Background Steroids and L-asparaginase (L-Asp) are agents used in induction phase chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both agents are often reported to have the side effect of hyperglycemia, and native L-Asp is also reported to cause hypoglycemia. In ALL patients, hyperglycemic events during chemotherapy can cause lower 5-year overall and relapse-free survival. Objective To investigate the incidence of abnormal blood glucose level (BG) as the side effect of prednisone and L-Asp during induction phase chemotherapy, its  predisposing factors, and its effect on remission status. Methods This cohort prospective study was conducted in 36 children aged 1-18 years who were newly diagnosed with childhood ALL at Dr. Moewardi Hospital, Surakarta, Central Java. Subjects’ nutritional status consist of wellnourished and undernourishment. Subjects underwent BG monitoring. At the end of induction phase chemotherapy, subjects underwent bone marrow puncture (BMP) evaluation to assess their response to chemotherapy and the effect of abnormal BG on remission status. Results Hypoglycemia, a combination of hypoglycemia and hyperglycemia, hyperglycemia, as well as euglycemia, were experienced by 9, 7, 6, and 14 subjects, respectively. Nutritional status was found to be a significant risk factor for abnormal BG. There was no significant difference in remission status at the end of induction phase chemotherapy between the euglycemic group and abnormal BG groups (P=0.533). Conclusion Abnormal BG during induction phase chemotherapy did not affect remission status at the end of induction phase.  Undernourishment is also found to be a predisposing factor in abnormal BG.

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Focal atrial tachycardia (AT) is defined as atrial activation originating from a discrete focus with centrifugal spread. Available information suggests that focal activity can be caused by automaticity, triggered activity, or microreentry. Generally, AT response poorly to medication but can be treated by radiofrequency ablation with high long-term success. Focal AT represents approximately 3% to 17% of the patients referred for supraventricular tachycardia (SVT) radiofrequency ablation (RFA). Electrophysiology study is important to correctly diagnose the mechanism of the SVT before RFA is performed. Observation and several pacing maneuver could be done to identify the mechanism of SVT.A 54 year old female came with chief complaint of palpitation. During palpitation her ECG showed narrow complex regular tachycardia with the P-wave that was difficult to ascertain clearly. Electrophysiology study showed VA interval 130 ms, differences between VA interval during tachycardia and VA interval during RV pacing was 55 ms, no advanced in atrial activation, difference between ventricular post pacing interval (PPI) and tachycardia cycle length (TCL) was 130 ms, ventricular pacing during tachycardia results in V-A-A-V response before tachycardia resumes, and showed concentric atrial activation with earliest point at CS 9-10, indicating an AT from coronary sinus origin. AT was terminated during the RFA.Electrophysiology study is important to correctly diagnose AT, especially when P-wave during tachycardia in the surface ECG is uncertain. Several pacing maneuver during electrophysiology study can be very helpful to verify the diagnosis of AT.

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