ABSTRACT
ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001-2010) and time trends (1993-2012) of cancer incidence in children aged 0-19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001-2010 and incidence trends over 1993-2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001-2010 the overall WSR in age 0-14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15-19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0-14 years and the other and unspecified tumors at any age. Overall incidence at age 0-19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993-2012. The included registries covered 16% of population aged 0-14 years and 10% of population aged 15-19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.
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RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.
ABSTRACT
OBJECTIVE: To determine the presence of bacterial and viral infectious agents in children with fever during anticancer chemotherapy. DESIGN: Analysis of data obtained during a prospective cohort study. SETTING: The pediatric oncology unit of Tygerberg Children's Hospital; Cape Town. SUBJECTS: All patients up to the age of 15 years who deve- loped fever secondary to anticancer chemotherapy from February 9th 2000 to April 9th 2001. OUTCOME MEASURES: Viruses were isolated or antigens detected on venous blood samples; nasopharyngeal aspirates; throat swabs; urine and feces where possible. Blood for aerobic and anaerobic culture was obtained from an indwelling intravenous catheter and/or a peripheral vein. RESULTS: Thirty-four children were analyzed for a total of 102 febrile episodes. The absolute neutrophil count on admission was below 0.5*109/L in 57 (56) episodes and thus considered neutropenic. Thirty-five viral isolates were identified in 31 (30) febrile episodes: HSV-1 (n=14); HSV-2 (n=2); CMV (n=10); rotavirus (n=5); adenovirus (n=2); Para influenza type 3 (n=1) and hepatitis B (n=1). The blood culture was positive in 24 (24) febrile episodes. Within these; a combined viral and bacterial infection was demonstrated in 6 (6) episodes. Infections were more frequent in neutropenic compared to non-neutropenic episodes; however; this was not significant. CONCLUSIONS: Viral infections clearly are an important cause of fever in children receiving anticancer therapy and may occur together with a bacterial infection. Diagnostic tests for viral infections should be used more frequently and could be of considerable value in evaluating fever and establishing appropriate treatment in these patients
Subject(s)
Anti-Infective Agents , Bacterial Infections , Child , Neoplasms/drug therapy , Pediatrics , Virus DiseasesABSTRACT
In 1991 a cut-off weight of 1 000 g and/or 28 weeks' gestation for neonatal intensive care unit (NICU) admission was decided on by attending neonatologists at a Priorities in Perinatal Care Conference. These recommendations were not based on published evidence. At the time there were few data on the outcome of babies born in the public sector who received NICU. Aim. The aim of this study was to describe the demographic data (mother and baby) and outcomes of babies admitted to a tertiary NICU. Methods. During 1992 - 1996 (1992 cohort) and 1999 - 2000 (1999 cohort) two cohorts of babies treated in the NICU at Tygerberg Hospital; Western Cape; South Africa; were studied. Demogra- phic data were collected prospectively on all admissions with a birth weight of less than 1 501 g and a gestational age of less than 32 weeks. Outcome data were survival; days of ventilation and NICU stay. Results. There were 455 babies in the 1992 cohort and 272 in the 1999 cohort. The mothers' mean income was R892 per month and was higher in the 1999 cohort.The 1999 cohort comprised significantly smaller babies; at a mean birth weight of 1 119 g v. 1 198 g. The mean gestational age in the 1999 cohort was lower (29.2 v. 30.3 weeks); but so was the mortality rate (21.6v. 26.1). The main differences between the survivors and non-survivors were in their birth weight and gestational age and the mean income of their mothers. The mean number of ventilation days needed by these infants was low at 8.5 days; with an average stay in the NICU of 13 days. Discussion. Babies admitted to an NICU have a good chance of survival at a low mean number of ventilation and NICU days. The increase in survival in the 1999 cohort; in spite of low income; is in keeping with international trends and underlines the good short-term outcome of these small babies