ABSTRACT Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 – 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 – 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures. (HSCT increased COVID19. COVID19 COVID 19. 19 COVID-1 Paulo postHSCT, postHSCT post HSCT, post-HSCT 202 2022 allcause all cause 4 632 63 2 63.2 years AllogeneicHSCT Allogeneic 51.2% 512 51 (51.2% autologousHSCT autologous 48.9% 489 48 9 (48.9% included 39 IQR (IQR 1211134, 1211134 1211 134 , 1211-134) 44.8% 448 44 8 (44.8% 1 transplantation pandemic nonvaccinated non vaccinated n=35 n35 n 35 (n=35 71.4%. 714 71.4% . 71 71.4%) 24.4% 244 24 (24.4% 40.8% 408 40 (40.8% disease 673 67 3 67.3 COVID19, 19, 53.0%. 530 53.0% 53 0 (53.0%) 102 10 10.2% Allcause All 514 51.4 142 14 14.2 vaccine analyses OR (OR 101.01 10101 101 01 95 CI 8205 205 8.20 1,242.93 124293 242 93 0.003 0003 003 50 ≥50 26.61 2661 26 61 106 06 1.0 664.26 66426 664 0.04 004 04 Thus measures COVID1 COVID- 20 6 63. 51.2 5 (51.2 48.9 (48.9 121113 121 13 1211-134 44.8 (44.8 n=3 n3 (n=3 71.4 7 24.4 (24.4 40.8 (40.8 67. 53.0 (53.0% 10.2 51. 14. 101.0 1010 820 8.2 1,242.9 12429 0.00 000 00 ≥5 26.6 266 1. 664.2 6642 66 0.0 (51. 48. (48. 12111 1211-13 44. (44. n= (n= 71. 24. (24. 40. (40. 53. (53.0 10. 101. 82 8. 1,242. 1242 ≥ 26. 664. 0. (51 (48 1211-1 (44 (n (24 (40 (53. 1,242 124 (5 (4 1211- (2 (53 1,24 ( 1,2 1,

RESUMO Racional: A duodenopancreatectomia é um procedimento cirúrgico tecnicamente desafiador, com uma incidência de complicações pós-operatórias variando de 30% a 61%. O procedimento requer experiência de alto nível, e para minimizar complicações relacionadas à cirurgia uma padronização de alta qualidade é imperativa. Objetivo: Compreender o padrão da prática brasileira para duodenopancreatectomia. Método: Um questionário foi elaborado com a finalidade de obter uma visão geral da prática cirúrgica em câncer do pâncreas, treinamento específico e experiência em duodenopancreatectomia. O questionário foi enviado para cirurgiões com declarado interesse em cirurgia pancreática. Resultados: Um total de 60 questionários foi enviado e 52 retornaram (86,7%). A região sudeste foi a que mais respondeu, com 25 cirurgiões (48,0%). Apenas dois cirurgiões (3,9%), realizaram mais do que 50% das duodenopancreatectomia por videolaparoscopia. O procedimento clássico de Whipple foi realizado por 24 cirurgiões (46,2%) e a linfadenectomia padrão do Grupo Internacional de Estudo em Cirurgia Pancreática foi realizada por 43 cirurgiões (82,7%). Para a reconstrução, a pancreatojejunostomia foi realizada por 49 cirurgiões (94,2%), em alça única por 41 (78,9%), com anastomose do tipo ducto-mucosa por 38 (73,1%). O cateter transanastomose foi realizado por 26 cirurgiões (50%), reconstrução gástrica antecólica por 39 (75%) e enteroanastomose tipo Braun apenas por seis cirurgiões (11,5%). A drenagem abdominal profilática foi realizada por todos os cirurgiões e o uso de análogos da somatostatina por seis cirurgiões (11,5%). Nutrição enteral precoce no pós-operatório foi utilizada de rotina por 22 cirurgiões (42,3%) e 34 cirurgiões (65,4%), usaram sonda nasogástrica de rotina. Conclusão: Heterogeneidade foi observada na prática padrão da duodenopancreatectomia pelos cirurgiões no Brasil e, algumas delas em contraste com evidências estabelecidas na literatura.

ABSTRACT Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.

