Management and Long-Term Outcomes of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review.

Drug reaction with eosinophilia and systemic symptoms (DReSS) is known to cause mortality and long-term sequelae in the pediatric population, however there are no established clinical practice guidelines for the management of pediatric DReSS. We conducted a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the currently available data on treatment, mortality, and long-term sequelae of DReSS in children (aged 0-18 years). Data from 644 individuals revealed that various treatment strategies are being used in the management of pediatric DReSS, and strategies were often used in combination. The diversity in treatment approaches cannot be solely attributed to age or disease severity and reflects the lack of evidence-based management guidelines for DReSS. Children are also at risk of developing autoimmune sequelae following DReSS, most commonly thyroid disease and type 1 diabetes mellitus. We found that the eventual development of autoimmune disease was more often associated with DReSS caused by antibiotics, especially minocycline and sulfamethoxazole, in comparison with individuals who did not develop sequelae. In this study, we identify strengths and weaknesses in the currently available literature and highlight that future prospective studies with structured and long-term follow-up of children with DReSS are needed to better understand potential risk factors for mortality and development of sequelae after DReSS.

Clinical Presentation and Diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review.

Effective treatment of drug reactions with eosinophilia and systemic symptoms (DReSS) requires early diagnosis and close monitoring. Diagnosing DReSS is especially challenging in children due to a low incidence rate, heterogeneous clinical presentation, and a lack of (pediatric) diagnostic criteria and clinical practice guidelines. We performed a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the clinical presentation and diagnostic process of DReSS in children (aged 0-18 years). Data from 644 individuals showed that DReSS manifests differently in children compared to adults. Children have a higher number of organs involved, including higher rates of cardiac and respiratory involvement compared to adults. Children < 6 years of age appear more prone to develop neurologic symptoms. Conversely, eosinophilia, edema, and kidney involvement are less frequently observed in children. Anti-seizure medications are by far the most common causative drug class, but the range of implicated drugs increases as children get older. This study highlights that children with DReSS not only differ from adults but also that differences exist between children of different ages. As such, there is a need to establish pediatric-specific diagnostic criteria. These efforts will promote earlier diagnosis of DReSS and likely lead to improved clinical care offered to children and their families.

Distribution of Cancer and Cancer Screening and Treatment Services in Lagos: A 10-Year Review of Hospital Records.

PURPOSE: In Lagos State, Nigeria, the population distribution of cancers is poorly described because studies are conducted at a few tertiary hospitals. Therefore, this study aims to map all health facilities where cancer screening takes place and describe the cases of cancer screened for and treated. METHODS: A cross-sectional survey to identify facilities involved in screening and management of cancers was performed followed by extraction of data on individual cases of cancer screened for and treated at these facilities from 2011 to 2020. All health care facilities in the state were visited, and the survey was performed using standardized national tools modified to capture additional information on cancer screening and treatment. Data analysis was performed using STATA version 14 and R version 3.6.3. RESULTS: Cervical cancer was the commonest cancer, accounting for 55% of 2,420 cancers screened, followed by breast (41%), prostate (4%), and colorectal cancers (0.2%). Of the 7,682 cancers treated among Lagos residents, the top five were breast (45%), colorectal (8%), cervical (8%), prostate (5%), and ovarian (4%). The female:male ratio of cancer cases was 3:1. The peak age for cancer among females and males was in the 40- to 49-year age group and 60- to 69-year age group, respectively. The Ikorodu local government area had the highest rate of reported cancer per million population. CONCLUSION: Cancer screening is poor with a significant gap in screening for breast cancer since it is the commonest cancer in the state. The findings indicate the urgent need for the establishment of organized screening programs for the predominant cancers in the state and the prioritization of cancer research that addresses key policy and program questions.

Cancer Registration in Resource-limited Environments-Experience in Lagos, Nigeria.

BACKGROUND: Cancer registration provides data that can be utilized to study the etiology, diagnosis, prevention, and treatment of cancer. Despite the efforts of the World Health Organization (WHO), cancer registration is still underdeveloped in low- and middle-income countries (LMICs). This is the case in Lagos, Nigeria. Lakeshore Cancer Center (LCC) sought to retrospectively collect and describe the characteristics of the patients seen in its first 2 y of existence. METHODS: A retrospective review of patient records presenting at LCC was performed. Various parameters were collected such as demographics and diagnoses. These data were used to perform a simple descriptive analysis. A series of consultations determined what parameters to include in the registry. CanReg, a cancer registration application, was customized to include these parameters. RESULTS: Between July 2014 and June 2016, a total of 226 cancer incidence cases were presented at LCC. There was an increasing number of new cancer cases when evaluated at 6-mo intervals. The most common cancers presented were breast (38%), prostate (12%), and colorectal (8%) cancers. The majority of patients (85%) were presented at later cancer stages. CONCLUSIONS: Breast, prostate, and colorectal cancers were the three most common cancer cases seen at LCC. Late-stage presentation remains a challenge. These results reveal the need for early detection and screening methods to help change the stage distribution. The cancer registry will be utilized to collect cancer data and to allow for analysis and better treatment/prevention protocols. Collaboration with other academic centers in the region will facilitate the establishment of a population-based registry.

Role of Private Enterprise in Cancer Control in Low to Middle Income Countries.

Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) where prioritization and allocation of resources to cancer care are often quite poor. In the absence of governmental focus on this problem, public-private partnerships may be an avenue to provide effective cancer control. Methods. This manuscript highlights the establishment of a nongovernmental organization (NGO) to stimulate the development of partnerships between oncology professionals, private enterprise, and academic institutions, both locally and internationally. Examples of capacity building, grant support, establishment of collaborative networks, and the development of a facility to provide clinical care are highlighted. Results. Collaborations were established between oncology professionals at academic institutions in the US and Nigeria. Cancer control workshops were conducted in Nigeria with grant support from the Union for International Cancer Control (UICC). A monthly tumor board conference was established at LASUTH in Lagos, and further capacity building is underway with grant support from the United States NCI. An outpatient, privately funded oncology clinic in Lagos has been launched. Conclusion. In LMICs, effective partnership between public and private institutions can lead to tangible strides in cancer control. The use of creative healthcare financing models can also support positive change.

Differential cardiovascular and hypothalamic pituitary response to amphetamine in male pathological gamblers versus healthy controls.

Cardiovascular and hypothalamic pituitary axis (HPA) disturbances have been observed in individuals who are pathological gamblers (PGs). These may partly derive from chronic exposure to gambling. Response to amphetamine (AMPH) may reveal such disturbances while controlling for differential conditioned responses to gambling in PGs vs healthy controls (HCs). This study assessed heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and plasma cortisol following oral AMPH (0.4 mg/kg) in male PGs (n=12) and HCs (n=11) who underwent a positron emission tomography (PET) scan. The Stop Signal Task enabled assessment of the link between physiological and behavioral dysregulation. Trait moderating effects were explored. The responses of PGs to AMPH differed from those of HCs on every index. PGs displayed persistent elevation in DBP and concomitant reduction in HR (i.e. baroreflex) compared to HCs beyond 90 min post-dose. PGs displayed deficits in cortisol compared to HCs that were partially reversed by AMPH. Impairment on the Stop Signal Task correlated positively with HR in controls, but negatively with HR in PGs, suggesting that strong initial and compensatory cardiac responses to a stimulant may each predict disinhibition. Extraversion predicted greater disinhibition in PGs. Noradrenergic disturbances may contribute to sensitized responses to stimulant challenge and disinhibition in PGs.

The D2/3 dopamine receptor in pathological gambling: a positron emission tomography study with [11C]-(+)-propyl-hexahydro-naphtho-oxazin and [11C]raclopride.

AIMS: Pathological gambling (PG) shares diagnostic features with substance use disorder (SUD), but the neurochemical mechanisms underlying PG are poorly understood. Because dopamine (DA), a neurotransmitter implicated in reward and reinforcement, is probably involved, we used positron emission tomography (PET) to test whether PG is associated with abnormalities in D2 and D3 receptor levels, as observed in SUD. DESIGN: Case-control study comparing PG to healthy control (HC) subjects. SETTING: Academic research imaging centre. PARTICIPANTS: Thirteen non-treatment-seeking males meeting DSM-IV criteria for PG, and 12 matched HC (11 of whom completed PET). MEASUREMENTS: Two PET scans (one with the D3 receptor preferring agonist [11C]-(+)-propyl-hexahydro-naphtho-oxazin (PHNO) and the other with [11C]raclopride) to assess D(2/3) DA receptor availability, and behavioural measures (self-report questionnaires and slot-machine game) to assess subjective effects and relationships to PET measures. FINDINGS: Binding of both radiotracers did not differ between groups in striatum or substantia nigra (SN) (all P > 0.1). Across PG, [11C]-(+)-PHNO binding in SN, where the signal is attributable primarily to D3 receptors, correlated with gambling severity (r = 0.57, P = 0.04) and impulsiveness (r = 0.65, P = 0.03). In HC, [11C]raclopride binding in dorsal striatum correlated inversely with subjective effects of gambling (r = -0.70, P = 0.03) and impulsiveness (r = -0.70, P = 0.03). CONCLUSIONS: Unlike with substance use disorder, there appear to be no marked differences in D2 /D3 levels between healthy subjects and pathological gamblers, suggesting that low receptor availability may not be a necessary feature of addiction. However, relationships between [11C]-(+)-PHNO binding and gambling severity/impulsiveness suggests involvement of the D3 receptor in impulsive/compulsive behaviours.