Current knowledge on HIV-associated Plasmablastic Lymphoma

HIV-associated PBL is an AIDS-defining cancer, classified by WHO as a distinct entity of aggressive DLBCL. To date less than 250 cases have been published, of them 17 are pediatric. The pathogenesis of this rare disease is related to immunodeficiency, chronic immune stimulation and EBV. Clinically is a rapid growing destructive disease mainly involving the oral cavity even if extraoral and extranodal sites are not infrequent. The diagnosis requires tissue mass or lymph node biopsy and core needle or fine needle biopsy is acceptable only for difficult access sites. Classically immunophenotype is CD45, CD20, CD79a negative and CD38, CD138, MUM1 positive, EBER and KI67 is >80%. Regarding the therapy, standard treatment is, usually, CHOP or CHOP-like regimens while more intensive regimens as CODOX-M/IVAC or DA-EPOCH are possible options. Use of cART is recommended during chemotherapy, keeping in mind the possible overlapping toxicities. Rituximab is not useful for this CD20 negative disease and CNS prophylaxis is mandatory. Intensification with ABMT in CR1 may be considered for fit patients. For refractory/relapsed patients, therapy is, usually, considered palliative, however, in chemo-sensitive disease, intensification + ABMT or new drugs as Bortezomib may be considered. Factors affecting outcome are achieving complete remission, PS, clinical stage, MYC, IPI score. Reported median PFS ranges between 6–7 months and median OS ranges between 11–13 months. Long term survivors are reported but mostly in pediatric patients. Finally, due to the scarcity of data on this subtype of NHL we suggest that the diagnosis and the management of HIV-positive PBL patients should be performed in specialized centers

LINFOMA DE CÉLULAS GRANDES B DIFUSO, EPSTEIN-BARR VIRUS POSITIVO

El Linfoma de células grandes B difuso EBV positivo es una entidad descrita el 2008 en la clasificación de la WHO y que ha sufrido cambios hasta la fecha. Corresponde del 2 al 15% de todos los Linfomas de células grandes B difuso, con variación de acuerdo a la localización geográfica. Afecta a jóvenes y adultos. Inicialmente reconocida como una entidad agresiva con pobre sobrevida, hoy se conoce su alta sensibilidad al rituximab. El pronóstico mejora notablemente cuando el tratamiento está basado en inmunoquimioterapia. DOI: https://doi.org/10.25176/RFMH.v17.n3.119

Immunophenotypical Switch versus Tumor Heterogeneity in a Patient with HIV-Associated Diffuse Large B-Cell Lymphoma

Patients with HIV/AIDS have a higher risk of developing aggressive B-cell lymphomas, such as diffuse large B-cell lymphoma (DLBCL). Lymphomas are rather heterogeneous in nature and in a few cases can switch their genetic or immunohistochemical phenotype, transform into other lymphomas or carry more than one malignant clone. In this report, we present the case of a 47-year-old man with HIV infection who was diagnosed with an apparent low-risk, early-stage DLBCL, but became refractory to therapy while undergoing treatment with rituximab-containing chemotherapy. We postulate that the development of his refractory disease occurred in the context of an immunohistochemical switch or the surge of a clone refractory to therapy. This phenomenon was not associated with a superinfection with EBV or HHV-8

The biology and treatment of plasmablastic lymphoma

AbstractPlasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. However, PBL can also be seen in patients with other immunodeficiencies as well as in immunocompetent individuals. Because of its distinct clinical and pathological features, such as lack of expression of CD20, plasmablastic morphology, and clinical course characterized by early relapses and subsequent chemotherapy resistance, PBL can represent a diagnostic and therapeutic challenge for pathologists and clinicians alike. Despite the recent advances in the therapy of HIV-associated and aggressive lymphomas, patients with PBL for the most part have poor outcomes. The objectives of this review are to summarize the current knowledge on the epidemiology, biology, clinical and pathological characteristics, differential diagnosis, therapy, prognostic factors, outcomes, and potential novel therapeutic approaches in patients with PBL and also to increase the awareness toward PBL in the medical community

