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Abstract Evaluating the prognosis of ARDS patients using grading systems can enhance treatment decisions. This retrospective observational study evaluated the predictive accuracy of the SOFA score, APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio for mortality in ARDS patients in Vietnam. The study included 335 adult ARDS patients admitted to a central hospital from August 2015 to August 2023. Among them, 66.9% were male, the median age was 55 years, and 61.5% died in the hospital. The SOFA (AUROC: 0.651) and APACHE II scores (AUROC: 0.693) showed poor discriminatory ability for hospital mortality. The SpO2/FiO2 (AUROC: 0.595) and PaO2/FiO2 ratios (AUROC: 0.595) also displayed poor discriminatory ability. In multivariable analyses, after adjusting for the same set of confounding variables, the APACHE II score (adjusted OR: 1.152), SpO2/FiO2 ratio (adjusted OR: 0.985), and PaO2/FiO2 ratio (adjusted OR: 0.989) were independently associated with hospital mortality. Although the SOFA score (adjusted OR: 1.132) indicated a potential association with hospital mortality, it did not reach statistical significance (p = 0.081). However, a SOFA score of ≥ 10 emerged as an independent predictor (adjusted OR: 3.398) of hospital mortality. These findings emphasize the need for further studies to develop more accurate scoring systems for predicting outcomes in ARDS patients.

Abstract To determine the characteristics of the changes in the amplitude of the flicker electroretinograms (ERGs) after combined cataract surgery and vitrectomy for an idiopathic epiretinal membrane (ERM). To accomplish this, we conducted a prospective study on 20 patients. Flicker ERGs and central macular thickness (CMT) were measured before the surgery (baseline), and at 1 week, 1 month, 3 months, and 6 months postoperatively. The mean amplitude of the flicker ERGs increased significantly by 63.5% at 1 week after surgery (P

Objectives To investigate the serum IL-6 levels and their rate of change in predicting the mortality of critically ill patients with COVID-19 in Vietnam.Design A single-centre, cross-sectional study.Setting An Intensive Care Centre for the Treatment of Critically Ill Patients with COVID-19 in Ho Chi Minh City, Vietnam.Participants We included patients aged 18 years or older who were critically ill with COVID-19 and presented to the study centre from 30 July 2021 to 15 October 2021. We excluded patients who did not have serum IL-6 measurements between admission and the end of the first day.Primary outcome measures The primary outcome was hospital all-cause mortality.Results Of 90 patients, 41.1% were men, the median age was 60.5 years (Q1–Q3: 52.0–71.0), and 76.7% of patients died in the hospital. Elevated IL-6 levels were observed on admission (41.79 pg/mL; Q1–Q3: 20.68–106.27) and on the third day after admission (72.00 pg/mL; Q1–Q3: 26.98–186.50), along with a significant rate of change in IL-6 during that period (839.5%; SD: 2753.2). While admission IL-6 level (areas under the receiver operator characteristic curve (AUROC): 0.610 (95% CI: 0.459 to 0.761); cut-off value ≥15.8 pg/mL) and rate of change in IL-6 on the third day of admission (AUROC: 0.586 (95% CI: 0.420 to 0.751); cut-off value ≥−58.7%) demonstrated poor discriminatory ability in predicting hospital mortality, the third day IL-6 rate of change from admission ≥−58.7% (adjusted OR: 12.812; 95% CI: 2.104 to 78.005) emerged as an independent predictor of hospital mortality.Conclusions This study focused on a highly selected cohort of critically ill COVID-19 patients with a high IL-6 level and mortality rate. Despite the poor discriminatory value of admission IL-6 levels, the rate of change in IL-6 proved valuable in predicting mortality. To identify critically ill COVID-19 patients with the highest risk for mortality, monitoring the serial serum IL-6 measurements and observing the rate of change in serum IL-6 levels over time are needed.

Introduction: DLBCL presents clinical, biological, and prognostic heterogeneity. The composition of the tumor TME strongly contributes for its biological diversity, being able to predict treatment response and determine prognosis. DLBCL with TME enriched in CD8+T-lymphocytes and NK cells demonstrate increased OS compared to those with TME enriched in histiocytes. Data from patients with solid tumors have established associations between absolute quantification of lymphocyte subpopulations (LS) in peripheral blood (PB) and prognosis. Therefore, it is hypothesized that the cellular constituents of PB may mirror the TME, and their quantification may constitute an easy and fast tool to access biological biomarkers predictive of therapeutic response and prognosis in malignancies. This study aims to determine the absolute quantification of LS in the PB of DLBCL patients, seeking associations with outcomes and specific clinical phenotypes. Methods: This study involved 54 newly-diagnosed DLBCL patients. PB collection was performed before starting any therapy, for blood count and immunophenotyping on a BD Facs Calibur flow cytometer. End points included OS and EFS. Survival curves were constructed using the KM method. The Mann-Whitney test and the Kruskal-Wallis test were used to establish the relationship between the lymphocyte profile, clinical variables, therapeutic response and outcomes. The Contal O'Quingley test was used to determine cut-offs for each LS capable of discriminating outcomes. Univariate analysis was performed using the Cox method and a p-value ≤ 0.05 was considered statistically significant. Results: The median age at diagnosis was 54 years and 55.6% were female. Clinical stage III/IV was observed in 77.8%, 57.4% had bulky ≥ 7 cm, 63.0% had B-symptoms, and 53.7% presented IPI ≥ 3. The ORR was 80.8%. With a median follow-up of 21.3 months, the estimated 2-year OS and EFS were 73.3% and 64.7%. The median absolute values obtained for the PB lymphocyte subpopulations were: 1026 cells for CD3+ T-lymphocytes, 591 cells for CD4+ T-helper lymphocytes, 412 cells for CD8+ T-cytotoxic lymphocytes, 1.6 for CD4/CD8 ratio, 240 cells for T-reg lymphocytes, 112 cells for LG T-lymphocytes, 173 cells for NK cells, and 70 cells for B-lymphocytes. In univariate analysis, using a cut-off value = 367 CD8+T-cells/mm3 and 141 NK-cells/mm3, cytotoxic T-lymphodepletion was associated with decreased OS (p = 0.005) and EFS (p < 0.001), as well as NK-lymphodepletion was associated with decreased EFS (p = 0.033), but not with shortened OS (p = 0.240). DLBCL patients presenting higher NK-cell counts had lower rates of chemoresistance to the R-CHOP (p = 0.024), and those with higher NK-cell counts (p = 0.033) and higher CD8+T-lymphocyte counts (p = 0.039) had lower probability to develop relapse, progression or death, confirming the central role of these PB cellular constituents in anti-tumor immunity. We observed that B-cell lymphodepletion was associated with an adverse clinical phenotype, including higher frequency of bulky disease (p = 0.009), B-symptoms (p < 0.001) and advanced clinical stage (p = 0.033). Conclusion: In newly-diagnosed DLBCL, the lymphodepletion of CD8+T-cells and NK cells quantified in PB were associated with decreased OS and EFS. Similarly, peripheral T-cytotoxic and NK lymphodepletion were associated with absence of response to the R-CHOP regimen, as well as higher probability of relapse, progression or death. Therefore, the absolute quantification of these LS in PB may be considered potential biomarkers capable of predicting response and prognosis in DLBCL. Also, we believe it may mirror the cellular composition of the immune TME.

Introduction: DLBCL commonly affects the older population. Elderly patients often present high-risk molecular profile, lower tolerability to chemotherapy, and poor outcomes. In this setting, attenuated therapeutic regimens, such as R-miniCHOP and R-miniCHOP of the elderly, have emerged for this fragile population. Albeit its relevance, response rates, clinical outcomes, and toxicities of these regimens remain poorly understood, because these individuals are usually excluded from controlled trials. Therefore, this study aims to assess the outcomes, determine survival predictors, and compare responses and toxicities between R-CHOP, R-miniCHOP, and R-miniCHOP of the elderly protocols in the management of elderly DLBCL patients. Methods: This retrospective, observational, and single-center study involved 185 DLBCL patients older than 70 years, treated at USP, from 2009 to 2020. Endpoints included ORR, OS, PFS. Survival curves were constructed using the KM method and the Log-Rank test was used to assess the relationship between variables and outcomes. The chi-square test and the Kruskal-Wallis test were applied to assess statistically significant differences in clinical characteristics, adverse event profile, and responses between different treatment modalities. Univariate analysis was performed using the Cox test and multivariate analysis by Cox regression method. The results were presented in HR and 95% CI, and a p-value ≤0.05 was considered significant. Results: The median age at diagnosis was 75 years, and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition and 24.8% with polypharmacy. Advanced clinical stage (III/IV) was observed in 72.4%, 48.6% had bulky ≥ 7 cm, 63.2% had B-symptoms, and 67.0% presented IPI ≥ 3. Among the 182 (98.4%) effectively treated cases, 57.1% received R-CHOP, 18.0% R-miniCHOP, 13.2% R-miniCHOP of the elderly, and 1.7% were palliated using R-CVP. The ORR for the whole cohort was 68.1%, with CR achieved in 65.9%. ORR was 72.1% for R-CHOP, 70.6% for R-miniCHOP, and 45.6% for R-miniCHOP of the elderly, p = 0.040. Although R-miniCHOP of the elderly regimen promoted lower ORR, patients in this group had higher rates of unfavorable clinical-laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The estimated 2-year OS was 82.0% for R-CHOP, 67.5% for R-miniCHOP, and 48.1% for R-miniCHOP of the elderly, p = 0.003. The estimated 2-year PFS was 61.1% for R-CHOP, 56.4% for R-miniCHOP, and 20.5% for R-miniCHOP of the elderly, p = 0.005. Although correlated with increased OS and PFS in comparison to attenuated protocols, R-CHOP regimen was associated with higher rates of severe neutropenia (p = 0.003), but not translated into febrile neutropenia (p = 0.907), therapy interruption (p = 0.671), or higher early mortality rates (p = 0.681). In multivariate analysis, age≥75 years (HR: 2.08, p = 0.001), neutrophilia (HR: 2.18, p = 0.007), low lymphocyte/monocyte ratio (HR: 1.98, p = 0.010), and clinical stage III/IV (HR: 2.36, p = 0.003) were predictors of decreased OS. Conclusion: In this large and real-life LATAM cohort, we demonstrated that DLBCL patients older than 70 years still do not have satisfactory outcomes, with half of cases not reaching 5 years of life expectancy after diagnosis. Although a significant portion of older DLBCL patients is highly fragile and ineligible for enhanced regimens, attenuated anthracycle-based protocols promoted remarkably inferior outcomes compared to those achieved by the R-CHOP.

Introduction: FL has heterogeneous biological behavior, variable clinical outcomes, and a natural history marked by histological transformation (HT). The management of FL and its outcomes are highly dependent on staging (CS) and tumor burden (TB). The identification of new molecular biomarkers is crucial, not only to understand FL's biology, but also, can guide better prognostic stratification, and determine new therapeutic targets. This study aims to outline the GEP in tissue samples from FL categorized by CS and TB using a large-scale gene microarray platform with subsequent expansion by RT-qPCR. Methods: This study involved 219 FL cases. FL patients were categorized into early-stage disease (I/II) (ES), advanced-stage (AS) (III/IV) with low tumor burden (LTB), and AS with high tumor burden (HTB) according to GELF criteria. The experimental phase involved 126 FFPE samples. Firstly, 42 samples (12 ES, 11 AS-LTV, 12 AS-HTV, 6 control lymph nodes and 1 control HELA) were submitted to the array using the Clariom D Array Human platform. The identification of differentially expressed genes (DEGs) between the 4 groups used the Transcriptome Analysis Console by the eBay ANOVA method. Bidimensional PCA sought to identify discriminatory DEGs clusters. A comparison between pairs was subsequently performed. The 7 most discriminatory DEGs were selected for a cohort expansion by RT-qPCR. Results: According to CS and TB, 14.6% of FL cases were categorized as ES, 17.8% as AS-LTB, and 67.6% as AS-HTB. With a median follow-up of 80.7 months, the median OS was 208.2, 130.5, and 126.3 months for ES, AS-LTB, and AS-HTB,p = 0.249. The median PFS was 113.3, 110.7, and 59.5 months, for the same groups, p = 0.018. The array identified 135,750 genes comparisons between the control, ES, AS-LTB, and AS-HTB. PCA analysis was not able to identify discriminatory DEGs clusters among the 4 groups. Pairwise comparative analysis identified 1913 DEGs among the 4 groups. Of these, 1759 (91.9%) were DEGs between FL and healthy controls, but only 218 (11.3%) were DEGs among the 3 different FL subgroups, evidencing a low molecular diversity in FL when categorized by CS and TB. In the cohort expansion by qRT-PCR, 7 pre-selected DEGs based on the microarray were tested, including the genes GNG7, ITGAM, AZN1, TIMD4, IL7R, PTGS2, and MTTL10. The comparison between the median expression of these genes among the 3 FL's groups showed that the expression of the ILR7 was downregulated with the progression of the disease, with marked hypoexpression in AS-HTB patients. These data may suggest downregulation of IL7R gene in the FLs natural history. We found that hypoexpression of the GNG7 (p = 0.024) and PTGS2 (p = 0.090) were associated with higher rates of disease progression/relapse, and hypoexpression of the GNG7 (p = 0.006) was associated with a higher probability of HT, highlighting the potential prognostic impact of these molecular biomarkers. Finally, we established phenotypic-genotypic associations, as hypoexpression of ITGAM was associated with higher rates of B-symptoms (p = 0.017) and bulky disease (p = 0.026), as well as hypoexpression of IL7R was correlated with a higher probability of bulky (p = 0.025) and extranodal involvement (p = 0.016). Conclusion: Although CS and TB are strong determinants of the prognostic heterogeneity of FL, this study did not find high molecular diversity by this categorization. We observed a relatively homogeneous GEP with low biological diversity in FL presenting different disease evolution phases. Moreover, new molecular biomarkers potentially implicated in FLs natural history, prognostication and specific clinical phenotypes were revealed.

Unsupervised machine learning techniques are employed to understand patterns and behaviors of variables in databases. Multiple Correspondence Analysis (MCA), an extension of correspondence analysis, can be used to verify the association of categorical variables and their categories. In this study, we evaluated the relationship between clinical-demographic variables of 154 patients with nodal peripheral T-cell lymphoma (PTCL) to understand how these variables relate to the unfavorable clinical outcome, death. Methodology: MCA was used to reduce the dimensionality of the real world database by creating two dimensions, 1 and 2, which were subsequently categorized into group 1 and group 2. Dimension 1, comprising ECOG, IPI, treatment, overall response, remission, and bone marrow transplant, represented about 30% of the total observed variance. Survival analysis was conducted to assess the association between these groups and overall survival (OS) and mortality rate. Results: The categories of dimension 1, group 1 and group 2, were associated with OS and mortality rate, with group 1 being associated with 5.5 months (95% CI: 2.70 – 8.40) of OS, while group 2 had a survival time of 277.20 months (95% CI: 91.21 – 463.12). Moreover, the mortality rate in group 1 was 87% (n = 67) and in group 2 it was 36% (n = 28) (p < 0.001). The risk of death for group 1 was 11.11 times (95% CI: 9.75-18.30; β= 2.41; p < 0.001). Discussion: These findings indicate a significant disparity in survival outcomes based on the clinical-demographic profiles of the patients. Group 1, characterized by poorer clinical indicators, exhibited substantially shorter OS and higher mortality rates. The ability of MCA to effectively reduce dimensionality while preserving the clinical relevance of the variables underscores its utility in identifying key prognostic factors. Conclusion: The MCA technique was effective in reducing the dimensionality of the database, maintaining the clinical characteristics of the variables robustly for use in Cox regression. This approach can aid in the identification of high-risk patient groups and inform treatment strategies aimed at improving clinical outcomes.

Introduction: Infection with Human T-Lymphotropic Virus Type 1 (HTLV-1) is endemic in various regions worldwide. Brazil has an estimated 800,000 to 2.5 million infected individuals. This virus is associated with a broad spectrum of clinical manifestations, ranging from asymptomatic infection to severe diseases such as tropical spastic paraparesis/HTLV-1-associated myelopathy (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL). Both conditions are linked to high morbidity and mortality. HTLV-1 can infect and alter the function of immune system cells, particularly CD4+ T lymphocytes, causing abnormalities in genes involved in cellular senescence, proliferation, and apoptosis. This study aimed to evaluate the differential expression of genes regulating senescence and cellular proliferation in asymptomatic HTLV-1 carriers. Methods: Peripheral blood samples were collected from healthy individuals (controls), asymptomatic HTLV-1 carriers, and ATLL patients. Gene expression analysis was performed using RNA extracted from CD4+ T lymphocytes separated by magnetic microbeads. The extracted RNA was converted into cDNA for quantitative real-time polymerase chain reaction (qRT-PCR). Results: A total of 32 asymptomatic HTLV-1 carriers, 30 healthy controls, and 7 ATLL cases were analyzed (N = 69). Of the 32 asymptomatic HTLV-1 carriers, 22 (68.8%) were female; in the control group, 16 (53.3%) were female, and in the ATLL group, 5 (71.4%) were female. The age of asymptomatic HTLV-1 carriers ranged from 20 to 87 years (median 58 years), from 31 to 66 years (median 52 years) in the control group, and from 43 to 79 years (median 64 years) in the ATLL group. Three (43%) patients were classified as having smouldering ATLL, and 1 (14.3%) as acute ATLL. The genes CDKN1A, PIK3CA, and RBL2 were underexpressed in asymptomatic HTLV-1 carriers. ATLL patients exhibited underexpression of CDKN1A and overexpression of COL3A1. Conclusion: Asymptomatic HTLV-1 carriers showed underexpression of CDKN1A, PIK3CA, and RBL2 in CD4+ T lymphocytes. CDKN1A was also significantly underexpressed in ATLL. Asymptomatic carriers and ATLL patients did not show differential expression of the genes AKT1, ID1, IFNG, NFKB1, PTEN, TERT, TWIST1, and SPARC. COL3A1 was overexpressed in ATLL patients.

