Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects

Breast cancer is the most common cancer diagnosed among women worldwide and more than half are diagnosed above the age of 60 years. Life expectancy is increasing and the number of breast cancer cases diagnosed among older women are expected to increase. Undertreatment, mostly due to unjustifiable fears of advanced-age and associated comorbidities, is commonly practiced in this group of patients who are under-represented in clinical trials and their management is not properly addressed in clinical practice guidelines. With modern surgery and anesthesia, breast surgeries are considered safe and is usually associated with very low complication rates, regardless of extent of surgery. However, oncoplastic surgery and management of the axilla can be tailored based on patients\u27- and disease-related factors. Most of chemotherapeutic agents, along with targeted therapy and anti-Human epidermal growth factor receptor-2 (HER2) drugs can be safely given for older patients, however, dose adjustment and close monitoring of potential adverse events might be needed. The recently introduced cyclin-D kinase (CDK) 4/6-inhibitors in combination with aromatase inhibitors (AI) or fulvestrant, which changed the landscape of breast cancer therapy, are both safe and effective in older patients and had substituted more aggressive and potentially toxic interventions. Despite its proven efficacy, adjusting or even omitting adjuvant radiation therapy, at least in low-risk older patients, is safe and frequently practiced. In this paper, we review existing data related to breast cancer management among older patients across the continuum; from resection of the primary tumor through adjuvant chemotherapy, radiation and endocrine therapy up to the management of recurrent and advanced-stage disease

Manufacture of Some Ferrite Compounds with Hexagonal Crystalline Structure and Study of their Structural Properties

PbFe12O19 from this mixture and BaFe12O19 And (Pb (BaFe12O19), as the samples were examined using an X-ray diffraction device, and it was found that the patterns of diffraction rays X-ray (XRD) for the three samples, respectively. I showed Results that All samples are polycrystalline, as shown tops X-ray diffraction of hexa- A with Miller coefficients (Miller indices) (103) and (110) and (107) and (114) and (206) when Bragg diffraction angles 2 θ are equal to 20.90 °, 30.39 °, 32.41 °, 34.30 °, and 42.58 °, respectively

Effect of binary and ternary solid dispersions prepared by fusion method on the dissolution of poorly water soluble diacerein

The poor solubility of drug substances in water and their low dissolution rate in aqueous G.I.T fluid often leads to insufficient bioavailability. The present investigation is an attempt to improve the solubility and dissolution rate of diacerein (a poorly soluble drug) by solid dispersion technique. Binary solid dispersions were made using PEG-4000 or PEG-6000 as carriers with varying drug: carrier ratios 1:1, 1:3 and 1:5. Also ternary solid dispersions were made using PEG-4000 and Pluronic F-68 at ratios 1:5:1, 1:5:2 and 1:5:3. Nine formulae were prepared and evaluated for saturated solubility, In-vitro drug release. Solid state characterization including DSC, FTIR, XRD and SEM is also carried out. All formulae showed marked significant improvement in the solubility and dissolution rate of the drug. The interaction studies showed no interaction between the drug and any of the used carriers. Formula SD9 (1:5:3; drug: PEG-4000: Pluronic F-68) showed the best dissolution profile with about 44.73% of the drug being released in the first 5 minutes and more than 79 % of the drug being released in the first 15 minutes. Also this formula showed the highest dissolution rate of 6.66 %/min. It was concluded that combination of PEG-4000 and Pluronic F-68 can be well utilized to improve the solubility of poorly soluble drugs

Effect of binary and ternary solid dispersions prepared by fusion method on the dissolution of poorly water soluble diacerein

The poor solubility of drug substances in water and their low dissolution rate in aqueous G.I.T fluid often leads to insufficient bioavailability. The present investigation is an attempt to improve the solubility and dissolution rate of diacerein (a poorly soluble drug) by solid dispersion technique. Binary solid dispersions were made using PEG-4000 or PEG-6000 as carriers with varying drug: carrier ratios 1:1, 1:3 and 1:5. Also ternary solid dispersions were made using PEG-4000 and Pluronic F-68 at ratios 1:5:1, 1:5:2 and 1:5:3. Nine formulae were prepared and evaluated for saturated solubility, In-vitro drug release. Solid state characterization including DSC, FTIR, XRD and SEM is also carried out. All formulae showed marked significant improvement in the solubility and dissolution rate of the drug. The interaction studies showed no interaction between the drug and any of the used carriers. Formula SD9 (1:5:3; drug: PEG-4000: Pluronic F-68) showed the best dissolution profile with about 44.73% of the drug being released in the first 5 minutes and more than 79 % of the drug being released in the first 15 minutes. Also this formula showed the highest dissolution rate of 6.66 %/min. It was concluded that combination of PEG-4000 and Pluronic F-68 can be well utilized to improve the solubility of poorly soluble drugs

High-Dose Therapy and Autologous Hematopoietic Progenitor Cells Transplantation for Recurrent or Refractory Hodgkin's Lymphoma: Analysis of King Hussein Cancer Center Results and Prognostic Variables

Purpose. to evaluate the outcome of patients with Hodgkin's lymphoma who underwent autologous transplantation at KHCC bone marrow transplant program. Patients and Methods. Over 6 years, 63 patients with relapsed or refractory Hodgkin's lymphoma underwent high dose chemotherapy followed by autologous transplant. There were 25.4% patients in complete remission (CR), 71.4% with chemotherapy responsive disease at the time of transplant. Prior to conditioning regimen, 56% received two chemotherapy lines, and, 44% received more than two lines. Results. The main outcomes of the study are the rate of complete remission at day 100, overall survival (OS), relapse-free survival (RFS), The impact of the following variables on OS and RFS: (a) disease status at the time of transplant, (b) number of chemotherapy lines prior to conditioning, (c) age group, (d) time of relapse < or >12 months were investigated. The CR at day 100 was 57%. The median overall survival for the whole group was 40.6 months; the median RFS was 20 months. The only factor which significantly impacts the study outcomes was the number of chemotherapy lines prior to conditioning on OS in favor of patients received two lines. Conclusion. In our study only the number of chemotherapy lines received before conditioning had statistically significant impact on OS

Report on needs and priorities in the field of international cooperation agreements on water management in the target MACs

This report aims to provide a revision of the water related goals within the international agreements joined by the three case study countries,Egypt, Morocco and Tunisia, while emphasizing the critical points that should be developed and reinforced in the near future through an integrated approach for water policies, initiatives and management

Serum IL-21 level and its relation to activity and severity of alopecia areata

Background: Alopecia areata (AA) is a non-cicatricial alopecia that is postulated to be a hair-specific autoimmune disease, with genetic factors playing a role in disease susceptibility and severity. The disease presentation ranges from circular patches on the scalp to complete hair loss with devastating psychosocial consequences.Patients and methods: This was a case control study carried out on 40 patients diagnosed as alopecia areata. They were recruited from the outpatient clinic of Dermatology, Andrology and STDs Department, Mansoura University Hospitals. In addition 40 normal healthy subjects with matched age and sex were selected to act as a control group.Results: Serum levels of IL-21 were significantly increased in AA patients, and showed significant positive correlation with activity of the disease. Higher serum levels of IL-21 in active cases support its role as predictor of disease activity. There were no significant differences in IL-21 level with different SALT scores. Receiver Operating Characteristic (ROC) curve analysis of IL-21 was conducted to evaluate the sensitivity and specificity of serum IL-21 as a diagnostic index for AA. The AUC-ROC of IL-21 was excellent (0.962); and the best cut off point for IL-21 was determined to be 22.22 pg/ml. It was good predictive value. Its accuracy was 86.3%.Conclusions: The results of this study indicate that the serum IL-21 could be promising marker in the diagnosis of alopecia areata, and also can be used as prognostic marker of its activity