The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study

BACKGROUND

The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.

PATIENTS AND METHODS

Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.

RESULTS

A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.

CONCLUSIONS

In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.

Bacillus Calmette-Guerin lymphadenitis: a 6-year experience in two Saudi hospitals

BACKGROUND

The World Health Organization (WHO) has recommended Bacillus Calmette-Guerin (BCG) vaccination as a part of the global expanded program for immunization. Although the BCG vaccine is usually a safe vaccine, a number of complications with lymphadenitis being the most common complication, can occur.

AIM

We evaluated the frequency, the clinical presentation and treatment modalities of lymphadenitis after BCG vaccine in Saudi children.

RESULTS

A total of 145 patients with BCG lymphadenitis presented between January 2005 and December 2010. In the majority (103) of the cases, the lymphadenitis involved ipsilateral left axillary nodes. Other sites of involvement included the left supraclavicular lymph nodes in 26 (18%) patients, and both the left axillary and supraclavicular lymph nodes were involved in 7 cases (4.8%). A total of 75 patients (65%) were given antituberculous medication. Eight (27%) patients had positive acid-fast bacilli and positive cultures for Mycobacterium bovis.

CONCLUSION

In light of the findings of this study, it would be advisable to administer the BCG vaccine in Saudi Arabia at a time later than at birth, as the younger children are commonly affected.

Virtual Crossmatch: Reality of Perception

Results of 773 actual flow crossmatches (aFXMs) and virtual flow crossmatches (vFXMs) performed for living and deceased donor kidney transplantation in our center were analyzed retrospectively and evaluated for their concordance. Prediction of vFXMs was based on antibody identification using single antigen bead assay and locally established mean fluorescence intensity cutoff point compared with donor HLA antigens. The vast majority of aFXMs were in concordance with vFXMs with an overall concordance of 97%. Twenty-three predicted to be negative showed positive aFXMs; 12 of them had 0% calculated panel-reactive antibody, and 11 were found in patients with multiple non-donor-specific HLA antibodies. Three predicted positive vFXMs yielded negative aFXMs; 2 of them had allele-specific antibodies. CONCLUSIONS: vFXMs based on precise characterization of antibody specificities detected by single antigen bead assay using our cutoff point accurately predicted FXMs in the majority of patients and can be used safely to allocate kidney offers without performing physical crossmatches in selected patients.

The prevalence of CCR5-Δ32 mutation in a cohort of Saudi stem cell donors

CCR5 is a chemokine receptor that was found to be used by HIV as a co-receptor for entering target cells. A 32 bp deletion was described in certain people that rendered CCR5 non-functional. The mutant allele CCR5-Δ32 has been shown to prevent HIV infection. In addition, stem cell transplantation with the CCR5-Δ32 homozygous genotype can lead to clearance of HIV infection. In this study, our aim was to investigate the frequency of CCR5-Δ32 mutation in a cohort of stem cell donors from cord blood bank and stem cell donor registry. A total of 3025 samples were collected from healthy stem cell donors (2625) and from cord blood units (400). DNA was extracted and the CCR5 gene was amplified by polymerase chain reaction (PCR) in a light cycler system using SYBR Green dye. The mutated gene was further confirmed by direct gene sequencing. We found 38 heterozygous for CCR5-Δ32 and one homozygous CCR5 mutation (Δ32/Δ32) out of the 3025 tested individuals. We conclude that the protective CCR5-Δ32 allele appears to be rarely present in Saudi Arabia.

Association of indoor air pollution on cognitive dysfunction among elderly

OBJECTIVE

Cognitive dysfunction among the elderly is a devastating condition preceded by accumulation of neuropathology leading to accelerated cognitive decline. Many epidemiologic studies have reported the relation between indoor air pollution exposure and cognitive impairment. To clarify the nature of the association, a comprehensive systematic review and meta-analysis were performed.

MATERIALS AND METHODS

The analysis included all observational studies, including cross-sectional studies, prospective and retrospective cohort studies. Experimental studies, randomized controlled trials (RCTs), and controlled clinical trials were excluded. Studies on the relationships of indoor air pollution and cognition published before 30 April 2021 which are peer-reviewed scientific publications available in English were included after performing a structured literature search through electronic databases, including PubMed, Embase, Cochrane Library, and clinical trial.gov. A total of 146 articles were collected, and after screening thoroughly only, 9 studies were selected. Meta-analysis for the final set of selected studies was performed using the R software.

