FREDERICO LUIZ DULLEY
Projetos de Pesquisa
Unidades Organizacionais
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
conferenceObject Oral leukoplakia in chronic graft versus host disease(2012) PAVESI, V. C. S.; FRANCA, C. M.; CASTELLI, J. B.; SABOYA, R.; DULLEY, F. L.; CORACIN, F. L.Introduction: Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies and early diagnosis of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors. Patients with oral epithelial dysplasia after allogeneic HSCT include oral cGVHD as a potential risk factor for oral cancer. A better understanding of the clinical features and potential factors associated with secondary oral cancer, may be benefit predicting and identifying this late complication of allogeneic HSCT. Case details: A 37 years old male who had received an allogeneic hematopoietic stem cell transplantation in October/2002 was referred to a Oral Medicine Outpatient in August 2011 with a white-plaque lesion of the oral mucosa the conditioning regimen to HSCT comprised busulfan-melphalan and graft-versus-host disease prophylaxis was cyclosporine-methotrexate. The patient developed lichenoid-oral cGVHD around day 60 and treatment comprised corticosteroid-cyclosporine. Clinical examination revealeda non-symptomatic 2 cm white-plaque of the hard palate. Exfoliative cytology was performed and no atypical cells were seen. The lesion increased in size to 4 cm long during the next 10-days. An incisional biopsy was undertaken and histopathological analysis revealed an epithelial tissue with acanthosis, hypergranulosis, hyperkeratosis, papilomatosis and apoptosis plus lymphocyte exocitosis. No atypical, cell dysplasia or koylocites were present. Mild to moderate cGVHD activity was seen. In this case, the patient was monitored in our outpatient program and no changes were noted in the lesion. Conclusion: The associationbetweenchronic graftversus host disease andoralsquamous cell carcinoma suggests a close monitoring of patients for early diagnosis of possible secondaryneoplasmsanddemonstratestheaggressivebehaviourofthislatecomplication. Relevance: Due to this aggressive behaviour and the increase number of HSCT worldwide, careful long-term follow-up by a cancer team, including oral medicine expertise, is recommended, and patients should be aware of cancer risk.- Prophylaxis of fungal infections in transplant patients(2012) ABDALA, Edson; COSTA, Silvia Figueiredo; STRABELLI, Tania Mara Varejao; PIERROTTI, Ligia Camera; CARAMORI, Marlova Luzzi; AZEVEDO, Luis Sergio Fonseca de; IBRAHIM, Karim Y.; DULLEY, Frederico Luiz; VARKULJA, Glaucia Fernanda; CASTRO JUNIOR, Gilberto de; ALMEIDA, Gisele Madeira Duboc de; MARQUES, Heloisa Helena de Souza; SHIKANAI-YASUDA, Maria Aparecida
- Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome(2012) MENDES, Elisa Teixeira; DULLEY, Frederico; BASSO, Mariusa; BATISTA, Marjorie Vieira; CORACIN, Fabio; GUIMARAES, Thais; SHIKANAI-YASUDA, Maria Aparecida; LEVIN, Anna Sara; COSTA, Silvia FigueiredoObjective: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization. Methods: We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in Sao Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1. Results: Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6). Conclusions: BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population. (C) 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
conferenceObject Patients oral conditions before hematopoietic stem-cell transplantation in Brazil(2012) CORACIN, F. L.; SOARES JUNIOR, L. A. V.; DULLEY, F. L.; SABOYA, R.; SILVA-SANTOS, P. S. da; TINOCO-ARAUJO, J. E.; COLTURATO, V. A. R.; ANTUNES, H. S.; FERREIRA, C. G.; BOUZAS, L. F. S.; PEREIRA, S. C. M.; MONTEIRO, M. C. P.; RAMPINI, M. P.; MAYHE, R.; LIME, E. M.; TANIMOTO, H. M.; PATON, E. J. A.; SILVA, G. B. L.; SACONO, N. T.; BATISTA, A. C.; BARIANI, C.; PERES, M. P. S. M.Objectives: This prospective multicenter study aims to conduct an epidemiologic survey of oral health status of the patients waiting for the hematopoietic stem cell transplantation (HSCT) in five Brazilian Centers to identify oral needs prior to HSCT. Methods: Patients enrolled in this study were submitted to a dental clinical evaluation whilst they were awaiting for HSCT, performed by a dentist from the participating Institution. Demographic and medical data were collated together with, gingival (GI) and plaque (PI) indexes and index of decay missed and filled teeth (DMFT) were evaluated. These indexes are indicators of oral health according to the World Health Organization (WHO). Results: During the period between April 2011 and April 2012, 101 (73 male and 48 female) patients were enrolled in this prospective study at five HSCT Brazilian Centers. Underlying diseases comprised 25 multiple myeloma, 24 non-Hodgkin lymphoma, 19 acute lymphoblastic leukemia, 16 acute myelogenous leukemia, 13 severe aplastic anemia, 11 Hodgkin lymphoma, six chronic myelogenous leukemia, three myelodisplastic syndrome, one testicular tumor, one retinoblastoma, one myelofibrosis and one chronic lymphoblastic leukemia. Median age was 40 years (range: 4–67). At the time of the survey, patients presented mean GI = 0.8, mean PI = 1.2. DMFT index were evaluated in 104/121 patients and showed mean of 16.1. Conclusion: Patients undergoing HSCT need comprehensive oral care in Brazil due a poor oral health at the time of transplantation, to avoid possible infections secondary to myelosuppression and mucosal barrier injury. Relevance: The patients’ status prior-HSCT may to lead to protocols of dental treatment before HSCT suggesting an important role in the maintenance of oral integrity. Prior dental intervention can lead a better quality of life and improve the results of transplantation, reducing time of mucositis and infections.conferenceObject Ciclosporine-induced fibrovascular polyps in the tongue(2012) TORRES-PEREIRA, C.; SABOYA, R.; CASTELLI, J. B.; ROCHA, A. C.; ROCHA, G. B. L.; BONFIM, C. S.; DULLEY, F. L.; CORACIN, F. L.Introduction: Cyclosporine (CsA) is used for chronic graft-versus-host disease (cGVHD) treatment and can lead to increased or synthesis of collagen and fibrous eposition. Gingival overgrowth is a common adverse effect of CsA, however it is rarely seen in patients using CsA for treatment of cGVHD. The development of CsA- associated nongingival growth is rare and represents polyps of granulation/fibrous tissue. These lesions have been referred as oral inflammatory polyps that may be aggravated in the presence of cGVHD. Case details: A 6 year old male with Fanconi Anemia underwent an unrelated hematopoietic stem-cell transplantation (HSCT) in March/2007. cGVHD was diagnosed in skin and oral mucosa and was treated with cyclosporine and corticosteroids. In August 2008 the patient was referred to the Oral Medicine Service for evaluation of a 3 cm growing polyps in the border of the tongue. Incisional biopsy was performed and revealed fibrous-vascular hyperplasia. While the patient waited for an excisional biopsy, the polyps increased in size to 10 cm. This biopsy revealed the same histopathological characteristic. In May 2011 the patient presented with other polyps of the middle side of tongue associated with other small nodules. These lesions were completely removed and again the diagnosis of fibrous-vascular hyperplasia was given immunohistochemistry examination revealed negativity to anti-cytomegalovirus (CMV)/anti-herpesvirus (HSV) and Ki-67 expression showed moderate to strong staining. No atypical cells were observed. Conclusions: Although it is an unusual reported lesion, fibrous-vascular polyps are a recent described pathological entity associated with the use of CsA. These lesions should be considered as a differential diagnosis of oral masses in post HSCT Fanconi Anemia patients, particularly to exclude malignancies in this high risk group of individuals. Relevance: Fanconi anaemia patients need to be closely monitored due to a high prevalence of secondary malignancies.