Chronic Lymphocytic Leukemia in Pregnancy: A Review of the Available Literature and the Pharmacological Challenges in Management.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a rare hematologic malignancy to occur in pregnancy, with an estimated incidence of 1 in 75,000 pregnancies. Pregnant women with CLL face increased susceptibility to infections, due to a weakened immune system. Higher risks of fetal malformations and death are associated with CLL treatment during pregnancy, emphasizing the need for careful consideration and management in these cases. SUMMARY: This review aimed to summarize the current evidence regarding the diagnosis, prognosis, and treatment of CLL in pregnant cases. A comprehensive search strategy was employed across multiple databases, yielding 14 case reports for inclusion. The cases were divided based on CLL diagnosis onset, either before or during pregnancy. Our results showed that patients diagnosed during pregnancy (n = 5) were mostly asymptomatic at diagnosis, with management ranging from supportive care to leukapheresis and transfusions. Postpartum treatment varied, with some patients requiring no additional therapy and others receiving chemotherapy. Pregnancy outcomes were generally favorable, with most neonates born healthy at term. However, one case of Richter transformation resulted in maternal death despite treatment. Among patients with pre-existing CLL (n = 9), the majority experienced an indolent course during pregnancy, with only supportive care required. A few cases necessitated treatment due to progressive disease or complications, including chemotherapy, leukapheresis, and splenectomy. KEY MESSAGES: This review highlights the heterogeneous nature of CLL in pregnancy and the importance of individualized management based on disease severity, gestational age, and maternal-fetal risks. Close monitoring, supportive care, and a multidisciplinary approach are essential for optimizing outcomes in this rare and complex clinical scenario.

Virtual monochromatic reconstructions of dual energy CT in abdominal trauma: optimization of energy level improves pancreas laceration conspicuity and diagnostic confidence.

PURPOSE: Pancreatic injury is associated with significant morbidity and mortality. Pancreatic lacerations can be challenging to identify as the pancreas is not scanned at peak enhancement in most trauma CT protocols. This study qualitatively and quantitively assessed pancreatic lacerations with virtual monoenergetic dual-energy CT (DE CT) to establish an optimal energy level for visualization of pancreatic lacerations. METHODS: Institutional review board approval was obtained. We retrospectively examined 17 contrast-enhanced CT studies in patients with blunt trauma with MRCP, ERCP, or surgically proven pancreatic lacerations. All studies were performed in our Emergency Department from 2016 to 2019 with a 128 slice dual-source DE CT scanner. Conventional 120 kVp and noise-optimized virtual monoenergetic imaging (VMI) datasets were created. VMI energy levels were constructed from 40 to 100 keV in 10 keV increments and analyzed quantitatively and qualitatively. Pancreatic laceration attenuation, background parenchymal attenuation, and noise were calculated. Qualitative assessment was performed by two independent readers. RESULTS: The optimal CNR for the assessment of pancreatic lacerations was observed at VMI-40 in comparison with standard reconstructions and the remaining VMI energy levels (p = 0.001). Readers reported improved contrast resolution, diagnostic confidence, and laceration conspicuity at VMI at 40 keV (p = 0.016, p = 0.002, and p = 0.0012 respectively). However, diagnostic acceptability and subjective noise were improved on conventional polyenergentic images (p = 0.0006 and p = 0.001 respectively). CONCLUSION: Dual energy CT at VMI-40 maximizes the CNR of pancreatic laceration, improves diagnostic confidence, and increases laceration conspicuity.

Emergency Imaging in Pregnancy and Lactation [Formula: see text].

