Early mortality in children with acute lymphoblastic leukemia in a developing country: the role of malnutrition at diagnosis. A multicenter cohort MIGICCL study.

The role of malnutrition at diagnosis as a predictor of early mortality in Mexican leukemia children remains controversial. The objective of present study was to investigate whether malnutrition was a predictor of early mortality during the first year of treatment in Mexican acute lymphoblastic leukemia (ALL) children through the first population-based study. A total of 794 newly diagnosed ALL pediatric patients from public hospitals of Mexico City were enrolled. A multivariate Cox proportional hazards regression model was constructed and adjusted by patient's age at diagnosis, gender, hospital of treatment, and socioeconomic status. Early mortality was high (12.1%) and malnutrition by different indicators was not associated with mortality at induction phase and at 6th month; a high risk of dying (RR = 2.08; 95% CI: 1.08-4.01) was observed in the group of malnourished children with a high-risk ALL.

Lack of evidence for human T-lymphotropic virus type 1 and mouse mammary tumor-like virus involvement in the genesis of childhood acute lymphoblastic leukemia.

BACKGROUND: In Mexico City, the incidence of childhood acute lymphoblastic leukemia (ALL) is one of the highest in the world; epidemiologic evidence suggests that infectious agents could be involved in the genesis of this disease. Early transmitted oncogenic retroviruses infecting lymphocytes are important candidates. METHODS: PCR-based assays were used to screen viral genomic sequences of human T-cell lymphotrophic virus, type 1 (HTLV1) and mouse mammary tumor virus (MMTV)-like virus (MMTV-LV) in leukemic cells from 67 pediatric patients with ALL. RESULTS: Viral genomic sequences were not detected in any sample by neither standard nor nested PCR. CONCLUSIONS: Because of the methodologic strictness and high statistical power of the study, these results suggest that HTLV1 and MMTV-LV are not involved in the genesis of childhood ALL in Mexican children. IMPACT: To our knowledge, this is the first work exploring the direct participation of HTLV1 and MMTV-LV retroviruses in childhood ALL development.

Childhood acute leukemias are frequent in Mexico City: descriptive epidemiology.

BACKGROUND: Worldwide, acute leukemia is the most common type of childhood cancer. It is particularly common in the Hispanic populations residing in the United States, Costa Rica, and Mexico City. The objective of this study was to determine the incidence of acute leukemia in children who were diagnosed and treated in public hospitals in Mexico City. METHODS: Included in this study were those children, under 15 years of age and residents of Mexico City, who were diagnosed in 2006 and 2007 with leukemia, as determined by using the International Classification of Childhood Cancer. The average annual incidence rates (AAIR), and the standardized average annual incidence rates (SAAIR) per million children were calculated. We calculated crude, age- and sex-specific incidence rates and adjusted for age by the direct method with the world population as standard. We determined if there were a correlation between the incidence of acute leukemias in the various boroughs of Mexico City and either the number of agricultural hectares, the average number of persons per household, or the municipal human development index for Mexico (used as a reference of socio-economic level). RESULTS: Although a total of 610 new cases of leukemia were registered during 2006-2007, only 228 fit the criteria for inclusion in this study. The overall SAAIR was 57.6 per million children (95% CI, 46.9-68.3); acute lymphoblastic leukemia (ALL) was the most frequent type of leukemia, constituting 85.1% of the cases (SAAIR: 49.5 per million), followed by acute myeloblastic leukemia at 12.3% (SAAIR: 6.9 per million), and chronic myeloid leukemia at 1.7% (SAAIR: 0.9 per million). The 1-4 years age group had the highest SAAIR for ALL (77.7 per million). For cases of ALL, 73.2% had precursor B-cell immunophenotype (SAAIR: 35.8 per million) and 12.4% had T-cell immunophenotype (SAAIR 6.3 per million). The peak ages for ALL were 2-6 years and 8-10 years. More than half the children (58.8%) were classified as high risk. There was a positive correlation between the average number of persons per household and the incidence of the pre-B immunophenotype (Pearson's r, 0.789; P = 0.02). CONCLUSIONS: The frequency of ALL in Mexico City is among the highest in the world, similar to those found for Hispanics in the United States and in Costa Rica.

[Fibromatosis infantile. Report of an aggressive disease]. / Miofibromatosis infantil. Relato de una enfermedad desesperante.

This rare entity is characterized by multiple nodular lesions largely composed of collagen-forming spindle cells and involving the subcutis, skeletal muscle, bone and viscera of newborns and infants that occurs in either a solitary or multicentric form. The clinical course of a case is presented. The patient is a 2-year-old male who was brought to our hospital because of a large cervical mass. On physical examination a firm, subcutaneous, immobile painless mass measuring 4.5x6 cm was palpated at right side of neck. After the first admission, 13 complete surgical resections were performed. This patient is the eleventh familial case in the literature. The patient died 10 years after the first surgery.

[Implications for professional development in nursing; focus based on professional competencies (II)]. / Implicaciones para la formación en enfermería. Enfoque basado en competencias profesionales (y II).

