Acute myeloid leukemia with unreported translocation (x; 3) (q24; p13): A case report

Key Clinical Message

Novel and rare chromosomal aberrations in AML are important to understand, particularly if associated with tumorigenesis and how they contribute to prognostic risk. It is important that acute leukemia be treated right away. Herein, novel (x; 3) (q24; p13) is described.

Abstract

Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. It is the most common type of acute leukemia in adults. This type of cancer usually gets worse quickly if it is not treated. Here, we report an unusual case of AML with an unreported translocation associated with AML.

Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial

PURPOSE

Neutropenic fever remains a major complication in acute leukemia. Decolonization is assumed as a promising intervention for eradicating causative agents of infection.

METHODS

In this randomized clinical trial, 96 patients with acute leukemia were assigned randomly to mupirocin nasal drop 2% (n = 32), chlorhexidine mouthwash 0.2% (n = 33), and control group (n = 31). In control group, patients did not receive any medication for decolonization. All patients received treatment for 5 days (2 days prior to chemotherapy until 3 days after chemotherapy). Pharynx and nasal swabs were taken prior to the intervention and at the end of decolonization period in all groups. Antibiotic susceptibility testing was performed by the disc diffusion method in order to identify bacterial isolates.

RESULTS

Bacterial recovery of both nasal and pharynx swabs was observed after global decolonization with mupirocin nasal drop. Decolonization with mupirocin significantly eradicated Coagulase-negative staphylococci (CONS) in both nasal and pharynx swabs (p-value = 0.000). Moreover, mupirocin decreased Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) species. Chlorhexidine mouthwash significantly eradicated CONS in pharynx swabs (p-value = 0.000). In addition, both decolonization strategies decreased both antibiotic use and frequency of fever in leukemic patients.

CONCLUSION

Global decolonization with mupirocin nasal drop not only eradicates both nasal and pharynx microorganisms, but also reduces antibiotic requirement and frequency of fever in patients with acute leukemia. The protocol of the present study was approved on December 2016 (registry number: IRCT20160310026998N6).

Delayed presentation of vincristine extravasation

INTRODUCTION

Vincristine is a vesicant chemotherapeutic agent which may leak from the vessel at the infusion site to the perivascular tissue and cause extravasation. Extravasation, a severe complication of chemotherapeutic drugs, can result in tissue necrosis that is considered an oncological emergency.

CASE REPORT

We aimed to report a case of a 29-year-old woman with ALL-B cell (Acute lymphoblastic leukemia) on maintenance chemotherapy regimen including vincristine, methotrexate, prednisolone, and 6-mercaptopurine (POMP). 48 h after administering intravenous vincristine, the patient experienced burning, pain and tenderness at the injection site (left hand - cubital cavity).

MANAGEMENT & OUTCOME

7 days after the onset of symptoms, the patient was hospitalized with a large brown lesion at the site. She was prescribed betamethasone cream, DSMO (Dimethyl sulfoxide) solution, and oral levofloxacin on his second day after admission. The lesion was completely improved 10 days after initiation of therapy and there were no serious problems.

DISCUSSION

Due to the ineffectiveness of antidote therapy for the management of delayed extravasation of vincristine and beneficial effect of our clinical approach, it could consider for the management of similar cases with delayed extravasation following vincristine administration.

Prostate cancer in omics era

Recent advances in omics technology have prompted extraordinary attempts to define the molecular changes underlying the onset and progression of a variety of complex human diseases, including cancer. Since the advent of sequencing technology, cancer biology has become increasingly reliant on the generation and integration of data generated at these levels. The availability of multi-omic data has transformed medicine and biology by enabling integrated systems-level approaches. Multivariate signatures are expected to play a role in cancer detection, screening, patient classification, assessment of treatment response, and biomarker identification. This review reports current findings and highlights a number of studies that are both novel and groundbreaking in their application of multi Omics to prostate cancer.

Clinical, pathological, and CT scan findings of multiple Coenurus cerebralis cysts in a non-native lamb in Iran

Coenurus cerebralis is the larval stage of Taenia multiceps which involves particularly the central nervous system of humans and ungulates. A six-month-old Charollais lamb was presented with cortical blindness, dullness, convulsion, head deviation, reluctancy to move, drooling of saliva and ataxia. Haematological findings revealed an inflammatory process. CSF analysis showed leukocytosis associated with increased total protein. By CT imaging, nine cysts were detected in the cerebrum and one in the cerebellum. Hounsfield units were below 10 in all these regions. CT images perfectly revealed multiple Coenurus cysts in various parts of the brain, which was confirmed by necropsy. At necropsy, cysts of variable size were noted at different anatomical sites of the brain. In the cerebrum, atrophy, liquefactive necrosis and mild demyelination were presenty adjacent to the cystic structures. Perivascular and perineuronal oedema, neuronal degeneration, hyperaemia and thrombosis were also seen in the cerebrum. The meninges revealed oedema, thrombosis, and mononuclear meningitis. Based on authors’ knowledge, this is the first study in Iran on Coenurus cysts in a lamb brain utilising CT scan

A rare case of coexistence of Wegener's granulomatosis and pulmonary tuberculosis with subsequent development of thrombosis of the cerebral veins

BACKGROUND

Granulomatosis with polyangiitis (GPA), also known as Wegener's granulomatosis, is an idiopathic systemic disease typically affecting the lungs, although other organs may also be involved.

CASE PRESENTATION

A 28-year-old male was admitted to Baqiyatallah university hospital in Teheran (Iran) after a 3-week history of fever and productive cough. The patient gradually developed fatigue, arthralgia, hematuria, nausea, vomiting, dyspnea, hemoptysis, weight loss, oliguria and then anuria. Chest-X-ray (CXR) and computerized tomography scan revealed cavitating nodular opacities in the right lung lobe. Furthermore, plasma creatinine increased from 2.2 to 4 mg/dl in a few days. Histopathological examination of kidney biopsy revealed peri-glomerular and peri-vascular inflammation, degeneration and necrosis of the tubular epithelial lining, red blood cell casts, distorted glomerular structure, fibrin thrombi, segmental breaks of the glomerular basal membrane, disruption of Bowman's capsular membrane and crescent formation of the affected glomeruli. An abnormal CXR, an abnormal urinary sediment and a typical kidney histology were used as criteria to diagnose glomerulonefritis with poliangiitis (GPA). Bronchoalveolar lavage smear and PCR turned out positive for mycobacterium tuberculosis. After 3 months of treatment for (GPA) and tuberculosis the patient developed headache and seizure. Cerebral Magnetic Resonance Venography revealed cerebral venous thrombosis of the sinus transverse and sigmoid.

CONCLUSIONS

Tuberculosis may coexist with GPA, as it occurred in our patient. Since a crescentic glomerulonephritis can progress to renal failure, clinicians should always be aware of potential multiple conditions when considering differential diagnoses.

Gastrointestinal cancers, ACE-2/TMPRSS2 expression and susceptibility to COVID-19

Recent studies on the pathophysiology of COVID-19 are indicating that the Angiotensin convertase enzyme 2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) can act as a major component in the fusion of SARS-Cov-2 with target cells. It has also been observed that the expression of ACE-2 and TMPRSS2 can be altered in malignancies. Shedding light on this matter could be crucial since the COVID-19 pandemic interfered with many gastrointestinal cancer screening programs. Herein we discuss the possibility of severe forms of COVID-19 in patients with gastrointestinal cancers due to the gastrointestinal entry route of SARS-CoV-2 into the human body. The disruption of cancer screening programs caused by the current COVID-19 pandemic could therefore have massive negative health impact on patients affected by gastrointestinal malignancies.

Isolated hyperbilirubinemia as the manifestation of acute liver failure in a patient with acute myelogenous leukemia and COVID-19 infection

Acute liver failure is a rare but catastrophic syndrome. Liver function tests usually reveal cholestatic or hepatocellular pattern, but in this case, we report a previously undescribed manifestation of this condition as isolated hyperbilirubinemia. Our patient was a 50 years old male who was diagnosed with acute myelogenous leukemia (AML(M4)). The patient had no history of liver disease and had normal liver function tests at the time of admission. After chemotherapy treatment, the patient developed signs of acute liver failure and had a rapid demise. After further investigations, we found two possible causes. Firstly, liver involvement of acute myelogenous leukemia (AML) which after induction chemotherapy is a rare condition and has high mortality rates despite treatment. Secondly, acute liver injury due to COVID-19 infection.

Complete resolve of primary cardiac sarcoma by chemotherapy: A case report

Primary cardiac tumors (PCT) are rare with high mortality rate and low survival. There are several treatment approaches in the PCT management. Complete surgical resection is the main base of treatment and there is disagreement on adjuvant chemotherapy or radiotherapy after surgical resection. In this case report, complete remission of the relapsed non-metastatic cardiac synovial sarcoma was observed after salvage chemotherapy and complete surgical resection.

Effect of non-alcoholic fatty liver disease on carotid artery intima-media thickness as a risk factor for atherosclerosis

AIM

This study aimed to evaluate the effect of NAFLD on CIMT as a risk factor for atherosclerosis.

BACKGROUND

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide due to rise of obesity and diabetes mellitus (DM) prevalence. Non-invasive assessment of carotid intima-media thickness (CIMT) by high-resolution carotid B-mode ultrasonography is widely used for determining the atherosclerosis.

PATIENTS AND METHODS

In this case-control setting, 151 subjects were categorized in three groups: group I including 49 patients with NAFLD and DM; group II including 50 non-diabetic NAFLD patients; and the control including 52 normal subjects as group III. The right and left CIMTs and its maximum reading (CIMTmax) were measured by a skilled sonographist blind to the groups. The sonographic grading of the NAFLD was determined in group I and II.

RESULTS

Median CIMTmax was significantly higher in group I comparing with group II and control group (p<0.001). This difference between group I and group II was not significant after adjusting for age and history of hypertension and hyperlipidemia (p=0.089). After controlling the confounders, there was statistical significant between group I and group II with the control group (p<0.05). There was no significant difference in median maximal thickness of intima-media in the carotid of group I compare to group II in patients with and without elevated liver enzymes (in both groups, 0.6 mm, p= 0.402).

CONCLUSION

Based on our findings, there is a significant association between the presence of NAFLD and atherosclerosis. This association was independent to the DM presence. The grade of NAFLD and elevated liver function tests had no effect on severity of atherosclerosis.

The effect of an aerobic exercise on serum level of liver enzymes and liver echogenicity in patients with non alcoholic fatty liver disease

AIM

The aim of this study was to evaluate the effect of an aerobic exercise on serum level of liver enzymes and liver echogenicity in patients with non alcoholic fatty liver disease.

BACKGROUND

Non alcoholic fatty liver disease (NAFLD) has different prevalence in various parts of the world. Obesity and low physical activity are main risk factors for the development of NAFLD.

PATIENTS AND METHODS

Ninety patients diagnosed by ultrasound as NAFLD was evaluated in a clinical trial as case (A) and control groups (B). The effect of aerobic exercise on changing in liver enzymes and liver echogenicity was assessed in cases compared with control group which were only on medical therapy.

RESULTS

The mean age in the sample group was 37.6±8.3 in the 17-56 yrs age range. In group A, fatty liver was in stage I in 26 (57.8%) cases, stage II in 17 (37.8%), and stage III in 2 (4.4%). In group B, fatty liver was in stage I in 30 (66.7%) patients, in stage II in 14 (31.1%) and stage III in 1 (2.2%). After an aerobic exercise, serum level of liver enzymes and liver echogenicity in patients with non alcoholic fatty liver disease was significant improved in case group (ALT (P= 0.0001), AST (P = 0.01).

CONCLUSION

Considering the present study, we can suggest that a controlled aerobic exercise schedule can be helpful in the association of medical therapy in the treatment of NAFLD.

Metastatic medullary thyroid carcinoma: A case report

Medullary thyroid carcinoma accounts for 4% of thyroid carcinoma and originates from parafollicular cells, secreting calcitonin and carcinoembryonic antigen (CEA). Conventional radiographic modalities such as Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), and Ultrasonography (U/S), are used for detecting recurrences following total thyroidectomy. However, metastatic disease frequently escapes detection by the above modalities, even when its presence is suggested by persistently elevated serum calcitonin levels. In this paper, we report a case of medullary thyroid carcinoma in a 40 year-old woman who had whole body octreotide scintigraphy to evaluate and detect the origin of calcitonin and CEA secretion.

Kimura's disease with eosinophilic panniculitis--treated with cyclosporine: a case report

Kimura's disease is a rare, benign, slow growing chronic inflammatory swelling with a predilection for the head and neck region and almost always with peripheral blood eosinophilia and elevated serum IgE levels. Here, we report a 25-year-old male patient with asthma, Reynaud phenomenon, eosinophilic panniculitis, bilateral inguinal lymphadenopathy and peripheral blood eosinophilia.

He responded initially to oral prednisolone with the subsidence of peripheral blood eosinophilia, asthma and the Reynaud phenomenon. But with tapering of prednisolone symptoms reappeared and hereby he was treated with cyclosporine. He has been symptom free for 6 months of follow up while taking cyclosporine 25 mg orally per day. Eosinophilia has resolved. This case shows that in addition to previously reported associations, Kimura disease may be associated with eosinophilic panniculitis and that cyclosporine could be effective in its treatment.

The prevalence of iron deficiency anaemia in female medical students in Tehran

INTRODUCTION

Female adolescents and adults are among the population groups who are most affected by iron deficiency. Thus, the aim of this study was to investigate the prevalence of iron deficiency and iron deficiency anaemia in female students aged 18 to 25 years old from the Tehran University of Medical Sciences, Iran.

METHODS

295 female university students participated in the study. The mean corpuscular volume (MCV) and haemoglobin (Hb), serum ferritin, serum iron and total iron binding capacity (TIBC) levels were measured. Iron deficiency anaemia was defined as a situation where Hb is less than 12 g/dL, MCV is less than 78 microm3, ferritin is less than 12 ng/ml or transferin saturation (TS) (iron/TIBC x 100) is less than 15 percent, Iron deficiency (ID) was defined as a situation where Hb is greater than or equal to 12 g/dL, MCV is greater than or equal to 74 microm3, ferritin is less than 12 ng/ml or TS is less than 15 percent.

RESULTS

The complete data was available for 237 students. The prevalence of ID was 40.9 percent and that of IDA was 3.8 percent. Normal iron status was found in 49.8 percent of the subjects. The remaining (5.5 percent) had other kinds of anaemia or required confirmatory tests.

CONCLUSION

ID is common among 18 to 25-year-old Iranian female university students. Iron supplementation is thus required for the target group.

Thirteen UDPglucuronosyltransferase genes are encoded at the human UGT1 gene complex locus

The original novel UGT1 complex locus previously shown to encode six different UDP-glucuronosyltransferase (transferase) genes has been extended and demonstrated to specify a total of 13 isoforms. The genes are designated UGT1A1 through UGT1A13p with four pseudo ones. UGT1A2p and UGT1A11p through UGT1A13p have either nucleotide deletions or flawed TATA boxes and are therefore pseudo. In the 5' region of the locus, the 13 unique exons 1 are arranged in a tandem array with each having its own proximal TATA box element and, in turn, are linked to four common exons to allow for the independent transcriptional initiation to generate overlapping primary transcripts. Only the lead exon in the nine viable primary transcripts is predicted to undergo splicing to the four common exons generating mRNAs with identical 3' ends and transferase isozymes with an identical carboxyl terminus. The unique amino terminus specifies acceptor-substrate selection, and the common carboxyl terminus apparently specifies the interaction with the common donor substrate, UDP-glucuronic acid. In the extended region, the viable TATA boxes are either A(A)TgA(AA)T or AT14AT; in the original locus the element for UGT1A1 is A(TA)7A and TAATT/CAA(A) for all of the other genes. UGT1A1 specifies the critically important bilirubin transferase isoform. The relationships of the exons 1 to each other are as follows: UGT1A2p through UGT1A5 comprises a cluster A that is 87-92% identical, and UGT1A7 through UGT1A13p comprises a cluster B that is 67-91% identical. For the two not included in a cluster, UGT1A1 is more identical to cluster A at 60-63%, whereas UGT1A6 is identical by between 48% and 56% to all other unique exons. The locus was expanded from 95 kb to 218 kb. Extensive probing of clones beyond 218 kb with coding nucleotides for a highly conserved amino acid sequence present in all transferases was unable to detect other exons 1. The mRNAs are differentially expressed in hepatic and extrahepatic tissues. This locus is indeed novel, indicating the least usage of exon sequences in specifying different transferase isozymes that have an expansive substrate range.