scholarly journals Evaluation of Electrolytes Disturbances in Iraqi Chronic Myeloid Leukemia Patients treated with Nilotinib with Monitoring of Response by FISH Study

2015 ◽  
Vol 12 (1) ◽  
pp. 110-118
Author(s):  
Baghdad Science Journal

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence Philadelphia chromosome (Ph) which was created by a reciprocal translocation between chromosomes 9 and 22 (t [9;22] [q34;q11]. The approval of the 2nd generation TKI ( Nilotinib) takes the treatment of CML patients into new erea with more efficiency and mild to moderate adverse effects. This study was aimed at evaluation of molecular cytogenetic response by (FISH) for Nilotinib in Iraqi patients with assessment for electrolytes disturbances of Nilotinb by measuring a panel of electrolyte (Na+, K+, Ca++, PO4--- and Mg++) , where thirty Iraqi patients with CML who have resistance or no response to Imatinib treatment, attending to Baghdad Teaching Hospital/Hematology Department, have been submitted to this study. Blood samples have been taken pre and post starting treatment with Nilotinib, FISH study was done only for CML patients, while 30 normal healthy control volunteers submitted to the same panel of electrolytes measurements (Na+, K+, Ca++, PO4--- and Mg++) in addition to pre and post treatment Nilotinib patients. The results show out of 30 patients (17) males and (13) females with male to female ratio 1.3:1, FISH results for patients (pre and post) treatment mean±SD were(58.7%±26.2 % and 45.7%±29.9%) obviously significant with good cytogenetic response in resistance CML for Imatinib. Sodium levels in mmol/L pre, post treatment and control mean±SD were (139.2±6.9 , 142.4±9.2 and 140.4±2.52) respectively, with no significant difference between each other with P value > 0.05 in all comparisons. Potassium levels mean±SD in mmol/L results for patients (pre, post) and control were (4.6±0.69, 4.3±0.68 and 4.46±0.76) respectively, with no significant difference between each other with P value > 0.05 in all comparisons. Calcium levels in mg/dL results for patients (pre, post) and control as mean±SD were (8.68 ±1.68, 8.1±1.72 and 9.12±0.38) respectively with no significant differences except between post treatment and control group with P value > 0.05 in all comparisons. Phosphate levels in mg/dL results for patients (pre, post) and control as mean±SD were (2.5±0.84, 2.95±1.04 and 3.4±0.49) respectively with significant difference with P value < 0.05 in all comparisons. Magnesium levels in mg/dL results for patients pre, post and control as mean±SD were (1.93±0.34, 2.06±0.44 and 2.1±0.34) respectively with no significant difference between each other with P value > 0.05 in all comparisons. This study sheds a light on the molecular cytogenetic response for CML patients who have already resistance to Imatinib and Nilotinib that has much more potent effect as approved by studies and this study has used FISH technique. This study emphasizes on the importance of evaluation of electrolyte panel for CML patients before starting Nilotinib study taking in to consideration if these patients are already receiving Imatinib which can also affect bone metabolism and calcium and phosphate levels.

Blood ◽  
1998 ◽  
Vol 91 (8) ◽  
pp. 2713-2721 ◽  
Author(s):  

Interferon-α (IFN-α) is considered the standard therapy for chronic myeloid leukemia (CML) patients not suitable for allogeneic stem cell transplantation. From 1987 through 1992, 195 patients in the Benelux with recent untreated CML were randomized between low-dose IFN-α2b (3 MIU, 5 days/wk) or hydroxyurea alone (control group). The white blood cell count had to be kept less than 10 × 109/L in both arms; to this end, the IFN group received additional hydroxyurea, if necessary. The complete hematologic responses at 6 months in the IFN group were 62%, versus 38% in the control group. In the IFN group, a complete hematologic response at 6 months predicted a better survival (P = .001), but such a tendency was also seen in the control group (P = .07). Cytogenetic responses in the IFN group yielded 9% complete responders, 7% partial responders (&lt;35% Ph+), and 24% minor responders (36% to 95% Ph+). The quality of cytogenetic response within the first 24 months was highly predictive for survival (P = .002). Twenty-four patients discontinued IFN-α because of side effects, but they did this at a long median interval of 17.6 months; the remaining patients did not require dose adaptations. Although the hematologic and cytogenetic responses in the IFN group were higher than in the control group, the duration of chronic phase from randomization was not statistically different with 53 and 44 months in the IFN and control group, respectively. Also, no advantage for survival calculated from diagnosis was seen for the IFN group (median, 64 months) compared with the control group (median, 68 months).


