Impact of a Regional Pediatric Hematology/Oncology Fellowship Program in Guatemala.

PURPOSE: This study aimed to describe and assess the regional experience of a pediatric hematology/oncology fellowship program based in Guatemala. METHODS: The Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, is the only hospital in Central America dedicated exclusively to childhood and adolescent cancer. To address the regional need for specialists, a fellowship program in pediatric hematology/oncology was launched in 2003. The UNOP fellowship program comprises 3 years of training. Although the program is based at UNOP, it also includes rotations locally and internationally to enhance clinical exposure. The curriculum is based on international standards to cover clinical expertise, research, professionalism, communication, and health advocacy. Trainees are selected according to country or facility-level need for pediatric hematologists/oncologists, with a plan for them to be hired immediately after completing their training. RESULTS: Forty physicians from 10 countries in Latin America have completed training. In addition, there are currently 13 fellows from five countries in training. Of the graduates, 39 (98%) are now practicing in pediatric hematology/oncology in Latin America. Moreover, many of them have leadership positions within their institutions and participate in research, advocacy, and policy making. Graduates from the UNOP program contribute to institutions by providing care for an increasing number of patients with pediatric cancer. The UNOP program is the first pediatric hematology/oncology fellowship program in the world to be accredited by Accreditation Council for Graduate Medical Education-International, an international body accrediting clinical training programs. CONCLUSION: The UNOP program has trained specialists to increase the available care for children with cancer in Latin America. This regional approach to specialist training can maximize resources and serve as a model for other programs and regions.

Classic Hodgkin lymphoma in Guatemalan children of age less than six years: analysis of immune regulatory pathways and the tumor microenvironment.

Classic Hodgkin lymphoma (cHL) in young children (ages 0-6) is rare in high income countries (HICs) but is more prevalent in low- and middle-income countries (LMICs) like Guatemala. Given that the majority of cHL studies have evaluated adolescent/adults, and the immune system changes with age, we sought to characterize Epstein-Barr virus (EBV) expression, immune regulatory pathway markers and the tumor microenvironment in 42 children ages 0-6 with cHL from Guatemala. We found a very high frequency of EBV expression (97.5%). Hodgkin cells showed increased expression of PD1 ligands and CD137, indicative of shared immune regulatory mechanisms with adult cHL. Pediatric cHL also showed an increase in CD8+ tumor infiltrating lymphocytes and tumor associated macrophages within the tumor microenvironment. Despite 25 having high risk disease, only 4 patients died from progressive disease, relapse or infection.

Multinational Retrospective Central Pathology Review of Neuroblastoma: Lessons Learned to Establish a Regional Pathology Referral Center in Resource-Limited Settings.

CONTEXT.­: Several countries of the Central America and Caribbean region have been sharing regional neuroblastoma (NB) treatment guidelines. However, there is no standardization in the diagnosis, subclassification, or tumor biology to aid in the risk stratification of these patients. OBJECTIVE.­: To examine the histology and assess the accuracy of the local pathology reports; to evaluate the usefulness of manual MYCN immunohistochemistry (IHC); and to use NB as a model to identify the needs to establish a central pathology review (CPR) program in this region. DESIGN.­: A retrospective CPR of specimens derived from patients with a diagnosis of NB and treated under the regional NB guidelines between 2012 and 2017 was conducted, allowing for a comparison between local diagnoses and the CPR diagnoses. Manual MYCN IHC was performed in the confirmed NB specimens and the results compared with known fluorescence in situ hybridization or automated IHC results, when available. RESULTS.­: The 156 specimens reviewed included 460 blocks and 183 original slides. Neuroblastoma was confirmed in 138 samples (88.5%), but low concordance rates for Shimada classification (n = 39; 25.0%), mitotic-karyorrhectic index (n = 4; 2.5%), and International Neuroblastoma Pathology Classification (n = 18; 11.5%) were noted. Manual MYCN IHC performed on 120 specimens showed conclusive results in 89.2% (28 positive, 23.4%; 79 negative, 65.8%) and questionable results in 10.8% (n = 13). CONCLUSIONS.­: This retrospective CPR highlights the need for a CPR program to serve this region, to ensure correct diagnosis and subclassification of NB, and to provide manual MYCN IHC-with reflexing to fluorescence in situ hybridization, if questionable. This approach can further regional collaboration, enhance test utilization, and ultimately improve patients' outcomes.

