Publications by authors named "Luis Juárez-Villegas"

20 Publications

  • Page 1 of 1

Association of Genetic Polymorphisms and Serum Levels of IL-6 and IL-8 with the Prognosis in Children with Neuroblastoma.

Cancers (Basel) 2021 Jan 30;13(3). Epub 2021 Jan 30.

Subdirección de Pediatría Ambulatoria Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Col Doctores, Delegación Cuauhtémoc, Ciudad de Mexico 06720, Mexico.

There is evidence that high circulating levels of IL-6 and IL-8 are markers of a poor prognosis in various types of cancer, including NB. The participation of these cytokines in the tumor microenvironment has been described to promote progression and metastasis. Our objective was to evaluate the prognostic role of genetic polymorphisms and serum levels of IL-6 and IL-8 in a cohort of Mexican pediatric patients with NB. The detection of the SNPs rs1800795 IL-6 and rs4073 and rs2227306 IL-8 was carried out by PCR-RFLP and the levels of cytokines were determined by the ELISA method. We found elevated circulating levels of IL-8 and IL-6 in NB patients compared to the control group. The genotype frequencies of the rs1800795 IL-6 and rs4073 IL-8 variants were different between the patients with NB and the control group. Likewise, the survival analysis showed that the GG genotypes of rs1800795 IL-6 ( = 0.014) and AA genotypes of rs4073 IL-8 ( = 0.002), as well as high levels of IL-6 ( = 0.009) and IL-8 ( = 0.046), were associated with lower overall survival. We confirmed the impact on an adverse prognosis in a multivariate model. This study suggests that the SNPs rs1800795 IL-6 and rs4073 IL-8 and their serum levels could be promising biomarkers of a poor prognosis, associated with overall survival, metastasis, and a high risk in Mexican children with NB.
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http://dx.doi.org/10.3390/cancers13030529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866803PMC
January 2021

Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis.

Front Oncol 2020 21;10:608282. Epub 2021 Jan 21.

Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.

Background: The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all age groups, including the pediatric population, in 3-5% of all cases. We performed a meta-analysis to understand the survival and associated complications in pediatric cancer patients as well as their hospitalization, intensive care, and ventilation care (supplemental oxygen/endotracheal intubation) needs.

Methods: A systematic search was performed using MEDLINE, TRIP Database, International Clinical Trials Registry Platform (WHO), The Cochrane Library, Wiley, LILACS, and Google Scholar. Additionally, a search using the snowball method was performed in , , , , , , , and . Searches were conducted until July 18, 2020. A total of 191 cancer patients with coronavirus disease 2019 (COVID-19) were integrated from 15 eligible studies. In a sub-analysis, patients were stratified into two groups: hematological cancer and solid tumors. Outcome measures were overall survival, risk of hospitalized or needing intensive care, and need for ventilatory support in any modality. The random effects statistical analysis was performed with Cochran's chi square test. The odds ratio (OR) and heterogeneity were calculated using the I test.

Results: The overall survival was 99.4%. There were no statistically significant differences in the risk of hospitalization between hematological malignancies and solid tumors (95% confidence interval [CI] 0.48-18.3; OR = 2.94). The risk of being admitted to the intensive care unit was also not different between hematological malignancies and other tumors (95% CI 0.35-5.81; OR = 1.42). No differences were found for the need of ventilatory support (95% CI 0.14-3.35; OR = 0.68). Although all the studies were cross-sectional, the mortality of these patients was 0.6% at the time of analysis.

Conclusions: In the analyzed literature, survival in the studied group of patients with COVID-19 was very high. Suffering from hematological neoplasia or other solid tumors and COVID-19 was not a risk factor in children with cancer for the analyzed outcomes.
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http://dx.doi.org/10.3389/fonc.2020.608282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861039PMC
January 2021

COVID-19 in Children and Adolescents With Cancer From a Single Center in Mexico City.

J Pediatr Hematol Oncol 2020 Dec 14. Epub 2020 Dec 14.

Department of Pediatric Oncology and Hematology, Hospital Infantil de México "Federico Gómez", National Institute of Health, México City.

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http://dx.doi.org/10.1097/MPH.0000000000002040DOI Listing
December 2020

Acute myeloid leukemia associated with t(16:21)(p11;q22) in a pediatric patient.

