Lessons learned from Jordan's response to the Syria refugee crisis

The number of refugees across the world has jumped from 15.7 million to 34.6 million in the past 10 years, and their forced displacement situation remain for an average period of 20 years. To ensure sustainable benefits, health system strengthening through development cooperation should be a priority in parallel to humanitarian aid early on in refugee crises.

Neuropeptide substance P alters stem cell fate to aid wound healing and promote epidermal stratification through asymmetric stem cell divisions

Loss of sensory innervation delays wound healing and administration of the neuropeptide substance P improves re-epithelialization. Keratinocyte hyperproliferation post-wounding may result from symmetric stem cell (SC) self-renewal, asymmetric SC self-renewal, committed progenitor divisions, or a combination of these. However, the effects of sensory denervation and of neuropeptides on SC proliferation are not known. Here we show that early after wounding both asymmetric and symmetric SC self-renewal increase, without significant committed progenitor (CP) activation. Decreased sensory innervation is associated with a decrease in both SC and CP proliferation. Based on previous work showing that substance P is decreased in capsaicin-treated mice and improves wound healing in normal skin, we examined the effects of substance P on SC and CP proliferation during wound healing. Substance P restored asymmetric SC proliferation in skin with decreased sensory innervation, both at baseline and following wounding. Epidermis with decreased sensory innervation was severely thinned. Consistent with this, substance P-induced asymmetric SC proliferation resulted in increased stratification in skin with both normal and decreased innervation. Lapatinib prevented the substance P-induced increase in asymmetric SC divisions in murine epidermis, as well as the increase in epidermal stratification, suggesting that asymmetric SC divisions are required for epidermal stratification.

Control and treatment of type 2 diabetes in private patients in the Egyptian "DIACONTROL study"

OBJECTIVE

This study aims to identify the characteristics of Egyptian patients suffering from type 2 diabetes mellitus (T2DM), determine disease control rates, and gain insights into clinical treatments.

PATIENTS AND METHODS

A total of 2,516 patients with T2DM were recruited from 244 private clinics across Egypt in a one-month period from May to June 2017. Data collected from patients included glycemic control parameters of glycosylated hemoglobin, fasting plasma glucose, and postprandial glucose. Additional information gathered included patients' weight, age, level of physical activity, smoking habits, presence of comorbidities, type of treatment received for type 2 diabetes, number and severity of hypoglycemic events, as well as treatment modification by the physician in the last visit. The type of statistics used for the analysis is descriptive statistics and regression model.

RESULTS

Only 18.4% of participating patients achieved the target level of glycosylated hemoglobin of 7% or below. The mean age of these patients was 54±11.2 years, and the mean duration since the first diagnosis was 6.6±6.4 years. A total of 33.4% of all patients had no known comorbidity, while the rest had one or more known and treated comorbidities. A total of 76% of patients received sulfonylurea either as monotherapy or in combination with other treatments. In addition, no treatment modifications or adjustments were provided for 32% of the study participants who did not reach their glycemic control target.

CONCLUSIONS

In Egypt, there is a low rate of glycemic control among private patients and a high prevalence of comorbid conditions. This is likely to cause a significant health burden to people with T2DM, the healthcare system, and the economy due to a loss in productivity. This study presented an argument for better-managed measures to improve glycemic control in the population, such as patient education to increase patient awareness and adherence to treatment protocols as well as improved adherence to guidelines by clinicians.

Cyclic fasting bolsters cholesterol biosynthesis inhibitors' anticancer activity

Identifying oncological applications for drugs that are already approved for other medical indications is considered a possible solution for the increasing costs of cancer treatment. Under the hypothesis that nutritional stress through fasting might enhance the antitumour properties of at least some non-oncological agents, by screening drug libraries, we find that cholesterol biosynthesis inhibitors (CBIs), including simvastatin, have increased activity against cancers of different histology under fasting conditions. We show fasting's ability to increase CBIs' antitumour effects to depend on the reduction in circulating insulin, insulin-like growth factor-1 and leptin, which blunts the expression of enzymes from the cholesterol biosynthesis pathway and enhances cholesterol efflux from cancer cells. Ultimately, low cholesterol levels through combined fasting and CBIs reduce AKT and STAT3 activity, oxidative phosphorylation and energy stores in the tumour. Our results support further studies of CBIs in combination with fasting-based dietary regimens in cancer treatment and highlight the value of fasting for drug repurposing in oncology.

