RESUMEN
Suicidality in adolescents has been associated with emotional distress, stressful life events, relationship issues, and nightmares to name a few. This study explored the actual dream content and the mood at pre-sleep, during a reported dream, and in the morning in 33 adolescents admitted to the hospital on account of a suicide attempt. In all aspects, hospitalized adolescents were compared to 33 matched adolescents who had followed the same protocol. In accordance with the Continuity and the Threat Simulation theories of dream formation, it was hypothesized that the waking-life experiences of suicidal adolescents would transpire in both dream mood and content as well as in the frequency of nightmares. Dreams were analyzed by independent judges using traditional dream content scales, including for the presence of negative and destructive themes and types of interpersonal relationships. As predicted, more suicidal adolescents experienced frequent nightmares, which was significant. A higher negative mood at pre-sleep, within dreams, and at post-sleep was also observed. Furthermore, their dreams contained a higher prevalence of destructive themes and failures, as well as self-directed and death-resulting aggressions. Regression analyses indicated that morning mood was most accurately predicted by positive and negative dream mood in the normative adolescents, whereas only negative dream mood appeared to predict subsequent waking affect in suicidal participants. Our results underline the valuable potential of implementing nightmare-reducing therapies in the presence of suicidal adolescents who suffer from frequent nightmares.
RESUMEN
INTRODUCTION: Anthracycline chemotherapy contributes to improved outcomes in Ewing sarcoma; however, the most feared complication is cardiotoxicity. Echocardiograms were routinely used to monitor cardiac function after anthracycline treatment. Nevertheless, indices chosen to assess cardiac toxicity vary significantly among different centers, and no uniform protocol has been accepted as ideal. METHODS: This retrospective study included children with Ewing sarcoma treated at Children's Cancer Hospital Egypt over 4years. All echocardiograms and related clinical assessments were reviewed. RESULTS: In total, 149 patients (median age 11years; range 1-18years) were included. Although all patients had a reduced ejection fraction compared with their baseline echocardiogram, only 39 patients developed cardiotoxicity (26%): 43% acute-onset, 36% chronic early-onset, and 21% chronic late-onset. There were no statistically significant association between the frequency of myocardial dysfunction and risk factors, including age, sex, follow-up duration, cumulative doxorubicin dose, and mediastinal irradiation. Over one-third (39%) of the patients with cardiac toxicity regained normal cardiac parameters, whereas seven patients died of acute cardiac toxicity. CONCLUSION: The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed.