Incidence and predictors of treatment-related mortality in paediatric acute leukaemia in El Salvador.

Survival rates among children with leukaemia in low-income countries are lower than those in high-income countries. This has been attributed in part to higher treatment-related mortality (TRM). We examined the demographics, treatment, and outcomes of paediatric patients in El Salvador with acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) to determine the incidence, causes, and risk factors for TRM. Two trained data managers collected data prospectively; no patients were excluded. Biological, socioeconomic and nutritional predictors were examined. A total of 469 patients with ALL and 78 patients with AML were included. The 2-year cumulative incidence of TRM was significantly higher among children with AML (35.4+/-6.4%) than those with ALL (12.5+/-1.7%; P<0.0001). However, the proportion of deaths attributable to the toxicity of treatment did not differ significantly between AML (25/47, 53.2%) and ALL (55/107, 51.4%; P=0.98). Among children with ALL, low monthly income (P=0.04) and low parental education (P=0.02) significantly increased the risk of TRM. Among children with AML, biological, socioeconomic, and nutritional variables were not associated with TRM. In this low-income country, toxic death significantly contributes to mortality in both ALL and AML. A better understanding of the effect of socioeconomic status on TRM may suggest specific strategies for patients with ALL.

Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador.

In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an important infection control practice, namely good hand hygiene. A comparison was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing countries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants' knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feedback obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to patients' families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flipcharts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. Although the use of flipcharts requires a skilled and well-trained instructor, flipcharts could be used more widely to deliver education in resource-poor settings.

Modelo de atención del cáncer en la infancia y adolescencia / Model of cancer care for children and adolescents

La atención integral de niños y adolescentes con cáncer es uno de los grandes desafíos para el sistema de salud pública de nuestros países donde el cáncer infantil representa un problema de salud pública y un problema social. El cáncer pediátrico en Paraguay, un país de escasos recursos, es un problema social y de salud pública por las consecuencias que se infringen a los pacientes, sus familias, las comunidades y los sistemas de salud. Un modelo descentralizado con clínicas más cercanas y dedicadas a cuidados primarios y referencias de niños con diagnóstico potencial de cáncer mejoraron el acceso a cuidados especializados y seguimiento del cáncer. Estas clínicas, implementadas dentro de los hospitales regionales de los sistemas nacionales de salud, ofrecen soluciones sostenibles y efectivas para un mejor acceso y seguimiento del cuidado de los niños con cáncer. El análisis de los desafíos, el éxito y la rentabilidad de estas clínicas regionales de cáncer pediátrico para referencias y seguimiento, permite sugerir un modelo óptimo para tales clínicas en entornos de bajos ingresos. Este modelo podría ser replicado para el cuidado de otras enfermedades y en otros grupos de edad. Presentamos aquí el resultado de la evaluación de los resultados de los pacientes de las cuatro clínicas regionales desde su implementación inicial.

Comprehensive care for children and adolescents with cancer is one of the major challenges for the public health system in our countries where childhood cancer represents a public health problem and a social problem. Pediatric cancer in Paraguay, a country with limited resources, is a social and public health problem because of the consequences that are inflicted on patients, their families, communities and health systems. A decentralized care model with closer-to-home clinics dedicated to primary care and referrals of children with a potential cancer diagnosis improved access to specialized care and cancer follow-up. These clinics, implemented within the regional hospitals of national health systems, offer sustainable and effective solutions for better access and follow-up care for children with cancer. An analysis of the challenges, success and cost-effectiveness of these regional pediatric cancer clinics for referral and follow-up allows us to suggest an optimal model for such clinics in low-income settings. This model could be replicated for the care of other diseases and in other age groups. We present here the results of the evaluation of the results of the patients of the four regional clinics since its initial implementation.

Bartonella henselae: etiology of pulmonary nodules in a patient with depressed cell-mediated immunity.

We describe an immunocompromised renal transplantation patient with opportunistic lung infection due to Bartonella henselae (formerly Rochalimaea henselae) and provide evidence suggesting transmission from a pet cat. Computed tomographic scans of the chest and lung biopsies provided material for diagnosis. The etiology was established by polymerase chain reaction and sequencing of a 16S ribosomal DNA segment from infected lung tissue. Histopathologic and serological evidence supported the molecular data. B. henselae was isolated from the blood of eight of the patient's many cats. The patient responded to prolonged therapy with doxycycline, and relapse did not occur during a 1-year follow-up. B. henselae joins a long list of pathogens that can cause lung infections in association with cell-mediated immunodeficiency states. Molecular methods are useful in diagnosis of this infection in light of the bacterium's fastidious growth characteristics. If an immunocompromised patient has lung nodules and a history of exposure to cats, B. henselae should be sought in biopsy specimens.