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Samodova, O. V., I. I. Volkova, G. P. Smirnova, T. V. Pyatlina, E. I. Smetanina, Yu L. Khovanova, and A. V. Morozova. "Pediatric visceral leishmaniasis: diagnosis and therapy." Journal Infectology 13, no. 1 (March 30, 2021): 130–34. http://dx.doi.org/10.22625/2072-6732-2021-13-1-130-134.
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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.
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Escobar, Susana María Godoy, Thelma Beatriz Velásquez Herrera, Roy Enrique Rosado, Alicia Chang Cojulun, Mario Augusto Melgar Toledo, and Federico Antillón Klussmann. "#37: Description of Moderate-Severe Cases of COVID-19 in Pediatric Cancer at the Unidad Nacional de Oncologia Pediatrica, Guatemala." Journal of the Pediatric Infectious Diseases Society 10, Supplement_2 (June 1, 2021): S19. http://dx.doi.org/10.1093/jpids/piab031.045.
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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.
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Rykov, Maxim Yu. "Analysis of Medical Care for Children with Cancer in the Central Federal District in 2017: Ecological Study." Oncopediatrics 5, no. 2 (July 19, 2018): 81–90. http://dx.doi.org/10.15690/onco.v5i2.1910.
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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.
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Rozhkov, A. A., R. I. Nuriev, and M. I. Sekacheva. "Molecular diagnostics and targeted treatment approaches in pediatric oncology (literature review)." Medical alphabet, no. 38 (January 23, 2021): 29–33. http://dx.doi.org/10.33667/2078-5631-2020-38-29-33.
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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.
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Koo, Kevin S. H., Matthew P. Lungren, and Allison Aguado. "Interventional Oncology for Hepatic Malignancy in Children." Digestive Disease Interventions 03, no. 03 (August 27, 2019): 193–202. http://dx.doi.org/10.1055/s-0039-1694784.
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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.
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Vázquez-López, Rosalino, Omar Rivero Rojas, Andrea Ibarra Moreno, José Erik Urrutia Favila, Adan Peña Barreto, Guadalupe Lizeth Ortega Ortuño, Jorge Andrés Abello Vaamonde, et al. "Antibiotic-Resistant Septicemia in Pediatric Oncology Patients Associated with Post-Therapeutic Neutropenic Fever." Antibiotics 8, no. 3 (July 30, 2019): 106. http://dx.doi.org/10.3390/antibiotics8030106.
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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.
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Rykov, M. Yu, O. A. Manerova, I. A. Turabov, V. V. Kozlov, and V. A. Reshetnikov. "Algorithm for determining the feasibility of referring a patient for consultation with pediatric oncologist: results of implementation." Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 64, no. 6 (January 16, 2020): 84–88. http://dx.doi.org/10.21508/1027-4065-2019-64-6-84-88.
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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”.
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Tibirna, Gheorghe, Eva Gudumac, Ion Mereuta, Silvia Railean, Aurelia Spinei, Jana Bernic, Andrei Tibirna, et al. "Epidemiology of benign and malignant tumors in children in the Republic of Moldova (1 year of activity-2020)." Bulletin of the Academy of Sciences of Moldova. Medical Sciences 70, no. 2 (July 2021): 8–23. http://dx.doi.org/10.52692/1857-0011.2021.2-70.01.
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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.
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Kameda-Smith, Michelle, Gregory Pond, Forough Farrokhyar, and Hsien Seow. "EPCT-11. RURALITY INDEX SCORE AND PEDIATRIC NEURO-ONCOLOGICAL OUTCOME IN ONTARIO." Neuro-Oncology 23, Supplement_1 (June 1, 2021): i49. http://dx.doi.org/10.1093/neuonc/noab090.197.
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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]
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Kogan, S., K. Kirgizov, G. Muftakhova, G. Serik, and S. Varfolomeeva. "Building of Collaboration Between National Research Center of Pediatric Hematology, Oncology and Immunology, Professional Society and Medical Institutions in the Russian Federation: Unique Experience." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 166s. http://dx.doi.org/10.1200/jgo.18.56700.
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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
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Baumann, Fanni, Steven Hebert, Wolfgang Rascher, Joachim Woelfle, and Chara Gravou-Apostolatou. "Clinical Characteristics of the End-of-Life Phase in Children with Life-Limiting Diseases: Retrospective Study from a Single Center for Pediatric Palliative Care." Children 8, no. 6 (June 19, 2021): 523. http://dx.doi.org/10.3390/children8060523.
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Background: Data on the end-of-life phase of children receiving palliative care are limited. The purpose of this study is to investigate the spectrum of symptoms of terminally ill children, adolescents, and young adults, depending on their underlying disease. Methods: Findings are based on a 4.5-year retrospective study of 89 children who received palliative care before they died, investigating the symptomatology of the last two weeks before death. Results: In this study, the most common clinical symptomatology present in children undergoing end-of-life care includes pain, shortness of breath, anxiety, nausea, and constipation. Out of 89 patients included in this study, 47% suffered from an oncological disease. Oncological patients had a significantly higher symptom burden at the end of life (p < 0.05) compared to other groups, and the intensity of symptoms increased as the underlying disease progressed. The likelihood of experiencing pain and nausea/vomiting was also significantly higher in oncological patients (p = 0.016). Conclusions: We found that the underlying disease is associated with marked differences in the respective leading clinical symptom. Therefore, related to these differences, symptom management has to be adjusted according to the underlying disease, since the underlying disorder seems to exert an influence on the severity of symptoms and thereby on the modality and choice of treatment. This study is intended to aid underlying disease-specific symptom management at the end-of-life care for children, adolescents, and young adults, with a specific focus on end-of-life care in a home environment.
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Avagnina, Irene, Chiara Paolin, Micaela Santini, and Franca Benini. "Scialorrea e tappi di muco: consigli pratici di gestione nei pazienti eleggibili alle cure palliative pediatriche." QUADERNI ACP 28, no. 2 (2021): 76–79. http://dx.doi.org/10.53141/qacp.2021.76-79.
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Pediatric palliative care is a multidisciplinary area of pediatrics that aims to ensure a quality of life for children suffering from incurable diseases with high care complexity and also respond to their needs and those of their families. At the clinical level, there are many disturbing symptoms with a wide impact on the quality of life, which must be managed and treated. In particular some of them represent a major challenge for caregivers and health professionals looking after children eligible for PPC. This work aims to present, with a practical and immediately useful cut for the pediatrician, the management strategies of frequent symptoms, starting with drooling and mucus plugs; the latter are very frequent in children with non-oncological disease, followed by PPC. If not treated, they limit the child’s quality of life and have a significant impact on the concerns and management of family members / caregivers.
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Kumukova, I. B., P. I. Trakhtman, N. N. Starostin, L. J. Kadaeva, and O. A. Chaykina. "Results of clinical application of pathogen-reduced red blood cell suspension in children with oncological and hematological diseases." Pediatric Hematology/Oncology and Immunopathology 17, no. 4 (January 13, 2019): 43–50. http://dx.doi.org/10.24287/1726-1708-2018-17-4-43-50.
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The problem of blood-borne infections remains relevant in transfusion medicine. Pathogen reduction technologies (PRT) provide a preventive approach to a wide range of transfusion-transmitted infectious diseases. To date, PRT widely used for a number of blood components, however, the use of these technologies for the treatment of erythrocyte-containing components has not been studied. Objective: to conduct a comparative analysis of the clinical efficacy of transfusions of pathogen-reduced and gamma-irradiated erythrocyte suspension in pediatric patients with various oncological and hematological diseases. Seventy transfusions of red blood cell suspensions (RBC-S) (35 transfusions of pathogen-reduced RBC-S and 35 transfusions of gammairradiated RBC-S) in pediatric patients with oncological and hematological diseases were analized. Clinical efficacy parameters such as the hemoglobin and the hematocrit increment after transfusion, the interval between transfusions, the frequency and severity of transfusion reactions were estimated. We also evaluated the correlation between the hemoglobin and the hematocrit increment with age, patient’s body weight, the hemoglobin concentration and patient's hematocrit before transfusion, the volume of transfusion, the hemoglobin dose and the adjusted hemoglobin dose received for transfusion. We found that the clinical efficacy and safety of RBC-Ss of the compared groups did not differ: the hematocrit and the hemoglobin increment, the frequency and severity of transfusion reactions, and the interval between transfusions were comparable between groups. There was no evidence of immune elimination and allo-sensibilization caused by pathogen-reduced RBC-S. In the group of patients receiving pathogen-reduced RBC-S, a correlation was found between the increase in the hemoglobin and hematocrit values with some of the EV indices. According to our data, the spectrum of efficiency and safety indicators of pathogen-reduced RBC-S is no worse than that of gamma-irradiated RBC-S, provided that RBC-S is used for 14 days of storage.
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Pshonkin, Alexey V., Iruna V. Serkova, Nikolay V. Zhukov, Vladislav V. Shukin, Elena V. Polevichenko, and Elena A. Spiridonova. "Tolerability and safety of strong opioid analgesics in children and adolescents with incurable oncological diseases." Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care 9, no. 2 (August 16, 2019): 57–66. http://dx.doi.org/10.30946/2219-4061-2019-9-2-57-66.
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Relevance. One of the basic tasks of palliative medical care is to control pain in an incurable patient. To administer strong opioid analgesics as basic pain management in terminal patients, a treating physician must understand the risk of opioid-related adverse effects. According to the World Health Organization, the occurrence of the pain syndrome and importance of correct analgesic therapy in children and adolescents with incurable oncological diseases are underestimated.Purpose. To improve the quality of palliative medical care provided to children and adolescents with incurable oncological diseases.Materials and methods. A retrospective and prospective study was carried out. 400 patients with incurable oncological diseases aged 0 months to 20 years (median 9 years) were included into the study from June 2014 to December 2017, in particular, 235 boys and 165 girls (189 patients with extracranial solid tumors, 117 patients with CNS tumors and 94 patients with hemoblastoses). The study was approved by the Independent Ethics Committee and the Council of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (Protocol No. 5 dated May 21, 2013). Of 284 patients with the pain syndrome, 227 (80%) of children and adolescents aged 0–20 years (median 12 years) used strong opioid analgesics (morphine hydrochloride, morphine sulfate and transdermal therapeutic system with fentanyl) for pain relief. Their dosage was set in accordance with WHO 2012 recommendations related to the management of persisting pain syndrome in children. To estimate the severity of adverse events (AE) when strong opioids were used (nausea, vomiting, constipation, skin itching, urinary retention and respiratory failure), the CTCAE (Common Terminology Criteria for Adverse Events) displays Grades 1 through 5. Opioid-induced hyperalgesia and opioid-induced neurotoxicity were estimated by clinical signs (absence or presence of a symptom).Results. Of 227 patients, 59 (26%) patients had AE associated with the administration of strong opioid analgesics: 11.5% of cases for constipation, 7.5% cases for nausea, 4% of cases for pruritus, 2.2% of cases for urinary retention, 0.44% of cases for opioid-induced hyperalgesia, 0.44% of cases for opioid-induced neurotoxicity. No respiratory failure was noted when strong opioid analgesics were used. In the majority of cases (95%), the registered AE were mild and required no termination of therapy with opioid analgesics. Of 284 patients, 281 (98.9%) underwent analgesic therapy with complete pain management.Conclusion. Strong opioid analgesics are safe and effective in children and adolescents with incurable oncological diseases.
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Kasatkin, V. Nikolaevich, S. M. Chechelnitskaya, E. V. Glebova, E. V. Zhukovskaya, A. Yu Vashura, A. F. Karelin, and A. G. Rumiantsev. "PRINCIPLES AND METHODS OF RENDERING ASSISTANCE IN THE SECOND STAGE OF REHABILITATION TO CHILDREN WHO UNDERWENT ONCOLOGICAL DISEASES." Physical and rehabilitation medicine, medical rehabilitation 1, no. 2 (June 15, 2019): 3–9. http://dx.doi.org/10.36425/2658-6843-19179.
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The article describes the model of complex rehabilitation of children treated for cancer, developed by specialists of the Research Clinical Rehabilitation Center "Russkoe Pole" Federal Research Clinical Center of Pediatric Hematology, Oncology and Immunology named after D.Rogachev. Two areas of assistance have been proposed: a retrospective based on identifying potential health risks posed by anamnestic events and a prospective one that reflects the identification of relevant factors related to health and social functioning, the impact on these factors and the tracking of future effects. Methods batteries are described that allow studying and influencing different aspects of the health-related quality of life of patients: physical, psychological and social functioning, as well as an algorithm for directed diagnostics of toxic effects.
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Rykov, M. Yu, and I. A. Turabov. "Medical Care for Children with Cancer in the North-West Federal District of the Russian Federation: An Ecological Study." Oncopediatrics 5, no. 3 (October 28, 2018): 155–63. http://dx.doi.org/10.15690/onco.v5i3.1933.
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Background.Analysis of statistical data in the federal districts of the Russian Federation provides opportunities to assess the quality of medical care delivery in children with cancer and plan further development with consideration for the point elimination of existing defects. Objective. Our aim was to analyze the main indicators characterizing medical care for children with cancer in the North-West Federal District.Methods.The study analyzed operative reports for 2017 provided by the executive public health authorities of 11 subjects of the Russian Federation affiliated to the North-West Federal District.Results.The pediatric population was 2 537 133 children (0–17 years), the pediatric oncological bed capacity — 174 (0.7 per 10 000 aged 0–17 years), the annual berth average occupancy — 290.7 days. 6 (54.5%) subjects did not provide pediatric population with departments of pediatric oncology, 4 (36.4%) subjects did not have bed capacity. The number of practitioners providing medical care to children with cancer was 38, 27 among them (71%; 0.1 per 10 thousand 0–17 years) had a certificate of pediatric oncologist. 2 (18.2%) subjects did not have pediatric oncologists in the medical stuff. The incidence of malignant tumors in children aged 0–17 was 15.6 (per 100,000), the prevalence was 92.6 (per 100,000), the mortality rate was 2.6 (per 100,000), one-year mortality rate — 4.5% (18/397). The number of patients identified actively was 11 (2.8%). 160 (40.3%) primary patients were sent to Federal medical facilities, 6 (1.5%) — left the territory of the Russian Federation for the further treatment.Conclusion.The incidence and mortality rates are rather low which indicates the defects in patient detection and lack of reliable follow-up data. The percentage of patients referred for treatment to Federal medical facilities is not very high; however, to interpret this indicator according to patient routing, we have to analyze the medical history of all the patients. We can assert that health care delivery service for children with oncological diseases is at an acceptable standard level but needs to be improved.
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Kostylev, Alexandr A., Vyacheslav B. Silkov, and Margarita B. Belogurova. "Neoplasms, as one of the causes of the syndrome of palpable abdominal tumor in children." Pediatrician (St. Petersburg) 7, no. 2 (June 15, 2016): 121–26. http://dx.doi.org/10.17816/ped72121-126.
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Syndrome of palpable abdominal tumor in children is a difficult diagnostic problem. The difficulties associate with many disease entities that underlie this syndrome, often erased clinical picture and late referral to a doctor. In this article we will try to clarify the problems of diagnosis and treatment of exactly oncological diseases, as a cause of the syndrome palpable abdominal tumor. The vast majority of patients with complaints palpable education seek medical care to pediatricians or general practitioners. Prolongation of the diagnosis is often and directly associate with two factors: low oncological alertness by pediatricians (rarely by Pediatric Surgeons) and the lack of attention of parents to the initial manifestations of tumor in children. We have tried to describe the most characteristic symptoms inherent in the majority of tumors localized in the abdomen, the pelvis and the retroperitoneal space. Also there is information about on laboratory and instrumental methods of research used in the diagnosis of tumors, side by side the “routine” methods such as the complete blood count, abdominal ultrasound, in some cases, determination of specific tumor markers. There are the results of the comparative analysis and distinctive features of benign and malignant tumors of this localization are highlighted. Also the basic principles of the treatment of solid tumors in children are presented in this article. The article is focused primarily on all pediatricians, pediatric surgeons and general practitioners.
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Rykov, M. Yu, and O. A. Manerova. "On the issue of introducing an electronic database of children with oncological diseases into specialized medical organizations: results of a medical and social research." South Russian Journal of Cancer 2, no. 1 (March 29, 2021): 57–64. http://dx.doi.org/10.37748/2686-9039-2021-2-1-7.
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Accounting for children with cancer is characterized by low reliability of statistics. In addition, the available data do not have significant scientific value., Since they represent only an approximate number of patients identified annually and some general information (incidence, prevalence, etc.). Moreover, subsequent analysis of the accumulated information is of particular importance. An electronic database of children with cancer has been developed that meets these requirements and has been introduced into the clinical practice of pilot medical organizations.Purpose of the study. Our aim was to study the opinions of pediatric oncologists on the issues of registration of children with oncological diseases.Materials and methods. In order to assess the results of the implementation of the electronic database, a "Questionnaire for a survey of a pediatric oncologist to assess the effectiveness of the implementation of an electronic database" was developed, which contained 15 questions. For objectivity, the questionnaires were filled in anonymously by the respondents.Results. The medico- social study involved 187 pediatric oncologists. The majority of respondents (71.3 ± 3.3%) noted that currently there is no register of children with cancer in the Russian Federation, 15.4 ± 2.6% noted the regional register, 9.1 ± 2.1% – independent in individual medical organizations, 1.7 ± 0.9% is a single register for the Russian Federation and 2.5 ± 1.1% are not aware of this. Among respondents, 81.9 ± 2.8% noted that the electronic database is an effective tool for recording children with cancer, while as an advantage, 15.1 ± 2.6% noted an increase in the reliability of statistical data, 9.2 ± 2.1% – reduction of time for searching patient information, 4.4 ± 1.5% – optimization of working time, 71.3 ± 3.3% – a combination of the above options.Conclusion. A medical and social study showed the feasibility of introducing an electronic database of children with cancer into the clinical practice of pediatric oncologists.
