RESUMEN
PURPOSE: Pediatric neuro-oncology resources are mostly unknown in Chile. We report the human and material resources available in Chilean hospitals providing pediatric neuro-oncology services. METHODS: A cross-sectional survey was distributed to 17 hospitals providing pediatric neuro-oncology services (Programa Infantil Nacional de Drogas Antineoplásicas [PINDA] hospitals, 11; private, 6). RESULTS: Response rate was 71% (PINDA, 8; private, 4). Pediatric neuro-oncology services were mainly provided within general hospitals (67%). Registries for pediatric CNS tumors and chemotherapy-related toxicities were available in 100% and 67% of hospitals, respectively. CNS tumors were treated by pediatric oncologists in 92% of hospitals; none were formally trained in neuro-oncology. The most used treatment protocols were the national PINDA protocols. All WHO essential medicines for childhood cancer were available in more than 80% of the hospitals except for gemcitabine, oxaliplatin, paclitaxel, and procarbazine. The median number of pediatric neurosurgeons per hospital was two (range, 2-6). General neuroradiologists were available in 83% of the centers. Pathology specimens were sent to neuropathologists (58%), adult pathologists (25%), and pediatric pathologists (17%). Intensity-modulated radiotherapy, conformal radiotherapy, and cobalt radiotherapy were used by 67%, 58%, and 42% of hospitals, respectively. Only one private hospital performed autologous hematopoietic cell transplant for children with CNS tumors. CONCLUSION: A wide range of up-to-date treatment modalities are available for children with CNS tumors. Our survey highlights future directions to improve the pediatric neuro-oncology services available in Chile such as the expansion of multidisciplinary clinics, palliative care services, long-term cancer survivorship programs, dedicated clinical research support teams, establishing standardized mechanism for sending pathologic specimen for second opinion to international specialized centers, and establishing specialized neuro-oncology training program.
Asunto(s)
Neoplasias del Sistema Nervioso Central , Trasplante de Células Madre Hematopoyéticas , Neoplasias del Sistema Nervioso Central/terapia , Niño , Chile , Estudios Transversales , Humanos , Oncología MédicaAsunto(s)
Infecciones por Coronavirus/epidemiología , Oncología Médica/estadística & datos numéricos , Neoplasias/terapia , Neumonía Viral/epidemiología , Betacoronavirus , COVID-19 , Niño , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , América Latina/epidemiología , Neoplasias/diagnóstico , Pandemias , Factores de Riesgo , SARS-CoV-2RESUMEN
La tuberculosis debe aún ser incluida en el diagnóstico diferencial de síndrome febril y sintomatología respiratoria en la infancia. Se presenta el caso de un adolescente con TBC miliar, patología frecuente en este grupo etario.
Asunto(s)
Humanos , Masculino , Adolescente , Niño , Fiebre/etiología , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/terapiaAsunto(s)
Humanos , Femenino , Lactante , Atrofias Musculares Espinales de la Infancia/complicaciones , Atrofias Musculares Espinales de la Infancia/diagnóstico , Atrofias Musculares Espinales de la Infancia/fisiopatología , Atrofias Musculares Espinales de la Infancia/terapia , Enfermedades Pulmonares Obstructivas/complicaciones , Enfermedades Pulmonares Obstructivas/etiología , Resultado Fatal , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/etiologíaRESUMEN
A 57-year-old, fair-skinned female patient with lesions of granuloma annulare located on her forearms - with signs of actinic damage - is described. No response was observed after successive treatments with topical corticosteroids and oral pentoxifylline. Four years later, the patient developed open comedones on the rim of granuloma annulare lesions. The loss of elastic fibers seen in both granuloma annulare and solar elastosis is presumed to have induced the appearance of open comedones, because of a loss of supporting properties of the dermis inducing a distension of the infundibular canal of the sebaceous follicle, as seen in the Favre-Racouchot disease and actinic comedonal plaque. Concomitantly, the patient developed insulin-dependent diabetes mellitus. Treatment with insulin resulted in the disappearance of open comedones and notably regression of lesions of granuloma annulare. Response to insulin therapy in our case supports the hypothesis that insulinopenia could participate in the development of granuloma annulare in some cases.
Asunto(s)
Acné Vulgar/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Granuloma Anular/diagnóstico , Neoplasias Cutáneas/diagnóstico , Luz Solar/efectos adversos , Acné Vulgar/complicaciones , Acné Vulgar/patología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/patología , Diagnóstico Diferencial , Femenino , Antebrazo/patología , Granuloma Anular/complicaciones , Granuloma Anular/patología , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patologíaRESUMEN
Las urgencias oncológicas son un capítulo importante dentro de la oncología pediátrica y de especial interés, tanto para los médicos generales como pediatras, ya que éstas son causa de morbimortalidad en pacientes con cáncer y pueden estar presentes desde el momento del diagnóstico. Aunque existe una gran variedad de ellas, en este capítulo sólo abordaremos las de mayor frecuencia como son la lisis tumoral, muchas veces presente al momento del diagnóstico y que puede conducir a una insuficiencia renal; la hiperleucocitosis, que es capaz de producir enfermedad por lisis tumoral o por un síndrome de hiperviscosidad, que se manifiesta por complicaciones pulmonares y neurológicas, siendo la más grave de ellas la hemorragia intracraneala; finalmente revisaremos la urgencia oncológica más frecuente que es la neutropenia febril que es secundaria a la toxicidad por quimioterapia y que puede causar la muerte en estos pacientes.