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The latest edition of the Bucharest Institute of Oncology (IOB) Conference was held between 20 and 22 May 2021, in the capital of Romania. The conference was a hybrid event, with live and virtual participation and was attended by more than 1000 participants. The central theme was the value added by the tumor boards, underlining the significance of teamwork and collaboration between the different disciplines and oncology centers in the country. The opening session was attended by representatives from national and international cancer associations and societies, the mayor of Bucharest, the Vice-chancellor of the University of Medicine and Pharmacy, C. Davila, the health advisor of the President of Romania, as well other dignitaries and health experts in oncology in Romania. The conference sections covered all major types of cancer, education, research, health policies and new updates in guidelines and therapeutics. Since it is a yearly event of the institute, the current situation of the institute was presented in the context of the full COVID-19 pandemic as well as the ways of managing and overcoming the negative impact on the access to care for cancer patients.

The incidence of noncommunicable disease, including cancer, is growing rapidly. This has spurred significant funding and research activity focused on early diagnostic methods and advanced therapeutic schemes. However, there is growing evidence of the impact of the environment and climate change on the prevalence of malignant pathologies. In a century characterized by industrialization and dynamic climate, evidence shows that in the last 15 years, the incidence of malignancies like lung, breast, colorectal, and prostate cancer has increased by 33%. Even though a part of this increase is a result of improvements in screening and diagnostic methods, it is estimated that environmental factors and lifestyle changes contribute approximately 45% to the cancer burden. Moreover, the gap and lack of communication between different fields of research, such as healthcare and natural and social sciences, may be concealing a more severe statistic. More restrictive data is available for the tertiary prevention, which refers to the influence of the external environment upon the therapy efficacy and survival of patients. The present chapter presents the latest available data on cancer burden connected to environmental factors (land use and climate change) highlighting specific examples and predicted statistics.

BackgroundPatients with autoimmune inflammatory diseases (AID) have been prioritized for urgent vaccination to mitigate COVID-19 risk. However, few studies in the literature assessed the immunogenicity and safety of the COVID-19 vaccine in patients with AID.ObjectivesIn this context, the present study aims to evaluate the immunogenicity and safety of the vaccine against COVID-19 in patients with AID.MethodsThese data are from “Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease” - SAFER study, a Brazilian multicentric prospective phase IV study to evaluate COVID-19 Vaccine in AID, in the real-life, in Brazil. Immunogenicity and adverse events (AE) from a single center were assessed, after 2 doses of ChAdOx1 (Oxford/AstraZeneca), 8 weeks of interval, in patients with AID and healthy controls (HC). Inclusion criteria were age ≥ 18 years and fulfilling criteria according to international classification for AID. Exclusion criteria: pregnancy, previous severe AE to any vaccine, other immunosuppression causes. Stratification of post-vaccination AE was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Participants were followed up through blood collection for measurement of IgG antibodies against SARS-CoV-2 spike receptor-binding domain by chemiluminescence (SARS-CoV-2 IgG II Quant assay, Abbott Laboratories, Abbott Park, IL, USA) at baseline and 28 days after the second dose. The seropositivity was defined for titers ≥50 AU/mL. Quantitative analyses were presented as observed frequency, percentage, central tendency, and variability measurements. The sample’s normal distribution was verified through the Shapiro-Wilk test. The Kruskal-Wallis test and the post-hoc Dwass-Steel-Critchlow-Fligner pairwise comparisons test were used to compare the IgG-S titers between the groups through the evaluation period. Categorical data were addressed using the Fisher´s exact or Chi-squared (χ2) test. An alpha level of 5% significance was used in all analyses.ResultsA total of 377 volunteers with AID and 50 HC were included in the study. Patients with spondyloarthritis (N=64), systemic lupus erythematosus (N=63), rheumatoid arthritis (N=61), primary Sjögren’s syndrome (N=61), vasculitis (N=31), systemic sclerosis (N=14), inflammatory myopathy (N=9), Crohn´s disease (N=49), ulcerative colitis (N=11) and other systemics AID (N=12) were evaluated. Both groups had female predominance (73.5% vs. 74.0%, p=0.937) and were homogeneous for age (43.5 vs. 41.7,p=0.308). The seroconversion among those not reactive (IgG-S negative at baseline) (46 HC and 191 AID), 28 days after second dose was 97.1% for spondyloarthritis (p=0.425), systemic lupus erythematosus 88.2% (0.006), rheumatoid arthritis 93.5% (0.158), primary Sjögren’s syndrome 92.6% (0.133), systemic sclerosis or inflammatory myopathy 47.1% (0.001), inflammatory bowel disease 100% (0.999) and vasculitis 80% (0.006), while in healthy control was 100%. In comparison with HC, there was a statistically significant difference in IgG-S titles only in systemic sclerosis or inflammatory myopathy (1.694 AU/ml vs. 3.719 AU/ml; p=0.006). Both groups only presented mild AE. Pain at the injection (85.7% vs. 78.4%, p=0.239), headache (67.3% vs. 53.8, p=0.074) and fatigue (59.2% Vs. 46.2%, p=0.089) were more common in HC than AID. Overall, reactions like arthralgia (52.6 vs. 22.4%, pConclusionIn conclusion, our data indicated that ChAdOx1 vaccine is safe and induced high titers and seroconversion rate in AID. More severe AID, such as vasculitis, systemic lupus erythematosous, and systemic sclerosis and myositis showed a lower seroconversion rate. Further analysis will explore the association between immunossupressant and reactivity, and booster dose.AcknowledgementsAcknowledgements to DECIT/MS and ICEPI/SESA for supporting the study.Disclosure of InterestsNone declared

Background: The first cases of Zika virus infection and microcephaly in Brazil were reported in 2015. However, phylogenetic studies suggest that the virus may have previously circulated in the country. Methods: The head circumference of 62,298 newborns was analysed to identify cases of microcephaly between 2014 and 2017. We compared the groups of newborns with normal head circumference and those with microcephaly to identify risk factors. A time series with the incidences of microcephaly was analysed to assess the appearance of anomalous values to identify the beginning of the microcephaly epidemic. Data on the incidence of dengue fever were used to develop a control chart, aiming to identify changes in incidence and seasonality that could suggest the circulation of a new arbovirus. Findings: Premature newborns, children of mothers under 20 years of age and those born in 2014 and 2015 had a higher risk of microcephaly. Three quarters with anomalous incidences of microcephaly were identified, the first in 2014 and the others in 2015. The dengue epidemic curve in 2013 shows persistence of high incidences in atypical periods, suggesting the entry of a new virus in the third and fourth quarters. Interpretation: These findings represent epidemiological evidence of the existence of cases of Zika virus between the second quarter of 2013 and the beginning of 2014. The results add new elements to understanding the Zika virus epidemic in the Americas. Funding Statement: No funding was received. Declaration of Interest: Declaration of interests: We declare no competing interests Ethical Approval Statement: The ethics and research committee of the Federal University of Paraiba (2.520.770, CAAE 81168517.6.0000.8069) approved the research.

Las leucemias son la primera causa de muerte por enfermedad en niños en Colombia, incluso representan la mitad de las muertes por cáncer pediátrico en el país. En la actualidad, la Organización Mundial de la Salud, en conjunto con expertos internacionales, ha actualizado los criterios para la clasificación y el diagnóstico de las neoplasias hematolinfoides, de manera que, con base en todas las pruebas diagnósticas disponibles y las manifestaciones clínicas, se logre el diagnóstico, pronóstico y tratamiento adecuado para cada paciente. No obstante, no todas las herramientas diagnósticas están al alcance en nuestro medio, por lo que se requiere una adecuada interpretación y uso racional de las técnicas disponibles para lograr la clasificación y estadificación más acertada de los pacientes. En términos generales, las leucemias agudas incluyen las mieloides y las linfoides agudas, las cuales presentan diferencias importantes en su origen celular y genético, epidemiología, comportamiento clínico, pronóstico y tratamiento. En este módulo se revisa específicamente la clasificación y el diagnóstico de las leucemias mieloides agudas, con énfasis en las de mayor interés para la población pediátrica.