Plasmablastic Lymphoma: A Systematic Review

Plasmablastic lymphoma (PBL) is a very aggressive variant of diffuse large B-cell lymphoma initially described in the oral cavity of HIV-infected individuals. PBL represents a diagnostic challenge given its characteristic morphology and lack of CD20 expression, and also a therapeutic challenge, with early responses to therapy, but with high relapse rates and poor prognosis. In recent years, our understanding and clinical experience with PBL has increased in both HIV-positive and -negative settings. However, given its rarity, most of the data available rely on case reports and case series. The main goal of this article is to systematically review the most recent advances in epidemiology; pathophysiology; clinical, pathologic, and molecular characteristics; therapy; and prognosis in patients with PBL. Specific covered topics include new pathological markers for diagnosis, its association with Epstein-Barr virus, and the need of more intensive therapies

HIGHLAND AVIAN SURVEYS IN CERRO HOYA NATIONAL PARK (AZUERO, PANAMÁ) REVEAL NEW RANGE EXTENSIONS, INCLUDING A RARE HUMMINGBIRD (SELASPHORUS SP.)

Abstract ∙ Cerro Hoya National Park in Panama (CHNP) is one of the least explored protected areas in southern Mesoamerica. It houses the greatest ecosystem diversity in the degraded Azuero Peninsula, but its inaccessibility hinders expeditions and scientific research. Avian richness in CHNP was previously estimated by combining data from five ornithological expeditions at ca. 225 species. However, the highest altitude areas remained relatively unexplored and some historical records were not verified. We intensively surveyed highlands and foothills of CHNP and identified five new range extensions. One of these included a Selasphorus sp., of which we collected three male (two adults, one immature) and one female specimens. We compared morphology and plumage color patterns of these with closely related species in detail and confirm their likely classification with the endangered Glow-throated Hummingbird (Selasphorus ardens). This species is rare, with few documented sightings, confirmed specimens, and no unambiguous female museum specimen until now. We also confirmed historical records and provide 26 unlisted species (one by an external source) to CHNP. Our results confirm that Cerro Hoya is a highly biodiverse skyisland of Mesoamerica. We urge improved enforcement of its protection in combination with further studies of the ecology and evolutionary processes in this unique region. Resumen · Censos ornitológicos en ambientes de altura en el Parque Nacional Cerro Hoya (Azuero, Panamá) revelan nuevas extensiones de distribución, incluyendo un inusual colibrí (Selasphorus sp.) El Parque Nacional Cerro Hoya (PNCH) es una de las áreas protegidas menos exploradas de Panamá y el sur de Mesoamérica. Este alberga la mayor diversidad de ecosistemas en la degradada península de Azuero, pero su inaccesibilidad dificulta la investigación científica. Combinando datos de cinco expediciones ornitológicas, se estimó una riqueza aviar de alrededor de 225 especies. No obstante, las áreas de mayor altitud permanecieron relativamente inexploradas y algunos registros históricos no fueron verificados. Exploramos intensivamente las tierras altas y estribaciones del PNCH e identificamos cinco nuevas extensiones de distribución. Uno de estos incluye Selasphorus sp., del cual colectamos tres especímenes machos (dos adultos, un juvenil) y una hembra. Comparamos detalladamente la morfología y los patrones de coloración del plumaje con especímenes de especies relacionadas estrechamente. Confirmamos que estos individuos podrían pertenecer al amenazado Colibrí Ardiente (Selasphorus ardens). Esta especie es rara, con pocos avistamientos y especímenes de museo con información inconsistente, principalmente en hembras. También confirmamos los registros históricos y agregamos 26 especies no listadas para el PNCH (una obtenida por fuente externa). Nuestros resultados confirman que Cerro Hoya es una isla-cielo de gran biodiversidad en Mesoamérica. Es urgente mejorar la aplicación de su protección, así como estudiar la ecología y los procesos evolutivos en esta región única

