Search

Abstract Background As the use of donor eggs for in vitro treatment has increased, both medically affiliated and private donor egg agencies have turned to online advertisements to recruit donors. The American Society for Reproductive Medicine provides recommendations encouraging ethical recruitment of donors, however there is no formal regulation for the informed consent process for egg donor recruitment and compensation. Underrepresentation of risks and targeted financial incentives may pose a risk to the informed consent process. Methods Data from online advertisements for egg donors active between January 1 - August 31, 2020, were collected to analyze content related to risks, Covid-19 precautions, donor payment, and desired donor characteristics. Advertisements for egg donors on Google, Craigslist, and social media were analyzed. Primary outcomes included the mention of the risks of egg donation, including the risk of Covid-19 exposure, in donor egg advertisements. Secondary outcomes included language targeting specific donor characteristics and financial compensation. Results 103 advertisements were included. 35.9% (37/103) of advertisements mentioned some risk of the egg donation process, and 18.5% (19/103) mentioned risks or precautions related to Covid-19 exposure. Of advertisements for private donor egg agencies, 40.7% (24/59) mentioned any risk, compared to 29.6% (13/44) of medically affiliated egg donation programs; the difference was not statistically significant (p-value = 0.24). Agencies targeting students and donors of a specific race were more likely to offer payments over $10,000 for an egg donation cycle. Among advertisements offering over $20,000 for donor compensation, 72.7% (8/11) recruited women under the age of 21. Conclusion Egg donor recruitment advertisements, for both medically affiliated programs and private agencies, were unlikely to mention risks including the risk of exposure to Covid-19. Non-medically affiliated private donor egg agencies were more likely to violate multiple American Society for Reproductive Medicine ethics guidelines, including offering higher than average compensation, and recruiting donors from young and vulnerable populations.

Este artigo investiga a questão da responsabilidade civil dos apoiadores na tomada de decisão à luz da Lei 13.146/2015, que confere capacidade civil às pessoas com deficiência. No âmbito da tomada de decisão apoiada, as pessoas com deficiência podem nomear apoiadores para assegurar a plena e segura realização de seus direitos. Contudo, a legislação não aborda detalhadamente a responsabilidade civil dos apoiadores, o que suscita a possibilidade de responsabilização por danos a terceiros, desde que se evidencie má-fé por parte dos apoiadores.

Background: When considering the significant prevalence of transgender and gender nonconforming individuals, it is imperative that physicians work to understand the unique needs of this population including paths to family building and fertility preservation. Objective: To understand the thoughts and opinions about fertility preservation and family building within the transgender community. Study design: Survey-based study and qualitative study at a single, large hospital-affiliated fertility center. A 16-question survey followed by a 30-minute virtual interview was utilized. Forty-three participants completed the survey and were used for quantitative analysis, and 40 audio files were used for qualitative analysis. Results: The average age of participants was 27.0±7.3 years old. The majority of participants were assigned female at birth (70.7%); however, most participants’ gender identities were transgender (54.8%) or nonbinary (47.6%). The average age at which participants realized they were transgender and disclosed their identity to a friend, or partner, was 16.2±7.0 (range 3–30) and 20.1±5.6 (range 11–33), respectively. The average age that participants disclosed their gender identity to their parents, siblings, or other family was 22.4±5.9 (range 12–35). Five categories were utilized to summarize the experiences and opinions of the participants: family building and parenthood goals, influences of family background/partner on parenthood goals, awareness and knowledge about fertility preservation, barrier to family building, and recommended healthcare provider communication and education. Sixteen participants (40.0%, n/N=16/40) were interested in having children in the future, 18 (45.0%, n/N=18/40) were unsure/dependent on their partner, and 6 (15.0%, n/N=6/40) were not interested in having children. Of those interested in having children (n/N=16/40), the majority wished to utilize adoption to build their family (68.8%, n/N=11/16). Nine participants (22.5%, n/N=9/40) reported that fertility preservation was never discussed. Most participants agreed that gender dysphoria, cost, inadequate counseling, and improvements in healthcare knowledge about transgender individuals were key influences on their opinions about pursuing fertility preservation or parenthood. Conclusion: Transgender individuals want to build families, and the majority consider adoption the preferred method. There are still transgender individuals who are not counseled about fertility preservation. It is imperative the healthcare system continues to improve the education of healthcare providers about management and care of transgender individuals to provide the best care for this vulnerable population.

Introduction: Laboratory diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH), as well as clone size determination, is essential for defining PNH subtypes and treatment strategies. In Brazil, PNH guideline define as treatment criteria a clone size > 10%, combined with clinical and laboratory evidences of high hemolytic activity. However, symptomatic patients more often have clones > 30%. Objectives: To present observed differences in flow cytometry evaluation of PNH patients, we analyzed the results from 4265 unique patients assessed by flow cytometry in our remote hematology laboratory in Brazil. Methods: From 2014 to 2024, 4,265 unique cases were processed for PNH evaluation through immunophenotyping. The analysis was conducted according to international guidelines, examining three populations: erythrocytes, neutrophils, and monocytes using mAbs for CD235a, CD59, CD45, CD15, CD64, CD157, and FLAER. Analyses were conducted using Kaluza software after acquisition with Navios or DxFlex flow cytometers (Beckman Coulter). The cases were categorized as negative (no clone present), PNH I (< 10%), PNH II (10-30%), and PNH III (> 30%). Results: Among the 4,265 cases, 58.3% were female and 41.7% were male, with an average age of 44.7 years. Of these, 3,652 cases were negative, 279 (6.54%) were identified as PNH I, 76 (1.78%) as PNH II, and 258 (6.0%) as PNH III. The average percentage of neutrophils was relatively lower than that of monocytes for PNH II and III (paired t-test < 0.0001), with median counts for neutrophils and monocytes in PNH II and III being 11% vs. 17% (p < 0.0001), and 75% vs. 78% (p = 0.065), respectively. Furthermore, 38% of PNH II cases had neutrophil counts below 10%, compared to a monocyte positivity rate over 10% in 98% of cases. The size of the clone in erythrocytes was not highlighted in this study because it is expected to be underestimated in many situations, mainly due to hemolysis and transfusion. Among men, the positivity rate was 21%, and among women, it was 13.8% (chi-squared < 0.0001). There was no association between positivity and age. Conclusions: The robust caseload of this study reinforces the importance of analysis across different lineages and indicates that in cases of clonal quantification near the threshold of over 10% clonal cells, monocyte counting is crucial for accurate quantification of PNH clone.

Introduction: Immunophenotyping is pivotal in diagnosing and monitoring oncohematologic diseases, yet it remains predominantly manual, involving lengthy processes of marking, pipetting, and centrifugation, significantly impacting turnaround time (TAT). Objectives: This study aims to validate results obtained using the automated preparation with CellMek, Beckman Coulter Life Sciences, an automated sample preparation system (ASPS) compared to the current manual methodology (MAN), assessing efficacy and reproducibility. Materials and methods: We evaluated 31 samples for lymphocyte counting and subclassification (CD3/CD4/CD8), 20 multiple myeloma (MM) cases, and 15 chronic lymphocytic leukemia (CLL) cases. Additionally, a descriptive tube containing 14 markers (kappa, lambda, CD4, CD8, CD3, CD14, CD5, CD33, CD34, CD10, CD19, CD45, CD56, CD20) in 32 cases for hematologic disease screening was used for qualitative method comparison. Results: Correlation analysis of CD19 cell counts in CLL cases using ASPS and MAN revealed medians of 53.21 and 54.85, respectively (paired t-test p = 0.46), with highly correlated results r2 = 0.90 (Pearson 0.95, p < 0.0001). In 20 MM cases, plasma cell quantification showed means of 7.8% (ASPS) and 5.3% (MAN) (p = 0.07) and a correlation of r2 = 0.98 (p < 0.0001). Furthermore, a more appropriate separation of kappa and lambda was observed. The average CD4/CD8 lymphocyte ratio in ASPS was 1.51 versus 1.52 in MAN (paired t-test p = 0.55). Although ASPS did not reduce TAT, batch sample allocation reduced operator interaction, ensuring standardized processing of marking, washing protocols, and traceability of the entire process through system integrations. All 32 cases of disease screening with 14 markers produced identical qualitative results (100% qualitative correlation). Discussion: The results indicate that automating the immunophenotyping process with ASPS maintains result accuracy and reproducibility while offering advantages in standardization and traceability. Despite similar processing times to manual methods, batch processing capability and reduced operator interaction provide significant benefits, potentially reducing operational costs and TAT for medium-sized flow cytometry laboratories. Conclusion: This study describes the first clinical validation of an ASPS for immunophenotyping in oncohematology in South America. The findings suggest that, despite similar processing times to manual methods, batch processing capability and high result reproducibility may lead to cost reductions and improved TAT for medium-sized flow cytometry laboratories.

Introduction: Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic disorder that exhibits both myelodysplastic and myeloproliferative features. Progression to acute monocytic leukemia is a notable complication, especially in elderly patients. This case report describes the transformation of CMML to acute monocytic leukemia in an 84-year-old male patient, emphasizing the importance of regular monitoring and timely intervention. Case report: M.O., an 84-year-old male, was diagnosed with CMML in August 2020. During a routine follow-up in July 2024, he presented with extensive bruising but no other apparent complaints. At the initial diagnosis, bone marrow studies revealed morphological abnormalities in granulocytic, erythroid, and megakaryocytic lineages with 2% blasts and 18% mature monocytes. Immunophenotyping showed 15.7% monocytic lineage cells, including 11.8% mature monocytes, 2.9% promonocytes, and 1.0% monoblasts and morphological dysplasia. Cytogenetic analysis identified a clone with deletion of part of the long arm of chromosome 20 in 2 out of 20 metaphases analyzed, with the remaining metaphases being normal (46,XY, del(20)(q12)[2]/46,XY[18]). The complete blood count (CBC) at diagnosis was Hb: 15.6 g/dL, WBC: 6,600/mm3 (Basophils: 66/mm3, Neutrophils: 3,102/mm3, Eosinophils: 66/mm3, Lymphocytes: 1,122/mm3, Monocytes: 2,244/mm3), and Platelets: 101,000/mm3. During the current visit in July 2024, CBC showed Hb: 11.5 g/dL, WBC: 9,400/mm3 (Basophils: 564/mm3, Neutrophils: 5,452/mm3, Lymphocytes: 1,222/mm3, Monocytes: 1,598/mm3, Blasts: 6%) with hypogranular neutrophils, and Platelets: 32,000/mm3. The presence of 6% blasts suggested disease progression. A repeat bone marrow examination confirmed disease evolution, showing massive infiltration by medium to large blasts with a moderate nucleocytoplasmic ratio, loose chromatin, basophilic cytoplasm, and frequent microvacuolizations with highly aberrant morphology. Immunophenotyping confirmed these cells to be immature with moderate CD45 expression and moderate internal complexity, exhibiting the following phenotype: positive for CD13 (weak), CD33 (strong), CD38 (strong), CD45 (moderate), CD56 (strong), CD64 (moderate), and cMPO (weak), and negative for cCD3, CD4, CD7, CD10, CD11b, CD14, CD16, CD19, CD34, cCD79a, CD117, CD123, IREM-2, and HLA-DR. Cytogenetic analysis revealed a clonal expansion with complex karyotyping (48,XY,+8,+8[12]/49,idem,+mar[3]/46,XY[5]). Discussion: The progression of CMML to acute monocytic leukemia is marked by an increase in blasts in both peripheral blood and bone marrow, along with notable changes in hematological parameters. This case demonstrates the transformation of CMML, corroborated by immunophenotyping and morphological studies. The presence of trisomy 8 and complex karyotype might be associated with a poor prognosis in CMML patients, often correlating with more aggressive disease and reduced overall survival. Identifying specific immunophenotypic markers is critical for diagnosing and differentiating acute monocytic leukemia. Conclusion: This case highlights the necessity of regular monitoring and timely reassessment of CMML patients. The transition to acute leukemia, a known complication, demands prompt diagnosis and intervention to manage the disease effectively.

Abstract Recent research has demonstrated the increasing interest in using insects for the extraction of bioactive compounds, particularly peptides. These compounds offer a spectrum of beneficial physiological effects. The aim of this study was to standardize a methodology for obtaining bioactive peptides from Tenebrio molitor and evaluate its physicochemical characterization, antioxidant, and antimicrobial potential. Six assays were carried out to hydrolyse larvae protein, with variations in Alcalase concentration (0.04 to 0.08%) and reaction time (3 to 8 h). The results indicated that the process applied to defatted mealworm flour was effective in reducing lipids by 82.5%. Consequently, it was an observed increase of 38.4% in protein content. Additionally, an increase in glycogen content was found in defatted mealworm flour (177 µmol glucose g-1 sample) and peptides (152.81 µmol glucose g-1 sample). The degree of hydrolysis was higher in assays with longer hydrolysis durations (8.14 - 8.38%). The antioxidant capacity was 12 to 14% lower in assays with an incubation time of 8h. In this sense, the methodology proposed in the present study proved to be efficient in obtaining bioactive peptides from T. molitor.

Abstract Hepatic and pulmonary lesions are common in cetaceans, despite their poorly understood viral etiology. Herpesviruses (HV), adenoviruses (AdV) and hepatitis E virus (HEV) are emerging agents in cetaceans, associated with liver and/or pulmonary damage in mammals. We isolated and molecularly tested DNA for HV and AdV (n = 218 individuals; 187 liver and 108 lung samples) and RNA for HEV (n = 147 animals; 147 liver samples) from six cetacean families. All animals stranded or were bycaught in Brazil between 2001 and 2021. Positive-animals were analyzed by histopathology. Statistical analyses assessed if the prevalence of viral infection could be associated with the variables: species, family, habitat, region, sex, and age group. All samples were negative for AdV and HEV. Overall, 8.7% (19/218) of the cetaceans were HV-positive (4.8% [9/187] liver and 11.1% [12/108] lung), without HV-associated lesions. HV-prevalence was statistically significant higher in Pontoporiidae (19.2%, 10/52) when compared to Delphinidae (4.1%, 5/121), and in southeastern (17.1%, 13/76)—the most industrialized Brazilian region—when compared to the northeastern region (2.4%, 3/126). This study broadens the herpesvirus host range in cetaceans, including its description in pygmy sperm whales (Kogia breviceps) and humpback whales (Megaptera novaeangliae). Further studies must elucidate herpesvirus drivers in cetaceans.

Kimberly Daniels,1 Stephan Lanes,1 Arlene Tave,1 Michael F Pollack,2 David M Mannino,3 Gerard Criner,4 Amanda Neikirk,1 Kirsty Rhodes,5 Norbert Feigler,2 Clementine Nordon5 1Safety and Epidemiology, Carelon Research, Wilmington, DE, USA; 2Global Medical Affairs, AstraZeneca, Wilmington, DE, USA; 3College of Medicine, University of Kentucky, Lexington, KY, USA; 4Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 5BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKCorrespondence: Kimberly Daniels, Safety and Epidemiology, Carelon Research, 123 Justison Street, Suite 200, Wilmington, DE, 19801, USA, Tel +1 443-812-1731, Email Kimberly.Daniels@carelon.comPurpose: This study estimated the magnitude and duration of risk of cardiovascular events and mortality following acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and whether risks varied by number and severity of exacerbation in a commercially insured population in the United States.Methods: This was a retrospective cohort study of newly diagnosed COPD patients ≥ 40 years old in the Healthcare Integrated Research Database from 2012 to 2019. Patients experiencing exacerbations comprised the “exacerbation cohort”. Moderate exacerbations were outpatient visits with contemporaneous antibiotic or glucocorticoid administration; severe exacerbations were emergency department visits or hospitalizations for AECOPD. Follow-up started on the exacerbation date. Distribution of time between diagnosis and first exacerbation was used to assign index dates to the “unexposed” cohort. Cox proportional hazards models estimated risks of a cardiovascular event or death following an exacerbation adjusted for medical and prescription history and stratified by follow-up time, type of cardiovascular event, exacerbation severity, and rank of exacerbation (first, second, or third).Results: Among 435,925 patients, 170,236 experienced ≥ 1 exacerbation. Risk of death was increased for 2 years following an exacerbation and was highest during the first 30 days (any exacerbation hazard ratio (HR)=1.79, 95% CI=1.58— 2.04; moderate HR=1.22, 95% CI=1.04— 1.43; severe HR=5.09, 95% CI=4.30— 6.03). Risks of cardiovascular events were increased for 1 year following an AECOPD and highest in the first 30-days (any exacerbation HR=1.34, 95% CI=1.23— 1.46; moderate HR=1.23 (95% CI 1.12— 1.35); severe HR=1.93 (95% CI=1.67— 2.22)). Each subsequent AECOPD was associated with incrementally higher rates of both death and cardiovascular events.Conclusion: Risk of death and cardiovascular events was greatest in the first 30 days and rose with subsequent exacerbations. Risks were elevated for 1– 2 years following moderate and severe exacerbations, highlighting a sustained increased cardiopulmonary risk associated with exacerbations.Keywords: COPD, cardiopulmonary, cardiac events, epidemiology, longitudinal studies

The article seeks to apply AI to the rationality of the legislative process: avoiding contradictions and reinforcing the coherence and efficiency of legislation in the environment of legislative overproduction. The rationalities of the legislative process are pointed out and explained, correlating them with means of AI’s usage, so that the legislative process obeys the certainty of law and legal certainty required by Rule of Law.

Sooty Tern, Onychoprion fuscatus (Linnaeus 1766), is a rare species along the Brazilian coast due to oceanic habits. We report the first documented record of this species from São Paulo state, southeastern Brazil. The specimen was found beached in Mongaguá municipality. Morphological assessment, necropsy, and histological analysis allowed us to identify species, reproductive state (non-breeding), and sex (male) of this specimen.

The aim of this study was to assess the impact of nitrogen doses on the yield of two barley cultivars, namely BRS Brau and BRS Cauê, cultivated in various growing environments in Southern Brazil. The research was conducted during the 2017 harvest season in Alegrete and Pelotas, RS, Brazil. A randomized block design with a factorial scheme of 2 x 2 x 4 (growing environments x barley cultivars x nitrogen doses) was employed, with four replications. Various parameters were evaluated, including plant height, number of tillers per plant, number of ears per square meter, number of seeds per plant, thousand seeds weight (TSW), and yield. The results indicated that the two barley cultivars responded differently to the growing environments and nitrogen doses. In Pelotas, BRS Brau exhibited superior performance in terms of plant height and TSW, while BRS Cauê showed a higher number of seeds per plant and seed yield. Furthermore, the combination of the Pelotas growing environment and a nitrogen dose of 200 kg ha-1 resulted in optimized growth and yield of barley seeds.

The negative perception of the ethical climate is a triggering factor for occupational complications and illnesses, including burnout syndrome. Objective: To identify the association between ethical climate and burnout syndrome among nurses working in the hospital environment. Method: Cross-sectional study carried out with a sample of 269 nurses from a public hospital in southern Brazil. The Hospital Ethical Climate Survey-Brazilian Version and the Maslach Burnout Inventory were used for collection. For analysis, descriptive statistics and bivariate analysis were used. Results: Significant association between the ethical climate and the dimensions of burnout syndrome. Nurses with low emotional exhaustion, low depersonalization and high professional achievement evaluated the ethical climate as positive. Conclusion: The results will help nurses and management to introduce improvements to reduce the incidence of burnout syndrome, as well as promoting a positive perception of the ethical climate.

Abstract Background This study aims to look at the prevalence and characteristics of postpartum depression symptomatology (PPDS) among Canadian women. Studies have found that in developed countries, 10-15% of new mothers were affected by major postpartum depression. Mothers who suffer from postpartum depression may endure difficulties regarding their ability to cope with life events, as well as negative clinical implications for maternal-infant attachment. Methods An analysis based on 6,421 Canadian women, who had a live birth between 2005 and 2006 and were part of the Maternity Experience Survey (MES), was performed. PPDS was measured based on the Edinburgh Postnatal Depression Scale. Various factors that assessed socio-economic status, demographic factors, and maternal characteristics were considered for the multinomial regression model. Results The national prevalence of minor/major and major PPDS was found to be 8.46% and 8.69% respectively. A mother's stress level during pregnancy, the availability of support after pregnancy, and a prior diagnosis of depression were the characteristics that had the strongest significant association with the development of PPDS. Conclusions A significant number of Canadian women experience symptoms of postpartum depression. Findings from this study may be useful to increase both the attainment of treatment and the rate at which it can be obtained among new mothers. Interventions should target those with the greatest risk of experiencing PPDS, specifically immigrant and adolescent mothers.

Abstract Background In spite of the evidence supporting the importance of breastfeeding during the first year of life, data on breastfeeding practices remain limited in Canada. The study aimed to examine the prevalence and predictors of 6-month exclusive breastfeeding among Canadian women. Methods The analysis was based on the Maternity Experience Survey targeting women aged ≥ 15 years who had singleton live births between February 2006 - May 2006 in the Canadian provinces and November 2005 - February 2006 in the territories. The main outcome was exclusive breastfeeding based on the World Health Organization definition. Socioeconomic, demographic, maternal, pregnancy and delivery related variables were considered for a multivariate logistic regression using stepwise modeling. Bootstrapping was performed to account for the complex sampling design. Results The sample size in this study was 5,615 weighted to represent 66,810 Canadian women. While ever breastfeeding was 90.3%, the 6-month exclusive breastfeeding rate was 13.8%. Based on the regression model, having higher years of education, residing in the Northern territories and Western provinces, living with a partner, having had previous pregnancies, having lower pre-pregnancy body mass index and giving birth at older age were associated with increased likelihood of 6-month exclusive breastfeeding. Moreover, smoking during pregnancy, Caesarean birth, infant's admission to the intensive care unit and maternal employment status before 6 months of infant's age were negatively associated with exclusive breastfeeding. Mothers choosing to deliver at home were more likely to remain exclusively breastfeeding for 6 months (Odds Ratio: 5.29, 95% Confidence Interval: 2.95-9.46). Conclusions The 6-month exclusive breastfeeding rate is low in Canada. The study results constitute the basis for designing interventions that aim to bridge the gap between the current practices of breastfeeding and the World Health Organization recommendation.

Abstract Taking into account that the transport of grains can be carried out over long distances and that the mass of grains during transport often has high moisture content, there may be risks of heat and moisture transfer and heating of the grains mass, proving quanti-qualitative losses. Thus, this study aimed to validate a method with probe system for real-time monitoring of temperature, relative humidity and carbon dioxide in the grain mass of corn during transport and storage to detect early dry matter losses and predict possible changes on the grain physical quality. The equipment consisted of a microcontroller, system's hardware, digital sensors to detect air temperature and relative humidity, a non-destructive infrared sensor to detect CO2 concentration. Real-time monitoring system determined early and satisfactorily in an indirect way the changes in the physical quality of the grains confirming by the physical analyses of electrical conductivity and germination. The equipment in real-time monitoring and the application of Machine Learning was effective to predict dry matter loss, due to the high equilibrium moisture content and respiration of the grain mass on the 2-h period. All machine learning models, except support vector machine, obtained satisfactory results, equaling the multiple linear regression analysis.

Abstract The objective of this work was to evaluate packaging for preserving the quality of soybean (Glycine max) seeds stored in different environments. The experiment design was completely randomized, in a factorial arrangment with six seed storage conditions: natural atmosphere (NA), laminated packaging atmosphere (LPA), modified atmosphere in polyethylene packaging (MAPP), refrigerated atmosphere in raffia packaging (RARP), refrigerated atmosphere in laminated packaging (RALP), and modified and refrigerated atmosphere in polyethylene packaging (MRAPP), with four storage times (zero, two, four, and six months). Storage time reduces the quality of soybean seeds after two months in all tested packaging. The germination of the soybean seeds was maintained in the following packaging: LPA, RARP, RALP, and MRAPP. LPA is the most efficient packaging for soybean seeds, which show the highest percentage of germination for the longest storage time, without requiring any modification or refrigeration of the atmospheric storage environment.

Objetivo: verificar a associação entre o clima ético e as variáveis laborais entre enfermeiros hospitalares. Método: estudo transversal com enfermeiros de um hospital universitário do Rio Grande do Sul, Brasil. Utilizou-se para coleta um questionário laboral e o Hospital Ethical Climate Survey-Versão Brasileira. Empregou-se estatística descritiva e analítica. Resultados: participaram do estudo 269 enfermeiros. Dentre as variáveis sóciolaborais, escolaridade, setor de trabalho, turno de trabalho, o cargo de chefia, satisfação no setor de trabalho, afastamento do trabalho, intenção de deixar o emprego e intenção de deixar a enfermagem estiveram associados a um ou mais fatores da escala de clima ético, isto é, pares, pacientes, gerentes, hospital e médicos, e ainda a uma variável de clima ético geral. Conclusão: o clima ético está associado a variáveis de formação, condições de trabalho, satisfação e intenção de deixar o trabalho, o que remete à necessidade de se investir em ambientes saudáveis de trabalho.

