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Owosho AA, Aguirre SE, Dayo AF, Omolehinwa TT, Shintaku WH. Radiographic Orofacial Findings of Systemic Diseases. Dent Clin North Am 2024; 68:409-427. [PMID: 38417998 DOI: 10.1016/j.cden.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.
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Affiliation(s)
- Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adeyinka F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Temitope T Omolehinwa
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Werner H Shintaku
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
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Nielsen IH, Tolver A, Piil K, Kjeldsen L, Grønbæk K, Jarden M. Family caregiver quality of life and symptom burden in patients with hematological cancer: A Danish nationwide cross-sectional study. Eur J Oncol Nurs 2024; 69:102538. [PMID: 38457934 DOI: 10.1016/j.ejon.2024.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To investigate the quality of life (QoL) and the impact of caregiving in family caregivers of hematological cancer patients and its association with patient symptom burden. METHODS A cross-sectional study including Danish patients (n = 375) and caregivers (n = 140). Caregivers completed scales for anxiety and depression using the Hospital Anxiety and Depression Scale, sleep quality using the Pittsburgh Sleep Quality Index, health related QoL using the 12-item Short-Form Health Survey, and caregiver roles using the Caregiver Roles and Responsibilities Scale. Patients reported symptoms using the MD Anderson Symptom Inventory. Analysis of covariance was used to examine associations between patient symptom burden and caregivers' QoL outcomes. RESULTS The results show that caregivers experience sleep difficulties, moderate anxiety, and reduced QoL. Patient symptom burden was significantly associated with caregiver anxiety (p = 0.009), and mental well-being (p = 0.002), while patient treatment status was a significant factor associated with caregiver anxiety (p = 0.016), depression (p = 0.009), emotional well-being (p = 0.002), and sleep (p = 0.01). CONCLUSION Caregivers of patients with hematological cancers undergoing active treatment face a high symptom burden, which significantly impacts their QoL, including sleep, psychological well-being, and emotional health. Patients reported a high symptom burden, and patient symptom burden was significantly associated with caregiver QoL. Adequate patient and caregiver support is needed to promote their well-being and mitigate adverse health effects in caregivers, and this should be acknowledged in the context of caring for patients with hematological cancer.
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Affiliation(s)
- Iben Husted Nielsen
- Department of Haematology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Anders Tolver
- Department of Mathematical Sciences, Data Science Laboratory, University of Copenhagen, Universitetsparken 5, 2200, Copenhagen, Denmark
| | - Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Lars Kjeldsen
- Department of Haematology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kirsten Grønbæk
- Department of Haematology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Ole Maaløes Vej 5, 2200, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Mary Jarden
- Department of Haematology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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Jin F, Tian W, Xia L, Yang M, Chen Y, Li J, Liu L. Knowledge, attitude, and practice toward leukemia in the general population and among family members of patients with leukemia: A cross-sectional study. Heliyon 2024; 10:e26276. [PMID: 38439856 PMCID: PMC10909635 DOI: 10.1016/j.heliyon.2024.e26276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
Background Patients with leukemia rely on social and family support. This study aimed to explore the knowledge, attitude, and practice (KAP) toward leukemia among family members of patients with leukemia and the general population in southeast China. Methods A cross-sectional study was conducted in September 2022 in southeast China (Anhui Province). The KAP scores and demographic data were assessed by questionnaire and analyzed by multivariable logistic regression and structural equation modeling. Results A total of 760 valid questionnaires were collected, including 117 (15.39%) answered by family members of patients with leukemia. The mean knowledge (8.30 ± 2.79 vs. 8.72 ± 2.56, P = 0.103), attitude (52.17 ± 5.52 vs. 52.27 ± 5.53, P = 0.862), and practice (8.06 ± 2.00 vs. 8.18 ± 2.05, P = 0.547) scores were comparable among family members and the general population. Higher knowledge scores [OR = 1.18 (1.10, 1.27), P < 0.001] and higher attitude scores [OR = 1.05 (1.02, 1.09), P = 0.002] were independently associated with better practice scores. Being a family member of a patient with leukemia had no significant effect on the KAP scores. Conclusion The participants demonstrated satisfactory knowledge, positive attitude, and appropriate practices toward leukemia, suggesting that access to information about leukemia to the general public might be sufficient in China. Health education might effectively improve knowledge, which could translate into improved attitude and practice.
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Affiliation(s)
- Fengbo Jin
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Wanlu Tian
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Leiming Xia
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Mingzhen Yang
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Yingying Chen
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Jianjun Li
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Lixia Liu
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Hematology, Anhui Public Health Clinical Center, Hefei, 230011, China
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Marumo Y, Yoshida T, Furukawa Y, Ina K, Kamiya A, Kataoka T, Kayukawa S. Serological response 5 months after the BNT162b2 COVID-19 vaccination in patients with various hematological disorders in Japan. Clin Exp Vaccine Res 2023; 12:319-327. [PMID: 38025915 PMCID: PMC10655153 DOI: 10.7774/cevr.2023.12.4.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Patients with hematological malignancies are at an increased risk of severe infection with coronavirus disease 2019 (COVID-19). However, developing an adequate immune response after vaccination is difficult, especially in patients with lymphoid neoplasms. Since the long-term effects of the BNT162b2 vaccine are unclear, the humoral immune response 5 months after the two vaccinations in patients with hematological disorders was analyzed. Materials and Methods Samples were collected from 96 patients vaccinated twice with BNT162b2 and treated with at least one line of an antitumor or immunosuppressive drug in our hospital from November 2021 to February 2022. Serum anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike (S) antibody titers were analyzed. Patients were age- and sex-matched using propensity matching and compared with a healthy control group. Patients with serum anti-SARS-CoV-2 S antibodies were defined as 'responder' if >50 U/mL. The patients had B-cell non-Hodgkin lymphoma (B-NHL), multiple myeloma, chronic myeloid leukemia, etc. Results Patients had significantly low antibody levels (median, 55.3 U/mL vs. 809.8 U/mL; p<0.001) and a significantly low response rate (p<0.001). Multivariate analysis showed that patients with B-NHL, aged >72 years, were associated with a low response to vaccination. There were no significant differences between patients with chronic myeloid leukemia and healthy controls. Conclusion Our study shows that patients with hematological disorders are at risk of developing severe COVID-19 infections because of low responsiveness to vaccination. Moreover, the rate of antibody positivity differed between the disease groups. Further studies are warranted to determine an appropriate preventive method for these patients, especially those with B-NHL.
