Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab-Challenging Recognition and Treatment.

A Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) led to a pandemic outbreak in 2019. COVID-19's course and its treatment in immunocompromised patients are uncertain. Furthermore, there is a possibility of protracted SARS-CoV-2 infection and the need for repeated antiviral treatment. Monoclonal antibodies against CD20, which are used, among other things, in the therapy of chronic lymphocytic leukaemia and follicular lymphoma, can induct immunosuppression. We present a case report of a patient with follicular lymphoma, treated with obinutuzumab, who was diagnosed with prolonged, ongoing SARS-CoV-2 infection and related organizing pneumonia. The recognition and the treatment were challenging which makes this case noteworthy. Antiviral therapy with several medications was administrated to our patient and their temporary, positive effect was observed. Moreover, high-dose intravenous immunoglobulin was applied, because slowly decreasing IgM and IgG levels were observed. The patient also received standard treatment of organizing pneumonia. We believe that such a complex approach can create an opportunity for recovery. Physicians should be conscious of the course and treatment possibilities facing similar cases.

Patterns of relapse in large-cell lymphoma patients with bulk disease: implications for the use of adjuvant radiation therapy.

In patients with large-cell lymphoma (LCL) treated with combination chemotherapy, the presence of bulk disease has consistently been associated with a poorer response rate and a shortened survival. The optimal therapy for patients with bulk disease (greater than or equal to 10 cm) will depend on whether treatment failures result from inadequate tumor eradication in prior bulk sites or from distant dissemination. To address this issue, we have evaluated patterns of relapse in patients with bulk disease who relapsed after achieving a complete remission with methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (M- or m-BACOD). Eighty-one II, III, or IV patients with disease greater than or equal to 10 cm were identified; 45 of the 81 patients achieved a confirmed complete response (CR) and are included in the analysis. The 45 complete responders included 21 patients with localized (stage II) disease and 24 patients with advanced (stage III/IV) disease. Six of the 21 stage II complete responders and three of the 24 stage II/IV complete responders also received adjuvant radiation therapy following completion of M- or m-BACOD. Only one of the 21 patients with stage II disease relapsed, doing so in the site of prior bulk involvement. In contrast, nine of 24 patients with stage III/IV disease relapsed, although no patient failed solely in the site of prior bulk disease. Stage III/IV patients recurred in either a new site (one patient), a new and old site (five), an old non-bulk site (two), or both old non-bulk and bulk sites (one). These results indicate that advanced-stage bulk-disease patients do not consistently relapse in sites of prior bulk disease; therefore, this group of patients is unlikely to benefit from adjuvant radiation therapy administered following completion of combination chemotherapy. Although the low relapse rate and the addition of adjuvant radiation therapy in a subgroup of the stage II bulk-disease patients precludes a definitive analysis, our results further suggest that these patients may be effectively treated with combination chemotherapy alone.

The m-BACOD combination chemotherapy regimen in large-cell lymphoma: analysis of the completed trial and comparison with the M-BACOD regimen.

One hundred thirty-four assessable patients with stage II-IV large-cell lymphoma (LCL) were treated with the combination chemotherapy regimen methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) between July 1981 and May 1986. The m-BACOD regimen substituted moderate-dose methotrexate (200 mg/m2 x 2) for the high-dose methotrexate used in the preceding M-BACOD regimen; all other drugs were administered as with m-BACOD. Eighty-two patients (61%) in the completed m-BACOD trial achieved a complete response (CR). With a median follow-up of 3.6 years, 62 patients (76%) continue in CR. Predicted survivals of 1, 3, and 5 years for the entire m-BACOD group are 80%, 63%, and 60%, respectively, with a 5-year disease-free survival (DFS) of 74% for the patients who achieve CR. The results obtained with m-BACOD are comparable with those obtained in the preceding M-BACOD trial, which now has a median follow-up of 8.0 years. The reduction in methotrexate dosage in m-BACOD patients was not associated with an increased incidence of CNS relapse. Long-term follow-up of the 215 M/m-BACOD patients indicates that the regimens are not associated with an increased incidence of secondary malignancy. Prolonged follow-up also indicates that advanced-stage patients have a persistent rate of late relapse of about 7.0% per year for years 2 to 5 of their follow-up and that stage II patients have an approximate 2.1% per year rate of late relapse. Application of the previously described prognostic factor model to the 215 M/m-BACOD patients from the completed trials identifies a high-risk group of patients with a CR rate and predicted 5-year survival (38% and 24%, respectively) that are significantly worse than those of the group as a whole (65% and 57%, respectively).

The m-BACOD combination chemotherapy regimen in the treatment of diffuse large cell lymphoma.

The m-BACOD regimen attempted to lower the dose of methotrexate in the M-BACOD (methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone) program. Between July 1981 and January 1985, 87 previously untreated or minimally treated patients with diffuse large cell lymphoma were treated with the m-BACOD regimen (methotrexate 200 mg/m2 on days 8 and 15, bleomycin 4.0 mg/m2 on day 1, doxorubicin 45 mg/m2 on day 1, cyclophosphamide 600 mg/m2 on day 1, vincristine 1.0 mg/m2 on day 1, and dexamethasone 6 mg/m2 on days 1 to 5; leucovorin was given 24 hours after methotrexate at 10 mg/m2 every six hours for eight doses orally). Of 86 evaluable patients, 59 (68.5%) had a complete remission (CR). Partial response was seen in 21 patients with six still surviving (5 to over 15 months). Of the seven patients who had no change, all have died. The median duration of follow-up for the entire series was 30 months (range, 2 to 61). Relapse from CR occurred in 15 of 59 (25%). Currently, 56 of 87 patients (64%) survive; all but 12 are in their first remission. Overall survival was 84% for those achieving an apparent CR. The major toxic effect of the m-BACOD regimen was myelosuppression with severe leukopenia and fever, which required hospitalization for about 33% of patients. Mucositis occurred in 39 patients; 19 had severe mucositis. No significant difference in overall survival was seen between the high-dose methotrexate M-BACOD and the low-dose m-BACOD regimens.

Primary and acquired drug resistance in Polish tuberculosis patients: results of a study of the national drug resistance surveillance programme.

OBJECTIVE: To determine the prevalence and patterns of primary and acquired drug resistance among Mycobacterium tuberculosis isolates recovered from tuberculosis patients in Poland. DESIGN: In a prospective survey, M. tuberculosis strains were collected from 3970 tuberculosis patients (2976 newly diagnosed cases and 994 previously treated patients) bacteriologically confirmed by culture between November 1996 and October 1997. METHODS: Drug susceptibility testing to isoniazid (INH), streptomycin, ethambutol and rifampicin (RMP) was performed on Löwenstein-Jensen medium according to the proportion method and/or using the radiometric Bactec 460 TB system. RESULTS AND CONCLUSION: The male to female ratio was 2.61:1. The patients were aged between 6 and 82 years, with 86% of males and 77% of females aged over 35 years. Primary resistance to any drug was found in 3.6% of new patients; any INH resistance was 2.6%, any RMP resistance was 0.7%, and multidrug resistance (to INH and RMP [MDR]) was 0.6%. In previously treated cases, resistance to any drug was 17.0%, any INH resistance 14.1%, any RMP resistance 7.8%, and MDR 7.0%. Drug-resistant tuberculosis does not present a big problem in Poland; primary drug resistance has been monitored since 1960 with decreasing frequency, and rates remain at the same level as 20 years ago. Studies such as this should be conducted regularly to monitor drug resistance in Poland in order to effectively manage national tuberculosis control efforts.

Drug-resistant tuberculosis in Poland in 2000: second national survey and comparison with the 1997 survey.

SETTING: Three years after the last survey of drug-resistant tuberculosis in Poland, a nationwide survey was conducted by the National Tuberculosis Reference Laboratory in cooperation with all TB laboratories. OBJECTIVE: To determine the prevalence and patterns of primary and acquired drug resistance among Mycobacterium tuberculosis isolates recovered from tuberculosis patients in Poland in 2000 and to compare the results with an earlier survey carried out in 1997. DESIGN: In a prospective survey based on the questionnaires and strains of M. tuberculosis from all 16 regional centres participating in the study, 3705 questionnaires and cultures were obtained from 3037 new and 668 previously treated patients excreting TB bacilli during the 12-month period of 2000. Tests of resistance to isoniazid, rifampicin, streptomycin and ethambutol were performed using Löwenstein-Jensen and the Bactec system. RESULTS AND CONCLUSION: Compared with the previous survey in 1997, the current survey showed a twofold increase in tuberculosis resistance in new cases: any resistance was 3.6% in 1997 vs. 6.1% in 2000 (P < 0.001), multidrug resistance was 0.6% vs. 1.2% (P < 0.01), and no cases of four-drug resistance in 1997 vs. 15 cases in 2000. No statistical differences were observed in the rate of acquired resistance in both surveys.

