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Introduction: Febrile neutropenia (FN) is a serious complication of cancer chemotherapy. The present study aimed to identify risk factors for documented infection in pediatric patients with FN and cancer. Methods: This prospective cohort study included patients under 18 years from 2016 to 2018. Infection was defined according to the Centers for Disease Control and Prevention criteria. Results: A total of 172 febrile neutropenic episodes were evaluated. From univariate analysis, the risk factors were: female gender; monocyte count < 100 cell/mm³, platelets < 50,000, C-reactive protein (CRP) > 90 mg/dl and hemoglobin < 7mg/dl at the onset of an episode; two or more episodes of FN, and; fever onset; positive blood culture at the fever onset. Independent risk factors according to the multivariate analysis were: CRP at the onset of a febrile episode > 90mg/dl, fever onset and first blood culture with a positive result. The lowest probability of infection was related to first episode and to platelets > 50,000 at the onset of fever. Conclusion: A CRP > 90 at the onset of a febrile episode, platelets < 50,000, second episode or more, first fever episode during hospitalization and positive first blood culture were found to be associated with a higher risk of infection and they could be useful for the establishment of risk scores for infection in neutropenic children.

Coagulase-negative Staphylococcus has been identified as the main nosocomial agent of neonatal late-onset sepsis. However, based on the pharmacokinetics and erratic distribution of vancomycin, recommended empirical dose is not ideal, due to the inappropriate serum levels that have been measured in neonates. The aim of this study was to evaluate serum levels of vancomycin used in newborns and compare the prediction of adequate serum levels based on doses calculated according to mg/kg/day and m2/day. This is an observational reprospective cohort at a referral neonatal unit, from 2011 to 2013. Newborns treated with vancomycin for the first episode of late-onset sepsis were included. Total dose in mg/kg/day, dose/m2/day, age, weight, body surface and gestational age were identified as independent variables. For predictive analysis of adequate serum levels, multiple linear regressions were performed. The Receiver Operating Characteristic curve for proper serum vancomycin levels was also obtained. A total of 98 patients received 169 serum dosages of the drug, 41 (24.3%) of the doses had serum levels that were defined as appropriate. Doses prescribed in mg/kg/day and dose/m2/day predicted serum levels in only 9% and 4% of cases, respectively. Statistical significance was observed with higher doses when the serum levels were considered as appropriate (p

Background and objectives: The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. Methods: 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2 mg were randomized to receive, after the child's birth, metoclopramide 10 mg (Group I – control), droperidol 2.5 mg (Group II) or ondansetron 8 mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. Results: Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23–0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49–1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively. Conclusions: Ondansetron does not inhibit subarachnoid morphine-induced pruritus. Resumo: Justificativa e objetivos: O efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea. Métodos: 180 pacientes ASA I ou II programadas para serem submetidas a cesarianas sob anestesia subaracnoidea à qual foram acrescentados 0,2 mg de morfina foram divididas aleatoriamente para receber, logo após o nascimento da criança, 10 mg de metoclopramida (grupo I – controle), 2,5 mg de droperidol (grupo II),ou 8 mg de ondansetron (grupo III). No período pós-operatório as pacientes foram avaliadas quanto ao prurido (ausente, leve, moderado ou intenso) ou outros efeitos colaterais por observadores que não sabiam a alocação das pacientes. As pacientes também não sabiam da sua alocação. Os grupos foram comparados pela sua tendência a apresentar formas mais severas de prurido. Também determinamos o NNT. Resultados: As pacientes alocadas para receber droperidol [Odds Ratio Proporcional: 0,45 (Intervalo de Confiança de 95% 0,23 – 0,88)] relataram menos prurido do que as que receberam metoclopramida. O efeito do ondansetron foi semelhante ao da metoclopramida [Odds Ratio Proporcional: 0,95 (Intervalo de Confiança de 95% 0,49 – 1,83)]. O NNT do droperidol foi 4,0 e o do ondansetron foi 14,7. Conclusões: O ondansetron não inibiu o prurido provocado pela morfina subaracnoidea. Keywords: Droperidol, Morphine, Ondansetron, Pruritus, Subarachnoid injection, Palavras-chave: Droperidol, Morfina, Ondansetron, Prurido, Injeção subaracnoidea

Aplastic anemia is an uncommon complication of thymoma and is extremely infrequent after the surgical removal of a thymic tumor. Aplastic anemia is a result of marrow failure and is characterized by peripheral pancytopenia and severely depressed marrow cellularity; it may be an autoimmune manifestation of thymoma. As thymoma-associated hematological dyscrasias, which include pure red cell aplasia, aplastic anemia and myasthenia gravis, are supposed to be of immunologic origin, two cases of very severe aplastic anemia following the resection of lymphocytic thymomas treated with immunosuppression are herein presented.

