Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE)....Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .展开更多
BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,qualit...BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.展开更多
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality...Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.展开更多
A third of the world’s population is latently infected with TB with an increased risk of developing active TB. Household contacts (HHCs) of pulmonary TB cases are at a greater risk of developing disease. Early identi...A third of the world’s population is latently infected with TB with an increased risk of developing active TB. Household contacts (HHCs) of pulmonary TB cases are at a greater risk of developing disease. Early identification and treatment of latent TB infected individuals may reduce progression to active TB. This study aimed to determine latent TB infections (LTBI) point prevalence among HHCs and community contacts (CCs) using Tuberculin Skin Test (TST) and whole blood IFN-γ release assay in an area of high TB prevalence. In a prospective, longitudinal and community-based study and following informed consent, 768 volunteers (HHCs n = 245;CCs n = 523) were enrolled. Tuberculin Skin Test (TST), whole blood stimulation with PPD and IFN-γ levels determination using ELISA were performed. Mean ages of HHCs and the CCs were not significantly different (HHCs 35.6 ± 15.7 and CCs 30.6 ± 11.7 years;p = 0.99), with a Male:Female ratio of 1:2. Mean recruitment TST indurations were 4.6 ± 5.5 mm and 2.8 ± 3 mm for HHCs and CCs respectively (p = 0.000). Follow-up (Day 614) mean TST indurations increased significantly to 9.1 ± 7.2 mm and 4.4 ± 3.2 mm for HHCs and CCs respectively (p = 0.001). Using TST indurations ≥ 10 mm, LTBI point prevalence for HHCs and CCs was significantly different (HHCs 461/1000 and 367/1000 individuals, p = 0.03). The mean IFN-γ levels for HHCs and CCs at recruitment day (Day 0) were 0.66 ± 0.17 IU/ml and 0.06 ± 0.04 respectively. The mean of IFN-γ production levels dropped significantly at Day 614 for HHCs and CCs to 0.66 ± 0.15 IU/ml and 0.02 ± 0.02 respectively (p = 0.03) (p = 0.00001). Recruitment LTBI point prevalence using IFN-γ level ≥ 0.35 IU/ml for HHCs and CCs was 440/1000 and 203/1000 respectively (p = 0.000000001). No correlations between TST indurations and IFN-γ levels were detected among HHCs or CCs (p > 0.05). TST is a simple, efficient and cheap technique for LTBI diagnosis and triaging individuals for treatment.展开更多
Objectne:To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection-post swine flu pandemic era-using rapid influenza diagnostic tests.Methods...Objectne:To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection-post swine flu pandemic era-using rapid influenza diagnostic tests.Methods:During two year,(2010&2011),1200 children with influenza like illness or acute respiratory tract infections(according to World Health Organization criteria)were recruited.Their ages ranged from 2-60 months.Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test.Results:Influenza A virus rapid test was positive in 47.5%of the children;the majority(89.6%)were presented with lower respiratory tract infections.Respiratory rate and temperature were significantly higher among positive rapid influenza test patients.Conclusions:Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children.It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.展开更多
Objective:The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma (MPM). Methods:Thirty-three eligible pa...Objective:The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma (MPM). Methods:Thirty-three eligible patients with histologically proven advanced MPM with ECOG PS of ≤ 2 and had adequate liver and kidney functions received gemcitabine (1000 mg/m 2 ) on days 1 and 8 combined with cisplatin (80 mg/m 2 ) on day 1. Results:The majority of the study group were males and constituted 87.9% (n = 29), while females constituted 12.1% (n = 4). The median age was 52 years and ranged from 37 to 69 years. Regarding SWOG performance status, 5 patients were PS 0, 21 patients were PS 1 and 7 patients were PS 2. Regarding pathological subtypes, epithelial histology represented 84.8% of the study (n = 28) while sarcomatoid type represented 6% (n = 2) and biphasic type accounted for 9% (n = 3). Regarding staging according to IMIG staging system, 12.1% of patients were stage II, 54.5% were stage III and 33.3% were stage IV. Only one patient (3%) had attained a complete response, 18 patients (54.5%) showed partial response, 12 patients (36.4%) showed stationary disease, while 2 patients (6.1%) showed progressive disease. The correlation between response rate obtained and PS was statistically significant (P = 0.029). After a median follow-up of 14.4 months, the median survival time was 20.3 months (95% CI:14.58-26.01 months) and the progression free survival time was 11.8 months (95% CI:10.76-12.83 months) Conclusion:The combination of gemcitabine and cisplatin is an active and safe treatment in patients with MPM. Further larger comparative studies are warranted to document this finding.展开更多
Bacille Calmette-Gu6rin(BCG) vaccine is one of the most widely used vaccines in children.In Egypt,it is a part of the national compulsory childhood immunization program.The most controversial aspect of BCG is the vari...Bacille Calmette-Gu6rin(BCG) vaccine is one of the most widely used vaccines in children.In Egypt,it is a part of the national compulsory childhood immunization program.The most controversial aspect of BCG is the variable efficacy found in different studies.This study was to evaluate the efficacy status of the available BCG vaccine in Egypt within the last 10 years(BCG-Copenhagen).The pilot cross sectional study included 597 Egyptian children randomly selected.Their ages ranged from 6 months to 10 years old(mean_ 5 years,median: 3 years).All were assessed for history of BCG vaccine intake(primary at infancy and/or secondary at school age) and examined for the presence BCG scar.A group of the vaccinated children(62 children with BCG scar and 69 children without BCG scar) were further assessed with tuberculin skin test(TST).Prevalence of BCG vaccine intake in the studied children was 86.9%(519/597).Efficacy in term of BCG scar after vaccination was 66.6%(346/519).However,efficacy in term of post BCG vaccination tuberculin sensitization was only 3.8%(5/131).BCG vaccination program in Egypt seems to be widely prevalent;however, the immunological efficacy of the available strain is questionable.展开更多
Objective:To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA(BioNTech/Pfizer)vaccine.Methods:Totally...Objective:To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA(BioNTech/Pfizer)vaccine.Methods:Totally 10735 adult volunteers that received at least one dose of BioNTech/Pfizer or triple doses of CoronaVac participated in this cross-sectional-online survey between 1 and 10 September 2021.The information was collected covering a 5-month period from April 2021 to September 2021.Information about people who were vaccinated with only single and double dose CoronaVac were not included in this study.Results:At least one side effect after single and double dose of BioNTech/Pfizer and triple doses of CoronaVac were observed in 42.1%,42.5%and 10.9%,respectively.The most common side effects were shoulder/arm pain,weakness/fatigue,muscle/joint pain and headache.The side effects were the most frequent in single BioNTech/Pfizer,while it was the least in triple CoronaVac.The rate of positive PCR tests before vaccination was 17.6%,and decreased to 3.0%after vaccination.The rates of positive SARS CoV-2-PCR were 18.8%,3.5%,3.1%,0.5%and 4.6%in single BioNTech/Pfizer,double BioNTech/Pfizer,double CoronaVac+single BioNTech/Pfizer,double CoronaVac+double BioNTech/Pfizer and triple CoronaVac,respectively.While 1.8%of PCR positive COVID-19 cases needed intensive unit care in the pre-vaccination period,intensive care unit was required in 0%,1.5%,2.4%,0%and 4.2%after single BioNTech/Pfizer,double BioNTech/Pfizer,double CoronaVac+single BioNTech/Pfizer,double CoronaVac+double BioNTech/Pfizer and triple CoronaVac,respectively.Reinfection rate after vaccination was 0.4%.Conclusions:The rarity of COVID-19 infection after vaccination suggests that efficacy of vaccines is maintained.On the other hand,the data underscore the critical importance of continued public health mitigation.展开更多
Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleedin...Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study included 56 patients with clinical, laboratory and radiological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were subjected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was successful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax.展开更多
Primary lung graft dysfunction could significantly attribute to ischemia-reperfusion lung injury(IRLI)during transplantation surgery.β2-adrenergic agonists were one of the bronchodilators that had been well-establish...Primary lung graft dysfunction could significantly attribute to ischemia-reperfusion lung injury(IRLI)during transplantation surgery.β2-adrenergic agonists were one of the bronchodilators that had been well-established in the management of asthma and chronic obstructive pulmonary disease(COPD)with anti-inflammatory potency.By applying the model of isolated rat lung,we evaluated the efficacy of short-actingβ2-agonist inhalation to ameliorate ischemia-reperfusion damage.The experiment protocol was 180 min of global ischemia and then reperfusion for 60 min.In theβ2-agonist inhalation group,aerosolized albuterol was administrated prior ischemia procedure.Increased weight ratios of wet to dry lung and microvascular permeability were characterized in the IRLI group.In contrast,pre-inhaledβ2-agonist significantly mitigated the severity of pulmonary edema.Bronchoalveolar lavage from theβ2-agonist group presented decreased leukocyte counts and cytokines production,including interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and macrophage inflammatory protein 2(MIP-2).Devastating oxidative stress was widely recognized during the ischemia-reperfusion process,whileβ2-agonist pretreatment revealed subsided H2O2,myeloperoxidase(MPO),and the cleavage of caspase-3.Western blotting from lung homogenates identified the blockade of NF-κB and MAPK activation in theβ2-agonist inhalation group.Currently,there was no specific pharmacotherapy in IRLI management.Our results elucidated the protective effect ofβ2-agonist bronchodilator against ischemia-reperfusion induced oxidative stress,inflammation reaction,and pulmonary edema.展开更多
The reported incidence of radiation pneumonitis (RP) has varied widely in clinical studies ranging from 0% to 54%. This wide range is probably the result of differences in its precipitating factors. This study aimed t...The reported incidence of radiation pneumonitis (RP) has varied widely in clinical studies ranging from 0% to 54%. This wide range is probably the result of differences in its precipitating factors. This study aimed to find out the predictive factors of RP in patients with NSCLC who were treated with concurrent chemotherapy and radiotherapy (CCRT). We prospectively studied 76 lung cancer patients who were treated with CCRT consecutively between January 2011 and May 2013 in the Department of Radiation Oncology at Cancer Institute, Assiut University. Radiographic images, pulmonary function tests and symptom assessment were used for the diagnosis of RP. Of the studied 76 patients, 25 patients developed RP (33%), 15 of them developed grade 2 RP, 8 patients developed grade 3 RP, 1 patient developed grade 4 toxicity, and 1 patient developed grade 5 toxicity. In multivariate analysis, FEV1 value (p = 0.000) and chronic obstructive pulmonary disease (COPD) (p = 0.012) were the most significant factors associated with RP. Pretreatment FEV1 value and COPD are useful indicators for predicting RP in NSCLC patients treated with CCRT. Pretreatment of pulmonary function and base-line pulmonary disease is critical for patients’ well being after chemoradiotherapy.展开更多
Background: The combination of the clinical features, HRCT score and echocardiographic evidence of pulmonary hypertension help assess the prognosis in bronchiectasis. Aim: To test whether pulmonary and cardiac functio...Background: The combination of the clinical features, HRCT score and echocardiographic evidence of pulmonary hypertension help assess the prognosis in bronchiectasis. Aim: To test whether pulmonary and cardiac functions associated with bronchiectasis would differ according to its type (cystic versus cylindrical) utilizing HRCT score, PFTs and echocardiography. Patients and Methods: A cross-sectional study of patients with bronchiectasis was conducted at Chest and Internal Medicine Departments at Assiut University Hospital, Egypt. The diagnosis of bronchiectasis type was based on HRCT findings. PFTs, HRCT score and echocardiography were assessed in all cases. Results: We studied 56 patients with bronchiectasis;31 were cystic (group A) and 25 were cylindrical (group B). Forced vital capacity (FVC%) and Dlco% were significantly lower in group A (P as compared with group B;whereas FEF 25%-75% and FEV1 (0.04) were lower in group B. Global HRCT score, RVD and SPAP were significantly higher in group A (P = 0.002) and correlated with FEV1% (r = ?0.51), and with SPAP (r = 0.16). Conclusions: Airway obstruction and small airway dysfunction were more significantly seen in cylindrical bronchiectasis. Patients with cystic bronchiectasis had significantly, higher global HRCT scores, RVD and SPAP. HRCT scores correlate with FEV 1% and SPAP and could be a predictor of future PH. Routine echocardiographic assessment of patients with bronchiectasis, particularly in those with cystic disease is highly recommended.展开更多
Introduction: Although an increased prevalence of airway obstruction, bronchial hyperreactivity and allergic diseases such as asthma has been associated with bronchiectasis, studies investigating role of atopy in bron...Introduction: Although an increased prevalence of airway obstruction, bronchial hyperreactivity and allergic diseases such as asthma has been associated with bronchiectasis, studies investigating role of atopy in bronchiectasis are few and controversial. We have therefore studied IgE level and reversible airways obstruction in bronchiectasis which have not previously been evaluated in bronchiectasis. Patients and Methods: This study was conducted at Department of Chest Diseases of Al-Azhar University, Assiut, Egypt from January 2012 to December 2013, all consecutive patients with bronchiectasis admitted to the department were enrolled to the study. Serum IgE, pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) were done to all cases. Results: Patients with high IgE (32/50) had longer disease duration and frequent history of allergic diseases. They also had significantly worse FEV1 (49.38 ± 12.65;p = 0.041) and FEV1/FVC (60.89 ± 13.52, p = 0.015) values. Mean HRCT score was significantly higher in patients with high IgE than in patients with normal (18/50) IgE (23.6 ± 10.1 and 7.83 ± 2.43 respectively). IgE showed positive correlation (r = 0.266, p = 0.015) with HRCT scores. Furthermore, the mean increase in FEV1 after inhalation of salbutamol was significantly greater (p = 0.002) in high IgE patients. Conclusions: In conclusion, IgE level is significantly high in bronchiectasis and it may lead to worse pulmonary function and more HRCT extent. Appreciable reversible airways obstruction should be sought in all cases of bronchiectasis and treated appropriately.展开更多
Introduction: The examination of three sputum samples per suspect has been severely criticized from a public health viewpoint and several recent trials have documented the relative inefficiency of the third smear and ...Introduction: The examination of three sputum samples per suspect has been severely criticized from a public health viewpoint and several recent trials have documented the relative inefficiency of the third smear and the necessity for confirmation of a positive smear has also been contested. Aim: This study, undertaken in Qena, Egypt, aimed to determine the usefulness of examining the second and third direct smear microscopy (DSM) specimen in the diagnosis of pulmonary TB. Patients and methods: A retrospective study using record review at TB outpatient clinic;Qena Chest Hospital, Egypt, was done from 2010-2013. Direct smear results were collected as one of the following combinations PNN, PPP, PPN, PNP, NNP, NPP, and NPN, NNN, where N is a negative and P a positive smear. The proportion of positive, first, second and third specimen were calculated. Cases were considered positive having at least one positive smear confirmed by another positive one in the absence of sputum culture. Results: Out of 9420 recorded suspects, 719 of them were positive, so smear positivity was 7.6%. The majority of them were diagnosed from the first sample (96.4%). For only 3.6% (26 of 719), the second smear was positive and a third specimen was required (NPP) to make a definitive diagnosis of TB. No recorded isolated positive or negative smears in the third sample (NNP or PPN). Conclusions: These data indicated that, in our locality with limited financial resources, the incremental yield of a second sputum direct smear examination was low, and the third one was negligible indicating that examination of two sputum samples is enough among pulmonary TB patients. A third sample is required only as confirmatory if the second sample was positive. Smear microscopy can be substantially simplified with favourable resource implications.展开更多
Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxa...Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.展开更多
Pulmonary embolism is a common and potentially lethal condition. Clinical signs and symptoms for pulmonary embolism are nonspecific. New and simple tests are therefore needed in order to help in early diagnosis of pul...Pulmonary embolism is a common and potentially lethal condition. Clinical signs and symptoms for pulmonary embolism are nonspecific. New and simple tests are therefore needed in order to help in early diagnosis of pulmonary embolism. The aim of this work is to elucidate the role of IMA in the diagnosis of pulmonary embolism. Subjects and Methods: 75 patients with suspected pulmonary embolism and 20 control healthy subjects were included in this study. Measurement of IMA was done in all subjects. Results: The mean values of IMA were statistically significantly higher among the PE patient group (0.43 ± 0.104 ABSU) in comparison with non PE patient group (0.27 ± 0.053 ABSU) and healthy control subjects (0.21 ± 0.080 ABSU). At cut-off value of 0.305 ABSU, IMA had 97.5% sensitivity and 71.42% specificity. The area under the curve was 0.952. The positive predictive value of this cut-off value was 79.59% while the negative predictive value was 96.15%. Conclusions: IMA is a good alternative to D-dimer in the diagnosis and exclusion of PE. Larger studies are needed to augment our results.展开更多
Background: Small cell lung cancer (SCLC) is a high grade neuroendocrine tumor, and has aggressive nature, so the majority of cases are presented with extensive disease. SCLC was staged into 2 categories: limited-stag...Background: Small cell lung cancer (SCLC) is a high grade neuroendocrine tumor, and has aggressive nature, so the majority of cases are presented with extensive disease. SCLC was staged into 2 categories: limited-stage disease (LS-SCLC) and extensive disease (ES-SCLC). Despite SCLC is sensitive to ra-diotherapy and chemotherapy, SCLC has high tendency for rapid dissemina-tion to regional and distant sites. Median survival time ranged from 2 - 4 months in patients with untreated SCLC. Multiagent chemotherapy was the primary treatment for SCLC. Aim of the work: This retrospective study was conducted to evaluate and analyze clinical features, treatment outcome, sur-vival and prognostic factors affecting survival in patients with SCLC presented to Clinical Oncology and Nuclear Medicine department, Chest department and Medical oncology unit in Mansoura Oncology Centre during the period from 2000-2015. Methods: Data of patients were collected from their files. The information obtained included demographic features, treatment received;its toxicity and outcome, survival and its prognostic factors. Demographic data were: age, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), smoking status, stage of disease. Data also included disease presentation and metastatic sites. Several factors affecting survival were analysed as age, sex, stage, PS, smoking status and LDH. Results: Sixty-three patients were enrolled in this study. Median age was 56.2 ± 6. Strong male predominance (92.1%) was observed;84.1% of them were smoker. Thirty six patients (57.2%) were of ECOG-PS of 0 - 1. ES-SCLC was reported in 65% of cases and LDH was high (>1.5 xN) in 47.6%. The most common symptom was chest pain (38.1%) followed by cough (31.8%), weight loss (30%). Fifteen patients had single metastatic site (23.8%) and bone was the most common site of metastasis (reported in 8 patients) followed by brain, lung and liver. 2-year overall survival rate was 35% with median survival time of 14 months. On multivariate analysis, there were significantly higher survival in patients aged Conclusion: This clinico-epidemiologic study provides multiple prognostic factors that have important impact on survival as age, sex, LDH level, stage, smoking and performance status. Larger number of patients and prospective studies are needed to clarify more prognostic factor.展开更多
Percutaneous nephrolithotomy (PCNL) is very popular and an efficient method as a gold standard in management of renal calculi. It is the first-choice method in management of renal calculi larger than 2 cm. Our patient...Percutaneous nephrolithotomy (PCNL) is very popular and an efficient method as a gold standard in management of renal calculi. It is the first-choice method in management of renal calculi larger than 2 cm. Our patient underwent PCNL upon observing multiple renal calculi larger than 10 mm in a lower pole of the right kidney. Biopsy was performed during PNCL because morphology and endoscopic view of the calyx were irregular, calcific and pale white in color. The patient developed prolonged urinary leakage from the lumbar region and J-stent was inserted after the re-entry catheter had been removed following successful PCNL. Prolonged urinary leakage persisted although location of the J-stent was normal. Tuberculosis of the urinary tract should be the first option in the dif ferential diagnosis of fistula discharge following PCNL. In our patient, the biopsy taken at the time of PCNL revealed renal tuberculosis. Urinary tract tuberculosis must definitely be considered in the fistula tract persisted and not closed fol lowing PCNL as in the present case. Diagnosis of tuberculosis was made early in this case owing to tissue sampling during operation, and thus the treatment was begun early. So we consider this patient as a special case.展开更多
文摘Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .
文摘BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.
文摘Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.
文摘A third of the world’s population is latently infected with TB with an increased risk of developing active TB. Household contacts (HHCs) of pulmonary TB cases are at a greater risk of developing disease. Early identification and treatment of latent TB infected individuals may reduce progression to active TB. This study aimed to determine latent TB infections (LTBI) point prevalence among HHCs and community contacts (CCs) using Tuberculin Skin Test (TST) and whole blood IFN-γ release assay in an area of high TB prevalence. In a prospective, longitudinal and community-based study and following informed consent, 768 volunteers (HHCs n = 245;CCs n = 523) were enrolled. Tuberculin Skin Test (TST), whole blood stimulation with PPD and IFN-γ levels determination using ELISA were performed. Mean ages of HHCs and the CCs were not significantly different (HHCs 35.6 ± 15.7 and CCs 30.6 ± 11.7 years;p = 0.99), with a Male:Female ratio of 1:2. Mean recruitment TST indurations were 4.6 ± 5.5 mm and 2.8 ± 3 mm for HHCs and CCs respectively (p = 0.000). Follow-up (Day 614) mean TST indurations increased significantly to 9.1 ± 7.2 mm and 4.4 ± 3.2 mm for HHCs and CCs respectively (p = 0.001). Using TST indurations ≥ 10 mm, LTBI point prevalence for HHCs and CCs was significantly different (HHCs 461/1000 and 367/1000 individuals, p = 0.03). The mean IFN-γ levels for HHCs and CCs at recruitment day (Day 0) were 0.66 ± 0.17 IU/ml and 0.06 ± 0.04 respectively. The mean of IFN-γ production levels dropped significantly at Day 614 for HHCs and CCs to 0.66 ± 0.15 IU/ml and 0.02 ± 0.02 respectively (p = 0.03) (p = 0.00001). Recruitment LTBI point prevalence using IFN-γ level ≥ 0.35 IU/ml for HHCs and CCs was 440/1000 and 203/1000 respectively (p = 0.000000001). No correlations between TST indurations and IFN-γ levels were detected among HHCs or CCs (p > 0.05). TST is a simple, efficient and cheap technique for LTBI diagnosis and triaging individuals for treatment.
文摘Objectne:To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection-post swine flu pandemic era-using rapid influenza diagnostic tests.Methods:During two year,(2010&2011),1200 children with influenza like illness or acute respiratory tract infections(according to World Health Organization criteria)were recruited.Their ages ranged from 2-60 months.Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test.Results:Influenza A virus rapid test was positive in 47.5%of the children;the majority(89.6%)were presented with lower respiratory tract infections.Respiratory rate and temperature were significantly higher among positive rapid influenza test patients.Conclusions:Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children.It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.
文摘Objective:The aim of our study was to evaluate the efficacy and safety of gemcitabine and cisplatin in patients with previously untreated advanced malignant pleural mesothelioma (MPM). Methods:Thirty-three eligible patients with histologically proven advanced MPM with ECOG PS of ≤ 2 and had adequate liver and kidney functions received gemcitabine (1000 mg/m 2 ) on days 1 and 8 combined with cisplatin (80 mg/m 2 ) on day 1. Results:The majority of the study group were males and constituted 87.9% (n = 29), while females constituted 12.1% (n = 4). The median age was 52 years and ranged from 37 to 69 years. Regarding SWOG performance status, 5 patients were PS 0, 21 patients were PS 1 and 7 patients were PS 2. Regarding pathological subtypes, epithelial histology represented 84.8% of the study (n = 28) while sarcomatoid type represented 6% (n = 2) and biphasic type accounted for 9% (n = 3). Regarding staging according to IMIG staging system, 12.1% of patients were stage II, 54.5% were stage III and 33.3% were stage IV. Only one patient (3%) had attained a complete response, 18 patients (54.5%) showed partial response, 12 patients (36.4%) showed stationary disease, while 2 patients (6.1%) showed progressive disease. The correlation between response rate obtained and PS was statistically significant (P = 0.029). After a median follow-up of 14.4 months, the median survival time was 20.3 months (95% CI:14.58-26.01 months) and the progression free survival time was 11.8 months (95% CI:10.76-12.83 months) Conclusion:The combination of gemcitabine and cisplatin is an active and safe treatment in patients with MPM. Further larger comparative studies are warranted to document this finding.
文摘Bacille Calmette-Gu6rin(BCG) vaccine is one of the most widely used vaccines in children.In Egypt,it is a part of the national compulsory childhood immunization program.The most controversial aspect of BCG is the variable efficacy found in different studies.This study was to evaluate the efficacy status of the available BCG vaccine in Egypt within the last 10 years(BCG-Copenhagen).The pilot cross sectional study included 597 Egyptian children randomly selected.Their ages ranged from 6 months to 10 years old(mean_ 5 years,median: 3 years).All were assessed for history of BCG vaccine intake(primary at infancy and/or secondary at school age) and examined for the presence BCG scar.A group of the vaccinated children(62 children with BCG scar and 69 children without BCG scar) were further assessed with tuberculin skin test(TST).Prevalence of BCG vaccine intake in the studied children was 86.9%(519/597).Efficacy in term of BCG scar after vaccination was 66.6%(346/519).However,efficacy in term of post BCG vaccination tuberculin sensitization was only 3.8%(5/131).BCG vaccination program in Egypt seems to be widely prevalent;however, the immunological efficacy of the available strain is questionable.
文摘Objective:To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA(BioNTech/Pfizer)vaccine.Methods:Totally 10735 adult volunteers that received at least one dose of BioNTech/Pfizer or triple doses of CoronaVac participated in this cross-sectional-online survey between 1 and 10 September 2021.The information was collected covering a 5-month period from April 2021 to September 2021.Information about people who were vaccinated with only single and double dose CoronaVac were not included in this study.Results:At least one side effect after single and double dose of BioNTech/Pfizer and triple doses of CoronaVac were observed in 42.1%,42.5%and 10.9%,respectively.The most common side effects were shoulder/arm pain,weakness/fatigue,muscle/joint pain and headache.The side effects were the most frequent in single BioNTech/Pfizer,while it was the least in triple CoronaVac.The rate of positive PCR tests before vaccination was 17.6%,and decreased to 3.0%after vaccination.The rates of positive SARS CoV-2-PCR were 18.8%,3.5%,3.1%,0.5%and 4.6%in single BioNTech/Pfizer,double BioNTech/Pfizer,double CoronaVac+single BioNTech/Pfizer,double CoronaVac+double BioNTech/Pfizer and triple CoronaVac,respectively.While 1.8%of PCR positive COVID-19 cases needed intensive unit care in the pre-vaccination period,intensive care unit was required in 0%,1.5%,2.4%,0%and 4.2%after single BioNTech/Pfizer,double BioNTech/Pfizer,double CoronaVac+single BioNTech/Pfizer,double CoronaVac+double BioNTech/Pfizer and triple CoronaVac,respectively.Reinfection rate after vaccination was 0.4%.Conclusions:The rarity of COVID-19 infection after vaccination suggests that efficacy of vaccines is maintained.On the other hand,the data underscore the critical importance of continued public health mitigation.
文摘Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study included 56 patients with clinical, laboratory and radiological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were subjected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was successful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax.
基金the Tri-Service General Hospital,National Defesnse Medical Center in Taiwan(TSGH-C108-109).
文摘Primary lung graft dysfunction could significantly attribute to ischemia-reperfusion lung injury(IRLI)during transplantation surgery.β2-adrenergic agonists were one of the bronchodilators that had been well-established in the management of asthma and chronic obstructive pulmonary disease(COPD)with anti-inflammatory potency.By applying the model of isolated rat lung,we evaluated the efficacy of short-actingβ2-agonist inhalation to ameliorate ischemia-reperfusion damage.The experiment protocol was 180 min of global ischemia and then reperfusion for 60 min.In theβ2-agonist inhalation group,aerosolized albuterol was administrated prior ischemia procedure.Increased weight ratios of wet to dry lung and microvascular permeability were characterized in the IRLI group.In contrast,pre-inhaledβ2-agonist significantly mitigated the severity of pulmonary edema.Bronchoalveolar lavage from theβ2-agonist group presented decreased leukocyte counts and cytokines production,including interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and macrophage inflammatory protein 2(MIP-2).Devastating oxidative stress was widely recognized during the ischemia-reperfusion process,whileβ2-agonist pretreatment revealed subsided H2O2,myeloperoxidase(MPO),and the cleavage of caspase-3.Western blotting from lung homogenates identified the blockade of NF-κB and MAPK activation in theβ2-agonist inhalation group.Currently,there was no specific pharmacotherapy in IRLI management.Our results elucidated the protective effect ofβ2-agonist bronchodilator against ischemia-reperfusion induced oxidative stress,inflammation reaction,and pulmonary edema.
文摘The reported incidence of radiation pneumonitis (RP) has varied widely in clinical studies ranging from 0% to 54%. This wide range is probably the result of differences in its precipitating factors. This study aimed to find out the predictive factors of RP in patients with NSCLC who were treated with concurrent chemotherapy and radiotherapy (CCRT). We prospectively studied 76 lung cancer patients who were treated with CCRT consecutively between January 2011 and May 2013 in the Department of Radiation Oncology at Cancer Institute, Assiut University. Radiographic images, pulmonary function tests and symptom assessment were used for the diagnosis of RP. Of the studied 76 patients, 25 patients developed RP (33%), 15 of them developed grade 2 RP, 8 patients developed grade 3 RP, 1 patient developed grade 4 toxicity, and 1 patient developed grade 5 toxicity. In multivariate analysis, FEV1 value (p = 0.000) and chronic obstructive pulmonary disease (COPD) (p = 0.012) were the most significant factors associated with RP. Pretreatment FEV1 value and COPD are useful indicators for predicting RP in NSCLC patients treated with CCRT. Pretreatment of pulmonary function and base-line pulmonary disease is critical for patients’ well being after chemoradiotherapy.
文摘Background: The combination of the clinical features, HRCT score and echocardiographic evidence of pulmonary hypertension help assess the prognosis in bronchiectasis. Aim: To test whether pulmonary and cardiac functions associated with bronchiectasis would differ according to its type (cystic versus cylindrical) utilizing HRCT score, PFTs and echocardiography. Patients and Methods: A cross-sectional study of patients with bronchiectasis was conducted at Chest and Internal Medicine Departments at Assiut University Hospital, Egypt. The diagnosis of bronchiectasis type was based on HRCT findings. PFTs, HRCT score and echocardiography were assessed in all cases. Results: We studied 56 patients with bronchiectasis;31 were cystic (group A) and 25 were cylindrical (group B). Forced vital capacity (FVC%) and Dlco% were significantly lower in group A (P as compared with group B;whereas FEF 25%-75% and FEV1 (0.04) were lower in group B. Global HRCT score, RVD and SPAP were significantly higher in group A (P = 0.002) and correlated with FEV1% (r = ?0.51), and with SPAP (r = 0.16). Conclusions: Airway obstruction and small airway dysfunction were more significantly seen in cylindrical bronchiectasis. Patients with cystic bronchiectasis had significantly, higher global HRCT scores, RVD and SPAP. HRCT scores correlate with FEV 1% and SPAP and could be a predictor of future PH. Routine echocardiographic assessment of patients with bronchiectasis, particularly in those with cystic disease is highly recommended.
文摘Introduction: Although an increased prevalence of airway obstruction, bronchial hyperreactivity and allergic diseases such as asthma has been associated with bronchiectasis, studies investigating role of atopy in bronchiectasis are few and controversial. We have therefore studied IgE level and reversible airways obstruction in bronchiectasis which have not previously been evaluated in bronchiectasis. Patients and Methods: This study was conducted at Department of Chest Diseases of Al-Azhar University, Assiut, Egypt from January 2012 to December 2013, all consecutive patients with bronchiectasis admitted to the department were enrolled to the study. Serum IgE, pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) were done to all cases. Results: Patients with high IgE (32/50) had longer disease duration and frequent history of allergic diseases. They also had significantly worse FEV1 (49.38 ± 12.65;p = 0.041) and FEV1/FVC (60.89 ± 13.52, p = 0.015) values. Mean HRCT score was significantly higher in patients with high IgE than in patients with normal (18/50) IgE (23.6 ± 10.1 and 7.83 ± 2.43 respectively). IgE showed positive correlation (r = 0.266, p = 0.015) with HRCT scores. Furthermore, the mean increase in FEV1 after inhalation of salbutamol was significantly greater (p = 0.002) in high IgE patients. Conclusions: In conclusion, IgE level is significantly high in bronchiectasis and it may lead to worse pulmonary function and more HRCT extent. Appreciable reversible airways obstruction should be sought in all cases of bronchiectasis and treated appropriately.
文摘Introduction: The examination of three sputum samples per suspect has been severely criticized from a public health viewpoint and several recent trials have documented the relative inefficiency of the third smear and the necessity for confirmation of a positive smear has also been contested. Aim: This study, undertaken in Qena, Egypt, aimed to determine the usefulness of examining the second and third direct smear microscopy (DSM) specimen in the diagnosis of pulmonary TB. Patients and methods: A retrospective study using record review at TB outpatient clinic;Qena Chest Hospital, Egypt, was done from 2010-2013. Direct smear results were collected as one of the following combinations PNN, PPP, PPN, PNP, NNP, NPP, and NPN, NNN, where N is a negative and P a positive smear. The proportion of positive, first, second and third specimen were calculated. Cases were considered positive having at least one positive smear confirmed by another positive one in the absence of sputum culture. Results: Out of 9420 recorded suspects, 719 of them were positive, so smear positivity was 7.6%. The majority of them were diagnosed from the first sample (96.4%). For only 3.6% (26 of 719), the second smear was positive and a third specimen was required (NPP) to make a definitive diagnosis of TB. No recorded isolated positive or negative smears in the third sample (NNP or PPN). Conclusions: These data indicated that, in our locality with limited financial resources, the incremental yield of a second sputum direct smear examination was low, and the third one was negligible indicating that examination of two sputum samples is enough among pulmonary TB patients. A third sample is required only as confirmatory if the second sample was positive. Smear microscopy can be substantially simplified with favourable resource implications.
