BK Polyomavirus Subtypes II and IV in Hematopoietic Cell Transplant Recipients

Symptomatic BK polyomavirus (BKPyV) infections are common and relevant in immunocompromised patients. Here, we present full-length BKPyV genomes from samples from patients who received hematopoietic cell transplants in the United States. These individuals had non-subtype I BKPyV, as determined by amplification, next-generation sequencing, and phylogenetic analysis.

Successful Non-Operative Management of Extensive Pneumatosis Cystoides Intestinalis Due to Graft Versus Host Disease

Graft versus host disease is a serious complication of allogenic stem cell transplants and can manifest with gastrointestinal complications including pneumatosis cystoides intestinali (PCI). A 43-year-old male with a history of acute myeloid leukemia presented to the hospital with abdominal pain and sepsis. The patient was intubated and admitted to the ICU. His CT scan demonstrated extensive colonic pneumatosis. He was high risk for laparotomy so was treated non-operatively. He improved and his abdominal exam remained benign. With aggressive resuscitation, close monitoring, and antibiotics, the patient was able to avoid major abdominal surgery. pneumatosis cystoides intestinali is a concerning finding that often leads to surgical interventions. Concurrent sepsis, gut ischemia, and frank perforation often lead to surgical intervention. In patients with high surgical risk and lack of critical bowel findings, non-operative management can be successful.

Insulin for diabetes: 100 years of therapy

This month is the 100th anniversary of insulin use in humans. Peter Jennings and Martha Stewart provide an overview of how this advancement improved care for people living with diabetes January 2022 marks 100 years since insulin was first successfully used to treat diabetes in humans. Everyone with type 1 diabetes – except those who have received pancreas or islet-cell transplants – and more than half of people with type 2 diabetes use insulin to manage their diabetes. Instead of being seen as a death sentence, type 1 diabetes is now seen as a long-term condition that can be self-managed for people with access to insulin and glucose monitoring technology. However, many people living with diabetes around the world are still unable to access affordable insulin, technologies and the support needed to self-manage their diabetes.

Nursing diagnosis after hematopoietic stem cell transplant due to Fanconi anemia

ABSTRACT Objectives: to identify nursing diagnoses in patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, according to the NANDA-I taxonomy. Methods: exploratory study using a retrospective analysis of 85 records from patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, developed in a specialize transplant center in the South of Brazil. The results were analyzed using descriptive statistics. Results: 73 different diagnoses were found in 9 out of the 13 domains from the NANDA-I taxonomy. From these, 22 were in 50% or more of the patients investigated, and most of them are related to the domain Safety/Protection. Conclusions: it was possible to identify the nursing diagnosis in the patients who underwent hematopoietic stem cell transplants due to Fanconi anemia, contributing to design a plan for the care of these patients. The same was true for those with other syndromes of chromosomal instability that need to undergo this transplant.

Viral cultures, PCR Cycle threshold values and viral load estimation for COVID-19 infectious potential assessment in transplant patients: systematic review - Protocol Version 29 December 2021

This is the protocol for a systematic review focussing on people receiving solid organ or hematopoietic stem cell transplants. Our research questions are as follows: What is the relationship between serial PCR Ct value or other measures of viral burden, and the likelihood and duration of the presence of infectious virus from viral culture, among transplant recipients with SARS-CoV-2 infection? What is the influence of age, sex, underlying pathologies, degree of immunosuppression, vaccination status, COVID-19 symptoms and COVID-19 disease course on viral burden and the likelihood of presence of infectious SARS-CoV-2? We will include single studies reporting serial Cts from sequential rt-PCR testing or other measures of viral burden such as RNA gene copies of respiratory samples (from nasopharyngeal specimens) along with viral culture data on the same samples, from patients about to receive a transplant or who are post transplant with SARS-CoV-2 infection.

