High-dose methotrexate (HD MTX) is critical for treating pediatric malignancies such as acute lymphoblastic leukemia and neuro-carcinoma. However, its significant toxicity due to drug accumulation poses substantial risks. This retrospective study assesses the impact of demographic factors on MTX toxicity and clearance in pediatric oncology patients. Patient records from Saint Mary Hospital were analyzed, focusing on two MTX administration protocols: a 24-hour infusion followed by alkaline hydration and a 4-hour infusion followed by alkaline hydration. We hypothesize that factors such as age, body surface area (BSA), and body mass index (BMI) are associated with MTX clearance and toxicity. The study found no significant difference in clearance between genders, but females exhibited higher toxicity rates. Ethnicity comparisons showed Caucasians had the fastest clearance, followed by Hispanics, African Americans, and others, with Hispanics experiencing the highest toxicity rates. Patients with a BSA of less than one had a lower risk of delayed clearance, although toxicity levels were similar across BSA groups. BMI analysis indicated that patients with a BMI over 25 were at a higher risk of toxicity. Taken together, these findings suggest the need for personalized treatment plans in pediatric oncology to enhance therapeutic efficacy and reduce adverse effects. Future research should expand the sample size and develop a risk stratification guideline to identify patients suitable for outpatient treatment.

A mucosite bucal (MB) é uma complicação comum no tratamento do câncer e o desenvolvimento de intervenções efetivas para sua prevenção e tratamento são vistos como prioridade nos cuidados de suporte ao paciente oncológico. O objetivo do presente estudo foi investigar fatores de risco relacionados à incidência de mucosite bucal em pacientes submetidos a transplante de células progenitoras hematopoiéticas (TCPH) e em pacientes oncológicos pediátricos. Foram realizados dois estudos: o primeiro analisando a relação entre a incidência de mucosite bucal e o estado de saúde bucal, neutropenia, leucopenia e níveis de IL-1β em pacientes submetidos ao TCPH; e, o segundo, avaliando a incidência de mucosite bucal em pacientes oncopediátricos submetidos a diferentes protocolos quimioterápicos e sua relação com toxicidade hematológica, hepática e renal. Estudo 1: Foram avaliados 54 pacientes submetidos ao TCPH coletados dados demográficos e de à história médica foram coletados. Todos os pacientes foram avaliados quanto a saúde bucal através da análise do índice de placa (IP), índice gengival (IG), número de dentes cariados, perdidos e obturados (CPOD) e exame da mucosa bucal. Todos os pacientes receberam tratamento dentário e orientações de higiene bucal prévio bem como, fotobiomodulação (FBM) com laser de diodo InGaAlP como protocolo preventivo para mucosite bucal. Os pacientes foram avaliados diariamente desde o condicionamento ate o final do transplante. Avaliações de mucosite bucal, níveis de neutrófilos e leucócitos e análise de IL-1β foram realizados nos períodos de condicionamento, D+3 e D+8. Os pacientes que apresentaram gengivite severa anterior ao condicionamento para o transplante e que apresentaram neutropenia grave e leucopenia mostraram associação com o desenvolvimento OM. Os pacientes com mucosite bucal apresentaram níveis mais baixos de IL-1β. Estudo 2: Foram acompanhados 172 ciclos de quimioterapia realizados em 40 pacientes pediátricos. Dados de toxicidade hematológica (níveis de plaquetas, leucócitos, neutrófilos e hemoglobina), hepática (níveis de bilirrubina, TGO, TGP) e renal (creatinina e uréia) nos períodos D1, D5, D10 e D15 foram coletados. Avaliação do grau de mucosite bucal foi realizado diariamente a partir de D1 até D15. Os pacientes que desenvolveram mucosite receberam FBM 3 vezes por semana como tratamento. Os resultados mostraram que a mucosite bucal em pacientes oncológicos pediátricos tem relação com o tipo de protocolo quimioterápico utilizado, com a diminuição nos níveis de plaquetas, leucócitos e hemoglobina bem como, com o aumento dos níveis de bilirrubina. Os níveis de plaquetas e de bilirrubina podem ser considerados como fatores de risco para predizer o desenvolvimento de mucosite bucal. Conclui-se que ambos os trabalhos vieram a contribuir para a elucidação de fatores envolvidos no desenvolvimiento de mucosite bucal em pacientes submetidos ao TCPH e em pacientes oncopediátricos. / Oral mucositis (OM) is a common complication in cancer treatment. The development of effective interventions for prevention and treatment are seen as priority in supportive care cancer patients. The aim of this study was to investigate risk factors related to the incidence of oral mucositis in patients undergoing to hematopoietic stem cells transplantation (HSCT) and in pediatric oncology patients. Two studies were performed: the first analyzing the relationship between oral mucositis incidence with oral health status, neutropenia, leukopenia, and IL-1β levels in patients undergoing to HPCT; and the second, evaluating the incidence of oral mucositis in pediatric oncological patients undergoing to different chemotherapy protocols and their relationship with toxicity haematological, of liver and of kidney. Study 1: A total of 54 patients undergoing to HSCT were collected demographic data and medical history. All patients were evaluated for the oral health through plaque index (PI), gingival index (GI), number of decayed, missing and filled (DMF) and oral mucosa examination. All patients received prior dental and oral hygiene as well as photobiomodulation (PBM) InGaAlP diode laser as a preventive protocol for oral mucositis. Patients were evaluated daily from the conditioning until the end of transplantation. Reviews of oral mucositis, neutrophil ans leukocytes levels and IL- 1β analysis were performed in periods of conditioning, D+3 and D+8. Patients with previous severe gingivitis to conditioning for transplantation and who had severe neutropenia and leukopenia showed association with OM development. The oral mucositis patients had lower levels of IL-1β. Study 2: Wewre analyzed a total of 172 cycles of chemotherapy conducted in 40 oncological pediatric patients. Haematological toxicity data (levels of platelets, leukocytes, neutrophils, and hemoglobin), liver (bilirubin, GOT, GPT) and renal (creatinine and urea) in the periods D1, D5, D10 and D15 were collected. oral mucositis grade evaluation was performed daily from D1 to D15. Patients who developed oral mucositis received three times a week PBM as treatment. The results showed that oral mucositis in pediatric oncology patients is related to the type of chemotherapy protocol used with the decrease in the levels of platelets, leucocytes and hemoglobin as well as with the increase of the bilirubin level. The levels of platelets and bilirubin may be considered as risk factors to predict the development of oral mucositis. We conclude that both studies contributed to the elucidation of factors involved in the development of oral mucositis in patients undergoing HSCT and pediatric oncology patients.

Made available in DSpace on 2014-12-17T15:38:50Z (GMT). No. of bitstreams: 1 Silvia RSMP.pdf: 485662 bytes, checksum: c0e1bb8853ddea493b71396d1c9a5b2a (MD5) Previous issue date: 2004-04-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Cancer goes on to be a frightening disease by humanity, simetimes,it is considered as death, suffering and stigma synonym. Occurring at childhood, this meaning seems to acquire a more intense conotation, having in view of the perplexity and godliness feeling in the presence of the precocity of events, nearly always associated to the death. A psychologist co-existence with the cancer children is going acquiring, thus, a permeated sense by incognitas , fears and fantasy, which raised us the following question: how does the psychologist that answers children with cancer lives this experience? Therefore, the aim this research was to understand this co-existence experience. Our theoretical perspective comes from an existencial fenomenology and, more specifically, the Humanistic Approach and Martin Heidegger Existencial Ontology. The metodology is qualitative of phenomenological character. The access instrument to the experience was the narrative, such as purpose by Walter Benjamin. They were carried out nine semi-open interviews with psychologists who work on pediatric oncology services of Natal-RN city. Such interviews were recorded in cassette, transcripted and later, re-educated. These interviews were recorded, transcribed and later on edited with the help of the interviewee and turned into a text. The narrative comprehension was carried out on Heidegger Existencial Ontology, on dada exaustive reading and the clipping of indicative passages of experience sense of being psychologist on this area. The research suggests that the experience is oriented of clinic kowing-doing, being crossed by implications of key thematics which indicate the care as central ontologic element that orientates the way as these professionals come being in the world in association with the client?le. Besides, the caring experience of these children acquire the sense of true living experience, since the cancer undoes the immortality illusion, launching the psychologist to his/her condition of being to the death and with that, calling him/her the authenticity. Is is only not dealt with to experience the anguish and the death imminence, but above all, re-meaning them in favour of a continual learning, of quality answering , besides other possibilities. Working with child cancer brings news perspectives and world views, making the psychologist a more human people and sensitive to the distracted needs. And we believe that, regardless of area which actuates, being psychologist is a particular way which choose to be citizen. Is is a project that will be delimited by society, history and culture and after all, by us like human being. Therefore, we understand that the results this research suggest the discussed thematic deepening on this intervention field in order to new sense possibilities can arise giving origin to other reflections about the clinical practice, the