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Objective: To report the outcomes of a systematic literature review of guidelines and consensus on the management of paroxysmal nocturnal hemoglobinuria (PNH) and describe the main therapeutic options available worldwide. Methods: A systematic literature review was conducted in April 2018 with no time limit and reported in line with the PRISMA statement. The AGREE II instrument was used to determine the quality of each guideline included in the systematic review. Results: Eight guidelines/consensus were eligible, one developed by an international group, two in Spain, and one each in Turkey, Germany, Argentina, Australia and the United Kingdom. Supportive treatment with erythrocyte transfusion, anticoagulants and steroids is indicated by all guidelines and consensus. The use of erythropoietin is suggested by three of them. Recommendations for the prescription of eculizumab were consistent in all but one guideline, published in 2005. Allogeneic hematopoietic stem cell transplantation is reported as the only potentially curative treatment for PNH, although its association with high mortality and morbidity rates is emphasized, being indicated for a selected group of patients. The AGREE II scores applied for each domain showed in general a low and heterogeneous methodological quality among guidelines. Conclusion: Despite the low and heterogeneous methodological quality, in general the comparison of guidelines and consensus for PNH management showed consistent recommendations regarding supportive care, eculizumab and hematopoietic stem cell transplantation.

This is an observational and cross-sectional study, carried out in May 2020, targeting adult individuals of both sexes who are members of multiprofessional teams working in Brazilian HSCT units in the current period of the pandemic by completing and analyzing a questionnaire. pre-formulated. HSCT units that cannot access the questionnaire were excluded from the study. The analysis of the operation profile of HSCT units in Brazil, through the application of a pre-structured questionnaire, is not an accurate tool, since it assumes some premises that may prove to be wrong, especially in this current scenario in Brazil. However, the data reveal the vulnerability of patients with onco-hematological diseases to infection by COVID-19, especially during HSCT procedures, in relation to the general population. Despite its limitations, it can be valuable to plan policies.

Faced with the major health crisis of the century – Coronavirus Disease (COVID19) Pandemic, we could see two waves installing in society: incredulity and fear. This issue was politicized several times and the vast amount of scientific publications made the discussion very controversial and consequently society became more and more confused and insecure. Brasilia - the Capital of Brazil, is the heart of the country, it is centrally located and therefore politically strategic. It was one of the first places in Brazil to spread, under public decree, radical measures of social isolation (such as closing schools, colleges, commerce, and other public places) in mid March / 2020. Only the so-called “essential activities” continued working. When such measures were adopted, the city had just over 50 confirmed cases of COVID19. Concerns about the pandemic moved the entire local health care assistance, with homeric financial investments by hospitals with massive testing for Coronavirus and a reduction in the number of elective surgeries (important profit providers). The Bone Marrow Transplant (BMT) Unit, traditionally considered to be a very vulnerable space, gained special focus and numerous efforts were designed to make it virtually a COVID19 free area. The view of doctors during this period was also very heterogeneous, and it varied between fearlessness and major worry. Finding a balance and offering a safe environment for carrying out the procedures proved to be a great challenge, whose building still occurs daily until today. Despite being a hard social, political and economic moment, it would not be appropriate to shoot all over the place like a war. The elaboration of new protocols, periodically reviewed and modified, was carried out based on intense involvement and collaborative works by the Hospital Coordination, the Infectious Diseases Specialists, doctors and multidisciplinary team. The Good Practices policies published periodically by the Medical Societies of Infectious Diseases and Bone Marrow Transplant guided our local protocols. Among the main measures adopted are the testing of patients and caregivers with PCR lab test to check the coronavirus infection before hospitalization, the prohibition of visitors and the use of reverse vestments (use of cloaks, gloves, caps and masks), which although controversial, was used to potentially reduce the risk of coronavirus transmission by asymptomatic health professionals. In addition, daily screening of respiratory symptoms was applied to all caregivers and employees of the unit, in order to identify suspected cases and keep them away before contact with patients. Such measures were crucial to the excellent results achieved and to strengthen the medical teams trust in the hospital logistic and support. According to data published by the Brazilian Organ Transplant Association - ABTO, in the first half of 2020, 31 transplants were performed in two institutions that predominantly receive public institutions patients (3 allogeneic and 28 autologous) and 23 transplants in the private services (18 autologous and 5 allogeneic) - represented by two private hospitals in Brasília1. The peak of the pandemic occurred in July and August 2020, with periods of significant overload in the hospital structure in the public and private sectors. The depletion of resources caused by the pandemic associated with previous institutional issues have compromised the care of adult patients who are candidates for BMT from public services. This fact generated an important patient demand for centers in other regions of the country associated with an increase in the obstacles of moving and welcoming these patients in the pandemic scenario. In private practice, there was a strong and well-structured work-ethic, which allowed the program to continue without impairing the quality of care or the expected outcomes. To date, we have had no cases of death by COVID19 in the scenario of bone marrow transplantation in Brasília, reflecting the efforts and protocols previously mentioned. At this moment, we are experiencing a significant reduction in the number of COVID19 cases in Brasilia, making it possible to observe an increase in the number of patients undergoing transplant procedures. This fact reflects the postponement of treatment of non-urgent cases in the previous three months. After six months of Pandemic, it is essential to recognize the strong presence of the spirit of cooperation, tolerance and patience that has been installed in all the scenarios that permeate the BMT, associated with the relevant growth of all involved. The “new normal” is uncomfortable because it is characterized by restrictions imposed by the pandemic and not by our choices and preferences, but above all it symbolizes our ability to adapt and to have resilience. We are important characters in this memorable historical period, and we carry the desire to continue pulsating in the heart of Brazil.

Objective: The aim of this study was to evaluate the effects of dietary supplementation with Agaricus sylvaticus fungus on hematological, immunological, and glycemia levels of postsurgical patients with colorectal cancer. Methods: A randomized, placebo-controlled, clinical trial was conducted at the General Hospital of Brazil for 6 months. Fifty-six patients with colorectal cancer (stages I, II, and III) were divided into 2 groups: A. sylvaticus (30 mg/kg/day) and placebo. Complete hemogram, serum iron, and fasting glycemia evaluations were carried out throughout the treatment course. Subjects were divided according to body mass index (BMI), sex, and stage of colorectal cancer. Data were analyzed using SPSS 14.0 programs, Student’s t test, and F statistical test, with P ≤ 0.05 considered significant. Results: After 6 months of supplementation, the group that received A. sylvaticus showed significant increases in hemoglobin ( P = 0.0001), hematocrit ( P = 0.0001), erythrocytes ( P = 0.01), mean cell volume ( P = 0.01), mean cell hemoglobin ( P = 0.0001), mean cell hemoglobin concentration ( P = 0.0001), and neutrophil levels ( P = 0.0001). The platelet count was significantly reduced ( P = 0.03), but remained within normal levels. No significant alterations were observed in the placebo group. The study group was composed of 32 women (57.1%) and 24 men (42.9%). Mean BMI was 24.65 kg/m2. Glycemia levels in the placebo group (average age 59.14 ± 12.95 years) were: initial, 94.36 ± 15.34 mg/dl; 3 months, 98.12 ± 15.54 mg/dl ( P = 0.03); and 6 months, 98.52 ± 9.03 mg/dl ( P = 0.01). Glycemia levels in the supplemented group (average age 56.34 ± 15.53 years) were: initial, 95.92 ± 11.64 mg/dl, 3 months, 94.88 ± 12.24 mg/dl ( P = 0.65); and 6 months, 92.86 ± 6.82 mg/dl ( P = 0.01). Conclusions: The results of this study suggest that supplementation with A. sylvaticus produces benefits in hematological and immunological parameters and can reduce glycemia levels in patients with colorectal cancer.

INTRODUÇÃO: Alterações no metabolismo lipídico são comuns em pacientes com câncer. Fungos medicinais podem exibir atividade hipolipidêmica. OBJETIVO: Avaliar os efeitos da suplementação dietética com fungos Agaricus sylvaticus no perfil lipídico de pacientes com câncer colorretal em fase pós-operatória. MÉTODOS: Ensaio clínico randomizado, duplo-cego, placebo-controlado, realizado no Hospital de Base do Distrito Federal por seis meses. Amostra constituída por 56 pacientes, estádios I, II e III, separados em dois grupos: placebo e suplementado com Agaricus sylvaticus (30mg/kg/dia). Resultados analisados pelos programas Microsoft Excel 2003 e SPSS 14.0 com p = 0.05. RESULTADOS: O grupo Agaricus sylvaticus apresentou níveis séricos iniciais de colesterol total de 207.36±52.67mg/dL, lipoproteína de baixa densidade de 120.79±44.02mg/dL e triglicérides de 181.64±187.52mg/dL. Após seis meses de suplementação, observou-se redução para 191.11±39.72mg/dL (p = 0.01), 103.08±39.20mg/dL (p = 0.0001) e 168.04±146.91mg/dL (p = 0.18), respectivamente. No grupo placebo, observou-se aumento não-significativo de colesterol total (p = 0.08) e aumento significativo de lipoproteína de baixa densidade (p = 0.01) e triglicérides (p = 0.0001). Não foram observadas, em ambos os grupos, alterações significantes nos níveis de lipoproteína de alta densidade e lipoproteína de muito baixa densidade. CONCLUSÃO: Os resultados sugerem que a suplementação dietética com Agaricus sylvaticus pode melhorar significativamente o perfil lipídico de pacientes com câncer colorretal em fase pós-operatória. INTRODUCTION: Alterations in the lipidic metabolism are common in patients with cancer. Medicinal fungus may show hypolipidemic activity. OBJECTIVE: To evaluate the effects of dietary supplementation with Agaricus sylvaticus fungus in lipidic profile of patients with colorectal cancer in post-surgery phase. MEHTODS: Randomized, double-blind, placebo-controlled clinical trial carried out at the Federal District Base Hospital, for six months. Samples of 56 enrolled patients, stadiums phase I, II and III, divided in two groups: placebo group and group supplemented with Agaricus sylvaticus (30mg/kg/day). Results were analyzed with Microsoft Excel 2003 and SPSS 14.0 programs, with p = 0.05. RESULTS: The Agaricus sylvaticus group had initial total cholesterol levels of 207.36±52.67mg/dL, low-density lipoprotein of 120.79±44.02mg/dL and triglycerides of 181.64±187.52mg/dL. After six months of supplementation it was observed a reduction 191.11±39.72mg/dL (p = 0.01), 103.08±39.20mg/dL (p = 0.0001) and 168.04±146.91mg/dL (p = 0.18), respectively. In the placebo group it was observed not-significant increase of total cholesterol levels (p = 0.08) and significant increase of low-density lipoprotein (p = 0.01) and triglycerides (p = 0.0001). No significant statistically alterations were observed in the levels of high-density lipoprotein and very-low-density lipoprotein in both groups. CONCLUSION: Results suggest that the dietary supplementation with Agaricus sylvaticus may significantly improve the lipidic profile of colorectal cancer patients in post-surgery phase.

Introdução: Estilo de vida é fator de risco para o câncer colorretal, pois a interação entre dieta inadequada, alcoolismo, tabagismo, obesidade e inatividade física podem levar ao seu desenvolvimento. Objetivo: Analisar os hábitos dietéticos de portadores de câncer colorretal em fase pós-operatória. Metodologia: Estudo transversal descritivo. Amostra constituída por 70 pacientes com câncer colorretal, atendidos no Ambulatório de Proctologia do Hospital de Base do Distrito Federal. Foram coletados dados antropométricos, dietéticos e de hábitos de vida. Resultados: Os pacientes assistidos, 28 homens e 42 mulheres, idade média de 58,30 anos, praticavam alguma atividade física: 71,43%. Eram tabagistas 8,60% e ex-tabagistas 24,30%. Consumiam bebida alcoólica 11,40%. Quanto aos hábitos dietéticos: 87,10% consumiam de cinco a nove porções/dia de cereais, pães, raízes e tubérculos; 7,10%, de três a cinco porções/dia de frutas; 2,90%, de quatro a cinco porções/dia de hortaliças; 28,60%, uma porção/dia de leguminosas; 15,70%, três porções/dia de leite e derivados; 61,40%, de uma a duas porções/dia de carnes e ovos; 31,40%, de uma a duas porções/dia de doces e açúcares; 8,60%, >25g/dia de fibras; 11,40%, >2 litros/dia de água e, 70%, >2 xícaras/dia de café. Quanto ao preparo dos alimentos, 72,90% usavam gordura vegetal, e 22,90% animal; 12,90% usavam condimentos industrializados, 72,90% naturais, e 12,90% usavam ambos. Conclusão: Foi observada ingestão dietética precária da maioria dos fatores protetores contra o câncer colorretal. Os resultados sugerem a necessidade da realização de programas educacionais multidisciplinares com o intuito de orientar os pacientes à melhoria da qualidade de vida com reforço dos hábitos de vida saudáveis.

INTRODUÇÃO: O câncer gastrointestinal compromete a qualidade de vida devido às alterações fisiológicas, metabólicas e psicológicas. Fungos medicinais podem melhorar a qualidade de vida de pacientes com câncer. OBJETIVO: Avaliar os efeitos da suplementação dietética com fungos Agaricus sylvaticus na qualidade de vida de pacientes com câncer colorretal em fase pós-operatória. METODOLOGIA: Ensaio clínico randomizado, duplo-cego, placebo-controlado, realizado no Hospital de Base do Distrito Federal. Amostra constituída por 56 pacientes (24 homens e 32 mulheres), estádios I, II e III, separados em grupos placebo e Agaricus sylvaticus (30mg/kg/dia), e acompanhados por um período de seis meses. Para avaliar os indicadores da qualidade de vida foram utilizados um formulário-padrão e uma anamnese dirigida-padrão. Os resultados foram analisados de forma qualitativa e descritiva, utilizando os programas Microsoft Excel 2003 e Epi Info 2004. RESULTADOS: Após seis meses de tratamento, observou-se, no grupo Agaricus sylvaticus, aumento da adesão à prática de atividade física, melhora da disposição e do humor, redução das queixas de dores e das alterações do sono como insônia e noites mal dormidas comparado com o grupo placebo. CONCLUSÃO: Os resultados sugerem que a suplementação dietética com Agaricus sylvaticus pode melhorar a qualidade de vida de pacientes no pós-operatório de câncer colorretal. INTRODUCTION: Gastrointestinal cancer jeopardizes the quality of life through physiological, metabolic and psychological alterations. Medicinal fungus may boost the quality of life of patients with cancer. OBJECTIVE: To evaluate the effects of the dietary supplementation with Agaricus sylvaticus fungus in relation to the quality of life in patients with colorectal cancer during post-surgery phase. METHODOLOGY: Randomized, double-blind, placebo-controlled clinical trial carried out at the Federal District Hospital - Brazil, for six months. Samples of 56 enrolled patients (24 men and 32 women), stadiums phase I, II and III, separated as placebo and Agaricus sylvaticus (30mg/kg/day) supplemented groups: In order to evaluate indicators for quality of life, it was used form-standard and direct anamnese-standard. The method of analysis for results was qualitative and descriptive, using the Microsoft Excel 2003 and Epi Info 2004 programs. RESULTS: After six months of treatment, it was observed an increase of adhesion to physical activity; improved disposition and good mood, reduction of complaints, pains, and alterations of sleep such as insomnia and bad nights of sleep when Agaricus sylvaticus and placebo groups were compared. CONCLUSION: The results suggest that the dietary supplementation with Agaricus sylvaticus may improve the quality of life of patients with colorectal adenocarcinoma in post-surgery phase.