Mohamad Haroon Noori ,Nasser Ahmad Shinwari ,Ahmad Mujtaba Barekzai

1Department of Hematology,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.2Department of Pediatric,Andhra Gandhi Government Hospital.3Department of Biotechnology and Microbial Technology,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.4Research Director,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.5Department of Public Health,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.6Technical Manager of Food Safety,providing quality and quantity inspection services for UN-WFP,KIC,Afghanistan.

Abstract Objective: Almost all leukemia patients died,fortunately now with the advancement of medicine and science and with the advent of treatment Chemotherapy,Radiotherapy,and Surgical treatment 75%of patients with leukemia who need treatment for up to 5 years,live longer than patients with leukemia who do not receive treatment.On the one side,in our country,Afghanistan the number of incidents has increased recently,and on the other side,we do not have data at the national level.Therefore,the child health hospital administration considered the necessary and left me to research this case in the last 6 months of 2018.Methods: This is an observational descriptive study,which observed 10,293 patients that come to the pediatric internal which 300 patients who indicate leukemia,and 200 patients with acute lymphoblastic leukemia (ALL),who were admitted to the oncology service of Andhra Gandhi Child Health Hospital in 2018 the study took place.Results: Based on the age we detect less than one year’s 10(5%) patients,1-10 years old 150 (75%) patients,and more than 10 years old 40 (20%) patients.Based on sex,boys were 120 (60%) patients and girls 80 (40%) patients.Based on clinical findings,anemia 155 (77.5%) patients,fever 130(65%) patients,bleeding 90 (45%) patients,spleen thickness 88 (44%) patients,liver thickness 73 (36.6%) patients,lymph nodes thickness 70 (35.55%) patients,great pains 66(33%) patients and nervous system disorders 38 (19%) patients.Conclusion: We can say with great conviction that 200 patients out of 10,293 had acute lymphoblastic leukemia.Further studies with prospective nature are required to confirm this observation.

Keywords: acute lymphoblastic leukemia;Afghan children;Indira Gandhi Children’s Hospital

Background

Cancer is a fatal disease that affects 150 million people under the age of 20 each year worldwide,and the most frequent type of cancer that affects children is leukemia,according to recent research [1].Leukemia is a group of malignant diseases caused by a genetically complex structure of proliferation and irregular evolution in the hemopoietin cells of the bone marrow.When it affects lymphoid cells and grows rapidly,it is called acute lymphoblastic leukemia,one of the most common leukemia cases in children.Chronic lymphoblast Leukemia is common adult leukemia in western countries and is characterized by the clonal expansion of mature CD5+B cells.In addition,it usually takes in the form of acquisition,but it can also take in terms of childbirth in some cases[2].The economic burden of acute lymphoblastic leukemia (ALL) in the U.S.A takes place in 3 phases(induction,consolidation and maintenance)the cost is 103,250$among ages.As well,in Afghanistan,the process treatment takes 4 place phases (induction,consolidation,central nervous system prophylaxis,and maintenance trophies) the cost is 10,000 $ [3].

Various factors have been involved in the development and proliferation of Leukemia,including hereditary and genetic factors,climate pollution,food,medicine,gasoline,and radioactive radiation.For instance,a cross-sectional study revealed that chemical exposure such as Benzene associated with quinine metabolism has a mutation with decreased enzymatic activity that has been linked to the development of ALL [4].A cross-sectional study demonstrated that radiation exposure,and ionizing radiation related to increasing the risk of acute leukemia among children,which was demonstrated after the atomic bomb expulsion in Hiroshima,according to a cross-sectional study [5].Most recent studies showed that acute lymphoblastic leukemia has more likely among children under 50 years old [6].In addition,acute lymphoblastic leukemia is more common among males than females,and the reasons for this are unknown reported.Furthermore,a review article demonstrated that genetic certain inherited diseases are associated with a higher risk of ALL [7].Furthermore,the incidence rate of Leukemia among males is 606 (5.8%) [2].According to our research in Afghanistan,there is no study to examine acute lymphoblastic leukemia among children in Afghanistan.Therefore,we aimed to examine the ALL among Afghan children at Indira Gandhi Children’s Hospital.

