Background: Anthracycline-induced cardiotoxicity in survivors of childhood cancer initially presenting as sub-clinical cardiac abnormalities that, if left undetected or untreated, can lead to clinical cardiac dysfunction. The present study aimed to evaluate the early myocardial changes that develop with anthracycline therapy. Material and Methods: In this prospective study the preanthracycline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were analyzed for cardiac dysfunction. The demographic information, including age, sex, type of anthracycline, and cumulative dose, were recorded, as well. Results: In this study, 115 patients with childhood cancer, including 81 males (70.4%) and 34 females (29.6%) with the mean age of 11.1±3.8 years were enrolled. Their normal baseline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were compared for myocardial changes. Doxorubicin alone was used in 91 (79%) patients while daunorubicin alone in 24 (21%). Only 16 children (14%) received a high dose of anthracycline (cumulative dose > 300 mg/m 2). QTc interval significantly prolonged 6-months after chemotherapy than the baseline readings (P0.001). There was a significant increase in the left ventricular dimensions, and all myocardial functional parameters were significantly deteriorated in children who received anthracycline (P0.001). The incidence of cardiac dysfunction found more in female patients (20/28; 71.4%). Myocardial dysfunction was significantly higher among children who received a high cumulative dose of doxorubicin (P0.001). Conclusion: The incidence of subclinical anthracycline-related cardiac dysfunction is high. Children treated with anthracycline require a long-term follow-up to identify and establish optimal prevention and management strategies that balance oncologic efficacy with long-term safety.

Background: Anthracycline-induced cardiotoxicity in survivors of childhood cancer initially presenting as sub-clinical cardiac abnormalities that, if left undetected or untreated, can lead to clinical cardiac dysfunction. The present study aimed to evaluate the early myocardial changes that develop with anthracycline therapy. Material and Methods: In this prospective study the preanthracycline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were analyzed for cardiac dysfunction. The demographic information, including age, sex, type of anthracycline, and cumulative dose, were recorded, as well. Results: In this study, 115 patients with childhood cancer, including 81 males (70.4%) and 34 females (29.6%) with the mean age of 11.1±3.8 years were enrolled. Their normal baseline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were compared for myocardial changes. Doxorubicin alone was used in 91 (79%) patients while daunorubicin alone in 24 (21%). Only 16 children (14%) received a high dose of anthracycline (cumulative dose > 300 mg/m 2). QTc interval significantly prolonged 6-months after chemotherapy than the baseline readings (P0.001). There was a significant increase in the left ventricular dimensions, and all myocardial functional parameters were significantly deteriorated in children who received anthracycline (P0.001). The incidence of cardiac dysfunction found more in female patients (20/28; 71.4%). Myocardial dysfunction was significantly higher among children who received a high cumulative dose of doxorubicin (P0.001). Conclusion: The incidence of subclinical anthracycline-related cardiac dysfunction is high. Children treated with anthracycline require a long-term follow-up to identify and establish optimal prevention and management strategies that balance oncologic efficacy with long-term safety.

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Due to the importance of arginase enzyme in different malignant disorders, the purpose of the present study was to determine and compare the arginase activity in cancerous cells and their normal and benign counterparts. The tissue arginase activity level was evaluated in 30 females with breast cancer, in 6 females with benign breast disease and in 9 healthy control subjects. The arginase activity levels were significantly increased in malignant breast tissues in comparison to healthy ones, while the difference did not reach the level of significance

Due to the importance of arginase enzyme in different malignant disorders, the purpose of the present study was to determine and compare the arginase activity in cancerous cells and their normal and benign counterparts. The tissue arginase activity level was evaluated in 30 females with breast cancer, in 6 females with benign breast disease and in 9 healthy control subjects. The arginase activity levels were significantly increased in malignant breast tissues in comparison to healthy ones, while the difference did not reach the level of significance

Due to the importance of arginase enzyme in different malignant disorders, the purpose of the present study was to determine and compare the arginase activity in cancerous cells and their normal and benign counterparts. The tissue arginase activity level was evaluated in 30 females with breast cancer, in 6 females with benign breast disease and in 9 healthy control subjects. The arginase activity levels were significantly increased in malignant breast tissues in comparison to healthy ones, while the difference did not reach the level of significance

Due to the importance of arginase enzyme in different malignant disorders, the purpose of the present study was to determine and compare the arginase activity in cancerous cells and their normal and benign counterparts. The tissue arginase activity level was evaluated in 30 females with breast cancer, in 6 females with benign breast disease and in 9 healthy control subjects. The arginase activity levels were significantly increased in malignant breast tissues in comparison to healthy ones, while the difference did not reach the level of significance

Due to the importance of arginase enzyme in different malignant disorders, the purpose of the present study was to determine and compare the arginase activity in cancerous cells and their normal and benign counterparts. The tissue arginase activity level was evaluated in 30 females with breast cancer, in 6 females with benign breast disease and in 9 healthy control subjects. The arginase activity levels were significantly increased in malignant breast tissues in comparison to healthy ones, while the difference did not reach the level of significance

Background: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. Study Design: A randomized, double-blind, prospective study. Setting: Academic medical center. Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). Limitations: This study is limited by its sample size. Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy.

Background: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. Study Design: A randomized, double-blind, prospective study. Setting: Academic medical center. Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). Limitations: This study is limited by its sample size. Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy.