Search

In elementary school, inclusive education should be adapted to the needs of students with special abilities in areas such as recreational activities, feedback and methodologies and planning. The objective of the research is to analyze and describe the perspectives of educational inclusion factors among elementary school teachers to improve students’ learning with special abilities. The methodology of the research is descriptive with a quantitative correlational approach in which 823 elementary school teachers participated through a voluntary and anonymous online survey with a measurement instrument that had two dimensions of eight and ten items which were optimal in the different statistical tests as in the analysis of the reliability factors of Cronbach’s alpha (0. 968). The result shows that teachers are willing to improve the curriculum plan, provide specialized attention after training. There is a high perspective to interact with students with special abilities to improve student learning. There are institutional constraints on primary education teachers to improve the learning factors of inclusive education as well as unknown applications or technologies that can help the learning of students with special abilities in primary education. There are non-governmental organizations that seek the welfare of students with special abilities but the results are not very encouraging due to a lack of financial capacity.

Childhood central nervous system (CNS) tumors have longer delays in diagnosis than do other pediatric malignancies because health care providers (HCPs) lack awareness about clinical presentation of these tumors. To evaluate the knowledge gap among HCPs, we conducted a global cross-sectional survey. The survey consisted of a set of CNS tumor knowledge questions focused on symptoms, signs, and imaging indications. The survey was disseminated to HCPs via email (November 2018-March 2020). Participants had to complete a pre-test survey, attend an education seminar on CNS tumors, and complete a post-test survey. The knowledge gap was evaluated using pre-test and post-test scores. We received 889 pre-test and 392 post-test responses. Most respondents were from Asia (73.1% of pre-test responses; 87.5% of post-test responses). The median pre-test score was 40.0% (range: 13.1-92.9%). A high percentage of correct answers were given in post-test responses (median score: 77.1%, range: 14.9-98.2%). In the pre-test, 18.7% of participants accurately responded that Cushing's triad was a less common symptom, and 15.0% recognized that children aged 10 years are at risk of late diagnosis. Surprisingly, 21.9% falsely reported that patients with malignancy experienced the longest pre-diagnostic symptom interval, and 54.5% of respondents wrongly selected medulloblastoma as the most common CNS tumor. Overall, pediatricians demonstrated a greater knowledge gap on both surveys than did other specialties. Conclusion: Pre- and post-test surveys revealed significant knowledge gaps in childhood CNS tumors among HCPs. Thus, raising professional awareness on clinical presentations of CNS tumors through educational strategies is important to address this knowledge deficit. What is Known: • Diagnostic delay in childhood central nervous system (CNS) tumors continues to be a significant problem that negatively impacts the quality of life and treatment sequelae. • Lack of medical education on CNS tumors is a contributing factor to this problem. What is New: • Most health care providers do not realize that low-grade tumors are the most common neoplasm in children. • Health care providers fail to recognize that teenagers and adolescents are a vulnerable age group for diagnostic delays, with the longest pre-diagnostic symptom interval.

Introduction Due to higher survival rates among patients with bone tumors, there is a growing interest in determining these individuals' limb functionality and psychosocial prognosis. Objectives This study aimed to analyze the differences in functionality and quality of life (QoL) related to health in patients diagnosed with a malignant bone tumor during childhood, according to the type of surgery performed. Materials and Methods A cross-sectional study was performed for patients older than 14 years who treated for osteosarcoma or Ewing's sarcoma of the lower limb by who receiving surgery. To assess lower limb functionality and QoL among patients surviving malignant bone tumors, 19 patients surviving osteosarcoma or Ewing's sarcoma of the lower extremity were studied. An evaluation of functionality and QoL was done using the “Enneking and Medical Outcomes Study Short-Form 36 scales.” We compared the functional results according to the surgical technique used. Categorical variables were compared according to the Mann–Whitney and Kruskal–Wallis tests, with an established 95% level of significance. Results QoL among patients who had conservative surgery was not significantly better than amputee patients in the physical or mental aspects, nor in any of their components. Limb functionality, according to Enneking's staging, was significantly higher in non-amputee patients (p = 0.035). Conclusion According to the data analysis done in this study, the QoL was found to be not significantly different, based on the type of surgery performed; however, there were differences in limb functionality.

Las emociones se clasifican desde un enfoque biológico, social, psicológico, complejo, básico, primario y secundario. El objetivo fue buscar una explicación teórica de la relación del canto con el manejo de las emociones primarias y brindar un programa utilizándolo como beneficio para las emociones. Su diseño metodológico responde a una investigación preexperimental, de enfoque cuantitativo y alcance descriptivo. La muestra está representada por 24 estudiantes del 1er ciclo del taller de música de la Facultad de Ciencias de la Vida y la Salud de la Universidad Nacional de Trujillo del año 2021. Se aplicó un cuestionario para medir las emociones tomado de la propuesta de Rodríguez, Oñate y Mesurado, que, si bien ya había sido aplicado el año 2017, fue validado por un psicólogo y sometido al proceso de la prueba de confiabilidad Alfa de Cronbach, dando como resultado que el nivel de varianza fue de 0.74, es decir rango de excelente confiabilidad. Se aplicó al inicio y salida de cada sesión un cuestionario y se registraron los detalles de la experiencia a través de una guía de anecdotario. Los resultados más resaltantes muestran que sí existía una problemática de falta de control de emociones, reflejado en un 16% de estudiantes, no obstante, después de la propuesta, donde cantaban solos-grupo, en la esquina de su barrio con un amigo, en karaokes de clase, imitaban cantando artistas y adivinaban canciones, sus comentarios, videos y productos expresaron que un 95% sentía emociones primarias positivas con la experiencia, quedando demostrado como conclusión que cualitativa y cuantitativamente el programa fue eficiente.

Recognition of pathogen-associated molecular patterns can trigger the IRE1α arm of the endoplasmic reticulum (ER) stress response in immune cells. IRE1α activation has been shown to maintain ER homeostasis while simultaneously coordinating diverse immunomodulatory programs in the setting of bacterial and viral infections. However, the role of IRE1α signaling in innate immune responses to fungal pathogens is unknown. Here we report that systemic infection with the fungusCandida albicanscauses severe renal immunopathology by triggering inflammatory IRE1α hyperactivation in host myeloid cells. Mechanistically, sensing of fungal β-glucans by the C-type lectin receptor Dectin-1 induced Src–Syk–NOX-dependent accumulation of intracellular reactive oxygen species and the ensuing generation of lipid peroxidation byproducts that sustained IRE1α activation. Selective deletion of IRE1α in leukocytes, or treatment with an IRE1α pharmacological inhibitor, reduced detrimental inflammatory responses in the kidney and extended survival in mice systemically infected withC. albicans. Hence, controlling IRE1α overactivation may be useful to impede the fatal immunopathogenic progression of disseminated candidiasis.One sentence summaryInnate IRE1α signaling in disseminated candidiasis

The ongoing coronavirus 2019 disease (COVID-19) pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year.Four cross-sectional surveys were electronically distributed among pediatric onco-hematologists in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners.Four hundred fifty-three pediatric onco-hematologists from 20 countries responded to the first survey, with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active ongoing patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (odds ratio [OR]: 1.84, 95% CI: 1.19-2.8), surgeries (OR: 3, 95% CI: 1.9-4.6) and radiotherapy (OR: 6, 95% CI: 3.5-10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR: 3, 95% CI: 1.4-6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR: 3.48, 95% CI: 1.6-7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability.Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.

La inmunoterapia ha significado un gran avance científico en el tratamiento del cáncer en los últimos años, siendo considerada como la piedra angular terapéutica de algunas neoplasias. Sin embargo, en algunos tipos de cáncer sólo una fracción de pacientes alcanza beneficio, planteando los desafíos y limitantes que nos llevan a la necesidad de entender la complejidad de la biología tumoral, el microambiente tumoral y la capacidad de respuesta de cada agente. Los resultados superan actualmente lo alcanzado por la quimioterapia convencional, aunque aún no se puede precisar si estas respuestas son duraderas o representan curación. En la presente revisión, se propone un enfoque amplio sobre la inmunoterapia en cáncer, desde los conceptos básicos hasta su aplicación clínica, descubrimiento que fue galardonado con el Premio Nobel de Medicina en el 2018.

The COVID-19 pandemic has led to unprecedented economic and health vulnerability and inequities globally. This study aims to determine the out-of-pocket (OOP) expenditure of families of children with cancer in Peru before and during the COVID-19 pandemic. We conducted a cross-sectional survey of 235 parents and caregivers of children diagnosed with cancer in Peru. Our study suggests that OOP expenses in these families constitute a catastrophic expense for health. This situation was aggravated due to a decrease in the economic income for most families due to the disruption in formal and informal employment.

espanolObjetivo: realizar estado del arte sobre el reintegro laboral en trabajadores de Latinoamerica entre los anos 1998 y 2019. Metodos: se realizo una revision narrativa con 27 estudios publicados en PubMed, EBSCO, SCIELO Scientifics Library y CENTRAL of the Cochrane Library. El reintegro laboral fue el criterio de busqueda, se asocio con ausentismo laboral y legislacion en diferentes paises. Resultados: destacaron las revisiones sistematicas (28.6%) y narrativas (25.0%). Entre los tres aspectos puntuales para la busqueda, prevalecieron los documentos sobre el proceso de reintegro del trabajador y en las enfermedades/situaciones desencadenantes de la ausencia laboral. A nivel de Latinoamerica, prevalecieron los estudios desarrollados en Colombia (n=10; 35.7%). Conclusiones: Las enfermedades, accidentes y condiciones laborales estan relacionadas con el tipo de actividad laboral desempenada por los trabajadores. En Latinoamerica y especificamente en Colombia, se percibe un notorio interes por el desarrollo y puesta en marcha de protocolos para el reintegro laboral del trabajador. Es notoria la falta de investigaciones en mas paises de la region y profundizar sobre los costos que dicha situacion acarrea para las empresas. EnglishObjective: to carry out state of the art on the labor reimbursement in workers of Latino-America between the years 1998 and 2019. Materials and methods: a narrative review was carried out with 27 studies published in PubMed, EBSCO, SCIELO Scientifics Library and CENTRAL of the Cochrane Library. The labor reimbursement was the search criterion, it was associated with labor absenteeism and legislation in different countries. The investigation is considered without risk according to Resolution 8430/1993. Results: systematic reviews (28.6%) and narratives (25.0%) stood out. Among the 3 punctual aspects for the search, the documents on the worker's reimbursement process and the illnesses / situations that trigger the absence from work prevailed. In Latin America, the studies developed in Colombia prevail (n = 10, 35.7%). Conclusions: Illnesses, accidents and working conditions are related to the type of work performed by workers. In Latin America and specifically Colombia, there is a noticeable interest in the development and implementation of protocols for the worker's reinstatement. The lack of research in more countries of the region and deepening the costs that this situation entails for companies is notorious.

BACKGROUND: Low-grade gliomas (LGG) are the most common central nervous system (CNS) tumors in children. Peru is an index country for the Global Initiative for Childhood Cancer (GICC). As part of the Initiative, a multidisciplinary brain tumor team was formed in 2020 that includes five national reference centers: National Institute of Neoplastic Diseases, National Children’s Health Institute-San Borja, National Children’s Health Institute-Breña, Edgardo Rebagliati Martins National Hospital and Guillermo Almenara Irigoyen National Hospital. This multicenter study sought to evaluate the survival and prognostic factors of patients younger than 18 years diagnosed with LGG, an index cancer for the GICC. METHODS: A retrospective study included all patients diagnosed with LGG in the five centers between 2014 and 2018. We analyzed clinical characteristics, histology, and treatment modalities. We used the Kaplan-Meier method for survival. RESULTS: 194 patients were registered; 136 patients were included. M/F ratio was 1.2, mean age 7 years old. The most frequent location was infratentorial (42.2%), supratentorial (34.9%), optic/chiasm/sellar (11%) and brainstem (11.9%). The most frequent histological types were pilocytic astrocytoma (61%), diffuse astrocytoma (10.3%), oligodendroglioma (5.2%), and other low-grade neoplasms (23.5%). Surgery was performed in 109 patients (83.2%). Chemotherapy alone was used in 17 (12.5%), while radiotherapy in 20 (14.7%). Overall survival at 5 years was 82.9% (95% CI 73.3 - 89.4). Age younger than 3 years (p=0.002), diffuse histological type (p=0.04), and location in the brainstem (p=0.001) were factors associated with a worse prognosis. CONCLUSIONS: Within the framework of the GICC, this work is one of the first steps to understand the current context of pediatric CNS tumor care in Peru. Although the reported survival rate is about the GICC goal of 60%, further improvements in care are needed to increase survival to level closer to high-resource setting and decrease long term morbidity.

Osteosarcoma is the most prevalent primary bone malignancy. Due to its high aggressiveness, novel treatment strategies are urgently required to improve survival of patients with osteosarcoma, especially those with advanced disease. Desmopressin (dDAVP) is a widely used blood-saving agent that has been repurposed as an adjuvant agent for cancer management due to its antiangiogenic and antimetastatic properties. dDAVP acts as a selective agonist of the vasopressin membrane receptor type 2 (AVPR2) present in the microvascular endothelium and in some cancer cells, including breast, lung, colorectal and neuroendocrine tumor cells. Despite the fact that dDAVP has demonstrated its antitumor efficacy in a wide variety of tumor types, exploration of its potential anti-osteosarcoma activity has, to the best of our knowledge, not yet been conducted. Therefore, the aim of the present study was to evaluate the preclinical antitumor activity of dDAVP in osteosarcoma. Human MG-63 and U-2 OS osteosarcoma cell lines were used to assess in vitro and in vivo therapeutic effects of dDAVP. At low micromolar concentrations, dDAVP reduced AVPR2-expressing MG-63 cell growth in a concentration-dependent manner. In contrast, dDAVP exhibited no direct cytostatic effect on AVPR2-negative U-2 OS cells. As it would be expected for canonical AVPR2-activation, dDAVP raised intracellular cAMP levels in osteosarcoma cells, and coincubation with phosphodiesterase-inhibitor rolipram indicated synergistic antiproliferative activity. Cytostatic effects were associated with increased apoptosis, reduced mitotic index and impairment of osteosarcoma cell chemotaxis, as evaluated by TUNEL-labeling, mitotic body count in DAPI-stained cultures and Transwell migration assays. Intravenous administration of dDAVP (12 µg/kg; three times per week) to athymic mice bearing rapidly growing MG-63 xenografts, was indicated to be capable of reducing tumor progression after a 4-week treatment. No major alterations in animal weight, biochemical or hematological parameters were associated with dDAVP treatment, confirming its good tolerability and safety. Finally, AVPR2 expression was detected by immunohistochemistry in 66% of all evaluated chemotherapy-naive human conventional osteosarcoma biopsies. Taking these findings into account, repurposed agent dDAVP may represent an interesting therapeutic tool for the management of osteosarcoma. Further preclinical exploration of dDAVP activity on orthotopic or metastatic osteosarcoma models are required.

Background/Aims Severe infections are the most important causes of morbidity and mortality in children with cancer. In Peru, a major limitation for an optimal treatment of children with fever and neutropenia due to chemotherapy is the delay in the administration of the first dose of antibiotics. We performed an intervention aimed to decrease the time to antibiotics (TTA) in pediatric patients presenting to the emergency room (ER) with fever and neutropenia: We increased the perception risk of neutropenic fever to the ER medical staff by explaining the importance of a timely administration of antibiotics as part of the initial approach of children with fever and neutropenia. This study forms part of a larger project (DoTT project) that is being implemented in Peru, and is aligned to the WHO Global Initiative of Childhood Cancer in Peru. Methods This study was performed at Hospital Nacional Edgardo Rebagliati, which is a tertiary care National Hospital located in Lima. We included patients younger than 14 years with hemato-oncological conditions who arrived at the Pediatric Emergency Room. The DoTT project consists in an quality improvement educational intervention for health care providers in the Pediatric ED and the Oncology and Hematology Departments, based on the Kern’s six-steps (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation. We defined time-to-antibiotic (TTA) by measuring the time elapsed between patient′s arrival to the ER and the administration of the fist dose of an antibiotic. We compared the TTA between thirteen patients admitted from July to December 2020 with fever and neutropenia (after intervention), and historical data from 2017–2018. Results Median age was 7 years. 9/13 patients had leukemia and 4 patients had malignant solid tumors receiving oncological treatment. Mean pre-hospital delay was 176 minutes (range, 14–906 minutes) and TTA was 133 minutes (range, 34–400 minutes). One patient died of sepsis. Age, sex, source and timing of antibiotics did not significantly affect hospital stay, antifungal use and/or antibiotic turnover. Based on our historical data, mean TTA was 206 minutes (range, 137–390). Early results indicate a decrease in the TTA, although not statistically significant, likely due to the sample size. General and targeted needs assessment was performed by the DoTT project team and administrators at Rebagliati hospital, which lead to develop a curriculum based on a 5-lectures mini-course for health care providers. Conclusions The TTA exceeds the recommended time at international level, causing the evitable morbimortality. It is necessary to perform a multidisciplinary intervention to improve antibiotic start time. Ongoing educational intervention refinement and testing of the instruments are planned.

Background: Osteosarcoma is still associated with poor response to therapy and alarmingly elevated mortality rates, especially in developing countries, highlighting the urgent need of novel therapeutic strategies. Given that β-adrenergic receptor (β-AR) signaling regulates many cellular processes involved in the initiation and progression of cancer, multiple efforts have been made to repurpose non-selective β-blocker propranolol in oncology. Considering the unsatisfied clinical needs of osteosarcoma, we evaluated the in vitro and in vivo antitumoral activity of propranolol as a monotherapy or in combination with metronomic chemotherapy, in β-AR-expressing human osteosarcoma cells. Methods: In vitro anti-osteosarcoma effects of propranolol were assessed on high-density cell growth, chemotaxis, colony-forming ability and three-dimensional spheroids. Cell cycle phase distribution and apoptosis were evaluated using flow cytometry analysis, and quantification of hypodiploid cell population and TUNEL labelling, respectively. Propranolol addition to chemotherapy was evaluated in vitro and in human osteosarcoma xenografts generated in athymic mice.Results: Propranolol significantly impaired MG-63 and U-2 OS cellular growth in a concentration range of 10-100 µM (IC50 ≈ 45µM) and was capable of blocking in vitro protumoral effects triggered by catecholamines. Cytostatic activity of propranolol was associated to reduced mitosis and G0/G1 cell cycle, but not to apoptosis induction. Moreover, β-blocker drastically reduced colony formation, spheroid progression and migration of osteosarcoma cells. Synergistic effects were observed in vitro after combining propranolol with chemotherapeutic agents methotrexate or cisplatin. In vivo, treatment with propranolol (10 mg/kg i.p.), alone and especially in addition to non-interrupted low-dose cisplatin (2 mg/kg i.p.), markedly abrogated xenograft progression, reducing tumor growth rates by 25 or 70%, respectively. After histological analysis, propranolol and cisplatin combined therapy resulted in low tumor mitotic index and increased tumor necrosis. Conclusions: Considering its robust antitumoral effects, β-AR antagonization using β-blocker propranolol seems to be an achievable and cost-effective therapeutic approach to modulate osteosarcoma aggressiveness, in addition to chemotherapy. Propranolol could be proposed as a co-adjuvant agent for the management of osteosarcoma, especially in low- and middle-income countries where access to treatment resources are limited. Further preclinical and clinical studies of propranolol repurposing in osteosarcoma are warranted.

Background Diagnosis delay in children and adolescents with cancer is a public health problem in Peru that leads to high rates of advanced disease and mortality. We aimed to assess the implementation feasibility and potential utility of ONCOpeds®, a mobile application that provides consultations with pediatric oncologists, in reducing the latency to diagnosis (LD) and referral time (RT) among children and adolescents in Peru diagnosed with cancer. Material and methods A prospective pilot study was conducted in the region of Callao between November 2017 and April 2018. Primary and secondary care providers were trained on the use of ONCOpeds in five educational sessions. Patients younger than 18 years who resided in Callao and were diagnosed with cancer at four pediatric cancer units in Lima were analyzed by referral type: ONCOpeds facilitated or conventional. Results ONCOpeds was successfully installed in the smartphones of 78 primary and secondary care providers of Callao. During the study period, 23 new cases of cancer in children and adolescents from the region were diagnosed. Ten patients received ONCOpeds-facilitated referrals and 13 received conventional referrals. The RT decreased among those who received ONCOpeds-facilitated referrals by 66% (P = 0.02); however, the LD did not significantly decrease with the use of ONCOpeds. Conclusions The implementation of ONCOpeds was found to be feasible in this pilot study, having a potential utility in improving early diagnosis and referral in children and adolescents newly diagnosed with cancer. Directions for future research include multicenter studies with a larger population to further test the application's effectiveness.

Although previous studies have suggested that the complications and mortality rate related to COVID-19 are substantially lower in the paediatric population,1 it is reasonable to consider that children with underlying conditions such as cancer will be at increased risk of severe disease... Fil: Vasquez, Liliana. Universidad de San Martín de Porres; Perú. Organización Panamericana de la Salud; Perú Fil: Sampor, Claudia. Fundacion Hospital de Pediatria Professor Dr. Juan P. Garrahan; Argentina Fil: Villanueva, Gabriela. Fundacion Hospital de Pediatria Professor Dr. Juan P. Garrahan; Argentina Fil: Maradiegue, Essy. Instituto Nacional de Enfermedades Neoplasicas; Perú Fil: Garcia Lombardi, Mercedes. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Gomez García, Wendy. Hospital Infantil Dr. Robert Reid Cabral; República Dominicana Fil: Moreno, Florencia. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina Fil: Diaz, Rosdali. Instituto Nacional de Enfermedades Neoplasicas; Perú Fil: Cappellano, Andrea M.. Universidade Federal de Sao Paulo; Brasil Fil: Portilla, Carlos Andres. Universidad del Valle; Colombia Fil: Salas, Beatriz. Hospital del Niño Manuel Ascencio Villarroel; Bolivia Fil: Nava, Evelinda. Hospital de Niños Jesus Garcia Coello; Venezuela Fil: Brizuela, Silvia. Instituto de Previsión Social ; Paraguay Fil: Jimenez, Soledad. Hospital Solca Núcleo de Loja; Ecuador Fil: Espinoza, Ximena. Hospital de Niños Dr. Roberto del Río; Chile Fil: Gassant, Pascale Yola. Hôpital Saint-Damien; Haití Fil: Quintero, Karina. Children's Hospital Dr Jose Renan Esquivel; Panamá Fil: Fuentes Alabi, Soad. Hospital Nacional de Niños Benjamin Bloom; El Salvador Fil: Velasquez, Thelma. No especifíca; Fil: Fu, Ligia. Hospital Escuela de Tegucigalpa; Honduras Fil: Gamboa, Yessika. National Children's Hospital; Costa Rica Fil: Quintana, Juan. Clinica Las Condes; Chile Fil: Castiglioni, Mariela. Hospital Pereira Rossell; Uruguay Fil: Nuñez, Cesar. Children's Cancer Hospital; Estados Unidos Fil: Moreno, Arturo. Hospital Universitario de Puebla; México Fil: Luna Fineman, Sandra. State University of Colorado at Boulder; Estados Unidos Fil: Luciani, Silvana. Pan American Health Organization; Estados Unidos Fil: Chantada, Guillermo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Hospital Sant Joan de Deu Barcelona; España

Purpose: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. Methods: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. Results: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. Conclusions: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.

Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas.Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses.In multivariate analysis, NLR2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338).Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.

Osteosarcoma of the skull is a rare primary malignant bone tumour in children, representing 1–2% of all cranial tumours. We describe a case of a 17-year-old adolescent with chondroblastic osteosarcoma of the parietal-occipital bone and no distant metastases at presentation treated with neoadjuvant chemotherapy, surgery and, later, concurrent chemoradiotherapy. The patient suffered progressive disease and died 15 months after diagnosis. There are at least 15 paediatric cases of osteosarcoma of the skull described in the literature. Due to its rarity, there are no broad prospective studies on this entity, which has distinctive features when compared to other craniofacial tumours, carrying a worse prognosis. Complete surgical resection is needed for long-term survival, whereas chemotherapy and radiotherapy have still questionable indications.

Background The aim of this study is to evaluate the relationship between the latency to diagnosis (LD) and the time to completion of chemotherapy (TCC) with clinical outcomes in children with osteosarcoma. Methods We performed a retrospective analysis of all patients who received treatment for osteosarcoma in two tertiary centers in Peru from 2008 to 2015. All causes of delayed LD or TCC were evaluated. Overall survival (OS) and event-free-survival (EFS) were estimated and compared according to LD, TCC, and established clinical prognostic factors. Results One hundred and thirteen patients were included in the study. The median LD was 13.5 weeks (interquartile range, 10-18.5 weeks). No association was observed among clinical stage, tumor size, and LD. Delayed LD was not associated with a worse clinical outcome. Multivariate analysis confirmed that OS and EFS were significantly worse in cases of a delayed TCC (≥4 weeks), with hazard ratios of 2.70 (1.11-6.76, P = 0.003) and 1.13 (1.00-1.26, P = 0.016), respectively. Most delays in TCC (85%) were due to extramedical reasons (e.g., lack of available hospital beds). Conclusion The LD did not seem to influence the EFS and OS in pediatric patients with osteosarcoma. However, a delay in TCC from any cause is independently associated with poor outcome in pediatric patients with osteosarcoma. Based on these results, further efforts may be needed to avoid treatment delays in patients with osteosarcoma in middle-income countries.

Background The latency to diagnosis is the time between the detection of a patient's first symptoms and the cancer diagnosis. The aim of this study was to identify the latency to the diagnosis of cancer in children in Peru and the clinical and sociodemographic factors associated with this latency. Methods All patients diagnosed with lymphoma and solid tumors between 2012 and 2014 at a social security referral hospital in Peru were retrospectively evaluated. Clinical and demographic variables were analyzed to assess their association with the latency to diagnosis. Results A total of 284 patients younger than 18 years of age were included in the study. The median time to diagnosis was 8.8 weeks, with a median patient interval of 2 weeks and diagnostic interval of 4.4 weeks. We found significant differences in the latency to diagnosis for different types of cancer (longer for Hodgkin lymphoma and shorter for Wilms tumor). Older children had significantly longer latencies to diagnosis (P = 0.048; OR: 1.05, 95% CI [1.0-1.1]), as did children who were first diagnosed by a general physician rather than by a pediatrician or surgeon (P = 0.028; OR: 2.1, 95% CI [1.1-4.2]). Parental age, level of education, marital status, metastatic disease, clinical stage, and gender did not significantly affect latency to diagnosis as analyzed by a multivariate analysis. Conclusion In Peru, median latency to diagnosis was comparable to that described in developing countries, where the index of suspicion for childhood cancer remains low. It is crucial to establish strategies to optimize early diagnoses using associated factors.

