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Introduction: The Syrian crisis, started in 2011, has had a profound impact on the entire region. Jordan, a low-middle income country with limited resources is ranked first in the region in relation to the number of refugees hosted. The latest national census reported over a million Syrian refugee in the country. Lack of sufficient funding, from either the host country or international refugee aid organizations, may lead to suboptimal treatment of cancer patients. The total number of Syrian cancer patients registered at King Hussein Cancer Center (KHCC) hospital-based cancer registry was 510 patients. Local and regional funds covered the treatment of almost two thirds of these patients. In this study, we report on patterns of presentation and management of Syrian patients with breast cancer treated and followed at our institution. Patients and methods: This is a retrospective data collection of Syrian refugees who presented to our institution with a diagnosis of breast cancer from January 2011 to December 2019. Adult patients aged 18 year or older with pathologically-confirmed diagnosis of breast cancer were required to have at least one medical encounter. Data was collected from the electronic medical records for eligible patients. Management was compared against our approved clinical practice guidelines (CPG). Results: During the study period, a total of 147 adult Syrian refugee patients with breast cancer had at least one medical encounter at our institution. All were females and median age (range) at diagnosis was 47 (21-84) years. Thirty-four (23.1%) patients did not complete the work up and missed subsequent visits and will be excluded from analysis. The remaining 113 patient had biopsy proven invasive (n=110) or ductal carcinoma in situ (n=3) and continued their treatment and follow up; 39 (34.5%) had early stage disease, 48 (42.5%) locally advanced and 26 (23.0%) presented with metastatic disease. Estrogen receptors (ER) were positive in 75 (66.4%) patients while 63 (55.8%) had positive progesterone receptor (PR). HER2 positive disease was documented in 31 (27.4%) while 18 (15.9%) patients had triple negative disease. Eighty (70.8%) patients underwent surgery, 60 (75.0%) were at KHCC. The median time from first encounter to surgery for those who underwent upfront surgery was 2 months. Breast conserving surgery (BCS) was done for 27 (45.0%). However, only 11 (35.4%) of the 31 patients eligible for breast reconstruction underwent such procedure. Adjuvant radiation was given to 49 (77.7%) of 63 candidate patients and some were delayed. Systemic treatment with chemotherapy was given to 103 patients; as neoadjuvant (n=37, 35.9%), adjuvant (n=45, 43.7%) and palliative (n= 21, 20.4%). Among the 31 patients with HER2-positive disease, only 11 (35.5%) patients received it. Additionally, only 3 (30.0%) of 10 patients who were candidates for CDK4/6 inhibitors received it. Genetic Testing and counselling were also suboptimal, only 8 (12.3%) of 65 candidate patients underwent genetic testing. Across all needed treatment, 37 (32.7%) patients had significant deviations when judged against our institutional CPGs. Conclusions: Syrian refugees with breast cancer had late presentation and more advanced-stage disease. They are more likely to receive delayed and suboptimal surgeries, genetic counseling and systemic therapy highlighting the urgent need for international systematic approach for cancer care among such unprivileged population. Citation Format: Hikmat Abdel-Razeq, Faris Tamimi, Maryam El-Atrash, Baha' Sharaf, Razan Mansour, Rawan Mustafa. Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-73.

Background: Acute Calcular Cholecystitis (A.C) is inflammation of the gallbladder and is the most common complication of gallstones, requiring hospital admission and prompt intervention. Its Symptoms include right upper abdominal pain, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, and inflammation of the common bile duct.Aim of The Work: To assess surgical outcome from laparscopic and open cholecystectomy in acute calcular cholecystitis by assessment and differentiate between both of them in these parameters as regards: 1-Hospital stay, 2-Wound infection, 3-Bilary fistula, 4-Missed stone, 5-intestinal injury.Patients and Methods: Type of Study: prospective clinical trial. Study Setting: This study will be carried out, at Ain Shams hospitals. Study Period: This study will be carried out during the period between October2018 and October 2019. Study Population: This study will include 30 patients with diagnosis of acute calcularcholycystitis.Results: The present study was a prospective, clinical, trial that included30 patients diagnosed with acute calcular cholecystitis attended to surgery theatre at Ain Shams hospital. The patients were divided into two groups: Group I including 15 patients underwent laparoscopic cholecystectomy during the first week of their presentation. Group II including 15 patients underwent open cholecystectomy during the first week of their presentation.Conclusion: Cholecystectomy during 1st week of acute cholecystitis should be attempted by laparoscopy at first in condition that there are no complications as gangerenous gall bladder. as, post-operative morbidity and hospital stay are reduced by laparoscopic cholecystectomy. Moreover, intestinal injury and wound infection rate are reduced by laparoscopy. A positive trend exists in operating time favoring laparoscopy, however more studies are necessary. Severe hemorrhage and bile leakage rate are not influenced by the technique.

Background: In the modern treatment of breast cancer, the Sentinel Lymph node biopsy indication is present in many clinical circumstances, instead of classical axillary lymphadenectomy. It presents the advantage of conservative surgery, which significantly decreases the rate of postoperative complications, offering the patients a better quality of Life and reducing the costs of patients care after surgery. Sentinel Lymph node biopsy (SLNB) vs. axillary Lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer.Aim of the Work: The aim of the present study is to evaluate staging the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in previous clinically node positive axilla in breast cancer to avoid the morbidity of an ALND.Patients and Methods: This was a prospective cohort study was held in El Demerdash hospital Ain Shams University hospitals, Cairo, Egypt started with one hundred and twenty female patients with clinically node positive axilla in breast cancer. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria.Results: Our study showed that SLNB is acceptable in cN1/2 patients who become cN0 after neoadjuvant therapy: particularly in those with no residual disease in the breast, because SN status maintains its expected prognostic role, but also in cases with residual disease, because Axillary dissection (AD) has no influence on outcomes.Conclusion: Sentinel lymph node biopsy will replace axillary lymph node dissection (ALND) in those patients with clinically node positive axilla without compromising their oncologic outcomes. Especially, rates of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have increased. In the neoadjuvant setting, SLN after NAC is feasible and accurate in clinically node positive patients as a continuous effort to avoid the morbidity of ALND.

Aims: Lead is well known environmental pollutant, which can cause toxic effects in multiple organ systems. Lead originates from various industrial and/or household sources, and enters the body through food and fluid intakes, as well as by inhalation. No sufficient information present about the toxic effect of acute lead nanoparticles on kidney and liver. Accordingly, current study was performed to study the therapeutic effects of Oats extract towards the injection of lead nanoparticles (Pb NPs) in rat induced kidney and liver damage by increasing kidney and liver functions, and electrolytes. Study Design: A total of 40 male adult albino rats were equally divided into four groups (Control group, Oats group, Pb NPs group as acute toxicity and last group is Pb NPs +Oats). Results: Current results revealed that; a significant increase in the levels of serum aspartate transaminase (AST) and alanine transaminase (ALT), alkaline phosphatase (ALP), urea, creatinine, potassium and chloride ions after injection with Pb NPs as compared to control group. In contrast; a significant decrease in serum albumin, total proteins, and sodium ions in Pb NPs as compared to control groups. Treatment of Pb NPs with Oats improved this change in liver and kidney functions as compared to Pb NPs group. Conclusion: These findings suggested that; lead nanoparticles injection induced hepatic and renal damage. This shows that the desired dose of Pb NPs can safely be used with Oats in improving hepatic and renal damage in toxic group in young rats.

