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.

[Hyperbaric oxygen therapy application in otorhinolaryngology and head and neck surgery: state of the art and review of literature]

Hyperbaric Oxygen Therapy (HOT) encompasses an extensive research area in which new indications, some of which are now well-codified, have emerged both in the fields of medical and surgical pathology. Its utilization in carefully targeted clinical situations, in which its true efficacy can be demonstrated, is first of all connected with medicolegal responsibility, in suspected iatrogenic accidents; its application must furthermore be subordinated to a favourable cost/benefit ratio for the health service employing it. In otorhinolaryngology and head and neck surgery, HOT is a strategic therapeutic weapon in several applications. Its most widely recognized indications are radiation lesions, chronic osteomyelitis of the mandible, head and neck infections, malignant external otitis, sudden hypoacusia, chronic tinnitus, encephalitis, treatment of the gasseous embolus, skin grafts, vascularized flaps, cervicoencephalic traumas. HOT indications as a radiosensitizing and/or chemiosensitizing factor are still being studied. Both a review of the literature and our experience appear, beyond any doubt, to confirm that HOT promotes faster recovery and reduces hospital stays, thus qualifying as a new therapeutic aid that complements the usual well-established methods.

[Tinnitus during headache: clinical-instrumental evaluation]

During the five years running from December 1993 to January 1998, 112 patients who had come to our University Clinic suffering from headache were examined. From this group 71 complaining of tinnitus during headache were recruited for the study: 19 patients suffered from migraine without aura, 8 migraine with aura, 15 tension headache, 21 mixed headache, 3 basic migraine and 5 cluster headache. The purpose of this work was to determine the incidence and to identify the frequency of the various types of tinnitus in the study sample. Once cardiovascular and metabolic pathologies, previous cranial or cervical traumas, barotrauma, chronic on-the-job noise exposure, cervical arthritis, ATM malocclusion, use of drugs that damage the hearing apparatus, morbose processes of the external and middle ear, otosclerosis, jugular tympanum paraganglioma, Meniere's disease, acoustic neurinoma were all ruled out, the patients underwent the following battery of instrumental tests: tonal audiometry, impedance measurement, vestibular examination, electronystagmography, ABR, simplified tinnitometry. Only those patients with normal hearing underwent the tinnitometry and, therefore, the type of tinnitus was established only for this group of 53 patients. Tinnitometry showed that 37% of these subjects had tinnitus at the higher frequency tones, 11% at the middle frequencies, 29% complained of tinnitus at the lower frequencies while 23% complained that the bothersome buzzing was a compound noise. In addition, the subjective intensity of the tinnitus was analyzed. The authors devised a tinnitus irritation scale covering a range from 0 (not irritating) to 10 (intolerable). The tinnitus was bilateral in 66% of the cases while it was limited to only one ear in the remaining 34%. In 15% of the cases tinnitus was present even when there was no headache. In the literature, the etiopathogenesis of tinnitus associated with migraine headache has been attributed to vascular and neuropeptide mechanisms. Even the psychological component appears to play a role in triggering the event. These hypotheses deserve more in depth study.

Outdoor pollution and headache

The aim of this study was to clarify a possible relationship between pollution and worsening of headache in the industrial city of Turin. From October 1992 to June 1993, we examined a group of 32 patients suffering from various headache types. During these months, they kept a daily record of their headaches and associated disturbances. Changes in pain frequency and severity were recorded every hour of the day and compared hour to hour with the various degrees of pollution recorded in the main streets by a monitoring station. The influence of meteorological parameters was also taken into consideration. During winter, carbon monoxide and nitrogen dioxide showed a simultaneous hyperconcentration on the same days and the same hours. Increased incidence of headache attacks and increase in severity corresponded to the same hours, days, and months. The findings were statistically significant (P = 0.008, Student's t-test). An isolated increase in nitrogen dioxide only (without an increase in carbon monoxide which was only recorded once) induced headache a couple of hours after the peak concentration was reached. Among the meteorological factors, only the highest values in wind velocity were shown to exert a significant influence on worsening headache frequency and severity.

Low prevalence of HIV in high-risk seronegative homosexual men evidenced by virus culture and polymerase chain reaction

OBJECTIVE

To assess the presence of covert HIV-1 infection.

SETTING

High-risk seronegative homosexual men from the Pittsburgh portion of the Multicenter AIDS Cohort Study were examined for the presence of HIV-1 infection.

PATIENTS, PARTICIPANTS

Ten men (group 1) were examined prospectively for the presence of HIV-1 in their freshly-obtained peripheral blood mononuclear cells (PBMC). Furthermore, cryopreserved PBMC from 26 men (group 2) at their first visit (1984-1985) were examined retrospectively for the presence of HIV-1.

