Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

A Terapêutica Cirúrgica e o Protocolo DH-II-90 no Tratamento da Doença de Hodgkin em Jovens e Adultos: um Estudo Ecológico / Surgical Therapy and DH-II-90 Protocol in the Treatment of Hodgkin Disease in Young Adults: an Ecological Study / La Terapia Quirúrgica y el Protocolo DH-II-90 en el Tratamiento del Linfoma de Hodgkin en Jóvenes y Adultos: un Estudio Ecológico

Introdução: A doença de Hodgkin (DH) é uma patologia que se inicia nos linfonodos, desenvolve-se nos tecidos neoplásicos e manifesta- -se, majoritariamente, em jovens adultos. Objetivo: Correlacionar os resultados da terapêutica cirúrgica e do protocolo DH-II-90 em jovens adultos acometidos pela DH, e associá-los ao perfil epidemiológico, aos dados de mortalidade pela doença e à distribuição de recursos físicos no Brasil. Método: Estudo ecológico exploratório, com informações coletadas do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), entre 2013 e 2021. O estudo, portanto, compara os resultados da terapêutica cirúrgica e do protocolo DH-II-90 associados a dados epidemiológicos, sendo o protocolo considerado o método mais eficiente, por apresentar melhores resultados quando comparado a métodos mais invasivos. Resultados: A Região Sudeste concentra maior número de leitos e procedimentos com números mais expressivos de pacientes diagnosticados de 0 a 29 anos. Em resumo, as taxas de mortalidade bruta por DH reduziram-se a partir de 1990, período no qual o protocolo DH-II-90 foi aplicado. Conclusão: O presente estudo fornece uma visão relevante sobre o perfil epidemiológico da DH e contribui para a comparação entre a terapêutica cirúrgica e o protocolo DH-II-90, sendo possível concluir que, após a aplicação do protocolo, houve redução da taxa de mortalidade por DH no Brasil e no mundo

Introduction: Hodgkin disease (HD) is a pathology that starts in the lymph nodes, develops in the neoplastic tissues and manifests, mainly, in young adults. Objective: To correlate the results of the surgical therapy and the DH- II-90 protocol in young adults affected by HD, and to associate them with the epidemiological profile, the mortality data by the disease and the distribution of physical resources in Brazil. Method: Exploratory ecological study with information collected from the Informatics Department of the National Health System (DATASUS), the National Cancer Institute José Alencar Gomes da Silva (INCA), the National Registry of Health Establishments (CNES) and the SUS Outpatient Information System (SIA/ SUS) between 2013 and 2021. The study, therefore, compares the results of surgical therapy and the DH-II-90 protocol associated with epidemiological data, and the protocol is considered the most efficient method, as it produces better results when compared to more invasive methods. Results: The Southeast Region concentrates high number of beds and procedures and stands out due to more expressive numbers of patients diagnosed from 0 to 29 years. In short, crude mortality rates per HD decreased from 1990, the period where the DH-II-90 protocol was applied. Conclusion: This study provides a relevant view on the epidemiological profile of HD and contributes for the comparison between surgical therapy and the DH-II-90 protocol, being possible to conclude that after the application of the protocol, there was a reduction of the mortality rate by HD in Brazil and worldwide

Introducción: El linfoma de Hodgkin (LH) es una patología que inicia en los ganglios linfáticos, se desarrolla en los tejidos neoplásicos y se manifiesta mayoritariamente en adultos jóvenes. Objetivo: Correlacionar los resultados de la terapéutica quirúrgica y del protocolo DH-II-90 en jóvenes adultos acometidos por el LH, y asociarlos al perfil epidemiológico, a los datos de mortalidad por la enfermedad y a la distribución de recursos físicos en Brasil. Método: Estudio ecológico exploratorio, con información recolectada del Departamento de Informática del Sistema Único de Salud (DATASUS), del Instituto Nacional de Cáncer José Alencar Gomes da Silva (INCA), del Registro Nacional de Establecimientos de Salud (CNES) y del Sistema de Informaciones Ambulatorias del SUS (SIA/SUS), entre 2013 y 2021. El estudio, por lo tanto, compara los resultados de la terapéutica quirúrgica y del protocolo DH-II-90, asociados a datos epidemiológicos, siendo el Protocolo considerado el método más eficiente, por presentar mejores resultados cuando comparado a métodos más invasivos. Resultados: La Región Sudeste tiene más camas y procedimientos y presenta mayores números de pacientes diagnosticados de 0 a 29 años. En resumen, las tasas de mortalidad bruta por LH disminuyeron a partir de 1990, período en el que se incorporó el protocolo DH-II-90. Conclusión: El presente estudio proporciona una visión relevante sobre el perfil epidemiológico del LH y contribuye a la comparación entre terapéutica quirúrgica y el protocolo DH-II-90, concluyendo que, tras la inserción del protocolo, hubo reducción de la tasa de mortalidad por LH en Brasil y en el mundo

