ABSTRACT Introduction: Lymphopenia is a laboratory marker of poor prognosis and severity of disease in the SARS-CoV-2 infection. This study aims to describe the immune profile of a Brazilian population. Methods: A total of 121 consecutive patients with severe acute respiratory syndrome (SARS) were analyzed between April and June 2020. Routine peripheral blood counts and multiparametric flow cytometry were performed on admission to assess lymphocytes and subsets (CD3, CD4, CD8). Demographic, clinical and laboratory data were collected from hospital sources. Results: The total of 116 patients included 63 (54.3%) males; 76 (62.8%) COVID-19 patients were divided, based on clinical characteristics and mechanical ventilation (MV) use, into moderate (n = 41; no MV) and severe (n = 35; MV) groups. The control group (n = 40) was comprised of patients with SARS of different etiologies. All patients had lymphopenia, with overall lymphocyte counts and their subsets considerably lower in severe patients, when compared to the moderate and controls. Patients with a high neutrophil-to-lymphocyte ratio (> 15.2) and T-cell lymphopenia (CD3 < 593 cells/μL, CD4 < 326 cells/μL, CD8 < 121 cells/μL) had a higher risk of being intubated and progressing to death. A total of 39 patients (95.1%) in the moderate group and 54.3% (n = 19) in the severe group were discharged; 28 patients died. Conclusion: Laboratory assessment of the neutrophil/lymphocyte ratio and T-cell subsets may be predictive of mortality and may be useful for stratifying COVID-19 patients.

ABSTRACT Introduction: Improving survival of Acute Lymphoblastic Leukemia (ALL) in adult patients has been a challenge. Despite intensive chemotherapy treatment, overall survival is poor. However, several studies demonstrate that young adult patients have better survival when treated with pediatric-based intensive regimens. Considering these results, We decided to treat newly diagnosed ALL patients according to age and risk factors. The goal of this study was to describe the results of this intensive chemotherapy treatment approach for ALL adult patients diagnosed at our institution. Methods: Fifty-eight ALL patients, diagnosed from 2004 to 2013, were included in the analysis. Patients were assigned to either the St. Jude Total Therapy XIIIB high-risk arm (St Jude) or the CALGB 8811 (CALGB). The Kaplan-Meier survival curve was used for the survival analyses and the Cox proportional hazard regression, for multivariable analysis. Results: The overall survival was 22.9% at 10 years. The St. Jude improved survival, compared to the CALGB (p = 0.007), with 32.6% vs. 7.4% survival rate at 10 years. However, no survival benefit was found for patients younger than 20 years old (p = 0.32). The multivariable analysis demonstrated that undetectable minimal residual disease (MRD) and hematopoietic stem cell transplantation (HSCT) had beneficial impact on survival (p = 0.0007 and p = 0.004, respectively). Conclusion: ALL is a disease of poor prognosis for adults. The joint effort to standardize treatment and seek solutions is the way to start improving this scenario.

The relationship between anthropometric measurements and lifestyle habits of schoolchildren with lipid profile is assessed by a descriptive, cross-sectional study on a sample of 135 school children aged between 6 and 10 years. Variables comprised body mass index, waist circumference, blood pressure, questionnaires on physical activity, dietary habits and metabolic changes. Analysis compares rates by Mann-Whitney test and associations by chi-square test, while effects were measured by odds ratio at 5% significance (p <0.05). There was no significant association between nutritional status and lipid profile. Lipid changes occurred inclusively in children with normal weight. Physical activity was inversely associated with dyslipidemia and suggests that physical activities associated with eating habits may be a preventive mechanism on cardiovascular disease risk factors.

RESUMO O Grupo Brasileiro de Citometria de Fluxo (GBCFLUX), fundado em 24 de abril de 2010, é composto por especialistas da área de citometria de fluxo (CF) que possuem o objetivo comum de contribuir para avanços técnico-científicos em laboratórios clínicos e de pesquisa brasileiros. Entre os grupos de trabalho do GBCFLUX, o subcomitê de Controle de Qualidade (CQ) é responsável por discutir dados da literatura e contribuir para a garantia da qualidade do processo pré-analítico, analítico e pós-analítico em CF. As ações do subcomitê de CQ iniciaram-se por meio de reuniões e palestras, nas quais dados da literatura foram revisados e discutidos com todos os membros participantes do GBCFLUX. Em uma segunda etapa, definiu-se elaborar um texto de recomendações consensuais técnicocientíficas, informativas e educativas para divulgação a todos os grupos que trabalham com CF no Brasil. Para tanto, foi elaborado um questionário com respostas objetivas, sendo enviado para 35 instituições brasileiras cadastradas, com a finalidade de avaliar o perfil de CQ dessas instituições. Dessa forma, as recomendações técnico-científicas de CQ que serão descritas neste artigo de atualização têm o objetivo de contribuir para a garantia da qualidade do processo, a padronização técnica e a reprodutibilidade dos resultados em CF.

ABSTRACT The Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo [GBCFLUX]), founded on April 24, 2010, is composed of experts in flow cytometry (FC) area who have the common objective of contributing to technical and scientific advances in Brazilian clinical and research laboratories. Among GBCFLUX working groups, the Quality Control (QC) subcommittee is responsible for discussing data in the literature and contributes to the quality assurance of the pre-analytical, analytical and post-analytical process in FC. The QC subcommittee's actions began through meetings and lectures, in which data from the literature were reviewed and discussed with all participating members of the GBCFLUX. In a second step, it was decided to draw up a text of technical and scientific consensus recommendations, informative and educative, for dissemination to all FC working groups in Brazil. To this effect, a questionnaire with objective responses was designed and sent to 35 recognized Brazilian institutions, in order to evaluate the QC profile of these institutions. Thus, the QC technical-scientific recommendations, which will be described in this updating article, are intended to ensure the process quality, technical standardization, and reproducibility of results in FC.

Background: Paroxysmal nocturnal hemoglobinuria is an acquired chronic hemolytic ane- mia, which often manifests as peripheral blood cytopenias and thrombosis. Objective: The aim of this study is to describe a Brazilian population of paroxysmal nocturnal hemoglobinuria patients. Methods: One hundred and three paroxysmal nocturnal hemoglobinuria cases were retrospectively reviewed and the clinical presentation, thrombosis, survival, and clone size were assessed. Diagnosis was established by flow cytometry. Results: Fifty-two male and 51 female patients with a median age of 24.1 years (5.5-62 years) were studied. Clinical symptoms included hemoglobinuria (18.4%), infection (46.6%) and thrombosis (16.5%), and 80.6% had pancytopenia. Patients were classified as classic parox- ysmal nocturnal hemoglobinuria (10), paroxysmal nocturnal hemoglobinuria with aplastic anemia (39), and paroxysmal nocturnal hemoglobinuria with subclinical features and aplas- tic anemia (54). There were significant differences in terms of median age, size of clone, clinical symptoms, and peripheral blood cell counts between the three subcategories. The clone size in erythrocytes and granulocytes were respectively 0.04% (range: 0-18%) and 7.3% (range: 0.3-68.7%) in patients with subclinical features and aplastic anemia, 15.8% (range: 0-99.7%) and 63.0% (range: 1.7-99.8%) in patients with aplastic anemia alone, and 82.2% (range: 0-99.85%) and 98.0% (81.3-100.0%) in Classic disease. Statistical differences were identified for platelets (p-value = 0.001), lactate dehydrogenase (p-value = 0.002) and the clone size (p-value < 0.001) in patients who suffered thrombotic events compared to those who did not. Overall survival was 81.7%, with patients with subclinical features and aplastic anemia having lower overall survival (76.5%). Conclusion: This retrospective review of 103 patients over an 11-year period represents the largest collection of paroxysmal nocturnal hemoglobinuria cases from a single center in Brazil. Flow cytometry showed that a larger clone was associated with classical symptoms and increased risk of thrombosis, even in patients with bone marrow failure, whereas a smaller clone was associated with bone marrow aplasia.

