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Stroke and TIAs are amongst the common neurological presentations encountered by specialists and non-specialist health care providers. Despite the advances of neuroimaging techniques, clinicians are frequently faced with diagnostic challenges on evaluation of patients with suspected stroke. In this review, we discuss the characteristic features of cerebrovascular diseases and how to identify them. We also aim to provide a resource for non-stroke specialist clinicians to help them to correctly identify the symptoms and signs of disorders that may masquerade as stroke such as migraine, seizure, and functional disorder, and at the same time we explore how we can identify strokes that present atypically., Competing Interests: Declaration of competing interest The authors declare that they have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matters or materials discussed in this manuscript., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke resulting from large vessel occlusion (LVO). At Hull Royal Infirmary (HRI), the MT service is available from 08:00 h to 16:00 h, Monday to Friday. Consequently, many patients who present outside of those times are denied a chance of having this treatment. The objective of this audit was to detect the percentage of patients who had presented out of hours and managed to have MT and to identify why the remaining proportion of patients did not receive this treatment. A total of 35 patients with anterior circulation LVO who presented out of hours and on weekends were included in this audit. Of these, only six patients (17%) received MT. Selection of those patients was favoured by their early-morning presentation shortly before the opening of the MT service at 08:00 h. Thus, a substantial number of patients presenting with LVO out of hours were not considered for MT. This could be attributed to inadequate communication between staff. Initiation of an in-hospital protocol could facilitate communication between stroke physicians and neuroradiologists and provide a pathway for consideration of such patients for late-window MT., (© Royal College of Physicians 2023. All rights reserved.)

Purposes: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and pressure algometry with sham ultrasound (control group) on the clinical measures of headache, pressure pain threshold (PPT) of upper trapezius and suboccipital muscles and cervical alignment in patients with tension type headache (TTH)., Methods: Seventy-two patients with TTH of both genders were randomly allocated to 3 experimental groups: a) the IASTM group (n=24), b) pressure algometry group (n=24), and c) sham ultrasound control group (n=24). Headache frequency and disability, pressure pain threshold of upper trapezius and suboccipital muscles, cervical lordosis angle (CA) and anterior head translation (AHT) were measured four weeks before and after intervention. Moreover, headache frequency was followed up for two more weeks after intervention., Results: Statistically significant improvements (P <0.05; effect size ranges 1.1-1.9) were observed in all outcome measures following IASTM compared to the other two intervention methods. In the IASTM group, the headache frequency decreased from 15 to 2 days/month. Also, headache disability decreased from 19 to 10. Further, CA increased from 17.5° to 31.4° and AHT decreased from 24.1 to 15.5 mm. The pressure algometry group showed significantly lower headache frequency at the follow-up (P < 0.01) than the sham ultrasound control group. However, Similar findings in the other evaluated outcomes were found between the pressure algometry and sham ultrasound control groups (P ˃ 0.05)., Conclusion: The results of the present study indicate the effectiveness of IASTM in improving headache symptoms and cervical alignment in patients with TTH.

Background: Children with chronic kidney disease (CKD), particularly those who require hemodialysis (HD), are at high risk of hepatitis B virus (HBV) infection. The HBV vaccine non-/hypo-response rate among HD children remains high, and it is critical to investigate the influencing factors and their linkages. The aim of this study was to identify the pattern of HB vaccination response in HD children and to analyze the interference of various clinical and biomedical factors with the immunological response to HB vaccination. Methods: This cross-sectional study included 74 children on maintenance hemodialysis, aged between 3 and 18 years. These children were subjected to complete clinical examination and laboratory investigations. Results: Out of a total of 74 children with HD, 25 (33.8%) were positive for the HCV antibody. Regarding the immunological response to hepatitis B vaccine, 70% were non-/hypo-responders (≤100 IU/mL) and only 30% mounted a high-level response (more than 100 IU/mL). There was a significant relation between non-/hypo-response and sex, dialysis duration, and HCV infection. Being on dialysis for more than 5 years and being HCV Ab-positive were independent variables for non-/hypo-response to HB vaccine. Conclusions: Children with CKD on regular HD have poor seroconversion rates in response to the HBV vaccine, which were influenced by dialysis duration and HCV infection.

Left ventricular hypertrophy (LVH) and cardiac fibrosis are common accompaniments of chronic kidney disease (CKD). They can be rather easily assessed by conventional cardiac imaging modalities, most practically by M-mode or two-dimensional (2D) echocardiography, with adequate recognition of pitfalls. This study uncovers the impact of impaired renal function on left ventricular mass (LVM) and LVM index (LVMI) in children with CKD on regular hemodialysis (HD) attending the Zagazig University Hospital for Children. A total of 80 Egyptian children, out of which 40 subjects having a mean age of 11.2 ± 3.12 years were cases with CKD in stage 5 on regular HD and the other 40 healthy subjects as controls, with a mean age of 12.2 ± 2.54 years, were included in the study and assessed for LVH and LVMI by 2D echocardiography. HD children had a significantly higher mean LVMI (102.3 ± 19.1 vs. 49.6 ± 4.11 g/m 2 , P <0.001) than controls. Relative wall thickness was significantly higher in the patients with CKD patients on HD compared with controls (P <0.001) with a mean value of 0.46 indicating concentric LVH in renal patients. Comparing mitral inflow velocities between both the groups revealed that the patient group had a significant decrease in mitral E-wave velocity (0.88 ± 0.2 vs. 1.1 ± 0.1 m/sec, P <0.001) and E/A velocity ratio (1.3 ± 0.3 vs. 1.7 ± 0.3, P <0.001) in comparison with the control group, but there was no statistically significant difference in A-wave velocity. This indicates early diastolic dysfunction in CKD patients. LV mass changes in CKD children were strongly related to hypocalcemia and Vitamin D deficiency. Children with CKD are prone to the development of cardiac diastolic dysfunction and LVH, so early and regular echocardiographic studies of all children with CKD are recommended to detect early cardiac changes and institute interventions.

The COVID-19 pandemic has clearly shown the importance of developing advanced protective equipment, and new antiviral fabrics for the protection and prevention of life-threatening viral diseases are needed. In this study, selenium nanoparticles (SeNPs) were combined with polyester fabrics using printing technique to obtain multifunctional properties, including combined antiviral and antibacterial activities as well as coloring. The properties of the printed polyester fabrics with SeNPs were estimated, including tensile strength and color fastness. Characterization of the SeNPs was carried out using TEM and SEM. The results of the analysis showed good uniformity and stability of the particles with sizes range from 40-60 nm and 40-80 nm for SeNPs 25 mM and 50 mM, respectively, as well as uniform coating of the SeNPs on the fabric. In addition, the SeNPs-printed polyester fabric exhibited high disinfection activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with an inhibition percentage of 87.5%. Moreover, a toxicity test of the resulting printed fabric revealed low cytotoxicity against the HFB4 cell line. In contrast, the treated fabric under study showed excellent killing potentiality against Gram-positive bacteria ( Bacillus cereus ) and Gram-negative bacteria ( Pseudomonas aeruginosa, Salmonella typhi, and Escherichia coli ). This multifunctional fabric has high potential for use in protective clothing applications by providing passive and active protection pathways.

Purpose: The present study aimed to compare treatment outcome of idarubicin versus doxorubicin in combination with Ara-C as induction therapy for untreated AML patients., Patients and Methods: This retrospective study included 143 patients with de novo AML. All patients received full dose of standard induction therapy (3 + 7) using anthracyclines (doxorubicin or idarubicin) and cytarabine., Results: The studied groups had comparable CR. No significant differences were noted between the studied groups regarding DFS and OS. The DXR group had significantly lower cost in comparison to IDA group., Conclusions: Idarubicin doesn't have a clear advantage over doxorubicin in treatment of AML., Competing Interests: Authors of the present study entitled “Treatment Outcome of Doxorubicin versus Idarubicin in Adult Acute Myeloid Leukemia” declares no conflict of interest., (© 2021 The Authors.)

The purpose of this study is to describe a Mendelian disorder of DNA damage repair. Phenotypic delineation of two families, one new and one previously published, with overlapping dysmorphic and neurodevelopmental features was undertaken. Functional characterization of DNA damage repair in fibroblasts obtained from the index individuals in each of the two families was pursued. We present new evidence of a distinct disorder caused by biallelic truncating variants in ZNF668 comprising microcephaly, growth deficiency, severe global developmental delay, brain malformation, and distinct facial dysmorphism. DNA damage repair defect was observed in fibroblasts of affected individuals. ZNF668 deficiency in humans results in a recognizable autosomal recessive disorder, which we propose to name ZNF668-related ZMAND (ZNF668-related brain malformation, microcephaly, abnormal growth, neurodevelopmental delay, and dysmorphism). Our results add to the growing list of Mendelian disorders of the DNA damage repair machinery., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In this study, we developed a new approach for depositing selenium nanoparticles (SeNPs) into polypropylene (PP) fabrics via a one-step process under hydrothermal conditions by using an IR-dyeing machine to incorporate several functionalities, mainly coloration, antibacterial activity and ultraviolet (UV) protection. The formation, size distribution, and dispersion of the SeNPs were determined using X-ray diffraction (XRD), ultraviolet-visible (UV/Vis), transmission electron microscopy (TEM) and the color strength, fastness, antibacterial properties, and UV protection of the treated fabrics were also explored. The UV-Vis spectra and TEM analysis confirmed the synthesis of spherical well-dispersed SeNPs and the XRD analysis showed the successful deposition of SeNPs into PP fabrics. The obtained results demonstrate that the SeNPs-PP fabrics is accompanied by a noticeable enhancement in measurements of color strength, fastness, and UV-protection factor (UPF), as well as excellent antibacterial activity. Viability studies showed that SeNPs-PP fabrics are non-toxic against wi-38cell line. In addition, the treated SeNPs-PP fabrics showed an increase in conductivity. The obtained multifunctional fabrics are promising for many industrial applications such as the new generation of curtains, medical fabrics, and even automotive interior parts.

Background: Assessment of the left ventricular function in the dialysis children and explore its association with vitamin D level and markers reflecting calcium and phosphate metabolism., Methods: In this case-control study, we enrolled forty children on regular hemodialysis and forty healthy controls from July 2019 to March 2020 at the pediatric dialysis unit. Echocardiographic evaluation using both conventional and Tissue Doppler Imaging (TDI) was done for all subjects. Vitamin D and its markers were analyzed to assess its association with ventricular dysfunction., Results: Diastolic function in children on hemodialysis was significantly impaired as evidenced by lower Mitral E/A velocity ratio (E/A), lower early diastolic velocity (E'), and higher E/E' ratio (Ratio of early diastolic mitral inflow velocity (measured by pulsed wave traditional Doppler) to early diastolic mitral annular velocity (measured by Tissue Doppler). in comparison with the controls. Most end stage renal disease (ESRD) participants had vitamin D deficiency. There was an important correlation between left ventricular (LV) dysfunction and both Vitamin D deficiency and hyperparathyroidism. Although our patients had normal systolic function by conventional and Tissue Doppler echocardiographic study, mean values of TDI- MPI (Mean Performance Index) in the haemodialysis group were significantly higher than in the control group, which indicates impaired global cardiac systolic and diastolic function., Conclusions: Tissue Doppler Imaging (TDI) provides a good reflection of the LV diastolic function. As vitamin D deficiency has been substantially associated with worsening of LV dysfunction, we suggest that TDI and Vitamin D might be included in the routine follow-up of pediatric dialysis patients.

Primary spontaneous upper extremity deep vein thrombosis is characterised by thrombosis within deep veins draining the upper extremity due to anatomical abnormalities of the thoracic outlet causing axillosubclavian compression and subsequent thrombosis. It is an uncommon condition that typically presents with unilateral arm swelling in a young male following vigorous upper extremity activity. The diagnosis of this condition is usually made by Doppler ultrasound, but other investigations are mandatory to exclude the secondary causes of upper extremity DVT. Different treatment options are available including anticoagulation, thrombolysis, and surgery. We report the case of a young healthy male with athletic physique who presented with pain and swelling of his dominant arm after weightlifting in the gym.

We report the outcomes of secondary acute myeloid leukemia (s-AML) patients included in one of 13 European Organisation for Research and Treatment of Cancer (EORTC) collaborative AML trials using intensive remission-induction chemotherapy. Among 8858 patients treated between May 1986 and January 2008, 960 were identified as having s-AML, either after MDS (cohort A; n = 508), occurring after primary solid tumors or hematologic malignancies other than MDS (cohort B; n = 361), or after non-malignant conditions or with a history of toxic exposure (cohort C; n = 91). Median age was 64 years, 60 years and 61 years in cohort A, B and C, respectively. Among patients ≤60 years and classified in the cohorts A or B ( n = 367), the 5-year overall survival (OS) rate was 28%. There was a systematic improvement in the 5-year OS rate over three time periods ( p < 0.001): 7.7% (95% CI: 1.3-21.7%) for patients treated before 1990 (period 1: n = 26), 23.3% (95% CI: 17.1-30.0%) for those treated between 1990 and 2000 (period 2: n = 188) and 36.5% (95% CI: 28.7-44.3%) for those treated in 2000 or later (period 3: n = 153). In multivariate analysis, male gender (HR = 1.39; p = 0.01), WBC ≥ 25 × 10 9 /L (HR = 2.00; p < 0.0001), age 46-60 years (HR = 1.65; p < 0.001) and poor-risk cytogenetics (HR = 2.17; p < 0.0001) were independently associated with shorter OS, while being treated during period 2 (HR = 0.50, p = 0.003) or period 3 (HR = 0.43; p = 0.0008). Having received high-dose cytarabine (HD-AraC) ( n = 48) in the induction chemotherapy (HR = 0.54, p = 0.012) was associated with a longer OS. In contrast, among patients >60 years of age ( n = 502), the OS was dismal, and there was no improvement over time.

Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

New and durable multifunctional properties of cotton/polyester blended fabrics were developed through loading of chitosan (Cs) and various metal oxide nanoparticles (MONPs) namely ZnO, TiO 2 , and SiO 2 onto fabric surface using citric acid/Sodium hypophosphite for ester-crosslinking and creating new anchoring and binding sites, COOH groups, onto the ester-crosslinked fabrics surface. The surface morphology and the presence of active ingredients (Cs & MONPs) onto selected - coated fabric samples were analyzed by SEM images and confirmed by EDS spectrums. The influence of various finishing formulations on some performance and functional properties such as wettability, antibacterial activity, UV-protection, self-cleaning, resiliency and durability to wash were studied. The obtained results revealed that the extent of improvement in the imparted functional properties is governed by type of loaded-hybrid and follows the decreasing order: Cs-TiO 2 NPs>Cs-ZnONPs>SiO 2 NP s >Cs alone, as well as kind of substrate cotton/polyester (65/35)>cotton/polyester (50/50). Moreover, after 15 washing cycles, the durability of the imparted functional properties of Cs/TiO 2 NP s - loaded substrates marginally decreased indicating the strong fixation of the hybrid components onto the ester-crosslinked substrates. The obtained bioactive multifunctional textiles can be used for producing eco-friendly protective textile materials for numerous applications., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Berberine (BBR) is a natural isoquinoline alkaloid with very impressive health benefits. It is one of the most effective natural supplements available; however, its ameliorative mechanism against methotrexate (MTX)-induced liver injury is not well defined. This study investigated the protective effect of BBR against MTX hepatotoxicity, focusing on its ability to attenuate oxidative stress and apoptosis and to activate nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling and peroxisome proliferator activated receptor gamma (PPARγ). Rats received BBR (25 and 50mg/kg) orally for 7days before MTX injection. Other groups received MTX followed by BBR (25 and 50mg/kg) orally for 7 days. MTX-induced rats showed significant body weight loss, increased serum liver function marker enzymes, bilirubin and tumor necrosis factor alpha (TNF-α). Liver lipid peroxidation, nitric oxide (NO) and caspase-3 were significantly increased following MTX administration. BBR supplemented either before or after MTX significantly ameliorated body weight, liver function markers, TNF-α, lipid peroxidation, NO and caspase-3. BBR increased serum albumin and liver antioxidant defenses in MTX-induced rats. Histological and immunohistochemical examination showed improved histological structure and decreased expression of Bax in liver of MTX-induced rats treated with BBR. In addition, BBR up-regulated Nrf2, HO-1 and PPARγ expression in the liver of MTX-induced rats. In conclusion, BBR attenuated MTX-induced oxidative stress and apoptosis, possibly through up-regulating Nrf2/HO-1 pathway and PPARγ. Therefore, BBR can protect against MTX-induced liver injury., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Purpose: To compare single-agent gemtuzumab ozogamicin (GO) with best supportive care (BSC) including hydroxyurea as first-line therapy in older patients with acute myeloid leukemia unsuitable for intensive chemotherapy., Patients and Methods: In this trial, patients at least 61 years old were centrally randomized (1:1) to receive either a single induction course of GO (6 mg/m(2) on day 1 and 3 mg/m(2) on day 8) or BSC. Patients who did not progress after GO induction could receive up to eight monthly infusions of the immunoconjugate at 2 mg/m(2). Randomization was stratified by age, WHO performance score, CD33 expression status, and center. The primary end point was overall survival (OS) by intention-to-treat analysis., Results: A total of 237 patients were randomly assigned (118 to GO and 119 to BSC). The median OS was 4.9 months (95% CI, 4.2 to 6.8 months) in the GO group and 3.6 months (95% CI, 2.6 to 4.2 months) in the BSC group (hazard ratio, 0.69; 95% CI, 0.53 to 0.90; P = .005); the 1-year OS rate was 24.3% with GO and 9.7% with BSC. The OS benefit with GO was consistent across most subgroups, and was especially apparent in patients with high CD33 expression status, in those with favorable/intermediate cytogenetic risk profile, and in women. Overall, complete remission (CR [complete remission] + CRi [CR with incomplete recovery of peripheral blood counts]) occurred in 30 of 111 (27%) GO recipients. The rates of serious adverse events (AEs) were similar in the two groups, and no excess mortality from AEs was observed with GO., Conclusion: First-line monotherapy with low-dose GO, as compared with BSC, significantly improved OS in older patients with acute myeloid leukemia who were ineligible for intensive chemotherapy. No unexpected AEs were identified and toxicity was manageable., (© 2016 by American Society of Clinical Oncology.)