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

The grim reaper evading modern medicine: aspergillosis, adenovirus, and Hodgkin lymphoma

Illustrative cases of diseases that are difficult to suspect and diagnose can serve as useful reminders. Invasive pulmonary aspergillosis and adenovirus hepatitis are two such diseases, both revealed by autopsy in this case of Hodgkin lymphoma refractory to chemotherapy treated with allogeneic hematopoietic stem cell transplantation complicated by these two fatal infections. This patient was cured of Hodgkin lymphoma, Clostridioides difficile colitis and thrombotic thrombocytopenic purpura using the marvels of modern medicine. This case illustrates many features of aspergillosis and adenovirus hepatitis, shows the value of autopsy in revealing diagnoses, and illustrates the limits of modern medicine, which should serve as a mental spur in our efforts to advance medical science, to try to defeat the numerous demons of disease, who seem to keep outwitting us.

Linfoma anaplásico de grandes células relacionado ao implante mamário: revisão sistemática da literatura / Breast implant-associated anaplastic large-cell lymphoma: a systematic literature review

O linfoma anaplásico de grandes células associado ao implante de mama (Breast Implant Associated Anaplastic Large Cell Lymphoma - BIA-ALCL) é uma doença maligna recentemente descoberta, rara e possivelmente associada aos implantes mamários texturizados. Essa revisão da literatura teve como objetivo trazer novas atualizações acerca da epidemiologia, fisiopatologia e fatores de risco para desenvolvimento do BIAALCL. Foi realizado o levantamento de dados do período de dezembro de 2018 a fevereiro de 2019, através das bases de dados PUBMED, LILACS e Scielo sendo selecionados 10 artigos publicados entre 2016 e 2018. Foi encontrada uma incidência variando entre 2,8:100.000 a 1:3 milhões de pacientes com implantes mamários. Os dados coletados corroboram para a teoria de que não há uma relação direta de causa e efeito entre os implantes mamários, mormente os texturizados, e o desenvolvimento do BIA-ALCL, podendo esses ser considerados somente como fatores de risco e não agentes causadores. A teoria fisiopatológica mais aceita é a de que os implantes mamários com maior área de superfície levariam a formação de maior biofilme por maior adesão bacteriana gerando inflamação crônica mais proeminente, levando ao gatilho para a transformação maligna das células T. As informações explicitadas nessa revisão devem auxiliar na ampliação de estudos acerca da doença e criação de políticas públicas para a prevenção e diagnóstico precoce de tal enfermidade. Pelos dados encontrados há necessidade de que cirurgiões plásticos realizem acompanhamento mais próximo de seus pacientes, assim como orientem os pacientes antes das cirurgias sobre a existência da doença.

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a newly discovered and rare cancer possibly associated with textured breast implants. This literature review investigates its epidemiology, pathophysiology, and risk factors. PubMed, LILACS, and SciELO databases were searched from December 2018 to February 2019, and 10 articles published between 2016 and 2018 were selected. The incidence of BIA-ALCL ranged from 2.8:100,000 to 1:3 million breast implants. The obtained data corroborate the hypothesis that there is no direct cause and effect relationship between breast implants, especially textured implants, and BIA-ALCL, and these implants can be considered risk factors but not causative factors. The most accepted hypothesis on disease pathophysiology is that breast implants with larger surface areas may promote bacterial adhesion and biofilm formation, leading to severe chronic inflammation, triggering the malignant transformation of T cells. This review provides knowledge on BIA-ALCL and helps develop and implement public policies for disease prevention and timely diagnosis. The data highlight that long-term follow up is necessary and that surgeons should advise patients of the potential risk of developing BIA-ALCL before performing the implant surgery.

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin / CT and PET/CT with 18-FDG to evaluate the response to treatment in Hodgkin's and non-Hodgkin's lymphoma

Resumen Introducción: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. Objetivo: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). Método: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. Resultados: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). Conclusión: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Abstract Introduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin's lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

Evaluación del tratamiento de linfoma de Hodgkin con esquema ABVD en Chile / Treatment of Hodgkin lymphoma: analysis of 915 patients

Background: Hodgkin lymphoma has a high rate of curability, even in advanced stages. Aim: To assess the results of Hodgkin lymphoma treatment using the ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy regimen. Material and Methods: Analysis of a database held by the Chilean Ministry of Health, including all patients treated at accredited cancer treatment centers. Results: Data for 915 patients, median age 35 years (range 15-86 years) and followed for a median of 97 months (range 1-347 months) were analyzed. Forty-one percent had localized disease. Overall survival at five years for localized and advanced stages was 92% and 74%, respectively. The figures for progression free survival were 87% and 64%, respectively. Patients with relapse who received autologous stem cell transplantation (ASCT) had a five year overall survival of 92%, compared to 64% among those who did not undergo this procedure (p < 0.01). The Guarantees in Health Program set up by the Ministry of Health, was associated with earlier stage disease at diagnosis. Conclusions: The ABVD regimen achieves high rates of cure in localized stages of the disease but the results in advanced stages are not optimal. ASCT significantly improves survival in patients with relapse. The Guarantees in Health Program is associated with earlier diagnosis of the disease.

Cardiovascular risk and use of conicity index in patients submitted to autologous hematopoietic stem cell transplantation / Risco cardiovascular e uso do índice de conicidade em pacientes submetidos ao transplante autólogo de células-tronco hematopoiéticas

ABSTRACT Objective To analyze the prevalence of overweight and the use of conicity index for cardiovascular risk assessment in individuals submitted to autologous hematopoietic stem cell transplantation. Methods The sample comprised 91 patients of both sexes, who underwent autologous hematopoietic stem cell transplantation from September 2008 to December 2013, aged 18 years or over. To determine the nutritional profile, we collected anthropometric data on weight, height, waist circumference upon hospital admission. The body mass index and the conicity index were calculated. Results A total of 91 patients diagnosed with multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and other conditions were evaluated. The mean age was 43.5 (14.2) years, 63.7% were male. We verified that according to the body mass index, 63.7% were overweight and, according to waist circumference, 74.7% had a higher risk for cardiovascular diseases. According to the calculation of the conicity index, 92.3% of patients presented increased cardiovascular risk. Patients with multiple myeloma had a higher conicity index when compared to other patients (p<0.01). Conclusion This study revealed a high prevalence of overweight and cardiovascular risk. It should be noted that the conicity index was a good method to evaluate cardiovascular risk and that new studies using this index should be performed.

RESUMO Objetivo Analisar a prevalência de excesso de peso e a utilização do índice de conicidade para a avaliação do risco cardiovascular em indivíduos submetidos ao transplante autólogo de células-tronco hematopoiéticas. Métodos A amostra foi composta por 91 pacientes, de ambos os sexos, submetidos ao transplante autólogo de células-tronco hematopoiéticas, de setembro de 2008 a dezembro de 2013, com idade igual ou superior a 18 anos. Para traçar o perfil nutricional, foram coletados dados antropométricos, como peso, altura e circunferência da cintura, na admissão hospitalar. Calcularam-se o índice de massa corporal e o índice de conicidade. Resultados Foram avaliados 91 pacientes, diagnosticados com mieloma múltiplo, linfoma de Hodgkin, linfoma não Hodgkin e outras patologias. A média de idade foi de 43,5 (14,2) anos, e 63,7% eram do sexo masculino. Verificou-se que, de acordo com o índice de massa corporal, 63,7% apresentavam excesso de peso e, segundo a circunferência da cintura, 74,7% possuíam maior risco para doenças cardiovasculares. De acordo com o cálculo do índice de conicidade, constatou-se que 92,3% dos pacientes apresentavam risco cardiovascular aumentado. Os pacientes com mieloma múltiplo apresentaram índice de conicidade mais elevado, se comparado aos outros pacientes (p<0,01). Conclusão Este estudo revelou alta prevalência de excesso de peso e de risco cardiovascular. Salienta-se que o índice de conicidade se mostrou um bom método para avaliação do risco cardiovascular e que novos estudos utilizando este índice devem ser realizados.

Sifilis secundaria, como simuladora de Linfoma de Hodgkin / SECONDARY SYPHILIS , SIMULATING A HODGKIN LYMPHOMA

La Sífilis es una infección adquirida por vía sexual, producida por la bacteria Treponema pallidum. Es una enfermedad crónica sin tratamiento y cursa por etapas con manifestaciones clínicas diferentes en cada una de ellas. Se presenta el caso de un paciente varón de 27 años, que presenta una dermatosis asintomática de 3 semanas de evolución, asociado a importantes adenopatías cervicales dolorosas y a compromiso del estado general, de 2 meses de evolución, lo que en primera instancia fue interpretado como un Linfoma de Hodgkin, y que resultó ser sífilis en etapa secundaria, con buena respuesta al tratamiento convencional de ésta.

Syphilis is a sexually acquired infection caused by the bacterium Treponema pallidum. It is a chronic disease without treatment and is staged in stages with different clinical manifestations in each one of them. Case report of a 27 years old male patient with asymptomatic dermatosis of 3 weeks of evolution, associated with significant painful cervical lymphadenopathy, and systemic symptoms, 2 months of evolution, was first interpreted as a Lymphoma of Hodgkin, and that was syphilis in secondary stage, with good answer to the conventional treatment of this one.

Funcionalidad familiar y estilos de vida saludable en pacientes con linfoma Hodgkin en Bogotá / Family functionality and healthy lifestyles in patients with Hodgkin lymphoma, Bogota / Funcionalidade familiar e estilos de vida saudável em pacientes com linfoma de Hodgkin, em Bogota

Se realizó una investigación cuantitativa descriptiva y transversal en un grupo de pacientes con linfoma Hodgkin para determinar \r\nla relación entre funcionalidad familiar y los estilos de vida saludable. Se usaron los instrumentos Escala de Evaluación de la Funcio\r\n-\r\nnalidad Familiar y el Health Promoting Lifestyle Profile II, los dos en su versión en español. El informante familiar fue el paciente con \r\ndiagnóstico de linfoma Hodgkin. Se encontró predominio de un nivel bajo de funcionalidad familiar y frecuencia de estilos de \r\nvida saludable A veces y Frecuentemente; se determinó que solo hubo correlación con significancia estadística entre la dimensión \r\nRelaciones interpersonales\r\n, perteneciente a los estilos de vida saludable, y la funcionalidad familiar. Se requiere profundizar en esta \r\ntemática con otros grupos de pacientes para lograr un mejor conocimiento al respecto.

A descriptive and cross-quantitative investigation in a group \r\nof patients with Hodgkin lymphoma was conducted to \r\ndetermine the relationship between family functionality \r\nand healthy lifestyles. The instruments Evaluation Scale of \r\nFamily Functionality in Spanish and the Health Promoting \r\nLifestyle Profile II in its version of the Spanish language were \r\nused, the family informant was the patient diagnosed with \r\nHodgkin lymphoma. Predominance of a low level of family \r\nfunctionality and frequent healthy lifestyles of "Sometimes" \r\nand "Often" was found; it was determined that there were \r\nonly statistically significant correlation for the dimension of \r\ninterpersonal relationships\r\n, pertaining to healthy lifestyles, with \r\nfamily functionality. It is required to deepen this subject, with \r\nother patient groups to achieve a better knowledge about it.

Uma pesquisa descritiva e cross-quantitativa em um grupo de \r\npacientes com linfoma de Hodgkin foi realizado para deter\r\n-\r\nminar a relação entre o funcionamento familiar e estilos de \r\nvida saudáveis. Os instrumentos Escala de Avaliação da Família \r\nfuncionalidade em espanhol e promoção da saúde Lifestyle \r\nProfile II, na sua versão em espanhol utilizado, o informante da \r\nfamília era o paciente diagnosticado com linfoma de Hodgkin. \r\nPredominância de uma baixa frequência de funcionamento \r\nfamiliar e estilos de vida saudáveis "às vezes" e "Muitas vezes" \r\nfoi encontrado; determinou-se que havia apenas estatisti\r\n-\r\ncamente dimensão correlação significativa para as \r\nrelações \r\ninterpessoais\r\n, pertencentes a estilos de vida saudáveis, com o \r\nfuncionamento familiar. É necessário aprofundar este assunto, \r\ncom outros grupos de pacientes para alcançar um melhor \r\nconhecimento sobre o assunto.

Características clínicas e histológicas de adenopatías en pacientes pediátricos / Clinical and histological characteristics of adenopathies in paediatric patients

Introducción: Las adenopatías son una causa muy frecuente de consulta en la población infantil, estando presente hasta en el 44% de los niños menores de 5 años. En algunos casos se requiere la toma de biopsias ganglionares para esclarecer el diagnóstico. Objetivo: Describir las características clínicas e histopatológicas de pacientes pediátricos con adenopatías sometidos a biopsias ganglionares. Pacientes y método: Estudio descriptivo, retrospectivo. Se incluyó la totalidad de los niños menores de 15 años a los que se les realizó biopsia ganglionar en hospital de alta complejidad en un periodo de 4 años. Se evaluaron las características demográficas, clínicas y de laboratorio de los pacientes, así como el diagnóstico histopatológico de las biopsias realizadas. Resultados: Sesenta y un niños, 54,1%, fueron del sexo masculino, mediana de edad de 6 años. El diagnóstico patológico más frecuente fue hiperplasia reactiva (50,8%), seguido de enfermedad neoplásica (27,9%), enfermedad granulomatosa crónica (4,9%) e infección bacteriana (3,3%). De las enfermedades neoplásicas, el linfoma de Hodgkin fue el más común, siendo su localización más frecuente la cervical (60,6%). Conclusiones: Con este estudio se demuestra la importancia de realización de diagnósticos diferenciales en el abordaje de pacientes con adenopatías. Al igual que lo reportado en la literatura mundial, la etiología benigna es la causa más común de adenopatías en niños.

Background: Lymphadenopathy is a common cause for medical consultation in the child population, accounting for up to 44% in children under 5 years old. In some cases, it is required to take lymph node biopsy specimens in order to clarify the diagnosis. Objective: To describe the clinical and histological features of paediatric patients with lymphadenopathy and lymph node biopsies. Patients and method: Descriptive and retrospective study conducted in Medellin (Colombia) in a fourth-level hospital between January 1st of 2009 and December 31st of 2012. In the study, lymph node biopsy specimens were taken from children under 15 years old. Demographic, clinical and laboratory features, and characteristics of the patients were evaluated, as well as the histopathological diagnosis of the lymph node biopsies. Results: From the child population, 61 children met the eligibility criteria and 33 (54.1%) of them were male with an average age of 6 years old. The most common pathological diagnoses in the study group were as follows: reactive hyperplasia (50.8%), neoplasms (27.9%), chronic granulomatous disease (4.9%), and bacterial infection (3.3%). It could be concluded from the findings in the study that Hodgkin lymphoma is very common among the neoplastic diseases, with 18%, and the most frequent location was the neck with 60.6%. Conclusions: This study demonstrates the importance of performing a differential diagnosis when approaching patients with lymphadenopathy. As reported in the world medical literature, benign origin is the most common cause of lymphadenopathy in children.

Desenlaces clínicos en hematoncología: diez años de investigaciones en Pubmed / Clinical outcomes in Hemato-Oncology: Ten year Pubmed literature review

Objetivo: Determinar cuáles son los desenlaces clínicos empleados en los estudios fase III de tratamiento de neoplasias hematoncológicas y qué proporción de ellos emplean supervivencia global como desenlace primario. Método: Mediante una búsqueda en Pubmed, analizar todos los experimentos clínicos aleatorios publicados en los últimos 10 años, de tratamientos de novo, en población adulta. Resultados: La búsqueda inicial arrojó 310 referencias, entre las que se seleccionaron 90 estudios clínicos. La enfermedad más estudiada fue mieloma múltiple, con 29 estudios, seguida de linfoma no Hodgkin, con 26. Las otras fueron: leucemia mieloide aguda (12), leucemia linfocítica crónica (10), leucemia mieloide crónica (8), síndromes mielodisplásicos (3) y linfoma de Hodgkin (2). En 20 estudios (22%) se empleó la supervivencia global como desenlace primario (en solo 3 de ellos alcanzó significación estadística), en 37 más (41%) se agrupó con otros desenlaces para conformar un desenlace compuesto. En 55 estudios (61%) la supervivencia global fue un desenlace secundario. Conclusiones: Aunque la supervivencia global es el estándar de oro en terapia oncológica, los desenlaces agrupados u otros, como tiempo libre de enfermedad o indicadores paraclínicos de actividad de la enfermedad, son más empleados, quizá por ser buenos predictores y requerir muestras y seguimientos menores. Su capacidad para predecir supervivencia global (en algunos casos calidad de vida) debe ser validada. Solo en las formas más agresivas de cáncer se justifica usar de rutina la supervivencia global como el desenlace primario.

Objective: To describe the clinical outcomes used in phase III studies in Hematology-Oncology malignancies, and to determine what proportion use overall survival as the primary outcome. Methods: Using a systematic literature search in PubMed, an analysis was made of phaseIII randomized clinical trials with de novo treatments of hematology-oncological neoplasias in adult populations published in the last 10 years. Results: The initial search yielded 310 references, 90 of which were finally selected. The overall survival rate was used in 20 studies (22%) as the primary outcome (in 3 of them it reached statistical significance). Grouped intermediate outcomes were used in 37 others (41%). As a secondary outcome the overall survival rate was used in 55 studies (61%). Among the intermediate outcomes used were, response rates, disease-free or relapse-free survival rates, and progression-free survival rate. Multiple myeloma was the most studied disease, with 29 studies (32%), followed by non-Hodgkin lymphoma (28%). Conclusions: Although overall survival rate is the gold standard in cancer therapy, it is not the most often used outcome. Intermediate outcomes, such as disease-free survival or biomarkers are often good predictors, and require smaller samples and less follow-up time. Nevertheless, their predictive capacity for overall survival rate (or, in some cases, quality of life) should also be assessed. The use of the overall survival rate as the routine primary outcome is only justified in the most aggressive forms of cancer.

Leisure activities and attitude of institutionalized elderly people: a basis for nursing practice / Atividades de lazer e atitude de idosos institucionalizados: subsídios para a prática de enfermagem / Las actividades de ocio y la actitud de ancianos institucionalizados: informaciones para la práctica de enfermería

Aim: to identify the leisure activities performed in Long-Stay Institutions for the Elderly (LSIEs), registered in the city of Maringá-PR, Brazil, and to analyze the attitude of the elderly people toward leisure promoted by the institutions. METHOD: this was a descriptive and transversal study with a quantitative approach, carried out with 97 elderly people, through the establishment of the socio-demographic profile and the application of the Leisure Attitude Scale. The data was subjected to descriptive statistical analysis, association tests (chi-square or Fisher's) and Spearman's correlation. RESULTS: males, aged 80 or over, widowed, with one to eight years of study, who had a monthly income were predominant. Age group and income were significantly associated with the performance of leisure activities. The results reflected the positive attitude of the elderly people in relation to leisure activities, except in the behavioral component. CONCLUSION: the findings of this study indicate the need for further investigation into the difficulties linked to the attitude toward leisure in the behavioral component, considering aspects such as individual concepts of leisure and the health status of the elderly people. .

