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The present study was conducted to detect the therapeutic effect of Moringa oleifera and Thymus vulgaris oils on hepatic coccidiosis in experimentally infected rabbits. Also, immunomodulatory effect of the two oils was detected. Twenty-four Newzealand rabbits were used in this study and divided into 4 groups; healthy rabbits, experimentally infected rabbits with Eimeria stiedae oocysts, and two infected treated groups (one with moringa (200 mg/kg) and the other with thyme (500 mg/kg) oils). The results showed highly significant reduction in oocysts shedding (P

Background: To measure the quality of life (QoL) of Egyptian females with breast cancer (BC) at the National Cancer Institute (NCI), Cairo University (CU) and its relations with the socio-demographic and clinical characteristics. Methods: A total of 200 female BC patients were recruited from the medical oncology outpatient clinic during a period from December 2015 to March 2018. The instrument of this study consisted of two parts: the first for Socio-demographic and clinicopathological characteristics, and the second was the Functional Assessment of Cancer Therapy-Breast for patients with Lymphedema (FACT-B+4) questionnaire. Results: The majority of the study participants were married, housewives, and without a family history of cancer (70.0%, 93.0%, and 63.0%, respectively). Most of them presented with breast mass, had IDC, grade II and disease stage III at diagnosis (89.0%, 84.5%, 85.6% and 56.8%, respectively) and had undergone modified radical mastectomy, received adjuvant chemotherapy, radiation, and hormonal therapy (62.0%, 83.8%, 73.5% and 60.5%, respectively). The median FACT-B score was 81 (range 35-133). The medians of subscales were: physical well-being 13 (range 0-28), social well-being 20 (range 0-28), emotional well-being 15 (range 2-24), and functional well-being 16 (range 2-28). The median score for breast subscale was 19 (range 2-32). Many factors affected the QoL scores, including age, marital status, occupation, smoking, residence, comorbidities, symptoms, grade, chemotherapy, radiation, and recurrence. Conclusion: QoL of Egyptian females with BC was influenced by several factors like age, marital status, occupation, smoking, residence, comorbidities, symptoms, grade, chemotherapy, radiation, and recurrence.

Background: To evaluate the response of the modern bladder-preservation treatment modality; trimodal therapy (TMT) in muscle-invasive bladder cancer (MIBC). Aiming at bladder preservation in MIBC, TMT was to offer a quality-of-life advantage and avoid potential morbidity and mortality of radical cystectomy (RC) without compromising oncologic outcomes.Aim of Study: To investigate the TMT as a treatment option for muscle-invasive bladder cancer confirmed by cancer specific and overall survival rates in two different institutes.Material and Methods: The study included 64 consecutive patients between 2008 and 2013, and was conducted in National Institute of Urology and Nephrology, Cairo, Egypt, Al-Azhar University, Girls Div., Urology Dept., Cairo, Egypt and National Cancer Institute, Cairo University, Cairo, Egypt. Forty nine patients were males and 15 were females. Mean age was 61±9 years (range, 34-82 years). Sixty nine percent of patients (44) were below 65 years old while 31% (20) were above 65. Sixty six percent (42 patients) were fit for surgery but refused RC as first line of treatment and 34% (22 patients) were unfit for surgery. Results: One third of patients (20) failed TMT and under went RC. Five years overall survival (OS) was 57% and disease specific survival (DSS) was 61%. There was no significant difference observed in OS or DSS between different age, sex or surgical fitness patients groups. Tumor stage showed significant statistical difference between T2 and T3 (p

Background: Fasciolosis is an important zoonotic disease affecting the productive performance of farm animals in Egypt. Aim: The aim of the present study was comparing the ovicidal effect of different extracts as an alcoholic (Methanolic and Ethanolic) and aqueous Moringa oleifera leaf extracts on Fasciola gigantica non-embryonated and developed eggs. Materials and Methods: Tested concentrations of extracts ranged from 12.5 to 800 mg/ml. Nitroxynil was used as reference drug with a dose of 100 mg/ml. Results: M. oleifera alcoholic and aqueous extracts showed a concentration-dependent ovicidal effect on F. gigantica non-embryonated and developed eggs. Based on LC50 values, water extract showed the highest ovicidal activity since it registered the lowest values of 2.6 mg/ml on non-embryonated eggs. Non-embryonated eggs were more susceptible to aqueous extract than developed eggs. On the other hand, the developed eggs were more susceptible to ethanolic extract than non-embryonated eggs even the lowest LC50 (12.38 mg/ml). Conclusion: M. oleifera leaf extracts especially aqueous extract could be a promising step in the field of controlling fascioliasis. Further, in vivo studies are needed to enlighten the therapeutic potential of M. oleifera extracts in treating F. gigantica infection.

Background: Identifying simple and reliable prognostic indicators in non-small cell lung cancer (NSCLC) is important to optimize its management. The mean platelet volume/platelet count (MPV/PC) ratio may be of prognostic value in some clinical conditions including NSCLC.Aim: To investigate the relationship between MPV/PC ratio and some important prognostic factors in Egyptian NSCLC patients.Methods: Retrospective study that included 69 patients with stage III/IV NSCLC in the period from January 2010 to December 2012. The complete blood picture done before starting treatment was the one considered for the calculation of MPV/PC. The relation between MPV/PC ratio and patients and disease characteristics was studied.Results: More advanced stage was associated with lower average MPV/PC ratio. The average MPV/PC ratio was 0.45963 (95%CI: 0.38829- 0.53098) in patients with stage IIIA, 0.33873 (95%CI: 0.2854-0.39208) in stage IIIB and 0.32752 (95%CI: 0.28642- 0.36862) in stage IV (p=0.015).Similarly, higher Eastern Cooperative Oncology Group performance status score was associated with lower MPV/PC ratio. The average MPV/PC ratio was 0.40949 (95%CI: 0.34959 – 0.46939) in patients with ECOG 1, 0.36369 (95%CI: 0.31009- 0.41724) in ECOG 2 and 0.28378 (95%CI: 0.24898 -0.31857) in ECOG 3 (p=0.004). Older patients had a significantly lower MPV/PC ratio (p=0.043).Conclusion: Low MPV/PC is associated with poor prognostic factors in NSCLC such as advanced stage and poor performance status. Future clinical studies to evaluate the prognostic value of MPV/PC ration in NSCLC are warranted.

