RESUMO
Background: Nasopharyngeal carcinoma is an endemic disease of Southeast Asia with incidence rates of between 15 and 50 per 100 000. There is an intermediate incidence in North Africa and Far Northern hemisphere while in the West the disease occurs sporadically. In Egypt the incidence rate is low and the peak at age [50-54] is 3.4%, and other age varying between 0.3 and 0.4 per 100 000
Aim of the Work: The aim of this study was to evaluate and compare both techniques as regard their efficacy on tumor response, local control, overall survival and progression free and treatment related toxicity between both techniques
Patients and Methods: This retrospective analysis included 54 patients diagnosed with primary nasopharyngeal carcinoma recruited from the clinical oncology department, Ain Shams University and the International Medical Center during 3 years [January 2014 -December 2016]. They were divided into 2 groups, group A was treated using 3D conformal radiotherapy [CRT] whereas group B was treated using intensity modulated radiation therapy [IMRT]
Results: In general, acute toxicity was tolerable and complete healing was the rule. As a whole, group A showed a higher toxicity profile as compared to group B. IMRT was able to decrease xerostomia and spare at least part of the parotid gland excretory function which was shown in the salivary gland scintigraphy. Results of the dosimetric comparison between both techniques showed that IMRT had a better tumor coverage and conformity index. Homogeneity index was similar in the two groups. Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT
Conclusion: IMRT is considered as a more advantageous radiation treatment technique as it can deliver high-dose irradiation to defined tumor targets while minimizing the dose delivered to the surrounding normal organs and tissues, thereby improving the therapeutic ratio of radiation therapy. IMRT has been shown to offer superior dose conformity to the tumor target and better sparing of critical organs in the treatment of NPC
RESUMO
Background: Hepatocellular carcinoma [HCC] is one of the very frequent malignancies that has poor prognosis. Chronic hepatitis B is the most important risk factor in the world particularly in developping countries. In developed world, HCC occurs in the background of chronic infection with HCV or alcohol abuse. Several factors affects the development of HCC in chronic hepatitis patients including viral genotype
Objectives:The aim of this study was to determine HCV and HBV viral profile in Egyptian and Yemeni HCC patients. Additionally, HCV and HBV were genotyped to investigate any possible correlation with HCC development
Methodology:Thirty HCC Egyptian patients admitted to the Hepatology Unit, Medical Research Institute, Alexandria University and thirty HCC Yemeni patients attending the oncology center in Al-Gomhory hospital in Sanaahave been enrolled in this study.Hepatitis B surface Ag [HBs-Ag] was not detected in Egyptian HCC patients but in 36.7% of Yemeni HCC patients. On the other hand, anti-HCV antibodies were detected in 93.3% of the Egyptian HCC patients and in 16.7% only in Yemeni patients.HBV genotyping by direct sequencing of pol gene showed 11 cases of genotype D and 1 case of genotype E among HCC Yemeni patients. HCV genotyping by sequencing of NS5b and 5'UTR showed 21 cases of genotype 4 and 2 cases of genotype 1 and genotype 2 among Egyptian HCC patients
Conclusion:From the current study HCC appears to be significantly associated with HBV and HCV chronic infections in Yemen and Egypt respectively. In Egypt, occult HBV co-infection might escalate the danger of HCC development among HCV patients
RESUMO
Background: The development of direct-acting antiviral agents [DAAs] has revolutionized the treatment of HCV infection. The main challenge to HCV effective treatment with daas is the emergence of HCV drug-resistant variants. Detection of resistance associated variants is of importance in clinical settings in order to optimize DAA regimens, maximize success rates and reduce the impact of treatment failure
Objectives: The prevalence of possible mutations expected to induce potential directly acting antiviral agent [DAA] resistance was investigated in twenty DAAs naïve HCV infected patients
Methodology: The twenty HCV isolates were genotyped using the full length NS3/4A, NS5B, and two third of the carboxy terminal region [including ISDR] of NS5A gene sequences
Results: Eighteen [90%] out of 20 strains were diagnosed as subgenotype 4a while 2 [10%] were of subgenotype 4n, Amino acid frequencies at each position in the NS3 protease sequence were determined with the VESPA software program. Twenty four Genotype4-specific amino acid signatures were present in almost all of our sequences, but were absent from all other genotypes. Among the twenty four amino acid signatures only one mutation at position 41 [T/S] reported to be associated with resistance to protease inhibitors. Compared to the wild type HCV GT-4; nine mutations were detected among our isolates at a frequency ranging from 27% to 100%. None of these mutations were associated with resistance to protease inhibitors. Forty three mutations were detected among our isolates at a much lower frequency ranging from 5.5% to 16.6%. Only 5 out of them were associated with protease inhibitor resistance. Amplification of domain II and III including the interferon sensitivity-determining region and the interferon/ribavirin resistance-determining region of the NS5a region showed a number of mutations exceeding 4 in all isolates and 82.3% of them had from 10-30 mutations. Thirty two Genotype 4-specific amino acid signatures were present in almost all of our sequences and absent from all other genotypes. The primary NS5B nucleoside polymerase inhibitors [NPIs] resistance variant 282T was not detected in our isolates
Conclusion: The large number of natural polymorphism of HCV 4 isolates as well as the large number of mutations detected in this study and different from those associated with DAA resistance makes it more practical to detect resistance associated mutations in DAA treatment failure then to look for these mutations in naïve patients