Clinical Staging and Flowcytomteric CD38 and Zap 70 Prognostic Indicators in Sudanese Patients with Chronic Lymphocytic Leukemia

Background: The clinical course of chronic lymphocytic leukemia is highly variable. The determination of ZAP70 and CD38 is increasingly utilized as prognostic factor for chronic lymphocytic leukemia. The aim of conducting this study was to investigate the frequency of CD38 and ZAP70 expression among Sudanese Chronic lymphocytic leukemia (CLL) patients and to relate them to the Binet and Rai clinical staging systems. Method: A total of 93 patients (mean age; 62.29 ± 11.68, sd) were enrolled in this cross-sectional study. CD38 and ZAP70 expression levels were measured with four color flowcytometry using the cut-off values of 20% for ZAP70 and 30% for CD38 expression. Staging was assessed by using clinical examination and CBC for all patients. Data were analyzed using the Statistical Package for Social science for Windows (SPSS), version 22. Results: There were 93 CLL patients and the median age of the group was 63 years (36–95 years). About 71% of the patients presented with lymphadenopathy, 53.8% with splenomegaly, 73.1% with anemia, and 45.2% with thrombocytopenia. There was higher frequency of Binet stage C and Rai stage IV (62 [66.6%] patients and 34 [36.5%] patients, respectively). In addition, CD38 and ZAP70 showed higher frequency among Binet and Rai advance stages. ZAP70 and CD38 positivity were detected in 21 patients (22.6%) and 31 patients (33.3%), respectively. There was no statistically significant association between ZAP70 and CD38 and clinical staging systems (P-value > 0.05). Conclusion: No significant association was observed between Flowcytometric (CD38 and Zap70) Prognostic Indicators and clinical staging systems. Keywords: chronic lymphocytic Leukemia, Flowcytometry, ZAP70, CD38, clinical staging system

ZAP-70 Expression in B-Chronic Lymphocytic Leukemia in Sudanese Patients

Background: Chronic lymphocytic leukemia is the most common form of leukemia in adults. The prognostic impact of ZAP-70 in CLL has been reported in several studies. The aim of conducting this study was to investigate the prevalence of ZAP-70 in Sudanese patients with chronic lymphocytic leukemia attending Khartoum Oncology Hospital.Materials and Methods: A total of 93 newly diagnosed patients with chronic lymphocytic leukemia were enrolled in this study. Lymphadenopathy and organomegaly were assessed in all participants using clinical examination, chest radiography, and abdominal ultrasound. Full blood count was carried out by an automated hematology analyzer. ZAP-70 was evaluated using flowcytometry on peripheral blood samples. ZAP-70 was defined as positive expression at a cutoff level of 20%. Results: There were 63 (67.7%) males and 30 (32.3%) females and the median age of the group was 63 years; 68 patients (73.1%) were presented with anemia and 66(70.9%) had lymphadenopath;y. Majority of our patients 35 (37.6%) were in Rai stage IV. ZAP-70 positivity was detected in 21 patients (22.6%). There was no statistically significant association of ZAP-70 with age, sex, lymphadenopathy, organomegaly, hemoglobin concentration, total white blood cell count, platelet count and Rai staging system (p-value > 0.05). Conclusion: Only 21 patients (22.6%) were ZAP-70 positive. There was no association between ZAP-70 and the study variables. Further studies to evaluate prognostic role of ZAP-70 in Sudanese patients with chronic lymphocytic leukemia are recommended

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of CD38 expression in Sudanese patients with chronic lymphocytic leukemia

Abstract Objective The objective of this study was to evaluate the cluster of differentiation-38 (CD38) expression in Sudanese patients with chronic lymphocytic leukemia (CLL) and to determine its association with clinical and laboratory characteristics of the disease. Results We conducted a cross-sectional study on 99 patients diagnosed with CLL in Khartoum Oncology Hospital in Khartoum, Sudan. Immunophenotyping and CD38 expression levels were measured with four-color flowcytometry. The results of physical examination and blood analyses were used for assigning a modified Rai clinical staging system. The collected data were analyzed using the Statistical Package for the Social Science, version 22 (SPSS Inc., Chicago, IL, USA). According to our findings, the frequencies of 7%, 20%, and 30% cutoff levels of CD38 expressions were 68.7%, 41.4%, and 36.4% respectively. CD38 cutoff level of 7% showed a significant association with hemoglobin concentration (P = 0.04), whereas other cutoff levels showed insignificant results. All the three cutoff levels showed insignificant associations with the other clinical and laboratory variables. In conclusion, the CD38 expression at a cutoff level of 7% seems to be more valuable clinically than higher cutoff levels in Sudanese CLL patients

Clinical presentation and hematological profile among young and old chronic lymphocytic leukemia patients in Sudan

Abstract Objective To assess the clinical presentation and hematological profile among young (≤ 55 years) and old (> 55 years) chronic lymphocytic leukemia patients in Sudan. Result In the present cross-sectional descriptive study, out of 110 cases studied, among them 31 (28.2%) were young (≤ 55 years) patients with mean age 48 years, and 79 (71.8%) were elder patients (> 55 years) with mean age 66 years, the overall mean age was 62.97 ± 12.06 with range (22–85 years), and 79 (71.8%) were males and 31 (28.2%) were females (M:F = 2.6:1) (P = 0.000). (7.3%) were asymptomatic, 61 (55.5%) presented with nonspecific complains. Generalized lymphadenopathy was seen in 52 (47.27%) with elder predominance (P = 0.03). Splenomegaly, hepatomegaly, thrombocytopenia and anemia were seen in 54 (49.1%), 14 (12.7%), 43 (39.1%) and 38 (34.5%) of patients respectively with male predominance. 54 (49.1%) and 42 (38.18%) of patients presented at Rai high risk and Binet C stages respectively with nearly same age and sex distribution. CLL in Sudan is a disease of elders, same as seen in literature, with high male to female ratio. In general hematological parameters means were noted to be distributed equally according to age and sex groups. Majority of patients were presented with nonspecific symptoms and nearly half of patients presented at late stages as reported in most developing countries

Para influenza virus 3 infection in cattle and small ruminants in Sudan

Objective: This study was aimed at elucidating the association between Para influenza virus 3 (PIV3) and respiratory infections in domestic ruminants in different areas of Sudan. Materials and methods: During 2010-2013, five hundred sixty five lung samples with signs of pneumonia were collected from cattle (n=226), sheep (n=316) and goats (n=23) from slaughter houses in different areas in Sudan. The existence of PIV3 antigen was screened in the collected samples using ELISA and Fluorescent antibody technique. PIV3 genome was detected by PCR, and sequence analysis was conducted. Results: Positive results were found in 29 (12.8%) cattle, 31 (9.8%) sheep and 11 (47.8%) goat samples. All the studied areas showed positive results. Highest prevalence (66.7%) was detected in the sheep and goats in Khartoum, followed by in goats in Nyala (33.3%) at western Sudan. Sequence analyses of PIV3 of different regions of Sudan indicated that these were similar in sequence and length. The BLAST analysis indicated that the test sequences were closely related to the available annotated sequences at the GenBank. All these sequences matched with Bovine parainfluenza virus 3 except two those were matching with Swine parainfluenza virus 3. Conclusion: The results prove the existence of PIV3 infection in cattle, sheep and goats in the studied areas in Sudan and suggest its possible role in the respiratory infections. Genetic analysis indicate that the virus is mostly similar with bovine PIV3. [J Adv Vet Anim Res 2016; 3(3.000): 236-241