Metronomic capecitabine as extended adjuvant chemotherapy in women with triple negative breast cancer

PURPOSE: High interest in triple-negative breast cancers is not surprising as this category of patients benefits neither from hormonal therapies nor from anti HER2 treatments. Blockade of angiogenesis by metronomic chemotherapy as well as other antiangiogenics might improve outcomes in this group of patients. This study aims to evaluate the tolerability and efficacy of metronomic capecitabine as extended adjuvant treatment for women with triple-negative breast cancer. Methods: This is a prospective phase II study that included 41 patients diagnosed with triple-negative breast cancer and who were indicated for adjuvant chemotherapy. They received capecitabine 500 mg PO twice daily and continuously for six months after finishing six cycles of adjuvant FEC100 +/- postoperative radiotherapy. Results: Forty-one patients were enrolled in this study between June 2010 and December 2013. Median age was 50 years ranging from 27 to 67 years. Treatment was well tolerated. Adverse effects were grade 1 palmar– plantar erythrodysesthesia in 13 patients [31.7%]; grade 1 diarrhea in five patients [12.2%]; and grade 1 vomiting in two patients [4.9%]. Estimated median follow-up duration was 34 months. Estimated mean disease-free survival [DFS] was 42.4 months [95% CI, 39.02–45.79], while median DFS was not reached. Estimated mean overall survival was 44.34 months [95% CI 41.9–46.9]. Conclusion: Extended adjuvant metronomic capecitabine is well tolerated with patient compliance. These results need to be compared in a study with control arm, larger sample, as well as longer follow-up

[Fetuin-A and high sensitivity-CRP in children with chronic kidney diseases]

Background: Fetuin-A is a circulating calcium- regulatory glycoprotein that inhibits vascular calcification. In end stage renal disease [ESRD], fetuin -A has been demonstrated to be reduced and inversely related to cardiovascular mortality. The present study aimed to determine the effect of renal function on serum levels of fetuin-A in patients with chronic kidney disease [CKD] and to investigate the relationship between fetuin-A serum level and vascular calcification which represents a risk factor for the development of endothelial dysfunction[ED]

Methods: 20 CKD patients on conservative treatment, 20 ESRD patients on regular hemodialysis [HD] treatment, as well as 40 apparently healthy controls of matchable age and sex were enrolled in the study. All the patients and controls were subjected to the following investigations: estimation of serum levels of fetuin-A, high sensitivity-CRP [hs-CRP], creatinine, calcium [Ca], phosphorus [Po4], alkaline phosphatase [ALP], and parathormone [PTH]. In addition, glomerular filtration rate was estimated for cases and controls

Results: There was significant reduction in fetuin-A serum levels in CKD and ESRD patients compared to controls. A significant decrease was also detected in ESRD group when compared to CKD group. The inflammation marker hs-CRP was significantly increased in CKD and ESRD patients in comparison to controls. The increase was also significant on comparing ESRD group with CKD group. A strong inverse correlation was found between serum fetuin-A and hs-CRP, Significantly increased serum levels of ALP and PTH were found in CKD and ESRD patients compared with controls. The increase was also significant in ESRD patients compared with CKD patients. In ESRD patients, Serum levels of fetuin-A showed significant inverse correlations with each of: duration of igalysis, ALP and PTH serum levels, while hs-CRP serum levels showed significant positive corelations with CaxPo4 ratio and PTH serum levels

Conclusion: Results of the present study demonstrate that inflammatory processes are increased among CKD and ESRD patients and linked to low fetuin-A serum levels and vascular calcification which represents a risk factor for the development of ED. The interaction of these incidents may be responsible for the development and progression of thrombogenesis in such cases

challenges of managing glioblastoma multiforme in developing countries: a between cost and quality of care

The management of glioblastoma multiforme [GBM] in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. Retrospective case series. Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age [median age, 51 years], with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months [median, 9.4 months]. The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients

Potential use of grapefruit extract as endodontic irrigant: antibacterial study

Grapefruit extract, a natural non-toxic solution derived from the seeds and pulp of grapefruit, has been shown to have antibacterial action. It disrupts the bacterial cell membrane and liberates cytoplasmic contents suggesting its potential to be used as endodontic irrigant. The antibacterial effect of grapefruit extract against three common endodontic pathogenic microorganisms [E. faecalis, S. aureus, and C. albicans] has been investigated and compared to two common endodontic irrigants [NaOCl 5.25% and CHX 2%]. Self-made ethanolic extract [33% m/V] of commercially available grapefruit was prepared. Two in vitro antimicrobial sensitivity tests [standard dilution susceptibility test and agar assay] were used. Ninety samples were studied per test. They were divided into 3 groups [n=30] according to the irrigant solution. Every group was further subdivided into 3 subgroups [n=10] according to the type of bacteria tested. NaOCl 5.25% and CHX 2% proved to be effective at lower concentrations than grapefruit extract [p

