Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study.

BACKGROUND: Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. METHODS: All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. RESULTS: A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5-14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. CONCLUSIONS: Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.

Primary central nervous system tumors survival in children in ten Colombian cities: a VIGICANCER report.

Purpose: Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. Methods: We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. Results: During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. Conclusion: We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.

Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America.

BACKGROUND: Pediatric early warning systems (PEWS) aid in the early identification of deterioration in hospitalized children with cancer; however, they are under-used in resource-limited settings. The authors use the knowledge-to-action framework to describe the implementation strategy for Proyecto Escala de Valoracion de Alerta Temprana (EVAT), a multicenter quality-improvement collaborative, to scale-up PEWS in pediatric oncology centers in Latin America. METHODS: Proyecto EVAT mentored participating centers through an adaptable implementation strategy to: (1) monitor clinical deterioration in children with cancer, (2) contextually adapt PEWS, (3) assess barriers to using PEWS, (4) pilot and implement PEWS, (5) monitor the use of PEWS, (6) evaluate outcomes, and (7) sustain PEWS. The implementation outcomes assessed included the quality of PEWS use, the time required for implementation, and global program impact. RESULTS: From April 2017 to October 2021, 36 diverse Proyecto EVAT hospitals from 13 countries in Latin America collectively managing more than 4100 annual new pediatric cancer diagnoses successfully implemented PEWS. The time to complete all program phases varied among centers, averaging 7 months (range, 3-13 months) from PEWS pilot to implementation completion. All centers ultimately implemented PEWS and maintained high-quality PEWS use for up to 18 months after implementation. Across the 36 centers, more than 11,100 clinicians were trained in PEWS, and more than 41,000 pediatric hospital admissions had PEWS used in their care. CONCLUSIONS: Evidence-based interventions like PEWS can be successfully scaled-up regionally basis using a systematic approach that includes a collaborative network, an adaptable implementation strategy, and regional mentorship. Lessons learned can guide future programs to promote the widespread adoption of effective interventions and reduce global disparities in childhood cancer outcomes. LAY SUMMARY: Pediatric early warning systems (PEWS) are clinical tools used to identify deterioration in hospitalized children with cancer; however, implementation challenges limit their use in resource-limited settings. Proyecto EVAT is a multicenter quality-improvement collaborative to implement PEWS in 36 pediatric oncology centers in Latin America. This is the first multicenter, multinational study reporting a successful implementation strategy (Proyecto EVAT) to regionally scale-up PEWS. The lessons learned from Proyecto EVAT can inform future programs to promote the adoption of clinical interventions to globally improve childhood cancer outcomes.

Routine Use of Biomarkers to Rationalize Antibiotic Use During Febrile Episodes in Pediatric Bone Marrow Transplantation Units.

BACKGROUND: Children frequently develop fever after hematopoietic stem cell transplant (HSCT). Although the etiology of many febrile episodes (FEs) is not an infection, patients often receive broad-spectrum antibiotics in response. METHODS: To improve the judicious use of antibiotics in pediatric HSCT patients, we performed a prospective cohort study of children receiving an HSCT in Clínica Imbanaco (Cali, Colombia) between September 2016 and December 2019. We assessed all FEs occurring during 3 periods (infusion, neutropenic and engraftment). We measured procalcitonin and C-reactive protein (CRP) sequentially during each FE and compared levels among patients with fever due to significant infection (FSI) versus fever not attributable to infection (FNI) in each transplant period. RESULTS: There were 166 FEs in 95 patients. FSI accounted for 12%, 42% and 42% of FE during infusion, neutropenic and engraftment periods, respectively. CRP had better discriminatory capacity for FSI versus FNI in the infusion period [area under the curve (AUC) 0.80 (95% confidence interval [CI], 0.62-0.96) for a CRP level of 50 mg/L]. Neither biomarker performed well in the neutropenic period. During the engraftment period, a CRP of 65 mg/L had an AUC of 0.81 (95% CI, 0.65-0.96), while a procalcitonin level of 0.25 ng/mL had an AUC of 0.83 (95% CI, 0.63-1.0). In contrast to procalcitonin, the CRP's pattern of change throughout the first 3 days of fever in each transplant period was different in FSI compared with FNI. CONCLUSION: Sequential measurement of biomarkers, especially CRP, may allow clinicians to more appropriately manage antibiotic use in pediatric HSCT units.

Infectious complications after allogeneic hematopoietic stem cell transplantation in children in a bone marrow transplant unit in Colombia.

