Needs assessment of children undergoing hemodialysis therapy

The renal failure children are at risk of several problems and complication due to renal failure and hemodialysis. The aim of the present study was to assess the needs of children under going hemodialysis therapy and asses factors that affect the daily living activities of those children under regular hemodialysis. The present study was carried out at two Hospital; Hemodialysis pediatric units of Benha University Hospital and Teaching Hospital in Benha City in Kaluobia Governorate. This study included one group of 80 patients on regular hemodialysis. Their age ranged from 4 to 16 years. The actual work of the current study started by an initial pilot study that was applied randomly on 10 children to test feasibility, clarity and objectivity of the tools and accordingly some changes were done in the tools to suitable for the subjects. Data collected through a period of 3 months. The study demonstrate that children's ranged between 4-16 years old, and more than half of the sample [61 .25%] of the sample were female and 38.75% were male. Regarding the education, 63.75% of the sample was illiterate. Regarding the number of dialysis week. It was found that all children [100.0%] were under regular dialysis three timed week. Regarding the disease associated with dialysis it was found that the highest percentage [63.75%] of children had heart disease followed by hepatitis [30%], while the lowest percentage [6.25%] of them had hypertension. The present study revealed that more than half of the sample [61.25%] undergoing hemodialysis had correct knowledge about concept of renal failure. While 52.5%, 47.5% of them don't know causes and complication of renal failure. It was found that 80.0% of the children undergoing hemodialysis therapy through fistula, While [20.0%] of them through catheter. It was noticed that 32.5% of children don't care their fistula site. As regard changes of children before dialysis that represented that [47.5%] was fatigue, while about [20.07] didn't have any changes. It was found that [63.75%] of children was active after dialysis. The study showed that 42.5% of children suffer from signs of depression, and also it was found 47.5% of children tired, 11.3% of them were anxious. The study showed that 60.0% of children visit their friends and relatives; while 40.0% of them faced problems when visit their relative. Also growth retardation is a major complication of children under going regular hemodialysis and was found about 72.5% of them had growth retardation. About 12.7% of the children exposed to bleeding, while 11.2% of children expose to infection through the dialysis units. The study showed about 16.3% of children was eating all type of food without any restriction. The present study revealed that 63.7% of children didn't going to school because the time of dialysis. It was found that 82.5% of children are suffering from difficulties in learning, while 12.5% of them had lack of concentration and also about 5.0% had lack of recall. From the present study all children need knowledge about renal failure and hemodialysis. Accordingly, they need to be adapted with the disease physically, socially and psychological we should emphasize on the importance of early intervention program for children under haemodialysis and their parents

Concomitant boost radiotherapy plus concurrent cisplatin for muscle invasive bladder cancer

To determine the efficacy and toxicity of accelerated concomitant boost radiotherapy [RT] plus concurrent cisplatin in patients with muscle invasive bladder cancer. Sixty four patients with muscle invading transitional cell bladder cancer were entered into a protocol of transurethral resection of the bladder tumor [TURBT] followed by concurrent cisplatin [10mg/m[2] thrice weekly] and accelerated concomitant boost radiotherapy. The whole pelvis was treated by l.8Gy conventional daily fractions up to a total dose of 45Gy. A concomitant boost limited to the bladder was delivered as a second daily fraction [1.4Gy] during the last 3 weeks up to a total dose of 66Gy. The patients were evaluated for local control, toxicity and survival. All but two patients completed the radiotherapy protocol. Fifty eight patients received the full doses of cisplatin. Grade 3 acute urinary toxicity was observed in 10 patients [15.6%]. Also, 6 patients [9.4%] presented with acute grade 3 bowel toxicity. Eight patients [12.6%] experienced late grade 3 toxicity [4 with bladder and 4 with bowel toxicity]. The 3-year actuarial local control, distant disease control and overall survival rates were 60% [95% CI, 50.1-69.3], 65.6% [95% CI, 53.7%-74.3%], and 37.5% [95% CI, 26.1%-45.9%] respectively. The results of our protocol of acclerated concomitant boost radiotherapy with concurrent cisplatin, as regard locoregional control and overall survival, did not appear to be improved in comparison with other studies combining cisplatin and standard conventional fractionation, moreover the observed toxicity was higher