Factors associated with the development of Tumor Lysis Syndrome among pediatric cancer patients at the Philippine Children’s Medical Center

BACKGROUND@#Tumor lysis syndrome (TLS) is an oncologic emergency resulting from cancer chemotherapy; delays in its recognition could be life-threatening. Early recognition of associated risk factors and its management may help prevent its occurrence.@*OBJECTIVE@#To identify the risk factors for TLS among cancer patients at the Philippine Children’s Medical Center.@*METHODS@#This was a retrospective case-control study. Categorical variables were compared using chi-square test and continuous variables were compared using independent t-test. The association between TLS and patients’ characteristics was determined through logistic regression analysis.@*RESULTS@#Medical records of 712 patients with cancer seen between 2016-2020 were reviewed. Children with (n=35) and without (n=137) TLS were selected as cases and controls and matched for age and cancer type. Factors associated with TLS are underweight patients with BMI < 18.5 (cOR 0.33, 95% CI 0.11-0.98); patients with both hepatomegaly and splenomegaly were four times more likely to develop TLS (cOR 3.946, 95% CI 1.2-12.94) while patients with lymphadenopathy were twice more likely to develop TLS (cOR 2.309, 95% CI 1.02-5.21). Patients with elevated WBC, low phosphorus and high uric acid at baseline have increased odds of developing TLS.@*CONCLUSIONS@#After group matching for age and cancer type, factors associated with increased odds of TLS among pediatric cancer patients in PCMC are hepatosplenomegaly, lymphadenopathy, elevated WBC, low potassium level, low phosphorus and high uric acid at baseline with higher fluid balance.

Erector Spinae Plane Block in pediatric cancer pain: Case report / Bloqueo del plano erector espinal en dolor oncológico pediátrico: reporte de caso

Abstract The advent of the erector spinae plane block brought a new therapeutic option in a multimodal analgesia strategy, as evidenced in this case, which describes a five-year old pre-school patient who presented with severe abdominal cancer pain, secondary to an abdominal neuroblastoma, with partial high-dose opioid response, undergoing bilateral erector spinal plane block. The technique used did not give rise to complications and proved to be effective in blocking pain and reducing the opioid dosage 36 hours after the procedure. The paper discusses the variables involved in the administration mode (continuous infusion vs. bolus) and the benefit for optimal analgesia in the pediatric oncology setting.

Resumen Con la aparición del bloqueo del plano erector espinal surgen nuevas alternativas terapéuticas dentro de una estrategia de analgesia multimodal, tal como se puede apreciar en este caso, en el cual se describe un paciente preescolar de cinco años, quien cursó con dolor abdominal oncológico intenso secundario a neuroblastoma abdominal con respuesta parcial a opioides en dosis altas y en el que se empleó el bloqueo mencionado aplicado bilateralmente. La técnica empleada no generó complicaciones y demostró ser efectiva al permitir el control del dolor y la disminución de las dosis de opioides en las 36 horas posteriores a su colocación. Se plantea la discusión de variables con relación a la forma de administración (infusión continua vs. bolo) y la utilidad en la optimización analgésica en el contexto oncológico pediátrico.

Childhood acute lymphoblastic leukemia in Mexico: mortality trend analysis, 1998-2018 / Mortalidad por leucemia linfoblástica aguda en niños y adolescentes mexicanos: análisis de tendencias 1998-2018

Abstract: Objective: To determine the magnitude of mortality due to acute lymphoblastic leukemia (ALL) nationally and by age group, sex, state of residence and insurance status, as well as to evaluate time trends during the period 1998-2018 Materials and methods: We obtained ALL mortality data and estimated age-standardized national, state-level and health insurance mortality rates. We conducted a joinpoint regression analysis to describe mortality trends across the study period and estimate the average annual percent change (AAPC). Results: In a 20-year period, age-standardized ALL mortality rates increased from 1.6 per 100 000 in 1998 to 1.7 in 2018. Nationally, a constant annual increase in mortality was observed for both sexes (1998-2002 AAPC 0.6 in boys, and 1998-2002 AAPC 0.3 in girls). We observed heterogeneity in childhood ALL at a state level. Conclusion: Our results reflect the social, economic, geographic diversity of the country. Monitoring and surveillance of this disease is crucial to assess quality of care.

Resumen: Objetivo: Determinar la magnitud de mortalidad por leucemia linfoblástica aguda (LLA) infantil a nivel nacional, por grupo de edad, sexo, estado y derechohabiencia, así como evaluar las tendencias en el tiempo. Material y métodos: Se estimaron las tasas de mortalidad estandarizadas por edad y estratificadas. Se realizó un análisis de regresión joinpoint para estimar el cambio porcentual anual promedio (AAPC). Resultados: En un periodo de 20 años, las tasas de mortalidad por LLA aumentaron de 1.6 por 100 000 en 1998 a 1.7 en 2018. A nivel nacional, se observó un aumento anual constante para ambos sexos (1998-2002 AAPC 0.6 en niños, y 1998-2002 AAPC 0.3 en niñas). Existe heterogeneidad en la LLA infantil a nivel estatal. Conclusión: Los resultados reflejan la diversidad social, económica y geográfica del país. El seguimiento y la vigilancia de esta enfermedad es fundamental para evaluar la calidad de atención e implementar medidas para su control.

