Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.

BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.

A multicentre, cross-sectional study on quality of life in patients with cutaneous lupus erythematosus.

BACKGROUND: A study at the University of Pennsylvania (UPenn) Medical Center demonstrated that quality of life in patients with cutaneous lupus erythematosus (CLE) is negatively impacted. Whether patients with CLE in other geographic locations have similar quality of life is unknown. OBJECTIVES: We sought to compare quality of life indicators between patients with CLE at the University of Texas Southwestern (UTSW) Medical Center at Dallas and those at UPenn. METHODS: Patients with CLE (total n=248) at UTSW (n=91) and UPenn (n=157) completed the Skindex-29 +3 and Short Form-36 (SF-36) surveys related to quality of life. Additional information, including demographics, presence of systemic lupus erythematosus (SLE) and disease severity, was collected from UTSW patients with CLE. RESULTS: Most Skindex-29 + 3 and SF-36 subdomain scores between UTSW and UPenn patients with CLE were similar. However, UTSW patients with CLE were significantly more affected in the functioning and lupus-specific Skindex-29 + 3 domains, and physical functioning, role-physical and general health SF-36 subscales than UPenn patients with CLE (P<0·05). Factors related to poor quality of life in UTSW patients with CLE include sex, income, education, presence of SLE, and skin disease activity. CONCLUSIONS: Most quality of life indicators were similar between the two CLE populations. Differences in psychosocial behaviour, and a larger proportion of patients with SLE and females in the UTSW group likely attributed to differences in a minority of Skindex-29+3 and SF-36 subdomains. Capturing data from CLE populations in different locations provides a more thorough picture of the quality of life that patients with CLE experience on a daily basis with special attention to quality of life issues in select patients with CLE.

[The remittances in U.S. dollars that Mexican migrants send home from the United States (a study based on data from the Survey of Migration in the Northern Frontier Region of Mexico)]. / Las remesas de dolares que envian los migrantes mexicanos desde Estados Unidos (medicion a traves de la Encuesta de Migracion en la Frontera Norte de Mexico).

PIP: The difficulties in obtaining reliable data on remittances to Mexico by Mexican immigrants in the United States are first outlined. An analysis of such remittances is then attempted using data from a recent survey, the Encuesta sobre Migracion en la Frontera Norte. Data from this survey are used to analyze several aspects of remittances "such as the direct determination of the amount of the remittances and the identification of the immigrants that send them according to their social and demographic features, and the location of Mexican zones where the remittances arrive, [and] the variations in the amount and frequency of the remittances among the different groups of immigrants." (EXCERPT)^ieng

[Early echography subprogramm. Southern Metropolitan Health Service evaluation 1989-1990]. / Subprograma de ecografía precoz. Servicio Salud Metropolitano Sur evaluación 1989-1990.

The results of an early level I ultrasound program performed in the Southern Health Area of Santiago during the years 1989 and 1991 are reported. It was noticed that suspect gestational age constituted the highest number of ambulatory attentions (23.9%) in the High Risk Obstetric Department of Barros Luco Trudeau Hospital in 1987. With this program, in 1990, 82% of pregnant women were examined before 20 weeks' gestation, with a total of 10447 ultrasound examinations. Suspect gestational age descended to 8.6% in 1990 (compared with 23.9% in 1987). Amniocentesis and amnioscopies also diminished abruptly. The value of early routine level I ultrasound program in obstetric population improves maternal, fetal and newborn health indexes. These conditions are discussed.