Analyses and Correlation of Pathologic and Ocular Cutaneous Changes in Murine Graft versus Host Disease

Graft versus host disease (GVHD) is initiated by donor allo-reactive T cells activated against recipient antigens. Chronic GVHD (cGVHD) is characterized by immune responses that may resemble autoimmune features present in the scleroderma and Sjogren’s syndrome. Unfortunately, ocular involvement occurs in approximately 60–90% of patients with cGVHD following allo-hematopoietic stem cell transplants (aHSCT). Ocular GVHD (oGVHD) may affect vision due to ocular adnexa damage leading to dry eye and keratopathy. Several other compartments including the skin are major targets of GVHD effector pathways. Using mouse aHSCT models, the objective was to characterize cGVHD associated alterations in the eye and skin to assess for correlations between these two organs. The examination of multiple models of MHC-matched and MHC-mismatched aHSCT identified a correlation between ocular and cutaneous involvement accompanying cGVHD. Studies detected a “positive” correlation, i.e., when cGVHD-induced ocular alterations were observed, cutaneous compartment alterations were also observed. When no or minimal ocular signs were detected, no or minimal skin changes were observed. In total, these findings suggest underlying cGVHD-inducing pathological immune mechanisms may be shared between the eye and skin. Based on the present observations, we posit that when skin involvement is present in aHSCT patients with cGVHD, the evaluation of the ocular surface by an ophthalmologist could potentially be of value.

Considering the Cellular Composition of Olfactory Ensheathing Cell Transplants for Spinal Cord Injury Repair: A Review of the Literature

Olfactory ensheathing cells (OECs) are specialized glia cells of the olfactory system that support the continual regeneration of olfactory neurons throughout adulthood. Owing to their pro-regenerative properties, OECs have been transplanted in animal models of spinal cord injuries (SCI) and trialed in clinical studies on SCI patients. Although these studies have provided convincing evidence to support the continued development of OEC transplantation as a treatment option for the repair of SCI, discrepancies in the reported outcome has shown that OEC transplantation requires further improvement. Much of the variability in the reparative potential of OEC transplants is due to the variations in the cell composition of transplants between studies. As a result, the optimal cell preparation is currently a subject of debate. Here we review, the characterization as well as the effect of the cell composition of olfactory cell transplantation on therapeutic outcome in SCI. Firstly, we summarize and review the cell composition of olfactory cell preparations across the different species studied prior to transplantation. Since the purity of cells in olfactory transplants might affect the study outcome we also examine the effect of the proportions of OECs and the different cell types identified in the transplant on neuroregeneration. Finally, we consider the effect of the yield of cells on neuroregeneration by assessing the cell dose of transplants on therapeutic outcome.

Exercise is Medicine: Implementing a New Initiative to Increase Patients' Activity and Functional Mobility in Pediatric Stem-Cell Transplant Unit

PURPOSE Patients undergoing stem-cell transplants endure prolonged hospitalizations and aggressive medical treatments. This combination can quickly evolve into loss of functional strength and physical debilitation. We aimed to promote independent patient activity during hospitalizations, to improve compliance with prescribed physical therapy (PT) sessions, and to focus those sessions on resistance and endurance exercises. METHODS We used the Institute for Healthcare Improvement Model of Improvement as our quality improvement (QI) framework, and we implemented an initiative called Exercise is Medicine. The initiative included three key components: (1) educating staff and caregivers about the importance of early ambulation, (2) incorporating the Miles in Motion (MiM) program to encourage patients' daily activity, and (3) eliminating barriers to allow for higher completion rates of prescribed PT sessions. Data were collected for the completion rate of PT sessions, rate of high-frequency PT sessions, participation in the MiM program, and 1-minute sit-to-stand test scores on admission and discharge. RESULTS Before intervention, 42% of patients required high-frequency PT because of significant debilitation, which decreased to 17% after intervention. The completion rate of PT sessions increased from 71% to 87%. By discharge, 79% of patients improved their 1-minute sit-to-stand test scores and 21% returned to baseline score, indicating stable or improved functional strength, and 92% of patients participated in MiM. CONCLUSION The Exercise is Medicine initiative facilitated positive changes with patients showing stable or improved functional strength and endurance and increased participation in independent activity during inpatient stays.