Recurrent hyperhemolytic transfusion reaction in myelodysplastic syndrome- A case based approach.

We present here a case report of a 27 year old female, with myelodysplatic syndrome suspected to have recurrent hyperhemolytic transfusion reactions (HHTR). Patient was transfusion dependent for ten years and was transfused with leukodepleted and irradiated Packed Red Blood Cells (PRBC). She presented with signs and symptoms of acute intravascular hemolysis, deranged coagulation profile with post transfusion Hb lower than baseline. Post transfusion workup was uneventful. She was managed conservatively with fluid support and methylprednisolone initially. After few uneventful transfusions, patient developed second episode of HHTR with compatible unit.Immunophenotype favored an inflammatory response possibly induced by monocytic lineage. As transfusion dependent, the patient required methylprednisolone as premedication and all subsequent transfusions were uneventful.

Infection at diagnosis-a unique challenge in acute myeloid leukemia treatment in developing world.

PURPOSE: A large number of AML patients present with infection at the time of initial presentation in Indian settings. There is lack of published data on the proportion of patients with infection at initial presentation and its impact on induction mortality. METHODS: A retrospective audit of patients with newly diagnosed AML more than 14 years of age, who underwent standard induction chemotherapy between the periods of January 2011 to December 2018, was done. Infection at presentation if any was documented. Induction mortality was defined as death happening within 28 days of starting induction chemotherapy. RESULTS: Among a total of 315 cases of AML, 96 (30%) patients underwent induction chemotherapy with 7 + 3 regimen. Documented infection at baseline was present in 30 (31%) of patients. Another 10 patients had fever at the time of presentation but without any documented infection focus. Fifteen patients died within 4 weeks of induction amounting to induction mortality of 15.6%. Induction mortality was 28% among patients with infection at baseline compared with 7% without baseline infections (P = 0.01). CONCLUSION: Around 40% of patients had fever at the time of presentation, and 31% had documented infections. Baseline infections led to increase in induction mortality. We would like to propose that infection at baseline is to be considered as one of the potential variables in the predictive scoring system for induction mortality in developing countries.

Effect of elevated CO2, high temperature, and water deficit on growth, photosynthesis, and whole plant water use efficiency of cocoa (Theobroma cacao L.).

In this study, the response of 6-month-old cocoa (Theobroma cacao L.) seedlings to elevated CO2 concentration [ECO2], elevated temperature [ET], and their interaction with water deficit stress was studied in an open top chamber (OTC). Each OTC was maintained at chamber control (400 ppm CO2), [ECO2] 550 ppm, [ECO2] 700 ppm, ET 3 °C above chamber control, and ET 3 °C + [ECO2] 550 ppm. Inside each OTC, a set of plants received moisture at 100% FC, while the other set was at 50% FC, which was the water deficit stress treatment. Increasing the CO2 concentration in cocoa increased photosynthesis (Pn) by 27%, which resulted in high biomass accumulation, thus improving the whole plant water use efficiency (WUE). The impact of high temperature (Tmax), around 39 °C in ET treatment against 36 °C in chamber control, is quite severe on Pn, leaf Ψ, and biomass accumulation. Similarly, water deficit at 50% FC resulted in the leaf Ψ reducing to - 14.06 bars at which Pn, leaf area, and biomass were significantly reduced. [ECO2] could ameliorate the negative effect of high temperature and water deficit stress to certain extent. However, the relative response of cocoa seedlings to [ECO2] in improving Pn, leaf Ψ, biomass, and WUE was greater under 50% FC compared to plants at 100% FC suggested additional advantage of [ECO2] to cocoa under water limited conditions.

Mechanisms of Filovirus Entry.

Filovirus entry into cells is complex, perhaps as complex as any viral entry mechanism identified to date. However, over the past 10 years, the important events required for filoviruses to enter into the endosomal compartment and fuse with vesicular membranes have been elucidated (Fig. 1). Here, we highlight the important steps that are required for productive entry of filoviruses into mammalian cells.

Comparison of Matching Pursuit Algorithm with Other Signal Processing Techniques for Computation of the Time-Frequency Power Spectrum of Brain Signals.