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Affiliation(s)
- Yoshiaki Marumo
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
- Department of Hematology and Oncology, Nagoya City University, Nagoya, Japan
| | - Takashi Yoshida
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Yuki Furukawa
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Kenji Ina
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
- Department of Geriatric Medicine, Shinseikai Daiichi Hospital, Nagoya, Japan
| | - Ayumi Kamiya
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Takae Kataoka
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Satoshi Kayukawa
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
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Yi HM, Xu CH, Yang DL, Lin QS, Li Y, Sun HY, Feng SZ. [Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:118-123. [PMID: 36948865 PMCID: PMC10033268 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.
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Affiliation(s)
- H M Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - C H Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - D L Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Q S Lin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - H Y Sun
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - S Z Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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Zhao J, Kuang Z, Xu J, Yu X, Dong J, Li J, Li L, Liu Y, He X, Xu C, Li X, Shi J. Association of lifestyle behaviors with health-related quality of life among patients with hematologic diseases. Qual Life Res 2023. [PMID: 36652183 DOI: 10.1007/s11136-023-03343-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is a multi-dimensional construct used to assess the impact of health status on quality of life, and it is known to be affected by lifestyle behaviors. This study focused on multiple lifestyle behaviors among patients with hematologic diseases, including physical activity, dietary intake, sleep quality, occupational exposure, alcohol consumption and smoking. The main objective was to investigate the association of both individual and clustering of health behaviors with HRQoL among the population with hematologic diseases based on a comprehensive lifestyle survey. METHODS A total of 539 patients with hematologic diseases aged over 18 years were enrolled in this cross-sectional study. Latent class analysis was used to identify homogeneous, mutually exclusive lifestyle classes, and multinomial logistic regression was then performed to explore the association of lifestyle classes membership with HRQoL. Meanwhile, multiple linear regression and quantile regression were used to identify the relationship between individual lifestyle behaviors and HRQoL. RESULTS A three-class model was selected based on conceptual interpretation and model fit. We found no association between multiple lifestyle behaviors and HRQoL in the 3-class model, either in the whole patients or in subgroups stratified by hematological malignancies. Further research on each lifestyle found that physical activity, dietary intake, occupational exposure, alcohol consumption or smoking were independent of HRQoL. Sleep quality was positively associated with HRQoL. CONCLUSION Our findings suggested that clustering of lifestyle behaviors may not be an indicator to reflect the health quality of patients with hematologic diseases. Sleep represents a viable intervention target that can confer health benefits on the hematologic patients.
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Gudauskaitė G, Kairienė I, Ivaškienė T, Rascon J, Mobasheri A. Therapeutic Perspectives for the Clinical Application of Umbilical Cord Hematopoietic and Mesenchymal Stem Cells: Overcoming Complications Arising After Allogeneic Hematopoietic Stem Cell Transplantation. Adv Exp Med Biol 2023; 1409:111-126. [PMID: 35995905 DOI: 10.1007/5584_2022_726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This review focuses on the therapeutic features of umbilical cord blood (UCB) cells as a source for allogeneic hematopoietic stem cell transplantation (aHSCT) in adult and child populations to treat malignant and nonmalignant hematologic diseases, genetic disorders, or pathologies of the immune system, when standard treatment (e.g., chemotherapy) is not effective or clinically contraindicated. In this article, we summarize the immunological properties and the advantages and disadvantages of using UCB stem cells and discuss a variety of treatment outcomes using different sources of stem cells from different donors both in adults and pediatric population. We also highlight the critical properties (total nucleated cell dose depending on HLA compatibility) of UCB cells that reach better survival rates, reveal the advantages of double versus single cord blood unit transplantation, and present recommendations from the most recent studies. Moreover, we summarize the mechanism of action and potential benefit of mesenchymal umbilical cord cells and indicate the most common posttransplantation complications.
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Affiliation(s)
- Greta Gudauskaitė
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ignė Kairienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Jelena Rascon
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ali Mobasheri
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liège, Belgium.
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Miranda CTDOF, Vermeulen-Serpa KM, Pedro ACC, Brandão-Neto J, Vale SHDL, Figueiredo MS. Zinc in sickle cell disease: A narrative review. J Trace Elem Med Biol 2022; 72:126980. [PMID: 35413496 DOI: 10.1016/j.jtemb.2022.126980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/07/2022]
Abstract
Sickle cell disease (SCD) is an inherited disease caused by hemoglobin S mutated hemoglobin S. It is characterized by chronic hemolysis, intermittent vaso-occlusive crises followed by ischemia-reperfusion, and organ damage. These patients have an increased risk of multiple micronutrient deficiencies, such as zinc. The reduced zinc bioavailability in sickle cell patients may lead to several complications such as growth retardation, delayed wound healing, increased vaso-occlusive crises, and infections. This narrative review aims to analyze the literature concerning the zinc status in SCD and their possible consequences on the patients' clinical evolution. We found in children and adolescents a direct association between zinc insufficiencies/deficiencies with increased disease severity in SCD. Monitoring zinc status in children and adolescent SCD appears essential for reducing disease-associated morbidity and infections. Zinc supplementation is a safe therapeutic modality for treating SCD patients. New research must be carried out, especially for adults, to ensure more remarkable survival for this population.
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Affiliation(s)
| | | | - Ana Carolina Cabañas Pedro
- Post-doctoral student Medicine Program (Hematology/Oncology), Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil.
| | - José Brandão-Neto
- Department of Internal Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | | | - Maria Stella Figueiredo
- Division of Hematology and Blood Transfusion, Department of Clinical and Experimental Oncology, Universidade Federal de Sao Paulo - UNIFESP, São Paulo, Brazil.
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Ahn H, Lee R, Cho SY, Lee DG. Advances in prophylaxis and treatment of invasive fungal infections: perspectives on hematologic diseases. Blood Res 2022; 57:101-111. [PMID: 35483934 PMCID: PMC9057668 DOI: 10.5045/br.2022.2022036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Invasive fungal infections (IFIs) are common causes of mortality and morbidity in patients with hematologic diseases. Delayed initiation of antifungal treatment is related to mortality. Aspergillus sp. is the leading cause of IFI followed by Candida sp. Diagnosis is often challenging owing to variable conditions related to underlying diseases. Clinical suspect and prompt management is important. Imaging, biopsy, and non-culture-based tests must be considered together. New diagnostic procedures have been improved, including antigen-based assays and molecular detection of fungal DNA. Among hematologic diseases, patients with acute myeloid leukemia, myelodysplastic syndrome, recipients of hematopoietic stem cell transplantation are at high risk for IFIs. Antifungal prophylaxis is recommended for these high-risk patients. There are continuous attempts to achieve ideal management of IFIs. Scoring system for quality control has been developed with important recommendations of current guidelines. Higher adherence to guidelines is related to decreased mortality in IFIs.
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Affiliation(s)
- Hyojin Ahn
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Moreno-Sanchez F, Gomez-Gomez B. Antibiotic Management of Patients with Hematologic Malignancies: From Prophylaxis to Unusual Infections. Curr Oncol Rep 2022. [PMID: 35316843 DOI: 10.1007/s11912-022-01226-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
Purpose of Review Patients with hematological malignancies are recognized for their high susceptibility and increased risk of developing infections associated with immunosuppression that can be caused by the infection itself or by the treatments that condition a decrease in the humoral and T lymphocyte response, so this review attempts to gather the main bacterial, viral, parasitic, and fungal agents that affect them and give recommendations for their approach and diagnosis. Recent Findings In recent years, with the discovery and use of new therapies including immunological and targeted treatments, it has been possible to improve the survival and response of patients with hematological malignancies; however, antimicrobial resistance has also increased; we have faced new and unknown microorganisms, such as the SARS-CoV-2 that caused the COVID-19 pandemic in the past year, and therefore, new risks and more severe infections are presented. Summary We present a review of the different circumstances where hematological malignancies increased the risk of infections and which microorganisms affect these patients, their characteristics, and the suggested prophylaxis.
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Hwang EJ, Kim S, Jung JY. Fully automated segmentation of lumbar bone marrow in sagittal, high-resolution T1-weighted magnetic resonance images using 2D U-NET. Comput Biol Med 2022; 140:105105. [PMID: 34864583 DOI: 10.1016/j.compbiomed.2021.105105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated a 2-dimensional (2D) U-Net model to delineate lumbar bone marrow (BM) using a high resolution T1-weighted magnetic resonance imaging. METHOD Healthy controls (n = 44, 836 images) and patients with hematologic diseases (n = 56, 1064 images) received MRI of the lumbar spines. Lumbar BM on each image was manually delineated by an experienced radiologist as a ground-truth. The 2D U-Net models were trained using a healthy lumbar BM only, diseased BM only, and using healthy and diseased BM combined, respectively. The models were validated using healthy and diseased subjects, separately. A repeated-measures analysis of variance was performed to compare segmentation accuracies with 2 validation cohorts among U-Net trained with healthy subjects (UNET_HC), U-Net trained with diseased subjects (UNET_HD), U-Net trained with all subjects including both healthy and diseased subjects (UNET_HCHD), and 3-dimensional Grow-Cut algorithm (3DGC). RESULTS When validated with the healthy subjects, UNET_HC, UNET_HD, UNET_HCHD and 3DGC achieved the mean and standard deviation of the Dice Similarity Coefficient (DSC) of 0.9415 ± 0.07056, 0.9583 ± 0.05146, 0.9602 ± 0.0486 and 0.9139 ± 0.2039, respectively. When validated with the diseased subjects, DSCs of UNET_HC, UNET_HD, UNET_HCHD and 3DGC were 0.8303 ± 0.1073, 0.9502 ± 0.0217, 0.9502 ± 0.0217 and 0.8886 ± 0.2179, respectively. The U-Net models segmented BM better than the semi-automatic 3DGC (P < 0.0001), and UNET_HD produced better results than UNET_HC (P < 0.0001). CONCLUSIONS We successfully constructed a fully automatic lumbar BM segmentation model for a high-resolution T1-weighted MRI using U-Net, which outperformed most of the previously reported approaches and the existing semi-automatic algorithm.
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Affiliation(s)
- Eo-Jin Hwang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sanghee Kim
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Cavestro C, Degan D, Micca G, Aloi R, Mandrino S, Frigeri MC, Pistoia F, Molinari F, Sacco S. Thrombophilic alterations, migraine, and vascular disease: results from a case-control study. Neurol Sci 2021; 42:3821-3828. [PMID: 33471261 DOI: 10.1007/s10072-020-05006-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The association between thrombophilic alterations, migraine, and vascular events has been broadly investigated but not been completely clarified. METHODS In this cross-sectional, case-control study, we included consecutive outpatients diagnosed with migraine referring to a tertiary headache center. Migraine patients were matched to headache-free control subjects. All participants were evaluated for free protein S anticoagulant, functional protein C anticoagulant, homocysteine, and antiphospholipid antibodies (aPLs). History of ischemic stroke (IS) or transient ischemic attack (TIA), coronary heart disease, and peripheral venous thrombosis was also ascertained. RESULTS We included 329 migraine patients and 329 control subjects (mean age 41 years, 77% women in both groups). Among migraine patients, 239 (72.6%) had migraine without aura and 90 (27.4%) had migraine with aura. Migraine patients had more frequently arterial hypertension, hypercholesterolemia, history of IS or TIA and, peripheral venous thrombosis compared to control subjects, whereas we found no differences in diabetes mellitus, BMI, and coronary heart disease between the two groups. At least one thrombophilic alteration was detected in 107 (32.5%) migraine patients and in 74 (22.5%) control subjects (OR = 1.66, 95% CI 1.17-2.35, p = 0.004). We identified an association of migraine with aPL positivity (OR = 2.6, 95% CI 1.5-4.7, p = 0.001) and with free protein S deficiency (OR = 4.7, 95% CI 1.6-14.0, p = 0.002), whereas we found no differences in protein C deficiency, APCR, and hyperhomocysteinemia between the two groups. Furthermore, aPL positivity and free protein S deficiency were more common in migraine patients with and without aura than in control subjects. We found that in migraine patients, aPL positivity was associated with both IS or TIA (OR = 5.6, 95% CI 1.5-20.4, p = 0.009) and with coronary heart disease (OR = 27.6, 95% CI 1.4-531.1, p = 0.028), whereas free protein S deficiency was associated with IS or TIA only (OR = 14.3, 95% CI 2.8-74.4, p = 0.002). CONCLUSIONS Our research documented a significative higher prevalence of aPL positivity and protein S deficiency in migraineurs than in controls. Data also showed an association between these alterations and some vascular thrombotic events in migraine patients. We can argue that thrombophilic disorders associated with migraine may contribute to the occurrence of vascular events.
