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  Citation statistics : Table of Contents
   2016| July-September  | Volume 41 | Issue 3  
    Online since December 27, 2016

 
 
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CASE REPORTS
Imatinib mesylate-related and dasatinib-related adverse effects in a case with chronic myeloid leukemia
Osman Yokus, Habip Gedik, Ceyda Aslan
July-September 2016, 41(3):148-150
DOI:10.4103/1110-1067.196219  
First-generation and second-generation tyrosine kinase inhibitors have marked an era in the treatment of chronic myeloid leukemia. In this case report, diffuse skin lesions and pleural effusions developed after administration of imatinib in a patient with chronic myeloid leukemia. Skin reactions may develop due to imatinib mesylate use often within the first 2 months. In this case, the drug is continued, switching to a different second-generation tyrosine kinase inhibitors.
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Squamous cell carcinoma of buccal mucosa metastasizing to bone marrow: a case report and review of the literature
Kriti Chauhan, Monica Jain, Pragya Shukla
July-September 2016, 41(3):151-153
DOI:10.4103/1110-1067.196223  
Bone marrow metastasis in patients with oral squamous cell carcinoma is a very rare phenomenon. A 38-year-old male patient presented with carcinoma of the buccal mucosa postoperatively. The histopathological diagnosis was that of a moderately differentiated squamous cell carcinoma. Biochemical, fine-needle aspiration findings, and PET scan suggested distant spread. The bone marrow showed involvement by squamous cell carcinoma, which was confirmed immunohistochemically. Clinical, biochemical, hematological, and radiological findings are essential for detecting early bone marrow metastasis in head and neck cancer patients, especially squamous cell carcinoma, and timely detection of bone marrow infiltration prevents unwarranted radical surgery.
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ORIGINAL ARTICLES
Lower Fas-associated phosphatase-1 expression predicted poor outcome in acute myeloid leukemia patients
Nahla F.A. Osman, Walaa M.H. Alzobary, Mohamed A.M. Samra, Hala H Alsaid, Iman A Eltounsi
July-September 2016, 41(3):111-115
DOI:10.4103/1110-1067.196175  
Background Fas-associated phosphatase-1 (FAP-1) mediates tumor suppressor and tumor promoter effects through the inhibition of oncogenic tyrosine kinases and apoptosis, respectively. It was claimed responsible for the pathogenesis of some cancers; nevertheless, its role in acute myeloid leukemia (AML) is not clear. Patients and Methods FAP-1 expression was measured in 20 new AML patients and 12 apparently healthy individuals using real-time PCR. Results FAP-1 expression was significantly lower in AML patients compared with controls (P<0.001). Patients with relatively higher FAP-1 expression had significantly higher hemoglobin and platelets but lower white cell count (WCC) and lactic dehydrogenase (LDH) (P<0.001), thus reflecting lower tumor burden in this group. Patients’ response was assessed on day 28 after chemotherapy; we found that one of seven patients with FAP-1 expression up to 0.03945 achieved complete remission (CR) compared with eight of 13 patients with levels more than 0.03945. FAP-1 levels predicted the response in the subgroup with normal karyotype and in those with no FLT3-ITD as the majority of those with higher levels achieved CR (77.8 and 80%, respectively), whereas CR was seldom achieved in those with low levels. Conclusion Our data showed significantly reduced FAP-1 expression in AML patients. FAP-1 can be a useful tool in identifying patient’s risk in AML as the level of expression predicted the response.
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Role of interleukin-27 in immune thrombocytopenic purpura and its impact on disease response
Hoda A Gad Allah, Mohammed M Moussa, Amro M.S. El-Ghammaz, Basma S.M. Ali
July-September 2016, 41(3):116-120
DOI:10.4103/1110-1067.196177  
Background Aberrant cytokine profiles play important roles in immune thrombocytopenia (ITP) pathogenesis. Interleukin-27 (IL-27) has pleiotropic immunomodulatory effects. However, the role of IL-27 in ITP and its impact on disease response are still controversial. Patients and methods This study included 60 adult ITP patients [20 de-novo patients (group 1), 20 with complete response (CR) to corticosteroids (group 2), and 20 with refractory ITP (group 3)]. Serum IL-27 level was assessed in all patients using enzyme-linked immunosorbent assay. Results The mean IL-27 for all patients was significantly higher than that for controls (P<0.001). There were significant differences in mean IL-27 levels between group 1 and group 2 (P=0.002) and between group 2 and group 3 (P=0.030). There was a significant negative correlation between IL-27 level in all studied patients and platelet count (P=0.003). A serum level of IL-27 of 32 pg/ml had a sensitivity of 100% and specificity of 90% in differentiating de-novo ITP patients from healthy controls as detected by means of receiver operating characteristic curve. Moreover, a serum level of IL-27 of 72.5 pg/ml had a sensitivity of 65% and specificity of 75% in differentiating refractory patients from those with CR. Conclusion Serum IL-27 is significantly elevated in ITP patients (de novo, in CR, and refractory) and it can be used as a predictor for disease occurrence and to a lower extent for its responsiveness to corticosteroid therapy.
