Outcomes of children,adolescents, and young adults following allogeneic stem cell transplantation for secondary acute myeloid leukemia and myelodysplastic syndromes—The MD Anderson Cancer Center experience

We conducted a retrospective analysis of outcomes for children and young adults with sAML/sMDS who underwent HSCT at our institution. Thirty‐two patients (median age 20 years) with sAML (n=24) and sMDS (n=8) received HSCT between 1990 and 2013. The median time from sAML/sMDS diagnosis to HSCT was 4.1 months (range: 1.2‐27.2 months). The transplant regimens were primarily busulfan based (n=19). BM was the primary donor source (n=15). Eleven recipients were transplanted with residual disease. At a median follow‐up of 62.3 months (range: 0.4‐250.9 months), 14 patients had disease recurrence. Acute GVHD, grade III/IV, occurred in three patients. Causes of death were as follows: disease relapse (n=12), infection (n=2), pneumonia (n=1), pulmonary hemorrhage (n=1), acute GVHD (n=1), and graft failure (n=1). A PS of ≥90% at the time of HSCT had a significant impact on PFS (P=.02). Patients achieving pretransplant primary CR (n=8) and those with sMDS and RA (n=6) had prolonged PFS (P=.04). On multivariate analysis, shorter time to transplantation (≤6 months from diagnosis of sAML/sMDS) was associated with superior OS (P=.0018) and PFS (P=.0005).     

Accounting for Intimate Partner Violence in the Treatment of Substance Use Disorders: Staff and Agency Readiness for Screening and Referral

Intimate partner violence (IPV) represents a serious threat to initiating and sustaining recovery from substance use disorder (SUD), but early research has demonstrated that addiction counselors may not systematically screen and refer victims and perpetrators of IPV for services, that addiction treatment programs may not provide systematic policies about IPV screening, and that practitioners and agencies may not formally engage IPV agencies in the community. The current study utilizes formative evaluation data from 294 addiction professionals in four states to quantify practitioner IPV screening practices, agency support of IPV screening, and agency engagement with community-based IPV providers. Results suggest that individual practitioners engage in relatively high levels of IPV screening behavior, but neither agencies nor practitioners are engaging IPV providers in sufficient numbers to make robust referrals for IPV services. The authors conclude with policy and practice recommendations for improving links between SUD and IPV agencies to enhance the opportunities for SUD recovery and the safety of IPV victims.     

Accuracy of cytologic diagnosis of central nervous system tumours in crush preparation

The aim of this study was to assess the usefulness and accuracy of cytologic smears by making crush preparation as a diagnostic method, in central nervous system tumors. 278 patients with central nervous system tumors were investigated. In 98 cases, material was obtained intraoperatively during craniotomy and in 180 cases stereotactic biopsies were done. In all the cases crush preparations were made, and cytologic diagnosis was correlated with final histologic diagnosis. 244 out of 278 patients showed correlation with histopathological diagnosis. So, in present study diagnostic accuracy was 87.76%. In 18 cases no definite diagnosis was made due to inadequate material. Majority of the patients were in age group 31 to 40 years (72 cases). The youngest patient was three years old and the eldest was 87 years old. The most common tumor in intracranial cavity was astrocytoma (56.68%), followed by meningioma (6.88%), medulloblastoma (5.66%) and ependymoma (5.56%). The most common tumor in intraspinal cavity was ependymoma (38.46%), followed by meningioma (23.07%) and schwannoma (23.07%). In conclusion, crush preparation is an effective, simple, rapid, relatively safe and reliable technique for the diagnosis of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 87.76%.     

