Clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenic patients with hematologic malignancies

Objective@#To evaluate the clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenic (FN) patients with hematologic malignancies (HM)@*Methodology@#This was a cross-sectional study which looked into medical records of Filipino children 0-18years old diagnosed with FN and HM and admitted from June 2016 up to June 2022 at the St. Luke’s Medical Center, Quezon City (SLMC-QC). Data on age, sex, underlying malignancy, stage of treatment, site of infection, presence of central line, initial antibiotic therapy, culture positivity and isolates were retrospectively evaluated. Incomplete records were excluded. The relationship between clinical & microbiologic profile and outcomes were analyzed using T-test and Chi-square test. Significance was set at p<0.05.@*Results@#This study included 267 episodes of FN. Patients had a mean age of 8.3 years with male preponderance (59%). The most frequent underlying malignancy was acute lymphoblastic leukemia (61%). Episodes occurred primarily during the induction (40%) and consolidation phases (28%) of chemotherapy. Most (65%) had an absolute neutrophil count (ANC) of <100/mm3 . Central line catheter was present in 59% of episodes and 52% had an implanted port. There was no identifiable focus of infection in 52% of cases. Gram-negative bacteria, specifically Klebsiella pneumoniae (13%) and Escherichia coli (11%) were the most common isolates. Most patients (88%) recovered. Age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection were significantly associated with duration of hospital stay. Presence of central venous line was the most significant factor associated with mortality. Conclusions: Several clinical and microbiological factors, specifically age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection, were documented to significantly affect outcome in Filipino pediatric FN patients with HM.

Síndrome da fragilidade e riscos para quedas em idosos da comunidade / Frailty syndrome and risks for falling in the elderly community

RESUMO Objetivo Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. Método Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. Resultados A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. Conclusão A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

ABSTRACT Purpose To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. Methods Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. Results EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. Conclusion Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.

Intervenção fonoaudiológica na prevenção de quedas no envelhecimento / Speech therapy´s intervention for falling prevention in aging

RESUMO Objetivo Verificar a eficácia de uma intervenção fonoaudiológica para diminuição do risco de quedas. Método Estudo exploratório e de intervenção em que 148 voluntários socialmente ativos, de ambos os sexos, com média de 68,6(±6,5) anos foram avaliados pelo Dynamic Gait Index (DGI)-Brazilian brief e o Timed Up and Go (TUG). Todos os voluntários, com e sem risco para quedas, foram convidados para o programa de intervenção realizado em cinco semanas consecutivas, com duração de 50 minutos baseados nos exercícios de Cawthorne e Cooksey. Destes, 72 com 68,1(±6,5) anos, com e sem riscos para quedas, que participaram de, pelos menos, três encontros foram reavaliados. Foram utilizados o teste de Wilcoxon, Qui-quadrado, Spearman e Matriz de Correlação, com p≤5,0%. Resultados Inicialmente, 37(25,0%) e 106(71,6%) dos voluntários apresentaram, respectivamente, riscos para quedas no DGI-Brazilian brief e no TUG. Verificou-se correlação negativa do DGI-Brazilian brief (p=0,034) e positiva com o TUG (p=0,0071) com a idade e entre os dois instrumentos (p=0,00000016). Na comparação dos dados iniciais e finais de 72 voluntários averiguou-se correlação positiva no DGI-Brazilian brief e TUG no teste do Qui-quadrado e de Wilkoxon. Foi observado melhor desempenho nestes testes após a intervenção. Conclusão A intervenção foi eficaz, uma vez que diminuiu o risco para quedas e melhorou o desempenho da marcha e equilíbrio funcional e dinâmico.

ABSTRACT Purpose to verify the effectiveness of a Speech Therapy intervention program to decrease the risk of falls in elderly people. Methods Exploratory and intervention study where upon 148 volunteers from community, both genders, with an average of 68.6(± 6.5) years were submitted to the Dynamic Gait Index (DGI)- Brazilian brief and the Timed Up and Go (TUG). Volunteers with or without potential risk for falling were invited to participate in a 50-minutes long intervention program carried out for five consecutive weeks, based on Cawthorne and Cooksey exercises. Seventy-two volunteers 68.1(±6.5) years presented in at least three meeting, were reassessed. The results were analyzed by Wilcoxon, Chi-square, Spearman and Correlation Matrix tests, with p≤5.0%. Results Thirty-seven (25.0%) and 106 (71.6%) participants presented, respectively, risks for falls in the DGI-Brazilian brief and TUG. There was negative correlation between the DGI-Brazilian brief (p=0.034) and positive with the TUG (p=0.0071) with age and both instruments (p=0.00000016). Through the comparison the initial and final data a positive correlation was found for the DGI-Brazilian brief and for TUG in the Chi-square test and by Wilcoxon's. Better performance was observed in both tests after the intervention. Conclusion The intervention was effective in decreasing the risk for falls and improving gait performance, and functional and dynamic balance.

