Pathogenesis and Immune Status in COVID-19 Pneumonia-A Minireview

The novel coronavirus (SARS-CoV-2), which was isolated in January 2020, emerged as a result of natural evolution and has already infected millions of people around the world due to its extensive human-to-human transmission capacity. Highlighting the clinical manifestations, pathology and immune response against the SARS-CoV-2 infection process, this review study was con-ducted through a comprehensive bibliographic search of academic papers that are available online at the following databases Science Direct, Pub Med, ACS Publications, Nature, BioRxiv and Me-dRxiv. According to the analyzed works, people infected with SARS-CoV-2 may display fever and dry cough as the main clinical symptoms and they may also present breathing difficulty, muscle pain (myalgia), chills, lack of appetite, fatigue, sore throat, altered consciousness, diarrhea, vomit-ing, nasal discharge and syncope. When considering the immune status of patients with COVID-19, it is highlighted that hypercytokinemia contributes to the severity that can even result in death. Lymphopenia is the most frequent prognosis described in cases of COVID-19. Thus, a de-tailed understanding of the specific inflammatory pathways that result in the pathology of COVID-19 is crucial for the immediate development of clinical therapeutic approaches.Copyright © 2021 Bentham Science Publishers.

Coping with COVID-19: Measuring self-efficacy, collective efficacy and proxy efficacy beliefs

Investigating efficacy beliefs for coping with COVID-19 can be helpful when proposing interventions that contribute to mitigate the disease. Six scales of efficacy beliefs for coping with COVID-19 were built: self-efficacy;family and community collective efficacy;and proxy efficacy to the municipal, state and federal governments. To obtain evidence of validity based on the internal structure and reliability estimates of these measures, 518 participants completed an online form. Exploratory factor analysis revealed that all scales had a unidimensional structure. Cronbach's alphas ranged from .819 to .968. Although positive correlations predominated between the scores of the six scales, the magnitudes were, in general, weak or moderate, showing that they were distinct constructs. These scores differed from each other, with levels of efficacy decreasing as individual control over the actions necessary to mitigate COVID-19 decreased. Thus, the six scales initially presented satisfactory psychometric properties. Study-related limitations, implications and recommendations are also presented. © 2022 Associacao Portuguesa de Psicologia. All rights reserved.

Linfoma Hepatoesplenico De Celulas T Gamma-Delta: Um Desafio Aos Hematologistas - Relato De Dois Casos

Objetivo: Descrever dois casos com desfechos diferentes de linfoma hepatoesplenico de celulas T gamma-delta (LHECTGD), entidade rara que corresponde a menos de 1% dos linfomas nao-Hodgkin. Caso clinico: Caso 1: Feminina, 71 anos, portadora de artrite reumatoide, HAS e glaucoma, internada por pancitopenia e pneumonia bacteriana sobreposta a infeccao por COVID-19. Fazia seguimento ha 2 anos com hematologia por anemia e plaquetopenia, sem exames diagnosticos. Em avaliacao medular, imunofenotipagem de medula compativel com linfoma T hepatoesplenico (LTHE). Devido intercorrencias infecciosas, paciente evoluiu para obito antes do tratamento da doenca hematologica. Caso 2: Masculino, 47 anos, avaliado em servico de hematologia devido hepatoesplenomegalia, baco ate 15cm do rebordo costal esquerdo (RCE), pancitopenia com neutropenia grau IV em hemograma inicial, descartadas infeccoes virais e leishmaniose visceral. Em avaliacao medular, biopsia de medula ossea evidenciou infiltracao por doenca linfoproliferativa B e imunohistoquimica inconclusiva. Imunofenotipagem de aspirado de medula ossea compativel com infiltracao por LTHE. O paciente recebeu tratamento com 6 ciclos de CHOEP e encontra-se com normalizacao de hemograma apos ultimo nadir, resposta clinica (reducao do baco para 3cm RCE e melhora dos sintomas B), alem de resposta em imagem no exame PET-CT. Atualmente, transplante autologo em andamento no intuito de consolidacao de resposta. Discussao: O LHECTGD tem pico de incidencia em adolescentes e adultos jovens e uma razao homem/mulher de 9:1. E uma doenca rara, visto que a maioria dos linfomas de celulas T expressa receptores alfa-beta e apenas 2-4% expressam receptores gamma-delta. Atualmente ha pouco mais de cem casos descritos na literatura, sendo definido como um linfoma de proliferacao maligna de celulas T nos sinusoides do figado, na polpa vermelha do baco e na medula ossea. O fenotipo frequentemente exposto e de celulas T CD2+, CD3+, CD4-, CD5-, CD7+-, CD8-, com expressao de receptor celula T gama delta ou alfa beta. Dentre as anormalidades citogeneticas associadas, inclui-se o isocromossomo 7q com ou sem trissomia do 8. Clinicamente, os pacientes apresentam sintomas B, alem de hepatoesplenomegalia acentuada, sem adenomegalias suspeita, o que aumenta o desafio diagnostico e leva a inferencias diagnosticas infecciosas e de hipertensao portal antes do diagnostico hematologico. O tratamento engloba desde a intervencao cirurgica, como a esplenectomia - no intuito de controlar o hiperesplenismo e evitar uma das principais causas de obito, a ruptura esplenica -, alem de quimioterapias baseadas em regimes que contenham etoposideo, sem esquemas com relato de superioridade na literatura. O transplante autologo (e em alguns relatos, o alogenico) foram indicados para consolidacao quando ha resposta ao tratamento. Conclusao: O LHETGD e uma doenca rara, de prognostico reservado, com multiplos relatos de atraso diagnostico devido a ausencia de sintomas especificos da doenca. Recomenda-se, assim, que, diante de paciente jovens, com quadro de trombocitopenia ou alteracoes de outras linhagens e hepatoesplenomegalia, a hipotese diagnostica de LHECTGD deve ser considerada. Em relacao ao arsenal terapeutico disponivel atualmente, novos estudos mostram-se necessarios, objetivando melhorar a expectativa e qualidade de vida dos pacientes. Copyright © 2022

