Environmentally-induced epigenetic changes of gene regulation could result from chronic, lifelong exposure, to low doses of environmental toxicants, such as chemicals including, tobacco smoking and endocrine disrupting compounds, or to other environmental factors such as nutritional changes, and lifestyle-related conditions. These environmentally-acquired epigenetic marks may influence the control of gene regulation through DNA methylation, histone modification, or through a large set of non-coding RNAs (ncRNAs). These epigenetic effects might be passed on to the developing embryo and child as inheritable non-genetic marks, which recapitulate previous lifelong history of exposure to environmental influences that start from the stage of primordial germ cell, passing through the maturing germ cell, and ending by the zygote stage. This involves the paternally transmitted information on the sperm that contribute to modulating embryogenesis functions and later childhood development, in concert with, the maternally transmitted information encountered by the exposure to a large milieu of environmental factors either periconceptionally or during lactation period.

Environmentally-induced epigenetic changes of gene regulation could result from chronic, lifelong exposure, to low doses of environmental toxicants, such as chemicals including, tobacco smoking and endocrine disrupting compounds, or to other environmental factors such as nutritional changes, and lifestyle-related conditions. These environmentally-acquired epigenetic marks may influence the control of gene regulation through DNA methylation, histone modification, or through a large set of non-coding RNAs (ncRNAs). These epigenetic effects might be passed on to the developing embryo and child as inheritable non-genetic marks, which recapitulate previous lifelong history of exposure to environmental influences that start from the stage of primordial germ cell, passing through the maturing germ cell, and ending by the zygote stage. This involves the paternally transmitted information on the sperm that contribute to modulating embryogenesis functions and later childhood development, in concert with, the maternally transmitted information encountered by the exposure to a large milieu of environmental factors either periconceptionally or during lactation period.

Environmentally-induced epigenetic changes of gene regulation could result from chronic, lifelong exposure, to low doses of environmental toxicants, such as chemicals including, tobacco smoking and endocrine disrupting compounds, or to other environmental factors such as nutritional changes, and lifestyle-related conditions. These environmentally-acquired epigenetic marks may influence the control of gene regulation through DNA methylation, histone modification, or through a large set of non-coding RNAs (ncRNAs). These epigenetic effects might be passed on to the developing embryo and child as inheritable non-genetic marks, which recapitulate previous lifelong history of exposure to environmental influences that start from the stage of primordial germ cell, passing through the maturing germ cell, and ending by the zygote stage. This involves the paternally transmitted information on the sperm that contribute to modulating embryogenesis functions and later childhood development, in concert with, the maternally transmitted information encountered by the exposure to a large milieu of environmental factors either periconceptionally or during lactation period.

Environmentally-induced epigenetic changes of gene regulation could result from chronic, lifelong exposure, to low doses of environmental toxicants, such as chemicals including, tobacco smoking and endocrine disrupting compounds, or to other environmental factors such as nutritional changes, and lifestyle-related conditions. These environmentally-acquired epigenetic marks may influence the control of gene regulation through DNA methylation, histone modification, or through a large set of non-coding RNAs (ncRNAs). These epigenetic effects might be passed on to the developing embryo and child as inheritable non-genetic marks, which recapitulate previous lifelong history of exposure to environmental influences that start from the stage of primordial germ cell, passing through the maturing germ cell, and ending by the zygote stage. This involves the paternally transmitted information on the sperm that contribute to modulating embryogenesis functions and later childhood development, in concert with, the maternally transmitted information encountered by the exposure to a large milieu of environmental factors either periconceptionally or during lactation period.

