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Over the past decade, studies on microRNA (miRNA) and cancer quickly became known. miRNAs are small non-coding RNAs that play a vital role in regulation of gene expression. In the present study, the expression of miR-27b, miR-29a, and miR-155, their prognostic roles, and their potential targets in chronic lymphocytic leukemia (CLL) and breast cancer (BC) by qRT-PCR were investigated. In two case-control studies, qRT-PCR was used to analyze the peripheral blood serum of 15 CLL patients and tissue samples of 15 BC patients for the expression of miR-27b, miR-29a, and miR-155. miRNA expression levels were calculated using the qRT-PCR method. The results revealed a significant increase in the expression of all miRNAs in patients with BC and CLL compared with respective healthy groups (p < 0.001). In BC patients, there was a significant difference between the expression of miR-155 and miR-29a (p < 0.05), miR-155 and miR-27b (p < 0.01), and miR-27b and miR-29a (p < 0.001). In CLL patients, a significant difference between expression of both miR-27b and miR-29a compared with expression of miR-155 (p < 0.001) was found. Furthermore, a significant association between miR-155 and prevascular invasion was found. Significantly, elevated circulating miRNAs were shown to be BC specific and could differentiate BC tissues from the controls. It was demonstrated that miRNAs used in this study and their expression profiles can be developed as biomarkers for early diagnosis and prognosis of CLL and BC. Further studies utilizing a larger test group of patients would provide identification of miRNAs as key players in intercellular interactions. Keywords: CLL, breast cancer, miRNAs, biomarker, qRT-PCR

Introduction: The goal of this study was to look at changes in pseudogene genes level as oncogenes and tumor suppressors in hepatocellular carcinoma (HCC) by large-scale analysis and to develop a survival prediction model based on their expression.Methods: The cancer genome data were applied to evaluate the expression alternations of all pseudogene in HCC and their correlation with patients' prognosis. Also, a risk model was computed based on the expression of pseudogenes and their predictive power in patient mortality rates. The co-expression network and RT-qPCR method were utilized to discover pathways related and confirmed the outcomes, respectively.Results: The results revealed that 12 pseudogenes were down-regulated in HCC, and their increased expression was associated with good prognosis. Also, 11 pseudogenes were overexpressed and associated with patients' poor prognoses. The multivariate Cox regression test indicated that overexpression of AKR1B10P1, RP11-465B22.3, WASH8P, and downregulation of NPM1P25 could predict the survival rate of patients independent of clinical parameters. The risk score model based on mentioned pseudogenes could considerably distinguish patients based on their fatality rate. Also, the co-expression network shown that the identified pseudogene genes can play a role in fatty acid metabolism, proliferation, and mTOR. RT-qPCR results also showed that the expression level of WASH8P was significantly increased in cancer specimens compared to normal.Conclusion: Our results revealed that change expression of AKR1B10P1, RP11-465B22.3, WASH8P, and NPM1P25 was independently associated with prognosis and the patient mortality risk model based on these four pseudogenes can reasonably predict the survival rate of patients.

We describe a 13-year-old boy with a bilateral hemorrhagic lesion in basal ganglia related to mild traumatic brain injury. Due to the severity of the traumatic brain injury, we did not expect the injury to either side of the basal ganglia. So tha

Autologous stem cell transplantation (ASCT) is a standard consolidation treatment for eligible patients with multiple myeloma (MM). There is no standardized mobilization regimen for collection of CD34+ stem cells, which is crucial to the success of ASCT. Cyclophosphamide/GCSF is an effective regimen, although reported associated toxicities include risk of febrile neutropenia (FN). Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. This single center, retrospective, quality improvement study evaluates mobilization and ASCT outcomes of MM patients who had undergone stem cell mobilization at KHSC with cyclophosphamide/GCSF+/-plerixafor without antibiotics, cyclophosphamide/GCSF+/-plerixafor with antibiotics, and GCSF+/-plerixafor without antibiotics.A retrospective chart review was conducted evaluating 137 patients. The primary outcome measure was FN rates with mobilization. Balancing measures include CD34+ cell collected, plerixafor usage, days of apheresis and transplant outcomes. Chi-square, ANOVA, or Kruskal-Wallis methods were used to test statistical significance where appropriate.Our study noted a higher total and day one CD34+ count in the two groups utilizing cyclophosphamide in mobilization. All nine cases of FN occurred in these two groups (P .05). Addition of antibiotics decreased, but did not eliminate risk of FN. There were no significant differences in the rate of plerixafor usage and number of apheresis days. Difference in transplant outcomes, including engraftment and transfusion support, were statistically but not clinically significant. A larger sample size may be needed to explore this fully. There was no significant difference in length of transplant hospital stay.The elimination of cyclophosphamide from mobilization regimens for MM appears to significantly reduce FN rates, without increasing balancing measures such as total number of apheresis days, plerixafor usage, duration of transplant hospitalization or mortality outcomes.

