Clinical networking results in continuous improvement of the outcome of patients with acute promyelocytic leukemia.

The introduction of all-trans retinoic acid (ATRA) combined with anthracyclines has significantly improved the outcomes for patients with acute promyelocytic leukemia (APL), and this strategy remains the standard of care in countries where arsenic trioxide is not affordable. However, data from national registries and real-world databases indicate that low- and middle-income countries (LMIC) still face disappointing results, mainly due to high induction mortality and suboptimal management of complications. The American Society of Hematology established the International Consortium on Acute Leukemias (ICAL) to address this challenge through international clinical networking. Here, we present the findings from the ICAPL study involving 806 patients with APL recruited in Brazil, Chile, Paraguay, Peru, and Uruguay. The induction mortality rate has decreased to 14.6% compared to the pre-ICAL rate of 32%. Multivariable logistic regression analysis revealed as factors associated with induction death: age ≥ 40 years, ECOG = 3, high-risk status based on the PETHEMA/GIMEMA classification, albumin level ≤ 3.5 g/dL, bcr3 PML/RARA isoform, the interval between presenting symptoms to diagnosis exceeding 48 hours, and the occurrence of central nervous system and pulmonary bleeding. With a median follow-up of 53 months, the estimated 4-year overall survival (OS) rate is 81%, the 4-year disease-free survival (DFS) rate is 80%, and the 4-year cumulative incidence of relapse (CIR) rate is 15%. These results parallel those observed in studies conducted in high-income countries, highlighting the long-term effectiveness of developing clinical networks to improve clinical care and infrastructure in LMIC.

Physiological adaptations to specific endurance training in professional female handball players.

Several Hungarian and foreign researchers have already studied the cardiorespiratory parameters of elite handball players. There are only a few studies though, which would separately review the changes in the functions of different organ systems. The aim of this study is to investigate the effect of an intervention (physical activity) on the cardiorespiratory system. In this study, 16 elite female handball players participated, whose body compositions were measured and took two vita maxima tests. During the analysis, each cardiorespiratory parameter was monitored for every 20 s. Between the two examinations, 6 weeks passed and an intervention took place. There was a significant decrease in relative body fat and a significant increase in relative muscle mass. Remarkable positive changes occurred in the values of ventilation, oxygen pulse, and in both absolute and relative aerobic capacities as well. The mean values of the team developed as expected, but the individual changes in body composition and cardiorespiratory parameters are just as important. First, we chose four players, who had the most outstanding changes. Second, we analyzed such parameters, which were expected to show adequate results in terms of the apparatus(es) functioning.

Relationship between the tumor necrosis factor system and the serum interleukin-4, interleukin-5, interleukin-8, eosinophil cationic protein, and immunoglobulin E levels in the bronchial hyperreactivity of adults and their children.

The aim of the study was to investigate the activation of inflammatory mediators interleukin (IL)-4, IL-5, and IL-8; immunoglobulin E (IgE); and eosinophil cationic protein (ECP) and to evaluate the regulatory role of the tumor necrosis system (TNF) system in bronchial hyperreactivity. Adults who had suffered from bronchial asthma in childhood but who had been symptom free for at least 3 years were examined together with their children who did not have asthma. The serum concentrations of TNF-alpha, soluble TNF receptor 1 (sTNF-R1), TNF-R2, IL-4, IL-5, IL-8, ECP, and IgE were studied in symptom-free adults (n = 22) and their children (n = 22) with bronchial hyperreactivity. Nonhyperreactive individuals with a similar medical history (adults, n = 17; children, n = 20) served as controls. Significantly elevated serum TNF-alpha (X +/- SD: 5.13 +/- 1.37 pg/mL versus 3.91 +/- 0.61 pg/mL; p < 0.0001), sTNF-R1 (X +/- SD: 1.37 +/- 0.28 ng/mL versus 1.16 +/- 0.13 ng/mL; p = 0.0002), and sTNF-R2 (X +/- SD: 0.78 +/- 0.42 ng/mL versus 0.43 +/- 0.41 ng/mL; p = 0.0001); IL-4 (X +/- SD: 4.05 +/- 1.02 pg/mL versus 3.34 +/- 0.84 pg/mL; p = 0.0016); IgE (X +/- SD: 390.1 +/- 361.4 KU/L versus 130.2 +/- 166.1 KU/L; p = 0.0001); and ECP (X +/- SD: 17.57 +/- 11.03 micrograms/L versus 10.65 +/- 6.01 micrograms/L; p = 0.0016) concentrations were measured in the subjects with bronchial hyperreactivity as compared with the nonhyperreactive group. Significant positive linear correlations were observed for the bronchial hyperreactive group between the concentrations of TNF-alpha and ECP, TNF-alpha and sTNF-R1, TNF-alpha and IL-8, sTNF-R1 and ECP, sTNF-R1 and IL-8, and sTNF-R2 and IL-8. Moreover, the TNF-alpha and sTNF-R2 levels correlated with the airway reactivity in the hyperreactive group. We suggest that the elevated cytokine levels indicate activation of the immune system in individuals who were previously asthmatic, but recovered, and are now symptom free and in their children with nonasthmatic bronchial hyperreactivity. The TNF system may play a key role in the pathomechanism of bronchial hyperreactivity.

[Effect of loratadine in children with allergic rhinitis]. / A loratadin hatásai allergiás rhinitisben szenvedö gyermekeknél.

The authors examined 25 children with allergic rhinitis, who were sensitive to grass, weed and tree pollens. During the allergic season nasal lavage was performed then repeated after 4 weeks of loratadine treatment. Tryptase, IL-5, ECP, TNF-alpha and RANTES levels were measured from the nasal lavage fluid. Tryptase, IL-5, and ECP levels were decreased significantly while the decrease of RANTES and TNF-alpha levels was not significant. The authors emphasize that loratadine is an effective anti-inflammatory drug which affects the early and late phase of immediate hypersensitivity. In the moderate cases loratadine is enough to relieve the symptoms, while in the severe forms anti-allergic eye drops and nasal antihistamine or steroid spray has to be added.

Oral montelukast versus inhaled beclomethasone in 6- to 11-year-old children with asthma: results of an open-label extension study evaluating long-term safety, satisfaction, and adherence with therapy.

This 6-month, open-label extension study of a previously described base study compared oral montelukast with inhaled beclomethasone in terms of safety, forced expiratory volume in one second (FEV1) measurements, parent and patient satisfaction with treatment, asthma-related medical resource utilization, school absenteeism, and parental work loss in children with asthma. A total of 124 of 266 asthmatic children, 6 to 11 years of age, who enrolled in the base study entered a 6-month open-label extension study (74 boys, 50 girls) and were re-randomized (2:1 ratio) to receive once-daily oral montelukast (n = 83) or inhaled beclomethasone 100 mcg three times daily (n = 41). Children were evaluated in the clinic prior to re-randomization (Month 0) and at regular visits at 1, 3, and 6 months. Children and their parents showed a significantly higher overall satisfaction for montelukast at 6 months than for inhaled beclomethasone (p = 0.001 and p < 0.05, respectively). According to parents, montelukast was more convenient (p < 0.001), less difficult to use (p = 0.005), and was used as instructed more of the time (p = 0.006) compared with beclomethasone. Oral corticosteroid use was similar in the montelukast (13% of patients) and beclomethasone (17%) treatment groups. The montelukast treatment group was more adherent with their regimen than the inhaled beclomethasone treatment group; almost twice as many children on montelukast compared with inhaled beclomethasone were highly compliant (82% versus 45%). The two study groups were similar with respect to overall safety, change in FEV1, asthma-related medical resource utilization, school absenteeism, and parental work loss. Montelukast represents a safe and effective asthma treatment regimen to which children with asthma are more likely to adhere.

[Levels of interleukin-4, interleukin-5, tryptase and eosinophil cationic protein of nasal lavage fluid in pollen allergic rhinitis]. / Interleukin-4, interleukin-5, triptáz és eosinophil kationos proteinszintek meghatározása az orrmosó folyadékban rhinitis allergicában.

IL-4, IL-5, tryptase and eosinophil cationic protein levels were measured in nasal lavage fluid from 15 pollen allergic rhinitis beyond pollen season. Allergy was proved by prick test. There were 15 non allergic children in the control group. Specific nasal allergen provocation was performed on the rhinitic group. Nasal lavage were done before, 1 and 12 hours after the provocation. Before the nasal provocation the ECP and IL-4 levels were significantly higher in the allergic group compared to the non allergic group. The levels of tryptase, ECP and IL-4 rose significantly after the provocation. The results reflect to the possibility of an activated immune status in allergic rhinitis even without the presence of the triggering pollens. After the specific provocation elevated tryptase levels were measured, referring to the activity of the early phase of the I. type hypersensitivity reaction, while the ECP and IL-5 elevation to its late phase. According to our examinations it can be said, that tryptase, ECP and IL-5 might be used to detect the activation of the early and late phases of the IgE mediated hypersensitive reaction.

[Evaluation of loretadine therapy by rhino-manometry in patients with allergic rhinitis]. / Loratadine terápia értékelése rhinitis allergicában szenvedö betegekben rhinomanometriával.

The authors evaluated the nasal flow and resistance by rhinomanometry in 21 children suffering from ragweed allergy during the season. After this process the loratadine was administered for 1 month. During the therapy the nasal parameters were checked at 2 and 4 weeks, again. The loratadine significantly decreased the nasal resistance in 18 children and improved the nasal airflow in 17 cases. In the second part of the examination 15 ragweed sensitized children were undergone nasal allergen-specific challenge after 40 minutes taken loratadine. The nasal parameters were checked after 30 minutes and 6-8 hours. The statistical analyzes proved that loratadine can prevent and inhibit the early and late-phase of Type I hypersensitivity in contrast of the 12 children who were challenged without loratadine administration. They showed nasal obstruction. Based on the results, loratadine can be considered very effective antihistamine-antiallergenic drug which improves the quality of life of the allergic patients.

[Multicenter studies of terfenadine-containing suspensions in children with hayfever]. / Multicentrikus vizsgálat terfenadin tartalmú szuszpenzióval szénanáthás gyermekeken.

Authors treated 50 seasonal allergic rhinitis ragweed sensitive patients with a second generation antihistamine, terfenadine containing suspension given twice/day for two weeks in the weeds season of 1996. Nasal (rhinorrhoea, stuffed nose, sneezing, itching) and eye symptoms (hyperaemia, itching, tearing), noted by the physicians and by the patients' diary, blood count, liver function, kidney function and ECG were examined. There was no meaningful difference between the symptoms registrated by the physicians and the patients. It was pointed out that according to both notes at all symptoms there was an improvement already on the 7th day of the treatment, which developed further for the 14th day. The only exception was rhinorrhoea which ameliorated only for the 14th day. ECG deviation related to the terfenadine treatment was not found. Repeated vomiting was experienced at one child. Transitional, slight SGOT, SGPT activity increase appeared in 4 children, the same was observed at two children in se kreatinine and carbamid nitrogen level. Nine patients needed (from the 7th day) supplementary local treatment (cromoglycate eyedrops or nasal spray).

[Eosinophilic cationic protein levels in feces and serum in children with food allergies]. / A széklet és a szérum eosinophil kationos protein szintek összehasonlítása táplálékallergiás gyermekekben.

The authors measured the serum and copro eosinophil cationic protein levels before and after the food challenge. Twenty children with food allergy and 20 controls were investigated. Under 6 years the oral food provocation test prepared a simplier way above 6 years double blind-placebo-controlled-food-challenge was made. The authors measured the serum and copro eosinophil cationic protein levels by Pharmacia CAP system. The faeces was prepared based on Kolmannskog method. The value of serum was 12.6 +/- 7.7 (mean +/- SD), while the values of faeces was 93.96 +/- 47.5 (micrograms/l). The serum level of control's was 7.72 +/- 5.2 (mean +/- SD) and than in the faeces the level was 13.78 +/- 8.97 (micrograms/l), 19 food allergic children's eosinophil cationic protein level significantly increased after challenge while then serum level did not change. It can be concluded that follow up of food allergic reaction can be regarded as a more exact with measure of the copro eosinophil cationic protein.

[Evaluation of copro-allergen specific IgE and eosinophilic cationic protein levels in children with food allergy]. / Specifikus copro-IgE és eosinophil kationos protein szintek értékelése tápanyagallergiás gyermekekben.

The authors studied copro-allergen specific IgE, eosinophil cationic protein, alpha-1 antitrypsin, IgA and IgG levels in 20 food allergic patients and in 20 controls. It was found that the copro-allergen specific IgE and eosinophil cationic protein levels were significantly higher in food allergic group than in the control group. Carrying out an oral challenge in real food allergic group the copro-allergen specific IgE and eosinophil cationic protein levels were measured before and after the provocation. The results proved that the stopping of allergenic exposure the local immunreactions will finish. Proving this fact it can be said that 24 hours later in the faeces samples the IgE levels decreased and in some case disappeared. The change of eosinophil cationic protein levels during and after the oral challenge proves the important role of eosinophils in late phase reaction. Finally it can be stated that authors introduced a new non invasive methods which is very suitable and reliable to study local immunoreaction in the gastrointestinal tract.