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To establish the prevalence of upper airway resistance syndrome (UARS) according to different diagnostic criteria and evaluate its epidemiological characteristics in a representative sample of a large urban center.This was a single-center evaluation involving volunteers from EPISONO, an epidemiological study focused on sleep disturbances and related factors in adults from São Paulo, Brazil in 2007.Considering the diagnostic criteria for UARS to be an apnea-hypopnea index of5 events/h, minimum SpOAlthough the diagnostic criteria for UARS, or even its existence as a syndrome, are still a subject of debate in the literature, the findings from this epidemiological study highlights UARS as a non-hypoxic sleep-disordered breathing condition with a significant prevalence in the general population, being more frequent among female young adults.

Background: Transcranial Doppler (TCD) is a noninvasive bedside tool for intracerebral hemodynamic assessments in multiple clinical scenarios. TCD, by means of measuring systolic and diastolic blood velocities allows the calculation of the pulsatility index (PI), a parameter that is correlated with intracranial pressure (ICP). Nevertheless, the predictive value of the PI for raised ICP appears to be low, since it is subjected to several, often confounding factors not related to ICP. Recently, the Pulsatile Apparent Resistance (PaR) was developed as a PI corrected for arterial blood pressure, reducing some of the confounding factors influencing PI. This study compares the predictive value of PaR versus PI for intracranial hypertension (IH, ICP >20 mmHg) in patients with traumatic brain injury (TBI). Methods: Patients with TBI admitted to the neurocritical care unit who required invasive ICP were included prospectively within five days of admission. TCD measurements were performed in both middle cerebral arteries, allowing calculations of the PI and PaR. The discriminative power of these parameters for ICP ≥20 mmHg was assessed by calculating the area under the Receiver Operator Characteristics curve (AUC). Results: 93 patients were included. A total of 20 (22%) patients experienced IH. The discriminative power was low for PI (AUC 0.64, 95% Confidence Interval (CI) 0.49 – 0.79) and moderate for PaR (AUC 0.75, 95% CI 0.63 – 0.86). With regard to subgroup analyses, the discriminative power of these parameters increased after exclusion of patients who had undergone a craniectomy. This was especially true for the PaR (AUC right side 0.88; CI 0,72 – 1,0) and PI (AUC right side 0.72; CI 0,44 – 1,0). Conclusion: In the present study, discriminative power of the PaR for IH was superior to the PI, especially in patients not having undergone craniectomy. The assessment of PaR may be an adjunct especially for improving timing on a neurosurgical intervention, but also for their monitoring after a neurosurgery is performed. Further studies are warranted to define its clinical application. Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219

Sergio Tufik,1 Monica Levy Andersen,1 Daniela Santoro Rosa,2 Sergio Brasil Tufik,1 Gabriel Natan Pires1 1Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; 2Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, BrazilCorrespondence: Gabriel Natan Pires, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, CEP: 04024-002, Brazil, Email gnspires@gmail.com; Gabriel.Pires@sono.org.brIntroduction: Previous studies have linked sleep disturbances (including sleep deprivation and obstructive sleep apnea) to an impairment in immune response after vaccination for several diseases, although it has not yet been tested for COVID-19. This study sought to evaluate the effects of obstructive sleep apnea on anti-SARS-CoV-2 IgG levels after vaccination against COVID-19 among older adults.Methods: The study was based on a convenience sample of inpatients who underwent full night type-I polysomnography. Inclusion criteria included being ≥ 60 years with full COVID-19 vaccination schedule. Exclusion criteria included previous COVID-19 diagnosis (assessed via self-report), less than 15 days between last dose and IgG testing, self-report of continuous positive air pressure (CPAP) use in the last three months, having undergone CPAP or split-night polysomnography, or incomplete/invalid data.Results: Out of 122 included patients (no/mild OSA: 35; moderate: 31; severe: 56), 9.8% were considered seronegative for the IgG anti-SARS-CoV-2 test (IgG count< 50.0 AU/mL), and the median IgG levels for the whole sample was 273 AU/mL (IQR: 744), with no statistically significant differences among OSA severity groups. There was neither association between OSA severity and IgG serostatus nor correlation between IgG levels and apnea-hypopnea index. A linear regression model to predict IgG levels was built, produced an R2 value of 0.066 and the only significant predictor was time from vaccination to testing; while OSA severity was considered non-significant.Discussion: Our results demonstrate that the severity of OSA is not correlated with a decrease in anti-SARS-CoV-2 IgG levels among older adults, and that the efficiency of COVID-19 vaccinations are not reduced from mild to severe OSA.Keywords: sleep, sleep apnea syndrome, COVID-19, SARS-CoV-2, vaccination

