Oral manifestations of graft-versus-host disease in patients submitted to allogeneic hematopoietic stem cell transplantation: the experience of a Brazilian Cancer Center.

PURPOSE: Graft-versus-host disease (GVHD) is an important complication of allogeneic hematopoietic stem cell transplantation (AHCT) that affects several organs, including the mouth. OBJECTIVES: The aim of the present study was to describe the prevalence and clinical manifestations of oral GVHD, to determine the time interval from AHCT to the onset of oral GVHD manifestations, to identify predictive factors of oral GVHD, and to evaluate the survival rates of patients diagnosed with oral GVHD. METHODS: Medical records of 147 patients who underwent AHCT between January 2010 and January 2015 were reviewed for clinical features and the statistical establishment of risk factors. RESULTS: Of the 147 patients in the study, 99 (67.3%) developed GVHD. The skin was the most affected site (45.6%), followed by the gastrointestinal tract (27.9%) and oral cavity (17.7%). The mean post-AHCT oral GVHD development time was 229 days. Among patients with oral GVHD, pain was the main complaint (96.2%) followed by xerostomia (65.4%). The most common oral manifestations were ulcers (53.8%) followed by striae-associated ulcers (19.2%), mostly affecting the buccal mucosa and tongue. Seventy-three patients (48.6%) died within 20 months of receiving AHCT. Cox regression analysis indicated that patients who received myeloablative conditioning regimen had higher survival rate than those who underwent a reduced-intensity conditioning regimen (RR = 0.541; 95% CI, 0.334-0.878; p = 0.03). CONCLUSION: The mouth was the third most common GVHD-affected site. Pain, xerostomia, and ulcers with or without striae were the main clinical manifestations of GVHD observed in our study cohort. Reduced-intensity conditioning regimen showed significant relationship with mortality risk.

PREVENTIVE EFFECT OF CRANBERRY GEL ON DENTIN SUBMITTED TO EROSION

Aims: Considering that Cranberry's components might inhibit dentin metalloproteinases exposed to erosive agents, the aim of this study was to evaluate in situeffect of a Cranberry gel application on dentin before an erosive challenge.Materials and methods: This crossover double-blinded study was performed in 2 phases of 5 days each, with 10 healthy volunteers who wore 2 palatal devices (1 for each phase) with 4 dentin specimens (2 specimens for each group). The groups under study were:First Phase: G1 -Erosivechallenge (Coca-cola®) over dentin without any previous treatment (1st negative control group); G2 -Erosive challenge over dentin previously treated with Cranberry gel (test group); and Second Phase: G3 -Erosive challenge over dentin previously treated with a gel without any active principle (2ndnegative control group); G4 -Erosive challenge over dentin previously treated with 0.12% Chlorhexidine gel (positive control group). Each device was immersed into the acid beverage, 3 times daily for 5 minutes during 5 days. Profilometry (µm) was used to quantify the dentin wear. Data were analyzed by Repeated Measures Analysis of Variance followed by Fisher's test (p<0.05).Results: Data (G1: 4.98 ± 1.36a; G2: 3.29 ± 1.16b; G3: 4.38 ± 1.19a; G4: 3.32 ± 1.55b) showed no statistical difference between G1 and G3. There was also no difference between G2 and G4. However, G2 and G4 presented lower wear when compared to G1 and G3, and this difference was statistically significant. Conclusion: The results of this studysuggest a significant efficacy of Cranberry gel in preventing wear of dentin subjected to dental erosion.

Síndrome de Werner: relato de caso / Werner's syndrome: case report / Síndrome de Werner: reporte de un caso

Introdução: Síndrome de Werner, doença autossômica recessiva, tem como característica o envelhecimento precoce e acelerado. Objetivo: Descrever a evolução clínica favorável da síndrome de Werner em paciente acompanhada periodicamente no ambulatório de geriatria para promover atenção ao processo de envelhecimento por meio de abordagem preventiva e tratamento precoce das alterações que caracterizam a doença. Material e Método: Paciente de 31 anos de idade, sexo feminino, admitida no ambulatório de Aconselhamento Genético de um hospital-escola do noroeste paulista, apresentando baixa estatura, ulcerações, dor em região plantar e dificuldade para deambular, alterações cutâneas pigmentares com fissuras e ressecamento de toda a pele, além de cabelos grisalhos e quebradiços, catarata bilateral, hipotireoidismo e osteoporose. Tinha antecedentes familiares compatíveis com pais consanguíneos, um casal de irmãos hígidos e mãe com histórico de ocorrência de dois abortos espontâneos consecutivos. Apresentava, portanto, critérios diagnósticos para síndrome de Werner. Foi tratada nos ambulatórios de geriatria, endocrinologia, dermatologia, oftalmologia e ortopedia da mesma Instituição. Resultado: O tratamento consistiu na remoção cirúrgica de catarata, uso de levotiroxina 75 mcg/dia e de creme hidratante para pele (ácido salicílico 20% e vaselina sólida 30g), calçado ortopédico para pé neuropático com solado em EVA de média compressão, antiderrapante, confeccionado sob medida. Houve melhora na sintomatologia, especialmente quanto à deambulação com as medidas terapêuticas adotadas. Conclusão: A avaliação interdisciplinar inicial da paciente foi fundamental, pois possibilitou a elaboração precoce do diagnóstico e o acompanhamento no ambulatório de geriatria, promovendo maior atenção ao processo de envelhecimento preconizado por uma abordagem preventiva e tratamento subsequente das alterações que caracterizam a síndrome de Werner.(AU)

Introduction: Werner syndrome, an autosomal recessive disease, is characterized by premature and accelerated aging. Objective: To describe the favorable clinical evolution of Werner's syndrome in a patient periodically followed in the geriatric outpatient clinic to promote attention to the aging process through a preventive approach and early treatment of the changes that characterize the disease. Material and Method: A 31-year-old female patient, admitted to the Genetic Counseling outpatient clinic of a school hospital in northwestern pigmentary skin changes with cracks and dryness of the entire skin, as well as gray and brittle hair, bilateral cataract, hypothyroidism and osteoporosis. She had a family history compatible with consanguineous parents, a couple of healthy siblings and a mother with a history of two consecutive miscarriages. It therefore presented diagnostic criteria for Werner syndrome. She was treated in geriatric, endocrinology, dermatology, ophthalmology and orthopedics clinics of the same institution. Result: The treatment consisted of surgical removal of cataract, use of levothyroxine 75 mcg/day and moisturizing cream for skin (salicylic acid 20% and solid petroleum jelly 30g), orthopedic footwear for neuropathic foot anti-slip, made to measure. There was improvement in symptomatology, especially regarding ambulation with the therapeutic measures adopted. Conclusion: The initial interdisciplinary evaluation of the patient was fundamental, since it enabled the early preparation of the diagnosis and the follow-up in the geriatric outpatient clinic, promoting greater attention to the aging process recommended by a preventive approach and subsequent treatment of the changes that characterize Werner's syndrome.(AU)

Introducción: El síndrome de Werner, una enfermedad autosómica recesiva, se caracteriza por un envejecimiento prematuro y acelerado. Objetivo: Describir la evolución clínica favorable del síndrome de Werner en un paciente en seguimiento periódico en la consulta externa de geriatría para promover la atención al proceso de envejecimiento a través de un abordaje...(AU)

Obesidade infantil: recomendações para orientação inicial / Childhood obesity: recommendation for initial guidance / Obesidad infantil: recomendaciones para orientación inicial

