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van den Bosch C, Moree J, Peeters S, Lankheet M, van der Steeg A, Wijnen M, van de Wetering M, van der Bruggen J. The effect of taurolidine on the time-to-positivity of blood cultures. Infect Prev Pract 2024; 6:100352. [PMID: 38510847 PMCID: PMC10950745 DOI: 10.1016/j.infpip.2024.100352] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
Background Taurolidine containing lock solutions (TL) are a promising method for the prevention of central line associated bloodstream infections. Per accident, the TL may not always be aspirated from the central venous catheter (CVC) before blood cultures are obtained. The TL could, unintentionally, end up in a blood culture vial, possibly altering the results. The aim of this study was to investigate the effect of the TLs on the detection of microbial growth in blood culture vials. Methods Different lock solutions (taurolidine-citrate-heparin (TCHL), taurolidine, heparin, citrate or NaCl) were added to BD BACTECTM blood culture vials (Plus Aerobic/F, Lytic/10 Anaerobic/F or Peds Plus/F) before spiking with Staphylococcus aureus (ATCC 29213 or a clinical strain) or Escherichia coli (ATCC 25922 or a clinical strain) in the presence and absence of blood. Subsequently, blood culture vials were incubated in the BD BACTEC FX instrument with Time-to-positivity (TTP) as primary outcome. In addition, the effect of the TCHL on a variety of other micro-organisms was tested. Discussion In the presence of taurolidine, the TTP was considerably delayed or vials even remained negative as compared to vials containing heparin, citrate or NaCl. This effect was dose-dependent. The delayed TTP was much less pronounced in the presence of blood, but still notable. Conclusion This study stresses the clinical importance of discarding TLs from the CVC before obtaining a blood culture.
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Affiliation(s)
- C.H. van den Bosch
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - J.E.P. Moree
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S. Peeters
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M. Lankheet
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A.F.W. van der Steeg
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - M.H.W.A. Wijnen
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - M.D. van de Wetering
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - J.T. van der Bruggen
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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O'Donnell N, Phillips B, Morgan JE, Howell D. 'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors. BMJ Open 2024; 14:e082779. [PMID: 38688668 DOI: 10.1136/bmjopen-2023-082779] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE AND DESIGN Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb. SETTING A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods. PARTICIPANTS 32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female). RESULTS Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies. CONCLUSIONS This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.
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Affiliation(s)
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Debra Howell
- Department of Health Sciences, University of York, York, UK
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Banerjee A, Babu R, Jayaraman D, Chilukuri S. Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour. BMJ Case Rep 2024; 17:e260600. [PMID: 38642931 PMCID: PMC11033631 DOI: 10.1136/bcr-2024-260600] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
Bilateral Wilms tumour (BWT) is a surgically challenging condition. Virtual reality (VR) reconstruction aids surgeons to foresee the anatomy ahead of Nephron Sparing Surgery (NSS). Three-dimensional (3D) visualisation improves the anatomical orientation of surgeons performing NSS. We herewith report a case of BWT where VR planning and 3D printing were used to aid NSS. Conventional imaging is often found to be inadequate while assessing the tumour-organ-vascular anatomy. Advances like VR and 3D printing help surgeons plan better for complex surgeries like bilateral NSS. Next-generation extended reality tools will likely aid robotic-assisted precision NSS and improve patient outcomes.
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Affiliation(s)
- Avijit Banerjee
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ramesh Babu
- Pediatric Urology, Sri Ramachandra University Medical College, Chennai, India
| | - Dhaarani Jayaraman
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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Singh R, Madasswery S, Colman M, Kent PM. Denosumab and sclerotherapy for recurrent spinal aneurysmal bone cyst in a child. BMJ Case Rep 2024; 17:e257450. [PMID: 38589235 PMCID: PMC11015305 DOI: 10.1136/bcr-2023-257450] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Aneurysmal bone cyst (ABC) is a non-malignant, locally destructive, blood-filled lesion in the bone that tends to grow aggressively. A young girl presented with a rapid recurrence after aggressive surgery of a large symptomatic sacral-spinal ABC. After a multidisciplinary tumour board, she was successfully treated with sclerotherapy and monthly intravenous denosumab. The patient has maintained asymptomatic for over 36 months now and has returned to full activity and strength. She never required surgery and has had radiologic resolution of the lesions. Treatment of recurrent ABC requires a multidisciplinary team approach. We believe this to be the first report to use this combined therapy to provide an alternative to morbid surgery for children with ABCs.
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Affiliation(s)
- Raj Singh
- College of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Matt Colman
- Rush University Rush Medical College, Chicago, Illinois, USA
| | - Paul McKeegan Kent
- Medical Director, FibroFighters Foundation LLC, Temecula, California, USA
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Sundari A, Gurusamy U. Cardiac fibroma presenting as hypoplastic left heart syndrome in a foetus: causal or coincidental? BMJ Case Rep 2024; 17:e258742. [PMID: 38514154 PMCID: PMC10961559 DOI: 10.1136/bcr-2023-258742] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Primary cardiac tumours are very rare. Cardiac tumours in the perinatal period are even more uncommon with a prevalence of 0.0017% to 0.28% in autopsy series. The majority of benign cardiac tumours are cardiac rhabdomyomas, followed by cardiac fibromas. Another rare congenital heart disease is hypoplastic left heart syndrome (HLHS). Here we present a 21-week-old foetus diagnosed antenatally with HLHS on foetal echocardiogram. An autopsy done on the foetus following medical termination of pregnancy revealed a cardiac fibroma in the ventricular septum. It is very uncommon to have a combination of two congenital heart diseases. An extensive literature review revealed only three cases that had rhabdomyoma and associated HLHS. This case presented with cardiac fibroma which in early gestation would have resulted in left ventricular outflow obstruction leading to the development of HLHS. Small cardiac tumours which are difficult to detect by echocardiogram in early gestation can lead to the development of HLHS. A thorough and hierarchical autopsy examination of such cases can help in a better understanding of the relationship between HLHS and cardiac tumours.
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Affiliation(s)
- Abinaya Sundari
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Umamaheshwari Gurusamy
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Sekimizu M, Fukano R, Koga Y, Mitsui T, Fujita N, Mori T, Hori D, Tanaka M, Ohki K, Iwafuchi H, Nakazawa A, Mori T, Kobayashi R, Hashimoto H, M Saito A, Kamei M. Rituximab-combined anthracycline-free chemotherapy in newly diagnosed paediatric and adolescent patients with non-high-risk aggressive mature B cell lymphoma: protocol for a single-arm, open-label, multicentre, phase II study (the Japan Children's Cancer Group Multicentre Trial, JPLSG B-NHL-20). BMJ Open 2024; 14:e080762. [PMID: 38508620 PMCID: PMC10953030 DOI: 10.1136/bmjopen-2023-080762] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Children and adolescents with mature B cell non-Hodgkin lymphoma (B-NHL) are treated with short-intensive chemotherapy. The burden of short-term and long-term toxicity is highly relative to its high cure rate in good-risk patients. Although the addition of rituximab to standard lymphome Malin B (LMB) chemotherapy markedly prolongs event-free survival and overall survival in high-risk patients, the benefit of rituximab in good-risk patients remains to be elucidated. This clinical trial will examine whether the addition of rituximab eliminates anthracyclines in good-risk patients without compromising treatment outcomes. METHODS AND ANALYSIS We will perform a single-arm, open-label, multicentre phase II study. Low-risk (stage I - completely resected, stage II abdominal) and intermediate-risk (stages I and II - incompletely resected; stage II - resected, other than abdominal; stage III with LDH <2× upper limit of normal) patients with newly diagnosed B-NHL are eligible. Low-risk patients receive two courses of R-COM1P (rituximab, cyclophosphamide, vincristine, methotrexate, prednisolone and intrathecal methotrexate with hydrocortisone), and intermediate-risk patients receive COP (cyclophosphamide, vincristine, prednisolone and intrathecal methotrexate with hydrocortisone) followed by two courses each of R-COM3P and R-CYM (rituximab, cytarabine, methotrexate and intrathecal methotrexate with hydrocortisone). The primary endpoint is a 3-year event-free survival rate in paediatric patients (<18 years) with intermediate-risk disease. 100 patients (10 low-risk and 90 intermediate-risk) will enrol within a 4-year enrolment period and the follow-up period will be 3 years. 108 institutions are participating as of 1 January 2024 (64 university hospitals, 29 general hospitals, 12 children's hospitals and three cancer centres). ETHICS AND DISSEMINATION This research was approved by the Certified Review Board at NHO Nagoya Medical Center (Nagoya, Japan) on 21 September 2021. Written informed consent is obtained from all patients and/or their guardians. The results of this study will be disseminated through peer-reviewed publications and conference presentations. STUDY REGISTRATION Japan Registry of Clinical Trials, jRCTs041210104.
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Affiliation(s)
- Masahiro Sekimizu
- Department of Pediatrics, NHO Nagoya Medical Center, Nagoya, Japan
- NHO Nagoya Medical Center, Nagoya, Japan
| | - Reiji Fukano
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University, Fukuoka, Japan
| | - Tetsuo Mitsui
- Department of Pediatrics, Yamagata University Hospital, Yamagata, Japan
| | - Naoto Fujita
- Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic bomb Survivors Hospital, Hiroshima, Japan
| | - Takeshi Mori
- Department of Hematology and Oncology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Daiki Hori
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Makito Tanaka
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hideto Iwafuchi
- Department of Pathology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Mori
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, NHO Nagoya Medical Center, Nagoya, Japan
| | - Akiko M Saito
- Clinical Research Center, NHO Nagoya Medical Center, Nagoya, Japan
| | - Michi Kamei
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Van Genechten T, De Laere M, Van den Bossche J, Stein B, De Rycke K, Deschepper C, Hazes K, Peeters R, Couttenye MM, Van De Walle K, Roelant E, Maes S, Vanden Bossche S, Dekeyzer S, Huizing M, Caluwaert K, Nijs G, Cools N, Verlooy J, Norga K, Verhulst S, Anguille S, Berneman Z, Lion E. Adjuvant Wilms' tumour 1-specific dendritic cell immunotherapy complementing conventional therapy for paediatric patients with high-grade glioma and diffuse intrinsic pontine glioma: protocol of a monocentric phase I/II clinical trial in Belgium. BMJ Open 2024; 14:e077613. [PMID: 38503417 PMCID: PMC10952861 DOI: 10.1136/bmjopen-2023-077613] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Diffuse intrinsic pontine glioma (DIPG) and paediatric high-grade glioma (pHGG) are aggressive glial tumours, for which conventional treatment modalities fall short. Dendritic cell (DC)-based immunotherapy is being investigated as a promising and safe adjuvant therapy. The Wilms' tumour protein (WT1) is a potent target for this type of antigen-specific immunotherapy and is overexpressed in DIPG and pHGG. Based on this, we designed a non-randomised phase I/II trial, assessing the feasibility and safety of WT1 mRNA-loaded DC (WT1/DC) immunotherapy in combination with conventional treatment in pHGG and DIPG. METHODS AND ANALYSIS 10 paediatric patients with newly diagnosed or pretreated HGG or DIPG were treated according to the trial protocol. The trial protocol consists of leukapheresis of mononuclear cells, the manufacturing of autologous WT1/DC vaccines and the combination of WT1/DC-vaccine immunotherapy with conventional antiglioma treatment. In newly diagnosed patients, this comprises chemoradiation (oral temozolomide 90 mg/m2 daily+radiotherapy 54 Gy in 1.8 Gy fractions) followed by three induction WT1/DC vaccines (8-10×106 cells/vaccine) given on a weekly basis and a chemoimmunotherapy booster phase consisting of six 28-day cycles of oral temozolomide (150-200 mg/m2 on days 1-5) and a WT1/DC vaccine on day 21. In pretreated patients, the induction and booster phase are combined with best possible antiglioma treatment at hand. Primary objectives are to assess the feasibility of the production of mRNA-electroporated WT1/DC vaccines in this patient population and to assess the safety and feasibility of combining conventional antiglioma treatment with the proposed immunotherapy. Secondary objectives are to investigate in vivo immunogenicity of WT1/DC vaccination and to assess disease-specific and general quality of life. ETHICS AND DISSEMINATION The ethics committee of the Antwerp University Hospital and the University of Antwerp granted ethics approval. Results of the clinical trial will be shared through publication in a peer-reviewed journal and presentations at conferences. TRIAL REGISTRATION NUMBER NCT04911621.
