RESUMEN
BACKGROUND AND PURPOSE Endemic Burkitt's lymphoma (eBL) remains the prevalent form of paediatric cancer in tropical Africa with subtle pathological differences. This calls for intensified efforts to validate the global prognostic markers within local settings for improved cancer treatment and survival. This study proposes prognostic markers for enhanced eBL treatment and management. PATIENTS AND METHOD One hundred and eighty histologically and/or clinically diagnosed BL patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana were eligible for this cross-sectional eight-year retrospective study. Biochemical, clinical and demographic data, before chemotherapy administration, were documented and examined for their progression-free (PFS) and overall survival (OS) significance. RESULTS A mean age of 6 (SD=2.7, range: 1-16) years was observed with general male dominance (M:F=1.69:1). Total serum lactate dehydrogenase (HR=2.04; 95% CI, 1.25-3.32; log rank=8.3; p=0.004), serum creatinine (HR=3.59; 95% CI, 1.62-7.98; log rank=15.4; p=0.002) and St. Jude stage (HR=1.74; 95% CI, 1.11-2.73; log rank=8.0; p=0.015) were important independent prognostic biochemical markers for both PFS and OS. Age, serum calcium, uric acid, potassium, sodium and phosphorus were non-prognostic. CONCLUSION The better monitoring of these prognostic indices coupled with risk-stratification treatment may improve patients' survival, especially in resource-limited settings.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores/análisis , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/mortalidad , Adolescente , Linfoma de Burkitt/metabolismo , Niño , Preescolar , Estudios Transversales , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Ghana , Humanos , Lactante , Masculino , Metotrexato/administración & dosificación , Prednisolona/administración & dosificación , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Vincristina/administración & dosificaciónRESUMEN
BACKGROUND AND PURPOSE Endemic Burkitt's lymphoma (eBL) remains the prevalent form of paediatric cancer in tropical Africa with subtle pathological differences. This calls for intensified efforts to validate the global prognostic markers within local settings for improved cancer treatment and survival. This study proposes prognostic markers for enhanced eBL treatment and management. PATIENTS AND METHOD One hundred and eighty histologically and/or clinically diagnosed BL patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana were eligible for this cross-sectional eight-year retrospective study. Biochemical, clinical and demographic data, before chemotherapy administration, were documented and examined for their progression-free (PFS) and overall survival (OS) significance. RESULTS A mean age of 6 (SD=2.7, range: 1-16) years was observed with general male dominance (M:F=1.69:1). Total serum lactate dehydrogenase (HR=2.04; 95% CI, 1.25-3.32; log rank=8.3; p=0.004), serum creatinine (HR=3.59; 95% CI, 1.62-7.98; log rank=15.4; p=0.002) and St. Jude stage (HR=1.74; 95% CI, 1.11-2.73; log rank=8.0; p=0.015) were important independent prognostic biochemical markers for both PFS and OS. Age, serum calcium, uric acid, potassium, sodium and phosphorus were non-prognostic. CONCLUSION The better monitoring of these prognostic indices coupled with risk-stratification treatment may improve patients' survival, especially in resource-limited settings (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Ciclofosfamida/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores/análisis , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/mortalidad , Linfoma de Burkitt/epidemiología , Estudios Transversales/métodos , Estudios Transversales/tendencias , Doxorrubicina/administración & dosificación , Ghana/epidemiología , Metotrexato/administración & dosificación , Prednisolona/administración & dosificación , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Linfoma de Burkitt/metabolismoRESUMEN
Hemolytic anemia is common in sickle cell disease (SCD), but the course and extent differ, depending on genetic, epigenetic, and environmental factors. In the malaria-endemic tropical environment, some vulnerable subjects would be infected and the impact of infection would vary. Therefore, this study was to find malaria incidence and the associated changes in some laboratory indices in 330 SCD subjects. Following blood smear preparation for falciparum detection, hematological and biochemical indices were measured for a comparison of parasitemic and age-matched, genotype-matched, and sex-matched nonparasitemics. For sixty-nine parasitemics, constituting about 21% of all subjects studied, and sixty-six matched nonparasitemics, hematological indices (hemoglobin, white-cell count, red-cell count, mean cellular volume, reticulocyte count, and HbF) as well as biochemical indices (LDH, total bilirubin, AST, and ALT) were determined. For all quantities, except the reticulocyte count (12.3% ± 12.4% for parasitemics and 23.6% ± 17.7% for nonparasitemics), no statistically significant differences were observed. Classification of both cohorts according to their genotypes showed some intergenotypic differences for hemoglobin and WBC counts. Mathematical modeling of the reticulocyte counts shows the distribution in the parasitemics followed an exponential pattern, while the nonparasitemic showed a polynomial distribution, with each model characterized by an equation of best fit. The study has shown about 21% incidence of parasitemia. All differences in the indices can be seen as normal variations, unattributable to the malaria infection. However, the lower reticulocyte count in the parasitemic is a reflection of lowered erythropoietic activity because of the infection.
