Nehal Elmashad | Tanta University (original) (raw)

Papers by Nehal Elmashad

International Journal of Veterinary Science, 2020

Canine meningeo-encephalitis triggered many causes, some of them can be distinguished and others ... more Canine meningeo-encephalitis triggered many causes, some of them can be distinguished and others are invisible and have a great challenge with small animal clinicians. The present study was conducted to detect the common causes of meningeo-encephalitis among dogs that were admitted to the small animal clinic, Faculty of veterinary medicine, Cairo University, Egypt from March to December 2019. About twenty-eight dogs were studied and included thirteen apparently healthy dogs while fifteen dogs suffered from meningeo-encephalitis. All dogs subjected to thorough clinical examination. Whole blood and serum samples were taken for evaluation of hematobiochemical changes. In addition, conjunctival and nasal swabs were taken for rapid detection of canine distemper virus infection (CDV) infection. Also, fecal samples were taken for detection of parasitic infection. Results showed that CDV is the most recorded cause for meningeo-encephalitis. Other causes were recorded included Toxocara canis, Toxascaris leonina, Babesia canis and head trauma. Physical examination revealed significant increase in both respiration and heart rates in affected dogs. Hematological status revealed significant decrease in RBCs count and relative lymphocytes in affected dogs while there was a significant increase in WBCs count and relative neutrophils. Biochemical status indicated significant decrease in serum albumin and A/G ratio while there was a significant increase in serum activity of aspartate amino transferase (AST) and C-reactive protein (CRP) level among diseased dogs. CDV infection is the most recorded cause for meningeo-encephalitis in dogs beside Toxocara spp., Babesia canis and head trauma. Infectious causes have an impact on physical, hematological and biochemical status in affected dogs.

International Journal of Cancer and Biomedical Research (Print), Aug 31, 2023

Background: In Egypt, pancreatic cancer (PC) is the 11th most prevalent malignancy and represents... more Background: In Egypt, pancreatic cancer (PC) is the 11th most prevalent malignancy and represents 2.2% of all cancers. PCs cause 3.2% of cancer deaths, ranking 8th. Gall bladder cancers represents about 0.70% of malignancies in Egypt, accounting for 0.77% of cancer deaths. In Gharbia governorate, Gall bladder cancers account for 0.8% and 0.7%, of male malignancies females, respectively. Aim: The aims of this retrospective study is to determine the incidence of pancreatic, gall bladder and biliary tract cancers (BTCs), describe the clinico-pathological pattern of pancreatic, gall bladder and BTCs, and detect progression free survival (PFS), disease free survival (DFS), and overall survival (OS) in correlation with the prognostic factors. Patients and Methods: This retrospective hospital-based clinico-epidemiological study was carried out on 299 patients who were histo-pathological proved pancreatic or biliary tract malignancies through the period from Jan 2015 to Dec 2020 at Clinical Oncology Department Tanta university Hospital, Egypt. Results: The estimated median OS for PC patients was 8 months which was statistically significant better in patients with T1/2, N0, M0 and curative surgical resection, while the estimated median PFS was 4 months with statistically significant better in patients with initial low CA19.9 (<37 U/ml) and in pancreatic body site and the estimated median DFS was 7 months with statistically significant better in N0 and initial low CA19.9 (<37U/ml). As regard BTC, the estimated median OS was 12 months with statistically significant better in patients with T1/2, N0, M0 and grade 2 tumors, the estimated median PFS was 3 with statistically significant better in patients with T1/2, N0, M0, low initial CA19.9 (<37U/ml) and ampulla of vater site while the estimated median DFS was 5 months with statistically significant better in patients with N0. Conclusions: We advocate for the use of genetic counselling to educate families about specific genetic disorders, the risks and advantages, disease management, and potential treatment choices. Multidisciplinary working groups should be established for adequate management.

