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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 45 | Issue 1
Page Nos. 1-56

Online since Thursday, September 10, 2020

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ORIGINAL ARTICLES  

CD62P and CD40 ligand in diabetic pregnant women p. 1
Nagwa I Okaily, Ashraf M Othman, Reem Y Elgarhy, Ahmed R Abdelraheem
DOI:10.4103/ejh.ejh_23_19  
Aim We evaluated the expression of CD62P and CD40 ligand in diabetic pregnant women to correlate between these parameters and hemostatic abnormalities and to evaluate the relationship of these parameters with the fetal outcome. Settings and design This is a prospective case–control study that included 60 patients: 40 diabetic pregnant women (patient group), who were subdivided into group Ia (20 pregnant women with preexisting diabetes) and group Ib (20 with gestational diabetes), and 20 apparently healthy, age-matched and sex-matched pregnant women (control group). Patients and methods Platelet activating markers (CD62P and CD40L) were measured using flow cytometry. Results A significant increase in CD40L and CD62P percentage in group I compared with group II was present (P<0.001). There were significant correlations between the groups Ia and Ib in percentages of both CD40L and CD62P (P=0.001). There was a significant increase in maternal complications in those with preexisting diabetes mellitus (60%) more than in those with gestational diabetes mellitus (10%) and significant positive correlations between CD40L and CD62P. Conclusion Expressions of CD62P and CD40 ligand are increased in diabetic pregnant women, and this means that platelet activation and aggregation play an important and possibly key role in fetal and maternal complications, whereas CD40L expression plays an important role in maternal complications.
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Clinical audit on management of aplastic anemia at hematology unit of Assiut University Children Hospital p. 8
Catherine S Attia, Gehan MK El-Din, Khalid I El-Sayeh
DOI:10.4103/ejh.ejh_41_19  
Background Aplastic anemia (AA) is a rare bone marrow failure disorder with high mortality rate, which is characterized by peripheral blood pancytopenia, with a hypocellular bone marrow. Objective The aim was to evaluate the management of aplastic anemia in Assiut University Children Hospital, trying to find any defects and suggest methods of their correction. Patients and methods A retrospective cross-sectional study was done on 50 children having AA for a period of 1 year. Results Management of AA in Assiut University Children Hospital is compatible with the British Committee for Standards in Hematology guideline 2015 except for some defects such as using high dose of cyclosporine alone, due to no availability of antithymocyte globulin in definitive drug therapy. There is no availability of stem cell transplantation, although it is the only curative treatment. Conclusion Management of AA in Assiut University Children Hospital is compatible with British Committee for Standards in Hematology guideline (2015), but there are some defects owing to limited recourses.
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Perceived stigma among adolescents with sickle cell anemia in a tertiary health facility p. 16
Chioma Okechukwu, Chukwuma U Okeafor, Innocent O George
DOI:10.4103/ejh.ejh_51_19  
Background Adolescents with sickle cell anemia (SCA) are challenged by a myriad of complex psychosocial issues, which may be triggered or exacerbated by stigmatization. The magnitude of childhood stigma is scarcely being assessed, as more focus is often given to the physical symptoms and signs of SCA. This study sought to assess the prevalence of perceived stigma and its associated factors among adolescents with SCA in steady state. Patients and methods Using a cross-sectional design, 200 adolescents with SCA (patients) were recruited consecutively from the Paediatric Haematology Clinic. Controls matched for age, sex, and socioeconomic class, with hemoglobin genotype AA or AS, were recruited from the Children Outpatient Clinic. A self-administered questionnaire was used to obtain the clinicodemographic data. A validated perceived stigma scale was used in this study. Bivariate and multivariate analyses were performed at 0.05 significant level. Results There were 97 (48.5%) males and 103 (51.5%) females in each group. Perceived stigma was present in 159 (79.5%) patients and 16 (8.0%) controls (P=0.001). Perceived stigma was significantly higher among patients who were in their early and mid-adolescence, those who had sickle cell pain crises frequency of greater than thrice a year, and those with poor self-perception. Patients in early and mid-adolescence were about three times more likely to experience perceived stigma than those in late adolescence (odds ratio=2.9; 95% confidence interval=1.1–7.7; P=0.031). Conclusion Stigma is a major problem among adolescents with SCA. Regular screening for stigma is recommended for patients with SCA, especially those in early and mid-adolescence.
