Mihaela Dragomir - Academia.edu (original) (raw)

Papers by Mihaela Dragomir

Research paper thumbnail of A Paradigm Shift in Public Health: Yoga and Meditation for Prevention

DIALOGO

In all its paradigms, the ideal modern public health systems should have eradicated by now the sp... more In all its paradigms, the ideal modern public health systems should have eradicated by now the spreading of the most fatal diseases, like cancer or cardiovascular disorders. Not only it has not, but these diseases are actually growing, showing the limits of the modern public health and the need of a paradigm shift. Using a narrative review, this paper aims to emphasize the limits of curative modern medicine and the benefits of yoga and meditation practices as prevention for the most common diseases, recognizing them as an important tool in public health systems. The relationship between yoga practice and the health status of individuals shows that they are strongly interdependent, being able to correct destructive behaviors and improve the quality of life. The spiritual practice of yoga is a way of restoring the “factory settings” by returning to essence, tradition, ancient knowledge and thus creating the mental and emotional environment for healing and thriving in human beings.

Research paper thumbnail of AML-139 Early Onset of Therapy-Related Acute Myeloid Leukemia in a Patient Treated for a Hodgkin Lymphoma

Clinical Lymphoma Myeloma and Leukemia

Research paper thumbnail of Therapy-related myelodysplastic syndrome after allogeneic BMT: successful treatment by donor lymphocyte infusions

Bone Marrow Transplantation, 2010

Research paper thumbnail of Essential Thrombocythemia: One-Center Data in a Changing Disease

Medicina

Introduction: Essential thrombocythemia is a chronic myeloproliferative neoplasm associated with ... more Introduction: Essential thrombocythemia is a chronic myeloproliferative neoplasm associated with thrombo-hemorrhagic events and the progression to myelofibrosis or acute myeloid leukemia. The purpose of this article is to present real-world data on ET cases diagnosed and managed between 1998 and 2020 in the largest, tertiary hematology reference center in Romania and to evaluate the impact of thrombotic events on survival. Methods: A real-world, retrospective cohort-type study was conducted. We collected and statistically analyzed data from 168 patients who met the 2016 WHO diagnostic criteria for ET and who were managed between 1998 and 2020 in our center. Results: The median age at diagnosis of ET was 51.8 years, with a female predominance (66.07%). The JAK2V617F mutation was detected in 60.71% of patients. Leukocytosis at diagnosis was associated with a higher risk of thrombosis, and JAK2V617F-positive cases exhibited a 1.5-fold higher risk of developing thrombotic events. The av...

Research paper thumbnail of Controversial Flow Cytometry Monitoring of a Relapse Case of Pediatric T Cell Acute Lymphoblastic Leukemia: A Case Report

Frontiers in Medicine, Mar 22, 2022

Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer, with 80-85% represented... more Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer, with 80-85% represented by B cell ALL and only 15% by T cell ALL. T Cell ALL (T-ALL) carries a more reserved prognosis compared to B Cell ALL (B-ALL) with regard to response to treatment, risk of relapse, and overall survival. Progress made in current monitoring protocols such as via flow cytometry immunophenotyping (FCM) and by PCR-based amplification of antigen-receptor genes led to improved management of patients with ALL and superior rates of survival. Nevertheless, challenges remain in some clinical cases. This manuscript describes a unique case of TALL and raises awareness of such clinical challenges. The article presents an overview of the flow cytometry immunophenotyping at diagnosis and during treatment of a pediatric patient with TALL from Fundeni Clinical Institute. In this case, in spite of various therapeutic measures such as first-line chemotherapy for high risk group, salvage chemotherapy (FLAG), conditioning regimen (FLU-BUTT -ATG), and stem cell transplant, a chemoresistance clone continued to be present.

Research paper thumbnail of Using Crowdsourcing to Foster Creativity in Children with Autism during Idea Generation

Previous work suggests involving autistic children in participatory design (PD) benefits them. Ho... more Previous work suggests involving autistic children in participatory design (PD) benefits them. However, such inclusion does not come without challenges. Decision-making and the ability to creatively Autism Spectrum Disorder (ASD) Autism Spectrum Disorder is a neurodevelopmental condition that affects social interaction, communication, interests and behaviour [1]. In light of the recent discussions around terminology, identify-first language will be adopted in this article [8]. express thoughts are two of the most acknowledged difficulties autistic children face during the PD process, particularly during the stage of idea generation. These are linked to the disorder-specific impairments in social interaction and rigidity in thought and behaviour. Recent work recommended technology as a tool to support children during idea generation. Building up on these efforts, this paper proposes using crowdsourcing with a team of selected online workers, as a way to generate child-specific hints ...

Research paper thumbnail of Facilitating Pretend Play in Autistic Children

Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility, 2018

Autistic children find pretend play difficult. Previous work suggests Augmented Reality (AR) has ... more Autistic children find pretend play difficult. Previous work suggests Augmented Reality (AR) has potential in eliciting pretend play in children with autism. This paper presents the evaluation of an Augmented Reality app to help autistic children engage in solitary pretend play. We followed a user-centred design process, involving various techniques and stakeholders. Results from a pre-post study design suggest the AR system is promising in facilitating quantitative aspects of pretend play in autistic children.

Research paper thumbnail of A trans-theoretical approach to alcohol abuse profile in the general population of an islamic country - Mashhad, Iran

Background:From a public health perspective, alcohol-related problems have enormous social and in... more Background:From a public health perspective, alcohol-related problems have enormous social and individual consequences. Objectives:The aim of the present study was to apply the TTM on the general population of Mashhad city to evaluate the change levels and possible relative factors regarding alcohol abuse. Methods:: In a cross-sectional design, a total number of 564 people from the General Population of Mashhad, Iran participated. Stages of change questionnaire based on trans-theoretical model (TTM) and the checklist including socio-demographic characteristics as well as possible related factors were used. SPSS 11.5 software was used for all statistical analyses. Results: Among 564 people who took part in this survey, 245 (43.43%) had the history of alcohol consumption or they were current alcohol users. The analysis showed that 19.2% of the participants were in pre-contemplation stage, 3.3% in contemplation, 1.2% in preparation, 2.9% in action, 2% in maintenance and 71.4% were in t...

Research paper thumbnail of The Effect of Concrete Materials on Children's Subsequent Numerical Explanations: Metaphorical Priming

This paper contributes evidence for the claim that gestures used to support numerical thinking ca... more This paper contributes evidence for the claim that gestures used to support numerical thinking can simulate prior concrete experiences. 114 children aged 6-9 years explained a numerical relationship (additive composition) three times consecutively. All children explained without materials for the 1st and 3rd explanation. For the 2nd explanation, children were randomly assigned to one of three conditions to use: physical objects; a number line; or no materials (control condition) to explain their thinking. Findings showed how using physical objects significantly influenced the particular types of gestures (e.g. splitting), hand morphology (e.g. pinching), and words (e.g. “take”, “big”) that children used in subsequent explanations without materials. Similar (although less pronounced) priming effects were found for the number line condition. The study provides support for conceptual metaphor theory (used to categorize gestures and language), and the potential for gesture research to a...

Research paper thumbnail of Expecting the Unexpected in Participatory Design

Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems, 2019

Participatory Design (PD) provides unique benefits in designing technology with and for specific ... more Participatory Design (PD) provides unique benefits in designing technology with and for specific target audiences. However, it can also be an intensive and difficult process, with unexpected situations which can arise at any stage. In this Special Interest Group (SIG), we propose that PD researchers may exchange "war stories" about their unexpected and difficult experiences with PD. This will facilitate reflective discussions and the identification of possible solutions, and enable future PD research to plan for similar situations, thereby making difficulties a little less unexpected.

Research paper thumbnail of AML-353: Molecular Relapse Associated with Central Nervous System Involvement in Patients with Acute Promyelocytic Leukemia – Three Case Reports

Clinical Lymphoma Myeloma and Leukemia, 2020

Context Extramedullary relapse in acute promyelocytic leukemia (APL) is a rare event, but increas... more Context Extramedullary relapse in acute promyelocytic leukemia (APL) is a rare event, but increasingly reported in the all-trans retinoic acid (ATRA) era. The implementation of central nervous system (CNS) prophylaxis is still debatable, and the strategies for further decreasing the rate of CNS relapse in APL patients, while following a risk-based approach, differ between the major study groups. Moreover, there is currently no standard of care for the treatment of CNS relapse in APL. Objective Evaluate the clinical and evolutive features of molecular relapse associated with CNS involvement in APL and assess the response to intrathecal chemotherapy. Design We present three cases of molecular relapse, associated with CNS involvement, in patients with APL who received induction therapy with ATRA and idarubicin, without CNS prophylaxis. Results Three patients (two males, one female) with a median age of 42 years (31 – 53 years) and a median leukocyte count at diagnosis of 5.6 × 109/L (2.74 — 78 × 109/L), who received induction therapy with ATRA and idarubicin, all of them achieving complete remission. Molecular analysis following consolidation showed the absence of the PML/RARα rearrangement in all three cases. The two patients who fell into the low/intermediate risk category showed a molecular relapse at 17 and 20 months respectively, while the high-risk case relapsed at 11 months after complete remission, maintaining morphologic remission. CNS involvement was certified at a median of 7 months (1 — 9 months) after the first documentation of molecular relapse. The therapeutic approach consisted of intrathecal administration of cytarabine, methotrexate and dexamethasone, associated with arsenic trioxide and ATRA, clearing the leptomeningeal disease and inducing a second complete response in two cases. The high-risk patient also underwent neuraxis radiotherapy but showed frank relapse 8 months after the CNS relapse and eventually died of hemorrhagic stroke. Conclusions Despite the low incidence of CNS relapse in APL patients, they should be fully evaluated at onset of neurologic symptoms, regardless of the risk profile. Further studies should be conducted in order to guide clinical management of APL patients with CNS relapse and better define the risk factors associated with CNS involvement in APL.

Research paper thumbnail of AML-258: Next-Generation Sequencing Used to Detect Multiple Mutations in Acute Myeloid Leukemia Patients

Clinical Lymphoma Myeloma and Leukemia, 2020

Context New molecular tecniques allow the characterization of clonal heterogeneity in acute myelo... more Context New molecular tecniques allow the characterization of clonal heterogeneity in acute myeloid leukemia (AML) at diagnosis or during treatment. In the past decades, the mutational landscape identified in AML has become more diverse and is allowing identification of new prognostic factors. Objective To develop an in-house next-generation sequencing method that can be used to assess the mutational status of the patient at diagnosis and during treatment. Design The sequencing method screens for 8 regions in 5 genes involved in pathogenesis and progression of AML: FLT3, IDH1, IDH2, DNMT3A, and RUNX1. Setting Screening for these mutations will permit the stratification of patients into risk group at diagnosis, and using the method for minimal residual assesment will permit the development of personalised treatment programs. Patients or other participants A number of 51 patients diagnosed with AML in the Molecular Biology Laboratory of the Fundeni Clinical Institute between 2017 and 2019 were tested using an in-house sequencing method. Every patient included was tested at diagnosis for the presence of a reciprocal translocation and for presence of FLT3-ITD. Interventions For all patients, standard treatment was started after diagnosis. Bone marrow transplant was recommended and performed for only three patients. Main outcome measures To determine the functionality of the method for mutation detection in AML patients, as well as to familiarize the physicians with these mutations and to use them in treatment decisions. Results From the 51 patients included, 20 patients (39%) harboured one or more mutations in the genes tested. Mutations in DNMT3A and IDH2 were found to be more frequent. In 4 out of 20 patients (20%) mutations in DNMT3A and FLT3-ITD+ concurred. Survival was poor, and only 3 patients are still in follow-up: one patient harboring FLT3-ITD and RUNX1, one with mutations in RUNX1, and one with mutations in IDH2. Conclusions The method developed to test for somatic mutation has proven to be useful and has a lower cost than a commercial kit. Also, the method can be improved by adding new testing targets. Funding We gratefully acknowledge the funding from the project Competitiveness Operational Programme (COP), MyeloAL-EDiaProT, Contract 149/26.10.2016.

Research paper thumbnail of Day 15 and Day 33 Minimal Residual Disease Assessment for Acute Lymphoblastic Leukemia Patients Treated According to the BFM ALL IC 2009 Protocol: Single-Center Experience of 133 Cases

Frontiers in Oncology, 2020

Conclusion : Prednisone response, day 15 FCM-MRD, day 33 FCM-MRD, and the risk group represent th... more Conclusion : Prednisone response, day 15 FCM-MRD, day 33 FCM-MRD, and the risk group represent the most important factors that in the current study independently predict childhood ALL prognosis.

Research paper thumbnail of The Management of Secondary Resistance CP-CML–Case Report

Clinical Lymphoma Myeloma and Leukemia, 2019

CP-CML, with long-term OS approaching that of aged-matched controls. The first FDA approved TKI w... more CP-CML, with long-term OS approaching that of aged-matched controls. The first FDA approved TKI was imatinib as first-line treatment for newly diagnosed CML in December 2002 with results showing outstanding effectiveness of imatinib. Most generic drugs carry a lower price than the brand name equivalent. This does not mean lower quality, but consumers should monitor information about the generic form with their physician and medical teams. Objective: To evaluate the efficacy and safety of a generic imatinib (Carcemia, Hikma pharmaceuticals) in patients with newly-diagnosed CML-CP and to compare its results with the reported similar studies using the original imatinib (Gleevec, Novartis). Design: This is observational, single center, retrospective, open-label study, patients with newly diagnosed CML-CP from December 2015 to February 2018 were assigned to receive generic imatinib (Carcemia, Hikma) an initial dose of 400 mg/d. Patients: Forty Patients newly diagnosed with CML-CP, ECOG performance 2. Interventions: Responses were defined using European Leukemia Net 2013 guidelines and assessed by CBCs and RT-Q-PCR. Adverse events (AEs) were evaluated using CTCAE, Version 5.0. Main Outcomes Measures: To assess rate of complete hematological, cytogenetic and molecular and major molecular responses (CHR, CCyR, MR and MMR) at 3, 6, 12 and 18 month respectively, and degree of AEs. Results: Forty eligible patients were assigned to Carcemia. At 3 months, rate of BCR/ABL% <10% was 45.5% (15/33). The rates of CCyR, (BCR/ABL% <1%) at 6, 12 months were 35% (7/20) and 55.5% (5/9) respectively. MMR (BCR/ABL% <0.1%) at 12, 18 months were 44.5% (4/9) and 40% (2/5) respectively. Overall grades 3, 4 AEs occurred in 4 patients (10%) mainly GI toxicity, and 7.5% discontinued treatment because of AEs. One patient (2.5%) progressed to blast phase; 2 patients (5%) lost their CHR after achieving CCyR. Conclusions: Albeit of short follow-up, early hematological, cytogenetic and molecular responses achieved with Carcemia in newly-diagnosed CML-CP patients are comparable with that of the originator (Glivec). Also, safety profiles were quite similar, with slightly higher rates of grades 3-4 AEs and treatment discontinuation due AEs. However, more patients and longer follow up are needed to draw a firm conclusion.

Research paper thumbnail of Coexpression of p190 and p210 Fusion Transcripts in Ph+ Acute Lymphoblastic Leukemia. A Case Report

Clinical Lymphoma Myeloma and Leukemia, 2019

with newly diagnosed acute lymphoblastic leukemia (ALL). Objective: The optimal time-points of MR... more with newly diagnosed acute lymphoblastic leukemia (ALL). Objective: The optimal time-points of MRD assessment at complete remission (CR) or later during consolidation and its impact on outcome remain unclear. Design: This is a retrospective chart review of 419 newly diagnosed adult patients with Philadelphia negative B-cell ALL. Setting: Patients received treatment at the MD Anderson Cancer Center between 01/2000 and 01/2015. Patients: Adult patients (older >18 years) with newly diagnosed untreated Philadelphia chromosome (Ph)-negative B-cell ALL were eligible. Interventions: Two hundred and fifteen patients (51%) had available MRD assessment (by multicolor flow cytometry) at CR (1st time-point: median 24 days) and first post-CR MRD assessment (2nd time-point: median 3.6 months), and constitute the current studied cohort. MRD responses were stratified as MRD negative (undetectable), low-positive (0.1%) and high-positive (>0.1%). Main Outcomes: We evaluated the dynamic of MRD status at early and late stages of therapy and investigate the impact of MRD changes on the outcome. Results: At first time-point, 148 patients (68%) were MRD negative and 67 (32%) were positive. Of the 148 patients with negative MRD at first time-point, 147 (99%) maintained it through second time-point. Fourteen of 16 (88%) patients with low-positive MRD and 33 of 51 (64%) with highpositive MRD at first assessment became MRD negative at the second assessment. Patients who were MRD negative at two timepoints, early MRD responders, had the 3-year EFS and OS rates of 65% and 76%, respectively. Patients with improved MRD status from positive to negative, late MRD responders, had lower 3-year EFS and OS rates, 42% and 58%, respectively (p¼0.001). The 3-year EFS and OS rates were the lowest (16% and 49%, respectively) in patients with persistent MRD at both time points (p¼0.001). Multivariate analysis showed that older age, MLL rearrangement, and MRD positivity at first-time point only correlated with worse survival. Conclusion: The early achievement of CR negative MRD is a strong predictive for survival. Innovative combinations of conventional chemotherapy and targeted agents that induce early MRD eradication may have the potential to improve cure rates in adult ALL.

Research paper thumbnail of Secondary Acute Myeloid Leukemia Following Myeloproliferative Neoplasms–A Unicentric Study

Clinical Lymphoma Myeloma and Leukemia, 2019

neoplasm providing accurate therapeutic strategies. More studies are necessary to establish the r... more neoplasm providing accurate therapeutic strategies. More studies are necessary to establish the role of chemotherapy in SHN development. This later event of cancer treatment is an emerging problem that can be detected with a proper long-term-follow-up available in some centers. Poor outcomes reinforce disease's gravity.

Research paper thumbnail of MGMT Promoter Methylation as an Epigenetic Biomarker for the Estimation of Chemosensitivity towards the Alkylating Agents Based Chemotherapies

Clinical Lymphoma Myeloma and Leukemia, 2017

in two patients (14%) who developed veno occlusive disease and died due to liver failure and infe... more in two patients (14%) who developed veno occlusive disease and died due to liver failure and infection. The median progression free survival (mPFS) and the median overall survival (mOS) were not reached. All the complications and outcomes post allo-SCT are listed in table 2. Conclusions: Our results indicate that this sequential conditioning regimen appears to be feasible, with low TRM, allows high rate of engraftment and good disease control among high-risk patients. Further large prospective trials needed to evaluate that.

Research paper thumbnail of JAK2 V617F Genetic Biomarker Used in Differential Diagnosis for BCR-ABL1 Negative Myeloproliferative Neoplasms

Clinical Lymphoma Myeloma and Leukemia, 2017

coefficients (cc) were as follows: 0.37 for absenteeism, 0.70 for presenteeism, 0.70 for work imp... more coefficients (cc) were as follows: 0.37 for absenteeism, 0.70 for presenteeism, 0.70 for work impairment, and 0.70 for activity impairment (all P<0.001; Table 2). Considerably high correlation was observed between WPAI scores and each of the ten symptoms in MPN TSS, with problems with concentration, inactivity, and fatigue showing the strongest correlation. Conclusion: Work productivity and daily activities of patients with MPNs were substantially impaired by their disease. A greater detrimental impact was observed in patients with higher symptom burden.

Research paper thumbnail of A new assay to identify recurrent mutations in acute myeloid leukemia using next-generation sequencing

Romanian Review of Laboratory Medicine, 2014

Research paper thumbnail of Chronic myelomonocytic leukemia “myelodysplastic type’’ in transformation to acute myeloid leukemia – diagnostic and therapeutic options: case report and literature review / Leucemie mielomonocitară cronică forma mielodisplazică în transformare spre leucemie acută mieloidă – diagnostic și opțiuni...

Revista Romana de Medicina de Laborator, 2016

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder that is chara... more Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder that is characterized by the presence of an absolute monocytosis (1 × 10^ 9/l) in the peripheral blood, the overlap of myelodisplastic aspects and myeloproliferative aspects in the bone marrow and tendency to transform into acute myeloid leukemia. CMML is considered to be the most aggressive chronic myeloid leukemia. We present the case of a 48 years old woman who was hospitalized in March 2013 in the Center of Hematology and Bone Marrow Transplantation for anemia related symptoms. Initial investigations showed anemia, relative monocytosis (10% monocytes of the WBC differential) with an increasing absolute number of monocytes (> 1,000/μl) in the following months. Initial exploration of the bone marrow (aspirate and bone marrow biopsy and immunohistochemistry IHC tests) revealed elements of trilinear dysplasia and an increased percentage of myeloblasts (11-14%). In the next four months myeloblasts ...

Research paper thumbnail of A Paradigm Shift in Public Health: Yoga and Meditation for Prevention

DIALOGO

In all its paradigms, the ideal modern public health systems should have eradicated by now the sp... more In all its paradigms, the ideal modern public health systems should have eradicated by now the spreading of the most fatal diseases, like cancer or cardiovascular disorders. Not only it has not, but these diseases are actually growing, showing the limits of the modern public health and the need of a paradigm shift. Using a narrative review, this paper aims to emphasize the limits of curative modern medicine and the benefits of yoga and meditation practices as prevention for the most common diseases, recognizing them as an important tool in public health systems. The relationship between yoga practice and the health status of individuals shows that they are strongly interdependent, being able to correct destructive behaviors and improve the quality of life. The spiritual practice of yoga is a way of restoring the “factory settings” by returning to essence, tradition, ancient knowledge and thus creating the mental and emotional environment for healing and thriving in human beings.

Research paper thumbnail of AML-139 Early Onset of Therapy-Related Acute Myeloid Leukemia in a Patient Treated for a Hodgkin Lymphoma

Clinical Lymphoma Myeloma and Leukemia

Research paper thumbnail of Therapy-related myelodysplastic syndrome after allogeneic BMT: successful treatment by donor lymphocyte infusions

Bone Marrow Transplantation, 2010

Research paper thumbnail of Essential Thrombocythemia: One-Center Data in a Changing Disease

Medicina

Introduction: Essential thrombocythemia is a chronic myeloproliferative neoplasm associated with ... more Introduction: Essential thrombocythemia is a chronic myeloproliferative neoplasm associated with thrombo-hemorrhagic events and the progression to myelofibrosis or acute myeloid leukemia. The purpose of this article is to present real-world data on ET cases diagnosed and managed between 1998 and 2020 in the largest, tertiary hematology reference center in Romania and to evaluate the impact of thrombotic events on survival. Methods: A real-world, retrospective cohort-type study was conducted. We collected and statistically analyzed data from 168 patients who met the 2016 WHO diagnostic criteria for ET and who were managed between 1998 and 2020 in our center. Results: The median age at diagnosis of ET was 51.8 years, with a female predominance (66.07%). The JAK2V617F mutation was detected in 60.71% of patients. Leukocytosis at diagnosis was associated with a higher risk of thrombosis, and JAK2V617F-positive cases exhibited a 1.5-fold higher risk of developing thrombotic events. The av...

Research paper thumbnail of Controversial Flow Cytometry Monitoring of a Relapse Case of Pediatric T Cell Acute Lymphoblastic Leukemia: A Case Report

Frontiers in Medicine, Mar 22, 2022

Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer, with 80-85% represented... more Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer, with 80-85% represented by B cell ALL and only 15% by T cell ALL. T Cell ALL (T-ALL) carries a more reserved prognosis compared to B Cell ALL (B-ALL) with regard to response to treatment, risk of relapse, and overall survival. Progress made in current monitoring protocols such as via flow cytometry immunophenotyping (FCM) and by PCR-based amplification of antigen-receptor genes led to improved management of patients with ALL and superior rates of survival. Nevertheless, challenges remain in some clinical cases. This manuscript describes a unique case of TALL and raises awareness of such clinical challenges. The article presents an overview of the flow cytometry immunophenotyping at diagnosis and during treatment of a pediatric patient with TALL from Fundeni Clinical Institute. In this case, in spite of various therapeutic measures such as first-line chemotherapy for high risk group, salvage chemotherapy (FLAG), conditioning regimen (FLU-BUTT -ATG), and stem cell transplant, a chemoresistance clone continued to be present.

Research paper thumbnail of Using Crowdsourcing to Foster Creativity in Children with Autism during Idea Generation

Previous work suggests involving autistic children in participatory design (PD) benefits them. Ho... more Previous work suggests involving autistic children in participatory design (PD) benefits them. However, such inclusion does not come without challenges. Decision-making and the ability to creatively Autism Spectrum Disorder (ASD) Autism Spectrum Disorder is a neurodevelopmental condition that affects social interaction, communication, interests and behaviour [1]. In light of the recent discussions around terminology, identify-first language will be adopted in this article [8]. express thoughts are two of the most acknowledged difficulties autistic children face during the PD process, particularly during the stage of idea generation. These are linked to the disorder-specific impairments in social interaction and rigidity in thought and behaviour. Recent work recommended technology as a tool to support children during idea generation. Building up on these efforts, this paper proposes using crowdsourcing with a team of selected online workers, as a way to generate child-specific hints ...

Research paper thumbnail of Facilitating Pretend Play in Autistic Children

Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility, 2018

Autistic children find pretend play difficult. Previous work suggests Augmented Reality (AR) has ... more Autistic children find pretend play difficult. Previous work suggests Augmented Reality (AR) has potential in eliciting pretend play in children with autism. This paper presents the evaluation of an Augmented Reality app to help autistic children engage in solitary pretend play. We followed a user-centred design process, involving various techniques and stakeholders. Results from a pre-post study design suggest the AR system is promising in facilitating quantitative aspects of pretend play in autistic children.

Research paper thumbnail of A trans-theoretical approach to alcohol abuse profile in the general population of an islamic country - Mashhad, Iran

Background:From a public health perspective, alcohol-related problems have enormous social and in... more Background:From a public health perspective, alcohol-related problems have enormous social and individual consequences. Objectives:The aim of the present study was to apply the TTM on the general population of Mashhad city to evaluate the change levels and possible relative factors regarding alcohol abuse. Methods:: In a cross-sectional design, a total number of 564 people from the General Population of Mashhad, Iran participated. Stages of change questionnaire based on trans-theoretical model (TTM) and the checklist including socio-demographic characteristics as well as possible related factors were used. SPSS 11.5 software was used for all statistical analyses. Results: Among 564 people who took part in this survey, 245 (43.43%) had the history of alcohol consumption or they were current alcohol users. The analysis showed that 19.2% of the participants were in pre-contemplation stage, 3.3% in contemplation, 1.2% in preparation, 2.9% in action, 2% in maintenance and 71.4% were in t...

Research paper thumbnail of The Effect of Concrete Materials on Children's Subsequent Numerical Explanations: Metaphorical Priming

This paper contributes evidence for the claim that gestures used to support numerical thinking ca... more This paper contributes evidence for the claim that gestures used to support numerical thinking can simulate prior concrete experiences. 114 children aged 6-9 years explained a numerical relationship (additive composition) three times consecutively. All children explained without materials for the 1st and 3rd explanation. For the 2nd explanation, children were randomly assigned to one of three conditions to use: physical objects; a number line; or no materials (control condition) to explain their thinking. Findings showed how using physical objects significantly influenced the particular types of gestures (e.g. splitting), hand morphology (e.g. pinching), and words (e.g. “take”, “big”) that children used in subsequent explanations without materials. Similar (although less pronounced) priming effects were found for the number line condition. The study provides support for conceptual metaphor theory (used to categorize gestures and language), and the potential for gesture research to a...

Research paper thumbnail of Expecting the Unexpected in Participatory Design

Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems, 2019

Participatory Design (PD) provides unique benefits in designing technology with and for specific ... more Participatory Design (PD) provides unique benefits in designing technology with and for specific target audiences. However, it can also be an intensive and difficult process, with unexpected situations which can arise at any stage. In this Special Interest Group (SIG), we propose that PD researchers may exchange "war stories" about their unexpected and difficult experiences with PD. This will facilitate reflective discussions and the identification of possible solutions, and enable future PD research to plan for similar situations, thereby making difficulties a little less unexpected.

Research paper thumbnail of AML-353: Molecular Relapse Associated with Central Nervous System Involvement in Patients with Acute Promyelocytic Leukemia – Three Case Reports

Clinical Lymphoma Myeloma and Leukemia, 2020

Context Extramedullary relapse in acute promyelocytic leukemia (APL) is a rare event, but increas... more Context Extramedullary relapse in acute promyelocytic leukemia (APL) is a rare event, but increasingly reported in the all-trans retinoic acid (ATRA) era. The implementation of central nervous system (CNS) prophylaxis is still debatable, and the strategies for further decreasing the rate of CNS relapse in APL patients, while following a risk-based approach, differ between the major study groups. Moreover, there is currently no standard of care for the treatment of CNS relapse in APL. Objective Evaluate the clinical and evolutive features of molecular relapse associated with CNS involvement in APL and assess the response to intrathecal chemotherapy. Design We present three cases of molecular relapse, associated with CNS involvement, in patients with APL who received induction therapy with ATRA and idarubicin, without CNS prophylaxis. Results Three patients (two males, one female) with a median age of 42 years (31 – 53 years) and a median leukocyte count at diagnosis of 5.6 × 109/L (2.74 — 78 × 109/L), who received induction therapy with ATRA and idarubicin, all of them achieving complete remission. Molecular analysis following consolidation showed the absence of the PML/RARα rearrangement in all three cases. The two patients who fell into the low/intermediate risk category showed a molecular relapse at 17 and 20 months respectively, while the high-risk case relapsed at 11 months after complete remission, maintaining morphologic remission. CNS involvement was certified at a median of 7 months (1 — 9 months) after the first documentation of molecular relapse. The therapeutic approach consisted of intrathecal administration of cytarabine, methotrexate and dexamethasone, associated with arsenic trioxide and ATRA, clearing the leptomeningeal disease and inducing a second complete response in two cases. The high-risk patient also underwent neuraxis radiotherapy but showed frank relapse 8 months after the CNS relapse and eventually died of hemorrhagic stroke. Conclusions Despite the low incidence of CNS relapse in APL patients, they should be fully evaluated at onset of neurologic symptoms, regardless of the risk profile. Further studies should be conducted in order to guide clinical management of APL patients with CNS relapse and better define the risk factors associated with CNS involvement in APL.

