Low platelet to lymphocyte ratio and high platelet distribution width have an inferior outcome in chronic lymphocytic leukaemia patients

Introduction.  Chronic lymphocytic leukaemia (CLL) is an incurable disease of the elderly, characterised by gradual accu­mulation of small mature B lymphocytes which escape apoptosis through inflammatory signals from the microenviron­ment. Elevated inflammatory markers are associated with very poor prognosis in different types of cancer. Therefore, we examined retrospectively the impact of platelet lymphocyte ratio (PLR) and platelet distribution width (PDW) on 180 CLL patients’ outcome. Materials and methods.  This retrospective study included 180 patients with CLL who were diagnosed and selected among cases referred to the Oncology Center Mansoura University between January 1st, 2008 and June 30th, 2016. All the relevant information was collected from the electronic medical records of the selected patients. Results.  Our results revealed that low PLR (<2.5) was more frequently observed in patients with stage C (p < 0.001), with 17p deletion (p = 0.017), and CD38 expression (p = 0.08), but not with seropositive HCV patients (p = 0.2). High PDW (≥18.5 fl) was more frequently associated with intention to treat population (p = 0.038), and CD38 expression (p = 0.068), but not with 17p deletion (p = 0.25) and seropositive HCV patients (p = 0.4). Multivariate analysis for overall survival showed that stage A and low PDW were independent factors for overall survival (p = 0.014 and 0.04 respectively), while high PLR (p = 0.05), and seronegative HCV patients (p = 0.1) lost their significance. Conclusion.  Our data showed that low PLR and high PDW were associated with poor prognostic markers. Stage C-CLL and high PDW were independent predictors of survival

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Low platelet to lymphocyte ratio and high platelet distribution width have an inferior outcome in chronic lymphocytic leukaemia patients

Introduction.  Chronic lymphocytic leukaemia (CLL) is an incurable disease of the elderly, characterised by gradual accu­mulation of small mature B lymphocytes which escape apoptosis through inflammatory signals from the microenviron­ment. Elevated inflammatory markers are associated with very poor prognosis in different types of cancer. Therefore, we examined retrospectively the impact of platelet lymphocyte ratio (PLR) and platelet distribution width (PDW) on 180 CLL patients’ outcome. Materials and methods.  This retrospective study included 180 patients with CLL who were diagnosed and selected among cases referred to the Oncology Center Mansoura University between January 1st, 2008 and June 30th, 2016. All the relevant information was collected from the electronic medical records of the selected patients. Results.  Our results revealed that low PLR (<2.5) was more frequently observed in patients with stage C (p < 0.001), with 17p deletion (p = 0.017), and CD38 expression (p = 0.08), but not with seropositive HCV patients (p = 0.2). High PDW (≥18.5 fl) was more frequently associated with intention to treat population (p = 0.038), and CD38 expression (p = 0.068), but not with 17p deletion (p = 0.25) and seropositive HCV patients (p = 0.4). Multivariate analysis for overall survival showed that stage A and low PDW were independent factors for overall survival (p = 0.014 and 0.04 respectively), while high PLR (p = 0.05), and seronegative HCV patients (p = 0.1) lost their significance. Conclusion.  Our data showed that low PLR and high PDW were associated with poor prognostic markers. Stage C-CLL and high PDW were independent predictors of survival.Introduction.  Chronic lymphocytic leukaemia (CLL) is an incurable disease of the elderly, characterised by gradual accu­mulation of small mature B lymphocytes which escape apoptosis through inflammatory signals from the microenviron­ment. Elevated inflammatory markers are associated with very poor prognosis in different types of cancer. Therefore, we examined retrospectively the impact of platelet lymphocyte ratio (PLR) and platelet distribution width (PDW) on 180 CLL patients’ outcome. Materials and methods.  This retrospective study included 180 patients with CLL who were diagnosed and selected among cases referred to the Oncology Center Mansoura University between January 1st, 2008 and June 30th, 2016. All the relevant information was collected from the electronic medical records of the selected patients. Results.  Our results revealed that low PLR ( < 2.5) was more frequently observed in patients with stage C (p < 0.001), with 17p deletion (p = 0.017), and CD38 expression (p = 0.08), but not with seropositive HCV patients (p = 0.2). High PDW (≥18.5 fl) was more frequently associated with intention to treat population (p = 0.038), and CD38 expression (p = 0.068), but not with 17p deletion (p = 0.25) and seropositive HCV patients (p = 0.4). Multivariate analysis for overall survival showed that stage A and low PDW were independent factors for overall survival (p = 0.014 and 0.04 respectively), while high PLR (p = 0.05), and seronegative HCV patients (p = 0.1) lost their significance. Conclusion.  Our data showed that low PLR and high PDW were associated with poor prognostic markers. Stage C-CLL and high PDW were independent predictors of survival

Significance of OCT3/4 and SOX2 antigens expression by leukemic blast cells in adult acute leukemia

