Co-existence of Antiphospholipid syndrome and Heparin-induced Thrombocytopenia in a patient with Recurrent Venous Thromboembolism.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug reaction in which heparin forms complexes with platelet factor 4 forming neoantigens that are recognized by autoantibodies. Antiphospholipid syndrome (APS) is similar to HIT in that it is mediated by autoantibodies that are also pro-thrombotic. We present a case of rare co-existence of antiphospholipid antibody syndrome and heparin-induced thrombocytopenia. Introduction Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug reaction in which heparin forms complexes with platelet factor 4 forming neoantigens that are recognized by autoantibodies (antiHPF4/HAPA). The Fc portions of the anti-HPF4 bind Fc receptors on platelets causing platelets activation, aggregation, release of α and dense granules and formation of procoagulants [1]. The hallmark of this is thrombocytopenia and thrombosis. HIT occurs in about 2% of all patients who receive heparin of whom about 35% develop thrombosis [2]. Antiphospholipid syndrome (APS) is similar to HIT in that it is mediated by autoantibodies that are also pro-thrombotic. Autoantibodies are generated to phospholipids or to phospholipid-binding proteins which are recognized risk-factors for thrombosis and pregnancy morbidity. Diagnosis of APS requires the elevation of at least one of the phospholipid autoantibodies and a clinical manifestation (Table 1). In this report we present a patient with recurrent venous thromboembolism despite been on full anticoagulation who was found to have concurrent HIT and APS

Bevacizumab Demonstrates Prolonged Disease Stabilization in Patients with Heavily Pretreated Metastatic Renal Cell Carcinoma: A Case Series and Review of the Literature

There are now a variety of therapies approved for the treatment of metastatic renal cell carcinoma (RCC). These include the immunotherapeutics, alfa-interferon, and interleukin-2, and agents that target the vascular endothelial growth factor receptor (VEGFR) via its tyrosine kinase, such as sorafenib, sunitinib, and pazopanib, or the mammalian target of rapamycin (mTOR), such as temsirolimus and everolimus. Bevacizumab, a monoclonal antibody directed against the ligand, VEGF, has shown activity against RCC as a single agent in patients who had failed prior cytokine therapy and as first line therapy in combination with interferon. The activity of bevacizumab in patients who had received and failed prior therapy has not been described. We report our experience in 4 patients with metastatic RCC who had failed prior cytokine, TKI, and mTOR inhibitors who were treated with bevacizumab as single agent therapy. These heavily pretreated patients sustained very prolonged periods of stable disease (median of 12 months) with very little toxicity and excellent quality of life. The activity of this agent in patients who had failed prior therapies directed against the VEGFR and mTOR suggests that therapy targeting the ligand, VEGF, is still a viable approach in these patients and deserves further study

An Extremely Indolent T-cell Leukemia: An 18-year Follow-Up.

T-cell prolymphocytic leukemia (T-PLL) is a rare malignancy that comprises about 2% of all mature lymphoid neoplasms. Patients usually present with prominent peripheral blood lymphocytosis, splenomegaly, hepatomegaly, lymphadenopathy, B symptoms, and occasionally with skin lesions.¹ The disease follows an aggressive clinical course with rapid progression and typically has a median survival of less than 1 year. In some cases, the disease is indolent for a period of time before becoming aggressive.² In 2002, 7 years after initial diagnosis in 1995, the case discussed herein was reported as a rare, indolent form of T-PLL.³ We now present 11 additional years of follow-up of this case, during which time the patient remained asymptomatic with respect to his lymphoid neoplasm

Gender Equity Commission Priorities: An Archival Study and Prospects for the Future

This research explores the priorities of the gender equity commission in New York City over forty-five years. Archival commission data was organized thematically to understand the history of gender equity and suggest future possibilities for gender equity beyond New York City. In our historical analysis, we see an expansion of the definition of gender and an adoption of an intersectional approach to gender. We identify four historical gender priorities: sexual harassment and violence, pay equity and economic advancement, health and safety, and gender recognition and celebration. To address systemic issues of gender inequity, we recommend local level administrators embed an intersectional approach in their policies and programming and move away from the commission model to one of a permanent office or agency. These recommendations will better equip municipalities with the resources to increase gender equity, particularly during COVID-19 recovery

A rare case of acute lymphoblastic leukemia in a patient with light chain (AL) amyloidosis treated with lenalidomide.

