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Neuroblastoma: The basis for cure in limited‐resource settings
No full textBackground Neuroblastoma (NB) contributes the most to the mortality of childhood malignancies worldwide. The disease spectrum is heterogenous and the management complex and costly, especially in advanced disease or disease with adverse biology. In low- and middle-income countries (LMICs) the majority of NB presents in advanced stages. Therefore, with limited resources and poor prognosis the treatment of NB is often not a priority. The aim of the study was to evaluate the research activities and perceptions of the management of NB that determine the research and treatment approaches in LMICs. Methods Data were sourced from identifying NB trials open to LMIC. s on NB research presented at the International Society for Paediatric Oncology (SIOP) Congresses between 2014 and 2020 were evaluated according to income status. An online survey evaluating medical views on NB in LMICs and the effect on the management was conducted. Descriptive analysis was done. Where appropriate categorical association between covariates was assessed using the Pearson chi-square (chi(2)) test or Fishers exact test. Results There were 15/562 (2.7%) trials open to LMIC. Only six of 138 (4.3%) LMIC participated in NB trials. Of the 688 abstracts presented between 2014 and 2020 at the SIOP International Congress on NB as primary subject, 297 (42.7%) were from LMICs. Only two were from low-income countries (LICs). Sixty-one countries responded to the NB survey. Positive views towards NB management were present when treatment was based on a national protocol, the availability of trimodal or advanced treatment options were present, and when a balance of metastatic or local disease were treated. Conclusion Management of NB in LMICs should include increased advocacy and research as well as implementation of national management strategies.We appreciate the support offered by Profs Kate Matthey, Guillermo Chantada and Scott Howard on behalf of the Global Neuroblastoma Network, Profs Laila Heississen and Lorna Renner on behalf of SIOPAfrica, Dr Joyce Balagadde-Kambugu on behalf of POGEA in the distribution of the survey. Our gratitude extends to all the participants of the survey. Dr van Heerden, as staff member of the Department of Paediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp acknowledges theDepartment for Research Support as well as the vzw Kinderkankerfonds, Belgium for the initial research grants. We acknowledge the Spanish and French translation services done by Mr Jorge Luis Rentaria, Mr Steve Populaire and Mrs Gaelle DuFour.van Heerden, J (corresponding author), Stellenbosch Univ, Tygerberg Hosp, Dept Paediat & Child Hlth, Paediat Haematol & Oncol,Fac Med & Hlth Sci, Cape Town, South Africa.
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Anthropometric profile and physical performance of youth players and challenges in the Ethiopian football talent identification program.
Full text linkDoctoral Degrees (Biokinetics, Exercise and Leisure Sciences). University of KwaZulu-Natal. Westville, 2018.The purpose of this study was to investigate the existing challenges that hinder the implementation of the talent identification program. Understand and develop basic standards to recruit talented young players based on their anthropometric and physical quality also the purpose of this study. Other purpose of the study was formulated and implement effective strategies for the coaching program. The study employed a cross-sectional study design. A homogenous group of 240 male Ethiopian football players (Age 15.6 ± 1.8 years) from 12 teams participated in this study. Sixty-one football coaches and 61 sport administrators also participated.
Anthropometric assessment, speed, power, agility, endurance and flexibility tests were conducted. The data was analysed using descriptive and inferential analysis techniques. The mean and the standard deviation of results across an anthropometric profile for all players are as follows: body mass weight was 55.47kg (6.14), standing height was 1.7m (0.06), body mass index was 19.12kg/m2 (1.99), sub-scapular skinfold was 6.88mm (1.37), triceps skinfold was 5.95mm (1.51), BF(Body Fat) % was 15.53% (2.91) and LBM(Lean Body Mass) was 46.82kg (5.11). Significant weight and height differences (p≤0.05) were found between club and academy players, but not in BMI, % BF and Lean Body Mass (LBM). club players had significantly greater body mass than EFF and academy players (p≤0.05). For standing height, club and EFF players were significantly taller than players in the academy teams (p≤0.05). The mean and the standard deviation of overall fitness values for all players were as follows: 10m speed was 2.15sec (0.19), 20m speed was 3.51sec (0.29), 40m speed was 5.16sec (0.31), sit and reach flexibility was 12.94cm (7.86), vertical jump power test was 42.93cm (6.58), Illinois agility test was 17.45cm (0.83) and V̇O2 max 49.74ml/kg/min (5.42). Mean values per setting from club, academy and EFF, respectively were: 10m speed 2.08sec, 2.26s and 2.14sec (p≤0.0001); 20m speed 3.4sec, 3.7sec and 3.49sec (p≤0.0001); 40m speed 5.87sec, 5.9sec, 6.07sec (p≤0.0001). Flexibility was 11.96cm, 11.31cm and 14.96cm (p≤0.05). Club’s youth players were taller, heavier, faster and more flexible than academy and Ethiopian football federation players. Significant differences were found in age groups: 10m speed between U-14 and U-15 (p≤0.01) and U-14 and U-17 (p≤0.05), In 20m speed between U-14 group and U-16 (p≤0.01) and U-14 and U-17 (p≤0.01). Significant
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differences were also found in 40m speed between U-14 and U-15 (p≤0.05). Older age players were faster than younger ones. Anthropometrical profiles and physical performance tests may assist to identify the talented players in the country. Significant differences found per climatic altitudes and geographical locations were as follows: high altitude players’ significantly greater body mass than low altitude players (p≤0.05). Low altitude players significantly better BMI than high altitude players (p≤0.0001). For LBM, high altitude players significantly greater results than low and moderate altitude players (p≤0.005). The moderate altitude group of players performed better results than the low and high-altitudes group of players. Eastern and northern players were significantly heavier than southern and western players. Compared to southern players, Eastern and northern players were significantly taller than southern and western players. Although players from eastern, performed better in the 10m speed test than western players. Regarding the 20m speed test, eastern players performed better results than the rest three altitudes groups.
A correlation matrix comparing anthropometry and physical performance indicated that: BMI was negatively related with 10m sprint (r = 0.134), 40m sprint (r = 0.232), vertical jump (r = 0.108) and agility (r = 0.123). Height was negatively related to performance in the 20m sprint (r = 0.141), 40m sprint (r = 0.201) and agility (r = 0.255).
Quantitative questionnaire data related to the practice of talent identification programs in Ethiopia showed that: Most of the players (62%) have information and knowledge about a talent identification program. Most players (74%) have also experienced or passed through a talent identification program. The same was true of most players (74%) being of the opinion that they were exposed to a proper training program. Player’s knowledge and experiences; with respect to rest, water, materials and playing fields; family and coach support and test batteries found statistically significant differences (p≤0.0001) between club, academy and Ethiopian football federation settings.
For the questionnaires about knowledge and experiences of coaches in the talent identification program, no statistically significant differences were found among club, academy or Ethiopian football federation settings, whereas significant differences were found with respect to experiences on upgrading of coaching knowledge related to talent
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identification, in academy and Ethiopian football federation (p≤0.05) TIP (Talent Identification Program) settings. For the questionnaires related to problems and solutions of talent identification program, statistically significant differences in opinion were found among club, academy and Ethiopian football federation settings, but opinions about incorporation of talent identification programs in training courses were not significantly different. In terms of setting up programs to evaluate the level of performances of the players, not all settings were in the affirmative. For the implementation or application of talent identification programs, statistically significant differences in opinion were found across club, academy and Ethiopian football federation (p≤0.0001) settings. However, no differences were found fin terms of using a manual to identify player’s talent. For the questions about availability of materials and equipment for the TIP (Talent Identification Program) statistically significant differences in opinion were found among coaches in clubs and the Ethiopian football federation, while only those in the Ethiopian football federation TIP felt that testing materials are appropriate.