RESULTS

The quality of all the studies was adequate as almost all reported an association between at least one pollutant and cognitive dysfunction. However, relatively few studies considered outcomes that provide the most substantial evidence for a causal effect. In total, 5 studies have reported on cognitive function. The pooled mean of cognitive function was 12.16 (95% CI: 10.73 to 13.58). However, the heterogeneity was very high (I2=100%; chi-square test for heterogeneity = p<0.001). We used a modified JBI structured risk of the bias assessment tool, and it was minimal among the included studies as most of the studies have followed a random sampling method and explicitly mention it in their methods.

CONCLUSIONS

Exposure to indoor air pollution through fuels used for cooking and heating was significantly associated with cognitive dysfunction among elderly women. Given the limitations, a more extensive meta-analysis and longitudinal studies are recommended to investigate the biological mechanism behind the impact of indoor air pollution on cognitive health.

Multiple Recurrent Copy Number Variations (CNVs) in Chromosome 22 Including 22q11.2 Associated with Autism Spectrum Disorder

Introduction

Autism spectrum disorder (ASD) is a developmental disorder that can cause substantial social, communication, and behavioral challenges. Genetic factors play a significant role in ASD, where the risk of ASD has been increased for unclear reasons. Twin studies have shown important evidence of both genetic and environmental contributions in ASD, where the level of contribution of these factors has not been proven yet. It has been suggested that copy number variation (CNV) duplication and the deletion of many genes in chromosome 22 (Ch22) may have a strong association with ASD. This study screened the CNVs in Ch22 in autistic Saudi children and assessed the candidate gene in the CNVs region of Ch22 that is most associated with ASD.

Methods

This study included 15 autistic Saudi children as well as 4 healthy children as controls; DNA was extracted from samples and analyzed using array comparative genomic hybridization (aCGH) and DNA sequencing.

Results

The aCGH detected (in only 6 autistic samples) deletion and duplication in many regions of Ch22, including some critical genes. Moreover, DNA sequencing determined a genetic mutation in the TBX1 gene sequence in autistic samples. This study, carried out using aCGH, found that six autistic patients had CNVs in Ch22, and DNA sequencing revealed mutations in the TBX1 gene in autistic samples but none in the control.

Conclusion

CNV deletion and the duplication of the TBX1 gene could be related to ASD; therefore, this gene needs more analysis in terms of expression levels.

Cholesterol granuloma of the maxillary sinus

INTRODUCTION

Cholesterol granuloma (CG) can be found in several areas of the body. Maxillary sinus localization is considered rare.

CASE REPORT

A 37-year-old male presented with acute febrile sinusitis. Nasal endoscopy showed a nasal polyp at the middle meatus. Computed Tomography (CT scan) of the sinus showed complete opacity of the right maxillary sinus without calcification and partial opacification of frontal and ethmoidal sinuses. Functional endoscopic sinus approach was performed. Marsupialization of the cyst which a brownish fluid, which evoked the diagnosis of cholesterol granuloma.

CONCLUSION

The definite diagnosis is made by histology, although intra-operative finding could be suggestive. Complete excision is achievable by endoscopic approach.

A245 IGG4- RELATED DISEASE AS A RARE CAUSE OF GASTRIC OUTLET OBSTRUCTION: A CASE REPORT AND LITERATURE REVIEW

Background

IgG4- related disease (IgG4-RD) is a newly recognized systemic fibroinflammatory condition that can affect a wide range of organs, including the pancreas, biliary system, retroperitoneum, lymph nodes and salivary glands. However, gastrointestinal luminal involvement is very rare, and the presentation with isolated gastrointestinal obstruction is extremely unusual.

Aims

We present a case of IgG4-RD presenting with gastric outlet obstruction secondary to severe duodenal stricture.

Methods

A 59-year-old female presented with 6 months history of abdominal pain, postprandial nausea and vomiting associated with significant weight loss. CT showed circumferential wall thickening of the 2ndand 3rd parts of the duodenum with gastroscopy showing severe ulcerated duodenal stricture that could not be passed through. Biopsies from the ulcerated area did not reveal a specific etiology, but malignancy could not be excluded, and the decision was made to pursue surgical management with Whipple’s procedure.

