Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes.

Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital-an acute care tertiary center-between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care.

The Relation between Atrial Fibrillation Cardioversion Success Rate with Vitamin D Level in Patients Underwent Elective Cardioversion in King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guards, Riyadh Saudi Arabia.

Objectives: To investigate the relation between serum Vitamin D (Vit-D) levels and the success rate of cardioversion for atrial fibrillation (AF). To examine the association between Vit-D level and successful cardioversion. This study also describes the general characteristics of patients with successful cardioversion. Materials and Methods: In this retrospective study, patients with AF who were treated using electrical cardioversion at King Abdulaziz Cardiovascular Center (KACC) between 2010 and 2021 were included. The information on demographic and clinical characteristics as well as outcome variables was collected. Results: Of 100 patients who were admitted to KACC during the study period, 63% were females and 9% were diagnosed with Vit-D deficiency. Furthermore, 66% of patients had successful cardioversion. Moreover, no significant difference in Vit-D deficiency was observed between patients who had successful cardioversion and those with unsuccessful outcomes (P = 0.485). Conclusions: There is no association between serum Vit-D levels and the success rate of cardioversion in patients with AF. However, further studies are needed for more conclusive evidence.

Over-Expression of LEDGF/p75 in HEp-2 Cells Enhances Autoimmune IgG Response in Patients with Benign Prostatic Hyperplasia-A Novel Diagnostic Approach with Therapeutic Consequence?

Lens epithelium-derived growth factor splice variant of 75 kDa (LEDGF/p75) is an autoantigen over-expressed in solid tumors and acts as a stress-related transcriptional co-activator. Participation of autoimmune responses in the pathophysiology of benign prostatic hyperplasia (PBH) and a corresponding immunosuppressive therapy by TNFalpha antagonists has been recently suggested. Thus, autoAb testing could aid in the diagnosis of BPH patients profiting from such therapy. We generated CRISPR/Cas9 modified HEp-2 LEDGF knock-out (KO) and HEp-2 LEDGF/p75 over-expressing (OE) cells and examined IgG autoantibody reactivity to LEDGF/p75 in patients with prostate cancer (PCa, n = 89), bladder cancer (BCa, n = 116), benign prostatic hyperplasia (BPH, n = 103), and blood donors (BD, n = 60) by indirect immunofluorescence assay (IFA). Surprisingly, we could not detect elevated binding of autoAbs against LEDGF/p75 in cancer patients, but autoAb reactivity to LEDGF/p75 OE cells in about 50% of patients with BPH was unexpectedly significantly increased. Furthermore, a line immunoassay enabling the detection of 18 different autoAbs revealed a significantly increased occurrence of anti-dsDNA autoAbs in 34% of BPH patients in contrast to tumor patients and BD. This finding was confirmed by anti-mitochondrial (mDNA) autoAb detection with the Crithidia luciliae immunofluorescence test, which also showed a significantly higher prevalence (34%) of anti-mDNA autoAbs in BPH. In summary, our study provided further evidence for the occurrence of autoimmune responses in BPH. Furthermore, LEDGF/p75 over-expression renders HEp-2 cells more autoantigenic and an ideal target for autoAb analysis in BPH with a potential therapy consequence.

PR3-ANCAs Detected by Third-Generation ELISA Predicts Severe Disease and Poor Survival in Primary Sclerosing Cholangitis.

A highly sensitive detection of anti-neutrophil cytoplasmic antibodies to serine proteinase-3 (PR3-ANCAs) aids in the serological diagnosis of autoimmune liver disorders and the prediction of severity in primary sclerosing cholangitis (PSC). Here, we evaluate a novel third-generation ELISA for the detection of PR3-ANCAs. In total, 309 patients with PSC, 51 with primary biliary cholangitis (PBC), and 120 healthy blood donors (BD) were analyzed. For the survival analysis in PSC, the outcome was defined as liver-transplantation-free survival during the follow-up. Positive PR3-ANCA levels were found in 74/309 (24.0%) of patients with PSC. No BDs and one patient with PBC demonstrated PR3-ANCA positivity. PR3-ANCAs were revealed as independent predictors for a poor PSC outcome (study endpoint: liver transplantation/death, log-rank test, p = 0.02). PR3-ANCA positivity, lower albumin levels, and higher bilirubin concentrations were independent risks of a poor survival (Cox proportional-hazards regression analysis, p < 0.05). The Mayo risk score for PSC was associated with PR3-ANCA positivity (p = 0.01) and the disease severity assessed with a model of end-stage liver disease (MELD) and extended MELD-Na (p < 0.05). PR3-ANCAs detected by a third-generation ELISA are diagnostic and prognostic markers for PSC. Their wider use could help to identify patients who are at-risk of a more severe disease.

Possibility of using low-field nuclear magnetic resonance (LF-NMR) and differential scanning calorimetry (DSC) to monitor frying oil degradation.

In this work, chemical degradation of oil was determined as a function of frying time during intermittent deep-fat frying (i.e. 185 °C for 5 h per day for 12 days) and was correlated with the thermal characteristics as measured by Differential Scanning Calorimetry (DSC) and proton mobility by Low-Field Nuclear Magnetic Resonance (LF-NMR). Linear increases of FFAs and PV were observed as a function of frying time. FFAs and PV were strongly correlated with the melting enthalpy. The melting enthalpy of oil decreased exponentially, and the melting temperature remained nearly same until 30 h of frying time followed by a sharp increase. The relaxation times of rigid, semi-rigid and mobile protons (i.e. T 2b , T 21 , and T 22 ) decreased with the increase of frying time. The decrease of T 21 , and T 22 were steeper as compared to the T2b. A strong correlation was observed between conventional chemical parameters (i.e. PV and FFAs), and T 21 and T 22. The populations of the three pools of protons as identified by Inverse Laplace Transformation and Gaussian distribution function showed the interchange of the protons with the chemical changes during frying. It is concluded that chemical free DSC and LF-NMR could be potential methods to monitor frying oil degradation.

Effects of crystallization temperature on the characteristics of sugar crystals in date fruit syrup as measured by differential scanning calorimetry (DSC), polarized microscopy (PLM), and X-ray diffraction (XRD).

Characteristics of sugar crystals are important for developing set-syrup due to their contribution to the desired mouth feel when consumed. Two types of set-syrup (i.e. seeds with and without) were developed by storing the syrup at -20, 4 and 15 °C. The melting temperatures (onset and peak), and enthalpy of set-syrup without seeds (SN) were 30.2 °C, 74.6 °C and 42.2 kJ/kg respectively. In the case of SN, enthalpy decreased with the decrease of crystallization temperature (P < 0.05), while there was insignificant change in the case of set-syrup with seeds (SW) (P > 0.05). Polarized Light Microscopy (PLM) images showed that finer crystals were formed in the cases of set-syrups (i.e. SN and SW) as the storage temperature was decreased. X-ray diffraction (XRD) analysis showed the formation of different polymorphic sugar crystals. Crystallization temperatures at 4 and -20 °C can be used to produce finer crystals with varied polymorphic characteristics.

Clinicopathological features of pulmonary mucinous adenocarcinoma: A descriptive analysis.

BACKGROUND: Mucinous adenocarcinoma is a rare subtype of lung cancer characterized by abnormal mucin production. We sought to investigate the clinical and pathological features of pulmonary mucinous adenocarcinomas and to identify prognostic factors. METHODS: This was a single-institution retrospective review of patients with pulmonary mucinous adenocarcinoma diagnosed between January 1, 2015 and December 31, 2020. Descriptive analysis included demographics, diagnostic data, and treatment modalities. The primary outcome was overall survival (OS). RESULTS: Fifty-six patients were included in the study. Median age was 65 years (range: 26-84), 30 (54%) were female, 48 (86%) had a smoking history, and 41 (73%) patients had ECOG performance status 0-1. Nearly half (26, 46%) were stage IV at presentation, while 11 (20%) presented as stage I, 10 (18%) stage II, and 9 (16%) stage III. Biomarker testing increased through the study period. Where performed, 4/48 (8%) cases were ALK positive, but there were no EGFR cases identified (0/36). Only 3/20 cases had PD-L1 expression >50%. Curative intent therapy was performed in 23 patients (17 had surgery +/- chemotherapy/radiation, 4 had radiotherapy alone, 2 had chemoradiation). Median OS in the entire population was 16.1 months (m). OS by stage was 50.0m for stage I, not reached for stage II, 20.7m for stage III, and 8.1m for stage IV. CONCLUSIONS: The overall prognosis of pulmonary mucinous adenocarcinoma appears similar to that of non-mucinous adenocarcinomas, with distinct differences noted in the incidence of oncogenic driver mutations, particularly an absence of EGFR mutations.

Impact of taxation policy on tobacco consumption in Saudi Arabia.