Bol Med Hosp Infant Mex 2020 ;77(6):327-330

Departmento de Oncología. Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

Background: Background">Rare subgroups of pediatric patients with acute myeloid leukemia (AML), such as t(16:21) (p11;q22), require international cooperation to establish a proper stratification system to assign clinical risk.

Case Report: Here, we report a 13-year-old female who was admitted for asthenia, fatigue, and intermittent fever. The hematological data showed thrombocytopenia and anemia, and the bone marrow test showed 82.5% blast cells, which were positive for CD13, CD33, CD38, and CD117. Blast cells showed negative myeloperoxidase staining and positive periodic acid-Schiff staining. A diagnosis of AML M6 was made. Cells were positive for the fusion transcript FUS-ERG t(16;21)(p11;q22). The patient achieved morphological remission. However, molecular remission was not achieved, and she died 11 months after diagnosis.

Conclusions: It is essential to report this sporadic case of AML to provide clinicians with data for clinical decision-making, such as for risk-group stratification. To the best of our knowledge, this is the first association between this translocation and this morphological subtype.
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http://dx.doi.org/10.24875/BMHIM.20000025DOI Listing
January 2020

Survival in pediatric patients with cancer during the COVID-19 pandemic: scoping systematic review.

Bol Med Hosp Infant Mex 2020 ;77(5):234-241

Investigación Clínica. Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

Background: Coronavirus disease (COVID)-19 has currently affected 8,015,502 million people worldwide with global mortality around 5%. Information in pediatric cancer patients is still limited, but it is emerging day by day. The objective of this scoping review was to analyze the available data associated with COVID-19 infection and mortality in pediatric cancer patients and to provide useful information to plan and design strategies in this group.

Methods: A search was conducted, and eight articles were obtained for qualitative analysis; 110 patients were included, all from cross-sectional studies. At the time of publication, all the analyzed documents reported no deaths associated with COVID-19.

Results: According to the information, COVID-19 infection appears to be less severe in the pediatric population in comparison with adults and does not appear to be a cause of mortality in patients with childhood cancer.

Conclusions: Given the nature of preliminary reports and a short follow-up in cancer patients, it is necessary to have medium- and long-term follow-up studies to determine the effects of infection and modifications to the treatments of these patients.
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http://dx.doi.org/10.24875/BMHIM.20000174DOI Listing
October 2020

Efficacy and safety of oral magnesium supplementation in reducing febrile neutropenia episodes in children with solid tumors treated with cisplatin-based chemotherapy: randomized clinical trial.

Cancer Chemother Pharmacol 2020 Nov 8;86(5):673-679. Epub 2020 Oct 8.

Research Uniton Gerontology, Facultad de Estudios Superiores Zaragoza, UNAM, Mexico City, Mexico.

Purpose: Hypomagnesemia has been associated with febrile neutropenia (FN) in pediatric patients receiving cisplatin-based chemotherapy (CDDPBC). The primary aim was to determine whether oral magnesium supplementation reduces FN episodes in pediatric patients with solid tumors treated with CDDPBC.

Method: This randomized clinical trial, with open-label, single-center, parallel group and superiority design was conducted in Hospital Infantil de Mexico Federico Gomez at Mexico City. Children ≥ 9 years with solid tumors that were to receive a CDDPBC cycle were invited to participate. Each chemotherapy cycle with CDDPBC was randomly assigned to receive oral magnesium supplementation (250 mg/day) or not receive magnesium supplementation (control group). Efficacy was determined by relative risks (RR) with 95% confidence intervals (95% CI) as well as with numbers needed to treat (NNT). Active surveillance was conducted to assess safety in both groups. Analyses were carried out by intention to treat. ClinicalTrials.gov number NCT03449693.

Results: One hundred and one chemotherapy cycles with CDDPBC were analyzed (50 in the magnesium supplement arm and 51 in control group). Baseline clinical characteristics were similar comparing both groups. Oral magnesium supplementation reduces FN episodes compared to control group [RR 0.53, (95% CI 0.32-0.89), NNT = 4]. In the supplemented group, patients had fewer episodes of septic shock secondary to FN [RR 0.43, (95% CI 0.02-0.94), NNT = 6] and FN appeared on average 5 days later (p = 0.031). Hypomagnesemia episodes and adverse events were similar across both groups.