2017 ◽  
Vol 3 (5) ◽  
pp. 470-477
Author(s):  
Anjar Astuti ◽  
Suryono Suryono ◽  
Melyana Nurul Widyawati ◽  
Ari Suwondo ◽  
Mardiyono Mardiyono

Background: Autism is a neurodevelopmental disorder. Audio therapy is considered as one of the complementary therapies to improve the behavior of children with autism.Objective: This study was to analysis the effectiveness of the Al-Qur'an murrotal audio therapy on behavioral development in children with autism.Methods: This study was a true-experimental research using pretest and posttest approach with control group. This research was conducted on November 2016 in the Autism Foundation of Semarang City. There were 30 samples were selected using simple random sampling, with 15 samples assigned in the experiment and control group. Mann Whitney and Wilcoxon tests were used for data analysis in this study.Results: Results showed that there was a significant difference in the mean of behavioral development after given intervention between the experiment group and control group with p-value 0.034 (<0.05). The mean of behavioral development in the experiment group (4.53) was higher than the mean in the control group (3.47).Conclusion: The Al-Qur'an murrotal audio therapy is effective to develop behavior of children with autism. Therefore, it is expected that this audio therapy can be applied an alternative therapy for children with autism.


2020 ◽  
Vol 2 (2) ◽  
pp. 52-67
Author(s):  
Anggi Vina Hariyati ◽  
Cahyaningrum ◽  
Adil Zulkarnain

Anemia is one of the public health problems that need more attention of the female because they experience menstruation and they are in the growth phase. From the data of Semarang City Health Office  in 2011, it is shown the incidence of anemia in adolescents aged 10-19 years old are 68.24%. The prevention effort of the case is by measuring hemoglobin and prescribing blood supplement. The objective of the study is to find out the effect of Fe tablets on Hemoglobin in Semarang Merchant Marine Polytechnique students. The objective of the study is to find out the effect of Fe tablets on Hemoglobin in Semarang Merchant Marine Polytechnique students. This research used pre-experimental design with the two group pretest posttest. The population in this Study were all Merchant Marine Polytechnique Semarang at the 4th semester of female students  amounting to 50 with the total respondents 34 respondents taken with purposive sampling technique. The data were collected by performing Hemoglobin examination. The results of the study show that the average Hemoglobin before being prescribed Fe on the intervention and control group was 11.29 g/dl. After being prescribed Fe to the intervention group, it is found the average increased to 13.69 g/dl, while in the control group it is found averaged 11.72 g/dl. Bivariate Analysis uses an independent t test, the value of t is 6.136 with a p-value of   0.000. It shows that the p-value is 0,000 <((0.05), this indicates that there is a significant difference in the decrease in Hemoglobin levels in the population after being prescribed blood supplement between the intervention and control groups in The Semarang Merchant Marine Politechnique Students. It is suggested that the female adolescents to consume more iron-containing foods or consume Fe supplements such as Fe, during menstruation. ABSTRAK  Anemia merupakan salah satu masalah kesehatan masyarakat yang perlu khusus nya pada remaja  putri yang perlu mendapatkan perhatian khusus karena remaja putri mengalami mestruasi tiap bulan dan dalam masa pertumbuhan . Hasil Data Dinas Kesehatan Kota Semarang tahun 2011.  Kejadian anemia pada remaja usia 10-19 sebanyak 68,24%. Untuk menangani masalah tersebut pencegahan yang dilakukan yaitu dengan cara mengukur hemoglobin dan pemberian suplemen tablet tambah darah . Penelitian ini bertujuan untuk melihat Pengaruh Pemberian Tablet Fe Terhadap Hemoglobin Pada Taruni Politeknik Ilmu Pelayaran Semarang. Penelitian ini bertujuan untuk melihat Pengaruh Pemberian Tablet Fe Terhadap Hemoglobin Pada Taruni Politeknik Ilmu Pelayaran Semarang. Jenis penelitian ini menggunakan  pre-eksperimen design dengan rancangan Two group pretest posttest. Populasi dalam penelitian iniadalah seluruh taruni politeknik ilmu pelayaran semarang semester 4 berjumlah 50 taruni dengan jumlah sempel 34 responden dengan tehnik pengambilan sempel purposive sampling. Pengambilan data dengan melakukan pemeriksaan Hemoglobin.  Penelitian menunjukan bahwa rata-rata Hemoglobin sebelum diberikan pada taruni kelompok intervensi  dan  kontrol sama yaitu  11,29 g/dl.  Dan setelah diberikan pada kelompok intervensi  rata-rata meningkat menjadi 13,69 g/dl, sedangkan  kelompok kontrol rata-rata sebesar 11,72 g/dl. Analisis bivariate Menggunakan uji t independen, didapatkan nilai t hitung 6,136 dengan p-value sebesar 0,000. Terlihat bahwa p-value 0,000 <a (0,05), ini menunjukkan bahwa ada perbedaan secara signifikan penurunan (selisih) kadar Hemoglobin b pada taruni sesudah diberikan tablet penambah darah antara kelompok intervensi dan kontrol pada taruni Politeknik Ilmu Pelayaran Semarang.  Hendaknya bagi remaja putri lebih banyak mengomsumsi makanan yang mengandung zat besi atau mengomsumsi suplemen yang mengandung besi seperti Fe terutama saat mestruasi


2018 ◽  
Vol 4 (1) ◽  
pp. 112-119
Author(s):  
Andika Siswoaribowo ◽  
Mateus Sakundarno ◽  
Muhammad Mu’in

Background: Diabetes Mellitus is a chronic disease that requires treatment for long periods of time so it can cause physical and psychological problems for sufferers and families (caregiver). Caregiver's role is expected to provide support for people with diabetes mellitus. Family psychoeducation is a strategy that can be applied for caregiver in overcoming problems that arise during the treatment of patients with diabetes mellitus.Objective: This study aims to determine the effect of family psychoeducation on caregiver support in the treatment of patients with diabetes mellitus type II.Methods: This research used a quasi experiment with  pre-test post-test control group design. A total of 46 caregivers and patients with diabetes mellitus were recruited puposively, with 23 respondents assigned in the experiment and control group. Caregiver support scale was used to measure caregiver support, and Hensarling Diabetes Family Support Scale (HDFSS) for measuring perception of patients toward the treatment of caregiver.  Data were analyzed using paired t-test and independent t-test. Results: Findings showed there was an increase of caregiver knowledge from 5.39 to 9.09 and an improvement of caregiver treatment from 40.30 to 67.04 after given family psychoeducation. There was a significant difference of caregiver support in the experimental and control group with p-value <0.001 (<0.05).Conclusion: Family psychoeducation can increase caregiver support in the treatment of diabetes mellitus patients. The intervention can be one of nurses interventions in the empowerment of family in improving the treatment of chronic diseases, particularly in diabetes mellitus.


2020 ◽  
Vol 12 (1) ◽  
pp. e2020004
Author(s):  
Enas A Dammag ◽  
Nahla A.M. Hamed ◽  
Nabil A El Halawani ◽  
Heba S Kassem ◽  
Mona W Ayad

Background: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm. The pathogenesis of CML is based on the oncoprotein termed BCR‐ABL1. TET2 initiates DNA demethylation and is frequently mutated in hematological malignancies including CML.(1) The relation between TET2 acquisition and CML transformation and/or imitinab resistance is needed to be investigated. (2) Aim: To evaluate Ten Eleven Translocation 2 gene (TET2) single nucleotide polymorphism (SNP) (rs2454206, rs34402524, rs61744960) in chronic myeloid leukemia (CML) in relation to the disease prognostic criteria. Materials & Method: The study included 84 subjects; 54 CML in chronic phase and 30 healthy subjects as control group matched for age and sex. Routine investigations including CBC, bone marrow aspiration, biochemical investigations and molecular study were performed in CML patients to identify the disease stage. DNA extraction and SNP assay for TET2 gene polymorphism was done using (Thermo-Fisher predesigned SNP, USA) PCR prism 7500. Results: The mean age was 45.98±15.7 yrs in CML patients and   39.3±6.587 yrs in control group (p>0.05). TET2 SNP rs 34402524 was either heterozygous and homozygous in CML (48%,and 46.2%) but was mainly homozygous among control (80%) group (p=0.012). TET2 SNP rs 2454206 cases within CML (65.4%) and control (63.3%) group had wild patterns (p=0.046). TET2 SNP rs 61744960 showed a homozygous pattern among all groups (CML and control) showing no statistical significance (p=0.528). TET2 SNP in CML cases did not alter the prognostic criteria as no statistical significance was noted (p>0.05) yet, it was significantly related to spleen size in rs 34402524 where homozygous group had huger sizes and higher BCR-ABL1 levels 6 months after starting TKIs (p<0.05). Conclusions/Recommendation: TET2 SNP is a common in Egyptian chronic myeloid leukemia. TET2 SNP rs 3442524 was associated with huger spleen size and higher BCR-ABL1 levels after 6 months of starting TKIs suggesting disease progression.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4941-4941
Author(s):  
Katia B. Pagnano ◽  
Bruna Vergilio ◽  
Eliana C M Miranda ◽  
Marcia Torresan Delamain ◽  
Maria Helena De Almeida ◽  
...  