New Nurses' Strategies in Prenatal Care in the Face of the Pandemic Scenario (Covid-19): An Integrative Review

To ensure periodic prenatal follow-up in a safe manner, health professionals and especially nurses, have been adopting strategic safety measures to face the challenges in the midst of the COVID-19 pandemic. Thus, the present study aims to describe strategic actions adopted by nurses, to ensure the performance of periodic prenatal care in a safe manner, as well as to welcome pregnant women in this difficult time. Materials and Methods: This is an integrative review, whose data sources used were, LILACS;Scielo;VHL;PubMed and Google Scholar. Results: There was an increase in the prevalence of gestational diabetes around 25.6% in pregnant women hospitalized and symptomatic for COVID-19. There was also an increase in the rate of premature births;and stillbirth cases occurred around four times more in pregnant women who had SARS-CoV-2. It is also worth mentioning that SARS-COV-2 can progress between phases I, II and III, ranging from mild to more severe symptoms, and pregnant women who progress to assistance in the intensive care unit have a high mortality rate. Conclusion: Among the strategies that stood out: the reorganization of the service flow of the units;holding teleconsultations and postponing face-to-face consultations with symptomatic pregnant women, also reinforced the importance of the professional nurse in the practice of skillful listening. Thus, for the future it is expected that lessons are learned, where the experiences lived by the population and health professionals, result in improvement of maternal-fetal health, with access and quality of assistance superior to those found before the pandemic.

LINFOMA DE HODGKIN CLÁSSICO RECÉM-DIAGNOSTICADO NO CONTEXTO DE DESABASTECIMENTO DE BLEOMICINA: TRATAMENTO COM DOXORRUBICINA, ETOPOSÍDEO, VIMBLASTINA E DACARBAZINA (AEVD)

Introdução: A combinação de doxorrubicina, bleomicina, vinblastina e dacarbazina (ABVD) representa a principal opção de tratamento em primeira linha para o Linfoma Hodgkin classico (LH). Desde 2018, o desabastecimento de bleomicina no Brasil têm trazido consequências graves aos pacientes com LH. No âmbito da medicina privada, instituições têm feito o uso de A+AVD, esquema no qual a bleomicina é substituída por brentuximabe-vedotina, ou importado a bleomicina de forma independente. Para diversas instituições públicas, entretanto, estas opções não são acessíveis. Objetivo: Avaliar a segurança e a eficácia da combinação AEVD (doxorrubicina;etoposídeo, em substituição à bleomicina, na dose de 100 mg/m2;vinblastina e dacarbazina) para tratamento de LH em primeira linha, nos dias 1 e 15 de ciclos de 28 dias. Métodos: Realizamos estudo clínico aberto não-randomizado para avaliar o regime AEVD como tratamento de primeira linha em pacientes com diagnóstico recente de LH no Hospital Municipal São José em Joinville, Brasil. Resultados: Vinte e cinco pacientes com mais de 18 anos e diagnóstico de LHc entre junho e novembro de 2020 foram incluídos. Quatorze pacientes (56%) eram homens, com mediana de idade de 27 anos (variando de 18 a 66 anos). A maioria dos pacientes tinham doença Estágio II (60%, n = 15), tinham sintomas B (56%, n = 14) e lactate-desidrogenase (LDH, 52%, n = 13). Para estágios III-IV (n = 5), 3 pacientes apresentaram IPS alto risco (escore >2;60%). Para doença localizada (n = 20), alto risco conforme GHSG foi observado em 16 pacientes (n = 80%). Todos os pacientes passaram por 3 a 6 ciclos de quimioterapia e não se observou evento adverso com necessidade de internação hospitalar, interrupção ou descontinuação de tratamento. A realização de PET-CT ocorreu exclusivamente fora da nossa instituição. Oito pacientes tiveram acesso a PET-CT no ínterim, todos com escore Deauville de 1-3. A taxa de resposta global foi de 96%, com um paciente apresentando progressão da doença após 5 ciclos. Sete pacientes tiveram avaliação de final de tratamento (FT) apenas com TC, com 5 respostas completas (RC) e 2 respostas parciais (RP), com ambos os pacientes RP mantiveram remissão após 10 e 12 meses. Avaliação ao FT com PET-CT (n = 18) resultou em DS 1-3 em 72% (n = 13), 4 em 22% (n = 4) e 5 em 6% (n = 1). Todos os 5 pacientes DS 4-5 foram submetidos a biópsia após avaliação FT, com confirmação de LH recidivado ou refratário (RR) em 4 casos (mulher de 22 anos, estágio IV, alto risco com doença progressiva;homem de 65 anos, estágio III, baixo risco, com recidiva 11 meses após FT;homem de 26 anos, estágio II, alto risco com recidiva 6 meses após FT;mulher de 25 anos, estágio II, alto risco com recidiva 4 meses após FT). Dois pacientes LH RR (50%) tiveram atraso de mais de 30 dias no tratamento devido a fatores psicossociais ou financeiros secundários à pandemia Covid-19. Todos os pacientes LH RR tiveram acesso a terapia de resgate. Com mediana de seguimento de 16 meses (variando de 8 a 36 meses), nenhuma morte foi registrada e a probabilidade de sobrevida livre de progressão foi de 66% (IC95%: 72%-100%). Conclusões: A escassez de quimioterápicos tem sido um problema recorrente em todo o mundo, e é mais evidente em medicações citotóxicas sem substituições validadas, como é o caso da bleomicina. O uso do esquema AEVD para tratamento de LH recém-diagnosticado parece ser seguro, eficaz e factível, em uma população composta principalmente por pacientes de alto risco.