Implication for health policy/practice/research/medical education Mechanistic impact of vitamin D therapy in glomerulopathies consists of preservation of morphological integrity of slit diaphragm, which leads to restoration of tight junction proteins. Vitamin D also avoids the loss of nephrin component of the glomerular basement membrane.

Introduction: Despite the significant advances in treatment of patients with multiple myeloma, therapy of patients with high risk disease remains challenging. Maintenance treatment with Lenalidomide following autologous stem cell transplant (ASCT) is the standard of care in patients with multiple myeloma; however its efficacy in patients with high risk features is conflicting. The efficacy of proteasome inhibitors (PI) ± lenalidomide (Len) maintenance in high risk patients has been evaluated in other studies with discrepant results with respect to improvement in long term outcomes. In this study we sought to assess the impact of various maintenance strategies on outcomes of transplant eligible newly diagnosed myeloma patients in the real world setting. Methods: This is a retrospective, single center Canadian cohort study (London, Canada) with the primary objective to compare the PFS in the high risk transplant eligible (TE) newly diagnosed multiple myeloma (NDMM) patients receiving maintenance treatment versus no maintenance post ASCT, diagnosed from January 1,2007 to April 30,2021. Secondary objectives are comparison of PFS, OS and overall response rate (ORR) based on risk group and various maintenance strategies. ORR is defined as partial response or better. To investigate the effect of different variables on survival outcomes we used Kaplan-Meier curves, univariate and multivariate cox regression analysis. Results: In total, 155 TE- NDMM patients were included. 61 (39%) were high risk defined as: deletion 17p, t (4; 14), t (14; 16), 1q amp. One hundred and thirty (84%) patients received PI or Len-based induction therapy. Of the entire cohort, 53 (34%) patients received maintenance treatment post ASCT: 41 Len to progression, 12 Len+Pi. In the entire cohort, ORR was 71% (38 of 53) for patients who received maintenance and 53% (55 of 102) for those who did not receive maintenance (p=0.7). In the 61 high risk patients, 33 received maintenance: 11 Len+PI and 22 Len single agent. ORR was significantly better for maintenance, 63% (21 of 33) compared to 11% (3 of 27) for no maintenance (p=0.0054). Maintenance therapy also influenced PFS. In total, median PFS was significantly higher in patients who received maintenance; with 63% of patients alive and on therapy at 60 months, compared to no maintenance with median PFS of 40 months (HR 0.46,95% CI(025-0.85),p= 0.011). A subgroup analysis of the impact of maintenance between the standard and high risk groups suggested excellent PFS for both: 56.8% for standard and 67.1% for high risk at 60 months. On the other hand, median PFS was dismal for the high risk no maintenance group: only 19 months versus 45.5 months in the standard group ( HR=0.14,95% CI(0.05-0.38), p In the entire cohort there was no difference in the median OS, NYR in both groups at 60 months; 51% in maintenance, 53% in no maintenance (p=0.25). Similarly in the high risk patients median OS was not different, 61 months in maintenance vs NYR in no maintenance (45% vs 52% at 60 months, p=0.38). OS was also not different in high risk patients who received Len+PI vs Len single agent maintenance, NYR vs 61 months (p= 0.68). In the standard risk group median OS was NYR at 60 months in both maintenance and no maintenance groups (p=0.57) Conclusion: In this Canadian single center retrospective cohort study we compared PFS and OS in patients with TE-NDMM who received maintenance compared to those with no maintenance treatment post ASCT. We found PFS was significantly improved in the high risk patients who received maintenance treatment but we found no impact on dual versus single maintenance strategy. This further validates the findings of large phase 3 clinical trials illustrating a positive impact of maintenance treatment post ASCT irrespective of the cytogenetics risk in the real world setting. Although the maintenance treatment could not entirely overcome the worse outcome in the high risk group, more than 40% of the high risk patients who received maintenance were still alive at 60 months. The question of the best maintenance strategy for high risk myeloma patients remains open and further studies are warranted Figure 1 Figure 1. Disclosures Lam: Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees; SeaGen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffmann-La Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees. Phua: Amgen: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria; NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria. Louzada: Pfizer: Honoraria; Janssen: Honoraria; Amgen: Honoraria; Celgene: Honoraria.

Introduction: Over the past decade, significant advances in the treatment strategy of newly diagnosed multiple myeloma patients (NDMM) have challenged the initial management strategy in transplant-eligible (TE) patients. The value of a single autologous stem cell transplant (ASCT) is established in standard-risk myeloma; however, the role for tandem ASCT reveals conflicting results, especially in patients with high-risk cytogenetic (HR) features. HR changes include at least one of the cytogenetic lesions: t(4;14), t(14;16), t(14;20), del17p, 1q amp +, 1q amp + del 1p. Subgroup analyses of HR patients in the EMN02 study suggest benefits with tandem ASCT. Methods: We retrospectively reviewed our single centre ASCT experience in TE NDMM patients with HR from London, Canada, from January 1, 2007, to April 30, 2021 with the primary objective to compare single versus tandem ASCT for patients with high-risk MM. Secondary objectives include progression-free survival (PFS), overall survival (OS) and the effect of maintenance therapy on survival. OS and PFS were estimated using the Kaplan-Meier method. We also applied univariate and multivariate cox regression to assess the effects of age, hemoglobin, and creatinine on survival. Results: 155 NDMM received at least one ASCT between January 1, 2007 to April 30, 2021. 61/155 (39.3%) patients had HR disease. T(4:14) was seen in 19/61 (31.1%) patients; t(14:16) in 9/61 (9.8%) patients; del 17p in 20/61 (32.7%) patients, 1q amp in 36/61 (59.0%) patients and 1p del + 1q amp in 8/61 (13.1%). Patients with more than one abnormality was seen in 22/61 (36.0%) patients. In this high-risk group, the most common induction regimen consisted of cyclophosphamide, bortezomib, and dexamethasone (CyBorD) in 58/61 patients (95.0%). 34 (55.7%) patients received single ASCT and 27 (44.2%) patients received tandem ASCT. 18/34 (52.9%) single ASCT patients and 15/27 (55.5%) tandem ASCT patients received maintenance therapy. Maintenance therapy included single-agent lenalidomide (imid) in 14/61 (22.9%); single-agent bortezomib or ixazomib (proteasome inhibitor (PI)) in 8/61 (13.1%), and; imid + PI combination in 11/61(18.0%). Baseline characteristics are summarized in Table 1. Single versus tandem ASCT in HR patients revealed no statistically significant PFS difference at 60 months (p=0.3). Maintenance therapy demonstrated a substantial improvement in PFS regardless of the number of ASCT (single ASCT HR=0.1687, 95% CI range 0.05-0.52, p At the 60-month follow-up, the median PFS for high-risk patients without maintenance was 18.8 months. In contrast, the PFS for patients on maintenance was not reached (HR=0.1446, 95% CI range 0.05-0.38, p Conclusion: In our single centre experience, single vs. tandem ASCT in TE NDMM with HR disease did not contribute to long-term survival outcomes, but the presence of any maintenance therapy had a more considerable impact on PFS. Our data does show a longer progression-free survival compared to previous published data, which is likely due to our sample size. Figure 1 Figure 1. Disclosures Lam: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; SeaGen: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffmann-La Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees. Phua: Amgen: Honoraria; NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria. Louzada: Amgen: Honoraria; Pfizer: Honoraria; Celgene: Honoraria; Janssen: Honoraria.

Introduction: Febrile neutropenia (FN) is a serious potential adverse event of myelosuppressive chemotherapy. Dose-adjusted EPOCH-R (DA-EPOCH-R: etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab, with doses adjusted to induce neutropenia of < 0.5 x 10 9/L) is a chemoimmunotherapy regimen used for aggressive lymphomas including diffuse large B-cell lymphoma, double/triple hit, Burkitt, primary mediastinal, and HIV-associated large cell lymphoma. It is associated with high rates of FN (13-25% of cycles) despite use of prophylactic Septra and granulocyte colony stimulating factor (G-CSF). Fluoroquinolone antibiotics have been used in various hematological malignancies to reduce infection rates while on chemotherapy, but this strategy has never been reported with DA-EPOCH-R. This study was conducted to assess the impact of adding routine Levofloxacin prophylaxis on FN and infection rates in patients receiving DA-EPOCH-R. Methods: This is a combined cohort study comparing the patients who received DA-EPOCH-R for newly diagnosed aggressive lymphoma at the London Regional Cancer Program in London, Ontario, Canada before and after the initiation of routine Levofloxacin prophylaxis in July 2020. The prospective cohort received Levofloxacin 500 mg x 7 days with each cycle starting on cycle day 8 in addition to standard supportive care with Septra and G-CSF. The primary objective was the rate of febrile neutropenia. Secondary objectives included days hospitalized, deaths related to infections, and adverse events secondary to Levofloxacin. Results: Thirty patients who received DA-EPOCH-R in the 5 years preceding the initiation of routine prophylactic Levofloxacin were included in the retrospective cohort. Median age was 58 (range 18-79), 66% were male, and 90% had stage III/IV disease. Total number of cycles of DA-EPOCH-R received was 110, with a median of 4 cycles per patient (range: 1-6). FN developed in 14 patients (46%), and complicated a total of 20 cycles (18%) of DA-EPOCH-R. There were 19 hospital admissions due to FN, with a median duration of hospitalization of 12 days (range 3-120). Two patients died, both due to infection. Thirteen patients have been treated so far in the prospective cohort, 12 of whom received levofloxacin prophylaxis. Median age was 59 (range 23-69), 66% were male, and 76% had stage III/IV disease. Total number of cycles of DA-EPOCH-R received was 60, with a median of 5 cycles per patient (range: 1-6 ). Only 1 patient (8%) developed FN, which complicated a total of 3 cycles (5%) of chemotherapy. All 3 episodes of FN resulted in hospitalization for a median duration of 30 days (range 20-49). There have been no deaths due to infection in this cohort thus far. No concerning adverse effects from Levofloxacin have been observed. Conclusions: Although enrollment in the prospective cohort is ongoing, preliminary data are highly encouraging, with significantly lower rates of FN and death due to infection observed since the introduction of routine Levofloxacin prophylaxis. The addition of Levofloxacin to standard prophylaxis with Septra and G-CSF seems to be an effective way to mitigate the risks to patients on DA-EPOCH-R for aggressive lymphomas, and this strategy is worthy of further study. Disclosures Lam: Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffmann-La Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; SeaGen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Phua: NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria.

Introduction: Ibrutinib, an oral Bruton Kinase inhibitor, is a highly effective treatment for patients with chronic lymphocytic leukemia (CLL). Previous studies reported an increased risk of bleeding due to impaired platelet function. Patients with CLL experience significant thrombocytopenia, which increases their risk for bleeding. This population was excluded from major trials and data is lacking to inform management in this setting. Methods: This is a single center retrospective study of all adult patients with CLL who received single agent ibrutinib in London, Ontario, Canada between January 2014 to December 2020. The primary objective was to investigate the risk of major bleeding associated with thrombocytopenia. Secondary objective was to investigate potential predictors of bleeding. Bleeding events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) grading system. A major bleed was defined as CTCAE grade 3 or higher as well as bleeding in the central nervous system. To assess the effect of independent variables on the outcome of bleeding, univariate analysis using chi square and t-tests was performed. Multivariate analysis was then preformed with the variables that were significant (p Results: A total of 170 patients were included in this study. There were 54 bleeding events documented in 42 patients (24.7 %) of which 19(35 %) were major bleeding occurring in 17 patients. Median time to major bleeding was 2.4 months. Of the patients with major bleeding, 4(21%) were on anticoagulation, 2(10%) were on antiplatelet and 2(10%) were on combined anticoagulation and antiplatelet. There were 8 central nervous system (CNS) bleeding and 2 of them died. The mean platelet (PLT) nadir, defined as lowest PLT count at any point during ibrutinib treatment, was 73 x 10 9/Lin patients with major bleeding compared to 116 x 10 9/L in patients with minor and 91 x 10 9/L in patients with no bleeding events. On the univariate analysis, when compared patients with major bleeding to patients with no bleeding, potential predictors of major bleeding included PLT nadir (p=0.09), haemoglobin (Hb) < 100 g/L at ibrutinib initiation (p=0.027) and anticoagulation (p=0.009). When compared patients with major bleeding to patients with minor or no bleeding, potential predictors of major bleeding included PLT nadir (p=0.045), Hb To confirm the significance of these variables, multivariate analysis was performed. When compared patients with major bleeding to patients with no bleeding, PLT nadir (OR= 0.9, p=0.008) and anticoagulation (OR=4.02, p=0.001) were confirmed to be the potential predictors of major bleeding. When compared patients with major bleeding to patients with minor or no bleeding, PLT nadir (OR=0.9 p=0.005) and Hb Conclusions: Although not common, Ibrutinib is associated with increased risk of bleeding and identifying high risk patients is essential to prevent major bleeding events. This retrospective Canadian study was done with the primary objective to assess the association between PLT count and major bleeding in patients on ibrutinib for treatment of CLL. In this analysis patients with major bleeding tend to have lower PLT counts compared to patients with minor or no bleeding, with mean PLT nadir of 73x 10 9/L. However, grade 3 thrombocytopenia (PLT nadir Figure 1 Figure 1. Disclosures Louzada: Amgen: Honoraria; Pfizer: Honoraria; Celgene: Honoraria; Janssen: Honoraria. Lam: AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffmann-La Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; SeaGen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees. Phua: Amgen: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria; NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria.

Objective: To detect the prevalence of Coxiella burnetii (C. burnetii) in two species of snails consisted of Lymnaea palustris (L. palustris) and Pomacea canaliculata (P. canaliculata) by using nested PCR method in Chaharmahel Va Bakhtiari Province which is located in the southwest of Iran. Methods: A total of 160 snail samples consisted of 100 L. palustris and 60 P. canaliculata were collected from 4 rice paddy fields in the southwest of Iran between June and August 2014. Snails' DNA was extracted by a genomic DNA purification kit according to the manufacturer's instructions. Detection of the presence of C. burnetii's DNA was carried out by using a nested PCR assay with [specific primers outer membrane protein 1 (OMP1)-OMP2 and OMP3-OMP4] targeting the com1 gene. Results: In this study, a total of 160 snail samples were tested and 15 (9.37%) samples were found positive for C. burnetii, 15 samples were positive from the L. palustris and there were no positive samples from P. canaliculata. Conclusions: Snails are kind of gastropods which seem to be harmless in life, but these small gastropods can be very dangerous for farmers, especially in humid climates. Also, C. burnetii in snails showed that this bacterium can be a factor of transmission of contamination to human beings and animals.

Cardiac repolarization of black athletes has a distinctive pattern. During an episode of pericarditis, this pattern may evolve into a "pseudonormalized" electrocardiography (ECG). On resolution of the pericardial inflammation, the ECG may return to the normal variant for a black athlete, sounding the alarms of extended disease to the myocardium. Recognizing the normal variant for a black athlete will reduce the need for unnecessary further testing or treatments. The case is discussed in detail.

Deaths due to road traffic accidents (RTAs) are a major public health concern around the world. Developing countries are over-represented in these statistics. Punitive measures are traditionally employed to lower RTA related behavioural risk factors. These are, however, resource intensive and require infrastructure development. This is a randomised controlled study to investigate the effect of non-punitive behavioural intervention through peer-comparison feedback based on driver behaviour data gathered by an in-vehicle telematics device.A randomised controlled trial using repeated measures design conducted in Iran on the drivers of 112 public transport taxis in Tehran province and 1309 inter-city busses operating nationwide. Driving data is captured by an in-vehicle telematics device and sent to a centrally located data centre using a mobile network. The telematics device is installed in all vehicles. Participants are males aged above 20 who have had the device operating in their vehicles for at least 3 months prior to the start of the trial.The study had three stages: 1- Driver performance was monitored for a 4-week period after which they were randomised into intervention and control groups. 2- Their performance was monitored for a 9-week period. At the end of each week, drivers in the intervention group received a scorecard and a note informing them of their weekly behaviour and ranking within their peer group. Drivers in the control group received no feedback via short messaging service (SMS). 3- Drivers did not receive further feedback and their behaviour was monitored for another 4 weeks.Primary outcome was changes in weekly driving score in intervention and control groups during stage 2 of intervention. Taxis and busses were analysed separately using generalised estimating equation analysis.This project was funded by the National Institute for Medical Research Development (Grant No.940576) and approved by its ethics committee (Code: IR.NIMAD.REC.1394.016). This trial was registered at www.irct.ir as IRCT20180708040391N1.

