Four levels of waste transformation are adapted and applied to the raising of pigs, chickens and ... more Four levels of waste transformation are adapted and applied to the raising of pigs, chickens and cows. Farmers ferment waste and use it as feed (Level 1). They feed fecal matter to the larvae of the black soldier fly, they feed larval residue to red worms, and they fertilize their crops primarily with vermicompost (Level 2). They house pigs, chickens and cows on a soft mesophilic bedding (Level 3) sprayed each day with probiotic liquids. They add biochar from top-lit, updraft gasifiers to the fermented feed and to the bedding, and they use syngas for household cooking (Level 4). The bedding has no odor. There are no flies. At no point in their lives are antibiotics or any other pharmaceuticals administered to pigs, chickens and cows raised in this unconventional way. Just about all of the behavioral and physiological needs of animals and poultry are met. Instead of inhumane confinement or freerange, we propose a third way: confinement in a clean, spacious and odorless setting that a...
Allogeneic hematopoietic cell transplant (HCT) is potentially curative for myeloid malignancy whe... more Allogeneic hematopoietic cell transplant (HCT) is potentially curative for myeloid malignancy when indicated. In patients age 60 years or older HCT has become feasible with the use of reduced intensity conditioning (RIC) and studies have shown improved outcome in this older population. There is no clear consensus concerning the superiority of any single reduced intensity conditioning regimen for elderly patients with myeloid malignancies. At the Princess Margaret Cancer Centre we have been using a combination of fludarabine/busulfan plus low dose total body irradiation (TBI) as the sole RIC regimen since the year 2006. We present a retrospective analysis on the outcomes of 116 patients aged 60 to 71 years who underwent allogeneic HCT during the time period 2006-2015 for myeloid malignancies. A total of 40 patients (34%) underwent RIC HCT during the years 2006-2010 and 76 patients (66%) during the years 2011-2015. Median age at HCT was 64 years (range 60-71). AML was diagnosed in 73 ...
To investigate the prognostic impact of the individual component comorbidities of the hematopoiet... more To investigate the prognostic impact of the individual component comorbidities of the hematopoietic cell transplant comorbidity index (HCT-CI) in patients with acute myeloid leukemia (AML) that underwent allogeneic hematopoietic cell transplant (HCT). This single-center study retrospectively investigated the individual comorbidities of the HCT-CI on the outcome of 418 patients that underwent HCT for AML, in CR1 (n = 303, 72%) or CR2 (n = 115, 28%) at our center between 1999 and 2014. Median age at HCT was 50 years (range 18-71). Univariate analysis of the HCT-CI, grouped as score 0 (n = 109), 1-2 (n = 157) and ≥3 (n = 152), demonstrated significant influence on overall survival (OS) (P = .004) and non-relapse mortality (NRM) (P = .02). For individual comorbidities constituting the HCT-CI, variables with a P-value ≤ .2 on univariate analysis were included in the multivariable analysis. For OS, none of the comorbidities of the HCT-CI demonstrated independent prognostic relevance. Howe...
he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20... more he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20 mg/day to maintain the International Normalized Ratio (INR) within the therapeutic range. It is usually encountered at the start of therapy, however, it may also occur in patients who have been already on warfarin therapy. Both diet and the co-administration of certain drugs can have a marked effect on the anticoagulant efficacy of warfarin. A 45-year-old lady who had a mechanical mitral valve prosthesis (Tilting Disc Prosthesis) 12 years ago presented with chest pain and shortness of breath on moderate exertion. She was maintained on warfarin until 3 years ago when she developed left hemiparesis. Since then there have been difficulty in getting her adequately anticoagulated and she was labeled as having "warfarin resistance". Despite giving her up to 35 mg of warfarin a day, her INR never reached a therapeutic level. She has not been on any medications that could have interfered with the action of warfarin. Subsequently, she was shifted to enoxaparin 80 mg subcutaneous injection twice a day and was even offered to have her
Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy... more Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy. The severe form of HIT has been associated with both venous and arterial thrombosis manifested by myocardial infarction, cerebrovascular occlusion, skin necrosis or limb ischemia. Several agents are now available as alternatives to heparin in patients with suspected HIT, including the thrombin specific inhibitors lepirudin and argatroban as well as the low molecular weight heparinoid known as danaparoid. When lacking these agents, here we report the use of plasmapheresis to create an artificial state of anticoagulation; exchanging patient's plasma with albumin rather than fresh frozen plasma, to allow the safe introduction of warfarin.
he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20... more he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20 mg/day to maintain the International Normalized Ratio (INR) within the therapeutic range. It is usually encountered at the start of therapy, however, it may also occur in patients who have been already on warfarin therapy. Both diet and the co-administration of certain drugs can have a marked effect on the anticoagulant efficacy of warfarin. A 45-year-old lady who had a mechanical mitral valve prosthesis (Tilting Disc Prosthesis) 12 years ago presented with chest pain and shortness of breath on moderate exertion. She was maintained on warfarin until 3 years ago when she developed left
Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy... more Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy. The severe form of HIT has been associated with both venous and arterial thrombosis manifested by myocardial infarction, cerebrovascular occlusion, skin necrosis or limb ischemia. Several agents are now available as alternatives to heparin in patients with suspected HIT, including the thrombin specific inhibitors lepirudin and argatroban as well as the low molecular weight heparinoid known as danaparoid. When lacking these agents, here we report the use of plasmapheresis to create an artificial state of anticoagulation; exchanging patient's plasma with albumin rather than fresh frozen plasma, to allow the safe introduction of warfarin.
Four levels of waste transformation are adapted and applied to the raising of pigs, chickens and ... more Four levels of waste transformation are adapted and applied to the raising of pigs, chickens and cows. Farmers ferment waste and use it as feed (Level 1). They feed fecal matter to the larvae of the black soldier fly, they feed larval residue to red worms, and they fertilize their crops primarily with vermicompost (Level 2). They house pigs, chickens and cows on a soft mesophilic bedding (Level 3) sprayed each day with probiotic liquids. They add biochar from top-lit, updraft gasifiers to the fermented feed and to the bedding, and they use syngas for household cooking (Level 4). The bedding has no odor. There are no flies. At no point in their lives are antibiotics or any other pharmaceuticals administered to pigs, chickens and cows raised in this unconventional way. Just about all of the behavioral and physiological needs of animals and poultry are met. Instead of inhumane confinement or freerange, we propose a third way: confinement in a clean, spacious and odorless setting that a...
Allogeneic hematopoietic cell transplant (HCT) is potentially curative for myeloid malignancy whe... more Allogeneic hematopoietic cell transplant (HCT) is potentially curative for myeloid malignancy when indicated. In patients age 60 years or older HCT has become feasible with the use of reduced intensity conditioning (RIC) and studies have shown improved outcome in this older population. There is no clear consensus concerning the superiority of any single reduced intensity conditioning regimen for elderly patients with myeloid malignancies. At the Princess Margaret Cancer Centre we have been using a combination of fludarabine/busulfan plus low dose total body irradiation (TBI) as the sole RIC regimen since the year 2006. We present a retrospective analysis on the outcomes of 116 patients aged 60 to 71 years who underwent allogeneic HCT during the time period 2006-2015 for myeloid malignancies. A total of 40 patients (34%) underwent RIC HCT during the years 2006-2010 and 76 patients (66%) during the years 2011-2015. Median age at HCT was 64 years (range 60-71). AML was diagnosed in 73 ...
To investigate the prognostic impact of the individual component comorbidities of the hematopoiet... more To investigate the prognostic impact of the individual component comorbidities of the hematopoietic cell transplant comorbidity index (HCT-CI) in patients with acute myeloid leukemia (AML) that underwent allogeneic hematopoietic cell transplant (HCT). This single-center study retrospectively investigated the individual comorbidities of the HCT-CI on the outcome of 418 patients that underwent HCT for AML, in CR1 (n = 303, 72%) or CR2 (n = 115, 28%) at our center between 1999 and 2014. Median age at HCT was 50 years (range 18-71). Univariate analysis of the HCT-CI, grouped as score 0 (n = 109), 1-2 (n = 157) and ≥3 (n = 152), demonstrated significant influence on overall survival (OS) (P = .004) and non-relapse mortality (NRM) (P = .02). For individual comorbidities constituting the HCT-CI, variables with a P-value ≤ .2 on univariate analysis were included in the multivariable analysis. For OS, none of the comorbidities of the HCT-CI demonstrated independent prognostic relevance. Howe...
he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20... more he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20 mg/day to maintain the International Normalized Ratio (INR) within the therapeutic range. It is usually encountered at the start of therapy, however, it may also occur in patients who have been already on warfarin therapy. Both diet and the co-administration of certain drugs can have a marked effect on the anticoagulant efficacy of warfarin. A 45-year-old lady who had a mechanical mitral valve prosthesis (Tilting Disc Prosthesis) 12 years ago presented with chest pain and shortness of breath on moderate exertion. She was maintained on warfarin until 3 years ago when she developed left hemiparesis. Since then there have been difficulty in getting her adequately anticoagulated and she was labeled as having "warfarin resistance". Despite giving her up to 35 mg of warfarin a day, her INR never reached a therapeutic level. She has not been on any medications that could have interfered with the action of warfarin. Subsequently, she was shifted to enoxaparin 80 mg subcutaneous injection twice a day and was even offered to have her
Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy... more Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy. The severe form of HIT has been associated with both venous and arterial thrombosis manifested by myocardial infarction, cerebrovascular occlusion, skin necrosis or limb ischemia. Several agents are now available as alternatives to heparin in patients with suspected HIT, including the thrombin specific inhibitors lepirudin and argatroban as well as the low molecular weight heparinoid known as danaparoid. When lacking these agents, here we report the use of plasmapheresis to create an artificial state of anticoagulation; exchanging patient's plasma with albumin rather than fresh frozen plasma, to allow the safe introduction of warfarin.
he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20... more he term warfarin resistance is usually reserved for patients who require warfarin in excess of 20 mg/day to maintain the International Normalized Ratio (INR) within the therapeutic range. It is usually encountered at the start of therapy, however, it may also occur in patients who have been already on warfarin therapy. Both diet and the co-administration of certain drugs can have a marked effect on the anticoagulant efficacy of warfarin. A 45-year-old lady who had a mechanical mitral valve prosthesis (Tilting Disc Prosthesis) 12 years ago presented with chest pain and shortness of breath on moderate exertion. She was maintained on warfarin until 3 years ago when she developed left
Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy... more Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy. The severe form of HIT has been associated with both venous and arterial thrombosis manifested by myocardial infarction, cerebrovascular occlusion, skin necrosis or limb ischemia. Several agents are now available as alternatives to heparin in patients with suspected HIT, including the thrombin specific inhibitors lepirudin and argatroban as well as the low molecular weight heparinoid known as danaparoid. When lacking these agents, here we report the use of plasmapheresis to create an artificial state of anticoagulation; exchanging patient's plasma with albumin rather than fresh frozen plasma, to allow the safe introduction of warfarin.
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