Search results for: mitotic count
704 MITOS-RCNN: Mitotic Figure Detection in Breast Cancer Histopathology Images Using Region Based Convolutional Neural Networks
Authors: Siddhant Rao
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Studies estimate that there will be 266,120 new cases of invasive breast cancer and 40,920 breast cancer induced deaths in the year of 2018 alone. Despite the pervasiveness of this affliction, the current process to obtain an accurate breast cancer prognosis is tedious and time consuming. It usually requires a trained pathologist to manually examine histopathological images and identify the features that characterize various cancer severity levels. We propose MITOS-RCNN: a region based convolutional neural network (RCNN) geared for small object detection to accurately grade one of the three factors that characterize tumor belligerence described by the Nottingham Grading System: mitotic count. Other computational approaches to mitotic figure counting and detection do not demonstrate ample recall or precision to be clinically viable. Our models outperformed all previous participants in the ICPR 2012 challenge, the AMIDA 2013 challenge and the MITOS-ATYPIA-14 challenge along with recently published works. Our model achieved an F- measure score of 0.955, a 6.11% improvement in accuracy from the most accurate of the previously proposed models.Keywords: breast cancer, mitotic count, machine learning, convolutional neural networks
Procedia PDF Downloads 223703 The Genotoxic Effect of Coal Fly Ash of Thermal Power Plant on Raphanus sativus L. (Radish)
Authors: Patel Kailash P, Patel Parimal M
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The effect of coal fly ash treatment on the chromosomes of Raphanus sativus L. was investigated. The seeds of Raphanus sativusL. were placed in petri dishes in three replicates and allowed to germinate for five days in different concentration of coal fly ash solution. The root was treated with the diluted, semidiluted, and concentrated solution of fly ash while the control group had distilled water.The total aberration were examined. The mitotic index was calculated and the results were statically evaluated by the analysis of variance 5% significant level. The mitotic index decreased as the concentration increased. The highest mitotic index value was diluted fly ash solution while the least was concentrated fly ash treatment. The results show the most frequent chromosomal abnormalities observed included: chromatid bridge, c-mitosis, and stickiness. Concentrated fly ash solution is much more genotoxic than semidiluted fly ash solution, as it induced more aberrations having percentage abnormalities for the highest concentration tested. Increased fly ash pollution can lead to some irreversible cytogenetic effect in plants. The study is an attempt to corroborate the toxic effect of coal fly ash of thermal power plant on the chromosome of plants. These results will be useful in environmental monitoring of the cytotoxicity of coal fly ash.Keywords: coal fly-ash, genotoxic, cytogenetic, mitotic index, Raphanus sativus L.
Procedia PDF Downloads 311702 Mechanisms and Regulation of the Bi-directional Motility of Mitotic Kinesin Nano-motors
Authors: Larisa Gheber
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Mitosis is an essential process by which duplicated genetic information is transmitted from mother to daughter cells. Incorrect chromosome segregation during mitosis can lead to genetic diseases, chromosome instability and cancer. This process is mediated by a dynamic microtubule-based intracellular structure, the mitotic spindle. One of the major factors that govern the mitotic spindle dynamics are the kinesin-5 biological nano motors that were believed to move unidirectionally on the microtubule filaments, using ATP hydrolysis, thus performing essential functions in mitotic spindle dynamics. Surprisingly, several reports from our and other laboratories have demonstrated that some kinesin-5 motors are bi-directional: they move in minus-end direction on the microtubules as single-molecules and can switch directionality under a number of conditions. These findings broke a twenty-five-years old dogma regarding kinesin directionality (1, 2). The mechanism of this bi-directional motility and its physiological significance remain unclear. To address this unresolved problem, we apply an interdisciplinary approach combining live cell imaging, biophysical single molecule, and structural experiments to examine the activity of these motors and their mutated variants in vivo and in vitro. Our data shows that factors such as protein phosphorylation (3, 4), motor clustering on the microtubules (5, 6) and structural elements (7, 8) regulate the bi-directional motility of kinesin motors. We also show, using Cryo-EM, that bi-directional kinesin motors obtain non-canonical microtubule binding, which is essential to their special motile properties and intracellular functions. We will discuss the implication of these findings to mechanism bi-directional motility and physiological roles in mitosis.Keywords: mitosis, cancer, kinesin, microtubules, biochemistry, biophysics
Procedia PDF Downloads 81701 Deubiquitinase USP35 Regulates Mitosis Progression by Blocking CDH1-Mediated Degradation of Aurora B.
