T-cell lymphoblastic lymphoma infiltration into the thyroid gland: A rare case report

Lymphomas account for approximately 2% of all malignancies of the thyroid gland. Infiltration of T-cell lymphoblastic lymphoma (T-LBL) into the thyroid gland is rare. This case is presented on account of the rarity of T-LBL infiltration into the thyroid gland. A 22-year-old male, diagnosed case of T-LBL by left cervical lymph node biopsy and immunohistochemistry (IHC) and on chemotherapy, presented with a thyroid swelling after 6 months of diagnosis of T-LBL. Ultrasound imaging of the neck showed symmetrically enlarged thyroid gland. Fine needle aspiration cytology of the thyroid swelling showed infiltration of lymphoma cells into the thyroid gland, which was confirmed with IHC. T-LBL is a high-grade lymphoma which rarely infiltrates the thyroid gland. Intensive chemotherapy regimens and long-term maintenance therapy improve the prognosis of T-LBL

Use of autologous platelet - Rich plasma in the treatment of intrabony defects

Platelet Rich Plasma (PRP) has been combined with autologous bone or bone substitutes and used for periodontal regeneration. The clinical efficacy of this combination has been noted. However, it remains questionable whether this clinical efficacy is due to the PRP or the bone graft material alone with which PRP is used in combination. Objective was to assess the clinical effectiveness of autologous PRP alone in treating intrabony defects in humans. 6 patients were recruited having interproximal intrabony defects with pocket probing depth ≥ 5 mm at re-evaluation following initial therapy, and angular osseous defect depth ≥ 4mm as assessed by using Spiral Computed Tomography. Autologous PRP gel was obtained by mixing autologous PRP with autologous thrombin and placed in the intrabony defects after defect debridement. At 6 months postoperatively, mean probing pocket depth (PPD) noted at baseline (7± 1.27)mm reduced to3.67± 1.03 mm, clinical attachment level (CAL) gain was 3.33± 0.51mm, both of which were statistically significant. Mean distance from cemento-enameljunction (CEJ) to base of the defect (BOD) at baseline was 8.55 ± 0.89 mm. At 6 months it reduced to 6.58 ±1.13 mm showing a defectfillof 1.96±00.32 mm, which was statistically significant. Thepercentage of defect fill noted was 23.01 % and mean defect resolution was 2.05 ±0.30 mm, both of which were statistically significant. Treatment of intrabony defects by autologous PRP gel alone caused significant soft tissue clinical improvement as well as hard tissue defect fill as evidenced by SSD view in spiral computed tomography

Renal allograft function in kidney transplant recipients infected with SARS-CoV 2: An academic single center experience.

BackgroundKidney transplant recipients are a unique cohort in regard to SARS-CoV 2 susceptibility and clinical course, owing to their immunosuppressed state and propensity for kidney injury. The primary purpose of this study is to ascertain if, in kidney transplant recipients, SARS-CoV 2 infection impacts long term renal allograft function.MethodsThis retrospective, single-center study reviewed 53 kidney transplant recipients with a positive SARS-CoV-2 PCR at NMH from January 1, 2020 to June 30, 2020.ResultsChange in eGFR from baseline kidney function prior to infection to 90 days after the first positive SARS-CoV 2 test was +1.76%, -17.5% and -23.16% the mild, moderate and severe disease groups respectively. There was a significant decline in kidney function in the moderate and severe disease cohorts as compared to the mild disease cohort, with respective p values of p = 0.0002 and p = 0.021. Relative to the mild disease cohort, the moderate and severe disease cohorts also demonstrated significantly increased risk of developing AKI (66%, 85%), both with p values of P = 0.0001.ConclusionsClinically severe SARS-CoV 2 infection is associated with greater risk of acute kidney injury and greater decline in renal allograft function at 90 days post infection, compared to mild disease

Mechanistic analyses in kidney transplant recipients prospectively randomized to two steroid free regimen-Low dose Tacrolimus with Everolimus versus standard dose Tacrolimus with Mycophenolate Mofetil.

