Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease-a report from a highly complex hospital in Brazil

ABSTRACT Introduction: Lymphopenia is a laboratory marker of poor prognosis and severity of disease in the SARS-CoV-2 infection. This study aims to describe the immune profile of a Brazilian population. Methods: A total of 121 consecutive patients with severe acute respiratory syndrome (SARS) were analyzed between April and June 2020. Routine peripheral blood counts and multiparametric flow cytometry were performed on admission to assess lymphocytes and subsets (CD3, CD4, CD8). Demographic, clinical and laboratory data were collected from hospital sources. Results: The total of 116 patients included 63 (54.3%) males; 76 (62.8%) COVID-19 patients were divided, based on clinical characteristics and mechanical ventilation (MV) use, into moderate (n = 41; no MV) and severe (n = 35; MV) groups. The control group (n = 40) was comprised of patients with SARS of different etiologies. All patients had lymphopenia, with overall lymphocyte counts and their subsets considerably lower in severe patients, when compared to the moderate and controls. Patients with a high neutrophil-to-lymphocyte ratio (> 15.2) and T-cell lymphopenia (CD3 < 593 cells/μL, CD4 < 326 cells/μL, CD8 < 121 cells/μL) had a higher risk of being intubated and progressing to death. A total of 39 patients (95.1%) in the moderate group and 54.3% (n = 19) in the severe group were discharged; 28 patients died. Conclusion: Laboratory assessment of the neutrophil/lymphocyte ratio and T-cell subsets may be predictive of mortality and may be useful for stratifying COVID-19 patients.

Survival benefit of pediatric-based regimen for adults with acute lymphoblastic leukemia: A single-center retrospective cohort

ABSTRACT Introduction: Improving survival of Acute Lymphoblastic Leukemia (ALL) in adult patients has been a challenge. Despite intensive chemotherapy treatment, overall survival is poor. However, several studies demonstrate that young adult patients have better survival when treated with pediatric-based intensive regimens. Considering these results, We decided to treat newly diagnosed ALL patients according to age and risk factors. The goal of this study was to describe the results of this intensive chemotherapy treatment approach for ALL adult patients diagnosed at our institution. Methods: Fifty-eight ALL patients, diagnosed from 2004 to 2013, were included in the analysis. Patients were assigned to either the St. Jude Total Therapy XIIIB high-risk arm (St Jude) or the CALGB 8811 (CALGB). The Kaplan-Meier survival curve was used for the survival analyses and the Cox proportional hazard regression, for multivariable analysis. Results: The overall survival was 22.9% at 10 years. The St. Jude improved survival, compared to the CALGB (p = 0.007), with 32.6% vs. 7.4% survival rate at 10 years. However, no survival benefit was found for patients younger than 20 years old (p = 0.32). The multivariable analysis demonstrated that undetectable minimal residual disease (MRD) and hematopoietic stem cell transplantation (HSCT) had beneficial impact on survival (p = 0.0007 and p = 0.004, respectively). Conclusion: ALL is a disease of poor prognosis for adults. The joint effort to standardize treatment and seek solutions is the way to start improving this scenario.

Minimal residual disease assessment in acute lymphoblastic leukemia by 4-color flow cytometry: Recommendations from the MRD Working Group of the Brazilian Society of Bone Marrow Transplantation

Abstract Introduction: The minimal residual disease (MRD) status plays a crucial role in the treatment of acute lymphoblastic leukemia (ALL) and is currently used in most therapeutic protocols to guide the appropriate therapeutic decision. Therefore, it is imperative that laboratories offer accurate and reliable results through well standardized technical processes by establishing rigorous operating procedures. Method: Our goal is to propose a monoclonal antibody (MoAb) panel for MRD detection in ALL and provide recommendations intended for flow cytometry laboratories that work on 4-color flow cytometry platforms. Results and conclusion: The document includes pre-analytical and analytical procedures, quality control assurance, technical procedures, as well as the information that needs to be included in the reports for clinicians.

