Predictive modeling for acute kidney injury after percutaneous coronary intervention in patients with acute coronary syndrome: a machine learning approach

BACKGROUND

Acute kidney injury (AKI) is one of the preventable complications of percutaneous coronary intervention (PCI). This study aimed to develop machine learning (ML) models to predict AKI after PCI in patients with acute coronary syndrome (ACS).

METHODS

This study was conducted at Tehran Heart Center from 2015 to 2020. Several variables were used to design five ML models: Naïve Bayes (NB), Logistic Regression (LR), CatBoost (CB), Multi-layer Perception (MLP), and Random Forest (RF). Feature importance was evaluated with the RF model, CB model, and LR coefficients while SHAP beeswarm plots based on the CB model were also used for deriving the importance of variables in the population using pre-procedural variables and all variables. Sensitivity, specificity, and the area under the receiver operating characteristics curve (ROC-AUC) were used as the evaluation measures.

RESULTS

A total of 4592 patients were included, and 646 (14.1%) experienced AKI. The train data consisted of 3672 and the test data included 920 cases. The patient population had a mean age of 65.6 ± 11.2 years and 73.1% male predominance. Notably, left ventricular ejection fraction (LVEF) and fasting plasma glucose (FPG) had the highest feature importance when training the RF model on only pre-procedural features. SHAP plots for all features demonstrated LVEF and age as the top features. With pre-procedural variables only, CB had the highest AUC for the prediction of AKI (AUC 0.755, 95% CI 0.713 to 0.797), while RF had the highest sensitivity (75.9%) and MLP had the highest specificity (64.35%). However, when considering pre-procedural, procedural, and post-procedural features, RF outperformed other models (AUC: 0.775). In this analysis, CB achieved the highest sensitivity (82.95%) and NB had the highest specificity (82.93%).

CONCLUSION

Our analyses showed that ML models can predict AKI with acceptable performance. This has potential clinical utility for assessing the individualized risk of AKI in ACS patients undergoing PCI. Additionally, the identified features in the models may aid in mitigating these risk factors.

Impacts of organic manganese supplementation on blood mineral, biochemical, and hematology in Afshari Ewes and their newborn lambs in the transition period

OBJECTIVE

Maternal mineral status, including manganese (Mn), is critical for fetal growth as well as the health of the newborn lamb. Consequently, it is essential to supply minerals at sufficient levels for the pregnant animal to achieve the development of the embryo and fetus during gestation.

METHODS

The current research was conducted to investigate the impact of organic Mn supplementation on blood biochemical, other mineral and, hematology in Afshari ewes and their newborn lambs in the transition period. Twenty-four ewes were randomly divided into three groups with eight replications. The control group was fed with a diet without organic Mn. The other groups were fed a diet supplemented with 40 (recommended by the NRC) and 80 (twice-recommended by the NRC) mg/kg of DM organic Mn.

RESULTS

In this study, the consumption of organic Mn caused a significant increase in ewes and lambs plasma Mn concentration. Moreover, in the groups mentioned, levels of glucose, insulin, and superoxide dismutase were significantly increased in both ewes and lambs. Concentrations of total protein and albumin were higher in ewes fed whit organic Mn. In both ewes and newborn lambs, the levels of red blood cells, hemoglobin, hematocrit, mean corpuscular hemoglobin, and mean corpuscular concentration in groups fed with organic Mn raised.

CONCLUSION

In general, the nutrition of organic Mn, improved factors of blood biochemical and hematology in ewes and their newborn lambs, and since the twice-recommended NRC level did not cause poisoning, it was recommended to supplement the diet with 80 mg of organic Mn per kg of DM.

Non-Infectious Complications in B-Lymphopenic Common Variable Immunodeficiency

BACKGROUND AND OBJECTIVE

Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, non-infectious complications are also a major challenge among CVID patients.

METHODS

All registered CVID patients in the national database were included in this retrospective cohort study. Patients were divided into two groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, non-infectious organ involvements, autoimmunity, and lymphoproliferative diseases were evaluated.

RESULTS

Among 387 enrolled patients, 66.4% were diagnosed with non-infectious complications; however, 33.6% had only infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly higher among patients with B-cell lymphopenia. Among organ involvement, dermatologic, endocrine and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher compared to other types of autoimmunity independent from the B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were slightly introduced as the most common type of malignancy. Meanwhile, the mortality rate was 24.5%, and respiratory failure and malignancies were reported as the most common cause of death in our patients without significant differences between the two groups.

CONCLUSION

Considering that some of the non-infectious complications might be associated with B-cell lymphopenia, therefore, regular patient monitoring and follow-up along with proper medications (besides immunoglobulins replacement therapy) are highly recommended to prevent further sequels and increase the patients' quality of life.

Knowledge of diagnosis and management of selected oral mucosal lesions among dentists in The Netherlands

BACKGROUND

Knowledge of oral mucosal lesions (OMLs) among dentists is relevant in diagnosing potentially malignant diseases and oral cancer at an early stage. The aim of this survey was to explore dentists' knowledge about OMLs.

MATERIAL AND METHODS

Respondents to a web-based questionnaire, containing 11 clinical vignettes representing patients with various OMLs, provided a (differential) diagnosis and management for each. Information about demographics and clinical experience of the participants was acquired as well. Descriptive statistics were performed and T-tests were used to test for significant (p<0.05) differences in mean scores for correct diagnosis and management between subgroups based on demographic variables.

RESULTS

Forty-four of 500 invited dentists completed the questionnaire. For (potentially) malignant OMLs, the number of correct diagnoses ranged from 14 to 93%, whilst the number of correct management decisions ranged from 43 to 86%. For benign OMLs, the number of correct diagnoses and management decisions ranged from 32 to 100% and 9 to 48%, respectively. For 11 clinical vignettes, mean scores for correct diagnosis, correct management and correct diagnosis and management were respectively 7.2 (±1.8), 5.7 (±1.5), and 3.8 (±1.7).

CONCLUSIONS

The results show that dentists in the Netherlands do not have sufficient knowledge to accurately diagnose some OMLs and to select a correct management. This may result in over-referral of benign OMLs and under-referral for (potentially) malignant OMLs. Clinical guidelines, that include standardized criteria for referral, and continuing education, may improve dentists' ability to correctly diagnose and accurately manage OMLs.

Autophagy-regulating microRNAs: two-sided coin in the therapies of breast cancer

Despite recent advances in the treatment of breast cancer (BC), it still remains as a prevalent and deadly cancer in the world. Given that BC is a heterogeneous disease, it is necessary to clarify molecular mechanisms in tumor cells to improve various therapy outcomes and overcome therapy resistance. Autophagy represents one of the most important intracellular degradation pathways involved in diverse biological processes and plays an important bi-directional role in tumor formation and progression. Among the several mechanisms that affect autophagy, microRNAs (miRNAs) play a crucial role as gene regulators. Several in vivo and in vitro studies have reported multiple miRNAs regulating autophagy in BC that affect tumor initiation, progression, and response to various therapies. In the present review, we highlighted the mechanisms through which miRNAs regulate autophagy in BC and their potential use as therapeutic targets.

Effects of curcumin on antioxidant capacity and gastric mucosal injury following strenuous endurance training in rats

Strenuous endurance training (SET) in endurance athletes can cause gastrointestinal problems, such as gastritis. Gastritis is associated with increased oxidative stress and an imbalance between free-radical production and antioxidant defences. The present study investigated the effects of SET and curcumin injection on systemic total antioxidant capacity (TAC), gastric mucosal injury and lipid peroxidation (malondialdehyde – MDA) in male rats. Twenty-six male Wistar rats were randomly divided into four groups including Control, Curcumin, Endurance, and Endurance + curcumin. Incremental endurance training (up to 70 min with 35 m/min), and curcumin injection (30 mg/kg bodyweight, three times per week) was carried out in relevant groups. The pathology of gastritis was measured concerning the restoration factors (the number of neutrophils, the formation of new vessels, and proliferation of fibroblasts), gastric MDA levels and the TAC were measured. SET-induced gastritis symptoms, such as gastric mucosal injury and lipid peroxidation and curcumin decreased systemic TAC. However, curcumin reduced exercise-induced gastric mucosal injury and lipid peroxidation. Also, serum levels of TAC were maintained at normal levels following a combination of SET and curcumin injection. These findings suggest that curcumin injection during SET could be useful for managing gastritis symptoms and improving antioxidant capacity in healthy and eutrophic rats.