Authors: Jinyoung Park, Eun Joo Song
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Introduction: Deubiquitinating enzymes (DUBs) are proteases that cleave ubiquitin or ubiquitin-like modifications on substrates. Deubiquitination could regulate cellular physiology, such as signal transduction, DNA damage and repair, and cell cycle progression. Although more than 100 DUBs are encoded in the human and the importance of DUBs has been realized, the functions of most DUBs are unknown. This study aims to identify the molecular mechanism by which deubiquitinating enzyme USP35 regulates cell cycle progression for the first time. Methods: USP35 RNAi was mainly used to identify the function of USP35 in cell cycle progression. To find substrates of USP35, we analyzed protein-protein interaction using LC-MS. Several biological methods, such as ubiquitination assay, cell synchronization, immunofluorescence, and immunoprecipitation assay were used to investigate the exact mechanism by which USP35 affects successful completion of mitosis. Results: USP35 knockdown caused not only reduction of mitotic cell number but also induction of mitotic cells with abnormal spindle formation. Actually, cell proliferation was decreased by USP35 knockdown. Interestingly, we found that loss of USP35 decreased the stability and expression of Aurora B, a member of chromosomal passenger complex (CPC), and the phosphorylation of its substrate. Indeed, USP35 interacted with Aurora B and deubiquitinated it. In addition, USP35 knockdown induced abnormal localization of Aurora B in mitotic cells. Finally, CDH1-mediated ubiquitination of Aurora B level was rescued by USP35 overexpression, but not inactive form of USP35, USP35 C450A. Discussion: Our findings suggest that USP35 regulates Aurora B-mediated mitotic spindle assembly and G2-M transition by blocking CDH1-induced degradation of Aurora B.Keywords: USP35, HSP90, Aurora B, cell cycle progression
Procedia PDF Downloads 358700 Undifferentiated Embryonal Sarcoma of Liver: A Rare Case Report
Authors: Thieu-Thi Tra My
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Undifferentiated embryonal sarcoma of the liver (UESL), a rare malignant mesenchymal tumor, is commonly seen in children. The symptoms and imaging were not specific, so it could be mimicked with other tumors or liver abscesses. The tumor often appears as a large heterogeneous echoic solid mass with small cystic areas while showing a cyst-like appearance on CT and MRI. The histopathological manifestation of the UESL consisted of stellate-shaped and spindle cells scattered on a myxoid background with high mitotic count. Cells with multiple or bizarre nuclear were also observed. Here, we aimed to describe a 9-year-old male diagnosed with UESL focused on imaging and histopathological characteristics.Keywords: undifferentiated embryonal sarcoma of liver, UESL, liver sarcoma, liver tumor, children
Procedia PDF Downloads 74699 Spatial Econometric Approaches for Count Data: An Overview and New Directions
Authors: Paula Simões, Isabel Natário
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This paper reviews a number of theoretical aspects for implementing an explicit spatial perspective in econometrics for modelling non-continuous data, in general, and count data, in particular. It provides an overview of the several spatial econometric approaches that are available to model data that are collected with reference to location in space, from the classical spatial econometrics approaches to the recent developments on spatial econometrics to model count data, in a Bayesian hierarchical setting. Considerable attention is paid to the inferential framework, necessary for structural consistent spatial econometric count models, incorporating spatial lag autocorrelation, to the corresponding estimation and testing procedures for different assumptions, to the constrains and implications embedded in the various specifications in the literature. This review combines insights from the classical spatial econometrics literature as well as from hierarchical modeling and analysis of spatial data, in order to look for new possible directions on the processing of count data, in a spatial hierarchical Bayesian econometric context.Keywords: spatial data analysis, spatial econometrics, Bayesian hierarchical models, count data
Procedia PDF Downloads 593698 Cows Milk Quality on Different Sized Dairy Farms
Authors: Ramutė Miseikienė, Saulius Tusas
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Somatic cell count and bacteria count are the main indicators of cow milk quality. The aim of this study was to analyze and compare parameters of milk quality in different-sized cows herds. Milk quality of ten dairy cows farms during one year period was analyzed. Dairy farms were divided into five groups according to number of cows in the farm (under 50 cows, 51–100 cows, 101–200 cows, 201–400 cows and more than 400 cows). The averages of somatic cells bacteria count in milk and milk freezing temperature were analyzed. Also, these parameters of milk quality were compared during outdoor (from May to September) and indoor (from October to April) periods. The largest number of SCC was established in the smallest farms, i.e., in farms under 50 cows and 51-100 cows (respectively 264±9,19 and 300±10,24 thousand/ml). Reliable link between the smallest and largest dairy farms and farms with 101-200 and 201-400 cows and count of somatic cells in milk has not been established (P > 0.05). Bacteria count had a low tendency to decrease when the number of cows in farms increased. The highest bacteria number was determined in the farms with 51-100 cows and the the lowest bacteria count was in milk when 201-400 and more than 401 cows were kept. With increasing the number of cows milk maximal freezing temperature decreases (significant negative trend), i. e, indicator is improving. It should be noted that in all farms milk freezing point never exceeded requirements (-0.515 °C). The highest difference between SCC in milk during the indoor and outdoor periods was established in farms with 201-400 cows (respectively 218.49 thousand/ml and 268.84 thousand/ml). However, the count of SC was significantly higher (P < 0.05) during outdoor period in large farms (201-400 and more cows). There was no significant difference between bacteria count in milk during both – outdoor and indoor – periods (P > 0.05).Keywords: bacteria, cow, farm size, somatic cell count
Procedia PDF Downloads 267697 Nitric Oxide and Blood Based Ratios as Promising Immuno-Markers in Patients with Complicated Crohn’s Disease: Benefits for Predicting Therapy Response
Authors: Imene Soufli, Abdelkrim Hablal, Manel Amri, Moussa Labsi, Rania Sihem Boussa, Nassim Sid Idris, Chafia Touil-Boukoffa
