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  • ISSN: 2333-6684
    Current Issue
    Volume 5, Issue 4
    Review Article
    Georges El Hachem*
    After many years of comprehensive research of the cancer immunity cycle, immunotherapy is getting more established and is rapidly emerging as a powerful weapon. It is a biologic therapy helping the immune system to fight the malignancy based on the tumor microenvironment.
    Research Article
    Caviglia Horacio, Lescano Sebastian, Bacigalupo Roberto, Perez Ballester Gustavo, Landro María Eulalia*, Douglas Price Ana Laura, Neme Daniela, and Ghissi Pablo
    Introduction: Differential diagnosis of testicular haematoma is a challenge. Testicular haematoma in patients with haemophilia is still more complicate. In PWH with testicular enlargement without previous trauma, an underlying condition such as an abscess, cyst, tumours, and peri-testicular pathologies can be suspected. Testicular sonography has become the imaging technique of choice, not only for differential diagnosis of a variety of pathologic processes with similar clinical manifestations, but also for diagnosis and monitoring of testicular trauma.
    The aim of this work was to evaluate the clinic usefulness of magnetic resonance (MR) imaging for correct diagnosis of testicular haematoma.
    Patients and methods: Two haemophilia type A severe patients were evaluated. Both patients presented pain and enlargement of testicles after micro trauma. The first one was a 24 year-old patient, who referred a micro trauma during sexual intercourse in the right testicle. The second was a 43 year-old patient, who referred a micro trauma during horse riding in the left testicle. A well-circumscribed mass was visible in the testicles and β-chain chorionic gonadotropin and α-fetoprotein blood tests were negative in both patients. MRI study confirmed the diagnosis of testicular hematoma.
    Results: Both patients responded positively to conservative treatment with factor VIII replacement therapy. Pain and testicle size were reduced and haemosiderine reabsorption improved.
    Discussion: Intratesticular haematoma caused by micro trauma is difficult to diagnose. We now report two patients who were correctly diagnosed by ultrasound and MRI and conservatively treated and monitored until their testicular haematomas disappeared. We suggest that MRI is a useful and essential tool in the diagnosis of scrotal and testicular abnormalities, and their evolution and response to treatment.
    Conclusion: This work shows that with correct diagnostics and suitable images like MRI and ultrasound, haematoma of the testicle can be diagnosed, resolved and followed-up with conservative treatment.
    Noorulain Fareed*, Sadaf shahab, Muhammad Tariq, Saba Faraz, Danish Zahid, Shariq Ahmed, Gulsafaida, Tasneem Farzana, Mehwesh Taj, Muhammad Nadeem, and Tahir Shamsi
    Background: Mixed lineage leukemia (MLL) is one of the most frequently involved genes in hematologic malignancies, in particular in some forms of acute leukemia, both lymphoblastic and myeloid. In adult ALL, MLL gene re-arrangement is found in 7% cases as reported in previous studies. MLL gene rearrangement is associated with poor prognosis. MLL gene rearrangements arise from fusions of this gene at 11q23 with a large number of partner genes. In ALL, the most common gene partner is the AF4 gene on chromosome 4q21 resulting in a t(4; 11) (q21; q23) rearrangement.
    Objective/Rationale: This study was planned to estimate the frequency of MLL gene rearrangement AF4 t(4;11) in patients of acute lymphoblastic leukemia because this rearrangement is associated with unfavorable prognosis.
    Material and methods: It was a cross-sectional observational study. All newly diagnosed cases of adult ALL were included in the study. Total 101 patients were included, 88 had B-cell lineage ALL and 13 had T-Cell lineage ALL. Institutional review board approved the study. Informed consent was obtained and details were noted in a Performa including age, gender, clinical features, complete blood count (CBC), and bone marrow aspirate and biopsy report. Diagnosis was done on the basis of WHO classification of neoplasm 2008. RT- PCR method was applied to detect MLL gene rearrangement AF4 t(4;11).
    Results: Out of 101 patients, 34 were females and 67 males, with mean age of 34.5 ± 18.9 (range 18-50 years in both females & males). MLL gene rearrangement AF4 t(4;11) was detected in 08(7.9%) patients of ALL. The mutation was observed in 03(37.5%) males out of 67 and 05(14.7%) females out of 34. Significantly more MLL gene rearrangement was found in patients with pre-B-Cell ALL (75%), then in pre-T-Cell ALL (25%).
    Conclusion: MLL gene rearrangement AF4 t(4;11) has been detected in 7.9% cases of ALL in our study. Further larger studies are needed to validate our data and follow up required for elucidation of clinical significance of mutation in this group of patients.
    Samra Waheed, Uzma Zaidi*, Sidra Maqsood, Munira Borhany, and Tahir Shamsi
    Background: Sokal score prognosticates patients of chronic myeloid leukaemia at diagnosis. Its value has been tested in pre-imatinib era. We hypothesise that Sokal score is a useful prognostic tool to predict response to Nilotinib therapy.
    Material and methods: CML patients were stratified into low, intermediate, and high Sokal score group at diagnosis. Nilotinib 300 mg twice a day was started and patients were followed up every 2 weeks for 4 weeks, then 4 monthly till 12 months, and then 4-8 weeks subsequently. Complete Haematological Response (CHR) and Major Molecular Response (MMR) were recorded at 3 months and 12 months respectively.
    Results: Of 128 patients, there were 69 male (53.9%). Median age was 39 years (range, 06-68). Sokal score was low, intermediate and high in 9 (07%), 59 (46%), and 60 (47%) patients respectively. At 3 months, 89%, 88%, and 92% achieved CHR. At 12 months, 67%, 73%, and 43% achieved MMR (p-value 0.05). Fifty-seven percent patients above 40 years of age at diagnosis showed better response to Nilotinib (p-value 0.01).
    Conclusion: Sokal score effectively prognosticates response to Nilotinib therapy. Most of our patients were in intermediate and high risk Sokal group. Age of patients and intermediate and high risk groups were found to be predictors of response to Nilotinib treatment.
    Mini Review
    Youssef Jounblat and Georges El Hachem*
    Anemia is a frequent debilitating problem, negatively affecting the quality of life of cancer patients. It is associated with poor prognosis and has been directly correlated with fatigue. Despite being more common in hematologic malignancies, anemia is frequently seen in solid tumors. It is multifactorial, and is caused by the cancer itself or secondary to cytotoxic treatment. Blood transfusion used to be a primary treatment of the anemia until the era of recombinant human erythropoietin. It is essential to correct all reversible causes, as bleeding, vitamins deficiencies and especially functional iron deficiency. Here we are writing a small review concerning the anemia in metastatic solid tumors, discussing the different etiologies, how anemia affects the prognosis and quality of life, then stressing on its adequate management. Our aim is to make clinicians more aware of this serious and common finding during the course of any metastatic solid tumor in order to improve the outcome.
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