Background: Breast cancer is by far the most common cancer among women of both developed and developing countries and the leading cause of cancer death in females. The incidence of multifocal breast cancer has increased due to the improvement in imaging studies and the use of MRI. Multifocal breast cancer was previously considered a contraindication for breast conservative surgery. However, with the recent progress in the neoadjuvant systemic therapy Together with development of oncoplastic surgeries breast conservation is being increasingly performed for multifocal cases. Skin sparing mastectomy can also be used for multifocal cases with superior aesthetic results without compromising the oncological safety. Aim of the work: This study aims to compare conservative breast surgery and skin sparing mastectomy in multifocal breast cancer regarding local recurrence. Patients and methods: This is a prospective randomized clinicaltrial study conducted in Ain-Shams University Hospitals Breast surgery unit over 30 patients with minimal follow-up of 18 months.2 groups of patients; Group A: composed of 15 patients that undergoing conservative breast surgery for multifocal breast cancer. Group B: composed of 15 patients that undergoing skin sparing mastectomy for multifocal breast cancer. An informed consent will be taken from all patients who will accept to participate. Results: The percentage of local recurrence were found to be comparable in both groups. Also the aesthetic results and patients’ satisfaction were similar in both groups. However, postoperative wound complications were higher in the skin sapring mastectomy group.Conclusion: This study suggests that any of the two procedures can safely be done to cases with multifocal breast cancer however the cosmetic results in skin sparing mastectomy group was more superior than in the conservative breast surgery group.

Background and Objective: Monosodium glutamate (MSG) is identified as an Accent that is used in the food industry as a flavour enhancer with an umami taste that intensifies the meaty, savoury flavour of food. The present study aimed at evaluating the protective and ameliorative role of rocket seeds extract against monosodium glutamate-induced hepatic renal toxicity and oxidative stress in the male rat. Materials and Methods: A total of 60 male adult albino rats were equally divided into six groups (G1, Control; G2, rocket seeds (RS); G3, ACCENT or MSG; G4, Co- treated (RS+MSG); G5, Post- treated (MSG+RS); G6, Self-treated MSG). Results: Current results revealed that; a significant increase in serum ALT, AST, ALP, AFP, Urea, Creatinine, potassium ions, chloride ions, cholesterol, triglyceride, HDL, and LDL levels in MSG as compared to control and RS groups. In contrast; a significant decrease in serum albumin, total proteins, catalase, GSH and SOD in liver and kidney homogenates in MSG as compared to control and RS groups. Co- or post-treatment of MSG with rocket seeds improved this change in liver and kidney functions, with best results for co-treatment than post and self-treatment. Conclusion: These findings suggested that the misuse of monosodium glutamate may contribute to continuous hepatic and renal damage. This shows that the desired dose of monosodium glutamate can safely be used with grapes seed in improving hepatic and renal damage in monosodium glutamate in young rats.

Background: Breast conserving treatment (BCT) has become the standard treatment in early breast cancer; its goal is to provide a treatment as effective as mastectomy with the added benefit of a preserved breast. However, it is sometimes difficult to achieve good cosmetic results, particularly in patients with breast cancer located in the upper inner quadrant, for which the traditional conservative surgery results in a deformed breast. Aim of the work: To compare prospectively the oncoplastic results of inferior pedicle mammaplasty and doughnut mastopexy as techniques for early breast cancers located at the upper inner quadrant. Patients and Methods: This is a prospective randomized study on twenty female patients who were diagnosed to have early breast cancer located in the upper inner quadrant and are candidates foroncoplastic breast surgery. The study was conducted at Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria. Results: There is significant difference between the two groups as regards the operative time, intraoperative blood loss, hospital stay, total drainage volume, drainage days, postoperative complications,cosmetic outcome and the need for contralateral symmetrization. Inferior pedicle mammaplasty needs longer operative time and postoperative hospital stay and drainagy days with more intraoperative blood loss in comparison to Doughnut mastopexy. As regards the postoperative complications, we found that there are more complications in Inferior pedicle mammaplasty than Doughnut mastopexy as wound wound infection and dehiscence. Conclusion: Patients with early breast cancer located in the upper inner quadrant are candidate for either Inferior pedicle mammaplasty or Doughnut mastopexy. Doughnut mastopexy is better for them as there is less morbidity, better cosmesis, no need for contralateral symmetrization and fewer complications, so no delay in radiotherapy and Inferior pedicle mammaplasty needs more surgeon experience.

