Health-Related Quality of Life Outcomes in Older Hematopoietic Cell Transplantation Survivors.

The use of hematopoietic cell transplantation (HCT) has been increasing in older patients. However, the levels if distress, psychosocial functioning, and health-related quality of life (HRQOL) among older HCT survivors remains largely unknown. In this secondary analysis using data from 2 randomized controlled trials, we analyzed baseline Cancer and Treatment Distress (CTXD) and Confidence In Survivorship Information (CSI) surveys of HCT survivors who were age ≥60 years at the time of transplantation and alive and disease-free ≥1 year post-autologous or -allogeneic HCT. We analyzed associations of these parameters with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) and a healthcare adherence (HCA) scale, after adjusting for transplantation and patient demographic factors. A total of 567 patients were included. The median patient age at HCT was 65 years, and 68% of the patients underwent autologous HCT. The median CTXD score was .7 (mild), and the greatest distress was reported in the "health burden" subscale. The median CSI score was 1.4 (moderate-high), with the lowest confidence reported in the "late effects" subscale. We found negative Spearman correlations between CTXD score and SF-12 PCS (P = -.59) and MCS (P = -.54) and positive Spearman correlations between CSI score and SF-12 PCS (P = .23) and MCS (P = .30). The median HCA scale score was high at .8. Male sex, autologous HCT, increased distress level, and worse CSI score were associated with lower use of preventive care. Older survivors experienced a low level of distress and moderate-high level of CSI at ≥1 year post-HCT. As lower distress and higher CSI were associated with improved HRQOL and optimized preventive HCA, CTXD/CSI measures can be used to individualize the care of older adult HCT survivors.

Witches' Broom Disease of Lime Contributes to Phytoplasma Epidemics and Attracts Insect Vectors.

An insect-transmitted phytoplasma causing Witches' Broom Disease of Lime (WBDL) is responsible for the drastic decline in lime production in several countries. However, it is unclear how WBDL phytoplasma (WBDLp) induces witches' broom symptoms and if these symptoms contribute to the spread of phytoplasma. Here we show that the gene encoding SAP11 of WBDLp (SAP11WBDL) is present in all WBDLp isolates collected from diseased trees. SAP11WBDL interacts with acid lime (Citrus aurantifolia) TCP transcription factors, specifically members of the TB1/CYC class that have a role in suppressing axillary branching in plants. Sampling of WBDLp-infected lime trees revealed that WBDLp titers and SAP11WBDL expression levels were higher in symptomatic leaves compared with asymptomatic sections of the same trees. Moreover, the witches' brooms were found to attract the vector leafhopper. Defense genes that have a role in plant defense responses to bacteria and insects are more downregulated in witches' brooms compared with asymptomatic sections of trees. These findings suggest that witches' broom-affected parts of the trees contribute to WBDL epidemics by supporting higher phytoplasma titers and attracting insect vectors.

Identification of patients with preeclampsia from normal subjects using wavelet-based spectral analysis of heart rate variability.

BACKGROUND: The spectral analysis of the heart rate variability (HRV) shows a decrease in the power of the high frequency (HF) component in preeclamptic pregnancy compared with normal pregnancy; such a decrease is associated with an increase in the low frequency (LF) and the very low frequency (VLF) power. The physiological interpretation is that preeclamptic pregnancy is associated with a facilitation of sympathetic regulation and an attenuation of parasympathetic influence of HR compared with non-pregnancy and normal pregnancy. OBJECTIVE: To use an efficient nased on spectral analysis non-invasive technique to identify preeclamptic pregnant subjects from normal pregnant in Oman. METHODS: The soft-decision wavelet-based technique is implemented to find the power of the HRV bands in high resolution manner compared to the classical fast Fourier Transform method. Data was obtained from 20 preeclamptic pregnant subjects and 20 normal pregnant controls of the same pregnancy duration, obtained from Nizwa and Sultan Qaboos University hospitals in Oman. RESULTS: The soft-decision wavelet method succeeds to identify patients from normal pregnant with specificity, sensitivity and accuracy of 90%, 80% and 85%, respectively, compared to the FFT which results in 75% specificity, sensitivity and accuracy. CONCLUSION: The LF power obtained by Soft-decision wavelet decomposition is shown to be a successful feature for identification of preeclampsia.

Investigation of heart rate variability of patients undergoing coronary artery bypass grafting (CABG).

BACKGROUND: Myocardial revascularization by coronary artery bypass grafting (CABG) is an effective measure for reducing symptoms and mortality in patients with unstable or severe coronary artery disease (CAD). Autonomic function can be estimated non-invasively using heart rate variability (HRV). HRV of patients undergoing CABG is investigated before and after CABG using a soft-decision wavelet based spectral analysis. OBJECTIVE: The main purpose of this work is to evaluate non-invasively HRV in patients undergoing CABG before operation; and to monitor the status of patients through HRV investigation on day 6 and day 30 after the CABG operation. The study intends to contribute scientific value to understanding the effect of CABG on the cardiovascular autonomic function and surgical outcome. METHODS: The soft-decision wavelet-based technique is used in this work in order to measure the power spectral density of the three main bands (VLF, LF, and HF) of HRV in 24 patients undergoing CABG operation, before the operation (Group 1: G1), and 6 days after operation (Group 2: G2) and 30 days after operation (Group 3: G3). The data is obtained from Sultan Qaboos University hospital in Oman. RESULTS: The HF power increases in 22 out of 24 patients in G2 compared to G1. While the LF power decreases in 21 out of 24 patients in G2 compared to G1. Comparing G3 to G1 the LF power decreases in 20 patients. The sum of the VLF and LF power is reduced in G2 in all 24 subjects compared to G1, and in 19 subjects in G3 compared to G1. CONCLUSIONS: The power spectral density of the HF shows increase in patients recorded on day 6 after operation compared to patients before the operation. The LF shows a decrease in G2 compared to G1. The results of G3 after 30 days of operation still show an increase of the HF power and a decrease in the LF power in most of the patients compared to their values before operation.

Increased tissue damage and lesion volumes in African Americans with multiple sclerosis.

BACKGROUND: African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS. OBJECTIVES: To investigate brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS. METHODS: We studied 567 patients with MS (age: 45.1 +/- SD 9.8 years, disease duration: 13.4 +/- 8.6 years), comprised of 488 WA and 79 AA. All patients obtained clinical and quantitative MRI evaluation. The majority of patients, 96% of AA and 94% of WA, were on disease-modifying therapies. The MRI measures included T1-, T2-, and gadolinium contrast-enhancing (CE) lesion volumes (LV) and CE number, global and tissue-specific brain atrophy, and magnetization transfer ratio (MTR) in lesions and normal-appearing gray matter (NAGM) and white matter (NAWM). The associations between race and clinical and MRI measurements were assessed in regression analysis. RESULTS: The MTR values in lesions and in NAGM and NAWM were significantly lower in AA compared to WA. The AA group had 31% greater T2-LV and 101% greater T1-LV compared to WA. The MS Severity Score for AA (mean +/- SD = 4.3 +/- 2.9) was greater than for WA (3.8 +/- 2.5), despite a shorter disease duration in AA, indicating more aggressive clinical disease. CONCLUSIONS: African American patients showed increased tissue damage, as measured by magnetization transfer ratio, and presented higher lesion volumes compared to white Americans. The greater tissue damage and faster lesion volume accumulation may explain the rapid clinical progression in African American patients.

Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis.

