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The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. While this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state of the art treatments including transplantation, by providing financial, technological, legal, ethical and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population, and potentially provide long-term cost-savings by circumventing the need for their citizens to seek care abroad. Costs of establishing HSCT program and the costs of the HSCT procedure itself can be substantial barriers in developing countries. Additionally, socioeconomic factors intrinsic to specific countries can influence access to HSCT, patient eligibility for HSCT and timely utilization of HSCT center capabilities. This report describes recommendations from the Worldwide Network for Blood and Marrow Transplantation (WBMT) for establishing HSCT programs with a specific focus on developing countries, and identifies challenges and opportunities for providing this specialized procedure in the resource constrained setting. Keywords: Bone marrow transplantation, Developing countries, Low income countries

Endoscopic mucosal resection (EMR) is a procedure commonly used for large sessile and flat polyps. However, it may cause bleeding, perforation, and complications related to anesthesia. There are limited data on the safety and efficacy of EMR in the elderly. Therefore, we conducted a comprehensive review and meta-analysis to assess EMR safety in elderly patients.We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection for studies evaluating EMR for large colorectal lesions (20 mm) in older patients (75+ years). Our primary result was post-polypectomy bleeding and perforation, while our secondary outcome was recurrence or residual polyp.The meta-analysis included 6 studies with 2903 patients. The rate of post-polypectomy bleeding was 5.3% (95% confidence interval [CI] 2.3-11.7%),EMR is as safe for the elderly as it is for younger patients, and is not associated with a greater risk of bleeding or perforation.

Coronavirus disease 2019 (COVID-19) patients are at higher risk of acute gastrointestinal bleeding (AGIB) due to higher use of steroids, mechanical ventilation, and use of anticoagulation. We performed this study to compare outcomes of AGIB in COVID-19-positive patients and those without COVID-19 and AGIB.This was a case-control study including patients admitted from March 2020 to February 2021 with the diagnosis of AGIB. Patients were divided into two groups: COVID-19-positive and non-COVID-19 patients. Our primary outcomes were in-hospital or 30 days mortality and length of stay. Secondary outcomes were the rate of rebleeding, the need for intensive care unit (ICU) level of care, and the need for blood transfusion.Eighteen COVID-19-positive patients and 54 matched non-COVID-19 patients were included. The COVID-19-positive patients less frequently had endoscopies performed (33.3% vs. 74.1%, P = 0.0059) and had greater steroid use (83.3% vs. 14.8%, P0.0001) compared to non-COVID-19 patients. ICU stays were more likely in the COVID-positive patients (odds ratio (OR): 20.41; 95% confidence interval (CI): 2.59 - 160.69; P = 0.004) as was longer hospital length of stay (OR: 1.08; 95% CI: 1.03 - 1.13; P = 0.002). Mortality, readmission within 30 days, need for blood transfusion, and having rebleeding during the admission did not differ for COVID-19 and non-COVID-19 patients.COVID-19 patients with AGIB are more likely to require ICU admission and had a longer length of stay. Despite the significantly lower rate of endoscopic procedures performed in patients with COVID-19, need for blood transfusion, mortality and rebleeding were not significantly different.

Recent advances in modern medicine have translated into increase in life expectancy in the USA and with that, a rise in the demand for invasive procedures in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for managing various benign and malignant pancreatobiliary conditions and can be associated with various adverse events.We performed a systematic review and meta-analysis to evaluate outcomes of ERCP in nonagenarians.A comprehensive literature search was performed in Embase, MEDLINE, Web of Science, and Cochrane Review library until July 2020. Our primary outcomes were the rate of technical success and adverse events in nonagenarians. Secondary outcomes were comparison of technical success and adverse events compared with younger patients.The initial search revealed 4933 studies, of which 24 studies with 5521 patients met our inclusion criteria. Pooled technical success rate of ERCP in nonagenarians was 92%, and pooled adverse event rate was 7.8%. There was no significant difference in technical success rate and overall rate of adverse events comparing ERCP outcomes in nonagenarians with a relatively younger population. The risk of post-ERCP bleeding was significantly higher in nonagenarians compared to younger patients with OR = 1.986 [1.113-3.544], I2 = 0. ERCP-related mortality was also significantly higher in nonagenarians compared to younger patients with OR = 4.720 [1.368-16.289], I2 = 0.There was no significant difference in technical success rate and risk of adverse events related to ERCP in nonagenarians compared to younger patients. However, the risk of bleeding and procedure-related mortality was significantly higher.

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.تنفيذ برنامج للتطوير المهني بالتوجيه في مجال قيادة وإدارة المختبرات في الشرق الأوسط وأفريقيا.لوسي برون، ديبورا كونفر، إليزابيث سكوت، لورا ليفينغستون، كاتلن برادبورن، أليكس ماك غي، توم فورتوانغلر، آن داونر، علي مُقداد، جين فريدريك فلاندين، سالماز شوتورباني، هومايون أصغر، ه. ي. طلبة، ه. جي. أحمد، علاء العلوان، روبرت مارتين.تحتاج المخترات لقادة يمكنهم الانتفاع مما فيها من موارد بفعالية، وتعظيم قدراتها لأقى قدر يتيح كشف الأمراض، ويدافعون عنها في بيئة متقلبة للرعاية الصحية. ولتلبية هذه الحاجة، أنشأت جامعة واشنطن في الولايات المتحدة الأمريكية برنامجاً لنيل شهادة القيادة والإدارة للمخترات بالشراكة مع المكتب الإقليمي لرق المتوسط لمنظمة الصحة العالمية، وفي عام 2014 تم تنفيذ البرنامج الذي ضم 17 مشاركاً و 11 موجِّهاً ينتمون إلى المخترات السريرية ومخترات الصحة العامة في 10 بلدان (مر والعراق والأردن ولبنان والمغرب وعُان وباكستان وقطر والمملكة العربية السعودية واليمن). وانطلاقاً من كون البرنامج قد تم تصميمه لتعليم المشرفن عى المخترات مهارات القيادة والإدارة، فقد وفّر البرنامج للمشاركين فيه إمكانية تحسن جودة الاختبارات والعمليات. ولقد كان البرنامج ناجحاً عى وجه الإجمال، فقد أكمل % 80 من المشاركين مشاركتهم به، وأحدثوا تغيرات ذات مردود ملحوظ في المخترات التي يعملون فيها. ويبدو نجاح البرنامج مشجعاً ويمكن أن يكون نموذجاً لتطوير المزيد من القدرات في المخترات في الإقليم.Mise en oeuvre d’un programme de mentorat en développement professionnel pour les directeurs et les cadres de laboratoire au Moyen-Orient et en Afrique du Nord.Les laboratoires ont besoin de directeurs à même d’utiliser les ressources internes de façon efficace, de maximiser leurs capacités à dépister les maladies, et d’oeuvrer pour le bien de ces établissements dans un environment de soins de santé en perpétuel changement. Pour répondre à ces besoins, l’Université de Washington (États-Unis), en partenariat avec le Bureau régional de l’OMS pour la Méditerranée orientale, a mis au point le Programme de certification en direction et gestion de laboratoire qui a été suivi par 17 participants et 11 mentors issus de laboratoires de santé clinique et publique dans 10 pays (Arabie saoudite, Égypte, Iraq, Jordanie, Liban, Maroc, Oman, Pakistan, Qatar et Yémen) au cours de l’année 2014. Conçu pour former les responsables de laboratoire aux compétences de direction et de gestion, le programme a permis aux participants de renforcer la qualité du dépistage et des opérations de leurs laboratoires. Le programme a été une réussite dans l’ensemble puisqu’il a été suivi jusqu’à son terme par 80 % des participants et que ceux-ci ont ensuite pu mettre en place des changements réels dans leurs laboratoires. Ce succès est encourageant et pourrait servir de modèle afin de renforcer davantage encore les capacités des laboratoires dans la Région.

Fetal megacystis, an abnormally enlarged bladder identified at any gestational age, may be transient and resolve spontaneously or may be an early manifestation of bladder outlet obstruction. Anterior urethral valves are the most common cause of the rare condition of congenital obstruction of the anterior urethra. Herein is reported the prenatal observation and postnatal management of a case of megacystis with anterior urethral valves. The etiology is reviewed and strategies recommended for patients with these rare entities.

Neuroendocrine tumors are a unique malignant neoplasm that can arise from the respiratory tree. Although well-differentiated bronchial neuroendocrine tumors (also called carcinoid tumors) are reported to account for approximately 25% of all neuroendocrine tumors, they represent only 1% to 2% of all lung cancers. The epidemiology, clinical behavior, and treatment of neuroendocrine carcinoid tumors differ significantly from other lung malignancies. In this article, the recent data regarding these tumors were reviewed with attention to the treatment modalities used. Although conventional cytotoxic therapy has not been reported to demonstrate much promise in this entity over the past 4 decades, newer molecular targeted agents including those that targeted angiogenesis and the mammalian target of rapamycin (mTOR) pathway have shown encouraging results in early phase trials for advanced carcinoid tumors.

Experiments were conducted to determine the effects of relative humidity on the population dynamics of single and mixed species of Dermatophagoides farinae Hughes, D. pteronyssinus (Trouessart), and Euroglyphus maynei (Cooreman) at specific relative humidities maintained at 20 degrees C, with unlimited food. The population density of single and mixed species (D. farinae and D. pteronyssinus) increased exponentially when cultured at 65, 70, and 75% RH. The mean population growth rates were 17.3 +/- 4.4 SD and 32.5% +/- 4.7/wk for D. farinae and D. pteronyssinus, respectively. Mean population doubling times were 2.2 +/- 0.3 and 4.2 +/- 1.3 wk for D. pteronyssinus and D. farinae, respectively. Mixed species cultures, started with equal numbers of D. farinae and D. pteronyssinus, resulted in higher percentages of D. farinae than D. pteronyssinus. In cultures started with 75% of one species and 25% of the other, the more numerous species remained dominant and in similar ratios throughout the experiment. Both D. farinae and D. pteronyssinus population densities maintained at 85% RH declined over a 12-wk culture period because of mold growth. E. maynei were unable to survive at 65, 70, 75, and 85% RH, which indicated that their climatic requirements were different from those of D. farinae and D. pteronyssinus. Population densities of D. farinae and D. pteronyssinus cultures declined when held at 21-22 degrees C and relative humidities ofor = 50%; however, at 50% RH, significant proportions of the populations survived for 10 wk. Half-life for desiccation of D. farinae and D. pteronyssinus at 45% RH was 11.5 and 1.2 wk, respectively, but at 50% RH was 86.3 and 4.0 wk, respectively. The data indicated that aor = 50% RH would have to be maintained for long periods to reduce both D. farinae and D. pteronyssinus by desiccation procedures. The results of this study show that D. farinae and D. pteronyssinus have high reproductive potentials and population growth rates, which indicate that mite reduction procedures must be thorough or mite densities will return to high levels quickly following remediation if adequate food and suitable microclimatic conditions exist.