Due to the increasing elderly population and the subsequent increase in their need for medication and more referrals to the pharmacy, this study was conducted to investigate the Iranian hospital pharmacies in terms of age-friendliness criteria. This was a cross-sectional study conducted in 2017. The study population included 3 metropolitan hospital pharmacies selected through clustered sampling, and all their 67 pharmacies were included by census. Data collection tool was a reliable researcher-made checklist (t = 0.85, α = 0.9) Data analysis was performed using Kruskal-Wallis test and Mann-Whitney test through SPSS version 24. The results in these three cities showed that only two pharmacies were in a high level of age-friendly. The relationship between type of pharmacy and the final score of age-friendly situation in these cities showed no significant relationship. There was no significant relationship among the average of the final score of the age-friendly situation in three studied cities. Due to the increasing elderly population and the aging society, readiness of Iranian hospital pharmacies to provide services to the elderly will be one of the most challenging issues in the long term. With proper legislation and policies on health-care systems, especially pharmacies, physical and psychological problems in elderly can be reduced in the future. Furthermore, with advancing toward age-friendly pharmacies, the community can be empower and become ready encountering elderly problems.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide.To synthesize data on the worldwide prevalence and severity of COPD by geographical region, age groups, and smoking status in a systematic review.A systematic search was performed following Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. International databases including PubMed, Scopus and Web of Science were searched for population- based studies published between January 2004 and May 2015 that reported the prevalence of COPD anywhere in the world. The prevalence of COPD was calculated based on World Health Organization (WHO) regions and sex and severity stages using metaprop. Meta-regression and subgroup analysis were applied to determine the sources of heterogeneity.Sixty papers were screened with a combined subject sample size of 127 598. The prevalence of post-bronchodilator COPD was 12.16% (10.91-13.40%). The pooled prevalence of COPD was 15.70% (13.80-18.59%) in men and 9.93% (8.73- 11.13%) in women. Among all WHO regions, the highest prevalence was recorded in the Region of the Americas (14.53%), and the lowest was recorded in the South-East Asia Region/Western Pacific Region (8.80%). Meta-regression model variables were: sample size, WHO region, study quality score, level of gathering data, publication year, and sampling methods that justified 29.82% of heterogeneity detected among COPD prevalence rates worldwide.Global prevalence of COPD among men is about 5% higher than among women. The most prevalent stage of COPD is stage 1.معدل الانتشار العالمي لمرض الانسداد الرئوي المزمن: استعراض منهجي وتحليل تلوي.مهدي ورمقاني، مينا دهقاني، إلهام حيدري، فارشاد شريفي، سحر سعيدي مقدم، فرشاد فرزادفر.يُعَدُّ مرض الانسداد الرئوي المزمن أحد الأسباب الرئيسية التي تسبب المراضة والوفيات على مستوى العالم.هدفت هذه الدراسة إلى جمع البيانات حول معدل الانتشار العالمي لمرض الانسداد الرئوي المزمن ومدى شدته حسب المنطقة الجغرافية والفئات العمرية وحالة التدخين، وذلك من خلال استعراض منهجي للمواد الطبية المنشورة.أُجري بحث منظَّم اتبع التحليل التلوي للمبادئ التوجيهية الخاصة بالدراسات الرصدية في علم الوبائيات. وتم البحث في قواعد البيانات الدولية، بما في ذلك PubMed و Scopus و Web of Science ، عن الدراسات القائمة على السكان التي أبلغت عن معدل انتشار مرض الانسداد الرئوي المزمن في أي مكان بالعالم، والمنشورة في الفترة بين يناير/كانون الثاني 2004 ومايو/أيار 2015. وتم حساب معدل انتشار مرض الانسداد الرئوي المزمن بناءً على أقاليم منظمة الصحة العالمية والجنس ومراحل شدة المرض باستخدام برنامج Metaprop الإحصائي. وطُبِقت أساليب التحوف التلوي وتحليل المجموعات الفرعية لتحديد مصادر عدم التباين.استُعرضت 60 ورقة بحثية إجمالاً، وبلغ مجموع حجم العينة 127.598 شخصًا. وبلغ معدل انتشار مرض الانسداد الرئوي المزمن ما بعد إعطاء موسع للقصبات 12.16% (10.91 – 13.40%). وبلغ مجموع معدل انتشار مرض الانسداد الرئوي المزمن 15.70% (13.80 – 18.59%) بين الرجال، و 9.93% (8.73 – 11.13%) بين النساء. ومن بين أقاليم منظمة الصحة العالمية، سُجِّل أعلى معدل انتشار في إقليم الأمريكتين (14.53 %)، وأقل معدل انتشار في إقليم جنوب شرق آسيا/إقليم غرب المحيط الهادئ (8.80 %). وفي نموذج التحوف التلوي، شملت المتغيرات ما يلي: حجم العينة، والأقاليم، ومستوى جودة الدراسة للبيانات المُجمَّعة، وسنة النشر، وأساليب أخذ العينات، والتي توضح 29.82% من عدم التباين المكتشف بين معدلات انتشار مرض الانسداد الرئوي المزمن على مستوى العالم.يبدو أن معدل الانتشار العالمي لمرض الانسداد الرئوي المزمن بين الذكور أعلى بنسبة 5% تقريبًا عنه بين النساء. وأكثر المراحل انتشارًا من المرض هو المرحلة الأولى.Prévalence mondiale de la bronchopneumopathie chronique obstructive : analyse systématique et méta-analyse.La bronchopneumopathie chronique obstructive (BPCO) est l’une des principales causes de morbidité et de mortalité dans le monde.Réaliser une synthèse des données relatives à la prévalence et à la gravité de la BPCO par régions géographiques, tranches d’âges et statut tabagique à partir d’une analyse systématique de la littérature médicale disponible.Une recherche systématique a été réalisée conformément aux lignes directrices pour la méta-analyse des études observationnelles (MOOSE). Des recherches ont été lancées dans des bases de données internationales, notamment PubMed, Scopus et Web of Science, afin d’identifier les études populationnelles, publiées entre janvier 2004 et mai 2015, faisant état de la prévalence de la BPCO partout dans le monde. La prévalence de la BPCO a été calculée à l’aide du programme Metaprop en fonction des régions définies par l’Organisation mondiale de la Santé (OMS), du sexe et du stade de sévérité. Des méthodes de méta-régression et d’analyse de sous-groupes ont été appliquées afin d’identifier les sources d’hétérogénéité.Au total, 60 articles ont été analysés portant sur un échantillon composite de 127 598 sujets. La prévalence de la BPCO après utilisation d’un bronchodilatateur était de 12,16 % (10,91 à 13,40 %). La prévalence globale de la BPCO était de 15,70 % (13,80 à 18,59 %) chez les hommes et de 9,93 % (8,73 à 11,13 %) chez les femmes. Sur l’ensemble des régions OMS, la prévalence la plus forte était enregistrée pour les Amériques (14,53 %) et la plus faible pour l’Asie du Sud-Est/le Pacifique occidental (8,80 %). Les variables du modèle de méta-régression utilisé incluaient la taille de l’échantillon, la région, le score de la qualité de l’étude, le niveau des données recueillies, l’année de publication et la méthode d’échantillonnage, justifiant ainsi l’hétérogénéité de 29,82 % associée aux taux de prévalence de la BPCO à travers le monde.La prévalence mondiale de la BPCO chez les hommes s’avère supérieure d’environ 5 % à celle observée chez les femmes. Le stade 1 de la BPCO est celui ayant la prévalence la plus élevé.

Background: Autologous stem cell transplantation (ASCT) as consolidation post induction is standard of care for eligible multiple myeloma patients. Multiple strategies are employed for mobilization of stem cells in ASCT. Cyclophosphamide/GCSF is an effective standard regimen. However there are reported toxicities associated with cyclophosphamide including risk of febrile neutropenia. Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. There is however high cost associated with plerixafor. To date, there is no standard mobilization regimen across Canada. This retrospective study evaluates mobilization and ASCT outcomes of multiple myeloma patients who had undergone stem cell mobilization with GCSF+/-plerixafor (GP) vs cyclophosphamide/GCSF+/-plerixafor (CyGP) at KHSC. The goal is to analyze the efficacy of each regimen balanced with adverse events to guide optimal mobilization regimen choice. Method: Patient with multiple myeloma who had ASCT at KHSC were selected consecutively based on date of ASCT in a reverse chronological order starting from Jan 2019. From Oct 2015 to March 2018, CyGP was the mobilization regimen used at KHSC. From March 2017 to January 2019, cyclophosphamide was eliminated and GP was used. Both groups could have received plerixafor as needed based on Cancer Care Ontario funding criteria such as failure to achieve target CD34+ cell count. Retrospective chart review was conducted to collect data on demographics, plerixafor use, days of apheresis, total cell collected, rate of febrile neutropenia, length of transplant hospital stay, time to engraftment, and transfusion requirement. Chi-Square, t-test, or Mann Whitney methods were used for test of statistical significance where appropriate. Results: Total 97 patients were included with 47 in the GP group and 50 in the CyGP group (Table 1). Average age was 64 and 63 respectively. 32% of patients in GP group and 36% of CyGP group required plerixafor rescue. No difference in the number of apheresis days were noted in the two groups. Total cell collection was significantly higher in the CyGP group (P Conclusions: Stem cell mobilization with CyGP resulted in significantly higher total collection cell count, and more efficient collection with higher yield on the first 2 days of apheresis. However, there was no difference in the total number of apheresis days. It also did not lead to less plerixafor usage and was associated with possibly higher rate of febrile neutropenia. There was no clinically significant difference in transplant outcomes in terms of transfusion support required, days to engraftment, or length of hospitalization for ASCT. Mobilization with GCSF+/-plerixafor without cyclophosphamide is a non-inferior regimen. Disclosures Bhella: Celgene: Consultancy, Honoraria.

Background: While psychological and behavioral symptoms are a major challenging aspect of dementia, they have not been considered as an important mental health issue in developing countries. The aim of the current study was to explore the prevalence and possible associated factors of psychiatric symptoms seen in patients with dementia. Methods: In a cross sectional study, 101 patients diagnosed with dementia were selected. Appropriated world-wide instruments, such as the Neuropsychiatry Inventory (NPI), Clinical Dementia Rating scale (CDR), barthel index and Cummulative Illmess Rating Scale (CIRS) were used to detect behavioral disturbance, severity of dementia, disability and burden of medical conditions, separately. In this study, the correlation between Behavioral and Psychological Symptoms of Dementia (BPSD) and severity of dementia, activity of daily living, organic dysfunction and type of dementia was also evaluated. Results: Behavioral and Psychological Symptoms of Dementia were frequent in about 70% of the study sample. The most common problematic behaviours were night time behaviours followed by delusion (58%), disinhibition (57%), anxiety (57%), irritability (56%), depression (55%), agitation (55%), and apathy (55%). The least frequent symptom was elation. These behavioral symptoms were significantly correlated with the severity of dementia, greater disability, higher burden of medical conditions, and the level of distress in both patients and their caregivers. Mood symptoms such as depression, anxiety, and elation were not increased with the severity of the dementia. Conclusions: The findings of this study suggested that the three main cluster symptoms were psychosis, behavioral disturbances such as disinhibition, irritability agitation and, mood symptoms including anxiety and depression.

Background Over the past three decades, interventions have been implemented to reduce childhood mortality in Iran. Despite declines in overall mortality rates, inequalities in mortality across socioeconomic groups have remained unchanged. In this study, we assessed inequalities in infant mortality in rural regions of Iran. Methods We obtained data from the Iranian vital registration system, which includes data on 5,626,158 live births, 79,457 neonatal deaths, and 36,397 postneonatal deaths in rural areas of Iran over the course of a 16-year period, which was then divided into 4 four-year intervals. In addition to building multivariate regression models to identify factors associated with mortality, we calculated a concentration index for each province to measure inequalities in neonatal and postneonatal mortality, using wealth index as the socioeconomic variable of interest. We further assessed these inequalities as a component of their contributors by using the decomposition method. Results Although both neonatal (17.62 to 10.92) and postneonatal (8.11 to 5.14) mortality rates exhibited decreasing trends from 1998-2001 to 2010–2013, the inequalities observed in these indices remained nearly unchanged (concentration indices of −0.062 to −0.047 and −0.098 to −0.083, respectively). Furthermore, fraction of births occurred in hospitals and literate women contributed positively to the inequalities observed in both neonatal and postneonatal mortality rates, whereas the proportion of infants classified as low birth weight contributed negatively over all study periods. We also identified decreasing trends in inequalities of the proportion of infants classified as having low birth weight, being born in hospitals, being covered by health insurance, mothers’ age, and literacy of women within the time intervals under study. Conclusions Although infant mortality rates in Iran decreased over the studied time period, we observed notable inequalities in these measures. Several steps are needed to overcome these inequalities, including improving access to professional health services for lower income households, fairly distributing facilities and human resources, and improving insurance coverage to protect families from financial hardships. Moreover, social factors, such as literacy of women, were found to be important in decreasing inequalities in infant mortality. These steps require improving societal awareness of infant mortality and implementing improved and problem-oriented health policies.

Background: The neutrophil to lymphocyte ratio (NLR) at the time of diagnosis has been shown as a prognostic marker to predict outcomes of treatment in patients with aggressive lymphoma in both non-Hodgkin (NHL) and Hodgkin lymphoma (HD). The growing evidence that tumor microenvironment, host immunity and inflammatory responses play an important role in progression of different malignancies supports this rationale. The prognostic significance of NLR has only been studied in the frontline setting in HD and NHL. Therefore the aim of this study is to evaluate correlation of NLR with response to salvage therapy in patients with relapsed or refractory aggressive lymphoma. Methods: This is a retrospective review of participants in the CCTG LY.10 trial, a phase 2 clinical trial evaluating treatment with Gemcitabine, Dexamethasone and Cisplatin (GDP) in patients with relapsed or refractory NHL and HD who are eligible for Autologous Stem Cell Transplantation (ASCT). Seventy-seven patients were treated with GDP, 23 with HD and 51 with NHL. The overall response rate (ORR) including complete and partial response to GDP salvage therapy was 69.5% in HD and 49% in NHL. NLR was calculated on all patients at the time of relapse. Biomarker Threshold Models (Chen et al, 2014, Computational Statistics and Data Analysis, V71, page 324-334) were applied to identify the optimal cut off point for NLR. Categorical variables were compared using Chi-square test and survival distributions were compared using KM curves and Log-rank test. Results: A NLR of 8.4 was determined to be the optimal cut-off for prognosis. Among the full cohort of 77 patients, ORR in those with a NLR of < 8.4 was 70.6%, as compared with 33.4% for those with a NLR of > 8.4 (p=0.005). In the HD cohort the RR was 86.7% vs 50% (P =0.059) and was 63.9% vs 26.7% in the NHL cohort (P =0.015). In NHL the ability to proceed to transplant was correlated with NLR of Conclusion: NLR is a readily available marker correlated with outcomes (ORR, transplant rate and PFS) and can be used to identify high risk patients at the time of relapse of aggressive lymphoma. This easily measurable prognostic marker would be especially useful in the era of novel treatment options to identify higher risk patients. Further analysis on larger data sets are required to validate this finding. Disclosures Hay: Seattle Genetics: Research Funding; Roche: Research Funding; Janssen: Research Funding; Novartis: Research Funding; Amgen: Research Funding; Kite: Research Funding. Baetz:Merck: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Research Funding.

The knapsack problem (KP) and its multidimensional version are basic problems in combinatorial optimisation. In this paper, we consider the bi-objective multidimensional integer knapsack problem (BOMIKP), for which the aim is to approximate the set of non-dominated solutions using an evolutionary algorithm named non-dominated sorting particle swarm optimisation (NSPSO). The proposed methodology is based on a new variant of particle swarm optimisation (PSO) specialised in multi-objective optimisation. To aid the decision maker choosing the best compromise solution from the Pareto front, the fuzzy-based mechanism is employed for this purpose. For ensuring the robustness of the proposed method, the computational results are compared with those obtained by non-dominated sorting genetic algorithm II (NSGA-I) and multi-objective particle swarm optimisation (MOPSO) algorithm. Results show the advantages and effectiveness of the used procedures in reporting the optimal Pareto front. In addition, the results indicate that while MOPSO is able to generate Pareto solutions in significantly less amount of time, NSPSO and NSGA-II are capable of providing better quality results and better distribution of solutions in the trade-off surface.