ABSTRACT Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

Abstract Objectives: present a case of Inborn errors of immunity (IEI) as a potential diagnosis in pediatric patients with recurrent infections. Description: male patient, 13 years old, since he was eight months old had recurrent diarrhea, sinusitis, otitis, abscesses and urinary tract infections. At the age of ten, he presented mastoiditis progressing to meningitis, he was admitted to a tertiary hospital, where an immunological evaluation was performed, which led to the diagnosis of Predominantly Antibody Deficiency (PAD), with suspected X-linked Agammaglobulinemia (XLA). Treatment was initiated with administration of intravenous gamma globulin 400 mg/kg every four weeks, with a significant improvement of the condition. Discussion: usually, the diagnosis of XLA tends to be made in the first three years of life. However, in this report, although the first manifestations started at eight months of age, there was a delay of ten years before starting the treatment. In fact, the diagnosis of children and adults with IEI can be delayed if healthcare professionals are unable to find the true cause of recurrent infections. Therefore, the relevance of considering such pathologies in the presence of risk signs is highlighted, as early diagnosis being essential in treating and preventing morbidities.

Resumo Objetivos: apresentar um caso de Erro Inato da Imunidade (EII) como diagnóstico em potencial de pacientes pediátricos com infecções de repetição. Descrição: paciente masculino, 13 anos, desde os oito meses de idade apresentou quadros repetidos de diarreias, sinusites, otites, abscessos e infecções do trato urinário; destacando-se a otite, sinusite e diarreia pela maior recorrência. Aos dez anos, quando apresentou mastoidite evoluindo para meningite, foi internado em um hospital terciário, onde foi realizada avaliação imunológica, a qual levou ao diagnóstico de Deficiência Predominantemente de Anticorpos (DPAs), tendo como suspeita a agamaglobulinemia ligada ao cromossomo X (ALX). Foi iniciado tratamento com administração de gamaglobulina endovenosa 400 mg/kg a cada quatro semanas, ocorrendo melhora significativa do quadro. Discussão: normalmente, o diagnóstico da ALX tende a ser feito nos primeiros três anos de vida. Neste relato, entretanto, embora as primeiras manifestações tenham iniciado aos oito meses de idade, ocorreu um atraso de dez anos até o início do tratamento. De fato, o diagnóstico de crianças e adultos com EII pode ser retardado se os profissionais de saúde não conseguirem encontrar a causa das infecções recorrentes. Destaca-se, portanto, a relevância de se considerar tais patologias na vigência de sinais de riscos, pois o diagnóstico precoce é fundamental para tratar e prevenir morbidades.

RESUMEN Bixa orellana L. es una planta nativa de Brasil, pero también está presente en otros países tropicales como Perú, Colombia, Ecuador, México, Indonesia, India y África Oriental. Es conocida popularmente como Urucum en Brasil. Esta revisión expone el potencial de los compuestos bioactivos derivados de B. orellana para tratar enfermedades debido a sus propiedades antimicrobianas y antioxidantes. Esta planta también está relacionada como un agente antiinflamatorio para el tratamiento de enfermedades pulmonares e incluso como gotas para los ojos para el enrojecimiento. Sus hojas se utilizan para el tratamiento de la mordedura de serpiente, diarrea, gonorrea, hepatitis, gastritis, diuréticos, antipiréticos y para enfermedades de la piel. Ese conocimiento popular ha fomentado la identificación de compuestos bioactivos en esa planta. Los compuestos β-criptoxantina, geranilgeraniol, luteína, procianidina B2, procianidina B3, isómero elagitanino y ácido elágico desoxihexosa inhibieron microorganismos patógenos como bacterias, hongos, protozoos y virus. En ese sentido, B. orellana es una fuente prometedora de compuestos que podrían aplicarse en la terapia antimicrobiana. Este trabajo de revisión puede ayudar a comprender e incentivar nuevas investigaciones para los descubrimientos de antimicrobianos que utilizan diferentes compuestos de B. orellana.

SUMMARY Bixa orellana L. is a native plant from Brazil, but it is also present in other tropical countries such as Peru, Colombia, Ecuador, Mexico, Indonesia, India and East Africa. It is popularly known as Urucum in Brazil. This review shows the potential of bioactive compounds derived from B. orellana to treat infectious diseases due their antimicrobial and antioxidant properties. This plant is also related as an antiinflammatory agent for treatment of pulmonary diseases, or even as eye drops for redness. Its leaves are used for treatment of snakebite, diarrhea, gonorrhea, hepatitis, gastritis, diuretic, antipyretic, and for skin disease. This popular knowledge has encouraged the identification of bioactive compounds in this plant. Compounds as β-cryptoxanthin, geranylgeraniol, lutein, procyanidin B2, procyanidin B3, ellagi tannin isomer and ellagic acid deoxyhexose have been described. These compounds inhibited pathogenic microorganisms such as bacteria, fungi, protozoan and viruses. In addition, some compounds with anti-inflammatory and antioxidant activities were also described. In this sense, B. orellana is a promising source of compounds that could be applied in antimicrobial therapy. This review work may help in the understanding and incentive of new research for antimicrobial discoveries using different B. orellana compounds.