Asunto(s)
Anemia de Células Falciformes/sangre , Malaria Falciparum/epidemiología , Parasitemia/epidemiología , Plasmodium falciparum , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/genética , Niño , Preescolar , Estudios Transversales , Recuento de Eritrocitos , Femenino , Ghana/epidemiología , Humanos , Incidencia , Masculino , Cooperación del Paciente , Recuento de ReticulocitosRESUMEN
Endemic Burkitt's lymphoma (BL) is a juvenile malignant neoplasm of B-lymphocyte origin, markedly affected by climate, vegetation and geographical location. This real country-based, cross-sectional, retrospective study reviews all out-patient clinical records of patients histologically and/or clinically diagnosed with BL from January, 2000 to December, 2007 at the Komfo Anokye Teaching Hospital, Ghana, a country within the malaria and lymphoma belts of the world. The aim of the study is to clinically and epidemiologically characterise all cases of BL over an eight-year period to ascertain the most common form of BL demographically prevalent. A mean age of 6.9 +/- 2.7 (range: 1-16) was observed. Males generally dominated in incidence (M:F=1.43:1, P<0.001) and significantly with facial presentation (P<0.05). Females weakly dominated in abdominal tumour presentation (P>0.05). The age range 4-8 years was the high risk range (P<0.001) for both sexes. Males were affected early in life (4-7 years) compared to their female counterparts (6-11 years). Of the 551 cases reviewed, 48.3%, 32.7%, 15.8% and 3.3% involved the face, abdomen, combined facial and abdominal and either facial or abdominal with central nervous system (CNS) involvement (usually paraplegia), respectively. An intriguing observation was evident between facial and combined facial and abdominal cases which exhibited reversed trends in incidence. Three regions within the forest zone showed significantly higher (P<0.001) incidences compared to the seven cohorts from the coastal and savannah agro-ecological zones of Ghana. No region was explicitly associated with any particular clinical presentation. The study has shown that although BL can present with demographic patterns in prevalence within a given geographical location, no clinical characterisation is associated with such patterns.
Asunto(s)
Linfoma de Burkitt/epidemiología , Adolescente , Distribución por Edad , Linfoma de Burkitt/patología , Niño , Preescolar , Femenino , Ghana/epidemiología , Humanos , Lactante , Masculino , Estudios Retrospectivos , Distribución por SexoRESUMEN
BACKGROUND: Young infant mortality has remained high and relatively unchanged compared with deaths of older infants. Strategies to reduce infant mortality, however, are mostly targeted at the older child. OBJECTIVES: To describe the clinical profile of sick young infants presenting to a hospital and to define important signs and symptoms that will enable health workers to detect young infants with severe illness requiring hospital admission. METHODS: Young infants aged 0-59 days presenting to a paediatric out-patient clinic were evaluated by a nurse using a standardised list of signs and symptoms. A paediatrician independently evaluated these children and decided whether they needed hospitalisation. RESULTS: A total of 685 young infants were enrolled, 22% of whom were <7 days of age. The commonest reasons for seeking care were jaundice in the 0-6-day group, skin problems in the 7-27-day group and cough in the 28-59-day group. The primary clinical diagnoses for admissions were sepsis in the 0-6- and 7-27-day groups and pneumonia in the 28-59-day group. Clinical signs and symptoms predicting severe illness requiring admission were general (history of fever, difficult feeding, not feeding well and temperature >37.5 degrees C) and respiratory (respiratory rate > or =60/min, severe chest in-drawing). CONCLUSION: General and respiratory signs are important predictors for severe illness in young infants. Training peripheral health workers to recognise these signs and to refer to hospital for further assessment and management might have a significant impact on young infant mortality.
Asunto(s)
Enfermedad Aguda/epidemiología , Enfermedades del Recién Nacido/diagnóstico , Triaje/métodos , Factores de Edad , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Ghana/epidemiología , Hospitalización , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Infecciones/diagnóstico , Infecciones/epidemiología , Servicio Ambulatorio en Hospital , Pronóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , Triaje/normasRESUMEN
BACKGROUND: Many conventional treatments for uncomplicated malaria are failing because malaria parasites develop resistance to them. One way to combat this resistance is to treat people with a combination of drugs, such as atovaquone-proguanil. OBJECTIVES: To compare atovaquone-proguanil with other antimalarial drugs (alone or in combination) for treating children and adults with uncomplicated Plasmodium falciparum malaria. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (June 2005), CENTRAL (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), LILACS (1982 to June 2005), reference lists, and conference abstracts. We also contacted relevant pharmaceutical manufacturers and researchers. SELECTION CRITERIA: Randomized controlled trials comparing atovaquone-proguanil with other antimalarial drugs for treating children and adults confirmed to have uncomplicated P. falciparum malaria. DATA COLLECTION AND ANALYSIS: Three authors independently assessed trial eligibility and methodological quality, and extracted data for an intention-to-treat analysis (where possible). We used relative risk (RR) and 95% confidence intervals (CI) for dichotomous data. We contacted trial authors for additional information where needed. MAIN RESULTS: Ten trials, with a total of 2345 participants, met the inclusion criteria. The trials were conducted in four geographical regions and were often small, but they included comparisons across eight drugs. Nine trials were funded by a pharmaceutical company, only three carried out an intention-to-treat analysis, and allocation concealment was unclear in seven. Atovaquone-proguanil had fewer treatment failures by day 28 than chloroquine (RR 0.04, 95% CI 0.00 to 0.57; 27 participants, 1 trial), amodiaquine (RR 0.22, 95% CI 0.13 to 0.36; 342 participants, 2 trials), and mefloquine (RR 0.04, 95% CI 0.00 to 0.73; 158 participants, 1 trial). There were insufficient data to draw a conclusion for this outcome from comparisons with sulfadoxine-pyrimethamine (172 participants, 2 trials), halofantrine (205 participants, 1 trial), artesunate plus mefloquine (1063 participants, 1 trial), quinine plus tetracycline (154 participants, 1 trial), and dihydroartemisinin-piperaquine-trimethoprim-primaquine (161 participants, 1 trial). Adverse events were mainly common symptoms of malaria and did not differ in frequency between groups. AUTHORS' CONCLUSIONS: Data are limited but appear to suggest that atovaquone-proguanil is more effective than chloroquine, amodiaquine, and mefloquine. There are insufficient data for comparisons against sulfadoxine-pyrimethamine, halofantrine, artesunate plus mefloquine, quinine plus tetracycline, and dihydroartemisinin-piperaquine-trimethoprim-primaquine in treating malaria. There are not enough data to assess safety, but a number of adverse events were identified with all drugs. Large trials comparing atovaquone-proguanil with other new combination therapies are needed.