Calcineurin inhibitors (CNI), the cornerstone of immunosuppression after transplantation are implicated in nephrotoxicity and allograft dysfunction. We hypothesized that combined low doses of CNI and Everolimus (EVR) may result in better graft outcomes and greater tolerogenic milieu. Forty adult renal transplant recipients were prospectively randomized to (steroid free) low dose Tacrolimus (TAC) and EVR or standard dose TAC and Mycophenolate (MMF) after Alemtuzumab induction. Baseline characteristics were statistically similar. EVR levels were maintained at 3-8 ng/ml. TAC levels were 4.5±1.9 and 6.4±1.5 ng/ml in the TAC+EVR and TAC+MMF group respectively. Follow up was 14±4 and 17±5 months respectively and included protocol kidney biopsies at 3 and 12 months post-transplantation. Rejection-rate was lower in the TAC+EVR group. However patient and overall graft survival, eGFR and incidence of adverse events were similar. TAC+EVR induced expansion of CD4+CD25hiFoxp3+ regulatory T cells as early as 3 months and expansion of IFN-γ+CD4+CD25hiFoxp3+ regulatory T cells at 12 months post-transplant. Gene expression profile showed a trend toward decreased inflammation, angiogenesis and connective tissue growth in the TAC+EVR Group. Thus, greater tolerogenic mechanisms were found to be operating in patients with low dose TAC+EVR and this might be responsible for the lower rejection-rate than in patients on standard dose TAC+MMF. However, further studies with longer follow up and evaluating impact on T regulatory cells are warranted

Lack of effectiveness of Bebtelovimab monoclonal antibody among high-risk patients with SARS-Cov-2 Omicron during BA.2, BA.2.12.1 and BA.5 subvariants dominated era.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N = 1,091) compared to propensity score (PS) matched control (N = 1,091). The primary composite outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary composite outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p = 0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (<65 years or ≥65), and immunocompromised status (patients with HIV/AIDS or solid organ transplants or malignancy including lymphoproliferative disorder). The number needed to treat (1/0.026-0.022) with BEB MAb was 250 to avoid one hospitalization and/or death over 30 days. The BEB MAb use lacked efficacy in patients with SARS-CoV-2 Omicron subvariants (mainly BA.2, BA.2.12.1, and BA.5) in the Banner Healthcare System in the Southwestern United States

Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.

BACKGROUND: Living kidney donation is possible for people living with HIV (PLWH) in the United States within research studies under the HIV Organ Policy Equity (HOPE) Act. There are concerns that donor nephrectomy may have an increased risk of end-stage renal disease (ESRD) in PLWH due to HIV-associated kidney disease and antiretroviral therapy (ART) nephrotoxicity. Here we report the first 3 cases of living kidney donors with HIV under the HOPE Act in the United States. METHODS: Within the HOPE in Action Multicenter Consortium, we conducted a prospective study of living kidney donors with HIV. Pre-donation, we estimated the 9-year cumulative incidence of ESRD, performed genetic testing of apolipoprotein L1 (APOL1), excluding individuals with high-risk variants, and performed pre-donation kidney biopsies (HOPE Act requirement). The primary endpoint was ≥grade 3 nephrectomy-related adverse events (AEs) in year one. Post-donation, we monitored glomerular filtration rate (measured by iohexol/Tc-99m DTPA [mGFR] or estimated with serum creatinine [eGFR]), HIV RNA, CD4 count, and ART. FINDINGS: There were three donors with two-four years of follow-up: a 35 year-old female, a 52 year-old male, and a 47 year-old male. Pre-donation 9-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 persons, respectively. In two donors with APOL1 testing, no high-risk variants were detected. Biopsies from all three donors showed no kidney disease. Post-donation, two donors developed nephrectomy-related&nbsp;≥grade 3 AEs: a medically-managed ileus and a laparoscopically-repaired incisional hernia. GFR declined from 103 to 84&nbsp;mL/min/1.73&nbsp;m2&nbsp;at four years (mGFR) in donor 1, from 77 to 52&nbsp;mL/min/1.73&nbsp;m2&nbsp;at three years (eGFR) in donor 2, and from 65 to 39&nbsp;mL/min/1.73&nbsp;m2&nbsp;at two years (eGFR) in donor 3. HIV RNA remained &lt;20 copies/mL and CD4 count remained stable in all donors. INTERPRETATION: The first three living kidney donors with HIV under the HOPE Act in the United States have had promising outcomes at two-four years, providing proof-of-concept to support living donation from PLWH to recipients with HIV. FUNDING: National Institute of Allergy and Infectious Diseases, National Institutes of Health

The primary composite outcome between the propensity matched Bebtelovimab (BEB) monoclonal antibody (MAb) and untreated control groups.

The primary composite outcome between the propensity matched Bebtelovimab (BEB) monoclonal antibody (MAb) and untreated control groups.</p

Patient characteristics and covariate balance before and after propensity matching.

Patient characteristics and covariate balance before and after propensity matching.</p