Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Hidroxiureia/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Fortalecimento Institucional , Criança , República Dominicana/epidemiologia , Humanos , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Ultrassonografia Doppler TranscranianaRESUMO
BACKGROUND: In the Dominican Republic, where the burden of sickle cell anemia (SCA) is high, many children lack access to routine screening and preventative care. Children with SCA are at risk for stroke, an event that leads to significant morbidity and mortality. In the United States, screening via transcranial Doppler (TCD) identifies children with SCA at highest stroke risk, allowing early intervention with blood transfusions. The need for indefinite transfusions for primary stroke prevention limits their practicality in limited-resource countries. Hydroxyurea has been shown to lower TCD velocities and to prevent conversion from conditional (170 to 199 cm/sec) to abnormal (greater than or equal to 200 cm/sec) velocities. In resource-limited settings, implementation of a TCD screening program, coupled with hydroxyurea therapy, could reduce the burden of SCA and stroke. OBJECTIVE: The aims of the Stroke Avoidance for Children in REpública Dominicana (SACRED) trial are (1) to screen children with SCA for stroke risk using TCD and to determine the prevalence of elevated velocities in a cross-sectional sample; (2) to identify clinical and laboratory correlates of elevated velocities; and (3) to obtain longitudinal data on the natural history of TCD velocities and to measure therapeutic effects of hydroxyurea. METHODS: This prospective trial, designed and conducted by Cincinnati Children's Hospital Medical Center (CCHMC) and Hospital Infantil Robert Reid Cabral (HIRRC) with Centro de Obstetricia y Ginecología, includes a baseline cross-sectional epidemiological survey of the distribution of TCD velocities across a large cohort of children with SCA in the Dominican Republic. Children with conditional velocities are eligible to begin protocol-directed hydroxyurea if laboratory criteria are met. The treatment schedule begins with a fixed-dose of approximately 20 mg/kg/day for 6 months, after which it escalates to maximum tolerated dose (MTD). All participants undergo longitudinal annual TCD evaluation, while those on hydroxyurea have semi-annual evaluations during the 3-year study period. Data are collected using an Internet-based Research Electronic Data Capture (REDCap) system with forms translated into Spanish; both remote and on-site monitoring are used. RESULTS: To date, 122 children with SCA have enrolled in SACRED including 85 (69.7%, 85/122) with normal, 29 (23.8%, 29/122) with conditional, 5 (4.1%, 5/122) with abnormal, and 3 (2.5%, 3/122) with inadequate TCD velocities. Of the 29 children with conditional TCD velocities, 17 (59%, 17/29) have initiated hydroxyurea per protocol, with plans for escalation to MTD. CONCLUSIONS: The SACRED trial will provide novel epidemiologic data about the prevalence of children with SCA and increased stroke risk in the Dominican Republic. The study also includes an investigation of the impact of hydroxyurea at MTD on elevated TCD velocities, as well as clinical and laboratory parameters. The design and implementation of SACRED reflect a successful international institutional partnership, one that features local capacity building and training in research methods and clinical care. The trial's results have important implications for screening and prevention of primary stroke in children with SCA living in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT02769845; https://www.clinicaltrials.gov/ct2/show/NCT02769845 (Archived by WebCite at http://www.webcitation.org/6qf6n0Egh).
RESUMO
Sickle cell disease (SCD) is a significant problem in the Caribbean, where many individuals have African and Asian forebears. However, reliable prevalence data and specific health care programs for SCD are often missing in this region. Closer collaboration between Caribbean territories initiated in 2006 to set up strategies to promote better equity in the health care system for SCD patients led to the formation of CAREST: the Caribbean Network of Researchers on Sickle Cell Disease and Thalassemia. We present the effectiveness of collaborations established by CAREST to promote SCD newborn screening programs and early childhood care, to facilitate health worker training and approaches for prevention and treatment of SCD complications, and to carry out inter-Caribbean research studies.
