Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.
Male and female tennis players (N = 100) completed the Competitive State Anxiety. Inventory-2 about 1 hr. before playing singles and doubles matches. Multivariate analysis of variance of anxiety and self-confidence responses by match result indicated that winners of singles matches had significantly lower scores on Cognitive Anxiety and higher ones on Self-confidence scores than losers. Winners of doubles matches had significantly higher Self-confidence scores than losers. Discriminant function analysis indicated that 72% of results for singles matches and 70% of results for doubles matches could be correctly classified from responses to the precompetition measures. A comparison of anxiety responses by playing condition indicated that, irrespective of the match outcome, scores on Cognitive and Somatic Anxiety were higher and scores on Self-confidence were lower before playing singles than before playing doubles. The findings suggest that precompetition scores on measures of anxiety provide significant indicators of performance in tennis but that responses vary for singles and doubles play.
Background
Healthcare associated mold infections (HAEMI) increase morbidity and mortality in children with leukemia. Excavation adjacent to Children’s Medical Center Dallas (CMCD) April 2006–February 2007 provided an opportunity to determine if excavation adjacent to a hospital building is associated with increased risk of developing HAEMI in children receiving intensive chemotherapy for acute leukemia.
Methods
Children who began receiving intensive chemotherapy for acute leukemia at CMCD from 2004–2008 were identified (N=275). Exposures to the CMCD campus during intensive chemotherapy and duration of neutropenia per exposure were recorded. Proven, probable or possible invasive fungal disease (IFD) was classified using EORTC/MSG guidelines. Institutional guidelines categorized mold infections as definite or possible HAEMI. A bivariate time-to-event model compared the association of excavation with HAEMI and yeast infections, controlling for neutropenia.
Results
There were 7454 CMCD exposures, 1007(13.5%) during excavation. Of 50 cases of IFD, 31 were HAEMI. By time-to-event analysis exposure to the CMCD campus during the excavation period was significantly associated with HAEMI (HR=2.8, P=0.01) but not yeast infections (HR=0.75, P=0.75). Neutropenia was significantly associated with both HAEMI and yeast infections (P<0.001). Voriconazole prophylaxis did not prevent HAEMI in 42% of the 14 patients with AML who had been receiving this agent.
Conclusion
This study is the first to demonstrate an association between exposure to hospital construction that includes excavation and HAEMI in pediatric oncology patients. Since neutropenic patients need protection from aerosolized fungal spores during visits to expanding medical centers, preventive strategies with adherence monitoring need additional study.
achievement of steady state. The half life (t 1/2) of voriconazole was 5.0965.15 hours. The dose normalized (per mg) AUC (mg*hr/ml) was 0.11160.081. Voriconazole dose did not correlate with AUCo-N (r 2 5 0.028). There was a good correlation between AUCo-N and C trough (r 2 5 0.94). Population estimates of bioavailability, clearance, apparent volume of the central compartment (Vc) and apparent volume of peripheral compartment (Vp) were 46.5%, 5.76L/hr, 19.4L and 58.8L. Conclusions: The bioavailability of voriconazole was significantly lower in pediatric BMT patients than in non-transplant adult subjects. The t 1/2 at steady state tended to be lower than adult patients. Our study suggests that pediatric patients may require dosing higher than 7 mg/kg twice daily. The wide individual variability and the lack of correlation between dose and AUC support therapeutic monitoring of voriconazole and dose adjustments based on steady state blood levels.
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