Background. Intrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia. Dexmedetomidine
is a fascinating adjuvant with regards to neuraxial anesthesia in children experiencing surgery for abdominal malignancy.
Patients and Methods. After endorsement by the institutional reviewing board (IRB) and guardians’ written informed
consent, this research was carried out on 60 pediatric malignancy patients scheduled for major abdominal
surgery. Children were randomly distributed into three groups (20 patients each): Group C: given 2mL of bupivacaine
0.5% (0.4 mg/kg) intrathecally, injected gradually over 20 seconds. Group F: the same as group C, plus fentanyl
0.2 lg/kg. Group D: the same as group C, plus dexmedetomidine 0.2 lg/kg. Pain at zero, two, four, six, 12, 18, and
24 hours postoperatively was evaluated by Face, Legs, Activity, Crying, and Consolability (FLACC) score. First analgesic
request and postoperative unfavorable effects were recorded for 24 hours postoperatively. Results. A significant
decrease was recognized in the mean FLACC score in groups D and F at six, eight, and 12 hours postoperatively,
in contrast to group C (P0.05). First analgesic request was significantly prolonged in group D (7.6760.57 hours),
in contrast to groups F and C (5.4061.09 hours and 4.2363.27 hours, respectively, P < 0.04). Paracetamol utilization
was significantly decreased in group D (316.67628.86 mg), in contrast to group C (391.00652.00 mg, P < 0.03),
without a significant difference between group F (354.44646.67 mg) and groups D and C (P > 0.05). Conclusions.
Adding dexmedetomidine and fentanyl to intrathecal bupivacaine improved postoperative analgesia following
abdominal surgery for cancer in children, with better overall analgesia of dexmedetomidine compared with
fentanyl.
Key Words: Intrathecal; Fentanyl; Dexmedetomidine; Bupivacaine; Pediatric Major Abdominal Cancer Surgery

Background: Fever and neutropenia (FN) is a potentially life-threatening
complication of chemotherapy in children with cancer. Aim: Our objectives were
to describe the characteristics of episodes of FN experienced by our patients and
evaluate their outcomes and factors affecting them. Material & Methods: A
prospective observational study was conducted at Pediatric Oncology
Department, South Egypt Cancer Institute, Assiut University. All pediatric patients
≤ 18 years with either hematological or solid tumors admitted with documented
episodes of FN after receiving myelosuppressive chemotherapy were included in
this study between February 2018 and February 2020. Results: 200 episodes of
FN experienced by 125 pediatric cancer patients were included. The median age
was six years; 60% of the patients were boys. FN was more prevalent among
patients with hematological malignancies. Associated comorbidities were
reported in 10.5%. Eighty percent of episodes were stratified as high-risk, with
profound neutropenia reported in 47%. The focus of infection was documented in
82% of episodes. Blood-stream infections were 53.1% for Gram-negative and
24.4% for fungal isolates. Infection-related mortality was reported in 7% of
episodes. Diagnosis, disease status, risk stratification, presence of comorbidity,
and the grade of neutropenia significantly affected the outcome. Conclusion:
Although satisfactory therapeutic interventions for neutropenic patients with
fever, life-threatening resistant bacterial and fungal isolates were reported at high
rates that mandate calling for an urgent review of infection control policy.
Keywords: Fever, Neutropenia, Pediatric, Oncology, South Egypt

Objectives: The administration of ketamine as nebulized inhalation is relatively new and studies
on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized
ketamine (1 and 2 mg.kg−1) administered 30 min before general anesthesia in children undergoing
elective tonsillectomy in comparison with intravenous ketamine (0.5 mg.kg−1) and saline
placebo.
Methods: One hundred children aged (7---12) years were randomly allocated in four groups
(n = 25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5 mg.kg−1 (Group K-IV), Nebulized
Ketamine 1 mg.kg−1 (Group K-N1) or 2 mg.kg−1 (Group K-N2). The primary endpoint was
the total consumption of rescue analgesics in the first 24 h postoperative.
Results: The mean time to first request for rescue analgesics was prolonged in K-N1
(400.9
±
60.5 min, 95% CI 375.9---425.87) and K-N2 (455.5
±
44.6 min, 95% CI 437.1---473.9) groups
compared with Group K-IV (318.5
±
86.1 min, 95% CI 282.9---354.1) and Group C (68.3
±
21.9 min,
95% CI 59.5---77.1; p < 0.001), with a significant difference between K-N1 and K-N2 Groups
(p < 0.001). The total consumption of IV paracetamol in the first 24 h postoperative was reduced
in Group K-IV (672.6
±
272.8 mg, 95% CI 559.9---785.2), Group K-N1 (715.6
±
103.2 mg, 95% CI
590.4---840.8) and Group K-N2 (696.6
±
133.3 mg, 95% CI 558.8---834.4) compared with Control
Group (1153.8
±
312.4 mg, 95% CI 1024.8---1282.8; p < 0.001). With no difference between
intravenous and Nebulized Ketamine Groups (p = 0.312). Patients in intravenous and Nebulized
Ketamine Groups showed lower postoperative VRS scores compared with Group C (p < 0.001),
no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects.

Background and objectives: Pediatric lymphoma is known to be associated with Epstein–Barr virus (EBV) infection. The objectives were to detect the frequency of EBV infection in pediatric lymphomas in our locality and to study its relationship with the clinicopathological characteristics of the patients.
Methods: In this descriptive cross-sectional study, we examined 78 consecutive cases of pediatric lymphomas for the presence of EBV in tumor cells by real-time Polymerase Chain Reaction on paraffin blocks for latent membrane protein-1 (LMP-1) over 3 years (January 2012 –January 2015). We collected data of the patients with pathology-proven primary lymphoma including age, sex, histologic subtype, and risk stratification.
Results: The most common subtype of pediatric lymphomas was NHL (52/78, 66.5%), while HL was diagnosed in 33.5%. EBV LMP-1 gene detection was found in 38.5% of HL, and 28.8% of NHL cases. EBV infection was significantly related to age, gender, and histological subtype in NHL cases; however, it was related to age only in those with HL. The overall difference in EBV LMP-1 gene detection was statistically significant regarding the age at presentation (P < 0.001).
Conclusion: The frequency of EBV infection in pediatric lymphomas in our locality is higher compared to Western countries, but it is lower than in endemic areas. Younger age at diagnosis was the most significant factor associated with EBV infection.
Keywords: Pediatrics, Epstein–Barr virus, Lymphoma, South Egypt Cancer Institute.

Our study aimed to evaluate the levels of MDSCs and Tregs in pediatric B-cell acute lymphoblastic
leukemia (B-ALL), their relation to patients’ clinical and laboratory features, and the impact of these
cells on the induction response. This study included 31 pediatric B-ALL patients and 27 healthy
controls. All patients were treated according to the protocols of the modified St. Jude Children’s
Research Hospital total therapy study XIIIB for ALL. Levels of MDSCs and Tregs were analyzed using
flow cytometry. We observed a reduction in the levels of CD4 + T-cells and an increase in both the
polymorphonuclear MDSCs (PMN-MDSCs) and Tregs. The frequencies of PMN-MDSCs and Tregs were
directly related to the levels of peripheral and bone marrow blast cells and CD34 + cells. Complete
postinduction remission was associated with reduced percentages of PMN-MDSCs and Tregs, with
the level of PMN-MDCs in this subpopulation approaching that of healthy controls. PMN-MDSCs and
Tregs jointly play a critical role in maintaining an immune-suppressive state suitable for B-ALL tumor
progression. Thereby, they could be independent predictors of B-ALL progress, and finely targeting
both PMN-MDSCs and Tregs may be a promising approach for the treatment of B-ALL.

Background and Objectives: Risk-adapted therapy for children with HL is
directed toward high survival, minimal toxicity and optimal quality of life,
with long term follow up. We assess the impact of prognostic factors associated
with local treatment failure of pediatric HL patients with unfavorable
criteria treated with combined modality: Alternating ABVD (Doxorubicin,
Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide,
Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-
field radiation for newly diagnosed unfavorable pediatric HL patients,
also will detect toxicities and long-term complications observed in the patients.
Methods: This prospective study was carried out from January 2010 to
January 2018, with a median follow up of 74 months (range 8 - 103 months).
54 patients were eligible for this study stratified into two groups: intermediate
risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles)
and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed
by involved-field radiation therapy (IFRT): 15 Gy for patients achieved
complete response, and 25.5 Gy for those achieved a partial response. Results:
27 patients were IR and 27 patients were HR. There were 16 treatment failures;
5 patients had progressive disease; and 11 patients had a relapse. 9 patients
died from their disease progression. The 5-year overall survival (OS)
and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ±
6.2% respectively. Multivariate analysis revealed that the only independent
factor for inferior OS was radiotherapy. Conclusion: Treatment results of
unfavourable HL patients in our study are satisfactory for with IR group but
not for HR group who needs intensification of therapy. Radiotherapy is considered
as a cornerstone in the treatment of the patients with unfavourable
How to cite this paper: Ali, A.M., Mo