BACKGROUND.Many studies have succeeded in identifying a subset of children with febrile neutropenia (FN) who are at lower risk of infectious complications and eventual death. Conversely, to the authors' knowledge, no scoring system has been published to date with which to assess the risk of mortality for the whole group of children with neutropenia and fever.METHODS.Between March 2000 and July 2004, 1520 episodes of FN in 981 children were included in a multicentric prospective study to evaluate a scoring system that was designed to identify high mortality risk at the onset of an FN episode in children with cancer.RESULTS.In the derivation set (714 episodes), 18 patients died (2.5%). A multivariate analysis yielded the following significant mortality‐related risk factors: advanced stage of underlying malignant disease (odds ratio [OR], 3122.1; 95% confidence interval [95% CI], 0.0001–5.2), associated comorbidity (OR, 25.3; 95% CI, 7.7–83.2), and bacteremia (OR, 7.2; 95% CI, 2.4–22.0). A mortality score could be built with 3 points scored for the presence of advanced‐stage underlying malignant disease, 2 points scored for the presence of associated comorbidity, and 1 point scored for bacteremia. If patients collected 4 points of the risk score at onset, then their risk of mortality was 5.8%; if patients had a score of 5 points, then their risk of mortality was 15.4%; and, if they reached the maximum score of 6 points, then their risk of mortality was raised to 40%. The sensitivity of the scoring system was 100%, and it had a specificity of 84.2%. In the validation set (806 episodes), 19 children died (2.3%). For children with scores >3, the scoring system had a sensitivity of 84.2%, a specificity of 83.2%, and a negative predictive value of 99.54% for predicting mortality.CONCLUSIONS.The use of a mortality score for high‐risk patients was validated statistically by the current results. This is a major prognostic approach to categorize patients with high‐risk FN at onset. A better initial predictive approach may allow better therapeutic decisions for these children, with an eventual impact on reducing mortality. Cancer 2007. © 2007 American Cancer Society.

Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence where the chronic adult clinical form has historically been reported. Juvenile form in children and adolescents is rare in this area since only one case was reported in the last 10 years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has been exposed to ecological variations as consequences of certain climatic and anthropogenic changes, including El Niño-Southern Oscillation phenomenon during 2009, and deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in children from NEA and to discuss climatic and anthropogenic changes as possible contributing factors in the emergence of this disease in children. This acute/subacute PCM cluster was characterized by severe disseminated and aggressive presentations to localized form, with a high spectrum of clinical manifestations uncommonly observed. Due to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article.

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RESUMOAs neoplasias mamárias são as mais comuns em cadelas e geralmente acometem fêmeas de meia-idade a idosas, não castradas ou que foram submetidas ao procedimento de ovario-histerectomia tardiamente. A principal forma de tratamento é a excisão cirúrgica, sendo a ressecção unilateral das glândulas mamárias o procedimento mais realizado na prática veterinária. O objetivo do presente estudo foi comparar a dor pós-operatória em cadelas submetidas ao procedimento de mastectomia unilateral sob efeito das técnicas anestésicas de tumescência ou convencional. Foram utilizadas 20 cadelas, divididas em dois grupos: um grupo recebeu apenas a anestesia geral inalatória (grupo convencional), e o outro recebeu adicionalmente a anestesia infiltrativa por tumescência (grupo tumescência). Elas foram avaliadas nas primeiras 24 horas do período pós-operatório, e o processo álgico foi avaliado pela escala de dor da Universidade de Melbourne. As médias dos escores obtidos ao longo do tempo foram submetidas ao teste de Tukey a um nível de 5% de significância (p<0,05). Não foram observadas diferenças significativas entre os grupos com relação à dor pós-operatória. A técnica anestésica infiltrativa por tumescência apresentou a vantagem da redução do sangramento transoperatório e mostrou-se exequível em pequenos animais, entretanto seu uso está relacionado à experiência e à preferência do cirurgião e do anestesista.

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