Experience with a hybrid chemotherapy regimen and involved-field radiotherapy in paediatric hodgkin's disease

Although survival rates have improved dramatically for childhood Hodgkin's disease current treatment entails substantial risks for the late effects such as infertility, second malignancies and cardiopulmonary toxicities. A treatment regimen was chosen with decreased risks of long term sequelae while maintaining efficacy in terms of response and survival. Sixteen children with newly diagnosed and previously untreated Hodgkin's disease were registered and monitored over a two year period. After pretreatment evaluation all patients were treated with six cycles of combination chemotherapy-three of chlorambucil, procarbazine, vinblastine and prednisolone [ChIVPP] and three of adriamycin, bleomycin, vincristine and DTIC [ABVD]. Residual disease was treated with 15-20 Gy of involved-field irradiation. Patients were followed up at six-monthly intervals with physical examination, ECG, chest radiographs, echocardiography and levels of thyroid hormones. After the twelfth birthday patients underwent assessment for levels of gonadotrophins and male patients for testosterone every six months.The observation period now ranges from eleven months to twenty-five months. Fourteen patients are in continued complete remission. One patient died of bilateral severe pneumonia six weeks after the completion of therapy. No long term adverse effects of treatment have been observed so far. In our experience this regimen is well-tolerated and effective and is expected to reduce the risks for late toxicities. A longer follow up duration is, however, required for definitive evaluation

Neonatal hypoglycemia

Neonatal hypoglycemia was studied in 2876 neonates born in Military Hospital Rawalpindi, over a period of 6 months. On selective screening [plasma glucose concentratioin less then 2.6 mmol/l] was detected in 100 cases having an incidence of 3.5% in total births. In preterm and small for date babies, it was 8% and 6% respectively reflecting an increased risk of having hypoglycemia in these babies. 43 cases of hypoglycemia were symptomatic while 57 cases were asymptomatic. Asymptomatic hypoglycemia had occurred at a relatively earlier postnatal age as compared to symptomatic hypoglycemia. More than 70% of these 100 hypoglycemic babies had one or more risk factors. 30% were small for dates babies and 23% were preterm babies. 5% of hypoglycemic cases were large for gestational age babies, 10% were cases of respiratory distress and 5% were infants of diabetic mothers. Most frequent symptom in symptomatic hypoglycemia was lethargy [53.5%], jitteriness in 29%, cyanosis 19%, hypotonia 16% and seizures 9%, pallor and tachypnoea were noted 7% in each, while poor feeding. high pitched cry and apnoea was 2% of each. Seizures due to hypoglycemia had occurred at blood glucose level of less than 1.5 mmol/l. We did not find any case of persistent hypoglycemia in these 100 cases

Pattern of neonatal mortality in Military Hospital, Rawalpindi

The study was undertaken to determine neonatal mortality rate [NMR] and pattern of diseases in our set up of Military Hospital [MH], Rawalpindi. Cohort study of all the newborns delivered in maternity ward of MH, over a period of 6 months was carried out. Follow up was done over a period of one month. IMMR in our study population was 27 per thousand live births, 12% of all the babies were low birth weight and 5.9% were premature. Major causes of mortality were birth asphyxia, infections, respiratory distress and congenital infections. The results were comparable with other regional studies. The incidence of mortality, low birth weight and prematurity along with other complications is still high in our region of the world cost effective and simple measures should be adopted as a remedy

Visceral leishmaniasis in children a new focus in Azad Kashmir

Fourteen cases of Visceral Leishmaniasis, all children below 8 years of age, were diagnosed at Rawalpindi from March 1983 to September 1985. Nine out of these fourteen cases came from Azad Kashmir, a hitherto unreported endemic area. All the cases were severly toxic with irregular fever, anaemia and hepatosplenomegaly. The diagnosis in each case was made by bone marrow examination. Some of these cases were treated with sodium stibogluconate with satisfactory response