Identification of new FK866 analogues with potent anticancer activity against pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal diseases for which chemotherapy has not been very successful yet. FK866 ((E)-N-(4-(1-benzoylpiperidin-4-yl)butyl)-3-(pyridin-3-yl)acrylamide) is a well-known NAMPT (nicotinamide phosphoribosyltransferase) inhibitor with anti-cancer activities, but it failed in phase II clinical trials. We found that FK866 shows anti-proliferative activity in three PDAC cell lines, as well as in Jurkat T-cell leukemia cells. More than 50 FK866 analogues were synthesized that introduce substituents on the phenyl ring of the piperidine benzamide group of FK866 and exchange its buta-1,4-diyl tether for 1-oxyprop-3-yl, (E)-but-2-en-1,4-diyl and 2- and 3-carbon tethers. The pyridin-3-yl moiety of FK866 was exchanged for chlorinated and fluorinated analogues and for pyrazin-2-yl and pyridazin-4-yl groups. Several compounds showed low nanomolar or sub-nanomolar cell growth inhibitory activity. Our best cell anti-proliferative compounds were the 2,4,6-trimethoxybenzamide analogue of FK866 ((E)-N-(4-(1-(2,4,6-trimethoxybenzoyl)piperidin-4-yl)butyl)-3-(pyridin-3-yl)acrylamide) (9), the 2,6-dimethoxybenzamide (8) and 2-methoxybenzamide (4), which exhibited an IC50 of 0.16 nM, 0.004 nM and 0.08 nM toward PDAC cells, respectively.

Abstract 6254: Identification of nicotinic acid phosphoribosyltransferase inhibitors with anticancer properties by in silico drug design

Cancer cells rely heavily on sustained NAD levels to support their survival and proliferation. Thus, depleting NAD levels in tumor cells through interference with their NAD-biosynthetic machinery has been proposed as a promising anticancer strategy. Several pathways contribute to NAD production in mammals, such as the de novo and the Preiss-Handler (PH) pathways, which generate NAD from tryptophan and from nicotinic acid, respectively. In addition, the NAD salvage pathway, which utilizes nicotinamide as a substrate, is also a major NAD-producing route and its rate-limiting enzyme, nicotinamide phosphoribosyltransferase (NAMPT), is commonly overexpressed in a multitude of human cancers. Over the past two decades, several potent NAMPT inhibitors have been developed, such as FK866. However, their clinical efficacy has proven limited, suggesting that the other NAD-producing routes are frequently also active in cancer cells and are responsible for causing resistance to NAMPT inhibitors. Recently, we have shown nicotinic acid phosphoribosyl transferase (NAPRT), the key enzyme in the PH pathway, to play an important role in NAD metabolism in cancer cells. We demonstrated that NAPRT is amplified and overexpressed in several types of solid tumors and that its expression is a critical determinant of cancer cell susceptibility to NAMPT inhibitors. Although several NAPRT inhibitors have been reported, including 2-hydroxy nicotinic acid (2-HNA), their low potency and/or poor solubility limit their clinical applicability. To identify new NAPRT inhibitors with enhanced pharmacological profiles, we performed a high-throughput molecular docking screen, taking advantage of the availability of NAPRT crystal structure. The first 500 hits were visually inspected to prioritize compounds that reproduced, at least in part, the putative binding mode of known substrates and inhibitors and complied with simple physicochemical rules such as Lipinski’s rule of five. In addition, several 2-HNA analogs were selected. Altogether, this led to a final list of 50 compounds that were tested in vitro. We show that four compounds from this list were able to sensitize NAPRT-overexpressing ovarian cancer cells to FK866, resulting in a more significant reduction in intracellular NAD levels, as well as in a much more pronounced cytotoxicity as compared to FK866 alone. The inhibitory constant (Ki) of the new NAPRT inhibitors was found to be in the micromolar range. In conclusion, in silico molecular docking screens are a promising approach to identify new NAPRT inhibitors with anticancer effects.

Citation Format: Moustafa Ghanem, Amr Khalifa, Irene Caffa, Aimable Nahimana, Michel Duchosal, Alberto Del Rio, Santina Bruzzone, Francesco Piancente, Alessio Nencioni. Identification of nicotinic acid phosphoribosyltransferase inhibitors with anticancer properties by in silico drug design [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6254.