Rett syndrome (RTT) is a monogenic neurodevelopmental disorder caused primarily by mutations in the MECP2 gene. This study presents the spectrum of MECP2 mutations in 50 Egyptian RTT females with identified gene mutation. Molecular analysis was carried out by direct sequencing of the gene coding region, followed by multiplex ligation-dependent probe amplification (MLPA) for patients without detected pathogenic variation. In total, 23 different disease-causing mutations, including 5 novel frameshift mutations, have been reported. In the study cohort, T158 M is the most common mutation (18%), followed by R270X (14%). Large rearrangements account for 10% of cases intensifying the emergency of gene quantitative analysis. This study provides an effective and simple instrument for molecular analysis of MECP2 gene and genetic counseling of RTT cases.

Background: Emotional distress is common among cancer patients (25-30 %), as a result of the serious diagnosis and suffering from aggressive treatment. This may negatively affect their participation in treatment, quality of life, and satisfaction with care. To best of our knowledge, it has not been studied before in Egypt, this study aims to implement the distress thermometer in Egyptian cancer patients as a screening tool for the distress and its associated factors. Methods: The Arabic version of DT that has been recently validated was used in this study to screen patients. Egyptian Patients diagnosed with different types of hematological malignancies and solid cancers who were following at three Oncology Centers (South Egypt Cancer Institute, Assiut University Hospital, and Mansura University Oncology department) were recruited. All Patients were asked to rate their distress in the past week on an 11-point visual analog scale ranging from 0 (no distress) to 10 (extreme distress), then, they were asked to fill in the Problem List (PL), to check whether or not they had any of the problems listed during the previous 7 days. Univariate and multivariate analyses were used to identify the significant problems correlated with the patient distress at a cut-off score of 4. Results: A total of 550 patients agreed to participate. The mean age was 51.3 (18–85) years. Different types of solid and hematological malignancies were included; the most common three types were breast cancer (32.7 %), gastrointestinal cancer (23%), and hematological malignancies (15.5 %). The patients’ average DT score was 3.7. The most frequent problems were fatigue (49%), worry (47%), fear (44 %), and pain (42%). The univariate analysis showed a significant correlation between the DT at Cut – off the value of 4 and transportation, dealing with children, depression, fears, sadness, sleep, loss of usual activity, and fatigue. Multivariate analysis confirmed the transportation, depression, fears, sadness, sleep and fatigue as independent factors for such distress. Conclusion: Egyptian cancer patients are suffering from significant distress at a cut value of 4. We recommend the involvement of the psycho-oncology service for all cancer patients at the time of diagnosis.

Background Still, there is no clinically reliable marker to detect micrometastasis or breast cancer relapse. This study aimed to evaluate the role of circulating tumor cells (CTCs) as a biomarker in patients with nonmetastatic breast cancer. Patients and methods CTC quantification was carried out using flow cytometry for 50 patients with breast cancer postoperatively: before starting, after three cycles, and at the end of adjuvant chemotherapy. The relationship between CTCs and other tumor characteristics and outcomes were studied. Results The median follow-up duration was 35 months. Before starting adjuvant chemotherapy, CTCs were positive (cutoff point ≥5/7.5 ml) in 36% of the patients and decreased to 20% after finishing chemotherapy (P = 0.04). CTCs were detected in 88.9% (n = 16 of 18) of node-positive patients and in 11.1% of node-negative patients (n = 2 of 18, P = 0.04). No significant association was found with tumor size, grading, or hormone receptor status. Distant metastasis was detected in 20% (n = 10 of 50) of patients and was significantly associated with CTCs more than or equal to 5 in 80% of them (n = 8 of 10) (P = 0.01). The presence of more than or equal to 5 CTCs at baseline was associated with a reduction in both the disease-free survival and overall survival (P Conclusions The current work suggested that the presence of more than or equal to 5 CTCs/7.5 ml at baseline would predict early disease recurrence and reduce the overall survival in patients with nonmetastatic breast cancer receiving adjuvant chemotherapy.

Pancreatic cancer is the deadliest of the 21 most common cancers, largely because it is often identified at a late stage, we aimed to determine the control rates, and PFS for patients who received docetaxel-oxaliplatin regimen as a 2nd line therapy. Twenty-five patients with advanced cancer pancreas progressed or failed on 1st line treatments and justified the inclusion criteria were eligible to receive Docetaxel 75 mg/m2 over 1h iv infusion on day 1, Oxaliplatin 80 mg/m2 over 2 h iv infusion on day 2, the cycle was repeated every 3 weeks for 6-8 cycles unless disease progression or severe toxicity appeared. No patients achieved complete response (CR), and the control rate (control rate = partial response (PR = 6/25, 24%) + stable disease (SD = 9/25, 36%) was 60% while disease progression (DP) was demonstrated in (10/25) 40% of patients, the median PFS was 7 ± 0.777 ms (95% confidence interval: 5.467-8.524 ms), grade 3 neutropenia, fatigue, diarrhea, and vomiting were developed in 12%, 8%, 12% and 8% of patients respectively. Docetaxel-oxaliplatin regimen was an active regimen in advanced cancer pancreas based on our encouraging results without occurrence of grade four toxicities.

