Introduction:In patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods:We conducted a prospective hospital based study to the patients who had fever and neutropenia during caner chemotherapy. Only low risk patients i.e. neutropenia of less than seven days, ANC >250/cmm, without any signs of shock were included in the study. All the patients were hospitalized and given oral antibiotics Ofloxacin and Amoxy-Clav and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results: A total of 54 cases were enrolled in the study. Out of 54 patients two patients were lost, 8 needed IV antibiotics for different reasons and 44 patients (81%) improved well with oral antibiotics only. Conclusion: In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics.

Keywords: Empyema; chest tube drainage, decorticationDOI = 10.3126/jnps.v28i2.1387J. Nepal Paediatr. Soc. Vol.28(2) 2008 p.49-51

Introduction: Leukemia commonly known as blood cancer is the most common malignant neoplasm in childhood accounting for about 41 % of all malignancies that occur in children younger than 15 year of age. The objectives of this study were to find out the clinico-laboratory features and survival of children with acute lymphoblastic leukemia (ALL) during fourteen years in pediatric oncology unit of a tertiary care hospital. Materials and Methods: This was a retrospective study conducted at Kanti Children's Hospital (KCH) from March 1998 to March 2012. Bone marrow aspiration showing ≥25 % blast cells was the criteria for diagnosis of ALL. Results: Out of 755 childhood cancers reported in this hospital during study period, total number of Acute leukemia patients were 375 (49.7%). Among acute leukemia, patients with ALL were 300, which was 80.0 % among all leukemias and 39.7% of all cases of cancers. Among cases of ALL, L1, L2 and L3 constituted 163 (54.3%), 131 (43.7%) and 6 (2%) respectively. The age of the children with acute leukemia ranged from six months to fourteen years, with a mean age of 7.3 years. The majority of children (61.7 %) with ALL fell into the age group of 2-9 years. Males: Female ratio was (M:F=1.3:1 ). The most common presenting features in ALL were fever (89.2 %), followed by splenomegaly (89.1%), hepatomegaly (69.2%) and lymphadenopathy (58.4 %). Among all patients, remission rate was 28.3% at ≥ 5 years, 17.7% were on maintenance, 30.3% abandoned treatment and 23.7 % died. Conclusion: This study showed that the patients on remission at ≥ 5 years in this centre were 28.3%.

Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs. Key words: Pleural effusion; pyogenic; decortication; adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti- tubercular drugs. Key words: Pleural effusion, pyogenic, decortication, adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134

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