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Shimaa A Ahmed,1 Ghada EM Abdallah,2 Mai M Aly,2 Eman M Nagiub Abdelsalam,3 Mostafa F Mohammed Saleh2 1Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt; 2Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Mostafa F Mohammed Saleh Tel +201013701057Fax +2088-2332278-2080278Email mostafafaisal2017@yahoo.comIntroduction: A positive direct antiglobulin test (DAT) with or without autoimmune hemolytic anemia is a frequent finding in chronic lymphocytic leukemia (CLL). The heterogenic clinical course of CLL mainly depends on different pathogenetic mechanisms which appears in a form of variable biological and clinical features. These features allow stratification of patients into subsets with different outcomes.Patients and Methods: We evaluated the DAT as a prognostic marker in 120 CLL patients treated with chemoimmunotherapy. Clinical and laboratory features, treatment response, and survival outcomes of CLL patients were assessed in relation to their DAT test status. Additionally, the English literature was extensively reviewed regarding the prognostic impact of a positive DAT in CLL.Results: DAT positivity was detected in 36 patients (30%) and was associated advanced disease staging (P = 0.03). No correlations were found with other clinical, laboratory, or biological factors such as ZAP-70 or CD38. Both a positive DAT and an Eastern Cooperative Oncology Group performance status > 2 were predictors for non-response to first-line treatment in the multivariate analysis (OR = 0.3, 95% CI: 0.12– 0.8 and OR = 0.2, 95% CI: 0.08– 0.8, respectively). The five-year progression-free survival was significantly lower in the DAT-positive group (P = 0.004). No significant association was found with overall survival (P = 0.2). Sixteen reports analyzing more than 11,000 patients were identified in our review.Conclusion: In conclusion, DAT positivity in CLL patients is associated with poor response to treatment and disease progression.Keywords: autoimmunity, chronic lymphocytic leukemia, direct antiglobulin test, autoimmune hemolytic anemia

Recent studies have attempted to measure several biomarkers to understand the complex interactions of the anatomic systems that may be involved in autism spectrum disorder (ASD). In CNS, galanin takes part in a variety of pathological and physiological processes. Prior research has indicated it is involved in several neuropsychiatric disorders and has a role in inhibiting the neuronal firing and release of serotonin, norepinephrine, and acetylcholine. To date, serum galanin levels have not been investigated in the context of ASD. This study aimed, therefore, to compare the serum galanin levels of children with ASD and healthy controls and to reveal any association between galanin level and the severity of ASD, as well as other psychological and demographic parameters. Serum galanin levels were measured by radioimmunoassay in 116 children with ASD and 98 healthy children. We observed significantly increased serum concentrations of galanin in children with ASD relative to healthy children. Moreover, children with severe ASD had significantly higher galanin levels than those with less severe disease. We also confirmed significant positive correlations between galanin and psychiatric parameters in children with ASD. For the first time, we suggest a possible correlation between serum galanin and the degree of ASD severity. Increased galanin levels may play a role in the pathogenesis of ASD., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Background: Fascioliasis is a neglected zoonosis with major public health implications in humans. Although triclabendazole (TCBZ) is the drug of choice, there are records of TCBZ failure worldwide. TCBZ-resistant fascioliasis is treated with alternative approved drugs including nitazoxanide (NTZ), with varying levels of efficacy. Data on NTZ efficacy after TCBZ failure in Egypt is scarce. This study evaluated the efficacy of NTZ in cases of TCBZ failure during an outbreak of fascioliasis in Assiut governorate of Upper Egypt., Methodology/principal Findings: This prospective study included 67 patients from the outpatient clinic in Manfalout locality of Assiut governorate with clinical manifestations of acute fascioliasis. These included high eosinophilia (> 6% eosinophils in peripheral blood), positive anti-Fasciola antibodies, and hepatic focal lesions (HFL) or ascites on abdominal ultrasound or computed tomography. All patients initially received TCBZ at recommended doses. Patients were followed up after 1 month to assess response. According to the responses, patients were categorized as non-responders and responders. The non-responders received a trial of NTZ and were re-assessed for response based on clinical manifestations, eosinophil count, and abdominal ultrasound. Patients not responding to NTZ received additional doses of TCBZ. One month after initial TCBZ treatment, 37 patients responded well to TCBZ, while 30 patients failed to respond with persistence of fever, abdominal pain, high eosinophilia, and HFL. Most non-responders were male (56.7%); females predominated among TCBZ responders (62.2%). The mean age of the non-responders was relatively lower, at 20.57 ± 14.47 years (p = 0.004). Following NTZ therapy, HFL disappeared in 9/30 (30%) patients and eosinophil counts normalized in only 2 (6.7%) patients, indicating an overall efficacy of 36.6%. The remaining cases received additional doses of TCBZ with complete clinical, biochemical, and radiological resolution., Conclusions/significance: Nitazoxanide was partially effective in TCBZ failure in acute human fascioliasis in Upper Egypt. Further studies with larger samples are highly encouraged and further research is urgently needed to find new therapeutic alternatives to TCBZ., Competing Interests: The authors have declared that no competing interests exist.

Fresh frozen plasma (FFP) is a crucial substitute therapy in management of bleeding; producing plasma from whole blood stored within 24 h offers operational flexibility and leukocyte filtration significantly reduce transfusion reactions, it is necessary to consider the impact of these plasma preparations on clotting factors activity. Total of 75 plasma samples collected from 25 blood donors distributed as 3 groups; FFP (Group A), leukocyte filtrated FFP (Group B) and plasma frozen within 24 h i.e. PF24 (Group C), for all samples prothrombin time (PT), INR, (APTT), Factors V, VII, VIII, IX levels and Fibrinogen were done, also comparing coagulation factors levels in FFP in different blood groups. There were significant difference between three groups in (PT), INR and (APTT): ( P  = 0.00). Concerning Factor VII: significant difference ( P  = 0.03) between the three groups, FFP had a significantly higher level of FVII compared to filtrated FFP (98.92 vs. 82.52%; P  = 0.02), while no significant difference between FFP and PF24 was detected ( P  = 0.76). Factor VIII: had significant difference ( P  = 0.00) between the three groups, FFP and Filtrated FFP had no significant difference regarding level of FVIII ( P  = 0.72), but FFP had significantly higher level of FVIII compared to PF24 ( P  < 0.05). Concerning Fibrinogen level: no significant difference between FFP and filtrated FFP ( P  = 0.99), while FFP had a higher level versus PF24 ( P  < 0.05). On the Contrary, no significant difference between three groups in Factor V: ( P  = 0.22) and Factor IX: ( P  = 0.12). ABO blood group effect on studied parameters in FFP: FVIII was statistically higher in Non-O blood group ( P  = 0.03), other factors had no statistical differences ( P  > 0.05). The leukocyte filtration of FFP did not affect the majority of coagulation factors activities, although FVII level was reduced, it stills enough for surgical hemostasis. The PF24 resulted in reduced FVIII and fibrinogen levels but no significant changes in FV, FVII or FIX, thus, can be used for FFP indications except that specifically requiring replacement of FVIII and/or fibrinogen as Hemophilia or DIC. No significant difference in coagulation factors of FFP between O and non-O blood groups except FVIII that was reduced in O blood group., Competing Interests: Conflict of interestThe Authors declare no conflicts of interest.