Use of granulocyte growth factors: recommendations of the Portuguese Society of Hematology

The administration of cytotoxic chemotherapy may be complicated by the emergence of neutropenia and febrile neutropenia, frequently determining hospital admission and intravenous treatment with broad spectrum antibiotics. Frequently, it is necessary to reduce the dose or to delay the administration of the cytotoxic drugs reducing the relative dose intensity of the chemotherapy regimen. Granulocyte growth factors stimulate the proliferation and differentiation of neutrophils and reduce the number of days of severe neutropenia and febrile neutropenia associated with cytotoxic chemotherapy. They are also indicated for the collection of hematopoietic progenitors for autologous and allogeneic transplantation, as well as in non malignant diseases associated with chronic neutropenia. This article reviews the evidence supporting the use of granulocyte growth factors in Hematology

A kinematically unbiased, all-sky search for nearby, young, low-mass stars

The past two decades have seen dramatic progress in our knowledge of the population of young stars of age $< 200\,$Myr that lie within $150\,$pc of the Sun. These nearby, young stars, most of which are found in loose, comoving groups, provide the opportunity to explore (among many other things) the dissolution of stellar clusters and their diffusion into the field star population. Here, we exploit the combination of astrometric and photometric data from {\it Gaia} and photometric data from GALEX (UV) and 2MASS (near-IR) in an attempt to identify additional nearby, young, late-type stars. Specifically, we present a sample of 146 GALEX UV-selected late-type (predominantly K-type) field stars with {\it Gaia}-based distances $< 125\,$pc (based on {\it Gaia} Data Release 1) that have isochronal ages $< 80\,$Myr even if equal-components binaries. We investigate the spectroscopic and kinematic properties of this sample. Despite their young isochronal ages, only $\sim 10$ per cent) of stars among this sample can be confidently associated with established nearby, young moving groups (MGs). These candidate MG members include 5 stars newly identified in this study. The vast majority of our sample of 146 nearby young star candidates have anomalous kinematics relative to the known MGs. These stars may hence represent a previously unrecognised population of young stars that has recently mixed into the older field star population. We discuss the implications and caveats of such a hypothesis---including the intriguing fact that, in addition to their non-young-star-like kinematics, the majority of the UV-selected, isochronally young field stars within $50\,$pc appear surprisingly X-ray faint

Near-IR period-luminosity relations for pulsating stars in ω\omega Centauri (NGC 5139)

$\omega$ Centauri (NGC 5139) hosts hundreds of pulsating variable stars of different types, thus representing a treasure trove for studies of their corresponding period-luminosity (PL) relations. Our goal in this study is to obtain the PL relations for RR Lyrae, and SX Phoenicis stars in the field of the cluster, based on high-quality, well-sampled light curves in the near-infrared (IR). $\omega$ Centauri was observed using VIRCAM mounted on VISTA. A total of 42 epochs in $J$ and 100 epochs in $K_{\rm S}$ were obtained, spanning 352 days. Point-spread function photometry was performed using DoPhot and DAOPHOT in the outer and inner regions of the cluster, respectively. Based on the comprehensive catalogue of near-IR light curves thus secured, PL relations were obtained for the different types of pulsators in the cluster, both in the $J$ and $K_{\rm S}$ bands. This includes the first PL relations in the near-IR for fundamental-mode SX Phoenicis stars. The near-IR magnitudes and periods of Type II Cepheids and RR Lyrae stars were used to derive an updated true distance modulus to the cluster, with a resulting value of $(m-M)_0 = 13.708 \pm 0.035 \pm 0.10$ mag, where the error bars correspond to the adopted statistical and systematic errors, respectively. Adding the errors in quadrature, this is equivalent to a heliocentric distance of $5.52\pm 0.27$ kpc.Comment: 10 pages, 8 figures, accepted for publication in A&

STREGA: STRucture and Evolution of the GAlaxy - I : Survey overview and first results

STREGA (STRucture and Evolution of the GAlaxy) is a guaranteed time survey being performed at the VST (the ESO Very Large Telescope Survey Telescope) to map about 150 square degrees in the Galactic halo, in order to constrain the mechanisms of galactic formation and evolution. The survey is built as a 5 yr project, organized in two parts: a core programme to explore the surrounding regions of selected stellar systems and a second complementary part to map the southern portion of the Fornax orbit and extend the observations of the core programme. The adopted stellar tracers are mainly variable stars (RR Lyraes and long-period variables) and main-sequence turn-off stars for which observations in the g, r, i bands are obtained. We present an overview of the survey and some preliminary results for three observing runs that have been completed. For the region centred on ω Cen (37 deg^2), covering about three tidal radii, we also discuss the detected stellar density radial profile and angular distribution, leading to the identification of extratidal cluster stars. We also conclude that the cluster tidal radius is about 1.2 deg, in agreement with values in the literature based on the Wilson model.Peer reviewedFinal Accepted Versio

Portuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes Mellitus

Background: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction ( 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.info:eu-repo/semantics/publishedVersio

Horizontal Branch Stars: The Interplay between Observations and Theory, and Insights into the Formation of the Galaxy

We review HB stars in a broad astrophysical context, including both variable and non-variable stars. A reassessment of the Oosterhoff dichotomy is presented, which provides unprecedented detail regarding its origin and systematics. We show that the Oosterhoff dichotomy and the distribution of globular clusters (GCs) in the HB morphology-metallicity plane both exclude, with high statistical significance, the possibility that the Galactic halo may have formed from the accretion of dwarf galaxies resembling present-day Milky Way satellites such as Fornax, Sagittarius, and the LMC. A rediscussion of the second-parameter problem is presented. A technique is proposed to estimate the HB types of extragalactic GCs on the basis of integrated far-UV photometry. The relationship between the absolute V magnitude of the HB at the RR Lyrae level and metallicity, as obtained on the basis of trigonometric parallax measurements for the star RR Lyrae, is also revisited, giving a distance modulus to the LMC of (m-M)_0 = 18.44+/-0.11. RR Lyrae period change rates are studied. Finally, the conductive opacities used in evolutionary calculations of low-mass stars are investigated. [ABRIDGED]Comment: 56 pages, 22 figures. Invited review, to appear in Astrophysics and Space Scienc

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far

The non-peculiar velocity dispersion profile of the stellar system omega Centauri

We present the results of a survey of radial velocities over a wide region extending from r~10 arcmin out to r~80 arcmin (~1.5 tidal radii) within the massive star cluster omega Centauri. The survey was performed with FLAMES@VLT, to study the velocity dispersion profile in the outer regions of this stellar system. We derived accurate radial velocities for a sample of 2557 newly observed stars, identifying 318 bona-fide cluster red giants. Merging our data with those provided by Pancino et al. (2007), we assembled a final homogeneous sample of 946 cluster members that allowed us to trace the velocity dispersion profile from the center out to r~32 arcmin. The velocity dispersion appears to decrease monotonically over this range, from a central value of sigma_{v}~17.2 Km/s down to a minimum value of sigma_{v}~5.2 Km/s. The observed surface brightness profile, rotation curve, velocity dispersion profile and ellipticity profile are simultaneously well reproduced by a simple dynamical model in which mass follows light, within the classical Newtonian theory of gravitation. The comparison with an N-body model of the evolution of a system mimicking omega Cen during the last 10 orbits into the Galactic potential suggests that (a) the rotation of stars lying in the inner ~20 arcmin of the clusters is not due to the effects of the tidal field of the Milky Way, as hypothized by other authors, and (b) the overall observational scenario is still compatible with the possibility that the outer regions of the cluster are subject to some tidal stirring.Comment: 12 pages, 12 figures, accepted for publication by MNRA

Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies:a report from the EPICOVIDEHA registry

Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan–Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448–4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619–8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093–0.732) and obesity (aOR 0.105, 95%CI 0.014–0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223).</p