Effect of peppermint-lemon aromatherapy on nausea-vomiting and quality of life in pediatric patients with leukemia: A randomized controlled trial.

BACKGROUND: Nausea and vomiting, frequently induced by chemotherapy, can delay treatment protocols and the healing process. PURPOSE: The aim of this study is to determine how aromatherapy inhalation with peppermint and lemon using a diffuser affects nausea-vomiting management and quality of life in 2-12-year-old children undergoing chemotherapy. DESIGN AND METHODS: The study utilized a pretest-posttest control group experimental design with randomized groups. A total of 90 children who met the inclusion criteria were included in the study. The experimental group received Mentha Piperita and Citrus Lemon essential oils through a diffuser, while the placebo group received water through a diffuser. The control group did not receive any intervention. RESULTS: Pulse and respiratory rates of children treated with aromatherapy were found to be significantly lower than the other groups. After aromatherapy application, quality of life of the children in the experimental group was significantly higher than the other groups. The change in the Index of Nausea, Vomiting, and Retching scores of the experimental group on the 4th chemotherapy cycle compared to the 1st chemotherapy cycle was significantly higher than the change in the other groups. CONCLUSIONS: Consequently, it was determined that inhalation aromatherapy with peppermint-lemon was effective in the management of chemotherapy-induced nausea-vomiting symptoms and quality of life compared to the placebo and control groups. PRACTICE IMPLICATIONS: Inhalation aromatherapy with mint-lemon can be used as an alternative method to improve the quality of life in children with leukemia who suffer from chemotherapy-induced nausea and vomiting.

Long-term Results of Splenectomy in Transfusion-dependent Thalassemia.

Splenectomy is indicated in transfusion-dependent thalassemia (TDT) only in certain situations. This study aimed to present the effectiveness, complications, and long-term follow-up results of splenectomy in children with TDT. We performed a 30-year single-institution analysis of cases of splenectomy for TDT between 1987 and 2017 and their follow-up until 2021. A total of 39 children (female/male: 24/15) were included. The mean age at splenectomy was 11.2±3.2 years, and their mean follow-up duration after splenectomy was 21.5±6.4 years. Response was defined according to the patient's annual transfusion requirement in the first year postsplenectomy and on the last follow-up year. Complete response was not seen in any of the cases; partial response was observed in 32.3% and no response in 67.6%. Thrombocytosis was seen in 87% of the patients. The platelet counts of 7 (17.9%) patients were >1000 (10 9 /L), and aspirin prophylaxis was given to 22 (56.4%) patients. Complications were thrombosis in 2 (5.1%) patients, infections in 11 (28.2%) patients, and pulmonary hypertension in 4 (10.2%) patients. Our study showed that after splenectomy, the need for transfusion only partially decreased in a small number of TDT patients. We think splenectomy can be delayed with appropriate chelation therapy up to higher annual transfusion requirement values.

Safety and efficacy of deferasirox in patients with transfusion-dependent thalassemia: A 4-year single-center experience.

This study was organized to determine the efficacy and safety of deferasirox (DFX) in reducing the SF of patients with transfusion-dependent thalassemia (TDT). This is a retrospective, descriptive study of 101 transfusion- dependent patients with thalassemia major who were followed for 48 months. Twenty-nine patients who used an alternative chelator either alone or combined, who were not compliant to the treatment, changed the drug due to adverse reactions, and had multiple transfusions and did not complete 4 years of DFX use were excluded. A total 72 out of 101 patients completed the study. SF decreases were noted for the 6-12 and >18-year age groups, from a median of 1532 ng/mL to 1190 ng/mL, and from 1386 ng/mL to 1165 ng/mL, respectively (p > 0.05). The proportion of patients with SF concentrations >2000 ng/mL is decreased (29% at baseline decreased to 15% at the end of the study) during the 48 months. The median SF of those who used <30 mg/kg/day (n = 38) increased from 767 ng/mL to 1006 ng/mL, whereas the >30 mg/kg/day (n = 34) group's SF concentrations decreased from a median of 1575 ng/mL to 1209 ng/mL (p = 0.029). The decrease of median SF values for Syrian patients was statistically significant (p = 0.043). Most common adverse events were gastric irritation symptoms (19.4%). The total DFX discontinuation ratio was calculated as 9.7%. Although dosages between 25-30 mg/kg/day are adequate to stabilize SF concentrations higher dosages are needed to achieve a statistically significant decrease.