Doxorubicin, Etoposide, Vinblastine and Dacarbazine (AEVD) for Newly Diagnosed Classic Hodgkin Lymphoma

[Formula presented] Introduction: Combination of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is the standard of care in frontline therapy for classic Hodgkin lymphoma (cHL). Since 2018, bleomycin shortages have been reported in Brazil, with severe consequences for cHL patients. In the private setting, many institutions chose to use A+AVD, in which bleomycin is replaced by brentuximab-vedotin, or to import bleomycin from vendors not registered at the national drug agency. For public institutions, however, these costly strategies are largely unattainable. Methods: We conducted a single-arm open-label study to evaluate the substitution of bleomycin with etoposide 100 mg/m2 on days 1 and 15 of every 28-day cycle (AEVD) in previously untreated cHL, at Hospital Municipal São José, in Joinville, Brazil. Here we present preliminary data on the safety and efficacy of this combination in a scenario of lack of approved treatment options for this patient population. Results: Twenty-five patients aged 18 or more with cHL diagnosed between June 2018 and November 2020 were included. Fourteen patients (56%) were male, with median age of 27 years (range: 18-66). Most patients were stage II (60%, n=15), presented with B symptoms (56%, n=14) and high lactate dehydrogenase (LDH, n=13, 52%). For stage III-IV (n=5), high-risk IPS was present in 3 patients (score >2;60%). For localized disease (n=20), unfavorable features according to the GHSG were seen in 16 patients (n=80%). All patients received between 3 and 6 chemotherapy cycles, with no recorded adverse event requiring hospitalization, treatment interruption or discontinuation. PET-CT was performed solely outside of our institution. Eight patients had access to interim PET-CT, all with Deauville scores (DS) 1-3. Overall response rate was 96%, with one disease progression after 5 cycles. Seven patients had CT scan-alone end-of-treatment (EOT) assessment, with 5 complete responses (CR) and 2 partial responses (PR), with both PR patients sustaining remissions after 10 and 12 months. EOT assessment with PET-CT (n=18) resulted in DS 1-3 in 72% (n=13), 4 in 22% (n=4) and 5 in one (6%). All 5 patients with DS 4-5 underwent biopsy after EOT assessment, with confirmation of relapsed or refractory (RR) cHL in 4 cases (22 year-old, stage IV high-risk female with progressive disease;65 year-old, stage III low-risk male with relapse 11 months after EOT;26 year-old, stage II high-risk male with relapse 6 months after EOT;25 year-old, stage II high-risk female with relapse 4 months after EOT). Two RR cHL patients (50%) had treatment delays exceeding 30 days due to psychosocial or financial impacts emerging from the COVID-19 pandemic. All RR cHL patients had access to salvage treatments. At a median follow-up of 16 months (range: 8-36), no death was recorded and 12-month progression-free survival probability was 86% (95%CI: 72%-100%). Conclusions: Drug shortages impacting chemotherapy treatments have been a recurring problem worldwide, most noticeably among cytotoxic agents without in-class validated substitutions, as is the case with bleomycin. AEVD, as a novel approach to newly diagnosed cHL, appears to be safe, feasible and highly active in a population composed mostly of high-risk patients. [Formula presented] Disclosures: Boettcher: Novartis: Speakers Bureau.