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Alternative medical therapy with multiple intravenous colloidal silver infusions may cause severe illness, including profound copper deficiency‐induced anemia and hepatic toxicity. No chelating agent for silver poisoning exists and effective therapy requires apheresis in combination with continuous administration of oral copper. Alternative medical therapy with multiple intravenous colloidal silver infusions may cause severe illness, including profound copper deficiency‐induced anemia and hepatic toxicity. No chelating agent for silver poisoning exists and effective therapy requires apheresis in combination with continuous administration of oral copper

Purpose Chemotherapy-induced peripheral neuropathy (CIPN) may necessitate chemotherapy dose reduction, delay, or discontinuation. This pilot study tested feasibility of patient enrollment, CIPN screening, and data collection in cancer patients for a future clinical study that will assess the safety and efficacy of an intervention that may prevent CIPN. Methods This prospective, observational, single-center, pilot study included adults with newly diagnosed lymphoma or multiple myeloma receiving neurotoxic chemotherapy. Patients were enrolled between September 2016 and February 2017. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire was completed by patients at 3 time points: baseline, week 6, and week 12. The primary outcome was change in the neurotoxicity score between these time points. Results Of 33 patients approached for consent, 28 (85%) provided consent and were enrolled. The FACT/GOG-Ntx questionnaire was completed by 28 (100%) at baseline, 25 (89%) at week 6, and 24 (86%) at week 12. Average (standard deviation) neurotoxicity scores were 36.5 (6.6) at baseline, 34.0 (8.3) at week 6, and 30.6 (7.6) at week 12. Neurotoxicity scores changed from baseline by − 2.7 points (95% CI − 5.5 to 0.1; p  = 0.061) at week 6 and − 6.0 points (95% CI − 5.6 to − 0.8; p  = 0.012) at week 12. Clinically meaningful declines (decrease of > 10% from baseline) in neurotoxicity score were detected in 36% (9 of 25) at week 6 and in 67% (16 of 24) at week 12. Conclusion Sixty-seven percent of patients experienced clinically significant CIPN within 12 weeks of starting chemotherapy. Feasibility metrics for enrollment, consent, CIPN assessment, and follow-up were met.

This report describes the serologic and clinical findings in 29 patients in whom thrombocytopenia developed during treatment with vancomycin. Vancomycin-dependent antiplatelet antibodies were detected in these patients. The platelet counts returned to normal within days after discontinuation of the antibiotic. This report describes the serologic and clinical findings in 29 patients in whom thrombocytopenia developed during treatment with vancomycin. Many medications can induce antibodies that cause thrombocytopenia. 1 , 2 Neutropenia is a well-recognized complication of therapy with vancomycin, a glycopeptide antibiotic widely used for the treatment of bacterial infections that are resistant to other agents. 3 – 5 However, we have found reports of only 12 cases of thrombocytopenia associated with exposure to this agent, 6 – 9 and there is only limited evidence for an immune mechanism underlying the thrombocytopenia. 6 , 7 Patients receiving vancomycin may have life-threatening bacterial sepsis and are often given heparin; vancomycin may not be considered as the cause of thrombocytopenia in such patients because both sepsis and treatment with . . .

Post-transplant lymphoproliferative disorder (PTLD) is generally caused by an uncontrolled B-cell proliferation induced by Epstein-Barr virus (EBV) in the setting of impaired EBV-specific T-cell immunity. PTLD has been described in allogeneic hematopoietic stem cell transplant (HSCT) and rarely in autologous HSCT. Anti-thymocyte globulin (ATG) is being increasingly utilized for acute rejection in organ transplantation, severe autoimmune diseases and aplastic anemia. Mainly, the use of rabbit ATG has been associated with PTLD, which is considered to be more immunosuppressive than equine ATG. The sole administration of equine ATG has rarely been associated with PTLD. Due to the increased use of these potent and novel immunosuppressive agents, it is paramount to be aware of these complications. We present a 55-year-old man with an autologous HSCT who presented with an unusual case of monoclonal plasmacytic PTLD. His lymphoproliferative disorder occurred 3 years after his HSCT and 1 month after the use of equine ATG administered for severe aplastic anemia. We review current concepts of EBV-PTLD, including risk factors, the potential for preemptive therapy and various management strategies.

