Cancer remains a major cause of death in children, but recent advances in supportive care and progress in the use of chemotherapy have considerably improved the prognosis. The need for intensive care management in pediatric oncology patients is increasing. However, studies demonstrating their outcome in the literature are still deficient, especially in developing countries. Here, we aim to report our experience in managing patients admitted to the pediatric intensive care unit (PICU) at South Egypt Cancer Institute, a tertiary university oncology center in a developing country.A review of all cancer patients admitted to the PICU at South Egypt Cancer Institute between January 2007 and December 2011 and an evaluation of prognostic factors that may correlate to their short-term outcome were performed.A total of 550 pediatric oncology patients were admitted to the PICU on 757 occasions. Hematological malignancies represented 73.6% of the cases. The median duration of PICU stay was 5 days. Sepsis and respiratory failure were the most frequent indications for PICU admission. The overall survival at the time of discharge from the PICU was 60%. Several factors were found to significantly affect the outcome of patients admitted to the PICU, including the underlying disease, the reason for admission, the intervention used, and the number of failing organs at the time of admission to the PICU.The prognosis of patients admitted to the PICU in developing countries is still behind those in developed ones. Late referral, especially of patients presenting with respiratory failure, sepsis, and multiorgan failure usually, requires urgent intervention with inotropic support, oxygen therapy, and mechanical ventilation and is significantly associated with poor outcomes, especially in patients with hematological malignancies.

Cancer remains a major cause of death in children, but recent advances in supportive care and progress in the use of chemotherapy have considerably improved the prognosis. The need for intensive care management in pediatric oncology patients is increasing. However, studies demonstrating their outcome in the literature are still deficient, especially in developing countries. Here, we aim to report our experience in managing patients admitted to the pediatric intensive care unit (PICU) at South Egypt Cancer Institute, a tertiary university oncology center in a developing country.A review of all cancer patients admitted to the PICU at South Egypt Cancer Institute between January 2007 and December 2011 and an evaluation of prognostic factors that may correlate to their short-term outcome were performed.A total of 550 pediatric oncology patients were admitted to the PICU on 757 occasions. Hematological malignancies represented 73.6% of the cases. The median duration of PICU stay was 5 days. Sepsis and respiratory failure were the most frequent indications for PICU admission. The overall survival at the time of discharge from the PICU was 60%. Several factors were found to significantly affect the outcome of patients admitted to the PICU, including the underlying disease, the reason for admission, the intervention used, and the number of failing organs at the time of admission to the PICU.The prognosis of patients admitted to the PICU in developing countries is still behind those in developed ones. Late referral, especially of patients presenting with respiratory failure, sepsis, and multiorgan failure usually, requires urgent intervention with inotropic support, oxygen therapy, and mechanical ventilation and is significantly associated with poor outcomes, especially in patients with hematological malignancies.

Background Metronomic chemotherapy (mctx) combined with radiation therapy (rt) is an emerging anticancer strategy. The aim of the present study was to assess the efficacy of mctx combined with rt as salvage treatment in children with refractory or relapsed solid malignancies. Methods This prospective study enrolled patients with refractory or relapsed pediatric solid tumours from January 2013 to January 2015. Treatment consisted of 3–12 courses of mctx in all patients, followed by rt in patients who experienced local recurrence, distant metastases, or both. Each course of mctx consisted of oral celecoxib 100–400 mg twice daily (days 1–42), intravenous vinblastine 3 mg/m2 weekly (weeks 1–6), oral cyclophosphamide 2.5 mg/m2 daily (days 1–21), and oral methotrexate 15 mg/m2 twice weekly (days 21–42). Statistical methods used were the log-rank test and binary logistic regression. Results A favourable disease response (partial response or stable disease) was seen in 49 of 64 patients (76.6%), with mild acute toxicity occurring in 41 (64%). After a median follow-up of 14 months, 1-year overall survival was 62%. Pattern of disease relapse (p 0.0001), time from initial treatment to relapse (p = 0.0002), and response to treatment (p 0.0001) significantly affected survival. Age was the only factor that significantly correlated with treatment toxicity (p = 0.002; hazard ratio: 3.37; 95% confidence interval: 1.53 to 7.35) Conclusions Combining mctx with rt resulted in a favourable response rate, minimal toxicity, and 62% 1-year overall survival in patients with heavily pretreated recurrent disease. Patients with localized late recurrence or disease progression are the most likely to benefit from this regimen.

