A prospective study was conducted in 1999 at the National Cancer Institute, Cairo University, to estimate the incidence, morbidity and mortality of fungal infections along with the evaluation of risk factors influencing outcome of infections among paediatric cancer patients. Of 1917 infectious episodes, the fungal infection rate as documented both clinically and microbiologically was 3.7% (70 cases). Fungal pathogens isolated were yeasts in 55 patients (78.6%) and moulds in 15 patients (21.11%). Among yeasts, Candida parapsilosis was the commonest, followed by C. tropicalis. Pneumonia was the most common fungal infection (n = 25, 35.7%), followed by fungaemia (n = 18, 25.7%). The overall mortality rate was 40% (n = 28), with an infection-related mortality of 28.5% (n = 20). Risk factors that accompanied mortality were relapsing or recurrent disease, profound neutropenia, ADE (Ara-C, daunorubocin and etoposide) protocol of chemotherapy, C. tropicalis isolated and fungaemia as a site of infection. Early use of empirical antifungal therapy (day 4) was not associated with a better outcome. In the light of the poor outcome of patients with fungaemia and fungal pneumonia, every effort should be made to prevent these infections in paediatric cancer patients.

No abstract

The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed.

A global increase in the prevalence of obesity and type 2 diabetes is strongly connected to an increased prevalence of non-alcoholic fatty liver disease (NAFLD) worldwide. In this article, the progression of the NAFLD process is modeled by continuous time Markov chains (CTMCs) with nine states. Maximum likelihood is used to estimate the transition intensities among the states. Once the transition intensities are obtained, the mean sojourn time and its variance are estimated, and the state probability distribution and its asymptotic covariance matrix are also estimated. A hypothetical example based on a longitudinal study assessing patients with NAFLD in various stages is discussed. The mean time to absorption is estimated, and the other abovementioned statistical indices are examined. In this article, the maximum likelihood estimation (MLE) function is utilized in a new approach to compensate for the missing values in the follow-up period of patients evaluated in longitudinal studies. A MATLAB code link is provided, at the end of the article, for the estimation of the transition rate matrix and transition probability matrix.