Essential core competencies for scope of practice of paediatric oncology nurses in Latin America: a scoping review protocol.

INTRODUCTION: Nurses comprise the largest group of health workers globally and are essential to the provision of care necessary for delivering curative therapy to children with cancer. In high-income countries, previous studies of the nurse workforce have shown an association between patient morbidity and mortality and nursing-related factors such as staffing, education and the nursing practice environment. There is currently limited evidence available to define the scope of essential core competencies for paediatric oncology nursing (PON) practice internationally and specifically in Latin America. Clearly defined essential core competencies contribute to establishing nurses' scope of practice within clinical practice, education and research settings. Here, we aimed to map and synthesise the available evidence on the scope of PON practices in the context of clinical practice, educational training and research settings in Latin America. METHODS: A scoping review (ScR) protocol is reported, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. MEDLINE/PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Science Direct and Latin American and Caribbean Health Sciences Literature, plus additional sources: The ProQuest Dissertation & Theses Global, The British Library, Google Scholar, medRXiv, ClinicalTrials.gov and WHO-ICTRP will be searched. No date or language restrictions will be employed. Two independent researchers will conduct all the steps of this ScR. The findings will be presented through tables, charts, narrative summaries and assessed based on the outcomes. The search strategy will be updated in May 2022. The expected completion date for this ScR is November 2022. ETHICS/DISSEMINATION: This protocol does not require ethical approval. The dissemination plans comprise peer-reviewed publication and conference presentations, to be shared with International Oncology Societies/International Nursing Societies and advisory groups to inform discussions on future research. We expect that our results will be of interest to nurse professionals, especially, PON and nurse scholars concerned with this particular issue.

Prognostic factors for incomplete response in thyroid microcarcinoma: an analysis of initial response to therapy in 517 patients

ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favorable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

Immunohistochemistry of apoptosis-related proteins in retinoblastoma.

Retinoblastoma is the most common intraocular malignant neoplasia during childhood and results from the partial or total inactivity of the retinoblastoma protein (pRb). In the absence of pRb, the E2F transcription factors increase the levels of cell cycle proteins as well as some pro-apoptotic proteins. We intended to study the immunohistochemistry profile of apoptotic-related proteins in retinoblastoma. We also evaluated the association between the expression of apoptotic protein and stage of tumor or survivor after a 5year follow up. Apoptosis-related proteins (Apaf-1, Bak, Bax, Bcl-2, Bcl-xL, Bim-long, MDM2, p53, pro-caspase-3, PUMA, Smac/DIABLO and cleaved caspase-3) were evaluated using immunohistochemistry on tissue microarrays which contained samples of retinoblastoma tumors taken from ninety-three patients without any treatment previous to surgery. The immunohistochemistry reactions were evaluated using an optical microscope as well as the ACIS III® platform. The pro-apoptotic proteins (APAF-1, Bax, p53, PUMA, Smac/DIABLO) were more frequently expressed than the anti-apoptotic proteins (Bcl-2, Bcl-xL and MDM2). The protein Bcl-xL had a negative correlation with cleaved caspase-3, a marker of cell apoptosis. Bcl-xL may be implicated in an apoptosis block.

Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years.

PURPOSE: Few reports have evaluated cumulative survival rates of implants placed in the pterygoid region in the medium term. The objective of this study was to evaluate success rates of pterygoid implants and prostheses in patients treated in the atrophic posterior maxilla. MATERIALS AND METHODS: A retrospective study was performed of patients with an atrophic posterior maxilla rehabilitated with pterygoid implants between 1999 and 2010 and followed for at least 36 months after implant loading. Two outcome variables were considered: implant success and prosthesis success. The following predictor variables were recorded: sex, age, implant placement angulation, number and size of implants, prosthetic rehabilitation, bone loss, date of prosthesis delivery, and date of last follow-up. A statistical model was used to estimate the survival rates and associated confidence intervals. Data were analyzed using the Kaplan-Meier method and log-rank test to compare survival curves. RESULTS: A total of 238 titanium implants (172 anterior and 66 pterygoid) were placed in 56 patients. The 3-year overall pterygoid implant survival rate was 99%. The 3-year overall prosthesis survival rate was 97.7%. The mean bone loss around pterygoid implants after 3 years of loading was 1.21 mm (range, 0.31 to 1.75). All patients were wearing the prostheses at the most recent follow-up examination. CONCLUSION: Placement of implants in the pterygoid region is a viable alternative treatment modality for rehabilitation of patients with an atrophic posterior maxilla.

A school-based human papillomavirus vaccination program in barretos, Brazil: final results of a demonstrative study.

INTRODUCTION: The implementation of a public HPV vaccination program in several developing countries, especially in Latin America, is a great challenge for health care specialists. AIM: To evaluate the uptake and the three-dose completion rates of a school-based HPV vaccination program in Barretos (Brazil). METHODS: THE STUDY INCLUDED GIRLS WHO WERE ENROLLED IN PUBLIC AND PRIVATE SCHOOLS AND WHO REGULARLY ATTENDED THE SIXTH AND SEVENTH GRADES OF ELEMENTARY SCHOOL (MEAN AGE: 11.9 years). A meeting with the parents or guardians occurred approximately one week before the vaccination in order to explain the project and clarify the doubts. The quadrivalent vaccine was administered using the same schedule as in the product package (0-2-6 months). The school visits for regular vaccination occurred on previously scheduled dates. The vaccine was also made available at Barretos Cancer Hospital for the girls who could not be vaccinated on the day when the team visited the school. RESULTS: Among the potential candidates for vaccination (n = 1,574), the parents or guardians of 1,513 girls (96.1%) responded to the invitation to participate in the study. A total of 1,389 parents or guardians agreed to participate in the program (acceptance rate = 91.8%). The main reason for refusing to participate in the vaccination program was fear of adverse events. The vaccine uptake rates for the first, second, and third doses were 87.5%, 86.3% and 85.0%, respectively. The three-dose completion rate was 97.2%. CONCLUSIONS: This demonstrative study achieved high rates of vaccination uptake and completion of three vaccine doses in children 10-16 years old from Brazil. The feasibility and success of an HPV vaccination program for adolescents in a developing country may depend on the integration between the public health and schooling systems.

Extraoral implants in the rehabilitation of craniofacial defects: implant and prosthesis survival rates and peri-implant soft tissue evaluation.

PURPOSE: Few reports have evaluated cumulative survival rates of extraoral rehabilitation and peri-implant soft tissue reaction at long-term follow-up. The objective of this study was to evaluate implant and prosthesis survival rates and the soft tissue reactions around the extraoral implants used to support craniofacial prostheses. MATERIALS AND METHODS: A retrospective study was performed of patients who received implants for craniofacial rehabilitation from 2003 to 2010. Two outcome variables were considered: implant and prosthetic success. The following predictor variables were recorded: gender, age, implant placement location, number and size of implants, irradiation status in the treated field, date of prosthesis delivery, soft tissue response, and date of last follow-up. A statistical model was used to estimate survival rates and associated confidence intervals. We randomly selected 1 implant per patient for analysis. Data were analyzed using the Kaplan-Meier method and log-rank test to compare survival curves. RESULTS: A total of 150 titanium implants were placed in 56 patients. The 2-year overall implant survival rates were 94.1% for auricular implants, 90.9% for nasal implants, 100% for orbital implants, and 100% for complex midfacial implants (P = .585). The implant survival rates were 100% for implants placed in irradiated patients and 94.4% for those placed in nonirradiated patients (P = .324). The 2-year overall prosthesis survival rates were 100% for auricular implants, 90.0% for nasal implants, 92.3% for orbital implants, and 100% for complex midfacial implants (P = .363). The evaluation of the peri-implant soft tissue response showed that 15 patients (26.7%) had a grade 0 soft tissue reaction, 30 (53.5%) had grade 1, 6 (10.7%) had grade 2, and 5 (8.9%) had grade 3. CONCLUSIONS: From this study, it was concluded that craniofacial rehabilitation with extraoral implants is a safe, reliable, and predictable method to restore the patient's normal appearance.

Variação da qualidade de vida em pacientes tratadas com câncer de mama e submetidas a um programa de exercícios aeróbios / Variation of the quality of life in patients treated with breast cancer and submitted to a program of aerobic exercises

Objetivo: O objetivo deste estudo foi analisar o efeito de um programa de exercícios na qualidade de vida em pacientes que tiveram câncer de mama. Metodologia: Foram diagnosticadas 29 mulheres com câncer de mama e tratadas com intuito de cura, sendo submetidas a dez semanas de exercícios aeróbios (caminhada ou corrida leve). Os exercícios foram realizados três vezes por semana. Para instrumentos no controle da intensidade dos exercícios se utilizou a escala de percepção de esforço de BORG e monitor de frequência cardíaca (POLAR FS-1). Para a avaliação dos estados de humor, utilizou-se o score POMS - Profile of Mood States no início da primeira semana e no final da décima semana do programa de exercícios. A qualidade de vida foi mensurada no início e no final do estudo através do score SF-36. Resultados: Com exceção da confusão mental (p= 0,123), todas as outras variáveis dos estados de humor do score POMS demonstraram melhoras significativas no final do trabalho (p< 0,05) e, também, as variáveis relacionadas aos aspectos físicos e psicológicos (p< 0,05). A capacidade aeróbia também aumentou significativamente (762,7m pré versus 1025,3m pós p< 0,05). O percentual de gordura corporal também sofreu influência positiva dos exercícios, indo de 30,9% no início do programa para 29,5% ao final (p< 0,05). Não foi detectada variação significativa no peso corporal das pacientes. Conclusão: De forma geral, os exercícios aeróbios demonstraram impactos positivos na melhora da qualidade de vida e nos estados de humor nas participantes deste estudo após dez semanas.

Proteins involved in pRb and p53 pathways are differentially expressed in thin and thick superficial spreading melanomas.

Cutaneous melanoma is one of the leading causes of cancer-related death. Malignant transformation of epidermal melanocytes is a multifactorial process involving cell cycle and death control pathways. The purpose of this study was to analyze the immunohistochemical expression of cell-cycle-related and apoptosis-related proteins in cutaneous superficial spreading melanomas using the tissue microarray technique to further understand tumor development. A total of 20 samples of in-situ melanomas and 44 melanomas 1.0 mm) and metastases lost p16 expression in 100% of the cases and in-situ and thin melanomas (

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit.

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

Soroprevalência e fatores associados à infecção pelo Helicobacter pylori em doadores de medula óssea de São Paulo / Seroprevalence and epidemiological aspects of Helicobacter pylori infection in bone marrow donors in São Paulo

OBJETIVOS: Estimar a prevalência da infecção pelo Helicobacter pylori (HP) e determinar os fatores associados, em adultos saudáveis, doadores voluntários de medula óssea em São Paulo, Brasil. MÉTODOS: 248 indivíduos saudáveis, residentes na zona urbana de São Paulo, responderam a um questionário relatando condições sociais e domiciliares na infância e na vida adulta, assim como antecedentes gastrintestinais e principais fatores associados à infecção. Amostras de sangue foram coletadas e o soro foi analisado utilizando um teste de ELISA previamente validado. RESULTADOS: A prevalência da infecção pelo HP em 248 doadores foi de 48,8 por cento, IC95 por cento= [45,6; 52,0]. Na análise univariada, a infecção pelo HP esteve significativamente associada à ausência de água encanada (p=0,040), a escolaridade da mãe (p=0,005) e do indivíduo (p<0,001). Na análise múltipla, os fatores independentes foram a escolaridade da mãe e do indivíduo. CONCLUSÕES: A prevalência de infecção de 48,8 por cento mostra que na região urbana de São Paulo, onde há água tratada e esgoto encanado, temos uma prevalência semelhante à encontrada em países industrializados. O fator de maior significância para a aquisição do HP foi a escolaridade, seja individual ou materna, o que sugere que os hábitos higiênicos e comportamentais possam ser determinantes da infecção.

Osteossarcoma: experiência do Serviço de Oncologia Pediátrica da Santa Casa de Misericórdia de São Paulo / Osteosarcoma: experience of the Pediatric Oncology clinic of the Santa Casa de Misericórdia Hospital in São Paulo

OBJETIVOS: Descrever as características clínico-laboratoriais das crianças e adolescentes com osteossarcoma acompanhadas no Serviço de Oncologia Pediátrica da Santa Casa de Misericórdia de São Paulo e determinar as taxas de sobrevida livre de evento e sobrevida global, correlacionando-as com os principais fatores prognósticos. MÉTODOS: Estudo retrospectivo realizado no Serviço de Oncologia Pediátrica da Santa Casa de Misericórdia de São Paulo compreendendo o período entre abril de 1991 e setembro de 2002. Nesse período foram diagnosticados 60 casos de osteossarcoma. Observaram-se predomínio do sexo masculino (61,7 por cento), raça não-branca (65 por cento) e idade superior a 10 anos (70 por cento); história de trauma prévio em 53,3 por cento, relato de dor em 95 por cento e aumento de volume em 80 por cento dos casos. O joelho foi a região mais comprometida (74,9 por cento). Em 70,7 por cento dos casos o tumor apresentava tamanho inferior a 1/3 do comprimento do osso afetado, em 25 por cento o nível sérico de desidrogenase láctica era igual ou maior que 500U/L e em 48,3 por cento o nível de fosfatase alcalina era igual ou maior que 1.000U/L, 25 por cento dos pacientes apresentavam metástase pulmonar visível ao diagnóstico e 53,3 por cento pertenciam ao subtipo osteoblástico. O tratamento quimioterápico pré e pós-operatório foi realizado em 78,3 por cento dos pacientes, 64 por cento foram submetidos a procedimento cirúrgico conservador, 68,1 por cento apresentaram necrose tumoral graus I e II e houve recidiva em 60 por cento dos casos. RESULTADOS: Com seguimento de 48 meses observaram-se sobrevida livre de doença em 28,6 por cento dos pacientes e sobrevida global de 38,4 por cento. CONCLUSÕES: Os autores concluem que o diagnóstico precoce é fundamental, assim como novos estudos são necessários para aprimorar o manuseio e o tratamento desses pacientes e melhorar a sobrevida.

OBJECTIVES: To describe clinical and laboratorial features of children and adolescents with osteosarcoma seen at the Pediatric Oncology clinic of the Santa Casa de Misericórdia Hospital in São Paulo and to determine the uneventful rates of survival and the overall survival, and correlate such rates to the main factors of prognosis. METHODS: Retrospective study carried out at the Pediatric Oncology clinic of the Santa Casa de Misericórdia Hospital in São Paulo from April 1991 to September 2002. 60 cases of osteosarcoma were identified in the period. The authors saw a predominance of the male sex (61.7 percent), non-white race (65 percent), and age above 10 years (70 percent); history of previous trauma in 53.3 percent, reporting pain in 95 percent, and volume increase in 80 percent of the cases. The knee joint was the involved region in most cases (74.9 percent). In 70.7 percent of the cases, the tumor was smaller than 1/3 of the bone affected, in 25 percent the serum lactic dehydrogenase level was equal to or greater than 500U/L, and in 48.3 percent, the alkaline phosphatase level was equal to or greater than 1000U/L, 25 percent of the patients presented with lung metastasis that was visible in the diagnosis, and 53.3 percent were of the osteoblastic subtype. Pre and post surgical chemotherapy was conducted in 78.3 percent of the patients, 64 percent were submitted to conservative surgery, 68.1 percent had tumoral necrosis grades I and II, and recurrence was seen in 60 percent of the cases. RESULTS: With a 48 month follow-up, they observed disease-free survival in 28.6 percent of the patients, and overall survival in 38.4 percent. CONCLUSIONS: They concluded that early diagnosis is a must, and that new studies are required to improve the management and treatment of this patients and to improve survival.

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34 percent. The main neonatal NI was bloodstream infection (68.1 percent), with clinical sepsis accounting for 47.2 percent, and pneumonia was the second most common NI (8.6 percent). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

Risk factors for surgical-site infections in head and neck cancer surgery.

OBJECTIVE: The aim of this study was to identify risk factors for surgical-site infections (SSIs) in patients with head and neck cancer submitted to major clean-contaminated surgery. STUDY DESIGN: This is a prospective study conducted in a tertiary cancer center hospital. SUBJECTS AND METHODS: This study includes 258 patients submitted to a major clean-contaminated head and neck oncologic surgery. RESULTS: The overall SSI rate was 38.8%. The univariate analysis showed the following significant risk factors: race, tobacco consumption, clinical stage, comorbidities, time duration of the surgical procedure, and flap reconstruction. The final model by logistic regression identified the following independent predictors for SSI: tobacco consumption (odds ratio [OR] = 2.96), presence of metastatic lymph nodes (OR = 2.05), flap reconstruction (OR = 2.20), and antimicrobial prophylaxis exceeding 48 hours (OR=1.89). CONCLUSION: The high-risk patients for SSI in head and neck oncologic surgery were those with cancer at advanced stages, those who were smokers, those presenting comorbidities, those who needed major reconstruction of the surgical wound, or those who were submitted to inadequate antibiotic prophylaxis.

Trends in eye cancer mortality among children in Brazil, 1980-2002.

BACKGROUND: In the last few decades mortality from childhood cancers has shown substantial declines in industrialized countries, with smaller favorable trends in South America. OBJECTIVE: This study describes mortality trends in childhood eye cancer in Brazil from 1980 to 2002. PROCEDURE: Age-specific eye cancer death rates (0-4, 5-9, and 10-14 years) were calculated according to gender. Age-standardized mortality rates for children under 15 years were obtained through the direct method, using the 1960 world population as the standard. Trends in mortality were modeled using linear regression methods, with the age-standardized mortality coefficient (3-year centered moving average) as the dependent variable and the calendar year as the independent variable. RESULTS: The age-standardized mortality rates among the boys decreased from 0.14/100,000 habitants in 1981 and 1985 to 0.06 in 1994, whereas the observed corresponding decline among girls was from 0.17/100,000 habitants in 1982 and 1983 to 0.07 in 2001. Statistically significant declining trends in eye cancer mortality rates were observed for boys (r(2) adjusted = 0.54, P < 0.001) and also for girls (r(2) adjusted = 0.53, P < 0.001). When only subsite retina was analyzed a statistically significant decrease in mortality coefficients was also noted for males (r(2) adjusted = 0.55, P < 0.001) and females (r(2) adjusted = 0.32, P = 0.005). CONCLUSIONS: A consistent decrease in eye cancer mortality rates was noted in Brazil. In the absence of changes in incidence rates, this decline could be attributed to the improvement in treatment protocols and survival.

A proposed score for predicting severe infection complications in children with chemotherapy-induced febrile neutropenia.

BACKGROUND: Febrile neutropenia (FN) is one of most common complications in patients with cancer during chemotherapy. Identifying factors associated with severe infectious complications (SICs) at time of admission for fever and neutropenia is necessary for better treatment. PROCEDURE: We revised all medical charts of patients under 18 years old who developed a first episode of FN present from January 2000 to December 2003. Criteria for a SIC were defined. These included the presence of bacteremia or fungemia, sepsis, septic shock, and/or death from infection. To identify risk factors SIC was associated with the first FN episode. RESULTS: Factors identified in univariate analysis were female sex, age less than 5 years old, acute myeloid leukemia, baseline disease activity, use of central venous catheter, hemoglobin level < 7 g/dL, leukocytes count < 500 cells/mm(3), granulocytes count < 500 cells/mm(3), monocytes count < 100 cells/mm(3), platelets < 20,000, and body temperature > 38.5 degrees C, a chemotherapy interval < 7 days, presence of mucositis, pneumonia, absence of upper respiratory tract infection, or the presence of any clinical focus on first physical examination. In multivariate analysis the variables that remained as independent predictive risk factors for SIC were age less than 5 years, use of central venous catheter, body temperature > 38.5 degrees C, hemoglobin level < 7 g/dL, any clinical focus of infection on first examination and absence of upper respiratory tract infection. The FN population was than divided among 3 different risk groups as follows: group 1 (low risk), group 2 (intermediate risk), with a 13 (4.4 to 38.3)-fold risk for SIC; and group 3 (high risk) with a 50 (16.4 to 149.2)-fold risk for SIC. CONCLUSIONS: This study suggests that patients with FN can be stratified for risk of SIC using clinical parameters at hospital admission.

The importance of long-term follow-up of head and neck cancer patients for reliable survival analysis.

OBJECTIVE: Analyze the influence of patients lost to follow-up in estimated survival rates calculated by the Kaplan-Meier method. STUDY DESIGN: Only patients with previously untreated squamous cell carcinoma of the upper aerodigestive tract were selected. For the patients lost to follow-up anytime, the last medical evaluation date was collected to calculate the "estimate A" survival time. If the same patient returned to our outpatient clinic or further health information was obtained, the updated last information/evaluation date was also collected to calculate "estimate B" survival time. The survival curves considering "estimate A" and "B" survival rates were compared. RESULTS: The overall 5 and 10-years survival rates for all patients calculated for "estimate A" were 54.0% and 46.0%, respectively; compared with 42.8% and 28.2% when were calculated considering "estimate B" (P < 0.001). CONCLUSION: Close follow-up of the head and neck cancer patients is essential for an accurate estimate of survival by Kaplan-Meier method.

Histological classification of 1,025 cases of Hodgkin's lymphoma from the State of São Paulo, Brazil.

CONTEXT AND OBJECTIVE: It is currently asserted that, in industrialized countries, nodular sclerosis is the most frequent type of Hodgkin's lymphoma, in contrast to developing countries, where mixed cellularity and lymphocyte depletion are more frequently seen. The objective was to review histological data from cases of Hodgkin's lymphoma from São Paulo and Campinas cities. DESIGN AND SETTING: Cross-sectional histopathological analysis, in four university hospitals and one cancer care center. METHODS: 1,025 cases diagnosed as Hodgkin's lymphoma between 1990 and 2000 were collected from five institutions; 631 of them (61.5%) had been immunophenotyped using antibodies to CD20, CD3, CD15 and CD30. The relative frequencies of histological types (as informed by the contributing authors, who are hematopathologists in their institutions) were determined according to age and gender. RESULTS: The Hodgkin's lymphoma types were distributed as follows: lymphocyte predominance 4.8%, nodular sclerosis 69.2%, mixed cellularity 21.1% and lymphocyte depletion 4.6%. CONCLUSIONS: The controversy regarding the frequencies of Hodgkin's lymphoma types within the Brazilian setting seems to be due to the small number of cases in previous studies. The present data show a picture close to the situation in the industrialized countries.

Prognostic Factors in Pediatric Palliative Care: Development of a Survival Predicting Score

OBJECTIVE: To identify prognostic factors that predictssurvival in children and adolescents in palliative care.MATERIAL AND METHODS: 87 children referred to thepediatric palliative care team were evaluated for socialdemographic, clinical, and laboratory variables.RESULTS: A prognostic score was developed in 49patients based on a final model, which included thefollowing variables: diagnosis, anemia, home careprovider and patient’s (PPS) score given by homecaregiver. The sum of the single scores has given anoverall score for each patient and was used to subdividethe study population into three groups, with differentprobability of 60-day survival: (1) Group A: survivalprobability 84.4%; (2) Group B: survival probability57.8%; (3) Group C: survival probability 15.4% (p<0.001).CONCLUSION: A pediatric palliative care score basedon easily accessible variables proved to be statisticallysignificant (p<0.05) in a multivariate analysis. The scoreis valid to this population. Factors that helpmultidisciplinary team to predict the life expectancyenable adequate information to be given to patients andfamilies participating in therapeutic decision-makingissues.

Histological classification of 1,025 cases of Hodgkin's lymphoma from the state of São Paulo, Brazil

CONTEXTO E OBJETIVO: Tem-se afirmado correntemente que, em países industrializados, a esclerose nodular é o tipo mais freqüente de linfoma de Hodgkin, ao contrário de países em desenvolvimento, onde a celularidade mista e a depleção linfocitária são mais freqüentes. O objetivo do estudo é rever os dados histológicos de linfoma de Hodgkin das cidades de São Paulo e Campinas. TIPO DE ESTUDO E LOCAL: Transversal, por análise histopatológica, em quatro hospitais universitários e um centro oncológico de referência. MÉTODOS: 1.025 casos com o diagnóstico de linfoma de Hodgkin entre 1990 e 2000 foram coletados de cinco instituições. Em 631 (61,5%) casos fora feito estudo imunoistoquímico para os marcadores CD20, CD3, CD15 e CD30. As freqüências relativas dos tipos histológicos (informadas pelos autores que são hematopatologistas de suas respectivas instituições) foram determinadas nos diversos grupos etários e por gênero. RESULTADOS: Os tipos de linfoma de Hodgkin foram assim distribuídos: predominância linfocitária 4,8%, esclerose nodular 69,2%, celularidade mista 21,1% e depleção linfocitária 4,6%. CONCLUSÕES: Dados controversos sobre a freqüência dos tipos de linfoma de Hodgkin em nosso meio parecem ser devidos ao pequeno número de casos dos trabalhos anteriores. Nossos dados são comparáveis aos dos países industrializados.