الفهرس 
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Abstract
of cancer treatment is the nutritional management which ensures adequate antioxidant intake. Considerable benefits were seen in well nourished patients during cancer treatment. Patient outcomes may be improved by antioxidants through improving the therapeutic index of coadministered chemotherapy drugs, i.e. increasing a patient’s ability to tolerate full doses of antineoplastics with uninterrupted treatment schedules.
Nigella sativa is a phytochemical believed to be effective in combating or preventing disease due to its antioxidant effects. When consumed as part of foods, it can also provide protective effects at the cellular level in humans and animals.
The Egyptian N. sativa constitute mainly of 21% proteins, 35% carbohydrates, 35.5% fats, 6.6% fibers, 5.5% moisture and 3.7% ash, in addition to high content of vitamins and minerals and volatile oils, principally thymoquinone, its active ingredient responsible for most of the beneficial actions of Nigella sativa seeds.
The seeds are characterized by a very low degree of toxicity. They also have a remarkable array of biochemical, immunological and pharmacological effects including bronchodilatory, anti-inflammatory, hypoglycemic, antibacterial, antitumour and immunopotentiating effects. These effects occur through modulating the levels of inflammatory mediators and enhancing the oxidant Scavenger System.
The main objective of our study was to study the effect of Nigella sativa seed intake on prevention of febrile neutropenia during chemotherapy among children with brain tumors and assessing this effect through recording incidences of febrile neutropenia episodes and subsequent admissions to the hospital, in addition to length of hospital stay on each episode of febrile neutropenia. This study was a randomized pretest post-test control group intervention done on a total of 80 children (2 - 18 yrs) of both sexes with primary brain tumors and on chemotherapy, attending Alexandria University Pediatric Oncology unit”- Clinical Oncology Department. We interviewed the parents for their Socioeconomic data and for their children’s food consumption pattern through a food frequency questionnaire to estimate children’s daily dietary intake of total antioxidants
before initiating their chemotherapy treatment. Children’s nutritional status was also assessed through BMI percentile charts.
The intervention group received 5 gms of Nigella sativa seeds daily to be added on food throughout chemotherapy treatment. The control group did not receive anything.
On each follow up, anthropometric measurements were assessed and complete blood Counts of each child where recorded and given toxicity scores by referring to Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Results of this study showed that children with brain tumors had low intake of antioxidants even prior to starting chemotherapry treatment. Upon receiving a daily supply of the antioxidant and antibacterial Nigella sativa, by children of the intervention group, a Significant statistical difference in incidence of Febrile neutropenia was shown when compared to those of the control group who did not (2.2 vs. 19.3%, p=0.001). Those
Würen also had significant shorter lengths of hospital stay compared to those of the control group (2.4 + 0.5 vs. 3.8 + 1.3 days, p=0.006).
Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies. Comprising several distinct histological entities, brain tumors collectively remain the leading cause of cancer-related death and long-term morbidity in this age group. Prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Current treatment strategies, including combination of surgery, radiation, and chemotherapy, therefore aim to maintain or improve survival outcomes, while minimizing toxicity and subsequent long-term side effects.
Although this approach has led to impressive improvements in the cure rates for many pediatric malignancies, it has secondary effects on a variety of normal cells, including mucous membranes and the hematopoietic elements of the bone marrow, A primary mechanism of the cytotoxic effect seen by chemotherapy drugs on cancer cells and unfortunately rapidly dividing normal cells too, is the formation of reactive oxygen species (ROS), or free radicals that cause a condition of excessive oxidative stress in which cellular antioxidant mechanisms are unable to reverse the adverse impact of ROS on
critical cellular processes. However, some chemotherapy regimens are more myelotoxic than others.
The resulting myelosuppression produces intermittent periods of leukopenia (especially neutropenia), anemia, and thrombocytopenia of varying severity and duration. Myelosuppression represents the main dose-limiting toxicity associated with systemic cancer chemotherapy and is frequently complicated by episodes of fever and neutropenia, namely ”febrile neutropenia”, thus increasing the risk of morbidity and mortality.
”Chemotherapy-induced Febrile Neutropenia”(FN) is defined as an oral temperature >38.5°C or two consecutive readings of >38.0°C for 2 hours and an absolute neutrophil count <0.5 x 10/1, or expected to fall below 0.5 x 10/1.
Febrile neutropenia (FN) remains a major threat to patients treated with chemotherapy resulting in impaired quality of life, prolonged length of hospital leading to increased risk of infections specially multi-drug-resistant (MDR) infections, delays in their antineoplastic treatments and even death.
Mortality from FN has diminished steadily but still remains significant. Overall mortality rates are almost 5% in patients with solid tumors (1% in low-risk patients)
Granulocyte colony-stimulating factors (G-CSF) and prophylactic antibiotics were used for the prevention and treatment of febrile neutropenia. However, some drawbacks of using GCSF and the emergence of multidrug-resistant Gram-negative and Gram-positive bacteria, which has been associated with longer bacteremic episodes and worse outcome in febrile neutropenic children with cancer has compelled the WHO to suggest the need to find some new antibiotics or new approaches to overcome this problem.
Cancer is renowned for its high incidence of malnutrition in children and its patients often have low antioxidant levels prior to chemotherapy treatment and higher levels of Oxidative stress have been linked with more aggressive cancers. An important component
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Sинитary
Nigella sativa seeds also had shown modest improvements, though insignificant, on thrombocytopenia, leucopenia and neutropenia in intervention group compared to the control group. However, anaemia was not improved. Moreover, children who ate the Seeds showed less deterioration in nutritional status than children who did not eat the seeds throughout treatment. This could be due to the gastroprotective effect that the seeds exert On gastric mucosa against the damaging effect of chemotherapy, allowing the children to tolerate food much better thus enhancing their nutritional status.
Based on this study we would recommend the following:
O Nigella sativa seeds should be suggested by onco-nutritionists as an effective, available and cheap antioxidant and antibacterial for children with brain tumors, and perhaps all children with cancer, through their chemotherapy treatment period.
And for further studies:
O Implementing the study on different types of cancer.
O Working on adult populations.
O Extending follow-up period beyond the last cycle of chemotherapy. O. Using Nigella sativa as powder capsules.
o Measuring total body antioxidant level for all children in both groups at diagnosis
and after they complete their chemotherapy treatment.