For all questionnaires about administrators’ knowledge and experiences of talent identification, statistically significant differences were found in all groups. Questions on knowledge about TIP and facilitating refreshment courses for the coaches on talent identification were not statistically difference. For the questions about problems and solutions for the talent identification program, opinions varied statistically whereas opinions regarding their team’s conducting talent identification program and motivation of the players were similar. For the questionnaires about implementation responsibility of talent identification programs, statistically significant differences were found among the club, academy and Ethiopian football federation settings. For the questionnaires about manpower and materials for the talent identification program, statistically significant opinions were found among all the club, academy and Ethiopian football federation TID settings.
For open-ended questions, all responses were investigated by using the detective qualitative data computer software package (NVIVO). The themes identified focussed on problems, solutions and suggestions for the operation of the Ethiopian football talent identification program. Under the three themes, focus nodes were identified as being the
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system, knowledge and experience, hard-work, training, monitoring and support, manpower, while facilities and equipment were also mentioned.
The football talent identification program in Ethiopia is not an optimally functioning system. The improvement of the system is the first essential element for the talent identification program. This research has shown the need for a new systematic structure to be established for the talent identification program. Scarcity of knowledge and experience, also affects the talent identification program. Education and training were offered as keys to a solution
Knowledge, attitudes and practices of plyometrics among high school sports coaches in Harare province Zimbabwe.
Full text linkMasters Degree. University of KwaZulu-Natal, Durban.Strength and conditioning is an important component of athletic success. However, in an African context, strength and conditioning practices are often overlooked. For coaches to effectively implement strength and conditioning programmes, and plyometric training in particular, with their athletes they must address several important training factors which implies that they should be knowledgeable in the implementation of the program. A coach may hold a positive attitude about plyometric training, but if the understanding of the fundamentals of how it functions and improves performance then consistency in the program is not pronounced or translated into strength and conditioning practices. The purpose of this study was to systematically review the role of concurrent strength and endurance training in endurance running and to examine the knowledge, attitudes and practices of plyometrics among high school sports coaches in Harare Province, Zimbabwe. The study design comprised: i) a systematic review of professional peer-reviewed journal publications in the literature using Pubmed, Medline, Science Direct, Ebscohost, Biomed, CINAHL, Embase and Google Scholar as search engines; and ii) a questionnaire-based KNAP descriptive survey among males and female high school coaches (n=100) from 45 schools in the Harare province of Zimbabwe. Results from the systematic review showed that concurrent strength training and endurance running improves the running endurance of endurance runners, without impacting on their VO2max and LT. Combined core strength training and running had contradictory findings regarding the benefits for enhanced running performance. The use of strength training as a protective measure against musculoskeletal running injuries has shown to be a worthwhile intervention. The results from the survey indicated that high school coaches in Harare Province of Zimbabwe, are typically between 30 to 39 yrs of age, with between 5 and 15 years of coaching experience and are mostly male. Slightly more than half (54%) of the coaches let their athletes perform plyometrics. While almost all of the coaches (95%; p≤0.0001) have previously participated competitively themselves, very few (11%; p≤0.0001) have previously done plyometrics themselves and the majority (94%; p≤0.0001) have not had any formal training in plyometrics. With the exception of coaches with training in sport science, who scored an average of 65% for a 20 item knowledge test on plyometrics, generally the coaches have very poor knowledge with regards to plyometric strength training exercise. Although male coaches knowledge was better than that of females and those with 5-15 years of experience had better knowledge than those with more than 15 years of experience, overall the coaches only managed to score an average of 35% for the same a 20 item knowledge test on plyometrics, and accordingly there is a resistance to the practice of using plyometrics more often in the training of their athletes
Participation of Zimbabwean female students in university sports.
