Implicaciones de los diferentes modelos analgésicos en los marcadores inflamatorios tras colecistectomía laparoscópica / Implications of Different Analgesic Models on Inflammatory Markers after Laparoscopic Cholecystectomy

Antecedentes: Las cirugías laparoscópicas inducen dolores de hombro y abdominales significativos, que fluctúan entre 35 y 80% de los pacientes, a pesar de sus ventajas. La causa del dolor posterior a la laparoscopia no se comprende plenamente, suponiéndose que es multifactorial y posiblemente un tipo de dolor referido. Objetivo del estudio Evaluar el efecto de los diferentes modelos analgésicos en el dolor posterior a la laparoscopia y en las modulaciones del marcador inflamatorio. Métodos Se asignó aleatoriamente a los pacientes programados para colecistectomía laparoscópica electiva, para recibir una infiltración local en la fosa hepática y el área subdiafragmática derecha con uno de los cuatro tipos de mezcla analgésica de fármacos siguientes: grupo 1 (G1) con 20 mL de bupivacaína al 0,25%; grupo 2 (G2) con 20 mL de bupivacaína al 0,25% + 3 mg de sulfato de morfina; grupo 3 (G3) con 20 mL de bupivacaína al 0,25% + 3 mg de sulfato de morfina + 200 mcg/kg de ketamina; y grupo 4 (G4) con 20 mL de solución salina isotónica como grupo control. Resultados El G3 demostró unos niveles significativamente bajos en la escala de calificación numérica oral del dolor de hombro y marcadores inflamatorios, en contraste con los tres grupos restantes. Los altos niveles de marcadores inflamatorios, estadísticamente significativos, fueron registrados en el grupo control en la comparación entre los grupos de estudio. No se documentaron efectos secundarios ni complicaciones en los cuatro grupos. Conclusión La adición de ketamina y morfina a bupivacaína para insuflado hepático y subdiafragmático produjo buena analgesia y redujo los niveles de los marcadores inflamatorios tras colecistectomía laparoscópica. (AU)

Background: Despite the advantages of laparoscopic surgeries, its induced shoulder and abdominal pain are significant, ranging from 35% to 80%. The cause of post laparoscopic pain is not fully understood and supposed to be multifactorial and possibly referred to as pain. Aim of the study Evaluate the effect of different analgesic models on post-laparoscopic pain and inflammatory markers modulation. Methods Patients scheduled for elective laparoscopic cholecystectomy randomLy assigned to receive local infiltration of the hepatic and right subdiaphragmatic fossae with one of four types of the analgesic mixture of drugs:-Group-1 (G1): 20 mL of (bupivacaine 0.25%) Group-2 (G2): 20 mL of (bupivacaine 0.25% + 3 mg of Morphine sulphate) Group-3 (G3): 20 mL of (bupivacaine 0.25% + 3 mg of Morphine sulphate + 200 microgram/kg ketamine). Group-4 (G4): 20 mL of isotonic saline as the control group. Results Group 3 demonstrated significant low VNRS of shoulder pain and significantly low levels of inflammatory marker compared with the other three groups. Highest statistically significant levels of inflammatory markers recorded in the control group among the study groups. No side effects or complications documented in the four study groups. Conclusión The addition of Ketamine and Morphine to the Bupivacaine for hepatic and subdiaphragmatic insufflation produced good analgesia and reduced the levels of inflammatory markers after Laparoscopic cholecystectomy. (AU)

Implications of different analgesic models on inflammatory markers after laparoscopic cholecystectomy.

BACKGROUND: Despite its advantages, laparoscopic surgery causes significant shoulder and abdominal pain in 35%-80% of patients. The cause of post-laparoscopy pain is not fully understood, but it is assumed to be a multifactorial referred pain. AIM OF THE STUDY: To evaluate the effect of different analgesia techniques on post-laparoscopic pain and inflammatory markers. METHODS: Patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to receive local hepatic and right subdiaphragmatic infiltration of one of the 4 study drug combinations: Group 1 (G1) received 20 ml bupivacaine 0.25%; Group 2 (G2) received 20 ml bupivacaine 0.25% +3 mg morphine sulphate; Group 3 (G3) received 20 ml bupivacaine 0.25% + 3 mg morphine sulphate +200 µg/kg ketamine; and Group 4 (G4) received 20 ml isotonic saline as the control group. RESULTS: In G3, both shoulder pain on the verbal numerical rating scale and inflammatory marker levels were lower compared with the other groups. The highest levels of inflammatory markers were observed in the control group; this difference was statistically significant. No side effects or complications were observed in the study groups. CONCLUSION: The addition of ketamine and morphine to bupivacaine for hepatic and subdiaphragmatic infiltration produced good analgesia and reduced inflammatory marker levels after laparoscopic cholecystectomy.

THE BIO-STIMULATORY EFFECT OF ADVANCE PLATELET RICH FIBRIN COMBINED WITH LASER ON DENTAL IMPLANT STABILITY: AN EXPERIMENTAL STUDY ON SHEEP.

Implant stability is the major important requirement for the progress of a dental implant in the bone bed before loading the dental implant without clinical micro motion of the macula. Advance platelet rich fibrin (A-PRF) can be considered a "tissue engineering marvel" due to the typical properties of an osteo promoting matrix that improve the sustained release of growth factors that modulate and support osteoblast proliferation, migration, and adhesion, and at the same time regulates the production of collagen proteins. Low level laser therapy (LLLT) biostimulation increases blood circulation, promotes the revitalization process, reduces the risk of infection, improves metabolic activity, and accelerates the healing of damaged tissues. This study aimed to assess the effect of Advance platelet rich fibrin (A- prf) with low level laser therapy biostimulation (LLL Biostimulation) on implant stability. Four healthy male sheep were randomly divided into 2 groups (two in each group).Group 1 (control), at of which ten implants were placed on one side of the tibia and ten dental implants on the other side of the tibia with no additions for a total of 10 implants and Group 2 (study) where ten implants were placed on one side and ten dental implants on the other side of the tibia augmented with Advanced Platelet Rich Fibrin Membrane and LLLT Bio stimulation. Primary and secondary dental implant stability were recorded by radiofrequency evaluation using Osstell device immediately after placement, four and eight weeks postoperatively. The results of the current study showed no significant difference between control and study group in implant stability at baseline (day of surgery) but after four and eight weeks there was a significant difference between the control group and the study group. Advance platelet rich fibrin (A- prf) with low level laser therapy biostimulation (LLL Biostimulation) plays a role in new bone formation and enhance implant stability.

Impact of diet on human gut microbiome and disease risk.

The gut microbiome of humans comprises a diverse group of trillions of microorganisms including symbiotic organisms, opportunistic pathogens and commensal organisms. This microbiota plays a major role in digesting food; it also helps with absorbing and synthesizing some nutrients and releases their metabolites, which may deliver a variety of growth-promoting and growth-inhibiting factors that influence human health either directly or indirectly. The balance between microbial species, especially those responsible for the fermentation of different substrates within the microbial community, which are in the majority, depends on daily diet. Therefore, an unbalanced diet may lead to the progression and development of human diseases. These include metabolic and inflammatory disorders, cancer and depression, as well as infant health and longevity. We provide an overview of the effect of diet on the human microbiome and assess the related risk of disease development.

Plasma Levels and Gene Expression of RANK in Non-Alcoholic Fatty Liver Disease.

BACKGROUND: The pathobiology of initiation and progression of nonalcoholic fatty liver disease (NAFLD) has not been completely elucidated. It seems that the RANK/RANKL/OPG cytokine system play an etiologic role in pathogenesis of this disease. This study aimed to investigate the plasma content and gene expression of RANK in NAFLD patients as compared to healthy individuals. METHODS: This case-control work was performed on 63 patients with NAFLD and 25 healthy subjects. The plasma levels of RANK and biochemical parameters were measured using ELISA and colorimetric methods, respectively. Also, RANK mRNA content was evaluated by quantitative RT-PCR in peripheral blood mononuclear cells. RESULTS: RANK plasma contents were shown to be lower in NAFLD patients than in control subjects (1.02 ± 0.75 and 1.41 ± 1 ng/mL, respectively (p = 0.008)). The differences in gene expression of RANK between NAFLD patients and controls were significant (p = 0.001). In the NAFLD patients, RANK was inversely correlated with HDL. Logistic regression showed the association of RANK plasma content with the risk of NAFLD. Moreover, ROC curve analysis showed that RANK has a great ability to differentiate between NAFLD patients and controls. CONCLUSIONS: This study for the first time showed lower plasma and mRNA levels of RANK in NAFLD patients compared to control individuals. These results recommend a possible association between RANK and pathobiology of NAFLD.

EMAST status as a beneficial predictor of fluorouracil-based adjuvant chemotherapy for Stage II/III colorectal cancer.

BACKGROUND: Elevated microsatellite alteration at selected tetranucleotide repeats (EMAST) is a type of microsatellite instability that occurs in ∼60% of colorectal cancers (CRCs) and associated with MSH3 dysfunction. A 5-fluorouracil (5-FU)-related cytotoxicity is attenuated in MSH3-deficient colon cancer cells. Reported here is the predictive value of EMAST in CRCs with Stage II or III disease treated with 5-FU-based chemotherapy. METHODS: EMAST status was analyzed in 157 patients with CRC with Stage II or III disease and MSH3 expression was analyzed using immunohistochemistry. The patients treated with 5-FU-based chemotherapy were studied in terms of the links of EMAST status with MSH3 expression, clinicopathological features, and overall survival (OS). RESULTS: A total of 63 patients (40.1%) had EMAST positive (EMAST+ ) CRC and 77 patients (49.0%) had low MSH3 expression. EMAST+ tumors were associated with advanced TNM stage and poor and moderately differentiated tumor. EMAST CRC was more frequently observed in tumors with low expression of MSH3 in the nucleus (n = 53; 84.1%, p < .001). On multivariate analysis, patients with EMAST+ status had a worse OS (hazard ratio: 2.489, 95% confidence interval [1.149-5.394], and p = .021). Worse OS in EMAST+ patients who received 5-FU-based chemotherapy was significantly more common compared with EMAST- CRCs. CONCLUSION: There is a link between EMAST and reduced nuclear expression of MSH3. There is worse survival in patients with EMAST+ CRC after 5-FU-based chemotherapy. According to our findings, adjuvant 5-FU-based chemotherapy might not be advantageous in EMAST+ CRCs with Stage II or III disease.

Angioleiomyoma as a rare cause of a painful subcutaneous nodule in the leg: a case report.

Angioleiomyomas are benign tumors originating in the vascular smooth muscles. The tumor typically presents as a painful, solitary, small subcutaneous nodule. Herein, we have described a case report of chronic leg pain due to angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for a painful nodule of extremity. Although rare, angioleiomyoma should be included in the differential diagnosis of chronic leg pain.

The Combined Effect of Vitamin D Deficiency and Hyperparathyroidism on Postural Stability among Healthy Adult Males.

BACKGROUND AND OBJECTIVE: Vitamin D has been shown to improve muscle strength and bone health; consequently, be important for maintaining good balance. Possible risk factors related to postural stability in young adults still underdetermined. However, this study was designed to determine the effect of vitamin D status on postural stability. MATERIALS AND METHODS: A cross-sectional study of 704 healthy young adult males were enrolled in this study. Dynamic balance was measured as overall stability index (OSI) using biodex balance system (BBS). Vitamin D deficiency was defined when its serum level <20 ng mL-1. The effect size was measured for vitamin D, parathyroid hormone (PTH) and the interaction between vitamin D and PTH (VTD*PTH) with respect to the OSI values. Correlations between variables were examined according to the beta standardised coefficient (ß) and the effect size was measured using the partial eta-squared (η2) test. RESULTS: About 95, 3.8 and 1.2% of individuals had deficient, insufficient and normal vitamin D levels, respectively. Vitamin D had no significant effect to OSI, but PTH exhibited a significant correlation with OSI (adjusted ß = 0.095, p = 0.038). A significant effect size was observed between OSI and PTH (adjusted partial η2 = 0.012, p = 0.038) and between OSI and VTD*PTH (adjusted partial η2 = 0.034, p<0.001). CONCLUSION: A significant interaction of vitamin D deficiency and high PTH on postural stability is detected among healthy adult males.

Polypose naso-sinusienne et intolérance à l'aspirine: particularités cliniques et résultats du traitement chirurgical

: Comparer le tableau clinique et les résultats thérapeutiques du traitement chirurgical de la polypose nasosinusienne entre deux groupes de patients porteurs et non d'une intolérance à l'aspirine.PATIENTS ET MÉTHODES : Etude rétrospective sur une période de 13 ans [2002-2014] comparant deux groupes de patients opérés d'une polypose naso-sinusienne. Dix-huit patients étaient porteurs d'une maladie de Widal et 54 autres présentaient une polypose nasosinusienne associée ou non à un asthme mais sans intolérance aux anti-inflammatoires non stéroïdiens. RESULTATS : La symptomatologie clinique était jugée plus sévère chez les patients porteurs d'une maladie de Widal. Le taux d'échec fonctionnel était plus élevé en cas de maladie de Widal (55% versus 4% (p=0,001)). Les récidives étaient plus fréquentes et plus extensives dans cette population (100% VS 42% (p=0,00)).CONCLUSION : La maladie de Widal était associée à un taux d'échec fonctionnel et anatomique plus élevé

Prevalence of mites and their impact on laying hen (Gallus gallus domesticus) farm facilities in Egypt, with an analysis of deltamethrin residues in eggs and tissue.

This study was carried out on six laying hen farms, three mite-infested and three mite-free at Dakahlia and Damietta governorates in Egypt to demonstrate: (i) prevalence of different species of mites on laying hen farms; (ii) effects of mite infestation on chicken health and production; (iii) efficacy of deltamethrin (DMT) on treatment of mite infestation and (iv) residues of DMT in eggs and meat. The results showed that 12 mite species were detected in the mite-infested farms, this is the first record in Egypt, and that Dermanyssus gallinae was the highest identified species from 295 (40.9%) of 720 samples. There was a significant effect (P ≤ 0.05) of mites on the mortality %, feed consumption, egg production % and the tested haematological parameters. DMT had no impact on production performance, while transient respiratory signs post-spraying were recorded. The mites induced severe skin lesions. Egg samples showed the highest residue levels of DMT, followed by muscle and skin at P ≤ 0.05. It can be concluded that the mite species, as a first record, had a deleterious impact on the performance of the Egyptian laying hen farm facilities. Moreover, that DMT (Butox® 50 EC, Intervet Co., France) spraying was ineffective by one-time application, every 1 or 2 months in mite-infested laying hen farms, particularly when heavily infested. Furthermore, DMT residues in laying hen eggs and tissue should be considered to avoid the potential risk for humans.

Compounding effects of sea level rise and fluvial flooding.

Sea level rise (SLR), a well-documented and urgent aspect of anthropogenic global warming, threatens population and assets located in low-lying coastal regions all around the world. Common flood hazard assessment practices typically account for one driver at a time (e.g., either fluvial flooding only or ocean flooding only), whereas coastal cities vulnerable to SLR are at risk for flooding from multiple drivers (e.g., extreme coastal high tide, storm surge, and river flow). Here, we propose a bivariate flood hazard assessment approach that accounts for compound flooding from river flow and coastal water level, and we show that a univariate approach may not appropriately characterize the flood hazard if there are compounding effects. Using copulas and bivariate dependence analysis, we also quantify the increases in failure probabilities for 2030 and 2050 caused by SLR under representative concentration pathways 4.5 and 8.5. Additionally, the increase in failure probability is shown to be strongly affected by compounding effects. The proposed failure probability method offers an innovative tool for assessing compounding flood hazards in a warming climate.

Glutathione and its related enzymes in the gonad of Nile Tilapia (Oreochromis niloticus).

Glutathione (GSH) concentration, the activity of its metabolizing enzymes, glutathione transferase (GST), glutathione peroxidase (GPx), glutathione reductase (GR), and the antioxidant enzyme catalase (CAT) in O. niloticus ovary and testis were examined. GSH concentration of O. niloticus testis exhibited high concentration (129 ± 21 nmol/g tissue) compared with GSH concentration (49.2 ± 8.3 nmol/g tissue) in the ovary. GST, GPx, GR, and CAT activities of O. niloticus testis exhibited high values compared with their corresponding values in ovary homogenates. However, protein concentration in ovary homogenates exhibited higher values (175 ± 40.6 mg) compared with testis homogenates (27.1 ± 3.7 mg). O. niloticus ovary was less effective in excretion of xenobiotices compared with the testis, where its function is mainly in increasing the protein content of the eggs; however, in O. niloticus testis, the glutathione cycle operated in accelerated way in the direction of reduced GSH production in order to protect the maturation stages in a save way. A simple reproducible procedure for the purification of GST from O. niloticus ovary was established. The enzymes proved to be homogenous as judged by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and its molecular weight was calculated to be 25.1 kDa. GST of O. niloticus ovary exhibited maximum activity at pH 7.5. The Michaelis-Menten constant (K(m)) of the purified ovary GST for GSH and CDNB was 0.076 mM and 1.0 mM, respectively. Cibacron blue was the most potent inhibitor of ovary GST activity (IC50 value, concentration of inhibitor that will give 50% inhibition, equal 0.002 µM). The specific activity of GST toward different electrophilic substrates was determined. GST activity toward benzyl isothiocyanate was the highest compared with phenethyl isothiocyanate and allyl isothiocyanate.

Development of the Arabic Version of the Preschool Activity Card Sort (A-PACS).

AIM: The purpose of this study is to describe the process of developing the Arabic Version of the Preschool Activity Card Sort (A-PACS) derived from the Preschool Activity Card Sort (PACS), an internationally recognized tool, which uses parent interview, and photographs of pre-schoolers engaged in typical activities. BACKGROUND: Measuring participation among preschool children in daily activities is an essential part of the evaluation process by occupational therapists, utilizing valid and culturally relevant measurement tools. Given the newness of the occupational therapy profession in the Arab world, a major obstacle is the dearth of measurement tools especially for pre-schoolers. METHODS: Cultural adaptation of the PACS required a four phase process: collection of culturally appropriate activities using focus groups, translation, cognitive pilot testing and validation using two rounds of ranking (Delphi technique). Caregivers interviewed in all phases of the study included 115 participants. All were recruited from different geographical locations and socio-economic levels in Jordan, and were stratified by age and gender. RESULTS: Ninety-five activities were generated in the final version of the A-PACS in which 23 were specific to the Arabic culture. The activities were categorized into self-care (17), community mobility (16), high demand leisure (11), low demand leisure (17), social interaction (15), domestic (8) and education (11). Based on the A-PACS, the most common five activities of Jordanian children were drinking, walking on stairs, eating a sandwich, gathering with family and kicking a ball. CONCLUSION: A culturally adapted Arabic form of the PACS emerged from this investigation. This is the first step in developing a psychometrically sound assessment tool to evaluate participation of Arabic-speaking preschool children.

Consequence of Cryptosporidiosis on the immune response of vaccinated broiler chickens against Newcastle disease and/or avian influenza.

The consequence of cryptosporidiosis on the immune response of vaccinated chickens against Newcastle disease and/or avian influenza was studied by using 240, 1 day old, male, white Hy-Line chicks and divided into 8 groups and subgroups. Each group or subgroup was consisting of 30 chicks (15 × 2 replicates). The first and second groups were kept as unvaccinated control, G1uninfected and G2 infected. G3, G4 and G5 contained 2 subgroups A&B (G3A, G3B, G4A, G4B, G5A and G5B). Chicks of subgroup A were vaccinated only while chicks of subgroup B were infected and vaccinated. These chicks were orally inoculated with 5 × 10(5) oocysts of Cryptosporidium baileyi (C. baileyi) at 2 days of age. Chickens were vaccinated intraocular with live Newcastle disease (ND) vaccine (Hitchner on day 7th and LaSota on day 17th of chicken life) (G3) or vaccinated by subcutaneous route with Volvac®- H5N2- AI vaccine on day 10 of chicken life (G4). Last group (G5) was infected similarly and vaccinated with ND and AI vaccines with the same day, dose and route of vaccination for each one. Random blood samples were collected for 3 weeks post-vaccination for investigation of humoral immune response against Newcastle and/or avian influenza vaccines by the haemagglutination inhibition (HI) test. The results showed that H5N2 vaccine at day 10 of chicken life is effective in chickens indicated by the geometric mean of HI titer against AI virus. The findings of this study showed that the infection with Cryptosporidia in the broiler chicken has a depressive effect on the immune status of the birds vaccinated against ND and/or AI vaccination. Moreover, the obtained protection rates against challenge with virulent ND virus observed to be parallel to the results of HI- test. Also, by using 2 different antigens (one commercial and field prepared antigen) to avian influenza virus, lower Geometric mean (GM) HI titer were appeared in infected and vaccinated group than vaccinated group only. A study of the relative lymphoid organs weight such as bursa of Fabricius from the experimental chicks indicated that those organs were comparable between the groups infected-vaccinated and vaccinated only. Non significant variations in final live weight between uninfected control and infected groups were indicated. Also, H5N2-AI vaccination at 10 days old did not affect the final live weight. ND and/or AI Vaccination could not be a substitute to application of good hygienic measures and fecal examination of the birds especially for protozoal diseases such as cryptosporidiosis. It could be concluded that cryptosporidiosis could be one cause of ND and/or AI vaccination failure in poultry farms.

Synthetic tracheal mucus with native rheological and surface tension properties.

In this study, the development of a model tracheal mucus with chemical composition and physical properties (bulk viscoelasticity and surface tension) matched to that of native tracheal mucus is described. The mucus mimetics (MMs) were formulated using components that are abundant in tracheal mucus (glycoproteins, proteins, lipids, ions, and water) at concentrations similar to those found natively. Pure solutions were unable to achieve the gel behavior observed with native mucus. The addition of a bifunctional cross-linking agent enabled control over the viscoelastic properties of the MMs by tailoring the concentration of the cross-linking agent and the duration of cross-linking. Three MM formulations with different bulk viscoelastic properties, all within the normal range for nondiseased tracheal mucus, were chosen for investigation of surfactant spreading at the air-mimetic interface. Surfactant spread quickly and completely on the least viscoelastic mimetic surface, enabling the surface tension of the mimetic to be lowered to match native tracheal mucus. However, surfactant spreading on the more viscoelastic mimetics was hindered, suggesting that the bulk properties of the mimetics dictate the range of surface properties that can be achieved.

L'otite sereuse chez l'adulte : demarche diagnostique et therapeutique

L'otite seromuqueuse (OSM) de l'adulte est une situation regulierement rencontree en consultation ORL. Le but de notre travail est de dicter a travers notre serie et une revue de la litterature une demarche diagnostique et therapeutique en presence d'une otite seromuqueuse de l'adulte. Patients et Methodes : Nous avons mene une etude retrospective sur une periode de 10 ans allant de 2002 a 2011. Ont ete inclus les patients de plus de 18 ans chez qui a ete porte le diagnostic d'otite seromuqueuse avec un suivi minimum de un an. Resultats : Notre population etait constituee de 53 patients. 60 des patients avaient des antecedents de traitement par radiotherapie du massif facial. Vingt patients etaient suivis pour rhinite chronique. Tous les patients ont eu un examen ORL complet et un scanner des rocher dans tous les cas. 62 des patients ont eu un traitement medical. 92 de nos patients ont ete operes; 17 patients ont eu une regression complete et persistante dans le temps. Discussion : le diagnostique etiologique d'une otite seromuqueuse chronique de l'adulte passe par un examen ORL complet; suivi d'un scanner injecte des rocher. Le traitement n'est pas clairement codifie

Tuberculose lymphonodale cervicale chez les enfants vaccines par le BCG

La tuberculose ganglionnaire cervicale est une localisation extrapulmonaire relativement frequente chez l'enfant. Elle pose essentiellement des difficultes de prevention. L'objectif de ce travail est d'etudier les particularites diagnostiques et therapeutiques chez des enfants vaccines par le BCG. Materiel et methodes: Notre etude retrospective porte sur 23 cas de tuberculose ganglionnaire chez des enfants vaccines; colliges sur une periode de 10 ans allant de 2002 a 2011. Resultats : La moyenne d'age des enfants etait de 8 ans. Le delai de consultation etait en moyenne de 1 mois. Seize enfants presentaient une polyadenopathie cervicale bilaterale. L'echographie cervicale a objective une necrose intra ganglionnaire dans 17 cas. Le diagnostic de tuberculose ganglionnaire a ete confirme par l'examen anatomopathologique d'une piece d'adenectomie dans tous les cas. Aucun des enfants n'a presente de forme grave ou compliquee. Un traitement antituberculeux selon le schema national a ete instaure dans tous les cas. L'evolution a ete favorable dans tous les cas. Conclusion : Malgre tous les efforts deployes par notre pays pour la lutte contre la tuberculose; cette derniere sevit toujours a l'etat endemique. La vaccination par le BCG a permis de diminuer considerablement le nombre des formes graves mais ne protege pas parfaitement contre cette maladie

Docetaxel in advanced or metastatic endometrial cancer: Clinical Outcome (Mansoura University).

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy, safety and toxicity of docetaxel as first line chemotherapy or previously treated patients (one regimen) in patients with recurrent or metastatic endometrial cancer. PATIENTS AND METHODS: Prospective phase II, in patients referred to the Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt.. Fifty patients with advanced or metastatic endometrial cancer were enrolled to receive docetaxel 70 mg/m2 administered intravenously on day 1 of a 3-week cycle. If patients responded well to docetaxel, additional cycles were administered until progressive disease or unacceptable toxicity occurred. Therapy response was evaluated every 6-week. RESULTS: Fifty patients with a median age of 60 years (range, 40-70 years) who entered the study, 17 patients (34%) had received one prior chemotherapy regimen. All patients were evaluable for efficacy, yielding an overall response rate of 34% (95% confidence interval, 14.8-55.6%); complete response and partial response (PR) were 4 and 30%, respectively. Of 17 pretreated patients, five (29%) had a PR. The median duration of response was 2 months. The median time to progression was 4 months and the median survival time was 18 months . The predominant toxicity was grade 3-4 neutropenia, occurring in 92% of the patients, although febrile neutropenia arose in 10% of the patients. Oedema was mild and infrequent. CONCLUSION: This prospective phase II trial, clearly demonstrated that docetaxel is active in the treatment of endometrial cancer. Toxicity was manageable and predominantly haematologic. KEYWORDS: docetaxel; advanced or metastatic endometrial cancer; phase II.

Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University).

This trial compared 6 cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) with a sequential regimen of 3 cycles of FEC followed by 3 cycles of docetaxel (FEC-D) as adjuvant treatment for women with node-positive or/and T3 or T4 breast cancer. Between January 2006 and January 2010, 657 patients with operable breast cancer were randomly assigned to either FEC every 21 days for 6 cycles, or 3 cycles of FEC followed by 3 cycles of docetaxel, both given every 21 days. Radiotherapy was mandatory for all patients who had undergone breast conserving surgery. Radiation to the chest wall, supraclavicular area, was recommended following mastectomy. Hormone-receptor-positive patients received tamoxifen for 5 years after chemotherapy. The primary end point was 5-year disease-free survival (DFS). Median follow-up was 61 months. Five-year DFS rates were 74 % with FEC and 78 % with FEC-D (P = 0.013). Multivariate analysis adjusted for prognostic factors showed a 17 % reduction in the relative risk of relapse with FEC-D. Five-year overall survival rates were 85 % with FEC and 89.4 % with FEC-D, demonstrating a 27 % reduction in the relative risk of death (P = 0.014). The incidence of grade 3-4 neutropenia, the need for hematopoietic growth factor, and incidence of nausea/vomiting were higher with FEC. Docetaxel was associated with more febrile neutropenia, stomatitis, edema, and nail disorders. Though rare overall, there were fewer cardiac events after FEC-D, attributable mainly to the lower anthracycline cumulative dose. Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive or/and T3 or T4 breast cancer patients. Although the magnitude of the benefit observed with FEC-D, differences in the toxicity profiles of FEC and FEC-D may influence the choice of treatment for patients.