39 results on '"De la Maza V"'
Search Results
2. Predictive factors of contamination in a blood culture with bacterial growth in an Emergency Department
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Hernández-Bou, S., Trenchs Sainz de la Maza, V., Esquivel Ojeda, J.N., Gené Giralt, A., and Luaces Cubells, C.
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- 2015
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3. Poisonous plants: An ongoing problem
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Martínez Monseny, A., Martínez Sánchez, L., Margarit Soler, A., Trenchs Sainz de la Maza, V., and Luaces Cubells, C.
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- 2015
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4. Has the presence of parents during invasive procedures in the emergency department increased in the last few years?
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Angel Solà, J., Sagué Bravo, S., Parra Cotanda, C., Trenchs Sainz de la Maza, V., and Luaces Cubells, C.
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- 2015
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5. Antidote use in a paediatric emergency department
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Martínez Sánchez, L., Almario Hernández, A.F., Escuredo Argullós, L., Maçao, P., Trenchs Sainz de la Maza, V., and Luaces Cubells, C.
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- 2014
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6. Oral therapy for urinary tract infections in infants aged 3 to 12 months
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Claret Teruel, G., García García, J. J., Fernández de Sevilla Estrach, M., Corrales Magin, E., Trenchs Sáinz de la Maza, V., Rodríguez Arráez, A., Camacho Díaz, J. A., and Luaces Cubells, C.
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- 2008
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7. Poisonous snakebites: A five-year experience
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Vico Andueza, L., Martínez Sanchez, L., Martínez Osorio, J., Trenchs Sainz de La Maza, V., and Luaces Cubells, C.
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- 2015
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8. PIN16 - Caracterización Clínica Y Económica De Hospitalización Por Varicela En Niños En La Región Metropolitana Y Región De Valparaíso, Chile
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Torres, JP, De la Maza, V, Castro, M, Conca, N, Izquierdo, G, Suau, T, Rodriguez, P, Contardo, V, Rosales, A, and Ducasse, K
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- 2017
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9. Epidemiological changes of invasive fungal disease in children with cancer: Prospective study of the National Child Program of Antineoplastic Drugs network, Chile.
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Barraza M, Valenzuela R, Villarroel M, de la Maza V, Contardo V, Álvarez AM, Gutiérrez V, Zubieta M, Martínez D, and Santolaya ME
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- Humans, Chile epidemiology, Male, Prospective Studies, Child, Female, Child, Preschool, Incidence, Immunocompromised Host, Adolescent, Infant, Antineoplastic Agents therapeutic use, Invasive Fungal Infections epidemiology, Invasive Fungal Infections drug therapy, Neoplasms epidemiology, Neoplasms complications
- Abstract
Background: Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile., Methods: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated., Results: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020., Conclusion: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)
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- 2024
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10. Efficacy and safety of withholding antimicrobial therapy in children with cancer, fever, and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial.
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Torres JP, Ibañez C, Valenzuela R, Rivera S, De la Maza V, Villarroel M, Coria P, Contardo V, Álvarez AM, Zubieta CM, Gutierrez V, Ducasse K, Martínez D, and Santolaya ME
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- Humans, Male, Female, Child, Child, Preschool, Prospective Studies, Chile, Febrile Neutropenia drug therapy, Infant, Withholding Treatment, Fever drug therapy, Treatment Outcome, Anti-Infective Agents therapeutic use, Anti-Infective Agents administration & dosage, Anti-Infective Agents adverse effects, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents adverse effects, Hospitalization, Adolescent, Respiratory Tract Infections drug therapy, Respiratory Tract Infections virology, Virus Diseases drug therapy, Neoplasms drug therapy, Neoplasms complications
- Abstract
Objectives: To validate the efficacy and safety of withholding antimicrobial therapy in a new cohort of children with cancer and febrile neutropenia (FN) having a demonstrated viral respiratory tract infection., Methods: Prospective, multicenter, noninferiority, randomized study, approved by the ethical committee, in children presenting with FN at seven hospitals in Chile, evaluated at admission for diagnosis of bacterial and viral pathogens. Children who were positive for a respiratory virus, negative for a bacterial pathogen, and had a favourable evolution after 48-72 hours of antimicrobial therapy were randomized to either maintain or withhold antimicrobial therapy. The primary endpoint was the percentage of episodes with an uneventful resolution, whereas the secondary endpoints were days of fever, days of hospitalization, requirement of antimicrobial treatment readministration, sepsis, paediatric intensive care unit admission, and death., Results: A total of 301 of 939 children with FN episodes recruited between March 2021 and December 2023 had a respiratory virus as a unique identified microorganism, of which 139 had a favourable evolution at 48-72 hours and were randomized, 70 to maintain and 69 to withdraw antimicrobial therapy. The median days of antimicrobial therapy was 5 (IQR 3-6) versus 3 (IQR 3-6) days (p < 0.001), with similar frequency of uneventful resolution 66/70 (94%) and 66/69 (96%); relative risk, 1.01; (95% CI, 0.93 to 1.09), absolute risk difference 0.01; (95% CI, -0.05 to 0.08) and similar number of days of fever and days of hospitalization. No cases of sepsis, paediatric intensive care unit admission, or death were reported., Discussion: We validated the strategy of withdrawal antimicrobial therapy in children with FN and viral respiratory tract infection based on clinical and microbiological/molecular diagnostic criteria. This will enable advances in antimicrobial stewardship strategies with a possible future impact on antimicrobial resistance., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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11. Violence against healthcare workers in a high complexity pediatric center.
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Valls Ramon-Cortés J, Casas Cascante C, Dalmau Pons I, Trenchs Sainz de la Maza V, Luaces Cubells C, and Parra Cotanda C
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- Humans, Female, Male, Workplace Violence statistics & numerical data, Workplace Violence prevention & control, Health Personnel, Adult, Hospitals, Pediatric
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- 2024
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12. Prevalence of sexually transmitted infections after penetrative rape of pediatric patients.
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Curcoy Barcenilla AI, Alonso-Cadenas JA, Díez Sáez C, and Trenchs Sainz de la Maza V
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- Humans, Prevalence, Female, Child, Male, Adolescent, Spain epidemiology, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases diagnosis, Rape statistics & numerical data
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- 2024
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13. Evaluation of FebriDx® for the management of children with acute febrile respiratory infection.
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de la Matta Farrando P, Suay Torres MT, Sabater Sabate A, Trenchs Sainz de la Maza V, Luaces Cubells C, and Hernández Bou S
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- Humans, Prospective Studies, Child, Preschool, Infant, Child, Male, Female, Acute Disease, Adolescent, Anti-Bacterial Agents therapeutic use, Respiratory Tract Infections drug therapy, Respiratory Tract Infections diagnosis, Fever drug therapy, Fever etiology
- Abstract
Introduction: Acute respiratory infections (ARI) are a common cause of inappropriate antibiotic prescription (ATB) in pediatrics. FebriDx® is a rapid diagnostic test that differentiates between viral and bacterial infections. The objective is to analyse the impact of FebriDx® on ATB prescription when managing febrile ARI., Methods: Prospective study carried out in patients aged 1-<18 years with febrile ARI in the emergency department. FebriDx® was performed and the impact on management was evaluated at follow-up., Results: A total of 216 patients were included. Clinical assessment and FebriDx® result coincided coincided in 174 (80.5%) cases. A modification of the initial therapeutic plan was made in 22 (52.4%) of the 42 discordant ones (10.2% of the overall patients). In pneumonia the impact was 34.5%; in all cases it involved not prescribing ATB., Conclusions: FebriDx® could be a useful tool in the management of pediatric patients with febrile ARI to optimize ATB prescription., (Copyright © 2024 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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14. Transdisciplinary research before, during and after COVID-19 vaccination in Chile: a virtuoso collaboration with future perspectives.
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Torres JP, Basso L, Saure D, Zuñiga M, Couve A, Farfán M, de la Maza V, Campos N, and O'Ryan M
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- Child, Humans, Chile, Interdisciplinary Research, Pandemics, SARS-CoV-2, Vaccination, COVID-19 Vaccines, COVID-19
- Abstract
The COVID-19 pandemic presented numerous challenges that required immediate attention to mitigate its devastating consequences on a local and global scale. In March 2020, the Chilean government, along with health and science authorities, implemented a strategy aimed at generating relevant evidence to inform effective public health decisions. One of the key strengths of this strategy was the active involvement of the scientific community, employing transdisciplinary approaches to address critical questions and support political decision-making. The strategy promoted collaborations between the government, public and private institutions, and transdisciplinary academic groups throughout each phase of the pandemic. By focusing on pressing problems and questions, this approach formed the foundation of this report which reflects the collaborative effort throughout the pandemic of individuals from the Instituto de Sistemas Complejos de Ingeniería (ISCI), the Faculty of Medicine of the University of Chile, government authorities and industry. Early in the pandemic, it became crucial to gather evidence on how to minimize the impact of infection and disease while awaiting the availability of vaccines. This included studying the dynamics of SARS-CoV-2 infection in children, assessing the impact of quarantines on people's mobility, implementing strategies for widespread SARS-CoV-2 polymerase chain reaction (PCR) testing, and exploring pool testing for large populations. The urgent need to reduce disease severity and transmission posed a significant challenge, as it was essential to prevent overwhelming healthcare systems. Studies were conducted to predict ICU bed requirements at the local level using mathematical models. Additionally, novel approaches, such as using cellphone mobility-based technology to actively identify infected individuals, and to optimize population sampling, were explored following the first wave of the pandemic. Chile took early action in addressing vaccination through a high-level scientific board, before vaccines became available. Studies conducted during this period included population-based immunologic evaluations of different vaccines, which helped build confidence in the population and supported the need for booster doses and potential vaccination of children. These studies and collaborations, which will be discussed here, have provided valuable insights and will inform future approaches in a post-pandemic world. Importantly, highly conservative estimates indicate that 3,000 lives and more than 300 million USD were saved by this academic-public-private collaborative effort., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Torres, Basso, Saure, Zuñiga, Couve, Farfán, de la Maza, Campos and O’Ryan.)
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- 2024
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15. Usefulness of Peripheral Blood Cultures in Children With Cancer and Episodes of Fever and Neutropenia.
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Sarquis T, Ibáñez C, De La Maza V, Valenzuela R, Zubieta M, Labraña Y, Gutiérrez V, Greppi C, Martínez D, Díaz P, and Santolaya ME
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- Humans, Female, Child, Male, Retrospective Studies, Child, Preschool, Chile epidemiology, Adolescent, Infant, Central Venous Catheters adverse effects, Fever microbiology, Bacteremia diagnosis, Bacteremia microbiology, Neutropenia blood, Neutropenia complications, Blood Culture methods, Febrile Neutropenia microbiology, Febrile Neutropenia blood, Neoplasms complications
- Abstract
Background: The collection of blood cultures (BC) is key for guiding antimicrobial therapy in children with febrile neutropenia (FN), more than 90% have central venous catheters (CVC). There is no consensus on the need for peripheral BC over central BC in this population. The aim of this study was to determine the contribution of peripheral BC over central BC in the diagnosis of bloodstream infections in children with FN., Methods: Descriptive, retrospective study, episodes of FN recorded prospectively in 6 hospitals in Santiago, Chile, from 2016 to 2021. Central and peripheral BC were drawn upon admission. All episodes with at least one (+) BC were allocated to one of these groups: consistent (+) BC, inconsistent (+) BC, only CVC (+) BC and only peripheral (+) BC. The volume of the samples was recorded., Results: The analysis included 241 episodes of FN with at least one (+) BC. The median age was 7.2 years, 51% were female, 84% had hematological cancer and 98% had episodes of high-risk FN. Of a total of 241 episodes, 135 (56%) had consistent (+) BC, 13 (5%) had inconsistent (+) BC, 35 (15%) had only CVC (+) BC and 58 (24%) had only peripheral (+) BC. There were no significant differences in the volume of the samples between central and peripheral BC., Conclusions: The proportion of bloodstream infections detected only through peripheral BC was 24%, higher than previously reported, not due to sample volume. We recommend obtaining peripheral as well CVC BC in children with FN., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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16. Epidemiology of Meningococcal Disease in Four South American Countries and Rationale of Vaccination in Adolescents from the Region: Position Paper of the Latin American Society of Pediatric Infectious Diseases (SLIPE).
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Villena R, Safadi MA, Gentile Á, Pujadas M, De la Maza V, George S, and Torres JP
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Surveillance of meningococcal disease (MD) is crucial after the implementation of vaccination strategies to monitor their impact on disease burden. Adolescent vaccination could provide direct and indirect protection. Argentina, Brazil, and Chile have introduced meningococcal conjugate vaccines (MCV) into their National Immunization Programs (NIP), while Uruguay has not. Here, we analyze the epidemiology of MD and vaccination experience from these four South American countries to identify needs and plans to improve the current vaccination programs., Methodology: Descriptive study of MD incidence rates, serogroup distribution, case fatality rates (CFR), and MCV uptakes during the period 2010-2021 in Argentina, Brazil, Chile, and Uruguay. Data were extracted from national surveillance programs, reference laboratories, NIPs, and Pubmed., Results: MD overall incidence from 2010 to 2021 have a decreasing trend in Argentina (0.37 [IQR = 0.20-0.61]), Brazil (0.59 [IQR = 0.54-1.22]), and Chile (0.45 [IQR = 0.40-0.77]), while a significant increase in Uruguay (0.47 [IQR = 0.33-0.69]) was found from 2016 to 2019. During the COVID-19 pandemic, all countries sharply reduced their MD incidence. The highest incidence rates were observed among infants, followed by children 1-4 years of age. No second peak was evident in adolescents. A reduction in serogroup C, W, and Y cases has occurred in Argentina, Brazil, and Chile after introduction of MCV, serogroup B becoming predominant in all four countries. Median CFR was 9.0%, 21%, 19.9%, and 17.9% in Argentina, Brazil, Chile, and Uruguay, respectively. Median uptake of MCV for Argentina and Brazil were 66.6% and 91.0% for priming in infants; 54.7% and 84.5% for booster in toddlers; and 47.5% and 53% for adolescents; while for Chile, 95.6% for toddlers., Conclusions: Experience after the implementation of MCV programs in South America was successful, reducing the burden of MD due to the vaccine serogroups. High vaccine uptake and the inclusion of adolescents will be crucial in the post-pandemic period to maintain the protection of the population. The increase in the proportion of serogroup B cases emphasizes the importance of continuous surveillance to guide future vaccination strategies.
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- 2023
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17. Quality of care received by patients with alcohol poisoning in a pediatric emergency department.
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Cámara Costa C, Costa Félix de Oliveira EJ, Martínez-Sánchez L, Luaces Cubells C, and Trenchs Sainz de la Maza V
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- Child, Humans, Patients, Quality of Health Care, Emergency Service, Hospital, Alcoholic Intoxication diagnosis, Alcoholic Intoxication therapy
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- 2023
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18. [Impact of COVID-19 pandemic in oncological debut at Pediatric Emergency Department].
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Díaz-Miguel M, Martos Utande A, and Trenchs Sainz de la Maza V
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- Child, Humans, Pandemics, Emergency Service, Hospital, Retrospective Studies, COVID-19
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- 2023
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19. Efficacy, Safety, and Pain Level of Subcutaneous Catheter Use for Administration of Granulocyte Colony-Stimulating Factor (G-CSF) in Children With Cancer: A Randomized Pilot Study.
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de la Maza V, Fuentes V, Cabrolier E, Fernández MS, Saéz S, Concha C, Nicklas C, Castro M, and Torres JP
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- Humans, Child, Pilot Projects, Injections, Subcutaneous, Granulocyte Colony-Stimulating Factor adverse effects, Pain etiology, Neoplasms drug therapy
- Abstract
Background: The aim of this study was to explore the efficacy, safety, and pain level of granulocyte colony-stimulating factor (G-CSF) administration via a subcutaneous catheter compared with direct injection in children with cancer. Method: This was a pilot randomized controlled trial of standard G-CSF administration versus subcutaneous catheter administration. Children 2-15 years of age who were beginning G-CSF after their first chemotherapy cycle and anticipated to receive G-CSF following the next three cycles of chemotherapy were eligible. Efficacy, safety, and pain were as outcomes of the study. Results: Twenty-nine children with cancer (median age 12 years) were enrolled in the study (16 children in the subcutaneous catheter group and 13 children in the direct injection group). During Cycle 2, the median number of days to reach absolute neutrophil count (ANC) ≥ 500/mm
3 was greater among those in the subcutaneous catheter group (12 vs. 10; p = .02). In Cycle 3, however, the subcutaneous catheter group received fewer doses of G-CSF (8 vs. 12; p = .004). No complications related to subcutaneous catheter use were observed. No differences in the visual analog scale pain score were observed between groups in Cycles 1 to 3; however, in Cycle 4, children in the subcutaneous catheter group had lower median pain scores than those in the direct subcutaneous injection group ( Mdn = 0, [IQR] = 0-2 vs. Mdn = 1, IQR = 0-6; p < 0.01). Conclusion: Results demonstrated administering G-CSF via a subcutaneous catheter enables ANC to recover with no pain or complications associated with its use. Thus, oncology teams may consider this administration method to be used in children with cancer., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2023
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20. Emerging epidemic of head injuries related to electric scooter use by under-18-year-olds.
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Iriondo Muruzábal M, González Grado C, Trenchs Sainz de la Maza V, and Luaces C
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- Humans, Motorcycles, Craniocerebral Trauma epidemiology, Craniocerebral Trauma etiology
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- 2023
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21. Clinical Outcome in Children With Cancer With Two or More Microorganisms Isolated From Blood Cultures During Episodes of Fever and Neutropenia.
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Ibáñez C, Torres JP, De La Maza V, Rivera S, Valenzuela R, Simian ME, Payá E, Álvarez AM, Contardo V, Martínez D, Claverie X, and Santolaya ME
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- Child, Humans, Chile epidemiology, Blood Culture, Neoplasms complications
- Abstract
Background: Bacterial bloodstream infections are a major cause of morbidity and mortality in children with cancer and episodes of fever and neutropenia (FN). The aim of this study was to evaluate the clinical outcome in children with cancer with 2 or more microorganisms isolated from blood cultures during their episodes of FN., Methods: Between 2016 and 2021, children presenting with high-risk FN, admitted to any of the 6 participating hospitals in Santiago, Chile, were included in this study if they have positive blood cultures. We compared the clinical outcome of children with 2 or more microorganisms versus those with single agent isolation., Results: A total of 1074 episodes of high-risk FN were enrolled in the study period, of which 27% (298) had positive blood cultures and 3% (32) had 2 or more microorganisms isolated from blood cultures. The most frequent identified agents were Viridans group streptococci and Escherichia coli in 20%, followed by Coagulase negative staphylococci in 14%. Children with 2 or more microorganisms presented more days of fever (7 vs. 4 days, P = 0.02), needed longer courses of antimicrobial therapy (16 vs. 14 days, P = 0.04) and had higher mortality at day 30 (13% vs. 1%, P = 0.003)., Conclusions: Children with cancer and FN with 2 or more microorganisms isolated from blood cultures had a worse clinical outcome than children with single agent isolation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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22. Unintentional poisoning by cough and cold medications: Drugs with little usefulness and potential toxicity.
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Colom Gordillo A, Martínez Sánchez L, Pretel Echaburu C, Trenchs Sainz de la Maza V, Gotzens Bersch J, and Luaces Cubells C
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- Child, Humans, Pharmaceutical Preparations, Expectorants adverse effects, Cough chemically induced, Antitussive Agents adverse effects
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Introduction: The use of medications to relieve the symptoms of the "common cold" in children is very frequent. In addition to the lack of scientific evidence supporting its usefulness, there is evidence of potential toxicity, and serious and even fatal cases of intoxication have been described. The objective was to describe the clinical and epidemiological characteristics of the patients treated in a paediatric emergency department (PED) for suspected unintentional intoxication by a cold medicine., Material and Methods: Observational and analytical study of patients aged less than 18 years managed in a PED for suspected unintentional poisoning by a cold medicine between July 2012 and June 2020. We classified severity according to the Poisoning Severity Score (PSS): PSS-0 = no toxicity; PSS-1 = mild toxicity; PSS-2 = moderate; PSS-3 = severe; PSS-4 = lethal. If the intoxication occurred while the patient was in active treatment with the drug, we determined whether the patient's age was in the applicable range established in the therapeutic indications provided in the summary of product characteristics., Results: The study included data for 63 cases. The drugs involved were decongestants and mucolytics (31; 49.2%), antitussives (26; 41.2%) and oral bronchodilators (6; 9.5%). The distribution by severity was 40 cases with PSS-0 (63.5%), 21 with PSS-1 (33.3%), 1 with PSS-2 (1.6%) and 1 with PSS-3 (1.6%). In 29 patients (46.0%) there was a history of therapeutic use; in 15 of these cases (51.7%) the age was lower than recommended in the summary of product characteristics. In 14 patients (22.2%) the intoxication was due to administration of the wrong dose by caregivers., Conclusion: Although scientific evidence does not support the use of cold medicines in children, unintentional intoxications by these drugs keep happening, in some cases causing moderate or severe symptoms., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2022
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23. Ten principles for acting against child abuse: an essential tool to guide emergency department staff.
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Curcoy Barcenilla AI, Trenchs Sainz de la Maza V, Cózar Olmo JA, and Espinel Padrón Z
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- Child, Humans, Child Abuse diagnosis, Child Abuse prevention & control, Emergency Service, Hospital
- Published
- 2022
24. Impact of lockdown on pediatric poisonings.
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Fernández-Lázaro JC, Moya-Gómez I, Trenchs-Sainz de la Maza V, Castany-Capdevila E, Luaces-Cubells C, and Martínez-Sánchez L
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- Child, Humans, Emergency Service, Hospital
- Published
- 2022
25. Cytokine and chemokine profiles in episodes of persistent high-risk febrile neutropenia in children with cancer.
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Tapia LI, Olivares M, Torres JP, De la Maza V, Valenzuela R, Contardo V, Tordecilla J, Álvarez AM, Varas M, Zubieta M, Salgado C, Venegas M, Gutiérrez V, Claverie X, Villarroel M, and Santolaya ME
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- Child, Febrile Neutropenia diagnosis, Febrile Neutropenia microbiology, Febrile Neutropenia virology, Female, Humans, Male, ROC Curve, Risk Factors, Chemokines blood, Cytokines blood, Febrile Neutropenia blood, Neoplasms blood
- Abstract
Background: In children with cancer and persistent high-risk febrile neutropenia (HRFN), cytokines/chemokines profiles can guide the differentiation of febrile neutropenia (FN) due to infections and episodes of unknown origin (FN-UO)., Methods: A prospective, multicenter study in Santiago, Chile included patients ≤ 18 years with cancer and HRFN. Clinical and microbiological studies were performed according to validated protocols. Serum levels of 38 cytokines/chemokines were determined on day 4 of persistent HRFN. We performed comparisons between i) HRFN episodes with a detected etiological agent (FN-DEA) and FN-UO, and ii) bacterial versus viral infections. ROC curves were used to assess the discriminatory power of the analytes., Results: 110 HRFN episodes were enrolled (median age 8 years, 53% female). Eighty-four patients were FN-DEA: 44 bacterial, 32 viral, and 8 fungal infections. Twenty-six cases were categorized as FN-UO. Both groups presented similar clinical and laboratory characteristics. Nineteen out of 38 analytes had higher concentrations in the FN-DEA versus FN-UO group. G-CSF, IL-6, and Flt-3L showed the highest discriminatory power to detect infection (AUC 0.763, 0.741, 0.701). Serum levels of G-CSF differentiated bacterial infections and IP-10 viral agents. A combination of G-CSF, IL-6, Flt-3L, and IP-10 showed an AUC of 0.839, 75% sensitivity, and 81% specificity., Conclusion: A specific immune response is present on day four of persistent HRFN in children with cancer. We propose a combined measure of serum concentrations of G-CSF, IL-6, IP-10, and Flt-3L, in order to predict the presence of an infectious agent as compared to an episode of FN with unknown origin., (Copyright © 2021. Published by Elsevier Ltd.)
- Published
- 2021
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26. Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Prevalence in Blood in a Large School Community Subject to a Coronavirus Disease 2019 Outbreak: A Cross-sectional Study.
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Torres JP, Piñera C, De La Maza V, Lagomarcino AJ, Simian D, Torres B, Urquidi C, Valenzuela MT, and O'Ryan M
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- Adult, Child, Child, Preschool, Chile, Cross-Sectional Studies, Disease Outbreaks, Humans, Prevalence, Schools, Seroepidemiologic Studies, COVID-19, SARS-CoV-2
- Abstract
Background: A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak affecting 52 people from a large school community in Santiago, Chile, was identified (12 March) 9 days after the first case in the country. We assessed the magnitude of the outbreak and the role students and staff played using self-administered antibody detection tests and a self-administered survey., Methods: The school was closed on 13 March, and the entire community was placed under quarantine. We implemented a home-delivery, self-administered, immunoglobin (Ig) G/IgM antibody test and survey to a classroom-stratified sample of students and all staff from 4-19 May. We aimed to determine the overall seroprevalence rates by age group, reported symptoms, and contact exposure, and to explore the dynamics of transmission., Results: The antibody positivity rates were 9.9% (95% confidence interval [CI], 8.2-11.8) for 1009 students and 16.6% (95% CI, 12.1-21.9) for 235 staff. Among students, positivity was associated with a younger age (P = .01), a lower grade level (P = .05), prior real-time polymerase chain reaction (RT-PCR) positivity (P = .03), and a history of contact with a confirmed case (P < .001). Among staff, positivity was higher in teachers (P = .01) and in those previously RT-PCR positive (P < .001). Excluding RT-PCR-positive individuals, antibody positivity was associated with fever in adults and children (P = .02 and P = .002, respectively), abdominal pain in children (P = .001), and chest pain in adults (P = .02). Within antibody-positive individuals, 40% of students and 18% of staff reported no symptoms (P = .01)., Conclusions: Teachers were more affected during the outbreak and younger children were at a higher risk for infection, likely because index case(s) were teachers and/or parents from the preschool. Self-administered antibody testing, supervised remotely, proved to be a suitable and rapid tool. Our study provides useful information for school reopenings., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2021
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27. Impact of a structured educational programme for caregivers of children with cancer on parental knowledge of the disease and paediatric clinical outcomes during the first year of treatment.
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De la Maza V, Manriquez M, Castro M, Viveros P, Fernandez M, Vogel E, Peña E, Santolaya ME, Villarroel M, and Torres JP
- Subjects
- Child, Educational Status, Humans, Parents, Prospective Studies, Caregivers, Neoplasms therapy
- Abstract
Objective: To assess the impact of a structured educational programme for caregivers of children with cancer on their level of knowledge about the disease and patient's clinical outcome., Methods: This prospective, non-randomised, experimental study included caregivers of recently diagnosed children at two hospitals in Chile. Caregivers whose children were treated at the first centre were the structured education programme group (EPG), while the second hospital provided the standard care (SCG). We evaluated caregivers' level of knowledge on days 1, 10 and 90 as well as the children's clinical outcomes over 1 year of treatment., Results: A total of 102 caregivers were enrolled between 2014 and 2015. Only the EPG showed a significant increase in knowledge between days 1 and 90. The rate of central venous catheter infections was significantly lower in the EPG versus SCG (7% versus 26%; p = .01). The risk ratio was 0.35 (95% CI = 0.13-0.94), and a log-rank test showed a statistically significant difference between the two groups (p = .018). There were also fewer Emergency Department visits in the EPG for fever episodes., Conclusion: Providing a structured education to caregivers increased their level of knowledge and improved the clinical outcome of their children during the first year of treatment., (© 2020 John Wiley & Sons Ltd.)
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- 2020
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28. Usefulness of serum galactomannan in initiating and modifying antifungal therapy in children with cancer and persistent high-risk febrile neutropenia.
- Author
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Delgado-Araneda M, Valenzuela R, de la Maza V, Rabello M, Álvarez AM, Contardo V, Zubieta M, Gutierrez V, Claverie X, Torres JP, Salgado C, Tordecilla J, Varas M, Avilés CL, Venegas M, Villarroel M, and Santolaya ME
- Subjects
- Aspergillosis drug therapy, Case-Control Studies, Child, Female, Galactose analogs & derivatives, Hematologic Neoplasms complications, Humans, Invasive Pulmonary Aspergillosis drug therapy, Male, Antifungal Agents therapeutic use, Chemotherapy-Induced Febrile Neutropenia complications, Invasive Fungal Infections drug therapy, Mannans blood, Neoplasms complications
- Abstract
Background: Invasive fungal disease is a major cause of morbidity and mortality in children with cancer and high-risk febrile neutropenia (HRFN). Repeated serum galactomannan (sGM) measurements have been described as an effective tool to guide therapy in adults under suspicion of invasive aspergillosis. However, the utility of this approach has not been reported in paediatric population., Objectives: To evaluate the usefulness of sGM measurements in initiating and modifying antifungal therapy (AFT) in children with cancer and persistent HRFN., Patients/methods: Nested case-control study in children with cancer and persistent HRFN episodes, between July 2013 and January 2019. Patients were classified as cases and controls depending on if they received AFT or not, respectively. Through odds ratio analysis, we assessed the role of sGM positivity in the AFT initiation decision. Then, we analysed the group of patients that initiated AFT, and compared those who had AFT modifications and those who did not, analysing different sGM kinetics thresholds., Results: A total of 191 episodes from children with persistent HRFN were enrolled, of which 107 received AFT and 84 did not. The median age was 7 years (IQR 4-12), 52% were male and 89% had a haematologic malignancy as underlying disease. Positive sGM was not associated with AFT initiation (OR 0.99, 95% CI 0.43-2.33, P = .99). A difference threshold in sGM Δ ≥ 0.3 sGM was significantly associated with AFT modification (OR 5.07, 95% CI 1.02- 25.70, P = .04)., Conclusions: Our results suggest the utility of serial sGM sampling during AFT in children with persistent HRFN., (© 2020 Blackwell Verlag GmbH.)
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- 2020
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29. Perceived quality in a pediatric emergency department: what does the mother think about?
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Parra Cotanda C, Trenchs Sainz de la Maza V, Sabater Sabaté A, and Luaces Cubells C
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- Adult, Female, Humans, Perception, Attitude to Health, Emergency Service, Hospital standards, Hospitals, Pediatric standards, Mothers psychology, Quality of Health Care
- Published
- 2019
30. Efficacy of pre-emptive versus empirical antifungal therapy in children with cancer and high-risk febrile neutropenia: a randomized clinical trial.
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Santolaya ME, Alvarez AM, Acuña M, Avilés CL, Salgado C, Tordecilla J, Varas M, Venegas M, Villarroel M, Zubieta M, Farfán M, de la Maza V, Vergara A, Valenzuela R, and Torres JP
- Subjects
- Child, Child, Preschool, Chile, Female, Humans, Invasive Fungal Infections mortality, Length of Stay, Male, Prospective Studies, Survival Analysis, Treatment Outcome, Antifungal Agents therapeutic use, Chemoprevention methods, Febrile Neutropenia complications, Invasive Fungal Infections drug therapy, Invasive Fungal Infections prevention & control, Neoplasms complications, Neoplasms therapy
- Abstract
Objectives: To compare the efficacy of pre-emptive versus empirical antifungal therapy in children with cancer, fever and neutropenia., Methods: This was a prospective, multicentre, randomized clinical trial. Children presenting with persistent high-risk febrile neutropenia at five hospitals in Santiago, Chile, were randomized to empirical or pre-emptive antifungal therapy. The pre-emptive group received antifungal therapy only if the persistent high-risk febrile neutropenia was accompanied by clinical, laboratory, imaging or microbiological pre-defined criteria. The primary endpoint was overall mortality at day 30 of follow-up. Secondary endpoints included invasive fungal disease (IFD)-related mortality, number of days of fever, days of hospitalization and use of antifungal drugs, percentage of children developing IFD, requiring modification of initial treatment strategy and need for ICU. The trial was registered with Registro Brasileiro de Ensaios Clínicos (ReBEC) under trial number RBR-3m9d74., Results: A total of 149 children were randomized, 73 to empirical therapy and 76 to pre-emptive therapy. Thirty-two out of 76 (42%) children in the pre-emptive group received antifungal therapy. The median duration of antifungal therapy was 11 days in the empirical arm and 6 days in the pre-emptive arm (P < 0.001), with similar overall mortality (8% in the empirical arm and 5% in the pre-emptive arm, P = 0.47). IFD-related mortality was the same in both groups (3%, P = 0.97), as were the percentage of children with IFD (12%, P = 0.92) and the number of days of fever (9, P = 0.76). The number of days of hospitalization was 19 in the empirical arm and 17 in the pre-emptive arm (P = 0.15) and the need for ICU was 25% in the empirical arm and 20% in the pre-emptive arm (P = 0.47)., Conclusions: Pre-emptive antifungal therapy was as effective as empirical antifungal therapy in children with cancer, fever and neutropenia, significantly reducing the use of antifungal drugs.
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- 2018
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31. Invasive disease by Streptococcus pyogenes: patients hospitalized for 6 years.
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Arias-Constantí V, Trenchs-Sainz de la Maza V, Sanz-Marcos NE, Guitart-Pardellans C, Gené-Giralt A, and Luaces-Cubells C
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- Child, Child, Preschool, Cross Infection microbiology, Female, Hospitals, Maternity statistics & numerical data, Hospitals, Pediatric statistics & numerical data, Hospitals, Urban statistics & numerical data, Humans, Infant, Inpatients statistics & numerical data, Intensive Care Units statistics & numerical data, Length of Stay statistics & numerical data, Male, Retrospective Studies, Risk Factors, Spain epidemiology, Tertiary Care Centers statistics & numerical data, Cross Infection epidemiology, Streptococcal Infections epidemiology, Streptococcus pyogenes isolation & purification
- Abstract
Introduction and Objective: The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital., Material and Methods: Retrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014). To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected., Results: Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died., Conclusion: The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)
- Published
- 2018
- Full Text
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32. Intravenous palivizumab in respiratory syncytial virus infection after hematopoietic stem cell transplant in children.
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Torres JP, Tapia LI, Catalán P, De la Maza V, and Mejías A
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- Adolescent, Antiviral Agents administration & dosage, Child, Combined Modality Therapy, Female, Humans, Injections, Intravenous, Male, Palivizumab administration & dosage, Antiviral Agents therapeutic use, Hematopoietic Stem Cell Transplantation, Palivizumab therapeutic use, Respiratory Syncytial Virus Infections therapy
- Abstract
Respiratory syncytial virus (RSV) infection can cause lower respiratory tract disease and mortality in pediatric hematopoietic stem cell transplant (HSCT) recipients. We report two children who underwent HSCT and developed RSV infection simultaneously at the Bone Marrow Transplant Unit. The treatment with intravenous palivizumab was provided and sequential viral loads were measured in nasopharyngeal (NP) and whole blood samples. To our knowledge, this is the first report where RSV loads were measured in parallel (NP and blood), before and after palivizumab, in correlation with a favorable clinical outcome in both cases., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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33. Re: "Respiratory Viral Infections and Coinfections Caused by Human Metapneumovirus in Children With Cancer".
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Torres JP, De la Maza V, and Santolaya ME
- Subjects
- Child, Fever, Humans, Neoplasms, Neutropenia, Coinfection, Metapneumovirus
- Published
- 2017
- Full Text
- View/download PDF
34. Respiratory Viral Infections and Coinfections in Children With Cancer, Fever and Neutropenia: Clinical Outcome of Infections Caused by Different Respiratory Viruses.
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Torres JP, De la Maza V, Kors L, Villarroel M, Piemonte P, Izquierdo G, Salgado C, Tordecilla J, Contardo V, Farfán MJ, Mejías A, Ramilo O, and Santolaya ME
- Subjects
- Child, Child, Preschool, Chile epidemiology, Female, Humans, Male, Prospective Studies, Treatment Outcome, Viruses, Coinfection epidemiology, Coinfection virology, Febrile Neutropenia complications, Febrile Neutropenia epidemiology, Neoplasms complications, Neoplasms epidemiology, Respiratory Tract Infections complications, Respiratory Tract Infections epidemiology, Respiratory Tract Infections virology, Virus Diseases complications, Virus Diseases epidemiology, Virus Diseases virology
- Abstract
Background: Respiratory viral infections in episodes of fever and neutropenia (FN) in children with cancer are not well characterized. We compared the clinical outcome of infections caused by different respiratory viruses (RVs) and by RV coinfection in this population., Methods: Children with cancer and FN at 3 hospitals in Chile were prospectively evaluated by clinical examination, blood cultures and detection of 17 RVs using multiplex polymerase chain reaction (nasopharyngeal samples). Clinical characterization and outcome variables were determined and compared by the type of RV detected., Results: A total of 1044 episodes of FN in 525 children were included. At least 1 RV was detected in 46%. In 350 of 1044 (34%) episodes, we detected only RVs, of which 284 (81%) were classified as a single-RV infection and 66 (19%) as a viral coinfection. Respiratory symptoms were present at admission in 65% of the episodes with any detected RV. Median age was 6 years (interquartile range, 3-10), and 51% were women. The most common RVs detected were rhinovirus, respiratory syncytial virus, parainfluenza, influenza, adenovirus and human metapneumovirus. Episodes caused by different types of RVs had no differences in the clinical outcome (days of hospitalization, days of fever, O2 requirement, admission to the intensive care unit and death) and when comparing single and viral coinfection., Conclusions: To our knowledge, this is the largest report comparing clinical outcome in FN episodes caused by different RVs in children with cancer. A positive polymerase chain reaction for RV at admission was significantly associated with the presence of respiratory symptoms. Our data showed a favorable outcome in all episodes with RV detection, including single and viral coinfections.
- Published
- 2016
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- View/download PDF
35. Administration Time for the First Dose of Antimicrobials in Episodes of Fever and Neutropenia in Children With Cancer.
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De la Maza V, Simian D, Castro M, Torres JP, Lucero Y, Sepúlveda F, Mazquiaran S, Salazar C, Segovia L, and Santolaya ME
- Subjects
- Anti-Infective Agents therapeutic use, Antineoplastic Agents adverse effects, Antineoplastic Agents therapeutic use, Chemotherapy-Induced Febrile Neutropenia etiology, Child, Child, Preschool, Female, Hospitalization, Humans, Male, Neoplasms drug therapy, Neoplasms epidemiology, Prospective Studies, Anti-Infective Agents administration & dosage, Chemotherapy-Induced Febrile Neutropenia drug therapy, Chemotherapy-Induced Febrile Neutropenia epidemiology, Neoplasms complications, Time-to-Treatment
- Abstract
Background: Early administration of antimicrobial (AM) is relevant in children with cancer, fever and neutropenia (FN). The recommendation is to administer the first dose of AM within the first hour of hospital admission. Our aims were to determine the time from the moment that a child with FN is admitted to the hospital until they receive their first dose of AM and to determine the association with clinical outcomes., Methods: This prospective, multicenter study evaluated the time elapsed from the admission to the first dose of AM, comparing this variable by admitting hospital and presentation location (Emergency Department/Oncology Units) and evaluating the clinical outcomes by the following variables: days of fever, days of hospitalization, hypotension, transfer to intensive care unit, sepsis and mortality., Results: A total of 226 children with 388 episodes of FN were enrolled from 5 hospitals (July 2012-April 2014). The median time between hospital admission and administration of the first dose of AM was 132 minutes (interquartile range: 60-246 minutes). The median time to AM administration was significantly different between hospitals (70 vs. 200 minutes, P < 0.0001) and between presentation locations (Emergency Department vs. Oncology Units, median: 200 vs. 100 minutes, P < 0.0001). Twenty-five percentage of children received AM within 1 hour of admission. The administration of AM after 60 minutes was not associated with worse outcomes., Conclusions: Time to AM administration was longer than the recommendation. The findings described provide an opportunity to identify gaps and implement programs aimed at improving the equity and excellence of care in children with cancer and FN.
- Published
- 2015
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36. Prospective validation of a risk prediction model for severe sepsis in children with cancer and high-risk febrile neutropenia.
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Santolaya ME, Alvarez AM, Avilés CL, Becker A, Venegas M, O'Ryan M, Salgado C, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M, de la Maza V, Vergara A, Farfán MJ, and Torres JP
- Subjects
- Adolescent, C-Reactive Protein analysis, Chemotherapy-Induced Febrile Neutropenia microbiology, Chemotherapy-Induced Febrile Neutropenia pathology, Child, Child, Preschool, Female, Humans, Interleukin-8 blood, Male, Neoplasms blood, Neoplasms drug therapy, Risk, Sepsis blood, Chemotherapy-Induced Febrile Neutropenia epidemiology, Models, Statistical, Neoplasms epidemiology, Sepsis epidemiology
- Abstract
Background: We previously created a risk prediction model for severe sepsis not clinically apparent during the first 24 hours of hospitalization in children with high-risk febrile neutropenia (HRFN), which identified 3 variables, age ≥ 12 years, serum C-reactive protein (CRP) ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL, evaluated at the time of admission and at 24 hours of hospitalization. The combination of these 3 variables identified a risk for severe sepsis ranging from 8% to 73% with a relative risk of 3.15 (95% confidence interval: 1.1-9.06). The aim of this study was to validate prospectively our risk prediction model for severe sepsis in a new cohort of children with cancer and HRFN., Methods: Predictors of severe sepsis identified in our previous model (age, CRP and interleukin-8) were evaluated at admission and at 24 hours of hospitalization in a new cohort of children with HRFN between April 2009 and July 2011. Diagnosis of severe sepsis, not clinically apparent during the first 24 hours of hospitalization, was made after discharge by a blind evaluator., Results: A total of 447 HRFN episodes were studied, of which 76 (17%) had a diagnosis of severe sepsis. The combination of age ≥ 12 years, CRP ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL at admission and/or at 24 hours in the new cohort identified a risk for severe sepsis ranging from 7% to 46% with an RR of 6.7 (95% CI: 2.3-19.5)., Conclusions: We validated a risk prediction model for severe sepsis applicable to children with HRFN episodes within the first 24 hours of admission. We propose to incorporate this model in the initial patient assessment to offer a more selective management for children at risk for severe sepsis.
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- 2013
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37. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia.
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Torres JP, Labraña Y, Ibañez C, Kasaneva P, Farfán MJ, De la Maza V, Villarroel M, Vergara I, Piemonte P, Zubieta M, Salgado C, Tordecilla J, Topelberg S, O Ryan M, and Santolaya ME
- Subjects
- Bacterial Infections epidemiology, Bacterial Infections microbiology, Bacterial Infections virology, Chi-Square Distribution, Child, Child, Preschool, Chile epidemiology, Coinfection microbiology, Coinfection virology, Female, Fever microbiology, Fever virology, Humans, Leukemia epidemiology, Leukemia microbiology, Leukemia virology, Male, Neoplasms microbiology, Neoplasms virology, Neutropenia microbiology, Neutropenia virology, Prospective Studies, Respiratory Tract Infections microbiology, Respiratory Tract Infections virology, Treatment Outcome, Virus Diseases epidemiology, Virus Diseases microbiology, Virus Diseases virology, Coinfection epidemiology, Fever epidemiology, Neoplasms epidemiology, Neutropenia epidemiology, Respiratory Tract Infections epidemiology
- Abstract
Background: The role of respiratory viral infections (RVIs) as a cause of overall fever and neutropenia (FN) episodes in children with cancer has been less characterized than bacterial infections. We conducted a study aimed to determine the frequency of RVI in children with low compared with high risk for invasive bacterial infection (IBI) FN episodes and compare the clinical outcome of RVI and mixed RV-bacterial infections., Methods: Prospective, multicenter study in children with cancer and FN admitted to pediatric hospitals in Chile between May 2009 and January 2011. Children were evaluated by clinical examination and laboratory tests, including bacterial cultures and their risk for IBI. Nasopharyngeal sample was obtained for the detection of 17 respiratory viruses using polymerase chain reaction-DNA microarray platform., Results: A total of 331 episodes of FN in 193 children were enrolled of whom 55% were male, with the median age of 7 years and 61% had a hematological malignancy. A viral and/or bacterial pathogen was detected in 67% (224/331) episodes. Overall, RVIs were associated with 57% of FN of which one-third were mixed RV-bacterial infections. Bacterial infection was detected in 29% (97/331). Children classified at admission as high risk for IBI had a similar overall proportion of RVI compared with low-risk group. Respiratory syncytial virus (31%) and rhinovirus (23%) were the most frequently detected respiratory viruses, followed by parainfluenza (12%) and influenza A (11%). Children detected with any respiratory virus had fewer days of hospitalization and a significantly lower probability of hypotension and admission to pediatric intensive care unit irrespective of their risk classification status at admission when compared with children with mixed RV-bacterial or bacterial infections (P < 0.05). All children with a sole RVI had favorable outcome., Conclusions: RVIs were the most frequently detected agents irrespective of their initial risk assessment for IBI. The clinical outcome of mixed RVI was similar to sole RVI episodes as well as for bacterial infections compared with mixed viral-bacterial infections. Systematic and early detection of RVI in children with cancer and FN might help to optimize their management by reducing hospitalization and antimicrobial use.
- Published
- 2012
- Full Text
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38. Diagnosis of bacteremia in febrile neutropenic episodes in children with cancer: microbiologic and molecular approach.
- Author
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Santolaya ME, Farfán MJ, De La Maza V, Cociña M, Santelices F, Alvarez AM, Avilés CL, Becker A, O'Ryan M, Román P, Salgado C, Silva P, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M, and Torres JP
- Subjects
- Adolescent, Bacteremia blood, Bacteremia complications, Bacteremia microbiology, Child, Child, Preschool, Chile, Escherichia coli classification, Escherichia coli Infections blood, Escherichia coli Infections complications, Escherichia coli Infections microbiology, Female, Fever blood, Fever complications, Fever microbiology, Humans, Male, Neoplasms blood, Neoplasms complications, Neoplasms microbiology, Neutropenia blood, Neutropenia complications, Neutropenia microbiology, Neutrophils cytology, Predictive Value of Tests, Prospective Studies, Pseudomonas Infections blood, Pseudomonas Infections complications, Pseudomonas Infections microbiology, Pseudomonas aeruginosa classification, Real-Time Polymerase Chain Reaction, Staphylococcal Infections blood, Staphylococcal Infections complications, Staphylococcal Infections microbiology, Staphylococcus aureus classification, Bacteremia diagnosis, Bacterial Typing Techniques, Escherichia coli isolation & purification, Escherichia coli Infections diagnosis, Pseudomonas Infections diagnosis, Pseudomonas aeruginosa isolation & purification, Staphylococcal Infections diagnosis, Staphylococcus aureus isolation & purification
- Abstract
Background: Bacterial isolation using conventional microbiologic techniques rarely surpasses 25% in children with clinical and laboratory findings indicative of an invasive bacterial infection. The aim of this study was to determine the role of real-time polymerase chain reaction (RT-PCR) from whole blood samples compared with automated blood cultures (BC) in detection of relevant microorganisms causing bacteremia in episodes of high-risk febrile neutropenia (HRFN) in children with cancer., Methods: Children presenting with HRFN at 6 hospitals in Santiago, Chile, were invited to participate. Blood samples were obtained at admission for BC, and at admission and 24 hours for RT-PCR targeting DNA of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa causing bacteremia in children with HRFN., Results: A total of 177 HRFN episodes were evaluated from May 2009 to August 2010, of which 29 (16.3%) had positive BC, 9 (5%) positive for 1 of the 3 selected bacterial species: 5 for E. coli, 3 for S. aureus, and 1 for P. aeruginosa. RT-PCR detected 39 bacteria in 36 episodes (20%): 14 E. coli, 20 S. aureus, and 5 P. aeruginosa. The sensitivity, specificity, and positive and negative predictive values of RT-PCR compared with BC were 56%, 80%, 13%, and 97%. The final clinical diagnosis was compatible with an invasive bacterial infection in 30/36 (83%) RT-PCR-positive episodes., Conclusions: In our series, RT-PCR significantly improved detection of the most relevant bacteria associated with HRFN episodes. Large number of patients and close clinical monitoring, in addition to improved RT-PCR techniques will be required to fully recommend RT-PCR-based diagnosis for the routine workup of children with cancer, fever, and neutropenia.
- Published
- 2011
- Full Text
- View/download PDF
39. [Service of admission, selection, distribution & care of patients: control service].
- Author
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DE LA MAZA V and VALDES S
- Subjects
- Humans, Hospitalization, Hospitals
- Published
- 1958
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