Lymphomas are a large, heterogeneous and infrequent group of neoplasms. Peripheral t-cell lymphomas (PTCL) is still rarer, and it makes up about 10-15% of lymphoid malignancies. Its prognosis is poor and remains a challenge. In April 2017, the first Brazilian collaborative effort was created to collect data from T-cell Lymphoma patients diagnosed in the five distinct macro-regions of Brazil. To better understand PTCL, according to the revised WHO-2017 classification, excluding Mycosis fungoides, Sézary syndrome, and chronic Lymphoproliferative disorders, all histological subtypes diagnosed from January 2015 to December 2022 will be enrolled. Tissue biopsied, immunophenotypic markers from consecutive patients at each site will be reviewed by panels of expert hematopathologists every year. So far, 381 cases were enrolled by 32 Brazilian centers, most of them are from the Southeast and South region. Twenty-two cases were not evaluable due to lack of complete data; hence, 359 were analyzed. The overall survival at 24-month was 52% (95% CI: 46-58%) and progression-free survival 37% (95% CI: 31-43%) with a median time of follow-up of 10 months (0.2-64). T-cell Brazil Project has many challenges to overcome, mainly due to its vast territory and its disparity. However, we already have another sixteen centers waiting for approval in their Ethics Committees. It was created a network around the country, mainly among the pathologists, with educational goals and exchange of experiences. It is crucial to obtain knowledge of local epidemiology to optimize resources, design clinical trials, and identify minority entities, contributing to increasing the quality o

Objective T-cell Brazil Project was designed as an ambispective data collection from January 2015 to December 2022 of previously untreated patients diagnosed with Peripheral T-cell lymphoma (PTCL) or NK/T-cell lymphoma according to the revised WHO 2017 classification in Brazil. The primary and secondary end points were 2-year overall survival (OS) and progression-free survival (PFS). Clinical, treatment and survival data were also correlated. Methodology Twenty centers got approved for the study from the local and national institutional review board and registered their cases only online. OS was calculated from diagnosis date until last seen or death date, whereas PFS until first event, progression / relapse, date of death or last seen. Kaplan-Meier method was applied and a Log-rank test to compare their curves. P-value less than 5% was considered. From a total of 416 patients with PTCL, 46 (11%) were diagnosed as AITL. Results The median age was 65 years (31-82), with 63% males, 94% had advanced-stage disease. All patients received 61% CHOEP, 28% CHOP and 11% CT without anthracycline. 20% of pts were consolidated with autologous transplant (HSCT). There were 19 (41%) deaths, 10 by lymphoma, 8 infections, 1 new neoplasia. With 8-mo median f/u (1-36), OS at 24-mo was 27% and 2-year PFS was 21%. As consolidation, OS was 71% HSCT group vs. 16% no HSCT (P= 0.06) and PFS was 71% vs. 8%, respectively (P= 0.01). Conclusion These analyses are preliminaries but show a poor outcome of AITL in our population. Most patients were treated with anthracycline-containing combination chemotherapy and just 20% received autologous HSCT. A dismal survival was shown for those who did not receive HSCT.

