A potentially life-threatening complication called differentiation syndrome (DS), formerly known as retinoic acid syndrome, occurs in 2.5‒30% of newly diagnosed APL patients receiving ATRA treatment. This syndrome has also been described in patients with relapsed APL who received induction therapy with ATO. DS usually develops during induction therapy with ATRA and/ or ATO, typically during the first 30 days of therapy. It is present neither during consolidation or maintenance therapy using 2 drugs, nor during ATRA treatment in non-APL malignancies. Leukemic APL cells might play a fundamental role inthe development of DS. he clinical symptoms of DS are unexplained fever, cough, dyspnea, peripheral edema, weight gain, pleural fluid retention, interstitial pulmonary infiltrates, hypotension, pericardial effusion, andacute renal failure. This is often mistaken for fluid overload with pleural efusion or pneumonia, congestive heart failure, and difuse alveolar hemorrhage. The syndrome usually develops within 2 weeks of therapy and is commonly associated with a rapidly rising leukocyte count. The probable risk factors for DS are a high leukocyte count and a rapidly increasing leukocyte count. his syndrome is associated with increased cytokine release from differentiating myeloid cells and modulation of adhesion molecules on the surface of aggregated APL blasts and vascular endothelial cells as a result of exposure to ATRA, which results in capillary leak and increased adherence to capillary endothelium. Steroid rapidly reduces these aggregations
This review focuses on the most recentadvancesinthe diagnostic and prognostic work- up of adult acute lymphoblastic leukemia (ALL), and on their implications inthe clinical managementofthe disease. Over the years, information obtained through extensive immunophenotyping, karyotyping, molecular genetics, multidrug resistance and, more recently, genomic profiling is progressively contributing to a better understanding ofthe biology of this complex disease, to the identification of subgroups of patients with different clinical outcomes, to a more precise monitoring of minimal residual disease, to the use of different therapeutic protocols based on prognostic indicators and, finally, to the design of innovative and specific treatment strategies. The next few years will tell us if this biologically-guided approach, which is progressively individualizing themanagementof adult ALL patients, will ultimately impact on the prognosis of a disease that has stagnated over many decade. Rev. Bras. Hematol. Hemoter. 2009;31(Supl. 2):41-47.
The International Consortium on AcutePromyelocyticLeukemia (IC-APL 2006) aimed to deploy a network of National and International centers to improve diagnosis, treatment, monitoring of treatment response and support therapy and as a consequence the survival of patients with APL in developing countries. The treatment was based on the APL 2005 protocol ofthe Programa Espanhola de Hematologia (PETHEMA) group, adapted to the reality ofthe participating countries (Brazil, Mexico, Chile, Uruguay) with the substitu- tion ofthe anthracycline idarubicin for daunorubicin which is more affordable and is widely used inthe treatment of other leukemias. 3 Ofthe eight Brazilian centers participating inthe
Foreign body syndrome (FBS) is a fairly common disease of cattle and buffaloes, especially inthe developing countries. This disease is caused by ingestion of indigestible metallic and non-metallic blunt or sharp foreign objects. It is associated with high economic losses and therefore an urgent science-based policy is required to control and manage this syndrome. Indiscriminate feeding habits, feed scarcity, industrialization and mechanization of agriculture are predisposing factors for FBS in bovine and bubaline. The condition is difficult to diagnose solely on the basis of clinical signs and physical examination. However, laboratory diagnosisand imaging techniques like radiography and ultrasonography can be of high diagnostic value in detecting the condition. Anemia, increased packed cell volume, neutrophilia with a left shift, increased total protein, globulin, total bilirubin, Alanine Aminotransferase, Alkaline Phosphatase, Phosphorus and decreased albumin/globulin ratio and Calcium are the common abnormal laboratory findings. Recently, ultrasonography has replaced radiography for diagnosisof FBS in bovine and bubaline due to its availability and accuracy in evaluation of features ofthe reticulum, detection of penetrating metallic objects, diagnosisand assessment of various sequelae of FBS including; local and diffuse traumatic reticuloperitonitis, reticular, splenic, hepatic, abdominal and thoracic abscesses, diaphragmatic hernia, traumatic pericarditis and pleuropneumonia. Although, FBS is ideally treated with rumenotomy, it can be prevented to a large extent by proper management practices, increasing the awareness among the livestock keepers, oral administration of rumen magnets at the age of one year and reapplication of a new magnet every 4 years in animals at high risk.
