Abstract   Background:  Lung  cancer  is  the  main  cause of  cancer  deaths  worldwide.  It is  important to identify  the prognostic  factors  of  this  disease  which  leads  to  low  survival  times  despite  the  advancing  treatment  modalities.  Aim: To  investigate  the  role  of  clincopathological  parameters  and  treatment  modality  as  a  prognostic  factors  affecting survival  of  patients  with  advanced non-small cell  lung  cancer  (NSCLC).  Methods:  We retrospectively  reviewed  the clinical  records  of  patients  with  inoperable  stage  III/IV  NSCLC,  who  were  treated  at  the  department  of  Clinical Oncology,  Assiut  University  Hospital  between  2009 and 2014.  The  association  between  the  demographic  and clinical  characteristics  and  survival  of  these patients  was  analyzed.  Results:  A  total of  69  patients  (32  stage  III& 39 stage  IV)  were  identified  and  included  in this  study.  Sex  (males  vs.  females,  p=0.04),  Eastern  cooperative  Oncology group performance  status  (0 vs.  1 vs.  2,  p=0.001),  smoking  habit  (never  vs.  current  vs.  former,  p=0.001),  stage  (IIIA vs.  IIIB  vs.  IV,  p=0.008)  and the  initial  treatment  (no  vs.  chemotherapy  vs.  concurrent  chemoradiotherapy,  p=0.001) were found  to  be factors  affecting  survival  in  univariate  analyses.  Sex  and  histological  subtype did  not  affect survival.  Performance status,  stage and  initial  treatment  were determined  as  the independent  prognostic  factors affecting  survival in  multivariate  analyses.  Conclusion:  Performance  status,  stage  and  initial treatment  with concurrent  chemoradiotherapy  in  eligible patients  were prognostic  factors  affecting  overall survival  of  patients  with advanced  NSCLC. Keywords:  non-small  cell  lung cancer,  prognostic  factors,  survival 

Double primary malignancies could be divided into two categories, depending on the interval between tumor diagnoses. A secondary malignancy could be defined as a new cancer that has occurred as a result of previous treatment with radiation or chemotherapy. Second primary malignancy can occur at any age but it’s commonly at old age. A 46 premenopausal female patient presented to our outpatient clinic complaining from a mass in her right breast, routine metastatic work-up for distant metastasis declared multiple hepatic metastases, RT renal mass, and bone metastases. Palliative radiotherapy to tender and weight bearing sites followed by 4 cycles of systemic chemotherapy FEC regimen were received. Tru-cut needle biopsy from renal mass detected renal cell carcinoma of clear cell type, the patient started sunitinib and tamoxifen with bisphosphonate (Zoledronic acid), assessment of the response revealed reduction of the size and number of HFLs, and the size of renal mass, so the patient was decided to do cytoreductive nephrectomy and then continued on TAM and sunitinib. Collectively, due to the rising incidence of multiple primary malignancies, further studies should be done not only for better clinical evaluation and treatments but also for accurate determination of possible causes, pathogenesis, effective managements and screening programs.

Keywords:

Renal Cell Carcinoma, Breast Cancer, PET/CT, Double Malignancies

Triple-negative breast cancer (TNBC) has a very high rate of recurrence. Our aim is to investigate the efficacy of bevacizumab, platinum and paclitaxel as first-line in metastatic TNBC (mTNBC). This study included 54 female patients with mTNBC. They received bevacizumab, carboplatin and paclitaxel every 21 day for six cycles then who progressed shifted to second-line chemotherapy and the responders continue another two cycles. The median progression-free survival (PFS) was 27 months [95% confidence interval (CI), 17.019-36.981]. There were two factors that affect PFS; visceral only metastasis (hazard ratio, 0.23; P = 0.05) and performance status 0 (hazard ratio = 0.16; P = 0.02) with C-index 0.77. The median overall survival (OS) was 55 months (95% CI, 38.973-71.027). There were two factors that affect OS; type of presentation (hazard ratio = 7.91; P = 0.02) and performance status 0 (hazard ratio = 0.12; P = 0.01) with C-index 0.73. In the final evaluation, three factors have their print on achieving either stable disease (SD) or complete response (CR). Patients having ≤3 sites of metastasis odds ratio (OR) 3.92 (P = 0.02), patients with visceral only metastasis OR was 13.20 (P = 0.001), those with performance status 0 had the highest OR 19.5 (P = 0.001) and the percentage of this prediction was 64.8, 70.4 and 70.4%, respectively. Bevacizumab, carboplatin and paclitaxel were well tolerated, continuation of bevacizumab is recommended as long as SD or CR responses are obtained and tolerated.

Succinylcholine is a preferred muscle relaxant for rapid sequence intubation. Postoperative myalgia (POM) is one of its commonest adverse effects with unknown pathogenesis. Various modalities were examined to reduce POM. We hypothesized that duloxetine may reduce incidence and severity of fasciculation or succinylcholine‐induced POM in outpatient surgeries.

METHODS

This randomized double‐blinded trial involved controlled 70 adult participants scheduled for elective direct microlaryngoscopic surgeries. Before induction of general anesthesia by 2 hours, 35 patients received duloxetine 30mg orally (Group‐D) and 35 patients received similar oral starch placebo capsules (Group‐C). Fasciculations, POM, sedation score, time to first rescue analgesia, total analgesic consumption 24 hours after surgery, patients’ satisfaction, and adverse effects were recorded.

Background

Laparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.

Methods

Ninety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications …

Background and objectives: IL27 and IL35 are regulatory T cells (T-regs) related cytokines; they were accused in eukemogenesis of acute myeloid leukemia (AML). This study aimed to assess the expression of these cytokines in de novo AML and investigate their role as biomarkers.
Subjects and methods: Seventy newly diagnosed patients with primary AML and 30 matched healthy volunteers were recruited. AML diagnosis was confirmed with flowcytometric and immunophenotypic analyses, while ELISA was used to assess serum levels of IL27 and IL35 in patients and controls. Receiver operating characteristic curve analysis was used to estimate IL27 and IL35 optimum cutoff values for predicting AML.
Results: Serum levels of both cytokines were significantly higher in AML patients than controls (P<0.001), with no effect of gender or French-American-British subtypes. Significant correlations of IL27 and IL35 with poor prognostic factors and with each other were detected in patients only. IL27 optimum cutoff for predicting AML was >43, AUC (0.926) with a sensitivity 74% and specificity 96.6% (P<0.001), while for IL35>27.8, AUC (0.972) with 88% and 98% sensitivity and specificity, respectively (P<0.001).
Conclusion: Conclusively, this study proved that IL27and IL35 could identify AML patients from healthy subjects, and their overexpression denotes poor prognosis. Based on the simplicity and wide availability of their detection technique we recommend the inclusion of IL27 and IL35 in the diagnostic/prognostic workup of AML; however, further longitudinal research is needed to prove their exact prognostic value.
 

Background and objectives

Myeloid leukemias (MLs) are clonal stem cell disorders affecting myeloid lineage cells. Advances in cytogenetic and molecular studies partially disclosed the mystery about risk factors and pathophysiology of MLs. Regarding incidence, risk factors, response to treatment, and overall survival of patients, research showed differences among different countries. However, the Western registry data are the basis for the documented description of MLs in medical textbooks. This research aimed to study MLs in Middle Eastern health centers. Egypt has the highest population in the Middle East; furthermore, 96.6% of the population is native Egyptians; accordingly the study focused on Egypt.

Patients and methods

Data of 468 patients with MLs were collected from hospital records at two big tertiary health centers. They were grouped into group 1 (chronic myeloid leukemia, CML) and group 2 (acute myeloid leukemia, AML); the latter was subgrouped into 2a (primary AML) and 2b (secondary AML).

Results and conclusions

The median age of patients was 43 years; males predominate in group 2a and females in groups 1 and 2b. 37.2% of group 1 patients were treated with Gleevec. Hematopoietic stem cell transplantation was planned for only 5% of group 2 and 18% relapsed. Of groups 1 and 2 patients, 25% and 12%, respectively, stopped follow up, and 15% and 35% died. ORR and overall survival were 53%, 27% and 7%, 0.4% for groups 1 and 2, respectively. Conclusively, this study showed a young age of ML patients, with female predominance in CML, and poor outcome. This reflected racial, ethnic and risk factor differences in incidence of MLs.

Background: The distress thermometer (DT) is an effective tool for identifying distress among cancer patients
worldwide. However, DT has not been studied in Egyptian patients. We aimed to study the prevalence of distress
among Egyptian patients with different types of cancers using DT.
Methods: A total of 550 patients with newly diagnosed hematological and solid cancers who were followed up at
3 Oncology Centers in Egypt were enrolled. They completed a sociodemographic and clinical status questionnaire,
the DT and the Problem List (PL) scale.
Results: At a DT cut-off score of ≥4, 46% of patients had significant distress, which was related to the tumor site
and stage. The most frequent problems reported were treatment decision (64.4%), worry (47%), and fears (44.5%). In
univariate logistic regression analysis, participants who had significant distress described 23 out of 36 problems in
the practical, family, emotional, and physical areas. After adjustment to sociodemographic and clinical
characteristics, multivariable analysis confirmed that insurance, depression, fear, sadness, worry, loss of interest in
usual activity, and sleep were independent factors associated with significant distress in cancer patients.
Conclusions: Almost half of Egyptian patients newly diagnosed with cancer reported significant distress. Those
who had significant distress described extra problems in the practical, family, emotional, and physical areas. We
recommend the routine use of DT for screening Egyptian patients with cancer, as well as the involvement of the
psycho-oncology and social services, at the time of their initial diagnosis.