Nashwa K. Abousamra

Seroprevalence of and risk factors for Toxoplasma gondii antibodies among asymptomatic blood donors in Egypt

A cross-sectional study was conducted to evaluate the seroprevalence of and risk factors for Toxoplasma gondii antibodies in 260 blood donors seen at blood banks in Mansoura University Hospital, Egypt. Blood donors were interviewed about sociodemographic characteristics and risk factors for T. gondii infection. A blood sample was taken to document their T. gondii antibody status using enzyme-linked immunosorbent assay. Overall, 155 (59.6%) of 260 blood donors were positive for anti-T. gondii IgG antibodies. Multivariate logistic regression analysis showed a significant association between T. gondii seropositivity and eating meat by-products (luncheon/shawerma) (adjusted odds ratio [OR] 80.82 [95% CI 18.62–350.81], P < 0.0001) or being non-educated (adjusted OR 32.25 [95% CI 7.46–139.44], P < 0.0001). These findings highlight that T. gondii is prevalent among blood donors in Egypt.

Reverse hybridization StripAssay detection of β-thalassemia mutations in northeast Egypt

Abstract Aim: β-Thalassemias are widely distributed in Mediterranean and Middle Eastern countries. Reverse hybridization StripAssay method is reported to be rapid, simple, reproducible and less expensive. The aim of this study is to evaluate reverse hybridization StripAssay method for detection of β-thalassemia mutations in Egyptian children. Subjects and methods: Forty children with β-thalassemia major with mean age of 10·33±4·75 years were recruited consecutively from outpatient Hematology Clinic of Mansoura University Childrens Hospital. Mutation analysis was performed by the β-Globin StripAssay MED. Results: The most frequent mutant alleles detected were; IVS 1·110, IVS 1·1 and IVS 1·6 accounting for 33·75, 27·5 and 18·75% respectively. The detection rate of the used method in our population was 90%. Conclusion: β-globin StripAssay is a fast, easy-to-perform and reliable method for genetic screening of β-thalassemia patients in Egypt. IVS 1·110, IVS 1·1 and IVS 1·6 are the most frequent mutant alleles with poor phenotype/genotype correlation.

Upregulation of CD40/CD40L system in rheumatic mitral stenosis with or without atrial fibrillation.

Platelet activation occurs in peripheral blood of patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) and could be related to abnormal thrombogenesis. The CD40/CD40 ligand (CD40L) which reflects platelet activation, mediate a central role in thrombotic diseases. However, the role of CD40/CD40L system in rheumatic MS with or without AF remains unclear. Expressions of CD40 on monocytes and CD40L on platelets were determined by whole blood flow cytometry and serum levels of soluble CD40L were measured by enzyme-linked immunosorbent assay in group 1 (19 patients with MS) and group 2 (20 patients with MS and AF) compared to group 3 (10 controls). Patients with groups 1 and 2 had a significant increase in expression of CD40 on monocytes (P1 and P2 = 0.000) and serum levels of sCD40L (P1 = 0.014 and P2 = 0.033, respectively), but nonsignificant increase in expression of CD40L on platelets (P1 = 0.109 and P2 = 0.060, respectively) as compared to controls. There were no significant difference in all the parameters in group 1 compared to group 2. Correlation analysis demonstrated that there was a significant direct relationship between the severity of MS and serum levels of sCD40L (r = −0.469, p = 0.043). In conclusion, rheumatic MS patients with or without AF had upregulation of the CD40/CD40L system as well as elevated sCD40L levels. The levels of sCD40L had a significantly direct relationship with the severity of MS and it was the stenotic mitral valve, not AF, that had a significant impact on platelet activation.

T‐cell CD38 expression in B‐chronic lymphocytic leukaemia

B‐cell chronic lymphocytic leukaemia (B‐CLL) is a heterogeneous disease with some patients having an indolent course never needs treatment, while others having rapidly progressive one requires intensive treatment. In recent decades, numerous prognostic markers, such as immunoglobulin variable region heavy‐chain (IgVH) mutational status, ZAP‐70 and the expression of CD38 on leukaemic cells were introduced to screen for patients likely to have progressive course of B‐CLL bearing the potential to facilitate risk‐adapted treatment strategies. In B‐CLL, T cell function is shown to be dysregulated. CD38 has been demonstrated to be an important transmembrane signalling molecule of T cell with a direct effect on its function. The present study was conducted to analyse CD38 expression on T cells by flow cytometry to evaluate its impact on the clinical course of 88 unselected B‐CLL patients and correlate it with other risk factors. CD38 expression level on T cells was shown to predict the clinical course of B‐CLL in male patients but not in female patients. Male patients showed CD38 expression on T cells in a stage‐dependent manner, in contrast to female patients who showed higher expression irrespective to clinical staging. CD38 expression on T cells negatively interacted with treatment‐free survival in male patients. Multivariate analysis revealed that CD38 expression level on T cells is an independent prognostic factor in B‐CLL male patients. Simultaneous evaluation of CD38 expression on both B‐CLL cells and T cells allowed predicting male patient groups with the most favourable prognosis as well as those with the worst. Copyright

The expression and concentration of CD40 ligand in normal pregnancy, preeclampsia, and hemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome.