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Affiliation(s)
- Toon Van Genechten
- Pediatric Oncology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Maxime De Laere
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Jolien Van den Bossche
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Barbara Stein
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Kim De Rycke
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | | | - Katja Hazes
- Pediatric Oncology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Renke Peeters
- Pediatric Oncology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | | | | | - Ella Roelant
- Statistics, Universitair Ziekenhuis Antwerpen, Edegem, Antwerpen, Belgium
| | - Sabine Maes
- Anesthesiology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | | | - Sven Dekeyzer
- Radiology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Manon Huizing
- Cell and Tissue Bank, University Hospital Antwerp, Edegem, Antwerp, Belgium
- Faculty of Health Sciences, University Hospital Antwerp, Edegem, België, Belgium
| | - Kim Caluwaert
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- Cell and Tissue Bank, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Griet Nijs
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Joris Verlooy
- Pediatric Oncology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Koen Norga
- Pediatric Oncology, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Stijn Verhulst
- Pediatrics, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Sebastien Anguille
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Zwi Berneman
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Eva Lion
- Center for Cell Therapy and Regenerative Medicine, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- Laboratory of Experimental Hematology, University Hospital Antwerp, Edegem, Antwerp, Belgium
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Sardzikova S, Andrijkova K, Svec P, Beke G, Klucar L, Minarik G, Bielik V, Kolenova A, Soltys K. Gut diversity and the resistome as biomarkers of febrile neutropenia outcome in paediatric oncology patients undergoing hematopoietic stem cell transplantation. Sci Rep 2024; 14:5504. [PMID: 38448687 PMCID: PMC10918076 DOI: 10.1038/s41598-024-56242-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
The gut microbiota of paediatric oncology patients undergoing a conditioning regimen before hematopoietic stem cell transplantation is recently considered to play role in febrile neutropenia. Disruption of commensal microbiota and evolution of opportune pathogens community carrying a plethora of antibiotic-resistance genes play crucial role. However, the impact, predictive role and association of patient´s gut resistome in the course of the therapy is still to be elucidated. We analysed gut microbiota composition and resistome of 18 paediatric oncology patients undergoing hematopoietic stem cell transplantation, including 12 patients developing febrile neutropenia, hospitalized at The Bone Marrow Transplantation Unit of the National Institute of Children´s disease in Slovak Republic and healthy individuals (n = 14). Gut microbiome of stool samples obtained in 3 time points, before hematopoietic stem cell transplantation (n = 16), one week after hematopoietic stem cell transplantation (n = 16) and four weeks after hematopoietic stem cell transplantation (n = 14) was investigated using shotgun metagenome sequencing and bioinformatical analysis. We identified significant decrease in alpha-diversity and nine antibiotic-resistance genes msr(C), dfrG, erm(T), VanHAX, erm(B), aac(6)-aph(2), aph(3)-III, ant(6)-Ia and aac(6)-Ii, one week after hematopoietic stem cell transplantation associated with febrile neutropenia. Multidrug-resistant opportune pathogens of ESKAPE, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli found in the gut carried the significant subset of patient's resistome. Over 50% of patients treated with trimethoprim/sulfamethoxazole, piperacillin/tazobactam and amikacin carried antibiotic-resistance genes to applied treatment. The alpha diversity and the resistome of gut microbiota one week after hematopoietic stem cell transplantation is relevant predictor of febrile neutropenia outcome after hematopoietic stem cell transplantation. Furthermore, the interindividual diversity of multi-drug resistant opportunistic pathogens with variable portfolios of antibiotic-resistance genes indicates necessity of preventive, personalized approach.
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Affiliation(s)
- Sara Sardzikova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Kristina Andrijkova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Svec
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Gabor Beke
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lubos Klucar
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Viktor Bielik
- Department of Biological and Medical Science, Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia
| | - Alexandra Kolenova
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Katarina Soltys
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia.
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Keeling C, Davies S, Goddard J, Ramaswamy V, Schwalbe EC, Bailey S, Hicks D, Clifford SC. The clinical significance of sub-total surgical resection in childhood medulloblastoma: a multi-cohort analysis of 1100 patients. EClinicalMedicine 2024; 69:102469. [PMID: 38374970 PMCID: PMC10875250 DOI: 10.1016/j.eclinm.2024.102469] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Background Medulloblastoma patients with a sub-total surgical resection (STR; >1.5 cm2 primary tumour residuum post-surgery) typically receive intensified treatment. However, the association of STR with poor outcomes has not been observed consistently, questioning the validity of STR as a high-risk disease feature. Methods We collected extent of resection (EOR) data from 1110 patients (from UK CCLG centres (n = 416, collected between September 1990 and July 2014) and published (n = 694) cohorts), the largest cohort of molecularly and clinically annotated tumours assembled to specifically assess the significance of EOR. We performed association and univariable/multivariable survival analyses, assessing overall survival (OS) cohort-wide and with reference to the four consensus medulloblastoma molecular groups and clinical features. Findings STR was reported in 20% (226/1110) of patients. Non-WNT (p = 0.047), children <5 years at diagnosis (p = 0.021) and metastatic patients (p < 0.0001) were significantly more likely to have a STR. In cohort-wide analysis, STR was associated with worse survival in univariable analysis (p < 0.0001). Examination of specific disease contexts showed that STR was prognostic in univariate analysis for patients receiving cranio-spinal irradiation (CSI) and chemotherapy (p = 0.016) and for patients with Group 3 tumours receiving CSI (p = 0.039). STR was not independently prognostic in multivariable analyses; outcomes for patients who have STR as their only risk-feature are as per standard-risk disease. Specifically, STR was not prognostic in non-metastatic patients that received upfront CSI. Interpretation In a cohort of 1100 molecularly characterised medulloblastoma patients, STR (n = 226) predicted significantly lower OS in univariable analysis, but was not an independent prognostic factor. Our data suggest that maximal safe resection can continue to be carried out for patients with medulloblastoma and suggest STR should not inform patient management when observed as a sole, isolated risk-feature. Funding Cancer Research UK, Newcastle Hospitals Charity, Children's Cancer North, British Division of the International Academy of Pathology.
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Affiliation(s)
- Claire Keeling
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Simon Davies
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Jack Goddard
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Vijay Ramaswamy
- Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Edward C. Schwalbe
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Simon Bailey
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Great North Children's Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Steven C. Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
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10
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Ramamurthy A, Connolly EA, Mar J, Lewin J, Bhadri VA, Phillips MB, Winstanley M, Orme LM, Grimison P, Connor J, Lazarakis S, Hong AM, Omer N, Cayrol J. High-dose chemotherapy for Ewing sarcoma and Rhabdomyosarcoma: A systematic review by the Australia and New Zealand sarcoma association clinical practice guidelines working party. Cancer Treat Rev 2024; 124:102694. [PMID: 38325070 DOI: 10.1016/j.ctrv.2024.102694] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Patients with high-risk or metastatic Ewing sarcoma (ES) and rhabdomyosarcoma (RMS) have a guarded prognosis. High-dose chemotherapy (HDT) with autologous stem cell transplant (ASCT) has been evaluated as a treatment option to improve outcomes. However, survival benefits remain unclear, and treatment is associated with severe toxicities. METHODS A systematic review was conducted, using the population, intervention, comparison outcome (PICO) model, to evaluate whether utilization of HDT/ASCT impacts the outcome of patients with ES and RMS compared to standard chemotherapy alone, as part of first line treatment or in the relapse setting. Medline, Embase and Cochrane Central were queried for publications from 1990 to October 2022 that evaluated event-free survival (EFS), overall survival (OS), and toxicities. Each study was screened by two independent reviewers for suitability. A qualitative synthesis of the results was performed. RESULTS Of 1,172 unique studies screened, 41 studies were eligible for inclusion with 29 studies considering ES, 10 studies considering RMS and 2 studies considering both. In ES patients with high-risk localised disease who received HDT/ASCT after VIDE chemotherapy, consolidation with melphalan-based HDT/ASCT as first line therapy conveyed an EFS and OS benefit over standard chemotherapy consolidation. Efficacy of HDT/ASCT using a VDC/IE backbone, which is now standard care, has not been established. Survival benefits are not confirmed for ES patients with metastatic disease at initial diagnosis. For relapsed/refractory ES, four retrospective studies report improvement in outcomes with HDT/ASCT with the greatest evidence in patients who demonstrate a treatment response before HDT, and in patients under the age of 14. In RMS, there is no proven survival benefit of HDT/ASCT in primary localised, metastatic or relapsed disease. CONCLUSION Prospective randomised trials are required to determine the utility of HDT/ASCT in ES and RMS. Selected patients with relapsed ES could be considered for HDT/ASCT.
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Affiliation(s)
- Ashika Ramamurthy
- Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
| | - Elizabeth A Connolly
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006 Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Jeremy Lewin
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Victorian Adolescent & Young Adult Cancer Service, Melbourne, VIC 3000, Australia
| | - Vivek A Bhadri
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006 Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Marianne B Phillips
- Department Oncology, Haematology and Tissue & Cellular Therapies, Perth Children's Hospital, WA 6009, Australia; Telethon Kids Institute, Perth, WA 6009, Australia
| | - Mark Winstanley
- Starship Paediatric Blood and Cancer Centre, Central Auckland 1142, New Zealand
| | - Lisa M Orme
- Victorian Adolescent & Young Adult Cancer Service, Melbourne, VIC 3000, Australia; Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC 3000, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052 Australia
| | - Peter Grimison
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006 Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Joanna Connor
- Te Pūriri o Te Ora, Auckland Regional Cancer and Blood Service, Auckland Hospital, Grafton, 1050, New Zealand
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - Angela M Hong
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006 Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
| | - Natacha Omer
- Oncology Services Group, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Julie Cayrol
- Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC 3000, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052 Australia; Murdoch Children's Research Institute, Melbourne, Australia
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11
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Tamura R, Hirotani T, Yasui Y, Okajima H. Rapidly growing intramuscular lipoma: a unique entity of benign lipomas in children. BMJ Case Rep 2024; 17:e253408. [PMID: 38417947 PMCID: PMC10900357 DOI: 10.1136/bcr-2022-253408] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
This report presents a case of an intramuscular lipoma observed in the left back of a healthy female toddler. It was resected after 3 months of observation because of rapid enlargement, raising suspicion of malignancy. Histopathological examination confirmed a diagnosis of intramuscular lipoma without malignant and blastemal components. Intramuscular lipomas are benign neoplasms that mostly appear as a rapidly growing tumour. Several hypotheses regarding the pathogenesis of this characteristic growth pattern have been proposed, including atrophy of the surrounding muscle, reactive adipocytic neoformation and multiple contractive interactions between the lipoma and the surrounding muscle.
