The outcome of childhood adrenocortical carcinoma in Egypt: A model from developing countries.

Adrenocortical carcinoma (ACC) is a rare, aggressive endocrine neoplasm. Complete surgical resection is the single most important treatment. Most available information has been learned from experience with its more frequent adult counterpart. In this study, we assessed the features and survival outcome of patients with ACC at Children's Cancer Hospital Egypt (CCHE). Patients diagnosed at CCHE between July 2007 and November 2016 were followed up on until November 2018. Patients with stages I and II were operated upon, while stages III and IV had received combinations of doxorubicin, etoposide, platinol, and mitotane (DEPM) beside the attempt to conduct surgery when feasible. Data belonging to 18 patients (7 men and 11 women) were analyzed; median age at diagnosis was 48.5 months. Sixteen patients had presented with secreting tumors. Six patients were diagnosed with stage I disease; four with stage II; three with stage III; and five with stage IV carcinoma. By the end of this study, 10 patients have survived; five-year overall survival of 66.3%. Surviving patients were all of stage I or II diseases and were all in remission. Seven patients who did not survive died due to tumor progression, while one patient died after chemotherapy. The prognosis of ACC is essentially dependent on a successful complete resection of the tumor and thus on the initial tumor stage. The mitotane and DEP protocols may help control tumor growth in the advanced stages for only short periods. Key pointsInitial stage and resectability are the main indicators of outcomes in adrenocortical carcinoma.Chemotherapeutic agents used in developed countries did not achieve the same outcomes.Further molecular-pharmacology differentiation is needed for various ethnic populations.

Assessment of heavy metals pollution using AVS-SEM and fractionation techniques in Edku Lagoon sediments, Mediterranean Sea, Egypt.

A method is presented to evaluate the fractionation of metals (Fe, Zn, Cu, Pb, Cd and Ni), acid volatile sulfide (AVS) and simultaneously extracted metals (SEM) in Edku lagoon sediments. Thirteen sediment samples were collected from the study area in the period of 2010-2011 to assess the potential bioavailability and toxicity of the selected metals. According to classification of the Interim Sediment Quality Quidelines (ISQG), five stations near the drains exhibited 10% toxic probability. The high AVS and low ∑SEM ranges in Summer were identified as 6-138 and 0.86-3.3 µmol g(-1) dry wet, respectively which are referring to the low mobility of heavy metals in this season and vice versa for winter (2.5-23.9 and 1.16-3.82 µmol g(-1) dry wet, respectively). According to the evaluation of USEPA, all sediment samples showed ∑SEM/AVS < 1 and ΣSEM-AVS < 0 and this indicates that Edku lagoon sediments didn't cause any adverse effects. Meanwhile, the calculations of the global contamination factor (GCF) and the individual contamination factors (ICF) using fractionation technique gave values of 111.644 and 84.555 in El Bosily drain and station 1 near the cages of fish farm, respectively due to possible contamination. Interestingly, the collected data refer that the mobility and bioavailability of heavy metals in Edku lagoon sediments posed a low risk of adverse biological effects due to cadmium, copper, lead, nickel and zinc in all evaluated stations.

Spatial variation of acid-volatile sulfide and simultaneously extracted metals in Egyptian Mediterranean Sea lagoon sediments.

