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BACKGROUND: Primary central nervous system lymphoma (PCNSL) requires effective & well-tolerated treatment strategies. The use of high-dose methotrexate (HD-MT) with or without intra-thecal methotrexate (IT-MT) and whole-brain radiotherapy (WBRT) has emerged as a prominent approach for PCNSL. This systematic review aims to assess the efficacy and safety of these treatment modalities. METHODS: A comprehensive search strategy identified relevant studies from PubMed, EMBASE, and Cochrane Library. The following search terms were used: "high-dose methotrexate", "primary central nervous system lymphoma", "intra-thecal methotrexate", and "whole-brain radiotherapy". We included randomized controlled trials (RCTs), cohort studies & case-controlled studies evaluating the use of HD-MT with or without IT-MT and whole-brain radiotherapy in the treatment of confirmed PCNSL. Data extraction & quality assessment was conducted by two independent reviewers. Primary outcomes include overall survival (OS), progression-free survival (PFS) & treatment-related adverse events (TRAEs). Secondary outcomes were neurological function and quality of life (QOL) assessments. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: We identified 5 studies, consisting of 1 RCT, 3 cohort studies, and 1 case-controlled study. Pooled analysis revealed that HD-MT with or without IT-MT and whole-brain radiotherapy significantly improved both OS and PFS compared to other treatment modalities but we found no significant difference between patients who received HD-MT with or without IT-MT. Combination therapy was generally well-tolerated, with manageable TRAE. Subgroup analyses stratified by age, disease stage, and other relevant factors demonstrated consistent efficacy and safety profiles across different patient populations. The risk of bias assessment indicated that the majority of the included studies had low-moderate risk of bias. CONCLUSIONS: There was no significant difference between patients who received HD-MT with or without IT-MT plus radiotherapy, emphasizing the comparable efficacy of these treatment modalities. Combination therapy was generally well-tolerated, with manageable TRAE. This highlights the favourable safety profile of HD-MT with fewer side effects compared with the combination of IT-MT.

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BACKGROUND: Whole brain radiotherapy (WBRT) is commonly used as consolidation therapy in primary central nervous system lymphoma (PCNSL). However, high-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT) has emerged as an alternative approach for PCNSL. This systematic review aims to assess the efficacy and safety of both treatment modalities. METHODS: The systematic review follows PRISMA guidelines. A comprehensive search strategy identified relevant studies from PubMed, Europe PMC, and Cochrane Library. The following search terms were used: "primary central nervous system lymphoma", "Autologous Stem Cell Transplantation", and "whole-brain radiotherapy". We included randomized controlled trials (RCTs) cohort studies evaluating the use of whole-brain radiotherapy and high-dose chemotherapy followed by autologous stem cell transplantation in the treatment of histologically-confirmed PCNSL. Publications included were limited to English language full texts that were published in the past 10 years. Data extraction & manuscript quality assessment was done by two independent reviewers with a third reviewer to resolve any discrepancy. Primary outcomes include overall survival (OS), progression-free survival (PFS) & treatment related toxicity (TRT). Secondary outcomes were clinical neurological function and performance score assessments. Individual studies were assessed using the Jadad Scale and the Newcastle-Ottawa Scale for observational studies. RESULTS: We identified 5 studies, consisting of 2 RCTs and 3 cohort studies. After all studies considered, analysis revealed that consolidation therapy with HD-ASCT had a better overall PFS and OS compared to whole-brain radiotherapy (P<0.005). Both groups showed similar TRT with mostly haematological toxicity. Holistically clinical cognitive functions are found to be improved in HD-ASCT Patients and poorer results are exhibited by WBRT patients primarily in executive functions. Performance statuses are scored differently across all studies with slightly preferable results shown in patients treated with HDC-ASCT. CONCLUSIONS: Based on the findings of this systematic review, HDC-ASCT might be a preferable choice of consolidative therapy as shown with better OS, PFS with similar TRT. While WBRT are more feasible and cost-efficient, risks of cognitive impairment and reduced performance status after WBRT should be considered for further treatment choices. Further randomized clinical trials with a similar scoring system are needed.

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Em cenários de pandemia, como a COVID-19, a ruptura da cadeia de infecção é fundamental para a proteção da saúde da população. Este processo pode ser atingido mediante a adoção de medidas de restrição do contato humano, como isolamento, quarentena e distanciamento social. Embora fundamentadas em achados científicos e necessárias para conter o avanço da COVID-19, as medidas de isolamento social pode gerar impactos à saúde mental da população. Nesse sentido, a presente pesquisa visa avaliar a produção científica a respeito dos impactos da quarentena decorrente da COVID-19 na saúde mental. Trata-se de uma revisão integrativa da literatura científica, realizada por meio da exploração nas bases de dados PubMed e Biblioteca Virtual em Saúde (BVS), no período de março de 2020. Nessas bases de dados, foram utilizadas as palavraschave: COVID-19 and psychological consequences, COVID-19 and psychological impact of quarantine, obteve-se 10 artigos, dos quais 4 artigos, foram incluídos na análise após a exclusão de artigos duplicados e revisões de literatura, sendo 3 da PubMed e 1 da BVS. Os resultados sugerem alta frequência de relatos de reações e sintomas possivelmente associados a transtornos mentais, tais como queixas de ansiedade, depressão, insônia, estresse, pânico, solidão, angústia, obsessão e compulsão entre outros. Ficou evidente que grupos de risco como idosos e pessoas com doenças crônicas apresentaram maior probabilidade para o desenvolvimento de transtornos mentais. Ademais, análises dos impactos do coronavírus na dimensão psicológica podem corroborar para construção de intervenções pautadas na promoção, prevenção e tratamento em saúde mental.

In pandemic scenarios, such as COVID-19, the disruption of the infection chain is fundamental for the protection of the population's health. This process can be achieved through the adoption of measures to restrict human contacts, such as isolation, quarantine, and social distance. Although based on scientific findings and necessary to contain the advancement of COVID-19, social isolation measures can have an impact on the population's mental health. In this sense, this research aims to evaluate scientific production regarding the impacts of the quarantine resulting from COVID-19 on mental health. It is an integrative review of the scientific literature, carried out through the exploration in the PubMed and Virtual Health Library (BVS) databases, in March 2020. In these databases, the keywords were used: COVID -19 and psychological consequences, COVID-19 and psychological impact of quarantine, 10 articles were obtained, of which 4 articles were included in the analysis after excluding duplicate articles and literature reviews, 3 from PubMed and 1 from the BVS. The results suggest a high frequency of reports of reactions and symptoms possibly associated with mental disorders, such as complaints of anxiety, depression, insomnia, stress, panic, loneliness, anguish, obsession, and compulsion, among others. It was evident that risk groups such as the elderly and people with chronic diseases were more likely to develop mental disorders. In addition, analyzes of the impact of coronavirus on the psychological dimension can support the construction of interventions based on promotion, prevention, and treatment in mental health.

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