ABSTRACT
Pediatric acute promyelocytic leukemia (APL) can be cured with all-trans retinoic acid (ATRA) and anthracycline. However, most published trials have employed high cumulative doses of anthracyclines. Here, we report the outcome of newly diagnosed APL patients enrolled in the International Consortium for Childhood APL (ICC-APL-01) trial, which reduced anthracycline exposure but extended that of ATRA. The study recruited 258 children/adolescents with molecularly/cytogenetically proven APL. Patients were stratified into standard-risk (SR) and high-risk (HR) groups according to baseline white blood cell counts (<10 × 109/L or ≥10 × 109/L); both groups received identical induction treatment with ATRA and 3 doses of idarubicin. Two or 3 blocks of consolidation therapy were administered to SR and HR patients, respectively, while maintenance therapy with low-dose chemotherapy and ATRA cycles was given to all patients for 2 years. The cumulative dose of daunorubicin equivalent anthracyclines in SR and HR patients was lower than that of previous studies (355 mg/m2 and 405 mg/m2, respectively). Hematologic remission was obtained in 97% of patients; 8 children died of intracranial hemorrhage in the first 2 weeks following diagnosis. Five-year overall and event-free survival for the whole cohort were 94.6% and 79.9%, respectively; they were 98.4% and 89.4% in SR patients and 84.3% and 74.2% in HR patients (P = .002 and P = .043, respectively). These data demonstrate that extended use of ATRA coupled to a risk-adapted consolidation can achieve high cure rates in childhood APL and limit anthracycline exposure. The trial was registered at www.clinicaltrials.gov as EudractCT 2008-002311-40.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leukemia, Promyelocytic, Acute/drug therapy , Adolescent , Adult , Anthracyclines/administration & dosage , Child , Child, Preschool , Daunorubicin/administration & dosage , Female , Humans , Idarubicin/administration & dosage , Infant , International Agencies , Leukemia, Promyelocytic, Acute/pathology , Male , Remission Induction , Risk Factors , Treatment Outcome , Tretinoin/administration & dosage , Young AdultABSTRACT
Introduction: Hematopoietic malignancies are the most frequent type of cancer in childhood. Recent advances in cancer treatment have significantly improved survival until adulthood. There is an extensive literature on the effects of cancer treatment on the gonadal axis in adult survivors of childhood cancer mainly focused on sperm production, but scarce information exists on the immediate impact of cancer and its treatment in boys. Objectives: In this work, we determined the status of the hypothalamic-pituitary-testicular (HPT) axis function at diagnosis and the immediate impact of chemotherapy at the start of treatment in children and adolescents with hematopoietic malignancies. Subjects and methods: In a prospective study of 94 boys and adolescents with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) or non-Hodgkin lymphoma (NHL), we determined serum AMH, inhibin B and FSH to assess the gonadotrophin-Sertoli cell component of the HPT axis, and testosterone and LH to evaluate the gonadotrophin-Leydig cell component, at diagnosis and after 3 months of chemotherapy. Secondarily, the general health state was evaluated. Results: In prepubertal boys, at diagnosis, AMH, inhibin B and FSH were lower compared to the reference population, reflecting an FSH-Sertoli cell axis dysfunction. After 3 months of chemotherapy, all hormone concentrations increased. At pubertal age, at diagnosis, AMH and inhibin B were lower compared to the reference population for Tanner stage, with inappropriately normal FSH, suggesting a primary Sertoli cell dysfunction with insufficient gonadotrophin compensation. The LH-Leydig cell axis was mildly disrupted. After 3 months of chemotherapy, inhibin B and AMH were unchanged while median FSH levels rose to values that exceeded the reference range, indicating a significant impairment of Sertoli cell function. Testosterone normalized concomitantly with an abnormal LH elevation reflecting a compensated Leydig cell impairment. General health biomarkers were impaired at diagnosis and improved after 3 months. Conclusion: The HPT axis function is impaired in boys with hematopoietic malignancies before the initiation of chemotherapy. There is a primary testicular dysfunction and a concomitant functional central hypogonadism that could be due to an impaired overall health. The HPT axis function improves during the initial 3 months of chemotherapy concomitantly with the general health state. However, in pubertal boys the dysfunction persists as shown by elevated gonadotropin levels after 3 months.
Subject(s)
Hematologic Neoplasms , Neoplasms , Adult , Humans , Male , Child , Adolescent , Follicle Stimulating Hormone , Prospective Studies , Semen , Testosterone , Hematologic Neoplasms/drug therapyABSTRACT
La neumonía es una infección respiratoria que afecta a los pulmones y puede llevar a la muerte. Los niños menores de 5 años pueden adquirir la enfermedad a través de bacterias, virus y hongos, lo cual puede generarse por ciertos factores ambientales no propicios. Objetivos: Validar el instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años que acuden a consulta externa del hospital Martin Icaza del Cantón Babahoyo, julio - diciembre 2020; determinar la confiabilidad del instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años. Materiales y métodos: Se utiliza un diseño no experimental, con enfoque mixto, método deductivo, de tipo transversal, de campo, prospectivo. Se aplicó un plan piloto con el fin de identificar la validez, coherencia y pertinencia del instrumento, y a su vez determinar la confiabilidad del mismo con base al criterio de expertos. El componente cuantitativo constó de un plan piloto a 16 padres, donde 8 niños padecían neumonía, mientras los 8 restantes no; en tanto que la entrevista se realizó a dos representantes de niños con neumonía. Resultados: La validación de los instrumentos vino dada por tres profesionales que fueron seleccionados por su experiencia y prestigio, estos calificaron la validez, pertinencia y coherencia donde se obtuvo la ponderación de muy confiable. Los resultados mostraron que la enfermedad se transmite por contacto con personas que padecen estas enfermedades (62.5%), los principales síntomas son la tos, fiebre y dolor de garganta (50.0%), las personas viven con 4 o 5 personas en la misma casa (56.3%) y poseen animales (75.0%). Se identificó efectos emocionales negativos, tales como desesperación, ansiedad, tristeza, depresión e impotencia. Conclusión: El instrumento analizado es válido, coherente y pertinente, siendo muy confiable para su aplicación(AU)
Pneumonia is a respiratory infection that affects the lungs and can lead to death. Children under 5 years of age can acquire the disease through bacteria, viruses and fungi, which can be generated by certain unfavorable environmental factors. Objectives: To validate the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age who attend the outpatient clinic of the Martin Icaza hospital in Babahoyo Canton, July - December 2020; determine the reliability of the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age. Materials and methods: A non-experimental design is used, with a mixed approach, deductive method, cross-sectional, field, prospective. A pilot plan was applied in order to identify the validity, coherence and relevance of the instrument, and in turn determine its reliability based on expert criteria. The quantitative component consisted of a pilot plan for 16 parents, where 8 children suffered from pneumonia, while the remaining 8 did not; while the interview was conducted with two representatives of children with pneumonia. Results: The validation of the instruments was given by three professionals who were selected for their experience and prestige, they qualified the validity, relevance and coherence where the weighting of very reliable was obtained. The results showed that the disease is transmitted by contact with people suffering from these diseases (62.5%), the main symptoms are cough, fever and sore throat (50.0%), people live with 4 or 5 people in the same house (56.3%) and own animals (75.0%). Negative emotional effects were identified, such as despair, anxiety, sadness, depression and helplessness. Conclusion: The analyzed instrument is valid, coherent and pertinent, being very reliable for its application(AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Pneumonia/mortality , Respiratory Tract Infections , Child Health , Validation Study , Bacteria , Viruses , Environment , FungiABSTRACT
