Suicide in South African Indians

Biographical and psychiatric factors among South African Indians in Durban and the greater Durban area were investigated in 50 successive suicides so designated by a magistrate at the time of the inquest. Response to a suicide questionnaire and a symptom check-list compiled by the authors were analysed. Information was elicited from the families, relatives and friends of the deceased, or people who had known or treated or had some contact with the deceased. Major depression and alcohol abuse were noted in the vast majority of cases studied. Hanging was the most common method of suicide, closely followed by ingestion of toxic substances. Culturally attributable differences were found between the present sample and those reported in the existing literature. This and other findings are presented and discussed.     

20+ yr without leukemic or fibrotic transformation in essential thrombocythemia or polycythemia vera: predictors at diagnosis

Objectives: The current study identified patients with either essential thrombocythemia (ET) or polycythemia vera (PV) who have survived for at least 20 yr without the development of either acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) or myelofibrosis (MF) and compared their presenting features with those in whom these complications occurred in the first 10 yr of disease. Methods: The study patients were selected from an institutional database of 1061 patients with either ET (n = 603) or PV (n = 458). In both instances, three distinct groups were delineated and their presenting features compared; group A included patients who have remained AML/MDS/MF free after a minimum follow‐up of 20 yr; groups B and C included patients who developed either AML/MDS or MF, respectively, in the first decade of their disease. Results: The respective number of patients who fulfilled the above‐mentioned criteria for inclusion in groups A, B and C were 40, 12 and 8 for ET and 23, 18 and 12 for PV. In ET, compared with both groups B and C, group A displayed significantly fewer patients with less than normal hemoglobin level (P < 0.0001 and =0.02) or male sex (P = 0.005 and 0.05), respectively. On multivariable analysis, only anemia sustained its significance. A similar analysis in PV revealed an association between group B and leukocytosis using a leukocyte count threshold of either 10 or 15 × 10⁹/L (P = 0.02). Conclusion: The current study identifies PV patients with leukocytosis and ET patients with anemia as the most likely to undergo leukemic or fibrotic transformation.     

Leucocytosis in polycythaemia vera predicts both inferior survival and leukaemic transformation

Leucocytosis (leucocyte count >15 x 10(9)/l) was recently associated with thrombosis in polycythaemia vera (PV). This study sought the prognostic relevance of leucocytosis for survival and leukaemic or fibrotic transformation. Amongst 459 patients with PV seen at our institution in recent years (median age, 60 years; 56% males), 146 deaths and 88 leukaemic (n = 34) or fibrotic (n = 54) transformations were documented. Arterial or venous thrombosis occurred in 14% and 9% of patients at diagnosis and in 25% and 15% during follow-up, respectively. Multivariate analysis identified the advanced age (P < 0.0001), leucocytosis (leucocyte count >/=15 x 10(9)/l; P = 0.0006) and arterial thrombosis at diagnosis (P = 0.01) as independent predictors of inferior survival. In the absence of the first two risk factors, median survival was projected at 272 months as opposed to 108 months in the presence of both risk factors (P < 0.0001). Leucocytosis was also identified as an independent predictor of both leukaemic transformation and venous thrombosis during follow-up. Time-to-event analysis did not disclose a significant association between single or multiple cytotoxic drug exposure and either leukaemic or fibrotic transformation. The current study highlighted the prognostic relevance of leucocytosis on various aspects of the disease in PV.     

A compendium of cytogenetic abnormalities in myelofibrosis: molecular and phenotypic correlates in 826 patients

Among 826 patients with primary myelofibrosis (PMF) and analysable metaphases on cytogenetic studies, 352 (42·6%) had abnormal karyotype, of which 240 (68·2%) were sole aberrations and 48 (13·6%) were complex; the most frequent abnormalities were 20q? (23·3%), 13q? (18·2%), +8 (11·1%), +9 (9·9%), chromosome 1q+ (9·7%) and ?7/7q? (7·1%). Phenotypic correlates included: abnormal karyotype with anaemia (P = 0·02), leucopenia (P < 0·01) and thrombocytopenia (P < 0·01); complex karyotype with younger age (P = 0·04) and thrombocytopenia (P < 0·01); leucopenia with 20q?, +8 and ?7/7q? and thrombocytopenia with 20q? and ?7/7q?. Cytopenias were less likely to occur with 13q?. 476 patients were annotated for JAK2/CALR/MPL mutations; abnormal karyotype frequencies were 43% in JAK2, 42% CALR, 33% MPL mutated and 34% triple‐negative cases (P = 0·3). A proportion of patients were also screened for ASXL1, EZH2, IDH1, IDH2, SRSF2, U2AF1 and SF3B1 mutations; in all instances, mutational frequencies were higher in patients with normal karyotype, reaching significance for ASXL1 (P = 0·02) and U2AF1 (P = 0·01). 13q? was associated with mutant CALR (P = 0·03), +9 with mutant JAK2 (P = 0·02) and 20q? with mutant SRSF2 (P = 0·02). The current PMF study provides detailed cytogenetic information and correlations with mutations and clinical phenotype.     

Myoglobin--a marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

BACKGROUND: Early noninvasive identification of patients with occluded infarct-related arteries after thrombolysis has important prognostic and therapeutic implications. Recent reports indicate that plasma kinetics of cardiac marker proteins could be very useful in diagnosis of myocardial reperfusion. Although angiographic assessment remains the ideal procedure for determining patency, it is expensive, invasive, not within the reach of most patients in developing countries, and the long-term follow-up data are still sparse. HYPOTHESIS: The present study was undertaken to investigate whether plasma kinetics of myoglobin in conjunction with clinical markers and another biochemical marker, creatine kinase, could be used to predict myocardial reperfusion more accurately and to investigate the correlation between myoglobin release after thrombolysis and mortality in patients with acute myocardial infarction (AMI) over a follow-up period of 18 months. METHODS: Eighty-three consecutive patients with AMI receiving streptokinase treatment were studied for plasma kinetics of myoglobin in conjunction with clinical markers and creatine kinase to predict reperfusion and were followed for a period of 18 months. RESULTS: Increased baseline mean +/- standard deviation levels of myoglobin were observed among "nonresponders" to streptokinase treatment compared with "responders" (469 +/- 386 microg/l vs. 270 +/- 211 microg/l). There was significantly more release of myoglobin following thrombolytic treatment among the responders than among the nonresponders (mean ratio of myoglobin levels at 90 min to 0 min 6.01 +/- 9.2 vs. 1.03 +/- 0.64). In a follow-up of 61 patients over a period of 18 months, 31% mortality was observed in the nonresponder group compared with 11.7% in the responder group. In responders, the mean ratio of myoglobin levels at 90 and 0 min was significantly less among those who died (p = 0.019) than among those who survived. CONCLUSION: A myoglobin release profile in combination with other clinical markers offers inexpensive, noninvasive, and a reasonably reliable way of assessing coronary artery patency after thrombolytic treatment.