Context. —Properly managed, the myeloproliferative disorders are generally compatible with prolonged survival. Challenges to the hematologist include knowing when and how best to intervene to prevent and manage complications. The cytoreductive agent of choice for these disorders is currently hydroxyurea, emerging from randomized trials beginning with those of the Polycythemia Vera Study Group. Objective. —To examine the roles and shortcomings of interventions (including hydroxyurea, antiplatelet agents, anagrelide, interferon, thalidomide, alkylating agents, cell cytopheresis, erythropoietins, splenectomy, bone marrow transplantation, and imatinib) for myeloproliferative disorders. Data Sources. —This report uses actual case histories to illustrate the roles and shortcomings of these interventions. Conclusions. —Beyond phlebotomy for polycythemia vera, patients with polycythemia vera and essential thrombocythemia can be stratified by their risk for thrombosis, which guides the institution of cytoreductive therapies. High-risk patients generally benefit from cytoreductive therapy, and hydroxyurea has emerged as the agent of choice, because alkylating agents (and P32) have high leukemogenic potentials. Anagrelide and interferon are second-line agents. The addition of low-dose aspirin is beneficial for most, helping to prevent arterial thrombotic complications. Therapy in any of these disorders should be tailored to the unique characteristics of the individual patient. With myelofibrosis, therapeutic options run the gamut from observation, erythropoietic stimulators, cytotoxic agents, splenectomy, and bone marrow transplantation. Thalidomide and imatinib have shown some utility. Future challenges are the refinement of individualized treatment strategies and the development of targeted therapies based on rapidly expanding understanding of the molecular perturbations in these disorders.

Thrombotic thrombocytopenic purpura (TTP) is considered to be the most extensive and dangerous microvascular (arteriolar/capillary) platelet‐clumping disorder. The histopathological and clinical findings in TTP suggest that organ ischemia and thrombocytopenia are caused by potentially reversible platelet adhesion and aggregation in the microcirculation of multiple organs concurrently. Clinical presentations resembling either TTP or hemolytic‐uremic syndrome (HUS) are sometimes associated with similar underlying condition. HUS is a triad of thrombocytopenia, acute renal failure, and intravascular hemolytic anemia with schistocytosis and elevated serum lactate dehydrogenase (LDH). Complications of pregnancy that may be confused with hemolysis, elevated liver enzymes, and low platelets (HELLP) include TTP, aHUS, sepsis, connective tissue disorders, antiphospholipid antibody syndrome, and acute fatty liver of pregnancy. The safest therapy for hepatic rupture in HELLP syndrome is to pack the liver and abdomen, place a large‐bore drain to monitor continued bleeding, close the abdomen, and continue supportive therapy with blood and blood product transfusion.

Ecosystem management requires understanding society's goals for an ecosystem and managing for some optimal solution. Unlike terrestrial ecosystem managers, coastal and marine ecosystem management seldom integrates across sectors or scientific disciplines to achieve desired social benefits. An Integrated Ecosystem Assessment (IEA) considers the ecosystem (including humans) as a unit and can assist in setting goals, determining an ecosystem's ability to support ecological processes and society's desires, and predicting the outcome of alternatives. The use of Coupled Ecological-Societal Systems Models utilised within the Integrated Assessment and Ecosystem Management Protocol (IAEMP) allows managers to extend a graphical picture of risk hypotheses to forecast scenarios that can be analysed relative to management goals. Scenarios predicted to meet management goals are evaluated against management constraints to select the \"optimal\" option for a management action in an adaptive management process. The IAEMP thus helps characterise potential causes of environmental problems, select appropriate response options, and implement and evaluate the selected option, thereby either addressing the concern or improving the ecosystem model for future decisions.