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Infection remains the major cause of morbidity and mortality in immunocompromised children with malignancy. In addition, the economic impact of antibiotic treatment should always be evaluated, especially in developing countries. In our center between January 1998 and January 1999, 73 children with hematological malignancies [acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML)]; 9 children with solid tumors (rhabdomyosarcoma, neuroblastoma) had 87 febrile neutropenic episodes (related to chemotherapy). These children were randomized prospectively into three treatment groups. The first group (n: 28) received cefepime plus netilmicin, while the second group (n: 29) was treated with ceftazidime plus amikacin and the third (n: 30) with meropenem as monotherapy. The aim of the study was to compare the success rates and cost of fourth generation cephalosporin plus aminoglycoside and monotherapy of meropenem with ceftazidime plus amikacin, which is the standard therapy for febrile neutropenia. Microbiologically documented infections were 29.9%, clinically documented infections were 9.2% and 60.9% of the febrile neutropenic episodes were considered to be FUO. Gram-positive microorganisms were the most commonly isolated agents from blood cultures [MRSA (Methicillin Resistant Staphylococcus aureus) in 6 patients and MSSA (Methicillin Sensitive Staphylococcus aureus) in 4 patients]. The success rates were 78.5%, 79.3% and 73.3 % for the 1st, 2nd and 3rd groups respectively. In 4 patients (4.5%) fever responded only to amphotericin-B therapy. There was no statistically significant difference between the three treatment regimens with respect to efficacy, safety and tolerance (chi2 test, p>0.05), but while the third and fourth generation cephalosporins + aminoglycosides were comparable for cost, the monotherapy regimen was the most expensive. The main determining factors for the choice of treatment of febrile neutropenic children, especially in a developing country, are cost, presence of indwelling catheter and the bacterial flora of the unit, as well as efficacy.

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In this study dietary boron at different doses (0, 25, 50, 100 and 200 mg/kg feed) was supplemented to layers from 4 to 64 weeks of age. There was no significant difference between treatments with respect of mortality, egg production, egg weight, egg mass and cracked eggs. Significant increases were observed in body weight as age rose. Body weight was not affected by dietary boron supplementation at 16 and 40 weeks of age. At 64 weeks of age boron additions of 50, 100 and 200 mg/kg to the diet resulted in significant lower body weights than that of the control group. Egg quality parameters; albumen height and Haugh units, were improved when 25 or 50 mg boron/kg diet was supplemented above the other treatments. Shape index, shell thickness, shell breaking strength were not affected by treatments, though 25 mg boron/kg diet tended to increase shell breaking strength. Tibia bone strength and phosphorus content in the tibia and femur were not affected by boron supplementation. Boron supplementation at 25 and 50 mg/kg significantly increased femur bone strength, and ash and calcium content of the tibia and femur bones. Concentration of boron in bone increased with the increase in dietary boron.