Brazilian Group Research Articles

Michael Thompson, MD

Michael Thompson, MD

P-29 CLINICAL FEATURES OF PRIMARY BILIARY CHOLANGITIS IN BRAZIL

Little is known about primary biliary cholangitis (PBC) in Latin America, where this disease is thought to be rare. To analyze clinical and biochemical features of Brazilian PBC patients. The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical and laboratory features from PBC patients. 562 patients with PBC were included; 80 (14.2%) had overlapping syndrome with autoimmune hepatitis and were excluded. Most subjects were middle-aged women (95%; mean age 51 ± 11 years) with classical symptoms of pruritus and/or fatigue (65%) and jaundice (22%). Mean time to diagnosis was 2.5 years. Prevalence of antimitochondrial (AMA) and antinuclear antibodies was 82.8% and 72.1%, respectively. Concurrent autoimmune diseases occurred in 18.9%, mainly Hashimoto's thyroiditis and Sjogren syndrome. Celiac disease was diagnosed in 1:80 (1.2%). Osteopenia and osteoporosis were demonstrated in 42% and 26%, respectively. Liver pathology at diagnosis was available for 326 patients (67.6%). One third of them had advanced PBC. After a mean follow-up of 6.2 ± 5.3 years, 32% of the subjects had clinical, laboratory or imaging evidence of cirrhosis. Requirement for liver transplantation and liver-related deaths were reported in 6.6% and 3.2% of the patients, respectively. Hepatocarcinoma was diagnosed in 1.9% of the subjects. A higher predominance of PBC among females, compared to other populations, was observed, while AMA positivity was lower. Concurrent autoimmune, celiac and bone diseases are common and should be adequately screened. Prolonged time to diagnosis and high prevalence of advanced liver disease might reflect difficulties in health care access in Brazil.

O-10 PRIMARY BILIARY CHOLANGITIS PATIENTS DIAGNOSED BY DIFFERENT COMBINATIONS OF THE DIAGNOSTIC CRITERIA PRESENT CLINICAL AND LABORATORY PECULIARITIES

Primary biliary cholangitis (PBC) diagnosis is based on international criteria, which requires two of the following: (i) elevated alkaline phosphatase (AP), (ii) anti-mitochondrial antibody (AMA) and (iii) liver biopsy (BX) suggestive of PBC. It is still unclear if patients diagnosed by different criteria combinations present peculiarities, especially in highly-admixed populations. To investigate if patients diagnosed with PBC by different combinations of validated criteria present clinical or laboratory particularities. The Brazilian Cholestasis Study Group database was reviewed to compare clinical, biochemical and histological characteristics of PBC between four groups diagnosed by: (1) AP ≥2x upper limit of normality (ULN) + presence of AMA, (2) AP ≥2x ULN + BX suggestive of PBC, (3) presence of AMA + BX suggestive of PBC and (4) all criteria. 482 patients with PBC were included (Table 1). Group-1 presented with higher levels of IgG, lower frequency of arterial hypertension (AH) and lower response to ursodeoxycholic acid (UDCA), while Group-2 had lower: age at diagnosis and HDL-C levels. Group-3 had higher: age at diagnosis, frequency of neoplasms, AH and response to UDCA; and lower: frequency of pruritus and jaundice, levels of aminotransferases, GGT and bilirubin, advanced liver disease and esophageal varices. Group-4 showed higher frequency of symptoms at presentation, especially pruritus. PBC patients diagnosed by different combinations of established criteria may present singular features that can possibly impact in disease presentation and progression.

Knowledge networks in Brazil’s health sciences

AbstractThis study aims to analyze the network of interactions of Brazilian medical research groups, identifying key actors and their roles in generating and diffusing knowledge. Social network analysis was applied, with data from the Research Groups Directory Census of the National Council of Scientific and Technological Development, from 2016. The main results show (1) the central role of universities, public institutes, and university hospital research groups; (2) the importance of scientific infrastructure and research capability of scientists in knowledge production; (3) the minor role of the industry, denoting the fragility of university–industry interactions; (4) spatial concentration of network actors, mostly located in the south and southeast of Brazil; and (5) a great opportunity to expand flows and cooperation. Regarding these results, the recent budgetary cuts in science and technology resources since 2016 seem to be a misguided and detrimental strategy as these resources are essential for future technological and industrial development.

Clinical Features of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorders.

Background and ObjectivesTo describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD).MethodsThe Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described.ResultsAmong the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8–77), with disease onset at 31 years (range 4–69) and disease duration of 6 years (range 0.2–20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection.DiscussionMost NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.

Transparency in Global Agribusiness: Transforming Brazil’s Soybean Supply Chain Based on Companies’ Accountability

Background: Although agri-food supply chains have become fundamental for food security throughout the world, some are associated with negative environmental and socioeconomic impacts. This study explores the possibilities of transforming the governance in Brazil’s soybean supply chain based on stakeholders’ accountability. Methods: We used secondary data from companies’ reports and statistical yearbooks to identify key stakeholders in the soybean supply chain as well as to explore trade-offs between reducing farming expansion into new agricultural frontiers and increasing investments in agro-industrial sectors. Results: The results reveal that at the global level, multinational corporations along with domestic groups should be held accountable for improving the governance of the soybean supply chain in Brazil since foreign multinationals control 65.4% of it. At the domestic level, losses in Brazil’s farming sector can either be offset by an 11% or 5.2% market share increase in the trading segment or in the whole supply chain, respectively, since Brazilian groups control 93.4% of the farming sector but only 7.1% of the agro-industrial sectors. Conclusions: Global accountability and domestic trade-offs are fundamental for transforming governance in global agri-food supply chains. They serve as a means for overcoming the current strategy of expansion into new farming frontiers.

Brazilian Foods and Territories Digital Platform: Conceptual Bases for Development / Plataforma Digital Alimentos e Territórios Brasileiros: Bases Conceituais para o Desenvolvimento

There is limited and segmented access to information regarding the diversity of responsible and sustainable agrifood products in Brazil. There is a growing need to bridge the communication gap between farmers and consumers who wish to consume such differentiated products. This article aims to present the conceptual bases for the development of a Brazilian Digital Platform for Food and Territories involved bibliographic research methodology, analysis of international platforms and technical-scientific discussions between Brazilian and French research groups. The main result obtained was the modeling of the digital platform based on a multiscale view associated with the confluence of six conceptual aspects: Territories, Localized Food Systems, Brazilian Regional Foods, Adding Value, Consumer Empowerment, Technological and Knowledge Convergence. The results contribute to the physical development of the Platform, with literature and insights on digital innovations in agrifood for researchers, developers, public and private managers, creating new development opportunities for Brazilian rural territories.

‘A different fan group’: the performance of a Brazilian gay organized fan group

ABSTRACT Football in most parts of the world is historically associated with men and cisheteronormative masculinity. The virility demanded and valued in it is often accompanied by an endorsement of chauvinism and homophobia. The engagement of those who do not fit the standard is surrounded by obstacles. In view of this scenario, the Brazilian organized fan group Coligay, formed predominantly by men identified as homosexuals, was an unusual and transgressive initiative. The group was founded in 1977 and for approximately five years it was present in the stadiums supporting the traditional club Grêmio Foot-Ball Porto Alegrense. With demonstrations that explore aesthetic elements traditionally associated with homosexuality, they destabilized the legitimate and predominant model of a fan, and the norm that naturalizes football as a stronghold of cisgender and heterosexual men. From the crossing of oral sources and records from periodicals, we analyse such performance from the perspective of gender studies.

Fluorouracil Bolus Use in Infusional Regimens Among Oncologists-A Survey by Brazilian Group of Gastrointestinal Tumors.

