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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 45 | Issue 3
Page Nos. 121-159

Online since Wednesday, June 23, 2021

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ORIGINAL ARTICLES  

GRAF gene expression in patients with acute and chronic myeloid leukaemia: impact on the prognosis p. 121
Fetnat M Tolbaa, Safia M Diab, Doaa M El-Ghanam, Ghada M Mahmoud, Deena A El-Shabrawy
DOI:10.4103/ejh.ejh_31_17  
Objective We aimed to assess the expression level of GRAF gene in patients with acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) and to clarify its prognosticsignificance on the clinical outcome. Background GTPase regulator associated with focal adhesion kinase (GRAF) is a newly identified protein specifically binding to focal adhesion kinase and negatively regulates the small GTP-binding protein RhoA, which is well known for its growth-promoting effect in RAS-mediated malignant transformation. GRAF is recognized as a tumor suppressor gene that binds to focal adhesion kinase. Methods In this study, we investigated the expression of the GRAF transcript by realtime quantitative PCR in 37 AML patients, 35 CML patients and 15 healthy and sex-matched controls, and to clarify its prognostic significance on the clinical outcome. Results We found that the GRAF expression is low in patients with AML and CML. A high GRAF expression is a favorable prognostic marker in patients with AML and CML. In AML, high GRAF transcript. Conclusion High GRAF expression is a favorable prognostic marker in AML patients and a protective factor against CML progression.
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Glucocorticoid-induced hyperglycemia in oncohematological patients p. 129
Hosameldeen S Shabana, Mahmoud Bazeed, Hala Nayel, Mamdouh Attia, Mohammed Elwan
DOI:10.4103/ejh.ejh_63_19  
Background Glucocorticoids are a common component of systemic chemotherapy regimens for hematological malignancy. Steroid-induced hyperglycemia remains a common potentially harmful problem that must be considered when using any type of glucocorticoids. Little is known about the impact of hyperglycemia associated with steroid use on treatment morbidity, infectious complications, as well as disease remission and mortality. Objective The aim of the current work is to study glucocorticoid-induced hyperglycemia in patients with hematologic malignancies receiving repeated short-term pulse cycles of glucocorticoids (5–7 days), to estimate its prevalence, to define the risk factors, and to assess treatment response. Patients and methods The prospective study included 30 adult patients with acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia attending the outpatient clinic of Al Hussein Hospital, Al Azhar University during the period between November 2015 and April 2016. During the period of the study, 30 patients received a total of 60 cycles of chemotherapy including corticosteroid. Results Out of the 30 study patients, 15 (50%) were men and 15 (50%) were women with a mean age of 44.17. Corticosteroid-induced hyperglycemia was documented in 12 patients after one or more than one cycle (12/30–40%). Among the 60 cycles, corticosteroid-induced hyperglycemia was documented after 19 cycles (19/60–31%). The age of the patient was found to be the most important factor that affected the occurrence of hyperglycemia after corticosteroid where younger patients were less likely to develop hyperglycemia (P=0.013). Patients with BMI less than or equal to 25 had the lowest chance to develop hyperglycemia after corticosteroid. However, this difference was not statistically significant. The three patients who developed persistent hyperglycemia received hypoglycemic medications. Conclusion About one-third of patients with hematological malignancies receiving glucocorticoids may develop hyperglycemia. To allow for early detection and effective treatment, these patients should be screened for hyperglycemia at least before each cycle and 4–6 h after glucocorticoids intake, especially old obese patients Appropriate guidelines for the diagnosis and treatment of steroid-induced diabetes are needed in order to prevent complications associated with the hyperglycemic state
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Protein Z measurement in acute myeloid leukemia patients p. 136
Haydi S Mohamed, Hany M Hegab, Mostafa K El-Razzaz
DOI:10.4103/ejh.ejh_58_19  
Background Protein Z (PZ) is a vitamin K-dependent plasma protein. The role of PZ in the pathogenesis of hemostatic disorders remains to be established. However, a significant association was found between low PZ levels and arterial vascular diseases, pregnancy complications and disseminated intravascular coagulation, stroke and antiphospholipid syndrome. On the other hand, it has been suggested that PZ deficiency is associated with hemorrhagic disorders, perhaps related to capillary fragility. Aim Measurement of the level of PZ in newly diagnosed acute myeloid leukemia (AML) patients and correlate it with bleeding tendency or thrombosis. Patients and methods This study was held on 90 participants divided into 60 adult (AML) patients and 30 healthy controls of matched age and sex from the Internal Medicine Department, Ain Shams University Hospital. Enzyme-linked immunosorbent assay kits are used for the estimation of PZ levels after taking informed consent. Results A low level of PZ was detected in AML patients compared with controls (P<0.001). A statistical correlation was observed between bleeding attacks and PZ level (P=0.008). The best cutoff value for PZ as a predictor for bleeding was more than 350 ng/l by the receiver operating characteristic curve. Conclusion Low PZ level is a cofactor of bleeding in AML patients.
