Objective: To compare the clinical effectiveness of Paracetamol with Ibuprofen as an antipyretic, fever relief and linked discomfort in children. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Abbottabad Pakistan from Apr to Nov 2019. Methodology: Children aged six months to five years, who reported fever between 38-41°C were included. Two temperature groups were developed, i.e., 37.8–38.9ºC and 39–41ºC with baseline temperatures of 38.60±0.56 for Paracetamol-Group and 38.58± 0.56ºC for Ibuprofen-Group. The prescriptions were given over to the parents with clarification about the dose of the medication. The medication had active and placebo forms. Information was gathered until saturation was done. Results: A total of 104 children were taken in the study. Of these, 77(74.08%) were females, and 27(24.96) were males. Comparing Ibuprofen-treated children with Paracetamol-Group, the final result showed that the extent of children's temperature management was greater in the Ibuprofen-Group 37(71%) than in the Paracetamol-Group 34(65%). Conclusion: Doctors, attendants and guardians wishing to use medications to treat children suffering from fever should be encouraged to use Ibuprofen first and to consider the relative risks and advantages of using Ibuprofen in addition to Paracetamol for fever. Comparatively, Ibuprofen is more effective than Paracetamol.

Objective: To study the clinical profile and induction outcome in children diagnosed with T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2012 to Dec 2020. Methodology: One hundered and twenty-one diagnosed patients of T-ALL and LBL were evaluated with bone marrow biopsy and Contrast-enhanced CT scan of the active region after induction chemotherapy with Dexamethasone, Vincristine, Asparaginase and Daunorubicin along with intrathecal Methotrexate. This was carried out on days-8 and 29 to determine the early remission status and end of induction response, respectively. Results: Out of 121 patients, 99(81.8 %) had T–ALL, while 22(18.18%) had LBL. Day-8 assessment showed that 94(77.7%) patients were rapid early responders, 24(19.4%) were slow early responders, while 3(2.4%) patients expired before the day eight assessment. Day-29 bone marrow assessment of 88 T-ALL patients showed complete remission in 77 patients (87.5%), incomplete remission in 5(5.68%) patients and treatment failure in 2(2.27%) patients. 20(93.1%) patients with LBL achieved remission by Day-29, while 2 (0.02%) LBL patients died before the Day-29 assessment. Conclusion: The remission induction rates and mortality rates in our setup are encouraging and comparable to international data. Further improvements can be made by early management of the affected cases and more accessible pediatric oncology health services.

OBJECTIVE: To study the impact of nutritional status on induction mortality among pediatric patients suffering from acute lymphoblastic leukemia (ALL). METHODS: This descriptive analytical study was conducted on pediatric ALL patients who completed induction chemotherapy in Pediatric Oncology Department Combined Military Hospital, Rawalpindi, Pakistan from 1st January 2012 to 30th June 2021. All patients of ALL diagnosed on basis of National Comprehensive Cancer Network Clinical Practice Guidelines, aged 1-18 years were included. Patients who left before completion of induction chemotherapy or refused to participate were excluded. Cases were divided into three groups based on nutritional status. Induction chemotherapy was given as per UKALL 2011 protocol. RESULTS: Out of 926 patients diagnosed with ALL, 586 (63.3%) were males and 340 (46.7%) were females. Mean age of patients was a 5.83±3.627 years. Majority of the patients (n=679, 73.3%) were well-nourished; and 161 (17.4%) and 86 (9.3%) were moderately and severely malnourished, respectively. About 49.8% (n=461) patients received standard risk chemotherapy protocol with three-drug induction and 50.2% (n=465) received four-drug induction chemotherapy. Infection was the most common complication in 742 (80.1%) patients. Overall induction mortality was 12.9% (n=119/926) in all patients including 9.54% (n=44/461) in standard-risk and 16.12% (n=75/465) in high-risk patients (p=0.003). Induction mortality was significantly high in malnourished-group (17.8%) and 12.2% in normally-nourished children (p=0.008). CONCLUSION: Nutritional status and risk group at time of diagnosis emerged as predictors of induction mortality among ALL patients. Considerable number of patients died during induction phase of treatment. Malnourished children have a high mortality rate.