Lenalidomide belongs to a novel class of drugs called Immunomodulators which are now being used for the treatment of plasma cell dyscrasias with variable degrees of efficacy and toxicity. Though Second Primary Malignancies (SPM) have been a concern with its use, the benefits of the treatment outweigh the risks. The leukemogenic risk seems to be potentiated especially when combined with alkylating agents and the SPMs documented are predominantly myeloblastic. To date there are no reported cases of new lymphocytic leukemias in AL amyloidosis, regardless of whether undergone treatment or not. We present a case of AL amylodosis who was treated with lenalidomide and subsequently developed acute lymphoblastic leukemia

Clinical Characteristics and Treatment-Related Biomarkers Associated with Response to High-Dose Interleukin-2 in Metastatic Melanoma and Renal Cell Carcinoma: Retrospective Analysis of an Academic Community Hospital\u27s Experience.

Background Immunotherapy in the treatment of metastatic melanoma and renal cell carcinoma can produce durable therapeutic responses, which may improve survival. We aimed to identify clinical characteristics and biomarkers associated with response to high-dose interleukin-2 therapy (IL-2) in patients with metastatic melanoma and renal cell carcinoma treated at an academic community hospital. Patients/Methods We retrospectively analyzed clinical variables and biomarkers of 50 consecutive metastatic melanoma or renal cell carcinoma patients treated at our institution with IL-2 during 2004 – 2012. We evaluated clinical characteristics: metastatic sites of disease, prior therapies, number of IL-2 doses per cycle, response duration, autoimmune phenomena, and peak fever, as well as laboratory biomarkers: baseline LDH, platelet nadir, and baseline and highest absolute lymphocyte count (ALC). Survival outcomes were calculated using Kaplan-Meier curves. Results Variables differing between responders (clinical benefit group) and non-responders (no clinical benefit group) in metastatic melanoma included platelet nadir during treatment (p = 0.015), autoimmune phenomena (p = 0.049), and in renal cell carcinoma, platelet nadir (p = 0.026). There were no significant differences between number of doses of IL-2 received per cycle and response in either cancer subtype. Clinical benefit occurred in 25% of patients (9/36) when IL-2 was given as first-line therapy. Median overall survival for the clinical benefit group from the initiation of IL-2 to death or last follow-up was 61 months versus 17 months for the no clinical benefit group (p \u3c 0.001) for metastatic melanoma. In renal cell carcinoma overall survival for clinical benefit patients was 48 months versus 17 months. No treatment-related deaths occurred. Conclusions High-dose IL-2 can be safely administered by an experienced team in a non–intensive care oncology unit. The clinical benefit group developed autoimmune phenomena (melanoma patients), lower platelet nadir, and on average, received the same number of IL-2 doses as the no clinical benefit group, suggesting a response relationship to the patient’s baseline immune status. Further investigation of immune predictors of response may be useful to select appropriate patients for this therapy. Keywords: Interleukin-2, Metastatic melanoma, Metastatic renal cell carcinoma, IL-2, Biomarkers, Safety, Respons

Матеріали інформаційно-методичного забезпечення дисципліни «Правоохоронне право (Суд)»

Одержані знання дозволять студентам сформувати фаховий світогляд, пізнати органічні зв’язки даної навчальної дисципліни з іншими академічними курсами. Вибіркова дисципліна «Правоохоронне право (Суд)» межує з такими правовими дисциплінами, як ”Судові та правоохоронні органи України”, «Цивільне право», «Кримінальне право», «Цивільний процес», «Кримінальний процес», «Адміністративне судочинство», «Господарське право», «Господарський процес» та інші.Вибіркова дисципліна «Правоохоронне право (Суд)» займає особливе місце в навчальному плані і є невід’ємним фактором правової системи й основним недержавним інститутом захисту особистості, її прав і свобод. Зміст цієї навчальної дисципліни складається із знань, що регулюють діяльність суду – захисника у сфері судочинства, судового захисту прав та інтересів людей