A patient suffering from typhoid fever with severe pancytopenia is presented. Bone marrow examination revealed extensive haemophagocytosis which possibly contributed to the pancytopenia.

Introduction The Capizzi-style methotrexate (MTX) is an integral part of acute lymphoblastic leukemia (ALL) treatment. The escalating dose of MTX originally used in the United Kingdom and Children’s Oncology Group protocols along with L-asparaginase has been modified in the Indian Childhood Collaborative Leukemia (ICiCLe) group protocol where L-asparaginase has been omitted. The data regarding the incidence of toxicities and ease of administration on the Capizzi-style interim maintenance is not robust. Objectives We have compiled our experience with administration and toxicity profile in children with intermediate-risk ALL. Materials and Methods A retrospective data collection of all children diagnosed with intermediate-risk ALL as per the ICiCLe risk stratification in the year 2019 was included in the analysis. Each cycle of MTX was started after ensuring an absolute neutrophil count of >750/mm3 and transaminases <2 upper limit of normal. As a unit protocol, pre- and post-MTX hydration was administered in all our children. No urine pH or midcycle biochemical parameter monitoring was done. Statistical analysis was done using Microsoft Excel and SPSS version 24 IBM Corp. in Armonk, New York, United States. Results Forty-six children were included in the study. The median age of children in our study was 6 years (range: 1 year 2 months–12 years). Undernutrition was associated with a significant increase in toxicity (p = 0.02). Fifty-two percent of children had evidence of toxicity, elevated transaminases being the most common. There were recurring symptoms resulting in 53 episodes of toxicities overall. Incidence of toxicity was more in the early cycles (<3). Conclusion The pre- and post-MTX hydration is an effective way to reduce toxicities with the Capizzi-style MTX and this course can be administered with ease on outpatient basis with minimal need for monitoring or admission.

ication costs were not statistically different between two groups. Factor positively associated with service costs included excess filler (RRϭ7.9, pϽ0.0002), relapse event (RRϭ4.0, pϽ0.0001) and adverse event like EPS (RRϭ1.6, pϽ0.008), while types of antipsychotics and diagnoses were not significant factors after adjusting for covariates. CONCLUSIONS: SGAs were associated with reduced psychiatric service uses as compared to FGAs within the 12-month treatment period; however, service costs were not different and medication costs were significantly higher in the SGAs group. Excess fillers, relapse and incidence of EPS were factors of high costs among children and adolescents psychiatric patients treated with antipsychotics in Taiwan. OBJECTIVES:To assess clinical effectiveness of cognitive behavioural therapy (CBT) in patients with multiple sclerosis (MS) fatigue. METHODS: Embase® and Cochrane databases were searched up to June 2012 to identify randomised controlled trials published in English evaluating effect of CBT (disseminated by any mode) in patients with MS fatigue. Eligibility of trials was assessed by two reviewers with any discrepancy reconciled by a third, independent reviewer. To compare CBT with other therapies, random-effect meta-analysis was conducted using Stata® (v11.1) on change from baseline to endpoint in fatigue score. RESULTS: Four studies of 107 retrieved citations met pre-defined inclusion criteria. Two studies compared CBT to no therapy and one study each compared CBT to relaxation therapy (RT) and supportive-expressive group therapy (SEGP). All studies were well conducted and no significant differences were observed between treatment groups for demographic characteristics. Weighted mean difference (WMD) demonstrated statistically significant reduction for change in fatigue score at 2 months from baseline with CBT versus no therapy (-7.04; pϽ0.001). When CBT was compared to RT, WMD was -4.29 (pϽ0.001) at 2 months, -2.74 (pϭ0.013) at 5 months, and -2.74 (pϭ0.027) at 8 months indicating that CBT group improved significantly on fatigue than RT group and this improvement was sustained over a period of time. Further, A545 V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 2 7 7 -A 5 7 5 when CBT was assessed against SEGP, WMD was -12.2 (pϭ0.024) at 4 months, indicating that CBT (individualised therapy) demonstrated significantly better reduction in fatigue compared to SEGP (group therapy). CONCLUSIONS: Overall results demonstrated that CBT was significantly superior in alleviating fatigue compared to no therapy, RT, and SEGP. CBT appears to be promising, acceptable and clinically beneficial approach that could potentially benefit patients with MS fatigue in future. Thus, further research is warranted to determine which aspects of CBT are most effective and the optimal delivery of CBT for MS fatigue. OBJECTIVES:To report effects of BG-12 on the reduction in number of relapses requiring intravenous steroids and multiple sclerosis (MS)-related hospitalizations in DEFINE and CONFIRM, two Phase 3 studies o...

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