Abstract Several studies demonstrated the prognostic significance of an early molecular response in chronic myeloid leukemia (CML) patients (pts) treated with imatinib in first line or other tyrosine kinase inhibitors. Aims: The aim of this study was to evaluate the impact of early molecular responses, at 3 and 6 months after treatment with imatinib in CML pts and correlate these responses with CCR, MMR, overall survival (OS) and event free survival (EFS). Patients and Methods Between February 2006 and June 2012, 95  adult pts with newly diagnosed CML in chronic phase (CP) received imatinib 400mg/daily. CP was defined using WHO 2008 criteria. All pts received a short course of hydroxiurea until imatinib was available. Cytogenetic analysis was performed at diagnosis, 3, 6, 12 and 18 months after starting therapy and then every 12-24 months thereafter. BCR-ABL transcripts were measured in peripheral blood at 3-month intervals using quantitative RT-PCR (RQ-PCR). Results were expressed as BCR-ABL/ABL ratio, with conversion to the international scale (IS). Major molecular response (MMR) was defined as a transcript level ≤ 0.1% (IS). Statistical analysis: OS was measured from imatinib start until date of death or last visit. An event was defined as death from any cause. EFS was measured from imatinib start until the first event (loss of complete hematological response (CHR); complete cytogenetic response (CCR), progression to advanced phase, death or imatinib discontinuation) or last visit. OS and EFS rates were calculated using Kaplan-Meier method and log-rank test to compare its curves. The MMR probabilities according to molecular responses at 3 and 6 months were calculated by c2 method and cumulative incidence, considering as competitive event death or progression, before the event. Results 95 pts were analyzed, 57 (60%) male, with a median age of 47 years (17-79); Sokal score: high, intermediate and low was 30, 38.6 and 31.4% respectively; EUTOS scores was 81.5% low and 18.5% high. The median time from diagnosis until imatinib therapy was 1 month (0-5) and the follow-up was 39 month (3-89). Responses: 88% achieved CHR; 50% CCR and 53% MMR. One patient progressed to advanced phase during follow-up, while on imatinib treatment. 21 (22%) pts discontinued imatinib due to intolerance (47.6%); resistance (42.9%), death (4.8%) and Allo-HSCT (4.8%). At 3 months from the start of therapy, 30/64 (46.8%) achieved CCR, 15/64 (23.4%) partial cytogenetic response and 20/64 (31.2%) less than partial; by RQ-PCR, 72.3% (68/94) achieved at 3 months BCR-ABL transcripts ≤10% and 27.7% (26/94) > 10%. At 6 months 55.2% (48/87) had BCR-ABL transcripts ≤ 1% and 44.8% (39/87) >1%. The OS was 97% (95%CI: 95-99%) and EFS 63% (95%CI: 52-75%).There was no significant difference in OS and EFS in pts with RQ-PCR > 10% vs ≤ 10% at 3 months (figure 1), but pts with BCR-ABL transcripts > 10 and >1-10% at 6 months had an inferior EFS in comparison with pts with  BCR-ABL transcripts ≤ 1%  (41%,50%,89% respectively - p= 0.005), (figure 2). The CI showed that CCR pts at 3 months reached MMR earlier at 24 month (54% vs 18%, p=0.03), as well as CCR pts at 6 months, albeit no significance statistically (52% vs 37%, p= 0.16). For RQ-PCR at 3 months, pts with BCR-ABL transcripts 0-1% had a probability of 88% to achieve MMR, 1-10% had 52% and >10% 42%, p< 0.0001 (figure 3). In conclusion, our results show that early molecular responses are predictive of achieving MMR and BCR-ABL transcripts <1% at 6 months is predictive of EFS in CP-CML treated with imatinib. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5180-5180
Author(s):  
Enaam Mohammed Alsobhi ◽  
Mohammed m Abrar ◽  
Mohammed A Abdelaal ◽  
Ahmad S. Alsaeed ◽  
Ahmed Al-Absi ◽  
...  

