A rapid assessment framework for food system shocks: Lessons learned from COVID-19 in the Indo-Pacific region.

The frequency and severity of shocks to food systems is accelerating globally, exemplified by the current COVID-19 outbreak. In low- and middle-income countries, the impacts have exacerbated existing food system vulnerabilities and poverty. Governments and donors must respond quickly, but few tools are available that identify interventions to build food system resilience, or emerging opportunities for transformation. In this paper we reflect on the application of a systems-based rapid assessment which we applied across 11 Indo-Pacific countries in May-July 2020. Our approach was shaped by three design parameters: the integration of key informants' perspectives engaged remotely within the countries, applicability to diverse food systems and COVID-19 experiences across the region, and the consideration of food systems as complex systems. For the rapid assessment we adopted an analytical framework proposed by Allen and Prosperi (2016). To include a development lens, we added the analysis of vulnerable groups and their exposure, impacts, recovery potential and resilience, and pro-poor interventions. We concluded that the framework and approach facilitated integration and triangulation of disparate knowledge types and data to identify priority interventions and was sufficiently flexible to be applied across food systems, at both national, sub-national and commodity scales. The step-wise method was simple and enabled structured inquiry and reporting. Although the systems concepts appeared more easily transferrable to key informants in some countries than others, potentially transformational interventions were identified, and also some risks of maladaptation. We present a refined framework that emphasises analysis of political, economic and institutional drivers of exposure and vulnerability, the constraints that they pose for building recovery potential and resilience, and trade-offs amongst winners and losers inherent in proposed interventions.

Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukapheresis was not available.

Hyperleukocytosis is a rare but potentially serious complication of haematological malignancies. It is usually treated with rehydration, prevention of tumour lysis syndrome and the administration of cytotoxic therapy. Leukapheresis may be life-saving in emergency cases. In this article we describe how, in a resource-limited setting where leukapheresis was not available, manual exchange transfusion was utilised as a life-saving intervention in three patients with different haematological malignancies complicated by hyperleukocytosis. Further we outline the procedure that was carried out and evaluated possible complications associated with this rarely used practice.

WITHDRAWN: Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukapheresis was not available.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.transci.2013.09.003. The duplicate article has therefore been withdrawn.

Chronic myeloid leukaemia and human immunodeficiency virus (HIV) infection.

The occurrence of chronic myeloid leukaemia (CML) in patients infected with the human immunodeficiency virus (HIV) has rarely been reported in the literature. In this report, we describe the experience of a single centre in the management of 10 such patients, including demographic information, disease characteristics and response to therapy. We had a black female predominance in our series, with only a minority of patients achieving a complete cytogenetic response. The main reason for this appears to be compliance, which was influenced by distance to the treating centre. The side-effect profile was similar to that expected, with the exception of one patient who developed a drug rash with eosinophilia and systemic symptoms. Although CML patients co-morbid for HIV face certain unique challenges when compared to non-infected patients, their long-term outcome can be positive when appropriately managed.

Imatinib use in pregnancy.

UNLABELLED: The outcome in patients with chronic myeloid leukemia (CML) has dramatically improved over the last decade due to the widespread use of novel tyrosine kinase inhibitors such as imatinib. As overall survival has improved, the number of women with CML that wish to become pregnant has increased. As such, attending physicians are faced with a dilemma - continue life-prolonging medication to treat the cancer, or interrupt its use due to its potential teratogenicity. Herein we describe 2 CML patients that gave birth. Case 1 was managed via substitution of imatinib with interferon. The patient's child underwent genetic evaluation at age 3 years, achieved normal developmental milestones, and despite being shorter than his peers was proportional. In terms of morphology, the child had clinodactyly, short fifth fingers, and slightly downward slanting palpebral fissures, but otherwise appeared normal. In case 2 imatinib was continued throughout the pregnancy. This patient's child underwent postpartum evaluation by a geneticist and was observed to be morphologically normal, except for clinodactyly and low-set ears. CONFLICT OF INTEREST: None declared.

Prognosis and treatment of Waldenström's macroglobulinemia.

Waldenström's macroglobulinemia is classified by the World Health Organization (WHO) as one of the mature B cell lymphomas. It is a rare clinical entity characterized by a serum monoclonal IgM with morphological evidence of lymphoplasmacytic lymphoma and a specific immunophenotype. Due to the scarcity of the disease, the most optimal therapeutic strategy has not yet been identified. There are, however, a number of active agents used in the treatment of this disease. In this paper we will examine the prognostication of the disease, with emphasis on the International Prognostic Scoring System for Waldenström's macroglobulinemia (IPSSWM), and outline current therapeutic options.