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Objetivo. Comparar la percepción de la calidad de vida relacionada con la salud (CVRS) tras la COVID-19 en función del sexo. Metodología. Estudio observacional descriptivo y transversal en pacientes post-COVID de neumología-medicina interna del Complejo asistencial de Zamora, diagnosticados de COVID-19 al menos 3 meses antes. La CVRS se valoró mediante el cuestionario EQ-5D-5L. Resultados. Se incluyeron 192 pacientes, 91 mujeres (47,4 %), edad 57±13 años. 127 pacientes (66,0%) reflejaron un EQ-5D Index < 1, lo que supone una merma en su CVRS. En el análisis comparativo en función del sexo, las mujeres manifestaron mayor dificultad para las actividades cotidianas (38 [41,3%] vs. 22 [21,6%]; p=0,003), dolor/malestar de forma habitual (50 [54,3%] vs. 35 [34,3%]; p=0,005) y ansiedad/depresión (48 [52,2%] vs. 38 [37,3%]; p=0,037). La Escala Visual Analógica (EVA) fue mayor en hombres (69,8±18,7 vs. 63,1±19,5; p=0,016), así como el EQ-5D Index (0,84±0,22 vs. 0,76±0,25; p=0,023). La regresión lineal multivariante confirmó que las mujeres tenían una peor autopercepción de la CVRS independientemente del resto de factores analizados, tanto en el EQ-5D Index [b (IC95%): -0,090 (-0,153 a -0,026)] como en la EVA [b (IC95%): -6,858 (-12,083 a -1,633)]. Discusión. El sexo femenino es un factor de riesgo significativo para una peor calidad de vida auto percibida en pacientes que han pasado la COVID-19, con mayor incidencia de ansiedad, depresión, dolor y limitaciones en actividades cotidianas. Estos problemas fueron más prevalentes en mujeres, quienes mostraron diferencias significativamente menores en el índice EQ-5D y la escala EVA en comparación con los hombres. ABSTRACT Objective. To compare the health-related quality of life perception (HRQoL) after COVID-19 according to sex. Methodology. Cross-sectional study in post-COVID patients attending neumology and internal medicine consultation rooms at Complejo Asistencial de Zamora, diagnosed from COVID-19, at least 3 months before. HRQoL was evaluated using the EQ-5D-5L questionnaire. Results: 192 patients were included, 91 women (47,4 %), aged 57±13. 127 patients (66,0%) obtained EQ-5D Index < 1, what means a decrease in their HRQoL. Comparative analysis according to sex showed women had higher difficulties for daily activities (38 [41,3%] vs. 22 [21,6%]; p=0,003), usual pain/discomfort (50 [54,3%] vs. 35 [34,3%]; p=0,005), anxiety/depression (48 [52,2%] vs. 38 [37,3%]; p=0,037). Visual Analogue Scale (VAS) was higher among men (69,8±18,7 vs. 63,1±19,5; p=0,016), as well as EQ-5D Index (0,84±0,22 vs. 0,76±0,25; p=0,023). Multivariate linear regression confirmed women had a worse HRQoL perception with independence of the rest of the analyzed factors, in EQ-5D Index [b (IC95%): -0,090 (-0,153 a -0,026)] as well as VAS [b (IC95%): -6,858 (-12,083 a -1,633)]. Discussion: Female sex is a significative risk factor for a worse self-perceived quality of life in patients who had suffered from COVID-19, with a high incidence of anxiety, depression, pain, and limitations for daily activities. These problems were more prevalent in women, who showed significant lower differences in the EQ-5D index and the VAS scale compared to men.

Immune thrombocytopenia (ITP) is an acquired bleeding disorder observed in the clinical practice. Little is known about its epidemiology in Brazil. The present study was conducted at a hematology referral center which covers a population of over 8 million in 184 municipalities in the state of Ceará. The purpose of this study was to draw a demographic profile of adult ITP patients with regard to sex, age, geographical origin and distribution across the state, and the proportion of secondary ITP. Following ethics committee approval, information was collected with an ad hoc instrument. The sample consisted of 187 adult ITP patients attending the Walter Cantídio University Hospital in 2015. The median follow-up time was 67 months (range: 1 month to 29 years). Female sex (n = 154; 82.35 %) was strongly prevalent in all age brackets, with an overall female/male ratio of 4.7:1. The median age was 41 ± 16.1 with an interquartile range of 29–55.5 years; there was no difference between the genders. Secondary ITP (18/187; 9.6 %) displayed a bimodal distribution and a linear increase between 38 and >68 years of age. The results of this survey on the epidemiology of ITP in Brazil suggest that ethnic and geographical factors may have a great impact on age and sex distribution and on the distribution of secondary ITP.

Background: Person- and family-centered care is one of the recommendations to achieve quality of care and patient safety. However, many health professionals associate the family with insecurity in care. Objective: To analyze, based on nurses’ statements, the advantages and disadvantages of the family’s presence in hospitals for the safety of hospitalized patients. Methods: This was a qualitative interpretative study based on James Reason’s risk model, conducted through semi-structured interviews with 10 nurses selected by convenience. A content analysis was performed using Bardin’s methodology and MAXQDA Plus 2022 software. Results: We identified 17 categories grouped according to the representation of the family in patient safety: The family as a Potentiator of Security Failures (7) and Family as a Safety Barrier (10). Conclusions: The higher number of categories identified under Family as a Safety Barrier shows that nurses see strong potential in the family’s involvement in patient safety. By identifying the need to intervene with and for families so that their involvement is safe, we observed an increase in the complexity of nursing care, which suggests the need to improve nursing ratios, according to the participants.

Carentonosaurus soaresi was recently described in the uppermost middle Cenomanian (Upper Cretaceous) of Casais dos Carecos (Coimbra, western Portugal) based on a diverse set of new material (cervical and dorsal vertebrae) of the Pythonomorpha lizard. The main morphological characteristics observed in the vertebrae used for the diagnosis of this species are the presence of distinct lateral and subcentral foramina, highly laterally projected paradiapophyses beyond the prezygapophyses, a low subrectangular neural spine ornamented with longitudinal grooves, and dorsal vertebrae displaying a sagittal furrow along the ventral surface. Additional diagnostic details observed both in new material and the previously studied vertebrae are described herein, such as the presence of keels in the zygantrum and zygosphene. These and other important morphological characteristics present in the species soaresi are absent in the genotype Carentonosaurus mineaui and in other known Squamata, allowing for the definition of the new genus Segurasaurus.

Objetivos: descrever o perfil epidemiológico e clínico dos pacientes com Linfoma de Hodgkin Clássico (LHc) tratados com o protocolo ABVD (doxorrubicina, bleomicina, vimblastina e dacarbazina) associando-os aos fatores que interferem na mortalidade e na sobrevida global (SG). Metodologia: estudo descritivo e retrospectivo dos pacientes diagnosticados com LHc, atendidos no Hospital Universitário Walter Cantídio (HUWC) no período de 2000 a 2018. As análises univariada e multivariada foram realizadas para estabelecer a associação entre os fatores prognósticos e o desfecho óbito. A SG foi determinada usando o método Kaplan-Meier. Resultados: População com predominância do sexo masculino (50,64%), idade menor ou igual a 45 anos (88,54%), subtipo histológico Esclerose Nodular (EN) (74,52%) e tratamento com ciclos de ABVD (56,37%). Na análise dos fatores preditivos de proteção ao óbito foram significativos, para idade menor ou igual a 45 anos (OR 3,152; IC95% 1,198–8,292; p=0,02), utilização da radioterapia (RT) (OR 0,345; IC95% 0,158-0,753; p=0,008) e a Resposta Completa (RC) (OR 0,090; IC95% 0,038-0,216; p=0,000) ao tratamento. As variáveis que apresentaram associação a uma maior SG estão relacionadas a idade menor ou igual de 45 anos (IC95% 85,61-89,02; p=0,0252), utilização da RT (IC95% 92,37; p=0,0002), RC ao tratamento (IC95% 94,51-95,43; p

Several disarticulated fish scales and a vertebral centrum were collected from the uppermost middle to lowermost upper Cenomanian beds of the vertebrate fossil site of Casais dos Carecos (Baixo Mondego region, Coimbra, West Portugal), corresponding to shallow carbonate and mixed facies (“Unit B”) of the Tentúgal Formation. The taphonomic preservation of these remains is adequate for their detailed taxonomical study. The scales are diagnosable for the species Obaichthys africanus Grande, as each one has a strong spine protruding from the middle of the posterior border in a rostrocaudal direction, a dorsoventral peg and socket, and a small anterodorsal process for articulation of adjacent scales. The sculpture with ganoid ridges and grooves distinguishes the studied remains from those of O. decoratus Wenz and Brito, which display rounded tubercles. The isolated Lepisosteoidea centrum is tentatively attributed to O. africanus as well, as it was found together with the scales, and no other compatible remains were found in the site. The fish material reported here constitutes the first record of O. africanus in the Baixo Mondego region and northern ranges of the Albian–Turonian West Portuguese Carbonate Platform, as well as in the uppermost middle to basal upper Cenomanian of Portugal.

Objetivos: Analisar, nos pacientes com síndrome mielodisplásica (SMD) variante hipoplásica do serviço de transplante de medula óssea, a resposta ao transplante e realizar comparação com os dados do banco de dados Latino-Americano de SMD. Metodologia: Estudo analítico, corte transversal e retrospectivo por análise de prontuários, incluídos todos os pacientes com diagnóstico de SMD submetidos a transplante de medula óssea, avaliação do seguimento pós-transplante, sobrevida global e complicações. Comparação com dados do banco de dados da Sociedade Latino-Americana de SMD. Análise estatística pelo programa JAMOVI e MedCalc. Resultados: Um total de 13 pacientes com SMD receberam transplante de medula óssea alogênico, dos quais 6 apresentavam variante hipoplásica, correspondendo a 46,15%. Comparado aos dados do banco de dados latino-americano, essa porcentagem é de apenas 12,75%. Conclusões: Nosso serviço apresentou uma frequência maior de SMD variante hipoplásica que a descrita na literatura médica, que corresponde a apenas 10-15%. Dos 6 pacientes portadores de SMDh, dois evoluíram a óbito, chegando a 33,3% contra os 13,5% do banco de dados Latino-Americano. Os outros pacientes transplantados encontram-se em remissão até o presente momento com taxa de sobrevida global em 2 anos de 83,3%, apresentando bons resultados comparados à literatura mundial.

Introdução: Síndromes mielodisplásicas (SMD) são um grupo heterogêneo de distúrbios hematopoiéticos clonais que têm maior chance de progressão para Leucemia Mielóide Aguda (LMA). O Transplante Alogênico de Células Tronco Hematopoiéticas (TCTH) representa o tratamento curativo mais efetivo para SMD até o momento. Objetivos: descrever o perfil dos pacientes com SMD, que realizaram TCTH alogênico, no Hospital Universitário Walter Cantídio (HUWC) em Fortaleza, Ceará. Metodologia: estudo retrospectivo observacional e descritivo com onze pacientes com SMD de novo que realizaram TCTH alogênico no período de fevereiro de 2015 a junho de 2018. Resultados: total de onze pacientes, idade ao diagnóstico de dezenove a sessenta e seis anos (média 46 anos). Três pacientes deleção do 5q (duas com alterações adicionais), quatro hipocelulares, um com displasia de múltiplas linhagens (p53 positivo na imunohistoquímica), duas com excesso de blastos tipo 2, uma com sideroblastos em anel (baixo risco). Dez doadores aparentados com fonte das células de sangue periférico e um não aparentado com fonte de medula óssea. Óbitos: uma paciente com excesso de blastos e um paciente com displasia multilinhagem. Conclusão: é possível identificar pacientes com SMD de baixo risco que tenham indicação de TCTH alogênico. Anormalidades citogenéticas adicionais à deleção 5q não tiveram impacto negativo. Também reforçamos a importância prognóstica do p53.

Introduction: Coronavirus disease 2019 (COVID-19) may present with extrapulmonary manifestations, including hematologic changes. Previous studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can interact with the renin-angiotensin system, ultimately causing increased production of angiotensin II. By reporting the cases of previously healthy young adults diagnosed with a hematologic malignancy after experiencing COVID-19, we raise the hypothesis that the SARS-Cov-2 infection could act as a trigger for leukemogenesis in predisposed individuals. Methods: This was a case series performed through extraction of relevant clinical information from the medical records of three patients admitted to our Hematology unit between August 2020 and September 2020. Main Results: Considering the relatively rapid development of cytopenias following recovery from COVID-19, it cannot be ruled out that SARS-Cov-2 played a role in leukemogenesis in those patients. Based on previous in vitro studies, the renin-angiotensin system imbalance induced by SARS-CoV-2 could potentially promote in vivo leukemogenesis through several mechanisms. Conclusion: Despite the advances in pathophysiological and clinical characterization of COVID-19, the consequences of the pandemic to the incidence of hematologic diseases are still to be elucidated. In this context, future dissection of the status of the local bone marrow renin-angiotensin system in leukemogenesis is a clinically relevant basic research area.

Introduction: Due to the pandemic by COVID-19, to ensure the safety of health care and to contain its transmission, restrictive measures were taken to keep families away from hospitalized patients. Such measures have implications. Objective: to analyze, from the speeches of nurses specialized in rehabilitation nursing (EEER), the advantages, disadvantages and contexts of the family's presence in hospitals, in the light of patient safety, in a pandemic context. Methodology: Qualitative interpretative study based on James Reason's risk model, conducted through semi-structured interviews with 6 EEERs chosen for convenience. Content analysis was performed using the Atlas.ti software. and Bardin's methodology. Results: 17 categories were identified, grouped according to the representation of the family in patient safety: 10 categories in the view of the family that potentiates security failures and 7 within the family as a security barrier. Discussion: The EEERs consider the presence of the family as very important for hospitalized patients and for safety care, however, their speeches show that their performance was strongly influenced by the view of the family as a potential disseminator of infection, demonstrating a more negative assessment than positive of this presence for the maintenance of this security, not always supported by the available evidence. Conclusion: Restrictive measures may be contributing to a setback in the provision of care centered on the hospitalized patient's family. However, there is a lack of data at the national level that allows us to understand whether families in Portugal represent a safety risk in hospitalized patients.

Teeth provide information about the evolutionary pathway of an organism, its biology and habitat. This is the case even of fossilized teeth, since they have perdurable biomineralized structures, as biological apatite. The material that has been selected for this study comprises teeth from modern crocodilian individuals and extinct Cretaceous crocodylomorphs from Lo Hueco site. Microanatomy, histochemistry and crystallographic nature of enamel, dentine and cementum have been characterized by Polarized Light Microscopy, SEM-EDS, Confocal Raman Spectroscopy and SR-µXRD. A focus has been made on dentine lamination. In the fossil sample short-period incremental lines show alternate presence of dentinal tubules that has not been described previously either in living or fossil archosaur. This could be related to influence of environmental circadian rhythms in the abundance, size and/or activity of cells depositing dentine in the day-night cycle. Regarding histochemical and crystallographic compositions, the major and mostly unique phase is HA, but in the case of fossil teeth, a secondary phase identified as hematite appears locally between discontinuities of the material. Incremental lines would not be related to variation in chemical composition and furthermore do not present different HA crystallographic nature (different directions of HA or different crystallite sizes) either. Only small intensity oscillations are observed in the fossil sample by SR-µXRD which are compatible with the alternating abundance of dentinal tubules. Crystallinity differences between modern and fossil material, as crystallite size and presence of CO32- groups could be explained by postdepositional processes.

ABSTRACT Post-transplantation lymphoproliferative disease (PTLD) comprises a heterogeneous group of hematolymphoid proliferations resulting from a monoclonal or polyclonal proliferation of lymphoid cells. The clinical presentation varies according to the affected sites. The gastrointestinal tract and the central nervous system are the most common, and constitutional symptoms are frequent. Isolated allograft involvement is rare. We report a case of polyclonal PTLD isolated in the kidney allograft in a patient who received an HLA-identical living donor seven years before. Noteworthy, this patient did not present constitutional symptoms, and his only clinical manifestation was graft dysfunction, expressed by an increase in serum creatinine and mild proteinuria. The diagnosis was performed through renal biopsy, which showed dense lymphoid interstitial infiltrate. The PTLD was polyclonal, unrelated to Epstein-Bar virus (EBV), and it was successfully treated with chemotherapy, reduced immunosuppression, and sirolimus.

O Mieloma Múltiplo (MM) é uma neoplasia hematológica caracterizada pela infiltração de medula óssea por plasmócitos clonais (malignos) e pela produção de uma proteína monoclonal (PM). A doença permanece incurável, embora, nos últimos anos, com o advento de novos tratamentos, tenha-se observado melhoras progressivas nas taxas e duração da remissão, traduzindo-se por um aumento na sobrevida dos pacientes acometidos. Portanto, esse trabalho tem como objetivo descrever o protocolo de tratamento do serviço de hematologia de um hospital universitário.

Accessible palaeontological sites conform highly adequate out-of-school environments for meaningful learning experiences regarding formal and non-formal teaching of geosciences. With a perspective of international cooperation, two correlative Cenomanian–Turonian (Upper Cretaceous) outcrops from the Iberian Peninsula have been chosen as the focus of this project—the sections of Figueira da Foz (Portugal) and Tamajón (Spain)—along with the Palaeontological and Archaeological Interpretation Centre of Tamajón (CIPAT). Virtualization of fossil samples and sites has been undertaken by means of phase-shift scanning, photogrammetry, and small object scanning by structured light and laser triangulation, resulting in three-dimensional virtual models of the main fossil tracks and invertebrate fossil samples. These virtual fossils have allowed the development of transdisciplinary didactic activities for different educational levels and the general public, which have been presented as file cards where the age of participants, objectives, multiple intelligences, European Union key competences, needed resources, development, and further observations are specified. This work aims to contribute to improving the design and development of didactic sequences for out-of-school education at these sites, organizing effective transdisciplinary teaching tools, and developing awareness, values, and responsibility towards geoheritage.

PURPOSE: Limited information is available on multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and non-Hodgkin lymphoma (NHL) management in Latin America. The primary objective of the Hemato-Oncology Latin America (HOLA) study was to describe patient characteristics and treatment patterns of Latin American patients with MM, CLL, and NHL. METHODS: This study was a multicenter, retrospective, medical chart review of patients with MM, CLL, and NHL in Latin America identified between January 1, 2006, and December 31, 2015. Included were adults with at least 1 year of follow-up (except in cases of death within 1 year of diagnosis) treated at 30 oncology hospitals (Argentina, 5; Brazil, 9; Chile, 1; Colombia, 5; Mexico, 6; Panama/Guatemala, 4). RESULTS: Of 5,140 patients, 2,967 (57.7%) had NHL, 1,518 (29.5%) MM, and 655 (12.7%) CLL. Median follow-up was 2.2 years for MM, 3.0 years for CLL, and 2.2 years for NHL, and approximately 26% died during the study observation period. Most patients had at least one comorbidity at diagnosis. The most frequent induction regimen was thalidomide-based chemotherapy for MM and chlorambucil with or without prednisone for CLL. Most patients with NHL had diffuse large B-cell lymphoma (DLBCL; 49.1%) or follicular lymphoma (FL; 19.5%). The majority of patients with DLBCL or FL received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. CONCLUSION: The HOLA study generated an unprecedented level of high-quality, real-world evidence on characteristics and treatment patterns of patients with hematologic malignancies. Regional disparities in patient characteristics may reflect differences in ethnoracial identity and level of access to care. These data provide needed real-world evidence to understand the disease landscape in Latin America and may be used to inform clinical and health policy decision making.

Introduction and objective: In this study, we evaluated the influence of the transcript type on hematological and clinical parameters, as well as the event-free survival of 50 patients in the Chronic myeloid leukemia chronic phase. Methods: We reviewed the medical records of 55 patients with Chronic myeloid leukemia. The eligibility criteria were based on the availability of hematological and clinical baseline data in the medical records. Data on BCR-ABL transcripts were obtained from medical records. Results: Eighteen patients (36%) had the b2a2 transcript, 24 (48%) had b3a2 and 8 (16%) had b2a2/b3a2. The median platelet count for transcripts b2a2, b3a2 and b2a2/b3a2 was 320.65 × 103/L, 396 × 103/L, and 327.05 × 103/L, respectively (p = 0.896). We could not find any differences in relation to the other hematological parameters, when compared to the transcript type. Comparison between spleen and liver size and type of transcript did not differ inside the groups (p = 0.395 and p = 0.647, respectively) and the association between risk scores and transcript type did not show statistical significance (p > 0.05). The 21-month probability for event-free survival was 21%, 48% and 66% for the transcripts b2a2, b3a2 and b2a2/b3a2 respectively (p = 0.226) Conclusion: We conclude that the expression BCR-ABL transcripts have no influence on hematological, clinical and event-free survival parameters of patients in the Chronic myeloid leukemia chronic phase. Keywords: Chronic myeloid leukemia, BCR-ABL, Prognosis

Introdução: Os dados atuais sobre segurança em cuidados de saúde continuam a ser preocupantes pelo que o tema tem sido estudado e avaliado sobre várias vertentes e em diversos domínios. Entre as recomendações para a melhoria da segurança, surge a centralização dos cuidados de saúde no cliente e consequentemente a necessidade de um maior envolvimento do próprio e da família neste processo. É neste âmbito que a Enfermagem poderá desempenhar um papel preponderante. Há teóricos de enfermagem que reconhecem a importância da família e da parceria de cuidados. Contudo, a aceitabilidade e as perceções que os enfermeiros têm desta estratégia são, em alguns estudos, contraditórias e colocam-se questões sobre a segurança do cliente. Objetivos: Analisar a melhor evidência disponível sobre as implicações da presença da família na segurança do cliente internado Métodos: Propõe-se a realização de uma revisão sistemática de acordo com a metodologia do Joanna Briggs Institute para revisões sistemáticas de prevalência e incidência. A estratégia de busca deve ser adaptada a cada banco de dados proposto neste protocolo. A seleção dos estudos atenderá aos critérios de inclusão e exclusão definidos bem como à qualidade metodológica dos mesmos. Conclusões: A partir da análise crítica dos dados obtidos, pretende-se contribuir com conhecimento e argumentos sobre o envolvimento familiar no processo prestação de cuidados hospitalares no âmbito da segurança do doente.

The important paleontological and archaeological discoveries made in Tamajón in recent years have enriched the exceptional natural and cultural heritage of this town in the north of the Guadalajara province (central Spain). The extraordinary educational and outreach value of these findings led the PaleoIbérica Research Group to develop a project for the design and creation of the Paleontological and Archaeological Interpretation Centre of Tamajón (CIPAT, acronym in Spanish). In this new space, students and the general public have access to knowledge of the past of the region through three exhibition and didactic areas and the support of a rigorous and engaging infographic. The Paleontological Area allows visitors to explore, through fossils, replicas, models (real and virtual) and dioramas, the diversity of coastal and marine life that inhabited the region during the Late Cretaceous Age. Moreover, the area highlights crocodylomorphs, dinosaurs and fishes (identified through their fossilized tracks), and the remains of plants and invertebrates. The Archaeological Area shows the origin and uses of the building material known as Tamajón Stone by means of rough or carved samples, tools traditionally used in its extraction and carving, and historical photographs. Furthermore, in the Didactic Area, innovative specific educational activities are carried out, facilitating the knowledge and appreciation of the rich natural and cultural heritage of Tamajón. After its recent inauguration (August 2021), the CIPAT is a valuable tool to encourage the practice of positive attitudes toward geoconservation and to promote the sustainable and socioeconomic development of the region through geotourism.

Abstract Background Myelodysplastic syndromes are heterogeneous disorders. Patients with myelodysplastic syndrome disease often have ineffective hematopoiesis, cytopenias, blood cell dysplasia in one or more cell types, and are at high risk for developing acute myeloid leukemia. In myelodysplastic syndrome, mutations of TP53 gene are usually associated with complex karyotype and confer a worse prognosis. In the present study, two mutations in this gene are presented and discussed with the clinical evolution of the patients. Case presentation The first case is a 77-year-old Brazilian woman diagnosed as having multiple lineage dysplasia myelodysplastic syndrome according to World Health Organization 2016 and classified as very low-risk by Revised International Prognostic Scoring. The second case is an 80-year-old Brazilian man also diagnosed as having multiple lineage dysplasia myelodysplastic syndrome and classified as low risk. The mutation described in the first case was already identified in some neoplasias and it is associated with a poor prognosis, but it had never been reported before in myelodysplastic syndrome. The second mutation has never been described. Conclusions This is a novel report for the scientific community and may be very helpful as we can better understand the disease and the impact of mutations through the follow-up of these patients and others in the future. Both patients are in a good clinical condition, suggesting that these mutations may not alter the clinical course of the disease or may be associated with a good prognosis, but their role in the disease must be investigated more deeply in a larger population.

Infecção respiratória viral é causa significativa de morbi-mortalidade em paciente com doenças hematológicas. Deve ser suspeitado sempre que houver sintomas como coriza, obstrução nasal, odinofagia, tosse e dispnéia e deve-se seguir à identificação viral, quando possível. Os casos podem ser classificados como possível, provável ou confirmado. E observando-se o risco de progressão da infecção para vias aéreas inferiores, o diagnóstico deve ser precoce e as medidas terapêuticas específicas aos vírus bem como medidas de controle da infecção no ambiente hospitalar devem ser prontamente tomadas. O presente trabalho visa descrever um protocolo de manejo da infecção viral de vias respiratórias em pacientes com neoplasia hematológica dentro do Serviço de Hematologia e Transplante de medula do Hospital Universitário Walter Cantídio.

Mixed phenotype acute leukemia is a rare subtype of leukemia that probably arises from a hematopoietic pluripotent stem cell. The co-expression of two of myeloid, B- or T-lymphoid antigens is the hallmark of this disease. Herein, the case of a 28-year-old female patient is reported who presented with hemoglobin of 5.8 g/dL, white blood cell count of 138 × 109/L and platelet count of 12 × 109/L. The differential count of peripheral blood revealed 96% of blasts. Moreover, the patient presented with lymphadenopathy, splenomegaly and bone marrow infiltration by monocytoid blasts characterized as 7% positivity by Sudan Black cytochemical staining. Immunophenotyping revealed the involvement of blasts of both T- and monocytic lineages. The cytogenetic analysis showed an isolated 17p deletion. Thus, the diagnosis of T-cell/myeloid mixed phenotype acute leukemia was made with two particular rare features, that is, the monocytic differentiation and the 17p deletion as unique cytogenetic abnormalities. The possibility of concomitant expressions of T-cell and monocytic differentiation antigens in the same blast population is hard to explain using the classical model of hematopoiesis. However, recent studies have suggested that myeloid potential persists even when the lineage branches segregate toward B- and T-cells. The role of an isolated 17p deletion in the pathogenesis of this condition is unclear. At present, the patient is in complete remission after an allogeneic stem cell transplantation procedure.

BACKGROUND: At the time of diagnosis, more than 50% of patients with myelodysplastic syndrome have a normal karyotype and are classified as having a favorable prognosis. However, these patients often show very variable clinical outcomes. Furthermore, current diagnostic tools lack the ability to look at genetic factors beyond karyotyping in order to determine the cause of this variability.OBJECTIVE: To evaluate the impact of p53 protein expression at diagnosis in patients with low-risk myelodysplastic syndrome.METHODS: This study enrolled 38 patients diagnosed with low-risk myelodysplastic syndrome. Clinical data were collected by reviewing medical records, and immunohistochemical p53 staining was performed on bone marrow biopsies.RESULTS: Of the 38 participants, 13 (34.21%) showed p53 expression in their bone marrow. At diagnosis, this group of patients also presented clinical features characteristic of a poor prognosis more often than patients who did not express p53. Furthermore, patients expressing p53 had a shorter median survival time compared to those without p53 expression.CONCLUSION: This study shows that the expression of p53 at diagnosis is a useful indicator of distinct clinical characteristics and laboratory profiles found in low-risk myelodysplastic syndrome patients. These data indicate that the immunohistochemical analysis of p53 may be a prognostic tool for myelodysplastic syndrome and should be used as an auxiliary test to help determine the best therapeutic choice.

BACKGROUND: Chronic myeloid leukemia is a neoplasm characterized by clonal expansion of hematopoietic progenitor cells resulting from the (9:22)(q34,11) translocation. The tyrosine kinase abl fusion protein,the initial leukemogenic event in chronic myeloid leukemia, is constitutively activated thus inducing the production of reactive oxygen species. Of particular relevance is the fact that an increase in reactive oxygen species can facilitate genomic instability and may contribute to disease progression. OBJETIVE: To evaluate oxidative stress by determining the levels of malondialdehyde and nitrite in chronic myeloid leukemia patients under treatment with 1st and 2nd generation tyrosine kinase inhibitors monitored at a referral hospital in Fortaleza, Ceará. METHODS: A cross-sectional study was performed of 64 male and female adults. Patients were stratified according to treatment. The levels of malondialdehyde and nitrite were determined by spectrophotometry. Statistical differences between groups were observed using the Student t-test and Fisher's exact test. The results are expressed as mean ± standard error of mean. The significance level was set for a p-value < 0.05 in all analyses. RESULTS: The results show significantly higher mean concentrations of nitrite and malondialdehyde in chronic myeloid leukemia patients using second-generation tyrosine kinase inhibitors compared to patients on imatinib. Conclusion: It follows that chronic myeloid leukemia patients present higher oxidative activity and that the increases in oxidative damage markers can indicate resistance to 1st generation tyrosine kinase inhibitors.

Isotopic studies of multi-taxa terrestrial vertebrate assemblages allow determination of paleoclimatic and paleoecological aspects on account of the different information supplied by each taxon. The late Campanian-early Maastrichtian "Lo Hueco" Fossil-Lagerstätte (central eastern Spain), located at a subtropical paleolatitude of ~31°N, constitutes an ideal setting to carry out this task due to its abundant and diverse vertebrate assemblage. Local δ18OPO4 values estimated from δ18OPO4 values of theropods, sauropods, crocodyliforms, and turtles are close to δ18OH2O values observed at modern subtropical latitudes. Theropod δ18OH2O values are lower than those shown by crocodyliforms and turtles, indicating that terrestrial endothermic taxa record δ18OH2O values throughout the year, whereas semiaquatic ectothermic taxa δ18OH2O values represent local meteoric waters over a shorter time period when conditions are favorable for bioapatite synthesis (warm season). Temperatures calculated by combining theropod, crocodyliform, and turtle δ18OH2O values and gar δ18OPO4 have enabled us to estimate seasonal variability as the difference between mean annual temperature (MAT, yielded by theropods) and temperature of the warmest months (TWMs, provided by crocodyliforms and turtles). ΔTWMs-MAT value does not point to a significantly different seasonal thermal variability when compared to modern coastal subtropical meteorological stations and Late Cretaceous rudists from eastern Tethys. Bioapatite and bulk organic matter δ13C values point to a C3 environment in the "Lo Hueco" area. The estimated fractionation between sauropod enamel and diet is ~15‰. While waiting for paleoecological information yielded by the ongoing morphological study of the "Lo Hueco" crocodyliforms, δ13C and δ18OCO3 results point to incorporation of food items with brackish influence, but preferential ingestion of freshwater. "Lo Hueco" turtles showed the lowest δ13C and δ18OCO3 values of the vertebrate assemblage, likely indicating a diet based on a mixture of aquatic and terrestrial C3 vegetation and/or invertebrates and ingestion of freshwater.

OBJECTIVES: To evaluate the effects of epoetin (EPO) alfa treatment on overall survival, event-free survival and response duration in patients with myelodysplastic syndrome (MDS) who were treated at a haematological referral centre in northeastern Brazil. METHODS: This was a retrospective cohort study of 36 patients diagnosed with MDS and treated with EPO alfa at 30,000 to 60,000 IU per week. Clinical data were collected from medical records. The events assessed were non-response to treatment and progression to acute myeloid leukaemia (AML). Statistical analyses were performed using GraphPad Prism 7 and SPSS 24 software. RESULTS: The overall survival of patients who received EPO alfa treatment was 51.64%, with a median of 65 months of treatment, and the overall survival of this group was 100% during the first 24 months. We detected a 43.5-month median event-free survival, with a response rate of 80.5%. We observed responses from 25 to 175 months. Patients with transfusion dependence and those with a high-risk stratification, as determined by the International Prognostic Scoring System (IPSS), the Revised International Prognostic Scoring System (IPSS-R), the WHO classification-based Prognostic Scoring System (WPSS) and the WHO 2016, had a lower event-free survival than other patients. CONCLUSIONS: Despite the wide use of EPO alfa in the treatment of anaemia in patients with MDS, the median response duration is approximately only 24 months. Our data provide encouraging results concerning the benefits of using EPO alfa for the improvement of the quality of life, as patients treated with EPO showed higher overall survival, event-free survival rates and longer response durations than have been previously described in the literature.