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INTRODUCTION: Brazil has high rates of caesarean sections, which has been suggested as a risk factor for acute lymphoblastic leukaemia (ALL). In addition, some pre- and postnatal conditions have been identified as relevant in the etiology of ALL. OBJECTIVES: Investigate the association of caesarean sections, pre- and postnatal conditions with childhood ALL in the State of São Paulo. METHODS: Population-based case-control study including children that are below10 years old. Information on study variables was obtained through face to face interviews, through a questionnaire, and the State of São Paulo Declarations of Live Births database. The conditional and unconditional logistic regression approaches were used to calculate the odds ratio (OR) of the associations between caesarean sections, pre- and postnatal conditions with ALL, and 95 % confidence intervals (95 % CI). RESULTS: We observed a weak and non-statistically significant risk for ALL among children exposed to caesarean sections (unconditional logistic regression OR 1.08; 95 % CI 0.70-1.66; conditional logistic regression OR 1.21; 95 % CI 0.72-2.02), but among children under 3 years old and born through a caesarean sections, the risk of ALL was greater (unconditional logistic regression OR 1.70; 95 % CI 0.69-4.21). A negative association for ALL was observed among children with mothers who reported 12 years of schooling or more (unconditional logistic regression OR 0.34; 95 % CI 0.16-0.69). CONCLUSIONS: We found a tenuous suggestive association between caesarean sections and childhood ALL. The mother's high level of education showed an inverse association with ALL.
Assuntos
Cesárea/estatística & dados numéricos , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Adulto , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Fatores de Risco , Adulto JovemRESUMO
AIM: Maintenance therapy is an important phase of the childhood ALL treatment, requiring 2-year long therapy adherence of the patients and families. Weekly methotrexate with daily 6-mercaptopurine (6MP) constitutes the backbone of maintenance therapy. Reduction in the maintenance therapy could overweight problems related with poverty of children with ALL living in limited-income countries (LIC). OBJECTIVE: To compare, prospectively, the EFS rates of children with ALL treated according to two maintenance regimens: 18 vs. 24 months duration. MATERIALS AND METHODS: From October 1993 to September 1999, 867 consecutive untreated ALL patients <18 years of age were treated according to the Brazilian Cooperative Group for Childhood ALL Treatment (GBTLI) ALL-93 protocol. Risk classification was based exclusively on patient's age and leukocyte count (NCI risk group) and clinical extra medullary involvement of the disease. Data were analyzed by the intention-to-treat approach. RESULTS: Fourteen patients (1.6%) were excluded: wrong diagnosis (n = 7) and previous corticosteroid (n = 7). Of the 853 eligible patients, 421 were randomly allocated, at study enrollment, to receive 18-month (group 1) and 432 to receive 24-month (group 2) maintenance therapy. Complete remission rate was achieved in 96% of the patients (817/853). Twenty-eight patients (3.4%) died during the induction phase. Thirty-four patients (4.0%) were lost to follow-up. The overall EFS was 66.1 ± 1.7% at 15 years. No difference was seen according to maintenance: EFS15y was 65.8 ± 2.3% (group 1) and 66.3 ± 2.3% (group 2; p = 0.79). No difference between regimens was detected after stratifying the analyses according to factors associated with adverse prognosis in this study (age group <1 year or >10 years and high WBC at diagnosis). Overall death in remission rate was 6.85% (56 patients). Deaths during maintenance were 13 in group 1 and 12 in group 2, all due to infection. Over 15 years of follow-up, two patients both from group 2 presented a second malignancy (Hodgkin's disease and thyroid carcinoma) after 8.3 and 11 years off therapy, respectively. CONCLUSION: Six-month reduction of maintenance therapy in ALL children treated according to the GBTLI ALL-93 protocol provided the same overall outcome as 2-year duration regimen.
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PURPOSE: We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors. PATIENTS AND METHODS: From May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg/m(2) and etoposide 2,040 mg/m(2). Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg/m(2), etoposide 1,200 mg/m(2), and ifosfamide 30 g/m(2). Patients at HR with a PR received six cycles of PEI. RESULTS: The risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event-free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR-PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome. CONCLUSION: Reduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR.
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Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina , Cisplatino/administração & dosagem , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Vaginais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Brasil , Criança , Intervalo Livre de Doença , Etoposídeo/administração & dosagem , Feminino , Humanos , Ifosfamida/administração & dosagem , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Medição de Risco , Taxa de Sobrevida , Vimblastina/administração & dosagemRESUMO
The efficacy and safety of a 2-year treatment with deferasirox was evaluated in 31 patients with sickle cell anemia and transfusional iron overload. At 24 months, there were significant decreases from baseline in mean serum ferritin (from 2,344.6 to 1,986.3 µg/l; p = 0.040) and in mean liver iron concentration (from 13.0 ± 5.4 to 9.3 ± 5.7 mg Fe/g dry weight; p < 0.001). Myocardial T2* values were normal (>20 ms) in all patients at baseline and did not change significantly over the course of the study. However, there was a significant improvement from baseline in left ventricular ejection fraction at 24 months (62.2-64.6%; p = 0.02). Deferasirox was generally well tolerated with no progressive increases in serum creatinine or renal failure observed. These data confirm that deferasirox is effective in reducing body iron burden in patients with sickle cell anemia and transfusional iron overload.
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Anemia Falciforme/tratamento farmacológico , Benzoatos/uso terapêutico , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Triazóis/uso terapêutico , Adolescente , Adulto , Benzoatos/efeitos adversos , Deferasirox , Feminino , Humanos , Quelantes de Ferro/efeitos adversos , Masculino , Estudos Prospectivos , Triazóis/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: Epidemiological studies have identified increased risks of leukemia in children living near power lines and exposed to relatively high levels of magnetic fields. Results have been remarkably consistent, but there is still no explanation for this increase. In this study we evaluated the effect of 60 Hz magnetic fields on acute lymphocytic leukemia (ALL) in the State of São Paulo, Brazil. METHODS: This case-control study included ALL cases (n=162) recruited from eight hospitals between January 2003 and February 2009. Controls (n=565) matched on gender, age, and city of birth were selected from the São Paulo Birth Registry. Exposure to extremely low frequency magnetic fields (ELF MF) was based on measurements inside home and distance to power lines. RESULTS: For 24h measurements in children rooms, levels of ELF MF equal to or greater than 0.3microtesla (µT), compared to children exposed to levels below 0.1 µT showed no increased risk of ALL (odds ratio [OR] 1.09; 95% confidence interval [95% CI] 0.33-3.61). When only nighttime measurements were considered, a risk (OR 1.52; 95% CI 0.46-5.01) was observed. Children living within 200 m of power lines presented an increased risk of ALL (OR 1.67; 95% CI 0.49-5.75), compared to children living at 600 m or more of power lines. For those living within 50 m of power lines the OR was 3.57 (95% CI 0.41-31.44). CONCLUSIONS: Even though our results are consistent with the small risks reported in other studies on ELF MF and leukemia in children, overall our results do not provide support for an association between magnetic fields and childhood leukemia, but small numbers and likely biases weaken the strength of this conclusion.
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Campos Eletromagnéticos/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiologia , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Habitação , Humanos , Lactente , Masculino , Razão de ChancesRESUMO
OBJETIVO: Analisar o comportamento da temperatura em crianças febris medicadas com dose oral única do ibuprofeno (10 mg/kg), dose recomendada para febre alta, comparado à dipirona (15 mg/kg), dose preconizada pelo fabricante, após 2, 3, 4, 5, 6, 7 e 8 horas da medicação antitérmica. MÉTODOS: Ensaio clínico, aberto e randomizado (1:1), em crianças de ambos os sexos, com doenças febris, com idade entre 6 meses e 8 anos, temperatura axilar basal entre 38,0 e 40,3 °C, e divididas em dois grupos: febre alta (> 39,1 °C) e febre baixa (38,0 a 39,1 °C). A análise do comportamento baseou-se nos critérios de descontinuidade, segurança, resposta ao tratamento, tolerabilidade e eficácia terapêutica. RESULTADOS: Das 80 crianças, 31 permaneceram afebris ao longo de 8 horas (38,8 por cento), 100,0 por cento obtiveram decréscimo da temperatura com ambas as medicações nas 2 primeiras horas. No grupo de febre alta, 11 crianças medicadas com ibuprofeno foram mantidas até a 5ª hora (100,0 por cento), e 11 com dipirona até a 3ª hora (100,0 por cento). A eficácia antipirética na febre alta foi estatisticamente significante a favor do ibuprofeno na 3ª e na 4ª hora, e, na febre baixa, na 3ª hora após a medicação. CONCLUSÕES: Este estudo demonstrou que, em dose oral única, o ibuprofeno proporciona atividade antipirética mais acentuada do que a dipirona, principalmente na febre alta. Ambas as medicações foram bem toleradas e seguras em curto prazo.
OBJECTIVE: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration. METHODS: This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. RESULTS: Of the 80 children, 31 remained febrile during the 8 hours (38.8 percent), but 100 percent had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00 percent) and in the 11 that received dipyrone, up to the third hour (100.00 percent). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. CONCLUSIONS: A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term.
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Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Antipiréticos/administração & dosagem , Dipirona/administração & dosagem , Febre/tratamento farmacológico , Ibuprofeno/administração & dosagem , Administração Oral , Antipiréticos/efeitos adversos , Índice de Massa Corporal , Dipirona/efeitos adversos , Ibuprofeno/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration. METHODS: This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. RESULTS: Of the 80 children, 31 remained febrile during the 8 hours (38.8%), but 100% had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00%) and in the 11 that received dipyrone, up to the third hour (100.00%). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. CONCLUSIONS: A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term.
Assuntos
Antipiréticos/administração & dosagem , Dipirona/administração & dosagem , Febre/tratamento farmacológico , Ibuprofeno/administração & dosagem , Administração Oral , Antipiréticos/efeitos adversos , Índice de Massa Corporal , Criança , Pré-Escolar , Dipirona/efeitos adversos , Feminino , Humanos , Ibuprofeno/efeitos adversos , Lactente , Masculino , Resultado do TratamentoRESUMO
A principal causa de anemia no feto é a doença hemolítica do recém-nascido (RN). As gestantes anêmicas na sua forma moderada não acarretam baixos estoques de ferro no concepto, porém podem evoluir para o trabalho de parto prematuro e RN com baixo peso ao nascer. O ferro é transportado para o feto por via transplacentária, principalmente durante o terceiro trimestre de gestação. A deficiência de ferro não ocorre no período neonatal, porém os prematuros e ou RN com baixo peso constituem o principal grupo de risco para desenvolver a deficiência de ferro. Nos RN nascidos a termo podemos observar uma deficiência de ferro naqueles que sofreram ressecção cirúrgica do duodeno devido à malformação congênita. A fim de evitarmos a deficiência de ferro neste grupo de risco, indica-se a suplementação de ferro a partir dos 30 dias de vida. A via de administração preferencial é a enteral, apesar de sabermos que no prematuro ocorre uma deficiência do controle da absorção do ferro. O complexo de ferro polimaltosado e o ferro aminoquelado são os de escolha para a profilaxia da deficiência de ferro em prematuros. A via endovenosa é segura e não acarreta piora das lesões causadas pela ação oxidativa do ferro em prematuros.
The main cause of anemia in the fetus is hemolytic disease. Mildly anemic pregnant women may evolve with premature labor and have low birth weight babies, but the baby's iron status is not influenced by the mother's iron deficiency. Iron transportation through the placenta occurs in the third trimester of gestation and premature labor results in reduced iron stores. Iron deficiency anemia does not occur during the neonatal period, but premature and low birth weight babies are at risk of developing iron deficiency. In full-term babies iron deficiency can occur due to intestinal malformation that leads to duodenal resection. To avoid iron deficiency in at-risk babies, iron supplementation is recommended from the thirtieth postnatal day. The best method to avoid iron absorption deficiency in premature babies is the enteral administration of iron. Iron polymaltose complex and amino acid-based iron chelators are preferable to ferrous sulfate in premature babies because of the reduced oxidative side effects of iron administration. Intravenous administration is safe and does not increase the oxidative side effects.