Auswahl der wissenschaftlichen Literatur zum Thema „Pediatric oncological diseases“

Visceral leishmaniasis is a generalized infection of the reticuloendothelial system, it is fatal if left untreated in most cases. Early diagnosis and effective therapy can reduce the risk of disability and mortality. However, in non-endemic areas diagnosis may be delayed or missed. In the article we presented a case report of a child with imported visceral leishmaniasis. The gradual onset of the disease with irregular fever, growing weakness, fatigue, loss of appetite, anemia, cytopenic syndrome required differential diagnosis with oncological diseases. The diagnosis of leishmaniasis was made by microscopy of a bone marrow smear and the detection of leishmania. Recovery occurred after the prolonged course of amphotericin B and supportive treatment.

Abstract Introduction Guatemala reported the first confirmed SARS-CoV-2 case on March 13th 2020. Up to now, more than 140,000 confirmed cases have been documented, with 8% of them being <20 years-old. The impact of COVID-19 in pediatric cancer in not well known, even though pediatric oncological institutions did some initial recommendations, this new disease still represents a challenge in this population. The objective of the report is to describe the moderate-severe cases of COVID-19 in pediatric cancer during the first 8 months of the pandemic in the Unidad Nacional de Oncologia Pediatrica (UNOP). Methods This is a descriptive, prospective report of pediatric cancer patients <20 years-old and SARS-CoV-2 infection confirmed by nasopharyngeal swab with PCR technique at UNOP from May to December 2020. The SARS-CoV-2 test was performed to all patients who developed symptoms of infection or as screening in patients who were admitted to UNOP regardless of symptoms. Information about sex, age, primary oncological diagnosis, confirmed coinfections and treatment received at time of COVID-19 was collected. Moderate illness was considered if the patient required supplemental oxygen and severe illness if admitted to Intensive Care Unit -ICU- secondary to COVID-19. Results Two hundred one patients with pediatric cancer with the SARS-CoV-2 infection were confirmed. Sixty four percent were male (n=128), median of age was 9.5 years (5-m to 18-y). The primary oncologic diagnosis was leukemia 65% (n=129), and other solid tumors 35% (n=72), 5% (n=10) of patients were in palliative care. In leukemia patients, 40% were receiving induction therapy (n=51), 25% consolidation (n=32), and 19% maintenance (n=25). The most common initial symptom was fever in 32% (n=64) and 33% were asymptomatic (n=67). Twenty two percent developed moderate disease (n=44) and 13% severe disease (n=26). A total of 13 patients died during COVID-19 period (6%) and 7 of them died receiving active treatment (3%). The risk of developing moderate-severe disease was not higher in leukemia patients compared to patients with other tumors who were receiving intense chemotherapy (OR=0.7), but there might be a higher risk of death (OR=1.41). In patients with leukemia, the risk of developing moderate-severe disease was higher for patients receiving induction therapy compared with those in consolidation (OR=6.7) or maintenance (OR=3.04). Mortality risk seems to be higher in patients with leukemia during induction therapy (OR=1.94). Confirmed coinfections correlated with higher risk of severe illness (OR=1.95) and death during the COVID-19 period (OR=5.2). Conclusions The mortality due to COVID-19 in pediatric cancer is low and could be related to coinfections or intensive chemotherapy. Important limitation of our report is the lack of analysis of underlying clinical conditions in moderate-severe disease (neutropenia or other comorbidities), factors that could have an impact on our data analysis.

Background. Planning the management for medical care delivery for children with cancer, as well as analysis of the effectiveness of medical care delivery is based on the statistical indicators analysis.Objective. Our aim was to analyze the main indicators characterizing medical care delivery for children with cancer in the Central Federal District.Methods. The operative reports for 2017 provided by the executive health protection authorities of 18 subjects of the Russian Federation that are part of the Central Federal District have been analyzed.Results. The study enrolled the following data: number of children was 6 824 049 (0–17 years), pediatric oncological departments — 9, pediatric oncological beds — 464, days of berth employment per year — 319.3. The number of practitioners providing medical care to children with cancer was 91, 64 (70.3%) of them had a certificate of training as a pediatric oncologist. In 11 subjects, the department of pediatric oncology was not available; one of the districts did not provide any pediatric oncological beds. The number of primary patients with malignant neoplasms was 821. The number of deceased patients was 156 including 66 identified in 2017. The incidence of malignant tumors was 12 (per 100 000 for the 0–17 age group), the mortality rate was 2.3 (per 100 thousand for the age group 0–17 years), one-year mortality rate — 8%. We failed to reveal the average time from diagnosis establishing till its validation before the treatment onset since the reports did not provide precise information on the point. 12 (1.5%) primary patients left for treatment abroad.Conclusion. Most reports included indicators which lack congruity with one another. The incidence rates were significantly lower than those in countries with high statistical reliability. The percentage of patients identified actively remained extremely low. To improve the revealed defects a single database of children with oncological diseases should be implemented in the Russian Federation.

The continuous evolution of new technologies in the field of molecular diagnostics and genome analysis, the development of new approaches in pharmacogenetics and the emergence of a range of different targeted drugs have expanded the possibilities of clinical practice, resulting in personalized approaches to treatment. The diagnosis and therapy of pediatric oncological diseases are some of the vivid examples of the successful application of a personalized approach in clinical practice. Today, many pediatric neoplastic diseases are successfully treated with targeted drugs, which significantly increases patient survival. Targeted therapy allows to choose a specific drug for each patient, thereby increasing the effectiveness of treatment, reducing the risk of side effects, and also reducing the likelihood of a relapse of the disease.

AbstractThe field of interventional radiology has become an integral contributor in the multidisciplinary oncological treatment of numerous solid tumors in the adult population, especially hepatic malignancies. With continued growth and sophistication in the field of pediatric interventional radiology, interventional oncology (IO) principles and techniques are increasingly applied to children. While primary pediatric hepatic malignancies are less frequent than in the adult population, application of these IO principles and modalities in adults is becoming more commonplace. This article reviews the increasing application of these IO principles and modalities for the treatment of primary pediatric hepatic malignancy, as well as their role in the multidisciplinary care of children afflicted with these diseases.

Death in cancer patients can be caused by the progression of tumors, their malignity, or other associated conditions such as sepsis, which is a multiphasic host response to a pathogen that can be significantly amplified by endogenous factors. Its incidence is continuously rising, which reflects the increasing number of sick patients at a higher risk of infection, especially those that are elderly, pediatric, or immunosuppressed. Sepsis appears to be directly associated with oncological treatment and fatal septic shock. Patients with a cancer diagnosis face a much higher risk of infections after being immunosuppressed by chemotherapy, radiotherapy, or anti-inflammatory therapy, especially caused by non-pathogenic, Gram-negative, and multidrug-resistant pathogens. There is a notorious difference between the incidence and mortality rates related to sepsis in pediatric oncologic patients between developed and developing countries: they are much higher in developing countries, where investment for diagnosis and treatment resources, infrastructure, medical specialists, cancer-related control programs, and post-therapeutic care is insufficient. This situation not only limits but also reduces the life expectancy of treated pediatric oncologic patients, and demands higher costs from the healthcare systems. Therefore, efforts must aim to limit the progression of sepsis conditions, applying the most recommended therapeutic regimens as soon as the initial risk factors are clinically evident—or even before they are, as when taking advantage of machine learning prediction systems to analyze data.

