RESUMO
INTRODUCTION: C-reactive protein (CRP), a marker of inflammation, shows high serum levels in invasive bacterial infections. We investigated the potential of a single CRP measurement at different phases of acute childhood bacterial meningitis to predict outcomes. METHODS: Using whole-blood finger-prick samples with no centrifugation, CRP was measured quantitatively on arrival and on day 3 or 4 in children participating in 2 prospective, randomized, double-blind treatment studies conducted in Latin America or Angola. The results were compared with patient outcomes. RESULTS: Although initial CRP values from 669 children gave useful prognostic information, the 3rd or 4th day measurements taken from 275 children associated significantly with seizures, slow recovery and low scores on the Glasgow Outcome Scale, with odds ratios for CRP values above the median (62 mg/L) ranging from 2 to 6, 2 to 5, and 3 to 5 (Latin America-Angola), respectively. Hearing impairment, although not full deafness, was 3 to 7 times more likely if CRP was above the median soon after hospitalization. CONCLUSIONS: Especially in resource-poor settings, clinicians have few simple-enough tools to identify the child with meningitis who requires maximum attention. CRP is a worthy addition.
Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/patologia , Adolescente , Angola , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , América Latina , Masculino , Meningites Bacterianas/mortalidade , Prognóstico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. STUDY DESIGN: In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included. RESULTS: Based upon the costs of screening 36,453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola. CONCLUSIONS: These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.
Assuntos
Anemia Falciforme/diagnóstico , Triagem Neonatal/economia , Anemia Falciforme/epidemiologia , Anemia Falciforme/terapia , Angola/epidemiologia , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Morbidade/tendências , Projetos PilotoRESUMO
We explored the changes of the initially highly upgraded cerebrospinal fluid matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of MMP 1 (TIMP-1) response during recovery of childhood bacterial meningitis and their association with outcome. The sizes of these changes varied substantially, but a steeper decrease in the MMP-9 and an increase of the TIMP-1 concentrations augured a better outcome.
Assuntos
Líquido Cefalorraquidiano/química , Metaloproteinase 9 da Matriz/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/patologia , Inibidor Tecidual de Metaloproteinase-1/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Pré-Escolar , Monitoramento de Medicamentos , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: Sickle cell disease complications are an important mortality cause in children mainly in Africa and India. Notwithstanding the magnitude of the problem on the African continent, studies identifying factors related to the adverse outcomes of sickle cell disease in the pediatric population are still scarce. OBJECTIVE: To identify prognostic factors associated with mortality in children and adolescent aged under fifteen years with diagnosis of sickle cell disease. METHODS: Patients meeting inclusion criteria were listed and randomly selected. Clinical and laboratory data collected at time of admission were collected from medical records through the use of standard forms. The association between mortality and explanatory variables was tested using univariable and multivariable analysis. RESULTS: The overall mortality rate was 64 (12.9%), and bacterial infections 26 (40.1%) were the most common cause of death. Place of residence out of Luanda, lack of outpatient follow-up, symptoms onset more than three days, disease manifestation before age of eighth months and hemoglobin level of < 7 g/dl were independent risk factors related to death. In the study population, sickle cell related deaths were related to quality of health care and access to care. CONCLUSION: The creation of regional sickle cell disease centers to support those afflicted by the disorder and their families would contribute to reduce the burden associated with the disease.