Hyperlipidemia is a risk factor for osteonecrosis in children and young adults with acute lymphoblastic leukemia

TesisLa intoxicación con plomo es un problema de trascendental importancia para la salud pública por sus efectos en la calidad de vida de las personas, particularmente de los niños expuestos. La presente investigación fue de tipo descriptivo transversal y se realizó con la finalidad de determinar los niveles de plomo sanguíneo en los habitantes del Centro Poblado de Taca, durante los meses de junio y julio de 2013. Participaron del estudio 42 personas voluntarias: 32 varones y 10 mujeres, cuya media de edad fue de 33,23 años (rango: 21-72 años). Se tomaron muestras de sangre mediante venopunción previo consentimiento informado, utilizando tubos al vacío con anticoagulante, se mantuvieron bajo refrigeración a 8 °C, se trataron con mezcla sulfonítrica - ácido nítrico concentrado a ebullición lenta en un equipo de digestión y luego leídas en un espectrofotómetro de absorción atómica Thermo Scientific ¡CE 3300 a 217 nm. Se obtuvieron los siguientes resultados: todos los sujetos estudiados presentan algún grado de contaminación con plomo, encontrándose un nivel de plumbemia medio de 26,62 ug/dl y los niveles de plomo en sangre de varones y mujeres de 18 a 72 años de edad, encontrándose medias de 33,96 y 3,16 ug/dl, respectivamente, existiendo relación entre el género y plumbemia (p<0,05). El nivel de plomo en sangre de los habitantes del Centro Poblado de Taca, Distrito Canaria, Provincia de Víctor Fajardo, se incrementa en función del tiempo de residencia, por lo que existe relación entre estas dos variables (P<0,05)

Pathological and Incidental Findings on Brain MRI in a Single-Center Study of 229 Consecutive Girls with Early or Precocious Puberty

Central precocious puberty may result from organic brain lesions, but is most frequently of idiopathic origin. Clinical or biochemical factors which could predict a pathological brain MRI in girls with CPP have been searched for. With the recent decline in age at pubertal onset among US and European girls, it has been suggested that only girls with CPP below 6 years of age should have brain MRI performed

Dyslipidemia at diagnosis of childhood acute lymphoblastic leukemia.

As survival of acute lymphoblastic leukemia (ALL) exceeds 90%, limiting therapy-related toxicity has become a key challenge. Cardio-metabolic dysfunction is a challenge during and after childhood ALL therapy. In a single center study, we measured triglycerides (TG), total cholesterol (TC), high (HDL) and low density lipoproteins (LDL) levels at diagnosis and assessed the association with BMI, early therapy response, on-therapy hyperlipidemia and the toxicities; thromboembolism, osteonecrosis and pancreatitis. We included 127 children (1.0-17.9 years) all treated according to the NOPHO ALL2008 protocol. Dyslipidemia was identified at ALL-diagnosis in 99% of the patients, dominated by reduced HDL levels (98%) and mild hypertriglyceridemia (61%). Hypertriglyceridemia was not associated with body mass index (P = 0.71). Five percent of patients had mild hypercholesterolemia, 14% had mild hypocholesterolemia, 13% had decreased and 1% elevated LDL-levels. Increased TG and TC levels at ALL-diagnosis were not associated with any on-therapy lipid levels. Lipid levels and BMI were not associated to MRD after induction therapy; However, BMI and hypercholesterolemia were associated with worse risk group stratification (P<0.045 for all). The cumulative incidence of thromboembolism was increased both for patients with hypo- (20.0%) and hypercholesterolemia (16.7%) compared to patients with normal TC levels (2.2%) at diagnosis (P = 0.0074). In conclusion, dyslipidemic changes were present prior to ALL-therapy in children with ALL but did not seem to affect dysmetabolic traits during therapy and were not predictive of on-therapy toxicities apart from an association between dyscholesterolemia at time of ALL-diagnosis and risk of thromboembolism. However, the latter should be interpreted with caution due to low number in the groups

Non-infectious chemotherapy-associated acute toxicities during childhood acute lymphoblastic leukemia therapy

During chemotherapy for childhood acute lymphoblastic leukemia, all organs can be affected by severe acute side effects, the most common being opportunistic infections, mucositis, central or peripheral neuropathy (or both), bone toxicities (including osteonecrosis), thromboembolism, sinusoidal obstruction syndrome, endocrinopathies (especially steroid-induced adrenal insufficiency and hyperglycemia), high-dose methotrexate-induced nephrotoxicity, asparaginase-associated hypersensitivity, pancreatitis, and hyperlipidemia. Few of the non-infectious acute toxicities are associated with clinically useful risk factors, and across study groups there has been wide diversity in toxicity definitions, capture strategies, and reporting, thus hampering meaningful comparisons of toxicity incidences for different leukemia protocols. Since treatment of acute lymphoblastic leukemia now yields 5-year overall survival rates above 90%, there is a need for strategies for assessing the burden of toxicities in the overall evaluation of anti-leukemic therapy programs