OBJECTIVE: There is a relative lack of information about infections occurring in children following allogeneic hematopoietic stem cell transplants (allo-HSCT) in developing countries. Herein, we describe the incidence rates of different infections according to the transplant period and baseline condition in Colombia. METHODS: In a retrospective cohort study of all children who underwent allo-HSCTs from 2012 to 2017 in a hospital in Cali, Colombia, we reviewed medical records from the first post-transplant day until day + 365 to describe microbiologically confirmed incidence rates of infections and deaths during three post-transplant periods and according to baseline condition. RESULTS: Most allo-HSCT (n = 144, 96%) were followed by infections over the following year, mostly due to bacteria and cytomegalovirus (4.3 and 3.3 per 1000 patient-days, respectively). Children were at the highest risk for infection in the first 30 days post-HSTC, but mortality was highest after 100 days. Overall, high mortality (n = 44, 31.7%) was associated with infections, especially from extensively drug-resistant bacteria, adenovirus, and aspergillosis. Infection rates were similar independent of the baseline condition. CONCLUSION: Almost all children in this cohort developed infections post allo-HSCT. Describing the distribution of infections throughout the first post allo-HSCT year allows clinicians to narrow the differential diagnosis of infections according to the post-transplant period. This is especially useful when prioritizing interventions in children receiving HSCT in stringent healthcare systems in developing countries.

Twelve New Species Reveal Cryptic Diversification in Foliicolous Lichens of Strigula s.lat. (Strigulales, Ascomycota).

We employed a molecular phylogenetic approach using five markers (ITS, nuSSU, nuLSU, TEF1-α, and RPB2) to assess potential cryptic speciation in foliicolous members of Strigula s.lat. (Strigulaceae), including the recently segregated genera Phylloporis, Puiggariella, Raciborskiella, Racoplaca, and Serusiauxiella, from tropical areas in Asia, with selected materials from the Neotropics as reference. On the basis of combined molecular and phenotypic datasets, two new species of Racoplaca and 10 new species of Strigula s.str. are described: Racoplaca macrospora sp. nov., R. maculatoides sp. nov., Strigula guangdongensis sp. nov., S. intermedia sp. nov., S. laevis sp. nov., S. microcarpa sp. nov., S. pseudoantillarum sp. nov., S. pseudosubtilissima sp. nov., S. pycnoradians sp. nov., S. sinoconcreta sp. nov., S. stenoloba sp. nov., and S. subtilissimoides sp. nov. In addition, we propose the new combination Phylloporis palmae comb. nov. (≡ =Manaustrum palmae) and we validate the earlier combination Racoplaca melanobapha comb. nov. (≡ Verrucaria melanobapha; Strigula melanobapha). Our data clearly indicate a considerable degree of cryptic diversification in foliicolous representatives of Strigula s.lat., particularly in the presumably widespread taxa Strigula antillarum, S. concreta, S. nitidula, and S. smaragdula. Given that these phylogenetic revisions are thus far limited to few regions, we predict that our findings only represent the proverbial tip of the iceberg in this group of lichenized fungi.

Caregivers' Self-Reported Absence of Social Support Networks is Related to Treatment Abandonment in Children With Cancer.

BACKGROUND: Treatment abandonment (TxA) is a primary cause of therapy failure in children with cancer in low-/middle-income countries. We explored the absence of social support network (SSN), among other predictive factors, and TxA in children with cancer in Cali, Colombia. PROCEDURE: In this prospective cohort study, we included children diagnosed with cancer at a public university hospital. A social worker and a psychologist administered semistructured questionnaires to patients' caregivers. We extracted information from the questionnaires about social, economic, and psychological conditions of the patients' families. Outcomes were death, relapse, and TxA. Failure either to start or to continue the planned course of curative treatment for 4 weeks or more was defined as TxA. We identified events with Cali's childhood cancer outcomes surveillance system (VIGICANCER). We adjusted the hazard ratios (HRs) for potential confounders using multivariate Cox regression analyses. RESULTS: Among 188 patients diagnosed from January 2011 to June 2013, 99 interviews were conducted. Median age was 5 years old (range: 0.3, 14.9), 53% were male, 17% were of Colombian-Indian ethnicity, and 68% lived in rural areas. The 2-year cumulative incidence of TxA was 21% (95% confidence interval [CI]: 13, 35) and the annual proportion was 14%. The adjusted HR for the absence of SSN was 4.9 (95% CI: 1.6, 15.3). CONCLUSIONS: We found a strong association between the absence of SSN and TxA that was independent of other covariates, including surrogate measures of wealth. Our findings highlight the imperative understanding of social ties and support surrounding children's families for planning strategies to prevent TxA.

