Mahmoud, A. M., M. M. Hussein, and M. M. Moneer, "Outcome and surgical strategy in critical sites in cases of psuedomyxoma peritonei", Journal of the Egyptian National Cancer Institute, vol. 28, issue 4, pp. 249-255, 2016. AbstractWebsite

BACKGROUND:
For a long time peritoneal neoplasms were considered beyond surgical intervention and beyond cure, till the concept of cytoreductive surgery (CRS) and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced. However this surgical intervention is technically demanding and associated with considerable postoperative morbidity.
OBJECTIVE:
To describe the surgical strategy in resection of critical sites loaded by heavy tumor deposits and to evaluate short and long term results of CRS and HIPEC, in a cohort of Egyptian patients with pseudomyxoma peritonei (PMP) from appendiceal origin.
PATIENTS AND METHODS:
21 patients with PMP, age ranged from 40 to 63years, 12 males and 9 females. All were recruited from the department of surgery at the National Cancer Institute (NCI), Cairo University over the period from February 2011 to February 2016. They were subjected to CRS and HIPEC with mitomycin-C.
RESULTS:
The median peritoneal carcinoma index (PCI) was 22 (range: 10-39). Optimal cytoreduction (CCR-0/1) was achieved in 19 patients (90.4%) of whom 17 patients (80.9%) had a complete cytoreduction (CCR-0). The median follow up period was 51.5months (range: 0.07-82.3months). The cumulative overall survival was 85.7% while the cumulative disease free survival was 76.9%.
CONCLUSION:
To the best of our knowledge, this is the first study reporting five years postoperative outcome of CRS and HIPEC in Egyptian patients with PMP from appendiceal origin. Our results support that although technically demanding this treatment modality is safe and associated with favorable outcome.

medhat khafagy, Mayla, Ahmed M, A. Khafagy, N. Baraya, E. Gamal, and M. M. Moneer, "Postoperative anaerobic sepsis could be combated by prophylactic vaccination", Journal of Chemical and Pharmaceutical Research, vol. 8, issue 3, pp. 402 - 404, 2016. Abstract

Postoperative sepsis is the leading cause of morbidity and mortality after major surgery, resulting in hefty financial
costs in hospitals all over the world. 40 Fischer rats were injected intra-peritoneally with 0.05 ml Covexin 10 which
contains toxoids from different Clostridial species, 2 weeks prior to caecal ligation and puncture. Another 40
Fischer rats, as a control, underwent caecal ligation and puncture without vaccination. 16 of 40 vaccinated rats
died (40%), peritoneal fluid cultures from the dead rats grew E. coli only, and 36 of 40 control rats died (90%),
peritoneal fluid cultures from the dead rats were: 19 grew E. coli and C. perfringens; 12 grew E. coli,C.
perfringens, and enterococci; 3 grew E. coli only; 1 grew E. coli, and enterocci; and 1 grew no organisms.
Prophylactic vaccination with clostridial toxoids proved effectiveness in preventing anaerobic infection, and reduce
mortality in rats that underwent caecal ligation and puncture; the gold standard model for polymicrobial sepsis.
Currently, a pilot study is underway in which human patients who will undergo major surgery are prophylactically
vaccinated with clostridial toxoids, in an attempt to eradicate postoperative anaerobic sepsis.

Nagy, N., M. Mostafe, H. Makhlof, M. Moneer, and W. Zekry, "Impact of Child’s Cancer on Family Life Case Study: Children with Cancer Newly admitted to the National Cancer Institute (NCI), Cairo University", Pak.j.stat.oper.res, vol. 13, issue 2, pp. 463-482, 2017. Abstract

The diagnosis of a family member with any disease certainly affects the family life in general. Hence, this
study aims at exploring how the diagnosis of a child with cancer affects family life. Additionally, the study
seeks to identify the extent to which the life of family can change when they have a child diagnosed with
cancer. This study uses advanced statistical analysis through conducting a random sampling field study of
(804) individuals, of which (402) were mothers of children diagnosed with cancer (as a case group), and
(402) were mothers whose children’s samples gave negative results when tested for cancer (as a control
group). Through a Questionnaire Form designed to track the extent to which the lives of families covered
by the two study samples (the case group and the control group) have changed, data were collected in 2015,
the researcher used a number of indicators, which she believes to have an effect on family status, to
compare the changes experienced by families in both groups. The 11 indicators used by the study measure
the effects of having a child with cancer in each family individually. Results revealed significant
differences in the values of indicators between the group having a child with cancer and the group whose
children tested negative for cancer before and after diagnosis/examination. A composite indicator
consisting of the previous indicators is developed using Factor Analysis, which calculated the said indicator
based on four factors. These factors are then multiplied by their corresponding weights and aggregated into
the new composite indicator(Family Status Indicator). The indicator was clustered using the K-Mean
Cluster Analysis into 3 clusters, i.e. low, medium, and high. Conclusion: The child cancer has an impact on
the Family Status indicator, demographics and socioeconomic determinants affect the Family Status
indicator like (mother work and Education, Education of the father, Place of Residence,...etc.) after child
examination or disease.

Zayed, S. M., K. A. Elsetohy, M. Zayed, and U. M. Fouda, "Factors affecting pain experienced during office hysteroscopy", Middle East Fertility Society Journal, vol. 20, issue 3, pp. 154 - 158, 2015. AbstractWebsite
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Zeeneldin, A. A., F. M. Taha, and M. Moneer, "Past and future trends in cancer and biomedical research: a comparison between Egypt and the world using PubMed-indexed publications", BMC research notes, vol. 5, pp. 349, 2012. Abstract

BACKGROUND: PubMed is a free web literature search service that contains almost 21 millions of abstracts and publications with almost 5 million user queries daily. The purposes of the study were to compare trends in PubMed-indexed cancer and biomedical publications from Egypt to that of the world and to predict future publication volumes.METHODS: The PubMed was searched for the biomedical publications between 1991 and 2010 (publications dates). Affiliation was then limited to Egypt. Further limitation was applied to cancer, human and animal publications. Poisson regression model was used for prediction of future number of publications between 2011 and 2020.
RESULTS: Cancer publications contributed 23% to biomedical publications both for Egypt and the world. Egyptian biomedical and cancer publications contributed about 0.13% to their world counterparts. This contribution was more than doubled over the study period. Egyptian and world's publications increased from year to year with rapid rise starting the year 2003. Egyptian as well as world's human cancer publications showed the highest increases. Egyptian publications had some peculiarities; they showed some drop at the years 1994 and 2002 and apart from the decline in the animal: human ratio with time, all Egyptian publications in the period 1991-2000 were significantly more than those in 2001-2010 (P < 0.05 for all). By 2020, Egyptian biomedical and cancer publications will increase by 158.7% and 280% relative to 2010 to constitute 0.34% and 0.17% of total PubMed publications, respectively.
CONCLUSIONS: The Egyptian contribution to world's biomedical and cancer publications needs significant improvements through research strategic planning, setting national research priorities, adequate funding and researchers' training.

Gamal T Ebid, I. A. Sedhom, M. M. El-Gammal, and M. M. Moneer, "MDM2 T309G has a synergistic effect with P21 ser31arg single nucleotide polymorphisms on the risk of acute myeloid leukemia", Asian Pacific journal of cancer prevention: APJCP, vol. 13, issue 9, pp. 4315 - 4320, 2012. Abstract

BACKGROUND: The P53 tumor suppressor gene plays a pivotal role in maintaining cellular homeostasis by preventing the propagation of genome mutations. P53 in its transcriptionally active form is capable of activating distinct target genes that contribute to either apoptosis or growth arrest, like P21. However, the MDM2 gene is a major negative regulator of P53. Single nucleotide polymorphisms (SNP) in codon Arg72Pro of P53 results in impairment of the tumor suppressor activity of the gene. A similar effect is caused by a SNP in codon 31 of P21. In contrast, a SNP in position 309 of MDM2 results in increased expression due to substitution of thymine by guanine. All three polymorphisms have been associated with increased risk of tumorigenesis.AIM OF THE STUDY: We aimed to study the prevalence of SNPs in the P53 pathway involving the three genes, P53, P21 and MDM2, among acute myeloid leukemia (AML) patients and to compare it to apparently normal healthy controls for assessment of impact on risk.
RESULTS: We found that the P21 ser31arg heterozygous polymorphism increases the risk of AML (P value=0.017, OR=2.946, 95% CI=1.216-7.134). Although the MDM2 309G allele was itself without affect, it showed a synergistic effect with P21 ser/arg polymorphism (P value=0.003, OR= 6.807, 95% CI= 1.909-24.629). However, the MDM2 309T allele abolish risk effect of the P21 polymorphic allele (P value= 0.71). There is no significant association of P53 arg72pro polymorphism on the risk of AML.
CONCLUSION: We suggest that SNPs in the P53 pathway, especially the P21 ser31arg polymorphism and combined polymorphisms especially the P21/ MDM2 might be genetic susceptibility factors in the pathogenesis of AML.

