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Organ Transplantation ; (6): 120-2022.
Article in Chinese | WPRIM | ID: wpr-907042


Graft-versus-host disease (GVHD) is a major cause that prevents widespread application of allogeneic hematopoietic stem cell transplantation. GVHD is a complication that can affect all systems of the body, such as skin, liver, lung and gastrointestinal tract, among which skin is the most vulnerable organ. At present, the pathogenesis of skin GVHD has not been fully elucidated, and no effective treatment has been established. Severe or extensive chronic GVHD significantly affects the quality of life of the recipients. Consequently, it is urgent to unravel the pathogenesis of skin GVHD and explore novel therapeutic treatment. Cytokines, such as interleukin (IL)-22, IL-17, IL-6 and interferon (IFN)-γ, have been proven to play pivotal roles in the progression of skin GVHD. Nevertheless, the specific mechanism remains elusive. In this article, research progresses at home and abroad on the mechanism underlying the roles of these cytokines in skin GVHD were reviewed, aiming to provide novel ideas for the prevention and treatment of skin GVHD.

Article in Chinese | WPRIM | ID: wpr-904710


Objective@#To investigate the effects of apoptotic bodies (ABs) derived from dental pulp stem cells (DPSCs) on macrophage polarization and inflammation response in vivo. @*Methods @#Human DPSCs were extracted, cultured and identified. Staurosporine was used to apoptosis induction and differential methods were performed for ABs identification. The in vitro cultured macrophages were divided into 3 groups: solvent control, lipopolysaccharide (LPS), and the LPS+ABs. The macrophages were stimulated with LPS to induce inflammation followed by ABs treatment. In the untreated group, macrophages were added with an equal amount of solvent. The specific uptake of ABs by macrophages, the expression level of CD206 and the levels of inflammatory cytokines were analyzed. The mouse models of cutaneous wounds and dextran sulfate sodium (DSS)-induced colitis were established, and the mice were randomly divided into 3 groups: the PBS-treated group, the DPSCs-treated group, and the ABs-treated group. The mice were injected with the same volume of PBS, DPSCs and ABs, respectively. The body weight, histological pathology, the expression levels of CD206 and cytokines, and the extent of tissue regeneration were measured.@* Results @#DPSCs and ABs derived from DPSCs were successfully isolated and characterized. ABs could be taken up by macrophage. While lipopolysaccharide(LPS) induced production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), ABs significantly reduced the levels of these pro-inflammatory cytokines and increased the expression of transforming growth factor-β (TGF-β) and CD206 (P < 0.01). In the cutaneous inflammatory wound model, the wound closure rate in mice intravenously injected with ABs was significantly accelerated (P < 0.05). The administration of ABs markedly reduced the pro-inflammatory factors levels and increased the CD206+ cell number. In the colitis model, treatment with ABs markedly reduced the loss in bodyweight (P < 0.05), recovered the colon length (P < 0.01), and significantly increased the CD206+ cell number.@* Conclusion@# DPSCs-derived ABs could enhance macrophage M2 polarization and attenuate inflammation. Therefore, ABs could be used as a promising cell replacement for inflammatory regulation and tissue regeneration.

Organ Transplantation ; (6): 253-2022.
Article in Chinese | WPRIM | ID: wpr-920857


Ocular graft-versus-host disease is one of the common complications after hematopoietic stem cell transplantation. Dry eye is the main clinical manifestation. Severe complications, such as corneal ulcer perforation and ocular surface failure may occur along with the progression of ocular graft-versus-host disease, which affects the visual acuity and quality of life of the patients. At present, multiple international researches and clinical guidelines for adult ocular graft-versus-host disease have been available. Nevertheless, pediatric ocular graft-versus-host disease has captivated insufficient attention, and relevant basic data and diagnostic criteria are still lacking. Children possess limited capability to express ocular symptoms, and lack of cooperation in clinical examination. In addition, ophthalmologists have insufficient understanding of this disease, which collectively increase the risk of missing diagnosis and misdiagnosis. In this article, the research progress on the pathogenesis, incidence, risk factors, clinical manifestations, diagnosis and treatment of pediatric ocular graft-versus-host disease was reviewed, aiming to provide ideas for strengthening clinical trials and expanding basic research of this disease in children.

Organ Transplantation ; (6): 187-2022.
Article in Chinese | WPRIM | ID: wpr-920848


Allogeneic hematopoietic stem cell transplantation (allo-HSCT) could effectively treat multiple hematological diseases. At present, with persistent improvement of transplantation techniques and rapid development of economy, more and more patients with hematological diseases are able to survive for a long time due to allo-HSCT treatment. Chronic ocular graft-versus-host disease (coGVHD) is the most common ocular complication after allo-HSCT, which is primarily manifested with refractory dry eye. In severe cases, it may cause imbalance of ocular surface homeostasis and limbal stem cell insufficiency, further leading to a series of complications that threaten the visual function and eye health, such as corneal perforation and symblepharon, etc. It is highly difficult to cure these symptoms. At present, relevant studies of clinical manifestations, diagnostic criteria, treatment specification and pathogenesis of coGVHD have been gradually deepened within the international community. However, related research and the establishment of clinical specification are still in the primary stage in China. In this article, research progress on clinical characteristics and related mechanisms of coGVHD was reviewed, aiming to deepen the understanding of this disease by ophthalmologists, especially specialists in corneal and ocular surface diseases, and provide novel ideas for subsequent in-depth research.

Rev. bras. enferm ; 75(4): e20210488, 2022. tab
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1365632


ABSTRACT Objectives: to describe the use of the International Classification for Nursing Practice (ICNP®) in the construction of a nursing care protocol for children undergoing hematopoietic stem cell transplantation. Methods: experience report. Results: nursing problems were defined based on complications identified in a previous study; later, the ICNP® enabled the organization and systematization of childcare. The care protocol consists of 40 nursing problems, with their human needs affected, diagnoses and nursing interventions. The axes Focus, Judgment, Location, Action, Means, Time, and Client were used in the elaboration of diagnoses and interventions proposed in the protocol. Final Considerations: the use of the classification allowed the establishment of nursing interventions compatible with the needs of the child undergoing transplantation, providing support for the care protocol. It made it possible to encourage the use of classification in this context, contribute to patient safety and strengthen professional practice.

RESUMEN Objetivos: describir utilización de la Clasificación Internacional para la Práctica de Enfermería (CIPE®) en la construcción de protocolo de cuidados de enfermería al niño sometido al trasplante de células madre hematopoyéticas. Métodos: relato de experiencia. Resultados: los problemas de enfermería delimitados basados en complicaciones identificadas en estudio anterior; posteriormente, la CIPE® posibilitó la organización y sistematización del cuidado al niño. Protocolo de cuidados es compuesto por 40 problemas de enfermería, con respectivas necesidades humanas afectadas, diagnósticos e intervenciones de enfermería. Ejes Enfoque, Juicio, Ubicación, Acción, Medios, Tiempo y Cliente utilizados en la elaboración de diagnósticos e intervenciones propuestos en el protocolo. Consideraciones Finales: utilización de la clasificación permitió el establecimiento de intervenciones de enfermería compatibles con las necesidades del niño sometido al trasplante, ofreciendo sostenimiento al protocolo de cuidados. Posibilitó incitar el uso de la clasificación en ese contexto, contribuir con la seguridad del paciente y fortalecer la práctica profesional.

RESUMO Objetivos: descrever a utilização da Classificação Internacional para a Prática de Enfermagem (CIPE®) na construção de protocolo de cuidados de enfermagem à criança submetida ao transplante de células-tronco hematopoiéticas. Métodos: relato de experiência. Resultados: os problemas de enfermagem foram delimitados com base em complicações identificadas em estudo anterior; posteriormente, a CIPE® possibilitou a organização e sistematização do cuidado à criança. O protocolo de cuidados é composto por 40 problemas de enfermagem, com respectivas necessidades humanas afetadas, diagnósticos e intervenções de enfermagem. Os eixos Foco, Julgamento, Localização, Ação, Meios, Tempo e Cliente foram utilizados na elaboração de diagnósticos e intervenções propostos no protocolo. Considerações Finais: o uso da classificação permitiu o estabelecimento de intervenções de enfermagem compatíveis com as necessidades da criança submetida ao transplante, fornecendo sustentação ao protocolo de cuidados. Possibilitou incitar o uso da classificação nesse contexto, contribuir com a segurança do paciente e fortalecer a prática profissional.

Braz. oral res. (Online) ; 36: e016, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1360249


Abstract: The aim of the present study was to analyze the relationship of OM with possible risk factors such as oral health condition, immunological status and IL-1β profile in patients submitted to hematopoietic stem cell transplantation (HSCT). Fifty-four individuals submitted to HSCT were included. All patients received previous dental treatment and photobiomodulation (PBM) as the institutional OM preventive protocol. OM scores, immune status, and IL-1β levels were determined during the conditioning period and at D+3 and D+8 after HSC infusion. IL-1β gene polymorphism was also analyzed during conditioning. Possible associations of OM with risk factors were analyzed using conditional Fisher's exact test. OM was observed in 34 patients (62.9%) classified as Grade 1 (13 patients/24.1%), Grade 2 (14 patients/25.9%), Grade 3 (3 patients/5.5%), and Grade 4 (4 patients/7.4%). Allogeneic HSCT individuals exhibited a higher OM grade than autologous subjects. Moreover, an association was observed between severe OM and severe gingivitis (p = 0.01), neutropenia (p = 0.03), and leukopenia (p = 0.04). A significant association between OM and lower IL-1β levels was detected at three time points, i.e., conditioning (p = 0.048), D+3 (p = 0.01), and D+8 (p = 0.005). The results showed that IL-1β gene polymorphism was not associated with OM. Our study provided important insights into the scope of OM risk factors in the setting of HSCT. Patients submitted to HSCT with severe gingivitis prior to chemotherapy and with severe neutropenia and leukopenia exhibited a higher OM grade. Further investigation will be necessary to better understand the exact role of IL-1β in the context of OM pathobiology and to validate cytokine analysis in larger cohorts.

Acta Paul. Enferm. (Online) ; 35: eAPE03502, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1364238


Resumo Objetivo Construir e validar uma tecnologia informativa para famílias de crianças/adolescentes com câncer submetidos ao transplante de células-tronco hematopoiéticas. Métodos Estudo metodológico fundamentado no Modelo do Cuidado Centrado no Paciente e Família e User-Centered Design, realizado em quatro etapas: avaliação das necessidades de informações; construção teórica e desenvolvimento do aplicativo; validação de conteúdo e semântica pelo comitê de juízes e população-alvo; avaliação da usabilidade por experts em informática. Os participantes do estudo foram profissionais e famílias de crianças com câncer. Para a validação de conteúdo e semântica, estabeleceu-se percentual de concordância entre juízes de 80% e Índice de Validade de Conteúdo de 0,8. Para a avaliação da usabilidade foram utilizadas as heurísticas de Nielsen. Os dados foram analisados por meio de estatística descritiva. Resultados Após identificação das necessidades de informações da família, na literatura e no estudo de campo, e construção do aplicativo, este foi validado por especialistas, obtendo percentual de concordância de 87% e índice de validade de conteúdo de 0,87; e pela população-alvo, de 98% e 0,98, respectivamente. Quanto a usabilidade, atingiu o grau de severidade simples. O aplicativo móvel TMO-App apresenta 268 telas e 95 ilustrações, contemplando as necessidades de informações da família antes, durante e após o transplante. Conclusão Os métodos utilizados para o desenvolvimento e validação mostraram-se satisfatórios para atingir os objetivos propostos. O aplicativo construído é confiável, de fácil uso, útil, completo e adequado. O estudo avança na proposição de nova estratégia informativa para promover o empoderamento da família em situação de doença crônica.

Resumen Objetivo Elaborar y validar una tecnología informativa para familias de niños/adolescentes con cáncer sometidos al trasplante de células madre hematopoyéticas. Métodos Estudio metodológico fundamentado en el Modelo del Cuidado Centrado en el Paciente y la Familia y User-Centered Design, realizado en cuatro etapas: evaluación de las necesidades de información, construcción teórica y desarrollo de la aplicación, validación semántica y del contenido por el comité de jueces y el público destinatario, evaluación de usabilidad por especialistas en informática. Los participantes del estudio fueron profesionales y familias de niños con cáncer. Para la validación semántica y de contenido, se estableció un porcentaje de concordancia entre los jueces del 80 % y un Índice de Validez de Contenido de 0,8. Para la evaluación de usabilidad se utilizaron las heurísticas de Nielsen. Los datos fueron analizados mediante estadística descriptiva. Resultados Después de identificar las necesidades de información de la familia, en la literatura y en el estudio de campo, y de elaborar la aplicación, esta fue validada por especialistas y obtuvo un porcentaje de concordancia del 87 % y un Índice de Validez de Contenido de 0,87. A su vez, los resultados del público destinatario fueron 98 % y 0,98, respectivamente. Respecto a la usabilidad, alcanzó un nivel de severidad simple. La aplicación móvil TMO-App presenta 268 pantallas y 95 ilustraciones que contemplan las necesidades de información de la familia antes, durante y después del trasplante. Conclusión Los métodos utilizados para el desarrollo y validación demostraron ser satisfactorios para alcanzar los objetivos propuestos. La aplicación elaborada es confiable, de fácil uso, útil, completa y adecuada. El estudio avanza en la propuesta de una nueva estrategia informativa para promover el empoderamiento de familias en situación de enfermedad crónica.

Abstract Objective To develop and validate an informative technology for families of children/adolescents with cancer undergoing hematopoietic stem cell transplantation. Methods A methodological study grounded on the Patient-and Family-Centered Care Model and User-Centered Design, conducted in four stages: assessment of information needs; theoretical construction and development of the mobile application; content and semantic validation by a committee of experts and target population; usability evaluation by computer experts. The participants of the study were professionals and families of children with cancer. For content and semantic validation, an inter-rater agreement percentage of 80% and a Content Validity Index of 0.8 were established. For usability evaluation, Nielsen's heuristics were used. The data were analyzed using descriptive statistics. Results After the information about the family's needs was obtained from the published literature and field study, the application was developed and validated by experts. Agreement of 87%, and a content validity index of 0.87, were achieved with the expert group; 98% and 0.98, respectively, with the target population. With regard to usability, the level of simple severity was reached. The BMT-App mobile application contains 268 screens and 95 illustrations, addressing the family's information needs before, during, and after transplantation. Conclusion The methods used for development and validation were satisfactory to achieve the intended objectives. The application constructed is reliable, easy to use, useful, complete, and adequate. The study advances the proposition of a new informative strategy to promote empowerment of the family confronting chronic disease.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Hematopoietic Stem Cell Transplantation , Mobile Applications , Neoplasms , Family/psychology , Epidemiology, Descriptive , Patient-Centered Care , Evaluation Studies as Topic
Enferm. foco (Brasília) ; 12(4): 753-759, dez. 2021. tab, ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-1353202


Objetivo: Construir uma cartilha educativa para orientações no cuidado na Doença do Enxerto Contra o Hospedeiro em pacientes submetidos ao Transplante de Células-Tronco Hematopoiéticas. Método: Pesquisa metodológica, dividida em três etapas. Na primeira, realizou-se revisão integrativa da literatura, na segunda etapa foram levantadas em manuais e websites especializados as orientações de cuidados realizadas a pacientes em pós-transplante, e na terceira etapa, através de entrevista semiestruturada foram identificados cuidados de enfermagem orientados por profissionais experts, atuantes em Serviço de Transplante de Medula Óssea. Após essas etapas e unificação dos cuidados, foi construída a cartilha educativa, com auxílio do programa Canva e suporte de profissional de marketing. Resultados: A cartilha utiliza de recursos visuais e é composta por orientações organizadas conforme o órgão acometido pela complicação, como pele, trato gastrointestinal, pulmão, boca, olho, entre outros. Como cuidados para a pele cita-se: evitar exposição ao sol; uso diário de protetor solar; uso de roupas de algodão e manga longa; atenção ao aparecimento de prurido corporal. Conclusão: A integração de evidências encontradas na literatura, informações de sites renomados e experiência de enfermeiros especialistas permitiu produzir um material de suporte às orientações para o cuidado, realizadas por enfermeiros, corroborando o processo de educação em saúde. (AU)

Objective: To build an educational booklet for guidance in the care of Graft Against Host Disease in patients undergoing Hematopoietic Stem Cell Transplantation. Methods: Methodological research, divided into three stages. In the first, an integrative literature review was carried out, in the second stage, the care guidelines for post-transplant patients were raised in specialized manuals and websites, and in the third stage, semi-structured interviews identified nursing care guided by professionals. experts, active in Bone Marrow Transplant Service. After these steps and unification of care, an educational booklet was built, with the help of the Canva program and support from a marketing professional. Results: The booklet uses visual aids and consists of guidelines organized according to the organ affected by the complication, such as skin, gastrointestinal tract, lung, mouth, eye, among others. As skin care is mentioned: avoid exposure to the sun; daily use of sunscreen; use of cotton clothes and long sleeves; attention to the appearance of body itching. Conclusion: The integration of evidence found in the literature, information from renowned websites and the experience of specialist nurses allowed the production of support material for the guidelines for care, carried out by nurses, corroborating the health education process. (AU)

Objetivo: Elaborar un folleto educativo para orientar en el cuidado del injerto contra la enfermedad del huésped en pacientes sometidos a trasplante de células madre hematopoyéticas. Metodos: Investigación metodológica, dividida en tres etapas. En la primera se realizó una revisión integradora de la literatura, en la segunda etapa se plantearon las pautas de atención al paciente postrasplante en manuales y sitios web especializados, y en la tercera etapa, las entrevistas semiestructuradas identificaron cuidados de enfermería guiados por profesionales. expertos, activos en el Servicio de Trasplante de Médula Ósea. Después de estos pasos y la unificación de la atención, se creó un folleto educativo, con la ayuda del programa Canva y el apoyo de un profesional de marketing. Resultados: El folleto utiliza ayudas visuales y consta de pautas organizadas según el órgano afectado por la complicación, como piel, tracto gastrointestinal, pulmón, boca, ojo, entre otros. Como se menciona el cuidado de la piel: evite la exposición al sol; uso diario de protector solar; uso de ropa de algodón y mangas largas; atención a la aparición de picazón corporal. Conclusión: La integración de evidencias encontradas en la literatura, información de sitios web de renombre y la experiencia de enfermeras especializadas permitió la producción de material de apoyo a los lineamientos de atención, realizados por enfermeras, corroborando el proceso de educación en salud. (AU)

Hematopoietic Stem Cell Transplantation , Nursing Methodology Research , Health Education , Graft vs Host Disease , Nursing Care
Rev. cuba. med ; 60(3): e2515, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347507


Introducción: El trasplante autólogo de progenitores hematopoyéticos es una terapéutica aplicable en determinadas situaciones a pacientes con Linfoma de Hodgkin. Objetivo: Evaluar la influencia de factores pronósticos seleccionados en los resultados del trasplante autólogo de progenitores hematopoyéticos en pacientes con Linfoma de Hodgkin. Métodos: Se realizó un estudio retrospectivo de 57 pacientes con diagnóstico de Linfoma de Hodgkin trasplantados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras entre 1991 y 2018. La influencia de varios factores desfavorables fue evaluada según sobrevida libre de enfermedad a los cinco años de forma univariada y multivariada. Resultados: Se comprobó una sobrevida libre de enfermedad menor para todos los grupos con las categorías desfavorables. El análisis univariado indicó que el haber recibido tres o más líneas de tratamiento previas, aumentó como promedio 3,48 veces la probabilidad de recaída. En la evaluación múltiple, aumentó de forma significativa la probabilidad de recaída la existencia de enfermedad activa al momento del trasplante (p= 0,023) y el no recibir radioterapia en el tratamiento acondicionante (p= 0,010). Conclusiones: Se demostró la importancia de conocer los factores desfavorables. Notable importancia tuvo evitar enfermedad activa al trasplante y realizar una correcta evaluación de riesgos y beneficios en cuanto a la posible inclusión de la radioterapia en el tratamiento acondicionante(AU)

Introduction: Autologous hematopoietic stem cell transplantation is a therapy used in certain situations to patients with Hodgkin's Lymphoma. Objective: To evaluate the influence of selected prognostic factors on the results of autologous hematopoietic stem cell transplantation in patients with Hodgkin's Lymphoma. Methods: A retrospective study of 57 patients with a diagnosis of Hodgkin Lymphoma transplanted at Hermanos Ameijeiras Clinical Surgical Hospital from 1991 to 2018 was carried out. The influence of several unfavorable factors was evaluated according to univariate and multivariate disease-free survival at five years. Results: A lower disease-free survival was found for all groups with unfavorable categories. Univariate analysis indicated that receiving three or more previous lines of treatment increased the probability of relapse on average 3.48 times. In the multiple evaluation, the probability of relapse was significantly increased by the existence of active disease at the time of transplantation (p = 0.023) and by not receiving radiotherapy in the conditioning treatment (p = 0.010). Conclusions: The importance of knowing the unfavorable factors was established. It was of noteworthy importance to avoid active disease at transplantation and to carry out a correct evaluation of risks and benefits regarding the possible inclusion of radiotherapy in the conditioning treatment(AU)

Humans , Prognosis , Transplantation, Autologous/methods , Hodgkin Disease , Retrospective Studies
Article in English | LILACS-Express | LILACS | ID: biblio-1292098


Objetivo: O objetivo deste estudo foi estimar os custos do tratamento do transplante de células--tronco hematopoéticas (TCTH) em um centro de referência no Brasil. Métodos: A população do estudo foi composta por pacientes provenientes da lista de TCTH do Sistema Único de Saúde submetidos ao TCTH em um hospital do sul do Brasil, entre 2016 e 2019. A avaliação de custos foi realizada por meio de um estudo de microcusteio, baseado no Time-Driven Activity-based Costing (TDABC) adaptado para estudos econômicos em saúde e incluiu as seguintes etapas: definição da questão de pesquisa, coleta de dados estruturada e análise estatística dos resultados. Resultados: O custo total do TCTH foi de $ 155.110 ($ 92.794 ­ $ 249.146 USD). O TCTH de doador não aparentado compatível foi mais caro do que o TCTH de doador aparentado compatível. Os principais fatores de custo envolvem complicações pós-transplante, principalmente a ocorrência de infecções. Em relação à composição dos custos, exames e procedimentos representam o maior custo em TCTH (45%). Conclusão: Essas estimativas podem ser aplicáveis a novas avaliações de custo-efetividade do TCTH e ajudar os gestores na tomada de decisão em saúde, especialmente em países de média renda

Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 ­ $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post- -transplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries

Arch. argent. pediatr ; 119(4): 230-237, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280899


Introducción: El trasplante de células progenitoras hematopoyéticas (TPH) en niños es un procedimiento no exento de complicaciones graves. El ingreso de esta población a unidades de cuidados intensivos pediátricos (UCIP) se asocia con elevada mortalidad. Objetivos: Analizar la sobrevida y los factores predictivos de la mortalidad en niños que recibieron TPH e ingresaron a la UCIP y elaborar un modelo predictivo de mortalidad en esta población. Materiales y métodos: Revisión retrospectiva de niños y adolescentes que recibieron un TPH entre el 01/01/2005 y el 31/12/2019 e ingresaron a la UCIP de un hospital universitario de alta complejidad. Resultados: De un total de 264 niños que recibieron el trasplante, 114 ingresaron a la UCIP. La mortalidad general fue del 29 % (n = 34). El tipo de trasplante, enfermedad basal, evento de neutropenia febril, infección por citomegalovirus, insuficiencia respiratoria, enfermedad de injerto contra huésped (EICH), quimioterapia mieloablativa y desnutrición previa se asociaron con tasas de mortalidad más elevadas. En el análisis multivariado, la EICH (razón de posibilidades [OR, por su sigla en inglés]: 2,23; intervalo de confianza del 95 % [IC 95 %]: 1,92-2,98), la necesidad de ventilación mecánica invasiva (OR: 2,47; IC95 %: 1,39-5,73), el trasplante de donante alternativo (OR: 1,58; IC 95 %: 1,14-2,17) y la desnutrición previa (OR: 1,78; IC 95 %: 1,223-3,89) se asociaron con mayor mortalidad. Conclusión: En la población estudiada, dos de cada tres niños que recibieron TPH e ingresaron a la UCIP sobrevivieron. La EICH, ventilación mecánica, trasplante de donante alternativo y desnutrición previa fueron factores predictivos de mortalidad

Introduction: Hematopoietic stem cell transplantation (HSCT) in children is a procedure that is not exempt of severe complications. Admission to the pediatric intensive care unit (PICU) is associated with a high mortality rate. Objectives: To analyze survival and predictors of mortality among children who received a HSCT and were admitted to the PICU, and to develop a mortality prediction model in this population. Materials and methods: Retrospective review of children and adolescents who received a HSCT between January 1st, 2005 and December 31st, 2019 and were admitted to the PICU of a tertiary care teaching hospital. Results: Out of 264 children receiving the transplant 114 were admitted to the PICU. The overall mortality rate was 29 % (n = 34). The type of transplant, underlying disease, febrile neutropenia event, cytomegalovirus infection, respiratory failure, graft versus host disease (GVHD), myeloablative chemotherapy, and previous malnutrition were associated with higher mortality rates. In the multivariate analysis, GVHD (odds ratio [OR]: 2.23; 95 % confidence interval [CI]: 1.92-2.98), need for mechanical ventilation (OR: 2.47; 95 % CI: 1.39-5.73), alternative donor transplant (OR: 1.58; 95 % CI: 1.14-2.17), and previous malnutrition (OR: 1.78; 95 % CI: 1.22-3.89) were associated with a higher mortality rate. Conclusion: In the studied population, 2 out of 3 children who received a HSCT and were admitted to the PICU survived. GVHD, mechanical ventilation, alternative donor transplant, and previous malnutrition were predictors of mortality

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric/statistics & numerical data , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Respiration, Artificial , Retrospective Studies , Critical Illness , Sepsis , Malnutrition , Graft vs Host Disease
Curitiba; s.n; 20210812. 188 p. ilus, graf, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1363993


