Correlation of initial blast and minimal residual disease with biological characteristics of acute leukaemia.

Introduction: Acute leukaemias (AL) are highly malignant neoplasms and responsible for a large number of haemopoietic cancerrelated deaths. Prognosis of AL is dependent upon various biological and clinical factors. There is growing body of evidence that supports minimal residual disease (MRD) values and initial blast count (IBC) at diagnosis in predicting treatment outcome and relapse risk in AL. However, there is scarcity of data on the relationship of IBC and MRD with biological characteristics [gender, age groups, AL types and immunophenotypic aberrancy (IA)]. Therefore, this study was designed to determine the correlation of IBC, MRD (post-induction chemotherapy) and biological characteristics of AL. Materials & Methods: This was a retrospective study involving all the 493 AL patients diagnosed at the Flow Cytometry Laboratory of UNIMAS from 2006 to 2014. Results & Discussion: The AL patients comprised 44.2% children and 55.8% adults with a male predominance (55.6%). The mean ages for children and adults were 5 and 45 years old, respectively. There were more AML (55.2%) than ALL (44.8%) cases. B-ALL and AML-M2 predominated the AL subtypes in children and adults, respectively. ALL patients showed significantly higher IBC (p£0.001) and MRD (p£0.001) levels than AML. Significantly higher IBC (p£0.001) and lower MRD (p=0.014) levels were observed in children, indicating a better response to treatment, as compared to adults. However, there was no significant difference in IBC and MRD found between genders. In addition, expression of IA was more common in AML than ALL (p=0.037). Conclusions: To the best of our knowledge, this was the first report of a significant negative correlation between IBC and MRD (r=-0.24, p=0.001), whereas IBC and MRD did not correlate significantly with IA. As MRD studies were more routinely performed in ALL, these findings reflected the successful management of ALL patients in our local clinical settings. Future studies should be embarked to further assess the value of IBC, MRD and IA in prognosticating the disease outcome among the local AL patients

Low prevalence of the BCR–ABL1 fusion gene in a normal population in southern Sarawak

The BCR–ABL1 fusion gene is the driver mutation of Philadelphia chromosome-positive chronic myeloid leukemia (CML). Its expression level in CML patients is monitored by a real-time quantitative polymerase chain reaction defned by the International Scale (qPCRIS). BCR–ABL1 has also been found in asymptomatic normal individuals using a non-qPCRIS method. In the present study, we examined the prevalence of BCR–ABL1 in a normal population in southern Sarawak by performing qPCRIS for BCR–ABL1 with ABL1 as an internal control on total white blood cells, using an unbiased sampling method. While 146 of 190 (76.8%) or 102 of 190 (53.7%) samples showed sufcient amplifcation of the ABL1 gene at>20,000 or>100,000 copy numbers, respectively, in qPCRIS, one of the 190 samples showed amplifcation of BCR–ABL1 with positive qPCRIS of 0.0023% and 0.0032% in two independent experiments, the sequence of which was the BCR–ABL1 e13a2 transcript. Thus, we herein demonstrated that the BCR–ABL1 fusion gene is expected to be present in approximately 0.5–1% of normal individuals in southern Sarawak

Antimicrobial susceptibility of bacteria isolated from various clinical specimens in a private hospital in Kuching - A retrospective study

Introduction: Antimicrobial resistance is an emerging global health problem that impacts quality of patient care. Bacterial spectrum and antimicrobial susceptibility vary among countries and regions. Selection of empirical antibiotic therapy should be guided by local microbial profile and antimicrobial susceptibility pattern. This retrospective study was conducted at Borneo Medical Centre in Sarawak to determine the profile of bacteria isolated from various clinical specimens with their antibiotic susceptibility patterns. Materials & Methods: All the 2728 clinical specimens sent for bacterial culture and sensitivity from January to December 2018 were included in this study. Clinical and laboratory data were extracted from the hospital digital database. Results & Discussion: There were 31.3% of samples yielded positive cultures. Most frequently isolated gram-positive bacteria were Staphylococcus spp. (19.8%), Streptococcus spp. (5.9%) and Enterococcus spp. (3.9%). Most frequently isolated gram-negative bacteria were Escherichia coli (20.4%), Pseudomonas spp. (12.8%) and Klebsiella spp. (11.3%). E. coli was the commonest pathogen isolated from urine and blood. Klebsiella spp. and Staphylococcus aureus were most isolated from sputum and wound, respectively. Ceftriaxone was sensitive against Klebsiella spp. (94.9%), E. coli (86.0%) and Pseudomonas spp. (50.0%). Ceftazidime was sensitive against Pseudomonas spp. (94.3%), Klebsiella spp. (91.3%) and E. coli (86.4%). S. aureus and Streptococcus spp. showed 100% sensitivity to vancomycin. Resistance rate of gram-negative bacteria to third generation cephalosporins was low (15.2%). Rates of MRSA (4.1%) and ESBL producing bacteria (1.9%) were also low. Conclusions: Antibiotic resistance rate of the commonly isolated bacteria in this study was low. The commonly used first-line antibiotics are still effective

