Outcome and complications of pediatric acute promyelocytic leukemia in Bangladesh.

Pediatric acute promyelocytic leukemia (APL) is one of the most curable subtypes of acute myeloid leukemia of childhood. But it may have many early complications, especially in developing countries. This study aims to describe the outcome and complications of pediatric APL patients in Bangladesh. This prospective observational study was conducted in the pediatric hematology and oncology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to March 2019. In this study, PML:RAR-α (Promyelocytic leukemia-retinoic acid receptor-α) positive APL cases were included and observed while being treated with risk-directed ATRA (All-trans-retinoic acid) based chemotherapy. Among twenty PML:RAR-α positive APL cases, 13 children were in the high risk group and hemorrhagic manifestations were present in 95% of patients. Post-induction remission was achieved in 85% of the patients. 3-year overall survival was 70% (45-85% with 95% confidence interval). There was no refractory disease or relapses. Neutropenic sepsis was the most common complication and also the most common cause of mortality. In Bangladesh, the 3-year overall survival of pediatric APL is 70% (45-85% with 95% CI). Post-chemotherapy neutropenic sepsis is the most common complication and also the most common cause of mortality in this potentially curable malignancy in Bangladesh.

Pathogens causing diarrhoea among Bangladeshi children with malignancy: Results from two pilot studies.

BACKGROUND: Diarrhoea is a frequent symptom in children with cancer, and occurs due to a composite effect of underlying disease and immunosuppression consequent to therapy, malnutrition, and non-infective aetiologies such as mucositis. In a large proportion of cases, the aetiology of diarrhoea remains unknown but is often attributed to multiple pathogens including parasites. AIM: To identify and describe the pathogens causing diarrhoea in Bangladeshi children with cancer. METHODS: Two cross-sectional pilot studies were conducted involving paediatric oncology patients with diarrhoea. Stool samples were collected from children who were hospitalised with or without being treated with chemotherapy during the study period, and had diarrhoea at any stage during their admission. In the first study, stool samples were tested by conventional microbiological methods and by polymerase chain reaction for parasites, and by immunoassays for Clostridium difficile. In the second study, conventional microbiology was conducted for bacteria and parasites including an enzyme-linked immunosorbent assay for Cryptosporidium antigen, and in a subset, immunoassays for Clostridium difficile. RESULTS: In the first study Giardia lamblia was detected in 68.5% of samples, Entamoeba histolytica in 13%, Cryptosporidium in 5.6%, non-toxigenic C. difficile in 22.4%, and other bacteria in 5.2%. In the second study, E. histolytica was detected in 10% of samples, Cryptosporidium in 4.3%, G. lamblia in 1.4%, C. difficile in 5.1%, and other bacteria in 5.7% of samples. CONCLUSION: These pilot data suggest that parasites are important aetiologies of diarrhoea in Bangladeshi children with malignancy. While molecular diagnostic tools detect an array of stool pathogens with greater sensitivity, conventional diagnostic methods are also useful.

Brief report on pediatric oncology in Bangladesh.

Cancer in children is emerging as a significant threat to life as deaths from infections and malnutrition have begun to decrease due to concerted maternal and child health initiatives. Efforts are being made to create a comprehensive service for children with Cancer. The major challenges to be overcome are professional and public awareness, late diagnosis, perceptions of incurablity, treatment refusal and abandonment, toxic deaths and drug costs/inconsistent availability.

Immune thrombocytopenic purpura among the children attending at two teaching hospitals.

The presenting features, diagnostic evaluation, seasonal variation and management performed in 110 children with immune thrombocytopenic purpura (ITP) attending at two tertiary level hospitals were evaluated. A peak incidence of children with ITP was observed during the month of June, July and the first step was found in May and lowest in the month of October to December. Mean initial platelet count was 65.5 x 10(9)/L. 35 patients with ITP did not require any treatment who were kept under observation and the rest 75 children who were admitted to hospital given platelet count enhancing treatment- intravenous immunoglobulin in 9, corticosteroids in 60 or both in 6 children with ITP. Intracranial hemorrhages were noticed in two children with ITP. So, this study suggests that ITP had special predilection during summer season and the least in winter along with variable approaches to management of these children.