Can NLR be a biomarker for mucositis and gvhd in patients undergoing allogeneic HSCT?

Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment for many diseases; however, it can induce complications such as Oral Mucositis (OM) and Graft-versus- Host Disease (GVHD). The neutrophil-lymphocyte ratio (NLR) is a peripheral biomarker of systemic inflammation and an independent prognostic factor for several inflammatory diseases. Aim: This study aimed to evaluate the association of NLR with OM and GVHD in patients undergoing allogeneic HSCT. Methods: Patients who underwent allogeneic HSCT at the Bone Marrow Transplant Service of the Hospital de Clínicas Complex of the Federal University of Paraná were included in the study. Socio-demographic data and blood counts were collected from patients' medical records. The NLR was calculated and associated with OM and GVHD. Results: 45 patients were included in the study. Although NLR was higher in patients with OM and oral GVHD, no statistical difference was observed, and no relationship between OM and GVHD with NLR could be stated. Conclusion: Although both OM and GVHD are associated with an inflammatory response as well as the immune system, it was not associated with NLR. Further investigation considering other variables related to HSCT might find possible associations, as it could favor patient management and prevention

Extracorporeal photopheresis in chronic graft-versus-host disease: clinical description and economic study

Abstract Introduction Although extracorporeal photopheresis (ECP) is a promising second-line therapy in the treatment of chronic graft-versus-host disease (cGVHD), its use is limited by its high cost. This study aims to describe the clinical evolution of patients who underwent ECP therapy for cGVHD and to perform an economic analysis of the therapy Methods This was a case series between 2016 and 2020 describing the clinical response to ECP and a micro-cost analysis of the therapy using time-driven activity-based costing. Results Six patients underwent ECP for corticosteroid-dependent cGVHD The cost per ECP session is 14,960.90 Brazilian reais (BRL), which primarily consists of the ECP kit with an activator (82.78%), followed by the hospital's physical structure (14.66%), human resources (2.48%) and exams/inputs (0.08%). The number of sessions performed ranged from 2 to 42. The total cost of the therapy per patient ranged from BRL 30,000 to 500,000. Conclusion The response of the patient with cGVHD to treatment with ECP was variable. These micro-costing results can be used to develop remuneration and cost control strategies in hematopoietic stem cell transplantation programs, as well as in further economic studies.

A Study on relationship between Gold, Silver, Crude Oil and Exchange rate during Covid – 19

COVID – 19 is not only impact on heath of the society but also influence the wealth of the country. Any disaster uncertainty affect directly or indirectly to the Economy. The main purpose behind this study is to know the relationship between Gold, Silver, Crude Oil and Exchange rate during Covid – 19. This research is based on Covid – 19 during the 1st Lockdown from April - 2020 to March – 2021. This study shows that there is correlation between Gold, Silver and Crude oil. There is an interdependence between Silver, Crude Oil and Exchange rate.

Functional activation of the periaqueductal gray matter during conditioned and unconditioned fear in guinea pigs confronted with the Boa constrictor constrictor snake

The periaqueductal gray matter (PAG) is an essential structure involved in the elaboration of defensive responses, such as when facing predators and conspecific aggressors. Using a prey vs predator paradigm, we aimed to evaluate the PAG activation pattern evoked by unconditioned and conditioned fear situations. Adult male guinea pigs were confronted either by a Boa constrictor constrictor wild snake or by the aversive experimental context. After the behavioral test, the rodents were euthanized and the brain prepared for immunohistochemistry for Fos protein identification in different PAG columns. Although Fos-protein-labeled neurons were found in different PAG columns after both unconditioned and conditioned fear situations at the caudal level of the PAG, we found greater activation of the lateral column compared to the ventrolateral and dorsomedial columns after predator exposure. Moreover, the lateral column of the PAG showed higher Fos-labeled cells at the caudal level compared to the same area at the rostral level. The present results suggested that there are different activation patterns of PAG columns during unconditioned and conditioned fear in guinea pigs. It is possible to hypothesize that the recruitment of specific PAG columns depended on the nature of the threatening stimulus.

Clinical features of 24 cases of scleroderma-like cutaneous graft-versus-host disease / 中华皮肤科杂志

Objective:To investigate clinical features of and risk factors for scleroderma-like cutaneous graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation.Methods:Clinical data were collected from 24 patients with scleroderma-like cutaneous GVHD in Department of Dermatology, Peking University People′s Hospital from 2014 to 2019. Clinical features, treatment, prognosis, and possible factors influencing the development of scleroderma-like cutaneous GVHD were analyzed retrospectively.Results:Among the 24 patients, 11 were males, and 13 were females, aged 33 ± 12 years; 20 were human leukocyte antigen (HLA) -identical recipients, 4 were HLA-haploidentical recipients; GVHD occurred 18.5 (8.0, 30.9) months after transplantation. Nineteen patients had discontinued anti-rejection therapy or received low-dose anti-rejection drugs before the onset of GVHD. Fifteen patients presented with generalized scleroderma-like lesions, 1 with linear scleroderma-like lesions, 5 with morphea-like lesions, and 3 with fasciitis-like lesions. None of the 15 patients with generalized scleroderma-like GVHD had Raynaud syndrome. Thirteen patients were accompanied by graft rejection in other systems, 8 had joint mobility limitations, and 1 developed cutaneous squamous cell carcinoma secondary to chronic skin ulcers. All patients were treated with systemic glucocorticoids and immunosuppressive agents, and 11 also with topical glucocorticoids. An intensive follow-up was carried out in 11 patients, of whom 3 achieved marked improvement, 4 achieved improvement, 2 experienced exacerbation, and 2 died. A total of 223 patients with non-sclerodermatous cutaneous GVHD admitting during the same period served as controls, and the proportion of HLA-identical patients was significantly higher in the scleroderma-like cutaneous GVHD group (20/24, 83.3%) than in the non-sclerodermatous cutaneous GVHD group (47/223, 21.1%; P < 0.001) . Conclusions:Scleroderma-like cutaneous GVHD commonly occurs late, and can mimic clinical manifestations of all 4 types of spontaneous scleroderma. HLA-identical transplants, premature discontinuation or excessive dose reduction of anti-rejection drugs may be risk factors for scleroderma-like cutaneous GVHD.

Clinical characteristics of hematologic disease patients with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation and their effects on prognosis / 白血病·淋巴瘤

Objective:To explore the clinical characteristics and influencing factors of hematologic disease patients with chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their effects on the prognosis of patients.Methods:The clinical data of 225 hematologic disease patients who underwent allo-HSCT from January 2014 to February 2021 in the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The efficacy of allo-HSCT, post-transplantation infection, as well as the incidence of cGVHD and its related factors, and its effect on the overall survival (OS) rate, disease-free survival (DFS) rate, cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) rate of patients according to Seattle diagnostic criteria and National Institutes of Health (NIH) diagnostic criteria were analyzed.Results:All 225 hematologic disease patients had hematopoietic reconstruction after allo-HSCT. Among the 225 patients, 156 patients (69.33%) had early infection (207 times), and 92 patients (40.89%) had late infection (107 times). According to the Seattle diagnostic criteria, 58 patients developed cGVHD (111 times), with a cumulative incidence of 39.5%. The involved organs included skin (33 times), liver (32 times), eyes (19 times), lung (11 times), oral cavity (10 times), intestine (4 times) and hematological system (twice). Multivariate Cox regression analysis showed that acute graft-versus-host disease (aGVHD) was an independent influencing factor for cGVHD ( HR= 3.706, 95% CI 2.025-6.783, P<0.001). Compared to patients without cGVHD, patients with cGVHD had lower 5-year CIR (4.0% vs. 21.8%, P= 0.010) and higher 5-year NRM rate (25.5% vs. 11.8%, P= 0.029), while 5-year OS rate (72.5% vs. 73.6%, P= 0.908) and DFS rate (64.6% vs. 65.9%, P= 0.670) between the two groups had no statistical difference. Compared to patients with limited cGVHD, patients with extensive cGVHD had lower 5-year OS rate (56.0% vs. 83.9%, P= 0.035), lower 5-year DFS rate (52.0% vs. 73.4%, P = 0.038) and higher 5-year NRM rate (43.0% vs. 13.0%, P = 0.018). More erythrocyte suspension infusion during the transplantation was an independent influencing factor for early infection ( P = 0.011). Blood type incompatibility between donor and recipient ( P = 0.017), limited cGVHD ( P = 0.039) and extensive cGVHD ( P = 0.003) were independent influencing factors for late infection. According to the NIH diagnostic criteria, 5 patients (8.62%) who developed cGVHD after 100 days of transplantation were reclassified as aGVHD, and 12 patients (20.69%) were reclassified as overlap syndrome. The cumulative incidence of cGVHD was 36.4%, and aGVHD was the only independent influencing factor for cGVHD ( P<0.001). Compared to patients without cGVHD, patients with cGVHD had lower 5-year CIR (6.7% vs.21.7%, P = 0.006) and higher 5-year NRM rate (26.1% vs. 12.0%, P = 0.035), while 5-year OS rate (73.7% vs. 73.2%, P = 0.845) and DFS rate (64.9% vs. 65.7%, P = 0.522) between the two groups had no statistical difference. Conclusions:The incidence of cGVHD after allo-HSCT in hematologic disease patients is high, and there are many organs involved. cGVHD can reduce the relapse rate of patients, but severe cGVHD increases the mortality of patients. aGVHD is the only independent influencing factor for cGVHD.

O papel da odontologia no diagnóstico da doença enxerto-contra-hospedeiro / The role of dentistry in the diagnosis of Graft-versus-host disease

Objetivo: Elucidar quais as formas mais adequadas de se proceder para que haja um efetivo diagnóstico da Doença Enxerto-Contra-Hospedeiro pelo cirurgião-dentista. Revisão de literatura: A Doença Enxerto Contra Hospedeiro acomete diversos pacientes que realizam transplante de células tronco hematopoiéticas. Os sinais clínicos muitas vezes são manifestados apenas na cavidade bucal e, por isso, é importante que o cirurgião-dentista tenha conhecimento. Esta patologia é proveniente de uma complicação do TCTH (Transplante de Células Tronco Hematopoiéticas) alogênico, onde ocorre uma resposta de ativação de linfócitos T do doador e um reconhecimento de antígenos contra o receptor. Discussão: As alterações mais evidentes são lesões ulceradas, estrias brancas, mucocele, leucoedema, lesões bolhosas, ardência, dor e xerostomia. Estes aspectos tendem a corresponder a um diagnóstico de lesões malignas, síndrome de Sjogren, lúpus e líquen plano. A biópsia é fundamental para o diagnóstico, assim como para graduar a severidade da Doença Enxerto Contra Hospedeiro. Conclusão: Caso o cirurgião-dentista identifique algum dos sinais, deverá alertar à equipe médica do paciente para iniciar o tratamento e evitar a recidiva da doença original.

Aim: elucidate which are the most appropriate ways to proceed so that there is an effective diagnosis of Graft--versus-Host Disease by the dentist. Literature review: Graft-versus-host disease affects several patients who undergo hematopoietic stem cell transplantation. Clinical signs are often manifested in the oral cavity only, rea-son why it is important the dentist to be aware of them. This pathology is caused by a complication of allogeneic HSCT, in which there is an activation response of donor T lymphocytes and a recognition of antigens against the recipient. Discussion: The most evident changes are ulcerated lesions, white streaks, mucocele, leukedema, bullous lesions, burning, pain and Xerostomia. These aspects tend to correspond to a diagnosis of malignant lesions, Sjogren's syndrome, lupus and lichen planus. A biopsy is essential for diagnosis as well as for grading the severity of Graft versus Host Disease. Conclusion: If the dental surgeon identifies any of the mentioned signs, he must alert the patient's medical team to start treatment to prevent the recurrence of the original disease.

Hematoma duodenal posvideoendoscopia digestiva alta para diagnóstico de enfermedad de injerto contra huésped en pediatría: a propósito de dos casos / Duodenal hematoma after upper gastrointestinal endoscopy in pediatric graft vs host disease: Report of two cases

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.

Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.

Implicaciones clínicas de las quimiocinas y sus receptores en la medicina transfusional y el trasplante / Clinical implications of chemokines and their receptors in transfusion medicine and transplantation

Introducción: Las quimiocinas son proteínas secretadas con tamaño en el rango de 8-10 kDa, con numerosas funciones en la fisiología normal y patológica. El término deriva de las palabras citocinas quimiotácticas, que refleja su importante participación en la quimioatracción de leucocitos. Sin embargo, las evidencias muestran que las quimiocinas tienen muchas otras funciones como la comunicación intercelular, la activación celular y la regulación del ciclo celular. Objetivo: Analizar los conocimientos actuales sobre las quimiocinas y sus receptores, y la significación clínica de estas en la medicina transfusional y el trasplante. Métodos: Se realizó revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 10 años. Se efectuó análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: La transcripción de la mayoría de los genes de quimiocinas es inducible y se produce en respuesta a estímulos celulares específicos. Las quimiocinas son importantes en la movilización de células progenitoras hematopoyéticas para el trasplante y localización de células progenitoras hematopoyéticas trasplantadas. En los modelos de incompatibilidad ABO, las quimiocinas CXC y CC se producen en niveles elevados. Conclusiones: Muchas son las oportunidades de futuras investigaciones sobre las quimiocinas en la medicina transfusional por la considerable redundancia y superposición en la función biológica de estas moléculas y sus receptores. Son solo una parte de un proceso mucho más grande y complejo dentro de la red de citoquinas y otras moléculas del sistema inmune(AU)

Introduction: Chemokines are secreted proteins with size in the range of 8-10 kDa, with numerous functions in normal and pathological physiology. The term derives from the words chemotactic cytokines, reflecting its important role in the chemoattraction of leukocytes. However, the evidence shows that chemokines have many other functions such as intercellular communication, cell activation and cell cycle regulation. Objetive: To present current knowledge about chemokines and their receptors, and the clinical significance of these in transfusion medicine and transplantation. Method: A review of the literature was made, in English and Spanish, through the PubMed website and the Google academic search engine of articles published in the last 10 years. An analysis and summary of the revised bibliography was made. Developing: The transcription of most of the chemokine genes is inducible and occurs in response to specific cellular stimuli. Chemokines play an important role in the mobilization of hematopoietic progenitor cells for the transplantation and localization of transplanted hematopoietic progenitor cells. In the ABO incompatibility models, the CXC and CC chemokines are produced at high levels. Conclusions: There are many opportunities for future research on chemokines in transfusion medicine due to their considerable redundancy and superposition in the biological function of these molecules and their receptors. They are just one part of a much larger and more complex process within the network of cytokines and other molecules of the immune system(AU)

Treatment of oral chronic graft-versus-host disease: a retrospective cohort study / Tratamento da doença do enxerto contra hospedeiro crônica oral: um estudo de coorte retrospectivo

ABSTRACT Objective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment. Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only. Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042). Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.

RESUMO Objetivo Avaliar os pacientes com resposta completa da doença do enxerto contra hospedeiro crônica oral ao tratamento com imunossupressor. Métodos Vinte e nove pacientes submetidos ao transplante alogênico de células tronco hematopoiéticas, com doença do enxerto contra hospedeiro crônica oral, foram incluídos neste estudo retrospectivo, de setembro de 2012 a fevereiro de 2018. Os pacientes foram tratados com dexametasona para bochecho associada ao tacrolimo pomada, dexametasona para bochecho associada ao tacrolimo tópico, tratamento imunossupressor sistêmico, e dexametasona tópica apenas. Resultados O tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações usando dexametasona e imunossupressor sistêmico foi de 105, 42 e 42 dias, respectivamente (p=0,013). Quando a dexametasona estava associada ao tacrolimo e a medicação imunossupressora sistêmica, o tempo médio para resposta completa das lesões liquenóides, eritema e ulcerações foi de 91, 84 e 77 dias (p=0,011). Quando foi utilizada apenas dexametasona, o tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações foi de 182, 140 e 21 dias, respectivamente (p=0,042). Conclusão Nosso estudo mostra que as lesões liquenoides requerem mais tempo para cicatrização completa. É notável que as lesões liquenoides tendem a responder melhor ao tratamento da dexametasona combinada com o tacrolimo e o imunossupressor sistêmico. Já o eritema e as ulcerações respondem melhor à dexametasona combinada com medicação imunossupressora sistêmica, e dexametasona apenas, respectivamente.

Manifestaciones cutáneas de la enfermedad injerto versushuésped en una población pediátrica y de adultos jóvenes / Cutaneous manifestations of graft versus host disease in a population of pediatric and young adults patients

El trasplante de médula ósea es una terapia potencialmente curativa para múltiples enfermedades; el alogénico es el más indicado en leucemias. La enfermedad injerto versus huésped (EIVH) constituye la principal complicación del trasplante de médula ósea alogénico. Tanto en la EIVH aguda como crónica, la piel es el órgano más frecuentemente comprometido. El objetivo fue analizar las manifestaciones cutáneas de esta entidad. Trabajo retrospectivo y descriptivo, que incluyó a 59 pacientes trasplantados de edades entre 0 y 20 años. En 50 casos, se realizó trasplante de médula ósea alogénico. Veinticinco pacientes desarrollaron EIVH (17, la forma aguda, y 8, la forma crónica), y 24 tuvieron compromiso cutáneo. En concordancia con lo comunicado se encontró que las manifestaciones cutáneas fueron la manifestación clínica más común de EIVH. El hallazgo principal en EIVH aguda en nuestra serie fue el rash eritematoso maculopapular y, en EIVH crónica, las lesiones escleróticas símil morf

Bone marrow transplant is a potentially curative therapy for several diseases, and allogeneic bone marrow transplant is the most commonly indicated type for leukemias. Graft versus host disease (GVHD) is the main complication of allogeneic bone marrow transplant. In both acute and chronic GVHD, the skin is the most frequently involved organ. The objective of this study was to analyze cutaneous manifestations of this disease. Retrospective and descriptive study that included 59 transplanted patients aged 0 to 20 years. In 50 cases allogeneic bone marrow transplant was performed. Twenty-five patients developed GVHD (17 acute disease and 8 chronic disease) and 24 of them had cutaneous involvement. According to the literature, skin compromise was the commonest clinical manifestation of GVHD. Main finding in acute GVHD in our series was the erythematous maculopapular rash, while in chronic GVHD they were sclerotic lesions resembling morphe

Poejo (Cunila galioides Benth. ) Production in Five Agroecological Regions of Rio Grande do Sul

Abstract The objective of this study was to evaluate the biomass and essential oil production of nine populations of poejo (Cunila galioides) cultivated in five agroecological regions of the state of Rio Grande do Sul, under different edaphoclimatic conditions. The experiments were performed in field conditions in Erechim, Caxias do Sul, Pelotas, São Francisco de Paula, and Santa Vitoria do Palmar. The experimental design was completely randomized, with nine populations, eight plants per plot and four repetitions. The following were evaluated: biomass production and essential oil chemical composition and yield. The data underwent ANOVA, followed by Tukey's multiple range test. The adaptability and stability of the populations in the different environments were also evaluated by regression analysis. The results showed great differences between the populations and cultivation sites, with genotype vs. environment interaction. Most populations presented the best biomass production results at Erechim. Pelotas and Santa Vitória do Palmar were the worst locations for poejo production, mainly due to a water deficit occurred during the experiment. The Santa Lucia population presented broad stability and the greatest adaptability to the environments for biomass and essential oil production, but its average production was not satisfactory. The André da Rocha population presented the highest average production of essential oil, and was favored in favorable environments. Regarding essential oil chemical composition, the populations kept stable contents of the major compounds at all locations, with a few variations. In some populations, a higher concentration of sesquiterpenes was observed, which can be attributed to environmental stress.

Evaluation of congenital heart disease clinically and by echocardiography in children of age group 0-12 years

Background: The present study was conducted to evaluate clinical and echo-cardio graphic findings of congenital heart disease in children of age-group 0-12 years attending present hospital.Methods: A study was done at Katuri Medical College and hospital in 65 patients aged 0-12 years; both sexes; for a period of 2 years. study design is exploratory, with proforma been designed to study congenital heart diseases. Alexander Nada's criteria is used.Results: Out of 4145 cases; 65 cases aged 0-12 years have congenital heart disease over a period of 2 years; (acyanotic 55 cases and cyanotic 10 cases). 23 cases are between 1-5 years and 20 cases are >5 years; 1/3rd cases diagnosed before 1 year of age. male 40 cases and female 25 cases. Urban cases-27 and rural cases are 38.48 cases have consanguinity and family history in 12 cases. extra cardiac manifestations in 6 cases. Normal sized heart with normal vascularity of lung was seen in 14 / 65 cases. 51/65 cases showed various radiological features depending on type of lesion based on echo findings. Among the ACHDs VSD was the commonest CHD seen in children. Among the cyanotic heart diseases TOF was the commonest CHD observed, comprising of 6 cases.Conclusions: Chest X-ray was abnormal in 80% of cases with increased CT ratio in 58.3% cases. ECG was abnormal in 73.3% of cases and majority of them had left axis deviation.95%of CHDs, including ACHDs and CCHDs which were diagnosed clinically include ASD, VSD, PDA, AS, PS, CoA, TOF, TGA. Most common clinically diagnosed CHD was VSD. Clinico echo correlation was accurate in 75% cases. Clinico echo correlation was highest with isolated lesions like VSD, ASD and in cases with typical findings like CoA, PDA, AS, TOF and least with multiple lesions or atypical findings.

Usefulness of fine needle aspiration cytology in diagnosis of causes of lymphadenopathy in children

Background: The present study was conducted to study the causes of lymphadenopathy, associated clinical findings, usefulness of FNAC in diagnosis of various causes of lymphadenopathy as lymph node biopsy is a difficult and invasive procedure in children attending pediatric department.Methods: A study was done at Katuri medical college and hospital. A total of 50 patients with lymphadenopathy including both local and generalized were studied for a period of 2 years by taking proper history, through physical examination both generalized and systemic and all the patients were subjected for relevant investigations for establishment of diagnosis which is essential for institution of proper treatment. A prospective study consisting 50 patients with lymphadenopathy (<12year) is undertaken to find the incidence of various causes of lymphadenopathy in the affected patients for 2 year.Results: It was observed that 10, 17 and 23 children were having lymphadenopathy in the age groups of 0-3-year, 4-8 year and 9-12 year respectively. Majority of patients were having lymphadenopathy only after 4 year of age, male 28 and female 22. The major symptoms in order of incidence were palpable swelling, fever, cough, weight loss, loss of appetite and sore throat. Duration of lymphadenopathy of less than 1 month was seen in 25 cases ,1-6 months 24 cases and more than 6 months in 1 case. Enlargement of lymph nodes in cervical region, was the major finding in these patients. 47 cases were having local lymphadenopathy mainly in the cervical region and 3 cases were having generalized lymphadenopathy. 80% of the patients were having firm lymph nodes, remaining 20% of the patients were having soft lymphadenopathy. 36 patients were having mobile lymph nodes while 14 patients were having matted lymph nodes. Tenderness was observed in 21 cases against absence of tenderness in 29 cases. Analysis of the FNAC results revealed positive for tuberculosis in 11 cases reactive hyperplasia in 26 cases, granulomatous changes seen in 4 cases and suppurative lymphadenitis in 6 cases.Conclusions: In developing countries like India whenever a patient attends the Department of Paediatrics with lymphadenopathy it is always be prudent to exclude tuberculosis, which is quite prevalent. FNAC is helpful in those with benign conditions like reactive hyperplasia to rule out underlying serious systemic diseases and reassuring the parents.

Doença do Enxerto-versus-hospedeiro ocular: Revisão / Graft-versus-Host Disease: Review

Resumo Doença do Enxerto-versus-hospedeiro (do inglês Graft-versus-Host Disease - GVHD) é uma complicação importante e com altas taxas de morbidade e mortalidade nos pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas. O acometimento ocular, denominado GVHD ocular, pode acometer todas as estruturas dos olhos, porém a unidade lacrimal (glândulas lacrimais e superfície ocular) é o principal alvo da resposta inflamatória mediada por células T doadas. O desenvolvimento de doença do olho seco grave é a principal manifestação clínica ocular, e a associação de diversas opções terapêuticas se faz necessário. O objetivo desta revisão é descrever as manifestações clínicas, os critérios diagnósticos, o impacto na qualidade de vida, o tratamento atual e as perspectivas desta doença, que precisa de um acompanhamento multidisciplinar.

Abstract Graft-versus-host Disease (GVHD) is a major complication with high morbidity and mortality rates on patients undergoing hematopoietic stem cell transplantation. The ocular involvement, named ocular GVHD, may affect all structures of the eyes, but the lacrimal unit (lacrimal glands and ocular surface) is the main target of the inflammatory response mediated by the donor T cells. The development of dry eye disease is the main clinical ocular manifestation, and the association of a variety of therapeutics options is necessary. The aim of the review is to describe the clinical manifestations, diagnostic criteria, impact in quality of life, the current treatment and future perspectives of this disease that demands a multidisciplinary follow-up.

Significance of APTT as early predictor of bleeding in comparison to thrombocytopenia in dengue virus infection

Background: Dengue is a systemic viral infection transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue Fever (DF) is characterized by fever, headache, muscle or joint pain, and rash. The spectrum of dengue virus infection spreads from an undifferentiated fever and dengue fever (DF) to dengue haemorrhagic fever (DHF) with shock. Factors responsible for bleeding manifestations in dengue are vasculopathy, thrombocytopenia, coagulopathy, and disseminated intravascular coagulation (DIC). Coagulopathy results in derangement of activated partial thromboplastin time (APTT) which is an indicator of impending bleeding risk.Methods: A prospective study was conducted from June to December in 2017 in R L Jalappa Hospital. Patients aged above 18 years with febrile thrombocytopenia who are positive for dengue virus serology (NS1Ag and/ or IgM) were included in the study. Serial daily monitoring of platelet count and analysis of APTT levels were done. APTT was considered abnormal if it was more than 33.8s. Patients were followed up for evidence of leaking and bleeding manifestations.Results: Out of 170 patients 28.1% patients had bleeding manifestations. Bleeding signs were seen on clinical examination in 52.37% of patients. capillary leak was found in the form of Pleural effusion in 35.3%, Ascites in 41.2% and Periorbital edema in 31.2% of patients. Elevated APTT levels were seen in 110(64.7%) patients. Among patients with abnormal APTT platelet transfusion was done in 78.9% of patients, and among those with normal APTT levels platelet transfusion was done in 21.1% of patients.Conclusions: Our study showed significant correlation between bleeding manifestations and prolonged APTT levels as well as thrombocytopenia with abnormal APTT levels. Study concluded that 21.1% of platelet transfusions could have been prevented considering prolonged APTT as a predictor of bleeding manifestation, thus saving the resources and reactions due to platelet concentrate transfusion.

Rehabilitation in Children With Sclerodermoid Chronic Graft-Versus-Host Disease: Case Series

Joint contracture in chronic graft-versus-host disease (cGVHD) is refractory to treatment, and tends to deteriorate gradually over time. There is scant clinical research focusing on timing and intensity of rehabilitation on joint contractures in children with sclerodermoid cGVHD after hematopoietic stem cell transplantation. We retrospectively reviewed rehabilitative therapeutic effects in 6 children with sclerodermoid cGVHD, whose clinical records documented their condition, before and after rehabilitation therapies. Three children who started treatment within a mean of 2 months after the onset of joint symptoms, and who underwent home-based exercise twice daily for 30 minutes showed more prominent improvement in range of motion compared with the other 3 children, who started rehabilitation therapy later than 6 months after onset of joint symptoms, without regular home-based exercise.

Filosofía de la educación: educación médica y universidad / Philosophy of education; medical education; medical education and university

La educación médica deberá tener en cuenta los profundos cambios sociales y educativos profesionales de nuestra época. Hoy la educación se relaciona con nuevos conocimientos como la ética, la sociología y la política. Sigue siendo materia de debate "lo formativo" vs. "lo instructivo", con predominio del conocimiento instrumental. Pensamos en una impronta que pueda quedar marcada para siempre en el espíritu del agente de salud. En todos estos aspectos, el rol fundamental corresponde a las escuelas de Medicina, donde se deben recordar los principios fundamentales de ese saber, junto con una formación cultural que permita adaptarse al desarrollo de los nuevos conocimientos. (AU)

