Severe acute respiratory syndrome coronavirus 2 infection in patients with hematological malignancies in the Omicron era: Respiratory failure, need for mechanical ventilation and mortality in seronegative and seropositive patients.

Background: Patients with hematological malignancies (HM) have a high risk of severe coronavirus disease 2019 (COVID-19), also in the Omicron period. Material and methods: Retrospective single-center study including HM patients with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) infection from January 2022 to March 2023. Study outcomes were respiratory failure (RF), mechanical ventilation (MV), and COVID-related mortality, comparing patients according to SARS-CoV2 serology. Results: Note that, 112 patients were included: 39% had negative SARS-CoV2 serology. Seronegative were older (71.5 vs. 65.0 years, p = 0.04), had more often a lymphoid neoplasm (88.6% vs. 69.1%, p = 0.02), underwent anti-CD20 therapy (50.0% vs. 30.9% p = 0.04) and had more frequently a severe disease (23.0% vs. 3.0%, p = 0.02) than seropositive.Kaplan-Meier showed a higher risk for seronegative patients for RF (p = 0.014), MV (p = 0.044), and COVID-related mortality (p = 0.021). Negative SARS-CoV2 serostatus resulted in a risk factor for RF (hazards ratio [HR] 2.19, 95% confidence interval [CI] 1.03-4.67, p = 0.04), MV (HR 3.37, 95% CI 1.06-10.68, p = 0.04), and COVID-related mortality (HR 4.26, 95% CI 1.09-16.71, p = 0.04). Conclusions: : HM patients with negative SARS-CoV2 serology, despite vaccinations and previous infections, have worse clinical outcomes compared to seropositive patients in the Omicron era. The use of serology for SARS-CoV2 diagnosis could be an easy tool to identify patients prone to developing complications.

A rare case of necrotizing fasciitis of the leg in an intravenous drug user caused by Prevotella denticola.

Background: Intravenous drug users (IDUs) have a high risk of developing skin and soft tissue infections such as erysipelas, abscesses, and less frequently necrotizing fasciitis (NF) or gas gangrene. Rarely, the cause of the infection is microorganisms residing in the oral cavity and can lead to life-threatening infections. Methods: We describe the case of a 43-year-old man intravenous drug user (IDU) who was admitted for intense leg pain following an injection of cocaine at that site. Results: A clinical and radiological diagnosis of NF was made, so the patient was started on empirical antibiotic therapy and underwent surgical fasciotomy (after 8 hours from admission). Prevotella denticola was isolated from multiple intraoperative specimens and was resistant to initial antimicrobial therapy. The man, suffering from periodontal disease, reported sucking the syringe several times to unblock it. Both fasciotomy surgery and adjustment of antimicrobial therapy enabled therapeutic success. Conclusions: In IDUs the risk of deep skin and soft tissue infections is high and may be aggravated by contamination with oral microorganisms. The choice of empirical antibiotic treatment should include agents active against oral cavity anaerobes, such as P. denticola.

Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study.

BACKGROUND: Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. METHODS: A retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. RESULTS: A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). CONCLUSIONS: Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.

COVID-19 omicron variant outbreak in a hematopoietic stem cell transplant unit.

Recommendations and guidelines for management of SARS-COV-2 infection in hematologic patients were developed in the very difficult context of dealing with novel viral variants from one pandemic wave to another, with different susceptibility to available drugs and vaccines. Moreover, the largest SARS-COV-2 case series in patients treated for hematologic malignancies, including stem cell transplant recipients, was published before the Omicron surge, and refers mainly to Alpha and Delta viral variants. These infections had very high mortality, in a period when antivirals and monoclonal antibodies were mostly unavailable. Here, we report for the first time a SARS-COV-2 Omicron variant outbreak inside a Bone Marrow Transplant (BMT) Unit, describing the characteristics, clinical course, and infection outcomes shortly before and shortly after myeloablative transplantation. We detail how infections were treated off-label and managed inside the BMT ward, to guarantee the best possible outcomes while avoiding risks for non-infected inpatients. The positive outcomes observed suggest that it may not be absolutely necessary to obtain SARS-CoV-2 PCR negativity before BMT in hematologic patients after treated infection, in cases with long-term PCR positivity and high-risk hematologic disease.

A Fatal Case of Pseudomonas aeruginosa Community-Acquired Pneumonia in an Immunocompetent Patient: Clinical and Molecular Characterization and Literature Review.

Rare cases of Pseudomonas aeruginosa community-acquired pneumonia (PA-CAP) were reported in non-immunocompromised patients. We describe a case of Pseudomonas aeruginosa (PA) necrotizing cavitary CAP with a fatal outcome in a 53-year-old man previously infected with SARS-CoV-2, who was admitted for dyspnea, fever, cough, hemoptysis, acute respiratory failure and a right upper lobe opacification. Six hours after admission, despite effective antibiotic therapy, he experienced multi-organ failure and died. Autopsy confirmed necrotizing pneumonia with alveolar hemorrhage. Blood and bronchoalveolar lavage cultures were positive for PA serotype O:9 belonging to ST1184. The strain shares the same virulence factor profile with reference genome PA01. With the aim to better investigate the clinical and molecular characteristics of PA-CAP, we considered the literature of the last 13 years concerning this topic. The prevalence of hospitalized PA-CAP is about 4% and has a mortality rate of 33-66%. Smoking, alcohol abuse and contaminated fluid exposure were the recognized risk factors; most cases presented the same symptoms described above and needed intensive care. Co-infection of PA-influenza A is described, which is possibly caused by influenza-inducing respiratory epithelial cell dysfunction: the same pathophysiological mechanism could be assumed with SARS-CoV-2 infection. Considering the high rate of fatal outcomes, additional studies are needed to identify sources of infections and new risk factors, along with genetic and immunological features. Current CAP guidelines should be revised in light of these results.

Persistent SARS-CoV-2 infection with multiple clinical relapses in two patients with follicular lymphoma treated with bendamustine and obinutuzumab or rituximab.

PURPOSE: People with hematologic malignancies have a significantly higher risk of developing severe and protracted forms of SARS-CoV-2 infection compared to immunocompetent patients, regardless of vaccination status. RESULTS: We describe two cases of prolonged SARS-CoV-2 infection with multiple relapses of COVID-19 pneumonia in patients with follicular lymphoma treated with bendamustine and obinutuzumab or rituximab. The aim is to highlight the complexity of SARS-CoV-2 infection in this fragile group of patients and the necessity of evidence-based strategies to treat them properly. CONCLUSIONS: Patients with hematological malignancies treated with bendamustine and anti-CD20 antibodies had a significant risk of prolonged and relapsing course of COVID-19. Specific preventive and therapeutic strategies should be developed for this group of patients.

Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study.

OBJECTIVE: To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. PATIENTS AND METHODS: A prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Israel and Italy. Hospitalized patients with Gram-negative bacteremia who survived until day 90 and were not bedridden at baseline were included. The primary end point was functional decline at 90 days. RESULTS: Five hundred and nine patients were included. The median age of the cohort was 71 years (interquartile range [IQR], 60-80 years), 46.4% (236/509) were male and 352 of 509 (69%) patients were independent at baseline. Functional decline at 90 days occurred in 24.4% of patients (124/509). In multivariable analysis; older age (odds ratio [OR], 1.03; for an one-year increment, 95% confidence interval [CI] 1.01-1.05), functional dependence in instrumental activities of daily living at baseline (OR, 4.64; 95% CI 2.5-8.6), low Norton score (OR, 0.87; 95% CI 0.79-0.96) and underlying comorbidities: cancer (OR, 2.01; 95% CI 1.14-3.55) and chronic pulmonary disease (OR, 2.23 95% CI 1.12-4.42) and longer length of hospital stay (OR 1.09; for one-day increment, 95% CI 1.04-1.15) were associated with functional decline. Appropriate empirical antibiotic treatment was associated with lower rates of functional decline within 90 days (OR, 0.4; 95% CI 0.21-0.78). CONCLUSIONS: Patients surviving bloodstream infections have poor long term trajectories after clinical recovery and hospital discharge. This has vast implications for patients, their family members and health policy makers.

Como vaga-lumes na escuridão: histórias de adolescentes em instituição de acolhimento / Como luciérnagas en la oscuridad: historias de adolescentes en una institución de acogida / As fireflies in the darkness: stories about adolescents in the shelter care

O artigo apresenta e analisa histórias de vida produzidas a partir de uma experiência realizada com meninas adolescentes em uma instituição do Sul do Brasil. A pesquisa buscou compreender como essas jovens em situação de acolhimento institucional atribuem sentidos às suas vivências e quais processos de subjetivação estão implicados nesses sujeitos marcados pela infâmia. O trabalho está articulado à esfera da Proteção Social Especial e faz uso de algumas chaves de leitura de Michel Foucault para pensar as experiências vivenciadas pelas adolescentes, bem como as relações que atravessam grande parte das instituições de acolhimento brasileiras. Faremos esse exercício analítico com o uso da governamentalidade e da subjetivação. Para compor as histórias de vida inspiradas nos encontros desenvolvidos com as duas participantes da pesquisa, utilizamos o método da cartografia, desenvolvido por Gilles Deleuze e Félix Guattari. A partir desta experiência, problematizamos os efeitos do processo de acolhimento institucional e fomos desafiadas pelas outras possibilidades de resistência e de produção de subjetividades na adolescência.(AU)

The article presents and analyses life stories produced from an experience with adolescents in an institution in Southern Brazil. The research sought to understand how these young people living in out-of-home care attribute meanings to their experiences, and which ways of subjectivation are implicated in these blokes marked by infamy. The work is articulated to the sphere of Special Social Protection and makes use of some keys of reading of Michel Foucault to think about the experiences lived by these adolescents, as well as the relations that cross great part of the Brazilian shelter cares. We will do this analytical exercise with the use of governmentality and subjectivation. To compose the life stories inspired by the meetings developed with the two participants of the research, we used the method of cartography, developed by Gilles Deleuze and Félix Guattari. From this experience, we problematize the effects of the shelter care process and are challenged by the other possibilities of resistance and the production of subjectivities in adolescence.(AU)

El artículo presenta y analiza historias de vida producidas a partir de una experiencia realizada con chicas adolescentes en una institución del sur de Brasil. La investigación buscó comprender cómo estas mujeres jóvenes en situaciones de acogimiento institucional atribuyen significados a sus vivencias y qué procesos de subjetivación están involucrados en estos sujetos marcados por la infamia. El trabajo está vinculado al ámbito de la Protección Social Especial y hace uso de algunas claves de lectura de Michel Foucault para reflexionar sobre las vivencias vividas por las chicas adolescentes, así como las relaciones que permean la mayoría de las instituciones de acogida brasileñas. Haremos este ejercicio analítico utilizando la gobernamentalidad y subjetivación. Para componer las historias de vida inspiradas en los encuentros desarrollados con dos participantes de la investigación, utilizamos el método de la cartografía, desarrollado por Gilles Deleuze y Félix Guattari. A partir de esta experiencia, problematizamos los efectos del proceso de acogimiento institucional y fuimos desafiados por otras posibilidades de resistencia y producción de subjetividades en la adolescencia.(AU)

O ato de narrar e a produção de conhecimento em psicologia social / The act of narrating and the production of knowledge in social psychology / El acto de narrar y la producción de conocimiento en psicología social

Este artigo tem como objetivo discutir possibilidades teóricas no que tange às narrativas de mulheres, dando a ver um ensaio composto por plurais vozes. Partimos do campo da Psicologia Social, a fim de pluralizar suas referências diante daquilo que incide do/no tempo presente e que permeia as discussões pertinentes aos estudos de gênero. Para tanto, buscamos dialogar com autores e autoras que não costumam frequentar as páginas de textos desta área, tais como Conceição Evaristo. Nossa aposta metodológica pauta-se na ideia de narrar enquanto meio de produção de histórias de mulheres que, por sua vez, produzem conhecimento; elegemos um viés interseccional, numa discussão que leve em conta marcadores de raça, gênero e classe social. Deste modo, pactuamos com a ideia de que a produção de conhecimento em Psicologia possa se dar pela produção de novas narrativas, nas quais estas mulheres sejam reconhecidas como protagonistas e porta-vozes de suas próprias histórias.

This article aims to discuss theoretical possibilities regarding women's narratives, presenting an essay composed of plural voices, starting from the field of Social Psychology, in order to pluralize their references in face of what affects / at the present time and which permeates the pertinent discussions to gender studies. Therefore, we seek to start a conversation with authors who do not usually partake on texts in this area, such as Conceição Evaristo. Our methodology focus is based on the idea of narration as a mean of reproducing stories of women who, in turn, generates knowledge; we present their narratives through an intersectional bias, whether in a discussion that takes into account markers of race, gender and/or social class. As such, we agree with the idea that generating knowledge in Psychology can happen through bringing to light new narratives, in which these women are recognized as protagonists and spokespeople of their own stories.

Este artículo tiene como objetivo discutir posibilidades teóricas con respecto a las narrativas de mujeres, mostrando un ensayo compuesto de voces plurales. Comenzamos, por lo tanto, desde el campo de la psicología social, para pluralizar sus referencias frente a lo que afecta / en la actualidad y lo que impregna las discusiones pertinentes a los estudios de género. Por lo tanto, buscamos dialogar con autores que generalmente no visitan las páginas de textos en esta área, como Conceição Evaristo. Nuestro enfoque metodológico se basa en la idea de narrar como un medio para producir historias de mujeres que, a su vez, producen conocimiento; presentamos sus narrativas a través de un sesgo interseccional, ya sea en una discusión que tenga en cuenta los marcadores de raza, género y clase social. De esta manera, estamos de acuerdo con la idea de que la producción de conocimiento en Psicología puede ocurrir a través de la producción de nuevas narrativas, en las que estas mujeres son reconocidas como protagonistas y portavoces de sus propias historias.

Um céu estrelado. Como acreditar em um mundo sem nós? Manifesto memória como céu de amor irreversível / A starry sky. How to believe in a world without us? Manifest memory as a sky of irreversible love / Un cielo estrellado. ¿Cómo creer en un mundo sin nosotros? Manifiesto memoria como cielo de amor irreversible

Este texto foi escrito pelos integrantes do grupo de pesquisa Corpo, Arte e Clínica após o falecimento de nossa querida orientadora, professora e amiga Tania Mara Galli Fonseca, cuja presença em nossas vidas deixa marcas da ordem do indizível. O texto foi lido em voz alta junto à comunidade acadêmica no evento Temas em Debate, em 25/10/2019. Na plateia havia pessoas que a admiravam e amavam, tanto por sua pessoa quanto por seu significativo trabalho de escrita e pesquisa, sua incessante produção de pensamento diante dos mais sensíveis pulsares revolucionários da vida coletiva. Para quem endereçaríamos nossas escritas dali para frente? - nos perguntávamos uns aos outros. Com vozes embargadas de saudade e dor, em torno de pequenas luzes que brilhavam como vagalumes na escuridão, dedicamos à Tania esse texto. Escrito a muitas mãos, assim como ela nos ensinou, buscamos palavras para homenageá-la ao colocarmos nossa saudade em movimento.

This text was written by the members of the research group Corpo, Arte e Clínica after the passing of our dear supervisor, teacher and friend Tania Mara Galli Fonseca, whose presence in our lives leaves marks of the unspeakable. The text was read aloud along with the academic community at the Themes in Debate event, on 10/25/2019. In the audience there were people who admired and loved her, due to both for her person and also for her significant work of writing and research, her incessant production of thought in the face of the most sensitive revolutionary pulsars of collective life. To whom would we address our writings from now on? - we asked each other. With voices choked with longing and pain, around small lights that shone like fireflies in the darkness, we dedicate this text to Tania. Written by many hands, just as she taught us, we look for words to honor her by putting our longing in motion.

Este texto fue redactado por los integrantes del grupo de investigación Corpo, Arte e Clínica tras el fallecimiento de nuestra querida supervisora, profesora y amiga Tania Mara Galli Fonseca, cuya presencia en nuestras vidas deja huellas de lo indecible. El texto fue leído en voz alta junto con la comunidad académica en el evento Temas em Debate, el 25/10/2019. En el público había gente que la admiraba y amaba, tanto por su persona como por su importante labor de escritura e investigación, su incesante producción de pensamiento frente a los púlsares revolucionarios más sensibles de la vida colectiva. ¿A quién dirigiremos nuestros escritos de ahora en adelante? - nos preguntamos el uno al otro. Con voces sofocadas por el anhelo y el dolor, alrededor de lucecitas que brillan como luciérnagas en la oscuridad, dedicamos este texto a Tania. Escrito por muchas manos, como ella nos enseñó, buscamos palabras para honrarla, poniendo en movimiento nuestro anhelo.

Efficient T-Cell Compartment in HIV-Positive Patients Receiving Orthotopic Liver Transplant and Immunosuppressive Therapy.

BACKGROUND: In patients undergoing orthotopic liver transplant (OLT), immunosuppressive treatment is mandatory and infections are leading causes of morbidity/mortality. Thus, it is essential to understand the functionality of cell-mediated immunity after OLT. The aim of the study was to identify changes in T-cell phenotype and polyfunctionality in human immunodeficiency virus-positive (HIV+) and -negative (HIV-) patients undergoing immunosuppressive treatment after OLT. METHODS: We studied peripheral blood mononuclear cells from 108 subjects divided into 4 groups of 27: HIV+ transplanted patients, HIV- transplanted patients, HIV+ nontransplanted patients, and healthy subjects. T-cell activation, differentiation, and cytokine production were analyzed by flow cytometry. RESULTS: Median age was 55 years (interquartile range, 52-59 years); the median CD4 count in HIV+ patients was 567 cells/mL, and all had undetectable viral load. CD4+ and CD8+ T-cell subpopulations showed different distributions between HIV+ and HIV- OLT patients. A cluster representing effector cells expressing PD1 was abundant in HIV- transplanted patients and they were characterized by higher levels of CD4+ T cells able to produce interferon-γ and tumor necrosis factor-α. CONCLUSIONS: HIV- transplanted patients have more exhausted or inflammatory T cells compared to HIV+ transplanted patients, suggesting that patients who have already experienced a form of immunosuppression due to HIV infection respond differently to anti-rejection therapy.

Comparison of two perioperative antibiotic schedules in patients undergoing surgical reconstruction with dermal matrix after excision of skin cancer.

Perioperative antibiotic treatment duration in skin reconstruction with dermal substitutes is not well established. This study compares the incidence of infective complications after two different durations of perioperative antibiotic treatment in patients undergoing surgical reconstruction with skin dermal substitutes (SDS) after excision of skin cancer. Infective complications at the site of SDS were compared in subjects undergoing surgical reconstruction who received either a > 24-hour (extended protocol) or a ≤ 24-hour (short protocol) perioperative antibiotic treatment. Of 116 patients undergoing SDS surgical reconstruction, 62 (53.4%) received an extended schedule, and 54 (46.6%) received a short schedule. The two groups were similar for gender, age, comorbidities, American Society of Anesthesiologists score, and type of skin cancer. Overall incidence rate of infection was 20.7% (24/116). No differences in terms of risk of infection were observed between the two groups (OR: 1.04, 95% CI: 0.42-2.55; P = .937). Patients undergoing SDS reconstruction in the limb/foot had a higher risk of infection in comparison with those undergoing SDS reconstruction in the chest/head (OR: 2.69, 95% CI: 1.06-6.86; P = .038). The short protocol was demonstrated to be beneficial to patients undergoing surgical reconstruction with SDS. A ≤ 24-hour perioperative antibiotic schedule did not increase the infection rate, potentially allowing a reduction of antibiotic exposure.

Not just minor resections: robotic approach for cystic echinococcosis of the liver.

INTRODUCTION: Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections. METHODS: We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers. RESULTS: 15 patients were included in this study, median age 51 years (24-76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50-550 ml), and median operative time including docking was 210 min (95-590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment. CONCLUSIONS: In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called "difficult segments", with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.

Perder-se na cidade, encontrair-se com o tempo / Getting lost in the city at a meeting duration: from instant to the archive space / Se pierde em la ciudade, se-encontra-er con el tiempo: de los instantes ao espacio del archivo

Através de um percurso à deriva, provocado pelo encontro com as imagens intensivas da cidade, buscamos delinear neste artigo, questões relativas à experiência do olhar e da sua possibilidade em extrapolar o campo do visível para encontrar elementos presencialmente ocultos, elementos tais, que guardam a capacidade de se tornarem visuais quando coadunam as linhas do passado com as do presente. Neste caso, tratamos da experiência, como arquivistas, no Acervo da Oficina de Criatividade do Hospital Psiquiátrico São Pedro de Porto Alegre (RS), no qual estabelecemos conexões entre o espaço e os conceitos referentes ao olhar em sua relação com o tempo enquanto memória e esquecimento, surgindo como uma possibilidade de habitar e compor-se com os arquivos de imagens que ali são produzidos.(AU)

Drifting through a flow of intensive images of the city, this research aims to investigate issues related to the experience of the look, considering its potential to extrapolate the realm of visibility and find elements that are actively concealed. Elements that become visible when incorporate lines of past and present. In this study, the work as archivists in the collection of Creativity Workshop of São Pedro Psychiatric Hospital in Porto Alegre (RS) allowed the establishment of connections between space and other concepts regarding perspective, memory and oblivion. The research observated how one can set itself and reside in the image files that are produced in the workshop.(AU)

Através de un recorrido a la deriva, provocado por el encuentro con las imágenes intensivas de la ciudad, buscamos delinear en este artículo, cuestiones relativas a la experiencia de la mirada y de su posibilidad en extrapolar el campo de lo visible para encontrar elementos presencialmente ocultos, elementos tales, que guardan la luz La capacidad de volverse visual cuando coinciden las líneas del pasado con las del presente. En este caso, tratamos de la experiencia, como archivistas, en el Acervo del Taller de Creatividad del Hospital Psiquiátrico São Pedro de Porto Alegre (RS), en el que establecemos conexiones entre el espacio y los conceptos referentes a la mirada en su relación con el tiempo como memoria y El olvido, surgiendo como una posibilidad de habitar y componerse con los archivos de imágenes que allí se producen.(AU)

Immunophenotypic profile and clinical outcome of monoclonal B-cell lymphocytosis in kidney transplantation.

Monoclonal B-cell lymphocytosis (MBL) is a lymphoproliferative disorder characterized by clonal expansion of a B-cell population in peripheral blood of otherwise healthy subjects. MBL is divided into CLL (chronic lymphocytic leukemia)-like, atypical CLL-like and non-CLL MBL. The aim of this study was to evaluate immunophenotypic characteristics and clinical outcomes of MBL in kidney transplant (KT) recipients. We retrospectively evaluated 593 kidney transplant (KT) recipients in follow-up at our center. Among them, 157 patients underwent peripheral blood flow cytometry for different clinical indications. A 6-color panel flow cytometry was used to diagnose MBL. This condition was detected in 5 of 157 KT recipients. Immunophenotypic characterization of MBL showed four cases of non-CLL MBL and one case of CLL-like MBL. At presentation, median age was 65 years (range 61-73). After a median follow-up of 3.1 years (95%CI; 1.1-5) from diagnosis, patients did not progress either to CLL or to lymphoma. The disorder did not increase the risk of malignancy, severe infections, graft loss and mortality among our KT recipients. Surprisingly, all cases were also affected by concomitant monoclonal gammopathy of undetermined significance, which did not progress to multiple myeloma during follow-up. In conclusion, our data suggest that MBL is an age-related disorder, with non-CLL MBL being the most common subtype among KT recipients.

Clinical Utility of Epstein-Barr Virus Viral Load Monitoring and Risk Factors for Posttransplant Lymphoproliferative Disorders After Kidney Transplantation: A Single-Center, 10-Year Observational Cohort Study.

BACKGROUND: Posttransplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality in solid organ transplants. Epstein Barr virus (EBV) plays a major role in PTLD development. Guidelines recommend EBV viral load (VL) monitoring in high-risk populations in the first year. METHODS: Retrospective observational study in all adult patients who had at least 1 EBV-VL performed in the postkidney transplant (KT) period from January 2005 to December 2014 at the Policlinico Modena Hospital. We compared patients with negative EBV-DNA to patients with positive EBV-DNA and we described PTLD developed in the study period. RESULTS: One hundred ninety (36.3%) KT patients of 523 were screened for EBV-DNA with 796 samples. One hundred twenty-eight (67.4%) of 190 tested patients presented at least 1 positive sample for EBV. Older age, the use of sirolimus, everolimus, and steroids were associated with EBV-DNA positivity in the univariate analysis. Nine (1.7%) of 523 patients had PTLD. Incidence rate of PTLD in the KT cohort was 0.19/100 person year follow-up (95% confidence interval, 0.09-0.37). One of 9 patients developed early PTLD and was a high-risk patient. Only this PTLD case was positive for EBV. No PTLD case had an EBV-VL superior to 4000 copies/mL. CONCLUSIONS: Our results suggest that the keystone of PTLD diagnosis is the clinical suspicion. Our study suggests that, in line with guidelines, EBV-VL assays may be avoided in low-risk patients in the absence of a strong clinical PTLD suspicion without increasing patients' risk of developing PTLD. This represents a safe and cost-saving clinical strategy for our center.

