Ashraf S. Zaghloul

The role of hepatitis C in hepatocellular carcinoma: a case control study among Egyptian patients.

Background Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world; however, the risk and attribution related to HCV in Egyptian patients with hepatocellular carcinoma (HCC) remains unknown. Goals The current study was undertaken to estimate the risk of HCC in relation to HCV in Egypt. Study Thirty-three patients with HCC and 35 healthy controls who had a similar socioeconomic status were prospectively enrolled at the University of Cairo National Cancer Institute. Results Anti-HCV antibodies were present in 75.8% of the patients and in 42.9% of the controls (p = 0.01); hepatitis B surface antigen (HBsAg) was present in 15.2% of the patients and in 2.9% of the controls (p = 0.03). In addition, the sex-and age-adjusted odds ratio (OR) for anti-HCV antibodies was 5.1 (95% CI = 1.5–17.4) and for HBsAg was 13.2 (95% CI = 1.2–148.2). Concurrent Schistosoma mansoni and anti-HCV was associated with an OR of 10.3 (95% CI = 1.3–79.8), which was higher than that for anti-HCV (6.5; 95% CI = 1.6–26.6) and S. mansoni infection (0.2; 95% CI = 0.1–6.2) alone. Finally, we estimated the attributable fraction of HCC to HCV to be 64% in this study population and 48% in the general Egyptian population. Conclusions Both HCV and hepatitis B virus infection increase the risk of HCC in Egyptian patients, whereas isolated Schistosoma infection does not. Because of the very high prevalence rate of HCV in the general Egyptian population, it accounts for most HCC cases in Egypt.

Clinical value of circulating lipocalins and insulin-like growth factor axis in pancreatic cancer diagnosis.

Objectives Early diagnosis of pancreatic cancer (PC) in diabetic patients is difficult owing to late presentation of symptoms. Hence, finding a marker to identify cancer stage early would be useful to improve survival. We aimed to determine levels of serum retinol binding protein 4 (RBP-4), neutrophil gelatinase–associated lipocalin (NGAL), insulin-like growth factor I (IGF-I), and its binding protein 3 (IGFBP-3) in patients with PC with preexisting type 2 diabetes. Moreover, we assessed their clinical usefulness in PC diagnosis and their association with tumor severity. Methods Twenty-three patients with PC, 32 diabetic patients, and 20 healthy controls were examined. Preoperative and postoperative samples were obtained from 15 patients with PC. Serum insulin, cancer antigen (CA 19-9), RBP-4, NGAL, IGF-I, and IGFBP-3 levels were estimated by enzyme-linked immunosorbent assay. Results Significant elevation in the levels of RBP-4 (60.1 [46.3–71.4] ng/mL), NGAL (142 [80–235] ng/mL), and IGF-I (174 [9.3] ng/mL) together with significant reduction in the level of IGFBP-3 (3669 [299] ng/mL) was found in patients with PC. Moreover, RBP-4 and NGAL levels were reduced in postoperative samples compared with preoperative ones. Receiver operating characteristic curve analysis revealed that they can distinguish PC from non-PC cases with significant area under the curve. Conclusions Retinol binding protein 4, NGAL, IGF-I, and IGFBP-3 are associated with PC in type 2 diabetic patients. They could be useful in distinguishing PC from non-PC cases when used in combination or with cancer antigen.

Serum retinol binding protein-4 and neutrophil gelatinase-associated lipocalin are interrelated in pancreatic cancer patients.

Objectives. Pancreatic cancer has an extremely dismal clinical course and high fatality rate. Knowing that, adipokines could regulate insulin resistance, inflammation, immunity and carcinogenesis. Accordingly, an understanding of adipokines in relation to pancreatic cancer could be useful to improve disease outcome. We aimed to determine serum retinol binding protein-4 (RBP-4) and neutophil gelatinase-associated lipocalin (NGAL) levels in pancreatic cancer patients. Moreover, we assessed their association with tumor severity and with each other. Methods. A total of 23 pancreatic cancer patients and 20 healthy controls were enrolled. Fifteen of the pancreatic cancer patients underwent Whipple resection and were examined before and after operation. Serum glucose, insulin, lipid profile, CA19-9, RBP-4 and NGAL were estimated by ELISA. Results. Significant elevation in serum concentrations of RBP-4 (64.4 ± 5.6 ng/ml) and NGAL (142(80–235) ng/ml) at p < 0.001 was found in pancreatic cancer patients. Both RBP-4 and NGAL were significantly lower after operation than before operation. Moreover, NGAL was elevated in advanced pathological T stage. Interestingly, RBP-4 and NGAL levels were positively correlated (r = 0.484, p = 0.05) and they are associated with some of the lipid profile parameters. Conclusions. Elevated serum RBP-4 and NGAL are associated with pancreatic cancer. They were positively interrelated; highlighting the possible interplay between them in pancreatic cancer.