Resumo: O objetivo desta tese foi investigar o impacto do coping religioso/espiritual na qualidade de vida relacionada à saúde dos pacientes adultos com câncer hematológico no quinto ano após a realização do transplante de células-tronco hematopoéticas. Trata-se de um estudo quantitativo, longitudinal, observacional e analítico, realizado em hospital público do sul do Brasil, referência para esta modalidade de tratamento, com 55 participantes adultos, que se submeteram a esta terapia. A coleta de dados ocorreu de setembro de 2013 a janeiro de 2021, com avaliações nas etapas basal (antes de iniciar o condicionamento), pancitopenia, préalta hospitalar (quando se dá a "pega" medular), pós 100 dias, pós 180 dias, pós 360 dias e anualmente até completar cinco anos da realização do procedimento. Os instrumentos utilizados para avaliação foram sociodemográfico e clínico, Quality of life Questionnaire Core 30 e Functional Assessment of Cancer Therapy - Bone Marrow Transplant, ambos traduzidos, adaptados e validados para o português - Brasil, e a escala de coping religioso/espiritual aplicada na última etapa da avaliação. Leucemias foram o diagnóstico mais frequente (65%), assim como o transplante de células-tronco alogênico foi a modalidade predominante (71%). No tocante aos óbitos, a maior causa foi por recidiva da doença (26%) e o maior número ocorreu no primeiro ano (37%). A qualidade de vida global (56,6/100) e geral (90,7/148) apresentou os menores escores na etapa de pancitopenia, com melhores índices no quinto ano, (80,4/100) e (116,1/148), respectivamente. A análise com o modelo linear misto generalizado apontou alterações significativas dos escores de qualidade de vida relacionada à saúde e domínios entre as etapas ao longo do tempo (p<0,05). Quanto ao coping religioso/espiritual, houve média utilização (3,19/5,00), com maior uso do coping religioso/espiritual positivo (3,15/5,00), quando comparado ao coping religioso/espiritual negativo (1,77/5,00), com razão de 0,6. Observou-se associação significativa negativa entre os escores de qualidade de vida relacionada à saúde, domínios e ao coping religioso/espiritual negativo (p<0,05). A tese de que o uso de coping religioso/espiritual positivo leva a melhores índices de qualidade de vida relacionada à saúde não pode ser comprovada, pois não houve associação significativa no teste de correlação. No entanto, quando realizada a análise de correlação entre o uso do coping religioso/espiritual negativo e a qualidade de vida relacionada à saúde, observou-se correlação negativa significativa para a maioria dos domínios de ambos os instrumentos de qualidade de vida relacionada à saúde. Este resultado indica que a utilização de estratégias de enfrentamento negativas como posição negativa frente à religiosidade/espiritualidade está associada a uma pior qualidade de vida relacionada à saúde e domínios no quinto ano, o que comprova parcialmente a hipótese deste estudo. Ademais, as correlações entre os domínios dos dois instrumentos de avaliação da qualidade de vida relacionada à saúde sustentam o modelo teórico utilizado, que infere haver uma interação ativa entre os domínios. O estudo poderá contribuir no reconhecimento da multidimensionalidade do constructo qualidade de vida relacionada à saúde, mostrando ainda que a avaliação do domínio espiritual é necessária para detectar possíveis comprometimentos nesta área.

Abstract: The current thesis aimed to investigate the impact of religious/spiritual coping on the health-related quality of life of adult patients with blood cancer five years after hematopoietic stem-cell transplantation. This is a quantitative, longitudinal, observational, and analytical study, conducted in a public hospital in southern Brazil, a center for this type of treatment, with 55 adult participants who underwent this therapy. Data collection took place from September 2013 to January 2021, with assessments at baseline (before starting conditioning regimen), pancytopenia, pre-hospital discharge (when the spinal cord "engraftment" takes place), after 100 days, after 180 days, after 360 days, and annually out to five years of the procedure. For the assessment, we used sociodemographic and clinical instruments, the quality-of-life Questionnaire Core 30 and Functional Assessment of Cancer Therapy - Bone Marrow Transplant, both translated, adapted, and validated for Portuguese - Brazil, and the religious/spiritual coping scale applied in the latter evaluation stage. Leukemia was the most frequent diagnosis (65%), and allogeneic stem cell transplantation was the predominant modality (71%). Regarding deaths, the most frequent cause was disease relapse (26%) and the most occurred in the first year (37%). The overall (56.6/100) and general (90.7/148) quality of life had the lowest scores in the pancytopenia stage, with better rates in the fifth year, (80.4/100) and (116.1/148), respectively. The analysis with the generalized mixed linear model showed significant changes in health-related quality of life scores and domains between stages over time (p<0.05). There was an average use of religious/spiritual coping (3.19/5.00), with greater adoption of positive religious/spiritual coping (3.15/5.00), when compared to negative religious/spiritual coping (1.77 /5.00), with a ratio of 0.6. There was a significant negative association between health-related quality of life scores, domains, and negative religious/spiritual coping (p<0.05). The thesis that the adoption of positive religious/spiritual coping leads to better health-related quality of life indexes cannot be proven, as there was no significant association in the correlation test. Yet, when analyzing the correlation between the use of negative religious/spiritual coping and health-related quality of life, a significant negative correlation was observed for most domains of both health-related quality of life instruments. This result suggests that the use of negative coping strategies as a negative attitude towards religiosity/spirituality is associated with a worse quality of life-related to health and domains in the fifth year, which partially validates the hypothesis of this study. Moreover, the correlations between the domains of the two health-related quality of life assessment instruments support the theoretical model adopted, which infers that there is an active interaction between the domains. The study may contribute to the acknowledgment of the multidimensionality of the health-related quality of life construct, also showing that the assessment of the spiritual domain is necessary to detect possible impairments in this area.

Humans , Male , Female , Oncology Nursing , Patients , Quality of Life , Adaptation, Psychological , Health Personnel , Hematopoietic Stem Cell Transplantation
Bol. méd. Hosp. Infant. Méx ; 78(3): 191-199, May.-Jun. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1285483


Abstract Background: Viral respiratory infections in pediatric patients with hematopoietic stem cell transplantation (HSCT) significantly impact morbidity and mortality. It is necessary to determine the viral agents and their frequency of presentation to understand their impact on transplantation patients’ evolution. Methods: From January 2017 to December 2019, we conducted a cross-sectional, descriptive, and observational study of patients who underwent HSCT with a viral respiratory infection. Viral identification was performed using multiplex polymerase chain reaction for nine respiratory viruses. Descriptive statistics were performed with a report of central tendency measures and percentages. Results: Of the 54 pediatric patients who underwent HSCT, 59.2% presented an airway infection; in turn, at least one viral agent was identified in 59.3% of these patients. The most frequent viral agents were influenza (25.9%), human rhinovirus (18.5%), and respiratory syncytial virus (18.5%). Viral co-infections occurred in 36.8% of the cases. The reported complications were supplemental oxygen requirement (73.6%), support with mechanical ventilation (21%), admission to the pediatric intensive care unit (15.7%), and mortality associated with a viral respiratory infection (10.5%). Conclusions: Viral respiratory infections are frequent in pediatric patients with HSCT; influenza A/B virus was the most frequent agent. As morbidity and mortality increase due to these infections in patients with HSCT, strategies are necessary for its prevention and timely treatment after transplantation.

Resumen Introducción: Las infecciones respiratorias virales en los pacientes pediátricos con trasplante de células progenitoras hematopoyéticas (TCPH) impactan significativamente la morbilidad y la mortalidad. Para comprender su impacto en la evolución de los pacientes receptores de trasplantes es necesario conocer la frecuencia de presentación y los agentes virales. Métodos: De enero de 2017 a diciembre de 2019 se llevó a cabo un estudio transversal, descriptivo y observacional de los pacientes sometidos a TCPH que tuvieron una infección viral de vías respiratorias. La identificación de los virus se realizó por medio de la prueba de reacción en cadena de la polimerasa multiplex para nueve virus respiratorios. Se realizó estadística descriptiva con reporte de medidas de tendencia central y porcentajes. Resultados: De los 54 pacientes incluidos, el 59.2% presentaron una infección de vías respiratorias y se identificó al menos un agente viral en el 59.3% de estos casos. Los virus más frecuentes fueron influenza (25.9%), rinovirus humano (18.5%) y virus sincitial respiratorio (18.5%). En el 36.8% de los casos se detectaron coinfecciones virales. Se presentaron las siguientes complicaciones: requerimiento de oxígeno suplementario (73.6%), soporte con ventilación mecánica (21%), ingreso a la unidad de cuidados intensivos pediátricos (15.7%) y muerte asociada a infección por virus respiratorios (10.5%). Conclusiones: Las infecciones respiratorias virales en los pacientes pediátricos con TCPH son frecuentes; el virus influenza A/B es el agente más habitual. Debido a que estas infecciones se asocian con mayor morbimortalidad en los pacientes con TCPH, son estrategias necesarias para su prevención y tratamiento oportuno posterior al trasplante.

Bol. méd. Hosp. Infant. Méx ; 78(3): 225-233, May.-Jun. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1285487


Abstract Background: Osteopetrosis is a rare hereditary bone dysplasia characterized by insufficient osteoclast activity that results in increased bone mineral density. Hematopoietic stem cell transplantation (HSCT) can reverse skeletal abnormalities and restore hematopoiesis. Case report: We present the case of a 3-year and 2-month-old male patient with the diagnosis of osteopetrosis. The patient underwent allogeneic HSCT (Allo-HSCT) using 100% compatible bone marrow from a related donor and received a myeloablative conditioning regimen and a CD34 cell dose (4.7 × 107/kg). In the early post-transplant, frequent complications such as pneumonitis, hypercalcemia, and hyperphosphatemia ocurred. With a suitable granulocytic graft and chimerism of 100%, it was considered a successful transplant. However, the patient showed a delayed platelet graft treated with a platelet-stimulating factor for 6 months. The patient is currently disease-free, outpatient follow-up, with no data on graft-versus-host disease, and no progressive neurological damage. Conclusions: Osteopetrosis is a childhood disease that requires clinical suspicion and early diagnosis. HSCT is necessary at an early age to prevent disease progression and sensorineural, hematological, and endocrinological functions damage that can lead to death.

Resumen Introducción: La osteopetrosis es una displasia ósea hereditaria poco común, caracterizada por una actividad osteoclástica deficiente que aumenta la densidad mineral ósea. Se considera que el trasplante de células progenitoras hematopoyéticas (TCPH) puede revertir las anormalidades esqueléticas y restaurar la hematopoyesis. Caso clínico: Se presenta el caso de un paciente de sexo masculino, de 3 años y 2 meses de edad, con diagnóstico tardío de osteopetrosis. Se realizó un TCPH alogénico de donador relacionado 100% compatible con médula ósea. Se utilizaron un régimen de acondicionamiento mieloablativo y una dosis celular de CD34 de 4.7 × 107/kg de peso. En el postrasplante temprano, el paciente desarrolló complicaciones como neumonitis, hipercalcemia e hiperfosfatemia. Con un injerto granulocítico adecuado y quimerismo del 100% se consideró un trasplante exitoso. Sin embargo, el paciente presentó retraso en el injerto plaquetario, por lo que se administró factor estimulante de plaquetas por 6 meses. Actualmente el paciente se encuentra libre de enfermedad, en seguimiento ambulatorio, sin datos de enfermedad del injerto contra el hospedero y con pruebas de neurodesarrollo sin deterioro neurológico progresivo. Conclusiones: La osteopetrosis es una enfermedad infantil que requiere una sospecha clínica y un diagnóstico temprano, ya que es necesario un TCPH a corta edad como tratamiento para evitar la progresión de la enfermedad y el deterioro de las funciones neurosensoriales, hematológicas y endocrinológicas que puede derivar en la defunción del paciente.

Arch. argent. pediatr ; 119(5): e559-e561, oct. 2021.
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292831


El síndrome de Pearson (SP) comparte varias características con la anemia de Diamond-Blackfan (ADB), incluida la anemia grave de inicio temprano, por lo que es importante hacer un diagnóstico diferencial. El diagnóstico diferencial de la ADB y el SP es fundamental, ya que los pacientes con ADB podrían res-ponder al tratamiento con corticoesteroides, presentar remisión o beneficiarse del trasplante de células madre hematopoyéti-cas (TCMH). Sin embargo, los pacientes con SP tienen un pronós-tico diferente, con un riesgo muy elevado de acidosis, problemas metabólicos y disfunción pancreática, y una expectativa de vida menor en comparación con aquellos con ADB. En este artículo, presentamos el caso de un paciente sometido a TCMH para la ADB, pero que luego fue diagnosticado con SP tras desarrollar algunas complicaciones.

Pearson syndrome (PS), shares a number of overlapping features with Diamond-Blackfan anemia (DBA), including early onset of severe anemia, making differential diagnosis important. Differential diagnosis of DBA and PS is critical, since those with DBA may respond to treatment with steroids, may undergo remission, or may benefit from hematopoietic stem cell transplantation (HSCT). However, patients with PS have a different prognosis, with a very high risk of developing acidosis, metabolic problems, and pancreatic dysfunction, and a shorter life expectancy than those with DBA. Here we present a patient who underwent HSCT for DBA but was subsequently diagnosed with PS after developing some complications

Humans , Infant , Anemia, Diamond-Blackfan , Mitochondrial Diseases , Lipid Metabolism, Inborn Errors , Congenital Bone Marrow Failure Syndromes , Muscular Diseases
J. pediatr. (Rio J.) ; 97(supl.1): 39-48, Mar.-Apr. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1250227


Abstract Objectives: Inborn Errors of Immunity (IEI), also known as primary immunodeficiencies, correspond to a heterogeneous group of congenital diseases that primarily affect immune response components. The main clinical manifestations comprise increased susceptibility to infections, autoimmunity, inflammation, allergies and malignancies. The aim of this article is to review the literature on combined immunodeficiencies (CIDs) focusing on the diagnosis and treatment and the particularities of the clinical management of these patients. Source of data: Critical integrative review, aimed to present articles related to primary immunodeficiencies combined with a searchin the PubMed and SciELO databases, with evaluation of publications from the last twenty years that were essential for the construction of knowledge on this group of diseases. Summary of data: We highlight the main characteristics of CIDs, dividing them according to their pathophysiological mechanisms, such as defects in the development of T cells, TCR signaling, co-stimulatory pathways, cytokine signaling, adhesion, migration and organization of the cytoskeleton, apoptosis pathways, DNA replication and repair and metabolic pathways. In CIDs, clinical manifestations vary widely, from sinopulmonary bacterial infections and diarrhea to opportunistic infections, caused by mycobacteria and fungi. Neonatal screening makes it possible to suspect these diseases before clinical manifestations appear. Conclusions: The CIDs or IEI constitute a complex group of genetic diseases with T-cell involvement. Neonatal screening for these diseases has improved the prognosis of these patients, especially in severe ones, known as SCIDs.

