Favorable impact of allogeneic stem cell transplantation in patients with therapy-related myelodysplasia regardless of TP53 mutational status

Therapy-related myelodysplastic syndrome is a long-term complication of cancer treatment in patients receiving cytotoxic therapy, characterized by high-risk genetics and poor outcomes. Allogeneic hematopoietic cell transplantation is the only potential cure for this disease, but the prognostic impact of pre-transplant genetics and clinical features has not yet been fully characterized. We report here the genetic and clinical characteristics and outcomes of a relatively large cohort of patients with therapy-related myelodysplastic syndrome (n=67) who underwent allogeneic transplantation, comparing these patients to similarly treated patients with de novo disease (n=199). The 5-year overall survival was not different between patients with therapy-related and de novo disease (49.9% versus 53.9%; P=0.61) despite a higher proportion of individuals with an Intermediate-2/High International Prognostic Scoring System classification (59.7% versus 43.7%; P=0.003) and high-risk karyotypes (61.2% versus 30.7%;

Outcome after transabdominal cervicoisthmic cerclage.

Contains fulltext : 51215.pdf (publisher's version ) (Closed access)OBJECTIVE: To estimate benefits and risks of transabdominal cervicoisthmic cerclage in women with cervical insufficiency in whom transvaginal cerclage is considered surgically unfeasible. METHODS: This was an observational cohort study with historical controls of 101 pregnancies after transabdominal cervicoisthmic cerclage in 101 women with a classic history of cervical insufficiency and severe cervical defects precluding transvaginal cerclage. RESULTS: Median gestational age at elective transabdominal cerclage (n = 95) was 14 (range 12-16) weeks and at emergency cerclage (n = 6) was 18 (range 17-22) weeks. Perioperative complications were blood loss 500 mL or more (n = 3) and rupture of membranes (n = 2). Patients were delivered by cesarean. Before cerclage 76% (95% confidence interval [CI] 70.2-81.1%) of births occurred before 32 weeks of gestation; total neonatal survival was 27.5% (95% CI 22.5-33.8%). After transabdominal cervicoisthmic cerclage 7% (95% CI 2.9-13.9%) of births took place before 32 weeks of gestation, and total neonatal survival was 93.5% (95% CI 85.5-96.6%). CONCLUSION: In women with a classic history of cervical insufficiency and a traumatized cervix that precludes transvaginal cerclage, transabdominal cervicoisthmic cerclage is associated with successful outcome in the absence of procedure-related major complications. LEVEL OF EVIDENCE: II-2

Validade das informações ocupação e causa básica em declarações de óbito de Botucatu, São Paulo Validity of information on occupation and principal cause on death certificates in Botucatu, São Paulo

O objetivo deste trabalho é estudar a validade das informações sobre ocupação habitual e causa básica em declarações de óbito (DO) de moradores de Botucatu falecidos nesta cidade. Analisou-se a concordância dessas informações com seus padrões-ouro, estabelecidos por intermédio de entrevistas com familiares de 552 falecidos em 1997 e análise de documentação médica. O coeficiente Kappa para a concordância entre a informação sobre ocupação e o padrão-ouro foi 0,31 (IC 95% 0,29-0,34). Para a concordância entre a causa básica declarada e o padrão-ouro, o coeficiente Kappa foi de 0,76 (IC 95% 0,75-0,77). Conclui-se que, embora a validade da informação sobre a causa básica do óbito seja boa, a validade da informação sobre a ocupação habitual é bastante precária. Isto impossibilita a utilização dessas informações em estudos epidemiológicos locais. Tal constatação alerta para a necessidade de previamente verificar a fidedignidade de informações ocupacionais provenientes de declarações de óbito em estudos de saúde do trabalhador. Outra implicação desse achado é enfatizar a necessidade de investir-se na melhoria da qualidade dessas informações.<br>The aim of this paper was to evaluate the accuracy of data on death certificates for occupation and main cause of death. Measure of agreement was assessed comparing data from death certificates with those from both medical records and next-of-kin interviews, analyzing information for 552 residents of Botucatu, Southeast Brazil, who died in 1997. Kappa coefficients of 0.31 (95% C.I. 0.29-0.34) and 0.76 (95% C.I. 0.75-0.76) were obtained for data on occupation and main cause of death, coded by a Brazilian two-digit classification and the three-digit ICD-10 classification, respectively. One can conclude that, although quality of the main cause of death is acceptable for pilot studies, data on occupation taken only from death certificates is not accurate enough to be used in epidemiological research