Abstract Background The introduction of Imatinib therapy has significantly changed the treatment of patients with newly diagnosed chronic myeloid leukemia (CML) and improved survival. Since the International Randomized Study of Interferon (IRIS), a number of studies were conducted involving diverse populations and showed significant variations in the treatment outcome. To date, there has been no published study on the effectiveness of imatinib in adult CML patients in Saudi Arabia. The aim of the present study was to present a single-institution experience in the treatment with imatinib of newly diagnosed patients with CML and compare it with results from international studies. Methods A total of 101 medical records of consecutive adult CML patients treated with imatinib as first line therapy at King Abdulaziz Medical City, Jeddah, Saudi Arabia between 2001 and 2012 were retrospectively reviewed. Survival and response rates were evaluated. Results The estimated overall survival (OS) rates at 5 and 10 years were 95%±2.3% when patients were stratified by cytogenetic type (stander vs.variant Ph positive chromosome) at presentations, significant difference in OS, EFS, and PFS were noted (P=0.001). Complete haematological response was achieved in 94 (93.1%) of our patients, cytogenetic response (CR) in 84 (83.2%) while complete and major cytogenetic response (MCR) were observed in 70 (69.3%) and 6 (5.9%) of the patients respectively. (MR), 62 patients (61.4%) achieved major molecular response (MMR) and 34 (33.7%) complete molecular response. Conclusion compared to other studies among different population, our results confirm the previously noted variation in the response to imatinib. Our study has shown that Ph variant has an impact on the outcome. Further study may be indicated. However second TKI generations as first line in treatment CML with Ph variants should be consider! Disclosures: No relevant conflicts of interest to declare.


2019 ◽  
Vol 12 (1) ◽  
pp. 1-11
Author(s):  
Kusnanto Kusnanto ◽  
Moh Zen Arifin ◽  
Ira Suarilah ◽  
Hidayat Arifin

Introduction: Diabetes mellitus was an uncurable metabolic disease but it can be controlled. Diabetes can be controlled independently by diabetic with diabetes self-care behavior. Self-care behavior was challenge problem causing in adherence in majority diabetic clients especially in Persadia Darmo Hospital. Method: Research design was Quasy-Experiment study among type 2 diabetic client. This study involved 30 samples taken by purposive sampling. The independent variable were What is Important For You (WIFY) and Life Map. The dependent variable was self-care behavior. Data were taken by using SDSCA questionnaire then analyzed by using t-test with a= £0.05. Result and Analyze: WIFY and Life Map change self-care behavior in treatment group before and after treatment significantly with p value = 0,024. There was significant difference between treatment and control group of self-care behavior with p value = 0,029. Discussion: It could be concluded that application of WIFY and Life Map with goal attainment model increase self-care behavior in type 2 diabetic clients. The use of this approach could be optimizing diabetic counseling and education for clients. Further research to investigate WIFY and Life map effect on blood glucose level and HbA1c test in Type 2 Diabetic.


2020 ◽  
Vol 2 (3) ◽  
pp. 99-107
Author(s):  
Zahra Sativani ◽  
Riza Pahlawi

The activities of children more involve the foot. One of the common problems in the foot is flexible flatfoot. A disturbance in the process of the formation of the arch foot could result in a deformation of the foot and increases the risk of an injury due to postural balance change. Normally, the arch of the foot formed the first five years for the age range of 2-6 years. The right choices of the intrinsic muscle exercises of the foot can prevent deformation and improve postural balance. This study aimed to discuss the effectiveness of foot strengthening exercise to improving postural balance and functional ability of foot on a flexible flatfoot 6-10 years old. This study was pre-experimental research with two groups of pre-post test design. The subjects of this research were 30 students that had been divided into two groups, case, and control. Each group consists of 15 students selected used purposive sampling method based on the criteria of inclusion that had been set. There was a significant difference after foot strengthening exercise between the case and control group, p-value = 0,000. The foot strengthening exercise could improve the postural balance and functional ability of the foot on a flexible flatfoot 6-10 years old.


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