MicroRNA (miRNA) expression profiling of peripheral blood samples in multiple myeloma patients using microarray

MicroRNAs (miRNAs) are mostly located at cancer-associated genomic regions or in fragile sites, suggesting their important role in the pathogenesis of human cancers. Multiple myeloma (MM) is a cancer of plasma cells, the third most common cancer of the blood after lymphoma and leukaemia. There are several published reports on miRNAs in MM, however most used bone marrow rather than peripheral blood samples. The aim of this study is to characterise miRNA expression in normal and MM patients using peripheral blood samples as it is less invasive and is readily available from patients. Blood samples from 35 MM patients were analysed using the microarray method. We identified up-regulation of 36 miRNAs (57%) and down-regulation of 27 miRNAs (43%). We also identified the CCND2, HMGA2 and IGF1R genes were among the highly predictive target genes (P(CT) > 0.80) for most of the deregulated miRNAs. These genes are known to play important roles in MM as well as other cancers. Five miRNAs (let-7c, miR-16, miR- 449, miR-181a and miR-181b) were found to exhibit similar expression patterns (p < 0.05) in peripheral blood when compared to data obtained by using bone marrow aspirates from MM patients in other studies. In conclusion, our study has demonstrated that miRNAs are also present and differentially expressed in the peripheral blood of MM patients compared to controls and may potentially serve as candidate tumour biomarkers in MM. In particular, let-7c and miR-16 have been shown to be significantly expressed in the bone marrow.

Minimal Residual Disease Status in Childhood Acute Lymphoblastic Leukaemias by Flow Cytometry and Their Clinical and Haematological Features

Residual disease in patients with acute leukaemia indicates unfavorable prognosis. The evaluation of remission using flow cytometry allows a better estimation of minimal residual disease (MRD) after induction chemotherapy in childhood acute lymphoblastic leukaemia (ALL) cases. Patients in morphological marrow remission with presence of blast cells of less than 5%, may still have up to 1010 leukaemic cells. However with flow cytometric analysis, lower levels of the residual leukaemic cells (1 in 104 cells) can be detected and it can be used as a tool to predict relapse. This study compared the presenting clinical and haematological features of children with ALL and their residual disease status determined by flow cytometry. Analysis of their MRD status following remission-induction chemotherapy were done at day-28, week-12 and week-20. The cases were also followed up to five years, to determine their survival status. Their residual disease status by flow cytometric immunophenotyping was also compared with their bone marrow findings morphologically. Thirty-eight cases of precursor B-ALL in pediatric patients from UKM Medical Centre (UKMMC) were analyzed. There was no significant correlation between demographic, clinical and haematological features with MRD status at day-28. However, there was a significant correlation between MRD status by flow cytometry and by morphological marrow examination at week-12. Three cases showed persistent MRD findings until week-20 where two of the cases relapsed and died subsequently. Twenty four patients were still alive after five years of follow up.

Ventral penile papillae as a new anatomical structure: a clinical-epidemiological study among Iraqi males

Ventral Penile Papillae [VPP] are benign asymptomatic structures that are found on the skin of the ventral aspect of penile shaft of many adult males; yet, no frank record or description of them is found in the English medical literatures. To hit light on the VPP. finds their frequency among circumcised Iraqi adult males, seeks about their associations with other skin conditions, and examines the histological picture. Forty seven Iraqi circumcised adult males were included in this case descriptive, comparative study which extended between July 2007-November 2007 was conducted in Department of Dermatology-Baghdad Teaching Hospital. All 47 persons were asked about sociodemographic aspects, medical and skin conditions. They were evaluated clinically regarding different clinical aspects. Statistical data were deduced. Biopsies were done for 8 papillae from 6 persons for histological assessment. Also, 50 circumcised children under the age of 10 years were examined for the presence of these papillae as a control group. Forty seven males were enrolled the present work, their ages ranged from 14-59[29.72+10.57] years. Twenty five [53.2%] persons had VPP, while 22 [46.8%] subjects showed no papillae. Fifty circumcised children of ages ranged from 3.5.40[5.97+1.42] years, all were lacking the papillae. The papillae were asymptomatic. Shapes of papillae were distributed as follows: skin tag-like papillae were 53, 93%, dome-shaped 40.44%, while wartlike in 5.61% of these papillae. Histology was normal apart from finding of dermal encapsulated structures which simulate mechanoreceptor nerve endings, so called Meissner' corpuscles. All facts start as speculative thoughts as had been proved by the present study. Ventral penile papillae are normal anatomical and physiological structures that are present in only adult males while completely absent in children. So the age of onset lies during adulthood, The location, morphology, age of onset, and the histology of these papillae are very suggestive of their sexual stimulatory function. Still further physiological and histological studies are strongly recommended

Growth velocity in transfusion dependent prepubertal thalassemia patients: results from a thalassemia center in Malaysia.

Growth impairment is commonly seen in children with thalassemia despite regular blood transfusions and desferrioxamine treatments. We investigated the growth velocity of 26 prepubertal patients with beta-thalassemia or HbE-beta thalassemia who were transfusion dependent aged between 2 and 13 years. The prevalence of impaired growth velocity (ie, growth velocity less than the third percentile) amongst the transfusion dependent prepubertal thalassemics was 57.7% compared to 19.2% in the control group. The mean height velocity of the thalassemics was 11.1% less than controls but this difference was not statistically significant (4.23cm/year vs 4.76cm/year, p = 0.08). The mean serum ferritin level of the thalassemics with a height < 3rd percentile was higher compared to those with a height > 3rd percentile (4,567.0 vs 2,271.0, p = 0.01). Our study showed that there was a high prevalence of impaired growth velocity amongst our transfusion dependent prepubertal thalassemics. This highlights the problem of inadequate chelation therapy, and compliance with chelation therapy amongst our patients. This study emphasizes the importance of monitoring growth parameters and optimal iron chelation therapy in these patients.

Bacille Calmette-Guerin immunotherapy of viral warts

To assess the effectiveness of the Bacille Calmette-Guerin [BCG] vaccine in the treatment of viral warts. A single blind placebo controlled study conducted at the Department of Dermatology; Baghdad Teaching Hospital, Baghdad, Iraq from March 2005 to June 2006. Two hundred patients with viral warts were enrolled in this study, and were fully assessed before therapy. The patients were divided into 2 equal matched groups. Group 1 was designed as the treatment group and received BCG vaccine in 1-3 doses with a one-month interval, while group 2 was injected with distilled water. The patients were evaluated every 2 weeks for evidence of regression of lesions. The follow up period lasted for 3 months after the last dose. A total of 154 patients completed the study: 81 patients in group I and 73 patients in group II. Thirty [39.7%] patients out of 81 patients in group I showed complete recovery. These results were significantly high [p<0.05] when compared with total response, 10 [13.7%] out of 73 patients in group II. No recurrence has been reported during the follow up period. When cases that failed to respond to placebo were treated with BCG in a similar manner to group I, there was total response in 15 [42.7%] out of 44 patients. No side effects were observed. The BCG vaccine was an effective and safe modality of treatment of viral warts

Prolonged remission after splenectomy for refractory Evans syndrome--a case report and literature review.

We describe a patient with Evans syndrome (autoimmune hemolytic anemia and autoimmune thrombocytopenia) who was refractory to steroids and intravenous immunoglobulin. She responded to splenectomy and has remained in clinical remission for 3 years. In the majority of cases, splenectomy rarely induces a durable remission but it may be beneficial in a small group of patients, hence should be considered as alternative therapy in the management of these patients.

Case report post-splenectomy sepsis in thalassemic patients.

Thalassemia is the commonest hemoglobinopathy in Malaysia. Patients with thalassemia major are transfusion dependent, and a large proportion of them will require splenectomy. As this particular group of patients is immunocompromized, overwhelming sepsis is a recognized complication. We report a series of three patients who all developed intra-abdominal abscesses following splenectomy.

Abnormalities in lung function among multiply-transfused thalassemia patients: results from a thalassemia center in Malaysia.

The aim of this study was to: (1) determine the prevalence and patterns of lung dysfunction among transfusion dependent thalassemics; (2) determine the associated factors that might contribute to this problem. This was a cross-sectional study involving 66 patients with transfusion dependent thalassemia aged 10 years and above. All patients underwent physical examination, standardized pulmonary function tests including spirometry, lung volume, and the carbon monoxide diffusion capacity. A restrictive pattern of lung dysfunction was observed in 22 patients (33.3%) and none showed the presence of obstructive ventilatory impairment. A reduction in the carbon monoxide diffusion capacity (DLCO) was seen 87.9% of the patients, including 7.6% who had evidence of hypoxemia. Ten patients showed a reduction in the FEF25-75% although they did not fulfil the criteria for small airway disease. No correlation was found between lung dysfunction and serum ferritin levels in the patients. Restrictive lung dysfunction and diffusion impairment were the predominant abnormalities found in our cohort of patients.