BACKGROUND: Cigarette smoking has been linked to higher susceptibility and increased risk of progressive multiple sclerosis (MS). The effects of smoking on MRI characteristics of patients with MS have not been evaluated. OBJECTIVES: To compare the MRI characteristics in cigarette smoker and nonsmoker patients with MS. METHODS: We studied 368 consecutive patients with MS (age 44.0 +/-SD 10.2 years, disease duration 12.1 +/- 9.1 years) comprising 240 never-smokers and 128 (34.8%) ever-smokers (currently active and former smokers). The average number of packs per day smoked (+/-SD) was 0.95 +/- 0.65, and the mean duration of smoking was 18.0 +/- 9.5 years. All patients obtained full clinical and quantitative MRI evaluation. MRI measures included T1, T2, and gadolinium contrast-enhancing (CE) lesion volumes (LVs) and measures of central, global, and tissue-specific brain atrophy. The associations between smoking status and MRI measurements were assessed in regression analysis. RESULTS: Smoking was associated with increased Expanded Disability Status Scale (EDSS) scores (p = 0.004). The median EDSS scores (interquartile range) in the ever-smoker group and the active-smoker group were both 3.0 (2.0), compared with 2.5 (2.5) in never-smokers. There were adverse associations between smoking and the lesion measures including increased number of CE lesions (p < 0.001), T2 LV (p = 0.009), and T1 LV (p = 0.003). Smoking was associated with decreased brain parenchymal fraction (p = 0.047) and with increases in the lateral ventricle volume (p = 0.001) and third ventricle width (p = 0.023). CONCLUSIONS: Smoking is associated with increased blood-brain barrier disruption, higher lesion volumes, and greater atrophy in multiple sclerosis.

The stem cell transplant program in Pakistan--the first decade.

Stem cell transplantation is curative in a number of otherwise fatal hematological diseases. In Pakistan, SCT was started in October 1995 at Dr Ziauddin Hospital by Dr Tahir Shamsi and his team. The first case was of a young man suffering from AML. In 1999, allogeneic BMT was started at Bismillah Taqee Institute of Health Sciences and Blood Diseases Centre, Karachi. In 2001, the Armed Forces Bone Marrow Transplant Centre, started functioning. Since then, over 350 allogeneic stem cell transplants have been carried out in these latter two centers. Another 50 autologous procedures were carried out in all centers. In 2004, a third center started transplants at the Aga Khan Hospital. The main indications for transplant are aplastic anemia, beta-thalassemia major and hematological malignancies. HLA-identical sibling donors provide stem cells for the recipient. In 70% of cases, a matched donor is identified. In sharp contrast to the rest of the world, the majority of transplants are allogeneic, donor-recipient pairs are CMV positive and fungal infection, tuberculosis and malaria are particular problems. The early results are promising, with transplant-related mortality reported to be 10-20%, whereas long-term survival is reported to be 78, 72 and 49% in aplastic anemia, beta-thalassemia major and leukemia, respectively. Financial constraints, poor socioeconomic status, poor transfusion services, trained human resources and difficulty in keeping pace with technological advances are major hurdles in the growth of transplant medicine. Government support is badly needed to strengthen existing facilities and to develop more centers.

Allogeneic bone marrow transplantation in beta-thalassaemia--single centre study.

OBJECTIVE: To evaluate outcome of allogeneic BMT in beta-Thalassaemia at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from August 2001 to November 2003. METHODS: Nineteen patients with beta-Thalassaemia underwent allogeneic BMT/PBSC transplantation from HLA identical sibling donors. Patients were classified in three groups according to Pesaro (Italy) risk classification. Class-I (n = 9) and Class-II (n = 7) patients received conditioning with busulphan/cyclophosphamide, whereas Class-III (n = 3) patient received conditioning with hydroxyurea, azathioprine, fludarabine, along with Bu14 / Cy 200. Cyclosporine, prednisolone and methotrexate were given for GvHD prophylaxis. Stem cells dose infused was >4.0 x 10(8)/kg body weight of the patient. RESULTS: Engraftment was achieved in all Class-I patients, whereas in Class-II and Class-III , graft rejection was observed in one patient from each class. Median time to achieve absolute neutrophil recovery (> 0.5 x 10(9)/l) was 13 days, platelet count (> 20 x 10(9)/1) was 15 days and reticulocyte count (>0.5%) was 15 days. Acute GvHD was observed in 15 patients. One patient developed grade IV GvHD (liver and skin) and died within 30 days post BMT. Post transplant infectious complications were pseudomonas septicemia, disseminated fungal infection, CMV pneumonia and tuberculosis. Three patients died of these complications during post transplant period (31-90 days). Median stay in hospital was 25 days. CONCLUSION: Allogeneic BMT is the only curative therapy for beta-Thalassaemia patients, however the success rate can be increased if the patients are selected carefully and transplanted at an early age.

