THE OUTCOME OF ATG ON THE STEM CELL TRANSPLANTS FROM MATCHED UNRELATED DONOR, A SINGLE INSTITUTE EXPERIENCE

poster abstractBACKGROUND: Antithymocyte globulin (ATG) was found to decrease the morbidity of stem cell transplant (SCT) from matched unrelated donor (MUD) by decreasing the incidence of chronic graft vs host disease cGvHD, and at high doses, acute GvHD. We reviewed our results of MUD transplants where ATG was incorporated into the preparative regimen, and compared the results to patients prior to September 2006 where ATG was not used. The primary endpoints were the effect on GvHD and lethal infectious complications. Method: All stem cell transplants from MUD performed after 2000 at IU hospital for treatment of hematological malignancies using a myelo-ablative regimen were retrospectively reviewed. Result: between 1/2000 and 3/2009 seventy nine stem cell transplants were conducted using stem cells from MUD. 28 patients received ATG at a total dose of 7.5mg/kg vs 51 patients who did not receive ATG. Both groups were matched in term of age, sex, underline malignancies, degree of HLA-match, CMV serology, and conditioning regimens. Ninety-six percent of patient in ATG group received prophylaxis for GvHD using FK506/Sirolimus vs 14% in the no ATG group where a methotrexate based treatment was used (P<0.0001). The rate of Grade II-VI acute GVHD at day 100 was significantly lower in the ATG group compare to no ATG (14% vs 39%, P =0.011). Although however, the rate of chronic GVHD at 1 year was higher in ATG group than in the no ATG group, this was statistically not significant (43% and 23%; P=0.2). The rates of overall fungal infections and lethal fungal infections were comparable (14% and 10%) for ATG vs (17% and 11%) for no ATG (p =0.70). The rate of primary CMV infection (i.e., in patient not receiving corticosteroid treatment for GVHD) was higher in ATG group, although not statistically significant (31% vs 17%, P=0.27). Day 100 mortality was 15% and 25% in ATG and no ATG group respectively, overall survival at 1 and 2 years was 47% and 31% for ATG group vs 49% and 36% for no ATG group (P>0.05), Median time to death was 8.6 months (CI95%, 1.8-15.4) and 11.9 months (CI95%, 8-15.7) with P=0.7. The mortality from GVHD at 4 months was 0% in ATG group vs 12% in no ATG group (P =0.08).While the mortality rate from bacterial infection and sepsis were equivalent, more patients in the ATG group who did not receiving corticosteroid treatment for aGVHD died from viral and fungal infection (15% vs 0% at 8 months, P=0.013). Summary: While ATG was associated with a trend toward lower mortality rate at day 100 due to statistically significant decrease in incidence and mortality of aGVHD, it was associated with increase rate of delayed-onset acute GVHD and statistically significant high rate of lethal viral and fungal infection leading to similar overall survival at 1 and 2 years. This study demonstrates the lack of overall benefit of ATG at dose of 7.5mg/kg. Further study to investigate the outcome of using lower doses of ATG to lower the rate of lethal infections while still reducing the risk of GvHD is recommended

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

HUMAN FACTORS\u27 CONTRIBUTION INTO MARITIME ACCIDENTS BY APPLYING THE SHIELD HF TAXONOMY

Despite the continuous improvement of safety measures, maritime accidents remain a concern in our society. Thus, as the literature has shown, over the last ten years, the frequency of groundings and collisions accidents in the maritime domain has increased. An official accident investigation is conducted for each serious maritime accident, however, the level of detail changes from accident to accident, hence, the details about human contributors and organizational issues are not systematically analyzed and reported in a way that makes future extraction of trends and comparisons possible. With the aim to better capture human and organizational factors, this paper proposes to utilize the Safety Human Incident &amp; Error Learning Database (SHIELD) HF Taxonomy, which was developed in the context of the European Union SAFEMODE project, in line with the key components of NASA-HFACS, HERA, and Reason\u27s Swiss Cheese Model. Therefore, in this study, ten collision and ten grounding maritime accidents reported by various maritime agencies are analyzed via the SHIELD HF Taxonomy to identify the main accident contributors, including design deficiencies. The paper demonstrates the benefits of using the SHIELD HF taxonomy for identifying the underlying causes as well as developing mitigating design solutions

Physiological and Biochemical Changes in Vegetable and Field Crops under Drought, Salinity and Weeds Stresses: Control Strategies and Management

Weeds are one of the most damaging biotic stresses in crop production, and drought and salinity are considered the most serious abiotic stresses. These factors harmfully affect growth and development in several vegetable and field crops by causing harmful effects on physiological and biochemical characteristics such as water uptake, photosynthesis, relative water content, electrolyte leakage, and antioxidant compounds linked with oxidative stress and the accumulation of reactive oxygen species (ROS). These oxidative stress-related components affect most physiological and biochemical characteristics in plants under natural conditions and environmental stresses, especially weed infestation, salinity, and drought stress. ROS such as superoxide (O2&bull;&minus;), hydrogen peroxide (H2O2), peroxyl radical (ROO&bull;), and singlet oxygen (1O2) are very important molecules produced naturally as by-products of metabolic processes in chloroplasts, mitochondria, peroxisomes, and the apoplast. Under stress conditions such as weed infestation, drought and salinity, the morphological and yield characteristics of stressed plants are negatively affected; however, superoxide (O2&bull;&minus;) and hydrogen peroxide (H2O2) are significantly increased. The negative impact of weeds can be mitigated with integrated controls which include herbicides, allelopathy, and crop rotation as well as the different methods for weed control. The defense system in various crops mainly depends on both enzymatic and nonenzymatic antioxidants. The enzymatic antioxidants include superoxide dismutase, glutathione reductase, and catalase; nonenzymatic antioxidants include ascorbic acid, carotenoids, &alpha;-Tocopherols, proline, glutathione, phenolics, and flavonoids. These antioxidant components can scavenge various ROS under several stresses, particularly weeds, drought and salinity. In this review, our objective is to shed light on integrated weeds management and plant tolerance to salinity and drought stresses associated with the ROS and the induction of antioxidant components to increase plant growth and yield in the vegetable and field crops

An Overview on the Potential Hazards of Pyrethroid Insecticides in Fish, with Special Emphasis on Cypermethrin Toxicity

Pesticides are chemicals used to control pests, such as aquatic weeds, insects, aquatic snails, and plant diseases. They are extensively used in forestry, agriculture, veterinary practices, and of great public health importance. Pesticides can be categorized according to their use into three major types (namely insecticides, herbicides, and fungicides). Water contamination by pesticides is known to induce harmful impacts on the production, reproduction, and survivability of living aquatic organisms, such as algae, aquatic plants, and fish (shellfish and finfish species). The literature and information present in this review article facilitate evaluating the toxic effects from exposure to various fish species to different concentrations of pesticides. Moreover, a brief overview of sources, classification, mechanisms of action, and toxicity signs of pyrethroid insecticides in several fish species will be illustrated with special emphasis on Cypermethrin toxicity

Physiological and Biochemical Changes in Vegetable and Field Crops under Drought, Salinity and Weeds Stresses: Control Strategies and Management

Weeds are one of the most damaging biotic stresses in crop production, and drought and salinity are considered the most serious abiotic stresses. These factors harmfully affect growth and development in several vegetable and field crops by causing harmful effects on physiological and biochemical characteristics such as water uptake, photosynthesis, relative water content, electrolyte leakage, and antioxidant compounds linked with oxidative stress and the accumulation of reactive oxygen species (ROS). These oxidative stress-related components affect most physiological and biochemical characteristics in plants under natural conditions and environmental stresses, especially weed infestation, salinity, and drought stress. ROS such as superoxide (O2•−), hydrogen peroxide (H2O2), peroxyl radical (ROO•), and singlet oxygen (1O2) are very important molecules produced naturally as by-products of metabolic processes in chloroplasts, mitochondria, peroxisomes, and the apoplast. Under stress conditions such as weed infestation, drought and salinity, the morphological and yield characteristics of stressed plants are negatively affected; however, superoxide (O2•−) and hydrogen peroxide (H2O2) are significantly increased. The negative impact of weeds can be mitigated with integrated controls which include herbicides, allelopathy, and crop rotation as well as the different methods for weed control. The defense system in various crops mainly depends on both enzymatic and nonenzymatic antioxidants. The enzymatic antioxidants include superoxide dismutase, glutathione reductase, and catalase; nonenzymatic antioxidants include ascorbic acid, carotenoids, α-Tocopherols, proline, glutathione, phenolics, and flavonoids. These antioxidant components can scavenge various ROS under several stresses, particularly weeds, drought and salinity. In this review, our objective is to shed light on integrated weeds management and plant tolerance to salinity and drought stresses associated with the ROS and the induction of antioxidant components to increase plant growth and yield in the vegetable and field crops