Background: Bacterial infection is a frequent complication in cancer and immunocompromised patients. The emergence of antibiotic resistance is a significant health problem and cancer patients are at risk of repeated infections with drug-resistant bacteria. Objective: This investigation aimed to identify predictors of repeat infections of Escherichia coli and Klebsiella pneumoniae and drug resistance in cancer patients admitted to the intensive care unit (ICU) in Upper Egypt. Methods: Blood, urine, sputum, pus, and mouth and nose swabs were collected form patients at the Pediatric Oncology and Medical Oncology ICUs during the period from February 2017 to May 2018. The samples were assessed by antibiotic susceptibility test and further evaluated by genetic testing for the temoniera (TEM) gene of β-lactamase. Samples positive for K. pneumoniae and E. coli were included and isolates positive for other microorganisms were excluded. Results: The study included 107 patients with malignant neoplasms and 136 samples. Repeated infection with K. pneumoniae and E. coli occurred in 31% and 22.45% of patients, respectively. Patients stayed for a longer period in the ICU were more likely to have repeated infections (OR 1.25, 95%CI 1.10-1.44, p=0.001) after control of other confounding factors. The type of malignant neoplasm whether it was hematologic or solid tumor (OR 7.46, 95% CI 2.56-21.7, p=0.0002) and a longer prior stay in the ICU (OR 1.14, 95% CI 1.02-1.28, p=0.025) remained the independent predictors for the drug resistance in the last infection. The TEM type of β-lactamase was encoded in 48.68% and 66.67% of K. pneumoniae and E. coli, respectively. Conclusion: Reinfection with K. pneumoniae and E. coli in patients with cancer can occur as the number of days in the hospital increases. Total prior days spent in the ICU by cancer patients were independently associated with both repeated infections and drug resistance. Samples from patients with hematologic neoplasms were associated with drug resistance.

Background: Bacterial infection is a frequent complication in cancer and immunocompromised patients. The emergence of antibiotic resistance is a significant health problem and cancer patients are at risk of repeated infections with drug-resistant bacteria. Objective: This investigation aimed to identify predictors of repeat infections of Escherichia coli and Klebsiella pneumoniae and drug resistance in cancer patients admitted to the intensive care unit (ICU) in Upper Egypt. Methods: Blood, urine, sputum, pus, and mouth and nose swabs were collected form patients at the Pediatric Oncology and Medical Oncology ICUs during the period from February 2017 to May 2018. The samples were assessed by antibiotic susceptibility test and further evaluated by genetic testing for the temoniera (TEM) gene of β-lactamase. Samples positive for K. pneumoniae and E. coli were included and isolates positive for other microorganisms were excluded. Results: The study included 107 patients with malignant neoplasms and 136 samples. Repeated infection with K. pneumoniae and E. coli occurred in 31% and 22.45% of patients, respectively. Patients stayed for a longer period in the ICU were more likely to have repeated infections (OR 1.25, 95%CI 1.10-1.44, p=0.001) after control of other confounding factors. The type of malignant neoplasm whether it was hematologic or solid tumor (OR 7.46, 95% CI 2.56-21.7, p=0.0002) and a longer prior stay in the ICU (OR 1.14, 95% CI 1.02-1.28, p=0.025) remained the independent predictors for the drug resistance in the last infection. The TEM type of β-lactamase was encoded in 48.68% and 66.67% of K. pneumoniae and E. coli, respectively. Conclusion: Reinfection with K. pneumoniae and E. coli in patients with cancer can occur as the number of days in the hospital increases. Total prior days spent in the ICU by cancer patients were independently associated with both repeated infections and drug resistance. Samples from patients with hematologic neoplasms were associated with drug resistance.

