Predictors of severe adverse outcomes in febrile neutropenia of pediatric oncology patients at a single institute in Thailand

Abstract

Febrile neutropenia in pediatric oncology patients may lead to severe infection, with adverse events including septic shock or death. The aim of the study was to investigate the prevalence of severe adverse outcomes and to determine the associated risk factors. This is a retrospective cohort study of pediatric oncology patients with febrile neutropenia from October 2013 to September 2017 at Thammasat University Hospital, Thailand. Clinical assessment and time-to-event of severe outcomes were analyzed. There were 95 febrile neutropenic episodes; severe adverse outcomes were documented in 11 (11.5%), with no infection-associated mortalities. Those with severe outcomes were older, received prophylactic granulocyte-colony stimulating factor (G-CSF), and had documented infection, lower initial ANC, and central venous catheter insertion. The proportional hazard regression model revealed age ≥ 10?years (hazard ratio [HR], 5.96; p?=?0.005), prophylactic G-CSF (HR, 4.52; p?=?0.028), and microbiologically documented infections (HR, 12.53; p?=?0.017) independently predicted severe adverse outcomes. Although severe adverse outcomes occurred in only 11.5% of our febrile neutropenic episodes, we identified a few risk factors that may help predict those at highest risk.     

Aeroallergen sensitivity among Thai children with allergic respiratory diseases: a hospital-based study

One hundred and twenty patients, aged 3-15 years, attending the Allergy Clinic, Thammasat University Hospital, with allergic rhinitis, asthma or both conditions were studied. Standardized skin prick tests were performed with 15 common aeroallergens. The subjects were 85 boys and 35 girls with the mean age of 8.1 years (SD = 3.4 years). There were 63 cases (53%), 22 cases (18%) and 35 cases (29%) diagnosed with allergic rhinitis only, asthma only and both conditions, respectively. The prevalence of asthma among the allergic rhinitis patients was 36 percent whereas the prevalence of allergic rhinitis among the asthmatic patients was 61 percent. The sensitization patterns for major aeroallergens among the three groups were similar with the most common sensitized allergens as D. pteronyssinus, followed by D. farinae, American cockroach, Kopok and German cockroach, respectively. Among the atopic patients, a greater number of allergen reactivity was significantly associated with the increased risk of having their coexistence of allergic rhinitis and asthma (p = 0.0046; score test for trend of odds ratio).     

The study of broken quadrilateral surface in fractures of the acetabulum

Purpose

Three-dimensional computerised tomography (3DCT) can provide comprehensive patho-anatomy of complex bone on a single image. Though important, the key articular quadrilateral [Q] surface has not been a part of the systems developed for classifying acetabulum fractures. The purpose of the study was to simplify the complexity of classification by the direct sign of the broken Q surface which lies opposite the entire floor of the acetabulum.

Methods

The study reviewed 84 acetabular fractures using 3DCT images of the interior lateral view (IL) taken between June 2002 to December 2009. Fractures were traditionally classified using the anatomical disruption, plane of the fracture line breaking through or not through the bone column described by Judet and Letournel.

Results

The 3D images clearly show the primary site of impaction acting on the acetabulum and the whole course of fracture. The image could not illustrate disruption of the lips of acetabulum and congruity of hip joints in 20 cases of wall (W) fracture. There were 30 transverse (T) fractures classified when the acetabulum was divided horizontally from front to back into upper and lower parts and 34 cases of column (C) fracture when the main vertical lines run and collide along the anterior and posterior column.

Conclusions

This study showed that the well-known complex fractures can be satisfactorily classified with the broad flat inner plane of the Q surface.     

Reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 4.0

Purpose

The study aimed to evaluate the reliability and validity of the Thai version of the Pediatric Quality of Life Inventory? 4.0 Core Scales (PedsQL) as a measure of health-related quality of life (HRQOL).

Methods

The PedsQL items were completed by 2,086 pupils aged 8–15 years and 1,914 parents from four schools, and 100 pediatric outpatients and 100 parents from a University Hospital. Test–retest reliability was conducted in a randomly selected of 150 pupils at a 1-month interval.

Results

Internal consistency reliability for the Total Scale score (α = 0.84 self-report, 0.88 proxy-report), Physical Health Summary score (α = 0.76 self-report, 0.79 proxy-report), and Psychosocial Health Summary score (α = 0.74 self-report, 0.85 proxy-report) exceeded the minimum reliability standard of 0.70. School children had significantly higher mean HRQOL scores compared to those with chronic health conditions for all subscales with the mean differences of 3.1–12.4 for self-report (p < 0.03) and 7.7–15.6 for proxy-report (p < 0.001). Test–retest reliability showed intraclass correlation coefficients above 0.60 in all subscales (p < 0.001).

Conclusions

The Thai version of PedsQL had adequate reliability and validity and could be used as an outcome measure of HRQOL in Thai children aged 8–15 years.     

Type of injury and number of anastomosed vessels: impact on digital replantation

A retrospective study of 130 digital replantations was analyzed to identify factors influencing success rates. At the amputation between the middle phalanx and distal interphalangeal joint, it was found that type of injury and number of anastomosed vessels and veins were the most important factors. Amputations caused by mechanical crush reduced the number of available vessels for anastomoses. Having an anastomosed artery without any anastomosed vein significantly reduced the success rate compared with cases of amputation by knife or sawing machine, where at least an artery and a vein could be anastomosed. In replantation at the distal phalanx, only one anastomosed artery without any anastomosed vein could also result in high success. And in most cases of amputation between the proximal phalanx and proximal interphalangeal joint, there was no difficulty in finding at least an artery and a vein. Knowledge of anatomical transitions is therefore important for surgeons.     

HLA‐B*1502 Strongly Predicts Carbamazepine‐Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Thai Patients with Neuropathic Pain

Background: Carbamazepine (CBZ) is one of the standard pharmacological treatments for neuropathic pain. However, its serious adverse drug reactions include Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Recently, HLA‐B*1502 allele was implicated as a genetic marker of CBZ‐induced SJS/TEN in some Asian epilepsy populations. Methods: This is a case control study to describe the clinical characteristics of SJS/TEN in Thai patients with neuropathic pain who were treated with CBZ, and to determine the association of HLA‐B*1502 in these patients, comparing with those who exposed to CBZ for at least 6 months without any cutaneous reactions. Results: Thirty‐four SJS/TEN patients and 40 control patients were included in this study. Mean age of SJS/TEN patients was 47 years. SJS/TEN was developed in 10.8 ± 1.4 days after initiation of CBZ. HLA‐B*1502 allele was found in 32 of 34 SJS/TEN patients (94.1%) but it was found only in 7 of 40 control patients (17.5%). The association was very strong with an odds ratio of 75.4. Sensitivity and specificity of this HLA‐B*1502 genotype test were 94.1% and 82.5%, respectively, while the positive predictive value and negative predictive value were 1.43% and 99.98%, respectively. Positive and negative likelihood ratios were 5.37 and 0.07, respectively. Conclusions: HLA‐B*1502 is a strong genetic marker for CBZ‐induced SJS/TEN in Thai patients with neuropathic pain. The screening for this marker should be performed prior to initiation of CBZ treatment to assess the risk of this serious side effect.