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4. Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Author

Dave, Rajiv V., Kim, Baek, Courtney, Alona, O’Connell, Rachel, Rattay, Tim, Taxiarchi, Vicky P., Kirkham, Jamie J., Camacho, Elizabeth M., Fairbrother, Patricia, Sharma, Nisha, Cartlidge, Christopher W. J., Horgan, Kieran, McIntosh, Stuart A., Leff, Daniel R., Vidya, Raghavan, Holcombe, Chris, Copson, Ellen, Coles, Charlotte E., Cutress, Ramsey I., Gandhi, Ashu, Kirwan, Cliona C., Agrawal, Amit, Benson, John, Forouhi, Parto, Wignarajah, Primeera, Shrotri, Anu, Kattakayam, Arjun, Noronha, Jarin Louis, Martin, Lee, Lafi, Mohamed, Hardy, Rob, Amin, Khalid, AL-Zawi, Abdalla Saad Abdalla, Elamass, Mohamed, Salih, Ali, Alkistawi, Firas Eddin Bachir, Heeney, Anna, Hill, Arnold D. K., Power, Colm, Allen, Michael J., Chouhan, Ashok, Rathinaezhil, Rathi, Shaheed, Samy, Zammit, Charles, Clayton, Gillian, Dua, Sascha, Smith, Simon, Gandamihardja, Tasha, Williams, Chloe, Egbeare, Donna, Davies, Eleri, Sweetland, Helen M., Chopra, Sharat, Goyal, Sumit, Elfadl, Dalia, Rana, Dheer Singh, Kalakouti, Eliana, Barkeji, Musa, Vashisht, Rajiv, Bunza, Ralia, Phyu, Saung Hnin, Hollywood, Ciaran, Azmy, Iman, Massey, Julia, Hargreaves, Anita, Harding-Mackean, Claudia, Ooi, Jane, Seward, Joanna, Mathers, Helen, Scally, Norah, Salman, Reem, Shin, Hyunjin, Turner, Jane, Noor, Lubna, Joshi, Sanjay, Horne, Sarah, Sarakbi, Wail Al, Liptay-Wagner, Peter, Jacklin, Rosamond, Chandrasekharan, Sankaran, Marsh, Simon, Saha, Sunita, Wilson, Christopher, Rutherford, Claire Louise, Doughty, Julie, Romics, Laszlo, Stallard, Sheila, Chaudhry, Anushka, Peck, Jennifer, Coombs, Nathan, Williams, Samantha K., Hawkins, Simon, Kothari, Ashutosh, Hamed, Hisham, Jain, Urvashi, Daltrey, Ian, Abbott, Nick, Mullen, Russell, Dumitru, Dorin, Khalifa, Eiman, Sarker, Masuma, Elahi, M. Bilal, Bichoo, Raouef Ahmed, Gvaramadze, Anzors, Thekkinkattil, Dinesh, Jibril, Jibril, Hadjiminas, Demetrios, St John, Edward R. C., Robb, Henry Douglas, Hogben, Katy, Bakri, Nur Amalina Che, Thiruchelvam, Paul, Exarchos, Georgios, Al-Mufti, Ragheed, Mortimer, Caroline, Mallidis, Evangelos, Karagiannidis, Georgios, Tuffaha, Hussein, Peerlink, Inga, Nair, Rajive, Prusty, Lydia, Sami, Amtul, Knight, Alex, Ravichandran, Duraisamy, Kirkpatrick, Katharine, James, Ruth, Akolekar, Deepika, Mehta, Disha, Barua, Ellora, Knowles, Hannah, Devalia, Haresh, Cox, Karina, Dani, Mohsin, Chalmers, Ritchie, Satpathy, Anjana, Quinn, Edel, Byrne, Gerard, Harvey, James, Murphy, John, Highton, Lyndsey, Sharif, Mohammad Amir, Barnes, Nicola, Dimopoulos, Nikitas, Johnson, Richard, Chatterjee, Sumohan, Fatayer, Hiba, Mathen, Vinod, Taylor, Amanda, Soulsby, Rachel, Walsh, Adam, Thorne, Amanda, Gill, Jasper, Merker, Louise, Critchley, Adam, Pieri, Andrew, Cain, Henry, Ralph, Jane, Kalra, Loraine, Thomas, Robert, Young, Ian, Khan, Lucy R., Elsberger, Beatrix, Smyth, Elizabeth, Urquhart, Gordon, Fuller, Mairi, Masannat, Yazan, Chrysafi, Ada, Salman, Muhammad, Abdalla, El-Rasheed, Zechmeister, Katalin, Hussien, Maged, Youssef, Mina M. G., Tanhueco, Angeline, Salvador, Reginald, Wallace, Sharon, Pain, Simon, Sahu, Ajay, Chambers, Alice, Moody, Alice, Dash, Isabella, Cook, James, Batt, Jeremy, Mullan, Michelle, Shere, Mike, Gallegos, Nicholas, Ainsworth, Rachel, Govindarajulu, Sasi, Potter, Shelley, Rayter, Zenon, Williams, Kate