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   Table of Contents - Current issue
Coverpage
July-September 2017
Volume 42 | Issue 3
Page Nos. 81-127

Online since Thursday, November 9, 2017

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ORIGINAL ARTICLES  

Cluster of differentiation 97 as a biomarker for the detection of minimal residual disease in common acute lymphoblastic leukemia p. 81
Laila M Sherif, Mervat M Azab, Ghada M Al-Akad, Marwa Zakaria, Maha Atfy, Sara M Sorour
DOI:10.4103/ejh.ejh_18_17  
Background Acute lymphoblastic leukemia (ALL) is a biologically heterogeneous disorder. Clinical parameters, immunophenotype, cytogenetic factors, and minimal residual disease (MRD) are among currently used factors in risk stratification and therapy determination of ALL patients. MRD is gaining importance nowadays for therapy efficacy, follow-up, and relapse risk estimation. Recent studies have highlighted potential markers that may improve the sensitivity of MRD detection by flow cytometry. Cluster of differentiation (CD) 97 is one of the markers that show overexpression in pediatric ALL. In this study, we aimed to assess the value of CD97 as a biomarker for MRD detection in pediatric ALL. Patients and methods This cohort study was conducted on 30 newly diagnosed patients with B-ALL. There were 16 male and 14 female patients with a mean age of 8.38±4.21. Twenty patients were in the low-risk group and 10 patients were in the high-risk group and were treated according to modified CCG 1991. A panel of monoclonal antibodies was used, with special emphasis on CD10, CD19, CD34, and CD97 at diagnosis and at day 14 postinduction of chemotherapy for MRD detection. Results The percentage of CD19/CD97, CD34/CD97, and CD10/CD97 at day 0 was 57.15±21.74, 57.73±21.20, and 57.87±20.77, whereas at day 14 it was 6.09±2.50, 10.67±8.89, and 5.97±2.44, respectively (P<0.001). CD97 was expressed in 81.5% of patients at diagnosis and was not detected at day 14 (P<0.001). One patient had blast counts more than 5% by light microscopy, whereas 29 patients had MRD more than 0.1 by flow cytometry at day 14 (P<0.001). Conclusion CD97 can be used for MRD tracing in pediatric ALL.
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CD135 expression in childhood acute lymphoblastic leukemia: association with chromosomal aberrations and survival p. 88
Deena M.M Habashy
DOI:10.4103/ejh.ejh_30_17  
Background Building strategies for targeted therapy in acute lymphoblastic leukemia (ALL) patients has been a challenge over the past few years; this raised the importance of revealing new prognostic markers of which CD135, an fms-like tyrosine kinase 3 (FLT3), expression may play a role in patients’ survival and prognosis. Objective This study aimed at detecting the expression of CD135 in childhood ALL, searching for a possible association with chromosomal aberrations and overall survival (OS). Patients and methods Forty newly diagnosed pediatric ALL patients and 20 age-matched and sex-matched controls were studied for the expression of CD135 by flow cytometry. Results Medians of total leukocytic count and CD135 expression [percentage and mean fluorescence intensity (MFI)] were higher in the patient group compared with controls, whereas medians of hemoglobin and platelet count were higher in controls compared with the patient group (P<0.001). Median of CD135 MFI was higher in the patient group with unfavorable chromosomal aberrations, CD33+ and those with poor outcome than those with favorable chromosomal aberrations, CD33 and those with good outcome (P<0.001). CD135 MFI was inversely correlated to OS in the patient group (P<0.001). Patients with MFI values more than or equal to 2.25 had median survival of 13 months, whereas patients with values less than 2.25 had a median survival of 30 months (P<0.001). Conclusion CD135 is expressed in ALL pediatric patients. High CD135 MFI is associated with unfavorable chromosomal aberrations, poor outcome, and is correlated with shorter OS in those patients, which highlights its possible role in follow-up of ALL patients and disease outcome.
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The role of the tumor-suppressive microRNA-370 and microRNA-29b in acute myeloid leukemia p. 95
Marwa Saied, Fatma Mohamed, Mohamed Eissa, Dalia Naefae
DOI:10.4103/ejh.ejh_28_17  
Background MicroRNAs (miRNAs) are small noncoding RNAs that play important roles as diagnostic and prognostic markers in malignancy. They have diverse effects in acute myeloid leukemia (AML), mainly as tumor suppressors and occasionally provoke the disease. Aim The aim of this research was to study the expressions of both miRNA-370 and miRNA-29b in de-novo AML Egyptian patients and correlate their expression with clinical and laboratory parameters. Patients and methods This is a case–control study that was conducted in Alexandria Main University Hospital, Alexandria University. MiRNA quantification by real-time PCR was conducted on 30 de-novo AML patients admitted to the hematology unit of internal medicine department. Their age ranged between 13 and 63 years. Their results were compared with 10 age-matched and sex-matched controls. Descriptive statistics was performed using SPSS statistics software. Results Both miRNA-370 and miRNA-29b were significantly downregulated in AML patients (P=0.011 and 0.015, respectively). There was significant positive correlation between the expressions of miRNA-370 and miRNA-29b in AML patients (P=0.003). Neither miRNAs showed significant correlation with FAB subtypes. Moreover, miRNA-370 expression was significantly negatively correlated with the age of the patients (P=0.034) − that is, the older the patient the lower the expression level of miRNA-370. Conclusion There was a significant down-regulation of both miRNA-370 and miRNA-29b in de-novo AML patients. The positive correlation between both miRNA expressions might point to their potential roles as tumor suppressors.
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Prognostic role of tissue expression and serum level of YKL-40 in patients with diffuse large B-cell lymphoma p. 99
Maaly M Mabrouk, Omnia AbdElfattah, Tamer A Elbedewy, Dareen A Aziz, Asmaa E Bedeer
DOI:10.4103/ejh.ejh_27_17  
Background Serum YKL-40 levels are increased in various inflammatory disorders and a wide range of malignancies. Moreover, these elevated levels correlate with poor prognosis of patients with cancer, suggestive of YKL-40 as a prognostic biomarker. The effect of YKL-40 on non-Hodgkin lymphoma prognosis has not been fully explained. Aim The aim of this article was to study the serum levels and expression of YKL-40 in tissue specimens of patients with diffuse large B-cell lymphoma (DLBCL) for assessing its prognostic value and shedding light on their effect on survival. Patients and methods The study included 60 patients with DLBCL. Enzyme-linked immunosorbent assay was used to assess the serum YKL-40 levels. Immunohistochemical staining was used to detect YKL-40 protein expression in lymphoma specimens. Results YKL-40 serum levels were significantly higher in patients with DLBCL when compared with the control group. YKL-40 protein was expressed in 66.67% of examined specimens. Receiver–operator curve analysis showed serum YKL-40 at a cutoff value of greater than or equal to 95.5 ng/ml had a sensitivity of 70% and a specificity of 95% for DLBCL diagnosis. In patients with DLBCL, progression-free and overall survival rates significantly decreased with increased serum levels of YKL-40 above the cutoff level as well as in YKL-40 positive expressed patients. Conclusion Serum YKL-40 and its tissue expression could be a valuable prognostic marker in patients with DLBCL.
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Knowledge, attitude and practice of haemovigilance among healthcare professionals in a Nigerian Tertiary Hospital p. 108
John C Aneke, Nkiru Ezeama, Chide E Okocha, Adaora N Onyeyili, Christian E Onah, Nancy C Ibeh, Ugochinyere J Chilaka, Geoffrey C Egbunike
DOI:10.4103/ejh.ejh_25_17  
Background The institution of effective haemovigilance protocols in health facility is essential to the attainment of universal blood transfusion safety. Objective The objective of the article was to determine the knowledge, attitude and practice of haemovigilance by healthcare professionals in a Nigerian Hospital. Patients and methods This was a cross-sectional study; an anonymous structured questionnaire was used. In all, 270 consenting hospital staff were randomly selected from among medical doctors, nurses and medical laboratory scientists. Statistical analysis of the data was done using SPSS, version 20.0. Results Only 28.4 and 4.1% of all respondents were aware that graft versus host disease and cryoprecipitate were types of blood transfusion reaction and blood component, respectively. Fever was the most identified blood transfusion reaction among all respondents (84.6%) while a good number were not aware of the existence of local blood transfusion service (71.0%) and hospital blood transfusion committee (53.1%); 37.1 and 56.1% study participants were not aware that blood transfusion reactions should be investigated and results communicated to all stakeholders, respectively, while 20.8 and 28.8% did not know that there is a checklist for blood transfusion safety and reactions, respectively. Conclusion The knowledge and practice of some key elements of haemovigilance is suboptimal among our health professionals. This will need to be improved through intensive in-service training and continuous medical education.
