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The aim of this study is to analyze the level of implantation of the Tuberculosis Control Program in Primary Health Care in a medium-sized city. Normative evaluation study, with a quantitative approach, emphasizing the level of implantation of programs. The sample included 80 nurses and data collection took place from November 2017 to March 2018, using a questionnaire with 62 questions. To identify the level of implantation, the percentage of responses identified was distributed in four classifications: not implanted (from 0% to 25%); incipient (from 26% to 50%); partially implanted (from 51% to 75%) and implanted (from 76% to 100%). The Tuberculosis Control Program in the city was classified as partially implanted (62.85%). The dimensions Structure and Process were also evaluated as being in the same level (61.80% and 63.17%, respectively). The level of implantation of the program was classified as partially implanted, showing shortcomings with regard to the activities developed in the city. Health professionals are expected to make decisions to improve the program.

Objetivo: Analisar o conceito da vulnerabilidade de pessoas em situação de rua que vivem com tuberculose. Método: Trata-se de uma revisão integrativa da literatura, fundamentada no modelo de Análise de Conceito proposto por Walker e Avant. Foram utilizadas as bases de dados: LILACS, PUBMED, Web of Science e Scopus, utilizando os descritores: pessoas em situação de rua, tuberculose e vulnerabilidade nas línguas portuguesa, inglesa e espanhola. Resultados: Fizeram parte da amostra final 9 artigos, os atributos identificados para vulnerabilidade a tuberculose foram: pobreza, difícil acesso aos serviços de saúde, populações carentes, falta de moradia e desigualdades de saúde. Além disso, foi construído caso modelo, caso contrário e evidenciado os antecedentes e consequentes. Conclusão: A realização deste estudo pode contribuir para o refinamento e aprimoramento da visão dos profissionais de saúde em relação à vulnerabilidade de pessoas em situação de rua que vivem com tuberculose, e, portanto, contribuir para a prática mais humanizada e de forma integral.

Objetivo: Refletir sobre as ações dos profissionais enfermeiros da Atenção Primária à Saúde no enfrentamento da COVID-19 à luz da Teoria de Adaptação de Callista Roy. Método: Estudo teórico reflexivo a respeito da pandemia da COVID-19, sob a luz da teoria de adaptação de Callista Roy. Foram utilizados documentos das bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medline e Banco de Dados em Enfermagem, bem como as obras de referência da autora Callista Roy e sua teoria, buscados entre os meses de janeiro e fevereiro de 2023. Resultados: observa-se que a aplicação dos fundamentos teóricos propostos na teoria de adaptação subsidia e contribui com as práticas de enfermeiros no combate à pandemia da COVID-19. Considerações finais: Os estudos e reflexões com base na teoria de adaptação nos possibilitou vislumbrar claramente que sua associação com a prática pode fornecer um olhar integral às necessidades do indivíduo envolvendo a pessoa, ambiente, saúde e a enfermagem como forma de alcance as medidas de enfrentamento. Ademais, é notório que a compreensão desta conjuntura pelo enfermeiro e a articulação com a equipe multiprofissional, pode promover a redução dos agravos emergentes, assim como estimular melhoria nos fatores biopsicossociais da saúde da população

FDA approved agents for the treatment of chronic GVHD including ruxolitinib and belumosudil are effective steroid-sparing agents, with overall response rates (ORR) of 76% and 65% respectively. Ruxolitinib and belumosudil are well tolerated with different primary targets. Little data is available on the use of combination ruxolitinib and belumosudil. This is a single center, retrospective analysis of 20 treatment-refractory patients with chronic GVHD treated with combination ruxolitinib and belumosudil. The ORR including complete response (CR) and partial response (PR) at any time was 55% (11/20). Among responding patients, other immunosuppressive agents were tapered or discontinued in all patients. None of the patients developed EBV or CMV reactivation requiring treatment. 4 patients (20%) developed pneumonia and 2 patients (10%) developed viral URI. Cytopenias were not exacerbated. No patients had graft failure or relapsed disease. The combination is tolerable, delays the need for alternative therapies, and facilitates tapering of corticosteroids.

Objectives: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data., Results: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts., (© 2024. The Author(s).)

Chimeric antigen receptor T-cell (CAR-T) therapy has significantly impacted treatment algorithms and clinical outcomes for a variety of patients with hematologic malignancies over the past decade. The field of cellular immunotherapy is currently experiencing a rapid expansion of the number of patients eligible for CAR-T therapies as approvals are being seen in earlier lines of therapy. With the expanded patients eligible for these therapies, more treatment centers will be necessary to keep up with demand. Building a cellular therapy program can be a daunting task, and therefore, we present our experience with building a clinical cellular therapy program., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

High-mountain water bodies represent critical components of their ecosystems, serving as vital freshwater reservoirs, environmental regulators, and sentinels of climate change. To understand the environmental dynamics of these regions, comprehensive analyses of lakes across spatial and temporal scales are necessary. While remote sensing offers a powerful tool for lake monitoring, applications in high-mountain terrain present unique challenges. The Ancash and Cuzco regions of the Peruvian Andes exemplify these challenges. These regions harbor numerous high-mountain lakes, which are crucial for fresh water supply and environmental regulation. This paper presents an exploratory examination of remote sensing techniques for lake monitoring in the Ancash and Cuzco regions of the Peruvian Andes. The study compares three deep learning models for lake segmentation: the well-established DeepWaterMapV2 and WatNet models and the adapted WaterSegDiff model, which is based on a combination of diffusion and transformation mechanisms specifically conditioned for lake segmentation. In addition, the Normalized Difference Water Index (NDWI) with Otsu thresholding is used for comparison purposes. To capture lakes across these regions, a new dataset was created with Landsat-8 multispectral imagery (bands 2-7) from 2013 to 2023. Quantitative and qualitative analyses were performed using metrics such as Mean Intersection over Union (MIoU), Pixel Accuracy (PA), and F1 Score. The results achieved indicate equivalent performance of DeepWaterMapV2 and WatNet encoder-decoder architectures, achieving adequate lake segmentation despite the challenging geographical and atmospheric conditions inherent in high-mountain environments. In the qualitative analysis, the behavior of the WaterSegDiff model was considered promising for the proposed application. Considering that WatNet is less computationally complex, with 3.4 million parameters, this architecture becomes the most pertinent to implement. Additionally, a detailed temporal analysis of Lake Singrenacocha in the Vilcanota Mountains was conducted, pointing out the more significant behavior of the WatNet model.

Abstract: Chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment for relapsed/refractory B-cell non-Hodgkin lymphoma (NHL). Robust biomarkers and a complete understanding of CAR T-cell function in the postinfusion phase remain limited. Here, we used a 37-color spectral flow cytometry panel to perform high dimensional single-cell analysis of postinfusion samples in 26 patients treated with CD28 costimulatory domain containing commercial CAR T cells for NHL and focused on computationally gated CD8+ CAR T cells. We found that the presence of postinfusion Programmed cell death protein 1 (PD-1)+ CD8+ CAR T cells at the day 14 time point highly correlated with the ability to achieve complete response (CR) by 6 months. Further analysis identified multiple subtypes of CD8+ PD-1+ CAR T cells, including PD-1+ T cell factor 1 (TCF1)+ stem-like CAR T cells and PD-1+ T-cell immunoglobulin and mucin-domain containing-3 (TIM3)+ effector-like CAR T cells that correlated with improved clinical outcomes such as response and progression-free survival. Additionally, we identified a subset of PD-1+ CD8+ CAR+ T cells with effector-like function that was increased in patients who achieved a CR and was associated with grade 3 or higher immune effector cell-associated neurotoxicity syndrome. Here, we identified robust biomarkers of response to CD28 CAR T cells and highlight the importance of PD-1 positivity in CD8+ CAR T cells after infusion in achieving CR., (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Background: The short-term complications from chimeric antigen receptor T-cell therapy (CART) are well characterized, but the long-term complications still need to be further investigated. Therefore, herein, we will review the currently available literature published on the late adverse events following CART., Methods: We reviewed published data available from pivotal trials and real-world experiences with anti-CD19 CART (CART19) for adults with lymphoma. We defined late events as occurring or persisting beyond 1 month after CART infusion. We focused our literature review on the following late-event outcomes post-CART19: cytopenia, immune reconstitution, infections, and subsequent malignancies., Results: Grade 3-4 cytopenia beyond 30 days occurs in 30%-40% of patients and beyond 90 days in 3%-22% of patients and is usually managed with growth-factor and transfusion support, along with neutropenic prophylaxis. B-cell aplasia and hypogammaglobulinemia are expected on-target off-tumor effects of CART19, 44%-53% of patients have IgG < 400 mg/dL, and approximately 27%-38% of patients receive intravenous immunoglobulin (IVIG) replacement. Infections beyond the initial month from CART19 are not frequent and rarely severe, but they are more prevalent and severe when patients receive subsequent therapies post-CART19 for their underlying disease. Late neurotoxicity and neurocognitive impairment are uncommon, and other causes should be considered. T-cell lymphoma (TCL) after CART is an extremely rare event and not necessarily related to CAR transgene. Myeloid neoplasm is not rare post-CART, but unclear causality given heavily pretreated patient population is already at risk for therapy-related myeloid neoplasm., Conclusion: CART19 is associated with clinically significant long-term effects such as prolonged cytopenia, hypogammaglobulinemia, and infections that warrant clinical surveillance, but they are mostly manageable with a low risk of non-relapse mortality. The risk of subsequent malignancies post-CART19 seems low, and the relationship with CART19 and/or prior therapies is unclear; but regardless of the possible causality, this should not impact the current benefit-risk ratio of CART19 for relapsed/refractory B-cell non-Hodgkin lymphoma (NHL)., Competing Interests: AC received support for meetings and travels by Novartis and lectures for Kite and Novartis and is on the Advisory Board for Janssen. EB provides advisory board meeting consultancy for Novartis and Kyverna Therapeutics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Cordeiro, Durisek, Batista, Schmidt, de Lima and Bezerra.)