Riesgo de mortalidad en candidemia en niños oncohematológicos: revisión sistemática / Mortality risk in candidemia in children with cancer and blood disorders: a systematic review

Introducción: La tasa de mortalidad de la candidemia es variable, pero puede estar influenciada por la patología de base, en especial aquella que condiciona la presencia de neutropenia. En niños con patología oncohematológica, son pocos los trabajos que han abordado la mortalidad relacionada a candidemias y sus factores asociados. Las preguntas que promueven esta revisión sistemática, son: ¿Cuáles son las características epidemiológicas, clínicas y de evolución de los pacientes pediátricos oncohematológicos con candidemia? ¿Cuál es la mortalidad relacionada con esta entidad? Materiales y métodos: Revisión sistemática de la literatura. Se utilizaron los siguientes términos de búsqueda: candidemia por Candida spp. y los siguientes filtros humanos, niños y adolescentes y patología oncohematológica. Se revisaron los artículos publicados en inglés, español o francés hasta el 21 de septiembre de 2023. Las referencias bibliográficas de los artículos incluidos se revisaron manualmente para identificar estudios relevantes adicionales. Resultados: Se encontraron 66 artículos. Del análisis cualitativo realizado en sus textos completos, quedaron finalmente 4 estudios que se consideró que cumplían con los criterios de inclusión. Todos los artículos seleccionados sumaron 191 pacientes con diversas patologías oncohematológicas. La presencia de accesos vasculares fue frecuente en esta serie y la no extracción del catéter venoso central fue el factor más prevalente entre los que fallecieron. El agente infectante predominante fue Candida no albicans y la mortalidad osciló entre el 11,3 y el 31% con una mediana de 25%. No fue posible establecer si la especie de Candida influía en la letalidad

Introduction: The mortality rate of candidemia is variable, but may be influenced by underlying diseases, especially those causing neutropenia. In children with cancer and blood disorders, few studies have addressed mortality related to candidemia and its associated factors. The questions that motivated this systematic review were: What are the epidemiological, clinical and outcome characteristics of pediatric cancer patients with candidemia? What is the mortality related to this condition? Materials and methods: Systematic review of the literature. The following search terms were used: Candida spp., candidemia, with the following filters: human, children and adolescents, and cancer and blood disorders. Articles published in English, Spanish, or French up to September 21, 2023 were reviewed. References of included articles were manually reviewed to identify additional relevant studies. Results: 66 articles were identified. From the qualitative analysis carried out on their full texts, 4 studies that were considered to meet the inclusion criteria were finally selected. The selected articles included a total of 191 patients with various types of cancer and blood disorders. The presence of vascular access was common in this series and failure to remove the central venous catheter was the most prevalent factor among those who died. The predominant infectious agent was non-albicans Candida and mortality ranged from 11.3% to 31% with a median of 25%. It was not possible to establish whether Candida species influenced mortality.

Presentación clínica de patologías no malignas que simulan leucemia cutis: a propósito de dos casos / Clinical presentation of non-malignant diseases mimicking leukemia cutis: A report of two cases

La infiltración cutánea por células leucémicas conocida como leucemia cutis es una presentación infrecuente de esta patología y constituye un desafío diagnóstico. Los diagnósticos como infecciones, otras patologías neoplásicas con afectación cutánea y los trastornos histiocíticos, entre otros, constituyen los principales diagnósticos diferenciales, ya que configuran un escenario pronóstico y terapéutico diferente. Se presentan dos pacientes que fueron diagnosticados inicialmente como leucemia cutis, cuyo diagnóstico final fue de patologías no malignas.

The infiltration of leukemia cells into the skin, known as leukemia cutis, is a rare presentation of this disease and accounts for a diagnostic challenge. The main differential diagnoses include infections, other neoplastic diseases with skin involvement and histiocytic disorders, among others, as they entail different prognostic and therapeutic approaches. Here we describe two patients who were initially diagnosed with leukemia cutis, whose final diagnosis was of non-malignant diseases.

Real-world practice of acute leukemia intrathecal chemotherapy administration: A Mexican nationwide survey

ABSTRACT Introduction: Intrathecal chemotherapy is a mainstay component of acute lymphoblastic leukemia treatment. In Mexico, there is a considerable practice variability in aspects, such as the manner of preparation and the administration technique. Objective: Our objective was to describe the different techniques used for the application of ITC and review the existing recommendations in the literature. Method: A cross-sectional, nationwide survey study was conducted by an electronic questionnaire sent to hematologists and oncologists in Mexico. We collected demographic data, personal experience, intrathecal chemotherapy techniques, drug preparation and postprocedural conduct. Results: We received 173 responses. Twenty percent had an anesthesiologist administering sedation and pain management. The platelet count considered safe was 50 × 109/L in 48% of the participants. In 77% (n = 133) of the cases, the conventional needle with stylet used was, 49% did not receive any added diluent in the intrathecal chemotherapy and only 42% were recommended to rest in a horizontal position for more than 30 min. Conclusion: We identified a considerable variation in the administration of intrathecal chemotherapy across the hematologists in Mexico. We discuss the implications and opportunities in reducing the variation in our setting, highlighting the unmet need to establish guidelines that should be evaluated by the Mexican professional society to produce a position paper regarding practice standardization.

Applicability of the acute leukemia (AL) - EBMT score as a prognostic model for allogeneic hematopoietic stem cell transplantation: a single-center, prospective, cohort study at a reference transplant center in Brazil

Abstract Introduction The Acute Leukemia-European Society for Blood and Marrow Transplantation (AL-EBMT) risk score was recently developed and validated by Shouval et al. Objective To assess the ability of this score in predicting the 2-year overall survival (OS-2), leukemia-free survival (LFS-2) and transplant-related mortality (TRM) in acute leukemia (AL) adult patients undergoing a first allogeneic hematopoietic stem cell transplant (HSCT) at a transplant center in Brazil. Methods In this prospective, cohort study, we used the formula published by Shouval et al. to calculate the AL-EBMT score and stratify patients into three risk categories. Results A total of 79 patients transplanted between 2008 and 2018 were analyzed. The median age was 38 years. Acute myeloid leukemia was the most common diagnosis (68%). Almost a quarter of the cases were at an advanced stage. All hematopoietic stem cell transplantations (HSCTs) were human leukocyte antigen-matched (HLA-matched) and the majority used familial donors (77%). Myeloablative conditioning was used in 92% of the cases. Stratification according to the AL-EBMT score into low-, intermediate- and high-risk groups yielded the following results: 40%, 12% and 47% of the cases, respectively. The high scoring group was associated with a hazard ratio of 2.1 (p= 0.007), 2.1 (p= 0.009) and 2.47 (p= 0.01) for the 2-year OS, LFS and TRM, respectively. Conclusion This study supports the ability of the AL-EBMT score to reasonably predict the 2-year post-transplant OS, LFS and TRM and to discriminate between risk categories in adult patients with AL, thus confirming its usefulness in clinical decision-making in this setting. Larger, multicenter studies may further help confirm these findings.

Sobrevida en población pediátrica con leucemia linfoblástica aguda tratada con protocolo ALLIC-BFM de quimioterapia. Revisión sistemática / Survival of pediatric population with acute lymphoblastic leukemia treated with ALLIC-BFM chemotherapy protocol. Systematic review

La leucemia linfoblástica aguda constituye la neoplasia infantil más frecuente. Los tratamientos actuales posibilitan más del 80% de supervivencia libre de enfermedad por cinco años. En el 2000, se probó un protocolo de quimioterapia llamado leucemia linfoblástica intercontinental Berlín-Frankfurt-Münster (ALLIC BFM). El proceso investigativo se realizó mediante la metodología PRISMA, con el propósito de sistematizar la información acerca de la supervivencia de los pacientes pediátricos con leucemia linfoblástica aguda tratados con el uso del protocolo de quimioterapia ALLIC BFM en sus versiones de 2002 o 2009. La supervivencia global en pacientes donde se utilizó el protocolo de 2002 fue del 52% al 91,7% y la libre de enfermedad fue del 45% a 83,3%; mientras que, con el uso del protocolo 2009 se reportó una supervivencia global del 71,1% al 90% y la libre de enfermedad fue del 69,4% al 90,3%. Los principales factores que afectaron la supervivencia fueron las complicaciones relacionadas con el tratamiento, los pacientes de alto riesgo y la medicación insuficiente.

Acute lymphoblastic leukemia is the most common childhood neoplasia. Current treatments allow more than 80% disease-free survival for five years. In 2000, a chemotherapy protocol called Berlin-Frankfurt-Münster intercontinental lymphoblastic leukemia (ALLIC BFM) was tested. The investigative process was carried out using the PRISMA methodology. This study aimed to systematize the information about the survival of pediatric patients with acute lympho-blastic leukemia treated with the ALLIC BFM chemotherapy protocol in its 2002 or 2009 versions. 52% to 91.7% of patients showed an overall survival in patients where the 2002 proto-col was used, and disease-free was from 45% to 83.3%; while, with the use of the 2009 protocol, an overall survival of 71.1% to 90% was reported, and disease-free survival was 69.4% to 90.3%. The main factors affecting survival were treatment-related complications, high-risk patients, and insufficient medication.

Cáncer infantil: lo que debemos saber / Childhood cáncer: What we should know

Introducción: el cáncer representa una de las principales causas de muerte en niños, niñas y adolescentes a nivel global, el cual es superado escasamente por los accidentes. Las neoplasias más frecuentes son, en primer lugar, las leucemias; segundo, los tumores del Sistema Nervioso Central; y, tercero, los linfomas. Es importante destacar que no existe prevención, sin embargo, hay signos de alarma que si se logran identificar a tiempo pueden verse traducidos en una enfermedad más manejable con una sobrevida más alta y un mejor pronóstico. Objetivo: realizar una actualización académica sobre la importancia de los signos y síntomas de alarma del cáncer infantil. Método: se realizó una investigación documental y se utilizó como buscador de información científica Google Académico. Se evaluaron artículos de investigación y revisión de diferentes bases de datos, como: site de la Organización Mundial de la Salud, site de la Oficina Panamericana de la Salud, Revista de Pediatría Integral, American Cáncer Society y publicaciones periodísticas locales, entre otros. Conclusiones: el cáncer en la infancia y adolescencia no puede prevenirse; sin embargo, si los médicos de los distintos niveles de atención en salud pueden reconocer los signos de alarma ante un probable caso de malignidad, se lograrán referimientos oportunos, diagnósticos tempranos y una mejor tasa de curabilidad y sobrevida en los niños.

Introduction: Cancer represents one of the main causes of death in children and adolescents globally, which is barely surpassed by accidents. The most frequent neoplasms are leukemias first, Central Nervous System tumors second, and lymphomas third. It is important to note that there is no prevention, however, there are warning signs that, if identified in time, can be translated into a more manageable disease with higher survival and a better prognosis. Objective: To carry out an academic update on the importance of warning signs and symptoms of childhood cancer. Method: A documentary research was carried out and Google Scholar was used as a search engine for scientific information. Research and review articles from different databases were evaluated, such as: the World Health Organization site, the Pan American Health Office site, the Comprehensive Pediatrics Review, the American Cancer Society, local journalistic publications, among others. Conclusions: Cancer in childhood and adolescence cannot be prevented, however, if doctors at the different levels of health care can recognize the warning signs in the event of a probable case of malignancy, timely referrals, early diagnoses and a better curability rate will be achieved and survival in children.

Adesão às recomendações do protocolo de neutropenia febril em pacientes pediátricos portadores de leucemia, em um centro de referência oncológico do município de São Paulo / Adherence to the recommendations of the febrile neutropenia protocol in pediatric patients with leukemia, in an oncological reference center in the city of São Paulo

INTRODUÇÃO: Pacientes com leucemia aguda estão suscetíveis a quadros de neutropenia febril (NF) após tratamento quimioterápico, com consequente impacto na sobrevida.OBJETIVO: Estabelecer as taxas atuais da terapia antimicrobiana empírica inapropriada (TAEI) durante os episódios de NF e os fatores de risco associados ao óbito. MATERIAL E MÉTODOS: Estudo do tipo coorte, retrospectivo, descritivo, com dados obtidos de prontuário eletrônico de sujeitos menores de 18 anos, com diagnóstico de leucemia aguda e NF, em vigência de quimioterapia em um Cancer Center brasileiro, no período de 2010 a 2020. RESULTADOS: Foram 329 episódios de NF em 84 pacientes. A taxa global da TAEI foi de 130 (40%), justificados em três momentos de avaliação. A principal razão para a TAEI foi no 2º momento, de 24-72 horas com as culturas positivas em que o antibiótico (ATB) não foi adequado em 10 (11%), o ATB não foi removido nas culturas negativas em 39 (78%) e não foi removido em 83 (62%), a respeito das culturas negativas, na hora 96, com febre, o antifúngico não foi associado à terapia antimicrobiana em 39 (78%). Infecções microbilogicamente documentadas, em corrente sanguinea ocorreram em 73 (22%) episódios de NF. Os principais fatores de risco associados à mortalidade foram leucemia mieloide aguda, idade superior a 13 anos e infecção de corrente sanguínea. CONCLUSÃO: Embora a TAEI não tenha sido associada a mortalidade neste estudo, as consequências da TAEI podem ter impactos deletérios imediatos e a longo prazo, como aumento da duração da hospitalização, custos elevados, emergência de bactérias multi-droga resistente e disbiose intestinal, este com potencial impacto na doença de base.

INTRODUCTION: Patients with acute leukemia are susceptible to febrile neutropenia (FN) after chemotherapy treatment, with a consequent impact on survival. PURPOSE: To establish current rates of inappropriate empirical antimicrobial therapy (IEAT) during episodes of FN and risk factors associated with death. MATERIAL AND METHODS: Cohort, retrospective, descriptive study, with data obtained from electronic medical records of subjects under 18 yo, diagnosed with acute leukemia and FN, undergoing chemotherapy in a Brazilian Cancer Center, from 2010 to 2020. RESULTS: There were 329 FN episodes in 84 patients. The overall IEAT rate was 130 (40%), justified in three evaluation moments of FN protocol. The main reason for IEAT were at 24-72 hours with positive cultures the antibiotic was not adequate antibiotic in 10 (11%), with negative cultures in which the antibiotic was not de-escalated in 39 (78%) and not removed in 83 (62%), despite negative cultures, at 96 hours, with fever, whose antifungal was not associated with antimicrobial therapy 39 (78%). Bloodstream infection (BSI) were observed in 73 (22%). The main risk factors associated with mortality was acute myeloid leukemia, > 13 years old and microbiologically documented bloodstream infection. CONCLUSION: Although IEAT was not associated with a mortality rate in this study, its consequences can have immediate and long-term deleterious impacts, such as incresead length of hospital stay, high costs, the emergence os multidrug-resistant bactéria, and intestinal dysbiosis, which has a potential impacto n the underlying disease.

Acute Kidney Injury after Bone Marrow Transplantation in Patients with Lymphomas and Leukemias / Lesão Renal Aguda após Transplante de Medula Óssea em Pacientes com Linfomas e Leucemias Insuficiencia Renal Aguda tras / Trasplante de Médula Ósea en Pacientes con Linfomas y Leucemias

Introduction: Hematologic malignancies, including lymphomas and leukemias, may be treated with autologous or allogeneic bone marrow transplantation. However, these approaches can increase the risk of infection, sepsis, graft-versus-host disease, and nephrotoxicity, possibly resulting in acute kidney injury (AKI). Objective: To evaluate AKI in patients with lymphomas or leukemia submitted to bone marrow transplantation (BMT). Method: Retrospective, observational cohort study of cases from a database of 256 patients (53.9% males) hospitalized for BMT between 2012 and 2014 at a cancer hospital in São Paulo, Brazil. Of these, 79 were selected randomly for analysis. Demographic data, length of hospitalization, and associated morbidities were recorded. AKI was identified according to Kidney Diseases Improving Global Outcomes (KDIGO) criteria. Results: The most frequent diagnoses for the 79 cases were non-Hodgkin's lymphoma (30.4%), acute myeloid leukemia (26.6%), and Hodgkin's lymphoma (24.1%). The probability of 100 days-survival after BMT was 81%, and three years after BMT was 61%. In-hospital mortality was significantly higher among patients who presented AKI during hospitalization (p<0.001). However, there was no difference in overall life expectancy (p=0.770). Conclusion: A significant prevalence of AKI was found in patients with leukemia or lymphoma while they were hospitalized for BMT, resulting in significantly increased rates of in-hospital mortality. The presence of AKI during hospitalization was not associated with a subsequent reduction in life expectancy.

Introdução: As neoplasias hematológicas, incluindo linfomas e leucemias, podem ser tratadas com transplante autólogo ou halogênico de medula óssea. No entanto, essas abordagens podem aumentar o risco de infecção, sepse, doença do enxerto contra o hospedeiro e nefrotoxicidade, possivelmente resultando em lesão renal aguda (LRA). Objetivo: Avaliar LRA em pacientes com linfomas ou leucemia submetidos a transplante de medula óssea (TMO). Método: Estudo de coorte observacional retrospectivo de casos de um banco de dados de 256 pacientes (53,9% do sexo masculino) internados por TMO entre 2012 e 2014 em um hospital oncológico de São Paulo, Brasil. Destes, 79 prontuários foram selecionados aleatoriamente para análise. Dados demográficos, tempo de internação e morbidades associadas foram registrados. A LRA foi identificada de acordo com os critérios de Kidney Diseases Improving Global Outcomes (KDIGO). Resultados: Os diagnósticos mais frequentes da amostra de 79 casos foram linfoma não Hodgkin (30,4%), leucemia mieloide aguda (26,6%) e linfoma de Hodgkin (24,1%). A probabilidade de sobrevivência em 100 dias após o TMO foi de 81% e, em três anos após o TMO, foi de 61%. A mortalidade intra-hospitalar foi significativamente maior entre os pacientes que apresentaram LRA durante a internação (p<0,001). No entanto, não houve diferença na expectativa de vida geral (p=0,770). Conclusão: Neste estudo, observou-se prevalência significativa de LRA em pacientes com leucemia ou linfoma durante a internação por TMO, resultando em aumento significativo das taxas de mortalidade intra-hospitalar. A presença de LRA durante a hospitalização não se associou a uma subsequente redução da expectativa de vida

Introducción: Las neoplasias malignas hematológicas, incluidos los linfomas y las leucemias, pueden tratarse con trasplante autólogo o alogénico de médula ósea. Sin embargo, estos enfoques pueden aumentar el riesgo de infección, sepsis, enfermedad de injerto contra huésped y nefrotoxicidad, lo que posiblemente provoque lesión renal aguda (IRA). Objetivo: Evaluar el FRA en pacientes con linfomas o leucemias sometidos a trasplante de médula ósea (TMO). Método: Se realizó un estudio de cohorte observacional retrospectivo de casos de una base de datos de 256 pacientes (53,9% hombres) hospitalizados por TMO entre 2012 y 2014 en un hospital de cáncer en São Paulo, Brasil. De estos, 79 registros fueron seleccionados aleatoriamente para su análisis. Se registraron los datos demográficos, la duración de la hospitalización y las morbilidades asociadas. La IRA se identificó según los criterios de Kidney Diseases Improving Global Outcomes (KDIGO). Resultados: Los diagnósticos más frecuentes en la muestra de 79 casos fueron linfoma no Hodgkin (30,4%), leucemia mieloide aguda (26,6%) y linfoma de Hodgkin (24,1%). La probabilidad de supervivencia 100 días después del BMT fue del 81% y tres años después del BMT fue del 61%. La mortalidad hospitalaria fue significativamente mayor entre los pacientes que presentaron FRA durante la hospitalización (p<0,001). Sin embargo, no hubo diferencia en la esperanza de vida global (p=0,770). Conclusión: En este estudio, se observó una prevalencia significativa de LRA en pacientes con leucemia o linfoma mientras estaban hospitalizados por TMO, lo que resultó en un aumento significativo de las tasas de mortalidad hospitalaria. La presencia de FRA durante la hospitalización no se asoció con una reducción posterior de la esperanza de vida.

Como Deve Ser um Material Educativo? Percepção dos Familiares de Crianças com Leucemia / How an Educational Material Would Be Like? Perceptions of Relatives of Children with Leukemia

Introdução: A criança com leucemia, quando no domicílio, requer cuidados especiais. Nesse contexto, os familiares deparam-se com demandas de cuidados que precisam ser aprendidas em função da condição clínica de sua criança. Este artigo é um recorte da pesquisa "As demandas de aprendizagem dos familiares de crianças com leucemia para o cuidado domiciliar". Objetivo: Conhecer as percepções de familiares de crianças com leucemia sobre a proposta de construção de materiais educativos para o cuidado domiciliar e descrever os temas que os familiares julgarem significativos na composição desses materiais. Método: Estudo participativo desenvolvido em uma enfermaria de hematologia infantil no Rio de Janeiro. A teoria utilizada para fundamentar o estudo foi a educação problematizadora de Paulo Freire. Os dados foram coletados por meio de três círculos de discussão e, posteriormente, examinados a partir da análise de conteúdo de Bardin. Resultados: Oito familiares de crianças com leucemia participaram do estudo. Duas categorias emergiram: "a proposta de construção de materiais educativos para o cuidado domiciliar" e "temas relevantes para compor os materiais educativos". Conclusão: Considerar a percepção dos familiares na construção de material educativo pode contribuir de maneira assertiva na escolha de conteúdos e na forma de abordá-los, e ser uma estratégia mais eficaz nesse processo contínuo da educação em saúde dos familiares das crianças com leucemias.

Introduction: The child with leukemia, when at home, requires special care. In this context, family members are faced with care-related demands that need to be learned due to their child´s clinical condition. This article is part of the research "The learning demands of family members of children with leukemia for home care". Objective: To know the perceptions of family members of children with leukemia about the proposal to build education materials for home care and describe the themes that family members considered significant in the composition of these materials. Method: Participatory study developed in a children's hematology ward in Rio de Janeiro. Paulo Freire´s problematizing education was the theory utilized to support the study. Data were collected through three discussion circles, and subsequently examined using Bardin´s content analysis. Results: Eight family members of children with leukemia participated in the study. Two categories emerged: The proposal for the construction of education materials for home care and relevant themes to compose the educational materials. Conclusion: Considering the perception of family members in the construction of educational material can make an assertive contribution in choosing content, and how to approach them, and be a more effective strategy in this continuous process of health education for relatives of children with leukemias.