Actuality. Over the past decades, there has been a steady increase in the number of oncological diseases in children, most of which are detected at common stages. Moreover, only 5.2% of patients are actively detected (during routine preventive examinations).Material and methods. In order to detect oncological diseases in children in the early stages, an “Algorithm for determining the feasibility of referring a patient for consultation with a pediatric oncologist” (hereinafter referred to as the Algorithm) has been developed, which is a questionnaire of 20 questions. Answering with unambiguous answers (yes / no), a local pediatrician may decide on further tactics of examination and treatment of the patient. In order to analyze the results of the implementation of the Algorithm, a “Questionnaire for a local pediatrician to evaluate the effectiveness of the implementation of the Algorithm for determining the feasibility of referring a patient for a consultation with a pediatric oncologist” has been developed, which consisted of 10 questions.Results. 427 district pediatricians took part in the medical and social study, taking into account stratification by federal districts of the Russian Federation: from the Central Federal District – 101 (23.6%) respondents, from the North-West Federal District – 40 (9.2%), from the Southern Federal District – 47 (10.9%), from the North Caucasus Federal District – 32 (7.7%), from the Volga Federal District – 92 (21.4%), from the Ural Federal District – 32 (7.7%), from the Siberian Federal District – 55 (12.9%) ), from the Far Eastern Federal District – 28 (6.6%). After the implementation of the Algorithm in clinical practice, the number of patients referred for consultation with a pediatric oncologist increased, which was noted by 61.9±2.4% of respondents. In this case, the Algorithm is used by 11.3±1.5% of the respondents, sometimes used by 12.6±1.6%, used if they are suspected of having an oncological disease by 21.9±2.0%. Among those who do not apply the Algorithm in clinical practice, 78.1±2.0% indicated that they had not received it before.Conclusion. A survey showed the feasibility of introducing into clinical practice the “Algorithm for determining the feasibility of referring a patient for consultation with a pediatric oncologist”.

The work was carried out within the State Program (1 year of activity-2020); „Modern personalized surgery in the diagnosis and complex treatment of tumors in children” N. 20.80009.8007.06. Analyzing the statistical data during the first year of activity of the project were registered 777 children with tumors, of which 279 (35.2%) primary and 498 (64.8%) – secondary. Of the 777 children, 455 (58.5%) had benign tumors and 97 (12.4%) had malignancies, 231 (29.7%) patients underwent surgical treatment, 455 (58.5%) chemotherapeutic treatment, 13 (1.9%) radiotherapy. Since March 2020, we have been active under the SARS-CoV-2 pandemic. We have developed a special proce- dure for the prevention of coronavirus infection. The COVID-19 pandemic is a new situation, unprecedented for the whole world, with many unknowns, including for the field of Pediatric Oncology and Dental Surgery. First of all, we highlight the adult or child oncological ill patient – as an emergency patient, therefore, the child with the malignant tumor must be treated urgently. Therefore, the treatment of oncological ill patients was conditionaly devided into 3 groups. Group I – primary patients with a diagnosis of malignant tumor, histologically confirmed, who must undergo treat- ment. Postponing this treatment is more dangerous than coronavirus. The treatment should be conducted under pandemic conditions: at distance, using disinfectants, masks, visiting relatives prohibition. Group II – pediatric patients, who at the beginning of the pandemic were at the treatment stage (chemo- or radiother- apy). If the concrete situation allows, the treatment continues. Hormone injection therapy can be performed at home by the specialized team (doctor and nurse). Group III – consisting of children – patients, who have undergone treatment and currently have no signs of disease, but require monitoring. These patients must be in quarantine. Oncological ill patients are considered to have compromised immunity. In adolescent and children, immunity is rela- tively good if there are no serious diseases such as systemic diseases. The tactics must be personalized, strictly individual. During 2020 we performed 3 types of surgical interventions in pediatric oncology: typical surgeries, enlarged surger- ies, combined surgeries.

Abstract Introduction Rapid access to neurosurgical decisions and definitive management are vital for the outcome of neurocritical patients. There are increased challenges of providing services and to maintain critical infrastructure for rural citizens. The relationship between rurality, marginalization and health outcomes has been identified as associated with higher mortality rates and higher rates of many diseases[G1]. Methods Employing linked administrative databases, we retrospectively analyzed a population based cohort of patients diagnosed with a pediatric brain tumour between 1996 to 2017 in Ontario, Canada. The Ontario Marginalization Index was employed as a surrogate for rurality providing an overall Rurality Index for Ontario (RIO) in addition to the 2016 Ontario Marginalization Index (ON-MARG). Results Of 1457 patients included, 54.0% were male, 277 of whom were diagnosed in infancy (i.e., < 3 years of age). Income quintile was evenly distributed with 11.5% classified as living in a rural area of Ontario. The median[G2] distance to the nearest pediatric neurosurgical hospital was 59.6km. The rurality index score (RIO) was 0 in 38.8% of children with the majority of patients with a RIO score of <39. The ON-MARG identified 51.9% of patients living in communities with low concentration of individuals without income from employment. A higher RIO score was not a significant factor (Continuous p=0.092/Ordinal p=0.20) associated with length[G3] of follow up, indicating rurality was not a significant factor for determining compliance to[G4] clinical follow-up. However, a trend towards reduced follow-up compliance in the higher RIO score cohort was identified. Conclusion Rurality and social determinants of health of the region pediatric neuro-oncological patients reside were not associated with patient outcome but a trend towards lower follow-up compliance was identified when children were from regions with RIO>39. Implementation of telehealth follow-up for these patients may overcome barrier to clinical follow-up.[G5]

Background and context: More than 4000 cases of pediatric cancer are registered in the Russian Federation annually. A well-functioning system of the centers and departments of pediatric, hematology and oncology required to obtain good treatment results. Features of the Russian Federation require close collaboration between Dmitry Rogachev Center, NSPHO and regional medical institutions. Aim: Development and implementation of the system of direct collaboration between Dmitry Rogachev Center, NSPHO and regional medical institutions for improvement of diagnostics, treatment and rehabilitation of children with hematologic and oncological diseases on the all territory of the Russian Federation. Strategy/Tactics: Dmitry Rogachev Center was set by the Ministry of Health of the Russian Federation as the National Center in charge of pediatric hematology and oncology. Thus, the collaborative initiatives between Dmitry Roigachev Center, NSPHO and regional medical institution were prioritized. Key points of the regional strategy are 24/7 telemedicine support for regional institutions, forming of database of centers and specialists based on NSPHO catalogue of institutions, usage of unique clinical guidelines and standards for all regions of Russia based on tandem agreements and continuous medical education and scientific work. Program/Policy process: To obtain above-mentioned goals, the following steps were made. Federal Center of Telecommunication for Children with hematologic and oncological diseases was founded. A special Web-based application was constructed for the forming of the database of the institutions (the base of this work is the 9 years experience of NSPHO in accumulating of data on centers and specialists on the Russian territory). More than 50 guidelines were prepared and approved for hematologic and oncological diseases treatment in children. Tandem agreements are signing now between Dmitry Rogachev Center, NSPHO and regional medical institutions. Different educational activities are available for specialists from all Russian regions (e.g., on-site seminars, online meetings, etc.). Outcomes: Regional network consists of 86 institutions in all Russian regions (about 3900 beds). During the test period of work of FCT in 2017 more than 5000 consultations were made. Estimated number for 2018 is 6000. All these institutions and specialists (1050) are included to the monthly updated database including the contact and other information. Approved guidelines updating periodically based on the results of multicenter studies. Nowadays more than 50 institutions signed the tandem agreements. These steps allowed to control all pediatric cancer cases in country. What was learned: Only scientific-based multicentre collaboration under the leadership of the National Center and strong national society with support of the government could lead to control of cancer cases and success in treatment. This experience could be used in other countries