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Red cell distribution width as a predictive index for multiorgan damage in disseminated intravascular coagulation p. 117
Sagir G Ahmed, Modu B Kagu, Umma A Ibrahim
DOI:10.4103/ejh.ejh_9_17  
Background Red cell distribution width (RDW) is raised in many diseases. Although disseminated intravascular coagulation (DIC)-triggering diseases such as sepsis and cancer are also associated with raised RDW, we believe that a superimposed DIC would further raise the RDW owing to fibrin deposition with attendant red cell fragmentation. Hence, we also believe that extensive fibrin deposition will lead to higher RDW (due to red cell fragmentation) and higher risk of multiorgan damage (MOD) (due to microvascular blockade) in DIC. This implies that high RDW in DIC would partly reflect the intensity of fibrin deposition and risk of MOD. We therefore hypothesize that RDW elevation may be associated with an increased risk of MOD in DIC. If our hypothesis is correct, DIC patients with MOD will have significantly higher RDW than their counterparts without MOD. Materials and methods We performed a retrospective comparative analysis of the frequencies of organ damage with respect to RDW values among 96 DIC patients seen from 1996 to 2007 in two tertiary hospitals in Nigeria. Results Patients with organ damage had higher mean values of RDW as compared with patients without organ damage (22.3 vs. 16.8%, P<0.05). Pearson’s analysis showed positive correlation between values of RDW and number of damaged organs among DIC patients with MOD (r=0.78, P<0.05). Discussion This study suggests that high RDW values were associated with organ damage, and the number of damaged organs increased with rising values of RDW, as revealed by a significant positive correlation between RDW values and number of damaged organs. This correlation suggests that higher RDW values were associated with higher risk of MOD. These findings have validated our hypothesis that fibrin deposition, which is a major cause of MOD in DIC, would also cause red cell fragmentation and elevation of RDW. We conclude that high RDW is a risk factor for MOD in DIC, and RDW values may be of predictive significance in assessing the risk of MOD in patients with DIC.
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Oxidative stress in pediatric patients with β thalassemia major p. 123
Asmaa Nafady, Sanaa Shaker Ali, Hosny Mohammed Ahmed El Masry, Khaled Abdel Baseer, Heba M Qubaisy, Samar Gallab Mahmoud, Hanaa A Nafady-Hego
DOI:10.4103/ejh.ejh_41_16  
Background β-thalassemia major (β-TM) is a common inherited hemolytic type of anemia. Repeated blood transfusions predispose β-TM patients toward peroxidative tissue injury because of secondary iron overload. Objectives This study aimed to evaluate the effects of iron overload on antioxidant enzymes and liver cell damage in β-TM patients undergoing regular blood transfusions. Patients and methods This prospective case–control cohort study included 30 pediatric patients with a confirmed diagnosis of β-TM on regular blood transfusions and 20 age-matched and sex-matched healthy children attending the Qena University Hospital, Pediatric Clinic. Blood samples were withdrawn from each patient to measure serum levels of ferritin, glutathione peroxidase (GPX), and superoxide dismutase (SOD). Results Total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), and ferritin levels were significantly higher in the β-TM group (P<0.001, 0.001, 0.001, and 0.001, respectively), whereas GPX and SOD were significantly lower in the β-TM group (P<0.001 and 0.001). The correlation between serum ferritin level and age, bilirubin, AST, and ALT in patients group showed that, the correlation between serum ferritin level and age was (0.745) while P-value was <0.001, the correlation between serum ferritin level and bilirubin level was (0.665) while P-value was <0.001, the correlation between serum ferritin level and (AST) level was (0.727) while P-value was <0.001 and the correlation between serum ferritin level and (ALT) level was (0.737) while P-value was <0.001. The correlation between SOD and age, ferritin, bilirubin, AST, and ALT in patients group in patients group showed that, the correlation between (SOD) and age was (−0.454) while P-value was 0.012, the correlation between (SOD) and ferritin level was (−0.664) while P-value was <0.001, the correlation between (SOD) and bilirubin level was (−0.535) while P-value was 0.002, the correlation between (SOD) and (AST) level was (−0.567) while P-value was <0.001 and the correlation between (SOD) and (ALT) level was (−0.558) while P-value was <0.001. Conclusion Impaired levels of antioxidant enzymes SOD and GPX in patients with β-TM on repeated transfusion, in addition to excessive free iron concentration, iron overload may attribute to oxidative damage in these patients. Antioxidant systems that compensate for reduced lipid peroxidation to lower tissue damage are needed.
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