Retrospective study of the corticosteroids administration in glioblastoma patients as a prognostic factor in the disease

Background: Glioblastoma multiforme [GBM] is the most common and most malignant of the glial tumors. Optimum management consists of maximal safe surgical resection, followed by concurrent chemoradiotherapy treatment then adjuvant chemotherapy with temozolomide. A considerable part from the care of patients with GBM involves general medical management, containing corticosteroids. Despite steroids common use, there is experimental and clinical evidence that corticosteroids have direct effects on tumor cell proliferation and apoptosis

Aim of the Work: was to discuss the clinical relation between corticosteroids usage in Glioblastoma Multiforme [GBM] patients and quality of life as well as the disease progression free survival according to the recorded data from the joined hospitals

Patients and Methods: Retrospective analysis of 66 adult patients diagnosed with GBM by surgery or imaging criteria. In order to assess the relation between corticosteroid dependence and the survival, patients were recruited into two groups [arms] according to dependency. Arm [A] was steroid dependent [34 patients] and arm [B] was steroid non-dependent [32 patients]

Results: Corticosteroids dependency was statistically significant correlated to both Overall Survival [OS] [median 2.5 in arm [A] vs. 13.1 months in the arm [B], p < 0.001], and Progression-free survival ratio [PFS] [median 2.3 in arm [A] vs. 9.4 months in arm [B], p = 0.035]. Also, steroid dependency was independent prognostic factor by doing the COX regression analysis

Conclusion: Dependence on corticosteroids during course of treatment is identified as a poor prognostic factor

Combination of transarterial chemoembolisation [TACE] plus antivirals for the management of hepatitis B-related hepatocellular carcinoma: a systematic review of the literature

Hepatocellular carcinoma [HCC] is the most frequently occurring liver neoplasm and the fifth most common cancer worldwide. Intermediate-stage HCC is a distinct disease entity that is traditionally treated with transarterial chemoembolisation [TACE]. However, the risk of viral reactivation and subsequent hepatic decompensation is considerable. Therefore, in this systematic review, we explore the evidence surrounding the benefits of using TACE/antiviral combination in this subset of HCC. PubMed, Medline, the Cochrane Library, Trip Database, and Google Scholar were searched using the terms [Hepatocellular carcinoma] OR [Hepatoma] or [Liver cancer] AND [Transarterial chemoembolization] OR [Chemoembolisation] AND [Antivirals] and specifying only English literature. The outcomes of interest included progression-free survival and overall survival [PFS and OS], tumour response, and toxicities. A total of six potentially relevant trials were identified, from which one study was excluded. Hence, five trials involving 818 patients were included, encompassing three phase II studies and two retrospective studies.The median PFS was reported in one out of the five studies, which was 23 months in the combination arm versus 20 months in the TACE-only arm. The median OS was reported in one out of the four studies: 29 months in the combination arm versus 26 months in the TACE-only arm.The hepatic toxicity parameters showed consistent benefit for the combination arm versus the TACE-only arm in the five studies included. An antiviral/TACE combination shows promise as an effective and tolerable treatment strategy for intermediate-stage HCC. The reported efficacy and toxicity of the antiviral/TACE combination appears to compare favorably with TACE monotherapy, the most commonly implemented strategy for intermediate-stage HCC. Further clinical studies are warranted to accurately determine which patients are expected to benefit most from such combination strategies

association of the knee injury, obesity and sex difference with unilateral and bilateral osteoarthritis of the knee

A cross sectional study was conducted to investigate the relative importance of knee injury compared with obesity and sex difference in association with unilateral and bilateral osteoarthritis of the knee. The study included 212 patients suffering from osteoarthritis and attending the orthopedic outpatient clinic of El-Zahraa Hospital. The results revealed that the occurrence of bilateral osteoarthritis was more frequent than unilateral one. Bilateral osteoarthritis was strongly associated with obesity than with history of knee injury, and the reverse was observed as regard to unilateral osteoarthritis which was found to be more prevalent with patients giving history of knee injury than with obese ones. The regular exercise programs, weights control, and avoiding injury were the important recommendations

Use of external fixator in the treatment of open comminuted tibial shaft fractures

18 cases of comminuted tibial shaft fractures were treated by the external fixator device. All fractures were open. Skeletal and extraskeletal injuries were present in 77.8% of cases. Road traffic accidents were the causative trauma in 77.8%. The average period of follow up was 18 months. The results were very good in 11.1%, good in 44.5%, fair in 22.2%, and poor in 22.2%. The high incidence of fair and poor results was due to the severity of trauma, associated injuries, development of infection, and the strict scheme for evaluation. The average time for full recovery was 40 weeks

Management of segmental tibial shaft fractures

14 cases of segmental tibial shaft fractures were analysed as regards the results of conservative and surgical treatment. Only one was a female. Their age was 21-69 years, average 45 years. The conservative method showed early failed reduction in 21% of cases [group A] and late non union in another 21% [group B]. A and B groups [6 cases] were treated with plate and screws fixation with or without bone graft. Results of conservative treatment were 37.8% very good. 62.5% good. Those of internal fixation were 33.3% very good, 50% good and poor in 16.7%. There was no infection with conservative treatment, but there was a high rate of nonunion. In internal fixation there was a high rate of infection with low incidence of nonunion. The final end results were very good in 5 cases [35.7%-], good in 8 [57.2%], and poor in one case [7.1%]

Eight years follow-up of internal fixation of tibial plateau fractures

The long term results of 12 tibial plateau fractures were evaluated after 8 years. All cases were treated surgically with internal fixation according to the AO principles. According to the grading system of Rasmussen, of David and Hohl, and of Jensen et al, the final results of 3 [25%] were excellent, 5 [41.7%] good, 3 [25%] fair, and 1 [8.3%] poor. The functional result was better than the radiological. The osteparthritic changes were present in different degrees in 9 [75%] of the injured knees. Six patients had also variable degrees of arthritic changes in flip uninjured knee