N-Acetylcysteine supplementation reduces oxidative stress and DNA damage in children with ß-thalassemia.

There are several reports that increased oxidative stress and DNA damage were found in ß-thalassemia major (ß-TM) patients. In this study, we aimed to evaluate the effects of N-acetylcysteine (NAC) and vitamin E on total oxidative stress and DNA damage in children with ß-TM. Seventy-five children with transfusion-dependent ß-thalassemia (ß-thal) were randomly chosen to receive 10 mg/kg/day of NAC or 10 IU/kg/day of vitamin E or no supplementation; 28 healthy controls were also included in the study. Serum total oxidant status (TOS) and total antioxidant capacity (TAC) were measured, oxidative stress index (OSI) was calculated, and mononuclear DNA damage was assessed by alkaline comet assay; they were determined before treatment and after 3 months of treatment. Total oxydent status, OSI, and DNA damage levels were significantly higher and TAC levels were significantly lower in the thalassemic children than in the healthy controls (p < 0.001). In both supplemented groups, mean TOS and OSI levels were decreased; TAC and pre transfusion hemoglobin (Hb) levels were significantly increased after 3 months (p ≤ 0.002). In the NAC group, DNA damage score decreased (p = 0.001). N-Acetylcysteine and vitamin E may be effective in reducing serum oxidative stress and increase pre transfusion Hb levels in children with ß-thal. N-Acetylcysteine also can reduce DNA damage.

Efficacy of deferasirox in children with ß-thalassemia: single-center 3 year experience.

BACKGROUND: Iron chelation therapy is an important component in the management of patients with ß-thalassemia. METHODS: The study included 87 children with transfusion-dependent ß-thalassemia aged 2-17 years (mean, 8.2 ± 4.1 years), 49 (56%) of whom were male. The patients received deferasirox 9-40 mg/kg per day as a single dose for 36 months. They were clinically and laboratory monitored. RESULTS: The treatment was generally well tolerated. Drug-related adverse events, including abdominal pain (14.9%) and nausea (5.8%), high alanine aminotransferase more than double the upper limit of normal (5.8%), and non-progressive rise in serum creatinine (2.3%), were generally mild to moderate, transient, and reduced in frequency over time. Two patients discontinued treatment due to severe abdominal pain and nausea. Mean deferasirox dose was calculated as 21.2 ± 8.6, 23.7 ± 8.1, 30.7 ± 8.2 and 32.4 ± 7.6 mg/kg per day at 0, 12, 24 and 36 months, respectively. Mean (median) serum ferritin level was found to increase progressively during the first 22 months of treatment, from 3.161 ± 1.683 ng/mL (2.760 ng/mL) to 3.679 ± 1.997 ng/mL (3.071 ng/mL; P < 0.001) and then decreased gradually to 2.907 ± 1.436 ng/mL (2.670 ng/mL; P = 0.023) at 36 months. CONCLUSION: Deferasirox is safe and well tolerated; doses 21-24 mg/kg per day were not able to maintain stable iron balance, but ≥ 30 mg/kg per day was able to reduce iron in regularly transfused pediatric patients.

Fototerapia causa danos ao DNA de leucócitos mononucleares periféricos em recém-nascidos a termo / Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants

OBJETIVO: Determinar se a fita de DNA de leucócitos mononucleares endógenos é alvo de fototerapia. MÉTODOS: O estudo incluiu 65 recém-nascidos a termo com idades entre 3 e 10 dias que haviam sido expostos a fototerapia intensiva (n = 23) ou convencional (n = 23) por pelo menos 48 horas devido à icterícia neonatal, além de um grupo controle (n = 19). Dano ao DNA foi avaliado por eletroforese alcalina em gel de célula única (ensaio cometa). A capacidade antioxidante total plasmática e os níveis de estado oxidativo total também foram medidos, e a correlação entre danos ao DNA e estresse oxidativo foi investigada. RESULTADOS: Os valores médios de escores de danos ao DNA nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p < 0,001). Os valores médios e desvio padrão foram 32 (9), 28 (9), 21 (7) unidades arbitrárias, respectivamente. Os níveis de estado oxidativo nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p < 0,005). Os valores médios (desvio padrão) foram 18, 1 (4,2), 16.9 (4,4), 13,5 (4,2) µmol H2O2 equivalente/L, respectivamente. De maneira semelhante, os níveis de estresse oxidativo nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p = 0,041). A capacidade antioxidante total plasmática e os níveis de bilirrubina total não diferiram entre os grupos (p > 0,05). Não houve correlações significativas entre escores de danos ao DNA e bilirrubina, estado oxidante total e níveis de estresse oxidativo entre os grupos de fototerapia (p > 0,05). CONCLUSÕES: Tanto a fototerapia intensiva quanto a convencional causam danos ao DNA dos leucócitos mononucleares endógenos em recém-nascidos a termo com icterícia.

OBJECTIVE: Our aim was to determine whether endogenous mononuclear leukocyte DNA strand is a target of phototherapy. METHODS: The study included 65 term infants aged between 3-10 days that had been exposed to intensive (n = 23) or conventional (n = 23) phototherapy for at least 48 hours due to neonatal jaundice, and a control group (n = 19). DNA damage was assayed by single-cell alkaline gel electrophoresis (comet assay). Plasma total antioxidant capacity and total oxidant status levels were also measured, and correlation between DNA damage and oxidative stress was investigated. RESULTS: Mean values of DNA damage scores in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p < 0.001). Mean values and standard deviation were 32 (9), 28 (9), 21 (7) arbitrary unit, respectively. Total oxidant status levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.005). Mean (standard deviation) values were 18.1 (4.2), 16.9 (4.4), 13.5 (4.2) µmol H2O2 equivalent/L, respectively. Similarly, oxidative stress index levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.041). Plasma total antioxidant capacity and total bilirubin levels did not differ between the groups (p > 0.05). There were no significant correlations between DNA damage scores and bilirubin, total oxidant status and oxidative stress levels in either phototherapy group (p > 0.05). CONCLUSIONS: Both conventional phototherapy and intensive phototherapy cause endogenous mononuclear leukocyte DNA damage in jaundiced term infants.

Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants.

OBJECTIVE: Our aim was to determine whether endogenous mononuclear leukocyte DNA strand is a target of phototherapy. METHODS: The study included 65 term infants aged between 3-10 days that had been exposed to intensive (n = 23) or conventional (n = 23) phototherapy for at least 48 hours due to neonatal jaundice, and a control group (n = 19). DNA damage was assayed by single-cell alkaline gel electrophoresis (comet assay). Plasma total antioxidant capacity and total oxidant status levels were also measured, and correlation between DNA damage and oxidative stress was investigated. RESULTS: Mean values of DNA damage scores in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p < 0.001). Mean values and standard deviation were 32 (9), 28 (9), 21 (7) arbitrary unit, respectively. Total oxidant status levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.005). Mean (standard deviation) values were 18.1 (4.2), 16.9 (4.4), 13.5 (4.2) micromol H2O2 equivalent/L, respectively. Similarly, oxidative stress index levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.041). Plasma total antioxidant capacity and total bilirubin levels did not differ between the groups (p > 0.05). There were no significant correlations between DNA damage scores and bilirubin, total oxidant status and oxidative stress levels in either phototherapy group (p > 0.05). CONCLUSIONS: Both conventional phototherapy and intensive phototherapy cause endogenous mononuclear leukocyte DNA damage in jaundiced term infants.

Estado oxidante/antioxidante total em recém-nascidos ictéricos antes e depois da fototerapia / Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy

OBJETIVO: Avaliar o efeito da fototerapia no estado oxidante e antioxidante no soro de recém-nascidos a termo com hiperbilirrubinemia. MÉTODO: Trinta e quatro recém-nascidos a termo com idades entre 3 e 10 dias submetidos a fototerapia foram avaliados. O estado antioxidante do soro foi determinado pela capacidade antioxidante total e por componentes antioxidantes individuais: vitamina C, ácido úrico, albumina, concentração de tiol e bilirrubina total. O estado oxidante foi avaliado através do estado oxidante total, índice de estresse oxidativo e componentes oxidantes individuais: malondialdeído e níveis de hidroperóxido lipídico. RESULTADOS: As concentrações de vitamina C, ácido úrico, bilirrubina total e malondialdeído foram significativamente mais baixas, enquanto que o estado oxidante total, níveis de hidroperóxido lipídico e o índice de estresse oxidativo foram significativamente maiores após a fototerapia (p < 0,05). Houve correlações positivas significativas entre a bilirrubina sérica total e a concentração de malondialdeído (r = 0,434, p = 0,001). CONCLUSÕES: Embora a concentração de malondialdeído tenha diminuído após a fototerapia, esta exerce um efeito negativo sobre as diversas partes do sistema de defesa oxidante/antioxidante em recém-nascidos a termo ictéricos, expondo-os a um possível estresse oxidativo.

OBJECTIVE: To assess the effect of phototherapy on serum oxidant and antioxidant status in hyperbilirubinemic full-term newborns. METHOD: Thirty-four full-term infants from 3 to 10 days of age exposed to phototherapy were studied. The serum antioxidant status was assessed by measuring the total antioxidant capacity (TAC) and individual antioxidant components: vitamin C, uric acid, albumin, thiol contents and total bilirubin. The oxidant status was assessed by determining the total oxidant status (TOS), oxidative stress index (OSI) and individual oxidant components: malondialdehyde (MDA), and lipid hydroperoxide levels. RESULTS: Vitamin C, uric acid, total bilirubin and MDA concentration were significantly lower, whereas serum TOS, lipid hydroperoxide and OSI levels were significantly higher after phototherapy (p < 0.05). There were significant positive correlations between serum total bilirubin and MDA (r = 0.434, p = 0.001). CONCLUSIONS: Although the MDA level was reduced after phototherapy, phototherapy has a negative impact on numerous parts of the oxidant/antioxidant defense system in jaundiced full-term newborns, exposing them to potential oxidative stress.

Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy.

OBJECTIVE: To assess the effect of phototherapy on serum oxidant and antioxidant status in hyperbilirubinemic full-term newborns. METHOD: Thirty-four full-term infants from 3 to 10 days of age exposed to phototherapy were studied. The serum antioxidant status was assessed by measuring the total antioxidant capacity (TAC) and individual antioxidant components: vitamin C, uric acid, albumin, thiol contents and total bilirubin. The oxidant status was assessed by determining the total oxidant status (TOS), oxidative stress index (OSI) and individual oxidant components: malondialdehyde (MDA), and lipid hydroperoxide levels. RESULTS: Vitamin C, uric acid, total bilirubin and MDA concentration were significantly lower, whereas serum TOS, lipid hydroperoxide and OSI levels were significantly higher after phototherapy (p < 0.05). There were significant positive correlations between serum total bilirubin and MDA (r = 0.434, p = 0.001). CONCLUSIONS: Although the MDA level was reduced after phototherapy, phototherapy has a negative impact on numerous parts of the oxidant/antioxidant defense system in jaundiced full-term newborns, exposing them to potential oxidative stress.