Alaska's model program for surveillance and prevention of occupational injury deaths.

The National Institute for Occupational Safety and Health (NIOSH) established its Alaska Field Station in Anchorage in 1991 after identifying Alaska as the highest-risk state for traumatic worker fatalities. Since then, the Field Station, working in collaboration with other agencies, organizations, and individuals, has established a program for occupational injury surveillance in Alaska and formed interagency working groups to address the risk factors leading to occupational death and injury in the state. Collaborative efforts have contributed to reducing crash rates and mortality in Alaska's rapidly expanding helicopter logging industry and have played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry (historically Alaska's and America's most dangerous industry). Alaska experienced a 46% overall decline in work-related acute traumatic injury deaths from 1991 to 1998, a 64% decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. Extending this regional approach to other parts of the country and applying these strategies to the entire spectrum of occupational injury and disease hazards could have a broad effect on reducing occupational injuries.

Effective injury prevention using surveillance data: helicopter logging, Alaska, 1992-1995.

BACKGROUND AND PURPOSE: To reduce the fatality rate in helicopter sling-load logging in Alaska. These operations--on rugged terrain, due to environmental restrictions and economics--are an emerging technology application worldwide. During 1992 and 1993, crashes during these operations in Alaska resulted in multiple fatalities. METHODS: During 1992, comprehensive surveillance for these events was established, combining electronic media and interagency notification with active investigation to identify preventable risk factors. These data were applied in mid-1993 by an interagency working group, which included representatives of the Alaska Department of Health and Social Services, Alaska Department of Labor, Federal Aviation Administration, National Transportation, Safety Board, U.S. Coast Guard, Occupational Safety and Health Administration, U.S. Forest Service, and National Institute for Occupational Safety and Health. In response to surveillance data, consensus safety recommendations were developed. Working closely with industry, immediate improvements were made in worker training, work/rest cycles, and oversight. Surveillance results are being used to evaluate the effectiveness of interventions. On March 1-2, 1995, an international workshop was convened in Ketchikan, Alaska, to involve industry and government agencies in planning for durable prevention in this industry. RESULTS: In Alaska between January 1, 1992, and June 30, 1993, there were 6 helicopter crashes, with 9 fatal (4 in pilots) and 10 severe nonfatal injuries, out of only 25 helicopters flying in helicopter logging operations. Alaska logging helicopters thus had the extraordinarily high annual crash rate of 16% and a catastrophic pilot fatality rate of 5,000/100,000/year. Investigation revealed that all crashes involved improper operational and/or maintenance practices. Since these recommendations were implemented in July 1993, there have been no additional helicopter logging fatalities in Alaska through 1995. The 1995 meeting resulted in further recommendations, including more vigorous oversight; development of rigorous voluntary industry standards for equipment, maintenance, and training; exclusive use of multi-engine rotocraft; and more vigorous controls on alcohol and drug use in this industry.

Preventing deaths in Alaska's commercial fishing industry.

BACKGROUND AND PURPOSE: The arctic and sub-arctic waters of Alaska provide a very hazardous work setting, with special hazards posed by great distances, seasonal darkness, cold waters, high winds, brief fishing seasons, and icing. Our intent is to reduce the remarkably high occupational fatality rate (200/100,000/year in 1991-1992) among Alaska's commercial fishing workers. Over 90% of these deaths have been due to drowning or drowning plus hypothermia, primarily associated with vessel capsizings and sinkings. METHODS: Comprehensive surveillance for commercial fishing occupational fatalities was established during 1991 in Alaska. During 1990 through 1994, the U.S. Commercial Fishing Industry Vessel Safety Act of 1988 required the implementation of comprehensive prevention measures for all fishing vessels in offshore cold waters, including immersion suits and other personal flotation devices, survival craft (life rafts), emergency position-indicating radio beacons, and crew training in emergency response and first aid. Parallel to this, voluntary training efforts by nonprofit organizations have greatly increased. RESULTS: During 1990-1994, drowning was the leading cause of occupational death in Alaska. During this period, 117 fishers died, 101 of them from drowning or drowning/hypothermia. During 1991-1994, there was a substantial decrease in Alaskan commercial fishing-related deaths, from 34 in 1991 to 35 in 1992, 22 in 1993, and 10 in 1994. While man-overboard drownings and some other categories of deaths (falls, fires) have continued to occur, the most marked progress has been in vessel-related events. CONCLUSION: Specific measures tailored to prevent drowning in vessel capsizings and sinkings in Alaska's commercial fishing industry have been very successful so far. Additional efforts must be made to reduce the frequency of vessel events and to prevent man-overboard events and drownings associated with them.

