ABSTRACT
PURPOSE: This study evaluates the capacity of ultrasonography as a diagnostic method to confirm the proper positioning of central venous catheter (CVC) when compared to the current gold standard, chest radiography (CR). METHODS: A prospective study was performed including children from 0 to 14 incomplete years, who underwent CVC placement between March and May 2018 at a teaching hospital in Brazil. A four-chamber view of the heart was performed with ultrasound during a rapid injection of saline solution to identify hyperechoic images and confirm the central position of the catheter. After that, a CR was performed. The diagnostic quality of ultrasound was evaluated based on accuracy, sensitivity, specificity, positive and negative predictive values. RESULTS: A total of 21 patients were analyzed. The mean age was 3.95 ± 4.01 years. The preferred puncture site was the right internal jugular vein (71.4%). Ultrasound accuracy to detect CVC positioning was 81%. Sensitivity, specificity and positive and negative predictive values were 33%, 100%, 100% and 79%, respectively. CONCLUSION: Ultrasound is a reliable method for detection of CVC positioning. Even so, with the four-chamber cardiac view, this method is unable to identify catheters inside heart chambers, therefore, needing to confirm the positioning with CR.
Subject(s)
Catheterization, Central Venous/methods , Central Venous Catheters , Jugular Veins/diagnostic imaging , Radiography, Thoracic/methods , Ultrasonography/methods , Adolescent , Brachiocephalic Veins , Child , Child, Preschool , Equipment Design , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , PuncturesABSTRACT
The molecular fingerprinting of a collection of 94 Staphylococcus aureus isolates from patients with osteomyelitis in Argentina was performed. Twenty-three SmaI pulsed-field gel electrophoresis (PFGE) types and 37 spa types were identified. The isolates were assigned to 23 sequence types (STs). The proportion of methicillin-resistant S. aureus (MRSA) isolates was significantly higher among cap5 S. aureus (35/61) compared with cap8 S. aureus (8/33) isolates (p = 0.0025). Twenty-four of the 94 isolates carried the lukS-PV/lukF-PV genes, which were significantly associated to cap5 [(23/38) compared with cap8 S. aureus isolates (1/32) (p = 0.0001)]. Forty of the 94 isolates carried genes of the egc locus (seg/sei). The distribution of seg/sei genes among isolates was related to certain clones. Isolates of the four agr types were found in the S. aureus collection. Whereas agr I isolates were evenly distributed among cap5 and cap8 S. aureus isolates (32/61 and 14/33, respectively), the agr II group was composed of 29 cap5 S. aureus isolates and agr III was composed of 16 cap8 S. aureus isolates. Two clones originally associated to animals (ST 188, 7 isolates and ST 1796, 5 isolates) were associated with chronic osteomyelitis and lack of capsular polysaccharide (CP) production. Loss of CP production remains the single factor among those investigated that is associated with chronic osteomyelitis.
Subject(s)
Bacterial Proteins/genetics , Osteomyelitis/microbiology , Polysaccharides, Bacterial/genetics , Staphylococcus aureus/isolation & purification , Virulence Factors/genetics , Argentina/epidemiology , Bacterial Typing Techniques , Electrophoresis, Gel, Pulsed-Field , Enterotoxins/genetics , Genes, Bacterial , Genetic Loci , Humans , Penicillin-Binding Proteins , Prevalence , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/classification , Staphylococcus aureus/genetics , Superantigens/genetics , Trans-Activators/geneticsABSTRACT
We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.
ABSTRACT
The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.
ABSTRACT
The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.
ABSTRACT
Background: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosupressive therapy (IT). Aim: To report the experience in the management of SAA. Patients and methods: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. Results: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. Conclusions: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Anemia, Aplastic/mortality , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Follow-Up Studies , Immunosuppressive Agents/adverse effects , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
BACKGROUND: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosuppressive therapy (IT). AIM: To report the experience in the management of SAA. PATIENTS AND METHODS: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. RESULTS: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. CONCLUSIONS: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Adolescent , Anemia, Aplastic/mortality , Child , Child, Preschool , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Male , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
OBJECTIVES: The present study was designed to investigate the association between the DRD4 genotype and auditory P300 amplitudes in a high-risk community sample. METHODS: ERPs were elicited in 197 eight-year-olds (98 boys, 99 girls) using a passive and an active oddball task. Auditory stimuli of 60 dB HL were presented binaurally at 1000 (standard stimulus) and 2000 Hz (target stimulus), at a relative frequency ratio of 80:20. Two trial blocks of 250 stimuli each were collected. P300 amplitudes were analyzed from Fz, Cz and Pz. DNA was genotyped for the DRD4 exon III polymorphism. RESULTS: A pattern of significant interactions of the DRD4 genotype with gender and experimental conditions was obtained. In both the active and the passive task, boys with at least one copy of the DRD4 7-repeat allele displayed significantly lower P300 amplitudes during the second trial block than boys carrying other alleles. CONCLUSIONS: This finding provides further evidence supporting a role of P300 amplitude reduction as an endophenotype for disinhibited psychopathology.