BMC Immunology, Aug 14, 2023

Introduction Cytotoxic (CD8+) and natural killer (NK) cells play critical roles in anti-tumor imm... more Introduction Cytotoxic (CD8+) and natural killer (NK) cells play critical roles in anti-tumor immunity. Dysfunction in these cells is considered as one of the extrinsic mechanisms for tumor relapse. Aim We aimed in this study to assess cytotoxic activities of CD8 + T and NK cells in the peripheral blood from lung cancer patients before and after induction of chemotherapy. Subjects and methods Healthy (n = 5) volunteers and lung cancer patients (n = 15:5 before, 5 during, and 5 after induction of chemotherapy) were recruited. Flow cytometry was used to analyze the numbers of CD8 + T cells, NK and CD56 + T cells and their intracellular expression of granzyme B (GzB) in fresh peripheral blood mononuclear cells (PBMCs) and after 72 h of their culture in vitro and stimulation with 5 µg/ml Concanavalin A (Con A) and 50ng/ml IL-2). In addition, the plasma levels of inflammatory cytokines were measured using luminex. Results After culture, significant increases in the number of GzB expressing cells gated on CD3+, CD4+, CD8 + and NKCD8 + T cells in the PBMCs from lung cancer patients before induction of chemotherapy as compared to control individuals as well as patients during and after induction of chemotherapy. Serum levels of IL-1 and CXCL8 in patients before induction of chemotherapy showed 37-and 40-fold increases, respectively, as compared to control individuals. Both GzB expression and cytokines levels in patients during and after chemotherapy were similar. Conclusion Polyclonal stimulation of PBMCs can restore the cytolytic activities of cytotoxic CD8 and NK cells from lung cancer patients even after chemotherapy.

InTech eBooks, Apr 26, 2017

It is amazing to see how medical science has progressed. Medical research is now crossnational an... more It is amazing to see how medical science has progressed. Medical research is now crossnational and cross-cultural, the relentless progress of globalization poses complex ethical questions for those wishing to do medical research in developing countries. In developing countries, poverty, endemic diseases, and a low level of investment in health care systems influence both the ease of performing and the selection of trials that can benefit the people of the countries. In this chapter, we present an overview of medical research situation in developing countries with critique of different clinical trials that was conducted in Egypt after review. Egypt has 41 universities and 94 health related medical schools. There are 24 faculties of medicine with up to 34 departments in each. Clinical research is an essential mandate for getting Master, Doctorate Degrees, and for promotion of faculty members. In Egypt, the Profession Ethics Regulations issued by the Ministry of Health (MOH) No. 238/2003 was endorsed and maintained in Law 71/2009. Beside these regulations, more than 56 Institutional Review Board (IRB) have been registered. The Egyptian Network of Research Ethics Committees (ENREC) was created in 2008. Yet, in the absence of robust legislative constraints, there is no clear way to avoid violations. Our experience in Tanta Faculty of Medicine is also highlighted in this chapter.

Egyptian Journal of Radiology and Nuclear Medicine, Apr 6, 2023

Background Whole-body diffusion-weighted magnetic resonance is being developed as a tool for asse... more Background Whole-body diffusion-weighted magnetic resonance is being developed as a tool for assessing tumor spread. Patients with known primary tumors require meticulous evaluation to assess metastasis for better staging; we attempted to detect bony metastasis without radiation exposure. Our study's goal was to use whole-body diffusionweighted imaging with background body signal suppression (WB-DWBIS) to evaluate bony metastasis in confirmed patients who have primary tumors. Results Our study included 90 patients with known primary cancer, 10 patients were excluded as they had no bony metastasis, from 80 patients: 36 (45.0%) having one site of metastasis, 36 (45%) having two sites of metastasis, and 8 (10.0%) having three sites of metastasis. 56 (70.0%) of the metastasis sites were bony metastasis, and 76 were mixed both bony and non-bony, including 32(40.0%) lung, 16 (20.0%) liver, and 28 (35%) lymph nodes. Sensitivity of bone scanning in detecting metastasis was as follows: 95.1% sensitivity and 92.0% accuracy, while that of whole-body diffusion-weighted image with background signals suppression was 94.8% sensitivity and 91.7% accuracy, WB-DWBIS inter-observer agreement in the detection of bony metastatic deposits in cancer patients was good (0.7 45, agreement = 93.2%). Conclusions Using WB-DWBIS images, bone lesion identification and characterization (site and number) were improved, producing outcomes similar to bone scanning without the use of ionizing radiation.

