Outcome of young age at diagnosis of breast cancer in South Egypt

Incidence of breast cancer in patients <40 years old accounts for 20% of the total breast cancer patients in Egypt which is quite higher than the incidence reported worldwide. This study was conducted to evaluate the differences in survival between age groups below and above the age of 40. 170 patients <40 years and 500 patients >40 years were evaluated retrospectively to assess the differences in disease free survival [DPS] and overall survival [OS] between age groups after adjustment of other risk factors like stage, lymph node status, tumor size, and hormonal positivity. After median follow up of 49 months, there was no significant difference between the 2 age groups with regards to DPS p= 0.6 and OS P=0.7 and there was no significant difference between the 2 groups when we stratified the patients according to stages, hormonal status and number of metastatic lymph nodes. However, we found significant increase in local recurrence after breast conserving surgery in patients <40 years compared to patients >/=40 years. Patients <40 years exhibited more often at advanced stage and large tumors size compared to patients > 40 years; However, there was no significant difference in DPS and OS when we adjusted other risk factors. Furthermore, our analysis revealed that age <40 years can be considered as an adverse prognostic factor for the locoregional failure after breast conserving surgery

Some eco - Physiological responses of Mail Nileand ilapia [Oreochromis Niloticus] to thermal and salinity conditions

Two trials were conducted in Animal Physiology Lab., Faculty of Agriculture; Cairo University from May to November, 1999 to quantify and evaluate the growth performance of male Nile Tilapia [Oreochromis niloticus] affected by physiological responses to thermal and salinity conditions in aquaria. The experiments were conducted cither on fry [for 30 days] or fingerlings [for 42 days]. The experimental study incorporated six treatments [T1-T6] between two temperature degrees [28.59, 33°C for fry mid 23.91, 33°C for fingerlings] and three salinity levels fresh brackish and sea water [0.1, 15 and 30 ppt, respectively]. Both dissolved oxygen [DO] and pH did not reach critical values for both fry and fingerlings. The daily weight gain of fry was greater [0.145 g/ fish/day] in fresh water than in brackish water [0.041 g/fish/ day]. The lowest daily gain was in seawater [0.037 g/fish/day], the differences were significant [p < 0.05]. After 30 days from starting the experiment, the daily weight gain of finger-lings showed equal means [0.1955 and 0.196 g/ fish/day] in both fresh water and brackish water, compared to half value in seawater [0.096 g/fish/ day]. The fish could not tolerate the high temperature and/or concentrated salinity [seawater 30 ppt] further than 30 days. It was obvious that the fish chemical constitutions were not affected by temperature or salinity us well as their interactions. The concentrations of Na[+], K[+], P[---] and Cl- in blood plasma were, 477 47, 40.44, 0.88 and 249.09 mg/dl, respectively, under fresh water [0.1 ppt salinity]. In the sea water [30 ppt salinity] the values were 490.97, 34.37, 1.24 and 300.5 mg/dl, while in brackish water were 456.45, 31.99, 1.31 and 337.59, respectively. The ions [Na[+], K[+] and P[---]] besides Ca[++] and Mg[++] in the fish tissue [dried body] were 22.95, 0.21, 3.36, 41.18 and 2.27 mg/g respectively in fresh water [0.1 ppt], while in seawater [30 ppt] the values were 18.1, 0.19, 3.38, 42.09 and 2.31 mg/g respectively. Fish in seawater treatments had the highest concentration of aldosterone hormone in blood plasma with the average of 0.55 picag/ml, while fresh and brackish water treatments induced lower and similar concentrations of aldosterone, 0.46 and 0.48 picog/ml, respectively after 30 days

Thirst distress scale for hemodialysis patients

Thirst is the most frequently occurring symptom in hemodialysis patients. An increase in thirst is usually associated with an increase in both fluid intake and an increase in weight gain. Intervention to reduce the symptom of thirst may provide a meaningful way to decrease intra-dialytic weight gain [IWG] and prevent associated complications. The purpose of the present study was to develop and test the psychometric properties of an instrument to measure thirst in hemodialysis patients. Hemodialysis Unit of the Main University Hospital / Alexandria University and Hemodialysis Unit of El Mouassat Hospital. Instrument development study. Two hundred and four adult patients receiving thrice-weekly outpatient hemodialysis therapy. Four dimensions of thirst were conceptualized in the instrument development in this study as follows: thirst intensity, distress, duration, and frequency. During a midweek scheduled hemodialysis session, participants were asked to verbally respond to the items based on experiences with thirst since their last dialysis treatment. The items were scored on 5-point rating scale from 1 [strongly disagree] to 5 [strongly agree]. Data were analyzed using the Statistical Package for Social Sciences [SPSS 10.0] and LISREL [LISREL 8.3]. Reliability was assessed using item analysis, and coefficient alpha. Validity was tested using confirmatory factor analysis, exploratory factor analysis, and relationship testing of constructs identified in the theoretical model. The sample age ranged from 18 to 74 years with a mean of 5 3 +/- 14.8 years. The individual's mean daily interdialytic weight gain [IWG] since the last hemodialysis treatment was 1.2 +/- 0.7 Kg. The mean thirst intensity was 54.23 +/- 27.31. The final thirst distress scale had 6 items whose correlations ranged from 0.43 to 0.68 and the Cronbach's alpha for the thirst distress scale was satisfactory [0.78]. The mean thirst distress score was 17.1 +/- 4.2. There was a positive relationship between thirst distress and IWG [r=0.17, P < 0.01], and also between thirst distress and thirst intensity [r=0.31, P<0.001]. The present study provided evidence for the reliability and validity of the thirst distress scale proposed herein. Although this scale was initially developed for use in a research study, it appears to have potential for use in a clinical setting, particularly in conjunction with measures that may be related to weight gain. The scale could also be tested on patients without end stage renal disease, such as persons with congestive heart failure