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DNA methyltransferase 3B gene promotor and interleukin-1 receptor antagonist polymorphisms in Egyptian children with immune thrombocytopenic purpura
Dina Ahmed Ezzat, Amira Ahmed Hammam, Waleed Mostafa El Malah, Sanaa Ahmed Hussein
July-September 2016, 41(3):121-127
DOI:10.4103/1110-1067.196179  
Background and objectives Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition characterized by increased platelet destruction. Although the etiology of ITP remains unclear, it is accepted that both environmental and genetic factors play an important role in the development of the disease. Many gene polymorphisms have been reported to be closely associated with the susceptibility to ITP. Aim of the work The current study aimed to investigate the association between the DNA methyltransferase DNMT3B-46359 C/T promoter and IL-1Ra polymorphism and the risk for acquisition of pediatric ITP in a cohort of Egyptian children. Patients and methods Genotyping of the studied genes using PCR-RFLP assays was conducted on 40 children with ITP and 20 age-matched and sex-matched normal controls. Results Our results revealed that DNMT3B-46359 C/T heterotype was higher in patients than in controls but did not reach statistical significance and conferred 2.2-fold increased risk for ITP (odds ratio=2.2, confidence interval = 1.4–2.6). There was no statistically significant difference between ITP patients and controls as regards allele frequency. Moreover, there was no statistically significant difference in the clinical and laboratory data between ITP patients with wild or mutant genotypes. Moreover, there was no statistically significant difference in the distribution of DNMT3B-46359 . C/T genotypes between acute and chronic ITP patients. Conclusion This genetic polymorphism cannot be considered as a molecular marker for ITP risk among Egyptian children. Moreover, it is not a molecular predictor for chronicity.
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The prognostic role of chemokine ligand-3 in chronic lymphocytic leukemia
Fetnat M Tolbah, Howayda M Kamal, Mona M El-behisy, Yasmin N El-Sakhawy, Shaimaa Abd-El Latif
July-September 2016, 41(3):128-131
DOI:10.4103/1110-1067.196196  
Introduction Chemokines are responsible for dissemination and survival of many malignant tumors including chronic lymphocytic leukemia (CLL). Chemokine ligand-3 (CCL3), previously known as macrophage inflammatory protein-1a, has been found to be secreted from CLL cells in response to B-cell receptor activation, enhancing the interaction between CLL cells and the leukemia microenvironment. In the present study, we measured CCL3 serum levels by using the enzyme-linked immunosorbent assay in 40 CLL patients and examined CCL3 levels for associations with established prognostic markers. A significant increase in the serum level of CCL3 in CLL patients (mean=147.2±62.3?pg/ml) was found in comparison with normal healthy controls (8.2±23.7?pg/ml); in addition, this increase in the CLL serum levels was significantly correlated with established prognostic factors as CD38 and the advanced stages of Rai and Binet staging system. Conclusion CCL3 serum level could be a valuable and independent prognostic marker and should be useful in risk assessment in patients with CLL, and it may provide insights into creating a new therapeutic modality.