Asian Pacific Journal of Cancer Prevention, Aug 1, 2022

Objective: Uterine or endometrial cancer affects many women postmenopausal and may reach an advan... more Objective: Uterine or endometrial cancer affects many women postmenopausal and may reach an advanced stage before signs and symptoms can be noticed. Micro RNAs (miRNAs), non-coding RNAs, play key roles in gene expression regulation and are linked to cancer. This study aimed to elucidate whether some specific types of miRNAs (miRNA133-a, miRNA-21, miRNA-205) can act as prognostic or diagnostic biomarkers for endometrial carcinoma (ER) in Egyptian patients. Methods: Blood samples from 36 patients suffering from endometrial carcinoma and 15 healthy volunteers were tested for expression levels of miRNA 133a-2, 21 and 205. Results: The expression levels of miRNA133a-2, miRNA-21, and miRNA-205 were significantly elevated in ER patients when compared with the control group, the highest levels were noticed in miRNA133a-2. The CA125 levels were significantly higher in all patients as compared with healthy subjects. Conclusion: The findings could support the use of circulating miR133a-2, miR-21 and miR-205 as virtuous prognostic biomarkers for EC in Egyptian patients. The studied miRNA species warrant validation for prospective targeting inhibitory protocols in EC.

Authorea, Apr 7, 2020

Cytotoxic T cells are one of the most specialized immune cells to defend the body against foreign... more Cytotoxic T cells are one of the most specialized immune cells to defend the body against foreign invaders in the best scenario, but failure in the function of these cells, leading to decrease defense of the body against cancer. We aims to address the functionality of cytotoxic T lymphocytes (CTLs), Natural killer (NK) and Natural killer T-cells (NKT) cells in lung cancer patient's pre and post-stimulation of these cells in-vitro using laboratory activation protocol. Five healthy persons as volunteers and fifteen lung cancer patients were subjected to this study. The count of CTLs, NK and NKT cells and the expression of their intracellular granzyme B (GzB) pre and post-stimulation for 72 hrs in-vitro was determined. The plasma level of cytokines and chemokines was correlated with the patient's prognosis. Data showed that after culture, there were highly significantly increased in the fold change of the percentage of GzB expression on CD3, CD4, CD8 and NKCD8 T cells in lung cancer patients before induction of chemotherapy when compared to healthy control and other lung cancer patients. The level of Proinflammatory cytokines in patients before and during induction of chemotherapy showed IL-1 and CCL-2 in a 13000, 250 fold increase respectively while it decreases in patients after induction of chemotherapy compared with the control group. Patients before the induction of chemotherapy have the ability to improve their CTL and NK functionality under activation conditions. The use of immune activation mechanisms is needed before the induction of chemotherapy.

Annals of Oncology, Sep 1, 2012

Objective: Gamma knife radiosurgery GKS was used for the treatment of the patients with Neurofibr... more Objective: Gamma knife radiosurgery GKS was used for the treatment of the patients with Neurofibromatosis type II (NFII) for years to achieve better tumor control and to avoid the post operative neurological deficits. This study aimed at exploring the effect of GKS on the tumor control rate, the avoidance of new neurological deficits, and the associated morbidity. Methods: We revised the data of 50 intracranial NFII patients (either vestibular schwannomas or meningiomas) who were treated consequently between July 2001 and October 2009 in our center, the data of 43 patients were evaluable. The mean follow up period was 43.7 months (range 6 to 96). We treated 22 females (51.2%) and 21 males (48.8%) with a mean age of 27.6 years (range 9-53 years). Eight patients (18.6%) had a family history of NFII, 29 patients (67.4%) had previous surgeries. A hundred and seventy NFII lesions were treated in 169 treatment procedures, 83/170 were vestibular schwannomas and 87 were meningiomas. The mean number of treated lesions per patient was 3.97 (range 1-14). The mean marginal dose was 11.9 Gy (range 8 to 13 Gy), with a mean isodose of 52.5%, mean percent coverage was 95.7% (ranged 71-100%). The mean target volume was 11.1 cc (range 0.1 to 26.11 cc). Results: Regarding the overall radiological response, 16 lesions (9.4%) had regressed, 146 (85.9%) remained stable, and 8 (4.7%) had progressed. For 83 schwannomas, 7 lesions (8.4%) had regression, 72 (86.7%) remained stable, and 4 (4.8%) developed progression. For the 87 meningiomas, 9 (10.3%) had regressed, 74 (85.1%) were stable, and 4 (4.6%) had progressed. The Overall survival rate (OS) for all patients was 95.3% (only 2 died), the mean tumor control rate of 95.1%. The overall Freedom from neurological deficits was 97.7%. Only one patient complained of Grade III facial palsy which was temporary and resolved after medical treatment. Using a median dose of 12 Gy maintained serviceable hearing in 56.6% of ears. Conclusion: Gamma knife radiosurgery for NFII patients can achieve good tumor control and preserved function with low risk of morbidity. Disclosure: All authors have declared no conflicts of interest.

