Riesgo de mortalidad en infecciones invasivas por Mucor SPP. en niños con enfermedades hemato-oncológicas: revisión sistemática / Mortality risk of invasive Mucor spp. infections in children with cancer: A systematic review

Los estudios sobre la infección fúngica invasiva (IFI) por Mucor spp. en pacientes pediátricos con patología hematooncológica, son de baja solidez científica, lo que dificulta conocer en profundidad sus características y evolución. Con el objetivo de analizar la evolución fatal de esos pacientes, se llevó a cabo esta revisión sistemática (RS). Material y métodos: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de Pubmed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de Ebsco HOST), SCI-EXPANDED, SciELO (a través de la WOS) y Scopus (a través de Scopus-Elsevier), libre (mediante el motor Google) y revisando las citas de los artículos incluidos. Resultados: Se rescataron 1393 artículos, de los cuales se descartaron 1386 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 7 estudios. Todos los estudios eran series de casos (nivel 4). La mediana de la frecuencia de muerte observada fue de 36,6% (Q1 20% - Q347%). Conclusiones: Esta RS mostró en niños con patología hemato-oncológica, que la mortalidad por IFI por Mucor spp. alcanzó a casi un tercio de los pacientes (AU)

Studies on invasive fungal infection (IFI) by Mucor spp. in pediatric patients with cancer have a low level of evidence, which makes it difficult to elucidate its characteristics and progression. To analyze the fatal outcome of these patients, this systematic review (SR) was conducted. Material and methods: A literature search was carried out on March 23, 2023, in the following main databases (Medline (via Pubmed), Embase (via Embase-Elsevier), The Cochrane Library (via Wiley), Cinahl (via Ebsco HOST), SCI-EXPANDED, SciELO (via the WOS) and Scopus (via Scopus-Elsevier). Additionally, a complementary search was carried out using free search engines (such as Google) and by reviewing the references of the included articles. Results: A total of 1393 articles were retrieved, of which 1386 were excluded for various reasons. After a thorough analysis of the full-text articles, 7 studies were ultimately included in the review. All studies were case series (level 4). The median observed death rate was 36.6% (IQR, 20% - 47%). Conclusions: This SR showed that in children with hematological-oncological disease, mortality due to IFI by Mucor spp. affected almost one third of the patients (AU)

Análisis de series temporales respecto tasas de mortalidad general e intrahospitalaria en egresos hospitalarios, población pediátrica oncohematológico, Chile 1997-2016 / Analysis of time series related general and in-hospital mortality rates in hospital discharges, pediatric onco hematological population, Chile 1997-2016

INTRODUCTION: Before the start of the GES program in 2002, mortality was 128.2 deaths per million children under 15 years of age (RENCI). This public program managed to ensure the opportunity for diagnosis and treatment in children under 15 years of age and those less than 25 years of age who recur. Objective: To assess how GES has impacted on in-hospital mortality and lethality between1997and 2016. Methods: Retrospective case control study of 28,997 hospital discharges and 12,434 deaths analyzed using Prais-Weinstein time series between the years 1997 to 2016. They prepared contingency tables with data on: hospital discharges, age, sex and forecasts for 2001 and 2016. Fisher's p <0.05 test was used. Results: For the PreGes period an increase of 1.8% in the male crude mortality rate was observed, while for the Post Ges period an increase was observed with a breaking point at the end of 2008, with an increase of 11.04% compared to the PreGes period. An unexpected increase in the female mortality rate was observed. The odd's ratios associated with sex (higher mortality inmen than in women)0.816CI-0.679- 0.982; p <0.05; OR'S age 1,047 (0.981 per year) IC-1.044-1.051; p <0.0001 FORECAST (FONASA-1.942 IC 1.304-2.89 / ISAPRE = 2.186; IC = 1.267-3.773 p <0.005); Hospitalization days = 1.031 confirmed our research hypothesis 1.026-1.035 p <0.0001. Conclusion: This study found that there are statistically significant differences regarding hospital discharges between the public-private system, in relation to mortality andincreasein sustained crudemalemortality between the years1997 to 2016

INTRODUCCIÓN: Antes del inicio del programa GESen2002, la mortalidad era 128,2 muertes por millón de niños menores de 15 años (RENCI). Este programa público logró asegurar la oportunidad de diagnóstico y tratamiento en menores de15 años y aquellos menores de25añosque recidivan. Objetivo: Evaluar cómo el GES ha impactado en la mortalidad y letalidad intrahospitalaria entre1997a2016. Métodos: Estudio retrospectivo de control de casos en 28.997 egresos hospitalarios y 12.434 defunciones analizadas mediante series temporales de Prais-Weinstein entre los años 1997 a 2016. Se prepararon tablas de contingencia con datos sobre: egresos hospitalarios, edad, sexo y previsiones para2001y 2016.Se utilizóla prueba p <0.05de Fisher. Resultados: Se observó para el período PreGES un incremento de 1.8% en la tasa mortalidad cruda masculina, mientras que para el período Post GES se observó un incremento con punto de quiebre a fines del año 2008, con incremento del 11,04% respecto al período PreGES. Se observó incremento no sostenido en la tasa mortalidad femenina. Los odd's ratios asociados al sexo (mayor mortalidad en hombres que en mujeres) 0.816 IC-0.679-0.982; p <0,05; OR'S edad 1,047 (0.981 por año) IC-1.044-1.051; p<0.0001 PREVISIÓN (FONASA-1.942 IC 1.304-2.89 / ISAPRE =2.186; IC= 1,267-3,773 p<0.005); Días de Hospitalización=1,031 confirmó nuestra hipótesis de investigación 1,026-1,035 p<0.0001. Conclusión: Este estudio encontró que hay diferencias estadísticamente significativas respecto egresos hospitalarios entre el sistema público privado, en relación con la mortalidad e incremento en la mortalidad cruda masculina sostenida entre los años 1997 a 2016. acción en la función auditiva mediante audiometría tonal.

Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes / Infecção por bactérias gram-negativas multirresistentes em uma unidade de terapia intensiva pediátrica oncológica: fatores de risco e resultados

ABSTRACT OBJECTIVE: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). METHODS: Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. RESULTS: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. CONCLUSIONS: Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.

RESUMO OBJETIVO: Este estudo visou a avaliar os preditores e resultados associados às infecções por bactérias gram-negativas multirresistentes (BGN-MR) em uma unidade de terapia intensiva pediátrica oncológica (UTIP). MÉTODOS: Foram coletados dados com relação a todos os episódios de infecção por BGN que ocorreram em uma UTIP entre janeiro de 2009 e dezembro de 2012. As infecções por BGN foram divididas em dois grupos para comparação: 1) infecções atribuídas a BGN-MR e 2) infecções atribuídas a BGN não multirresistente. As variáveis de interesse incluíram idade, sexo, presença de tumor sólido ou malignidade hematológica, câncer, uso de cateter venoso central, infecção anterior por Pseudomonas aeruginosa, infecção hospitalar, neutropenia nos sete dias anteriores, duração da neutropenia, tempo de internação antes da UTI, duração da internação na UTI e uso de quaisquer dos seguintes nos 30 dias anteriores: agentes antimicrobianos, corticosteroides, quimioterapia ou radioterapia. Outras variáveis incluíram: tratamento antimicrobiano inicial adequado, tratamento antimicrobiano definitivo inadequado, duração do uso de antibióticos adequados, tempo de início da terapia antibiótica adequada, mortalidade em sete dias e mortalidade em 30 dias. RESULTADOS: As análises de regressão logística multivariada mostraram relações significativas entre as BGN-MR e as doenças hematológicas (razão de chance (RC) 5,262; intervalo de confiança de 95% (IC de 95%) 1,282-21,594; p = 0,021) e infecções hospitalares (RC 18,360; IC de 95% 1,778-189,560; p = 0,015). Houve diferenças significativas entre os pacientes com BGN-MR e BGN não MR com relação às seguintes variáveis: recebimento de terapia antibiótica empírica inicial inadequada, tempo para início do tratamento antibiótico adequado e recebimento de terapia antibiótica inadequada. CONCLUSÕES: A malignidade hematológica e a infecção hospitalar foram significativamente associadas à infecção por BGN-MR nessa amostra de pacientes pediátricos oncológicos.

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

Predictors of 7- and 30-day mortality in pediatric intensive care unit patients with cancer and hematologic malignancy infected with Gram-negative bacteria

Background: Infection with Gram-negative bacteria is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of 7- and 30-day mortality in pediatric patients in an intensive care unit with cancer and/or hematologic diseases and Gram-negative bacteria infection. Methods: Data were collected relating to all episodes of Gram-negative bacteria infection that occurred in a pediatric intensive care unit between January 2009 and December 2012, and these cases were divided into two groups: those who were deceased seven and 30 days after the date of a positive culture and those who survived the same time frames. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, infection by multidrug resistant-Gram-negative bacteria, colonization by multidrug resistant-Gram- negative bacteria, neutropenia in the preceding seven days, neutropenia duration ≥3 days, healthcare-associated infection, length of stay before intensive care unit admission, length of intensive care unit stay >3 days, appropriate empirical antimicrobial treatment, definitive inadequate antimicrobial treatment, time to initiate adequate antibiotic therapy, appropriate antibiotic duration ≤3 days, and shock. In addition, use of antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy in the previous 30 days was noted. Results: Multivariate logistic regression analysis resulted in significant relationship between shock and both 7-day mortality (odds ratio 12.397; 95% confidence interval 1.291–119.016 p = 0.029) and 30-day mortality (odds ratio 6.174; 95% confidence interval 1.760–21.664 p = 0.004), between antibiotic duration ≤3 days and 7-day mortality (odds ratio 21.328 95% confidence interval 2.834-160.536; p = 0.003), and between colonization by multidrug re...

Factors influencing the early mortality in haematological malignancy patients with nosocomial Gram negative bacilli bacteraemia: a retrospective analysis of 154 cases

BACKGROUND: The aim of this study is to assess the factors influencing the early mortality (7- day after index blood culture) in haematological malignancy patients with Gram negative bacilli (GNB) bacteraemia. METHODS: Infection control committee records were reviewed to identify the cases between March 2006 and June 2011. Only one bacteraemic episode per patient was included in the study. RESULTS: A total of 154 patients with GNB bacteraemia were identified. The early mortality rate was 19.5% (30 out of 154). Blood cultures revealed Enterobacteriacea in 120 patients (Escherichia coli; 86, Klebsiella spp.; 28, Enterobacter cloacea; 6) and glucose non-fermenting GNB in 34 patients (Pseudomonas aeruginosa; 15, Acinetobacter baumannii; 11, Stenotrophomonas maltophilia; 7, Burkholderia cepacia; 1). Forty (33.3%) out of 120 Enterobacteriaceae were extended spectrum beta-lactamase (ESBL) producers and 18 (52.9%) out of 34 glucose non-fermenting GNB were multidrug resistant. Carbapenems were administered as first line therapy in 139 out of 154 patients. In univariate analysis Pitt's bacteraemia score, presence of aplastic anaemia, bacteraemia caused by glucose non-fermentating GNB, inappropriate empirical antibacterial treatment, presence of severe sepsis or septic shock, unable to achieve microbiological cure, and intensive care unit (ICU) acquired bacteraemia were associated with mortality. Multivariate analysis showed ICU acquired bacteraemia (OR, 12.55; 95% CI, 2.34-67.38, p = 0.003) as an independent factor associated with early mortality. CONCLUSION: Haematological malignancy patients who require ICU care are at high risk for early mortality related to GNB bacteraemia. Based on the local findings pointing out high rate of multidrug resistance, carbapenems combined with colistin seems to be a reasonable approach as empirical treatment of these patients. However, increasing carbapenem resistance rate is of concern.