Prevalence of asymptomatic urinary tract infection among primary school children in Iraq [Hilla]

Urinary tract infections are common in infancy and childhood associated with potentially serious long term consequences of renal scarring, hypertension and chronic renal failure. To determine the prevalence of urinary tract infections among Iraqi children and some associated risk factors a cross-sectional study was conducted in Hilla province during the period from the 1st October 2001 through March 2002. Two stage-randomized samples, in the first stage a sample of schools was chosen. In the second stage 250 boys and 250 girls were chosen. The criteria used for enhanced urinalysis were Pyuria; presence of at least 10 white blood cells /mm3 by using a Neubaure counting chamber and /or Bacteriuria; presence of any bacteria /20 oil immersion field on gram stain smear. The questionnaire papers distributed to all those included in the sample. Chi-square test was used. The age range was 7-12 years. Mean +/- SD [9.36 +/- 1.39]. Prevalence of asymptomatic urinary tract infection was 6.6% but among girls was significantly higher than boys [11.2% Vs 2%] [P=0.00007]. The results of urinanylsis and cultures were positive in 28.6% of infected girls only, bacteriuria present in 46.42% of infected girls and in 80% of infected boys. Pyuria and bacteriuria present in 25% infected girls and in 20% infected boy [P>0.05].Urine culture showed E. coli in 57% of infected girls and 80% of infected boys. There was no significant difference between age groups [P>0.05]. Asymptomatic urinary tract infection is a hidden disease affecting young children and early adolescence, mainly girls 11.2%. Urine culture could be replaced by enhanced urinalysis as a screening test. We encourage the use of this test in school health program at least once per year

Short stature and truncal shortening in transfusion dependent thalassemia patients: results from a thalassemia center in Malaysia.

One of the major complications in patients with transfusion dependent thalassemia is growth impairment secondary to iron overload. We studied the growth status in 66 patients with beta-thalassemia major and HbE-beta thalassemia who were transfusion dependent, aged from 2 to 24 years, and 66 controls matched for sex and age. The prevalence of short stature in transfusion-dependent thalassemics was 54.5% compared to 4.5% in control group (p<0.001). Short stature was more prevalent in those above the age of 10 years in this study group (83.3% vs 16.7%). Transfusion dependent thalassemics with short stature were found to have significantly lower mean standing height standard deviation scores (SDS), sitting height SDS and subischial leg length SDS values (p<0.001). There was also a significant difference between the mean sitting height SDS and the mean subischial leg length SDS in our thalassemics with short stature, suggesting that the short stature was due to disproportionate truncal shortening. Serum ferritin levels were significantly higher in transfusion dependent thalassemics who were short compared to those who were of normal height (p = 0.002). However, the mean pre-transfusion hemoglobin levels did not differ significantly between patients with short stature and those with normal height (p = 0.216). The prevalence of short stature also did not differ significantly between those with beta-thalassemia major and those with HbE-beta thalassemia (p = 0.32). This study highlighted the importance of providing optimal treatment in these patients, including monitoring of growth parameters and optimizing iron chelation therapy.

Seroprevalence of hepatitis B, hepatitis C, CMV and HIV in multiply transfused thalassemia patients: results from a thalassemia day care center in Malaysia.

Regular blood transfusions for patients with thalassemia have improved their overall survival although these transfusions carry a definite risk of the transmission of certain viruses. Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV) leads to complications which contribute to the morbidity and mortality of patients with thalassemia. We analyzed the blood samples taken from 85 transfusion dependent thalassemics receiving treatment at the day care center in Hospital Universiti Kebangsaan Malaysia and found that the seroprevalence rates for HBV, HCV and CMV were 2.4%, 22.4% and 91.8% respectively. None of the patients tested positive for HIV. Those positive for HBV and HCV will require further tests and treatment if chronic hepatitis is confirmed.