Reactions related to asparaginase infusion in a 10-year retrospective cohort

Abstract Introduction: Although it is an essential component of the treatment of acute lymphoid leukemia in children, asparaginase causes adverse reactions that sometimes make it impossible to use it fully. Hypersensitivity reactions are the most frequent and may lead to early discontinuation of treatment. The present study aimed to investigate suspicions of adverse reactions during the infusion of asparaginase in a pediatric cohort. Methods: A retrospective observational study was carried out at a university pediatric institute in the state of Rio de Janeiro. Information regarding clinical features and characteristics of adverse reactions was collected from hospital medical records. Suspicions of adverse reactions were classified regarding causality and severity. Results: Seventy-three suspicions of adverse reactions were recorded during asparaginase infusion in 72 children in the study period. Allergic hypersensitivity reactions were suspected in 60.5% of the cases. Of these, 25% of the reactions occurred during induction and 61.1% in concomitant use with vincristine, findings that diverge from other studies. High-risk classification and younger age were considered risk factors for these reactions. A total of 72.4% of the reactions were classified as grade 1 or 2, which suggest that not all are related to antibody formation; this highlights the importance of differential diagnosis with other reactions, such as non-allergic hypersensitivity and hyperammonemia. Conclusion: The implementation of the differential diagnosis of reactions related to infusion of asparaginase with ammonia dosage and classification of the grade of reactions is crucial to facilitate the identification and proper management of each type of reaction.

Onde estão os homens? O que os distanciam ou os aproximam dos serviços da atenção primária à saúde / Where are the men? What keep them away or approach them to the primary health care

Os homens não possuem comumente hábitos de práticas preventivas. Logo, ouvi-los tornou-se imprescindível para compreender as suas concepções que justificam tais atitudes. O presente estudo teve como objetivos identificar os motivos que os levam a procurar atendimento nos serviços da Atenção Primária à Saúde, e compreender os motivos que os afastam dos serviços da Atenção Primária à Saúde. Trata-se de um estudo de caso qualitativo, exploratório e descritivo. Participaram da pesquisa treze homens residentes no município de Vitória da Conquista (Bahia), na faixa etária de 25 a 59 anos. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados por meio da técnica de Análise de Conteúdo Temática. Os resultados mostraram a forma como os homens concebem a saúde e como isto reflete em suas atitudes em relação à busca pelos serviços de saúde. Revelou também os fatores da aproximação e do afastamento do público masculino no cenário da Atenção Primária à Saúde que envolve concepções culturais e até mesmo questões institucionais. Portanto, o resultado deste estudo pode subsidiar os profissionais no desenvolvimento de estratégias para estimular e acolher a população masculina, considerando as limitações e barreiras singulares que este público apresenta.

Men usually don't have preventive habits. Thus, listening to them is necessary to understand the conceptions they have that justify their attitudes. This study is focused on identifying the reasons that make men look for Primary Health Care and to understand the reasons that keep them away or approach them. This is a qualitative, exploratory and descriptive case study. Thirteen men aged 25-59 years old, who live in Vitória da Conquista city, participated in the study. The data was collected by semi-structured interviews and was analyzed by Thematic Content Analysis. The results showed how men understand health and how their perception reflects the way they are looking for health services. The study also showed the reasons why men approach or keep away from Primary Health Care, including cultural conceptions and even institutional issues. The results of the study support the development of strategies that could stimulate and welcome the male population, in spite of the limitations and natural barriers that this group contains.