A significant concern of physicians treating patients with pleural effusion is to rule out a malignant etiology, which, in the majority of series, is the first cause of pleural exudates. Determination of tumor markers in serum and pleural fluid has been proposed as a nonaggressive means of establishing a diagnosis of pleural malignancy. Cancer antigen 125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently, it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. The aim of this study was to determine the level of serum and pleural fluid CA-125 to evaluate its value as a marker for differentiation between different types of pleural effusion. The study was carried out on 30 patients with pleural effusion of different etiologies. They were further subdivided into two groups: exudates and transudates; the levels of both serum and pleural fluid CA-125 were evaluated. In terms of pleural CA-125, there was a statistically significant increase in the exudative subgroup compared with transudative subgroup. Furthermore, it was found that malignant effusion was observed more frequently compared with benign effusion and tuberculosis was observed more frequently in comparison with other infections. The highest level of pleural fluid CA-125 was found in malignancy, followed by tuberculosis, and so pleural fluid CA-125 can be used as a marker for the diagnosis of pleural effusion. Egypt J Broncho 2015 9:283–286

Background Neurocutaneous syndromes (NCS) are a broad term for a group of neurologic disorders that involve the nervous system and the skin. The most common examples are neurofibromatosis type 1 (NF-1) and type 2 (NF-2), tuberous sclerosis (TS), Sturge–Weber syndrome (SWS), ataxia telangiectasia (AT), and Von Hippel Lindau disease (VHL). These disorders are characterized clinically by neurological manifestations such as convulsions, mental retardation and learning disabilities in addition to cutaneous manifestations, and lastly tubers (benign growths found in different organs of the body). Aim of the study This study aimed to identify clinical, imaging, and neurophysiological profiles of neurocutaneous disorders. Children presented to the Pediatric neurology and Dermatology clinics, Sohag University Hospital who fulfilled the criteria for diagnosis of specific neurocutaneous syndromes were eligible for this study. Patients and methods All studied patients were subjected to thorough clinical history, full clinical examination, developmental assessment, and dermatological examination. Computed tomography of the brain (CT) and electroencephalography (EEG), ophthalmic, and phoniatric evaluation were also done for all children. Echocardiography was done for only twenty children. Results During the period of the study we diagnosed 27 cases with neurocutaneous disorders, tuberous sclerosis represented the majority of cases as it was detected in 12 cases (44.45%). The main complaint was convulsions in 19 cases (70.37%), whereas skin pigmentation was detected in 18 cases (66.66%). Developmental assessment showed that global developmental delay was found in 20 cases (74%). CT of the brain showed that 15 cases (55.55%) had intracranial calcifications and abnormal EEG findings were detected in 23 cases (85.2%). 85% of the studied children had various degrees of mental retardation. Echocardiography showed that three cases (15%) had ventricular wall tumor mostly rhabdomyoma. Conclusion Neurocutaneous disorders had multiple clinical presentations and required a team work approach including various specialties in their evaluation and management.

Glucosamine sulfate (GS) has been used orally for the treatment of osteoarthritis (OA). However, it may be susceptible to the liver first pass phenomenon, which greatly affects its bioavailability, in addition to its side effects on the gastrointestinal tract. Alginate nanoparticles (Alg NPs) were investigated as a new drug carrier for transdermal delivery of GS to improve its effectiveness and reduce side effects. GS-Alg NPs were characterized by encapsulation efficiency, NP yield, particle size and surface charge properties. The in vitro release studies of GS and the ex vivo permeability through rat skin were determined using a UV-Vis spectrophotometer. GS-Alg NPs are within the nanometer range of size. High negative surface charge values are obtained and indicate the high suspension stability of the prepared formulation. The in vitro release studies showed that GS is released from Alg NPs in a sustained and prolonged manner. The ex vivo permeability of GS through rat skin is enhanced significantly after encapsulation in the negatively charged Alg NPs. We successfully reported a highly stable nanoparticlulate system using Alg NPs that permits the encapsulation of GS for topical administration, overcoming the disadvantages of oral administration.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. The canalith repositioning procedure (CRP) is known to be an effective therapy for the treatment of BPPV. However, because of its various movements of the head and body, it is impossible to perform in BPPV patients with orthopedic impairments or in the elderly. The rolling-over maneuver (ROM) involves easy movements, with only a small load. This therapy is suitable for most BPPV patients, especially for those without an indication for CRP. Hence, we propose that ROM is as effective as CRP for the treatment of BPPV. In this study, we compared among the ROM, Epley, and Brandt-Daroff maneuvers in the management of patients with posterior semicircular canal-type BPPV. The study included 60 patients with BPPV who were randomized and divided into the following three groups: (i) those treated by Epley maneuver as CRP; (ii) those treated by ROM; and (iii) those treated by the Brandt-Daroff maneuver. The findings of this study demonstrated that the success rate was the best in patients who were treated with Epley maneuver (90%), then in patients treated with ROM (85%) followed by those treated with the Brandt-Daroff maneuver (80%). The recurrence rate after management was high in patients treated with the Brandt-Daroff maneuver (31.25%), with no statistically significant difference. We recommend either Epley maneuver in the office or ROM at home, according to the general condition of the patient.

