Grupo De Research Articles

NANORREDES EM CORRENTE CONTÍNUA: PRINCIPAIS CONFIGURAÇÕES E UM CASO PRÁTICO APLICADO NA AMAZÔNIA

This article aims to provide an overview of the use of direct current electrical distribution grids, especially small-scale ones classified as nanogrids and microgrids. It presents a brief literature review and discusses various aspects of these network types, such as polarity and structures. Additionally, it highlights significant advantages of employing DC grids over alternating current grids. Furthermore, the article explores the potential use of DC networks for electricity supply in remote communities in the Amazon. It emphasizes a practical case study of an experimental real-scale DC nanogrid implemented in the testing area of the Grupo de Estudos e Desenvolvimento de Alternativas Energéticas(GEDAE) at the Universidade Federal do Pará (UFPA). This nanogrid was later improved and replicated in the field to provide electricity to twelve residences and a church along the Piramanha River on Ilha das Onças, municipality of Barcarena, state of Pará. The article evaluates the relevance of nanogrids as a feasible and satisfactory alternative for supplying energy to communities without access to conventional electrical grids, drawing on the experiences of the real case study. It also discusses the applicability of this approach to other remote communities in the Amazon.

APLICATIVO GAMMA-GUI: UMA INTERFACE GRÁFICA AMIGÁVEL PARA PLANEJAMENTO DE EXPERIMENTOS NO MATLAB

GAMMA-GUI APP: A FRIENDLY GRAPHICAL USER INTERFACE FOR THE MULTIVARIATE DESIGN OF EXPERIMENTS IN MATLAB. We present to users unfamiliar with the programming language a user-friendly interface for the multivariate design of experiments (DoE) in Matlab®. The interface of the GAMMA app - Grupo de Análise Multivariada em Matrizes Alimentares, in Portuguese-BR, is available for free download on GitHub https://github.com/appGAMMA, and has a YouTube channel https://www.youtube.com/@appGAMMA with a series of tutorial videos. In this tutorial, some practical demonstrations are made using the DoE interface with real applications: (i) screening design for variable selection; (ii) optimization by Box-Behnken design; (iii) optimization by central composite design; (iv) factorial design for variable selection following by optimization with Doehlert design; (v) optimization by mixture design; (vi) optimization by mixture design with pseudocomponents; (vii) optimization by mixture design with process variable; and (viii) multiple-response optimization; also reproduced in the software Statistica v.13, StatSoft® for comparison. The GAMMA-GUI is constantly developing; suggestions for improvements or new ideas are welcome and can be directed to the developers.

Clinical Features, Treatment Patterns and Outcomes of 864 Newly Diagnosed Hodgkin Lymphoma Patients in Latin America and the Impact of PET Scan Availability on Survival: A Study from the Grupo De Estudio Latinoamericano De Linfoproliferativos (GELL)