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Crohn’s Disease (CD) is a relapsing–remitting inflammatory bowel disease with a progressive course. The aim of our study was to evaluate the relationship between the immunomarkers: Nitric Oxide (NO), pro-inflammatory cytokines, and blood count-based ratios and the outcome of corticosteroid or anti-TNF-α therapy in patients with complicated Crohn’s Disease. In this context, we evaluated the NLR as the ratio of neutrophil count to lymphocyte count, PLR as the ratio of platelet counts to lymphocyte count, and MLR as the ratio of monocyte count to lymphocyte count in patients and controls. Furthermore, we assessed NO production by the Griess method in plasma along with iNOS and NF-κB expression by immunofluorescence method in intestinal tissues of patients and controls. In the same way, we evaluated plasma TNF-α, IL-17A, and IL-10 levels using ELISA. Our results indicate that blood count-based ratios NLR, PLR, and MLR were significantly higher in patients compared to controls. In addition, increased systemic levels of NO, TNF-α, and IL-17A and colonic expression of iNOS and NF-κB were observed in the same patients. Interestingly, the high ratio of NLR and MLR, as well as NO production, was significantly decreased in treated patients. Collectively, our findings suggest that Nitric Oxide, as well as the blood count-based ratios (NLR, PLR, MLR), could constitute useful immuno-markers in complicated Crohn’s Disease, predicting the response to treatmentKeywords: complicated crohn’s disease, nitric oxide, blood count-based ratios, treatments, pro-inflammatory cytokines
Procedia PDF Downloads 79696 In Vitro Evaluation of the Antimitotic and Genotoxic Effect by the Allium cepa L. Test of the Aqueous Extract of Peganum harmala L. Leaves (Laghouat, Algeria)
Authors: Ouzid Yasmina, Aiche-Iratni Ghenima, Harchaoui Lina, Saadoun Noria, Houali Karim
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Medicinal plants are an important source of bioactive molecules with biological activities such as anticancer, antioxidant, anti-inflammatory, antibacterial, antimitotic.... These molecules include alkaloids, polyphenols and terpenes. The latter can be extracted by different solvents, namely: water, ethanol, methanol, butanol, acetone... This is why it seemed interesting to us to evaluate in vitro the antimitotic and genotoxic effect of these secondary metabolites contained in the aqueous extract of the leaves of Peganum harmala L. by the Allium cepa L. test on meristematic cells by calculating the mitotic parameters (The mitotic index, the aberration index and the limit value of cytotoxicity).A spectrophotometric determination of secondary metabolites, namely alkaloids and flavonoids in the aqueous extract of this essence, was performed. As a result, the alkaloid content is estimated to be 28.42 μg EC/mg extract, and the flavonoid content is 12.52 μg EQ/mg extract. The determination of the mitotic index revealed disturbances in cell division with a highly significant difference between the negative control (distilled water) and the different samples (aqueous extracts, colchicine and quecetin). The exposure of meristematic cells to our samples resulted in a large number of chromosomal, nuclear and cellular aberrations with an aberration index reaching 16.21±1.28% for the 4mg/ml aqueous extract and 11.71±3.32% for the 10mg/ml aqueous extract. The limit value of cytotoxicity revealed that our samples are sublethal on Allium cepa L. meristematic cells.Keywords: allium cepa l., antimitotic and genotoxic effect, aqueous leaf extract, laghouat (algeria), peganum harmala l., secondary metabolites
Procedia PDF Downloads 95695 Statistical Analysis for Overdispersed Medical Count Data
Authors: Y. N. Phang, E. F. Loh
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Many researchers have suggested the use of zero inflated Poisson (ZIP) and zero inflated negative binomial (ZINB) models in modeling over-dispersed medical count data with extra variations caused by extra zeros and unobserved heterogeneity. The studies indicate that ZIP and ZINB always provide better fit than using the normal Poisson and negative binomial models in modeling over-dispersed medical count data. In this study, we proposed the use of Zero Inflated Inverse Trinomial (ZIIT), Zero Inflated Poisson Inverse Gaussian (ZIPIG) and zero inflated strict arcsine models in modeling over-dispersed medical count data. These proposed models are not widely used by many researchers especially in the medical field. The results show that these three suggested models can serve as alternative models in modeling over-dispersed medical count data. This is supported by the application of these suggested models to a real life medical data set. Inverse trinomial, Poisson inverse Gaussian, and strict arcsine are discrete distributions with cubic variance function of mean. Therefore, ZIIT, ZIPIG and ZISA are able to accommodate data with excess zeros and very heavy tailed. They are recommended to be used in modeling over-dispersed medical count data when ZIP and ZINB are inadequate.Keywords: zero inflated, inverse trinomial distribution, Poisson inverse Gaussian distribution, strict arcsine distribution, Pearson’s goodness of fit
Procedia PDF Downloads 542694 The Abnormality of Blood Cells Parasitized by Plasmodium vivax
Authors: Manas Kotepui, Kwuntida Uthaisar, Phiman Thirarattanasunthon, Bhukdee PhunPhuech, Nuoil Phiwklam
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Introduction: Malaria due to Plasmodium vivax has placed huge burdens on the health, longevity, and general prosperity of large sections of the human population. This study aimed at prospectively collecting information on the clinical profile of Plasmodium vivax from subjects acutely infected with P. vivax residing in some of the highest malaria transmission regions in Thailand. Methods: A retrospective study of malaria cases, hospitalized between 2013 and 2015 was performed. Clinical characteristics, diagnosis, and parasitological results on admission, age, and gender were mined from medical records at Phop Phra Hospital located in endemic areas of Tak Province, Thailand. Venous blood samples were collected at the time of admission to the hospital to determine the present of parasite and also parasite count by thick and thin film examination, and also Complete blood count (CBC) parameters. Results: Results showed that patients infected with Plasmodium vivax (276 cases) had a high monocyte count (mean=390 cells/µL) during initial stage of infection and continuously lower during later stage (any stage with gametocyte, mean=230 cells/µL) of infection (P value=0.021) whereas, patients infected with Plasmodium vivax had a low basophil count (mean=20 cells/µL) during initial stage of infection and continuously higher during later stage of infection (mean at stage with gametocyte=70 cells/µL) (P value=0.033). In addition, patients with more than one stage infection tend to have lower lymphocyte count (mean=1180 cells/µL) than patients with only one stage infection (mean=1350 cells/µL)(P value=0.011) whereas, patients with more than one stage infection tend to have lower basophil count (mean=60 cells/µL) than patients with only one stage infection (mean=80 cells/µL) (P value=0.01). Conclusion: This study indicated that patients infected with Plasmodium vivax had high monocyte count and low basophil count during initial stage of infection which was continuously lower during later stage of infection. Patients with more than one stage infection tend to have lower lymphocyte count than patients with only one stage infection whereas, patients with more than one stage infection tend to have lower basophil count than patients with only one stage infection. This information contributes to better understanding of pathological characteristic of Plasmodium vivax infection.Keywords: plasmodium vivax, Thailand, asexual erythrocytic stages, hematological parameters
