Flow cytometric detection of leukemic blasts in Libyan pediatric patients with acute lymphoblastic leukemia

ABSTRACTThe diagnosis of acute lymphoblastic leukemia (ALL), which is the most common type of cancer in children, has become more accurate with the use of flow cytometry. Here, this technology was used to immunophenotype leukemic cells in peripheral blood samples from Libyan pediatric ALL patients. We recruited 152 newly diagnosed patients at Tripoli Medical Center (Tripoli, Libya) by morphological examination of blood and bone marrow. Twenty-three surface and cytoplasmic antigen markers were used to characterize B and T cells in circulating blood cells by four-color flow cytometry. Six children (3.9%) turned out to have biphenotypic acute leukemia, 88 (57.9%) had B ALL, and 58 (38.1%) had T ALL. There were 68 cases of pro-B ALL CD10-positive (44.7%), 8 cases of pro-B ALL CD10-negative (5.2%), 6 cases of pre-B ALL (3.9%), and 6 of mature-B ALL (3.9%). CD13 was the most commonly expressed myeloid antigen in ALL. We present immunophenotypic data for the first time describing ALL cases in Libya. The reported results indicate that the most common subtype was pro-B ALL, and the frequency of T-ALL subtype was higher compared to previous studies. Six cases were positive for both myeloid and B lymphoid markers. Our findings may provide the basis for future studies to correlate immunophenotypic profile and genetic characteristics with treatment response among ALL patients

Income deprivation and groin wound surgical site infection: cross-sectional analysis from the groin wound infection after vascular exposure multicenter cohort study

Background: Living in deprived areas is associated with poorer outcomes after certain vascular procedures and surgical site infection in other specialties. Our primary objective was to determine whether living in more income-deprived areas was associated with groin wound surgical site infection after arterial intervention. Secondary objectives were to determine whether living in more income-deprived areas was associated with mortality and clinical consequences of surgical site infection. Methods: Postal code data for patients from the United Kingdom who were included in the Groin Wound Infection after Vascular Exposure (GIVE) multicenter cohort study was used to determine income deprivation, based on index of multiple deprivation (IMD) data. Patients were divided into three IMD groups for descriptive analysis. Income deprivation score was integrated into the final multivariable model for predicting surgical site infection. Results: Only patients from England had sufficient postal code data, analysis included 772 groin incisions (624 patients from 22 centers). Surgical site infection occurred in 9.7% incisions (10.3% of patients). Surgical site infection was equivalent between income deprivation tertiles (tertile 1 = 9.5%; tertile 2 = 10.3%; tertile 3 = 8.6%; p = 0.828) as were the clinical consequences of surgical site infection and mortality. Income deprivation was not associated with surgical site infection in multivariable regression analysis (odds ratio [OR], 0.574; 95% confidence interval [CI], 0.038–8.747; p = 0.689). Median age at time of procedure was lower for patients living in more income-deprived areas (tertile 1 = 68 years; tertile 2 = 72 years; tertile 3 = 74 years; p < 0.001). Conclusions: We found no association between living in an income-deprived area and groin wound surgical site infection, clinical consequences of surgical site infection and mortality after arterial intervention. Patients living in more income-deprived areas presented for operative intervention at a younger age, with similar rates of comorbidities to patients living in less income-deprived areas. Groin wound surgical site infection (SSI) after arterial surgery is common [1], and research into reducing SSIs in vascular surgery is recognized as a priority by both clinicians and patient/caregiver representatives [2]. Despite the substantial potential morbidity and mortality of these SSIs [3,4], the available evidence relating to contributory factors is largely historic or reliant on retrospective data [5–7]. Further research on the epidemiology of SSI in this patient group is needed to allow better risk stratification, improve pre-operative discussions of risk with patients, and to guide targeted SSI prevention strategies that often include expensive prophylactic interventions [8]. However, little is currently known about the impact of socioeconomic characteristics on groin wound SSIs in this population. Socioeconomic deprivation is linked to health [9], and lifestyle-influenced cardiovascular diseases are more prevalent in more deprived areas [10]. Higher rates of unhealthy lifestyles (smoking, poor diet, and lack of physical exercise) in deprived areas are postulated to cause higher rates of cardiovascular risk increasing comorbidities, such as obesity and hyperlipidemia [10–12]. Several cardiovascular risk factors (e.g., smoking, body mass index, and diabetes mellitus), and peripheral arterial disease itself, are well recognized risk factors for SSI [13–16]. The association between socioeconomic deprivation and SSIs has previously been demonstrated in orthopedic surgery, cardiac surgery, and general surgery [17–19]. It is currently unknown whether living in an income-deprived area is associated with groin wound SSIs after arterial intervention. It was recently demonstrated in a large registry study in the United Kingdom, that outcomes following endovascular intervention for occlusive peripheral arterial disease were worse for patients living in deprived areas [20]. To the best of our knowledge, this aspect of outcomes after arterial intervention through a groin incision has not been investigated. Furthermore, studies demonstrating higher prevalence of cardiovascular disease risk factors in more deprived areas are now mostly historic and have not specifically investigated those presenting for arterial intervention through a groin incision for demographic differences in relation to deprivation [9–12]. Updated, prospective evidence is required to determine whether health inequalities persist for such patients today. Our primary objective was to determine whether residing in a more income-deprived area was associated with a higher risk of groin wound SSI after arterial intervention, by analyzing a subset of patients enrolled in the Groin wound Infection after Vascular Exposure (GIVE) multicenter cohort study [1,21]. Secondary objectives were to determine whether living in more income-deprived areas was associated with 30-day mortality and the clinical sequelae of SSI, and whether patients living in more income-deprived areas differed in terms of demographics and comorbidities compared with patients from less income-deprived areas

Outcomes of Vascular and Endovascular Interventions Performed During the Coronavirus Disease 2019 (COVID-19) Pandemic: The Vascular and Endovascular Research Network (VERN) Covid-19 Vascular Service (COVER) Tier 2 Study

The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic