Rachel S. Hicklen

The prognosis of mucormycosis after hematopoietic stem cell transplantation (HSCT) is generally poor but data on post-HSCT outcomes in patients with pre-HSCT mucormycosis are limited. We reviewed patients with documented mucormycosis at MD Anderson Cancer Center (2008–2024) and identified five patients who subsequently underwent HSCT. A literature review identified 24 additional such cases. Most patients had acute myeloid leukemia (69%). The most common site of mucormycosis was pulmonary (59%), while 31% had disseminated mucormycosis. All patients received antifungals and 76% had surgery prior to HSCT. At the time of HSCT, 67% had mucormycosis responding to treatment. No patient went to transplant with progressing mucormycosis. Eighty percent of patients with ≥12 months of follow-up after HSCT were alive. Five of the twenty-nine patients (17%) had documented or suspected mucormycosis recurrence post-HSCT. Relapsed malignancy pre-HSCT was associated with increased 12-month post-HSCT mortality (p = 0.031). Furthermore, post-transplant mortality was higher in cord blood recipients (p = 0.019) and tended to be higher in patients not undergoing surgery pre-HSCT (p = 0.062). Despite publication bias, our data suggest that HSCT can be conducted safely in selected patients with pre-HSCT mucormycosis, particularly when underlying hematologic malignancy is in remission, mucormycosis is stable, and surgical source control is feasible.

Background: Clinical care globally faces increasing strain due to escalating documentation demands. Simultaneously, technological solutions for clinical workflows, particularly inpatient handovers, are being developed to alleviate workforce stress. However, the maturity, adoption scale, and impact of these technologies on clinical practice remain unclear. Objective: To address this gap, we conducted a scoping review to summarize current advancements in technological solutions for inpatient handovers. Methods: This study was prospectively registered on Open Science Framework. Publications from January 1, 2010, to January 1, 2024, were retrieved from MEDLINE, Embase, Cochrane Library, and Scopus. To be included in this review, studies were required to focus on (1) the implementation, assessment, or enhancement of health care provider handover workflows; (2) inpatient setting; and (3) the proposal or implementation of one or more technological solutions. Abstract and full-text screenings were conducted independently by 2 reviewers, with conflicts resolved by a third reviewer. Data extraction and synthesis were performed by multiple authors and cross-reviewed for accuracy. Results: The search identified 779 publications, of which 53 met the inclusion criteria. Analysis revealed a predominance of low-complexity technologies, such as electronic checklists, with limited exploration of advanced solutions like natural language processing. Most studies were in the pilot stage (33/53, 62%), while some described documented implementations (11/53, 21%). Reported outcomes included improvements in the completeness, accuracy, and consistency of critical information during patient transfers (20/53, 38%). Challenges included scalability, inconsistent adoption, and difficulties integrating advanced technologies into existing workflows. Conclusions: Low-complexity technological solutions show potential for enhancing inpatient handovers but face barriers to scalability and sustained adoption. While artificial intelligence (AI) has the potential to bring transformative benefits, a limitation of this review is that none of the included studies reported successful clinical implementations of AI solutions aimed at improving handover processes.

Background and Aims: Open access (OA) publishing improved the reach of scientific discoveries, particularly among researchers in lower-income countries. However, OA publishing still has a global imbalance. This bibliometric analysis evaluates anaesthesia OA journals to explore geographical and economic disparities in publication volume. Methods: We queried the Directory of Open Access Journals for OA anaesthesia-related journals between 2014 and 2024. Data from the included journals were analysed using Scopus, from which we extracted the year of publication and the corresponding author’s affiliation. Additional metrics were obtained from each journal website. Countries were then categorised by income level and geographical region. Results: Thirty-four anaesthesiology OA journals were analysed, encompassing 27,634 publications from 120 countries. The leading contributors were India (23.96%), the USA (14.98%) and China (6.54%). Low-income countries accounted for 0.37% of total publications, followed by upper-middle-income (17.97%), lower-middle-income (29.07%), and high-income (52.54%) countries. The geographical distribution of publication volume was as follows: Southeast Asia (25.38%), Europe (23.18%), Western Pacific (18.92%), Americas (23.91%), Eastern Mediterranean (8.03%) and Africa (0.59%). Nineteen journals required a mean article processing charge (APC) of US $2,164.89, accounting for 51.89% of the total publications. India ranked first in non-APC journals, while the USA led in APC journals . Conclusion: While OA publishing enhances accessibility for readers, it still presents challenges for authors, particularly in economically disadvantaged countries. Significant geographical and economic disparities exist in OA publication volume, likely due to limited investment and structural barriers in lower-income countries.

Hepatic mucormycosis is a rare but often fatal opportunistic fungal infection, primarily affecting immunocompromised patients. Herein, we report such a case from MD Anderson Cancer Center (Houston, TX, USA) and systematically review published cases in patients ≥ 19 years of age to better characterize clinical presentation, diagnostic challenges, and treatment outcomes of hepatic mucormycosis. Among the 40 identified cases (including ours), hematologic malignancies (55%) and solid organ transplantation (30%) were the most common underlying conditions. Fever (70%) and abdominal pain (63%) were the predominant symptoms. Imaging revealed multiple hepatic lesions in 72% of cases. Diagnosis was primarily based on histopathology (73%), whereas culture positivity was low (36%), underscoring the difficulty of pathogen isolation. Mucorales-active antifungal therapy was often delayed but eventually used in 85% of cases (all amphotericin B +/− Mucorales-active triazoles), while 45% underwent additional surgical intervention. Despite treatment, 1-year all-cause mortality remained high at 46%, with a trend towards lower mortality for those who underwent surgery compared to non-surgical management (35% vs. 55%, p = 0.334). These findings highlight the aggressive nature of hepatic mucormycosis and the importance of early recognition as well as the need for non-culture-based diagnostics and multimodal treatment approaches. Improved awareness and further research into optimized management strategies are crucial to improve the outcomes of this challenging infection.

We performed a thorough search of the literature published through December 2024 with no date exclusions on invasive fungal infection (IFI)-induced hemophagocytic lymphohistiocytosis (HLH) in non-human immunodeficiency virus (HIV) patients. The frequency of IFI-induced HLH reported across 16 articles was 9%. Of the 116 identified cases with available clinical information, 53% occurred in immunocompromised patients. IFIs were usually disseminated (76%), with Histoplasma capsulatum being the most common pathogen (51%). IFI and HLH were diagnosed simultaneously in most cases (78%). The 30-day survival rate was 64%. Reported cases had significant heterogeneity in patient characteristics, management strategies, and outcomes.

This article has been retracted. Please see: https://doi.org/10.1093/ofid/ofae730

Ruxolitinib, a selective inhibitor of Janus kinases, is a standard treatment for intermediate/high-risk myelofibrosis (MF) but is associated with a predisposition to opportunistic infections, especially herpes zoster. However, the incidence and characteristics of invasive fungal infections (IFIs) in these patients remain uncertain. In this report, we present the case of a 59-year-old woman with MF who developed disseminated histoplasmosis after seven months of ruxolitinib use. The patient clinically improved after ten weeks of combined amphotericin B and azole therapy, and ruxolitinib was discontinued. Later, the patient received fedratinib, a relatively JAK2-selective inhibitor, without relapse of histoplasmosis. We also reviewed the literature on published cases of proven IFIs in patients with MF who received ruxolitinib. Including ours, we identified 28 such cases, most commonly due to Cryptococcus species (46%). IFIs were most commonly disseminated (39%), followed by localized lung (21%) infections. Although uncommon, a high index of suspicion for opportunistic IFIs is needed in patients receiving JAK inhibitors. Furthermore, the paucity of data regarding the optimal management of IFIs in patients treated with JAK inhibitors underscore the need for well-designed studies to evaluate the epidemiology, pathobiology, early diagnosis, and multimodal therapy of IFIs in patients with hematological malignancies receiving targeted therapies.

Background: Sleep disturbances constitute a common complication in pediatric cancer patients and survivors and are frequently severe enough to warrant treatment. Suboptimal sleep has been associated with decreased emotional well-being and cognitive functioning and increased behavioral problems. Standardized guidelines for non-pharmacological sleep interventions for adults with cancer exist, but no standard of care intervention or standard guidelines are available to guide such intervention in pediatric cancer patients and survivors. Therefore, effective behavioral interventions for improving sleep quality need to be identified. The objective of the review is to evaluate the effect of non-pharmacological sleep interventions on sleep quality in pediatric cancer patients and survivors. Methods: The review will consider studies that include children and adolescents between 0 and 18 years diagnosed with cancer or who have a history of cancer who have non-respiratory sleep disturbance. We will include experimental and quasi-experimental studies evaluating non-pharmacological interventions such as psychological interventions, technical/device interventions, interventions targeting physical activity, and complementary and alternative medicine interventions (e.g., yoga, massage, music). Interventions involving medications, ingestible supplements, products purported to work through absorption, and medical devices will be excluded. Primary outcome will be sleep quality as measured by methods including retrospective ratings, daily sleep diary, and validated questionnaires. Secondary outcomes will include total sleep time, sleep onset latency, wake after sleep onset, daytime sleepiness, and daytime sleep duration (naps) as measured by retrospective ratings, daily sleep diary, validated questionnaires, and/or actigraphy. Databases will include MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, CINAHL (Ebsco), and PsycINFO (Ovid) and will be queried from database inception to present. Two reviewers will independently screen all citations, full-text articles, and extract data. The study methodological quality will be assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Data will be extracted and findings pooled and synthesized using a meta-aggregation approach via the JBI System for the Unified Management, Assessment, and Review of Information (SUMARI). If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, study design, outcome measures). Discussion: This systematic review will synthesize and consolidate evidence on existing non-pharmacological interventions to improve sleep in pediatric cancer patients and survivors. Findings may help inform practitioners working with pediatric cancer patients and survivors experiencing sleep disturbances and is intended to identify gaps and opportunities to improve methodical quality of further non-pharmacological sleep intervention research in this population toward developing an eventual standard of care. Systematic review registration: PROSPERO CRD42020200397.