Sherif Omar

Global cancer surgery: delivering safe, affordable, and timely cancer surgery

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US

Postoperative radiotherapy of carcinoma in bilharzial bladder: Improved disease free survival through improving local control

6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

Lifestyle, occupational, and reproductive factors in relation to pancreatic cancer risk

Abstract Two hundred thirty-six patients with T 3 bladder cancer who survived radical surgery and proved to have P 3a , P 3b , or P 4a tumors were randomized in two phases into three groups: (a) no further treatment (83 patients (b) postoperative radiotherapy multiple daily fractionation (MDF), using 3 daily fractions of 1.25 Gy each, with 3 hr between fractions, up to a total dose of 37.5 Gy in 12 days (75 patients); and (c) postoperative radiotherapy conventional fractionation (CF), for a total dose of 50 Gy/5 weeks (78 patients). The tolerance of the patients to postoperative radiotherapy was quite acceptable, with equal acute reactions in MDF and CF groups. The 5-year disease-free survival (DFS) rates amounted to 49 and 44% in MDF and CF postoperative radiotherapy groups, respectively, compared to 25% in the cystectomy-alone group. The 5-year local control rates were 87% and 93% for those treated with multiple daily fractionation and conventional fractionation while it was 50% in the surgery-alone group. The therapeutic benefit of postoperative irradiation was consistent for all tumor types, histological grades, and pathological stages for both the disease-free survival and local control. Patients with nodal metastases demonstrated lower recurrence rates in the postoperative radiotherapy groups, but this was not associated with improved disease-free survival. Multivariate analysis using the Cox Model confirmed these results. The independent prognostic factors affecting both disease-free survival and local control were the addition of postoperative radiotherapy, the nodal status, the pathological stage, and the tumor grade. Late complications of radiotherapy in the skin, small intestine, rectum, and the anastomotic site of the urinary division were lower with MDF than with conventional fractionation.

Differing DNA methylation patterns and gene mutation frequencies in colorectal carcinomas from Middle Eastern countries

Objectives: This study examined the epidemiology of pancreatic cancer in Egypt. Methods: We obtained detailed information on smoking, occupational, medical, and reproductive histories from 194 pancreatic cancer cases and 194 controls. Results: Compared with not smoking, smoking cigarettes alone or in conjunction with other smoking methods (eg, water pipe, cigar) was associated with an increased risk (odds ratio [OR], 4.5 and 7.8; 95% confidence interval [95% CI], 1.9-10.7 and 3.0-20.6, respectively). Passive smoking was also a significant risk factor (OR, 6.0; 95% CI, 2.4-14.8). The risk of pancreatic cancer was elevated among subjects exposed to pesticides (OR, 2.6; 95% CI, 0.97-7.2). A prior diagnosis of diabetes mellitus for a period of 10 years was associated with higher risk (OR, 5.4; 95% CI, 1.5-19.9). For women, having 7 or more live births and lactating for 144 months or longer were associated with a reduced risk (OR, 0.5 and 0.2; 95% CI, 0.2-1.3 and 0.1-0.9, respectively). No association was found between family history, allergy, or obesity and pancreatic cancer in Egypt. Conclusions: Multiple tobacco consumption methods, passive smoking, pesticide exposures, and diabetes are associated with an increased risk for pancreatic cancer. Prolonged lactation and increased parity are associated with a reduced risk for pancreatic cancer.

Analysis of RhoC expression and lymphovascular emboli in inflammatory vs non-inflammatory breast cancers in Egyptian patients

Purpose: The epidemiology of colorectal carcinoma is well known to differ among countries but the molecular characteristics are usually assumed to be similar. International differences in molecular pathology have not been studied extensively but have implications for the management of patients in different countries and of immigrant patients. Experimental Design: We evaluated the CpG island methylator phenotype pathway characterized by concordant methylation of gene promoters that often silences transcription of the genes, the microsatellite instability pathway, and K-ras and p53 gene status in 247 colorectal carcinomas from the three selected Middle Eastern countries of Egypt, Jordan, and Turkey. Results: Colorectal carcinoma from Egypt had the lowest frequencies of methylation. In multinomial logistic regression analysis, Jordanian colorectal carcinoma more frequently had methylation involving the p16 tumor suppressor gene (odds ratio, 3.5; 95% confidence interval, 1.2-10.6; P = 0.023) and MINT31 locus (odds ratio, 2.3; 95% confidence interval, 1.0-5.1; P = 0.041). The K-ras proto-oncogene was more frequently mutated in colorectal carcinoma from Turkey (odds ratio, 2.9; 95% confidence interval, 1.2-6.7; P = 0.016), but p53 overexpression was more common in both Jordanian and Turkish colorectal carcinoma than in Egyptian cases (odds ratio, 2.5; 95% confidence interval, 1.2-5.5; P = 0.019; and odds ratio, 3.6; 95% confidence interval, 1.8-7.1; P = 0.0003, respectively). The findings in Turkish colorectal carcinoma were most similar to those reported for Western cases. Conclusions: Colorectal carcinoma from Middle Eastern countries have differing gene methylation patterns and mutation frequencies that indicate dissimilar molecular pathogenesis, probably reflecting different environmental exposures. These molecular differences could affect prevention strategies, therapeutic efficacy, and transferability of clinical trial results.

