Population Pharmacokinetics of Alemtuzumab (Campath) in Pediatric Hematopoietic Cell Transplantation: Towards Individualized Dosing to Improve Outcome

BACKGROUND AND OBJECTIVE: Alemtuzumab (Campath®) is used to prevent graft-versus-host disease and graft failure following pediatric allogeneic hematopoietic cell transplantation. The main toxicity includes delayed immune reconstitution, subsequent viral reactivations, and leukemia relapse. Exposure to alemtuzumab is highly variable upon empirical milligram/kilogram dosing. METHODS: A population pharmacokinetic (PK) model for alemtuzumab was developed based on a total of 1146 concentration samples from 206 patients, aged 0.2-19 years, receiving a cumulative intravenous dose of 0.2-1.5 mg/kg, and treated between 2003 and 2015 in two centers. RESULTS: Alemtuzumab PK were best described using a two-compartment model with a parallel saturable and linear elimination pathway. The linear clearance pathway, central volume of distribution, and intercompartmental distribution increased with body weight. Blood lymphocyte counts, a potential substrate for alemtuzumab, did not impact clearance. CONCLUSION: The current practice with uniform milligram/kilogram doses leads to highly variable exposures in children due to the non-linear relationship between body weight and alemtuzumab PK. This model may be used for individualized dosing of alemtuzumab

Duffy blood group gene polymorphisms among malaria vivax patients in four areas of the Brazilian Amazon region

<p>Abstract</p> <p>Background</p> <p>Duffy blood group polymorphisms are important in areas where <it>Plasmodium vivax </it>predominates, because this molecule acts as a receptor for this protozoan. In the present study, Duffy blood group genotyping in <it>P. vivax </it>malaria patients from four different Brazilian endemic areas is reported, exploring significant associations between blood group variants and susceptibility or resistance to malaria.</p> <p>Methods</p> <p>The <it>P. vivax </it>identification was determined by non-genotypic and genotypic screening tests. The Duffy blood group was genotyped by PCR/RFLP in 330 blood donors and 312 malaria patients from four Brazilian Amazon areas. In order to assess the variables significance and to obtain independence among the proportions, the Fisher's exact test was used.</p> <p>Results</p> <p>The data show a high frequency of the <it>FYA/FYB </it>genotype, followed by <it>FYB/FYB, FYA/FYA</it>, <it>FYA/FYB-33 </it>and <it>FYB/FYB-33</it>. Low frequencies were detected for the <it>FYA/FY</it>^<it>X</it>, <it>FYB/FY</it>^<it>X</it>, <it>FYX/FY</it>^{<it>X </it>}and <it>FYB-33/FYB-33 </it>genotypes. Negative Duffy genotype (<it>FYB-33/FYB-33</it>) was found in both groups: individuals infected and non-infected (blood donors). No individual carried the <it>FY</it>^<it>X</it><it>/FYB-33 </it>genotype. Some of the Duffy genotypes frequencies showed significant differences between donors and malaria patients.</p> <p>Conclusion</p> <p>The obtained data suggest that individuals with the <it>FYA/FYB </it>genotype have higher susceptibility to malaria. The presence of the <it>FYB-33 </it>allele may be a selective advantage in the population, reducing the rate of infection by <it>P. vivax </it>in this region. Additional efforts may contribute to better elucidate the physiopathologic differences in this parasite/host relationship in regions endemic for <it>P. vivax </it>malaria, in particular the Brazilian Amazon region.</p

Phylogeny in Aid of the Present and Novel Microbial Lineages: Diversity in Bacillus

Bacillus represents microbes of high economic, medical and biodefense importance. Bacillus strain identification based on 16S rRNA sequence analyses is invariably limited to species level. Secondly, certain discrepancies exist in the segregation of Bacillus subtilis strains. In the RDP/NCBI databases, out of a total of 2611 individual 16S rDNA sequences belonging to the 175 different species of the genus Bacillus, only 1586 have been identified up to species level. 16S rRNA sequences of Bacillus anthracis (153 strains), B. cereus (211 strains), B. thuringiensis (108 strains), B. subtilis (271 strains), B. licheniformis (131 strains), B. pumilus (83 strains), B. megaterium (47 strains), B. sphaericus (42 strains), B. clausii (39 strains) and B. halodurans (36 strains) were considered for generating species-specific framework and probes as tools for their rapid identification. Phylogenetic segregation of 1121, 16S rDNA sequences of 10 different Bacillus species in to 89 clusters enabled us to develop a phylogenetic frame work of 34 representative sequences. Using this phylogenetic framework, 305 out of 1025, 16S rDNA sequences presently classified as Bacillus sp. could be identified up to species level. This identification was supported by 20 to 30 nucleotides long signature sequences and in silico restriction enzyme analysis specific to the 10 Bacillus species. This integrated approach resulted in identifying around 30% of Bacillus sp. up to species level and revealed that B. subtilis strains can be segregated into two phylogenetically distinct groups, such that one of them may be renamed

Biomphalaria tenagophila: Genetic variability within intermediate snail hosts susceptible and resistant to Schistosoma mansoni infection

DNA analysis by molecular techniques has significantly expanded the perspectives of the study and understanding of genetic variability in molluscs that ere vectors of schistosomiasis. In tire present study, the genetic variability of susceptible and resistant B. tenagophila strains to S. mansoni infection was investigated using amplification of their genomic DNA by RAPD-PCR. The products were analyzed by PAGE and stained with silver. The results showed pdymorphism between tested strains with four different primers. We found two bonds of 1,900 and 3,420 bp that were characteristic of the susceptible strains with primer 2. The primers 9 end 10 identified a single polymorphic bond that was also characteristic of (3,136 and 5,041 bp, respectively) susceptible snails. Two polymorphic bonds were detected by primer 15: one with 1 800 bp was characteristic of the resistant strain and the other with 1,700 do in the susceptible one. These results provide additional evidence showing that the RAPD-PCR technique is adequate for the study of polymorphisms in intermediate hosts snails of S. mansoni. The obtained results are expected to expend the knowledge about the genetic variability of the snails and to permit the future identification of genomic sequences specifically related to the resistance/susceptibility of Biompholario to the larval forms of S. mansoni.111434

EFICÁCIA DO USO DA PROFILAXIA ANTIMICROBIANA ESTENDIDA NA PREVENÇÃO DE INFECÇÃO DE SÍTIO CIRÚRGICO NAS REDUÇÕES ABERTAS DE FRATURA E SEUS IMPACTOS NA EPIDEMIOLOGIA MICROBIOLÓGICA ASSOCIADA

Objetivo: Esse estudo tem como objetivo mensurar o impacto da profilaxia antibiótica combinada nas taxas de Infecção de Sítio Cirúrgico (ISC) de pacientes submetidos à Redução Aberta de Fratura (RAF) e avaliar o impacto dessa medida no perfil de resistência antimicrobiana dos pacientes com diagnóstico de Infecção Relacionadas a Fraturas (IRF). Métodos: Estudo de coorte retrospectivo, unicêntrico, realizado em um hospital universitário, utilizando banco de dados do Serviço de Controle de Infecção Hospitalar (SCIH) de pacientes submetidos a RAF no período de janeiro a dezembro de 2022. Foram excluídos da análise pacientes com fratura exposta e menores de 18 anos. IRF foi definido de acordo com os critérios de ISC do Centers for Disease Control and Prevention. Paciente de elevado risco para ISC foi definido como índice de comorbidades de Charlson maior ou igual a cinco. Os pacientes foram seguidos por três meses do pós-operatório. De janeiro a março de 2022 foi utilizado cefalotina como profilaxia cirúrgica (grupo pré-intervenção) e de abril a dezembro o grupo intervenção utilizou cefuroxima + gentamicina para os pacientes de risco elevado ou cefuroxima em monoterapia para os demais. Resultados: No total, 1.901 pacientes foram incluídos no estudo, 864 pré-intervenção e 1.037 no grupo intervenção. As taxas de ISC do grupo pré vs. intervenção foram 6,9% (72) e 2,8% (24), respectivamente (RR=0,4; 95% IC 0,22‒0,58; p=0,000). No ano de 2022, os microrganismos mais frequentemente identificados na FRI foram S. aureus (28%), S. coagulase negativo (14%), Klebsiella aerogenes (13%) e Pseudomonas aeruginosa (9%). A profilaxia antibiótica estendida aplicada para pacientes com elevado risco de ISC não alterou a epidemiologia microbiana da IRF, enquanto não aumentou as taxas de microrganismos Multirresistentes (MDR) (p=0,784). Paralelamente, houve aumento na sensibilidade à oxacilina para Gram-positivos (pré-40% vs. 67%) e aumento na sensibilidade aos carbapenêmicos aos Gram-negativos (pré-82% e pós-100%). Conclusão: A profilaxia antibiótica estendida aplicada para um grupo selecionado de pacientes com maior risco de desenvolverem IRF não elevou as taxas de ISC por microrganismos multirresistentes, porém, contribuiu para redução significativa das taxas de ISC. Estratégias individualizadas de prevenção de ISC e mais estudos multicêntricos, especialmente para infecções associadas a biofilme são necessárias

Biomphalaria tenagophila: genetic variability within intermediate snail hosts susceptible and resistant to Schistosoma mansoni infection

DNA analysis by molecular techniques has significantly expanded the perspectives of the study and understanding of genetic variability in molluscs that ere vectors of schistosomiasis. In tire present study, the genetic variability of susceptible and resistant B. tenagophila strains to S. mansoni infection was investigated using amplification of their genomic DNA by RAPD-PCR. The products were analyzed by PAGE and stained with silver. The results showed pdymorphism between tested strains with four different primers. We found two bonds of 1,900 and 3,420 bp that were characteristic of the susceptible strains with primer 2. The primers 9 end 10 identified a single polymorphic bond that was also characteristic of (3,136 and 5,041 bp, respectively) susceptible snails. Two polymorphic bonds were detected by primer 15: one with 1 800 bp was characteristic of the resistant strain and the other with 1,700 do in the susceptible one. These results provide additional evidence showing that the RAPD-PCR technique is adequate for the study of polymorphisms in intermediate hosts snails of S. mansoni. The obtained results are expected to expend the knowledge about the genetic variability of the snails and to permit the future identification of genomic sequences specifically related to the resistance/susceptibility of Biompholario to the larval forms of S. mansoni