Full text linkMasters Degree. University of KwaZulu-Natal, Durban.This study sought to establish the factors affecting the participation of female students in university sports and identify the measures that can help to increase the participation of Zimbabwean female students in university sports. Data was collected through a methodological triangulation of questionnaires, semi-structured interviews and focus group discussions from purposively sampled sports participants (n=125) and non-sports participant female students (n=125), Sports Directors (n=5) and Deans of Students (n=5) drawn from five of the eleven universities that are affiliated to the Zimbabwe Universities Sports Association (ZUSA). The resultant data was analysed by means of quantitative and qualitative procedures using Chi-square with p≤0.05 for quantitative data and by NVIVO 11 Qualitative Data Analysis Software (QDAS). The study established that, although the participation of female students in university sports has improved drastically in the last five years, female students still participate less than their male counterparts. It was also noted that, although institution based constraints have played a part in shaping the current trends of sport participation in Zimbabwean universities, these trends were mainly shaped by the gender stereotypes in the wider Zimbabwean society. The study established that the levels of female student participation can be improved by adopting a national strategy where gender mainstreaming is incorporated in the primary and secondary school curriculum as a means to influence people away from the societal gender stereotypes that have produced the current gender disparities in university sports participation. The findings show that female students derive recreational, material, monetary and psychological benefits. The findings showed that there were no deliberate institutional efforts to try and improve the levels of sport participation by female students in the five case study universities. It was also established that the participation of female students in sports can be improved through the adoption of such institutional measures as; employing female coaches and female sports administrators to be in charge of female student teams, using female role models in campaigns to motivate females to participate in sport, instituting policy measures that redress gender imbalances in sport participation and availing campus accommodation and accessible sporting facilities
Diet and supplementation practice in professional Ethiopian football players : effects on performance and recovery.
Full text linkDoctoral Degree. University of KwaZulu-Natal, Durban.The game of football places high physiological demands on players, who are expected to
react by carrying out a range of physical activities at different intensities. Such movement
patterns contribute to a high energy turnover in both training and match-play, which in
turn must be sustained by the intake of adequate fuel sources. In this thesis, three studies
were undertaken with the intention of gaining greater insight into, and adding to the body
of knowledge of, football nutrition in Ethiopia. The studies included an evaluation of the
impact of a sports nutrition education programme on the dietary, sports nutrition and
supplement practices of the Ethiopian national football squad during the period 2012 to
2014 (Study 1). The dietary intake, sports nutrition and supplementation practices of
professional Ethiopian football players currently playing in Ethiopian Premier League
clubs (Study 2) were then studied, as well as the relationships between training load,
energy balance, performance and recovery (Study 3).
Study – 1. Football players require adequate knowledge of nutrition to allow correct
selection and consumption of food and fluids to meet their performance, body
composition and overall health needs. The aim of this study was to examine the effect of
a sports nutrition intervention on the nutrition knowledge and dietary choices of the
players who were members of the Ethiopian national football squad between 2012 and
2014. The following sports nutrition topics were discussed: timing of nutrition, recovery,
hydration, post exercise physiological perceptions, macronutrients, sports drinks, fruit
and vegetables, alcohol and its impact on performance. Participants attended nutrition
education sessions for six months, each one 20 to 30 minutes in duration. Interview and
focus group discussions were administered to 20 Ethiopian national squad players and the
head and two assistant coaches working with them. The data were analysed using manual
coding matrices. The analysis of the interview data revealed that all the national team
players exhibited significant knowledge of football nutrition after the nutrition education
intervention. The intervention helped them to adhere to proper dietary and recovery
procedures, and also significantly helped the players understand dietary CHOs as a vital
source of fuel for football which as a result benefited them to change their misconception
they had about CHO before the intervention. Some players had believed, at the beginning
of the intervention, that alcohol had an ergogenic effect. In conclusion, this study revealed
that nutrition education for professional football players can have positive results. The
education programme must be entertaining and should not be too long. Based on these
findings, was concluded that football players in Ethiopia would benefit from nutrition
education targeting an improvement in nutrition knowledge and dietary practices.
Key words: Ethiopian national squad football players, dietary practices, Nutrition
education, nutrition knowledge.
Study – 2.
Similarly, to other professional football players, Ethiopian players require appropriate
nutritional intake because of the physiological demands of the game. To understand the
dietary practices and nutrition plans of these players, a dietary assessment of current
Ethiopian professional players was conducted.
The aim of this study was to assess the dietary intake of 126 players age M = 27.3, ±SD
= 3.0 years), weight M = 72.4, ±SD = 7.0 kg, height M = 1.77, ±SD = .06 m, BMI M =
23.1, ±SD = 1.6 kg.m2 from seven Ethiopian premier league football clubs; during a
competitive week, over a four-day period. Food was weighed and means (standard
deviation) and 95% confidence limits were calculated and compared across clubs using
one-way analysis of variance followed by Bonferroni post-hoc testing.
There were significant differences in dietary macronutrient composition across the teams
in the four study periods, the dietary intake in g/day and in g/kg of body weight for CHO
on Thursday was significantly different M = 344.6, ± SD = 12.5, p = 0.030, g/day
compared with Monday’s dietary CHO intake, in g/day and in g/kg of body weight, M =
308.3, ± SD = 96.4 g/day. The study revealed a dietary CHO intake was below the
recommendation of 500-600 g/day. With great significant difference among clubs ranging
from M = 459.9, ± SD = 104.1, p < 0.001. g/day to M = 256.0, ± SD = 58.5, p < 0.001
The mean dietary CHO, compositions in g/kg of body weight, across the teams were
significantly different ranging from, 3.6 (.9) g/kg of body weight to 6.1 (1.3) g/kg of body
weight.; In conclusion, the results show that the nutritional intake of the players was not
optimal unlike protein and fat the mean daily CHO intake of Ethiopian professional
football players was lower than recommended. These findings may have both short- and
long-term negative consequences on the performance and recovery as well as health of
the players. On the basis of our results, we recommended that nutritional education should
be given to the players at an early age and should continue throughout adolescence.
Key words: Ethiopian premier league, Dietary macronutrient intake, dietary
assessment.
Study – 3. It is important that football training load, which includes functional testing,
is closely linked with optimal energy intake. This enhances performance and recovery
process between training sessions. The aim of this study was to investigate the
associations between dietary practice and performance and recovery of twenty
professional Ethiopian football players from the same team (M = 23.8, ± SD = 3.3 years).
During an intense seven-day, (Monday to Sunday) pre-season training period, food was
weighed and recorded, and total and macronutrient energy intake was determined, and
energy expenditure calculated. Performance testing (Yo-Yo Intermittent Recovery Test
Level 1 (YYIR1) was also performed pre- and post the seven-day period. Data were
expressed as the mean (standard deviation). A one-way ANOVA, with Bonferroni posthock
testing, paired t-tests, Pearson correlation, and multiple regression were used in the
statistical analysis. The mean dietary intake for protein was significantly higher in terms
of daily intake in grams and per kilogram of body weight across the seven days ranging
from M = 257, ± SD = 44, p < 0.001 g/day, to M = 168, ± SD = 24, p < 0.001, g/day. And
M = 3.6, ± SD = .7, p < 0.001 g/kg of body weight to M = 2.3, ± SD = .4, p < 0.001 g/kg
of body weight. Overall, our results show that the nutritional intake of the players was
not optimal and resulted in a high mean daily energy deficit of M = -144.8, ± SD = 1111.7
calories was observed between the energy intake of M = 3765.1, ± SD = 1104.7 calories
and the energy expenditure of M = 3909.9, ± SD = 191.2 calories. The study revealed that
dietary fat was the highest source of energy, which is not the preferred fuel for football
players. The mean distance covered post the seven days of training for the YYIR1
significantly decreased by 25% (pre: M = 2266 ± SD = 526 m versus post: M = 1666 ±
SD = 456 m). This result represented a 10% decrease in VO2max values among the study
participants from session 1 pre: M = 55.4 ± SD = 4.4 ml/kg/min versus post: M = 50.4 ±
SD = 3.8 ml/kg/min. In summary, the YYIRT1 result may have been related to the energy
deficit of the players over the seven days of pre-season training. In addition, players
consumed higher levels of dietary fat and low levels of CHO during intense training,
which is not the recommended for optimal performance and recovery in professional
football players
Key words: Preseason training, YYIRT1, energy balance and training load.
