Clinical features and outcome of hepatosplenic fungal infections in children with haematological malignancies

Hepatosplenic fungal infection (HSFI) is a severe invasive fungal infection observed during neutrophil recovery in patients with acute leukaemia treated with intensive chemotherapy. Retrospective analysis including all paediatric haematological malignancies patients with HSC treated in Children Cancer Hospital Egypt (2013-2018). Twenty-five patients with acute leukaemia developed HSFI (19 patients diagnosed as hepatosplenic candidiasis). Most of the cases (92%) occurred during the induction phase. Organs affected were as follows: liver in 18 patients, renal in 13 patients, spleen in 12 patients, skin in four patients and retina in one patient. Five (20%) patients had proven HSC, 14 (56%) probable and six (24%) possible HSFI. Ten patients had a PET-CT for response assessment. Candida tropicalis was the most common isolated spp. from blood/tissue culture. Six (24%) patients developed HSFI on top of antifungal prophylaxis. Steroids were given in 12 (52%) patients with HSFI as immune reconstitution syndrome (IRS). Caspofungin was the first line of treatment in 14 (56%) patients, liposomal amphotericin B in six (24%) patients and azoles in five (20%) patients. HSFI was associated with delayed of intensification phase of chemotherapy (median 42 days). The success rate was reported in 24 patients with complete response (68%) and partial response in (28%) patients, while failure (death) seen in 1(4%) patient. HSC is still a major challenge in paediatric leukaemias patients with impact on treatment delay and survival outcome. PET scan, non-culture diagnostics and steroid role evidence in IRS are growing. Antifungal stewardship for screening, early detection for high-risk patients and better response assessment is challenging.     

Studying the effect of adding growth factors to the autologous melanocyte keratinocyte suspension in segmental vitiligo

Addition of different growth factors to the medium used in autologous melanocyte‐keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3′5′ cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB‐UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point‐counting technique and complications were recorded. Excellent response (90%‐100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P = .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B; P value: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.     

Antioxidant capacity in Fasciola hepatica patients before and after treatment with triclabendazole alone or in combination with ascorbic acid (vitamin C) and tocofersolan (vitamin E)

The aim of the present study was to investigate the effect of triclabendazole (CAS 68786-66-3) therapy alone or in combination with ascorbic acid (vitamin C, CAS 50-81-7) and tocofersolan (vitamin E, CAS 30999-06-5), in Fasciola hepatica patients, on Lipo-peroxidation (LPO) and blood antioxidant capacity. 32 Fasciola hepatica patients were divided into two groups (16 acute and 16 chronic). Each group was divided into two subgroups of 8 patients each. One subgroup was given two consecutive oral doses each of 10 mg/kg body weight of triclabendazole suspension and the other received vitamin C (1000 mg/day) and vitamin E (600 mg/day) for two months, together with the same dose of triclabendazole given to the first subgroup. Ten healthy subjects served as controls. The results revealed a significant increase in serum and erythrocyte lipid peroxide levels and a significant decrease in glutathione levels as well as in glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities in all study groups compared to their corresponding control values. After triclabendazole treatment, pronounced improvements in all studied parameters were observed which could be attributed to the fasciolicidal effect of the drug. The significant improvement of SOD and GPX activities and in lipid peroxide levels after vitamins supplementation as compared to their corresponding values after treatment with triclabendazole alone could be explained on the basis of the potent action of these vitamins in protection against oxidative damage.     

Effect of cobra venom (Naja haje) on insulin release by rat pancreas in vitro

Additions of cobra venom at 10, 20 and 30 μg per ml to incubation media of rat pancreas caused no significant effect on insulin release. Additions of the venom at a concentration of 60 μg per ml caused a significant inhibition of glucose induced insulin secretion at low (60 mg per 100 ml) and high (300 mg per 100 ml) glucose concentrations. The possibilities of local release of adrenergic transmitter, impaired glucose metabolism by the beta cells and diminished intracellular levels of cyclic AMP in the beta cells, by venom are discussed.     

Effect of amino acids on glucose tolerance and hyperkalemia in very low birth weight infants

OBJECTIVE: The purpose of the study was to investigate alimentation of very low birth weight (VLBW) infants and its effect on blood concentration of glucose, urea nitrogen, creatinine and potassium. METHODS: The subjects were 100 VLBW infants born between 1993-1999. The gestational age ranged from 23 to 32 weeks and the birth weight from 443 to 1470 g. Intravenous glucose infusions were begun shortly after birth, amino acids on day 3 and lipids on day 4. Blood samples were drawn for determinations of urea nitrogen, creatinine and potassium. RESULTS: Mean caloric intake of glucose rose from 24.7 kcal/kg/day on day 1 to 58.1 kcal/kg/day on day 8 (p < 0.0001) and of amino acids from 1.1 g/kg/day on day 3 to 1.9 g/kg/day on day 8 (p < 0.0001). Potassium administration increased from 1 mq/kg/day on day 2 to 1.9 mq/kg/day on day 8. Urea nitrogen was at a mean level of 21.4 mg/dl on day 4 and declined afterwards (p < 0.0001). Serum potassium levels declined from 5.9 mmol/L on day 2 to 4.1 mmol/L on day 8 (p < 0.0001), while creatinine levels remained stable. CONCLUSION: Our findings suggest that a catabolic state in VLBW infants begins to be reversed when the caloric intake of 40-50 kcal/kg/day is achieved.     

Clinical relevance of angiopoietin-1, angiopoietin-2, and their receptor Tie-2 expression in acute myeloid leukemia

The angiogenic-related factors, angiopoietin-1 and angiopoietin-2 and their receptor Tie-2, have wide-ranging effects on tumor behavior that includes angiogenesis and inflammation. These multifaceted pathways present a potential target in developing novel inhibition strategies for cancer therapy. The present work aimed at detecting the prevalence of expression of angiopoietin-1, angiopoietin-2, and their receptor Tie-2 in 56 Egyptian de novo acute myeloid leukemia (AML) patients by conventional RT-PCR to verify the prognostic impact of their expression on the response to induction chemotherapy. Thirty age- and sex-matched healthy volunteers were subjected to the same analysis as a control group. High expression of Ang-1 was detected in the patient group but not the control group. AML patients expressing Ang-2 either solely or in combination with high Ang-1 and/or Tie-2 showed unfavorable response to induction chemotherapy, either failed induction or death during induction. These data provide evidence that the alternation of angiopoietin balance in favor of Ang-2 may play a critical role in the pathophysiology of AML. Furthermore, positive pre-therapeutic expression of Ang-2 indicates viable unfavorable prognostic marker in AML patients and may be used as a prognostic tool in the risk-adaptive management of AML.