PubMed, Jul 1, 2014

The aim of this study is to clarify the magnitude of the risk-to-benefit ratio with adjuvant ther... more The aim of this study is to clarify the magnitude of the risk-to-benefit ratio with adjuvant therapy in high risk stage II colon cancer. Patients and methods: 162 patients with pathologically documented stage II colon cancer were randomly distributed into two groups. The first group (80 patients) received Capecitabine for 6 cycles and the second group (82 patients) received FOLFOX4 for 6 cycles . All patients in both groups were assessed for disease-free survival (DFS) and overall survival (OS) as regards to chemotherapy regimen and high risk factors. Tolerability and safety were assessed for all study population in both groups. Results: Three-year DFS rates were 73% and 87% (Hazard ratio (HR)=2.051, 95%Cl(1.13-3.721) , P-value= 0.018), 3-year OS rates were 87% and 93% (P-value=0.26); corresponding 5-year OS rates for patients with stage II disease were 34% and 93% (HR=2.555, 95%Cl(1.276-5.119), P-value=0.008) in the Capecitabine and Folfox4 groups, respectively. Statistical significant differences in 5-year DFS and OS with lymph node sampling > 12 lymph nodes in favor Folfox4 group (HR=0.172, 95%Cl(0.0080- 0.370), P-value=<0.001) and (HR=0.087, 95%Cl(0.028-0.268), P-value=0.001) respectively. Multivariate analysis for all study population stated that the only significant risk factor was the inadequate lymph node sampling as regards to relapse (HR= 0.244, 95%CI (0.094-0.631), P-value=0.004) in stage II colon cancer. Diarrhea and peripheral sensory neuropathy (PSN) were the most pronounced side effects in FOLFOX4 treatment arm. Conclusion: This study has demonstrated that patients with microscopic disease do behave more like stage III colon cancer patients; our data suggest that we must analyze tumors at this level if at all possible and those patients with more than 12 lymph nodes resection should received adjuvant chemotherapy in favor of FOLFOX4 regimen with significant improvement in DFS which can be translated into an OS benefit.

Arab journal of urology, Mar 1, 2016

To evaluate the impact of a luteinising hormone-releasing hormone (LHRH) agonist, goserelin aceta... more To evaluate the impact of a luteinising hormone-releasing hormone (LHRH) agonist, goserelin acetate (GA), on surgical blood loss during transurethral resection of the prostate (TURP), as well as its histopathological effect on prostatic microvessel density (MVD). Patients and methods: Patients who underwent TURP due to benign prostatic enlargement (60-100 mL) were randomly subdivided into two equal groups according to whether they received preoperative GA administration (3.6 mg; group A) or not (group B). Evaluation parameters were operative time, weight of resected prostatic tissue, perioperative haematocrit (HCT) changes, estimation of intraoperative blood loss, and suburethral and stromal prostatic MVD. Effects of GA on prostate weight and any possible side-effects were also monitored.

