Endotracheal Intubation in Children: Practice Recommendations, Insights, and Future Directions

Management of airway is mandatory in a critically ill child with severe trauma or any other situation that threatens his or her life. It is important, that clinicians who attend critically ill pediatric patients requiring airway management know the rapid sequence intubation (RSI) procedure, identify a patient with difficult airway, know the devices and techniques for the management of difficult airway, and look for receiving a formal training in endotracheal intubation (ETI). Future strategies for teaching and/or training clinicians in pediatric and neonatal ETI should be evaluated through conducting controlled clinical trials to identify which type will be the most effective by considering the less number of attempts and complications

Exploring the Spatial Distribution of Air Pollution and Its Association with Socioeconomic Status Indicators in Mexico City

Air pollution is one of the most challenging global sustainability problems in the world. Roughly 90 of global citizens live in areas that exceed the acceptable air pollution levels according to the World Health Organization air quality guidelines. However, socially disadvantaged groups are disproportionately located in areas exposed to higher levels of air pollution. Understanding the association between risk exposure to air pollutants and the underlying socio-economic factors determining risk is central for sustainable urban planning. The purpose of this study was to explore environmental inequalities in Mexico City, specifically the spatial association between air pollutants and socioeconomic status (SES) indicators. We propose that SES indicators will be expected to spatially cluster vulnerable individuals and groups into heavily polluted areas. To test this hypothesis, we used 2017–2019 data from governmental records to perform spatial interpolations to explore the spatial distribution of criteria pollutants. We carried out spatial autocorrelations of air pollutants and SES indicators using the bivariate Moran’s I index. Our findings provide strong evidence of spatial heterogeneity in air pollution exposure in Mexico City. We found that socially deprived areas located in the southern periphery of Mexico City were exposed to higher ozone concentrations. On the contrary, wealthiest areas concentrated in the city center were exposed to greater concentrations of nitrogen dioxide and carbon monoxide. Our findings highlight the need for policy-driven approaches that take into consideration not only the geographic variability and meteorological dynamics associated with air pollution exposure, but also the management of socioeconomic risk factors aimed at reducing disparate exposure to air pollution and potential health impacts

Subclassification of B-acute lymphoblastic leukemia according to age, immunophenotype and microenvironment, predicts MRD risk in Mexican children from vulnerable regions

The decisive key to disease-free survival in B-cell precursor acute lymphoblastic leukemia in children, is the combination of diagnostic timeliness and treatment efficacy, guided by accurate patient risk stratification. Implementation of standardized and high-precision diagnostic/prognostic systems is particularly important in the most marginalized geographic areas in Mexico, where high numbers of the pediatric population resides and the highest relapse and early death rates due to acute leukemias are recorded even in those cases diagnosed as standard risk.This work was supported by grants from the National Council of Humanities, Science and Technology (CONAHCYT) FORDECYT-PRONACES 302994 to RP, FORDECYT-PRONACES 302941 to SP-T, and Investigadoras e Investigadores por México CONAHCYT to DC-A.Peer reviewe

Evidence of spatial clustering of childhood acute lymphoblastic leukemia cases in Greater Mexico City: report from the Mexican Inter-Institutional Group for the identification of the causes of childhood leukemia

BackgroundA heterogeneous geographic distribution of childhood acute lymphoblastic leukemia (ALL) cases has been described, possibly, related to the presence of different environmental factors. The aim of the present study was to explore the geographical distribution of childhood ALL cases in Greater Mexico City (GMC).MethodsA population-based case-control study was conducted. Children <18 years old, newly diagnosed with ALL and residents of GMC were included. Controls were patients without leukemia recruited from second-level public hospitals, frequency-matched by sex, age, and health institution with the cases. The residence address where the patients lived during the last year before diagnosis (cases) or the interview (controls) was used for geolocation. Kulldorff’s spatial scan statistic was used to detect spatial clusters (SCs). Relative risks (RR), associated p-value and number of cases included for each cluster were obtained.ResultsA total of 1054 cases with ALL were analyzed. Of these, 408 (38.7%) were distributed across eight SCs detected. A relative risk of 1.61 (p<0.0001) was observed for the main cluster. Similar results were noted for the remaining seven ones. Additionally, a proximity between SCs, electrical installations and petrochemical facilities was observed.ConclusionsThe identification of SCs in certain regions of GMC suggest the possible role of environmental factors in the etiology of childhood ALL

Mutational Landscape of CEBPA in Mexican Pediatric Acute Myeloid Leukemia Patients: Prognostic Implications

BackgroundIn Mexico, the incidence of acute myeloid leukemia (AML) has increased in the last few years. Mortality is higher than in developed countries, even though the same chemotherapy protocols are used. CCAAT Enhancer Binding Protein Alpha (CEBPA) mutations are recurrent in AML, influence prognosis, and help to define treatment strategies. CEBPA mutational profiles and their clinical implications have not been evaluated in Mexican pediatric AML patients.Aim of the StudyTo identify the mutational landscape of the CEBPA gene in pediatric patients with de novo AML and assess its influence on clinical features and overall survival (OS).Materials and MethodsDNA was extracted from bone marrow aspirates at diagnosis. Targeted massive parallel sequencing of CEBPA was performed in 80 patients.ResultsCEBPA was mutated in 12.5% (10/80) of patients. Frameshifts at the N-terminal region were the most common mutations 57.14% (8/14). CEBPA biallelic (CEBPABI) mutations were identified in five patients. M2 subtype was the most common in CEBPA positive patients (CEBPAPOS) (p = 0.009); 50% of the CEBPAPOS patients had a WBC count > 100,000 at diagnosis (p = 0.004). OS > 1 year was significantly better in CEBPA negative (CEBPANEG) patients (p = 0.0001). CEBPAPOS patients (either bi- or monoallelic) had a significantly lower OS (p = 0.002). Concurrent mutations in FLT3, CSF3R, and WT1 genes were found in CEBPAPOS individuals. Their contribution to poor OS cannot be ruled out.ConclusionCEBPA mutational profiles in Mexican pediatric AML patients and their clinical implications were evaluated for the first time. The frequency of CEBPAPOS was in the range reported for pediatric AML (4.5–15%). CEBPA mutations showed a negative impact on OS as opposed to the results of other studies

Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy

The main objective of the National Project for Research and Incidence of Childhood Leukemias is to reduce early mortality rates for these neoplasms in the vulnerable regions of Mexico. This project was conducted in the states of Oaxaca, Puebla, and Tlaxcala. A key strategy of the project is the implementation of an effective roadmap to ensure that leukemia patients are the target of maximum benefit of interdisciplinary collaboration between researchers, clinicians, surveyors, and laboratories. This strategy guarantees the comprehensive management of diagnosis and follow-up samples of pediatric patients with leukemia, centralizing, managing, and analyzing the information collected. Additionally, it allows for a precise diagnosis and monitoring of the disease through immunophenotype and measurable residual disease (MRD) studies, enhancing research and supporting informed clinical decisions for the first time in these regions through a population-based study. This initiative has significantly improved the diagnostic capacity of leukemia in girls, boys, and adolescents in the regions of Oaxaca, Puebla, and Tlaxcala, providing comprehensive, high-quality care with full coverage in the region. Likewise, it has strengthened collaboration between health institutions, researchers, and professionals in the sector, which contributes to reducing the impact of the disease on the community