Predicting type 2 diabetes risk before and after solid organ transplantation using polygenic scores in a Danish cohort.

Type 2 diabetes mellitus (T2DM) can be multifactorial where both genetics and environmental factors play a role. We aimed to investigate the use of polygenic risk scores (PRS) in the prediction of pre-transplant T2DM and post-transplant diabetes mellitus (PTDM) among solid organ transplant (SOT) patients. Using non-genetic risk scores alone; and the combination with PRS, separate logistic regression models were built and compared using receiver operator curves. Patients were assessed pre-transplant and in three post-transplant periods: 0-45, 46-365 and >365 days. A higher PRS was significantly associated with increased odds of pre-transplant T2DM. However, no improvement was observed for pre-transplant T2DM prediction when comparing PRS combined with non-genetic risk scores to using non-genetic risk scores alone. This was also true for predictions of PTDM in all three post-transplant periods. This study demonstrated that polygenic risk was only associated with the risk of T2DM among SOT recipients prior to transplant and not for PTDM. Combining PRS with a clinical model of non-genetic risk scores did not significantly improve the predictive ability, indicating its limited clinical utility in identifying patients at high risk for T2DM before transplantation, suggesting that non-genetic or different genetic factors may contribute to PTDM.

Risk of Bacterial, Viral, and Fungal Infections in Patients With Solid Malignant Tumors Treated With Curative Intent Radiation Therapy.

Purpose: The incidence, etiology, and association of infections with radiation therapy (RT)-induced lymphopenia in patients with solid tumors is not well elucidated. Methods and Materials: We identified possible, probable, and definite infections caused by bacteria, fungi, and viruses, combining data on medication, microbiology, and diagnoses. Definite infections had either a diagnosis or a positive microbiological isolation. We analyzed the incidence and adjusted incidence-rate ratio of infections in the year after the start of RT among patients who received RT plus chemotherapy and RT monotherapy, by type of infection and according to the degree of RT-induced lymphopenia. Results: A total of 4450 of 6334 (70.3%) patients experienced 11264 infections overall; 1424 (22.5%) patients developed 2104 definite infections in the first year after RT. Infections were more frequent among patients who received RT plus chemotherapy (2590 of 3469; incidence: 16.5 [95% confidence interval {CI}, 16.1-17.0], per 100 patient-years) compared with patients who received RT monotherapy (1860 of 2865; incidence: 12.7 [95% CI, 12.3-13.2]). The incidence of infection was highest in the first 3 months overall (28.2 vs 18.0 in patients who received RT plus chemotherapy compared with those who received RT monotherapy) and for definite infections (4.7 vs 3.8). The proportion of specific bacterial infections were similar among patients who received RT plus chemotherapy versus those who received RT monotherapy. Urinary tract infections were the most frequent (51.2% vs 56.2%), followed by pneumonias (24.1% vs 22.4%). Viral and fungal infections were more frequent among patients who received RT plus chemotherapy, but they were uncommon. In multivariable analyses, patients who received RT plus chemotherapy with a lymphopenia grade of 1-2 or ≥3 versus no lymphopenia at end of RT had an increased risk of bacterial infections 0 to 3 months after RT (incidence rate ratio, 1.45 [95% CI, 1.06-1.97] and 1.71 [95% CI, 1.26-2.34], respectively). Limiting to definite bacterial infections, the incidence rate ratio for lymphopenia grade ≥3 versus no lymphopenia was 2.66 (95% CI, 1.40-5.03). Conclusions: The incidence of bacterial infections 0 to 3 months after RT plus chemotherapy for solid tumors was high, especially among patients with RT-induced lymphopenia grade 1-2 and ≥3.

Posttransplantation Diabetes Mellitus Among Solid Organ Recipients in a Danish Cohort.

Post-transplant diabetes mellitus (PTDM) is associated with a higher risk of adverse outcomes. We aimed to describe the proportion of patients with diabetes prior to solid organ transplantation (SOT) and post-transplant diabetes mellitus (PTDM) in three time periods (early-likely PTDM: 0-45 days; 46-365 days and >365 days) post-transplant and to estimate possible risk factors associated with PTDM in each time-period. Additionally, we compared the risk of death and causes of death in patients with diabetes prior to transplant, PTDM, and non-diabetes patients. A total of 959 SOT recipients (heart, lung, liver, and kidney) transplanted at University Hospital of Copenhagen between 2010 and 2015 were included. The highest PTDM incidence was observed at 46-365 days after transplant in all SOT recipients. Age and the Charlson Comorbidity Index (CCI Score) in all time periods were the two most important risk factors for PTDM. Compared to non-diabetes patients, SOT recipients with pre-transplant diabetes and PTDM patients had a higher risk of all-cause mortality death (aHR: 1.77, 95% CI: 1.16-2.69 and aHR: 1.89, 95% CI: 1.17-3.06 respectively). Pre-transplant diabetes and PTDM patients had a higher risk of death due to cardiovascular diseases and cancer, respectively, when compared to non-diabetes patients.

