Consenso chileno de manejo de fármacos antiepilépticos en algunos síndromes electro-clínicos y otras epilepsias en niños y adolescentes / Chilean consensus on the use of antiepileptic drugs in electro-clinical syndromes

Por iniciativa de tres instituciones: Liga Chilena contra la Epilepsia (LICHE), Sociedad de Epileptología de Chile (SOCEPCHI) y Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA) de Chile, se constituye un comité de trabajo que convoca a un consenso de uso de fármacos antiepilépticos (FAEs) en un grupo de 16 Síndromes electro-clínicos y otras Epilepsias en niños y adolescentes. Cuarenta y dos médicos neuropediatras especialistas en Epilepsias de todas las regiones de Chile, participaron en la discusión y realizaron una propuesta de tratamiento farmacológico para cada cuadro. El comité de trabajo realizó un análisis exhaustivo y discusión de los documentos, para finalmente concluir en una recomendación de tratamiento para cada cuadro. Este consenso es una guía práctica de orientación para ayudar a las decisiones de tratamiento en situaciones clínicas concretas. Su objetivo final es ofrecer una mejor calidad de atención a los niños y adolescentes con epilepsias, a través de decisiones fundadas que contribuyan a disminuir la variabilidad de las decisiones terapéuticas.

Committed by three institutions: Liga Chilena contra la Epilepsia (LICHE), Sociedad de Epileptología de Chile (SOCEPCHI) y Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA) de Chile, a 6-member working committee called for a meeting of 42 Chilean pediatric epileptologists from all over the country, with the aim of reaching a consensus on the use of antiepileptic drugs in 16 selected children and adolescents electro-clinical syndromes and epilepsies. These treatment proposals were analyzed and fully discussed by the working committee, ending in an antiepileptic drug treatment recommendation guideline for each condition. This consensus is a practical guideline to be used in specific clinical situations, which aims to support treatment decision making. Its main purpose is to offer the best evidence based treatments to our children and adolescents patients with epilepsy, thus contributing to diminish variability in therapeutic decisions.

Larvicide and oviposition deterrent effects of fruit and leaf extracts from Melia azedarach L. on Aedes aegypti (L.) (Diptera: Culicidae).

Aedes aegypti (L.) (Diptera: Culicidae), the main urban vector of dengue, has developed resistance to various insecticides, making its control increasingly difficult. We explored the effects of Argentine Melia azedarach L. (Meliaceae) fruit and senescent leaf extracts on Ae. aegypti larval development and survival, by rearing cohorts of first instar mosquitoes in water with different extract concentrations. We also analysed oviposition deterrent activity in choice tests with extract-treated ovitraps. The leaf extract showed a strong larvicide activity, with all larvae dying before pupation, and significantly delayed development time. It strongly inhibited oviposition by Ae. aegypti females. The fruit extract showed much weaker effects. This first report of highly effective larvicidal, growth regulating and oviposition deterrent activity of a senescent leaf extract of M. azedarach against Ae. aegypti, suggests that such extract could represent a promising tool in the management of this mosquito pest.

Is autologous bone marrow transplant (ABMT) and high-dose chemotherapy an approach that can rescue some children with advanced cancer disease?

The object was to determine the role ABMT in children with advanced cancer Those included had failed to respond to conventional treatment with 4 different ablative chemotherapy regimens. Bone marrow stem cells were identified with CD34. Cellular viability was determined after the bone marrow extraction and before the infusion. Fifteen patients were included, whose ages ranged from 1 to 13 years old with a median of 7. Six had acute leukemia, 6 with primitive neuroectodermic tumors, and 3 with other tumors. The median disease-free survival for the whole group was of 2 months, range of 1 to 29 months and SD of 10.1. A total of 6 children are alive (40%) and without evidence of tumor activity from 1 to 29 months. The disease-free survival rate for these group was of 19.1 months, with an SD of 7.9 months.

Four species of digeneans, including Allocreadium patagonicum sp. n. (Allocreadiidae), from freshwater fishes of Patagonia, Argentina.

Four species of adult digeneans are reported from freshwater fishes of two lakes in Neuquén, Patagonia, Argentina. Allocreadium patagonicum sp. n. (Allocreadiidae) is described from the intestine of Percichthys colhuapiensis MacDonagh and Percichthys trucha (Cuvier et Valenciennes) (Percichthyidae) from Lago Aluminé. Three species redescribed are: Acanthostomoides apophalliformis Szidat, 1956 (Acanthostomidae) from the intestine of P. colhuapiensis and P. trucha from Lago Aluminé and of Salmo trutta (Linnaeus) (Salmonidae) from Lago Huechulafquén; Deropegus patagonicus (Szidat, 1956) comb. n. (= Genarches patagonicus Szidat, 1956) (Derogenidae) from the stomach of P. colhuapiensis, P. trucha, Oncorhynchus mykiss (Walbaum) (Salmonidae) and Salvelinus fontinalis (Mitchill) (Salmonidae) from Lago Aluminé and of S. trutta from Lago Huechulafquén; and Austrocreadium papilliferum Szidat, 1956 from the intestine of P. trucha from Lago Aluminé. The genus Polylekithum Arnold, 1934 is considered a synonym of the genus Allocreadium Looss, 1900. The genus Austrocreadium Szidat, 1956 is removed to the family Homalometridae.

