Assessing the risk of venous thromboembolism in patients with haematological cancers using three prediction models.

PURPOSE: Assessment of individual VTE risk in cancer patients prior to chemotherapy is critical for determining necessity of interventions. Risk assessment models (RAM) are available but have not been validated for haematological malignancy. We aimed to assess the validity of the Vienna Cancer and Thrombosis Study (V-CATS) score in prediction of VTE in a variety of haematological malignancies. METHODS: This is a prospective cohort study conducted on 81 newly diagnosed cancer patients undergoing chemotherapy. Demographic, clinical and cancer related data were collected, patients were followed up for 6 months, and VTE events were recorded. Khorana score (KS) was calculated. Plasma D-dimer and sP-selectin were measured, and then, V-CATS score was calculated. Receiver operator curve (ROC) was used to assess the sensitivity and specificity of RAMs. A modified V-CATS was generated and subsequently assessed by using new cut-off levels of d-dimer and sP-selectin based on ROC curve of the patients' results and compared the probability of VTE occurrence using all three RAMs. RESULTS: Among the 81 patients included in this study, a total of 2.7% were diagnosed with advanced metastatic cancer. The most frequent cancer was non-Hodgkin lymphoma (39.5%), and 8 patients (9.8%) developed VTE events. The calculated probability of VTE occurrence using KS, V-CATS and modified V-CATS scores at cut-off levels ≥ 3 was 87.5%, 87.5% and 100%, respectively. The AUC in ROC curve of modified Vienna CATS score showed significant difference when compared to that of V-CATS and KS (P = 0.047 and 0.029, respectively). CONCLUSION: The findings of our study highlight the value of three VTE risk assessment models in haematological malignancies. The modified V-CATS score demonstrated higher specificity compared to both V-CATS and KS, while all three scores exhibited similar sensitivity. We encourage the implementation of RAMs in haematological cancers for an appropriate use of thromboprophylaxis.

Soluble E-selectin, platelet count and mean platelet volume as biomarkers for pre-eclampsia.

OBJECTIVES: Preeclampsia remains a major cause of maternal mortality and morbidity worldwide with increased risk for cardiovascular disease later in life. Many previous studies have examined several biomarkers including E-selectin. We aimed to assess the role of sE-selectin together with platelet count and mean platelet volume (MPV) as biomarkers for the prediction of preeclampsia. STUDY DESIGN AND MAJOR OUTCOME MEASURES: This case-control study included 85 pregnant women; 40 healthy (mean age 27.1 ±â€¯4.8 years) and 45 with preeclampsia (mean age 26.8 ±â€¯6.7 years), recruited at the third trimester of pregnancy and subjected to full clinical and laboratory testing. This included complete blood picture, urine analysis and plasma sE-selectin using ELISA. RESULTS: A significant decrease in platelet count (P = 0.003), and a significant increase in MPV (P < 0.001) were seen in patients versus controls. Plasma sE-selectin levels were significantly higher in patients versus control (P = 0.002). ROC curve showed the best cut-off values for sE-selectin was 64.3 ng/mL, with 58% sensitivity 80.0% specificity. Positive predictive value was 76.5; negative predictive value was 62.7 and accuracy was 68.2 with a statically significant area under curve (P = 0.002). Platelet count, MPV and sE-selectin were significantly associated with PE in univariate analysis. In multivariate analysis, only MPV and sE-selectin were independent risk factors for PE development. Higher MPV or sE-selectin were associated with PE development (P < 0.001). CONCLUSION: The simultaneous use of sE-selectin and platelet count and volume may help earlier recognition of preeclampsia and thus appropriate and more efficient therapy. Larger studies are likely to help verify data and justify wider application of these markers.

Pharmacogenetic Warfarin Dosing Algorithms: Validity in Egyptian Patients.

