Nine months versus 12 months of adjuvant trastuzumab for patients with HER2-positive breast cancer

PURPOSE: This study aimed to compare the results of treatment with adjuvant trastuzumab for 9 months versus 12 months in human epidermal growth factor 2 (HER2)-positive breast cancer patients. The primary endpoint was disease-free survival. Secondary endpoints included cardiac safety, tolerability, and overall survival.METHODS: The study included 60 non-metastatic HER2-positive breast cancer patients. All study patients underwent surgery, received adjuvant chemotherapy, radiotherapy and hormonal therapy if indicated. Thirty patients were randomized in each group. Group I patients received adjuvant trastuzumab for 12 months, while group II patients received adjuvant trastuzumab for 9 months. Patients were assessed by clinical examination and Echocardiography during treatment.RESULTS: After median follow-up of 12 months, 90% of the patients in group I were disease free and 83.3% of patients in group II were disease free (P=0.402). All studied population in both groups I and II were alive at the end of the 1-year follow-up period after the completion of adjuvant trastuzumab treatment thus overall survival is 100%.CONCLUSION: Trastuzumab is tolerable and its side effects are reversible. Nine months of adjuvant trastuzumab treatment is more cost effective than the standard 12 months.

Impact of Sildenafil on Smooth Muscle and Blood Vessels by Using Light and Electron Microscopy.

The present study aimed to examine the histological changes in the smooth muscles of corpus cavernosum and veins of rats as an eventual outcome of the ceaseless use of Sildenafil citrate. The comparison of the histological aftereffects of the veins among the control and experimental groups revealed extended thickness of tunica intima and media, as exhibited by a picture analyzer. The findings indicated that the steady usage of Sildenafil reduced smooth muscles and enabled the growth of collagen fibers in corpus cavernosum of penis and mass of veins.

[Hepatitis B and C infection as a part of hospital acquired infection at the Renal Dialysis Unit in Assiut University Hospital]

Background: Hospital-acquired hepatitis B [HBV] and C virus [HCV] infections continue to occur despite increased awareness of this problem among the medical community. Infection with hepatitis viruses continues to be a major concern for hemodialysis patients, who are recognized as a high-risk group

Objectives: To measure the HBV and HCV seroconversion in hospitalized patients at the hemodialysis unit in Assiut University hospital and to assess the potential risk factors for infection with these viruses in this unit

Methods: This study was performed in Assiut University Hospital at the renal dialysis unit. A total of 63 patients on regular hemodialysis who should be negative for anti HCV, HBsAg and IgG anti HBc with normal liver enzymes and abdominal ultrasound were included in this study between June 2011 and August 2014. An identification questionnaire for possible risk factors for HBV and HCV was done at the start of study. Then follow up after 3 months with another questionnaire for the risk factors and screening by anti HCV, HBsAg and IgM anti HBc were done. Then another follow up after 6 months with other questionnaire for the risk factors and screening by anti HCV and HBsAg. Qualitative PCR test for HCV was used for patients whose results were positive for anti HCV either at 3 months or 6 months follow up. The study also include 12 health care workers and they were screened for anti HCV and HBsAg. Their history of vaccination for HBV was also assessed. Assessment of adherence to infection control measures was also done

Results: Twenty one patients were anti HCV positive, seven of them were positive after 3 months follow up and 14 were positive after 6 months follow up with seroconversion rate of 33.3%. No patient was positive for HBV throughout the study period. All these positive for anti HCV were negative for qualitative PCR for HCV All the included health care workers were negative for HBV and HCV markers. Furthermore all of them had complete vaccination for HBV. The potential risk factors for HCV seroconversion were duration and frequency of dialysis, blood transfusions, dialysis with patients positive for HCV in the same room, lack of strict adherence to infection control measures by the health care workers

Conclusion: Regular screening of all patients and health care workers in hemodialysis units for HBV and HCV with improvements in infection control practices should be done. Therefor health education of the health care workers and their vaccination against HBV infection should be considered

The Effect of In Vivo Mobilization of Bone Marrow Stem Cells on the Pancreas of Diabetic Albino Rats (A Histological & Immunohistochemical Study)

BACKGROUND AND OBJECTIVES: The rapidly increasing number of diabetic patients across the world drew the attention to develop more effective therapeutic approaches. Recent investigations on newly differentiated insulin producing cells (IPCs) revealed that they could be derived from embryonic, adult mesenchymal and hematopoietic stem cells. This work was planned to evaluate the role of StemEnhance (Aphanizomenon flos-aquae [AFA] plant extract) in mobilizing naturally occurring bone marrow stem cells as well as in improving streptozotocin-induced diabetic rats. METHODS AND RESULTS: Twenty adult male albino rats were divided into four groups namely the control, the diabetic, the positive control-StemEnhance and the diabetic-StemEnhance groups. After diabetes induction by streptozotocin (STZ), rats received StemEnhance for four weeks. The mean number of blood CD34 immunopositive cells was measured by flowcytometry and random blood sugar was measured weekly. The pancreas was removed from the sacrificed rats and processed for staining with H&E and immunohistochemical staining for CD34+ve and insulin +ve cells. CD34+ve cells increased in the blood after introduction of StemEnhance. CD34+ve cells were observed in the pancreas and the insulin producing cells in the islets of Langerhans were increased from the second to the fourth week of treatment. Blood glucose level improved but it was still higher than the control level after four weeks of StemEnhance treatment. CONCLUSIONS: This work points to the significant role of StemEnhance in stem cell mobilization and the improvement of diabetes mellitus.

Histological and immunohistochemical assessment of the immunological aspect of certain cells in human palatine tonsils

Tonsils contain four specialized lymphoid compartments that together are involved in immune functions. The capacity of tonsillar lymphocytes to counter infections may be altered during one's lifetime. The classification of lymphocytes by CD antigen expression is now widely used in clinical medicine and experimental immunology. The present work was designed to study the distribution of CD4 and CD8 antigen expression in T lymphocytes in human tonsils at different periods of life. Sixty-two tonsillar specimens were obtained from still birth infants and from children aged 1-9 years. Paraffin sections were prepared and stained with H and E and with immunohistochemical stains to demonstrate CD4 and CD8 T lymphocytes. The distribution of these cells in the different components of the tonsils was evaluated with an image analyzer. The obtained data were statistically analyzed using SPSS. There was a significant increase in the distribution of stained CD4 and CD8 T lymphocytes in the interfollicular areas, mantle zones of lymphoid follicles, and partially in the germinal centers of the examined tonsils with the advancement of age. Activated T lymphocytes differentiate into several subtypes, among which are CD4 and CD8 cells. These types of T lymphocytes express surface antigens, which can interact with different foreign pathogens

Pediatric poisoning in egypt.

Poisoning exposures are a widespread public health problem for children and represents one of the most common medical emergencies encountered in young children, and accounts for a significant proportion of emergency room visits for the adolescent population. The aim of this work is to collect data for management of the most common pediatric poisoning in Egypt as a guideline for physicians and toxicologists. Most common childhood ingestions involve nontoxic substances or nontoxic doses of potentially toxic drugs or products, although a few ingestions can be very dangerous and require treatment. There are three things that typically put children at risk for toxic ingestion: improper storage of substances in the home, children spending more time in other people's homes, and caregiver distraction. The majority of exposures is accidental and occurs in children under the six years of age. The pediatric population is a very dynamic group because the physiologic processes that determine drug disposition undergo rapid changes as children grow, these pharmacokinetic properties, change as children mature with the most dramatic changes occurring in the first year of life. Most common pediatric poisoning in Egypt include insecticides, corrosives, hydrocarbons, food poisoning, analgesics, antihistamines, carbamazepines, phenol and oral contraceptive pills. Assessment of an acutely poisoned child involves the taking of an appropriate history, assessment of the level of consciousness, ventilation and circulation, a physical examination, and requesting appropriate toxicological and non-toxicological investigations. When a child presents with suspected poisoning, begin with an assessment of the airway, breathing and circulation. Activated charcoal is a universal antidote for the majority of poisons. Antidotes are playing an increasing role in therapy for pediatric poisonings. Poison prevention should continue as an integral part of anticipatory guidance activities of infant and child health care providers.

Role of helicobacter pylori infection and autoimmunity in chronic idiopathic urticaria

Urticaria is a vascular reaction characterized by transient erythematous or pale swellings of skin and/or mucous membrane representing localized edema caused by dilatation and increased permeability of capillaries and venules result in leakage of plasma into the surrounding connective tissue, marked by development of wheals. If edematous process extends through the dermis into subcutaneous or sub mucous tissue it results in angioedema. Wheats and angioedema often coexist in the same patient but may occur separately. During the last few years some authors reported their experience about cases of CIU related to presence of Helicobacter pylori [Hp] infection. Hp is a micro aerophilic gram positive bacterium, periodic infection with which is associated with reduced gastric acidity secretion where as chronic infection with Hp is associated with increased secretion of acid and pepsin. However recent study found that no relation between Hp infection autoantibody productions in CIU could be proved using direct measures of serum antibodies. Was to evaluate the role of autoimmunity and Helicobacter pylori infection in cases of chronic idiopathic urticaria. Forty patients with chronic urticaria [recurrent hives lasting 4 to 36 hours occurring at least four times/ week for six weeks] were enrolled for this study. All patients were subjected to the following: history taking included, general examination, skin examination, routine laboratory tests and specific tests included: Autologous Serum Skin Test [ASST], Antithvroicl peroxidase autoantibody test [TPO] and Helicobacter pylori IgG antibody test. Forty patients with age ranged between 17 and 58 years, the highest frequency was encountered in age group of 21- 30 years. The control subjects were age matched ranged between 18 and 50 years. Routine laboratory investigations showed no significant findings in CBC, SGPT, serum creatinine, urinalysis and stool analysis. Only ESR was significantly higher in cases of CIU than in control subjects in both first and second hour. Moreover, ESR was significantly higher in patients with positive ASST than those with negative ASST in both hours. The ASST was positive in 4 patients [10%] all of them were females, and negative in 36 patients [90%]. Serum level of TPO was significantly higher in patients with positive ASST than those with negative ASST. Hp IgG level in the sera of patients with CIU did not reveal a significant difference with that of the control subjects. The gastroscopic examination revealed that 55% of patients with CIU had Hp gastritis [only 25 out of 40 patients underwent gastroscopy]. In most patients with chronic idiopathic urticaria, no underlying disorders or cause can be discerned. Diagnostic studies should be directed by the findings elicited by the history and physical examination. There is no recommended standard diagnostic laboratory evaluation for CIU, and routine laboratory tests seems to be of limited value

Short term profile changes after mandibular set back surgery [cephalometric analysis]

This retrospective study analyzed lateral profile soft and hard tissue changes that occurred shortly two months after bilateral sagittal split ramus osteotomy [BSSRO] and set back mandibular surgery in both horizontal and vertical planes, it also assessed the significance and correlations between the soft tissue changes and the dentoskeletal changes. The subjects enrolled were six patients suffering from mandibular prognathism [4 males and 2 femals] operated with BSSRO and rigid fixation. This study was conducted using digitized lateral profile cephalometric radiographs immediate presurgical and 2 months after surgery. Soft and hard tissues were traced and landmarks located in relation to an X and Y coordinate system. Variables corresponding to the horizontal and vertical relationships of the skeletal and soft tissue profiles and incisal relationships were measured. The statistical elaboration of the data made by means of paired t-test and Pearson's coefficient of correlation to examine relationships between tissue and hard tissue changes. The assessment of the results showed changes of the lower anterior 1/3 of the facial profile characterized by significant decrease in height as a result of cranial movement of soft landmarks of the lip [subnasale and superior sulcus] and chin landmarks [gnathion and pogonion]. On the other hand significant cranial movement was found including bony landmarks A point B, pogonion and menton. Also facial profile changed as a result of significant posterior movement of bony tissues and soft tissues below the stomion with increase in the lower facial 1/3 convexity. Both incisors showed upward movement and retroclination which was more significant in lower incisors. A strong correlation was found between both soft and hard tissue changes. In conclusion, lateral cephalometric analysis in this study proved that there was short term lateral profile soft and hard tissue changes after BSSRO and set back surgery with significant correlation between changes. Cephalometry is a valuable method used for assessment of these changes in spite of the existent limitations

Effect of some medicinal plants on liver and kidney functions in diabetic albino rats

The present study aimed to clarify the effect of aqueous extracts of five plants [Nigella sativa, Aloe vera, Ferula assafoetida, Boswellia carterii Birdw and Commiphora myrrha] and their mixture on liver and kidney functions and protein profiles. Eighty adult male albino rats were divided into eight groups, the first served as control group, other groups were injected with alloxan [120mg/kg b.wt]. The second group served as diabetic rats, the third were treated with a mixture [0.1g/100g b.wt], the fourth was treated with Nigella sativa [0.1g/100g b.wt], the fifth was treated with Aloe vera [0.05 g/100g b.wt], the sixth was treated with Ferula assafoetida [0.1g/100g b.wt], the seventh was treated with Boswellia carterri Birdw [0.1g/100g b.wt] and the eighth group was treated with Commiphora myrrha [0.05 g/100g b.wt]. After thirty days of treatment half of each group was decapitated and the other one was left for 15 days without any additional treatment as recovery period to followup their hazards if present. The results revealed highly significant increase [p<0.01] in serum transaminases [aspartate [AST] and alanine [ALT]], alkaline phosphates [ALP], total bilirubin, urea and creatinine and recorded highly significant decrease [p<0.01] in serum total protein, albumin and globulin concentrations in the diabetic group when compared with normal rates. Otherwise, all plants extracts treated groups showed insignificant changes in the previous parameters when compared with control one. It seams, therefore that the water extracts of these plants and their mixture have protective effect against the side effects of alloxan on liver and kidney

Effect of Commiphora myrrha extract on some physiological parameters and histological changes in diabetic albino rats

The present study aimed to clarify the antidiabetic activity of Commiphora myrrha [CM] aqueous extract on thirty adult male albino rats, which were divided into two groups; the first served as a control group, the second was injected with alloxan [120mg/Kg body weight] and divided into two subgroups the first served as diabetic group, the second treated with [CM] water extract [0.05mg/100 gm bwt]. After 30 days of the treatment half of each group was sacrificed and the other half was left for other 15 days without any additional treatment [recovery period]. Our results revealed highly significant decrease [p< 0.01] in blood glucose level and highly significant increase in body weight of the diabetic rats with different histological changes in cells of islets of Langerhans. These histological and physiological changes were ameliorated in rats treated with CM. Water extract of CM has a definite hypoglycemic, hyperinsulinimic effect, on the other hand, a significant increase in body weight, beta cell number and liver glycogen contents were achieved. The results of the present study clarify the role of CM as an active antidiabetic plant and suggest a relationship between drenching CM extract and insulin production. Other of investigations want be done to detect effects of different doses and time intervals of CM in diabetic animals

Evaluation of the safety limits and potential toxicity of chlorinated drinking water in rats; immunobiochemical and ultrastructural study

Recently, studies have been attempted to evaluate the risks associated with a lifetime exposure to chlorinated drinking water, where it has been reported to impair some immune functions. The present study amis to investigate the safety limits and the potential toxic effects of different concentrations of chlorinated drinking water on the cell mediated immunity. In this study, 56 adult male albino rats were used. Animals were divided into seven equal groups [n= 8], one control and three group were treated with sodium hypochlorite at different concentrations 2, 15, 30 parts per million, and the remaining three groups were also treated with monochloramine at concentrations 2, 15, 30 parts per million respectively. The study Lasted for three months. For each animal, body weight, spleen weight per body weight ratio, phagocytic function of peritoneal macrophages, electron microscopic study of splenic macrophages, lymphocyte blastogenesis and interleukin-2 were investigated for evaluation of immune activity at the different concentrations of both agents. Results showed that the whole body weight was not significantly affected. While the spleen weight/body weight ratio was significantly decreased. Also, phagocytic function of peritoneal macrophages, lymphocyte blastogenesis and interleukin-2 were significantly decreased. Electron microscopic examination of the splenic macrophages showed high activation at the lowest concentration 2 parts per million, while higher concentrations 15 and 30 parts per million showed different degrees of suppression, reaching it's maximal effect at the highest concentration [30 parts per million]. These changes could be attributed to the toxic effects of the chlorine byproducts on the immune system