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Styczyński, Jan, Krzysztof Czyżewski, Jowita Frączkiewicz, Małgorzata Salamonowicz, Agnieszka Piekarska, Monika Adamska, Przemysław Gałązka, et al. "Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019." Acta Haematologica Polonica 51, no. 3 (September 16, 2020): 157–63. http://dx.doi.org/10.2478/ahp-2020-0028.
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AbstractNo epidemiological data exist so far on invasive mucormycosis (IM) in Polish hematopoietic cell transplantation (HCT) and pediatric hemato-oncology (PHO) centers. The objective of this study was to analyze the incidence, clinical course, therapy, and outcome of IM in pediatric and adult patients undergoing HCT and children with hemato-oncological diseases in Poland. A total number of 12425 at-risk patients were retrospectively analyzed, and the period between 2010 and 2019 was included. Patients were analyzed in three groups: nontransplant children with malignancies, children undergoing HCT, and adults after HCT. Twenty-one patients were diagnosed with IM, including 15 children (10 non-HCT, 5 HCT) and 6 HCT adults. Proven IM was confirmed in 18 patients, probable in 2 patients, and possible in 1 patient. Proven IM was diagnosed in 7.1% of all patients with invasive fungal diseases (IFDs), including 8.1% among PHO patients, 5.4% among pediatric HCT patients, and 7.0% among adult HCT patients. Clinically, pneumonia was diagnosed in 10 (47.6%) patients, involvement of the paranasal sinuses was found in 3 (14.3%) patients, gastrointestinal disease was noted in 2 (9.5%) patients, and disseminated mucormycosis was found in 6 (28.6%) patients. The probability of overall survival in IM patients was 0.50 ± 0.11. Infection-related mortality (IRM) was 10% for pediatric nontransplant IM patients and 82% for transplant IM (pediatric + adult) patients (p = 0.004). Among the transplant patients, all adults died within 120 days. IRM for pediatric HCT patients was 60% (p = 0.038). The only prognostic factor was HCT, which adversely influenced survival in IM patients.
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Morgacheva, D. A., Yu V. Dinikina, Yu K. Toshina, and M. B. Belogurova. "The microbiome role in pathogenesis of inflammatory and immune alterations of gastrointestinal tract in pediatric patients with cancer." Oncohematology 16, no. 2 (June 7, 2021): 86–93. http://dx.doi.org/10.17650/1818-8346-2021-16-2-86-93.
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Infectious complications remain one of the most significant problem associated with anticancer therapy in oncological patients. Cytotoxic, radiation and antibacterial therapy induce dysbiosis and gastrointestinal mucosal barrier injury. These changes lead to the mucositis, thereby increasing the risk of endogenous microflora translocation with following probable development of severe infectious and inflammatory diseases. In addition, current evidence suggests that there is a relationship between gut microbiome disturbances and post-transplant graft versus host disease development. The article presents the existing paradigms of determining the role of gastrointestinal tract functional condition in cancer patients in order to optimize prevention and antimicrobial treatment approaches.
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Cesaro, Simone, Roberta Corrò, Piergiorgio Gamba, and Giovanni Zanon. "Is there really a need for anti-coagulant prophylaxis for CVC-related thrombotic complications in pediatric oncological-hematological diseases?" Supportive Care in Cancer 10, no. 3 (April 2002): 258–59. http://dx.doi.org/10.1007/s00520-001-0324-1.
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Shvydkaya, M. G., D. T. Dzhandarova, and S. D. Mitrokhin. "Clostridium difficile infection in pediatric patients of oncological hospital: cultivation of anaerobic intestinal flora and treatment." Microbiology Independent Research Journal 8, no. 1 (March 18, 2021): 10–17. http://dx.doi.org/10.18527/2500-2236-2021-8-1-10-17.
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In recent years, the number of infectious diseases caused by Clostridium difficile in the world has grown with a significant increase in relapses and mortality in patients, particularly among the cancer patients in hospitals. There is also observed an increase in the resistance of Clostridium difficile to the first-line drugs, namely metronidazole and vancomycin, which makes the search for new methods of treatment and prevention of this infection even more urgent. In this review, we analyze the recent data on the methods of cultivation and isolation of the pure bacterial culture of Clostridium difficile and other anaerobic enteropathogens over the course of enterocolitis treatment with antimicrobial drugs in pediatric patients with oncopathology. Novel approaches to the therapy of this infection are discussed.
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Dinikina, Yu V., Yu K. Toshina, and M. B. Belogurova. "diagnostic utility of procalcitonin in children with infectious complications during chemotherapy-induced neutropenia: single center experience, literature review." Oncohematology 15, no. 1 (April 19, 2020): 65–72. http://dx.doi.org/10.17650/1818-8346-2020-15-1-65-72.
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Background. Infectious complications cause significant mortality in children with oncological diseases during chemotherapy-induced neutropenia. The absence of sensitive and specific signs and symptoms of infectious conditions as well as its microbiological identification, leads to inappropriate antibiotic exposure. The use of laboratory biomarkers (procalcitonin (PCT) and C-reactive protein (CRP)) may be helpful for differential diagnostics of inflammatory conditions and for rational antimicrobial therapy.Objective: to assess the current value of PCT as an additional marker for differentiating inflammatory conditions in children with chemotherapy-induced neutropenia.Materials and methods. We presented the analysis of infectious complications in pediatric patients with oncological and onco- / hematological diseases between 2017–2020 (54 patients from 2 mnths – 17 years). PCT and CRP with clinical and instrumental diagnostic data were used for differential diagnosis of fever and development of antimicrobial therapy decision rules. Literature review concerning the discussed theme from 2006–2018 was done.Results. Eighty-five infectious episodes in 36 months were registered, among them 42 in pts with onco- / hematological diseases and 43 – with solid tumors. In the group of bacterial infectious complications mean CRP and PCT values were significantly higher than in group of nonbacterial, moreover the discriminative value was higher for PCT. We revealed the correlation between severity of infectious complications and values of markers of acute-phase reactions. In case of non-severe bacterial complications and other types of infections significant difference was revealed only for PCT mean values.Conclusion. Specificity of PCT concentration in bacterial infections exceeds that of CRP, which confirms the hypothesis of advantages in using PCT as differential marker of inflammatory conditions in children with malignancies.
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Pelosin, Anna, Piergiorgio Gamba, Fabio Fusaro, Marta Pillon, Riccardo Cusinato, Gloria Tridello, Gianfranco Zanon, et al. "A prospective survey on incidence and outcome of Broviac/Hickman catheter-related complications in pediatric patients affected by hematological and oncological diseases." Annals of Hematology 83, no. 3 (March 1, 2004): 183–88. http://dx.doi.org/10.1007/s00277-003-0796-9.
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Morello, Fulvio, Paolo Bima, Enrico Ferreri, Michela Chiarlo, Paolo Balzaretti, Gloria Tirabassi, Paolo Petitti, et al. "After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions." Internal and Emergency Medicine 16, no. 6 (March 8, 2021): 1683–90. http://dx.doi.org/10.1007/s11739-021-02667-2.
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AbstractThe first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient “lockdown and fear” phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January–August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.
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Donath, Helena, Stefan Zielen, Boris Wittekindt, Thomas Klingebiel, Jürgen Graf, Martin Eckrich, Christian Walter, and Katharina Blümchen. "Effects of the SARS-CoV2-Lockdown on Pediatric Care in the Rhine-Main Area." Klinische Pädiatrie 233, no. 01 (November 12, 2020): 31–36. http://dx.doi.org/10.1055/a-1263-1467.
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Abstract Background The effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and lockdown on pediatric diseases and care are not well characterized in Germany. Patients and Methods To investigate the effects of the lockdown on pediatric medical care in the Rhine-Main area, a survey asking 115 pediatricians and an analysis of the inpatient admissions at the Department for Children and Adolescents Goethe-University, Frankfurt in April 2020 compared to April 2019 was performed. Results 65/115 (56.5%) pediatricians answered the survey. Pediatricians estimated the reduction of patient consultations in April 2020 vs. 2019 by 40% (median), however, according to their practice administration software, patient visits decreased by 30%. The median number of cases with the diagnosis J21 (acute bronchitis) were significantly less in April 2020 vs. April 2019 (50 vs. 10 cases per pediatrician; p<0.001). Simultaneously, hospital admissions decreased by 43.7% from 402 total cases in April 2019 to 226 cases in April 2020. Hospital admissions due to acute respiratory tract infections or asthma exacerbations as well as neonatal and oncological disorders were significantly reduced compared to the previous year (83.7; 38.1 and 22.1% respectively less to 2019). Conclusion The lockdown in April 2020 resulted in significantly fewer visits to pediatricians in general practice and hospital admissions, especially for acute respiratory tract infections. The health and economic consequences are discussed.