Introdução: A obesidade infantil é definida como o acúmulo excessivo de gordura no organismo, com origem atribuída a causas multifatoriais e o método mais utilizado para sua medição é o Índice de Massa Corporal. Segundo estudos do Ministério da Saúde do Brasil, uma em cada três crianças brasileiras está acima do peso. Diante do atual cenário, em que muitas crianças vivem em ambientes obesogênicos, torna-se evidente a importância da conscientização sobre obesidade infantil. Objetivos e Método: Para guiar os profissionais de saúde na orientação sobre as consequências da obesidade, alimentação e os hábitos de vida adequados à prevenção, foram levantadas as recomendações dos principais órgãos nacionais: Associação Brasileira para estudos da Obesidade e Síndrome Metabólica, Sociedade Brasileira de Pediatria, Sociedade Brasileira de Endocrinologia e Metabologia, e mundial, como a Organização Mundial da Saúde, além de literatura disponível. Resultados: Foram resumidas as recomendações para que profissionais de saúde iniciem a orientação dos responsáveis pelo paciente durante uma primeira consulta ambulatorial. Estas são: esclarecimento sobre as consequências e comorbidades da obesidade, como diabetes, dislipidemias, doença cardiovascular, câncer; estímulo ao aleitamento materno, em especial nos primeiros seis meses de vida; importância do envolvimento da família e da escola no estímulo à ingestão de alimentos saudáveis e aumento de atividade física recreativa; diminuição de tempo de tela, diminuição do consumo de alimentos processados; higiene do sono; e orientação nutricional básica. Conclusão: Dessa forma, aproveitar a consulta ambulatorial em Pediatria pode ser uma estratégia para abordagem adequada da obesidade infantil.(AU)

Introduction: Childhood obesity is defined as the excessive amount of fat in the organism, which origin is associated to multifactorial causes and the most used method to its measurement is the Body Mass Index. According to Brazil's Health Ministry's studies, one among three Brazilian children is overweight. Facing the current scenario, with several children living in obesogenic environments, it is evident the importance of conscientization about childhood obesity. Objectives and Method: In order to guide healthcare professionals during orientation about the consequences of obesity, adequate food and lifestyle to prevent it, recommendations were raised from the main Brazilian health organizations: Brazilian Association for Studies of Obesity and Metabolic Syndrome, Brazilian Society of Pediatrics, Brazilian Society of Endocrinology and Metabolism; and global, such as the World Health Organization, beyond available literature. Results: The recommendations were summarized for healthcare professionals to start orientating the patient's parents during the first outpatient appointment. They approach: elucidation about obesity's consequences and comorbidities, such as diabetes, dyslipidemias, cardiovascular disease, cancer; stimulating breastfeeding, especially during the first six months of life; importance of family and school's encouragement to children to ingest healthy food and to practice recreational physical activities; decreasing screen time; decreasing processed food; sleep hygiene; and basic nutritional orientation. Conclusion: Therefore, utilizing Pediatric's outpatient appointment may be a good strategy for an adequate approach of childhood obesity.(AU)

Introducción: La obesidad infantil se define como la acumulación excesiva de grasa en el organismo, con origen atribuido a causas multifactoriales y el método más utilizado para su medición es el Índice de Masa Corporal. Según estudios del Ministerio de Salud de Brasil, uno de cada tres niños brasileños tiene sobrepeso. Ante el escenario actual, en el que muchos niños viven en ambientes obesogénicos, se hace evidente la importancia de la conciencia sobre la obesidad infantil. Objetivos y Método: Con el fin de orientar a los profesionales de la salud en la orientación sobre las consecuencias de la obesidad, la alimentación y los hábitos de vida adecuados para la prevención, se plantearon las recomendaciones de los principales organismos nacionales: Asociación Brasileña de Estudios sobre Obesidad y Síndrome Metabólico, Sociedad Brasileña de Pediatría, Sociedad Brasileña de Endocrinología y Metabología, y en todo el mundo, como la Organización Mundial de la Salud, además de la literatura disponible. Resultados: Se resumieron las recomendaciones para que los profesionales de la salud comiencen a orientar a los responsables del paciente durante una primera consulta externa. Estos son: aclaración sobre las consecuencias y comorbilidades de la obesidad, como diabetes, dislipidemia, enfermedades cardiovasculares, cáncer; fomentar la lactancia materna, especialmente en los primeros seis meses de vida; la importancia de la participación de la familia y la escuela para fomentar la ingesta de alimentos saludables y una mayor actividad física recreativa; disminución del tiempo de pantalla, disminución del consumo de alimentos procesados; higiene del sueño; y orientación nutricional básica. Conclusión: Así, aprovechar la consulta externa en Pediatría puede ser una estrategia para un abordaje adecuado de la obesidad infantil.(AU)