Assuntos
Anemia Falciforme/etnologia , Promoção da Saúde/organização & administração , Triagem Neonatal , Pesquisa/organização & administração , Talassemia/etnologia , Região do Caribe/epidemiologia , Comportamento Cooperativo , Competência Cultural , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Capacitação em Serviço , Idioma , PrevalênciaRESUMO
Bridging the survival gap for children with cancer, between those (the great majority) in low and middle income countries (LMIC) and their economically advantaged counterparts, is a challenge that has been addressed by twinning institutions in high income countries with centers in LMIC. The long-established partnership between a Central American consortium--Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA)--and institutions in Europe and North America provides a striking example of such a twinning program. The demonstrable success of this endeavor offers a model for improving the health outcomes of children with cancer worldwide. As this remarkable enterprise celebrates its 15th anniversary, it is appropriate to reflect on its origin, subsequent growth and development, and the lessons it provides for others embarking on or already engaged in similar journeys. Many challenges have been encountered and not all yet overcome. Commitment to the endeavor, collaboration in its achievements and determination to overcome obstacles collectively are the hallmarks that stamp AHOPCA as a particularly successful partnership in advancing pediatric oncology in the developing world.
Assuntos
Institutos de Câncer/organização & administração , Serviços de Saúde da Criança/organização & administração , Gerenciamento Clínico , Cooperação Internacional , Neoplasias/prevenção & controle , Pediatria/organização & administração , América Central , Criança , Conservação dos Recursos Naturais , Europa (Continente) , HumanosRESUMO
BACKGROUND: The prevalence of malnutrition in children may exceed 50% in countries with limited resources. The aims of this study were to assess nutritional status at diagnosis in children and adolescents with cancer, and to correlate it with clinical outcomes in the Spanish speaking countries of Central America that formed the AHOPCA (Asociacion de Hemato-Oncologia Pediatrica de Centro America) consortium. METHODS: Patients aged 1-18 years, diagnosed with cancer between 1st October 2004 and 30th September 2007, were eligible for study. Weight (kg) and height or length (m), mid upper arm circumference--MUAC and triceps skin fold thickness--TSFT were measured and their Z-scores or percentiles were calculated. Three categories of nutritional status were defined according to these parameters. RESULTS: A total of 2954 new patients were enrolled; 1787 had all anthropometric measurements performed and 1513 also had measurements of serum albumin. By arm anthropometry 322/1787 patients (18%) had moderate nutritional depletion and 813/1787 patients (45%) were severely depleted. Adding serum albumin, the proportion classified as severely depleted rose to 59%. Malnourished children more often abandoned therapy and their event free survival was inferior to that of other children. CONCLUSIONS: Arm anthropometry in children with cancer is a sensitive measure of nutritional status. Since malnutrition at diagnosis was related to important clinical outcomes, an opportunity exists to devise simple, cost-effective nutritional interventions in such children that may enhance their prospects for survival.
Assuntos
Países em Desenvolvimento , Desnutrição/diagnóstico , Neoplasias/diagnóstico , Estado Nutricional , Adolescente , Antropometria , Braço/anatomia & histologia , Estatura , Peso Corporal , América Central/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Desnutrição/epidemiologia , Neoplasias/complicações , Neoplasias/fisiopatologia , Prevalência , Dobras CutâneasRESUMO
La adolescencia es un proceso de desarrollo de múltiples dimensiones que incluyen los significados sociales que se le atribuyen colocando a la juventud en un limbo social; no son niños o niñas pero todavia no son adultos. Es importante contextualizar las dificultades que enfrentan los adolescentes gay debido a su identidad sexual, su vulnerabilidad social asociada a su particular etapa de desarrollo y su etnicidad. Exploramos las vulnerabilidades y fortalezas de una muestra de jóvenes adolescentes gay puertorriqueños. Participaron 61 jóvenes gay y bisexuales de alto nivel educativo, que residían en Puerto Rico. Examinamos los niveles de depresión, el apoyo social percibido, el uso de alcohol y drogas y la conducta sexual. Los resultados demuestran que el 45 por cento de los participantes informaron altos niveles de depresión. Sin