Background: Hodgkin lymphoma (HL) is a lymphoid neoplasm with high cure rates. Around 90% of patients (pts) will achieve response to first-line treatment. Real-world studies in Latin America (LATAM) are lacking. Moreover, inequity in the access to imaging technology and drugs represent a real challenge for Latin American countries with palpable influences in patient outcomes. Herein, we describe the clinical features, treatment patterns, and outcomes of HL pts managed in LATAM. Method: We conducted a retrospective cohort study of adults aged ≥17 years with newly diagnosed HL across academic centers in 7 LATAM countries from 2003 to 2022, with follow-up through July 2023. Medical records were manually reviewed, and data were abstracted in a standardized form. Cancer staging was performed by Ann Arbor and German HL Study Group criteria. Survival probabilities were estimated with the Kaplan-Meier method and compared with the Log-rank test. Multivariable Cox regression models were fitted by cancer stage stratification. A landmark analysis was performed to assess the lack of PET scan availability at the end of treatment (EOT) in LATAM. Results: Of 965 pts identified, 864 had sufficient data for analysis. Pts were young (56% <40 years; median 36 [17-88]) with slight male predominance (53%). 9 (3%) pts were HIV positive. Nodular sclerosing (62%) and mixed cellularity (22%) were the most common HL subtypes (p<0.01). Clinically, most pts had good performance status (ECOG≤1, 96%), no B symptoms (62%) and normal serum LDH (60%). Mediastinal presentation was seen in 14%, bulky mass (>10 cm) 23%, nodal involvement >3 sites 34% and extranodal involvement 25%. Advanced stage was common (57%); 22% and 21% had favorable and unfavorable limited stage HL, respectively. ABVD was the most common first-line regimen (96%); 8 pts received BEACOPP, and 1 BV-AVD. Radiation was utilized in 40% of limited and 21% of advanced stage HL. Only 63% and 48% had interim (iPET) and EOT PET scan, respectively. Most pts were managed at private than public institutions (59%, p<0.01). With a median follow up of 65 [59-71] months the 5-yr overall survival (OS) and progression-free survival (PFS) rates in all HL pts were 85% (82-88, 95% CI not reached, NR) and 64% (60-69, 95% CI NR), respectively. Better OS and PFS were seen in pts younger than 60 (p<0.01), ECOG≤1 (p<0.01) and limited stage HL (p<0.01). Overall response rate at the EOT assessed by either PET or CT scan was 89% (76% complete and 13% partial). In those assessed by iPET, results yielded 86% keeping same plan, 7% de-escalation and 3% escalation. In our cohort, 11% had refractory HL and 18% relapsed after achieving response. Given the inferior PFS to first-line seen in our LATAM HL pts compared to historical cohorts, we looked at possible factors associated to early relapse. Those assessed by PET at the EOT had significantly superior 5-yr PFS than those assessed by CT scan (PET vs CT: favorable HL 91 vs 71%; unfavorable 83 vs 35%; advanced 79 vs 51%) ( Figure). OS was inferior only in pts with unfavorable HL not assessed by PET (94 vs 76%, p=0.03). In the multivariable analysis, the lack of PET assessment at the EOT was associated with short PFS in unfavorable (aHR 7.81 [1.46-41.88], p=0.02) and advanced (aHR 17.35 [4.66-64.61], p<0.01), and a non-statistically significant worse PFSvin favorable HL (aHR 5.05 [0.56-45.72], p=0.15). Other factors associated to short PFS were extranodal disease (aHR 35.29 [5.62-209.07], p<0.01) in unfavorable, and high serum LDH (aHR 2.31 [1.2-4.46], p=0.01) in advanced HL. Interestingly, pts with advanced HL managed in public institution had less risk for relapse than those in private institutions (aHR 0.13 [0.03-0.51], p<0.01). Conclusion: To our knowledge, this is the largest cohort of newly diagnosed HL pts in LATAM in the real-world setting. We observed similar clinical features in LATAM HL pts than those previously reported. ABVD was widely utilized in LATAM, and the 5-yr OS of 85% in all pts aligns with international estimates. However, our findings underscore the impact of limited access to PET scan at the EOT in LATAM, leading to lower PFS outcomes compared to those reported in developed countries. Despite this challenge, salvage therapy seems to rescue our LATAM HL pts, thus, OS remains optimal. To improve outcomes and minimize late effects following treatment completion, increasing the use of PET-adapted therapy for managing adult pts with HL in LATAM should be prioritized.

Fatty acids analysis by capillary electrophoresis: Fundamentals, advantages and applications.

This review covers the know-how of the Grupo de Química Analítica e Quimiometria regarding the analysis of fatty acids by capillary electrophoresis acquired over its 20 years of existence. Therefore, the fundamentals, advantages, and applications of this technique for analyzing different fatty acids in samples such as food, oils, cosmetics, and biological matrices are presented and discussed. Capillary electrophoresis is, thus, shown as an interesting and valuable separation technique for the target analysis of these analytes as an alternative to the gas chromatography coupled to flame ionization detection, as it offers advantages over the latter such as low analysis times, low sample and reagent consumption, the use of a nondedicated column, and simpler sample preparation. In addition, the methods shown in this literature review can be useful for quality control, adulteration, and health-related research by regulatory agencies.

Epidemiology, Clinical Features and Outcomes of Peripheral T-Cell Lymphoma in Latin America

INTRODUCTION: Peripheral T-cell lymphomas (PTCL) represent a rare and heterogenous group of mature T-cell lymphomas often characterized by aggressive behavior. Previous studies evaluating the distribution of PTCL subtypes across Latin America (LATAM) were limited in their representation of most countries in the region. Additionally, a lack of standardized management for several subtypes and the absence of comprehensive lymphoma registries in LATAM suggests exploring real-world treatment patterns and clinical outcomes. We conducted an international pooled analysis to assess the distribution of PTCL across LATAM countries and report treatment outcomes. METHODS: We compiled data from patients aged ≥18 years with newly diagnosed PTCL from the retrospective registry of the Grupo de Estudio Latinoamericano de Linfoproliferativos (GELL, n=988, 1975-2023), the Brazilian T-cell Project (Brazilian TCP, 2015-2017, 168 cases retrospective; 2017-2023, 425 cases prospective) and the prospective registry of the International T cell Project (ITCP, n=529, 2006-2023). Data were abstracted from medical records in a standardized form. Survival data was only available from the GELL and Brazilian TCP. Overall survival (OS) was estimated from diagnosis to death from any cause, while progression-free survival (PFS) was defined from diagnosis to relapse, progression, or death from any cause. We used the Kaplan-Meier method and Log-rank test to estimate and compare survival probabilities. RESULTS: We enrolled 2110 patients from 11 LATAM countries. Overall, the median age at diagnosis was 54 years (range 18-95 years), most were male (59%), present with advanced stage disease (Ann Arbor III-IV, 67%), and had good performance status (ECOG ≤1, 71%) (Table 1). After PTCL not otherwise specified (NOS, 39%), adult T-cell leukemia/lymphoma (ATL, 18%) and extranodal NK/T cell lymphoma (ENKTL, 16%) were the most frequently diagnosed PTCL subtypes with varying distribution across LATAM countries. Peru had a higher prevalence of ATL (39%) and ENKTL was frequently diagnosed in Central America (43%). In contrast, ALK-negative (ALK-) anaplastic large T-cell lymphoma (ALCL) was the second more frequent subtype in Brazil (18%), Chile (16%), and Argentina (9%). The percentage of mature T-cell NOS was 27% in Argentina and 28% in Chile. A total of 1620 received chemotherapy. First-line chemotherapy varied across subtypes. Patients with ENKTL were frequently treated with asparaginase/platinum-based therapy (62%), while CHOP was more commonly used for ATL or PTCL NOS (46% for both). Chemotherapy with CHOEP/EPOCH was frequent for patients with ALK- ALCL (45%), ALK+ (ALCL 47%), or AITL (48%). With a median follow-up of 33 months, the 3-year OS and PFS for the overall cohort were 40% and 30%, respectively. ALK+ ALCL had superior survival estimates, with a 3-year OS of 77% and a 3-year PFS of 73%. The 3-year OS for patients with ENKTL was 48% and the PFS was 45%. Patients with ATL experienced the lowest survival rates (OS and PFS of 23% and 16% at 3 years, respectively). The use of asparaginase/platinum or CHOP-based therapy was associated with superior 3-year OS (61% and 52%, respectively; p=0.011) and PFS (57% and 49%, respectively; p=0.017) among patients with ENKTL. For ATL, the use of CHOEP/EPOCH was associated with improved 3-year OS (21%, p=0.009) and PFS (15%, p=0.024), but outcomes remained dismal. CONCLUSION: To our knowledge, we report the largest pooled cohort of PTCL subtypes across LATAM by leveraging the retrospective registry of the GELL consortium and data from the Brazilian TCP and ITCP. Our findings suggest a distinct distribution of PTCL subtypes across LATAM countries, with a higher prevalence of ATL and ENKTL compared to the epidemiological patterns in Western countries. This distribution underscores a unique opportunity to increase trial enrollment and accrual of rarer PTCL subtypes. The relatively high percentage of mature T-cell NOS suggests difficulties in providing specific lymphoma diagnoses in the region. The low survival rates for some subtypes indicate the need to develop novel therapies to improve patient outcomes. A larger prospective assessment of PTCL epidemiology and treatment outcomes is being planned to expand the ascertainment of cases, improve pathological classification of the different PTCL subtypes, and validate our results in the LATAM region.

A multi-platform approach to identify a blood-based host protein signature for distinguishing between bacterial and viral infections in febrile children (PERFORM): a multi-cohort machine learning study

Differentiating between self-resolving viral infections and bacterial infections in children who are febrile is a common challenge, causing difficulties in identifying which individuals require antibiotics. Studying the host response to infection can provide useful insights and can lead to the identification of biomarkers of infection with diagnostic potential. This study aimed to identify host protein biomarkers for future development into an accurate, rapid point-of-care test that can distinguish between bacterial and viral infections, by recruiting children presenting to health-care settings with fever or a history of fever in the previous 72 h. In this multi-cohort machine learning study, patient data were taken from EUCLIDS, the Swiss Pediatric Sepsis study, the GENDRES study, and the PERFORM study, which were all based in Europe. We generated three high-dimensional proteomic datasets (SomaScan and two via liquid chromatography tandem mass spectrometry, referred to as MS-A and MS-B) using targeted and untargeted platforms (SomaScan and liquid chromatography mass spectrometry). Protein biomarkers were then shortlisted using differential abundance analysis, feature selection using forward selection-partial least squares (FS-PLS; 100 iterations), along with a literature search. Identified proteins were tested with Luminex and ELISA and iterative FS-PLS was done again (25 iterations) on the Luminex results alone, and the Luminex and ELISA results together. A sparse protein signature for distinguishing between bacterial and viral infections was identified from the selected proteins. The performance of this signature was finally tested using Luminex assays and by calculating disease risk scores. 376 children provided serum or plasma samples for use in the discovery of protein biomarkers. 79 serum samples were collected for the generation of the SomaScan dataset, 147 plasma samples for the MS-A dataset, and 150 plasma samples for the MS-B dataset. Differential abundance analysis, and the first round of feature selection using FS-PLS identified 35 protein biomarker candidates, of which 13 had commercial ELISA or Luminex tests available. 16 proteins with ELISA or Luminex tests available were identified by literature review. Further evaluation via Luminex and ELISA and the second round of feature selection using FS-PLS revealed a six-protein signature: three of the included proteins are elevated in bacterial infections (SELE, NGAL, and IFN-γ), and three are elevated in viral infections (IL18, NCAM1, and LG3BP). Performance testing of the signature using Luminex assays revealed area under the receiver operating characteristic curve values between 89·4% and 93·6%. This study has led to the identification of a protein signature that could be ultimately developed into a blood-based point-of-care diagnostic test for rapidly diagnosing bacterial and viral infections in febrile children. Such a test has the potential to greatly improve care of children who are febrile, ensuring that the correct individuals receive antibiotics. European Union's Horizon 2020 research and innovation programme, the European Union's Seventh Framework Programme (EUCLIDS), Imperial Biomedical Research Centre of the National Institute for Health Research, the Wellcome Trust and Medical Research Foundation, Instituto de Salud Carlos III, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Grupos de Refeencia Competitiva, Swiss State Secretariat for Education, Research and Innovation.

Resilience in the Time of a Pandemic: Developing Public Policies for Ollas Comunes in Peru

The coronavirus (Covid-19) pandemic has created economic, social, and food security crises in many countries throughout the world. Faced with growing hunger in Peru, and the government’s delayed and inadequate reaction, the most important response came from the citizens themselves, particularly the women, in the form of thousands of social care initiatives known as ollas comunes (literally ‘communal pots’, similar to soup kitchens, whereby local communities pool their resources to supply food for everyone in the neighbourhood). This article tells the parallel stories of the resurgence of these ollas comunes and the state-funded support initiatives, alongside the process followed by GRADE (Group for the Analysis of Development – Grupo de Análisis para el Desarrollo; a non-profit research centre founded in Peru) that enabled it to contribute to those institutions looking to improve access to food for the most vulnerable people. Both stories are underpinned by a common ability to adapt quickly, which is crucial for achieving objectives in uncertain and ever‑changing situations.

Actions to Avoid in Pain Management and Sedoanalgesia Procedures in Pediatric Emergencies.

The aim of this study was to show the process of elaboration and the results obtained of the list of "do not do" recommendations for pain management and sedoanalgesia procedures in pediatric patients within the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergencies (Grupo de Trabajo de Analgesia y Sedación de la Sociedad Española de Urgencias de Pediatría [GTAS-SEUP]). The process of drawing up the list was carried out in 3 phases: (1) "brainstorming," open to all members of the GTAS-SEUP; (2) selection of recommendations, after a modified Delphi methodology; and (3) drafting and consensus of the final document. Initially, 57 proposed recommendations were obtained, which were reduced to 39 by unifying those that were similar. Of the 14 "do not do" in pain management, 6 were accepted: 3 in the first round and 3 in the second round. Of the 25 "do not do" recommendations for sedoanalgesia procedures, 6 were accepted: 4 in the first round and 2 in the second round. The final text consisted of 12 actions to avoid, 6 referring to pain management and 6 to sedoanalgesia procedures. The list of "do not do" recommendations for pain management and sedoanalgesia procedures in the pediatric patient is a consensual tool, within the GTAS-SEUP. These recommendations promote an improvement in the quality of care offered to these patients, based on avoiding unnecessary measures, which can sometimes be harmful.

Spanish Presidency of the EU High Risk Security Network held by the Guardia Civil through the Grupo de Acción Rápida

Spanish Presidency of the EU High Risk Security Network held by the Guardia Civil through the Grupo de Acción Rápida

How we approach conservative treatment of retinoblastoma in South America in the era of local ocular treatments: A consensus of the Grupo America Latina de Oncologia Pediatrica (GALOP).

Local therapies are increasingly used for ocular preservation in retinoblastoma. In middle-income countries, these techniques pose specific challenges mostly related to more advanced disease at diagnosis. The Grupo de America Latina de Oncología Pediátrica (GALOP) developed a consensus document for the management of conservative therapy for retinoblastoma. Intra-arterial chemotherapy (OAC) is the preferred therapy, except for those with less advanced disease or age younger than 6months. OAC allowed for a reduction in the use of external beam radiotherapy in our setting. Intravitreal chemotherapy is the preferred treatment for vitreous seeding. Enucleation is the treatment of choice for eyes with advanced disease.

Think tanks, redes de gobernanza y política educativa en Uruguay

This paper aims to account for the formation of governance networks with strong power to influence Uruguayan educational policies, constituted by a diversity of actors with a common interest in disputing the traditional hegemony of public education in the country.
 The starting point is a conceptual framework influenced by the post-foundationalist perspective in the social sciences, which is particularly interested in the constitution of political networks and governance networks in the framework of the promotion and definition of educational policies.
 A methodological strategy based on a network ethnography perspective (Howard, 2002) is proposed, based on the analysis of institutional documents, educational policy texts, various websites and press releases.
 The paper aims to show the incidence of two local think tanks (CERES and Eduy21) in the production of meanings and proposals that dispute the public meaning of education in Uruguay.
 The text is part of a broader research entitled "Disputes around the public nature of education in Uruguay" (Martinis, 2022), based in the Grupo de Estudios en Políticas y Prácticas Educativas of the Facultad de Humanidades y Ciencias de la Educación of the Universidad de la República de Uruguay.

Haemosporidians in Non-Passerine Birds of Colombia: An Overview of the Last 20 Years of Research

The Neotropics are highly diverse in avian species. Neotropical countries contribute a large part of the estimated diversity of haemosporidian parasites reported for the planet’s tropical zones. However, sampling is limited and biased, illustrated by only 30% of the genetic records (barcodes) from non-passerines, most of them not linked to a nominal species. This paper aimed to perform the molecular and morphological characterization of the haemosporidians that infect non-passerine birds from Colombia deposited in the biological collection named “Grupo de Estudio Relación Parásito Hospedero (GERPH)”. We analyzed 1239 samples from twelve biomes and two animal care facilities. Phylogenetic relationships using barcodes and mitochondrial genomes were estimated. In addition, the reports of haemosporidian infections in non-passerine birds from the Neotropics recorded after 1978 were summarized. We reported the presence of thirteen morphological haemosporidian species, four potential new species deposited in GERPH, a host range expansion for two Plasmodium species, and a barcode sequence for Haemoproteus caprimulgi. We confirmed the species associated with 56 molecular lineages reported in other neotropical countries at the genus level. Thus, biological collections and curated databases such as MalAvi are essential to support integrative approaches demanded in modern taxonomy.

Qualidade de Vida no Trabalho: Análise Comparativa Entre dois Grupos de Servidores Públicos

ABSTRACT The general objective of the study was to compare the analysis of the perception of Quality of Work Life of workers from two federal entities in the infrastructure area based on the Activity-centered Ergonomics Applied to QWL. A total of 3.136 workers participated in this research. As an instrument it was used an electronic version of the QWL Valuating Inventory. The result presents no significant differences in perception of the two groups of works in relation to the quality of life at work. The element work organization was the worst evaluated indicating alertness and risk of illness. The research indicates issues that deserve attention during the elaboration of QWL Policy and Program in the evaluated organizations.

Renewable Energies in the Agricultural Sector: A Perspective Analysis of the Last Three Years

Renewable energy arises as a tool for the supply of energy to the agriculture sector. Currently, there is a growing concern for the environment. This circumstance has led to technological progress in energy use in relation to natural resources and their availability for all productive sectors, including agriculture. The main objective of this work is to perform analysis from a bibliometric point of view and to analyze scientific advances in renewable energy and agriculture worldwide that have occurred in the last three years (2019–2021). The purpose of this study is to provide an overview of the last three years on the topic in order to contribute to the international scientific community, specifically towards collaboration between authors, institutions, and countries. A keyword analysis using community detection was applied to detect the five main clusters of this research and was largely dedicated to the following topics: renewable energy technologies in agriculture, bioenergy, sustainable agriculture, biomass energy, and the environmental impact of agriculture. The main countries found to be conducting research on renewable energy and agriculture include India, China, the United States, Italy, the United Kingdom, Poland, Indonesia, Germany, the Russian Federation, and Spain; the most important institutions conducting research in this area include the Ministry of Agriculture of the People’s Republic of China, the Tashkent Institute of Irrigation and Agricultural Mechanization Engineers at the National Research University in Uzbekistan, the Chinese Academy of Agricultural Sciences, and the Grupo de Investigação em Engenharia e Computação Inteligente para a Inovação e o Desenvolvimento in Portugal. These results may contribute to the identification of new research needs and therefore to the development of future directions of research on renewable energies in the agricultural sector.

Survival analysis of transplant-eligible newly-diagnosed multiple myeloma patients harboring t(4;14), t(14;16), and/or del(17p) in the real-world setting

Cytogenetic abnormalities (CA) such as t(4;14), t(14;16), and del(17p), are associated with a poor prognosis in Multiple Myeloma (MM) patients. However, there is scarce information regarding the Latin-American population. This study aims to analyze the impact of t(4;14), t(14;16), and del(17p) on the progression-free survival (PFS) and overall survival (OS) of transplant-eligible newly-diagnosed MM (NDMM) patients in Latin America. Retrospective survival analysis based on the Grupo de Estudio Latinoamericano de MM (GELAMM) registry, including all adult patients with NDMM harboring CA t(4;14), t(14;16), and/or del(17p). Fifty-nine patients were included; the median age was 57 years, 55.9% males, 22% ISS-I, 25.4% ISS-II, and 47.5% ISS-III. The majority (89.8%) had one alteration, whereas 10.2% had del(17p) and t(4;14). The frequencies of CA were del(17p) in 61.0%, t(4;14) in 25.4%, and t(14;16) in 3,4%. Autologous stem cell transplantation was performed in 36 cases, 20 patients did not use this consolidative strategy, and this data was missed in three cases.Five-year OS for the entire cohort was 60.8% and 5-year PFS was 28.1%. Bortezomib-based induction regimen (BBR) (p=0.029), consolidation with ASCT (p<0.001), and maintenance therapy (p=0.004) were associated with an improved 5-year OS. In the multivariate analysis, ASCT was the only variable with a positive impact on OS (HR 0.11, 95% CI 0.033 to 0.34, p<0.001). The median PFS presented a non-statistically significant benefit in BBR, ASCT, and maintenance therapy groups. BBR induction, ASCT, and maintenance therapy were associated with improved OS in high-risk NDMM patients.

Treatment Patterns and Survival of Patients with Relapsed and Refractory Classical Hodgkin Lymphoma in Latin America

Alana von Glasenapp, MD1. Luis Villela,MD2,3,4. Henry Idrobo,MD5. Perla Colunga, MD6. Fernando Perez-Jacobo, MD7. Arianna Robles-Rodriguez, MD8. Rosa Oliday Rios, MD9. Diego Fernando Garces Paz, MD10. Denisse Castro Uriol,MD11,12. Sally Paredes, MD 11,12. Brady Beltran Garate, MD11,12. Ana Carolina Oliver Solimano, MD13. Victoria Irigoin, MD14. Alejandro Ospina-Idarraga, MD MSc15,16Humberto Martinez-Cordero, MD MSc15,16. 1Hospital Central Instituto de Prevision Social, Asuncion,Paraguay. 2Universidad Autonoma de Sinaloa Facultad de Medicina, Sinaloa,Mexico. 3Hospital Fernando Ocaranza. ISSSTE, Hermosillo, Sonora Mexico. 4Centro Medico Dr. Ignacio Chavez. ISSSTESON, Hermosillo, Sonora,Mexico. 5Prof. Universidad del Valle,Cali,Colombia. 6Servicio de Hematología, Hospital Universitario, UANL, Monterrey Nuevo León,Mexico. 7Hospital Central Norte PEMEX, Ciudad de México, Mexico. 8Hospital General de Occidente, Servicio hematología, SSA, Guadalajara, Jalisco, Mexico. 9Prof auxiliar Hospital Hermanos Ameijeira. Havanna,Cuba. 10Universidad del Cauca,Colombia. 11Hospital Edgardo Rebagliati Martins, EsSalud, Lima Peru. 12Centro de Medicina de Precisión Universidad San Martin de Porres,Lima, Perú. 13Hospital Britanico y Casmu,Montevideo,Uruguay. 14Casmu y Cosem,Montevideo,Uruguay. 15Instituto Nacional de Cancerologia, Bogota, Colombia. 16Master Program in Epidemiology-Universidad del Bosque, Bogota, Colombia. On Behalf of GELL (Grupo de estudio Latinoamericano de Linfoma)Background The standard of care (SOC) in first relapse/refractory Hodgkin Lymphoma (r/rHL) is salvage therapy, including high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT). This treatment approach has been shown to improve event-free survival (EFS), progression-free survival (PFS), and freedom from treatment failure (FFTF) in controlled clinical trials. This study aims to determine the treatment patterns and outcomes of patients with Hodgkin Lymphoma in Latin America. Materials y Methods Here we present a retrospective international study of patients diagnosed with R/R HL treated at 16 centers in seven countries between 2010 and 2020. Results We found 142 patients with R/R disease fulfilling the inclusion criteria. Clinical characteristics are shown in table 1. Platinum-based regimens were the most widely used, followed by gemcitabine-based regimens and only 36 patients proceeded with ASCT (25.4%). Patients who ultimately did undergo ASCT had the best progression-free survival compared with those who did not. The median progression-free survival for the entire cohort was 17 months (95% CI 8.2-25.7). Progression-free survival for those patients who underwent ASCT was 40 months (95% CI 28-52), and for those who did not proceed to ASCT, it was only 12 months (95% CI 8-16). In the multivariate analysis, the only independent predictor of better survival was having proceeded with the transplant HR: 0.393 p= 0.030 (95% CI 0.17 -0.91). Conclusion Our retrospective study showed that access to ASCT is limited in Latin America, and the survival is lower than reported in the literature. The ASCT is essential for achieving a potential cure in R / RHL patients with the chemotherapy-sensitive disease. Health systems must guarantee access to transplantation for all patients who are candidates for this therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Non-Hodgkin lymphoma treatment in middle-income countries in Latin America: perspective of the Latin American Study Group of Lymphoproliferative Disorders [Grupo de Estudio de Linfoproliferativos de Latino América (GELL)

