Immunophenotypic characterization of leukemic stem cells in acute myeloid leukemia using single tube 10-colour panel by multiparametric flow cytometry: Deciphering the spectrum, complexity and immunophenotypic heterogeneity.

INTRODUCTION: Despite extensive research, comprehensive characterization of leukaemic stem cells (LSC) and information on their immunophenotypic differences from normal haematopoietic stem cells (HSC) is lacking. Herein, we attempted to unravel the immunophenotypic (IPT) characteristics and heterogeneity of LSC using multiparametric flow cytometry (MFC) and single-cell sequencing. MATERIALS AND METHODS: Bone marrow aspirate samples from patients with acute myeloid leukaemia (AML) were evaluated using MFC at diagnostic and post induction time points using a single tube-10-colour-panel containing LSC-associated antibodies CD123, CD45RA, CD44, CD33 and COMPOSITE (CLL-1, TIM-3, CD25, CD11b, CD22, CD7, CD56) with backbone markers that is, CD45, CD34, CD38, CD117, sCD3. Single-cell sequencing of the whole transcriptome was also done in a bone marrow sample. RESULTS: LSCs and HSCs were identified in 225/255 (88.2%) and 183/255 (71.6%) samples, respectively. Significantly higher expression was noted for COMPOSITE, CD45RA, CD123, CD33, and CD44 in LSCs than HSCs (p < 0.0001). On comparing the LSC specific antigen expressions between CD34+ (n = 184) and CD34- LSCs (n = 41), no difference was observed between the groups. More than one sub-population of LSC was demonstrated in 4.4% of cases, which further revealed high concordance between MFC and single cell transcriptomic analysis in one of the cases displaying three LSC subpopulations by both methods. CONCLUSION: A single tube-10-colour MFC panel is proposed as an easy and reproducible tool to identify and discriminate LSCs from HSCs. LSCs display both inter- and intra-sample heterogeneity in terms of antigen expressions, which opens the facets for single cell molecular analysis to elucidate the role of subpopulations of LSCs in AML progression.

Acute myeloid leukemia with RAM immunophenotype: A new underdiagnosed entity.

INTRODUCTION: Acute myeloid leukemia (AML) with RAM immunophenotype is a distinct subtype of AML, as described by the Children's Oncology Group (COG), with characteristic morphological and immunophenotypic properties. It is characterized by strong CD56 expression with dim to negative CD45, HLA-DR, and CD38 expression. It is an aggressive leukemia with a poor response to induction chemotherapy and/or frequent relapses. METHODS: Seven cases with the characteristic RAM immunophenotype were identified in this retrospective analysis of newly diagnosed pediatric AML cases from January 2019 to December 2021. Herein, we have critically analyzed their clinical, morphological, cytochemical, immunophenotyping, cytogenetic, and molecular profiles. The patients were traced and followed for their current disease and treatment status. RESULTS: Of 302 cases of pediatric AML (age <18 years), seven cases (2.3%) with the distinct RAM phenotype were observed, with age ranging from 9 months to 5 years. Two patients were misdiagnosed earlier as small round cell tumor because of the strong CD56 positivity and the absence of leukocyte common antigen (LCA), but they were later correctly identified as granulocytic sarcoma. The bone marrow aspirate showed blasts with unusual cohesiveness and clumping with nuclear moulding, mimicking non-hematologic malignancies. Flow cytometry revealed blasts with low side scatter, dim to negative CD45 and CD38, negative cMPO, CD36, and CD11b; moderate to bright CD33, CD117, and bright CD56. The Mean fluorescence intensity (MFI) of CD13 expression was significantly lower as compared to the internal controls. Cytogenetic and molecular studies did not show any recurrent abnormalities. Reverse transcription polymerase chain reaction for CBFA2T3-GLIS2 fusion was performed in 5/7 cases, with one positive result. On clinical follow-up, two patients were refractory to chemotherapy. Six of the seven cases had succumbed to death (duration of survival: 3-343 days after initial diagnosis). CONCLUSION: AML with RAM immunophenotype, a distinct form of pediatric AML with a poor prognosis, may pose a diagnostic challenge if presented as a soft tissue mass. A comprehensive immunophenotypic evaluation, including stem cell and myeloid markers, is critical for an accurate diagnosis of myeloid sarcoma with the RAM-immunophenotype. Our data demonstrated weak CD13 expression as an additional immunophenotypic finding.

Thermal plasma processing of Moringa oleifera biochars: adsorbents for fluoride removal from water.

Anthropogenic activities accelerate fluoride contamination in groundwater, which largely affects public health. Though biochars have been explored for defluoridation, the plasma technology-based production of biochars has not received as considerable attention as other methods and it is also important that biochars be tested on groundwater samples. In the present study, for the first time, we report the preparation of biochars from different parts of Moringa oleifera using thermal plasma processing and demonstrate fluoride adsorption in both synthetic and contaminated groundwater. Water samples were collected from different locations in Nuapada district of Odisha such as Kotamal-Makardampada (20°24'46''N 82°37'19''E), Pandrapathar (20°34'41''N 82°39'25''E), Karlakot-Kadobhata (20°22'52''N 82°37'24''E), Kotamal-Jhakarpada (20°24'35''N 82°37'20''E), and Dohelpada (20°33'50''N 82°38'57''E). The Moringa leaf samples are processed at 1600 °C for 3 min in an inert atmosphere under a continuous flow of argon to get suitable biochars. The plasma-synthesized biochars contain larger exposed surfaces, which are efficient for the adsorption of fluoride. The prepared biochars were highly porous, amorphous, and contain > 72% carbon, which increases the efficiency of defluoridation due to the surface adsorbate site exposed. XRD of the samples showed the presence of calcium hydroxide, magnesium oxide, and calcium oxide, and large peaks of carbon. Raman data showed the double bond of carbon with oxygen in the form of carbonyl bonds, thioether, and sulfhydryl bonds, which contribute to the protonated site for the adsorption of fluoride, and assist in water penetration and swelling of biochars. The biochar of Moringa oleifera is very efficient for the adsorption of fluoride from standard samples as well as groundwater samples up to a concentration of 6 ppm. Conclusively, the present investigation shows that Moringa oleifera leaves are a good alternative adsorbent that could be used for the removal of fluoride from groundwater samples with > 85% removal in 18 h using 1 g biochar for 100 mL or 10 g biochar for 1 L water containing 4 ppm fluoride. To our knowledge, this is the first report on the thermal plasma-based production of Moringa biochars for the removal of fluoride from drinking water.

CD34 negative HLA-DR negative acute myeloid leukaemia: A higher association with NPM1 and FLT3-ITD mutations.

INTRODUCTION: CD34 and HLA-DR negativity is often used as a characteristic immunophenotypic feature of acute promyelocytic leukaemia (APL) that differentiates APL from other subtypes of acute myeloid leukaemia (AML). However, other subtypes of AML, without expression of CD34 and HLA-DR antigens, have also been reported. METHODS: We analysed the HLA-DR negative de novo non-APL AML cases by dividing HLA-DR negative non-APL group into 2 sub-groups based on CD34 expression and compared the characteristics of CD34 negative HLA-DR negative with CD34 positive HLA-DR negative non-APL AML cases with respect to morphologic, immunophenotypic, molecular and clinical parameters. RESULTS: There were 70 cases (8.54%) which were CD34 negative HLA-DR negative and 52 cases (6.34%) were CD34 positive HLA-DR negative. The median age at diagnosis was higher in CD34 negative HLA-DR negative AML than in CD34 positive HLA-DR negative AML group (38 years vs. 12 years, p < 0.001). DIC rate was higher in CD34 negative HLA-DR negative group than the other group (p < 0.001). Median total leucocyte count was higher with higher blast count in peripheral blood and bone marrow in CD34 negative HLA-DR negative AML cases than the other group (p < 0.05). CD34 negative HLA-DR negative AML was more associated with normal karyotype (96.2% vs. 38.5%; p < 0.001), NPM1 mutation (67.8% vs. 8.3%; p < 0.001) and FLT-ITD mutation (37.3% vs. 13.9%; p < 0.05). In CD34 negative HLA-DR negative group, 16 cases had co-occurrence of NPM1 and FLT3-ITD mutations, whereas no case of CD34 positive HLA-DR negative group had such dual mutation positivity. There was poor median overall survival [3.8 months (95%CI: 2.3-7.8 months) vs. 20.4 months (95% CI: 12.8-25.7 months); p = 0.0148] in CD34 positive HLA-DR negative AML than CD34 negative HLA-DR negative AML cases. CONCLUSION: We found that the CD34 negative HLADR negative non APL AML is highly associated with NPM1 and FLT3-ITD mutation, older age at diagnosis, DIC, higher total leucocyte count, higher blast counts and normal karyotype in comparison to CD34 positive HLA-DR negative AML group. Co-occurrence of NPM1 and FLT3-ITD mutation was also exclusively seen in CD34 negative HLA-DR negative group. There was poor overall survival in CD34 positive HLA-DR negative AML than CD34 negative HLA-DR negative AML cases.