El embarazo es un período de emoción y ansiedad. La realidad para las mujeres embarazadas es que sus acciones podrían afectar al embarazo y al feto, por lo que es necesario que conozcan lo que deben y no deben hacer para minimizar riesgos y optimizar resultado. Objetivo: Determinar las tres demoras de salud que llevan a complicaciones obstétricas en embarazadas en Ecuador. Metodología: Esta investigación se desarrolló bajo una perspectiva cualitativa, de carácter documental, de tipo monográfico. Resultados: Primera demora, Se refiere al retraso en la búsqueda de ayuda. Segunda demora, se relaciona con el retraso en alcanzar la ayuda una vez reconocida la complicación, las principales causas reportadas como origen de este retraso son: falta de transporte para el traslado al hospital, falta de recursos económicos para su pago, miedo a acudir a los servicios de salud por malas experiencias. Tercera demora, cuando la mujer llega al servicio de salud, el tiempo de espera de la atención puede prolongarse hasta más de una hora. Conclusión: En el ecuador se diseñó un modelo de las "tres demoras" específica que la decisión de buscar ayuda es el primer paso a dar si una mujer con una complicación quiere recibir cuidados obstétricos de emergencia. Una vez tomada la decisión de buscar ayuda, la mujer debe llegar a la unidad de salud donde se brinden cuidados obstétricos de emergencia(AU)
Pregnancy is a period of excitement and anxiety. The reality for pregnant women is that their actions could affect the pregnancy and the fetus, so they need to know what they should and should not do to minimize risks and optimize results. Objective: To determine the three health delays that lead to obstetric complications in pregnant women in Ecuador. Methodology: This research was developed from a qualitative, documentary, monographic perspective. Results: First delay refers to the delay in seeking help. The second delay is related to the delay in reaching help once the complication has been recognized, the main causes reported as the origin of this delay are lack of transportation to go to the hospital, lack of financial resources for payment, fear of going to health services for bad experiences. Third delay, when the woman arrives at the health service, the waiting time for care can last up to more than an hour. Conclusion: A model designed was the "three delays" designed in Ecuador, specifying that the decision to seek help is the first step to take if a woman with a complication wants to receive emergency obstetric care. When the woman decides to seek help, she must go to the health unit where emergency obstetric care(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Maternal and Child Health , Risk Factors , Obstetric Labor Complications , Time , Transportation , Ambulatory Care , Procrastination , Health ServicesABSTRACT
La tuberculosis pulmonar constituye una enfermedad de salud pública en el territorio ecuatoriano en expansión que provoca muerte y sufrimiento para la población. El objetivo del estudio es caracterizar la tuberculosis pulmonar en individuos mayores de 15 años que asisten al Hospital de Día "Dr. Efrén Jurado López" de la ciudad de Guayaquil. Se realizó una investigación cuantitativa, descriptiva, retrospectiva. La muestra de estudio quedó conformada por 58 pacientes de ambos géneros mayores de 15 años, diagnosticados con tuberculosis en todas sus formas, atendidos en el contexto de estudio entre enero 2017 y enero de 2018. En la recolección de la información se aplicó una ficha de observación validada por expertos con previo consentimiento informado de los pacientes estudiados. Como resultados se obtuvo que el 72,4% eran del sexo masculino y el 27,6% femenino. El predominio de diagnóstico presentado fue sintomático TBP BK+ en un 100%. Por otra parte para el diagnóstico por TBP cultivo + fue 87,9% (51/58) y TBP cultivo- de 12,1% (7/58). Por otra parte la TB EP fue de 25,9% (15/58) con predominio en el sexo masculino 80%, las formas de tuberculosis y la comorbilidad asociada al al Virus de Inmunodeficiencia Humana (VIH), se observó una frecuencia de 6,9% (4/58) de personas con TB que tenían VIH, de las cuales el 5,2% correspondían a casos de VIH con tuberculosis extra pulmonar y 1,7% a casos de TBP BK+/VIH. Se debe continuar trabajando en la búsqueda de TB en pacientes sintomáticos respiratorios para un diagnóstico oportuno(AU)