ABSTRACT Introduction Non-Hodgkin lymphomas (NHL) are the most frequently recognized entities among lymphoproliferative syndromes and rank fifth among neoplasms not associated with gender. There is scarce information on the clinical characteristics of the most frequent NHL, and no data on treatment regimens and their outcomes in Latin America. Although many factors affect a patient’s possibilities of receiving treatment, the annual income per person/country is pivotal in Latin America. Aim We present the clinical characteristics, risk groups, and treatment regimens of the three most frequent lymphoma subtypes in Latin America [diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and peripheral T-cell lymphoma (PTCL)], based on the data collected by the largest study group of lymphoproliferative diseases in Latin America: The Latin American Study Group of Lymphoproliferative Disease [Grupo de Estudio de Linfoproliferativos de Latino America (GELL)]. Outcomes The most frequent treatment regimen for B-cell lymphomas is immunochemotherapy (R-CHOP ≥70%), and CHOP for PTCL. Survival is similar to that reported by industrialized nations. We have no solid data on the results of treatment with salvage regimens nor stem cell transplantation in refractory/ relapsed NHL. Conclusion In Latin America, the same treatment regimens are used as in highly developed countries, although we lack the necessary technology to apply CAR T-cell therapies or a network of trials sponsored by the pharmaceutical industry.

Outpatient Parenteral Antibiotic Treatment vs Hospitalization for Infective Endocarditis: Validation of the OPAT-GAMES Criteria.

BackgroundOutpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used.MethodsThis was a prospective multicenter nationwide cohort study (2008–2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpaña) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use.ResultsA total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P < .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio [OR], 1.43; 95% CI, 1.03–1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53–0.98; P = .03).ConclusionsOPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered.

La conceptualización del núcleo en las construcciones (pseudo)partitivas: la concordancia sujeto-verbo

The aim of this work is to analyze the influence of semantic-pragmatic factors in the establishment of Spanish subject-verb agreement in those cases in which the nominal that functions as a subject is manifested through a (pseudo)partitive construction, formed by a singular nucleus + plural prepositional phrase (un grupo de neurocientíficos han decidido acabar con los interrogantes del experimento / un grupo de chicos se acercó a mí y comenzaron a golpearme). The Royal Spanish Academy defines agreement as the “formal expression of various syntactic relationships” (NGLE, 2009: 13). It states that this relationship arises from the morphological agreement between two lexical units that are in specific positions. The agreement, then, is understood, from a syntactic position, as the reiteration of inflectional information in various places in the chain. However, from cognitive linguistics, the establishment of agreement is about a conceptual superposition, a common characteristic of grammatical constructions, whereby the same information is symbolized in multiple places” (Langacker, 2008, p. 347). Based on the notions of figure and ground proposed by Langacker (1991 and 2008), our hypothesis argues that the agreement between the subject and the verb is defined, in the cases analyzed, according to the conceptualization of the nominal and which is the element that the speaker brings into focus during the construction of his speech.

Hereditary Breast Cancer in the Brazilian State of Ceará (The CHANCE Cohort): Higher-Than-Expected Prevalence of Recurrent Germline Pathogenic Variants.

PurposeThere is a significant lack of epidemiological data on hereditary cancer in Northeast Brazil. This is the largest study on the prevalence and mutational spectrum of cancer predisposition genes conducted in this region and the first in the State of Ceará.MethodsPatients ≥18 years of age that were referred to CHANCE (Grupo de Câncer Hereditário do Ceará) from March 2014 to December 2020 with testing criteria for breast cancer susceptibility genes according to NCCN v.1.2021 were eligible to participate. The inclusion of patients was limited to one individual per family and to those born in the State of Ceará. All patients underwent a hereditary cancer panel testing with at least 30 genes.ResultsA total of 355 patients were included, and 97 (27.3%) carried a P/LP germline variant in 18 different genes. Among the 97 P/LP carriers, BRCA1 (31, 31.9%) and BRCA2 (25, 25.7%) were the most frequently mutated genes, followed by PALB2 (10, 10.3%), CHEK2 (7, 7.2%) and ATM (4, 4.1%). A small number of recurrent variants (detected in three or more individuals) in BRCA1, BRCA2, CHEK2 and ATM represented the majority of the P/LP variants described in this cohort.ConclusionIn this cohort, the prevalence of L/PL was high, particularly involving the BRCA1, BRCA2, PALB2, CHEK2 and ATM genes and, to a lesser extent than expected, the TP53 gene. A high frequency of recurrent variants was also observed, for which further and larger analyses should clarify the presence of any possible founder effect. Characterizing the mutational profile of cancer predisposition genes in diverse populations may contribute to cancer prevention and therapeutic management.