Abstract Objective This study aimed to address the prognostic impact of SOX2 and OCT3/4 expression on adult acute leukemia patients’ outcomes. Methods SOX2 and OCT3/4 expression by blast cells were evaluated by flow cytometry in 80 acute leukemia patients and 8 healthy controls. Results Baseline SOX2 and OCT3/4 expression were significantly higher in both ALL (P = < 0.001, P = 0.005 respectively) and AML patients (P < 0.001, P = 0.003 respectively) as compared to control, and decline at complete remission (CR) and elevated again at relapse. High SOX2 and OCT3/4 levels were significantly correlated with the presence of adverse risk stratification parameters. Conclusion Our findings indicated that both SOX2 and OCT3/4 could serve as biomarkers that could improve risk stratification of acute leukemia patients. Also, both SOX2 and OCT3/4 might be a therapeutic target, especially in resistant acute leukemia

Wilms Tumor 1 Gene Mutations in Patients with Cytogenetically Normal Acute Myeloid Leukemia

OBJECTIVE: This study aimed to assess the prognostic impact of Wilms tumor 1 (WT1) mutations in cytogenetically normal acute myeloid leukemia (CN-AML) among Egyptian patients. METHODS: Exons 1, 2, 3, 7, 8, and 9 of WT1 were screened for mutations in samples from 82 CNAML patients out of 203 newly diagnosed AML patients, of age ranging from 21 to 74 years, using high-resolution capillary electrophoresis. RESULTS: Eleven patients out of 82 (13.41%) harbored WT1 mutations. Mutations were detected in exon 7 (n=7), exon 9 (n=2), exon 8 (n=1), and exon 3 (n=1), but not in exons 1 or 2. There was no statistically significant difference between the WT1 mutants and wild types as regards age, sex, French-American-British subtypes, and the prevalence of success of induction remission therapy (p=0.966; 28.6% vs. 29.3%). Patients with WT1 mutations had overall survival lower than patients with the wild type (HR=1.38; 95% CI 4.79-6.86; p=0.004). CONCLUSION: CN-AML patients with WT1 mutations have poor clinical outcome. We recommend molecular testing for WT1 mutations in patients with CN-AML at diagnosis in order to improve risk stratification of those patients

Correlation between clinical and magnetic resonance imaging (MRI) findings in temporomandibular disorders

This study was carried out to determine the value of Magnetic resonance imaging (MRI) as a diagnostic tool in patients with temporomandibular disorders. The clinical presentation and MRI findings on 88 temporomandibular joints belonging to 44 symptomatic patients were retrospectively studied. The disk position, configuration and signal intensity; mandibular condyle morphology and signal intensity; temporomandibular joint space and surrounding soft tissue abnormality were assessed. The correlation between the clinical and MRI findings was statistically analyzed using Fisher&apos;s exact (1-sided) test. Pain in the temporomandibular region was the most common clinical presentation, it accounts for 64% of cases. There was significant correlation between pain, and disc displacement with no reduction (DDWNR) and condylar hyperlaxity (p = 0.04, 0.03, respectively), as well as between clicking and each type of DD (p = 0.00). Statistically significant relationship was also found between tenderness, and DDWNR and presence of joint effusion (p = 0.02, 0.03, respectively) as well as between limitation of mouth opening and condylar marrow edema (p = 0.02). Causes of temporomandibular disorders can be well defined by clinical examination. However, MRI can be preserved for patients with pain in whom an initial medical conservative oral treatment failed in order to exclude other pathological process

Polymethylmethacrylate-Based Nanocomposites for Denture Base Fabrication: Impact of Nanoparticle Type and Concentration on the Color Change In Vitro

Background. Although the mechanical behaviors of PMMA were improved with nanoparticles addition, there is a lack of study on the color changes of nanocomposite denture base resin. This study aimed to assess and compare the color of nanocomposite denture base resin modified with different nanoparticles and concentrations. Materials and Methods. Three nanoparticles (zirconium dioxide (ZNP), titanium dioxide (TNP), and silicon dioxide (SNP)) were added to heat-polymerized acrylic resin in 3 and 7 wt% concentrations. A total of 70 acrylic discs (20 × 2 ± 0.03 mm) specimens were prepared while one without addition (control) and three main groups according to nanoparticles and two subgroups according to % (3ZNP, 7ZNP, 3TNP, 7TNP, 3SNP, and 7SNP) with total 70 acrylic discs (n = 10). Spectrophotometer was used for color change (ΔEab) followed by value conversion to National Bureau of Standards units (NBS) to relate the color alterations (ΔEab) to the clinical environment which aids in determining a threshold for clinical acceptance of the color change. ΔEab data were analyzed and compared using one- and two-way ANOVA tests followed by Bonferroni’s post hoc test (α = 0.05). Results. Two-way ANOVA showed that filler type (regardless of filler concentration) had a statistically significant effect on mean ΔEab (P<0.001). Filler concentrations (regardless of filler type) showed a significant effect on mean ΔEab while the filler type and concentration interaction showed no significant effect on mean ΔEab (P<0.001). One-way ANOVA in terms of filler types results showed a significant difference between mean ΔEab (P<0.001), where TNP group showed the highest mean ΔEab followed by ZNP and SNP. Pair-wise comparison revealed that 3% concentration showed a significant lower mean ΔEab than 7% concentration (P<0.001). Conclusion. Modification of heat-polymerized denture base resin with ZNP, TNP, or SNP causes clinically unacceptable color change. TNP produced the highest color change followed by ZNP and SNP, and the color change is concentration dependent; the color change increases as the concentration increases