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- A nd 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

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

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

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

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

Alimentation des nourrissons reçus a la vaccination au Togo

Introduction : l’amélioration de l’état nutritionnel, de la santé et du développement desnourrissons dépend des pratiques de leur alimentation. L’objectif de notre étude a étéd’évaluer l’alimentation des nourrissons de 2 à 6 mois apparemment sains reçus envaccination dans le service de pédiatrie du CHU Sylvanus Olympio (SO) de Lomé selonles recommandations de l’UNICEF pour l’alimentation.Matériel et méthodes : il s’est agi d’une étude transversale réalisée du 10 mai au 12novembre 2012 dans l’unité de vaccination du service de pédiatrie du CHU (SO) deLomé. Le logiciel WHO Anthro version 3.2.2. de l’OMS pour déterminer l’étatnutritionnel de chaque patient a été utilisé. Les données ont été enregistrées et analyséespar le logiciel EPI info version 3.5.1. Le test de Khi carré a été utilisé avec un seuilsignificatif &lt; 0,05.Résultats : Il a été évalué 621 nourrissons dont l’âge médian était de 2,53 mois.L’allaitement était pratiqué dans 599 cas (96,5 %). Le taux de mise au sein dans lespremières 24 heures était donc de 68,8 %. La pratique de l’allaitement a été évaluée chez289 couples mère-nourrisson. Une bonne pratique de l’allaitement dans 53 cas (18,3%)et un taux d’alimentation artificielle de 3,6 % ont été notés. L’eau a été introduite dansl’alimentation de 133 nourrissons (21,5%). Du jus de fruit a été donné à 9 nourrissons(1,5%), de la tisane à 13 nourrissons (2,1%) et de la bouillie à 16 nourrissons (2,6%). Letaux d’allaitement maternel exclusif des nourrissons de moins de 3 mois était de 71,3%.Ce taux a été de 69,9% chez les plus de 3 mois.Conclusion : la bonne pratique de l’alimentation chez le nourrisson de 2 à 6 mois dépenddes connaissances de leurs parents. Il s’avère nécessaire de donner les conseilsalimentaires aux mères de nourrissons à chaque contact avec le système de santé.Mots clés : alimentation, nourrissons sains, vaccination

Les urgences medicales dans les unites de soins continus pediatriques au CHU Sylvanus Olympio de Lome

Pré-requis: La morbidité et la mortalité liées aux enfants restent élevées dans les pays d’Afrique subsaharienne. Pour atteindre les Objectifs du Millenium pour le Développement, il importe de considérer les urgences médicales pédiatriques qui y jouent un role important et de définir des interventions pour leur réduction.But: Décrire le profil épidémiologique des enfants admis dans les unités pédiatriques de soins continus et rapporter la morbi-mortalité liée aux urgences en pédiatrie.Méthodologie: Etude retrospective portant sur 4791 dossiers d’enfants âgés de 0 à 15 ans hospitalisés pour une urgence dans les unités de soins continus du service de pédiatrie du CHU Sylvanus Olympio de Lomé du 1er janvier 2014 au 31 décembre 2015.Résultats: les urgences ont représenté 21,2% des consultations et 63,2% des hospitalisations. Dans les premières 24 h, 30,7% des patients ont consulté. L’âge moyen des patients était de 3,2 ± 3,6 ans. La majorité des patients (86,6%) avait moins de 5 ans. Il y avait 34,7% de nouveau-nés. Chez les nouveau-nés, les principaux types d’urgence étaient infectieuses (84,2%). Chez les enfants de plus de 1 mois, les urgences étaient hématologiques (48,7%), infectieuses (46,6%) et neurologiques (31,4%). Le taux de létalité était de 18,7%. Chez les nouveau-nés, il était de 23,8% et chez les enfants de plus de 1 mois 15,9%. La majorité des patients décédés (90%) avait moins de 5 ans.Conclusion: La réduction des décès d’enfants admis pour une urgence passe par une consultation précoce et la diffusion d’interventions multifacettes sur le paludisme et l’infection néonatale.Mots clés: urgences, réanimation pédiatrique, LoméEnglish Title: Pediatric emergencies medicine in intensive care unit at CHU Sylvanus Olympio LomeEnglish AbstractBackground: Morbidity and mortality of children still high in african subsaharian country. The pediatric medical emergencies must take important place in the causes and to reach millennium goals it’s important to considers them and determine how to manage.Objectives: To determine the epidemiological profile of pediatric medical emergencies and report their morbidity and mortality.Methods: We retrospectively reviewed the medical records of 4791 children aged 0 to 15 years hospitalized for medical emergencies in intensive care unit in pediatric department at CHU Sylvanus Olympio Lomé between 1st January 2014 and 31 December 2015.Results: Emergencies represented 21.2% of all consultation and 63.2% of hospitalization. In the first 24 hours, 30.7% of patients were admitted. Median (range) patient age was 3.2 ± 3.6 years. Most patients (86.6%) were under five years. There were 34.7% of newborn. In newborn, infectious disease accounted for 84.2%. In children aged more than 1 month, hematological events accounted for 48.7% of cases, infectious disease for 46,6%, and neurological events for 31,4%. The overall mortality rate was 18.7%. The mortality in newborn 23.8% and 15.9% in over 1 month. Most deaths (90%) occurred in children under five.Conclusion: Early specialist consultation and multi-disciplinary intervention targeting malaria and neonatal sepsis may reduce the mortality rate among neonates and children admitted for emergencies in tropical countries.Keywords: emergencies, intensive care unit, pediatric, Lom

Facteurs de risque et causes de la prématurité au Centre Hospitalier Régional de Tsévié (Togo

Introduction: Selon l'Organisation Mondiale de la Santé, 12,9 millions d'enfants naissent prématurément, soit 9,6% de naissances. Les taux de prématurité sont plus élevés dans les pays en développement. Elle constitue l'une des premières causes de mortalité néonatale et est un problème de santé publique. L'objectif de ce travail était de décrire les facteurs de risque et les causes de la prématurité au Centre Hospitalier Régional de Tsévié.Matériel et méthodes: Une étude rétrospective a été réalisée de janvier 2016 à septembre 2016 à la maternité du centre hospitalier régional de Tsévié. Les cas qui étaient de 100 correspondaient aux accouchées dont l'âge gestationnel était inférieur à 37 Semaines d’Aménorrhée. Les données ont été recueillies à partir des registres d'admission et des dossiers. Il s'agissait de l'âge à l'admission, le terme de la grossesse, les caractéristiques sociodémographiques et obstétricales de leurs mères. L'analyse des données a été faite avec le logiciel Epi info version 7.2.0.1Résultats: 100 accouchements prématurés ont été enregistrés sur 1212 accouchements soit une fréquence de 8,25%. Nous avons identifié comme facteurs de risque maternels le célibat, le nombre de consultations prénatales &lt; 3. Les pathologies maternelles influençant significativement la prématurité étaient le paludisme (15%), la pré éclampsie/éclampsie (11%), les ruptures prématurée et chorioamniotite (14% et 2%), les infections cervico-vaginales (8%) et la menace d'accouchement prématuré (7%). Chez 7% aucun facteur n’a été identifié. Les grossesses multiples et les malformations congénitales étaient les facteurs de risque de prématurité liés au foetus.Conclusion: La fréquence de la prématurité était de 8,25%. Les facteurs de risque de la prématurité sont autant maternels que foetaux. Le célibat, le non suivi de la grossesse et les pathologies durant la grossesse étaient des facteurs maternels prédisposant à la prématurité, alors que les grossesses multiples et les anomalies congénitales étaient les principaux facteurs foetaux prédisposant.Mots clés: Causes ; Facteurs ; Accouchement ; PrématuréEnglish Title: Risk factors and causes of prematurity at the Tsévié Regional Hospital Center (Togo)English AbstractIntroduction: According to the World Health Organization, 12.9 million children are born prematurely, or 9.6% of births. Prematurity rates are higher in developing countries. It is one of the leading causes of neonatal mortality and is a public health problem. The objective of this work was to describe the risk factors and causes of prematurity at the Tsévié Regional Hospital Center.Methods: A retrospective study was carried out from January 2016 to September 2016 at the maternity hospital of the Tsévié regional hospital. Cases that were 100 corresponded to women who had gestational age less than 37 Amenorrhea weeks. Data were collected from admissions records and records. These were the age at admission, the term of pregnancy, the socio-demographic and obstetric characteristics of their mothers. The analysis of the data was done with the software Epi info version 7.2.0.1Results: 100 premature deliveries were recorded in 1212 deliveries, or a frequency of 8.25%. Maternal risk factors were defined as celibacy, the number of prenatal consultations &lt;3. Maternal diseases significantly influencing prematurity were malaria (15%), preeclampsia / eclampsia (11%), premature ruptures and chorioamnionitis (14 % And 2%), cervico-vaginal infections (8%) and the threat of premature delivery (7%). In 7% no factor was identified. Multiple pregnancies and congenital malformations were the risk factors for prematurity associated with the fetus.Conclusion: The frequency of prematurity was 8.25%. Risk factors for prematurity are both maternal and fetal. Pregnancy, non-pregnancy and pregnancy were maternal factors predisposing to prematurity, while multiple pregnancies and congenital abnormalities were the main predisposing fetal factors.Keywords: Causes; Factors; Childbirth; Prematur

An assessment of the contamination of Achatina achatina by toxic metals in Okpara village (Benin)

The assessment of the contamination by toxic metals (Pb, Al, Cd, Cu, Cr, Zn, Mn) has been achieved in samples of the giant snails (Achatina achatina) in the Okpara village (North of Benin). This work has been performed for, lately a survey revealed a strong contamination by toxic metals in sediments, water and fish in the Okpara River which waters this village. Otherwise, it is in this environment watered by the Okpara River,that snails are picked and consumed. The appropriated samples underwent the necessary treatment by mineralization before the analysis by electrochemical atomic absorption spectrophotometer (Varian A300 withZeeman correction), in the Laboratory of Toxicology and Applied Hygiene/UFR of the Pharmaceutical Sciences (Bordeaux-France). The results of the analysis revealed a high bioaccumulation of heavy metals in all the samples and the concentrations exceed the recommended limits for human consumption. Only the level of chromium respects the recommended limits. This study permitted us to confirm as it has already proved by several authors, that the snail is a toxic metal bioaccumulator and can be considered therefore like a bioindicator of pollution, whose consumption will be a risk for health.Keywords: Environment pollution, snail quality, bioaccumulation, consumption risk