No abstract

Post-transplant diabetes mellitus (PTDM) is associated with a higher risk of adverse outcomes. We aimed to describe the proportion of patients with diabetes prior to solid organ transplantation (SOT) and post-transplant diabetes mellitus (PTDM) in three time periods (early-likely PTDM: 0–45 days; 46–365 days and >365 days) post-transplant and to estimate possible risk factors associated with PTDM in each time-period. Additionally, we compared the risk of death and causes of death in patients with diabetes prior to transplant, PTDM, and non-diabetes patients. A total of 959 SOT recipients (heart, lung, liver, and kidney) transplanted at University Hospital of Copenhagen between 2010 and 2015 were included. The highest PTDM incidence was observed at 46–365 days after transplant in all SOT recipients. Age and the Charlson Comorbidity Index (CCI Score) in all time periods were the two most important risk factors for PTDM. Compared to non-diabetes patients, SOT recipients with pre-transplant diabetes and PTDM patients had a higher risk of all-cause mortality death (aHR: 1.77, 95% CI: 1.16–2.69 and aHR: 1.89, 95% CI: 1.17–3.06 respectively). Pre-transplant diabetes and PTDM patients had a higher risk of death due to cardiovascular diseases and cancer, respectively, when compared to non-diabetes patients.

Purpose: Organ-at-risk contouring is still a bottleneck in radiotherapy,with many deep learning methods falling short of promised results when evaluated on clinical data. We investigate the accuracy and time-savings resulting from the use of an interactive-machine-learning method for an organ-at-risk contouring task. Methods:We implement an open-source interactive-machine-learning software application that facilitates corrective-annotation for deep-learning generated contours on X-ray CT images. A trained-physician contoured 933 hearts using our software by delineating the first image, starting model training, and then correcting the model predictions for all subsequent images. These corrections were added into the training data, which was used for continuously training the assisting model. From the 933 hearts, the same physician also contoured the first 10 and last 10 in Eclipse (Varian) to enable comparison in terms of accuracy and duration. Results: We find strong agreement with manual delineations, with a dice score of 0.95. The annotations created using corrective-annotation also take less time to create as more images are annotated, resulting in substantial time savings compared to manual methods. After 923 images had been delineated, hearts took 2 min and 2 s to delineate on average, which includes time to evaluate the initial model prediction and assign the needed corrections, compared to 7 min and 1 s when delineating manually. Conclusions: Our experiment demonstrates that interactive-machine-learning with corrective-annotation provides a fast and accessible way for non computerscientists to train deep-learning models to segment their own structures of interest as part of routine clinical workflows.

No abstract

Se presenta el caso de un varón de cuatro años y medio con toxocariosis atípica, procedente de La Matanza, Morropón, Piura. El paciente presentó síntomas inespecíficos durante nueve días; la sospecha de toxocariosis derivó del hallazgo de eosinofilia periférica marcada (15% ó 1470 células/µL) en el hemograma. El diagnóstico se confirmó por serología mediante el método de enzimoinmunoanálisis (ELISA) demostrando la presencia de anticuerpos anti-Toxocara de tipo IgG, así como de tipo IgM. El cuadro se autolimitó antes de que el paciente recibiera tratamiento con albendazol 15mg/ kg/día durante cinco días.

No abstract

We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patient had non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cell blood count (15% or 1470 cells/μL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.

Background Cancer treatments suppress immune function and are associated with increased risk of infections, but the overall burden of serious infectious diseases in treated patients has not been clearly elucidated. Methods All patients treated for solid malignant tumours with curative intent radiotherapy (RT) and/or standard first line chemotherapy (C) at the Department of Oncology at Rigshospitalet between 01/1/2010 to 31/12/2016 were included. Patients were followed from treatment initiation to new cancer treatment, end of follow up or death whichever came first. We calculated incidence rates (IR) of positive blood culture (PBC) per 1000 person years follow up using Kaplan-Meier methods, and examined the proportion who died within 30 days of PBC. Results 13,275 individuals were included, 4,372 (33%), 6,349 (48%), and 2,554 (19%) treated with RT, C, or concomitant RT&C, respectively, contributing 21,493 person years follow-up. 6,930 (52%) were female, the median (IQR) age was 63 (53, 70), and the most common cancer diagnoses were breast (n = 2,593 [19%]), colorectal (n=1,422 [11%]), and stomach (n=1,246 [9%]). Overall, 564 individuals (4%) experienced 746 unique episodes of PBC, 188, 408, and 150 events in 143, 311 and 110 individuals treated with RT, C, and RT&C, of which 49 (26%), 104 (25%), 38 (25%) died within 30 days of PBC, respectively. IR of PBC significantly varied by treatment: 13.0 (95% confidence interval 11.1, 15.4), 43.9 (39.3, 49.0) and 32.0 (26.5, 38.5) per 1000 person-years follow up in the RT, C and RT&C groups, respectively (IR ratio = 3.36 (2.75, 4.10) and 2.45 (1.91, 3.14) for C and RT&C compared to RT, respectively) and time since treatment (figure). Escherichia coli (n=185, 25%), Staphylococcus aureus (n=102, 14%), Klebsiella pneumoniae (n=76, 10%), Enterococcus faecium (n=48, 6%), and Enterococcus faecalis (n= 37, 5%) were the top 5 microorganisms identified and did not vary by treatment category, p = 0.11, there were 31 (4%) cases of Candida. Incidence rate of positive blood culture (PBC) by time since treatment initiation (0–3 months, 0–6 months and >6 months) and the proportion who died within 30 days of PBC by treatment type among individuals treated for solid malignant tumours with radiotherapy [RT], chemotherapy [C] and concomitant RT&C at Department of Oncology at Rigshospitalet, University of Copenhagen between 01/1//2010 to 31/12/2016. Conclusion PBCs are seen more often within 3 – 6 months after C than after RT alone. PBCs are not common, but when they occur, mortality is high. More precise risk factors for PBC and prophylactic means and empiric treatments in selected high-risk patients should be investigated. Disclosures All Authors: No reported disclosures