Conclusion: Oral supplementation with magnesium reduces FN episodes neutropenia in pediatric patients with solid tumors treated with CDDPBC.
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http://dx.doi.org/10.1007/s00280-020-04155-4DOI Listing
November 2020

Patient and health service factors associated with delays in cancer treatment for children without social security in Mexico.

Pediatr Blood Cancer 2020 09 15;67(9):e28331. Epub 2020 Jul 15.

Division of Social Protection and Health. Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica.

Background: The objective was to investigate factors associated with patient-related timing (PRT) to seek healthcare and health service-related timing (HSRT) to diagnose cancer and provide treatment to children without social security in Mexico.

Procedure: A cross-sectional survey was conducted in 13 Ministry of Health hospitals in the states of Chihuahua, Jalisco, Mexico City, Morelos, Oaxaca, Puebla, Queretaro, State of Mexico, and Tlaxcala. Study participants were parents of recently diagnosed pediatric cancer patients (≤ 17 years of age). Three groups of factors were investigated: (1) patients (child and parent characteristics); (2) healthcare providers (HCPs) (first-contact HCP, institution, perceptions of barriers to healthcare, etc.); and (3) disease factors (cancer type/site, stage/risk at diagnosis). PRT and HSRT-associated factors were identified using multiple negative binomial regressions.

Results: The study included 265 children; 49% sought care when symptoms first appeared. The median PRT was seven days, and the median HSRT was 40 days. Parents' perceptions of long wait times for appointments were associated with longer PRT and HSRT. Residing in the lowest or highest socioeconomic regions and persistent or worsening symptoms increased the probability of longer PRT. Older patient age, HCP requests for imaging tests or prescription for steroids, a higher number of doctors consulted, having a urinary tract cancer, and having an advanced stage or high-risk cancer increased the probability of longer HSRT.

Conclusion: Strategies to shorten lag time from symptom onset to diagnosis and treatment are urgently needed for childhood cancers in Mexico.
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http://dx.doi.org/10.1002/pbc.28331DOI Listing
September 2020

The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis.

Pathol Oncol Res 2020 Oct 13;26(4):2693-2701. Epub 2020 Jul 13.

Research Methodology Department, Instituto Nacional de Pediatria, Mexico City, Mexico.

There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.
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http://dx.doi.org/10.1007/s12253-020-00875-3DOI Listing
October 2020

A case series of cutaneous lymphomas in Mexico.

Bol Med Hosp Infant Mex 2020 ;77(2):90-93

Universidad Veracruzana, Xalapa, Veracruz. México.

Background: Primary cutaneous lymphomas are a rare heterogeneous group of T and B cell skin neoplasms without any evidence of extracutaneous disease at the time of diagnosis, which show considerable differences in histology, phenotype and prognosis.

Case Reports: Five cases of cutaneous lymphomas treated at the Hospital Infantil de México Federico Gómez from 2010 to 2018 are described. The most frequent clinical presentations in these patients were dermatitis, blood scabs, and necrotic ulcers. The most common immunophenotype was non-Hodgkin T/NK primary nasal extranodal cutaneous lymphomas. The treatment scheme used in most patients was SMILE. The average time to diagnosis was 7 months.

Conclusions: The prognosis depends on the stage of the disease at diagnosis, the degree of skin involvement, and the presence of extracutaneous disease. As primary cutaneous lymphomas are infrequent neoplasms, the stage of the disease is usually advanced and generally shows an aggressive behavior due to a late diagnosis.
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http://dx.doi.org/10.24875/BMHIM.19000126DOI Listing
January 2020

Safety and efficacy of step-down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial.

Pediatr Blood Cancer 2020 06 20;67(6):e28251. Epub 2020 Mar 20.

Oncology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: It has been suggested that low-risk febrile neutropenia (FN) episodes can be treated in a step-down manner in the outpatient setting. This recommendation has been limited to implementation in middle-income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step-down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low-risk FN.

Procedure: A noninferiority randomized controlled clinical trial was conducted in three hospitals in Mexico City. Low-risk FN was identified in children younger than 18 years. After 48 to 72 hours of intravenous treatment, children were randomly allocated to receive outpatient oral treatment (experimental arm, cefixime) or to continue inpatient treatment (standard of care, cefepime). Daily monitoring was performed until neutropenia resolution. The presence of any unfavorable clinical outcome was the endpoint of interest. We performed a noninferiority test for comparison of proportions.

Results: We identified 1237 FN episodes; 117 cases were randomized: 60 to the outpatient group and 57 for continued inpatient treatment. Of the FN episodes, 100% in the outpatient group and 93% in the inpatient group had a favorable outcome (P < 0.001). The mean duration of antibiotics was 4.1 days (SD 2.5; 95% CI, 3.4-4.8 days) in the outpatient group and 4.4 days (SD 2.5; 95% CI, 3.7-5.0 days) in the inpatient group (P = 0.70).

Conclusions: In our population, step-down oral outpatient treatment of low-risk FN was as safe and effective as inpatient intravenous treatment. Clinical Trials Identifier: NCT04000711.
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http://dx.doi.org/10.1002/pbc.28251DOI Listing
June 2020

Medication errors in a cohort of pediatric patients with acute lymphoblastic leukemia on remission induction therapy in a tertiary care hospital in Mexico.

Cancer Med 2019 10 24;8(13):5979-5987. Epub 2019 Aug 24.

Directorate of Research, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.

Introduction: Medication errors (MEs) are the main type of preventable adverse events in medical care, as well as safety indicators in the medication processes. Advances in the quality of care in pediatric acute lymphoblastic leukemia (ALL) have enabled to improve clinical outcomes. However, ME epidemiology in pediatric oncology is still incipient in developing countries. In view of this, the objectives of this study were to estimate the incidence of MEs, determine their types and consequences, as well as their preventability in the induction treatment of children with ALL at Hospital Infantil de Mexico Federico Gómez.

Methods: We reviewed the remission-induction chemotherapy records of children with ALL between January 2015 and December 2017. A two-phase review was carried out for ME identification and verification. The consequences of errors were determined by agreement between reviewers.

Results: We reviewed 1762 chemotherapy orders involving 181 children. MEs were observed in 16.9% of orders and in 57.5% of patients. Prescription errors were the most common (93.3%), with wrong dose errors (90.2%) being predominant. Only 3.7% of wrong dose errors were intercepted, while 12.2% of the children experienced adverse drug events (ADEs) preceded by some wrong dose error.

Conclusions: MEs were common, since they occurred in 57.5% of children with ALL on induction treatment and involved 16.5% of chemotherapy orders. Only 3.7% of MEs were intercepted, while 12.2% of children had ADEs related to overdose. Measures are required to prevent calculation error in prescriptions, as well as training of the nursing staff to intercept MEs.
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http://dx.doi.org/10.1002/cam4.2438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792484PMC
October 2019

Expression of YY1 in Wilms tumors with favorable histology is a risk factor for adverse outcomes.

Future Oncol 2019 Apr 27;15(11):1231-1241. Epub 2019 Feb 27.

Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico.

Aim: To investigate the role of the transcription factor YY1 in Wilms tumor (WT).

Patients & Methods: We measured YY1 expression using tissue microarray from patients with pediatric renal tumors, mainly WT and evaluated correlations with the predicted clinical evolution. YY1 expression was measured using immunohistochemical and protein expression was determined by digital pathology.

Results & Conclusion: YY1 significantly increased in WT patients. In addition, an increase in YY1 expression had a greater risk of adverse outcomes in WT patients with favorable histology. YY1 expression was higher in the blastemal component of tumors, and high nuclear expression positively correlated with metastasis. YY1 may be considered as a metastasis risk factor in WT.
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http://dx.doi.org/10.2217/fon-2018-0764DOI Listing
April 2019

Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment.

Bol Med Hosp Infant Mex 2019 ;76(1):35-43

Departamento de Oncología Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Cuidad de México. México.

Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients.

Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish.

Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = -0.720 and r = -0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01).

Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.
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http://dx.doi.org/10.24875/BMHIM.18000146DOI Listing
January 2020

[The horizon of medical attention in pediatrics: what to do in the case of children who are in abandonment, conflict, harm or danger situations in combination with a severe disease?]

