Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.

At the beginning of the COVID-19 pandemic, there was high mortality and a lack of effective treatment for critically ill patients. Build on the experience in argentine hemorrhagic fever with convalescent plasma, we incorporated 90 patients into a multicenter study, and 87 were evaluable. We collected 397 donations from 278 convalescent donors. Patients received plasma with an IgG concentration of 0.7-0.8 (measured by Abbott chemiluminescence) for every 10 kg of body weight. Survival during the first 28 days was the primary objective. 77% were male, age 54 (+/-15.6 y/o (range 27-85); body mass index 29.7 +/-; 4,4; hypertension 39% and diabetes 20%; 19.5% had an immunosuppression condition; 23% were healthcare workers. Plasma was administered to 55 patients (63%) on spontaneous breathing with oxygen supplementation (mainly oxygen mask with reservoir bag in 80%), and 32 patients (37%) were infused on mechanical ventilation. The 28-day survival rate was 80%, with 91% in patients infused on spontaneous breathing and 63% in those infused on mechanical ventilation (p = 0.0002). There was a significant improvement in the WHO pneumonia clinical scale at 7 and 14 days, and in PaO2 / FiO2, ferritin and LDH, in the week post-infusion. We observed an episode of circulatory volume overload and a febrile reaction, both mild. Convalescent plasma infusions are feasible, safe, and potentially effective, especially before requiring mechanical ventilation, and are an attractive clinical option for treating severe forms of COVID-19 until other effective therapies become available.

INTRODUCTION: paroxysmal nocturnal hemoglobinuria (PNH) is a clonal, non malignant disease of hematopoiesis characterized by intravascular hemolysis, a variable depth of bone marrow failure and a marked thrombophilia. Classic therapeutic resources are supportive care and allogeneic hematopoietic stem cell transplantation. Eculizumab arrival to our country -in 2009- revolutionized PNH treatment. We report here our experience with a cohort of 33 patients treated with eculizumab. AIMS: to evaluate indications of eculizumab, hematologic response, delays to initiate treatment, interruptions and its consequences, and mortality in our patients. PATIENTS and METHODS: data of 33 patients with PNH who begun treatment with eculizumab between '01/09 and '12/14 were collected with a specific questionnaire. Qualitative data were analyzed as proportions. Quantitative data were evaluated as median (Md), range (R) and percentiles 25% and 75%, or mean (Mn) and 95% confidence interval (95% CI). Quantitative responses to treatment were evaluated with a non parametric test for paired data (Wilcoxon signed Rank test). A probability value <0.05 was used to define statistical significance. RESULTS: cohort characteristics: Md age at diagnosis: 32 years old. R: 18 a 73. Eighteen were females and 15 males. Interval simptoms-PNH diagnosis Md: 284 days, R: 1 a 4,518. Granulocyte PNH clon size Md: 91%, R: 18 a 99%. Symptoms prevalence: fatigue: 90.6%, dyspnea: 71.9%, abdominal pain 56.2%, dysphagia 25%, erectil dysfunction: 20% (of males). Complications frequency: thrombosis 27.3%, impaired renal function 21.2%, pulmonary hypertension 3.1%. Severity criteria of PNH leading to eculizumab prescription: disabling symptoms 90.6%, steroid dependence 70%, transfusional requirement 54.5%, thrombosis 24.2%, impaired renal function 21.2%, severe dyspnea/ pulmonary hypertension 21.2%. Delay of eculizumab treatment (from medical prescription to first infusion) in 28 patients: Md: 196 days, R: 37 to 592. Hematologic responses to eculizumab: Mn LDH decline: 2,081 U/L (95% CI: 1,204 to 2,958) p=0.0003. Mn elevation of hemoglobin 1,5 g/dL (95% CI: 0.82 to 2.18) p=0.0005. Platelet counts increase in thrombocytopenic patients (<150,000 platelets/µL) Mn: 20,720/µL (95% CI: 712 to 40,730) p=0.042. There were no significant changes in neutrophil counts. Eculizumab treatment interruptions were extremely frequent: 93.7% of patients suffered at least one or more treatment delay(s) ≥ 7 days. Only 2/33 patients did not have any treatment interruption. The mean cause of this treatment irregularities were delays in drug provision by the medical insurance (in 100% of affected patients). In only 10% of cases, lack of patient adherence was responsible for treatment interruptions. Even more, 25.8% of drug supplies were delayed for 7 days or more (99/384 provisions). Results of treatment interruptions were: transfusional requirement in 41.4% of cases, severe anemia in 34.5%, hospital admission in 27.6%, acute renal impairment in 16.7%, Budd-Chiari syndrome progression in one case, and probable cause of death in another one. Three patients died (9.1%). Causes were infection in 1, advanced colon cancer in 1, and multiorgan failure, probably related to visceral thrombosis, in the third case. CONCLUSIONS: this argentinian cohort shows that disabling symptoms, corticosteroids dependence and transfusional requirements are the most frequents causes to start eculizumab treatment in our patients. Eculizumab was effective to block hemolysis, to improve anemia and thrombocytopenia and to prevent new thrombotic events. However, eculizumab achievements were hindered in our experience by the delay to initiate treatment and the frequent interruptions it suffered, as it is usual in Latin America. These treatment delays/interruptions, uncommon in the medical literature, led to multiple and severe complications. Disclosures Brodsky: Alexion Pharmaceuticals: Consultancy, Speakers Bureau. Touliet:Alexion Pharmaceuticals: Speakers Bureau. Dinardo:Alexion Pharmaceuticals: Speakers Bureau. Blanca:Alexion Pharmaceuticals: Speakers Bureau.

