Acute lymphoblastic leukemia is the most common childhood malignancy. One of the drugs used in the treatment is Asparaginase, and monitoring of its activity levels enables better outcomes. Since 2018, our laboratory has been working to establish a regular analysis of activity. This implementation allowed to qualify care by detecting silent inactivation and also establishing desensitization as a safe way to overcome the lack of Erwinia. We were able to monitor children aged 0 to 18 years who were being treated with PEG-ASNase. The activity was assessed on days 7 (90 samples) and 14 (52 samples) after ASNase infusions. 142 samples were analyzed. 95.7% reached an adequate activity level (≥ 0.1 IU/mL). Patients treated with ASNase can develop allergic reactions. With the activity monitoring, is possible to circumvent situations like these and implement desensitization protocols for patients who had clinical hypersensitivity without inactivation. Desensitization induces temporary unresponsiveness to drug antigens, allowing the patients to proceed with the prescribed chemotherapy. We have received samples from four patients being treated with different desensitization protocols. Patients tolerated the protocols well. Only one had a grade 2 reaction during the infusion and activity < 0.1 IU/mL, which resulted in the switch to Erwinia. The dose adaptation is a possible and more recent use of ASNase monitoring and we were able to confirm the feasibility of PEG-ASNase desensitization protocols.
A exposição acidental a materiais biológicos representa uma importante fonte de transmissão de doenças infecciosas, em especial HIV, hepatite B e hepatite C. Apresentamos nesse trabalho uma revisão prática para definição de condutas diante dessas situações.
Accidental exposure to biological materials is an important source of transmission of infectious diseases, specially HIV, hepatitis B ans hepatitis C. We present in this paper a practical review for management of such situations.
Containment of Biohazards , Accidents, Occupational , Health Personnel
Em pediatria, a meningite aguda é considerada uma doença grave, com grande potencial para morbidade e mortalidade. Para melhor desfecho, deve ser manejada precoce e eficazmente, em consonância com protocolos correntes. Este artigo busca apresentar, de forma prática, a abordagem inicial recomendada.
Acute meningitis in children is a dangerous disease with great potential of morbidity and mortality. It demands an effective management and the better available therapy, in agreement to the current guidelines. This paper presents the recommended initial approach in a practical way.
Meningitis , Pediatrics , Child , Emergencies , Practice Guideline
A sepse é uma grave complicação relacionada a quadros infecciosos, com altas taxas de mortalidade. Deve ser manejada precoce e efetivamente, conforme as referências atuais e os protocolos institucionais. Este artigo apresenta de forma prática a abordagem inicial adequada em quadros de sepse que chegam à emergência clínica.
Sepsis is a serious complication related to infectious diseases, with high mortality rates. It demands an early and effective management, in agreement to the current guidelines and institutional protocols. This paper presents the adequate initial approach, in a practical way, of sepsis cases in clinical emergency room.
Sepsis , Shock, Septic