Cancer patterns in Karachi division (1998-1999).

OBJECTIVE: A minimal cancer incidence data for Karachi, the largest city of Pakistan, is being presented here, for the years 1998-1999. The city has a population of 9,802,134; males 5,261,712 (52.6%) and females 4,540,422 (47.4%); census 1998. METHODOLOGY: A predominantly mixed (passive and active) registration system has evolved in Karachi, the data sources being the hospitals within the Karachi Division. The reported/retrieved cancer data sets at the Karachi Cancer Registry are checked, coded, computerised in an analytical format and analysed. RESULTS: The incident cancer cases registered in Karachi, during the 2-year period, 1st January 1998 to 31st December 1999 were analysed. The age-standardised incidence rate (ASR) of cancer, all sites was 132.4/100,000 for the males. Cancer of the lung 10.8%; ASR 17.3 was the most frequently recorded malignancy, followed by oral cavity 10.5%; ASR 13.2 and larynx 5.0%; ASR 7.4. The age-standardised incidence rate (ASR) of cancer, all sites was 133.0/100,000 in the females. Cancer of the breast, 32.0%; ASR 40.7 was the most frequently recorded malignancy, followed by oral cavity 8.1%; ASR 11.7 and gall bladder 3.6%; ASR 5.5. CONCLUSION: The present data has been calculated with an estimated 15-20% probable under ascertainment. Tobacco-associated cancers in Karachi were responsible for 38.3% of the tumours diagnosed amongst the males. Two principal cancers, breast and oral cavity were responsible for 40.1% of the cancers in females. A rare finding was the high incidence of gall bladder cancer in the females. At present it is difficult to determine whether this indicates a genuine high risk or a selection bias. A continuous process of cancer registration to study the trends in the incidence and an adequate cancer control program are possible and essential for Pakistan and can be based on the pattern being practiced in Karachi.

Assessment of aerobic fitness and its correlates in Omani adolescents using the 20-metre shuttle run test: A pilot study.

OBJECTIVE: To assess aerobic fitness in male and female adolescents using the multistage 20-metre shuttle run test and correlate it with selected fitness variables. METHOD: The subjects comprised 83 girls and 64 boys aged 15-16 years, randomly selected from two segregated government schools in Muscat. After the pupils filled in a short questionnaire on their personal leisure time activities of the preceding week, their heights and weights were measured. Aerobic fitness was assessed by estimating each pupil's minimal oxygen uptake levels (VO2max) using the multistage 20-metre shuttle running test (20-MST). RESULTS: Boys spent more time than girls on leisure physical activities, television, computer and video games and the Internet. The estimated VO2max in both boys and girls showed high correlation with their weekly physical activities. The time spent on television and computer negatively correlated with VO2max in girls but not in boys. Girls had higher body mass index (BMI) and less VO2max compared to boys; BMI showed a negative correlation with VO2max in girls but not in boys. CONCLUSION: Aerobic fitness in this sample was higher in boys than in girls and was strongly influenced by weekly physical activities in both genders. The 20-MST has proved a simple and inexpensive field test for aerobic fitness that could be implemented on a wide scale.

The impact of pulmonary infections on the survival of lung cancer patients.

