Revisiting intrathecal thiotepa: Efficacy and safety in secondary CNS malignancies.

Treating metastatic malignancies to the central nervous system (CNS) is challenging because many drugs cannot cross the blood-brain-barrier (BBB). Direct intrathecal (IT) drug administration into the cerebrospinal fluid (CSF) is a strategy to overcome this problem. Thiotepa has effective CNS penetration but its popularity has waned over the last two decades due to concerns about its efficacy and potential systemic toxicity. This review evaluates the available evidence for the use of IT thiotepa in hematologic malignancies and non-CNS solid tumors with leptomeningeal disease metastases (LMD). Our search shows that IT thiotepa is a reasonable alternative in hematologic malignancies and LMD due to solid organ malignancies. This suggests a potential role of IT thiotepa in second-or third-line treatment or a substitute role in cases of drug-shortages and adverse effects with other agents. Future research should focus on rigorous comparative trials to establish its definitive role in the evolving landscape of CNS-directed chemotherapy.

Multiple Myeloma: A Personal Account of My Journey With the Disease and Response to Teclistamab.

Multiple myeloma (MM) remains an incurable hematologic cancer leading to damage to the bone marrow that causes destructive bone lesions in addition to many other effects. I am a patient with MM who has undergone treatment to date since the diagnosis of this disease in December 2019. This paper reviews the treatments and observations made throughout this period. The salient results of such treatments are discussed in chronological order. During this period, my MM relapsed and then I was introduced to teclistamab treatment. The outcome of teclistamab treatment is quite promising, and I anticipate a longer life at a maintenance dose of this drug with a better quality of life. When writing this article, I am still receiving the teclistamab treatment cycles that maintain a constant normal level of my kappa-free light chain (FLC) and kappa/lambda ratio, with no significant side effects.

Time to optimize vaccination strategies in blood cancer patients.

Immune response to vaccinations is dampened in patients with indolent lymphomas due to disease and treatment-related factors. The study by Lim et al. demonstrated impaired humoral response but intact cellular response to the SARS-CoV2 vaccine in patients with follicular lymphoma receiving front-line therapy. The results highlight the importance of several factors in predicting immune response to vaccination and provide estimates of immune response for different clinical scenarios and treatment points. Commentary on: Lim et al. Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19562.

Comparative Efficacy of Photobiomodulation on Osseointegration in Dental Implants: A systematic review and meta-analysis.

AIM: This study aimed to assess the effectiveness of photobiomodulation therapy (PBM) in enhancing bone integration with dental implants. METHOD: PubMed, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar were searched. Studies assessing PBM effectiveness with defined intervention/control groups were included, while those lacking specified laser types, involving severe maxillofacial defects or surgery, and not reporting outcomes related to dental implant osseointegration post-PBM therapy were excluded. The studies' risk of bias was assessed using Robvis for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. The meta-analysis was conducted utilizing a random-effects model at a significance level of 0.01. RESULTS: The study reviewed 26 papers involving 571 patients undergoing dental implant procedures with PBM/Low-Level Laser Therapy (LLLT) or placebo/control. Implant stability quotients (ISQ) analysis showed a non-significant difference (p=0.06, mean difference: 1.02, 95% CI: 0.28 to 1.75, I2=28%), while the Periotest method indicated significant improvement in stability (p<0.01, mean difference: -0.51, 95% CI: -0.78 to -0.24, I2=71%). PBM resulted in a significant bone density increase (p<0.01, mean difference: 26, 95% CI: 6.93 to 45.06, I2=91%), but marginal bone loss showed no significant difference (p=0.11, mean difference: 0.00, 95% CI: -0.06 to 0.05, I2=45%). Implant survival rate did not significantly differ (p=0.73, mean difference: 1.56, 95% CI: 0.38 to 6.46, I2=0%). Most studies raised concerns regarding randomization. CONCLUSION: PBM could improve implant stability, as assessed with Periotest, and increase bone density, enhancing osseointegration. However, implant stability assessed with ISQ, marginal bone loss, and implant survival rate were comparable between the study groups.

Peripapillary Choroidal Neovascular Membrane: A Case Report.

Peripapillary choroidal neovascular membrane (PCNM) is an abnormal growth of blood vessels beneath the retina near the optic disc. We report a case of a 60-year-old Saudi female with a history of hypertension, hypothyroidism, and epilepsy who presented to the emergency room (ER), reporting a sudden decrease in vision over the past month. Ophthalmic examination revealed reduced visual acuity. The patient received aflibercept via intravitreal injection every four weeks. On follow-up, she reported improvement in symptoms. It has been shown that intravitreal anti-vascular endothelial growth factor (VEGF) not only preserves visual acuity but also produces anatomic improvement when used alone or in conjunction with other therapeutic modalities like photodynamic therapy, laser photocoagulation, and subretinal surgery, as PCNM is aberrant blood vessel growth under the retina. Only a few cases have been recorded in Saudi Arabia; we report this case to emphasize the importance of diagnosis and timely treatment with anti-VEGF.

Tetralogy of Fallot regurgitation energetics and kinetics: an intracardiac flow analysis of the right ventricle using computational fluid dynamics.

Repaired Tetralogy of Fallot (rTOF) patients suffer from pulmonary regurgitation and may require pulmonary valve replacement (PVR). Cardiac magnetic resonance imaging (cMRI) guides therapy, but conventional measurements do not quantify the intracardiac flow effects from pulmonary regurgitation or PVR. This study investigates intracardiac flow parameters of the right ventricle (RV) of rTOF by computational fluid dynamics (CFD). cMRI of rTOF patients and controls were retrospectively included. Feature-tracking captured RV endocardial contours from long-axis/short-axis cine. Ventricular motion was reconstructed via diffeomorphic mapping, serving as domain boundary for CFD simulations. Vorticity (1/s), viscous energy loss (ELoss, mJ/L) and turbulent kinetic energy (TKE, mJ/L) were quantified in RV outflow tract (RVOT) and RV inflow. These parameters were normalized against total RV kinetic energy (KE) and RV inflow vorticity to derive dimensionless metrics. Vorticity contours by Q-criterion were qualitatively compared. rTOF patients (n = 15) had mean regurgitant fraction 38 ± 12% and RV size 162 ± 35 mL/m2. Compared to controls (n = 12), rTOF had increased RVOT vorticity (142.6 ± 75.6/s vs. 40.4 ± 11.8/s, p < 0.0001), Eloss (55.6 ± 42.5 vs. 5.2 ± 4.4 mJ/L, p = 0.0004), and TKE (5.7 ± 5.9 vs. 0.84 ± 0.46 mJ/L, p = 0.0003). After PVR, there was decrease in normalized RVOT Eloss/TKE (p = 0.0009, p = 0.029) and increase in normalized tricuspid inflow vorticity/KE (p = 0.0136, p = 0.043), corresponding to reorganization of the "donut"-shaped tricuspid ring-vortex. The intracardiac flow in rTOF patients can be simulated to determine the impact of PVR and improve the clinical indications guided by cardiac imaging.

Review of MR spectroscopy analysis and artificial intelligence applications for the detection of cerebral inflammation and neurotoxicity in Alzheimer's disease.

INTRODUCTION: Magnetic resonance spectroscopy (MRS) has an emerging role as a neuroimaging tool for the detection of biomarkers of Alzheimer's disease (AD). To date, MRS has been established as one of the diagnostic tools for various diseases such as breast cancer and fatty liver, as well as brain tumours. However, its utility in neurodegenerative diseases is still in the experimental stages. The potential role of the modality has not been fully explored, as there is diverse information regarding the aberrations in the brain metabolites caused by normal ageing versus neurodegenerative disorders. MATERIALS AND METHODS: A literature search was carried out to gather eligible studies from the following widely sourced electronic databases such as Scopus, PubMed and Google Scholar using the combination of the following keywords: AD, MRS, brain metabolites, deep learning (DL), machine learning (ML) and artificial intelligence (AI); having the aim of taking the readers through the advancements in the usage of MRS analysis and related AI applications for the detection of AD. RESULTS: We elaborate on the MRS data acquisition, processing, analysis, and interpretation techniques. Recommendation is made for MRS parameters that can obtain the best quality spectrum for fingerprinting the brain metabolomics composition in AD. Furthermore, we summarise ML and DL techniques that have been utilised to estimate the uncertainty in the machine-predicted metabolite content, as well as streamline the process of displaying results of metabolites derangement that occurs as part of ageing. CONCLUSION: MRS has a role as a non-invasive tool for the detection of brain metabolite biomarkers that indicate brain metabolic health, which can be integral in the management of AD.

Radiation hazards of the Ukraine nuclear power plants: how can international blood and marrow stem cell transplant societies help?

Any conflict in countries that process nuclear power plants raises concerns of the potential radiation injuries to the people in that region and beyond such as the current conflict in Ukraine. International healthcare organizations and societies should prepare for the potential scenarios of nuclear incidents. The Worldwide Network for Blood and Marrow Transplantation (WBMT) and its members, have recent experience preparing for this type of events such as the Fukushima incident in 2011. In this article, we discuss the risks of radiation exposure, current guidelines, and scientific evidence on hematopoietic support, including the role of hematopoietic stem cell transplant (HCT) for those exposed to nuclear radiation, and the role that the WBMT and other global BMT societies can play in triaging and managing people suffering from radiation injuries.

Dietary supplement of fermented grass forage regulates growth performance, antioxidant capacity, and immune response of broiler chickens.

The current study aimed to determine the effects of different levels of fermented Juncao grass (FG) on growth parameters, blood constituents, immunity, and antioxidative properties of broilers. A total of 240 (21-d-old) broiler chicks were randomly distributed to four dietary treatments of sixty birds, with six replicate pens and ten birds in each. Fermented grass was added to the basal diet at four levels with 0, 5, 10, and 15% FG. The results revealed that broilers fed 5% FG had significantly higher (P < 0.05) final body weight (FBW), average daily gain (WG) and average daily feed intake (ADFI). The best conversion ratio (FCR) was recorded for broilers supplemented with 5% FG compared to the group supplemented with 15% FG (P < 0.05). Increasing FG % decreased (P < 0.05) anti-inflammatory cytokines IL-4, IL-6, and IL-10. However, FG increased (P < 0.05) proinflammatory cytokines IFN-γ, IL-1, IL-2, IL-12, and TNF-α (P < 0.05). Moreover, IgA, IgG, and IgM levels increased (P < 0.05) with increasing FG %. In addition, increasing FG % in broiler rations significantly increased (P < 0.05) serum antioxidant levels of T-AOC, GSH-PX, SOD, CAT, NO and GSH, but decreased (P < 0.05) MDA levels compared to the control group. Conclusively, fermented Juncao grass would be considered a novel herbal feed additive for improving broiler performance, immunity, antioxidant, and health status. Nevertheless, further research at the molecular level is needed to quantify the effects of these herbal components on cellular and humoral immune functions in broiler chickens.

Thyroid Cancer Knowledge and Awareness in Saudi Arabia: A Cross-Sectional Study.

Background Thyroid cancer incidence has been increasing worldwide over the last few decades. It is the most common endocrine cancer and is most common among females. The study contributes to filling the knowledge gap among Saudi people regarding thyroid cancer. Objectives This research aims to investigate the level of thyroid cancer knowledge and awareness in Saudi Arabia, identify potential knowledge gaps, and develop targeted strategies for enhancing public awareness and education. Methods A cross-sectional, voluntary online survey was conducted from 1st August 2023 to 1st October 2023 among residents living in Saudi Arabia over 18 years of age. The participants included were 2030 respondents. Data analysis was performed using RStudio (R version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). Results Among the participants, the majority were female (60.4%). A total of 49.7% of the individuals reported having a moderate to high level of knowledge about thyroid cancer. While 63.9% knew the association of a lump in the neck to thyroid cancer, 82.6% affirmed to consult a doctor upon discovering a lump, 72.1% knew that regular monitoring of neck lumps is crucial for early diagnosis and treatment of precancerous conditions, 38.7% were aware of females being prone to thyroid cancer, and 59.2% were aware of the link between lifestyle and increased risk. Higher awareness scores were positively associated with female gender, previously having thyroid function tests done, and previously undergoing a US scan of the thyroid. Conclusion In this study, Saudi individuals are reported to lack some aspects of knowledge and perception of thyroid cancer. This study emphasizes filling the existing knowledge gap in thyroid cancer awareness in the Saudi population.

Machine learning applications and challenges in graft-versus-host disease: a scoping review.

PURPOSE OF REVIEW: This review delves into the potential of artificial intelligence (AI), particularly machine learning (ML), in enhancing graft-versus-host disease (GVHD) risk assessment, diagnosis, and personalized treatment. RECENT FINDINGS: Recent studies have demonstrated the superiority of ML algorithms over traditional multivariate statistical models in donor selection for allogeneic hematopoietic stem cell transplantation. ML has recently enabled dynamic risk assessment by modeling time-series data, an upgrade from the static, "snapshot" assessment of patients that conventional statistical models and older ML algorithms offer. Regarding diagnosis, a deep learning model, a subset of ML, can accurately identify skin segments affected with chronic GVHD with satisfactory results. ML methods such as Q-learning and deep reinforcement learning have been utilized to develop adaptive treatment strategies (ATS) for the personalized prevention and treatment of acute and chronic GVHD. SUMMARY: To capitalize on these promising advancements, there is a need for large-scale, multicenter collaborations to develop generalizable ML models. Furthermore, addressing pertinent issues such as the implementation of stringent ethical guidelines is crucial before the widespread introduction of AI into GVHD care.

Parasitic infections in hematopoietic stem cell transplant recipients.

INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) is a vital treatment for various hematological disorders. However, HSCT recipients face increased risks of infectious complications due to immunosuppression. Parasitic infections are a significant concern in this vulnerable population and can lead to substantial morbidity and mortality. This review examines parasitic infections in HSCT recipients, focusing on major infections affecting different organ systems, including intestinal parasites (Giardia spp., Entamoeba histolytica, and Cryptosporidium spp.), hematologic parasites (Plasmodium spp. and Babesia spp.), and tissue/visceral parasites (Toxoplasma gondii, Leishmania spp., and Trypanosoma cruzi). METHODS: A systematic search of relevant literature was conducted and included studies up to August 2023. Databases included PubMed, Google Scholar, were queried using specific keywords related to parasitic infections in HSCT patients. The epidemiology, risk factors, clinical presentation, diagnostic methods, and treatment approaches for each infection were evaluated. RESULTS AND CONCLUSION: Knowing the epidemiology, risk factors, and clinical presentations are crucial for timely intervention and successful management. By emphasizing early detection, effective therapies, and the unique challenges posed by each of these infections, this review highlights the importance of tailored strategies for HSCT recipients. Future research can further refine management protocols to enhance care and outcomes for these patients.

Role of Anti-CD38 Monoclonal Antibodies in the Treatment of Adult Immune Hematological Diseases.

Daratumumab is a first-in-class human anti-CD38 IgG1 monoclonal antibody approved for treating newly diagnosed and relapsed refractory multiple myeloma. Pre-clinical data supported daratumumab's ability to deplete autoantibodies producing plasma cells, B-cells, and NK cells. Those reports showed promising results on using daratumumab in autoimmune disorders that are refractory to multiple lines of therapies, which encouraged using daratumumab in various autoimmune conditions that are refractory to standard therapies. This review aims to summarize the literature reporting experience using anti-CD38 antibodies in hematological autoimmune diseases, focusing on the most common autoimmune hematological diseases, including autoimmune hemolytic anemia, immune thrombocytopenia, post-transplant cytopenia, and pure red blood cell aplasia.

