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.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.