Introduction: Peripheral T-cell lymphomas (PTCL) are a rare group of malignancies derived from mature T-cells or natural killer cells, characterized by significant clinical-biological heterogeneity despite being grouped together. These entities have unique clinical, morphological, phenotypic, and molecular signatures. The predominantly nodal presentation group includes the histological variants ALK-positive anaplastic large cell lymphoma (ALK1+ ALCL), ALK-negative anaplastic large cell lymphoma (ALK1- ALCL), angioimmunoblastic T-cell lymphoma (AITL), and PTCL, not otherwise specified (PTCL-NOS). The central pillar of treatment for this subgroup of lymphomas is based on anthracycline-containing polychemotherapy regimens and upfront consolidation with autologous hematopoietic stem cell transplantation, although unfavorable outcomes such as primary refractory disease and early relapses are still common, except for the ALK1+ ALCL subgroup. Methodology: Hence, a multicenter, real-world, ambispective study was conducted, involving reference institutions in Brazil and two in the USA, to evaluate the main clinical-demographic characteristics associated with the outcomes of 179 patients diagnosed with nodal PTCL. Results and discussion: Individuals with nodal PTCL often presented at diagnosis with unfavorable clinical features, including a high frequency of advanced disease (stages III and IV), high tumor burden, poor performance status (ECOG ≥ 2 points), and frequent allocation in high-risk categories of the IPI and PIT prognostic indices. Patients with nodal PTCL included in this study globally exhibited low Complete Response rates, as well as shortened Overall Survival (OS) and Progression-Free Survival (PFS). In this cohort, we did not identify a robust survival benefit from the intensification of the CHOP regimen with the addition of etoposide (CHOEP protocol) or with BV-CHP. Age ≥ 60 years, ECOG ≥ 2, and lack of complete remission after primary therapy centered on CHOP-like chemotherapy were identified as independent prognostic factors associated with worse survival in this cohort represented by the four main histopathological subtypes of nodal PTCL. Conclusion: This analysis demonstrated a high frequency of unfavorable clinical features and poor OS and PFS outcomes in patients with nodal PTCL, regardless of the frontline chemotherapy regimen.

Introduction: Circulating free DNA (cfDNA), particularly circulating tumor DNA (ctDNA), has emerged as a pivotal tool for diagnosis, response assessment, and monitoring of various malignancies. However, in most cancers, it has yet to be incorporated into clinical practice due to the lack of reproducible and widely accessible methodological standardization. In this context, numerous studies have been conducted to achieve such standardization. The purpose of this study was to evaluate the quantification of cfDNA and the identification of plasma ctDNA using the Z-scan technique in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Peripheral blood samples were prospectively collected from DLBCL patients at diagnosis, after the fourth treatment cycle, and at the end of R-CHOP-like treatment. Simultaneously, samples from healthy individuals matched by sex and age were collected. After obtaining cfDNA, its concentration was assessed using Nanodrop, Qubit, Bioanalyzer, and Z-scan equipment. The results were compared and correlated with the clinical characteristics of the patients. Results: From January 2018 to December 2022, 54 DLBCL patients were recruited, with a median age of 58 years (ranging from 21 to 91 years), 33 (62.9%) of whom were female. The overall response rate of the cohort was 68.52%, with a median follow-up of 24.6 months, showing an overall survival of 32 months and event-free survival of six months. The concentrations of cfDNA varied significantly among the different reading methodologies used. The peak-to-valley distance (Theta values - Θ) of cfDNA from patients at diagnosis (mean of 0.438) obtained in the Z-scan was statistically distinct between the control group (background) and patients at different collection points. The peak-to-valley distance (Θ) of cfDNA samples collected at diagnosis was higher than that of the control group (background), p = 0.068, those collected after cycle 4 (mean 0.33), p = 0.016, and after treatment completion (mean 0.33), p = 0.0005. Several cut-off points for “Θ” were tested to identify the best discriminatory value between DLBCL and healthy control, with a sensitivity of 64.71% (95% CI: 50.99% to 76.37%) and specificity of 86.61% (95% CI: 62.86% to 93.02%) for Θ > 0.406. No correlations were found between “Θ” values and the clinical and demographic characteristics of the patients. Conclusion: The Z-Scan technique was able to distinguish DLBCL patients from healthy controls, as well as samples obtained during and after treatment from those collected before the start of anti-lymphoma therapy. We hypothesize that this discrimination was possible because the Z-scan technique may have been capable of distinguishing ctDNA from cfDNA.

ABCs and LRP transport proteins are involved in several metabolic processes, among which the transport of lipids and xenobiotics can be highlighted. Thus, the overexpression of some of these proteins, such as ABC-G2 and the LRP protein, are associated with the phenotype of resistance to multiple drugs, one of the main causes of relapses and relapses in patients with acute myeloid leukemia. Mesenchymal stem cells (MSC) are multipotent cells present in the bone marrow and are part of the hematopoietic niche. Phenotypic changes in MSCs are related to AML progression. The oxysterols, 7-KC and Triol, are derived from the auto-oxidation of the cholesterol molecule; and have functions in cell signaling, survival and death. Therefore, the objective of this work was to evaluate the action of oxysterols, in subtoxic concentrations, of 7-KC (30 μM, 50 μM and 70 μM) and Triol (20 μM, 30 μM and 40 μM) on the ABCs and LRP transport proteins of MSCs derived from bone marrow from patients with AML (MSC-D), being used as a comparator MSC of bone marrow from healthy individuals (MSC-S). Using the indirect immunofluorescence technique, it was observed that the amount of ABC-A1 protein was higher in MSC-S strains and that treatment with 30 μM of 7-KC increased ABC-A1 only in MSC-S strains. On the other hand, treatment with Triol decreased the concentration of ABC-A1 in MSC-S strains, and this decrease in ABC-A1 was associated with a decrease in the amount of the LXR-β receptor. Furthermore, treatment with 70 μM of 7-KC decreased LRP protein expression in MSC-S strains, while in MSC-D strains there was no difference. Treatment with Triol showed no significant effect on LRP protein expression in MSC-S, only in MSC-D strains, where there was an increase in the concentration of 20 μM, followed by a decrease in the concentrations of 30 μM and 40 μM of Triol. Both 7-KC and Triol treatment increased the concentration of SMO protein in the cytoplasm and its translocation to the nucleus in MSC-S cell lines. This effect was not observed in MSC-D strains. Treatment with Triol increased the concentration of ABC-D4 protein in the cytoplasm. Furthermore, the presence of ABC-D4 protein was observed in the nucleus of MSC-S and MSC-D strains. Our results demonstrated that in the MSCs lineages the effect of 7-KC and Triol is mainly metabolic, in which an increase in the oxidized glutathione content, alteration in the processes of mitochondrial dynamics with induction of genes related to the fission and fusion process in both 7-KC and Triol-treated MSC lines. Increased expression of the BCL2 gene and cytoplasmic survivin was also observed in MSCs treated with 7-KC. In conclusion, it is possible to observe differences in the expression of ABC transporters and LRP between CTM-S and CTM-D strains. Furthermore, at the same concentrations of 7-KC and Triol used, the observed effect was different between MSC-S and MSC-D, which demonstrates that there are different mechanisms between mesenchymal stem cell lines. In summary, our results are characteristic of the metabolic action of the oxysterols 7-KC and Triol on MSCs.

Introduction: A specific instrument for monitoring the transfusion process was designed with the aim of managing, monitoring and tracking all stages of the transfusion process, in the Hemotherapy Service of the Cancer Institute of the State of São Paulo (ICESP) and improving the reliability of notification of transfusion reactions. The management of indicators through this instrument makes it possible to support decision-making and the reorganization of processes in real time, contributing to maintaining the standard of excellence and safety of hemotherapy care. Therefore, the objective of this study was to evaluate the perception of nursing professionals in the use of an instrument for managing the transfusion process in the Hemotherapy Service of (ICESP). Methods: Therefore, a prospective interventional study was conducted in which a questionnaire consisting of six questions was applied regarding the use of the instrument for recording the stages of the transfusion process. This study consisted of 200 participants, divided into five groups, according to the area of activity, being: hemotherapy (n = 40), ICU (n = 40), hematology (n = 40), day hospital (n = 40) and outpatient clinic (n = 40). The outpatient group was evaluated as a control in data analyses. Results: After applying the questionnaire, it was observed that regarding question 1 about Understanding the information in the instrument, all hemotherapy and ICU participants responded that they completely agreed with the presentation of the content present in the instrument. Regarding the difficulty in filling out the instrument, of the groups evaluated, hemotherapy (75%), HD (65%), hematology (57.5%), outpatient clinics (37.5%), ICU (30%) responded that the instrument It is easy to fill out. For the majority of participants (70.5%) there is a positive impact on the time spent filling out the instrument. The hemotherapy (97.5%), ICU (62.5%), HD (90%) and outpatient (90%) groups fully agreed that the information contained in the instrument contributes to continuous improvement in transfusion therapy. In the fifth question in which the ease of the steps to be followed was evaluated, it was evidenced that for hemotherapy (82.5%), ICU (95%), HD (92.5%), hematology (90%) and outpatient clinic ( 80%), completing the instrument makes it easier to understand all the steps that must be followed. Finally, hemotherapy (82.5%), ICU (90%), HD (85%), Hematology (92.5%) and Outpatient Clinic (72.5%) are satisfied with using the instrument during the transfusion process. Conclusion: Based on the results obtained, it was observed that in the perception of professionals working in the hemotherapy service, the instrument helps in control, monitoring and traceability at all stages of the transfusion process.

Abstract This multicentre prospective cohort study aimed to compare the accuracy of the PAASH, WFNS, and Hunt and Hess (H&H) scales in predicting the outcomes of adult patients with aneurysmal SAH presented to three central hospitals in Hanoi, Vietnam, from August 2019 to June 2021. Of 415 eligible patients, 32.0% had a 90-day poor outcome, defined as an mRS score of 4 (moderately severe disability) to 6 (death). The PAASH, WFNS and H&H scales all have good discriminatory abilities for predicting the 90-day poor outcome. There were significant differences in the 90-day mean mRS scores between grades I and II (p = 0.001) and grades II and III (p = 0.001) of the PAASH scale, between grades IV and V (p = 0.026) of the WFNS scale, and between grades IV and V (p

Introdução: O diagnóstico de câncer durante a gestação é uma condição de alto risco a saúde da gestante, podendo causar repercussões emocionais, além de grande preocupação aos profissionais de saúde envolvidos no acompanhamento da paciente relacionado, à conduta terapêutica e ao prognóstico, sendo necessário avaliar o risco materno e as consequências para o feto, bem como as repercussões para o futuro reprodutivo da mulher. Objetivo: Relatar a experiência de Enfermeiros Oncologistas na assistência de uma paciente diagnosticada com Leucemia Mieloide Aguda grávida no segundo trimestre da gestação em um hospital de referência no estado do Ceará. Método: Estudo descritivo, tipo relato de experiência vivenciado por enfermeiros oncologistas em um hospital público terciário em Fortaleza-CE. Resultados: Paciente de 17 anos, gestante (IG:18s5d) com diagnóstico de LMA, apresentou mielograma com 39% de blastos. Hemograma inicial mostrou leucocitose com 10% de blastos e plaquetopenia. A equipe de saúde conversou com a paciente e familiares sobre a gravidade do quadro e chances de desfecho desfavorável da gestação, e que o tratamento da doença requer urgência com risco de morte para a paciente. A paciente e os responsáveis entenderam os riscos associados a tal condição, tendo optado pela não interrupção da gestação. Iniciada administração pelos enfermeiros da citorredução com hidroxiureia 3 g/d e citarabina conforme prescrição médica, por leucocitose importante. Realizada administração do protocolo quimioterápico de indução (7+3 DAUNO 90) e MADIT. Após administração do protocolo foi realizado novo mielograma evidenciando 3% de blastos, tendo a paciente atingido a remissão citomorfológica com doença residual mínima negativa. Em ultrassonografia obstétrica evidenciou embrião vivo, bulhas cardiofetais presentes, porém com restrição de crescimento. Não foi indicada interrupção da gestação pela equipe, pois a idade gestacional já estava em 22 semanas. Paciente foi acompanhada durante toda a gestação, tendo dado continuidade ao tratamento. A criança nasceu sem nenhuma malformação ou condições patológicas identificadas ao nascimento. A mãe recebeu alta por remissão completa da doença. Seguindo em acompanhamento ambulatorial. Destaca-se o grande dilema vivenciado por toda a equipe multiprofissional ao ter que decidir um tratamento que reduzisse o máximo do risco a vida da adolescente, assim como garantir o mínimo de segurança para o feto, considerando a escolha da gestante pela não interrupção da gestação. Conclusão: É importante a atuação de equipe multidisciplinar com participação multidisciplinar e multiprofissional com: obstetras, pediatras, hematologistas, psicólogos, fisioterapeutas, enfermeiros e assistente social que, em conjunto, devem considerar o estágio e agressividade do câncer, a idade gestacional, os fatores maternos e fetais associados, bem como respeitar as autonomia da paciente, após orientação clara e objetiva na tomada de decisões sobre as condutas propostas.Os enfermeiros Oncologistas tiveram um papel extremamente importante em todas as etapas do tratamento, ao orientar sobre o tratamento, sobre as possíveis complicações, ao administrar os antineoplásicos e monitorar intensivamente os possíveis efeitos colaterais, além de acolher a gestante de forma empática.

Introdução: O câncer ocupa atualmente o ranking das principais causas de morte no mundo. Os cânceres de origem hematológica vêm apresentando um aumento no número de casos, dentre eles o Linfoma de Hodgkin vem ganhando destaque. O motivo do surgimento desta doença ainda não está totalmente esclarecido, mas sabe-se que é uma doença adquirida de etiologia multifatorial. Objetivo: Identificar o perfil epidemiológico do Linfoma de Hodgkin no Brasil no período de 2013 a 2023. Métodos: Estudo descritivo de abordagem quantitativa, sendo extraído os dados do Departamento de Informática do Sistema Único de Saúde - DATASUS do período de 2013 a 2023 em âmbito nacional. Resultados: Nos últimos dez anos houve um total de 19.263 casos novos dessa neoplasia no país, sendo o sexo masculino correspondente ao maior número dos casos com 10.516 casos seguido do sexo feminino com o total de 8.747 casos. Em relação às regiões do país, verifica-se uma diferença regional no número de casos diagnosticados nos últimos dez anos. A região sudeste ocupa o primeiro lugar com 8.359 casos diagnosticados, a região nordeste segundo lugar com 4.449 casos diagnosticados, a região sul o terceiro lugar com 4.076 casos diagnosticados, seguidos de centro-oeste com 1.351 casos e norte em último com 1.028 casos diagnosticados. As diferenças nos números podem estar relacionadas a fatores como: dificuldade na identificação dos sintomas da doença, acesso limitado aos serviços de saúde e a exames diagnósticos, diferença no número de serviços de oncologia dentre as regiões, entre outros fatores. Em relação a modalidade de tratamento, a quimioterapia é a modalidade de tratamento mais utilizada para esta neoplasia em 17.285, seguida de radioterapia com 1.369 registros, seguido de cirurgia em 602 registros. Dentro do período em estudo, observa-se o crescimento no número total de diagnósticos novos, em 2013 houve 1.795 casos diagnosticados e em 2022 houve 1.898 casos diagnosticados. No primeiro semestre de 2023 de forma parcial houve o registro de 424 diagnósticos no país. O aumento no número de diagnósticos desta neoplasia pode estar relacionado com ações de mobilização do poder público e dos profissionais de saúde com foco no reconhecimento de sinais e sintomas sugestivos da doença, ações para o diagnóstico precoce e tratamento em tempo oportuno. Conhecer o perfil epidemiológico desta neoplasia possibilita alocação de recursos logísticos, econômicos e humanos de forma equânime.

Introduction: FL is the most common low-grade B-cell NHL. Although indolent, it has heterogeneous biological behavior and variable clinical outcomes. Histologic transformation (HT) to high-grade B-cell NHL is associated with dismal survival. The therapeutic management of FL and its prognosis are highly dependent on its staging and tumor burden. Here we aimed to describe clinical characteristics, assess outcomes, determine predictors of survival and HT, and compare responses between different therapies applied in a large cohort of FL patients. Methods: This retrospective study involved 223 patients with FL G1-3A, diagnosed at USP, Brazil, from 2006 to 2022. FL patients were categorized into early-stage (I/II) (ES), advanced-stage (AS) (III/IV) with low tumor burden (LTV), and AS with high tumor burden (HTV) according to the GELF criteria. Endpoints were OS, PFS, early-relapse (< 24 months) and HT rates. Survival curves were constructed using the KM method and the Log-Rank test was used to assess the relationship between variables and outcomes. Univariate and multivariate analysis were performed. The results were presented in HR and 95% CI and p ≤ 0.05 was considered significant. Results: The median age at diagnosis was 60 years and 54.8% were female. 15% of cases had ES, 18.4% had AS-LTV, and 66.8% had AS-HTV. BM involvement, leukemic presentation, splenomegaly, and serous effusions occurred in 48.9%, 11.7%, 12.6%, and 21.1%, respectively. Bulky ≥ 7 cm, B-symptoms, ECOG ≥ 2, and involvement of ≥ 4 nodal areas were observed in 44.4%, 51.6%, 15.2%, and 56%, respectively. 49% of patients were categorized as high-risk according to the FLIPI score. With a median follow-up of 79.5 months (95% CI 67.0-92.0) the OS medians were 18 years (95% CI 14.9-21.1), 11 years (95% CI 9.2-12.9), and 10.5 years (95% CI 9.3-11.8) for ES, AS-LTV, and AS-HTV, respectively, p = 0.138. Similarly, the PFS medians were 6.7 years (95% CI 3.6-9.8), 8.4 years (95% CI 2.0-14.8), and 3.5 years (95 CI 1.8-5.3) for ES, AS-LTV, and AS-HTV, respectively, p = 0.171. Early-relapses occurred in 36.3% of cases, being 18.2%, 31.7%, and 41.0% for ES, AS-LTV, and AS-HTV, respectively, p = 0.032. The overall mortality rate was 29.1% for the whole cohort. HT was documented in 16.7% of cases, being 3.0%, 14.6% and 20.1% for ES, AS-LTV, and AS-HTV, respectively, p = 0.053. Among patients with AS-HTV, the R-CHOP regimen did not promote increased OS compared to the R-CVP regimen (p = 0.415), however it was associated with a substantial increase in PFS (p = 0.005). Age ≥ 60 years (HR 1.06, p < 0.001), ≥ 2 comorbidities (HR 3.85, p = 0.014), B-symptoms (HR 2.35, p = 0.015), HT (HR 2.77, p = 0.002) and thrombocytopenia (HR 2.96, p = 0.028) were predictors of poor OS. Similarly, age ≥ 60 years (HR 1.08, p < 0.001), involvelment of ≥ 4 nodal areas (HR 1.27, p < 0.001), and high LDH (HR 1.65, p = 0.002) predicted decreased PFS. Serous effusions (HR 2.09, p = 0.05), albumin < 3.5 g/dL (HR 2.82, p = 0.05), B-symptoms (HR 2.00, p = 0.006), involvement of ≥ 4 nodal areas (HR 1.21, p = 0.014), and BM infiltration (HR 2.11, p = 0.05) were the main predictors for HT. Conclusion: Although it is characteristically an indolent disease, we demonstrated that a significant portion of FL patients have shortened survival. We confirmed this prognostic heterogeneity, particularly considering the clinical staging and tumor burden. Therefore, FL patients with AS-HTV had higher HT rates and early-relapses, both classic adverse prognostic markers, as well as a tendency to higher mortality. Additionally, we identified clinical and laboratory predictors for HT, which may in a near future direct adapted-risk therapeutic strategies.

Introduction: DLBCL is a malignancy with marked clinical, biological and prognostic heterogeneity. Its different outcomes may be predicted by the identification of molecular biomarkers. Therefore, quantification of circulating cell-free DNA (ccfDNA) and circulating tumor DNA (ctDNA) have emerged as minimally invasive methods able to predict its prognosis. However, such measurements are based on the use of costly technologies and with restricted access in clinical practice. Here, we aimed to quantify ccfDNA in DLBCL using capillary electrophoresis (CEF), a low-cost and widely available methodology, in order to establish prognostic associations between its serum concentrations, clinical characteristics and outcomes. Methods: This prospective study involved 54 DLBCL patients, diagnosed at USP, from 2019 to 2020, and 23 healthy-controls. All cases were treated with 6-8 cycles of R-CHOP. Plasma samples were collected from DLBCL at three moments: at diagnosis, after the 4th CT cycle and at the end of treatment. ccfDNA was extracted using the QIAamp MinElute ccfDNA kit and quantified by CEF (Agilent 2100 Bioanalyzer). Comparison between two groups was performed using the Mann-Whitney test, and between three groups using the Kruskall-Wallis test. The cut-off for [ccfDNA] (1147 ng/μl) was determined by ROC methodology. Survival curves were constructed using the KM method and Log-Rank test was used to assess the relationship between variables and outcomes, and p≤0.05 was considered significant. Results: The median age at diagnosis was 57 years and 61.1% were female. Advanced-stage was observed in 59.3%, 29.6% had ECOG ≥ 2, 52.6% had IPI ≥ 3, and 44.4% had bulky ≥ 10 cm. BM infiltration and involvement of ≥ 2 EN sites occurred in 5.6% and 16.8%, respectively. With a median follow-up of 32 months, the medians OS and EFS were 32 months (95% CI 28-35) and 31 months (95% CI 28-34), respectively. The ORR was 76% (95% CI 63.5-86). The overall mortality rate was 20.4% (95% CI 11.1-32.3). ccfDNA concentrations were significantly higher in DLBCL compared to controls (p < 0.001), however, it did not differ significantly between samples from DLBCL collected at the 3 different time points (p = 0.602). We observed positive associations between ccfDNA [ ] in diagnostic DLBCL samples and biomarkers of high tumor burden, including higher LDH levels (p = 0.003), bulky (p = 0.011), ECOG ≥ 2 (p < 0.001), and IPI ≥ 3 (p = 0.069). However, ccfDNA[ ] at diagnosis were not statistically associated with ORR (p = 0.264), nor with clinical outcomes, including OS (1-year OS: 92% for [ccfDNA] < 1147 ng/μl vs 76% for [ccfDNA] ≥ 1147 ng/μl, p = 0.217) and EFS (1-year EFS: 92% for [ccfDNA] < 1147 ng/μl vs 69% for [ccfDNA] ≥ 1147 ng/μl, p = 0.270). We believe that the short follow-up time and sample number restriction may have contributed to the lack of statistically significant association between ccfDNA [ ] and responses/outcomes observed. In this sense, cohort expansion and NGS techniques for ctDNA identification are ongoing to assess its potential impact as a prognostic biomarker in our cohort. Conclusion: We demonstrated that ccfDNA [ ] measured by CEF were able to accurately discriminate healthy individuals from DLBCL, highlighting its potential role as a minimally invasive diagnostic biomarker. Furthermore, ccfDNA [ ] at diagnosis in DLBCL patients were positively associated with markers of high tumor burden and adverse prognosis. Our results suggest that measurement of ccfDNA by CEF may be a highly cost-effective methodology to identify high-grade B-cell NHLs and recognize DLBCL subgroups with adverse clinical-prognostic characteristics.

Introduction: Mantle cell lymphoma (MCL) is a rare malignancy with heterogeneous behavior. Despite the therapeutic advances recently achieved, MCL remains incurable. Currently, the standard of care for young and fit patients involves induction immunochemotherapy followed by up-front ASCT. However, the role of more intensive induction regimens, such as those based on high-doses of cytarabine (HDAC) remains controversial in the management of ASCT-eligible patients. Based on this premise, the current study aims to describe clinical and laboratory characteristics, assess outcomes, determine survival predictors, and compare responses between different primary therapeutic strategies, with focus on assessing the impact of HDAC-based regimens on outcomes in ASCT-eligible patients. Methods: This retrospective, observational, and single-center study involved 165 MCL patients, diagnosed and treated at the University of São Paulo, Brazil, from 2010 to 2022. Endpoints included overall OS, EFS, and POD-24 from up-front treatment. Survival curves were constructed using the Kaplan-Meier method and the Log-Rank test was used to assess the relationship between variables and outcomes. Univariate analysis was performed using the semi-parametric Cox test and multivariate analysis by Cox regression method or proportional ratios model. The results were presented in HR and 95% CI, and a p-value ≤ 0.05 was considered statistically significant. Results: The median age at diagnosis was 65 years and 73.9% were male. More than 90% of cases had a classic nodal variant (cnMCL), 76.4% had bone marrow infiltration, and 56.4% presented splenomegaly. Bulky ≥ 7 cm, B-symptoms, ECOG ≥ 2, and advanced-stage III/IV were observed in 32.7%, 64.8%, 32.1%, and 95.8%, respectively. Sixty-four percent of patients were categorized as high-risk according to MIPI score. With a median follow-up of 71.1 months (95% CI: 61.8-80.4) the estimated 2-year OS and EFS were 64.1% (95% CI: 56.2-71.9%) and 31.8% (95% CI: 23.0-40.6%), respectively. The ORR for the whole cohort was 64.7% (95% CI: 57.1-71.7%), with CR achieved in 41.5% (95% CI: 34.1-49.1%). POD-24 was observed in 46.7% (95% CI: 39.1-54.3%), and the overall mortality rate during all follow-up was 58.2% (95% CI: 50.6-65.5%), with disease progression being the main cause of death. Patients treated with R-HDAC-based regimens (43.4%-66/152) had higher ORR (85.9% vs 65.7%, p = 0.007) compared to those receiving R-CHOP (46.0%-70/152), as well as lower POD-24 rates (61.9% vs 80.4%, p = 0.043) and lower mortality (43.9% vs 68.6%, p = 0.004). However, intensified induction regimens using R-HDAC were not associated with a real OS benefit in MCL patients undergoing up-front consolidation with ASCT (2-year OS: 88.7% for R-HDAC plus ASCT vs 78.8% for R-CHOP plus ASCT, p = 0.289). Furthermore, up-front ASCT was independently associated with increased OS (p < 0.001), EFS (p = 0.005), and lower POD-24 rates (p < 0.001) in MCL. Additionally, CNS involvement (HR: 3.12, p = 0.004), tumor lysis syndrome (HR: 2.79, p = 0.026), albumin < 3.5 g/dL (HR: 2.69, p < 0.001), and failure to achieve remission after induction therapy (HR: 3.71, p < 0.001) were predictors of poor OS. Conclusion: In the largest Latin American cohort of MCL reported to date, we confirmed the OS benefit promoted by up-front consolidation with ASCT in young anf fit patients, regardless of the intensity of the immunochemotherapy regimen used in the pre-ASCT induction. Although HDAC-based regimens were not associated with an unequivocal increase in OS, it was associated with higher ORR and lower rates of early-relapses.

Introdução: O câncer é um problema de saúde pública de âmbito mundial. O Mieloma Múltiplo é uma das principais neoplasias hematológicas. Conhecer o perfil de morbidade é de suma importância, pois a doença pode apresentar-se desde assintomática ou até desenvolver complicações com dores ósseas, fraturas e infecções constantes que estão relacionados ao perfil da doença. Objetivo: Identificar o perfil epidemiológico do Mieloma Múltiplo no Brasil no período de 2013 a 2023. Métodos: Estudo descritivo de abordagem quantitativa, sendo extraído os dados do Departamento de Informática do Sistema Único de Saúde - DATASUS do período de 2013 a 2023 em âmbito nacional. Resultados: Nos últimos dez anos houve um total de 27.763 casos novos dessa neoplasia no país, sendo o sexo masculino correspondente ao maior número dos casos com 14.715 seguido do sexo feminino com o total de 13.048 casos. Em relação às regiões do país, verifica-se disparidades entre as regiões no número de casos diagnosticados nos últimos dez anos. A região sudeste ocupa o primeiro lugar com um total de 12.747 casos diagnosticados, a região nordeste ocupa o segundo lugar com um total de 6.700, a região sul está em terceiro com 5.244, seguidos de centro-oeste com 1.997 e norte em último lugar com 1.075 casos diagnosticados. As diferenças nos números podem estar relacionadas a fatores como: dificuldade na identificação dos sintomas da doença, acesso limitado aos serviços de saúde e a exames diagnósticos, diferença no número de serviços de oncologia dentre as regiões, entre outros fatores. Em relação a modalidade de tratamento, a quimioterapia ocupa o primeiro lugar como terapêutica mais utilizada em 24.830 pessoas para o tratamento, seguida de radioterapia com 2.796, combinação de duas modalidades (quimio e radio) com 66 e cirurgia em 68 pessoas para tratamento. Dentro do período em estudo, observa-se um aumento no número total de diagnósticos novos, em 2013 houve um total de 2.325 diagnósticos e em 2022 um salto para 3.322 diagnósticos e no primeiro semestre de 2023 o registro parcial de 731 diagnósticos. Conclusões: A análise do perfil epidemiológico do Mieloma Múltiplo no âmbito nacional, nos últimos dez anos, auxilia aos profissionais de saúde e gestores na alocação de recursos em saúde conforme disparidades regionais, buscando o diagnóstico precoce e tratamento em tempo oportuno conforme legislação, podendo reduzir a morbidade relacionada a doença e promoção da saúde para a população em geral.

Introdução: O transplante de medula óssea é um procedimento complexo e de alto custo que possibilita sobrevida e/ou cura de pessoas com doenças hematológicas e onco hematológicas. Nos últimos anos houve um aumento no número de centros transplantadores em todo o país, sendo o tratamento ofertado tanto na rede pública como na rede privada de saúde no país. Objetivo: Descrever o perfil epidemiológico do Transplante de Células Tronco Hematopoiéticas (TCTH) autogênico no estado do Ceará no período de 2013 a 2023. Métodos: Estudo descritivo, de abordagem quantitativa. Os dados foram extraídos do Departamento de Informática do Sistema Único de Saúde ‒ DATASUS do período de 2013 a 2023 para o estado do Ceará sobre as internações para os Transplantes de Medula Óssea autólogos de sangue periférico e medula óssea realizados no estado. Resultados: Nos últimos dez anos foram realizados 469 transplantes de medula óssea autólogos no estado do Ceará realizados no período, estes representam um percentual de 73% das internações para TCTH realizados nos últimos 10 anos. Em relação às regiões do país, o nordeste ocupa o terceiro lugar para o período analisado com 2.350 TCTH autólogos. Em relação a fonte de obtenção das células: 424 (90,4%) foram coletadas de sangue periférico por aférese e 45 (9,6%) foram através de punção por agulha, nos ossos da bacia em centro cirúrgico. Conclusões: Portanto, o transplante de medula óssea é um importante procedimento realizado pelo SUS e pela rede privada de saúde no país sendo fundamental conhecer o perfil epidemiológico desse procedimento no estado do Ceará e demais estados para que recursos humanos, logísticos e financeiros sejam alocados de acordo com as necessidades da população de forma equânime.

Introdução: O monitoramento da Doença Residual Mensurável (DRM) tornou-se prática clínica de rotina no tratamento das Leucemias Linfoblásticas Agudas (LLA). A avaliação da DRM tem demostrado fator prognóstico, que permite a atribuição de grupos de risco nos diferentes braços de tratamento, variando desde redução significativa do tratamento a intensificação. Além do uso em pacientes com LLA recaída e pacientes submetidos à transplante de células-tronco, e mais recentemente nos casos de tratamento com células CAR-T. A imunofenotipagem por Citometria de Fluxo Multiparamétrica (CFM) tornou-se uma ferramenta importante no monitoramento na pesquisa da DRM (Doença Residual Mensurável), no monitoramento das células imunes infundidas (CAR) e na avaliação da resposta imunológica pós CAR-T. Relato de dois casos: Paciente 1, masculino, 16 anos. Diagnóstico em 2017 de LLA B. Transplante de medula em 09/2021. Apresentou recaída combinada (medula e sistema nervoso central) pós TMO haploidêntico em 10/2022. DRM pré infusão era de 0,38%. Terapia CAR-T em 17/01/2023. Condicionamento: Fludarabina (FLU) 120 mg/m2 e Ciclofosfamida (CY) 1.000 m2. Intercorrências durante o internamento: febre diariamente de 20/01 a 24/01 e Hipotensão (83/35), resolvida com uma fase rápida. Grau I na classificação de CRS (síndrome de liberação de citocinas). Não apresentou sinais de neurotoxicidade. Alta no D+10. Necessitou de duas transfusões de plaquetas e uma infusão de imunoglobulina. DRM 30 dias pós CART – negativa. Segue em acompanhamento ambulatorial com DRM negativa. Paciente 2. LLA-B BCR:ABL positivo. Em 2018 troca Imatinibe por Desatinibe devido toxicidade hematológica. E no mesmo ano recaída em SNC e MO. TMO Haploidêntico em 01/2019. Recaída em SNC em 2022. Tratamento com MADIT e radioterapia (24 Gy em 12 frações). DRM pré infusão era negativa. Realizou terapia CAR-T em 02/2023. Condicionamento: Flu 120 mg/m2 e Cy 1.000 m2. Não teve intercorrências durante o internamento (10 dias). Transfusões: zero. Não apresentou sinais de CRS e neurotoxicidade. Citometria de Fluxo: Foi realizada a técnica de lise total e painel de anticorpos monoclonais padrão Euroflow. Citômetro de Fluxo FACS Canto II (BD). Os anticorpos monoclonais utilizados: Painel de anticorpos monoclonais utilizado: CD3, CD10, CD19, CD20, CD22, CD24, CD34, CD38, CD45, CD66c/CD123, CD73/CD304, CD81, CD79a (citoplasma). As DRMs foram negativas nas amostras analisadas nos dias D+30 e D+60 e D+90. Conclusão: O acompanhamento clínico ao diagnóstico e durante a avaliação contínua nas diferentes fases da doença são fundamentais para o êxito no desfecho. A Citometria de Fluxo Multiparamétrica (CFM) é uma ferramenta importante não só no diagnóstico da LLA mas também na avaliação da DRM, através de técnicas e painéis padronizados e o acompanhamento da DRM tem demonstrado a eficácia do tratamento.

Introdução: A Leucemia Aguda Indiferenciada (LAI) é caracterizada pela proliferação clonal de células hematopoiéticas primitivas, por definição, não possui marcadores específicos de linhagem linfoide ou mieloide sendo necessário excluir leucemias de linhagens incomuns como as de células dendríticas plasmo citoides, células NK, basófilos ou mesmo tumores não hematopoiéticos. Portanto o diagnóstico de LAI pode ser complexo e requerer outras análises além da imuno fenotipagem convencional. Dada sua raridade, pouco se sabe sobre sua incidência, sobrevida e manejo ideal. Os pacientes apresentam leucocitose, anemia, contagem variável de plaquetas e uma variedade de sintomas inespecíficos relacionados à hematopoese ineficaz (fadiga, sangramento e hematomas, infecções recorrentes, dor óssea) e/ou envolvimento de locais extramedulares (linfadenopatia, esplenomegalia, hepatomegalia). Relato de caso: Paciente masculino, 7 anos, astenia, 4 dias com febrícula, perda ponderal de 2 Kg. Hemograma externo: Hb: 7,4g/dL; VCM: 77,8fL (2% eritroblastos). Leuco: 4.000 uL; Neutro: 1.080 uL; Plaquetas: 13.000 uL. Exame Físico: Presença de linfonodos palpáveis em cadeia cervical anterior, posterior e supraclaviculares, móveis, fibroelásticos, < 1 cm, baço a 4 cm da borda costal esquerda; fígado a 6 cm da borda costal direita. Exames na admissão: Hb: 10,0 g/dL; VCM 80 fL; Leuco: 4.320 uL; Linf.: 1.666 mm3; Neutro: 648 uL; Blastos: 58,0%; Plt: 38.000 uL. Ferritina: 431 ng/mL; LDH: 269U/L; VHS: 50 mm. Medula óssea com celularidade diminuída, com presença de 55% de blastos de difícil diferenciação morfológica. Alguns blastos de tamanho pequeno e formato regular; núcleo ocupando quase todo o citoplasma, de cromatina frouxa e heterogênea sem nucléolo evidente; outros de tamanho mediano, formato regular; núcleo de formato irregular com cromatina frouxa e heterogênea por vezes com um nucléolo evidente; citoplasma escasso levemente basofílico e finamente granular. A Citometria de Fluxo mostrou no aspirado da MO 58,8% de blastos e na biópsia 67,0%. Positividade para: TdT-/+ nuclear (31,0%), CD15-/+ (58,0%), CD19+/++ heterogêneo, CD24+/++, (50,5%), CD33-/+ (26,6%), CD38++, CD45+/++, CD66c+/++, CD71-/+ (34,0%), CD123-/+ (40,0%), HLA-DR+/++ heterogêneo, NG2 (proteína 7,1)+/++ e negatividade para antígenos citoplasmáticos MPO, CD79, CD22, CD3, IgM e antígenos de membrana: CD3, CD7, CD10, CD11b, CD11c, CD13, CD16, CD22, CD34, CD35, CD36, CD41, CD42a, CD42b, CD56, CD61, CD64, CD105, CD117, IgM, IREM-2. Citogenética: 47, XY, +14/46, XY. Molecular: KMT2A-AFF1 por PCR Inconclusiva. ETV6-RUNX1: Negativo. FISH: KMT2A-AFF1 positivo, BCR:ABL negativo. As alterações cromossomo 10, 17,4 negativas. LCR sem infiltração. O paciente iniciou tratamento com protocolo GBTLI 2021, alto risco, e a Pesquisa de DRM D19 e D49 foram negativas. Técnica lise total Euroflow Positividade: CDD19, CD20, CD22, CD45, CD81, HLA-DR. Negatividade: CD10, CD15, CD34, CD38, CD66c/CD123, NG2 (proteína 7,1). LOD (limit of detection): 0,00086%. LLOQ (lower limit of quantification): 0,0021% e LOD: 0,0017% LLOQ: 0,0045% respectivamente. Conclusão: : Descrevemos um caso de leucemia aguda sem marcadores definidoras de linhagem. O prognóstico da AUL é geralmente ruim, mas tem melhorado ao longo do tempo. A imuno fenotipagem por Citometria de Fluxo Multiparamétrica (CFM) tornou-se uma ferramenta importante no manejo clínico das neoplasias hematológicas, tanto para fins de diagnóstico quanto de monitoramento (Doença Residual Mensurável ‒ DRM).

Introdução: Sarcoma eritroide é uma variante extremamente rara do Sarcoma Mieloide (SM), anteriormente conhecido como sarcoma granulocítico ou cloroma, é uma neoplasia mieloide incomum que consiste em uma proliferação maligna derivada de blastos hematopoiéticos mieloides ocorrendo em um local anatômico diferente da Medula Óssea (MO). O SE pode preceder, seguir ou ocorrer na ausência de leucemia mieloide aguda sistêmica no contexto do diagnóstico ou recidiva em qualquer parte do corpo. O SEjá foi relatado em quase todos os locais anatômicos, mas é mais frequentemente encontrado na pele e tecidos moles, linfonodos e trato gastrointestinal. Relato de caso: Paciente masculino, 7 anos, 20 dias com dor em hipocôndrio, emagrecimento 5 Kg. RX do Tórax com DP ‒ Dreno Tórax e Tomo com massa torácica. Hb: 11 g/dL, VCM 68 fL, Leucócitos 7.310 uL, Linfócitos 7.240, Neutrófilos 4.094 uL, Plaquetas 469.000 uL, LDH 419 U/L, VHS 50 mm. Aspirado bilateral da medula óssea Mielograma e Citometria de Fluxo: Não evidenciaram blastos e/ou células não hematopoiéticas. Biópsia da MO negativa para neoplasia (AP e IH). Biópsia do linfonodo: Segmento de tecido adiposo contendo três linfonodos com histiocitose sinusal de aspecto reacional. AP da biópsia do mediastino: Neoplasia pouco diferenciada, de células redondas e azuis. Citometria de Fluxo do linfonodo: 31,7% de linfócitos B maduros não clonais e 65,2% de linfócitos T de tamanho e complexidade de baixos de fenótipo normal. Os linfócitos T CD3+TCRab+CD4-CD8- estão dentro do valor de referência (menor que 2,5%). Análise normal para pesquisa de clonalidade da TRBC-1 tanto para os linfócitos T CD4 quanto para os linfócitos T CD8. Não foram observadas células CD15/CD30/CD40/CD95 positivas. A Citometria de Fluxo do líquido pleural (660 leucócitos) mostrou 81,9% de células anormais. Positividade para CD36++, CD56-/+ (8,5%), CD71++, CD117++ e negatividade para antígenos citoplasmáticos MPO, CD79, CD3, CD61, antígeno nuclear Miogenina (nuclear) e antígenos de membrana CD3, CD4, CD5, CD7, CD8, CD9, CD10, CD11b, CD14, CD15, CD16, CD19, CD20, CD22, CD30, CD33, CD34, CD35, CD38, CD40, CD42a, CD44, CD45, CD61, CD64, CD73, CD81, CD95, CD99, CD105, CD123, CD271, GD2, Glicoforina A, HLA-DR, IREM-2, NG2 (proteína 7,1), cadeias leves Kappa e Lambda, GD2. Na amostra da biópsia do tumor com 110 leucócitos/uL mostrou 44,5% de células anormais com fenótipo semelhante ao líquido. Sarcoma eritroide? Tumor sólido? LCR sem infiltração. Na sequência a IH mostrou positividade para CD99, Ki-67 (60%) e TdT fraco, MPO positivo focal, E-caderina positivo difuso, Glicoforina A positivo focal. Após 3 meses recebemos amostra da medula óssea, sem infiltração.LOD (limit of detection): 0,00096% e LLOQ (lower limit of quantification): 0,0016%. Iniciado tratamento com protocolo GELMAI, entretanto, com pouca resposta tumoral. Optou-se por ressecção tumoral, laudo de AP com pequenas células redondas e azuis, aguardamos o resultado da imunohistoquímica. Conclusão: Descrevemos um caso de Sarcoma Eritroideque devido a raridade da doença foi possível diagnóstico rápido e preciso através da Citometria de Fluxo (CF) de 8 cores padronizada e com a utilização do painel Euroflow. Esta metodologia, é muito importante para investigar cuidadosamente a presença de celularidade eritroide atípica, mesmo em amostras de líquido e tecido de tumor. A CF fornece rapidamente resultados reprodutíveis e pode ser utilizada como uma ferramenta para diagnosticar de forma rápida e confiável esse tipo de malignidade.

Introdução/objetivo: A Leucemia de Linhagem Ambigua (LLAM) é um evento raro (< 4% das leucemias), e é dividida em: Leucemia Aguda de Fenótipo Misto, Leucemia Aguda Bilinhagem e Leucemia Aguda Indiferenciada. A sobrevida dos pacientes é inferior em relação à outras leucemias agudas. O exame de Citometria de Fluxo (CF) é fundamental no diagnóstico, com critérios bem definidos da OMS para diagnóstico. Os marcadores fundamentais para definição de linhagem são: MPO ou diferenciação monocítica para linhagem mieloide (esterase não específica, CD11c, CD14, CD64, lisozima), CD3 citoplasma ou superfície para linhagem T e associação de CD19 com CD79a, CD22 citoplasmático e CD10 para linhagem B. Iremos descrever relato do diagnóstico clínico e imunofenotípico de um paciente com diagnóstico de LAFM Resultado: Pte sexo masculino, 13 anos, previamente hígido. História de 2 meses com quadro febril intermitente. Coletou hemograma: H 3,9 g/dL Leucócitos 32.040 mm3 34% blastos Plaquetas 4.000 mm3 LDH 574 U/L. Ao exame físico: importante esplenomegalia e linfonodomegalias cervicais. Foi submetido a avalição de medula óssea. Mielograma: sem definição morfológica de linhagem. CF: 46,2% de blastos linfoides T. Fenótipo: CD3+/++, MPO e CD79a negativos, TdT (nuclear) negativo. CD2, CD7, CD13, CD15 (60,6%), CD34, CD45, CD45RA, CD99, CD117, CD123 (28,2%) positivos e CD1a, CD3, CD4, CD5, CD8, CD10, CD11c, CD14, CD16, CD19, CD33, CD44, CD56, CD66c, CD64, CD73/CD304, IREM-2, NG2 (proteína 7,1), TCRab, TCRgd negativos. 24,7% linhagem monocíticas. MPO (28,4%); CD3 e CD79a negativos. TdT (nuclear) negativo. CD2, CD8 (20,0%), CD11c, CD13, CD15 (42,5%), CD14 (72,3%), CD16 (49,0%), CD33, CD44, CD45, CD45RA, CD99, CD123, HLA-DR (66,0%), IREM-2 (79,5%) positivos e CD3, CD4, CD5, CD7, CD1a, CD10, CD19, CD34, CD56, CD66c, CD73/CD304, CD117, NG2 (proteína 7,1), TCRab, TCRgd negativos. Fenótipo compatível com Leucemia Aguda de Linhagem Ambígua/Fenótipo Misto Linfoide T/Mieloide. Citogenética: 46,XY,add(1)(q36),add(6)(q27)/46,XY. Biologia molecular: PCR BCR-ABL, ETV6-RUNX1, KMT2A-AFF1, TCF3-PBX1 Negativos. Iniciou tratamento para LLA-ETP (GBTLI 2021). Durante a indução, apresentou aspergilose fúngica disseminada, com lesões pulmonares, em parênquima cerebral, trombo arterial em perna e trombo intra-cardíaco. Paciente foi submetido a toracotomia aberta para ressecção de trombo e apresentou bom controle da disseminação fúngica com voriconazol. Devido ao quadro infeccioso houve atraso importante nas quimioterapias da indução, entretanto a DRM do D19 e do D49 foram negativas. Atualmente em remissão, segue quimioterapia. Discussão: O diagnóstico de LLAM requer uma ampla avaliação de marcadores pela CF, com atenção aos critérios da classificação da OMS para que o diagnóstico seja correto. A presença de CD3 citoplasmático com CD13, CD 34 e CD117, confirmaram a etiologia de ETP nos blastos linfoides, com clara diferenciação monocítica nos blastos mieloides. Em relação ao tratamento da LFM, não há nenhum estudo prospectivo que defina a melhor abordagem, entretanto é observado um aumento da remissão quando utilizados protocolos para LLA. A indicação de TCTH deve ser individualizada. Conclusão: O diagnóstico das LLAM deve ser feito com cautela e o tratamento deve ser direcionado para cada paciente, avaliando os marcadores positivos e a resposta ao tratamento. Novos estudos são necessários para definir protocolos mais específicos.

Introdução: O câncer é um problema de saúde pública de ordem global. Complicações decorrentes da doença e do tratamento relacionadas a déficit de autocuidado são eventos preveníveis e passíveis de intervenção por parte dos profissionais que prestam assistência à saúde dessa população. Objetivos: Relatar a experiência de residentes em onco hematologia e alunos de mestrado em promoção da saúde em uma atividade educativa sobre autocuidado com foco na promoção da saúde e pacientes onco hematológicos. Métodos: Estudo descritivo, relato de experiência, ocorrido em junho de 2023 em um ambulatório de quimioterapia de um hospital de ensino em Fortaleza (CE). A estratégia educativa teve como referencial teórico a teoria do autocuidado de Dorothea Orem. Resultados: A atividade foi construída e realizada por enfermeiros, um residente multiprofissional em onco hematologia e uma mestranda do Programa de Pós-graduação em Promoção da Saúde. Participaram da atividade cerca de 25 pessoas entre pacientes e acompanhantes. Homens e mulheres, jovens e idosos que estavam na sala de espera para consulta médica ou administração de tratamento quimioterápico. Foi utilizado um baú construído pelos autores que contém objetos que remetem ao autocuidado como: copo de água, protetor solar, álcool gel, medicamento, termômetro, dentre outros. A atividade teve duração de uma e meia, sendo realizada de forma dialogada de acordo com que os objetos fossem retirados do baú. Houve participação dos pacientes com comentários adicionais e tira dúvidas. Ao final foi realizado jogo sobre mitos e verdades com plaquinhas temáticas para avaliar o aprendizado dos participantes, sendo exemplo de uma das perguntas formuladas pelos pesquisadores: Beber bastante água e líquidos durante o dia ajuda no tratamento? Ao todo, foram feitas cinco perguntas. Foi possível verificar que a maior parte dos participantes acertou as perguntas. Conclusão: Estratégias diferenciadas de educação em saúde para promoção do autocuidado aos pacientes onco hematológicos com o baú do autocuidado são importantes ferramentas de promoção do autocuidado e prevenção de possíveis complicações relacionadas ao contexto oncológico, sendo uma estratégia de baixo custo e impacto positivo no público alvo contribuindo para sensibilizar público alvo a implementar mudanças nos hábitos de vida, gerando impacto a curto, médio e longo prazo na saúde.

Objectives To compare the accuracy of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Scores in predicting mortality among intensive care unit (ICU) patients with sepsis in a low-income and middle-income country.Design A multicentre, cross-sectional study.Setting A total of 15 adult ICUs throughout Vietnam.Participants We included all patients aged ≥18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 to 23:59 of the specified study days (ie, 9 January, 3 April, 3 July and 9 October of the year 2019).Primary and secondary outcome measures The primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality).Results Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA Score (areas under the receiver operating characteristic curve (AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5; PAUROC

BackgroundSARS-CoV-2 Delta variant caused a large number of COVID-19 cases in many countries, including Vietnam. Understanding mortality risk factors is crucial for the clinical management of severe COVID-19.MethodsWe conducted a retrospective study at an intensive care center in Ho Chi Minh City that urgently built by Bach Mai Hospital during the COVID-19 outbreak in Vietnam, when the Delta variant predominated. Participants were laboratory-confirmed patients with SARS-CoV-2 infection, admitted in August 2021. Data on patients' demographic and clinical characteristics, radiographic and laboratory findings, treatment, and clinical time course were compared between survivors and non-survivors. Risk factors to mortality were assessed using logistic regression.ResultsAmong 504 eligible COVID-19 patients, case fatality was 52.2%. Unvaccinated patients accounted for 61.2% of non-survivors and 43.6% of survivors (p < 0.001). The time from onset to hospital admission was 8 days in non-survivors and 7 days in survivors (p = 0.004). Among non-survivors, 90.2% developed acute respiratory distress syndrome (ARDS). Oxygen therapy was administered for all patients, but antiviral agent was given to 51.7% of non-survivors. 54.2% of non-survivors tested positive for the bacterial infection using blood culture. The risk factors for mortality were diabetes mellitus, respiration rate, oxygen saturation, vaccination status, time from onset to admission, and older age.ConclusionsCritical patients with COVID-19 owing to the Delta variant in Vietnam had delayed hospital admission, leading to ARDS and death. Early availability of vaccines and preventing bacterial infections are crucial for reducing mortality of COVID-19, especially in low- and middle-income countries.

BackgroundEvaluating the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) who may be at risk of poor outcomes using grading systems is one way to make a better decision on treatment for these patients. This study aimed to compare the accuracy of the modified World Federation of Neurosurgical Societies (WFNS), WFNS, and Hunt and Hess (H&H) Grading Scales in predicting the outcomes of patients with aSAH.MethodsFrom August 2019 to June 2021, we conducted a multicenter prospective cohort study on adult patients with aSAH in three central hospitals in Hanoi, Vietnam. The primary outcome was the 90-day poor outcome, measured by a score of 4 (moderately severe disability) to 6 (death) on the modified Rankin Scale (mRS). We calculated the areas under the receiver operator characteristic (ROC) curve (AUROCs) to determine how well the grading scales could predict patient prognosis upon admission. We also used ROC curve analysis to find the best cut-off value for each scale. We compared AUROCs using Z-statistics and compared 90-day mean mRS scores among intergrades using the pairwise multiple-comparison test. Finally, we used logistic regression to identify factors associated with the 90-day poor outcome.ResultsOf 415 patients, 32% had a 90-day poor outcome. The modified WFNS (AUROC: 0.839 [95% confidence interval, CI: 0.795-0.883]; cut-off value≥2.50; PAUROCConclusionsIn this study, the modified WFNS, WFNS, and H&H scales all had good discriminatory abilities for the prognosis of patients with aSAH. Because of the better effect size in predicting poor outcomes, the modified WFNS scale seems preferable to the WFNS and H&H scales.

Recently, bio-based materials that are both environmental-friendly and highly functional were synthesized from various waste and biomass. Rice straw, a by-product of paddy production, is abundant lignocellulosic biomass with high cellulose content. The utilization of this natural resource for high functional material often meets with difficulties due to a large amount of lignin and silica present in the material matrix. While rice straw has been employed for biofuel production on pilot scale, its use for cellulose recovery has only been performed in laboratory-scale equipment. Here we show a simple process to effectively recover cellulose from rice straw on a pilot scale, after which the extracted cellulose was used for the preparation of aerogel. The alkali pretreatment removed the majority of lignin and silica, yielding semi-product with cellulose content of 73 %, then the bleaching step with hydrogen peroxide further eliminated colored impurities to increase the cellulose content to 90 %. The obtained cellulose was then employed to fabricate cellulose aerogel with low density, high surface area, and porous structure, which showed a good performance in the separation of oil and water, with the maximum capacity reaching 21.7 g/g. The process is a promising solution for converting rice straw into a more valuable product for water treatment on a larger scale.

Oil-based plastics, a popular material in the packaging industry with inexpensive and long-lasting durability, have become a significant threat to the ecosystem due to their single-use, recalcitrant nature. Therefore, finding biodegradable plastic to replace oil-based plastics has attracted more interest. Nanocellulose and chitosan, an abundant polymer in nature, have remarkable properties such as biodegradability, bioavailability, and biocompatibility. Both materials can be produced from low-cost sources such as lignocellulosic biomass and crustacean waste, respectively. Hence, in this study, nanocellulose from agro-waste and chitosan from shrimp waste were combined to create a biofilm food packaging. The biofilms were characterized using FTIR, TGA, SEM, while the physical properties of the biofilm demonstrated the role of nanocellulose in biofilm reinforcement. As a result, PVA/CS/CNC film exhibited tensile strength up to 18.25 MPa and water resistance up to 160 % compared to the control sample. This biodegradable film offers a potential alternative to synthetic materials like food packaging.

Nanocellulose is one of the most valuable biomass-derived materials, possesses outstanding properties, and is widely used in numerous applications for biomedical fields, packaging, and environmental waste treatment. Rice straw is an abundant by-product from the rice industry and among cellulose-rich feedstocks. The pristine structural network of this raw material is complicated composing cellulose, hemicellulose, and lignin. Therefore, the pretreatment step is necessary to facilitate further stages in the biomass conversion process. The effect of such methods on the characteristics of nanocellulose products from rice straw has not been widely investigated in comparison with other types of biomass. This review summarized the common methods for rice straw pretreatment and the effects of distinct methods on the obtained nanocellulose. Alkaline pretreatment is considered as one of the most effective method for the extraction of cellulose from lignocellulosic complex. Based on a comprehensive summary, this review also shows that cellulose nanocrystals (CNCs) which is usually isolated by acid hydrolysis, has a high crystallinity index due to the removal of amorphous region. Cellulose nanofibrils (CNFs) is obtained by employing mechanical methods to reduce the particle size of cellulose fibers.

Solid waste treatment is a major concern all around the world, especially in developing countries. Unlike plasticand metals, organic waste is invaluable and requires a high cost for treatment. Black Soldier Fly (BSF) is a novel option since not only provides waste treatment solutions but also converts organic waste into high-economic products. An in-depth understanding of this species must be required for researchers who are looking for alternative processes as well as scaling up for larger plants or commercial purposes. In this review, the valorization of BSF at different life stages has been successfully developed. After treating organic waste, the frass of BSF has been seen as an organic fertilizer. Due to the highest lipid content (47.65 %) in prepupae stages, they are used for biodiesel production. The protein content is highest in the larva stage, so it is a lower-cost replacement for conventional animal feed. Since the chitin content in BSF’s cuticles makes up to 40 %, prepupae and cocoons can be seen as promising sources of chitin.

Abstract Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122–0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083–1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621–12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445–10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318–6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126–0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

Abstract Background The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). Methods NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) – Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. Results Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3–3.3) in rural public to 9.0% (95% CI; 6.2–13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. Conclusion Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Abstract Background Acute respiratory tract infection (ARI) is a leading cause of hospitalization, morbidity, and mortality worldwide. Respiratory microbes that were simultaneously detected in the respiratory tracts of hospitalized adult ARI patients were investigated. Associations between influenza A(H1N1)pdm09 virus (H1N1pdm) detection and intensive care unit (ICU) admission or fatal outcome were determined. Methods This prospective observational study was conducted between September 2015 and June 2017 at Bach Mai Hospital, Hanoi, Vietnam. Inclusion criteria were hospitalized patients aged ≥15 years; one or more of symptoms including shortness of breath, sore throat, runny nose, headache, and muscle pain/arthralgia in addition to cough and fever > 37.5 °C; and ≤ 10 days from the onset of symptoms. Twenty-two viruses, 11 bacteria, and one fungus in airway specimens were examined using a commercial multiplex real-time PCR assay. Associations between H1N1pdm detection and ICU admission or fatal outcome were investigated by univariate and multivariate logistic regression analyses. Results The total of 269 patients (57.6% male; median age, 51 years) included 69 ICU patients. One or more microbes were detected in the airways of 214 patients (79.6%). Single and multiple microbes were detected in 41.3 and 38.3% of patients, respectively. Influenza A(H3N2) virus was the most frequently detected (35 cases; 13.0%), followed by H1N1pdm (29 cases; 10.8%). Hematological disease was associated with ICU admission (p

Background The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. Methods We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. Results Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). Conclusion In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. Clinical trial registration Clinical trials registry–India: CTRI/2019/01/016898