RootPainter3D: Interactive-machine-learning enables rapid and accurate contouring for radiotherapy.

PURPOSE: Organ-at-risk contouring is still a bottleneck in radiotherapy, with many deep learning methods falling short of promised results when evaluated on clinical data. We investigate the accuracy and time-savings resulting from the use of an interactive-machine-learning method for an organ-at-risk contouring task. METHODS: We implement an open-source interactive-machine-learning software application that facilitates corrective-annotation for deep-learning generated contours on X-ray CT images. A trained-physician contoured 933 hearts using our software by delineating the first image, starting model training, and then correcting the model predictions for all subsequent images. These corrections were added into the training data, which was used for continuously training the assisting model. From the 933 hearts, the same physician also contoured the first 10 and last 10 in Eclipse (Varian) to enable comparison in terms of accuracy and duration. RESULTS: We find strong agreement with manual delineations, with a dice score of 0.95. The annotations created using corrective-annotation also take less time to create as more images are annotated, resulting in substantial time savings compared to manual methods. After 923 images had been delineated, hearts took 2 min and 2 s to delineate on average, which includes time to evaluate the initial model prediction and assign the needed corrections, compared to 7 min and 1 s when delineating manually. CONCLUSIONS: Our experiment demonstrates that interactive-machine-learning with corrective-annotation provides a fast and accessible way for non computer-scientists to train deep-learning models to segment their own structures of interest as part of routine clinical workflows.

Hematological toxicity in patients with solid malignant tumors treated with radiation - Temporal analysis, dose response and impact on survival.

PURPOSE: To describe the kinetics of the peripheral blood components after radiotherapy, to examine radiation exposure vs. End-of-Radiation-Therapy (EoRT) counts and to associate the EoRT lymphocyte count with death and cancer treatment failure. MATERIALS AND METHODS: Cohort study of patients who received curative intent radiotherapy for solid tumor diagnoses from 2009-2016 at Rigshospitalet, Copenhagen and had available 3D radiation exposure data. We illustrated peripheral blood count kinetics within 12 months before and after radiotherapy start and analyzed the impact of the irradiated body volume. We investigated overall survival and cancer treatment failure according to EoRT lymphopenia using Cox regression analyses. RESULTS: We analyzed 4055 patients with both pre-treatment and EoRT platelet counts and 2318 patients who also had neutrophil and lymphocyte counts. Only the lymphocyte decline after radiotherapy start was clinically relevant and remained low one year after radiotherapy. The higher the volume of the body exposed to radiation, the lower the EoRT blood counts. Female gender (p < 0.001), number of fractions (p = 0.010), dose-volume (p < 0.001) and concomitant use of chemotherapy, particularly the platinum compounds (p < 0.001) were independently associated with a lower EoRT lymphocyte count. Patients with head and neck cancer had the lowest EoRT lymphocyte count. Patients with lymphopenia had a higher risk of death in the year after radiotherapy, compared with patients with no lymphopenia. CONCLUSION: Radiation schemes with fewer fractions and radiation techniques allowing reduction of the volume of the body exposed to radiation could be expected to better preserve patients' immune function.

Lymphocyte Count Kinetics, Factors Associated with the End-of-Radiation-Therapy Lymphocyte Count, and Risk of Infection in Patients with Solid Malignant Tumors Treated with Curative-Intent Radiation Therapy.

PURPOSE: Lymphopenia has been associated with poor outcomes in patients with cancer. We sought to describe the lymphocyte kinetics in patients who received radiation therapy; to identify factors associated with the end-of-radiation-therapy (EoRT) lymphocyte count; and to determine the association of radiation therapy-induced lymphopenia with subsequent infection. METHODS AND MATERIALS: Patients with solid malignant tumors treated at the Department of Oncology at Rigshospitalet, University of Copenhagen, Denmark, were included if they had received their first external beam radiation therapy with curative intent from January 2005 to December 2016 and had pretreatment and EoRT lymphocyte counts measured. Factors associated with the EoRT lymphocyte count were identified using regression analyses. The risk of subsequent infection was estimated using Cox proportional hazards regression. RESULTS: We included 3920 patients. More patients had lymphopenia (<1000 cells/µL) at EoRT than at pretreatment (67.1% vs 14.9%; P < .001). Patients who received schemes with higher intensities (equivalent dose in 2-Gy fractions [EQD2] >65 Gy) in shorter time (<25 days) had a higher predicted EoRT lymphocyte count than patients who received schemes delivering EQD2 of 50 to 65 Gy in 25 to 45 days (1439 cells/µL, 95% confidence interval [1293-1585] vs 784 [754-814]). Radiation to multiple sites and concomitant chemotherapy use, particularly platinum compounds versus none, were associated with a lower EoRT lymphocyte count (698 [655-742] vs 852 [833-870]; and 612 [565-659] vs 937 [909-964], respectively). Patients with EoRT lymphopenia grade ≥3 (<500 cells/µL) had a higher risk of infection in the 3 months after radiation therapy (hazard ratio, 2.15 [95% confidence interval, 1.53-3.02]; P < .001), compared with patients with an EoRT lymphocyte count >1000 cells/µL. CONCLUSIONS: The lymphocyte count declined during radiation therapy. Short duration schemes (<25 days), despite high total radiation dose (EQD2 >65 Gy), were associated with a higher EoRT lymphocyte count, whereas radiation to multiple sites and concomitant chemotherapy were associated with a lower count. EoRT lymphopenia was associated with an increased risk of infection.

[Atypic toxocariasis: a case report from the Peruvian north coast]. / Toxocariosis atípica: reporte de un caso en la costa norte del Perú.

We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patient had non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cell blood count (15% or 1470 cells/µL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.

Toxocariosis atípica: reporte de un caso en la costa norte del Perú / Atypic toxocariasis: a case report from the Peruvian north coast

Se presenta el caso de un varón de cuatro años y medio con toxocariosis atípica, procedente de La Matanza, Morropón,Piura. El paciente presentó síntomas inespecíficos durante nueve días; la sospecha de toxocariosis derivó del hallazgo de eosinofilia periférica marcada (15 por ciento ó 1470 células/uL) en el hemograma. El diagnóstico se confirmó por serología mediante el método de enzimoinmunoanálisis (ELISA) demostrando la presencia de anticuerpos anti-Toxocara de tipo IgG, así como de tipo IgM. El cuadro se autolimitó antes de que el paciente recibiera tratamiento con albendazol 15mg/ kg/día durante cinco días.

We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patienthad non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cellblood count (15 per cent or 1470 cells/uL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.

Conocimientos, actitudes y prácticas respecto a la bartonelosis aguda (fiebre de la Oroya) en los pobladores del distrito de Ollantaytambo, provincia de Urubamba, en el Valle Sagrado de los Incas, Cusco, Perú / Knowledge, Attitudes and Practices regarding acute Bartonellosis (Oroya fever`s) in Persons Living in Ollantaytambo District, Urubamba Province in the Sacred Valley of the Incas, Cusco, Peru

Introducción: la bartonelosis humana por Bartonella bacilliformis (BHxBb) o enfermedad de Carrión (EC) es una enfermedad prevalente de los valles interandinos del Perú, tradicionalmente en zonas endémicas reconocidas como Ancash, Cajamarca, Junín y Amazonas. Sin embargo, en los últimos años se han identificado nuevas zonas endémicas como el Valle Sagrado de los Incas, en el Cusco. Objetivo: describir los conocimientos, actitudes y prácticas sobre la bartonelosis aguda (BA) o fiebre de la Oroya (FO), en pobladores del distrito de Ollantaytambo, provincia de Urubamba, Valle Sagrado de los Incas, en el departamento del Cusco en julio del año 2004. Material y método: se realizó un estudio descriptivo de conocimientos, actitudes y prácticas (CAP), utilizando como instrumento una encuesta. Ésta se aplicó a 280 pobladores de diez comunidades en riesgo para bartonelosis aguda o fiebre de la Oroya. Se elaboró una clave de respuestas para determinar el nivel de conocimientos que se clasificó en tres niveles. Resultados: encontramos que, 151/280 (53,94%) pobladores pertenecían al nivel III (avanzado); en caso de presentar sintomatología, 228/242 (94,21%) acudirían a la posta médica; y que 32,02% (92/242) no realiza ninguna medida preventiva. Conclusiones: más de la mitad reconoce de manera óptima aspectos elementales sobre la bartonelosis y el vector que la transmite. La población en su mayoría desconoce qué medidas preventivas son efectivas para evitar la enfermedad, por lo tanto no las practica. Paralelamente la población tiene actitudes favorables para prevenir la enfermedad.

Introduction: Bartonellosis is a prevalent disease in Andean valleys of Peru, typically in endemic areas such as Ancash, Cajamarca, Junín, and Amazonas. However, in the past few years, new endemic areas have been identified, such as the Sacred Valley of the Incas in Cusco. Objective: To describe knowledge, attitude and practices regarding Bartonellosis in persons living in Ollantaytambo District, Urubamba Province in the Sacred Valley of the Incas, Cusco-Peru, July 2004. Materials and Methods: A knowledge, attitude and practices (KAP) survey was conducted in 280 persons from ten communities identified as being at risk for Bartonellosis in Ollantaytambo. A score was used to identify knowledge levels in three categories. Results: We found that 151/280 persons (53.94%) had advanced (level III) knowledge, that in case of feeling sick, 228/242 (94.21%) residents would go to the health care center, and that 32.02% (92/242) do not practice any activity to prevent Bartonellosis. Conclusions: More than half of people living in the surveyed areas adequately recognize basic aspects regarding Bartonellosis and the vector involved in its transmission. Most people do not know preventive measures against; therefore, they do not practice such activities. However, they have a favorable attitude for preventing the disease.