4 research outputs found
Global Retinoblastoma Presentation and Analysis by National Income Level
Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved
Toxicological effects and resistance to pyrethroids in Boophilus microplus from Goiás, Brazil Efeitos toxicológicos e resistência a piretróides em Boophilus microplus de Goiás
In order to monitor the susceptibility of Boophilus microplus to acaricides and improve control measures, the effects of cypermethrin, deltamethrin and permethrin on larvae obtained in the city of Goiânia in the Brazilian state of Goiás were studied. Although these pyrethroids are already sold as acaricides, their cost-benefit efficiency has been questioned. Fasting 14-21 day-old larvae were immersed in solutions of the acaricides under test, maintained at 27±1° C, and relative humidity over 80%, and observed under the stereoscope within an apparatus originally designed for studying the non-parasitic phase of the tick life cycle. The observed toxicological effects were: excitability, repetitive motion, decreased motor ability, detachment, paralysis, knock-down and cuticular proliferation of liquids and gases. The materials used in the manufacture of this apparatus consisted of disposable Petri dishes, "organza" cloth and paraffin, none of which are toxic to tick larvae. Mean death rates after 24h were 76.3%, 87.5%, 77.6%, 91.2%, 86.2% and 100% for 25 and 50ppm deltamethrin, 150 and 300ppm cypermethrin and 1250 and 2500ppm permethrin, respectively. The ticks were resistant to commercial concentrations of deltamethrin and cypermethrin. Only 2500ppm permethrin produced the mortality recommended by the Brazilian Ministry of Agriculture.<br>Estudaram-se os efeitos de cipermetrina, deltametrina e permetrina sobre larvas de uma cepa de campo de Goiânia, com o objetivo de monitorar a susceptibilidade de Boophilus microplus para esses acaricidas e fomentar medidas de controle. Larvas em jejum com 14 a 21 dias, imersas em soluções desses piretróides, foram mantidas a 27±1°C e UR% > ou = 80% e observadas por 24h ao estereoscópio, contidas em dispositivo desenvolvido originalmente para estudos da fase não parasitária do ciclo evolutivo. O material utilizado em sua confecção, placa de petri descartável, tecido organza e parafina, não foi tóxico para as larvas. Os seguintes efeitos toxicológicos foram observados: excitabilidade, movimentação repetitiva, diminuição da capacidade locomotora, desprendimento, paralisia, knock-down e proliferação cuticular de líquidos e gases. A mortalidade média na 24ªh foi de 76,3%, 87,5%, 77,6%, 91,2%, 86,20%, e 100,0%, respectivamente, para deltametrina 25ppm e 50ppm, cipermetrina 150ppm e 300ppm e permetrina 1250ppm e 2500ppm. O ixodídeo foi resistente às concentrações comerciais de deltametrina e cipermetrina. Apenas permetrina 2500ppm provocou índice de mortalidade superior ao valor recomendado pelo Ministério da Agricultura para acaricidas
Global Retinoblastoma Presentation and Analysis by National Income Level
This cross-sectional analysis reports the retinoblastoma stage at
diagnosis across the world during a single year, investigates
associations between clinical variables and national income level, and
investigates risk factors for advanced disease at diagnosis.
Key PointsQuestionIs the income level of a country of residence
associated with the clinical stage of presentation of patients with
retinoblastoma? FindingsIn this cross-sectional analysis that included
4351 patients with newly diagnosed retinoblastoma, approximately half of
all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from
low-income countries had extraocular tumor at time of diagnosis compared
with 1.5\% of patients from high-income countries. MeaningThe clinical
stage of presentation of retinoblastoma, which has a major influence on
survival, significantly differs among patients from low-income and
high-income countries, which may warrant intervention on national and
international levels.
ImportanceEarly diagnosis of retinoblastoma, the most common intraocular
cancer, can save both a child's life and vision. However, anecdotal
evidence suggests that many children across the world are diagnosed
late. To our knowledge, the clinical presentation of retinoblastoma has
never been assessed on a global scale. ObjectivesTo report the
retinoblastoma stage at diagnosis in patients across the world during a
single year, to investigate associations between clinical variables and
national income level, and to investigate risk factors for advanced
disease at diagnosis. Design, Setting, and ParticipantsA total of 278
retinoblastoma treatment centers were recruited from June 2017 through
December 2018 to participate in a cross-sectional analysis of
treatment-naive patients with retinoblastoma who were diagnosed in 2017.
Main Outcomes and MeasuresAge at presentation, proportion of familial
history of retinoblastoma, and tumor stage and metastasis. ResultsThe
cohort included 4351 new patients from 153 countries; the median age at
diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976
patients (45.4\%) were female. Most patients (n=3685 {[}84.7\%]) were
from low- and middle-income countries (LMICs). Globally, the most common
indication for referral was leukocoria (n=2638 {[}62.8\%]), followed by
strabismus (n=429 {[}10.2\%]) and proptosis (n=309 {[}7.4\%]). Patients
from high-income countries (HICs) were diagnosed at a median age of 14.1
months, with 656 of 666 (98.5\%) patients having intraocular
retinoblastoma and 2 (0.3\%) having metastasis. Patients from low-income
countries were diagnosed at a median age of 30.5 months, with 256 of 521
(49.1\%) having extraocular retinoblastoma and 94 of 498 (18.9\%) having
metastasis. Lower national income level was associated with older
presentation age, higher proportion of locally advanced disease and
distant metastasis, and smaller proportion of familial history of
retinoblastoma. Advanced disease at diagnosis was more common in LMICs
even after adjusting for age (odds ratio for low-income countries vs
upper-middle-income countries and HICs, 17.92 {[}95\% CI, 12.94-24.80],
and for lower-middle-income countries vs upper-middle-income countries
and HICs, 5.74 {[}95\% CI, 4.30-7.68]). Conclusions and RelevanceThis
study is estimated to have included more than half of all new
retinoblastoma cases worldwide in 2017. Children from LMICs, where the
main global retinoblastoma burden lies, presented at an older age with
more advanced disease and demonstrated a smaller proportion of familial
history of retinoblastoma, likely because many do not reach a
childbearing age. Given that retinoblastoma is curable, these data are
concerning and mandate intervention at national and international
levels. Further studies are needed to investigate factors, other than
age at presentation, that may be associated with advanced disease in
LMICs