Procedia PDF Downloads 212693 Characterizing Nanoparticles Generated from the Different Working Type and the Stack Flue during 3D Printing Process
Authors: Kai-Jui Kou, Tzu-Ling Shen, Ying-Fang Wang
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The objectives of the present study are to characterize nanoparticles generated from the different working type in 3D printing room and the stack flue during 3D printing process. The studied laboratory (10.5 m× 7.2 m × 3.2 m) with a ventilation rate of 500 m³/H is installed a 3D metal printing machine. Direct-reading instrument of a scanning mobility particle sizer (SMPS, Model 3082, TSI Inc., St. Paul, MN, USA) was used to conduct static sampling for nanoparticle number concentration and particle size distribution measurements. The SMPS obtained particle number concentration at every 3 minutes, the diameter of the SMPS ranged from 11~372 nm when the aerosol and sheath flow rates were set at 0.6 and 6 L/min, respectively. The concentrations of background, printing process, clearing operation, and screening operation were performed in the laboratory. On the other hand, we also conducted nanoparticle measurement on the 3D printing machine's stack flue to understand its emission characteristics. Results show that the nanoparticles emitted from the different operation process were the same distribution in the form of the uni-modal with number median diameter (NMD) as approximately 28.3 nm to 29.6 nm. The number concentrations of nanoparticles were 2.55×10³ count/cm³ in laboratory background, 2.19×10³ count/cm³ during printing process, 2.29×10³ count/cm³ during clearing process, 3.05×10³ count/cm³ during screening process, 2.69×10³ count/cm³ in laboratory background after printing process, and 6.75×10³ outside laboratory, respectively. We found that there are no emission nanoparticles during the printing process. However, the number concentration of stack flue nanoparticles in the ongoing print is 1.13×10⁶ count/cm³, and that of the non-printing is 1.63×10⁴ count/cm³, with a NMD of 458 nm and 29.4 nm, respectively. It can be confirmed that the measured particle size belongs to easily penetrate the filter in theory during the printing process, even though the 3D printer has a high-efficiency filtration device. Therefore, it is recommended that the stack flue of the 3D printer would be equipped with an appropriate dust collection device to prevent the operators from exposing these hazardous particles.Keywords: nanoparticle, particle emission, 3D printing, number concentration
Procedia PDF Downloads 182692 Relationship between Blow Count Number (N) and Shear Wave Velocity (Vs30) from the Specified Embankment Material: A Case Study on Three Selected Earthen Dams
Authors: Tanapon Suklim, Prachaya Intaphrom, Noppadol Poomvises, Anchalee Kongsuk
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The relationship between shear wave velocity (Vs30) and blow count Number from Standard Penetration Tests (NSPT) was investigated on specified embankment dam to find the solution which can be used to estimate the value of N. Shear wave velocity, Vs30 and blow count number, NSPT were performed at three specified dam sites. At each site, Vs30 measurement was recorded by using seismic survey of MASW technique and NSPT were measured by field Standard Penetration Test. Regression analysis was used to derive statistical relation. The relation is giving a final solution to applicable calculated N-value with other earthen dam. Dam engineer can use the statistical relation to convert field Vs30 to estimated N-value instead of absolute N-value from field Standard Penetration Test. It can be noted that the formulae can be applied only in the earthen dam of specified material.Keywords: blow count number, earthen dam, embankment, shear wave velocity
Procedia PDF Downloads 236691 Microbial Load of Fecal Material of Broiler Birds Administered with Lagenaria Breviflora Extract
Authors: Adeleye O. O., T. M. Obuotor, A. O. Kolawole, I. O. Opowoye, M. I. Olasoju, L. T. Egbeyale, R. A. Ajadi
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This study investigated the effect of Lagenaria breviflora on broiler poultry birds, including its effect on the microbial count of the poultry droppings. A total of 240-day-old broiler chicks were randomly assigned to six groups, with four replicates per group. The first group was the control, while the other four groups were fed water containing 300g/L and 500g/L concentrations of Lagenaria breviflora twice and thrice daily. The microbial load was determined using the plate count method. The results showed that the administration of Lagenaria breviflora in the water of broiler birds significantly improved their growth performance with an average weight gain range of 1.845g - 2.241g. Mortality rate was at 0%. The study also found that Lagenaria breviflora had a significant effect on the microbial count of the poultry droppings with colony count values from 3.5 x 10-7 - 9.9 x10-7CFU/ml, The total coliforms (Escherichia coli, and Salmonella sp.) was obtained as 1 x 10 -5CFU/ml. The reduction in microbial counts of the poultry droppings could be attributed to the antimicrobial properties of Lagenaria breviflora, which contain phytochemicals reported to possess antimicrobial activity. Therefore, the inclusion of Lagenaria breviflora in the diets of broiler poultry could be an effective strategy for improving growth performance and immune function and reducing the microbial load of poultry droppings, which can help to mitigate the risk of disease transmission to humans and other animals.Keywords: gut microbes, bacterial count, lagenaria breviflora, coliforms
Procedia PDF Downloads 96690 The microbial evaluation of cow raw milk used in private dairy factories in of Zawia city, Libya
Authors: Obied A. Alwan, Elgerbi, M. Ali
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This study was conducted on the cow milk which is used in the local milk factories of Zawia. This was completely random sampling the unscheduled samples. The microbiologic result have approved that the count of bacteria and the count of E.Coli are very high and all the manufacturing places which were included in the study have lacked the health conditions.Keywords: raw milk, dairy factories, Libya, microbiologic
Procedia PDF Downloads 439689 Effect of Yeast Selenium on CD4 T Cell and WAZ of HIV1 Positive Children in Nyamasaria in Kisumu Kenya
Authors: S. B. Otieno1, F. Were, A. Afullo, K. Waza
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Background: Multi drug resistance HIV has emerged rendering the current conventional treatment of HIV ineffective. There is a need for new treatment regime which is cheap, effective and not prone to resistance development by HIV. Methods: In randomized clinical study of 68 HIV positive children 3 – 15 years to asses the efficacy of yeast selenium in HIV/AIDS patients, 50μ yeast selenium was administered to 34 children while in matched control of 34 were put on placebo. Blood samples and weight of the both groups which were taken every 3 months intervals up to 6 months, were analyzed by ELIZA for CD4T cells, the data was analyzed by SPSS version 16, WAZ scores were analyzed by Epi Info version 6. Results: No significant difference in age { χ2 (1, 62) =0.03, p =0.853}, cause of morbidity between test and controls {χ2 (1, 65) = 5.87, p= 0.015} and on condition of foster parents {χ2 ( 1,63) = 5.57, p= 0.0172} was observed. Children on selenium showed progressive improvement of WAZ and significant difference at six months {F (5,12) = =5.758, P=0.006}, and weight gain of up to 4.1 kilograms in six months, and significant CD4 T cell count increase t= -2.943, p<0.05 compared to matched controls t = -1.258 p> 0.05. CD4 T cell count increased among all age groups on test 3-5 years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 and in matched controls a decrease 3-5 years (-71), 5-8 years (-125) and 9-13 years (-10.1) cells/mm3 . No significant difference inCD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between boys {F (2, 49) = 1.040, p= 0.361} on test and between boys and girls {F (5, 81) = 1.379, p= 0.241} on test. Similarly no significant difference between boys and girls were observed {F (5, 86) = 1.168, p= 0.332}.In the test group there was significant positive correlation β =252.23 between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F< 0.05. In matched controls no significant correlation between weight gain and CD4 T cell count change was observed at six months p > 0.05. No positive correlation β =-138.23 was observed between CD4T Cell count, WAZ, p=0.934, R2 =0.0337 F >0.05. Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. Conclusion: From this study it can be concluded that yeast Selenium is effective in slowing the progress of HIV 1 in children from WHO clinical stage I by improving CD4 T cell count and hence the immunity.Keywords: selenium, HIV, AIDS, WAZ
Procedia PDF Downloads 476688 Platelet Transfusion Thresholds for Pediatrics; A Retrospective Study
Authors: Hessah Alsulami, Majedah Aldosari
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Introduction: Platelet threshold of 10x109 /L is recommended for clinically stable thrombocytopenic pediatric patients. Transfusions at a higher level (given the absence of research evidence, as determined by clinical circumstances, generally at threshold of 40x109 /L) may be required for patients with signs of bleeding, high fever, hyper-leukocytosis, rapid fall in platelet count, concomitant coagulation abnormality, critically ill patients, and those with impaired platelet function (including drug induced). Transfusions at a higher level may be also required for patients undergoing invasive procedures. Method: This study is a retrospective observational analysis of platelet transfusion thresholds in a single secondary pediatric hospital in Riyadh. From the blood bank database, the list of the patients who received platelet transfusions in the second half of 2018 was retrieved. Patients were divided into two groups; group A, those belong to the category of high platelet level for transfusion (such as those with bleeding, high fever, rapid fall in platelet count, impaired platelet function or undergoing invasive procedures) and group B, those who were not. Then we looked at the pre and post transfusion platelet levels for each group. The data was analyzed using GraphPad software and the data expressed as Mean ± SD. Result: A total of 112 of transfusion episodes in 61 patients (38% female) were analyzed. The age ranged from 24 days to 8 years. The distribution of platelet transfusion episodes was 64% (n=72) for group A and 36% (n= 40) for group B. The mean pre-transfusion platelet count was 46x103 ± (11x 103) for group A and 28x103 ± (6x103) for group B. the post-transfusion mean platelet count was 61 x 103 ± (14 x 103) and 60 x103 ± (24 x 103) for group A and B respectively. Among the groups the rise in the mean platelet count after transfusion was significant among stable patients (group B) compared to unstable patients (group A) (P < 0.001). Conclusion: The platelet count threshold for transfusion varied with the clinical condition and is higher among unstable patients’ group which is expected. For stable patients the threshold was higher than what it should be which means that the clinicians don’t follow the guidelines in this regard. The rise of platelet count after transfusion was higher among stable patients.Keywords: platelet, transfusion, threshold, pediatric
Procedia PDF Downloads 71687 Role of Activated Partial Thromboplastin Time (APTT) to Assess the Need of Platelet Transfusion in Dengue
Authors: Kalyan Koganti
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Background: In India, platelet transfusions are given to large no. of patients suffering from dengue due to the fear of bleeding especially when the platelet counts are low. Though many patients do not bleed when the platelet count falls to less than 20,000, certain patients bleed even if the platelet counts are more than 20,000 without any comorbid condition (like gastrointestinal ulcer) in the past. This fear has led to huge amounts of unnecessary platelet transfusions which cause significant economic burden to low and middle-income countries like India and also sometimes these transfusions end with transfusion-related adverse reactions. Objective: To identify the role of Activated Partial Thromboplastin Time (APTT) in comparison with thrombocytoenia as an indicator to assess the real need of platelet transfusions. Method: A prospective study was conducted at a hospital in South India which included 176 admitted cases of dengue confirmed by immunochromatography. APTT was performed in all these patients along with platelet count. Cut off values of > 60 seconds for APTT and < 20,000 for platelet count were considered to assess the bleeding manifestations. Results: Among the total 176 patients, 56 patients had bleeding manifestations like malena, hematuria, bleeding gums etc. APTT > 60 seconds had a sensitivity and specificity of 93% and 90% respectively in identifying bleeding manifestations where as platelet count of < 20,000 had a sensitivity and specificity of 64% and 73% respectively. Conclusion: Elevated APTT levels can be considered as an indicator to assess the need of platelet transfusion in dengue. As there is a significant variation among patients who bleed with respect to platelet count, APTT can be considered to avoid unnecessary transfusions.Keywords: activated partial thromboplastin time, dengue, platelet transfusion, thrombocytopenia
Procedia PDF Downloads 216686 Integrated Nested Laplace Approximations For Quantile Regression
Authors: Kajingulu Malandala, Ranganai Edmore
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The asymmetric Laplace distribution (ADL) is commonly used as the likelihood function of the Bayesian quantile regression, and it offers different families of likelihood method for quantile regression. Notwithstanding their popularity and practicality, ADL is not smooth and thus making it difficult to maximize its likelihood. Furthermore, Bayesian inference is time consuming and the selection of likelihood may mislead the inference, as the Bayes theorem does not automatically establish the posterior inference. Furthermore, ADL does not account for greater skewness and Kurtosis. This paper develops a new aspect of quantile regression approach for count data based on inverse of the cumulative density function of the Poisson, binomial and Delaporte distributions using the integrated nested Laplace Approximations. Our result validates the benefit of using the integrated nested Laplace Approximations and support the approach for count data.Keywords: quantile regression, Delaporte distribution, count data, integrated nested Laplace approximation
Procedia PDF Downloads 163685 Haematological Changes and Anticoccidial Activities of Kaempferol in Eimeria Tenella Infected Broiler Chickens
Authors: Ya'u Muhammad, Umar Umar A. Mallammadori, Dahiru Mansur
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Effect of kaempferol on haematological parameters in two weeks old broiler chickens with experimental Eimeria tenella infection was evaluated in this study. Sixty-day old broilers were randomly allotted into six groups (I-VI) of ten broilers each and brooded for two weeks with commercial broiler feed (vital feed®) and provided water ad libitum. At two weeks of age broilers in group 1 were neither infected nor treated. Broilers in groups II-VI were infected with Eimeria tenella sporulated oocyst (104/ml) via oral inoculation. After infection was established, broilers in groups II-IV were treated orally with 1 mg/kg, 1.5 mg/kg, and 2 mg/kg of kaempferol, respectively. Broilers in group V were treated for five days with amprolium, 1.25 g/L in drinking water. Broilers in group VI were administered normal saline, 5 ml/kg per os for five days. Five days post infection; all broilers were sacrificed by severing their jugular veins. Blood sample from each bird was collected in EDTA container for haematology. Caecal contents were harvested and used to determine the lesion score and caecal Oocyst count respectively. Data obtained was analyzed using pad prism version 5.0. Mean Packed Cell Volume (PCV), haemoglobin (Hb) concentration, and Red Blood Cell (RBC) count significantly (P < 0.05) increased in groups II, III, and IV in a dose dependent manner. Similarly, PCV, Hb concentration, and RBC count significantly (P < 0.05) increased in groups II, III, and IV when compared to VI. No significant (P > 0.05) difference in the mean values of PCV, Hb and RBC count were recorded between groups treated with kaempferol and group V. Caecal Oocyst counts and lesion scores reduced significantly (P < 0.05) in groups II, III, and IV in a dose dependent manner. It was therefore observed in this study that kaempferol improved haematological parameters and reduced Oocyst count as well as the lesion scores in broilers infected with Eimeria tenella.Keywords: broilers, Eimeria tenella, kaempferol, lesion scores, oocyst count,
Procedia PDF Downloads 194684 Bacteriological Safety of Sachet Drinking Water Sold in Benin City, Nigeria
Authors: Stephen Olusanmi Akintayo
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Access to safe drinking water remains a major challenge in Nigeria, and where available, the quality of the water is often in doubt. An alternative to the inadequate clean drinking water is being found in treated drinking water packaged in electrically heated sealed nylon and commonly referred to as “sachet water”. “Sachet water” is a common thing in Nigeria as the selling price is within the reach of members of the low socio- economic class and the setting up of a production unit does not require huge capital input. The bacteriological quality of selected “sachet water” stored at room temperature over a period of 56 days was determined to evaluate the safety of the sachet drinking water. Test for the detection of coliform bacteria was performed, and the result showed no coliform bacteria that indicates the absence of fecal contamination throughout 56 days. Heterotrophic plate count (HPC) was done at an interval 14 days, and the samples showed HPC between 0 cfu/mL and 64 cfu/mL. The highest count was observed on day 1. The count decreased between day 1 and 28, while no growths were observed between day 42 and 56. The decrease in HPC suggested the presence of residual disinfectant in the water. The organisms isolated were identified as Staphylococcus epidermis and S. aureus. The presence of these microorganisms in sachet water is indicative for contamination during processing and handling.Keywords: coliform, heterotrophic plate count, sachet water, Staphyloccocus aureus, Staphyloccocus epidermidis
Procedia PDF Downloads 341683 Evaluation of the Potability Qualities of Pretreated Distilled Water Produced from Biomass Fuelled Water Distiller
Authors: E. I. Oluwasola, J. A. V. Famurewa, R. Aboloma, K. Adesina
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Water samples with pretreatment and without pretreatment were obtained from locally constructed biomass fuelled stainless steel water distiller. The water samples were subjected to Microbial, Physicochemical and Minerals analyses for comparison with NAFDAC and WHO Standards for potable water. The results of the physicochemical and microbiological properties of the raw water(A), and the two distilled water samples (B; distill water without pretreatment) and (C; distill water with pretreatment) showed reduction in most of the quality parameters evaluated in the distilled water samples to the level that conforms to the W.H.O standards for drinking water however, lower values were obtained for the pretreated distilled water sample. The values of 0.0016mg/l, 0.0052mg/l and 0.0528mg/l for the arsenic, chromium and lead content respectively in the raw water were within the permissible limit specified by WHO however; the values of cadmium (0.067mg/l) and mercury (0.0287mg/l) are above the maximum tolerable for drinking water thus, making the raw water unsafe for human consumption. Similarly, the high total plate count (278cfu /ml) and coliform count (1100/100ml) indicate that the raw water is potentially harmful while the distilled water samples showed nil coliform count and low total plate count (35cfu/ml,18cfu/ml) for B and C respectively making the distilled water microbiologically safer for human consumption.Keywords: biomass, distillation, mineral, potable, physicochemical
Procedia PDF Downloads 496682 Correlation of Hematological Indices with Fasting Blood Glucose Level and Anthropometric Measurements in Geriatric Diabetes Mellitus Subjects in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Authors: Dada. O.Akinola, Uche. I. Ebele, Bamiro .A.Rafatu, Akinbami A. Akinsegun, Dada O. Adeyemi, Adeyemi. O. Ibukun, Okunowo O.Bolanle, Abdulateef O. Kareem, Ibrahim.N. Ismaila, Dosu Rihanat