Journal of Pain and Symptom Management, Nov 1, 2014

Context. The vertebral column is the most common site of bone metastases irrespective of the prim... more Context. The vertebral column is the most common site of bone metastases irrespective of the primary tumor. Vertebral metastases are a major cause of motor deficit of the lower extremities. The use of radiotherapy is the treatment of choice in these patients. A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem. Steroid infusion has welldocumented neuroprotective effects. Objectives. Our study objective is to evaluate the effect of pre-emptive infusion of methylprednisolone on pain flare and motor function in patients with vertebral metastases. Methods. One hundred twenty patients with vertebral metastases received shortcourse external beam radiotherapy as high-voltage irradiation with a 6 MeV, via linear accelerator. In addition to the short-course radiotherapy, 60 patients received pre-emptive methylprednisolone infusion (5 mg/kg) the day just before initiation of radiotherapy (Group 1 [G1]). The other 60 patients received shortcourse radiotherapy without pretreatment methylprednisolone infusion, and only normal saline was infused (Group 2 [G2]). The Brief Pain Inventory, incidence of pain flare during radiotherapy, and motor functions were evaluated using the Tomita scale at the time of initial assessment, at the end of external beam radiotherapy, and after two weeks. Results. Four patients (6.6%) in G1 experienced pain flare compared with 12 patients (20%) in G2 during the two-week short-course radiotherapy. The mean values of pain scores were significantly reduced in both groups at the end of radiotherapy; the mean value of worst, average, and current pain scores in G1 remained statistically significant in comparison to pretreatment and G2 mean values two weeks later. Significant increase was noticed in patients with normal motor and ambulatory status in G1 at two and four weeks of initial assessment.

BMC Immunology

International Journal of Cancer and Biomedical Research

Background: Induction gemcitabine-based chemotherapy followed by concomitant chemoradiation would... more Background: Induction gemcitabine-based chemotherapy followed by concomitant chemoradiation would increase response rate and resectability in locally advanced unresectable pancreatic cancer. Patients: Patients with locally advanced unresectable pancreatic adenocarcinoma. Methods: were assigned to receive gemcitabine-based chemotherapy for 2-4 cycles, patients who showed partial response were assigned to receive CCRT with IMRT technique, our primary endpoint was surgical resection, secondary end point was disease progression or unacceptable toxicity. Results: After 2-4 cycles of induction chemotherapy. Only 28 patients received the planned protocol of chemoradiation. Nine patients underwent surgical resection. No marginal involvement (R0) was observed in 3 patients. They reached a complete response until the end of the study. Nineteen patients received chemoradiation only. Good partial response was observed in 13 patients, one showed stationary disease. Disease progression occurred in seven patients. Chemotherapy toxicity was mild in all patients. Neutropenia was more with Gemcitabine/oxaloplatin. Thrombocytopenia was more in both gemciatabine monotherapy and gemcitabine/cisplatin arm. Anemia was more common with gemcitabine/cisplatin. Non heametological toxicity included, fatigue, Weight loss, gastrointestinal toxicity, nausea & vomiting. Radiation side effects were mild in all patients and included mild inflammatory skin reaction, delayed gastric emptying, flatulence or diarrhea. Gastrointestinal bleeding was observed in 5 patients. Progression free and overall survival rates were better in patients who received CCRT even who did not proceed for surgery. Conclusion: The use of concomitant chemoradiation as part of a neoadjuvant multi-modality treatment is associated with improved outcomes, tumor downstaging, increased rate of R0 resection and better survival.

The Gulf journal of oncology, 2020

BACKGROUND Recent studies indicate the immune dysfunction in cancer patients in comparison with h... more BACKGROUND Recent studies indicate the immune dysfunction in cancer patients in comparison with healthy individuals. The quality and quantity of this dysfunction are not equal in all patients even with similar cancer type. AIM This study aims to correlate health locus of control (HLC) beliefs with CD4+ helper T (Thelper) cells, T regulatory (Treg) cells, NK cells, IL-1ß and TNF-a in breast cancer patients. PATIENTS AND METHODS The study included 30 early diagnostic breast cancer patients who responded to Form C of the MHLC questionnaire that assessed internal (IHLC), chance (CHLC), doctor (DHLC) and other person's (OHLC) control of the patient's health status. Peripheral blood samples were collected to analyze the numbers and phenotype of Thelper cells, Treg cells and NK cells by flow cytometry and to measure gene expression of IL-1ß and TNF-a with real time PCR. RESULTS A significant positive correlation was found between IHLC with Thelper cells and NK cells. However, a sig...