Linfoma anaplásico de células grandes associado a implante mamários: um desafio diagnóstico / Breast implant-associated anaplastic large cell lymphoma: a diagnostic challenge

O linfoma anaplásico de células grandes associado a implante mamário (BIA-ALCL ) é uma entidade provisória com características morfológicas e imunofenotípicas indistinguíveis do linfoma anaplásico de células grandes (ALCL) ALK negativo. Ao contrário do ALCL, o BIA-ALCL surge principalmente em associação ao implante mamário. A confirmação diagnóstica do BIA-ALCL pode ser difícil e a associação de características morfológicas e patológicas com citometria de fluxo e imuno-histoquímica pode auxiliar no diagnóstico. O objetivo deste relatório é descrever um caso de BIA-ALCL no qual a análise citológica e imunofenotipológica utilizando citometria de fluxo sugeriu a presença de grandes células positivas para CD30 no líquido de derrame.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a provisional entity with morphological and immunophenotypic characteristics indistinguishable from ALKnegative anaplastic large cell lymphoma (ALCL). Unlike ALCL, BIA-ALCL arises mainly in association with breast implantation. Diagnostic confirmation of BIA-ALCL can be difficult and associating morphological and pathological hallmarks with flow cytometry and immunohistochemistry can assist in the diagnosis. The objective of this report is to describe a case of BIA-ALCL in which cytological and immunophenotypological analysis using flow cytometry suggested the presence of large CD30-positive cells in the effusion fluid.

Acute promyelocytic leukemia: evaluation of diagnostic tests from 2000 to 2018 in a public hospital / Leucemia promielocítica aguda: avaliação dos testes diagnósticos entre o período de 2000 e 2018 em um hospital público

ABSTRACT Introduction: Acute promyelocytic leukemia (APL) is caused by t(15;17)(q24;q21) translocation, which product is the fusion oncoprotein PML-RARa (promyelocytic leukemia-retinoic acid receptor alpha). The morphology of leukemic promyelocytes is usually characteristic, with the presence of faggot cells and coarse cytoplasmic granulations; immunophenotype is characteristic in most cases. However, definitive laboratory diagnosis should be performed by detecting t(15;17) or by PML-RARa fusion protein. Objectives: To compare cytomorphology, flow cytometry, and classical cytogenetic of bone marrow samples from patients with APL, treated at the Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), as well as describe the possible discrepancies between the methodologies. Method: Retrospective analysis of APL cases treated at the CHC-UFPR from January 2000 to July 2018. Results: Eighty-eight patients (42 man/ 46 woman; mean age: 34 years), 42.1% of them presented a high-risk prognosis. Flow cytometry was performed in 83 cases (94.3%); karyotype was performed in 79 cases (89.7%), but translocation t(15;17) was confirmed in only 53 cases (60.2%). From the 28 patients with a non-conclusive karyotype; fourteen (15.9%) of them presented the PML-RARa transcript in the molecular analysis. In total, 35 patients (39 8%) performed research of the PML-RARa gene by molecular biology. Only 45 patients (51.1%) presented concordant diagnosis among the three technical exams (morphology, flow cytometry and cytogenetics). Overall survival was 67% at 4.8 years, with 29 deaths. Conclusion: Genetic confirmation was observed in 76.1% of samples, 60.2% by conventional cytogenetics and 15.9% by molecular biology. There was a disagreement between the methodologies, and a low sensibility of the conventional cytogenetics, demonstrating the importance of performing molecular techniques for diagnostic confirmation.

RESUMEN Introducción: La leucemia promielocítica aguda (LPA) es causada por la translocación t(15;17)(q24;q21), cuyo producto es la oncoproteína de fusión PML-RARa (proteína de la leucemia promielocítica-receptor alfa de ácido retinoico). La morfología de los promielocitos leucémicos suele ser típica, con presencia de células faggot (células en haces) y gruesasgranulaciones citoplásmicas; el inmunofenotipo es característico en la mayor parte de los casos. No obstante, el diagnóstico final de laboratorio debe ser hecho por la detección de la t(15;17) o por la oncoproteína PML-RARa. Objetivos: Comparar la citomorfología, la citometría de flujo y la citogenética clásica de muestras de médula ósea de pacientes con LPA asistidos en el Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), así como describir lasposibles discrepancias entre los métodos. Método: Análisis retrospectivo de los casos de LPA asistidos en el CHC-UFPR entre enero de 2000 y julio de 2018. Resultados: De los 88 pacientes (42 hombres y 46 mujeres; edad promedio: 34 anos), 42,1% presentaron pronóstico de alto riesgo. Citometría de flujo se realizó en 83 casos (94,3%); cariotipo en 79 casos (89,7%),pero la translocación se confirmó en sólo53 (60,2%) casos. Entre los28 pacientes con cariotipo no concluyente, 14 (15,9%) presentaron el transcripto PML-RARa. En total, 35 pacientes (39,8%) realizaron la pesquisa del gen PML-RARa por biología molecular. Cuarenta y cinco pacientes (51,1%) tuvieron diagnóstico acorde entre los métodos (morfología, citometría de flujo y citogenética). La supervivencia global fue de 67% en 4,8 anos, con 29 muertes. Conclusión: Hubo confirmación genética en 76,1% de las muestras, siendo 60,2% por citogenética y 15,9%por biología celular. Hubo desacuerdo entre los métodos y baja sensibilidad de la citogenética convencional, lo que demuestra la importancia de la realización de técnicas moleculares para confirmación diagnóstica.