Abstract 3020: Periodic fasting and cholesterol biosynthesis inhibitors achieve a synergistic antitumor activity in gastrointestinal cancers

Periodic fasting enhances the activity of several chemotherapeutics, molecularly-targeted drugs, endocrine agents and immune checkpoint inhibitors. Identifying drugs that are approved for non-oncological conditions, but acquire antitumor properties through fasting could pinpoint new cancer cell liabilities and define new treatment options. By screening over 800 approved drugs in PK9 pancreatic ductal adenocarcinoma (PDAC) cells, we identified several azoles (antifungal agents), including clotrimazole (CTZ), as agents whose cytotoxic activity against cancer cells is synergistically enhanced by starvation conditions. Since azoles inhibit 14alpha-demethylase, which is a key enzyme for cholesterol (CE) biosynthesis, we hypothesized that starvation and azoles would cooperate by blunting CE production in PDAC cells. Consistent with this notion, we found that simvastatin (an HMG-CoA reductase inhibitor) and terbinafine (TRB), which obstruct squalene epoxidase (SQLE), another key enzyme from the CE biosynthetic pathway, also had their antitumor effects strongly enhanced by starvation. Combined starvation and CTZ or starvation and TRB reduced intracellular CE in Capan-1 cells both in vitro and in vivo. Methyl-beta-cyclodextrin, which depletes intracellular CE, and starvation also showed a synergistic interaction in Capan-1 and in MiaPaCa2 cells (another PDAC cell line). Finally, culture media supplementation with a water-soluble CE formulation prevented the synergistic interaction between starvation and CE biosynthesis inhibitors. TRB potentiation through starvation was countered through supplementation with insulin, IGF1 and leptin, which are downregulated during fasting. Consistent with CE being an essential constituent of membrane lipid rafts, that harbor the growth- and survival-promoting PI3K/AKT signaling cascade, we found combined CTZ or TRB and starvation to markedly downregulate phosphorylated AKT in Capan-1 xenografts. Similar results were obtained in MiaPaCa2 cells. Capan-1 cell transduction with constitutively active, myristoylated AKT protected them from combined CTZ or TRB and starvation, indicating that AKT inhibition mediates the synergistic interaction between CE production inhibitors and fasting. Weekly 48h fasting enhanced CTZ and TRB antitumor effects in vivo in Capan-1 xenograft-bearing mice and, when combined with TRB, lowered circulating LDL (while increasing HDL) cholesterol as compared to TRB alone. Overall, these findings support the potential of fasting-based diets in combination with CE biosynthesis inhibitors against PDAC.

Citation Format: Amr Khalifa, Ana Guijarro, Asmaa Namatalla, Moustafa Ghanem, Matteo Lambertini, Alessio Nencioni, Irene Caffa. Periodic fasting and cholesterol biosynthesis inhibitors achieve a synergistic antitumor activity in gastrointestinal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3020.

POS0933 IMPACT OF SACROILIAC JOINT STEROID INJECTION IN AXIAL SpA PATIENTS WITH BONE MARROW EDEMA ON DIFFERENT DISEASE OUTCOME MEASURES: A RANDOMIZED CONTROLLED TRIAL

Background

Sacroiliac joint injection in axial spondyloarthritis (SpA) patients with steroid was controversial. A well designed randomized clinical trial testing its effect on different disease outcome measures particularly bone marrow edema was missing [1].

Objectives

To test the effect of steroid injection in the sacroiliac joint of axial SpA patients on different disease outcome measures.

Methods

N = 43 were registered. They were randomly assigned into 2 groups; Group I (23 cases) received sacroiliac joint injection lidocaine hydrochloride mixed with triamcinolone, whereas Group II (22 cases) received subcutaneous saline injections. All participants fulfilled the ASAS criteria for axial SPA and they all had bone marrow edema at baseline. Outcomes measures were: Visual Analogue Scale (VAS), ASDAS, BASFI, and SPARCC scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after 3 months.

Results

There was a significant difference between both groups regarding pain, spine mobility, SPARCC and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC and ASDAS scores showed improvement after 3 months. Higher disease activity, younger age, and shorter disease duration all were associated with better outcomes. Bilateral hip involvement was a predictor of poor response

Conclusion

Sacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is effective in controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect.

References

[1]Elsaman, A., A. Hamed, and A. Radwan, Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. The Korean journal of pain, 2021. 34(1): p. 114.

