TITLE PAGEManuscript title: Isolated neutropenia preceding acute lymphoblastic leukemia in children

Background: Heart transplantations are ideal for most patients with end-stage heart failure refractory to medical treatment. The transplantation program at the Peruvian National Heart Institute started with a 10-year-continuity in 2010. Objective: To report the results of a 10-year heart transplantation experience at the Peruvian National Heart Institute. Methods: We studied 83 patients who underwent orthotopic heart transplantation at a single center between January 2010 and December 2019. The recipients’ profiles and survival were analyzed according to sex and age group, ensuring the information’s confidentiality. Results: The recipients’ mean age was 41.2 ± 17 years, 88% were adult, and 68.7% were male. The main indications for transplantation were idiopathic dilated cardiomyopathy. 85.5% of recipients were clinically categorized as INTERMACS Profile 1 to 3 before transplantation. There was a significant difference between sexes regarding the preoperative left ventricular ejection fraction and between age groups regarding the waiting time. The average ischemia time was 3.1 hours, operating time was 6.1 hours, cardiopulmonary bypass time was 3 hours, and aortic cross-clamp time was 1.7 hours. The principal early postoperative complications were hematological disorders and acute kidney failure. The principal late ones were kidney failure and severe anemia. The postoperative mortality was 15.9%, and the principal causes were infection and then acute rejection. The survival at one, five, and ten years was 87.5%, 79.8%, and 79.8%, respectively. The survival results were not influenced by sex or age group. Conclusion: Our patients’ postoperative complications, mortality, and survival rates coincided with those reported by the ISHLT registry.

I read with interest the articles by Wang and colleagues about comparison of risk scores for predicting outcomes after isolated tricuspid valve surgery and the commentary by Russo and colleagues about prediction of mortality in isolated tricuspid surgery1

Pulmonary infections represent the major causes of morbidity and mortality in cystic fibrosis(CF). Here, we report a3-month old infant with pancreatic insufficient CF was hospitalized with positive RT-PCRtest for COVID-19. He was treated successfully. Hypertonic saline can be hypothesized as a treatment regimen against COVID-19 infection after further investigation

Clinical and research laboratories extensively use exome sequencing due to its high diagnostic rates, cost savings, impact on clinical management, and efficacy for disease gene discovery. While the rates of disease gene discovery have steadily increased, only ~16% of genes in the genome have confirmed disease associations. Here we describe our diagnostic laboratory’s disease gene discovery and ongoing data-sharing efforts with GeneMatcher. In total, we submitted 246 candidates from 243 unique genes to GeneMatcher, of which 45.93% are now clinically characterized. Submissions with at least one case meeting our candidate genes reporting criteria were significantly more likely to be characterized as of October 2021 compared to genes with no candidates meeting our reporting criteria (p=0.025). We reported relevant findings related to these gene-disease associations for 480 probands. In 219 (45.63%) instances, these results were reclassifications after an initial candidate gene (uncertain) or negative report. Since 2013, we have co-authored 105 publications focused on delineating gene-disease associations. Diagnostic laboratories are pivotal for disease gene discovery efforts and can screen phenotypes based on genotype matches, contact clinicians of relevant cases, and issue proactive reclassification reports. GeneMatcher is a critical resource in these efforts.

A 16-year-old female presented to our ED with fever and coughing of blood for 3 days. She is known to have SLE for 5 months and takes oral prednisone. She was tested positive for COVID19. She developed hypocalcemia with clinically-diagnosed massive pulmonary embolism. She was treated with heparin and recovered.

We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds.

The relativistic properties of Hydrogen-like atoms (HLAs) are here investigated in the Heisenberg picture for the first time. The relativistic vibrational Hamiltonian (RVH) is first defined as a power series of harmonic oscillator Hamiltonian by using the relativistic energy eigenvalue . By applying the first-order RVH (proportional to ) to the Heisenberg equation, a pair of coupled equations is turned out for the relativistic motion of the electron’s position and linear momentum. A simple comparison of the first-order relativistic and nonrelativistic equations reveals this reality that the natural (fundamental) frequency of HLA (like entropy) is slowly raised by increasing the atomic number from . The second-order RVH (proportional to ) has then been implemented to determine an exact expression for the electron relativistic frequency in the different atomic energy levels. In general, the physical role of RVH is fundamental because it not only specifies the temporal relativistic variations of position, velocity, and linear momentum of the oscillating electron, but also identifies the corresponding relativistic potential, kinetic, and mechanical energies. The results will finally be testified by demonstrating energy conservation.

We report a rare case of cervical epidural abscess at the C5-C6 levels. The patient underwent surgery with complete abscess removal through C6 vertebral body corpectomy. The result of bacteriological culture was Brucella melitensis. Brucellosis must be considered as a possible cause of epidural abscess in patients from endemic area.

