Prognostic factors of non-small cell lung cancer and their relation to the clinical outcomes

Background: Lung cancer is the main cause of cancer deaths worldwide. Around 1.8 million people are diagnosed worldwide with lung cancer each year. This accounts for about 13% of total cancer diagnoses making it the most common cancer disease. Lung cancer is also the type of cancer that has the highest mortality, killing approximately 1.6 million people annually. The highest incidence rates among men are in the United States and Eastern Europe, whereas the highest among women are in North America and Northern Europe

Aim of the Work: The aim of this study is to analyze the importance of clinicopathological parameters and treatment modality as prognostic factors affecting survival of patients diagnosed as Non small cell lung cancer [NSCLC] and the quality of life

Methods: We retrospectively reviewed the clinical records of patients with inoperable stage III/IV NSCLC, who were treated at the department of Clinical Oncology, Ain Shams University Hospital and the International Medical center between 2009 and 2017. The association between the demographic and clinical characteristics and survival of these patients was analyzed

Results: A total of 69 patients [32 stage III and 39 stage IV] were identified and included in this study. Sex [males vs. females, p=0.04], Eastern cooperative Oncology group performance status [0 vs. 1 vs. 2, p=0.001], smoking habit [never vs. current vs. former, p=0.001], stage [IIIA vs. IIIB vs. IV, p=0.008] and the initial treatment [no vs. chemotherapy vs. concurrent chemoradiotherapy, p=0.001] were found to be factors affecting survival in univariate analyses. Sex and histological subtype did not affect survival. Performance status, stage and initial treatment were determined as the independent prognostic factors affecting survival in multivariate analyses

Conclusion: Performance status, stage and initial treatment with concurrent chemoradiotherapy in eligible patients were prognostic factors affecting overall survival of patients with advanced NSCLC

Extent of subclinical macrovascular disease n patients with rheumatoid arthritis and the related vascular risk factors

To compare the extent of subclinical macrovascular disease [atherosclerosis] and the related potential vascular risk factors including thrombotic variables in patients with well controlled rheumatoid arthritis [RA], and in population controls. Fifty RA patients were compared with an age and sex matched fifty controls. Traditional vascular risk factors such as smoking, high blood pressure, blood sugar, lipids and steroid usage were assessed. Also thrombotic variables including plasma fibrinogen, von Willebrand factor antigen [vWE], tissue plasminogen activator antigen [t-PA] and fibrin D-dimer were assessed. Non invasive vascular tests including; carotid duplex scanning for measuring common carotid artery intima-media thickness [IMT], QT dispersion on ECG [QTD], and ankle-brachial blood pressure index [ABPI] were performed for patients and controls. The average IMT mean [SE] in RA patients was 0.79 [0.07] mm, compared with 0.63 [0.04] mm in the control group [P=0.001, MW]. QTD was higher in RA patients; mean [S.E] 58 [3.6] ms compared with 44 [2.9] ms for controls [P0.001, MW]. Low ABPI [< 1.0] was found in 14 out of 50 RA patients [28%] vs 3 out of 50 controls [6%] [P=0.001, X2 - test], all these results were statistically significant. There were no significant differences in the prevalence of traditional risk factors between RA patients and controls. RA patients who received long-term steroid showed significant positive correlation in the prevalence of macrovascular disease; IMT [P=0.02], QTD [P=0.032], and ABPI [0.03], Pearson's correlation test. Significant elevations of thrombotic variables were found in RA patients [fibrinogen [P=0.001], vWF [P=0.001], t-PA [P=0.006] and fibrin D-dimer [P=0.028], t-test] compared with controls. High thrombotic variables within the RA patients correlated positively with the prevalence of macrovascular disease. PA patients have an increased risk for subclinical macrovascular disease [atherosclerosis] as shown by the high prevalence of carotid disease [increased IMT], cardiac disease [prolonged QTD] and peripheral arterial disease [lower ABPI]. Among the related vascular risk factors, we found that long term steroid therapy and increased thrombotic variables are potential risk factors

5-FU and mitomycin-C in conjunction with radiotherapy in patients with locally advanced pancreatic carcinoma

To evaluate the outcome of concomitant radiocemotherapy [RCT] in terms of treatment response, tolerability, possibility of subsequent surgical resection and survival in locally advanced pancreatic carcinoma. Twenty patients with locally advanced pancreatic carcinoma had been included in a prospective study. Patients had attended to Kas El Aini Center of Clinical Oncology and to the Menoufiya University Hospital and Liver institute, between September 1998 and December 2000. All patients were treated by RCT compirising 5400 cGy daily fractions of180 cGy 5 days a week, 5-Floruracil [5-FU] : 600mg/m2 by continuous intravenous infusion day 1-day 5 and Mitomycin-C': 10mg/m[2], i.v.-bolus day 2. Chemotherapy was repeated on day 29. patients were re-evaluated for the treatment outcome and the possibility of surgical resection 4 weeks after RCT Treatment response, toxicity and overall survival were the study end point. Twelve patients [60%] had decreased primary tumor size. Five cases appeared potentially respectable by CT and exp1plorative laparotomies were done but only four could be respected. The median survival of the study group was 10 months [range 4-21]. Themedian survival of patients who had undergone surgery was 19 ms [1421] response but appeared irresistible by the CT scan. The mediam survival of patients with stationary or progressive tumors was 6.5 ms [4-10]. The treatment applied in the study is feasible and have o significant acute toxicity. The respectability was improved but with no improvement of survival. Additional neoadjuvanl chemotherapy trials with new regimens may support the potential benefits of this line of treatmen

Prevalence of post partum depression among women with high risk factors

The aim of this study was to identify the high risk factors for depression among pregnant women and to detect the postpartum depression among those with high risk factors. The sample consisted of 882 Egyptian women registering for antenatal clinics at the Health Center and the University Hospital. Forty-two mothers were lost for follow up for various reasons and the remaining number of the mothers consented to complete the tools for data collection. A structured interview questionnaire sheet for personal and medical information, life event stress sheet to detect the different levels of stress and an Arabic version of the Beck Depression Inventory to assess postpartum depression were used for data collection. The findings revealed that 620 mothers had risk factors for developing postpartum depression. The prevalence of postpartum depression among mothers with risk factors was 11.1, also some risk factors were found out to make the mothers more exposed to the postpartum depression. From these factors, life event stress, history of depression, low income level and medical serious diseases

Value of transvaginal ultrasonography in the diagnosis of endometrium abnormalities in patients treated with tamoxifen

This study was conducted to investigate the value of endovaginal ultrasound in the assessment of tamoxifen associated changes of the endometrium in patients with breast cancer and to correlate sonographic and pathologic findings to symptoms and duration of tamoxifen therapy. Medical records and sonograms of 80 post-menopausal women treated for cancer breast with adjuvant tamoxifen therapy were reviewed retrospectively. Endometrial thickness was recorded as a single layer thickness and considered abnormal when greater than 2.5 mm for post-menopausal women. Sonographic endometrial thickness was correlated to histologic findings, symptoms and duration of tamoxifen therapy. Fifty seven of 80 post-menopausal women had single layer endometria1 thickness of 2.5 mm or greater measured by TVS and 55 of 57 had endometrial biopsies or dilatation and curettage. Biopsies detected 24 cases of abnormal endometrial including endometrial carcinoma [2], breast carcinoma metastatic to the endometrium [one], endometrial polyps [13], tuba1 metaplasia [3] and benign endometrial hyperplasia [5]. Using a single- layer endometrial thickness greater than 2.5 mm by TVS, 21 of 24 women with abnormal endometrial were detected. Women with abnormal pathologic findings had a significantly thicker mean single layer endometrial thickness than those with normal findings [7 mm versus 4 mm]. Twelve women had post-menopausal bleeding all of whom had a single layer endometrial thickness greater than 2.5 mm on TVS

Chlamydia trachomatis and cellular DNA content in cervical ectopy

The study was conducted on 68 women with cervical ectopy referred to the Early Cancer Detection Unit of Ain Shams University Maternity Hospital from November 1997 to October 1998 to study chlamydia trachomatis infection serologically in cases of cervical ectopy and its relation to DNA abnormalities. 38 out of 68 women were diagnosed cytologically to have chlamydia trachomatis. 36 of them were also confirmed by positive IgA antibodies of chlamydia trachomatis by solid phase ELISA technique so immuno-enzymatic and cytological methods were both accurate in the diagnosis. Chlamydia was found to be the commonest infections in cervical ectopy 55.8% followed by the HIPV 35.3%. 44% of patients with cervicalectopy had inflammatory atypia, 26.5% of which were found to be chlamydia positive, low grade squamous intraepithelial lesion [LSIL] was diagnosed in 35.2% of patients, 29.4% of which were chlamydia positive and 35.3% were associated with HPV infection. On DNA analysis of chlamydia positive smears, four had aneuploidy, two slides were suspicious for aneuploidy and the rest were diploid. It can be concluded that, the immuno-enzymatic method and cytological method are accurate in diagnosis of chlamydia trachomatis which was found to be the commonest infection in cases of cervical ectopy and there is no relation between chlamydial infection and DNA changes in cervical ectopy

Chronic pelvic pain in women: doppler ultrasound versus laparoscopy: a comparative study

To compare between the laparoscopy and doppler ultrasound in the diagnosis of cases presented with chronic pelvic pain. Prospective observational comparative study. The study was conducted from August 1997 till June 1998. Ain Shams University Maternity Hospital and Radiology Department. 40 patients with chronic pelvic pain that continues for more than 6 months, patients were subjected to the following: A] Full history, general and local examinations. B] Cervical smear. C] Pain scoring using the modified MC Gill present pain intensity score [PPI]. D] Postmenstrual doppler ultrasound: determine uterine and ovarian arteries pulsitility index [PI] and resistant index [RI]. E] Postmnenstrual diagnostic laparoscopy. Statistical analysis of the results had shown that the mean age of patients was 34.4 +/- 8.02 years, the mean duration of pain was 0.5-13 years [mean 2.5] and the mean score of pain was 2 +/- 0.79. According to the laparoscopic findings of the patients, at laparoscopy we classified them into 2 groups, one with normal pelvic findings [15%] and a group having pelvic pathology [85%] in the form of: 40% pelvic adhesions, 20% pelvic congestion, 10% endometriosis, 5% hydrosalpnix, 5% polycystic ovaries and 5% ovarian cyst. The group that had pelvic pathology had a significant increase in the pain score and significant decrease in the ovarian artery pulsitility index [PI]. Patients diagnosed as having adhesions had a significant negative correlation with both the uterine artery PI as well as ovarian artery PI. Patients having positive vaginal smear had a highly significant lower uterine artery PI than the negative vaginal smear ones. However, there was no significant difference between patients whether contraceptive method used or not as regards the pain score, pelvic adhesions and doppler parameters studied. There was a significant lower ovarian artery [PI] in the nulliparous patients versus the parous ones. Ultrasound doppler assessment of pelvic circulation may suggest the presence of pelvic adhesions or pelvic congestion in patients with chronic pelvic pain and is considered as a simple, acceptable and non-invasive technique. However, laparoscopy though is an invasive method, still is the most definitive measure for the diagnosis of any pelvic pathology causing chronic pelvic pain

Metformin therapy in women with polycystic ovary syndrome

To determine the effect of metformin on insulin resistance, testosterone level and gonadotrophin levels in obese patients with polycystic ovarian syndrome and to study menstrual pattern among them. Prospective follow up observational study. The Ain Shams University Maternity Hospital during the period from 1st of January 1998 to 30th of June 1999. 60 obese women with PCOS were enrolled in the study, 50 patients completed the study. Metformin was given 1500 mg/day for 12 weeks, serum LH, FSH, fasting insulin, fasting glucose, total and free testosterone and serum progesterone were measured at the beginning and after 12 weeks of metformin therapy. Menstrual length was decreased from [47.18 +/- 3.26 to 33.54 +/- 6.06 days], BMI did not decrease and also waist hip ratio. There is also decrease in LH level from 13.98 +/- 2.1 to 7.94 +/- 1.15 mlu/mL, fasting insulin level decreased from 25.48 +/- 2.37 micro U/mL to 14.06 +/- 1.73 micro U/mL. There was a decrease in the level of both free and total testosterone and spontaneous ovulation in 62% of patients as detected by serum progesterone after 12 weeks of study. Metformin therapy in obese women with PCOS is safe, cheap and effective therapy in reducing abnormal high testosterone, decreasing insulin level, restoration of normal menses and ovulation