To evaluate the impact of nutritional knowledge following interventional educational sessions in chronic dialysis patients, we studied 40 children on chronic regular hemodialysis (HD) at the beginning and after six months of nutrition educational sessions using a predesigned questionnaire. We also measured the anthropometric parameters of nutrition to evaluate the impact of this education on the health of patients. We found a highly statistically significant increase in patients' scores and in adequate knowledge using the questionnaire after the educational sessions. Our results showed a statistically significant decrease in body mass index and weight after educational sessions for six months. Moreover, there were no significant decreases in serum phosphorus, ferritin, iron and creatinine, in contrast with no significant increase in hemoglobin, serum calcium, blood urea nitrogen and serum albumin. We conclude that nutritional education is significantly effective with regard to the level of knowledge, but not with regard to the attitude and practice in children on chronic HD.

Background: Despite aggressive local therapy, patients with locally advanced bladder cancer have a significant risk of distant metastases. This study evaluated the role of neoadjuvant combination chemotherapy with gemcitabine/cisplatin (GC) in improving the outcome of this group of patients over radical cystectomy alone., Patients and Methods: A total of 114 patients with newly diagnosed bladder cancer (T3-4, N0-2, M0) were randomized to radical cystectomy alone or initial 3 cycles of GC, then managed according to response. Patients who achieved complete response completed 6 cycles of GC followed by local radiation therapy (RT) only. If tumors were downstaged to T1, complete transurethral resection was done, followed by 3 cycles of GC and then RT. Patients with partial response underwent radical cystectomy followed by 3 cycles of GC. Patients with stable disease or disease progression underwent radical cystectomy., Results: The overall response rate to GC was 55.1%, and complete response was achieved in 28.6%. The 3-year overall survival (OS) was 51.9% versus 51.2% in the chemotherapy and surgery arms, respectively (P = .399). The 3-year disease-free survival was 31.8% in the chemotherapy arm and 45.1% in the surgery arm (P = .06). Bladder preservation was achieved in 22.5% of patients in the neoadjuvant arm. OS was 78% in responding patients and 100% in patients with complete response., Conclusion: Neoadjuvant GC did not improve survival in locally advanced bladder cancer over radical cystectomy alone. However, bladder preservation was feasible, and OS in responding patients was impressive. Therefore, predictive models to select patients are needed. This is the largest prospective study of squamous cell carcinoma and transitional cell carcinoma using neoadjuvant GC., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first- and second-line therapy is still unknown. We report the outcome of 31 acute promyelocytic leukemia patients (median age 39 years) who underwent allogeneic transplant in second remission (n=15) or beyond (n=16). Sixteen patients were real-time polymerase chain reaction positive and 15 negative for PML/RARA pre-transplant. The 4-year overall survival was 62% and 31% for patients transplanted in second remission and beyond, respectively (P=0.05), and 64% and 27% for patients with pre-transplant negative and positive real-time polymerase chain reaction, respectively (P=0.03). The 4-year cumulative incidence of relapse was 32% and 44% for patients transplanted in second remission and beyond, respectively (P=0.37), and 30% and 47% for patients transplanted with negative and positive real-time polymerase chain reaction, respectively (P=0.30). Transplant-related mortality was 19.6%. In conclusion, allogeneic transplant is effective in advanced acute promyelocytic leukemia in the all-trans-retinoic acid and arsenic trioxide era, and should be considered once relapse is diagnosed.

Therapy-related acute myeloid leukemia is an unfortunate complication of cancer treatment, particularly for patients with highly curable primary malignancies and favorable life expectancy. The risk of developing therapy-related acute myeloid leukemia also applies to patients with non-malignant conditions, such as autoimmune diseases treated with cytotoxic and/or immunosuppressive agents. There is considerable evidence to suggest that there is an increased occurrence of hematologic malignancies in patients with autoimmune diseases compared to the general population, with a further increase in risk after exposure to cytotoxic therapies. Unfortunately, studies have failed to reveal a clear correlation between leukemia development and exposure to individual agents used for the treatment of autoimmune diseases. Given the dismal outcome of secondary acute myeloid leukemia and the wide range of available agents for treatment of autoimmune diseases, an increased awareness of this risk and further investigation into the pathogenetic mechanisms of acute leukemia in autoimmune disease patients are warranted. This article will review the data available on the development of acute myeloid leukemia in patients with autoimmune diseases. Possible leukemogeneic mechanisms in these patients, as well as evidence supporting the association of their primary immunosuppressive status and their exposure to specific therapies, will also be reviewed. This review also supports the idea that it may be misleading to label leukemias that develop in patients with autoimmune diseases who are exposed to cytotoxic agents as 'therapy-related leukemias'. A better understanding of the molecular defects in autoimmune disease patients who develop acute leukemia will lead to a better understanding of the association between these two diseases entities.

We report the clinical features and treatment outcome of 33 patients with multiple sclerosis who developed acute promyelocytic leukemia. Thirty patients were previously exposed to mitoxantrone. The median latency period between treatment initiation and acute promyelocytic leukemia diagnosis was 32 months. The PML-RARA bcr1 iso-form was identified in 87% of cases. Twenty-nine (90%) patients achieved hematologic remission after all-trans retinoic acid and chemotherapy (n = 31) or arsenic trioxide and all-trans retinoic acid. Consolidation included modified chemotherapy or arsenic trioxide. At a median follow up of 26 months, 23 patients are in complete remission, 4 relapsed and one developed secondary leukemia. The 5-year cumulative incidence of relapse and overall survival were 23% and 68%, respectively. Although treatment heterogeneity and suboptimal post-remission therapy must be taken into account, overall results and development of secondary leukemia in one patient suggest that effective and less toxic agents like arsenic trioxide warrants further investigation in this context.

