Globe Salvage With Intra-Arterial Topotecan-Melphalan Chemotherapy in Children With a Single Eye.

INTRODUCTION: Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity. OBJECTIVE: The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City. METHODS: We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle. RESULTS: From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336). CONCLUSIONS: Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.

Burnout syndrome in first to sixth-year medical students at a private university in the north of Mexico: descriptive cross-sectional study.

INTRODUCTION: Burnout syndrome is a three-dimensional clinical syndrome caused by stress at work. It is frequent in professions which require direct contact with people. In Mexico, the presence of Burnout Syndrome in doctors and medical students, is characterized as a threat to their health, quality of life and professional performance. OBJECTIVES: To evaluate the prevalence of burnout syndrome in students of years 1 through 6 of medical school at a private university in northern Mexico. METHODS: Cross-sectional study in the Escuela de Medicina Campus Laguna de la Universidad Autónoma de Durango. The one-dimensional scale of Burnout Student (EUBE) and the Maslach Burnout Inventory (MBI) were applied to the participants. SPSS 19 was used to analyze the data. RESULTS: Of the 344 students, 255 participated; 153 from years 1 to 3 (group 1); and 72 from years 4 to 6 (group 2). We found that 94.1% of the students of group 1 had mild burnout syndrome, and 2.8% had moderate burnout syndrome. In Group 2, 27.8% had moderate burnout syndrome, and 8.3% had severe burnout syndrome. The prevalence of severe burnout syndrome was higher in group 2 than in group 1 (p=0.02). CONCLUSIONS: Burnout syndrome affects medical students across all stages of their studies, and develops in a progressive way. In our study, external factors have no influence on the development of burnout syndrome.

INTRODUCCIÓN: El síndrome de burnout es un síndrome clínico tridimensional, causado por estrés laboral. Es frecuente en profesiones que exigen contacto directo con las personas. En México, la presencia del síndrome de burnout en médicos y estudiantes de medicina, se está caracterizando como una amenaza para la salud, calidad de vida y rendimiento de estos profesionales. OBJETIVO: Conocer la prevalencia de síndrome de burnout en estudiantes de primero a sexto año de medicina en una universidad privada del norte de México. MÉTODOS: Estudio transversal realizado en la Escuela de Medicina, Campus Laguna de la Universidad Autónoma de Durango. A los participantes se les aplicaron los instrumentos de medición Escala Unidimensional de Burnout Estudiantil (EUBE) y Maslach Burnout Inventory (MBI). Para el análisis de los datos se usó SPSS 19. RESULTADOS: De los 344 alumnos participaron 225, 153 de primero a tercer año (grupo 1) y 72 de cuarto a sexto año (grupo 2). El 94,1% de los alumnos del grupo 1 tuvo síndrome de burnout leve y 2,8% tuvo síndrome de burnout moderado; en el grupo 2 el síndrome de burnout moderado se presentó en 27,8% y profundo 8,3%, siendo más elevado en el grupo 2 que en el grupo 1 (p=0,02). CONCLUSIONES: El síndrome de burnout afecta a estudiantes de medicina de todos los niveles, se desarrolla en forma progresiva y, en nuestro estudio, los factores externos no influyeron.

[Use of alternative and complementary medicine in pediatric cancer: investigation of 100 cases at a level III care institute]. / Uso de la medicina alternativa y complementaria (MAC) en cáncer infantil: encuesta de 100 casos en un instituto del tercer nivel de atención.

INTRODUCTION: Alternative medicine is well accepted and widely used in Mexico so we researched the frequency and reasons for the use of alternative or complementary treatment (ACT) in pediatric oncologic patients at the Instituto Nacional de Pediatría (INP). METHODS: One hundred questionnaires were applied to caregivers of children with cancer in a course of 100 hundred consecutive patients. RESULTS: Fifty-one percent of caregivers interviewed accepted the use of some kind of ACT; biological therapies were the most frequent treatments used, and 73% felt satisfied with the results. Caregivers told their physicians they were using ACT in 35% of the questionnaires analyzed, and only 2% of the physicians asked directly about its use. None of the caregivers substituted or stopped allopathic treatment. ANALYSIS: These questionnaires reveal that more than a half of the caregivers use ACT. We believe superstitious and cultural beliefs, as well as the desire of the caregivers to participate actively in their patient's treatment, are the main reasons for the use of ACT; nevertheless, some caregivers do not notify their physicians and this may affect chemotherapy treatment in ways not investigated yet. CONCLUSIONS: The wide use of ACT in Mexico obliges every physician to enquire into it intentionally. It is therefore necessary to establish a stratification risk according to the combination of ACT and allopathic treatment used.

[The use of alternative or complementary treatment in pediatric oncologic patients: Survey of 100 cases in a level III attention institute]. / Uso de la medicina alternativa y complementaria (MAC) en el cáncer infantil: encuesta de 100 casos en un instituto de tercer nivel de atención.

INTRODUCTION: Alternative medicine is well accepted and widely used in Mexico, so we researched the frequency and causes of the use of alternative or complementary treatment (ACT) in pediatric oncologic patients at the Instituto Nacional de Pediatría (INP). METHODS: One hundred questionnaires were applied to caregivers of children with cancer in a course of 100 hundred consecutive patients. RESULTS: Fifty-one percent of caregivers interviewed accepted the use of some kind of ACT; biologic therapies were the most frequent treatments used, and 73% felt satisfied with the results. Caregivers told their physicians they were using ACT in 35% of the questionnaires analyzed, and only 2% of the physicians asked directly about its use. None of the caregivers substituted or stopped allopathic treatment. ANALYSIS: These questionnaires reveal that more than a half of the caregivers use ACT. We believe superstitious and cultural beliefs, as well as the desire of the caregivers to participate actively in their patient's treatment, are the main causes of the use of ACT; nevertheless, some do not notify their physicians and this may affect chemotherapy treatment in ways not investigated yet. CONCLUSIONS: The wide use of ACT in Mexico obliges every physician to enquire into it intentionally; it is therefore necessary to establish a stratification risk according to the combination of ACT and allopathic treatment used.

Treating retinoblastoma in the first year of life in a national tertiary paediatric hospital in Mexico.

AIM: Retinoblastoma is the most common primary ocular malignancy in childhood, but little has been documented on the clinical and biological differences in children diagnosed before one year of age. We observed patients in this age group and followed them for up to 19 years. METHODS: This retrospective, descriptive, observational study reviewed the medical records of Mexican patients, who were diagnosed with retinoblastoma before one year of age at a national paediatric hospital from 1995 to 2014. The variables analysed were age at diagnosis, weight, presenting signs, the time from first symptoms to diagnosis, family history, laterality, ocular rescue and survival rate. RESULTS: The 108 patients had a mean age of 7.65 months and 15.7% had a family history of retinoblastoma. The majority (55.5%) had bilateral retinoblastoma, the most common presenting sign was leukocoria (86.1%), and the most common stage of diagnosis was Group V (84.1%). More than half were underweight for their age. The overall survival rate was 92% and the disease-free survival rate was 84%. CONCLUSION: Retinoblastoma is a malignancy that can be present at birth, especially if it is a bilateral hereditary form of the disease. Leukocoria was the main presenting sign. Early diagnosis dramatically improved the prognosis for ocular rescue.