#24: Neutropenic Enterocolitis in the Pediatric Patient with Hematological Cancer at Centro Medico Nacional 20 de Noviembre, from June 2019 to May 2020

Abstract Background Neutropenic Enterocolitis is a life-threatening condition which occurs in patients presenting neutropenia (absolute neutrophil count <500 / mm3), where secondary to the use of chemotherapy there is an aggressive destruction of tumor cells, which alters the rapid replication phase, in which different types of epithelia are also involved, this is why they decrease their turnover rate, evolving into injury in the intestinal mucosa, especially at the level of the terminal ileus and cecum, although it can affect any part of the intestine. Clinically manifested by fever, pain, and abdominal distension; it is more frequently associated with hematological cancer, although it can occur in other types of cancer. CT is the Gold Standard for diagnosis. Ultrasonography may also be useful, however, this diagnostic tool is operator dependent so its sensitivity and specificity decrease. Medical treatment is usually sufficient, but surgical intervention may be necessary in patients with perforation or deterioration. Methods The incidence of Neutropenic Enterocolitis cases in the pediatric population was identified by means of a descriptive, cross-sectional and retrospective study. We used clinical records of patients admitted with a diagnosis of leukemia. Data analysis was carried out by means of a non-probability sampling for convenience, creating the database in electronic system followed by the data analysis obtained by the JASP software version 0.13.1.0. Results we took into account a total of 1019 patients with leukemia, from which 95.58 % (n=974) were ALL (Acute Lymphoblastic Leukemia) and 4.41 % (n=45) AML (Acute Myeloblastic Leukemia); the Neutropenic Enterocolitis diagnostic, gave us 49 files, from which we eliminated 12 with a different diagnosis, obtaining a total sample of 37 clinical records. The most affected population was the group of between 10–17 years with an incidence of 51.35 %, the most common type of hematologic cancer was ALL representing 86.4 % of the cases, from which 40.54 % were in the induction phase of treatment when they started with the clinical symptoms of neutropenic enterocolitis, being fever, abdominal pain and diarrhea the most common symptoms. The diagnosis was made based on clinical presentation, and radiology tests being abdominal ultrasound the most common diagnostic tool. The most efficacious treatment because there were no complications and there was no need for escalation, was Piperacillin/Tazobactam, followed by Meropenem. Conclusions Neutropenic Enterocolitis was more frequently diagnosed in patients with ALL and in those who were receiving the induction phase of treatment; a total of 28 % presented with sepsis or septic shock. The antibiotic scheme Piperacillin/Tazobactam suffered less modifications unlike Cefepime/Metronidazole which had to be scaled to carbapenem and just 10.81 % of the patients had the Gold Standard diagnostic tool (Abdominal Computed Tomography).

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Chemotherapeutic Complications in Adult Colombian Patients with Acute Lymphoblastic Leukemia in Hospital San Rafael: A Descriptive Study

Latin american journal of clinical sciences and medical technology ◽

10.34141/ljcs3067409 ◽

2019 ◽

Vol 1 (1) ◽

pp. 35-42

Author(s):

Carlos Alberto Castro Vásquez ◽

Gabriel Alexander Quiñones Ossa ◽

María Alejandra Pineda Castañeda ◽

Diana Carolina Maldonado Gantiva ◽

Julián Stiven Casas González ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Febrile Neutropenia ◽

Hematological Malignancies ◽

Lymphoblastic Leukemia ◽

Infectious Complications ◽

Induction Phase ◽

Chemotherapeutic Regimen ◽

San Rafael ◽

Tract Infections ◽

Clinical Records

Background. Acute Lymphoblastic Leukemia (ALL) is a hematolymphoid neoplasm with multiple complications and variable prognosis, which depends on several factors, one of them related to chemotherapeutic treatment. Objective. To describe the complications developed in patients diagnosed with ALL and who received chemotherapy treatment in Hospital San Rafael. Materials and methods. A retrospective analysis of clinical, paraclinical and demographic variables taken from clinical records of adult patients diagnosed with ALL admitted to hospital between 2016 and 2017. Results. A hundred and sixteen patients had hematological malignancies, 24 had ALL. Most of them had B-cell precursor ALL (79.2 %), 86.4 % were in the chemotherapy induction phase, 87.5 % developed febrile neutropenia, 37.5 % had tumor lysis syndrome, 58.3 % developed infectious complications, and 45.8 % died. Discussion. This is the first study known to date describing the complications in patients with ALL at Hospital San Rafael in Colombia. One of the major findings was the high frequency of febrile neutropenia episodes and infectious complications mainly associated with unfavorable outcomes, such as multiple organ failure and death. Therefore, clinicians should always have these complications in mind when a patient with hematological malignancies is receiving or is about to start a chemotherapeutic regimen. Conclusions. Bloodborne and respiratory tract infections were the most common sources of infection by Staphylococcus epidermidis and Klebsiella pneumoniae as causative agents. Likewise, the most frequent complication was febrile neutropenia. The first cause of death were infections complicated by sepsis; however, only one-third of the patients had a microbial isolation.

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Management of Venous Thromboembolism (VTE) in Patients with Acute Leukemia: Results from a Multicenter Study

Blood ◽

10.1182/blood.v124.21.3688.3688 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3688-3688 ◽

Cited By ~ 1

Author(s):

Mariasanta Napolitano ◽

Luca Valore ◽

Giorgia Saccullo ◽

Alessandra Malato ◽

Calogero Vetro ◽

...

Keyword(s):

Venous Thromboembolism ◽

Acute Leukemia ◽

Conflicts Of Interest ◽

Sinus Thrombosis ◽

Lymphoblastic Leukemia ◽

Laboratory Data ◽

Induction Phase ◽

Severe Thrombocytopenia ◽

Significant Difference ◽

Clinical Records

Abstract Background In the last decades, evaluation of thrombotic complications secondary to acute leukemia (AL) has been poorly investigated. Only scant data are available on management and prevention of thrombosis in this setting. We performed a multicenter retrospective study with the aim to evaluate the management of venous thromboembolism (VTE) in patients with AL and to report the most commonly adopted regimens of treatment. Materials and methods Available clinical records of out and in-patients diagnosed with AL from January 2008 to June 2013 in 7 Reference Regional Hospitals were analyzed. Cases of VTE, including thrombosis in atypical sites [Retinal occlusion (RO) and Cerebral Sinus Thrombosis (SCT)], were reported. All data were recorded in a dedicated electronic database. The patient’s basic demographic data (age, gender, race), medical history, disease-related information, and laboratory data were extracted. Instrumental diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE) and RO and SCT was performed according to ACCP guidelines. Data were collected and analysed by the IBM SPSS Software 21.0 version (SPSS, Inc., Chicago, Ill, US) and the Epi Info software, version 3.2.2, (Centers for Disease Control and Prevention). Statistical analysis of quantitative and qualitative data, included descriptive statistics, was performed for all the items. Results Over a population of 1461 patients with AL, 99 (6.8%) cases of VTE were recorded, mainly in hospitalized patients: 72 cases were associated with Acute Myeloid Leukemia (AML) and 27 with Acute Lymphoblastic Leukemia (ALL), with a mean age of 52.2 ± 15.4 years (median age: 53years). In particular the incidence/ratio over the sub-population of AML-patients was 6.0%, that is 72/1191 cases; with a mean age of 54.7 ± 14.3 years (median age: 57 years). VTE occurred during chemotherapy (CHT) in 90/99 (90%) cases, mainly during the induction phase of treatment (in 70% of cases ),the remaining 9 cases were diagnosed in concomitance with acute leukemia. In both subgroups with VT, there was no statistical significant difference between time at diagnosis of VT and time at diagnosis of AL. Treatment of VTE was mainly based on Low Molecular Weight Heparin (LMWH), in accordance with results from previous studies and current guidelines (full dosage for the first month from diagnosis and reduced dosage at 75% for the following months). Thrombocytopenia occurred in 55 patients at diagnosis of AL, in 33 cases platelets were <50x109/L. Most VTE episodes (73/99, 73.7%) were treated with LMWH as above reported . In patients with moderate/severe thrombocytopenia, a dose adjusted to platelet count was adopted; most of the investigators used LMWH at prophylactic dosage. Two cases received fondaparinux, one patient was treated with unfractioned heparin; six cases did not receive any treatment due to severe thrombocytopenia. No cases of VT–related deaths nor fatal complications during treatment for VTE were reported. All treatments with LMWH lasted from 3 to 6 months. All patients clinically recovered from VTE, only 2 late recurrences (PEs) were observed. Conclusion VTE can complicate the clinical course of AL in a not negligible percentage of cases. Anticoagulant treatment schedules and duration in patients with AL are influenced by many factors, mainly related to chemotherapy and severe thrombocytopenia. In the analyzed subset of patients, full dose treatment with LMWH for at least one month followed by a dose reduction for at least three months was appropriate. Disclosures No relevant conflicts of interest to declare.