The current study reports the clinical features and treatment outcome of 67 patients with acute promyelocytic leukemia (APL) treated at National Cancer Institute (NCI-Cairo), in Egypt from January 2007 to January 2011. The median age at presentation was 29 years. Bleeding was the most common presenting symptom (79%). Most patients had an intermediate risk Sanz score (49%) and 34% had a high risk score. The median follow-up time was 36 months. All evaluable patients were treated for induction with the simultaneous administration of all-trans retinoic acid (ATRA) and an anthracycline. The original AIDA treatment protocol was modified due to resource limitations at the NCI-Cairo by replacing of idarubicin with daunorubicin or doxorubicin in most of the cases and the inclusion of cytarabine during the consolidation phase only in pediatric patients. All patients who achieved molecular complete remission after consolidation received two-year maintenance treatment with low dose chemotherapy composed of 6 mercaptopurine, methotrexate and intermittent ATRA courses. Five patients died before treatment initiation due to bleeding, three died during induction chemotherapy due to infectious complications (n=2) and bleeding (n=1) and one patient died during consolidation therapy due to infection. The main therapeutic complications during the induction phase were febrile neutropenia (42%), bleeding (18%) and differentiation syndrome (11%). All patients achieved molecular CR at end of consolidation therapy at a median time of 100 days. The 3-year OS was 89%. Two patients relapsed at 13 and 24 months, respectively. Adapting standard AIDA treatment protocols to limited resources by reducing dose-intensity during consolidation, using ATRA in the consolidation phase and alternative anthracyclin (doxorubicin) may be a valid treatment option for APL in developing countries. In spite of the increased incidence of high and intermediate risk disease in our cohort, we reported an acceptable CR rate, toxicity and OS.

The treatment and survival outcome of acute leukemia in women is generally similar to that of men. However, acute leukemia in women poses additional challenges in clinical practice. In addition to important precautions during therapy, such as prevention of abnormal uterine bleeding in premenopausal women and therapy during pregnancy, women who are survivors of acute leukemia face unique and potentially long-term health-related problems. In this review, we address the aforementioned issues, as well as the various health and psychosocial challenges faced by women who survive childhood leukemia during their path to adulthood. Finally, we address the issue of therapy-related acute leukemia in the category of women who are survivors of breast and ovarian cancer.

Fifty pulmonary tuberculous patients (minimal; moderate and far-advanced), 18 TB-healed persons and 15 healthy control subjects were examined for plasma levels of adrenaline (AD), noradrenaline (NA), dopamine (DA), ACTH and cortisol. The estimated hormones were found to be increased significantly with the severity of the disease suggesting that the stress of infection plays a role in induction of enzymes responsible for catecholamines synthesis with subsequent stimulation of ACTH and cortisol secretion. Noradrenaline appeared the most effective in this respect.

This work was carried out on 150 subjects. They were classified into four groups: group I: Bronchogenic pulmonary T. B. (n = 96); group II: Haematogenous T. B. (n = 15); group III: Healed T. B. (n = 16), group IV: Healthy control (n = 23). Insulin tolerance test was done for each subject to assess the hypothalamo-hypophyseal axis. Glucose, ACTH, cortisol, GH, and PRL levels were estimated during fasting and over three hours after insulin administration. In group I and II the patients exhibited higher fasting levels of anti-insulin hormones and they respond greater than normals to insulin-induced hypoglycaemia. This might indicate early affection of the pituitary gland by TB infection, yet insulin-induced hypoglycaemia assured efficient function of the gland. In healed TB patients, no significant changes were obtained in the different hormonal behaviour, whether in the fasting state or after stimulation. This might be explained by improvement of the health condition of the patients, and relief of the stress induced by TB infection.

The amplitude and rate of transient and maintained responses of an identified giant neurone of the pond-snail, Lymnaea stagnalis, to a maintained injected current were investigated. The responses of the isopotential soma to a maintained current density of less than 10 microamperemeter cm -2 includes repetitive discharges of action potentials, sawtooth oscillations and amplitude-modulated oscillations. The frequency of the maintained response increases as the injected current increases, while the amplitude decreases until the maintained response is a stable steady state at a membrane potential of about -20 mV. This bifurcation from small amplitude periodic solutions to a depolarized stable steady state has the characteristics of a supercritical Hopf bifurcation.

The statistical properties of background spike train activity recorded from a molluscan neurone are used to identify lengths of discharge which are produced by endogeneous pacemaker mechanisms. Such pacemaker discharge has an infinitely divisible interspike interval probability density function.