ABSTRACT
Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population
Subject(s)
Humans , Male , Child, Preschool , Adolescent , Female , Mycoses , Neoplasms , Fungemia , Fever , Mycoses , Neutropenia , Antineoplastic Agents/adverse effectsABSTRACT
Introducción: El tratamiento del rabdomiosarcoma (RMS) es multidiciplinario. La radioterapia tiene un rol fundamental. los estudios internacionales como el de International Rhabdomysarcoma Study Group (IRSG) demostraron que la radioterapia moderna, conformacional, tiene un impacto en términos de control local y de sabrevida global de los pacientes. Los resultados publicados en el ámbito nacional son claramente inferiores a los internacionles. Creemos que la técnica de radioterapia empleada puede ser en parte responsable de estos resultados. Objetivo: mostrar las distintas modalidades de radioterapia disponibles actualmente en nuestro pais para este tipo de patología y destacar la importacia de utilizar técnicas modernas. Material y método: análisis retrospectivo de un caso representativo para cada una de las modalidades de radioterapia moderna, branquiterapia y radioterapia conformacional. Conclusiones: actualmente es factible utilizar radioterapia utilizando los mismos criterios de calidad que el IRSG en todos los pacientes portadores de rebdomiosarcoma en Chile. Esto debiera repercutir en el control local y sobrevida, permitiéndolos alcanzar valores más cercanos a los descritos en la literatura
Subject(s)
Humans , Male , Female , Child , Rhabdomyosarcoma , Tongue Neoplasms , Brachytherapy , Disease-Free Survival , Retrospective Studies , Rhabdomyosarcoma , Tongue NeoplasmsABSTRACT
Background: The Objective Structured Clinical Examination (OSCE) has become a respected and widely used tool for the assessment of clinical competence in medical education. Aim: To describe the first experience of an OSCE as a summative assessment in undergraduate Pediatric Internship, in two universities. Material and Methods: The OSCE was structured by a committee of faculty members of the 5 campi of University of Chile and I campus of the Catholic University. A 21 station OSCE was administered simultaneously to 124 Pediatric Interns (University of Chile =104, Catholic University=20), in 3 centers. A total of 50 faculty members participated in the examination. The OSCE consisted of 20 clinical problems, including videotape recordings, photographs, x-rays and laboratory exams, phantoms and 7 simulated standardized parents. Results: The average total OSCE score was 67.3 percent (range: 84.5 percent-43.5 percent). The maximum theoretic score was achieved in 19 stations. A significant correlation between station and total score, was found for 18 of the 20 clinical problems. Conclusions: The experience of using OSCE has been a success. The OSCE was an adequate procedure to assess a large number of interns simultaneously and it allowed us to measure the main objectives in all domains and a wide range of clinical competence of Pediatric Internship Programs
Subject(s)
Humans , Pediatrics , Education, Medical, Undergraduate/methods , Educational Measurement , Internship and Residency , Schools, MedicalABSTRACT
Background: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. Aim: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. Material and methods: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. Results: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43 percent), Staphylococcus aureus (16 percent), Escherichia coli (9 percent), Klebsiella spp. (8 percent), Pseudomonas spp. (5 percent) and Candida spp. (4 percent). Coagulase negative Staphylococcus was 55 percent resistant to meticilin and S. aureus was 44 percent resistant. Enterobacteriae had 15 percent resistance to gentamicin and amikacin, 2 percent to imipenem, 26 percent to ceftriaxone, 21 percent to cefotaxim and 20 percent to ceftazidim. Among non fermenting agents resistance was 6 percent for imipenem, 9 percent for amikacin 10 percent for ciprofloxacin, 19 percent for ceftazidim and 22 percent for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50 percent and that of Enterococcus spp. was of 33 percent. Conclusions: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised