2020 CiteScore: 2.6
Ardeshir Ghavamzadeh, MD.
Vol 12, No 1 (2018)
Background: Abiraterone acetate was approved by FDA and EMA in April and September 2011, respectively for treatment of patients with casteration resistant prostate cancer and those previously treated with docetaxel. It is a selective inhibitor of androgen biosynthesis which potentially and irreversibly blocks CYP17, a crucial enzyme in oestrogen and testosterone synthesis.
Materials and Methods: This retrospective study was conducted to evaluate the safety and efficacy of abiraterone acetate in the treatment of castration resistant prostate cancer patients. Twenty-two male patients diagnosed with CRPC and experienced treatment failure with one or more lines of treatment (hormonal manipulation or chemotherapy) were selected and administered abiraterone acetate (1,000 mg daily) along with prednisone (5 mg twice daily).
Results: Out of 22 patients, 32% had a good response in reduction of PSA values, while 22% had progression in disease and 45% had a stable disease. Potassium, Haemoglobin, and serum sreatinine levels were not affected by the drug. Due to severe GI intolerance, the drug had to be stopped for one patient. The results of this study showed that abiraterone acetate significantly lowered the PSA values and prolonged progression- free survival in metastatic castration resistant prostate cancer patients who had progressed after first-line or second-line treatment. The overall average median survival and the median duration of drug exposure for CRPC who received AA was found to be 11.1 months [range 3−18]. Since AA plus prednisolone are available as oral dosage forms, they can be given in outpatient setting.
Conclusion: Abiraterone acetate is a drug of choice for CRPC and also for those who had previously received one or two chemotherapy regimens. Since it is a new therapeutic regimen, this study included small sample size, but there are a few studies indicating the therapeutic efficacy of AA among patients with castration-resistant prostate cancer.
Background: Chronic myeloid leukemia (CML) is a hematological disorder caused by fusion of BCR and ABL genes. BCR-ABL dependent and independent pathways play equally important role in CML. TGFβ-Smad pathway, an important BCR -ABL independent pathway, has scarce data in CML. Present study investigate the association between TGFβ-Smad pathway and CML.
Materials and Methods: Sixty-four CML patients and age matched healthy controls (n=63) were enrolled in this study. Patients were segregated into responder and resistant groups depending on their response to Imatinib mesylate (IM). TGFβ1 serum levels were evaluated by ELISA and transcript levels of TGFβ1 receptors, SMAD4 and SMAD7 were evaluated by Real-Time PCR. Sequencing of exons and exon-intron boundaries of study genes was performed using Next Generation Sequencing (NGS) in 20 CML patients. Statistical analysis was performed using SPSS version 16.0.
Results: TGFβ1 serum levels were significantly elevated (p = 0.02) and TGFβR2 and SMAD4 were significantly down-regulated (p = 0.012 and p = 0.043 respectively) in the patients. c.69A>G in TGFβ1, c.1024+24G>A in TGFβR1 and g.46474746C>T in SMAD7 were the most important genetic variants observed with their presence in 10/20, 8/20 and 7/20 patients respectively. In addition, TGFβR1 transcript levels were reduced in CML patients with c.69A>G mutation. None of the genes differed significantly in terms of expression or genetic variants between responder and resistant patient groups.
Conclusion: Our findings demonstrate the role of differential expression and genetic variants of TGFβ-Smad pathway in CML. Decreased TGFβR2 and SMAD4 levels observed in the present study may be responsible for reduced tumor suppressive effects of this pathway in CML.
Background: Epidemiologic studies indicated that dietary pattern plays a determinant role in cancer incidence. They also indicated that 1/3 of cancers are associated to foods. Diet contains different carcinogenic agents: naturally occurring chemicals, synthetic components and compounds produced during cooking such as kebab. This traditional food is one of the most popular foods in the Middle East, particularly in Iran. Red meat, especially lamb or veal, is the most common meat used in preparation of kebab. Since kebab is considered as a food containing carcinogenic compounds, so the purpose of this study was to assess the consumption pattern of kebab in a sample of Iranian adults and its relationship with demographic characteristics.
Materials and Methods: This cross-sectional study was conducted between March and April 2015 on 705 Iranian adults who were living in Kermanshah province in the west of Iran. Subjects were selected randomly from different districts of Kermanshah. Data were collected through a questionnaire survey which had been designed by academic members of Department of Nutrition at Kermanshah University of Medical Sciences. Data analysis was performed using SPSS Version 20. The results were expressed as mean ± SD. Student’s t-test, ANOVA and chi-square tests were performed to compare the study groups. The normality of data was assessed using the Kolmogorov-Smirnov test. All results were analyzed using a significance level of P <0.05.
Results: The results indicated that nearly 60% of subjects have a high tendency to consume kebab. The average of kebab consumption among the participants in this study was 4 times per month. Nearly, 85% of study participants tended to consume kebab with a large amount of salt. The chi-square test determined the significant difference between education and tendency to consume kebab; individuals with higher level of education had more tendency to consume kebab than those having lower level of education (p=0.021). In this study, 93.9% of participants used charcoal, a cooking fuel, to prepare kebab.
Conclusion: The results of this study point out that the study participants, regardless of socio-economic status, consume high amounts of kebab, and thus this unhealthy eating habit will increase the risk of carcinogenesis. Therefore, the immediate attention of Public Health Officials is required.
Background: Diagnosis of myelodysplastic syndromes (MDS) is challenging in the presence of morphological mimickers. Flow cytometric immunophenotyping (FCI) has been added to the diagnostic armamentarium, but its use in clinical practice is variable.
Materials and Methods: Bone marrow aspirate samples from 54 patients with a clinical and/or morphological suspicion of MDS were subjected to FCI using a single-tube, 6-colour panel comprising of monoclonal antibodies against CD13, CD11b, CD16, CD34, CD45 and CD56. Analysis was centered on the abnormal maturation pattern of granulocytes, blast percentage (≥3%) and ratio of side scatter peak channel value (SSC-PCV) of granulocytes and lymphocytes. Each of these parameters was assigned a score of 1. Overall sensitivity and specificity of this panel was ascertained to differentiate cytopenia/s of MDS from non-MDS cases.
Results: Forty MDS and 14 non-MDS cases were diagnosed based on morphology and cytogenetic results. Twenty control samples were also processed simultaneously for FCI to assign the cutoff for various flow cytometric parameters. A score ≥2 was defined as positive for MDS. Hypogranularity was present in 62.5% cases of MDS. The median SSC-PCV of granulocytes and lymphocytes was 6.16 in the MDS group, 7.9 in the non-MDS group and 8.90 in the control group (p <0.05). This cut-off value of 6.16 had a specificity of 92.5% based on the ROC curve analysis. Abnormal granulocyte maturation patterns for CD13/16, CD13/11b and CD11b/16 dot plots were observed in 95.3, 69.8 and 74.4% cases, respectively. The overall sensitivity and specificity of the panel was found to be 87.5% and 64.2%, respectively.
Conclusion: FCI is now an important tool for diagnostic workup in patients presenting with persistent cytopenia with or without morphological evidence of dyspoiesis. Inclusion of objective parameters like SSC-PCV would also reduce inter-lab variability in MDS diagnosis.
Background: Some of the red cell storage lesions (RCSLs) take place during red blood cell (RBC) storage and may reduce the function of these cells dramatically, which mostly caused by residual leucocytes in blood components. This study was planned to observe the biochemical and hematological changes in pre-storage leukoreduced RBC (LR-RBC) compared with unfiltered RBC during in vitro storage.
Materials and Methods: Ten unit RBCs were collected, processed and stored according to Iranian standard operating procedure (SOP) of Iranian Blood Transfusion Organization (IBTO). Every unit was split into two equal parts, unfiltered RBC and LR-RBC. Samples were collected and tested on weeks of storage. Biochemical parameters such as lactate dehydrogenase (LDH), lactate concentration and glucose-6-phosphate dehydrogenase (G6PD) enzyme activity were measured by auto-analyzer. In addition, hematology analyzer was used to monitor the change of RBC indices such as (MCV), (MCH) and (MCHC).
Results: In this study, both groups showed progressive increase of LDH and lactate levels, and also G6PD activity decreased during storage. Mean of LDH and lactate in unfiltered RBC was significantly increased compared with LR-RBC during all days of storage (p< 0.05). There was statically significant decrease in the G6PD enzyme activity between the two groups and weeks of storage (p< 0.05). However, the RBC indices remained within the expected levels in both groups.
Conclusion: LR-RBC and RBC both exhibited RCSL during storage, but LR-RBC is effective in reducing Red cell storage lesion (RCSL) and also improves the quality of stored red blood cells.
Background: Glanzmann Thrombasthenia (GT) is a rare autosomal disease. HPA (Human Platelet Alloantigen) is a surface polymorphic alloantigen of platelets. This study was intended to investigate and compare the polymorphism of HPA-1 and HPA-5 genes in two groups of GT patients, with and without resistance to platelet and recombinant factor VII therapy.
Materials and Methods: This case control study was performed on GT patients (n=16) with resistance to platelet therapy and recombinant factor VII and control group of GT patients (n=16) without resistance to platelet therapy and recombinant factor VII. The consent form was completed by each patient. Gene polymorphisms of HPA-1 and HPA-5 were investigated using SSP-PCR, and the obtained data were analyzed using statistical software SPSS16.0.
Results: The results indicated no significant relationship between the studied genes and their resistance to platelet therapy and recombinant factor VII. The frequencies of HPA-1 genotype a/a were 98% and 94% in patient and control groups, respectively. The frequency of allele b was found to be less than allele a. The value of this allele was 4% in patient group and 1% in control group. In addition, the HPA-5a/a (98%) was the most frequent alloantigen?? (check it) in both groups. Seven percent (7%) of the patients had the HPA-5a/b genotype, and the HPA-5b/b was found to be absent in these individuals.
Conclusion: According to the results obtained, it could be concluded that these genes play no role in resistance to platelet therapy.
Background: Acute leukemia is a common pediatric cancer. Novel strategies for treatment of acute leukemia have been developed, but treatment resistance has remained as the most problematic issue. It is hypothesized that the HO-1 gene up-regulation is responsible for tumor resistance to chemotherapy or radiotherapy-induced apoptosis. HO-1 expression levels have been related to (GT)n microsatellite polymorphisms in the location of its promoter.This study designed to compare allelic frequencies of (GT)n microsatellite polymorphisms in HO-1 gene between acute leukemia patients and healthy controls. Indeed, 3-year disease-free survival was also evaluated.
Materials and Methods: The study included 63 acute leukemia patients and 70 healthy infants. We used patient’s medical records to collect data regarding the post-chemotherapy survival. The number of GT repeats in HO-1 promoter was determined by an ABI 3100 sequencer.
Results: The HO-1 GT repeats ranged from 14 to 34 with peaks at 27 repeats in both cases and controls. Children with longer alleles ((GT)n ≥ 27) had enhanced 3-year survival rate after treatment with chemotherapy or radiotherapy (P<0.05).
Conclusion: Although no significant differences were observed between leukemia patients and controls regarding allelic frequency, we found elevated frequency of “LL” genotype in leukemia patients with good 3-year surveillance. Radiotherapy and chemotherapy might elevate the expression levels of HO-1 with subsequent increased resistance of leukemia patients to therapy.
Background: Hodgkin's lymphoma (HL) is a unique cancer of lymphocytes that has unknown reason. As lymphocytes are found throughout the lymphatic system, HL can start almost anywhere in the body. It usually starts in a group of lymph nodes in one part of the body; it usually spreads in a predictable form, from one group of lymph nodes to the next. Eventually, it can spread to almost any tissue or organ in the body through the lymphatic system or the bloodstream. So it's important to evaluate the prognostic factors of mortality and recurrence. The aim of this study is to use multistate model to consider the event history of patients and assess important prognostic factors.
Materials and Methods: We performed a retrospective review on 389 patients with Hodgkin's disease referred to the Oncology and Hematology Center, Shafa Hospital, Ahvaz during 2002 and 2012. An illness – death model was fitted to assess the hazard of transitions during the course of the disease for each prognostic factor.
Results: The results showed that the prevalence rate was higher in male population ≥50 years of age with a hemoglobin level of less than 10.5 g per deciliter and diagnosis of advanced stage of disease. The risk of death for males was twice more than females (HR=2.07). Moreover, patients with mediastina and spleen involvement were more than others in danger of death (1.66 and 1.36, respectively).
Conclusion: In conclusion, the multistate model offers an appropriate method to consider the event history of patients and determine main prognostic factors, which play an important role in rapid diagnosis and choosing the best treatment choice for each patient.
Background: Although fatigue is the most important symptom of Sickle Cell Disease, the extent of it is unknown, and causal mechanisms are not well understood. This article explores biopsychosocial characteristics that can potentially contribute to fatigue in SCD.
Materials and Methods: This cross-sectional, correlational study included 97 SCD patients who aged over 16 years and had records in Thalassemia Ward and Clinic of Shafa Hospital affiliated to Ahvaz University of Medical Sciences, Ahvaz, Iran. Data were collected from a self- reported demographic questionnaire, measuring depression, anxiety stress scale (DASS-21) and fatigue severity scale (FSS). Data analysis was done by descriptive statistics, independent sample t-tests, Pearson's correlation coefficient, one-way ANOVA and multiple stepwise regression.
Results: More than 50% of study participants were mostly single women. A majority of patients had a diagnosis of HgbSS disease. Levels of depression, anxiety and stress were severe in more than half of the participants. About 65% of SCD patients reported signs of fatigue. Moreover, fatigue, depression, anxiety and stress had a high intercorrelation. Depression, blood transfusion, renal diseases and work status were predictors of fatigue according to the models used in this survey.
Conclusion: The results of the study indicated that SCD patients who had depression, blood transfusions, SCD-related renal complications, students and working people experienced more fatigue. So, if fatigue is present, it is important to recognize the existence of these conditions or vice versa. Routine assessment and improved management of fatigue, effective interventions to reduce fatigue, are highly recommended for patients with SCD.
Serpentine supravenous hyperpigmentation (SSH) is a rare vasculo-cutaneous entity that has been associated with peripheral infusion of chemotherapy agents, in particular 5-FU1-3,but also seen with docetaxel4,5, fotemustine6, and vinorelbine7. It consists of a marked hyperpigmentation along the superficial network of veins proximal to the chemotherapy infusion site and was originally described in a 1976 case report in association with 5-FU1. Here, for the first time, we report SSH in association with R-CHOP chemotherapy
Neurologic symptoms are quite common in multiple myeloma, but direct invasion of central nervous system is extremely rare. Leptomeningeal multiple myeloma, as a rare neurological manifestation of multiple myeloma, presents with impairment of consciousness, cranial nerve palsies and convulsions. Here, we describe a 52-year- old male patient, known case of multiple myeloma, who presented with bilateral visual loss and difficulty in swallowing.
Clear cell sarcoma (CCS), a deep-rooted tumor with a predilection for lower extremities, has a proclivity to involve the tendons and aponeuroses. This sarcoma is seen predominantly around the foot and ankle region. Diagnosis is mainly finalized using histological and immunohistochemical assessment. The main treatment strategy is surgery followed by chemotherapy. An erratic challenge is posed by histological similarity and immunohistochemical overlap to the diagnosis and distinguishing of clear cell sarcoma from primary or metastatic malignant melanoma (MM) which is more common. Here, we described a CCS case located in the left leg of a 37-year-old male patient.
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