Preeclampsia has been associated with increased platelet activation detected before disease onset. Inappropriate activation of platelets may be involved in pathogenesis in preeclampsia by promoting coagulation and thrombosis and also as a mediator of inflammation. The exaggerated platelet activation and inflammation leading to endothelial damage in preeclampsia can be explained by the CD40–CD40 ligand (CD40L) system. Expression of CD40L on platelets was determined by whole-blood flow cytometry, and serum levels of soluble CD40L (sCD40L) were measured by enzyme-linked immunosorbent assay in 11 women with mild preeclampsia, 11 women with severe preeclampsia, and six women with hemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome compared with 13 normotensive pregnant women as a control group. The platelet surface expression of CD40L was significantly higher in women with mild and severe preeclampsia and HELLP compared with normal pregnancy group (P = 0.001; P ⩽ 0.001; P = 0.003, respectively), with no significant difference being found between women with mild preeclampsia compared with HELLP and severe preeclampsia compared with HELLP (P = 0.2; P = 0.8, respectively). The serum concentration of sCD40L was significantly higher in women with mild and severe preeclampsia and HELLP compared with the normal pregnancy group (P = 0.001; P ⩽ 0.001; P = 0.022, respectively), with no significant difference being found between women with mild compared with severe preeclampsia or HELLP and severe preeclampsia compared with HELLP (P = 0.7; P = 0.6; P = 0.6, respectively). In conclusion, the higher expression and concentration of CD40L in women with preeclampsia and HELLP syndrome compared with normal pregnant women may indicate an exaggerated activation of platelets and endothelial cells in the disorder.

CEBPA gene mutations in Egyptian acute myeloid leukemia patients: impact on prognosis

Abstract Aim To assess the prognostic role of myeloid transcription factor gene CEBPA (CCAAT/enhancer binding protein-α), a novel gene involved in leukemia in Egyptian adults AML. Materials and Methods Screening for CEBPA mutations was assessed using PCR-single-strand conformation polymorphism (PCR-SSCP) in pretreatment bone marrow samples from 55 newly diagnosed adult AML. Results CEBPA mutations were found in 11 (20%) of 55 AML patients. They had significantly higher hemoglobin (P = 0.037), and lower LDH (P = 0.003) levels when compared to those without. CEBPA mutations were frequently detected in M4 (45.5%) and M2 (27.2%) subtypes, and significantly associated with normal karyotype (90.9%, P = 0.007). We distinguished six cases with two different mutations or one homozygous mutation (CEBPAdouble-mut) as well as five cases with only one single heterozygous mutation (CEBPAsingle-mut). Patients with CEBPA mutations had significantly higher complete remission (P = 0.047), lower mortality (p = 0.047). Double CEBPA mutant cases showed longer disease free survival (DFS) and overall survival (OS) when compared to wild type CEBPA (for DFS; median = 27 versus 24 months respectively; P = 0.009 and for OS; median = 28 versus 25 months respectively; p = 0.008). No significant differences were found between CEBPAsingle-mut cases and wild type cases regarding DFS and OS (for DFS; median = 13 versus 24 months respectively; P = 0.615 and for OS; median = 14 versus 25 months respectively; P = 0.703). Conclusion CEBPA mutation status is known to be a prognostic factor for favorable outcome in AML patients. CEBPAdouble-mut is associated with favorable DFS and OS. In contrast, CEBPAsingle-mut AMLs survival studies did not differ significantly with wild-type cases. These results demonstrate significant underlying heterogeneity within CEBPA mutation positive AML with prognostic relevance. Based on these findings, we propose that CEBPAdouble-mut should be clearly defined from CEBPAsingle-mut AML and considered as a separate entity in the classification of AML. Furthermore, incorporation of CEBPA mutation status into novel risk-adapted therapeutic strategies in Egypt will improve the currently disappointing cure rate of this group of patients.

Prevalence of, risk factors for, and oxidative stress associated with Toxoplasma gondii antibodies among asymptomatic blood donors in Egypt

Methods Blood donors were recruited (169 men and 61women) from blood banks, Mansoura University Hospital, Egypt. We interviewed blood donors about sociodemographic characteristics and potential risk factors for T. gondii infection using a structured questionnaire. A venous blood sample was taken to document their T. gondii antibody status using enzyme-linked immunosorbent assay (ELISA). Also, serum level of malondialdehyde (MDA) and activity of glutathione peroxidase (GSH-Px) and tocopherol fractions (a, g, δ) was assessed.