Heterogeneous Manifestations of Posttransplant Lymphoma in Renal Transplant Recipients: A Case Series

Posttransplant lymphoproliferative disorder (PTLD) occurs in 1% to 3% of adult renal transplant recipients (RTRs). PTLD has a heterogeneous presentation and is often associated with Epstein-Barr virus (EBV) and immunosuppression. We present a descriptive case series of 16 RTRs who demonstrate a variety of PTLD manifestations. Fifty-six percent received rabbit antithymocyte globulin induction, and 37.5% received basiliximab. Maintenance immunosuppression included glucocorticoids, tacrolimus, and mycophenolate mofetil. Median time from transplantation to PTLD diagnosis was 96.5 months. PTLD involved a single site in 44% of RTRs and multiple sites in 56%. PTLD was localized to the gastrointestinal tract in 9 RTRs, in lymph nodes in 9, central nervous system in 4, bone marrow in 3, skin in 3, lungs in 2, perinephric space in 2, mediastinum in 1, and native kidney in 1. PTLD was EBV positive in 8 RTRs, monomorphic/monoclonal in 14, and of B-cell lineage in 13. Three RTRs had T-cell PTLD. Immunosuppressive agents, except glucocorticoids, were discontinued at diagnosis. Treatment was chemotherapy either alone (in 14 RTRs) or in combination with radiation. Complete remission was achieved in 62.5% of RTRs. Renal dysfunction developed in 62.5% of RTRs, and 4 received dialysis. The overall mortality rate was 62.5%, with median time of death 6.5 months after diagnosis. PTLD that was EBV negative and had T-cell involvement presented with aggressive disease and a higher mortality. Clinicians should be aware of the various PTLD manifestations. Early diagnosis and a multidisciplinary approach to treatment is crucial for improved patient outcomes

Effect of percutaneous balloon mitral valvuloplasty on left ventricular function in rheumatic mitral stenosis

Objective: Patients with rheumatic mitral stenosis, despite having normal left ventricular ejection fraction (LV EF), have ventricular dysfunction in the form of impaired longitudinal excursion. Tissue Doppler velocity is a useful indicator for assessment of long-axis ventricular shortening and lengthening. The aim of our study was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on LV function in rheumatic MS and to study echocardiographic parameters with M-Mode and Tissue Doppler Imaging pre PBMV, post PBMV and on follow-up to determine predictors of LV function. Methods: We analysed 52 patients with severe mitral stenosis with normal LV EF, who underwent PBMV at our institute. Baseline parameters of LV function were compared with immediate post PBMV and at three months follow up. Results: The mean age of the patients was 33.73 (10.87) years with female preponderance. The mean mitral valve area before PBMV was 0.92 (0.13) cm2 which increased to 1.65 (0.21) cm2 after PBMV and at 3 month it was 1.61 (0.23) cm2 (p0.05). Mitral valve E’ was 8.71 (1.54) cm/s which increased to 10.13 (1.68) cm/s post PBMV and at 3 month it was 10.83 (1.34) cm/s (p<0.001).. Mitral annular systolic velocity (MASV), before PBMV was 7.90 (0.96) cm/s which increased to 9.31 (1.68) cm/s after PBMV and at 3 month it was 10.13 (0.96) cm/s (p<0.001). Myocardial performance index (MPI) before PBMV was 0.54 (0.48) which decreased post PBMV to 0.47 (0.06) and at 3 month it was 0.38 (0.04) (p=0.01). Pre PBMV MPI value <0.48 predicted improvement in LV function (sensitivity: 81%, specificity: 58.1%). Conclusion: Thus, PBMV leads to improvement in LV function in patients with severe MS with normal LV EF

Significance of myocardial injury on in-hospital clinical outcomes of in-hospital and COVID-19 patients

Introduction: Acute Myocardial injury defined by increased troponin I level is associated with poor in-hospital outcomes and cardiovascular complications in patients with COVID-19. The current study was designed to determine the implications and clinical outcome of myocardial injury in COVID-19. Methods: This retrospective study included hospitalized COVID-19 patients. Myocardial injury was defined by high sensitivity Troponin I (hs-TNI)≥26ng/l. Cardiac biomarkers, inflammatory markers and clinical data were systemically collected and analyzed. Hazard ratio for in-hospital mortality and logistic regression for predictors of acute myocardial injury were analyzed. Results: Of the 1821 total patients with COVID-19, 293(16.09%) patients died and 1528 (83.91%) patients survived. Patients who died had significantly higher association with presence of cardiovascular risk factors, severe CTSS ( CT severity score ) and myocardial injury as compared to survived group. 628 (34.5%) patients had evidence of myocardial injury and they had statistically significant association with cardiovascular risk factors, in-hospital mortality, procalcitonin; higher hospital, and ICCU stay. We found significant hazard ratio of diabetes (HR=2.66, (CI:1.65-4.29)), Severe CT score (HR=2.81, (CI:1.74-4.52)), hs-TNI≥26 ng/l (HR=4.68, (CI:3.81-5.76)) for mortality. Severe CTSS score (OR=1.95, CI: 1.18-3.23, P=0.01) and prior CVD history (OR=1.65, CI:1.00-2.73, P=0.05) were found significant predictors of myocardial injury in regression analysis. Conclusion: Almost one third of hospitalized patients had evidence of acute myocardial injury during hospitalization. Acute myocardial injury is associated with higher hospital and ICCU stay, mortality, higher in-hospital infection which indicates more severe disease and the poor in-hospital outcomes

Challenges Faced by Persons with Disabilities Using Self-Service Technologies

Foreseeable game changing solutions to SSTs will allow for better universal access by better implementing features that are easy and intuitive to use from the inception. Additional robotic advancements will allow for better and easier delivery of goods for consumers. Improvements to artificial intelligence will allow for better communication through natural language and alternative forms of communication. Furthermore, artificial intelligence will aid consumers at SSTs by remembering the consumers preferences and needs. With all foreseeable game changing solutions people with disabilities will be consulted when new and improved SSTs are being developed allowing for the SST to maximize its potential

Key Elemental Differences causing Cisplatin Induced Hearing Loss

Cisplatin is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (i.e. small cell lung cancer, and ovarian cancer), lymphomas and germ cell tumors (DrugBank, 2021). Cisplatin can cause hearing loss in the cochlea, which is a result of some of the cancer therapies that happen in hospitals. In this study three experimental groups were looked at, Cisplatin alone, Cisplatin in conjunction with Honokiol, and Honokiol by itself. Honokiol is used due to the possibility that the drug can provide effects to limit cisplatin induced hearing loss by inhibiting the production of ROS. Samples of the three test groups were taken and scanned at Argonne National Laboratory using an 8-BM photon beam. A comparison using the Image J program reveals the concentration of elements located within the inner ear. A closer look at Cisplatin with Honokiol revealed significant differences in Platinum levels when compared to Cisplatin alone and reports of significantly less hearing loss is recorded with these patients. Cisplatin levels of Platinum reveal ototoxicity and with a complement of Honokiol can bind to platinum and significantly reduce the ototoxicity presen

Elimination disorders: Enuresis

Enuresis is a common childhood condition which is usually treatable. Enuresis at any age can lead to embarrassment. This coupled with teasing by peers resulting in social withdrawal, avoidance of overnight stay at relatives, and friends can have a long term effect in relationships than the enuresis itself. Organic and psychological causes should be considered, especially with the late onset or exacerbation of existing enuresis. Principles of management should be focused to address any precipitating and maintaining factors and also provide appropriate advice and explanation

Prerenal Transplant Education and Evaluation Positively Impacts Outcomes

Introduction: An outstanding question in kidney transplantation is how to prepare candidates and their social supports for optimal posttransplant outcomes. Project Aims: This program evaluation assessed whether a pretransplant quality improvement clinic improved clinical outcomes in the year posttransplant compared to recipients receiving standard of care. Design: The Countdown to Transplant Clinic was implemented with kidney transplant candidates expected to receive a transplant within the next few months. The clinic included an enhanced education session on posttransplant lifestyle management, confirmation of support (≥2 adults), and evaluations by transplant social work, psychology, and nephrology. Results: Seventy-five patients participated in the clinic and underwent a transplant. A retrospective chart review of posttransplant laboratory values, rehospitalizations (within 3-months posttransplant), biopsy-confirmed graft failure, and mortality (within 1-year posttransplant) were collected from both groups. Univariate and multivariate propensity score-weighted linear or logistic regression models were used to evaluate the association between clinic participation and outcomes. In models adjusting for relevant covariates, participation in The Countdown to Transplant Clinic (vs standard care) was associated with a lower coefficient of variation of serum tacrolimus (all values collected 3-12 months posttransplant), 30-day posttransplant white blood cell counts (but not 90-day), 90-day posttransplant potassium, and 30 and 31 to 90 days rehospitalizations. Clinic participation did not predict serum glucose levels at 30- or 90-days posttransplant. Due to low rates of rejection and mortality, meaningful comparisons were not possible. Conclusion: Participation in a pretransplant, multicomponent clinic may improve certain outcomes of interest posttransplantation. Pilot testing for feasibility for randomized controlled trials is a necessary next step