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De Angelis, C., C. Pacheco, G. Lucchini, M. Arguello, V. Conter, A. Flores, A. Biondi, G. Masera, and F. Baez. "The Experience in Nicaragua: Childhood Leukemia in Low Income Countries—The Main Cause of Late Diagnosis May Be “Medical Delay”." International Journal of Pediatrics 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/129707.
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Background. The event-free survival for pediatric leukemia in low-income Countries is much lower than in high-income countries. Late diagnosis, which is regarded as a contributing factor, may be due to “parental” or “medical” delay.Procedures. The present study analyses determinants of lag time from first symptoms to diagnosis of leukemia, comparing pediatric (0–16 years old) patients in two referral centers, one in Nicaragua and one in Italy. An observational retrospective study was conducted to assess factors influencing the time to diagnosis.Results. 81 charts of children diagnosed with acute myeloid leukemia or lymphoblastic leukemia were analyzed from each centre. Median lag time to diagnosis was higher in Nicaragua than in Italy (29 versus 14 days,P<0.001) and it was mainly due to “physician delay” (16.5 versus 7 days,P<0.001), whereas “patient delay” from symptoms to first medical assessment was similar in the two centers (7 versus 5 days,P=0.27). Moreover, median lag time from symptoms to diagnosis was decreased in Nicaraguan districts were a specific training program upon childhood oncological diseases was carried out (20.5 versus 40 days,P=0.0019).Conclusions. Our study shows that delay in diagnosis of childhood leukemia is mainly associated with “physician delay” and it may be overcome by programs of continuous medical education.
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Cesca, Eleonora, Giacomo Garetto, Emanuela Frascella, Simone Cesaro, Patrizia Dall'Igna, and Giovanni Cecchetto. "Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease." Pediatric Reports 4, no. 1 (December 27, 2011): 1. http://dx.doi.org/10.4081/pr.2012.e1.
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This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5-16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.
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Oñate, José M., Pilar Rivas, Christian Pallares, Carlos H. Saavedra, Ernesto Martínez, Wilfrido Coronell, Eduardo López, et al. "Colombian consensus on the diagnosis, treatment, and prevention of Candida Spp. disease in children and adults*,+." Infectio 23, no. 3 (March 19, 2019): 271. http://dx.doi.org/10.22354/in.v23i3.792.
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Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.
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Lucan, C., Laura-Ancuta Pop, A. Florian, Valentina Pileczki, B. Petrushev, Delia Dima, Ioana Frinc, et al. "HLA Genotyping using Next Generation Sequencing." Romanian Journal Of Internal Medicine 54, no. 2 (June 1, 2016): 98–104. http://dx.doi.org/10.1515/rjim-2016-0019.
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Abstract From an oncological perspective, the second most common malignancies in children are brain tumors. Despite the recent therapeutic breakthroughs in this field, concerning surgery, radiotherapy and chemotherapy alike, some cases still have poor outcomes in curability. This is especially the case in patients with high-risk histological types of tumors, and those suffering from residual, remitting and disseminated diseases. Due to the unique neuroanatomical emplacement of brain tumors and their aggressive infiltrative behavior, their total removal remains a demanding task. This can be perceived in the high rates of failure treatment and disease recurrence. Furthermore, the adjacent healthy brain tissue is inevitably damaged in the surgical process of effectively removing these tumors. Thus, stem cell transplantation may be a viable solution for the clinical management of these malignancies, as proven by various recent breakthroughs. In the current concise review, we present the role of next generation sequencing in HLA typing for stem cell transplantation in primary CNS pediatric malignancies.
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Mendieta, Ana, Ligia Rios, Walter Delgadillo, Maria Vargas, Carlos Rueda, Carlos Santillán, Liliana Vasquez, and Miguela Caniza. "#55: Development of a quality improvement educational intervention in febrile neutropenia in pediatric cancer patients in Peru: Preliminary results of the DoTT project." Journal of the Pediatric Infectious Diseases Society 10, Supplement_2 (June 1, 2021): S20—S21. http://dx.doi.org/10.1093/jpids/piab031.050.
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Abstract Background/Aims Severe infections are the most important causes of morbidity and mortality in children with cancer. In Peru, a major limitation for an optimal treatment of children with fever and neutropenia due to chemotherapy is the delay in the administration of the first dose of antibiotics. We performed an intervention aimed to decrease the time to antibiotics (TTA) in pediatric patients presenting to the emergency room (ER) with fever and neutropenia: We increased the perception risk of neutropenic fever to the ER medical staff by explaining the importance of a timely administration of antibiotics as part of the initial approach of children with fever and neutropenia. This study forms part of a larger project (DoTT project) that is being implemented in Peru, and is aligned to the WHO Global Initiative of Childhood Cancer in Peru. Methods This study was performed at Hospital Nacional Edgardo Rebagliati, which is a tertiary care National Hospital located in Lima. We included patients younger than 14 years with hemato-oncological conditions who arrived at the Pediatric Emergency Room. The DoTT project consists in an quality improvement educational intervention for health care providers in the Pediatric ED and the Oncology and Hematology Departments, based on the Kern’s six-steps (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation. We defined time-to-antibiotic (TTA) by measuring the time elapsed between patient′s arrival to the ER and the administration of the fist dose of an antibiotic. We compared the TTA between thirteen patients admitted from July to December 2020 with fever and neutropenia (after intervention), and historical data from 2017–2018. Results Median age was 7 years. 9/13 patients had leukemia and 4 patients had malignant solid tumors receiving oncological treatment. Mean pre-hospital delay was 176 minutes (range, 14–906 minutes) and TTA was 133 minutes (range, 34–400 minutes). One patient died of sepsis. Age, sex, source and timing of antibiotics did not significantly affect hospital stay, antifungal use and/or antibiotic turnover. Based on our historical data, mean TTA was 206 minutes (range, 137–390). Early results indicate a decrease in the TTA, although not statistically significant, likely due to the sample size. General and targeted needs assessment was performed by the DoTT project team and administrators at Rebagliati hospital, which lead to develop a curriculum based on a 5-lectures mini-course for health care providers. Conclusions The TTA exceeds the recommended time at international level, causing the evitable morbimortality. It is necessary to perform a multidisciplinary intervention to improve antibiotic start time. Ongoing educational intervention refinement and testing of the instruments are planned.
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Rykov, Maxim Yu. "MORBIDITY AND MORTALITY RATE FROM MALIGNANT TUMORS IN CHILDREN IN THE RUSSIAN FEDERATION OVER 2011-2016." Russian Journal of Oncology 22, no. 6 (December 15, 2017): 322–28. http://dx.doi.org/10.18821/1028-9984-2017-22-6-322-328.
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Introduction Planning the medical care management for cancer children is based, inter alia, on epidemiological data: morbidity and mortality rates in children with malignant neoplasms. Material and methods. The data of the public health care executive authorities of the constituent entities of the Russian Federation have been analyzed. These reports included data on morbidity, mortality, one-year mortality rates, and the period of the medical care delivery for children with oncological diseases in subjects. Results. Over past 6 years, the number of primary patients, identified annually (by 2011 - 3230, 2016 - 3875) increased by 20%; the number of patients under observation was increased by 34.8% (2011 - 17,958, 2016 - 24,207). The incidence increased by 9.8%: from 12.2 per 100,000 (0-17 years) in 2011 to 13.4 in 2016. The standardized mortality rate in 2011-2013 was 4 (per 100 thousand. 0-19 years), in 2014-2016 - 3.6 (per 100 thousand. 0-17 years). The one-year mortality rate decreased by 2%: from 10.8% in 2011 to 8.8% in 2016, the number of actively identified patients increased by 1.4% (in 2007 - 3.8%, in 2016 - 5.2%), the one-year mortality rate decreased by 5.9% (2007 - 14.7%, 2016 - 8.8%). Among causes of death the first place was occupied by leukemia, the second one - by tumors of the brain and spinal cord, the third - sarcomas of soft tissues. Conclusion. The noted dynamics demonstrates an increase in the detectability of oncological diseases in children, therefore, it indicates to the improvement of diagnostic methods. Taking into consideration the average world morbidity rate to account of 15 per 100 thousand children, it is possible to forecast a further increase in the incidence (detectability) of up to 4 500 primary patients by 2022. Thus, at present, an annual underreport is about 700(16%) patients. A low percentage of actively identified children shows the insufficient training of primary care physicians (district pediatricians) in pediatric oncology.
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Książek, Teofila, Katarzyna Szewczyk, Agnieszka Grabowska, Agnieszka Grabowska, Mirosław Bik-Multanowski, Beata Sadowska, and Przemysław Kaczówka. "The importance of cooperation between cytogenetic and molecular laboratory in the genetic testing of hemato-oncological diseases on the example of a pediatric patient with acute myeloid leukemia (AML)." Diagnostyka Laboratoryjna 54, no. 4 (December 17, 2019): 225–32. http://dx.doi.org/10.5604/01.3001.0013.7751.