Aims: Non-Hodgkin’s lymphoma (NHL) is a heterogeneous group of hematological malignancies. Several angiogenic factors are important in NHL. The objective of this study was to determine plasma levels of various proangiogenic [vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF), tumor necrosis factor (TNFα), transforming growth factor (TGF-β), interleukin (IL-6), IL-8] and antiangiogenic [IL-4, IL-12, interferon gamma (IFN-)] factors in NHL patients and implication of CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) therapy on these mediators. Study Design: This study was conducted on 100NHL patients recruited from the Oncology Hospital, Menofia University, Egypt. Fifty patients had different doses of CHOP chemotherapy and 50 patients were without treatment. Another 119 healthy blood donors were served as healthy controls. Methodology: Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of these mediators in plasma of NHL patients and normal controls. Results: Several proangiogenic (VEGF, PDGF, IL-8, and TNF-α) (P

The knowledge of the prevalence of spinal cord disorders (SCD) is important to understand specific causes in each part of the worldand to allow to potentially adapt health care and public policy including law enforcement to the main causes. SCD have important personal, biopsychological, socio-economic, short-term and long-term consequences. An SCD is the underlying cause for 1 of every 40 patients admitted to a major trauma centre. The affected population consists primarily of young male adults. The aim of the present study was to determine the prevalence and cause of SCD in Al-Quseir City, using a door-to-door method. The total of inhabitants was 33,285 in Al-Quseir City screened by 3 specialists of neurology. Suspected cases were subjected to full clinical assessment and MRI or CT of the spine. The prevalence rate of SCD was 63/100,000 for the total population. Traumatic spinal cord injury had a prevalence of 18/100,000, while non-traumatic SCD was found in 45/100,000. Degenerative cervical disc prolapse was the most common aetiology of SCD with a prevalence rate of 27/100,000.

Flow disturbance and reduced blood flow have been associated with higher restenosis rates and clinical adverse events after coronary interventions. In the present study, we sought to investigate flow alterations that occurred after stent implantation in a coronary model, within and adjacent to the stented segment. Two stents (Carbostent, Tetrastent) with different strut design were deployed in the left anterior descending artery (LAD) of a 1:1 scaled silicon coronary model. The model was mounted into an artificial circulation and showed distensibility and rheologic behavior comparable to human coronaries. Flow profiles were assessed using laser-Doppler anemometry. Both stents induced a transitional flow within the stents, in the jailed branch as well as in the adjacent segments. However, the alterations in flow were less marked using the Carbostent having stents with thinner struts and a larger strut cell area, and thus seem to be more favorable in avoiding bifurcation lesions. This study shows precisely that stent implantation induces flow disturbances in segments known to be prone for restenosis. Investigations using laser-Doppler measurements may enlighten rheologic phenomena inducing restenosis and help in optimizing stent design and deployment techniques.

Gallstones are more common in patients with liver cirrhosis than in healthy individuals. Higher morbidity and mortality were reported in cirrhotic patients with either laparoscopic or open cholecystectomy. The aim of this study was to compare laparoscopic and open cholecystectomy in cirrhotic patients with symptomatic cholelithiasis in a prospective, randomized manner.Thirty patients with symptomatic cholelithiasis associated with Child-Pugh class A or B liver cirrhosis were prospectively and randomly grouped equally to either laparoscopic or open cholecystectomy. The two groups were compared regarding operative time, morbidity, mortality, postoperative liver function, and hospital stay.The two groups were comparable regarding demographic data, preoperative and postoperative Child-Pugh scoring, mean operative time (57.3 minutes for laparoscopic and 48.5 for open), and complications (33.3% for each). Hospital stay was shorter for the laparoscopic group. One conversion (6.7%) to open surgery was reported. No periopertive mortality occurred in either group.For Child-Pugh class A and B cirrhotics, laparoscopic cholecystectomy is comparable to the open approach regarding operative time, morbidity, mortality, and effect on liver function, but with shorter hospital stay. Considering the other well-documented advantages of the laparoscopic approach, namely, less pain, earlier mobilization and feeding, and better cosmoses, laparoscopic cholecystectomy would be the first choice in cirrhotic patients.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is a very common and highly malignant tumor, associated mainly with chronic viral hepatitis, cirrhosis of any cause, aflatoxin exposure and ethanol consumption. Cytogenetic analysis on HCC has been limited because of poor hepatocyte growth in vitro. Conventional cytogenetic studies have demonstrated frequent abnormalities of specific chromosomes in HCC. Molecular cytogenetic approaches have been applied only rarely in the characterization of HCC. The main aim of this study was to evaluate genetic aberrations of different chromosomes in HCC. The study included 35 patients with HCC, who have been diagnosed and treated at National Cancer Institute, Cairo University, Egypt. The clinico-pathologic features of the studied patient were collected from patient’s files. MATERIALS AND METHODS: Interphase cytogenetics by fluorescence in situ hybridization with the use of a panel of centromere-associated DNA probes for chromosomes 1, 4, 8, 9, 13, 17, 20 and Y were performed on paraffin-embedded HCC specimens. RESULTS: The most common chromosomal aberrations detected were gain of chromosomes 8 in 12 cases (34.28%), 17 in 6 cases (17.14%). Loss of chromosome Y was detected in 6 of male cases (30%). Monosomy 4 was also detected in 5 cases (14.28%). Negative correlation could be detected only between chromosome 4 and 8. (r = -0.381, P < 0.05). Correlations between gain or loss of chromosomes and the different clinicopathologic parameters in the patients investigated, indicated negative correlation between: chromosome Y and age and chromosome 1 and cirrhosis. CONCLUSION: Gains and losses of DNA found in this study probably involve oncogenes and tumor suppressor genes that play a role in the puzzle of hepatocarcinogenesis.

Background: Cystic echinococcosis (CE) of the brain is an uncommon parasitic infestation. The World Health Organization (WHO) recently published a classification of hepatic CE based upon ultrasonographic findings. Purpose: To evaluate whether the new WHO classification of hepatic CE can be used in the classification of cerebral CE. Material and Methods: The magnetic resonance (MR) imaging findings of 17 patients (14 male, three female), aged 10–24 years (mean age 16 years), with pathologically proved cerebral CE, and who underwent pre- and postcontrast MR imaging, were retrospectively evaluated. The cysts were classified according to the new WHO classification and their clinical stages. The MR imaging findings were correlated to the histopathologic findings. Results: The fertile active cysts ( n=12) that showed protoscoleces appeared as unilocular cysts with no visible wall (cystic lesions; CL), unilocular spherical cysts with a clear visible wall (CE1), or as a unilocular mother cyst with multiple vesicles arranged peripherally along the cyst wall (CE2). The transitional form (CE3) ( n=2) containing scoleces showed multiple daughter cysts entirely filling the maternal cyst. The inactive cysts ( n=3) that had lost their fertility appeared as a “ball of wool” with collapsed membrane or had detached membrane with water-lily sign (CE4) and calcified lesions (CE5). Conclusion: The WHO classification of hepatic CE can be used in the classification of cerebral CE when evaluated by MRI, as it can differentiate fertile active cysts from the transitional and inactive forms of cerebral cystic echinococcosis. This information is essential for treatment planning.

Myeloperoxidase (MPO) is an important enzyme that found in neutrophils and involved in reactive oxygen species (ROS) production. The aim of the current study was to clarify the potential role of MPO in oxidative stress and liver fibrosis associated with hepatitis C virus (HCV) infection. This study was conducted on 90 subjects, 10 normal con- trols and 80 patients having HCV infection classified into chronic hepatitis C without cirrhosis (CHC) (50 cases) and CHC with cirrhosis (LC) (30 cases). Myeloperoxidase was assessed in plasma by ELISA technique and in liver tissue by immunohistochemistry. Malondialdehye (MDA), as a marker of lipid peroxidation and oxidative stress was also measured in plasma by spectrophotometric assay. Results revealed significant increase of both plasma and hepatic tissue MPO in cirrhotic patients compared to either controls or CHC patients (p

Lung cancer is still a leading cause of cancer related mortality all over the world with the majority of cases are discovered at a late stage. Various panels of molecular prognostic markers are being studied to map the association of these markers with response and survival. The aim of this study is to study levels of epidermal growth factor receptor (EGFR), HER-2 neu in both serum and bronchoalveolar lavage (BAL) in patients with non small-cell lung cancer (NSCLC), correlate their levels with clinical, pathological characters as well as prognosis. A total of 30 patients with pathologically proven NSCLC were enrolled in this study in addition to ten normal controls subjects and ten cases with benign pulmonary diseases as broncheicatsis, chronic obstructive pulmonary disease. Results revealed significantly increased levels of EGFR and HER-2 neu in both serum and bronco-alveolar lavage compared with controls. The levels were significantly higher in those with stages III, IV compared with I, II, and in those with higher grades of the tumor. There was no statistically significant correlation with performance status or survival. In conclusion, serum measurement of these markers is a promising noninvasive technique which needs correlation with other methods of determination, measurement at different chronological points during disease evolution to explore its full potential. Standardization of techniques for determination of EGFR and HER-2 neu over-expression must become a priority in future studies that should also include larger number of patients, conducted in a prospective manner together with comparisons of various methods and correlation of protein expression with gene copy numbers.

Aims and background There is currently no consensus as to which chemotherapy to combine with thoracic radiotherapy (TRT) in the setting of definitive chemoradiation for non-small-cell lung cancer (NSCLC). We aimed to retrospectively evaluate the efficacy and report outcome measures of cisplatin/etoposide with conventionally fractionated TRT over a 9-year period. Methods Cisplatin 50 mg/m² on days 1, 8, 29, and 36 and etoposide 50 mg/m² on days 1-5 and 29-33 with conventionally fractionated conformal radiation therapy starting on day 1 was given to 201 eligible patients. Patient records were reviewed for overall survival (OS) and progression-free survival (PFS). Results The 2-year OS and PFS were 53% and 47%, respectively, while the 3-year OS and PFS were 18% and 17%, respectively. No grade 4 or treatment-related deaths were recorded, and grade 3 hematologic toxicity occurred in only 22 patients (11%) in the form of granulocytopenia and thrombocytopenia. Multivariable analysis showed clinical stage and Eastern Cooperative Oncology Group performance status to statistically significantly affect PFS and OS. Conclusions Cisplatin and etoposide in these doses with conventionally fractionated TRT is a well-tolerated, effective treatment schedule in the definitive treatment of unresectable or inoperable NSCLC.

Pulmonary artery aneurysm is the best-defined type of pulmonary disease in Behcet’s disease (BD) with an important morbidity and mortality. The objective of this study was to assess the contribution of high-resolution dynamic chest CT imaging for one of the most serious aspects of BD: pulmonary artery aneurysm and other pulmonary parenchymal involvement. Sixteen BD patients were recruited for this study, (14 men, 87.5%, and 2 women, 12.5%). All patients fulfilled the 1990 American College of Rheumatology criteria for classification of BD [International Study Group for Behcet’s Disease, Lancet 335:1078–1080, (1990)]. All patients underwent thorough history taking, full clinical examination, and routine laboratory investigations. Plain chest X-rays and pulmonary CT angiography were performed on all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Pulmonary vascular abnormalities were as follows: pulmonary artery aneurysms of varying sizes in nine patients (56.3%%), main pulmonary artery ectasia in two patients (12.5%), pulmonary artery embolism in two patients (12.5%), venacaval thrombosis in seven patients (43.8%), and pulmonary venous varices in four patients (25%). Pulmonary parenchymal abnormalities were as follows: three patients (18.8%) with mild central bronchiectasis, one patient (6.3%) with atelectasis, one patient (6.3%) with subpleural nodule, and four patients (25%) with interstitial lung disease. Eight of the male patients were smokers. Multislice CT is useful in demonstrating the entire spectrum of thoracic manifestations of BD. Multislice CT is noninvasive and provides excellent delineation of the vessel lumen and wall and perivascular tissues, as well as detailed information concerning the lung parenchyma, pleura, and mediastinal structures.

We report a case of a 29-year-old male who presented with paraesthesia and skin lesions with excessive bleeding after skin biopsy leading to hematology consultation. He was found to have prolonged partial thromboplastin time (PTT) and monoclonal gammopathy on serum protein electrophoresis (SPEP). He experienced excessive bleeding leading to hospitalization after bone marrow biopsy and required blood transfusion. He was diagnosed with Waldenstrom's Macroglobulinemia (WM), based on the presence of IgM-κtype monoclonal (M) protein and infiltration of lymphoplasmacytic cells identified in bone marrow aspirates. He was noticed to have features of peripheral neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS syndrome). This is a very rare case of WM with POEMS syndrome which responded to chemotherapy using bortezomib, steroids, and rituximab.

The major histocompatibility complex (MHC) is a set of closely-linked genes encoded on the short arm of chromosome 6. It is important for understanding human immunological diseases, transplantation and in host defense against infection. The membrane proteins are two types; class I MHC proteins and class II MHC proteins. Strong arguments supporting genetic linkage between susceptibility to lymphomas and human leukocyte antigens (HLA)-class II are reported and give a clue about susceptibility or protection from the disease.To evaluate the possible changes of HLA class II (DR, DQ) alleles in children with lymphoma.Thirty cases were included in this limited study. Nineteen cases of non Hodgkin's lymphoma (NHL) and eleven patients with Hodgkin's lymphoma (HD). Their ages ranged from 1.5 to 15 years. The control group consisted of 121 unrelated healthy subjects for DRB1 alleles and 59 unrelated healthy subjects for DQB1 alleles (only 59 subjects were typed for both DRB1 and DQB1). All cases in the study were assessed by thorough history taking, physical examination and laboratory investigations that included complete blood count, renal function tests, liver function tests, serum uric acid and HLA typing. Patients and controls were typed for HLA class II DRB1 and DQB1 alleles using INNO-LIPA reverse hybridization line probe assay (Innogenetic, Belgium).HLA-DRB1 *0403 and *1301 and HLA-DQB1 *0501,* 0201 and *0301 were significantly increased in patients with NHL when compared with control; whereas HLA-DRB1 *1302 and HLA-DQB1 *0502 and *0602 were significantly decreased when compared with control. In patients with HD, HLA-DRB1 *0403 and *1202 and HLA-DQB1 *0604, *0201 and *0203 were significantly increased when compared with control.(1) The susceptibility to NHL is related to HLA-DRB1 *0403 and *1301 and HLA-DQB1 *0501,* 0201 and *0301. (2) The susceptibility to HD is related to HLA-DRB1 *0403 and *1202 and HLA-DQB1 *0604, *0201 and *0203. (3) HLA-DRB1 *1302 and HLA-DQB1 *0502 and *0602 may confer protection to NHL. (4) Different HLA alleles may have a role in patients with both groups of lymphoma and further study is needed to better define the possible prognostic value of different HLA associations in patients with lymphomas regarding increased risk in the presence of certain HLA alleles and the possibility for treatment modifications in the future based on the presence or absence of certain HLA alleles.

The introduction of targeted agents has improved survival for patients with a number of types of cancer, including several breast cancer subtypes. However, these agents are not without toxicities, and the fact that many patients are now on targeted therapy for extended periods of time has presented new challenges for the management of adverse effects. Everolimus is an inhibitor of mtor (the mammalian target of rapamycin) that is used as targeted therapy for advanced, hormone receptor&ndash, positive, her2-negative breast cancer in postmenopausal women in combination with exemestane, after treatment failure with letrozole or anastrozole. Minor hemorrhagic events are relatively common with targeted agents, but life-threatening hemorrhages, although uncommon, can also occur. We report a case of life-threatening gastrointestinal bleeding in a 48-year-old woman being treated with everolimus for advanced infiltrating ductal carcinoma of the breast. The bleeding was successfully treated with 13 sessions of endoscopic hemostasis using argon plasma coagulation.

Interest in translational studies on breast cancer is presently devoted to identifying biological predictors of disease prognosis and response to treatment. In this study, we determined the plasma levels of bcl-2 and nitric oxide in 45 patients with metastatic breast cancer using an ELISA technique and correlated them with clinical and biological factors that may affect the outcome of disease. The results were as follows. The mean level of bcl-2 was 278.44±383.2 U/L compared with 64.42±14.4 U/L (p=0.007) for controls. Levels of bcl-2 were higher in patients less than 50 yr old, premenopausals., GIII tumors, positive nodes, ER positive tumors (p=0.6, 0.5, 0.9, 0.4, and 0.005, respectively). The site of metastatic disease and the number of metastatic sites did not show statistically significant influences over bcl-2 levels. Furthermore, there was a trend, although not significant, toward improvement of survival in patients with higher levels of bcl-2. The mean level of the nitric oxide (NO) was 297.12±220.54 µM compared with 13.91±1.1 µM for controls (p=0.003). The levels were higher in patients over 50 yr, postmenopausal patients, those with visceral deposits, grade III tumors, positive lymph nodes, and those with disease-free survival of less than 6 mo following primary treatment (p=0.1, 0.2, 0.1, 0.09, 0.4, and 0.08 respectively). Furthermore, there was no correlation between NO levels and survival (r=0.002). This study demonstrates a potential role for NO and bcl-2 as prognostic factors in patients with metastatic breast cancer. However, larger studies with more patients together with a comparison of serum levels (ELISA) and tissue levels (MOAb) are still required.