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Initially presented acute coronary syndrome: does D-dimer imply any clinical significance? p. 23
Hazem M Mansour, Yasmin N El-Sakhawy
DOI:10.4103/ejh.ejh_40_19  
Background D-Dimer is an enzymatic degradation product that is formed as a result of breakdown of cross-linked fibrin clots by plasmin. The plasma level of D-dimer is vital for evaluating the patient’s fibrinolytic status. D-dimer testing was proven to be beneficial marker in the identification of deep vein thrombosis of the lower limbs and pulmonary embolism [16]. The relationship between the level of D-dimer levels & acute coronary syndrome is uncertain and conflicting. Aim The aim of this study was to assess D-dimer levels in patients presented to the emergency room (ER) with acute chest pain. Subjects and methods The first group involved those diagnosed with acute coronary syndrome (ACS); which included unstable angina pectoris [UA], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group involved those diagnosed with non-cardiac chest pain. The serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were assessed in the two groups. Results Levels of D-dimer, CK-MB and TPI was higher in the patient group. There were also higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups as compared with the control group. Merely the D-dimer level was higher in the UA subgroup as compared with the control group. Conclusion D-dimer levels assessment seemed to be useful in the ER for identifying ACS patients and to predict mortality hazards in patients presenting with acute chest pain.
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Platelet count/splenic diameter ratio: a noninvasive method for diagnosis of esophageal varices in Egyptian cirrhotic patients p. 28
Walaa A Elsalakawy, Ahmed G El-Rab
DOI:10.4103/ejh.ejh_48_19  
Aim/Objectives To assess the utility of of platelet count (PC)/ SD ratio as a noninvasive predictor of EV. Background Bleeding esophageal varices (EV) remain a leading cause of death in cirrhotic Egyptian patients. Although current guidelines recommend screening for EV, repeated endoscopies cause a significant burden and cost to endoscopy units and may expose patients to unnecessary procedures. Methods This prospective cross-sectional analytic study included 100 Egyptian patients with liver cirrhosis, where splenic diameter assessment by ultrasound and upper endoscopy for grading of EV were done. Results We found that the mean platelet count (PL) in patients with varices is 103 300±25 520/ml, whereas in patients with no varices is 212 390±58 980/ml. The mean spleen diameter (SD) in patients with varices is 154.59±10.57 mm, whereas in patients with no varices is 140.14±8.74 mm. The mean PL/SD ratio in patients with varices is 668.22±169.10 whereas in patients with no varices is 1515.56±470.40. The three relations werehighly significant (P≤0.00). At a cutoff value of 909, PL/SD showed sensitivity of 82.81% and specificity of 91.67%, with diagnostic accuracy of 89.8%. Conclusions In conclusion, the use of PC/SD ratio can be of help to the physicians as a noninvasive predictor of EV to restrict the use of endoscopic screening only to patients presenting a high probability of EV. This is especially useful in clinical settings where resources are limited and endoscopic facilities are not present in all areas.
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Wilms’ tumor gene (WT1) expression levels as prognostic marker in pediatric acute lymphoblastic leukemia p. 35
Neveen L Mikhael, Areej M Ibrahim, Myriam A Helmy, Hoda El Sheikh
DOI:10.4103/ejh.ejh_30_19  
Background Wilms’ tumor gene (WT1) encodes a transcription factor that has a role in kidney development and malignancy. WT1 is shown to be overexpressed in most adult acute myeloid leukemias and hence is an adverse prognostic factor. Its use as a prognostic marker in childhood acute lymphoblastic leukemia (ALL) is controversial. Aim The aim was to study WT1 gene expression levels for diagnosis of ALL in a group of Egyptian children and to relate it to prognosis. Participants and methods This study was conducted on 140 children newly diagnosed as having ALL; assessment of WT1 gene was done by real-time PCR in bone marrow (BM) samples at diagnosis and at day 28 of treatment. Results WT1 gene expression was positive in 96 (68.6%) cases and negative in 44 (31.4%) cases. WT1 expression was related to aberrant expression of myeloid markers. There was a significant correlation between WT1 expression at diagnosis and at day 28 and minimal residual disease detected at day 28. No correlation was detected between outcome and WT1 level during follow-up. Conclusion WT1 gene expression is related to response to therapy as defined by day 28 minimal residual disease.
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Value of assessment of factor XI in patients with myeloproliferative neoplasms with and without thrombotic events p. 40
Hanan Hamed, Emad A Abdelhady, Mostafa K Elrazzaz, Rana G Abdelfatah, Mohamed T Hamza
DOI:10.4103/ejh.ejh_46_19  
Background Although high levels of factor XI and contact factors have been implicated as a risk factor for deep venous thrombosis and possibly cardiovascular disease in some cancers like prostatic cancer, the relationship between elevated factor XI activity and thrombosis in myeloproliferative neoplasm (MPN) is not established yet. Aim The aim was to study the possible relation between factor XI in patients with MPNs with and without thrombotic events in comparison with normal controls and the possible effect of its altered level to occurrence of such events. Patients and methods This is a cross-sectional study conducted in Ain Shams University Hospitals and included 50 patients with MPN. Patients were investigated to assess the relation between level of factor XI and thrombus formation. Results There was no statistically significant difference between the level of factor XI and thrombotic incidence in patients with MPN. Conclusion This study focusing on the contribution of factor XI to the thrombotic risk in patients with MPN showed that there was no link between the high levels of factor XI and the thrombotic risk in patients with MPN.
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Assessment of B-lymphocyte and T-lymphocyte function in patients with myelodysplastic syndromes p. 48
Mohamed M Moussa, Walaa Elsalakawy
DOI:10.4103/ejh.ejh_2_20  
Background An activated immune system has been observed in patients with myelodysplastic syndrome (MDS), but its exact contribution to disease development and control has not been fully clarified. The successful use of immunosuppressive therapies, the potentially curative role of allogeneic stem cell transplant, and the more recent data showing improved peripheral cytopenias and elimination of certain common cytogenetic abnormalities with immunomodulatory agents highlight the role immune dysregulation in the development of MDS. Aim The aim of this study is to assess B-cell and T-cell function in patients with MDS and correlate them to the risk status of MDS. Patients and methods The study included 30 adult Egyptian patients diagnosed with MDS based on blood picture, bone marrow (BM) examination, and cytogenetic studies. Patients were classified according to International Prognostic Scoring System risk scoring system. Immune system assessment was done by performing antinuclear antibodies, direct Coombs test, serum protein electrophoresis, and CD4/CD8 ratio in peripheral blood. Results We have found an association between inverted CD4/CD8 ratio and higher risk strata, presence of neutropenia, and transfusion dependence. Regarding humoral immune system involvement, a positive Coombs test was related significantly to younger age and higher BM blasts count. Marked polyclonal gammopathy as well was found to be associated with higher BM blasts count and presence of cytogenetic abnormalities. Conclusion Immune dysregulation, in the form of inverted CD4/CD8 ratio, positive antinuclear antibodies, positive Coombs test, and polyclonal gammopathy, is well documented in MDS. It is probably related to younger age, higher International Prognostic Scoring System risk, higher BM blasts count, and the presence of cytogenetic abnormalities.
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