Utility of CD229 as novel marker in measurable residual disease assessment in multiple myeloma-An evidence-based approach.

INTRODUCTION: CD229 has been found to be a useful plasma cell (PC) gating marker in multiple myeloma (MM). This study analyses the expression profile of CD229 on various bone marrow compartments namely, PC, non-PC and hematogones (HGs) using Multiparameter flow cytometry (MFC). Furthermore, it evaluates the ability of CD229 to delineate normal PC (NPC) from aberrant PC (APC) in measurable residual disease assessment (MRD) in MM. METHODS: Bone marrow aspirates from patients diagnosed with MM (per standard IMWG criteria) were collected in EDTA and processed for MFC using a single tube 14-color antibody panel as per standard operating procedure. RESULTS: A total of 74 patients with a diagnosis of MM (26 treatment naïve and 48 on therapy) were evaluated. The expression of CD229 was homogenous on both the PC and HG compartments as compared to CD138 and CD38. On comparing the expression of individual markers, it was found to be statistically significant between PC, HGs and non-PC for all three markers (p < 0.001). APC showed lower median expression of CD38 and higher median expression of CD138 and CD229 as compared to NPC and was found to be statistically significant for all markers (p < 0.001). In terms of differential expression on NPC and APC; CD38 was found to be the most aberrantly expressed (70%; 52/74) followed by CD229 (7%; 5/74) and CD138 (5%; 4/74). CONCLUSIONS: CD229 can be used for the identification of PC and due to relatively homogenous expression; it can be used as a suitable marker for targeted therapies. However, precise discrimination of NPC from APC cannot be reliably achieved with CD229, limiting its utility as a useful marker of diagnostic relevance and MRD assessment in MM.

Histopathological Changes in Placenta of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) Infection and Maternal and Perinatal Outcome in COVID-19.

Background: Whether vertical transmission or placental pathology occurs after maternal infection during pregnancy remains unknown. There is a clear need for studies on the impact of COVID-19 on pregnancy outcome. A systemic inflammatory or hypercoagulable state may be the contributing factor for placental pathology. Methods: The pregnant women with COVID-19 who delivered between May 2020 and May 2021 were followed and data were collected about pregnancy course and placentas were examined for macro- and microscopical changes and were compared to controls with non-infected women. Results: Placenta of COVID-19-infected females had increased prevalence of decidual arteriopathy and placental injury reflecting hypoxia and uteroplacental insufficiency within the intervillous space. Features of maternal vascular malperfusion such as increased syncytial knots were present in 100% cases. Fibrinoid necrosis was seen in 100% cases and increased focal perivillous fibrin depositions were presented in 37.7% cases. About one fourth infected placentas had evidence of villitis. Even after matching for comorbidities like preeclampsia, these changes were present. Conclusion: The most common pathological findings of the placenta of COVID-19 infections are signs of maternal and fetal malperfusion. Future studies should target infections in different stage of gestation, including first and second trimesters.

Relevance of polyclonal plasma cells and post-therapy immunomodulation in measurable residual disease assessment in multiple myeloma.

BACKGROUND: Immunophenotypic profile and post-therapy alteration in antigenic expression were evaluated in normal, reactive, and aberrant plasma cells (NPC, RPC, and APC) for impact on measurable residual disease (MRD) assessment in multiple myeloma (MM). METHODS: Samples from non-MM staging marrow (n = 30), Hodgkin's lymphoma (n = 30) and MM (n = 724) were prospectively evaluated for expression profiles of NPC, RPC, and APC using antigens recommended in consensus guidelines. RESULTS: Polyclonal NPC-RPC demonstrated aberrations for all antigens evaluated with a higher frequency of aberrancies in post-therapy samples compared to treatment naïve samples (p < 0.001%). Immunomodulation in APC was observed in 79% of post-therapy samples with a change in expression of 1, 2, and ≥3 antigens in 19.9%, 15.6%, and 43.5% samples, respectively. In 13.4% of samples, APC showed no aberrancy and aberrant status was assigned based on cytoplasmic light chain restriction (cyLCR) alone. 9% samples with an admixture of NPC and APC displayed normal cytoplasmic kappa to lambda ratio (cyKLR) when the percentage of APC of total PC (neoplastic plasma cell index, NPCI), was below 25% and 50% for kappa and lambda restricted cases, respectively. CONCLUSION: The panorama and high frequency of antigenic aberrations on polyclonal PC signify the importance of MRD assay validation on a large cohort under normal and reactive conditions. Frequent Immunophenotypic shifts in APC re-confirm the redundancy of baseline immunophenotype for MRD evaluation. Small clones of APC may be missed by assessment of cyKLR alone and therefore, surface marker aberrancy supported by cyLCR is required for definitive assignment of residual APC.

Flow cytometric immunophenotyping of plasma cells across the spectrum of plasma cell proliferative disorders: A fresh insight with pattern-based recognition.

BACKGROUND: The expression pattern of common antigens including cytoplasmic kappa/lambda ratio (cyKLR) was evaluated by flow cytometric immunophenotyping (FCMI) to explore their relevance in discriminating normal and aberrant plasma cells (NPC and APC, respectively) across spectrum of plasma cell proliferative disorders (PCPD). METHODS: In this prospective analysis, 791 samples from PCPD (treatment naive = 455; partially treated = 336) were evaluated for expression of CD38, CD138, CD45, CD19, CD56, CD27, CD81, CD117, Cy-kappa, and Cy-lambda using FCMI. RESULTS: Amongst the entire cohort, 20.7% (n = 164) samples displayed only APC, 21% (n = 165) only NPC and 58% (n = 462) showed coexistence of NPC and APC. Using pattern-based recognition (PBR) for three common patterns (CD19 vs. CD56; CD27 vs. CD56 and CD19 vs. CD27), APC was separable from NPC in 93% samples. In 6.5% samples, the gating markers contributed in APC-NPC differentiation and in the remaining 0.5% CD117 and CD81 proved useful. Clonality assessment was found to be crucial to label plasma cell compartment as completely normal or aberrant in 42% cases with either all NPC or all APC. Sixty one out of 462 cases (13%) revealed cyKLR within normal reference range and in these cases; abnormal cyKLR was demonstrable only after gating APC separately based on PBR. CONCLUSION: Fair discrimination between NPC and APC is achievable in all PCPD samples using eight markers (Gating: CD38, CD138, CD45; PBR:CD19, CD56, CD27; clonality: Cy-kappa and Cy-lambda). Thus, combined assessment of clonality and immunophenotypic aberrancies is required for accurate, reliable and precise assessment of NPC and APC compartments in PCPD.

Clinical Outcome of Cu-T 375 PPIUCD by Novel Dedicated Inserter Technique.