Virulence factors in salmonellae of human origin

Background: The search for plasmid genes associated with virulence gene is of great epidemiological interest

Purpose of study: Demonstration the correlation between virulence gene either chromosomal or plasmid located in different locally isolated serovars and the pathogenicity of the isolated serovars through following stages

Study design: Isolation of the Salmonella from different sources [foecal swabs, blood and food poising], identification of isolates [cultural characters, biochemical and serotyping], pathogenicity of isolates in mice, plasmid profile in isolates and detection of virulence gene[s] in isolates using PCR

Main finding: The percent of Salmonella isolated from Egyptian population in different ages revealed that out of 515 examined samples 24 [4.66%] proved to be positive for salmonellosis. Children harbor Salmonella in a percent of 8% in blood samples and 5% from foecal swabs. At the same time samples from old aged population reached 6.6% in blood and 4% in foecal samples. Meanwhile the percentage of salmonellosis incidence in adult population was 4%. The results revealed that the most prevalent Salmonella serovars isolated were S. typhi 20%, S. typhimurium 20% and S. enteritidis 20% while S. paratyphi A, S. paratyphi B and S. paratyphi C in 16%, 12.5% and 8%, respectively. It can be observed that the percentage of non-typhoid Salmonella serovars as S. typhimurium and S. enteritidis were isolated in the same percentage as S. typhi which indicate the role of animals or their products in transmission of non typhoid Salmonella for this reason we performed isolation of Salmonella from milk, milk products, poultry products and beef products

Conclusion: The present study has confirmed the multifactorial elements responsible for pathogenesis of Salmonellae

Laboratory screening for rhabdomyolysis among beginners practicing vigorous exercises

The objectives of this study were: screening for cases of exertional rhabdomyolysis among beginners in practicing vigorous exercises, and finding out reference laboratory values for the students who will exercise for the first time. The study was conducted in Assuit university hospital on 222 male students of first year of faculty of sports, who practiced vigorous exercises for one hour with maximal load, for the first time, and 20 apparently healthy subjects as a control group [GI]. Twenty four hours after vigorous exercise [24hs AVE], blood samples were collected and the students were classified according to [CK] levels into two groups, group II [GII] :125 students, with total CK<183U/L[cut off value] and group III [GIII]: 97 students, with total CK>183U/L. One month after vigorous exercises [I m AVE], blood samples were collected from [GIII] which represent the follow up group [GIV, baseline]. All participants were subjected to medical history, clinical examination including body mass index [BMI], and quadriceps circumferences. Laboratory investigations included peripheral haemogram, kidney and liver function tests, blood minerals, and specific tests including: total CK, CK-MB and CK-MM isoenzymes, LDH, and serum myoglobin. This study revealed statistically highly significant elevation of total CK, CK-MM, CK-MB, AST and serum myoglobin when comparing [GIII] with each of [GI] and [GII] while a high significant reduction was found when comparing [GIV] with [GIII]. No significant difference could be detected when [GIV] compared with [GI] and [GII] compared with [GI]. There was a significant reduction in serum Na+ and serum Ca+ + level and highly significant elevation in serum K+ and phosphorus in GIII when compared with GI. No statistical significance in [BMI] was detected. Twenty four hours after vigorous exercises, 16 students [7.2%] showed total CK level more than 5 times the cut off value [183 U/L]. These students showed no signs and symptoms of rhabdomyolysis except muscle pain. The participant students who showed total CK values five times or more than the cut off value [183 U/L], are considered by some authors to be suspicious of having rhabdomyolysis. Laboratory values of the students who did not show rhabdomyolysis, could be taken as reference values for students and untrained persons who will practice exercise vigorously for the first time