Table 1.

Comparison between the two study groups

Group I (N=24)Group II (N=23)P value*Age35.4±6.233.5±6.70.354SexMale17(77.3%)16(76.2%)1.000Female5(22.7%)5(23.8%)VASBefore injection (0)7.95±0.847.86±0.730.688After injection (1)3.55±1.446.95±1.02<0.00112 weeks later (2)4.82±1.377.19±0.81<0.001P value 0 vs 1**<0.0010.003-P value 0 vs 2**<0.0010.001-P value 1 vs 2**<0.0010.397-ASDASBefore injection2.69±0.442.60±0.370.45112 weeks later1.51±0.442.40±0.46<0.001P value **<0.0010.022BASFIBefore injection61.91±9.7062.95±11.710.75212 weeks later57.50±8.1361.24±0.530.199P value **<0.0010.081-SPARCCBefore injection34.73±9.1433.48±8.930.65212 weeks later15.68±6.6030.95±7.85<0.001P value **<0.0010.024-Finger to floorBefore injection (0)27.68±9.9426.90±11.620.815After injection (1)17.09±7.0025.48±11.230.00512 weeks later (2)19.64±7.8326.76±11.790.024P value 0 vs 1**<0.0010.001-P value 0 vs 2**<0.0010.791-P value 1 vs 2**0.0010.072-Lateral bendingBefore injection (0)21.64±5.9122.29±4.510.688After injection (1)25.50±6.1322.57±3.430.06012 weeks later (2)24.55±4.9522.24±2.950.071P value 0 vs 1**<0.0010.649-P value 0 vs 2**0.0030.947-P value 1 vs 2**0.0870.426-

* p values were calculated using Independent t test, except for the sex, where Fisher Exact test was used.

** p values for paired data was calculated using paired t test, to compare the baseline values (0) with either immediate post-injection (1) or 12 weeks later (2) values.

Disclosure of Interests

None declared

In vitro antibacterial activities of silver nanoparticles synthesised using the seed extracts of three varieties of Phoenix dactylifera

Green synthesis of ‏silver nanoparticles (AgNPs) is an ecofriendly, cost-effective and promising approach for discovery of novel therapeutics. The aim of the current work was to biogenic synthesize, characterize AgNPs using seed extracts of three economically important varieties of date palm (Iklas, Irziz and Shishi), and assess their anti-pathogenic bacterial activities. AgNPs were synthesised then characterised using electron microscopy and Fourier transform infrared analyses. The bactericidal activities of AgNPs against five different bacterial pathogens, Bacillus subtilis, Escherichia coli, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae, were determined in vitro. In particular, changes in membrane integrity of virulent bacterial strains in response to AgNPs were investigated. Results of lactate dehydrogenase, alkaline phosphatase activity assays, and measurement of membrane potential revealed that the cytotoxic effects of the AgNPs were mainly centred on the plasma membrane of bacterial cells, leading to loss of its integrity and eventually cell death. In conclusion, green synthesis of AgNPs is an efficient, cost-effective and promising strategy to combat virulent antibiotic-resistant strains.

SIRT6 enhances oxidative phosphorylation in breast cancer and promotes mammary tumorigenesis in mice

BACKGROUND

Sirtuin 6 (SIRT6) is a NAD⁺-dependent deacetylase with key roles in cell metabolism. High SIRT6 expression is associated with adverse prognosis in breast cancer (BC) patients. However, the mechanisms through which SIRT6 exerts its pro-oncogenic effects in BC remain unclear. Here, we sought to define the role of SIRT6 in BC cell metabolism and in mouse polyoma middle T antigen (PyMT)-driven mammary tumors.

METHODS

We evaluated the effect of a heterozygous deletion of Sirt6 on tumor latency and survival of mouse mammary tumor virus (MMTV)-PyMT mice. The effect of SIRT6 silencing on human BC cell growth was assessed in MDA-MB-231 xenografts. We also analyzed the effect of Sirt6 heterozygous deletion, of SIRT6 silencing, and of the overexpression of either wild-type (WT) or catalytically inactive (H133Y) SIRT6 on BC cell pyruvate dehydrogenase (PDH) expression and activity and oxidative phosphorylation (OXPHOS), including respiratory complex activity, ATP/AMP ratio, AMPK activation, and intracellular calcium concentration.