RESUMO Introdução: A leucemia promielocítica aguda (LPA) écausada pela translocação t(15;17)(q24;q21), cujo produto éa oncoproteína de fusão PML-RARa (leucemia promielocítica-receptor alfa do ácido retinoico). A morfologia dos promielócitos leucêmicos é habitualmente característica, com presença de faggot cells (células em maços ou feixes) e granulações citoplasmáticas grosseiras; o imunofenótipo é característico na maioria dos casos. Porém, o diagnóstico laboratorial definitivo deve ser feito pela detecção da t(15;17) ou pela oncoproteína PML-RARa. Objetivos: Comparar a citomorfologia, a citometria de fluxo e a citogenética clássica de amostras de medula óssea de pacientes com LPA atendidos no Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), bem como descrever as possíveis discrepâncias entre as metodologias. Método: Análise retrospectiva dos casos de LPA atendidos no CHC-UFPR entre janeiro de 2000 e julho de 2018. Resultados: Dos 88 pacientes (42 homens e 46 mulheres; média de idade: 34 anos), 42,1% apresentaram prognóstico de alto risco. A citometria de fluxo foi realizada em 83 casos (94,3%); o cariótipo, em 79 casos (89,7%), mas a translocação foi confirmada em apenas 53 (60,2%) casos. Dos 28 pacientes com cariótipo não conclusivo, 14 (15,9%) tinham a presença do transcrito PML-RARa. No total, 35 pacientes (39,8%) realizaram a pesquisa do gene PML-RARa por biologia molecular. Quarenta e cinco pacientes (51,1%) obtiveram diagnóstico concordante entre as metodologias (morfologia, citometria de fluxo e citogenética). A sobrevida global foi de 67% em 4,8 anos;com 29 óbitos. Conclusão: A confirmação genética foi realizada em 76,1% das amostras, sendo 60,2%por citogenética e 15,9% por biologia molecular. Houve discordância entre as metodologias e baixa sensibilidade da citogenética convencional, o que demonstra a importância da realização de técnicas moleculares para confirmação diagnóstica.

Recommendations for quality assurance in multiparametric flow cytometry: first consensus of the Brazilian Group of Flow Cytometry (GBCFLUX) / Recomendações para garantia da qualidade em citometria de fluxo multiparamétrica: primeiro consenso do Grupo Brasileiro de Citometria de Fluxo (GBCFLUX)

ABSTRACT The Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo [GBCFLUX]), founded on April 24, 2010, is composed of experts in flow cytometry (FC) area who have the common objective of contributing to technical and scientific advances in Brazilian clinical and research laboratories. Among GBCFLUX working groups, the Quality Control (QC) subcommittee is responsible for discussing data in the literature and contributes to the quality assurance of the pre-analytical, analytical and post-analytical process in FC. The QC subcommittee's actions began through meetings and lectures, in which data from the literature were reviewed and discussed with all participating members of the GBCFLUX. In a second step, it was decided to draw up a text of technical and scientific consensus recommendations, informative and educative, for dissemination to all FC working groups in Brazil. To this effect, a questionnaire with objective responses was designed and sent to 35 recognized Brazilian institutions, in order to evaluate the QC profile of these institutions. Thus, the QC technical-scientific recommendations, which will be described in this updating article, are intended to ensure the process quality, technical standardization, and reproducibility of results in FC.