Surgical pathology revealed IgG4 related disease in the form of an ulcerated gastric mass invading the duodenum and the pancreas with normal serum IgG4 level. Postoperatively, the patient developed anastomotic leak that was managed conservatively with antibiotics and drainage resulting in significant improvement in her symptoms. MRCP did not show any pancreatic or biliary abnormalities.

Results

A few weeks later, she represented with abdominal pain as well as nausea and vomiting. CT scan revealed severe inflammatory changes at the anastomosis site with mucosal thickening concerning for persistent leak. However, as she was optimally treated before, it was concluded that these changes are likely related to recurrent IgG4-RD. To induce remission, prednisone was started with remarkable improvement in her symptoms within two weeks, and complete resolution of the previous inflammatory changes around the anastomosis on repeat imaging. Subsequently, she was started on mycophenolate mofetil (MMF) with a slow prednisone taper.

Conclusions

IgG4-RD involving the gastrointestinal tract is rare with rare cases reported in the literature presenting in variable ways. Our case demonstrates the possibility of IgG4-RD presenting as gastric outlet obstruction; IgG4-RD should be considered in the differential diagnosis of unexplained duodenal stricture or gastric outlet obstruction. IgG4-RD usually responds to steroids but long-term response rates to steroid-sparing agents, especially in the subset of patients with luminal IgG4-RD, remains to be seen.

Funding Agencies

None

Copy number variations in autistic children

Autism spectrum disorder (ASD) manifests as a neurodevelopmental condition marked by challenges in social communication, interaction and the performing of repetitive behaviors. The prevalence of autism increases markedly on an annual basis; however, the etiology remains incompletely understood. Cytogenetically visible chromosomal abnormalities, including copy number variations (CNVs), have been shown to contribute to the pathogenesis of ASD. More than 1% of ASD conditions can be explained based on a known genetic locus, whereas CNVs account for 5-10% of cases. However, there are no studies on the Saudi Arabian population for the detection of CNVs linked to ASD, to the best of our knowledge. Therefore, the aim of the present study was to explore the prevalence of CNVs in autistic Saudi Arabian children. Genomic DNA was extracted from the peripheral blood of 14 autistic children along with four healthy control children and then array-based comparative genomic hybridization (aCGH) was used to detect CNVs. Bioinformatics analysis of the aCGH results showed the presence of recurrent and non-recurrent deletion/duplication CNVs in several regions of the genome of autistic children. The most frequent CNVs were 1q21.2, 3p26.3, 4q13.2, 6p25.3, 6q24.2, 7p21.1, 7q34, 7q11.1, 8p23.2, 13q32.3, 14q11.1-q11.2 and 15q11.1-q11.2. In the present study, CNVs in autistic Saudi Arabian children were identified to improve the understanding of the etiology of autism and facilitate its diagnosis. Additionally, the present study identified certain possible pathogenic genes in the CNV region associated with several developmental and neurogenetic diseases.

Pediatric hearing loss: common causes, diagnosis and therapeutic approach

Pediatric hearing loss limits the child ability to develop effective auditory and speech capabilities. Early rehabilitation of hearing loss results in higher levels of linguistic, academic and social skills. To achieve the best outcomes, proper and timely diagnosis is essential. The etiology of hearing loss can be classified according to its nature as sensorineural hearing loss (SNHL), conductive hearing loss (CHL) or mixed hearing loss (MHL). Congenital hearing loss could be genetic or non genetic (acquired), syndromic or non-syndromic. Hearing loss can be classified according to the severity into mild (26-40 dB HL), moderate (41-70 dB HL), severe (71-90 dB HL) and profound (more than 90 dB HL). Management of hearing loss is mainly influenced by the nature, the bilaterality, the severity and the age at diagnosis. Severe to profound bilateral SNHL can be managed by cochlear implantation (unilateral or bilateral), if picked up at early age while mild to moderate bilateral SNHL are easier to manage with conventional hearing aids. CHL has less impact on the speech development of the child. It is usually managed by correcting the underlying etiology such as otitis media with effusion or even surgically in cases of external ear atresia or ossicular malformations. Unilateral SNHL have fortunately no impact on the language development of the child and can be passed undiagnosed until preschool-aged children. The implementation of national newborn hearing screening programs has improved the management of affected children by rehabilitating them at early stages to allow for normal speech development. In this review article, we aim to highlight the most common causes of pediatric hearing loss, their character and presentation and to review the diagnostic and therapeutic approaches of a deaf child.