Bacterial and fungal infections are major causes of morbidity and mortality after liver transplantation (LT). The role of intestinal decontamination in the prevention of post-LT infections is controversial. Rifaximin is widely used for the treatment of hepatic encephalopathy. The effect of rifaximin on post-LT infections is unknown. The aim of our study was to determine the effect of rifaximin therapy in the pretransplant period on early bacterial infections (EBIs) and fungal infections within the first 30 days after LT. All adult patients who underwent LT at our institution (January 2009 to July 2011) were included in this retrospective cohort study. Patients receiving antibiotics other than pretransplant protocol antibiotics were excluded. Patients were stratified into 2 groups based on the presence or absence of rifaximin therapy for at least 2 days before LT. Infections were defined by the isolation of any bacterial or fungal organisms within 30 days of LT. Multivariate regression analysis, Student t tests, and Pearson's chi-square tests were used to compare the 2 groups. Two hundred sixty-eight patients were included, and 71 of these patients (26.5%) were on rifaximin at the time of LT. The 2 groups were comparable with respect to age, sex, race, and Model for End-Stage Liver Disease score. There were no significant differences in the rates of EBIs (30% for the non-rifaximin group and 25% for the rifaximin group, P = 0.48) or fungal infections between the 2 groups. There was no increase in antimicrobial resistance among the infecting organisms. There was no difference in survival between the rifaximin and non-rifaximin groups (98% versus 97%, P = 0.36). In conclusion, the use of rifaximin in the pre-LT period was not associated with an increased risk of bacterial or fungal infections in the early post-LT period.

Background: House dust mites, Dermatophagoides farinae and Dermatophagoides pteronyssinus , are important components in the development of asthma. Objective: We measured the prevalence of house dust mites in a tertiary care hospital located in a temperate geographic region where dust mites were prevalent in homes. Methods: The density of Dermatophagoides spp. was measured in hospital hallways, carpeted patients' rooms, and noncarpeted patients' rooms by vacuuming the floor in the summer and winter seasons. Bedrooms in the homes of employees were sampled as a summer control group. A total of 141 dust samples was obtained. Results: No D. farinae or D. pteronyssinus was found in 60 hospital dust samples that were obtained during the winter season. Although mites were found in some locations in the hospital during the summer dust collection, mite density in these locations and the average mite density for all samples were insignificant. During the summer dust samples from the bedroom carpets of all employees' homes sampled were positive for mites, with many homes having moderate or high populations (range, 22 to 8340 mites per gram of dust). Conclusions: The dust mite prevalence in a hospital could be kept very low even though mite levels in employees' homes were moderate to high. The factors responsible for the low mite density in the hospital were maintenance of low relative humidity, use of low-pile carpets, and good housekeeping and laundering practices. (J ALLERGY CLIN IMMUNOL 1995;95:801-5.)

Patients with myelodysplasia often have urological pathology, with 25% to 40% requiring reconstructive procedures to achieve urinary and/or fecal continence. Complication rates from these major reconstructive procedures range between 10% and 50%. Additionally many of these patients have significant comorbidities, including a nonambulatory status that leads to an increased body mass index. It is currently unknown whether a high body mass index is associated with increased surgical complications. In this study we compare body mass index and postoperative complications.We retrospectively reviewed the charts of all patients with myelodysplasia undergoing urinary or fecal reconstructive procedures. We analyzed data for body mass index and any documented complication occurring during hospitalization or at any time during followup. Patients were categorized based on body mass index as normal weight (less than 85th percentile), overweight (85th to 95th percentile) or obese (greater than 95th percentile). Statistical analyses using chi-square and Fisher's exact tests were then performed.Reconstructive procedures were carried out in 66 patients with myelodysplasia between 1997 and 2005. A total of 48 bladder augmentations were performed with a total of 101 stomas created. Mean followup was 39 months. Height and weight were available for body mass index calculation in 60 patients. Obesity was common in our patients with myelodysplasia, affecting 33% of the population (20 of 60 patients). We found a total of 53 complications in 31 patients (52%). There was a significant association between presence of complications and weight category, with complications occurring in 40% of normal weight, 40% of overweight and 75% of obese patients (p = 0.0380). An association between stomal stenosis and weight category was also found (p = 0.0373). In addition, multiple complications were more prevalent in obese patients. Of the 15 patients (25%) with 2 or more complications 10 (67%) were obese (p = 0.0066).Patients with myelodysplasia have a high incidence of obesity. Since obesity is associated with a higher complication rate, weight loss programs are highly recommended for obese patients with myelodysplasia before and after any reconstructive surgery.

Pancytopenia is an uncommon manifestation of cystinosis, a congenital lysosomal storage disease. We describe a 34-year-old patient with nephropathic cystinosis with multisystem involvement who developed progressive bone marrow failure after renal transplantation. Bone marrow examination demonstrated widespread deposition of cystine crystals in histiocytes and in the background. We review the literature on the hematologic manifestations of cystinosis and discuss the available treatment options for patients with bone marrow failure secondary to cystine accumulation. The availability of effective oral therapy and the limited activity of hematopoietic growth factors in these patients highlight the importance of bone marrow examination early in the evaluation of cystinosis patients with abnormal blood counts.

Obstruction of a ureter secondary to tumor, fibrosis, or inflammation has been well documented in published reports. A review of English studies revealed no reported cases of hydronephrosis of a native kidney resulting from hyperstimulation of an ovary. We report a case of hydronephrosis in a woman undergoing ovarian stimulation for in vitro fertilization. Her presentation was prompted by symptoms of flank pain with nausea and vomiting. Management with ureteral stent placement was successful in relieving the obstructive symptoms. This case demonstrates the importance of imaging and close monitoring of symptoms in women undergoing in vitro fertilization.

The use of in vitro systems in the assessment of xenobiotic metabolism has distinct advantages and disadvantages. While isolated hepatocytes and microsomes prepared from human liver may be used to generate data for comparisons among species and in vitro systems, such comparisons are generally performed on the basis of microsomal protein or million (viable) hepatocytes. Recently, in vitro data have been investigated for their value as quantitative predictors of in vivo metabolic capacity. Because of the existence of large amounts of trichloroethylene (TRI) data in the human, we have examined the metabolism of TRI as a case study in the development of a method to compare metabolism across species using in vitro systems and for extrapolation of metabolic rates from in vitro to in vivo. TRI is well metabolized by human hepatocytes in culture with a K(m) of 266 +/- 202 ppm (mean +/- SD) in headspace and a Vmax of 16.1 +/- 12.9 nmol/h/10(6) viable hepatocytes. We determined that human liver contains approximately 116 x 10(6) hepatocytes and 20.8 mg microsomal protein/g, based on DNA recovery and glucose-6-phosphatase activity, respectively. Thus, the microsomal protein content of hepatocytes is 179 micrograms microsomal protein/10(6) isolated hepatocytes. The microsomal apparent Vmax value of 1589 pmol/min/mg microsomal protein extrapolates to 17.07 nmol/h/10(6) hepatocytes. The combination of protein recovery and metabolic rate predicted a Vmax of approximately 1400 nmol/h/g human liver, which, when extrapolated and incorporated into an existing physiologically based pharmacokinetic (PBPK) model for TRI, slightly underpredicted TRI metabolism in the intact human. The quantitation, extrapolation, and inclusion of extrahepatic and cytochrome P450 (CYP)-independent TRI metabolism may increase the predictive value of this approach.

Trichloroethylene (TRI) is a common groundwater contaminant that has been shown to be tumorigenic and toxic in laboratory animals. The toxicity of TRI is increased by inducing the production of cytochrome P-450-dependent metabolites. Cytochrome P450 (CYP) 2E1 metabolizes TRI in mammals; however, this isoform of CYP2E1 does not appear to be expressed in fish. Medaka microsomal protein containing CYP was exposed to TRI and extracted with ethyl acetate. The extract was analyzed using gas chromatography (liquid injection) with an electron capture detector and separately using mass spectrometry. The formation of chloral hydrate, a precursor of toxic metabolites, was confirmed following exposure of hepatic microsomes of the medaka to TRI. These results indicate that medaka catalyze the first step in the formation of toxic metabolites and CYP forms in addition to CYP2E1 which catalyzes this reaction in fish.

The immediate application for the propellant ammonium dinitramide (ADN) is as a clean burning replacement for ammonium perchlorate in a formulation that also gains in performance. Currently, Air Force personnel are working with ADN during field testing trials. Reproductive toxicity evaluation of ADN through use of a modified Screening Information Data Set study using Sprague-Dawley rats produced adverse effects on litter parameters of treated animals. An in vitro developmental toxicity screen was performed to determine the developmental hazard index (A/D ratio) for ADN using the hydra assay. Hydra attenuata have the capability for whole body regeneration. The assay employs exposing both adult hydra and 'artificial embryos' composed of disassociated hydra cells to test compounds to investigate developmental toxicity. Artificial embryos are created by disassociating adult hydra into their component cells. Results from the hydra assay of ADN indicated the minimal effective concentrations required to elicit a toxic response in the adult hydra and in the regenerating hydra were 750 mg ADN/L, respectively. The A/D ratio of 2.14 determined for ADN demonstrates that ADN should not be considered a primary developmental toxic in the context of this assay.

Increasingly strong medical and political pressures are stimulating consideration of the transplantation of baboon organs and cells into humans. Critical to the success of these xenotransplants is management of the immune system such that graft rejection and, in the case of bone marrow transplantation, graft-versus-host disease do not result in transplant failure. The polymorphic products of the major histocompatibility complex (MHC) are the primary barrier to successful allotransplantation, and here we describe class I MHC molecules from baboon (Papio anubis) to gain an understanding of how similarities and differences between baboon and human MHC molecules might affect xenograft survival and function. Comparative analyses of our five novel baboon class I molecules with defined HLA class I molecules demonstrate that the baboon class I molecule are up to 90% identical. Disparity between baboon class I proteins and their human homologues lies predominately at positions in the antigen-binding groove, while C-terminal portions of the class I heavy chain are more conserved between the two species. Such concentration of cross-species differences within the alpha1 and alpha2 domains involves a majority of substitutions at positions demonstrating polymorphism in human alleles; the location of substitutions distinguishing baboon and human molecules thus resembles the positioning of human class I allopolymorphisms. Because this preliminary characterization indicates that both baboon and human T cells with be restricted by xenogeneic class I molecules, immune responses triggered during baboon-to-human transplantation should mimic those arising during MHC mismatched human allotransplantation.

We report the case of a 72-year-old man with arcal-lentiginous type melanoma of the penis who had undergone local excision and bilateral inguinal lymphadenectomy but developed recurrence at the subcoronal ridge of the glans penis. To our knowledge, this is the 10th reported case in English published studies. We believe this case demonstrates the importance of close follow-up postoperatively and to beware of the recurrence of penile melanoma in patients without total penectomy.

Trichloroethylene (TRI), a common groundwater contaminant, is readily metabolized by mammals to produce chloral hydrate (CH), trichloroacetic acid (TCA), and trichloroethanol (TCOH). Cytochrome P450 (CYP) and other enzymes are responsible for formation of these metabolites, which are implicated in TRI's toxicity and carcinogenicity. To establish the validity of the Japanese medaka (Oryzias latipes) as an alternate test species for TRI, we examined the metabolism of TRI and CH, as well as CYP expression, in medaka liver preparations. Trichloroethylene was incubated with medaka microsomal protein, and metabolites were extracted and analyzed using gas chromatography. Microsome-mediated metabolism of TRI was observed, and a K m value for TRI oxidation of 540 μM and a V max value of 213 pmol/min.mg -1 protein were obtained. Conversion of TRI to CH, TCA, and TCOH was found with medaka hepatic subcellular fractions. In addition, a sex difference in hepatic microsomal TRI metabolism, specific CYP content, and ethoxyresorufin O-deethylase activity was noted. The lower specific activity of preparations from the livers of female medaka is compensated for by increased total protein in the larger liver mass of the female. Immunochemical analysis showed that CYPIA was readily detectable in medaka liver, but CYP2EI was present at very low levels. These data suggest that TRI metabolism in medaka liver preparations mimics that observed in mammalian systems and supports their use as an alternative test species in the evaluation of the toxicity of TRI.

A technique is proposed for the perfusion of cadaveric kidneys to minimize damage to the renal artery.