No abstract

Hepatocellular carcinoma (HCC) is a rare pediatric tumor. It differs from its adult counterpart in many ways like etiology, biological behavior, and association with cirrhosis. Treating HCC requires a multidisciplinary team involving pediatric gastroenterology, oncology, hepatobiliary surgery, and interventional radiology. This case series aims to describe presenting features and management plan of three children with HCC treated at a tertiary care liver transplant center in Pakistan.

Objectives: The aim was to review outcome with residual disease at the end of first line chemotherapy in patients with extracranial germ cell tumor (GCT) in our resource limited setting.Methods: A retrospective analysis of 196 patients with GCT recruited at Shaukat Khanum Memorial Cancer Hospital (SKMCH) from January 2008 to December 2016. Data fields included site, histopathology, stage, risk groups, baseline alpha fetoprotein, beta human chorionic gonadotropin levels, residuum after primary treatment, completeness of surgical excision and outcomes. Data analysis involved quantitative analysis, mean and median calculations, event free survival (EFS) and overall survival (OS) calculations using Kaplan-Meier curves.Results: In 196 included patients, M:F ratio was 1. There were 81 (41.3%) adolescents. Alpha fetoprotein was > 10,000 IU/L in 56 (28.6%) patients. Sixty-two (31.6%) patients had extragonadal disease. Most patients (n = 137, 69.9%) presented with advanced stage (III/IV). Seventy-six patients had postchemotherapy residual disease (n = 59 [78%] with partial response (PR) and 17 [22%] with no response [NR]). Five-year OS was 83% and EFS was 67%. Fiveyear EFS of patients with complete remission after primary chemotherapy was 85% versus 70% in patients with PR and 6% in those with NR (P = 0.001). OS in patients with complete remission, PR and NR was 94%, 87%, and 46%, respectively. All patients with NR progressed or relapsed and 8/17 died. Four patients with normalized tumor marker response were found to have active tumor on resection of postchemotherapy residuum. Conclusion:Patients with postchemotherapy residual disease in pediatric extracranial GCTs, fare better if their residuum is resected compared with those who do not undergo resection.

Objective: To study organisms causing bacteremia and their outcome in cancer children with febrile neutropenia (FN) admitted at our centre. Study Design: Retrospective longitudinal study.  Place and duration of study: Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from Feb to Dec 2017.  Methodology: All pediatric oncology patients with febrile neutropenia admitted to the inpatient department were included. Data fields included age, diagnoses, demographics, organism types, time to positivity, multi-drug resistance, antibiotics, and outcome. Results: A total of 391 episodes of febrile neutropenia were documented among 86 patients. The mean age was 4.7±2.7 years. Twelve (14.0%) patients had intensive care admission, and 9(10.5%) of them died. Fifty-four (63.0%) children had primary diagnoses of haematological malignancies. Sixty-five percent had mucositis, central catheter, or both as risk factors. Thirty-nine isolates were cultured in 391 febrile-neutropenic episodes. Escherichia coli was the most frequently isolated organism in 16(41.0%) cultures, followed by Pseudomonas and Streptococcus pneumoniae in 4(10.3%) each. Poly-microbial isolates were seen in 6(15.4%) cultures. Multi-drug resistance was found in 12(30.8%) isolates. Thirty-four (87.0%) patients with positive cultures received appropriate antibiotics. Majority organisms were sensitive to Piperacillin/Tazobactam (14,35.9%) followed by Meropenem (10, 25.6%) and Colistin (6, 15.4%). Conclusions:  Rapid identification of organisms from positive blood cultures combined with antimicrobial stewardship can have improved antibiotic treatment and outcomes.

Introduction: Rhabdomyosarcoma is the most common soft tissue sarcoma in children. This paper aimed to assess the stage, site, and treatment outcome among rhabdomyosarcoma (RMS) patients. Materials and Methods: A retrospective chart review was completed from January 2011 to December 2017 of patients that presented to the Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, for the management of RMS. Data collection included clinical characteristics, staging, grouping, risk stratification, treatment plan, radiotherapy doses, and treatment outcome. Results: Among 24 subjects, there were a total of 13 (54.2%) males and 11 (45.8%) females. The median age at the time of diagnosis was 2.5 years (range: 0.75 - 17 years). The majority of the subjects (91.7%) were less than 10 years of age. The median follow-up time was 0.6 years. According to the Children's Oncology Group Classification, 4 (16.7%) subjects were classified as low risk, 14 (58.3%) subjects were rated as intermediate risk, and 6 (0.25%) subjects were stratified as high risk. The most common primary tumor site were genitourinary (62.5%) and abdomen/retroperitoneal (20.8%) regions. At the time of analysis, nine (37.5%) subjects had died because of the disease, twelve (50%) were alive with no evidence of disease, and one subject had a recurrence of disease and was alive. One subject had abandoned the therapy, and another was lost to follow-up. Conclusion: Patients with Rhabdomyosarcoma presented at the late stages of the disease, and it most frequently affected genitourinary and abdomen or retroperitoneal areas. Overall, Rhabdomyosarcoma was found to have a poor outcome to therapy.

Aim/Objective: The aim of this in-vitro study is to assess the antibacterial activity of a propolis-modified experimental dental composite resin in terms of reducing and preventing recurrent caries, usually caused by Streptococcus mutans. Materials and methods: Control group specimens were made using the 70/30 (filler/resin) method without the use of EPE. Group 1 specimens were made by mixing 12% EPE with 30% resin in experimental dental composite resin. The experimental dental composite was created by adding 16%EPE and 20% EPE to Group 2 and Group 3, respectively. Antibacterial testing was carried out in the inhibition zone using the minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC). Surface roughness was assessed using scanning electron microscopy. Results: The results were evaluated using one-way ANOVA and Tukey's high significant difference test (HSD). The EPE displayed antibacterial action against S.mutans, according to the findings. The inhibitory zone of 20% EPE integrated dental composite resin was 2.2mm to 2.5mm. Inhibition zones ranging from 1.2mm to 1.8mm were found in 12% and 16% of the samples, respectively. The results of the minimum inhibitory concentration showed that 20% had stronger antibacterial activity than 12 and 16 %. Scanning electron microscopy research revealed that 20% of EPE samples had decreased surface roughness. Conclusion: The experimental dental composite showed antibacterial activity against S.mutans. Antibacterial activity is increased by increasing the proportion of EPE in the experimental composite. Due to its dark color appearance it is recommended for usage as a lining material under restorative materials. Keywords: Streptococcus mutans, Secondary Caries, Antibacterial activity, Propolis, Ethanolic extract of Propolis, Dental Composite Resin

Osteoarthritis (OA) of the knee is a relatively prevalent disorder, and prevalence rises with age. Total knee replacement surgery (TKA) is a frequent operation that has significantly improved the quality of life for millions of people with symptomatic knee OA. TKA postoperative care has been discussed regarding the utility of CPM; it has been shown to speed up the recovery of full range of motion, shorten hospital stays, lessen discomfort, speed up wound healing, and lower the risk of DVT. The current study was conducted to compare Effectiveness of CPM protocol as an adjunct to Standard Physiotherapy protocol in Post-operative Rehabilitation of TKA cases. From July to December 2021, three affiliated hospitals hosted the randomised controlled study, which included patients who had complete knee arthroplasty surgery. After surgery, patients were randomly allocated to one of two groups: From the first surgical day till discharge, Group A got twice daily PT and continuous passive motion (CPM), while Group B only received the usual physiotherapy programme from the first postoperative day. Evaluation of the results took place the day after discharge. The participants in the 2 groups' baseline outcome measurement characteristics were comparable.