The role of age and sex in the presentation and outcome of endemic Burkitt lymphoma (BL) has not been studied recently. This study analysed these factors in 934 patients with BL who had received ...cyclophosphamide and intrathecal methotrexate as treatment.
Records of 934 children diagnosed with BL from 2004 to 2015 were obtained from our Paediatric Oncology Networked Database (POND) cancer registry. Age at diagnosis, sex, disease stage, time to diagnosis, delay in diagnosis, completion of treatment, rate of abandonment, and one-year survival rates were recorded and statistically analysed.
The male to female ratio of 1.41 for the study population of 934. The median delay from onset of symptoms to diagnosis was 31 days. The St Jude stage distribution was I = 6.4%, II = 5.9%, III = 71.5% and IV = 16.2%. Significantly more patients presented with stage III disease in age groups 5-9 and 10-14 years than 0-4 years. The overall 1-year survival rate was 53.45%, respectively 77.1% for stage I, 67.9% for stage II, 55.1% for stage III and 32.4% for stage IV disease (p<0.001). There was no significant difference in survival by sex and age group.
Patients aged under 5 years presented with less-advanced disease, but survival was not affected by age. Sex did not influence delay to diagnosis and overall survival. The long delay between the onset of symptoms and diagnosis emphasises the need for interventions to achieve an earlier diagnosis and a better survival rate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background and objectives
Outcomes of rare paediatric teratomas have not previously been reported nor treatment regimens standardised in low‐ and middle‐income settings. We sought to evaluate ...treatment outcomes of children and adolescents with histologically confirmed extracranial germ cell tumours, both mature teratomas (MT) and immature teratomas (IT) in preparation for the development of the South African national treatment guideline.
Methods
Retrospective data by folder review were collated from nine South African paediatric oncology units. Kaplan–Meier analysis with Cox regression was performed to determine 5‐year overall survival (OS) and prognostic factors.
Results
From January 1990 to December 2015, 60 patients were diagnosed with MTs; 14 males (median age 2 months; interquartile range IQR: 0–8.75 months) and 46 females (median age 9 months; IQR: 0–88.5 months). Forty patients were diagnosed with ITs; 10 males (median age less than 1 month; IQR: 0–1.75 months) and 30 females (median age 4.5 months; IQR: 1–162 months). There were high rates of upfront surgical resections in patients with MTs (58/60; 96.6%) and ITs (36/40; 90%), and similarly satisfactory rates of complete resection in patients with both MTs (55/60; 91.7%) and ITs (32/40; 80%). The 5‐year OS for the whole group was 85.4%, significantly influenced by stage: Stage I (96.9%), Stage II (100%), Stage III (38.9%) (p < .001 MT; p = .013 IT). The event‐free survival (EFS) ratio for the whole cohort was 78.7%.
Conclusions
Five‐year OS for those with low‐stage disease was excellent, but was poorer for patients with advanced disease. The implementation of a national treatment guideline will facilitate the standardising of surgical approaches, indications for chemotherapy and specifications for follow‐up to improve survival and to collect more robust late effects data.
Childhood cancer is an under resourced medical field that is emerging as a great healthcare concern in low- and middle-income countries such as South Africa. Therefore, reporting data in this field ...that may inform policymakers should be representative of the subject matter. This article aims to discuss why medicines claims as an indicator for incidence, as per an article published in 2020, is not representative of childhood malignancies in the South African setting. Literature to support the commentary were sourced using Pubmed, Google scholar, and data presented by members of the South African Children's Cancer Study Group (SACCSG). Private medical aid coverage in South Africa between 2002 and 2018 varied between 15.5% and 18.2%. Of these, 9.5% were children under 18 years and 3.5% were under the age of six. Only 13.5% of children were treated in private paediatric oncology units during 2015. The limitations in the study were the variable medical aid coverage, the disproportionate age representation, and lack of reliable indicators for measurement and calculation of incidence. Utilising one medicines claims data base to evaluate the incidence of childhood cancer in South Africa is not representative and cannot inform policy.
This article highlights the importance of accurate registration of childhood cancer diagnoses, especially when data and conclusions based on these results inform policy. The study highlights the limitations of extrapolating general conclusions based on data representing only a small sector of the childhood cancer landscape in South Africa.
Objectives
To describe growth in HIV‐infected children on long‐term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal ...growth.
Methods
This observational cohort study included all HIV‐infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow‐up. Growth was assessed using weight‐for‐age Z‐scores (WAZ), height‐for‐age Z‐scores (HAZ) and body mass index (BMI)‐for‐age Z‐scores (BAZ). Children were stratified according to pre‐treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes.
Results
The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<−2 = 50%, HAZ<−2 = 73%, BAZ<−2 = 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5‐year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (P < 0.001), and infants (<1 year) demonstrated superior improvement in terms of BMI (P = 0.04). Tuberculosis was an independent risk factor for suboptimal weight (P = 0.01) and height (P = 0.02) improvement. Weight gain was also hindered by lack of electricity (P = 0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study endpoint.
Conclusions
Malnutrition was a major clinical concern for this cohort of HIV‐infected children. Early ART initiation, tuberculosis co‐infection management and nutritional interventions are crucial to ensure optimal growth in HIV‐infected children.
Objectifs
Décrire la croissance chez les enfants infectés par le VIH, sous traitement antirétroviral (TAR) de longue durée et évaluer les facteurs sociaux, cliniques, immunologiques et virologiques associés à la croissance sous‐optimale.
Méthodes
Cette étude de cohorte observationnelle a inclus tous les enfants infectés par le VIH dans un site de TAR urbain en Afrique du Sud, qui avaient moins de 5 ans au début du TAR et avec plus de 5 ans de suivi. La croissance a été évaluée à l'aide des Z‐scores du poids pour l’âge (WAZ), Z‐scores de la taille‐pour l’âge (HAZ) et Z‐scores de l'indice de masse corporelle (IMC) pour‐âge (BAZ). Les enfants ont été stratifiés en fonction de l'anthropométrie prétraitement et de l’âge. Les analyses univariée et linéaire mixte ont été utilisées pour déterminer les associations entre les variables indépendantes et les résultats du poids et de la taille.
Résultats
La majorité des 159 enfants présentaient une maladie clinique avancée (90%) et une immunosuppression (89%). Avant le traitement, l'insuffisance pondérale, le retard de croissance et l'amaigrissement étaient communs (WAZ <‐2 = 50%, HAZ <‐2 = 73%, BAZ <‐2 = 19%). Le poids et l’IMC se sont améliorés au cours des 12 premiers mois, tandis que la taille s'est améliorée sur toute la période de 5 ans. La taille à la sortie de l’étude était significativement pire pour les enfants ayant des troubles de la croissance au moment de l'initiation du TAR (p <0,001), quoique les nourrissons (<1 an) ont montré une amélioration supérieure en terme d’IMC (p = 0,04). La tuberculose était un facteur de risque indépendant pour le poids sous‐optimal (p = 0,01) et l'amélioration de la taille (p = 0,02). Le gain de poids était également entravé par le manque d’électricité (p = 0,04). La reconstitution immunitaire et la suppression virologique n’étaient pas associées à l'insuffisance pondérale ou au retard de croissance à la fin de l’étude.
Conclusions
La malnutrition était un problème clinique majeur pour cette cohorte d'enfants infectés par le VIH. Le TAR précoce, la prise en charge de la coinfection par tuberculose et les interventions nutritionnelles sont essentielles pour assurer une croissance optimale chez les enfants infectés par le VIH.
Objetivos
Describir el crecimiento en niños infectados con VIH recibiendo terapia antiretroviral (TAR) de larga duración y evaluar los factores sociales, clínicos, inmunológicos y virológicos asociados con un crecimiento subóptimo.
Métodos
Este estudio observacional de cohortes incluyó a todos los niños infectados con VIH de un centro de TAR urbano en Sudáfrica que eran menores de 5 años en el momento de iniciar el TAR y que tenían más de 5 años de seguimiento. El crecimiento se evaluó utilizando puntuación Z de peso para la edad (ZPE), puntuación Z de altura para la edad (ZAE) y puntuación Z de índice de masa corporal (IMC) para la edad (ZMCE). Los niños se estratificaron según la antropometría antes del tratamiento y la edad. Se utilizaron los análisis univariado y linear mixto para determinar las asociaciones entre variables independientes y los resultados de peso y altura.
Resultados
La mayor parte de los 159 niños se presentaron con una enfermedad clínica (90%) e inmunosupresión (89%). Un bajo peso antes del tratamiento, el retraso en el crecimiento y la emaciación eran comunes (ZPE<–2= 50%, ZAE<‐2= 73%, ZMCE<‐2= 19%). El peso y el IMC mejoraron durante los 12 meses iniciales, mientras que la altura mejoró a lo largo de todo el periodo de 5 años. La altura al terminar el estudio era significativamente peor para los niños con retraso en el crecimiento en el momento de iniciar TAR (p<0.001), aunque los niños más jóvenes (<1 año) demostraron una mejoría superior en términos de IMC (p=0.04). La tuberculosis era un factor de riesgo independiente para la mejoría pobre en el peso (p=0.01) y en la altura (p=0.02). La ganancia de peso también se veía afectada por la falta de electricidad (p=0.04). La reconstitución inmune y la supresión virológica no estaban asociadas con tener bajo peso o retraso en el crecimiento al final del estudio.
Conclusiones
La desnutrición era una preocupación clínica importante para esta cohorte de niños infectados con VIH. La iniciación temprana del TAR, el manejo de la coinfección con tuberculosis y las intervenciones nutricionales son cruciales para asegurar un crecimiento óptimo en niños infectados con VIH.
Summary Childhood cancer is a major global health issue. Every year, almost 100 000 children die from cancer before the age of 15 years, more than 90% of them in resource-limited countries. Here, we ...review the key policy issues for the delivery of better care, research, and education of professionals and patients. We present a key list of time-limited proposals focusing on change to health systems and research and development. These include sector and system reforms to make care affordable to all, policies to promote growth of civil society around both cancer and Millennium Development Goals, major improvements to public health services (particularly the introduction of national cancer plans), improved career development, and increased remuneration of specialist health-care workers and government support for childhood cancer registries. Research and development proposals focus on sustainable funding, the establishment of more research networks, and clinical research specifically targeted at the needs of low-income and middle-income countries. Finally, we present proposals to address the need for clinical trial innovation, the complex dichotomy of regulations, and the threats to the availability of data for childhood cancers.
Background The South African Constitution affords everyone the right to access healthcare services, but in children the care must ensure survival.Aim This study aimed to determine whether there was ...access to equitable paediatric oncology services for the management of neuroblastoma in South Africa.Setting Paediatric oncology services in South Africa between 2000 to 2014.Methods A literature review was carried out, focussing on access to healthcare in South Africa for children with neuroblastoma. Services were classified in accordance with the International Society of Paediatric Oncology resource settings for neuroblastoma diagnosis. Supplementary data from a retrospective study of the management of neuroblastoma in South Africa were evaluated.Results The neuroblastoma care services in South Africa were not uniformly resourced and accessible across the provinces. Two provinces (2/9 provinces) had excellent healthcare services that included access to transplant facilities, whilst three (3/9 provinces) had no services. Traveling distances to healthcare services pose major challenges, whilst number of medical staff providing oncology care were unequally distributed. The Constitution did not define basic healthcare for children, nor did the National Cancer Control plan acknowledge childhood cancer as a defined entity without provision until 2022.Conclusion Children diagnosed with neuroblastoma do not have equitable access to healthcare as stated in the South African Constitution. The case of neuroblastoma highlights the inequitable access to childhood care as a whole in South Africa. As the health of children is a national priority, it is therefore necessary to sensitise policymakers to the needs of children with cancer.
Microbial biofilms are formed at oil/water interfaces in storage tanks containing diesel–biodiesel blends, decreasing fuel quality and increasing economic and environmental losses. Biocides may ...suppress the microorganisms responsible for the damage, but they are not used in all parts of the world. A B10 diesel–biodiesel blend (oil as received with or without an inoculum derived from diesel sludge) was incubated with or without 3,3′-methylene bis(5-methyloxazolidine, MBO) – 100% and 50% formulations at 1000, 500, and 0 ppm – over 60 days. The biofilms formed at the oil–water interface were collected for extraction of genomic DNA followed by amplification, purification, and Illumina HiSeq sequencing of the 16S rRNA gene. The prevalent genera in the control fuel (as-received and inoculated) were similar at 28 days (Pseudomonas, Comamonas, and Burkholderia); by the 60th day, the microbial community had changed only in the as-received fuel, where the prevalent genera were Comamonas, Klebsiella, and Tolumonas. Archea were detected in samples at 28 and 60 days. 500 ppm (as supplied) MBO 50% did not control the microbial growth and an interfacial biofilm was formed. After 28 days of incubation, taxonomic diversity in the as-received fuel and inoculated fuel decreased by 99.7% and 80.9%, respectively. The analysis also revealed that Firmicutes dominated the communities in the treatments with 500 ppm (as supplied) MBO 50%, followed by Proteobacteria, except in the 60 days sample from the as-received fuel, where Proteobacteria dominated, followed by Firmicutes. Inoculation increased degradation of the fuel.