OBJETIVO: Associar o estado nutricional com sexo, grupo etário e nível econômico de escolares do ensino fundamental por meio de um estudo transversal nas escolas municipais do município de Cruzeiro do Oeste, Paraná, Brasil. MÉTODOS: A pesquisa foi realizada em 2010 com 939 alunos com idades entre seis e dez anos. Para tanto, realizou-se a classificação do nível econômico das famílias por meio do questionário de ranking econômico (Associação Brasileira de Empresas de Pesquisa) e foi calculado o índice de massa corpórea. A análise dos dados foi realizada por estatística descritiva, e a verificação de diferenças entre grupos independentes pelos testes de Mann-Whitney e Kruskal-Wallis, bem como possíveis associações foram verificadas pelo teste do qui-quadrado. Para todos os procedimentos adotou-se o nível de significância de p<0,05. RESULTADOS: A prevalência de obesidade na amostra estudada foi de 8,0% e de sobrepeso, 16,4%. Não houve associação entre nível econômico e estado nutricional, assim como entre estado nutricional e sexo. CONCLUSÕES: A prevalência de sobrepeso e obesidade foi considerada alta, evidenciando que crianças de ambos os sexos são afetadas, independentemente de seus níveis econômicos e grupo etário.

OBJECTIVE: To associate the nutritional status of elementary schoolchildren with their gender, age group, and economic status based on a cross-sectional study carried out at public schools in the municipality of Cruzeiro do Oeste, Southern Brazil. METHODS: The study was performed in 2010 including 939 schoolchildren aged six to ten years-old. The economical status of the families was classified based on a socioeconomic ranking questionnaire (Brazilian Association of Survey Companies), and the body mass index was calculated. Data were analyzed by descriptive statistics, and differences between independent groups were verified by Mann-Whitney and Kruskal-Wallis tests, while possible associations were verified by the chi-square test, being significant p<0.05. RESULTS: The prevalence of obesity in the sample was 8.0%, and overweight, 16.4%. No association was found between the socioeconomic and nutritional status or between the nutritional status and gender. CONCLUSIONS: A high prevalence of overweight and obesity was found in this study, indicating that children of both genders are affected regardless of their economical status and age.

OBJETIVO: asociar el estado nutricional con el sexo, la franja de edad y el nivel socioeconómico de escolares de la enseñanza primaria, mediante estudio transversal en las escuelas municipales de la ciudad de Cruzeiro do Oeste (Paraná, Brasil). MÉTODOS: La investigación fue realizada en 2010, con 939 alumnos entre seis y diez años. Para eso, se realizó la clasificación del nivel económico de las familias mediante cuestionario de clasificación económica (Asociación Brasileña de Empresas de Investigación - ABEP) y se calculó el índice de masa corporal. El tratamiento estadístico se realizó por medio de los recursos de la estadística descriptiva y la verificación de diferencias entre grupos independientes por las Pruebas de Mann-Whitney y Kruskal-Wallis, así como posibles asociaciones fueron verificadas por la prueba de chi-cuadrado. Para todos los procedimientos se adoptó el nivel de significancia de p<0,05. RESULTADOS: La prevalencia de obesidad en la muestra estudiada fue de 8,0% y la de sobrepeso fue de 16,4%. No hubo asociación entre nivel económico y estado nutricional, así como entre estado nutricional y sexo. CONCLUSIONES: La prevalencia de sobrepeso y obesidad fue considerada alta, evidenciando que niños de ambos sexos son afectados, independiente de su nivel económico y franja de edad.

Relatamos o caso de um jovem de 14 anos que procurou atendimento médico por edema e hipertensão, sendo insuficiência renal aguda secundária a linfoma de Burkitt renal diagnosticada após avaliação laboratorial, de imagem e biópsia de massa tumoral renal.

This case report is from a 14-year-old boy who had edema and hypertension due to a primary renal Burkitt's lymphoma, diagnosed through laboratory and image evaluation and kidney tumor biopsy.