RESUMO O Grupo Brasileiro de Citometria de Fluxo (GBCFLUX), fundado em 24 de abril de 2010, é composto por especialistas da área de citometria de fluxo (CF) que possuem o objetivo comum de contribuir para avanços técnico-científicos em laboratórios clínicos e de pesquisa brasileiros. Entre os grupos de trabalho do GBCFLUX, o subcomitê de Controle de Qualidade (CQ) é responsável por discutir dados da literatura e contribuir para a garantia da qualidade do processo pré-analítico, analítico e pós-analítico em CF. As ações do subcomitê de CQ iniciaram-se por meio de reuniões e palestras, nas quais dados da literatura foram revisados e discutidos com todos os membros participantes do GBCFLUX. Em uma segunda etapa, definiu-se elaborar um texto de recomendações consensuais técnicocientíficas, informativas e educativas para divulgação a todos os grupos que trabalham com CF no Brasil. Para tanto, foi elaborado um questionário com respostas objetivas, sendo enviado para 35 instituições brasileiras cadastradas, com a finalidade de avaliar o perfil de CQ dessas instituições. Dessa forma, as recomendações técnico-científicas de CQ que serão descritas neste artigo de atualização têm o objetivo de contribuir para a garantia da qualidade do processo, a padronização técnica e a reprodutibilidade dos resultados em CF.

Paroxysmal nocturnal hemoglobinuria clone in 103 Brazilian patients: diagnosis and classification

Background: Paroxysmal nocturnal hemoglobinuria is an acquired chronic hemolytic ane- mia, which often manifests as peripheral blood cytopenias and thrombosis. Objective: The aim of this study is to describe a Brazilian population of paroxysmal nocturnal hemoglobinuria patients. Methods: One hundred and three paroxysmal nocturnal hemoglobinuria cases were retrospectively reviewed and the clinical presentation, thrombosis, survival, and clone size were assessed. Diagnosis was established by flow cytometry. Results: Fifty-two male and 51 female patients with a median age of 24.1 years (5.5-62 years) were studied. Clinical symptoms included hemoglobinuria (18.4%), infection (46.6%) and thrombosis (16.5%), and 80.6% had pancytopenia. Patients were classified as classic parox- ysmal nocturnal hemoglobinuria (10), paroxysmal nocturnal hemoglobinuria with aplastic anemia (39), and paroxysmal nocturnal hemoglobinuria with subclinical features and aplas- tic anemia (54). There were significant differences in terms of median age, size of clone, clinical symptoms, and peripheral blood cell counts between the three subcategories. The clone size in erythrocytes and granulocytes were respectively 0.04% (range: 0-18%) and 7.3% (range: 0.3-68.7%) in patients with subclinical features and aplastic anemia, 15.8% (range: 0-99.7%) and 63.0% (range: 1.7-99.8%) in patients with aplastic anemia alone, and 82.2% (range: 0-99.85%) and 98.0% (81.3-100.0%) in Classic disease. Statistical differences were identified for platelets (p-value = 0.001), lactate dehydrogenase (p-value = 0.002) and the clone size (p-value < 0.001) in patients who suffered thrombotic events compared to those who did not. Overall survival was 81.7%, with patients with subclinical features and aplastic anemia having lower overall survival (76.5%). Conclusion: This retrospective review of 103 patients over an 11-year period represents the largest collection of paroxysmal...

Relationship between anthropometric and hemodynamic indexes in school children / Relação entre os indicadores antropométricos e hemidonâmicos em escolares

Cardiovascular diseases are the main cause of death in world population. Current analysis with 1074 schoolchildren in municipal schools of Cruzeiro do Oeste, Paraná State, Brazil, evaluated anthropometric indexes and blood pressure levels of schoolchildren and verified the relationship between Body Mass Index (BMI) and Waist Circumference (WC) with blood pressure (BP). Evaluations comprised weight and height for the calculation of BMI, waist circumference and arterial pressure. Chi-square test and Cramer's coefficient verified whether the variables were associated. High percentage of weight excess was reported, or rather, 16.6% of children were overweight; 9.8% were obese; 30.6% had high WC and 38.3% had high blood pressure. BMI and WC were associated with high BP. Overweight schoolchildren with central adiposity had a great trend of having high blood pressure.

As doenças cardiovasculares são a principal causa de morte na população. O estudo objetivou avaliar os indicadores antropométricos e os níveis pressóricos de escolares e verificar a relação entre esses indicadores: Índice de Massa Corporal (IMC) e Circunferência de Cintura (CC) com Pressão Arterial (PA). O estudo foi realizado com 1.074 escolares, em escolas municipais do município de Cruzeiro do Oeste, Estado do Paraná. As avaliações consistiram em medida de peso e estatura para o cálculo do Índice de Massa Corporal, da Circunferência da Cintura e da Pressão Arterial. Associações entre as variáveis foram verificadas utilizando do teste de qui-quadrado e pelo coeficiente de Cramer. Observou-se elevado percentual de excesso de peso, sendo sobrepeso de 16,6% e obeso 9,8%, 30,6% de CC alterada e 38,3% de escolares com medidas pressóricas elevadas. Tanto IMC como CC demonstraram associação com PA elevada. Os escolares com excesso de peso e adiposidade central apresentam maiores chances de elevar suas medidas pressóricas.

Prevalência de sobrepeso/obesidade e nível econômico de escolares / Prevalence of overweight/obesity and economical status of schoolchildren / Prevalencia de sobrepeso/obesidad y nivel económico de escolares

OBJETIVO: Associar o estado nutricional com sexo, grupo etário e nível econômico de escolares do ensino fundamental por meio de um estudo transversal nas escolas municipais do município de Cruzeiro do Oeste, Paraná, Brasil. MÉTODOS: A pesquisa foi realizada em 2010 com 939 alunos com idades entre seis e dez anos. Para tanto, realizou-se a classificação do nível econômico das famílias por meio do questionário de ranking econômico (Associação Brasileira de Empresas de Pesquisa) e foi calculado o índice de massa corpórea. A análise dos dados foi realizada por estatística descritiva, e a verificação de diferenças entre grupos independentes pelos testes de Mann-Whitney e Kruskal-Wallis, bem como possíveis associações foram verificadas pelo teste do qui-quadrado. Para todos os procedimentos adotou-se o nível de significância de p<0,05. RESULTADOS: A prevalência de obesidade na amostra estudada foi de 8,0% e de sobrepeso, 16,4%. Não houve associação entre nível econômico e estado nutricional, assim como entre estado nutricional e sexo. CONCLUSÕES: A prevalência de sobrepeso e obesidade foi considerada alta, evidenciando que crianças de ambos os sexos são afetadas, independentemente de seus níveis econômicos e grupo etário.

OBJECTIVE: To associate the nutritional status of elementary schoolchildren with their gender, age group, and economic status based on a cross-sectional study carried out at public schools in the municipality of Cruzeiro do Oeste, Southern Brazil. METHODS: The study was performed in 2010 including 939 schoolchildren aged six to ten years-old. The economical status of the families was classified based on a socioeconomic ranking questionnaire (Brazilian Association of Survey Companies), and the body mass index was calculated. Data were analyzed by descriptive statistics, and differences between independent groups were verified by Mann-Whitney and Kruskal-Wallis tests, while possible associations were verified by the chi-square test, being significant p<0.05. RESULTS: The prevalence of obesity in the sample was 8.0%, and overweight, 16.4%. No association was found between the socioeconomic and nutritional status or between the nutritional status and gender. CONCLUSIONS: A high prevalence of overweight and obesity was found in this study, indicating that children of both genders are affected regardless of their economical status and age.

OBJETIVO: asociar el estado nutricional con el sexo, la franja de edad y el nivel socioeconómico de escolares de la enseñanza primaria, mediante estudio transversal en las escuelas municipales de la ciudad de Cruzeiro do Oeste (Paraná, Brasil). MÉTODOS: La investigación fue realizada en 2010, con 939 alumnos entre seis y diez años. Para eso, se realizó la clasificación del nivel económico de las familias mediante cuestionario de clasificación económica (Asociación Brasileña de Empresas de Investigación - ABEP) y se calculó el índice de masa corporal. El tratamiento estadístico se realizó por medio de los recursos de la estadística descriptiva y la verificación de diferencias entre grupos independientes por las Pruebas de Mann-Whitney y Kruskal-Wallis, así como posibles asociaciones fueron verificadas por la prueba de chi-cuadrado. Para todos los procedimientos se adoptó el nivel de significancia de p<0,05. RESULTADOS: La prevalencia de obesidad en la muestra estudiada fue de 8,0% y la de sobrepeso fue de 16,4%. No hubo asociación entre nivel económico y estado nutricional, así como entre estado nutricional y sexo. CONCLUSIONES: La prevalencia de sobrepeso y obesidad fue considerada alta, evidenciando que niños de ambos sexos son afectados, independiente de su nivel económico y franja de edad.

Prevalência e fatores associados ao excesso de peso em escolares / Overweight prevalence and factors associated with school-aged children / Prevalencia y factores asociados al sobrepeso en los escolares

O excesso de peso em escolares deve ser visto com atenção, pois a obesidade ou excesso de gordura corporal é comprovadamente fator de risco para a saúde humana. O estudo teve como objetivo verificar a prevalência e os fatores associados ao excesso de peso em escolares. Participaram 1.074 escolares de 6 a 10 anos, das escolas municipais do município de Cruzeiro do Oeste (PR). Foram coletadas informações antropométricas, sociodemográficas e comportamentos sedentários. A prevalência de excesso de peso para toda a amostra foi de 26,4% e não houve associação entre os sexos para as variáveis: idade, massa corporal, estatura, Índice de Massa Corporal (IMC) e nível econômico; fatores socioeconômicos e comportamentais não apresentaram associação entre os sexos com exceção da variável tempo em frente à televisão (TV). Escolares com hábito de assistir TV por mais de 4 horas por dia apresentaram 1,4 vezes mais chance de ter excesso de peso em relação àqueles que assistem menos de 4 horas diárias. Escolares com hábito de comer em frente à TV, computador (PC) ou Game apresentaram 34% mais chance de ter excesso de peso. Concluiu-se que deve ser dada atenção à prevalência de excesso de peso em escolares, voltadas à orientação nutricional e à atividade física.

Overweight prevalence in school-aged children should be viewed carefully since obesity or excess of body fat has proven to be a risk factor for human health. The purpose of this study was to determine prevalence and factors associated with overweight in school-agedchildren. A number of 1074 school-aged children participated in this research from 6 to 10 years, from public schools in the municipality of Cruzeiro do Oeste, state of Paraná, Brazil. Anthropometric and sociodemographic data was collected as well as sedentary behaviorinformation. The prevalence of overweight for the entire sample was 26.4%, there was no association between the sexes for the variables: age, body mass, height, BMI (Body Mass Index) and economic level. Socio-economic status and behavioral factors were not associated with gender, except the variable time in front of the TV (television). School-aged children that have the habit of watching TV for more than 4 hours per day had 1.4 times more probability to be overweighed than those who watch less than 4 hours daily. School-aged children with the habit of eating in front of the TV, computer or playing games had 34% more chanceto be overweight. These results indicate that attention should be paid to the prevalence of overweight in school-aged children, focusing on nutrition education and physical activities.

El sobrepeso en escolares requiere atención pues, la obesidad o exceso de grasa corporal es comprobadamente factor de riesgo para la salud humana. El objetivo de este estudio fue determinar la prevalencia y los factores asociados con el sobrepeso en escolares. Participantes 1.074 escolares de 6 a 10 años, de las escuelas públicas del municipio de Cruzeiro do Oeste (PR). Fueron recolectadas informaciones antropométricas, sociodemográficas y comportamientos sedentarios. La prevalencia del sobrepeso para toda la muestra fue de 26,4%, no hubo asociación entre los sexos para las variables: edad, peso, talla, IMC (índice de masa corporal) y nivel económico; factores socioeconómicos yde comportamiento no se asociaron con el género, con excepción de la variable tiempo en frente de la TV. Los estudiantes con el hábito de ver la TV durante más de 4 horas por día, presentaron 1,4 veces más probabilidades de tener sobrepeso, en comparación con aquellos que ven TV menos de 4 horas diarias. Los estudiantes con el hábito de comer en frente de la TV, del ordenador (PC) o juegos, presentaron 34% más probabilidades de tener sobrepeso. Se concluye que se debe prestar atención a la prevalencia de sobrepeso en los escolares a escuela, orientada a la educación nutricional y a la actividad física.

Prevalência de llteração das medidas antropométricas em escolares / Prevalence of ntthropometric measurement alteration in school childeen

O sobrepeso e a obesidade estão entre os principais problemas de saúde pública. As medidas de índice de massa corporal (IMC) e circunferência da cintura (CC) têm sido ferramentas importantes para detectar o sobrepeso e obesidade. A medida da CC em crianças, além de apresentar relação com adiposidade da região central do corpo, apresenta associação com fatores de risco para Doenças Cardiovasculares (DCV). O objetivo do presente estudo foi associar as alterações antropométricas de IMC e CC e comparar as variáveis de acordo com os grupos etários em escolares de seis a dez anos de idade. O diagnóstico consistiu em avaliação antropométrica de 1074 escolares de 6 escolas de Cruzeiro do Oeste, PR. As medidas antropométricas utilizadas neste estudo foram: Peso, Estatura e Circunferência da Cintura. Apresentaram excesso de peso 26,4%, destas 9,8% são obesas. Entre as meninas 33,3%, apresentaram CC alterada e entre os meninos 27,9%, sem diferença significativa entre os gêneros sexuais.

Overweight and obesity are major public health problems. Measurementss of body mass index (BMI) and waist circumference (WC) have been important tools to detect overweight and obesity. WC measurement in children, besidespresenting a relationship with central adiposity of the body, is associated with risk factors of Cardiovascular Disease (CVD). The aim of this study was to associate anthropometric changes of BMI and WC and compare variables according to age groups in six- to ten-year-old school children. The diagnosis consisted of anthropometric measurements of 1074 students from six schools in Cruzeiro do Oeste, PR. The anthropometric measurements used in this study were: weight, height and waist circumference. Were overweight 26.4% were considered overweigh, and 9.8% of them were classified as obese. Among the girls,33.3% had altered CC, and among boys 27.9%. There was no significant difference between the genders.

O tratamento da Leucemia Mielóide Crônica com mesilato de imatinibe / Therapy of Chronic Myeloid Leukemia with imatinib mesylate

O mesilato de imatinibe é atualmente o tratamento de escolha para pacientes com Leucemia mielóide Crônica (LMC) recém-diagnosticados. Desde os primeiros estudos clínicos em 1998 até o estudo IRIS, que comparou o uso em primeira linha de imatinibe com interferon + ara-C, esta droga vem se consolidando em segurança e eficácia. Ainda há, entretanto questionamentos sobre a melhor dose inicial, a identificação dos pacientes que mais se beneficiariam e a melhor abordagem frente a respostas sub-ótimas e resistência. Os principais estudos clínicos publicados com mesilato de imatinibe são revisados no presente artigo, e discutidos sob a perspectiva da realidade brasileira.

Imatinib mesylate is currently the gold-standard therapy for patients with newly diagnosed Chronic Myelogenous Leukemia. From the clinical trials in 1998 to the IRIS study, which compared first line imatinib treatment with interferon and low dose ara-C, this drug has been consolidated in regards to its safety and efficacy. There are still some questions to answer. Which would be the best initial dose? Are there any patients who benefit more than others? What is the best approach to suboptimal response and resistance? The most important published clinical studies are reviewed in the current article and discussed from a Brazilian perspective.

Insuficiência renal aguda como manifestação inicial de linfoma de Burkitt renal / Acute renal failure as first clinical presentation of BurkittÆs renal lymphoma

Relatamos o caso de um jovem de 14 anos que procurou atendimento médico por edema e hipertensão, sendo insuficiência renal aguda secundária a linfoma de Burkitt renal diagnosticada após avaliação laboratorial, de imagem e biópsia de massa tumoral renal.

This case report is from a 14-year-old boy who had edema and hypertension due to a primary renal Burkitt's lymphoma, diagnosed through laboratory and image evaluation and kidney tumor biopsy.

Histological and immunohistochemical evaluation of sarcoma 180 in mice after treatment with and alfa-D-glucan from the lichen Ramalia celastri

The antitumoral activity of an alfa-D-glucan from the lichen Ramalia celastri was investigated using the tumor Sarcoma 180 (S-180). Mice were inoculated with the tumor and 24 h later received a single dose of alfa-D-glucan (200 mg/kg). Thirty-five days after inoculation the mice were sacrificed and the tumors were examined histopathologically. Morphological analyses showed that the tumor was invasive and that it produced typical and atypical mitoses, neovascularization and an infiltration of inflammatory cells. In treated mice, inflammatory cells were more frequent and the presence of nuclear fragments suggested tumor cell death by apoptosis. The tumors of control and alfa-D-glucan treated mice were negative for laminin but expressed fibronectin, the intensity and distribution of which varied in the connective tissue surrounding the tumor mass, in treated mice than in control mice, but in tumor cells, the expression was greater in control mice. The results indicate that alfa-D-glucan can inhibit tumor growth and affect host defense cell responses. The differences in fibronectin distribution between the control and alfa-D-glucan treated mice, suggest that this protein may play an important role in limiting the invasiveness of malignant cells.