Gelatin-modified gold nanoparticles for direct detection of urinary total gelatinase activity: Diagnostic value in bladder cancer.

Matrix metalloproteinases (MMPs), in particularly gelatinases (MMP-2 and MMP-9) were reported as urinary markers of bladder cancer. In this work, we developed a simple colorimetric gold nanoparticle (AuNP) assay for rapid and sensitive detection of urinary total gelatinase activity based on the surface plasmon resonance (SPR) property of AuNPs. Gelatin-modified AuNPs were stably suspended in solution even upon addition of an aggregation inducer as 6-mercaptohexan-1-ol (6-MCH). Gelatinases digest gelatin capping. Subsequently, addition of 6-MCH leads to AuNPs aggregation with red to blue color shift. In a pilot study, results of the developed AuNP assay were consistent with zymography for qualitative detection of urinary total gelatinase activity. The sensitivity and specificity of both assays were 80% and 90.9% respectively. The absorption ratios, A625/A530 of the reacted AuNP solutions were used to quantify the total gelatinase concentration. The best cut off value was 0.01895ng/μg protein, at which the sensitivity was 87.5% and the specificity was 86.4%. The developed AuNP assay is simple, low-cost and can aid non-invasive diagnosis of bladder cancer.

First experience of the Egyptian National Cancer Institute using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer

AIM OF WORK Robotics in surgery led to an improvement of visualization, a better handling of tissues and better suturing. This study aimed to document the first experience of the Egyptian National Cancer Institute (NCI) using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer and to highlight observed advantages, disadvantages, morbidity and oncological outcomes. PATIENTS AND METHODS Data of cases that had either early cervical cancer (stage IB-IIA1 with a tumor ≥2 cm) or locally advanced cervical cancer (Stage IIA2-IIB after chemo-radiotherapy) were collected prospectively. Study patients underwent robotic radical hysterectomies for their cervical cancers at the NCI, Cairo University, between January 1, 2015 and December 31, 2016. For each patient, duration of surgery, amount of blood loss, and intra-operative complications were recorded. Similarly, the duration of postoperative hospital-stay, analgesia used and post-operative gastrointestinal recovery were documented. Pathological assessment of safety margins and the lymph nodes number yield were also assessed. RESULTS Twenty patients underwent robotic radical hysterectomy during the study period. Twelve cases had early cervical cancer while 8 suffered locally advanced disease. The mean procedure time was 319 (range 240-560) minutes; the mean blood loss was 309 (range 150-600) ml. Three cases had bladder injuries during their procedures. The median hospital stay was 6 (range 4-10) days. One case had a positive margin. The median of lymph nodes yield number was 15 (range 10-25). Follow-up ranged 9-31 months, with only one case developing local recurrence. CONCLUSION Robotic radical hysterectomy is a feasible approach with a tolerable rate of complications.

Preliminary results of robotic colorectal surgery at the National Cancer Institute, Cairo University

BACKGROUND The available literature on minimally invasive colorectal cancer demonstrates that laparoscopic approach is feasible and associated with better short term outcomes than open surgery while maintaining equivalent oncologic safety. Reports have shown that robotic surgery may overcome some of the pitfalls of laparoscopic intervention. OBJECTIVE OF THE WORK To evaluate early results of robotic colorectal surgery, in a cohort of Egyptian patients, regarding operative time, operative and early post-operative complications, hospital stay and pathological results. PATIENTS AND METHODS A case series study which was carried out in surgical department at National Cancer Institute, Cairo University. Ten Egyptian cases of colorectal cancer (age ranged from 30 to 67, 5 males and 5 females) were recruited from the period of April 2013 to April 2014. Robotic surgery was performed to all cases. RESULTS Three patients had low anterior resection, three anterior resection, one total proctectomy, one abdominoperineal resection, one left hemicolectomy and one colostomy. The study reported no mortalities and two morbidities. The mean operative time was 333min. The conversion to open was done in only one patient. A total mesorectal excision with negative circumferential margin was accomplished in all patients, distal margin was positive in one patient. Mean lymph nodes removed was 10.7. Mean hospital stay was 7.4days. CONCLUSION To the best of our knowledge, this is the first study reporting the outcomes of robotic colorectal cancer intervention in Egyptian patients. Our preliminary results suggest that robotic-assisted surgery for colorectal cancer can be carried out safely and according to oncological principles.