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Affiliation(s)
- Cinzia Cavestro
- Headache Center, Department of Neurology, 'San Lazzaro' Hospital, ASL CN2, Alba, Italy.
| | - Diana Degan
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Gianmatteo Micca
- Main Laboratory and Hematology and Coagulation Disorders Laboratory, ASL CN2, Alba, Italy
- Main Laboratory and Hematology and Coagulation Disorders Laboratory, 'Santa Croce' Hospital, Cuneo, Italy
| | | | - Silvia Mandrino
- Headache Center, Department of Neurology, 'San Lazzaro' Hospital, ASL CN2, Alba, Italy
| | | | - Francesca Pistoia
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Filippo Molinari
- Main Laboratory and Hematology and Coagulation Disorders Laboratory, ASL CN2, Alba, Italy
| | - Simona Sacco
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Zhu L, Wang L, Zhang Y, Chen R, Li X, Sun J, Zhou D, Zhu M, Zheng X, Li L, Zhu J, Xie M, Yang X, Yu W, Tong H, Zhu H, Xie W, Jin J, Ye X. Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study. BMC Infect Dis 2021; 21:723. [PMID: 34332526 PMCID: PMC8325812 DOI: 10.1186/s12879-021-06420-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. Hemorrhagic pneumonia (adjusted HR 2.316, 95% CI 1.140–4.705; P = 0.020) was an independent risk factor of 30-day mortality in hematological patients with SM bacteremia. Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin (PCT). Multivariate analysis showed that neutropenia, high levels of PCT, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Neutropenia, high level of PCT and prior tigecycline therapy within 1 month were significant independent predictors of hemorrhagic pneumonia in hematologic patients with SM bacteremia. Due to no effective antibiotics to prevent hemorrhagic pneumonia, prophylaxis of SM infection and its progression to hemorrhagic pneumonia is particularly important.
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Affiliation(s)
- Lixia Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Lulu Wang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Yuping Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Rongrong Chen
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Xueying Li
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Jianai Sun
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - De Zhou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Mingyu Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Xiaolong Zheng
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Li Li
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Jingjing Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Mixue Xie
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Xiudi Yang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Wenjuan Yu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Honghu Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Wanzhuo Xie
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Xiujin Ye
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.
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Abstract
Radiographic changes of the oral and maxillofacial hard tissues can be an indication of an underlying systemic disease. In this article, the range of individual disease entities that have both systemic and dental manifestations are reviewed. Images for many conditions are provided to illustrate the radiographic changes. A summary of the most common jaw affected, radiographic and pathognomonic findings, and management aspects is listed in a table format within this article for quick reference.
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Affiliation(s)
- Eugene Ko
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Temitope Omolehinwa
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Sunday O Akintoye
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Mel Mupparapu
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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de Mello RAF, Mello MBN, Pessanha LB, Fonseca APA. Skeletal involvement in Gaucher disease: extent of bone disease, splenic volume, and quality of life. Radiol Bras 2021; 54:71-76. [PMID: 33854259 PMCID: PMC8029931 DOI: 10.1590/0100-3984.2020.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the correlations among the extent of bone involvement, splenic volume, and quality of life in patients with Gaucher disease. Materials and Methods This was a descriptive, prospective cross-sectional study of 18 patients with Gaucher disease who underwent 3-T magnetic resonance imaging of both femurs and the lumbar spine. Semiquantitative analyses were performed on the basis of the bone marrow burden (BMB) score. We looked for linear relationships among the variables splenic volume, quality of life score, and BMB score. Results We identified a linear relationship between the BMB scores and splenic volume. The quality of life score showed no statistically significant relationship with splenic volume or the BMB score. Conclusion The linear relationship between the BMB score and the splenic volume indicates that the extent of bone disease is greater in individuals with splenomegaly. No correlation was found between the BMB and quality of life scores, illustrating the insidious and silent progression of Gaucher disease.
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Affiliation(s)
| | | | - Laís Bastos Pessanha
- Department of Internal Medicine, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Ana Paula Alves Fonseca
- Department of Internal Medicine, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
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Fauer A, Choi SW, Wallner LP, Davis MA, Friese CR. Understanding quality and equity: patient experiences with care in older adults diagnosed with hematologic malignancies. Cancer Causes Control 2021; 32:379-389. [PMID: 33566250 PMCID: PMC7946754 DOI: 10.1007/s10552-021-01395-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oncology settings increasingly use patient experience data to evaluate clinical performance. Given that older patients with hematologic malignancies are a high-risk population, this study examined factors associated with patient-reported health care experiences during the first year of their cancer diagnosis. METHODS Cross-sectional study using the 2000-2015 SEER-CAHPS® data to examine patient experiences of Medicare enrollees with a primary diagnosis of leukemia or lymphoma. The primary outcomes were three CAHPS assessments: overall care, personal doctor, and health plan overall. We estimated case-mix adjusted and fully adjusted associations between factors (i.e., clinical and sociodemographic) and the CAHPS outcomes using bivariate statistical tests and multiple linear regression. RESULTS The final sample included 1,151 patients, with 431 diagnosed with leukemia and 720 diagnosed with lymphoma (median time from diagnosis to survey 6 months). Patients who completed the survey further apart from the diagnosis date reported significantly higher adjusted ratings of care overall (β .39, p = .008) than those closer to diagnosis. American Indian/Alaska Native, Asian, and Pacific Islander patients had lower adjusted ratings of care overall (β - .73, p = .003) than Non-Hispanic white patients. Multimorbidity was significantly associated with higher adjusted personal doctor ratings (β .26, p = .003). CONCLUSIONS Unfavorable patient experiences among older adults diagnosed with hematologic malignancies warrant targeted efforts to measure and improve care quality. Future measurement of experiences of cancer care soon after diagnosis, coupled with careful sampling of high-priority populations, will inform oncology leaders and clinicians on strategies to improve care for high-risk, high-cost populations.
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Affiliation(s)
- Alex Fauer
- School of Nursing, University of Michigan, 400 North Ingalls St., Ann Arbor, MI, 48109, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
| | - Sung Won Choi
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Lauren P Wallner
- Medical School, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Matthew A Davis
- School of Nursing, University of Michigan, 400 North Ingalls St., Ann Arbor, MI, 48109, USA
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Christopher R Friese
- School of Nursing, University of Michigan, 400 North Ingalls St., Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Fauer A, Wallner LP, Davis MA, Choi SW, Friese CR. Health care experiences for older adults diagnosed with leukemia and lymphoma: Factors associated with emergency department use, timeliness and access of health care. J Geriatr Oncol 2021; 12:250-255. [PMID: 32962952 PMCID: PMC7936946 DOI: 10.1016/j.jgo.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study examined the association of ED use in the first year of diagnosis and patient experiences in care among older adults with hematologic malignancies. MATERIALS AND METHODS Cross-sectional design using SEER-CAHPS® data from 2002 to 2015 to study Medicare fee-for-service enrollees with a primary diagnosis of leukemia or lymphoma. We linked the CAHPS survey data (patient-reported experiences with health services) to patients' cancer registry information and Medicare outpatient claims from the SEER-CAHPS resource. We estimated associations of ED use and clinical characteristics with two CAHPS outcomes - "getting care quickly" (timeliness) and "getting needed care" (access) - with bivariate and multivariate analyses. RESULTS The analytic sample included 751 patients, 125 of whom had an ED claim in the first year of cancer diagnosis. The most frequent ED diagnosis clusters were fever and infection (n = 17, 13.6%), orthopedic and injury (16, 12.8%) and pain (16, 12.8%). Significantly more enrollees with an ED claim were diagnosed with lymphoma (p < 0.01), lived in rural areas (p < 0.01), and lived in areas with many families living in poverty (p < 0.01). In adjusted models, enrollees with an ED claim reported significantly worse access to care (β - 4.83; 95%CI -9.29,-0.38; p = 0.03). CONCLUSION The management of urgent care concerns for adults with hematologic malignancies remains an important clinical and quality improvement imperative. Further study is warranted to enhance the management of emergent complications in older adults receiving care for hematologic malignancies, with efforts that enhance coordination of ambulatory oncology care.
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Affiliation(s)
- Alex Fauer
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America; University of Michigan, School of Public Health, Ann Arbor, MI, United States of America.
| | - Lauren P Wallner
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI, United States of America; University of Michigan, Medical School, Ann Arbor, MI, United States of America; University of Michigan, School of Public Health, Ann Arbor, MI, United States of America
| | - Matthew A Davis
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America
| | - Sung Won Choi
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI, United States of America; University of Michigan, Medical School, Ann Arbor, MI, United States of America
| | - Christopher R Friese
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America; University of Michigan, Rogel Cancer Center, Ann Arbor, MI, United States of America; University of Michigan, School of Public Health, Ann Arbor, MI, United States of America
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18
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Mori SI. [Changes in the diagnostic and treatment strategies of patients with hematological diseases during the COVID-19 pandemic with reference to recommendations from American Society of Hematology and European Hematology Association]. Rinsho Ketsueki 2021; 62:101-105. [PMID: 33678768 DOI: 10.11406/rinketsu.62.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The novel coronavirus (COVID-19) pandemic has affected all aspects of human life worldwide. Under this situation, the American Society of Hematology and European Hematology Association have provided resources and recommendations for the management of hematologic diseases during the COVID-19 pandemic. This review aims to summarize these recommendations and provide helpful, accurate, and up-to-date information for Japanese hematologists.
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Schiffer M, Kowalski A, Zhao J, Bewersdorf JP, Lewis RS, Zeidan AM. Fedratinib hydrochloride to treat intermediate-2 or high-risk primary or secondary myelofibrosis. Drugs Today (Barc) 2020; 56:755-768. [PMID: 33332482 DOI: 10.1358/dot.2020.56.12.3230206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fedratinib hydrochloride is a selective Janus kinase 2 (JAK2) inhibitor approved by the U.S. Food and Drug Administration (FDA) in August 2019 for intermediate- 2 or high-risk primary or secondary myelofibrosis. The approval of this novel oral agent was based on the phase II and III JAKARTA-2 and JAKARTA trials, which both showed significant reduction in splenomegaly and myelofibrosis symptom burden. The most common adverse effects associated with fedratinib include anemia, gastrointestinal symptoms and elevation in liver transaminases. Early clinical trial data was concerning for an increased incidence of Wernicke's encephalopathy (WE), which led the FDA to place a clinical hold on further drug development. However, upon further investigation it was determined that there was no clear evidence that fedratinib causes WE, and the clinical hold was lifted in 2017. This inclusive review provides insight into the pharmacology, safety and efficacy, and future direction of fedratinib use in myeloproliferative neoplasms.
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Affiliation(s)
- M Schiffer
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - A Kowalski
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - J Zhao
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - J P Bewersdorf
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R S Lewis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - A M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA.
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Rodrigues LCB, Guimaraes AF, de Oliveira IS, de Sousa PHM, de Castro Romanelli RM, Kakehasi FM, de Sá Rodrigues KE. Acute invasive fungal rhinosinusitis in pediatric patients with oncohematological diseases. Hematol Transfus Cell Ther 2020; 44:32-39. [PMID: 33288493 PMCID: PMC8885399 DOI: 10.1016/j.htct.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. Objectives The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. Methods This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. Results A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. Conclusion Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.
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Affiliation(s)
| | | | | | | | | | - Fabiana Maria Kakehasi
- Hospital das Clínicas da Universidade Federal Minas Gerais (HC UFMG), Belo Horizonte, MG, Brazil
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El Majzoub I, Cheaito RA, Cheaito MA, Bazarbachi A, Sweidan K, Sarieddine A, Al Chami F, Tamim H, El Cheikh J. Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center. Am J Emerg Med 2020; 46:295-302. [PMID: 33046319 DOI: 10.1016/j.ajem.2020.07.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality. OBJECTIVES This study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT. METHODS This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED. RESULTS Our study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015). CONCLUSION In our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.
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Affiliation(s)
- Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rola A Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Kinda Sweidan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Aseel Sarieddine
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Farouk Al Chami
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jean El Cheikh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Schop A, Stouten K, Riedl JA, van Houten RJ, Leening MJG, van Rosmalen J, Bindels PJE, Levin MD. A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices. BMC Fam Pract 2020; 21:167. [PMID: 32799818 PMCID: PMC7429725 DOI: 10.1186/s12875-020-01241-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Background To study etiologies of anemia using an extensive laboratory analysis in general practices. Method An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results. Results Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA. Conclusion Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.
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Affiliation(s)
- A Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands.
| | - K Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - J A Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - R J van Houten
- General practice van Houten, Hendrik-Ido-Ambacht, the Netherlands
| | - M J G Leening
- Departments of Epidemiology and Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M-D Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands
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Wei J, Zhu QL, Sun Z, Wang C. [The impact of carbapenem-resistance Pseudomonas aeruginosa infections on mortality of patients with hematological disorders]. Zhonghua Nei Ke Za Zhi 2020; 59:353-359. [PMID: 32370463 DOI: 10.3760/cma.j.cn112138-20191104-00728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the risk factors for mortality and clinical outcome of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections in patients with hematological disorders. Methods: The data of in-patients with hematological disorders infected by CRPA or carbapenem-susceptible Pseudomonas aeruginosa (CSPA) were recorded in a seven-year retrospective cohort study. Risk factors for CRPA infections and impact of on mortality were identified. The primary end point was 30-day all-cause mortality. Results: A total of 81 patients with PA infections were included in the study, including 58 CSPA and 23 CRPA. Most of the primary diseases were acute leukemia or lymphoma (79.0%, 64/81). The median absolute neutrophil count at infection onset was 0.24×10(9)/L. Independent risk factors associated with carbapenem-resistance included longer duration of hospital stay (P=0.013, OR=1.045) and carbapenem exposure one month prior to infections (P=0.005, OR=8.132). The 30-day all-cause mortality of the whole cohort was 29.6%(24/81), and 30-day attributable mortality was 13.6%(11/81). Pulmonary infection was the leading cause of death, accounting for 41.7%(10/24). The adjusted 30-day mortality rate was significantly higher in patients with CRPA compared with CSPA [60.9%(14/23) vs. 17.2%(10/58), P<0.001, respectively]. CRPA infection was an independent prognostic factor for 30-day mortality(P=0.011, OR=5.427). Other factors included old age, longer duration of neutropenia and poor functional performance. Conclusions: Patients with hematological disorders have high mortality rate and poor prognosis caused by CRPA infections, which mainly develop in lungs.
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Affiliation(s)
- J Wei
- Department of Hematology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
| | - Q L Zhu
- Department of Nosocomial Infection Control, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Z Sun
- Department of Nosocomial Infection Control, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - C Wang
- Department of Hematology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
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Abstract
Hepatitis E virus (HEV) is a significant health problem with approximately 20 million individuals infected annually. HEV infection has been associated with a wide spectrum of extrahepatic manifestations, including neurological, hematological and renal disorders. Guillain-Barré syndrome and neuralgic amyotrophy are the most frequent neurological manifestations. In addition, HEV infection has been observed with other neurological diseases, such as encephalitis, myelitis and Bell’s palsy. Hematologic manifestations include anemia due to glucose-6-phospate dehydrogonase deficiency, autoimmune hemolytic anemia and severe thrombocytopenia. Membranoproliferative glomerulonephritis and relapse IgA nephropathy with or without coexisting cryoglobulinemia appear to be the most common renal injuries related with HEV infection. Also, HEV infection has been associated with acute pancreatitis and other immune-mediated manifestations, such as arthritis and myocarditis. However, the pathophysiologic mechanisms of HEV-related extrahepatic manifestations are still largely unclear.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis V Mitselos
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina, School of Health Sciences, University of Ioannina, Ioannina, Greece
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25
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Weinberg OK, Kuo F, Hasserjian RP. Introduction. Am J Clin Pathol 2019; 152:254-257. [PMID: 31141600 DOI: 10.1093/ajcp/aqz047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olga K Weinberg
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - Frank Kuo
- Department of Pathology, UCLA, Los Angeles, CA
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AlEnazi A, Alhedaithy R, Alfayez A, Alghonaim Y. Acute profound sensorineural hearing loss as the initial manifestation of Hairy Cell Leukemia, Case Report and literature review. Int J Surg Case Rep 2019; 60:200-203. [PMID: 31295705 PMCID: PMC6616356 DOI: 10.1016/j.ijscr.2019.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Hematologic diseases are rarely present with sudden hearing loss as an initial symptom. Although the precise cause of sudden sensorineural hearing loss has not been identified, several pathophysiological mechanisms have been proposed. However, a variety of hematologic diseases are among the causes of sudden onset deafness. This article represents the first reported case of Hairy cell leukemia (HCL) which presented with acute unilateral profound sensorineural hearing loss as an inital mainfestation. PRESENTATION OF CASE A 41-year-old man presented with unilateral sudden hearing loss for one day's duration was found to have HCL during a worked up for his hearing loss. The disease worsened, and there was no improvement in his hearing. DISCUSSION Sudden sensorineural hearing loss can rarely be seen as a paraneoplastic occurrence.Very few cases have been reported in the literature. It has been reported as a presenting symptom of leukemia in numerous clinical and histopathological reports concerning the hearing loss in hematologic diseases. Our case is an example of such a rare incidence. CONCLUSION The purpose of this study is to draw physicians' attention to the possible association between acute sensorineural hearing loss to HCL, and to highlights permanent deafness as a complication secondary to HCL. Furthermore, it is important to increase awareness on early diagnosis and treatment that may improve treatment outcomes.
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Affiliation(s)
- Abdulaziz AlEnazi
- Department of Otorhinolaryngology - Head and Neck Surgery , Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia.
| | - Riyadh Alhedaithy
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrhman Alfayez
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yazeed Alghonaim
- King Saud Bin Abdulaziz University for Health Sciences, Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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Lee-Tsai YL, Luna-Santiago R, Demichelis-Gómez R, Ponce-de-León A, Ochoa-Hein E, Tamez-Torres KM, Bourlon MT, Bourlon C. Determining the risk factors associated with the development of Clostridium difficile infection in patients with hematological diseases. Blood Res 2019; 54:120-124. [PMID: 31309090 PMCID: PMC6614093 DOI: 10.5045/br.2019.54.2.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center. Methods We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively. Results Univariate analysis revealed that episodes of febrile eutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3-12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4-10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1-1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5-15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6-10.7; P=0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5-12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1-18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7-11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively. Conclusion The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.
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Affiliation(s)
- Yu Ling Lee-Tsai
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Luna-Santiago
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roberta Demichelis-Gómez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Department of Infectology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eric Ochoa-Hein
- Departament of Hospital Epidemiology and Quality Control of Medical Care, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Karla María Tamez-Torres
- Department of Infectology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María T Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Drößler L, Lehmann C, Töpelt K, Nierhoff D, Vehreschild JJ, Rybniker J, Hallek M, Fischer J, Stormberg V, Fätkenheuer G, Wieland U, Jung N. HBsAg-negative/anti-HBc-positive patients treated with rituximab: prophylaxis or monitoring to prevent hepatitis B reactivation? Infection 2019; 47:293-300. [PMID: 30689161 DOI: 10.1007/s15010-019-01271-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/16/2019] [Indexed: 12/30/2022]
Abstract
Rituximab (RTX) has been classified as a drug associated with a high risk for hepatitis B virus (HBV) reactivation in HbsAg-negative/anti-HBc-positive patients. However, data on frequency of HBV reactivation are limited especially for RTX monotherapy. Several new recommendations for screening, monitoring and prophylactic antiviral treatment have been published recently. Here, we report the real-life experience in the management and reactivation rate of HbsAg-negative/anti-HBc-positive patients treated with RTX with or without chemotherapy from a large cohort and discuss our results in the light of updated recommendations.
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Sotelo-Estévez JC, Souza-Gallardo LM, Kim-Koh MJ, Orellana-Parra JC. [Esplenectomía laparoscópica, una opción eficaz en un hospital de segundo nivel]. CIR CIR 2019; 87:23-27. [PMID: 30600809 DOI: 10.24875/ciru.18000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Laparoscopic splenectomy was reserved for selected cases, however and because of the improvement in surgical technique and laparoscopic instruments, nowadays, there are few contraindications. Method Retrospective and observational study of patients surgically treated of laparoscopic splenectomy secondary to hematologic diseases in a period span of 6 years. We analyzed demographic, preoperative, transoperative and postoperative variables. Results We studied eight patients, 62.5% were men with a mean age of 47.5 years. The most frequent hematologic diagnosis was idiopathic thrombocytopenic purpura (50%). The approach was laparoscopic in 100%. Median surgical time was 129.87 min and median transoperative bleeding was 396.25 cc. Median length of resected spleen was 15 cm. Median time for oral feeding was 20.62 h and total hospital stay was 4 days. There was only one reported complication. Conclusion Laparoscopic splenectomy represents a safe and feasible option with rapid recovery and few complications.
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Affiliation(s)
- Julio C Sotelo-Estévez
- Servicio de Cirugía General, Hospital General de Zona #32 Dr. Mario Madrazo Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luis M Souza-Gallardo
- Servicio de Cirugía General, Hospital General de Zona #32 Dr. Mario Madrazo Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Min J Kim-Koh
- Servicio de Cirugía General, Hospital General de Zona #32 Dr. Mario Madrazo Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan C Orellana-Parra
- Servicio de Cirugía General, Hospital General de Zona #32 Dr. Mario Madrazo Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
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30
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Liu W, Xue F, Liu XF, Jiang EL, Yang DL, Liu KQ, Xiao ZJ, Zhang FK, Feng SZ, Han MZ, Zhang L, Yang RC. [Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders]. Zhonghua Xue Ye Xue Za Zhi 2018; 38:410-414. [PMID: 28565741 PMCID: PMC7354194 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
目的 研究重组人凝血因子Ⅶa(rFⅦa)治疗血液病患者出血的疗效。 方法 回顾性分析rFⅦa治疗31例血液病患者共38次出血的临床资料。 结果 rFⅦa治疗获得性血友病A(AHA)/血友病伴抑制物、急性早幼粒细胞白血病(APL)、急性非APL白血病患者出血的总体有效率分别为90%(9/10)、71.4%(5/7)、60.0%(3/5),高于造血干细胞移植后患者(30.8%);rFⅦa治疗评分为2分出血的有效率(100.0%)高于3分(66.7%)及4分(51.6%)出血;5例次颅内出血中2例次(25.0%)有效;9例次血尿中6例次(66.7%)有效;12例次消化道出血中5例次(41.7%)有效。3例次关节及肌肉出血的疗效均为极好,5例次出血部位为皮肤、鼻黏膜、咽部及齿龈,疗效均为极好;移植后患者在出血评分为4分时,高剂量以及多次使用rFⅦa并不一定能取得好的疗效。AHA/血友病伴抑制物及急性白血病患者合并的出血,在评分为4分时,使用低剂量rFⅦa能取得好的疗效,但最低用药剂量(22.5 µg/kg)的疗效差。 结论 rFⅦa的止血疗效受疾病类型、出血部位以及严重程度等多个因素的影响。rFⅦa对AHA/血友病伴抑制物以及急性白血病患者的出血具有较好的疗效,但对移植后患者的出血疗效欠佳。出血早期使用rFⅦa对于疗效至关重要。在止血治疗的同时,应积极治疗基础疾病。
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Affiliation(s)
- W Liu
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Wang L, Gu ZY, Liu SF, Ma DX, Zhang C, Liu CJ, Gao R, Guan LX, Zhu CY, Wang FY, Gao CJ, Wei HP. Single- Versus Double-Unit Umbilical Cord Blood Transplantation for Hematologic Diseases: A Systematic Review. Transfus Med Rev 2019; 33:51-60. [PMID: 30482420 DOI: 10.1016/j.tmrv.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/11/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022]
Abstract
Controversial results exist regarding the clinical benefits of single- vs double-unit umbilical cord blood transplantation (UCBT) in patients with hematologic diseases. A systematic review was conducted to evaluate this issue. The PubMed, Embase, and Cochrane Library databases were searched up to May 2018. A total of 25 studies including 6571 recipients were identified. Although double-unit UCB contained higher doses of total nucleated cells and CD34+ cells, it offered no advantages over single-unit UCB in terms of hematologic recovery, including the rate and speed of neutrophil and platelet engraftment. Double-unit UCBT was associated with higher incidences of grades II-IV acute and extensive chronic graft-vs-host disease, accompanied by a lower relapse incidence, which may be attributed to a graft-vs-graft effect induced by double-unit UCB. However, transplant-related mortality, disease-free survival, and overall survival were comparable between single- and double-unit UCBT. Although double-unit UCBT confers no clinical advantages over single-unit UCBT, certain patients, such as those at high risk of relapse, might benefit from double-unit UCBT, a possibility that needs to be clarified in future randomized trials.
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Gravina AG, Zagari RM, De Musis C, Romano L, Loguercio C, Romano M. Helicobacter pylori and extragastric diseases: A review. World J Gastroenterol 2018; 24:3204-3221. [PMID: PMID: 30090002 PMCID: PMC6079286 DOI: 10.3748/wjg.v24.i29.3204] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/19/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is very common and affects approximately half of the world population. It causes gastric diseases, but some authors have reported an association of H. pylori infection with other systemic manifestations beginning in 1994. The list of potential effects of H. pylori outside the stomach includes a number of extragastric manifestations and we focused on neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases. This review discusses these important reported manifestations that are not related to the gastrointestinal tract.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Rocco Maurizio Zagari
- Dipertimento Di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna 40138, Italy
| | - Cristiana De Musis
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Lorenzo Romano
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Carmelina Loguercio
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Marco Romano
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
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Gomes AOF, Silva Junior A, Noce CW, Ferreira M, Maiolino A, Torres SR. The frequency of oral conditions detected in hematology inpatients. Hematol Transfus Cell Ther 2018; 40:240-244. [PMID: 30128432 PMCID: PMC6098180 DOI: 10.1016/j.htct.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/05/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. OBJECTIVE To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. METHODS Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. RESULTS Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. CONCLUSION This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.
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Affiliation(s)
| | | | - Cesar Werneck Noce
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marisa Ferreira
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Angelo Maiolino
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Dalfardi B. A man with generalized weakness. Eur J Intern Med 2018; 51:e7-e8. [PMID: 28693943 DOI: 10.1016/j.ejim.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Behnam Dalfardi
- Student Research Committee, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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35
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Narayan N, Rigby S, Carlucci F. Sulfasalazine induced immune thrombocytopenia in a patient with rheumatoid arthritis. Clin Rheumatol 2016; 36:477-479. [PMID: 27778097 PMCID: PMC5290041 DOI: 10.1007/s10067-016-3420-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/16/2016] [Indexed: 11/05/2022]
Abstract
Sulfasalazine has long been used for the treatment of rheumatoid arthritis and is often chosen as a first-line treatment. Here, we report a case of sulfasalazine-induced autoimmune thrombocytopenia and review the mechanisms behind drug-induced immune thrombocytopenia (DITP) and the approach to its diagnosis and management.
