Individual quality assessment of autografting by probability estimation for clinical endpoints: a prospective validation study from the European group for blood and marrow transplantation.

The aim of supportive autografting is to reduce the side effects from stem cell transplantation and avoid procedure-related health disadvantages for patients at the lowest possible cost and resource expenditure. Economic evaluation of health care is becoming increasingly important. We report clinical and laboratory data collected from 397 consecutive adult patients (173 non-Hodgkin lymphoma, 30 Hodgkin lymphoma, 160 multiple myeloma, 7 autoimmune diseases, and 28 acute leukemia) who underwent their first autologous peripheral blood stem cell transplantation (PBSCT). We considered primary endpoints evaluating health economic efficacy (eg, antibiotic administration, transfusion of blood components, and time in hospital), secondary endpoints evaluating toxicity (in accordance with Common Toxicity Criteria), and tertiary endpoints evaluating safety (ie, the risk of regimen-related death or disease progression within the first year after PBSCT). A time-dependent grading of efficacy is proposed with day 21 for multiple myeloma and day 25 for the other disease categories (depending on the length of the conditioning regimen) as the acceptable maximum time in hospital, which together with antibiotics, antifungal, or transfusion therapy delineates four groups: favorable (≤7 days on antibiotics and no transfusions; ≤21 [25] days in hospital), intermediate (from 7 to 10 days on antibiotics and 7 days on antibiotics, >3 but 30/34 days in hospital after transplantation), and very unfavorable (>10 days on antibiotics, >6 transfusions; >30 to 34 days in hospital). The multivariate analysis showed that (1) PBSC harvests of ≥4 × 106/kg CD34 + cells in 1 apheresis procedure were associated with a favorable outcome in all patient categories except acute myelogenous leukemia and acute lymphoblastic leukemia (P = .001), (2) ≥5 × 106/kg CD34 + cells infused predicted better transplantation outcome in all patient categories (P 500 mL) (P = .002), and (5) patients with a central venous catheter during both collection and infusion of PBSC had a more favorable outcome post-PBSCT than peripheral access (P = .007). The type of mobilization regimen did not affect the outcome of auto-PBSCT. The present study identified predictive variables, which may be useful in future individual pretransplantation probability evaluations with the goal to improve supportive care

Importancia de las Cuidadoras en la Constitución Psíquica de Niños Abrigados

Attachment is a means of showing affection and allows for a healthier psychological development. This research aimed to understand the importance of caring and welcoming by carers in attachment building, targeting the reduction of institutionalized children’s suffering. A semi structured interview was conducted with nine carers of an Association located in a country town in São Paulo. Results showed that carers develop attachment to the children and help in lowering the impacts of institutionalization, as they perform maternal roles. On the other hand, carers were displeased with the institution due to the reduced number of employees, especially the rota system, as a factor that interferes with children’s care. Besides, they showed difficulties in understanding the limits of attachment with the children, for the relationship to be healthy for both parts. It is hoped that this research’s results provide knowledge to carers, concerning the importance of caring and the role of attachment in psychological development during institutionalization. Keywords: psychological development; carers; attachment.La vinculación es una manera de demonstrar afectividad y permite un desarrollo psíquico saludable. Esta pesquisa tuvo el objetivo de comprender la importancia del cuidado y acogida de las cuidadoras en la construcción de la vinculación, para reducir el sufrimiento de niños abrigados. Fue efectuada una entrevista semiestructurada con nueve cuidadoras de una Asociación localizada en una ciudad del interior de São Paulo. Resultados muestrearan que las cuidadoras desarrollan vinculaciones afectivas con los niños y contribuyen en la diminución de los impactos de la institucionalización, porque realizan el papel de figura maternal. En contrapartida, las cuidadoras retrataran una insatisfacción con la institución, relacionada a el número reducido de empleados, especialmente la rotatividad como un factor prejudicial a los cuidados con los niños. También presentaran dificultad em comprender el límite de envolvimiento afectivo con los niños, para que sea una relación saludable para ambos. Se espera que los resultados de esta pesquisa traigan conocimiento a las cuidadoras, referente a la importancia del proceso de cuidar y el papel de la vinculación en el desarrollo psíquico en el proceso de abrigamento. Descriptores: desarrollo psíquico; cuidadoras; vinculación.O vínculo é uma das formas de se demonstrar a afetividade e permite um desenvolvimento psíquico mais saudável. Esta pesquisa teve o objetivo compreender a importância do cuidado e acolhimento realizado por parte das cuidadoras na construção do vínculo, visando reduzir o sofrimento de crianças institucionalizadas. Foi realizada uma entrevista semiestruturada com nove cuidadoras de uma Associação localizada numa cidade do interior do estado de São Paulo. Os resultados mostraram que as cuidadoras desenvolvem vínculo afetivo com as crianças, e contribuem na amenização dos impactos da institucionalização, uma vez que realizam o papel de figura materna. Em contrapartida, as cuidadoras demonstraram um descontentamento com a instituição referente ao número reduzido de funcionárias, destacando a alta rotatividade como um fator que prejudica o cuidado das crianças. Além disso, apresentaram dificuldades em compreender o limite de envolvimento afetivo com as crianças, para que seja uma relação saudável para ambas as partes. Espera-se que os resultados desta pesquisa forneçam conhecimento às cuidadoras, referente à importância no processo de cuidar, e o papel do vínculo no desenvolvimento psíquico ao longo do processo de abrigamento. Palavras-chave: desenvolvimento psíquico; cuidadoras; vínculo

ÁLCOOL COMO SINTOMA: HISTÓRIAS DE VIDA DE DEPENDENTES

Esta pesquisa objetivou investigar a relação entre dependência do álcool e história de vida num grupo de sete homens, com idades entre 42 a 70 anos, frequentadores, há mais de dois anos, do AA, numa cidade do interior de São Paulo. Apresentou-se aos participantes uma Narrativa Interativa inacabada, elaborada pelos pesquisadores, sobre o tema do alcoolismo, que os participantes completavam por escrito, além de entrevistas gravadas. Foram definidos sete campos de sentido a partir da interpretação das narrativas e das entrevistas, articulados teoricamente com a literatura psicanalítica. Observou-se que cada sujeito possui histórias singulares quanto ao início e permanência no uso do álcool; a importância da fala do sujeito e seu poder curativo; a necessidade de reparação pelos danos causados à própria vida e/ou no ambiente familiar e a identificação dos sujeitos dependentes com o grupo AA, no qual buscam ajuda para recuperação.

Transient aplasia preceding adult acute lymphoblastic leukemia.

A 62-year-old woman developed common acute lymphoblastic leukemia (ALL) after spontaneous recovery from transient marrow aplasia. Although the mechanisms underlying bone marrow suppression in acute leukemia are obscure, it is important to know that transient aplasia may be observed as a prodromal feature in ALL in adult patients as well as in children

Acute promyelocitic leukemia toluidine blue subtype.

In the hypergranular group of acute promyelocytic leukemia (APL) a rare subvariant with basophilic granules, metachromatic for toluidine blue, is recognizable. To evaluate the incidence as well as the biological and clinical significance of this subtype, we studied 53 consecutive untreated patients with APL with morphological, cytochemical, immunological and cytogenetic methods. In 10 cases (19% of the total) granules stained metachromatically in percentages of promyelocytes ranging from 16 to 60. In these cases peroxidase positivity was weaker than in the classic hypergranular and microgranular M3 and activities of esterases were usually present; at the ultrastructural level granules contained particulate material. Immunophenotypic and cytogenetic characteristics seemed not to differ from those of other M3 cases. Coagulopathy was usually life-threatening, notwithstanding the low white cell count, and the median survival was short. Hyperhistaminemia-related symptoms were not observed. Cytochemical, immunologic and cytogenetic findings are useful to differentiate this form from M2 with basophilic differentiation and from mast cell leukemia

Personality Disorders in Brazilian Homeless Compared with Non-Psychiatric and Psychiatric Patients

International audienc

Multicentric Clinical Audit of Chemotherapy Administration for Lymphoprolipherative Diseases in Day Hospital Patient Setting

The phagocyte NADPH oxidase (NOX2) is critical for the bactericidal activity of phagocytic cells and plays a major role in innate immunity. We showed recently that NOX2 activity in mouse dendritic cells (DCs) prevents acidification of phagosomes, promoting antigen cross-presentation. In order to investigate the role of NOX2 in the regulation of the phagosomal pH in human DCs, we analyzed the production of reactive oxygen species (ROS) and the phagosomal/endosomal pH in monocyte-derived DCs and macrophages (M 8s) from healthy donors or patients with chronic granulomatous disease (CGD). As expected, we found that human M 8s acidify their phagosomes more efficiently than human DCs. Accordingly, the expression of the vacuolar proton ATPase (V-H+-ATPase) was higher in M 8s than in DCs. Phagosomal ROS production, however, was also higher in M 8s than in DCs, due to higher levels of gp91 phoxexpression and recruitment to phagosomes. In contrast, in the absence of active NOX2, the phagosomal and endosomal pH decreased. Both in the presence of a NOX2 inhibitor and in DCs derived from patients with CGD, the cross-presentation of 2 model tumor antigens was impaired. We conclude that NOX2 activity participates in the regulation of the phagosomal and endosomal pH in human DCs, and is required for efficient antigen cross-presentation

Acute promyelocytic leukemia: morphological and clinical features.

Acute promyelocytic leukemia (APL) is not a morphologically homogeneous entity: to verify whether there is any relationship between this heterogeneity and other biological and clinical aspects, we studied 43 cases of APL with morphological, cytochemical, cytogenetic and immunological methods.Three morphological categories were present: a classic hypergranular type (30 cases), a microgranular type (6 cases) and a form with basophilic granules (M3b) that stained metachromatically with toluidine blue (7 cases). In all these groups there were cases with cytochemical features of both myeloid and monocytic type (alpha-naphthyl-acetate esterase positive). No immunological and cytogenetic differences were observed; the morphological variant with basophilic granules was more frequent in females; age distribution was not related to the morphological subtype; organomegaly was extremely rare in M3b. A low white blood cell count was constant in M3b, whereas no differences were observed in hemoglobin and platelet values. Severity of bleeding was worst in the group with toluidine blue metachromasia; this and the microgranular type had poor prognosis.Our study confirms the importance of identifying different cytologic categories in APL. In particular we focused our attention on a new variant with basophilic granules