Retrospective review of intravenous pentamidine for Pneumocystis pneumonia prophylaxis in allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk of numerous opportunistic infections. Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that can develop in immunocompromised individuals. Current prophylaxis for PJP includes trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, atovaquone, or inhaled pentamidine (PEN), often with varying breakthrough rates. The use of intravenous (IV) PEN for PJP prophylaxis has been evaluated in pediatric patients. METHODS: A single-institution retrospective review of electronic medical records was conducted for patients who underwent allo-HSCT between January 2001 and May 2013 and who had received at least 1 dose of IV PEN for PJP prophylaxis. Data collected included patient demographics, diagnosis, previous chemotherapy, pre-transplant conditioning regimen, other medications, microbiology test results, and clinical outcomes. RESULTS: A total of 113 patients were included in the study. The median number of PEN doses administered per patient was 3 (range 1-23). IV PEN was primary PJP prophylaxis in 74 of the patients (65%) and second-line prophylaxis in 39 (35%) post transplant, with the majority switching from oral TMP-SMX. Side effects of IV PEN administration were minimal. No patients who received IV PEN prophylaxis developed PJP infection. No case of PJP was seen in patients who received other agents for PJP prophylaxis. CONCLUSION: This retrospective study showed that IV PEN is very effective and well-tolerated prophylaxis for PJP; IV PEN can be considered a favorable alternative for PJP in situations where other agents might be contraindicated. Our findings provide strong support for prospective studies of IV PEN for PJP prophylaxis in adult HSCT recipients.

Treatment of refractory ITP and Evans syndrome by haematopoietic cell transplantation: is it indicated, and for whom?

Several lines of therapy have been established for patients with immune thrombocytopenia (ITP) and Evans syndrome. However, these therapies generally require prolonged administration, lead to profound immunosuppression and increased infectious risk, and are often poorly tolerated. While most patients with these disorders will respond to first-line steroid therapy, others will prove refractory or intolerant to multiple treatments. In these patients (and possibly even selected patients who are not considered refractory), autologous or allogeneic haematopoietic stem cell transplantation (HCT) may provide definitive therapy. We review the literature on the treatment of ITP and Evans syndrome with HCT and discuss its use in the management of these disorders. We also pose, for the purpose of discussion, research questions that will be important to address if HCT is to be considered a viable option for more patients with these diseases.

Fluorescent antinuclear antibody and anti-double-stranded DNA antibody testing: a four years experience.

Fluorescent antinuclear antibody test (FANA) and anti-double stranded deoxytribonucleic acid (dsDNA) antibody testing is an integral part of the evaluation of the patients who are suspected of having connective tissue disease. We tested 2,140 serum samples for FANA and 1,460 serum samples for anti-dsDNA antibodies. Of 2,140 serum samples tested for FANA, 492 (23%) yielded a positive result (titre of 1:80 or greater) and of 1,460 serum samples tested for anti-dsDNA, 69 (4.7%) yielded positive results. Highest number (n = 27) of serum samples positive for anti-dsDNA antibodies were found in serum samples that were positive for FANA test at a titre of 1:1280 or greater. In conclusion, FANA test can be used as an initial screening test for connective tissue/autoimmune disorders.

Nontuberculous Mycobacteria subcarinal lymphadenitis and severe airway obstruction.

This report has emphasized the importance of a careful evaluation of the chest roentgenogram for lymphadenopathy in children with wheezing, cough, or other symptoms of lower airway disease. This patient report also illustrates that intrathoracic lymphadenitis caused by nontuberculous mycobacteria should be considered in children with unexplained airway obstruction.

Anti-tumor effect of human lymphocytes and interleukin-2.

We studied the anti-tumor effect of control human lymphocytes and interleukin-2 (IL-2) activated lymphocytes (lymphokine activated killer cells, LAK-cells), on two different cell lines: SW742 human colon adenocarcinoma and K562 human myeloid leukaemia cell line. Our results indicate that IL-2 augment the anti-tumor activity of human lymphocytes and these LAK-cells lyse the tumor cells very efficiently. Furthermore, we treated the target cells (SW742 and K562) with different cytokines in order to establish whether these cytokines have any effect on susceptibility to lysis by LAK-cells. Anti-tumor activity of human lymphocytes and IL-2 is discussed in this study.

Detection of HIV-antibody evaluation of four commercially available enzyme immunoassays.

We evaluated 550 serum samples with four commercially available enzyme immunoassays and Western Blot was used as the confirmatory test for antibodies against human immunodeficiency virus (HIV). The Wellcozyme (Wellcome), Flow HIV-TEK G, and Behring test kits identified all 50 Western Blot positive samples correctly, whereas DuPont failed to detect one sample. None of the kit was able to pickup one sample that showed a faint P24 band on Western Blot strip. The frequency of false positive reaction in the 500 negative serum samples were Wellcome 0%, Behring and DuPont 0.2% and Flow HIV-TEK 0.4%.

Prevalence of cryptosporidium in Rawalpindi/Islamabad a comparison of saline, iodine and stained preparations.

Three hundred stool samples for routine ova and parasite examination were examined as saline and iodine wet preparations, the results were then compared with the Zeihl-Neelsen-modified Acid Fast staining (MAFS), as the oocysts are acid fast in character. Examination with saline preparation was unable to detect any oocyst, while iodine preparation yielded three oocyst and stained smears with MAFS revealed five positive stool samples.