Consolidación de la memoria implícita: efecto de la valencia emocional y el tiempo de exposición mediante el uso de Priming perceptual

The effect of emotional valence and prime’s exposure length on implicit memory consolidation was examined using a modified masked perceptual priming paradigm for emotion recognition under conditions of limited awareness. Priming faces of either happiness, anger and neutral emotional expressions were displayed for different durations (17ms vs 33ms vs 83ms), followed by an implicit memory task (target’s facial emotion recall). Statistically significant differences were found in emotional valence across different exposure lengths in the perceptual processing task when compared to reaction times in the implicit memory consolidation task. Significant differences were also observed for exposure length between perceptual processing task and implicit memory consolidation task. Results showed a significant association between hit rate and emotional valence as a function of exposure length. Overall, our results suggest that emotional valence impacts on perceptual processing and implicit memory consolidation.Se estudió el efecto de la valencia emocional y los tiempos de exposición en la consolidación de la memoria implícita mediante el uso del paradigma de priming perceptual enmascarado modificado, con reconocimiento de emociones bajo condiciones de consciencia limitada. Se presentaron rostros priming con expresiones emocionales de felicidad, rabia y neutro, en tiempos de exposición de 17ms, 33ms y 83 ms; posteriormente, los sujetos ejecutaron la tarea de memoria implícita, la cual consistía en recordar la emoción del rostro target de la primera tarea. Se encontraron diferencias estadísticamente significativas a nivel de la valencia emocional entre los diferentes tiempos de exposición en la tarea de procesamiento perceptual, en comparación con la tarea de consolidación de la memoria implícita a nivel de los tiempos de reacción. Igualmente, se encontraron diferencias estadísticamente significativas en los tiempos de exposición al comparar la tarea de procesamiento perceptual y la de consolidación de la memoria implícita. Los resultados obtenidos explican que existe una correlación entre las respuestas correctas de esta última tarea y las valencias emocionales, con cada uno de los tres tiempos de exposición. Estos resultados sugieren que las valencias emocionales influyen diferencialmente en las tareas de procesamiento perceptual y consolidación de la memoria implícita

Classe invertida (flipped classroom). Experiència en el grau d'Infermeria.

Projecte finalitzat desembre 2015En l’aula invertida (flipped classroom) (FC), els estudiants treballen fora de classe, tasques prèviament preparades amb aquest fi pel professorat. L’objectiu del estudi es motivar als estudiants suplint per FC les classes teòriques magistrals. Superar favorablement FC evita l’examen final (30% de l’avaluació). Context d’aplicació: grup C, 89 estudiants (finalitzen n=81). Programa de Ciències Psicosocials Aplicades a la Salut, assignatura anual, formació bàsica, 9 ECTS, primer curs, Grau d’Infermeria, tarda, segon semestre, curs 2014-15. Metodologia: resposta escrita a preguntes amb suport bibliogràfic i avaluació amb instruments específics estandaritzats. A classe: avaluació per parells i contrastos verbals sobre continguts, tutelats per la professora, que presenta una segona avaluació setmanal (campus virtual). Resultats: Contrast estadístic de notes FC amb examen test, igual al realitzat en grup A (intraclasse). Puntuació (sobre 10) superior a FC (mitja: 7,96 + DE: 0,67) que en l’examen (mitja 5,89 + DE: 1,26), <0.001. També es contrasten resultats d’examen de FC i de grup A (mitja: 6,02 + DE 1,18) (interclasse) i no es troben diferencies estadísticament significatives 0.508 . Degut a que el grup C (FC) no s’havia preparat ni estudiat l’examen, la diferencia de dècimes mostra una adquisició de coneixements favorable per la experiència flipped classroom.2014PID-UB/5