Research paper thumbnail of AML-258: Next-Generation Sequencing Used to Detect Multiple Mutations in Acute Myeloid Leukemia Patients

Clinical Lymphoma Myeloma and Leukemia, 2020

Context New molecular tecniques allow the characterization of clonal heterogeneity in acute myelo... more Context New molecular tecniques allow the characterization of clonal heterogeneity in acute myeloid leukemia (AML) at diagnosis or during treatment. In the past decades, the mutational landscape identified in AML has become more diverse and is allowing identification of new prognostic factors. Objective To develop an in-house next-generation sequencing method that can be used to assess the mutational status of the patient at diagnosis and during treatment. Design The sequencing method screens for 8 regions in 5 genes involved in pathogenesis and progression of AML: FLT3, IDH1, IDH2, DNMT3A, and RUNX1. Setting Screening for these mutations will permit the stratification of patients into risk group at diagnosis, and using the method for minimal residual assesment will permit the development of personalised treatment programs. Patients or other participants A number of 51 patients diagnosed with AML in the Molecular Biology Laboratory of the Fundeni Clinical Institute between 2017 and 2019 were tested using an in-house sequencing method. Every patient included was tested at diagnosis for the presence of a reciprocal translocation and for presence of FLT3-ITD. Interventions For all patients, standard treatment was started after diagnosis. Bone marrow transplant was recommended and performed for only three patients. Main outcome measures To determine the functionality of the method for mutation detection in AML patients, as well as to familiarize the physicians with these mutations and to use them in treatment decisions. Results From the 51 patients included, 20 patients (39%) harboured one or more mutations in the genes tested. Mutations in DNMT3A and IDH2 were found to be more frequent. In 4 out of 20 patients (20%) mutations in DNMT3A and FLT3-ITD+ concurred. Survival was poor, and only 3 patients are still in follow-up: one patient harboring FLT3-ITD and RUNX1, one with mutations in RUNX1, and one with mutations in IDH2. Conclusions The method developed to test for somatic mutation has proven to be useful and has a lower cost than a commercial kit. Also, the method can be improved by adding new testing targets. Funding We gratefully acknowledge the funding from the project Competitiveness Operational Programme (COP), MyeloAL-EDiaProT, Contract 149/26.10.2016.

Research paper thumbnail of Day 15 and Day 33 Minimal Residual Disease Assessment for Acute Lymphoblastic Leukemia Patients Treated According to the BFM ALL IC 2009 Protocol: Single-Center Experience of 133 Cases

Frontiers in Oncology, 2020

Conclusion : Prednisone response, day 15 FCM-MRD, day 33 FCM-MRD, and the risk group represent th... more Conclusion : Prednisone response, day 15 FCM-MRD, day 33 FCM-MRD, and the risk group represent the most important factors that in the current study independently predict childhood ALL prognosis.

Research paper thumbnail of The Management of Secondary Resistance CP-CML–Case Report

Clinical Lymphoma Myeloma and Leukemia, 2019

CP-CML, with long-term OS approaching that of aged-matched controls. The first FDA approved TKI w... more CP-CML, with long-term OS approaching that of aged-matched controls. The first FDA approved TKI was imatinib as first-line treatment for newly diagnosed CML in December 2002 with results showing outstanding effectiveness of imatinib. Most generic drugs carry a lower price than the brand name equivalent. This does not mean lower quality, but consumers should monitor information about the generic form with their physician and medical teams. Objective: To evaluate the efficacy and safety of a generic imatinib (Carcemia, Hikma pharmaceuticals) in patients with newly-diagnosed CML-CP and to compare its results with the reported similar studies using the original imatinib (Gleevec, Novartis). Design: This is observational, single center, retrospective, open-label study, patients with newly diagnosed CML-CP from December 2015 to February 2018 were assigned to receive generic imatinib (Carcemia, Hikma) an initial dose of 400 mg/d. Patients: Forty Patients newly diagnosed with CML-CP, ECOG performance 2. Interventions: Responses were defined using European Leukemia Net 2013 guidelines and assessed by CBCs and RT-Q-PCR. Adverse events (AEs) were evaluated using CTCAE, Version 5.0. Main Outcomes Measures: To assess rate of complete hematological, cytogenetic and molecular and major molecular responses (CHR, CCyR, MR and MMR) at 3, 6, 12 and 18 month respectively, and degree of AEs. Results: Forty eligible patients were assigned to Carcemia. At 3 months, rate of BCR/ABL% <10% was 45.5% (15/33). The rates of CCyR, (BCR/ABL% <1%) at 6, 12 months were 35% (7/20) and 55.5% (5/9) respectively. MMR (BCR/ABL% <0.1%) at 12, 18 months were 44.5% (4/9) and 40% (2/5) respectively. Overall grades 3, 4 AEs occurred in 4 patients (10%) mainly GI toxicity, and 7.5% discontinued treatment because of AEs. One patient (2.5%) progressed to blast phase; 2 patients (5%) lost their CHR after achieving CCyR. Conclusions: Albeit of short follow-up, early hematological, cytogenetic and molecular responses achieved with Carcemia in newly-diagnosed CML-CP patients are comparable with that of the originator (Glivec). Also, safety profiles were quite similar, with slightly higher rates of grades 3-4 AEs and treatment discontinuation due AEs. However, more patients and longer follow up are needed to draw a firm conclusion.

Research paper thumbnail of Coexpression of p190 and p210 Fusion Transcripts in Ph+ Acute Lymphoblastic Leukemia. A Case Report

Clinical Lymphoma Myeloma and Leukemia, 2019

with newly diagnosed acute lymphoblastic leukemia (ALL). Objective: The optimal time-points of MR... more with newly diagnosed acute lymphoblastic leukemia (ALL). Objective: The optimal time-points of MRD assessment at complete remission (CR) or later during consolidation and its impact on outcome remain unclear. Design: This is a retrospective chart review of 419 newly diagnosed adult patients with Philadelphia negative B-cell ALL. Setting: Patients received treatment at the MD Anderson Cancer Center between 01/2000 and 01/2015. Patients: Adult patients (older >18 years) with newly diagnosed untreated Philadelphia chromosome (Ph)-negative B-cell ALL were eligible. Interventions: Two hundred and fifteen patients (51%) had available MRD assessment (by multicolor flow cytometry) at CR (1st time-point: median 24 days) and first post-CR MRD assessment (2nd time-point: median 3.6 months), and constitute the current studied cohort. MRD responses were stratified as MRD negative (undetectable), low-positive (0.1%) and high-positive (>0.1%). Main Outcomes: We evaluated the dynamic of MRD status at early and late stages of therapy and investigate the impact of MRD changes on the outcome. Results: At first time-point, 148 patients (68%) were MRD negative and 67 (32%) were positive. Of the 148 patients with negative MRD at first time-point, 147 (99%) maintained it through second time-point. Fourteen of 16 (88%) patients with low-positive MRD and 33 of 51 (64%) with highpositive MRD at first assessment became MRD negative at the second assessment. Patients who were MRD negative at two timepoints, early MRD responders, had the 3-year EFS and OS rates of 65% and 76%, respectively. Patients with improved MRD status from positive to negative, late MRD responders, had lower 3-year EFS and OS rates, 42% and 58%, respectively (p¼0.001). The 3-year EFS and OS rates were the lowest (16% and 49%, respectively) in patients with persistent MRD at both time points (p¼0.001). Multivariate analysis showed that older age, MLL rearrangement, and MRD positivity at first-time point only correlated with worse survival. Conclusion: The early achievement of CR negative MRD is a strong predictive for survival. Innovative combinations of conventional chemotherapy and targeted agents that induce early MRD eradication may have the potential to improve cure rates in adult ALL.

Research paper thumbnail of Secondary Acute Myeloid Leukemia Following Myeloproliferative Neoplasms–A Unicentric Study

Clinical Lymphoma Myeloma and Leukemia, 2019

neoplasm providing accurate therapeutic strategies. More studies are necessary to establish the r... more neoplasm providing accurate therapeutic strategies. More studies are necessary to establish the role of chemotherapy in SHN development. This later event of cancer treatment is an emerging problem that can be detected with a proper long-term-follow-up available in some centers. Poor outcomes reinforce disease's gravity.

Research paper thumbnail of MGMT Promoter Methylation as an Epigenetic Biomarker for the Estimation of Chemosensitivity towards the Alkylating Agents Based Chemotherapies

Clinical Lymphoma Myeloma and Leukemia, 2017

in two patients (14%) who developed veno occlusive disease and died due to liver failure and infe... more in two patients (14%) who developed veno occlusive disease and died due to liver failure and infection. The median progression free survival (mPFS) and the median overall survival (mOS) were not reached. All the complications and outcomes post allo-SCT are listed in table 2. Conclusions: Our results indicate that this sequential conditioning regimen appears to be feasible, with low TRM, allows high rate of engraftment and good disease control among high-risk patients. Further large prospective trials needed to evaluate that.

Research paper thumbnail of JAK2 V617F Genetic Biomarker Used in Differential Diagnosis for BCR-ABL1 Negative Myeloproliferative Neoplasms

Clinical Lymphoma Myeloma and Leukemia, 2017

coefficients (cc) were as follows: 0.37 for absenteeism, 0.70 for presenteeism, 0.70 for work imp... more coefficients (cc) were as follows: 0.37 for absenteeism, 0.70 for presenteeism, 0.70 for work impairment, and 0.70 for activity impairment (all P<0.001; Table 2). Considerably high correlation was observed between WPAI scores and each of the ten symptoms in MPN TSS, with problems with concentration, inactivity, and fatigue showing the strongest correlation. Conclusion: Work productivity and daily activities of patients with MPNs were substantially impaired by their disease. A greater detrimental impact was observed in patients with higher symptom burden.

Research paper thumbnail of A new assay to identify recurrent mutations in acute myeloid leukemia using next-generation sequencing

Romanian Review of Laboratory Medicine, 2014

Research paper thumbnail of Chronic myelomonocytic leukemia “myelodysplastic type’’ in transformation to acute myeloid leukemia – diagnostic and therapeutic options: case report and literature review / Leucemie mielomonocitară cronică forma mielodisplazică în transformare spre leucemie acută mieloidă – diagnostic și opțiuni...

Revista Romana de Medicina de Laborator, 2016

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder that is chara... more Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder that is characterized by the presence of an absolute monocytosis (1 × 10^ 9/l) in the peripheral blood, the overlap of myelodisplastic aspects and myeloproliferative aspects in the bone marrow and tendency to transform into acute myeloid leukemia. CMML is considered to be the most aggressive chronic myeloid leukemia. We present the case of a 48 years old woman who was hospitalized in March 2013 in the Center of Hematology and Bone Marrow Transplantation for anemia related symptoms. Initial investigations showed anemia, relative monocytosis (10% monocytes of the WBC differential) with an increasing absolute number of monocytes (> 1,000/μl) in the following months. Initial exploration of the bone marrow (aspirate and bone marrow biopsy and immunohistochemistry IHC tests) revealed elements of trilinear dysplasia and an increased percentage of myeloblasts (11-14%). In the next four months myeloblasts ...