Introducción: El niño con leucemia, cuando está en casa, requiere cuidados especiales. En este contexto, los familiares se enfrentan a demandas de cuidado que necesitan ser aprendidas debido a la condición clínica de su hijo. Este artículo forma parte de la investigación "Las demandas de aprendizaje de los familiares de niños con leucemia para el cuidado domiciliario". Objetivo: Conocer las percepciones de los familiares de niños con leucemia sobre la propuesta de elaboración de materiales educativos para el cuidado domiciliario y describir los temas que los familiares consideraron significativos en la composición de materiales educativos. Método: Estudio participativo desarrollado en una sala de hematología infantil de Río de Janeiro, teniendo como base la teoría de la educación problematizadora de Paulo Freire. Los datos fueron recolectados a través de tres círculos de discusión y, posteriormente, analizados mediante el análisis de contenido de Bardin. Resultados: Participaron del estudio ocho familiares de niños con leucemia. Emergieron dos categorías: La propuesta de construcción de materiales educativos para la atencíon domiciliaria y temas relevantes para componer los materiales educativos. Conclusión: Considerar la percepción de los familiares en la construcción del material educativo puede contribuir asertivamente en la elección de los contenidos, en la forma de abordarlos, y ser una estrategia más efectiva en este proceso continuo de educación en salud para los familiares de niños con leucemia.

Influência da religiosidade/espiritualidade em cuidadores informais de crianças com leucemia / Influence of religiosity/spirituality on informal caregivers of children with leukemia / Influencia de la religiosidad/espiritualidad en cuidadores informales de niños con leucemia

Resumo Perante diagnóstico e tratamento de doença grave em crianças, incluindo a oncológica, os pais, em especial as mães, tendem a assumir integralmente as demandas de cuidados, necessitando desenvolver estratégias de enfrentamento situacional. Nesse sentido, este estudo descritivo e transversal objetivou identificar o uso do coping religioso/espiritual em cuidadores informais de crianças com leucemia linfoide aguda mediante aplicação da escala de coping religioso/espiritual breve. Participaram 30 cuidadores informais, que apresentaram coping religioso/espiritual alto (média=3,90; Dp=0,34) na modalidade positiva (média=3,67; Dp=0,48). Por fim, identificou-se que as mães utilizam coping religioso/espiritual para lidar com a demanda de cuidados a elas imposta, vinculada à condição de saúde da criança. Com isso, reforça-se a possibilidade de utilizar a espiritualidade e/ou a religiosidade como indicadores de bem-estar físico e mental, visto que a qualidade dos cuidados prestados está intimamente relacionada à saúde de quem cuida.

Abstract Faced with diagnosis and treatment of serious illness in children, including oncology, parents, especially mothers, tend to fully assume the demands of care and, consequently, must develop situational coping strategies. In this regard, this descriptive and cross-sectional study sought to identify the use of religious/spiritual coping by informal caregivers of children with acute lymphoid leukemia via the Brief Religious/Spiritual Coping (SRCOPE) scale. A total of 30 informal caregivers participated in the study, presenting high religious/spiritual coping (mean=3.90; SD=0.34) regarding positive methods (mean=3.67; SD=0.48). Finally, results show that mothers use religious/spiritual coping deal with the imposed demands for care, linked to the child's health condition. This reinforces the possibility of using spirituality and or religiosity as indicators of physical and mental well-being, since the quality of care is closely related to the caregivers' health.

Resumen Ante el diagnóstico y tratamiento de una enfermedad grave en niños como el cáncer, los padres, sobre todo las madres, tienden a asumir plenamente las demandas de cuidado, por lo que necesitan desarrollar estrategias de afrontamiento de la situación. Este estudio descriptivo y transversal tuvo por objetivo identificar el uso de coping religioso/espiritual en los cuidadores informales de niños con leucemia linfocítica aguda mediante la aplicación de la escala de coping religioso/espiritual breve. Participaron 30 cuidadores informales, quienes presentaron un alto coping religioso/espiritual (media=3,90; DE=0,34) en la modalidad positiva (media=3,67; DE=0,48). Se identificó que las madres utilizan coping religioso/espiritual para hacer frente a la demanda de cuidados que realizan, relacionada al estado de salud del niño. Esto refuerza la posibilidad de utilizar la espiritualidad y/o la religiosidad como indicadores de bienestar físico y mental, ya que la calidad de la asistencia prestada está relacionada directamente con la salud del cuidador.