OBJETIVOS: identificar as atividades de lazer realizadas em Instituições de Longa Permanência para Idosos (ILPI), regularmente cadastradas no município de Maringá - PR, Brasil, e analisar a atitude dos idosos face ao lazer promovido pelas instituições. MÉTODO: trata-se de uma pesquisa de caráter descritivo e transversal, com abordagem quantitativa, realizada com 97 idosos, por meio de levantamento do perfil sociodemográfico e da aplicação da Escala de Atitudes Face ao Lazer. Os dados passaram por análise estatística descritiva, testes de associação (quiquadrado ou Fisher) e correlação de Spearman. RESULTADOS: predominaram homens, na faixa etária de 80 anos ou mais, viúvos, com um a oito anos de estudo e que possuíam renda mensal. Faixa etária e renda tiveram associação significativa com a realização de atividades de lazer. Os resultados refletiram atitude positiva dos idosos em relação às atividades de lazer, exceto no componente comportamental. CONCLUSÃO: os achados deste estudo indicam a necessidade de investigação das dificuldades atreladas à atitude face ao lazer no componente comportamental, considerando aspectos como concepções individuais de lazer e condição de saúde dos idosos. .

OBJETIVOS: identificar las actividades de ocio o tiempo libre realizadas en Instituciones de Larga Permanencia para Ancianos (ILPA) regularmente registradas en el municipio de Maringá-PR, Brasil, y analizar la actitud de los ancianos frente al tiempo libre promovido por las instituciones. MÉTODO: se trata de una investigación de carácter descriptivo y transversal, con abordaje cuantitativo, realizada con 97 ancianos, por medio del levantamiento del perfil sociodemográfico y de la aplicación de la Escala de Actitudes Frente al Ocio. Los datos pasaron por análisis estadístico descriptivo, test de asociación (chi-cuadrado o Fisher) y correlación de Spearman. RESULTADOS: predominaron hombres, en el intervalo etario de 80 años o más, viudos, de uno a ocho años de estudio y que poseían renta mensual. El intervalo etario y la renta tuvieron asociación significativa con la realización de actividades de tiempo libre. Los resultados reflejaron una actitud positiva de los ancianos en relación a las actividades de tiempo libre, excepto en el componente comportamental. CONCLUSIÓN: los hallazgos de este estudio indican la necesidad de investigar las dificultades vinculadas a la actitud frente al tiempo libre en el componente comportamental, considerando aspectos como las concepciones individuales de tiempo libre y la condición de salud de los ancianos. .

Linfomas asociados a infección por VIH en pacientes del Hospital Clínico San Borja Arriarán / Fundación Arriarán2001-2008 / Lymphomas associated with HIV infection in patients at the Hospital San Borja Arriarán /Fundación Arriarán 2001-2008, Santiago, Chile

Introduction: Hodgkin lymphomas (HL) and non Hodgkin lymphomas (NHL) are frequently associated to acquired immunodeficiency syndrome in adults. Objective: To systematize the clinical features and histological characteristics of lymphomas in AIDS patients, its treatment and outcomes in our institution. Patients and Methods: Retrospective analysis of patients with HIV-associated lymphoma between January 2001 and December 2008 at the San Borja Arriarán Hospital complex. Results: Information was obtained from 30 patients with NHL and 7 with HL, with a median of 40 years. The majority of tumors were Burkitt lymphoma (47%), diffuse large cell lymphoma B-cell (37%) and NHL of T lineage (10%). There was no CNS or cavities lymphoma. Almost all patients (86.7%) with NHL were treated with CHOP chemotherapy, 57% of those receiving treatment had progression or relapse from complete remission. A rescue chemotherapy was indicated in 4 patients. 73% of patients receiving CHOP, complete 5 to 6 cycles of chemotherapy. The use of CHOP chemotherapy for the subgroup of patients with Burkitt lymphoma achieved low rates of complete remission and frequent relapse and disease progression, showing that CHOP was ineffective in improving survival, especially in high risk patients. We found statistically significant differences in survival according to IPIae (International prognostic Index age-adjusted). Conclusion: Non-Hodgkin lymphoma in HIV patients treated with chemotherapy protocols PAlNDA persists in our environment as a disease with a poor prognosis compared with findings in the international literature. The incorporation of new drugs of proven utility as rituximab and specific schemes chemotherapy could improve these results. The establishment of prognostic groups established by IPIae can guide clinical work for the use of chemotherapy tailored to their specific risk and optimized according to histological type.