Background Metronomic chemotherapy (mctx) combined with radiation therapy (rt) is an emerging anticancer strategy. The aim of the present study was to assess the efficacy of mctx combined with rt as salvage treatment in children with refractory or relapsed solid malignancies. Methods This prospective study enrolled patients with refractory or relapsed pediatric solid tumours from January 2013 to January 2015. Treatment consisted of 3–12 courses of mctx in all patients, followed by rt in patients who experienced local recurrence, distant metastases, or both. Each course of mctx consisted of oral celecoxib 100–400 mg twice daily (days 1–42), intravenous vinblastine 3 mg/m2 weekly (weeks 1–6), oral cyclophosphamide 2.5 mg/m2 daily (days 1–21), and oral methotrexate 15 mg/m2 twice weekly (days 21–42). Statistical methods used were the log-rank test and binary logistic regression. Results A favourable disease response (partial response or stable disease) was seen in 49 of 64 patients (76.6%), with mild acute toxicity occurring in 41 (64%). After a median follow-up of 14 months, 1-year overall survival was 62%. Pattern of disease relapse (p 0.0001), time from initial treatment to relapse (p = 0.0002), and response to treatment (p 0.0001) significantly affected survival. Age was the only factor that significantly correlated with treatment toxicity (p = 0.002; hazard ratio: 3.37; 95% confidence interval: 1.53 to 7.35) Conclusions Combining mctx with rt resulted in a favourable response rate, minimal toxicity, and 62% 1-year overall survival in patients with heavily pretreated recurrent disease. Patients with localized late recurrence or disease progression are the most likely to benefit from this regimen.

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Study Objective: The aim of this study was to evaluate the analgesic efficacy and safety of pectoralisserratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain. Design: A prospective randomized controlled study. Setting: Tertiary center, university hospital. Patients: Sixty-four adult women, American Society of Anesthesiologists physical status classes I, II, and III, scheduled for unilateral modified radical mastectomy with axillary evacuation. Interventions: Patients were randomized to receive either pectoralis-serratus interfascial plane block, PS group (n = 32), or thoracic paravertebral block, PV group (n = 32). Measurements: Twenty-four-hour morphine consumption and the time to rescue analgesic were recorded. The pain intensity evaluated by visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24 hours postoperatively was also recorded. Main Results: The median (interquartile range) postoperative 24-hour morphine consumption was significantly increased in PS group in comparison to PV group (PS vs PV), 20 mg (16-23 mg) vs 12 mg (10-14 mg) (P b .001). The median postoperative time to first analgesic request was significantly shorter in PS group compared to PV group (PS, 6 hours [5-7 hours], vs PV, 11 hours [9-13 hours]) (P b .001). The intensity of pain was low in both groups inVAS 0, 2, and 4 hours postoperatively. However, therewas significant reduction in VAS in PV group compared to PS group at 8, 16, and 24 hours postoperatively. Conclusions: Pectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block. © 2016 Elsevier Inc. All rights reserved.

Study Objective: The aim of this study was to evaluate the analgesic efficacy and safety of pectoralisserratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain. Design: A prospective randomized controlled study. Setting: Tertiary center, university hospital. Patients: Sixty-four adult women, American Society of Anesthesiologists physical status classes I, II, and III, scheduled for unilateral modified radical mastectomy with axillary evacuation. Interventions: Patients were randomized to receive either pectoralis-serratus interfascial plane block, PS group (n = 32), or thoracic paravertebral block, PV group (n = 32). Measurements: Twenty-four-hour morphine consumption and the time to rescue analgesic were recorded. The pain intensity evaluated by visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24 hours postoperatively was also recorded. Main Results: The median (interquartile range) postoperative 24-hour morphine consumption was significantly increased in PS group in comparison to PV group (PS vs PV), 20 mg (16-23 mg) vs 12 mg (10-14 mg) (P b .001). The median postoperative time to first analgesic request was significantly shorter in PS group compared to PV group (PS, 6 hours [5-7 hours], vs PV, 11 hours [9-13 hours]) (P b .001). The intensity of pain was low in both groups inVAS 0, 2, and 4 hours postoperatively. However, therewas significant reduction in VAS in PV group compared to PS group at 8, 16, and 24 hours postoperatively. Conclusions: Pectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block. © 2016 Elsevier Inc. All rights reserved.

Study objective:We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption. Design: Prospective randomized controlled clinical trial. Setting: Postanesthesia care unit. Patients: One hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation. Interventions: Patients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg. Measurements: The assessment parameters were the postoperative analgesic effect using visual analog scale (VAS) pain scores, the subsequent 24-hour morphine consumption, and the systemic adverse effects of pregabalin doses. Main results: The VAS score at rest and movement was significantly decreased only in group P300 and group P150 in comparison to group P0 and group P75 at 0 hour (P b .01). The median (interquartile range) consumption of morphine in the first postoperative 24 hours was significantly decreased in group P300 in comparison to group P0 and group P75 (P300 vs P0: 6.5 [5-6.5] vs 20.5 [15.8-20.5] [P b .001]; P300 vs P75: 6.5 [5-6.5] vs 20 [14-20] [P b .001]), but there was no significant difference between group P300 and group P150. In addition, there was a significant decrease in consumption of morphine in group P150 in comparison to group P0 and group P75 (P150 vs P0: 7 [5-7] vs 20.5 [15.8-20.5] [P b .001]; P150 vs P75: 7 [5-7] vs 20 [14-20] [P b .001]). There were statistical significant increase in dizziness and blurred vision in group P300 in comparison to other groups (P b .05). Conclusions: A single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM. © 2016 Elsevier Inc. All rights reserved.

Study objective:We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption. Design: Prospective randomized controlled clinical trial. Setting: Postanesthesia care unit. Patients: One hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation. Interventions: Patients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg. Measurements: The assessment parameters were the postoperative analgesic effect using visual analog scale (VAS) pain scores, the subsequent 24-hour morphine consumption, and the systemic adverse effects of pregabalin doses. Main results: The VAS score at rest and movement was significantly decreased only in group P300 and group P150 in comparison to group P0 and group P75 at 0 hour (P b .01). The median (interquartile range) consumption of morphine in the first postoperative 24 hours was significantly decreased in group P300 in comparison to group P0 and group P75 (P300 vs P0: 6.5 [5-6.5] vs 20.5 [15.8-20.5] [P b .001]; P300 vs P75: 6.5 [5-6.5] vs 20 [14-20] [P b .001]), but there was no significant difference between group P300 and group P150. In addition, there was a significant decrease in consumption of morphine in group P150 in comparison to group P0 and group P75 (P150 vs P0: 7 [5-7] vs 20.5 [15.8-20.5] [P b .001]; P150 vs P75: 7 [5-7] vs 20 [14-20] [P b .001]). There were statistical significant increase in dizziness and blurred vision in group P300 in comparison to other groups (P b .05). Conclusions: A single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM. © 2016 Elsevier Inc. All rights reserved.

Study objective:We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption. Design: Prospective randomized controlled clinical trial. Setting: Postanesthesia care unit. Patients: One hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation. Interventions: Patients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg. Measurements: The assessment parameters were the postoperative analgesic effect using visual analog scale (VAS) pain scores, the subsequent 24-hour morphine consumption, and the systemic adverse effects of pregabalin doses. Main results: The VAS score at rest and movement was significantly decreased only in group P300 and group P150 in comparison to group P0 and group P75 at 0 hour (P b .01). The median (interquartile range) consumption of morphine in the first postoperative 24 hours was significantly decreased in group P300 in comparison to group P0 and group P75 (P300 vs P0: 6.5 [5-6.5] vs 20.5 [15.8-20.5] [P b .001]; P300 vs P75: 6.5 [5-6.5] vs 20 [14-20] [P b .001]), but there was no significant difference between group P300 and group P150. In addition, there was a significant decrease in consumption of morphine in group P150 in comparison to group P0 and group P75 (P150 vs P0: 7 [5-7] vs 20.5 [15.8-20.5] [P b .001]; P150 vs P75: 7 [5-7] vs 20 [14-20] [P b .001]). There were statistical significant increase in dizziness and blurred vision in group P300 in comparison to other groups (P b .05). Conclusions: A single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM. © 2016 Elsevier Inc. All rights reserved.