ABSTRACT Purpose: To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. Materials and Methods: Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. Results: A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. Conclusion: For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.

ABSTRACT Introduction: It has been described that, at the medullary level, SARS-COV2 can compromise hematopoiesis, manifesting with cytopenias and there are only studies carried out in autopsies. Objective: to describe the morphological characteristics of the bone marrow of patients hospitalized for COVID-19 pneumonia at the Hospital Nacional “Dos de Mayo”. Materials and methods: Retrospective cross-sectional observational study carried out in patients over 18 years of age with a confirmed diagnosis of COVID-19 by rapid or molecular testing, and those with incomplete, illegible or missing medical history and / or bacterial or fungal pneumonia were excluded. The findings of the bone marrow readings were confirmed by a trained hematologist, collecting data such as: hemosiderin, cellularity, myelo / erythroid ratio, myeloid series, megakaryocytic and plasma cells. Descriptive statistics based on frequencies and percentages were used for qualitative variables and mean and standard deviation for quantitative variables. Results: A total of 30 patients were included. The most frequent marrow findings were: macrophages with cytophagocytosis in 87% (n = 26), hyperplasia with arrest in the maturation of myeloid progenitors in 70% (n = 21). 87% (n = 26) of the samples presented eosinophilia. No or little evidence of platelet formation was observed in 57% (n = 17) of the samples. In 40% (n= 12) 6% of plasma cells were found. Conclusion: Patients with SARS-COV2 infection present medullary alterations, among which are: cytophagocytosis with hyperplasia and maturation arrest in the myeloid series, little or no platelet production in megakaryocytes and eosinophilia.

RESUMEN Introducción: Se ha descrito que, a nivel medular, el SARS-COV2 puede comprometer la hematopoyesis, manifestándose con citopenias y solo se cuenta con estudios realizados en autopsias. Objetivo: Describir las características morfológicas de las médulas óseas de los pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional “Dos de Mayo”. Materiales y métodos Estudio observacional transversal retrospectivo llevado a cabo en pacientes mayores de 18 años con diagnóstico confirmado de COVID-19 mediante prueba rápida o molecular y se excluyeron a aquellos con historia clínica incompleta, ilegible o extraviada y/o neumonía bacteriana o fúngica. Los hallazgos de las lecturas de las médulas óseas fueron confirmados por un hematólogo entrenado, recabándose datos como: Hemosiderina, celularidad, relación mielo/eritroide, serie mieloide, megacariocítica y células plasmáticas. Se utilizó estadística descriptiva basada en frecuencias y porcentajes para las variables cualitativas y media y desviación estándar para las variables cuantitativas. Resultados Se incluyeron a un total de 30 pacientes. Los hallazgos medulares más frecuentes fueron: macrófagos con citofagocitosis 87% (n=26), hiperplasia con detención en la maduración de los progenitores mieloides en el 70% (n=21). El 87% (n=26) de las muestras presentó eosinofilia. En el 57% (n=17) de las muestras se observó ninguna o poca evidencia de formación plaquetaria. En el 40% (n=12) se encontró 6% de células plasmáticas. Conclusión Los pacientes con infección por SARS-COV2, presentan alteraciones medulares entre los que destacan: la citofagocitosis con hiperplasia y detención de la maduración en la serie mieloide, poca o nula producción plaquetaria en los megacariocitos y eosinofilia.