E., Bramley, Maria, Absar, Mohammed, Nasir, Nabila, Tabbakh, Rami, Pereira, Bernadette, Gahir, Jasdeep, Bosch, Karen, Fafemi, Oladapo, Touqan, Nader, Oni, Georgette, Khout, Hazem, Asgeirsson, Kristjan, Whisker, Lisa, Lee, Rachel Xue Ning, Macmillan, Robert, McCulley, Stephen, Rasheed, Tuabin, Adwani, Asha, Segaran, Ashvina, Dodwell, David, Remoundos, Dennis, MacLean, Gael, Cuffolo, Giulio, Douek, Michael, Roy, Pankaj, Gathani, Toral, Najeeb, Erum, Simonca, Claudiu, Verroiotou, Maria, Ramzi, Sa’ed, Jenkins, Stephanie C., Gopalan, Vallipuran, Barker, Sarah, McGoldrick, Ciara, Irwin, Gareth W., Mallon, Peter, Sloan, Samantha A., Imran, Abbas, Mondani, Giuseppina, Brown, Iain, Abbas, Imran, Sulieman, Mona, Drew, Philip, King, Polly, English, Rachel Elizabeth, Sharma, Anita, Ives, Charlotte, Ferguson, Douglas, Boundouki, George, Bentley, James, Banks, Jenny, Dunn, Julie, Tillett, Rachel, Olsen, Sisse, Tansley, Anne, Sousa, Emma De, Mitchell, Geraldine, Whitehead, Ian, Henderson, Julia, Rowland, Matthew, Chandrashekar, Mysore, Eid, Raja, Clayton, Elizabeth, Pakzad, Farrokh, Horsnell, Jonathan D., Hague, Matthew, Partlett, Polly, Irvine, Tracey, Kallaway, Charlotte, Fairhurst, Katherine, Laban, Christiana, McIntosh, Jamie, Laurence, Nicola, Sutton, Richard, Sharma, Anup, Banerjee, Dibyesh, Betambeau, Nadine, Bezzaa, Sabrina, Bathla, Sonia, Ray, Atanu, Chagla, Leena, Kiernan, Tamara, Hogan, Brian, Navin, Channegowda, Macinnes, Emma, Turton, Philip, Achuthan, Raj, Kantola, Venla, Mckenzie, Shireen, Dent, Helen, Pogson, Caroline, Waheed, Shamaela, De Silva, Tania S., Suleiman, Usama, Jones, Lucie, Athwal, Ruvinder, Harries, Simon, Krzyzanowska, Catherine, Abbas, Abeera, Hurley, Anna R., Gui, Gerald, Rusby, Jennifer E., Krupa, Katherine, Harborough, Kathryn E., Roche, Nicola, Barry, Peter A., Law, Rebekah, Allum, William H., Lobo, Cheryl, Ntakomyti, Eleni, Franks, Joanna, Cariati, Massimiliano, Patani, Neill, Stanilov, Noyko, Charalampoudis, Petros, Taraki, Zarghuna, McEvoy, Kat, Sait, Mohamed Razick, Robertson, Stuart, Zeidan, Bashar, Rew, David, Mazari, Fayyaz, Alder, Louise, Sakellariou, Vasileios, Hamad, Ahmed, Goyal, Amit, Carmichael, Amtul, Courtney, Carol-Ann, Sibbering, David Mark, Garreffa, Emanuele, Cheung, Kwok-Leung, Williams-Jones, Susan, Wahedna, Yasmin, Ansari, Aonghus, Kenny, Frances, Valassiadou, Kalliope, Lambert, Kelly, Krupa, Jaroslaw, Sardar, Mini V., Kaushik, Monika, Shokuhi, Sheila, Pilgrm, Simon, Sasi, Walid, McManus, Penelope, Parmeshwar, Rishikesh, Somasundaram, Santosh, Gowda, Manoj, Jafferbhoy, Sadaf, Narayanan, Sankaran, Marla, Sekhar, Soumian, Soni, Goh, Ngee-Ming, Vatish, Jamie, Sein, Tin Aung, Agabiti, Ennio, Maalo, Joseph, Chong, Kelvin, Lai, Lee-Min, Elkorety, Mohamed, Monib, Sherif, Thomson, Simon, Mikhael, Youhana, Mirshekar-Syahkal, Bahar, Aitken, Jane, Girgis, Mina, Betal, Dibendu, Rapisarda, Fabio, Cook, Lorna, Odofin, Olubunmi, Bonomi, Riccardo, Wardle, Stacy, Sotheran, Wendy, Athanasiou, Irene, Lund, Jonathan, Callaghan, Maria, Burrah, Rajaram, Vinayagam, Raman, James, Karen, Poonawala, Shabbir, Isgar, Brian, Matey, Pilar, Mylvaganam, Senthurun, Podesta, Carl, Sircar, Tapan, Salem, Fathi, Al-Ishaq, Zaid, Dave, Rajiv V. [0000-0001-6827-8090], McIntosh, Stuart A. [0000-0002-4123-9611], Potter, Shelley [0000-0002-6977-312X], Copson, Ellen [0000-0001-8994-4056], and Apollo - University of Cambridge Repository