Relación clínico-citogenética en una muestra de pacientes con síndrome Turner / Clinical-genetic relation in a sample of patients with Turner syndrome

El síndrome Turner es un trastorno causado por la ausencia completa o parcial de un segundo cromosoma sexual en mujeres. Este trabajo tuvo como objetivos describir la relación edad-fenotipo según el motivo de indicación de los casos correspondientes al síndrome Turner, analizar las frecuencias de los diferentes cariotipos encontrados en el síndrome Turner y establecer la relación sexo fenotípico - cariotipo en los casos de mosaicismo 45, X / 46, XY. Tomando en cuenta el cariotipo de 4 387 pacientes, realizado en el Laboratorio de Citogenética del Centro Nacional de Genética Médica, fueron seleccionados los casos con aberraciones de los cromosomas sexuales y analizados los que presentaron síndrome Turner y mosaicismo 45,X/ 46, XY. El cariotipo 45, X fue el que predominó; dentro de los mosaicismos, el más frecuente fue 45, X/ 46, XX. Todos los casos con anillo del X fueron mosaicos y los casos con mosaicismo 45, X/46, XY pueden presentar diferentes fenotipos sexuales. Se evidenció que la baja talla constituye un signo cardinal para el diagnóstico del síndrome, es importante pesquisar su detección precoz para brindar la posibilidad de tratamiento en la etapa adecuada…(AU)

The combined expression patterns of Ikaros isoforms characterize different hematological tumor subtypes.

A variety of genetic alterations are considered hallmarks of cancer development and progression. The Ikaros gene family, encoding for key transcription factors in hematopoietic development, provides several examples as genetic defects in these genes are associated with the development of different types of leukemia. However, the complex patterns of expression of isoforms in Ikaros family genes has prevented their use as clinical markers. In this study, we propose the use of the expression profiles of the Ikaros isoforms to classify various hematological tumor diseases. We have standardized a quantitative PCR protocol to estimate the expression levels of the Ikaros gene exons. Our analysis reveals that these levels are associated with specific types of leukemia and we have found differences in the levels of expression relative to five interexonic Ikaros regions for all diseases studied. In conclusion, our method has allowed us to precisely discriminate between B-ALL, CLL and MM cases. Differences between the groups of lymphoid and myeloid pathologies were also identified in the same way.

Frecuencia de algunas enfermedades genéticas en Neuropediatría / Frequency of some genetic diseases in Neuropediatrics

Introducción: las enfermedades neurológicas en Pediatría son diversas y obedecen a un gran número de causas: infecciosas, genéticas, metabólicas y degenerativas, entre otras. El diagnóstico genético, dentro del método clínico en Neurología, está relacionado con el diagnóstico etiológico. Existen muy pocas publicaciones que reflejen la frecuencia de las enfermedades neurogenéticas como grupo etiológico. Objetivo: describir la frecuencia de algunas enfermedades neuropediátricas en la Consulta de Neurogenética del Instituto de Neurología y Neurocirugía. Métodos: se realizó una investigación descriptiva y prospectiva en el periodo 2008-2010. Se clasificó a los pacientes por grupos etarios, y se calculó el porcentaje de frecuencia para la atrofia muscular espinal de la infancia, la distrofia muscular tipo Duchenne/Becker, las lesiones estáticas del sistema nervioso central de causa prenatal genética, y para la clasificación de los grupos según tipo de herencia. Resultados: el universo de estudio estuvo conformado por 161 pacientes, 72,6 % del sexo masculino, para una razón de la variable sexo de 2,5. Los escolares fueron mayoría (37,8 %), y la edad promedio 5 años. La distrofia muscular tipo Duchenne fue la enfermedad más frecuente (24,8 %). El 41,40 % clasificó en la herencia autosómica recesiva. Los resultados coinciden con lo reportado en la literatura. Conclusiones: las enfermedades neuromusculares hereditarias, y las lesiones estáticas del sistema nervioso central de causa prenatal genética, son las más frecuentes de solicitud de asesoramiento genético en un servicio de Neurogenética.