Higher prevalence of harbouring BCR::ABL1 in first-degree relatives of chronic myeloid leukaemia (CML) patients compared to normal population

Abstract Background The role of familial influence in chronic myeloid leukaemia (CML) occurrence is less defined. Previously, we conducted a study to determine the prevalence of harbouring BCR::ABL1 in our local adult normal population (designated as StudyN). We present our current study, which investigated the prevalence of harbouring BCR::ABL1 in the normal first-degree relatives of local CML patients (designated as StudyR). We compared and discussed the prevalence of StudyR and StudyN to assess the familial influence in CML occurrence. Methods StudyR was a cross-sectional study using convenience sampling, recruiting first-degree relatives of local CML patients aged ≥ 18 years old without a history of haematological tumour. Real-time quantitative polymerase chain reaction standardised at the International Scale (BCR::ABL1-qPCRIS) was performed according to standard laboratory practice and the manufacturer’s protocol. Results A total of 96 first-degree relatives from 41 families, with a mean age of 39 and a male-to-female ratio of 0.88, were enrolled and analysed. The median number of relatives per family was 2 (range 1 to 5). Among them, 18 (19%) were parents, 39 (41%) were siblings, and 39 (41%) were offspring of the CML patients. StudyR revealed that the prevalence of harbouring BCR::ABL1 in the first-degree relatives was 4% (4/96), which was higher than the prevalence in the local normal population from StudyN, 0.5% (1/190). All four positive relatives were Chinese, with three of them being female (p > 0.05). Their mean age was 39, compared to 45 in StudyN. The BCR::ABL1–qPCRIS levels ranged between 0.0017%IS and 0.0071%IS, similar to StudyN (0.0023%IS to 0.0032%IS) and another study (0.006%IS to 0.016%IS). Conclusion Our study showed that the prevalence of harbouring BCR::ABL1 in the first-degree relatives of known CML patients was higher than the prevalence observed in the normal population. This suggests that familial influence in CML occurrence might exist but could be surpassed by other more dominant influences, such as genetic dilutional effects and protective genetic factors. The gender and ethnic association were inconsistent with CML epidemiology, suggestive of a higher familial influence in female and Chinese. Further investigation into this topic is warranted, ideally through larger studies with longer follow-up periods

Biological and clinical characteristics of COVID-19 cases detected in a private hospital in Kuching, Sarawak.

Introduction: Coronavirus Disease 2019 (COVID-19) is a contagious infection caused by highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through respiratory droplets. Since its first reported case in December 2019, it has spread rapidly across the globe causing a pandemic. The biological and clinical characteristics of COVID-19 provide an important scientific basis for effective epidemic prevention and control in the local community. Therefore, this cross-sectional study was conducted in a private hospital in Sarawak. Methods: All the 5621 laboratory-confirmed COVID-19 cases detected from August-December 2021 were recruited into this study. Results: The cases were racially diverse with almost equal male-to-female ratio. Most cases were adults (93%), fully or partially vaccinated (88.2%) with a mean age of 37.61 years. Symptomatic cases accounted for 75.1% of the total cases. The three most common presenting symptoms were cough, runny nose and fever. Olfactory and gustatory dysfunction were more common in adults while gastrointestinal symptoms were mainly seen in children. The median duration from onset of symptoms to molecular diagnosis was 3 days. Patients who were unvaccinated, symptomatic and having comorbidities demonstrated significantly lower cycle threshold (Ct) values. Ct values (E and N genes) correlated negatively with age, indicating higher infectivity in older patients. Conclusion: This report summarised the baseline biological and clinical characteristics of mild COVID-19 cases in Sarawak. Our findings showed that despite widespread awareness, patients did present late for testing, which might contribute to sustained viral transmission in the community. Hence, this highlights the importance of vaccination to reduce the occurrence of severe cases