BACKGROUND: Intrauterine contraceptive devices (IUCDs) have been used by women in India for decades for spacing pregnancies. The increased institutional deliveries are an opportunity to provide women easy access to immediate PPIUCD services. Hence, we planned a study to evaluate the role of a novel dedicated inserter technique to improve compliance in postpartum women. MATERIALS AND METHODS: A prospective case-control study was conducted on postpartum women who underwent vaginal delivery. Cases were selected and divided randomly into two groups: the long inserter (n = 292) and control groups (n = 301 using conventional method of insertion). PPIUD was inserted by trained providers, followed by ultrasound within 48 hours of insertion to assess location and fundal placement of the IUD. Follow-up was done at 2 weeks, 6 weeks and 3 months post-insertion, and ultrasound assessment was done for IUD location at each visit. Final statistical analysis was done by using Chi-square test. RESULTS: There were fewer complications like pain and irregular bleeding in the long inserter group as compared to the control group. None of the cases reported missing thread in the long inserter group. Expulsion was seen in only one case from the long inserter group and five cases in the control group. Client satisfaction was good (98.4%) in the long inserter group, and with each follow-up, satisfaction level also improved in the control group (96.6%, p value- 0.03). CONCLUSION: The long inserter PPIUD insertion is a safe and convenient method. It has better ease of insertion, high fundal placement and good thread visibility and has reduced risk of infections as compared to the conventional PPIUD insertion technique.

Coronavirus disease 2019 in pregnancy: Maternal and perinatal outcome.

BACKGROUND: Since the advent of coronavirus disease 2019 (COVID-19) infection, there is debate whether pregnancy outcome in COVID-19 is more severe as compared to general population. Pregnant population is particularly susceptible to viral infections due to altered immune response. H1N1 infection and Zika virus infection led to unfavorable maternal and fetal outcomes. SARS during pregnancy has been linked previously with high risk of spontaneous abortions, preterm births and intrauterine growth restriction. The effects of this novel virus need to be studied. MATERIALS AND METHODS: This is a single-center descriptive prospective observational study of 65 pregnant women with reverse transcriptase-polymerase chain reaction confirmed COVID-19 infection, regardless of gestational age at diagnosis, admitted from April 15 to June 30, 2020, at the COVID hospital in SN Medical college a tertiary center of Agra in North India. Maternal and perinatal outcomes were studied. Data were analyzed using the SPSS software for windows. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as numbers and percentages. RESULTS: Majority 88.4% of the women were asymptomatic. Rest had mild illness only. Majority 94.23% were third-trimester pregnancies; preterm birth was not reported in any singleton pregnancy. Majority 85% were delivered by cesarean section done for obstetric indications. Maternal outcome of all patients was favourable, and only two women who had moderate pneumonia recovered. Maternal mortality was reported in only 1 case. All neonates were negative for COVID-19. Neonatal outcome was favorable. CONCLUSION: COVID-19 in pregnancy led to mild symptoms only. Infection in the third trimester did not led to adverse obstetric outcome including preterm labor and premature membrane rupture. SARSCoV2 infection in pregnancy did not increase the risk of maternal mortality. Vertical transmission of COVID-19 was not found in neonates. The maternal, neonatal, and perinatal outcomes of COVID-19 patients infected in late pregnancy were favorable.

Critical evaluation of the utility of pre- and post-therapy immunophenotypes in assessment of measurable residual disease in B-ALL.

Measurable residual disease (MRD) is an important parameter to predict outcome in B-cell acute lymphoblastic leukemia (B-ALL). Two different approaches have been used for the assessment of MRD by multiparametric flow cytometry that include the "Leukemia Associated Aberrant Immunophenotype (LAIP)" and "Difference from Normal (DFN)" approach. In this retrospective study, we analyzed 539 samples obtained from 281 patients of which 258 were paired samples and the remaining 23 samples were from post-induction time point only, to explore the utility of baseline immunophenotype (IPT) for MRD assessment. Single-tube 10-color panel was used both at diagnosis and MRD time points. Out of 281 patients, 31.67% (n = 89) were positive and 68.32% (n = 192) were negative for MRD. Among 258 paired diagnostic and follow-up samples, baseline IPT was required in only 9.31% (24/258) cases which included cases with hematogone pattern and isolated dim to negative CD10 expression patterns. Comparison of baseline IPT with post-induction MRD positive samples showed a change in expression of at least one antigen in 94.04% cases. Although the immunophenotypic change in expression of various antigens is frequent in post-induction samples of B-ALL, it does not adversely impact the MRD assessment. In conclusion, the baseline IPT is required in less than 10% of B-ALL, specifically those with hematogone pattern and/or dim to negative expression of CD10. Hence, a combination of DFN and LAIP approach is recommended for reliable MRD assessment.

UV protection and antibacterial treatment of cellulosic fibre (cotton) using chitosan and onion skin dye.

Interest in environment-friendly textile processing techniques has been augmenting in recent years. Natural dyes are environment friendly, low toxic and less allergenic owing to the existence of large number of structurally diverse active compounds which makes natural colourants promising options for the development of antimicrobial and ultra-violet (UV) protective textiles. The purpose of the present study was to investigate the effect of biopolymer and dyeing treatment with natural dye on the functional properties (antibacterial and UV protection) of cotton fabric and the assessment was done using standard test method. It was found that the chitosan treated onion skin dyed cotton fabric showed 97.20 percent and 98.03 % reduction in the growth of E. coli and S. aureus bacteria respectively. The chitosan treated dyed cotton fabric showed the higher ultra-violet protection factor (UPF) value (84.80) as compared to alum treated dyed cotton fabric (66.70) depicting that the chitosan treated dyed cotton fabric provided more ultraviolet protection than the alum treated dyed fabric.

Facile Synthesis and Synergetic Interaction of VPO/ß-SiC Composites toward Solvent-Free Oxidation of Methanol to Formaldehyde.

Composite materials have revealed remarkable activities in various catalytic applications. However, choosing an appropriate material to enhance the catalytic activity and stability is a major challenge in the field of catalysis. In this article, we reported vanadium phosphorus oxide (VPO)/ß-SiC as a stable composite material with good catalytic activity. VPO/ß-SiC composite materials with different compositions were fabricated by the impregnation technique to investigate the catalytic activity and stability of these materials in liquid-phase reactions. The physiochemical characteristics of the prepared catalysts were analyzed by several spectroscopic methods. The catalytic activities of VPO/ß-SiC composites were studied in a solvent-free oxidation of methanol using tert-butyl hydroperoxide (TBHP) as an oxidant. The reaction conditions were optimized by changing various reaction parameters. Under optimized reaction conditions, the 10 wt % VPO/ß-SiC composite showed 100% conversion with 89.8% selectivity to formaldehyde.

Prognostic significance of CD56 and CD7 in acute myeloid leukaemia and their outcome.

BACKGROUND: The expression of CD7 and CD56 in Acute Myeloid Leukaemia was considered to be a poor prognostic factor for overall survival, complete remission but the result were limited and more prognostic parameter need to study. The importance of validating new prognostic parameters in acute myeloid leukaemia was the reason to investigate the prognostic significance of CD7 and CD56. MATERIAL AND METHODS: Study involving patients who had newly diagnosed AML. Imunophenotyping was carried out at diagnosis and after induction therapy also compared with molecular and cytogenetics studies. End points were the leukaemia free survival, relapse-free survival, and overall survival. RESULT: All 87 patients that were included in the study were divided into 4 groups based on expression of CD56 and CD7 as Group 1 (CD7+, CD56+), group 2 (CD7-, CD56+), group 3 (CD7+, CD56-) and group 4 (CD7-, CD56-) and were compared clinically and immunophenotypically. The clinical parameters that were correlated were age, sex, LFS (leukaemia free survival), Overall survival (OS) and Relapse Free survival (RFS) and were followed up with MRD at day 30 along with Molecular abnormalities and cytogenetic karyotyping. CONCLUSION: The study data suggest that prognostic significance of CD7 and CD56 expression in patients of acute myeloid leukaemia could be indicative of poor prognosis as it was also associated with the adverse prognostic parameter (Minimal Residual Disease, high risk, shorter overall survival).

A Real-world Perspective of CD123 Expression in Acute Leukemia as Promising Biomarker to Predict Treatment Outcome in B-ALL and AML.

