Objective: To find out the rate of remission of Pre-B Acute Lymphoblastic Leukaemia in children at the end of induction treatment with United Kingdom Acute Lymphoblastic Leukaemia (UKALL) 2011 chemotherapy protocol. Study Design: Prospective observational study. Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital Rawalpindi, from Nov 2017 to Oct 2018. Methodology: Data of newly diagnosed patients of Pre-B Acute lymphoblastic Leukaemia, between 1 and 15 years of age was analysed. Patients were divided into low and high-risk groups and treated with United Kingdom Acute Lymphoblastic Leukaemia 2011 induction chemotherapy on regimens A and B respectively. Bone marrow aspiration was performed at the end of induction therapy (28 days), to document their remission status. Patients having ≤5% of blast cells were categorized to be in remission state and those with >5% blast cells were not considered in a state of remission. Results: A total of 79 patients, 45 (57%) male and 34 (43%) females were enrolled. The mean age was 5.79 ± 3.59 years. Fever (86.1%) and pallor (77.2%) were the most common presentations. Fifty-three (67.1%) patients were treated with regimen A and 26 (32.9%) had regimen B chemotherapy. Febrile neutropenia and myopathy were the most common complications seen in 73 (92.4%) and 54 (71.1%) patients respectively. Eight patients (10.1%) died during induction chemotherapy. Bone marrow aspiration done at the end showed a 100% rate of remission for both regimens A and B. Conclusion: Risk-based treatment of paediatric Acute lymphoblastic Leukaemia............

Introduction: Panton Valentine-Leukocidin (PVL) toxin is secreted by Staphylococcus aureus and is mostly associated with skin and soft tissue infections (SSTI). This study aims to find out the prevalence of lukS/F-PV gene, which encode PVL toxin from strains of SSTI, burn wounds and nasal colonizers of out-patients and to measure the antimicrobial susceptibility of S. aureus isolates. Methodology: This is an analytical observational cross-section study and was conducted from July 2014 to June 2015 at four tertiary care hospitals and PCSIR Laboratories Complex, Lahore, Pakistan. A total of 376 random clinical swabs were collected from SSTI (n = 179), nasal nares (n = 134) and burn wounds (n = 63) from out-patients’ departments (OPD). The specimens were cultured on nutrient and mannitol salt agar (MSA) and the organism was identified by catalase, coagulase, and DNase tests. Antimicrobial susceptibility, methicillin, inducible clindamycin, and high-level mupirocin (HLMR) resistance were determined as per CLSI guidelines. Molecular identification of mecA and lukS/F-PV genes was performed by PCR. Results: We isolated 127 S. aureus, where 41 (32.3%) were MRSA and 86 (67.7%) were MSSA. All MRSA carried mecA gene whereas lukS/F-PV gene was found in 21 MRSA and 31 MSSA strains. Overall, a high antimicrobial resistance was found against MRSA and lukS/F-PV positive MSSA. Inducible clindamycin and high-level mupirocin resistance (HLMR) was 23.6% and 19.5% respectively. Conclusions: A high rate of PVL toxin gene was detected among S. aureus strains and a high prevalence of antimicrobial resistant strains was observed.

Objective: To find out the frequency of chemotherapy-induced febrile neutropenia (FN) in children diagnosed with Acute Lymphoblastic Leukemia (ALL) and its response to empirical antibiotic therapy. Study Design: Cross-sectional study. Place and Duration of Study: Department of Peadiatric Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2017 to Oct 2018. Methodology: Newly diagnosed pediatric patients suffering from acute lymphoblastic leukemia between 1 to 15 years of age were included. All patients were treated with chemotherapy according to the United Kingdom National Randomized Trial for Children and Young adults with Acute Lymphoblastic Leukemia (UKALL) 2011 protocol. Patients with febrile neutropenic (FN) episodes were treated with empirical antimicrobial therapy as per hospital guidelines. Patients ‘response to antimicrobial therapy, blood culture results and related complications were noted. Results: Out of a total 77 patients, 45 (58.4%) had 69 episodes of febrile neutropenia (FN), 62 (78.5%) episodes of febrile neutropenia (FN) were started empirical treatment with first-line antibiotics (piperacillin-tazobactam and amikacin) whereas 15 (21.7%) episodes of febrile neutropenia (FN) not responding to the 1st line were shifted to second-line antibiotics (meropenem and amikacin). Mean duration of fever was 4.1 ± 2.8 days on 1st line antibiotic regimen, 2.6 ± 1 days on 2nd line antibiotics and 6.3 ± 3.3 days on combination with antifungal drug. Ten patients received antifungal therapy empirically. Efficacy of the 1st line and the 2nd line was 72.5% and 77% respectively. Staphylococcus aureus was the most frequent organism isolated from blood culture results. During the induction phase, 10 (12.9%) patients..............

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