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