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Affiliation(s)
- Ryo Tamura
- Pediatric surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Taichi Hirotani
- Pediatric surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Yoshitomo Yasui
- Pediatric surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Hideaki Okajima
- Pediatric surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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12
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Prabaharan H, Chandrasekaran S, Shetty N, Nayak K P. Benign paraspinal ganglioneuroma with paraneoplastic opsoclonus myoclonus syndrome. BMJ Case Rep 2024; 17:e256846. [PMID: 38417946 PMCID: PMC10900366 DOI: 10.1136/bcr-2023-256846] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare immune-mediated movement disorder occurring as a paraneoplastic manifestation of neuroblastic tumours (NTs), especially neuroblastoma in infancy. Ganglioneuroma (GN), the benign tumour in the spectrum, is rarely associated with OMAS. We report the case of a child in her second year of life presenting with acute onset of progressive paraplegia and OMAS. MRI showed diffuse and infiltrating left paraspinal mass from T3-T9 levels with differentials of neuroblastoma or ganglioneuroblastoma. Histopathological and immunohistochemistry examination of the excised tumour showed maturing GN. The OMAS was managed with intravenous immunoglobulin and steroids. In the 6-month follow-up, the child has a residual motor weakness with myelomalacia in neuroimaging. The case report substantiates the occurrence of OMAS as paraneoplastic manifestation in NTs, including benign, in children younger than 2 years with a female predilection.
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Affiliation(s)
- Haritha Prabaharan
- Pediatrics, NITTE (Deemed to be University), Mangalore, Karnataka, India
| | | | - Niharika Shetty
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Praveen Nayak K
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
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13
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Nielsen CL, Clemensen J, Callesen MT, Jensen CS, Smith AC, Holm KG. Who is supporting the parents during their child's cancer treatment? A qualitative study through the lens of compassion. Eur J Oncol Nurs 2024; 70:102534. [PMID: 38490044 DOI: 10.1016/j.ejon.2024.102534] [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: 09/13/2023] [Revised: 01/21/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Parents of children/adolescents with cancer are placed in a state of severe suffering due to serious concerns, fears, and radical daily life changes. Human support is an important source of support for successful coping. This study explored fundamental aspects of parents' daily, social, and personal life during their child's treatment to deepen our understanding of 'who' plays a significant role in supporting parents, and how, and to what extent this support is provided. METHODS This qualitative study was undertaken in a compassion paradigm, designed and guided by Heidegger's and Gadamer's philosophy and compassionate methods. Data were generated through ethnographic observations (144 h), focus group interviews (n = 2), and individual/couple interviews (n = 16) at two Danish hospitals. Inductive content analysis was used to analyse data. RESULTS Overall, support from peers, health professionals, and social networks constituted significant sources of support. Especially peers and health professionals had a continuous support role, which was fundamental for establishing interpersonal closeness and relieving suffering. Sharing responsibilities between parents and among social networks seemed to ease the emotional and practical burden. However, to ensure effectiveness, social networks must be available, outreach, and responsive to needs. Moreover, parents disclosed little self-awareness and resources and options for self-care due to a combination of lack of awareness, time, and space in the hospitals. CONCLUSION Safeguarding interpersonal and interparental understanding and closeness in parental care is essential. One way is building resilience and a broader human-to-human-based safety net around the family, including social networks and professional psychosocial support, advantageously using compassion.
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Affiliation(s)
- Camilla Littau Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Compassion in Healthcare, Department of Clinical Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Compassion in Healthcare, Department of Clinical Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | | | - Claus Sixtus Jensen
- Research Centre for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Paediatrics and Adolescent Medicine, Unit for Research and Development in Nursing for Children and Young People, Aarhus University Hospital, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
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14
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Wong CL, Li H, Li CK, Chan CWH, Cheung YT, Choi KC, So WKW. Effects of immersive virtual reality for alleviating anxiety, nausea and vomiting among patients with paediatric cancer receiving their first chemotherapy: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079837. [PMID: 38401901 PMCID: PMC10895243 DOI: 10.1136/bmjopen-2023-079837] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/15/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Anxiety, nausea and vomiting are common side effects suffered by paediatric patients receiving chemotherapy. Emerging evidence supports the efficacy of immersive virtual reality (IVR) on improving anxiety and distress symptoms including nausea and vomiting in this vulnerable group. This trial aims to evaluate the effects of IVR intervention on anxiety, chemotherapy-induced nausea and vomiting and anticipatory nausea and vomiting in patients with paediatric cancer receiving first chemotherapy. METHOD AND ANALYSIS An assessor-blinded, randomised controlled trial with a mixed methods evaluation approach. On the basis of our pilot results, 128 chemotherapy-naive patients with paediatric cancer scheduled to receive their first intravenous chemotherapy will be recruited from a public hospital and randomly allocated to intervention (n=64) or control groups (n=64). The intervention group will receive the IVR intervention for three sessions: 2 hours before the first chemotherapy, 5 min before and during their first chemotherapy and 5 min before and during their second chemotherapy, respectively. The control group will receive standard care only. A subsample of 30 participants in the intervention group will be invited for a qualitative interview. Study instruments are: (1) short form of the Chinese version of the State Anxiety Scale for Children, (2) visual analogue scale for anticipatory nausea and vomiting, (3) Chinese version of the Multinational Association of Supportive Care in Cancer Antiemesis Tool and (4) individual face-to-face semistructured interviews to explore intervention participants' perceptions of the IVR intervention. ETHICS AND DISSEMINATION This study has been approved by the Hong Kong Children's Hospital Research Ethics Committee (HKCH-REC-2021-009). The findings will be disseminated in peer-reviewed journals and through local or interventional conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2100048732.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Chi Kong Li
- Deparment of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Carmen Wing Han Chan
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, People's Republic of China
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15
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Aleshchenko E, Swart E, Voigt M, Langer T, Calaminus G, Glogner J, Baust K. VersKiK qualitative study design: actual follow-up needs of paediatric cancer survivors, their informal caregivers and follow-up stakeholder perceptions in Germany. BMJ Open 2024; 14:e072860. [PMID: 38326270 PMCID: PMC10860087 DOI: 10.1136/bmjopen-2023-072860] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors' transition from paediatric to adult healthcare. METHODS AND ANALYSIS We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement. ETHICS AND DISSEMINATION The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above. TRIAL REGISTRATION NUMBER Registered at German Clinical Trial Register, ID: DRKS00026092.
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Affiliation(s)
- Ekaterina Aleshchenko
- Medical Faculty, Institut for Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Enno Swart
- Medical Faculty, Institut for Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Mathias Voigt
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Rheinland-Pfalz, Germany
| | | | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Juliane Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
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16
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Arora SK, Jana M, Seth R. Unusual case of 'scorbutic proptosis'. BMJ Case Rep 2024; 17:e253380. [PMID: 38296501 PMCID: PMC10831456 DOI: 10.1136/bcr-2022-253380] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Proptosis is a frequent presenting symptom/sign of many paediatric malignancies. Acute-onset proptosis is an ophthalmic emergency that can endanger vision if not treated promptly. Appropriate treatment must be instituted only after investigating for the underlying aetiology. Here, we report a developmentally delayed boy in middle childhood who presented with recent onset bilateral proptosis. Clinical examination followed by radiological evaluation suggested scurvy to be the underlying cause and vitamin C supplementation led to prompt reversal of proptosis. The relevant literature has been reviewed and presented here to apprise the paediatric oncologists about this rare but easily treatable cause of proptosis.
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Affiliation(s)
- Shilpa Khanna Arora
- Pediatrics, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), NewDelhi, India
| | - Rachna Seth
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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17
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van den Bosch CH, van de Ven CP, Hulsker CCC, Bökkerink GMJ, Terwisscha-van Scheltinga CEJ, van de Wetering MD, Koopman MMW, van der Pal HJH, Wijnen MWHA, van der Steeg AFW. Satisfaction of Paediatric Oncology Patients, Survivors, and Nurses with the Position of Their Totally Implantable Venous Access Port (SPACE-Study). J Pediatr Surg 2024:S0022-3468(24)00003-4. [PMID: 38212153 DOI: 10.1016/j.jpedsurg.2023.12.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND To compare paediatric oncologic vascular access ports located on the anterior thoracic wall to ports on the lower lateral thoracic wall, in terms of perceived port-related hindrance and scar-quality. METHODS A cross-sectional survey study including paediatric oncology patients (≥8-<19 yrs), caregivers (in patients <8 yrs), survivors (>22 yrs with only anterior ports) and nurses of the Princess Máxima Center, the Netherlands, was performed. The survey consisted of questions regarding satisfaction, hindrance during daily life, and port position preference. For survivors, scar-quality was assessed using the validated Patient and Observer Scar Assessment Scale (POSAS 2.0); a high score (i.e., a displeasing scar) was defined as a score higher than the third quartile of the median for that question. RESULTS In total, 147 participants were included; 83 patients/caregivers, 31 survivors, and 33 nurses. Overall, 81 % was satisfied with the position of their port. Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. For the anterior position, minimal pressure on the port during daily life was a mentioned reason to prefer this position. For the lower lateral position, less visibility of the scar and easiest access were mentioned. Of all survivors with an anterior port scar, one in five had a displeasing scar and all scars observed were widened. Female patients preferred a lower lateral port, and scar-quality was better for left-sided port scars. CONCLUSION The port position should be chosen together with patients/caregivers based on the (dis-)advantages of each position, as identified by this study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - C P van de Ven
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - C C C Hulsker
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | | | - M D van de Wetering
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M M W Koopman
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M W H A Wijnen
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - A F W van der Steeg
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
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18
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de Beijer IAE, Skinner R, Haupt R, Grabow D, Bardi E, Beccaria A, Nieto AC, Essiaf S, Filbert AL, Gsell H, Kienesberger A, Langer T, McColgan P, Muraca M, Rascon J, Tallone R, Tomasikova Z, Uyttebroeck A, Kremer LCM, van der Pal HJH, Mulder RL. European recommendations for short-term surveillance of health problems in childhood, adolescent and young adult cancer survivors from the end of treatment to 5 years after diagnosis: a PanCare guideline. J Cancer Surviv 2023:10.1007/s11764-023-01493-z. [PMID: 38048011 DOI: 10.1007/s11764-023-01493-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Childhood, adolescent and young adult (CAYA) cancer survivors require ongoing surveillance for health problems from the end of cancer treatment throughout their lives. There is a lack of evidence-based guidelines on optimal surveillance strategies for the period from the end of treatment to 5 years after diagnosis. We aimed to address this gap by developing recommendations for short-term surveillance of health problems based on existing long-term follow-up (LTFU) care guidelines. METHODS The guideline working group, consisting of healthcare professionals, parents and survivor representatives from 10 countries, worked together to identify relevant health problems that may occur in survivors between the end of treatment and 5 years after diagnosis and to develop recommendations for short-term surveillance of health problems. The recommendations were drawn from existing LTFU guidelines and adapted where necessary based on clinical expertise. RESULTS The working group developed 44 recommendations for short-term surveillance of health problems, which were divided into four categories based on the level of surveillance required: awareness only (n = 11), awareness, history and/or physical examination without surveillance test (n = 15), awareness, history and/or physical examination with potential surveillance test (n = 1) and awareness, history and/or physical examination with surveillance test (n = 17). CONCLUSION The development of a guideline for short-term surveillance of health problems fills a critical gap in survivorship care for CAYA cancer survivors, providing much-needed support immediately after treatment up to 5 years after diagnosis. IMPLICATIONS FOR CANCER SURVIVORS This guideline will support healthcare professionals to provide appropriate follow-up care and improve the quality of life of CAYA cancer survivors.
