Universidad Francisco Marroquín

Adrenal leiomyomas are rare, benign tumors originating in the adrenal glands. They have a varied age of presentation, occur with a slight female predominance, and are typically unilateral, although bilateral cases can occur. Symptoms typically include abdominal or flank pain. This report presents a rare case of an 11-year-old male with disseminated molluscum contagiosum, diagnosed with bilateral adrenal leiomyomas. Imaging revealed large, heterogeneous adrenal masses, and the patient underwent successful adrenalectomy. This case underscores the rarity of adrenal leiomyomas in the pediatric population and highlights the critical role of imaging and surgical intervention in their management.

PURPOSE Clinical and histopathologic diagnosis of pediatric mature B-cell lymphomas (eg, Burkitt lymphoma [BL]) must be accurate to select appropriate risk-based treatment. The Central American Pediatric Hematology-Oncology Association (AHOPCA) in 2000 implemented standardized, resource-adapted treatments for these lymphomas. We evaluated the concordance of local histopathologic diagnoses through central review, determined the impact on therapy selection, and described the clinical characteristics and outcomes of pediatric patients with these lymphomas. We suggest recommendations to improve the accuracy of diagnoses. METHODS Pathology samples and reports were submitted by six AHOPCA sites to St Jude Children's Research Hospital for central review. The concordance of sample assessments was evaluated using three criteria: histologic diagnosis, morphology, and immunohistochemistry. Clinical characteristics, treatment, and outcomes were also analyzed. RESULTS Of the 68 eligible patients, 53 (78%) received an accurate pathologic diagnosis of BL. For nine (13%) patients, diagnoses changes with therapy implications were made upon central review, while in six patients, there was a minor disagreement with no therapy implications. Most (87%) patients presented with advanced disease. Detailed cellular features were absent in many reports, and immunohistochemistry was routinely performed at only one site. Of the 50 patients whose treatment data were reported, 44 (88%) completed therapy, five died during treatment, and one abandoned treatment. Treatment outcome was satisfactory: 3-year event-free survival was 74% (SE ± 11%), and overall survival was 73% (SE ± 11%). CONCLUSION Pathology laboratories in limited-resource hospitals and regions need further optimization to increase accurate diagnoses of mature B-cell lymphomas. Creating regional pathology networks will enhance diagnostic support. Despite resource limitations and advanced disease at presentation, the AHOPCA sites' adapted treatment strategies have improved patient outcomes.

This study explores public perceptions and the barriers to voluntary blood donation during the first year of the COVID-19 pandemic in Guatemala, a country with one of the lowest voluntary donation rates in Latin America. We additionally aimed to identify the population factors influencing blood donation behavior and to inform strategies for enhancing blood availability in the region. Between August and September 2020, an anonymous cross-sectional survey was conducted using purposive sampling. Respondents were asked about their donation history, awareness of donation processes, preferences, and barriers and motivators for blood donation. Data collection included quantitative and qualitative data. Comparative analyses by gender, age, and education level were performed and regression models were used to identify predictors of blood donation behavior. Thematic content analysis was applied to open-ended responses. Among 1141 respondents, 53.5% reported a history of previous blood donation, with the majority occurring via referred donations to family or friends (78.5%). Key factors such as male gender, older age, and higher education correlated with a higher likelihood of previous donation. Familiarity with donation centers and willingness to donate strongly influenced donation behavior. Despite 89% of never donors expressing willingness to donate, barriers like limited access to donation centers, insufficient information, and concerns over hygiene and safety were prevalent. This study highlights the significant public willingness to donate blood in Guatemala, but identified key barriers that must be addressed. Understanding these factors is essential for developing targeted initiatives to improve blood availability in Guatemala and across Latin America, particularly during health crises, such as the COVID-19 pandemic,.

