Elements for assistance to patients with hematological malignancies to propose care lines: a scoping review.

OBJECTIVES: to identify the elements for assistance to patients with hematological malignancies to propose a care line. METHODS: this is a scoping review, anchored in the JBI theoretical framework, with searches carried out in April 2021, in eight electronic databases and 10 repositories of theses and dissertations. RESULTS: the final sample consisted of 93 studies, and the main forms of assistance provided that can support a care line for this public were imaging tests, immunophenotyping, chemotherapy regimens, radiotherapy, infection management, assessment of nutritional status, maintenance of oral function, symptom management and screening for second malignancies. CONCLUSIONS: the elaboration of a care line for onco-hematologic patients is necessary, considering the complexity surrounding the diagnosis and treatment of hematologic malignancies, in addition to the difficulties that are imposed in relation to access and continuity of care in the network.

Elements for assistance to patients with hematological malignancies to propose care lines: a scoping review / Elementos de asistencia a pacientes con neoplasias hematológicas para proponer líneas de atención: revisión de alcance / Elementos para assistência a pacientes com neoplasias hematológicas para propor linhas de cuidado: scoping review

ABSTRACT Objectives: to identify the elements for assistance to patients with hematological malignancies to propose a care line. Methods: this is a scoping review, anchored in the JBI theoretical framework, with searches carried out in April 2021, in eight electronic databases and 10 repositories of theses and dissertations. Results: the final sample consisted of 93 studies, and the main forms of assistance provided that can support a care line for this public were imaging tests, immunophenotyping, chemotherapy regimens, radiotherapy, infection management, assessment of nutritional status, maintenance of oral function, symptom management and screening for second malignancies. Conclusions: the elaboration of a care line for onco-hematologic patients is necessary, considering the complexity surrounding the diagnosis and treatment of hematologic malignancies, in addition to the difficulties that are imposed in relation to access and continuity of care in the network.

RESUMEN Objetivos: identificar los elementos para la asistencia a pacientes con neoplasias hematológicas para proponer una línea de atención. Métodos: se trata de una revisión de alcance, anclada en el marco teórico del JBI, con búsquedas realizadas en abril de 2021 en ocho bases de datos electrónicas y 10 repositorios de tesis y disertaciones. Resultados: la muestra final estuvo compuesta por 93 estudios, y las principales formas de asistencia brindadas que pueden sustentar una línea de atención a este público fueron pruebas de imagen, inmunofenotipificación, regímenes de quimioterapia, radioterapia, manejo de infecciones, evaluación del estado nutricional, mantenimiento de la función oral, manejo de síntomas y detección de segundas neoplasias malignas. Conclusiones: es necesario el desarrollo de una línea de atención al paciente oncohematológico, dada la complejidad que rodea al diagnóstico y tratamiento de las neoplasias hematológicas, además de las dificultades que se imponen en relación al acceso y continuidad de la atención en una red.

RESUMO Objetivos: identificar os elementos para assistência a pacientes com neoplasias hematológicas para propor uma linha de cuidado. Métodos: trata-se de uma scoping review, ancorada no referencial teórico do JBI, com buscas realizadas em abril de 2021 em oito bases de dados eletrônicas e 10 repositórios de teses e dissertações. Resultados: a amostra final foi composta por 93 estudos, e as principais formas de assistências prestadas que podem embasar uma linha de cuidado para esse público foram exames de imagem, imunofenotipagem, regimes quimioterápicos, radioterapia, gestão de infecções, avaliação do estado nutricional, manutenção da função oral, gerenciamento de sintomas e rastreio para segundas neoplasias. Conclusões: a elaboração de uma linha de cuidados para pacientes onco-hematológicos se faz necessária, tendo em vista a complexidade que cerca o diagnóstico e tratamento das neoplasias hematológicas, além das dificuldades que se impõem em relação ao acesso e continuidade do cuidado em rede.

Community acceptability to antimalarial mass drug administrations in Magude district, Southern Mozambique: A mixed methods study.

BACKGROUND: This study aimed to capture the acceptability prior to, during and after the implementation of the first year of MDA rounds conducted under the Magude project, a malaria elimination project in southern Mozambique. METHODS: This was a mixed-methods study, consisting of focus group discussions (FGDs) prior to the implementation of MDA rounds (September 2015), non-participant observations (NPOs) conducted during the MDA rounds (November 2015 -beginning of February 2016), and semi-structured interviews (SSIs) after the second round (end of February 2016). Community leaders, women in reproductive age, general members of the community, traditional healers and health professionals were recruited to capture the opinions of all representing key members of the community. A generic outline of nodes and codes was designed to analyze FGDs and SSI separately. Qualitative and quantitative NPO information was analyzed following a content analysis approach. FINDINGS: 222 participants took part in the FGDs (n = 154), and SSIs (n = 68); and 318 household visits during the MDA underwent NPOs. The community engagement campaign emerged throughout the study stages as a crucial factor for the acceptability of MDAs. Acceptability was also fostered by the community's general will to cooperate in any government-led activity that would reduce malaria burden, the appropriate behavior and knowledge of field workers, or the fact that the intervention was available free of charge to all. Absenteeism of heads of households was identified as the main barrier for the success of the campaign. The most commonly reported factors that negatively affected acceptability were the fear of adverse events, rumors of deaths, being unable to drink alcohol while taking DHAp, or the fear to take DHAp while in anti-retroviral treatment. Pregnancy testing and malaria testing were generally well accepted by the community. CONCLUSION: Magude's community generally accepted the first and second antimalarial MDA rounds, and the procedures associated to the intervention. Future implementation of antimalarial MDAs in southern Mozambique should focus on locally adapted strategies that engage the community to minimize absenteeism and refusals to the intervention.

Community acceptability to antimalarial mass drug administrations in Magude district, Southern Mozambique: A mixed methods study

Background This study aimed to capture the acceptability prior to, during and after the implementation of the first year of MDA rounds conducted under the Magude project, a malaria elimination project in southern Mozambique. Methods This was amixed-methods study, consisting of focus group discussions (FGDs) prior to the implementation of MDA rounds (September 2015), non-participant observations (NPOs) conducted during the MDA rounds (November 2015 ­beginning of February 2016), and semi-structured interviews (SSIs) after the second round (end of February 2016). Community leaders, women in reproductive age, general members of the community, traditional healers and health professionals were recruited to capture the opinions of all representing key membersofthecommunity. A generic outline of nodes and codes was designed to analyze FGDsandSSIseparately. Qualitative and quantitative NPO information was analyzed following a content analysis approach. Findings 222participants took part in the FGDs (n = 154), and SSIs (n = 68); and 318 household visits during the MDAunderwent NPOs.Thecommunityengagement campaign emerged throughout the study stages as a crucial factor for the acceptability of MDAs. Acceptability wasalso fostered by the community's general will to cooperate in any government-led activity that would reduce malaria burden, the appropriate behavior and knowledge of field workers, or the fact that the intervention was available free of charge to all. Absenteeism of heads of households was identified as the main barrier for the success of the campaign. The most commonly reported factors that negatively affected acceptability were the fear of adverse events, rumors of deaths, being unable to drink alcohol while taking DHAp, or the fear to take DHAp while in anti-retroviral treatment. Pregnancy testing and malaria testing were generally well accepted by the community. Conclusion Magude's community generally accepted the first and second antimalarial MDA rounds, and the procedures associated to the intervention. Future implementation of antimalarial MDAs in southern Mozambique should focus on locally adapted strategies that engage the community to minimize absenteeism and refusals to the intervention.

Current global scenario of guidelines on the management of paroxysmal nocturnal hemoglobinuria: a systematic literature review / Cenário global de diretrizes para o manejo da hemoglobinúria paroxística noturna: uma revisão sistemática da literatura

Objective: To report the outcomes of a systematic literature review of guidelines and consensus on the management of paroxysmal nocturnal hemoglobinuria (PNH) and describe the main therapeutic options available worldwide. Methods: A systematic literature review was conducted in April 2018 with no time limit and reported in line with the PRISMA statement. The AGREE II instrument was used to determine the quality of each guideline included in the systematic review. Results: Eight guidelines/consensus were eligible, one developed by an international group, two in Spain, and one each in Turkey, Germany, Argentina, Australia and the United Kingdom. Supportive treatment with erythrocyte transfusion, anticoagulants and steroids is indicated by all guidelines and consensus. The use of erythropoietin is suggested by three of them. Recommendations for the prescription of eculizumab were consistent in all but one guideline, published in 2005. Allogeneic hematopoietic stem cell transplantation is reported as the only potentially curative treatment for PNH, although its association with high mortality and morbidity rates is emphasized, being indicated for a selected group of patients. The AGREE II scores applied for each domain showed in general a low and heterogeneous methodological quality among guidelines. Conclusion: Despite the low and heterogeneous methodological quality, in general the comparison of guidelines and consensus for PNH management showed consistent recommendations regarding supportive care, eculizumab and hematopoietic stem cell transplantation.

