Update on Myelodysplastic Syndrome: An Essay Submitted for Partial Fulfillment of The Master Degree in Clinical and Chemical Pathology 2008

Myelodysplastic syndrome comprises a group of clonal hematologic disorders characterized clinically and morphologically by ineffective hematopoiesis. It is viewed by most hematologists as encompassing stages of neoplastic hematopoiesis associated with cytopenias and as excluding nonneoplastic conditions. Neoplastic transformation of hematopoietic cells can occur at various levels of stem-cell development. The initial hematopoietic stem cell injury can result from cytotoxic chemotherapy, radiation exposure, viral infection, chemical exposure, or genetic predisposition. A clonal mutation predominates over bone marrow suppressing healthy stem cells. The decision about how to deal with the morbidity of the disease versus the potential benefits and toxicities from treatment will ultimately be made by the individual patient. This decision is based on age, personal preferences, and available information about disease biology and prognostic factors. The aim of the present work is to review recent advances in myelodysplastic syndrome as regard molecular pathogenesis, diagnosis, classification and treatment.

A Cambodian refugee woman ponders her future at Ban Kaeng camp in Thailand. UNHCR/ R. Burrows/ 1982 Theanvy Kuoch Profession:Therapist Country of Origin:Cambodia Country of Asylum:United States of America Date of birth:10 January 1946 Theanvy Kuoch turned her own experience as a Cambodian refugee into something positive - she now helps other victims of persecution to overcome the scars of the past and has won international recognition for her achievements. After suffering for four years under the Khmer Rouge regime, she managed to escape from Cambodia in 1979. She recalls the horror of the 1970s: "From 1975 to 1979, I was a slave of the Khmer Rouge and forced to do heavy labour. I watched as my family died one by one from starvation and abuse until I had lost more than 19 relatives." Following the Vietnamese invasion of Cambodia, Kuoch, fearing Khmer Rouge reprisals, ran away with her six-year-old son and her niece. They hid in the forest, staying until it was safe to go back to her home, where she was reunited with her father and three sisters. Kuoch left her little boy with her sisters and went to the Thai border in search of food. On their way, together with other needy Cambodians, they crossed an area where clashes had broken out between the Khmer Rouge and the Vietnamese Army. "I ran for many hours and when I got to the border, my feet were so swollen that all my toenails fell off." The Red Cross located them and helped them reach Khao-i-Dang, a UNHCR refugee camp. In the refugee camp, Kuoch was able to regain her self-respect, lost during the long years of harsh treatment. She began working for a surgical hospital operated by the German Catholic Relief Organization and was trained as a theatre nurse. After spending two years working in various refugee camps, she was resettled in the United States. In America, she obtained a master's degree in Cross Cultural and Contextual Family Therapy at Goddard College, Vermont. Since 1982, Kuoch, together with other devoted nurses from the Khao-i-Dang camp, has provided health services to survivors of torture and persecution through Khmer Health Advocates. As she has said: "I learned that my own pain was eased by helping others." This organisation, based in West Hartford, Connecticut, co-operates closely with other international refugee agencies and assists families to locate and resettle relatives. Finding her own son after 11 years of separation was the greatest reward for her lifelong work. In the late 1980s, Kuoch started a project called Cambodian Mothers for Peace, a women's group that advocated an end to fighting in Cambodia through discussions and presentations about their Cambodian experience. This year, she organised the National Cambodian American Health Taskforce to address a health crisis in Cambodian communities across the United States. Kuoch has been awarded on several occasions for her enduring refugee work: in 1984, she was one of the humanitarians honoured as "Outstanding Women" in commemoration of the United Nations Decade of Women. In 1991, President George Bush declared her a "point of light" on National Refugee Day. In 1992, she received an award by the Women's Refugee Commission for Refugee Women and Children for her advocacy work.

Students in the Master of Science in Nursing (MSN) program at UMDNJ take a break from their classroom studies. Nurses with master's degrees, especially nurse practitioners command higher salaries and have broader job opportunities.