Signals recorded from the brain often show rhythmic patterns at different frequencies, which are tightly coupled to the external stimuli as well as the internal state of the subject. In addition, these signals have very transient structures related to spiking or sudden onset of a stimulus, which have durations not exceeding tens of milliseconds. Further, brain signals are highly nonstationary because both behavioral state and external stimuli can change on a short time scale. It is therefore essential to study brain signals using techniques that can represent both rhythmic and transient components of the signal, something not always possible using standard signal processing techniques such as short time fourier transform, multitaper method, wavelet transform, or Hilbert transform. In this review, we describe a multiscale decomposition technique based on an over-complete dictionary called matching pursuit (MP), and show that it is able to capture both a sharp stimulus-onset transient and a sustained gamma rhythm in local field potential recorded from the primary visual cortex. We compare the performance of MP with other techniques and discuss its advantages and limitations. Data and codes for generating all time-frequency power spectra are provided.

Characterizing the metabolic trade-off in Nitrosomonas europaea in response to changes in inorganic carbon supply.

The link between the nitrogen and one-carbon cycles forms the metabolic basis for energy and biomass synthesis in autotrophic nitrifying organisms, which in turn are crucial players in engineered nitrogen removal processes. To understand how autotrophic nitrifying organisms respond to inorganic carbon (IC) conditions that could be encountered in engineered partially nitrifying systems, we investigated the response of one of the most extensively studied model ammonia oxidizing bacteria, Nitrosomonas europaea (ATCC19718), to three IC availability conditions: excess gaseous and excess ionic IC supply (40× stoichiometric requirement), excess gaseous IC supply (4× stoichiometric requirement in gaseous form only), and limiting IC supply (0.25× stoichiometric requirement). We found that, when switching from excess gaseous and excess ionic IC supply to excess gaseous IC supply, N. europaea chemostat cultures demonstrated an acclimation period that was characterized by transient decreases in the ammonia removal efficiency and transient peaks in the specific oxygen uptake rate. Limiting IC supply led to permanent reactor failures (characterized by biomass washout and failure of ammonia removal) that were preceded by similar decreases in the ammonia removal efficiency and peaks in the specific oxygen uptake rate. Notably, both excess gaseous IC supply and limiting IC supply elicited a previously undocumented increase in nitric and nitrous oxide emissions. Further, gene expression patterns suggested that excess gaseous IC supply and limiting IC supply led to consistent up-regulation of ammonia respiration genes and carbon assimilation genes. Under these conditions, interrogation of the N. europaea proteome revealed increased levels of carbon fixation and transport proteins and decreased levels of ammonia oxidation proteins (active in energy synthesis pathways). Together, the results indicated that N. europaea mobilized enhanced IC scavenging pathways for biosynthesis and turned down respiratory pathways for energy synthesis, when challenged with excess gaseous IC supply and limiting IC supply.

Anammox moving bed biofilm reactor pilot at the 26th Ward wastewater treatment plants in Brooklyn, New York: start-up, biofilm population diversity and performance optimization.

New York City Environmental Protection in conjunction with City College of New York assessed the application of the anammox process in the reject water treatment using a moving bed biofilm reactor (MBBR) located at the 26th Ward wastewater treatment plant, in Brooklyn, NY. The single-stage nitritation/anammox MBBR was seeded with activated sludge and consequently was enriched with its own 'homegrown' anammox bacteria (AMX). Objectives of this study included collection of additional process kinetic and operating data and assessment of the effect of nitrogen loading rates on process performance. The initial target total inorganic nitrogen removal of 70% was limited by the low alkalinity concentration available in the influent reject water. Higher removals were achieved after supplementing the alkalinity by adding sodium hydroxide. Throughout startup and process optimization, quantitative real-time polymerase chain reaction (qPCR) analyses were used for monitoring the relevant species enriched in the biofilm and in the suspension. Maximum nitrogen removal rate was achieved by stimulating the growth of a thick biofilm on the carriers, and controlling the concentration of dissolved oxygen in the bulk flow and the nitrogen loading rates per surface area; all three appear to have contributed in suppressing nitrite-oxidizing bacteria activity while enriching AMX density within the biofilm.

Our Experience of OSAKA Regimen (Bladder Preservation) in Patients with Advanced Bladder Cancer.

Introduction and Objectives: OSAKA regimen is a novel bladder preservation therapy involving balloon-occluded selective arterial infusion of radio-sensitizing chemotherapeutic agent with concurrent hemodialysis (HD), followed by radiation therapy. Objectives are to study the feasibility of this novel regimen in patients with advanced cancer bladder (Ca Bladder). Methods: Two patients having advanced Ca Bladder with cisplatin ineligibility and poor performance status were managed with OSAKA regimen. Patients undergo super selective catheterisation of the anterior division of the internal iliac artery, followed by concurrent instillation of cisplatin (100 mg) via microcatheters and hemodialysis. Within 72 h, definitive radiation therapy is given. Image-guided radiation therapy (IGRT) with Helical Tomo using an Accuracy Radixact Tomography machine was used. 60 Gray/30 fractions is given to the bladder and nodes (50 Gray to bladder and nodes plus margin, with a boost of 10 Gray to bladder plus margin). Response is monitored by 3 monthly fluorodeoxyglucose positron emission tomography (FDG PET) imaging. Results: Our first patient tolerated the procedure well and showed a complete response at 3 months of FDG PET imaging, but unfortunately, 1 year of FDG PET showed bony metastases, and the patient was managed accordingly. Our second patient also tolerated the regimen well, showed a complete response at 3 and 12 months of FDG PET imaging, and is under follow-up. Conclusions: The OSAKA regimen, as a bladder preservation strategy, is feasible and safe in selective advanced Ca Bladder patients.

Prognostic Factors and Outcomes of Early-Stage Hodgkin's Lymphoma: Multi-Institutional Data From South India.

Early-stage Hodgkin's lymphoma (ESHL) is highly curable, usually with a combination of chemotherapy and radiation. Real-world data may show differences in survival and prognostic factors when compared to clinical trials. There is limited published literature on ESHL from India. The data on the baseline characters, treatment, and outcomes of patients with ESHL (stage IA, IB, and IIA) were obtained from five institutions' medical records and entered in a common database. Event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan Meier method, and cox-regression analysis was used to identify prognostic factors. There were 258 patients [median age was 37 (18-75) years; [males:160 (62%); stage I: 41%; B symptoms: 17 (6%); bulky disease:19 (15%)] treated between 2000 and 2020 who were evaluable. The common chemotherapies used were ABVD [N = 180 (70%)], COPP-ABVD hybrid [N = 52 (21%)], and COPP [N = 14 (5%)]. Median number of cycles were 4 (2-8) and 93 (47%) received radiation at end of treatment. After a median follow-up of 60 months, the 5 years EFS was 87% and OS was 92%. On multivariate analysis, the following factors adversely affected the EFS: Male gender [hazard ratio (HR) = 2.23, P = 0.02] and Hemoglobin < 10.5g/dL [hazard ration (HR) = 2.20, P = 0.02], and the following adversely affected the OS: Hemoglobin < 10.5g/dL [hazard ratio (HR) = 4.05, P = 0.001], Male gender [hazard ratio (HR) = 3.59, P = 0.004], Stage 2 [hazard ratio (HR) = 2.65, P = 0.002] and ECOG PS (2-3) [hazard ratio (HR) = 3.35, P = 0.01]. Using the hemoglobin, stage and gender a 3-item prognostic score could identify patients with very good outcomes (score 0; 5 years OS:100%) and poor outcomes (score 3; 5 years OS; 49%). This is one of the first multi-center real-world data exclusively focusing on ESHL from India. Though the survival of the entire population was good, there are subsets of patients who have poor outcomes, which may be identified using simple parameters. These parameters need validation in a larger dataset. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01692-9.

Factors influencing the density of aerobic granular sludge.

In the present study, the factors influencing density of granular sludge particles were evaluated. Granules consist of microbes, precipitates and of extracellular polymeric substance. The volume fractions of the bacterial layers were experimentally estimated by fluorescent in situ hybridisation staining. The volume fraction occupied by precipitates was determined by computed tomography scanning. PHREEQC was used to estimate potential formation of precipitates to determine a density of the inorganic fraction. Densities of bacteria were investigated by Percoll density centrifugation. The volume fractions were then coupled with the corresponding densities and the total density of a granule was calculated. The sensitivity of the density of the entire granule on the corresponding settling velocity was evaluated by changing the volume fractions of precipitates or bacteria in a settling model. Results from granules originating from a Nereda reactor for simultaneous phosphate COD and nitrogen removal revealed that phosphate-accumulating organisms (PAOs) had a higher density than glycogen-accumulating organisms leading to significantly higher settling velocities for PAO-dominated granules explaining earlier observations of the segregation of the granular sludge bed inside reactors. The model showed that a small increase in the volume fraction of precipitates (1-5 %) strongly increased the granular density and thereby the settling velocity. For nitritation-anammox granular sludge, mainly granular diameter and not density differences are causing a segregation of the biomass in the bed.

A critical review of silicon nanowire electrodes and their energy storage capacities in Li-ion cells.

The electrochemical performances of silicon nanowire (SiNW) electrodes with various nanowire forms, intended as potential negative electrodes for Li-ion batteries, are critically reviewed. The lithium storage capacities, cycling performance, and how the volume expansion is possibly accommodated in these structures are discussed. The SiNW morphology can have a greater impact on the energy storage capacity and cycling performance if the parameters affecting the performance are clearly identified, which is the objective of this review. It is shown that the specific capacity measure is not adequate to truly assess the potential of an electrode and the necessity of the areal capacity measure is highlighted. It is shown that both measures are essential for the assessment of the true potential of a SiNW electrode relative to competing electrodes. Si mass loading in SiNWs has been found to be important for areal and specific capacities. An increase of mass loading of SiNWs is shown to increase the areal capacity significantly, but the specific capacity is found to decrease in thicker Si electrodes. Further, modifications of SiNW electrodes, with coating and doping, have shown significant increases in the performance of these electrodes in Li-ion batteries. The SiNW electrodes, to date, are far below the areal capacity of 3 mA h cm-2, which may be the minimum threshold capacity for a promising SiNW electrode with respect to Li-ion batteries.

Primary Well-Differentiated Neuroendocrine Tumor of the Kidney.

Primary neuroendocrine tumors (NET) of the kidney are rare. They present with varied symptoms, making their diagnosis difficult clinically as well as pathologically. We present to you the case of a renal NET, which presented in a young female patient. A 48-year-old female patient came with an incidentally detected right renal mass during the evaluation of a nonspecific gynecological problem. She underwent contrast-enhanced computed tomography (CT) of the abdomen, which showed a 57*45*34 mm mass with enlarged retrocaval and aortocaval nodes (25*12 mm). Renal cell carcinoma was suspected as per the CT findings, and metastatic workup in the form of FDG PET CT was done in view of the unusually enlarged nodes. She underwent robot-assisted radical nephrectomy along with lymph node dissection. Surgery was uneventful, and she recovered well in the postoperative period. In the final pathology, there was confusion regarding the diagnosis, and further immunohistochemistry (IHC) was recommended by the pathologist. IHC showed synaptophysin positive, chromogranin negative, CD56 focally positive with Ki-67 of 2-3%, which was suggestive of low-grade NET of the kidney. Lymph nodes were negative. She was kept on follow-up and a Ga 68-DOTANOC scan at 3 months showed no evidence of disease. Diagnosis and management of NET of the kidney still remains a debatable and controversial topic in view of its rarity. High index of suspicion needs to be observed in patients presenting with carcinoid syndrome and a renal mass. Nuclear scans like PET scan and DOTANOC scan can accurately stage the disease. Management includes partial or radical nephrectomy depending on the tumor characteristics. Further studies are required to optimize the treatment protocols for these patients.

Identification of rare atypical BCR-ABL1 transcript: A case report.

CML is characterized by the presence of a BCR-ABL1 fusion transcript. Several guidelines have been published for its detection and molecular monitoring. Here, a case is described of chronic myeloid leukemia presenting in the blast phase with a rare variant transcript, with a discussion on possible red flags in its detection and genetic testing and description of the patient's clinical characteristics. This case highlights the pitfalls of using real-time quantitative reverse-transcription polymerase chain reaction (RQ-PCR) for diagnosis of CML, especially when the clinical picture and the test results are discordant.

Accuracy of freehand versus guided immediate implant placement: A randomized controlled trial.

PURPOSE: This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery. METHODS: An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n = 40 implants) and static guided surgery with R2Gate® (Megagen, Gyeongbuk, South Korea, test group, n = 40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment. RESULTS: In the freehand group (control), crestal deviations of 1.13 ± 0.89 mm and 1.00 ± 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 ± 0.26 mm (p<0.001) and 0.37 ± 0.24 mm (p = 0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 ± 1.90 mm vs. 0.97 ± 0.55 mm, p = 0.04) and buccolingual directions (3.46 ± 1.82 mm vs. 0.94 ± 0.67 mm, p = 0.02). Freehand surgery had greater angular deviation (6.09° ± 3.23) compared to guided surgery (0.83° ± 0.53, p = 0.02). However, depth deviation was similar in the freehand surgery group (2.24 ± 1.58 mm) and static guided surgery group (0.66 ± 0.43, p = 0.09). CONCLUSIONS: Immediate implant placement with static guided surgery demonstrated better accuracy than freehand surgery. STATEMENT OF CLINICAL RELEVANCE: Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.

Diffuse Large B-Cell Lymphoma with pseudo Rosettes, A Rare Entity: Case Report with Literature Review.

Background: Rosette formation is an unusual finding in malignant lymphomas. We report a case of a diffuse large B-cell lymphoma (DLBCL) with abundant rosette formation histologically mimicking non lymphoid tumors. Case presentation: A sixty-five-year-old female presented with a complaint of swelling on left side axillary region since a period of six months with no history of fever, fatigue or weight loss or other similar swellings elsewhere. No relevant personal and family history relatable to the present complaint. Subsequent clinical and radiological investigations revealed isolated left axillary lymphadenopathy. The lymph node on further biopsy showed a particular morphology of pseudorosette formation masquerading a metastatic rosette forming malignancies. Subsequent histopathological and immunohistochemical investigations revealed a rare morphological variant of diffuse large B cell lymphoma. The fluorodeoxyglucose positron emission tomography scan showed multiple discreet supra-diphramatic (left lower cervical and left axillary lymph nodes) metabolically active lymph nodes. Conclusion: Diffuse large B cell lymphoma with rosette formation is a rare entity which can mimic other tumors with rosette formation in a metastatic node. Knowledge on the rosette forming lymphoma entity is thus essential for diagnosis and treatment plan. To the best of our knowledge this case report is the sixth known documented case of a diffuse large B cell lymphoma with rosette in literature.

A Comparative Analysis of CSF and the Blood Levels of Monoamines As Neurohormones in Rats during Ontogenesis.

According to the literature, the cerebrospinal fluid (CSF) in the cerebral ventricles contains numerous neuron-derived physiologically active substances that can function as neurohormones and contribute to volume neurotransmission in the periventricular region of the brain. This study was aimed at carrying out a comparative analysis of CSF and the blood levels of monoamines in rats during ontogenesis as an indicator of age-related characteristics of monoamine transport to body fluids and their function as neurohormones in volume neurotransmission in the periventricular region of the brain. We have shown that CSF in the perinatal period and adulthood contains the most functionally significant monoamines: dopamine, noradrenaline, and serotonin. A comparison of the monoamine levels in the CSF and blood of animals of different age groups revealed that CSF contains monoamines of predominantly neuronal (cerebral) origin and almost no monoamines derived from the general circulation. We also established that monoamines are found in the CSF at physiologically active levels that allow them to act as neurohormones in both reversible volume neurotransmission in the adult brain and irreversible regulation of brain development in the perinatal period.

Pattern of extranodal involvement and its impact on survival in diffuse large B-cell lymphoma from a tertiary cancer center in rural India.

INTRODUCTION: Extranodal (EN) involvement in diffuse large B-cell lymphoma (DLBCL) carries poor prognosis. Both the number and the specific sites of EN involvement are important in predicting prognosis. Given that the epidemiologic pattern of DLBCL in India is different from the rest of the world and such data correlations are scarce from developing countries, we aimed to find out if specific site and number of EN involvement could predict survival in DLBCL. METHODS: Patients with DLBCL treated with combination chemotherapy plus rituximab were included. Site and number of EN involvement were noted. Univariate analysis for survival was performed for EN involvement or not, specific site of involvement, and number of EN involvement (0/1 vs. ≥2). RESULTS: Among a total of 177 patients, 92 (52%) patients had EN disease. When patients with 2 or more EN sites were compared against patients with 0 or 1 site, there was significant reduction in both progression-free survival (PFS) and overall survival (OS) (3-year OS of 55% vs. 79%, P = 0.001, 3-year PFS of 42% vs. 65%, P = 0.001). When specific EN sites were studied for correlation with survival, involvement of skin/soft tissue, and serosa were associated with significant reduction in 3-year OS (33% vs. 74%, P = 0.011, and 63% vs. 75%, P = 0.03, respectively) and 3-year PFS (25% vs. 62%, P < 0.001, and 46% vs. 62%, P = 0.01, respectively). CONCLUSION: Two or more EN sites in DLBCL predicted inferior survival. Serosal and skin/soft tissue involvement also predicted poor survival.

