Prognostic and Therapeutic Implications of Lymphocytes in Hematological Disorders and Solid Malignancies

An efficient and specific cytotoxic immune response against a tumor requires a complex, rapidly evolving interaction between various immune cell types in the adaptive and innate immune system. This pliable interplay is a relentless process that has been concisely organized in three different phases: elimination, equilibrium, and escape. The identification of key immune players and molecules involved in this interplay has been crucial for the introduction of reliable prognostic factors and effective therapeutic protocols against cancers. In this chapter, we aim to depict the roles of these distinct immune cell subsets, summarize the prognostic value of immune cells in different cancer types, and discuss briefly the principles of different immunotherapeutic approaches against hematologic malignancies and solid tumors

Right heart thrombus-in-transit with pulmonary embolism in a patient with primary hypercoagulable state

A 25 year-old female with a history of Caesarian section ten weeks ago presented with symptoms suggestive of pulmonary embolism. Transthoracic echocardiography revealed a free- -floating large thrombus traversing the right atrial cavity. Transesophageal echocardiography confirmed the presence of an unattached thrombus that originated from the most proximal part of the inferior vena cava. Multi-slice computed tomography of the chest and abdomen revealed the thrombus to start from the intra-hepatic part of the inferior vena cava and extend through the right atrium. It also demonstrated multiple thrombi in the pulmonary vasculature, the largest being in the right main pulmonary artery and its lower lobe branch. The patient was triaged for surgical embolectomy under cardio-pulmonary bypass. Follow-up trans-thoracic and transesophageal echocardiography confirmed adequate removal of the thrombus. By genetic examination, she proved to have factor V ’Leiden’ gene and two thrombophilia genes, all of which were positive in the heterozygous state. She had also a high serum homocysteine. (Cardiol J 2010; 17, 4: 408-411

Usporedba dvaju inhibitora cikooksigenaze u eksperimentalnom modelu suhog oka u albino kunića

The purpose of this study was to compare the topical anti-inflammatory effects of the nonselective cyclooxygenase (COX) inhibitor, ketorolac, with the selective COX-2 inhibitor, nimesulide, in an animal model of dry eye in albino rabbits. All animals were examined by the Schirmer test, tear break-up time (TBUT) and fluorescein corneal staining test. Dry eye model showed significant reduction in tear volume, TBUT, corneal staining and histopathological signs of dryness and inflammation. On treating dry eye model with nimesulide 0.1% eye drops and ketorolac 0.5% eye drops, there were improvements in Schirmer test values, TBUT and fluorescein corneal staining and histopathologically reduced inflammatory reaction, with signs of healing and regeneration. Both nimesulide and ketorolac ameliorate atropine sulphate induced dry eye in albino rabbits. The use of selective COX-2 inhibitor, nimesulide, is preferred to avoid local and systemic side effects which may occur with the use of the nonselective COX inhibitor, ketorolac.Cilj istraživanja bila je usporedba topičkog protuupalnog učinka neselektivnog inhibitora ciklooksigenaze (COX), ketorolaka i selektivnog COX-2 inhibitora, nimesulida na animalnom modelu suhog oka u albino kunića. Na životinjama je proveden Schirmerov test, vrijeme prestanka suzenja oka tear break-up time (TBUT) i test bojenja rožnice fluoresceinom. U animalnom modelu suhog oka značajno je smanjen volumen suza, TBUT, bojenje rožnice i histopatološki simptomi suhoće i upale. Obradom suhog oka s kapima za oči koje sadrže 0,1% nimesulida, odnosno 0,5% ketorolaka, poboljšane su vrijednosti u Schirmerovom testu, TBUT i bojanje rožnice fluoresceinom, smanjena je upalna reakcija, a na oku su se pokazali simptomi ozdravljenja i regeneracije. I nimesulid i ketorolak smanjuju suhoću oka induciranu atropin sulfatom u albino kunića. Uporaba selektivnog COX-2 inhibitora, nimesulida, se preferira jer se izbjegavaju lokalne i sistemske nuspojave koje se mogu pojaviti uz uporabu neselektivnog COX inhibitora, ketorolaka

Myeloid sarcoma of the vulva post-bone marrow transplant presenting as isolated extramedullary relapse in a patient with acute myeloid leukemia

Myeloid sarcoma is a tumor of myoblasts or immature myeloid cells occurring in an extramedullary site. Myeloid sarcoma of the female genital tract as an isolated initial presentation or isolated relapse is very rare as evidenced from a literature review. We report a case of vulvar myeloid sarcoma presenting as isolated relapse of acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplant (HSCT). A 41-year-old female diagnosed with AML M5 achieved remission with chemotherapy and underwent allogeneic HSCT from an HLA-matched sibling donor. The post-transplant period was complicated with chronic graft-versus-host disease. At 10 months post-transplant, she presented with a vulvar mass of six weeks duration. Excisional biopsy of the vulvar mass confirmed the diagnosis of myeloid sarcoma as extramedullary relapse. Bone marrow biopsy was without evidence of leukemia. Involvement of the vulva, vaginal and adjacent cervical area only was confirmed. She received re-induction chemotherapy with clinical regression of both the vulvar, vaginal and the cervical masses; this was followed by radiation therapy to an extramedullary site. The correct diagnosis of myeloid sarcoma, particularly of an isolated mass in the genital area, is important because of its rarity and the need for appropriate institution of therapy

The risk and prognosis of COVID-19 infection in cancer patients: A systematic review and meta-analysis

Numerous studies have been published regarding outcomes of cancer patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) infection. However, most of these are single-center studies with a limited number of patients. To better assess the outcomes of this new infection in this subgroup of susceptible patients, we performed a systematic review and meta-analysis to evaluate the impact of COVID-19 infection on cancer patients. We performed a literature search using PubMed, Web of Science, and Scopus for studies that reported the risk of infection and complications of COVID-19 in cancer patients and retrieved 22 studies (1018 cancer patients). The analysis showed that the frequency of cancer among patients with confirmed COVID-19 was 2.1% (95% confidence interval [CI]: 1.3-3) in the overall cohort. These patients had a mortality of 21.1% (95% CI: 14.7-27.6), severe/critical disease rate of 45.4% (95% CI: 37.4-53.3), intensive care unit (ICU) admission rate of 14.5% (95% CI: 8.5-20.4), and mechanical ventilation rate of 11.7% (95% CI: 5.5-18). The double-arm analysis showed that cancer patients had a higher risk of mortality (odds ratio [OR]\u202f=\u202f3.23, 95% CI: 1.71-6.13), severe/critical disease (OR\u202f=\u202f3.91, 95% CI: 2.70-5.67), ICU admission (OR\u202f=\u202f3.10, 95% CI: 1.85-5.17), and mechanical ventilation (OR\u202f=\u202f4.86, 95% CI: 1.27-18.65) than non-cancer patients. Furthermore, cancer patients had significantly lower platelet levels and higher D-dimer levels, C-reactive protein levels, and prothrombin time. In conclusion, these results indicate that cancer patients are at a higher risk of COVID-19 infection-related complications. Therefore, cancer patients need diligent preventive care measures and aggressive surveillance for earlier detection of COVID-19 infection