Red cell distribution width, neutrophil lymphocyte ratio and interleukin 10 are good prognostic markers in multiple myeloma.

Background: Multiple myeloma (MM) is still an incurable disease so we need to continue developing new diagnostic and prognostic options for its management. There are multiple prognostic factors for MM, but most of them are costly and time consuming. Hence comes the urge to identify bed side and low cost prognostic tools, that is why this study was aiming to identify in Egyptian MM patients. Materials and methods: The study was carried on 60 newly diagnosed multiple myeloma patients and 20 age and sex matched healthy individuals as controls. Studied subjects were subdivided into two groups: Group I: 60 multiple myeloma patients which were subdivided into three subgroups: Stage I: 10 patients, Stage II: 17 patients, Stage III: 33 patients, Group II: 20 healthy controls. Results: A progressive significant increase in IL-10, RDW, NLR, and beta2 microglobulin (ß2M) with disease progression from stage I towards stage III as compared to the control group. However, IL-10, RDW, and NLR have the best prognostic efficiency value regarding to sensitivity, specificity and positive predictive value when compared with ß2M. Conclusions: IL-10, RDW, and NLR are simple, easy and bedside tests (in the case of RDW, and NLR). They have high sensitivity and specificity when compared to ß2M, which is a well-established prognostic factor that highlights the valuable role they play as prognostic markers in MM.

High Bax/Bcl-2 ratio is associated with good prognosis and better survival in patients with B cell chronic lymphocytic leukemia.

Determination of Bax/Bcl-2 ratio may be a good predictive tool to recognize chronic lymphocytic leukemia (CLL) patients' outcome and prognosis to decide the time and type of therapy. This prospective study was carried out on 100 patients with newly diagnosed CLL. Bax and Bcl-2 expression in peripheral blood were measured by flow-cytometry. The association of Bax/Bcl-2 ratio with CLL laboratory markers, Rai stage, overall survival (OS) and progression-free survival (PFS) at 18 months was investigated. The sensitivity and specificity of Bax/Bcl-2 in predicting survival was evaluated. The best cut-off value of Bax/Bcl-2 ratio to predict the survival, detected by receiver operating characteristic (ROC) curve, was 1.2 with 80 % sensitivity and 60.86 % specificity. A ratio of ≤1.20 was detected in 78 % of patients and was associated with worse prognosis. A lower Bax/Bcl-2 ratio was associated with higher modified Rai stage at time of diagnosis and a significantly shorter both OS (64.1 % versus 90.9 %, p < 0.026) and PFS (66.7 % versus 90.9 %, p < 0.031) at 18 months. In multivariate analysis, bax/bcl-2 ≤ 1.2 was an independent prognostic factor for overall survival, (p = 0.025). We concluded that lower Bax /Bcl-2 ratios were associated with worse prognosis as evidenced by lower OS and PFS in CLL patients. It was also associated with markers of high tumor burden and unfavorable prognostic markers. Recognition of patients with low Bax /Bcl-2 ratio would make them good candidates for the novel Bcl-2 inhibitory targeted chemotherapy to avoid resistance to the traditional therapy.

Myeloid-derived suppressor cells anticipate sustained treatment response in newly-diagnosed and persistent primary immune thrombocytopenia.

BACKGROUND: Myeloid-Derived Suppressor Cells (MDSCs) are used as markers for short-term immune thrombocytopenia (ITP) course. This study aimed to assess their reliability to predict the sustained treatment response within 6 months. METHODS: We tested the sensitivity and specificity of MDSCs and proposed cut-off MDSCs values to predict the prognosis in newly diagnosed ITP. We enrolled 80 adults with primary ITP; 50 newly diagnosed (group I), 30 chronic (group II), and 20 controls (group III). Flow cytometry was used for peripheral blood MDSCs estimation with correlation, sensitivity, and specificity of MDSCs to predict sustained treatment response. RESULTS: After 6 days and 6 months of treatment, MDSCs were significantly higher than pre-treatment in group I, (P < 0.001, P < 0.001). MDSCs were significantly higher in group I compared to groups II and III, (P < 0.001 for both). Cut-off values were 15.75% and >5.9% at 6 days and 6 months respectively. MDSCs sensitivity was 85.7% and 100% and specificity was 94.44% and 100% at 6 days and 6 months. CONCLUSIONS: MDSCs may constitute a reliable predictor for ITP initial and prolonged treatment response with good sensitivity and specificity. This may guide the use of a specific therapeutic agent as maintenance therapy or its replacement in practice.

Outcomes and predictors of treatment response with sofosbuvir plus daclatasvir with or without ribavirin in Egyptian patients with genotype 4 hepatitis C virus infection.

BACKGROUND AND AIMS: Treatment of hepatitis C virus (HCV) changed dramatically with the introduction of oral direct-acting antiviral drugs due to their high antiviral potency and safety profile. Sofosbuvir plus daclatasvir combination therapy was extensively investigated in HCV genotypes 1, 2, and 3, while published data regarding its real-life application in the treatment of genotype 4 is lacking. Therefore, we conducted this study to assess the outcomes and predictors of treatment response with sofosbuvir plus daclatasvir with or without ribavirin in Egyptian patients with genotype 4 hepatitis C virus infection. PATIENTS AND METHODS: This prospective study included 300 Egyptian patients with chronic genotype 4 HCV, treated with sofosbuvir plus daclatasvir with or without ribavirin for 12-24 weeks. Primary outcome was the number of patients who achieved sustained virologic response (SVR12), and secondary outcome was the occurrence of adverse events. RESULTS: A total of 92.67% of all patients achieved SVR12. SVR12 rates of 96.55% and 84.54% were reported in non-cirrhotic and cirrhotic patients, respectively. SVR12 in treatment-naïve and treatment-experienced patients were 94.12% and 87.01%, respectively. A total of 19.7% of patients experienced mild adverse events. Older age, cirrhosis, and low platelet count were the predictors of treatment non-response. CONCLUSION: Based on this multi-center prospective study, sofosbuvir plus daclatasvir with or without ribavirin for 12-24 weeks appears to have favorable outcomes in the treatment of genotype 4 HCV-infected Egyptian patients. Older age, cirrhosis, especially Child-Pugh class B, and low platelet count are independent risk factors of treatment non-response.

Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

Assessment of leptin and resistin levels in non-obese multiple myeloma patients and their relation with Ig level and disease stage.

INTRODUCTION: Multiple myeloma (MM) accounts for approximately 0.8% of all cancer diagnoses and 0.9% of cancer deaths. Leptin receptors were expressed on CD34(+) cells. Resistin receptors were expressed on inflammatory cells and pro-inflammatory cytokines increase the expression of resistin on monocytes. AIM OF WORK: To assess the level of leptin and resistin in non-obese multiple myeloma patients and to study their relation with Ig level and disease stage. SUBJECTS & METHODS: 32 subjects were included; 16 patients diagnosed with MM and 16 healthy individuals served as control. All were subjected to history taking, clinical examination, routine laboratory investigations and leptin & resistin blood level. Laboratory investigations were done for diagnosis and staging for MM patients. RESULTS: Leptin was significantly higher in MM patients compared with the control group, unlike resistin which showed no significant difference between the two groups. A significant positive relation was found between IgG level & leptin. Similarly, a significant difference in leptin level has been observed between stage I & stage II (higher in II). CONCLUSIONS: Leptin may play a role in the pathogenesis of MM and its level may be changed in different stages.