Years of potential life lost and lost future productivity due to occupational fatalities--Alaska, 1990-1994.

INTRODUCTION: Alaska had the highest occupational fatality rate of any state for the 1980s. The impact of these events is estimated by the index of years of potential life lost before age 65 (YPLL), which was developed to measure the potentially preventable mortality occurring early in life. METHODS: Lost future productivity (wages) and YPLL were calculated from surveillance statistics for all workers killed on the job during this 5-year period. RESULTS: During 1990-1994, Alaska experienced 343 work-related deaths among civilians under age 65. YPLL was 9,690 years with an estimated lost future productivity of $367,000,000. DISCUSSION: Premature death due to occupational traumatic injury in Alaska for 1990-1994 was extremely costly to society. Premature death not only adversely affects the deceased workers' family, friends, and coworkers, but also society economically. Effective intervention strategies are needed to significantly reduce both the number and the cost of fatal occupational trauma in Alaska.

[A new, automatic, non-radiometric system for culturing MB/BACT bacilli and its value in the microbiologic diagnosis of tuberculosis]. / Nowy, automatyczny, nieizotopowy system hodowli pratków MB/BACT i jego wartosc w diagnostyce mikrobiologicznej gruzlicy.

The MB/BacT is a fully automated, rapid, non-radiometric system, for the culture of Mycobacteria for clinical samples other than blood. CO2 production is measured and reported as reflective units from the MB/BacT Process Bottle colorimetric sensor. We are evaluating the MB/BacT system in comparison to our routine culture method--culture on egg media (glycerol and puruvate), in the Bactec 460-Tb radiometric machine and in MB Redox. A total of 286 clinical samples from respiratory tract were inoculated into three or four culture systems and incubated at 37 degrees C. There was only little difference in mean time to detection between the MB/BacT and Bactec system (for M.tuberculosis 11 days versus 9 days), but both systems were faster than egg media (16 days). Contamination rates for MB/BacT system was 8.4%, and for Bactec 6.9%. The colorimetric technology used in the MB/BacT is a rapid and sensitive for the measurement of mycobacterial growth.

[Usefulness of redux properties in acid-resistant bacilli for rapid detection of their growth in culture]. / Wykorzystanie zdolnosci reduckcyjnych pratków kwasoopornych do szybkiego wykrywania ich wzrostu w hodowlach.

MB REDOX a new system for detection of Mycobacterium is described. It is a modified, serum supplemented Kirchner-medium containing a colourless tetrazolium salt reduced by the redox system used for self-indicating microbial growth. In this study we have tested sensitivity and time of isolation of Mycobacteria in MB REDOX and compared to the other different systems of cultivation.

Minkowski tensor shape analysis of cellular, granular and porous structures.

Predicting physical properties of materials with spatially complex structures is one of the most challenging problems in material science. One key to a better understanding of such materials is the geometric characterization of their spatial structure. Minkowski tensors are tensorial shape indices that allow quantitative characterization of the anisotropy of complex materials and are particularly well suited for developing structure-property relationships for tensor-valued or orientation-dependent physical properties. They are fundamental shape indices, in some sense being the simplest generalization of the concepts of volume, surface and integral curvatures to tensor-valued quantities. Minkowski tensors are based on a solid mathematical foundation provided by integral and stochastic geometry, and are endowed with strong robustness and completeness theorems. The versatile definition of Minkowski tensors applies widely to different types of morphologies, including ordered and disordered structures. Fast linear-time algorithms are available for their computation. This article provides a practical overview of the different uses of Minkowski tensors to extract quantitative physically-relevant spatial structure information from experimental and simulated data, both in 2D and 3D. Applications are presented that quantify (a) alignment of co-polymer films by an electric field imaged by surface force microscopy; (b) local cell anisotropy of spherical bead pack models for granular matter and of closed-cell liquid foam models; (c) surface orientation in open-cell solid foams studied by X-ray tomography; and (d) defect densities and locations in molecular dynamics simulations of crystalline copper.

Molecular analysis of drug-resistant Mycobacterium tuberculosis isolates collected in central Poland.

