Use of prophylactic pegfilgrastim for chemotherapy-induced neutropenia in the US: A review of adherence to present guidelines for usage.

Evidence-based US guidelines provide recommendations for the use of granulocyte colony-stimulating factor (G-CSF) as supportive therapy in patients with cancer receiving chemotherapy. Pegfilgrastim is recommended for FN prophylaxis in patients with non-myeloid malignancies receiving a high-risk chemotherapy regimen, or an intermediate-risk regimen if one or more risk factors are present. The guidelines highlight the patient characteristics and chemotherapy regimens for solid tumors and hematologic malignancies that may influence a patient's overall risk of FN and may benefit from pegfilgrastim support.

Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment.

Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study.

Background: Acute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5-14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care.

Patterns of growth factor usage and febrile neutropenia among older patients with diffuse large B-cell non-Hodgkin lymphoma treated with CHOP or R-CHOP: the Intergroup experience (CALGB 9793; ECOG-SWOG 4494).

Patterns of myeloid growth factor (GF) usage and febrile neutropenia (FN) were examined in patients >60 years of age with diffuse large B-cell non-Hodgkin lymphoma (DLBCL) enrolled on CALGB 9793/ECOG-SWOG 4494, receiving initial therapy with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or rituximab + CHOP (R-CHOP). Myeloid GFs were administered to 256/520 (49%) patients. Indications for use were: prevent dose reduction/dose delay (81%, 207/256); treat FN or non-febrile neutropenia (NFN) (19%, 48/256).

Honoring Roots in Multiple Worlds: Professionals' Perspectives on Healthy Development of Latino Youth.

Purpose: To obtain contextualized insights from professionals regarding factors that contribute to or inhibit the healthy development of Latino youth.

Method: A community-engaged study in which semistructured in-depth interviews were conducted with 30 professionals who work extensively with Latino youth in urban clinics, schools, and other community-based settings.

Results: Every key informant expressed opinions regarding factors that contribute to healthy development of Latino youth, ranging from cultural identity and a sense of belonging to family connectedness and adult role models.

Comparison of time to treatment between intravenous and endovascular thrombolytic treatments for acute ischemic stroke.

Background: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is used to treat acute ischemic stroke (AIS) within 4.5 hours of symptom onset. Endovascular treatment (ET) may provide higher rates of recanalization, but longer time to treatment may limit comparative clinical benefit and widespread applicability.

Reperfusion phenomenon masking acute and subacute infarcts at dynamic perfusion CT: confirmation by fusion of CT and diffusion-weighted MR images.

Objective: The purpose of this study was to evaluate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay in a selected sample of patients with visually normal or increased cerebral blood volume to facilitate detection of a postischemic CT perfusion hyperperfusion-reperfusion phenomenon that may mask subacute and acute infarcts.

Materials And Methods: Ten patients were included who had visually normal or elevated cerebral blood volume in infarcts larger than 1.5 cm confirmed on diffusion-weighted MR images within 48 hours of perfusion CT.

Endoscopic approach to acute pancreatitis.

This review focuses on the use of endoscopic techniques in the diagnosis and management of pancreatic disorders. Endoscopic retrograde cholangiopancreatography (ERCP) has been used primarily to evaluate and treat disorders of the biliary tree. Recently, endoscopic techniques have been adapted for pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections, and stone extraction via the major and minor papillae.

Endoscopic therapy of benign biliary strictures.

Benign biliary strictures result from many etiologies, including postoperative injuries, anastomotic strictures, and chronic pancreatitis. Therapy is generally required to relieve symptoms of cholestasis or cholangitis and prevent secondary cirrhosis. Surgery has been the traditional method for treatment of benign biliary strictures but is associated with significant morbidity and variable long-term outcomes.

Health care facility and community strategies for patient care surge capacity.

Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for "surge capacity" must thus be made to accommodate a large number of patients.

Fosphenytoin in infants of extremely low birth weight.

Fosphenytoin, a phosphorylated prodrug of phenytoin, is useful for acute seizures, is given by parenteral administration, and has few cardiac and local irritation adverse effects. There is limited experience in the administration of this new agent to newborns, and concern has been raised regarding the conversion of the prodrug to phenytoin. In two low--birth-weight infants, it was observed that fosphenytoin was converted adequately with varying effects on seizure control.

Bifid epiglottis.

Bifid epiglottis is a rare congenital defect that is often associated with other congenital annomalies. The most common defect associated with a bifid epiglottis are anomalies of the hands and/or feet (90%) while the most dangerous and potentially lethal anomaly if not recognized and treated are hypothalamic hamartomas and hypopituitarism (50%). A bifid epiglottis will often result in severe respiratory distress secondary to laxity of the cartilage and chronic aspirations, which may require surgical intervention.

Correlation of laryngeal chemoreflex severity with laryngeal muscle response.

Objectives: To examine the relationship between the severity of the laryngeal chemoreflex (LCR) and the pattern of laryngeal muscle activity during an LCR-induced apnea.

Methods: The laryngeal mucosa of 20 piglets aged 17 to 20 days was stimulated under both hypoxic and normoxic conditions. Respiration, blood pressure, and activity of the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were monitored during the LCR-induced apnea.

Gallstone-dissolving agents.

It can be anticipated that most new therapies will generate considerable excitement and optimism when introduced. This is usually tempered with time as additional clinical experience is gained and therapeutic limitations and adverse effects are realized. All areas in the nonsurgical management of gallstones have experienced this course--some, such as ESWL, rather meteorically.