A cephalometric study to investigate the skeletal relationships in patients with increasing severity of hypodontia

Objectives:To determine the skeletal relationships in patients with hypodontia and analyze the effects of severity and pattern.Materials and Methods:Pretreatment lateral cephalograms from 277 patients with hypodontia, categorized by the number of missing teeth as mild (1–2), moderate (3–5), or severe (≥6), were digitized recording angular measurements and ratios and compared with published norms matched for age and gender. Pattern was determined as mandibular, maxillary, bimaxillary, bilateral, anterior, posterior, and anteroposterior. Linear regression models assessed relationships between number of missing teeth and cephalometric parameters, controlling for the pattern of hypodontia.Results:For every additional missing tooth, SNA, SNB, and ANB decreased 0.3°, 0.1°, and 0.2°, respectively; this was clinically significant for >4, >10, and >5 missing teeth, respectively. Mandibular to cranial base ratio decreased 0.3% for every additional missing tooth; this was clinically significant for >10 missing teeth. The MMPA decreased 0.3° for every additional missing tooth; this was clinically significant for >7 missing teeth. Percentage LAFH decreased 0.2% for every additional missing tooth; this was significant for >7 missing teeth. Jarabak ratio increased 0.2% for each additional missing tooth; this was clinically significant for >10 missing teeth. Anterior hypodontia significantly decreased most cephalometric parameters.Conclusions:Patients with hypodontia demonstrated a tendency toward a Class III relationship, caused by decreased maxillary and mandibular angular prognathism and MnCB ratio, though the effect was greater on the maxilla than the mandible. Clinical significance was only associated with severe hypodontia. Vertically, there was a tendency toward decreased MMPA and %LAFH; this was clinically relevant only with severe hypodontia. Anterior hypodontia had a significant effect on skeletal relationship.     

D-penicillamine Induced Degenerative Dermopathy

D-penicillamine interferes with elastin and collagen metabolism and produces several cutaneous and multi-systemic side-effects. We present two cases of Wilson''s disease who on long-term penicillamine therapy developed drug-induced degenerative dermopathy manifesting as skin fragility over pressure sites and cutis laxa-like changes.     

Synthetic modifications of the immunomodulating peptide thymopentin to confer anti-mycobacterial activity

Effective global control of tuberculosis (TB) is increasingly threatened by the convergence of multidrug-resistant TB and the human immunodeficiency virus (HIV) infection. TB/HIV coinfections exert a tremendous burden on the host's immune system, and this has prompted the clinical use of immunomodulators to enhance host defences as an alternative therapeutic strategy. In this study, we modified the clinically used synthetic immunomodulatory pentapeptide, thymopentin (TP-5, RKDVY), with six arginine residues (RR-6, RRRRRR) at the N- and C-termini to obtain the cationic peptides, RR-11 (RKDVYRRRRRR-NH₂) and RY-11 (RRRRRRRKDVY-NH₂), respectively. The arginine residues conferred anti-mycobacterial activity to TP-5 in the peptides as shown by effective minimum inhibitory concentrations of 125 mg/L and killing efficiencies of >99.99% against both rifampicin-susceptible and -resistant Mycobacterium smegmatis. The immunomodulatory action of the peptides remained unaffected as shown by their ability to stimulate TNF-α production in RAW 264.7 mouse macrophage cells. A distinct change in surface morphology after peptide treatment was observed in scanning electron micrographs, while confocal microscopy and dye leakage studies suggested bacterial membrane disruption by the modified peptides. The modified peptides were non-toxic and did not cause hemolysis of rat red blood cells up to a concentration of 2000 mg/L. Moreover, RY-11 showed synergism with rifampicin and reduced the effective concentration of rifampicin, while preventing the induction of rifampicin resistance. The synthetic peptides may have a potential application in both immunocompetent and immunocompromised TB patients.     

Tuberculous fistulas of the pharynx and esophagus

Four patients with tuberculous fistulas communicating with the pharynx or the esophagus are reported. In 1 patient, there was strong evidence to suggest primary involvement of the esophageal mucosa. The other 3 cases were related to involvement of the pharynx or the esophagus from adjacent tuberculous process, as confirmed by histopathological proof.The patients had varying degrees of symptoms, which in two dramatically responded to antituberculous therapy; the third patient needed surgery for complete cure and the last patient was lost to follow-up.