In conclusion, the studies included in this thesis found that 1) elite Ethiopian football
players benefitted from a sports nutrition education intervention, 2) there is a disparity in
macronutrient composition across football teams participating in the Ethiopian Premier
League and 3) energy deficit during a week of intense preseason training is associated
with reduced performance and recovery of players
The management and outcomes of neuroblastoma in South Africa
Full text linkThesis (PhD)--Stellenbosch University, 2021.ENGLISH ABSTRACT: Neuroblastoma (NB) is the second most diagnosed childhood solid tumour in high-income countries (HIC), but the incidence has not accurately been described in low- and middle-income countries (LMICs). The diagnostic difficulty, with limited treatment modalities, contributes to poor outcomes in LMICs. This PhD dissertation investigates the management of NB in South Africa with the aim to develop the first prospective national neuroblastoma treatment protocol/clinical trial to improve overall survival (OS).Using the South African Cancer Study Group’s Tumour Registry data, between 2000 and 2016 the incidence of NB in South Africa was found to be between 1.74 to 2.6 cases/million children, which waslower than the 10.5 cases per million children reported in HICs. South Africa had a higher number of patients with high-risk (HR) tumours (75.6%), mainly due to advanced disease (70%). The 2-year OS was excellent for very low risk (VLR) (94.1%) and low risk (LR) disease (81.6%), while acceptable for intermediate risk (IR) disease (66.7%) but poor for HR disease (27.6%) (p<0.001, 95% CI). Limitations in risk stratification included the low number of tumours tested for MYCN (38.4%), with more than half being MYCN-amplified (54%), and no other NB related genetic characteristics.
Several treatment protocols were used in the different paediatric oncology units in South Africa during the study period (2000-2014) and the OPEC/OJEC (carboplatin, cisplatin, etoposide, cyclophosphamide and vincristine) induction chemotherapy regimen proved to be the least toxic with better metastatic remission rates for HR-NB. Ferritin had predictive value for complete metastatic remission rate, while LDH had predictive value for two-year OS and were found to be suitable tumour markers to use as surrogates for sophisticated genetic testing and mIBG-scans in the context of limited resources. Age at diagnosis, specifically the 18-month cut-point value, remained a significant prognostic factor, similar to HICs.Due to limited access to autologous stem cell transplants, the role of surgery and radiotherapy in the management of HR disease were investigated and found to significantly improve five-year OS with surgery and marginally with radiotherapy (p<0.001, 95% CI). Furthermore, the disparities in neuroblastoma health care provision in the different provinces in South Africa was found to exist and should be addressed to ensure equitable health care provision for all children as per the South African Constitution.
The implementation of the newly developed national NB single arm clinical trial in South Africa, adjusted to available national resources, was a complex process with major navigational bureaucratic challenges. Yet the process might serve as a guideline for similar processes in LMICs. The recruitment of patients into the national NB clinical trial proved to be difficult due to both the COVID-19 pandemic and reluctance to recruit advanced stage patients into clinical trials. However, with careful investigation and in collaborative spirit, rare diseases such as neuroblastoma in South Africa could be managed in national management protocols, aimed at improving overall survival and cure.AFRIKAANSE OPSOMMING: Neuroblastoom (NB) is die tweede mees gediagnoseerde soliede tumor by kinders in hoëinkomstelande (HIL’e). Tog word die voorkoms daarvan in lae- en middelinkomstelande (LMIL’e) nie akkuraat beskryf nie. Die diagnostiese uitdaging, sowel as beperkte behandelingsmetodes, lei dus tot swak uitkomste in LMIL’e. Hierdie PhD dissertasie ondersoek die behandeling van NB in Siud Afrika ten einde die algehele oorlewingsyfer (AO) te verbeter. Deur van data tussen 2000 en 2016 van die Suid Afrikaanse Kinderkanker Studie Groep se Tumor Register gebruik te maak, was die voorkomssyfer van NB in Suid-Afrika as 1,74 tot 2,6 gevalle per miljoen kinders bereken, wat veel laer was as die aangemelde 10,4 gevalle per miljoen kinders in HIL’e. Suid-Afrika het ’n hoër getal pasiënte met hoërisiko- (HR-)tumore (75,6%), hoofsaaklik vanweë gevorderde siekte (70%). Die AO oor twee jaar het was uitstekend vir uiters laerisiko- (ULR-) (94,1%) en laerisiko- (LR-)siekte (81,6%), aanvaarbaar vir matigerisiko- (MR-) (66,7%), maar sleg vir HR-siekte (27,6%) (p<0,001, 95% CI). Beperkings in risikostratifikasie het ingesluit die klein aantal tumore wat vir MYCN getoets is (38,4%), met meer as die helfde met MYCN-amplifikasie (54%), en die onvermoë om NB-verwante genetiese kenmerke te bepaal.