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Affiliation(s)
- Nehal Narayan
- Nuffield Orthopaedic Centre, Headington, Oxford, UK.
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Abstract
Chronic itch (CI) is a frequent and sometimes tormenting symptom in many skin and systemic diseases. In systemic diseases, it mostly appears on primarily unaffected skin. As a sequelae of intense scratching, secondary skin lesions such as excoriations, scars, and prurigo nodularis may occur. Due to the lack of valid pathogenetic concepts and good clinical trials, the therapy of CI remains mostly symptomatic. In Europe almost all drugs used to treat CI are not approved for this indication. CI is frequent in patients with chronic kidney diseases in advanced stages. Gabapentin and pregabalin, anticonvulsants, and centrally acting calcium channel blockers have been shown to exert a profound effect in CI. Furthermore, UVB phototherapy has been proven to attenuate pruritus in uremic patients. Randomized controlled studies have recently shown that nalfurafine, a κ-opioid receptor agonist, is able to ameliorate itch in patients with uremic itch. In patients suffering from cholestatic itch, the anion exchange resin colestyramine and rifampicin are effective antipruritic drugs. Furthermore, µ-opioid receptor antagonists and sertraline may be used to alleviate CI in hepatic diseases. In refractory cases, naso-biliary drainage or albumin dialysis are effective invasive procedures. For the treatment of chronic itch in hematological diseases no controlled trials have been performed so far. The mainstay in these cases is to treat the underlying disease.
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Affiliation(s)
- T Mettang
- DKD Helios Kliniken Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Deutschland.
| | - S Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - A E Kremer
- Medizinische Klinik 1 (Gastroenterologie, Pneumologie und Endokrinologie), Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
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Girard N, Brunel H, Dory-Lautrec P, Chabrol B. Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol 2016; 46:603-14. [PMID: 26718196 DOI: 10.1007/s00247-015-3509-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 09/24/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury.
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de Mello RAF, Mello MBN, Pessanha LB. Magnetic resonance imaging and BMB score in the evaluation of bone involvement in Gaucher's disease patients. Radiol Bras 2015; 48:216-9. [PMID: 26379319 PMCID: PMC4567359 DOI: 10.1590/0100-3984.2014.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/08/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate by magnetic resonance imaging changes in bone marrow of patients
undergoing treatment for type I Gaucher’s disease. Materials and Methods Descriptive, cross-sectional study of Gaucher’s disease patients submitted to 3 T
magnetic resonance imaging of femurs and lumbar spine. The images were blindly
reviewed and the findings were classified according to the semiquantitative bone
marrow burden (BMB) scoring system. Results All of the seven evaluated patients (three men and four women) presented signs of
bone marrow infiltration. Osteonecrosis of the femoral head was found in three
patients, Erlenmeyer flask deformity in five, and no patient had vertebral body
collapse. The mean BMB score was 11, ranging from 9 to 14. Conclusion Magnetic resonance imaging is currently the method of choice for assessing bone
involvement in Gaucher’s disease in adults due to its high sensitivity to detect
both focal and diffuse bone marrow changes, and the BMB score is a simplified
method for semiquantitative analysis, without depending on advanced sequences or
sophisticated hardware, allowing for the classification of the disease extent and
assisting in the treatment monitoring.
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Affiliation(s)
| | | | - Laís Bastos Pessanha
- MD, Resident in Radiology, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
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Kim TY, Jung JI, Kim YJ, Kim HW, Lee HG. CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review. Int J Cardiovasc Imaging 2015; 31 Suppl 2:159-67. [PMID: 25651878 DOI: 10.1007/s10554-015-0610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.
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Boada Burutaran M, Guadagna R, Grille S, Stevenazzi M, Guillermo C, Diaz L. Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay. Rev Bras Hematol Hemoter 2014; 37:28-33. [PMID: 25638764 PMCID: PMC4318844 DOI: 10.1016/j.bjhh.2014.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/09/2014] [Indexed: 12/03/2022] Open
Abstract
Background Febrile neutropenia is an important cause of mortality and morbidity in hematology–oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods A retrospective cohort study (2011–2012) was conducted of patients with high-risk neutropenia in a hematology–oncology service. Results Forty-four episodes of 17 patients with a median age of 48 years (range: 18–78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol.
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Affiliation(s)
| | | | - Sofia Grille
- Universidad de la República, Montevideo, Uruguay
| | | | | | - Lilian Diaz
- Universidad de la República, Montevideo, Uruguay
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Bracho-Blanchet E, Dávila-Pérez R, Zalles-Vidal C, Fernández-Portilla E, Ordorica-Chávez R, Nieto-Zermeño J. [Laparoscopic splenectomy in hematologic diseases in children. Analysis of 11-year experience]. Cir Pediatr 2014; 27:68-73. [PMID: 27775274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES A common indication for splenectomy in children is hematologic diseases. Indications, clinical course and complications of laparoscopic splenectomy are shown; factors associated with open conversion are analyzed. MATERIAL AND METHODS Retrospective, longitudinal, descriptive series of laparoscopic splenectomy during 11 years and its long-term follow-up. RESULTS We studied 88 laparoscopic splenectomies. Average age was 9 years and weight 30 kg. The indication was hemolytic anemia in 77% and thrombocytopenic purpura in 18%. Eleven percent was operated with severe thrombocytopenia and two patients urgently; cholecystectomy was done in 13%. The median surgical time was 180 minutes and bleeding 100 ml. Conversion rate was 5.7% mainly because of persistent bleeding, being risk bleeding greater than 300 ml and the need for red cell concentrate transfusion. The median length of stay was 3 days, longer in those affected by purpura. Three patients developed pneumonia and one, intra-abdominal abscess. Follow-up was 3.6 years average with two late complications. Treatment response was cure in 72%, improvement in 11.3% and failure in 6.8%. DISCUSSION It is feasible to operate patients under 5 years of age and patients with anemia or thrombocytopenia at the time of surgery without major problems. The conversion rate is low and risk factors for conversion are bleeding more than 300 ml and needing to transfuse erythrocyte concentrate.
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Affiliation(s)
- E Bracho-Blanchet
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
| | - R Dávila-Pérez
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
| | - C Zalles-Vidal
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
| | - E Fernández-Portilla
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
| | - R Ordorica-Chávez
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
| | - J Nieto-Zermeño
- Departamento de Cirugía General. Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F
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