ABSTRACT Objective: To evaluate the influence of the ethical climate on workers’ health among healthcare professionals. Method: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. Results: Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). Conclusion: The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

Introduction: The diagnosis of onco-hematologic conditions in medical and hospital settings typically involves relying on centralized reference laboratories for investigative and clinical-laboratory diagnostic support. However, Flow Diagnostics is a specialized remote laboratory in oncology-hematology that has implemented a unique approach utilizing reflex testing methodology and real-time medical advisory services for all partnering facilities. Methods and results: Between January and May 2023, our remote oncology-hematology laboratory conducted immunophenotyping investigations using flow cytometry on 1862 cases. Among these, 1378 (75%) cases were aimed at investigating or diagnosing hematological diseases, while 474 (25%) cases were dedicated to measurable residual disease research. Among the 1378 cases subjected to immunophenotyping, we diagnosed 154 cases of acute myeloid leukemia (AML), including 18 (11.7%) cases identified as acute promyelocytic leukemia (APL) within the AML cohort. One particular APL case drew significant attention: a 31-year-old male patient presenting with a history of anemia and gum bleeding. The analysis of the complete blood count revealed severe pancytopenia (hemoglobin: 6 g/dL; WBC: 39,600 with 90% blast-like cells; platelets: 26,000/mm3), alongside a history of repeated blood transfusions. The patient experienced respiratory decompensation. Immunophenotyping analysis conducted via flow cytometry identified cells exhibiting moderate CD45 expression and moderate-to-high internal complexity. These cells accounted for 85.8% of the total analyzed cells, representing the blasts, and displayed the following positive phenotype for the markers: CD2 (weak), CD13 (heterogeneous), CD33 (strong, homogeneous), CD34 (moderate), CD45 (moderate), CD64 (moderate), CD117 (weak), and cMPO (strong). The cells were negative for CD4, CD11b, CD14, CD15, CD16, CD56, CD123, and HLA-DR. To further support the laboratory investigation, our reflex testing algorithm included qualitative detection of PML-RARA transcripts, prompting the medical advisory team to seek authorization from the clinical medical staff for performing the molecular biology test. Real-time PCR analysis confirmed the presence of the PML-RARA BCR3 transcript, indicating a positive result. The presence of the PML-RARA BCR3 transcript, in conjunction with weakly positive CD2 and moderately positive CD34 markers, is consistent with microgranular APL. Conclusions: This aforementioned case serves as a proof of concept for the value added by specialized remote laboratories, automated reflex testing methods, and real-time medical advisory services in the field of oncology-hematology. This approach enables the identification of rare and specific cases, such as CD34+ APL, reduces the turnaround time between investigative procedures and laboratory diagnosis, and ultimately decreases the overall cost of the diagnostic process.

Introduction: This study aimed to evaluate the technical quality performance of a remote onco-hematology laboratory facility (ROLF) in Brazil, with a focus on its crucial role in the diagnosis and monitoring of onco-hematology diseases. We specifically assessed the effectiveness of bone marrow cytogenetic analysis conducted on samples received from various onco-hematology services throughout the country. Furthermore, we examined the potential impact of implementing a ROLF for the diagnosis of blood and bone marrow cancers, placing particular emphasis on enhancing accessibility, ensuring sample stability, and improving karyotyping performance. Through this investigation, we aim to shed light on the valuable contributions and benefits offered by a remote laboratory setting in the field of onco-hematology diagnostics. Methods: A retrospective study was conducted on 554 bone marrow samples collected between January and May 2023. The samples were sent to the laboratory via our own logistics system, and the processing of the samples commenced within 24 hours of collection. Immunophenotyping classification was performed using a 13-parameter DxFLEX flow cytometer (Beckman Coulter). Cytogenetic analysis using G-banding was performed on cell cultures, which were incubated for 24-72 hours based on the cell type indicated in the immunophenotyping examination. The metaphases were analyzed, and the results were described following the guidelines of the International System for Human Cytogenomic Nomenclature (ISCN - 2020). Results: Cytogenetic analysis was successfully performed in 542 (97.8%) of the cases, while only 12 (2.2%) were classified as unsuccessful cytogenetics (UC). The comparison between karyotyping analysis and immunophenotyping classification revealed the absence of metaphases (UC) in specific neoplasia types: 3 samples (2.7%) out of 88 AML cases, 1 sample out of 39 MDS cases, 1 sample out of 67 myeloma cases, 1 sample out of 15 lymphoproliferative disease cases, and 2 samples (1.8%) out of 69 cases for measurable residual disease investigation. However, successful cytogenetics were obtained in all 39 cases of acute lymphoblastic leukemia and 33 cases of myeloproliferative disease. Four cases (3.52%) out of 204 normal bone marrow samples showed UC results. Discussion: The data indicates that the implementation of a ROLF for cytogenetics and immunophenotyping improves efficiency in achieving accurate diagnoses, with a high percentage of successful cytogenetic results (98%) when compared to previously published results in Brazil and Europe. The low rate of UC and the identification of karyotypic alterations in a significant number of cases highlight the reliability and improvement in cell culture techniques and the identification of clonal lineages, leading to reliable results in understanding and managing each diagnostic approach. Conclusion: Our remote laboratory for immunophenotyping, molecular biology, and cytogenetics has demonstrated excellent technical performance and operational efficiency. These results support the effectiveness of remote support in providing accurate and timely diagnoses for hematological malignancies, contributing to improved patient care and outcomes.