Objetivo Avaliar a cognição em idosos com depressão Maior (DM), doença de Alzheimer (DA) e Depressão na DA. Método Utilizou-se o Mini Mental, Rey Auditory Verbal Learning Test, Figura de Rey, Dígitos, Semelhanças, Trail Making A/B, Fluência Verbal e Stroop. ANOVA one-way e modelos multivariados foram utilizados para comparar o desempenho dos grupos. Resultados Foram avaliados 212 sujeitos. Comparado com DM, controles apresentaram desempenho significativamente melhor na atenção, memória de trabalho, velocidade de processamento e evocação. Os controles apresentaram desempenho significativamente superior em todas as avaliações, exceto na atenção comparado com DA. Fluência verbal, memória, velocidade de processamento e raciocínio abstrato na DM foi significativamente maior comparado com DA. DA foi significativamente melhor no estado cognitivo geral comparado a depressão na DA, os outros domínios foram semelhantes. Conclusão Observou-se um gradiente decrescente na cognição dos controles até a Depressão na DA, com os grupos DM e DA com desempenhos intermediários.

Objective To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. Method Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. Results We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. Conclusion A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Objetivo Avaliar o efeito do exercício aeróbio na cognição e na capacidade funcional em pacientes com Doença de Alzheimer (DA). Método Idosos (n=20) com demência leve ((NINCDS-ADRDA/CDR1) foram randomizados em grupo exercício (GE) na esteira (30 minutos, 2 vezes por semana e intensidade moderada de 60% VO2max)e grupo controle (GC) 10 pacientes. A medida principal foi a função cognitiva através do Cambridge Cognitive Examination (CAMCOG). Instrumentos específicos também foram aplicados para avaliar a função executiva, atenção e concentração, flexibilidade cognitiva, controle inibitório e capacidade funcional. Resultados Após 16 semanas, o GE mostrou melhora na cognição CAMCOG enquanto o CG declinou. Comparado ao GC, o GE apresentou melhora significativa na capacidade funcional. A análise do tamanho de efeito mostrou resposta favorável do exercício físico em todas as variáveis dependentes. Conclusão Caminhar na esteira pode ser recomendado como um tratamento adicional para pacientes com doença de Alzheimer.

Objective To assess the effect of aerobic exercise on the cognition and functional capacity in Alzheimer’s disease (AD) patients. Method Elderly (n=20) with mild dementia (NINCDS-ADRDA/CDR1) were randomly assigned to an exercise group (EG) on a treadmill (30 minutes, twice a week and moderate intensity of 60% VO2max) and control group (GC) 10 patients. The primary outcome measure was the cognitive function using Cambridge Cognitive Examination (CAMCOG). Specifics instruments were also applied to evaluate executive function, memory, attention and concentration, cognitive flexibility, inhibitory control and functional capacity. Results After 16 weeks, the EG showed improvement in cognition CAMCOG whereas the CG declined. Compared to the CG, the EG presented significant improvement on the functional capacity. The analysis of the effect size has shown a favorable response to the physical exercise in all dependent variables. Conclusion Walking on treadmill may be recommended as an augmentation treatment for patients with AD.

OBJECTIVE: The goal of this study was to assess the acute effect of physical exercise on the cognitive function of depressed elderly patients in a dual-task experiment. INTRODUCTION: Physical exercise has a positive effect on the brain and may even act as a treatment for major depressive disorder. However, the effects of acute cardiovascular exercise on cognitive function during and after one session of aerobic training in elderly depressive patients are not known. METHODS: Ten elderly subjects diagnosed with major depressive disorder performed neuropsychological tests during and after a moderate physical exercise session (65-75%HRmax). A Digit Span Test (Forward and Backward) and a Stroop Color-Word Test were used to assess cognitive function. The elderly participants walked on an electric treadmill for 30 minutes and underwent the same cognitive testing before, during, immediately after, and 15 minutes after the exercise session. In the control session, the same cognitive testing was conducted, but without exercise training. RESULTS: The results of the Digit Span Test did not change between the control and the exercise sessions. The results of the Stroop Color-Word Test improved after physical exercise, indicating a positive effect of exercise on cognition. CONCLUSIONS: These data suggest that the cognitive functions of depressed elderly persons, especially attention and inhibitory control, are not impaired during and after an acute session of physical exercise. In contrast, the effect of dual-tasks showed beneficial results for these subjects, mainly after exercise. The dual-task may be a safe and useful tool for assessing cognitive function.