Characterization of pulmonary tuberculosis in teenagers older than 15 years in thedr.Efrénjuradolópez day time hospital. Pulmonary tuberculosis is a public health disease in the expanding Ecuadorian territory that causes death and suffering for the population. The objective of the study is to characterize pulmonary tuberculosis in individuals over 15 years of age attending the "Dr. Efrén Jurado López" Day Hospital in the city of Guayaquil. A quantitative, descriptive, retrospective investigation was carried out. The study sample consisted of 58 patients of both genders over 15 years of age, diagnosed with tuberculosis in all its forms, treated in the context of the study between January 2017 and January 2018. A data sheet was applied in the collection of information observation validated by experts with prior informed consent of the patients studied. As a result, it was obtained that 72.4% were male and 27.6% female. The prevalence of diagnosis presented was symptomatic TBP BK + in 100%. On the other hand for the diagnosis by TBP culture + it was 87.9% (51/58) and TBP culture- of 12.1% (7/58). On the other hand, the TB TB was 25.9% (15/58) with a predominance in the male sex 80%, the forms of tuberculosis and the comorbidity associated with the Human Immunodeficiency Virus (HIV), a frequency of 6 was observed, 9% (4/58) of people with TB who had HIV, of which 5.2% corresponded to HIV cases with extra pulmonary tuberculosis and 1.7% to cases of BK + / HIV TBP. Work should continue in the search for TB in symptomatic respiratory patients for a timely diagnosis(AU)
Subject(s)
Female , Pregnancy , Adolescent , Young Adult , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/etiology , Tuberculosis, Pulmonary/epidemiology , HIV Infections/diagnosis , Ecuador/epidemiologyABSTRACT
RESUMEN Introducción: La ultrasonografía es un procedimiento que utiliza ondas de sonido de alta energía para estudiar tejidos y órganos, formándose imágenes que permiten diagnosticar enfermedades. La eficacia en su implementación es útil para determinar acciones de intervención en procesos de salud. Objetivo: Determinar la eficacia del uso de la ultrasonografía asociada a características clínicas y epidemiológicas en pacientes con dolor abdominal agudo por apendicitis en el Centro Médico "Popular" Vinces. Métodos: Se realizó un estudio correlacional, descriptivo, de cohorte retrospectivo realizado durante 7 meses (enero a julio del 2019). La población estuvo constituida por 162 pacientes, se incluyó, además, a derivados con dolor abdominal agudo diagnosticados con apendicitis a través de la clínica y/o ultrasonografía del Centro Médico "Popular" Vinces. Resultados: De los 162 pacientes observados se intervinieron 157, diagnóstico anatomopatológico de apendicitis en 130. La sensibilidad de la ecografía con criterio de certeza y sospecha fue 96,7 por ciento. La muestra aleatoria piloto contenía 162 participantes de un total de 180 pacientes, mujeres (16,67 por ciento) y hombres (83,33 por ciento). Conclusiones: Se demostró que la ecografía abdominal es el método diagnóstico eficaz, de elección para este estudio por su sensibilidad y criterio de certeza, fácil acceso y costo mínimo, permitiéndose un control adecuado y seguimiento preventivo de las complicaciones, más aún en los casos, con cuadro clínico y laboratorio dudoso, con el fin de evitar posibles complicaciones y reducir los costos económicos durante su diagnóstico(AU)
ABSTRACT Introduction: This article is an extensive review of the different aspects of this pathology, acute appendicitis despite being the first cause of emergency abdominal surgery, the delay in diagnosis implies an increase in surgical interventions with perforated appendices and, therefore, an increase in morbidity and mortality. Objective: To present the results of the efficacy of the use of ultrasonography associated with clinical and epidemiological characteristics in patients with acute abdominal pain due to appendicitis at the "popular" Medical Center Vinces-Ecuador. Methods: A correlational, descriptive, Retrospective cohort study conducted for 7 months (January to July 2019), in which the study population