BACKGROUND: Taxes on tobacco products that increase the price and target demand-reduction have been shown to be an efficient means of reducing tobacco consumption. A new policy introduced in 2017 has increased the price of a 20-cigarette pack of the most popular brand to 27.50 SAR (7.33 USD) with the tax portion being 68.09%, which is within the yardstick recommended by the World Bank. OBJECTIVE: Assess impact of taxes on cigarette consumption. DESIGN: Retrospective econometric analysis. MAIN OUTCOMES MEASURES: The annual importation of cigarettes containing tobacco (commodity code 24022000) in metric tons (as a proxy measure of consumption). METHODS: An econometric analysis of cigarette prices and consumption was performed using the methods of the World Bank Economics of Tobacco Toolkit. The impact was assessed statistically through price elasticity of cigarette demand. The study used yearly data for the period 2013-2019 to compare the price elasticity of demand according to the change in price. Cigarette consumption was equated to cigarette imports (dependent variable), and correlation with the cigarette price, income, education, and unemployment was assessed as independent variables of interest. RESULTS: Annual importation of cigarettes declined by 27.41% for the period 2013-2019 after the imposition of ad valorem and value-added taxes in 2017 and 2018, respectively. The price of a pack of cigarettes increased by 115.1% from 2016 to 2018. The per capita consumption was inversely correlated with price *P=.0003285, r=-0.969). The inverse correlation between income and per capita consumption was also statistically significant (P=.025, r=-0.816). Education did not correlate with per capita consumption (P=.740, r=-0.155), but unemployment was inversely correlated (P=.008, r=-0.884). From 2016 to 2018, the price elasticity of demand became negative with respect to income as recommended by the World Health Organization. The price elasticity of demand reached -0.07, -0.8, -0.93 in 2016, 2017, 2018, respectively. CONCLUSION: The modification of tax policy in 2017 has resulted in a decrease in both cigarette affordability and consumption. An additional 42.67% increase in the price, or pack price of 35.81 SAR (9.54 USD) might offset the increase in individual income noted in 2019 and maintain the decreased affordability. LIMITATIONS: The lack of more granular data on cigarette sales and more reliable data on prevalence. CONFLICT OF INTEREST: None.

Recent Advancements in the Nanomaterial Application in Concrete and Its Ecological Impact.

At present, nanotechnology is a significant research area in different countries, owing to its immense ability along with its economic impact. Nanotechnology is the scientific study, development, manufacturing, and processing of structures and materials on a nanoscale level. It has tremendous application in different industries such as construction. This study discusses the various progressive uses of nanomaterials in concrete, as well as their related health risks and environmental impacts. Nanomaterials such as nanosilica, nano-TiO2, carbon nanotubes (CNTs), ferric oxides, polycarboxylates, and nanocellulose have the capability to increase the durability of buildings by improving their mechanical and thermal properties. This could cause an indirect reduction in energy usage and total expenses in the concrete industry. However, due to the uncertainties and irregularities in size, shape, and chemical compositions, some nanosized materials might have harmful effects on the environment and human health. Acknowledgement of the possible beneficial impacts and inadvertent dangers of these nanosized materials to the environment will be extremely important when pursuing progress in the upcoming years. This research paper is expected to bring proper attention to the probable effects of construction waste, together with the importance of proper regulations, on the final disposal of the construction waste.

Assess and evaluate knowledge, attitude and practice of first aid management of epistaxis among general population in Aseer region.

INTRODUCTION: Epistaxis or nose bleeds is one the most common reported emergencies in the ear, nose and department. Causes of epistaxis varies from being trivial such as nose picking or dry air or trauma to concerning such as infections or elevated blood pressure to life threatening condition such as malignancies. METHODS: The purposely constructed questionnaire was used for this research. The questionnaire was constructed by the panel of experts, language, psychological, doctors and subject specialist was there in the team. Internal consistencies of the questionnaire was measure through cronbach alpha. RESULTS: Cronbach alpha = 0.84. Mean ± S.D of age of the respondents were 27.8 ± 9.8. 71.6% were females, 91.5% were belongs to Aseer region, 86.6% were living in village, 77.0% have intermediate level of education, 59.2% were single, 41.6% having health care profession. 51.1% having income less than 5000SAR. CONCLUSION: Most of them rely on internet and social media to gain knowledge regarding home management of epistaxis. This has limitations as they do not get a hands-on experience. Therefore, we recommend that first aid camps and workshops in management of epistaxis should be organized in order to properly educate the general population regarding its home management.

Three Decades of Malignant Pleural Mesothelioma: An Academic Center Experience.

