O trabalho faz parte de um projeto de Educação Ambiental realizado em uma escola localizada em um município do estado de São Paulo, com alunos do Ensino Fundamental, e buscou envolver a comunidade escolar nas questões ambientais, principalmente na problemática que envolve a inadequada disposição de resíduos sólidos apontando alternativas que possibilitem o gerenciamento deles. Dentre as atividades realizadas, destaca-se a montagem de uma composteira, apresentada aos membros da escola (funcionários e alunos) como alternativa para o tratamento dos resíduos orgânicos gerados na escola, obtendo-se como resultado um composto, rico em matéria orgânica, sendo este depositado em um espaço que futuramente transformar-se-á em uma horta. Experiências laboratoriais, como a produção de um biodigestor e a síntese do biodiesel, contribuíram para a confirmação de que alguns resíduos sólidos descartados no ambiente domiciliar podem ser utilizados como fontes de energia limpa e renovável; outros resíduos serviram como matéria-prima para a produção de sabão em barra e papel reciclado, sendo que para a confecção do sabão utilizou-se óleo de cozinha usado e a produção do papel reciclado, contou com os papéis descartados e não inutilizados pelos membros da escola. Cabe ressaltar que parte destes papéis, serviram como material reutilizado, fundamental para a montagem de bloquinhos de anotações. A prática desenvolvida na execução das atividades foi utilizada como ferramenta estratégica e eficaz na difusão da Educação Ambiental na escola, conforme demonstraram os resultados obtidos.

Chest pain is a major cause of medical evaluation at emergency department (ED) and demands observation to exclude the diagnosis of acute myocardial infarction (AMI). High-sensitivity cardiac troponin assays used as isolated measure and by 0- and 1-h algorithms are accepted as a rule-in/rule-out strategy, but there is a lack of validation in specific populations. The IN-HOspital Program to systematizE Chest Pain Protocol (IN-HOPE study) is a multicentre study that prospectively included patients admitted to the ED due to suspected symptoms of AMI at 16 sites in Brazil. Medical decisions of all patients followed the standard approach of 0 h/3 h protocol, but, in addition, blood samples were also collected at 0 and 1 h and sent to a central laboratory (core lab) to measure high-sensitivity cardiac troponin T (hs-cTnT). To assess the theoretical performance of 0 h/1 h algorithm, troponin < 12 ng/L with a delta < 3 was considered rule-out while a value ≥ 52 or a delta ≥ 5 was considered a rule-in criterion (the remaining were considered as observation group). The main objective of the study was to assess, in a population managed by the 0 h/3 h protocol, the accuracy of 0 h/1 h algorithm overall and in groups with a higher probability of AMI. All patients were followed up for 30 days, and potential events were adjudicated. In addition to the prospective cohort, a retrospective analysis was performed assessing all patients with hs-cTnT measured during the year of 2021 but not included in the prospective cohort, regardless of the indication of the test. A total of 5.497 patients were included (583 in the prospective and 4.914 in the retrospective analysis). The prospective cohort had a mean age of 57.3 (± 14.8) and 45.6% of females with a mean HEART score of 4.0 ± 2.2. By the core lab analysis, 74.4% would be eligible for a rule-out approach (45.3% of them with a HEART score > 3) while 7.3% would fit the rule-in criteria. In this rule-out group, the negative predictive value for index AMI was 100% (99.1-100) overall and regardless of clinical scores. At 30 days, no death or AMI occurred in the rule-out group of both 0/1 and 0/3 h algorithms while 52.4% of the patients in the rule-in group (0 h/1 h) were considered as AMI by adjudication. In the observation group (grey zone) of 0 h/1 h algorithm, GRACE discriminated the risk of these patients better than HEART score. In the retrospective analysis, 1.091 patients had a troponin value of <5 ng/L and there were no cardiovascular deaths at 30 days in this group. Among all 4.914 patients, the 30-day risk of AMI or cardiovascular death increased according to the level of troponin: 0% in the group < 5 ng/L, 0.6% between 5 and 14 ng/L, 2.2% between 14 and 42 ng/L, 6.3% between 42 and 90 ng/L, and 7.7% in the level ≥ 90 ng/L. In this large multicentre study, a 0 h/1 h algorithm had the potential to classify as rule-in or rule-out in almost 80% of the patients. The rule-out protocol had high negative predictive value regardless of clinical risk scores. Categories of levels of hs-cTn T also showed good accuracy in discriminating risk of the patients with a very favourable prognosis for cardiovascular death in the group with value < 5 ng/L. NCT04756362.

