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Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high-dose cytarabine in the outpatient setting. Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with highdose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff. Results: Twenty-seven patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference in relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Nonrelapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03). Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years.

Background: Glioblastoma with oligodendroglioma component (GBMO) is a recently classified subtype of glioblastoma, which carries different clinical and prognostic outcomes, being frequently misdiagnosed. Both glioblastoma and GBMO are mainly seen in older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence in children or adolescents and more frequent in male patients. Case report:A 15-year-old female patient, presented with history of daily headache, not relieved by painkillers, vomiting, blurred vision and strabismus. Magnetic resonance imaging of the brain revealed expansive tumour on left temporo-occipital lobe. Patient was submitted to intracranial exeresis, along with histopathological examination: glial neoplasm with areas of pleomorphism, hyperchromatism, anaplasia, foci of oligodendroglial component, perinuclear halo and ramified capillaries, resembling oligodendroglioma, necrosis and intense mitotic activity. The immunohistochemical analysis revealed positive Glial Fibrillary Acidic Protein (GFAP), synaptophysin, Ki-67 (MindBomb E3 ubiquitin protein ligase 1 -MIB-1) and hyperexpression of Epidermal Growth Factor Receptor (EGFR), indicating GBMO. Subsequently, Fluorescence in situ Hybridization (FISH) showed positive for 19q deletion, negative for 1p deletion and also positive for Isocitrate Dehydrogenase 1 (IDH 1) mutation, suggesting an oligodendroglioma component. Tumour resection was total and symptoms disappeared. Afterwards, she started adjuvant oral chemotherapy with temozolomide. Treatment was completed after 12 cycles adjuvant temozolomide, with no greater symptoms or complications and complete remission. Furthermore, according to the most recent WHO classification, in 2016, a new addition was made to this diagnosis: the evidence of isocitrate dehydrogenase (IDH) mutation, which is present on about 10% of gliobastomas [2]. This genetic marker has been shown as an important predictor of prognostic and longer survival rate [3,4,5].Moreover, the overall median survival of GBMO and GBM are still controversial, since it has shown a longer survival [4] in GBMO while others did not identify differences whatsoever [5].Regarding age, although GBMO has been said to have a younger onset than GBM, both are mainly seen on older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence on children or adolescents [3,5,6].About gender, GBMO has been said as more prevalent in men at a 3,25:1 rate [3], but this prevalence is controversial, since many time GBMO is still misdiagnosed as a regular GBM or as anaplastic oligoastrocytoma (AOA). However, Karsy et al showed the rarity of this subtype of GBM and, moreover, how rare is its occurrence in children and adolescents [6].In Brazil, literature about GBMO is scarce, although some cases of GBMs have been reported, most of it was in adults and located in the cerebellum [7]. Furthermore, cases related regarding specifically pediatric patients include a cerebral case, located in the right hemisphere [8].How...

Objetivo: Analisar o consumo de álcool, tabaco e outras substâncias psicoativas entre universitários do curso de Medicina, identificando os fatores que influenciam a utilização dessas substâncias. Método: Caracteriza-se como um estudo transversal, descritivo e observacional, do qual participaram 141 acadêmicos, correspondente àqueles cursando do primeiro ao oitavo período, cujos dados foram obtidos através da aplicação do questionário ASSIST – OMS Vs 3.1 e de questionário próprio para variáveis independentes. Resultados: 58,2% dos entrevistados pertenciam ao sexo feminino, em média com 20 anos de idade, cursando o 2º ano em sua maioria (30,5%). 51,1% relataram fazer uso de substâncias psicoativas, 26,2% já terem feito uso e 22,7% nunca terem utilizado. 59,63% apontou influência da faculdade de medicina no início ou aumento da utilização. A prevalência do consumo foi maior entre acadêmicos do sexo masculino e de semestres mais avançados, e menor entre os praticantes de atividades religiosas. O álcool foi a substância mais consumida, seguida de tabaco e maconha, sendo a necessidade de intervenção psicológica breve evidenciada em 36,1%, 42,9% e 46,2% desses usuários, respectivamente. Conclusão: Observa-se uma alta prevalência de utilização de substâncias psicoativas, especialmente de álcool, tabaco e maconha, cujo consumo pode ser incentivado desde o início do curso. Ainda, observou-se que uma parcela considerável dos estudantes necessita de intervenção psicológica breve acerca do uso a fim de prevenir danos cognitivos e impactos negativos na prática clínica e no aconselhamento dos pacientes.

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