COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies.

INTRODUCTION: Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population. METHODS: This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21 years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy. RESULTS: Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p < .001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR] = 2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR = 4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR = 4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p = .001), but not when unrelated to neutropenia (p = .88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR = 1.20, 95% CI: 0.7-2.1). CONCLUSIONS: We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.

Immune-checkpoint inhibitor toxicity during a pandemic: Overcoming patient fears to provide care. A case report.

BACKGROUND: Pembrolizumab is a humanized monoclonal antibody that is used to treat a variety of cancers. It exerts its mechanism of action by blocking the programmed death receptor-1 (PD-1). Toxicity concerns include immune-related toxicities, including colitis, hepatitis, pneumonitis, nephritis, endocrine toxicities and more rarely, myocarditis and other organ system toxicities. OBJECTIVE: To review a real-world case involving immunotherapy induced myocarditis after a patient received pembrolizumab and discuss how the current pandemic created complexity in toxicity management. DISCUSSION: An 83 year old male with metastatic lung cancer developed fatal myocarditis after receiving 2 doses of pembrolizumab. Applying the Naranjo score, the likelihood of pembrolizumab causing the myocarditis is probable, with a score of 6. Severe cardiac toxicities are rare with pembrolizumab, but can still occur. It is vital to be aware of these toxicities, and educate patients on signs and symptoms. Complicating the situation even further was the global pandemic, which created fear and hesitation in the patient and the patient's family to seek medical treatment out of fear of exposure. This pandemic adds another layer to the complexity of care for patients with cancer and management of toxicities. Pharmacists play a significant role in ensuring the safety and efficacy of medications, especially oncology agents. CONCLUSION: Proper education of patients regarding symptoms and when to report are paramount to assisting in early detection and intervention for immunotherapy-related adverse events. New management and treatment strategies will need to be discussed and implemented considering the changing landscape around the SARS-CoV-2 pandemic.

Scalpel blade contamination and risk of postoperative surgical site infection following abdominal incisions in dogs.

OBJECTIVE: This prospective observation sought to determine if scalpel blades used for abdominal skin incisions in dogs are a significant source of bacterial contamination, and if these blades should be changed prior to use in deeper dissection. RESULTS: Scalpel blades were swabbed for culture prior to skin incision as a control, and then again following ventral midline abdominal skin incision in a total of 75 dogs. Culture and sensitivity results were compared with review of medical records for any evidence of pre- or postoperative incisional surgical site infection/inflammation (SSI). Of the 75 blades swabbed after skin incision, only 2 (2.7%) had positive culture results. Of the 69 patients that survived to suture removal, there was evidence of SSI in 6 patients (8.7%), only one of which had a positive scalpel blade culture (16.7%). Neither the use of postoperative antibiotics nor positive scalpel blade culture results were good predictors of whether a patient would develop a SSI. Results of this pilot study suggest that there is no bacteriological evidence to support the use of a separate blade for deep dissection in routine surgical procedures.

Lactate uptake by skeletal bone in anoxic turtles, Trachemys scripta.

Previous studies have shown that freshwater turtle shells can accumulate lactate during periods of anoxic submergence. Our objective in this study was to determine lactate uptake in other parts of the turtle's skeleton. We measured lactate concentration of 7 skeletal elements and 4 shell samples of red-eared slider turtles, Trachemys scripta, in control animals (N=12) and in animals following submergence for 4-5 days in N(2)-equilibrated water at 10 degrees C (N=8). We also collected blood samples and measured blood pH, PCO(2), and PO(2), and plasma lactate. Contralateral bone samples from 6 control turtles were analyzed for % water and mineral composition; bone from the other 6 were equilibrated with lactate solution in vitro. Anoxic submergence resulted in a combined respiratory/non-respiratory (lactic) acidosis and plasma lactate of 45.6+/-2.5 mmol l(-1). Shell and skeletal lactates all increased significantly in the anoxic animals (30.1-43.9 mmol kg(-1)) with limb bones having the highest levels and skull the least. Skeletal samples equilibrated in lactate solution in vitro for 2 days accumulated lactate in similar fashion with limb bones, except for fibula, higher, and skull significantly less than other bones. We conclude that the entire skeleton of the red-eared slider, like its shell, sequesters lactate and contributes thereby to lactic acid buffering.

Divergence of streamlines approaching a pectinate insect antenna: consequences for chemoreception.

Pectinate (feathery) antennae have high resistance to air flow, and therefore most of the air approaching an antenna is diverted around it and is not available for chemical sampling by the sensory hairs on that antenna. The small fraction (approximately 10-20%) of approaching air that passes through the air spaces or gaps in the antenna decelerates and the streamlines diverge as the air approaches the antenna. Sampling a small fraction of air that is decelerating and diverging has consequences for chemoreception that are described here for the first time. The behavior of the air is predicted from application of a fluid mechanical law: the principle of continuity. As this small fraction of air decelerates and flows through the air gaps in the antenna, it will be "stretched" in the plane perpendicular to the air flow. Therefore, the air may be sampled by the sensory hairs at a greater spatial resolution than expected from the distribution of the odorant molecules in the air upstream of the antenna. However, the slowing down of odorant-laden air as it passes through an antenna will not change the perceived temporal characteristics of the chemical stimulus (e.g., the rate of odorant filament encounter). This distortion or stretching of the air sample is expected to develop within about one antennal width upstream of the antenna, as verified by examining wakes of simple physical models.