Clinical presentation and outcome of enteric fever in adult patients with cancer: a perspective from Pakistan.

Introduction. Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients, limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients. Methodology. This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with Salmonella typhi or paratyphi A, B, or C. We examined clinical presentation, laboratory parameters, antimicrobial resistance, complications, and outcomes. Additionally, we explored the effects of chemotherapy, comorbidities, type of malignancy, and patient age on complications and mortality. Results. Salmonella typhi was the most prevalent organism (72.2 %), followed by Salmonella paratyphi A (22.2 %) and B (5.5 %). Variably-resistant isolates constituted 51.5 %, multi-drug resistant (MDR) isolates accounted for 20 %, extensively drug-resistant (XDR) for 14.4 % and ESBL-producers for 15.5 %, of all enteric fever infections. Enteric fever-associated complications were observed in 21.1 % of cases. Chemotherapy in the preceding month did not affect mortality, nor did age, gender, or malignancy type. However, comorbidities were statistically significant for mortality (p-value 0.03). A total of 8.8 % of patients required ICU care, and the all-cause 30 day mortality rate was 13.3 % Conclusion. Enteric fever remains prevalent in our geographical region. Unlike non-typhoidal Salmonella (NTS), enteric fever does not behave differently in an immunocompromised population, including cancer patients.

Clinical Characteristics and Outcomes of Pneumocystis jirovecii Pneumonia in Cancer Patients From a Tertiary Care Hospital.

Objective To investigate the predisposing factors, disease course, potential complications, role of primary prophylaxis, and overall outcomes of Pneumocystis jirovecii pneumonia (PJP) in cancer patients. Methods The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. We analyzed the medical records of cancer patients diagnosed with PJP from January 2018 to December 2022 and collected data about demographic characteristics, clinical presentation, predisposing factors, treatment, complications, and mortality rates. We used SPSS 20 (IBM Corp., Armonk, NY, USA) for data analysis. Results Out of 84 patients, 59.5% (n=50) were males and most of the patients belonged to the age group 41 to 65 years. Sixty-seven point nine percent (67.9%; n=57) of patients had underlying hematological malignancy, including three bone marrow transplant recipients while 32.2% (n=27) of patients had underlying solid organ malignancy. We also observed the use of corticosteroids, rituximab, and fludarabine as predisposing factors in 15% (n=13), 27% (n=23), and 3.7%(n=03) of patients, respectively. The most common symptoms were dyspnea (88%; n=74), followed by fever (69%; n=58) and cough (69%; n=58). The former one was more prevalent in hematological malignancy patients as compared to the solid organ tumor group (p-value 0.001). We noted respiratory failure (45.2%; n=38), ICU stay (52.38%; n=44), death (32%; n=27), and shock (10.7% n=9) as the most common PJP-related complications. Moreover, all these complications were more frequent in hematological malignancy patients. We also observed that only three patients developed PJP while on adequate primary prophylaxis for this condition. The overall all-cause one-month mortality was 32% (n=27). Conclusion Cancer patients, especially those with hematological malignancies presenting with symptoms suggestive of PJP, need careful evaluation and preemptive treatment as PJP-related mortality is higher in cancer patients. Early diagnosis and treatment in this population can be lifesaving. Moreover, all cancer patients should receive PJP prophylaxis when indicated.

Low-Permittivity and Low-Temperature Cofired BaSO4-BaF2 Microwave Dielectric Ceramics for High-Reliability Packaged Electronics.

In developing low-temperature cofired ceramic (LTCC) technology for high-density packaging or advanced packaged electronics, matching the coefficient of thermal expansion (CTE) among the packaged components is a critical challenge to improve reliability. The CTEs of solders and organic laminates are usually larger than 16.0 ppm of °C1-, while most low-permittivity (εr) dielectric ceramics have CTEs of less than 10.0 ppm °C1-. Therefore, a good CTE match between organic laminates and dielectric ceramics is required for further LTCC applications. In this paper, we propose a high-CTE BaSO4-BaF2 LTCC as a potential solution for high-reliability packaged electronics. The BaSO4-BaF2 ceramics have the advantages of a wide low-temperature sintering range (650-850 °C), low loss, temperature stability, and Ag compatibility, ensuring excellent performance in LTCC technology. The 95 wt %BaSO4-5 wt %BaF2 ceramic has a εr of 9.1, a Q × f of 40,100 GHz @11.03 GHz (Q = 1/tan δ), a temperature coefficient of the resonant frequency of -11.2 ppm °C1-, a CTE of +21.8 ppm °C1-, and a thermal conductivity of 1.3 W mK-1 when sintered at 750 °C. Furthermore, a dielectric resonant antenna using BaSO4-BaF2 ceramics, a typically packaged component of LTCC and laminate, was designed and used to verify the excellent performance by a gain of 6.0 dBi at a central frequency of 8.97 GHz and a high radiation efficiency of 90% over a bandwidth of 760 MHz. Good match and low thermal stress were found in the packaged components of BaSO4-BaF2 ceramics, organic laminates, and Sn-based solders by finite element analysis, proving the potential of this LTCC for high-reliability packaged electronics.