ABSTRACT
Context: In Hodgkin's lymphoma [HL], PET-CT scan has established itself as the functional imaging modality of choice when it comes to evaluation and guiding treatment decisions. However, it remains an expensive imaging technique and therefore the number of PET-CTs is limited for each patient. Recent studies show that Interim PET-CT scan is gaining an important role as a predictor of survival and an influencer for treatment modifications
Objective: To identify the patients that are most likely to benefit from interim PET-CT scan and to acknowledge the utility of this imaging technique in the daily practice of Lebanese oncologists
Methods: We retrospectively reviewed the charts of 98 patients diagnosed with HL, treated and followed from 2009 to 2016 in our center. Patients were divided into three groups according to the stage of their disease: Group A[limited], Group B [intermediate] and Group C [advanced] according to ESMO guidelines. We studied the characteristics and the progression free survival [PFS] of patients in each group
Results: The progression free survival of the limited, intermediate and advanced stages were 75 months, 84 months and 61.51 months, with a p value of 0.482, 0.343 and 0.025 respectively. Patients who had a positive interim PET-CT scan had a PFS of 59.51 months, whereas patients who had a negative interim PET-CT scan had a PFS of 80.85 months, with a significant p value [p = 0.033]. In the advanced stage, patients with a positive interim PETCT scan were more likely to relapse with a PFS of 16.6 months vs 71.8 months for patients with negative interim PET-CT of the same category [p = 0.025]
Conclusion: In a country with limited resources, where functional imaging techniques remain restricted to a certain number of patients, interim PET-CT scan is most valuable in patients with advanced Hodgkin's lymphoma, where a positive Interim PET-CT is an indicator of a poor prognosis and therefore should influence an escalation in treatment strategies
ABSTRACT
Context: Smoking, unhealthy diet, physical inactivity, high alcohol intake and obesity have all been considered as cancer risk factors, and directly related to an increase in cancer recurrence and mortality, in cancer survivors and more so, it affects morbidity and mortality in cancer patients. That resulted in an increased interest in the role of lifestyle recommendations to improve long-term cancer outcome among cancer survivors. This study was conducted to evaluate Lebanese oncologists' position regarding lifestyle changes
Objective: The primary objective of this study was to evaluate the situation in Lebanon, when it comes to lifestyle recommendations provided by the Lebanese oncologists. A secondary objective was to study the relation between the lifestyle of each doctor, and their choice of advising different lifestyle changes to their patients
Methods: A cross-sectional study was conducted to survey the Lebanese oncologists via a questionnaire. One section regarding the lifestyle recommendations provided and the second to gather personal information about each oncologist
Results: With a response rate of 41 percent, Lebanese oncologists were found to be recommending lifestyle changes at high rates for smoking cessation [95 percent], improve physical activity [92.5 percent] and improve nutrition [85 percent]; with lower rates regarding decrease alcohol intake [52.5 percent] and lose weight [62.5 percent]. An average number of 3.88 recommendations per oncologist was noted. No statistical relation was found between the likelihood of an oncologist to recommend a certain change and his personal lifestyle. One exception though existed. In fact, the oncologists who followed a healthy diet had a strong intent to advise their patients about their diet/nutrition
Conclusion: When it comes to offering beneficial interventions, the majority of Lebanese oncologists are dedicated to offer the best for their cancer patients, with rates close to those of Western countries and even surpass them
ABSTRACT
Background: Pancreatic adenocarcinoma [PAC] forms 85 percent of pancreatic cancers. In Lebanon the annual mortality rate is 4.3 per 100 000 persons. Data are lacking in the Lebanese population on the treatment evolution of pancreatic adenocarcinoma. We conducted a study to compare two groups of pancreatic adenocarcinoma patients through time
Methods: We randomly assigned 70 patients from NDS-UH who were diagnosed having PAC from the beginning of the year 2000 until the end of 2017. All patients were above 18 years old at time of diagnosis, with an ECOG PS of 0 or 1. All of them had not received any prior chemotherapy or radiotherapy, and they all had a locally advanced i.e. inoperable or metastatic PAC. The 70 patients were divided into 2 groups. The first group is formed by all patients diagnosed before 2010 and the second group by all patients diagnosed after 2010. The primary endpoint is the OS rate in each group. The secondary endpoints are the PFS1, PFS2, RR and the mean OS variability in each gender with time