Verskeie behandelingsprotokolle was gebruik deur die verskillende kinderkanker eenheide in Suid Afrika gedurende hierdie periode (200-2014) en dit was getoon dat die OPEC/OJEC-regimen (karboplatien, sisplatien, etoposied, siklofosfamied en vinkristien) die grootste voordeel vir HR-NB inhou wat toksisiteit en metastatiese remissiesyfers betref. Ferritien het waarde om die metastatiese algehele-remissiesyfer te voorspel, terwyl LDH by die voorspelling van die AO oor twee jaar waardevol was en kan albei tumormerkers gebruik word as surogate van gesofistikeerde genetiese toetse en mIBG-skandering in omstandighede met beperkte hulpbronne. Soos wat in HIL’e bevind is, bly ouderdom ten tyde van diagnose, maar spesifiek die 18 maande afsnypunt, ’n beduidende prognostiese faktor. Met beperkte toegang tot outoloë stamseloorplantings, was die rol van sowel chirurgie as radioterapieondersoek en dit was bewys dat chirurgie die AO oor vyf jaar noemenswaardig verbeter terwyl tumorbestraling ’n effens beter AO oor vyf jaar getoon het (p<0.001, 95% CI). Verder het ons aangetoon dat daar noemenswaardige hulpbron verskille tussen provinsies bestaan wat aangespreek moet word om regverdige gesondheidsorg aan alle kinders te besorg volgens die Soud Afrikaanse Grondwet.
Met die implementering van ’n nasionale NB-protokol enkel arm kliniese studie in Suid-Afrika, met die doel om die benutting van nasionale hulpbronne te optimaliseer, was ‘n kompleks onderneming waartydens vele burokratiese uitdagings genavigeer moes word, maar kan as ‘n riglyn vir ander LMIL’e dien. Die proses om patiente vir die nasionale NB kliniese studie in te win was was uitdagend as gevolg van beide COVID-19 pandemie en die onwilligheid om patiente met gevorderde siekte by die studie in te sluit. Egter, met respekvolle ondersoek en ‘n gees van samewerking, kan seldsame siektes soos neuroblastoom in Suid Afrika volgens ‘n nasionale behandelingsprotokol behandel word met die doel om die algemene oorlewing te verbeter en patiente te genees.Dutch SAMENVATTING: Neuroblastoom (NB) is de tweede, meest gediagnosticeerde solide tumor bij kinderen in ‘high-income countries’ (HIC), maar de incidentie is niet nauwkeurig beschreven in ‘low- and middle-income countries’ (LMIC's). De diagnostische problemen met de beperkte behandelingsmodaliteiten dragen bij aan een slechte prognose in LMIC’s. Dit proefschrift onderzoekt de behandelingsresultaten van NB in Zuid-Afrika met als doel de prognose te verbeteren. De data van het Tumor Register van de Zuid Afrikaanse Kinkerkanker Studie tussen 2000 en 2006 laten een incidentie van NB in Zuid-Afrika zien van 1,74-2,6 gevallen per miljoen kinderen, hetgeen lager is dan de 10,4 gevallen per miljoen kinderen die gerapporteerd worden in HIC. Zuid-Afrika heeft een groter aantal patiënten met hoog risico (HR) tumoren (75,6%), voornamelijk vanwege de gevorderde ziekte bij presentatie (70%). De 2-jaars ‘overal survival’ (OS) waren uitstekend bij zeer laag risico (VLR) (94,1%) en laag risico (LR) (81,6%), aanvaardbaar bij gemiddeld risico (IR) (66,7%), maar slecht bij HR-ziekte (27,6%) (p <0,001, 95% CI). Beperkingen in risicostratificatie waren onder meer, het lage aantal tumoren dat op MYCN werd getest (38,4%), met meer dan het helft (54%) MYCN geamplificeerd, en het onvermogen om NB-gerelateerde genetische kenmerken te bepalen.Tijdens de studie periode (2000-2014) werden meerdere behandelingsprotocollen door verschillende pediatrische oncologie-eenheden gebruikt en bleek het OPEC/OJEC-regime (carboplatine, cisplatine, etoposide, cyclofosfamide en vincristine) de meeste voordelen te bieden met betrekking tot de toxiciteit en tumorremissie bij HR-NB. Ferritine blijkt belangrijk te zijn bij het voorspellen van het percentage van complete remissie, terwijl LDH van waarde is