MAIN OUTCOME MEASURES

PBMC samples from groups 1 and 2 were examined for HIV-1 by polymerase chain reaction (PCR) using gag, env and strong-stop (long terminal repeat) specific primers. In addition, fresh PBMC samples from group 1 were examined for HIV-1 by virus culture.

RESULTS

None of the 10 PBMC samples from group 1 were positive for virus culture and PCR. Only one of the 26 men from group 2 was positive for gag and strong-stop DNA sequences. This PCR-positive, seronegative subject was found to be negative for HIV-1 by PCR at follow-up visits up to 48 months later. None of 15 seronegative, low-risk homosexual men and 12 seronegative heterosexual men were found to be PCR-positive for HIV-1. However, six HIV-1-seropositive men were positive by PCR for gag, env, and strong-stop HIV-1 DNA sequences.

CONCLUSIONS

These results suggest a low prevalence of covert HIV-1 infection in high-risk seronegative homosexual men in our geographic area.

Human immunodeficiency virus isolates from asymptomatic homosexual men and from AIDS patients have distinct biologic and genetic properties

Human immunodeficiency virus type 1 (HIV-1) isolates from asymptomatic homosexual men and AIDS patients were compared for their in vitro biologic and genetic properties. Most of the HIV-1 isolates from asymptomatic men, but not from AIDS patients, failed to infect CD4+ H9 cells and phytohemagglutinin-stimulated peripheral blood lymphocytes. In a longitudinal study, serial HIV-1 isolates obtained from men who seroconverted to HIV-1 and later developed AIDS were able to infect H9 cells. In contrast, longitudinal isolates from men who remained asymptomatic did not infect H9 cells. HIV-1 isolates from AIDS patients in general exhibited increased production of intracellular viral DNA, RNA, and protein as compared to isolates from asymptomatic men. Cells infected with HIV-1 isolates from asymptomatic men produced very little gp120, p24, and p55 proteins as compared to those from AIDS patients. The overall restriction patterns of HindIII, Sac-1, Pst-1, EcoR1, and BamH1 were very similar between HIV-1 isolates from asymptomatic men and those from AIDS patients. However, the restriction endonuclease pattern of BglII was quite distinct for isolates from asymptomatic men as compared to AIDS patients. Preliminary studies mapped a unique BglII site in the gag region of most of the isolates from asymptomatic men, approximately 2.0 kb from the 5' end. Thus, HIV-1 isolates from asymptomatic subjects and from AIDS patients have distinct biologic and genetic properties which may be related to the various clinical outcomes of HIV-1 infection.

A semiquantitative microassay for measurement of relative number of blood mononuclear cells infected with human immunodeficiency virus

A simple semiquantitative microassay was developed for the measurement of relative number of infected peripheral blood mononuclear cells (PBMC) from individuals infected with human immunodeficiency virus (HIV). The assay is based on cocultivation of serially diluted PBMC of a seropositive person with phytohemagglutinin-stimulated normal PBMC. The microassay has comparable sensitivity with the standard virus culture method in detecting positive HIV cultures. Since the microassay uses only 2-3 x 10(5) patients' PBMC, the assay is also most suitable for HIV isolation from HIV-infected infants or from AIDS patients with extremely low T-cell counts. The microassay can also be used to measure antiviral effects of a drug on persistent HIV infection in vitro. Because the microassay measures the relative number of infected PBMC, it can be readily used for following the quantitative antiviral effect of a drug in a clinical trial.

Cell-to-cell transmission of human immunodeficiency virus type 1 in the presence of azidothymidine and neutralizing antibody

Very few peripheral blood lymphocytes of seropositive individuals are presumably actively infected with human immunodeficiency virus type 1 (HIV-1). During coculture of lymphocytes of a seropositive individual with mitogen-stimulated normal peripheral blood lymphocytes, the number of infected cells becomes amplified such that detectable HIV-1 is produced. We report here that in addition to transmission by extracellular virus, cell-to-cell transmission is responsible for spreading HIV-1 infection from infected to uninfected cells. Azidothymidine and virus-neutralizing antibody had no effect on cell-to-cell transmission of HIV-1. Monoclonal antibodies to the CD4 receptor, but not to the CD3 receptor, prevented cell-to-cell transmission, which suggests that CD4 receptor-mediated cell fusion is involved in cell-to-cell transmission. Spread of infection in a cell-to-cell manner may be important in development of drug therapies for HIV-1 infection.