Análisis de la mortalidad en enfermedades Hemato-oncológicas malignas en pediatría en hospitales públicos de Argentina / Analysis of Mortality due to Hemato-Oncological Pediatrics Malignancies in Public Hospitals in Argentina

INTRODUCCIÓN: En Argentina, la mortalidad por enfermedades malignas en edad pediátrica ocupa un lugar relevante y sus causas todavía no han sido estudiadas en el país. OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en centros públicos seleccionados, desde enero de 2000 a diciembre de 2010. MÉTODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en centros registrados en el Registro Oncopediátrico Hospitalario Argentino (ROHA) y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de mortalidad, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de comorbilidad y las demoras en el diagnóstico y tratamiento. RESULTADOS: En 13 centros se analizó exitosamente un promedio >70...

INTRODUCTION: In Argentina, the mortality of pediatric malignant diseases occupies an important place causes have not yet been studied in the country. OBJECTIVE:To analyze mortality rates, causes and moment of death related to neoplasias in selected public centers from January 2000 until December 2010. METHODS: The analysis was conducted in clinical records of patients who died due to cancer. The cases were registered in the Argentine Hospital Oncopediatric Registry (ROHA)and by different registries belonging to hemato-oncological departments. Mortality causes were classified according to the phase of therapy when the event occurred and the relation shipof death with the treatment or underlying disease. Causes of comorbility and delays in diagnosis/treatment were also analyzed. RESULTS: In 13 centers, more than 70...

Use of inflammatory molecules to predict the occurrence of fever in onco-hematological patients with neutropenia

Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM) may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group) and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02). Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients.

Câncer da infância e da adolescência: tendência de mortalidade em menores de 20 anos no Brasil / Cancer of childhood and adolescence: mortality trends in children under 20 years in Brazil

O câncer pediátrico corresponde a 2 a 3 por cento de todos os tumores malignos e no mundo são diagnosticados mais de 160.000 casos por ano. O objetivo desse estudo foi analisar a tendência da mortalidade por câncer da infância no país e nas suas cinco regiõesgeográficas, no período de 1981 a 2008 e descrever a tendência de mortalidade por leucemias e linfomas no Brasil e nas capitais brasileiras que dispõem de Registros de Câncer de Base Populacional no período de 1996 a 2008. Foram utilizados dados deóbitos por câncer de menores de 20 anos obtidos do Sistema de Informações sobre Mortalidade/DATASUS. No primeiro artigo foram considerados como óbitos por câncer aqueles cuja causa básica foi codificada como C149-C239 da CID 9, no período 1981-95; e como C00-D48 da CID 10, no período 1996-2008. O período de estudo de1981 a 2006 foi estratificado em sete quadriênios e foram calculadas taxas demortalidade para as neoplasias para o Brasil e as regiões brasileiras, ajustadas pela população mundial. No segundo artigo foram considerados óbitos por leucemias aqueles codificados como C91 a C95 e óbitos por linfomas os codificados como C81 a C85 eC96 de acordo com o CID-10, de indivíduos de ambos os sexos, residentes nas capitais brasileiras, no período de 1996 a 2008. O período de 1996 a 2008 foi estratificado emtriênios e foram calculadas taxas de mortalidade para o Brasil e as capitais, ajustadas pela população mundial. Modelos de regressão polinomial foram utilizados para a análise considerando o nível de significância de 5 por cento.Para o Brasil foi observada tendência de declínio não constante das taxas demortalidade. Para as faixas etárias menor 1 ano e 1 a 4 anos foi observada tendência decrescente e constante da mortalidade por câncer durante todo o período.

Maiores magnitudes das taxas foram observadas para o sexo masculino. As regiões brasileiras que apresentaram taxas de mortalidade mais elevadas foram as regiões Sul e Sudeste.Observou-se aumento da magnitude das taxas padronizadas de mortalidade nas regiões Nordeste e Norte. Na região Centro-oeste observou-se declínio significativo das taxas de mortalidade por câncer. Para linfomas, foi observada tendência de declínio não constante das taxas de mortalidade e não foi observada tendência significativa para amortalidade por leucemias no Brasil. Houve ainda variação da tendência por neoplasias hematológicas segundo capitais brasileiras. As leucemias apresentaram maiores magnitudes de mortalidade para todo o período e para todas as faixas etárias estudadas.Para o grupo dos linfomas houve redução das taxas de mortalidade em todos os grupos etários, exceto o de 10 a 14 anos, sendo observado aumento da mortalidade no último período do estudo. As tendências de declínio observadas no Brasil podem estarrefletindo melhora na sobrevida, particularmente nos anos mais recentes. A variação das taxas de mortalidade por neoplasias hematológicas entre as capitais brasileiras sugere diferenças no acesso ao diagnóstico e tratamento dessas doenças.

Much Concern but Little Research on Semiconductor Occupational Health Issues

No abstract available.

Mortalidad por cáncer infantil en Colombia durante 1985 a 2008 / Child mortality from cancer in Colombia, 1985-2008

OBJETIVO: Determinar la magnitud de la mortalidad por cáncer infantil en Colombia y evaluar las tendencias en su evolución entre 1985 y 2008. MÉTODOS: Se analizó durante dicho período la mortalidad en la población colombiana de 0 a 14 años provocada por cáncer en todas las localizaciones -leucemias, tumores malignos del sistema nervioso central (SNC), linfomas no Hodgkin, linfomas Hodgkin, tumores óseos y tumores renales. Se calculó el cambio promedio en las variaciones de las tendencias de mortalidad por cáncer en dicho grupo etario. RESULTADOS: Las muertes por cáncer constituyeron el 3,5 por ciento de la mortalidad en menores de 15 años. Entre los períodos 1985-1989 y 2005-2008 las tasas de mortalidad por cáncer mostraron un descenso en ambos sexos, pasando de 54,4 muertes por millón a 44,8 muertes por millón en niños y de 40,9 muertes por millón a 37,9 muertes por millón en niñas. La mortalidad por leucemias y linfomas registró un descenso estadísticamente significativo, mientras que la mortalidad por cánceres del SNC, contrariamente, aumentó también de manera significativa. CONCLUSIONES: Pese a leves tendencias a la baja en la mortalidad por leucemias y linfomas no Hodgkin, las tasas de mortalidad por cáncer infantil en Colombia permanecen altas y requieren esfuerzos importantes en los tratamientos para obtener mayores logros.

OBJECTIVE: Determine the magnitude of child mortality from cancer in Colombia and evaluate the trends in its evolution from 1985 to 2008. METHODS: Mortality in the Colombian population aged 0-14 years from cancer in any site (e.g., leukemia, malignant tumors of the central nervous system (CNS), nonHodgkin's lymphoma, Hodgkin's lymphoma, bone tumors, kidney tumors) during this period was analyzed. The mean change in the variations of cancer mortality trends in this age group was calculated. RESULTS: Deaths from cancer accounted for 3.5 percent of mortality in children under 15 years of age. During the periods 1985-1989 and 2005-2008 there was a decrease in mortality from cancer in both sexes, with figures dropping from 54.4 deaths per million to 44.8 deaths per million in boys and from 40.9 deaths per million to 37.9 deaths per million in girls. There was a statistically significant decrease in leukemia- and lymphoma-related mortality, whereas mortality associated with cancers of the CNS increased significantly. CONCLUSIONS: In spite of slight downward trends in mortality from leukemia and non-Hodgkin's lymphoma, childhood cancer mortality rates in Colombia remain high. Significant work on treatments for childhood cancer is required to obtain greater success.