included patients referred with acute abdominal pain diagnosed with appendicitis through the clinic and / or ultrasonography of the "popular" Vinces Medical Center, Ecuador. This population is constituted by 162 patients. Results: Of the 162 patients observed, 157 underwent surgery, an anatomopathological diagnosis of appendicitis in 130. The sensitivity of the ultrasound with criteria of certainty and suspicion was 96.7 percent. The pilot random sample contained 162 participants out of a total of 180 patients, women (16.67 percent) and men (83, 33 percent). Conclusion: it was shown that abdominal ultrasound is the effective diagnostic method of choice for this study because of its sensitivity and certainty, easy access and minimal cost, allowing adequate control and preventive monitoring of complications, even more so in cases, with symptoms. clinical and laboratory doubtful, in order to avoid possible complications and reduce economic costs during diagnosis(AU)
Subject(s)
Humans , Male , Female , Appendicitis/diagnosis , Abdominal Pain/diagnostic imaging , Epidemiology, Descriptive , Retrospective Studies , Cohort StudiesABSTRACT
Introducción. Con el objetivo de clarificar la controversia sobre la eficacia del hidróxido férrico polimaltosado en relación al sulfato ferroso, se comparó prospectivamente la eficacia y la tolerabilidad deambos.Población, material y métodos. Niños de 6-48 meses,con hemoglobina <11,0 g/dl, volumen corpuscularmedio <72 fl y saturación de transferrina ≤15%o ferritina <16 ng/ml fueron estratificados por gruposetarios y aleatorizados para recibir hidróxidoférrico polimaltosado o sulfato ferroso (5 mg/kg/día)durante 90 días. Se analizaron hemoglobina, hematócrito,volumen corpuscular medio, ferremia, saturacióny ferritina. La tolerabilidad se evaluó comobuena, regular o mala, según el porcentaje de dosisque efectivamente recibía el niño.Resultados. Se incluyeron 59 pacientes (23 con hidróxidoférrico polimaltosado, 36 con sulfato ferroso).Hemoglobina y hematócrito mostraron valores significativamente más elevados en el grupo sulfatoferroso que en el hidróxido férrico polimaltosado desde el día 30 hasta el final (p <0,05). Ferremia,saturación y ferritina al día 90 fueron significativamente mayores en el grupo sulfato ferroso (p <0,05).La diferencia inicial-final fue significativamente mayor en el grupo sulfato ferroso para todas lasvariables. Un mayor porcentaje de pacientes delgrupo sulfato ferroso alcanzó valores normales parahemoglobina, hematócrito, volumen corpuscularmedio, ferremia y saturación (p <0,05). Sólo un paciente del grupo sulfato ferroso (por mala tolerancia)y uno del grupo hidróxido férrico polimaltosado(por caída de hemoglobina >1 g/dl) debieronsuspender tratamiento.Conclusiones. El sulfato ferroso es de elección pues produce incrementos más precoces y de mayor intensidad para todos los parámetros, permite la normalización de valores en mayor cantidad depacientes y presenta similar tolerabilidad y grado de adhesión al tratamiento que el hidróxido férricopolimaltosado.(AU)
Introduction. The usefulness of iron polymaltose (IP) for the treatment of iron deficiency anemia is still controversial. The aim of this prospective, randomized study was to compare efficacy and tolerability of IP and ferrous sulfate (FS). Patients, materials y methods. Children aged 6-48 months, with hemoglobin <11.0 g/dl, mean corpuscular volume <72 fl and transferrin saturation ≤15% or ferritin <16 ng/ml were stratified in age groups and randomized to receive IP or FS (5 mg/kg per day) throughout 90 days. Hemoglobin, hematocrit, mean corpuscular volume, serum iron, transferrin saturation, and ferritin were determined. Tolerability to oral administration was classified as good,intermediate or poor, according to the percentage of the total daily iron dose received. Results. Fifty-nine patients (23 IP, 36 FS) were included. Hemoglobin and hematocrit showed significantly higher values in group FS than in group IP from day 30 to the end of the study (p <0.05). Serum iron, saturation and ferritin at day 90 were significantly higher in group FS (p <0.05). The difference between initial and final values was significantly higher in group FS for every determination. Normal values for hemoglobin, hematocrit, mean corpuscular volume, serum iron and saturation were achieved by significantly more patients in group FS (p <0.05). Only one patient in group FS (due to poor tolerance) and another in group IP (due to hemoglobin fall >1 g/dl) had to discontinue treatment. Conclusions. The first choice for treatment is FS, since it is more effective, with similar safety, tolerability and compliance profiles than IP.(AU)
