Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Background: Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting. Methods: We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct. Results: We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99). Conclusions: Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

Defining acute renal dysfunction as a criterion for the severity of Clostridium difficile infection in patients with community-onset vs hospital-onset infection.

BACKGROUND: Acute renal dysfunction can be used to define severe Clostridium difficile infection (CDI). The Society for Healthcare Epidemiology of America (SHEA) and Infectious Disease Society of America (IDSA) guidelines define acute renal dysfunction as serum creatinine (SrCr) ≥1.5 times the premorbid level. AIM: To determine the ability to assess premorbid SrCr in hospitalized patients with CDI, stratified into community-onset CDI (CO-CDI) and hospital-onset CDI (HO-CDI); and to evaluate differing definitions for premorbid SrCr as a criterion for acute renal dysfunction. METHODS: Hospitalized patients with CDI were stratified into CO-CDI and HO-CDI. The ability to assess premorbid SrCr was determined, and the incidence of acute renal dysfunction and the severity of CDI were compared using varying definitions of premorbid SrCr. FINDINGS: In total, 293 patients with CDI were evaluated; of these, 135 (46%) had CO-CDI and 158 (54%) had HO-CDI. Premorbid SrCr data were not available for 37 (27%) patients with CO-CDI and one (<1%) patient with HO-CDI (P < 0.0001). Depending on the definition of premorbid SrCr used, acute renal dysfunction ranged from 17% to 24% for patients with CO-CDI (P = 0.26), and from 13% to 14% for HO-CDI (P = 0.81). The severity of CDI could not be determined for 43 out of 293 (15%) patients, primarily due to the lack of premorbid SrCr data (N = 38). CONCLUSION: Assessment of acute renal dysfunction and the severity of CDI was not possible for many patients with CO-CDI using the current SHEA/IDSA guidelines. Given the increasing incidence of CO-CDI, an alternative definition of acute renal dysfunction may be required.

Velocity of an electric-field-induced synclinic solitary wave invading the anticlinic liquid crystal phase.

The electric-field dependence of the velocity of synclinic fingers invading the anticlinic phase is determined by a time-of-flight technique. The time delay for a rapid increase in the transmitted optical intensity through the sample is measured between two points as a function of their separation along the trajectory of the solitary wave. The data are quantitatively consistent with the rapid velocities deduced from a previous measurement [Liq. Cryst. 27, 249 (2000)], demonstrating that the previous data were not affected by multiple nucleation sites occurring at higher fields.

Krypton laser photocoagulation of peripapillary choroidal neovascular membrane.

The Macular Photocoagulation Study criteria require that at least 1.5 clock hours of temporal peripapillary retina be spared when treating choroidal neovascular membrane in that location. The authors successfully treated peripapillary choroidal neovascular membrane involving temporal 180 degrees with the krypton laser without any loss of visual acuity and central field.

Choroidal neovascular membrane.

Choroidal neovascular membrane in the macular area is one of the leading causes of severe visual loss. Usually a manifestation in elderly population, it is often associated with age-related macular degeneration. The current mainstay of management is early diagnosis, usually by fundus examination, aided by angiography and photocoagulation in selected cases. Various other modalities of treatment including surgery are being considered as alternate options, but with limited success. The purpose of this review is to briefly outline the current concepts and the management strategy from a clinician's viewpoint.

Experimental transplantation of human retinal pigment epithelial cells on collagen substrates.

We studied the use of human retinal pigment epithelial cells cultured on a collagen support as a potential transplantation therapy to replace diseased or damaged retinal pigment epithelium. Using a transvitreal approach, we transplanted human retinal pigment epithelial cells attached to either a sheet of noncross-linked or cross-linked type I collagen into the subretinal space of New Zealand white rabbits, whose eyes lack pigment. Animals were killed after six weeks, and the eyes were fixed for light microscopy. The results demonstrated that, in eyes receiving the noncross-linked collagen support, a layer of pigmented donor retinal pigment epithelium was visible within the subretinal space, with a normal-appearing retina and no evidence of proliferative vitreoretinopathy or graft rejection. We believe this method may be applicable to replace dysfunctional retinal pigment epithelial cells in humans.

What ails the present medical care?

In spite of the vast amount of medical data at our disposal, there are limitations and drawbacks of medical care. This is due to the defective medical knowledge - the restricted narrow concepts of human being, illness, etiology and treatment. This has resulted in undue emphasis on physical aspect of human existence ignoring the mental and spiritual aspects in understanding the illness and treating them. There isa) Unnecessary medicalisation while the other methods of treatment remain underused.b) Only symptomatic relief, rather than a cure by removal of the cause, with likelihood of recurrence or syndrome shift.c) Incompleteness of treatment which tackles only the external cause without rectifying the inherent susceptibility leaving the possibility of recurrence.d) Overspecialization and unnecessary referrals, and non-individualisation of treatment causing avoidable side-effects.

Totalistic and integrated approach to health - a proposal.

In an earlier article the authors had traced the defects in medical practice to the flaws in the medical knowledge. In the present paper they propose a plan for the rectification of these defects.As the current medical research is unsuited for this purpose there is a need to adopt an alternative method of research, consisting of three phases viz.a) Formulation of hypothesisb) Development of tools of assessment andc) Experimental verification of the hypothesis using the instruments of assessment.This method must be used to revise the concepts of human being, illness, etiology and treatment. The first topic that must be taken up for such consideration is the concept of human being. An outline of the various constituents of human being is given. Also the factors that account for individual difference s among human beings, are enumerated. Subsequent research aimed at revision of concepts of illness, etiology and treatment should be based upon such a totalistic and integrated concept of human being.

Need for an integrated system of medicine-a proposal for its attainment.

Integration of various systems of medicine is in the best interest of all concerned. It enables the physician to provide the best available therapeutic care to the patient without undue delay, making way for a better prognosis. It also makes available to him a greater variety of treatment measures hitherto restricted to one or the other system. Integration must be achieved at the theoretical level first by pooling together the facts available in the existing systems. From this pooled data must be formulated newer integrated concepts of human being, illness, etiology and treatment. It is not difficult to achieve such integrations for their already exist certain similarities among the prevalent systems of medicine. This will help to translate ancient wisdom into practice and find proper orientation to modern discoveries. Therefore the adherents of various systems must sink their differences and strive to develop an integrated system of medicineThe entire world is the teacher to the intelligent and the foe to the unintelligent. Caraka Vimana 8/14.