Impact of pain management using the WHO analgesic ladder in children with cancer in South Egypt Cancer Institute, Assiut University /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 24/10/2018
تاريخ قبول البحث 24/10/2018
عدد صفحات البحث 8
صلاح صالح عبد الهادى - مؤلف رئيسي
Analgesia; Cancer; Children; Oncology; Pain; WHO ladder
Background: The 2012 WHO guidelines recently recommended the 2 – step strategy in managing pediatric cancer pain. There is little experimental evidence to support this practice. Objectives: To describe characteristics & causes of pain in department of pediatric oncology in South Egypt Cancer Institute, to ascertain the effectiveness of WHO analgesic ladder in these pediatric cancer patients & to address side-effects occurred under treatment with opioid therapy in accordance with step 2 & 3 of the ladder. Methods: During 30 months duration from (1 Jan 2011 till 30 June 2013), A prospective study was conducted on pediatric cancer patients who complained of pain & fulfilled all the inclusion criteria for enrollment in this study. Data collected were: patients’ demographics, pain characteristics & pain intensity scores. The 1st 24h average intensity pain scores after change of pain therapy & reduction of > 30 % from their initial levels were used to calculate the adequacy of pain control. All patients who had persisting pain after treatment with step – 1 (paracetamol) divided into 2 groups: ”group 1” received step – 2 (tramadol) & ”group 2” moved directly to step – 3 of WHO analgesic ladder (Low dose of morphine). Results: The study included 133 pain cycles comprising a total of 1028 treatment days. Step – 1 analgesia was effective in 50.6% of all documented treatment days, while Step – 2 analgesia was effective in 17.02% of all documented treatment days and Step – 3 analgesia was required in 23.6% of all documented treatment days. After failure to obtain adequate pain control on non-opioid analgesics, it was found that median average intensity pain scores in the 1st 24h after administration of low dose morphine as a two-step strategy (step – 3) was 1.33, which was lower compared to those obtained after tramadol therapy (step – 2), which was 3.33 and the difference was statistically significant (p value = 0.002). Adverse effects which included somnolence, constipation, nausea &/ or vomiting and pruritis were found to be less frequent in weak opioid drugs compared to strong opioid drugs and these differences were statistically significant (p value < 0.05). Conclusions: Efficacy of WHO analgesic ladder was ascertained in managing pain in children with cancer in our department. Disease-related pain was the most frequent cause of pain cycles and somatic type of pain was the most frequently occurring type. Use of low dose morphine in a two-step strategy was associated with lower pain scores, fewer drug changes for pain therapy when treatment was initiated & shorter duration of pain, but associated with more frequent side-effects than the conventional three-step WHO ladder
Assessment of Nestin and Hypoxia Inducible Factor -1? Expression in Apparently Normal Brain Tissue / Peritumoral Areas Adjacent to Astrocytoma /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 24/10/2018
تاريخ قبول البحث 24/10/2018
عدد صفحات البحث 9
داليا اسامه السرس - مؤلف رئيسي
Normal Brain Tissue ,Nestin immunoreactivity
The surgical biopsy from astrocytomas is usually obtained from enhanced lesion but sometimes may include fragments of apparently normal brain tissue /peritumoral areas. We hypothesize that the evaluation of these fragments for presence of cancer stem cells may have prognostic and /or diagnostic implication. This work has been planned to 1) verify nestin and hypoxia inducible factor-1? location in apparently normal brain tissue/peritumoral areas and its relation to the presence of neoplastic cells in these fragments and 2) analyze the correlation between nestin and hypoxia inducible factor-1 ? expression in apparently normal brain tissue/peritumoral areas adjacent to different grades of astrocytomas. Material and Methods: Paraffin-embedded sections of selected thirty specimens of astrocytomas contain apparently normal brain tissue/peritumoral areas (12 diffuse astrocytomas, 6 anaplastic astrocytomas and 12 glioblastoma multiforme) were stained with nestin and hypoxia inducible factor-1? using standard immunohistochemical approaches. The immunoreactivity for nestin and Hypoxia-inducible factor -1 ? was evaluated. Results: Compared to nearby astrocytomas, nestin immunoreactivity was scarcely expressed in apparently normal brain tissue/peritumoral tissue. There was statistically significant (P =0.03) gradual increase of mean percentage of nestin positive cells that present in these fragments with increasing grade of the adjacent astrocytomas from diffuse astrocytoma to anaplastic astrocytoma to glioblastoma multiforme (27.1± 4, 38.3±3 and 47.5±5.9, respectively). There was statistically insignificant (P < 0.1) gradual increase of mean percentage of hypoxia inducible factor-1? positive neoplastic cells that infiltrate peritumoral areas with increasing grade of the adjacent astrocytomas. There was statistically significant gradual increase of counting of microvessels that showed positivity for nestin and hypoxia inducible factor-1? expression with increasing grade of the adjacent astrocytomas (P=0.008, P=0.01, respectively). Conclusion: Nestin and hypoxia inducible factor-1? was expressed in apparently normal brain tissue/peritumoral tissue adjacent to astrocytomas. Positivity for nestin in apparently normal fragments may indicate premalignant changes or nearby tumor when a biopsy contain only apparently normal brain tissue. Evaluation of nestin expression in peritumoral areas may have prognostic value as it may be an indicator for rapid recurrence and resistance of treatment.
Effect of protective ventilation on pro-inflammatory cytokine response during one lung ventilation in esophagectomy: a randomized controlled study /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 24/10/2018
تاريخ قبول البحث 24/10/2018
عدد صفحات البحث 7
محمد عبد المنعم بكر - مؤلف رئيسي
cytokine response , lung ventilation ,anesthetic practice
Background: Esophagectomy is associated with increase in pro-inflammatory cytokine whose extent has been claimed as a causative agent of postoperative acute lung injury. Objectives: The aim of this study was to determine whether a ventilatory strategy based on the reduction of tidal volume (VT) and a moderate level of positive end-expiratory pressure (PEEP) during one lung ventilation (OLV) could reduce the pro-inflammatory cytokine response associated with esophagectomy. Also, its impact on oxygenation and postoperative outcome were evaluated. Patients and methods: Thirty patients were randomly allocated into two groups: group (CV), Patients (n = 15) received a conventional ventilation strategy (tidal volume of 9 ml/kg during two-lung and OLV); no PEEP was applied and group (PV), Patients (n = 15) received a protective ventilation strategy (tidal volume of 9 ml/kg during two-lung ventilation, reduced to 5 ml/kg during OLV and PEEP 5 cm H20 was applied. Serum level of interleukins (IL-6 and IL-8) were measured at baseline time after anesthetic induction (TBaseline,); at the end of abdominal stage of the operation (TAbdo,); at the end of OLV (TOLV end, ); 1 hour and 20 hour after The end of the surgical procedure respectively (TPostop1) and (TPostop20,). Also, peri-operative oxygenation and post-operative outcome were evaluated. Results: There were significant increases in blood level of IL-6 and IL-8 all over the time in both groups in comparison to their baseline values (p= 0.001). However there were significant reduction in blood level of IL-6 and IL-8 in group PV compared to CV group all over the study period (p<0.05). The oxygenation index was significantly higher in PV group during the period of OLV (p< 0.001) and during the first day postoperatively (p< 0.001). There was no significant difference in post-operative outcome between groups. Conclusion: The use of VT 5 ml /kg and PEEP of 5 cm H2O during OLV reduced the systemic pro-inflammatory cytokine response, improved peri-operative oxygenation, but there were no significant differences in occurrence of ARDS or postoperative outcome in patients undergoing esophagectomy.
The effect of Ketamine infusion on post mastectomy pain syndrome: a randomized controlled study /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 24/10/2018
تاريخ قبول البحث 24/10/2018
عدد صفحات البحث 10
محمد عبد المنعم بكر - مؤلف رئيسي
Ketamine infusion ,mastectomy pain
Background: Acute postoperative pain after breast surgery is one of the major factors contributing to prolonged hospital stay. In addition persistent post mastectomy pain (PPMP) is rated as the most important cause of suffering in those patients. Objectives: The objectives of this study are to investigate the efficacy and safety of ketamine infusion on the incidence of acute postoperative and chronic post-mastectomy pain in female patients undergoing modified radical mastectomy. Patients and methods: 40 Patients were included in this study, divided into 2 groups (20 patients for each): group 1 (G1): Control group in which patients received I.V. saline infusion before skin incision and for 24 hours after surgery. group 2 (G2): In which patients received pre-emptive I.V bolus 0.5 mg / kg ketamine before skin incision followed by a continuous infusion of 0.25 mg / kg per hour for 24 hours post-operative. We measured hemodynamic variables, Visual Analogue Score at rest and movement of the limb or cough (VAS-R and VAS-M respectively) at zero line, 2, 4, 8, 12, 16, 24 hours postoperatively, time to the first request of analgesia, total morphine consumption, sedation score and development of side effects. LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score was assessed at 1, 2, 3, 6 months postoperatively. Results: There was a significant reduction in VAS-R and VAS-M (p<0.05), total morphine consumption (p<0.01) with significant delay in the 1st analgesic request (p<0.001) at all time points in ketamine group. LANSS score was significant reduced (p<0.05) in ketamine group compared to control group at all time points. Conclusion: Perioperative use of ketamine in patients undergoing modified radical mastectomy, reduced acute postoperative pain, morphine consumption and the development of chronic post mastectomy pain with no serious side effects
Background: The short and long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. Aim of the study: This study aimed to assess the short term outcomes of laparoscopic assisted colorectal resections in comparison with conventional open resections. Methods: 20 patients assigned to undergo elective laparoscopic assisted resection of primary colon and rectal cancer matched with 20 cases of colorectal cancer patients with the same epidemiological data (age, site, stage and histological grade) to whom conventional open resections was done in the period from March 2010 to September 2013.The following data were collected and analyzed: preoperative data (individual patient data, indication for surgery), intraoperative data (conversion to open surgery, operative time, complication rate), postoperative data (oncological parameters: length of removed specimen; safety margin; retrieved lymph nodes, post operative pain, recovery of gastrointestinal tract functions, morbidity, mortality and length of hospital stay) Results: There were significant decrease in postoperative pain, rapid recovery of pulmonary and GIT functions, decreased hospital stay in the laparoscopic group compared to the conventional group. Conclusion: Laparoscopic surgery for colorectal cancer is a good alternative for open surgery with favorable short term outcomes of surgery and reasonable oncologic results.
Gemcitabine and Carboplatin in Patients with Refractory or Progressive Metastatic Breast Cancer after Treatment /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 28/10/2018
تاريخ قبول البحث 28/10/2018
عدد صفحات البحث 7
على زيدان تهامى - مؤلف رئيسي
Carboplatin ,Gemcitabine, Breast Cancer
Background, Patients with metastatic breast cancer (MBC) are increasingly exposed to anthracyclines and taxanes either during treatment of primary breast cancer or during initial therapy of metastatic disease. The combination of gemcitabine and carboplatin was therefore investigated as an anthracycline- and taxane-free treatment option; Methods, Fifty patients with confirmed metastatic breast cancer previously treated were recruited from medical oncology department at South Egypt Cancer Institute starting from the start of July 2009 till the start of December 2012; the study populations were followed till the start of December 2013 in a multicenter phase II study. Treatment consisted of gemcitabine (1,000 mg/m 2 i.v. on days 1 and 8) and carboplatin (AUC 4 i.v. on day 1) applied every 3 weeks; Results, Fifty patients with confirmed MBC were recruited to participate in this study with a treatment protocol approved by the local ethics committee. A total number of 273 cycles were delivered, patients received a median number of 6 and a range of 1-8 cycles, all patients were assessable for response and toxicity. Only three (6%) achieved CR, twenty-seven (54%) achieved PR, seven (14%) had a stable disease while thirteen (26%) had progressive disease. Thirty-seven patients achieved disease control with a rate of 74% DCR (CR+PR+SD). Median overall survival equals 7.72 months and time to progression equals 5.73 months. The predominant toxicity was hematological which occurred in fifteen (30%) patients and only three (6%) had non-hematological toxicity. Fourteen (28%) had both types of toxicity and eighteen (36%) were free. Main hematological toxicity was grade 2 anemia; sixteen (32%) patients , ten (20%) had grade 2 neutropenia while nine (18%) had grade 2 and 3 thrombocytopenia, only one (2%) patient had grade 4 neutropenia and no cases experienced febrile neutropenia. Conclusions, Combination chemotherapy with gemcitabine and carboplatin is an effective and generally welltolerated treatment option for intensively pretreated patients with MBC.
Background: Fungi have emerged as important causes of human infection, due primarily to the increased numbers of patients subjected to severe immunosuppression; therefore, the demand for information on the pathogenic role of these microorganisms and the diseases they cause is growing. This study aimed to evaluate invasive fungal infection (IFI) in adult patients with hematological neoplasms to identify common site of infection, type of causative fungi, the percentage of patients developing fungemia and determine high risk patients required early intervention. Methods: A prospective study was conducted in South Egypt Cancer Institute, Assiut University. Diagnosis of fungal infection was made by conventional culture media (Sabaroud?s agar), radiological finding and fungal DNA- PCR that performed on serum samples of patients to detect fungemia. Results: Of 960 hematologic malignancy patients with high risk for infection, rate of fungal infection as documented both clinically and microbiologically was 8.3% (80 cases). Acute leukemia was the majority of the underlying hematological disease with fungal infection (58.8%). AML patients represented 33.8%, which was the highest percentage of cases followed by patients with ALL 25%, then NHL 23.8%. The most encountered hematological finding was Neutropenia which recorded in 71/80 (88.75%) patients, 35 out of 80 patients (43.75%) suffer from severe neutropenia. Lower respiratory tract infection (LRTI) was the most common presentation of fungal infection in patients (n 39, 48.75%), followed by fungemia and fungal oral mucositis grade ??? or ?? (n 30, 37.5%) for each. Isolated pathogens were yeasts in 25 patients (31.25%), molds in 19 patients (23.75%), mixed yeast and mold in 4 patients (5%) and polymicrobial pathogens (fungus and bacteria) in 32 patients (40%). Among isolated fungi, Candida species was the commonest, followed by Aspergillus species. . Conclusion: Hematological malignancy especially acute leukemia patients were at high risk of invasive fungal infection. LRTI was the commonest detected clinical presentation specifically in patients with marked and prolonged neutropenia.
Risk-adapted Therapy of Pediatric Hodgkin Lymphoma in Upper Egypt /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 28/10/2018
تاريخ قبول البحث 28/10/2018
عدد صفحات البحث 8
حمدى محمد غزالى - مؤلف رئيسي
Hodgkin’s lymphoma ,Risk-adapted Therapy
Background: Hodgkin’s lymphoma (HL) is a highly curable malignant disease. Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life. Objectives: To assess the outcome of the HL patients treated with risk-adapted therapy approach at pediatric oncology department in South Egypt Cancer Institute and to assess the prognostic factors of survival in pediatric HL patients. Methods: This prospective study was carried out from January 2009 to January 2014, with median follow up of 36.5 months (range 8-58 months). Thirty four patients were eligible for this study stratified into three risk groups: low risk (LR), intermediate risk (IMR) and high risk (HR). Patients treated with two, four and six cycles respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved partial response. Results: Six patients were LR, 18 patients were IMR and 10 patients were HR. Six patients had events, progressive disease in 3 patients, relapse in 2 patients, and death in one patient due to fever neutropenia. The 3-years overall survival (OS) and event free survival (EFS) rates (± SE) were 91.2% ± 5.3% and 82.3% ± 7.3% respectively. Multivariate analysis revealed ”B” symptoms and anemia were the significant independent factors for inferior EFS, however, hypoalbuminemia and anemia were the significant independent factor for lower OS. Conclusion: Risk-adapted combined-modality therapy with ABVD/COEP and involved-field radiation therapy has high efficacy and minimal toxicity in the treatment of pediatric HL.
Background: FMS-Like Tyrosine kinase 3 (FLT3) plays an important role in early stages of hematopoiesis. FLT3 stimulation enhances proliferation and reduces apoptosis. One potential mechanism of FLT3 involvement in leukemia is over expression of its wild type and its ligand. The FLT3 protein is highly expressed in most patients with AML. In patients with ALL, FLT3 protein is highly expressed in up to 50% of leukemic blasts. Here, we aimed to evaluate the frequency of FLT3 protein expression in pediatric patients with ALL at South Egypt Cancer Institute, Assiut University, Egypt. Method: FLT3 surface protein expression on leukemic blasts was detected by flowcytometry of 101 denovo pediatric acute lymphoblastic leukemia patients. High FLT3 expression considered when ?20% of malignant cells expressed CD135 and low FLT3 expression considered when <20% of malignant cells expressed CD135. Relation between FLT3 expression and other clinical and laboratory findings were studies. Results: High FLT3 expression was found in 47.5% of patients {39/74(52.7%) of precursor B-ALL and 9/27(33.3%) of precursor T-ALL}. High FLT3 level was significantly expressed in patients with the low risk age group (p<0.001), patients who had no mediastinal mass, patients without lymphomatous features at presentation and patients with no CNS involvement at presentation (p<0.001). 75% of patients with high FLT3 expression had TLC <50.000×109 (p=0.004). Conclusion: High FLT3 protein expression may be more commonly associated to favorable criteria of our ALL patients.
The role of Circulating Tumor Cells (CTCs) in Predicting the Response of Primary (Neoadjuvant) Chemotherapy and its Impact as a Prognostic Factor in Early Breast Cancer /
تخصص البحث : General
SECI Oncology Journal / / vol.2 - 2014
تاريخ تقديم البحث 28/10/2018
تاريخ قبول البحث 28/10/2018
عدد صفحات البحث 8
على زيدان تهامى - مؤلف رئيسي
Tumor Cells ,Chemotherapy ,Early Breast Cancer
Background: The enumeration of circulating tumor cells (CTCs) has long been regarded as an attractive diagnostic tool of malignancy, as these cells are thought to reflect aggressiveness of the tumor and may assist in therapeutic decisions in patients with solid malignancies. Primary or neoadjuvant chemotherapy (NACT) which was a standard of care in patients with inoperable locally advanced or inflammatory breast cancer, is now may be considered for patients with early breast cancer. Even though at early stages tumors are clinically restricted to locoregional tissue, there is often early dissemination of viable tumor cells. One of the purposes of systemic NACT is to attack these circulating tumor cells. This fact has potentiated the interest in the use of NACT Aim of the study: to detect and measure the count of CTCs in the blood of patients before starting “baseline CTCs count” and after finishing neoadjuvant chemotherapy “post-treatment CTCs count” for early (nonmetastatic) breast cancer patients. In addition to determine the correlation between baseline CTCs count with relapse rate, other prognostic factors, disease free survival (DFS) and overall survival (OS). Patients and methods: Forty patients with confirmed early non-MBC at South Egypt Cancer Institute were recruited to participate in this study with treatment protocols. All patients received three to four cycles of NACT either with AC (adriamycin and cyclophosphamide); FAC (fluorouracil, doxorubicin and cyclophosphamide) or FEC (fluorouracil, epirubicin and cyclophosphamide). CTCs count was measured using flowcytometry in all patients before starting treatment and in only 25 patients after the end of therapy. The study approved by the local ethics committee. Results: There was statistically significant difference between baseline and post-treatment CTCs counts (P<0.003). Also, there was statistically significant difference between primary tumor size before and after NACT (p=0.001). Pathological complete response (pCR) rate was 55%. The mean baseline and post-treatment CTCs counts were significantly higher in patients who did not achieve pCR than in patients who achieved pCR (P=0.001 and 0.003 respectively). Patients were divided according to baseline CTCs count into 2 prognostic groups: the first group included patients with low CTCs count (<5 cells/ 5 ml blood) while the second group included patients with high CTCs count (?5cells/ 5 ml blood). There was statistically significant higher relapse rate in the high CTCs count group compared to low CTCs count group (P<0.001). Also, DFS and OS were significantly shorter in the high CTCs count group compared to low CTCs count group (P=0.001 and 0.008 respectively). There was no significant correlation between baseline CTCs count and other prognostic factors. Conclusion: CTCs count in breast cancer patients before starting neoadjuvant chemotherapy could predict response to neoadjuvant chemotherapy. High CTCs count is associated with an increased risk of disease recurrence or relapse and shortened DFS and OS. We should consider detection on a large scale and more standardization of the methodology
جميع البيانات التي يتم تسجيلها على النظام هي ملك للجهة صاحبة هذه البيانات
لا يتم الاطلاع على هذه البيانات من قبل مهندسي المركز إلا للضرورة القصوى ولغرض الدعم الفني وبالاتفاق مع الجهة صاحبة البيانات شفوياً أو كتابياً
لا يتم إعطاء أي بيان من بيانات النظام لأي فرد او جهة فرعية تنتمي للجهة صاحبة البيانات او لأي جهة أخرى إلا بموافقة كتابية من الجهة صاحبة البيانات
يمكن استخدام البيانات المسجلة على النظام بهدف عمل إحصائيات يستفاد منها فى قياس اداء النظام وكفاءة استخدامه من قبل مستخدميه
يتم تأمين جميع البيانات الخاصة بالنظام من خلال تأمين الحاسب الخادم الذي يستضيف البيانات ومن خلال تأمين انتقال البيانات بين جهاز المستخدم والحاسب الخادم وكذلك تأمين واجهة النظام التي يستخدمها المستخدم
كل مستخدم للنظام مسئول مسئولية كاملة عن كلمة المرور الخاصة به وعليه اتخاذ كافة الاحتياطات الممكنة حتى لا يستطيع أى شخص آخر الحصول عليها
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