We read with keen interest the article recently published by El-Dessouky et al on "prenatal Ultrasound Findings of Holoprosencephaly Spectrum: Unusual associations". 1 The authors rightly selected their cases and sufficiently investigated the genetic correlates of holoprosencephaly (HPE). However, we are intrigued by the striking variations between the reports of El-Dessouky et al and El-Bassyouni et al, 1,2 considering the fact that the both investigations were carried out in Cairo, Egypt. The former did not make any reference to or discuss their findings in the light of the earlier report of the latter. This creates a gap in the literature and limits the ability of policy makers to rightly channel interventions in health care. First, El-Dessouky et al investigated 25 cases of HPE (between 2017 and 2019) at Cairo Fetal Medicine Unit and reported a male:female (M:F) sex ratio of 1:1.8. 1 Contrastingly, El-Bassyouni et al investigated 24 cases of HPE at National Research Centre (between 2008 and 2012) and reported an M:F sex ratio of 2:1. 2 Globally, HPE is preponderant in females and M: F sex ratio ranges from 1:1.4 to 1:2.5. 3-5 The reason for the initial preponderance in males and the shift from male preponderance to female preponderance in Egypt is yet unexplained. This warrants more investigations.

This cross-sectional study evaluated the expression of miR-let-7b, miR-21, miR-125b, miR-143, miR-145, miR-155, miR-182, miR-200c, p53 gene, Ki67, SCCA1 and CD4+ T-cell counts among 319 women, to Epstein-Barr virus, human papillomavirus and herpes simplex virus 2 mono-infections and co-infections, using enzyme-linked immunosorbent assay and reverse transcriptase-polymerase chain reaction methods. This study suggests that malignancies associated with viral co-infection could be diagnosed early by monitoring cluster of differentiation 4+ T-cell counts and serum expression of miR-145 and miR-182.

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Cervical cancer is the 9 th most common cancer in world, and the 6 th most common and 3rd most deadly cancer among women (Fitzmaurice et al., 2019). Studies show a minor reduction in age standardized incidence rate (ASIR per 100,000) from 14.5 to 13.1 between 2017 and 2018, and a minor increase in the age standardized mortality rate (ASMR per 100,000) from 6.1 to 6.9 within the same period (Fitzmaurice et al., 2019;Arbyn et al., 2020). Despite the fact that majority of the countries in Asia and Africa have similar economy (less developed),

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Cancer is a complex multifaceted disease caused by alterations at the genetic or epigenetic level in cells. Cancers in females majorly consist of ovarian, breast and cervical cancers, all of which, occurring concurrently, are referred to as 'Tri-positive cancer (TPC)'. Genetic and epigenetic mechanisms in TPC involve microRNAs; which are a class of endogenous, small, non-coding RNAs of 22 to 24 nucleotides that control gene expression. In TPC, upregulated oncogenic miRNAs includes: miR-21, miR-146a, miR-155, miR-182 and miR-200c while the downregulated tumour suppressor miRNAs includes: let-7b, miR-125b, miR-143 and miR-145. Cross-talk in TPC, which is the interaction between miRNAs and pathways, is an upshot of a complex network engaging the interplay of target genes such as PTEN, Muc-1, ERRB2/3, ZEB1/2, RAS, Bcl-2 and c-Myc among others, and occurring mostly through the P13k/Akt signaling pathway. Furthermore, an inverse relationship between miR-146a and miR-182, and BRCA gene with a direct relationship between miR-125b and BRCA gene was observed in the emergence of TPC. This review also showed that there are variations in the expression of let-7, miR-21, miR-125b and miR-200c between Tumour Initiating Cells (T-ICs) and TPC. Thus, since some of these miRNAs are dysregulated in chronic inflammations which play a critical role in tumourigenesis, proper investigation of these miRNAs and target genes in high risk individuals may aid prediction and early diagnosis of cancer and effective therapy with high reduction in mortality.