Background This prospective, observer-blinded, randomised, multicentre study aimed at determining the non-inferiority of 50 mg of plain 1% 2-chloroprocaine vs. 10 mg of 0.5% plain bupivacaine in terms of sensory block onset time at T10 after spinal injection. The study hypothesis was that the difference in onset times of sensory block to T10 between the two drugs is ≤ 4 min. Methods One hundred and thirty patients undergoing lower abdominal or lower limb procedures (≤ 40 min) were randomised to receive one of two treatments: 50 mg of plain 1% 2-chloroprocaine (Group C, n = 66) or 10 mg of plain 0.5% bupivacaine (Group B, n = 64). Times to sensory and motor block onsets, maximum sensory block level, readiness for surgery, regression of sensory and motor blocks, first analgesic requirements, unassisted ambulation, home discharge, and side effects after 24 h and 7 days were registered blindly. Results Chloroprocaine was comparable with plain 0.5% bupivacaine in terms of time to sensory block at T10 level. Group C showed faster onsets of motor block (5 vs. 6 min), maximum sensory block level (8.5 vs. 14 min), resolution of sensory (105 vs. 225 min) and motor (100 vs. 210 min) blocks, unassisted ambulation (142.5 vs. 290.5 min), first analgesic requirement (120 vs. 293.5 min), and home discharge (150 vs. 325 min) (all comparisons, P

BACKGROUND The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)-infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally. METHODS We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged

En el contexto de los cambios sociales y políticos que caracterizaron la década del 60 en Perú y como uno de los efectos a largo plazo del Grito de Córdoba que impulsó la reforma universitaria en el continente se produjo un evento que marcó la educación médica nacional y a la universidad peruana con consecuencias hasta el presente. Este evento es conocido como el segundo sisma de San Fernando que tuvo como hecho culminante la renuncia de 455 profesores de la centenaria Escuela de Medicina fundada por Hipólito Unanue. El motivo, su negativa a aceptar una ley que disponía el cogobierno estudiantil en la universidad peruana y que no exceptuaba a la Facultad de Medicina como ellos solicitaban arguyendo la especial índole académica de los estudios de medicina. El presente trabajo de investigación histórica transcurridos más de cincuenta años se aboca a estudiarlos basada en una exhaustiva revisión de fuentes primarias en archivos de la época y el testimonio de los principales actores docentes y estudiantiles del conflicto. El objetivo es desentrañar las raíces ideológicas, sociales y políticas del proceso sin descuidar el examen de las circunstancias y características que imprimieron a los acontecimientos ribetes dramáticos que concitaron, en su momento, expectativa nacional. Una indagación recorre todo el estudio: ¿pudo evitarse el conflicto? No hay una respuesta sencilla porque los actores en ambos bandos en contienda estaban convencidos de la certeza de sus posiciones y ambos la justificaban en la convicción de estar sirviendo de mejor manera a los intereses del país. Al presentar los hechos, las versiones y el análisis pertinente consideramos estar abriendo el debate en el seno de la comunidad médica y universitaria que conduzca a un productivo y aleccionador balance de estos acontecimientos históricos., In the context of political and social changes that characterized the decade of the 1960s in Peru and as one of the long-term outcomes of the «Grito de Córdoba» leading to educational reform in the entire continent, an event came about which left a lasting mark in Peru´s university education with consequences still impacting our present day. This major event, known as San Fernando ´s second «sisma» culminated in the resignation of 455 professors from the 100-year-old Medical School founded by famous historical figure Hipólito Unanue. The professors´ motive was their opposition to legislation requiring shared governance with the student body. This law did not exempt the Medical School from shared governance as which the professors had argued for on the grounds of the special academic nature of medical studies. This paper presents historical research spanning over fifty years. It is based on a thorough study of primary sources from the period as well as testimonies from key faculty and students involved in the conflict. The goal is to unearth the ideological, social, and political roots of this process while maintaining a rigorous study of the circumstances and characteristics of the dramatic historical events that sparked national attention. An important question permeates this study: Could this conflict have been prevented? There is no simple answer since both dissenting parties were convinced their position was true and both justified such conviction as an honorable patriotic endeavor. In presenting the facts, various accounts and relevant analysis we wish to ignite a debate in the medical and scholastic community that would lead to an enriching and balanced interpretation of these historical events.

The African Organization for Research and training in Cancer (AORTIC) bases the following position statements on a critical appraisal of the state on cancer research and cancer care in Africa including information on the availability of data on cancer burden, screening and prevention for cancer in Africa, cancer care personnel, treatment modalities, and access to cancer care.