Purpose High-quality graduate medical education programs are essential to expand the care available to children with cancer worldwide. The authors used the Education Program Assessment Tool (EPAT), a standardized tool for evaluating pediatric hematology/oncology (PHO) fellowship programs, to describe the impact of the Accreditation Council for Graduate Medical Education International (ACGME-I) accreditation process. Methods The EPAT is a comprehensive, validated tool for evaluating the elements of PHO fellowship programs. The authors used the EPAT in May 2018 and December 2023 to compare the pre-accreditation and post-accreditation status of the Unidad Nacional de Oncología Pediátrica (UNOP) PHO fellowship program. Results The authors used the EPAT to identify program gaps and to prioritize interventions to meet ACGME-I accreditation standards. Before accreditation, the overall score of the UNOP PHO fellowship program was 77.2%. The highest score was for Hospital Infrastructure (86.4%) and the lowest score was for Research (63.0%). After accreditation, the overall score was 88.3%. Eight of the 10 EPAT domains had higher post-accreditation scores, with a significant improvement in domain scores overall (P < 0.0001) (Fig. 2). In alignment with the improvement workstreams, the Educational Infrastructure and Evaluation domains had the greatest increases in scores (27% and 25%, respectively). Research continued to have the lowest score (75.9%), but this was improved by 13%. Conclusions This study provides quantitative data on the enhancement of a PHO fellowship program in a middle-income country after the process ACGME-I accreditation based on the improvement of EPAT scores. Additional analyses and evaluation tools are needed to identify strategies optimize training approaches and to meet the evolving accreditation standards for health care around the world.

ETV6::RUNX1 is the most common fusion gene in childhood acute lymphoblastic leukemia (ALL) associated with favorable prognosis, but the optimal therapy for this subtype remains unclear. Profiling the genomic and pharmacological landscape of 194 pediatric ETV6::RUNX1 ALL cases, we uncover two transcriptomic clusters, C1 (61%) and C2 (39%). Compared to C1, the C2 subtype features higher white blood cell counts and younger age at diagnosis, as well as better early treatment responses. Pharmacologically, C2 is more sensitive to thiopurines and prednisolone, partially explained by the enrichment of PAX5 deletions. Re-introducing PAX5 in ETV6::RUNX1 ALL of the C2 subtype converts its gene expression and drug resistance profile to C1, with partial blockade of G1 to S transition mediated by CDK6 expression. Our results point to molecular heterogeneity within ETV6::RUNX1 ALL linked to divergent drug responses, providing insights into the pathogenesis and therapeutic vulnerability of this common pediatric ALL subtype.

This case report highlights the rare presentation of an acute thoracic disc herniation in a 27-year-old male. Thoracic disc herniations are uncommon, accounting for less than 1% of all disc herniations, and acute presentations have scantly been recorded in literature. The patient, a mechanic, presented with a sudden onset of dorsal pain and bilateral lower limb weakness after lifting heavy equipment, leading to a sudden cease of most motor functions in the patient’s lower limbs. Magnetic resonance imaging revealed a severe T9/T10 herniation with significant spinal cord compression. Emergency surgical decompression via a right-sided transpedicular thoracic approach was performed, resulting in progressive neurological recovery. This case underscores the importance of early diagnosis, timely surgical intervention, and multidisciplinary management in achieving favorable outcomes for this rare condition.

Popliteal artery pseudoaneurysms are rare, especially from acupuncture-related trauma. We report a 67-year-old male with hypertension, diabetes, chronic kidney disease, and an abdominal aortic aneurysm (AAA), who developed a popliteal pseudoaneurysm after acupuncture. Imaging confirmed the pseudoaneurysm and a 55 mm AAA. Urgent surgical repair with a Gore-Tex graft led to a smooth recovery. This case emphasizes the vascular risks of acupuncture and the importance of early diagnosis, multidisciplinary care, and personalized follow-up in patients with complex comorbidities.

A 17-year-old female presented with a mass in the right nasal fossa and eye protrusion. Imaging revealed a large osseous mass originating from the right turbinates, causing exophthalmos without tissue invasion. A partial resection via the Caldwell–Luc approach was performed, but hemodynamic instability halted the procedure, leaving a residual mass. Histopathology confirmed an osseous lesion with osteoblasts in a hypocellular stroma. The patient required blood transfusions postoperatively due to significant blood loss, but recovered well with antibiotics and supplements and was discharged after mild nausea was managed.

There is currently a global shortage of healthcare professionals equipped to handle the rising burden of childhood cancer. St. Jude Global is an initiative to improve survival rates of children with cancer worldwide while improving access to quality care. One of the overriding goals of St. Jude Global is focused on education: the training of the clinical workforce needed to expand quality care for all children with cancer. Herein, we describe the St. Jude Global Academy (SJGA) and its programs. The three main workstreams of the SJGA are: clinical training programs, courses, and distance learning. St. Jude collaborates with eight institutions in seven low‐ and middle‐income countries to train pediatric subspecialists. Each year, approximately 20 new fellows start at these clinical training programs. To date, 92 specialists have been trained. The SJGA's courses create educational opportunities that provide a structured learning experience in key areas that are relevant to pediatric cancer care. To date, 1081 participants from 372 institutions in 84 countries have successfully completed these educational opportunities. Cure4Kids is the SJGA's distance learning platform. Over 9000 healthcare professionals in 177 countries use Cure4Kids. The platform receives 1400 visits and over 13,000 page views per day. The SJGA's multifaceted approach encompasses various disciplines and skills, providing healthcare professionals from around the world the skills to address the needs of children diagnosed with cancer in their respected institutions. These efforts are essential for building workforce capacity to improve outcomes.

We provide an empirical review of fiscal sustainability of Eurozone governments by using quarterly data on debt to Gross Domestic Product (GDP) and primary deficit to GDP over the period 1999 to 2010. We verify the conditions of fiscal sustainability, defined by the government’s present value borrowing constraint, by applying unit root tests that involve one, two, or multiple structural breaks. We select the best performing model of structural breaks and group Eurozone governments with respect to fiscal sustainability.

Nudix hydrolase 15 (NUDT15) deficiency is strongly associated with thiopurine‐induced myelosuppression. Currently, testing for NUDT15 deficiency is based on the genotyping of the most frequent and clinically characterized no‐function variants, that is, * 2 , * 3 and * 9 . The Hispanic/Latino‐predominant variant NUDT15 * 4 (p.R139H) is classified as “uncertain function” by the Clinical Pharmacogenetics Implementation Consortium, because of insufficient data to ascertain its clinical actionability. In this study, we evaluated the association of NUDT15 * 4 with mercaptopurine (6‐MP) tolerance in a retrospective cohort of 1,399 patients with acute lymphoblastic leukemia (ALL) of diverse ancestries. All patients were wildtype for thiopurine methyltransferase gene. Patients were treated with 6‐MP in the context of ALL frontline clinical trials. The tolerated dose of 6‐MP was used to assess drug toxicity during the maintenance phase of ALL therapy. Patients with NUDT15 * 1 /* 4 ( n = 16, all of whom self‐identified as Hispanic/Latino) tolerated a significantly lower dose of 6‐MP than did those with NUDT15 * 1 /* 1 : median [interquartile range] of 39.0 [21.2–52.8] mg/m ² , vs. 62.2 [47.9–71.6] mg/m ² , P value < 0.001. No patient homozygous for * 4 was detected. In a separate retrospective validation study, six patients were identified as having NUDT15 * 1 /* 4 by routine clinical pharmacogenetics testing and tolerated a 6‐MP median dose of 38.7 mg/m ² (IQR, 33.7–54.0), confirming the need for dose reduction attributed to the NUDT15 * 4 variant. These results point to the need to include NUDT15 * 4 in pharmacogenetics‐guided thiopurine dosing algorithms.

We introduce the quasi-vector autoregressive fractionally integrated (QVAR-FI) model. We apply QVAR-FI to climate data and introduce the fractionally integrated score-driven ice-age model. We use global sea ice volume, atmospheric carbon dioxide (CO 2) concentration, and Antarctic land surface temperature data from 798,000 to 1,000 years ago. We control for the eccentricity of the Earth's orbit, the obliquity of Earth, and the precession of the equinoxes (i.e. Milankovitch cycles). We estimate QVAR-FI using the maximum likelihood (ML) method for fractional integration parameters ∈ (−1/2, 1/2). The statistical and forecasting performances of QVAR-FI are superior to QVAR and VAR. The impulse response functions (IRF) for QVAR-FI capture better dynamic effects of the shocks than QVAR and VAR. We confirm, with more confidence than previous works for these data, that for the last 12,000-15,000 years when humanity influenced the Earth's climate (i.e. Anthropocene), the global sea ice volume forecasts are above the observed sea ice volume, the atmospheric CO 2 concentration forecasts are below the observed atmospheric CO 2 concentration, and the Antarctic land surface temperature forecasts are below the observed Antarctic land surface temperature, after controlling for natural forces of climate change due to orbital variables.

