CANCER PATIENTS
1Soad K. Al Jaouni, MD, FRCPC, 1Mohammad S. Al Muhayawi, MD, 1Abear Hussein, MD, MSc, 2
Steve Harekeh, PhD, 3Saad M. Al Muhayawi 1Department of Pediatric Hematology / Oncology, King Abdulaziz University Hospital, Faculty of Medicine, 2Special Infectious Agents Unit-Biosafety Level 3 Head of Safety Committee, King Fahd Medical Research Center,
3Department of Ear Nose Throat & Head & Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
KAU, SJaouniSlide5
Objective:
This study was to evaluate the efficacy and safety of Saudi honey as integrative approach in prophylaxis and treatment of chemo-radiotherapy induced mucositis among pediatric cancer patients at King Abdulaziz University Hospital at King Abdulaziz University during October 2004 to October 2005.Patients and methods: Forty patients were randomized into two groups: receiving chemo/radiotherapy with the additional Saudi honey and control group receiving treatment without the use of honey. All patients were evaluated clinically, mouth ulcers were evaluated. Cultures were done.
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Results:
A total of 390 episodes of fever & neutropenia associated with mucositis. The honey group experienced significant reduction in grade IV mucositis 15 out of 200 febrile neutropenia episodes and grade III mucositis
was reported in 20 out of 190 febrile neutropenia episodes. In the control group, grade III & IV mucositis were reported in 60 and 40 out of 200 febrile neutropenia. Candida colonization was found in 15 per cent of the honey group and 60 per cent of the control group. Positive cultures for aerobic pathogenic bacteria were observed in 20 per
cent of the honey group and 65 per cent of the control group. The honey group had a positive weight gain, and decreased duration of hospitalization and severity of
mucositis with a significant decrease in bacterial and fungal infection. (p = 0.001).KAU, SJaouniSlide7
Figure 1. Comparison between the two group in developing Grade III & IV oral
mucositis.
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Figure 2. Comparison between the two group in
candida colonization and positive aerobic culture.
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Treatment group
Control group
Grade III1534Grade IV
8
20Candida colonisation1560Aerobic culture1565Table 1. The percentages of developing Grade III & IV oral mucositis, candida colonization, and positive aerobic culture among the two groups.
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Conclusion:
This study showed that the honey treatment is effective and safe in reducing and minimizing the damage of the mucosa and improving the quality of life. Honey inhibits and minimize bacterial and fungal growth, honey have antimicrobial activity.We recommend to use honey as a standard
supportive care in the pediatric cancer patients.KAU, SJaouniSlide11
Effect of Phoenix
dactylifera palm date (Ajwa) on infection, hospitalization and mortality among Pediatric Cancer patients at King Abdulaziz University Hospital 1
Prof. .Soad K. Al Jaouni, 1Dr.. Abear Hussein, 1Dr. Nora Alghamdi, , 2Dr. Dalia
Ezzat, 3Prof. Steve Harakeh, 4
Prof. Nahla Khamis Ibrahim, 5Dr. Rajaa Raddadi, & 6Prof. Shaker Mousa 1Department of Pediatric Hematology/Oncology, 2Department of Clinical Microbiology, King Abdulaziz University Hospital, 3Special Infectious Disease Department, King Fahd Medical Research Center, 4Department of Public & Epidemiology, Faculty of Medicine at King Abdulaziz University, 5 Preventive Medicine & Public Health at Ministry of Health, Jeddah, Kingdom of Saudi Arabia, 6 Professor of Pharmacology, Vice Provost for Research Executive Vice President and Chairman, The Pharmaceutical Research Institute, Albany, USA.KAU, SJaouniSlide12
Objective:
To determine the effect of regular intake of Phoenix dactylifera palm date called Ajwa on number of infections, hospitalization associated with fever neutropenia and mortality of pediatric cancer patients admitted to King Abdulaziz University Hospital, a tertiary care medical center, Faculty of Medicine, King
Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Methods: A non-randomized controlled intervention study was done during the period from January 2008 to September 2015. A total of 55 pediatric cancer patients with hematologic or non-hematologic malignancies (who were treated by chemotherapy/radiotherapy) were enrolled in the study. A total of 32 patients were given Ajwa and 23 did not.
The outcomes were compared between both groups within the 5 years follow-up period. Culture and sensitivity was done.
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Results:
The study included 27 males and 28 females, with male to female ratio of around 1:1. The mean age was 9.3 with S.D. of 4.4. Children enrolled in the Ajwa group showed minimal positive cultures as compared to non Ajwa (control) groups more than 5-year follow-up period.
There was significant reduction in the mortality rate of patients enrolled in Ajwa group as compared to other group (RR= 0.74; 95 % CI: 0.06-1.00). There was a significant reduction in the number of hospital admission per year in the Ajwa group (5.74±5.8 times) as compared to control group (17.34±10.29 times), with a statistical significant difference (p≤0.05).
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Variables
N
Min
Max
MeanSDAge551
208.604.3
Admissions
55
1
30
12.49
10.7
Count
Total
55
Gender
Male
27
Female
28
Ajwa Intake
No
32
Yes
23
Infection
No
23
Yes
32
Mortality
Dead
13
Alive
42
Cause
of mortality
Progression and Infection
10
(No
Ajwa
intake)
Infection
1
(No
Ajwa intake)Disease Progress 1(Ajwa Group)Cardiac Failure1(No Ajwa intake)Off TreatmentNo32Yes23
Characteristics of the 55 Pediatric Oncology
patients treated at King
Abdulaziz
University Hospital January 2008 – September 2015 Slide15
Patients characteristic of
55 pediatric oncology , on
Ajwa study related to to infection, number of admissions, mortality and outcome at KAUH from 2008 to 2015
Variable
Ajwa intakeTotal
Yes (%)No (%)
P value
55
32
23
Gender
Male
29 (51.8)
10 ( 45.5
%)
19 (55.9)
0.45
Female
27 (48.2)
12 (54.5)
15 (
44.4
)
Age (mean and SD)
9.3 (
4.4)
9.5 (
3.4)
8.9 (
4.5)
0.57
Variable
Ajwa
intake
Yes (%)
No (%)
P value
32
23
Infection
No (n=23)
23 (
100.0%)
0(0.0%)
<0.001
Yes(n=32)
0(0.0%)32 (100.0%)KAU, SJaouniSlide16
Variables
Total
Ajwa Intake
p-value
aNoYesTotal55
3223
Infection
No
23(41.8%)
0(0.0%)
23(100.0%)
<0.001
Yes
32(58.2%)
32(100.0%)
0(0.0%)
Admission
<10
Prolonged
31 (56.4%)
24 (43.6%)
11(34.4%) 21(65.6%)
20(87.0%)
3 (13.0%)
<0.001
Mortality
Dead
13(23.6%)
11(34.4%)
2(8.7%)
0.027
Alive
42(76.4%)
21(65.6%)
21(91.3%)
Off Treatment
No
32(58.2%)
23(71.9%)
9(39.1%)
0.015
Yes
23(41.8%)
9(28.1%)
14(60.9%)
Ajwa
intake relative to infection, number of admissions, mortality and off treatment at King Abdulaziz University Hospital, Jeddah, KSAa-significant using Chi-Square Test @<0.05 level.KAU, SJaouniSlide17
Variables
Ajwa
Intake
RR(95%CI)
ARR(95%CI)NNT(95%CI)No(n=32)
Yes(n=23)
Mortality
Dead(n=13)
11 (
34.4%)
2 (8.7
%)
0.25 (
0.06 to 1.04)
0.26 (
0.16to0.36)
3.9 (
2.8 to 6.3)
Alive(n=42)
21 (
65.6%)
21 (
91.3%)
Off Treatment
No(n=23)
23 (
71.9%)
9 (
39.1%)
41.8 (
29.7 to 55)
-
0.33
(-
0.43,to 0.23)
3.1 (
2.3 to 4.4)
Yes(n=23)
9 (
28.1%)
14 (
60.9%)
P-
value
Mean
difference
(95%CI)Mean (SD)MaximumMinimumAjwa IntakeGroup Statistics<.0013 (1.2to4.8)4.4(3.8)130No (n=32)Number of positive culture1.1(1.7)50Yes(n=23)<0.0111.6 (7.2to16)17.3(10.3) 940No (n=32)days of Admission 5.7(5.9) 120Yes(n=23)KAU, SJaouniSlide18
Patients with AML & Cardiac evaluation on Ajwa
Study at KAUH (2008 – 2015)CommentCultures
No. of Admission FN/yearAjwa intakeDiagnosis & outcomeAge & Sex
Patient Name
2 PICU admissions, frequent infections psedomonus infections, multiple , antifungal, 8/year2/yearNoYesAML-2010Down syndrome on cardiac failure treatment, off treatment 20132/FFABlood-klebsiella pneumonia ssp pneumonia x4, blood enterococcus
faecalis, blood-acinetobacter baumannil12/yearNoAML-2008 Down syndrome, off treatment 2011
1/F
AL
Blood,staph
capitis
,
ESBl
, E-coli, cog staph
staph
homins
urine: E-coli,
coagulase-ve,staph
,
staph,hominis
,
psodomonus
infection, ESBL,
citrobacter
treundi
No +
ve
culture
acintobacter
, K-pneumonia
proteus
microbilis
No +
ve
culture, no admission
15/year
1/year
No
(2007-2011)
Yes
Biphenotypic
leukemia, 2007 multiple BM /CNS relapses
Off treatment 2011
12/MASpulmonary aspergillosis, multiple positive c/sContinue chemotherapy6/year 1/year NoYesAML 2013Arrhythmias & chest pain Off treatment Sept. 20158/MMADied 2013Multiple episodes of positive blood c/s10/yearNoAML 2012Arrhythmias, cardiac failure13/FANSlide19
The majority of patients on Ajwa group are currently
off treatment.The main cause of death of patients in the non Ajwa group was disease progression and infections (76.9%). Ten patients with Acute Myeloid Leukemia in the Ajwa group (31.2%) showed protection against chemotherapy induced cardiac complications, while
this was not the case among those in the control group.KAU, SJaouniSlide20
Conclusions and Recommendations:
Regular intake of Phoenix dactylifera (Ajwa) showed a significant decreases in the number of infections, number of hospitalization per year, and decrease of mortality rate among pediatric cancer patients. Ajwa have antimicrobial effect and improved the quality of life
pediatric oncology.Ajwa have some sort of cardiac protection. Further larger study are required.We recommend regular Ajwa intake with a standard chemotherapy treatment in pediatric cancer patients which can improve their treatment outcome.
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Thank you
for working together to improved the quality of life of your patientsWith ComplimentsProf.
Soad Khalil Al Jaouni, MD .FRCPCsaljaouni@kau.edu.sa