Fludarabine induced immune thrombocytopenia in a patient with CD5 positive B cell chronic lymphocytic leukemia

Fludarabine is a purine nucleoside analogue, which inhibits DNA synthesis by inhibiting DNA polymerase and ribonucleoside reductase.1 It affects both dividing and non- dividing cells.2 Fludarabine possesses proven efficacy in the treatment of a variety of indolent B cell lymphoproliferative disorders including chronic lymphocytic leukemia3, low-grade non-Hodgkin\u27s lymphoma4 and Waldenstrom macroglobulinemia.5 It is also a part of conditioning regimes in non-myeloablative bone marrow transplantation.6 The common side effects include myelosuppression, immunosuppression, and neurologic toxicity.7 The rare side effects are immune mediated hemolytic anemia8 and thrombocytopenia.9 Here we describe a case of a middle-aged lady who was diagnosed as B cell chronic lymphocytic leukemia and developed immune mediated thrombocytopenia following oral Fludarabine

Precise Computation of Energy Levels and Radiative Lifetimes in the s, p, d, and f Sequence of Hydrogen Isotope, with Natural Line Widths

Energy levels and Radiative lifetimes in Deuterium for the following: ns 2S1/2(n≥2), np2Po(1/2,3/2)(n≥2), nd 2D(3/2,5/2)(n≥3), and nf 2Fo(5/2,7/2)(n≥4) sequence have been  evaluated with uncertainties in energies caused due to uncertainty principal. Theoretical calculations performed utilizing the Weakest Bound Electron Potential Model Theory (WBEPMT). Both sets of data show quite an excellent agreement with the experimental data listed at NIST.  This theoretical computation is also a continuation of the work by Raza. S. et al. in Neutral Hydrogen. The high ‘n’ (principal quantum number) values for both sets  of data are presented very first time by utilizing WBEPMT. Keywords: Energy levels, Radiative lifetimes, Quantum defects, Weakest bound electron, Natural line width. DOI: 10.7176/JNSR/9-10-07 Publication date:May 31st 201

Improving best route using intelligent Ad Hoc system

This study aims to studing possibility transferring data with short time, without or liitle cost and minimum lost of data This study attempts to find a system with high performance in sending and receiving message between nodes minimum lost with information using a genetic algorithm to improve this advantage. Main problem of our study with the system is how to decrease (cost and time) and improve it by intelligent function with GA create two or more back up of distributed node depend on time; route calculation saves as a backup map to direct switch without any delay when simulation execution indicated good result. Simulation results are carried out for both algorithms using MATLAB. The goal of our paper is process of data transferring with the most important three factors less expensive, less time and the least possible loss of transferred data

Increased expression of HLA DR2 in acquired aplastic anemia and its impact on response to immunosuppressive therapy

Objective: To study the frequency of HLA DR2 status of patients with aplastic anemia and their response to immunosuppressive therapy at a tertiary care hospital. Methods: Thirty eight consecutive patients of acquired aplastic anemia were evaluated with respect to demographic features, severity of HLA DR2 status and response outcome to immunosuppressive therapy. Results: The mean age of the patients was 24.6 years + 16.4 with a male to female ratio of 2.8:1. Positivity of HLA DR2 was markedly high in acquired aplastic anemia patients. Twenty four (65%) out of 38 patients as compared to 45 (15%) of 300 healthy controls (p\u3c0.0001) were positive for HLA DR2. Response to immunosuppressive therapy, which included antilymphocyte globulin, cyclosporin and methylprednisolone, was available in sixteen HLA DR2 positive patients and was found satisfactory in 12/16 (75%) patients. Conclusion: HLA DR2 was significantly higher in patients with acquired aplastic anemia and favourable response to immunosuppressive therapy was also associated with HLA DR2 positivity (JPMA 54:251;2004)

Polycythemia vera and idiopathic erythrocytosis: comparison of clinical and laboratory parameters

Objective: To evaluate the various clinical and laboratory parameters of Polycythemia vera and idiopathic erythrocytosis in order to differentiate between two entities at the Aga Khan University Hospital. Methods: Twenty six patients of polycythemia vera and 34 patients of idiopathic erythrocytosis were analyzed with respect to clinical features and laboratory findings. Results: Patients with idiopathic erythrocytosis were males with a mean age of 41 years and no splenomegaly. Patients with polycythemia were older males and females with splenomegaly, red cell count of mor than 6.5 million/cmm, haematocrit 55%, leucocytosis, thrombocytosis and low erythropoietin level. Conclusion: Based on the above-mentioned findings, we suggest that polycythemia vera and idiopathic erythrocytosis are separate entities and the diagnosis of these can be made on the basis of clinical and laboratory parameter