OBJETIVOS El objetivo principal de la tesis es determinar la efectividad de la ventilación no invasiva (VNI) e identificar factores pronósticos de fracaso en una cohorte general pediátrica. Los objetivos secundarios de la tesis son: 1. Estudiar si las cohortes establecidas según la clasificación cronológica presentan diferencias fisiológicas significativas anteriores al inicio de la VNI 2. Determinar la efectividad y los factores pronósticos de fracaso de la VNI de las tres cohortes (inicial, rescate y electiva) por separado 3. Evaluar la seguridad de la técnica, analizando su morbilidad y mortalidad asociadas MATERIAL Y MÉTODOS Diseño del estudio: Estudio de cohortes prospectivo realizado en UCIP del Hospital Sant Joan de Déu mediante muestreo consecutivo desde Enero 2005 - Diciembre 2009. Criterios de inclusión: • Pacientes de ambos sexos entre los 0-18 años con criterios de insuficiencia respiratoria aguda grave (IRA). Criterios de exclusión: • Pacientes con contraindicación para el uso de la VNI o con indicación paliativa. Variables a estudiar: Los datos de los pacientes fueron recogidas. Tipo de interfase, ventilador, modos (CPAP, BLPAP)y parámetros usados; variables fisiológicas (previo, 2ª hora, 8, 12 y 24 horas); el cociente SpO2/FiO2 (SF), fue calculado retrospectivamente, eliminándose valores con SatHb superior a 97; Tiempo de uso de la VNI, duración de la estancia en UCIP y hospital. Las complicaciones y mortalidad atribuibles a la VNI. El fracaso de la VNI se define como la necesidad de intubación. RESULTADOS En el análisis descriptivo de los 491 episodios, las variables demográficas definen una población diana para el uso de la VNI: Edad media de 36 a 46 meses, con predominio sexo masculino, sin enfermedad de base, la causa más frecuente de IRA es la INFECCIÓN RESPIRATORIA. Las complicaciones han sido poco frecuentes (5,5%). No hubo mortalidad asociada al uso de la VNI. En la cohorte general según el grupo de edad, se diferencian significativamente, mayores y menores de seis meses. El análisis multivariable las variables independientes halladas son edad, modalidad (CPAP/BLPAP), el tipo de fallo respiratorio tipo II, el menor valor de SF y menor descenso de la FC a las dos horas. En el análisis de las cohortes generadas según la clasificación cronológica se observan diferencias significativas en las variables fisiológicas y las necesidades de oxígeno previas al inicio de la VNI. En el análisis multivariable de la cohorte inicial se observa : Modalidad CPAP, valores bajos de SF y altos de FC a las 2 horas, la edad mayor a 6 meses , así como los valores más bajos de IPAP a las 2 horas son factores independientes de fracaso CONCLUSIONES Conclusiones principales 1. La ventilación no invasiva es una técnica efectiva para prevenir la intubación en Pediatria 2. Los factores pronósticos de fracaso en la cohorte general son: • Recibir tratamiento con CPAP en lugar de BLPAP • Tener un fallo respiratorio tipo II, un valor de SF a las 2 horas y un descenso de la FC menor yun valor de FC a las 2 horas mayor Conclusiones secundarias 1. Las cohortes generadas por la clasificación cronológica presentan diferencias significativas en las variables fisiológicas previas 2. La efectividad en la cohorte general aumenta con la edad 3. La efectividad y factores pronósticos en las cohortes inicial, rescate y electiva fue superior en la cohorte-r (84%) respecto cohorte-i (71%) y cohorte-e (77%). En la VNI inicial, son factores pronósticos de fracaso: • El valor más bajo de cociente SF, y el valor más alto de FC a las 2 horas • Pertenecer al grupo CPAP 4. La técnica es segura, siendo su morbilidad baja y muy leve, y la mortalidad asociada nula.
Objectives The primary objective of our study was to confirm safety and effectiveness of non-invasive ventilation (NIV) in children with acute respiratory failure (ARF). Our secondary objective was identify predictive factors of failure for NIV in children after describing and analyzing separately the characteristics of first-line or initial NIV, rescue and elective post-extubation NIV. Methods Patients and setting A prospective cohort study was carried out from January 2005 to December 2009 in a tertiary hospital PICU admitting patients from birth to 18 years of age. Consecutive sampling was conducted on all admitted patients who presented ARF and received NIV. Exclusion criteria were presence of any contraindications to NIV and NIV used as a palliative measure. Ethics Committee of Hospital Sant Joan de Deu approval was obtained. Data collected The patient’s data and clinical variables of NIV support for each episode were documented; type interface, ventilator and ventilation mode used (CPAP, BLPAP); settings and physiological variables prior to starting NIV, at 2, 8, 12 and 24 hours of NIV treatment; therefore, the SpO2/FiO2 ratio (SF) was also calculated retrospectively using the some intervals; appearance of complications or contraindications; mortality; NIV duration; NIV outcome (success/failure) and PICU and hospital stay. Failure of NIV was defined as the need for intubation. Results Descriptive study During the study period our PICU admitted 2238 patients, needing respiratory support. Out of this group, 491 episodes of NIV were collected. This gives us a study sample of 282 initial NIV episodes, Patients who received NIV after extubation were divided in rescue NIV 75, and elective NIV 134. Effectiveness was 71, 84 and 77% respectively. Effectiveness decreases with age, older 2 years (85%), 6months-2 years (75%), younger than 6 months (65%). Skin sores were the most common complication observed. No mortality was associated to NIV use. Multivariate analysis Independent predictive factors for NIV failure are: receiving CPAP instead of bilevel, showing respiratory failure type II, and having lower SF ratio value, greater Heart rate value and lower decrease of Heart rate at 2 hours. Conclusions Non-invasive ventilation is a safe and effective respiratory support for children with ARF.

The diploma thesis deals with the attitude of parents and teachers of pupils with chronic diseases in the attenuation of compulsory school attendance at the 1st stage of ordinary primary school. The objective of the work is to identify the problems that parents and teachers of chronically ill students encounter during the educational process. From this basis, the purpose is also to find the basis for the best possible cooperation between parents and teachers. The theoretical idea is represented by individual chronic diseases, namely asthma, cystic fibrosis, pediatric oncological diseases, type 1 diabetes mellitus and epilepsy. In addition, the legislative framework for the education of pupils with these diseases, the methodology of working with pupils with chronic diseases and a search of domestic and foreign research conducted on a similar topic are addressed. The methodological part is devoted to qualitative research, the main goal of which is to find out the attitudes of teachers and parents to the educational process of pupils suffering from the above diseases. Using a questionnaire survey and a semi-structured interview, it is ascertained what are the attitudes of parents and teachers towards the education of pupils with the above-mentioned types of chronic diseases in ordinary primary school....

Coagulopathy, thrombosis, and other hematological abnormalities are common in the pediatric intensive care unit . Current guidelines recommend red blood cell transfusion for a hemoglobin concentration less than 7 g/dL in critically ill, hemodynamically stable patients; platelets for a concentration less than 10,000 in nonbleeding patients; and cryoprecipitate in bleeding patients for fibrinogen values less than 100 to 150 mg/dL. Massive transfusion protocols that push blood products to the bedside are more practical than reactive protocols. Transfusion reactions include transfusion-associated acute lung injury and transfusion-associated circulatory overload. Hematologic crises in the PICU are commonly complications of other primary disorders. Sickle cell disease may lead to acute chest syndrome, sequestration crisis, and stroke, and require aggressive intervention. Oncological diseases produce hyperleukocytosis, tumor lysis syndrome, veno-occlusive disease, graft-versus-host disease, and sepsis in association with leukopenia. A relatively newly recognized disorder, hemophagocytic lymphohistiocytosis, requires early recognition and treatment to avoid adverse outcomes.

Schools across the country serve children with a variety of health-related conditions, some which are hematological disorders (i.e., related to blood or bone marrow). Of these, some are oncologic disorders that affect the blood (e.g., leukemia), others are disorders of the blood system (e.g., sickle cell disease), and others are infectious diseases that may involve blood-borne pathogens (e.g., human immunodeficiency virus). This chapter describes each of the aforementioned disorders with a specific focus on factors of particular relevance to school-based clinicians and teachers. Common symptoms and relevant complications with each condition are listed in a table. Each condition’s description includes a case example to emphasize practical applications of material presented. Subsequently, pertinent considerations for assessment and intervention work in the school setting are highlighted for the three conditions concurrently.