Methods

Ethical Approval

The study was ethically approved by the medical bioethics committee of the Spinghar Institute of Higher Education (No:1386-1410).The patients/participants provided their written informed consent to participate in this study.

Participants

In this study,we have observed 10,293 patients that come to the pediatric internal ward,300 patients indicated with leukemia,and 200 patients with acute Lymphoblastic Leukemia,who were admitted to the oncology service of Andhra Gandhi Child Health Hospital in 2018 the study took place.The department of pediatrics of the Indira Gandhi Children’s Hospital has assigned me to research this matter to collect the exact numbers of children infected with the disease,in the future for the treatment of children with leukemia necessary measures and better and more treatment facilities (cure chemotherapy) and radiotherapy.In addition,the Indira Gandhi Children’s hospital provides in other hospitals in our country,if possible the government will establish specific centers to diagnose and treat the disease.Because every year,a large number of our compatriots travel abroad to treat their patients with leukemia,in addition to being a leader,it causes financial hardship and economic blows to sick families.Considering the importance of research and the growing number of leukemia in our country by collecting accurate statistics and statistics and providing the necessary diagnostic and treatment facilities for medicinal and radiological (chemotherapy and radiotherapy) in the country and reducing the incidence and mortality of most children suffering from this disease.

Inclusion criteria

All patients who had the clinical evidence of the disease and had completed the necessary examinations available in the country,and in addition to their complementary reputation,the inclusion of their registry and case file included my research.

Exclusion criteria

Those who didn’t meet the above criteria were not included in my research.Bleeding disorders such as (Idiopathic Thrmobocytopmia Purpora,Honch Seclone Purpora,Hemophilia,and Thalassemia) and anemia such as (Iron Deficiency Anemia,Megaloblastic,Aplastic anemia).

Sample taking

Universally,all patients with acute lymphoblastic leukemia from the beginning of October 2018-December 2019 were registered in the register books of Child Health Hospital,and the sample of the research was done by taking samples from the same books of registers and patients files.

Data collection

Collecting data from the books of the emergency room register,clinic,and patients file was a data collection form,this data form includes serial number,registration number,patients age,patients sex,and patient residence.SPSS was used to analyze patients’data according to the data collection form.

Results

The results of a research work entitled receiving cases of acute lymphoblastic leukemia in more than 200 patients,which is one of 300 patients with leukemia in the oncology service of Indira Gandhi Children Hospital from 2016-20 have been done descriptively.In these 300 patients,we detect leukemia based on types demonstrated in Table 1.Based on the age we detect less than one year 10 (5%)patients,1-10 years old 150 (75%) patients,and more than 10 years old 40 (20%) patients.Based on sex,boys were 120 (60%) patients and girls were 80 (40%) patients.Based on clinical findings,anemia 155 (77.5%) patients,fever 130 (65%) patients,bleeding 90 (45%)patients,spleen thickness 88 (44%) patients,liver thickness 73(36.6%) patients,lymph nodes thickness 70 (35.55%) patients,great pains 66 (33%) patients and nervous system disorders 38 (19%)patients.Based on white blood cells per cubic millimeter,less than 10,000,150 (75%) patients,10,000-50,000,20 (10%) patients,and more than 50,000,30 (15%) patients.Based on thrombocytes per cubic millimeter,less than 20,000,14 (7%) patients,20,000-10,0000,156 (78%) patients,and more than 100,000,30 (15%) patients,as shown in Table 2.Outcome-based on death of patients,ages,less than one year’s 8 (10%) patients,1-10 years old 65 (81%) patients,and 7(9%) patients.Sex,boys 52 (65.5%) patients and girls 28 (35.5%)patients in Table 3.