Introduction: Research on point mutations in onco-hematology plays a critical role in understanding neoplasias and formulating effective treatment strategies. In this context, investigating the V617F mutation in the JAK-2 gene is of particular significance for diagnosing BCR-ABL negative myeloproliferative syndromes, notably Polycythemia vera. A range of techniques, including sequencing, PCR + RFLP, and real-time PCR, can be employed for this purpose. This study aims to describe the utilization of real-time PCR with a specific MGB probe to detect the V617F mutation in the JAK-2 gene. We also present the retrospective results obtained from peripheral blood samples of 250 patients who were assessed between July 2022 and July 2023 due to suspected myeloproliferative disorders (MPD). Objectives: The primary objectives of this study are to validate a rapid, cost-effective, and sensitive MGB TaqMan probe-based real-time PCR method, coupled with automatic magnetic DNA extraction (EXTRACT MPTA, Loccus) compared with column manual extraction (Promega), for detecting the JAK-2 V617F mutation in an onco-hematology remote laboratory (ROLF). Additionally, we aim to evaluate the incidence of the V617F mutation in the 250 cases submitted to ROLF. Methods: For the real-time PCR reaction, we utilized a specific MGB probe (Thermo) targeting the V617F mutation (rs77375493) along with the SNP detection master mix reagent. The PCR was performed using a Rotor-Gene Q instrument (Qiagen), and the raw fluorescence data were analyzed at cycle 45. To assess sensitivity, we conducted tests using a homozygous cell line for the mutation (HEL 92). Results: Among the 250 cases (126 females and 124 males) originating from 28 different hospitals in Brazil, 63 (25.2%) tested positive for the V617F mutation, with a relatively equal distribution between genders (p = 0.1459). The mean age of V617F positive samples was 66 years compared to 55 years for negative samples (p < 0.0001). Analysis of fluorescence intensity at cycle 45 of real-time PCR in positive and negative samples for the V617F mutation revealed remarkable sensitivity, detecting the presence of the mutated allele down to 1% (limit of detection - LOD). The average fluorescence intensity was 0.52 for mutated samples and 0.04 for non-mutated samples (p < 0.0001, Mann-Whitney test). DNA from 32 samples and diluted controls were extract manually and automatically (magnetic) and 100% agreement was obtained. Conclusion: Our study demonstrates the clinical relevance and high sensitivity of real-time PCR with the MGB probe for detecting the V617F mutation in the JAK-2 gene. It accurately identifies V617F mutation even at low levels (1% LOD). The automatic magnetic DNA extraction setting offers a rapid and cost-effective alternative to manual column extraction. Notably, we observed a significant correlation between the V617F mutation and older age, with positive samples having a mean age of 66 years compared to 55 years for negative samples (p < 0.0001). These findings have important implications for molecular diagnostics in onco-hematology, enabling early and precise diagnosis of myeloproliferative disorders (MPD).

Background: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of a BCR-ABL1 rearrangement; its detection and quantification by real-time quantitative PCR (RQ-PCR) plays a central role in CML diagnosis, therapy monitoring, and sequencing to identify resistance mutations in case of therapy failure. To evaluate the molecular response of CML, BCR-ABL1 quantification must be calculated on the international scale (IS%) for which RQ-PCR has the necessary sensitivity (up to 10−5). Currently, BCR-ABL1 quantifications are ubiquitous in onco-hematology laboratories (OHLs; ̃70% of tests performed in our OHL), whereby quality, cost, and turn-around-time are of critical importance. Today, the majority of OHLs in Brazil rely on laborious manual RNA-extraction methods (e.g., Trizol) that usually require 8 mL of peripheral blood (PB) to monitor CML. Here, we report a strategy that requires only 2 mL of PB in combination with the automated magnetic DNA/RNA-extraction kit Extracta-MPTA (Loccus do Brasil) for CML diagnosis and monitoring. Methods: BCR:ABL1 was quantified and its IS% determined using our developed kit, which was calibrated using ERM-AD263 and UK-NEQAS (external quality assessment). Total RNA was extracted from 40 PB samples, after erythrocyte lysis using two different methods: 1) Leukocytes from 8 mL of PB were extracted manually using Trizol; 2) leukocytes from 2 mL of PB were automatically extracted using Extracta-MPTA (Loccus do Brasil). BCR-ABL1 quantification, BCR-ABL1 IS%, and BCR quantification (internal control) were compared statistically (paired t-test). The reproducibility was evaluated by analyzing 20 replicates; the low limit of the leucocyte number to BCR:ABL1 quantification using Extracta-MPTA were also evaluated. Median and moving means of 135 unpaired samples were used to monitor BCR-ABL1 IS% between Trizol, Extracta-MPTA, while EQA from UK-NEQAS was also evaluated using both methods. In parallel, RNA was extracted by both methods from 20 samples for the diagnosis of acute lymphoblastic leukemia (ALL) (BCR-ABL p190 transcript) and acute promyelocytic leukemia (APL) (PML-RARA transcript). Results: A comparison of BRC-ABL1, BCR, and %IS in 40 paired samples showed that the results obtained from Trizol or Extracta-MPTA are comparable (paired t-test: p = 0,4222, p = 0,9263, and p = 0,071, respectively). The reproducibility was evaluated by BCR quantification (24%).. A comparison of the medians from 135 unpaired samples extracted using Trizol and Extracta-MPTA revealed that BCR-ABL1 IS% distribution among our patients is stable over time (p = 0,7704; Mann Whitney: r2 = 0,0012). EQA was extracted using both methods and the results were identical. A comparison between Trizol and EXTRACTA_MPTA for ALL and APL was 100% identical (Fischer; p = 1,000). Conclusions: Both RNA extraction methods are suitable for OHLs for PML-RARA and BCR-ABL (p190 and p210) detection and CML diagnosis/monitoring by BCR-ABL1 detection/quantification. By using Extracta-MPTA the amount of PB used to obtain RNA can be reduced by 75%, test results can be obtained within 4 h, and direct reagent costs are reduced by 25% with a minimum of hands-on time.

Introduction: The advancement of chronic myeloid leukemia (CML) treatment through tyrosine kinase inhibitors (TKIs) has brought about a revolutionary transformation in patient outcomes, clinical responses, and survival rates. Nevertheless, specific patient subsets exhibit inferior responses to therapy and poor prognosis. Moreover, a small fraction of patients might develop clonal chromosomal anomalies in Philadelphia-negative (Ph-) cells, referred to as CCA/Ph-, which the European Leukemia Net (ELN) designates as having an adverse prognosis. In this study, we present a unique case of a CML patient who underwent CCA/Ph- evolution. Case report: GSB, a 78-year-old male, received a CML diagnosis in 2019 at 74 years old, with an intermediate Sokal risk classification. At diagnosis, 100% of cells were Ph+ (Philadelphia chromosome positive), and p210 BCR-ABL was detected. Due to severe grade 3 skin lesions caused by Imatinib, the patient was switched to Dasatinib in August 2019, exhibiting good tolerance. In December 2021, pleural effusion occurred, accompanied by clinical and radiological deterioration, leading to furosemide treatment in May 2022. Dasatinib was temporarily suspended in November 2022, resulting in progressive clinical improvement. By December, the dose was adjusted to 80 mg/day, maintaining a major molecular response (BCR-ABL1: 0.00375, International Scale). In June 2023, the patient presented with acute malaise, nausea, and diarrhea. Notably, a complete blood count revealed substantial bicytopenia (anemia and thrombocytopenia), prompting the suspension of Dasatinib. A bone marrow evaluation in August 2023 unveiled myeloid blast transformation, with BCR-ABL1 p210 remaining nearly undetectable (0.002%). Immunophenotyping disclosed that 10.2% of myeloblasts were positive for CD4, CD13, CD33, CD34, CD38, CD45, CD117, HLA-DR, and cMPO, while being negative for cCD3, CD7, CD10, CD11b, CD14, CD16, CD19, CD56, CD64, cCD79a, and CD123. Moreover, 59.1% of viable cells were categorized as monocytes/monoblasts and positive for CD4, CD11b, CD13, CD14 (partial, 88,7%), CD33, CD34, CD38, CD45, CD56 (partial, 38,0%), CD64, HLA-DR, cMPO and negative for cCD3, CD7, CD10, CD16, CD19, cCD79a, CD117, CD123. Cytogenetic analysis exhibited a monosomy of chromosome 7 (45, XY, -7[20]) in all metaphases. Discussion and conclusions: In this context, we portray a case of a 74-year-old patient who developed AML, myelodysplasia-related (AML-MR) after four years of a major molecular response to second line TKI treatment. The earliest documented instance of a patient developing monosomy 7, following 12 months of imatinib therapy, with hypoplastic bone marrow and dysplastic features, dates to 2002. Among CML patients treated with TKIs, around 25% with CCA/Ph- exhibit chromosome 7 abnormalities (-7/del(7q)) and derive the greatest benefits from second line TKIs. Drawing from prior descriptions, as well as observations in this case, it is essential to closely examine clinical and laboratory characteristics (morphological, immunophenotypic, cytogenetic, and molecular) in cases where blast counts in the bone marrow increase. This scrutiny is crucial for accurately classifying the AML-MR clone with CCA/Ph- progression in CML.

O objetivo deste trabalho foi avaliar o desempenho fisiológico e bioquímico de sementes de trigo produzidas em diferentes estados do Brasil. Este estudo foi conduzido em delineamento de blocos casualizados com 11 tratamentos dispostos em três repetições. A análise de variância revelou significância para Germinação (G), Velocidade de germinação (GS), Envelhecimento acelerado (AA), Comprimento da raiz (RL), Velocidade de emergência (ES), Comprimento da plântula (SL), Massa de mil sementes (TSM), Peso hectolitro (HW), Área foliar (LA), Teor de proteína (PTN), lipídios (LIP), fibra bruta (FB), cinzas (CNZ), amido (AMD), carboidratos totais (CT) e carboidratos não fibrosos (CNF). As sementes da cultivar TBIO Audaz oriundas de Brasília apresentaram qualidade superior, com maior vigor no teste de envelhecimento acelerado, comprimento da parte aérea e velocidade de emergência, sendo também a cultivar com maior teor de amido. Dentre os materiais estudados, verifica-se que independente da cultivar e local de produção das sementes de trigo existe uma associação positiva entre os atributos bioquímicos e físicos que influenciam na qualidade fisiológica do trigo, destacando-se o teor de amido, fibra e material mineral, bem como - massa de mil sementes, germinação, vigor e comprimento de plântulas.