In risk assessment of aquatic sediments, the immobilizing effect of acid-volatile sulfide (AVS) on trace metals is a principal control on availability and associated toxicity of metals to aquatic biota, which reduces metal bioavailability and toxicity by binding and immobilizing metals as insoluble sulfides. Spatial variation pattern of AVS, simultaneously extracted metals (SEM), and sediment characteristics were studied for the first time in surface sediment samples (0-20 cm) from 43 locations in Egyptian northern delta lagoons (Manzalah, Burullus, and Maryut) as predictors of the bioavailability of some divalent metals (Cu, Zn, Cd, Pb, and Ni) in sediments as well as indicators of metal toxicity in anaerobic sediments. The results indicated that the ∑SEM (Cu + Zn + Cd + Pb + Ni) values in sediments of lagoon Burullus had higher concentrations than those of Maryut and Manzalah. In contrast, AVS concentrations were considerably higher in lagoons Manzalah and Maryut and seemed to be consistent with the increase in organic matter than lagoon Burullus. Generally, the average concentrations of the SEM in all lagoons were in the order of Zn > Cu > Ni > Pb > Cd. The ratios of ∑SEM/AVS were less than 1 at all the sampling stations except at one station in lagoon Maryut as well as four stations located in lagoon Burullus (∑SEM/AVS > 1), which suggests that the metals have toxicity potential in these sediments. Therefore, SEM concentrations probably are better indicators of the metal bioavailability in sediments than the conventional total metal concentrations.

Chemical speciation and comprehensive risk assessment of metals in sediments from Nabq protectorate, the Red Sea using individual and synergistic indices.

The study evaluates metal concentrations, distributions, contamination, risk, sources, fractionation, and mobility in Nabq Protectorate sediments, revealing a metal content order of Fe, Mn, Pb, Ni, and Cd. Metals are dominated by residual fractions, with Cd (83.70 %) > Ni (82.98 %) > Pb (80.96 %) > Fe (80.31 %) > Mn (76.65 %) reflecting the natural sources of investigated metals. Mn (23.35 %) was the most abundant mobile metal, and the sediments of the protectorate had low toxicity and moderate risk according to the synergistic indices (1 ≤ mRAC<10 and ERM; 5-10). The results from the proposed individual indices showed that Mn, Fe, and Pb are the most bioavailable (BIM 0.1-0.4), Cd, Mn, Ni, Fe, and Pb are of moderate mobility (MIM 0.1-0.4), and Cd is the most available (ARIM 5-10), with Cd posing the most ecological risk. The total hazard quotient (THQ) for child was greater than one, exposure to manganese through ingestion and skin contact while swimming may endanger human health.

Impact of a structured sleep education program on mothers' knowledge and attitudes toward infant sleeping.

Introduction: Sleeping is necessary for the infant growth and development. Sufficient and quality of sleep can have an impact on physical, cognitive, and emotional functioning. Infancy is a critical time for establishing healthy habits and routines. However, many infants were suffering from sleeping issues that impact their health. Objectives: This study aims to evaluate the effect of educational programs given to mothers regarding their infants' sleep on mothers' knowledge and attitudes toward infant's sleeping. Method: A quasi-experimental design for nonequivalent groups was used, and data was collected from 208 mothers with infants aged 5-12 months from all Jordanian governorates who had not been exposed to educational programs prior to this study. Data was collected in two stages: pre-test and post-test, with two weeks in between for both groups. Results: The final results indicated that the educational intervention had a significant impact on mothers' knowledge over time. It was found that mothers in the intervention group had significantly higher mean of infant sleep health knowledge at follow up time compared to their baseline time (B = 0.236, P 0.001). Also, the yielded analysis showed that there was no significant change in mothers' mean attitudes toward infants sleeping over time (P = 0.011). The mothers' measured sleep health knowledge correlated positively and significantly statistically with their sleep health attitudes score (r = 0.436, P 0.010).

LncRNA HULC and miR-122 Expression Pattern in HCC-Related HCV Egyptian Patients.

Hepatocellular carcinoma (HCC) is a highly prevalent malignancy. It is a common type of cancer in Egypt due to chronic virus C infection (HCV). Currently, the frequently used lab test is serum α-fetoprotein. However, its diagnostic value is challenging due to its low sensitivity and specificity. Genetic biomarkers have recently provided new insights for cancer diagnostics. Herein, we quantified Lnc HULC and miR-122 gene expression to test their potential in diagnosis. Both biomarkers were tested in the sera of 60 HCC patients and 60 with chronic HCV using real-time RT-PCR. miR-122 was highly expressed in HCV patients with a significant difference from the HCC group (p = 0.004), which points towards its role in prognosis value as a predictor of HCC in patients with chronic HCV. HULC was more highly expressed in HCC patients than in the HCV group (p = 0.018), indicating its potential use in screening and the early diagnosis of HCC. The receiver operating characteristic (ROC) curve analysis showed their reliable sensitivity and specificity. Our results reveal that miR-122 can act as a prognostic tool for patients with chronic HCV. Furthermore, it is an early predictor of HCC. LncRNA HULC can be used as an early diagnostic tool for HCC.

Contamination of the marine environment in Egypt and Saudi Arabia with personal protective equipment during COVID-19 pandemic: A short focus.

Plastic pollution and its impact on marine ecosystems are major concerns globally, and the situation was exacerbated after the outbreak of COVID-19. Clean-up campaigns took place during the summer season (June-August 2020) in two coastal cities in Egypt (Alexandria and Hurghada) and Jeddah, Saudi Arabia to document the abundance of beach debris through public involvement, and then remove it. A total of 3673, 255, and 848 items were collected from Alexandria, Hurghada, and Jeddah daily, respectively. Gloves and face masks (personal protective equipment "PPE") represent represented 40-60% of the total plastic items collected from each of the three cities, while plastic bags represented 7-20% of the total plastics litter collected from the same cities. The results indicated the presence of 2.79, 0.29, and 0.86 PPE item m-2 in Alexandria, Hurghada and Jeddah, respectively. This short focus provides an assessment of the environmental impacts of single-use gloves and masks used for COVID-19 protection from June to August 2020. To the best of our knowledge, this study presents the first such information from the Middle East, specifically Egypt and Saudi Arabia. It highlights the need for further knowledge and action, such as safe, sustainable, and transparent waste management processes related to COVID-19 to reduce the negative impacts now, as well as in future events. Furthermore, this study helps in achieving key components of the United Nation's Sustainable Development Goals (SDGs). This short focus can serve as a multipurpose document, not only for scientists of different disciplines but for social media and citizens in general.

Novel eco-friendly amino-modified nanoparticles for phenol removal from aqueous solution.

Herein, the impact of using dried Caulerpa prolifera nanoparticles and silica-coated Caulerpa prolifera nanoparticles for the removal of phenol from aqueous solution has been investigated. The chemical structure and morphology of both dried Caulerpa prolifera nanoparticles and silica-coated Caulerpa prolifera nanoparticles were characterized by using Fourier-transform infrared spectroscopy (FTIR), Brunauer Emmett Teller (BET), scanning electron microscopy (SEM), and transmission electron microscope (TEM). Batch mode experiments were conducted depending on adsorbent dosage, pH, contact time, and initial phenol concentration. In order to investigate the adsorption mechanism of the phenol molecules to the surface of the nanoparticles, kinetic models including pseudo-first-order, pseudo-second-order, and intra-particle diffusion models were executed. To describe the equilibrium isotherms, Langmuir and Freundlich isotherms were analyzed. However, the Langmuir isotherm model was agreed to be more significant with the obtained experimental data.

An insight into fractionation, toxicity, mobility and source apportionment of metals in sediments from El Temsah Lake, Suez Canal.

El Temsah Lake is one of the most important wetlands in the Suez Canal area and the major source of fish for the area. In this study, the relative role of sediments' geochemical properties and metals geochemical fractionation in determining Cd, Cr, Fe, Mn, Ni, and Pb mobility and toxicity was especially concerned. The results reflected that the increasing order of contamination for the investigated metals according to individual contamination factor (ICF) was: Cr > Mn > Ni > Pb > Cd > Fe. Risk assessment code (RAC) classification showed that the relative amounts of easily dissolved phases of metals in the sediments followed the order of Ni > Cr > Cd > Pb > Fe > Mn. The toxicity as indicated by toxic unit (TU) due to an individual metal followed a descending order of Ni > Cr > Pb > Cd, indicating that Ni and Cr accounted for the majority of the overall sediment toxicity while, Cd contributed the least to the ΣTU. This work constitutes a good basis for further studies about metal fractionation in El Temsah Lake which might help policy makers to take effective decisions for proper management of the lake.

A prospective randomized trial for postoperative vs. preoperative adjuvant radiotherapy for muscle-invasive bladder cancer.

PURPOSE: Although radical cystectomy is considered to be the primary treatment for muscle-invasive bladder cancer, it is associated with unfavorable outcome. Local recurrence is still a major problem. Survival rates as well as quality of live are far from being satisfactory. Postoperative radiotherapy is considered the standard adjuvant treatment in the NCI-Egypt. This is a prospective randomized study conducted to compare preoperative with postoperative radiotherapy as regard the survival and complication rates. PATIENTS AND METHODS: In the period from May, 2004 to June 2007, 100 eligible patients were included into the study, 50 patients in each treatment arm. Pelvic irradiation was identical in both groups aiming at 50 Gy/25 Fs/5 wk. Radical cystectomy was the standard surgery. Locoregional control, survival rates, and complications rates were compared in both arms. RESULTS: Patients had a median follow-up period of 32 months (range 0-69 months). Patients had an average age of 54.8 ± 9.5 years with a male/female ratio 3:1. In the present study, transitional cell carcinoma constitutes (51%), while squamous cell carcinoma was reported in 46% of cases. Grades II and III pathology were 81% and 17%, respectively. Pathological stage P2b was encountered in 39.5% of the patients followed by P3b (33.3%) and P3a (14.6%). For the preoperative group, the 3-year overall survival, disease-free survival, locoregional control, and metastases-free survival rates were 53.4%, 47.4%, 89.3%, and 61.5%, respectively. The corresponding figures for the postoperative group were 51.8%, 34.1%, 80.6%, and 55.7% for the postoperative group. None of the patients had serious radiation reactions. CONCLUSION: In our study, preoperative radiotherapy was almost equivalent to postoperative radiation therapy as regard OS, DFS, as well as complication rates. Given the recent physical developments in radiation therapy techniques and the biological rationale for treating the pelvis after cystectomy, adjuvant radiotherapy should be re-evaluated world wide. Preoperative radiotherapy may re-emerge as a useful tool for adjuvant treatment.

Time-trend in epidemiological and pathological features of schistosoma-associated bladder cancer.

OBJECTIVE: To investigate the different emerging trends in the features of bladder cancer along 17 years. PATIENTS AND METHODS: During a 17-year period (1988- 2004), 5071 epithelial bladder cancer patients underwent radical cystectomy at the National Cancer Institute (NCI), Cairo University, Egypt. The time was divided into 3 time periods to detect changes of the clinicopathologic features of patients in these periods. RESULTS: There was a significant progressive increase in the patients' age with time and decrease in squamous/transitional ratio, with transient increase in male predominance during the 2nd time period. Moreover, there was a decrease in the well differentiated (grade 1) tumor (p<0.001) and an increase in the frequency of pelvic nodal involvement (p<0.001). Transitional cell carcinoma (TCC) patients were significantly older than those with squamous cell carcinoma (SCC) (p<0.001). Progressive increase of age with time was evident in TCC, SCC and adenocarcinoma patients. Male to female ratio changed significantly in TCC and SCC. CONCLUSION: Time trend was confirmed with relative decrease in frequency of SCC and increase of TCC with changes in their pathological details. The differences between their characteristics and that of the Western countries are decreasing.

Cytoreductive surgery for advanced epithelial tumors of the ovary: technical considerations and outcome.

PURPOSE: To study the role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. PATIENTS AND METHODS: A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending the National Cancer Institute, Cairo University during the period from January 2003 to of December 2004. All patients were evaluated clinically, radiologically (including plain chest-X-ray and abdomino-pelvic ultrasound and/or CT), laboratory work up and CA-125. Abdominal exploration under general anesthesia with intent of maximum surgical cytoreduction was performed for all patients. Patients were followed up during the period of the study by history and physical examination, CA-125 measurement and abdomino-pelvic ultrasound or CT. RESULTS: Our study included 58 female patients with advanced epithelial tumors of the ovary. Their age ranged from 18 to 73 years with a mean age of 49 years. Pathological distribution of the lesions were borderline malignancy in 5 patients (8.6%) and malignant in 53 patients (91.4%). According to FIGO classification there were 46 patients stage III (79%) and 12 patients stage VI disease (21%). Eighteen patients (31%) had surgery prior to admission to NCI. Cytoreductive surgery was done for 51 patients (88%), while 7 patients (12%) had exploration and biopsy only, one of whom had palliative colostomy for large bowel obstruction. Intraoperative surgical complications were encountered in 5 patients (8.6%), all were managed intraoperatively. We had no early postoperative mortalities and 8 postoperative morbidities (13.7%). All patients were referred for chemotherapy. Thirteen patients (22.4%) had local recurrence within the follow up period of the study which was between 8-24 months. One patient died from locally advanced disease and the rest of the patients were explored and lesions were surgically resected. CONCLUSION: Surgery remains a major line of therapy in ovarian cancer including advanced lesions. Extensive procedures to maintain a R0 result are crucial to reach a satisfactory local disease control. The NCI, as well as all tertiary cancer centers, has an important role in providing this quality of surgery especially in advanced cases. Chemotherapy remains the hope to ameliorate the survival especially in advanced cases. The close coordination between surgery and chemotherapy in the form of Intra- Peritoneal Hyperthermic Chemotherapy (IPHC) represents a hope for patients with advanced disease and should be introduced and established in all major cancer centers.

Surgical management for giant cell tumor of bones.

PURPOSE: To evaluate the different surgical techniques used in the treatment of giant cell tumor of bone and their effect on the rate of local recurrence. PATIENTS AND METHODS: This is a prospective study of fifty-two patients with giant cell tumor (GCT) of the bones treated at the National Cancer Institute, Cairo University between 1998 and 2002. All patients were evaluated by clinical examination, plain X-ray, CT scan and MRI (in some cases). Biopsy was taken in all cases to confirm the diagnosis and to define the grade of the tumor. All patients underwent surgical treatment including curettage, curettage combined with cryosurgery and bone cement or bone graft, bone resection and amputation. Selection of the surgical technique was based on site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), tumor grade and if recurrent or not. Patients were followed up for a minimum of twenty-four months. RESULTS: Out of 52 patients 14 patients were males and 38 patients were females, (male to female ratio was (1: 2.7). The age of our patients ranged from 13 to 71 years, with a mean age of 32.9 years. Based on Enneking's staging system, 40 patients (77%) were stage IA, 9 patients (17%) were stage IB & 3 were stage IIB. Histopathological examination of all cases revealed giant cell tumor of borderline malignancy. Curettage alone was done in 4 patients, curettage and bone cement in 7 patients, curettage, cryosurgery and bone graft in 4 patients, curettage, cryosurgery and bone cement in 18 patients, resection in 16 patients and amputation in 3 patients. There were no mortalities among our cases. Local recurrence was highest in cases treated with curettage only (50%), lowest in cases treated with curettage and cryosurgery with bone cement (16.6%). CONCLUSION: The main primary treatment of GCT is surgery; the type of which depends on preoperative evaluation, which includes clinical evaluation that involves the site and size of the tumor in relation to surrounding structures, together with plain X-ray, CT scan and/or MRI as indicated, and tissue biopsy to define tumor grade. Curettage alone results in high rate of local recurrence. On the other hand, curettage and adjuvant cryosurgery using bone cement or bone grafts give low rate of local recurrence. Resection is recommended for stages IB and IIB, extremely large lesions, and in cases where resection results in no significant morbidity as proximal fibula and flat bones. Amputation is preserved for massive recurrences and malignant transformation.