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Affiliation(s)
- Ismay A E de Beijer
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, UK
- Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4 LP, UK
- Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, UK
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | | | | | - Samira Essiaf
- European Society for Paediatric Oncology, C/O BLSI, Clos Chapelle-Aux-Champs 30, Bte 1.30.30, Brussels, Belgium
| | - Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - Patricia McColgan
- Childhood Cancer Ireland, Carmichael House, 4 Brunswick Street North, Dublin, D07 RHA8, Ireland
| | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Helena J H van der Pal
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Renée L Mulder
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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de Beijer IAE, Hardijzer EC, Haupt R, Grabow D, Balaguer J, Bardi E, Cañete Nieto A, Ciesiūniene A, Düster V, Filbert AL, Gsell H, Kapitančukė M, Ladenstein R, Langer T, Muraca M, van den Oever SR, Prikken S, Rascon J, Tormo MT, Uyttebroeck A, Vercruysse G, van der Pal HJH, Kremer LCM, Pluijm SMF. Barriers and facilitators to the implementation of a new European eHealth solution (SurPass v2.0): the PanCareSurPass Open Space study. J Cancer Surviv 2023:10.1007/s11764-023-01498-8. [PMID: 38015382 DOI: 10.1007/s11764-023-01498-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To identify barriers and facilitators for implementing the Survivorship Passport (SurPass) v2.0 in six long-term follow-up (LTFU) care centres in Europe. METHODS Stakeholders including childhood cancer survivors (CCSs), healthcare providers (HCPs), managers, information and technology (IT) specialists, and others, participated in six online Open Space meetings. Topics related to Care, Ethical, Legal, Social, Economic, and Information & IT-related aspects of implementing SurPass were evaluated. RESULTS The study identified 115 barriers and 159 facilitators. The main barriers included the lack of standardised LTFU care in centres and network cooperation, uncertainty about SurPass accessibility, and uncertainty about how to integrate SurPass into electronic health information systems. The main facilitators included standardised and coordinated LTFU care in centres, allowing CCSs to conceal sensitive information in SurPass and (semi)automatic data transfer and filing. CONCLUSIONS Key barriers to SurPass implementation were identified in the areas of care, ethical considerations, and information & IT. To address these barriers and facilitate the implementation on SurPass, we have formulated 27 recommendations. Key recommendations include using the internationally developed protocols and guidelines to implement LTFU care, making clear decisions about which parties have access to SurPass data in accordance with CCSs, and facilitating (semi)automated data transfer and filing using Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). IMPLICATIONS FOR CANCER SURVIVORS The findings of this study can help to implement SurPass and to ensure that cancer survivors receive high-quality LTFU care with access to the necessary information to manage their health effectively.
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Affiliation(s)
- Ismay A E de Beijer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Emma C Hardijzer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Balaguer
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | | | - Vanessa Düster
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lübeck, Germany
| | | | - Selina R van den Oever
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Sofie Prikken
- University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Malik SA, Eltayeb H. Recurring cardiac tumour in an asymptomatic child. BMJ Case Rep 2023; 16:e257443. [PMID: 38011959 PMCID: PMC10685951 DOI: 10.1136/bcr-2023-257443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Saad Ahmad Malik
- East Midlands Congenital Heart Centre, Leicester Royal Infirmary, Leicester, UK
| | - Haifa Eltayeb
- East Midlands Congenital Heart Centre, Leicester Royal Infirmary, Leicester, UK
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21
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Filali I, Azitoune S, El Moussaoui S, Kriouile Y. Ecthyma gangrenosum as the first presentation of acute lymphocytic leukaemia in an infant. BMJ Case Rep 2023; 16:e256683. [PMID: 38000809 PMCID: PMC10679998 DOI: 10.1136/bcr-2023-256683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Affiliation(s)
- Imane Filali
- Pediatric, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Sanae Azitoune
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Sanae El Moussaoui
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Yamna Kriouile
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
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22
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Anderson D, Pandya A, Patankar C. Acute onset facial oedema: an unusual presentation of acute lymphoblastic leukaemia in a child. BMJ Case Rep 2023; 16:e257705. [PMID: 37996148 PMCID: PMC10668131 DOI: 10.1136/bcr-2023-257705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
A previously fit and well girl of middle-childhood age presented to her local emergency department after waking with upper-facial swelling. She had a 24-hour preceding history of mild vomiting illness and fatigue. Examination revealed palpable splenomegaly and mild cervical lymphadenopathy, with pitting oedema of the forehead, nasal bridge and eyelids. Admission full blood count showed anaemia and neutropenia, and further investigations confirmed a diagnosis of acute lymphoblastic B-cell leukaemia. X-ray of the chest and CT imaging did not reveal any local facial mass, veno-occlusive disease or mediastinal pathology to explain her facial swelling. She was referred to the tertiary paediatric oncology service for commencement of induction chemotherapy.
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Affiliation(s)
- Darren Anderson
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Atisha Pandya
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Chhaya Patankar
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
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23
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Guerreiro GM, Deodato S, Graça D, Fernandes C. Human responses in adolescents with oncological disease: a scoping review protocol. BMJ Open 2023; 13:e076393. [PMID: 37993162 PMCID: PMC10668176 DOI: 10.1136/bmjopen-2023-076393] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION The classification of human responses to health conditions or life processes, assuming that human responses are the way that a person responds, referring to the individual's experiences, feelings, perceptions, behaviours and physical reactions, can be an exercise that, although challenging, is central to nursing diagnoses and, consequently, to nursing practice. It is necessary to gather and organise the existing knowledge about the human responses in adolescents with cancer, starting from the moment of diagnosis, due to the specificities inherent to this stage of human development. A scoping review is an appropriate method to use in order to map the existing knowledge on human responses in adolescents with oncological diseases experienced since the diagnosis. INCLUSION CRITERIA Will encompass all types of studies, including 'grey literature' that centres on human responses related to adolescents aged 10-19 years with oncological diseases. There will be no restrictions based on the type of cancer, disease stage or other contextual factors, whether in home or healthcare settings. METHODS AND ANALYSIS The review will be conducted following the guidelines outlined by the Joanna Briggs Institute for scoping reviews. The search will encompass the following databases: CINAHL Complete (EBSCOhost), Cochrane Database of Systematic Reviews (EBSCOhost), MEDLINE Complete (EBSCOhost), Nursing and Allied Health Collection: Comprehensive (EBSCOhost), Cochrane Clinical Answers (EBSCOhost Answers), Latin American and Caribbean Literature on Health Sciences (LILACS) and 'grey literature' sources accessible through the Scientific Open Access Repositories of Portugal (RCAAP). A three-step search strategy will be implemented. Titles and abstracts will undergo analysis by two independent reviewers. Articles selected for a full-text review will be organised. The results will be presented in tables and narratively summarised. ETHICS AND DISSEMINATION Ethics approval and patient consent for publication are not necessary. Findings will be disseminated through publication in scientific journals and through conference presentations. REVIEW REGISTRATION NUMBER EXUB4. Registration was made in the Open Science Framework (OSF).
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Affiliation(s)
- Gonçalo Miguel Guerreiro
- Pediatrics, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Faculdade de Ciências da Saúde e Enfermagem, Centre for Interdisciplinary Research in Health, Nursing Research Platform, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Sérgio Deodato
- Faculdade de Ciências da Saúde e Enfermagem, Centre for Interdisciplinary Research in Health, Nursing Research Platform, Universidade Católica Portuguesa, Lisboa, Portugal
- School of Nursing, Faculdade de Ciências da Saúde e Enfermagem, Universidade Catolica Portuguesa, Lisboa, Portugal
| | - Daniela Graça
- Pediatrics, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Catarina Fernandes
- Pediatrics, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
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24
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Morgan JD, Weishar RC, Kwok RM, Lieuw KM. Hodgkin lymphoma associated vanishing bile duct syndrome treated successfully with a brentuximab based regimen. BMJ Case Rep 2023; 16:e257211. [PMID: 37989332 PMCID: PMC10668144 DOI: 10.1136/bcr-2023-257211] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
We report a combination therapy to successfully treat a patient with Hodgkin's lymphoma complicated by vanishing bile duct syndrome. Our patient was in his 20s and presented with jaundice, emesis, B symptoms and diffuse lymphadenopathy along with cholestatic liver injury prompting a liver biopsy, which revealed this diagnosis, after the exclusion of other aetiologies. Our treatment regimen incorporated brentuximab along with other more conventional agents which attempted to maximise therapeutic efficacy while minimising the consequences of hepatotoxicity on the treatment protocol. Although this patient's treatment course was complicated because of neutropenic infections, the patient achieved a complete metabolic response and is now more than 1 year off therapy.
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Affiliation(s)
- Judah D Morgan
- Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Robert C Weishar
- Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
| | - Ryan M Kwok
- Hepatology, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Kenneth M Lieuw
- Pediatric Oncology, Madigan Army Medical Center, Tacoma, Washington, USA
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25
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Khera S, Kurup A, Agarwal S, Tripathi P. Synchronous presentation of ETV6::RUNX1 fusion positive concordant B-acute lymphoblastic leukaemia in identical twin toddlers. BMJ Case Rep 2023; 16:e257139. [PMID: 37967932 PMCID: PMC10660162 DOI: 10.1136/bcr-2023-257139] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Concordant leukaemia in identical twins is rare. The likelihood of concordance of leukaemia in twins is near 100% in infancy, around 10% from 1 to 6 years of age, and rare at a later age with variable latency. Reporting of new cases of concordant leukaemia in twins is encouraged to contribute to data pool of this infrequent but exceptional condition; especially when the theories with respect to evolution, natural history and molecular evidence explaining concordant leukaemia in identical twins are still evolving.We discuss identical pair of monochorionic twin toddlers who were detected to have pallor and blood investigations revealed pancytopenia. Further work up including bone marrow studies revealed synchronous diagnosis of B-acute lymphoblastic leukaemia (B-ALL) with ETV6::RUNX1 fusion. Synchronous presentation of concordant leukaemia in identical twins is extremely rare. Index twins are the only second set of twins and first one beyond infantile age with synchronous presentation of B-ALL.
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Affiliation(s)
- Sanjeev Khera
- Pediatrics, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Arjun Kurup
- Pediatrics, Military Hospital Patiala, Patiala, Punjab, India
| | - Samir Agarwal
- Pathology, Army Hospital Research & Referral, New Delhi, Delhi, India
| | - Preeti Tripathi
- Pathology, Army Hospital Research & Referral, New Delhi, Delhi, India
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26
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Ma J, Li J, Huang W, Wang H. Developing a theory-driven framework for a web-based intervention to improve transition in childhood cancer survivors: a protocol of realist synthesis. BMJ Open 2023; 13:e074162. [PMID: 37963702 PMCID: PMC10649388 DOI: 10.1136/bmjopen-2023-074162] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUNDS AND PURPOSE Childhood cancer survivors (CCSs) who transition through adolescence and enter young adulthood may suffer psychological, cognitive, social, fertility, and sexual issues and concerns. There is an urgent need for comprehensive intervention strategies to improve the transition of CCSs. Web-based technologies are gaining momentum as a new mechanism to provide healthcare and education for adolescents. However, previous frameworks have been limited in their effectiveness in explaining web-based interventions.This realist synthesis aims to synthesise current evidence on transition of CCSs to develop a framework for web-based interventions. The framework can foster understanding of the integrity of web-based intervention implementation chain, examine which mechanistic factors will be triggered by web-based interventions, note and examine the flows, blockages and points of contention in the implementation, to refine web-based interventions. METHOD AND ANALYSIS A realist synthesis that adheres to the Realist and Meta-narrative Evidence Syntheses-Evolving Standard will be used. Studies will be identified through PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid and Cochrane Library from the period of January 2005 to May 2023. We will also search the reference lists provided in relevant studies and reviews. Articles will be screened based on two principles: (1) Relevance: does the research address the initial programme theory? (2) Rigour: whether a particular inference drawn by the original researcher has sufficient weight to make a methodologically credible contribution to the test of the initial programme theory. No restrictions regarding the design or language of publication will be considered. ETHICS AND DISSEMINATION As a review, ethical approval is not required. The results from this study will be presented at international conferences and disseminated through peer-reviewed publications. Patients and the public will be involved in the dissemination plans.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Huang
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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27
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Kanneganti P, Verma A, Kumar B, Nigam N. Retroperitoneal yolk sac tumour encroaching the liver and adrenal gland with tumour thrombus in cavo-atrial region and hepatic veins. BMJ Case Rep 2023; 16:e255968. [PMID: 37923340 PMCID: PMC10626902 DOI: 10.1136/bcr-2023-255968] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Paediatric germ cell tumours (GCT) are rare tumours and are unique because of varied clinical presentation and locations. Yolk sac tumour is the predominant malignant histology and a serum marker; alpha fetoprotein is used to see treatment response and recurrent disease. It is extremely rare to find a retroperitoneal GCT with tumour thrombus extending up to the cavo-atrial region with involvement of the hepatic veins. We report a case of retroperitoneal yolk sac tumour (RPYST) with extension to the liver and right adrenal gland along with tumour thrombus in the inferior vena cava and in the right and middle hepatic veins. The child was operated after satisfactory response to chemotherapy. Excision of the tumour along with the right adrenal gland and around 5 cm of retro-hepatic caval resection was done. Inferior vena cava resection was tolerated without reconstruction. Currently child is disease-free and symptom-free at 22 months of follow-up with normal serum marker.
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Affiliation(s)
- Pujana Kanneganti
- Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Anju Verma
- Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Basant Kumar
- Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Neha Nigam
- Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
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28
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Schwartz ER, Rensen N, Steur LMH, Gemke R, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, Kaspers GJL, Van Litsenburg RRL. Health-related quality of life and its determinants during and after treatment for paediatric acute lymphoblastic leukaemia: a national, prospective, longitudinal study in the Netherlands. BMJ Open 2023; 13:e070804. [PMID: 37899146 PMCID: PMC10619055 DOI: 10.1136/bmjopen-2022-070804] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is impaired in paediatric patients with acute lymphoblastic leukaemia (ALL). Over the past decades, ALL treatment has successfully been adjusted to the risk of relapse, which is now reflected by the stratification of patients into three risk groups who receive treatment of differing intensities. This study is the first to evaluate the longitudinal course of HRQoL in light of these adjustments and identify determinants of HRQoL. DESIGN Two prospective, national cohort studies (add-on studies within the two most recent treatment protocols for children with ALL (ALL-10 and ALL-11)). SETTING Dutch paediatric oncology hospitals between October 2006 and October 2009 (ALL-10) and between August 2013 and July 2017 (ALL-11). PARTICIPANTS Patients with ALL (2-18 years) are treated according to the ALL-10 or ALL-11 treatment protocol. Patients treated according to the ALL-10 protocol only completed a cancer-specific QoL measure and patients treated according to the ALL-11 protocol completed both a cancer-specific and generic QoL measure (see below). OUTCOME MEASURES HRQoL, assessed with parent-proxy questionnaires (PedsQL Generic and Cancer module) within the first 5 months (T0), at 1 year (T1), 2 years (T2) and 3 years (T3) after diagnosis. The proportion of patients with clinically relevant generic HRQoL impairment was compared with healthy norm values. Multivariable mixed model analyses were used to evaluate the development of HRQoL over time and its medical and sociodemographic determinants (collected on enrolment). RESULTS Of the ALL-10 cohort, 132 families participated and of the ALL-11 cohort, 136 families participated (268 total). Thus, cancer-specific HRQoL assessments were available for 268 patients (median age 5.3 years (IQR 6.15), 56.0% boys, 69.0% medium-risk ALL), and generic HRQoL assessments for 136 patients (median age 4.8 years (IQR 6.13), 60.3% boys, 75.0% medium-risk ALL). Generic HRQoL improved between timepoints T0 and T3 (total score B 16.1, 95% CI 12.2 to 20.1, p<0.001), but did not restore to normal 1 year after the end of treatment: 28.0% of children remained impaired compared with 16% in the general population (p=0.003). Cancer-specific HRQoL generally improved from T0 to T2 (Pain B 11.3, 95% CI 7.1 to 15.5; Nausea B 11.7, 8.4 to 15.1; Procedural Anxiety B 19.1, 14.8 to 23.4; Treatment Anxiety B 12.8, 9.5 to 16.0; Worry B 3.5, 0.6 to 6.3; Communication B 8.5, 5.0 to 11.9; all p<0.001 except for Worry (p=0.02)), while Physical Appearance and Cognitive Functioning remained stable. Higher treatment intensity and experiencing pain or simultaneous chronic illness were associated with lower HRQoL over time for multiple subscales. CONCLUSIONS HRQoL impairment is prevalent during and after ALL treatment. Patients with standard-risk ALL and reduced treatment intensity have better HRQoL than patients in higher risk groups. Systematic monitoring of HRQoL is of utmost importance in order to provide timely psychosocial interventions and supportive care.
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Affiliation(s)
- Emily R Schwartz
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Niki Rensen
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lindsay M H Steur
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Reinoud Gemke
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | | | - Inge M van der Sluis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Natasja Dors
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Cor van den Bos
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Martha A Grootenhuis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaele R L Van Litsenburg
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Kai-Jing Z, Xiao-Juan L, Xiao-Hui H. Patient with concurrent anti-NMDAR autoimmune encephalitis and immature teratoma of the ovary. BMJ Case Rep 2023; 16:e256807. [PMID: 37899082 PMCID: PMC10619114 DOI: 10.1136/bcr-2023-256807] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
In young women with anti-N-methyl-D-aspartate receptor (anti-NMDAR) autoimmune encephalitis (AE), co-occurrence with ovarian teratoma is common. While the management of mature teratoma with AE is well documented, literature on managing immature teratoma (IT) in tandem with AE is relatively scarce. Here, we report a case of a female patient in her early adolescence who presented with abdominal pain and was diagnosed with grade 3 IT combined with anti-NMDAR AE after an ovarian tumour was discovered and resected. Postsurgery, the patient received immunotherapy, chemotherapy and antiepileptic therapy, and two follow-up evaluations showed no signs of recurrence or sequelae. This case highlights the importance of a high index of suspicion for concurrent AE in the presence of ovarian teratoma, particularly IT, and the crucial role of concurrent administration of immunotherapy and chemotherapy following tumour resection in impacting prognosis.
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Affiliation(s)
- Zhang Kai-Jing
- Hematology, Hangzhou Children's Hospital, Hang-zhou, Zhe-jiang, China
| | - Lv Xiao-Juan
- Department of Children's Hematology, Hangzhou Children's Hospital, Hang-zhou, Zhe-jiang, China
| | - Huang Xiao-Hui
- Pediatric Internal Medicine, Hangzhou Children's Hospital, Hang-zhou, Zhe-jiang, China
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30
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Offor UT, Hollis P, Ognjanovic M, Parry G, Khushnood A, Long HM, Gennery AR, Bacon CM, Simmonds J, Reinhardt Z, Bomken S. Immunology of THymectomy And childhood CArdiac transplant (ITHACA): protocol for a UK-wide prospective observational cohort study to identify immunological risk factors of post-transplant lymphoproliferative disease (PTLD) in thymectomised children. BMJ Open 2023; 13:e079582. [PMID: 37865406 PMCID: PMC10603490 DOI: 10.1136/bmjopen-2023-079582] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Paediatric heart transplant patients are disproportionately affected by Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disease (PTLD) compared with other childhood solid organ recipients. The drivers for this disparity remain poorly understood. A potential risk factor within this cohort is the routine surgical removal of the thymus-a gland critical for the normal development of T-lymphocyte-mediated antiviral immunity-in early life, which does not occur in other solid organ transplant recipients. Our study aims to describe the key immunological differences associated with early thymectomy, its impact on the temporal immune response to EBV infection and subsequent risk of PTLD. METHODS AND ANALYSIS Prospective and sequential immune monitoring will be performed for 34 heart transplant recipients and 6 renal transplant patients (aged 0-18 years), stratified into early (<1 year), late (>1 year) and non-thymectomy groups. Peripheral blood samples and clinical data will be taken before transplant and at 3, 6, 12 and 24 months post-transplant. Single cell analysis of circulating immune cells and enumeration of EBV-specific T-lymphocytes will be performed using high-dimensional spectral flow cytometry with peptide-Major Histocompatibilty Complex (pMHC) I/II tetramer assay, respectively. The functional status of EBV-specific T-lymphocytes, along with EBV antibodies and viral load will be monitored at each of the predefined study time points. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the North of Scotland Research Ethics Committee. The results will be disseminated through publications in peer-reviewed journals, presentations at scientific conferences and patient-centred forums, including social media. TRIAL REGISTRATION NUMBER ISRCTN10096625.