The use of diagnostic imaging studies in the emergency setting has increased dramatically over the past couple of decades. The emergency imaging of pregnant and lactating patients poses unique challenges and calls upon the crucial role of radiologists as consultants to the referring physician to guide appropriate use of imaging tests, minimize risk, ensure timely management, and occasionally alleviate unwarranted trepidation. A clear understanding of the risks and benefits involved with various imaging tests in this patient population is vital to achieve this. This review discusses the different safety and appropriateness issues that could arise with the use of ionizing radiation, iodinated-, and gadolinium-based contrast media and radiopharmaceuticals in pregnant and lactating patients. Special considerations such as trauma imaging, safety concerns with magnetic resonance imaging and ultrasound, management of claustrophobia, contrast extravasation, and allergic reactions are also reviewed. The consent process for these examinations has also been described.

Using Social Media to Characterize Public Sentiment Toward Medical Interventions Commonly Used for Cancer Screening: An Observational Study.

BACKGROUND: Although cancer screening reduces morbidity and mortality, millions of people worldwide remain unscreened. Social media provide a unique platform to understand public sentiment toward tools that are commonly used for cancer screening. OBJECTIVE: The objective of our study was to examine public sentiment toward colonoscopy, mammography, and Pap smear and how this sentiment spreads by analyzing discourse on Twitter. METHODS: In this observational study, we classified 32,847 tweets (online postings on Twitter) related to colonoscopy, mammography, or Pap smears using a naive Bayes algorithm as containing positive, negative, or neutral sentiment. Additionally, we characterized the spread of sentiment on Twitter using an established model to study contagion. RESULTS: Colonoscopy-related tweets were more likely to express negative than positive sentiment (negative to positive ratio 1.65, 95% CI 1.51-1.80, P<.001), in contrast to the more positive sentiment expressed regarding mammography (negative to positive ratio 0.43, 95% CI 0.39-0.47, P<.001). The proportions of negative versus positive tweets about Pap smear were not significantly different (negative to positive ratio 0.95, 95% CI 0.87-1.04, P=.18). Positive and negative tweets tended to share lexical features across screening modalities. Positive tweets expressed resonance with the benefits of early detection. Fear and pain were the principal lexical features seen in negative tweets. Negative sentiment for colonoscopy and mammography spread more than positive sentiment; no correlation with sentiment and spread was seen for Pap smear. CONCLUSIONS: Analysis of social media data provides a unique, quantitative framework to better understand the public's perception of medical interventions that are commonly used for cancer screening. Given the growing use of social media, public health interventions to improve cancer screening should use the health perceptions of the population as expressed in social network postings about tests that are frequently used for cancer screening, as well as other people they may influence with such postings.

The Legionella pneumophila Dot/Icm-secreted effector PlcC/CegC1 together with PlcA and PlcB promotes virulence and belongs to a novel zinc metallophospholipase C family present in bacteria and fungi.

Legionella pneumophila is a water-borne bacterium that causes pneumonia in humans. PlcA and PlcB are two previously defined L. pneumophila proteins with homology to the phosphatidylcholine-specific phospholipase C (PC-PLC) of Pseudomonas fluorescens. Additionally, we found that Lpg0012 shows similarity to PLCs and has been shown to be a Dot/Icm-injected effector, CegC1, which is designated here as PlcC. It remained unclear, however, whether these L. pneumophila proteins exhibit PLC activity. PlcC expressed in Escherichia coli hydrolyzed a broad phospholipid spectrum, including PC, phosphatidylglycerol (PG), and phosphatidylinositol. The addition of Zn(2+) ions activated, whereas EDTA inhibited, PlcC-derived PLC activity. Protein homology search revealed that the three Legionella enzymes and P. fluorescens PC-PLC share conserved domains also present in uncharacterized fungal proteins. Fifteen conserved amino acids were essential for enzyme activity as identified via PlcC mutagenesis. Analysis of defined L. pneumophila knock-out mutants indicated Lsp-dependent export of PG-hydrolyzing PLC activity. PlcA and PlcB exhibited PG-specific activity and contain a predicted Sec signal sequence. In line with the reported requirement of host cell contact for Dot/Icm-dependent effector translocation, PlcC showed cell-associated PC-specific PLC activity after bacterial growth in broth. A PLC triple mutant, but not single or double mutants, exhibited reduced host killing in a Galleria mellonella infection model, highlighting the importance of the three PLCs in pathogenesis. In summary, we describe here a novel Zn(2+)-dependent PLC family present in Legionella, Pseudomonas, and fungi with broad substrate preference and function in virulence.

The cocaine trail: levamisole-induced leukocytoclastic vasculitis in a cocaine user.

Two million Americans use cocaine on a regular basis. Sixty-nine percent of cocaine in the United States is adulterated with levamisole, a veterinary antihelminthic drug. In 2008, the first cases of levamisole-induced agranulocytosis and vasculopathy associated with adulterated cocaine were reported in the southwestern United States. Since then, reports of levamisole-associated toxicity have become increasingly common. The authors present the case of a 47-year-old woman from Michigan with purpuric lesions likely secondary to levamisole-induced leukocytoclastic vasculitis.

Revolutionizing chronic lymphocytic leukemia diagnosis: A deep dive into the diverse applications of machine learning.

Chronic lymphocytic leukemia (CLL) is a B cell neoplasm characterized by the accumulation of aberrant monoclonal B lymphocytes. CLL is the predominant type of leukemia in Western countries, accounting for 25% of cases. Although many patients remain asymptomatic, a subset may exhibit typical lymphoma symptoms, acquired immunodeficiency disorders, or autoimmune complications. Diagnosis involves blood tests showing increased lymphocytes and further examination using peripheral blood smear and flow cytometry to confirm the disease. With the significant advancements in machine learning (ML) and artificial intelligence (AI) in recent years, numerous models and algorithms have been proposed to support the diagnosis and classification of CLL. In this review, we discuss the benefits and drawbacks of recent applications of ML algorithms in the diagnosis and evaluation of patients diagnosed with CLL.

The Association Between Short Sleep Duration and Metabolic Syndrome: A Case-Control Study.

Purpose: Short sleep duration and quality are increasingly common in the Middle East and North Africa (MENA) region and has been linked to metabolic syndrome, which increases the risk of cardiovascular disease and diabetes. This study aimed to examine the link between short sleep duration and metabolic syndrome. Patients and Methods: We conducted a case-control study using data from Qatar Biobank, with 1000 participants categorized into two groups: less than 7 hours of sleep (n=500) and 7 or more hours of sleep (n=500). Metabolic syndrome was defined using WHO criteria, and logistic regression analysis adjusted for age and gender. Results: There was a higher proportion of individuals with MetS in the short sleep duration group compared to the normal sleep duration group (22.8% vs 15.8%, respectively). The multivariable regression showed that short sleep duration was associated with metabolic syndrome (OR 1.91, 95% CI: 1.14-3.20, P=0.014) and having 1-2 components of metabolic syndrome (OR 1.91, 95% CI: 1.14-3.20, P=0.014), particularly in males (OR: 2.30, 95% CI: 1.07-4.94, P=0.032). Being overweight (OR 2.17, 95% CI: 1.30-3.63, P=0.003) was also associated with a shorter sleep duration. BMI was identified as the main contributor to the association between short sleep duration and metabolic syndrome, while diabetes played a minor role. Conclusion: Short sleep duration was associated with metabolic syndrome in Qatar, particularly in males.

Deep learning enhances acute lymphoblastic leukemia diagnosis and classification using bone marrow images.

Acute lymphoblastic leukemia (ALL) poses a significant health challenge, particularly in pediatric cases, requiring precise and rapid diagnostic approaches. This comprehensive review explores the transformative capacity of deep learning (DL) in enhancing ALL diagnosis and classification, focusing on bone marrow image analysis. Examining ten studies conducted between 2013 and 2023 across various countries, including India, China, KSA, and Mexico, the synthesis underscores the adaptability and proficiency of DL methodologies in detecting leukemia. Innovative DL models, notably Convolutional Neural Networks (CNNs) with Cat-Boosting, XG-Boosting, and Transfer Learning techniques, demonstrate notable approaches. Some models achieve outstanding accuracy, with one CNN reaching 100% in cancer cell classification. The incorporation of novel algorithms like Cat-Swarm Optimization and specialized CNN architectures contributes to superior classification accuracy. Performance metrics highlight these achievements, with models consistently outperforming traditional diagnostic methods. For instance, a CNN with Cat-Boosting attains 100% accuracy, while others hover around 99%, showcasing DL models' robustness in ALL diagnosis. Despite acknowledged challenges, such as the need for larger and more diverse datasets, these findings underscore DL's transformative potential in reshaping leukemia diagnostics. The high numerical accuracies accentuate a promising trajectory toward more efficient and accurate ALL diagnosis in clinical settings, prompting ongoing research to address challenges and refine DL models for optimal clinical integration.

Integrating AI and ML in Myelodysplastic Syndrome Diagnosis: State-of-the-Art and Future Prospects.

Myelodysplastic syndrome (MDS) is composed of diverse hematological malignancies caused by dysfunctional stem cells, leading to abnormal hematopoiesis and cytopenia. Approximately 30% of MDS cases progress to acute myeloid leukemia (AML), a more aggressive disease. Early detection is crucial to intervene before MDS progresses to AML. The current diagnostic process for MDS involves analyzing peripheral blood smear (PBS), bone marrow sample (BMS), and flow cytometry (FC) data, along with clinical patient information, which is labor-intensive and time-consuming. Recent advancements in machine learning offer an opportunity for faster, automated, and accurate diagnosis of MDS. In this review, we aim to provide an overview of the current applications of AI in the diagnosis of MDS and highlight their advantages, disadvantages, and performance metrics.

The restoration and erection of the world's first elevated obelisk.

Obelisks presented an important element in the architecture of ancient Egypt. This research is concerned with the re-erection of an obelisk that belongs to the famous Pharoah Ramses II. It was found broken and was transported to the Grand Egyptian Museum for restoration and display. An observation of Ramses II Cartouche at the bottom side of the obelisk base inspired the authorities to provide an innovative architectural design to display the obelisk elevated. The supporting structure was designed to allow the visitors to walk underneath the obelisk and observe Ramses II's signature. The idea of elevating the obelisk presented several challenges including evaluating the obelisk's current condition, restoration and fixation methodology, structural stability, and uncertainties of material characteristics, amongst others. To control the obelisk deformations under lateral loading, state-of-the-art base isolators were introduced. For the task to be achieved, a multidisciplinary team including historians, conservators, archaeologists, architects, and engineers with different specialties was appointed. The team performed the task successfully and currently, the obelisk stands at the entrance piazza of the Grand Egyptian Museum representing the world's first elevated obelisk.

The role of endoscopy in the management of recurrent pyogenic cholangitis: a review.

Recurrent pyogenic cholangitis (RPC) is a clinical syndrome characterized by repeated episodes of suppurative cholangitis due to hepatolithiasis and extrahepatic stones in the biliary ducts. It is now recognized as a distinct syndrome with a different natural history and pathoetiology than spontaneously occurring liver abscesses. Most commonly seen in East Asian populations, this syndrome is growing increasingly common in Western Nations due to migration patterns. The exact pathogenesis of RPC remains elusive; although colonization of the biliary tract with particular enteric bacterial species, in combination with possible dietary factors, has been attributed as causative factors. Hepatobiliary surgery, in particular segmental hepatectomy, is often described as the definitive treatment of choice for RPC. The exact role of endoscopic intervention has been less clearly described in the literature. This review focuses on the management of RPC while highlighting situations in which endoscopic retrograde cholangiopancreatography may be preferred over surgery as an initial or salvage therapeutic measure.