Chronic lymphocytic leukemia in Kenya: an immunophenotypic and clinicopathologic study

Objective: To define cases of chronic lymphocytic leukemia (CLL) by immunophenotypic criteria and describe the associated clinical features in patients diagnosed at Aga Khan University Hospital, Nairobi. Background: Rising to the growing cancer challenge will require improved diagnostic services. CLL is common in elderly patients. The current international standard in diagnosis incorporates findings of immunophenotyping. Facilities for immunophenotyping have generally been unavailable in Kenya. Method: A cross-sectional survey was conducted between August 2011 and April 2012. Potential cases were identified based on morphologic criteria. Consecutive samples were obtained and subjected to 3 colour immunophenotyping on a Cytomics FC 500 cytometer. CLL was defined using the Royal Marsden Hospital scoring system. Baseline clinical and diagnostic data were also obtained. Results: Forty nine cases met the eligibility criteria. Thirty one were known CLL cases, and 18 were newly diagnosed. Median age at diagnosis was 62 years. Male:female ratio was 1.3:1. Black patients (42/49) were more likely to present with high risk disease (Rai stages III–IV) and with higher lymphocyte counts than non-blacks at diagnosis. Twenty six point five percent of patients in this study were diagnosed in Rai stage 0. The prevalence of CD5/ CD23 co-expression was found to be 95.9%. CD5 was universally expressed, whereas CD23 was present in all but 2 cases. Both were associated with atypical morphology. Complete absence of light chain expression using a monoclonal antibody was found in 12.2% of cases. Five patients had their diagnosis revised. Of 31 patients on follow-up for CLL, only 5 had had any form of immunophenotyping done

Acute Leukemias Immunophenotypes at Agakhan University Hospital, Nairobi

Objective: The aim was to determine relative frequencies of acute  leukemia immunophenotypes using commonly expressed markers and to describe the clinicopathological characteristics.Design: This was a prospective cross-sectional study.Setting: The study was based at Aga khan clinical laboratory department.Subjects: One hundred and thirty two (132) consecutive blood and bone marrow specimens from patients suspected to have acute leukemia were analysed for cytomorphological characteristics and immunophenotyping. The clinical-pathological characteristics were also recorded. Immunological category was assigned using the EGIL criteria.Results: There were 88 AML and 42 ALL patients analysed for  immunophenotypes. Only tw cases of biphenotypic leukemia were found. The commonest overall AML morphological sub-type was AML-M2, 26 (29.5%). Majority of ALL cases were B-cell immunological sub-type (96.6%). Early pre-B phenotype constituted 62.07% and Common B-cell ALL 37.93%. There were only 4 cases of T-cell ALL. Majority of patientspresented with anaemia with a median hemoglobin of 7.5g/dl (range 2-15g/dl). The median platelet count was 55 (range 4-462 × 109/L).Conclusion: Immunophenotyping of acute leukemia is beneficial in accurate diagnosis of patients with these malignancies in this setup. T-cell ALL, AML-M6 and M7 are less frequent than what has been reported in most studies in Africa.Key words: acute leukemia, immunophenotype, WHO, EGIL, CD marker

High magnetic field studies of the Vortex Lattice structure in YBa2Cu3O7

We report on small angle neutron scattering measurements of the vortex lattice in twin-free YBa2Cu3O7, extending the previously investigated maximum field of 11~T up to 16.7~T with the field applied parallel to the c axis. This is the first microscopic study of vortex matter in this region of the superconducting phase. We find the high field VL displays a rhombic structure, with a field-dependent coordination that passes through a square configuration, and which does not lock-in to a field-independent structure. The VL pinning reduces with increasing temperature, but is seen to affect the VL correlation length even above the irreversibility temperature of the lattice structure. At high field and temperature we observe a melting transition, which appears to be first order, with no detectable signal from a vortex liquid above the transition

Unconventional gap structures and the intermediate mixed state: a vortex lattice study of the noncentrosymmetric superconductor BiPd

We report on neutron scattering measurements on the vortex lattice of the noncentrosymmetric superconductor BiPd. We observe the existence of the intermediate mixed state, a region where Meissner and vortex lattice phases coexist, which is a feature of low $\kappa$ Type-II superconductors. Following this, we obtain an estimate of the value of $\kappa$ using the extended London model, which confirms the expectation that $\kappa$ should be small. Finally, we find that the temperature dependence of the vortex lattice form factor fits well to a model designed to describe singlet-triplet mixing in non-centrosymmetric superconductors, which may shed light on the question of the gap structure in BiPd

Background Determination for the LUX-ZEPLIN (LZ) Dark Matter Experiment

The LUX-ZEPLIN experiment recently reported limits on WIMP-nucleus interactions from its initial science run, down to $9.2\times10^{-48}$ cm$^2$ for the spin-independent interaction of a 36 GeV/c$^2$ WIMP at 90% confidence level. In this paper, we present a comprehensive analysis of the backgrounds important for this result and for other upcoming physics analyses, including neutrinoless double-beta decay searches and effective field theory interpretations of LUX-ZEPLIN data. We confirm that the in-situ determinations of bulk and fixed radioactive backgrounds are consistent with expectations from the ex-situ assays. The observed background rate after WIMP search criteria were applied was $(6.3\pm0.5)\times10^{-5}$ events/keV$_{ee}$/kg/day in the low-energy region, approximately 60 times lower than the equivalent rate reported by the LUX experiment.Comment: 25 pages, 15 figure

A search for new physics in low-energy electron recoils from the first LZ exposure

The LUX-ZEPLIN (LZ) experiment is a dark matter detector centered on a dual-phase xenon time projection chamber. We report searches for new physics appearing through few-keV-scale electron recoils, using the experiment's first exposure of 60 live days and a fiducial mass of 5.5t. The data are found to be consistent with a background-only hypothesis, and limits are set on models for new physics including solar axion electron coupling, solar neutrino magnetic moment and millicharge, and electron couplings to galactic axion-like particles and hidden photons. Similar limits are set on weakly interacting massive particle (WIMP) dark matter producing signals through ionized atomic states from the Migdal effect.Comment: 13 pages, 10 figures. See https://tinyurl.com/LZDataReleaseRun1ER for a data release related to this pape

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

BONE MARROW EXAMINATION FINDINGS AT AGA KHAN UNIVERSITY HOSPITAL, NAIROBI

Objective: To establish the bone marrow examination findings and determine the indication for bone marrow examination.Design: A retrospective audit.Setting: Aga Khan University Hospital, Nairobi.Subjects: All bone marrow aspirates done at Aga Khan University for the period comprising February 2003 to February 2006 were retrieved and analysed.Results: A total of 356 patient’s case histories including bone marrow examination results were analysed. Ages of the patients ranged from 18 months to 91 years. Males were 180 (50.6%) and females were 176 (49.4%). Nutritional anaemia as a group was the most common haematological disorder found on bone marrow examination in ourpatients with megaloblastic anaemia predominating. Acute myeloid leukaemia was the most common malignant haematological disorder. The most common indication for bone marrow examination was anaemia followed by diagnostic work up of fever of unknown origin.Conclusion: Nutritional anaemia predominated as the commonest benign haematologicalfinding on bone marrow examination while acute myeloid leukaemia was the mostfrequent haematological malignancy. Most bone marrow examinations were performedon patients with anaemia