Subject(s)
Infant , Child , Hydroxides , Ferrous Sulfate , Anemia, Iron-Deficiency , Iron Deficiencies , Prospective Studies , Random AllocationABSTRACT
Introducción. Con el objetivo de clarificar la controversia sobre la eficacia del hidróxido férrico polimaltosado en relación al sulfato ferroso, se comparó prospectivamente la eficacia y la tolerabilidad deambos.Población, material y métodos. Niños de 6-48 meses,con hemoglobina <11,0 g/dl, volumen corpuscularmedio <72 fl y saturación de transferrina ≤15%o ferritina <16 ng/ml fueron estratificados por gruposetarios y aleatorizados para recibir hidróxidoférrico polimaltosado o sulfato ferroso (5 mg/kg/día)durante 90 días. Se analizaron hemoglobina, hematócrito,volumen corpuscular medio, ferremia, saturacióny ferritina. La tolerabilidad se evaluó comobuena, regular o mala, según el porcentaje de dosisque efectivamente recibía el niño.Resultados. Se incluyeron 59 pacientes (23 con hidróxidoférrico polimaltosado, 36 con sulfato ferroso).Hemoglobina y hematócrito mostraron valores significativamente más elevados en el grupo sulfatoferroso que en el hidróxido férrico polimaltosado desde el día 30 hasta el final (p <0,05). Ferremia,saturación y ferritina al día 90 fueron significativamente mayores en el grupo sulfato ferroso (p <0,05).La diferencia inicial-final fue significativamente mayor en el grupo sulfato ferroso para todas lasvariables. Un mayor porcentaje de pacientes delgrupo sulfato ferroso alcanzó valores normales parahemoglobina, hematócrito, volumen corpuscularmedio, ferremia y saturación (p <0,05). Sólo un paciente del grupo sulfato ferroso (por mala tolerancia)y uno del grupo hidróxido férrico polimaltosado(por caída de hemoglobina >1 g/dl) debieronsuspender tratamiento.Conclusiones. El sulfato ferroso es de elección pues produce incrementos más precoces y de mayor intensidad para todos los parámetros, permite la normalización de valores en mayor cantidad depacientes y presenta similar tolerabilidad y grado de adhesión al tratamiento que el hidróxido férricopolimaltosado.
Introduction. The usefulness of iron polymaltose (IP) for the treatment of iron deficiency anemia is still controversial. The aim of this prospective, randomized study was to compare efficacy and tolerability of IP and ferrous sulfate (FS). Patients, materials y methods. Children aged 6-48 months, with hemoglobin <11.0 g/dl, mean corpuscular volume <72 fl and transferrin saturation ≤15% or ferritin <16 ng/ml were stratified in age groups and randomized to receive IP or FS (5 mg/kg per day) throughout 90 days. Hemoglobin, hematocrit, mean corpuscular volume, serum iron, transferrin saturation, and ferritin were determined. Tolerability to oral administration was classified as good,intermediate or poor, according to the percentage of the total daily iron dose received. Results. Fifty-nine patients (23 IP, 36 FS) were included. Hemoglobin and hematocrit showed significantly higher values in group FS than in group IP from day 30 to the end of the study (p <0.05). Serum iron, saturation and ferritin at day 90 were significantly higher in group FS (p <0.05). The difference between initial and final values was significantly higher in group FS for every determination. Normal values for hemoglobin, hematocrit, mean corpuscular volume, serum iron and saturation were achieved by significantly more patients in group FS (p <0.05). Only one patient in group FS (due to poor tolerance) and another in group IP (due to hemoglobin fall >1 g/dl) had to discontinue treatment. Conclusions. The first choice for treatment is FS, since it is more effective, with similar safety, tolerability and compliance profiles than IP.