Revisiting surgical management of breast cancer in a geriatric population

Abstract OBJECTIVE: Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS: This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS: Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS: Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.

Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases?

SUMMARY OBJECTIVE: This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS: The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS: Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION: The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.

Phytocompounds of Anonna muricata leaves extract and cytotoxic effects on breast cancer cells

Objective:To identify the phytochemical compounds from Annona muricata (A. muricata) and to determine their in vitro anti-proliferative activities against breast cancer cells, MCF7 and MDA-MB-231.Methods:A. muricata leaves were successively extracted by soxhlet method using n-hexane, ethyl acetate and methanol, and decocted with water. Each extract was analysed by gas chromatography mass spectrometry (GCMS) and characterized with Wiley and NIST library searches. Anti-proliferative activity of each extract was evaluated on MCF7 and MDA-MB-231 breast cancer cells using MTT assay.Results:The GCMS analysis of different solvent extracts of A. muricata leaves showed presence of different chemical groups of compounds such as steroids, terpenoids, phenolic compounds, sugars, sugars alcohol and others including vitamin E. Ethyl acetate leaves extract exhibited the lowest ICConclusion:Steroids and phenolic compounds were the main phytocompound groups identified from all A. muricata leaves extracts. The antiproliferative activity of n-hexane and ethyl acetate extract towards breast cancer MCF7 and MDA-MB-231 respectively might be due to the presence of biologically active compounds in the extracts, hence, providing some scientific evidences of the effectiveness of its traditional usages.

potential protective and therapeutic effects of aloe vera juice against malathion induced haematological changes in rabbits

The potential protective and therapeutic effects of Aloe vera juice against malathion induced haematological changes in young rabbits [Oryctolagus cuniculus] were evaluated in this study. Rabbits were allocated into two sets of experiments short [7 days] and long [21 days] periods. Animals of each set were divided into eight groups; four treated groups and each treated group had its own control. The animals of the first group were orally dosed with Aloe vera juice [0.84 ml/kg b. wt.]. Rabbits of the second group were orally dosed with malathion [5 mg/kg b. wt.]. In the third group [the protective group] animals were dosed orally with malathion concomitant with Aloe vera juice. Animals of the fourth group [the therapeutic group] were dosed orally with malathion; for 7 days followed by Aloe vera juice for the same period. All the animals were sacrificed, blood samples were collected and used to determine the levels of hematological indices: red blood cells [RBCs], white blood cells [WBCs], haemoglobin [Hb], haematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH] and mean corpuscular haemoglobin concentration [MCHC]. Rabbits treated with Aloe vera juice [group 1] showed insignificant change in WBCs count, MCH and MCHC after treatment for both periods. On the other hand, other parameters exhibited significant [RBCs count] and highly significant [Hb and Hct values] change in rabbits treated for the short period. The rabbits of the second group [treated with malathion] exhibited a marked increase in WBCs count, MCV and MCH values, while, the values of RBCs, Haemoglobin and Hct were decreased. The protective group [Group3] showed that the values of all the tested haematological parameters [except MCHC, in both periods of treatment, and WBCs count in the short period of treatment] recorded a significant change in rabbits treated for short [7 days] or long [21 days] periods. A marked recovery in RBCs count and MCH value was observed in rabbits treated for 21 days. Regarding to group 4 [the therapeutic group], it was found that in both terms the rabbits exhibited insignificant changes in the values of all the tested haematological parameters compared to their corresponding controls, except three parameters in which they recorded significant [WBCs count, MCHC] and highly significant [Hct] increase compared to their control values after the long period only. These observations indicated the ability of Aloe vera juice to improve the deleterious effects caused by malathion administration

A Retrospective Study To Evaluate The Effect Of Type 2 Diabetes Mellitus On The Severity Of Periodontal Disease. A Preliminary Investigation

Aim: A preliminary investigation to assess the relationshipin the severity of periodontal disease in diabetics whencompared with non-diabetic subjects. Materials andMethods: A retrospective, comparative study usingperiodontal case notes of 40 subjects (20 Type 2 diabetics,20 non-diabetics) who were selected based on theinclusion and exclusion criteria. Severity of periodontaldisease was assessed through number of periodontalpocket ≥5mm. The results were compared betweensubjects whose age, gender and plaque scores are matchedwith the test group. Data obtained was then analyzed bySPSS Version 12. Results: When comparisons were madebetween test (Type 2 diabetic) and control (non-diabetic)groups, there were no significant difference (p>0.05) inthe severity of periodontal disease. However, there wasa clinically mean difference between the two groups.Conclusions: This preliminary investigation indicatedthat the severity of chronic periodontitis, as indicated inperiodontal pocketing, increased in diabetic patients whencompared to non-diabetics clinically, although it was notstatistically significant. The finding of this investigationwas thus not conclusive as it was only a retrospectivestudy using patients’ case notes. However, the resultsare now being further investigated with a proper clinicaltrial which examines periodontal parameters and diabeticstatus (HbA1c) of the subjects to determine the associationbetween periodontal disease and diabetes mellitus.

Unmet health care needs among clients from outpatient clinic of Ain Shams University Hospitals , Cairo, Egypt

Background: The concept of unmet needs refers to the difference between health services necessary to treat a particular health problem and services actually received

Aim: This study examined the prevalence of self-reported unmet needs for health care and the extent to which they were attributable to perceived problems with service availability or accessibility or acceptability. Study design: descriptive analytical study

Sample: 1316 individuals Clients from some out patients, clinic of Ain Shams University hospitals. Setting: out patients, Clinic of Ain Shams University Hospitals, Cairo, Egypt

Subjects: patients randomly chosen from out patients, clinic of Ain Shams University hospitals

Tools of the study: A questionnaire tool developed to collect data about the prevalence of unmet needs for health care in the previous 6 months

Results: This study conducted on 1316 individuals where 580 [44.8%] reported unmet health care needs. As regard causes of unmet needs, 33.6% of unmet needs attributed to accessibility problems, while service availability problems accounted for 57.4% of the unmet needs. The largest group, accounting for 92.4% of unmet needs was acceptability problems

Conclusions: The causes of unmet needs attributed to accessibility and availability problems. The most common reported reason for an unmet health care need was that the too long waiting time, and the high cost of examination

Recommendations: Re-plan health care service to treat causes of unmet needs, which attributed to accessibility and availability problem

Comparison betweell auditory findings in early and late rheumatoid arthritis

The present study was undertaken in an attempt to clarify a debate regarding the nature and extent of hearing impairment in rheumatoid arthritis patients. The study group included forty subjects suffering from rheumatoid arthritis. Ten normal adult subjects acted as controls. The study group was subdivided according to duration of disease into early and late cases. The results showed that rheumatoid arthritis could result in sensorineural hearing loss. Prolonged duration of rheumatoid arthritis affected outer hair cell function; which was reflected on transient evoked otoacoustic emissions. Also, the prevalence of distortion product otoacoustic emissions at lower frequencies was less than that at higher frequencies

Long latency auditory evoked potentials [LAEPs] with different tonal frequencies

Long latency auditory evoked potentials [LAEPs] were recorded in 20 right handed normal hearing adult subjects, 11 males and 9 females. Their ages ranged from 25 to 56 years. Five stimuli with different frequencies were used [click, 500, 1000, 2000 and 4000 Hz]. The response was present in all five different stimuli for all subjects. N1, P2 latencies were longest at 500 Hz, while N1-P2 amplitude was largest at 500 Hz. Females had shorter latencies and larger amplitude than males. Right ears showed shorter latencies and larger amplitude than left ears

Evaluation of BCG vaccination; an intervention study in Hail region, Saudi Arabia

Inspection of 300 infants attending a primary health care [PHC] center at Hail region showed that 18.8% of children failed to develop BCG reations. This directed attention to inspect the process of vaccination at hospitals in which 80% of deliveries and BCG vaccination took place. Defects in the process of vaccination and sold chain system were noticed. Reorganization of the process of vaccination in addition to training the staff responsible for vaccination were done. A survey was followed to evaluate failure of BCG vaccination before and after the intervention. We checked 4145 infants, two to twelve months of age, for any reaction at the site of BCG vaccination. After intervention vaccination failure dropped from 20.4% to 4.9% for infants vaccinated in hospitals [p = 0.00001], and from 7.9% to 3.2% for those vaccinated in health centers [p = 0.01]. Moreover, before intervention success of BCG vaccination was significantly higher in PHC centers [92.1%] than in hospitals [79.6%]. This difference became insignificant after intervention because success of BCG vaccination in hospitals has increased, up to 95.1% compared to 96.8% in health centers. Inspection of all infants for BCG reaction is continued as a part of routine work at PHC centers, and re-vaccination of those who failed to develop reation to BCG is conducted without any reported complications

Effect of aminophylline on the recovery of atracurium in major surgical procedures

In this study a trial to shorten the recovery time of atracurium by using aminophylline 3 mg.kg-1 body wt. slowly i.v. was done on 40 cases comparing the results with a control group of another 40 cases. Aminophylline was found to be very effective in decreasing the mean recovery time of atracurium from 15.24 +/- 2.08 to 11.6 +/- 23 minutes, and this difference was statistically significant [P <0.001]. The recovery of aminophylline showed less pain, less bronchospasm on extubation, and more liability to ventricular extrasystoles. So, aminophylline is recommended to be given at the end of major surgical procedures to enhance the recovery of atracurium, but, it must be given very slowly under ECG monitoring

Modified peribulbar anesthesia

Posterior peribulbar anesthesia is a safe and an effective alternative to retrobulbar anesthesia for ophthalmic surgery 10 ml of an anesthetic mixture formed of Xylocaine 2% and Marcaine 0.5% mixed in a ratio 1: 1, with Hyaluronidase 1500 IU was injected along the superior and inferior orbital walls. The ocular massage was applied for 10 minutes at pressure of 35 mmHg. A booster dose was injected whenever judged necessary. This technique was applied to 36 patients scheduled for intraocular surgery, and compared to 15 patients receiving the standard technique. 3 parameters were used to evaluate the efficacy of the technique: Lid akinesia, eye movement and intraocular pressure. The success rate reached 83.3% increasing to 94% after giving a booster dose to the residual cases compared to a rate of 86.6% in the standard technique