Kinetics of BCR::ABL1 transcript levels and molecular relapse after tyrosine kinase inhibitors discontinuation in chronic myeloid leukemia patients: preliminary results from the DES-CML study.

Tyrosine kinase inhibitors (TKI) have revolutionized the treatment of patients with chronic myeloid leukemia. Patients who achieve sustained deep molecular response are eligible for treatment discontinuation. DES-CML is an ongoing, phase 2 multicentric discontinuation trial. Adult patients with CML in chronic phase with typical BCR::ABL1 transcripts, stable deep molecular response (MR4.5 IS) for two years, and no previous resistance were eligible. Patients underwent a phase of TKI dose de-escalation for six months before discontinuation. TKI was reintroduced at the previous dose if the patient lost major molecular response (MMR) at any time. This study aimed to assess the impact of BCR-ABL transcript kinetics during TKI de-escalation and discontinuation phases on treatment-free survival. So far, the study recruited 41 patients, and 38 patients discontinued therapy (4 were in the second discontinuation attempt). Eleven patients lost MMR, one during the de-escalation phase and ten after discontinuation. 24-month treatment-free survival was 66% (95% CI: 48-84%) in a median follow-up of 7 (1-30) months. No patient lost hematological response or had disease progression. A higher rate of molecular relapses occurred in patients with fluctuating BCR::ABL1 levels after the discontinuation phase (with loss of MR4.5, but no loss of MMR) (P=0.04, HR-4.86 (1.03-22.9) but not confirmed in the multivariate analysis. The longer duration of TKI treatment (P=0.03, HR-1.02, 95%CI - 1.00-1.04) and MMR (P=0.004, HR-0.95, 95%CI - 0.92-098) were independent factors of a lower relapse rate.

What is happening with the clinical nutritionist? Realities and challenges.

BACKGROUND: At hospital level, clinical nutritionists play a fundamental role in health recovery, contributing to shorter hospital stays and addressing hospital malnutrition. However, in Latin America no studies have been conducted on the activities of the nutritionist and the factors influencing their performance. AIMS: to describe the activities of the clinical nutritionist in public and private hospital settings in Latin America and to determine the factors associated with disciplinary practice. METHODS: A cross-sectional analytical, quantitative study was conducted. Participants consisted of hospital nutritionists from 13 Latin American countries who had participated in a previously validated online survey on the activities performed during their daily work, obtaining a Professional Activities Score (PAS). RESULTS: 1222 nutritionists participated. Of the activities associated with the professional role, the only ones who reached over 75 % of execution were: performing nutritional intervention; performing nutritional assessment and diagnosis; providing counseling and dietary prescription; developing nutritional care plans for patients with nutritional problems; and performing the monitoring and evaluation of results of priority patients. The least frequent activities were: university teaching and collaborating in research. Regarding the reasons for not performing activities: 34.0 % reported not being included in the activities, 24.5 % mentioned lack of time, and 13.6 % indicated that the activities were conducted by another professional. Variables positively associated with an increase in the PAS were: having spent more years exercising the profession (Beta: 0.028, 95 % CI: 0.004; 0.051), and having a greater number of specialties (4 or more, Beta: 2.294, 95 % CI: 1.031; 3.557). Working in lower-complexity facilities (Low: Beta: -1.037, 95 % CI: -1.443; -0.630), and having more reasons for not performing the activities (3 or more: Beta: -3.105, 95 % CI: -4.111; -2.099) were inversely associated. From the sample, 1.8 % held a doctorate in clinical nutrition, 43.9 % had a specialty, and 64.4 % had a diploma or postgraduate degree in clinical nutrition. CONCLUSION: None of the activities related to the nutritionist work was performed on a 100 % basis. In Latin America, Ministries of Health should standardize and regulate the functions of the clinical nutritionist, as well as quantifying understaffing and proposing solutions to alleviate the shortage of these professionals, acknowledging the positive impact that they have on the recovery of hospital patients.

Self-Reported Nutritional Status and Breakfast Characterization in Latin American University Students.

OBJECTIVE: To associate breakfast consumption frequency with self-reported nutritional status and dietary patterns of Latin American university students by human development. MATERIAL AND METHODS: This was a cross-sectional, multicenter observational study. University students from 11 Latin American countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, Peru, Paraguay, Panama and Uruguay) were invited to participate by answering an online self-administered questionnaire on food consumption and sociodemographic indicators, associations were investigated using logistic regression. RESULTS: The logistic regression analysis showed significant associations between breakfast consumption and the crude model, models 2 and 3 in countries with very high and upper-middle/high human development. However, after adjustment in the most comprehensive model, the association is no longer statistically significant. In the fully adjusted model of the variables, a significant relationship was observed between breakfast consumption and both healthy and unhealthy dietary patterns. Specifically, students who typically consume breakfast exhibit greater consumption of oatmeal and fruits, as well as healthier dinner choices. Conversely, they exhibit lower consumption of fast food, sugary drinks, and juices. In particular, in highly developed countries, along with the mentioned foods, consumption of dairy was linked to breakfast consumption in a positive way, while alcohol consumption was negatively associated. CONCLUSION: University students who eat breakfast on a regular basis maintain a healthier diet in comparison to those who do not, irrespective of their country's level of human development.

Factors associated with the consumption of fruits and vegetables in latin american university students

Objective: Explore the association between compliance with recommended consumption (5-a-day) of fruits and vegetables (F&V) with sociodemographic factors of university students of Latin America. Subjects: We conducted an analytical cross-sectional study in which 4,880 university students from 10 Latin American countries completed a self-administered online survey. Methods: F&V consumption and other sociodemographic variables were measured according to a validated survey. Body mass index was self-reported. Ordinal logistic regression models were applied. Results: Regarding the consumption of F&V, 4.7% of men complied with the recommendation, while in women this value reached 7.7%. In the adjusted model, having a normal weight (OR= 0.59; 95% CI 0.44-0.7; p=<0.001), being female (OR= 0.67; 95% CI 0.49-0.89; p=<0.01), being enrolled in a health-related degree program (OR= 0,60; IC95% 0,45-0,78; p<0.001), having professional parents (OR= 0.75; 95% CI 0.60-0.95; p=<0.05) and practicing physical activity (OR= 0.34; 95% CI 0.27-0.42; p=<0.001) were associated with compliance to F&V consumption recommendations. In the analysis by country, physical activity was the variable most associated with F&V consumption. Conclusion: We observed a low consumption of F&V in university students. The variables associated with compliance to the F&V recommendation were being normal weight, female, being enrolled in a health-related degree program, having professional parents, and practicing physical activity, the latter being the most important variable.

Objetivo: Explorar la asociación de la frecuencia de cumplimiento de las recomendaciones de consumo (5 al día) de frutas y verduras (F&V) con factores sociodemográficos de estudiantes universitarios de América Latina. Metodología: Se realizó un estudio transversal analítico con 4.880 estudiantes universitarios de 10 países de América Latina, quienes completaron una encuesta en línea autoadministrada. Se midió el consumo de F&V y otras variables sociodemográficas según una encuesta previamente validada. El índice de masa corporal fue autoinformado. Se aplicaron modelos de regresión logística ordinal. Resultados: En cuanto al consumo de F&V, en los hombres el 4,7% cumple con la recomendación, mientras que en las mujeres este valor alcanza el 7,7%. En el modelo más ajustado, presentar normopeso (OR= 0,59; IC 95% 0,44-0,7; p=<0,001), ser mujer (OR= 0,67; IC 95% 0,49-0,89; p=<0,01), estar matriculado en carrera relacionada con la salud (OR= 0,60; IC95% 0,45-0,78; p<0,001), tener padres profesionales (OR= 0,75; IC 95% 0,60-0,95; p=<0,05) y realizar actividad física (OR= 0,34; IC 95% 0,27-0,42; p=<0,001) fueron las variables asociadas al cumplimiento del consumo de F&V. En el análisis por país, la actividad física fue la variable más asociada al consumo de F&V. Conclusión: Se observa un bajo consumo de F&V en estudiantes universitarios, y entre las variables asociadas al cumplimiento de la recomendación de F&V se encuentran estar normopeso, sexo femenino, estar cursando una carrera relacionada con la salud, tener los padres y la práctica de actividad física, siendo esta última la variable más importante.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

[Diet and body weight at the beginning of the COVID-19 pandemic in Mexico]. / Alimentación y peso corporal al inicio de la pandemia por COVID-19 en México.

Background: Weight changes in adults have strong repercussions on people's health status. During the COVID-19 pandemic, these changes could be more evident due to the mandatory confinement, as well as eating habits and lifestyle. In this study, changes in diet and body weight in Mexican population at the beginning of COVID-19 lockdown period (weeks 4-7) were evaluated using an online survey. Objective: To identify the characteristics of the diet and the perceived change in body weight at the beginning of the COVID-19 pandemic in Mexico. Material and methods: Descriptive, cross-sectional study of 1281 people over 18 years of age, electronic survey in weeks 4-7 of confinement with sociodemographic data, food consumption and perception of body weight. Results: The change in food consumption was 53.9%, finding differences according to gender in beverages (carbonated, juices, alcoholic), coffee/tea, fruits, legumes (p < 0.05). The perception of body weight increases by 3.4 (increased) and 2.1 (lowered) times more than the risk of change in diet. Conclusions: The dietary differences refer to a tendency to the type of food consumed, mainly sugary drinks, with the perception of changes in positive body weight in women.

Introducción: los cambios de peso corporal tienen fuertes repercusiones en el estado de salud de las personas. Durante la pandemia, estos cambios podrían verse más pronunciados debido al confinamiento obligatorio, así como a los malos hábitos alimentarios y al estilo de vida. En este estudio se examinaron los cambios en la alimentación y el peso corporal en población mexicana durante el inicio de la pandemia por COVID-19 (semanas 4-7 de confinamiento) mediante una encuesta en línea. Objetivo: identificar las características de la alimentación y el cambio percibido del peso corporal al inicio de la pandemia por COVID-19 en México. Material y métodos: estudio descriptivo, transversal, de 1281 personas mayores de 18 años, mediante encuesta electrónica en las semanas 4-7 de confinamiento, con datos sociodemográficos, consumo alimentario y percepción del peso corporal. Resultados: el cambio de consumo de alimentos fue del 53.9%, encontrando diferencias según sexo en bebidas (carbonatadas, jugos, alcohólicas), café/té, frutas, leguminosas (p < 0.05). La percepción del peso corporal incrementó en 3.4 (subieron) y 2.1 (bajaron) veces más el riesgo de cambio en la alimentación. Conclusiones: las diferencias alimentarias refieren una tendencia al tipo de alimentos que consumen, principalmente bebidas ricas en azúcares, con percepción de cambios en el peso corporal positivo en mujeres.

Ultra-processed food and homemade fried food consumption is associated with overweight/obesity in Latin American university students during COVID-19.

OBJECTIVE: We estimated the association between the consumption of select ultra-processed food (UPF), homemade fried food and overweight/obesity in Latin American university undergraduate students during the COVID-19 pandemic. METHODS: We conducted an analytical cross-sectional study. 4539 university students (73.6% female, mean age 22.5 ± 4.4) from 10 Latin American countries completed a self-administered online survey. UPF eating habits and homemade fried food were measured according to a validated survey. Height and body weight were self-reported. Body mass index (BMI) was calculated. A BMI ≥25 kg/m2 was categorized as overweight/obesity. Ordinal logistic regression models were applied. RESULTS: Snacks (36.2%) and homemade fried food (30.2%) had a higher prevalence of consumption than sugary drinks (22.5%) and fast food (7.2%). The greatest strength of association was found between fast food consumption [odds ratio (OR) = 2.16; 95% confidence interval (CI): 1.63-2.85], sugary drinks [OR = 2.05; CI: 1.63-2.59] and homemade fried food [OR = 1.46; CI: 1.16-1.85] with overweight/obesity. CONCLUSION: Latin American university undergraduates present risky eating behaviors associated with overweight and obesity. Effective policies to promote healthy eating should be incorporated and issued from universities to reduce the consumption of UPF and promote homemade, healthier and more natural food.

Asociación entre consumo de alcohol y exceso de peso entre estudiantes universitarios de América Latina

Introducción: El sobrepeso y la obesidad son problemas de salud pública de nivel mundial. Si bien existe información respecto al consumo de alcohol en estudiantes universitarios durante la pandemia, pocos autores han señalado la asociación entre este hábito y el exceso de peso en esta población. El objetivo fue determinar la asociación entre el consumo de alcohol y el exceso de peso en estudiantes universitarios de 10 países de Latinoamérica durante la pandemia por COVID-19. Metodología: Se realizó un estudio transversal y multicéntrico con 4.539 estudiantes universitarios matriculados en diez países de América Latina. Para la valoración del consumo de alcohol se utilizó la pregunta ¿Consumes bebidas alcohólicas? (1 porción 1 vaso de 200 ml). El índice de masa corporal (IMC) se determinó a partir del peso y la altura auto informado. Para determinar si el exceso de peso (IMC ≥25 kg/m2) estaba asociado con el consumo de alcohol, se utilizó un análisis de regresión logística, ajustado por edad, sexo, año de estudio, nivel socioeconómico, actividad física y tabaquismo. Resultados: Entre los estudiantes con estado nutricional normal, un 59,6% no consumía alcohol, mientras entre los que presentaban un exceso de peso era un 55,1%. Los estudiantes que consumían 2 o más porciones de alcohol al día tenían 2,18 veces más riesgo de tener exceso de peso (OR: 2.18 [95% IC: 1,26 a 3,77]), comparado con aquellos que no consumían alcohol. Conclusión: Se observó que aquellos estudiantes que consumieron más alcohol tuvieron más probabilidades de tener exceso de peso.

Introduction: Overweight and obesity are public health problems worldwide. Alcoholic beverages could increase total energy intake causing an increase in body weight. However, few authors have pointed out the association between this habit and excess weight in this population. The objective of this study was to determine the association between alcohol consumption and excess weight in university students from 10 Latin American countries during the COVID-19 pandemic. Methodology: A cross-sectional and multicenter study was carried out with 4,539 university students enrolled in ten Latin American countries. To assess alcohol consumption, the question Do you consume alcoholic beverages? (1 portion 1 glass of 200 ml). Body mass index (BMI) kg/m2 was determined from self-reported weight and height. To determine if excess weight was associated with alcohol consumption, a logistic regression analysis was used, adjusted for age, sex, year of study, socioeconomic level, physical activity, and smoking. Results: Among students with normal nutritional status, 59.6% did not consume alcohol, while among those with a BMI ≥25 kg/m2 it was 55.1%. Students who consumed 2 or more servings of alcohol per day had a 2.18 times greater risk of being overweight (OR: 2.18 [95% CI: 1.26 to 3.77]), compared with those who did not consume alcohol. Conclusion: It was observed that those students who consumed more alcohol were more likely to be overweight.

Chronic graft-versus-host-disease treatment in Brazil: analyses of failure-free survival.

Failure-free survival (FFS), defined as the absence of new systemic treatment, recurrence of original malignancy and mortality not associated with recurrence after allogeneic hematopoietic stem cell transplantation (HCT), is a robust clinical measure to interpret results of initial systemic treatment of chronic graft-versus-host disease (cGVHD). We evaluate FFS after initial treatment of cGVHD in a mixed-race cohort from a resource-constrained country. This retrospective study included 354 consecutive patients after their first HCT between January 2014 and August 2020, who received initial systemic treatment for moderate or severe cGVHD at 13 Brazilian centers. Cox regression models were used to identify risk factors for treatment failure. The overall median follow-up among survivors was 28 months (range 1-71) after initial treatment. FFS was 89% at 6 months, 71% at 1 year and 52% at 2 years. New systemic treatment was the major cause of failure. In multivariable models, prior grades II-IV acute GVHD, a National Institutes of Health severity score of 3 in liver, gastrointestinal tract or lung involvement, and onset of initial treatment of cGVHD within 12 months after transplantation were all associated with an increased risk of treatment failure. Our results could serve as a benchmark for the design of future clinical trials evaluating initial treatment of cGVHD in resource-constrained locations.

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation.

OBJECTIVE: To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). METHODS: From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. RESULTS: 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p  ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p  = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. CONCLUSION: Cardiorespiratory rehabilitation can preserve functional capacity and quality of life.

Healthy Lifestyle Habits in Latin American University Students during COVID-19 Pandemic: A Multi-Center Study.

Background: Deterioration in the health-related quality of life (HRQoL) and healthy eating behavior due to the effect of COVID-19 lockdown has been reported. The aim of this study was to associate eating habits and HRQoL with physical activity behavior in Latin American university students during COVID-19 pandemic.Methods: Measured 4,859 university students with a mean age of 22.4 years and they were mostly female (73.7%) from 10 Latin American countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, Panama, Paraguay and, Peru). Eating habits were measured using a survey validated with other university students, HRQoL was assessments using the short version of the World Health Organization (WHOQOL-BREF) scale and physical activity behavior with a dicotomous question based on the international recommendations for physical activity.Results: There is a higher complaince for all the international recommendations for healthy foods intake in the physically active group of students (p < 0.01), with the exception of alcohol and salt. In addition, physically active students presented a significantly higher HRQoL (p < 0.001) in all the dimensions analyzed when compared to physically inactive students.Conclusions: Latin American university students who are physically active are more likely to have a healthier eating behavior and a lower risk of a decreased HRQoL during COVID-19 pandemic.

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation

Abstract Objective To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). Methods From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. Results 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. Conclusion Cardiorespiratory rehabilitation can preserve functional capacity and quality of life.

Bodyweight change and its association with food and beverage consumption at the beginning COVID-19 confinement.

OBJECTIVES: SARS-CoV-2, a newly identified coronavirus responsible for the COVID-19 pandemic, has challenged health services and profoundly impacted people's lifestyles. The objective of the present study was to evaluate the effect of confinement during the COVID-19 pandemic on food consumption patterns and body weight in adults from 12 Ibero-American countries. METHODS: Multicentric, cross-sectional study. Data was collected using an online survey disseminated by social networks. The sample included 10 552 people from Spain and 11 Latin American countries who were selected by snowball sampling. RESULTS: While 38.50% of the sample reported weight gain, 16.90% reported weight lost. Weight change was associated with sex, age, country of residence, and education level. People who were not confined more often reported having maintained their weight in comparison to people who were confined. All Latin American countries showed an increased consumption of sweetened drinks, pastry products, fried foods, and alcoholic beverages during confinement. Consumption of eggs and dairy products was independent from body weight change. People who consumed more fruits and vegetables during confinement more often reported having lost weight. In contrast, body weight gain during confinement was associated with increased intake of sugary drinks, baked goods and pastries, pizza, fried foods, and alcoholic beverages. CONCLUSION: During COVID-19 confinement, the Latin American countries included in this study showed a change in their consumption patterns toward less healthy diets, which in turn was associated with an increase in the body weight of their population.

Conocimientos de la población adulta sobre etiquetado nutricional de alimentos

Los consumidores a menudo informan dificultades para interpretar la información cuantitativa contenida en las etiquetas nutricionales de los alimentos. El objetivo fue estudiar los principales conocimientos sobre etiquetado de alimentos que la población adulta del Paraguay tiene incorporado en el periodo de agosto de 2021. Este es un estudio descriptivo observacional de corte trasversal en el cual se evaluaron a adultos de ambos sexos de 18 a 60 años consumidores de alimentos con etiquetado nutricional. Se recabarón datos sociodemográficos y de conocimientos sobre etiquetado nutricional de alimentos a través de una encuesta tipo on-line con la herramienta de Google forms. El 73% fueron del sexo femenino, la edad promedio fue de 36,9 años, 57,1% residía en Gran Asunción, 49,1% tenía nivel educativo universitario y 37,5%eran profesionales de la salud. Los aspectos generales sobre etiquetado nutricional revelaron que 88,3% sabía su concepto, 55,3% refirió que lo lee casi siempre, 84% sabía que es obligatorio y 44% se fijaba más en las calorías. Al evaluar los conocimientos generales, 91% sabía la diferencia entre caducidad y consumo preferente, 71,4% conocía el concepto de cantidades orientativas, 62,5% supo cuáles son las grasas menos saludables, y 71,4% respondió correctamente el concepto de alimento light. Los encuestados tuvieron un conocimiento general adecuado sobre etiquetado nutricional, no obstante, hubo un porcentaje considerable de individuos que no supieron los conceptos básicos, por lo que se debe realizar intervenciones de educación nutricional enfocadas al consumidor.

Consumers often report difficulties in interpreting the quantitative information contained in the nutritional labels of foods. The objective was to study the main knowledge about food labeling that the adult population of Paraguay has incorporated in the period of August 2021. This is a cross-sectional descriptive observational study in which male and female adults between 18 and 60 years old consumers of foods with nutrition labelling were evaluated. Sociodemographic data and knowledge about nutritional labeling of food was collected through an online survey with the Google forms tool. Seventy three percent was female, the average age was 36.9 years, 57.1% lived in Greater Asunción, 49.1% had a university education level, and 37.5% were health professionals. The general aspects about nutritional labeling revealed that 88.3% knew the concept, 55.3% said that they read it almost always, 84% knew that it was mandatory and 44% paid more attention to calories. When evaluating general knowledge, 91% knew the difference between expiration and preferential consumption, 71.4% knew the concept of indicative quantities, 62.5% knew which are the less healthy fats, and 71.4% correctly answered the concept of light food. The survey respondents had an adequate general knowledge about nutrition labeling, however, there was a considerable percentage of individuals who did not know the basic concepts, for which consumer-focused nutrition education interventions should be carried out.

High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project.

Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study aims to report clinical characteristics, prognostic factors, and outcomes in a multicenter cohort of ENKTL patients from Brazil. This retrospective, observational and multicenter study included 98 ENKTL patients treated during two decades in Brazil. Data were extracted from the T-Cell Brazil Project database. In our cohort, 59/98 patients (60.2%) were male, with a median age of 50 years. Sixty-two patients (63.3%) had B-symptoms, 26/98 (26.5%) had Eastern Cooperative Oncology Group scale ≥ 2; 16/98 (16.3%) presented extranasal disease and 34.7% (34/98) were advanced-stage (Ann Arbor/Cotswolds III/IV). The median follow-up for the whole cohort was 49 months, with an estimated 2-year overall survival (OS) and progression-free survival (PFS) of 51.1% and 17.7%, respectively. In early-stage disease (IE/IIE), the median OS was 21.8 months for patients treated with concurrent radiotherapy plus chemotherapy (CCRT-VIPD [etoposide/vp-16, ifosfamide, cisplatin and dexamethasone), 16.2 months for sequential chemoradiotherapy (SCRT) followed by asparaginase-based regimens, and 56.7 months for SCRT followed by CHOP-like (cyclophosphamide, doxorrubicin, vincristine and prednisone) treatments, p = 0.211. CCRT was associated with higher rates of early-mortality, hematological toxicity, and mucositis. Median OS was 8.2 months for patients with advanced-stage disease receiving regimens containing asparaginase compared to 3.2 months for anthracycline-based therapy, p = 0.851. Chemo-radiotherapy (CRT) regimens demonstrated better OS (p = 0.001) and PFS (p = 0.007) than chemotherapy alone. Multivariate analysis revealed anemia, relapsed/refractory (R/R) disease and radiotherapy omission as poor outcome predictors for OS. Lymphopenia and radiotherapy omission adversely affected PFS. Concerning progression of disease within 24-months (POD-24), clinical stage III/IV was a poor outcome predictor. In this real-life Brazilian cohort, ENKTL presented dismal outcomes. Radiation therapy was an independent factor for increased OS and PFS, but CCRT regimens were associated with higher toxicities. Polychemotherapy based on anti-multi drug resistant agents was not associated with survival benefit in either early or advanced-stage disease in our patient cohort.

Characteristics and clinical outcomes of patients with ALK-positive anaplastic large cell lymphoma: Report from the prospective international T-cell lymphoma project.

The T-cell Lymphoma Project is an international registry prospective study that enrolled patients with newly diagnosed peripheral T-cell and NK-cell lymphomas (PTCL). The main objective was to define the clinical features and outcomes, establishing a robust benchmark for future clinical trials. Seventy-four institutions from 14 countries in North America, South America, Europe, and Asia collected data on patients diagnosed and treated at their respective centers between September 2006 and February 2018. Among 1553 PTCL patients, 131 (8.4% of the total cohort) were confirmed to have anaplastic large cell lymphoma - kinase positive (ALCL, ALK+). The median age of the patients was 39 years (18-84). Sixty-five patients (66%) had advanced-stage disease, although majority (45 patients, 54%) had a low-risk International Prognostic Index (IPI) score (0-1). Of 97 patients treated with chemotherapy, 97% received anthracycline-containing regimens. The overall response rate was 81%, with 69 patients (70%) achieving complete remission. Estimated OS and PFS at 3 years were 77% (95% CI: 54%-99%) and 68% (95% CI: 46%-90%), respectively, and at 5 years were very similar, 77% of OS (95% CI: 62%-92%) and 64% of PFS (95% CI: 34%-94%). Multivariate analysis for PFS showed advanced stage (hazard ratios [HR]: 4.72, 95% CI: 1.43-23.9, p = 0.015), elevated lactate dehidrogenade (LDH) (HR 4.85; 95% CI: 1.73-13.60, p = 0.001), and Eastern Cooperative Oncology Group Performance Status scale (ECOG-PS) ≥2 (HR: 5.25; 95% CI: 1.68-16.4, p = 0.024). For OS, elevated LDH (HR: 3.77; 95% CI: 1.98-14.17, p = 0.014) and ECOG-PS ≥2 (HR: 4.59; 95% CI: 1.46-14.39, p = 0.004) were identified. In summary, although the outcome of ALK+ ALCL is superior to that of other PTCLs, it remains sufficiently favorable, given the young median age of the patients. Our results confirm the usefulness of both IPI and Prognostic Index for T-cell Lymphoma (PIT) in identifying groups of patients with different outcomes. Clinical Trials ID: NCT01142674.

Quality of the diet during the COVID-19 pandemic in 11 Latin-American countries.

BACKGROUND AND OBJECTIVES: The confinement by COVID-19 has affected the food chain and environments, which added to factors such as anxiety, frustration, fear and stress have modified the quality of the diet in the population around the world. The purpose of this study was to explore diet quality during the COVID-19 pandemic in 11 Latin American countries. METHODOLOGY: Multicentric, cross-sectional study. An online survey was applied to residents of 11 Latin-American countries, during April and May 2020, when confinement was mandatory. Diet quality was evaluated using a validated questionnaire. RESULT: 10,573 people participated in the study. The quality of the food by country shows that Colombia presented the best quality, while Chile and Paraguay presented the lowest. When comparing the overall results of diet quality by gender, schooling and age, women, people with more schooling and people under 30 years of age, presented better diet quality. The regression model showed that the variables associated with diet quality were: age (df = 3, F = 4. 57, p < 0.001), sex (df = 1, F = 131.01, p < 0.001), level of education (df = 1, F = 38.29, p < 0.001), perception of weight change (df = 2, F = 135.31, p < 0.001), basis services (df = 1, F = 8.63, p = 0.003), and quarantine (df = 1, F = 12.14, p = 0.001). CONCLUSION: It is necessary for governments to intervene to reverse these indicators, considering that inadequate feeding favors the appearance of no communicable diseases, which favor a higher risk of infection and worse prognosis with COVID-19.

Body weight in relation to hours of sleep, and physical activity in Latin American university students during the Covid-19 pandemic.

Introduction: Short sleep, physical inactivity, and being locked up are risk factors for weight gain. Objective: We evaluated weight gain according to sex, age, hours of sleep and physical activity in university students from 10 Latin American countries during the COVID-19 pandemic. Methods: Cross-sectional and multicenter study (n = 4880). Results: The average age was 22.5 ± 4.4 years. 60.2% were currently locked up. 73.6% were women, 48.2% increased their body weight, 66% reported insufficient sleep hours, and 65.9% were inactive. Women gained more weight than men (73.2%) and younger students gained more weight (85.1%). Those who had insufficient sleep hours gained most weight (67.6%). Inactive participants gained most weight (74.7%). Students who have insufficient sleep are 21% more likely to have changes in body weight compared to students who have optimal sleep. Conclusion: The increase in body weight and its risk factors during confinement should be considered as emerging from public health.

Evaluación del estado nutricional, los patrones de alimentación y realización de actividad física de los médicos residentes del Hospital General de Luque del año 2020

RESUMEN Los médicos residentes enfrentan cambios en el estilo de vida, adquisición de hábitos alimenticios inadecuados, influencia de modas, publicidad y necesidad de pertenecer a un grupo social, por lo cual se encuentran en riesgo de padecer sobrepeso y obesidad. Nuestro objetivo fue determinar el estado nutricional, los patrones de alimentación y la realización de actividad física de los médicos residentes del Hospital General de Luque del año 2019. Se realizó un estudio descriptivo, observacional de corte transversal en el que se evaluaron variables sociodemográficas, antropométricas, estado nutricional, patrón alimentario y actividad física. Se incluyó un total de 58 médicos residentes de los cuales 66% fueron del sexo femenino, y la edad promedio fue de 28,12 años. Según el IMC, la mayoría presentó sobrepeso (34,5%). En cuanto a los patrones de alimentación, la mayoría no cumplía con las recomendaciones de las Guías Alimentarias del Paraguay de consumir 3 frutas por día ni de evitar alimentos ricos en grasas, sodio y altos en calorías como lo son las comidas rápidas. Se observó que 49% no realizaba actividad física. Los médicos residentes del Hospital General de Luque presentaron en su mayoría exceso de peso, tenían un patrón alimentario inadecuado y no realizaban actividad física.

ABSTRACT Resident physicians face changes in lifestyle, acquisition of inappropriate eating habits, influence of fashions, advertising and the need to belong to a social group, which is why they are at risk of being overweight and obese. Our objective was to determine the nutritional status, eating patterns and physical activity of the resident doctors of the General Hospital of Luque in 2019. A descriptive, observational cross-sectional study was carried out in which sociodemographic variables, anthropometric, nutritional status, eating pattern and physical activity were evaluated. A total of 58 resident physicians were included, of which 66% was female, and the average age was 28.12 years. According to the BMI, the majority were overweight (34.5%). Regarding eating patterns, most did not comply with the recommendations of the Paraguayan Dietary Guidelines of consuming 3 fruits per day or avoiding foods rich in fat, sodium and high in calories such as fast foods. It was observed that 49% did not perform physical activity. The resident physicians of the General Hospital of Luque were mostly overweight, had an inadequate eating pattern and did not perform physical activity.

Psychological factors of diet quality among rural populations of Latin America during the COVID-19 pandemic: a cross-sectional study.

INTRODUCTION: This study aimed to determine the relationship between symptoms of anxiety and/or anhedonia (inability to feel pleasure) and diet quality during confinement due to COVID-19 in rural populations in Latin America. METHODS: This was a multicentric, cross-sectional study. An online survey was applied, which included the Beck Anxiety Inventory, Snaith-Hamilton Pleasure Scale for assessing the presence of anhedonia, the Food Intake Questionnaire and sociodemographic questions. RESULTS: The study included 10 552 people from 11 countries; 708 participants were living in rural areas. More than half of the participants were quarantined at the time of the survey. Diet quality was inversely associated with anhedonia (p<0.001) and anxiety (p=0.003). In addition, a healthier diet was associated with being female (p=0.030), having a higher level of education (p=0.008) and country of residence (p=0.001). CONCLUSION: Among the rural population during the COVID pandemic, this study found a worse diet quality was associated with symptoms of anhedonia and anxiety, as well as lower level of education and being male. Proposals to improve the quality of the diet could include interventions aimed at people's mental health.