Results: The groups of people studied in this analysis were 64.3 percent male 35.7 percent female with a mean age of 64.37 years. 58.6 percent had an ECOG-PS of 0 while the remaining 41.4 percent had an ECOG-PS of 1. 60 percent of the cancers were located in the head of the pancreas, 14.3 percent in its tail and 22.9 percent in the body. The mean size of the tumor regarding the location was 36.24 mm [body: 36.88 mm, tail: 57.4 mm, head: 30.95 mm]. The stages were divided as follow: 17.15 percent stage IIB, 24.28 percent stage III and 58.57 percent stage IV. 40 percent of the patients had metastases in the lymph nodes at diagnosis while 44.3 percent, 5.7 percent, 4.3 percent and 5.7 percent had hepatic, pulmonary, hepatic and pulmonary metastases and peritoneal carcinoses at diagnosis respectively. The mean Ca 19-9 was 16 080.8197 U/ml. Our two groups were statistically similar in terms of sex, age, ECOG PS, stages and location of the cancer in the pancreatic gland at diagnosis with identical mean WBC, LDH, Ca19-9, total and direct bilirubin and HbA1C levels at time of diagnosis. The mean glycemia level was different in the 2 groups with 132 mg/ml in the group diagnosed before 2010 versus 181.32 mg/ml in the group diagnosed after 2010 with a p value of 0.019. The mean OS was 11.5 months [95 percent CI, 7.4 to 15.5] in patients diagnosed before 2010 vs. 14.39 months [95 percent CI, 11.4 to 17.3] in patients diagnosed after 2010. The median OS was 7.3 months [95 percent CI, 4.28-10.45] in the first group vs. 12.4 months [95 percent CI, 8.15-16.64] in the second group with a p value of 0.23; p > 0.005 percent. The mean PFS1 was 10.34 months [95 percent CI, 8.05 to 12.63] after 2010 vs. 7.94 months [95 percent CI, 4.7 to 11.14] in the first group. We saw an increase of 4 months in the median PFS1 between the 2 groups with 4.27 months [95 percent CI, 3.2 to 5.2] in the first group vs. 8.23 months [95 percent CI, 5.4 to 10.9] in the second with a p value of 0.18; p > 0.005 percent. Mean PFS2 in the first group is 6.08 months [95 percent CI, 3.4 to 8.7] vs. 6.96 months [95 percent CI, 1.088 to 4.8] in the second group. Median PFS2 is 3.8 months [95 percent CI, 1.84 to 5.76] for the former group vs. 6.1 months [95 percent CI, 2.68 to 9.5] for the latter group, with a p value of 0.43; p > 0.005 percent. The response rate was higher in the group of patients diagnosed after 2010 with 37.5 percent com- pared to 20 percent in the group of patients diagnosed before 2010. When comparing the OS between genders we saw a stable OS in female patients within the 2 groups while the male groups had an increase in their OS. In the group of patients diagnosed before 2010, males had a mean OS of 10 months [95 percent CI, 5.2 to 14.8] and females had a mean OS of 14.4 months [95 percent CI, 7.1 to 21.6]. In the group of patients diagnosed after 2010, males had a mean OS of 14.1 months [95 percent CI, 9.9 to 18.2] and females a mean OS of 14.8 months [95 percent CI, 11 to 18.6]. In other terms, the MR in female remained stable with time, while it decreased in the males that were diagnosed after 2010
Conclusion: Overall, there was an absolute increase of 5.1, 3.96 and 2.3 months in the median OS, PFS1 and PFS2 respectively, between the groups of patients diagnosed before and after 2010 without any statistical significance. This lack of significance can be due to the fact that our study was based on comparing two periods of time and not different chemotherapeutic regimens as seen in all the literature
ABSTRACT
Objective: To estimate the frequency of patients in Lebanon who report an impact of chemotherapy-induced nausea and vomiting [CINV] on their daily life and to evaluate the determinants of such impact, considering not only the prognostic factors related to the patient, disease and treatment, but also the intrinsic characteristics of the CINV, namely, the distinction between acute and delayed phase, and the intensity of nausea and vomiting
Methods: This prospective cross-sectional study, performed between January 2016 and December 2016, included 328 patients. The Functional Living Index - Emesis [FLIE] score was used to evaluate the impact of CINV on patients' daily lives and day-to-day functioning
Results: The results of the backward logistic regression taking the two-category FLIE score as dependent variable showed that current alcohol drinking would increase the odds of having a high FLIE score . 108 by more than 8 times [p = 0.047; ORa = 8.114], while having an anticipatory feeling of nausea/vomiting, number of acute vomiting episodes and the intensity of late nausea would significantly increase the odds of having a FLIE score < 108 by 98.6 percent, 48.4 percent and 29.6 percent respectively [p < 0.0001, ORa = 0.014; p < 0.0001, ORa = 0.516 and p = 0.006, ORa = 0.704]
Conclusion: Chemotherapy-induced nausea and vomiting are still affecting the quality of life[QOL] of oncology patients despite all treatment novelties. Astrong association between the number of vomiting episodes, the intensity of late nausea and the anticipatory feeling of nausea/vomiting and a decrease in the patient's QOL and comfort was found. This research was able to shed the light on the importance of well-controlling CINV to preserve the patient's QOL
ABSTRACT
Recent reports suggest that the pancreas participates in tumor necrosis factor alpha (TNF-A) production during stress, and that the islets are predominantly responsible for such synthesis. In vitro TNF-A and interleukin 1-beta (IL-1-beta) inhibit insulin release from islet beta-cells. We measured the circulating levels of IL-1-beta, TNF-A and islet cell antibody (ICA) in 30 children with IDDM (10 of them at their first presentation), 30 of their non-diabetic siblings, and 30 normal age-matched children. In the non-diabetic children we investigated the early phase of insulin release after intravenous bolus of glucose and evaluated tolerance to oral glucose (OGTT). IL-1-beta and TNF-A concentrations were significantly higher in IDDM-siblings (31.8 +/- 7.7 pg/ml and 650 +/- 155 pg/ml respectively) versus normal children (21.2 +/- 6.4 pg/ml and 383 +/- 122 pg/ml respectively). IL-1-beta and TNF-A concentrations did not differ significantly between the diabetic children and healthy age-matched controls. ICA were detected in 60% of the recently diagnosed diabetic children vs. 30% of those with longer duration of diabetes (3.1 +/- 1.2 years). Despite the significantly high prevalence of ICA in the recently diagnosed children with IDDM, their IL-1-beta and TNF-A concentrations were lower than those for the normal children. In experimental animals these cytokines can induce round cell infiltration (insulinitis) and inhibit insulin secretion by beta-cell. The presence of significantly higher concentrations of these cytokines in IDDM siblings, with high prevalence of ICA (16%), was associated with normal oral glucose tolerance and normal peak insulin response (60 +/- 10.4 mlU/ml) after i.v. glucose bolus compared to normal children (52.3 +/- 9.5 mlU/ml). However, after 2 years of follow up, one of them developed IDDM and another developed IGT but none of the normal controls developed abnormal glucose tolerance. It appears that the process of autoimmune aggression against beta-cells, and its effect on insulin release and glucose homeostasis, is a slow and chronic process. However, the production of these cytokines and consequently the degree of beta-cell destruction, in a genetically susceptible subject, might be enhanced by several factors including viral infections. In summary, IL-1-beta and TNF-A levels can be used as indicators of continuing autoimmune aggression against beta-cells before the development of extensive beta-cell destruction.
Subject(s)
Child , Child, Preschool , Diabetes Mellitus, Type 1/diagnosis , Female , Genetic Predisposition to Disease/genetics , Glucose Tolerance Test , Humans , Insulin/blood , Interleukin-1/blood , Male , Nuclear Family , Risk Factors , Tumor Necrosis Factor-alpha/metabolismABSTRACT
Patients with chronic liver disease will proceed to advanced course and will die from liver cell failure unless liver transplantation is done. Autotransplantation has several practical advantages over allotransplantation or xenotransplantation. Immunologic rejection does not occur. The donnor is at all times readily available and prolonged preservation is usually unnecessary. Autotransplantation of hepatocytes in the spleen was done in dogs. Hepatocyte cell suspension was injected slowly in the splenic artery after occlusion by vascular clamp and this occlusion is removed on finishing of infusion by 10 minutes. Nodules of hepatocytes have growing in the splenic tissue mainly in the sinusoids of red pulp and rarely in trabeculae and white pulp. No growth of bile duct epithelium was noticed. Although our work is a mere trial, our results are promising in intrasplenic hepatocyte autotransplantation in dogs, we hope to more success and to be applied in humans
Subject(s)
Animals, Laboratory , Hepatocytes , Chronic Disease , Dogs , Liver Diseases , Postoperative ComplicationsABSTRACT
Insulin and glucose concentrations in the portal and peripheral venous blood have been determined in connection with oral glucose load in 10 patients with Schistosomal Hepatic Fibrosis [SHF] and Portal hypertension [PH] and compared with five control subjects matched for age, sex and weight. All patients had normal liver function tests and had no history of bleeding. Portal and peripheral venous blood samples were simultaneously obtained at fasting and at one hour after 75 gms oral glucose load. Portal venous samples were obtained by umbilical vein catheterization. In the control subjects, higher levels of insulin secretion in the portal than in the peripheral venous blood were observed at fasting and postprandial states. In SHF patents, the mean insulin level at fasting condition was 27 +/- 4.81 micro U/ml in the portal blood and 25.4 +/- 3.4 micro U/ml in the peripheral blood, while at postpandial state. It was 110 +/- 21.8 micro U/ml in the portal blood and 107 +/- 18.9 micro U/ml in the peripheral blood. These comparatively similar portal and peripheral insulin concentrations denote abnormal insulin concentration gradient mostly due to the presence of portosystemic shunts associated with elevated portal blood pressure. In the fasting and postprandial states, there were no significant differences in the portal insulin concentrations between SHF patients and control subjects, but, in the peripheral blood, the mean insulininulin levels were significantly higher in SHF patients than in control subjects. This denotes peripheral hyperinsulinemia but with normal insulin secretory capacity of the pancreas in patients with SHF. The blood glucose concentrations, however, seemed to be without influence upon the relation between the portal and peripheral insulin concentration in both normal subjects and patients with SHF