Evaluation of the role of TAX, HBZ, and HTLV-1 proviral load on the survival of ATLL patients

BACKGROUND: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy with very poor prognosis and short survival, caused by the human T-lymphotropic virus type-1 (HTLV-1). The HTLV-1 biomarkers trans-activator x (TAX) and HTLV-1 basic leucine zipper factor (HBZ) are main oncogenes and life-threatening elements. This study aimed to assess the role of the TAX and HBZ genes and HTLV-1 proviral load (PVL) in the survival of patients with ATLL. METHODS: Forty-three HTLV-1-infected individuals, including 18 asymptomatic carriers (AC) and 25 ATLL patients (ATLL), were evaluated between 2011 and 2015. The mRNA expression of TAX and HBZ and the HTLV-1 PVL were measured by quantitative PCR. RESULTS: Significant differences in the mean expression levels of TAX and HBZ were observed between the two study groups (ATLL and AC, P=0.014 and P=0.000, respectively). In addition, the ATLL group showed a significantly higher PVL than AC (P=0.000). There was a significant negative relationship between PVL and survival among all study groups (P=0.047). CONCLUSION: The HTLV-1 PVL and expression of TAX and HBZ were higher in the ATLL group than in the AC group. Moreover, a higher PVL was associated with shorter survival time among all ATLL subjects. Therefore, measurement of PVL, TAX, and HBZ may be beneficial for monitoring and predicting HTLV-1-infection outcomes, and PVL may be useful for prognosis assessment of ATLL patients. This research demonstrates the possible correlation between these virological markers and survival in ATLL patients.

Comparison between early and delayed images of [67]Ga scintigraphy for evaluation of recurrent lymphoma

Despite widespread use of [67]Gallium for lymphoma evaluation, timing of imaging after injection is a matter of controversy and to the extent of our knowledge no direct comparison has been made between early and delayed gallium images. We aimed to compare 24 and 48 hours post injection planar gallium imaging for evaluation of lymphoma recurrence. 255 patients suspicious of recurrent lymphoma were included in the study. Twenty four and 48 hours post injection [10 mCi] whole body Gallium imaging was performed. Semi-quantitative evaluation [background corrected] was carried out in positive whole body [67]Gallium scans. Diagnosis of recurrence was made by combination of clinical or pathologic examination if possible. In 59 patients the final diagnosis was made by tissue biopsy. In case of uncertain diagnosis, follow up of the patients [mean duration of 13 months] was used. The diagnosis was finally made by the referring hematologist. Whole body gallium scintigraphy was positive in 115 out of 150 patients with recurrence [sensitivity of 76%]. Comparison of the 24 and 48 hour images did not show any new lesion in the 48 hour images. However, delayed 48 hours images were required for definite detection of the gallium avid lesions in the abdominal and pelvic areas in 40 patients. Semi-quantitative evaluation of the lesion showed higher lesion to background ratio for 48 compared to the 24 hour images [p<0.001]. Considering higher lesion to background activity in the 48 hour images, delayed whole body [67]Gallium imaging may be more desirable for diagnosis of recurrent lymphoma, however 24 hour images may be sufficient. Delayed imaging can be reserved for suspicious activities [such as in abdominal images]. The strategy can save time and is more convenient for the imaging centers

functional polymorphism of the granulocyte macrophage colony stimulating factor is not associated with the outcome of HTLV-I infection

Genetic background has known to be associated with the outcome of human T cell lymphotropic virus [HTLV] type I infection. In The present study we investigate the association between GM-CSF gene polymorphisms with the outcome of HTLV-I infection. We analyzed 3 single-nucleotide polymorphisms in the promter region of granulocyte macrophage colony stimulating factor [GM-CSF] at positions -677A/C, -1440A/G and -1916T/C in 68 patients with HTLV- I-associated myelopathy/tropical spastic paraparesis [HAM/TSP] and 77 HTLV-I-seropositive asymptomatic carriers and 175 healthy controls from an area in Iran, Mashhad, where HTLV-I is endemic. No significant differences were observed in the distribution of GM-CSF polymorphisms between HAM/TSP patients, HTLV-I carriers and healthy controls [P> 0.05]. The -611A/C polymorphism fall within the transcriptional enhancer factor-2 [TEF-2] binding site, so an electrophoretic mobility shift assay [EMSA] was performed to determine the effects of polymorphisms on protein binding to the GM-CSF promoter. The result showed a significantly higher binding efficiency of nuclear protein to the A allele compared with the C allele. Our study suggests that polymorphisms in the GM-CSF promoter is not associated with the outcome of HTLV-I infection, however, GM-CSF polymorphism at position -677 could indeed influence gene expression

[ study of folate and cobalamin deficiency in elderly by determining a cut-off point with laboratory markers]

