Nutritional status at diagnosis of cancer in children and adolescents in Guatemala and its relationship to socioeconomic disadvantage: A retrospective cohort study.

BACKGROUND: At least 80% of children with cancer live in low- and middle-income countries where the prevalence of malnutrition and socioeconomic disadvantage is high. We examined the relationship between nutritional status (NS), assessed by arm anthropometry, and socioeconomic status (SES) in children diagnosed with cancer at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala over a three-year period. METHOD: Patients aged 0 to 18 years of age diagnosed between January 2015 and December 2017 were included. NS was evaluated by mid-upper arm circumference, triceps skin fold thickness, and serum albumin level, and subjects were classified as adequately nourished, moderately depleted, and severely depleted nutritionally. SES was measured by a 15-item instrument developed at UNOP. RESULTS: Of 1365 patients diagnosed in the study period, 1060 (78%) fulfilled the eligibility criteria. Only 6% of patients were classified as medium to high, the remainder as medium-low to extremely low SES. Almost 47% were severely depleted at diagnosis, 19% moderately depleted, and 34% adequately nourished. SES was shown to be a determinant of NS; with progressively lower SES, the probability of a decline in NS increased by a factor of 1.04 points (P < 0.0001). Leukemia and lymphoma were also important predictors of nutritional depletion with odds ratios of 6.08 (95% CI, 1.74-28.28; P = 0.008) for leukemias and 4.83 (95% CI, 1.33-23.03; P = 0.03) for lymphomas. CONCLUSION: Both low SES and a diagnosis of leukemia or lymphoma are strong predictors of poor NS at diagnosis in children with cancer in Guatemala.

Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala.

BACKGROUND: Most children with cancer live in developing countries where the prevalence of malnutrition may reach 50% and influence the course of the disease. This study examined the prevalence and severity of malnutrition at diagnosis, as well as after 3 and 6 months of chemotherapy, in children with acute lymphoblastic leukemia (ALL) in Guatemala. METHODS: Triceps skin fold thickness (TSFT) and mid upper arm circumference (MUAC) provided measures of nutritional status (NS) in three categories: adequately nourished (A): TSFT and MUAC > 10th percentile; severely depleted (SD): TSFT or MUAC < 5th percentile; and moderately depleted (MD): all the remaining patients. RESULTS: Of 331 new patients, 241 had NS assessed at diagnosis. A = 113 (46.9%); MD = 28 (11.6%); SD = 100 (41.5%). At 3 months A = 106 (52.2%); MD = 25 (12.3%); SD = 72 (35.5%). At 6 months A = 146 (76.0%); MD = 12 (6.3%); SD = 34 (17.7%). In multivariate analysis, SD children at 6 months of treatment had a hazard of death that was 2.4-fold the hazard of those A or MD (95% CI: 1.3-4.7) CONCLUSIONS: Malnutrition is prevalent in newly diagnosed children with ALL in Guatemala and severe nutritional depletion is apparently predictive of abandonment of therapy and relapse of disease, but if children survive and improve their NS in the first 6 months after diagnosis, their chances of survival may improve significantly to approximate those in children not presenting with nutritional depletion.

Pioderma gangrenoso: reporte de caso / Pyoderma gangrenosum: case report

El pioderma gangrenoso es una enfermedad inflamatoria crónica, poco común, con una incidencia de 3 a 10 casos por millón de habitantes, su etiología aún se desconoce pero se ha asociado con múltiples condiciones sistémicas dentro de las que sobresale la enfermedad inflamatoria intestinal. Hasta el momento se conocen cuatro variantes clínicas y la más común de todas es la forma ulcerativa. El diagnóstico es principalmente clínico y de descarte. En la histología se caracteriza por un infiltrado neutrofílico de la dermis. El tratamiento de elección son los glucocorticoides orales, aunque hay otras opciones terapéuticas descritas. Reportamos un caso representativo de un pioderma gangrenoso ulcerativo asociado con enfermedad inflamatoria intestinal.

Pyoderma gangrenosum is a chronic inflammatory disease, uncommon, with an incidence of 3 to 10 cases per million inhabitants, whose etiology remains unknown but has been associated with multiple systemic conditions in which stands out inflammatory bowel disease. So far, four clinical variants are known to be the most common ulcerative form of all. The diagnosis is mainly clinical and of discard. In histology its characterized by a neutrophilic infiltrate in the dermis. The treatment of choice is oral corticosteroids, although there are many other therapeutic options described. we report a representative case of an ulcerative pyoderma gangrenosum associated with inflammatory bowel disease

Nutritional status at diagnosis is related to clinical outcomes in children and adolescents with cancer: a perspective from Central America.

BACKGROUND: The prevalence of malnutrition in children may exceed 50% in countries with limited resources. The aims of this study were to assess nutritional status at diagnosis in children and adolescents with cancer, and to correlate it with clinical outcomes in the Spanish speaking countries of Central America that formed the AHOPCA (Asociacion de Hemato-Oncologia Pediatrica de Centro America) consortium. METHODS: Patients aged 1-18 years, diagnosed with cancer between 1st October 2004 and 30th September 2007, were eligible for study. Weight (kg) and height or length (m), mid upper arm circumference--MUAC and triceps skin fold thickness--TSFT were measured and their Z-scores or percentiles were calculated. Three categories of nutritional status were defined according to these parameters. RESULTS: A total of 2954 new patients were enrolled; 1787 had all anthropometric measurements performed and 1513 also had measurements of serum albumin. By arm anthropometry 322/1787 patients (18%) had moderate nutritional depletion and 813/1787 patients (45%) were severely depleted. Adding serum albumin, the proportion classified as severely depleted rose to 59%. Malnourished children more often abandoned therapy and their event free survival was inferior to that of other children. CONCLUSIONS: Arm anthropometry in children with cancer is a sensitive measure of nutritional status. Since malnutrition at diagnosis was related to important clinical outcomes, an opportunity exists to devise simple, cost-effective nutritional interventions in such children that may enhance their prospects for survival.

Linfoma de células T del adulto por HTLV1 con compromiso cutáneo / Adult T-cell lymphoma associated with HTLV-1 infection with cutaneous lesions

La leucemia/linfoma de células T del adulto es una alteración maligna linfoproliferativa causada por HTLV-1, con múltiples manifestaciones sistémicas y cutáneas, incluyendo placas, nódulos, lesiones ulceradas y eritrodermia. Presentamos el caso de una mujer con linfoma de células T por HTLV-1 con compromiso cutáneo confirmado por histología e inmunohistoquímica.

Carcinoma basocelular congénito y múltiple / Congenital and multiple basal cell carcinoma

El carcinoma basocelular es la neoplasia más frecuente en los adultos, pero es rara en los pacientes menores de 15 años. Reportamos el caso de una paciente con carcinoma basocelular congénito y múltiple, sin otras manifestaciones asociadas.