Background: Urinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function.
Background: Small cell lung cancer is a neuroendocrine neoplasm representing about 15 percent of all lung cancers. Sarcoidosis is a multisystem granulomatous disease. The involvement of mediastinal lymph nodes is common in both and makes the diagnosis challenging when these conditions coexist. We report a rare case of a patient with history of sarcoidosis who was diagnosed with small cell lung cancer. Case presentation: 65-year-old African American female with history of sarcoidosis, who presented with right sided shoulder pain for two months. CT thorax showed right upper lobe nodule with mediastinal and bilateral hilar lymphadenopathy. FDG-PET scan showed increased uptake in the right upper lobe and in mediastinal and hilar lymph nodes. She subsequently underwent an EBUS with biopsies of multiple lymph node stations. Pathology of these lymph nodes revealed non-necrotizing granulomas without evidence of malignancy. She underwent a CT guided biopsy of the right upper lobe lesion and pathology was consistent with small cell carcinoma. It was unclear whether the enlarged and active mediastinal and hilar lymph nodes were related to sarcoidosis or small cell cancer. A multidisciplinary meeting was conducted and decided to treat the patient presumably as small cell cancer with nodal disease. She was given 2 cycles of carboplatin and etoposide. Follow-up CT thorax after the second cycle showed decrease in size of the nodule along with mediastinal and hilar lymph nodes. She also underwent radiation therapy including mediastinum in the field of radiation. Discussion: Sarcoid-like reactions have been noted either in the vicinity of the tumor or within the regional lymph nodes draining that particular tumor. This has been described in less than 1 percent of lung cancers and mostly in squamous cell lung cancers. True sarcoidosis may be confused with a sarcoid-like reaction in cancer patients. It was not possible to definitively differentiate if the nodal involvement was from sarcoidosis or small cell cancer metastasis or a sarcoid like reaction in our patient. Given the diagnostic dilemma, we treated her nodal involvement as small cell lung cancer metastasis since under treatment could lead to relapse and compromise survival.
Parvovirus B19 (PVB19) is a DNA virus which causes clinically relevant infection in renal transplant recipients (RTR) leading to significant morbidity. Manifestations include erythropoietin resistant anemia, proteinuria, and glomerulosclerosis in the allograft. Severe infection may require administration of intravenous immunoglobulin, reduction in immunosuppression and transfusions. The major challenge in managing and preventing the infection in RTR involves the act of balancing the decreased level of immunosuppression and the risk of rejection. The objective of this article is to understand the importance of PVB19 infection and its outcome in RTR. We reviewed the medical records of three RTR with confirmed PVB19 infection and recorded patient information including demographics, clinical and laboratory data, management, and outcome. The average time of occurrence of PVB19 infection as transplant was 8.6 weeks and they presented with symptomatic anemia. Elevated creatinine values were noted in two of them. Following treatment, anemia improved and creatinine values returned to baseline. One of them developed an early relapse and had to be treated once again similarly. We emphasize the importance of maintaining a high index of suspicion for PVB19 infection in patients with anemia in the posttransplant phase, especially in patients on higher doses of immunosuppressants. Early and proper treatment can prevent worsening clinical condition and possible effects on the allograft.
New approaches are needed for understanding and treating acute myeloid leukemia (AML). MicroRNAs (miRs) are important regulators of gene expression in all cells and disruption of their normal expression can lead to changes in phenotype of a cell, in particular the emergence of a leukemic clone. We collected peripheral blood samples from 10 adult patients with newly diagnosed AML, prior to induction chemotherapy, and 9 controls. Two and a half ml of whole blood was collected in Paxgene RNA tubes. MiRNA was purified using RNeasy mini column (Qiagen). We sequenced approximately 1000 miRs from each of 10 AML patients and 9 controls. In subset analysis, patients with NPM1 and FLT3 mutations showed the greatest number of miRNAs (63) with expression levels that differed from control with adjusted p-value of 0.05 or less. Some of these miRs have been described previously in association with leukemia, but many are new. Our approach of global sequencing of miRs as opposed to microarray analysis removes the bias regarding which miRs to assay and has demonstrated discovery of new associations of miRs with AML. Another strength of our approach is that sequencing miRs is specific for the 5p or 3p strand of the gene, greatly narrowing the proposed target genes to study further. Our study provides new information about the molecular changes that lead to evolution of the leukemic clone and offers new possibilities for monitoring relapse and developing new treatment strategies.
BackgroundUrinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function.MethodsWe reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed.ResultsFive patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction.ConclusionRTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.
Several classifications systems have been developed to predict outcomes of kidney transplantation based on donor variables. This study aims to identify kidney transplant recipient variables that would predict graft outcome irrespective of donor characteristics. All U.S. kidney transplant recipients between October 25,1999 and January 1, 2007 were reviewed. Cox proportional hazards regression was used to model time until graft failure. Death-censored and nondeath-censored graft survival models were generated for recipients of live and deceased donor organs. Recipient age, gender, body mass index (BMI), presence of cardiac risk factors, peripheral vascular disease, pulmonary disease, diabetes, cerebrovascular disease, history of malignancy, hepatitis B core antibody, hepatitis C infection, dialysis status, panel-reactive antibodies (PRA), geographic region, educational level, and prior kidney transplant were evaluated in all kidney transplant recipients. Among the 88,284 adult transplant recipients the following groups had increased risk of graft failure: younger and older recipients, increasing PRA (hazard ratio [HR],1.03?1.06], increasing BMI (HR, 1.04?1.62), previous kidney transplant (HR, 1.17?1.26), dialysis at the time of transplantation (HR, 1.39?1.51), hepatitis C infection (HR, 1.41?1.63), and educational level (HR, 1.05?1.42). Predictive criteria based on recipient characteristics could guide organ allocation, risk stratification, and patient expectations in planning kidney transplantation.
COVID-19 (coronavirus disease-19) is associated with an increased risk for thrombosis due to endothelial dysfunction and hyperactivation of the immune system induced by the virus. Most cases of venous thromboembolism associated with COVID-19 are either pulmonary emboli or deep vein thromboses. Ovarian vein thrombosis is a rare condition most commonly seen in the postpartum period. This report describes a case of COVID-19-associated ovarian vein thrombosis in a nonpregnant woman with no evidence of underlying inherited coagulopathy.
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