Secondary Acute Myeloid Leukemia in a One-Year-Old Girl Diagnosed with JAK2-V617F Mutation Positive Myeloproliferative Neoplasm

Myeloproliferative neoplasms (MPNs) are a group of clonal disorders characterized by hyperproliferation of hematologic cell lines and have been associated with tyrosine kinase JAK2-V617F mutations. Secondary acute myeloid leukemia (sAML) is a known complication of JAK2-V617F+ MPNs and bears a poor prognosis. Although the evolution of a JAK2-V617F+ MPN to a mixed-lineage leukemia has been reported in the pediatric population, no evolutions into sAML have been described. We present a case of a one-year-old girl diagnosed with JAK2-V617F+ MPN with evolution into sAML. Despite initial morphologic remission, she eventually relapsed and succumbed to her disease

Agriculture Irrigation and Water Use

The 17 Western States, plus Arkansas, Florida, and Louisiana, account for 91 percent of all U.S. irrigated acreage, with the Western States alone contributing over 85 percent. This report integrates data on the distribution, characteristics, uses, and management of water resources from a wide variety of data sources. The report includes charts and tables on water use in irrigation; farm data comparing selected characteristics of irrigated and nonirrigated farms; and data on water application systems, sources of water, pump energy expenses by energy type, values of irrigated and nonirrigated land, and cash rents

Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant

Rationale: Little is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients. Objective: We sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement. Methods: This is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016. Results: 97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056). Conclusions: In this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation

IRRIGATION IN HUMID REGIONS AN ANNOTATED INTERDISCIPLINARY BIBLIOGRAPHY

This bibliography identifies some of the important literature on the economic and related aspects of irrigation, with special but not exclusive reference to the humid regions of the Eastern United States. The bibliography is categorized under three main headings: on-farm irrigation planning; state, regional, geographic, and economic assessments; and national irrigation and selected policy assessments. To account for distinctive climatic variations reflected in irrigated cropland patterns in the Eastern States, four specific agricultural areas are given intensive treatment, including Florida, the Delmarva Peninsula, southern New Jersey, and Minnesota

Agricultural Irrigation and Water Supply

The 17 Western States plus Arkansas, Florida, and Louisiana account for 94 percent of all U.S. irrigated acreage, with the Western States alone contributing over 85 percent. This report integrates data on the distribution, characteristics, uses, and management of water resources from a wide variety of data sources. The report includes charts and tables on the climatic and physiographic influence on irrigation development; farm data comparing selected characteristics of irrigated and nonirrigated farms; and data on water application systems, sources of water, pump energy expenses by energy type, values of irrigated and nonirrigated land, and cash rents

Pulmonary infection with : A case report

Mycobacterium szulgai is a non-tuberculous mycobacterium that is an uncommon cause of infection in humans. Risk factors for infection include immunosuppression and pre-existing lung pathology. Herein, we present a case of a 42-year-old male with chronic obstructive pulmonary disease with pulmonary infection caused by M. szulgai that was successfully treated with a regimen of rifampin, isoniazid, pyrazinamide and ethambutol for 2 months, followed by rifampin, isoniazid and azithromycin for an additional 8 months. Symptomatic and radiographic resolutions were achieved

Efficacy of Prompt Initiation of Antiretroviral Therapy in the Treatment of Hemophagocytic Lymphohistiocytosis Triggered by Uncontrolled Human Immunodeficiency Virus

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, rapidly progressive hematologic disorder involving uncontrolled immune system activation. HLH has been associated with viral infections, including human immunodeficiency virus (HIV) infections. We report a case of a critically ill 30-year-old female who was hospitalized with HIV-associated HLH, with a CD4 count of 4 cells/mL and HIV viral load of 1,842,730 copies/mL. After ruling out other potential infectious causes of HLH, antiretroviral therapy (ART) was initiated with darunavir, ritonavir, tenofovir, and emtricitabine. Within one week of initiation of ART, the patient began to improve clinically and hematologically and was stable enough for discharge from the hospital three weeks after starting therapy. This case suggests that treatment with ART in patients with HIV-associated HLH should be considered even in critically ill patients with low CD4 counts

Agricultural Irrigation and Water Use

The 17 Western States, plus Arkansas, Florida, and Louisiana, account for 91 percent of all U.S. irrigated acreage, with the Western States alone contributing over 85 percent. This report integrates data on the distribution, characteristics, uses, and management of water resources from a wide variety of data sources. The report includes charts and tables on water use in irrigation; farm data comparing selected characteristics of irrigated and nonirrigated farms; and data on water application systems, sources of water, pump energy expenses by energy type, values of irrigated and nonirrigated land, and cash rents