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

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

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 middle-income 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 low-income 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 low-income, 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

Análisis de las Estrategias Metodológicas implementadas por el docente en el desarrollo del proceso de enseñanza- aprendizaje en la disciplina de Geografía e Historia de Nicaragua y su Didáctica en los alumnos/as de Primer año “B” del turno regular de Formación Inicial Docente en la Escuela Normal Central de Managua Alesio Blandón Juárez durante el I semestre del Curso Escolar 2016

El presente trabajo de investigación tiene como finalidad analizar la efectividad que tienen las Estrategias Metodológicas implementadas por el docente en el desarrollo del proceso de enseñanza- aprendizaje en la disciplina de Geografía de Nicaragua y su Didáctica en los alumnos/as de Primer año “B” del turno regular de Formación Inicial Docente en la Escuela Normal Central de Managua Alesio Blandón Juárez durante el I semestre del Curso Escolar 2016. Dicho trabajo de investigación tiene un enfoque naturista o cualitativo, es una vía de transformación social, a través de la cual el ser humano descubre la realidad que le rodea, determina los medios y procedimientos para actuar sobre ella y transformarla de acuerdo a una intensión social. Los procesos de investigación cualitativa, tienen como finalidad primordial la generación y construcción de conocimientos que contribuyen al desarrollo social y personal de cada uno de los miembros de una comunidad. La fase de recolección de los datos de la investigación desarrollada, se realizó de dos formas: una información que se recogió mediante la observación directa del comportamiento de los informantes claves y una información que se obtuvo mediante la interrogación de algunos informantes claves. Para ello, primeramente el investigador realizo una inmersión en el campo de trabajo, con el propósito de identificar los lugares adecuados para recoger y producir la información necesaria y requerid

Association of contrast sensitivity with LogMAR visual acuity and glycosylated hemoglobin in non-insulin dependent diabetes mellitus

A tertiary care center-based prospective case–control study was undertaken to evaluate the association of contrast sensitivity with LogMAR visual acuity and glycosylated hemoglobin (HbA1c) in 205 cases of non-insulin dependent diabetes mellitus and 115 controls. LogMAR visual acuity and contrast sensitivity were scored using ETDRS and Pelli-Robson charts, respectively. Bivariate correlation between contrast sensitivity and LogMAR visual acuity showed significant inverse correlation in cases without retinopathy (r = −0.466) and with non-proliferative retinopathy (r = −0.307). In a multivariate model, on applying linear regression analysis, LogMAR visual acuity (p < 0.001) and HbA1c (p = 0.002) had significant association with contrast sensitivity. Significant difference in contrast sensitivity was not observed between cases without diabetic retinopathy and with non-proliferative diabetic retinopathy, implying no association with retinal microvascular changes. Contrast sensitivity dysfunction observed in diabetes mellitus results from changes in retinal function secondary to alteration in carbohydrate metabolism depicted in glycosylated hemoglobin

Thermal behaviour of the TiO2-based gels obtained by microwave-assisted sol–gel method

In order to establish the influence of the preparation method on thermal behaviour of gels obtained by the sol-gel and microwave-assisted sol-gel methods, a comparative thermal analysis study was conducted by the thermogravimetric and differential thermal analysis (TG/DTG/DTA) and evolved gas analysis (EGA) on TiO2 and V2O5-doped TiO2 gels, where TiO2:V2O5 molar ratio was set to 99.95:0.05 and 98.0:2.0. In contrast to TiO2 gels, for which the thermal behaviour was not significantly influenced by the preparation method, the microwave-irradiated binary samples showed a more complex and prolonged decomposition compared to their non-irradiated counterparts. This observation was correlated with influence of microwaves in enhancing the reaction rate between the Ti and V reagents leading to formation of more complex compositions of gels. Based on TG/DTG/DTA results, the temperatures of 300 and 450 A degrees C were chosen for the processing of powders in air. All samples thermally treated at 300 and 450 A degrees C crystallized in a single anatase phase except the TiO2:V2O5 with a molar ratio 99.95:0.05, obtained by microwave-assisted sol-gel method that contains also small amount of rutile phase. At 550 A degrees C all samples contain mixture of anatase and rutile phases

Clinical standards for drug-susceptible pulmonary TB.

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB