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Chrysostom had a lot to pulse pressure lying down generic 120 mg cardizem with visa say about the luxuries that accompanied bathing: in a particular example blood pressure medication names starting with c order cardizem 120mg line, a rich man is opposed to blood pressure of 90/50 discount cardizem 180mg amex one suffering from poverty: the rich man enjoys fine clothes pulse pressure low diastolic buy generic cardizem 60mg online, good food, overall well-being – and the pleasures of bathing. While it was not uncommon for the poor to be able to go to the baths, especially when the entry was free, the rhetoric used here obviously could not have mentioned this. Admittedly, the wealthy could afford to go to some of the more lavish, private baths, while using more expensive cosmetics and having more attendants at their disposal, both their own and provided by the bath 380 house. It should be also remembered that there were usually many baths available in any town or city, and that they varied greatly in size and the number and quality amenities they offered. Unless a poor person was able to find a sponsored bath, he would have to satisfy himself with the cheapest place, perhaps bathe without any assistance and, in all likelihood, spend less time relaxing there in general. In a similar manner, the wealthy person is placed in a bath-house in another homily, enjoying the pleasures provided by the facility; these are presented as a luxury, put together with an excessively well supplied table and a number of servants 381 attending the rich man’s matters. Chrysostom concludes that the poor should not be covetous of the earthly pleasures that are out of their reach, as in leading a simple life in poverty they are following a path to salvation. The less well-off should thus be happy that at least some of the temptations of this life are outside their means – while the wealthy, once again, are sent a signal that they ought to avoid indulging in pleasures that they can afford. Bathing again appears, together with eating, as one of the things that are 382 necessary in life – but which are harmful when overused. However, when Chrysostom finds himself in a situation where he is accused of, among other things, using the baths, and sees that there are some who think that he should not frequent them, he defends himself by saying that there is nothing which would forbid 383 Christians from bathing, and that there is no honour to be gained from being dirty. This has interesting implications for considering the negative approach to bathing common among the ascetics, but the contradiction here is not explicit: the monks were to avoid pleasure and various temptations, and both abounded in the baths; but not necessarily the cleanliness. Baths can be found listed by Chrysostom among the 384 things that were made by God common and for all to use, like cities or markets. I have briefly discussed in the previous chapter the alleged eagerness of the Vandal people to embrace the luxurious Roman lifestyle. It is worth noting that, in this case at least, their religious affiliation is not brought up by Procopius. The excessive love of wealth and extravagance ascribed to the Vandals by the author could have easily been linked with the Arian faith, should Procopius wished to do so. Otherwise willing to pay at least lip service to the role of the religion in shaping of many of the events he described (and, occasionally, not shying from including mentions of events bordering on supernatural), the historian seems to have been content to indicate the ethnicity, rather than religion, of the conquerors of the previously Roman North Africa as the chief cause of the moral failings of the 385 Vandals. That said, the criticism of the Vandal people, while dressed in different words is, quite clearly, based on the same ideas and values that were preached by Chrysostom over a century before. Far from moralising or trying to provide a better model of life in his text, Procopius is nonetheless pointing out the same failings for which the Romans themselves were criticised by their own preachers. A particular reference to the functioning of the baths (and the use of wealth) can be found in a fragment where Chrysostom compares a pile of gold a rich man possesses to a heap of dung: the comparison is clearly in favour of the dung, as it can be used in a number of useful ways, for example, in heating a bath (while the gold 386 itself has no practical uses whatsoever). Baths and popular beliefs Christians were not the only ones to casually mention baths when talking about religious (or quasi-religious) matters. Ammianus Marcellinus, when discussing the extent to which superstitions were common among fellow pagans, remarks mockingly that some of them needed to consult calendars to make sure that astrological signs are good before various undertakings. The practice itself does not seem to be criticised, but the comments on resorting to astrology even before engaging in activities such as eating a meal, showing publicly or going to the baths 385 Procopius, History, 4, 4, 6-9. Ammianus is, of course, exaggerating, but the examples he provides do make clear the mundane and everyday nature of bathing. Ammianus mentions another instance of belief in the supernatural, specifically, belief in omens, that involved a bath-house. During Valens’ 388 stay in Savaria (in 375), an owl was spotted perching on the top of the imperial bath, and made sounds that were interpreted as foretelling death; despite attempts of many people to chase away the owl with thrown objects, nobody was able to 389 successfully hit the hooting bird. In this case, the link between the building and the emperor seems to have been the key element in interpreting the omen – one that, while coming relatively early, would have later be seen as quite true. Bath-houses themselves were sometimes used for quasi-magical purposes; one example provided by Ammianus describes how a young man was executed during the reign of Valens’ for “magically” (as it was apparently judged to be) trying to alleviate his stomach trouble by first touching the marble (of wall or floor) in a bath-house, then his chest, while reciting the seven (Greek) vowels; he was tortured and beheaded 390 for this. Ammianus does not elaborate on whether the practice was indeed supposed to have a “magical”, pseudo-medical or actual medical significance. Trombley argues that the little “ritual” was most likely prescribed by a physician in order to take the patient’s mind off the recurring pain, and the authorities simply mistook the 391 recitation for some form of sorcery. The location where the man was seen performing his little ritual was important only in so far as the public character of the baths was concerned (in that the youth was spotted doing something suspicious). The link between the baths and superstition appears also in a homily targeting a practice that Chrysostom found laughable: he mentions seeing some servant girls making a mark with mud on a child’s forehead that was supposed to turn away evil charms and protect the child from other supernatural influences. Here, the baths themselves do not seem to have any particular significance: they are not mentioned 387 Ammianus Marcellinus, Res Gestae, 28, 4, 24. Rike, Apex Omnium: Religion in the Res Gestae of Ammianus, University if California Press 1987. One more example of (what might be called superstition) associated in the baths, this time noted with some approval, comes from Chrysostom: at one point he must have noticed that his faithful were making sign of the cross when entering the baths (or, also absent-mindedly, when lighting a candle); seeing this evidently habitual behaviour, he advises his flock to consciously develop beneficial habits – 393 like, for example, not swearing. This habitual making sign of the cross could potentially indicate the awareness of the somewhat risky (that is, providing opportunities to sin, if only by thought) nature of bathing establishments. It also shows Chrystostom’s appreciation of simple conditioning of his listeners (as means of 394 reducing the risk of sinning). Baths were given considerable attention in the dream book of Artemidorus, nd 395 written during 2 century. The interpretation of dreams seems fairly straightforward – qualities and properties of everyday objects, places and events seen in a dream are extrapolated and given explanation that is in one way or another directly relevant to those meanings. Artemidorus even comments on earlier authors, and explains how meaning of certain dreams has changed, reflecting the change in bathing customs. While written prior to the times that are of main interest for the purpose of this study, the wealth of information on bathing customs included in the nd dreambook and the fact that bathing practices changed relatively from the 2 to the th th 5, and even 6 centuries, are enough to justify giving this source more attention. Artemidorus comments that early authors did not link dreams of bathing or 396 washing with inauspicious events, as bathing took place in private bath-tubs. However, since public baths came into being, the dreams of bathing or even seeing a bath were believed to indicate bad luck. In a similar vein, sweating meant harm and change of the skin colour meant anguish and anxiety. This is the main section of the dream book devoted to bathing, and by far the longest entry on the subject. In his times, however, bathing was a common and luxurious activity; he believes that dreams of washing in bright, spacious and warm baths are auspicious. He notes that this is only true if the bathing takes place as normal; entering hot baths with clothes on meant sickness and mental anguish; for the sick enter the baths clothed, and anxiety causes people to sweat. The remark indicating that the sick would enter the bathing area dressed is worth additional attention; this is not something commonly mentioned in other sources. Assistance or lack thereof while bathing might also indicate problems: a poor person dreaming of being attended by many others indicated illness (for in no other circumstances this would have happened normally), and for wealthy, conversely, bathing alone was an ill omen – as they would normally be accompanied by others. The following were considered ill omens for everyone: not being able to sweat, seeing bath-houses where rooms or ceilings have caved in or finding no water in the tanks. Here Artemidorus mentions how an acquaintance of his, a lyre player, had a dream that he went to wash himself, but found no water to do so. He was subsequently disqualified from a contest for trying to bribe the judges (and thus was unable to achieve what he wanted). Dreams of bathing in natural, warm springs signified health for the sick, but unemployment for the healthy – as the people likely to visit the springs were the sick and those who did not have anything to do, reinforcing the idea of hot springs’ association with recuperation and leisure. Dreams of washing in clean, clear water, wherever it was found, were auspicious, but dreams of swimming, Artemidorus notes without giving further explanation, were always symbolic of danger and disease. Following the dream book’s advice, one learns that scrapers, brushes, towels meant attendants; losing one of them in a dream signified loss of an attendant; this provides further evidence for the presence of private attendants in the baths. On their own, scrapers meant harm (as they scrape off sweat, but add nothing to the body); they could also mean a courtesan, Artemidorus argues, and for the same reasons. A flask of oil or box with scrapers meant a good wife, faithful handmaid, or a useful slave, further hinting at the usefulness and value of bath-related accessories. Dreams of 117 397 singing in the baths were believed to be generally inauspicious. They meant that the dreamer’s voice will become indistinct and furthermore, many people were condemned to prison after having such dreams (although this passage lacks further explanation). The act of washing was a figurative way of saying that something will be disclosed (thus threatening to wash someone meant revealing some information 398 about them).

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Recent Development hypertension jnc 7 guidelines cardizem 120mg with visa, Applications heart attack jack smack u blue buy cheap cardizem 180mg online, and Perspectives of Mesoporous Silica Particles in Medicine and Biotechnology heart attack nitroglycerin buy 180mg cardizem overnight delivery. Cancer cell response to blood pressure chart guide discount cardizem 180 mg nanoparticles: criticality and optimality Nanomedicine: 2012 Aug 8(6) 842-852. Problems in the evaluation of alternative medicine, Social Science & Medicine, Volume 25, Issue 6, 1987, Pages 669-678 Paterson, C. Meta-analysis of homoeopathy trials the Lancet, Volume 351, Issue 9099, 31 January 1998, Pages 365-366 Paterson C, Ewings P et al. Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer. Protective potentials of a potentized homeopathic drug, Lycopodium-30, in ameliorating azo dye induced hepatocarcinogenesis in mice. Arsenic-induced biochemical and genotoxic effects and distribution in tissues of Sprague-Dawley rats Microchem J. Top down and bottom-up approaches in production of aqueous nanocolloids of low solubility drug paclitaxel. Interim results of a randomised controlled trial of homeopathic treatment for irritable bowel syndrome Homeopathy Vol. Effect of Atropa belladonna and Echinacea angustifolia in homeopathic dilution on experimental peritonitis. Serum-derived nanoparticles: de novo generation and growth in vitro, and internalization by mammalian cells in culture. Physicochemical and biological properties of biomimetic mineralo-protein nanoparticles formed spontaneously in biological fluids. An overview of silica in biology: its chemistry and recent technological advances. Homeopathy and general practice: an urban perspective British Homoeopathic journal, Volume 89, Issue 1, January 2000, Pages 13-16 Persons, S. The effect of extremely diluted agitated gibberellic acid (10e−30) on wheat stalk growth—A two researcher pilot study, Complementary Therapies in Medicine, Volume 19, Issue 3, June 2011, Pages 164-169 Philip D. Homeopathy for depression: a systematic review of the research evidence Homeopathy, Volume 94, Issue 3, July 2005, Pages 153-163 Pilkington K. Kirkwood G, Rampes H, Fisher P, and Richardson J, “Homeopathy for anxiety and anxiety disorders:a systematic review of the research,” Homeopathy, vol. Pilla, Arthur Electromagnetic fields instantaneously modulate nitric oxide signaling in challenged biological systems Biochemical & Biophysical Research Communications August, 2012 Pilla et al. Electromagnetic fields as first messenger in biological signaling: Application to calmodulin-dependent signaling in tissue repair Biochimica et Biophysica Acta October, 2011 Pillai, R. A clinical, randomized, double-blind, controlled crossover study in healthy volunteers. Lipid peroxidation, erythrocyte antioxidants and plasma antioxidants in osteoarthritis before and after homeopathic treatment, Homeopathy, Volume 97, Issue 4, October 2008, Pages 185-189 Pirotta, M. Research into the Language of the Patient: Improving Clinical Outcomes Am Homeopath. In Vitro Immunological Degranulation of Human Basophils is Modulated by Lung Histamine and Apis mellifica. Experimental study of homoeopathy in allergology, British Homoeopathic journal, Volume 87, Issue 1, January 1998, Page 52 Poitevin B. Experimental study of homoeopathy in allergology: 2) Biological Studies, British Homoeopathic journal, Volume 87, Issue 3, July 1998, Pages 154-164 Poitevin B. The Relationship between allergy and homeopathy: a framework Homeopathy, Volume 95, Issue 2, April 2006, Pages 65-67 Poitevin, B. Opinions and self-reported health status of Italians seeking homeopathic treatment, Homeopathy, Volume 95, Issue 2, April 2006, Pages 81-87 Pomposelli R, Piasere V, Andreoni C, Costini G, Tonini E, Spalluzzi A, Observational study of Homeopathic and Conventional therapies in patients with Diabetic Polyneuropathy. Ponce A, Mejia-Rosales S, Jose-Yacaman M: Scanning transmission electron microscopy methods for the analysis of nanoparticles. Clinical evaluation of Viscum album mother tincture as an antihypertensive: a pilot study. Homeopathy for everyone Nurse Education Today Volume 7, Issue 6, December 1987, Pages 299 Pounds, F. Amorphous calcium phosphate nanoparticles could function as a novel cancer therapeutic agent by employing a suitable targeted drug delivery platform. In vitro bioactivity and antimicrobial tuning of bioactive glass nanoparticles added with neem (Azadirachta indica) leaf powder. Homeopathy booming in India the Lancet, Volume 370, Issue 9600, 17–23 November 2007, Pages 1679-1680 Pratt, N. Induction of apoptosis of tumor cells by some potentiated homeopathic drugs: implications on mechanism of action. Clastogenic potential of Ruta graveolens extract and a homeopathic preparation in mouse bone marrow cells. Prut L and Belzung C, “The open field as a paradigm to measure the effects of drugs on anxiety-like behaviors: a review,” European Journal of Pharmacology, vol. A Survey of Complementary and Alternative Medicine Use in Cancer Patients Treated with Radiotherapy in Thailand Evid Based Complement Alternat Med. Cytotoxicity and Oxidative Stress Induced by Different Metallic Nanoparticles on Human Kidney Cells. Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey, Vaccine, Volume 31, Issue 37, 20 August 2013, Pages 3943-3949 Pulcri R, Ferreri R et al. Improvements in the quality of life in anxious depressive syndromes treated in homeopathy in Pitigliano Hospital Center of Integrated Medicine European Journal of Integrative Medicine, Volume 4, Supplement 1, September 2012,Page 44 Pulcri R, Ferreri R et al. Homeopathy in chronic osteoarticular diseases: results of the protocols of integrated medicine, European Journal of Integrative Medicine, Volume 4, Supplement 1, September 2012, Page 32 Pulford, A. Canova medication modifies parasitological parameters in mice infected with Trypanosoma cruzi. Cell (A549)–Particle (Jasada Bhasma) Interactions Using Raman Spectroscopy Biopolymers Volume 89 / Number 6 555-564. Patient-centered care and its effect on outcomes in the treatment of asthma Patient Relat Outcome Meas. Mood disorders and complementary and alternative medicine: a literature review Neuropsychiatr Dis Treat. Effectiveness and tolerability of a homoeopathic remedy compared with conventional therapy for mild viral infections. Complementary and Alternative Medicine and Cardiovascular Disease: An Evidence-Based Review Evid Based Complement Alternat Med. Influence of Size, Surface Area and Microporosity on the in Vitro Cytotoxic Activity of Amorphous Silica Nanoparticles in Different Cell Types. Folk Medicinal Uses of Verbenaceae Family Plants in Bangladesh Afr J Tradit Complement Altern Med. In vitro and in vivo hepatoprotective effects of the total alkaloid fraction of Hygrophila auriculata leaves Indian J Pharmacol. Antimalarial potential of China 30 and Chelidonium 30 in combination therapy against lethal rodent malaria parasite: Plasmodium berghei. Effect of a Homeopathic complex on oestrus induction and hormonal profile in anoestrus cows. Comparative analysis of the influence of nano and ionic forms of silver on biochemical indices in laboratory animals. Investigation of cytokine expression in human leukocyte cultures with two immune-modulatory homeopathic preparations. Homoeopathic treatment of upper respiratory tract infections in children: evaluation of thirty case series. British Homoeopathic journal, Volume 84, Issue 2, April 1995, Pages 112-113 Rampes, H. Successful management of refractory cases of canine demodicosis with homeopathy medicine Graphitis J Parasit Dis 4 January 2013 Rankin-Box, D. Practical homoeopathy: A complete guide to home treatment, Complementary Therapies in Nursing and Midwifery, Volume 3, Issue 2, April 1997, Page 41 Ransome, S. A novel method for synthesis of silica nanoparticles Journal of Colloid and Interface Science 289 (2005) 125–131 Rao, M. The defining role of structure (including epitaxy) in the plausibility of homeopathy. Homeopathy 96(2007):175-182, Homeopathy, Volume 96, Issue 4, October 2007, Page 292.

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Therefore blood pressure 00 cardizem 180 mg fast delivery, conditioning regimens containing thiotepa Belgian Journal of Hematology Volume 7 heart attack vomiting cheap 120mg cardizem with mastercard, Issue 2 prehypertension at 25 years old purchase cardizem 60mg, April 2016 76 2 Figure 1 blood pressure 9664 discount cardizem 60mg without a prescription. In particular, received nine cycles of lenalidomide, resulting in a the busulfan-thiotepa association is associated with a long-lasting remission of more than 24 months, with 13% treatment-related mortality. High dose chemotherapy (thiotepa-based) with autologous stem cell support in frst line remains experimental and should be discussed on an individual basis, and only used in experienced centres. Salvage treatment depends on age, performance status, and type(s) of previous treatment(s). The beneft of surveillance studies aimed at the detec In ft patients, systemic chemotherapy is the preferred tion of early relapse is controversial. Clinical responses have been be reassessed, after completion of therapy, every three documented. Thus, additional irradiation of both globes with initial involvement of the eyes or the spinal fuid has been proposed. Additional blood tests or dation radiotherapy of the eyes needs to be carefully imaging studies may be added as appropriate, consid balanced against the risk of radiation-related toxicity. Proof of superi References ority of intraocular chemotherapy versus radiotherapy For the complete list of references we refer to the elec is lacking. A recent large retrospective study showed tronic version of this article which can be downloaded no difference in outcome between local and systemic from Radiotherapy in the treatment of primary central nervous system system lymphomas: analysis of 83 cases. Rational administration schedule disease detected by fow cytometry in newly diagnosed aggressive B-cell for high-dose methotrexate in patients with primary central nervous system lymphomas at risk for central nervous system involvement: the role of fow lymphoma. Summary statement on primary central patients with primary central nervous system lymphoma: does drug exposure nervous system lymphomas from the Eighth International Conference on really matter? Relevance of intraocular involvement in signifcantly improves outcome in primary cns lymphoma: the frst randomization the management of primary central nervous system lymphomas. Cancer has become a major killer in the world which almost surpasses the cardiovascular diseases and will become the main lethal 5. Besides that there are so many types of serious side efects caused by the tumor itself be it solid cancer or hematological cancer. Terefore it became an obligate matter for all clinicians the cancer patients who receive chemotherapy in order to prevent to be aware of these chemotherapy side efects. Moreover it is important to focus on research within this feld in order to detect the Chemotherapy Background proper ways which can help to overcome these side efects. Chemotherapy was developed and used since the Word War I References from the chemical weapon program of the United State of America 1. In thackery, (edn) the gale potentially high risk with many side efects which are difcult to encyclopedia of cancer detroit, gale group. The goal of chemotherapy is to be as efective as possible with tolerable side efects, since the dose of chemotherapy will be toxic to the cancer cells as well as to the normal cells. A proportion of the cancer patients sufer from only mild side efects whereas others may sufer from serious side efects. Occurrence of specifc side efects will vary according to the chemotherapy or medications used. The most common side efects experienced are nausea and vomiting, anemia, hair loss, bleeding (thrombocytopenia), hyperuricemia, bone marrow depression, alopecia and mucositis. So diferent parameters must be taken into consideration to prevent, reduce and overcome these side efects [3-5]. Classifcations of Chemotherapy Side Efects *Corresponding author: Bassam Abdul Rasool Hassan, Clinical Pharmacy Discipline, School of Pharmaceutical Sciences, University of Sains Malaysia, 11800, The side efects commonly associated with chemotherapy treatment Minden, Penang, Malaysia, Tel: +6-016-423-0950; E-mail:bassamsunny@yahoo. This risk is conditioned by a range of factors, including the high cell turnover rate of the oral mucosa, the diversity and complexity of the oral microfora, and soft tissue trauma during normal oral function. The present study offers a literature review of the main oral complications secondary to chemotherapy, and describes the different options for dental treatment before, during and after oncological treatment, published in the scientifc literature. To this effect a PubMed-Medline search was made using the following keywords: chemotherapy, can cer therapy, dental management, oral mucositis, neurotoxicity, intravenous bisphosphonates and jaw osteonecrosis. The search was limited to human studies published in the last 10 years in English or Spanish. A total of 50 articles were identifed: 17 research papers, 25 reviews, 6 letters to the Editor, and two clinical guides developed by expert committees. The data obtained showed the main oral complications of chemotherapy to be mucositis, neurotoxici ty, susceptibility to infections, dental, salivary and taste alterations, and the development of osteonecrosis. Based on the reviewed literature, elective dental treatment can be provided before chemotherapy, with emphasis on the elimination of infectious foci. During chemotherapy, dental treatment should be limited to emergency procedures, while dental treatment of any kind can be prescribed after chemotherapy – with special considerations in the case of patients who have received treatment with intravenous bisphosphonates. Key words: Chemotherapy, cancer treatment, dental treatment, oral mucositis, neurotoxicity, jaw osteonecrosis, intravenous bisphosphonates. Introduction most commonly used in head and neck malignancies are Anticancer chemotherapy currently involves the use of bleomycin, cisplatin, methotrexate, 5-fuorouracil, vin drugs (cytostatic or cytotoxic agents) that avoid prolife blastine and cyclophosphamide (2). The main problem posed by such Antineoplastic drugs can act upon the different tissues ei treatment is the lack of selectivity of most antineoplastic ther directly or indirectly. The direct side effects of such drug substances, since they also act upon normal cells drugs start with the primary oral tissue damage caused with an accelerated cell cycle, such as bone marrow by their indiscriminate effect upon the cell replication cells, hair follicle cells and the epithelial cells of the cycle, such as for example in the oral mucosa, where gastrointestinal tract (1). Dental abnormalities in children after chemotherapy treatment for acute lymphoid Minicucci et al. Sepúlveda Oral ulcers in children under chemotherapy: clinical characteristics and their relation with Med Oral Patol Cross 2005 et al. López-Galindo Clinical evaluation of dental and periodontal status in a group of oncological patients Med Oral Patol 2006 Case-control et al. J Oral Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum Marx et al. The Impact of low power laser in the treatment of conditioning-induced oral mucositis: A Med Oral Patol Antunes et al. Chemotherapy-induced acral erythema: a clinical and histopathologic study of 44 cases 2008 Case series Dermosifliogr. Boonyapakorn Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with Oral Oncol. Oral Surg Oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant Oral Med Oral Jensen et al. Decreased occurrence of osteonecrosis of the jaw after implementation of dental Ripamonti preventive measures in solid tumour patients with bone metastases treated with Ann Oncol. Osteonecrosis of the jaws by intravenous bisphosphonates and osteorradionecrosis: a Bagan et al. Guideline Effcacy of a spray compound containing a pool of collagen precursor synthetic Int J aminoacids (l-proline, l-leucine, l-lysine and glycine) combined with sodium Colella et al. Immunopathol 2010 Clinical Trial hyaluronate to manage chemo/radiotherapy-induced oral mucositis: preliminary data of an Pharmacol. Zoledronate inhibits endothelial cell adhesion, migration and survival through the J Thromb Hasmim et al. Guideline Oral Surg Oral pathoses caused by Candida albicans during chemotherapy: update on development Oral Med Oral Bunetel et al. Raber Support Care Periodontal infection in cancer patients treated with high-dose chemotherapy. Oral Surg the role of salivary function in modulating chemotherapy-induced oropharyngeal Oral Med Oral Epstein et al. Caribé-Gomes Dental management of the complications of radio and chemotherapy in oral cancer. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Interventions for treating oral candidiasis for patients with cancer receiving treatment. Jimenez Med Oral Patol Bisphosphonates, as a new cause of drug-induced jaw osteonecrosis: An update. Managing the care of patients with bisphosphonate-associated osteonecrosis: an AmericanJ Am Dent Migliorati et al. López-Castaño Measurement of secondary mucositis to oncohematologic treatment by means of different Med Oral Patol 2005 Review et al.

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Physical Efects l Ask your child’s doctor for a written summary of the Children treated for leukemia or lymphoma may be at risk cancer treatment that your child received blood pressure medication increased urination buy cardizem 180mg amex, including for fatigue blood pressure quiz pdf purchase cardizem 120 mg, growth delays blood pressure medication and zoloft discount cardizem 60mg without prescription, thyroid dysfunction arrhythmia from excitement cardizem 120 mg, hearing names of all drugs used, whether or not radiation was loss and the development of a secondary cancer. Children used, what type of surgical procedures were performed may also become infertile. The risk of infertility is related and whether your child experienced any unusual or to the areas of the body involved with cancer and the type, especially severe acute complications of cancer therapy. However, some studies indicate that a small Enlist the help of health professionals as needed. Returning to School School personnel may not be aware of the potential for Managing Long-Term and Late Efects long-term and late efects of treatment. Parents and Treatment for childhood leukemia or lymphoma consists medical professionals need to inform educators about the of chemotherapy and other drug therapies and may include child’s education needs before the child returns to school. Parents, educators and medical professionals can work Tere are risks for long-term and late efects common to all together to develop a program tailored to the child’s specifc of these treatments, which may include learning problems, needs. The program may include fatigue, bone or joint pain and an increased risk for developing a secondary cancer. Please see Examples of l Baseline testing—Children may beneft from baseline Long-Term and Late Efects of Treatment on page 3. Cho a child through certain situations such as transitioning lesterol and triglyceride levels should be tracked as they from middle school to high school or going on from may afect development of coronary artery heart disease. Follow-up Care l Cisplatin or carboplatin should have creatinine clearance Childhood cancer survivors should have physical measured at baseline and then every 3-5 years as needed. Regular medical follow-up for childhood cancer survivors enables l Ifosfamide should be monitored yearly for evidence of doctors to assess the efects of therapy, identify recurrence of Fanconi syndrome, a type of kidney problem. The Pediatric Oncology (Ped-Onc) Resource Center maintains a list of follow-up l Allogeneic stem cell transplantation and children who clinics at ped-onc. This common infections, bone health (osteoporosis) and can help the primary care doctor who might not be familiar chronic lung disease. Tese plans are individualized and Data has not been collected for a long enough time period long-term. It is helpful for a child to be seen yearly at a for the long-term and late efects of newer drugs to be long-term follow-up clinic along with regular visits to a identifed. You can fnd information about survivorship plans and Examples of Long-Term and Late guidelines for survivors of childhood, adolescent and young Efects of Treatment adult cancers by visiting the Resources section on page 7. The following is a general list of examples of potential risks Children treated with for long-term or late efects. Keep in mind that risk depends l Radiation therapy should have yearly physical on many factors, including treatment, treatment examinations, including growth, thyroid, bone and combinations, dosages and other individual risk factors. Girls treated with mediastinal following information is provided as a basis for discussion radiation therapy should be taught breast between parents and doctors. Talk to your child’s treatment self-examination; begin baseline mammograms at age team about the actual risks of your child’s treatment. Common drugs in this class include types of drugs used and their potential long-term and late prednisone and dexamethasone. Etoposide and teniposide are examples of this and sperm counts in boys and premature ovarian failure class of drugs. The combination of alkylating drugs and radiation therapy increases the risk Drugs that prevent the cells from dividing by blocking for fertility problems. Examples of alkylating drugs are mitosis, such as vincristine and vinblastine, have been associated with peripheral neuropathy. Intrathecal and intravenous methotrexate can cause l Procarbazine, nitrogen mustard, and ifosfamide, which cognitive impairment. Research is ongoing to understand the potential long-term and late efects for newer therapies, including imatinib l Carmustine and busulfan, which can increase risk for mesylate (Gleevec ) and dasatinib (Sprycel ) for Philadelphia scarring and infammation of the lungs. Studies are Anthracyclines have been associated with heart damage ongoing to determine other long-term and late efects for. Radiation therapy is the use of ionizing radiation to kill Anthracyclines include doxorubicin, idarubicin and cancer cells. Children appear to have less tolerance to head and neck may lead to doses of multiple chemotherapeutic agents than adults do, l Learning disabilities (cognitive impairment) and when chest radiation is combined with these chemotherapeutic agents, the risk for heart failure is l Growth hormone defciency possible at lower dosages of the drugs. Scientists are also l Hypothyroidism or hyperthyroidism studying whether exposure to anthracyclines afects later development of coronary artery disease. A small percentage Corticosteroids have been associated with osteoporosis and experience premature puberty, while in other children cataracts. In girls, stomach radiation may cause fertility problems including premature ovarian failure or premature menopause. The Glossary efect of radiation on the ovaries and testes depends upon You may see or hear some of the following terms. Total body irradiation for individuals undergoing hematopoietic stem cell transplantation can potentially Avascular Necrosis cause gonadal failure and fertility issues. A condition in which the blood vessels that nourish the High-dose radiation to the spleen can increase the risk of bones die, causing parts of the bone to weaken or collapse. Cognitive Impairment Treatments Under Investigation See Learning Disabilities Research to learn more about long-term and late efects continues to increase. Patients may have the opportunity Dental Abnormalities to take part in clinical trials. Tese trials, conducted The most common dental problems are failure of the teeth under rigorous guidelines, help clinicians and researchers to develop (dental or tooth agenesis), arrested root to determine the benefcial and adverse efects of potential development, microdontia (unusually small teeth), new treatments. Studies are also conducted to evaluate new underdevelopment of the jaw and enamel abnormalities. Fatigue In addition, research to better understand and treat An unusual tiredness that interferes with daily life and long-term and late efects associated with certain cancer cannot be overcome by resting or a good night’s sleep. Researchers are studying ways to afects many patients (of all ages) treated for leukemia, lessen or minimize the negative impact of existing therapies. For some patients, Researchers are also identifying biomarkers–high levels of fatigue following treatment can last for months or years, certain substances in the body, such as antibodies or causing physical issues such as difculty performing daily hormones, or genetic factors that might increase tasks and cognitive issues such as concentration problems. Tese biomarkers may indicate a higher-than-normal risk for developing a specifc Fertility long-term or late efect. Some biomarkers allows researchers to develop tests that detect cancer treatments afect fertility in males and females. Test results can predict a Survivors of leukemia or lymphoma who have been treated patient at risk for the specifc efects associated with a with modern conventional therapy have relatively low risk particular biomarker and thus allow doctors to plan for infertility or delayed or impaired puberty. Both males and females may experience some sexual Secondary Cancers efects during and after treatment. Males may have difculty sustaining an erection, may have low sperm counts and may Cancer survivors treated with chemotherapy or radiation become sterile. Survivors of childhood Hodgkin lymphoma have the greatest risk for Hyperthyroidism developing a secondary cancer. The highly variable l Acute Myeloid Leukemia and Myelodysplastic symptoms include nervousness, sudden weight loss, rapid Syndromes—Treatment-related acute myeloid heartbeat, fatigue and increased sensitivity to heat. The highly variable l Brain Tumors—The incidence of secondary solid symptoms include increased sensitivity to cold, weight gain, tumors is very low following diagnosis of childhood painful joints, muscle aches and pale, dry skin. Problems that afect thinking or memory, including l Breast Cancer—Treatment with mantle radiation organization, reading, processing speed, visual memory, therapy for Hodgkin lymphoma increases the risk for understanding math concepts or remembering math facts. Females treated before the age of 21 years The degree of impairment depends on whether or not have a signifcantly greater risk than adult women. Children treated and biannual breast exams, starting a decade after their during infancy or early childhood are at the highest risk. The risk for developing osteosarcoma depends upon the dosage of radiation and Peripheral Neuropathy whether individuals were also concurrently treated with alkylating drugs. Numbness, tingling or pain in the hands and feet may persist for months or years following treatment with certain drugs that are toxic to the nerves. With menopause, a female has School of Medicine and Dentistry no follicles left at all. To reach their Long-Term important contributions to the material presented in this Follow-Up Guidelines for Survivors of Childhood, Adolescent publication. Information Specialists can answer social, and economic efects of cancer and its treatment general questions about diagnosis and treatment options, among pediatric and adult survivors of cancer and their ofer guidance and support and assist with clinical-trial families. Late mortality among 5-year survivors of childhood cancer: a summary from the Centers for Disease Control and Prevention Childhood Cancer Survivor Study.

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