In total, 48 Mycobacterium tuberculosis clinical isolates from 48 patients with drug-resistant pulmonary tuberculosis (TB) in central Poland during 2004 were analysed by spoligotyping and IS6110-Mtb1/Mtb2 PCR. Twelve (25%) isolates were clustered by spoligotyping in combination with IS6110-Mtb1/Mtb2 PCR. Patients from whom these isolates were obtained were assumed to have developed TB as a result of recent transmission. Spoligotyping, used alone, overestimated the number of clustered isolates. However, combined use of spoligotyping and IS6110-Mtb1/Mtb2 PCR was an efficient approach for revealing clonal relatedness among M. tuberculosis isolates.

Immunodiffusion screening method for detection of motile Salmonella in foods: collaborative study.

A collaborative study was performed to validate the performance of the 1-2 TEST for detection of motile salmonellae in foods. Detection is based on observation of an immobilized band of cells. Twenty-three laboratories participated in the study. The 1-2 TEST (immunodiffusion test) was compared with the standard culture procedure (BAM/AOAC; FDA Bacteriological Analytical Manual) for detection of Salmonella in 6 food types: ground black pepper, soy flour, dried whole egg, milk chocolate, nonfat dry milk, and raw deboned turkey. Uninoculated and inoculated samples were included in each food group analyzed. After the tests on the 6 foods were completed, analysis of the data for turkey and soy flour showed that certain collaborators obtained data inconsistent with the data from the majority of collaborators. No specific method deviations to account for the inconsistencies were reported by those collaborators, so the collaborative testing of these 2 foods was repeated. Analysis of data for pepper, chocolate, nonfat dry milk, dried whole egg, and the second set of soy flour and turkey indicated 96.1% agreement between the BAM/AOAC and immunodiffusion test methods. The false negative rates for the immunodiffusion test and BAM/AOAC methods were 3.6 and 1.7%, respectively. There was no significant difference in the productivity of the immunodiffusion test and BAM/AOAC method at the 5% level for any of the 6 foods. The immunodiffusion screening method has been approved official first action for detection of motile Salmonella in foods.

Visual immunoassay for detection of Salmonella in foods: collaborative study.

A collaborative study was performed in 13 laboratories to validate a visual enzyme immunoassay (EIA) procedure, TECRA, for rapid detection of Salmonella in foods. The EIA method was compared with the standard culture procedure for detection of Salmonella in 6 food types: ground black pepper, soy flour, dried whole eggs, milk chocolate, nonfat dry milk, and raw deboned turkey. Uninoculated and inoculated samples were included in each food group analyzed. There was no significant difference in the productivity of the EIA and culture procedures at the 5% level for any of the 6 foods. The enzyme immunoassay screening method has been approved interim official first action.

Colorimetric deoxyribonucleic acid hybridization assay for rapid screening of Salmonella in foods: collaborative study.

A collaborative study was performed in 11 laboratories to validate a colorimetric DNA hybridization (DNAH) method for rapid detection of Salmonella in foods. The method was compared to the standard culture method for detection of Salmonella in nonfat dry milk, milk chocolate, soy isolate, dried whole egg, ground black pepper, and raw ground turkey. Samples inoculated with high (0.4-2 cells/g) and low (0.04-0.2 cells/g) levels of Salmonella and uninoculated control samples were included in each food group analyzed. There was no significant difference in the proportion of samples positive by DNAH and culture procedure for any of the 6 foods. The colorimetric DNA hybridization assay screening method has been adopted official first action as a rapid screening method for detection of Salmonella in all foods.

Evaluation of abbreviated enzyme immunoassay method for detection of Salmonella in low-moisture foods.

A modified enzyme immunoassay method (EIA) utilizing an 18 h pre-enrichment, a 6-8 h selective enrichment, and a 14 h M-broth post-enrichment is compared to the standard culture method (AOAC/BAM) on selected low-moisture foods. Tested samples included 238 inoculated, 30 naturally contaminated, and 30 uninoculated foods. By EIA, 235 samples were positive (optical densities greater than 0.2 at 405 nm), 233 of which were confirmed culturally. By the culture methods, 221 samples were positive. The EIA method was more productive in detecting salmonellae in inoculated samples of dry cheese powder, chocolate, and nonfat dry milk, whereas the culture method gave better recovery from naturally contaminated meat and bone meal. The modified EIA could be completed in 40 h and required no centrifugation.