Kirtikant V. Sheth

Immunophenotypic and age patterns of childhood acute lymphoblastic leukemia in Saudi Arabia

Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood in the West, characteristically showing a peak incidence in children aged between two and five years, and being predominantly of the common ALL (cALL) phenotype. In this article, we examine the hypotheses that ALL is relatively less common among childhood malignancies in Saudi Arabia; that the cALL phenotype is uncommon; that T cell ALL (TALL) is relatively more common. We report that of 163 children with ALL seen at the King Faisal Specialist Hospital and Research Centre, we find that their median age was 5.0 years with a modal value of 3 years, with a range of 4 months to 14 years; that there were 93 cALL patients who were predominantly young (median age 5.0 years). There were 20 (12.3%) patients with TALL, whose median age was 8.5 years, 35 (21.5%) patients who were null cell ALL and whose median age was 6.0 years, 14 (8.6%) patients with B cell ALL whose median age was 9.0 years, and 3 (1.8%) patients with mixed phenotype ALL. We also identify a group of 6 (3.7%) patients whose blasts were CD10 negative and showed B cell differentiation without surface membrane immunoglobulin. We conclude that age and phenotypic characteristics of ALL patients are mainly similar to ALL in the West but that L3 was much more common. A small group of six patients showed unusual B cell phenotype and require further evaluation and analysis.

Lineage ambiguity in acute leukemia.

Two cases of acute nonlymphocytic leukemia that showed surface phenotypes characteristic of lymphoid cells are reported. The cases, both involving female patients were studied by a variety of methods including flow cytometry and karyotyping. In Case 1, the patient, a 10‐year‐old girl, had poorly differentiated myeloblasts (FAB Ml), which were weakly positive for Sudan black B (SBB), but negative for alpha naphthyl acetate esterase (NAE) and naphthol ASD chloroacetate esterase (CAE). Myeloperoxidase was demonstrated ultrastructurally in some of the blasts. In Case 2, the 30‐year‐old patient had typical myelo‐monocytic leukemia (FAB M4), with SBB‐, NAE‐, and CAE‐positive blasts. Both cases were negative for terminal deoxynucleotidyl transferase. Case 1 was negative for myeloid membrane markers, whereas Case 2 was strongly positive for My7 and My9. Surprisingly, both cases showed significant positivity for B‐cell restricted antigens Bl, B2, and B4. These findings suggest ambiguous or dual lineage, supporting the concepts that some leukemias could arise from a pluripotent hematopoietic progenitor cell (Case 1) or from cells that though differentiated in some respects, could still preserve some early antigens (Case 2).

Prevalence of HBV Markers in Adult Saudis in Relation to Age and Sex

ABSTRACT Five hundred adult Saudi nationals (179 males, 321 females) were screened for hepatitis B virus markers. The prevalence of positive markers was: HBsAg = 26 (5.2%), anti-HBs = 158 (31.6%), ...

Anti-Delta-Virus Antibody in Sera Positive for Hepatitis B Surface Antigen in Male Saudi Blood Donors

ABSTRACT Anti-delta-virus antibody was determined by radioimmunoassay technique in 490 healthy male Saudi blood donors with serum positive for hepatitis B surface antigen. The presence of anti-delt...

Effectiveness of Four Intravenous IgG Preparations in Prevention of Phagocytosis of Anti‐Rh‐(D)‐Coated Erythrocytes by Mononuclear Phagocytes

Four commercial intravenous immunoglobulin G (IGIV) preparations, Sandoglobulin (Sandoz), Intraglobin (Biotest), Gammonativ (Kabivitrum) and Gammaogard (Kabivitrum) showed percent inhibition of Fc receptor‐mediated phagocytosis of anti‐Rh(D)‐coated erythrocytes as follows: 45±14 SD, 41±23 SD, 35±14 SD, 25±13 SD, respectively. Pre‐incubation of Rh(D)‐positive and antibody‐coated Rh(D)‐positive erythrocytes with IGIV did not lead to any inhibitory effects on phagocytosis. However, preincubation of mononuclear phagocytes with IGIV gave marked inhibition of phagocytosis of antibody‐coated erythrocytes. In summary, all four IGIV preparations showed Fc receptor‐mediated inhibition of phagocytosis of anti‐Rh(D)‐coated erythrocytes by mononuclear phagocytes.

Hepatitis B Serological Markers in a Saudi Arabian Patient Population and their Implications for Health Care Workers

ABSTRACT The present study was undertaken to determine the prevalence rate of hepatitis B in the patient population and the risk of contracting hepatitis B by health care workers in this comprehens...

Results of 2426 in vitro fertilization cycles from King Faisal Specialist Hospital and Research Centre, 1986-1992.

The report consists of summary in vitro fertilization (IVF) results for the period of 1986 to 1992, concerning 2426 IVF cycles on 954 patients. Tubal factor accounted for 48.7% of cases; male factor, 15.2%; unexplained factors, 15.8%; tubal plus male factor, 12.2%; with 7.7% miscellaneous pathologies. Stimulation regimes were of seven varieties over the period described. All cycles were monitored by transvaginal ultrasound and serum estradiol/LH. All oocyte retrievals were carried out at 34 hours post-HCG. Standard laboratory procedures were utilized for oocyte and pre-embryo culture and a maximum of four embryos were replaced approximately 48 hours after ovum pickup (OPU). Luteal support was by either progesterone suppository or intramuscular injection for 14 days following embryo transfer. Average number of oocytes per retrieval was 7.8, with a fertilization rate of 54% over all groups. Two hundred and sixty-eight pregnancies were initiated (16.1% per embryo transfer [ET]) with 53 of these being biochemical. Pregnancy rates followed a learning curve in the early years with a plateau at 17.8% per ET. Thus, the IVF program has evolved to yield acceptable results after refinement of stimulation regimes, laboratory techniques (especially with regard to sperm preparation), ET techniques and luteal support, thereby tailoring its protocols to suit the local population.

Kidney transplantations at King Faisal Specialist Hospital and Research Centre.

During the five year period from 1987G to 1991G, 161 kidney transplantations were performed at King Faisal Specialist Hospital and Research Centre (KFSH&RC); 79 from cadaveric donors (CD) and 82 from living related donors (LRD). All cadaveric kidneys except one were harvested within Saudi Arabia and 67% were from Saudi nationals. The immunosuppresive protocol was a triple drug regimen comprising cyclosporin-A (CyA), azathioprine (Aza), and prednisone. The actuarial graft survival rates at one and three years were 85% and 76% for the cadaveric donor transplants and 96% and 91%, respectively for the living related donor transplants (P<0.01). The corresponding patient survival rates for cadaveric donor transplants (CDTxs) were 97% and 94% and for the living related donor transplants (LRDTxs), 99% and 97% (NS). These results compare well with the best results in the Western world. The most serious surgical complications were vascular thromboses (five cases) and infections of the arterial anastomosis line with bleeding (two cases), all leading to loss of the cadaveric graft. The most common causes of death were virus infection, varicella, cytomegalovirus, and hepatitis B and C. The organ donation rate, from cadaveric donors as well as living related donors, is stil low in Saudi Arabia. Lack of organs is the main obstacle to an expansion of this promising transplantation activity. Continuous education of the multinational medical profession as well as the lay population is necessary to improve the situation.

Predictive power of sperm motion analysis in in vitro fertilization.

The correlation between sperm motion characteristics and in vitro fertilization was studied in 160 cycles, divided in two groups: those with male subfertility (N=42) and those with tubal disease (N=118). The group with male subfertility showed inferior performance, as indicated by a lower fertilization rate per oocyte (40% versus 66%) and per pick-up cycle (67% versus 93%). These two groups exhibited no significant difference in the mean sperm velocity, linearity, amplitude of lateral head displacement, and beat cross frequency in the pre swim-up and post swim-up specimens. The two groups differed in pre and post swim-up sperm motility, pre and post swim-up concentration, pre swim-up cumulative velocity at 110 to 140 Amicrom/sec and post swim-up cumulative velocity at 130 microm/sec. Logistic regression analysis was used to determine those variables that would predict fertilization; pre swim-up count and post swim-up motility proved to be the significant determinants. The results indicate that assessment of motion by automated semen analyzers does not supplement conventional semen analysis in the ability to predict fertilization.

Modified whole blood microtechnique for measurement of mitogens and allogeneic lymphocyte stimulated proliferation of human lymphocytes.

A modified micro whole blood technique for the measurement of human lymphocyte proliferative response upon stimulation with commonly used mitogens such as phytohemagglutinin (PHA), concanavalin-A (con-A), pokeweed mitogen (PKW) and pooled allogeneic lymphocytes is described. The modified microtechnique results are comparable to the conventional techniques using density gradient separated lympocyte. The advantage of this micro whole blood technique is the capability of measuring response to common additional equipment is needed. It can easily be adopted by laboratories performing lymphocyte proliferative assay.