Subjects
692/700/784, article, 692/4028/67/1347, 692/700/3934, 692/700/1538, 692/4028/546
Abstract

Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Published
2021
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7. Tumor Mutation Burden Prediction Model in Egyptian Breast Cancer patients based on Next Generation Sequencing.

Author

Nassar A, Lymona AM, Lotfy MM, Youssef ASE, Mohanad M, Manie TM, Youssef MMG, Farahat IG, and Zekri AN

Subjects
Adult, Aged, Breast Neoplasms pathology, Egypt, Female, Humans, Ki-67 Antigen metabolism, Machine Learning, Middle Aged, Receptor, ErbB-2 metabolism, Receptors, Estrogen metabolism, Receptors, Progesterone metabolism, Tumor Burden, Biomarkers, Tumor metabolism, Breast Neoplasms genetics, High-Throughput Nucleotide Sequencing
Abstract

Objectives: This study aimed to identify the tumor mutation burden (TMB) value in Egyptian breast cancer (BC) patients. Moreover, to find the best TMB prediction model based on the expression of estrogen (ER), progesterone (PR), human epidermal growth factor receptor 2 (HER-2), and proliferation index Ki-67., Methods: The Ion AmpliSeq Comprehensive Cancer Panel was used to determine TMB value of 58 Egyptian BC tumor tissues. Different machine learning models were used to select the optimal classification model for prediction of TMB level according to patient's receptor status., Results: The measured TMB value was between 0 and 8.12/Mb. Positive expression of ER and PR was significantly associated with TMB ≤ 1.25 [(OR =0.35, 95% CI: 0.04-2.98), (OR = 0.17, 95% CI= 0.02-0.44)] respectively. Ki-67 expression positive was significantly associated with TMB >1.25 than those who were Ki-67 expression negative (OR = 9.33, 95% CI= 2.07-42.18). However, no significant differences were observed between HER2 positive and HER2 negative groups. The optimized logistic regression model was TMB = -27.5 -1.82 ER - 0.73 PR + 0.826 HER2 + 2.08 Ki-67., Conclusion: Our findings revealed that TMB value can be predicted based on the expression level of ER, PR, HER-2, and Ki-67.