We retrospectively analyzed medical chart data of 157 APL patients treated from January 2003 to March 2006 at 12 Brazilian institutions. Thediagnosis was based on detec- tion ofthe t(15;17) chromosomal translocation by cytoge- netic analysis or of PML/RARα rearrangement by RT-PCR analysis. Laboratory diagnosisof disseminated intravascular coagulation (DIC) was based on changes in activated partial thromboplastin time, prothrombin time, fibrinogen degra- dation products (FDPs), and/or D-dimers. Central nervous system, pulmonary, or gastrointestinal hemorrhages were considered a severe bleeding. Patients were classified according to the risk of relapse on the basis of WBC and platelet counts (PLT) at diagnosis: low risk, WBC ≤ 10×10 9 /L
W e present the case of a child w ith acute lym phoid leukem ia (A LL) w ho w as m orphologically classified as FA B L 1 (P A S and peroxi- dase w ere negative). R em ission w as achieved w ith an A LL-type protocol (G B TLI). Five m onths after the discontinuation of therapy, the patient presented m ixed leukem ia (C 01O , C 019, C 013 and C 033 w ere positive) w ith t (9;11) (p21 ;q23) translocation. U nfortu- nately, as cytogenetic and im m unophenotype studies w ere not perform ed at diagnosis, tw o possibilities could be considered for the relapse; secondary m ixed leukem ia w ith clonal chrom osom e changes, or m ixed leukem ia from the beginning.
A total of 103 hospitalized patients with newly diagnosed de-novo APL were treated at Tongji hospital (Wuhan, China) during March 2008 to January 2015. These cases consisted of 60 males and 43 females, with age ranging from 14 to 74 years and a median of 37 years. 263 de novo AML (other than APL) were retrospectively analyzed at the same period as control group for comparisons of laboratory parameters at initial diagnosis. The diagnostic criteria of AML were based on theof World Health Organization Classification of Tumors- Pathology and Genetic of Tumors of Haematopoietic and Lymphoid Tissue (2008) and FAB (1976). Other inclusion criteria were: no serious liver disease or other hemorrhagic diseases, and no usage of anticoagulants during initial induction therapy. We collected the data from December 2014 to January 2015 and identify the information during and after data collection. This study has been approved by the ethics committee of Tongji Hospital Affiliated of Huazhong Univer- sity of Science and Technology. Written informed consent was obtained from all enrolled sub- jects, including the next of kin on behalf ofthe minors recruited in our study.
The appropriate managementofacute viral encephalitis is a challenge. Clinical picture includes general symptoms and a wide range of neurological signs. Etiological diagnosis cannot be performed only by clinical means and depends on neuroimaging studies and cerebrospinal fluid molecular analyses. It is recommended since some of these viruses are treatable and that the prognoses of these infections depend on the prompt administration of antiviral and/or immunomodulatory drugs. Themanagementofacute viral encephalitis in Brazil has some peculiarities. First, the etiological distribution ofthe viral encephalitis may differ from what is found in other countries. Some viruses, such as dengue virus, are more common in Brazil than in developed countries while others, like West Nile virus, are not found here. Second, there are some regions in Brazil where neuroimaging and laboratorial methods are not available, and a clinical-based decision is the only therapeutic approach. As most ofthe guidelines inthe literature are based on complimentary methods, it is relevant to establish an alternative approach compatible with the Brazilian health system reality. The goal of this study was to review therecentadvancesinthe field oftheacute viral encephalitis, to discuss thediagnosisandthe treatment ofthe main etiologies ofacute viral encephalitis found in Brazil, and to propose a viable guideline for the evaluation ofthe suspected acute viral encephalitis cases inthe emergence room in Brazil.
This work was conducted under the EMF Project-SP, P&D project, with resources allocated by the Brazilian Electricity Regulatory Agency (0390-041/2004 ANNEL), coordinated by the Brazilian Association for Electromagnetic Compatibility (ABRI- CEM), and performed at the University of Sa˜o Paulo School of Public Health. The authors are grateful to Monica La Porte Teixeira and Rosa Maria Vieira Freitas ofthe Fundac ¸a˜o Sistema Estadual de Ana´lise de Dados (SEADE), who contributed to selection of controls from Sa˜o Paulo Birth Registry; Aparecida Nata´lia Rodrigues, Moˆnica Magalha˜es Leite, and Rosemairy Inamine, who coordinated the selection of cases and controls andthe interviews; andthe team of interviewers, who interviewed cases and controls; and Anderson da Costa for managementofthe data bank.
Acutepromyelocyticleukemia is potentially a highly curable type ofleukemia that usually presents with pancytopenia, coagulopathies and bleeding. We describe a case of an unusual presentation ofacutepromyelocyticleukemia. A 53 year-old male was admitted complaining of pain and weakness in his legs. He presented at examination a spastic paraparesis with a sensitive level at the eighth thoracic medullar (T8) segment. Magnetic resonance imaging showed a posterolateral extradural mass from T6 through T8 segments with medullar compression. A complete blood count showed anemia, thrombocytopenia andthe presence of promyelocytes and blasts. Marrow examination was compatible with thediagnosisofacutepromyelocyticleukemia by cytogenetics and polymerase chain reaction for the PML-RARα gene. He was treated with all-trans-retinoic acid therapy plus daunorubicin and presented an all-trans-retinoic acid syndrome. Despite hematological remission, the patient presented neurologic deterioration and had to be treated with radiotherapy (total dose 3000 cGy) ofthe extradural lesion. The patient evolved with severe sepsis and died without any recovery from his neurologic deficit. Extramedullary infiltration is a very rare complication inacutepromyelocyticleukemia. Most cases are related to relapse after initial treatment with all-trans-retinoic acid. The skin andthe central nervous system are the most frequently involved sites. This is possibly the first case reported of this condition in which the patient had a symptomatic extradural mass.
Hybrid gene PML-RARα is the molecular target found in most cases ofacutepromyelocyticleukemia (APL) and has been used for diagnosisand minimal residual disease studies. The standard molecular technique employed is qualitative reverse transcriptase-polymerase chain reaction (RT-PCR), but with the emergence of real time PCR (Q-PCR), PML-RARα gene detection approaches have been described allowing transcript detection, with the methodological advantage of eliminating post-PCR processing. However, current protocols report the use of expensive luorescent labeled probes, limiting its routine application inthe laboratory. The objective of this study was to optimize PML-RARα gene detection method for Q-PCR, using SYBR ® Green luorescent dye. The analysis was performed with NB4 cellular
Acute promyeloclocytic leukemia can present coagulopathies which are frequently very serious due to hemorrhagic conditions. Treatment using anthracyclines and retinoids provide a good response. The development of arterial thrombosis is uncommon. In this work a 56-year-old male patient with acute arterial insufficiency was evaluated. This patient was immediately submitted to thrombo- embolectomy with the removal of a white thrombus. Postoperative tests showed acutepromyelocyticleukemia with transposition (15;17) Treatment with ATRA and Idarubicin chemotherapy was initiated with the patients's response being satisfactory. Currently, the patient is incomplete remission and a recent cytogenetics test does not show the t(15;17). Rev. bras. hematol. hemoter. 2007; 29(4):418-419.
The prognostic factors that influence the risk of relapse in APL were evaluated in a series of 217 patients aged from one to 74 years, diagnosed with APL and confirmed by the presence ofthe PML-RARα fusion transcript by the Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA: n = 108) andthe Spanish Programa para el Estudio de la Terapéutica en Hemopatía Maligna group (PETHEMA: n = 109). The variables analyzed were: age, gender, hemoglobin level, leukocyte count, platelet count, French-American-British (FAB) subtype (typical or variant) andthe isoforms ofthe PML-RARα fusion transcript (bcr-1, bcr-2 or bcr-3). In a univariate analysis, leukocytosis, thrombocytopenia andthe classification of APL as typical or variant were significant for increased risk of relapse (p-value < 0.0001, p-value < 0.05 and p-value < 0.05, respectively). In multivariate regression analysis of relapse-free survival, the leukocyte and platelet counts were the only variables with independent prognostic value. The resulting predictive model for relapse-free survival allowed the classification of patients as low risk (leukocyte count ≤ 10 × 10 9 /L, platelet count > 40
Type 1 DM : Type 1 diabetes mellitus, results from insulin deficiency following destruction ofthe insulin-producing pancreatic beta cells and these patients depend on insulin for survival.On withdrawl of insulin they develop hyperglycemia ,ketoacidosis and coma.It most commonly presents inchildhood but one-fourth of cases are diagnosed in adults. The genetic factors, autoimmunity and environmental factors play a role in causation and precipitation of type-1DM. Symptoms are caused by hyperglycemia and include polyuria, polydipsia, and weight loss despite increased appetite initially. The absence or poor response of glucogon stimulated C peptide levels are diagnostic of type-1 diabetis as these patients have low residual beta cell function. Type 2 DM : Type -2 diabetis mellitus (T2DM) is the most common form of diabetes. The pathophysiological basis is a combination of impaired beta cell function , with marked increase in peripheral insulin resistance at receptor /post receptor levels
Gupta (2000) views gender to refer to the widely shared expectations and norms within a society about appropriate male and female behavior, characteristics, and roles. It is a social and cultural construct that differentiates women from men and defines the ways in which women and men interact. Worthy to note that there has been some controversy on the social relationship between the two sexes that make up gender and this has raised a lot of dust and storm. Agriculture is the most assured engine of growth and development and reliable key to industrialization. Nigeria is the largest producer of cassava inthe world (Ogbe et al, 2003). It is a very important staple food consumed in different forms by millions of Nigerians. Cassava roots are rich in energy, containing mainly starch and soluble carbohydrates, but are poor in protein. Cassava is once seen as the food for the poor but due to its value addition it is therefore a food for all. These and other features endowed it with a special capacity to bridge the gap in food security, poverty alleviation and environmental protection (Clair et.al, 2000). In many rural areas in Nigeria and several developing countries, women play a crucial role in providing and improving household food security (CTA, 2005).
Based on the objectives to be achieved and problems that have been formulated, the method used is juridical- sociological. The juridical approach is intended to explore and study the legislation as a basis for a research, while the sociological approach is intended to explore the factors and impacts incurred from the occurrence of border-area dispute and solution by the government. The specifications of this research are normative law called also as doctrinal research. A site was chosen by researcher to conduct a research is a government agency that includes the Navy (Department of Hydro-Oceanographic) related to the sea boundaries ofthe Republic of Indonesia and neighboring countries, local governments, especially inthe leading islands border to the Republic of Indonesia related to culture, security, politics and thinking about the area/island they occupy, as a part ofthe Unitary ofthe Republic of Indonesia. The population is all research objects to be researched. In this research, the population is Navy andthe relevant agencies involved inthe security of sea area. The samples were chosen to be a material of research is the bearer ofthe security function in marine areas through the random system and interviews with relevant parties, such as Bakorkamla and community.
Mangoes are susceptible to a range of pest and diseases that can significantly reduce commercial production and fruit quality. One ofthe most significant diseases of mango is anthracnose caused by the fungal pathogen Colletotrichum gloeosporioides . Anthracnose affects the flowers, leaves and fruit at various stages of growth and is a major cause of fruit rots inthe postharvest supply chain. Despite the development of chemical and cultural control measures for this disease, significant losses to production during harvest are still a reality, especially in years where wet wether is experienced. Over recent years several areas of pathogen / host interactions have been studied that may lead to new management options for the disease. These include: investigations of natural defence mechanisms with inthe mango and identification genotypes with high levels of natural resistance to the disease. In many plants pre-formed natural anti-fungal compounds act as protective chemical barriers against a range of pathogen infections when found in high concentrations.
The instrument used to directly assess exposure to infection is another limitation we found. Most studies used data from mothers via questionnaires for the recall of infection occurrence. This method is subject to misclassiication bias, with differential recall between cases and controls. Only three ofthe studies in this review obtained clinical records to evaluate children’s exposure to infection. 9,64,75 Although this latter method is not affected by recall bias, it does present other dificulties. The lack of a clinical records system with extensive population coverage and good quality data hinders the use of this instrument. Furthermore, the number of infections can be underestimated because the occurrence of common infections does not always mean that the mother seeks health service help. Simpson et al 75 compared results from clinical diagnoses of infection with those based on maternal self-report. They observed that mothers of cases and controls under-re- ported the frequency of infections inthe irst year of life. However, the degree of under-reporting appeared greater for mothers of cases than of controls.
Colorimetric assays were performed to evaluate cytotoxicity. Human acutepromyelocyticleukemia cells (NB4), human lung adenocarcinoma (A549), human neuroblastoma (SHSY5Y), human prostate (PC3), and human breast adenocarcinoma (MCF7) tumor cell lines were purchased from the American Type Culture Collection (ATCC). All cells were cultured in Roswell Park Memorial Institute-1640 (RPMI-1640) or Dulbecco’s modification of Eagle’s medium (DMEM) medium (Hyclone, Logan, UT) supplemented with 10% fetal bovine serum (Hyclone) at 37 °C in a humidified atmosphere with 5% CO 2 . Cell viability was assessed by conducting