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Background: Hyperglycaemia alters qualitatively and quantitatively all the full blood count parameters. The alterations among other factors are responsible for the macrovascular and microvascular complications associated with diabetes mellitus (DM). This study is aimed at correlating haematological parameters in DM subjects with their fasting blood glucose (FBG) and anthropometric parameters. Materials and Methods: This was a cross-sectional study of participants attending DM clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja. The study recruited one hundred and two (102) DM subjects and one hundred (100) non-DM controls. Venous blood samples were collected for full blood count (FBC) assay while FBG was done, structured questionnaires were administered, and anthropometric measurements of all participants were done. Data were analyzed with Statistical Package for Social Science (SPSS) version 23. P was set at ≤0.05. Results: The mean age of DM patients was 64.32± 11.31 years. Using a haemoglobin concentration cut-off of 11g/dl, 39.2%, and 13% DM and control participants respectively had values lower than 11g/dl. A total of 22.5% and 3% of DM and controls respectively gave a history of previous blood transfusion.White blood cells count and platelet count means were (6.12±1.60 and 5.30±7.52,p=0.59) and (213.31±73.58 and 228.91±73.21,p = 0.26) *109/L in DM subjects and controls respectively. FBG and all the anthropometric data in DM subjects were significantly higher than in controls. Conclusions: The prevalence of anaemia in DM subjects was three times higher than in controls. The white blood cell count was higher but not statistically significant in DM compared with controls. But platelet count was higher but not statistically significant in controls compared with DM subjects.Keywords: haematological profile, diabetes mellitus, anthropometric data, fasting blood glucose
Procedia PDF Downloads 85681 Cytoxicity Studies of Sachets Beverages Using Allium Cepa Test
Authors: Ja’Afar Umar, Naziru Salisu
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The consumption of powdered or industrialized juices has increased globally due to the fast pace of city life. These foods, with their attractive color, odor, and taste, are easily diluted in water and can lead to obesity, diabetes, hypertension, and cardiovascular problems. In a study, 80 purple varieties of onion bulbs were used to evaluate the cytotoxicity of the Tiara and Bevi mix beverage powder. The viability of the bulbs was tested using the A. cepa toxicity test. The bulbs were divided into five groups, and the root growth was recorded. The mixture was then squashed in a 45% acetic acid solution and examined for chromosomal abnormalities. The chromosomal abnormalities were classified as bridges, c-mitoses, vagrants, fragments, stickiness, bi-nuclei, and multi-polar. The study found that the highest number of dividing cells was in the negative control group, followed by the group treated with BM beverage. The highest number of aberrant cells was in the group treated with TR beverage, followed by BM 5%. Stickiness of cells was observed in both BM and TR 5% beverage concentrations. No lagging chromosome was present in the negative control group. The highest mitotic index was in the negative control group, and bridge fragrance was observed in the groups treated with different beverages. This study highlights the importance of Allium cepa L. in genotoxic substance testing, revealing chromosomal and mitotic abnormalities in root tip cells. The study also reveals that at 5% concentrations, root growth decreases, indicating potential genetic abnormalities in Allium cepa's genetic material.Keywords: cytotoxicity, Allium cepa, Beverages, Chromosome
Procedia PDF Downloads 16680 Effects of Essential Oils on the Intestinal Microflora of Termite (Heterotermes indicola)
Authors: Ayesha Aihetasham, Najma Arshad, Sobia Khan
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Damage causes by subterranean termites are of major concern today. Termites majorly treated with pesticides resulted in several problems related to health and environment. For this reason, plant-derived natural products specifically essential oils have been evaluated in order to control termites. The aim of the present study was to investigate the antitermitic potential of six essential oils on Heterotermes indicola subterranean termite. No-choice bioassay was used to assess the termiticidal action of essential oils. Further, gut from each set of treated termite group was extracted and analyzed for reduction in number of protozoa and bacteria by protozoal count method using haemocytometer and viable bacterial plate count (dilution method) respectively. In no-choice bioassay it was found that Foeniculum vulgare oil causes high degree of mortality 90 % average mortality at 10 mg oil concentration (10mg/0.42g weight of filter paper). Least mortality appeared to be due to Citrus sinensis oil (43.33 % average mortality at 10 mg/0.42g). The highest activity verified to be of Foeniculum vulgare followed by Eruca sativa, Trigonella foenum-graecum, Peganum harmala, Syzygium cumini and Citrus sinensis. The essential oil which caused maximum reduction in number of protozoa was P. harmala followed by T. foenum-graecum and E. sativa. In case of bacterial count E. sativa oil indicated maximum decrease in bacterial number (6.4×10⁹ CFU/ml). It is concluded that F. vulgare, E. sativa and P. harmala essential oils are highly effective against H. indicola termite and its gut microflora.Keywords: bacterial count, essential oils, Heterotermes indicola, protozoal count
Procedia PDF Downloads 247679 The Evaluation of Complete Blood Cell Count-Based Inflammatory Markers in Pediatric Obesity and Metabolic Syndrome
Authors: Mustafa M. Donma, Orkide Donma
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Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.Keywords: children, complete blood cell count, high density lipoprotein cholesterol, metabolic syndrome, obesity
Procedia PDF Downloads 129678 Human Immuno-Deficiency Virus Co-Infection with Hepatitis B Virus and Baseline Cd4+ T Cell Count among Patients Attending a Tertiary Care Hospital, Nepal
Authors: Soma Kanta Baral
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Background: Since 1981, when the first AIDS case was reported, worldwide, more than 34 million people have been infected with HIV. Almost 95 percent of the people infected with HIV live in developing countries. As HBV & HIV share similar routes of transmission by sexual intercourse or drug use by parenteral injection, co-infection is common. Because of the limited access to healthcare & HIV treatment in developing countries, HIV-infected individuals are present late for care. Enumeration of CD4+ T cell count at the time of diagnosis has been useful to initiate the therapy in HIV infected individuals. The baseline CD4+ T cell count shows high immunological variability among patients. Methods: This prospective study was done in the serology section of the Department of Microbiology over a period of one year from august 2012 to July 2013. A total of 13037 individuals subjected for HIV test were included in the study comprising of 4982 males & 8055 females. Blood sample was collected by vein puncture aseptically with standard operational procedure in clean & dry test-tube. All blood samples were screened for HIV as described by WHO algorithm by Immuno-chromatography rapid kits. Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. After informed consent, HIV positive individuals were screened for HBsAg by Immuno-chromatography rapid kits (Hepacard). Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. EDTA blood samples were collected from the HIV sero-positive individuals for baseline CD4+ T count. Then, CD4+ T cells count was determined by using FACS Calibur Flow Cytometer (BD). Results: Among 13037 individuals screened for HIV, 104 (0.8%) were found to be infected comprising of 69(66.34%) males & 35 (33.65%) females. The study showed that the high infection was noted in housewives (28.7%), active age group (30.76%), rural area (56.7%) & in heterosexual route (80.9%) of transmission. Out of total HIV infected individuals, distribution of HBV co-infection was found to be 6(5.7%). All co- infected individuals were married, male, above the age of 25 years & heterosexual route of transmission. Baseline CD4+ T cell count of HIV infected patient was found higher (mean CD4+ T cell count; 283cells/cu.mm) than HBV co-infected patients (mean CD4+ T cell count; 91 cells/cu.mm). Majority (77.2%) of HIV infected & all co-infected individuals were presented in our center late (CD4+ T cell count;< 350/cu. mm) for diagnosis and care. Majority of co- infected 4 (80%) were late presented with advanced AIDS stage (CD4+ count; <200/cu.mm). Conclusions: The study showed a high percentage of HIV sero-positive & co- infected individuals. Baseline CD4+ T cell count of majority of HIV infected individuals was found to be low. Hence, more sustained and vigorous awareness campaigns & counseling still need to be done in order to promote early diagnosis and management.Keywords: HIV/AIDS, HBsAg, co-infection, CD4+
Procedia PDF Downloads 215677 Cytotoxic Effect of Neem Seed Extract (Azadirachta indica) in Comparison with Artificial Insecticide Novastar on Haemocytes (THC and DHC) of Musca domestica
Authors: Muhammad Zaheer Awan, Adnan Qadir, Zeeshan Anjum
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Housefly, Musca domestica Linnaeus is ubiquitous and hazardous for Homo sapiens and livestock in sundry venerations. Musca domestica cart 100 different pathogens, such as typhoid, salmonella, bacillary dysentery, tuberculosis, anthrax and parasitic worms. The flies in rural areas usually carry more pathogens. Houseflies feed on liquid or semi-liquid substances besides solid materials which are softened by saliva. Neem botanically known as Azadirachta indica belongs to the family Meliaceae and is an indigenous tree to Pakistan. The neem tree is also one such tree which has been revered by the Pakistanis and Kashmiris for its medicinal properties. Present study showed neem seed extract has potentially toxic ability that affect Total Haemocyte Count (THC) and Differential Haemocytes Count (DHC) in insect’s blood cells, of the housefly. A significant variation in haemolymph density was observed just after application, 30 minutes and 60 minutes post treatment in term of THC and DHC in comparison with novastar. The study strappingly acclaim use of neem seed extract as insecticide as compare to artificial insecticides.Keywords: neem, Azadirachta indica, Musca domestica, differential haemocyte count (DHC), total haemocytes count (DHC), novastar
Procedia PDF Downloads 205676 Sustainable Drinking Water Treatment Method Using Solar Light
Authors: Ayushi Arora
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Solar photocatalysis has the potential to treat drinking water in a sustainable and cost effective manner. According to WHO, there should not be any colony forming units (CFU) per 100 mL present in drinking water, and as per the Central Pollution Control Board (CPCB) of India, the bathing water should have less than 500 CFU/100 mL and the maximum permissible limit is 2500 CFU/100 mL. In this study, 8 water sources near our collaborators, Indian Institute of Technology, Kharagpur, India, were analysed, and it was found that 6 out of 8 sources of water had significant coliform count in them. Two of them were chosen to be treated by solar photocatalysis a) well water which had a count of 4800 CFU/100 mL for total coliforms and was used by people for drinking purposes, and b) pond water which had a count of 92000 CFU/100 mL for total coliforms and 3000 CFU/mL for E.Coli and was used by people for washing and bathing purposes. In this study, a semiconductor-semiconductor, composite BTO-TiO2-RMSG & TiO2-SiO2 were tested for their ability to be activated under solar light and to reduce Total Coliforms and E.Coli bacteria in real world contaminated water, and it was found that both catalysts were both able to reduce the total coliform count in water by 99.7% and 98.2 % in 2 hrs respectively. They have also shown promising results in reusability tests. This study demonstrates the ability of solar photocatalysis to be used in real world drinking water treatment and will promote future advancements in this field.Keywords: sustainable water treatment, waterpurification technologies, water policies, water pollution and environmental engineering
Procedia PDF Downloads 80675 Refractory T-Cell Prolymphocytic Leukemia with JAK3 Mutation: In Vitro and Clinical Synergy of Tofacitinib and Ruxolitinib
Authors: Mike Wei, Nebu Koshy, Koen van Besien, Giorgio Inghirami, Steven M. Horwitz
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T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic disease characterized by a T-cell phenotype, rapid progression, and poor prognosis with median survival of less than a year. Alemtuzumab-based chemotherapy has increased the rate of complete remissions but these are often short-lived, and allogeneic transplant is considered the only curative therapy. In recent studies, JAK3 activating mutations have been identified in T-cell cancers, with T-PLL having the highest rate of JAK3 mutations (30 – 42%). As such, T-PLL is a model disease for evaluating the utility of JAK3 inhibitors. We present a case of a 64-year-old man with relapsed-refractory T-PLL. He was initially treated with alemtuzumab and obtained complete response and was consolidated with matched unrelated donor stem cell transplant. His disease stayed in remission for approximately 1.5 years before relapse, which was then treated with a clinical trial of romidepsin-lenalidomide (partial responses then progression at 6 months) and later alemtuzumab. Due to complications of myelosuppression and CMV reactivation, his treatment was interrupted leading to disease progression. The doubling time of lymphocyte count was approximately 20 days and over a span of 60 days the lymphocyte count rose from 8 x 109/L to 68 x 109/L. Exon sequencing showed a JAK3 mutation. The patient consented to and was treated with FDA-approved tofacitinib (initially 5 mg BID, increased to 10 mg BID after 15 days of treatment). An initial decrease in lymphocyte count was followed by progression. In vitro treatment of the patient’s cells showed modest effects of tofacitinib and ruxolitinib as single agents, in the range of doxorubicin, but synergy between the agents. After 40 days of treatment with tofacitinib and with a lymphocyte count of 150 x 109/L, ruxolitinib (5mg BID) was added. Over the 60 days since dual inhibition was started, the lymphocyte count has stabilized. The patient has remained completely asymptomatic during treatment with tofacitinib and ruxolitinib. Neutrophil count has remained normal. Platelet count and hemoglobin have however declined from ~50 x109/L to ~30 x109/L and from 11 g/dL to 8.1 g/dL respectively, since the introduction of ruxolitinib. The stabilization in lymphocyte count confirms the clinical activity of JAK inhibitors in T-PLL as suggested by the presence of JAK3 mutations and by in-vitro assays. It also suggests clinical synergy between ruxolitinib and tofacitinib in this setting. Prospective studies of JAK inhibitors in PLL patients with formal dose-finding studies are needed.Keywords: tofacitinib, ruxolitinib, T-cell prolymphocytic leukemia, JAK3
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