Table 1 Leukemia based on types

Table 2 The demographic of participants

Table 3 The death process of the participants

Discussion

As noted in the literature,75% of acute lymphocytic leukemia 25% of acute leukemia miluginus,and 0% of chronic leukemia miluginus.As a result of my research,it was found that 85.37% of acute lymphoblastic leukemia 10.97% of acute myelogenous leukemia,and 3.66%of chronic myelogenous leukemia[8].The literature has shown that 72% of acute lymphoblastic leukemia cases are more common in 1-10 years as a result of my research,it was found that the percentage research 74.29%,from 10 years up to 23%but in my research 21.42%,from less than a year,5% has been shown,but in my research,4.29%.The majority of 56% of cases of acute lymphoblastic leukemia is shown in boys and 44% in girls,but my research showed that 65.72%more cases of acute lymphoblastic leukemia occur in boys and 34.29%in girls.

Anemia in the literature,it mentioned that 88% of patients with acute lymphoblastic leukemia have anemia,in my research,it was found that 94.29% of these patients have anemia,Liver and spleen thickness as seen in the literature,patients with acute lymphoblastic leukemia have 63% of the spleen and 68% of the liver,but in my research showed that patients have 50% of the spleen and 45.7% of the liver,Lymphocytic thickening as seen in the literature,50% of patients with acute lymphoblastic leukemia have lymphatic thickening,but in my research found that 38.57% of patients have lymphatic thickening [9].Bleeding as seen in the literature,48% of patients with acute lymphoblastic leukemia have to bleed,my research has shown that 70% of patients have to bleed.Great pain as seen in the literature 25% of patients with acute lymphoblastic leukemia pain but my research 25.71%patients were pains,symptoms of the central nervous system were seen in the literature 5-10% of patients with acute lymphoblastic leukemia have symptoms of the central nervous system,but in my research,it is 8.57%,Fever,as seen in the literature,60% of patients with acute lymphoblastic leukemia have a fever,but in my research showed that 62% of patients have fever [10].

White blood cells as seen in the literature,the number of white blood cells in 50% of patients with acute lymphoblastic leukemia is less than 10,000 per cubic millimeter,but my research showed that it was 45.72%,thrombocytes as seen in the literature are 75%smaller in acute lymphoblastic leukemia and my research it is 77.14%.The literature showed that the number of thrombocytes in 10-20% of patients with acute lymphoblastic leukemia was less than 20,000 per cubic millimeter.In the literature,60% of acute lymphoblastic leukemia has been seen in patients who are less than one-year-old and more than ten years old,but in my research,68.75% of the patients die between 1-10 years old.In terms of sex,literature found that the incidence of acute lymphoblastic leukemia patients was 62%higher in boys than girls,but in my research,62.5% higher in girls than boys[11].

Our study has several limitations,which included that there is no oncology service without child health hospitals in other pediatric hospitals in the center and provinces,so I was unable to have any other facilities.Additionally,the price of anti-locomia spice,especially for patients with acute leukemia lymphoblastic,the lack of free chemotherapy services in the hospital,and on the other hand,the high time or duration of treatment,has caused the patients to leave the hospital arbitrarily.Furthermore,the lack of necessary diagnostic devices in the diagnosis of leukemia patients,especially acute leukemia lymphoblastic and lack of petal jests in the kitchen,and low experience with leukemia and problems in the diagnosis of its types,caused a defect in my development.In addition,the emergence of the majority of anti-locomia treatments,especially those for acute leukemia and lymphoblastic diseases in the market,as well as the lack of radiotherapy centers in the hospital and the country,has caused the patients to be sent to neighboring countries for radial treatment,which caused problems in the evaluation of treatment.Likewise,the lack of follow-up of patients in the center of the provinces and the other hand,the lack of ease of telephone in some remote provinces caused problems in the patients’ beliefs.Finally,the lack of history of acute leukemia lymphoblastic patients,lack of completed examinations of some of these patients,and lack of available complementary biography of patients with pain caused problems in the mentioned studies.On the other hand,the strength of our study is:that various factors are involved in the creation and proliferation of diseases,including hereditary and genetic factors,weather pollution,food,medications,gasoline,radioactive radiation,and the use of various weapons,bombs,and rockets from hostile factions in the devastating wars of the last three decades in our country.

Conclusion

We can say with great conviction that 200 patients out of 10,293 had acute lymphoblastic leukemia.Further studies with prospective nature are required to confirm this observation.