Hepatocellular carcinoma in qatar.

OBJECTIVE: The main aim of this study was to report and discuss epidemiological, etiological, type of treatment and data on survival of the patients with each mode of treatment using available data for patients with hepatocellular carcinoma (HCC) who have been diagnosed at Hamad Medical Corporation during the period March 2004-December 2010 inclusive. MATERIALS AND METHODS: Retrospective analysis of 150 patient's data had been done, including demographic, epidemiological, etiological disease status assessment with child Pugh criteria, modes of treatment and treatment related outcome. Patient's various characteristics such as demographic, epidemiological, and other clinical characteristics were summarized using an appropriate descriptive statistics. Univariate Kaplan-Meier survival curve analysis was performed to estimate overall and group wise survival at different time points. Furthermore, the log-rank test was applied to determine any statistical difference in survival among various subgroups. In addition, the multivariate Cox regression method was used to assess the significant effects of various prognostic factors on outcome survival time. RESULTS: The mean age of the studied HCC patients was 58.8 years (31-87years) with a male: female ratio of 3:1 (76% Male 24% Female). There were 48 (32%) Qatari and 102 (62%) non-Qatari patients. The underlying etiology HCV was the most common (45%) similar to Western European countries, HBV in (27%), alcoholic liver disease only in 6 (4%), Child-Pugh assessment was A in (33%), B in (37%) and C in (30%), nearly half of the patients (53%) were in advanced stage and had palliative treatment, the other half had chemoembolization in (17%), systemic therapy sorafenib in (13%), surgery (liver resection or transplantation) in (12%) and local ablation in (5%). CONCLUSION: HCC is more common in males (ratio M:F 3:1). HCV is the most common underlying cause, similar to the pattern in western European countries. The survivals in our patient were comparable to other studies reported in the literature. Patients who had chemoembolization had the longest median survival [Median = 27 months, 95% CI (20.27- 33.72). Majority of cases (53%) were diagnosed at advanced stage. To improve the outcome of treatment of HCC patients, the number of early and very early stage diagnosis should be increased by improving the implementation and effectiveness of the strategic screening program. KEYWORDS: Hepatocellular carcinoma, chemoembolization, radiofrequency, sorafenib, hepatitis C, Hepatitis B.

A phase II trial of a differentiating agent (tRA) with cisplatin-VP 16 chemotherapy in advanced non-small cell lung cancer.

The prognosis for advanced non-small cell lung cancer remains poor. Response to chemotherapy is infrequent and overall survival is low. Trans-retinoic acid (tRA), a differentiating agent whose mechanism of action is thought to be different from conventional chemotherapy has activity in preclinical models and low but definite activity in the clinical setting. Its use has been hampered by decrease in bioavailability during continuous administration. We used an interrupted dosing schedule with a drug holiday for tRA that has since been confirmed to restore blood levels in combination with chemotherapy (Cisplatin-VP 16) in 20 patients with stage IIIB and IV non-small cell lung cancer. Ten patients had partial responses among 19 evaluable pts (53%; 95% confidence interval 30-75%) and 4 had minor responses. Neutropenia was the most common acute toxicity-grade 3/4 neutropenia occurring in 90% of patients at some point in the treatment course. Median survival was 25.5 weeks. This regimen of trans-retinoic acid given with drug holiday and chemotherapy has significant activity in advanced non-small cell lung cancer, is fairly well tolerated and is worthy of confirmation in a larger, multi-institutional setting.

Rapid sequence treatment of advanced squamous cell carcinoma of the upper aerodigestive tract: a pilot study.

A review of the literature suggested that prolonged treatment time may lessen the probability of cure for patients with advanced squamous cell carcinoma of the upper aerodigestive tract. To shorten treatment time, rapid sequence treatment (RST) was devised in which chemotherapy, surgery, and irradation were administered in a total treatment time of 8 weeks. Twelve patients were treated and followed 3 years or longer. Medical complications were minor. Osteonecrosis occurred in each of the first five patients and was the only major complication of the protocol. Surgical techniques were modified, and no additional patient developed osteonecrosis. No patient developed local or regional recurrence. Two patients developed distant metastases and three other patients developed second primaries. Absolute survival was 50%. Rapid sequence treatment is an aggressive and potentially hazardous protocol that yielded encouraging results in this pilot study.

Listeria monocytogenes contamination of crops grown on soil treated with sewage sludge cake.

Listeria monocytogenes was found in the sewage sludge cake which is commonly used as an agricultural fertilizer in Iraq. Soils treated with this material were contaminated with the organism. Pot and field experiment showed that crops grown on treated soil became contaminated with L. monocytogenes and when alfalfa plant was grown on farmland soil treated with sewage sludge cake, listerias were found on 10% of 50 plants sampled at harvest, but the organism was detected only in low numbers on these crops (less than or equal to 5 cells/g). This could add to the risk to animals and man.

Effects of sewage treatment on the removal of Listeria monocytogenes.

Two sewage treatment plants in Baghdad, Iraq, were investigated to assess the effects of the different treatment stages on the removal of Listeria monocytogenes. The bacteria were severely affected after the activation and digestion stages at both plants. A dramatic decrease in numbers of listerias after each of these two stages was noticed during the cold months (September-January). The organisms were able to survive these treatments and were present in the final effluent and even in low numbers in the sewage sludge cake. Sufficient dewatering of sewage sludge is recommended to obtain sewage free of listerias. Improvements in the isolation procedure of L. monocytogenes from such heavily contaminated material is also discussed.

Storage effects of sewage sludge cake on the survival of Listeria monocytogenes.

Sewage sludge cake is widely used as an agricultural fertilizer in Iraq. Listeria monocytogenes was shown to be present in small numbers in this material despite sewage treatments. In an attempt to reduce the numbers of this pathogen in this sewage end product, the survival of L. monocytogenes was monitored in a heap of sewage sludge cake stored for over 23 weeks on farm land. The organisms were reduced in numbers and eliminated to undetectable limits during 8 weeks of storage under subtropical weathering and did not recover even 2 months after disappearance. Dewatering processes seem to have some affect on the survival of the bacteria. Therefore, solar dewatering by heaping the sewage sludge cake and exposing it to sun for no less than 8 weeks is recommended to obtain a listeria-free product.

Detection and enumeration of Listeria monocytogenes in a sewage treatment plant in Iraq.

Listeria monocytogenes was isolated from a sewage treatment plant in Baghdad, Iraq, at all stages of treatment. The treatment processes did not yield a sewage sludge cake or a final discharge free of listerias. The agricultural practice of using such sewage products as fertilizers could become a route of spreading the organism in Iraq, particularly by infecting animals that consume vegetation in fields spread with such sewage. Dewatering of sewage reduced the number of L. monocytogenes but long periods of exposure to sun would be needed to obtain a 'safe' sewage sludge cake.

Tachyphylaxis after repeated dosage of decamethonium in anaesthetized man.

1 The tetanic and single twitch responses to the adductor pollicis muscle were used to study the neuromuscular effects of repeated dosage of decamethonium in nine anaesthetized patients. 2 In two of three patients who received the same total dose of decamethonium in three separate series of injections, blockade of the tetanic response was less after the third administration. In the third patient tachyphylaxis was evident after the second series of injections. 3 In three other patients, tachyphylaxis occurred after the second series of injections when the total dose of decamethonium administered was at least twice that given on the first occasion. 4 In terms of tachyphylaxis the single twitch response followed a similar pattern to that of the tetanic response. 5 Once tachyphylaxis had developed, neuromuscular block of the tetanic response by decamethonium was antagonised by neostigmine (2.5 mg) and enhanced by 2% halothane. 6 In contrast, in three patients who were not exposed to more than one series of injections of decamethonium, and presumably therefore before tachyphylaxis had developed, neuromuscular block of the tetanic response was potentiated by neostigmine. Under these circumstances recovery was unaffected by halothane. 7 Thus, when tachyphylaxis occurs with decamethonium the characteristics of the block change to resemble those of the competitive neuromuscular blocking agents; these findings could be of importance in clinical anaesthesia.

Neuromuscular blockade by neostigmine in anaesthetized man.

The tetanic and single twitch responses of the adductor pollicis muscle were used to study the neuromuscular effects of neostigmine in 26 patients anaesthetized with thiopentone and nitrous oxide. Neostigmine 2.5 mg i.v. given 5 min after exposure to halothane antagonized non-depolarizing neuromuscular block, whereas a second dose give 2-5 min later depressed the peak tetanic contraction and re-established tetanic fade. In the absence of halothane the second dose of neostigmine had less effect. Recovery of the single twitch was not impaired by the second dose. A single dose of neostigmine 5 mg rapidly antagonized the competitive block of the tetanic response but the subsequent slight depression of the peak contraction and the brief reappearance of fade were less than after 5 mg given in two doses of 2.5 mg. In patients who were not given neuromuscular blocking drugs, one or two injections of neostigmine 2.5 mg caused a substantial reduction in the peak tetanic contraction and severe tetanic fade which persisted for about 20 min; the single twitch was slightly potentiated. The neostigmine block of the tetanic response could be antagonized by gallamine and potentiated by suxamethonium. These findings indicate that neostigmine in clinical doses can produce an acetylcholine-induced block which be a potential hazard in anaesthetic practice.