Does COVID-19 really impact on the oxy-hemoglobin dissociation curve?

The COVID-19 pandemic has had a crucial impact on lifestyle worldwide. In this way, many studies have been presented, leading to continuous revaluation and questioning of conducts and concepts. Such is the case of the Chinese study suggesting that the new coronavirus has the potential to code anomalous nonstructural proteins capable of dissociating the iron atom from the porphyrin structure, contributing significantly to the characteristic hypoxemia conditions of the disease. Considering the potential impacts of those findings, the current study aims to evaluate and measure the dissociation curve of oxy-hemoglobin in COVID-19 patients. The project consists of a retrospective cohort study with data regarding oximetry and hemoglobin levels collected from digital patients records. The correlation between the measures and estimated values by Spearmen test was 0.843 (P < .001). A multiple linear regression model was applied using measured SO2 as a predicted variable and hemoglobin, PO2, and pH levels as predictors. The coefficients were pH 0.16-0.31 (P < .001); PO2 0.52-0.66 (P < .001) and Hb 0.088-0.059 (P = .706). Despite its limitations, the present study suggests that, at least in situations of clinical severity, the proposed mechanism does not appear to be universal or to have a significant clinical impact.

Mieloma múltiplo: experiência de cinco anos em um Hospital Universitário / Multiple myeloma: five-year experience at a University Hospital

Objective: To present a descriptive analysis of patients diagnosed with multiple myeloma, correlating it with mortality. Methods: A retrospective study that analyzed consecutive patients diagnosed with multiple myeloma under follow-up at the Faculdade de Medicina do ABC from 2006 to 2010. Results: The median age was 58.5 years. Anemia was observed upon diagnosis in 87% of patients, hypercalcemia in 38%, and creatinine levels higher than 2 mg/dL in 19%. M protein was detected in 85.7%. The five-year survival rate was 74.6%. Multivariate analysis showed statistical significance for Durie-Salmon staging (p = 0.037). The International Staging System and immunoglobulin type did not correlate significantly with survival of the group. Conclusion: This set of cases from a tertiary public healthcare service reflect theapproach of multiple myeloma in a predominantly young population with advanced clinical staging, with results comparable to those of the literature.

Objetivo: Apresentar uma análise descritiva de pacientes com diagnóstico de mieloma múltiplo, correlacionando à mortalidade. Métodos: Estudo retrospectivo que analisou pacientes consecutivos com diagnóstico de mieloma múltiplo, em seguimento na Faculdade de Medicina do ABC, entre os anos de 2006 a 2010. Resultados: A mediana de idade foi de 58,5 anos. A anemia foi observada ao diagnóstico de 87% dos pacientes, hipercalcemia em 38% e níveis de creatinina superior a 2 mg/dL em 19%. A proteína M foi detectada em 85,7%. A taxa de sobrevida em 5 anos foi de 74,6%. A análise multivariada demonstrou significância estatística para o estadiamento de Durie-Salmon (p = 0,037). O International Staging System e o tipo de imunoglobulina não se correlacionaram significativamente com a sobrevida do grupo. Conclusão: Esta casuística de um serviço público terciário reflete a abordagem do mieloma múltiplo em uma população predominantemente jovem e com estadiamento clínico avançado, com resultados comparáveis aos da literatura.

Multiple myeloma: five-year experience at a University Hospital.

OBJECTIVE: To present a descriptive analysis of patients diagnosed with multiple myeloma, correlating it with mortality. METHODS: A retrospective study that analyzed consecutive patients diagnosed with multiple myeloma under follow-up at the Faculdade de Medicina do ABC from 2006 to 2010. RESULTS: The median age was 58.5 years. Anemia was observed upon diagnosis in 87% of patients, hypercalcemia in 38%, and creatinine levels higher than 2 mg/dL in 19%. M protein was detected in 85.7%. The five-year survival rate was 74.6%. Multivariate analysis showed statistical significance for Durie-Salmon staging (p = 0.037). The International Staging System and immunoglobulin type did not correlate significantly with survival of the group. CONCLUSION: This set of cases from a tertiary public healthcare service reflect the approach of multiple myeloma in a predominantly young population with advanced clinical staging, with results comparable to those of the literature.

Clinical management of six cases of low-risk primary tonsillar non-Hodgkin's lymphoma

CONTEXT: There have been many reports that favor aggressive systemic treatment with chemotherapy and radiotherapy, even for well-localized lymphomas, avoiding the need for tonsillectomy of the normal tonsil. CASE REPORT: We report six cases of primary tonsillar lymphoma with a median patient age of 42 years. There were two lymphoma cases with diffuse large cells, two cases with mixed small and large cells, one with small cells and one indeterminate. They were treated with six cycles of chemotherapy and cervical radiotherapy. All patients achieved durable complete remission. Our data agree with previous reports that suggested that primary tonsillar high-grade B-cell NHL has a good prognosis if aggressively treated.

Linfoma de grandes células da mama: relato e abordagem terapêutica de um caso / Large cells lymphoma of the breast: case report and therapy approach

Relatamos um caso de linfoma de mama, paciente de 46 anos que apresentava, ao diagnóstico, grande massa palpável em mama direita. A primeira biópsia da mama revelou apenas alteraçöes fibrocísticas locais e foi negativa para células neoplásicas. A segunda biópsia demonstrou um LNH de grandes células B. Os exames de estadiamento classificaram a paciente como II A E e o tratamento proposto foi quimioterapia (seis ciclos ProMACE-CytaBOM) e radioterapia local (4.000 cGy). Atualmente a paciente se encontra em remissäo completa da doença 12 meses após o diagnóstico.