Immunology is highly specialized and utilized in prophylactic vaccines, laboratory tests and treatments for patient care. It is also an essential tool for cutting-edge biomedical research designed to deepen scientific understanding and produce new therapies and technologies.[1] At the William Soler Pediatric University Hospital in Havana, as pediatric immunologists, we work to improve our patients’ […]
COVID-19, the disease caused by the novel coronavirusSARS-CoV-2, is present in more than 200 countries and regions and is having a devastating impact worldwide. The sheer number of critical and convalescent patients—including pediatric patients—represents a challenge to the global medical community. Although children with COVID-19 are often asymptomatic or exhibit only mild symptoms, they can […]
INTRODUCTION Pediatric urinary lithiasis (urolithiasis) is an important health issue linked to urinary metabolic disorders. In the United States alone, annual costs associated with urolithiasis are $229 million for hospital admissions and $146 million for emergency care.
OBJECTIVE Identify urinary metabolic disorders in Cuban pediatric patients with urolithiasis and better understand the relationship of age, demographic and anthropometric variables to urinary metabolic disorders strongly associated with urolithiasis.
METHODS We carried out a descriptive, cross-sectional study. The study universe was comprised of Cuban patients aged 2 to 19 years with urinary lithiasis who underwent renal metabolic studies at the Dr Abelardo Buch López Nephrology Institute in Havana, Cuba, from 2008 through 2019. All data were obtained from reports of the aforementioned metabolic studies. We collected the following variables: age, sex, nutritional status, urinary volume, plasma and urinary creatine concentrations; and calcium, uric acid, oxalate and citrate urinary excretions collected during a 24-hour period. We included results of urinary cystine tests and urine mini-cultures. We obtained frequency distributions for categorical and qualitative variables and calculated means and standard deviations for quantitative variables. We also evaluated homogeneity of metabolic disorders between children and adolescents.
RESULTS We studied 1592 pediatric patients, of whom 67.7% (1078/1592) were adolescents. The main metabolic disorders included hypercalciuria (39.1%; 622/1592), decreased urinary flow (22.4%; 357/1592) and hypocitraturia (18.2%; 289/1592). Hypercalciuria, hypocitraturia and hyperoxaluria were more common in children, while decreased urinary flow and hyperuricosuria were more common in adolescents. Hyperuricosuria was more frequent in male patients (6.3%; 40/639 vs. 1.8%; 8/439) and had the greatest impact on lithogenesis. Hypercalciuria was more frequent in undernourished children (62.5%; 30/48) than in overweight children (21.7%; 10/46), or those with obesity (33.3%; 15/45).
CONCLUSIONS The main metabolic disorders among Cuban pediatric patients with urinary lithiasis are: hypercalciuria, decreased urinary flow and hypocitraturia. Hypercalciuria, hypocitraturia and hyperoxaluria are more common in children, and decreased urinary flow and hyperuricosuria are more common in adolescents. Identifying urinary metabolic disorders facilitates formulation of treatment plans tailored to decreasing the likelihood of urolithiasis.
KEYWORDS Pediatrics, urolithiasis, urinary lithiasis, hypercalciuria, urine, Cuba
Coordinator, National Pediatric Cardiology Network William Soler Children’s Heart Center, Havana “Our family wasn’t rich, but we didn’t want for anything,” says Dr Palenzuela by way of introduction. In 1950s Cuba, her father drove a taxi and her mother was a homemaker, raising two daughters—one now an economist and the other a top pediatric cardiologist. […]
Growth and development is considered the best positive indicator of children’s quality of life and well-being. Studies have been carried out in Cuba since the early 20th century and large scale, periodic anthropometric surveys have been regularly conducted by its National Health System to chart modifications in growth patterns of children and adolescents. These surveys have produced national references for the anthropometric indicators most commonly applied in individual assessment of the health and nutritional status of children and adolescents in health care settings. These have also provided data for estimating the magnitude and characteristics of secular growth trends, and for comparing growth of Cuban children with that of children in other countries and with WHO’s proposed growth standards. The data have also served as evidence of persisting social gradients. The most important results include, as positive data, the positive secular trend in school-aged children’s growth of 9.7 cm between 1919 and 2005, with an average increase of 1.1 cm per decade, and, in preschool children, 1.9 and 1.8 cm in boys and girls, respectively, between 1972 and 2015. More recent studies have detected unfavorable changes associated with a marked increase in adiposity and, therefore, in the prevalence of excess weight and obesity. Another interesting result is the gradual movement toward WHO height-for-age standards in preschool children in Havana, verified in surveys conducted in 2005 and 2015.
KEYWORDS Growth and development, growth, child development, children, adolescents, nutrition, obesity, pediatrics, Cuba
INTRODUCTION Acute liver failure is rare in pediatric patients and is one of the most challenging medical emergencies due to its prognostic and therapeutic implications. The best scientific evidence worldwide comes from multicenter studies in developed countries. In Cuba, there are no prior studies of this disorder in children.
OBJECTIVES Describe the main clinical features of Cuban children treated at a national referral center for acute liver failure, as defined by recognized diagnostic criteria for pediatric patients.
METHODS A case series study was conducted comprising patients diagnosed with acute liver failure treated from 2005 to 2011 in the hepatology and liver transplant service at Havana’s William Soler University Children’s Hospital. Variables were age group, etiology of acute liver failure, grade of hepatic encephalopathy, blood chemistry variables, and clinical outcome (whether or not spontaneous recovery of liver function occurred). Associations between variables were assessed using contingency tables, and case fatality was calculated, as well as relative risk with its 95% confidence interval. The Mann-Whitney U test was used to compare means of laboratory test results.
RESULTS Median age of the 31 patients studied (14 boys and 17 girls) was 24 months (range 1–180). Time between symptom onset and diagnosis of acute liver failure was 25.1 days (SD 16.8). Infection was the most common etiology, present in 61.3% of cases (19/31); nonhepatotropic viruses, especially cytomegalovirus, predominated in infants. Spontaneous recovery occurred in 15 patients (48.4%), 3 (9.7%) received transplants, and 13 died, for a case fatality of 41.9%. Outcome was not associated with etiology (p = 0.106), but was statistically associated with degree of hepatic encephalopathy (p <0.01): 77.8% of patients (7/9) with grades III–IV encephalopathy died, for a relative risk of 4.0 (95% CI 1.15–13.8), versus 11.1% (1/9) with grade II or less encephalopathy. Cholesterol levels were significantly lower in patients who failed to recover spontaneously (p <0.01).
CONCLUSIONS Patients’ clinical characteristics in this case series were similar to those described in developed countries.The fact that nonhepatotropic viruses (basically, cytomegalovirus in infants) are the main cause of acute liver failure in Cuban children calls for further epidemiologic study and identification of local underlying determinants of this phenomenon.
KEYWORDS Acute liver failure/etiology, transplants, infections, cytomegalovirus, children, pediatrics, Cuba
INTRODUCTION Hypertension and obesity in adults have been linked to increased EKG P-wave dispersion; the association has been shown in relation to hypertension, left ventricular hypertrophy and atrial enlargement. Though studies in children have linked P-wave dispersion to left ventricular hypertrophy, scant pediatric literature relates P-wave dispersion to hypertension and obesity.
OBJECTIVE Assess the association of P-wave dispersion with blood pressure and nutritional status in a pediatric population.
METHODS This cross-sectional study is part of the PROCDEC II project for pediatric hypertension diagnosis and control in Santa Clara, Cuba. Twelve-lead EKG and four blood pressure readings were conducted on a sample of 656 children aged 8–11 years. Blood pressure <90th percentile for age, sex and height was considered normal; 90th–95th percentile, prehypertension; and >95th percentile, hypertension. The main study variables were P-wave dispersion and systolic, diastolic and mean arterial pressure (MAP). Secondary variables were sex, height, weight, and body mass index. Comparisons of means, analysis of variance and linear correlations were done.
RESULTS Mean P-wave dispersion differed significantly (p ≤0.05) among normotensive (30.10 ms), prehypertensive (32.99 ms) and hypertensive children (39.14 ms), as did mean MAP (p <0.05). P-wave dispersion and MAP were significantly correlated in prehypertensive and hypertensive children. Most overweight and obese children with high P-wave dispersion were prehypertensive or hypertensive.
CONCLUSIONS Associations observed between P-wave dispersion and MAP in normotensive, prehypertensive and hypertensive children suggest potential for early detection of EKG patterns showing vulnerability. Given the relationship between increased P-wave dispersion and hypertension already described in adults, use of P-wave dispersion could be a simple, economical and noninvasive method of predicting risk of hypertensive cardiomyopathy in prehypertensive and hypertensive children; this in turn could guide timely, effective treatment and secondary prevention. Similar studies on a larger sample are needed to corroborate these results.
KEYWORDS Arterial hypertension, pediatrics, prevention, electrocardiogram, ECG, EKG, mean arterial pressure, P-wave dispersion, Cuba
INTRODUCTION: Recombinant human erythropoietin (RHuEPO) is an erythropoiesis stimulating agent (ESA) used to treat anemia in patients with total or relative erythropoietin deficit. In cancer patients, it is administered to optimize hemoglobin (Hb) levels, correct anemia and reduce the need for transfusions. Cuba produces a RHuEPO, registered in 1998 as ior®EPOCIM, that is widely used in the national public health system, mainly to treat patients with anemia due to chronic kidney disease (CKD).
OBJECTIVE: Evaluate the efficacy and safety of ior®EPOCIM in pediatric cancer patients with anemia following chemotherapy or radiotherapy. The working hypothesis posed an Hb increase ≥15 g/l in 70% of patients receiving ior®EPOCIM for 8 weeks.
METHODS: A Phase IV, multicenter, open clinical trial was conducted. Participants were 157 patients aged 1–19 years with anemia and cyto-histological diagnosis of cancer in any location. Patients received either 600 U/kg ior®EPOCIM intravenously, once weekly, or 150 U/kg ior®EPOCIM subcutaneously, 3 times a week, for 8 weeks. All patients had blood tests every week to determine hemoglobin and hematocrit, and reticulocyte and platelet counts. Mean number of transfusions required by patients during the treatment period was compared to the mean number of transfusions received in the preceding 8 weeks. Adverse events (AE) were recorded at the 4th and 8th weeks and classified by intensity and causality.
RESULTS: Hb levels rose ≥15 g/l in 68.8% of patients, and transfusion requirements decreased 17%. The most frequent adverse events were fever (19.3%), vomiting (10.2%) and flu-like syndrome (9.6%). Intensity of AE was predominantly mild. Only 7 AE were classified as very probably related to the product and none of those was severe.
CONCLUSIONS: ior®EPOCIM proved to be safe and effective at the doses and frequencies used in this patient population. As a result, this medication was recommended for use in all pediatric oncology and hematology services in the country.
Keywords: Erythropoietin, recombinant; anemia, cancer, pediatrics, medical oncology, Cuba
INTRODUCTION: Estimating childhood cancer incidence globally is hampered by lack of reliable data and uniform age limits for classifying and analyzing data reported. In Cuba, cancer data has been systematically gathered and processed by the National Cancer Registry (NCR) since 1964. The International Classification of Childhood Cancer (ICCC) is currently recommended for registering neoplasms in the population aged ≤19 years. Cancer incidence data published by the Cuban Ministry of Public Health, however, uses ICCC diagnostic groups for the population aged <15 years, and topographic sites for the population aged ≥15 years.
OBJECTIVE: The objectives of this study are to describe cancer incidence in the Cuban population aged ≤19 years in 2001–2003 using the ICCC, as well as geographic distribution of incidence by sex and by principal diagnostic groups.
METHODS: A descriptive study of cancer incidence in the population aged ≤19 years was conducted using NCR data for 2001–2003. ICCC diagnostic groups and subgroups were used, and 5 age groups (<1, 1–4, 5–9, 10–14 and 15–19 years) were analyzed. Total incidence and percentages for each diagnostic group were calculated. Number of cases in each diagnostic group and subgroup was also recorded by age group, and age-specific rates per 100,000 population aged ≤19 years (ASR) and age-adjusted rates to the standard world population aged ≤19 years (AAR) were calculated. AARs for leukemias, lymphomas and central nervous system (CNS) tumors were used to analyze childhood cancer risk by sex and geographical distribution in the country’s 14 provinces and Isle of Youth Special Municipality.
RESULTS: In 2001–2003, the NCR reported 1285 new cancer cases in the population aged ≤19 years for an overall incidence of 13.9 per 100,000 population aged ≤19 years (AAR). Highest risk was found in children aged <1 year with an ASR of 21.9 per 100,000 population aged ≤19 years. Leukemias, lymphomas and central nervous system tumors comprised 61.1% of new cases, and geographic distribution of these diagnostic groups varied by sex. Childhood cancer risk was highest for males in Ciego de Avila, Villa Clara and the Isle of Youth Special Municipality and highest for females in Sancti Spíritus, Villa Clara and Cienfuegos.
CONCLUSIONS: Incidence of childhood cancer in Cuba conforms to rates reported internationally and to the incidence pattern most common in Latin America. Further research is recommended to examine risk factors influencing geographical variations in incidence within Cuba.
Keywords Pediatrics, cancer, incidence, risk, registries, epidemiology
