Age, Blasts, Performance Status and Lenalidomide Therapy Influence the Outcome of Myelodysplastic Syndrome With Isolated Del(5q): A Study of 58 South American Patients.

BACKGROUND: Myelodysplastic Syndrome (MDS) with isolated deletion 5q is associated with a low risk to leukemic evolution and long overall survival (OS); it comprises 3%-4.5% of MDS cases in Latin America classified according to the World Health Organization 2008. This study aims to describe clinical, laboratory and the outcome of patients according to the newest World Health Organization 2016 proposal. METHODS: We retrospectively reviewed patients from four Brazilian (BR) and four Argentinean (AR) centers diagnosed between 1999 and 2019. RESULTS: The 58 patients (16-AR and 42-BR) presented a median age of 67 (IQR 61-75) years old, women predominance (70.7%) and transfusion dependency (62.5%) at diagnosis. Median hemoglobin level was 8.1g/dL, 27.5% and 44.4% presented thrombocytosis and neutropenia, respectively. Bone marrow (BM) was predominantly hypercellular (43.1%) with 66% showing dysplasia >1 lineage and 37.9% with >2% of blasts. Deletion 5q was mostly isolated (79.3%) and a variety of abnormalities were observed in remaining cases. Most patients were treated with erythropoietin-stimulating agents (ESA), 18 with lenalidomide and 15 with thalidomide. Median follow-up was 7.6 years, with a median OS of 3.5 years and an 8-years leukemic evolution rate of 18.4%. Multivariate analysis showed that age >75 years (HR 2.19), ECOG ≥2 (HR 5.76), BM blasts >2% (HR 2.92) and lenalidomide treatment (HR 0.25) independently influenced the OS. CONCLUSION: Older age, worse performance status and higher percentage of blasts, that can be easily assessed, were associated to a worse prognosis. Also, our results corroborate the protective influence of lenalidomide in terms of OS in this South American series.

Fusarium solani infection as an initial manifestation of AML transformation in myelodysplastic syndrome: A case report.

Severely immunocompromised patients are at increased risk for uncommon infectious diseases with atypical presentations. Fusarium sp., has been reported in patients with hematological malignancies and prompt diagnosis is necessary due to high mortality. We report a myelodysplastic syndrome (MDS) patient who presented Fusarium solani infection associated with granulocytic sarcoma as an initial presentation of acute myeloid leukemia (AML) transformation. We performed histological examination, immunohistochemistry analysis, culture of the biopsy tissue and DNA sequencing to make a conclusive diagnosis of F. solani and granulocytic sarcoma, reinforcing the necessity of performing complete evaluation of skin lesions in immunocompromised patients.

Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM).

A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.

Toxic concentrations of metronidazole to Microcystis protocystis.

Antimicrobials are among the most commonly used drugs and have become a class of contaminants with great environmental importance. Metronidazole is an antimicrobial used for the therapeutic management of several human diseases. The toxicity of antimicrobials on aquatic species may affect sensitive microorganisms and reduce metabolic processes. Cyanobacteria is a group of organisms that are of great ecological importance in aquatic environments. Studies indicate that cyanobacteria are very sensitive to some antimicrobials. Therefore, it is necessary to evaluate the effects of metronidazole contamination on phytoplankton. The aim of this study was to investigate the effects of metronidazole on the growth of the cyanobacterium Microcystis protocystis and to evaluate the stability of this antimicrobial agent in the culture medium over a period of 96 hours. M. protocystis was resistant to growth inhibition by metronidazole. The EC50 of this antimicrobial for M. protocystis was 117.3 mg L(-1). Under the growth inhibition test conditions, neither a significant change in the MNZ concentration nor the presence of drug metabolites or degradation products was observed. These results indicate low cellular uptake of the antimicrobial agent and its persistence in the culture medium.

Case report of isochromosome 17q in acute myeloid leukemia with myelodysplasia-related changes after treatment with a hypomethylating agent.

Isochromosome 17q is a relatively common karyotypic abnormality in medulloblastoma, gastric, bladder, and breast cancers. In myeloid disorders, it is observed during disease progression and evolution to acute myeloid leukemia in Philadelphia-positive chronic myeloid leukemia. It has been reported in rare cases of myelodysplastic syndrome, with an incidence of 0.4-1.57%. Two new agents have been approved for treatment of myelodysplastic syndrome/chronic myelomonocytic leukemia. These are the hypomethylating agents, 5-azacytidine and decitabine, recommended by consensus guidelines for high-risk myelodysplastic syndrome patients not eligible for hematopoietic stem cell transplantation. We present a case of chronic myelomonocytic leukemia with normal cytogenetics at diagnosis treated with decitabine (with good response); however, the patient evolved to acute myeloid leukemia with i(17q) shortly after suspending treatment. To the best of our knowledge, this is the first report of acute myeloid leukemia with myelodysplasia-related changes with i(17q) after the use of a hypomethylating agent.

Fatores associados com os tipos de heparina usados no tratamento da angina instável em um hospital brasileiro / Factors Associated with the Types of Heparin used in the Treatment of Unstable Angina at a Brazilian Hospital

Unfractionated heparin (UFH) and low-molecularweight heparins (LMWHs) are widely used in curative and preventive treatments of thromboembolic disorders. The aim of the study was to investigate factors associated with the choice of these types of heparin to treat patients with unstable angina under real conditions of hospital use. A cross-sectional study was performed in a private general hospital in Belo Horizonte, Brazil, from January 1st to December 31th, 2001. Data were collected from the hospital electronic database. Inpatients with angina who received enoxaparin or UFH were included in the survey. Data for 555 patients were recorded, including 401 treated with enoxaparin and 154 with UFH. Univariate analysis showed that male and elderly people predominated in both groups, with no statistical difference in the proportions (p>0.05). Multivariate analysis showed 4 factors associated with the use of enoxaparin: cardiac revascularization surgery (OR=0.434), arrhythmias (OR=9.343), risk factors for coronary artery disease (OR=1.333) and private health insurance (OR=0.297). Thus, clinical and organizational factors were associated with the type of heparin used by patients with unstable angina at this hospital. Further drug utilization studies are necessary to expand and improve the data available on the use of heparins in the hospital setting.

A heparina não-fracionada (HNF) e heparinas de baixo peso molecular (HBPM) são amplamente utilizadas em tratamentos curativos e preventivos de tromboembolismo. O objetivo do estudo foi investigar os fatores associados com a escolha desses tipos de heparinas para tratar pacientes com angina instável sob as condições reais de uso hospitalar. Trata-se de um estudo transversal realizado em hospital geral privado, na cidade de Belo Horizonte,MG Brasil, no período de Janeiro a Dezembro de 2001. Para a coleta de dados, utilizou-se o banco de dados informatizado do referido hospital. Pacientes internados com angina que receberam enoxaparina ou HNF foram incluídos no estudo. Registrou-se dados de 555 pacientes, incluindo 401 tratados com enoxaparina e 154 com HNF. Na análise univariada, observouse que o gênero masculino e pacientes idosos foram predominantes em ambos os grupos, sem diferença estatística entre as proporções (p>0,05). A análise multivariada revelou quatro fatores associados ao uso de enoxaparina: cirurgia de revascularização cardíaca (OR=0,434), arritmias (OR=9,343), fatores de risco para doença coronariana (OR=1,333) e atendimento por plano de saúde (OR=0,297). Assim, fatores clínicos e organizacionais estão associados com o tipo de heparina usado por pacientes com angina instável, neste hospital. A realização de mais estudos de utilização de medicamentos é necessária para aprimorar o conhecimento sobre o uso de heparinas, em hospitais.

Investigations into the application of a combination of bioventing and biotrickling filter technologies for soil decontamination processes--a transition regime between bioventing and soil vapour extraction.

Bioventing has emerged as one of the most cost-effective in situ technologies available to address petroleum light-hydrocarbon spills, one of the most common sources of soil pollution. However, the major drawback associated with this technology is the extended treatment time often required. The present study aimed to illustrate how an intended air-injection bioventing technology can be transformed into a soil vapour extraction effort when the air flow rates are pushed to a stripping mode, thus leading to the treatment of the off-gas resulting from volatilisation. As such, a combination of an air-injection bioventing system and a biotrickling filter was applied for the treatment of contaminated soil, the latter aiming at the treatment of the emissions resulting from the bioventing process. With a moisture content of 10%, soil contaminated with toluene at two different concentrations, namely 2 and 14 mg g soil(-1), were treated successfully using an air-injection bioventing system at a constant air flow rate of ca. 0.13 dm(3) min(-1), which led to the removal of ca. 99% toluene, after a period of ca. 5 days of treatment. A biotrickling filter was simultaneously used to treat the outlet gas emissions, which presented average removal efficiencies of ca. 86%. The proposed combination of biotechnologies proved to be an efficient solution for the decontamination process, when an excessive air flow rate was applied, reducing both the soil contamination and the outlet gas emissions, whilst being able to reduce the treatment time required by bioventing only.

Anemia reduction in preschool children with the addition of low doses of iron to school meals.

BACKGROUND: In developing countries there is high prevalence of iron deficiency anemia, which causes negative impact on growth, development and quality of life for infant population. Currently several strategies are being elaborated and tested to tackle this problem. OBJECTIVE: To measure anemia prevalence in preschool children. To evaluate fortification effectiveness with 5 or 10 mg of elemental iron/daily added to school meals by increasing hemoglobin levels in anemic children. METHODS: Double-blind, cluster randomized intervention study with 728 students from public network. Blood count was taken at beginning of study, to evaluate anemia prevalence, those anemic were selected for intervention, after intervention new blood count was taken to evaluate fortification effectiveness. Ferrous Sulphate was added in individual dosage of 5 or 10 mg of elemental iron/daily to usual school meal. From 35 schools 3 were randomized to receive 5 mg/daily (group A) and 3 to receive 10 mg/daily (group B). Hemoglobin and hematocrit averages before and after intervention were compared in each group and between them. RESULTS: In group A, the anemia prevalence reduced 34.9 to 12.4%, and in group B 39.0 to 18.7%. In both groups a significant increase in hemoglobin was observed: in group A from 10.1 to 11.5 g/dl (p < 0.01) and in group B from 10.0 to 11.0 g/dl (p < 0.01). There was no statistically significant difference in final levels of hemoglobin among groups. CONCLUSIONS: Both dosages of elemental iron were equally effective in increasing hemoglobin levels, and reducing anemia prevalence. Fortification of school meals was shown to be an effective, low cost and easy to manage intervention.