Psychological adjustment of children with cancer: relapse and survival perspectives / Ajustamento psicológico de crianças com câncer: perspectivas da recidiva e da remissão / Ajuste psicológico de niños con cáncer: perspectivas de recaída y supervivencia

In Brazil, few studies have investigated the psychological aspects of childhood cancer. The aim of this article was to compare the psychological adjustment of children with cancer from different survival perspectives with that of children without cancer, besides examining potential risk factors. The sample consisted of 179 participants (6-14 years-old) recruited in two Brazilian public hospitals and three schools, and divided in three groups (relapsed, survivors and control). Children answered orally the self-reported Behavior Assessment Scale for Children, the Revised Children's Manifest Anxiety Scale and Piers-Harris' Self-Concept Scale. No differences were found between groups regarding school and clinical maladjustment, personal adjustment, emotional symptoms and self-concept. Findings also showed positive associations between psychological maladjustment and gender, younger age, lower household income, single parenthood and lower levels of parental education. Conclusions indicate that children with cancer adapt well to the disease and do not present more psychological problems than controls (AU).

No Brasil, poucos estudos investigaram os aspectos psicológicos do câncer infantil. O objetivo deste artigo foi comparar o ajustamento psicológico de crianças com câncer com diferentes perspectivas de sobrevivência com o de crianças sem câncer, além de examinar potenciais fatores de risco. A amostra consistiu em 179 participantes (6-14 anos de idade) recrutados em dois hospitais públicos e três escolas brasileiras. As crianças responderam oralmente à Escala de Avaliação Comportamental para Crianças, à Escala de Ansiedade Manifesta para Crianças Revisada e à Escala de Autoconceito Piers-Harris. Não foram constatadas diferenças entre os grupos com relação ao desajustamento clínico e escolar, ajustamento pessoal, sintomas emocionais e autoconceito. Os resultados também mostraram associações positivas entre o desajustamento psicológico e gênero, menor idade, menor renda, famílias monoparentais e menor nível educacional parental. As conclusões indicam que crianças com câncer se adaptam bem à doença e não apresentam mais problemas psicológicos que as do grupo controle (AU).

Na Brasil, pocos estudios han investigado los aspectos psicológicos del cáncer infantil. El objetivo de este artículo fue comparar el ajuste psicológico de niños na cáncer na diferentes perspectivas de supervivencia na el de niños sin cáncer, además de examinar los posibles factores de riesgo. La muestra consistió en 179 participantes (6-14 años de edad) reclutados en dos hospitales públicos y tres escuelas brasileñas. Los niños contestaron oralmente a la Escala de Evaluación del Comportamiento del Niño, la Escala Revisada de Ansiedad Manifiesta en Niños y la Escala de Autoconcepto de Piers-Harris. No se constataron diferencias entre los grupos con respeto al desajuste clínico y escolar, el ajuste personal, los síntomas emocionales y el autoconcepto. Los resultados también mostraron asociaciones positivas entre el desajuste psicológico y el género, la menor edad, la menor renta, las familias monoparentales y el nivel educativo parental más bajo. Las conclusiones señalan que niños con cáncer se adaptan bien a la enfermedad y no presentan más problemas psicológicos que los del grupo de control (AU).

Enfrentamento materno do câncer pediátrico em quatro fases da doença / Maternal coping with childhood cancer in four stages of the disease

O cuidador familiar fornece apoio fundamental em doenças crônicas como o câncer, sofrendo a maior sobrecarga física, emocional e social. Esta pesquisa analisou o processo de enfrentamento de quatro mães de crianças com câncer com idade entre 7-13 anos, em diferentes fases da doença - diagnóstico [M1], tratamento [M2], manutenção [M3] e terminalidade [M4]. As mães responderam individualmente o Protocolo de Entrevista sobre Enfrentamento Materno do Câncer de Crianças e Adolescentes, com 34 questões. Os maiores estressores relacionaram-se à dificuldade do prognóstico do caso, à falta de tempo e energia para dedicar-se à família e às dificuldades financeiras. As mães apresentaram mais estratégias de enfrentamento adaptativas, como: Autoconfiança, Resolução de problemas, Busca de informação e Acomodação, indicativas de percepção de desafio às necessidades de Relacionamento, de Competência e de Autonomia. Os dados evidenciam a necessidade de avaliar e atender às demandas dessa população, considerando a fase da doença.

The family caregiver provides fundamental support in chronic diseases such as cancer, suffering the greatest physical, emotional and social burden. This research analyzed the process of coping with four mothers of children with cancer aged 7-13 years, at different stages of the disease - diagnosis [M1], treatment [M2], maintenance [M3] and terminality [M4]. Mothers individually answered the Interview Protocol on Coping with Cancer of Children and Adolescents, with 34 questions. The biggest stressors were related to the difficulty of the prognosis of the case, the lack of time and energy to dedicate to the family and the financial difficulties. Mothers presented more adaptive coping strategies, such as: Self-confidence, Problem solving, Information search and Accommodation, indicative of perceived challenge to the needs of Relationship, Competence and Autonomy. The data show the need to assess and meet the demands of this population, considering the stage of the disease.

Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B / Generalized bone pain and hypercalcemia in an infant as an initial symptom of lymphoblastic lymphoma of B cells

Resumen Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.

Abstract Background: Non-Hodgkin lymphomas are heterogeneous neoplasms derived from lymphohematopoietic cells, which are rarely found in children < 2 years of age and have a higher prevalence in males. Case report: One-year and eleven-month-old male patient started with pain in the lower and upper limbs, intermittent claudication, bone deformity, and generalized hypotonia, for which juvenile arthritis was suspected. He received non-steroidal anti-inflammatory drug treatment. As no improvement was reported, he was admitted in a different hospital with lymph nodes and nodulations in the scrotal and brachial region and hepatomegaly. Therefore, early activation of puberty with evidence of hypercalcemia was presumed. Radiological studies indicated possible bone dysplasia; however, positron emission tomography detected areas compatible with malignant process. Precursor B lymphoma was diagnosed. Hypercalcemia is a metabolic disorder considered a paraneoplastic syndrome in the presence of cancer, which is an exceptional clinical finding in children with acute lymphoblastic leukemia. Conclusions: Bone pain in the pediatric age deserves a thorough physical examination to favor an early diagnosis of childhood cancer and a better prognosis.