B-lineage acute lymphoblastic leukemia of childhood. An institutional experience.

A total of 119 children (1990-95) with acute lymphoblastic leukemia (ALL) B-lineage either CD10+ or CD10- were registered into a single non-randomized chemotherapy protocol. Only untreated patients with standard risk were included in the study. Their ages ranged from 1.8-10 years with a mean of 5.1 years. There were 82 (68%) children with early pre B-All, 35 (29%) with pre B-ALL and 2(1.6%) with transitional pre B-ALL (p < 0.00001). The patients were divided according to CD10 reactivity, either + (94 children) or -(25 patients). The event-free survival (EFS) at 60 months for the CD10+ children was of 78% (alive 73/94), while for the CD10- was 71% (alive 18/25) (p = 0.6) and 74% for both groups. The factors that influenced favorably the survival in the CD10+ group were the age between 3 to 5.99 years (p < 0.00001), sex (either male or female), leukocyte count between 10-24.9 x 10(9)/l (p < 0.00001), LDH under 300 U/I (p < 0.00001) and L1 bone marrow cytomorphology (p < 0.00001). In the CD10- patients, the EFS was favorably influenced by the female sex (p = 0.04), leukocyte count under 10 x 10(9)/l (p = 0.05) and LDH < 300 U/l (p = 0.02). CNS infiltration was documented in 4.2% (5/119). Mortality secondary to chemotherapy was seen in 7%. In conclusion, this is the first large series in Mexican children with B-lineage ALL published. Because of the relatively small number of patients in each group (pre B and transitional pre B), all the patients in the current series were treated alike. When the 119 patients were divided only on the basis of CD10 reactivity, the EFS for both groups (CD10+ and-) was similar; therefore, the reactivity to CD10 has no prognostic value in this type of ALL.

[Lymphoblastic lymphoma in children. Poor response in advanced disease with chemotherapy for non-Hodgkin's lymphoma]. / Linfoma linfoblástico en niños. Respuesta pobre en enfermedad avanzada con quimioterapia de linfoma no Hodgkin.

Fifty three pediatric patients with the histopathological diagnosis of lymphoblastic lymphoma (LL) were studied in a retrospective analysis during a 14 year period. Their age ranged from 1 to 16 years with a median of 7 years. Clinical staging was performed according to Murphy's system. There was one child in stage I (2%), 11 in stage II (21%), 14 stage III (26%) and 27 stage IV (51%). Patients in stage IV, 21 (78%) had initial bone marrow involvement, 4 (15%) central nervous system (CNS) infiltration and 2 (7%) simultaneous infiltration to the bone marrow and the CNS. The chemotherapy program consisted of induction, consolidation and maintenance with CNS prophylaxis. The whole program lasted 36 months. Out of 53 patients there were only 45 evaluable for treatment analysis response. A total of 14 (31%) are alive and in a continuous complete remission, with a median duration of remission of 66 months, 8 (18%) children abandoned treatment with a median duration of remission of 10 months. Twenty three patients (51%) are dead. The actuarial survival at 11 year is of 39% +/- 11% with a median remission rate for the whole group of 11.8 months. No patient in complete remission for more than 24 months has relapsed. We conclude that our chemotherapy program is more than adequate for early stages, but for advanced disease it has been a failure. There is a need to modify the chemotherapy program using a very similar protocol as the one used in high risk childhood acute lymphoblastic leukemia.

Leiomiosarcoma hepático como segunda neoplasia: informe sobre un niño con leucemia aguda linfoblástica y tumor hepático / Hepatic leiomyosarcoma as a second malignancy: report in a child with acute lymphoblastic leukemia and hepatic mass

Los pacientes pediátricos con leucemia aguda linfoblástica (LAL) presentan alto índice de curación, pero con mayor incidencia de segundas neoplasias condicionadas por la radioterapia, por la quimioterapia con agentes alquilantes o las epipodofilotoxinas. Se presenta un paciente con LAL en el Instituto Nacional de Pediatría, quien durante el tratamiento de LAL sin presentar alteración citogénica demostrable, desarrolla un leiomiosarcoma hepático de focos primarios múltiples, no existieron antecedentes de uso de manera importante de agentes alquilantes, epipodofilotoxinas ni radiaciones ionizantes. Consideramos la posibilidad de una susceptibilidad genética, que no podemos demostrar actualmente, como condicionante para el desarrollo de esta segunda neoplasia con patrón de presentación clínica poco usual

Male influences on cervical cancer risk.

Risk factors for squamous cell carcinoma of the uterine cervix were studied among low income, married Hispanic women and their husbands, using a case-control design. A total of 45 eligible cases were identified at public hospitals and community clinics in the San Francisco Bay Area. For each case, a control was selected within two years of age from among Hispanic women seen at the same institution. Thirty-nine matched pairs of couples were interviewed to assess histories of sexual behavior and other possible risk factors. Cases and controls differed markedly in the number of past sexual partners of their husbands. Cases were 5.3 times more likely to be married to husbands who had had 20 or more sexual partners than were controls. Cases and controls themselves did not differ in their number of sexual partners, but cases were younger at first intercourse than were controls. The association with husband's sexual history persisted after adjusting for the woman's number of sexual partners or age at first intercourse. These results support the infectious and venereal transmission of cervical cancer and indicate the important role of husbands in its occurrence in a population with high incidence rates.