Qualidade terapêutica de medicamentos adquiridos em drogarias da região central de Belo Horizonte - MG / Therapeutic quality of medicines acquired at drugstores in central area of Belo Horizonte - MG

A qualidade terapêutica das vinte especialidades farmacêuticas mais dispensadas em três drogarias situadas na região central de Belo Horizonte - MG nos meses de novembro e dezembro de 2000 foi avaliada. Os medicamentos foram classificados quanto ao valor terapêutico potencial e grau esperado de uso. Foram determinados a freqüência dos subgrupos terapêuticos, o total de princípios ativos e as associações em dose fixa. Observou-se uma predominância de medicamentos de venda livre. Somente metade das especialidades farmacêuticas analisadas apresentava valor terapêutico potencial elevado. Analgésicos/antipiréticos e antiácidos foram os subgrupos mais freqüentes, observando-se elevada proporção de associações em doses fixas. Os dados sugerem que a automedicação esteja associada ao padrão de vendas observado. Dentre outros fatores, a publicidade de medicamentos dirigida à população leiga, o número excessivo de especialidades farmacêuticas disponíveis no mercado e a inexistência da atenção farmacêutica foram considerados possíveis determinantes deste consumo

Multiple lymphoid nodules in bone marrow biopsy in immunocompetent patient with cytomegalovirus infection: an immunohistochemical analysis.

In Brazil, a high prevalence of cytomegalovirus (CMV) infection has been documented. In immunocompetent adults CMV infection is usually asymptomatic and therefore morphologic and immunophenotypic bone marrow changes have rarely been described. The authors report the case of a previously healthy patient who developed fever of undetermined origin. The diagnosis of acute CMV infection was based on serological testing. A computed tomographic scan showed mediastinal lymphadenopathy. A bone marrow biopsy revealed a hypercellular haematopoiesis with eosinophilia and large mixed T- and B-cell lymphoid aggregates. In spite of bcl-2 positivity, their reactive nature was demonstrated. Polymerase chain reaction (PCR) and immunohistochemistry were unable to detect CMV-DNA in paraffin-embedded bone marrow sections. Much like in other systemic disorders, the lymphoid nodules in this case seemed to be caused by immunological mechanisms, possibly due to cytokines released in response to the systemic infectious process.

Multiple lymphoid nodules in bone marrow biopsy in immunocompetent patient with cytomegalovirus infection: an immunohistochemical analysis

In Brazil, a high prevalence of cytomegalovirus (CMV) infection has been documented. In immunocompetent adults CMV infection is usually asymptomatic and therefore morphologic and immunophenotypic bone marrow changes have rarely been described. The authors report the case of a previously healthy patient who developed fever of undetermined origin. The diagnosis of acute CMV infection was based on serological testing. A computed tomographic scan showed mediastinal lymphadenopathy. A bone marrow biopsy revealed a hypercellular haematopoiesis with eosinophilia and large mixed T- and B-cell lymphoid aggregates. In spite of bcl-2 positivity, their reactive nature was demonstrated. Polymerase chain reaction (PCR) and immunohistochemistry were unable to detect CMV-DNA in paraffin-embedded bone marrow sections. Much like in other systemic disorders, the lymphoid nodules in this case seemed to be caused by immunological mechanisms, possibly due to cytokines released in response to the systemic infectious process.

Uma elevada prevalência de infecção pelo citomegalovírus (CMV) está documentada no Brasil. Em adultos imunocompetentes a infecção pelo CMV é, em geral, assintomática e, portanto, as alterações morfológicas e imunohistoquímicas na medula óssea têm sido raramente descritas. Relatamos o caso de um paciente previamente assintomático que desenvolveu febre de origem obscura. O diagnóstico de infecção aguda pelo CMV foi baseado em estudo sorológico. A tomografia computadorizada do tórax mostrou linfadenopatia mediastinal. A biópsia óssea revelou medula hipercelular com eosinofilia e grandes agregados linfóides mistos de células B e T. Apesar da positividade para bcl-2, a sua natureza reacional foi demostrada. A reação em cadeia da polimerase (PCR) e a imunohistoquímica não detectaram DNA viral nos cortes de medula óssea em parafina. Assim como em outros distúrbios sistêmicos, os nódulos linfóides no nosso caso parecem ser causados por mecanismos imunológicos, possivelmente relacionados a citoquinas liberadas em resposta ao processo infeccioso sistêmico.