Subject(s)
Event-Related Potentials, P300/genetics , Polymorphism, Genetic/genetics , Receptors, Dopamine D4/genetics , Alleles , Child , DNA/genetics , Exons/genetics , Female , Genotype , Humans , Male , Psychiatric Status Rating Scales , Risk FactorsABSTRACT
Objetivos: Los tumores del Sistema Nervioso Central (TSNC) representan la segunda neoplasia más frecuente en la infancia. Por este motivo se decidió determinar la presentación clínica previa al diagnóstico y la latencia de la primera consulta, el diagnóstico y el inicio del tratamiento. Material y Métodos: Se analizó retrospectivamente la historia clínica de los niños atendidos en la Unidad de Oncología del Hospital Sótero del Río, con diagnóstico de TSNC, entre noviembre del 1994 y julio del 2002. La información se analizó mediante la prueba de t-student. Resultados: Los síntomas más frecuentes fueron cefalea (62,5 por ciento) y vómitos (56,2 por ciento). La latencia media de la primera consulta fue de 1 semana y los servicios más consultados fueron Consultorio (45,2 por ciento) y Urgencia (25,8 por ciento). El diagnóstico fue acertado en un 32,2 por ciento de las primeras consultas. La latencia media entre la primera consulta y el diagnóstico fue de 4 semanas, con un promedio de 2 consultas. La latencia media entre el diagnóstico y el inicio de tratamiento fue de 6 días para la cirugía, 37 días para la quimioterapia y 42 días para la radioterapia. Discusión: La cefalea y vómitos son los síntomas más frecuentes, su asociación con síntomas neurológicos debiera alertar al profesional de salud. La primera consulta es precoz, demorándose el diagnóstico por la baja sospecha, especialmente en los Consultorios. Respecto al tratamiento, la cirugía fue precoz, pero la radioterapia y quimioterapia sufrieron retrasos. En conclusión, es necesario reforzar la importancia de la sospecha diagnóstica, sobre todo a nivel de la atención primaria, así como también el manejo postoperatorio para no retrasar el inicio del resto del tratamiento.
Subject(s)
Humans , Child , Cancerous Symptoms , Central Nervous System Neoplasms , Headache , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
El manejo de los pacientes pediátricos con cáncer y neutropenia febril (NF) requiere de su clasificación en alto o bajo riesgo de adquirir infecciones bacterianas invasoras (IBI), con el fin de implementar estrategias selectivas de tratamiento. Basados en nuestra experiencia y publicaciones internacionales al respecto, proponemos recomendaciones para el diagnóstico y manejo de niños con cáncer y NF, categorizadas según riesgo de IBI. Todos los pacientes pediátricos que presenten episodios de NF deben ser ingresados al hospital por al menos 24 horas. Durante este lapso se efectuará su evaluación clínica y de laboratorio con el objeto de clasificar el riesgo de este episodio y precisar el (los) posible(s) foco(s). Los pacientes de alto riesgo deben continuar internados hasta su recuperación. Los de bajo riesgo pueden ser manejados en forma ambulatoria. La elección de la terapia antimicrobiana inicial y los criterios para su ajuste deberán basarse en el hallazgo o no de focos infecciosos y en los patrones epidemiológicos e institucionales de susceptibilidad. La reevaluación de ambos grupos debe ser periódica (al menos en los días 3, 5 y 7 de evolución), y la respuesta terapéutica será clasificada como favorable o desfavorable según criterios clínicos y parámetros de laboratorio preestablecidos.
Subject(s)
Humans , Child , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Fever/etiology , Bacterial Infections/etiology , Bacterial Infections/drug therapy , Neoplasms/complications , Neutropenia/complications , Neutropenia/etiology , Neutropenia/therapy , Outcome Assessment, Health Care , Treatment OutcomeSubject(s)
Humans , Child, Preschool , Adolescent , Infant, Newborn , Infant , Child , Neoplasms , Life Expectancy , Prognosis , Treatment OutcomeABSTRACT
Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population
Subject(s)
Humans , Male , Child, Preschool , Adolescent , Female , Mycoses , Neoplasms , Fungemia , Fever , Mycoses , Neutropenia , Antineoplastic Agents/adverse effectsSubject(s)
Humans , Male , Female , Blood Chemical Analysis/methods , Anemia , Erythrocyte Indices , Hematocrit/methods , Hemoglobins, Abnormal , Leukocytosis , NeutropeniaABSTRACT
Un grupo oncológico pediátrico nacional, PINDA, reporta el primer protocolo prospectivo, no randomizado, para tratamiento de la leucemia linfoblástica (LLA), usando una versión modificada del protocolo de Berlín-Frankfurt-Munster (LLA BFM 86). Los objetivos de este estudio fueron clasificar inmunofenotipos, disminuir radioterapia de cráneo y comprobar si este protocolo podía mejorar la sobrevida de nuestros pacientes. Procedimiento: desde junio 1987 a junio 1992 se registraron 444 pacientes, no seleccionados; de ellos 425 fueron evaluables. La terapia fue estratificada según riesgo: riesgo bajo (RB), riesgo alto (RA) y riesgo muy alto (RMA). Los pacientes en RB y RA recibieron inducción con protocolo I, consolidación con protocolo M (RMA usó protocolo E), reinducción con protocolo II y mantención. Todos recibieron tratamiento de prefase con prednisona oral y metotrexato (MTX) intratecal. Radioterapia de cráneo solo en RA y RMA (12-18 Gy). Los siguientes cambios se introdujeron al protocolo LLA BFM 86: en protocolo M 1 g/m² en vez de 5 g/m²; en protocolo E, 1 g/m² de citarabina en vez de 2 g/m², la mitoxantrona e ifosfamida fueron sustituidas por teniposido y ciclofosfamida. Resultados: inmunofenotipo: LLA común 67,4 por ciento, LLA proB 14 por ciento, LLA T 10 por ciento, LLA preB 4,3 por ciento. La frecuencia de sobrevida libre de eventos (SLE) global a 5 años fue 60 por ciento ñ 2 por ciento error standard; según riesgo fue: RB 75 por ciento, RA 62 por ciento, RMA 28 por ciento con una mediana de seguimiento de 6,5 años (rango 4,5 - 9,5 años). La incidencia acumulada de recaída en sistema nervioso central SNC fue 5,4 por ciento. Conclusión: hemos tenido éxito en realizar un estudio a nivel nacional. Nuestra estrategia para adaptar el protocolo BFM fue efectiva para mejorar la SLE. La distribución por fenotipos es similar a otras series
Subject(s)
Humans , Male , Female , Child, Preschool , Antineoplastic Combined Chemotherapy Protocols , Clinical Protocols , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Chile , Cranial Irradiation , Cyclophosphamide/administration & dosage , Cytarabine/administration & dosage , Developing Countries , Disease-Free Survival , Immunophenotyping/methods , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Methotrexate/pharmacology , Prednisone/pharmacology , Prognosis , Teniposide/administration & dosageABSTRACT
Seven seed samples of J. curcas, both in raw and roasted state, sold in some villages in Quintana Roo state, Mexico for human consumption were analyzed for physical characteristics, nutrients and antinutrients. The average seed weight varied from 0.53 to 0.74 g and kernel weight as proportion of raw seed weight was from 61 to 66%. The contents of crude protein, lipid and ash of kernels from raw seeds were 27-30%, 55-62% and 3.7-5.2% respectively. The levels of antinutrients in meal from the raw seeds were: trypsin inhibitor activity (14.6-28.7 mg trypsin inhibited/g), lectin (25.6-52.2 unit; one unit is the reverse of minimum amount of mg meal/ml assay which produced haemagglutination), saponins (1.9-2.3% as diosgenin equivalent) and phytate (8.4-10%). Phorbol esters in kernels from raw seeds were not detected in four samples and in other three samples it ranged from 0.01 to 0.02 mg/g as phorbol-12-myristate 13-acetate equivalent. Roasting of seeds inactivated almost 100% of trypsin inhibitor activity. Although lectin activity reduced on roasting, it was still present in high amounts. Saponins, phytate and phorbol esters were not affected by roasting.
Subject(s)
Euphorbiaceae , Plants, Edible , Cooking , Euphorbiaceae/chemistry , Mexico , Plants, Edible/chemistry , Plants, Toxic , Seeds/chemistryABSTRACT
Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer. The leukemic cells of ALL patients show several well defined numeric and structural chromosomal abnormalities which are universally known for its prognostic implications. We studied a group of 44 children with ALL, to investigate the incidence of chromosome aberrations in ALL, its lymphocyte lineage and some clinical feature associations, ans the finding of non previously described aberrations. A high proportion of patients (79.5 per cent) showed chromosomal abnormalities. Most of them had a pseudodiploid karyotype (46 chromosomes), characterized mainly by a translocation. In relation to chromosome number, 27 percent of them were hyperdiploid with more than 50; 9 percent hyperdiploid between 47 - 50 and 7 percent hypodiploid (less than 46). Among structural aberrations found, were the following recurrent translocations: t(1;19), t(4;11), t(9;22) in 6.8 percent, 9.1 percent and 2.3 percent of cases respectively, all related to an early B immunophenotype. Other translocations found, compromised regions 7q22,9p21 -24. Two new translocations in ALL were found: 8(1;5)(q23;q33), apparently balanced and t(13;21)(q14;q22), unbalanced. Other recurrent structural changes found were: deletion (6q), (7q), (7q), (11q), (12q), inversion (3q), isochromosome (7q), maker chromosomes and double minutes. The distribution of chromosome abnormalities in this group of patients was in agreement with previous reports from other investigators
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Ploidies , Translocation, Genetic/genetics , Chromosome Aberrations/classification , Chromosome Aberrations/epidemiology , Karyotyping/methods , Cytogenetics/methods , Immunophenotyping/methods , PrognosisABSTRACT
Thirty-three children with post-streptococcal acute glomerulonephritis, age x:8.3 years (range 6-12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6 percent with 90 percent showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was <0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentaje of transferrin saturation were normal for this age group although 75 percent of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1 percent but 44 percent still had anemia. Hct increased spontaneously for 105 days stabilizing at 38 percent. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p<0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group II, suggest other pathogenic factors