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OBJECTIVE: This study investigated the concentrations of neutrophil extracellular traps (NET) and salivary cytokines (IL-1ß, IL-6, IL-8/CXCL8, TNF, and TGF-ß1) in patients undergoing chemotherapy and their associations with oral mucositis (OM) and Candida infection. MATERIALS AND METHODS: This prospective longitudinal study performed at a Brazilian service included 60 adults diagnosed with hematolymphoid diseases. Saliva samples were collected on days D0, D3, D10, and D15. Cytokines were analyzed by ELISA and NET formation by identification of the myeloperoxidase-DNA complex. Oral Candida spp. was cultured. RESULTS: OM occurred in 43.3% of patients and oral candidiasis in 20%. However, 66% of individuals had positive cultures for C. albicans. Higher concentrations of IL-6, IL-8/CXCL8, and TNF and lower concentrations of TGF-ß1 were observed in patients with OM. C. albicans infection contributed to the increase in IL-8/CXCL8, TGF-ß1, and TNF. Individuals with OM or with oral candidiasis had significant reductions in NET formation. In contrast, individuals with C. albicans and with concomitant C. albicans and OM exhibited higher NET formation. CONCLUSION: The kinetics of cytokine levels and NET formation in chemotherapy-induced OM appears to be altered by Candida infection, even in the absence of clinical signs of oral candidiasis.
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Candidiasis Bucal , Citocinas , Trampas Extracelulares , Saliva , Estomatitis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Citocinas/metabolismo , Candidiasis Bucal/microbiología , Estomatitis/microbiología , Estomatitis/metabolismo , Estudios Prospectivos , Adulto , Trampas Extracelulares/metabolismo , Saliva/microbiología , Saliva/metabolismo , Anciano , Estudios Longitudinales , Factor de Crecimiento Transformador beta1/metabolismo , Interleucina-8/metabolismo , Interleucina-8/análisis , Factor de Necrosis Tumoral alfa/metabolismo , Candida albicans , Antineoplásicos , Interleucina-6/análisis , Interleucina-6/metabolismo , Interleucina-1beta/metabolismo , Neoplasias Hematológicas/complicacionesRESUMEN
Abstract Objective The aim of this study was to analyze the effects of fluid overload related to mechanical ventilation, renal replacement therapy, and evolution to discharge or death in critically ill children. Methods A retrospective study in a Pediatric Intensive Care Unit for two years. Patients who required invasive ventilatory support and vasopressor and/or inotropic medications were considered critically ill. Results 70 patients were included. The mean age was 6.8 ± 6 years. There was a tolerable increase in fluid overload during hospitalization, with a median of 2.45% on the first day, 5.10% on the third day, and 8.39% on the tenth day. The median fluid overload on the third day among those patients in pressure support ventilation mode was 4.80% while the median of those who remained on controlled ventilation was 8.45% (p = 0.039). Statistical significance was observed in the correlations between fluid overload measurements on the first, third, and tenth days of hospitalization and the beginning of renal replacement therapy (p = 0.049) and between renal replacement therapy and death (p = 0.01). The median fluid overload was 7.50% in patients who died versus 4.90% in those who did not die on the third day of hospitalization (p = 0.064). There was no statistically significant association between death and the variables sex or age. Conclusions The fluid overload on the third day of hospitalization proved to be a determinant for the clinical outcomes of weaning from mechanical ventilation, initiation of renal replacement therapy, discharge from the intensive care unit, or death among these children.
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OBJECTIVE: The aim of this study was to analyze the effects of fluid overload related to mechanical ventilation, renal replacement therapy, and evolution to discharge or death in critically ill children. METHODS: A retrospective study in a Pediatric Intensive Care Unit for two years. Patients who required invasive ventilatory support and vasopressor and/or inotropic medications were considered critically ill. RESULTS: 70 patients were included. The mean age was 6.8 ± 6 years. There was a tolerable increase in fluid overload during hospitalization, with a median of 2.45% on the first day, 5.10% on the third day, and 8.39% on the tenth day. The median fluid overload on the third day among those patients in pressure support ventilation mode was 4.80% while the median of those who remained on controlled ventilation was 8.45% (pâ¯=â¯0.039). Statistical significance was observed in the correlations between fluid overload measurements on the first, third, and tenth days of hospitalization and the beginning of renal replacement therapy (pâ¯=â¯0.049) and between renal replacement therapy and death (pâ¯=â¯0.01). The median fluid overload was 7.50% in patients who died versus 4.90% in those who did not die on the third day of hospitalization (pâ¯=â¯0.064). There was no statistically significant association between death and the variables sex or age. CONCLUSIONS: The fluid overload on the third day of hospitalization proved to be a determinant for the clinical outcomes of weaning from mechanical ventilation, initiation of renal replacement therapy, discharge from the intensive care unit, or death among these children.
