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Castelán-Martínez OD, Palomo-Colli MA, Barrios-López VE, Silva-Jivaja KM, Juárez-Villegas LE, Castañeda-Hernández G, Sánchez-Rodríguez MA. 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; 86:673-679. [PMID: 33030582 DOI: 10.1007/s00280-020-04155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
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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Affiliation(s)
- Osvaldo D Castelán-Martínez
- Clinical Pharmacology Laboratory, UMIEZ, Facultad de Estudios Superiores Zaragoza, UNAM, Batalla 5 de mayo s/n esquina Fuerte de Loreto, Col. Ejército de Oriente, Iztapalapa, CP 09230, Mexico City, Mexico.
| | - Miguel A Palomo-Colli
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Victoria E Barrios-López
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,Pharmacology Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Karla M Silva-Jivaja
- Clinical Pharmacology Laboratory, UMIEZ, Facultad de Estudios Superiores Zaragoza, UNAM, Batalla 5 de mayo s/n esquina Fuerte de Loreto, Col. Ejército de Oriente, Iztapalapa, CP 09230, Mexico City, Mexico
| | - Luis E Juárez-Villegas
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Gilberto Castañeda-Hernández
- Pharmacology Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
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Juárez-Villegas LE, Díaz-Salazar Y, Palomo-Collí MÁ, Vega-Real EV, Moctezuma-Juan ODLÁ. A case series of cutaneous lymphomas in Mexico. Bol Med Hosp Infant Mex 2020; 77:90-93. [PMID: 32226002 DOI: 10.24875/bmhim.19000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Luis E Juárez-Villegas
- Departamento de Oncología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Miguel Á Palomo-Collí
- Departamento de Oncología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
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Vázquez-Cornejo E, Morales-Ríos O, Juárez-Villegas LE, Islas Ortega EJ, Vázquez-Estupiñán F, Garduño-Espinosa J. 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; 8:5979-5987. [PMID: 31445000 PMCID: PMC6792484 DOI: 10.1002/cam4.2438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/28/2019] [Accepted: 07/08/2019] [Indexed: 11/09/2022] Open
Abstract
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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Affiliation(s)
- Edmundo Vázquez-Cornejo
- Post-degree in Medical, Dentistry and Health Sciences, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Evidence-based Medicine Unit, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Olga Morales-Ríos
- Department of Clinical Research, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Luis E Juárez-Villegas
- Department of Oncology, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Erika J Islas Ortega
- Department of Pharmaceutical Services, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | | | - Juan Garduño-Espinosa
- Directorate of Research, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
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Gutiérrez-Vargas R, Velasco-Rojano E, Villasís-Keever MÁ, Portilla-Robertson J, Gutiérrez-Rodelo A, Flores-Navarro S, Juárez-Villegas LE, Zapata-Tarrés M. Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment. Bol Med Hosp Infant Mex 2019; 76:35-43. [PMID: 30657465 DOI: 10.24875/bmhim.18000146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Rosaura Gutiérrez-Vargas
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México. México
| | | | - Miguel Á Villasís-Keever
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México. México
| | - Javier Portilla-Robertson
- Coordinación de Patología Bucal, División de Estudios de Posgrado, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad de México. México
| | | | | | - Luis E Juárez-Villegas
- Departamento de Oncología Médica, Hospital Infantil de México Federico Gómez, Ciudad de México. México
| | - Marta Zapata-Tarrés
- Departamento de Oncología Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Cuidad de México. México
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Guadarrama-Orozco JH, Cantú-Quintanilla GR, Ávila-Montiel D, Altamirano-Bustamante M, Peláez-Ballestas I, Caballero-Velarde C, Juárez-Villegas LE, Vega-Morell NDL, Kelly-García J, Hoyos-Bermea AD, Dorantes-Acosta E, Gamboa-Marrufo JD, Muñoz-Hernández O, Garduño-Espinosa J. [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; 75:166-177. [PMID: 29799532 DOI: 10.24875/bmhim.m18000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
| | | | | | | | | | | | | | | | - Javier Kelly-García
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS. Ciudad de México, México
| | | | | | | | - Onofre Muñoz-Hernández
- Hospital Infantil de México Federico Gómez. Ciudad de México, México.,Universidad Nacional Autónoma de México. Ciudad de México, México
| | - Juan Garduño-Espinosa
- Hospital Infantil de México Federico Gómez. Ciudad de México, México.,Universidad Nacional Autónoma de México. Ciudad de México, México
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Ruíz-Cano J, Cantú-Quintanilla GR, Ávila-Montiel D, Gamboa-Marrufo JD, Juárez-Villegas LE, de Hoyos-Bermea A, Chávez-López A, Estrada-Ramírez KP, Merelo-Arias CA, Altamirano-Bustamante MM, de la Vega-Morell N, Peláez-Ballestas I, Guadarrama-Orozco JH, Muñoz-Hernández O, Garduño-Espinosa J. [Review of models for the analysis of ethical dilemmas]. Bol Med Hosp Infant Mex 2015; 72:89-98. [PMID: 29425998 DOI: 10.1016/j.bmhimx.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022] Open
Abstract
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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Affiliation(s)
| | | | | | | | | | - Adalberto de Hoyos-Bermea
- Universidad Nacional Autónoma de México, México, D.F., México; Universidad Anáhuac, México, D.F., México
| | | | | | | | | | | | | | | | - Onofre Muñoz-Hernández
- Hospital Infantil de México Federico Gómez, México, D.F., México; Universidad Nacional Autónoma de México, México, D.F., México
| | - Juan Garduño-Espinosa
- Hospital Infantil de México Federico Gómez, México, D.F., México; Universidad Nacional Autónoma de México, México, D.F., México.
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Medina-Sanson A, Martínez-Avalos A, Gallegos-Castorena S, Juárez-Villegas LE, González-Montalvo P, Perales-Arroyo A, Gallegos-González E, Ayometzi-Ouchi MT. Pediatric oncology at Hospital Infantil de Mexico: fifty-five years of accomplishment. Pediatr Hematol Oncol 2002; 19:383-7. [PMID: 12186360 DOI: 10.1080/08880010290097198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The Department of Oncology at Hospital Infantil de México Federico Gómez (HIMFG) was the first unit in our country, and one of the first in Latin America, to specialize in the management of children with cancer. The HIMFG is part of the National Institutes of Health of Mexico, and is a reference hospital with research, educative, and tertiary care medical function. To date, the HIMFG and the Instituto Nacional de Pediatria are the principal medical centers in which children with cancer receive comprehensive care.
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Affiliation(s)
- A Medina-Sanson
- Oncology Department, Hospital Infantil de Mexico, Colonia Doctores
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