Brain death (BD) is characterized by a complex inflammatory response, resulting in dysfunction of potentially transplantable organs. This process is modulated by cytokines, which amplify graft immunogenicity. We have investigated the inflammatory response in an animal model of BD and analyzed the effects of thalidomide, a drug with powerful immunomodulatory properties.BD was induced in male Lewis rats. We studied three groups: Control (sham-operated rats) (n = 6), BD (rats subjected to brain death) (n = 6) and BD + Thalid (BD rats treated with one dose of thalidomide (200 mg/Kg), administered by gavage) (n = 6). Six hours after BD, serum levels of urea and creatinine, as well as systemic and renal tissue protein levels of TNF-α and IL-6, were analyzed. We also determined the mRNA expression of ET-1, and macrophage infiltration by immunohistochemistry.BD induced a striking inflammatory status, demonstrated by a significant increase of plasma cytokines: TNF-α (2.8 ± 4.3 pg/mL [BD] vs. 9.4 ± 2.8 pg/mL [Control]), and IL-6 (6219.5 ± 1380.6 pg/mL [BD] vs. 1854.7 ± 822.6 pg/mL [Control]), and in the renal tissue: TNF-α (2.5 ± 0.3 relative expression [BD] vs. 1.0 ± 0.4 relative expression [Control]; p 0.05), and IL-6 (4.0 ± 0.4 relative expression [BD] vs. 1.0 ± 0.3 relative expression [Control]; p 0.05). Moreover, BD increased macrophages infiltration (2.47 ± 0.07 cells/field [BD] vs. 1.20 ± 0.05 cells/field [Control]; p 0.05), and ET-1 gene expression (2.5 ± 0.3 relative expression [BD] vs. 1.0 ± 0.2 relative expression [Control]; p 0.05). In addition, we have observed deterioration in renal function, characterized by an increase of urea (194.7 ± 25.0 mg/dL [BD] vs. 108.0 ± 14.2 mg/dL [Control]; p 0.05) and creatinine (1.4 ± 0.04 mg/dL [BD] vs. 1.0 ± 0.07 mg/dL [Control]; p 0.05) levels. Thalidomide administration significantly reduced plasma cytokines: TNF-α (5.1 ± 1.4 pg/mL [BD + Thalid] vs. BD; p 0.05), and IL-6 (1056.5 ± 488.3 pg/mL [BD + Thalid] vs. BD; p 0.05), as well as in the renal tissue: TNF-α (1.5 ± 0.2 relative expression [BD + Thalid] vs. BD; p 0.05), and IL-6 (2.1 ± 0.3 relative expression [BD + Thalid] vs. BD; p 0.05). Thalidomide treatment also induced a significant decrease in the expression of ET-1 (1.4 ± 0.3 relative expression [BD + Thalid] vs. BD; p 0.05), and macrophages infiltration (1.17 ± 0.06 cells/field [BD + Thalid] vs. BD; p 0.05). Also thalidomide prevented kidney function failure by reduced urea (148.3 ± 4.4 mg/dL [BD + Thalid] vs. BD; p 0.05), and creatinine (1.1 ± 0.14 mg/dL [BD + Thalid] vs. BD; p 0.05).The immunomodulatory properties of thalidomide were effective in decreasing systemic and local immunologic response, leading to diminished renal damage, as reflected in the decrease of urea and creatinine levels. These results suggest that use of thalidomide may represent a potential strategy for treating in BD kidney organ donors.

Nesta dissertação, inserido no amplo espectro de temáticas que compõem a educação, tem-se como objeto de estudo o Plano Municipal de Educação – PME do município de São Borja-RS, política pública majoritária cujos benefícios podem ser usufruídos por toda a coletividade, tendo custos, também, arcados por todos. A Lei Municipal nº 5.039, de 1º de julho de 2015, que aprova o PME, tem vigência por dez anos e, neste período (de 2015 a 2025), pretende alterar o status quo, no que se refere à educação oferecida em âmbito local. Tal pretensão instigou a responder ao seguinte problema: “Qual a efetividade (impacto) do PME para a melhoria da qualidade da educação no município de São Borja-RS?” A fim de elucidar esse questionamento, delineou-se um objetivo geral, qual seja: “Avaliar o Plano Municipal de Educação – PME de São Borja-RS, no período compreendido entre 2015 e 2019”. Visando atingir esse objetivo desenvolveu-se uma pesquisa aplicada, na qual se utilizaram as pesquisas qualitativa e quantitativa combinadas para abordar o problema e, devido à necessidade de explicitá-lo, optou-se pela pesquisa exploratória do tipo estudo de caso, cujo desenvolvimento deu-se por meio de uma avaliação in itinere (acompanhamento/monitoramento), tendo como procedimento para a coleta de dados o levantamento bibliográfico. Também, fez-se necessário lançar mão de dados secundários das bases do Ministério da Educação – MEC, do Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira – INEP e do Instituto Brasileiro de Geografia e Estatística – IBGE, entre outros. Outrossim, com relação à avaliação in itinere do PME de São Borja-RS, propriamente dita, destaca-se a utilização da “Ficha de Monitoramento do Plano Municipal de Educação” proposta pelo MEC para a apreciação da execução das estratégias e dos indicadores utilizados pelo INEP para monitorar o Plano Nacional de Educação – PNE, conforme o “Relatório do 2º Ciclo de Monitoramento das Metas do Plano Nacional de Educação – 2018”. No desenvolvimento da dissertação, abordam-se, principalmente, duas etapas do ciclo de políticas públicas: a execução e o acompanhamento, as quais são apresentadas de dois modos distintos: um teórico e um prático. O referencial teórico destaca a execução, como a realização efetiva da política, e o acompanhamento, como um processo de supervisão do andamento das atividades estratégicas, bem como de mensuração de resultados em relação às metas estabelecidas. A avaliação in itinere, uma das atividades práticas inerentes ao profissional de políticas públicas, evidencia o monitoramento do PME do município de São Borja-RS cujos resultados mais relevantes apontam que, do total de 20 metas, somente cinco foram alcançadas. São elas: meta 9 – Alfabetização (15 anos ou mais), meta 13 – Ensino superior (proporção de mestres e doutores), meta 14 – Pós-graduação, meta 18 – Educação básica (planos de carreira e piso salarial) e meta 19 – Gestão democrática. Quanto à execução das estratégias relacionadas as 20 metas do PME, verifica-se que, de um total de 240 estratégias, apenas 30 (12,5%) foram executadas com êxito, outras 97 (40,4%) foram atingidas parcialmente e 111 (46,3%) não foram alcançadas, além de duas estratégias (0,8%) consideradas impossíveis de serem avaliadas. Por fim, nas considerações finais, em virtude de diversas correções que se fazem necessárias, argumenta-se sobre a necessidade premente de retificação do PME do município ou, até mesmo, de revogação da Lei Municipal 5.039/2015, com a devida substituição por um novo Plano que contenha um texto mais adequado, no sentido de apresentar metas e estratégias factíveis, devendo estar em consonância com o PNE, mas considerando a realidade local. In this dissertation, inserted in the broad spectrum of themes that make up education, the object of study is the Municipal Education Plan - PME of the municipality of São Borja-RS, a majority public policy whose benefits can be enjoyed by the whole community, having costs, too, borne by all. Municipal Law nº 5,039, of July 1, 2015, which approves the PME, is in force for ten years and, in this period (from 2015 to 2025), intends to change the status quo, with regard to education offered at the local level. This claim prompted the response to the following problem: “What is the effectiveness (impact) of the PME for improving the quality of education in the municipality of São Borja-RS?” In order to elucidate this questioning, a general objective was outlined, namely: “To evaluate the Municipal Education Plan - PME of São Borja-RS, in the period between 2015 and 2019”. In order to achieve this objective, an applied research was developed, in which combined qualitative and quantitative research were used to address the problem and, due to the need to explain it, the exploratory research of the case study type was chosen, through an in itinere evaluation (follow-up/monitoring), using the bibliographic survey as a procedure for data collection. Also, it was necessary to make use of secondary data from the databases of the Ministry of Education - MEC, the National Institute of Educational Studies and Research Anísio Teixeira - INEP and the Brazilian Institute of Geography and Statistics - IBGE, among others. Furthermore, with regard to the on-the-spot evaluation of the SME of São Borja-RS, properly speaking, the use of the “Municipal Education Plan Monitoring Form” proposed by MEC to assess the execution of the strategies and indicators used by the INEP to monitor the National Education Plan - PNE, according to the “Report on the 2nd Cycle of Monitoring the Goals of the National Education Plan - 2018”. In the development of the dissertation, two stages of the public policy cycle are approached: execution and monitoring, which are presented in two different ways: a theoretical and a practical one. The theoretical framework highlights execution, as the effective implementation of the policy, and monitoring, as a process of supervising the progress of strategic activities, as well as measuring results in relation to the established goals. The in itinere evaluation, one of the practical activities inherent to the public policy professional, shows the monitoring of the PME of the municipality of São Borja-RS whose most relevant results indicate that, of the total of 20 goals, only five were achieved. They are: goal 9 - Literacy (15 years or more), goal 13 - Higher education (proportion of masters and doctors), goal 14 - Postgraduate, goal 18 - Basic education (career plans and salary floor) and goal 19 - Democratic management. Regarding the execution of the strategies related to the 20 SME goals, it appears that, out of a total of 240 strategies, only 30 (12.5%) were successfully implemented, another 97 (40.4%) were partially achieved and 111 (46.3%) were not achieved, in addition to two strategies (0.8%) considered impossible to be evaluated. Finally, in the final considerations, due to several corrections that are necessary, it is argued about the pressing need for rectification of the municipality's PME or, even, for the repeal of Municipal Law 5,039/2015, with the due substitution by a new Plan that contains a more appropriate text, in the sense of presenting feasible goals and strategies, which must be in line with the PNE, but considering the local reality.

O projeto político-pedagógico – PPP é um instrumento de gestão democrática e um guia para a organização das atividades administrativas, financeiras e pedagógicas das escolas públicas que deve estar em constante processo de (re)construção coletiva. No entanto, observam-se dificuldades das gestões escolares para obtenção da participação da comunidade escolar nesse processo que pode contribuir para consolidar a gestão democrática e para melhorar a qualidade do ensino. Dada a importância dessa (re)construção, este estudo estabeleceu como objetivo revelar ações/atividades/práticas pedagógicas que visem aprimorar a gestão democrática, bem como atingir os objetivos do PPP, melhorando a qualidade do ensino. Metodologicamente, empregou-se a pesquisa descritiva do tipo estudo de caso e utilizou-se, como procedimentos técnicos para coleta de dados, a entrevista semiestruturada e a observação sistemática/não participante para acompanhar o desenvolvimento de práticas pedagógicas realizadas em uma escola pública que evidenciassem conexões com os objetivos traçados em um PPP (re)elaborado coletivamente. Entre os principais resultados alcançados com esta investigação, destacam-se as práticas pedagógicas desenvolvidas, de acordo com os planos de trabalho que, por sua vez, são concebidos para alcançar os objetivos definidos no PPP e a conexão entre teoria (legislação e propostas dos autores referenciados neste estudo) e prática (gestão democrática, (re)construção coletiva do PPP, elaboração dos planos de trabalho e execução das práticas pedagógicas planejadas). Essas constatações revelam-se importantes para a afirmação da gestão democrática como modelo de gestão das escolas públicas, para a obtenção da participação efetiva das comunidades escolar e local nos processos decisórios e para a melhoria da qualidade do ensino.

Introduction:Adult T cell Leukemia/Lymphoma (ATLL) is a mature T-Cell-neoplasm related to human T-cell lymphotropic virus type 1 (HTLV-1) infection that shows variable clinical presentation and adverse prognosis with shorter overall survival (OS) when compared to other peripheral T-cell lymphomas (PTCL). Previous epidemiological studies estimated cumulative incidence in endemic regions around the world. In Brazil, mainly due to its vast dimension, data collection has limitations and is subject to bias. In April 2015 theBrazilianT-cell longitudinal project initiative was launched. One of the primary purposes was the collection of epidemiological and clinical data from the most frequent subtypes of newly diagnosed PTCL. Among them, 41 cases of ATLL were recorded. Objectives:The aim of this study is to describe clinical features, frequency and overall survival (OS) of 41 cases of ATLL registered in the ongoingBrazilianT-Cell Project. Methods:This is an ambispective observational study design collecting baseline characteristics, clinical features including date of diagnosis, clinical subtypes, B symptoms, performance status, Ann-Arbor staging, HTLV-1 status, number of sites, nodal and extra nodal presentation and types of skin lesions, peripheral blood counts and biochemical tests, front-line treatment and best response after first-line treatment. REDcap Platform has been used to collect and store data and for descriptive analysis the IBM-SPSS version 24 was applied. Kaplan-Meier method estimated the OS, whereas Log-Rank tests to compare its curves. OS period was calculated from diagnosis date until death or last seen date, and event was death by any cause. Results:Out of 281 cases of PTCL registered so far, 41 were ATLL cases. The median age was 50 years (34-88), 25 (64%) female; a higher incidence of lymphoma subtype was observed (46%), followed by acute (29%), chronic (17%) and smoldering (8%). Most of the patients (85%) had advanced-stage disease (III-IV, Ann-Arbor) and 56% had B symptoms (Table 1); 73% received chemotherapy with anthracycline-based regimens (46.5% CHOEP; 33.5% CHOP; 20% others) whereas 17% were managed with immunotherapy and antiviral therapy. The overall response rate was 30%; no response or progression 46%; stable disease 9% and 15% no data available yet (Table 2). Median follow-up was 13 months and 25 months for 41% of alive patients. Two year OS was 39% (95%CI: 23-55%) (Figure 1). Smoldering and Chronic subtypes showed better OS when compared with acute and lymphoma (100% smoldering, 86% chronic; 30% lymphoma type and 13% acuteP=0.04) (Figure 2). The multivariate Cox Regression analysis found male gender (HR 10.9 95%CI: 3.0-39.7, P Discussion:ATLL prognosis remains poor regardless of the type of treatment regimen and may be associated with the high incidence of lymphoma and acute subtypes, as well as advanced stage disease presentation. Despite the high number of cases seen in southeastern region of Brazil, it is important to emphasize there are still limited data from other regions. Albeit the sample size is small, these findings confirmed literature review data so far, with poor overall survival in a short time and gender and albumin as predictors of OS in the multivariate analysis. Conclusion:This study highlights the poor prognosis associated with ATLL. Moreover, it seems relevant to expand this study to all Brazilian regions. Hence, the need for early diagnosis and new treatment strategies, able to reduce mortality is warranted, that could possibly change the nature and spectrum of disease. Disclosures Federico: Spectrum:Consultancy, Membership on an entity's Board of Directors or advisory committees;Sandoz:Consultancy, Membership on an entity's Board of Directors or advisory committees;Cephalon/Teva:Research Funding;Mundipharma s.r.l.:Research Funding;Celgene:Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Millennium/Takeda:Research Funding;Roche:Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Takeda:Consultancy, Membership on an entity's Board of Directors or advisory committees.

Context: Diffuse large B cell lymphoma (DLBCL) is non-Hodgkin lymphoma's most common histological subtype. It has a slight predominance in men, around 65 years old median age, but an age-increasing prevalence. Although R-CHOP (rituximab associated to cyclophosphamide, doxorubicin, vincristine and prednisone) is considered its standard treatment, studies generally exclude patients over 80 years old due to their clinical conditions. This results in a lack of scientific data for best therapeutic management to this group of patients. Objective: To evaluate clinical, laboratory and therapeutic profile of DLBCL patients aged equal to or over 80 years old treated at Santa Casa hospital in Sao Paulo, Brazil between January 1, 2013, and December 31, 2017. Design: Retrospective, cross-sectional cohort study of DLBCL patients diagnosed with 80 years old or older treated at Santa Casa hospital in Sao Paulo, Brazil from January 1, 2013 to December 31, 2017. We analyzed their clinical, laboratory and therapeutic data. Patients or other participants: We analyzed 13 patients with DLBCL diagnosed between January,2013 and December 2017. HIV, HBC, and HCV positive serology patients were excluded. Results: We analyzed 13 patients with 83 years old median age, predominantly female (M / F ratio 1.0 / 2.25). More than 90% had some previous comorbidity; cardiovascular and endocrine-metabolic diseases were the most prevalent. At diagnosis, 61.5% had constitutional symptoms and 46.2% had Ann Arbor advanced staging. Concerning laboratory data at diagnosis, 46.2% were anemic, 15.4% were plaquetopenic, 23.1% were lymphopenic and 69.3% were hypoalbuminemic. According to Hans' criteria, 53,8% were non-GCB DLBCL. In prognostic evaluation according to the R-IPI and NCCN-IPI respectively 46.1% were intermediate-risk and 61.5% high-risk, respectively. R-mini-CHOP was more frequently used for treatment (38.5%) followed by R-CHOP. About 60% of patients who underwent chemotherapy completed treatment initially proposed. The median overall survival (SG) was 118 days and 84.6% died, almost 40% by sepsis. Patients with high serum albumin values and higher hemoglobin values had a statistically significant better OS (p = 0.020). Conclusions: DLBCL in very elderly patients is an orphan clinical situation. It has some relevant characteristics that must be taken into account to offer more adequate and safer therapy.

Context: WM is a rare indolent non-Hodgkin lymphoma that mainly affects people over 60 years old. It is characterized by lymphoplasmacytic cells bone marrow infiltration and IgM gammopathy. Patients have asthenia, weight loss, mucosal bleeding, lymph node enlargement, splenomegaly and neurological changes resulting from hyperviscosity and/or cytopenias. Treatment goal is to relieve symptoms. Recently, targeted drugs have been used, which may increase its median overall survival in the next years. Notwithstanding these drugs are not equally available around the world. Objective: To recognize clinical, epidemiological profile and treatment evaluation of WM patients at Santa Casa de Sao Paulo, Brazil. Design: WM retrospective analysis cohort diagnosed between January 1, 2000 and December 31, 2016. Patients or other participants: We analyzed patients with WM diagnosis. HIV, HBV, and HCV positive serology patients were excluded. Results: There were 18 patients, 10 men/8 women, with 61 years old median age. Fifteen patients presented with splenomegaly; 14 had B symptoms at diagnosis. Median serum IgM was 3019 mg/dL; 8 patients were submitted to plasmapheresis because of symptomatic hyperviscosity syndrome. 70% were classified as High/Very-high risk and all patients were treated upfront. As 1st line treatment we used alkylant + prednisone in 12 patients; alkylant + prednisone + anthracycline in 3 patients; fludarabine in 2 patients and to 1 patient only prednisone. Less than 25% got CR/VGPR; 5.5% got PR and 72% were refractory. There were 2 deaths before 2nd line treatment for which we used fludarabine-based therapy in 9, alkylant + prednisone + anthracycline in 2 and alkylant + prednisone in 1 patient. Ten patients were dead before 3rd line therapy. Mean OS was 55 months. Hb under 9.5 g/dl and platelets under 120×103mm3 had statistically significant worse median OS. Conclusions: Our Waldenstrom macroglobulinemia cohort showed poor response to 1st line chemotherapy regimens. IPSS-WM showed that they arrive in severe clinical conditions making it a challenging treatment. The absence of new available target drugs might have resulted in bad 1st line response and a high relapse rate.

A realidade da maioria das escolas públicas no Brasil mostra que tem sido um desafio para a gestão escolar angariar a participação das comunidades escolar e local na (re)construção do projeto político-pedagógico – PPP. Por isso, o objetivo deste artigo é apresentar alternativas a serem desenvolvidas pelas escolas para viabilizar uma maior participação dessas comunidades no processo de (re)construção do PPP. Para atingi-lo utilizou-se o estudo de caso, como método de pesquisa, e entrevistas e diálogos com professores e funcionários, participações nas reuniões do corpo docente e observações no ambiente escolar para coletar os dados. Neste estudo, evidencia-se que o PPP (re)construído coletivamente configura-se em um instrumento relevante para o modelo de gestão democrática e que as alternativas expostas demonstram, na prática, que é viável fazer da gestão democrática uma realidade nas escolas públicas.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: To investigate the value of computed tomography (CT) as an independent predictor of hemoglobin levels in a hospitalized...

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: Introduce related pathologies. Demonstrate different imaging modalities and techniques available. Discuss imaging method for each particular case and outline main imaging...

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: Review important anatomic landmarks in the axilla. Illustrate imaging features of normal and abnormal lymph nodes, including the differential diagnosis of each one. Discuss the role of imaging in staging the axilla for patients with breast...

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: Brief review of the mechanisms of spine trauma. To point the role of imaging methods on evaluation of spine trauma, discussing the image characteristics and the advantages and disadvantages of each imaging modality, besides outlining the main...

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: - to describe the main imaging findings of mucinous carcinomas (MC) and the differences between the 2 subtypes; - to illustrate the differential diagnosis of T2W hyperintense tumors in a case­based review; - to highlight the relevant clinical...