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Interleukin-17 and interleukin-27 in newly diagnosed multiple myeloma patients: interrelationship and correlation with leukocyte differential counts
Mervat A Al-Feky, Rasha A El-Gamal, Ghada M El Gohary, Gihan M Kamal
July-September 2016, 41(3):132-139
DOI:10.4103/1110-1067.196216  
Objectives Efforts to uncover factors affecting multiple myeloma (MM) prognosis are unremitting. Recently, white blood cells differential (WBCD) counts were reported to affect MM prognosis. Cytokines, including interleukin-17 (IL-17) and IL-27, are known to influence the bone marrow microenvironment. The interrelation between both cytokines in previous studies is conflicting and their correlations to WBCD have not been investigated in MM. Our aim was to study the relationship between IL-17 and IL-27 in newly diagnosed MM patients, and to investigate possible association with the newly introduced prognostic WBCD. Materials and methods Patients were classified according to the International Staging System (ISS). Plasma levels of IL-17 and IL-27 were assessed using the solid-phase sandwich enzyme-linked immunosorbent assay. Results IL-17 and IL-27 median values showed no significant difference between patients and healthy controls, and a significant positive correlation between both cytokines was observed (P=0.001). IL-17 was significantly higher in International Staging System stage III and morphologically group II patients. IL-17 was significantly correlated with various prognostic parameters. However, on using multivariate analysis, monoclonal immunoglobulin concentration and absolute lymphocyte count/absolute monocyte count ratio continued to be correlated with IL-17 (P=0.007; 0.009, respectively). IL-27 was positively correlated with monoclonal immunoglobulin (P=0.001), negatively correlated with absolute lymphocyte count (P<0.001), and its higher levels were associated with circulating plasma cells. Conclusion IL-17 and IL-27 were positively correlated and variably linked to prognostic markers of MM. Their relation to WBCD introduces an area of investigation as to assess its potential use in newer modalities of treatment.
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Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients
Soumia Zeggai, Noria Harir, Anfal Belkacem, Abdenacer Tou, Feriel Sellam, Nesrine M Mrabent, Rachida Salah
July-September 2016, 41(3):140-143
DOI:10.4103/1110-1067.196218  
Context Hodgkin's lymphoma is an uncommon disorder with heterogeneous clinical, histological, and epidemiological characteristics. Aims The aim of this study was to describe the epidemiological and histopathological characteristics in patients with Hodgkin's lymphoma in Western Algeria. Materials and methods Our retrospective descriptive study was conducted at the Departments of Haematology in Western Algerian hospitals over 11 years (2001–2011). Statistical analysis used SPSS 18.0 was used. Results A total of 526 patients were identified in our study. There were 273 male and 253 female patients, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years (range = 14–89 years), and most of the patients were young adults [20–29 years (38.2%)]. Nodular sclerosis was the most frequent histological type (51%), followed by mixed cellularity (26%); nodular sclerosis was more common among female patients, whereas mixed cellularity was more common among male patients compared with female patients. Staging classification of the disease indicated high frequency of early stage II, with 184 cases (35%). Conclusion Most of the patients were young adults with nodal lymphoma at an early stage of disease and a dominance of nodular sclerosis as the histological type. Further studies are required to determine the factors that play a major role in the etiology of this disease.
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Serum micronutrient levels and disease severity score in patients with sickle cell anaemia
Chide E Okocha, John C Aneke, Patrick O Manafa, Samuel C Nwogbo, Nancy C Ibeh, Christian E Onah
July-September 2016, 41(3):144-147
DOI:10.4103/1110-1067.196220  
Background Disease severity in patients with sickle cell anaemia (SCA) is accentuated by the risk for infection, which could potentially be influenced by serum levels of micronutrients, particularly those that are components of the antioxidant system of the body. Objective The aim of this study was to evaluate serum levels of the micronutrients zinc, copper, selenium and magnesium in our SCA patients and to compare these with the objective score of disease severity. Patients and methods Twenty-six confirmed (using cellulose acetate electrophoresis, in alkaline pH) homozygous sickle cell patients were prospectively recruited in steady-state conditions. Each participant had 8 ml of venous blood collected for haemoglobin electrophoresis and determination of serum levels of the micronutrients zinc, copper, selenium and magnesium (using atomic absorption spectrophotometry). The objective score of disease severity was calculated as previously described and correlated with serum micronutrient levels using the Pearson's linear regression for bivariate correlation. A P value less than 0.05 was taken as significant. Ethical approval was obtained from the institutional review board and each participant gave informed consent. Results The mean age of study participants was 21.58 ± 9.58 years, and the mean serum level of selenium, copper, magnesium and zinc was 0.60 ± 0.29, 0.13 ± 0.07, 8.76 ± 1.14, and 0.40 ± 0.14 mg/l, respectively. Serum copper was significantly correlated with disease severity score (r = 0.61, P = 0.001), whereas no significant correlation was observed between disease severity score and other micronutrients. Conclusion Serum copper level has the potential to become a surrogate marker of disease severity in steady-state SCA patients.
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