Aspectos clínicos do câncer durante o período gestacional: desafios diagnósticos e terapêuticos / Clinical aspects of cancer during the gestational period: diagnostic and therapeutic challenges

O câncer é uma das maiores causas de morte em mulheres na idade reprodutiva e ocorre em aproximadamente 0,05% a 0,1% das gestações. Os cânceres ginecológicos, de mama, tireoide e hematológicos são os mais comuns na gravidez. O obstetra é o principal médico para investigar sintomas que podem estar relacionados à malignidade. O diagnóstico pode ser dificultado devido à sobreposição de sintomas da gravidez, como náusea, vômitos, aumento do útero e das mamas, dor abdominal, além da limitação para uso de exames de imagem e alterações comuns em exames laboratoriais. O risco e o benefício do diagnóstico e o tratamento para o bem-estar materno e fetal devem ser avaliados com cuidado pelos profissionais envolvidos. Este artigo tem como objetivo realizar uma revisão sobre quando suspeitar e como investigar os principais cânceres na gestação.(AU)

Cancer is the major cause of death in women on reproductive age and occurs in approximately 0.05% to 0.1% of pregnancies. Gynecological, breast, thyroid and hema- tological cancers are the most common in pregnancy. The obstetrician is the primary physician to investigate symptoms that may be related to malignancy. The diagnosis can be difficult due to the overlap of pregnancy symptoms, such as nausea, vomiting, enlargement of the uterus and breasts, abdominal pain, in addition to the limitation for the use of imaging tests and common changes in laboratory tests. The risk and be- nefit of diagnosis and treatment for maternal and fetal well-being should be carefully assessed by the professionals involved. This article aims to conduct a review on when to suspect and how to investigate the main cancers in pregnancy.(AU)

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Virus de la leucemia e inmunodeficiencia felina: un estudio retrospectivo en clínicas veterinarias particulares en Bogotá y Chía (Colombia), 2015-2019 / Leukemia viruses and feline immunodeficiency: a retrospective study in private veterinary clinics in Bogotá and Chía (Colombia), 2015-2019

Resumen Los virus de inmunodeficiencia y leucemia felina representan un problema de gran envergadura para los felinos domésticos debido a la multiplicidad de sintomatologías que manifiestan. El objetivo del presente estudio fue establecer, retrospectivamente, la prevalencia en la presentación de ViLeF y VIF en pacientes de seis clínicas de pequeños animales en Bogotá y Chía, en relación con factores como su edad, raza y género. Se realizó un estudio transversal y retrospectivo, mediante la recopilación de datos de 1.014 historias clínicas de pacientes felinos que ingresaron a seis clínicas de la ciudad de Bogotá y Chía, para determinar la prevalencia de VIF y ViLeF y la asociación de estas con factores como edad, género y raza, entre 2015 y 2019, a través de la prueba OR. La detección de los virus se realizó mediante una prueba rápida basada en inmunocromatografía. La mayor prevalencia para cada enfermedad por año fue: 12,3% para VIF en 2012 y 18% para ViLeF en 2019. Los machos presentaron mayores seroprevalencias para ambas enfermedades durante la mayoría los años evaluados. Factores como raza (criolla: VIF: 1,85; ViLeF: 2,01), género (macho: VIF: 1,53 OR; ViLeF: 1,64) y edad (> 7 años: VIF: 3,82; ViLeF: 3,21) se relacionaron positivamente con la presentación de ambas enfermedades en la población felina evaluada.

Abstract Immunodeficiency virus and feline leukemia virus represent major problems for domestic felines due to the multiplicity of symptoms they manifest. The objective of the present study was to establish, retrospectively, the prevalence in the presentation of FeLV and FIV in patients from six small animal clinics in Bogota and Chia, related to factors such as age, race, and gender. A cross-sectional and retrospective study was carried out, collecting data from 1.014 clinical records of feline patients who were admitted to six clinics in the city of Bogota and Chia, to determine the prevalence of FIV and FeLV and their association with factors such as age, gender, and race, between 2015 and 2019 through the OR test. The detection of the viruses was carried out through a rapid test based on immunochromatography. The highest prevalence for each disease per year was 12,3% for FIV in 2012 and 18% for FeLV in 2019. Males presented higher seroprevalences for both diseases during most of the years evaluated. Factors such as race (Creole: FIV: 1,85; FeLV: 2,01), gender (male: FIV: 1.53 OR, FeLV: 1,64), and age (> 7 years: FIV: 3.82; FeLV: 3.21) were positively related to the presentation of both diseases in the feline population evaluated.

Calidad de vida en pacientes pediátricos tratados con quimioterapia por diagnóstico de leucemia linfoblástica aguda / Quality of life in pediatric patients treated with chemotherapy for the diagnosis of acute lymphoblastic leukemia

La leucemia es una patología neoplásica maligna que constituye un problema de salud que afecta fundamentalmente a la población infantil. Así, se realizó un proceso investigativo con el objetivo de describir la calidad de vida en pacientes pediátricos de LLA con edades entre 2 y 18 años, atendidos en 2019, en el Hospital Pediátrico Baca Ortiz y en el Hospital de Solca - Núcleo Quito, Ecuador; para lo cual se hizo un estudio observacional, transversal, descriptivo, con enfoque cuantitativo. Los datos fueron recopilados mediante la revisión de las historias clínicas de los 60 pacientes en el contexto de investigación. El 66,7% correspondió al sexo masculino, el 43,3% tenía edades entre 2 y 4 años, el 38,3% tuvo fiebre como síntoma inicial. El síndrome de Down resultó la comorbilidad más frecuente (6,7%). En 54 pacientes se diagnosticó LLA tipo B. El 66,7% recibía terapia psicológica, 22 de los enfermos estaban en la fase de inducción y mantenimiento. El 65% abandonó la escuela mientras se le administraba quimioterapia. Predomina-ron los que consideraron su calidad de vida como buena, seguido de los que tuvieron severa afectación. Las mayores afectaciones en los participantes fueron: dificultades con la alimentación, presencia de dolor, falta de comunicación, existencia de ansiedad y presencia de estrés por la preocupación debido a la posible infectividad del tratamiento.

Leukemia is a malignant neoplastic disease that constitutes a health problem that mainly affects children. Thus, this research aimed to describe the quality of life in pediatric ALL patients between 2 and 18 years of age, treated in 2019, at the Baca Ortiz Pediatric Hospital and at the Solca Hospital - Núcleo Quito, Ecuador. A cross-sectional, descriptive, and observational study with a quantitative approach. Data were collected by reviewing the medical records of the 60 patients in the research context. 66.7% were male, 43.3% were between 2 and 4 years old, 38.3% had fever as the initial symptom. Down syndrome was the most frequent comorbidity (6.7%). Type B ALL was diagnosed in 54 patients. 66.7% received psychological therapy. 22 of the patients were in the induction and maintenance phase. 65% dropped out of school while recei-ving chemotherapy. Those ones who considered their quality of life as good predominated, followed by those ones who were severely affected. The greatest effects on the participants were: difficulties with feeding, presence of pain, lack of communication, existence of anxiety and presence of stress due to worry due to the possible infectivity of the treatment.

Can SARS-CoV-2 induce hematologic malignancies in predisposed individuals? A case series and review of the literature

Abstract Introduction Coronavirus disease 2019 (COVID-19) may present with extrapulmonary manifestations, including hematologic changes. Previous studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can interact with the renin-angiotensin system, ultimately causing increased production of angiotensin II. By reporting the cases of previously healthy young adults diagnosed with a hematologic malignancy after experiencing COVID-19, we raise the hypothesis that the SARS-Cov-2 infection could act as a trigger for leukemogenesis in predisposed individuals. Methods This was a case series performed through extraction of relevant clinical information from the medical records of three patients admitted to our Hematology unit between August 2020 and September 2020. Main Results Considering the relatively rapid development of cytopenias following recovery from COVID-19, it cannot be ruled out that SARS-Cov-2 played a role in leukemogenesis in those patients. Based on previous in vitro studies, the renin-angiotensin system imbalance induced by SARS-CoV-2 could potentially promote in vivo leukemogenesis through several mechanisms. Conclusion Despite the advances in pathophysiological and clinical characterization of COVID-19, the consequences of the pandemic to the incidence of hematologic diseases are still to be elucidated. In this context, future dissection of the status of the local bone marrow renin-angiotensin system in leukemogenesis is a clinically relevant basic research area.

Trabalho rural associado a cânceres linfohematopoiéticos em hospital público de referência: estudo caso-controle, Ceará, Brasil, 2019-2021 / Rural labor associated with lymphohematopoietic cancers in a public reference hospital: a case-control study, Ceará, Brazil, 2019-2021 / Trabajo rural asociado a cánceres linfohematopoyéticos en un hospital público de referencia: estudio de caso control, Ceará, Brasil, 2019-2021

Trata-se de um estudo do tipo caso-controle pareado com o objetivo de verificar a associação entre ocupações e cânceres linfohematopoiéticos em um hospital público de referência no Estado do Ceará, Brasil, durante 2019-2021. O grupo caso foi constituído por pacientes hematológicos que apresentavam mieloma múltiplo, leucemias ou linfomas não Hodgkin, acompanhados pelo serviço social de uma unidade hospitalar de transplante de medula óssea (n = 114), enquanto indivíduos comparáveis de unidade hospitalar distinta constituíram o grupo controle (n = 114), formando pares 1:1. O diagnóstico foi efetuado por equipe médica e as variáveis foram aferidas por acesso aos registros hospitalares. Comparamos os grupos em regressão logística condicional bivariada e ajustada por região de residência. Entre os resultados, destacamos que o câncer de maior prevalência no grupo caso foi o mieloma múltiplo (43,9%), seguido pelas leucemias (43%) e por linfomas não Hodgkin (13,2%). Proporções de ocupações, zona de residência, abastecimento de água e Superintendência Regional de Saúde de residência apresentaram diferença estatisticamente significante entre os grupos caso e controle. Verificamos que trabalhadores rurais possuíam maiores chances de apresentar os cânceres estudados (ORbruto = 5,00, IC95%: 1,91; 13,06 e ORajustado = 3,38, IC95%: 1,20; 9,54), enquanto trabalhadores do comércio apresentaram menores chances (ORbruto = 0,26, IC95%: 0,10; 0,70 e ORajustado = 0,30, IC95%: 0,10; 0,88). Os achados deste estudo possibilitam reflexões sobre o processo de adoecimento dos trabalhadores rurais e refletem o potencial dos serviços de saúde em contribuir com investigações sobre exposições ocupacionais.

This is a paired case-control study that sought to verify the association between professions and lymphohematopoietic cancers in a public reference hospital in the State of Ceará, Brazil, during 2019-2021. Case group consisted of hematological patients with multiple myeloma, leukemias or non-Hodgkin lymphomas, monitored by the social service of a bone marrow transplant hospital unit (n = 114), whereas comparable individuals from a different hospital unit made up the control group (n = 114), forming 1:1 pairs. Diagnosis was performed by a medical team and the variables were measured by accessing hospital records. Group comparison was conducted using bivariate conditional logistic regression and adjusted by region of residence. Results show that multiple myeloma (43.9%), leukemias (43%) and non-Hodgkin lymphomas (13.2%) were the cancer with the highest prevalence in the case group. Proportions of jobs, area of residence, water supply and Regional Superintendence of Health showed statistically significant difference between the case and control groups. Rural workers were more likely to present the cancers studied (ORraw = 5.00, 95%CI: 1.91; 13.06 and ORadjusted = 3.38, 95%CI: 1.20; 9.54), whereas trade workers had lower odds (ORraw = 0.26, 95%CI: 0.10; 0.70 and ORadjusted = 0.30, 95%CI: 0.10; 0.88). The findings allow us to reflect on the process of illness among rural workers and illustrate the potential of health services to contribute to investigations on occupational exposures.

Se trata de un estudio del tipo caso control apareado con el objetivo de verificar la asociación entre ocupaciones y cánceres linfohematopoyéticos en un hospital público de referencia en el estado de Ceará, Brasil, durante el período 2019-2021. El grupo caso estaba formado por pacientes hematológicos que presentaban mieloma múltiple, leucemias o linfomas no Hodgkin, bajo seguimiento por parte del servicio social de una unidad hospitalaria de trasplante de médula ósea (n = 114), mientras que individuos comparables de otra unidad hospitalaria constituyeron el grupo control (n = 114), formando pares 1:1. El diagnóstico fue realizado por un equipo médico, y las variables se midieron accediendo a los registros hospitalarios. Comparamos los grupos en regresión logística condicional bivariada y ajustada por región de residencia. Entre los resultados, destacamos que el cáncer de mayor prevalencia en el grupo caso fue el mieloma múltiple (43,9%), seguido de las leucemias (43%) y los linfomas no Hodgkin (13,2%). Las proporciones de ocupaciones, zona de residencia, abastecimiento de agua y Superintendencia Regional de Salud de residencia presentaron diferencia estadísticamente significativa entre los grupos caso y control. Constatamos que los trabajadores rurales tenían más probabilidades de padecer los cánceres estudiados (ORcrudo = 5,00, IC95%: 1,91; 13,06 y ORajustado = 3,38, IC95%: 1,20; 9,54), mientras que los trabajadores del comercio presentaron menos posibilidades (ORcrudo = 0,26, IC95%: 0,10; 0,70 y ORajustado = 0,30, IC95%: 0,10; 0,88). Los hallazgos de este estudio permiten reflexiones sobre el proceso de enfermedad de los trabajadores rurales y reflejan el potencial de los servicios de salud para contribuir a las investigaciones sobre exposiciones ocupacionales.

Temas para Construção de Material Educativo sobre Alimentação da Criança com Leucemia / Themes for the Construction of Educational Material about Feeding Children with Leukemia / Temas para la Construcción de Material Educativo sobre Alimentación de Niños con Leucemia

Introdução: A alimentação é um tema que gera muitas dúvidas nos familiares de crianças com leucemia, e os materiais educativos são fundamentais para preparar e orientar esses cuidadores para o cuidado domiciliar. Objetivo: Identificar os temas sobre a alimentação da criança com leucemia sob a ótica de enfermeiros e familiares cuidadores para construção de material educativo. Método: Pesquisa qualitativa participativa realizada em 2018 por meio de círculos de discussão, em um hospital oncológico no Rio de Janeiro-RJ, com seis familiares e seis enfermeiros, após aprovação dos Comitês de Ética em Pesquisa. Os dados foram analisados pelo método da análise de conteúdo na modalidade temático-categorial. Resultados: As falas dos familiares e enfermeiros subsidiaram o conteúdo para construção de materiais educativos, como cartilha, apontando a necessidade de orientações sobre alimentação oferecida à criança, destacando os seguintes temas: imunidade normal; neutropenia; náuseas e vômitos; mucosite; disgeusia; constipação; diarreia; higiene e forma de preparo dos alimentos. Conclusão: A construção de material educativo para familiares de crianças com leucemia poderá contribuir para sanar as dúvidas dos familiares, uma vez que permitirá aos enfermeiros orientá-los durante a internação de sua criança, servindo posteriormente como um guia para o desenvolvimento dos cuidados de sua criança no domicílio

Introduction: Food is a theme that raises many doubts in family members of children with leukemia and educational materials are essential to prepare and guide these caregivers for home care. Objective: To identify the topics on feeding children with leukemia from the perspective of nurses and family caregivers for the construction of educational material. Method: Qualitative participatory research conducted in 2018 through discussion circles, in an oncology hospital in Rio de Janeiro-RJ, with 6 family members and 6 nurses, after approval by the Institutional Review Board. The data were analyzed using the content analysis method in the thematic-categorical modality. Results: The narratives of family members and nurses were utilized to elaborate the content for the construction of educational materials such as primes, pointing out the need for guidance on food offered to the child, focusing on the following themes: normal immunity; neutropenia; nausea and vomiting; mucositis; dysgeusia; constipation; diarrhea; hygiene and food preparation. Conclusion: The construction of educational material for family members of children with leukemia may help to respond to their doubts, since it will enable nurses to guide them during the hospitalization, and later working as a guide for the development of their child's home care

Introducción: La alimentación es un tema que genera muchas dudas en los familiares de los niños con leucemia y los materiales educativos son fundamentales para preparar y orientar a estos cuidadores para el cuidado domiciliario. Objetivo: Identificar los temas de alimentación infantil con leucemia desde la perspectiva de enfermeras y cuidadores familiares para la construcción de material educativo. Método: Investigación cualitativa participativa realizada en 2018 a través de círculos de discusión, en un hospital oncológico de Rio de Janeiro-RJ, con seis familiares y seis enfermeros, previa aprobación de los Comités de Ética en Investigación. Los datos fueron analizados mediante el método de análisis de contenido en la modalidad temática-categórica. Resultados: Los discursos de familiares y enfermeras fueron utilizados para elaborar contenido para la construcción de materiales educativos como el cuadernillo, señalando la necesidad de orientación sobre la alimentación ofrecida al niño, centrándose en los siguientes temas: inmunidad normal; neutropenia náuseas y vómitos; mucositis; disgeusia; constipación; diarrea; higiene y forma de preparación de los alimentos. Conclusión: La construcción de material educativo para familiares de niños con leucemia puede ayudar a resolver las dudas, ya que permitirá al enfermero orientarlos durante la hospitalización de su hijo, sirviendo posteriormente como guía para el desarrollo del cuidado en el domicilio