Tanta Medical Journal, 2016

Background Locus of control (LOC), a psychological theory developed by Julian Rotter (1966), refe... more Background Locus of control (LOC), a psychological theory developed by Julian Rotter (1966), refers to the extent to which an individual believes in controlling the events affecting them. The effect of environment and sex on LOC belief differs from country to country. Aim The aim of the present study was to evaluate LOC belief in a population of university students and the impact of urban versus rural background and sex. Participants and methods Data were collected from a cross-sectional study among university students in Egypt. Two scales were used to measure LOC belief. The first is the Rotter Internal–External Locus of Control (I–E LOC) to measure belief in LOC according to general life. The second is the Multidimensional Health Locus of Control scale with five dimensions: Internal Health Locus of Control, Doctor Health Locus of Control, Powerful Other Health Locus of Control, Chance Health Locus of Control, and God Health Locus of Control to measure belief in LOC according to health. Results Urban population had a significantly higher Doctor Health Locus of Control (mean±SD=15.61±1.91) compared with rural population (mean±SD=14.16±3.38). Rural population had a higher I–E LOC score (mean±SD=8.37±3.24) compared with urban population (mean±SD=6.75±4.14). Women had a significantly higher Powerful Other Health Locus of Control (mean±SD=12.8±3.55) compared with men (mean±SD=10.27±2.84). Women had a significantly higher I–E LOC (high external LOC) (mean±SD=9.6±3.09) compared with men (mean±SD=10.6.33±4.42). Conclusion The findings show that urban population has higher belief in doctor as a controller of health compared with the rural one. Rural population has more external LOC belief in general life compared with the urban population. Women have more external LOC in general life compared with men. Women have higher belief in powerful others as a controller of their life compared with men.

Annals of Oncology, 2012

Asian Pacific Journal of Cancer Prevention

Journal of Cancer and Biomedical Research, 2018

Recent studies indicated to the immune disturbances in cancer patients in comparison with healthy... more Recent studies indicated to the immune disturbances in cancer patients in comparison with healthy individuals. Several studies suggested that individuals with external locus of control (E-LOC) have more symptoms of depression. Other studies indicated to the effective role of psychological status on the immune system. The association between E-LOC and immunity in cancer patients it is not clear. Study the relation between Rotter internal-external locus of control (I-E LOC) and God health locus of control (GHLC) and interleukin-6 (IL-6) in breast cancer patients. The study included hundred breast cancer patients and fifty healthy controls. Patients and participators responded to I-E LOC and GHLC questionnaires. Peripheral blood samples were collected to measure gene expression of IL-6 by using real time PCR. Breast cancer patients showed higher GHLC which was associated with higher level of IL-6 as compared to control subjects. By contrast, a significant inverse correlation between GHLC and IL-6 was found. However, there was no relationship between I-E LOC and IL-6. The results suggest no significant effect of LOC belief according to life on immune response against cancer, but high GHLC belief correlate with decreased IL-6. Further studies on the relations between other types of LOC and immune response in breast cancer is recommended.

International Journal of Veterinary Science, 2020

International Journal of Cancer and Biomedical Research (Print), Aug 31, 2023

BMC Immunology, Aug 14, 2023

InTech eBooks, Apr 26, 2017

Egyptian Journal of Radiology and Nuclear Medicine, Apr 6, 2023

Asian Pacific Journal of Cancer Prevention, Aug 1, 2022

Authorea, Apr 7, 2020

Annals of Oncology, Sep 1, 2012

PubMed, Jul 1, 2014

Arab journal of urology, Mar 1, 2016

Journal of Pain and Symptom Management, Nov 1, 2014

BMC Immunology

International Journal of Cancer and Biomedical Research

The Gulf journal of oncology, 2020

Tanta Medical Journal, 2016

Annals of Oncology, 2012

Asian Pacific Journal of Cancer Prevention

Journal of Cancer and Biomedical Research, 2018

Colorectal cancer is the third most common cancer worldwide and is the third leading cause of can... more Colorectal cancer is the third most common cancer worldwide and is the third leading cause of cancer mortality. Surgical management remains the mainstay of treatment for early and locally-advanced non-metastatic colon cancers. Systemic therapies have shown to significantly improve outcomes when given in the adjuvant setting in these patients. The addition of adjuvant chemotherapy in patients with Stage III and high risk stage II disease significantly improves recurrence free survival. In this chapter , we summarize important clinical trials that have led to an evidence-based approach to the management of non-metastatic colon cancer.