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Affiliation(s)
- Ugonna T Offor
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Department of Paediatric Haematology and Oncology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Paolo Hollis
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Milos Ognjanovic
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Department of Cardiopulmonary Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Abbas Khushnood
- Department of Cardiopulmonary Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Heather M Long
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Chris M Bacon
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jacob Simmonds
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Zdenka Reinhardt
- Department of Cardiopulmonary Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Simon Bomken
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Department of Paediatric Haematology and Oncology, Great North Children's Hospital, Newcastle Upon Tyne, UK
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Kavirayani V, Pai NG, Nayal B, Prabhu S. Infantile inflammatory myofibroblastic tumour of the sigmoid colon: a diagnostic dilemma. BMJ Case Rep 2023; 16:e256505. [PMID: 37832973 PMCID: PMC10583037 DOI: 10.1136/bcr-2023-256505] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
An inflammatory myofibroblastic tumour (IMT) is an uncommon neoplasm composed of inflammatory cells and myofibroblasts in a fibrous stroma. They are mostly seen in the lungs and rarely involve the gastrointestinal tract. An 8-month-old infant presented with a history of lower abdominal lump for 2 months. Her CT scan confirmed a large, lobulated mass in the retroperitoneum arising from the pelvis. The mass was found to be arising from the sigmoid colon on laparotomy which was excised. Histopathology showed a cellular tumour composed of spindle cells and inflammatory lymphocytic infiltrate. Immunohistochemistry revealed positive staining for anaplastic lymphoma kinase and smooth muscle actin, confirming the diagnosis of IMT. The patient is doing well at her 6-month follow-up. Ours is the youngest case of sigmoid IMT among the only other series of eight cases reported in the literature indicating its rarity.
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Affiliation(s)
- Vaishnavi Kavirayani
- Pediatric Surgery, Kasturba Medical College Manipal, Manipal academy of Higher education, Manipal, Karnataka, India
| | - Nitin G Pai
- Pediatric Surgery, Kasturba Medical College Manipal, Manipal academy of Higher education, Manipal, Karnataka, India
| | - Bhavna Nayal
- Pathology, Kasturba Medical College Manipal, Manipal academy of Higher education, Manipal, Karnataka, India
| | - Santosh Prabhu
- Pediatric Surgery, Kasturba Medical College Manipal, Manipal academy of Higher education, Manipal, Karnataka, India
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Majamanda MD, Chisoni F, Selemani A, Kearns I, Maree J. Paediatric oncology nursing education and training programmes: a scoping review protocol. BMJ Open 2023; 13:e070694. [PMID: 37813530 PMCID: PMC10565288 DOI: 10.1136/bmjopen-2022-070694] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment. METHODS The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary. ETHICS AND DISSEMINATION This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/X3Q4H.
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Affiliation(s)
- Maureen Daisy Majamanda
- Child Health Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Chisoni
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Apatsa Selemani
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Irene Kearns
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Maree
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
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33
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Melesse TG, Chau JPC, Li WHC, Yimer MA. Family caregivers' experiences of caring for children diagnosed with haematological malignancies receiving chemotherapy in Ethiopia: A qualitative study. Eur J Oncol Nurs 2023; 66:102376. [PMID: 37506611 DOI: 10.1016/j.ejon.2023.102376] [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: 08/26/2022] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Studies from different countries show that caregivers of children with haematological cancer receiving chemotherapy encounter substantial distress when witnessing their children's suffering from the illness and chemotherapy side effects, alongside experiencing psychosocial problems and financial difficulties. However, no studies for this are available from Ethiopia in its specific cultural background and health care system. Thus, this study aimed to explore and bring into light the experiences of Ethiopian family caregivers of children with haematological malignancies receiving chemotherapy. METHODS A qualitative descriptive study was conducted using a maximum variation purposive sampling method among 20 caregivers. Semi-structured in-depth face-to-face interviews were conducted until no new themes discovered. The data were analysed through qualitative thematic analysis. RESULTS Participants believed cancer comes from different reasons and chemotherapy is ineffective in curing cancer. They identified various chemotherapy-related side effects, and psychosocial problems. The lack of health insurance, loss of job or income, and high cost of treatments were the major financial challenges. Adhering to treatments, acceptance and reassurance, religious and spiritual therapies, traditional medicine, and a support system were the major coping strategies. They had needs for improved support in information and education, psychosocial support, and in the availability of medications. CONCLUSIONS Systematic health assessment, provision of targeted information and education, psychosocial support, nursing care respecting the caregivers' positive coping strategies, improvement in chemotherapy medication availability, and facilitating connections with supporting organisations would help improve child outcomes and address caregiver needs.
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Affiliation(s)
- Tenaw Gualu Melesse
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Markos University, Ethiopia
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - William Ho Cheung Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Mulugeta Ayalew Yimer
- Unit of Paediatric Haematology-Oncology, Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Ethiopia
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Sampath A, Panwar H, Kapoor NNA, Sharma PK. Osseous metaplasia in a rectal polyp. BMJ Case Rep 2023; 16:e254819. [PMID: 37751981 PMCID: PMC10533677 DOI: 10.1136/bcr-2023-254819] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Rectal polyps are finger-like projections of the mucosal surface that generally present with complaints of bleeding or mass per rectum. Polyps are classified histopathologically as neoplastic and non-neoplastic. Here, we present one such rare case of a middle-childhood boy who presented with complaints of bleeding per-rectum and revealed a 1.5 cm long rectal polyp. Histopathological examination revealed an osseous change in the rectal polyp. A detailed literature review of reported cases of benign rectal polyps with osseous metaplasia was conducted and consolidated all postulated theories of pathogenesis. This case report shows an interesting incidental finding of osseous metaplasia of the rectal polyp.
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Affiliation(s)
- Ananyan Sampath
- All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Hemalata Panwar
- Department of Pathology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Neelkamal N A Kapoor
- Department of Pathology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Pramod Kumar Sharma
- Pediatric Surgery, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
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35
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Pearson ADJ, Federico S, Gatz SA, Ortiz M, Lesa G, Scobie N, Gounaris I, Weiner SL, Weigel B, Unger TJ, Stewart E, Smith M, Slotkin EK, Reaman G, Pappo A, Nysom K, Norga K, McDonough J, Marshall LV, Ludwinski D, Ligas F, Karres D, Kool M, Horner TJ, Henssen A, Heenen D, Hawkins DS, Gore L, Bender JG, Galluzzo S, Fox E, de Rojas T, Davies BR, Chakrabarti J, Carmichael J, Bradford D, Blanc P, Bernardi R, Benchetrit S, Akindele K, Vassal G. Paediatric Strategy Forum for medicinal product development of DNA damage response pathway inhibitors in children and adolescents with cancer: ACCELERATE in collaboration with the European Medicines Agency with participation of the Food and Drug Administration. Eur J Cancer 2023; 190:112950. [PMID: 37441939 DOI: 10.1016/j.ejca.2023.112950] [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: 03/06/2023] [Revised: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023]
Abstract
DNA damage response inhibitors have a potentially important therapeutic role in paediatric cancers; however, their optimal use, including patient selection and combination strategy, remains unknown. Moreover, there is an imbalance between the number of drugs with diverse mechanisms of action and the limited number of paediatric patients available to be enrolled in early-phase trials, so prioritisation and a strategy are essential. While PARP inhibitors targeting homologous recombination-deficient tumours have been used primarily in the treatment of adult cancers with BRCA1/2 mutations, BRCA1/2 mutations occur infrequently in childhood tumours, and therefore, a specific response hypothesis is required. Combinations with targeted radiotherapy, ATR inhibitors, or antibody drug conjugates with DNA topoisomerase I inhibitor-related warheads warrant evaluation. Additional monotherapy trials of PARP inhibitors with the same mechanism of action are not recommended. PARP1-specific inhibitors and PARP inhibitors with very good central nervous system penetration also deserve evaluation. ATR, ATM, DNA-PK, CHK1, WEE1, DNA polymerase theta and PKMYT1 inhibitors are early in paediatric development. There should be an overall coordinated strategy for their development. Therefore, an academia/industry consensus of the relevant biomarkers will be established and a focused meeting on ATR inhibitors (as proof of principle) held. CHK1 inhibitors have demonstrated activity in desmoplastic small round cell tumours and have a potential role in the treatment of other paediatric malignancies, such as neuroblastoma and Ewing sarcoma. Access to CHK1 inhibitors for paediatric clinical trials is a high priority. The three key elements in evaluating these inhibitors in children are (1) innovative trial design (design driven by a clear hypothesis with the intent to further investigate responders and non-responders with detailed retrospective molecular analyses to generate a revised or new hypothesis); (2) biomarker selection and (3) rational combination therapy, which is limited by overlapping toxicity. To maximally benefit children with cancer, investigators should work collaboratively to learn the lessons from the past and apply them to future studies. Plans should be based on the relevant biology, with a focus on simultaneous and parallel research in preclinical and clinical settings, and an overall integrated and collaborative strategy.
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Affiliation(s)
- Andrew D J Pearson
- ACCELERATE, c/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30 BE-1200 Brussels, Belgium.
| | - Sara Federico
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Susanne A Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michael Ortiz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giovanni Lesa
- Paediatric Medicines Office, Scientific Evidence Generation Department, Human Division, European Medicines Agency (EMA), Amsterdam, the Netherlands
| | | | - Ioannis Gounaris
- Merck Serono Ltd (an affiliate of Merck KGaA, Darmstadt, Germany), Feltham, UK
| | | | | | - T J Unger
- Repare Therapeutics, Cambridge, MA, USA
| | | | | | | | - Gregory Reaman
- US Food and Drug Administration, Silver Springs, MD, USA
| | - Alberto Pappo
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Koen Norga
- Antwerp University Hospital, Antwerp, Belgium; Paediatric Committee of the European Medicines Agency (EMA), Amsterdam, the Netherlands; Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Joe McDonough
- The Andrew McDonough B+ Foundation, Wilmington, DE, USA
| | - Lynley V Marshall
- The Royal Marsden NHS Foundation Hospital, The Institute of Cancer Research, Sutton, Surrey, UK
| | | | - Franca Ligas
- Paediatric Medicines Office, Scientific Evidence Generation Department, Human Division, European Medicines Agency (EMA), Amsterdam, the Netherlands
| | - Dominik Karres
- Paediatric Medicines Office, Scientific Evidence Generation Department, Human Division, European Medicines Agency (EMA), Amsterdam, the Netherlands
| | - Marcel Kool
- Hopp Children's Cancer Center, Heidelberg, Germany
| | | | | | | | - Douglas S Hawkins
- Seattle Children's Hospital, Seattle, WA, USA; Children's Oncology Group, Seattle, WA, USA
| | - Lia Gore
- Children's Hospital Colorado, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Elizabeth Fox
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Teresa de Rojas
- ACCELERATE, c/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30 BE-1200 Brussels, Belgium
| | | | | | - Juliet Carmichael
- The Royal Marsden NHS Foundation Hospital, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Diana Bradford
- US Food and Drug Administration, Silver Springs, MD, USA
| | | | - Ronald Bernardi
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | - Sylvie Benchetrit
- National Agency for the Safety of Medicine and Health Products, Paris, France
| | | | - Gilles Vassal
- ACCELERATE, c/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30 BE-1200 Brussels, Belgium; Gustave Roussy Cancer Centre, Paris, France
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Seneviwickrama M, Gunasekera S, Liyanage G, Heiyanthuduwa W, Jayakody S. Availability of cytotoxic medicines in the WHO essential medicine list used in treating childhood malignancies in low-income and lower-middle-income countries: a systematic review protocol. BMJ Open 2023; 13:e071988. [PMID: 37336532 DOI: 10.1136/bmjopen-2023-071988] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Cancer is a leading cause of death globally with childhood cancers accounting for around 5% of the total incidence. Almost 90% of childhood cancers are recorded from low-income and lower-middle-income countries (LLMICs), where survival rates are comparatively low. The unavailability of essential medicines for childhood cancers is identified as a reason for this observed health inequity. The objectives of this review are to describe the availability of cytotoxic medicines in the WHO essential medicine list (EML) used in treating children with cancer in LLMICs and to determine the enablers and barriers to accessing WHO essential medicines for childhood cancer. METHODS AND ANALYSIS A systematic review will be conducted using electronic databases: MEDLINE, EMBASE and CINAHL. Additional articles and grey literature will be searched in Google Scholar and reference list of the selected articles. It will include primary studies, national/regional reports and policy documents. Review questions will be framed into different components according to the ECLIPSe framework. Children less than 19 years of age diagnosed with any malignant disorder in LLMICs will be the client group. Studies that have focused on the availability of EML for adult malignancies and care providers' knowledge of EML for childhood malignancies will not be considered. Only the studies reported in the English language will be included. Mixed methods Appraisal Tool will be used to assess the quality of included studies. Data will be presented as a narrative synthesis. ETHICS AND DISSEMINATION This research is exempt from ethics approval because the work is carried out on published documents. Findings of this review will be disseminated through a peer-reviewed journal for the authorities in LLMICs to understand the magnitude of the problem and to identify enablers and barriers to take evidence based decisions to improve their health system. PROSPERO REGISTRATION NUMBER CRD42022334156.
