The prevalence of malnutrition and its risk factors in children attending outpatient clinics in the city of Manaus, Amazonas, Brazil

The objective of this study was to determine the prevalence of malnutrition and its risk factors in children aged 0-10 years attending outpatient clinics in Manaus, Amazonas, Brazil. A cross-sectional epidemiological study of a population of 347 children was conducted. Data concerning socio-economic levels and food consumption were obtained by interviewing the accompanying guardian of each child. Dietetic evaluation was conducted using a semi-quantitative food frequency questionnaire, and faecal samples were examined by optical microscopy. Anthropometric measurements were transformed into percentiles and z-scores, and nutritional status was evaluated by reference to National Center for Health Statistics (NCHS) and Centers for Disease Control (CDC) indicators. Factors associated with undernutrition were analysed using a random-effects logistic regression model. The overall prevalences of underweight, stunting and wasting were 18.1, 15.5 and 10.7%, respectively, with reference to CDC growth curves, and 14.3, 17.3 and 4.4%, respectively, with reference to NCHS growth curves. The overall prevalence of wasting was statistical higher according to the CDC reference than that estimated using the NCHS reference (P=0.02). The prevalence rate of intestinal parasites was 58.8%. Risk factors associated with malnutrition were: low educational level of guardian respondent (OR=4.55), energy intake <54.5 kcal/kg (OR=4.55), children in age group 6-10 years (OR=3.54), and attendance at outpatient clinic for paediatric visit (OR=2.71). In the studied population, malnutrition (stunting, underweight and wasting) and parasite infection still represent serious public health problems. The risk factors identified in the present study confirm the influence of socio-economic factors on the nutritional status of children

Molecular Measurable Residual Disease Assessment before Hematopoietic Stem Cell Transplantation in Pediatric Acute Myeloid Leukemia Patients: A Retrospective Study by the I-BFM Study Group

Hematopoietic stem cell transplantation (HSCT) is a curative post-remission treatment in patients with acute myeloid leukemia (AML), but relapse after transplant is still a challenging event. In recent year, several studies have investigated the molecular minimal residual disease (qPCR-MRD) as a predictor of relapse, but the lack of standardized protocols, cut-offs, and timepoints, especially in the pediatric setting, has prevented its use in several settings, including before HSCT. Here, we propose the first collaborative retrospective I-BFM-AML study assessing qPCR-MRD values in pretransplant bone marrow samples of 112 patients with a diagnosis of AML harboring t(8;21)(q22; q22)RUNX1::RUNX1T1, or inv(16)(p13q22)CBFB::MYH11, or t(9;11)(p21;q23)KMT2A::MLLT3, or FLT3-ITD genetic markers. We calculated an ROC cut-off of 2.1 × 10−4 that revealed significantly increased OS (83.7% versus 57.1%) and EFS (80.2% versus 52.9%) for those patients with lower qPCR-MRD values. Then, we partitioned patients into three qPCR-MRD groups by combining two different thresholds, 2.1 × 10−4 and one lower cut-off of 1 × 10−2, and stratified patients into low-, intermediate-, and high-risk groups. We found that the 5-year OS (83.7%, 68.6%, and 39.2%, respectively) and relapse-free survival (89.2%, 73.9%, and 67.9%, respectively) were significantly different independent of the genetic lesion, conditioning regimen, donor, and stem cell source. These data support the PCR-based approach playing a clinical relevance in AML transplant management