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Enfermedad Crítica , Desequilibrio Hidroelectrolítico , Niño , Humanos , Lactante , Preescolar , Estudios Retrospectivos , Enfermedad Crítica/terapia , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/terapia , Unidades de Cuidado Intensivo Pediátrico , Terapia de Reemplazo Renal , Unidades de Cuidados IntensivosRESUMEN
Abstract Introduction Febrile neutropenia (FN) is a serious complication of cancer chemotherapy. The present study aimed to identify risk factors for documented infection in pediatric patients with FN and cancer. Methods This prospective cohort study included patients under 18 years from 2016 to 2018. Infection was defined according to the Centers for Disease Control and Prevention criteria. Results A total of 172 febrile neutropenic episodes were evaluated. From univariate analysis, the risk factors were: female gender; monocyte count < 100 cell/mm³, platelets < 50,000, C-reactive protein (CRP) > 90 mg/dl and hemoglobin < 7mg/dl at the onset of an episode; two or more episodes of FN, and; fever onset; positive blood culture at the fever onset. Independent risk factors according to the multivariate analysis were: CRP at the onset of a febrile episode > 90mg/dl, fever onset and first blood culture with a positive result. The lowest probability of infection was related to first episode and to platelets > 50,000 at the onset of fever. Conclusion A CRP > 90 at the onset of a febrile episode, platelets < 50,000, second episode or more, first fever episode during hospitalization and positive first blood culture were found to be associated with a higher risk of infection and they could be useful for the establishment of risk scores for infection in neutropenic children.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Sepsis , Neutropenia Febril , Factores de Riesgo , Bacteriemia , Quimioterapia , NeoplasiasRESUMEN
Abstract Introduction Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. Objectives The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. Methods This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. Results A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. Conclusion Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Fusariosis , Infecciones Fúngicas Invasoras , Enfermedades Hematológicas , Sinusitis , Neutropenia Febril , FusariumAsunto(s)
Escorbuto , Ácido Ascórbico/uso terapéutico , Niño , Dieta , Humanos , Escorbuto/diagnóstico , Escorbuto/etiologíaRESUMEN
RESUMO Objetivo: Analisar as características clínicas, laboratoriais e histopatológicas e o percurso até o estabelecimento do diagnóstico e do tratamento de pacientes com carcinoma de suprarrenal (CSR). Métodos: Estudo retrospectivo com 13 pacientes tratados no serviço de oncologia pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) entre 2004 e 2015. Resultados: A idade ao diagnóstico variou de 1,0 a 14,8 anos (mediana: 2,0 anos). As manifestações de hipercortisolismo foram identificadas em todos os casos, e as de virilização, em todas as meninas. Todos os pacientes preencheram os critérios de Weiss para diagnóstico histopatológico de CSR. A imuno-histoquímica foi realizada em 61,5% dos casos. A maioria dos pacientes apresentou doença em estádio I (76,9%). Todos foram submetidos à ressecção tumoral total. Dois pacientes (estádios III e IV) receberam quimioterapia associada ao mitotano. O único óbito observado foi do paciente com doença em estádio IV. A probabilidade de sobrevida global para todo o grupo aos 5,0 anos foi de 92,3±7,4%. A mediana de tempo entre o início dos sintomas e o diagnóstico foi de 9,5 meses, e de 6,0 meses entre a primeira consulta e o início do tratamento. Conclusões: A baixa idade ao diagnóstico, o predomínio de casos com doença localizada e a ressecção tumoral completa - com apenas um caso de ruptura de cápsula tumoral - são possivelmente a explicação para a evolução favorável da população estudada. O longo percurso entre o início dos sintomas e o diagnóstico sugere a importância da capacitação dos pediatras para o reconhecimento precoce dos sinais e dos sintomas do CSR.
ABSTRACT Objective: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC). Methods: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015. Results: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment. Conclusions: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Antineoplásicos/uso terapéutico , Evaluación de Procesos y Resultados en Atención de Salud , Brasil/epidemiología , Carcinoma/mortalidad , Carcinoma/patología , Carcinoma/terapia , Estudios Retrospectivos , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/terapia , Glándulas Suprarrenales/patología , Adrenalectomía/métodos , Adrenalectomía/estadística & datos numéricos , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiología , Detección Precoz del Cáncer , Tiempo de Tratamiento/estadística & datos numéricos , Estadificación de NeoplasiasRESUMEN
OBJECTIVE: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC). METHODS: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015. RESULTS: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment. CONCLUSIONS: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.