INTRODUCTION: CD123 is overexpressed in many hematologic malignancies and found to be useful in characterizing leukemic blasts of both acute myeloid leukemia (AML) and B-acute lymphoblastic leukemia (B-ALL). CD123 has been recently found to be a marker of leukemic stem cells, and its utility to measure residual disease and potential role in disease relapse is under evaluation. MATERIALS AND METHODS: Herein, we have evaluated the expression of CD123 in 757 samples of acute leukemia including 479 treatment-naive and 278 follow-up samples and compared with post-induction morphologic complete remission and measurable residual disease (MRD) status. Multiparametric flow cytometry was used for assessment of CD123 expression and immunophenotypic characterization of leukemic blasts at diagnostic and MRD assessment time points. RESULTS: Using variable cutoffs of 5%, 10%, and 20% to define a case as CD123-positive, expression of CD123 was observed in 75.6%, 66.2%, and 50% of AML and 88.6%, 81.8%, and 75% of B-ALL, respectively. Of 11 patients, 7 (63.63%) had mixed phenotype acute leukemia, but none of the 12 patients with T-acute lymphoblastic leukemia showed positivity for CD123. CD123 expression at diagnosis was associated with post-induction MRD-positive status in both B-ALL (P < .001) and AML (P = .001). We also evaluated the utility of CD123 as a leukemia-associated aberrant immunophenotype and found it to be useful in both patients with AML (baseline, 50.6%; follow-up, 53%) and B-ALL (baseline, 75%; follow-up, 73.07%). CONCLUSIONS: In conclusion, CD123 may be considered as a cardinal marker for residual disease assessment and response evaluation in AML and B-ALL.

Environmental toxic metals in placenta and their effects on preterm delivery-current opinion.

Preterm birth is a significant public reproductive health concern globally; Furthermore, preterm birth has long-lasting medical and pecuniary burdens on the society. Moreover, preterm birth is well-established as the underlying cause of low birth weight in infants as well as neonatal mortality. A growing body of literature suggests that the etiology of preterm delivery in women is elusive; however, countless environmental factors are considered responsible for preterm birth. Environmental contaminants that are toxic metals such as lead, cadmium, arsenic, and mercury are familiar confounding factors for preterm birth globally. Recent studies have indicated that these toxic heavy metals induce oxidative stress in the trophoblastic placental tissue by producing reactive oxygen species that alter the mechanism of antioxidants possibly leading to preterm birth. Moreover, no obvious mechanism underlying metal-induced oxidative stress in the placenta has been identified until date. Consequently, this review offers an outline of the currently existing scientific information on the association of toxic metals and redox status of the placental tissue with preterm birth. Furthermore, this study critically recognizes the gaps related to the deleterious effect of metals on the gestation period in scientific literature.

Evaluation of the Protection Provided by Hepatitis B Vaccination in India.

OBJECTIVE: In India, Hepatitis B vaccination is recommended at 6 wk except for hospital-deliveries. The authors examined protection afforded by the birth dose. METHODS: A case-control study was done. HBsAg and HBcAb were tested in 2671 children, 1 to 5 y and HBsAb was evaluated in a subset of 1413 children. Vaccination history was recorded. Cases were HBsAg carriers. In another analysis, children who got infected (HBsAg and/or HBcAb positive) were considered as cases. Exposed were the unvaccinated. In another analysis, exposed were those vaccinated without the birth dose. RESULTS: The odds ratio (OR) for HBsAg positivity with birth vaccination was 0.35 (95% CI 0.19-0.66); while with vaccination at 6 wk was 0.29 (95%CI 0.14-0.61), both compared to unvaccinated. Birth vaccination has no added protection when compared to the unvaccinated. Unvaccinated children in index study had HBsAg positivity of 4.38%. The number needed to treat (NNT) to prevent one case of HBsAg positivity was 32.6 (95% CI, 20.9 to 73.6). The odds of getting HBV infection was 0.42 (CI 0.25-0.68) with birth dose and 0.49 (CI 0.30-0.82) without the birth dose compared to the unvaccinated. Protective antibody (HBsAb) was present in about 70% of the vaccinated. In the unimmunised, in the first 2 y HBsAb protection was present in 40%. The odds ratio (OR) for HBsAb in the fully vaccinated between 4 and 5 y was 1.4 (95%CI 0.9-2.18) compared to the unvaccinated. CONCLUSIONS: The present study lends support to the pragmatic approach of the Government to vaccinate babies born at home starting at 6 wk.