T-cell large granular lymphocytic leukemia: treatment experience with fludarabine

OBJECTIVES: The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS: We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m2, for three to five days per month and 6 to 8 cycles. RESULTS: Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4x109/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment dueto liver toxicity, and one (16.6%) due to dyspesia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION: T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.

Concordância entre duas técnicas de quantificação do HBVDNA e associações com fibrose hepática em pacientes portadores de infecção crônica pelo vírus B da hepatite HBeAg negativos

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2010.INTRODUÇÃO: Para a infecção crônica pelo vírus da hepatite B (HBV) HBeAg negativo, a aplicabilidade clinica da quantificação do HBVDNA (carga viral) ficou mais clara nos últimos cinco anos, principalmente quanto ao diagnostico, a evolução e ao tratamento da infecção, influenciando, sobremaneira, a decisão de tratar. OBJETIVOS: Analisar a concordância dos títulos de carga viral quantificados por dois métodos distintos de biologia molecular e estimar as associações existentes entre carga viral e achados histológicos, ajustando por variáveis clinicas e laboratoriais selecionadas. MÉTODOS: Portadores de hepatite B crônica HBeAg negativo foram estudados quanto as suas características clinicas, laboratoriais, ecográficas e histológicas. Analises de correlação entre essas variáveis e as cargas virais – quantificadas com Amplicor (AMPL) e Taqman (TQM) foram realizadas. As concordâncias brutas e ajustadas por chance (índice Kappa) entre cargas virais obtidas pelas técnicas baseadas na reação de cadeia de polimerize (PCR) foram analisadas. RESULTADOS: Avaliados 54 pacientes (homens=33, 61,1%), a media de idade foi de 41,22 anos. Consumo de etanol era nulo em 66,7% (36/54). TGO estava aumentada em 48% (26/54) dos pacientes, com media de 30,83 ui/ml. TGP apresentava-se aumentada em aproximadamente 60% (32/54) dos pacientes estudados, com valor médio de 39,17 ui/mL. Quando os dois testes foram simultâneos em amostras pareadas, a media das cargas virais aferidas pelo TQM foi superior a media daquelas aferidas pelo AMPL (p<0,0001). AMPL detectou cargas virais < 2.000ui/ml em 74% dos pacientes (37/50). Para esse grupo, TQM detectou cargas virais ≥2.000ui/ml em 46% (17/37) dos pacientes. As variáveis independentes associadas a fibrose foram: idade, plaquetas, bilirrubina total e carga viral TQM. CONCLUSÃO: A concordância Kappa=0,31 entre os dois testes quantitativos de carga viral foi considerável (p<0,0001). Sem os resultados do teste TQM, mais da metade (54,8%) dos pacientes que tivessem sua avaliação limitada ao teste AMPL nao seriam considerados candidatos a tratamento. _______________________________________________________________________________________ ABSTRACTINTRODUCTION: In chronic hepatitis B virus (HBV) infected patients with hepatitis B e antigen (HBeAg) negative strand, the clinical relevance of serum HBV DNA measurement became clearer in the past five years regarding diagnosis, evolution and treatment. Starting therapy is directly influenced by quantitative evaluation of HBV viral load among other relevant variables. AIM: evaluate HBVDNA quantification concordance using two distinct PCR assays, Amplicor (AMPL) and Taqman (TQM), and estimate associations between viral load and biopsy findings, adjusting for clinical and laboratory variables. METHODS: 54 patients with HBeAg-negative chronic HBV infection were studied. Correlations between demographic, clinical, laboratory and HBVDNA variables were estimated. Serum HBV DNA quantification was obtained using two distinct assays. The concordance between these tests was estimated by Kappa index. RESULTS: Mean age was 41,9years, male patients predominant (61,1%). Ethanol use was absent in 36 individuals (66,7%), and less than 40g/day for all subjects enrolled. AST activity and ALT activity were abnormal at baseline in 48% (26/54) and in 60% (32/54), with mean values of 30,83 iu/ml and 39,17 iu/ml, respectively. For simultaneous quantification of HBVDNA, the mean viral load obtained with TQM assay was greater compared to AMPL assay (p<0,0001). Viral load obtained with AMPL was less than 2,000 iu/ml in 74% of patients (37/50). The TQM assay was able to detect HBVDNA levels greater than 2,000 iu/ml in 46% (17/37) of patients in this group. Independent variables associated with fibrosis were: age, platelets, total bilirubin and TQM viral load. CONCLUSION: The concordance of 0.31 between TQM and AMPL quantitative tests estimated by Kappa was considered considerable (p<0,0001). However, without simultaneous testing using TQM assay approximately half of patients with their evaluation limited to AMPL testing would not be adequately considered candidates for therapy