Published
2021
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8. Inflammatory Breast Cancer in Men: A rare clinical case report and a literature review.

Author

Tanhueco A and Youssef MMG

Abstract

Introduction and Importance: The initial misdiagnosis and delayed treatment for inflammatory breast cancer in men is brought about by its rarity and lack of readily available guidelines on pathways., Case Presentation: A 78-year-old male presented to the breast clinic with an abscess and was later diagnosed with inflammatory breast cancer. He presented with an abscess and was initially treated with antibiotics. Imaging showed a large left breast mass consistent with inflammatory carcinoma with axillary lymph node involvement. Patient was started on Tamoxifen as a bridge for surgery with no response. He eventually had a mastectomy and axillary clearance with the histology confirming the diagnosis and tumour emboli in the lymphatic vessels. Chemotherapy, radiation and dual hormone therapy were included in the adjuvant treatment plan. Two episodes of neutropenic sepsis led to completing only five out of six planned chemotherapy cycles., Clinical Discussion: A review of literature and the reported cases was done by the team to contribute to the little information published about the disease and its management. The presented to the breast clinic during the height of the SARS- CoV-2 pandemic. The global impact of SARS-CoV-19 made surgical teams find ways to lessen elective lists to give way for patients affected during the pandemic., Conclusion: Very few cases of inflammatory breast cancer have been reported in men. The diagnosis can be missed leading to delay in management. Management can be challenging and complex., (Copyright © 2021. Published by Elsevier Ltd.)

Published
2021
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10. The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance.

Author

Youssef MMG, Cameron D, Pucher PH, Olsen S, and Ferguson D

Subjects
Axilla, Breast Neoplasms therapy, Carcinoma, Ductal, Breast therapy, Carcinoma, Lobular therapy, Case-Control Studies, Chemotherapy, Adjuvant, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Lymph Nodes pathology, Lymphatic Metastasis, Mastectomy, Prognosis, Radiotherapy, Adjuvant, Retrospective Studies, Breast Neoplasms pathology, Carcinoma, Ductal, Breast pathology, Carcinoma, Lobular pathology, Lymph Node Excision methods, Lymphedema epidemiology, Neoplasm Micrometastasis pathology, Neoplasm Recurrence, Local epidemiology, Postoperative Complications epidemiology, Sentinel Lymph Node pathology
Abstract

Background: Management of micrometastasis in the sentinel node is a controversial topic. Most of the guidelines don't recommend further axillary treatment if micrometastasis are the only finding in the sentinel node. However, some evidence suggests that micrometastasis have significant effect on long term outcomes and therefore indicate systemic treatment., Method: Retrospective cohort study reviewing the management of patients with micrometastasis in the sentinel nodes. Two groups were compared, those who had further axillary clearance and those who had not. The primary endpoints were loco-regional recurrence and lymphedema rate. The secondary endpoints were distant metastasis rate, OS and DFS., Results: 95 patients were found to have micrometastasis or ITC in the axillary SNB over a period of 10 years. Of those, 38 patients had axillary clearance after SNB, while 57 did not. Lymphedema rate was 18.4% in the axillary clearance group versus 0% in the no axillary clearance group (p < 0.001). The LRR event was rare therefore not compared. Distant metastasis rate was 7.01% in the SNB group versus 2.6% in the axillary clearance group. There were no mortalities in the axillary clearance group. This compares to 7.01% among the patients who didn't have axillary clearance. All the patients who died had developed distant metastasis as a cause of death. There was a difference in OS between the two groups in favor of the axillary clearance group (p = 0.004)., Discussion: Although not an indication for axillary clearance recent guidelines, micrometastasis and ITC found in the SNB are a sign of a biologically different disease. This important information should be taken in consideration when planning the adjuvant treatment in those patients among other factors considered., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Published
2016
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