Water is one of the world's most valuable resources and indispensable for human survival. Given this, climate change and population growth generate an increase in demand for water resources, leading to water scarcity. The use of rainwater is a measure that mitigates environmental impacts, contributes to the retention of rainwater and reduces the demand for drinking water. Therefore, water scarcity stimulates the development of alternatives for water conservation. The objective of this study is to estimate the potential savings of potable water to be replaced by rainwater for non-potable use in a shopping center building in the Northeast of Brazil. The methodology consisted in simulating the volume of the reservoir for storage of collected rainwater. A study of the rainfall indexes and their periodicity was carried out, evaluating the months with highest and lowest precipitation. Subsequently, the Neptune computer program was used to determine the volume of the reservoir. To this end, a study was carried out with different catchment areas, in order to define the area that offers the best potential for supplying the water demands. The results indicated that the most suitable reservoir volume is 117 m³, with potential savings of 6.02% for drinking water and a complete and partial supply of 52.56% for rainwater demand. It was concluded that the potential for drinking water savings justifies the implementation of a rainwater harvesting system in a project of this size, proving to be technically feasible.

TPS7593 Background: Bruton tyrosine kinase (BTK) inhibitors (BTKi) have transformed the treatment of several hematologic malignancies. However, acquired resistance, commonly associated with BTK C481S mutations, can develop. Nemtabrutinib (MK-1026, formerly ARQ 531) is a noncovalent, competitive inhibitor of both wild type and C481S-mutant BTK that has shown promising antitumor activity at 65 mg once daily (QD) in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). BELLWAVE-003 (NCT04728893) is an open-label, phase 2 study investigating the safety and efficacy of nemtabrutinib in patients (pts) with R/R B-cell malignancies. Methods: BELLWAVE-003 includes a dose escalation and confirmation phase (part 1) and a cohort expansion phase (part 2). Enrollment of 450 pts is planned. Part 1 will enroll approximately 30 pts, with a minimum of 6 and maximum of 20 per dose level. Part 2 will enroll approximately 420 pts. All pts must be ≥18 years and have an ECOG performance status of 0 to 2. Part 1 will enroll pts with CLL/SLL that was R/R after ≥2 prior therapies. Part 2 will enroll pts in 8 cohorts: CLL/SLL that is R/R to a covalent irreversible BTKi and a BCL2 inhibitor, and, for pts with CLL, R/R to or ineligible for a PI3K inhibitor (cohort A); R/R CLL/SLL that is BTKi–naive (cohort B); del17p or TP53-mutant R/R CLL/SLL (cohort C); R/R Richter transformation (cohort D); R/R mantle cell lymphoma, including prior covalent BTKi (cohort E); R/R marginal zone lymphoma, including prior covalent BTKi (cohort F); R/R follicular lymphoma (cohort G); and R/R Waldenström’s macroglobulinemia, including prior covalent BTKi (cohort H). Initially, pts received nemtabrutinib 80 mg QD orally at dose level 1. Data from BELLWAVE-001 and BELLWAVE-003 subsequently established nemtabrutinib 65 mg QD as the recommended phase 2 dose (RP2D) for future pt enrollment. Treatment will continue until unacceptable toxicity, disease progression, or withdrawal. Adverse events will be monitored throughout and graded using NCI CTCAE version 5.0. Hematologic toxicities in pts with CLL will be assessed using iwCLL 2018 criteria. CT/MRI and/or PET will be performed every 12 weeks, unless needed more frequently. For part 1, the primary end points are safety and tolerability and establishing the RP2D; secondary end points are pharmacokinetics (PK), ORR, and DOR. For part 2, the primary end point is ORR; secondary end points are safety and tolerability, PK, and DOR; and exploratory end points include PFS, OS, and health-related quality of life. Safety and efficacy will be assessed in all pts who receive ≥1 dose of study drug. Pts receiving nemtabrutinib 80 mg and 65 mg QD will be analyzed separately. Safety will be summarized descriptively. ORR and 95% CI will be estimated using an exact binomial method. DOR, PFS, and OS will be estimated using the Kaplan-Meier method. Enrollment for this study is ongoing. Clinical trial information: NCT04728893 .

BackgroundNosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis.MethodsMatched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence.Results3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates.ConclusionThe impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.

Effective therapies for multidrug-resistant (MDR) microorganisms, especially Gram-negative bacteria, are becoming rare. Also, solid-organ transplant recipients are at high risk of MDR Gram-negative bacilli infection. Urinary tract infections are the most frequent bacterial infections in kidney transplant recipients and are an important cause of mortality after renal transplantation. We describe a case of complicated urinary tract infection in a kidney transplant patient due to extensively drug-resistant (XDR) K. pneumoniae treated successfully with a regimen comprising a combination of chloramphenicol and ertapenem. We do not recommend chloramphenicol as a first-line choice for treating complicated urinary tract infections. Still, we believe it is an alternative for infections caused by MDR and/or XDR pathogens in renal transplant patients, as other options are nephrotoxic.

587 Background: Biliary tract cancer, including cholangiocarcinoma and gallbladder carcinoma, have low incidence and poor prognosis. Despite representing a heterogeneous group, the studies encompass these malignancies as the same entity. There are few phase III trials that evaluate treatment sequencing in the metastatic setting. The ABC 02 trial showed an increase in overall survival (OS) with Gemcitabine and Cisplatin (GemCis) in first line and the ABC 06 trial an increase in OS in second-line Folfox. Recently, the TOPAZ 1 trial demonstrated benefit of first-line immunotherapy. The primary objective of this study was OS in patients with advanced cholangiocarcinoma according to treatment. The secondary objective was to analyze the patients characteristics. Methods: Retrospective analysis of medical records from two private institutions. Patients were eligible if they had advanced intra or extra cholangiocarcinoma or gallbladder carcinoma, undergoing chemotherapy from January of 2015 to January of 2021. Results: Database included 82 patients with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma or gallbladder carcinoma, 54%, 23% and 23%, respectively. Median age was 65 years old, with an equal proportion between sexes. 75% had metastasis at diagnosis and 12 patients (14%) underwent more than two lines of treatment. Median OS was 288 days. GemCis was the most common first line protocol (62%), followed by Gemcitabine and Oxaliplatin (17%). There was no difference in OS between the regimens, regardless of the primary site. Folfiri and Folfox were used in the same proportion in second line (17% for each), but with a significant increase in OS for Folfiri (485 days vs. 368 days, p=0.02), regardless of the primary site. According to univariate analysis of factors associated with mortality, the significant variables were: surgery for primary site (HR 0.49 [95% CI 0.28-0.85]; p=0.01), metastasis at diagnosis (HR 1.89 [95% CI 1.10-3.25]; p=0.02), liver metastasis at diagnosis (HR 1.69 [95% CI 1.02-2.80]; p=0.04), and more than two lines of treatment (HR 0.41 [95% CI 0.21-0.80]; p=0.009). Conclusions: Despite being retrospective and not using first-line immunotherapy, this study was able to demonstrate no difference in OS between first-line regimens with GemCis or Gemcitabine and Oxaliplatin. However, when analyzing second-line sequencing, Folfiri demonstrated benefit independent of the primary site.