Estratificación de riesgo de morbimortalidad en pacientes neutropénicos febriles hematooncológicos utilizando dos escalas de predicción / Risk stratification of mortality in patients febrile neutropenic hemato using two scales prediction

Determinar el pronóstico de mortalidad en los pacientes hematooncológicos con neutropenia febril a través del score de MASCC y el de PARK. Se realizó un estudio descriptivo, prospectivo constituido por 34 pacientes hematooncológicos, neutropénicos febriles hospitalizados del Hospital Universitario de Caracas, a quienes se aplicaron ambos score. No se halló correlación estadística. Sin embargo, se observó que en el grupo de bajo riesgo según el score de MASCC estuvieron todos los pacientes que fallecieron, mientras que según el score de PARK fallecieron principalmente los pacientes con valor de PCR mayor o igual a 20. El score de MASCC pareciera no ser una herramienta útil para evaluar pronóstico en estos pacientes, siendo probablemente más útil el score de PARK en especial el valor de PCR en el ingreso...

To determine the mortality prognosis in hematooncologic neutropenic febrile patients using MASCC and Park scores. Both scores were applied to 34 hospitalized patients of the Hospital Universitario de Caracas, Venezuela, in a descriptive, prospective study. No statistic correlation was found. However we found that that the patients who died were clasiffied as low risk by the Score of MASCC and had PCR values of 20 or more Parks score. MASCC ìs score seems not to be a useful tool to evaluate the prognosis of these patients versus the Park ìs, score wich was more useful especially taking in account the PCR value on the first day of admission...

Outcome of patients with hematological malignancies admitted to the intensive care unit with life-threatening complications

To assess the outcome of patients with hematological malignancies [HM] admitted to medical intensive care unit [MICU] and to identify prognostic factors that may affect patients' outcome. Data were collected in 44 patients with HM admitted to the MICU at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia within a 9-year period from 1993 to 2004. Demographic, physiological, clinical, laboratory and therapeutic data were collected on admission to MICU. Thirty-four% of the patients had acute lymphocytic leukemia; 25% had acute myelocytic leukemia [AML] followed by non-Hodgkin's lymphoma in 20%, only 13.6% of these patients were in remission. The reasons for admission of these patients into MICU were shock [34.15%], respiratory failure [31.8%], cardiac arrest [20.4%], neurological causes [9.1%] and for other causes like small bowel perforation, hepatic failure, acute renal failure and metabolic disorders [4.5%]. The overall in-hospital mortality was 72.7%, intensive care unit [ICU] mortality 61%, and the mean length of stay in the MICU was 5.4 +/- 4.8 days. A statistically significant association was demonstrated between both remission status and aspartate aminotransferase values on one side and patient's outcome on the other side. Patients with AML had poorer prognosis with mortality rate of 90.9%. Although mortality in patients with HM requiring ICU care is high, our results indicate that critical care support may be lifesaving. Apart from remission status and AML disease, no other prognostic factor could be identified

Peripheral blood cells transplantation--a review article.

In the twelve years since the first PBSCT were reported, impressive advancements in BCT techniques have made it easy to perform, effective, less costly, rapid haematologically recoverable, reduced morbidity and mortality, shorten overall duration of cancer treatment and hospital stay. Development of high-dose chemotherapy and new novel effective antitumor drugs otherwise limited by haematological toxicities may now become possible. Treatment of haematological malignancies with purged autologous PBPCT, e.g. Ph Chromosome negative progenitor cells in CML or with immunologically manipulated allogeneic PC having preserved GVL but not GVHD action, with hopeful prospects, is now becoming possible. Tailoring of BC for ex-vivo selection and expansion of specially active T Iymphocytes, NK cells and other immune effector cells will enable adoptive immunotherapeutic approach and treatment of Minimal residual disease [MRD] after high-dose chemotherapy both in grafts and in patients. The discovery of a nonhaematopoietic, engraftment facilitator cell form donor BM may usher in further precision in GVHD prevention by purification and in adoptive immunotherapeutic approach. Therefore, it is likely that BCT will supersede BMT, though the follow-up is too short to draw conclusions.