embargo los participantes también mostraron un bajo consumo de alcohol y drogas, poca o ninguna actividad sexual de riesgo y una gran satisfacción con el apoyo social recibido. Los participantes mostraron gran resiliencia asociada a sus redes de apoyo social, el uso consistente de protección en las conductas sexuales de alto riesgo y capacidad para integrar su orientación sexual en su desarrollo personal en una sociedad latina y heterosexista. Apesar de que los resultados no pueden generalizarse a toda la población de jóvenes adolescentes gay en Puerto Rico, esta información es útil para apoyar la necesidad de intervenciones a nivel de comunidad que manejen las fortalezas de esta población (AU)
Assuntos
Adolescente , Humanos , Masculino , Homossexualidade/psicologia , Bissexualidade/psicologia , Psicologia do Adolescente , Porto RicoRESUMO
La adolescencia es un proceso de desarrollo de múltiples dimensiones que incluyen los significados sociales que se le atribuyen colocando a la juventud en un limbo social; no son niños o niñas pero todavia no son adultos. Es importante contextualizar las dificultades que enfrentan los adolescentes gay debido a su identidad sexual, su vulnerabilidad social asociada a su particular etapa de desarrollo y su etnicidad. Exploramos las vulnerabilidades y fortalezas de una muestra de jóvenes adolescentes gay puertorriqueños. Participaron 61 jóvenes gay y bisexuales de alto nivel educativo, que residían en Puerto Rico. Examinamos los niveles de depresión, el apoyo social percibido, el uso de alcohol y drogas y la conducta sexual. Los resultados demuestran que el 45 por cento de los participantes informaron altos niveles de depresión. Sin embargo los participantes también mostraron un bajo consumo de alcohol y drogas, poca o ninguna actividad sexual de riesgo y una gran satisfacción con el apoyo social recibido. Los participantes mostraron gran resiliencia asociada a sus redes de apoyo social, el uso consistente de protección en las conductas sexuales de alto riesgo y capacidad para integrar su orientación sexual en su desarrollo personal en una sociedad latina y heterosexista. Apesar de que los resultados no pueden generalizarse a toda la población de jóvenes adolescentes gay en Puerto Rico, esta información es útil para apoyar la necesidad de intervenciones a nivel de comunidad que manejen las fortalezas de esta población
Assuntos
Humanos , Masculino , Adolescente , Bissexualidade/psicologia , Homossexualidade/psicologia , Psicologia do Adolescente , Porto RicoRESUMO
Comunicamos seis casos con diagnóstico de esferocitosis hereditaria, realizados en la Clínica Infantil Dr. Robert Read Cabral. Se discute el valor del diagnóstico en pacientes con trastorno hemolítico, ausencia de hemoglobinopatía y test de Coombs negativo. Se destaca el papel curativo que tiene la esplenectomía en relación a las manifestaciones clínicas de la enfermedad
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Esferocitose HereditáriaRESUMO
Se ha estudiado in vivo, en gatos domésticos y en macacos thesus, la incorporación de ascorbato y dehidroascorbato (DHA) al humor acuoso.l En el gato se encontró que los niveles de ayunas de ascorbato en el humor acuoso (1.49 mg%) se mantienen unas 6 veces por encima de los séricos, lo cual se ha tomado como undcación de la existencia de un proceso de transporte activo para ascorbato en el cuerpo ciliar de este animal. También se ha determinado que la transferencia de ascorbato al humor acuoso en el gato tiene dos componentes, uno saturable, mediado, con parámetros cinéticos Tm = 4.9 mg% y Kt = 0,53 mg%, que debe ser responsable del transporte activo, y otro que nos es saturable, sino tipo difusión sencilla. En el mono se detectó un sistema de transporte mediado, sin componente difusivo, con Tm = 22.6 mg% y Kt = 0.28mg%, y capaz de mantener en el humor acuoso una concentración de ascorbato 25 veces mayor que en el plasma. Los valores de ayunas de ascorbato en el suero del mono (0.69 mg%) se mantienen sobre el suero del mono (0.69 mg%) se mantienen sobre el nivel de saturación del sistema de transporte, a diferencia de lo que ocurre en el gato. DHA no pudo detectarse en el plasma del gato ni del mono, ni en el humor acuoso del gato. Sí pudo detectarse, sin embargo, en el humor acuoso del mono, a niveles de un 3% de la concentración de ascorbato total. La cinética de la incorporación de ascorbato al ojo del gato y del mono tras la inyección intravenosa de DHA apoya la idea de que la especie molecular que el cuerpo ciliar transporta es la forma reducida, ascorbato, y no DHA. Este sería convertido intravascularmente (leucocitos y hematíes) a ascorbato, antes de incorporarse al humor acuoso