RESUMO
BACKGROUND: Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS: A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS: Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION: Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.
Assuntos
Síndrome de Down/epidemiologia , Hipersensibilidade/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Modelos Logísticos , Masculino , México/epidemiologiaRESUMO
BACKGROUND: For a child to develop acute leukaemia (AL), environmental exposure may not be sufficient: interaction with a susceptibility factor to the disease, such as Down syndrome (DS), may also be necessary. We assessed whether breastfeeding and early infection were associated with the risk of developing AL in children with DS. METHODS: Children with DS in Mexico City, and either with or without AL, were the cases (N=57) and controls (N=218), respectively. Population was divided in children with AL and with acute lymphoblastic leukaemia (ALL) and also in children < or = 6 and >6 years old. RESULTS: Breastfeeding and early infections showed moderate (but not significant) association for AL, whereas hospitalisation by infection during the first year of life increased the risk: odds ratios (confidence interval 95%) were 0.84 (0.43-1.61), 1.70 (0.82-3.52); and 3.57 (1.59-8.05), respectively. A similar result was obtained when only ALL was analysed. CONCLUSION: We found that breastfeeding was a protective factor for developing AL and ALL, and during the first year of life, infections requiring hospitalisation were related to a risk for developing the disease in those children with DS >6 years of age. These data do not support the Greaves's hypothesis of early infection being protective for developing ALL.
Assuntos
Aleitamento Materno/efeitos adversos , Síndrome de Down/complicações , Infecções/complicações , Infecções/epidemiologia , Leucemia Mieloide/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Doença Aguda , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide/complicações , Leucemia Mieloide/diagnóstico , Masculino , Razão de Chances , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Análise de Regressão , Inquéritos e QuestionáriosAssuntos
Síndrome de Down/complicações , Exposição Ambiental/efeitos adversos , Leucemia Mieloide Aguda/etiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Criança , Síndrome de Down/genética , Feminino , Humanos , Leucemia Mieloide Aguda/epidemiologia , Masculino , México/epidemiologia , Fatores de Risco , Fumar/efeitos adversosRESUMO
OBJECTIVE: To measure the incidence rate and trend of acute leukemia (AL) in political districts of Mexico City. MATERIAL AND METHODS: Descriptive longitudinal study conducted at six hospitals that care for nearly 97.5% of all cancer cases among children in Mexico City. Study data were collected in 1995 and 1996, and were analyzed in 1999, at the National Medical Center "Siglo XXI" Children's Hospital, of the Mexican Institute for Social Security. Calculations of acute leukemia annual incidence rates, standardized rates, and standardized morbidity rates (SMR) with 95% confidence intervals, were obtained for each district. Morbidity trends were assessed through average change rates. RESULTS: In this study we observed an increasing trend of acute lymphoblastic leukemia (ALL) incidence in five districts: Alvaro Obregon, Cuauhtemoc, Gustavo A. Madero, Iztacalco, and Venustiano Carranza. Acute myeloblastic leukemia (AML) showed no significantly statistic increase of incidence in any district. AML did show a significant SMR in Alvaro Obregon district (SMR = 2.91, 95% CI 1.63-4.80). Higher SMRs were found in the south and southwest areas of the city. CONCLUSIONS: Increasing incidence of ALL was observed in five districts of Mexico City. AML incidence was the highest in Alvaro Obregon district.
Assuntos
Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Criança , Humanos , Incidência , Estudos Longitudinais , México/epidemiologiaRESUMO
UNLABELLED: Our objective was to compare the neurologic and psychological sequelae of children with acute lymphoblastic leukemia (ALL) after three or more years without antineoplasic treatment who underwent cranial irradiation plus intrathecal methotrexate (Group 1) or just intrathecal methotrexate (Group 2). In both groups, a neurologic evaluation, electroencephalogram (EEG) and cranial computed tomography (CCT) were performed. Intellectual quotient and the Bender test were done for the psychological evaluation. Investigators did not know the kind of treatment of each patient. STATISTICS: Fisher's exact test and Mann-Whitney U. There were fourteen patients in group 1 and eight patients in group 2. Intellectual quotient was statistically lower in the first group (median 83.5) than in the second (90.5). Neurologic impairments were found in one patient of each group, alterations of the EEG were found in 6 and 4 in group 1 and 2, respectively, and in the CCT of two patients in group 2 without statistical difference. Children with ALL after cranial irradiation have a greater alteration of intellectual performance than children with intrathecal methotrexate. Neurologic alterations were seen in both groups.
Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Encéfalo/efeitos da radiação , Inteligência , Metotrexato/administração & dosagem , Doenças do Sistema Nervoso/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Radioterapia/efeitos adversos , Adolescente , Fatores Etários , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Interpretação Estatística de Dados , Eletroencefalografia , Feminino , Humanos , Lactente , Injeções Espinhais , Inteligência/efeitos dos fármacos , Inteligência/efeitos da radiação , Testes de Inteligência , Masculino , Exame Neurológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Testes Psicológicos , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios XRESUMO
The objective of this study was to determine the validity of a questionnaire to measure daily performance as an evaluation of quality of life in pediatric leukemia patients. A questionnaire of the daily activities of a child according to Lickert's criteria was done. A pilot survey was performed in patients without a chronic or disabling disease in order to assess its validity. The impression of the medical attendance of each pediatric patient with leukemia, of their daily performance, was compared with the results of the instrument. A trained nurse applied the questionnaire to 60 mothers of patients (29 female/31 male) as outpatients during the clinical review. Fifteen questionnaires were applied twice to evaluate its consistency. According to the results, 77% of the patients were in remission. 15% in relapse, and 8% during induction to remission. The mean age of the patients was 9 = 3.6 years, ranging from 2-16 years. One hundred percent of the patients obtained a satisfactory grade greater than 35 points. In conclusion, the questionnaire identified adequately the level of the daily performance in addition to the specific affected areas of the patients with leukemia. Our findings are that their level of performance is satisfactory and is not affected because of the disease or the phase of the treatment.
Assuntos
Atividades Cotidianas , Leucemia , Qualidade de Vida , Inquéritos e Questionários , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Leucemia/psicologia , Masculino , Projetos PilotoRESUMO
The objective of this study was to identify the tendency of acute leukemia among children in Mexico City from 1982 to 1991. A hospital survey was performed. Medical records of children under 15 years of age with a diagnosis of acute leukemia were reviewed. The cases were chosen from hospitals which provide medical attention to children with cancer in Mexico City. The annual incidence rate (AIR) was calculated in general, by sex, age groups (under 1 year of age, from 1 to 4 years, 5 to 9 years and 10 to 14 years) and standardized with the world population. The trend was evaluated with Spearman's correlation method. Acute lymphoblastic leukemia showed a significantly increasing trend during the study period. The AIR was 7.75 (per million) in 1982 and 22.19 (per million) in 1991. For age groups a tendency to increase was observed in females of age group 1 to 4 years and in males of age group 10 to 14 years. Acute non-lymphoblastic leukemia did not display a specific trend. In conclusion, acute lymphoblastic leukemia shows a tendency to increase in the children of Mexico City.
Assuntos
Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Estudos RetrospectivosRESUMO
A randomized clinical trial was performed in children with cancer, fever and neutropenia, to evaluate the efficacy of amikacin once daily versus thrice daily dosing plus carbenicillin in both groups. Fifty patients were included, 25 patients in group A who received amikacin once daily and 25 in group B who received amikacin thrice daily. No intergroup differences were observed, i.e., fever diminished in a median of 6 days (2-8 days) vs. 7 days (3-12 days) in groups A and B respectively (p = 0.37);clinical improvement was observed in a median of 6 days (3-10 days) vs 7 days (2-14 days) (p = 0.68). One patient in group A and two in B died. The peak levels of amikacin on the 7th day of treatment were 10-60 and 7-25 micrograms/mL in groups A and B respectively, and the serum creatinine levels were 0.3 - 0.7 for group A and 0.2 - 0.8 mg/dL for group B; none of the patients presented a creatinine above 40% of the basal value. Three patients of group A had amikacin levels higher than 40 micrograms/mL without increasing the creatinine levels; our observations do not suggest that toxicity is higher. We conclude that the administration of aminoglycoside once daily seems to be as effective as the traditional dosing.