Objetivo: Relatar os desfechos de uma revisão sistemática da literatura de diretrizes e documentos de consenso sobre o manejo da hemoglobinúria paroxística noturna (HPN) e descrever as principais opções terapêuticas disponíveis mundialmente. Métodos: Uma revisão sistemática da literatura foi conduzida em abril de 2018 sem limite temporal e realizada de acordo com a recomendação PRISMA. O instrumento AGREE II foi utilizado para determinar a qualidade de cada diretriz incluída na revisão. Resultados: Foram elegíveis oito diretrizes/consensos, um desenvolvido por um grupo internacional, dois na Espanha e um em cada um dos países a seguir: Turquia, Alemanha, Argentina, Austrália e Reino Unido. O tratamento de suporte com transfusão de eritrócitos, anticoagulantes e esteroides é indicado por todos os documentos. A eritropoetina é indicada por três deles. A recomendação de prescrição do eculizumabe foi consistente em todos, exceto em um publicado em 2005. O transplante alogênico de células-tronco hematopoéticas é reportado como o único tratamento com potencial curativo para a HPN, apesar de uma enfática associação com maiores taxas de mortalidade e morbidade, sendo indicado para grupos selecionados de pacientes. Os escores AGREE II aplicados para cada domínio demonstraram, em geral, qualidade metodológica baixa e heterogênea entre as diretrizes. Conclusão: Apesar da qualidade metodológica baixa e heterogênea, em geral, a comparação de diretrizes e consensos para o manejo da HPN demonstrou recomendações consistentes quanto ao uso de tratamento de suporte, eculizumabe e transplante alogênico de células-tronco hematopoiéticas.

Impact of Treatment Prior to Allogeneic Transplantation of Hematopoietic Stem Cells in Patients with Myelodysplastic Syndrome: Results of the Latin American Bone Marrow Transplant Registry.

It has been suggested that bridging therapy with intensive chemotherapy and/or hypomethylating agents followed by hematopoietic stem cell transplantation (HSCT) can be valuable in the treatment of patients with myelodysplastic syndromes (MDS). However, the influence of this approach on HSCT outcomes remains poorly defined. Therefore, our objective was to investigate the influence of treatment before HSCT in patients with MDS. We retrospectively analyzed data from the Latin American registry of 258 patients from 17 Latin American centers who underwent HSCT from 1988 to 2019. Our data showed that there was pre-HSCT. We detected no significant difference regarding the impact on overall survival of treated and untreated patients before HSCT. Despite these data, the type of previous treatment among treated patients showed a significant difference in overall survival. Treatment with hypomethylating agents together with pre-HSCT chemotherapy seems to result in better survival of the studied population. These data correspond to the first results obtained through cooperative work between various centers in Latin America comparing the different approaches to patients and reflecting their reality and challenges. Therefore, the selection of pretransplant bridge therapy should be analyzed and focus given primarily to those approaches that result in better survival of patients with MDS.

Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV-infected patient: a case report.

BACKGROUND: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/µL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. CASE PRESENTATION: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/µL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. CONCLUSIONS: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/µL.

Cisto dentígero: diagnóstico e tratamento / Cisto dentígero: diagnosis and treatment / Cisto dentígero: diagnóstico y tratamiento

O cisto dentígero é um cisto odontogênico que é classificado como de desenvolvimento. Normalmente, está relacionado à coroa de um dente incluso, sendo um dos cistos odontogênicos mais frequentes nos ossos gnáticos. Na maioria das vezes é diagnosticado em pacientes entre a segunda e a terceira década de vida, com grande ocorrência em terceiros molares inferiores e caninos superiores. Clinicamente, apresenta evolução lenta, assintomática e pode causar discreta deformidade facial, deslocamento de dentes e alterações de estruturas na região. Radiograficamente, os cistos dentígeros são descritos como lesões radiolúcidas bem delimitadas e uniloculares. Na maioria dos casos, são observados em exames de rotina ou durante a pesquisa da causa da não erupção de um dente permanente. Apesar da singularidade clínica de cada caso, o prognóstico dessa lesão é favorável. O tratamento para o cisto dentígero pode ser a marsupialização em casos de lesões grandes, enucleação com exodontia do dente incluso ou preservação do elemento dental. Este trabalho visa apresentar um caso clínico de cisto dentígero em região posterior de mandíbula, abordando aspectos clínicos, imaginológicos, histopatológicos e terapêuticos, com a finalidade de familiarizar o cirurgião dentista com tal lesão(AU)

The dentigerous cyst is an odontogenic cyst that is classified as developmental cyst. It is usually related to the crown of an included tooth, being one of the most frequent odontogenic cysts in the gnatic bones. Most of the time it is diagnosed in patients between the second and third decade of life, with great occurrence in third molars and upper canines. Clinically, it presents slow evolution, asymptomatic and can cause discreet facial deformity, tooth dislocation and alterations of structures in the region. Radiographically, dentigerous cysts are described as well delimited and unilocular radiolucent lesions. Normally, they are seen in routine examinations or during the investigation of the cause of non-eruption of a permanent tooth. Despite the clinical singularity of each case, the prognosis of this lesion is favorable. The treatment for dentigerous cyst may be marsupialization in cases of large lesions, enucleation with exodontia of the included tooth or preservation of the dental element. This paper aims to present a case report of a dentigerous cyst in the mandible, posterior region, addressing clinical, imaging, histopathological and therapeutic aspects, in order to familiarize the dentist surgeon with such lesion(AU)

El quiste dentígero es un quiste odontogénico que se clasifica como de desarrollo. Normalmente, esta relacionada con la corona de un diente incluido, siendo uno de los quistes odontogénicos más frecuentes en los huesos gnáticos. La mayoría de las veces se diagnostica en pacientes entre la segunda y la tercera década de vida, con gran ocurrencia en terceros molares inferiores y caninos superiores. Clínicamente, presenta evolución lenta, asintomática y puede causar discreta deformidad facial, desplazamiento de dientes y cambios de estructuras en la región. Los cistos dentígeros se describen como lesiones radiolúcidas bien delimitadas y uniloculares. Normalmente, se observan en exámenes de rutina o durante la investigación de la causa de la no erupción de un diente permanente. A pesar de la singularidad clínica de cada caso, el pronóstico de esta lesión es favorable. El tratamiento para el quiste dentígero puede ser la marsupialización en casos de lesiones grandes, enucleación con exodoncia del diente incluido o preservación del elemento dental. Este trabajo pretende presentar un relato de caso clínico de quiste dentígero en mandíbula, región posterior, abordando aspectos clínicos, imaginológicos, histopatológicos y terapéuticos, con la finalidad de familiarizar al cirujano dentista con tal lesión(AU)

Overall survival of Brazilian acute myeloid leukemia patients according to the European LeukemiaNet prognostic scoring system: a cross-sectional study.

Prognostic stratification in acute myeloid leukemia (AML) relies, mostly, on cytogenetics and molecular features of leukemic blasts. The LeukemiaNet prognostic scoring system has been proposed as a standardized way of evaluating prognosis in AML. We have analysed outcomes in 65 AML cases (median age of 54 years, range 18-82) treated at five hematology centers in Brazil stritified according to the European Leukemia Net (ELN) recommendations for cytogenetic and molecular analysis. We classified patients as favorable (N = 13), intermediate-1 (N = 25), intermediate-2 (N = 15), or adverse risk (N = 9). Bone marrow transplantation (BMT) was performed in 13 patients (21%). Median follow-up was 12 months. The median overall survival (OS) for all patients was 12.4 months. Median OS was 19.8, 12.4, 10.1, and 10.4 months (p = 0.24) for patients in the favorable, intermediate-1, intermediate-2, and adverse groups, respectively. Among patients receiving BMT, median OS was 26.8 months. The ELN is a valuable tool for prognostic stratification of AML patients treated in Brazil. Nevertheless, its usefulness is limited when compared to data from developed countries.

Avaliação do atendimento a pacientes portadores de acidente vascular cerebral (avc) isquêmico submetidos à trombólise com alteplase / Evaluation of care for patients with cerebrovascular accident (stroke) ischemic undergoing thrombolysis with alteplase

Série de casos de pacientes que foram admitidos com AVC e realizado tratamento com terapia trombolítica endovenosa. Foram avaliados 14 prontuários de pacientes de fevereiro de 2008 a abril de 2010. Objetivando fazer uma avaliação das características dos pacientes admitidos; avaliar critérios de inclusão e exclusão; avaliar resposta ao tratamento; complicações; tempo de internação; e investigação diagnóstica destes pacientes.

Avaliação do atendimento a pacientes portadores de acidente vascular cerebral (avc) isquêmico submetidos à trombólise com alteplase

Série de casos de pacientes que foram admitidos com AVC e realizado tratamento com terapia trombolítica endovenosa. Foram avaliados 14 prontuários de pacientes de fevereiro de 2008 a abril de 2010. Objetivando fazer uma avaliação das características dos pacientes admitidos; avaliar critérios de inclusão e exclusão; avaliar resposta ao tratamento; complicações; tempo de internação; e investigação diagnóstica destes pacientes.

Avaliação do atendimento a pacientes portadores de acidente vascular cerebral (avc) isquêmico submetidos à trombólise com alteplase / Evaluation of care for patients with cerebrovascular accident (stroke) ischemic undergoing thrombolysis with alteplase

Série de casos de pacientes que foram admitidos com AVC e realizado tratamento com terapia trombolítica endovenosa. Foram avaliados 14 prontuários de pacientes de fevereiro de 2008 a abril de 2010. Objetivando fazer uma avaliação das características dos pacientes admitidos; avaliar critérios de inclusão e exclusão; avaliar resposta ao tratamento; complicações; tempo de internação; e investigação diagnóstica destes pacientes.(AU)