Introducción: Los linfomas de Hodgkin (LH) y no Hodgkin (LNH) se asocian con alta frecuencia al síndrome de inmunodeficiencia humana en adultos. Objetivo: Sistematizar los aspectos clínicos e histológicos de los linfoma que afectan a pacientes con SIDA, su tratamiento y resultados globales en nuestra institución. Pacientes y Métodos: Análisis retrospectivo de pacientes con linfoma asociado a VIH entre enero de 2001 y diciembre de 2008 en el complejo hospitalario San Borja Arriarán. Resultados: Se obtuvo información de 30 pacientes con LNH y 7 LH, con una mediana de 40 años. Los tipos histológicos predominantes fueron linfoma de Burkitt (47 %), linfoma difuso de células grandes de estirpe B (37 %) y LNH de estirpe T (10%). No se diagnosticaron LNH del SNC ni linfoma de cavidades. Casi la totalidad de los pacientes (86,7%) con LNH se trataron con esquema CHOP, 57% de quienes recibieron tratamiento presentaron progresión o recaída desde remisión completa, ofreciéndoles una quimioterapia de rescate a cuatro pacientes. El 73% de los pacientes que recibieron CHOP lograron completar entre cinco y seis ciclos de quimioterapia. El uso de quimioterapia CHOP para el subgrupo de pacientes con linfoma de Burkitt alcanzó bajos porcentajes de remisión completa y mayoritariamente progresó la enfermedad, siendo esta quimioterapia, inefectiva para mejorar la sobrevida, especialmente en los pacientes de riesgo alto. Se encontraron diferencias estadísticamente significativas en sobrevida según el IPIae (índice internacional pronóstico ajustado por edad) al ingreso. Conclusión: El LNH en los pacientes con VIH tratados con los protocolos de quimioterapia PANDA persiste en nuestro medio como una enfermedad de muy mal pronóstico comparado con los resultados en la literatura internacional. La incorporación de nuevos fármacos de demostrada utilidad como rituximab y esquemas específicos de quimioterapia podrían mejorar estos resultados. El establecimiento de grupos pronósticos establecidos por IPIae puede orientar el trabajo clínico para el uso de quimioterapia ajustada a su riesgo específico y optimizado según tipo histológico.

Epidemiología del linfoma con compromiso de cabeza y cuello en el Centro Asistencial Sótero del Río / Epidemiology of lymphoma of the head and neck in the Centro Asistencial Sótero del Río

Introducción: Los linfomas son la neoplasia hematológica más frecuente del adulto, ocupando el tercer lugar de las neoplasias de cabeza y cuello (CyC). Se distinguen dos tipos, el linfoma de Hodgkin (LH) y el linfoma no Hodgkin (LNH), constituyendo dos entidades clínicas separadas. Objetivo: Evaluar las manifestaciones de los linfomas en la región de CyC, analizando las diferencias de presentación y comportamiento entre en LH y el LNH. Material y método: Estudio retrospectivo de todos los casos de linfomas de CyC en el Centro Asistencial Dr. Sótero del Roo (CASR) entre los años 2005 y 2009, documentando específicamente presentación clínica, factores de riesgo, el tipo de linfoma, diagnóstico histológico, localización anatómica, etapificación al momento del diagnóstico, tratamiento administrado, sobrevida. Resultados: Se incluyeron 80 casos de pacientes con linfoma de CyC en el estudio, 16 (20 por ciento) con LH y 64 (80 por ciento) con LNH. Se encontraron diferencias estadísticamente significativas entre ambos para la edad de diagnóstico, el compromiso extranodal, compromiso de mediastino, presencia de síntomas B y sobrevida. Conclusión: En el CASR la presentación de los linfomas es similar a la reportada mundialmente con diferencias similares entre LH y LNH.

Introduction: Lymphomas are the most common hematologic neoplasia in the adult and the third most common neoplasias of the head and neck (CyC). There are two types of lymphoma: Hodgkin and non-Hodgkin lymphomas, which constitute two unique clinical entities. Aim: To evaluate the clinical manifestations of lymphomas in the CyC region, analizing the diferences between the clinical presentation and behavior of LH and LNH. Material and method: This is an retrospective study of all the cases of lymphoma of CyC in the Centro Asistencial Dr. Sótero del Río (CASR) between the years 2005 and 2009, describing specifically the clinical presentation, risk factors, type of lymphoma, histologic diagnosis, anatomical localization, etapification at diagnosis, treatment received and survival. Results: Eighty cases of lymphoma of the CyC were included, 16 patients (20 percent) with LH and 64 patients (80 percent) with LNH. We found statistically significant differences between both groups for their age at diagnosis, extranodal disease, mediastinal compromise, presence of "B" symptoms and survival. Conclusion: in the CASR the clinical presentation of lymphomas is similar to that reported in the international literature, maintaining the unique characteristics for LH and LNH.