Background: Bacterial infection is a frequent complication in cancer and immunocompromised patients. The emergence of antibiotic resistance is a significant health problem and cancer patients are at risk of repeated infections with drug-resistant bacteria. Objective: This investigation aimed to identify predictors of repeat infections of Escherichia coli and Klebsiella pneumoniae and drug resistance in cancer patients admitted to the intensive care unit (ICU) in Upper Egypt. Methods: Blood, urine, sputum, pus, and mouth and nose swabs were collected form patients at the Pediatric Oncology and Medical Oncology ICUs during the period from February 2017 to May 2018. The samples were assessed by antibiotic susceptibility test and further evaluated by genetic testing for the temoniera (TEM) gene of β-lactamase. Samples positive for K. pneumoniae and E. coli were included and isolates positive for other microorganisms were excluded. Results: The study included 107 patients with malignant neoplasms and 136 samples. Repeated infection with K. pneumoniae and E. coli occurred in 31% and 22.45% of patients, respectively. Patients stayed for a longer period in the ICU were more likely to have repeated infections (OR 1.25, 95%CI 1.10-1.44, p=0.001) after control of other confounding factors. The type of malignant neoplasm whether it was hematologic or solid tumor (OR 7.46, 95% CI 2.56-21.7, p=0.0002) and a longer prior stay in the ICU (OR 1.14, 95% CI 1.02-1.28, p=0.025) remained the independent predictors for the drug resistance in the last infection. The TEM type of β-lactamase was encoded in 48.68% and 66.67% of K. pneumoniae and E. coli, respectively. Conclusion: Reinfection with K. pneumoniae and E. coli in patients with cancer can occur as the number of days in the hospital increases. Total prior days spent in the ICU by cancer patients were independently associated with both repeated infections and drug resistance. Samples from patients with hematologic neoplasms were associated with drug resistance.

Background: The 2012 WHO guidelines recently recommended the 2 – step strategy in managing pediatric cancer pain. There is little experimental evidence to support this practice. Objectives: To describe characteristics & causes of pain in department of pediatric oncology in South Egypt Cancer Institute, to ascertain the effectiveness of WHO analgesic ladder in these pediatric cancer patients & to address side-effects occurred under treatment with opioid therapy in accordance with step 2 & 3 of the ladder. Methods: During 30 months duration from (1 Jan 2011 till 30 June 2013), A prospective study was conducted on pediatric cancer patients who complained of pain & fulfilled all the inclusion criteria for enrollment in this study. Data collected were: patients' demographics, pain characteristics & pain intensity scores. The 1st 24h average intensity pain scores after change of pain therapy & reduction of > 30 % from their initial levels were used to calculate the adequacy of pain control. All patients who had persisting pain after treatment with step – 1(paracetamol) divided into 2 groups: "group 1" received step – 2 (tramadol) & "group 2" moved directly to step – 3 of WHO analgesic ladder (Low dose of morphine. Results: The study included 133 pain cycles comprising a total of 1028 treatment days. Step – 1 analgesia was effective in 50.6% of all documented treatment days, while Step – 2 analgesia was effective in 17.02% of all documented treatment days and Step – 3 analgesia was required in 23.6% of all documented treatment days. After failure to obtain adequate pain control on non-opioid analgesics, it was found that median average intensity pain scores in the 1st 24h after administration of low dose morphine as a two-step strategy (step – 3) was 1.33, which was lower compared to those obtained after tramadol therapy (step – 2), which was 3.33 and the difference was statistically significant (p value = 0.002). Adverse effects which included somnolence, constipation, nausea &/ or vomiting and pruritis were found to be less frequent in weak opioid drugs compared to strong opioid drugs and these differences were statistically significant (p value 0.05. Conclusions: Efficacy of WHO analgesic ladder was ascertained in managing pain in children with cancer in our department. Disease-related pain was the most frequent cause of pain cycles and somatic type of pain was the most frequently occurring type. Use of low dose morphine in a two-step strategy was associated with lower pain scores, fewer drug changes for pain therapy when treatment was initiated & shorter duration of pain, but associated with more frequent side-effects than the conventional three-step WHO ladder.