professional formation in Psychology and other possible developments / O c?ncer continua a ser uma doen?a temida pela humanidade; n?o raro, ? considerado como sin?nimo de morte, sofrimento e estigma. Ocorrendo na inf?ncia, esse significado parece adquirir uma conota??o ainda mais intensa, tendo em vista o sentimento de piedade e perplexidade dos adultos diante da precocidade do evento quase sempre associado ? morte. A co-exist?ncia do psic?logo com a crian?a portadora de c?ncer,vai adquirindo, assim, um sentido permeado por inc?gnitas, medos e fantasias, que nos suscitou o seguinte questionamento: como o psic?logo que atende crian?as com c?ncer vivencia esta experi?ncia? O objetivo desta pesquisa foi, portanto, compreender esta experi?ncia de co-exist?ncia. Nossa perspectiva te?rica adv?m da fenomenologia existencial e, mais especificamente, da Abordagem Centrada na Pessoa e da Ontologia Existencial de Martin Heidegger. A metodologia ? qualitativa, de car?ter fenomenol?gico. O instrumento de acesso ? experi?ncia foi a narrativa, tal como proposta por Walter Benjamin. Foram realizadas nove entrevistas semi-abertas com psic?logas que trabalham nos servi?os de oncologia pedi?trica da cidade do Natal-RN. Tais entrevistas foram gravadas em fitas cassete, transcritas, e posteriormente, literalizadas. A compreens?o das narrativas foi realizada com base na ontologia heideggeriana, na leitura exaustiva dos dados e no recorte de trechos indicativos do sentido da experi?ncia de ser psic?logo nessa ?rea. A pesquisa sugere que a experi?ncia ? norteadora do saber-fazer cl?nico, sendo atravessada pelas implica??es de tem?ticas-chaves que indicam o cuidado como elemento ontol?gico central que orienta o modo como estes profissionais v?m-sendo-no-mundo, juntamente com sua clientela. Al?m disso, a experi?ncia de cuidar dessas crian?as adquire o sentido de verdadeira li??o de vida, uma vez que o c?ncer desfaz a ilus?o de imortalidade, lan?ando o psic?logo ? sua condi??o de ser-para-a-morte, e com isso, convocando-o a autenticidade. N?o se trata apenas de vivenciar a ang?stia e a imin?ncia de morte, mas, sobretudo, de ressignific?-las em prol de um aprendizado cont?nuo, de atendimentos de qualidade, dentre outras possibilidades. Trabalhar com c?ncer infantil traz novas perspectivas e vis?es de mundo, fazendo do psic?logo uma pessoa mais humana e sens?vel ?s necessidades alheias. E acreditamos que independente da ?rea de atua??o, ser psic?logo ? uma maneira particular que escolhemos para ser cidad?o. ? um projeto que ser? delimitado pela sociedade, pela hist?ria e pela cultura, e enfim, por n?s enquanto seres-no-mundo. Por isso, entendemos que os resultados desta pesquisa sugerem o aprofundamento das tem?ticas discutidas neste campo de interven??o, a fim de novas possibilidades de sentido possam emergir, dando margem a outras reflex?es sobre a pr?tica cl?nica, a forma??o profissional em Psicologia, dentre outros poss?veis desdobramentos

Made available in DSpace on 2014-12-17T15:39:05Z (GMT). No. of bitstreams: 1 DeboraSLS_DISSERT.pdf: 842349 bytes, checksum: edfd0464865223ade8a750fe80589852 (MD5) Previous issue date: 2014-07-11 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The present study investigated the impact of the treatment modalities of Acute Lymphoblastic Leukemia on neurocognitive abilities of children and adolescents survivors, aged between 6 and 16 years of age, accompanied in pediatric oncology sectors of public health services in the cities of Campina Grande-PB and Natal-RN. The study included 52 children, 13 of these being children and adolescents diagnosed with leukemia and 39 healthy children matched in relation to the study group considering gender, age, school type and level of maternal education. Later the group of children with leukemia was subdivided into two subgroups depending on treatment modality which were submitted: Group 1A (only chemotherapy) and 1B (chemotherapy and radiotherapy). All participants were subjected to a battery of neuropsychological tests that investigated the following neurocognitive abilities: intellectual ability, memory system, attention, visuospatiality and visuoconstruction, processing speed and executive functions. Data were analyzed using descriptive and inferential measurements with the aid of the U test of Mann-Whitney and T test, considering the influence of the variables: sex, age at diagnosis, time since completion of treatment and level of schooling mothers, on the performance of children. Overall, it is concluded that the illness and the treatment of acute lymphoblastic leukemia significantly favors the emergence of cognitive deficits, particularly in terms of visuospatial skills, and executive skills visoconstrutivas. In turn, the treatment modality of radiotherapy is associated with the presence of more severe deficits, highlighting the significant impact on the speed of information processing. It is hoped that the results presented here will contribute to a better understanding of the nature and extent of neurocognitive effects arising ALL treatment / O presente estudo investigou o impacto das modalidades de tratamento da Leucemia Linf?ide Aguda sobre as habilidades neurocognitivas de crian?as e adolescentes sobreviventes, com faixa et?ria entre 6 e 16 anos de idade, acompanhados nos setores de oncologia pedi?trica de servi?os p?blicos de sa?de das cidades de Campina Grande- PB e Natal-RN. Participaram deste estudo 52 crian?as, sendo destas 13 crian?as e adolescentes diagnosticados com leucemia e 39 crian?as saud?veis pareadas em rela??o ao grupo de estudo considerando-se o sexo, idade, tipo de escola e n?vel de escolaridade materna. Posteriormente o grupo de crian?as com leucemia foi subdividido em dois subgrupos em fun??o da modalidade de tratamento as quais foram submetidos: Grupo 1A (exclusivamente tratamento quimioter?pico) e 1B (tratamento quimioter?pico e radioter?pico). Todos os participantes foram submetidos ? bateria de testes neuropsicol?gicos que investigou as seguintes habilidades neurocognitivas: capacidade intelectiva, sistema mnem?nico, aten??o, visoespacialidade e visoconstru??o, velocidade de processamento e fun??es executivas. Os dados foram analisados atrav?s de medidas descritivas e inferenciais com o aux?lio do Teste U de Mann-Whitney e do Teste t, considerando-se a influ?ncia das vari?veis: sexo, idade ao diagn?stico, tempo decorrido desde o t?rmino do tratamento e n?vel de escolariza??o das m?es, sobre o desempenho das crian?as. De forma geral, conclui-se que o adoecimento e o tratamento da leucemia linfoide aguda favorece significativamente o surgimento de d?ficits cognitivos, em especial em termos de habilidades visoespaciais, visoconstrutivas e habilidades executivas. Por sua vez, a modalidade de tratamento da radioterapia est? associada ? presen?a de d?ficits mais severos, com destaque para o impacto significativo sobre a velocidade no processamento da informa??o. Espera-se que os resultados ora apresentados venham a contribuir para uma melhor compreens?o acerca da natureza e da extens?o dos efeitos neurocognitivos advindos do tratamento da LLA

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-10-10T14:41:56Z No. of bitstreams: 1 Patrícia Marinho Gramacho.pdf: 894548 bytes, checksum: 14b172ac7ae7bd51991d78d09ea301e1 (MD5) / Made available in DSpace on 2017-10-10T14:41:56Z (GMT). No. of bitstreams: 1 Patrícia Marinho Gramacho.pdf: 894548 bytes, checksum: 14b172ac7ae7bd51991d78d09ea301e1 (MD5) Previous issue date: 2011-08-01 / The real aesthetics of Gaston Bachelard is based on belief in a primitive human feeling formed from primordial organic interests, called "hormones of the imagination" - water, air, earth and fire, which characterize the material and dynamic imagination ontogenic capacity, responsible for the simultaneous pregnancy of man and the world. This paper aims to describe the pleasant interface approach the child in the process of hospitalization in a Pediatric Oncology with the Children's Literature, emphasizing the human capacity to transform itself from the "wonder" arising out of this dynamic view of the imaginary. Were prepared three chapters on the subject. The first two are theoretical, presenting the concept of imagination and material dynamics and their interrelationship with authors like. The third, empirical, includes comments on the use of four books for hospitalized children with specific emphasis to the presence of material elements - water, air, earth and fire - contained therein. Despite sharing to ensure that the images should not be studied in fragments, were presented the comments of every book into separate parts for better visualization of the chosen book and you can understand how each work influences the child's imagination. It remained thus the reliability of care in the transcription experienced by four specific children, keeping the representations relating to certain books. The representations related to the interactions established between the world and the world transformed by the stories, the fiction experienced as a possible easing of tensions hospital; literature enabling the experience of lightness by the expression of repressed feelings and chained to the repetition of history, as ensuring the continuity of life, despite repeated frustrations. Using the poetic-analysis Bachelard (Bachelard, 1988) and an operant view of psychoanalysis (Kon, 1996), enhances the possibility of creating unique realities in fiction, which are marked by the cultural heritage of each one. The results confirm the existence of a poetic vision of the child, captured by the possibility of making them believe this time of the eruption, the "wonder" provided for reading. / A estética concreta de Gaston Bachelard fundamenta-se na crença em um sentimento humano primitivo formado a partir de interesses orgânicos primordiais, chamados de “hormônios da imaginação” – a água, o ar, a terra e o fogo, que caracterizam a imaginação material e dinâmica, faculdade ontogênica, responsável pela gestação simultânea do homem e do mundo. Esta dissertação tem como objetivo descrever, a aproximação da relação prazerosa da criança em processo de hospitalização em uma Pediatria Oncológica, com a Literatura Infantil, ressaltando-se a