To determine the impact of pulmonary infections on survival in patients with lung cancer, a retrospective review of the records of 121 such patients treated at Howard University Hospital in Washington, DC, was done. There were 77 men and 44 women; 118 were black. The mean age was 63.5 years. Forty-three patients had squamous cell carcinoma, 31 had adenocarcinoma, 18 had large cell carcinoma, 19 had small cell carcinoma, and ten were unclassified. The stages were as follows: two patients in Stage 0, 15 in Stage I, seven in Stage II, 45 in Stage III, and 44 in Stage IV. Eight patients could not be staged at diagnosis. Eighty-five patients (70%) had documented infections; 37 had single episodes; and 48 had more than one. The five most common organisms recovered were alpha/gamma streptococci, Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter aerogenes, and Pseudomonas aeruginosa. The median survival of all infected patients was 4.2 months which was significantly shorter than that of uninfected patients who had a median survival of 12.9 months (P less than 0.05). When Stage III patients were analyzed separately, infected patients lived a median of 5.8 months and uninfected patients, 13.4 months (P less than 0.05). This study indicated that pulmonary infections frequently occur in patients with lung cancer and suggested that they may adversely affect survival.

Iron depletion and anaemia: prevalence, consequences, diagnostic and therapeutic implications in a developing Pakistani population.

The prevalence of iron deficiency anaemia in Karachi, Pakistan, was examined in a group of 100 children, aged 2 to 6 years, and 200 adult females, aged 17 to 35 years. Anaemia, defined as a haemoglobin level less than 11.5 g/dl, was present in 47% of the children and 30% of the adult females. The majority of subjects had normal red cell counts and MCV, but haematocrit and MCH were below normal in one-quarter of the children and one-third of the adult females. More than half of both children and adult females had serum ferritin levels below normal. Many also had elevated iron binding capacity and reduced serum iron levels. Iron deficiency may be superimposed on folate deficiency in this population. The potentially serious consequences and higher prevalence of iron deficiency anaemia in children and women of childbearing age demand greater efforts toward diagnosis and eradication in developing countries.

PIP: Iron deficiency anemia has more serious consequences on the health of people in developing than developed nations. In Karachi Pakistan 300 subjects were examined to determine the prevalence of iron deficiency anemia: 100 children (49 males and 51 females) aged 2-6 years; 100 females aged 17-21 years with no history of pregnancy; and 100 females aged 25-35 with at least 1 prior pregnancy. Most subjects came from the lower to middle income groups, with only 10% from the higher income bracket. Blood samples were taken to measure serum ferratin, serum iron, total iron binding capacity (TIBC), red cell indices and films. Results showed that anemia was present in 47% of the children, a 30% of the adult females. More than half of both children and adult females had serum ferritin levels measuring below normal. Elevated iron binding capacity and reduced serum iron levels were found in many subjects. In the children, iron deficiency may be superimposed on folate deficiency. As a result, low levels of serum ferritin go hand in hand with iron depletion, and this is directly dependent upon the diet and socioeconomic conditions of the populace.

Anti-T antibody in malignant melanoma patients. Influence of response and survival following chemotherapy--changes in serum levels following C parvum, BCG immunization.

The level of anti-T antibodies directed towards the precursor T antigen of the MN blood group system was measured in the sera of 55 patients with disseminated melanoma, before and during chemoimmunotherapy. The anti-T titer was subnormal in patients before therapy; patients who responded to therapy had significantly higher titers than did nonresponders in sera taken before therapy, at regression/progression of disease, and during the last pulse of treatment. Higher pretreatment titers were associated with a significntly longer survival time. A single infusion of Corynebacterium parvum was given to 14 other melanoma patients and significant elevation of preimmunization titers was observed on days 14, 21, and 28 after infusion; Bacillus Calmette-Guerin, vaccination of 9 patients did not significantly alter the anti-T titer. The expression of the normally cryptic T antigen on melanoma cells would absorb naturally circulating anti-T antibodies. Less dense expression of T antigen on melanoma cells that were responsive to therapy, i.e., less "malignant," would explain the better prognosis for patients with higher titers. The increase in anti-T antibodies following administration of C parvum but not of BCG is of possible clinical relevance when C parvum is used as an immunotherapeutic agent.