Infantile hemangiomas are the most common type of vascular tumors, affecting ~5% of infants within the first weeks of life. In rare instances, these tumors can lead to Kasabach–Merritt phenomenon (KMP), a life-threatening consumptive coagulopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and hypofibrinogenemia. In the present case, a 20-month-old patient is diagnosed with KMP. This case report highlights the challenges in diagnosis and management, reinforcing the importance of multidisciplinary approach.

In the following paper, we endorse the departure from traditional econometrics towards a more inclusive understanding of economic behavior. Humanomics, as championed by Vernon Smith and Bart Wilson, integrates cultural factors, transcending the limitations of quantitative models. We celebrate its potential for exploring emergent norms across diverse contexts and insights into philanthropy’s role in institution building. Offering a friendly critique of experimental economics, we advocate for a broader conversation among scholarly traditions. Our paper emphasizes the importance of embracing complexity and diversity in economic science, positioning humanomics as a valuable framework for interdisciplinary dialogue and inspiring scholars to explore new perspectives, thereby fostering an enlightened and open-minded academic community.

Background: 2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied. Methods: In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process. Results: A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings. Conclusions: Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.

Case-based diagnostic reasoning conferences, like morning reports, allow undergraduate medical trainees to practice diagnostic reasoning alongside senior clinicians. However, trainees have reported discomfort doing so. Peer-assisted learning offers an alternative approach. We describe the design, implementation, and evaluation of a virtual, student-only diagnostic reasoning conference that leverages peer-assisted learning. Student virtual morning report’s (VMR) design was informed by social and cognitive congruence and experience-based learning. We evaluated participant experiences using a survey focused on participant perceptions of Student VMR’s value, their methods for participation, and their preferences for Student VMR compared with VMR with more senior clinicians. 110 participants (28.9%) completed the survey. 90 participants (81.2%) reported that Student VMR was educational. Compared to VMR, participants reported being more likely to participate in Student VMR by turning on their video (50.0%), presenting a case (43.6%), verbally participating (44.5%), or participating in the chat (70.0%). Strengths included a safe learning environment to practice DR and the opportunity to engage with an international learning community. When asked whether they preferred Student VMR or non-Student VMR, most respondents (64.5%, 71/110) identified that they did not have a preference between the two. A student-focused DR conference may offer a valuable complement to, but not a replacement of, apprenticeship-based DR case conferences.

The article investigates a little‐known work titled De ponderibus et mensuris [On Weights and Measures] written by Juan de Mariana in 1599. It contains the embryo of his future monetary theories, and has other interesting aspects, not only juridical and historical but also epistemological. Significant points of convergence with the early modern mathematics and abacus tradition make it unique. Apart from its stylistic, pedagogical and technical originality, this work also appears as a watershed for the evolution of economic science, its language and methodology.

Explanatory models (EMs) are used in medical anthropology to characterize individual understandings of illness. This study investigated how interdisciplinary clinical interactions elicited caregiver EMs at a pediatric cancer center in Guatemala. This qualitative study included caregivers of 20 children with newly diagnosed cancer at Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala. UNOP’s diagnostic process includes social work intake, psychoeducation with a psychologist, and a diagnostic conversation with an oncologist and psychologist. Audio-recordings from the diagnostic process and a semi-structured interview were obtained, transcribed, and translated from Spanish. Transcripts were coded using a priori codes based on the five explanatory model (EM) components (occurrence, causation, pathophysiology, course of sickness, and treatment), as well as disease, and illness accounts. Thematic content analysis explored the EM framework as applied to diagnostic interactions between families and clinicians. All five components of the EM were addressed during the diagnostic process at UNOP. Clinicians, particularly psychologists, initiated conversation about the EM more than caregivers. When prompted, caregivers discussed all aspects of the EM but only rarely mentioned pathophysiology. Disease accounts were primarily described by clinicians, while caregivers used illness accounts to describe cancer causation. Clinicians validated existence of both disease and illness accounts. UNOP’s interdisciplinary team elicited families’ beliefs and facilitated in-depth discussion of all aspects of the EM, leading to a shared understanding of cancer and its treatment. Utilizing the EM framework in clinical practice may support culturally-competent pediatric cancer care.