Primary central nervous system lymphoma

O linfoma primário do sistema nervoso central (LPSNC) é um linfoma extralinfonodal que, ao diagnóstico, encontra-se restrito ao parênquima cerebral, às meninges e/ou cordão espinhal e/ou olhos. Sua incidência triplicou nas últimas três décadas para 0,4 casos por 100.000 habitantes, representando 4% dos tumores do sistema nervoso central (SNC). Embora pacientes infectados pelo HIV tenham 3.600 vezes maior risco para o desenvolvimento do LPSNC, a incidência não aumentou apenas neste grupo de pessoas. Dados sugerem reduções da incidência de LPSNC em pacientes infectados após a introdução de drogas anti-retrovirais. Cerca de 90% dos casos de LPSNC são classificados como linfoma difuso de grandes células B, 10% têm envolvimento ocular e 10% são HIV positivos. A apresentação clínica depende da localização tumoral, prevalecendo os sintomas neurológicos em detrimento aos sistêmicos. Os exames de tomografia computadorizada (TC) e ressonância nuclear magnética (RNM) são essenciais para o diagnóstico, porém o exame confirmatório deve ser o anatomopatológico. O estadiamento deve ser feito com exames de imagem e biópsia de medula óssea (BMO) bilateral. Os principais fatores de mau prognóstico são: performance status do paciente acima de 1, idade superior a 60 anos, DHL elevada, hiperproteinorraquia e acometimento de área cerebral não hemisférica. Alguns fatores de prognóstico biológicos também podem influenciar na sobrevida, a exemplo da expressão de Bcl-6, que confere melhor prognóstico. O tratamento de escolha é a combinação de quimioterapia contendo altas doses de metotrexate e radioterapia (RDT). Devido às altas taxas de neurotoxicidade associada à RDT, seu uso tem ficado mais restrito aos pacientes idosos, e os recidivados ou refratários.Primary Central Nervous System lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma in the brain, leptomeninges, spinal cord or eyes. The incidence of PCNSL increased approximately three-fold in the last decades. Nowadays, it represents 0.4 case per 100,000 people and accounts for 4% of all primary brain tumors. Although individuals infected with HIV have a 3,600-fold increased risk of developing PCNSL compared with the general population, the incidence has not increased only in AIDS group. Recent data suggest that the incidence of PCNSL declined in the AIDS group after the introduction of anti-retroviral drugs. Around 90% of PCNSL cases are classified as diffuse large B-cell lymphoma, 10% involve the eyes and 10% of patients are HIV positive. The clinical presentation depends on the location of the tumor with neurological rather than systemic symptoms. Computed tomography (CT) and magnetic resonance imaging (RMI) are essential in diagnosis, however the gold standard is tumor biopsy. Staging should be made with imaging and bilateral biopsy of bone marrow. The main poor prognosic parameters are performance status greater than 1, age older than 60 years, elevated DHL, high liquor protein concentration and tumor located within the deep regions of the brain. BCL-6 expression identified in the tumor confers a better prognosis. Currently, a combined therapy with high doses of methotrexate and whole-brain radiotherapy is the therapy of choice. Nowever, whole-brain radiotherapy should be carefully analyzed because neurotoxity is a frequent problem in the elderly and in relapsed and refractory patients

Penerimaan Diri dan Daya Juang Pada Wanita Penderita Systhemic Lupus Erythematosus (SLE)

Masa dewasa awal merupakan puncak dari perkembangan seseorang. Terutama untuk wanita usia dewasa awal yang harus membuat pencapaian perkembangan masa depan, seperti pekerjaan, hubungan dengan lawan jenis dan interaksi sosial, serta keluarga. Pencapaian hal-hal ini didukung oleh keadaan kesehatan fisik dan mental. Namun, bagi seorang wanita penderita lupus, pencapaian tugas perkembangan usia dewasa dini akan terhambat bahkan tertunda karena kondisi kesehatan mereka. Systemic Lupus Erythematosus adalah jenis lupus yang menyerang otak dan penderita saraf. Belum menemukan penyebab dan cara pengobatan yang tepat untuk pasien SLE. Tujuan dari penelitian penelitian ini adalah untuk mengetahui bagaimana proses semangat juang dan bentuk wanita dengan Systemic Lupus Erythematosus (SLE). Peneliti menggunakan penelitian kualitatif dengan pendekatan fenomenologis. Peneliti menggunakan teknik purposive sampling dalam menentukan subjek penelitian dan menggunakan dokumen tertulis sebagai sumber data. Metode pengumpulan data dalam penelitian ini menggunakan observasi dan wawancara. Penerimaan diri RS melibatkan keberanian untuk mengambil risiko berdasarkan keyakinan dan motivasi bahwa ia dapat mencoba untuk terus menyelesaikan sekolah, dan opsi RS memilih untuk tinggal bersama orang tuanya, serta rumah sakit mengikuti komunitas sosial di Malam hari karena rumah sakit harus menghindari paparan sinar matahari. NM mengaku mengundurkan diri ke kondisinya sebagai odapus meskipun NM melakukan perawatan rutin sehingga ada penolakan ketika NM mendapat tawaran membuat bros dan sulaman. Ketidaksempurnaan fisik tetap menjadi pekerjaan rumah yang berusaha menyulam dan mmebuat bros. PR dapat sejenak melupakan pekerjaan rumah yang berniat memulai bisnis online

Folate metabolism: a re-emerging therapeutic target in haematological cancers

Folate-mediated one carbon (1C) metabolism supports a series of processes that are essential for the cell. Through a number of interlinked reactions happening in the cytosol and mitochondria of the cell, folate metabolism contributes to de novo purine and thymidylate synthesis, to the methionine cycle and redox defence. Targeting the folate metabolism gave rise to modern chemotherapy, through the introduction of antifolates to treat paediatric leukaemia. Since then, antifolates, such as methotrexate and pralatrexate have been used to treat a series of blood cancers in clinic. However, traditional antifolates have many deleterious side effects in normal proliferating tissue, highlighting the urgent need for novel strategies to more selectively target 1C metabolism. Notably, mitochondrial 1C enzymes have been shown to be significantly upregulated in various cancers, making them attractive targets for the development of new chemotherapeutic agents. In this article, we present a detailed overview of folate-mediated 1C metabolism, its importance on cellular level and discuss how targeting folate metabolism has been exploited in blood cancers. Additionally, we explore possible therapeutic strategies that could overcome the limitations of traditional antifolates