Uma pesquisa de comportamento de risco ao HIV foi conduzida entre conscritos (17-20 anos) do Exército em 1998. A amostra (30.318) foi selecionada em três estratos: 1) municípios das regiões Norte e Centro-Oeste (N/CO); 2) municípios da região Sul (S); 3) municípios dos estados do Rio de Janeiro e São Paulo (RJ/SP), estimando-se a prevalência de infecção pelo HIV em cada estrato. O objetivo deste trabalho foi o de apreciar os resultados por nível sócio-econômico (NSE). A análise estatística utilizou um índice de comportamento sexual de risco para HIV e modelos de regressão logística. O estrato N/CO apresentou os piores indicadores - os relativos ao NSE, ao comportamento sexual de risco ou aos problemas relacionados às infecções sexualmente transmissíveis (IST) - assim como a maior proporção de infectados por HIV. Os melhores indicadores foram encontrados no estrato RJ/SP. O Sul mostrou resultados intermediários. O grau de escolaridade teve papel relevante. Os conscritos com primeiro grau incompleto apresentaram o pior índice de comportamento sexual de risco, o qual se mostrou importante preditor dos problemas relacionados às IST, incluindo a infecção por HIV.

A study of HIV-related risk behavior was carried out in 1998 among Brazilian military conscripts aged 17-20 years. A sample of 30,318 subjects was selected in three strata, pertaining to counties from: 1) the North and Central-West (N/CW); 2) South (S); and the states of Rio de Janeiro and São Paulo. HIV prevalence rates were estimated in all strata. The objective of this paper was to analyze the results according to differences in socioeconomic status (SES). The statistical analysis used an index of sexual risk behavior and logistic regression models. The N/CW stratum showed the worst indicators for SES, sexual risk behavior, and sexually transmitted infections (STIs), as well as the highest HIV seroprevalence rate. The best indicators for all variables were found in the RJ/SP stratum. The South showed intermediate results. Level of schooling also played a relevant role. In all three strata the conscripts with an incomplete high school education displayed the worst sexual risk behavior index, shown to be a relevant predictor of STI-related problems, including HIV infection.

Uma pesquisa de comportamento de risco ao HIV foi conduzida entre conscritos (17-20 anos) do Exército em 1998. A amostra (30.318) foi selecionada em três estratos: 1) municípios das regiões Norte e Centro-Oeste (N/CO); 2) municípios da região Sul (S); 3) municípios dos estados do Rio de Janeiro e São Paulo (RJ/SP), estimando-se a prevalência de infecção pelo HIV em cada estrato. O objetivo deste trabalho foi o de apreciar os resultados por nível sócio-econômico (NSE). A análise estatística utilizou um índice de comportamento sexual de risco para HIV e modelos de regressão logística. O estrato N/CO apresentou os piores indicadores - os relativos ao NSE, ao comportamento sexual de risco ou aos problemas relacionados às infecções sexualmente transmissíveis (IST) - assim como a maior proporção de infectados por HIV. Os melhores indicadores foram encontrados no estrato RJ/SP. O Sul mostrou resultados intermediários. O grau de escolaridade teve papel relevante. Os conscritos com primeiro grau incompleto apresentaram o pior índice de comportamento sexual de risco, o qual se mostrou importante preditor dos problemas relacionados às IST, incluindo a infecção por HIV.

A study of HIV-related risk behavior was carried out in 1998 among Brazilian military conscripts aged 17-20 years. A sample of 30,318 subjects was selected in three strata, pertaining to counties from: 1) the North and Central-West (N/CW); 2) South (S); and the states of Rio de Janeiro and São Paulo. HIV prevalence rates were estimated in all strata. The objective of this paper was to analyze the results according to differences in socioeconomic status (SES). The statistical analysis used an index of sexual risk behavior and logistic regression models. The N/CW stratum showed the worst indicators for SES, sexual risk behavior, and sexually transmitted infections (STIs), as well as the highest HIV seroprevalence rate. The best indicators for all variables were found in the RJ/SP stratum. The South showed intermediate results. Level of schooling also played a relevant role. In all three strata the conscripts with an incomplete high school education displayed the worst sexual risk behavior index, shown to be a relevant predictor of STI-related problems, including HIV infection.