Emerging of coagulase negative staphylococci as a cause of mastitis in dairy animals: An environmental hazard ☆

Understanding the molecular factors that distinguish inflammatory breast cancer (IBC) from non-IBC is important for IBC diagnosis. We reviewed the records of 48 IBC patients and 64 non-IBC patients from Egypt. We determined RhoC expression and tumor emboli and their relationship to demographic and reproductive characteristics. Compared with non-IBC patients, IBC patients had significantly lower parity (P=0.018) and fewer palpable tumors (P<0.0001). IBC tumors showed RhoC overexpression more frequently than non-IBC tumors (87% vs. 17%, respectively) (P<0.0001). Tumor emboli were significantly more frequent in IBC tumors than non-IBC tumors (Mean+/- SD: 14.1+/-14.0 vs. 7.0+/-12.9, respectively) (P<0.0001). This study illustrates that RhoC overexpression and tumor emboli are more frequent in tumors of IBC relative to non-IBC from Egypt. Future studies should focus on relating epidemiologic factors to molecular features of IBC in this population.

Bladder carcinogenesis using bilharzia-infested Swiss albino mice

Abstract In Egypt, knowledge about the coagulase negative staphylococci (CNS) involved in mastitic animals is limited. CNS have emerged to be pathogens causing intramammary infections in Egyptian dairy herds. Therefore, the current study was conducted to investigate the occurrence of CNS in dairy ruminants (cattle, buffaloes, sheep and goats). A total of 884 quarter milk samples were investigated to study the prevalence of CNS among mastitic and subclinically mastitic cows, buffalo–cows, ewes and does in Egypt. Identification of the isolates was achieved using API staph test and polymerase chain reaction (PCR). CNS were isolated from the examined subclinical mastitic cattle, buffaloes, sheep and goats with percentages of 16.6%, 59.4%, 50% and 55.6%, respectively. Staphylococcus xylosus, Staphylococcus cohnii, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus chromogenes, Staphylococcus lentus, Staphylococcus lugdunensis and Staphylococcus simulans were identified as CNS that recovered from the examined milk samples. The CNS as mastitis-causing agents could not be neglected as they can cause substantial economic losses.

Survival of Inflammatory Breast Cancer Patients Compared to Non‐inflammatory Breast Cancer Patients in Egypt

Abstract Experimental studies were carried out on female Swiss albino mice to evaluate the possible role of: liver injury, urine inborn carcinogens and local irritation of bladder mucosa in the development of bilharzial bladder cancer. In mice, the liver and intestine are only involved by parasite, but the urinary bladder is spared. Mice with induced liver injury due to either: bilharzial infestation alone, hepatocarcinogens alone (2-naphthylamine (2-NA) or 2-acetylaminofluorene (2-AAF)), or both together, did not develop bladder tumors. Also, mice receiving 1% indole (a tryptophan precursor) either alone, or after bilharzial infestation, did not show any change in bladder mucosa. Conversely, the insertion of glass beads in the bladder induced carcinomas in 26.6% of mice after 70 weeks. The induction of bladder tumors by glass beads was enhanced by 2-AAF treatment (40%), but not by bilharzia infestation (25%), 2-NA (27%) or indole (27%). The urinary bladders with glass beads were invariably the seat of bacterial infection ( E-coli and gram + ve cocci ) and showed epithelial hyperplasia and metaplasia.

Low-power implantable seizure detection processor

To the Editor: Inflammatory Breast Cancer (IBC) is a rare but aggressive form of breast cancer that is diagnosed clinically (1). IBC has characteristic clinical and biologic features suggestive of differences between IBC and non-IBC. Egypt has about a five times higher proportion of IBC patients than the USA (2‐4) with distinct molecular features of IBC tumors that may reflect a more aggressive nature of the disease (5,6). Within Egypt, there have been no past comparisons between IBC and non-IBC patients with respect to survival. Therefore, as a part of this study, we decided to compare survival of IBC and non-IBC patients while taking into account, the epidemiologic, pathologic, and treatment characteristics of these two groups of patients from the National Cancer Institute of Cairo University (NCI-Cairo) in Egypt. Patients included in this study were diagnosed and treated at NCI-Cairo from 2000 to 2005. The patients included two groups, 65 IBC patients and 52 non-IBC patients. IBC diagnosis was based on the presence of erythema, edema, and peau d’orange and some of the patients in this study were included in our previous studies (5,6). We reviewed the medical records, pathology reports and radiation records, and

Smoking Profile: A Study of A Developing Country (Egypt) as an Example

The detection processor is a part of an implantable integrated device used for detection of an electrographic seizure onset. The system is supposed to acquire the neural signals from 1024 electrodes implanted in the brain tissues, amplify the acquired signals, and then process them using the seizure detection processor to detect the occurrence of a seizure. Based on the decision of the processor, a stimulation signal can be applied to a number of the implanted electrodes to block the seizure progression.