To work with quality criteria is a demand Nursing care has, but one which requires recognition inside and outside the profession. The authors propose a focus based on competencies as a tool for continuous quality improvement. One area in this focus centers on the professional development for Nurses in the field of research and action which will permit one to enter in the spiral of continuing learning, establishing multiple connections.

[To innovate the practical nurse; focus based on professional competencies (I)]. / Innovar la práctica enfermera. Enfoque basado en competencias profesionales (I).

The Nursing practice has entered into a period of rapid, global changes which require firm support in order to maximize their role in the health field. Together with the transitional situation health systems are undergoing, this obliges nurses to search for new innovative methods to comply with their professional duties and for the creation of instruments that facilitate the increase in the quality treatment nurses provide, as well as the mechanisms through which excellence in educational preparation and professional compliance are recognized. In the following pages, the authors deal with this focus based on professional competencies as a tool which nears these objectives.

Implicaciones pra la formación en enfermería. Enfoque basado en competencias profesionales (y II) / Implications for professional develpment in nursing; focus based on professional competencies (II)

Trabajar con criterios de calidad es una exigencia en la atención de Enfermería, pero precisa reconocimiento dentro y fuera de la profesión. Proponemos el enfoque basado en competencias (EBC) como una herramienta para la mejora continua de la calidad. Un área de este enfoque se centra en la formación para Enfermería desde el marco de la investigación-acción, que permite entrar en la espiral del aprendizaje continuo estableciendo múltiples conexiones

To work with qua lit y criteria is a demand Nursing care has, but one which requires recognition inside and outside the profession. The authors propose a focus based on competencies as a tool for continuous quality improvement. One area in this focus centers on the professional development for Nurses in the field of research and action which will permit one to enter in the spiral of continuing learning, establishing multiple connections

Miofibromatosis infantil: relato de una enfermedad desesperante / Fibromatosis infantile: report of an aggressive disease

La miofibromatosis es una enfermedad tumoral que afecta casi exclusivamente a lactantes y preescolares. Se caracteriza por múltiples lesiones nodulares compuestas de tejido colágeno y células fusiformes que afectan piel, huesos, tejidos blandos e incluso las vísceras; puede ser solitaria o multicéntrica. Presentamos la evolución clínica de un niño que a los dos años de edad fue llevado por primera vez a consulta por una masa cervical derecha de 4.5 x 6 cm, subcutánea, inmóvil e indolora. Fue intervenido quirúrgicamente en 13 ocasiones; en la última falleció. El caso corresponde al número once reportado con patrón familiar.

This rare entity is characterized by multiple nodular lesions largely composed of collagen-forming spindle cells and involving the subcutis, skeletal muscle, bone and viscera of newborns and infants that occurs in either a solitary or multicentric form. The clinical course of a case is presented. The patient is a 2-year-old male who was brought to our hospital because of a large cervical mass. On physical examination a firm, subcutaneous, immobile painless mass measuring 4.5x6 cm was palpated at right side of neck. After the first admission, 13 complete surgical resections were performed. This patient is the eleventh familial case in the literature. The patient died 10 years after the first surgery.

Innovar la práctica enfermera. Enfoque basado en competencias profesionales (I) / To innovate the practical nurse; focus based on professional competencies (I)

La práctica de la Enfermería ha entrado en un periodo de cambios rápidos y globales que requieren un apoyo firme para potenciar su rol en el sector salud. Esto, unido a la situación de transición de los sistemas de salud, obliga a los enfermeros a buscar nuevas formas innovadoras del ejercicio profesional y la creación de instrumentos que faciliten el aumento de la calidad de la atención de Enfermería, así como mecanismos a través de los cuales se reconozca la excelencia de la educación y el ejercicio profesional. En las páginas que siguen abordamos el enfoque basado en competencias profesionales como una herramienta que nos acerca a esos objetivos

The Nursing practice has entered into a period of rapid, global changes which require firm support in order to maximize their role in the health field. Together with the transitional situation health systems are undergoing, this obliges nurses to search for new innovative methods to comply with their professional duties and for the creation of instruments that facilitate the increase in the quality treatment nurses provide, as well as the mechanisms through which excellence in educational preparation and professional compliance are recognized. In the following pages, the authors deal with this focus based on professional competencies as a tool which nears these objectives

Amibas de vida libre y anemia aplástica grave en niños / Aplastic anemia and free-living amoeba in two children

Introducción. Las amibas de vida libre habitualmente viven como fagótrofas en el agua y suelo donde se alimentan de bacterias; también pueden producir infecciones del sistema nervioso central y otros tejidos en seres humanos y animales. La anemia aplástica es una entidad caracterizada por pancitopenia secundaria a disminución de la producción en médula ósea de todos los elementos formes de la sangre y ausencia de enfermedad primaria que infiltre, reemplace o anule la hematopoyesis activa. Casos clínicos. Se presentan 2 niños con historia de sangrados, pancitopenia y el diagnóstico de anemia aplástica grave por biopsia y aspirado de médula ósea, que finalmente fallecieron. Se muestran los hallazgos de amibas de vida libre en la médula. Conclusión. En estos casos no se encontró agente causal de la anemia aplástica, y se sugiere a las amibas como oportunistas del padecimiento.