Epstein-Barr virus-associated risk factors for post-transplant lymphoproliferative disease in pediatric liver transplant recipients.

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) are the most common de novo malignancies after liver transplantation (LT) in children. The aim of our study was to assess the role of pre-LT EBV status and post-LT EBV viral load as risk factors for developing PTLD in a cohort of pediatric LT recipients. METHODS: Data of all children who underwent LT between January 2002 and December 2019 were collected. Two cohorts were built EBV pre-LT primary infected cohort and EBV post-LT primary infected cohort. Moreover, using the maximal EBV viral load, a ROC curve was constructed to find a cutoff point for the diagnosis of PTLD. RESULTS: Among the 251 patients included in the study, fifteen PTLD episodes in 14 LT recipients were detected (2 plasmacytic hyperplasia, 10 polymorphic PTLD, 2 monomorphic PTLD, and 1 Classical-Hodgkin's lymphoma). Patients of the EBV post-LT primary infected cohort were 17.1 times more likely to develop a PTLD than patients of the EBV pre-LT primary infected cohort (2.2-133.5). The EBV viral load value to predict PTLD was set at 211 000 UI/mL (93.3% sensitivity and 77.1% specificity; AUC 93.8%; IC 0.89-0.98). In EBV post-LT primary infected cohort, patients with a viral load above 211 000 were 30 times more likely to develop PTLD than patients with a viral load below this value (OR 29.8; 3.7-241.1; p < 0.001). CONCLUSIONS: The combination of pretransplant EBV serological status with EBV post-transplant viral load could be a powerful tool to stratify the risk of PTLD in pediatric LT patients.

Kaposi sarcoma in a child after hematopoietic stem cell transplantation: Should pre-transplant HHV-8 screening be considered in recipients from high prevalence areas?

Kaposi sarcoma (KS) is an angioproliferative disease associated with human herpesvirus 8 (HHV-8). We report the case of a 10-year-old male from a high HHV-8 prevalence area, diagnosed with severe aplastic anemia who underwent an upfront hematopoietic stem cell transplantation (HSCT). Five months after transplant, the patient was diagnosed with KS with skin, mucosae, lymph nodes and lung involvement. After withdrawal of immunosuppression the patient achieved complete remission without requiring further treatments. KS may occur after HSCT in patients from high HHV-8 prevalence areas. Considering that, we propose that screening of HHV-8 by antibody testing could be considered in HSCT donors/recipients from these areas.

Ten years of TRALI mitigation: measuring our progress.

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality for which multiple mitigation strategies have been implemented over the past decade. However, product-specific TRALI rates have not been reported longitudinally and may help refine additional mitigation strategies. STUDY DESIGN AND METHODS: This retrospective multicenter study included analysis of TRALI rates from 2007 through 2017. Numerators included definite or probable TRALI reports from five blood centers serving nine states in the United States. Denominators were components distributed from participating centers. Rates were calculated as per 100,000 components distributed (p < 0.05 significant). RESULTS: One hundred four TRALI cases were reported from 10,012,707 components distributed (TRALI rate of 1.04 per 100,000 components). The TRALI rate was 2.25 for female versus 1.08 for male donated components (p < .001). The TRALI rate declined from 2.88 in 2007 to 0.60 in 2017. From 2007 to 2013, there was a significantly higher TRALI rate associated with female versus male plasma (33.85 vs. 1.59; p < 0.001) and RBCs (1.97 vs. 1.15; p = 0.03). From 2014 through 2017, after implementation of mitigation strategies, a significantly higher TRALI rate only from female-donated plateletpheresis continued to be observed (2.98 vs. 0.75; p = 0.04). CONCLUSION: Although the TRALI rates have substantially decreased secondary to multiple strategies over the past decade, a residual risk remains, particularly with female-donated plateletpheresis products. Additional tools that may further mitigate TRALI incidence include the use of buffy coat pooled platelets suspended in male donor plasma or platelet additive solution due to the lower amounts of residual plasma.

How do we manage blood donors and recipients after a positive Zika screening result?

Zika virus (ZIKV) is a mosquito-borne flavivirus that is the focus of an ongoing pandemic. ZIKV is notable for its severe neurologic sequelae in babies born to infected mothers. High rates of subclinical infection, as evidenced by the finding of ZIKV RNA in asymptomatic donors, raise concerns of risk to the blood supply. To date, a total of four suspected cases of transfusion-transmitted ZIKV have been reported (all in Brazil), none of which were associated with clinical infection in the transfusion recipients. In 2016, the US Food and Drug Administration issued a guidance mandating national blood donor screening for ZIKV in the United States. Five days after implementation of donor screening at our facility, we encountered a ZIKV-positive donor. We provide a practical approach to donor, recipient, and blood product management in the setting of a positive donor ZIKV result. Such has been informed by the challenges we faced in the workup of a ZIKV-reactive donation and recipient lookback.