BACKGROUND/AIMS: Data from previous reports, addressing the significance of genotype-guided dosing of warfarin in Egyptian patients, are infrequent and controversial. This study is aimed at demonstrating the validity of genetic dosing algorithms in Egyptian patients on warfarin therapy. METHODS: A total of 100 Egyptian patients on a stable maintenance daily dose of warfarin were enrolled. The predicted warfarin dose for each patient was calculated using the warfarin dosing table, the Gage and the International Warfarin Pharmacogenetics Consortium (IWPC) clinical algorithms and the Gage and the IWPC genetic algorithms and compared to the actual dose. The accuracy of warfarin dosing algorithms was assessed by using the linear regression analysis. RESULTS: The most accurate model in predicting the ideal dose was the Gage genetic algorithm by R2 of 50.4% and the IWPC genetic algorithm by R2 of 42.3%, followed by the warfarin dosing table by R2 of 19.1%, and the Gage clinical algorithm by R2 of 18.9% and the least accurate was the IWPC clinical algorithm by R2 of 9.4%. CONCLUSIONS: The Gage -genetic warfarin dosing algorithm is the best model that could be implemented in Egyptian patients starting warfarin therapy.

Field experiment and numerical simulation of point source irrigation with multiple tracers.

Dyes like Brilliant Blue have similar adsorptive behaviour as some organic contaminants, e.g., pesticides. Bromide ions, on the other hand, move much like NO3-N (fertilizer) in soil. Consequently, by using these two tracers, it is possible to in a general way mimic how organic contaminants and fertilizers may move through soils. Three plots with sandy soil in semiarid Tunisia were irrigated during three successive hours using a single irrigation dripper and high-saline solution (10.50 dS m-1) containing dye and bromide. Fifteen hours after cease of infiltration, horizontal 5 cm trenches were dug in the soil and dye pattern, bromide concentration, and soil water content were recorded. Preferential flow occurred to some degree, however, it did not dominate the solute transport process. Therefore, drip irrigation can be recommended to improve plant culture for a better water and soil nutrient adsorption. Numerical simulation using HYDRUS-2D/3D was performed to replicate the field experiments. Observed soil water contents before and after infiltration were used to run an inverse parameter estimation procedure to identify soil hydraulic parameters. It was found that for both field experiments and numerical simulations the mobility of bromide is different from the mobility of dye. The dye was retarded approximately twice by volume as compared to bromide. The simulation results support the use of HYDRUS-2D/3D as a rapid and labor saving tool for investigating tracers' mobility in sandy soil under point source irrigation.

Prognostic value of the t(14;18)(q32;q21) in patients with diffuse large B-cell lymphoma.

The prognostic significance of the t(14;18) in diffuse large B-cell lymphoma is still controversial. To assess the impact of the t(14;18) on patient survival, we investigated 26 patients with diffuse large B-cell lymphoma for the presence of t(14;18). The t(14;18) was detected in 90.9% of patients with high international prognostic index score. The five-year overall survival was 0.0% and 68.75% in positive and negative cases of t(14;18) respectively. The detection of the t(14;18) combined with the international prognostic index score is a useful strategy for more appropriate risk stratification and prediction of outcome of patients with diffuse large B-cell lymphoma.

Flow cytometry detection of platelets autoantibodies in children with idiopathic thrombocytopenic purpura.

UNLABELLED: Immune thrombocytopenic purpura is an acquired disorder, in which accelerated platelet consumption is due to platelet autoantibodies. The aim of this study was to investigate the clinical value of platelet autoantibodies assay in children with ITP and to evaluate flow cytometry in the detection of platelet autoantibodies in comparison with monoclonal antibody specific immobilization of platelet antigen (MAIPA) assay. We measured platelet autoantibodies by flow cytometry and MAIPA in 18 children with ITP (6 acute, 7 chronic and 5 in remission), in addition to 5 healthy children with matched age and sex as a control group. Significant elevation of platelet-associated immunoglobulin G (PAIgG), PAIgM and PAIgA was demonstrated in children with acute ITP compared to controls and children with chronic ITP (P < 0.05). There was significant elevation of PAIgG and PAIgM in children with acute ITP compared to children with ITP in remission (P < 0.05). There was significant negative correlation between platelet count and PAIgG levels in ITP children (r = -0.717; P = 0.001). Flow cytometry found PAIgG in 94.4% of ITP children. MAIPA has detected platelet specific IgG autoantibodies in 83.3% of ITP children. ROC analysis revealed sensitivity of 94%, specificity of 57% with overall accuracy of 83% for detection of PAIgG by flow cytometry compared to MAIPA. CONCLUSIONS: Platelet autoantibodies testing in ITP can discriminate acute from chronic forms of the disease and is helpful in follow up of patients. Determination of PAIgM in combination of PAIgG could be of interest in the investigation of ITP. Flow cytometry is a sensitive method of detection of platelet autoantibodies that could be used in screening of suspected ITP and should be followed by MAIPA assay in positive cases to establish the diagnosis.

Coagulation disorders and inhibitors of coagulation in children from Mansoura, Egypt.

Disorders of coagulation in children often prove challenging to the medical care team. The aims of this study were to assess the spectrum and prevalence of coagulation disorders among children attending Mansoura University Children Hospital (MUCH), Mansoura, Egypt. A total of 105 pediatric patients were referred to MUCH. They were divided into two groups: congenital coagulation disorders (75 cases, age 45.36 +/- 48.59 months), and acquired coagulation disorders (30 cases, age 56.13 +/- 61.61 months). All patients were subjected to thorough history taking including the nature of bleeding, family, past history, mode of inheritance, and detailed physical findings. Hemostatic tests included: platelet count, bleeding time (BT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT). Specific tests in the congenital group include assay of coagulation factors according to each disorder, Von Willebrand factor assay, ristocetin aggregation test, APTT mixing study for detection of inhibitors in complicated hemophilia cases, F VIII C to VWAg ratio with cut off 0.7 for detection of carriers in some hemophilia A families. Congenital disorders constituted 71.4% of the studied cases vs. 28.6% for acquired disorders. Hemophilia A (42.85%), hemophilia B (14.28%) and liver diseases (14.28%) represented the majority of the studied cases. Mild and moderate cases of hemophilia A and B are more frequent than severe cases in both types. Male sex is more frequent than female in the congenital group (94.7 vs. 5.3%, P < 0.001). Direct correlation existed between factor level assay and severity of hemophilia (r = 0.73, P = 0.006). Three mothers and one sister were identified as carrier out of four families. Anti-clotting factors inhibitor was detected in 18.2% of patients with hemophilia A and in 9.1% with hemophilia B. In conclusion, our study found that hemophilias are the most prevalent congenital coagulation disorders among children. Attention must be given for detection of hemophilia carriers and inhibitors of clotting factors.

Plasma soluble fibrin monomer complex is a useful predictor of disseminated intravascular coagulation in neonatal sepsis.

Disseminated intravascular coagulation (DIC) is a major factor influencing mortality in neonatal sepsis.(1) Clinical trials have supported the use of antithrombin and activated protein C supplementation in DIC associated with sepsis.

Influence of storage time and temperature on international normalized ratio (INR) levels and plasma activities of vitamin K dependent clotting factors.

We designed this study to assess the effect of storage time and temperature on the international normalized ratio (INR) levels and plasma activities of vitamin K-dependent, clotting factors. A total of 100 subjects, comprising 34 healthy controls, 33 patients with liver cirrhosis and 33 patients on long-term coumarin therapy were enrolled. After centrifugation of collected specimens, aliquots of plasma were stored at room temperature (20 -22 degrees C), refrigerated at 2-6 degrees C and frozen at -40 degrees C. Determinations of INR and plasma activities of clotting factors II, VII, IX and X were performed immediately after sampling (0 time) and after 6, 12 and 24 h. We found no significant change of either INR levels or plasma activity of any of the studied clotting factors up-to 24 h at different studied temperatures (p >0.05). Our data demonstrates that clinical specimens for determination of INR levels and plasma activities of factors II, VII, IX and X are acceptable for testing for up-to 24 h whatever may be the temperature of storage.