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Ocular manifestations in SCD patients: role of fundus fluorescein angiography in the detection of sickle retinopathy p. 142
Nayera H Elsherif, Mahmoud A Kenny, Mohamed I Saleh, Waheed S Elhalfawy
DOI:10.4103/ejh.ejh_12_20  
Background Sickle cell retinopathy comprises a constellation of abnormal signs in the retinas of patients with sickle cell disease (SCD). The aim was to detect ophthalmological complications in patients with SCD, particularly macular microvascular alteration, using fundus fluorescein angiography (FFA), and to assess the role of potentially contributory clinicopathological factors including transcranial Doppler, genotypes, hydroxyurea, transfusion therapy, and finally, iron overload state on the development of sickle eye. Patients and methods This cross-sectional study included 30 patients with SCD randomly recruited from the Paediatric Haematology Clinic of Ain Shams University Children’s Hospital, Cairo, Egypt. Complete blood count, transcranial Doppler, and FFA were done. Results Of 30 patients, five had abnormal/conditional transcranial results. The FFA finding was normal in 60 eyes (all 30 SCD patients), and only one patient had abnormal visual acuity. This was a 29-year-old girl who was on simple blood transfusion and hydroxyurea treatment for recurrent cerebral strokes and vaso-occlusive crises, yet her FFA finding was normal. Conclusion The authors could not demonstrate any retinal microvascular alternations using FFA among patients with SCD. The authors related the results to their young age and the fact that all were on hydroxyurea therapy with fair compliance. Further studies using a large sample size are warranted to illustrate the utility of FFA as a tool for early detection of sickle retinopathy.
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Characteristics of extranodal classic Hodgkin lymphoma: a retrospective analysis of 175 patients p. 148
Shaimaa El-Ashwah, Maryan W Fahmi, Adel El-Badrawy
DOI:10.4103/ejh.ejh_9_20  
Aim To find out the characteristics of extranodal classical Hodgkin lymphoma (cHL). Patients and methods A retrospective analysis was done on 175 patients with cHL who attended the Oncology Center of Mansoura University from January 1, 2008 to May 31, 2016, with a median follow-up of 2.93 years (range, 0.05–10.2 years). Results One (0.6%) patient was diagnosed with primary extranodal cHL and 48 (27.4%) patients had secondary extranodal cHL. Liver (25.3%), lung (24.1%), and the bone (20.3%) were the most frequent extranodal sites. A total of 27 (55.1%) patients had one extranodal site, 16 (32.7%) patients had two extranodal sites, and six (12.2%) patients had more than or equal to three sites. Overall, 42 (85.71%) patients with extranodal sites were less than 45 years old (P=0.019), 15 (30.6%) had splenic involvement (P=0.003), 39 (79.6%) patients had absolute monocyte count /absolute lymphocyte count (monocyte-lymphocytes ratio) more than or equal to 0.305 (P<0.001), 36 (73.47%) patients had International Prognostic Score more than or equal to 3 (P<0.001), 23 (46.9%) patients achieved complete response, and 10 (20.4%) patients achieved partial response. In univariate analysis, extranodal disease was associated with inferior disease-free survival and overall survival (P=0.037 and 0.001, respectively), but it lost its significance using multivariate analysis (P=0.12 and 0.54, respectively). Conclusion Most of the extranodal cHL cases were secondary (97.96%) and significantly associated with unfavorable clinical features and lower response rate to standard treatment. To our knowledge, this is the first study to demonstrate that extranodal cHL is statistically associated with elevated monocyte-lymphocytes ratio.
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Serum and salivary ferritin levels in iron-deficiency anemia − is there a difference? p. 156
Amr M Gawaly, Abd A.Y El-Naby, Ghada M Alghazaly
DOI:10.4103/ejh.ejh_23_20  
Introduction Iron-deficiency anemia (IDA) is one of the most important nutritional deficiencies in Egypt. The assessment of serum ferritin has been the gold standard method in the detection of this disease However, this involves the drawing of venous blood, which is invasive and is sometimes physically and psychologically traumatic to the patients, and sometimes it is difficult to withdraw blood from hidden veins. This study was done to estimate and correlate serum ferritin levels and saliva ferritin levels of patients with IDA, thus assessing the effectiveness of saliva as an alternative noninvasive diagnostic tool. This study was done to estimate, compare, and correlate the ferritin levels in serum and saliva of patients with IDA, to determine whether saliva can be used as a predictive marker to monitor the iron levels in IDA. Patients and methods A total of 60 patients with IDA and 20 healthy participants as control were chosen for the study. Quantitative estimation of serum and salivary ferritin levels was performed by solid-phase ELISA. Hemoglobin levels were also estimated to confirm the anemic status of the patient. Data were statistically analyzed using SPSS software version 19. Results There was increased salivary ferritin level in patients with IDA. A negative significant correlation was found between serum hemoglobin and both salivary ferritin level and salivary/serum ferritin ratio, and a significant negative correlation between serum and salivary ferritin levels. Conclusion Salivary ferritin is a noninvasive method for the detection of IDA with a good predictive effect.
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