Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Background and aimsPediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico.MethodsPatients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined.ResultsOverall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1–10 years, with DNA index >0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS.ConclusionOutcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Adsorption of Zwitterionic Surfactant on Limestone Measured with High-Performance Liquid Chromatography: Micelle–Vesicle Influence

Herein is presented a new methodology to determine the static adsorption of a zwitterionic surfactant on limestone in three different aqueous media [high-performance liquid chromatography (HPLC) water, seawater, and connate water] with the use of HPLC at room temperature and 70 °C. The results showed that, in both HPLC water and seawater, the surfactant adsorption followed a monolayer Langmuir tendency. In contrast, for connate water, the surfactant presented a new adsorption profile, characterized by two regions: (i) At surfactant concentrations below 1500 mg L^–1, an increase of adsorption is observed as the amount of divalent cations increases in the aqueous media. (ii) At surfactant concentrations above 1500 mg L^–1, the adsorption decreases because the equilibrium, monomer ⇆ micelle ⇆ vesicle, is shifted to the formation of vesicles, giving as a result a decrease in the concentration of monomers, thus reducing the interaction between the surfactant and the rock, and therefore, lower adsorption values were obtained. The behavior of the surfactant adsorption under different concentrations of divalent cations was well-described by the use of a new modified Langmuir model: (dΓ/d<i>t</i>)_ads = <i>k</i>_ads<i>c</i>(Γ_∞ – Γ) – <i>k</i>_cmc(<i>c</i> – <i>c</i>_cmc)^<i>n</i>Γ<i>H</i>(<i>c</i> – <i>c</i>_cmc). It was also observed that, as the temperature increases, the adsorption is reduced because of the exothermic nature of the adsorption processes

TV - Arquitectura y Medio Ambiente - AR309 - 202102

Descripción: El curso TV - Arquitectura y Medio Ambiente, es un taller que toma como énfasis el entorno natural, la sostenibilidad y los medios pasivos de climatización y adecuación a las posibles inclemencias naturales. Procurando al mismo tiempo, defender al medio natural del posible impacto generado por la edificación, comprendiendo a ambos como un todo integrado. Propósito: l propósito del curso es el de permitir al futuro arquitecto poder abordar un proyecto arquitectónico en diversas escalas, desde lo macro (con la comprensión del lugar y de las condicionantes del medio geográfico) hasta lo micro (con la correcta utilización de materiales y criterios constructivos), desarrollando una sensibilidad hacia el medio ambiente. La asignatura del Taller V contribuye al desarrollo de la competencia general: Pensamiento Innovador, y las competencias específicas: Diseño fundamentado (que corresponde a los criterios NAAB: PC2, PC3, PC5 y SC5) y, Técnica y construcción (que corresponde a los criterios NAAB: SC1, SC4 y SC6), todas estas en el nivel 2. Este curso tiene como requisito haber aprobado el Taller AR308 TIV - Arquitectura y Funcionalidad

TV - Arquitectura y Medio Ambiente - AR309 - 202101

Descripción: El curso TV - Arquitectura y Medio Ambiente, es un taller que toma como énfasis el entorno natural, la sostenibilidad y los medios pasivos de climatización y adecuación a las posibles inclemencias naturales. Procurando al mismo tiempo, defender al medio natural del posible impacto generado por la edificación, comprendiendo a ambos como un todo integrado. Propósito: l propósito del curso es el de permitir al futuro arquitecto poder abordar un proyecto arquitectónico en diversas escalas, desde lo macro (con la comprensión del lugar y de las condicionantes del medio geográfico) hasta lo micro (con la correcta utilización de materiales y criterios constructivos), desarrollando una sensibilidad hacia el medio ambiente. La asignatura del Taller V contribuye al desarrollo de la competencia general: Pensamiento Innovador, y las competencias específicas: Diseño fundamentado (que corresponde a los criterios NAAB: PC2, PC5, SC5) y, Técnica y construcción (que corresponde a los criterios NAAB: SC1, SC4, SC6), todas estas en el nivel 2. Este curso tiene como requisito previo haber aprobado el Taller AR308 TIV - Arquitectura y Funcionalidad

TIII - Arquitectura y Entorno - AR307 - 202101

Descripción: El curso TIII - Arquitectura y Entorno, es un curso de especialidad en la carrera de Arquitectura; parte del estudio del patrimonio edificado y la ciudad histórica, y propone el adiestramiento en el diseño arquitectónico a partir de la transformación y/o reciclaje de un objeto arquitectónico preexistente, y/o la propuesta de edificaciones nuevas relacionadas con el espacio urbano, desde un enfoque contemporáneo. Propósito: El TIII - Arquitectura y Entorno busca que el futuro arquitecto tome conciencia que todo proyecto arquitectónico está destinado a relacionarse con el contexto urbano. A través de la identificación y el análisis, el alumno adquiere las herramientas para diseñar respondiendo al entorno. El curso contribuye directamente al desarrollo de las competencias generales de Ciudadanía y Pensamiento Innovador y la competencia específica de Diseño Fundamentado (que corresponde a los criterios NAAB: PC2, PC3, PC5, PC8, SC3, SC5). Tiene como requisitos: Dibujo Arquitectónico (AR286) y TII - Arquitectura y Arte (AR306)