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Affiliation(s)
- Maheeka Seneviwickrama
- Centre for Cancer Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sanjeeva Gunasekera
- Department of Paediatric Oncology, National Cancer Institute Sri Lanka, Maharagama, Sri Lanka
- Sri Lanka Cancer Research Group, Colombo, Sri Lanka
| | - Guwani Liyanage
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Wasana Heiyanthuduwa
- Centre for Cancer Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Surangi Jayakody
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Division of Health Sciences, University of Warwick Warwick Medical School, Coventry, UK
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Agarwal A, Amit M, Chaffin J, Strobel A. Blastic plasmacytoid dendritic cell neoplasm in an adolescent female: a rare entity with challenging diagnosis and management. BMJ Case Rep 2023; 16:16/5/e254008. [PMID: 37258047 DOI: 10.1136/bcr-2022-254008] [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: 06/02/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive haematopoietic neoplasm with poor prognosis. It usually presents with cutaneous lesions and symptoms secondary to bone marrow involvement. Due to rarity and lack of standard treatment protocols, these cases are difficult to diagnose and treat. We report a case of a female in early adolescence who presented with skin nodules on the leg. The diagnosis was established by immunophenotypic studies. We discuss the investigations and treatment options available to diagnose and treat this malignancy.
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Affiliation(s)
- Ankit Agarwal
- Pediatrics, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA
| | - Michelle Amit
- Pediatrics, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA
| | - Joanna Chaffin
- Department of Pathology, University of Florida, Gainesville, Florida, USA
| | - Amanda Strobel
- Pediatric Hematology/Oncology, University of Florida, Pensacola, Florida, USA
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Yadav R, Kandasamy D, Agarwal S, Gamanagatti S. Mesenteric lipoblastomatosis: an uncommon fat-containing childhood tumour diagnosed on imaging. BMJ Case Rep 2023; 16:16/5/e249928. [PMID: 37236672 DOI: 10.1136/bcr-2022-249928] [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: 05/28/2023] Open
Abstract
Lipoblastomatosis of mesentery is an extremely rare benign fat-containing mesenchymal tumour in infants and young children. On imaging, it appears as a solid infiltrating mass interspersed with macroscopic fat. We describe the distinctive imaging features of a large mesenteric Lipoblastomatosis, corroborated with intraoperative and histopathological features. We hope the case report and short review about this rare entity will increase the diagnostic confidence of reading radiologists while formulating differentials for lesions of similar appearance in the paediatric age group.
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Affiliation(s)
- Richa Yadav
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Sandeep Agarwal
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Prasad A, Elangaratnam D, Agrawal S, O'Donnell R. Use of an armoured endotracheal tube in a toddler with mediastinal mass. BMJ Case Rep 2023; 16:16/3/e254410. [PMID: 36958760 PMCID: PMC10040047 DOI: 10.1136/bcr-2022-254410] [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: 03/25/2023] Open
Abstract
Anterior mediastinal mass presents an airway challenge due to its relative size in a paediatric chest and its invasion and compression of the surrounding structures. We present a case of a toddler with airway obstruction secondary to an anterior mediastinal mass. We describe how the use of an armoured endotracheal tube helped with ventilation while waiting for steroids and chemotherapy to reduce the tumour size and compression.
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Affiliation(s)
- Aalekh Prasad
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | - Shruti Agrawal
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Roddy O'Donnell
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
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40
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van den Bosch CH, Loeffen Y, van der Steeg AFW, van der Bruggen JTT, Frakking FNJ, Fiocco M, van de Ven CP, Wijnen MHWA, van de Wetering MD. CATERPILLAR-study protocol: an assessor-blinded randomised controlled trial comparing taurolidine-citrate-heparin to heparin-only lock solutions for the prevention of central line-associated bloodstream infections in paediatric oncology patients. BMJ Open 2023; 13:e069760. [PMID: 36944461 PMCID: PMC10032404 DOI: 10.1136/bmjopen-2022-069760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The efficacy of taurolidine containing lock solutions for the prevention of central line-associated bloodstream infections (CLABSI) in paediatric oncology patients is still unknown. If the taurolidine-citrate-heparin lock appears to decrease the incidence of CLABSIs, we hope to increase the quality of life of children with cancer by subsequently reducing the central venous access device (CVAD)-removal rates, dispense of antibiotics, hospital admissions and incidence of severe sepsis resulting in intensive care unit admission. METHODS AND ANALYSIS This assessor-blinded randomised controlled trial including 462 patients was designed to compare the taurolidine-citrate-heparin lock to the heparin-only lock for the prevention of CLABSIs in paediatric oncology patients. Patients receiving their first CVAD at the Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands, are eligible for inclusion. The primary outcome of this study is the incidence of first CLABSIs from CVAD insertion until the end of the study, maximum follow-up of 90 days. An intention-to-treat and a per-protocol analysis will be performed. An interim analysis will be performed after the inclusion of 50% of the patients. The results of the interim analysis and overall conduct of the trial will be discussed by a data safety monitoring board. ETHICS AND DISSEMINATION The medical ethics committee NedMec, Utrecht, the Netherlands, has approved this research (number 20/370). Written informed consent for participation in this trial and publication of the trial data is obtained from all patients and/or their parents/guardians. The results of this trial will be published in a peer-reviewed journal and the data will be made available on reasonable request after publication of the main results manuscript. TRIAL REGISTRATION NUMBERS NTR6688; NCT05740150.
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Affiliation(s)
| | - Yvette Loeffen
- Department of Pediatric Infectious Diseases and Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Florine N J Frakking
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marta Fiocco
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Leiden University Mathematical Institute, Leiden, The Netherlands
| | | | - Marc H W A Wijnen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Norbäck K, Höglund AT, Godskesen T, Frygner-Holm S. Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals' perceptions and experiences. BMC Med Ethics 2023; 24:23. [PMID: 36918868 PMCID: PMC10012289 DOI: 10.1186/s12910-023-00901-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. METHODS An explorative qualitative study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. RESULTS The respondents' ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. CONCLUSION This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research.
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Affiliation(s)
- Kajsa Norbäck
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden.
| | - Anna T Höglund
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
| | - Tove Godskesen
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Box 11189, 100 61, Stockholm, Sweden
| | - Sara Frygner-Holm
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Physiotherapy and behavioral medicine, Department of Women's and Children's Health, Box 593, 751 24, Uppsala, Sweden
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van den Oever SR, de Beijer IAE, Kremer LCM, Alfes M, Balaguer J, Bardi E, Nieto AC, Cangioli G, Charalambous E, Chronaki C, Costa T, Degelsegger A, Düster V, Filbert AL, Grabow D, Gredinger G, Gsell H, Haupt R, van Helvoirt M, Ladenstein R, Langer T, Laschkolnig A, Muraca M, Rascon J, Schreier G, Tomasikova Z, Tormo MT, Trinkunas J, Trollip J, Trunner K, Uyttebroeck A, van der Pal HJH, Pluijm SMF. Barriers and facilitators to implementation of the interoperable Survivorship Passport (SurPass) v2.0 in 6 European countries: a PanCareSurPass online survey study. J Cancer Surviv 2023:10.1007/s11764-023-01335-y. [PMID: 36808389 DOI: 10.1007/s11764-023-01335-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) is essential to improve and maintain their quality of life. The Survivorship Passport (SurPass) is a digital tool which can aid in the delivery of adequate LTFU care. During the European PanCareSurPass (PCSP) project, the SurPass v2.0 will be implemented and evaluated at six LTFU care clinics in Austria, Belgium, Germany, Italy, Lithuania and Spain. We aimed to identify barriers and facilitators to the implementation of the SurPass v2.0 with regard to the care process as well as ethical, legal, social and economical aspects. METHODS An online, semi-structured survey was distributed to 75 stakeholders (LTFU care providers, LTFU care program managers and CCSs) affiliated with one of the six centres. Barriers and facilitators identified in four centres or more were defined as main contextual factors influencing implementation of SurPass v2.0. RESULTS Fifty-four barriers and 50 facilitators were identified. Among the main barriers were a lack of time and (financial) resources, gaps in knowledge concerning ethical and legal issues and a potential increase in health-related anxiety in CCSs upon receiving a SurPass. Main facilitators included institutions' access to electronic medical records, as well as previous experience with SurPass or similar tools. CONCLUSIONS We provided an overview of contextual factors that may influence SurPass implementation. Solutions should be found to overcome barriers and ensure effective implementation of SurPass v2.0 into routine clinical care. IMPLICATIONS FOR CANCER SURVIVORS These findings will be used to inform on an implementation strategy tailored for the six centres.
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Affiliation(s)
- Selina R van den Oever
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Ismay A E de Beijer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Julia Balaguer
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | | | | | | | | | | | - Vanessa Düster
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Anna-Liesa Filbert
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | | | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Justas Trinkunas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jessica Trollip
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Anne Uyttebroeck
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Ecker J, Selt F, Sturm D, Sill M, Korshunov A, Hirsch S, Capper D, Dikow N, Sutter C, Müller C, Sigaud R, Eggert A, Simon T, Niehues T, von Deimling A, Pajtler KW, van Tilburg CM, Jones DTW, Sahm F, Pfister SM, Witt O, Milde T. Molecular diagnostics enables detection of actionable targets: the Pediatric Targeted Therapy 2.0 registry. Eur J Cancer 2023; 180:71-84. [PMID: 36542877 DOI: 10.1016/j.ejca.2022.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Precision oncology requires diagnostic accuracy and robust detection of actionable alterations. The Pediatric Targeted Therapy (PTT) 2.0 program aims at improving diagnostic accuracy by addition of molecular analyses to the existing histological diagnosis and detection of actionable alterations for relapsed paediatric oncology patients, in cases with limited availability of tumour material. METHODS Paediatric patients diagnosed with relapse or progression of a central nervous system tumour (n = 178), a sarcoma (n = 41) or another solid tumour (n = 44) were included. DNA methylation array, targeted gene panel sequencing on tumour and blood (130 genes), RNA sequencing in selected cases and a pathway-specific immunohistochemistry (IHC) panel were performed using limited formalin-fixed paraffin embedded tissue from any disease episode available. The clinical impact of reported findings was assessed by a serial questionnaire-based follow-up. RESULTS Integrated molecular diagnostics resulted in refined or changed diagnosis in 117/263 (44%) tumours. Actionable targets were detected in 155/263 (59%) cases. Constitutional DNA variants with clinical relevance were identified in 16/240 (7%) of patients, half of which were previously unknown. Clinical follow-up showed that 26/263 (10%) of patients received mechanism-of-action based treatment matched to the molecular findings. CONCLUSION Next-generation diagnostics adds robust and relevant information on diagnosis, actionable alterations and cancer predisposition syndromes even when tissue from the current disease episode is limited.