文摘Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.
文摘Pulmonary embolism is a common and potentially lethal condition. Clinical signs and symptoms for pulmonary embolism are nonspecific. New and simple tests are therefore needed in order to help in early diagnosis of pulmonary embolism. The aim of this work is to elucidate the role of IMA in the diagnosis of pulmonary embolism. Subjects and Methods: 75 patients with suspected pulmonary embolism and 20 control healthy subjects were included in this study. Measurement of IMA was done in all subjects. Results: The mean values of IMA were statistically significantly higher among the PE patient group (0.43 ± 0.104 ABSU) in comparison with non PE patient group (0.27 ± 0.053 ABSU) and healthy control subjects (0.21 ± 0.080 ABSU). At cut-off value of 0.305 ABSU, IMA had 97.5% sensitivity and 71.42% specificity. The area under the curve was 0.952. The positive predictive value of this cut-off value was 79.59% while the negative predictive value was 96.15%. Conclusions: IMA is a good alternative to D-dimer in the diagnosis and exclusion of PE. Larger studies are needed to augment our results.
文摘Background: Small cell lung cancer (SCLC) is a high grade neuroendocrine tumor, and has aggressive nature, so the majority of cases are presented with extensive disease. SCLC was staged into 2 categories: limited-stage disease (LS-SCLC) and extensive disease (ES-SCLC). Despite SCLC is sensitive to ra-diotherapy and chemotherapy, SCLC has high tendency for rapid dissemina-tion to regional and distant sites. Median survival time ranged from 2 - 4 months in patients with untreated SCLC. Multiagent chemotherapy was the primary treatment for SCLC. Aim of the work: This retrospective study was conducted to evaluate and analyze clinical features, treatment outcome, sur-vival and prognostic factors affecting survival in patients with SCLC presented to Clinical Oncology and Nuclear Medicine department, Chest department and Medical oncology unit in Mansoura Oncology Centre during the period from 2000-2015. Methods: Data of patients were collected from their files. The information obtained included demographic features, treatment received;its toxicity and outcome, survival and its prognostic factors. Demographic data were: age, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), smoking status, stage of disease. Data also included disease presentation and metastatic sites. Several factors affecting survival were analysed as age, sex, stage, PS, smoking status and LDH. Results: Sixty-three patients were enrolled in this study. Median age was 56.2 ± 6. Strong male predominance (92.1%) was observed;84.1% of them were smoker. Thirty six patients (57.2%) were of ECOG-PS of 0 - 1. ES-SCLC was reported in 65% of cases and LDH was high (>1.5 xN) in 47.6%. The most common symptom was chest pain (38.1%) followed by cough (31.8%), weight loss (30%). Fifteen patients had single metastatic site (23.8%) and bone was the most common site of metastasis (reported in 8 patients) followed by brain, lung and liver. 2-year overall survival rate was 35% with median survival time of 14 months. On multivariate analysis, there were significantly higher survival in patients aged Conclusion: This clinico-epidemiologic study provides multiple prognostic factors that have important impact on survival as age, sex, LDH level, stage, smoking and performance status. Larger number of patients and prospective studies are needed to clarify more prognostic factor.
文摘Percutaneous nephrolithotomy (PCNL) is very popular and an efficient method as a gold standard in management of renal calculi. It is the first-choice method in management of renal calculi larger than 2 cm. Our patient underwent PCNL upon observing multiple renal calculi larger than 10 mm in a lower pole of the right kidney. Biopsy was performed during PNCL because morphology and endoscopic view of the calyx were irregular, calcific and pale white in color. The patient developed prolonged urinary leakage from the lumbar region and J-stent was inserted after the re-entry catheter had been removed following successful PCNL. Prolonged urinary leakage persisted although location of the J-stent was normal. Tuberculosis of the urinary tract should be the first option in the dif ferential diagnosis of fistula discharge following PCNL. In our patient, the biopsy taken at the time of PCNL revealed renal tuberculosis. Urinary tract tuberculosis must definitely be considered in the fistula tract persisted and not closed fol lowing PCNL as in the present case. Diagnosis of tuberculosis was made early in this case owing to tissue sampling during operation, and thus the treatment was begun early. So we consider this patient as a special case.