Background: The 2012 WHO guidelines recently recommended the 2 – step strategy in managing pediatric cancer pain. There is little experimental evidence to support this practice. Objectives: To describe characteristics & causes of pain in department of pediatric oncology in South Egypt Cancer Institute, to ascertain the effectiveness of WHO analgesic ladder in these pediatric cancer patients & to address side-effects occurred under treatment with opioid therapy in accordance with step 2 & 3 of the ladder. Methods: During 30 months duration from (1 Jan 2011 till 30 June 2013), A prospective study was conducted on pediatric cancer patients who complained of pain & fulfilled all the inclusion criteria for enrollment in this study. Data collected were: patients' demographics, pain characteristics & pain intensity scores. The 1st 24h average intensity pain scores after change of pain therapy & reduction of > 30 % from their initial levels were used to calculate the adequacy of pain control. All patients who had persisting pain after treatment with step – 1(paracetamol) divided into 2 groups: "group 1" received step – 2 (tramadol) & "group 2" moved directly to step – 3 of WHO analgesic ladder (Low dose of morphine. Results: The study included 133 pain cycles comprising a total of 1028 treatment days. Step – 1 analgesia was effective in 50.6% of all documented treatment days, while Step – 2 analgesia was effective in 17.02% of all documented treatment days and Step – 3 analgesia was required in 23.6% of all documented treatment days. After failure to obtain adequate pain control on non-opioid analgesics, it was found that median average intensity pain scores in the 1st 24h after administration of low dose morphine as a two-step strategy (step – 3) was 1.33, which was lower compared to those obtained after tramadol therapy (step – 2), which was 3.33 and the difference was statistically significant (p value = 0.002). Adverse effects which included somnolence, constipation, nausea &/ or vomiting and pruritis were found to be less frequent in weak opioid drugs compared to strong opioid drugs and these differences were statistically significant (p value 0.05. Conclusions: Efficacy of WHO analgesic ladder was ascertained in managing pain in children with cancer in our department. Disease-related pain was the most frequent cause of pain cycles and somatic type of pain was the most frequently occurring type. Use of low dose morphine in a two-step strategy was associated with lower pain scores, fewer drug changes for pain therapy when treatment was initiated & shorter duration of pain, but associated with more frequent side-effects than the conventional three-step WHO ladder.

Background: The 2012 WHO guidelines recently recommended the 2 – step strategy in managing pediatric cancer pain. There is little experimental evidence to support this practice. Objectives: To describe characteristics & causes of pain in department of pediatric oncology in South Egypt Cancer Institute, to ascertain the effectiveness of WHO analgesic ladder in these pediatric cancer patients & to address side-effects occurred under treatment with opioid therapy in accordance with step 2 & 3 of the ladder. Methods: During 30 months duration from (1 Jan 2011 till 30 June 2013), A prospective study was conducted on pediatric cancer patients who complained of pain & fulfilled all the inclusion criteria for enrollment in this study. Data collected were: patients' demographics, pain characteristics & pain intensity scores. The 1st 24h average intensity pain scores after change of pain therapy & reduction of > 30 % from their initial levels were used to calculate the adequacy of pain control. All patients who had persisting pain after treatment with step – 1(paracetamol) divided into 2 groups: "group 1" received step – 2 (tramadol) & "group 2" moved directly to step – 3 of WHO analgesic ladder (Low dose of morphine. Results: The study included 133 pain cycles comprising a total of 1028 treatment days. Step – 1 analgesia was effective in 50.6% of all documented treatment days, while Step – 2 analgesia was effective in 17.02% of all documented treatment days and Step – 3 analgesia was required in 23.6% of all documented treatment days. After failure to obtain adequate pain control on non-opioid analgesics, it was found that median average intensity pain scores in the 1st 24h after administration of low dose morphine as a two-step strategy (step – 3) was 1.33, which was lower compared to those obtained after tramadol therapy (step – 2), which was 3.33 and the difference was statistically significant (p value = 0.002). Adverse effects which included somnolence, constipation, nausea &/ or vomiting and pruritis were found to be less frequent in weak opioid drugs compared to strong opioid drugs and these differences were statistically significant (p value 0.05. Conclusions: Efficacy of WHO analgesic ladder was ascertained in managing pain in children with cancer in our department. Disease-related pain was the most frequent cause of pain cycles and somatic type of pain was the most frequently occurring type. Use of low dose morphine in a two-step strategy was associated with lower pain scores, fewer drug changes for pain therapy when treatment was initiated & shorter duration of pain, but associated with more frequent side-effects than the conventional three-step WHO ladder.