Chorioangioma: an uncommon cause of hydramnios and consequent preterm labor in second trimester of pregnancy.

Placental chorioangiomas are relatively common benign placental tumors occurring with an incidence of approximately 1% of histologically studied placentas. However, they show clinical manifestations in very rare pregnancies usually at a median gestational age of 28 weeks. Our report presents an interesting and rare case of severe hydramnios with consequent preterm labor and delivery in the second trimester leading to neonatal death due to placental chorioangioma. An earlier diagnosis could have led to closer monitoring and prevention of the development of severe hydramnios with resultant preterm labor.

Insights into highly engraftable hematopoietic cells from 27-year cryopreserved umbilical cord blood.

Umbilical cord blood transplantation is a life-saving treatment for malignant and non-malignant hematologic disorders. It remains unclear how long cryopreserved units remain functional, and the length of cryopreservation is often used as a criterion to exclude older units. We demonstrate that long-term cryopreserved cord blood retains similar numbers of hematopoietic stem and progenitor cells compared with fresh and recently cryopreserved cord blood units. Long-term cryopreserved units contain highly functional cells, yielding robust engraftment in mouse transplantation models. We also leverage differences between units to examine gene programs associated with better engraftment. Transcriptomic analyses reveal that gene programs associated with lineage determination and oxidative stress are enriched in high engrafting cord blood, revealing potential molecular markers to be used as potency markers for cord blood unit selection regardless of length of cryopreservation. In summary, cord blood units cryopreserved for extended periods retain engrafting potential and can potentially be used for patient treatment.

Congenital infection of SARS-CoV-2 in live-born neonates: a population-based descriptive study.

OBJECTIVE: To evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a descriptive, multicentre, observational study in nine tertiary care hospitals throughout Spain. The study population was women with coronavirus disease 2019 during pregnancy. Mother-to-child transmission was defined as positive real-time RT-PCR of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. RESULTS: We included 43 women with singleton pregnancies and one with a twin pregnancy, as a result we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14-41.3 weeks). The median interval between positive RT-PCR and delivery was 21.5 days (range 0-141 days). Fourteen women (31.8%, 95% CI 18.6%-47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95% CI 0.1%-11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95% CI 0%-9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24-48 hours, and one returned positive (9.1%, 95% CI 0.2%-41.3%). CONCLUSIONS: The presence of SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.

Leptomeningeal Carcinomatosis as the Initial Manifestation of Metastatic Disease diagnosed in Postmortem Examination: A Case Series.

Leptomeningeal carcinomatosis (LMC) refers to the infiltration of malignant cells in the pia-arachnoids. LMC is undiagnosed until autopsy in about 20% of cases. A nonspecific neurologic symptomatology makes diagnosis challenging; especially in the scenario of unknown malignancy. Diagnosis is made by the identification of malignant cells in CSF; though studies have shown that serial examination may be required for acceptable accuracy. We report 3 cases with distinct neurological presentations, negative cerebrospinal fluid (CSF) examinations and neurological imaging. A 52 year old woman with history of breast cancer on remission, a 2 year old male with left ear rhabdomyosarcoma status post resection, and a 59 year old woman with communicating hydrocephalus of unknown etiology. LMC was diagnosed at autopsy and confirmed by immunohistochemistry. LMC is a complication requiring a high level of clinical suspicion. Postmortem examination is an invaluable tool to confirm LMC as part of the multidisciplinary approach aiming towards the improvement of clinical diagnosis.

Zika Virus and the Blood Supply: What Do We Know?

Zika virus (ZIKV), a mosquito-borne Flavivirus and emerging infectious disease, is the focus of an international public health emergency after its rapid spread through the Americas and the Caribbean. Although most ZIKV infections are subclinical or characterized by mild febrile illness, ZIKV has been implicated in severe complications, most notably microcephaly in babies born to incident infected mothers during pregnancy. As yet, the extent to which ZIKV is transfusion transmissible remains undefined. Nonetheless, a high prevalence of asymptomatic infection during outbreaks, the demonstration of ZIKV in blood donors, and 4 possible cases of transfusion-transmitted ZIKV in Brazil have raised concern for risk to the blood supply. Consequently, a proactive response is underway by blood collection agencies, regulatory bodies, national funding agencies, and industry alike. Mitigation strategies differ between endemic and nonendemic areas. In the continental United States, the American Association of Blood Banks and Food and Drug Administration guidelines recommend travel-based deferral for those returning from affected areas, and nucleic acid testing is being initiated under an investigational new drug application in Puerto Rico and selected areas of the United States. Options are less clear for countries where autochthonous vector-borne transmission is active. The burden of Zika falls in low-resource countries where high cost and technical barriers associated with testing and pathogen reduction pose barriers to implementation. Additional strategies include maintaining selective inventory for high-risk recipients (eg, pregnant women). We review the available data as of July 2016 on ZIKV in relation to the blood supply including risk, mitigation strategies, and barriers to implementation in addition to the research that is needed to address current uncertainty.

Patterns of HER2 Gene Amplification and Response to Anti-HER2 Therapies.

A chromosomal region that includes the gene encoding HER2, a receptor tyrosine kinase (RTK), is amplified in 20% of breast cancers. Although these tumors tend to respond to drugs directed against HER2, they frequently become resistant and resume their malignant progression. Gene amplification in double minutes (DMs), which are extrachromosomal entities whose number can be dynamically regulated, has been suggested to facilitate the acquisition of resistance to therapies targeting RTKs. Here we show that ~30% of HER2-positive tumors show amplification in DMs. However, these tumors respond to trastuzumab in a similar fashion than those with amplification of the HER2 gene within chromosomes. Furthermore, in different models of resistance to anti-HER2 therapies, the number of DMs containing HER2 is maintained, even when the acquisition of resistance is concomitant with loss of HER2 protein expression. Thus, both clinical and preclinical data show that, despite expectations, loss of HER2 protein expression due to loss of DMs containing HER2 is not a likely mechanism of resistance to anti-HER2 therapies.

Relación entre situaciones generadoras de estrés, burnout y afrontamiento en entrenadores deportivos / Relation between stress-generating situations, burnout and coping in sports coaches / Relação entre situações geradoras de estresse, burnout e coping em treinadores esportivos

Este estudio investiga los índices de burnout en una muestra de entrenadores deportivos, así como su relación con los estilos de afrontamiento, situaciones generadoras de estrés y variables como sexo, edad y años de experiencia. Se trata de un estudio descriptivo correlacional en el que participaron 142 entrenadores deportivos. Se utilizó el Inventario de burnout adaptado al entrenador, el inventario Brief COPE-28 y una escala de situaciones generadoras de estrés. El 33.4% de las mujeres y el 20.9% de los hombres presentan niveles altos de burnout en más de dos dimensiones. En hombres y mujeres, hay una relación significativa entre las situaciones generadoras de estrés y agotamiento emocional y entre afrontamiento centrado en el problema y reducida realización personal. En el estudio se discute respecto a la importancia de centrar investigaciones en situaciones generadoras de estrés y la forma de afrontarlo en los entrenadores deportivos

This study investigates burnout rates in a sample of sports coaches, as well as their relation to coping styles, stress-generating situations and variables such as sex, age and years of experience. It is a descriptive correlational study in which 142 sports coaches participated. The Burnout Inventory adapted to the trainer, the Brief COPE-28 inventory and a scale of stress-generating situations were used. 33.4% of women and 20.9% of men have high levels of burnout in more than two dimensions. In men and women, there is a significant relationship between situations that generate stress and emotional exhaustion and in coping focused on the problem and reduced personal fulfillment. The study discusses the importance of focusing research on situations that generate stress and how to deal with it in sports coaches

Este estudo investiga as taxas de burnout em uma amostra de treinadores esportivos, bem como sua relação com estilos de enfrentamento, situações geradoras de estresse e variáveis como sexo, idade e anos de experiência. Trata-se de um estudo descritivo correlacional, no qual participaram 142 treinadores esportivos. Utilizamos o Burnout Inventory adaptado ao coach, o Inventário Brief COPE-28 e uma escala de situações geradoras de estresse. 33,4% das mulheres e 20,9% dos homens apresentam altos níveis de burnout em mais de duas dimensões. Em homens e mulheres, há uma relação signicativa entre as situações que geram estresse e exaustão emocional e entre enfrentamento focado no problema e redução da realização pessoal. O estudo discute a importância de focar a pesquisa em situações que geram estresse e como lidar comisso em treinadores esportivos

La enfermedad pulmonar intersticial en el niño. Todavía hoy un reto diagnóstico / Pediatric Interstitial Lung Disease: an Ongoing Challenge

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Síndrome de Burnout en deportistas universitarios mexicanos / Síndrome de Burnout em atletas universitários mexicanos / Burnout syndrome in Mexican university sportmen

El Síndrome de Burnout es producto del estrés crónico que se manifiesta por la fatiga crónica tanto física como psíquica, ira, sentimientos de autocrítica, impotencia, negatividad, irritabilidad, entre otros. Se manifiesta en los deportistas en tres áreas principalmente: psicológica, ambiental y deportiva. El objetivo de esta investigación fue conocer la prevalencia del síndrome de agotamiento crónico en deportistas de una competencia nacional entre universitarios. En la investigación participaron 531 estudiantes de diferentes deportes, estados, universidades y licenciaturas. Se utilizó un cuestionario sociodemográfico para conocer datos personales y del entorno donde interactúa el deportista; y para evaluar el Burnout se utilizó el inventario de Burnout de Maslach y Jackson en su versión adaptada al deporte. Se obtuvo una confiabilidad de .789 en el instrumento, y la media más alta en realización personal, no encontrando diferencias significativas respecto al sexo y las dimensiones que componen el síndrome (AU)

Burnout Syndrome is a result of chronic stress manifested by chronic fatigue both physical and mental, anger, feelings of self-criticism, impotence, negativity, irritability, among others. It manifests in the athletes in three main areas: psychological, environmental and sports. The aim of this research is to determine the prevalence of chronic fatigue syndrome in the athletes of Guadalajara´s National University, located in Jalisco, México in the year of 2008. In the research 531 students were involved, all of them from different sports, place of residence, universities and degrees. A sociodemographic questionnaire was implemented to obtain personal data as well as information of the environment where the athletes interact; to evaluate the Burnout, the Maslach and Jackson’s inventory was used in its adapted sport version. With the test, a reliability of .789 was obtained in the instrument, and the highest middle in personal accomplishment, not finding significant differences regarding to gender and the dimensions that compose the syndrome (AU)

A síndrome de Burnout é o resultado de estresse crônico manifestada pela fadiga crônica física e mental, raiva, sentimentos de auto-crítica, a impotência, a negatividade, irritabilidade, entre outros. Ela se manifesta em atletas em três áreas principais: psicológico, ambiental e desportivo. O objetivo desta pesquisa foi determinar a prevalência da síndrome da fadiga crônica em atletas de uma competição nacional entre os estudantes universitários. A pesquisa envolveu 531 estudantes de diferentes esportes, estados, universidades e graus. Um questionário sociodemográfico foi usado para aprender dados pessoais e do ambiente onde ele interage; e para avaliar o Burnout, o inventário de Burnout de Maslach e Jackson foi usado na sua versão adaptada para o esporte. Foi obtido 0,789 confiabilidade do instrumento, e a maior média na realização pessoal, sem diferenças significativas em relação ao gênero e dimensões que compõem a síndrome (AU)

Caso clínico: cansancioen el rol de cuidadora / Clinical case: carer’s tiredness

Se presenta un caso clínico de una paciente de 74 años con diagnósticosmédicos de HTA, insomnio y osteoporosis y que es la cuidadora principalde su esposo, el cual se encuentra en fase terminal. La cuidados enfermerosse desarrollan en el entorno domiciliario. Tras realizar la valoraciónsegún los Patrones Funcionales de Salud de Marjory Gordon seidentificó, entre otros problemas, el diagnóstico enfermero de Cansanciodel rol de cuidador (taxonomía II de la North American NursingDiagnosis Association). Después de implantar el plan de cuidados ymantener una gran implicación con la paciente se obtuvieron unos resultados,aunque lentos, muy satisfactorios en un corto período de tiempo;se observó una mejoría de la autoconfianza y del afrontamiento enla paciente, incrementando además sus relaciones sociales (AU)

A clinical case of a 74-year old patient with medical diagnoses of HT,insomnia and osteoporosis and is the main carer of her husband, whois in terminal phase, is presented. Nursing care is developed in a homesetting. After performing the assessment based on Marjory Gordon’sFunctional Health Patterns, the nursing diagnosis of carer’s tiredness(taxonomy II of the North American Nursing Diagnosis Association)was made.After implementing the care plan and maintaining high involvement ofthe patient, very satisfactory, albeit slow, results were obtained in a shortperiod of time; improved self-confidence and coping were observed inthe patient, in addition to increased social relationships (AU)