Improving Immunohistochemistry Capability for Pediatric Cancer Care in the Central American and Caribbean Region: A Report From the AHOPCA Pathology Working Group.

Accessibility to immunohistochemistry (IHC) is invaluable to proper diagnosis and treatment of pediatric patients with malignant neoplasms. Whereas IHC is widely available in anatomic pathology laboratories in high-income countries, access to it in anatomic pathology laboratories of low- and middle-income countries remains a struggle, with many limitations. To advance the quality of the pathology service offered to children with cancer in areas with limited resources, a 5-day pathology training workshop was offered to pathologists and histotechnologists from various countries of the Central American and Caribbean region. An initial assessment of the workshop participants' current laboratory capacities was performed, and a regional training center was selected. Didactic and hands-on activities were offered, and review and evaluation of the IHC slides produced during the training course were compared with original slides from the participants' sites. This model of intensive 5-day training appears to be effective and can potentially be used in other budget-constrained regions. Moreover, it can serve as a continuing education activity for pathologists and histotechnologists, and as part of validations and quality improvement projects to build capacity and develop IHC assay proficiency in low- and middle-income countries.

Factores que inciden en el maltrato intrafamiliar al adulto mayor en la provincia de Tiraque, Valle Alto Cochabamba, durante los meses de junio a agosto, gestión 2011 / Factors affecting the domestic abuse of the elderly in the province of Tiraque, Cochabamba Upper Valley during the months of June to August, 2011 managemen

La vejez es el éxodo de una persona que, por razón de su crecimiento en edad, sufre la decadencia biológica de su organismo y es un receso de su participación social. El adulto mayor vive una situación existencial de crisis, de soledad, por sus limitaciones, pero también tiene potenciales únicos y distintivos: serenidad de juicio, madurez vital, experiencia, perspectiva de la vida histórica personal y social. El presente estudio se realizó desde un enfoque mixto, es correlacional, prospectivo, descriptivo y transversal; se utilizó la entrevista mediante un instrumento estructurado que contenía los indicadores necesarios para medir las variables del estudio. Los resultados obtenidos reflejan que los factores que inciden en el maltrato intrafamiliar son: falta de comunicación y diálogo, un índice elevado de alcoholismo que provoca peleas y desintegración familiar, falta de confianza, resentimiento de los hijos por haber recibido golpes y riñas en el pasado. Se evidencia también un índice elevado de maltrato psicológico, donde el adulto mayor recibe: insultos, agresiones verbales, es ignorado por sus familiares. Seguidos por abusos de venta, de sus terrenos, casas, con engaños, dejándolos en la calle donde viven, soledad y depresión, esperando la muerte

Occult papillary thyroid carcinoma in postmortem species: prevalence at autopsy.

OBJECTIVE: The purpose of this study was to determine the prevalence of occult papillary thyroid cancer (OPTC) in a sample of cadavers from Guatemala, a country in Central America. STUDY DESIGN AND SETTING: This was a cross-sectional study of cadaver samples. We analyzed 150 glands that were removed during autopsy from 150 cadavers (34 women and 116 men) who were admitted to the morgue of the Judicial Bureau between January and March 2000. RESULTS: A total of 17 glands showed macroscopic evidence of disease, but only 3 glands (1 female and 2 males) showed microscopic evidence of malignancy. This corresponded to a 2% prevalence rate (range, 0.4-5.7%). The sex prevalence of OPTC was 2.9% (range, 0.07-15%) for females and 1.7% (range, 0.2-6.1%) for males. No significant difference was noted ( P = .47, exact unconditional test). The male-to-female ratio was 1:1.7. CONCLUSION: We concluded that the prevalence of OPTC in Guatemala is low but comparable to literature reports. Occult papillary thyroid carcinoma appears to have no sex predilection as opposed to the clinically evident papillary thyroid carcinoma, which develops more commonly in females. SIGNIFICANCE: Occult papillary thyroid carcinoma is a much more common pathology than clinically evident thyroid cancer, and the clinical implications still need to be determined.