OBJETIVO: Analisar as características clínicas, laboratoriais e histopatológicas e o percurso até o estabelecimento do diagnóstico e do tratamento de pacientes com carcinoma de suprarrenal (CSR). MÉTODOS: Estudo retrospectivo com 13 pacientes tratados no serviço de oncologia pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) entre 2004 e 2015. RESULTADOS: A idade ao diagnóstico variou de 1,0 a 14,8 anos (mediana: 2,0 anos). As manifestações de hipercortisolismo foram identificadas em todos os casos, e as de virilização, em todas as meninas. Todos os pacientes preencheram os critérios de Weiss para diagnóstico histopatológico de CSR. A imuno-histoquímica foi realizada em 61,5% dos casos. A maioria dos pacientes apresentou doença em estádio I (76,9%). Todos foram submetidos à ressecção tumoral total. Dois pacientes (estádios III e IV) receberam quimioterapia associada ao mitotano. O único óbito observado foi do paciente com doença em estádio IV. A probabilidade de sobrevida global para todo o grupo aos 5,0 anos foi de 92,3±7,4%. A mediana de tempo entre o início dos sintomas e o diagnóstico foi de 9,5 meses, e de 6,0 meses entre a primeira consulta e o início do tratamento. CONCLUSÕES: A baixa idade ao diagnóstico, o predomínio de casos com doença localizada e a ressecção tumoral completa - com apenas um caso de ruptura de cápsula tumoral - são possivelmente a explicação para a evolução favorável da população estudada. O longo percurso entre o início dos sintomas e o diagnóstico sugere a importância da capacitação dos pediatras para o reconhecimento precoce dos sinais e dos sintomas do CSR.
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Neoplasias de las Glándulas Suprarrenales , Adrenalectomía , Antineoplásicos/uso terapéutico , Carcinoma , Síndrome de Cushing , Adolescente , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/terapia , Glándulas Suprarrenales/patología , Adrenalectomía/métodos , Adrenalectomía/estadística & datos numéricos , Brasil/epidemiología , Carcinoma/mortalidad , Carcinoma/patología , Carcinoma/terapia , Niño , Preescolar , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiología , Detección Precoz del Cáncer , Femenino , Humanos , Lactante , Masculino , Estadificación de Neoplasias , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
OBJECTIVE: to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. METHODS: we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. RESULTS: we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. CONCLUSION: among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.
OBJETIVO: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. MÉTODOS: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. RESULTADOS: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. CONCLUSÃO: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade.
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Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Procedimientos Innecesarios , Neoplasias Óseas/patología , Niño , Preescolar , Hepatoblastoma/patología , Humanos , Neoplasias Renales/patología , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/diagnóstico por imagen , Osteosarcoma/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Teratoma/patología , Toracoscopía/métodos , Tomografía Computarizada por Rayos X , Tumor de Wilms/patologíaRESUMEN
RESUMO Objetivo: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. Métodos: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. Resultados: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. Conclusão: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade.
ABSTRACT Objective: to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. Methods: we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. Results: we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. Conclusion: among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.
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Humanos , Preescolar , Niño , Procedimientos Innecesarios , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/secundario , Teratoma/patología , Toracoscopía/métodos , Neoplasias Óseas/patología , Tomografía Computarizada por Rayos X , Osteosarcoma/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Hepatoblastoma/patología , Tumor de Wilms/patología , Neoplasias Renales/patología , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
Criança do sexo masculino, dois anos de idade, natural de Parauapebas (PA), apresentava reflexo branco em olho esquerdo em fotografias desde os primeiros meses de vida. Evoluiu com diminuição progressiva da acuidade visual, cefaleia e as alterações do globo ocular evidenciadas pela fotografia e pela tomografia computadorizada.
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Few studies have been performed during adolescents' cancer treatment to evaluate its interference on health-related quality of life (HRQL). The purpose of this prospective cohort study was to evaluate adolescents' HRQL during cancer treatment. The Health Utilities Index (HUI) was used for scoring. Forty-five individuals were questioned 1 month after the onset of treatment (T1) and at 4 or 6 months depending on disease type (T2). Median age was 14 years. Pain was the most frequent troublesome attribute referred to, but scores were significantly better from T1 to T2 for patients and proxies. A high correlation between patients' and family' HRQL scores was observed both at T1 and T2. Correlation of the general health scores between patients and their families was high at T1, but not so high at T2. Physicians' evaluation tended to underestimate HRQL of their patients. In conclusion, most patients and proxies reported a HRQL reduction during the initial phase of treatment, but HRQL was better later on. Generally, patient and proxy scores correlated well. Pain was the most frequently reported troublesome attribute. The patients' opinion concerning their own health and well-being should be of primary importance to assess QoL and determine therapeutic regimens.
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Neoplasias/psicología , Calidad de Vida , Adolescente , Niño , Estudios de Cohortes , Países en Desarrollo , Femenino , Humanos , Masculino , Neoplasias/terapia , Estudios Prospectivos , ApoderadoRESUMEN
Nas últimas décadas, houve aumento significativo nos índices de sobrevida das crianças e adolescentes com diagnóstico de neoplasias malignas. Essa acentuada melhora levanta questionamentos não só em relação à quantidade ou duração da sobrevida, mas também quanto à qualidade de vida. A mortalidade não é mais o ponto final apropriado quando se está considerando a eficácia de uma intervenção médica. As crianças e seus cuidadores experimentam significativo comprometimento da qualidade de vida nos meses que se seguem ao diagnóstico do câncer. Dessa forma, tanto as decisões clínicas quanto a condução de pesquisas só deveriam ser realizadas juntamente com o desenvolvimento de boas medidas de avaliação da qualidade de vida. Objetivo: alertar o pediatra a respeito da importância da avaliação da qualidade de vida relacionada à saúde de crianças e adolescentes com câncer.Métodos: foram selecionadas 39 referências em pesquisa realizada nas bases de dados Medline e no LILACS, utilizando-se as palavras-chave qualidade de vida, sobrevida, neoplasia. (AU)
There has been in the last decades a significant increase in the survival rate of children and adolescents with cancer diagnosis. This impressive improvement raises issues related not only to the amount of gained survival years but also to the quality of such survival. Mortality is no longer the more the appropriate end point to evaluate the efficacy of a medical intervention. Children and their parents suffer a remarkable decline in their quality of life during several months after the cancer diagnosis. Thus it would be highly appropriate that the evaluation of the quality of life was also an integral part of the clinical decisions and research in this area. Objective: to alert pediatricians to the importance of evaluating health related quality of life in children and adolescents with cancer. Methods: 39 references were selected from Medline and LILACS databases using the key words quality of life, survival and neoplasm. (AU)
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Humanos , Niño , Adolescente , Indicadores de Calidad de Vida , Neoplasias , Calidad de Vida , Estado de Ejecución de Karnofsky , Perfil de Impacto de EnfermedadRESUMEN
O câncer infanto-juvenil é uma doença relativamente rara, sendo responsável por 0,5-3% do total de casos de câncer. Entretanto, ainda é causa de grande morbimortalidade em pacientes nessa faixa etária em nosso meio. Diagnóstico precoce e tratamento em centros especializados são essenciais para aumento da sobrevida em longo prazo. Objetivo: alertar o pediatra a respeito da importância do reconhecimento precoce das principais neoplasias malignas da infância e adolescência, dando ênfance à epedemiologia e apresentação clínica dos tumores sólidos. Métodos: foram selecionados 26 referências bibliográficas em pesquisa realizada nas base de dados Medline e no LILACS, em português, espanhol e inglês, utilizando-se as palavras-chave câncer infanto-juvenil, apresentação clínica, sobrevida.
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Humanos , Niño , Adolescente , Neoplasias/epidemiología , Neoplasias de los Tejidos Blandos/epidemiología , Neoplasias del Sistema Nervioso Central/epidemiología , Neoplasias Óseas/epidemiología , Neuroblastoma/epidemiología , Retinoblastoma/epidemiologíaRESUMEN
Há um consenso geral de que o diagnóstico precoce do câncer, associado ao adequado tratamento resulta em maiores índices de cura. Apesar de extremamente importante, o atraso do diagnóstico do câncer na faixa etária pediátrica ainda é um tema pouco explorado. Este trabalho é resultado da investigação dos fatores relacionados com o atraso do diagnóstico do câncer infantil no nosso meio. Foram avaliados 2081 pacientes, entre O e 18 anos, com diagnóstico de neoplasia maligna, admitidos no Departamento de Pediatria do Hospital do Câncer de São Paulo, entre Janeiro de 1991 a Abril de 2002. O estudo compreendeu dois períodos, sendo o primeiro período, um estudo retrospectivo, de Janeiro de 1991 a Junho de 2000, onde foram revisados 1808 prontuários e o segundo período, um estudo prospectivo, de Julho de 2000 a Abril de 2002, onde foram entrevistadas as famílias de 273 pacientes. Tanto no primeiro quanto no segundo período, foram estudadas as variáveis sócio-demográficas (idade, sexo, raça e procedência) e clínicas (tipo histológico, extensão da doença, queixa, tempo de duração da queixa e tratamento oncológico prévio). No segundo período do estudo também foram estudadas variáveis sócio-econômicas (escolaridade dos pais, renda familiar, número de cômodos e moradores na casa da criança) e relacionadas com história da doença da criança (quem observou o primeiro sintoma, número de médicos consultados, número de consultas realizadas, quem encaminhou ao centro especializado e tratamento sintomático). A idade dos pacientes variou de 8 dias a 18 anos e 9 meses, com média de 71,2 meses no período retrospectivo e 90,8 meses no período prospectivo. As queixas mais freqüentes foram: tumor, leucocoria, dor óssea, dor abdominal, adenopatia, febre, cefaléia, anemia e estrabismo. O tempo médio de duração da queixa variou de 1 dia a 144 meses com média de 4,6 meses e mediana 2,0 meses nos dois períodos do estudo. O tempo médio de queixa foi diretamente proporcional à idade ou seja, quanto maior a idade maior o tempo de queixa. Os menores tempos médios de duração da queixa foram observados entre os portadores de tumor de Wilms, leucemia aguda e linfoma não Hodgkin (LNH) e o maiores tempos médios de duração da queixa foram observados entre os portadores de leucemia mielóide crônica, doença de Hodgkin e tumor do sistema nervoso central (SNC). Sintomas como anemia e adenopatia foram fatores preditivos independentes do atraso diagnóstico entre os portadores de leucemia aguda; assim como dor abdominal entre os portadores de LNH e estrabismo entre os portadores de retinoblastoma. O melhor nível de escolaridade da mãe reduziu o tempo médio de duração da queixa entre os portadores de leucemia linfóide aguda (LLA). A maior renda familiar reduziu o tempo de queixa entre os portadores de neuroblastoma e entre os portadores de tumor do SNC aumentou o tempo de queixa. O maior número de médicos consultados aumentou o tempo de queixa entre os portadores de LLA e osteossarcoma. Ter sido encaminhado ao centro de referência por um médico pediatra reduziu o tempo de queixa entre os portadores de leucemia mielóide aguda (LMA) e LNH. Ter recebido tratamento oftalmológico sintomático aumentou o tempo de queixa entre os portadores de retinoblastoma. Estes dados alertam para a necessidade de campanhas de esclarecimentos sobre os sinais precoces do câncer infantil entre a população leiga e os profissionais de saúde.
Early diagnosis has been suggested as a factor that could improve survival of children with cancer. In adults, cancer attention has been directed toward reducing the interval between symptom onset and diagnosis (lag time). There are few studies oflag time for childhood cancer. Lag time was descnbed for 2081 children who were referred to the Pediatric Department, Hospital do Cancer of São Paulo. This study was divided into two periods. In the :first period, clinicai records from 1991 to 2000 were reviewed, regarding the :first symptom and its duration, diagnostic group, disease extension, and clinicai data such as age, sex, race and place o f residence. In the second period, from 2000 to 2002, a prospective study was performed, consisting in an interview, regarding the family social-economic status (income, parenta} education, conditions o f the residence) and the diagnosis process ( who noticed the :first symptom, who referred the child to the Hospital do Cancer, the number of doctors that have seen the child, the number of appointments before the diagnosis of cancer and symptomatic treatment). Age ranged from 3 days of life to 18,9 months. Tumor mass, leucocoria, bone pain, abdominal pain, fever, headache, anemia and squint were the more frequent symptoms. Lag time ranged from 1 day to 144 months. Mean lag time was 4.6 months and median, 2.0 months. Age was positively and significantly correlated with lag time. Wilm.s' tumor, acute leukemia and nonHodgkin lymphoma (NHL) had the lowest lag time and chronic myeloid leukemia, Hodgkin's disease and central nervous system (CNS) tumor, the longer. Symptoms as anemia and adenopathy were positively correlated with lag time for acute leukemia; abdominal pain for NHL and squint for retinoblastoma. Mother education levei also influenced lag time for acute lymphoblastic leukemia (ALL); the lower the educationallevel, the longer lag time. Family income was positively correlated with lag time for CNS tumor and negatively for neuroblastoma. The number of doctors who have seen the child was positively correlated with lag time for ALL and osteosarcoma. Retinoblastoma patients who had received symptomatic treatment had longer lag time. Among NHL and acute myeloid leukemia patients lag time was lower when these patients were referred to the Hospital do Câncer de São Paulo by a pediatric physician. This study suggests the necessity of public campaigns for general population levei and health professionals stressing the need of detecting symptomatic childhood cancer during its early stages, thus possibly enhancing survival rate.