J. pediatr. (Rio J.) ; 97(supl.1): 17-23, Mar.-Apr. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1250229


Abstract Objectives: To provide an overview of drug treatment, transplantation, and gene therapy for patients with primary immunodeficiencies. Source of data: Non-systematic review of the literature in the English language carried out at PubMed. Synthesis of data: The treatment of patients with primary immunodeficiencies aims to control their disease, especially the treatment and prevention of infections through antibiotic prophylaxis and/or immunoglobulin replacement therapy. In several diseases, it is possible to use specific medications for the affected pathway with control of the condition, especially in autoimmune or autoinflammatory processes associated with inborn immunity errors. In some diseases, treatment can be curative through hematopoietic stem cell transplantation (HSCT); more recently, gene therapy has opened new horizons through new technologies. Conclusions: Immunoglobulin replacement therapy remains the main therapeutic tool. Precision medicine with specific drugs for altered immune pathways is already a reality for several immune defects. Advances in the management of HSCT and gene therapy have expanded the capacity for curative treatments in patients with primary immunodeficiencies.

Curitiba; s.n; 20210311. 128 p. ilus, graf, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1254859


A utilização do relaxamento com imagem guiada pode trazer benefícios ao paciente submetido ao transplante de células-tronco hematopoéticas ao possibilitar alívio de sintomas físicos e emocionais, influenciando na qualidade de vida relacionada à saúde. O objetivo deste estudo foi analisar as alterações nos domínios da qualidade de vida relacionada à saúde e variáveis fisiológicas de pacientes internados submetidos ao transplante de células-tronco hematopoéticas, que receberam a técnica de relaxamento com imagem guiada por realidade virtual. Trata-se de estudo quase-experimental, longitudinal, realizado em um Serviço de Transplante de Medula Óssea de hospital público no sul do Brasil. De outubro de 2019 a outubro de 2020, foram incluídos 42 participantes adultos submetidos ao transplante de células-tronco hematopoéticas, sendo alocados 35 no grupo intervenção e 7 no grupo controle em uma razão 5:1. Para o primeiro, foi utilizado como intervenção o relaxamento com imagem guiada por realidade virtual. Foram aferidas pressão arterial, frequências cardíaca e respiratória, saturação de oxigênio, temperatura e dor imediatamente antes e após a intervenção. A coleta de dados ocorreu em quatro momentos: internação (T1), dia zero (T2), fase de neutropenia (T3) e pré-alta hospitalar (T4). Para ambos os grupos foram aplicados questionários sociodemográfico e clínico e Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, Functional Assessment of Chronic Illness Therapy-Fatigue e Functional Assessment of Cancer Therapy-Neutropenia para avaliação da qualidade de vida relacionada à saúde, foram avaliados também valores de hemograma e leucograma. Os resultados mostraram média geral de idade de 37,8 anos e faixa de renda de 1 a 3 salários mínimos, 21 (70%) participantes do grupo intervenção e cinco (71,43%) no controle. O transplante alogênico foi predominante, 28 (80%) no grupo intervenção e cinco (71,43%) no controle. As leucemias foram o diagnóstico mais frequente em ambos os grupos, 13 (34,14%) no grupo intervenção e três (42,86%) no controle. Não houve diferenças entre os grupos nas avaliações de qualidade de vida relacionada à saúde, contudo foi encontrada diferença significativa entre as etapas e correlação positiva significativa entre as variáveis qualidade de vida geral, preocupações adicionais, fadiga e neutropenia em todas as etapas para o grupo intervenção. Foram encontradas diferenças significativas entre as médias das aferições antes e depois em frequência cardíaca e respiratória, temperatura, saturação de oxigênio e pressão arterial no grupo intervenção. Houve semelhança no comportamento dos valores de hemograma, leucograma e no tempo para pega medular em ambos os grupos. A intervenção é, em geral, bem aceita e não foram encontradas evidências de eventos adversos relacionados à sua aplicação. Apesar de não ter sido verificada influência da imagem guiada na qualidade de vida relacionada à saúde neste estudo, as alterações nos dados vitais demonstraram eficácia para a indução de estado de relaxamento. Assim, o relaxamento com imagem guiada por realidade virtual pode ser utilizado com segurança promovendo efeitos benéficos em pacientes submetidos ao transplante de células-tronco hematopoéticas. Os resultados encontrados apontam para a necessidade de ampliação da oferta de práticas integrativas para esses pacientes em face do comprometimento observado na qualidade de vida relacionada à saúde.

The use of guided imagery relaxation can bring benefits to patients undergoing hematopoietic stem cell transplantation by providing relief from physical and emotional symptoms, influencing health-related quality of life. The aim of this study was to analyze changes in the domains of health-related quality of life, and physiological variables, of hospitalized patients who underwent hematopoietic stem cell transplantation and received the guided imagery relaxation by virtual reality technique. This is a quasi-experimental, longitudinal, study carried out in a Bone Marrow Transplantation Service at a public hospital in southern Brazil. From October 2019 to October 2020, 42 adult participants who underwent hematopoietic stem cell transplantation were included, allocated 35 in the intervention group and 7 in the control group, in a 5:1 ratio. For the former, guided imagery relaxation by virtual reality was used as intervention. Blood pressure, heart and respiratory rates, oxygen saturation, temperature and pain were measured immediately before and after the intervention. Data collection took place in four moments : hospitalization (T1), day zero (T2), neutropenia phase (T3) and pre-hospital discharge (T4). Sociodemographic and clinical questionnaires and Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, Functional Assessment of Chronic Illness Therapy-Fatigue and Functional Assessment of Cancer Therapy-Neutropenia were applied to both groups to assess health-related quality of life, and hemogram and leukogram values were evaluated. The results show a general mean age of 37.8 years and an income range of 1 to 3 minimum wages, 21 (70%) participants in the intervention group and five (71.43%) in the control group. Allogeneic transplantation was predominant, 28 (80%) in the intervention group and five (71.43%) in the control group. Leukemias were the most frequent diagnosis in both groups, 13 (34.14%) in the intervention group and three (42.86%) in the control. There were no differences between groups in healthrelated quality of life assessments, however a significant difference was found between the stages and a significant positive correlation between the variables general quality of life, additional concerns, fatigue and neutropenia at all stages for the intervention group. Significant differences were found between the averages of the measurements before and after in heart and respiratory rate, temperature, oxygen saturation and blood pressure in the intervention group. There was a similarity in the behavior of the hemogram and leukogram values and time of engraftment in both groups. The intervention is, in general, well accepted and no evidence of adverse events related to its application has been found. Although there was no influence of the guided imagery on health-related quality of life in this study, changes in vital signs demonstrate efficacy for inducing a state of relaxation. Thus, guided imagery relaxation by virtual reality can be used safely promoting beneficial effects in patients undergoing hematopoietic stem cell transplantation. The results found point to the need to expand the offer of integrative practices for these patients in the face of the impairment observed in healthrelated quality of life.