capacidade humana de transformar-se a partir do “maravilhamento” advindo desta visão dinâmica do imaginário. Foram elaborados três capítulos sobre o tema. Os dois primeiros são de cunho teórico, apresentando-se o conceito de imaginação material e dinâmica e sua interrelação com autores afins. O terceiro, de caráter empírico, traz comentários sobre a utilização de quatro livros específicos junto às crianças hospitalizadas ressaltando-se a presença dos elementos materiais - água, ar, terra e fogo – neles contidos. Apesar de partilhar-se a certeza de que as imagens não devem ser estudadas em fragmentos, foram apresentados os comentários de cada livro em itens separados, para melhor visualização do livro escolhido e para que se possa entender como cada obra influencia o imaginário da criança. Manteve-se, assim, a fidedignidade na transcrição dos atendimentos vividos por quatro crianças específicas, mantendo-se as representações referentes a determinados livros. As representações relacionaram-se às interações entre o mundo estabelecido e o mundo transformado pelas histórias; à ficção vivenciada como uma possibilidade de alívio das tensões hospitalares; à literatura possibilitando a vivência da leveza pela expressão de sentimentos represados e à repetição encadeada da história, como uma garantia da continuidade da vida, apesar das frustrações sucessivas. Utilizando-se da poético-análise bachelardiana (BACHELARD,1988) e de uma visão operante da psicanálise (KON,1996), valoriza-se a possibilidade da criação de realidades singulares pela ficção,sendo estas marcadas pela herança cultural de cada um.Os resultados confirmam a existência de uma visão poética da criança, capturada pela possibilidade de fazê-las acreditar nesta irrupção do tempo ,ou seja, o “maravilhamento” proporcionado pela leitura.

Childhood cancer is the second leading cause of death in children aged 0-19 years. Research efforts to identify factors associated with or influencing this growing health problem are limited. The purpose of this research study was to examine, in reference to Louisiana during the period 2004-2010, the annual number of children diagnosed with cancer; the types of cancers; the possible effects of the environmental aftermath resulting from Hurricanes Katrina, Rita, and Gustav; and any correlation between environmental contaminants following these hurricanes with the number of children diagnosed with cancer. This study employed correlational quantitative methodology using archival data from the Louisiana Tumor Registry that identified childhood cancer types and incidence for the years 2004-2010. Data were analyzed using logistic regression. Data analysis demonstrated statistically significant differences in the number of children diagnosed with cancer in Louisiana following Hurricanes Katrina, Rita, and Gustav, more specifically between the northern (p = .011) and southern (p =.013) regions. However, this may have no or limited practical significance. The sample size was large in this study, and given a large enough sample, regardless of insignificant population differences, almost any difference or any correlation will be statistically significant. The positive social change implication of this study is that it may lead to the development of preventive tools/measures for healthcare professionals and parents to help reduce childhood cancers associated with exposure to adverse environmental factors.

Syftet med denna systematiska litteraturstudie som inkluderar 18 artiklar, har varit att belysa vilka nutritionsstöd som kan förebygga och behandla malnutrition hos barn med cancer samt vilka omvårdnadsbehov som finns i samband med nutritionsbehandling. Resultatet visade att barn med cancer som behandlas med strålning och/eller cytostatika ofta drabbas av olika biverkningar som påverkar nutritionen. Cirka 46 % av barnen utvecklade malnutrition. Näringsintaget försämrades ofta på grund av biverkningarna vilket fick till följd att behandlingen försämrades samt tillväxt och utveckling påverkades negativt. Olika sätt fanns för att upprätthålla gott nutritionsstatus. Oralt intag förordades för att upprätthålla mag- tarmkanalens struktur och funktion. Alternativ för kostbehandling när barnet inte klarade att inta oral kost var nasogastrisk sond (NS), Perkutan Endoskopisk Gastrostomi (PEG) och Total Parenteral Nutrition (TPN). NS visade sig vara relativt biverkningsfritt och ett alternativ att tillgå under kortare nutritionsbehandlingar. PEG var ett gott alternativ med relativt få biverkningar då barnet behöver nutritionsstöd under längre tid. TPN var ett alternativ enbart då barnet inte kunde äta relaterat till bristande upptag i mag- tarmkanalen. Försämrat näringsintag påverkade barnets livskvalitet. Familjen påverkades genom att ätandet var en stark källa till konflikt mellan barnet och föräldrarna. Det var viktigt att barnet och familjen fick stöd i barnets förmåga att kunna äta samt att erbjudas näringsrik kost. Bedömning av nutritionsstatus och dokumentation av oralt intag, parenteralt intag och effekter av nutritionsbehandlingen var av stor vikt för att kunna ge barnet optimal omvårdnad.

The most common form of childhood cancer is Acute Lymphoblastic Leukemia (ALL). Patients treated for ALL may experience short- and long-term physiological and cognitive effects due to treatment. However, delayed emotional and behavioral effects in pediatric survivors, as well as risk-factors that may make them more susceptible to developing problems with psychological and behavioral functioning are less understood. Studies investigating pediatric survivors have demonstrated that negative emotional and behavioral late effects can and do occur (Hobbie et al., 2000; Buizer et al. 2006; Novakovic et al., 1996; Mulhern, Wasserman, Friedman, & Fairclough, 1989), and it has been purported that survivors experience higher rates of depression, anxiety and low self-esteem (Koocher, O’Malley, Gogan, & Foster, 1980; Kazak, 1994). Anxiety in particular, has been identified as one of the longest lasting psychological sequelae of cancer (Kazak, 1994). Still, the data on long-term psychological sequelae is mixed, with some studies suggesting healthy, long-term, psychological adjustment (Brown et al., 1992; Fritz, Williams & Amylon, 1988; Greenberg, Kazak, & Meadows, 1989). This pilot study attempted to investigate emotional and behavioral late effects of cancer as reported by survivors and their caregivers on the Behavior Assessment System for Children, Second Edition (BASC-2). This study also investigated potential risk factors that made it more likely to develop emotional and behavioral late-effects. This study hypothesized that females, those undergoing high intensity chemotherapy, and those starting chemotherapy at an earlier age, would report significantly more internalizing and externalizing problems. Analysis revealed significant differences in reporting of anxiety, depression, attention and hyperactivity symptoms combined based on the age when treatment started. No other significant findings were uncovered; however, in an effort to provide directions for future research, patterns in the data were examined by comparing overall means on BASC-2 subscales. For example, females reported more hyperactive symptoms than males. In general, individuals who started treatment at younger ages reported more difficulty with emotional and behavioral functioning. Additionally, males and females adaptive behavior fell within normal limits. Overall, no BASC-2 mean scores were in the at-risk or clinically significant range of impairment suggesting adequate emotional, behavioral and adaptive functioning overall. / text

A mucosite bucal (MB) é uma complicação comum no tratamento do câncer e o desenvolvimento de intervenções efetivas para sua prevenção e tratamento são vistos como prioridade nos cuidados de suporte ao paciente oncológico. O objetivo do presente estudo foi investigar fatores de risco relacionados à incidência de mucosite bucal em pacientes submetidos a transplante de células progenitoras hematopoiéticas (TCPH) e em pacientes oncológicos pediátricos. Foram realizados dois estudos: o primeiro analisando a relação entre a incidência de mucosite bucal e o estado de saúde bucal, neutropenia, leucopenia e níveis de IL-1β em pacientes submetidos ao TCPH; e, o segundo, avaliando a incidência de mucosite bucal em pacientes oncopediátricos submetidos a diferentes protocolos quimioterápicos e sua relação com toxicidade hematológica, hepática e renal. Estudo 1: Foram avaliados 54 pacientes submetidos ao TCPH coletados dados demográficos e de à história médica foram coletados. Todos os pacientes foram avaliados quanto a saúde bucal através da análise do índice de placa (IP), índice gengival (IG), número de dentes cariados, perdidos e obturados (CPOD) e exame da mucosa bucal. Todos os pacientes receberam tratamento dentário e orientações de higiene bucal prévio bem como, fotobiomodulação (FBM) com laser de diodo InGaAlP como protocolo preventivo para mucosite bucal. Os pacientes foram avaliados diariamente desde o condicionamento ate o final do transplante. Avaliações de mucosite bucal, níveis de neutrófilos e leucócitos e análise de IL-1β foram realizados nos períodos de condicionamento, D+3 e D+8. Os pacientes que apresentaram gengivite severa anterior ao condicionamento para o transplante e que apresentaram neutropenia grave e leucopenia mostraram associação com o desenvolvimento OM. Os pacientes com mucosite bucal apresentaram níveis mais baixos de IL-1β. Estudo 2: Foram acompanhados 172 ciclos de quimioterapia realizados em 40 pacientes pediátricos. Dados de toxicidade hematológica (níveis de plaquetas, leucócitos, neutrófilos e hemoglobina), hepática (níveis de bilirrubina, TGO, TGP) e renal (creatinina e uréia) nos períodos D1, D5, D10 e D15 foram coletados. Avaliação do grau de mucosite bucal foi realizado diariamente a partir de D1 até D15. Os pacientes que desenvolveram mucosite receberam FBM 3 vezes por semana como tratamento. Os resultados mostraram que a mucosite bucal em pacientes oncológicos pediátricos tem relação com o tipo de protocolo quimioterápico utilizado, com a diminuição nos níveis de plaquetas, leucócitos e hemoglobina bem como, com o aumento dos níveis de bilirrubina. Os níveis de plaquetas e de bilirrubina podem ser considerados como fatores de risco para predizer o desenvolvimento de mucosite bucal. Conclui-se que ambos os trabalhos vieram a contribuir para a elucidação de fatores envolvidos no desenvolvimiento de mucosite bucal em pacientes submetidos ao TCPH e em pacientes oncopediátricos. / Oral mucositis (OM) is a common complication in cancer treatment. The development of effective interventions for prevention and treatment are seen as priority in supportive care cancer patients. The aim of this study was to investigate risk factors related to the incidence of oral mucositis in patients undergoing to hematopoietic stem cells transplantation (HSCT) and in pediatric oncology patients. Two studies were performed: the first analyzing the relationship between oral mucositis incidence with oral health status, neutropenia, leukopenia, and IL-1β levels in patients undergoing to HPCT; and the second, evaluating the incidence of oral mucositis in pediatric oncological patients undergoing to different chemotherapy protocols and their relationship with toxicity haematological, of liver and of kidney. Study 1: A total of 54 patients undergoing to HSCT were collected demographic data and medical history. All patients were evaluated for the oral health through plaque index (PI), gingival index (GI), number of decayed, missing and filled (DMF) and oral mucosa examination. All patients received prior dental and oral hygiene as well as photobiomodulation (PBM) InGaAlP diode laser as a preventive protocol for oral mucositis. Patients were evaluated daily from the conditioning until the end of transplantation. Reviews of oral mucositis, neutrophil ans leukocytes levels and IL- 1β analysis were performed in periods of conditioning, D+3 and D+8. Patients with previous severe gingivitis to conditioning for transplantation and who had severe neutropenia and leukopenia showed association with OM development. The oral mucositis patients had lower levels of IL-1β. Study 2: Wewre analyzed a total of 172 cycles of chemotherapy conducted in 40 oncological pediatric patients. Haematological toxicity data (levels of platelets, leukocytes, neutrophils, and hemoglobin), liver (bilirubin, GOT, GPT) and renal (creatinine and urea) in the periods D1, D5, D10 and D15 were collected. oral mucositis grade evaluation was performed daily from D1 to D15. Patients who developed oral mucositis received three times a week PBM as treatment. The results showed that oral mucositis in pediatric oncology patients is related to the type of chemotherapy protocol used with the decrease in the levels of platelets, leucocytes and hemoglobin as well as with the increase of the bilirubin level. The levels of platelets and bilirubin may be considered as risk factors to predict the development of oral mucositis. We conclude that both studies contributed to the elucidation of factors involved in the development of oral mucositis in patients undergoing HSCT and pediatric oncology patients.

A mucosite bucal (MB) é uma complicação comum no tratamento do câncer e o desenvolvimento de intervenções efetivas para sua prevenção e tratamento são vistos como prioridade nos cuidados de suporte ao paciente oncológico. O objetivo do presente estudo foi investigar fatores de risco relacionados à incidência de mucosite bucal em pacientes submetidos a transplante de células progenitoras hematopoiéticas (TCPH) e em pacientes oncológicos pediátricos. Foram realizados dois estudos: o primeiro analisando a relação entre a incidência de mucosite bucal e o estado de saúde bucal, neutropenia, leucopenia e níveis de IL-1β em pacientes submetidos ao TCPH; e, o segundo, avaliando a incidência de mucosite bucal em pacientes oncopediátricos submetidos a diferentes protocolos quimioterápicos e sua relação com toxicidade hematológica, hepática e renal. Estudo 1: Foram avaliados 54 pacientes submetidos ao TCPH coletados dados demográficos e de à história médica foram coletados. Todos os pacientes foram avaliados quanto a saúde bucal através da análise do índice de placa (IP), índice gengival (IG), número de dentes cariados, perdidos e obturados (CPOD) e exame da mucosa bucal. Todos os pacientes receberam tratamento dentário e orientações de higiene bucal prévio bem como, fotobiomodulação (FBM) com laser de diodo InGaAlP como protocolo preventivo para mucosite bucal. Os pacientes foram avaliados diariamente desde o condicionamento ate o final do transplante. Avaliações de mucosite bucal, níveis de neutrófilos e leucócitos e análise de IL-1β foram realizados nos períodos de condicionamento, D+3 e D+8. Os pacientes que apresentaram gengivite severa anterior ao condicionamento para o transplante e que apresentaram neutropenia grave e leucopenia mostraram associação com o desenvolvimento OM. Os pacientes com mucosite bucal apresentaram níveis mais baixos de IL-1β. Estudo 2: Foram acompanhados 172 ciclos de quimioterapia realizados em 40 pacientes pediátricos. Dados de toxicidade hematológica (níveis de plaquetas, leucócitos, neutrófilos e hemoglobina), hepática (níveis de bilirrubina, TGO, TGP) e renal (creatinina e uréia) nos períodos D1, D5, D10 e D15 foram coletados. Avaliação do grau de mucosite bucal foi realizado diariamente a partir de D1 até D15. Os pacientes que desenvolveram mucosite receberam FBM 3 vezes por semana como tratamento. Os resultados mostraram que a mucosite bucal em pacientes oncológicos pediátricos tem relação com o tipo de protocolo quimioterápico utilizado, com a diminuição nos níveis de plaquetas, leucócitos e hemoglobina bem como, com o aumento dos níveis de bilirrubina. Os níveis de plaquetas e de bilirrubina podem ser considerados como fatores de risco para predizer o desenvolvimento de mucosite bucal. Conclui-se que ambos os trabalhos vieram a contribuir para a elucidação de fatores envolvidos no desenvolvimiento de mucosite bucal em pacientes submetidos ao TCPH e em pacientes oncopediátricos. / Oral mucositis (OM) is a common complication in cancer treatment. The development of effective interventions for prevention and treatment are seen as priority in supportive care cancer patients. The aim of this study was to investigate risk factors related to the incidence of oral mucositis in patients undergoing to hematopoietic stem cells transplantation (HSCT) and in pediatric oncology patients. Two studies were performed: the first analyzing the relationship between oral mucositis incidence with oral health status, neutropenia, leukopenia, and IL-1β levels in patients undergoing to HPCT; and the second, evaluating the incidence of oral mucositis in pediatric oncological patients undergoing to different chemotherapy protocols and their relationship with toxicity haematological, of liver and of kidney. Study 1: A total of 54 patients undergoing to HSCT were collected demographic data and medical history. All patients were evaluated for the oral health through plaque index (PI), gingival index (GI), number of decayed, missing and filled (DMF) and oral mucosa examination. All patients received prior dental and oral hygiene as well as photobiomodulation (PBM) InGaAlP diode laser as a preventive protocol for oral mucositis. Patients were evaluated daily from the conditioning until the end of transplantation. Reviews of oral mucositis, neutrophil ans leukocytes levels and IL- 1β analysis were performed in periods of conditioning, D+3 and D+8. Patients with previous severe gingivitis to conditioning for transplantation and who had severe neutropenia and leukopenia showed association with OM development. The oral mucositis patients had lower levels of IL-1β. Study 2: Wewre analyzed a total of 172 cycles of chemotherapy conducted in 40 oncological pediatric patients. Haematological toxicity data (levels of platelets, leukocytes, neutrophils, and hemoglobin), liver (bilirubin, GOT, GPT) and renal (creatinine and urea) in the periods D1, D5, D10 and D15 were collected. oral mucositis grade evaluation was performed daily from D1 to D15. Patients who developed oral mucositis received three times a week PBM as treatment. The results showed that oral mucositis in pediatric oncology patients is related to the type of chemotherapy protocol used with the decrease in the levels of platelets, leucocytes and hemoglobin as well as with the increase of the bilirubin level. The levels of platelets and bilirubin may be considered as risk factors to predict the development of oral mucositis. We conclude that both studies contributed to the elucidation of factors involved in the development of oral mucositis in patients undergoing HSCT and pediatric oncology patients.