Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation

Most cases of strongyloidiasis associated with solid organ transplantation have been due to the reactivation of a latent infection in the recipient as a result of the immunosuppressive therapy; however, donor-derived infections are becoming increasingly frequent. The case of a patient who nearly died of a Strongyloides stercoralis hyperinfection after receiving simultaneous kidney/pancreas transplants is described herein. No specific parasitological tests were performed pre-transplantation, despite the fact that both the recipient and the donor originated from endemic areas. Serological analysis of the donor's serum performed retrospectively revealed the origin of the infection, which if it had been done beforehand would have prevented the serious complications. Current practice guidelines need to be updated to incorporate immunological and molecular techniques for the rapid screening of Strongyloides prior to transplantation, and empirical treatment with ivermectin should be applied systematically when there is the slightest risk of infection in the donor or recipient

Single versus tandem autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma and high-risk cytogenetics. A retrospective, open-label study of the PETHEMA/Spanish Myeloma Group (GEM)

Tandem ASCT has been suggested as a valid approach to improve the prognosis of patients with MM and HR cytogenetic. In this observational, retrospective study, 213 patients with newly diagnosed MM and HR cytogenetic in 35 hospitals from the Spanish Myeloma Group underwent single or tandem ASCT between January 2015 and December 2019 after induction with VTD/VRD. HR cytogenetic was defined as having ≥1 of the following: del17p, t(4;14), t(14;16) or gain 1q21. More patients in the tandem group had R-ISS 3 and >1 cytogenetic abnormality at diagnosis. With a median follow-up of 31 months (range, 10–82), PFS after single ASCT was 41 months versus 48 months with tandem ASCT (p = 0.33). PFS in patients with del17p undergoing single ASCT was 41 months, while 52% of patients undergoing tandem ASCT were alive and disease free at 48 months. In conclusion, tandem ASCT partly overcomes the bad prognosis of HR cytogenetic

From descriptive to predictive distribution models: a working example with Iberian amphibians and reptiles

BACKGROUND: Aim of the study was to identify the conditions under which spatial-environmental models can be used for the improved understanding of species distributions, under the explicit criterion of model predictive performance. I constructed distribution models for 17 amphibian and 21 reptile species in Portugal from atlas data and 13 selected ecological variables with stepwise logistic regression and a geographic information system. Models constructed for Portugal were extrapolated over Spain and tested against range maps and atlas data. RESULTS: Descriptive model precision ranged from 'fair' to 'very good' for 12 species showing a range border inside Portugal ('edge species', kappa (k) 0.35–0.89, average 0.57) and was at best 'moderate' for 26 species with a countrywide Portuguese distribution ('non-edge species', k = 0.03–0.54, average 0.29). The accuracy of the prediction for Spain was significantly related to the precision of the descriptive model for the group of edge species and not for the countrywide species. In the latter group data were consistently better captured with the single variable search-effort than by the panel of environmental data. CONCLUSION: Atlas data in presence-absence format are often inadequate to model the distribution of species if the considered area does not include part of the range border. Conversely, distribution models for edge-species, especially those displaying high precision, may help in the correct identification of parameters underlying the species range and assist with the informed choice of conservation measures

Osteological differentiation among Iberian <i>Pelodytes</i> (Anura, Pelodytidae)

