Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

ABSTRACT Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment.

Efeito de vídeo educativo no comportamento de higiene bucal de pacientes hematológicos / Effects of an educational video on the oral hygiene of patients with hematologic disorders / Efecto de video educativo en el comportamiento de higiene bucal de pacientes hematológicos

Este estudo teve como objetivo avaliar a eficácia e a aceitação de um vídeo como estratégia de ensino da higiene bucal para pacientes com doenças hematológicas em tratamento quimioterápico. Trata-se de estudo quase experimental, tipo antes-depois, no qual foram incluídos 23 sujeitos. Depois de observada a técnica de higiene bucalhabitual, o paciente assistiu a um vídeo sobre este procedimento. Posteriormente, o sujeito realizou novamente a higienização bucal. Aplicou-se o teste t de "Student" pareado para comparar as médias de acertos dos passos desta técnica antes e após apresentação do vídeo. O desempenho na realização do procedimento foi superior após os sujeitos assistirem ao vídeo (p <0.0001), sendo que a utilização desta estratégia foi bem-aceita pelos pacientes. O vídeo sobre a técnica de higiene bucal mostrou-se eficaz para o ensino deste procedimento e foi bem aceito pelos pacientes. (ClinicalTrials.gov Identifier: NCT 01718002)

The current study aims at evaluating the effectiveness and acceptance of a video as a strategy for teaching oral hygiene to patients with hematologic disorders receiving chemotherapy. It is a quasi-experimental before and after study, composed of 23 subjects. After their routine oral hygiene routine was observed, patients watched a video about the procedure. Afterwards, the subjects carried out their oral hygiene once more. A paired student's t-test was used to compare the average of how many steps were performed correctly before and after the video presentation. Procedure performance was higher after watching the video (p <0.0001), being that the strategy was well accepted by patients. The oral hygiene video proved to be effective for the teaching of this procedure and was well accepted by patients. (ClinicalTrials.gov Identifier: NCT 01718002)

Estudio que objetivó evaluar la eficacia y aceptación de un video como estrategia de enseñanza de la higiene bucal en pacientes con enfermedades hematológicas en tratamiento quimioterápico. Estudio cuasi-experimental, tipo antes-después, en el que fueron incluidos 23 sujetos. Luego de observada la técnica de higiene bucal habitual, el paciente vio un video sobre dicho procedimiento. Posteriormente, el sujeto realizó nuevamente la higienización bucal. Se aplicó test t de Student pareado, para comparar los promedios de acierto de los pasos de esta técnica antes y después de la presentación del video. El desempeño en la realización del procedimiento fue superior luego de ver el video (p<0,0001), siendo que la utilización de esta estrategia fue bien aceptada por los pacientes. El video sobre la técnica de higiene bucal se mostró efectivo para la enseñanza del procedimiento y fue bien aceptado por los pacientes. (ClinicalTrials.gov Identifier: NCT 01718002)

Effect of hydroxyurea on thalassemia major and thalassemia intermedia in iranian patients

Hydroxyurea has been used in thatassemia major [T.M.] and thalassemia intermedia patients since 1994 with some success in different centers. The objective was to evaluate the effect and possible side effects of hydroxyurea in these patients. This was a descriptive study done in 2007 after nine years of initiation of Hydroxyurea. Medical records of 1050 patients were reviewed. Patients who had received hydroxyurea for at Least three continuous months were enrolled into the study. Clinical and laboratory data during six months before and six month after starting hydroxyurea were compared. Two hundred ninety seven patients were enrolled of these two hundred forty eight [83.8%] were thalassemia major and forty eight [16.2%] were thatassemia intermedia. Dose of hydroxyurea was 15.5 +/- 6.4mg/kg /day and duration was 5.2 +/- 2 years [ranging 0.5-9 years]. Transfusions were completely stopped in one hundred eleven [44.7%] of thalassemia major patients with a mean Hb of l0g/dl. After 22.5 +/- 18 months, using Desferal was stopped in sixty six [26.6%] patients. The reasons for stopping hydroxiurea were "ineffectiveness" in 20%, "poor compliance" in 12.4% and side effects in 13.4% of patients. The side effects were nausea, palpitation, transient leucopenia and transient raising of creatinin. Hydroxyurea is effective and safe in thalassemia major and thalassemia intermedia patients and saves them from side effects of blood transfusions

Bradicardia asociada al uso de talidomida en pacientes con enfermedades hematológicas: experiencia en una sola institución / Thalidomide-associated bradycardia in patients with hematologic diseases: A single institution experience

Thalidomide, an immunomodulatory and antiangio genie agent, is useful in the treatment of some hematologic and oncologic diseases. Up to 6.8% of thalidomide-treated patients present bradycardia. Herein the incidence of thalidomide-associated bradycardia in patients with hematologic diseases treated in a single institution is reported. In a 34-month period, 33 patients with different hematologic diseases (multiple myeloma [MM], 20; myelodysplastic syndrome, eight; Waldenstróm macroglobulinemia, two; non-Hodgkin's lymphoma, two; malignant histiocytosis, one) were treated with thalidomide. Of them, five (15.1%) had bradycardia, all with MM. Bradycardia was detected with a daily thalidomide dose ranging from 100 to 300 mg and the time patients received thalidomide before cardiac event went from one to 18 months. In all affected cases the electrocardiogram showed sinus bradycardia with cardiac frequency between 32 to 48 beats per minute. Time to normal cardiac beat recovery ranged from 12 to 21 days after thalidomide discontinuation. There were no fatalities due to thalidomide-associated bradycardia. It is concluded that: a) thalidomide-associated bradycardia was detected only in patients with MM, b) herein the incidence of bradycardia was higher as compared with other series, and c) in patients with MM thalidomide therapy must be prescribed with caution particularly in those with cardiovascular diseases of any etiology.

La talidomida, agente inmunomodulador y antiangiogénico, es útil en el tratamiento de enfermedades hematologicas y oncológicas. Los efectos adversos asociados al uso de talidomida son múltiples e incluyen bradicardia sinusal que se presenta hasta en 6.8% de los casos. En el presente estudio se informa la frecuencia de bradicardia asociada al uso de talidomida en pacientes con enfermedades hematologicas atendidos en una sola institución. En un lapso de 34 meses se encontró que 33 pacientes con diversos padecimientos hematológicos (mieloma múltiple [MM], 20; síndrome mielodisplásico, ocho; macroglobulinemia de Waldenstróm, dos; linfoma no Hodgkin, dos; histiocitosis maligna, uno) recibieron tratamiento con talidomida. De ellos, cinco (15.1%) presentaron bradicardia, todos con MM. La dosis de talidomida al momento de la bradicardia fue de entre 100 a 300 mg por día y el tiempo que recibieron el fármaco antes del evento osciló entre uno y 18 meses. El electrocardiograma mostró bradicardia sinusal en todos los casos con frecuencia cardiaca (FC) de entre 32 a 48 latidos por minuto. Suspendida la talidomida la FC se normalizó en todos los enfermos en un tiempo que osciló entre 12 a 21 días. Ninguno de los pacientes falleció por esta complicación. Se concluye que: a) la bradicardia asociada a talidomida se identificó sólo en pacientes con MM, b) la frecuencia de bradicardia en nuestra serie fue superior a la informada en otras y c) en MM el tratamiento con talidomida debe prescribirse con precaución en aquellos pacientes con algún padecimiento cardiovascular de cualquier etiología.

Inmunoglobulina intravenosa: sus aplicaciones / Intravenous immunoglobulin: its applications

Se realizó una revisión acerca de la inmunoglobulina intravenosa y sus aplicaciones, la cual es de valor en los pacientes con deficiencia de anticuerpos primaria, aunque muchos otros usos han sido identificados incluido su uso en deficiencias de anticuerpos secundaria, en enfermedades hematológicas e inflamatorias, en trastornos neuromusculares y en ciertas infecciones. La terapia de inmunoglobulina intravenosa no está exenta de riesgos, por lo que se revisaron los efectos adversos más comunes, raros y los muy raros

Aspectos básicos y determinación de las vitaminas antioxidantes E y A / Basic aspects and measurement of the antioxidant vitamins A and E

Vitamin E usually works as a biological antioxidant, preventing the oxidation of polyunsaturated fatty acids and proteins, for which it is considered an important protective factor in the development of diseases related to oxidative processes. Beyond its antioxidant properties, it has been involved also in genetic expression, mitochondrial metabolism, cell differentiation and immune system regulation. From the point of view of its antioxidant protection properties, values > or = 1200-1300 micrograms/dL are considered optimum levels (standardized according to plasmatic lipid levels). In relation to the beneficial advantage effects of vitamin E on primary or secondary atherosclerotic disease, data are not conclusive. Vitamin A is part of the organism's defense barrier against free radicals. Its antioxidant mechanism of action includes scavenging of single oxygen and thiol free radicals, and it also could be related to processes that involve genetic expression and cell differentiation. As an antioxidant, vitamin A plasmatic levels > or = 80 micrograms/dL are considered optimal. The highest risk of using this vitamin is related to its acute or chronic toxicity. Quantification of serum vitamin E (alpha tocopherol) and vitamin A (retinol) are made by high performance liquid chromatography (HPLC), method of high precision, sensitivity and reproducibility.