Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

BACKGROUND: Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS: European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS: The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS: European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

¿Es la actitud expectante en el síndrome de Gorham una opción terapéutica? / Is the wait-and-see approach in Gorham syndrome a therapeutic option?

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Síndrome de preexcitación en paciente pediátrico durante inducción anestésica / No disponible

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Administración de carboxipeptidasa tras altas dosis de metotrexato. Tratamiento e interacciones medicamentosas / Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions

El metotrexato es un antineoplásico muy utilizado y eficaz en neoplasias como las leucemias, los linfomas y los osteosarcomas. La toxicidad renal es un efecto secundario indeseable que se pretende evitar con una alcalinización urinaria e hiperhidratación eficaz. En caso de intoxicación aguda se establece el uso de carboxipeptidasa G2, una enzima que provoca la hidrólisis del metotrexato en sus metabolitos inactivos. Por su parte, el uso de glutamina durante el tratamiento oncológico previene parte de los efectos indeseables secundarios a éste. Se presenta el caso clínico de un adolescente afectado de linfoma no hodgkiniano en tratamiento con glutamina, que tras la administración de un tercer ciclo de metotrexato (5g/m2) presentó un cuadro de insuficiencia renal que precisó la administración de carboxipeptidasa, con descenso no satisfactorio de las concentraciones de metotrexato en sangre, si bien no se pudo diferenciar la fracción activa del metabolito inactivo por carecer de esta técnica en España. Se revisó la bibliografía sobre la interacción de glutamina y metotrexato y se discutió su fisiopatología sobre un posible papel de la glutamina como favorecedora de la toxicidad por metotrexato (AU)

Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5g/m2) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity (AU)

[Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions]. / Administración de carboxipeptidasa tras altas dosis de metotrexato. Tratamiento e interacciones medicamentosas.

Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5 g/m(2)) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity.