Importance of scoring systems in prognosticating meningococcemia

Meningococcal diseases occur with a worldwide distribution as endemic or in epidemics with an overall mortality rate of 8% to 10%, mainly in patients with signs and symptoms of meningococcemia. Several investigators have devised scoring systems using clinical and laboratory parameters available at the time of presentation to prognosticate the outcome of the infection. This study was designed to determine the distribution of demographic, clinical and laboratory parameters among our patients and the relative frequency of individual Stiehm and Damrosch components. This was a prospective descriptive study, performed on patients with definite diagnosis of meningococcal infection admitted to Al-Zahra University hospital [adult and pediatric wards], Isfahan, Iran, between 1997 and 2002. The cases were 140 patients [99[70.7%] males and 41[29.3%]females] from 1 to 50 years old [25.5 +/- 1.32]. Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. In this study, the relative frequency of individual Stiehm and Damrosch components were as follows: hypotension [10.7%], peripheral white blood cell count <10,000/mm3 [39.3%], leukopenia [11.5%], ESR<10 mm/hr [19.3%], coma [6.4%], early widespread petechiae [18%], absence of meningitis [13.6%]. Overall mortality rate was [10.7%]. Meningococci are still killers, they affect men more than women. Teenagers are at more risk than other age groups. Mortality in our study was a little higher than what is suggested [10.7%]. we recommend using scoring systems for early separation of poor prognostic patients to provide them with more special care

Oncogenes: present status.

Oncogenes are genes associated with causation of cancer. They were originally associated with the ability of retroviruses to cause tumors in animals. These viral oncogenes (V-onc) have their cellular counterparts (C-onc) called Proto oncogenes. Function of Proto oncogenes is to maintain cellular growth and development. Activation of these proto-oncogenes can occur due to mutation which leads to uncontrolled cell growth. The Proto oncogenes can be grouped into different categories based on their protein products, i.e. protein kinases, growth factors, growth factor receptors, and DNA binding proteins. There are also genes that normally suppress malignant transformation and these are called anti oncogenes. Loss of their suppressor activity leads to unimpeded growth. Oncogene abnormalities are seen in pediatric leukemias, lymphomas, and various solid tumors. Anti oncogenes are associated with retinoblastoma (Rb gene), Wilms' tumor, rhabdomyosarcoma and neuroblastoma, etc. Identification of these abnormalities have diagnostic, prognostic and therapeutic implications. The utility of oncogenes in classification of human cancer and monitoring cancer therapy is quite clear, but the future of these for therapeutic interventions remains uncertain. Role of c-abl oncogene in chronic myeloid leukemia (CML), bcl-2, in lymphomas, N-myc in neuroblastomas and retinoblastoma (Rb) gene in retinoblastomas is well understood and used in designing proper therapeutic approaches. Since oncogenes also control normal cellular function, their use for therapy may be limited by the amount of damage to normal cells. Their maximum therapeutic benefit may be realized only when used in combination with other modalities.