Effect of chemical disinfection on the dimensional stability of polyvinyl ether siloxane impression material: a systemic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Polyvinyl ether siloxane (PVES) possesses ideal characteristics for making precise and accurate dental impressions. PVES dimensional stability owes to its better polymeric properties derived from its parent materials poly ethers and polyvinyl siloxanes. As recommended use of chemical disinfecting agents is getting more popular, there is a growing concern associated with the effect of disinfectants on PVES dimensional stability. This study was aimed to understand the PVES behavior when subjected to chemical disinfectants. MATERIALS AND METHODOLOGY: The data was collected from research studies retrieved from Google Scholar, Scopus, and PubMed using MeSH terms of keywords "vinyl polyether siloxane AND Disinfection" or (Vinyl polyether siloxane OR polyvinyl siloxane ether OR PVES) AND (disinfectant OR disinfection)" without any restriction to publication date. The PRISMA (Preferred Reporting Items for Systemic Review and Meta-Analysis) directions were observed during the data collection, screening of studies, and meta-analysis. The primary data were retrieved, and batch exported from databases using Harzing's Publish or Perish software; primary analysis was performed in Microsoft Excel, while statistical analysis for effect size, two-tailed p-values, and heterogeneity among studies was performed using Meta Essentials. The effect size was calculated using Hedge's g values at the 95% confidence level using the random-effects model. Heterogeneity among studies was measured using the Cochrane Q and I2. RESULTS AND CONCLUSION: Dental impressions made from the PVES elastomeric impression materials showed no significant changes in dimensional stability. Immersion in the chemical disinfectant for 10 min was associated with clinically irrelevant changes in the dimensions of the PVES impressions. Disinfection with sodium hypochlorite was associated with clinically significant changes in dimensions, with a two-tailed p-value of 0.049. Disinfection with 2-2.5% glutaraldehyde solution was not associated with any significant dimensional variability.

Chimeric Antigen Receptor T Cells in Hodgkin and T-Cell Lymphomas.

The authors review the current use of chimeric antigen receptor (CAR)-transduced T cells (CAR-T) in Hodgkin lymphoma (HL) and T-cell lymphomas (TCL) and discuss the data on CD30-targeting CAR-T cells, which seem to be safe and effective in HL. In addition, the authors examine the use of CAR-T cells targeting CD30, CD5, or CD7 in TCL, while highlighting the unique challenges of their use in this subset of lymphomas. Furthermore, the authors present future directions and ongoing trials investigating the use of CAR-T cells in TCL and HL.

New ion-imprinted polymer for selective removal of Cu2+ ion in aqueous solution using extracted Aloe vera leaves as a monomer.

