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Background: Colonization by multidrug-resistant organisms (MDRO) is a frequent complication in hematologic departments, which puts patients at risk of life-threatening bacterial sepsis. Fever of unknown origin (FUO) is a condition related to the delivery of chemotherapy in hematologic malignancies, in which the use of antibiotics is debated. The incidence, risk factors, and influence on the outcome of these conditions in patients with acute myeloid leukemia (AML) are not clearly defined., Methods: We retrospectively analyzed 132 consecutive admissions of non-promyelocytic AML patients at the Hematology Unit of the University Tor Vergata in Rome between June 2019 and February 2022. MDRO swab-based screening was performed in all patients on the day of admission and once weekly after that. FUO was defined as fever with no evidence of infection., Results: Of 132 consecutive hospitalizations (69 AML patients), MDRO colonization was observed in 35 cases (26%) and resulted independently related to a previous MDRO colonization (p=0.001) and length of hospitalization (p=0.03). The colonization persistence rate in subsequent admissions was 64%. MDRO-related bloodstream infection was observed in 8 patients (23%) and correlated with grade III/IV mucositis (p=0.008) and length of hospitalization (p=0.02). FUO occurred in 68 cases (51%) and correlated with an absolute neutrophilic count <500μ/L at admission (0.04)., Conclusion: In our experience, MDRO colonization is a frequent and difficult-to-eradicate condition that can arise at all stages of treatment. Prompt discharge of patients as soon as clinical conditions allow could limit the spread of MDRO. In addition, the appropriate use of antibiotics, especially in the case of FUO, and the contraction of hospitalization length, when feasible, are measures to tackle the further spread of MDRO., Competing Interests: Competing interests: The authors declare no conflict of Interest.

Acute myeloid leukemia (AML) is a malignant disease of hematopoietic precursors at the earliest stage of maturation, resulting in a clonalproliferation of myoblasts replacing normal hematopoiesis. AML represents one of the most common types of leukemia, mostly affecting elderly patients. To date, standard chemotherapy protocols are only effective in patients at low risk of relapse and therapy-related mortality. The average 5-year overall survival (OS) is approximately 28%. Allogeneic hematopoietic stem cell transplantation (HSCT) improves prognosis but is limited by donor availability, a relatively young age of patients, and absence of significant comorbidities. Moreover, it is associated with significant morbidity and mortality. However, increasing understanding of AML immunobiology is leading to the development of innovative therapeutic strategies. Immunotherapy is considered an attractive strategy for controlling and eliminating the disease. It can be a real breakthrough in the treatment of leukemia, especially in patients who are not eligible forintensive chemotherapy. In this review, we focused on the progress of immunotherapy in the field of AML by discussing monoclonal antibodies (mAbs), immune checkpoint inhibitors, chimeric antigen receptor T cells (CAR-T cells), and vaccine therapeutic choices.

Foetal spleen is described as a transient focus of haematopoiesis between the 3 rd and 5 th month of gestation: this function is however entirely replaced by the bone marrow before the end of pregnancy. This study identifies haematopoiesis in foetal spleen by exploring changes of echogenicity during its development throughout gestation. Two intervals of pregnancy were studied: Mid-Pregnancy (Mid-P, 19-23 weeks) and End-Pregnancy (End-P, 37-41 weeks). The foetal spleen was investigated in 80 pregnant women (41 vs 39). Due to quality criteria the comparison was made between 60 images (30 Mid-P vs 30 End-P). The acquisition of splenic parenchyma was followed by clustering segmentation. We identified two new parameters resulted from the clustering segmentation: Dark Ratio (DR) and Light Ratio (LR). These are related to splenic echogenicity expressing the percentage of dark and light signal in the clustered image, influenced by blood cellularity. The mean of DR value was different among the 2 groups (0.0631 vs 0.0483, P = 0.014 ), while LR did not show any significant differences. We conclude that DR may represent a reliable radiomic parameter in the determination of extramedullary haematopoiesis in the spleen., Competing Interests: None., (AJBR Copyright © 2021.)

Violence has been identified as one of the leading public health hazards of our time. The majority of the victims of violence are being seen in emergency departments and critical care areas. This compels today's nurse to be educated in the proper recognition, interpretation, collection, documentation, and photo-documentation of the ramifications of violence and the associated forensic evidence. The categorization of these patients should be determined by the critical care nurse. Categorical determinations will ensure that the nurse develops a systematic, algorithmic management plan for any client with potential forensic implications associated with their care. It will also assist the nurse in recognizing the mandated reporting that must be completed in certain instances. The additional benefit is to determine what educational needs are required by the critical care nurse staff to posit the forensic population; and, to consider what future research must be accomplished in order to better serve this unique clientele.

Students learn science by actually performing science activities. The 12 laboratories described in this article assist students in applying the fundamental techniques germane to the field of forensic science to "solve" contrived cases and present "evidence" in a mock trial. Moreover, students are also confronted with some of the legal and ethical issues concerning the validity, reliability, and application of some forensic techniques. The pedagogical design of the laboratory course provides a rich, challenging, and interdisciplinary academic experience intended to augment and compliment the didactic forensic lecture portion of the course. This laboratory course was designed to engender, embody, and articulate one of the University's directive goals to support interdisciplinary teaching, research, and programming. Because we developed the laboratories on minimal funds, we demonstrated that it could be cost-effective. And thus, we recommend a laboratory science course be included as part of the curriculum of all forensic nursing students and practitioners., (© 2011 International Association of Forensic Nurses.)

Munchausen by Proxy Syndrome (MBPS) is a rare form of abuse in which a caregiver fabricates or produces symptoms of an illness in a child, elder, or disabled person. The deception is usually repeated on numerous occasions, resulting in many hospitalizations, considerable morbidity, and sometimes death. MBPS is a factitious disorder in which caregivers injure their victims in order to gain sympathy or attention for themselves. It was named after Baron Karl von Munchausen, the 18th century cavalry officer who returned home from war and told embellished tales of his adventures. MBPS is a very horrifying circumstance of abuse. Unwillingness or the inability to recognize this abuse deprives the victim of the opportunity to be shielded from future harm. There is a need for strategic protocols and a multidisciplinary approach to this baffling problem. Discussing the clinical profile of the perpetrator, the victim, and the family may help nurses distinguish medical fact from fiction.

1. Although the nurse's first duty is to provide life-saving treatment for the trauma victim, the patient and society are best served when the nurse also can recognize and preserve evidence that may later be used in a forensic investigation. 2. Photography should become part of trauma protocol, along with performing the ABCs of cardiopulmonary resuscitation. It should be an automatic function. 3. Photographing injuries also protects the hospital and staff from allegations that patients never received the proper care.