Congenital cutaneous candidiasis is an infrequent invasive fungal infection that usually appears in the first days of life. Extremely low birth weight infants are the most frequently affected. Classic presentation includes diffuse extensive erythematous rash with papules, plaques, pustules and vesicles, which later undergoes desquamation. Systemic dissemination is common in extremely low birth weight infants. Blood, urine and cerebrospinal fluid evaluation should be included in the initial assessment. Early and prolonged treatment has been associated with decreased mortality. We report the case of congenital cutaneous candidiasis in a preterm infant. Early skin lesion recognition allowed establishing adequate treatment in the first hours of life.
The objective of this study was to analyze hematologic disorders, coagulation disorders, and transfusion requirements in children with continuous renal replacement therapies (CRRT). This is a retrospective analysis of a prospectively collected database of children receiving CRRT between 2010 and 2015. Patient characteristics, CRRT parameters, hematologic and coagulation parameters, and need for transfusions were recorded and analyzed. We compared patients after heart surgery and noncardiac patients, those requiring extracorporeal membrane oxygenation (ECMO) and those without ECMO, and patients with different anticoagulation therapies: heparin and citrate. Eighty-seven patients were included (69% after heart surgery). Thirty-four percentage of patients required ECMO. Hematologic alterations throughout the therapy included a descent in hematocrit from 33.6% to 30.3% (p = 0.002) and in platelet count from 159.291 to 101.163 (p < 0.001). Coagulation parameters improved as international normalized ratio decreased from 1.5 to 1.2 (p < 0.001), fibrinogen increased from 328 to 437 mg/dl (p = 0.04), and activated partial thromboplastin time (APTT) was normalized. There were no significant differences in hematologic parameters or need for blood products between patients after heart surgery and the rest of patients, or between patients receiving heparin or citrate for anticoagulation. Ninety percentage of patients received blood products, but patients on ECMO and those who deceased required more transfusions than the rest of the patients (p < 0.01). We conclude that children undergoing CRRT show a descent in hematocrit and platelet count and require large amounts of blood products, especially those ECMO and patients who died.
e12608 Background: Achieving a pCR (absence of residual invasive disease in breast and measurable disease in any of the axillary nodes sampled, ypT0/is and ypN0) after NAT correlates with improved survival. TNBC phenotype have a poor prognosis. However, it is associated with higher NAT response rates. With traditional schemes based on anthracyclines and taxanes, pCR rates of around 25-40% are obtained. Different schemes have been studied providing an increase in pCR such as using nab-paclitaxel, platinum salts, bevacizumab or dose dense (dd) anthracyclines. The purpose of the present study is to explore feasibility, toxicity and pCR of new aproach with carboplatine, nab-paclitaxel and antracycline in TNBC. Methods: Retrospective study with early and locally advanced TNBC pts, ECOG 0-1, without contraindications to antracyclines, were included. Treatment consisted of carboplatine AUC2 with nab-paclitaxel 80 mg/m2 i.v. weekly for 12 doses followed by epirubicin 90 mg/m2 (elderly pts recieved at 75 mg/m2) with cyclophosphamide 600 mg/m2 i.v., every 2 weeks (dd) or 3 weeks (if pts had G3-4 toxicity) for 4 doses. G-CSF support was allowed in pts with neutropenia G3-4. Pts with residual disease after NAT were offered capecitabine as adjuvant treatment. The primary endpoint was pCR. Results: From 02/2018 to 06/2022, 96 pts was included. Median age was 53 years (27-78). Clinical stage was I in 16 pts, II in 50 pts and III in 30 pts (N+ in 40'6%). 98% pts had tumours with a Ki67 20% or higher. 36’5% pts was premenopausal. 10 pts were germline BRCA mutated (8/10 gBRCA1, 2/10 gBRCA2) 50/96 pts (55’2%) had dd epirubicin-cyclophospamide (EC) and 44’8% pts recieved EC every 3 weeks (for G3 adverse events (AE)). pCR in pts who had dd treatment was 65’4% and 40’9% in pts with EC non-dd (p 0’016). 89’9% pts with residual disease completed adjuvant treatment with 8 cycles of capecitabine. 53/96 pts had an AE related with NAT. Neutropenia G3-4 (45’5% pts, all of them recieved dd treatment) and any grade of alopecia and mucositis (60% and 25% respectively) were the most frecuent AE reported. Pts with neutropenia G3-4 on blood test recieved G-CSF in subsequent cycles with resolution of haematological AE. All pts with dd treatment recieved G-CSF. One patient had a disease progression by radiological evaluation during the treatment. During follow-up 9 pts relapsed (1 had a pCR with NAT) and 5 pts died for progression disease. Conclusions: NAT on TNBC pts with carboplatine, nab-paclitaxel and antracycline dd is a feasible, safe and highly effective option. Even though survival analysis is not yet mature in our study, pCR has been shown to be a surrogate for overall survival. The excellent results obtained with this scheme, make it a good treatment option and could be an alternative to pembrolizumab (Keynote-522) in pts with autoinmmune diseases or immune-AE due to similar pCR.
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