Acute and chronic renal impairment can be developed in patients who undergo HSCT even though the pre-transplant renal function is in normal limits and the conditioning regimen does not include TBI. Both glomerular and tubular renal function evaluation should be part of a long-term follow-up in children following HSCT.
The aim of this study was to determine the clinical features and microbiological spectrum during episodes of fever and neutropenia (FEN) in children with cancer. Demographics, clinical information, treatment approaches, and outcomes of the patients admitted to Akdeniz University Department of Pediatric Hematology and Oncology from October 1996 to June 2004 were evaluated retrospectively. Of the total 621 episodes, 345 (55.5%) were microbiologically documented (MDI) (36.4%) or clinically suspected (CSI) (19.2%) infections. A total of 425 infections were diagnosed in 345 episodes, in which lower respiratory tract infections were the most common (32.7%). Among the microbiologically documented infections, Staphylococci (both coagulase-negative and coagulase-positive) (38.7%) and Escherichia coli (12.9%) were the most frequently isolated gram-positive and gram-negative organisms, respectively. Monocytopenia less than 100/microL (p = 0.01), duration of neutropenia (p = .01) and fever (p < .001) were significantly associated with documented infection by univariate analysis. In addition, presence of previous FEN episode (p = .001) and hypotension (p = .029) were also found to be risk factors. However, using the multivariate analyses, only the duration of fever was found to be an independent risk factor for MDI. The rate of mortality was significantly higher among under 1-year-old patients (p = .039). Hypotension and uncontrolled cancer were the significant determinants of poor prognosis. These results may help to consider a more selective management strategy for children with these problems.
Cardiac dysfunction, including congestive heart failure and fatal arrhythmia, is a frequent cause of death among children with thalassemia major (TM). Autonomic nervous system activity typically is measured by a series of cardiovascular autonomic function tests, but these tests are unsuitable for young patients because they are invasive or complex. Heart rate variability assessment is a technique that measures the beat-to-beat variability in R-R intervals. This variability reflects changes in autonomic activity and their impact on cardiovascular function. This study examined 32 patients with TM to evaluate heart rate variability (HRV) in a preclinical phase of cardiac involvement. The study patients showed no evidence of heart failure or signs of peripheral or autonomic neuropathy. All HRV parameters were significantly reduced in the TM patient group compared with the control group. The results of this study can be interpreted as evidence of early cardiac autonomic neuropathy in young thalassemic patients. Therefore, all TM patients should be screened using HRV analysis for that complication.
Serum cysC and GFRcysC cannot reflect GFR accurately in pediatric patients under chemotherapeutic treatment. Tubular cell damage induced by chemotherapeutics could be a responsible factor through the impairment of tubular absorption and metabolism of cysC.
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