In this paper, laboratory experiments were conducted on two different asphalt mixes, one using the Marshall mix design method (MMD) and the second using modified Marshall mix design (3M) method. The 3M method is based on the incorporation of two factors, the new asphalt binders (performance grade) and the Superpave gyratory compactor (SGC) as in Superpave mix design method, into the traditional MMD method. All specimens had the same mixtures of aggregate gradation incorporated with two different compaction methods and two asphalt grades using two different classification methods: asphalt cement binder (B60-70) based on the penetration test (Pen system) and PG 70-10 based on performance grade system (PG). However, there were some errors at low temperature (− 25, − 10 °C) and high temperature (54 °C), so these values may be discarded. The tension–compression complex modulus test |E*| is dependent on temperature and loading frequency. Thus, the results of this test will give a more accurate representation of the absolute value of the tension–compression complex modulus test |E*| that defines the elastic properties of a linear viscoelastic material subjected to a sinusoidal loading. In addition, 2-complex modulus (E*) and phase angles (ΦE*) in the test have been measured at temperatures of − 25, − 10, − 5, 10, 25, 35 and 54 °C as well as frequencies of 25, 10, 5, 1, 0.5 and 0.1 Hz. The value of the dynamic modulus reflects the stiffness of the mixture and its resistance to deformation at a designated frequency and temperature. The results show an improvement in the |E*| in the modified 3M mix over the traditional MMD mix. The 3M method using asphalt binder PG 70-10 and gyratory compactor (SGC) as in Superpave mix design method, improves the |E*| of the asphalt mixture in HA climate. As well, intrinsic characteristics related to binder properties, aggregate gradation and compaction method in HA climate have the most significant effect on the predicted |E*|.

Highlights • RI is a mysterious pathophysiology that is still uncommonly present post Roux en Y gastric bypass. • Exploratory laparoscopy is a more confirmative diagnostic option. • The state of the intussuscepted intestine determines the plan of treatment. • The most adequate surgical treatment technique is still debatable., Introduction Intestinal intussusception is an uncommon entity when preceded by Roux en Y gastric bypass. Retrograde intussusception is an enigmatic phenomenon characterized by reversely intussuscepted intestinal loop that may involve any piece of the Roux en Y limbs. Computed Tomography is gold standard for diagnosis. Surgical management is highly debatable. Case presentation A 35 years old female known for morbid obesity, post roux en Y gastric bypass since 5 years with 100 % excess weight loss presenting for on-off episodes of small bowel obstruction symptoms. She was diagnosed laparoscopically for retrograde intussusception that was reduced easily with closure of Peterson’s pouch due to high suspicion of an internal hernia. She did well postoperatively and followed up adequately with no recurrence of her symptoms. Conclusion Retrograde intussusception remains an interesting uncommon phenomenon in the horizon of the roux en Y gastric bypass surgeries. Several surgical options were discussed in the last 12 years and they are still debatable.

