Background and Aim of the Work: Frailty is a state of reduced physiological reserve associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. This work assessed the ...Background and Aim of the Work: Frailty is a state of reduced physiological reserve associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. This work assessed the ability of comprehensive geriatric assessment to detect frailty in elderly patients. Subjects and Methods: A total number of 104 elderly patients (above 60 years old) were included in this study and they were subjected to a comprehensive geriatric assessment (CGA) including: (history and full clinical examination, Mini mental status examination (MMSE), Geriatric depression scale (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008, each group included 52 patients. Results: There were no significant differences between the two groups regarding age gender or smoking habits. But there was higher percentage of ADL, IADL dependence in addition to higher incidence of depression and cognitive impairment among frail cases. Conclusion: Comprehensive geriatric assessment can be used to detect frailty and its associated impairment and comorbidities.展开更多
<strong>Introduction:</strong> Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associate...<strong>Introduction:</strong> Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associated with heavy health burden and cardiovascular complications particularly in sub Sahara Africa. An assessment of factors relating hyperuricemia to hypertension and chronic kidney disease would therefore be necessary as way of mitigating the poor quality of life, morbidity and mortality associated with these diseases in low income nations. <strong>Methods:</strong> A single centre, descriptive comparative study in which the demographic, clinical and laboratory data of hypertensive and non-dialyzed chronic kidney disease (CKD) patients were analyzed. Serum biochemical parameters with uric acid, hematocrit and urine dip strip protein were assessed. Predictors of hyperuricemia were determined using multivariate analysis. <strong>Results:</strong> One hundred and thirty nine hypertensives and 69 CKD were studied. The mean age of the participants was 54.3 ± 11.7 years, hypertensives (52.9 ± 15.7 years) and CKD (57.3 ± 16.1 years). Both groups had more males, P = 0.8. Majority (78.3%) of the CKD cohorts had stage 4 or 5 (non-dialyzed) disease. The systolic and diastolic blood pressure, creatinine and uric acid were lower in hypertension than in CKD, P = 0.07, P = 0.05, P < 0.001 and P = 0.004 respectively. The hematocrit, albumin and GFR were higher in HTN than CKD, P < 0.001, P < 0.001 and P < 0.001 respectively. The prevalence of hyperuricemia was 56.2%. The mean uric acid was 505.9 ± 23.6 mmol/L, 382 7 ± 10.5 mmol/L for hypertensive and 755.9 ± 14.8 mmol/L for CKD, P < 0.001. The prevalence of systolic HTN, proteinuria, hypoalbuminemia and anemia were 51%, 75%, 46% and 59%, and were higher in males. Hyperuricemia was related to advancing age, proteinuria, elevated creatinine, hypoalbuminemia, anemia and hypertriglyceridemia. Proteinuria (OR—4.66, 95% CI—2.42 - 9.65), elevated creatinine (OR—3.12, 95% CI—2.40 - 6.92), hypoalbuminemia (OR—2.92, 95% CI—1.83 - 5.78) and anemia (OR—4.01, 95% CI—3.78 - 7.99) independently predicted hyperuricemia.<strong> Conclusion:</strong> Hyperuricemia is commoner in CKD than hypertension and was higher in males and positively correlated with the blood pressure, proteinuria and creatinine, but negatively related to hematocrit, albumin and glomerular filtration rate. Independent predictors of hyperuricemia were proteinuria, elevated creatinine, hypoalbuminemia and anemia. Measures are needed to prevent and treat hyperuricemia to reduce the health burden associated with hypertension and CKD.展开更多
Objective:This phase II study aimed at investigating the correlation between O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation and protein expression,together with Ki-67 labeling index (LI),to respons...Objective:This phase II study aimed at investigating the correlation between O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation and protein expression,together with Ki-67 labeling index (LI),to response,time to progression (TTP),and overall survival (OS) in newly diagnosed glioblastoma multiforme (GBM) patients treated with temozolomide (TMZ) concomitant with and adjuvant to radiotherapy (RT).Methods:From June 2005 to August 2008,34 adult patients (18-65 years),PS ≥70,with newly diagnosed GBM received TMZ 75 mg/m2 plus RT up to 60 Gy,followed by TMZ 175 mg/m2 5 days every 4 weeks for 12 doses.MGMT Methylation-specific PCR assay,MGMT protein expression,and Ki-67 expression using immunohistochemistry (IHC) were performed on the tissue blocks.The patients were followed by MRI while MR spectroscopy (MRS) was performed for the stable cases or to confirm progression and accordingly Bevacizumab 10 mg/kg every 2 weeks was added to 7 patients till further progression was proved.Results:31 cases were evaluable,12 (38.7%) had unmethylated MGMT,while 19 (61.3%) were methylated.Seventeen cases (55%) were MGMT immunonegative while 14 cases (45%) were immunopositive.The cut off value of Ki-67 LI in relation to survival was 17%,where 15 were < 17% (48.4%),and 16 were ≥ 17% (51.6%).Response evaluation started after the second dose of the adjuvant TMZ and was repeated every 2 months.The overall disease control rate (ODC) was 74.2%,where 2 patients had complete response (CR),14 had partial response (PR),and 7 had stable disease (SD),while 8 (25.8%) had progressive disease (PD).The ODC was significantly higher among methylated patients and in those with Ki-67 < 17% (P=0.0003).The median overall TTP was 12 months and the median OS was 20 months for all the patients including those who received Bevacizumab for some stable cases or as a salvage treatment in patients with good PS,the MGMT-methylated patients had a higher median TTP of 13 months (range 8 to 18 months,95% CI of 9.36 to 12.9),and OS of 24 months (range 12 to 31 months,95% CI of 16.1 to 21.32),while the unmethylated patients had a median TTP of 6.5 months and a median OS of 12 months,such correlations were highly significant (P=0.0001).MGMT immunoexpression failed to show significant correlation with MGMT promotor methylation or the outcome of the patients.Patients with Ki-67 < 17% had a median TTP of 16 months and median OS of 24 months compared to 7 and 12.5 months respectively for the patients with Ki-67 ≥17%.Significant correlation was found between the ODC,TTP,and OS with age < 52,near total excision,and TMZ doses received ≥ 10.The commonest grade 3 and 4 toxicities was neutropenia recorded in 3 patients (9.67%),thrombocytopenia in 4 patients (12.9%),and one patient with G3 nausea,vomiting,and constipations (3%),all were medically manageable.Conclusion:MGMT promotor methylation status and Ki-67 LI (but not the MGMT protein expression),could serve as prognostic markers for survival,also MGMT could identify the newly diagnosed GBM patients who will have better response to TMZ.展开更多
Objective： The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma （MPM）. Methods： Thirty-three eligi...Objective： The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma （MPM）. Methods： Thirty-three eligible patients with histologically proven advanced MPM with ECOG PS of 〈 2 and had adequate liver and kidney functions received gemcitabine （1000 mg/m2） on days 1 and 8 combined with cisplatin （80 mg/m^2） on day 1. Results： The majority of the study group were males and constituted 87.9% （n = 29）, while females constituted 12.1% （n = 4）. The median age was 52 years and ranged from 37 to 69 years. Regarding SWOG performance status, 5 patients were PS 0, 21 patients were PS 1 and 7 patients were PS 2. Regarding pathological subtypes, epithelial histology represented 84.8% of the study （n = 28） while sarcomatoid type represented 6% （n = 2） and biphasic type accounted for 9% （n = 3）. Regarding staging according to IMIG staging system, 12.1% of patients were stage Ⅱ, 54.5% were stage Ⅲand 33.3% were stage Ⅳ. Only one patient （3%） had attained a complete response, 18 patients （54.5%） showed partial response, 12 patients （36.4%） showed stationary disease, while 2 patients （6.1%） showed progressive disease. The correlation between response rate obtained and PS was statistically significant （P = 0.029）. After a median follow-up of 14.4 months, the median survival time was 20.3 months （95% Cl： 14.58-26.01 months） and the progression free survival time was 11.8 months （95% CI： 10.76-12.83 months） Conclusion： The combination of gemcitabine and cisplatin is an active and safe treatment in patients with MPM. Further larger comparative studies are warranted to document this finding.展开更多