It is possible to remove a cataract and insert an intraocular lens under topical anaesthesia (lignocaine 4% preservative-free eye drops) with a van Lint block. This study was performed to evaluate this anaesthetic technique. Nineteen patients having cataract surgery with topical anaesthesia and a van Lint block were compared with 21 patients who received a retrobulbar block and a van Lint block. There were no significant differences between the two groups in patient characteristics, mean cardiovascular stress of the procedure, experience of pain during the operation or willingness to have the same anaesthetic technique again. Topical anaesthesia with a van Lint block is feasible for cataract surgery and is potentially safer than other regional anaesthetic techniques.

Thrombotic Thrombocytopenic Purpura (TTP) is a rare hematologic emergency, congenital or acquired, characterized by ischemic damage of various organs because of platelet aggregation. It is the common name for adults with microangiopathic hemolytic anemia, thrombocytopenia, with or without neurologic or renal abnormalities, and without another etiology; children without renal failure are also described as TTP. Plasma exchange (PE) is the main stay of treatment in combination with steroids and immunosuppressive therapies. The monoclonal antibody against CD20 Rituximab decreases the production of antibodies from B lymphocytes and it is used for antibodies-mediated diseases including TTP. We present our data on retrospective analysis of rituximab in treatment of TTP at University of Cincinnati in a series of 22 patients from 1997 to 2009. Our results showed that PE with immunosuppressive therapy resulted in decreased duration of PE, relapse rate, and increased duration of remission in patients with TTP.

Vitamin B12 deficiency can present with various hematological, gastrointestinal and neurological manifestations. We report a case of elderly female who presented with neuropathy and vitamin B12 deficiency where the final work-up revealed polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS). This case suggests that, although POEMS syndrome is a rare entity, it can present with vitamin-B12 deficiency and thus specific work up for early diagnosis of POEMS should be considered in patients with B12 deficiency unresponsive to therapy.

Objective: To illustrate the role of CD134 and FAS and FAS ligand genes polymorphism as biomarkers for disease activity in Egyptian patients with Lupus Nephritis. Materials and Methods: Twenty-five patients with biopsy-proven LN, 25 patients with SLE with no evidence of nephritis, and fifty patients matched apparently healthy volunteers. Levels of CD134 were measured using flow cytometry. FAS and FASL gene polymorphisms were detected using polymerase chain reaction-restriction fragment length polymorphism. Furthermore, carotid artery intima-media thickness (IMT) measurements were done. Results: LN group had highest level of CD134 compared to other two groups, and also higher among SLE compared to controls with highly significant differences in between. Frequency of AA genotype of FASA-670G polymorphism was significantly higher in LN and SLE patients than in controls. The frequency of A allele was statistically higher in LN and in SLE group than in controls. Furthermore, the frequency of CC genotype of C-844T polymorphism of FASL gene was significantly higher in LN and SLE patients than in healthy controls. The frequency of C allele was statistically higher in LN and in SLE group than in controls. Conclusion: Co-stimulatory molecules on CD4+ T-cells together with FAS, and FASL polymorphisms are associated with disease activity in this preliminary study.

This study aim was to determine the efficacy and safety of the combination of Gemcitabine 1000 mg/m(2) day 1 & 8 and Irinotecan 100 mg/m(2) day 1 & 8 with escalating dose of thalidomide in chemonaive patients with advanced non-small cell lung cancer. Among the 20 patients who met eligibility criteria and received treatment, two patients (10%) experienced partial response and 14 (70%) experienced stable disease. The median time to disease progression was 4 months (95% CI: 2.8-6.6). The 1 year and 2 year survival rates were 36% and 27%, respectively. This combination is active in advanced NSCLC with manageable toxicity profile.

Introduction: The role of adjuvant chemotherapy in breast cancer is well established, as are its indications. Likewise, the role of neoadjuvant chemotherapy in locally advanced breast cancer is well established. The use of neoadjuvant chemotherapy in operable breast cancer has only recently become of interest to researchers. Patients and methods: This study included 34 cases of operable breast cancer that were given four cycles of neoadjuvant chemotherapy in the form of FEC100 then subjected to surgery. The surgery done was either breast conserving surgery or modified radical mastectomy. All patients completed the treatment regimen and no patients were excluded from the study. All surgical specimens were studied pathologically for chemotherapy effect. Results: An overall objective response was observed in 70.6% of the patients. Seven patients (20.6%) experienced a clinical complete response (cCR), 17 patients (50.0%) had partial response, nine patients (26.5%) had no change of their disease and only one patient had disease progression. Of the seven patients who had a cCR, only four patients (11.8%) had pathologic complete response (pCR), while pCR for the whole group was 14.7%( 5/34). Tumour size of more than 2 cm was observed in 28 patients (82.4%) at time of presentation, while tumour size of 2 cm or less was seen in six patients (17.6%) only. After completion of the course of chemotherapy, 23 patients (67.6%) were observed to have tumours of 2 cm or less that allowed for less extensive resections. Twenty-three patients underwent breast conservative surgery (67.6%) while modified radical mastectomy was performed in 11 patients (32.4%). Conclusion: The use of neoadjuvant chemotherapy in operable breast cancer in this study was associated with tumour and axillary downstaging, which increased the proportion of cases undergoing breast conservation, with acceptable side effects and reasonable cost. During the limited follow-up time of this study no loco regional recurrences were recorded and one distant treatment failure was recorded. Its impact if any on overall or disease-free survival was not addressed in this study. Larger multi-centre randomized studies with a long follow-up are needed to compare the overall and disease-free survival benefit of this treatment modality, especially in different subtypes stratified by pathological response.