T cell responses to an HLA-A2-restricted adipophilin peptide correlate with BMI in patients with atherosclerosis

Introduction

Atherosclerosis is an inflammatory disease causing a vast array of cardiovascular diseases. Adipophilin has been reported to be highly expressed in atherosclerotic lesions. This study investigated the possible existence of auto-reactive T cells against an HLA-A02-restricted adipophilin-derived peptide as well as peptides from Epstein-barr virus (EBV), Cytomegalovirus (CMV) and influenza (Flu) virus in patients with atherosclerosis.

Methods

HLA-A02 expression on peripheral blood mononuclear cells (PBMCs) was examined by flow cytometry. PBMCs from HLA-A02 individuals were stimulated with adipophilin, CMV, EBV, and Flu peptides at a concentration of 10 µM. Interferon (IFN)-γ production was evaluated in the culture supernatant using a commercial ELISA test.

Results

The levels of IFN-γ production against an HLA-A02-restricted adipophilin peptide and peptides from CMV, EBV, and Flu revealed no statistically significant differences between patients and healthy controls. However, we found a positive correlation between IFN-γ production against adipophilin and Body mass index (BMI) of patients (R = 0.8, P = 0.003), whereas no significant correlation was found in healthy controls (R = -0.267, P = 0.378). No correlation between BMI and IFN-γ production against CMV, EBV, or Flu peptides was found.

Discussion

Atherosclerotic patients with higher BMIs might have greater numbers of T cells against adipophilin that is highly expressed in atherosclerotic plaques. Therefore, autoimmune reactions may have a greater role in the development of atherosclerosis in individuals with higher BMI.

Semiparametric Inference for Proportional Mean Past Life Model

The mean past lifetime provides the expected time elapsed since the failure of a subject given that he/she has failed before the time of observation. In this paper, we propose the proportional mean past lifetime model to study the association between the mean past lifetime function and potential regression covariates. In the presence of left censoring, martingale estimating equations are developed to estimate the model parameters, and the asymptotic properties of the resulting estimators are studied. To assess the adequacy of the model, a goodness of fit test is also investigated. The proposed method is evaluated via simulation studies and further applied to a data set.

Growth Inhibitory Effect of Lactocare on Vibrio cholerae

BACKGROUND AND OBJECTIVE

Acute microbial diarrheal diseases are the major public health problems in the developing countries. People affected by diarrheal diseases have the lowest financial resources and poorest hygienic facilities. Children under five, primarily in Asian and African countries, are mostly the subjects affected by microbial diseases transmitted through water.The current study aimed at investigating the comparative inhibitory effect of Lactocare (commercial probiotic) on clinical samples and standard strains of Vibrio cholerae.

METHODS

A total of 20 clinical samples and a standard strain (ATCC 14035) were provided by Health Reference Laboratory and Biotechnology Institute, respective ly. In order to confirm the samples, biochemical analysis and the polymerase chain reaction (PCR) were performed on intergenic space. Afterward, agar well diffusion method was performed in order to measure the minimum inhibitory concentration to monitor the antimicrobial activity of Lactocare.

RESULTS

Colony count of V. cholerae for the standard strain in 30% and mean for clinical samples in 50% concentration of Lactocare treatment revealed that it would propel to death phase. Since the number of colonies decreased to 100, it was considered that higher concentrations of Lactocare would completely inhibit the growth of V. cholera.

CONCLUSION

Probiotics are employed to develop new pharmaceutical preparations and functional foods in order to promote the public health.

Neuropsychiatric consequences of deep brain stimulation surgeries in the patients affected by chronic movement disorders: A brief report

The main surgical procedure for PD and other chronic movement disorders is deep brain stimulation. DBS has been reported to have specific consequences such as decline in verbal fluency and episodes of depression.

We designed an interventional study in 12 patients affected by Parkinson, dystonia and tic who underwent DBS surgery. Patient assessed before surgery, one month and one year after surgery.

The results proved a significant improvement in SF36. The Hamilton's anxiety scale showed an overall but insignificant improvement. The mean of scores of the BDI had a great drop one month after surgery but a raise at the 12th month (insignificant pattern).

Pearson's correlation test showed a significant negative correlation between age and the SF36 scores. The BDI's scores were assessed in relation with age. Although there was no actual relation between them before surgery, we detected a positive correlation between them after one year.

Conclusion

The pattern of changes can be related with the differences between perioperative expectations and real long-term outcomes. Correlations between changes seen in BDI and SF36 scores with age can be considered as a confirmatory evidence for this idea.

All cases showed an insignificant gradual decline in digit span test, which may be independent of the surgical procedure. Although the COWA test could not prove a significant deterioration in verbal fluency but a slight decline after one year was obvious, in addition to one patient who turned aphasic during this period.

The outcomes showed that the benefits of DBS outweigh the slight risk of developing depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

On the Residual and Inactivity Times of the Components of Used Coherent Systems

In the study of the reliability of technical systems in reliability engineering, coherent systems play a key role. In this paper we consider a coherent system consisting of n components with independent and identically distributed components and propose two time-dependent criteria. The first criterion is a measure of the residual lifetime of live components of a coherent system having some of the components alive when the system fails at time t. The second criterion is a time-dependent measure which enables us to investigate the inactivity times of the failed components of a coherent system still functioning though some of its components have failed. Several ageing and stochastic properties of the proposed measures are then established.

Dynamic Reliability Modeling of Three-State Networks

This paper is an investigation into the reliability and stochastic properties of three-state networks. We consider a single-step network consisting of n links and we assume that the links are subject to failure. We assume that the network can be in three states, up (K = 2), partial performance (K = 1), and down (K = 0). Using the concept of the two-dimensional signature, we study the residual lifetimes of the networks under different scenarios on the states and the number of failed links of the network. In the process of doing so, we define variants of the concept of the dynamic signature in a bivariate setting. Then, we obtain signature based mixture representations of the reliability of the residual lifetimes of the network states under the condition that the network is in state K = 2 (or K = 1) and exactly k links in the network have failed. We prove preservation theorems showing that stochastic orderings and dependence between the elements of the dynamic signatures (which relies on the network structure) are preserved by the residual lifetimes of the states of the network (which relies on the network ageing). Various illustrative examples are also provided.

Estimated incidence of cardiac contusion using transthoracic echocardiography in patients suffering from severe blunt trauma to the chest

BACKGROUND

Cardiac contusion (CC) is a known complication of blunt trauma to the chest. There have been debates about its true incidence and there are different reports which claim that it occurs in less than 10% to more than 70% of patients. The goal of this study is to estimate the incidence of CC in patients with severe blunt chest trauma (SBCT) using transthoracic echocardiography (TTE).

METHODS

After defining inclusion and exclusion criteria, all cases with clinical evidences of SBCT from February 2010 until October 2011 were included in this study. Patients were assessed using electrocardiography (ECG) and transthoracic echocardiography (TTE). Transient echocardiographic changes, including wall motion abnormalities, valvular or papillary muscle dysfunction, pericardial effusion or tamponade, free wall rupture and interatrial/interventricular septum defects, were considered to be abnormal and trauma-related.

RESULTS

A total of 210 patients were assessed for CC. Fifty-two trauma-related echocardiographic changes in 47 patients were observed, in which 34 cases had simultaneous transient ECG changes. The estimated incidence of CC in these subjects was calculated to be 23.38% and 16.19%, respectively. There was a statistically significant relationship between the presence of both echocardiographic changes and ECG abnormalities, and those subjects without ECG changes (P = 0.03). As we evaluated stable patients without any cardiac-related clinical manifestations and TTE was chosen as our diagnostic modality, we claim that the true incidence must be higher.

CONCLUSIONS

We believe that a comparison of our findings with those presented in the literature shows that the actual incidence of CC in blunt chest trauma is underestimated.

Anti-inflammatory effect of Prunus armeniaca L. (Apricot) extracts ameliorates TNBS-induced ulcerative colitis in rats

Prunus armeniaca L. (Apricot) is a tree cultivated in different parts of the world. Apricot kernel as a good dietary supplement has shown antioxidant, anti-inflammatory and other pharmacologic properties which suggest that it may be functional as an anticolitis agent. In this study we evaluated the effects of apricot kernel extract and oil on ulcerative colitis in rats. Rats were fasted for 36 h before the experiment. Colitis was induced by intra-rectal instillation of 50 mg/kg trinitrobenzene sulfonic acid in male Wistar rats. Treatments were started 6 h after colitis induction and continued every 24 h for 5 days. Apricot kernel extract (100, 200, 400 mg/kg p.o. and 100, 400 mg/kg i.p.) and apricot kernel extract/oil (100, 200, 400 mg/kg p.o.) were used as experimental treatments and prednisolone (4 mg/kg p.o. or i.p.) was used as reference drug. On the day 6, colon tissue was removed and macroscopic and pathologic parameters were evaluated. Ulcer index and total colitis index as representative of macroscopic and histologic parameters respectively showed ameliorating effects in experimental groups especially those treated by intraperitoneal administration route. Results also demonstrated that oil fraction was not able to potentiate the effects of extract. These data suggest that apricot kernel extracts (with or without oil) can be introduced for further mechanistic and clinical studies as a complementary medicine for inflammatory bowel disorders.

Reproducibility of lymphoscintigraphy before and after excisional biopsy of primary breast lesions: a study using superficial peri-areolar injection of the radiotracer

OBJECTIVE

A major controversial issue in the sentinel node biopsy of the breast is the applicability of sentinel node mapping in patients with the history of previous excisional biopsy of the breast lesions. In the current study, we evaluated the reproducibility of lymphoscintigraphy before and after excisional biopsy of the primary breast lesions using superficial peri-areolar injection of the radiotracer.

MATERIAL AND METHODS

Eighteen patients scheduled for excisional biopsy of breast lesions were included into the study. The patients received intra-dermal injection of the radiotracer in the peri-areolar area of the index quadrant 1 to 2h before surgery. Imaging was performed the day after surgery. Immediately after completion of the first imaging, the patients received another injection of the radiotracer with the same technique, dose, and location. Other sets of lymphoscintigraphy imaging were taken immediately and 4h post second injection. The two sets of lymphoscintigraphy images were compared.

RESULTS

In 2 patients, sentinel node could not be identified in either set of images. In the remaining 16 patients, one sentinel node was detected in both lymphoscintigraphy image sets. The sentinel nodes of the second image sets were all in the same location of the first sets with at least 5 times higher count.

CONCLUSIONS

Excisional biopsy of the primary breast lesions does not seem to change the superficial lymphatic drainage pattern from the areola of the breast and sentinel node mapping can be performed after this procedure using superficial periareolar technique.

Effects of Watercress (Nasturtium nasturtium) extract on selected immunological parameters of rainbow trout (Oncorhynchus mykiss)

Watercress (Nasturtium nasturtium) is a medical plant containing diverse chemically-active substances with biological properties. The present study was conducted to investigate the immunomodulatory effects of watercress extract on immunological and hematological parameters of rainbow trout (Oncorhynchus mykiss). Fish were fed for 21 days with diet supplemented with 0.1% and 1% of watercress extract per 1 kg food and with a normal diet as control. Hematological parameters such as red blood cells (RBC) and white blood cells (WBC), hematocrit (Hct), hemoglobin (Hb), RBC index like mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) as well as immunological parameters such as peroxidase, lysozyme and complement activities, total protein, albumin and globulin levels were measured after 21 days of watercress extract treatment. The results indicated that oral administration of 1 % watercress extract in fish may enhance some hematological and immunological parameters including Hb and MCHC, lysozyme and complement activities, total protein and globulin levels, compared to the controls after 21 days of experimental period. In conclusion, on the basis of these results, oral administration of watercress extract may be useful to improve fish’s immune system.

Detection and Molecular Characterization of Cryptosporidium species in Recreational Waters of Chaharmahal va Bakhtiyari Province of Iran using nested-PCR-RFLP

BACKGROUND

The aim of this study was to detect and characterize Cryptosporidium spp. in water samples collected from recreational ponds of Chaharmahal va Bakhtiyari Province of Iran.

METHODS

Thirty water samples were collected from November 2009 to May 2010. Each sample contained 10 liters of water. We used the SSU rRNA-based PCR-RFLP technique.

RESULTS

Out of thirty samples examined, 6 (20%) were positive for different Cryptosporidium spp. Restriction pattern analysis showed that C. parvum has been the most prevalent genotype, followed by C. hominis and C. canis, respectively. In this area, the higher prevalence of C. parvum compared with other genotypes is consistent with the distribution of cattle.

CONCLUSION

Farm animals, particularly cattle are the main source of cryptosporidial contamination for recreational waters in this area.

Comparision of barry and barry-taguchi ureterovesical reimplantation techniques in kidney transplantations: a randomized clinical trial

BACKGROUND

Renal transplantation is the treatment of choice for chronic renal failure. Using a suitable ureterovesical anastomosis technique can prevent most of risks for kidney graft. Extravesical ureteroneocystostomy is becoming popular in renal transplantation because of the low complication rate and technical ease. The decreased complication rate is due to limited bladder dissection and the need for a shorter ureteral segment from the donor.

OBJECTIVE

In this study we assessed the effectiveness and complications of a new technique, Barry-Taguchi technique and compared it with Barry technique.

METHODS

We recorded all urological complications developed in the recipient's kidney between September 2004 and March 2007 (mean follow-up 12 months) after performing extravesical Barry-Taguchi (new technique) and Barry ureteroneocystostomy. The urological complications studied included complicated hematuria, urinary fistula, and ureteral stenosis.

RESULTS

A total 100 patients who underwent Barry-Taguchi technique and 98 patients who underwent Barry technique were studied. The incidence of urological complications in Barry-Taguchi and Barry re-implantation technique was 4% (n=4) and 5% (n=5%), respectively. These complications included 1 urinary leakage and 3 ureteral obstructions for Barry-Taguchi technique, and 4 obstructions and 1 leakage from Barry group. In both trial groups, no complicated hematuria has occurred. In addition, the recorded time taken for ureteral anastomosis ranged from 4 to 16 (mean 8.3) min for Barry-Taguchi technique and 5 to 20 (mean 9.9) min in Barry technique.

CONCLUSION

The Barry-Taguchi extravesical ureteroneocystostomy technique is a rapid and rather simple technique. Without increasing the incidence of urological complication rate, it is a reliable method for performing ureteroneocystostomy.

Outpatient stem cell transplantation for multiple myeloma

e19553

Background: The aim of this study was to explore the feasibility and safety of performing aoutologous stem cell transplantation (ASCT) on an outpatient basis. Methods: 142 patients with multiple myeloma (MM) in complete remission (CR) or partial remission (PR) received ASCT on an outpatient or inpatient basis. In the inpatient group 77 patients and in outpatient group 65 patients received 200 or 140 mg/m2 melphalan as conditioning regimen respectively. In outpatient group all the patients were programmed to go home the day after ASCT and to be re-hospitalized in the case of febrile neutropenia or other sever toxicities. We used caregiver, general physician, staff nurse as an outpatient and visit team and also unequipped routine house of the patients during neutropenia. Results: Median age was 50.2 years (ranged 27–68) with 70% male. Median hospital stay were 25 days in inpatient and. 4.8 days in outpatient respectively (p<0.01). There were not significant differences between these groups in aphresis days, granulocyte colony stimulating factor requirement for mobilization and mononuclear cell, There were also significant reduction (p<0.001) in parenteral antibiotic, blood product requirement and need for total parenteral nutrition. The most frequent causes of re-admission (outpatient group) were febrile neutropenia and sever mucositis need TPN. 2 years overall survival rate was 98.2% (SE=2%) in inpatient groups and 86.6% (SE=5.7) in outpatient groups.We did not have any death in first month after transplantatio in outpatient group. Conclusions: We describe an outpatient program based on management of the patient in his/her house during aplastic phase. Our results clearly indicate that such a procedure is feasible and safe in a patient population with a caregiver.

No significant financial relationships to disclose.

Outpatient versus inpatient autologous stem cell transplantation for malignant hematologic disorders

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Background: High-dose chemotherapy with autologous stem cell support is utilized for the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. The aim of this study was to compare the time of engraftment and mortality rate and cost of neutropenic treatment in outpatient versus inpatient autologous stem cell transplantation (SCT). Methods: 9 outpatients (5 HL, 2 NHL, and 2 AML) were compared with 32 inpatients (15 HL, 8 NHL, and 9 AML; for whom the outpatient facilities were not ready) from May 2008 to December 2008. All patients were below 45 yrs; median age for outpatients and inpatients were 26 and 30 years respectively. Also all the patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, busulfan and etoposide for AML) and stem cell infusion in hospital. The day after SCT, outpatient group were discharged and followed by outpatient SCT team, and to be re-hospitalized in case of febrile neutropenia, after sepsis workup and performing chest x-ray, they were received the first dose of antibiotic in hospital and treatment continued in home. Results: For outpatients and inpatients, median time to WBC engraftment was 11 and 12 days (p = 0.03), time to PLT engraftment was 15 and 25 days (p = 0.20), number of transfused single donor PLT was 3 and 4.5 units (p = 0.21), duration of neutropenic fever was 6 and 9 days (p = 0.001), duration of hospitalization (after SCT) 0 and 16 (p < 0.001), respectively. All outpatients are alive and 3 patients from other group died between days +35 and +100 after SCT due to transplantation complications. For inpatient group the cost of drugs, just for neutropenic fever antibiotic therapy was six times than outpatient group. Conclusions: Results show that out-patient autologous SCT in malignant hematologic disorders is feasible and comparable with inpatient protocol. We are waiting for more patients and longer follow-up for future conclusions.

No significant financial relationships to disclose.

The Impact of Bone Marrow Transplantation on Sexual Functioning and it’s Relation to Depression and Anxiety

Aims:

The aim of this study was to investigate the prevalence of sexual dysfunctions and its relationship with depression and anxiety in a sample of patients underwent bone marrow transplantation (BMT).

Methods:

A cross-sectional study was conducted in 135 married patients who underwent BMT at least 1 year before evaluation. Sexual dysfunctions assessed by a questionnaire that was derived from Sexual History Form and Sexual Problem Measure. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety in patients.

Results:

Questionnaires were completed by 128 (82.5%) participant. Fifty three percents of participants was male. The mean age of participants was 39.57±8.74. Sexual dysfunctions in post BMT period were significantly more frequent than period prior to the beginning of oncologic malignancy (P< 0.05). Sexual activity was decreased significantly after BMT (P< 0.01). The three most prevalent sexual dysfunctions in male group were premature ejaculation(56%) and problem in orgasm(40%) and desire(32.7%), and in female group were problem in arousal(77%) and desire(77%) and painful intercourse(77%). Sexual dysfunction was more prevalent in female group.

According to HADS score, 42(32.8%) patients had clinical depression (HADS-D score>14) and 12 (9.8%) patients had clinical anxiety (HADS-A score>14). There was not any significant relationship between mean HADS-A and HADS-D scores and scores of sexual dysfunctions questionnaires.

Conclusion:

This study showed that sexual function and activity may be adversely affected by BMT. Factors other than anxiety and depression may have correlation with sexual dysfunction in these patients, of course limitation of this study should be considered.