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The genetic profiling of leukemic cells is currently the standard in routine diagnosis of haematopoietic malignancies. Detection of characteristic genetic abnormalities is extremely important in establishing the correct diagnosis and selecting the optimal treatment for the patient. In this paper we outline the problems of cytogenetic and molecular methods applied in the oncogenetic diagnostics. Moreover, we emphasize advantages and indicate limitations of these methods. Additionally, we present their practical use on the example of a comprehensive analysis of genetic changes in leukemic cells in a pediatric patient diagnosed with acute myeloid leukemia (AML). Simultaneous, proper interpretation of the results of all performed analysis – classical karyotype, fluorescence <I>in situ</I> hybridization (FISH), analysis of the expression of fusion genes and molecular karyotyping by microarrays, eventually led to the selection of optimal treatment which take into account the identified adverse genetic changes of the described patient.
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Failo, Alessandro, Sarah E. Beals-Erickson, and Paola Venuti. "Coping strategies and emotional well-being in children with disease-related pain." Journal of Child Health Care 22, no. 1 (December 19, 2017): 84–96. http://dx.doi.org/10.1177/1367493517749326.
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Disease-related pain and the consequences of pain in children and families are important areas for further research inquiry. There are limited data on the relationship between children’s emotional well-being, their experience of pain, and the strategies they employ to cope with pain within the context of serious medical illnesses. Understanding what strategies chronically ill children use to cope with pain and stress is essential for clinical intervention. This observational study examined the ways that children and adolescents with chronic diseases cope with pain and adapt to illness. The data were collected by self-report measures and projective drawing techniques in a novel way to assess the emotional functioning in a mixed cohort of youth with disease-related pain (oncological, rheumatic, and cystic fibrosis). This protocol was administered to 47 children, aged 7–14, recruited from pediatric wards of hospitals of Trento and Rovereto (Italy). The results showed that coping strategies in youth with disease-related pain differed across diagnoses and with self-representations (as part of the self-concept adaptive mode). We also provide evidence of the applicability of using projective drawing methods in assessing coping in youth with chronic illness and associated pain.
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Likar, Yu N., E. D. Kireeva, А. Kailash, M. Ya Yadgarov, D. D. Kuzyaev, and N. V. Myakova. "COMPARISON OF VARIOUS 18F-FDG PET/CT ACQUISITION PROTOCOLS IN CHILDREN WITH HODGKIN’S LYMPHOMA." Pediatria. Journal named after G.N. Speransky 100, no. 3 (May 28, 2021): 28–34. http://dx.doi.org/10.24110/0031-403x-2021-100-3-28-34.
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In adults with oncological diseases, most PET/CT studies with 18F-FDG are performed using a scanning protocol with a reduced scanning area (r-PET/CT). In pediatric oncology, PET/CT with 18F-FDG is recommended to be performed in the «whole body» mode. We hypothesized that the use of r-PET/CT in children with Hodgkin's lymphoma (HL) may be sufficient without loss of diagnostic value. Materials and methods of research: a comparative analysis of PET/CT scanning protocols in «whole body» mode and r-PET/CT mode in children with HL was carried out. The retrospective analysis included 105 patients aged 0–18 years. All patient underwent primary whole-body PET/CT examinations at the time of initial staging and intermediate follow-up PET/CT scan after 2-cycle of chemotherapy. 210 PET/CT studies were retrospectively analyzed. Results: in 94 (89,5%) of 105 patients the identified lesions were localized within the area of the field-of-view of r-PET/CT, and additional lesions detected in 11 (10,5%) patients in the whole-body PET/CT examinations have not affected the results of staging and management. Conclusion: the detection of additional foci of pathological metabolic activity beyond r-PET/CT has no further impact on the stage of the disease, the protocol of treatment and the evaluation of the early response to the therapy. The advantage of r-PET/CT protocol is the reduction in radiation exposure and study time, which is very important for pediatric patients with HL.
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Shifrin, I. A., P. V. Zharkov, and E. D. Pashanov. "Experience of protein C administration in children with acquired deficiency." Pediatric Hematology/Oncology and Immunopathology 18, no. 2 (June 29, 2019): 59–65. http://dx.doi.org/10.24287/1726-1708-2019-18-2-59-65.
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Тhere is increasing experience of protein C concentrate administration in world practice, but despite that, information of this drug administration in patients with oncohematological diseases and primary immunodeficiency syndromes is lacking. Objective: to study the effectiveness of protein C concentrate administration in pediatric patients with acquired protein C deficiency during the treatment of oncological, hematological or immunological diseases. Medical charts of 12 patients who received inpatient treatment and protein C concentrate administration in the Dmitry Rogachev National Clinical Research Center from 01/01/2012–12/31/18 were analyzed. Depending on the presence or absence of thrombosis, the patients were divided into two groups. Single and daily doses, the number of injections per day, the duration of therapy and the percentage of activity of protein C activity were studied in both groups. Вoth groups included 6 patients, median of a single administrated dose of protein C was lower in the group of patients with thrombosis than in patients without them (20 and 71.4 IU/kg, p < 0.0001), while there were obtained no differences between treatment efficacy (p = 0.45). When comparing the administered dose of the drug in children with unresolved and resolved thrombosis, it was found that the median single dose in patients with ineffective treatment was lower than in those who had effective treatment (8.78 and 71.4 IU/kg, respectively, p < 0.0001); the median daily dose was also lower in the group with ineffective treatment (20 and 71.4 IU/kg, respectively, p < 0.005). Рrotein C administration in children with acquired deficiency for the purpose of antithrombotic prophylaxis can be potentially effective, especially in those patients who already have a thrombosis at the moment of administration. The effectiveness of such prophylaxis may depend on the dose of the injected concentrate. To determine the appropriate dose and mode of administration of the drug in children a prospective study is required. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology.
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Pereira, Maria Conceição, Joana S. Pereira, Daniela Dias, Sara Donato, and Duarte Salgado. "Endocrine Health Problems Detected in 764 Patients Evaluated in a Late Effects Clinic." Case Reports in Oncology 10, no. 3 (October 31, 2017): 958–63. http://dx.doi.org/10.1159/000480494.
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Background: Many pediatric cancer survivors have endocrine conditions. After treatment with alkylating agents, steroids, methotrexate, and radiation, several endocrine dysfunctions may appear. Surveillance for late effects is recommended by guidelines worldwide. Objective: The objective of this study was to describe the endocrine outcomes of 764 patients followed during a 20 years’ period in our out-patient clinic. Design: We retrospectively reviewed the medical records. Patients: The study included 764 patients whose oncological or hematological dangerous diseases appeared before they were 18 years old. Larger groups were constituted by leukemias, central nervous tumors, and lymphomas. Outcome Measures: The frequency and types of endocrine conditions were analyzed. Results: 1,091 endocrine conditions were observed in all groups. The most common types of endocrine conditions were problems with growth and the thyroid. We found puberty abnormalities and bone problems in third and fourth places of frequency. ACTH insufficiency was found in seventh place. Conclusion: Endocrine dysfunctions are very common in survivor populations. Endocrinologists should be aware of international guidelines and make an effort to optimize screening and treatment of endocrine effects of cancer therapy. The crucial period is the puberty with growth spurt failure and accelerated maturity both of which can bring future social and professional difficulties.
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Stepanyan, N. G., N. V. Sidorova, M. V. Rubanskaya, N. N. Tupitsyn, N. V. Matinyan, K. I. Kirgizov, and S. R. Varfolomeeva. "Optimization of methods for collecting peripheral hematopoietic stem cells in children with cancer: literature review." Russian Journal of Pediatric Hematology and Oncology 7, no. 2 (July 4, 2020): 78–85. http://dx.doi.org/10.21682/2311-1267-2020-7-2-78-85.
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Autologous hematopoietic stem cell transplantation (auto-HSCT) is a standard for the treatment of oncological, hematologic, and also some immune diseases, ensuring the restoration of blood counts after high-dose chemotherapy. In children, the success of mobilization and collection of hematopoietic stem cells (HSCs) is especially important. Mobilization schemes for children are decided on an individual basis, which requires the development and implementation of recommendations for improving the efficiency of mobilization and collection of HSCs. Mobilization schemes include the use of granulocyte colony-stimulating factor in the form of monotherapy or in combination with CXCR4 antagonists. These schemes are ineffective in some children, which requires re-mobilization or rejection of transplantation, which negatively affects the prognosis. When preparing a patient for HSCs collection, it is necessary to take into account all previous therapy, the patient’s age, weight and height indicators, and general somatic state. Harvesting the required amount of HSCs will allow for high-dose therapy followed by auto-HSCT, and thereby increase the effectiveness of treatment. It is necessary to optimize the protocol for mobilization of HSCs with a large bias for pediatric patients, which will clearly define the criteria for mobilization, give indications for this procedure and determine the criteria for technical collection, which will allow to obtain the optimal number of CD34+ cells, which will ensure the success of the treatment.
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Vashura, A. Yu, A. A. Devyaterikova, S. S. Lukina, V. N. Kasatkin, and A. F. Karelin. "Behavioral disorders and their correlation with nutritional status of children, complete the treatment of acute lymphoblastic leukemia and embryonic central nervous system tumors." Oncohematology 15, no. 2 (July 16, 2020): 76–84. http://dx.doi.org/10.17650/1818-8346-2020-15-2-76-84.
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Background. A violation of nutritional status (obesity) and emotional-behavioral status (depression) is one of the urgent problems of modern health care. Often these two problems are at the same time. Particularly striking manifestations of a decrease in nutritional and emotional statuses are observed in children with oncological diseases of various origins.Objective: to assess the emotional-behavioral status and nutritional status in pediatric cancer and hematological diseases after treatment.Materials and methods. The study included 112 children with acute lymphoblastic leukemia (n = 49) and central nervous system tumors (n = 63) in remission. Age 6–18 years (median 11.5 years). 66 male (58.9 %). The Aachenbаch questionnaire was used to assess the behavioral and individual-personality characteristics. CDI (children depression inventory) questionnaire was used to assess the presence and level of depression. Body mass index (in percentile terms) and body tissue composition by bioimpedance analysis (body fat and lean body mass were evaluated) were used to assess nutritional status.Results. As a result, it was found that a significant proportion of children have delayed effects of treatment in the form of reduced nutritional status and emotional and behavioral difficulties. Children with brain tumors have an increased risk of nutritional and emotional-behavioral disorders compared to children who have survived acute lymphoblastic leukemia. The nutritional and emotional-behavioral statuses of children are related: the presence of excess fat mass increases the risk of emotional-behavioral disorders. According to questionnaires, parents identify detected problems much more often than patients themselves.Conclusion. In children who have experienced antitumor treatment and achieved remission, in case of excess body fat, the risk of emotionalbehavioral disorders increases. Emotional-behavioral disorders can have a negative effect on rehabilitation measures; therefore, before starting rehabilitation measures it is necessary to take into account the nutritional and emotional-behavioral status of patients.
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De Martinis, Massimo, Maria Maddalena Sirufo, Angelo Viscido, and Lia Ginaldi. "Food Allergies and Ageing." International Journal of Molecular Sciences 20, no. 22 (November 8, 2019): 5580. http://dx.doi.org/10.3390/ijms20225580.
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All over the world, there is an increase in the overall survival of the population and the number of elderly people. The incidence of allergic reactions is also rising worldwide. Until recently, allergies, and in particular food allergies (FAs), was regarded as a pediatric problem, since some of them start in early childhood and may spontaneously disappear in adulthood. It is being discovered that, on the contrary, these problems are increasingly affecting even the elderly. Along with other diseases that are considered characteristics of advanced age, such as cardiovascular, dysmetabolic, autoimmune, neurodegenerative, and oncological diseases, even FAs are increasingly frequent in the elderly. An FA is a pleiomorphic and multifactorial disease, characterized by an abnormal immune response and an impaired gut barrier function. The elderly exhibit distinct FA phenotypes, and diagnosis is difficult due to frequent co-morbidities and uncertainty in the interpretation of in vitro and in vivo tests. Several factors render the elderly susceptible to FAs, including the physiological changes of aging, a decline in gut barrier function, the skewing of adaptive immunity to a Th2 response, dysregulation of innate immune cells, and age-related changes of gut microbiota. Aging is accompanied by a progressive remodeling of immune system functions, leading to an increased pro-inflammatory status where type 1 cytokines are quantitatively dominant. However, serum Immunoglobulin E (IgE) levels and T helper type 2 (Th2 cytokine production have also been found to be increased in the elderly, suggesting that the type 2 cytokine pattern is not necessarily defective in older age. Dysfunctional dendritic cells in the gut, defects in secretory IgA, and decreased T regulatory function in the elderly also play important roles in FA development. We address herein the main immunologic aspects of aging according to the presence of FAs.
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Marisol, Trujillo-Gutierrez, and Rodriguez-Auad Juan Pablo. "#29: Analysis of Mortality Due to Infections in Pediatric Patients in the Oncology Unit of a Third Level Hospital in La Paz, Bolivia." Journal of the Pediatric Infectious Diseases Society 10, Supplement_2 (June 1, 2021): S18. http://dx.doi.org/10.1093/jpids/piab031.042.
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Abstract Background In recent decades, advances in cancer treatment have made it possible to improve the prognosis of hemato-oncological patients, however, mortality is still high in developing countries. One of the most important causes of morbidity and mortality during the treatment of children with cancer is infectious complications, especially in the induction phase. The multiple interventions that are carried out during treatment, such as the use of catheters, increase the risk of developing these infections, which can be more frequent if the recommended strategies to prevent them are not applied. The objective of this study was to investigate what were the causes of death in children with cancer at our institution. Methods The medical records of deceased patients were analyzed in the onco-hematology unit of the Children′s Hospital “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia. The causes of mortality, the stage of chemotherapy in which the death occurred, its relationship with infections and the microorganism identified during 2020 were classified. Results During 2020, 19 deaths were found in cancer patients, the mean age was 8.5 years and of which 52% were male. Regarding the basic diagnosis, there was a higher proportion of hematological diseases 68% and solid tumors 32%. Among the causes of death, 58% were due to their underlying pathology where most of the patients were in palliative care or in relapse and 42% were due to infectious causes, of which 62% were in induction phase of chemotherapy. Among the 8 patients who died from infections, the following causes were found: 50% neutropenic colitis, 25% bacteremia and 25% necrotizing fasciitis; in 7 (87.5%) patients the microorganism was isolated in blood culture, these were E. coli 43%, Klebsiella spp 43% and Bacillus spp 14%. Gram negative bacilli (GNB) represented 86% of the isolates and 50% were producers of extended spectrum beta-lactamases (ESBL). Conclusions Considering that infections are preventable and are among the most important causes of mortality in children with cancer in our hospital, it is essential that infection control teams are developed that apply evidence-based strategies to prevent these infections and thus achieve a reduction in morbidity and mortality, applying programs with training of human resources and equipment to reduce these deaths.
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Mitrakov, N. N., A. V. Shcherbukha, P. A. Shafran, K. A. Voronin, and O. A. Laysheva. "Clinical analysis of video recordings of the basic motor patterns (CLAVIR) for the assessment of movement disorders in children and adolescents with acute lymphoblastic leukemia." Pediatric Hematology/Oncology and Immunopathology 20, no. 1 (April 21, 2021): 114–27. http://dx.doi.org/10.24287/1726-1708-2021-20-1-114-127.
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Movement disorders arising in pediatric patients with acute lymphoblastic leukemia (ALL) during treatment require a more differentiated approach to diagnosis and the choice of rehabilitation methods. The aim of this study was to investigate the conceptional structure of supine-to-stand (STS) transition patterns and to develop a method for the diagnosis of movement disorders and the assessment of the effectiveness of medical rehabilitation in children and adolescents with ALL. We carried out a prospective comparative non-randomized study. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The study included 184 children who were assigned to three groups. Group 1 (study group) included patients with ALL treated at the Center (n = 48, the median age was 14.0 years). Group 2 (control group) included patients with various serious diseases (acute myeloid leukemia, primary immunodeficiency, CNS malignancies, bone tumors, etc.) who also underwent treatment at the Center (n = 69, the median age was 14.5 years). Group 3 (control group) included healthy children and adolescents (n = 67, the median age was 14.2 years). We analyzed the characteristics of video recordings of the supine-to-stand process in apparently healthy children (Group 3) and in the patients treated at the Center (Groups 1 and 2) and then performed comparative analysis. We managed to detect, document, and divide into phases the video-based criteria of invariant characteristics of the acyclic locomotor pattern of the STS movement (from a supine to standing position with both feet on the floor). We identified the STS movement phases and clinically significant variants of STS transition patterns which were easily detectable on the video recordings. The objectivity of the analysis of the video-based criteria of invariant characteristics of the STS movement was achieved by the registration of timing characteristics of the locomotion pattern phases on video recordings. By calculating the coefficients of variation for observations from different angles and inter-researcher variability, we detected the most representative phases of the STS movement pattern on video recordings. A quantitative analysis of the STS test performance revealed significant differences between healthy controls and children with oncological diseases. The clinical analysis of video recordings of the basic motor patterns (CLAVIR) contributes a substantial amount of objective data to the clinical assessment of the diagnostic supine-to-stand test results in children and adolescents treated for ALL.
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Teixeira, Sara Reis, Jorge Elias Junior, Marcello Henrique Nogueira-Barbosa, Marcos Duarte Guimarães, Edson Marchiori, and Marcel Koenigkam Santos. "Whole-body magnetic resonance imaging in children: state of the art." Radiologia Brasileira 48, no. 2 (April 2015): 111–20. http://dx.doi.org/10.1590/0100-3984.2014.0005.
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Whole-body imaging in children was classically performed with radiography, positron-emission tomography, either combined or not with computed tomography, the latter with the disadvantage of exposure to ionizing radiation. Whole-body magnetic resonance imaging (MRI), in association with the recently developed metabolic and functional techniques such as diffusion-weighted imaging, has brought the advantage of a comprehensive evaluation of pediatric patients without the risks inherent to ionizing radiation usually present in other conventional imaging methods. It is a rapid and sensitive method, particularly in pediatrics, for detecting and monitoring multifocal lesions in the body as a whole. In pediatrics, it is utilized for both oncologic and non-oncologic indications such as screening and diagnosis of tumors in patients with genetic syndromes, evaluation of disease extent and staging, evaluation of therapeutic response and post-therapy follow-up, evaluation of non neoplastic diseases such as multifocal osteomyelitis, vascular malformations and syndromes affecting multiple regions of the body. The present review was aimed at describing the major indications of whole-body MRI in pediatrics added of technical considerations.
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Dondurey, E. A., L. N. Isankina, O. I. Afanasyeva, A. V. Titeva, T. V. Vishnevskaya, V. A. Kondrat`ev, I. A. Gryaznova, M. V. Berezina, M. A. Zolotova, and V. M. Volzhanin. "Characteristics of CoVID-19 in children: the first experience in the hospital of st. Petersburg." Journal Infectology 12, no. 3 (August 2, 2020): 56–63. http://dx.doi.org/10.22625/2072-6732-2020-12-3-56-63.
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Objective: to identify the clinical, laboratory and epidemiological features of the new coronavirus (CV) infection in the provision of specialized medical care to children in the megalopolis of the Russian Federation. Methods: 674 cases of hospitalization of patients from birth to 17 years old inclusive with confirmed COVID-19 in the period from March 26 to June 26, 2020 in a children’s multidisciplinary hospital in St. Petersburg. Diagnostics of SARS-COV-2 in upper respiratory tract (URT) smears was carried out by PCR (a set of reagents for detecting RNA of coronavirus 2019-nCoV by PCR with hybridization-fluorescence detection “Vector-PCRRV-2019-nCoV-RG”). Patients underwent 4 (3; 5) repeated examinations depending on the diagnosis of the referral, as well as the duration of the convalescent virus carriage. The analysis of the severity of the course of the disease, the main clinical manifestations and their relationship with the development of pneumonia, as well as the epidemiological features of COVID-19 in children. The duration of inpatient treatment, outcomes and the need for intensive care are described. Changes in a number of laboratory parameters on analyzers made in the USA were assessed: a clinical blood test on a hematological one - Coulter UniCel (Beckman Coulter), a biochemical blood test on a biochemical one - Uni Cel DxC (Beckman Coulter), a coagulogram on a hemostasis analyzer (Instrumentation Laboratory). Results: Overall, there was a favorable course of COVID-19 in children. Intensive therapy was required only in 3.6% of cases with a total mortality rate of 0.15%, Kawasakilike syndrome was recorded in 0.3% of cases. In 1/3 of patients, prolonged viral shedding from the upper respiratory tract was detected. In children, intrafamilial infection from adults was in the lead; schoolchildren accounted for half of all hospitalizations. A distinctive feature of the new infection was mild clinical symptoms with fever and catarrhal symptoms up to 4/5 of cases, gastrointestinal symptoms - in every third patient. There were no significant differences in the severity of the disease by age. Pneumonia, diagnosed in ¾ cases by computed tomography, complicated the course in 13.1% of cases. The defeat of the lungs was accompanied by fever and dry cough, and in a more severe course: desaturation, chest pains, a feeling of insufficiency of inspiration. The age peaks of the incidence of pneumonia were revealed: at 4, 9, 12 years old and at the age of 17 years, the maximum (in 1/3 of cases). Laboratory changes were insignificant and quickly reversible. Conclusion: the course of COVID-19 in children in the megalopolis of Russia is comparable with foreign information. However, taking into account the experience of “Spanish ‘flu”, it is possible that in pediatric practice the number of severe forms and unfavorable outcomes may change in the near future, especially due to the difficulty of diagnosing Kawasaki-like syndrome and the need for a multidisciplinary approach to the treatment of such patients. Currently, the most vulnerable to the new CV are children with severe oncological, neurological and cardiovascular pathology, who have a rapid decompensation of the underlying disease against the background of COVID-19.
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Kolomiiets, S. V., K. O. Udaltsova, and V. I. Shynkevych. "RECOMMENDED TACTICS FOR THE EVALUATION OF POTENTIALLY MALIGNANT DISORDERS IN THE ORAL CAVITY." Ukrainian Dental Almanac, no. 1 (March 21, 2018): 75–78. http://dx.doi.org/10.31718/2409-0255.1.2018.18.
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Since oral cavity, head and neck are relatively well-visualized anatomical sites, the dentists have multifold possibilities for the evaluation of the oral mucosa, face skin, lips, and neck lymph nodes during their routine work. Dentists are the specialists who are able to detect malignant tumors and refer patients to the oncologists.
The aim of the article is to compare the clinical recommendations of the Ministry of Healthcare of Ukraine and the recommendation made by the American Dental Association (ADA) in their updated clinical practice guidelines for the evaluation of potentially malignant disorders in the oral cavity.
Basic principles of the oncological alertness in dentistry, and the route organization of clinical patient. The usage of the classification of precancerous diseases, proposed by Ye.V. Borovskyi, M.F. Danilevskyi, A.L. Mashquillain (1991) is the first step of the oncological alertness in dentistry. The role of dentist is adjuvant and helps to identify a suspicious oral lesion. A pattern of action in such situations is referring patients directly to an oncologist, who will conduct a biopsy, histological examination and treat the cancer. Consequently, the attention of Ukrainian dentists is focused on precancerous lesions, but less attention is paid actually to the cancer. Responsibility for dispanserisation (clinical follow up) is carried mainly by dentists-surgeons without participation of orthopedists, pediatric dentists, and orthodontists. Those involve whole series of redirections of the patient among dentists themselves, before referring to the really necessary specialist, and it represents a negative item in the organization.
In contrast to the algorithm provided by the Ministry of Healthcare of Ukraine, doing an immediate biopsy in patients with a suspicious oral lesion – or referring a patient to a specialist who can do that – remains the only most important recommendation made by the American Dental Association (ADA) in their updated clinical practice guidelines for the evaluation of potentially malignant disorders in the oral cavity.
Epidemiological data in Ukraine, unlike the USA, is not enough to understand the real situation and to plan the measures of oncological alertness.
Risk factors for malignant lesions in the oral cavity. The role of HPV-related cancer of the oral cavity is underestimated in Ukraine. “Over the past 20 years HPV infection has surpassed tobacco and alcohol as a major risk factor [for head and neck cancer],” the ADA authors note, and they estimate that HPV infection causes approximately 75% of all OPSCCs identified today.
Adjunctive test for precancerous and cancerous cases in the oral cavity (include autofluorescence, tissue reflectance, vital staining, and salivary adjuncts) is recognized by the Ukrainian and American experts, as “adjuncts”, none of which was felt to be accurate enough to identify target lesions in the primary care setting. These methods do not exceed the accuracy of the histological examination.
Conclusions. Regardless the geography, dentists have a good opportunity to assess patients for oral cancer caused by traditional head and neck risk factors. Dentists of Ukraine have a good opportunity at the primary care setting to get reports about head and neck cancer prevention, and to inform their patients. The clinical route of a patient with suspected oral lesions is flexible and is connected with appropriate consulting centers, which facilitates the activity of a dentist, but creates additional redirections instead of referring to the specialist immediately. Ukrainian dentists should take signs of HPV-related cancer – cancer that occur at the back of the throat, at the base of the tongue, and on the tonsils – are difficult if not impossible to visualize. So dentists must be trained not only to look inside the mouth but also to assess patients for tonsillar asymmetry.
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Grundy, Richard, and Ann Goldman. "Management of pain in haematological and oncological diseases." Current Paediatrics 3, no. 4 (December 1993): 238–42. http://dx.doi.org/10.1016/0957-5839(93)90093-k.
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Verna, Marta, Attilio Rovelli, Valentino Conter, Marta Canesi, Ignazio Majolino, Dosti Othman, Vian Faeq, et al. "Methodology for the Start-up of a Pediatric Hematopoietic Stem Cell Transplant Unit (pHSCTU) in Middle-Income Countries (MICs): An Exportable Model?" Blood 134, Supplement_1 (November 13, 2019): 2044. http://dx.doi.org/10.1182/blood-2019-121922.
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Introduction: Blood or marrow transplantation (BMT) programs are largely insufficient to meet the growing need in MICs. Where BMT is not available families, charities or governments often seek for alternative programs, usually to send children abroad for BMT; this policy is associated with many drawbacks, including costs, and difficulties to manage transplant related complications after the patient return home. Evaluation of feasibility and sustainability plays a crucial role in the success of all cooperative projects but especially of high specialization ones. Materials and methods: In 2016 the first HSCTU inclusive of a pediatric section was developed in Iraqi Kurdistan at Hiwa Cancer Hospital of Sulaymaniah, thanks to a cooperative project funded by the Italian Agency for Development Cooperation and to the availability of professionals from specialized centers to train local personnel. After verifying with an appropriate grid that essential requirements were in place, a capacity building project was started. An intensive educational course was carried on initially and then, using a training on the job approach, all specific skills were set-up and/or implemented. A complete protocol handbook was created with involvement of the local staff; a staggered approach to the disease was chosen, starting from low risk diseases and moving later to high risk ones. After 3 years project the center is now completely autonomous; up to now they have been performed 158 transplants (autologous and allogeneic, both in adult and children) with results comparable with those of high-income countries (HICs). In a cohort of 26 pediatric patients with thalassemia the event free survival (EFS) is over 90% with a median follow up of 492 days. Next to this experience, in 2018 a new project has been activated in Paraguay, following a specific request from the pediatric hospital Ninos de Acosta Nu in Asuncion. The similar methodology has been applied. After documenting the feasibility, a 3 years project has been set-up, with an initial intensive educational course, followed by training on the job by experts in the field and also limited training of the local staff abroad. A six months continuously oversight by experienced nurses and periodically by expert physicians has been planned along with the continuous support through on line contacts; focused training in Europe on minimal residual disease, chimerism, apheresis and HLA typing has been scheduled. The first allogeneic transplant from matched sibling donor is planned in autumn 2019. Discussion: Based on our experience new centers should start with patients highly curable, low-risk matched sibling transplants, well-established context-appropriate protocols with minimal toxicity, proven high success rates and contained costs. If socio-economical context of the country and needs of the population allow to move to oncological patients, a staggered approach is suggested: from matched sibling donor transplant to mismatched ones. Minimal essential requirements for a pediatric BMT start-up activity may be affordable in many MICs, if health authorities and/or local charities/foundations are committed. This shall include good quality blood products (leuco-reduced or irradiated); drugs for conditioning regimens (busulphan, tiothepa, fludarabine, cyclophosphamide, melphalan), GVHD prophylaxis and treatment (methotrexate, thymoglobuline, cyclosporine, mycophenolate mofetil), infections control (broad spectrum antibiotics, one anti-mold drug, ganciclovir) and essential laboratory tests (at least cyclosporin levels and citomegalovirus copies count). Conclusion: The strategy described above requires the availability of expert BMT physicians and nurses willing to rotate periodically in MICs Units for training on the job and supervision. This model is replicable in different contexts, allows a fast development of BMT units in MICs, and in our opinion compares favorably with that of offering training to multiple professionals in specialized centers. Figure Disclosures No relevant conflicts of interest to declare.
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Proleskovskaya, I. V., O. I. Bydanov, and N. E. Konoplya. "Epidemiology of neuroblastoma in children in the Republic of Belarus." Russian Journal of Pediatric Hematology and Oncology 8, no. 1 (April 7, 2021): 35–42. http://dx.doi.org/10.21682/2311-1267-2021-8-1-35-42.
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Introduction. Neuroblastoma (NB) in children is a rare disease, accounting for 7 % of all cases of oncological diseases in childhood. In this regard, epidemiological analysis requires the accumulation of data over a long period of time. The purpose of the study is to study the morbidity, mortality and survival rate of children 0–14 years old with NB in the Republic of Belarus (RB).Materials and methods. Based on the data from the children’s cancer subregister, morbidity, mortality and survival rates in child population were calculated from 1997 to 2017. A comparative epidemiological analysis was carried out in 2 time periods (1997–2007, 2008–2017).Results and discussion. The incidence rate of NB in the RB, standardized for age, was 1.142 ± 0.062 per 100 000 child population with an average annual growth rate of 3.2 % per year. The mortality rate for this period was 0.32 ± 0.03 per 100 000 child population, an increase of 0.51 % per year. The main cause of death in patients with NB is the recurrence of the underlying disease. In 2008, a single protocol was used to treat all risk groups, which led to a significant increase in the observed population survival rate from 56 % (1997–2007) to 72 % (2008–2017) (p = 0.0041). Comparing the age structure of morbidity in Germany and the RB, it is noted that we have a reliably later diagnosis of the disease in the age categories from 0 to 1 year, from 1 to 4 years, from 5 to 9 years. The median age of the patient at the time of diagnosis in Germany is 1 year and 2 months, in our country 1 year and 6 months.Conclusion. Indicators of standardized morbidity and mortality from NB in the RB correspond to the indicators of cancer registries in Western Europe and the USA. However, analyzing the age of the specific incidence of the disease, insufficient diagnosis of the disease is noted in the periods from 0 to 1 year, from 1 to 4 years and from 5 to 9 years compared to the data in Germany. This requires further improvement of the pediatric oncology service in the country.
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Wood, William A., and Stephanie J. Lee. "Malignant hematologic diseases in adolescents and young adults." Blood 117, no. 22 (June 2, 2011): 5803–15. http://dx.doi.org/10.1182/blood-2010-12-283093.
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Abstract Adolescents and young adults (AYA) with cancer have been designated as a vulnerable population by the National Cancer Institute. This group, defined by the ages of 16-39 years, has not enjoyed the same survival improvements over the past several decades as older and younger cohorts. Several barriers prevent the optimal delivery of oncologic care in this subpopulation. This review will describe these challenges in the context of the major hematologic malignancies affecting this population (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], Hodgkin lymphoma [HL], and non-Hodgkin lymphoma [NHL]). For example, historical differences in care delivery between pediatric and adult health care systems have created confusion about optimal treatment planning for AYAs, a population that spans the pediatric-adult divide. In the case of ALL, retrospective studies have demonstrated significantly better outcomes when AYAs are treated according to pediatric and not adult protocols. Additional challenges more specific to AYAs include increased treatment-related toxicity relative to younger patients; less access to care and, specifically, access to clinical trials; lower adherence to medications and treatment plans; and psychosocial stressors relevant to individuals at this stage of life. Recognizing and responding to these challenges in AYAs may create opportunities to improve the cancer outcomes of this group.
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Balmukhanova, Altynay, Kairat Kabulbayev, and Assiya Kanatbayeva. "Fibroblast growth factor 23 (FGF-23) and chronic kidney disease in children." Journal "Medicine" 11-12, no. 221-222 (January 30, 2021): 43–48. http://dx.doi.org/10.31082/1728-452x-2020-221-222-11-12-43-48.
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Chronic kidney disease (CKD) in children is a complex medical and social problem in healthcare. One of the serious complications is mineral bone disorder (MBD), the pathogenesis of which is related to a new biomarker of bone origin - fibroblast growth factor 23 (FGF-23). The aim. To study the features of fibroblast growth factor 23 (FGF-23) in children with chronic kidney disease. Material and methods. A cross-sectional study was carried out on 73 children with CKD and 14 healthy children. Inclusion criteria: chronic kidney disease stage 1-5, written informed consent of the participants. The exclusion criteria: tubulopathy, infectious and inflammatory processes, oncological diseases, kidney transplant, condition after surgery, taking glucocorticosteroids, calcium and vitamin D drugs. We took fasting blood samples of participants and carried out an enzyme-linked immunosorbent assay in order determine the level of FGF-23 (Biomedica Medizinprodukte GmbH, Austria). The obtained data were analyzed using IBM SPSS, version 22 (New York, USA). Results and discussion. In healthy children, the median (Q1-Q3) level of FGF-23 in serum was 0.65 (0.22-0.98) pmol/l, in patients with stage 1 CKD it was 0.65 (0.22-1.08) pmol/l. At stage 2, the level of FGF-23 significantly increased in comparison with healthy individuals and with patients of stage 1, p≤0.05. Further, there is a gradual increase by stages, p≤0.05. Thus, in stage 3 patients, the median FGF-23 value was 1.9 (1.15-3.5) pmol/l, at stage 4 - 3.55 (2.48-6.35) pmol/l, at 5 stages - 14 (7.5-18.75) pmol/l. As a percentage, there were 7.1% of patients at the stage 1 with increased levels of phosphatonin, at stage 2 - 53.3%, at stage 3 - 69.2%, respectively. At stages 4 and 5, absolutely 100% of patients had high levels of FGF-23. At the same time, FGF-23 did not depend on gender, age, birth weight and type of renal replacement therapy at stage 5, p>0.05. Conclusions. Thus, in our study, we determined the features of changes FGF-23 in serum in children at various stages of CKD. The obtained results allow us to consider FGF-23 as a predictor of the clinical course of CKD. Keywords: fibroblast growth factor 23, phosphatonin, pediatric nephrology, chronic kidney disease, mineral-bone disorder.