BACKGROUND: Malignant pleural mesothelioma (MPM) remains a challenging disease to manage. In the past few decades, extrapleural pneumonectomy (EPP), pemetrexed-based chemotherapy, and indwelling pleural catheters were introduced to MPM care with variable levels of efficacy and evidence. PATIENTS AND METHODS: This was a retrospective review of patients diagnosed with MPM between January 1991 and March 2019. The primary outcome was overall survival (OS). Data were examined by decade to assess trends in MPM demographics, management, and OS. A subgroup analysis was then conducted to examine the impact of EPP, pemetrexed, and indwelling pleural catheters on OS. RESULTS: The study included 337 patients; 309 patients had died at last follow-up (91.7%). Median age at diagnosis and the proportion of female patients increased from 65.8 years (interquartile range [IQR], 57.1-73.7) and 11.6% female from 1991 to 1999 to 75 years (IQR, 68.1-80.6) and 20.5% female from 2010 to 2019. Median OS was largely unchanged in the three study periods: 9.0 months (95% confidence interval [CI], 6.9-12.7) in the 1991-1999 cohort, 9.3 months (95% CI, 7.6-13.2) in the 2000-2009 cohort, and 10.1 months (95% CI, 7.9-13.6) in the 2010-2019 cohort. Controlling for a number of demographic and prognostic factors, EPP (hazard ratio [HR] = 0.50; 95% CI, 0.3-0.9; P = .02), pemetrexed-based chemotherapy (HR = 0.59; 95% CI, 0.40-0.87; P = .007), and indwelling pleural catheters (HR = 0.3; 95% CI, 0.13-0.71; P = .006) were each associated with improvements in OS. CONCLUSION: Despite the small incremental improvements in survival shown by the three interventions we examined, prognosis remains guarded for MPM patients. Better modalities of management are needed.

Burnout and depression among psychiatry residents during COVID-19 pandemic.

Very few studies have been concerned with assessing the prevalence of burnout and depressive symptoms, especially during an infectious outbreak on non-frontline health care workers, such as a psychiatrist. In such instances, the role of psychiatrists and other mental health providers as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depressive symptoms, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient's Health Questionnaire for the assessment of burnout and depressive symptoms. Burnout symptoms were found in 27.3%, and another 27.3% reported having depression symptoms. In addition, 16.5% reported having both burnout and depressive symptoms, with a significant relationship between them. Participants in the first 2 years of training and having a history of receiving mental health treatment in the past 2 years were at higher risk. The need is urgent to increase investment in mental health services and to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.

Chemotherapy for Non-Small Cell Lung Cancer in the Intensive Care Unit.

BACKGROUND: patients with non-small-cell lung cancer (NSCLC) admitted to the intensive care unit have poor prognosis. There is limited data on cytotoxic chemotherapy in this setting. The standard of care for these patients is usually best supportive care. CASE: 60-year-old previously healthy female was admitted to the ICU with newly diagnosed mucinous adenocarcinoma of the lung. She received cisplatin and pemetrexed while intubated and mechanically ventilated. She was extubated a week later and discharged home after achieving an excellent radiographic and clinical response. DISCUSSION: in select patients with NSCLC admitted to the ICU due to complications from their malignancy, a trial of cytotoxic chemotherapy may be reasonable. To our knowledge, this is the first case of mucinous NSCLC treated in the ICU.

Prevalence of Pre Diabetes and Type 2 Diabetes Mellitus among cement industry workers.

OBJECTIVES: Occupational and environmental pollution have become an imperative jeopardy for developing devastating metabolic diseases. Limited animal model studies have examined the impact of exposure to cement dust on metabolic conditions. This study aimed to assess the prevalence of pre-diabetes and Type-2 diabetic mellitus (T2DM) among non-smoking cement mill workers. METHODS: This epidemiological cross sectional study was conducted in the "Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia" during the period Oct 2016 to June 2017. Initially 310 cement mill workers were interviewed; after the interview and clinical history taking, 186 non-smoking cement mill employees were finally recruited. The cement mill employees were exposed to cement dust-related pollution in a cement industry for eight hours a day for six days a week. The mean age was 36.56 ± 0.78 years, mean BMI was 25.70 ± 0.29 m/kg2, and mean period of employment in the cement industry was 82.77 ± 6.95 months. HbA1c was measured using the Dimension Xpand Plus Integrated Chemistry System (USA). RESULTS: The cement mill employees were divided into three groups: non-diabetics group, with glycated hemoglobin (HbA1c) <5.7%; pre-diabetics group, with HbA1c 5.7-6.4%; and diabetics group, with HbA1c >6.4%. Among the cement mill personnel, 79 (42.47%) were non-diabetics, 28 (15.05%) were pre-diabetics, and 79 (42.47%) were diabetics. The prevalence of pre-diabetes and T2DM among cement mill employees was considerably associated with the period of employment in the cement industry (p=0.032). CONCLUSIONS: Exposure to cement dust was associated with an increased prevalence of pre- diabetes and T2DM among cement industry employees.

Paraneoplastic manifestations of salivary gland tumours: A case report and review.

Salivary gland cancers are an uncommon and heterogenous group of malignancies, accounting for approximately 3% of head and neck tumors. We describe a case of a patient who presented with paraneoplastic Cushing's syndrome secondary to metastatic salivary ductal carcinoma (SDC). Paraneoplastic ACTH secretion initially responded to chemotherapy with complete resolution of clinical symptoms. To our knowledge, this is the first described case of an ACTH-secreting SDC. We also review other paraneoplastic syndromes (PNS) that have been reported in association with salivary gland cancers.

Hybrid flower pollination algorithm strategies for t-way test suite generation.

The application of meta-heuristic algorithms for t-way testing has recently become prevalent. Consequently, many useful meta-heuristic algorithms have been developed on the basis of the implementation of t-way strategies (where t indicates the interaction strength). Mixed results have been reported in the literature to highlight the fact that no single strategy appears to be superior compared with other configurations. The hybridization of two or more algorithms can enhance the overall search capabilities, that is, by compensating the limitation of one algorithm with the strength of others. Thus, hybrid variants of the flower pollination algorithm (FPA) are proposed in the current work. Four hybrid variants of FPA are considered by combining FPA with other algorithmic components. The experimental results demonstrate that FPA hybrids overcome the problems of slow convergence in the original FPA and offers statistically superior performance compared with existing t-way strategies in terms of test suite size.

Ultrasound-guided continuous spinal anesthesia for cesarean section in a parturient with scoliosis corrected with Harrington's rod surgery.

With rapid improvement in healthcare in Saudi Arabia, increasing number of women with surgically corrected kyphoscoliosis are likely to present for cesarean section (CS) or vaginal delivery requiring anesthesia or analgesia. Despite the surgical correction, these patients have poor cardiopulmonary reserves which increase the risks associated with general anesthesia. Whereas altered vertebral anatomy from previous surgery and the presence of metal work in spine make performing of regional anesthesia (RA) difficult and unpredictable, we report anesthetic management of such a patient who underwent CS using continuous spinal anesthesia technique. Challenges of placement of a spinal catheter in such a patient are discussed, and use of ultrasonography to circumnavigate these challenges is described. We propose that ultrasound can prove extremely valuable in performing of RA in patients with surgically corrected kyphoscoliosis. We could not find a similar case report from Saudi Arabia in the published literature.

Prevalence of Irritable Bowel Syndrome and its Association with Anxiety among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh.

OBJECTIVE: To quantify the prevalence of Irritable Bowel Syndrome (IBS) among medical students of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and to observe the association between anxiety and IBS. METHODS: This cross-sectional observational study conducted during academic year 2015-2016 has used two self-administered, pre-validated questionnaires: Depression Anxiety Stress Scales-21 (DASS-21) and Rome III criteria. The sample size was 270, and proportional allocation was used to determine distribution of this sample across study population based on percentages of students in each academic year. Convenience sampling was used to select participants. RESULTS: The overall prevalence of IBS was 21% (n=57), with a higher prevalence among females (26%, n=23) than males (19%, n=34). IBS was most and least prevalent among first-year students (14%, n=5) and fifth-year students (29%, n=21) respectively. Anxiety levels were normal, mild, moderate, and severe or extremely severe in 39% (n=105), 7% (n=19), 26% (n=70), and 27%. A significant association was found between gender & IBS and anxiety levels & IBS. CONCLUSION: The prevalence of IBS in this study was 21% and higher among females than males but were highest among fifth-year students for both genders. More than 50% of students had moderate or high levels of anxiety for both genders. The prevalence of IBS was highest among students of 5th fifth year. The study provides evidence that, as medical students of higher year of their under graduation were having higher level of anxiety which leads to IBS.

Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy.

PURPOSE: Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. METHODS: All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004-2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study. RESULTS: A total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (≥5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=-0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases. CONCLUSION: Multidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care.