Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience.

The most important challenges in acute promyelocytic leukemia (APL) is preventing early death and reducing long-term events, such as second neoplasms (s-NPLs). We performed a retrospective analysis of 2670 unselected APL patients, treated with PETHEMA "chemotherapy based" and "chemotherapy free" protocols. Only de novo APL patients who achieved complete remission (CR) and completed the three consolidation cycles were enrolled into the analysis. Out of 2670 APL patients, there were 118 (4.4%) who developed s-NPLs with the median latency period (between first CR and diagnosis of s-NPL) of 48.0 months (range 2.8-231.1): 43.3 (range: 2.8-113.9) for s-MDS/AML and 61.7 (range: 7.1-231.1) for solid tumour. The 5-year CI of all s-NPLs was of 4.43% and 10 years of 7.92%. Among s-NPLs, there were 58 cases of s-MDS/AML, 3 cases of other hematological neoplasms, 57 solid tumours and 1 non-identified neoplasm. The most frequent solid tumour was colorectal, lung and breast cancer. Overall, the 2-year OS from diagnosis of s-NPLs was 40.6%, with a median OS of 11.1 months. Multivariate analysis identified age of 35 years (hazard ratio = 0.2584; p < 0.0001) as an independent prognostic factor for s-NPLs. There were no significant differences in CI of s-NPLs at 5 years between chemotherapy-based vs chemotherapy-free regimens (hazard ratio = 1.09; p = 0.932). Larger series with longer follow-up are required to confirm the potential impact of ATO+ATRA regimens to reduce the incidence of s-NPLs after front-line therapy for APL.

Characteristics and outcome of patients with acute myeloid leukemia and trisomy 4.

We retrospectively studied 125 patients with acute myeloid leukemia and trisomy 4 (median age at diagnosis, 58 years; range, 16-77 years) treated between 2000 and 2019 within a multicenter study. Trisomy 4 was the sole abnormality in 28 (22%) patients and additional abnormalities were present in 97 (78%) patients. Twenty-two (22%) and 15 (15%) of 101 tested patients harbored NPM1 and FLT3-ITD mutations. Two (3%) of 72 tested patients had double CEBPA mutations. Data on response to intensive anthracycline-based induction therapy were available for 119 patients. Complete remission was achieved in 67% (n=80) and the early death rate was 5% (n=6). Notably, patients with trisomy 4 as sole abnormality had a complete remission rate of 89%. Allogeneic hematopoietic cell transplantation was performed in 40 (34%) patients, of whom 19 were transplanted in first complete remission. The median follow-up of the intensively treated cohort was 5.76 years (95% confidence interval [95% CI]: 2.99-7.61 years). The 5-year overall survival and relapse-free survival rates were 30% (95% CI: 22-41%) and 27% (95% CI: 18-41%), respectively. An Andersen-Gill regression model on overall survival revealed that favorable-risk according to the European LeukemiaNet classification (hazard ratio [HR]=0.34; P=0.006) and trisomy 4 as sole abnormality (HR=0.41; P=0.01) were favorable factors, whereas age with a difference of 10 years (HR=1.15; P=0.11), female gender (HR=0.74; P=0.20) and allogeneic hematopoietic cell transplantation (HR=0.64; P=0.14) did not have an significant impact. In our cohort, patients with trisomy 4 as their sole abnormality had a high complete remission rate and favorable clinical outcome. Allogeneic hematopoietic cell transplantation did not seem to improve overall survival.

A risk score based on real-world data to predict early death in acute promyelocytic leukemia.