Introduction: The incorporation of light-curable resins has been proposed for mineral trioxide aggregate (MTA) to improve its properties and reduce its setting time. The aim of the present study was to assess the pH and calcium ion release of an experimental bisphenol A ethoxylate dimethacrylate/MTA-based root-end filling material (E-MTA) in comparison with white MTA Angelus (Angelus, Londrina, PR, Brazil) (W-MTA) and to evaluate the influence of the addition of calcium chloride (CaCl2) on these properties., Methods: Polyethylene tubes filled with the materials were immersed in deionized water for the measurement of pH (digital pH meter) and calcium release (atomic absorption spectrophotometry). The evaluations were performed at 3 and 24 hours and 7, 15, and 30 days. Data were measured using 2-way repeated measures of variance followed by the Holm-Sidak method (P < .05)., Results: All materials presented a reduction in the pH and released calcium ions during the 30 days of the study. E-MTA showed a significantly lower calcium ion release capacity when compared with W-MTA (P < .05). The calcium release of E-MTA + 5% CaCl2 was similar to W-MTA (P > .05)., Conclusions: The monomer bisphenol A ethoxylate dimethacrylate added to MTA formed a material with a lower capacity of calcium release than W-MTA despite maintaining a similar pH. However, the addition of CaCl2 improved the calcium release of this material., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Cisplatin and carboplatin are the most common platinum-based drugs used in cancer treatment. Pharmacokinetic investigations, the evaluation of the body burden during the treatment, as well as baseline levels of platinum in humans have attracted great interest. Thus, accurate analytical methods for fast and easy Pt monitoring in clinical samples become necessary. In the present study atomic absorption spectrometric methods for the determination of platinum in the forms of cisplatin and carboplatin in human urine were investigated. Platinum, in these different forms, could be determined in urine, after simple sample dilution. Regarding electrothermal atomic absorption spectrometry, the optimum parameters were defined by a central composite design optimization. Multiplicative matrix effects were overcome by using a mixture of HCl and NaCl as modifier. The limit of detection (LOD) was 0.004 mgL(-1) of platinum in the original sample. For the analysis of more concentrated samples, high resolution continuous source flame atomic absorption spectrometry was also investigated. Flame conditions were optimized by a multivariate D-optimal design, using as response the sum of the analyte addition calibration slopes and their standard deviations. Matrix matched external calibration with PtCl(2) calibration solutions, was possible, and the LOD was 0.06 mgL(-1) in the original sample. The results obtained by the proposed procedures were also in good agreement with those obtained by an independent comparative procedure., (Copyright © 2010 Elsevier B.V. All rights reserved.)

This work presents the development of an on-line pre-concentration system for simultaneous determination of Cd, Cu, Ni, V, Zn, Co and Pb in aqueous environmental samples and detection by inductively coupled plasma mass spectrometry. The system is based on cationic retention of the analytes onto a mini-column filled with silica gel modified with niobium(V) oxide. The effects of chemicals and flow variables have been investigated. The optimized operating conditions, selected as a compromise between sensitivity and analytical frequency were: sample pH 7.0, sample flow rate of 6.0mL min(-1), eluent flow rate of 2.0mL min(-1), and eluent (HNO(3)) concentration of 2.5mol L(-1). The relative standard deviation (n=7), enrichment factor and linear working range were 0.8-4.5%, 23.3-37.2 and 0.05-25.0microg L(-1), respectively. Limits of detection were between 0.01 and 0.03microg L(-1). The accuracy of the proposed method was checked with certified materials (NASS-4, NASS-5, CASS-4 and SRM 1643e). Values obtained were in accordance with those reported for the certified materials. Recovery was found to be in the range of 90-110% for a suit of water samples with variable matrices (seawater, tap water and ground water) collected in Florianopolis, Brazil.