The role of protective immunity to Plasmodium falciparum (Pf) malaria in Burkitt lymphoma (BL) is unknown. We investigated the association between BL and antibodies reactive to SE36 antigen, a recombinant protein based on P. falciparum serine repeat antigen 5 gene, targeted by protective malaria immune responses. Cases were children (0-14 years) enrolled at the Korle-Bu Teaching Hospital, Accra, Ghana, during 1965-1994 with BL confirmed by histology or cytology (92% of cases). Controls were apparently healthy children enrolled contemporaneous to the cases from the nearest neighbor house to the case house and were age,- sex-frequency-matched to the cases. Anti-SE36 IgG antibodies were measured using enzyme-linked absorbent immunoassays (ELISAs). SE36 titers were estimated by extrapolating ELISA optical density readings to a standard fitting curve. Anti-SE36 titers were log-transformed for analysis. Odds ratios (ORs) and two-sided 95% confidence intervals (95% CIs) were estimated using unconditional logistic regression. The mean log endpoint dilution titers were 0.63 logs lower in cases than in controls (8.26 [SD 1.68] vs. 8.89 [SD 1.75], Student's t-test, p = 0.019). Lower titers were observed in cases than controls aged 0-4 years (p = 0.05) and in those aged 5-14 years (p = 0.06). Low and medium tertiles of anti-SE36 IgG antibodies were associated with increased OR for BL ([OR 1.67, 95% CI 1.21-2.31] and [OR 1.33, 95% CI 0.96-1.86], respectively, p(trend) = 0.002) in analyses adjusting for age, sex, calendar period and test plate. Our findings suggest that compared to similarly aged children enrolled from the same community, children with BL in Ghana have lower antibodies to SE36 antigen.

Results: Thirty-nine children with cancer were transfused, between one unit and 34 units of blood products per patient, during their treatment in 2008. The total cost of this therapy in 2008 was ZAR 941,966 = USD 125,595 = EUR 89,711. The maximum cost per patient amounted to ZAR 70,682 = USD 9,424 = EUR 6,731 and the minimum ZAR 914 = USD 121 = EUR 87. The average expenditure per patient was ZAR 24,125 = USD 3,216 = EUR 2,297. The management of leukemia required the highest usage of blood products per patient. Conclusion: The use of blood products is indispensable during the treatment of numerous haematology – oncology diseases. Their indications should be specified in internal protocols and their actual use should be audited frequently due to the considerable costs.

BACKGROUND: The incidence of Kaposis sarcoma (KS) in sub-Saharan Africa increased tens of times since the onset of the AIDS epidemic. There is however very little literature concerning the clinical features of this disease its management and outcome in HIV-positive children in Africa. This study describes retrospectively the clinical presentation of the malignancy its management and outcome in a series of HIV-positive children. PATIENTS AND METHODS: Seventy children with KS and HIV infection were admitted consecutively from January 1998 to December 2009 in South African hospitals. Clinical data were extracted from tumor registries and patient records and analyzed. RESULTS: The average age in this series was 73 months. The males/females ratio was 1.59:1. Skin lesions were present in 36 out of 63 cases (57.14%) followed by lymph node lesions (28 cases 44.44%). The mean CD4+ lymphocyte count was 440 (SD = 385). The average CD4+ percentage was 12.20% (SD = 9.13). Only 14 patients (20%) were taking combined antiretrovirals at the time of diagnosis; a further 35 were given HIV treatment after diagnosis. Thirty-two patients (45.71%) survived only 4 months on average; 10 were lost to follow-up; and 28 (40%) were alive with an average follow-up of 16 months. Antiretrovirals improved survival (P = 0.001). CONCLUSIONS: The often present skin lesions facilitated the diagnosis; lymphadenopathy was less frequently seen than skin lesions. Antiretroviral drugs were associated with higher survival rate. The mortality remains high in spite of antiretrovirals and cytostatics. Copyright (c) 2010 Wiley-Liss Inc.

Media organizations have become a barometer in the development of a society. The way these organizations are managed depends on the context they can be placed in. Media organizations can be assimilated with a social and economic context. I attempted to emphasize the importance of good management that takes into account the basic principles and which can be integrated into a media organization. Leadership should be concerned with combining the specifics of management with those of human nature.The need for management is real. As it is the interdependence between the media organization and an efficient management. Despite their shortcomings, today’s managers are able to manage a newspaper, a radio or a television station. They can be divided into three categories, namely: managers of a media organization, having no knowledge of management; managers having the necessary training but unaware of how to implement management rules and finally, managers with very good training but lacking interest, who let things run by themselves.