Introduction. Osteosarcoma (OS) is the most common malignant primary bone tumor in children and young adults, with alarmingly elevated mortality rates, especially in developing countries. OS patients bear highly invasive and vascularized tumors, with limited response to standard of care (SoC) therapies, and are in urgent need of novel therapeutic strategies. Propranolol (PPN) is a non-selective β-adrenergic receptor (β-AR) antagonist originally used in the treatment of diverse heart diseases. On the other hand, desmopressin (dDAVP) is a hemostatic drug that acts as a selective agonist for the vasopressin type-2 receptor (AVPR2) present in blood microvessels and several tumor types. Given that β-ARs and AVPR2 signalling regulates many cellular processes involved in the initiation and progression of cancer, multiple efforts have been made to repurpose PPN and dDAVP in indications such as breast and colorectal cancer, melanoma and angiosarcoma, among others. Considering the unsatisfied clinical needs of OS, the objective of this work was to evaluate the in vitro/in vivo antitumoral activity of PPN and dDAVP on highly aggressive preclinical models of OS. Materials and methods. The human OS cell lines MG-63 and U2-OS were used for in vitro or in vivo experiments. Target expression was assessed by qPCR and immunohistochemistry. Sensitivity to PPN or dDAVP was evaluated by in vitro 72 h proliferation, 7 d clonogenic growth, 3D spheroid formation, transwell chemotaxis assays and MG-63 xenograft progression in nude mice. In addition, PPN was evaluated as monotherapy or in combination with SoC chemotherapy. Results. PPN (10-100 µM) and dDAVP (0.1-10 µM) drastically reduced clonogenic and 3D growth, migration, mitotic index and proliferation of β-AR and AVPR2-expressing OS cells (p Conclusions. Taking into account PPN and dDAVP robust antitumoral effects, β-ARs antagonization or agonist activation of AVPR2 are achievable and interesting therapeutic approaches to modulate OS tumor aggressiveness. Both agents could be proposed as coadyuvant agents for treating OS, not only in combination with chemotherapy but also administered during the perioperative setting. Citation Format: Luisina Solerno, Natasha Sobol, Rocío Rodriguez, Marina Pifano, Giselle Ripoll, Hernan Farina, Liliana Vasquez, Daniel F. Alonso, Juan Garona. Drug repurposing of β-blocker propranolol and hemostatic compound desmopressin in osteosarcoma: Preclinical antitumor activity on 2D and 3D cell growth, chemotaxis and xenograft progression [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3062.

Ovarian and paraovarian neoplasms are uncommon in children, mainly originating from germ cell tumors and, least frequently, epithelial tumors. There is an association between genital tract tumors and Proteus syndrome, a rare, sporadic, and progressive entity, characterized by a postnatal overgrowth in several tissues caused by a mosaic mutation in the AKT1 gene. We describe a 20-month-old asymptomatic infant with Proteus syndrome who developed an endometrioid paraovarian borderline cystic tumor. This is the youngest patient so far reported in the literature with this rare syndrome and an adnexal tumor of borderline malignancy. A total of nine patients have been described with female tract tumors and associated Proteus syndrome, which includes bilateral ovarian cystadenomas and other benign masses. A paraovarian neoplasm is extremely rare in children and could be considered a criterion for Proteus syndrome. Standardized staging and treatment of these tumors are not well established; however, most authors conclude that these neoplasms must be treated as their ovarian counterparts.