The objective of this project is to create a unique type of polymer known as an ion imprinted polymer (IIP) and a non-imprinted polymer (NIP) utilizing natural waste biosorbent materials. One example of this type of waste is Aloe vera, a plant with many medicinal uses that is grown globally. Aloe vera is considered one of the most valuable medicinal plants with a wide range of applications. Extracted Aloe vera was used as functional monomers for the first time to prepare new IIPs, epichlorohydrin, and Cu2+ ion as the cross-linking agent and template, respectively. The NIP was also synthesized for comparison, without the use of the Cu2+ salt. Following polymerization, the IIP particles were cleansed of template ions through a 0.1 M EDTA leaching process, resulting in the formation of cavities within the particles, these cavities in the polymer provide selective linking zones for these specific template ions. The synthesized IIPs were characterized using the most recent identification instruments. The experimental parameters for adsorption, such as pH of a solution, contact time, initial copper concentration, adsorbent dosage, and temperature have been optimized. The most effective conditions for metal adsorption onto the ionic imprinted polymer were found to be a pH of 8.0, a temperature of 30 °C, a concentration of 0.03 g/100 mL, and a contact time of 50 min. Based on the ANOVA statistical value, the adsorption of Cu2+ ion on IIP is significant with very low probability (p) values (<0.001). The Langmuir isotherm model and a second-order reaction were both used in the adsorption process. According to thermodynamic characteristics, Cu2+ adsorption over IIPs and NIP was an endothermic, spontaneous process. Compared to NIP, the imprinted polymer exhibits a significantly better capacity and selectivity for Cu2+ adsorption, the maximum removal percentage of IIPs and NIP was 96.02 % and 74.3 % respectively. Moreover, the research showed that ion imprinting can be a promising technique for preparing selective adsorbents to separate and preconcentrate metal in a medium of multiple competitive metals (Co2+, Cd2+, Ni2+, Zn2+, Fe2+, and Pb2+) The most important point for this new Cu2+-IIPs was shown superior reusability up to 8 cycles with small decrees in uptake capability.

A Brief Review of Demographic and Clinical Correlates of Cholesteatoma Surgery in the Qassim Region.

Background Cholesteatoma is described as the accumulation of squamous epithelium and keratinocytes within and around the middle ear cleft. There is a paucity of information regarding demographic and treatment outcomes for cholesteatoma in Saudi Arabia. An evaluation of the prevalence of comorbidities, complications and associations, of surgical treatment and demographics in the Qassim region was conducted. Methods This was a six-year retrospective review of patients treated for cholesteatoma at a private health facility, from August 2016 to July 2022. Data for age, gender, nationality, presence of comorbidities, type of surgery, type of anesthesia, and associated complications were collected from the electronic medical records and analyzed with Statistical Package for Social Sciences software. Results A total of 60 participants records were retrieved. The average age of the study population was ([43.2 ±SD] 21.8) years. There was a slightly higher male preponderance (males 51.7% and females 48.3%). Hypertension was the most commonly reported comorbidity (31.7%), followed by diabetes mellitus (25%). Age and gender were not statistically significantly associated with type of surgery or complications. Conclusion Demographic variables were not significantly associated with clinical correlates, however, further studies with larger sample sizes, robust clinical information, and long-term follow-up are required.

Endemic or regionally limited bacterial and viral infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review.

Literature discussing endemic and regionally limited infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America is scarce. This Worldwide Network for Blood and Marrow Transplantation (WBMT) article is part one of two papers aiming to provide guidance to transplantation centres around the globe regarding infection prevention and treatment, and considerations for transplantation based on current evidence and expert opinion. These recommendations were initially formulated by a core writing team from the WBMT and subsequently underwent multiple revisions by infectious disease experts and HSCT experts. In this paper, we summarise the data and provide recommendations on several endemic and regionally limited viral and bacterial infections, many of which are listed by WHO as neglected tropical diseases, including Dengue, Zika, yellow fever, chikungunya, rabies, brucellosis, melioidosis, and leptospirosis.

Endemic or regionally limited parasitic and fungal infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review.

There is a scarcity of data on endemic and regionally limited fungal and parasitic infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America. This Worldwide Network for Blood and Marrow Transplantation (WBMT) Review is one of two papers aiming to provide guidance to transplantation centres worldwide regarding prevention, diagnosis, and treatment based on the currently available evidence and expert opinion. These recommendations were created and reviewed by physicians with expertise in HSCT or infectious disease, representing several infectious disease and HSCT groups and societies. In this paper, we review the literature on several endemic and regionally limited parasitic and fungal infections, some of which are listed as neglected tropical diseases by WHO, including visceral leishmaniasis, Chagas disease, strongyloidiasis, malaria, schistosomiasis, histoplasmosis, blastomycosis, and coccidioidomycosis.