Bol Med Hosp Infant Mex 2018 ;75(3):166-177

Hospital Infantil de México Federico Gómez. Ciudad de México, México.

Background: Laws refer that minors do not have the capability to give informed consent for their own medical attention. However, there are special conditions in which they are allowed to decide about their health. The greater the judgement and experience limitations in minors, the less weight is given to the values and objectives they express. Also, the more adverse consequences might be, the higher the level of authority that is demanded to decide on behalf of the minor, thus granting the State the capability to guarantee the well-being of the minor.

Case Report: 12-year-old female patient with a diagnosis of acute lymphoblastic leukemia, with precarious social and family background; evolution of the disease obstructed by the disregard of the treatment due to her unsanitary and extreme poverty conditions. Both of her parents died soon after the start of the treatment and she was kept under the care of her half-sister of legal age. The work and the ethical dilemma of the pediatrician and the staff of Hospital Infantil de México Federico Gómez are exposed within the building of support -networks with the objective of prioritizing the minor's well-being, without allowing family break-up or disintegration, thus succeeding in her recovery.

Conclusions: The case was submitted to the Hospital Bioethics Committee. Inter-institutional support networks were built in order to improve dynamics of the family, thus solving the needs of the minor. Despite the misfortune of the situation, the disease was successfully overcome.
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http://dx.doi.org/10.24875/BMHIM.M18000022DOI Listing
August 2019

Genomics of a pediatric ovarian fibrosarcoma. Association with the DICER1 syndrome.

Sci Rep 2018 02 19;8(1):3252. Epub 2018 Feb 19.

Clinical Area, Instituto Nacional de Medicina Genomica, Mexico City, Mexico.

Ovarian fibrosarcomas are extremely rare tumors with little genomic information available to date. In the present report we present the tumoral exome and transcriptome and the germinal exome of an ovarian fibrosarcoma from a 9-years old child. We found a paucity of mutations (0.77/Mb) and CNV alterations. Of these, the most relevant were a point mutation in the metal-binding site of the microRNA-processing DICER1 enzyme and a frame-shift alteration in the tumor suppressor gene NF1. We validated a germinal truncating mutation in DICER1, which was consistent with a DICER1 Syndrome diagnosis, providing the first example of an ovarian fibrosarcoma as the presenting neoplasia in this syndrome. Network and enrichment analyses showed that both a mesenchymal signature and a Hedgehog cascade could be driving the progression of this tumor. We were also able to find a global lincRNA deregulation, as the number of lincRNAs transcripts expressed in the tumor was decreased, with a concomitant upregulation of previously described non-coding transcripts associated with cancer, such as MALAT1, MIR181A1HG, CASC1, XIST and FENDRR. DICER1 Syndrome should be considered as a possible diagnosis in children ovarian fibrosarcoma. The role of lncRNAs in neoplasias associated with DICER1 alterations need to be studied in more detail.
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http://dx.doi.org/10.1038/s41598-018-21663-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818504PMC
February 2018

A strategy for the clinical remission of acute lymphoblastic leukemia elicited by treatment of β-thalassemia major: A case report.

Mol Clin Oncol 2018 Feb 8;8(2):375-377. Epub 2017 Dec 8.

Department of Hematology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.

Acute lymphoblastic leukemia (ALL) has been suggested as a long-term complication in patients with β-thalassemia major (β-TM). A 12-months-old male patient was diagnosed with β-TM. The patient required a blood transfusion weekly for 2 years. At the age of 4 years, a splenectomy was performed due to massive splenomegaly and frequent transfusion requirements. The histopathological analysis of the spleen revealed extensive hemosiderosis. ALL-L1 with the T immunophenotype and without central nervous system (CNS) involvement was diagnosed when the patient was 5 years old, and treated with anti-leukemic combination chemotherapy and CNS radiotherapy. The patient completed 24 months of treatment and has been in complete remission for 7 years, without long-term adverse events.
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http://dx.doi.org/10.3892/mco.2017.1533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776416PMC
February 2018

[Review of models for the analysis of ethical dilemmas].

Bol Med Hosp Infant Mex 2015 Mar - Apr;72(2):89-98. Epub 2015 Jul 2.