Summary Background. Vitamin A and E are lipid soluble antioxidants that are necessary for our health. Deficiency in these vitamins can cause serious diseases. Administration of vitamin A and E to patients with acne was shown to improve their acne condition. Aims. To test the relationship between plasma vitamin A and E levels and acne. Methods. Plasma vitamin A and E concentrations were determined by high performance liquid chromatography in 100 newly diagnosed untreated patients with acne and were compared with those of 100 age-matched healthy controls. Patients were carefully graded using the Global Acne Grading System. Results. We found that plasma vitamin A concentrations in patients with acne were significantly lower than those of the control group (336.5 vs. 418.1 lg ⁄L, respectively) P ¼ 0.007. We also found that plasma vitamin E concentrations in patients with acne were significantly lower than those of controls (5.4 vs. 5.9 mg ⁄L) P ¼ 0.05. In addition, we found that there is a strong relationship between decrease in plasma vitamin A levels and increase in the severity of acne condition. Patients with severe acne had significantly lower plasma concentrations of vitamins A and E than did those with lower acne grade and the age-matched healthy controls. Discussion. Based on our results, we conclude that low vitamin A and E plasma levels have an important role in the pathogenesis of acne and in the aggravation of this condition.

The northeast Nile Delta, Egypt's most polluted region, appears to have a high incidence of pancreatic cancer. We sought to determine whether there is any geographic clustering of pancreatic cancers there and, if so, whether such clustering might be associated with environmental pollution. Using data from the medical records of the Gastrointestinal Surgical Center of Mansoura University in the Dakahleia Province of Egypt and detailed geographical maps of the northeast Nile Delta region, we plotted the residences of all 373 patients who had pancreatic cancer diagnosed between 1995 and 2000. The study region has 15 administrative districts, whose centroid coordinates, population, and number of pancreatic cancer patients were determined for this study. Monte Carlo simulation identified statistically significant clustering of pancreatic cancer in five subdivisions located near the Nile River and Delta plains. This clustering was independent of population size and formed two larger clusters. When data were analyzed by sex, clustering of pancreatic cancer was observed in the same five subdivisions for men but only two subdivisions showed clustering for women. Together, our data suggest that there is clustering of pancreatic cancer cases in the northeast Nile delta region and that this clustering may be related to water pollution. Our data also warrant future studies of the association between water pollution and pancreatic cancer in the region.

might impair hepatocyte cell cycle G1/S transition via, at least in part, the activation of the ATM pathway. In addition, histological quantifications showed that mitotic hepatocytes were significantly less abundant in the parenchyma of transgenic mice than in their wt counterparts after CCl4 injection. Conclusions: The expression of HCV proteins in the liver of HCV mice, in the absence of local inflammation or immune response, induces inhibition of the G1/S transition which could result from HCV-induced DNA damage/ATM pathway activation. This perturbation is a potential hepatocarcinogenic trigger.

Objective To study in depth the neurotoxic effects of chemotherapy on the cognitive functions. Also, to explore relationships between Neurocognitive function and metabolite ratios of specific brain regions using magnetic resonance spectroscopy (MRS). Method Observational analytical case control study which includes thirty patients with diagnosis of leukemia receiving chemotherapy “Cases” & another group of thirty patients with diagnosis of leukemia not receiving chemotherapy at all as “Controls”. All participants were subjected to Semi structured interview, Wechsler Intelligence Scale for Children (WISC) and Magnetic Resonance Spectroscopy (MRS). Results The means of Wechsler Intelligence Scale for Children (WISC) Total, Performance and verbal among the patient group were lower than the control group (P Conclusion MR spectroscopy is more sensitive method demonstrating metabolite changes in the brain after chemotherapy treatment of leukemic children in the absence of structural white matter abnormalities at MR imaging. A significant cognitive function difference was detected in leukemic treated cases compared to controls and correlated to the metabolic brain changes detected by MRS.

Abstract 4078 Poster Board III-1013 Introduction Osteoporosis is an important cause of morbidity in patients with β thalassemia major. Several genes are thought to be involved in the pathogenesis of osteoporosis. Collagen type I alpha 1 (COLIA1) is one of the most prominent candidate genes, which has been consistently associated with osteoporosis in different populations. Polymorphism at the Sp1 binding site within a key regulatory region of COLIA 1 has been reported to be associated with susceptibility to osteoprotic fractures. Our objective was to detect the allelic distribution of COLIA1 gene in beta thalassemia patients and its relation to bone mineral density (BMD). Patients and methods The study included 25 beta thalassemia major patients (12-28 years, mean = 18.12±5.077 years) and 20 controls (mean age = 23.05±2.3 years) with no family history of thalassemia. Anthropometric measurements were done to all patients .Femoral and lumbar BMD was measured in all patients and control groups using dual energy absorbiometry (DXA). Assessment of the COLIA1 genotypes (SS, Ss, ss) and G/T polymorphism were done using PCR amplification and restriction enzyme digestion (Bal1) of DNA amplified products to thalassemic patients and control groups. Results High prevalence of growth retardation was observed in β thalassemia major patients in the form of short stature (36%), truncal shortening (48%) and under weight (8%). Osteopenia and osteoporosis were detected in 68% of the thalassemia patients with a highly significant lower lumbar and femoral BMD compared to controls (P0.05) while the s allele was associated with femoral and lumbar BMD in the control group (P Conclusion High prevalence of growth impairment, osteopenia and osteoporosis in our β thalassemia major patients. Desferroxamine duration therapy was related to osteoporosis in our patients. The absence of association between BMD and COLIA 1 polymorphism and the low frequency of s allele in our thalassemic group may be due to the small sample size of the thalassemia patients together with the fact that BMD is determined by a variety of genetic and environmental factors. Further studies including larger number of patients are needed to evaluate these findings. Disclosures: No relevant conflicts of interest to declare.