Response to Tyrosine Kinase Inhibitors in Patients with BCR-ABL1 Positive Chronic Myeloid Leukemia; 13.5 Years’ Experience at Patan Hospital, Nepal

Background:Since the advent of Tyrosine Kinase Inhibitor (TKI), well controlled studies in developed world have shown that the life expectancy of patients with CML is comparable to normal people without the disease. But long-term follow up studies are lacking in resource poor setting. Methods:This is a retrospective follow up study looking at the molecular response and resistance to Tyrosine Kinase Inhibitors (TKI) in patients enrolled in the Max Access Program since February 2003 till March 2017. Patients with twoor more BCR-ABL1 levels by Karyotyping/ fluorescent in situ hybridization (FISH) / reverse transcriptase polymerase chain reaction (RT-PCR) were included. At baseline, complete blood count (CBC), renal function test (RFT), and liver function test (LFT) were evaluated. Bone marrow aspiration and biopsy for morphology, cytogenetic analysis by Karyotyping/FISH and/or molecular analysis by RT-PCR were also done if these tests were not performed earlier. FISH or RT-PCR was done on peripheral blood every 3–12 months as necessary if the patient could afford. Patients with warning response/failure underwent BCR-ABL1 Resistance Mutation Analysis (IRMA).Results:Three hundred and forty six (346) patients had two or more BCR-ABL1 monitoring tests done. Optimal response was seen in 49.42%. Similarly, suboptimal response and failure were seen in 16.5% and 34% respectively. Overall Survival is 89.6% (at 1.8 -165 months, mean 62 months) . If only CML related events is considered survival is 95.9%. Seventy seven (77) patients with a total of 80 BCR-ABL1 domain Imatinib Resistance Mutation Analyses (IRMA) showed 19 different types of mutations with the most common being T315I mutation (8 and 19.5%). About 22.25% of the total patients showed resistance to Glivec out of which 10.98% showed mutations. Nine patients underwent trial for treatment free response (TFR) and 5 of them relapsed between 2-8 months.Conclusions:Despite all the odds of having financial problem, accessibility problem due to distances, transportation, etc. and difficulty monitoring with routine BCR-ABL1 and IRMA, our findings show that the outcome of TKI therapy in our CML patients is comparable to well controlled studies done elsewhere. Overall survival, molecular and cytogenetic responses and mutations in our patients who developed resistance as well as TFR are also similar to other studies. The resistance rate of 22.25% is slightly higher compared to other studies in developed world. This is mainly because of poor monitoring due to unavailability of the test including IRMA in our country and affordability until 2012. It proves that TKI is very effective in CML even in a resource-poor, developing country

Aspectos clínicos y electrocardiográficos de la pericarditis aguda / Clinical and electrocardiographic aspects of acute pericarditis

El diagnóstico diferencial entre pericarditis aguda e infarto agudo del miocardio puede constituir un desafíodiagnostico para el médico de urgencia, ya que el dolor precordial y los marcadores bioquímicos pueden noser siempre distintivos. La presente revisión enfatiza los elementos electrocardiográficos diferenciadores entres ambas entidades. La elevación difusa del ST y el desnivel del PR con elevación especialmente en aVR,son pistas electrocardiograficas claves que orientan al diagnóstico de pericarditis.

Spotlight on the diagnosis of acute promyelocytic leukemia [AML-M3] using karyotyping, FISH and quantitative real-time PCR

This study aimed to confirm the diagnosis of AML-M3 and the frequency of occurrence of the breakpoint cluster region [bcrl] in patients provisionaly diagnosed according to FAB classification. Cytologenetic and molecular genetics methods were used. Bone marrow [BM] or Peripheral Blood [PB] samples collected from 27 AML-M3 patients [During the period 2005 through 2007] were subjected to conventional karyotyping G-banding, detection of t [15; 17] was performed by Fluorescence In Situ Hybridization [FISH] and PML-RARA gene rearrangements were detected by Quantitative Real-Time Reverse Transcriptase Polymerase Chain Reaction [QR-RT-PCR]. Karyotyping was successful in 24 out of 27 samples. Four patients out of 24 had a t [15; 17], 17 had normal karyotype and 3 had other abnormalities. The results obtained by FISH technique corresponded with karyotype results and revealed positivity in another 3 samples. QR-RT-PCR demonstrated bcrl positivity in the 4 patients diagnosed by Karyotyping with t [15; 17] and in the 8 patients can not diagnosed by Cytogenetic methods. Despite the fact that cytogenetics permit the identification of many chromosomal changes within a sample, FISH analysis is more sensitive when the karyotype fails to find out the t [15; 17]. Furthermore, QR-RT-PCR appears to be the only suitable approach to detect the molecular events underlying hematological malignancies and provides informations on the correlation between different levels of disease at early phases of therapy and clinical outcome

Genetic variability in three Amazon parrot species

Parrots of the genus Amazona are among the most threatened species of the Order Pscittaciformes. This work describes allozyme polymorphisms in three Amazon parrot species - the Blue-fronted Amazon (Amazona aestiva), the Orange-winged Amazon (Amazona amazonica), and the Festive Amazon (Amazona festiva) -, and provides useful data for the evaluation of their genetic variability. We electrophoretically analyzed blood samples from 68 wild-caught individuals, maintained in captivity in three Brazilian zoos. Eight of the ten studied enzyme loci exhibited polymorphism. Glucosephosphate isomerase (Gpi) proved to be a diagnostic locus for the identification of these Amazon species. The expected average heterozygosity of the Blue-fronted Amazon (0.060) differed significantly from the expected heterozygosities of the Orange-winged Amazon and the Festive Amazon (0.040 and 0.039, respectively). This result was discussed as a consequence of hybridization between two geographic A. aestiva subspecies, and alternatively as a particular trait of this species. Genetic variability of the Blue-fronted Amazon compared to birds in general is not low on a species-wide level, despite the fact that this parrot is one of the most illegally traded species. Allozyme analysis proved to be an useful tool in monitoring the genetic variation within the genus Amazona and can be applied in the management program of other threatened species of this genus.

Papagaios do gênero Amazona estão entre as espécies mais ameaçadas da Ordem Psittaciformes. O presente trabalho descreve polimorfismos enzimáticos em três espécies de papagaios do gênero Amazona: o papagaio verdadeiro (Amazona aestiva), o papagaio do mangue (Amazona amazonica) e o papa-cacau (Amazona festiva). Estes dados foram utilizados para avaliação da variabilidade genética dessas espécies. Foram analisadas, através de eletroforese, amostras de sangue de 68 indivíduos capturados na natureza e mantidos em cativeiro em três zoológicos brasileiros. Oito dentre dez locos enzimáticos analisados exibiram polimorfismo. O loco da Glicose Fosfato Isomerase (Gpi) demonstrou ser um loco diagnóstico para a identificação dessas espécies de papagaios. A heterozigosidade média esperada para A. aestiva (0,060) diferiu significativamente das heterozigosidades esperadas para A. amazonica e A. festiva (0,042 e 0,039, respectivamente). Este resultado foi discutido como uma conseqüência de hibridização entre duas subespécies geográficas de A. aestiva e, alternativamente, como uma característica particular da espécie. Comparada a aves em geral, a variabilidade genética de A. aestiva não é baixa, apesar deste papagaio ser uma das espécies mais comercializadas ilegalmente. A análise alozímica demonstrou ser uma ferramenta útil para o monitoramento da variabilidade genética do gênero Amazona, podendo ser aplicada em programas de manejo destas e de outras espécies ameaçadas pertencentes ao mesmo gênero.

Populational genetic structure of free-living maned wolves (Chrysocyon brachyurus) determined by proteic markers

Os produtos protéicos de 20 locos gênicos foram analisados eletroforeticamente em hemolisados e plasma de 28 lobos-guarás (Chrysocyon brachyurus) de uma área da região Nordeste do Estado de São Paulo, Brasil. A área de estudo foi dividida em 3 subáreas, considerando os rios Mogi-Guaçu e Pardo como barreiras ao fluxo gênico. O grau de polimorfismo e o nível de heterozigosidade (intraloco e média) estimados neste estudo foram semelhantes aos observados por outros autores para lobos-guarás e outras espécies de canídeos de vida livre. As diferentes amostras e a amostra total demonstraram freqüências genotípicas nos locos polimórficos consistentes com o modelo de equilíbrio genético. Os valores da estatística-F evidenciaram ausência de endocruzamento e de estruturação populacional e, como conseqüência, foram encontrados baixos valores de distância genética entre as amostras correspondentes a cada subárea.

Populational genetic structure of free-living maned wolves (Chrysocyon brachyurus) determined by proteic markers

Electrophoretic analysis of presumptive twenty gene loci products was conducted in hemolisates and plasma samples of twenty-eight maned wolves (Chrysocyon brachyurus) from an area in northeastern São Paulo State, Brazil. The area sampled was divided into three sub-areas, with the Mogi-Guaçu and Pardo rivers regarded as barriers to the gene flow. The polymorphism degree and heterozygosity level (intralocus and average) estimated in this study were similar to those detected by other authors for maned wolves and other species of wild free-living canids. The samples of each sub-area and the total sample exhibited genotype frequencies consistent with the genetic equilibrium model. The values of the F-statistics evidenced absence of inbreeding and population subdivision and, consequently, low genetic distances were found among the samples of each area.

Os produtos protéicos de 20 locos gênicos foram analisados eletroforeticamente em hemolisados e plasma de 28 lobos-guarás (Chrysocyon brachyurus) de uma área da região Nordeste do Estado de São Paulo, Brasil. A área de estudo foi dividida em 3 subáreas, considerando os rios Mogi-Guaçu e Pardo como barreiras ao fluxo gênico. O grau de polimorfismo e o nível de heterozigosidade (intraloco e média) estimados neste estudo foram semelhantes aos observados por outros autores para lobos-guarás e outras espécies de canídeos de vida livre. As diferentes amostras e a amostra total demonstraram freqüências genotípicas nos locos polimórficos consistentes com o modelo de equilíbrio genético. Os valores da estatística-F evidenciaram ausência de endocruzamento e de estruturação populacional e, como conseqüência, foram encontrados baixos valores de distância genética entre as amostras correspondentes a cada subárea.

Genetic characterization of the peptidases of Polistes versicolor (Hymenoptera: Vespidae)

Starch gel electrophoresis with L-leucyl-beta-naphthylamide as substrate revealed five aminopeptidases in extracts of Polistes versicolor. These enzymes are presumably products of five structural gene loci. All but Lap aminopeptidases exhibited differential distribution in the developmental stages and in the tissues. Five dipeptidases were revealed with different dipeptides. These enzymes exhibited significant differences in their substrate preferences, but a more homogeneous distribution throughout ontogenetic developmental stages than did aminopeptidases. Electrophoretic variants of Lap4 and PepA² were detected and although a low intralocus heterozygosity was found due to the low frequency of these variants, phenotypical segregation observed at these loci in pupae extracts of some colonies points to the occurrence of more than one egg-laying female. Otherwise, the detection of Lap4 allozyme restricted to nests of one area suggests low dispersion ability of the adults of Polistes versicolor

Detection of microdeletions involving the DAZ locus in idiopathic male infertility

Deletions of the AZFc [azoospermic factor c] region of the Y chromosome including DAZ gene are the most common known cause of spermatogenic failure. This study was conducted with the aim of detecting Y chromosome microdeletions involving the DAZ locus in idiopathic male infertility to allow rapid and accurate diagnosis required for proper genetic counseling. The study included 30 male patients with idiopathic azoospermia [24/30] or oligozoospermia [6/30]. A control group consisted of 10 normal fertile males and 5 females. All cases were subjected to detailed history, clinical examination, assessment of testicular volume, semen analysis, serum hormonal profile [FSH, LH, testosterone], testicular biopsy, chromosome analysis, polymerase chain reaction [PCR] amplification of two specific loci of the DAZ gene on the Y chromosome [sY254 and sY255], single strand conformations polymorphism analysis [SSCP]. The result of the study revealed that deletions involving the sY245 and sY255 DAZ loci were found in 4 cases [4/30; 13.3%]; 3 azoospermic patients and one with severe oligozoospermia. All four cases with microdeletions had decreased testicular volume, normal serum LH and T, serum FSH was elevated in 3 of them and normal in one. The two loci were amplified normally in the male control group and failed to amplify in the female control group. SSCP analysis failed to find any point mutations in sY254 and sY255 in patients with absence of microdeletions of DAZ gene. In conclusion, the estimated frequency of microdeletions involving the DAZ locus is 13.3% in azoospermic and severely oligozoospermic Egyptian men with idiopathic infertility. Polymerase chain reaction amplification of the DAZ locus is a rapid and accurate method for the diagnosis of microdeletions of the Y chromosome in patients with idiopathic infertility especially those seeking micromanipulation assisted reproduction