Arte e loucura como limiar para outra história / Art et folie comme le seuil pour autre histoire / Arte y locura como el umbral para otra historia / Art and madness as the threshold for another history

Pretendemos problematizar arte e loucura, inicialmente discutindo a experiência do pesquisador em relação às imagens do mundo, com o testemunho e a figura do louco e, consequentemente, com o fora que ela evoca. Em seguida nos colocamos diante do muro, situação-limite na qual a loucura enquanto catástrofe e a arte enquanto via poética vêm compor um limiar, ausência que Blanchot transpõe à linguagem para dar a ver outras constelações possíveis, tanto de palavras quanto de seus inomináveis. Por fim, com Walter Benjamin, pomos a história da loucura a contrapelo, e, mergulhados no Ateliê de Escrita do Hospital Psiquiátrico São Pedro, desvelamos que a arte pode, na relação com a loucura, tornar-se a linguagem essencial na perigosa travessia em direção à experiência, transpondo a vivência desse estado assustador para trazer ao mundo outro sentido, reconhecendo outros modos de existência que podem vir a ser outras poéticas de vida.

Nous désirons problématiser l´art et la folie, initialement en discutant l´expérience du chercheur par rapport aux images du monde, avec le témoignage et l´image du fou, et, par conséquent, l´extérieur qu´elle évoque. Puis, on se pose devant le mur, situation extrême dans laquelle la folie comme catastrophe et l´art comme voie poétique composent un seuil viennent à construire un seuil, absence que Blanchot transpose en langage afin de révéler d´autres constellations possibles tant comme des mots, tant comme ses innombrables. Enfin, avec Walter Benjamin, nous prenons l´histoire de la folie à contre-poil, et plongés dans l´Atelier d´écriture de l´Hôpital psychiatrique de São Pedro, à Porto Alegre au Brésil, nous révélons que l´art, par rapport à la folie, peut devenir le langage essentiel de la traversée dangereuse vers l´expérience, en transposant le vécu de cet état terrifiant, afin de donner un autre sens au monde, tout en reconnaissant d´autres modes d´existence qui pourraient devenir d´autres poétiques de vie.

Nuestra intención es de problematizar el arte y la locura, inicialmente discutiendo la experiencia del investigador en relación con las imágenes del mundo, el testimonio y la figura del loco, y por lo tanto con el afuera que ella evoca. Seguidamente, nos ponemos delante de un muro, una situación extrema en la que la locura como catástrofe y el arte como vía poética componen un umbral, una ausencia que Blanchot transpone en lenguaje para revelar las otras constelaciones posibles tanto como palabras, tanto como innombrables otros. Por último, con Walter Benjamin, ponemos la historia de la locura a contra pelo, y sumergidos en el Taller de escritura del Hospital Psiquiátrico São Pedro de Porto Alegre, Brasil, desvelamos que, en relación con la locura, el arte puede convertirse en el lenguaje esencial de ese peligroso pasaje que nos conduce a la experiencia, que transpone lo vivido en este estado aterrador para dar otro sentido al mundo, reconociendo otros modos de existencia que pueden llegar a ser otras poéticas de vida.

We intend to problematize art and madness. We begin by discussing the experience of the researcher in relation to images of the world, to witnessing and to the image of the insane, and then inevitably to the outside they evoke. Subsequently, we stand before a wall, a limit situation in which madness as catastrophe and art as poetics compose a threshold, an absence which Blanchot transposes to language to bring other possible constellations into view, both as words and as their unnamable others. Finally, with Walter Benjamin, we touch upon the grain of the history of madness - immersed in the Writing Workshop at the São Pedro Psychiatric Hospital, in Porto Alegre, Brazil, we reveal that, in relation to madness, art can become the essential language of the perilous passage towards experience, transposing the experience of this horrific state to bring another sense to the world, recognizing other modes of existence which may come to be other poetics of life.