Adverse events associated with aprepitant pediatric bone cancer patients.

An eight-year long case series follow-up study with pediatric bone cancer patients was conducted to compare the occurrence of adverse events associated with aprepitant with official sources of drug information (manufacturer's leaflet, clinical trials, and European Medicines Agency leaflet). All patients admitted were analyzed, representing 192 aprepitant cycles. Anorexia, febrile neutropenia, and headache were observed in frequencies over 43.8 per 100 patients, which was higher than previous estimates. Adverse events were classified as probable or possible, by using Naranjo score. The increased rates of adverse events, especially on the risk febrile neutropenia, warrant further safety studies on this population.

Safety of general anesthesia for lumbar puncture and bone marrow aspirate/biopsy in pediatric oncology patients.

INTRODUCTION: Painful short duration procedures such as bone marrow aspiration/biopsy and the lumbar puncture with or without intrathecal chemotherapy are frequently performed during the treatment of children with cancer. This study evaluated the frequency and severity of complications of bone marrow aspiration biopsy and lumbar puncture/intrathecal chemotherapy under general anesthesia. PATIENTS AND METHODS: A prospective observational study was performed from November 2003 to August 2005. Patients with cancer younger than 21 years old, receiving treatment at the Pediatric Oncology Unity of Hospital de Clínicas de Porto Alegre, undergoing diagnostic and/or therapeutic short duration procedures carried out under general anesthesia in the outpatient surgery unit. RESULTS: One hundred and thirty-seven patients were submitted to 423 procedures under general anesthesia. There were 61% boys, mean age of 7.5 years (0.2 to 21) and ASA II 98%. Eighty seven percent of the procedures were carried out in patients with leukemia or lymphoma. The majority of the procedures had no adverse events during intraoperative and postoperative periods. No procedure had to be suspended after it had begun. One patient had lumbar pain after the procedure and was admitted to the ward with suspected subdural bleeding, but this was not confirmed. No patient needed cardiopulmonary reanimation or treatment in the intensive care unit. CONCLUSIONS: General anesthesia for short duration painful procedures in children undergoing treatment for malignancies is safe when carried out by trained professionals in outpatient clinical surgery unit.

The influence of traumatic lumbar puncture and timing of intrathecal therapy on outcome of pediatric acute lymphoblastic leukemia.

The CNS is a frequent site of relapse of childhood acute lymphoblastic leukemia (ALL). Traumatic lumbar puncture (TLP) is thought to increase the risk of CNS relapse. The authors examined whether TLP at the time of diagnosis affected outcome and whether this effect was influenced by the timing of intrathecal therapy (IT) in 77 patients with newly diagnosed ALL. IT was instilled at the time of either the diagnostic LP (early) or a second LP 24--48 h later (delayed). Of the 19 patients who had a TLP at diagnosis and received late IT therapy, 6 had isolated CNS relapse and 2 had combined CNS and bone marrow (BM) relapse. Of the 9 patients who had TLP and received early IT therapy, 1 had a CNS relapse (p=.20). In an analysis stratified according to risk of relapse, the odds ratio (OR) for relapse was 0.8 among patients at low and standard risk who had delayed IT therapy after TLP (p=.99) vs. 0.17 for those who had early IT (p=.47). Importantly, among patients with high-risk ALL, the OR for relapse was 21.0 for delayed IT therapy (p=.09) and only 1.5 for early IT therapy after TLP (p=.99). The results indicate that TLP at diagnosis appears to increase the risk of CNS relapse markedly in patients with high-risk ALL, and the use of early IT therapy appears to reduce this risk. These findings need to be confirmed by prospective, randomized studies.

Poverty levels and children's health status: study of risk factors in an urban population of low socioeconomic level

Para testar a hipótese de que a populaçäo de baixo nível socioeconômico apresenta diferentes níveis de pobreza que repercutem em seu estado de saúde, foi realizado estudo transversal envolvendo 477 famílias de uma populaçäo urbana pobre residente na Vila Grande Cruzeiro, em Porto Alegre, RS, Brasil. O nível de pobreza dessas famílias foi medido por meio de um instrumento especialmente elaborado para populaçöes urbanas pobres. Crianças oriundas de famílias vivendo em extrema pobreza (quartil inferior) apresentaram maior taxa de mortalidade infantil, menor peso de nascimento, maior número de internaçöes hospitalares e maiores índices de desnutriçäo, além de pertencerem a famílias mais numerosas. A populaçäo de baixo nível socioeconômico mostrou-se heterogênea em relaçäo a diferentes indicadores de saúde. Concluiu-se que a identificaçäo de subgrupos mais vulneráveis numa populaçäo permite concentrar as açöes de saúde entre os mais necessitados