With increasingly effective treatments, early death (ED) has become the predominant reason for therapeutic failure in patients with acute promyelocytic leukemia (APL). To better prevent ED, patients with high-risk of ED must be identified. Our aim was to develop a score that predicts the risk of ED in a real-life setting. We used APL patients in the populationbased Swedish AML Registry (n=301) and a Portuguese hospital-based registry (n=129) as training and validation cohorts, respectively. The cohorts were comparable with respect to age (median, 54 and 53 years) and ED rate (19.6% and 18.6%). The score was developed by logistic regression analyses, risk-per-quantile assessment and scoring based on ridge regression coefficients from multivariable penalized logistic regression analysis. White blood cell count, platelet count and age were selected by this approach as the most significant variables for predicting ED. The score identified low-, high- and very high-risk patients with ED risks of 4.8%, 20.2% and 50.9% respectively in the training cohort and with 6.7%, 25.0% and 36.0% as corresponding values for the validation cohort. The score identified an increased risk of ED already at sub-normal and normal white blood cell counts and, consequently, it was better at predicting ED risk than the Sanz score (AUROC 0.77 vs. 0.64). In summary, we here present an externally validated and population-based risk score to predict ED risk in a real-world setting, identifying patients with the most urgent need of aggressive ED prevention. The results also suggest that increased vigilance for ED is already necessary at sub-normal/normal white blood cell counts.

Real-life data on safety and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma.

Autologous stem cell transplantation (ASCT) is still debatable in treatment of patients over 65 years with multiple myeloma (MM). We performed a retrospective analysis of newly diagnosed MM patients who underwent ASCT between January 2010 and July 2016. A non-transplanted group with similar clinical characteristics, aged 65-70 years old, diagnosed and treated in the same timeline was used for comparison. We analyzed a total of 155 patients, 132 of which underwent ASCT (≤ 65 years, n = 103, median 56 years; > 65 years, n = 29, median 67 years) and 23 non-transplanted (median 68 years). Conditioning consisted of melphalan 200 mg/m2 (MEL200) in younger patients and melphalan 140 mg/m2 (MEL140) in half of elderly patients. Stratifying by age, there were no statistically significant differences concerning transplant-related myelotoxicity and non-hematopoietic toxicity; however, elderly patients conditioned with MEL200 had higher needs of transfusional support and more days of intravenous antibiotics. Those patients also had higher needs of transfusional support, higher grade of mucositis (p = 0.028), and more days of intravenous antibiotics (p = 0.019) than the elderly transplanted with MEL140. Global transplant-related mortality was 3.8%. Survival was not influenced by age. Non-transplanted elderly patients had comparable disease features, and induction response was similar in both groups (before ASCT in the transplanted cohort). Survival of transplanted elderly patients was superior to non-transplanted (OS, 59 months vs 30 months, p = 0.037; EFS, 45 months vs 27 months, p = 0.014). Selected elderly patients when transplanted have similar disease response and survival as younger patients. A higher dose of melphalan has more toxicity, but it is globally a well-tolerated procedure.

New insights into the production, characterization and potential uses of vineyard pruning waste biochars.

Vineyard pruning waste (VP) can be converted into a useful char using pyrolysis as part of a valorization strategy. This study analyzed the effect of temperature (300 and 600 °C) and residence time (1 and 3 h) on an ample number of properties of VP derived biochars, including potential negative environmental impacts. The results showed a clear influence of temperature on biochar's properties and a weaker effect of residence time. Increasing temperature raised soil pH, electrical conductivity (EC), ash and C contents, aromaticity, specific surface area, solid density, mesoporosity and partial graphitization. However, higher pyrolysis temperature reduced O/C and N/C ratios, total N, P and Mg, and polycyclic aromatic hydrocarbons (PAHs). Particularly, the concentration of water extractable organic carbon (WEOC) decreased dramatically with pyrolysis temperature. Moreover, the WEOC fraction of biochars pyrolyzed at 300 °C exhibited a larger aromaticity than those pyrolyzed at 600 °C. Prolonged residence time increased ash content and fixed carbon (FC) and decreased H/C and O/C ratios; however, most frequently this parameter affected biochar properties following opposite trends for the two pyrolysis temperatures. Hydrophysical properties were adequate to consider VP derived biochars as growing media component. PAH concentration was much lower than thresholds following international standards. The germination index increased with temperature and decreased with residence time, so that phytotoxicity was observed in VP and in biochars pyrolyzed for 3 h. Our research demonstrates that, besides temperature, residence time can be useful to modulate the properties of biochars and that prolonged time effect is temperature-dependent.

Characteristics and Outcomes of Adult Patients in the PETHEMA Registry with Relapsed or Refractory FLT3-ITD Mutation-Positive Acute Myeloid Leukemia.

