Aplastic Anaemia Associated with Bendamustine Therapy - A Rare Side Effect.

Introduction: During treatment for malignant lymphoma, cytopenia can develop for several reasons. This can range from mild cytopenias leading to infection and bleeding to full-blown drug-induced aplastic anaemia. While aplastic anaemia affects individuals of all genders and ages, here, we describe aplastic anaemia after chemotherapy exposure to bendamustine in a 65-year-old female with non-Hodgkin's lymphoma. Case description: A 65-year-old woman with recurrent indolent marginal zone lymphoma and post-chemotherapy with bendamustine and rituximab, presented with a neutropenic fever and was admitted with a leading diagnosis of sepsis. In the previous two weeks, the patient required regular transfusions of packed red blood cells and platelets and maintained a daily ZARXIO® regimen. Laboratory results revealed pancytopenia, and broad-spectrum antibiotics (cefepime/vancomycin) were given. The patient was subsequently admitted to the hospital under the care of the haematology/oncology team and was ultimately diagnosed with aplastic anaemia, likely as a consequence of bendamustine chemoimmunotherapy. She elicited a positive response to the triple immunosuppressive therapy (IST) regimen (two immunotherapeutic agents plus one anti-thymocyte globulin (ATG), after which her cell counts returned to normal. Conclusions: This case underscores the importance of recognising haematologic complications linked to bendamustine and advocates for further research to increase the understanding among healthcare professionals of drug-induced aplastic anaemia. Bendamustine can cause severe autoimmune haemolytic anaemia and aplastic anaemia and may require multiple transfusions and a multidrug regimen for treatment. The use of ATG as a therapeutic intervention is appropriate because it has been effective in treating aplastic anaemia. LEARNING POINTS: Bendamustine can cause severe autoimmune haemolytic anaemia and aplastic anaemia, a side effect which has rarely been reported but is of significant clinical importance.Drug-induced aplastic anaemia is a complex, potentially devastating consequence of treating blood cancers and is a relatively unexplored area that requires further understanding.Anti-thymocyte globulin is effective in treating bendamustine-induced aplastic anaemia as it degrades lymphocytes that destroy the bone marrow.

Quantitative proteomic screening uncovers candidate diagnostic and monitoring serum biomarkers of ankylosing spondylitis.

BACKGROUND: We sought to discover serum biomarkers of ankylosing spondylitis (AS) for diagnosis and monitoring disease activity. METHODS: We studied biologic-treatment-naïve AS and healthy control (HC) patients' sera. Eighty samples matched by age, gender, and race (1:1:1 ratio) for AS patients with active disease, inactive disease, and HC were analyzed with SOMAscan™, an aptamer-based discovery platform. T-tests tests were performed for high/low-disease activity AS patients versus HCs (diagnosis) and high versus low disease activity (Monitoring) in a 2:1 and 1:1 ratio, respectively, to identify differentially expressed proteins (DEPs). We used the Cytoscape Molecular Complex Detection (MCODE) plugin to find clusters in protein-protein interaction networks and Ingenuity Pathway Analysis (IPA) for upstream regulators. Lasso regression analysis was performed for diagnosis. RESULTS: Of the 1317 proteins detected in our diagnosis and monitoring analyses, 367 and 167 (317 and 59, FDR-corrected q < .05) DEPs, respectively, were detected. MCODE identified complement, IL-10 signaling, and immune/interleukin signaling as the top 3 diagnosis PPI clusters. Complement, extracellular matrix organization/proteoglycans, and MAPK/RAS signaling were the top 3 monitoring PPI clusters. IPA showed interleukin 23/17 (interleukin 22, interleukin 23A), TNF (TNF receptor-associated factor 3), cGAS-STING (cyclic GMP-AMP synthase, Stimulator of Interferon Gene 1), and Jak/Stat (Signal transducer and activator of transcription 1), signaling in predicted upstream regulators. Lasso regression identified a Diagnostic 13-protein model predictive of AS. This model had a sensitivity of 0.75, specificity of 0.90, a kappa of 0.59, and overall accuracy of 0.80 (95% CI: 0.61-0.92). The AS vs HC ROC curve was 0.79 (95% CI: 0.61-0.96). CONCLUSION: We identified multiple candidate AS diagnostic and disease activity monitoring serum biomarkers using a comprehensive proteomic screen. Enrichment analysis identified key pathways in AS diagnosis and monitoring. Lasso regression identified a multi-protein panel with modest predictive ability.

Efficacy of chitosan in the treatment of chronic skin lesions in a horse: A case report.

Consultation was requested for a 7-year-old Gypsy Vanner male horse with a 2-year history of foreskin injury. Upon revision, an ulcer, 153 cm2 in size, with yellowish granules was observed; a RESVECH 2.0 evaluation revealed a score of 32/35 points. Medical history confirmed multiple failed deworming, anti-inflammatory, and antibiotic treatments with different topical therapies and recurrence in summer. Laboratory results confirmed elevated total proteins (8.8 g/dL) and globulins (5.5 g/dL), negative bacterial and fungal cultures, as well as negative coproparasitoscopic findings, and finally, identification of stable fly larvae (Stomoxys calcitrans) in the feces. Microscopy showed disorganized collagen, thickened tissue, polymorphonuclear cells, and acanthosis without neoplastic tissue or parasite remains. Debridement was performed and systemic treatment with ivermectin, penicillin, and non-steroidal anti-inflammatory drugs (NSAIDs) continued. In addition, 2% chitosan gel and films were applied to the entire surface of the lesion for 72 hours on 30 occasions; vector control with nets and insecticides was performed. On day 94, there was a 6 cm2 surface with involvement of the dermal and epidermal layers, moist epithelial tissue, and diffuse edges, with a RESVECH 2.0 evaluation of 6/35 points. Microscopy showed an intact basement membrane, presence of hair follicles, sweat glands, aligned collagen, and angiogenesis. It was concluded that chronic skin lesions in horses represent a diagnostic challenge, and topical chitosan is an adequate treatment due to its biocompatibility and efficacy, in addition to the functional and cosmetic results in dermal regeneration.

Dogs Detecting COVID-19 From Sweat and Saliva of Positive People: A Field Experience in Mexico.

Context: Molecular tests are useful in detecting COVID-19, but they are expensive in developing countries. COVID-19-sniffing dogs are an alternative due to their reported sensitivity (>80%) and specificity (>90%). However, most of the published evidence is experimental, and there is a need to determine the performance of the dogs in field conditions. Hence, we aimed to test the sensitivity and specificity of COVID-19-sniffing dogs in the field. Methods: We trained four dogs with sweat and three dogs with saliva of COVID-19-positive patients, respectively, for 4.5 months. The samples were obtained from a health center in Hermosillo, Sonora, with the restriction to spend 5 min per patient. We calculated sensitivity, specificity, and their 95% confidence intervals (CI). Results: Two sweat-sniffing dogs reached 76 and 80% sensitivity, with the 95% CI not overlapping the random value of 50%, and 75 and 88% specificity, with the 95% CI not overlapping the 50% value. The 95% CI of the sensitivity and specificity of the other two sweat dogs overlapped the 50% value. Two saliva-sniffing dogs had 70 and 78% sensitivity, and the 95% CI of their sensitivity and specificity did not overlap the 50% value. The 95% CI of the third dog's sensitivity and specificity overlapped the 50% value. Conclusion: Four of the six dogs were able to detect positive samples of patients with COVID-19, with sensitivity and specificity values significantly different from random in the field. We considered the performance of the dogs promising because it is reasonable to expect that with gauze exposed for a longer time to sweat and saliva of people with COVID-19, their detection capacity would improve. The target is to reach the sensitivity range requested by the World Health Organization for the performance of an antigen test (≥80% sensitivity, ≥97% specificity). If so, dogs could become important allies for the control of the COVID-19 pandemic, especially in developing countries.

Therapeutic effects of chitosan in veterinary dermatology: A systematic review of the literature.

Chitosan is a natural polysaccharide with biocompatibility, biodegradability, nontoxicity, antimicrobial, and hemostatic properties. This biopolymer has been used in different pharmaceutical forms; therefore, it has an attractive potential for dermal applications in veterinary medicine. The aim of this review is to assess the healing potential of chitosan, based on its dermatological effects on animals, to enrich the therapeutic options of veterinary clinicians. A systematic review was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) strategy, retrieving 1,032 studies and selecting 39 after the inclusion and exclusion criteria were applied. The studies included reports with confirmed positive effects (n = 46/99, 46.5 %) (P < 0.05), with positive effects (n = 49.5/99, 49.5 %), and with no effect (n = 4/99, 4 %); none of the studies reported adverse effects. There is an association between frequency of application and a decrease in healing time (P = 0.038); applying chitosan "every 48-72 hours" was the most recommended frequency (n = 10/19, 52.9 %). Chitosan, when applied to skin lesions on animals, produces positive effects on healing, potentially becoming a safe biomaterial for skin treatments in veterinary practice. As an initial protocol, we suggest applying chitosan every 48-72 hours for at least 2 weeks (7 applications).

[Origin of surgical metastatic bone disease]. / Origen de la enfermedad ósea metastática quirúrgica.

BACKGROUND: Metastatic bone disease should be considered as a public health problem. The alterations it may cause include pain that is refractory to medical treatment, metabolic instability, pathologic fractures and spinal disorders. MATERIAL AND METHODS: The primary tumor site that led to the need for surgery was investigated in a series of patients with a diagnosis of metastatic bone disease. The bone involved and the histology of the lesions were also studied. RESULTS: Kidney cancer was the one that most frequently required a surgical procedure; it was followed by breast and prostate cancer. The primary tumor was not found in 6.36% of cases. The bones affected by the lesions studied were as follows in order of occurrence: femur, spine, humerus and pelvis. Adenocarcinoma was the most frequent histological diagnosis. DISCUSSION: The diagnosis of metastatic bone disease should always be considered in patients over forty years of age with skeletal lesions, preferably lytic. CONCLUSIONS: In this study, kidney cancer, the proximal limbs and adenocarcinomas were the variables that most frequently produced metastatic bone lesions that warranted a surgical procedure.