Predictors of anthracycline-induced cardiotoxicity in a retro-prolective cohort of children surviving cancer

Introduction

Cardiotoxicity is an adverse reaction associated with the use of anthracyclines.

Objective

To estimate the factors associated with the development of anthracycline cardiotoxicity in pediatric patients surviving cancer.

Method

Retro-prolective cohort of children diagnosed with cancer and treated with anthracyclines. Baseline echocardiographic determination of ejection fraction (LVEF0) was carried out before the start of treatment and again at 12 months (LVEF1). Demographic characteristics and treatment were obtained from the medical record. A multiple logistic regression (MLR) model was constructed; LVEF1 < 50 % was the dependent variable, which was adjusted for the main confounding variables.

Results

Sixty-five patients were included, out of which 36.9 % were females and 56.8 % had a solid tumor. LVEF0 was 74.79 ± 7.3 % and LVEF1, 67.96 ± 6.7 % (p = 0.001); 60 % developed cardiotoxicity. In the MLR, only a cumulative dose > 430 mg was associated with cardiotoxicity (p = 0.001).

Conclusions

In Mexican children, an anthracycline cumulative dose > 430 mg should be avoided in order to prevent cardiotoxicity.

Comparison of International Reference Values for Bone Speed of Sound in Pediatric Populations: Meta-analysis

The aim of this study was to compare international reference values (RV) for tibial and radial speed of sound (SoS) assessed by quantitative ultrasound (QUS) in pediatric populations. These values were compared by age and country of origin in a systematic review with meta-analysis from studies published on QUS (Sunlight Omnisense). A search was carried out in electronic databases. Nine studies with 6963 patients were included in the meta-analysis. For the newborn populations, 3 studies (from Italy, Portugal, and Israel) were used. These studies included subjects with 27-42 wk gestational age. The mean difference (Portugal-Israel) was found to be 23.62 m/s [95% confidence interval [CI] 6.29, 40.95]. Additionally, no difference was found between Italy-Portugal (p = 0.69), or Italy-Israel (p = 0.28). In pediatric populations, we compared 8 studies from Canada, Mexico, Israel, Greece, Portugal, and Turkey. No significant differences found for SoS RV between Israel-Turkey, Israel-Greece, or Israel-Canada (p > 0.05). Significant differences were found in Mexico-Israel -105.29 m/s (95% CI -140.05, -70.54) (p < 0.001); Mexico-Portugal -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Greece: -239.14 m/s (95% CI -267.67, -210.62) (p < 0.001); Mexico-Turkey: -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Canada: -113.51 m/s (95% CI -140.25, -86.77) (p < 0.001).This study demonstrates that there are differences in SoS-RV obtained by tibial and radial QUS in pediatric populations between Mexico and other countries (Israel, Portugal, Greece, Turkey, and Canada).

[Anthracycline-induced cardiotoxicity: report of fatal cases]

BACKGROUND

Anthracyclines are effective drugs in pediatrics cancer treatment. However, anthracycline-induced cardiotoxicity (AIC) is a serious adverse drug reaction that affects the survival in patients treated for childhood cancer.

CLINICAL CASES

Case 1: Nine-year-old girl with stage IV Hodgkin lymphoma with 12 epirubicin doses and a cumulative dose of 576 mg/m2. After last chemotherapy dose, the patient was admitted with systemic inflammatory response, asthenia and adinamia. Echocardiography: LVEF of 22%, SF 11% and moderate mitral regurgitation. Patient died 2 days after diagnosed with dilated cardiomyopathy secondary to anthracyclines. Case 2: Fifteen-year-old girl with stage IV Burkitt lymphoma with two epirubicin doses and a cumulative dose of 90 mg/m2. After the last cycle, the patient developed several infectious foci. Echocardiography: LVEF of 49%, SF 20% and dilated left ventricle with septal flattening. Patient died 13 days after diagnosis of dilated cardiomyopathy by anthracyclines.

CONCLUSION

AIC is a problem in pediatric patients receiving anthracyclines, monitoring is essential to detect the onset of cardiac damage to provide an intervention to prevent heart failure progress.

[Effectiveness of the outpatient treatment of the community-acquired pneumonia: systematic review and meta-analysis]

BACKGROUND

Community-acquired pneumonia is an important cause of mortality and morbidity worldwide. Therefore, our aim was to assess the efficacy and safety of outpatient treatment of community-acquired pneumonia.

METHODS

We systematically reviewed randomized clinical trials evaluating efficacy and safety of outpatient treatment (OPT) compared with inpatient treatment (IPT) of community-acquired pneumonia in patients without added co-morbidity. Relative Risk (RR) and 95 % confidence interval (95 % CI) were calculated.

RESULTS

From 4088 reviewed articles, two articles were included for meta-analysis, including 2324 patients. One study was conducted in adults, and the other was carried out in pediatric patients. Treatment setting was not significantly associated with treatment failure (RR 0.84 [95% CI 0.68, 1.02]). Death occurred in 6 of 2324 with no difference between the two groups (RR 0.56 [95 % CI 0.12-2.61]). Finally, no differences were seen in hospital readmission between groups (RR 0.82 [95 % CI 0.52-1.30]).

CONCLUSION

Evidence shows that treatment setting of community-acquired pneumonia is not statistically associated with treatment failure or mortality.

Bladder agenesis and incomplete kidney duplication: Ileal reservoir with continent diversion as definitive treatment

Bladder agenesis is an extremely rare entity. A 12-year-old female patient presented with urinary incontinence, recurrent urinary tract infections, visible vaginal introitus and urethra, and two holes at the vulvar vestibule. An investigation revealed bladder agenesis. Surgery confirmed the absence of bladder, and ileal reservoir in omega (Ω) was performed with continent diversion. At the 30-month follow-up, there was no complication in clean intermittent catheterization.

[Surgical treatment of hypospadias and complications in relation to the child's age]

BACKGROUND

Hypospadias is one of the most common congenital malformations. Few studies have explored the association of age at time of surgery and the occurrence of complications after hypospadias repair.

OBJECTIVE

Determine whether age at hypospadias repair is a risk factor for development of complications.

METHODS

Retrospective cohort of patients with hypospadias repair in one surgical time. The data included: age, type of hypospadias, surgical technique and complications presented. The monitoring was conducted for six months after the surgery. Patients were classified according to age group A less than 24 months, group B from 24 to 48 months and group C over 48 months. We calculated the relative risk and confidence intervals of 95%.

RESULTS

170 patients were included in the analysis. The incidence of complications was 24.1%, the most frequent complication was urethrocutaneous fistula (52.2%). The median age in months of the complication group was 40.8 (6-196), whereas in the group without complications was 37.5 (6-196). Age was not associated with an increased risk for complications, group B (RR= 0.975 [95% CI 0.374-2.547]), and group C (RR= 0.966 [95% CI 0.386-2.416]) when compared with group A.

CONCLUSIONS

Age at time of surgery for hypospadias correction in one phase is not associated with complications.