Humans , Male , Female , Adult , Middle Aged , Aged , Quality of Life , Relaxation Therapy , Hematopoietic Stem Cell Transplantation , Imagery, Psychotherapy , Virtual Reality Exposure Therapy , Bone Marrow Transplantation , Nursing
Rev. cuba. hematol. inmunol. hemoter ; 37(1): e1101, ene.-mar. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251718


Introducción: Las quimiocinas son proteínas secretadas con tamaño en el rango de 8-10 kDa, con numerosas funciones en la fisiología normal y patológica. El término deriva de las palabras citocinas quimiotácticas, que refleja su importante participación en la quimioatracción de leucocitos. Sin embargo, las evidencias muestran que las quimiocinas tienen muchas otras funciones como la comunicación intercelular, la activación celular y la regulación del ciclo celular. Objetivo: Analizar los conocimientos actuales sobre las quimiocinas y sus receptores, y la significación clínica de estas en la medicina transfusional y el trasplante. Métodos: Se realizó revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 10 años. Se efectuó análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: La transcripción de la mayoría de los genes de quimiocinas es inducible y se produce en respuesta a estímulos celulares específicos. Las quimiocinas son importantes en la movilización de células progenitoras hematopoyéticas para el trasplante y localización de células progenitoras hematopoyéticas trasplantadas. En los modelos de incompatibilidad ABO, las quimiocinas CXC y CC se producen en niveles elevados. Conclusiones: Muchas son las oportunidades de futuras investigaciones sobre las quimiocinas en la medicina transfusional por la considerable redundancia y superposición en la función biológica de estas moléculas y sus receptores. Son solo una parte de un proceso mucho más grande y complejo dentro de la red de citoquinas y otras moléculas del sistema inmune(AU)

Introduction: Chemokines are secreted proteins with size in the range of 8-10 kDa, with numerous functions in normal and pathological physiology. The term derives from the words chemotactic cytokines, reflecting its important role in the chemoattraction of leukocytes. However, the evidence shows that chemokines have many other functions such as intercellular communication, cell activation and cell cycle regulation. Objetive: To present current knowledge about chemokines and their receptors, and the clinical significance of these in transfusion medicine and transplantation. Method: A review of the literature was made, in English and Spanish, through the PubMed website and the Google academic search engine of articles published in the last 10 years. An analysis and summary of the revised bibliography was made. Developing: The transcription of most of the chemokine genes is inducible and occurs in response to specific cellular stimuli. Chemokines play an important role in the mobilization of hematopoietic progenitor cells for the transplantation and localization of transplanted hematopoietic progenitor cells. In the ABO incompatibility models, the CXC and CC chemokines are produced at high levels. Conclusions: There are many opportunities for future research on chemokines in transfusion medicine due to their considerable redundancy and superposition in the biological function of these molecules and their receptors. They are just one part of a much larger and more complex process within the network of cytokines and other molecules of the immune system(AU)

Cytokines , Chemokines , Transfusion Medicine , Immune System
Rev. habanera cienc. méd ; 20(1): e3359, ene.-feb. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1156681


RESUMEN Introducción: La polineuropatía desmielinizante inflamatoria crónica (CIDP) es una enfermedad desmielinizante e inflamatoria de mediación autoinmune. El tratamiento convencional es basado en la inmunomodulación e inmunosupresión. El uso de células madre es una terapia novedosa en los trastornos autoinmune, siendo incluida como terapia. Objetivo: Determinar la eficacia de la movilización de células madre mediante la aplicación del factor estimulador de colonias granulocíticas (F-ECG) en pacientes con CIDP que han recibido otras líneas de tratamiento. Material y Métodos: Se realizó un estudio aleatorizado, doble ciego sobre una cohorte de 45 pacientes con CIDP, donde se administró el (F-ECG) en 25 pacientes y 20 continuaron con el tratamiento habitual, tratados anteriormente con otras variantes terapéuticas por más de tres años, sin respuesta satisfactoria. Resultados: Predominio de los hombres para 64,4 %, la Diabetes Mellitus tuvo mayor asociación y la medicación más usada fueron los esteroides. Los síntomas y signos clínicos mejoraron significativamente tras el tratamiento. Los valores de la puntuación del TCSS al mes y 3 meses después del tratamiento disminuyeron significativamente; pero este decremento no se mantuvo al final del estudio. La velocidad de conducción y el potencial de acción de los nervios sensoriales y motores mejoraron considerablemente después del tratamiento. Conclusiones: La efectividad de la aplicación del (F-ECG) para la mejoría de los síntomas clínicos y resultados de estudios neurofisiológicos evolutivamente son mayores que otras variantes terapéuticas en los primeros meses, con buena seguridad y tolerabilidad, por lo que se puede incluir en la terapéutica convencional para la CIDP.

ABSTRACT Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune demyelinating disease. Conventional treatment is based on immunomodulation and immunosuppression. The use of stem cells is a novel therapy in autoimmune disorders, so it is included as therapy. Objective: To determine the efficacy of mobilization of stem cells by applying granulocyte colony-stimulating factor (G-CSF) in patients with CIDP who have followed other lines of treatment. Material and Methods: A randomized, double-blind study was carried out on a cohort of 45 patients with CIDP. G-CSF was administered to 25 patients and 20 of them continued with the usual treatment. These patients were previously treated with other therapeutic variants for more than three years without satisfactory response. Results: There was a prevalence of men (64.4 %), Diabetes Mellitus had a greater association, and the most used medications were steroids. Clinical symptoms and signs improved significantly after treatment. TCSS scores significantly decreased at one and three months after treatment, but this decrease was not maintained at the end of the study. The conduction velocity and action potential of sensory and motor nerves improved considerably after treatment. Conclusions: The effectiveness of the use of G-CSF shows an improvement of clinical symptoms. The results of neurophysiological studies have a better course than other therapeutic variants during the first months, with good safety and tolerability, so it can be included in the conventional therapy for the CIDP.