Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Queima de biomassa e efeitos sobre a saúde Biomass burning and its effects on health

A primeira idéia que se forma na mente das pessoas e do pesquisador é associar a poluição do ar aos grandes centros urbanos, com a imagem de poluentes sendo eliminados por veículos automotores ou pela chaminé de suas fábricas. Entretanto, uma parcela considerável da população do planeta convive com uma outra fonte de poluição, que atinge preferencialmente os países em desenvolvimento: a queima de biomassa. Este artigo tem como objetivo chamar a atenção do pneumologista, da comunidade e das autoridades para os riscos à saúde da população exposta a essa fonte geradora de poluentes, seja em ambientes internos, seja em ambientes abertos. O presente trabalho caracteriza as principais condições que levam à combustão de biomassa, como a literatura tem registrado os seus efeitos sobre a saúde humana, discutindo os mecanismos fisiopatológicos envolvidos, e finaliza com a apresentação de dois estudos recentes que enfatizam a importância da queima de um tipo específico de biomassa, a palha da cana-de-açúcar, prática comum no interior do Brasil, e sua interferência no perfil de morbidade respiratória da população exposta.<br>The first thought that comes to mind concerning air pollution is related to urban centers where automotive exhausts and the industrial chimneys are the most important sources of atmospheric pollutants. However a significant portion of the earth’s population is exposed to still another source of air pollution, the burning of biomass that primarily affects developing countries. This review article calls the attention of lung specialists, public authorities and the community in general to the health risks entailed in the burning of biomass, be it indoors or outdoors to which the population is exposed. This review describes the main conditions that lead to the burning of biomass and how the literature has recorded its effects on human health discussing the psychopathological mechanisms. Finally two recent studies are presented that emphasize an important type of biomass burning that of the sugar cane straw. This is a common practice in several regions of Brazil changing the respiratory morbidity standards of the population exposed