Free radical scavenging activity of the flavonoids isolated from Tecoma radicans

Successive extracts of aerial parts of Tecoma radicans, F. Bignoniaceae, showed free radical scavenging activity. Ethyl acetate extract produced maximum inhibition [97.8%] of DPPH using electron spin resonance [ESR] technique. Activity-guided fraction led to the isolation of the flavonoids. Five were identified as luteolin; quercetin 3-methyl ether; apigenin; 6-hydroxyluteolin and chrysoeriol. The most potent of them as free radical scavenger is quercetin 3-methyl ether 68.9%, then luteolin 39.4%

Preparation, characterization and in-vitro studies of hydroxyapatite and biphasic of hydroxyapatite-tricalcium phosphate /co- polymeric biocomposites

Calcium phosphates with clinical applications constitute an interesting field of research and development in the production of useful biomaterials for implant fabrication and/or fixation. They exhibit very good biocompatibility and bone integration qualities. In this work hydroxyapatite [HAp] was prepared by precipitation method, while the biphasic hydroxyapatite/beta-tricalcium phosphate [H A/ beta-TCP] was prepared by heating the prepared HAp at 900°C for 5 hr in air. To improve bioactivity both HAp and HAp/ beta-TCP fillers were loaded onto grafted chitosan with two monomers, hydroxyethylmethacrylate [HEMA] and methylmethacrylate [MMA] during copolymcrization process. X-ray diffraction analysis revealed the HAp and biphasic HAp / beta-TCP phases for the prepared samples and proved integration and coating between these fillers and the copolymer. Thermogravimetric analyses of composites showed the attached layer of copolymer onto the surface of fillers particles were 59.818 and 37% for HAp and HAp/ beta-TCP composites, respectively. SEM and FTIR for fillers and composites confirmed the compatibility between the tillers and copolymer. In vitro studies were conducted by immersing the composites in simulated body fluid [SBF] at 37 °C for various time-points. Post-immersion results showed the formation of carbonated apatite layer on the surface of both fillers and their composites especially for HA tiller and it's composite. Also, deposition of Ca[2+] and PO[4][3-] ions onto the surface was achieved for HA filler and its composite more than biphasic filler and its composite as confirmed by FT-IR data. Therefore, these biocompoites can be used as bone substitutes or tissue engineering applications

Parasitological, blood cellular and biochemical studies on filariasisi of dogs

The present work was done on eighty two stray dogs in three localities in Sharkia province to be investigated for filariasis, hematological and serum chemistry profiles of naturally infested dogs. Out of the examined dogs, 14 [17.1%] were infested in Dipetalonema reconditum, 12 [85.7%] of them were males and 2 dogs [14.3%] were females. Microfilariae appeared as a snakelike with a rapidly, forward movement across the microscopic field in wet smear while in Giemsa stained smears showed a coiled or twisted appearance. The total length of the microfilariae ranged from 250-26 micro m [aver. 255 micro m] and the breadth was 3.5-4.5 micro m [aver. 4 micro m]. The anterior end of the microfilaria devoid from nuclei to a distance of 7-8 mm [aver. 7 mm] while the posterior end showed a hooked tail. The micofilariae showed a nocturnal periodicity. This is the first record of filariasis in dogs in Sharkia province. Hematological studies revealed hemolytic anemia [macrocytic hypochromic type] associated with low erythrocyte counts, hemoglobin concentration and hematocrit value. A marked increase in erythrocyte sedimentation rate [ESR], reticulocyte, thrombocyte, total and differential leucocytic counts were encountered, in comparison with the control group. Biochemical analysis of sera from infested dogs showed a significant increase In serum alanie aminotransferase [ALT] and aspartate aminotransferase [AST] activities, serum bilirubin [total and indirect], total proteins, globulins, urea nitrogen, creatinine, inorganic phosphorus, potassium and a decrease in serum glucose, albumin, calcium, and sodium values, with insignificant change in the magnesium level

Plexopathy in a heroin addict

Muscle and peripheral nerve disorders are important complications in intravenous heroin abusers. Rhabdomyolysis and acute lumbosacral plexopathy are important in the differential diagnosis of patients developing muscle weakness in an intensive care unit after intravenous overdoses of heroin. A 25-year-old man developed rhabdomyolysis with neuromuscular involvement, and consistent clinical and electrodiagnostic features of lumbar plexus neuropathy after an intravenous injection of heroin. The improvement occured slowly, over months, in spite of intensive physiotherapy

Trauma score systems: prediction of hospital outcome of critically ill trauma patients: a validation study

Most standard trauma score systems have been developed to predict the outcome and assess the severity of trauma patients. This study test the validity of seven current trauma scoring systems [Glasgow coma scale, APACHE II score, trauma score [TS], Revised Trauma Score [RTS], Injury Severity Score [ISS], TRISS TS, TRISS RTS in 612 patients. Between January 1, 2003 and December 31. 2003, all trauma patients who were admitted to the surgical ICU in Kasr Al Aini hospital with a trauma score [TS] below 16 were included in this study [n=625]. Complete evaluation was successfully done for 612 patients [97%]. Their hospital outcome regarding morbidity and mortality was correlated with their individual score result. All trauma score systems under study showed high accuracy rates. TR1SSRTS and TRJSSTS performed the best accuracy rates in assessing the hospital outcome of trauma patients

Radial keratotomy enhancement by laser in situ keratomileusis

The purpose of this study was to evaluate the predictability, efficacy, and safety of LASIK in the management of both undercorrection and overcorrection following RK. This prospective study included 30 eyes of 18 patients. All patients underwent previous RK surgery to treat myopia and all of them had residual refractive defect after surgery. Patients were divided according to this residual refractive defect into two groups: Group 1 [undercorrection group] included 17 eyes and group 2 [overcorrection group] included 13 eyes. All eyes underwent LASIK to correct the residual defect. The mean interval between RK and LASIK was 26 +/- 9.1 months [range 12-60 months]. All the patients were followed up for at least six months postoperatively. At the end of the 6-month follow-up period, in group 1, 14 eyes [82%] were within the +/- ID zone of intended correction, 13 eyes [76%] had UCVA of more than 0.5, and 16 eyes [94%] showed improvement or no change in BCVA. In group 2, 10 eyes [77%] were within the +/- ID zone of intended correction, 9 eyes [69%] had UCVA of more than 0.5 and 12 eyes [93%] showed improvement or no change in BCVA. Laser in situ keratomileusis performed to treat undercorrection and overcorrection after RK was predictable, effective and safe. However, special precautions should be taken pre- and intraoperatively to ensure its safety

Grafting on high alpha-cellulose pulp extracted from sunflower stalks for removal of Hg [II] from aqueous solution

Dissolving pulp containing 95.5% a-cellulose was extracted from sunflower stalks. The pulped sunflower stalks [PSFS] were used as starting material for grafting with acrylamide [Aam]. All factors affecting the grafting reaction were examined. These factors include, liquor ratio [L.R], ceric ammonium nitrate [CAN] concentration as a catalyst, Aam concentration as well as reaction time and temperature. The grafted PSFS [GPSFS] samples were chracterized by estimation of nitrogen%. The optimum conditions for grafting are, PSFS, Ig; L.R, 1:15; CAN, 20mmole/l; Aam, Ig; Temp., 60°C and time 3hr. The GPSFS was utilized as adsorbent material to remove Hg [II] ions from aqueous solutions. All. factors affecting adsorption process were examined. These factors include, pH, adsobent concentation, temperature and agitation time. The adsorption data show that, the maximum adsorption capacity, q,, of Hg [II] onto GPSFS is 625mg/g. The adsorption data also showed that the adsorption of Hg [II] onto GPSFS obeys Langmuir and Freundlish isotherms

Adsorption of Cr [VI] oxyanions onto modified wood pulp

A new adsorbent was prepared from wood pulp [WP] after reaction with epichlorohydrin and dimethylamine in the presence of pyridine and N,N-dimethylformamide [DMF]. The adsorption of Cr [VI] from aqueous solutions by the so-prepared wood pulp adsorbent [WP-A] was investigated. Various factors affecting adsorption, such as pH, adsorbent concentration [1-5 g/l], agitation time [5-60min], and Cr [VI] concentration [50-700] were taken into consideration. The adsorption of Cr [VI] onto [WP-A] was found to be pH-dependent and maximum adsorption was obtained at pH 3. The adsorption data obeyed Langmuir and Freundlich adsorption isotheims. The Langmuir adsorption capacity [Qmax] was found to be 588.24 mg/g. Freundlish constants, K[f] and n, were found to be 55.03 and 2.835, respectively.

Improvement of the cycling performance of LiMn[2]O[4] as cathode material for lithium batteries by Cr, Al, Co and Ni substitution

The main advantages of LiMn[2]O[4] spinel system are low cost, high cathode potential versus lithium and lack of toxic metals such as cobalt or nickel present in LiCoO[2] and LiNiO[2] cathode materials whereas the main drawback of the system is the fading capacity during cycling as compared to LiCoO[2] and LiNiO[2]. To improve the structural and electrochemical properties of LiMn[2]O[4], as cathode material for lithium secondary batteries, Co, Cr, AI and Ni ions were substituted for manganese ions. LiMn[2]O[4], and LiM[gamma]Mn[2-gamma]O[4] [M = Al, Co, Cr and Ni; gamma = 1/6] samples were prepared by solid state reactions. The X-ray powder diffraction patterns of the substituted samples are almost identical to the parent sample. A well defined highly pure spinel was characterized for all samples without observation of extra phases for substituted samples. The electrochemical performance of the prepared samples was evaluated through cyclic voltammetry and galvanostatic charge/discharge operations. The first discharge capacities of the substituted spinels are lower than that of LiMn[2]O[4], but better cycling performance and capacity retention was observed for the substituted spinels compared to the parent LiMn[2]O[4],. The improvement in the cycling performance of LiM[gamma]Mn[2-gamma]O[4][M = Co, Cr, Ni and Al; gamma = 1/6] compared to that of parent LiMn[2]O[4] is attributed to the stabilization of the spinel structure by the substituted metal cations

Porous polyethylene implant motility without muscle attachment

The clinical objective of this study was to evaluate a simple technique for porous polyethylene spherical implants after enucleation and to review literature to compare this technique with the classic technique. This study included 32 eyes but 7 cases could not be followed postoperatively, so only 25 cases were reported. The patients were not age or gender matched. Patients included in this study were patients coming for enucleation of their blind disfiguring, blind painful eye or blind disfiguring painful eye. No case of intraocular tumors was present in this study. Exclusion criteria were marked ocular motility defect, shallow contracted fornices, ocular infection, severe orbital vascular disorder or severe conjunctival fibrosis and dryness. Patients with lax lower lids underwent lid tightening surgery. All patients were operated under general anesthesia after a written consent was made. Patients were given systemic antibiotics for five days and local antibiotic drops for at least four weeks. Fitting of the prosthesis starts after four weeks. Outcome is assessed subjectively from patient satisfaction and reporting pain, if present. Objectively motility was assessed by reporting implant movement in the four cardinal position of gaze. Motility was described as good [15 degrees or more], fair [less than 15 degrees] or no motility. Follow up ranged from 6 months to 25 months. The average follow up period was 14.8 months. Good motility was achieved in 22 cases and fair motility in 3 cases. No pain was reported in 14 cases, tolerable pain in 9 cases and severe pain in 2 cases. Patients were satisfied in 18 cases, partially satisfied in 6 cases and unsatisfied in one case

Synthesis, characterization and saponification of poly [AN]-starch composites and properties of their hydrogels

Hydrogels based on saponified products of poly [acrylonitrile, AN]-starch composites were prepared, charact-erized and their water abosrbency properties examined. The term composite refered to the resultant products of polymerizatin of AN with starch in presence of eerie ammonium nitrate [CAN] as initiator, that is the composite consists of poly[AN]-starch graft copolymer, homopoly [AN], oxidized starch and unreacted starch. Thus AN monomer was polymerized with gelatinized starch using the ceric ion method. Gelatinization of starch prior to polymerization was affected by heating certain weight of starch in certain volume of distilled water at different temperrature [65, 75 and 85°C]. Polymerization was carried out under a variety of coditions. Saponification of poly [AN]-starch composites was performed in sodium hydroxide to yield the hydrogels. The water absorbency properties of these hydrogels were found to rely on variables affecting the magnitudes of both polymer-ization and saponification. Among these variables mention was made of the starch/liquor ratio, cocentration of ceric ammonium nitrate [CAN], monomer/starch molar ratio, duration of grafting and gelatinization temperature as well as saponification time. Hydrogels display their maximum water absorbency when granular starch was firstly gelatinized at 85°C for 30 min, and secondly subjected to polymerization with AN using AN/starch molar ratio of 4.8 and CAN concentration of 10 m.mol/l liquor ratio of 12.5, and thirdly sample of the so obtained poly [AN]-starch composite was saponified in sodium hydroxide [0.7N] at 95°C for 180 mm. The saponified product was then precipitated in excess methanol, dried and finally converted into powder. The product [hydrogel] in the powder form exhibited maximum water absorbency of 920 g water per gram hydrogel and 38 ml synthetic urine per gram hydrogel