Ahmad Darwish

Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients

BACKGROUND AND OBJECTIVES Though regular blood transfusion improves the overall survival of patients with β-thalassemia, it carries a definite risk of infection with blood-borne viruses. The present study was carried out to estimate the real frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) among Egyptian β-thalassemic patients, and determine the infection-associated risk factors in these patients. DESIGN AND SETTING A prospective study conducted in a university hospital from January 2009 to January 2010. PATIENTS AND METHODS Two hundred patients with β-thalassemia major were enrolled in this study. Using enzyme-linked immunoabsorbent assay (ELISA), their sera were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis C core antigen (anti-HBc), and HCV antibody (HCV Ab). The positive HCV Ab results were confirmed by second-generation recombinant immunoblot assay (RIBA). RESULTS The study sample consisted of 111 males and 89 females, with a median age of 13 years. Eighty-one (40.5%) patients were HCV Ab positive by ELISA and 39 (19.5) were anti-HCV positive by RIBA; 58 (29.0%) were HBsAg positive and 13 (6.5%) were anti-HBC positive. Older age, an increased number of transfusion units, and HBsAg seropositivity were significantly associated with a higher prevalence of HCV and HBV. CONCLUSION The prevalence of HCV and HBV infections are very high among Egyptian β-thalassemic patients, which calls for a critical look into the prevailing transfusion practices and adoption of stricter donor selection criteria to decrease the incidence rate of both HCV and HBV infections effectively. Furthermore, there is a compressing need for the use of more specific and sensitive methods for HCV testing in Mansoura university hospitals.

Adenocarcinoma of the colon in children: Case series and mini-review of the literature

Colon cancer is extremely rare in children. This article reports three cases of adenocarcinoma of the colon. A 12-year-old boy, a 13-year-old boy, and a 13-year-old girl presented with constipation and abdominal enlargement over a two-month duration. Abdominal ultrasound and barium enema confirmed a stenotic segment at the rectum with obvious shouldering. Adenocarcinoma was diagnosed following colonoscopic biopsy and laparotomy. We conclude that any child presenting with unexplained persistent constipation, abdominal distension or bleeding per rectum, colon cancer should be suspected and investigated with endoscopy or barium enema.

Optimal method for collection of umbilical cord blood: an Egyptian trial for a public cord blood bank.

Umbilical cord blood (UCB) contains stem cells and can be used as an alternative to bone marrow transplantation. Engraftment is dependent on the total nucleated cell (TNC) and CD34+ cell counts of the cord blood units. This study was designed to evaluate the effect of the method of collection of the UCB on the yield of the cord blood units.

Increased expression of costimulatory molecules CD86 and sCTLA-4 in patients with acute lymphoblastic leukemia

Abstract We herein evaluate the role of the B7-family molecule CD86 and the Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) as a possible immunopathogenic factors in patients with ALL. The results of 60 patients with de novo ALL were compared to 40 controls. A significant statistical difference between CD86 expression and sCTLA-4 levels in patients versus their controls has been detected. During follow up period of 28 months, patients suffered from relapse (16 patients) had significantly higher CD86 expression and sCTL-4 levels compared to those remained in complete remission (44 patients) (p = 0.005 and 0.03 respectively). Patients who died from the disease (9 patients) showed significantly higher CD 86 expression and sCTLA-4 levels than surviving patients (51 patients) (p = 0.004 and 0.01 respectively). In conclusion, the higher levels of sCTLA-4 and CD86 in B-ALL patients might be candidate parameters for poor prognosis and may serve to refine treatment stratification with intensification of therapy in those patients prone to relapse.

GATA3 rs3824662 gene polymorphism as possible risk factor in a cohort of Egyptian patients with pediatric acute lymphoblastic leukemia and its prognostic impact

Abstract To investigate the possible role of GATA3 rs3824662 polymorphism as risk factor for the development of acute lymphoblastic leukemia (ALL) in a cohort of Egyptian children and to evaluate its prognostic role. Typing of GATA3 rs3824662 polymorphism was done using real-time PCR for 116 patients with ALL and 273 healthy controls. The A allele and AA genotype were significantly higher in ALL patients (p = .015 and .016, respectively) especially B-ALL (p = .014 and .01, respectively). The AA genotype was associated with shorter disease free survival (DFS) in univariate (p = .017) and multivariate cox regression analysis (p = .028), increased incidence of relapse (p = .008) and poor prognosis (p = .028) in pediatric ALL. The GATA3 rs3824662 A allele and AA genotype may be risk factors for the development of pediatric ALL especially B-ALL in the studied cohort of Egyptian patients. The AA genotype is associated with shorter DSF, increased incidence of relapse and poor prognosis in pediatric ALL.

Psychiatric Disorders and Quality of Life in Egyptian Patients with Chronic Immune Thrombocytopenic Purpura: A Single Center Study

The impact of chronic immune thrombocytopenic purpura (ITP) on the psychological health and quality of life is evident among children and adolescents. We aimed to describe psychological disorders and assess quality of life in children with chronic ITP and compared their results with their healthy peers. A cross-sectional comparative study was carried out in a tertiary care university-affiliated hospital during a period from November, 2015 till April, 2018. We enrolled 119 children with chronic ITP and compared with 220 healthy peers. Relevant demographic and clinical data were collected and statistically analyzed. Quality of life for both patients and control groups was measured using pediatric quality of life inventory version 4 (Arabic one). Also psychiatric evaluation of both groups was done using Arabic version of Mini-International Neuropsychiatric Interview for Children (Mini-KID). Majority of patients (90.7%) exhibited mucocutaneous bleeding. Most of patients (61.3%) did not need any definitive treatment for chronic ITP while 38.6% received second line therapy. About one-third of the patients needed rescue medications to control active bleeding. The scores of all sub-scales of Peds QL 4.0 were significantly decreased among patients group when compared to their healthy peers (P < 0.001). General anxiety disorder and oppositional defiant disorders were the commonest psychiatric disorders among children with chronic ITP. Quality of life in children with chronic ITP is markedly impaired with occurrence of a variable spectrum of psychiatric disorders among the studied patients.

Molecular Study of Parvovirus B19 Infection in Children with Acute Myeloid Leukemia

Background: Parvovirus B19 is a common viral infection in children. Nearby evidences are present about its association with acute leukemia, especially acute lymphoblast leukemia. Nevertheless, scanty reports have discussed any role in acute myeloid leukemia (AML). Purpose: To evaluate the frequency of virological markers of B19 infection including its DNA along with specific immunoglobulins G (IgG) and M (IgM) among children with newly diagnosed AML. Besides, describing the clinical importance of Parvovirus B19 infection in those patients. Patients and methods: A case-control retrospective study was conducted on 48 children recently diagnosed with AML before and during chemotherapy induction and 60 healthy control. Specific serum IgM and IgG levels were determined by enzyme linked immunosorbant assay (ELISA) and DNA detection by polymerase chain reaction (PCR). Results: Parvovirus DNA was detected in 20 patients with AML. IgM was found in sera of four patients and one case had positive DNA and IgG (5%). Patients with recent parvovirus B19 infection had a significantly reduced hemoglobin levels, RBCs counts, platelet counts, neutrophil counts and absolute lymphocytosis (p=0.01, p=0.0001, p=0.01, p=0.02, p=0.0003, respectively). There were no clinical findings with statistically significant association to recent infection. Half of the patients with AML had positive PCR and/or IgM for parvovirus B19. Among children with AML under chemotherapy, there were reduced hemoglobin levels (P=0.03), reduced platelet counts (P=0.0001) and absolute neutropenia (mean±SD, 1.200 ±1.00) in those with parvovirus B19 infection. More than half of patients with parvovirus B19 (72.2%) had positive PCR and/or IgM and 36.4% of them had positive IgG. Conclusion: This study highlights that parvovirus B19 is common in children with AML either at diagnosis or under chemotherapy. There are no clinical manifestations that can be used as markers for its presence, but hematological laboratory findings can provide evidence for infection in the presence of anemia and neutropenia. Detection of parvovirus B19 by combined molecular and serological markers is required in such patients for accurate diagnosis.

Studying correlation between genotype and beta Thalassemia major severity factors

The progress in molecular biology methods allowed the definition of globin gene defects, including ßeta Thalassemia major (βTM) disorder. Translating the above definition into knowledge can help, with the aid of bioinformatics, improving medical diagnosis and severity assessment, in order to decide the most appropriate treatment. In this paper, we applied decision making trial and evaluation laboratory (DEMATEL) method to explore the interdependency between factors used in the severity assessment of βTM, including the mutations, differentiate between cause and effect groups, and present graphically the interdependencies among the groups using the impact relation map (IRM) MODEL.

Ewing's Sarcoma as Second Malignancy after Bilateral Retinoblastoma: A Case Report and Literature Review

Background: Children diagnosed with the hereditary form of retinoblastoma (Rb) have excellent survival, but face an increased risk of bone and soft tissue sarcomas. This predisposition to sarcomas has been attributed to genetic susceptibility due to inactivation of the RB1 gene as well as past radiotherapy for Rb. Objectives: To report the case of a child with hereditary form of bilateral RB, who developed Ewing’s sarcoma of the right femur 10 years after the Enucleation of the both eyes. Methods: The child was diagnosed as a case of bilateral RB at the age of 3 months. He was fully investigated and found to have locally advanced RB. Enucleation was done. The patient received chemotherapy and radiotherapy. At 14 years, he was investigated for a small swelling in his right lower leg. After extensive investigations, it was reported as Ewing’s sarcoma. He is treated with chemotherapy. Results: This report confirms that patients suffering from RB are at an increased risk of developing Second Malignant Neoplasms (SMNs). Conclusions: This case confirms the increased risk of a SMN in children with hereditary RB. These children need a very close follow-up for the early diagnosis of SMNs.