Cyclooxygenase-2 expression as a prognostic factor in pediatric classical Hodgkin lymphoma

PURPOSE

Cyclooxygenase-2 (COX-2) is an inflammation-related enzyme that has been shown to have a role in tumor initiation, angiogenesis, and proliferation. It has been demonstrated that COX-2 expression is increased in many tumors and is a negative prognostic parameter. Our objective is to investigate the prognostic value of COX-2 expression in pediatric patients with classical Hodgkin lymphoma (CHL).

METHODS

This was a retrospective analysis in pediatric patients (n = 127) diagnosed with CHL and treated at the pediatric oncology department, National Cancer Institute, Cairo University, January 2005-June 2013. We correlated COX-2 immunostaining in Reed-Sternberg (RS) cells with clinical variables and outcome.

RESULTS

COX-2 was expressed on 38.6% of RS cells. The median follow-up time was 48.4 months (range 4-114 months). The 5-year OS and PFS, in COX-2(+ve) versus COX-2(-ve) was 85.3% versus 96.0% (p = 0.248) and 78.6% versus 84.3% (p = 0.354), respectively. A multivariate analysis showed that COX-2(+ve) was not significantly associated with the 5-year OS (HR = 2.9; 95% CI 0.7-12.4, p = 0.149) or with the 5-year PFS (HR = 1.4; 95% CI 0.6-3.2, p = 0.490). High-risk patients in the COX-2(+ve) group had a significantly lower 5-year OS (p = 0.021). The 5-year PFS was significantly lower in the COX-2(+ve) group with B symptoms (p = 0.023) and bulky disease (p = 0.028). Radiotherapy was given only to high-risk patients; survival was much better in radiation-treated children in both the Cox-2(+ve) and Cox-2(-ve) groups. The magnitude of the radiotherapy effect was also greater in the Cox-2(+ve) group, but this difference was not statistically significant.

CONCLUSION

COX-2 expression showed a tendency to be a poor prognostic factor, but it failed to provide meaningful independent information. Further larger studies are needed to investigate COX-2 as a prognostic factor and potential therapeutic target.

P211 Short term impact of hemodialysis on right ventricular systolic function and pulmonary artery pressure in patients with end stage renal disease

Introduction

Chronic kidney disease (CKD) is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the most common complication and a chief cause of death in patients with end stage renal disease (ESRD) accounting for 45% to 50% of causes of death in ESRD patient. Pulmonary hypertension (PH) occurs frequently in patients with CKD. The role of hemodialysis in reducing pulmonary artery pressure (PAP) and improving RV systolic function in not properly studied.

Purpose

To evaluate the effect of hemodialysis on Right ventricular (RV) systolic function and Pulmonary artery pressures using echocardiography in newly diagnosed end stage renal disease patients and after three months of regular hemodialysis.

Patients and Methods

30 patients recently diagnosed to have ESRD were enrolled and were followed up after three months. Trans-thoracic echocardiography was done prior to the first dialysis session and after three months of regular hemodialysis to asses RV systolic function and PAP.

Results

There was a significant improvement of RV systolic function assessed by trans-annular plane systolic excursion (TAPSE)(mm)(pre dialysis 18.9 ± 3.76, post 21.56 ±3.51, p <0.01), fractional area change (FAC)(%)(pre dialysis 41.27 ± 8.9, post 47.5 ± 6.1, p < 0.01),tricuspid lateral annular systolic velocity (S’)(cm/s) (pre dialysis 12.3 ± 2.79, post 14.16 ± 2.3, p < 0.01),myocardial performance index (MPI)(pre dialysis 0.2 ± 0.1, post 0.1 ± 0.1, p < 0.01)and right ventricular outflow tract fractional shortening (RVOT-FS)(%)(pre dialysis 36.5 ± 9.5, post 39.3 ± 8.6, p < 0.01)post dialysis (P value <0.01). All parameters of assessing pulmonary artery pressures; systolic pulmonary artery pressure (PASP)(mmHg)(pre dialysis 48.03 ± 17.16, post 35.12 ± 14.73, p < 0.01), pulmonary diastolic artery pressure (PADP)(mmHg)(pre dialysis 24.05 ± 9.7, post 18.12 ± 9.64, p < 0.01), mean pulmonary artery pressure (MPAP)(mmHg) (pre dialysis 35.61 ± 15.07, post 25.8 ± 12.06, p < 0.01), pulmonary capillary wedge pressure (PCWP)((pre dialysis 23.28 ± 8.74, post 17.39 ± 5.87, p < 0.01) and pulmonary vascular resistance (PVR)(Wood unit)(pre dialysis 1.89 ± 0.57, post 1.43 ± 0.46, p < 0.01) improved significantly post dialysis (P value <0.01).There was a significant inverse correlation between the duration of renal impairment and the improvement in SPAP and PCWP after the initiation of dialysis (P values are 0.021 and 0.015, Correlation co-efficient -0.421, -0.441 respectively). The best cut-off value for weight reductionduring dialysis for prediction of improvement of SPAP is 2.75 Kg (AUC = 0.950, CI = 0.881-1.000, P value < 0.01).

Conclusions

The present study shows that significant improvement occurred in all RV systolic function parameters and all parameters of assessing pulmonary artery pressures post dialysis in patients recently diagnosed to have ESRD. RVOT FS is a reliable method for assessing RV function and it is significantly correlated only with TAPSE and FAC at the baseline before dialysis.

Seroprevalence of equine herpes virus-1 in endemic area of Egypt with risk factors assessment

Although equine herpesvirus-1 (EHV-1) infection occurs throughout the world; causing various health problems within horse population such as respiratory disease, abortion and myeloencephalopathy, there is information shortage concerning the epidemiological situation of EHVs in Egypt. This paper is the first study of EHV-1 prevalence rate in Monufia province (as a model for other pro­vinces). During 2015, two hundred and seventy serum samples from EHV non-vaccinated horses were randomly collected from 9 centres of Monufia province. The indirect ELISA was used to detect the prevalence rate of the disease while assessment of the associated risk factors was conducted using univariate and multivariate logistic regression models. The results showed that EHV-1 infection was widespread among horses at Monufia province (apparent prevalence rate 64% and true prevalence rate 28%) and posed risk for the health of other equines in the region. Results of risk factors identification showed that horses > 5 years of age were at significant risk of getting EHV-1 infection than < 1-year-old horses (OR: 5; P<0.02), while males were twice more prone than females of getting the EHV-1 infection (OR: 2 and P<0.03). There was a significant effect of different localities on the prevalence of EHV-1 infection. The obtained results could be extrapolated to the different districts and governorates of Egypt because of the similarity of the husbandry system of equines all over Egypt.

Efficacy and safety of a new intravenous immunoglobulin (Panzyga® ) in chronic immune thrombocytopenia

Objectives

To assess the efficacy and safety of intravenous immunoglobulin (IVIG) 10% (Panzyga^®), a novel human normal IVIG 10%, in patients with chronic immune thrombocytopenia (ITP).

Background

First‐line treatment options in ITP include IVIGs.

Methods

In this prospective, open‐label, non‐controlled, multicentre, phase III study, patients received a daily dose of IVIG 10% (1 g kg⁻¹ body weight) for two consecutive days. The primary end point was clinical response rate; secondary end points included alternate response definitions, time to response, response duration, platelet counts, regression of bleeding and safety.

Results

Forty patients were enrolled (57·5% male, mean age 36·7 years); the full analysis set comprised 36 patients. A clinical response was seen for 29 of 36 patients (80·6%). Median time to response and response duration was 2 days and 14 days, respectively. IVIG 10% was well tolerated at a maximum infusion rate of 8 mg (kg min)⁻¹ in all but one patient; adverse events were mainly mild to moderate in severity, and the most frequent was headache (42·5%).

Conclusion

IVIG 10% is well tolerated even at a high infusion speed and induces a rapid platelet count increase, thus decreasing the bleeding rate and the severity of bleeding events.

Trial registry: http://ClinicalTrials.gov record: NCT01349790.

Malignant renal obstruction without dilatation

A 61 year old male presented with a one-week history of abdominal pain and loose stools. He had recently received treatment for cellulitis with flucloxacillin. He was anuric on presentation requiring haemodialysis. His ultrasound scan showed patent vessels with no signs of obstruction. A kidney biopsy revealed tubulointerstitial nephritis, attributed to recent treatment with flucloxacillin. A week later he developed lower limb thromboembolic disease triggering further investigations. A FDG PET-CT scan revealed a large FDG-avid retroperitoneal mass causing non-dilated obstruction of both kidneys. Bilateral retrograde stents were inserted which resulted in a 1.6L diuresis and cessation of haemodialysis. Non-dilated obstruction should be considered in anuric AKI, particularly in the context of malignancy, and may require a therapeutic trial of decompression.

IL-28B rs12979860 polymorphism affect the course of chronic hepatitis and the development of HCC in Egyptian patients with hepatitis C type 4

BACKGROUND

A single nucleotide polymorphism (SNP) in the interleukin 28B (IL28B) gene may alter the trajectory of hepatitis C virus (HCV) chronic infection. Several studies have sought to determine a link between IL28B rs12979860 SNP and the development of HCV-related hepatocellular carcinoma (HCC), but with variable results, and consensus is awaited. We hypothesised that IL28B rs12979860 SNP is linked to HCC in patients with HCV type 4.

METHODS

IL28B genotyping of 300 patients with HCV-related fibrosis (n = 100), cirrhosis (n = 100) and HCC (n = 100) was carried out and the results were analysed to determine the association between the IL28B genotype and clinical outcome.

RESULTS

In IL28B TT genotype carriers, the proportions of moderate/severe fibrosis, advanced cirrhosis (Child B-C) and HCC (50%, 84% and 60.2%, respectively) were higher (p < 0.05) than in CC/CT (4.3%, 46% and 23%, respectively). IL-28B SNP was linked significantly (p < 0.05) with cirrhosis progression and HCC advanced stages. Moreover, HCC advanced Child, Okuda and CLIP stages were associated with T allele carriage (73.9%, 82.6% and 78.3% vs. 44.2%, 50.6% and 46.8% in CC/CT). The percentage of large tumour size (> 3cm) increased (p = 0.028) in TT genotype carriers (81.8% vs.52.6% in CC/CT).

CONCLUSION

IL-28B rs12979860 TT genotype is more prevalent in patients with advanced fibrosis, cirrhosis and HCC stages. Thus, it seems to be associated with poor outcomes in chronic HCV patients and to augment the risk of developing HCC.

Distinct recovery of copper and aluminum from waste electric wires using a roll-type electrostatic separator

Electrostatic separators are commonly employed for the sorting of insulating and conducting fractions of granular mixtures. However, separation of the various metals that compose the conductive fraction still represents a major challenge for the recycling industry. The aim of this paper is to identify the conditions in which a roll-type electrostatic separator could be used for distinctly recover the copper and aluminum from waste electric wires. A numerical model of particle trajectories was employed to predefine these conditions and guide the experimental study. The electrostatic separation experiments were carried out using a reverse-S-type-plate high-voltage electrode. The visualization of particle trajectories using a high-speed camera paved the way to an original design. Thus, a metallic trap was attached to the high-voltage electrode, to facilitate the collection of the aluminum flake-like particles from a mixture that also contains copper strands. With a plastic trap replacing the metallic one, to avoid electric field modification, 68.6% of the copper was recovered with a purity attaining 99%.

127 L-Carnitine Supplementation During In Vitro Maturation Improves Developmental Competence of Canine Oocytes

In vitro embryo production (IVP) in the domestic bitch is important for conservation of endangered canids. Compared with various domestic animals, the development of assisted reproductive technologies (ART) in the dog has lagged behind, mainly due to the low percentage of oocytes that can reach metaphase II (MII) stage after in vitro maturation (IVM). Beneficial effects of l-carnitine (LC) on embryonic development in culture have been reported in many mammalian species; however, no studies have been conducted in dogs. The aim of the present study was to investigate the effect of LC supplementation during IVM of canine oocytes on nuclear maturation, fertilization status, and pre-implantation development following IVM/IVF. Cumulus-oocyte complexes (COC) were collected by slicing ovaries obtained from dogs (n = 20, 1 to 6 years of age) after ovariohysterectomy. The COC were subjected to IVM for 72 h in a medium (TCM-199) supplemented with LC at different concentrations (0.1, 0.3, 0.6, 1.0, or 2.0 mg mL−1) or without LC supplements (0 mg mL−1; control). Matured oocytes were fertilized in vitro with frozen–thawed spermatozoa, and presumptive zygotes were cultured in SOF medium for 7 days. Frequencies of nuclear maturation (72 h post-IVM), fertilization rates (18 h post-insemination), and embryo development (Days 2 to 5 post-insemination) were evaluated. Data were analysed by one-way ANOVA followed by Tukey’s multiple comparisons test. Supplementation of IVM medium with 0.3 or 0.6 mg mL−1 LC significantly improved (P ≤ 0.05) maturation (35.4% and 41.4%) and fertilization (21.3% and 25.8%) rates compared with the controls and with other LC-supplemented groups; values ranged from 20.1% to 25.0% for maturation and from 12.1% to 14.6% for fertilization. Cleavage (2- to 16-cell stages) was significantly higher (P ≤ 0.05) in the 0.6 mg mL−1 LC supplemented group than the 0.3 mg mL−1 supplemented group (16.3% v. 13.3%). These values were significantly higher (P ≤ 0.05) than those in other groups. Interestingly, 4.5% of IVM/IVF oocytes were developed to morula in 0.6 mg mL−1 LC supplemented group which was significantly higher (P ≤ 0.05) than those developed in the 0.3 mg mL−1 supplemented group (1.0%). No embryos developed beyond the 2- to 16-cell stage in the rest of the groups. In conclusion, l-carnitine supplementation during IVM is particularly efficient in improving nuclear maturation and pre-implantation embryo development of canine oocytes after IVF. These outcomes are important for the improvement of IVM conditions that can advance the efficiency of ART in dogs.

Präoperative Identifikation von Patienten mit (primären) Hämostasestörungen

Wir präsentieren eine große prospektive Untersuchung, in der vor großen elektiven operativen Eingriffen nach Hämostasestörungen ein Screening erfolgte. 5649 erwachsene, nicht selektierte Patienten (2631 Frauen, 3018 Männer) wurden über ein Jahr im Universitätsklinikum Charité untersucht. Ein standardisierter Fragebogen mit 12 Fragen wurde benutzt. Des Weiteren wurden die plasmatischen Routinegerinnungstests (aPTT, PT) mit der Thrombozytenzählung und die In-vitro-Verschlusszeiten (PFA 100: Kollagen- Epinephrin, Kollagen-ADP) gemessen. Wenn die Blutungsanamnese positiv (eine Frage positiv beantwortet) war, wurden folgende Screening-Tests zusätzlich durchgeführt: In-vivo-Blutungszeit (Surgicutt), von-Willebrand- Faktor (VWF : Ag, VWF : Rcof) und weiterführende hämostaseologische Differenzialdiagnostik. Ergebnisse: Die Blutungsanamnese war negativ bei 5021 Patienten (88,8%) und positiv bzw. enthielt einen Hinweis auf Medikamente, die eine Hämostasestörung induzieren können, bei 628 Patienten (11,2%). Hämostasestörungen wurden bei 256 (40,8%) in dieser letzten Patientengruppe gefunden. Die meisten der Patienten mit Hämostasestörungen wurden mit dem PFA-100: C/E (n=250; 97,7%) identifiziert. Die Sensitivität des PFA-100: Kollagen-Epinephrin war am höchsten (90,8%) im Vergleich zu anderen Screeningtests (BT, aPTT, PT, VWF : Ag). Der positive Vorhersagewert (zu Erkennung von Hämostasestörungen) des PFA-100: Kollagen- Epinephrin mit der standardisierten Blutungsanamnese war hoch (82%), aber der negative war mit 93% höher. Schlussfolgerungen: Primäre Hämostasestörungen treten häufiger als plasmatische Hämostasestörungen auf. Ein standardisierter Fragebogen zur Blutungsanamnese und, sofern indiziert, der PFA-100: Kollagen-Epinephrin und/ oder weitere spezifische Tests können zu einer signifikanten Reduktion der Kosten bei einer hohen Identifikationssrate von vorwiegend primären Hämostasestörungen führen. Nationale Empfehlungen sind bereits formuliert.

Significance of assay of nucleated RBCs in umbilical cord blood in neonates with meconium-stained amniotic fluid

BACKGROUND

Approximately 8-15% of all infants are born with evidence of meconium-stained amniotic fluid (MSAF). MSAF is a potentially serious sign of fetal compromise and may indicate fetal hypoxia Objectives and aim of the work: The present study was designed to evaluate the relationship between meconium stained amniotic fluid and fetal nucleated red blood cell counts. As well, we aim to evaluate the relationship between the presence of meconium in amniotic fluid and Apgar scores in neonates.

SUBJECTS AND METHODS

A prospectively case-controlled study was performed on 40 women with clear amniotic fluid as control and 40 women with meconium-stained amniotic fluid as the study group. At delivery, 2 ml of umbilical cord blood was collected and analyzed for nucleated red blood cell (NRBC).

RESULTS

The mean NRBC counts in meconium-stained amniotic fluid was significantly higher than the control group (18.35 ± 7.7 and 9.6 ± 4.96), respectively (p < .001). There were statistically significant differences concerning 1- and 5-min Apgar scores with lower values in the MSAF group (p < .001 and .001, respectively).

CONCLUSION

Our results support previous studies which indicate the presence of meconium can be associated with chronic fetal hypoxia as demonstrated by elevated fetal NRBC levels.

Decrease of blood anti-α1,3 Galactose Abs levels in multiple sclerosis (MS) and clinically isolated syndrome (CIS) patients

The etiology of multiple sclerosis (MS) remains elusive. Among the possible causes, the increase of anti-Neu5Gc antibodies during EBV primo-infection of Infectious mononucleosis (IMN) may damage the integrity of the blood-brain barrier facilitating the transfer of EBV-infected B cells and anti-EBV T cell clones in the brain. We investigated the change in titers of anti-Neu5Gc and anti-α1,3 Galactose antibodies in 49 IMN, in 76 MS, and 73 clinically isolated syndrome (CIS) patients, as well as age/gender-matched healthy individuals. Anti-Gal and anti-Neu5Gc are significantly increased during IMN (p=0.02 and p<1.10^-4 respectively), but not in acute CMV primo-infection. We show that, whereas there was no change in anti-Neu5Gc in MS/CIS, the two populations exhibit a significant decrease in anti-Gal (combined p=2.7.10^-3), in contrast with patients with non-MS/CIS central nervous system pathologies. Since anti-Gal result from an immunization against α1,3 Gal, lacking in humans but produced in the gut, our data suggest that CIS and MS patients have an altered microbiota or an altered response to this microbiotic epitope.

Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

OBJECTIVES

To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.

METHODS

This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.

RESULTS

This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.

CONCLUSIONS

It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Report of a Patient With Heparin-induced Thrombocytopenia Type II Associated With IgA Antibodies Only

Heparin-induced thrombocytopenia type II (HIT II) is usually mediated by immunoglobulin G (IgG) antibodies that lead to platelet activation via the FcγIIA-receptor. Here we describe a patient who developed HIT II after aortocoronary bypass surgery. His serum contained an antibody that was detectable by the heparin-induced platelet activation assay (HIPA) and by the ID-HPF4 particle agglutination assay. The flow cytometric analysis showed that the antibody was of the IgA class.

A case series of the effects of a novel composition of a traditional natural preparation for the treatment of psoriasis

The objective of this study was to assess the effectiveness of a specific composition of a traditional herbal preparation (DurrDerma) in adult patients with moderate to severe skin psoriasis. The preparation is a newly developed topical combination containing plant-based extracts traditionally used in skin disease as black cumin, olive oil, tea tree oil, cocoa butter completed by vitamin A and vitamin B12. We documented the effectiveness of the preparation in a first case series. A total of 12 patients (8 males and 4 females, 21–86 y) with manifest and treatment-resistant psoriasis were included and treated for 12 weeks. All patients were assigned to twice-daily treatment with the DurrDerma preparation. Treatment success as determined by the Psoriasis Area and Severity Index (PASI) score, the body surface area, and the dermatology life index was achieved (PASI reduction of >75%) in 10 of the 12 treated patients (83%). The remaining two patients showed a PASI reduction of ≤50%. In 5 of the patients PASI reduction was achieved <12 weeks (between week 3–11). The beneficial effect in responder patients might be explained by a synergistic anti-oxidative and anti inflammatory activity of all components present in DurrDerma. We conclude that the new preparation using a traditional approach seems to be a promising complementary treatment for psoriasis.