Food allergy in Italian paediatric population: Preliminary results of a nationwide study on prevalence, clinical characteristics and common diagnostic approaches

OBJECTIVEThis nationwide study was organized to evaluate the clinical characteristics, especially the annual detected rate, of pediatric intracranial arteriovenous (AV) shunts such as brain AV malformations (BAVMs), pial AV fistulas (PAVFs), vein of Galen aneurysmal malformations (VGAMs), and dural AV fistulas (DAVFs) in Japan.METHODSParticipation invitation emails for the study were sent to all members of the Japanese Society for Neuroendovascular Therapy and the Japanese Society for Pediatric Neurosurgery, totaling 4123 physicians. Excel files were attached to the emails to collect clinical data on patients aged 5 years old or younger with intracranial AV shunts at each hospital in the 5-year period from 2012 to 2016.RESULTSRepresentative physicians from 209 hospitals returned Excel files containing the patient data. Thirty-four hospitals reported on 72 patients with intracranial AV shunts. Among this cohort, 24 patients (33%) had BAVMs, 22 (31%) had PAVFs, 16 (22%) had VGAMs, and 10 (14%) had DAVFs. Male predominance (70%) was observed among all types of AV shunts. Most PAVFs (73%), VGAMs (88%), and DAVFs (100%) were diagnosed in patients younger than 1 year, especially neonates, whereas most BAVMs (92%) were diagnosed in children older than 1 year. In the patients older than 1 year, BAVMs were relatively common, and VGAMs and DAVFs were rare.CONCLUSIONSThe annual detected rates of BAVMs, PAVFs, VGAMs, and DAVFs in patients 5 years old or younger were 0.0775, 0.0710, 0.0517, and 0.0323 per 100,000 persons, respectively. In neonates and infants, VGAM, DAVF, and PAVF were relatively common, but BAVMs were extremely rare.

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Is It Time for Early Cessation of Empirical Antibiotherapy in Patients Presenting with Febrile Neutropenia? Preliminary Results of a Risk-Adapted Approach in a Hematology Clinic

Blood ◽

10.1182/blood.v128.22.2503.2503 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2503-2503

Author(s):

Ali Hakan Kaya ◽

Emre Tekgunduz ◽

Filiz Bekdemir ◽

Hikmetullah Batgi ◽

Tugcenur Yigenoglu ◽

...

Keyword(s):

Febrile Neutropenia ◽

Clinical Characteristics ◽

Cost Effective ◽

High Risk Group ◽

Risk Category ◽

Study Cohort ◽

Preliminary Results ◽

Mascc Score ◽

Infectious Focus ◽

Neutropenic Patients

Abstract Introduction : Febrile neutropenia (FN) is an important cause of mortality in hematology practice. Prompt recognition and treatment of FN is crucial to prevent development of sepsis and subsequent mortality. The duration of empirical antibiotherapy in hemodynamically stabile, afebrile, culture negative patients without an infectious focus is a controversial issue. Recently published guidelines encourage the use of early cessation of empirical antibiotherapy in these patients. Here we report our preliminary experience of early discontinuance of empirical antibiotherapy in febrile neutropenic patients who were treated with a risk-adapted strategy. Methods: All consecutive patients who were treated during June 2014-April 2016 period and presented with FN were included. Demographic and clinical data of patient cohort was prospectively collected within the context of institutional FN registry and analyzed retrospectively. Previously established standard criteria are used to diagnose FN episodes. MASCC score defined the risk category of patients. A new FN episode was considered when FN re-occurred in a patient who remained afebrile for at least 72 hours after discontinuation of antibiotics. All patients were treated within the framework of a written, institutional FN guideline, which is in line with EGIL-4 (European Conference on Infections in Leukemia) recommendations. Empirical antibiotherapy was stopped in patients, who were hemodynamically stabile, had no infectious focus, had negative culture results, received broad-spectrum empiric antibiotherapy for 3 days and were afebrile for at least 2 days. Results: The study included a total of 137 patients (87 males-50 females). Median age of patients was 49 (16-87). All patients were in high-risk group according to MASSC criteria. Demographic and clinical features of the study cohort are summarized in Table-1. During the study period 249 FN episodes were evaluated. Empirical antibiotherapy was discontinued in 47 (18,9%) FN episodes in 44 (32,1%) patients. Following cessation of empirical antibiotherapy, 11 (23,4%) new FN episodes developed and no patient infection-related deaths in the following 100 days. Discussion: Our preliminary results indicate that cessation of empirical antibiotherapy in a strictly defined patient population with FN seems to be feasible. We were able to stop antibiotherapy in 18,9% of patients and 76,6% of them did not experience a new FN episode. This strategy is cost-effective and seems to be quite safe, as we did not observed any infection-related deaths in the first 100 days following discontinuation of antibiotherapy. These patients were also protected from possible side effects of unnecessary antibiotics. Future studies will define the role of this provocative approach and may change the way we treat febrile neutropenic patients. Table Demographic and clinical characteristics of patients Table. Demographic and clinical characteristics of patients Disclosures Demirkan: Amgen: Consultancy.

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