Cyclophosphamide (CTX) is a chemotherapeutic drug used for treatment of certain solid tumors, lymphomas, and some autoimmune diseases. The antitumor effect of CTX is associated with leukopenia and liver dysfunction. There is an interest in exploring agents that can minimize the adverse effect of CTX without ameliorating its antitumor efficacy. Among the potential agents is a recent study on white button mushroom, which has been found to exert anti-toxic effects. This study was designed to assess the beneficial effects of mushroom extract on the antitumor and toxic effects of CTX. Swiss albino mice were inoculated with intraperitoneal injection (i.p.) of 0.25 x 106 (day 0) of Ehrlich ascites carcinoma (EAC) cells. Mice were treated with a single dose of CTX (200mg/kg) on day 1 or day 7 post EAC inoculation. Agaricus bisporus mushroom extract (666 mg/kg) was administrated (i.p.) on days 8-14 post tumor challenge. The numbers of leukocytes as well as liver function were assessed on day 17. Treatment with CTX on day 7 induced 46% and 37% decrease in the absolute number of monocytes and neutrophils. It had no effect on serum alanine amino transferase activity, while it induced 57% decrease in serum alkaline phosphatase activity. It induced 41% decrease in liver GSH as compared with tumor-bearing mice. Co-administration of mushroom extract with CTX induced 86% decrease in the number of EAC cells, 72% increase in the absolute number of monocytes, 37% increase in the absolute numbers of neutrophils, 57% decrease in serum ALP activity, 100% increase in GPX activity and 35% increase in GSH as compared with tumor-bearing mice. These results indicate to the beneficial effects of mushroom to enhance the antitumor effect of CTX coincided with reduction of its toxic effect.

Introduction Female sexual dysfunction (FSD) has been reported in 46% of women with lower urinary tract symptoms (LUTS). FSD is a common health problem that remains under-investigated, especially in Eastern communities, where discussion of the issue is considered a taboo. In this study we determined the prevalence of various subtypes of FSD in relation to LUTS in women in Ismailia, Egypt. Patients and methods This was a case-control study to assess FSD in women with LUTS in comparison to normal women. In all, 101 women patients attending the Urology clinic at our institution were divided into two groups, a study group of 52 with LUTS and a control group of 49 with no LUTS. Validated Arabic versions of the FSD index and the Bristol questionnaire were used to assess the participants, and the data analysed statistically. Results FSD was diagnosed in 75 of the 101 patients (74%); 87 (86%) reported hypoactive sexual desire, 61 (60%) reported sexual arousal disorder, 56 (55%) had lubrication disorders, 65 (64%) complained of orgasmic deficiency, 36 (36%) had satisfaction disorder, and 59 (58%) had sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Arousal, satisfaction, orgasmic and lubrication disorders were more common in the women with LUTS. There was no statistically significant difference in desire disorders between the groups. Conclusions FSD and its subtypes are more prevalent in women with LUTS in this sample of Egyptian women.

Toxocariasis is a widespread soil-transmitted parasitic disease. Toxocara canis larvae migrate through the tissues with a special predilection for the central nervous system. Recently, neurotoxocariasis is being diagnosed in humans with increasing frequency due to improved diagnostic tools. The present study aimed at exploring the biochemical and immunopathological alterations in the brain in experimental T. canis infection. For this purpose, 75 Toxocara -infected mice were sacrificed at 2, 5, and 16 weeks post-infection. The brains were removed and assayed for total larval count, pro-inflammatory cytokines (TNF-α, IL-6), and central neurotransmitters (γ-aminobutyric acid, glutamate, dopamine, norepinephrine, and serotonin). Brain sections were also stained for histopathological study, and for assessment of the expression of inducible nitric oxide synthase (iNOS), and glial fibrillary acidic protein (GFAP) by immunohistochemical methods. We found that larval recovery showed progressive increase over the course of infection. Furthermore, the infected mice displayed increased expression of pro-inflammatory cytokines and iNOS, as well as significant disturbances in neurotransmitter profile. Astrocytic activation, evidenced by enhanced expression of GFAP, was also manifest in infected animals. These changes were maximal in the chronic stage of infection or intensified over time. In conclusion, experimental neurotoxocariasis is associated with significant biochemical, immunological, and pathological changes.

Boldenone (BOL) is an androgenic steroid that improves the growth and food conversion in food-producing animals. In most countries worldwide, this anabolic steroid is forbidden for human uses and meat production as it was developed for veterinary use. Recently, BOL is used by bodybuilders in both off season and pre-contest, where it is well known for increasing vascularity while preparing for a bodybuilding contest. The present study was designed to investigate the physiological and biochemical changes in rabbits after injection with the growth promoter BOL. A total of 32 adult New Zealand rabbits were divided into four groups, where the control group includes animals that were injected intramuscularly with olive oil and dissected after 3 weeks. The remaining three experimental groups included animals that received one, two and three intramuscular injections of 5 mg/kg body weight BOL, respectively, and were dissected after 3, 6 and 9 weeks, respectively. The animals from practice appeared healthy and did not show clinical signs of disease and none of the rabbits died during the experimental period. Serum total protein, globulin, alanine aminotransferase, asparate aminotransferase, urea, creatinine, testosterone, luteinizing hormone and follicle-stimulating hormone levels were significantly increased while serum direct bilirubin, albumin and albumin/globulin ratio were significantly decreased ( p

Thyroid hormones have marked effects on the growth, development, and metabolic function of virtually all organs and tissues. Thyroid status is an important determinant of cardiovascular function. The present work studied the histopathological and ultrastructural changes in the hypothyroid rat left ventricle at post-pubertal stage, in addition to the ameliorating role of folic acid. A total of 50 male albino rats were randomly divided into 5 groups (group I, control; group II, folic acid; group III, propylthiouracil-induced hypothyroid rats; group IV, co-treatment with folic acid; group V, post-treatment). In order to ensure the hypothyroid state, the level of serum triiodothyronine (T3) and thyroid stimulating hormone (TSH) through the dose period was regularly determined. The TSH levels were significantly higher while T3 levels were significantly lower in hypothyroid rats when compared to control group. The high-performance liquid chromatography analysis showed an increase in homocysteine (Hcy) in the hypothyroid rats group when compared to the control group. The histopathological studies of the ventricle in hypothyroid rats revealed hydrophobic changes in myofibrillar structure with striations, myocardial atrophy, nuclear pyknosis, cytoplasmic vacuoles, and cytoplasmic eosinophilia. Transmission electron micrographs in the myocardium of hypothyroid rats revealed a marked reduction in muscle fibre mass, a marked degeneration of muscle fibres, swollen mitochondria, dilated sarcoplasmic reticulum and more prominent perinuclear oedema observed in the cardiac myocytes. In co-treated hypothyroid rats with folic acid, a regular arrangement of muscle fibres, mild swelling of myofibrillar structure with striations and no continuity with adjacent myofibrils were observed while the post-treated hypothyroid rat with folic acid showed normal architecture of myofibrillar structure with striations and continuity with adjacent myofibrils. In conclusion, our results indicated that folic acid had ameliorative effect against cardiac damage induced by 6- n-propyl-2-thiouracil and the best results were found in case of using the folic acid as an adjuvant therapy after returning to the euthyroid state.

A chronic hyperalgesic condition was induced in mice by the injection of Freund's complete adjuvant (FCA) into the lower lumbar region or directly into the hind footpads. Although little or no visible inflammation was observed after a single intradermal injection of FCA into the lower lumbar area of rats or mice, significant alterations in nociceptive thresholds occurred in each species as determined by decreases in response latency in tail-flick and hot-plate assays. Unilateral intraplantar administration of FCA in mice resulted in visible inflammation in the area of the tibiotarsal (ankle) joint. Changes in the response latency to a noxious stimulus in the areas surrounding the inflamed joint were similar to those observed in non-inflamed limbs, suggesting that changes in sensitivity to noxious stimuli were not merely the result of local hypersensitivity of the inflamed tissue, but may also be due to alterations in nociception at the level of the central nervous system (CNS). When the chronic inflammatory condition induced in the mouse tibiotarsal joint was evaluated by histological and morphological techniques, it was found to have the same characteristics as described in the early stages of FCA-induced arthritis in rats. The similarities between the response to FCA in rat and mouse suggest that injection of FCA in mice may prove to be a useful model for the study of chronic pain in mice as well as in rats.