A 6 year old girl with Acute Lymphoblastic Leukaemia presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents discuss that they would like her to have a Portacath device inserted so that she can go swimming and is more comfortable around her friends. They are worried that she will be more susceptible to infection as the device is just below the skin and would like to avoid further hospital admissions. They ask if the portacath will increase her risk of infection during her remainder of her treatment? more…

It’s my own question, this time, and throws up lots of annoying little things.

The problem is straightforward: I’m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections.

Now, being both an EBMer and a Physician, I said I didn’t know, but didn’t think it could do, but might cause problems. (Remember we’re not supposed to give honey to infants ’cause of botulinism? Same concerns.)

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Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy?
A 15 year old girl with acute renal failure was found to have class IV systemic lupus erythematosus (SLE) nephritis on renal biopsy. A decision was taken to start her on the routine National Institute Health protocol of pulsed methyl-prednisolone and monthly intravenous cyclophosphamide (CYC) (0.5–1.0 g/m² of body surface area). With her post pubertal status and the possibility of CYC induced gonadal toxicity, the question was raised as to whether she should be put on gonadotropin releasing hormone analogue ( GnRH-a ) therapy for ovarian protection.

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A four-year old girl presents to the accident and emergency department with a history of being generally unwell for the preceding week and on examination is found to have cervical lymphadenopathy. In addition to a volley of tests, a Lactate Dehydrogenase (LDH) was requested by a registrar who had read that this was a predictor of malignancy which came back as 1,750. Should this be seen as suggestive of underlying malignancy? more…