Introduction: diverse neurological diseases are present in pediatrics and respond to a great number of causes, that is, infectious, genetic, metabolic and degenerative, among others. Within the clinical method in neurology, the genetic diagnosis is related to the etiological diagnosis. There are very few publications that show the frequency of neurogenetic diseases as an etiologic group. Objective: to describe the frequency of some neuropediatric diseases in the Neurogenetics Service of the Institute of Neurology and Neurosurgery. Methods: a prospective and descriptive research study was conducted in the 2008-2010 period. The patients were grouped by age and the frequency rate was estimated for infantile spinal muscular atrophy, Dechenne/Becker-type muscular dystrophy, the static lesions of prenatal genetic origin in the central nervous system, and finally for the classification of the groups by the type of inheritance. Results: the universe of study was composed by 161 patients of whom 72.6 % were males, for a sex ratio of 2.5. The schoolchildren were the majority (37.8 %) and the average age was 5 years. Duchene type muscular dystrophy was the most frequent (24.8 %). Of the total number, 41.40 % was classified as recessive autosomal inheritance. The results agreed with those of the literature. Conclusions: the hereditary neuromuscular diseases and the static lesions of the central nervous system of prenatal genetic origin are the most common reasons for the request of genetic counseling in the Neurogenetics Service.

Frecuencia de algunas enfermedades genéticas en Neuropediatría / Frequency of some genetic diseases in Neuropediatrics

Introducción: las enfermedades neurológicas en Pediatría son diversas y obedecen a un gran número de causas: infecciosas, genéticas, metabólicas y degenerativas, entre otras. El diagnóstico genético, dentro del método clínico en Neurología, está relacionado con el diagnóstico etiológico. Existen muy pocas publicaciones que reflejen la frecuencia de las enfermedades neurogenéticas como grupo etiológico.Objetivo: describir la frecuencia de algunas enfermedades neuropediátricas en la Consulta de Neurogenética del Instituto de Neurología y Neurocirugía.Métodos: se realizó una investigación descriptiva y prospectiva en el periodo 2008-2010. Se clasificó a los pacientes por grupos etarios, y se calculó el porcentaje de frecuencia para la atrofia muscular espinal de la infancia, la distrofia muscular tipo Duchenne/Becker, las lesiones estáticas del sistema nervioso central de causa prenatal genética, y para la clasificación de los grupos según tipo de herencia.Resultados: el universo de estudio estuvo conformado por 161 pacientes, 72,6 por ciento del sexo masculino, para una razón de la variable sexo de 2,5. Los escolares fueron mayoría (37,8 por ciento), y la edad promedio 5 años. La distrofia muscular tipo Duchenne fue la enfermedad más frecuente (24,8 por ciento). El 41,40 por ciento clasificó en la herencia autosómica recesiva. Los resultados coinciden con lo reportado en la literatura.Conclusiones: las enfermedades neuromusculares hereditarias, y las lesiones estáticas del sistema nervioso central de causa prenatal genética, son las más frecuentes de solicitud de asesoramiento genético en un servicio de Neurogenética(AU)

Introduction: diverse neurological diseases are present in pediatrics and respond to a great number of causes, that is, infectious, genetic, metabolic and degenerative, among others. Within the clinical method in neurology, the genetic diagnosis is related to the etiological diagnosis. There are very few publications that show the frequency of neurogenetic diseases as an etiologic group.Objective: to describe the frequency of some neuropediatric diseases in the Neurogenetics Service of the Institute of Neurology and Neurosurgery.Methods: a prospective and descriptive research study was conducted in the 2008-2010 period. The patients were grouped by age and the frequency rate was estimated for infantile spinal muscular atrophy, Dechenne/Becker-type muscular dystrophy, the static lesions of prenatal genetic origin in the central nervous system, and finally for the classification of the groups by the type of inheritance.Results: the universe of study was composed by 161 patients of whom 72.6 percent were males, for a sex ratio of 2.5. The schoolchildren were the majority (37.8 percent) and the average age was 5 years. Duchene type muscular dystrophy was the most frequent (24.8 percent). Of the total number, 41.40 percent was classified as recessive autosomal inheritance. The results agreed with those of the literature.Conclusions: the hereditary neuromuscular diseases and the static lesions of the central nervous system of prenatal genetic origin are the most common reasons for the request of genetic counseling in the Neurogenetics Service(AU)

Characterization and genetic evaluation of Holstein cattle in Nariño, Colombia / Caracterización y evaluación genética del ganado Holstein en Nariño, Colombia / Avaliação e caracterização do gado Holandês, no departamento de Nariño, Colômbia

Objective: to characterize and genetically evaluate the Holstein population located in the high tropics of Nariño province, Colombia, in order to propose an improvement program that meets the region's needs and conditions. Methods: first, values of heritability (h²), repeatability (R), and genetic correlations (Г) between milk production (PL), milk fat percentage (PG), milk protein percentaje (PP), open days (DIAB), number of services per conception (SPC), calving interval (IEP), and several shape or phenotypic variables were estimated. Historical information was collected from 296 farms between 1999 and 2006. Subsequently, the milk production control was conducted until 2010. An Animal Model was used to estimate the genetic parameters and genetic value. Results: a group of 22 males and 350 females was identified for the highest genetic values for productive and reproductive traits as well as anatomical conformation. Conclusion: intensive dissemination of this animal group to initiate the Holstein breeding improvement process in the dairy areas of Nariño was recommended.