PURPOSEThe utility of administering fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal malignancies among Brazilian oncologists.METHODSThis was a cross-sectional electronic survey composed of eight multiple-choice questions sent to Brazilian oncologists during 14 days in February 2021. The survey instrument collected demographic data of participants and assessed practices in terms of 5-FU bolus use. We evaluated the association of demographic variables and 5-FU prescribing patterns with Fisher’s exact test (odds ratio [OR]).RESULTSThe survey was completed by 332 medical oncologists. Overall, 37% were experienced oncologists and 32% were gastrointestinal specialists. In the first-line metastatic and in the adjuvant settings, 40% and 67% of oncologists always prescribe 5-FU bolus in infusional regimens, respectively. Experienced oncologists more frequently omit 5-FU bolus when compared with early-career oncologists, both in the metastatic (41% v 26%; OR, 1.98; P = .005) and adjuvant settings (28% v 14%; OR, 2.32; P = .003). In addition, more GI specialists remove 5-FU bolus when compared with generalists, but only in the metastatic setting (44% v 25%; OR, 2.33; P = .001). GI specialists are more likely to consider that treatment efficacy is not affected by 5-FU bolus withdrawal than are generalists (89% v 75%; OR, 2.65; P = .003). Most respondents (67%) keep leucovorin at the same doses when omitting 5-FU bolus, and only 16% always recommend dihydropyrimidine dehydrogenase testing.CONCLUSIONOur survey indicates that experience in oncology practice and percentage of time dedicated to treat GI cancers influence the prescription of 5-FU bolus in Brazil, with more frequent omission of it among experienced gastrointestinal specialists, particularly in the metastatic setting.

“The Ultimate Drive by”: Racionais MC’s, Ice Cube, and the Pursuit of Blackness

Abstract: Considering that hip-hop music is the foremost contemporary artistic expression of Black lives I discuss American rapper Ice Cube’s track “I wanna Kill Sam” and Brazilian group Racionais Mc’s’s track “Racistas otários”. The two tracks have in common the fact that they address the experiences of Black people through their relationship with public policies and institutions that claim to promote the emancipation of Black people in Brazil and in the USA. I, then, demonstrate that the Racionais and Ice Cube symbolically (re)dimension contemporary “Blackness” as a result of the constant physical and symbolic clashes that started back in the slavery regime.

Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ.

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panelof Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

Abstract 801: Acute leukemia excess in families

Abstract Acute leukemia (AL) is the most common type of childhood cancer and has two major subtypes: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Historically, studies in this field have pointed out driver somatic mutations with different mechanisms of pathogenesis. Family-based and large-scale high-throughput sequencing studies have recently uncovered several genetic germline variants, indicating an inherited origin. Familial history of cancer (FHC) is associated with an increased risk of both ALL and AML. Herein we explore the excess of hematological malignancies (HM) in first-degree relatives of patients diagnosed under 21 years old and compare rates of FHC between AML and ALL cases. We revisited the registry of the Brazilian group Estudos Multi-Institucionais das Leucemias Infantis (EMiLI) comprised of 89 cancer centers from 2009 to 2019. Socio-demographic, immunomolecular, and self-reported FHC data were collected using a structured questionnaire at the beginning of the follow-up. Descriptive statistics were used to assess the frequency distribution and differences between cases. We used unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals to evaluate the estimated FHC predisposition to AL. From a total of 5,831 samples, 42.6% were from North/Northeast, 35.7% from South/Southeast, and 21.7% from Midwest macroregions. There was a high frequency of cases (p < 0.001) of Non-White ethnicity in North/Northeast and White ethnicity in South/Southeast. B-cell Precursor ALL was more frequent in Midwest, T-cell acute lymphoblastic leukemia in North/Northeast, and AML cases in South/Southeast. Among 3,618 individuals with AL, 472 had a positive FHC (13%). Of these, 96 (20.3%) reported HM as the origin of cancer. We observed a higher odds of having at least one relative with cancer in AML cases compared to ALL (OR 1.36; 95% CI 1.01-1.82; p = 0.040). When considering only first-degree relatives with any type of cancer, the risk was even more considerable for the AML group than ALL (OR 2.92; 95% CI 1.57-5.42; p = 0.001). With a statistical significance value (p= 0.02), we observed that AML cases present higher odds of having a first-degree relative with FHC with hematologic origin than ALL cases (OR 5.71; 95% CI 1.91-17.08). This effect was not observed analyzing second degree-relatives or relatives with non-hematological malignancies. Our findings suggest that AML is more associated with a positive FHC than ALL, particularly when having a first-degree relative with HM. Both genetic and environmental exposure factors could be involved in the AL subtypes epidemiology. Identifying children with a higher risk of AL would be beneficial by performing early targeted cancer screening and improving prevention and surveillance programs. Further genomic studies exploring Brazilian childhood AL cases with FHC are crucial to elucidate the role of genetic background and ancestry as risk factors associated with leukemogenesis. Citation Format: Daniela P. Mendes-de-Almeida, Francianne G. Andrade, Paulo Chagas-Neto, Maria do Perpétuo Socorro S. Carvalho, José C. Córdoba, Marcelo dos S. Souza, Logan G. Spector, Maria S. Pombo-de-Oliveira, Brazilian Collaborative Study of Childhood Leukemia, Acronym EMiLI. Acute leukemia excess in families [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 801.

P-47 5-fluorouracil bolus use in infusional regimens among oncologists: A survey by Brazilian Group of Gastrointestinal Tumors

The utility of administering 5-fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. Yet how often this is practiced by oncologists is unknown. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal (GI) malignancies among Brazilian oncologists.

COVID-19 and the circulation information on social networks: analysis in a Brazilian Facebook group about the Coronavirus

This article aims to quantify and qualify the information circulating in social media groups about COVID-19, the subjects covered in posts, as well as the possible relations with other subjects, events or social events, in order to generate a representative panorama of perception and social reaction to the coronavirus pandemic. For this, statistical techniques, data mining and machine learning are used to the characterization, pattern detection, and grouping of textual data. The experiments are carried out on a dataset of textual data extracted from a Brazilian public group about COVID-19 (SARS-cov-2) of the social network Facebook. Statistical analyzes are crossed with data on the advance of the number of infected, and with specific political-social events, revealing variations and influences in terms of participation and engagement in the analyzed group. In addition, through the results obtained by the clustering method used, two main groups of posts are detected, the first presenting a content pattern geared to governmental issues, and the second to personal issues. The results achieved still allow a reflection on the possible social impacts of the creation or absence of public policies to deal with the COVID-19 pandemic.

Anti-mitochondrial Antibody-Negative Primary Biliary Cholangitis Is Part of the Same Spectrum of Classical Primary Biliary Cholangitis

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated. The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort. The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status. A total of 464 subjects (95.4% females, mean age 56 ± 5years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 ± 14 vs. 59.6 ± 11years, p = 0.001) and had their first symptom at an earlier age (43.2 ± 13 vs. 49.5 ± 12years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 ± 183 vs. 383.2 ± 378mg/dL, p = 0.01) and triglycerides (107.6 ± 59.8 vs.129.3 ± 75.7mg/dL, p = 0.025) and higher bilirubin (3.8 ± 13.5 vs. 1.8 ± 3.4mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34to62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups. AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features.

Obinutuzumab for CLL Relapsed and Refractory Patients When New Oral Drugs an Not Available

