retrospective study of febrile neutropenia in pediatric cancer patients

This current retrospective study reviewed 75 febrile neutropenic episodes occurred in children with cancer treated at the Pediatric Oncology Unit of Benha Children Hospital. The aim of this work was to study clinical and laboratory parameters of infection in febrile neutropenic children with cancer as well as the associated risk factors, therapeutic regimens and modification of therapy and their effects on the outcome of cases. We found 31 % of cases have clinically documented infection while 33% have bacteremia at the time of presentation. The lung WGS the most common site of infection [13 % of all cases] and gram-positive bacteria accounted for 63% of culture positive cases. Improvement rate was significantly lower in malnourished group [P<0.05] compared to well-nourished group. Thrombocytopenia was a significant risk factor determining improvement rate. Platelet count <50.000/mm3 significantly decreased the rate of infection control [P<0.05]. Also absolute neutrophilic count [ANC] =/> 500/mm3 had a bad outcome results. Four cases were died from group of ANC =/> 500/mm- and no one was died from other group [P<0.05]. High risk neutropenia [Al-C <1 00/mm3 and > 7 days] showed significantly lower percentage of improvement [P<0.05]. Therapeutic regimen of ceftazidime - amikacin have higher rate of success [P<0.05] Modification therapy with metronidazole, fluconazole or granulocyte stimulating factor have significant good results on rate of improvement of cases [P<0.05].We concluded that fever in neutropenic children with cancer is an alarming sign of infection and empirical antibiotic therapy should started immediately. Infection control and improvement rare are affected significantly by degree and duration of neutropenia, degree of thrombocytopenia, nutritional status and regimen and modification of therapy

Factors delaying the diagnosis of cancer in children

In this study, an interview questionnaire including the patient's age, the number of siblings as well as the order of the patient among them, the level of education of the parents and the primary complaint was administered to 150 patients and their families. 59% of the patients were younger than 5 years and 66% were males. 73% of the parents were illiterate and only 17% of them were colleague graduate. The primary complaint was fever and/or fatigue in 42% of the patients, mass in abdomen in 21% and lump in the neck in 18.5%, respectively. The patients included in the current study had leukemias and lymphomas [45%] as well as solid tumor [45%]. The delayed diagnosis was represented in an interval of more than three weeks between the first appearance of symptoms or signs and the diagnosis. Only 41 patients were diagnosed within the first 3 weeks of onset of symptoms

Parental factors in childhood malignancies

The current study included 125 children with cancer, in addition to 125 age and sex matched healthy children as a control group. 49% of the cancer patients were coming from rural places versus 35.2% of the controls, this difference was statistically significant. As regards the degree of consanguinity, there was a statistically significant high prevalence of first degree of consanguinity among children of cancer group than the controls; this was the same for children with solid tumors, but not for those with lymphoma and leukemia. The present study showed an increased percentage of parental exposures to pesticides, paints and dyes as well as maternal exposures to irradiation among children in the cancer group. However, this difference was mot statistically significant, may be due to the small number of the study group. However, there was a significant increase of the parental exposure to motor exhaust products in the cancer group

Problems in the management of pediatric acute lymphoblastic leukemia in Egypt: Clinic pathologic characteristics and treatment results of 133 cases [CPOCH 1991-1994]

This retrospective study analyzed the clinicopathologic characteristics and treatment results of 133 children with acute lymphoblastic leukemia. Ninety-seven patients were between two and ten years of age. Organ invasion was documented in 79% of patients at presentation. WBC greater than 100 x 109/L was encountered in 26 patients. L1 morphology was the commonest subtype encountered in 70.7% of the study group. Analysis of the pattern of receiving treatment revealed that 18% of the study group did not attend or died before or just after starting the treatment protocol. Thirty patients received the treatment irregularly due to various socioeconomic reasons. Induction mortality rate was 12.8%. Only 62 children received treatment regularly on time. Complete remission could be achieved in 59 patients. After a median period of follow up of 45 months, 17 patients relapsed. High initial WBC, organ invasion and L2 morphology was statistically significantly associated with high relapse rate. The five-year overall and disease free survival of the evaluable patients were 76%, respectively

Abdominal non-Hodgkin's lymphoma: a review of 75 cases

One hundred and fifty-four children with non-Hodgkin lymphoma [NHL] over a five-year period [1991 through 1995] were included in this study. Seventy-five patients were found to have primary abdominal NHL. All patients presented with symptoms suggestive of intestinal obstruction for a mean period of 2.3 months before diagnosis. Sixty- four patients were subjected to laparotomy. Treatment protocols were tailored according to the extent of resection and histopathologic subtypes. Complete surgical excision with macroscopic residual disease could be achieved in 38 patients. Maintained complete remission rate on combination chemotherapy was 84.4% for complete excision, 64.7% for partial excision and 31% for patients who had biopsy taken only. These differences were not statistically significant. The five-year overall actuarial survival for the whole group was 55%. Patients who had completely resected limited disease had a statistically significant higher survival [91%] than the other two groups [72% and 28%]. Three patients developed extra-abdominal relapse in spite of complete surgical excision and postoperative combination chemotherapy

Infection prophylaxis in the myelosuppresed patient with cancer

The present prospective study included 29 patients attending the Paediatric Unit of Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine. Eligible patients were randomly allocated to receive or not to receive oral prophylactic antibiotics as well as miconazole [2%] oral gel. Incidence of infection was higher among the control group [77.8%] than the antibiotic group [61%]. However, the difference was not statistically significant. On the other hand, more patients among the control group [86%] significantly developed oral moniliasis than those among the antibiotic group [55.5%] [P = 0.001]