In this paper, we mainly consider the well-posedness and long-time behavior of solutions for the nonlocal diffusion porous medium equations with nonlinear term. Firstly, we obtain the well-posedness of the solutions in L1(Ω) for the equations. Secondly, we prove the existence of a global attractor by proving there exists a compact absorbing set. Finally, we apply index theory to consider the dimension of the attractor and prove that there exists an infinite dimensional attractor of the equations under proper conditions.

We describe an adult patient who presented with purulent pericarditis in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images have not been reported previously in an adult patient with purulent pericarditis, to the best of our knowledge.

Background: Candida auris is an emerging fungal pathogen of worldwide interest. It is associated with high mortality rates and exhibits increased resistance to antifungals. Ultraviolet-C (UVC) light can be used to disinfect surfaces to mitigate its spread. In this study, we analyzed the performance of different UVC wavelengths against C. auris to determine its wavelength sensitivity and UVC dose requirements and evaluated biofilm prevention dose requirements on most used materials in healthcare settings. Objectives: 1. To investigate UVC disinfection performances and wavelength sensitivity of C. auris; 2. To evaluate the UVC dose required for prevention of biofilm prevention on stainless steel. Methods: C. auris was grown following standard procedures. The study utilized six different UVC LED arrays with wavelengths between 252 and 280 nm. Arrays were set at similar intensities, to obtain doses of 5-40 mJcm-2 and similar irradiation time. Disinfection performance for each array was determined using log reduction value (LRV) and percentage reduction by comparing the controls against the irradiated treatments. Evaluation of the ability of 267 nm UVC LEDs to prevent C. auris biofilm formation was investigated using stainless steel, plastic coupons, and poly-cotton fabric. Results: Peak sensitivity to UVC disinfection was between 267 and 270 nm. With 20 mJcm-2, the study obtained LRV 3. On steel coupons, 30 mJcm-2 was sufficient to prevent biofilm formation, on plastic only 10 mJcm-2. A dose of 60 mJcm-2 reduced biofilms on poly-cotton fabric significantly. Conclusions: Results revealed that C. auris was most susceptible at 267-270 nm. Additional highlights from the study allow for the design and implementation of disinfection systems.

Novel cocoa butter equivalents were designed using dry fractionated Pequi oil and solvent fractionated Kpangnan butter. Static crystallization of binary mixtures of these two fractions into the triclinic form (β2) was achieved after 12 days for all mixtures and after 4 days for the 80:20 w/w and 90:10 w/w fractionated Kpangnan:Pequi oil mixtures. Moreover, after 60 days of storage at 22oC, all binary blends (except 100% fractionated pequi oil and 100% fractionated Kpangnan butter) were crystallized in the most stable triclinic crystal form (β1). Here we also discovered an unusual melting behavior for the fractionaled 30:70 w/w and 20:80 w/w fractionated Kpangnan:Pequi oil mixtures, where after 4 days of static crystallization at room 22oC, these mixtures displayed higher than predicted melting points, 41.89 oC and 33.32 oC, respectively. This suggested a faster kinetics of transformation to the triclinic β2 form for those mixtures. Our results suggest that the 30:70 w/w fractionated Kpangnan:Pequi oil mixture with a melting point of 34oC after 60 days storage at 22oC, a stable triclinic β2 form, and a triglyceride composition of 28% POP, 4.6% POS and 33% SOS displayed solid state characteristics, melting point and crystal structure, of a commercial cocoa butter equivalent.

Staphylococcus saprophyticus is the second most frequent causative microorganism in acute uncomplicated urinary tract infections in young women. However, it is potentially capable of causing more invasive infections including bacteremia, particularly secondary to pyelonephritis.

Abstract Objective: To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia (NP). Methodology: This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community-acquired pneumonia and radiologically confirmed NP were included. Patients were classified into the mild, moderate, or massive necrosis groups. Results: Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to the pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p<0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p<0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis: C-reactive protein (CRP) ≥ 122 mg/L (adjusted odds ratio [aOR], 8.780; 95% confidence interval [CI], 3.320–21.089; p=0.003), serum albumin ≤ 30.8 g/L (aOR, 11.608; 95% CI, 5.147–27.058; p=0.001), and immunoglobulin M (IgM) ≤ 95.7 mg/dL (aOR, 7.152; 95% CI, 2.240–17.692; p=0.021). Receiver operating characteristic analysis demonstrated that these variables showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. Conclusion: NP is a potentially severe complication of pediatric community-acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.

Lymphangiomas are a common benign neoplasm, which can develop in the digestive tracts. Hemorrhagic jejunal tumors are relatively rare and diagnostic challenge. We report herein a case of hemorrhagic jejunal hemolymphangioma successfully diagnosed and treated by double-balloon enteroscopy.

Cutaneous manifestations are increasingly reported in patients with COVID-19 disease .A review of cutaneous manifestations of COVID-19 especially among health care workers (HCW) is thus required.

Management of bone metastases from renal cell carcinoma (RCC) has significantly changed after the era of targeted therapy that improved the overall survival (OS).Surgical decision-making remains a subject of controversy.We report a case of pelvic bone metastasis from RCC, 2 months after nephrectomy and surgery of a revealing clavicular metastasis