Medical education should pay attention to the new scientific changes of our times. Today the education is related to new knowledge like ethic, sociology and politic. It is a still material of debate "formation" vs. "instruction" remains as a problem together with the instrumental knowledge. In all this aspects, Medical schools are the educational units to learn the persisting principles together with a cultural formation to drive the new knowledge. (AU)

Association of Interleukin-10 -1082A>G (rs1800896) Polymorphism with Predisposition to Breast Cancer: a Meta-Analysis based on 17 Case-Control Studies

SUMMARY INTRODUCTION The association between the between IL-10 -1082A>G (rs1800896) polymorphism and breast cancer has been evaluated by several number case-control studies. However, these studies might be underpowered to reveal the true association. OBJECTIVE We have performed a comprehensive meta-analysis to investigate the association IL-10 -1082A>G polymorphism and breast cancer. MATERIALS AND METHODS A systematic literature search was conducted using PubMed, Google Scholar, and Web of Science up to September 20, 2017. Data was analysed with CMA software to identify the strength of the association by pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs). RESULTS A total of 17 case-control studies involving 3275 cases and 3416 controls obtained from database searches were examined. Overall, there was no significant association between IL-10 -1082A>G polymorphism and breast cancer risk under all genetic models. No significant publication bias was found for the five genetic models (G vs. A OR = 1.184, 95% CI = 0.895-1.180, p= 0.230; GG vs. AA: OR = 1.430, 95% CI = 0.927-2.204, p= 0.106; GA vs. AA: OR = 0.966, 95% CI = 0.765-1.221, p= 0.774; GG+GA vs. AA: OR = 0.957, 95% CI = 0.697-1.314, p= 0.786; and GG vs. GA+AA: OR = 1.221, 95% CI = 0.981-1.518, p= 0.073). Moreover, there was no significant association between the IL-10 -1082A>G polymorphism and breast cancer risk by ethnicity. CONCLUSION Our findings indicated that IL-10 -1082A>G (rs1800896) polymorphism might not be a risk factor for the development of breast cancer.

RESUMO

Population structure of Chinese southwest wheat germplasms resistant to stripe rust and powdery mildew using the DArT-seq technique / População de germoplasmas resistentes de trigo empregando a técnica de sequenciamento Dart-seq

ABSTRACT: Understanding genetic variability in existing wheat accessions is critical for collection, conservation and use of wheat germplasms. In this study, 138 Chinese southwest wheat accessions were investigated by genotyping using two resistance gene makers (Pm21 and Yr26) and DArT-seq technique. Finally, about 50% cultivars (lines) amplified the specific allele for the Yr26 gene (Gwm11) and 40.6% for the Pm21 gene (SCAR1265). By DArT-seq analysis, 30,485 markers (6486 SNPs and 23999 DArTs) were obtained with mean polymorphic information content (PIC) value 0.33 and 0.28 for DArT and SNP marker, respectively. The mean Dice genetic similarity coefficient (GS) was 0.72. Two consistent groups of wheat varieties were identified using principal coordinate analysis (PCoA) at the level of both the chromosome 6AS and the whole-genome, respectively. Group I was composed of non-6VS/6AL translocation lines of different origins, while Group II was composed of 6VS/6AL translocation (T6VS/6AL) lines, most of which carried the Yr26 and Pm21 genes and originated from Guizhou. Besides, a model-based population structure analysis revealed extensive admixture and further divided these wheat accessions into six subgroups (SG1, SG2, SG3, SG4, SG5 and SG6), based on their origin, pedigree or disease resistance. This information is useful for wheat breeding in southwestern China and association mapping for disease resistance using these wheat germplasms in future.

RESUMO: O conhecimento da estrutura da população é essencial para o mapeamento de associação de resistência a doenças para a população de trigo. Neste estudo, a técnica de DART-seq™ foi usada para genotipar o genoma inteiro de cultivares de trigo. Finalmente, 30,485 marcadores (6486 SNPs e 23999 dardos) foram obtidos, e dois grupos de variedades de trigo foram identificados por meio de análise principal-coordenadas (PCoA) do nível de todo o genoma e o nível 6AS cromossomo. O grupo I foi composto por linhas não T6VS/6Al de diferentes origens, enquanto o Grupo II foi composto de linhas T6VS/6Al, sendo que da maioria destes realizados os genes Yr26 e PM21 originários de Guizhou.