bij het voorspellen van tweejarige OS. Beiden zijn geschikte tumormarkers om te gebruiken als surrogaten voor geavanceerde genetische tests en mIBG-scans in de context van beperkte middelen. Leeftijd bij diagnose, met name de 18-maanden ‘cut-off’, is een belangrijke prognostische factor zoals in HIC's.Gezien de beperkte toegang tot autologe stamceltransplantaties, werden de rollen van zowel chirurgie als radiotherapie bij HR ziekte bestudeerd, en blijkt de vijfjarige OS significant te verbeteren met chirurgie en marginaal met radiotherapie (p<0.001, 95% CI). Bovendien blijken er verschillen in de gezondheidszorg voor neuroblastoom in de verschillende provincies in Zuid-Afrika te bestaan en deze zouden moeten worden aangepakt om te zorgen voor een rechtvaardige gezondheidszorg voor alle kinderen volgens de Zuid-Afrikaanse grondwet. De implementatie van de nieuw ontwikkelde nationale NB klinisch studie in Zuid-Afrika, aangepast aan de beschikbare nationale middelen, was een complex proces met grote bureaucratische uitdagingen die moesten worden overwonnen. Toch zou het proces als richtlijn kunnen dienen voor soortgelijke processen in LMIC's. De rekrutering van patiënten voor de nationale NB klinische studie bleek moeilijk te zijn vanwege zowel de COVID-19 pandemie als de onwil om patiënten in een gevorderd stadium voor klinische studies te werven. Met zorgvuldig onderzoek en in een samenwerkingsgeest zouden zeldzame ziekten zoals neuroblastoom in Zuid-Afrika echter kunnen worden behandeld met behulp van nationale managementprotocollen, gericht op het verminderen van de morbiditeit en mortaliteit.Doctora
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Management of neuroblastoma in limited-resource settings
Full text linkAbstract: BACKGROUND Neuroblastoma (NB) is a heterogeneous disease with variable outcomes among countries. Little is known about NB in low- and middle-income countries (LMICs). AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries (HICs). METHODS PubMed, Global Health, Embase, SciELO, African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB, LMICs and outcomes. Only English language manuscripts and abstracts were included. A descriptive review was done, and tables illustrating the findings were constructed. RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available. The disease characteristics varied among countries for the following variables: sex, age at presentation, MYCN amplification, stage and outcome. LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs. Implementation of evidence-based treatment protocols was still a barrier to care. Many socioeconomic variables also influenced the diagnosis, management and follow-up of patients with NB. CONCLUSION Patients presented at a later age with more advanced disease in LMICs. Management was limited by the lack of resources and genetic studies for improved NB classification. Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources
The multidisciplinary approach to ovarian tumours in children and adolescents
No full textAbstract: Ovarian tumours in children and adolescents are rare diseases. Although the majority of tumours are benign, the diagnosis and management present various challenges that require a wide range of expertise. The multidisciplinary team ensures not only accurate diagnosis and correct and minimally invasive management, but also minimal psychological impact and the preservation of fertility. This article outlines the multidisciplinary team approach to ovarian masses in children and adolescents. The team includes paediatric oncologists, gynaecological surgeons, pathologists, radiologists, fertility experts, geneticists and psycho-social services. (C) 2019 Elsevier B.V. All rights reserved
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