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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.

Aim: The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. Patients and Methods: A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. Results: With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. Conclusion: In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.

Background: The 2012 WHO guidelines recently recommended the 2step 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 1 st 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 1 st 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.