Determination of mononuclear cell count using peripheral smear and flow cytometry in peripheral blood stem cell products: A retrospective study from an Indian cancer center.

BACKGROUND: Mononuclear cells (MNCs) are considered equivalent to hematopoietic stem cells, and differential count using peripheral smear was routinely practiced to enumerate MNC. Flow cytometry plots used for CD34 enumeration assay can also be used in MNC enumeration as it counts more WBC events than manual methods. The aim was to determine the relationship and degree of agreement between peripheral smear and flow cytometry in MNC enumeration of peripheral blood stem cell (PBSC) products. METHODS: In 63 patients, 73 PBSC products were collected between January 2017 and September 2019. The differences in MNC count estimated by peripheral smear method and from flow cytometry plots used for CD34 enumeration were analyzed using Mann-Whitney test. Agreement between the two methods for MNC enumeration was determined by regression analysis. Receiver operating characteristic curve was performed to determine MNC threshold in peripheral blood and PBSC product for adequate mobilization and harvest. RESULTS: There was no difference in enumeration of median MNC count between peripheral smear and flow cytometry (52% vs. 59%, P = 0.185) in PBSC product. However, regression analysis indicated a constant and proportional difference between the methods with r = 0.52. Cumulative sum test for linearity showed deviation from linearity (P = 0.04). MNC counts in peripheral blood failed to achieve discrimination capacity in predicting adequate CD34+ yield/kg body weight in product. CONCLUSION: Peripheral smear estimated lower MNC counts than flow cytometry with weaker agreements between the two methods. Hence, MNC count derived from flow cytometry plot can substitute peripheral smear method for MNC dose calculations. MNC dose at 3.4 × 108/kg consistently predicted >2 × 106/kg CD34+ cells collected.

Extent of transfusion support in a developing country in managing a bleeding acute myeloid leukemia patient with platelet transfusion refractoriness.

Conventional platelet transfusion may not be adequate to deal with platelet transfusion refractoriness (PTR), and therefore human leukocyte antigen (HLA) or human platelet antigen (HPA) matched and platelet crossmatch compatible units are recommended. However, in developing countries, finding a unit that is HLA or HPA matched or platelet crossmatch poses a challenge. Hence, easier and cost-effective alternatives such as massive platelet transfusion and continuous platelet transfusion were attempted to manage bleeding in PTR. A 31-year-old male presented with acute myeloid leukemia relapse and chloroma in bladder underwent FLAG salvage chemotherapy. Despite almost daily platelet transfusion with single donor platelets (SDPs), patient presented with hematuria and low corrected count increment at 1 h and 24 h suggesting both immune and nonimmune refractoriness to platelet transfusion. The patient received SDP transfusion twice daily from day 19 to day 21 to maintain hemostasis. The patient had persistent hematuria, so massive platelet transfusion in the form of double adult doses of SDP given every 12th hourly for three events. Despite these measures, there was persistent hematuria and refractoriness to platelet transfusion. As HLA or HPA matched or crossmatch compatible platelets were unavailable, continuous platelet transfusion was started for this patient from day 23 to day 28. After 4 days of continuous platelet transfusion, hematuria subsided. In resource-constrained clinical settings, continuous platelet transfusion can be an effective alternative to HLA/HPA-matched platelets in the management of PTR.

Impact of active tuberculosis on treatment decisions in cancer.

Background Tuberculosis (TB) and cancer can coexist in some patients especially from low- and middle-income countries. Impact of active TB on treatment decisions in cancer is less well studied. Methods A retrospective case record review of all cases of cancer diagnosed and or treated between January 2012 and December 2019 who were also diagnosed to have active TB (pulmonary or extrapulmonary) was done. Results Any delay or change in standard treatment of cancer because of active TB or its treatment was noted. Among a total of 32,509 cancer cases, 56 (0.17%) patients were diagnosed to have active TB. Twenty six patients (46%) had delay in starting treatment or delay during cancer treatment. Six (11%) patients were changed from curative treatment option to palliative intent (either best supportive care or palliative Radiation) or no further treatment. Three (5%) patients required change from one type of curative treatment modality to another curative option. Conclusion Eleven percent of patients had to be changed from curative intent to palliative treatment or no further treatment, TB being either the direct or indirect cause in all of them. A nationwide data registry of cancer patients with TB, involving multiple centers, should be considered so that specific problems in this context can be identified and addressed in larger details.