Prevalence of folate and cobalamin deficiency in elderly is high. Determining a cut off point for low and marginal levels of folate and cobalamin deficiency before development of anemia or neurocognitive presentations in elderly is essential. In this cross-sectional study 280 persons above 65 years old in the twelve regions of Mashhad city were admitted to Emam Reza [pbuh] hospital. They were physically examined by a general practitioner. Other data were obtained by questionnaire. Serum cobalamin and folate level were analyzed by RIA method. 76 persons, who had cobalamin of 120-450 pg/ml and folate of 1.5-7 ng/ml without any interfering factor for homocystein [Hey] measurement [creatinin> 1.5 g/dl, cigarette smoking and consuming certain kind of drugs] were analyzed for serum homocystein by Elisa method. All collected data was statistically analyzed by SPSS software. 48.7% of elderly had hyperhomocysteinemia. Hey was inversely correlated with cobalamin [p=0.001] and folate below cut off point [p=0.044]. For Hcy>15 mol/micro, cut off points for cobalamin and folate deficiency were <330 pg/ml and <6.5 ng/ml respectively. Prevalence of cobalamin deficiency in low levels [<122 pg/ml] was 22.7% and in marginal levels [122-330 pg/ml] was 51.8%. Prevalence of folate deficiency in low levels [<3 ng/ml] was 16.7% and in marginal levels [<6.5 ng/ml] was 64.2%. According to definition of cut off point, Prevalence of cobalamin and folate deficiency especially in marginal levels was higher than which is recorded. It is recommended that before development of signs and symptoms and other complications of hyperhomocysteinemia, all elderly patients undergoes screening for cobalamin and folate deficiency in appropriate intervals

Evaluation of the relationship between periodontal parameters and liver cirrhosis

Liver cirrhosis and other chronic liver diseases are sometimes detected with oral manifestations, and in recent years, cirrhosis has been recognized as a potential predisposing condition for periodontal disease. The purpose of this study was to determine the periodontal parameters in cirrhotic patients. In this study, twenty hospitalized patients with liver cirrhosis [case group] and 20 healthy individuals [control group] were selected and matched by age, gender, oral hygiene, and smoking habit. All subjects were non-alcoholic. The diagnosis of liver cirrhosis was confirmed histologically, and no other systemic diseases were present. Periodontal indices including probing depth [PPD], clinical attachment level [CAL] bleeding points index [BPI], and plaque index [PI] were recorded in both groups. The data were analyzed using Mann-Whitney and t-test. Mean CAL in case and control groups were 5.05 +/- 0.33 mm and 4.90 +/- 0.32 mm, respectively [P > 0.05]. Mean PPD was 4.37 +/- 0.20 mm in case and 4.28 +/- 0.18 mm in control group [P > 0.05]. Mean BPI was found to be 21.1% and 19.9% in the case and control group, respectively [P>0.05] Mean PI was 21.55 in case and 19.45 in control subjects [P > 0.05]. According to the results of this study, it could be concluded there are no significant differences between cirrhotic and healthy subjects in terms of periodontal disease parameters

Myelomatous pleural effusion

Multiple myeloma [MM] is a common hematologic malignancy. Pleural effusion is a rare presenting feature of multiple myeloma which carries a poor prognosis. Few cases of multiple myeloma with pleural involvement have been reported in the medical literature. We report a patient with MM diagnosed by cytologic examination of pleural fluid. Our patient was a 64-year old man with multiple myeloma who was receiving chemotherapy. He had developed dry coughs and exertional dyspnea about a month prior to the admission. Radiographic examination showed left pleural effusion with mediastinal shift to the opposite side. Diagnostic thoracentesis of pleural fluid was performed for the patient. Pathologic examination of pleural fluid showed plasmocytes and plasmablast type mononuclear cells with atypical nuclei, consistent with the diagnosis of pleural effusion due to multiple myeloma. In view of multiple etiologies of pleural effusion in malignant diseases, rare etiologies should also be considered in order to treat the effusion appropriately

[Specific cutaneous manifestations in adult Tcell leukemia/lymphoma]

Adult T cell leukemia/lymphoma [ATLL] is an aggresive malignancy which may occur in human T lymphotropic virus [HTLVl] infected persons. HTLV1 is endemic in Khorasan with prevalence of 2.3% in general population. Since specific cutaneous manifestations of lymphoma may occur in a significant number of patients, we studied ATLL patients in Mashhad In this descriptive study the demographic and clinical data of 23 patient suffering from ATLL who were admitted in hematology and dermatology departments of Ghaem Hospital, during 1995-2004 and had specific cutaneous lesions confirmed histopathologically with atypical lymphocytes in skin lesions, were recorded and analyzed. Eleven patients were male and 12 were female. The mean age of patients was 48.17 +/- 14.1 years. Birth places of over 85% of cases were north of Khorasan. The most common types of specific skin lesions were maculopapular rash in 11 cases [47.8%] and papular lesions in 4 cases [17.4%]. Other lesions included plaque, icthyosis like, erythroderma, tumor, and nodular lesions. In most of patients [56.5%] the skin lesions were generalized The most common type of specific skin lesions in ATLL was maculopapular rash especially with generalized distribution. Other types of specific skin lesions in order of frequency were papule, plaque, icthyosis like, nodule, tumor and erythroderma