Kalikreína vascular y cardíaca en hipertensión asociada a alteraciones del metabolismo lipídico / Cardiovascular kallikrein in hypertension associated to lipidic metabolic disorders

ANTECEDENTES: La hipertensión arterial y la hiperlipemia dañan el endotelio vascular y predisponen al desarrollo de lesiones ateromatosas y enfermedades coronarias. Las células endoteliales y musculares son capaces de modular la función cardiovascular mediante la producción de factores autocrino/paracrinos. Se ha descripto la presencia de un sistema generador de kininas en vasos y corazón. El propósito de este estudio es examinar si existe modificación de la actividad kininogenásica en tejido cardiovascular de ratas dislipidémicas e hipertensas por inhibición de la producción del factor relajante derivado del endotelio. MATERIAL Y METODO: Se utilizaron ratas Wistar macho (430 ñ 50 g peso), las que se sometieron a los siguientes tratamientos: control (n= 10): dieta normal; lípidos (n= 10): dieta con sobrecarga de 16 por ciento de ácidos grasos saturados y 2 por ciento de colesterol durante 8 semanas; L-NAME (n= 10): administración oral de un inhibidor de la síntesis de factor relajante endotelial, L-nitro arginina metil éster, 100 mg/kg/ día durante las 2 últimas semanas del período experimental; lípidos + L-NAME (n= 10): administración de dieta con sobrecarga grasa durante 8 semanas y de L-NAME durante las 2 últimas semanas. Se midió la presión arterial, la concentración de lípidos plasmáticos y la actividad kininogenásica en homogenados de corazón y vasos sanguíneos (pgBK/mg/h). Resultados: La manipulación dietética de los animales no produjo cambios en su presión arterial, pero fue efectiva para instaurar un perfil lipoproteico aterogénico (p< 0,05). La administración de L-NAME produjo un aumento significativo de los niveles tensionales (p< 0,05), sin modificar las concentraciones de los metabolitos plasmáticos dosados. La actividad kininogenásica presente en homogenados de corazón aumentó significativamente en los animales sometidos a sobrecarga dietética de grasa y ese incremento fue aún mayor cuando se les adicionó al agua de bebida el inhibidor de la síntesis de factor relajante endotelial (p< 0,05). Un patrón semejante se observa en homogenados de aorta, arterias caudales y venas caudales (p< 0,05). CONCLUSIONES: El incrmento local de la capacidad generadora de kininas en tejido cardiovascular podría representar un esfuerzo tisular por contraponerse a la agresión endotelial causada por el aumento de los lípidos plasmáticos y el aumento de la presión arterial. Las kininas liberadas in situ tendrían efectos hemodinámicos y metabólicos ...

Hexokinase polymorphism in Apis mellifera and its use for africanized honeybee identification

Neste trabalho é descrito o alto grau de polimorfismo da hexoquinase (HK) em abelhas africanizadas do Brasil e confirmado o monomorfismo deste sistema em abelhas de origem européia. A detecçäo da alozima 87 em abelhas africanizadas do Brasil é explicada pela introduçäo de Apis mellifera scutellata no país em 1956. A frequência do gene HK nas populaçöes brasileiras analisadas é maior em Luiz Antonio, Estado de Säo Paulo, localidade próxima a Rio Claro, centro inicial de dispersäo dos enxames africanos. A frequência deste alelo diminui à medida que populaçöes situadas a uma maior distância deste centro säo amostradas, particularmente, em áreas mais ao sul do país, onde a atividade apícola com base em abelhas européias foi mais intensa. A detecçäo deste polimorfismo se reveste de significativa importância para o rastreamento de genes africanos em populaçöes de Apis mellifera existentes no continente americano