Background: Urinary bladder dysfunction is a major complication of diabetes mellitus and its mechanism has been attributed to autonomic and/or peripheral neuropathy. Objectives: Evaluation of diabetes mellitus and neu...Background: Urinary bladder dysfunction is a major complication of diabetes mellitus and its mechanism has been attributed to autonomic and/or peripheral neuropathy. Objectives: Evaluation of diabetes mellitus and neuropathy effect on the urinary bladder dynamics in children and adolescents with Type 1 diabetes mellitus. Patients and Methods: The study included 80 children and adolescents with Type 1 diabetes for at least 5 years;60 patients were with manifestations of autonomic and/or peripheral neuropathy and 20 patients were free of either. We assessed both groups for presence of cystopathy by means of uroflowmetry and cystometry. Results: All patients with diabetic neuropathy had abnormal urodynamic test results of variable types and degrees with bladder hypercompliance as the most frequent abnormality. Other urodynamic abnormalities were found in both diabetic patients’ groups with no significant difference in frequency. Conclusions: Diabetic neuropathy might be strongly related to urodynamic abnormalities particularly the bladder hypercompliance. Some diabetic patients may have cystopathy in absence of evident neuropathy. This may be due to undetected neuropathy or diabetes induced myopathy of the detrusor muscle.展开更多
Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants...Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.展开更多
Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of th...Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of this work is to detect the role of MDCT (multidetector computed tomography) in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging. Patients and Methods: This is a prospective study enrolling 20 patients who had histologically proven adenocarcinoma based upon an upper gastrointestinal endoscopic biopsy for MDCT staging of gastric carcinoma during the period from June 2016 to June 2017. The MSCT data were correlated and compared with the histopathological results. The study was conducted in the Radiology Department of Assiut University Hospital using 64-MDCT (Toshiba Aquilion). Results: According to our study results, the sensitivity of determining T1 stage on CT scan can’t be detected as there was only 1 case pathologically proved T1 and overstaged as T2 by MSCT;however, accuracy and specificity are quite high, which was 95% and 100% respectively. For T2 stage tumors (25.0% of cases), accuracy is 95%, sensitivity—100%, and specificity—93.7%. According to our results the accuracy and sensitivity of T3 staging are 75% and 100%, while those of T4 stage were 75% and 44.4% respectively. Tumor was correctly staged in 14 of 20 patients (the valid T staging rate was 70.0%). Tumor was under-staged in 5 of 20 patients (25.0%) (staged as T3, but pathologically proven to be T4a). As regards N staging accuracy found results for N0 (62.5%), N2 (87.5%) and N3 (75%), while N1 accuracy recorded 37.5%. As regards the nodal staging sensitivity which had a range from (0% for N4) to (66% for N2) this wide range of sensitivity demonstrates the problem of CT in nodal staging. As regards sensitivity of M0, accuracy was 100% and 85% respectively. While that of M1 was (62.5%) and (85%) respectively. Conclusion: MSCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma. It presents excellent accuracy in the staging of tumor invasion depth (T) and in the staging of metastatic neoplastic disease (M). Despite the good accuracy in the staging of patients without lymph node disease (N0), the method presents limitations in the staging of lymph node involvement.展开更多
Background and Aim of the Work: Frailty is a state of reduced physiological reserve and is associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. The aim of this ...Background and Aim of the Work: Frailty is a state of reduced physiological reserve and is associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. The aim of this work is to assess the association between the levels of homocystiene and C-reactive protein and frailty and to examine the ability of homocystiene as a new marker to detect frailty. Subjects and Methods: A total number of 104 elderly subjects (above 60 years old) were included in this study and they were subjected to history, examination, comprehensive geriatric assessment, and laboratory investigations including: C-reactive protein (CRP) and Homocystiene (Hcy). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008 and each group included 52 patients. Results: There was no significant difference between the two groups as regards age gender or smoking habits. But there were higher levels of CRP (>10 mg/dl) and homocystiene (>12 mmol/l) among frail cases and by comparing both homocystiene was more sensitive in detection of frailty. Conclusion: Frailty was associated with eleveted homocystiene and CRP and homocystiene is more specific than CRP in detection of frailty.展开更多
Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxa...Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.展开更多
<span style="white-space:nowrap;font-family:Verdana;"><strong>Background: </strong></span>This study aimed to determine the impact of the percutaneous coronary intervention (PCI)...<span style="white-space:nowrap;font-family:Verdana;"><strong>Background: </strong></span>This study aimed to determine the impact of the percutaneous coronary intervention (PCI) on myocardial function assessed by tissue Doppler echocardiography.<span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods:</span></b><i><span style="font-family:;" "=""> </span></i><span style="font-family:;" "=""><span style="font-family:Verdana;">Conventional two-dimensional echocardiography</span><b> </b><span style="font-family:Verdana;">and</span><i> </i><span style="font-family:Verdana;">Myocardial tissue peak velocities were recorded at the lateral, ant.septal, post.septal, posterior, ant. and inferior angles of the mitral annulus as well as at the lateral tricuspid annulus by pulsed-wave tissue Doppler echocardiography before PCI, as well as 1 day and 6 weeks after intervention.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results:</span></b><i><span style="font-family:;" "=""> </span></i><span style="font-family:;" "=""><span style="font-family:Verdana;">Fifty consecutive patients with chronic stable angina and </span><span style="font-family:Verdana;">preserved systolic left ventricular function (mean age, 58.3 ± 6.594 years;32 men) undergoing PCI were studied. Conventional echocardiographic revealed no statistically significant difference between pre- and post-PCI (1 day after PCI and 6</span><span style="font-family:Verdana;"> weeks after PCI) as regarding trans-mitral and trans-tricuspid flow velocities except as regarding LVEDD, LVESD and LVEF which showed a significant improvement post-PCI. Compared with pre-interventional values, systolic peak velocity and early diastolic velocities improved at all sites (P ≤ </span></span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05 for each). The most pronounced improvement occurred in the septal area. Similarly, late diastolic velocities improved at all sites (P ≤ </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05 for each) except at post</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Wall A’. Also, there was a significant improvement of E’DT & E’/A’ ratio after PCI (P value is significant <0.05 for each) but there was insignificant difference between pre & post PCI for E/E’ (P-value = 0.154). There was a significant improvement in tissue Doppler measures of early, late diastolic function and E’/A’ at the lateral tricuspid annulus after PCI compared with baseline values (P value is significant <0.05) but there was an insignificant change in tissue Doppler measures at the lateral tricuspid annulus of E’DT & E/E’ after PCI (repeated measures ANOVA P-value is >0.05 for each). There were significant reductions in IVRT, IVCT & MPI after PCI (P value is significant <0.05 for each) but there was insignificant change in ET after PCI (P-value = 0.09) at the septal angle of the mitral annulus and the lateral angle of the tricuspid annulus.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Tissue Doppler parameters of diastolic and systolic function improve early after successful PCI, and this effect persists to 6 weeks after the intervention that emphasizes its value in the improvement of regional and global LV functions and myocardial contractility.</span>展开更多
Introduction: Inflammation has been implicated as a major reason for the higher morbidity and mortality in chronic kidney disease (CKD) compared to the diseases that commonly precedes it. The neutrophil lymphocyte rat...Introduction: Inflammation has been implicated as a major reason for the higher morbidity and mortality in chronic kidney disease (CKD) compared to the diseases that commonly precedes it. The neutrophil lymphocyte ratio (NLR) has increasingly been reported to be a marker of systemic inflammation. We studied the neutrophil lymphocyte ratio and its relationship with kidney function and other markers of inflammation in health and in CKD. Methods: Two hundred and forty four participants in three cohorts: healthy, CKD stage 1 - 2 and, stage 3 - 4, were studied. Data of clinical, NLR, uric acid, urine albumin creatinine ratio (UACR), electrolytes were documented and independent associates of NLR were determined. Results: The NLR was higher in the CKD cohorts, P Conclusion: The NLR as an inflammatory marker is elevated in chronic kidney disease, and increases with disease severity hence it can be a useful tool in determining the presence and severity of inflammation in CKD.展开更多
文摘Background and Aim of the Work: Frailty is a state of reduced physiological reserve associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. This work assessed the ability of comprehensive geriatric assessment to detect frailty in elderly patients. Subjects and Methods: A total number of 104 elderly patients (above 60 years old) were included in this study and they were subjected to a comprehensive geriatric assessment (CGA) including: (history and full clinical examination, Mini mental status examination (MMSE), Geriatric depression scale (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008, each group included 52 patients. Results: There were no significant differences between the two groups regarding age gender or smoking habits. But there was higher percentage of ADL, IADL dependence in addition to higher incidence of depression and cognitive impairment among frail cases. Conclusion: Comprehensive geriatric assessment can be used to detect frailty and its associated impairment and comorbidities.
文摘<strong>Introduction:</strong> Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associated with heavy health burden and cardiovascular complications particularly in sub Sahara Africa. An assessment of factors relating hyperuricemia to hypertension and chronic kidney disease would therefore be necessary as way of mitigating the poor quality of life, morbidity and mortality associated with these diseases in low income nations. <strong>Methods:</strong> A single centre, descriptive comparative study in which the demographic, clinical and laboratory data of hypertensive and non-dialyzed chronic kidney disease (CKD) patients were analyzed. Serum biochemical parameters with uric acid, hematocrit and urine dip strip protein were assessed. Predictors of hyperuricemia were determined using multivariate analysis. <strong>Results:</strong> One hundred and thirty nine hypertensives and 69 CKD were studied. The mean age of the participants was 54.3 ± 11.7 years, hypertensives (52.9 ± 15.7 years) and CKD (57.3 ± 16.1 years). Both groups had more males, P = 0.8. Majority (78.3%) of the CKD cohorts had stage 4 or 5 (non-dialyzed) disease. The systolic and diastolic blood pressure, creatinine and uric acid were lower in hypertension than in CKD, P = 0.07, P = 0.05, P < 0.001 and P = 0.004 respectively. The hematocrit, albumin and GFR were higher in HTN than CKD, P < 0.001, P < 0.001 and P < 0.001 respectively. The prevalence of hyperuricemia was 56.2%. The mean uric acid was 505.9 ± 23.6 mmol/L, 382 7 ± 10.5 mmol/L for hypertensive and 755.9 ± 14.8 mmol/L for CKD, P < 0.001. The prevalence of systolic HTN, proteinuria, hypoalbuminemia and anemia were 51%, 75%, 46% and 59%, and were higher in males. Hyperuricemia was related to advancing age, proteinuria, elevated creatinine, hypoalbuminemia, anemia and hypertriglyceridemia. Proteinuria (OR—4.66, 95% CI—2.42 - 9.65), elevated creatinine (OR—3.12, 95% CI—2.40 - 6.92), hypoalbuminemia (OR—2.92, 95% CI—1.83 - 5.78) and anemia (OR—4.01, 95% CI—3.78 - 7.99) independently predicted hyperuricemia.<strong> Conclusion:</strong> Hyperuricemia is commoner in CKD than hypertension and was higher in males and positively correlated with the blood pressure, proteinuria and creatinine, but negatively related to hematocrit, albumin and glomerular filtration rate. Independent predictors of hyperuricemia were proteinuria, elevated creatinine, hypoalbuminemia and anemia. Measures are needed to prevent and treat hyperuricemia to reduce the health burden associated with hypertension and CKD.
文摘Objective:This phase II study aimed at investigating the correlation between O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation and protein expression,together with Ki-67 labeling index (LI),to response,time to progression (TTP),and overall survival (OS) in newly diagnosed glioblastoma multiforme (GBM) patients treated with temozolomide (TMZ) concomitant with and adjuvant to radiotherapy (RT).Methods:From June 2005 to August 2008,34 adult patients (18-65 years),PS ≥70,with newly diagnosed GBM received TMZ 75 mg/m2 plus RT up to 60 Gy,followed by TMZ 175 mg/m2 5 days every 4 weeks for 12 doses.MGMT Methylation-specific PCR assay,MGMT protein expression,and Ki-67 expression using immunohistochemistry (IHC) were performed on the tissue blocks.The patients were followed by MRI while MR spectroscopy (MRS) was performed for the stable cases or to confirm progression and accordingly Bevacizumab 10 mg/kg every 2 weeks was added to 7 patients till further progression was proved.Results:31 cases were evaluable,12 (38.7%) had unmethylated MGMT,while 19 (61.3%) were methylated.Seventeen cases (55%) were MGMT immunonegative while 14 cases (45%) were immunopositive.The cut off value of Ki-67 LI in relation to survival was 17%,where 15 were < 17% (48.4%),and 16 were ≥ 17% (51.6%).Response evaluation started after the second dose of the adjuvant TMZ and was repeated every 2 months.The overall disease control rate (ODC) was 74.2%,where 2 patients had complete response (CR),14 had partial response (PR),and 7 had stable disease (SD),while 8 (25.8%) had progressive disease (PD).The ODC was significantly higher among methylated patients and in those with Ki-67 < 17% (P=0.0003).The median overall TTP was 12 months and the median OS was 20 months for all the patients including those who received Bevacizumab for some stable cases or as a salvage treatment in patients with good PS,the MGMT-methylated patients had a higher median TTP of 13 months (range 8 to 18 months,95% CI of 9.36 to 12.9),and OS of 24 months (range 12 to 31 months,95% CI of 16.1 to 21.32),while the unmethylated patients had a median TTP of 6.5 months and a median OS of 12 months,such correlations were highly significant (P=0.0001).MGMT immunoexpression failed to show significant correlation with MGMT promotor methylation or the outcome of the patients.Patients with Ki-67 < 17% had a median TTP of 16 months and median OS of 24 months compared to 7 and 12.5 months respectively for the patients with Ki-67 ≥17%.Significant correlation was found between the ODC,TTP,and OS with age < 52,near total excision,and TMZ doses received ≥ 10.The commonest grade 3 and 4 toxicities was neutropenia recorded in 3 patients (9.67%),thrombocytopenia in 4 patients (12.9%),and one patient with G3 nausea,vomiting,and constipations (3%),all were medically manageable.Conclusion:MGMT promotor methylation status and Ki-67 LI (but not the MGMT protein expression),could serve as prognostic markers for survival,also MGMT could identify the newly diagnosed GBM patients who will have better response to TMZ.
文摘Objective： The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma （MPM）. Methods： Thirty-three eligible patients with histologically proven advanced MPM with ECOG PS of 〈 2 and had adequate liver and kidney functions received gemcitabine （1000 mg/m2） on days 1 and 8 combined with cisplatin （80 mg/m^2） on day 1. Results： The majority of the study group were males and constituted 87.9% （n = 29）, while females constituted 12.1% （n = 4）. The median age was 52 years and ranged from 37 to 69 years. Regarding SWOG performance status, 5 patients were PS 0, 21 patients were PS 1 and 7 patients were PS 2. Regarding pathological subtypes, epithelial histology represented 84.8% of the study （n = 28） while sarcomatoid type represented 6% （n = 2） and biphasic type accounted for 9% （n = 3）. Regarding staging according to IMIG staging system, 12.1% of patients were stage Ⅱ, 54.5% were stage Ⅲand 33.3% were stage Ⅳ. Only one patient （3%） had attained a complete response, 18 patients （54.5%） showed partial response, 12 patients （36.4%） showed stationary disease, while 2 patients （6.1%） showed progressive disease. The correlation between response rate obtained and PS was statistically significant （P = 0.029）. After a median follow-up of 14.4 months, the median survival time was 20.3 months （95% Cl： 14.58-26.01 months） and the progression free survival time was 11.8 months （95% CI： 10.76-12.83 months） Conclusion： The combination of gemcitabine and cisplatin is an active and safe treatment in patients with MPM. Further larger comparative studies are warranted to document this finding.
文摘Background: Urinary bladder dysfunction is a major complication of diabetes mellitus and its mechanism has been attributed to autonomic and/or peripheral neuropathy. Objectives: Evaluation of diabetes mellitus and neuropathy effect on the urinary bladder dynamics in children and adolescents with Type 1 diabetes mellitus. Patients and Methods: The study included 80 children and adolescents with Type 1 diabetes for at least 5 years;60 patients were with manifestations of autonomic and/or peripheral neuropathy and 20 patients were free of either. We assessed both groups for presence of cystopathy by means of uroflowmetry and cystometry. Results: All patients with diabetic neuropathy had abnormal urodynamic test results of variable types and degrees with bladder hypercompliance as the most frequent abnormality. Other urodynamic abnormalities were found in both diabetic patients’ groups with no significant difference in frequency. Conclusions: Diabetic neuropathy might be strongly related to urodynamic abnormalities particularly the bladder hypercompliance. Some diabetic patients may have cystopathy in absence of evident neuropathy. This may be due to undetected neuropathy or diabetes induced myopathy of the detrusor muscle.
文摘Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.
文摘Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of this work is to detect the role of MDCT (multidetector computed tomography) in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging. Patients and Methods: This is a prospective study enrolling 20 patients who had histologically proven adenocarcinoma based upon an upper gastrointestinal endoscopic biopsy for MDCT staging of gastric carcinoma during the period from June 2016 to June 2017. The MSCT data were correlated and compared with the histopathological results. The study was conducted in the Radiology Department of Assiut University Hospital using 64-MDCT (Toshiba Aquilion). Results: According to our study results, the sensitivity of determining T1 stage on CT scan can’t be detected as there was only 1 case pathologically proved T1 and overstaged as T2 by MSCT;however, accuracy and specificity are quite high, which was 95% and 100% respectively. For T2 stage tumors (25.0% of cases), accuracy is 95%, sensitivity—100%, and specificity—93.7%. According to our results the accuracy and sensitivity of T3 staging are 75% and 100%, while those of T4 stage were 75% and 44.4% respectively. Tumor was correctly staged in 14 of 20 patients (the valid T staging rate was 70.0%). Tumor was under-staged in 5 of 20 patients (25.0%) (staged as T3, but pathologically proven to be T4a). As regards N staging accuracy found results for N0 (62.5%), N2 (87.5%) and N3 (75%), while N1 accuracy recorded 37.5%. As regards the nodal staging sensitivity which had a range from (0% for N4) to (66% for N2) this wide range of sensitivity demonstrates the problem of CT in nodal staging. As regards sensitivity of M0, accuracy was 100% and 85% respectively. While that of M1 was (62.5%) and (85%) respectively. Conclusion: MSCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma. It presents excellent accuracy in the staging of tumor invasion depth (T) and in the staging of metastatic neoplastic disease (M). Despite the good accuracy in the staging of patients without lymph node disease (N0), the method presents limitations in the staging of lymph node involvement.
文摘Background and Aim of the Work: Frailty is a state of reduced physiological reserve and is associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. The aim of this work is to assess the association between the levels of homocystiene and C-reactive protein and frailty and to examine the ability of homocystiene as a new marker to detect frailty. Subjects and Methods: A total number of 104 elderly subjects (above 60 years old) were included in this study and they were subjected to history, examination, comprehensive geriatric assessment, and laboratory investigations including: C-reactive protein (CRP) and Homocystiene (Hcy). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008 and each group included 52 patients. Results: There was no significant difference between the two groups as regards age gender or smoking habits. But there were higher levels of CRP (>10 mg/dl) and homocystiene (>12 mmol/l) among frail cases and by comparing both homocystiene was more sensitive in detection of frailty. Conclusion: Frailty was associated with eleveted homocystiene and CRP and homocystiene is more specific than CRP in detection of frailty.
文摘Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.
文摘<span style="white-space:nowrap;font-family:Verdana;"><strong>Background: </strong></span>This study aimed to determine the impact of the percutaneous coronary intervention (PCI) on myocardial function assessed by tissue Doppler echocardiography.<span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods:</span></b><i><span style="font-family:;" "=""> </span></i><span style="font-family:;" "=""><span style="font-family:Verdana;">Conventional two-dimensional echocardiography</span><b> </b><span style="font-family:Verdana;">and</span><i> </i><span style="font-family:Verdana;">Myocardial tissue peak velocities were recorded at the lateral, ant.septal, post.septal, posterior, ant. and inferior angles of the mitral annulus as well as at the lateral tricuspid annulus by pulsed-wave tissue Doppler echocardiography before PCI, as well as 1 day and 6 weeks after intervention.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results:</span></b><i><span style="font-family:;" "=""> </span></i><span style="font-family:;" "=""><span style="font-family:Verdana;">Fifty consecutive patients with chronic stable angina and </span><span style="font-family:Verdana;">preserved systolic left ventricular function (mean age, 58.3 ± 6.594 years;32 men) undergoing PCI were studied. Conventional echocardiographic revealed no statistically significant difference between pre- and post-PCI (1 day after PCI and 6</span><span style="font-family:Verdana;"> weeks after PCI) as regarding trans-mitral and trans-tricuspid flow velocities except as regarding LVEDD, LVESD and LVEF which showed a significant improvement post-PCI. Compared with pre-interventional values, systolic peak velocity and early diastolic velocities improved at all sites (P ≤ </span></span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05 for each). The most pronounced improvement occurred in the septal area. Similarly, late diastolic velocities improved at all sites (P ≤ </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05 for each) except at post</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Wall A’. Also, there was a significant improvement of E’DT & E’/A’ ratio after PCI (P value is significant <0.05 for each) but there was insignificant difference between pre & post PCI for E/E’ (P-value = 0.154). There was a significant improvement in tissue Doppler measures of early, late diastolic function and E’/A’ at the lateral tricuspid annulus after PCI compared with baseline values (P value is significant <0.05) but there was an insignificant change in tissue Doppler measures at the lateral tricuspid annulus of E’DT & E/E’ after PCI (repeated measures ANOVA P-value is >0.05 for each). There were significant reductions in IVRT, IVCT & MPI after PCI (P value is significant <0.05 for each) but there was insignificant change in ET after PCI (P-value = 0.09) at the septal angle of the mitral annulus and the lateral angle of the tricuspid annulus.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Tissue Doppler parameters of diastolic and systolic function improve early after successful PCI, and this effect persists to 6 weeks after the intervention that emphasizes its value in the improvement of regional and global LV functions and myocardial contractility.</span>
文摘Introduction: Inflammation has been implicated as a major reason for the higher morbidity and mortality in chronic kidney disease (CKD) compared to the diseases that commonly precedes it. The neutrophil lymphocyte ratio (NLR) has increasingly been reported to be a marker of systemic inflammation. We studied the neutrophil lymphocyte ratio and its relationship with kidney function and other markers of inflammation in health and in CKD. Methods: Two hundred and forty four participants in three cohorts: healthy, CKD stage 1 - 2 and, stage 3 - 4, were studied. Data of clinical, NLR, uric acid, urine albumin creatinine ratio (UACR), electrolytes were documented and independent associates of NLR were determined. Results: The NLR was higher in the CKD cohorts, P Conclusion: The NLR as an inflammatory marker is elevated in chronic kidney disease, and increases with disease severity hence it can be a useful tool in determining the presence and severity of inflammation in CKD.