Boro e nitrogênio na incidência de hastes ocas e no rendimento de brócolis

A incidência de hastes ocas em brócolis (Brassica oleracea L. var. italica Plenck) depende de vários fatores que afetam a absorção e o transporte de B, elemento responsável pelo aparecimento dessa desordem fisiológica. O trabalho avaliou os efeitos de quatro níveis de nitrogênio e dois níveis de boro e da interação entre eles na incidência de hastes ocas e na produção de brócolis. As doses de N (100, 150, 200 e 250 kg ha-1) foram divididas em quatro aplicações iguais aos 15, 30, 45 e 60 dias após o transplante. O boro (0, 4 e 8 kg ha-1) foi aplicado metade no plantio e a outra metade em cobertura aos 45 dias após o transplante. A massa média das inflorescências e a produção total foram diminuídas com a aplicação de B em função do crescimento mais lento das plantas provocado pela toxicidade desse elemento. Contudo, nas áreas não adubadas com B, a porcentagem de plantas com hastes ocas foi, em média, de 44,14%, sendo que a incidência dessa anomalia sofreu drástica redução com a aplicação de B, onde a maior dose (8 kg ha-1) resultou em apenas 4,52% de inflorescências afetadas. Doses de N superiores a 215,4 kg ha-1 aumentaram o número de plantas com hastes ocas somente nas áreas que não receberam B.The incidence of hollow stem in broccoli (Brassica oleracea L. var. italica Plenck) depends on several factors that affect the absorption and transport of boron, which is the element responsible for the appearance of this physiological disorder. This study evaluated the effects of four levels of nitrogen and two levels of boron and the interaction between them in the incidence of hollow stem and yield of broccoli. The levels of N (100, 150, 200 and 250 kg ha-1) were divided into four applications equal to 15, 30, 45, and 60 days after transplant. Half of the boron (0, 4 and 8 kg ha-1) was applied at planting and half in coverage at 45 days after transplanting. Average mass and total yield were reduced with B application, as a result of the slower growth of plants, having been caused by the onset of symptoms of toxicity of this element. However, in areas not fertilized with B, the percentage of plants with hollow stems was on average 44.14%, while the incidence of this anomaly suffered drastic reduction in B application, where the highest level (8 kg ha-1) resulted in only 4.52% of affected inflorescences. Levels of more than 215.4 kg ha-1 of N have increased the number of plants with hollow stems only in areas that did not receive B

The relationship between TLR3 rs3775291 polymorphism and infectious diseases: a meta-analysis of case-control studies

Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Programa de Pós-Graduação em Epidemiologia e Vigilância Sanitária. Ananindeua, PA, Brasil.University of State of Pará. Postgraduate Program in Parasitic Biology in the Amazon. Belém, PA, Brazil.University of State of Pará. Postgraduate Program in Parasitic Biology in the Amazon. Belém, PA, Brazil.University of State of Pará. Postgraduate Program in Parasitic Biology in the Amazon. Belém, PA, Brazil.Federal University of Ceará. Faculty of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.As the host’s first line of defense against pathogens, Toll-like receptors (TLRs), such as the TLR3, are genes encoding transmembrane receptors of the same name. Depending on their expression, TLRs cause a pro- or anti-inflammatory response. The purpose of the article was to determine whether there is an association between the Toll-like receptor 3 (TLR3) rs3775291 Single Nucleotide Polymorphism—SNP and susceptibility to infections. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO under the code CRD42023429533. A systematic search for relevant studies was performed using PubMed, Scopus, SciELO, Google Scholar, and Science Direct by the MeSH descriptors and the Boolean Operator “AND”: “Infections”; “TLR3”; “SNP”, between January 2005 and July 2022. Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for genotypic comparison assuming a dominant genetic model (CT + TT vs. CC). A meta-analysis of 18 studies consisting of 3118 cases and 4368 controls found a significant association for risk between the presence of the TLR3 SNP rs3775291 and infections as part of the general analysis (OR = 1.16, 95% CI = 1.04–1.28, p = 0.004). In the subgroups of continents, the SNP had a protective role in Europe for 1044 cases and 1471 controls (OR = 0.83, 95% CI = 0.70–0.99, p = 0.04); however, the Asian (for 1588 patients and 2306 controls) and American (for 486 patients and 591 controls) continents had an increase in infectious risk (OR = 1.37, 95% CI = 1.19–1.58, p < 0.001; OR = 1.42, 95% CI = 1.08–1.86, and p = 0.01, respectively). Heterogeneity between studies was detected (I2 = 58%) but was explained in meta-regression by the subgroup of continents itself and publication bias was not evident. The results of the meta-analysis suggest a significant association between the TLR3 rs3775291 polymorphism and susceptibility to infections. Thus, when analyzing subgroups, the Asian and American continents showed that this SNP confers a higher risk against infections in a dominant genotypic model. Therefore, more studies are necessary to fully elucidate the role of TLR3 rs3775291 in infections