The morphological differentiation among <i>Pelodytes</i> species is analysed based on a sample of disarticulated bones from the main osteological regions of the male adult skeleton. A set of 35 interspecifically diagnostic characters, analysed under different outgroup hypotheses, clearly shows that <i>P. ibericus</i> and <i>P. punctatus</i> are a sister-group with respect to <i>P. caucasicus</i>. The Caucasian species retains a very primitive morphology, with only 17-23 % derived character-states, while both living Iberian species reach percentages of derivation over 68 %. There is little difference between <i>P. ibericus</i> and <i>P. punctatus</i> in their relative degree of evolutionary transformation, and when using <i>P. caucasicus</i> as the outgroup the percentage of derived character-states is 45 and 60 % respectively. Differentiation rates are calculated in darwin units for several characters, and we show that the skull components have higher rates than the traits directly related with locomotion. Several adult growth trajectories, different between species, are described and identified as diverse allometric heterochronies. Three factors have been detected that might have grouped several characters as coevolutionary units. These factors are: a) an ontogenetic factor, operating through heterochronic processes, expressed as a tendency to reduce ossification; b) a functional morphological integration, detected in the elements involved in skull size and proportions; and c) an ecomorphological factor, presumably an adaptive response, can be assumed for characters related to limb shape.<br><br>Se analiza la diferenciación morfológica en <i>Pelodytes</i> mediante el análisis comparado de una muestra de elementos óseos desarticulados procedentes de las principales regiones del esqueleto macho adulto. Un conjunto de 35 rasgos interespecíficamente diferenciales, analizada bajo diversos grupos externos, permite inferir que <i>P. ibericus</i> y <i>P. punctatus</i> forman un grupo hermano frente a <i>P. caucasicus</i>. La especie caucásica mantiene una morfología muy primitiva, con sólo 17-23% de estados derivados, en tanto que las especies ibéricas son ambas muy derivadas, con porcentajes superiores al 68 % de los rasgos. Hay poca diferencia entre <i>P. ibericus</i> y <i>P. punctatus</i> en cuanto a su grado relativo de transformación evolutiva, y utilizando a <i>P. caucasicus</i> como grupo externo presentan porcentajes de estados derivados del 45 y 60 % respectivamente. Se calculan las tasas de diferenciación de varios caracteres en darwines, presentando los componentes craneales tasas más altas que los rasgos directamente relacionados con la locomoción. Se describen e identifican en términos de alometrías heterocrónicas diversas trayectorias de crecimiento adulto, diferenciales entre especies. Se han detectado tres factores que permiten agrupar los caracteres en unidades de evolución conjunta. Estos factores son: a) un factor ontogenético producido mediante procesos heterocrónicos, apreciable en una tendencia a la disminución de la osificación; b) una integración morfológica funcional, detectable en los elementos implicados en el tamaño y proporciones del cráneo; y c) un factor ecomorfológico, presumiblemente una respuesta adaptativa, puede inferirse en rasgos relacionados con la robustez de las extremidades

Microseismicity surveys of the fault-systems of S. E. Spain

Three microseismicity surveys were carried out in 1982, 1984 and 1985 in south-east Spain. The main survey was in 1984 with 24 seismic recording stations installed during 41 days. A total of 103 earthquakes were recorded with magnitudes between 0.5 and 3.9. Epicenters can be associated to faults in the area, which are shown to be seismically active. Larger activity is concentrated at the southern part of the area. Joint fault plane solutions show mecanism of fault with vertical motion of normal and reverse character.Part of this work has been supported by the DGICT, project PB-86-0431-C05 and the Comité Conjunto Hispano-Norteamericano para la cooperación cientifica y tecnologíca project CCA-8309/009.Peer reviewe

Hidden myelodysplastic syndrome (MDS): A prospective study to confirm or exclude MDS in patients with anemia of uncertain etiology

[Introduction]: Diagnosis of myelodysplastic syndromes (MDSs) when anemia is the only abnormality can be complicated. The aim of our study was to investigate the primary causes of anemia and/or macrocytosis of uncertain etiology. [Methods]: We conducted a multicenter, prospective study over 4 months in three hematology laboratories. In step 1, we used an automated informatics system to screen 137 453 hemograms for cases of anemia and/or macrocytosis (n = 2702). In step 2, we excluded all patients whose anemia appeared to be due to a known cause. This left 290 patients had anemia of uncertain etiology. In step 3, we conducted further investigations, including a peripheral blood smear, and analysis of iron, vitamin B12, folate, and thyroid hormone levels. [Results]: A differential diagnosis was obtained in 139 patients (48%). The primary causes of anemia were iron deficiency (n = 59) and megaloblastic anemia (n = 39). In total, 25 hematologic disorders were diagnosed, including 14 patients with MDS (56%). The median age of MDS patients was 80 years, 12 had anemia as an isolated cytopenia, and most (n = 10) had lower‐risk disease (IPSS‐R ≤ 3.5). SF3B1 mutations were most frequent (n = 6) and correlated with the presence of ring sideroblasts (100%) and associated with better prognosis (P = 0.001). [Conclusions]: Our prospective, four‐step approach is an efficient and logical strategy to facilitate the diagnosis of MDS on the basis of unexplained anemia and/or macrocytosis, and may allow the early diagnosis of the most serious causes of anemia. Molecular analysis of genes related to MDS could be a promising diagnostic and prognostic approach.This work was also partially financed by the Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III (ISCIII) (PI 17/01741 from MDC and PI 17/01966 from JMB)