Eficácia de programa de prevenção de quedas em idosos / Efficacy in Falls Prevention Programs for the Elderly / Efectividad del programa de prevención de caídas en ancianos

Introdução:O envelhecimento dos sistemas envolvidos no equilíbrio corporal pode causar eventos de quedas e piorar a qualidade de vida de idosos. Objetivo: verificar a eficácia de um programa de prevenção a quedas em idosos socialmente ativos. Método: 60 idosos foram submetidos à Avaliação da Mobilidade Orientada pelo Desempenho (Performance Oriented Mobility Assessment ­ POMA) e à Escala de eficácia de quedas ­ Internacional ­ Brasil (Falls Efficacy Scale International ­ FES I-Brasil)l que avaliam, respectivamente, a tendência e o medo de quedas. Aqueles com escores alterados participaram de um programa de intervenção durante oito semanas consecutivas e foram reavaliados. Resultados: Na avaliação do equilíbrio orientado, 70,0% dos idosos apresentaram risco moderado, 5,0 % risco alto e 25,0% risco baixo para queda, ocorrendo associação siginificante e inversamente proporcional com a idade. No término do programa, verificou-se associação entre os resultados iniciais e finais nos testes, visto que ocorreu a redução total do risco alto e elevação do risco baixo para 68,0%. Verificou-se a diminuição com a preocupação com quedas frente à associação significante entre o medo de quedas inicial e a reavaliação. Conclusão: A proposta se mostrou eficaz uma vez que diminuiu o risco de quedas melhorando, consequentemente, o equilíbrio corporal dos voluntários da pesquisa. Promoveu, ainda, a redução com a preocupação de futuras quedas, principalmente nos idosos mais longevos.

Introduction: The aging of systems involved in body balance can cause fall episodes and worsen life quality in the elderly. Objective: To verify the efficacy of a fall prevention program in socially active elderly. Method: 60 elderly were submitted to a Performance Oriented Mobility Assessment and to the Falls Efficacy Scale International FES I-Brasil that evaluate, respectively, the tendency and the fear of falling. Those with altered scores participated in an intervention program during eight consecutive weeks and were reevaluated. Results: In the oriented balance evaluation, 70.0% of the elderly presented moderate risk, 5.0% high risk and 25.0% for low fall risk, resulting in a significant relationship to age. At the end of the program it was confirmed the relationship between initial outcomes and final tests, noticing there was a total reduction of high risk and an increase of low risk to 68.0%. The reduction of falling fear was confirmed in view of the significant relationship between the initial fall fears and the reevaluation. Conclusion: The proposal was effective once the falling fears diminished, improving, consequently, body balance with those who volunteered in the research. It even promoted the reduction of future falling concerns, especially with older seniors.

Introducción: El envejecimiento de los sistemas involucrados en el equilibrio del cuerpo, puede provocar episodios de caídas y empeorar la calidad de vida en los ancianos. Objetivo: Verificar la eficacia de un programa de prevención de caídas en ancianos socialmente activos. Métodos: 60 ancianos fueron sometidos a la Evaluación del Desempeño de la Mobilidad y la Eficacia de Caidas en la Escala Internacional. (Performance Oriented Mobility Assessment e Falls Efficacy Scale International), para evaluar, respectivamente, la tendencia y el miedo a caerse. Aquellas personas con puntuación alterada participaron en un programa de intervención durante ocho semanas consecutivas y fueron reevaluados. Resultados: En la evaluación del equilibrio orientado, el 70,0% de los sujetos presentaron riesgo moderado de caerse, 5,0% alto y de un bajo riesgo de 25,0%. En los extremos del programa, hubo una relación entre los resultados de las pruebas iniciales y finales, así como la reducción total de alto riesgo y un bajo riesgo que alcanzó 68,0%. Se confirmó una disminución del miedo de caerse frente a la relación significativa entre el miedo inicial y la revaluación. Conclusión: La propuesta mostró ser eficaz una vez que disminuyó el riesgo de caídas, mejorando, consecuentemente, el equilibrio corporal de los voluntarios en la investigación.También promovió la reducción con la preocupación de futuras caída, sobre todo en los más ancianos.

Metodologías alternas en el control y prevención de la malaria (Estudio realizado en el caserio "Las Majadas", Distrito Sucre, Estado-Bolívar, 1986) / Methods in the prevention and control of the malarie (Study made in the caserio \"Las Majadas\", Disctrit Sucre, Bolivar-State, 1986)

Un grupo de investigadores de la Universidad de Carabobo y Maravén, llevaron a cabo un experimento involucrando a los 350 pobladores del caserio Las Majadas en el control y prevención de la malaria mediante la educación sanitaria, organización comunal y uso del mosquitero impregnado con Permetrina. En mayo de 1986 con la ayuda de la comunidad, se impregnaron 33 de los 55 mosquiteros existentes. Seis meses más tarde, en octubre, el equipo volvio a la comunidad y entrevistaron a 21 de las 33 personas que habían contraido la malaria en al intervalo enero-octubre, 1986. Se encontro que hubo un brote serio en el mes de junio que solo produjo 22 casos. Catorce de las victimas dormian en sitios sin ninguna protección contra el mosquito..

La oncocercosis en América / The onchocerciasis in América

Las comunicaciones científicas presentadas en el Seminario hacen enfoque de las peculiaridades epidemiológicas, inmunológicas y parasitológicas de la oncocercosis en América. Incluye revisión de los progresos efectuados en el campo de la terapéutica, análisis de la relación riesgo/beneficios generados por el uso de la quimioterapia. Reseña las opiniones y conceptos de especialistas de los 6 paises Latinoamericanos donde la oncocercosis existe en forma endemica, así como también de los expertos de Francia, Inglaterra y OMS, quienes examinaron la información disponible sobre las manifestaciones de la helmintiasis en el Continente Americano