BACKGROUND Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa. METHODS We linked the records of five ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age, and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria. RESULTS Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI 55-122). The most frequent cancers were Kaposi Sarcoma (34 per 100,000 person-years) and Non Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR 0.29, 95%CI 0.09-0.86), and increased with age at enrolment (>10 versus

Background and objectives. Cancer is emerging as a critical public health problem in South Africa (SA). Recognising the importance of research in addressing the cancer burden, the Ministerial Advisory Committee on the Prevention and Control of Cancer (MACC) research working group undertook a review of the current cancer research landscape in SA and related this to the cancer burden. Methods. Academic and research institutions in SA were contacted to provide information on the titles of all current and recently completed (2013/2014) cancer research projects. Three MACC research working group members used the project titles to independently classify the projects by type of research (basic, clinical and public health – projects could be classified in more than one category) and disease site. A more detailed classification of projects addressing the five most common cancers diagnosed in males and females in SA was conducted using an adapted Common Scientific Outline (CSO) categorisation. Results. Information was available on 556 cancer research projects. Overall, 301 projects were classified as clinical, 254 as basic science and 71 as public health research. The most common cancers being researched were cancers of the breast ( n =95 projects) and cervix ( n =43), leukaemia ( n =36), non-Hodgkin’s lymphoma ( n =35) and lung cancer ( n =23). Classification of the five most common cancers in males and females in SA, using the adapted CSO categories, showed that the majority of projects related to treatment, with relatively few projects on prevention, survivorship and patient perspectives. Conclusion. Our findings established that there is a dearth of public health cancer research in SA.

Background Very little is known about the regional variation in the incidence of childhood malignancies in Africa. The aim of the study was to perform a comprehensive analysis of the distribution of childhood cancer in Sub-Saharan Africa and compare the results to the Globocan estimations. Methods A letter of invitation to participate was sent to all registry centers in Africa registered with the International Agency for Research on Cancer and to all African centers registered with AORTIC and SIOP Africa, requesting similar information as in CanReg 4. Childhood cancers were defined as those occurring below the age of 15 years. The data requested was from 2000 to 2010. The malignancies were classified and coded according to the International Classification of Childhood Cancer, 2004 system. Data obtained were analyzed using EpiInfo and Statistica 10 software. Information regarding the estimation of the numbers and incidence of the top 5 childhood cancers in specific countries was obtained from Globocan Web site. Results There were 21 centers included in the study from 18 Sub-Saharan African countries. The data analyzed differed from center to center and included cases from 1985 to 2011. The proportion of childhood cancer out of all cancers ranged between 1.4% in Ghana to 10.0% in Rwanda. In Southern Africa, Kaposi sarcoma was the most common malignancy in children in Mozambique (15.8% of all cases) and the second most common in Zambia (15.6%) and in Malawi (12.4%). In Eastern Africa, Uganda recorded Kaposi sarcoma as the most common tumor in children (22.0%), while two Kenyan centers reported mainly Burkitt lymphoma (25.1 and 37.1%, respectively). In Central Africa, Congo classified retinoblastoma as the most common childhood cancer with an incidence of 20.1%. In Western Africa, Non-Hodgkin lymphoma was the most common in Ghana (53.6%), in Ivory Coast (73.6%) and in Mali (32.7%). Nephroblastoma remains the most common solid tumor in Africa exceeding 10% of total pediatric cancers in many countries (Rwanda 21.3%, Senegal 22%, Ivory Coast 14.5%, Mali 17.6%, Congo 15.5%, etc). Conclusion Unlike developed countries, lymphomas, nephroblastoma, Kaposi sarcoma and retinoblastoma were the most common pediatric tumors in Africa. Globocan estimations despite bringing significant contribution to the registration map cannot replace the data from local hospital and population-based registries. All efforts should be directed in developing functional and reliable childhood cancer registries across the African continent.

True and therapeutic aromatherapy has many uses for personal care. Essential oils work on the psychological and physiological to balance mind, body, and spirit. Pure oils with the Latin binomial are the key to achieving the desired results in care. Uses are explained, and a suggested list of safe essential oils and hydrosols are included. Safety, storage, purchasing guidelines, as well as resources for education, oils, reading materials, and a research database conclude the article.

A multiteam effort was designed to provide chair massage and aromatherapy to alleviate the physical and mental stressors and respiratory complications encountered by the people involved in multiple aspects of the recovery process from the devastation and grief following the attack on the World Trade Centre on 11 September 2001.