This retrospective study investigated outcomes of 404 patients with relapsed/refractory (R/R) FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) acute myeloid leukemia (AML) enrolled in the PETHEMA registry, pre-approval of tyrosine kinase inhibitors. Most patients (63%) had received first-line intensive therapy with 3 + 7. Subsequently, patients received salvage with intensive therapy (n = 261), non-intensive therapy (n = 63) or supportive care only (n = 80). Active salvage therapy (i.e., intensive or non-intensive therapy) resulted in a complete remission (CR) or CR without hematological recovery (CRi) rate of 42%. More patients achieved a CR/CRi with intensive (48%) compared with non-intensive (19%) salvage therapy (p < 0.001). In the overall population, median overall survival (OS) was 5.5 months; 1- and 5-year OS rates were 25% and 7%. OS was significantly (p < 0.001) prolonged with intensive or non-intensive salvage therapy compared with supportive therapy, and in those achieving CR/CRi versus no responders. Of 280 evaluable patients, 61 (22%) had an allogeneic stem-cell transplant after they had achieved CR/CRi. In conclusion, in this large cohort study, salvage treatment approaches for patients with FLT3-ITD mutated R/R AML were heterogeneous. Median OS was poor with both non-intensive and intensive salvage therapy, with best long-term outcomes obtained in patients who achieved CR/CRi and subsequently underwent allogeneic stem-cell transplant.

Treatment patterns and outcomes of 2310 patients with secondary acute myeloid leukemia: a PETHEMA registry study.

Secondary acute myeloid leukemia (sAML) comprises a heterogeneous group of patients and is associated with poor overall survival (OS). We analyze the characteristics, treatment patterns, and outcomes of adult patients with sAML in the Programa Español de Tratamientos en Hematología (PETHEMA) registry. Overall, 6211 (72.9%) were de novo and 2310 (27.1%) had sAML, divided into myelodysplastic syndrome AML (MDS-AML, 44%), MDS/myeloproliferative AML (MDS/MPN-AML, 10%), MPN-AML (11%), therapy-related AML (t-AML, 25%), and antecedent neoplasia without prior chemotherapy/radiotherapy (neo-AML, 9%). Compared with de novo, patients with sAML were older (median age, 69 years), had more Eastern Cooperative Oncology Group ≥2 (35%) or high-risk cytogenetics (40%), less FMS-like tyrosine kinase 3 internal tandem duplication (11%), and nucleophosmin 1 (NPM1) mutations (21%) and received less intensive chemotherapy regimens (38%) (all P < .001). Median OS was higher for de novo than sAML (10.9 vs 5.6 months; P < .001) and shorter in sAML after hematologic disorder (MDS, MDS/MPN, or MPN) compared with t-AML and neo-AML (5.3 vs 6.1 vs 5.7 months, respectively; P = .04). After intensive chemotherapy, median OS was better among patients with de novo and neo-AML (17.2 and 14.6 months, respectively). No OS differences were observed after hypomethylating agents according to type of AML. sAML was an independent adverse prognostic factor for OS. We confirmed high prevalence and adverse features of sAML and established its independent adverse prognostic value. This trial was registered at www.clinicaltrials.gov as #NCT02607059.

Loss of erythroblasts in acute myeloid leukemia causes iron redistribution with clinical implications.

Acute myeloid leukemia (AML) is a heterogeneous disease with poor prognosis and limited treatment strategies. Determining the role of cell-extrinsic regulators of leukemic cells is vital to gain clinical insights into the biology of AML. Iron is a key extrinsic regulator of cancer, but its systemic regulation remains poorly explored in AML. To address this question, we studied iron metabolism in patients with AML at diagnosis and explored the mechanisms involved using the syngeneic MLL-AF9-induced AML mouse model. We found that AML is a disorder with a unique iron profile, not associated with inflammation or transfusion, characterized by high ferritin, low transferrin, high transferrin saturation (TSAT), and high hepcidin. The increased TSAT in particular, contrasts with observations in other cancer types and in anemia of inflammation. Using the MLL-AF9 mouse model of AML, we demonstrated that the AML-induced loss of erythroblasts is responsible for iron redistribution and increased TSAT. We also show that AML progression is delayed in mouse models of systemic iron overload and that elevated TSAT at diagnosis is independently associated with increased overall survival in AML. We suggest that TSAT may be a relevant prognostic marker in AML.

Frailty syndrome, feelings of impotence and functional capacity in elderly patients with venous ulcers / Síndrome de fragilidade, sentimento de impotência e capacidade funcional em idosos portadores de úlcera venosa

Introduction: Chronic venous ulcers have a negative impact on the physical, psychic, and social domains, affecting the quality of life of patients, especially the elderly. This study aimed to assess frailty, functional capacity, and feelings of helplessness in older people with venous ulcers. Method: 112 older people were divided into two groups according to the presence or absence of venous ulcers. All patients were interviewed using the Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ20), and the Impotence Feelings Measurement Instrument (IMSI) from May 2017 to August 2018. Results: Regarding the EFS score, 76.8% of patients with venous ulcers were classified as vulnerable and frail, compared to 28.6% of patients in the group without ulcers. Scores on the HAQ-20 showed statistically significant differences between groups in all categories of the instrument, indicating that older people with venous ulcers had reduced general functional capacity compared to older people without ulcers. The mean IMSI score was 41.2 for the group with venous ulcers and 33.4 for the group without ulcers. Conclusion: Venous ulcers had a negative impact on functional capacity and increased frailty and feelings of powerlessness in the elderly.

Introdução: Úlceras venosas crônicas exercem impacto negativo nos domínios físico, psíquico e social, afetando a qualidade de vida de pacientes, especialmente os idosos. O objetivo deste estudo foi avaliar o nível de fragilidade, capacidade funcional e sentimento de impotência em idosos com úlcera venosa. Método: Um total de 112 idosos foram distribuídos em dois grupos de acordo com a presença ou ausência úlcera venosa. Todos os pacientes foram entrevistados utilizando-se os questionários Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ-20) e o Instrumento de Medida de Sentimento de Impotência (IMSI) no período de maio de 2017 a agosto de 2018. Resultados: Em relação à pontuação na EFS, 76,8% dos pacientes com úlcera venosa foram classificados como vulneráveis e frágeis, em comparação a 28,6% dos pacientes do grupo sem úlcera. Pontuações no HAQ-20 mostraram diferenças estatisticamente significantes entre os grupos em todas as categorias do instrumento, indicando que idosos com úlcera venosa apresentavam redução da capacidade funcional geral em comparação aos idosos sem úlcera. A pontuação média para o IMSI foi de 41,2 para o grupo com úlcera venosa e 33,4 para o grupo sem úlcera. Conclusão: Úlceras venosas causaram impacto negativo na capacidade funcional e aumento de fragilidade e sentimento de impotência nos idosos.

Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil.

The epidemiological, clinical and laboratory features of 13 cases of neuroparacoccidioidomycosis (NPCM) were analysed. All patients were men, with a mean age of 41.6 years. The lungs were involved in 11 cases (84.6%) and only two cases had mycosis limited to the central nervous system. Co-morbidity was observed in four patients (malignant neoplasm in three and diabetes mellitus in one). The most frequent neurological manifestations were paresis (eight cases), headache (five cases) and gait disturbance (four cases). Neuroimaging diagnosis showed a predominance of multiple round lesions with ring enhancement following contrast medium injection. Lesions were seen in the brain hemispheres (nine cases), thalamus (nine cases), cerebellum (four cases), brainstem (four cases) and spinal cord (four cases). Most cases responded well to therapy. Lesions with enhancement following contrast medium injection persisted in four patients for a period of 6 months to 8 years. These findings emphasize the importance of considering NPCM in the differential diagnosis of brain and spinal cord lesions in endemic areas of paracoccidioidomycosis.

Prevalence of mycobacterium tuberculosis among professionals in a university hospital, Mato Grosso do Sul, 2004.

Several studies have demonstrated an elevated prevalence amongst professionals of mycobacterium tuberculosis, both in the rate of infections and illness. This study was carried out in a School Hospital in Campo Grande, MS, Brazil, aiming to establish the prevalence of infection with Mycobacterium tuberculosis. The results of the analysis of 194 subjects showed an overall positivity for the tuberculin test of 38.7%. There was a correlation with smoking (p=0.01, RP=1. 72 (1.20-2.45- Yates's correction). The conclusion is that the establishment of a program of tuberculin screening jointly with the implementation of interventions is necessary in order to reduce the risk of nosocomial transmission.

[Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed in Mato Grosso do Sul]. / Paracoccidioidomicose: estudo clínico e epidemiológico de 422 casos observados no Estado de Mato Grosso do Sul.

Clinical and epidemiological features of 422 cases of paracoccidioidomycosis attended at University Hospital of Universidade Federal de Mato Grosso do Sul (Campo Grande, Mato Grosso do Sul, Brazil) from January 1980 to August 1999, were analysed. The mean age was 43.4 years old and the male: female ratio was 10:1. Nearly half (45.5%) of the patients were agricultural workers at the moment of diagnosis. In the acute/subacute form (juvenile type) the phagocytic-monocytic system was very much impaired and mainly marked by lymphadenopathy (95.4%), hepatomegaly (40%), splenomegaly (23.1%). The chronic form (adult type) presents more lesions in oropharynx (66.4%), dysphonia (31.4%) and cough (50.7%). Mycological diagnosis was obtained by direct microscopy of wet mounts in 185/365 (50.7%) patients and by histopathological examination of biopsies in 294/302 (97.3%) patients. The treatment of choice was Sulfamethoxazole/ trimethoprim (Co-trimoxazole), used in 90.3% patients. Sequelae occurred in 30.3% and death in 7.6% of the cases.

Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil.

OBJECTIVE: To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (HIV) infection. METHODS: The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with HIV attended at a University Hospital of Mato Grosso do Sul, Brazil, were evaluated. RESULTS: All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. Lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin B. Eight patients died with progressive PCM manifestations. CONCLUSION: Our review demonstrates that PCM, an endemic systemic mycosis in Brazil, when associated with AIDS, behaves clinically as an opportunistic disease.

Efeito booster na prova tuberculínica em um hospital universitário de Mato Grosso do Sul / Booster effect on tuberculin skin tests at a university hospital in Mato Grosso do Sul

A triagem tuberculínica tem por objetivo realizar o rastreio da infecção tuberculosa.Uma retestagem em uma a três semanas tem sido recomendada quandoa prova tuberculínica for < 10 mm na 1ª dose para averiguar a ocorrência do efeito booster. Quando a prova tuberculínica for < 10 mm na 1ª dose e, uma a três semanas depois, na 2ª dose, ocorrer uma enduração 10 mm com aumento de pelo menos 6 mm em relação à primeira dose, tem-se, então, o efeito booster. Este estudo teve como sujeitos os profissionais de saúde de um hospital universitário e foi realizado na cidade de Campo Grande-MS com o objetivo de estimar a taxa de efeito booster. Dentre os 194 participantes, 65 (33,5%) foram reatores fortes ao PPD na primeira testagem e 129 foram reatores fracos ou não-reatores. Estes foram submetidos a uma segunda testagem, na qual, em 10 (7,8%) observou-se o efeito booster. A prevalência da infecção tuberculosa, avaliadaem dois tempos, foi de 38,7%. Conclui-se que identificar o efeito boosterna triagem tuberculínica é importante sob pena de obter-se taxas subestimadas de infecção tuberculosa. Útil também no acompanhamento da infecção recente e na avaliação segura da viragem tuberculínica, reduzindo a probabilidade de falsos negativos, que de outra forma seriam erroneamente interpretados como profissionais recém-infectados.

