Relationship of Race/Ethnicity and Survival after Single Umbilical Cord Blood Transplantation for Adults and Children with Leukemia and Myelodysplastic Syndromes

The relationship of race/ethnicity with outcomes of umbilical cord blood transplantation (UCBT) is not well known. We analyzed the association between race/ethnicity and outcomes of unrelated single UCBT for leukemia and myelodysplastic syndromes. Our retrospective cohort study consisted of 885 adults and children (612 whites, 145 blacks, and 128 Hispanics) who received unrelated single UCBT for leukemia and myelodysplastic syndromes between 1995 and 2006 and were reported to the Center for International Blood and Marrow Transplant Research. A 5-6/6 HLA-matched unit with a total nucleated cell count infused of ≥2.5 × 107/kg was given to 40% white and 42% Hispanic, but only 21% black patients. Overall survival at 2 years was 44% for whites, 34% for blacks, and 46% for Hispanics (P = .008). In multivariate analysis adjusting for patient, disease, and treatment factors (including HLA match and cell dose), blacks had inferior overall survival (relative risk of death, 1.31; P = .02), whereas overall survival of Hispanics was similar (relative risk, 1.03; P = .81) to that of whites. For all patients, younger age, early-stage disease, use of units with higher cell dose, and performance status ≥80 were independent predictors of improved survival. Black patients and white patients infused with well-matched cords had comparable survival; similarly, black and white patients receiving units with adequate cell dose had similar survival. These results suggest that blacks have inferior survival to whites after single UCBT, but outcomes are improved when units with a higher cell dose are used

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Luncheon at the Newark Club, Metropolitan Room

Featuring the Keynote Address by Paulette Brown Partner, Edwards Wildman Palmer LLP, and President of the American Bar Association Maintaining the Relevancy of a Law School Education in an Evolving Professio

Luncheon at the Newark Club, Metropolitan Room

Featuring the Keynote Address by Paulette Brown Partner, Edwards Wildman Palmer LLP, and President of the American Bar Association Maintaining the Relevancy of a Law School Education in an Evolving Professio

Infectious disease morbidity and growth among young HIV-exposed uninfected children in Jamaica

ABSTRACT Objective There is a growing body of data that demonstrates increased infectious disease outcomes for HIV-exposed uninfected (HIV-EU) infants as compared to their HIV-unexposed (HU) counterparts. We hypothesized that these HIV-EU infants are at greater risk for infectious morbidity and mortality when compared to the general childhood population. We therefore aimed to characterize infections and growth outcomes among HIV-EU infants in Jamaica during their first two years of life. By identifying these outcomes, specific interventions could be implemented to mitigate this risk of morbidity and mortality. Methods HIV-EU infants born between 1 January 2004 and 31 December 2006 in Kingston, Jamaica, were enrolled and followed in multicenter health facilities, using standardized protocols. HIV status was determined by RNA/DNA polymerase chain reaction (PCR) and confirmatory HIV enzyme-linked immunoassay (ELISA). Data were collected on demographic and anthropometric characteristics, infectious morbidity and mortality, and hospitalizations. Outcomes (incidence of infections and hospitalizations; growth (z scores for weight)) were determined, using univariate analyses. Results Of 195 HIV-EU infants followed for 25.9 months (standard deviation, 10.9 months), 102 (52%) were male, 185 (95%) were non-breast-fed, 161 (83%) experienced at least one infection, and 58 (30%) were hospitalized at least once. Infectious disease incidence per 1 000 child-weeks included upper respiratory tract infection of 7.25 (95% confidence interval (CI): 5.92–8.90), otitis media of 4.12 (3.21–5.20), and acute gastroenteritis (AGE) of 1.92 (1.35–2.65). Hospitalization incidence per 1 000 child-weeks included lower respiratory tract infections (LRTIs) of 0.89 (0.53–1.40), sepsis of 0.48 (0.23–0.89), and AGE of 0.43 (0.20–0.81). These infection incidence rates among the HIV-EU infants were higher than those for published community controls. Among the HIV-EU infants, the low-birthweight ones and those born via cesarean section had significantly higher hospitalization rates from LRTI and sepsis than did published community controls. The mean z score for weight during the infants’ first 6 months ranged from -0.06 to 0.78 in this predominantly non-breast-fed population. That score trended upwards to 24 months of age. Conclusions Infectious disease morbidity was higher but growth was normal in this cohort of HIV-EU non-breast-fed infants, in comparison to published community controls. Specific interventions should be implemented to mitigate the risk in this setting

The ZIKApp for detection of potential arbovirus infections and pregnancy complications in pregnant women in Jamaica: a pilot study

Background: Evidence of the benefits of mHealth technology including symptom tracking Apps for research, surveillance and prevention is growing, including for arboviruses and for pregnancy interventions. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: To evaluate the use of a smartphone app (“ZIKApp”) designed to self-report arbovirus symptoms and pregnancy complications, and to assess compliance with daily symptom diaries until the end of pregnancy in a cohort of women in an arbovirus endemic, subtropical, middle-developing country (Jamaica). Methods: Pregnant women aged 16 and over, having a smartphone, and planning on delivering at the recruiting centre were enrolled from an antenatal clinic in February-July 2020. The ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arboviral infection and/or pregnancy complications that triggered automatic notifications to participants. Socio-demographic, epidemiological and obstetric information was collected at enrolment, with additional review of medical records; and users' perception through an exit survey. Descriptive analyses and logistic regression of possible factors associated with diary adherence were performed. Results: Of 173 women enrolled, 90% (157) used ZIKApp for median duration of 155 days between enrolment and pregnancy end, six used the app for 34 years versus those 25-29 (AOR 3.14 95%CI 1.10-8.98) and two-fold higher odds for women with tertiary versus secondary education (AOR 2.26, 95% CI 1.06-4.83). Of 161 women who ever made a diary entry, a total of 5454 individual symptom reports were made (median 17 per woman, max 278). Nine (5.3%) women reported symptom combinations triggering a “potential arbovirus episode” (none had an adverse pregnancy outcome) and 55 (32.9%) women reported painful uterine contractions, or vaginal bleeding, mainly in the month before delivery. The exit survey showed that 52% (71/137) of women rated the App as an excellent experience and were less likely to be poor diary adherers (p=.04); 138/139 women reported that the App was easy to understand and to use. Conclusions: In the era of telemedicine and mHealth, adherence to the ZIKApp in pregnancy was high. The pilot has demonstrated the feasibility and usability of the App in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arboviral infections in pregnancy and promise for implementation by direct treatment and care teams to optimise maternal care

Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study

There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy

Antenatal Seroprevalence of Zika and Chikungunya Viruses, Kingston Metropolitan Area, Jamaica, 2017-2019

To determine the extent of exposure to Zika virus (ZIKV) and chikungunya virus (CHIKV) in Jamaica, we collected serum from 584 pregnant women during 2017-2019. We found that 15.6% had antibodies against ZIKV and 83.6% against CHIKV. These results indicate potential recirculation of ZIKV but not CHIKV in the near future