Objetivo: caracterizar y evaluar genéticamente la población Holstein en el Trópico Alto de Nariño, para proponer un programa de mejoramiento acorde con las necesidades y condiciones de esta región. Métodos: primero se estimaron los valores de heredabilidad (h²), repetibilidad (R), y correlaciones genéticas (Г) entre las variables producción de leche (PL), porcentaje de grasa en leche (PG), porcentaje de proteína en leche (PP), días abiertos (DIAB), numero de servicios por concepción (SPC), intervalo entre partos (IEP), y algunas variables de conformación o tipo. La información histórica se recolectó en 296 fincas entre los años 1999 y 2006. Posteriormente se efectuó el control de producción hasta el año 2010. Para la estimación de los parámetros y del valor genético se utilizó un Modelo Animal. Resultados: se identificó un grupo de 22 machos y 350 hembras con los valores genéticos más altos para los rasgos productivos, reproductivos, y de conformación anatómica. Conclusión: se recomendó la difusión intensiva de este grupo de animales con el fin de iniciar el proceso de mejoramiento genético del ganado Holstein en la cuenca lechera de Nariño.

Objetivo: caracterizar e avaliar geneticamente o gado Holandês no Trópico Alto de Nariño (Colômbia), com o intuito de propor um programa de melhoramento que esteja de acordo com as necessidades e condições da região. Métodos: estimaram-se os valores de herdabilidade (h²), repetibilidade (R) e correlações genéticas (Г) entre as variáveis: produção de leite (PL), percentagem de gordura (PG), percentagem de proteína (PP), dias abertos (DIAB), serviços por concepção (SPC), intervalo entre partos (IEP) e algumas características de avaliação lineal ou tipo. As informações históricas foram coletadas em 296 fazendas entre 1999 e 2006; após o controle de produção realizado até 2010. Para estimar os parâmetros e os valores genéticos, foi utilizado um modelo animal. Resultados: foi identificado um grupo composto por 22 machos e 350 fêmeas com maiores valores genéticos para as características de produção, reprodução e conformação anatômica. Conclusão: recomendou-se a divulgação intensiva desse grupo de animais com o objetivo de fazer um programa de melhoramento genético do gado Holandês na região leiteira de Nariño.

Compra, almacenamiento, preparación y consumo de alimentos en la alimentación del niño con cáncer / Purchase, storage, food preparation and consumption power in children with cancer

Durante el tratamiento del niño con cáncer las dificultades que se presentan en la alimentación son variadas. El cáncer en niños, puede acompañarse de desnutrición que puede ser asociada a la naturaleza de la enfermedad y/o como consecuencia de su tratamiento. Dentro de los objetivos en la manipulación de los alimentos se incluye varios aspectos como son los de evitar la contaminación y el control en el consumo. Se deben hacer algunas recomendaciones en cuanto a la compra, almacenamiento, preparación y consumo de los alimentos.

During the treatment of children with cáncer are varied difficulties that arise in their diet. Cancer in children, is a group of diseases that are different from one another, may be associated with manlnutrition associated with the nature of the disease and/or following treatment. The targets in the food handling of children with cáncer include avoiding food contamination and control its management. It should make recommendations regarding the purchase, storage, preparation and consumption of food.

Boca seca, mucositis, problemas dentales y del gusto en la alimentación del niño con cáncer / Dry mouth, mucositis, dental problems and taste power in children with cancer

En niños con cáncer, la quimioterapia y la radioterapia de ciertos tumores de cabeza y cuello, reducen la producción de saliva generando sensación de boca seca, ulceraciones bucales y mucositis. Los problemas dentales se resumen en caries, boca seca y endurecimiento de los músculos de la cara. Así mismo, la quimioterapia, la radiación y el cáncer mismo, ocasionan cambios en el sentido del gusto del niño con cáncer. Todos estas circunstancias se reflejan en el bajo consumo de nutrientes y desarrollo a futuro de desnutrición para lo cual es necesario estar alerta y proponer medidas preventivas.

In children with cáncer, chemotherapy and radiotherapy of ceratin tumors of the head and neck, reduce the production of saliva causing dry mouth, mouth ulcers and mucositis. Dental problems of children with cancer are summarized in caries, dry mouth and tightening of the muscles of the face. Likewise, chemotherapy, radiation and the cancer itself, cause changes in taste of the child with cancer. All these circumstances are reflected in the low nutrient intake and future development of malnutrition for which it is necessary to be vigilant and to suggestpreventive measures.

Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

Necesidades de nutrientes en la alimentación del niño con cáncer / Nutritional requirements in feeding the child with cancer

Los niños con cáncer se ven muy comprometidos en su alimentación en cuanto al consumo de proteínas y calorías. Las proteínas deben ser consumidas en cantidades suficientes de acuerdo a lo recomendado por la nutricionista infantil en su plan de alimentación. Las necesidades calóricas del niño con cáncer dependen de la edad, el peso, el estado nutricional, la actividad, el tipo de cáncer, las complicaciones y el estado del niño, entre otros, por lo que la nutricionista infantil junto con el pediatra, indicarán cómo ofrecer estas calorías al niño.

Children with cancer are very committed to their food in the consumption of protein and calories. Protein should be eaten in sufficient quantities in accordance with the recommendations of child nutrition in your food plan. Caloric needs of children with cáncer depends on age, weight, utritional status, type of cancer, complications and the child's condition, amongothers, so the child nutritionist with the pediatrician,tell you how to deliver these calories a child.

Nutrición enteral y parenteral en la alimentación del niño con Cáncer / Enteral and parenteral feeding in children with cancer

En muchas oportunidades, en los niños con cáncer, no se logra ofrecer toda la alimentación que el niño requiere por la boca, motivo por el cual son utilizadas algunas alternativas que han demostradas ser eficaces para evitar la malnutrición, como la nutrición enteral y la parenteral, las cuales deben ser determinadas por el pediatra o nutricionista infantl del niño. Cuando la nutrición enteral, no es suficiente, es requerida la nutrición parenteral, incluso en casa.

On many occasions, in children with cancer are not able to provide all nutrition required by the child's mouth, which is why some alternatives are used that have proven effective in preventing malnutrition, such as enteral nutrition and parenteral, which must be determined by the pediatrician or infant nutritionist. When enteral nutrition is insufficient, parenteral nutrition is required, even at home.

Exceso de peso y preguntas frecuentes sobre la alimentación del niño con cáncer / Overweight and frequently asked questions about feeding the child with cancer

Durante el tratamiento del niño con cáncer, es posible requerir el uso de corticoides, los cuales como efecto adverso tienen el aumento en el apetito, que unido al sedentarismo de estos niños, incrementan de peso y pueden concurrir en sobrepeso y obesidad, malnutrición que es tan dañina como la desnutrición. Es necesario un control y seguimiento estricto por parte del pediatra y nutricionista infantil en estos niños con malnutrición.

During the treatment of children with cancer, may require the use of corticosteroids, which have the adverse effect of increased appetite, which together with the inactivity of theses children, increased weight and may attend overweight and obesity, malnutrition that is as harmful as malnutrition. It is necessary to control and closely monitored by the pediatrician and infant nutritionist in these children with malnutrition.

Genetic diversity and population structure of the Guinea pig (Cavia porcellus, Rodentia, Caviidae) in Colombia.

The aim was to establish the genetic diversity and population structure of three guinea pig lines, from seven production zones located in Nariño, southwest Colombia. A total of 384 individuals were genotyped with six microsatellite markers. The measurement of intrapopulation diversity revealed allelic richness ranging from 3.0 to 6.56, and observed heterozygosity (Ho) from 0.33 to 0.60, with a deficit in heterozygous individuals. Although statistically significant (p < 0.05), genetic differentiation between population pairs was found to be low. Genetic distance, as well as clustering of guinea-pig lines and populations, coincided with the historical and geographical distribution of the populations. Likewise, high genetic identity between improved and native lines was established. An analysis of group probabilistic assignment revealed that each line should not be considered as a genetically homogeneous group. The findings corroborate the absorption of native genetic material into the improved line introduced into Colombia from Peru. It is necessary to establish conservation programs for native-line individuals in Nariño, and control genealogical and production records in order to reduce the inbreeding values in the populations.