•Illumina high throughput sequencing showed Archaea in B10 microbial population.•Sub-effective doses of the multifunctional biocide package may increase microbial growth.•Infrared analyses showed biodiesel degradation by the microbial population in fuel both with and without biocide.
We documented the prevalence of late effects in a South African childhood cancer survivor (CCS) cohort.
CCSs at Tygerberg Hospital, Cape Town, were evaluated for clinical abnormalities, whereafter ...late effects were identified, graded according to the Common Terminology Criteria for Adverse Events (CTCAE), and classified as significant or insignificant.
The cohort comprised 160 CCSs (median age 13 years (interquartile range 9.9 – 17.8 years); follow-up period eight years (range 5–37.2 years)). There were 89 (55.6%) hematological and 71 (44.4%) solid malignancies. Most CCSs (146/160; 91.3%) had at least one late effect; the majority were of Grade 1 CTCAE severity (73.7%). Common late effects were gastrointestinal (13.3%), metabolic (12.9%), hematological (9.2%), musculoskeletal (9.1%), and neurological (8.8%) disorders. Significant risk factors for late effects were cancer diagnosis (p = 0.005), chemotherapy (moderate intensity incidence rate ratio (IRR) 1.84; p = 0.036; high intensity IRR 2.8; p = 0.001), and radiotherapy (IRR 1.44) (p = < 0.001). Late effects severity was significantly associated with radiotherapy (IRR 1.54; p = 0.004). Solid tumor survivors were more likely to develop Grade 2 (IRR 2.4; p = < 0.001) and 3 late effects (IRR 2.8; p = 0.011).
This is the first prospective study of a CCS cohort in South Africa. Most CCSs developed mild or moderate long-term and late effects, significantly associated with cancer diagnosis, chemotherapy intensity, and radiotherapy. It is crucial to develop long-term surveillance plans for CCSs in South Africa to ensure early detection of late effects.
•First late effects report of a South African cohort of childhood cancer survivors (CCSs).•A high number of CCSs (91.3%) had at least one late effect; the majority were mild.•Most late effects were considered clinically significant to the CCSs.•Significant risk factors were cancer diagnosis, chemotherapy, and radiotherapy.•Socioeconomic and nutritional status worsened significantly over time.
The incidences of neuroblastoma (NB) differ significantly between various resource settings because of varying quality of cancer registries and underdiagnoses. This study aimed to evaluate current ...regional variations as reported by international cancer registries and the theoretical and reported differences in international NB incidences and to evaluate South Africa (SA) as a case for variable reporting.
A comprehensive literature review on registries reporting on NB was performed to construct incidence tables. The SEER Program incidence of 10.5/million children was used to calculate the expected number of NB cases for each country. Registry data of NB cases between 2000 and 2016 were requested from The South African National Cancer registry (SA-NCR) and the South African Children's Tumour Registry (SACTR) for comparison and to perform a probabilistic linkage study.
Internationally, incidences varied between -97.1% and +80% compared with the SEER program. SA under-reported NB cases by an estimated 74.2%. Between 2000 and 2016, the SA-NCR reported between 23 and 51 cases/year, whereas the SACTR reported between 18 and 57 cases/year for the same period. The incidence reported by the SA-NCR varied between 1.5 and 2.8/million children under 15-year per year, whereas the SACTR reported 1.74-2.6 cases/million children. Both registries reported incidences less than high-income country. A probabilistic record linkage of the two registries resulted in a combined incidence of 2.9 cases/million children.
As with most low- and middle-income countries, SA has either a lower incidence or underdiagnoses of NB cases. The reasons for under-reporting are not clear, but can be due to undiagnosed NB cases with spontaneous regression, missed possible cases because of lack of autopsies, and diagnosed cases not recorded in registries.
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