Hospital Infantil de México Federico Gómez, México, D.F., México; Universidad Nacional Autónoma de México, México, D.F., México. Electronic address:

In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations. A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell. The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.
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http://dx.doi.org/10.1016/j.bmhimx.2015.03.006DOI Listing
July 2015

[Malignant neoplasms in the neonate].

Bol Med Hosp Infant Mex 2014 Sep - Oct;71(5):261-270. Epub 2015 May 19.

Enseñanza, Instituto Nacional de Pediatría, México D.F., México.

Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.
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http://dx.doi.org/10.1016/j.bmhimx.2014.05.004DOI Listing
May 2015

Interleukin-1 receptor antagonist gene polymorphism increases susceptibility to septic shock in children with acute lymphoblastic leukemia.

Pediatr Infect Dis J 2013 Feb;32(2):136-9

Division of Pediatric Oncology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

Background: Interleukin-1 receptor antagonist polymorphism (ILRN) 2 (ILRN*2) has been associated with a poor outcome in septic patients because of an elevated production of anti-inflammatory cytokines. In >70% of patients, morbidity and mortality in childhood acute lymphoblastic leukemia is caused by infections. The aim of this study was to determine the association between this polymorphism and the frequency of septic shock from the time of diagnosis until completion of treatment.

Methods: This cohort study was conducted in 57 consecutive children with acute lymphoblastic leukemia. At the end of follow-up, children were stratified according to their IL1RN polymorphism (ILRN*1/ILRN*2), evaluating the impact of genotype on the severity of febrile neutropenic events during their treatment.

Results: Overall survival was 80% at 55 months after treatment. The average number of febrile neutropenic events in this cohort was 2.82 per patient. Genotype distribution was 50.9% for homozygote IL-1RN*1, 38.6% for heterozygote ILRN*1/ILRN*2 and 10.5% for homozygote IL-1RN*2. The risk of presenting septic shock for homozygote IL1RN*2/IL1RN*2 and heterozygote ILRN*1/ILRN*2 patients was significantly greater (odds ratio, 45; P = 0.001) adjusted for age, gender, risk of leukemia and presence of pathogenic bacteria. Genotype IL-1RN*2 is associated with the risk of development of septic shock in children with acute lymphoblastic leukemia. Further research in larger population-based studies is needed to replicate these findings.

Conclusions: This information would allow us to identify more predictive factors in this group of acute lymphoblastic leukemia patients in whom this information is lacking to establish an earlier and more aggressive approach.
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http://dx.doi.org/10.1097/INF.0b013e31827566ddDOI Listing
February 2013

Activated charcoal to prevent irinotecan-induced diarrhea in children.

Pediatr Blood Cancer 2008 Jul;51(1):49-52

Department of Pediatric Hematology and Oncology, Hospital Civil de Guadalajara, Dr. Juan I. Menchaca, Guadalajara, Jalisco, México.

Background: We performed a prospective study to evaluate the efficacy of activated charcoal (AC) to prevent irinotecan-induced diarrhea (IID).

Procedure: We designed a prospective trial including all patients receiving irinotecan as part of their chemotherapy treatment. Patients were divided into two groups. The experimental group received AC at a dose of 250 mg three times daily during irinotecan administration. The number and severity of events were graded according to the gastrointestinal toxicity criteria of the NCI Common Toxicity Criteria. We used descriptive statistics, Mann-Whitney U test, and Fisher's exact test to evaluate our results.

Results: Twenty-two evaluable patients were included for a total of 66 irinotecan chemotherapy cycles. Ten patients received AC and 12 did not. There were 45 cycles in the experimental group and 21 in the control group. A total of 28 events of diarrhea were registered, 13 in 45 cycles (28.88%) in the experimental group and 15 in 21 cycles (71.42%) in the control group (P = 0.002). Grade 3 and 4 diarrhea was present in 4.4% of patients receiving AC against 52.3% in the controls (P = 0.010). Chemotherapy was discontinued in 6.6% in the experimental group and 52.3% in the control group.

Conclusions: The use of AC decreased the frequency and severity of IID improving compliance with treatment. We consider AC and effective and safe prophylactic treatment to prevent IID.
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http://dx.doi.org/10.1002/pbc.21491DOI Listing
July 2008