Smudge cell percentage as a surrogate marker for ZAP-70 expression in patients with chronic lymphocytic leukemia

BACKGROUND: This study aimed to evaluate the prognostic value of smudge cell percentage as a surrogate marker for zeta-chain-associated protein kinase 70 (ZAP-70) expression in chronic lymphocytic leukemia (CLL) patients. METHODS: Sixty three newly diagnosed CLL patients were investigated at the Hematology Department of the Medical Research Institute of Alexandria University with complete blood count, lactate dehydrogenase, β2 microglobulin levels, ZAP-70 expression, and estimation of the percentage of smudge cells. RESULTS: The percentage of smudge cells ranged from 2 to 58% with a mean of 24.03±13.98%. Higher percentages of smudge cells (>30%) were statistically significantly associated with markers of better prognosis (negative ZAP-70, early-stage disease according to the Binet and Rai staging systems, as well as low and intermediate risk CLL prognostic index). The percentage of smudge cells showed significantly negative correlation with the ZAP-70 expression and higher area under the curve for prediction of ZAP-70 positivity with better survival for 36 months in patients with >30% smudge cells. CONCLUSION: The percentage of smudge cells at presentation of newly diagnosed CLL patients could be used as a surrogate marker for ZAP-70 expression and an additional prognostic marker for disease progression.

Intracerebral hemorrhage in children

Intracerebral hemorrhage [ICH] in children is relatively less common as compared to adults. It could be traumatic or spontaneous. There are limited studies about ICH in children. In this study, we analyze the etiology, clinical features, management options and outcome assessment in this population. All patients with intracerebral hemorrhage under 18 years of age admitted to the neurosurgery department; Alexandria University Main Hospital and Medical Research Institute over a period of one year [June 2008-May 2009] were subjected to clinical examination, laboratory and radiological investigations and the cause of hemorrhage was determined. Thirty patients with ICH were included in this study. Age of patients ranged from one month to 17.5 years with a higher predilection in males. Presenting features were symptoms of raised intracranial pressure [60%], deterioration in sensorium [46%], limb weakness [36%] and seizures [30.0%]. Trauma was the most common cause of ICH and was found in 13 patients [43%], followed by bleeding diathesis in nine patients [30%], arteriovenous malformation [AVM] in five patients [17%], intracranial tumor in two patients and an aneurysm in one patient. Treatment modalities consisted of: hematoma evacuation, excision of AVM, AVM emobilization, aneurysm clipping, tumor excision, and conservative management. Eleven patients were treated conservatively and 19 patients were treated surgically. The outcome showed: good recovery in 14[47%], fair recovery in seven [23%], poor recovery in seven [23%], and death in two patients [7%]. Trauma is the leading cause of ICH in children. Bleeding diathesis and AVM come next. The initial neurological status of patients, the size, location and underlying pathophysiology of the hematoma are the most important determinants of patient outcome. Intracerebral hemorrhage due to bleeding diathesis was generally associated with a better outcome

Plasma homocysteine as an indicator of folate and vitamin B[12] status in children with acute lymphoblastic leukemia

Folate and vitamin B[12] are important in ensuring proper DNA replication and normal cell division. Their depletion might enhance carcinogenesis. The sulphur containing amino acid homocysteine gained considerable interest as a useful marker of impaired function of folate and vitamin B[12]. The present work aimed to evaluate plasma homocysteine level as a more sensitive indicator of folate and vitamin B[12] status in children with acute lymphoblastic leukemia. This study included fifteen children with newly diagnosed acute lymphoblastic leukemia attending pediatric department of Shatby Hospital, Alexandria University. The control group included fifteen normal healthy volunteers matched for age and sex. In patients, blood samples were collected at the time of diagnosis before any treatment. RBC's folate, plasma folate and vitamin B[12] were estimated using RIA kit. Plasma homocysteine was determined using EIA kit. RBC's folate, plasma folate and vitamin B[12] were significantly lower while plasma homocysteine was significantly elevated in the patient group when compared to the control group. Plasma homocysteine correlated negatively with RBC's folate in both studied groups. This study showed a strong association between folate deficiency, hyperhomocysteinemia and ALL in children. Prospective studies are necessary to further define whether alterations in plasma tHcy and RBC's folate levels can be considered as risk markers or are a consequence of progression of acute lymphoblastic leukemia