Zaher, A. E. - S., A. M. Zaher, M. M. Moneer, and B. M. Elgamal, "Evaluation of morphological/immunohistochemical versus nuclear medicine imaging modalities in detecting metastatic bone and/or marrow deposits in neuroblastoma patients", Journal of the Egyptian National Cancer Institute, vol. 23, issue 2, pp. 79 - 88, 2011. Abstract

BACKGROUND & PURPOSE: In planning diagnostic or follow-up investigational strategies, neuroblastoma (NB) metastatic deposits in bone and/or bone marrow (BM) should be detected as early as possible. Therefore, all investigational detection tools should be conducted simultaneously for precise staging. However, because of the financial conditions in our developing countries and in view of the cost/benefit relationship, the question is, can one detection tool only become satisfactory and replacing others? The purpose of our study is to compare simultaneous results of bone and metaiodobenzylguanidine (MIBG) scans versus BM biopsies with immunohistochemical (IHC) staining; in detecting bone and/or BM metastatic deposits in NB patients.MATERIAL AND METHODS: This study included 138 NB patients; 46 were de novo and 92 were under follow-up. They were subjected to bilateral BM biopsies, IHC staining (using NSE McAb) and Tc-99m methylene diphosphonate (Tc-99m MDP) bone scan (BS). Only 57/138 patients were, in addition, subjected to I-131 MIBG scan.
RESULTS: Matched results between IHC-stained BM sections and bone scans (BSs) 107/138 (77.5%) were higher than the un-matched ones 31/138 (22.5%). There was a moderate agreement between the two methods in all studied cases (Kappa=0.538) and it was higher among de novo (Kappa=0.603) than follow-up group (Kappa=0.511). Among the 31 un-matched results, the most frequent (17/31) were due to the presence of minute amount of infiltrating NB cells that could be detected by IHC-stained BM sections and not by BSs. The less frequent (12/31) were due to the presence of metastatic deposits outside pelvic bones that could be detected by BSs and not by IHC-stained BM sections mainly in the follow-up cases (11/12) rather than de novo cases (1/12). The matched results between IHC-stained BM sections and MIBG scans 54/57 (94.7%) were higher than the un-matched ones 3/57 (5.3%). The agreement between the two methods was higher among de novo (Kappa=1.000) than follow-up group (Kappa=0.847). The agreement between IHC-stained BM sections and MIBG scans was substantial (Kappa=0.890) while that between IHC-stained BM sections and BSs was moderate (Kappa=0.538).
CONCLUSIONS: We suggest a step-wise strategy to be applied, at least in developing countries, in approaching de novo and follow-up NB cases for detecting bone and/or BM metastatic deposits. This strategy might be beneficial if it is considered during application of NB guide-lines for diagnosis and follow-up.

Elshafiey, M. M., A. A. Zeeneldin, H. I. Elsebai, M. Moneer, D. B. Mohamed, I. Gouda, and A. A. Attia, "Epidemiology and management of breast carcinoma in Egyptian males: experience of a single Cancer Institute", Journal of the Egyptian National Cancer Institute, vol. 23, issue 3, pp. 115 - 122, 2011. Abstract

OBJECTIVE: To assess the epidemiological and clinico-pathological features, surgical and reconstructive techniques, adjuvant treatments and clinical outcome of breast carcinoma in males (BCM) at the Egyptian National Cancer Institute (NCI).PATIENTS AND METHODS: Thirty-two males with breast carcinoma presented to NCI between January 2000 and December 2002. They were evaluated by complete history, physical examination, laboratory and radiological investigations.
RESULTS: Median age was 59 years. Left sided and retroareolar breast lumps were the commonest presentations. Grade II tumors positive for hormone receptors were very common. Stages I, II, III and IV of the disease were encountered in 6.2%, 34.4%, 34.4% and 25.0% of patients, respectively. Curative surgery was done in 22 patients; they received adjuvant hormonal therapy, chemotherapy and radiotherapy in 22, 16 and 10 patients, respectively. Eight metastatic patients were treated with palliative measures. Surgery was done in 25 patients; the most common procedure was modified radical mastectomy (40.6%). Primary closure was feasible in 17 patients (68%), local flaps were needed in 4 cases (16%), while myocutaneous flap was done in 3 cases (12%). The commonest complication was the development of seroma (9 cases). The overall survival (OS) at 5 years was 65.4%. The disease free survival (DFS) at 5 years was 53.9%. Stage and curative surgery significantly affected OS, while type of surgery was the only variable significantly affecting DFS.
CONCLUSION: Male breast carcinoma occurs at older ages than females, usually in advanced stage. This necessitates directing attention of males and awareness on the prevalence and risk factors for this disease.

Elsayed, G. M., M. M. Ismail, and M. M. Moneer, "Expression of P-glycoprotein, Cyclin D1 and Ki-67 in Acute Lymphoblastic Leukemia: Relation with Induction Chemotherapy and Overall Survival", Indian Journal of Hematology & Blood Transfusion, vol. 27, issue 3, pp. 157 - 163, 2011. AbstractWebsite

Previous studies showed that non-cycling cells have a higher multidrug resistance (MDR) expression, which may be down-regulated by proliferation induction. Triggering these cells into proliferation down-regulates high MDR expression. The aim of this study was to determine the expression of P-glycoprotein (PGP) and cell cycle parameters (cyclin D1 and Ki-67) in acute lymphoblastic leukemia (ALL) at diagnosis, and to evaluate the correlation between the expressions of each marker, and the clinical significance of such expression with response to induction chemotherapy and overall survival. A total of 78 newly diagnosed ALL patients were enrolled in our study. PGP, cyclin D1 and Ki-67 were determined by flow cytometry. PGP expression was encountered in 10/78 (12.8%) of ALL cases. Cyclin D1 and Ki-67 were expressed in 16/77 (20.6%) and 27/76 (34.6%) of ALL cases, respectively. None of the parameters were associated with response to induction chemotherapy and overall survival. Based on the current analysis, we conclude that a joint immunophenotypic evaluation of PGP and cell cycle parameters like that adopted in this study is unlikely to reveal mechanisms of multidrug resistance associated with the clinical outcome.

Zakhary, N. I., M. M. El-Merzabani, N. M. El-Sawi, S. M. Saleh, M. M. Moneer, and R. H. Mohamad, "Impact of different biochemical markers in serum of patients with benign and malignant liver diseases", Journal of Advanced Research, vol. 2, issue 1, pp. 49 - 55, 2011. AbstractWebsite

The only hope for effective treatment of liver cancer lies in early detection or screening for populations who are at high risk for developing liver cancer. This study was designed to study the levels of a collection of biochemical markers in the sera of patients suffering from hepatocellular carcinoma (HCC) and its predisposing diseases. The ultimate aim is to investigate their diagnostic impact in the early detection of HCC and discriminate from benign liver diseases. The study was carried out on 217 individuals divided into the following groups: Group 1: Normal controls, Group 2: Schistosomal patients (Schist), Group 3: Hepatitis B patients (HBV), Group 4: Hepatitis C patients (HCV), Group 5: Cirrhotic patients (Cirr), and Group 6: Hepatocellular carcinoma patients (HCC). The last group was further subdivided into the following subgroups: a – HCC alone; b – HCC on top of schistosomiasis; c – HCC on top of HBV; d – Hepato-cellular carcinoma on top of HCV; e – HCC on top of cirrhosis. Their sera were subjected to a quantitative determination of the tumour necrosis factor-alpha (TNF-α), epidermal growth factor and its receptor (EGF and EGFR), glutathione-S-transferase alpha (GST-α), iron, ferritin, transferrin, alpha-1-antitrypsin (α1AT) and alpha-fetoprotein (αFP). The results of this study indicate that it is advisable to determine a panel of markers composed of αFP, TNF-α and GST-α to confirm diagnosis of HCC and distinguish it from other benign liver diseases.