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

Hipercalcemia maligna, una urgencia oncológica: a propósito de un caso en el servicio de urgencias

Las urgencias oncológicas son comunes en la medicina de urgencias, pero no es habitual verlas en salas que no atiendan a una población oncológica robusta. Las cuatro urgencias oncológicas más comunes son la fiebre neutropénica, el síndrome de lisis tumoral, el síndrome de hiperviscosidad y la hipercalcemia maligna. Esta última es un síndrome clínico potencialmente mortal, uno de los desequilibrios hidroelectrolíticos menos comunes, cuya presencia es de gran importancia clínica pues se ha asociado a un incremento del riesgo de muerte. La hipercalcemia ha sido documentada en una proporción significativamente menor y su presencia está relacionada con una enfermedad maligna en el 72% de los casos. Algunos autores la asocian hasta en el 90% de los casos, por lo que el diagnóstico diferencial de cualquier hipercalcemia incluye la búsqueda de una neoplasia, y refiriendonos a estas hay un determinante, como lo es el mieloma múltiple, en el que la asociación es bien establecida e incluso es una manifestación clínica mayor dentro del abordaje diagnóstico

Monitoring the Algerian Basin through glider observations, satellite altimetry and numerical simulations along a SARAL/AltiKa track

The Algerian Basin is a key component of the general circulation in the Western Mediterranean Sea. The presence of both fresh Atlantic water and more saline Mediterranean water gives the basin an intense inflow/outflow regime and complex circulation patterns. Energetic mesoscale structures that evolve from meanders of the Algerian Current into isolated cyclonic and anticyclonic eddies dominate the area, with marked repercussions on biological activity. Despite its remarkable importance, this region and its variability are still poorly known and basin-wide knowledge of its meso- and submesoscale features is still incomplete. Studying such complex processes requires a synergistic approach that involves integrated observing systems. In recent years, several studies have demonstrated the advantages of combined use of autonomous underwater vehicles, such as gliders, with a new generation of satellite altimetry. In this context, we present results of an observational program conducted in the Algerian Basin during fall 2014 and 2015 that aimed to advance our knowledge of its main features. The study was carried out through analysis of high resolution glider observations, collected along the Algerian BAsin Circulation Unmanned Survey (ABACUS) chokepoint, in synergy with co-located SARAL/AltiKa altimetric products and CMEMS numerical simulations. Results show that glider-derived dynamic height and SARAL/AltiKa absolute dynamic topography have similar patterns, with RMS of the differences ranging between 1.11 and 2.90 cm. Even though larger discrepancies are observed near the Balearic and Algerian coasts, correlation coefficients between glider and satellite observations seem mostly to be affected by reduced synopticity between the measurements. Glider observations acquired during the four surveys reveal the presence of several water masses of Atlantic and Mediterranean origin (i.e., AW and LIW at different modification levels) with marked seasonal variability

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure. the SEMICA-2 study

Objective: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). Methods: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. Results: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. Conclusions: Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days