DLBCL. Among them, the Glasgow Prognostic Score (GPS), the modified Glasgow Prognostic Score (mGPS) are novel inflammatory indicators which consist of C-reactive protein (CRP) and albumin (ALB) and reflect both the systematic inflammatory response and nutritional status. Recently, the ratio of CRP-to-ALB (CAR) has been identified as another serum-based inflammatory indicator and several studies have reported that the CAR is significantly related to prognosis in various types of cancers.Methods: Four hundred and fourteen newly-diagnosed DLBCL patients were enrolled in the retrospective study. The univariate and multivariate Cox proportional hazards models were established for the estimation of prognostic factors. Receiver-operator characteristic (ROC) curves and the corresponding areas under the curve (AUC) were calculated to predicted probability of variables.Results: With a median follow-up of 40 months (range, 0 to 105 months), patients with higher CAR displayed unfavorable progression-free survival (PFS) (P<0.001) and overall survival (OS) (P<0.001) ( Figure 1). Multivariate Cox regression analysis validated that CAR was independent risk factor for both PFS (HR, 1.548; 95% CI, 1.224 to 1.958; P<0.001) and OS (HR, 1.763; 95% CI, 1.291 to 2.335; P<0.001). It was demonstrated that CAR + NCCN-IPI had a superior prognostic significance than NCCN-IPI alone (P=0.0028 for PFS, P=0.0011 for OS)Conclusions: The pre-existing high CRP-to-ALB ratio was an independent prognostic factor for PFS and OS. Synchronously, adding the criterion of high CAR evidently improved the prognostic capacity of the National Comprehensive Cancer Network -International Prognostic Index (NCCN-IPI) for predicting PFS and OS in DLBCL. ABSTRACT 6 Introduction: Immunochemotherapy (ICT) with R-CHOP (or R-CHOPlike) is the standard of care for patients (pts) diagnosed with DLBCL. Due to the aggressiveness of these lymphomas and their potential curability treated with the standard of care, treatment should be initiated without delay. Objectives: To define the impact generated by the delay in the different diagnostic-therapeutic stages, from the onset of symptoms to the administration of ICT, on therapeutic response rates in a series of pts diagnosed with DLBCL from various institutions from Argentina (public and private). We focused our analysis on the reasons of delay and their relationship with socioeconomic factors. Patients and methods: We designed a multicentric, descriptive, retrospective study in which patients diagnosed with DLBCL between 2/2004 and 4/2015 in the participating institutions were registered. Variables of interest were: date of beginning of the symptoms, 1 st consultation, date of anatomopathological diagnosis, beginning and end of treatment. All causes of identified delay on the process of diagnosis and treatment were recorded. The place of residence, educational level, health care coverage, availability of rituximab (R) in 1st cycle and response rate, completed the studied variables.Results: 278 pts were recorded (Male/female ra...

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