Tuberculin screening aims at tracking tuberculosis infection. A one-to-threeweek retest has been recommended when the tuberculin test is <10 mm in the first dose to check booster effect occurrence. The booster phenomenon occurs when the tuberculin screening is <10 mm in the first dose and after the second dose, in three weeks time, there is a >10 mm induration with an increase compared to the first dose of at least 6 mm. This study, aimed at estimating booster effect rate, involved health professionals from a University hospital in Campo Grande, a town in the Brazilian state of Mato Grosso do Sul. Among the 194 participants, 65 (33,5%) were strong PPD reactors in the first test and 129 were weak or non-reactors. They went through a second test which revelled 10were reactors. Hence, the booster effect rate was 7,8%. In the two-step tuberculin test reactor tuberculosis infection prevalence was 38.7%. The authors concluded that identifying booster effect in tuberculin screening is important to avoid under estimated rates of tuberculosis infection. It is also important to follow up recently acquired infections and evaluate the results of tuberculin screening accurately to reduce the probability of false negative results, which would otherwise be misinterpreted as refering to recently infected health professionals.

Prevalence of mycobacterium tuberculosis among professionals in a university hospital, Mato Grosso do Sul, 2004 / Prevalência da infecção tuberculosa entre profissionais de um hospital universitário / Existencia de la infección tuberculosis entre profesionales de un hospital universitario en Mato Grosso do Sur, 2004

Several studies have demonstrated an elevated prevalence amongst professionals of mycobacterium tuberculosis, both in the rate of infections and illness. This study was carried out in a School Hospital in Campo Grande, MS, Brazil, aiming to establish the prevalence of infection with Mycobacterium tuberculosis. The results of the analysis of 194 subjects showed an overall positivity for the tuberculin test of 38.7 percent. There was a correlation with smoking (p=0.01, RP=1. 72 (1.20-2.45- Yates's correction). The conclusion is that the establishment of a program of tuberculin screening jointly with the implementation of interventions is necessary in order to reduce the risk of nosocomial transmission.

Vários estudos têm demonstrado prevalência elevada de infecção tuberculosa, tanto quanto de adoecimento, entre os profissionais de saúde. Este estudo, realizado em um Hospital Universitário, situado na cidade de Campo Grande, MS, teve como objetivo conhecer a prevalência de infecção pelo Mycobacterium tuberculosis entre esses profissionais. Na análise de 194 indivíduos, encontrou-se prevalência global de positividade da prova tuberculínica de 38,7 por cento. Observou-se associação com o tabagismo (p 0,01, e RP 1,72 (1,20-2,45) - corrigido por Yates). Conclui-se que é necessário estabelecer um programa de triagem tuberculínica de rotina para acompanhamento de viragem tuberculínica, juntamente, com a instituição de intervenções para reduzir o risco de transmissão nosocomial.

Varios estudios han demostrado la alta prevalencia de infección tuberculosis, y también de la propia enfermedad, entre los profesionales de salud. Este estudio, realizado en un Hospital Universitario ubicado en la ciudad de Campo Grande-MS, tuvo como objetivo conocer la existencia de la infección causada por el Mycobacterium tuberculosis. En el análisis de 194 personas, fue encontrada la existencia de la prueba tuberculinilla del 38,7 por ciento. Fue observada una asociación con el tabaquismo (p 0,01, y RP 1,72 (1,20-2,45) corregido por yates). Concluimos que es necesario un programa de selección tuberculinilla de rutina para acompañar el viraje tuberculínico, junto a intervenciones para reducir el riesgo de transmisión nosocomial.

Leiomioma intrabrônquico: relato de um caso com sete anos de evolução / Intrabronchial leiomyoma: report of a case with seven years of tumor evolution

Os autores relatam caso raro de tumor pulmonar benigno, o LEIOMIOMA INTRABRÕNQUICO, em paciente masculino de 33 anos de idade. O diagnóstico foi realizado por broncoscopia com biópsia do tumor, que apresentou intensa proliferação de células musculares lisas. A escolha terapêutica, após sete anos de evolução do tumor, foi a pneumectomia.

Prevalence of antibodies to hepatitis B core antigen in blood donors in the Middle West region of Brazil

The prevalence of antibodies to hepatitis B core antigen in 552 prime blood donors was of 9.4 percent. The majority (71.2 percent) has antibodies to hepatitis B surface antigen. The hepatitis B surface antigen was present in 0.7 percent, all of them antibodies to hepatitis B core antigen positive