Introduction:The management of relapsed or refractory chronic lymphocytic leukemia (r/r CLL) has undergone profound changes due to a better understanding of the disease's biology and the new drugs. The choice of the best treatment at any time after the first line therapy, for a single patient, during the course of the disease depends on age, performance status, comorbidities, renal function, and effectiveness of the previous treatment received. In many countries, although approved by regulatory agencies, new therapeutic options are not available for the patients or can be offered just for a restricted group. In Brasil, for relapsed or refractory CLL patients, ibrutinib is not funded by the public nor private health insurance. This real world scenario imposes a limitation on standard international guidelines CLL treatment recommendations.Objective:To describe the acute toxicity and responses to treatment with Obinutuzumab, outside of a clinical trial, for CLL relapsed and refractory patients.Methods:Descriptive, real word, case series report of unfit refractory or relapsed CLL patients treated with obinutuzumab with or without chlorambucil as the second line and beyond. Data were obtained from a questionnaire collected through patient-record forms completed by attending physicians.Results:A total of 14 patient-completed questionnaires were analyzed. Median age was 72 (51-84) years, 10 pts (71%) had ECOG status ≥ 0-2. Four pts (28%) had ≥ 3 comorbidities and 11 pts (78%) an impaired renal function at baseline with a creatinine clearance of 30-70ml/min. No data on cytogenetic or IGHV status was collected. Previous treatments were FC or FCR in 7 pts (50%) and all patients were treated with rituximab in the previous line therapy. Prior obinutuzumab infusion, 3 pts (23%) presented thrombocytopenia grade 3 CTC, and median ALC was 49.938 (1.890- 194.000). Seven (50%) patients experienced infuse reaction in cycle one (6 pts CTC 2, pt 1 CTC 2). Some of the cycles were delayed in 7 pts (50%) and interrupted in 2 (15%) due to hematologic toxicity. Chlorambucil was associated in 12 (85%) and 2 pts (15%) were treated with obinutuzumab in monotherapy. Neutropenia 3/4 CTC was observed in 9 pts (64%) and thrombocytopenia 3 CTC in one patient. Median obinutuzumab cycles were 5 (1-6), and the overall response was achieved by 13 pts (9 CR + 3 PR, Hallek 2008). As of July 2017, one death was described in a patient with a severe and prolong hematologic toxicity after the first cycle of Clb+obinutuzumab in which bone marrow biopsy demonstrated persistent CLL infiltration. This patient started ibrutinib treatment but died of H1N1 infection. So far, 13 pts were alive, without further serious adverse event.Conclusion:New drugs for r/r CLL treatment are not available in some countries. Obinutuzumab demonstrated a superior efficacy over Rituximab in CLL patients. Although the administration of Obinutuzumab to CLL relapsed or refractory patients was not tested in large clinical trials, it can be an alternative for unfit patients. The results of this descriptive, real world data demonstrated that obinutuzumab was effective, with no unexpected AE/SAE. The r/r CLL unfit population, previously exposed to fludarabine, needs a special attention considering the safety aspects. Acknowledgments for Matheus Golçalves and Celso Rodrigues on behalf of Brazilian CLL Group. DisclosuresFogliatto:Roche: Honoraria, Other: Travel Support; accomodations; Novartis: Honoraria, Other: Travel support; AbbVie: Other: Travel Support.

P591 Anti-TNF therapy for Ulcerative Colitis in Brazil: a comparative real-world national multicentric study from the Brazilian Study Group of IBD (GEDIIB)

Abstract Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients, as public reimbursement is relatively recent. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian UC patients, and evaluate possible factors associated with remission after 1 year of treatment. Methods A national retrospective multicenter study (24 centers) was carried out including patients with moderate-to-severe UC treated with anti-TNF therapy. Disease activity was categorized using Mayo score at baseline, weeks 8, 26 and 52. Clinical remission was defined as a partial Mayo score ≤ 2. Endoscopic remission was defined as a Mayo endoscopic subscore ≤ 1. Patients were allocated in 2 groups (ADA and IFX) and a comparative efficacy study was performed. Statistical analysis: logistic regression model was used to study effects of predictor variables on categorical outcomes, such as presence or absence of remission at week 52. Statistical significance was assumed if p <0.05. Results Overall, 393 patients were included (111 ADA and 282 IFX). The mean age was 41.86 ± 13.60 y, 61.58% women, most patients had extensive colitis (62.40%) and 19.39% previous exposure to biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65 %, p <0.0001) and 52 (65.24% vs. 51.35%, p <0.0001) – figure 1. Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the two groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). The variables associated with clinical remission after 1 year of treatment were age, non-prior exposure to biological therapy, use of IFX, endoscopic remission at week 26 and no need for optimization (table 1). The variables associated with endoscopic remission after 1 year were non-prior exposure to biological therapy, clinical and endoscopic remission at week 26 and no need for optimization. Conclusion In this national multicentric study, overall efficacy of anti-TNF therapy was similar to real world data with IFX and ADA. IFX treatment was associated with higher rates of clinical remission after 1 year in comparison to ADA. Patients naive to biological therapy presented higher rates of clinical and endoscopic remission. This is the first real world national study analyzing efficacy of anti-TNF agents in UC in Brazil.

Updating recommendations of the Brazilian Group of Flow Cytometry (GBCFLUX) for diagnosis of acute leukemias using four-color flow cytometry panels

IntroductionFlow cytometry has become an increasingly important tool in the clinical laboratory for the diagnosis and monitoring of many hematopoietic neoplasms. This method is ideal for immunophenotypic identification of cellular subpopulations in complex samples, such as bone marrow and peripheral blood. In general, 4-color panels appear to be adequate, depending on the assay. In acute leukemias (ALs), it is necessary identify and characterize the population of abnormal cells in order to recognize the compromised lineage and classify leukemia according to the WHO criteria. Although the use of eight- to ten-color immunophenotyping panels is wellestablished, many laboratories do not have access to this technology. Objective and MethodIn 2015, the Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo, GBCFLUX) proposed antibody panels designed to allow the precise diagnosis and characterization of AL within available resources. As many Brazilian flow cytometry laboratories use four-color immunophenotyping, the GBCFLUX has updated that document, according to current leukemia knowledge and after a forum of discussion and validation of antibody panels. ResultsRecommendations for morphological analysis of bone marrow smears and performing screening panel for lineage (s) identification of AL were maintained from the previous publication. The lineage-oriented proposed panels for B and T cell acute lymphoblastic leukemia (ALL) and for acute myeloid leukemia (AML) were constructed for an appropriate leukemia classification. ConclusionThree levels of recommendations (i.e., mandatory, recommended, and optional) were established to enable an accurate diagnosis with some flexibility, considering local laboratory resources and patient-specific needs.

The organizational stigma of motorcycle groups

Since scholars have come into contact with Erving Goffman's work, "Stigma: Notes on the Handling of Deteriorated Identity," many issues have been discussed in an interdisciplinary way on the subject of stigma, at the individual level and, more recently, in the organizational level. At this level, there are studies on organizations that have been stigmatized since its inception; have become stigmatized; developed actions to circumvent stigma; and, they obtained the destigmatization. This is the level of analysis chosen for the development of this study. The general objective of this article is to describe how motorcycling groups respond to the organizational stigma that is typical of this urban tribe. And, the specific objectives were to identify and compare the emotional, social and collective responses and motivations that underlie and drive the actions used by motorcycling groups in the Brazilian context. Through an exploratory study, conducted through interviews with members of Brazilian motorcycling groups (some belonging to the motorcycle club), it was found that, surprisingly, despite the ethnic and cultural diversity among Brazilian motorcyclists, there are few women, blacks and homosexuals who drive and are members of motorcycle groups. Most motorcyclists encourage / collaborate on fraternization and philanthropic events, some of which are designed to circumvent the stigma of the organizations of which they are part and thus reduce the individual stigma they carry when they publicly show themselves as motorcyclists belonging to these groups.

THEORETICAL AND METHODOLOGICAL CONTRIBUTIONS OF THE KNOWLEDGE ECONOMY

With the emergence of new paradigms in social and labor relations, before the property or assets of a company are valued. However, today, in addition, it is also considered that knowledge (in innovations, technology, experience, trade secrets, among others) adds value to an institution. Therefore, this research seeks to detail the phenomenon of the knowledge economy, in job prospects, education, environment and innovation, in addition to relating this concept to the collection of recyclable materials. The problem question developed to initiate the reflections was: How is the knowledge economy related and positively influences work activities such as the collection of recyclable materials? The general objective, on the other hand, is to understand how knowledge, experience and innovations are configured as fundamental for the improvement of processes and work in industries and organizations, here, specifically, the recycling industry. The specific objectives are focused on: detailing the emergence of the concept of the “Knowledge Economy”; understand how the knowledge economy relates to aspects of education, labor and the environment; understand the concept of social innovation and how it applies to third sector organizations; and learn about the “Steps of knowledge” applied to the activity of recycling materials. The methodology was an analysis of the recurring literature related to the topic of the knowledge economy and the recycling industry. It is concluded, therefore, that the workers of this branch make up the large group of Brazilians in conditions of informality and social exclusion and rights, and that is why the discussion addressed here is so important. for believing that the condition of these recyclers continues to be highly undervalued, despite being so important, both for society and for the environment.