Posttransplant Thrombopoiesis Predicts Survival in Patients Undergoing Autologous Hematopoietic Progenitor Cell Transplantation

AbstractThe frequency and clinical significance of secondary thrombocytopenia following initial engraftment in autologous hematopoietic progenitor cell transplantation (HPCT) is unknown. An institutional review board approved retrospective study of thrombopoiesis was performed in 359 patients transplanted with autologous blood (97%) or marrow (3%) who achieved platelet engraftment to >50,000/μL. Idiopathic secondary posttransplant thrombocytopenia (ISPT) was defined as >50% decline in blood platelets to <100,000/μL in the absence of relapse or sepsis. ISPT occurred at a median of day +35 posttransplant in 17% of patients. Patients with ISPT had similar initial platelet engraftment (median 17 days) versus non-ISPT patients (18 days; P = NS) and recovered platelet counts (median 123,00 K/μL) by day 110 posttransplant. Four factors were independently associated with post-transplant death in a multivariate model: disease status at transplant; the number of prior chemotherapy regimens, failure to achieve a platelet count of >150,000/μL posttransplant, and the occurrence of ISPT. A prognostic score was developed based upon the occurrence of ISPT and posttransplant platelet counts of <150,000/μL. Survival of patients with both factors (n = 25) was poor (15% alive at 5 years); patients with 1 factor (n = 145) had 49% 5-year survival; patients with 0 factors (n = 189) had 72% 5-year survival. Patients who failed to achieve a platelet count of >150,000/μL received significantly fewer CD34+ cells/kg (P < .001), whereas patients with ISPT received fewer CD34+CD38− cells/kg (P = .0006). The kinetics of posttransplant thrombopoiesis is an independent prognostic factor for long-term survival following autologous HPC. ISPT and lower initial posttransplant platelet counts reflect poor engraftment with long-term and short-term repopulating CD34+ hematopoietic stem cells, respectively, and are associated with an increased risk of death from disease relapse

Whole genome analysis of Rhizopus species causing rhino-cerebral mucormycosis during the COVID-19 pandemic

IntroductionMucormycosis is an acute invasive fungal disease (IFD) seen mainly in immunocompromised hosts and in patients with uncontrolled diabetes. The incidence of mucormycosis increased exponentially in India during the SARS-CoV-2 (henceforth COVID-19) pandemic. Since there was a lack of data on molecular epidemiology of Mucorales causing IFD during and after the COVID-19 pandemic, whole genome analysis of the Rhizopus spp. isolated during this period was studied along with the detection of mutations that are associated with antifungal drug resistance.Materials and methodsA total of 50 isolates of Rhizopus spp. were included in this prospective study, which included 28 from patients with active COVID-19 disease, 9 from patients during the recovery phase, and 13 isolates from COVID-19-negative patients. Whole genome sequencing (WGS) was performed for the isolates, and the de novo assembly was done with the Spades assembler. Species identification was done by extracting the ITS gene sequence from each isolate followed by searching Nucleotide BLAST. The phylogenetic trees were made with extracted ITS gene sequences and 12 eukaryotic core marker gene sequences, respectively, to assess the genetic distance between our isolates. Mutations associated with intrinsic drug resistance to fluconazole and voriconazole were analyzed.ResultsAll 50 patients presented to the hospital with acute fungal rhinosinusitis. These patients had a mean HbA1c of 11.2%, and a serum ferritin of 546.8 ng/mL. Twenty-five patients had received steroids. By WGS analysis, 62% of the Rhizopus species were identified as R. delemar. Bayesian analysis of population structure (BAPS) clustering categorized these isolates into five different groups, of which 28 belong to group 3, 9 to group 5, and 8 to group 1. Mutational analysis revealed that in the CYP51A gene, 50% of our isolates had frameshift mutations along with 7 synonymous mutations and 46% had only synonymous mutations, whereas in the CYP51B gene, 68% had only synonymous mutations and 26% did not have any mutations.ConclusionWGS analysis of Mucorales identified during and after the COVID-19 pandemic gives insight into the molecular epidemiology of these isolates in our community and establishes newer mechanisms for intrinsic azole resistance

A warm Jupiter transiting an M dwarf: A TESS single transit event confirmed with the Habitable-zone Planet Finder

We confirm the planetary nature of a warm Jupiter transiting the early M dwarf TOI-1899, using a combination of available TESS photometry; high-precision, near-infrared spectroscopy with the Habitable-zone Planet Finder; and speckle and adaptive optics imaging. The data reveal a transiting companion on an $\sim29$-day orbit with a mass and radius of $0.66\pm0.07\ \mathrm{M_{J}}$and$1.15_{-0.05}^{+0.04}\ \mathrm{R_{J}}$, respectively. The star TOI-1899 is the lowest-mass star known to host a transiting warm Jupiter, and we discuss the follow-up opportunities afforded by a warm ($\mathrm{T_{eq}}\sim362$ K) gas giant orbiting an M0 star. Our observations reveal that TOI-1899.01 is a puffy warm Jupiter, and we suggest additional transit observations to both refine the orbit and constrain the true dilution observed in TESS.Comment: 24 pages, 5 figures, 3 tables, published in A

Durable Hematological and Major Cytogenetic Response in a Patient with Isolated 20q Deletion Myelodysplastic Syndrome Treated with Lenalidomide

Myelodysplastic syndrome (MDS) is a clonal bone marrow disorder characterized by ineffective hematopoiesis. It is characterized by peripheral blood cytopenia and significant risk of progression to acute myeloid leukemia result. Deletion of the long arm of chromosome 20 (20q deletion) is present in 3–7% of patients with MDS. Lenalidomide is an immunomodulatory agent with antiangiogenic activity. It is FDA approved for the treatment of anemia in patients with low or int-1 risk MDS with chromosome 5q deletion with or without additional cytogenetic abnormalities. Study of lenalidomide in patients with MDS without 5q deletion but other karyotypic abnormalities demonstrated meaningful activity in transfusion dependent patients; however, response of patients with isolated 20q deletion to lenalidomide is not known. We are reporting a patient with 20q deletion MDS treated with lenalidomide after he failed to respond to azacytidine; to our knowledge this is the first report of a patient with isolated 20q deletion treated with lenalidomide

Tratamiento de los lixiviados del relleno sanitario de Jaquira por electrocoagulación

En este estudio se evaluó la electrocoagulación como tratamiento para los lixiviados, producto de la percolación y la descomposición natural de los residuos sólidos del relleno sanitario de Jaquira, ubicado en la comunidad campesina de Jaquira, distrito de Santiago, provincia del Cusco. Los experimentos se llevaron a cabo en un reactor a escala laboratorio con configuración monopolar, con electrodos de aluminio (ánodo) y acero inoxidable (cátodo), con operación en modo discontinuo (batch). Se realizaron ensayos preliminares con volumen de muestra de 2 litros, área de electrodos sumergida de 120 cm2 y tiempo de residencia de 120 minutos para los lixiviados antiguo y nuevo, se evaluó el tiempo y el porcentaje de remoción de la demanda bioquímica de oxígeno (DBO5), sólidos suspendidos totales (TSS) y demanda química de oxígeno (DQO). Para un tiempo de 30 minutos se lograron las mejores remociones de DBO5 y TSS, y en caso de la DQO se observó que la remoción continúa en función al tiempo, por esta razón necesita más tiempo a los 120 minutos para tener mejores remociones. Para estos tiempos el lixiviado antiguo alcanzó una remoción de DBO5 mayor a70%, remoción de TSS mayor a 45% y remoción de DQO mayor a 20%, y en el caso del lixiviado nuevo se alcanzó una remoción mayor a 50% de DBO5, remoción mayor a 28% de TSS y remoción mayor a 8% de DQO. Se determinó que el tratamiento es mejor para el lixiviado antiguo con mayor remoción de parámetros (DBO5, DQO y TSS) para esta tecnología con densidad de corriente mayor a 5.5 mA/cm2, una distancia variable de 0.5cm a 2cm. En el diseño experimental final se evalúo la densidad de corriente y distancia entre electrodos, con tiempos de residencia de 30 minutos para la DBO5 y TSS, en caso de la DQO para 120 minutos, el lixiviado antiguo alcanzó remociones de 69.12% de DBO5, remoción de 70.54 % de TSS y remoción de 34.78 de DQO, con una densidad de corriente de 10 mA/cm2 y una distancia entre electrodos de 2cm. A las mejores condiciones del diseño experimental final se determinó la cinética de remoción de la DBO5 y DQO, determinándose la cinética de reacción de segundo orden para ambos casos. Así mismo se evaluó el comportamiento de los TSS. En el relleno sanitario de Jaquira, con los datos de la investigación se construyó el prototipo para el tratamiento de los lixiviados por electrocoagulación.Tesi

Tratamiento de los lixiviados del relleno sanitario de Jaquira por electrocoagulación

TesisEn este estudio se evaluó la electrocoagulación como tratamiento para los lixiviados, producto de la percolación y la descomposición natural de los residuos sólidos del relleno sanitario de Jaquira, ubicado en la comunidad campesina de Jaquira, distrito de Santiago, provincia del Cusco. Los experimentos se llevaron a cabo en un reactor a escala laboratorio con configuración monopolar, con electrodos de aluminio (ánodo) y acero inoxidable (cátodo), con operación en modo discontinuo (batch). Se realizaron ensayos preliminares con volumen de muestra de 2 litros, área de electrodos sumergida de 120 cm2 y tiempo de residencia de 120 minutos para los lixiviados antiguo y nuevo, se evaluó el tiempo y el porcentaje de remoción de la demanda bioquímica de oxígeno (DBO5), sólidos suspendidos totales (TSS) y demanda química de oxígeno (DQO). Para un tiempo de 30 minutos se lograron las mejores remociones de DBO5 y TSS, y en caso de la DQO se observó que la remoción continúa en función al tiempo, por esta razón necesita más tiempo a los 120 minutos para tener mejores remociones. Para estos tiempos el lixiviado antiguo alcanzó una remoción de DBO5 mayor a70%, remoción de TSS mayor a 45% y remoción de DQO mayor a 20%, y en el caso del lixiviado nuevo se alcanzó una remoción mayor a 50% de DBO5, remoción mayor a 28% de TSS y remoción mayor a 8% de DQO. Se determinó que el tratamiento es mejor para el lixiviado antiguo con mayor remoción de parámetros (DBO5, DQO y TSS) para esta tecnología con densidad de corriente mayor a 5.5 mA/cm2, una distancia variable de 0.5cm a 2cm. En el diseño experimental final se evalúo la densidad de corriente y distancia entre electrodos, con tiempos de residencia de 30 minutos para la DBO5 y TSS, en caso de la DQO para 120 minutos, el lixiviado antiguo alcanzó remociones de 69.12% de DBO5, remoción de 70.54 % de TSS y remoción de 34.78 de DQO, con una densidad de corriente de 10 mA/cm2 y una distancia entre electrodos de 2cm. A las mejores condiciones del diseño experimental final se determinó la cinética de remoción de la DBO5 y DQO, determinándose la cinética de reacción de segundo orden para ambos casos. Así mismo se evaluó el comportamiento de los TSS. En el relleno sanitario de Jaquira, con los datos de la investigación se construyó el prototipo para el tratamiento de los lixiviados por electrocoagulación

Alternative Therapy for Epstein-Barr Virus Related Hemophagocytic Lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a rapidly fatal condition characterized by excessive immune activation. HLH can occur as a familial or sporadic acquired disorder. Acquired HLH is more frequently found in adults and is commonly secondary to infections, malignancies, or autoimmune diseases. Diagnosing HLH is challenging because of the rare occurrence, variable presentation, and nonspecific findings of this disorder. Diagnosis of HLH can be based on the diagnostic criteria which were used in the HLH-2004 trial. Given the rarity of this disease, protocols for its treatment have developed slowly, and obtaining adequate short-term and long-term control of the disease continues to be a challenge. Conventional induction therapy for HLH is dexamethasone and etoposide (VP-16), followed by or with cyclosporine. Intrathecal methotrexate ± hydrocortisone is given to those with central nervous system disease. We are reporting a patient who was diagnosed with Epstein-Barr virus (EBV) related HLH. He achieved complete remission with rituximab alone. To our knowledge, this is the first case of an adult patient with EBV related HLH who went into remission with rituximab therapy alone, without using the conventional chemotherapy

Indicators of Occupational Balance and Occupational Experience among Graduate Healthcare Science Students

Purpose: The purpose of this study was to determine the relationship between graduate students\u27 perception of their occupational balance and their experience of occupational productivity, pleasure, restoration, and social connection. Methods: The mixed-methods study collected quantitative data from graduate students (n=22) using the Occupational Balance Questionnaire (OBQ - 11) and the Occupational Experience Profile (OEP). Results: Spearman’s rho correlation test revealed a moderate significant positive relationship, p=0.45 between OBQ-11 and OEP scores. This shows that high OBQ -11 scores concur with high OEP scores meaning that their perceptions of occupational balance correlates with their occupational experiences. Seven of twenty-two participants provided comments about their perception of their occupational experience. Descriptive coding on these comments, employing the Saldaña procedure revealed themes that their occupational experiences were mentally and physically taxing, socially engaging, generally gratifying, and promoting task discontentment. Conclusion: This study showed that graduate students’ perceptions of their occupational balance correlated with their experiences of productivity, pleasure, restoration and social connection