Delays in presentation, diagnosis, and treatment in Sudanese women with breast cancer: a cross-sectional study.

BACKGROUND: The poor prognosis of breast cancer in Sudan could be due to delayed treatment and diagnosis at an advanced stage. Our study aimed to assess the extent of delays from onset of symptoms to treatment in Sudanese women with breast cancer, as well as identify factors contributing to these delays. MATERIALS AND METHODS: We conducted a multi-center cross sectional study between March and April 2023. Data were collected from the medical records and interviews with women with breast cancer in the two main oncology centers in Sudan. Linear regression was used to identify the predictors of delayed presentation. RESULTS: We interviewed 601 women with breast cancer. The majority of women (50.1%) were diagnosed at locally advanced or metastatic disease. The median interval from the onset of symptoms to receiving oncologic treatment was 221 days (IQR = 92, 496). The longest delay was the presentation delay 61 (31 244) days. The median duration for diagnosis delay and treatment delay was 21 (10.57) days and 27 (10.64) days, respectively. Predictors of early presentation included, being young (ß = -5.3; 95% CI = 0.06 to 10), married (ß = -264; 95% CI = -427 to -101), divorced (ß = -306; 95% CI = -549 to -63), or widowed (ß = -320; 95% CI = --543 to -97), urban residence (ß = -107; 95% CI = -213 to -2.3), and seeking traditional healer (ß = -204; 95% CI = -383 to -26). CONCLUSION: Most Sudanese women with breast cancer experience significant patient delays, often presenting at advanced stages. Factors like being single, older, and living in rural areas contribute to these delays. Increasing breast cancer education, improving healthcare access and addressing sociodemographic barriers can potentially expedite diagnosis and improve outcomes.

Derivative constant wavelength synchronous fluorescence spectrometry for the simultaneous detection of cefadrine and cefadroxil in water samples.

A sensitive accurate spectrofluorimetric technique was developed to detect cefadroxil and cefradine traces in water samples simultaneously, by applying a procedure based on the formation of hydrolysis products corresponding to these compounds by sodium hydroxide (1 N NaOH) treatment. The conventional and the synchronous fluorescence spectra of these hydrolyzed products were totally overlapped making resolving of this mixture impossible. The second-derivative constant-wavelength synchronous fluorescence spectra allowed their detection simultaneously in a single scan after experimental conditions optimization, which was measured at 390 nm and 379 nm for cefadroxil and cefradine, respectively at Δλ = 30.0. The calibration curves between derivative synchronous fluorescence intensity and drugs concentration showed suitable linear correlation in the range of 0.1 to 5 µg.mL-1 for cefadroxil and 0.5-10 µg.mL-1 for cefradine. The proposed fluorimetric method is superior in being simple, environmental friendly and cost effective in comparison to the previously published reported methods.

Application of Chemometrics for Spectral Resolving and Determination of Three Analgesics in Water Samples.

BACKGROUND: Chemometrics is a discipline that allows the spectral resolution of drugs in a complicated matrix (e.g., environmental water samples) as an alternative to chromatographic methods. OBJECTIVE: Three analgesics were traced in wastewater samples with simple and cost-effective multivariate approaches using spectrophotometric data. METHODS AND RESULTS: Four chemometric approaches were applied for the simultaneous determination of diclofenac, paracetamol, and ibuprofen. Partial least squares (PLS), principal component regression (PCR), artificial neural networks (ANN), and multivariate curve resolution (MCR)-alternating least squares (ALS) were selected. The presented methods were compared and validated for their qualitative and quantitative analyses. Moreover, statistical comparison between the results obtained by the proposed methods and the official methods showed no significant differences. CONCLUSIONS: The proposed multivariate calibrations were accurate and specific for quantitative analysis of the studied components. MCR-ALS is the only method that has the capacity for both the quantitative and qualitative analysis of the studied drugs. HIGHLIGHTS: Four chemometric approaches were used for analysis of severally overlapped ternary mixture of three analgesics. The analytical performance of PCR, PLS, MCR-ALS, and ANN was compared and validated in terms of root mean square error of calibration (RMSEC), SE of prediction, and recoveries. ANN gave the highest predicted concentrations with the lowest RMSEC and root mean square error of prediction. MCR-ALS has the capacity for both qualitative and quantitative measurement. The methods have been effectively applied for real samples and compared to official methods.

Chemometrics for resolving spectral data of cephalosporines and tracing their residue in waste water samples.

Chemometrics approaches have been used in this work to trace cephalosporins in aquatic system. Principal component regression (PCR), partial least squares (PLS), multivariate curve resolution-alternating least squares (MCR-ALS), and artificial neural networks (ANN) were compared to resolve the severally overlapped spectrum of three selected cephalosporins; cefprozil, cefradine and cefadroxil. The analytical performance of chemometric methods was compared in terms of errors. Artificial neural networks provide good recoveries with lowest error. Satisfactory results were obtained for the proposed chemometric methods whereas ANN showed better analytical performance. The qualitative meaning in MCR-ALS transformation provided very well correlations between the pure and estimated spectra of the three components. This multivariate processing of spectrophotometric data could successfully detect the studied antibiotics in waste water samples and compared favorably to alternative costly chromatographic methods.

Comparative study of different chromatographic techniques for the analysis of multi-residues of some approved antimicrobials in fish tissues.

Two chromatographic methods were developed, optimized and validated for the simultaneous determination of three approved aquaculture antimicrobials, namely sulphadimethoxine sodium, trimethoprim and florphenicol in fish tissues. The developed methods were based on simple liquid extraction technique. The first method employs thin-layer chromatography as a clean-up procedure coupled with densitometric determination for the separated drugs. The second method is an HPLC one using X-Terra™ C18 column. Several mobile-phase systems and extracting solvents were tried to optimize the separation and the extraction procedures from fish tissues. The procedures were applied for the analysis of spiked fish tissue samples at three different concentration levels (10, 50 and 100 ppm). A comparative study was conducted between the proposed methods to discuss the advantage of each one. The methods were validated according to the international conference on harmonization guidelines. The proposed methods were successfully applied for the determination of the studied drugs in spiked fish tissues, pure powders and in their veterinary pharmaceutical formulation.

Multi-residues determination of antimicrobials in fish tissues by HPLC-ESI-MS/MS method.

A rapid, simple, sensitive and specific LC-MS/MS method was developed and validated for the simultaneous quantification of four antimicrobials commonly used in aquaculture, namely ciprofloxacin (CPX), trimethoprim (TMP), sulphadimethoxine (SDM) and florphenicol (FLOR) in fish tissues. The LC-MS/MS was operated under the multiple-reaction monitoring mode using electrospray ionization. Sample preparation involves simple liquid extraction step followed by post-extraction clean-up step with n-hexane. The purified extracts were chromatographed on Agilent Poroshell 120 EC, C18 (50 mm × 3 mm, 2.7 µm) column by pumping an isocratic mobile phase consisting of 0.1% formic acid in water:0.1% formic acid in methanol (20:80, by volume) at a flow rate of 0.4 mL/min. A detailed validation of the method was performed as per FDA guidelines and the standard curves were found to be linear in the range of 1-100 ng/g for both CPX and TMP, 0.5-100 ng/g for SDM and 1-50 ng/g for FLOR. The intra-day and inter-day precision and accuracy of the results were within the acceptable limits. A run time of 1.5 min for each sample made it possible to analyze multiple fish tissue samples per day. The developed assay method was successfully applied for the detection of antimicrobials in real fish tissue samples obtained from different fish farms.

Simultaneous determination of sitagliptin and metformin in their pharmaceutical formulation.

Two simple, accurate, and rapid methods were developed for simultaneous determination of sitagliptin phosphate and metformin hydrochloride in their pharmaceutical formulation. The first is a TLC method coupled with densitometry. The second is an HPLC method using a C18 column. The selectivity of the proposed methods was checked using laboratory-prepared mixtures. The proposed methods were successfully applied to the analysis of sitagliptin phosphate and metformin hydrochloride in bulk form and in their pharmaceutical formulation without interference from other additives.

The relationship of thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) in primary thyroid failure.

Thyroid-stimulating hormone (TSH), serum thyroxine (T4) and triiodothyronine (T3) in sera of 100 patients with primary thyroid failure were measured by radioimmunoassay. Effective thyroxine ratio (ETR) was also measured in 69 of these sera. TSH was elevated in all, with a mean of 76.7 +/- 55 micromicron/ml (range 11 to 140 micromicron/ml, and was used to confirm the diagnosis. Mean T4 and T3 levels in the group were 1.8 +/- 1.5 microgram/100 ml (range less than 0.2 to 7.0 microgram/100 u.) and 76.7 +/- 76 ng/100 ml (range less than 10 to 600 ng/100 ml), respectively. Mean ETR was 0.81 +/- 0.05. A moderate inverse relationship was observed between TSH and T4 (r = 0.73), in contrast to TSH and T3 and TSH and ETR, which showed comparatively poor relationships (r = 0.41 and 0.43). This observation, in addition to the finding that 17 patients had subnormal T4 but normal or elevated T3, suggests that normal T3 levels alone may not be sufficient to maintain euthyroidism. In contrast, there were only three clinically hypothyroid patients who had elevated TSH, normal T4, but subnormal T3 levels. This study indicates that T4 and T3 may function together to maintain euthyroidism, and that in addition to serum TSH, T4 determination has more diagnostic value than serum T3 or ETR in these patients.

Radioimmunoassay for serum cortisol with 125I-labeled ligand: comparison of three methods.

We evaluated a previously modified double-antibody radioimmunoassay for serum cortisol. It was compared with the conventional double-antibody method that includes the usual extraction step, and also with an antibody-coated tube method. In this modified method, cortisol was released from its binding globulin by enzymatic degradation rather than by extraction with ether, and a preincubated mixture of first and second antibody was used to separate antibody-bound cortisol from free. These two steps shortened total asssay time significantly. Results still correlated well (r = 0.87) with results by the conventional melthod, but the antibody-coated tube method gave lower results (r = 0.61). Because of its good correlation with the conventional method, this method was thought to be more accurate. In 52 normal subjects, mean cortisol concentrations at 0800 and 1700 hours were 161 +/- 52 (SD) mug/liter and 91 +/- 27 mug/liter, respectively. In 16 normal subjects, cortisol values before and after dexamethasone treatment (1 mg at midnight) were 134 +/- 53 mug/liter and less than 20 mug/liter. In the same subjects, cortisol concentrations before and 30 min and 60 min after Cortrosyn (synthetic corticotropin1-24, 0.25 mg) administration were 103 +/- 25, 205 +/- 45 and 223 +/- 51 mug/liter, respectively.

Treatment of hyperthyroidism with a large initial dose of sodium iodide I 131.

A retrospective study was undertaken of 229 patients with hyperthyroidism due to Graves disease treated at the Cleveland Clinic with a large initial dose of sodium iodide I 131 (mean dose, 12.7 +/- 7.5 millicuries). The results indicate that a large initial dose is the most effective therapy for this disorder. Ninety percent of this group of patients required only one dose and recovered from hyperthyroidism within 12 weeks. Because we are convinced that there is no way to prevent the development of hypothyroidism in these patients, we have prescribed permanent thyroid hormone replacement after the hyperthyroidism has been controlled. In a mean five-year follow-up of 190 patients, 174 (91.5%) were still taking thyroid hormone.