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Affiliation(s)
- Jonas Ecker
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Selt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany; Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Steffen Hirsch
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Department of Human Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, And German Consortium for Translational Cancer Research (DKTK), Berlin, Germany
| | - Nicola Dikow
- Department of Human Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Sutter
- Department of Human Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Carina Müller
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Romain Sigaud
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Cologne, Germany
| | - Tim Niehues
- Children's Cancer Center, Helios Hospital Krefeld, Krefeld, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Cornelis M van Tilburg
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany; Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
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Buch AC, Bhuibhar G, Londhe M, Dhaliwal S, Gurwale S. Extrarenal rhabdoid tumour of axillary soft tissue: a diagnostic challenge resolved by immunohistochemistry. BMJ Case Rep 2023; 16:16/1/e254438. [PMID: 36720509 PMCID: PMC9890742 DOI: 10.1136/bcr-2022-254438] [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: 02/02/2023] Open
Abstract
Extrarenal rhabdoid tumour of soft tissue in children is a rare tumour associated with poor prognosis. It is a heterogeneous group of aggressive tumours with distinct histopathological and immunohistochemistry findings. The tumour is characterised by diffuse proliferation of rhabdoid cells with hyaline like inclusion bodies. Defining feature is aberration of INI1/SMARCB1 gene located at chromosome 22q11.2. We report one such rare case in a female infant presenting as left axillary mass.
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Affiliation(s)
- Archana Chirag Buch
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Gayatri Bhuibhar
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Mangesh Londhe
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sargam Dhaliwal
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sushama Gurwale
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Deribe L, Addissie A, Girma E, Abraha A, Adam H, Berbyuk Lindström N. Stress and coping strategies among parents of children with cancer at Tikur Anbessa Specialized Hospital paediatric oncology unit, Ethiopia: a phenomenological study. BMJ Open 2023; 13:e065090. [PMID: 36609328 PMCID: PMC9827240 DOI: 10.1136/bmjopen-2022-065090] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study explores sources of stress, conditions that help reduce stress levels and coping strategies among parents of children with cancer receiving chemotherapy at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. DESIGN A qualitative phenomenological approach was used. SETTING Parents of children receiving chemotherapy at the TASH paediatric oncology unit. PARTICIPANTS Fifteen semistructured in-depth interviews were conducted with nine mothers and six fathers of children with cancer from November 2020 to January 2021. RESULTS Sources of stress related to child's health condition as the severity of the child's illness, fear of treatment side effects and loss of body parts were identified. Parents mentioned experiencing stress arising from limited access to health facilities, long waiting times, prolonged hospital stays, lack of chemotherapy drugs, and limited or inadequate information about their child's disease condition and treatment. Other sources of stress were insufficient social support, stigmatisation of cancer and financial problems. Conditions decreasing parents' stress included positive changes in the child's health, receiving cancer treatment and access to drugs. Receiving counselling from healthcare providers, getting social support and knowing someone who had a positive treatment outcome also helped reduce stress. Coping strategies used by parents were religious practices including prayer, crying, accepting the child's condition, denial and communication with health providers. CONCLUSION The main causes of stress identified by parents of children with cancer in Ethiopia were the severity of their child's illness, expectations of poor treatment outcomes, unavailability of cancer treatment services and lack of social/financial support. Measures that should be considered to reduce parents' stress include providing psycho-oncological care for parents and improving the counselling available to parents concerning the nature of the child's illness, its treatment, diagnostic procedures and treatment side effects. It may also be helpful to establish and strengthen family support groups and parent-to-parent communication, improve the availability of chemotherapy drugs and offer more education on coping strategies.
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Affiliation(s)
- Leul Deribe
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Department of Oncology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Haileyesus Adam
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Fraleigh R, Wei XC, Yu W, Miettunen PM. Chronic recurrent multifocal osteomyelitis with a comprehensive approach to differential diagnosis of paediatric skull pain. BMJ Case Rep 2023; 16:16/1/e252471. [PMID: 36599493 PMCID: PMC9815035 DOI: 10.1136/bcr-2022-252471] [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: 01/05/2023] Open
Abstract
A girl in middle childhood was referred to rheumatology with a 1-month history of progressive skull pain, preceded by fleeting musculoskeletal symptoms. Apart from a scaly rash on her scalp, she was well, with moderately elevated inflammatory markers. Skull imaging (radiographs, CT and MRI) revealed osteolytic lesions, soft tissue swelling and pachymeningeal enhancement at frontal and temporal convexities. Langerhans cell histiocytosis, bone infection/inflammation or malignancy was considered. Skin and bone biopsies eventually ruled out mimicking diseases and confirmed the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). She was treated with intravenous pamidronate (IVPAM) for 9 months, with rapid resolution of pain and gradual resolution of bony abnormalities. She remains in remission at 15-month follow-up. While CRMO can affect any bone, skull involvement is extremely rare, with a broad differential diagnosis. We recommend bone biopsy to confirm skull CRMO. The patient achieved excellent clinical and radiological response to IVPAM.
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Affiliation(s)
- Ross Fraleigh
- Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta, Canada.,Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- Diagnostic Imaging, Alberta Children's Hospital, Calgary, Alberta, Canada.,Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Weiming Yu
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Pathology and Laboratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Paivi Maria Miettunen
- Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta, Canada .,Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.,Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Samim A, Blom T, Poot AJ, Windhorst AD, Fiocco M, Tolboom N, Braat AJAT, Viol SLM, van Rooij R, van Noesel MM, Lam MGEH, Tytgat GAM, de Keizer B. [(18)F]mFBG PET-CT for detection and localisation of neuroblastoma: a prospective pilot study. Eur J Nucl Med Mol Imaging 2023; 50:1146-57. [PMID: 36504277 DOI: 10.1007/s00259-022-06063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Meta-[18F]fluorobenzylguanidine ([18F]mFBG) is a positron emission tomography (PET) radiotracer that allows for fast and high-resolution imaging of tumours expressing the norepinephrine transporter. This pilot study investigates the feasibility of [18F]mFBG PET-CT for imaging in neuroblastoma. METHODS In a prospective, single-centre study, we recruited children with neuroblastoma, referred for meta-[123I]iodobenzylguanidine ([123I]mIBG) scanning, consisting of total body planar scintigraphy in combination with single-photon emission computed tomography-CT (SPECT-CT). Within two weeks of [123I]mIBG scanning, total body PET-CTs were performed at 1 h and 2 h after injection of [18F]mFBG (2 MBq/kg). Detected tumour localisations on scan pairs were compared. Soft tissue disease was quantified by number of lesions and skeletal disease by SIOPEN score. RESULTS Twenty paired [123I]mIBG and [18F]mFBG scans were performed in 14 patients (median age 4.9 years, n = 13 stage 4 disease and n = 1 stage 4S). [18F]mFBG injection was well tolerated and no related adverse events occurred in any of the patients. Mean scan time for [18F]mFBG PET-CT (9.0 min, SD 1.9) was significantly shorter than for [123I]mIBG scanning (84.5 min, SD 10.5), p < 0.01. Most tumour localisations were detected on the 1 h versus 2 h post-injection [18F]mFBG PET-CT. Compared to [123I]mIBG scanning, [18F]mFBG PET-CT detected a higher, equal, and lower number of soft tissue lesions in 40%, 55%, and 5% of scan pairs, respectively, and a higher, equal, and lower SIOPEN score in 55%, 30%, and 15% of scan pairs, respectively. On average, two more soft tissue lesions and a 6-point higher SIOPEN score were detected per patient on [18F]mFBG PET-CT compared to [123I]mIBG scanning. CONCLUSION Results of this study demonstrate feasibility of [18F]mFBG PET-CT for neuroblastoma imaging. More neuroblastoma localisations were detected on [18F]mFBG PET-CT compared to [123I]mIBG scanning. [18F]mFBG PET-CT shows promise for future staging and response assessment in neuroblastoma. TRIAL REGISTRATION Dutch Trial Register NL8152.
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Rahamtalla D, Al Rawahi Y, Al Abri H, Wali Y. Intramural duodenal haematoma in a child post-endoscopic biopsy. BMJ Case Rep 2022; 15:15/12/e250884. [PMID: 36585043 PMCID: PMC9809290 DOI: 10.1136/bcr-2022-250884] [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: 12/31/2022] Open
Abstract
Intramural duodenal haematoma is a rare complication of endoscopic biopsy. Though other causes such as blunt abdominal trauma are more common, it remains a rare problem in paediatric population. In this article, we report a patient who developed intramural duodenal haematoma following an endoscopic biopsy that was performed to look for evidence of gut graft versus host disease.
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Affiliation(s)
| | | | - Hamda Al Abri
- Pediatric, Oman Medical Speciality Board, Al-Athaiba, Oman
| | - Yasser Wali
- Department of Child Health, Sultan Qaboos University, Muscat, Oman .,Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Warkad V, Tripathy D. Intravitreal chemotherapy-induced cataract in retinoblastoma: challenges and outcome. BMJ Case Rep 2022; 15:15/12/e250617. [PMID: 36535729 PMCID: PMC9764654 DOI: 10.1136/bcr-2022-250617] [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: 12/24/2022] Open
Abstract
A toddler with bilateral retinoblastoma (Rb) received intravenous chemotherapy for advanced tumours in both eyes. The right eye required enucleation due to a poor response, but the left eye was salvaged by additional treatment with intravitreal chemotherapy for tumour vitreous seeds. Though the vitreous seeds regressed, a gradually progressive cataract developed likely due to drug toxicity. On ensuring continued regression of tumour within the eye, cataract extraction was performed. Surgery was uneventful and the child recovered good functional vision in the left eye. Salvaging the eyeball followed by vision restoration through cataract surgery in the only remaining eye of the child necessitated a multidisciplinary approach involving the ocular oncologist, the paediatric medical oncologist and the paediatric ophthalmologist. Ensuring tumour quiescence within the eye clinically before cataract surgery was the most crucial element of management. Additionally, close monitoring of the progress of the cataract to decide when to intervene was also necessary to keep the risk of amblyopia at bay. The patient recovered good functional vision in the left eye after the surgery and remained free of any tumour recurrence or systemic metastasis at 10 months of follow-up.
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Affiliation(s)
- Vivekanand Warkad
- Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Child Sight Institute, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| | - Devjyoti Tripathy
- Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
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