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953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

British Journal of Surgery ◽

10.1093/bjs/znab134.339 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Hassan ◽

S Shah ◽

M Patel

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Clinical Assessment ◽

Clinical Symptoms ◽

Deformity Correction ◽

Cost Effective ◽

Cardiovascular Complications ◽

Anterior Correction ◽

Perioperative Complication ◽

Clinical Records

Abstract Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, >10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

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The Role of Salivary Biomarkers in the Early Diagnosis of Alzheimer’s Disease and Parkinson’s Disease

Diagnostics ◽

10.3390/diagnostics11020371 ◽

2021 ◽

Vol 11 (2) ◽

pp. 371

Author(s):

Patrycja Pawlik ◽

Katarzyna Błochowiak

Keyword(s):

Alzheimer’S Disease ◽

Parkinson’S Disease ◽

Alzheimer's Disease ◽

Parkinson's Disease ◽

Early Diagnosis ◽

Neurodegenerative Diseases ◽

Diagnostic Tool ◽

Clinical Symptoms ◽

Early Screening ◽

Salivary Biomarkers

Many neurodegenerative diseases present with progressive neuronal degeneration, which can lead to cognitive and motor impairment. Early screening and diagnosis of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) are necessary to begin treatment before the onset of clinical symptoms and slow down the progression of the disease. Biomarkers have shown great potential as a diagnostic tool in the early diagnosis of many diseases, including AD and PD. However, screening for these biomarkers usually includes invasive, complex and expensive methods such as cerebrospinal fluid (CSF) sampling through a lumbar puncture. Researchers are continuously seeking to find a simpler and more reliable diagnostic tool that would be less invasive than CSF sampling. Saliva has been studied as a potential biological fluid that could be used in the diagnosis and early screening of neurodegenerative diseases. This review aims to provide an insight into the current literature concerning salivary biomarkers used in the diagnosis of AD and PD. The most commonly studied salivary biomarkers in AD are β-amyloid1-42/1-40 and TAU protein, as well as α-synuclein and protein deglycase (DJ-1) in PD. Studies continue to be conducted on this subject and researchers are attempting to find correlations between specific biomarkers and early clinical symptoms, which could be key in creating new treatments for patients before the onset of symptoms.

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Adjuvant corticosteroid therapy in hepatosplenic candidiasis-related IRIS

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2012.018 ◽

2012 ◽

Vol 4 (1) ◽

pp. e2012018 ◽

Cited By ~ 3

Author(s):

Cengiz Bayram ◽

Ali Fettah ◽

Nese Yarali ◽

Abdurrahman Kara ◽

Fatih Mehmet Azik ◽

...

Keyword(s):

Corticosteroid Therapy ◽

Immune Reconstitution ◽

Inflammatory Responses ◽

Clinical Symptoms ◽

Lymphoblastic Leukemia ◽

Laboratory Findings ◽

Hepatosplenic Candidiasis ◽

Cell Acute Lymphoblastic Leukemia ◽

Inflammatory Syndrome ◽

Standard Risk

Hepatosplenic candidiasis (HSC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS) is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC and Candida-related IRIS during recovery of neutropenia associated with induction chemotherapy. Addition of corticosteroid therapy to antifungal treatment is associated with the resolution of the clinical symptoms and laboratory findings

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Recognition of Sleep-disordered Breathing in Children

PEDIATRICS ◽

10.1542/peds.98.5.871 ◽

1996 ◽

Vol 98 (5) ◽

pp. 871-882 ◽

Cited By ~ 4

Author(s):

Christian Guilleminault ◽

Rafael Pelayo ◽

Damien Leger ◽

Alex Clerk ◽

Robert C. Z. Bocian

Keyword(s):

Gold Standard ◽

Sleep Disordered Breathing ◽

Clinical Symptoms ◽

Upper Airway ◽

Esophageal Pressure ◽

Respiratory Events ◽

Obstructive Sleep ◽

Abnormal Breathing ◽

Polygraphic Recording ◽

Disordered Breathing

Objective. To determine whether upper airway resistance syndrome (UARS) can be recognized and distinguished from obstructive sleep apnea syndrome (OSAS) in prepubertal children based on clinical evaluations, and, in a subgroup of the population, to compare the efficacy of esophageal pressure (Pes) monitoring to that of transcutaneous carbon dioxide pressure (tcPco2) and expired carbon dioxide (CO2) measurements in identifying UARS in children. Study Design. A retrospective study was performed on children, 12 years and younger, seen at our clinic since 1985. Children with diagnoses of sleep-disordered breathing were drawn from our database and sorted by age and initial symptoms. Clinical findings, based on interviews and questionnaires, an orocraniofacial scale, and nocturnal polygraphic recordings were tabulated and compared. If the results of the first polygraphic recording were inconclusive, a second night's recording was performed with the addition of Pes monitoring. In addition, simultaneous measurements of tcPco2 and endtidal CO2 with sampling through a catheter were performed on this second night in 76 children. These 76 recordings were used as our gold standard, because they were the most comprehensive. For this group, 1848 apneic events and 7040 abnormal respiratory events were identified based on airflow, thoracoabdominal effort, and Pes recordings. We then analyzed the simultaneously measured tcPCo2 and expired CO2 levels to ascertain their ability to identify these same events. Results. The first night of polygraphic recording was inconclusive enough to warrant a second recording in 316 of 411 children. Children were identified as having either UARS (n = 259), OSAS (n = 83), or other sleep disorders (n = 69). Children with small triangular chins, retroposition of the mandible, steep mandibular plane, high hard palate, long oval-shaped face, or long soft palate were highly likely to have sleep-disordered breathing of some type. If large tonsils were associated with these features, OSAS was much more frequently noted than UARS. In the 76 gold standard children, Pes, tcPco2, and expired CO2 measurements were in agreement for 1512 of the 1848 apneas and hypopneas that were analyzed. Of the 7040 upper airway resistance events, only 2314 events were consonant in all three measures. tcPco2 identified only 33% of the increased respiratory events identified by Pes; expired CO2 identified only 53% of the same events. Conclusions. UARS is a subtle form of sleep-disordered breathing that leads to significant clinical symptoms and day and nighttime disturbances. When clinical symptoms suggest abnormal breathing during sleep but obstructive sleep apneas are not found, physicians may, mistakenly, assume an absence of breathing-related sleep problems. Symptoms and orocraniofacial information were not useful in distinguishing UARS from OSAS but were useful in distinguishing sleep-disordered breathing (UARS and OSAS) from other sleep disorders. The analysis of esophageal pressure patterns during sleep was the most revealing of the three techniques used for recognizing abnormal breathing patterns during sleep.

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ULTRASONIC STUDY IN DIAGNOSTICS OF PERIPHERAL NEUROPATHIES (CASE FROM PRACTICE)

Medical Journal ◽

10.51922/1818-426x.2021.4.144 ◽

2021 ◽

pp. 144-146

Author(s):

Hamanovich A.I. ◽

◽

Baida A.G. ◽

Koyalo L.G. ◽

Levantsevich V.V. ◽

...

Keyword(s):

Nervous System ◽

Gold Standard ◽

Peripheral Nerves ◽

Peroneal Nerve ◽

Clinical Case ◽

Clinical Symptoms ◽

Nerve Trunk ◽

Peripheral Neuropathies ◽

Ultrasound Scanning ◽

Electrophysiological Methods

Electrophysiological methods, such as electromyography and neuromyography, are traditionally recognized as the "gold standard" for detecting pathology of the peripheral nervous system. It should be noted, however, that the information obtained during the above examinations does not give an idea of the state of the surrounding tissues, does not indicate the nature and cause of damage to the nerve trunk, and does not always accurately reflect the localization of changes. At the same time, it is this information that helps to determine the tactics of conservative or surgical treatment of the patient. Ultrasound scanning is quite successfully used in the diagnosis of damage and diseases of the peripheral nerves. The article presents a clinical case of a diagnostic search for a causative disease in a patient with clinical symptoms of neuropathy of the peroneal nerve.

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Nutritional status and physical activity of childhood leukemia survivors

Paediatrica Indonesiana ◽

10.14238/pi54.2.2014.67-72 ◽

2014 ◽

Vol 54 (2) ◽

pp. 67

Author(s):

Conny Tanjung ◽

Johannes Bondan Lukito ◽

Prima Dyarti Meylani

Keyword(s):

Physical Activity ◽

Nutritional Status ◽

Childhood Leukemia ◽

Lymphoblastic Leukemia ◽

Induction Phase ◽

Childhood All ◽

Increased Risk ◽

Long Term Survivors ◽

First Time

Background Acute lymphoblastic leukemia (ALL), the mostcommon malignancy of childhood, has an overall cure rate ofapproximately 80%. Long-term survivors of childhood ALL areat increased risk for obesity and physical inactivity that may leadto the development of diabetes, dyslipidemia, metabolic syndrome,as well as cardiovascular dis eases, and related mortality in theyears following treatment.Objective To evaluate the physical activity and the propensityfor developing obesity longer term in ALL survivors.Methods This retrospective cohort study included all ALLsurvivors from Pantai Indah Kapuk (PIK) Hospital. We assessedtheir physical activity and nutritional status at the first time ofALL diagnosis an d at the time of interview.Results Subjects were 15 ALL survivors aged 7 to 24 years. Themedian fo llow up time was 6.4 years (range 3 to 10 years). Only2 out of 15 survivors were overweight and n one were obese.All survivors led a sedentary lifestyle. Most female subjectshad increased BMI, though most were not overweight/obese.Steroid therapy in the induction phase did not increase the riskof developing obesity in ALL survivors.Conclusion Lon g-term survivors of childh ood ALL do not meetphysical activity recommendations according to the CDC (Centersfor Disease Control). Howevei; steroid therapy do not seem tolead to overweight/obesity in ALL survivors.

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