Hematologic and cytogenetic findings in eleven chronic myelogenous leukemia patients treated with imatinib mesylate at a tertiary care hospital

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic ,accelerated and blast phase. Methods:Eleven patients with established diagnosis of chronic myeloid leukemia were treatedwith Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogeneticresponses were assessed according to established criteria. Patients with zero percent Philadelphia positivemetaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders. Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years(range 21-69). Male to female ratio was 7:4. Median follow-up was 34 weeks (range 8-78). Four patients werein blast crisis, 1 in accelerated phase and remaining six patients were in chronic phase. All patients achieved hematological response. Cytogenetic response was present in six patients, 3 were responders and the remainingwere non responders. Two patients achieved complete cytogenetic response and one patient had partial cytogenetic response. Both patients with complete cytogenetic response relapsed in twelve weeks time. Conclusion: Imatinib mesylate is a drug with curative potential and can be used as a first line drug in the management of CML, however at present the cure rate is unknow

Enhancing quality of service in IoT through deep learning techniques

When evaluating an Internet of Things (IoT) platform, it is crucial to consider the quality of service (QoS) as a key criterion. With critical devices relying on IoT technology for both personal and business use, ensuring its security is paramount. However, the vast amount of data generated by IoT devices makes it challenging to manage QoS using conventional techniques, particularly when attempting to extract valuable characteristics from the data. To address this issue, we propose a dynamic-progressive deep reinforcement learning (DPDRL) technique to enhance QoS in IoT. Our approach involves collecting and preprocessing data samples before storing them in the IoT cloud and monitoring user access. We evaluate our framework using metrics such as packet loss, throughput, processing delay, and overall system data rate. Our results show that our developed framework achieved a maximum throughput of 94%, indicating its effectiveness in improving QoS. We believe that our deep learning optimization approach can be further utilized in the future to enhance QoS in IoT platforms

Worldwide network for blood and marrow transplantation (WBMT) recommendations for establishing a hematopoietic stem cell transplantation program in countries with limited resources (Part II): Clinical, technical and socio-economic considerations

The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. While this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state of the art treatments including transplantation, by providing financial, technological, legal, ethical and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population, and potentially provide long-term cost-savings by circumventing the need for their citizens to seek care abroad. Costs of establishing HSCT program and the costs of the HSCT procedure itself can be substantial barriers in developing countries. Additionally, socioeconomic factors intrinsic to specific countries can influence access to HSCT, patient eligibility for HSCT and timely utilization of HSCT center capabilities. This report describes recommendations from the Worldwide Network for Blood and Marrow Transplantation (WBMT) for establishing HSCT programs with a specific focus on developing countries, and identifies challenges and opportunities for providing this specialized procedure in the resource constrained setting

Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: A descriptive study

<p>Abstract</p> <p>Background</p> <p>This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant <it>Enterococcus </it>species.</p> <p>Methods</p> <p>A descriptive study was performed by reviewing the blood culture reports from febrile neutropenic patients during the two study periods i.e., 1999–00 and 2001–06. Blood cultures were performed using BACTEC 9240 automated system. Isolates were identified and antibiotic sensitivities were done using standard microbiological procedures.</p> <p>Results</p> <p>Seven twenty six febrile neutropenic patients were admitted during the study period. A total of 5840 blood cultures were received, off these 1048 (18%) were culture positive. Amongst these, 557 (53%) grew Gram positive bacteria, 442 (42%) grew Gram negative bacteria, 43 (4%) fungi and 6 (1%) anaerobes. Sixty (5.7%) out of 1048 positive blood cultures were polymicrobial. In the Gram negative bacteria, <it>Enterobacteriaceae </it>was the predominant group; <it>E. coli </it>was the most frequently isolated organism in both study periods. Amongst non- Enterobacteriaceae group, <it>Pseudomonas aeruginosa </it>was the commonest organism isolated during first study period followed by <it>Acinetobacter </it>spp. However, during the second period <it>Acinetobacter </it>species was the most frequent pathogen.</p> <p><it>Enterobacteriaceae </it>group showed higher statistically significant resistance in the second study period against ceftriaxone, quinolone and piperacillin/tazobactam, whilst no resistance observed against imipenem/meropenem. The susceptibility pattern of <it>Acinetobacter </it>species shifted from sensitive to highly resistant one with significant p values against ceftriaxone, quinolone, piperacillin/tazobactam and imipenem/meropenem. Amongst Gram positive bacteria, MRSA isolation rate remained static, vancomycin resistant <it>Enterococcus </it>species emerged in second study period while no <it>Staphylococcus </it>species resistant to vancomycin was noted.</p> <p>Conclusion</p> <p>This rising trend of highly resistant organisms stresses the increasing importance of continuous surveillance system and stewardship of antibiotics as strategies in the overall management of patients with febrile neutropenia.</p