The Value of the "Lab-Score" Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections.

INTRODUCTION: Most children with fever without source will have a self limited viral infection though a small percent will develop a serious bacterial infection (SBI) like urinary tract infection, pneumonia, bacteraemia, meningitis or sepsis. The challenge facing practitioners is to distinguish between these two groups and currently biomarkers, like C-reactive protein (CRP) and Procalcitonin (PCT), are available for this purpose.The aim of the current study was to identify SBI in infants with fever without an identifiable cause using the recently introduced "Lab-score" combining C-reactive protein, procalcitonin and urine dipstick results. METHODS: This survey is part of an observational study aimed at identifying children with fever without source at risk of SBI. Patients were recruited from the Emergency Department of Tîrgu Mures Emergency Clinical County Hospital, Romania, during 2013. SBI diagnosis was based on urine, blood and cerebrospinal fluid cultures and chest radiographs. For infants, aged 7 days to 12 months, CRP and PCT were determined and the "Lab-score" was calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each parameter and score. RESULTS: Of the ninety infants included in the study, SBI was diagnosed in nineteen (21.11%). Ten had a urinary tract infection, seven had pneumonia, one had a urinary tract infection and bacteraemia, and one had sepsis. Positive and negative likelihood ratios for CRP (≥40.0 mg/L) and PCT (≥0.5 ng/mL) were 10.27/0.45 and 7.07/0.24 and post-test probabilities 73%/65%. For a "Lab-score" (≥3), positive and negative likelihood ratios were 10.43/0.28, and the posttest probability was 73%. CONCLUSIONS: In our survey the "Lab-score" proved a strong predictor for the identification of febrile infants at risk of SBI, but showed no significant difference compared with CRP and PCT which both proved equally good predictors for SBI.

Follow-up of childhood chronic myelogenous leukemia with monitoring the BCR-ABL fusion gene expression in peripheral blood.

UNLABELLED: Chronic myelogenous leukemia (CML) accounts for 15-20% of adult leukemias but is very rare in children (2%). Fewer than 10% of CML patients are younger than 20 years. CML is a myeloproliferative disorder characterized by the presence of the Philadelphia chromosome or the BCR-ABL fusion oncogene. The objective of this paper is to present the monitoring of imatinib therapy in two children with CML by the BCR-ABL fusion gene expression assessment from peripheral blood with quantitative real-time polymerase chain reaction (PCR) method. PATIENTS AND METHODS: The 18 and six months follow-up of the patients included clinical examination, routine laboratory tests, bone marrow aspirate investigation including cytogenetic tests and the major BCR-ABL fusion gene expression measurement with qRT-PCR method from the peripheral blood. RESULTS: Patient No. 1 diagnosed with chronic phase CML showed excellent adherence to daily 400 mg imatinib treatment and achieved complete hematologic (CHR) and cytogenetic response (CCR) by three months and major molecular response (MMR) by 12 months, with lack of side effects due to imatinib. Patient No. 2 experienced severe hematologic toxicity, which necessitated temporary withdrawal of the drug. Transient non-compliance together with imatinib dose reduction has driven to treatment failure. In this case, mutational analysis is warranted. CONCLUSIONS: BCR-ABL fusion gene expression level measurement from peripheral blood with qRT-PCR method is an excellent tool in the follow-up of CML patients.

The role of real-time elastography in the evaluation of post chemotherapy hepatotoxicity in children with cancer.

The drugs hepatotoxicity represents a major problem of the iatrogenic pathology, with various manifestations, directly through the hepatotoxic effect or through idiosycrasy reactions. The hepatic affection induced by chemotherapy appears in children in cases of prolonged therapy, chronic diseases, or other associated conditions. Hepatotoxicity clinically develops through hepatic disorder, cholestatic or mixed hepato-cholestatic manifestations and systematic affection. There are no specific hystological or biochemical characteristics for diagnostic of hepatotoxicity. The international criteria for asessing the hepatotoxicity includes the bilirubin, the transaminasis, GGT, FA, albumin and the flow on the vein. It has been noticed that these parameters are not enough for the right assesssment of the chemotherapics' hepatotoxicity. Thus it is required the abdominal ultrasonography and computerised tomography for the identification of billiary tract, vascularisation, associated conditions and the degree of fibrosis; also, the hepatic biopsy may be necessary. The ultrasound elastography is a method which can give information related to the elasticity/stiffness of the examined tissue and degree of fibrosis. Acustic radiation force imaging(ARFI) is an elastographic method which allows valid, accurate and flexible evaluation of liver stiffness, a quantification with a strong correlation with the fibrosis stage, not influenced by steatosis. In conclusion, the hepatic toxicity showed by alterated hepatic biochemical tests and by symptomes of hepatopathy needs a proper appreciation of the hepatic modifications, which can be obtained through hepatic biopsy or by assessing the hepatic elasticity through elastography. Thus, real-time elastography is an useful tool in assessing the chemotherapics hepatotoxicity in children with cancer.