End of life care issues: nurses' perception

Management of the dying has received considerable attention during the last decade. Studies have revealed that care of the dying patient receives little attention in the medical and nursing curriculum or in critical care orientation programs and literature. As a result nurses as well as physicians often feel unprepared to deal with end-of-life issues. Thus the aim of this study is to identify nurses' perception of end of life care issues. The study was conducted in the critical care units and the medical surgical units of the Alexandria Main University Hospital University of Alexandria. A convenient sample of 176 nurses providing direct patient care were included in the study. A structured interview sheet was developed by the researchers. The tool covered 6 broad areas namely, characteristics of the studied sample, nurses' perception regarding: the adequacy of basic nursing education program in aspects of end of life care, aspects of end of life care provided, dilemmas in end of life care, barriers, helps to providing good end of life care to dying patients and their families. A statistical significant association was found between qualification of nurses and the adequacy of basic nursing education program in aspects of end of life care. Also a significant association exists between aspects of end of life care provided and the different working areas. As well as between the frequency of dilemmas in end of life care occurrence and the different working areas. Among the top items perceived by nurses as barriers to providing good end of life care to dying patients were: physicians giving false hope and lack of knowledge by health care professionals. Whereas, among helps to providing good end of life care: having family shows appreciation to nurses for care of patient, followed by health professionals teaching families how to act with dying patient or what to say. There is a crucial need for better education of health care team members about end of life care focusing on how to support families, ensuring respect for various religious and cultural beliefs and emphasizing general communication and teamwork skills

Hepatic tumors: predictive accuracy and role of radio frequency [R.F.] percutaneous thermal ablation on guidance of multiphase spiral-[C.T.] and color doppler U/S.

A retrospective assessment of the use of [R. F.] in the management of [25] patients with hepatocellular carcinoma [HCC] was carried out, The study of multiphase spiral [C.T.] and Color Doppler U/S of these patients and under guidance of both. The mean age was 55 years [99%] were farmers from Lower Egypt. The impact of needle [RE] on the management of these patients at high risk was limited [the lesion more than 6 cm diameter and with ascites]. However, unnecessary operations was avoided in 3 cases proved no changes by follow up until 12 months. The management of the patients was usually determined by other factors rather than by results of [R.F.] only [size of lesions, presence and severity of liver cirrhosis, histology, -number of lesions, early detection, Precise localization, and characterization of Liver lesions and presence or absence of distant metastases]. It was found that the contribution of [R.F.] to the management of the patients with [HCC] at high risk of malignancy [over the age of 55 years and with metastases, more than [4] lesions and with size more than 5 cm] is not significant and direct referral of the operable cases to surgery is justifiable On the other hand, those at lower risk could benefit from this technique, as a positive malignancy will prompt an early treatment and should improve the prognosis of some of these patients

Non penetrating deep lamellar sclerolimbectomy with placement of space maintainer [preliminary short term report]

To evaluate the intraocular pressure [IOP] lowering effect of this non penetrating filtering surgery in management of cases with primary open angle glaucoma 15 selected eyes of 15 patients having primary open angle glaucoma [POAG] under medical treatment and not operated upon their eyes before. The procedure was done. This new technique comprises non penetrating subscleral lamellar sclerolimbectomy with placement of space maintaining suture. Patients were followed up for evaluation of IOP lowering effect and occurrence of complications for a period of 6 months post-operatively. IOP had been lowered in all eyes enrolled in the study immediately post-operatively. A significant reduction of IOP [>/= 18 mmHg] in 11 eyes [73%] was maintained until the end of follow up period. Non penetrating deep lamellar sclerolimbectomy with placement of space maintainer suture is a new technique that found to be effective in lowering IOP with no complications as those of traditional [penetrating] subscleral trabeculectomy. Long term follow up is needed for further evaluation of the prolonged efficacy of this procedure

Nautral coagulation inhibitors in coronary heart disease [CHD]

Haemostasis may be implicated in the pathogenesis of various thrombotic disease. Assay of natural coagulation inhibitors [AT III and PC] in coronary heart diseases may be informative in such cases. In this work, AT III and PC were assayed for 23 patients with coronary ischaemia and infarction besides 12 controls. A highly significant reduction in AT III had been observed in patient groups which had been attributed to an activated coagulation mechanism with consequent consumption of AT III. On the other hand, a significant increase in PC activity had been observed in both studied groups. This rise may be a body attempt to overcome hypercoagulability in those patients. We recommend a trial to use AT III and recombinant APC as therapeutic lines in patients with coronary heart diseases

Some reactions with cinnamyl cyclohexene-none derivatives

Condensation of la and b with aromatic aldehydes under Claisen-Schmidt conditions afforded the corresponding cinnamoyl cyclohexenones IIa-f. The reactivity of the latter towards Michael reaction, condensation with hydrazine and hydroxylamine hydrochloride was investigated. The high reactivity of the cinnamoyl cyclohexenone derivatives IIa-f arised from the fact that they contain four active centers, especially the alpha, Beta-unsaturated ketone and 1,3-diketone systems. Thus, reaction of IIa-f with ethyl acetoacetate in the presence of sodium ethoxide under Michael conditions afforded the corresponding Michael products IIIa-f and IVa-f in 5 percent and 55 percent ratio respectively, depending on the mode of addition and the high pure state of the alcohol used. Condensation of IIa-f with hydrazines and hydroxylamine hydrochloride processed as 1,3-dilketone system, and two factors can affect the reaction pathway namely: [i] amount of the produced water from the reaction and [ii] pH value. The first factor aids to make the reversible step of the condensation reaction possible and the yield can be raised up by using water traping system. While the second gives a maximum yield at about pH 6.7 - 7.2 Condensation with hydrazine hydrate or phenylhydrazine was carried out in [1:1] molar ratio with elimination of water and the formation of the corresponding 4,5-dihydro indazole derivatives Va-1. Boiling compounds Va-f with acid of base at pH 2 or 12 respectively for 20 hr gave the native compounds [IIa-f]. On the other hand, condensation of IIa-f with hydroxylamine hydrochloride in boiling pyridine gave the expected dihydrobenzisoxazoles [VIa-f]. I.R. and PMR spectra of adducts showed the characteristic signals recorded in Table 1

incidence of dental fluorosis amongst school boys aged 6 to 12 years in Gizan region, Saudi Arabia

The incidence and severity of dental fluorosis in 269 school boys aged 6-12 years in four different districts of Gizan region were studied in relation to the water fluoride content in these areas. All children were born and were permanent residents in the respective areas in which they were examined. The water samples analysed for fluoride concentration were obtained from water sources which were the only ones available for the last 10 years. Dental fluorosis affected 38% of the children in areas where fluoride levels in drinking water were less than 1.0 ppm. Very mild-to moderate fluorosis dominated in the primary teeth while moderate to severe fluorosis dominated in the permanent teeth. The most severe fluorosis was seen in the last erupting teeth. Teeth with moderate and severe florosis were more frequently affected by dental caries than teeth with very mild or no fluorosis. It seems that climatic factors and not weather affect the water consumption of the children and hence their total fluoride intake exceeds the permissible limit

Unsaturated polyesters 1 Polyesterifiction of cinnamylsuccinic anhydride with ethylene glycol

The Polyesterification of Cinnamylsuccinic anhydride with ethylene glycol, in the presence or absence of p-toluenesulphonic acid as a catalyst, follows a second order rate equation. Curing of the prepared polyester with styrene was studied. I.R. and N.M.R. spectroscopy were used for both qualitative and quantitative analyses of the polyester resin and its hydrolyzate product after curing with styrene

Beta[2] microglobulin in tuberculous pleural effusion

Beta[2] microglobulin [B[2] m] levels in serum and pleural fluid from 14 patients with tuberculous pleural effusion were studied and compared with those of other pleural disorders. The level of pleural fluid B[2] m was so high in patients with tuberculous pleural effusion that we suggested that concomitant pleural fluid and serum B[2] m measurements should be considered when pleural effusion of tuberculous origin is suspected

Serum alpha1-antitrypsin in bronchial asthma

Serum alpha[1] antitrypsin was measured in 33 asthmatic patients and 20 normal persons of comparable age and sex. Results showed significant increase in serum alpha[1] AT levels in patients with bronchial asthma [mean +/- S.D. = 291.9 +/- 70.18 mg%] compared to normal control [mean +/- S.D. 246.7 +/- 61.8 mg%]. Such rise was attributed to chest infection as all cases were studied during winter. No statistically significant difference between serum level of alpha[1], antitrypsin in atopic and non atopic asthmatics could be detected