Valoración de la musicoterapia en pacientes oncológicos pediátricos y sus cuidadores / Assessment of musictherapy in pediatric cancer patients and their caregivers

Introducción: La musicoterapia, como algunos estudios ya lo han demostrado, es efectiva en la reducción de la ansiedad, el miedo y el dolor tanto en pacientes oncológicos pediátricos, como en sus cuidadores; aumentando la relajación, el bienestar del paciente, mejorando su calidad de vida y la relación paciente-cuidador. Objetivos: Valorar la satisfacción de los cuidadores y pacientes con los beneficios obtenidos de la intervención musicoterapéutica recibida en el Departamento de Hemato- Oncología Pediátrica del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo, transversal, tras el diseño y la puesta en marcha del voluntariado de Musicoterapia. Se elaboró un cuestionario de satisfacción a los familiares y pacientes que recibieron sesiones de musicoterapia. Resultados: Fueron encuestadas 22 personas, 10 pacientes (45.5%), 12 familiares (54.5%). El 100% de los encuestados respondió que vio beneficio al terminar la sesión y recomendaría este tipo de intervención a otro paciente o cuidador. Se solicitó a las personas que califiquen del 1 al 5 la sesión de Musicoterapia. 19 personas (86.4%) dieron calificación 5 y 3 personas (13.6%) la calificaron con 4. Conclusión: Tras la realización de este trabajo se pudo observar la importancia de la aplicación de la musicoterapia en pacientes oncológicos pediátricos y en sus cuidadores, por su efectividad para animarlos, distraerlos, relajarlos y de esta manera disminuir la ansiedad, el dolor físico, el malestar y la angustia; mejorando así su calidad de vida, aunque el número de encuestados no es estadísticamente significativo para sacar conclusiones definitivas.

Introduction: Music therapy, as some studies have already shown, is effective in reducing anxiety, fear and pain in both pediatric cancer patients and their caregivers; increasing relaxation, patient well-being, improving their quality of life and the patient-caregiver relationship. Objectives: To measure the satisfaction of caregivers and patients with the benefits obtained from the music therapy intervention received in the Department of Pediatric Hemato-Oncology of the Hospital of Clinics of the Faculty of Medical Sciences of the National University of Asunción. Materials and methods: Quantitative observational, descriptive, cross-sectional study, after the design and implementation of the Music Therapy volunteer. A satisfaction questionnaire was prepared for family members and patients receiving music therapy sessions. Results: 22 people were surveyed, 10 patients (45.5%), 12 relatives (54.5%). 100% of respondents responded that they saw some benefit at the end of the session and would recommend this type of intervention to another patient or caregiver. People were asked to rate the Music therapy session from 1 to 5. 19 people (86.4%) rated 5 and 3 people (13.6%) rated it 4. Conclusion: After the completion of this work, it has been possible to observe the importance of the use of music therapy in pediatric cancer patients and their caregivers, for its effectiveness in encouraging them, distracting them, relaxing them and thus reducing anxiety, physical pain, malaise and anguish, thus improving their quality of life.

Invasive pneumococcal disease in children with cancer: Incidence density, risk factors and isolated serotypes

ABSTRACT Background: Pediatric oncology patients (POP) have a high risk of infections due to impaired immunity. Invasive pneumococcal disease (IPD) is an important cause of severe infection in these patients and it is associated with high mortality. This study aimed to evaluate the incidence and risk factors associated with IPD at a Pediatric Oncology Center in Brazil. Methods: This was a retrospective case-control study. All IPD cases in children with cancer from 2005 through 2016 were reviewed. Each case of IPD was matched with two controls from a cohort of patients matched for year of IPD, age and disease in order to assess risk factors. The incidence density was calculated as the number of IPD per 100,000 patients-year. Results: A total of 51 episodes of IPD in 49 patients was identified. All pneumococci were isolated from blood cultures. The median age was five years and 67% were male; mortality rate was 7.8%. The IPD incidence density rate in POP was 311.21 per 100,000 patients-year, significantly higher than the rate in the general pediatric population. Severe neutropenia was the only risk factor associated with IPD, after multivariate conditional logistic regression analysis. Conclusion: Although pneumococcal disease decreased after the introduction of 10-valent pneumococcal vaccine in the Brazilian national immunization schedule in 2010, there was no decrease in the IPD incidence rate in our cohort. A higher coverage rate of pneumococcal vaccination in children in the general population might be necessary to reduce the incidence rate in this high-risk population.

Incidencia y determinantes demográficos de la leucemia linfoide aguda en pacientes con cáncer pediátrico, Antioquia / Incidence and demographic determinants of lymphocytic leukemia in pediatric patients with cancer, Antioquia

Introducción: En el mundo las leucemias agudas son los tumores más frecuentes en la edad pediátrica, de gran interés por sus implicaciones en el niño y su familia. Objetivo: Identificar la incidencia de leucemia linfoide aguda y su asociación con determinantes demográficos en pacientes con cáncer pediátrico, Antioquia, 2017. Materiales y métodos: Estudio observacional, descriptivo, transversal, retrospectivo con intención analítica, sobre la incidencia de leucemia linfoide aguda (LLA) y su asociación con determinantes demográficos no causales de pacientes con cáncer infantil, en 190 registros del Sistema de Vigilancia en Salud Pública (SIVIGILA). Resultados: Las tasas de incidencia de cáncer infantil y LLA fueron 10 casos y 4 casos por cada 100.000 habitantes ≤18 años respectivamente. Las variables asociadas a LLA son: ser hombre (RPa: 1,02 IC95%: 0,52 - 2,02), residencia rural (RPa: 1,59 IC95%: 0,55 - 4,56), afiliación al régimen subsidiado (RPa: 1,41 IC95%: 0,68 - 2,92), edad ≥ 9 años (RPa: 0,76 IC95%: 0,38 - 1,50) y oportunidad diagnóstica confirmatoria ≥ 16 días (RPa: 0,34 IC95%: 0,10 - 1,15). Conclusiones: Ser hombre, vivir en zona rural y estar afiliado al régimen subsidiado, está relacionado con la incidencia de leucemia linfoide aguda.

Introduction: Acute leukemias are the most frequent pediatric malignancies worldwide that have led to a great interest due to their implications for children and their families. Objective: To identify the incidence of acute lymphocytic leukemia and its association with demographic determinants in pediatric cancer patients from Antioquia (Colombia) in 2017. Materials and methods: An observational, descriptive, cross-sectional, retrospective study was carried out with an analytical approach to identify the incidence of acute lymphocytic leukemia (ALL) and its association with non-causal demographic determinants in patients with pediatric cancer. 190 records from the Public Health Surveillance System (SIVIGILA) were analyzed. Results: The incidence rates of childhood cancer and ALL were 10 and 4 cases per 100,000 inhabitants ≤18 years of age, respectively. The variables associated with ALL are: being male (APR: 1.02 95% CI: 0.52 - 2.02); living in rural areas (APR: 1.59 95% CI: 0.55 - 4.56); being affiliated to the subsidized regime (APR: 1.41 95% CI: 0.68 - 2.92); being ≥ 9 years of age (APR: 0.76 95% CI: 0.38 - 1.50); and having a confirmatory diagnosis after 16 days (APR: 0.34 95% CI: 0.10 - 1.15). Conclusions: The variables related to acute lymphocytic leukemia are: being a man; living in rural areas; and being affiliated to the subsidized regime.

Keberkesanan Bahan Pendidikan Bercetak untuk Pengurusan Pemakanan dalam Kalangan Penjaga Pesakit Kanser Kanak-kanak (Effectiveness of Printed Educational Material on Nutrition Management Among Paediatric Oncology Caregives) / Jurnal Sains Kesihatan Malaysia

@#Malnutrition is a common occurrence during cancer treatment among pediatric cancer patients and without proper care, it can bring negative implications. The purpose of this study was to develop a printed educational material titled “Penjagaan Pemakanan untuk Penjaga Kanser Kanak-Kanak” (Nutrition Care for Children with Cancer) to help the caregivers to manage their child in terms of nutrition. The objective of this study was to evaluate caregiver’s knowledge, attitude and practice (KAP) before and after receiving the printed educational material and to evaluate the acceptance of the printed educational material among caregiver. This quantitative study (Quasi-Experiment) was conducted among pediatric oncology caregivers in Institute of Pediatrics Hospital Kuala Lumpur (IPHKL)(n=34) and Universiti Kebangsaan Malaysia Medical Center (UKMMC)(n=34). IPHKL served as the experimental group where the caregivers received the developed booklet meanwhile UKMMC served as the control group where the caregivers received a pamphlet published by Institut Kanser Negara titled “Terapi Diet Pesakit Kanser – Kesan Sampingan Rawatan dan Cara Mengatasinya” (Nutrition Care for Cancer – How to Overcome the Side Effects of the Treatment). Results from this study showed that there was a significant increase (p<0.05) for KAP of the caregivers in both groups with a higher increase was seen in the experimental group. The score for KAP in the experimental group was (70 ± 8%) and after receiving the printed educational material, the score significantly increased to (92 ± 10%) which was higher compared to control group where their score before was (70 ± 11%) and increased to (77 ± 10%). For the evaluation of acceptance, there was a significant difference (p<0.05) for the mean score between experimental group (48.85 ± 4.931) and control (42.29 ± 6.834) with t= 4.538. In conclusion, the printed educational material developed from this study was well accepted and has the potential to effectively increase caregivers’ nutritional knowledge of managing the nutritional aspect of pediatric cancer patients during treatment. This could improve their nutritional status for a better clinical outcome.

Quality-of-life of Pediatric Cancer Patients Receiving End-of-life Care and Related Factors: Using a Proxy QOL Rating Scale from the Nurse’s Perspective

Objectives: The study purpose was to examine quality-of-life (QOL) of pediatric cancer patients at end-of-life and related factors using a QOL proxy rating scale from the nurse’s perspective. Methods: We conducted a survey in October 2015−February 2016. The subjects to be surveyed were nurses who were primarily in charge of patients with childhood cancer at end-of-life. We investigated 22 items of the Good Death Inventory for Pediatrics (GDI-P) and their related factors. Results: In total, 53 proxy evaluate questionnaires were completed from 18 centers. Among the eight factors of GDI-P, “Relief from physical and psychological suffering” was the lowest. The total score of GDI-P was positively correlated with the structure and process of care (r=0.58). Although there was a bias in the number of cases, in the case of the place of death was the intensive care unit, the total score of GDI-P was lower than home and the general ward. Conclusions: It was suggested that the top priority in improving QOL was relief from suffering and the structure and process of care were related to QOL.

Perfil clínico-funcional de niños que ingresan a un programa de rehabilitación oncológica en una ONG chilena / Clinical-functional profile of children admitted into an oncology rehabilitation program in a Chilean NGO

INTRODUCCIÓN: Los pacientes oncológicos infantiles presentan diversas deficiencias en sus funciones y estructuras corporales derivados de los tumores mismos o de los distintos tratamientos empleados, ya sea cirugía, quimioterapia, radioterapia o la suma de ellos. Estas deficiencias generan gran discapacidad en todas las áreas del funcionamiento. OBJETIVO: Describir el perfil clínico y funcional de niños que ingresan a un programa de rehabilitación oncológica. MATERIALES Y MÉTODOS: Estudio observacional, restrospectivo y descriptivo. Se revisaron 109 fichas clínicas de pacientes ingresados al programa de rehabilitación oncológica de Fundación Nuestros Hijos entre los años 2014 y 2017, que cumplieron criterios de ingreso. Se obtuvieron los datos de la evaluación clínica realizada por médico fisiatra y pruebas funcionales al ingreso, incluyendo Timed Up and Go Test, Pediatric Balance Scale y test de Marcha de 6 min. RESULTADOS: El promedio de edad fue de 8,7 ± 3,4 años. Los diagnósticos más frecuentes fueron tumores de sistema nervioso central (50,4%), leucemias y linfomas (24,4%). Un 53,2% de los pacientes se encontraba en tratamiento activo al momento del ingreso. El déficit motor fue el más frecuente (79,8%). Dentro de este grupo, 19 niños (17,4%) presentaron hemiparesia y 18 niños (16,5%) tetraparesia. Del total, 44% reportó presencia de fatiga, 28,4% presentó trastorno de la deglución, 34,9% trastorno visual y un 56,9% compromiso cognitivo.CONCLUSIONES: Los niños que ingresan a rehabilitación oncológica presentan múltiples deficiencias en diversas áreas de su funcionamiento, tanto en etapas tempranas como tardías de su tratamiento. El compromiso, motor, deglutorio, visual y cognitivo son las deficiencias más frecuentes de encontrar, sobre todo en pacientes con tumores de SNC.

INTRODUCTION: Pediatric cancer patients present several dysfunctions in their body functions and structures caused by the tumors or by therapies, such as surgery, chemotherapy, radiotherapy or the sum of all of these treatments. these dysfunctions cause impairment of all areas of functioning. OBJECTIVE: to describe the clinical and functional profile of children admitted to an oncology rehabilitation program. MATERIALS AND METHODS: A retrospective, descriptive, observational study that reviewed 109 clinical records of patients admitted between 2014 and 2017 to the oncology rehabilitation program of 'Fundación Nuestros Hijos', in compliance with the admission criteria. Data were obtained from the clinical assessment performed by the physiatrist and from functional tests such as 'Timed Up and Go Test', 'Pediatric Balance Scale' and '6-minute walk test'. RESULTS: Average age was 8.7 ± 3.4 years. the most frequent diagnoses were central nervous system (CNS) tumors (50.4%), leukemia and lymphoma (24.4%). A 53.2% of the patients were under active treatment at the time of admission. Motor deficit was the most frequent symptom (79.8%). In this group, 19 children (17.4%) had hemiparesis and 18 (16.5%) quadraparesis. of the total, 44% reported fatigue, 28.4% swallowing disorders, 34.9% vision disorders, and 56% cognitive impairment. CONCLUSIONS: Children admitted to oncology rehabilitation programs present several deficiencies in areas of functioning, both in early and late stages of their treatment. Motor, visual and swallowing impairment are the most common dysfunctions, particularly in patients with CNS tumors.

Antitumoral effects of Amblyomma sculptum Berlese saliva in neuroblastoma cell lines involve cytoskeletal deconstruction and cell cycle arrest / Efeito antitumoral da saliva do carrapato Amblyomma sculptum Berlese em células de neuroblastoma envolve desconstrução do citoesqueleto e parada do ciclo celular

Abstract The antitumor properties of ticks salivary gland extracts or recombinant proteins have been reported recently, but little is known about the antitumor properties of the secreted components of saliva. The goal of this study was to investigate the in vitro effect of the saliva of the hard tick Amblyomma sculptum on neuroblastoma cell lines. SK-N-SK, SH-SY5Y, Be(2)-M17, IMR-32, and CHLA-20 cells were susceptible to saliva, with 80% reduction in their viability compared to untreated controls, as demonstrated by the methylene blue assay. Further investigation using CHLA-20 revealed apoptosis, with approximately 30% of annexin-V positive cells, and G0/G1-phase accumulation (>60%) after treatment with saliva. Mitochondrial membrane potential (Δψm) was slightly, but significantly (p < 0.05), reduced and the actin cytoskeleton was disarranged, as indicated by fluorescent microscopy. The viability of human fibroblast (HFF-1 cells) used as a non-tumoral control decreased by approximately 40%. However, no alterations in cell cycle progression, morphology, and Δψm were observed in these cells. The present work provides new perspectives for the characterization of the molecules present in saliva and their antitumor properties.

Resumo As propriedades antitumorais de extratos de glândulas salivares de carrapatos ou proteínas recombinantes foram relatadas recentemente, mas pouco se sabe sobre as propriedades antitumorais dos componentes secretados da saliva. O objetivo deste estudo foi investigar o efeito in vitro da saliva bruta do carrapato duro Amblyomma sculptum sobre as linhagens celulares de neuroblastoma. Células SK-N-SK, SH-SY5Y, Be(2)-M17, IMR-32 e CHLA-20 foram suscetíveis à saliva, com redução de 80% na sua viabilidade em comparação com controles não tratados, como demonstrado pelo ensaio de Azul de Metileno. Investigações posteriores utilizando CHLA-20 revelaram apoptose, com aproximadamente 30% de células positivas para anexina-V, e G0/G1 (> 60%) após tratamento com saliva. O potencial de membrana mitocondrial (Δψm) foi reduzido significativamente (p <0,05), e o citoesqueleto de actina foi desestruturado, como indicado pela microscopia de fluorescência. A viabilidade do fibroblasto humano (células HFF-1), usado como controle não tumoral, diminuiu em aproximadamente 40%. No entanto, não foram observadas alterações na progressão do ciclo celular, morfologia e Δψm nestas células. O presente trabalho fornece novas perspectivas para a caracterização das moléculas presentes na saliva e suas propriedades antitumorais.

Oral Complications after Antineoplastic Treatment in Pediatric Patients / 대한소아치과학회지

The purpose of this study was to examine dental complications and to evaluate the effects of initial treatment age, treatment modalities, and treatment duration on the disorder after radiation and chemotherapy in pediatric cancer patients.For 93 children with clinical and radiographic data, the number of teeth, the morphology of teeth, the shape of the roots, and development status of the dentition were evaluated.Dental development disorders were found in 61.3% of the children. The mostly found abnormality was root deformity with the prevalence of 31.2%. In children submitted to the therapy before the age of 6, the number of missing teeth (p = 0.029) and microdontia (p = 0.003) were greater compared to the children who started to receive the treatment after the age of 6. The combination of radiation and chemotherapy showed significantly greater incidences of missing teeth (p = 0.030), microdontia (p = 0.046), and root deformity (p = 0.009) when compared with the sole application of chemotherapy. When the children were submitted to anticancer therapy for 18 months or longer duration, greater number of missing teeth (p = 0.032), microdontia (p = 0.011), root deformity (p = 0.025), and total number of teeth affected (p = 0.036) were observed compared with duration less than 18 months.The number of dental abnormalities increased when the children were treated at earlier ages, with combination of radiation and chemotherapy, and for longer period of time.

Ethical Reflection on Treatment Abandonment of Pediatric Cancer / 中国医学伦理学

About 80％ of children with malignant cancer in developed countries could be cured, while the sur-vival rate in developing countries that account for 80％ of the cases was lower than that of the developed countries. Treatment abandonment is the primary cause leading to the therapeutic failure and mortality in developing coun-tries. This paper discussed the current situation of treatment abandonment of pediatric cancer, the ethical issues and put forward the corresponding solutions, in order to attract more attention of scholars and take corresponding measures, thus to help improve the prognosis of pediatric cancer.

Fertility preservation in pediatric and young adult female cancer patients

As the 5-year survival rate increases up to 80% in pediatric cancer patients, the number of women patients with reduced gonadal function by chemotherapy and radiotherapy increases. The gonadal toxicity of pediatric patients varies highly according to the chemotherapeutic agent and the type of radiotherapy. Although American Society of Clinical Oncology published the guideline for fertility preservation, additional scientific and ethical concerns should be considered for clinical practice. In addition, only the experimental method can be applied for the prepubertal patients in contrast to the postpubertal patients. In this review, we will discuss some options for preserving fertility among women’s quality of life issues.

Epidemiología descriptiva del cáncer en la edad pediátrica en el Hospital del Niño Dr. José Renán Esquivel, 2001-2010 y 2011-2014

Objetivo:Describir la incidencia, supervivencia, mortalidad, tasa específica de mortalidad y tasa de incidencia en los niños menores de 15 años en el Hospital del Niño en el período 2001 al 2010 y 2011 al 2014. Material y métodos:Tipo de estudio descriptivo, retrospectivo, transversal. Resultados:En el periódo del 2001-2010 fueron diagnosticados 146 pacientes y del 2010-2014 un total de 69, mientras que la tasa de supervivencia en ambos periodos fue del 67% y 75% respectivamente. El grupo de más alta incidencia está en el rango de edad de 1 a 4 años.La tasa de mortalidad por tumores en menores de 15 años por 100,000 niños fue de 4.49 y la tasa de incidencia de 20.57 por 1,000,000 de niños menores de 15 años.

Objective: To describe the incidence, survival, mortality, specific mortality rate and incidence rate in children under 15 years of age at the Hospital del Niño from 2001 to 2010 and from 2011 to 2014. Material and methods: Descriptive, retrospective, transversal study. Results: In the 2001-2010 period, 146 patients were diagnosed, and from 2010-2014 a total of 69 , while the survival rate in both periods was 67% and 75%, respectively. The group with the highest incidence is in the age range 1 to 4 years.The tumor mortality rate in children under 15 years per 100,000 children was 4.49 and the incidence rate was 20.6 per 1,000,000 children under the age of 15 years.

Factores de riesgo en infecciones por organismos multidroga resistentes en pacientes pediátricos oncológicos en la Unidad Nacional de Oncología Pediátrica (UNOP) de Guatemala

Introducción: Las infecciones por organismos multidroga resistentes (MDR) en pacientes oncológicos pediátricos se han convertido en una causa frecuente de morbilidad y mortalidad. Objetivos: El objetivo principal de este estudio fue determinar la incidencia y los factores de riesgo para estas infecciones en una muestra de pacientes de la UNOP. Métodos: Se realizó un estudio de tipo retrospectivo. Se incluyeron pacientes de la unidad de nosocomiales con infección por organismos MDR con cultivo positivo (hemocultivo, uro cultivo, aspirado oro traqueal cultivo de secreción). Se revisaron los registros comprendidos entre 1 de enero del 2015 al 31 de diciembre del 2015; obteniendo los registros médicos de 30 pacientes que cumplían con los criterios de inclusión. Resultados: Se observó que el 60% de los pacientes con infecciones por organismo MDR son del sexo femenino, el 70% poseen el diagnóstico de un tumor hematológico y el 37% tuvieron como diagnóstico bacteriemia/sepsis, siendo la incidencia de ésta de 3.49%. Palabras Claves: factores de riesgo, Infecciones por organismos multidroga resistentes, pacientes oncológicos pediátricos. A. baumannii, K. pneumonie; cancer pediátrico.

Introduction: Multidrug resistant (MDR) organism infections in pediatric oncology patients have become a frequent cause of morbidity and mortality. The main objective of the following study was to determine the incidence and risk factors associated to MDR organisms infections in a sample of patients from UNOP. Methods: Retrospective study. The inclusion criteria were documented MDR infection with positive culture (blood, urinary, tissue or endotracheal aspirate). We reviewed medical records between January 1st, 2015 to December 31st, 2015; obtaining the medical records of 30 patients who fulfilled the inclusion criteria. Results: Sixty percent (60%) of patients female; 70% had the diagnosis of hematologic malignancy; 37% of patients were diagnosed with clinical sepsis and the incidence of sepsis was 3.49%. Key words: risk factors, infections by multidrug-resistant organisms, pediatric cancer patients. A. baumannii, K. pneumonie; pediatric cancer

Neuroimmunoendocrine trajectories and the response to stress and fatigue in pediatric cancer patients under chemotherapy submitted to clown intervention / Trajetórias neuroimunoendócrinas e resposta ao estresse e à fadiga em pacientes oncológicos pediátricos em tratamento quimioterápico submetidos à intervenção do palhaço

Cancer and the hospitalization process often have a psychological impact on the children and adolescents, usually leading to intense stress as well as fatigue. This especially applies to children and adolescents who have been submitted to chemotherapy, since it still constitutes a stressful and threatening experience for them and may exacerbate cancer symptom burden clusters, leading to a decrease in their health related quality of life (QoL). In addition, stress associated with cancer development leads to disturbances/disruption in the hypothalamicpituitary-adrenal (HPA) axis and suppresses important neuroimmunoendocrine pathways. Hence, interventions aimed at attenuating the physiological changes related to stress favor the recovery of the immune system and, consequently, induce alterations in neuroimmunoendocrine factors that increase immunological surveillance during cancer treatment. With the increase in cancer rates, it is crucial that healthcare professionals develop effective interventions to support pediatric cancer patients during the hospitalization process in order to relieve the burden of cancer treatment, which may contribute to a better prognosis of the disease. In an attempt to alleviate some of the cancer-related symptoms, pediatric oncology patients can take advantage of non-pharmacological interventions, including clown intervention, which can be a very advantageous approach to reduce unpleasant symptoms in pediatric cancer patients. However, few studies have investigated the molecular mechanisms that mediate health outcomes of clown intervention. The main purpose of this study was to investigate the effects of the clown intervention on psychological stress and cancer-related fatigue (CRF) in pediatric cancer inpatients undergoing chemotherapy. Also, we aimed to investigate whether changes in the levels of biomarkers, including cortisol, ?-amylase (sAA), cytokines, and matrix metalloproteinase-9 (MMP-9) are associated with psychological stress and CRF levels in pediatric osteosarcoma inpatients following clown intervention. A pretestposttest quasi-experimental study was undertaken with pediatric cancer inpatients. Eight nonfasting saliva samples were collected at identical times upon clown intervention, i.e., at baseline (pre-intervention) and post-intervention (+ 1h, + 4h, + 9h, and + 13h post awakening). Salivary cortisol, sAA, cytokines and MMP-9 concentrations were measured using high sensitivity Enzyme-Linked Immuno Sorbent Assay. Sociodemographic and clinical data, and Child Stress Scale-ESI(TM) and PedsQL(TM) Multidimensional Fatigue Scale were applied and the results were compared at baseline and after the clown intervention, and also correlated with biomarker trajectories. Data analysis was performed using nonparametric statistical tests. In comparison with baseline measurements, the overall psychological stress for pediatric cancer inpatients as well as their perception of fatigue improved upon clown intervention (p= 0.003; p= 0.049, respectively). There were no significant correlations between sAA and cortisol for both Areas Under Curve (AUC) at baseline or at post-intervention. Also, clown intervention reduced IL1? and salivary cortisol levels in pediatric osteosarcoma inpatients. Additionally, AUC for IL1? positively correlated with AUC for cortisol as well as with AUC for sAA at postintervention. In contrast, levels of IL-6, TNF-?, IL-12p70, IL-10, TGF-? and MMP-9 did not show significant differences upon clown intervention. Overall, our results suggest that clown intervention is a good non-pharmacological intervention to reduce psychological stress and CRF in pediatric cancer inpatients undergoing chemotherapy

O câncer e o processo de hospitalização comumente cursam com forte impacto psicológico sobre as crianças e adolescentes, gerando estresse e fadiga. Isto aplica-se especialmente, para àqueles sob quimioterapia, pois esta, constitui-se em uma das experiências mais estressantes e ameaçadoras que pode exacerbar os sintomas relacionados ao câncer e levar a uma diminuição da qualidade de vida (QV). O estresse associado ao desenvolvimento do câncer pode causar disrupturas no eixo hipotálamo-hipófise-adrenal, e suprimir importantes vias neuroimunoendócrinas. Assim, intervenções destinadas a atenuar as alterações fisiológicas relacionadas ao estresse podem favorecer a recuperação do sistema imune e induzir alterações neuroimunoendócrinas para potencializar a vigilância imunológica durante o tratamento oncológico. Com o aumento da incidência de câncer, é crucial que os profissionais de saúde desenvolvam intervenções eficazes para o manejo dos sintomas oncológicos, de modo a aliviar a sobrecarga do tratamento nesses pacientes durante o processo de hospitalização, de modo a contribuir para um melhor prognóstico da doença. Ademais, pacientes pediátricos oncológicos podem se beneficiar de intervenções não-farmacológicas, por exemplo, a intervenção dos clowns, para aliviar os sintomas relacionados ao câncer. Contudo, poucos estudos têm investigado os mecanismos moleculares envolvendo a intervenção dos clowns. Nosso objetivo principal foi investigar os efeitos da intervenção dos clowns sobre o estresse psicológico e a fadiga-relacionada ao câncer (FRC) em pacientes pediátricos oncológicos sob quimioterapia. Além disso, nós investigamos se alterações nos níveis de cortisol, ?-amilase (sAA), citocinas e metaloproteinases de matriz (MMP-9) estão associadas com estresse psicológico e com FRC de pacientes pediátricos com osteossarcoma submetidos à intervenção dos clowns. Trata-se de um estudo quase-experimental pré-teste/pós-teste. Foram colhidas oito amostras de saliva em momentos idênticos, isto é, no baseline (pré-intervenção) e no pós-intervenção (+ 1h, + 4h, + 9h e + 13h após o despertar). As concentrações de cortisol salivar, sAA, citocinas e MMP-9 foram mensuradas por ELISA. Dados sociodemográficos e clínicos foram coletados via prontuários médicos, além disso, foram aplicadas a Escala de Estresse Infantil-ESI(TM) e a Escala Multidimensional de Fadiga-PedsQL(TM). Os escores das escalas foram comparados entre o baseline e o pós-intervenção, e também, foram correlacionados com os níveis dos biomarcadores. Para análise dos dados, utilizou-se da estatística descritiva e estatística não paramétrica. Em comparação com as medidas do baseline, observamos que os níveis de estresse psicológico total, bem como os de fadiga geral dos pacientes pediátricos oncológicos, melhoraram significativamente após a intervenção dos clowns ( p= 0.003; p= 0.049, respectivamente). Não houve correlações significativas entre as Áreas sob Curva (AUC) da sAA e do cortisol no baseline e nem no pós-intervenção. Além disso, a intervenção dos clowns reduziu os níveis de IL-1? e de cortisol nos pacientes pediátricos com osteossarcoma. A AUC da IL-1? correlacionou-se positivamente com AUC do cortisol e com a AUC da sAA no pósintervenção. Inversamente, os níveis de IL-6, TNF-?, IL-12p70, IL-10, TGF-? e MMP-9 não mostraram diferenças significativas no pós-intervenção. Em síntese, nossos resultados sugerem que a intervenção dos clowns é uma boa intervenção não-farmacológica para reduzir o estresse psicológico e a FRC em pacientes pediátricos oncológicos sob quimioterapia

Metas de socialização e práticas educativas de mães de crianças com câncer: um estudo comparativo com mães de crianças sem diagnóstico de doença / Socialization goals and educational practices of mothers of children with cancer: a comparative study with mothers of children without diagnose of disease / Metas de socialización y las prácticas educativas de madres de niños con cáncer: un estudio comparativo con madres de niños sin diagnostico de enfermedad

Metas de socialização e práticas educativas constituem importantes temas na pesquisa recente em diferentes subáreas da Psicologia. Informam a respeito de aspectos relevantes da parentalidade e do desenvolvimento de crianças. O presente trabalho visou aprofundar o estudo sobre tais metas e práticas a partir de situações de vida particularmente difíceis, como uma doença crônica de filho(a). Comparou dados de mães cujos filhos estão em tratamento oncológico com os de mães de crianças saudáveis. Participaram deste estudo 20 mães de crianças de três a cinco anos que estavam em tratamento no Instituto Nacional de Câncer e 20 mães de crianças da mesma idade, saudáveis, todas residentes no Rio de Janeiro. Foram aplicados instrumentos de coleta de informação sociodemográfica e sobre metas de socialização, e realizada entrevista semiestruturada para investigar práticas educativas. Verificou-se que as metas de socialização das mães de crianças em tratamento oncológico apresentaram diferenças em relação às outras mães, no sentido de valorizarem mais características individualistas (bem-estar, desenvolvimento pessoal) do que sociocêntricas (bom comportamento, exercício de papéis sociais). Quanto às práticas educativas, identificou-se tendência das mães de crianças em tratamento oncológico a adotarem mais práticas coercitivas em situações ligadas ao tratamento e mais práticas indutivas em outras situações.

Parental socialization goals for their children and the practices adopted to achieve these goals constitute an important theme in recent research in Social Psychology. This study aims to further study on the impacts of complicated life situations on these goals and practices. It compares mothers whose children are undergoing cancer treatment with mothers of healthy children. The study accessed 20 mothers of children from three to five years that were undergoing cancer treatment at the National Cancer Institute and 20 mothers of children in the same age interval without disease diagnosis, all residents in the city of Rio de Janeiro. Instruments were applied to collect socio-demographic information and data about socialization goals and semi-structured interviews were conducted to investigate educational practices. It was found that the socialization goals of mothers of children undergoing cancer treatment are different from those of the other mothers in the sense of valuing more individualistic (welfare, personal development) than sociocentric treats (good behavior, exercise of social roles). As for the educational practices, it identified a tendency of mothers of children undergoing cancer treatment to adopt more coercive practices when facing the need of medical interventions and more inductive practices in other situations.

Metas de socialización de madres para sus hijos y prácticas adoptadas para lograr estas metas constituyen importante tema de investigación en Psicología Social. Este estudio objetiva investigar los impactos de situaciones de vida complicadas en estos objetivos y practicas. Compara madres de hijos en tratamiento del cáncer con madres de niños sanos. Incluye 20 madres de niños de tres a cinco años sometidos a tratamiento contra el cáncer en el Instituto Nacional del Cáncer y 20 madres de niños de la misma edad sin diagnóstico de enfermedad, todos residentes en Río de Janeiro. Cuestionarios se aplicaron para recopilar información sociodemográfica y datos sobre objetivos de socialización y entrevistas semi-estructuradas se llevaron a cabo para investigar las prácticas educativas. Se encontró que los objetivos de socialización de las madres de los niños sometidos a tratamiento contra el cáncer son diferentes de los de las otras madres en el sentido de valorar más características individualistas (bienestar, desarrollo personal) que sociocéntricas (buena conducta, ejercicio de roles sociales). En cuanto a las prácticas educativas, se identificó una tendencia de las madres de niños sometidos al tratamiento a adoptar prácticas más coercitivas cuando enfrentan necesidad de intervenciones médicas y prácticas más inductivas en otras situaciones.