Oncohematological diseases in the Vale do Paraíba, State of São Paulo: demographic aspects, prevalences and incidences

BACKGROUND: Based on the necessity of detailed information that supports effective strategies to improve cancer outcomes in the different regions of Brazil, the aims of this study were to report demographic aspects and to calculate the prevalence and incidence rates of oncohematological diseases in the region of Vale do Paraíba. METHODS: This is a multicentric prospective study carried out from October 2009 to March 2010. A total of 500 over 19-year-old patients were enrolled. Data such as type of healthcare insurance, gender, age, ethnic classification, place of residence, schooling, income, body mass index, new cases and the period between the first symptoms and a definite diagnosis were collected. The prevalence and incidence rates were calculated according to an estimated number of 1,319,800 inhabitants. RESULTS: The prevalence and incidence rates per 100,000 inhabitants in the period of six months were, respectively: acute myeloid leukemia 1.5 and 0.7; acute lymphoblastic leukemia 0.5 and 0.1; chronic lymphocytic leukemia 2.4 and 0.4; chronic myeloid leukemia 6.2 and 0.8; Hodgkin's lymphoma 2.9 and 0.9; non-Hodgkin lymphoma 9.8 and 4.3; multiple myeloma 5.7 and 0.7; myelodysplastic syndromes 2.1 and 0.2 and myeloproliferative syndromes 5.1 and 0.3. CONCLUSION: Giving the paucity of data in this field of investigation, our data may be useful for comparisons with those of other regions of Brazil and will assist in the implementation of treatment programs of oncohematological diseases in this region.

Revisión histopatológica de 20 casos de linfoma de Hodgkin infantil (0-14 años) provenientes de áreas de deficiente situación socioeconómica / Histopathological revision of 20 cases of Hodgkin's lymphoma of infants (0-14 years) coming from areas of poor socioeconomical conditions

Los resultados obtenidos en la revisión histopatológica de 20 casos con confirmación de su baja situación socioeconómica han mostrado que la totalidad de los mismos correspondieron a una forma histológica de mejor pronóstico y, por ende, a una aplicación terapéutica de menor agresividad para el paciente, permitiendo a su vez actuar sobre la hipotética causa primaria de la enfermedad con medidas dedicadas a mejorar la respuesta inmune del niño.

The results obtained from histopathological revision of 20 cases with corroboration of their bad socioeconomical condition proof about the total of the casuistry to pertain into a good prognostic histological type, and for this reason submitted to a low aggresive chemotherapy treatment for the patient, and consecutively to put in action the therapeutic to restore the immunological response.

Associação de ictiose adquirida, linfoma de Hodgkin e Hepatite B / Combination of acquired ichthyosis, Hodgkin's lymphoma and Hepatitis B

Ictiose adquirida é um distúrbio raro da queratinização, associado a diversas doenças, como neoplasias. Aqui relatamos o caso de uma paciente que se apresentou com ictiose de início recente e no decorrer da investigação foi descoberta hepatite B crônica e linfoma de Hodgkin. Não encontramos relatos da associação destas três entidades na literatura.

Acquired Ichthyosis is a rare disorder of keratinization associated with several diseases such as neoplasias. Here we report the case a patient presenting with ichthyosis of recent onset, and along the investigation chronic hepatitis B and Hodgkin lymphoma were diagnosed. No previous report of the combination of these three entities was found in the literature.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation

CONTEXT AND OBJECTIVE: This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT). DESIGN AND SETTING: This was a retrospective study at Charles University Hospital, Hradec Kralove. METHODS: The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkin's and non-Hodgkin's lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years. RESULTS: Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5 percent and among ML respondents it was 82.7 percent. CONCLUSION: The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

CONTEXTO E OBJETIVO: O transplante de células tronco hematopoiéticas (TCTH) é um método a ser utilizado na terapêutica das doenças hemato-oncológicas e tumores sólidos, assim como no tratamento de doenças não-malignas. O TCTH tem influência na evolução da doença e na qualidade de vida do doente, assim como outros métodos curativos. TIPO ESTUDO E LOCAL: Este estudo é retrospectivo. Foi desenvolvido no Departamento Clínico de Hematologia do 2º Departamento de Medicina Interna do Hospital da Universidade de Charles em Hradec Kralove, República Checa. MÉTODOS: Amostra de 36 adultos sujeitos ao tratamento com transplante autólogo de células tronco do progenitor, sendo 12 com leucemia mielóide aguda: sete homens e cinco mulheres, e 24 com linfoma maligno: 11 homens e 13 mulheres. Foi utilizada a versão checa do questionário internacional de qualidade de vida européia versão EQ - 5D. RESULTADOS: Houve associação estastiticamente significante entre qualidade de vida e idade, fumantes, pacientes com baixo nível educacional em ambos os sujeitos com leucemia mielóide aguda (p < 0.05). Houve associacão estatisticamente significante entre qualidade de vida e idade em ambos os sujeitos com linfoma maligno (p < 0.05). CONCLUSÃO: A qualidade de vida dos pacientes com linfoma maligno e leucemia mielóide aguda, submetidos a transplante autólogo do progenitor, mantém-se preservada na maioria dos pacientes. Pacientes com idade acima de 50 anos, baixo nível educacional e fumantes têm pior qualidade de vida. Estes fatores devem ser melhor avaliados em estudos longitudinais e com amostras maiores.