RESULTS

The heterozygous Sirt6 deletion extended tumor latency and mouse survival in the MMTV-PyMT mouse BC model, while SIRT6 silencing slowed the growth of MDA-MB-231 BC cell xenografts. WT, but not catalytically inactive, SIRT6 enhanced PDH expression and activity, OXPHOS, and ATP/AMP ratio in MDA-MB-231 and MCF7 BC cells. Opposite effects were obtained by SIRT6 silencing, which also blunted the expression of genes encoding for respiratory chain proteins, such as UQCRFS1, COX5B, NDUFB8, and UQCRC2, and increased AMPK activation in BC cells. In addition, SIRT6 overexpression increased, while SIRT6 silencing reduced, intracellular calcium concentration in MDA-MB-231 cells. Consistent with these findings, the heterozygous Sirt6 deletion reduced the expression of OXPHOS-related genes, the activity of respiratory complexes, and the ATP/AMP ratio in tumors isolated from MMTV-PyMT mice.

CONCLUSIONS

Via its enzymatic activity, SIRT6 enhances PDH expression and activity, OXPHOS, ATP/AMP ratio, and intracellular calcium concentration, while reducing AMPK activation, in BC cells. Thus, overall, SIRT6 inhibition appears as a viable strategy for preventing or treating BC.

Development of an intraoperative 3D C-arm technique for torsion control of femur fractures: a cadaver study

AIM

This study aims to test the accuracy and feasibility of a measurement of femoral torsion of a 3D C-arm system (Linea aspera method) in a cadaver setting.

MATERIALS AND METHODS

A total of 11 intact femora were used. Schanz screws were inserted in the femoral bone in a parallel manner with the help of a fixed drill sleeve. Femur bones were then fractured in a controlled manner and three different internal and external torsion angles were fixed with the help of a Goniometer. After that, a 3D scan was performed. The 3D data set was analyzed using a radiologic software (Visage 7, Visage Imaging Inc, USA). Measurements were then compared in the two methods with a dependent t test.

RESULTS

Specific measurements for different angles did not show any differences between those two utilities.

CONCLUSION

Intraoperative estimation of femoral antetorsion using a 3D C-Arm system and the Linea aspera method seems to be an accurate and feasible method. Nevertheless, more studies with higher patient numbers, comparison to CT seems to be the next step and can be recommended.

P1615IDENTIFICATION OF URINARY PROTEOMIC PROFILE OF PATIENTS WITH CHRONIC ALLOGRAFT NEPHROPATHY

Background and Aims

Chronic allograft nephropathy (CAN) is a major complication that occurs post-transplantation. At present, the diagnosis of chronic allograft nephropathy (CAN) is based on renal biopsy. Therefore, there is an ultimate need to identify more specific and sensitive noninvasive methods for the early diagnosis of CAN. Recently, proteomic-based modalities have been developed to discover biomarkers of CAN.

Method

Urine samples from 75 participants were collected. Participants were divided into 3 groups: Group I: 25 patients with chronic allograft nephropathy, group II: 25transplanted patients with stable renal functions, and group III: 25 healthy control subjects matched for age and sex. Each group was divided into training set and test set. Specimens were purified with magnetic beads-based weak cation exchange chromatography and analyzed in a MALDI-TOF MS.

Results

A Genetic Algorithm (GA) was used to set up the classification models. Five peaks represented the proteomic profile that differentiates between the CAN patients and the control group with sensitivity of 100%, specificity of 100%, recognition capability of 100 % and cross-validation91.7 % and five peaks differentiate between the transplant patients with normal renal functions and the control groups with sensitivity of96.8 %, specificity of  95.5 %, recognition capability of 98 % and cross-validation of 100 %.

Conclusion

We identified a pattern for CAN and transplant patients with normal renal functions by proteomic profiling using MALDI-TOF-MS and magnetic beads.

The rotational fixator: A new device

Objectives

Malrotation after surgical treatment of femoral shaft fractures is a common problem and often leads to follow-up procedures with uncertain outcome. The aim of this study is the validation of a new device (Rotational Fixator) to perform the correction safely and accurately.

Methods

In an in-vitro study, we tested the Rotational Fixator on 21 corpse bones against a commercially available standard goniometer for measurement inaccuracies. For this purpose, we varied the rotation width from 10 to 30° in inside and outside rotation.

Results

We found a small measurement inaccuracy of 1-2° with increasing rotation. The smallest differences are found at 10° IR with 0.9524° (SD ± 1.0713; p = 0.001) difference and 10° ER with at 0.5952° (SD ± 0.6823; p = 0.001) difference and increase up to 30° (IR 1.6667°, SD ± 1.7121, p < 0.000/ER 1.5000°, SD ± 1.0488, p < 0.000).

Conclusions

The measurement results of the device show a constant deviation from the gold standard but are constant in the measurement error and slightly in relation to the desired correction range, so that a further review of the device and further testing in in vivo studies makes sense.

Levels of evidence

Level 3.

102Diagnosis of coronary plaque rupture, plaque erosion, and calcified nodule by using near-infrared spectroscopy intravascular ultrasound

Objectives

This study sought to investigate the ability of near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) to differentiate among plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) in acute myocardial infarction (AMI) using an optical coherence tomography (OCT) diagnosis as a reference standard.

Background

In vivo, precise differentiation among PR, PE and CN is a major challenge for intravascular imaging.

Methods

The study enrolled 156 AMI patients who had a de novo culprit lesion in a native coronary artery. The culprit lesions were assessed by both NIRS-IVUS and OCT.

Results

OCT identified 112 PR, 29 PE, and 15 CN. IVUS-detected plaque ulceration showed a high specificity (100%) to identify OCT-PR although the sensitivity (62%) was intermediate. IVUS-detected convex calcium showed a high sensitivity (93%) and specificity (100%) to identify OCT-CN. In NIRS, the maximum lipid core burden index in 4 mm (maxLCBI4mm) was greatest in OCT-PR (values are median [interquartile range]) (671 [530 to 853]), followed by OCT-CN (355 [303 to 432]) and OCT-PE (283 [89 to 357]) (p<0.001). MaxLCBI4mm of <422 was the best cut-off to discriminate OCT-PE from OCT-PR and OCT-CN. The NIRS-IVUS classification algorithm using plaque ulceration, convex calcium, and maxLCBI4mm <422 showed a sensitivity and specificity of 96% and 95% for identifying OCT-PR, 93% and 95% for OCT-PE, and 93% and 100% for OCT-CN, respectively.

NIRS-IVUS classification algorism

Conclusion

Lipid component assessed by NIRS-IVUS was different among OCT-PR, OCT-PE and OCT-CN. The NIRS-IVUS classification algorism was highly sensitive and specific for differentiating these unstable lesion types in AMI.

Acknowledgement/Funding

None

[Acute on chronic renal failure in a 62-year-old man with ANCA-associated vasculitis]

We describe a patient with ANCA (antineutrophil cytoplasmic antibodies) associated vasculitis and acute-on-chronic renal failure. He had initially presented with severe pulmonary hemorrhage and anuric renal failure and improved rapidly with immunosuppressive therapy. Repeat renal biopsy revealed candida interstitial nephritis. Candida was also detected in bronchoalveolar lavage. Kidney function improved with long-term antifungal therapy. This report adds induction therapy for ANCA vasculitis to the conditions where invasive candidal infections including nephritis need to be considered.

The burden and epidemiology of community-acquired central nervous system infections: a multinational study

Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Clinical symptomatology and empathy in schizophrenia: Which relationship?

Introduction

The impairment of cognitive and affective empathy among patients with schizophrenia (SCZ) may represent a significant feature of the illness. However, the relationship between those impairment and dimensions of psychosis remains unclear.

Objectives

To explore whether cognitive and affective empathy are associated with severety of different psychotic symptoms.

Methods

Cognitive and affective empathy were evaluated in 58 patients with stable schizophrenia with the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).

Results

Patients with better cognitive empathy had less total CDSS scores (P = 0.036, r = −0.449) and lower CGI-severity scale scores (P = 0.01, r = −0.536). Patients with better affective empathy had lower scores (which means a better improvement) at the CGI-improvement scale (P = 0.03, r = −0.461).

Conclusions

Our results suggest that empathy with its different component is not totally independent of the clinical state of the patient. Further studies are required to confirm whether empathy deficits are state or trait aspects of SCZ.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Is empathy correlated to patients’ level of cognitive impairment in schizophrenia?

Introduction

Empathy, which refers to the ability to understand and share the thoughts and feelings of others, may be compromised in schizophrenia (SCZ). Yet the relationship between empathy and neurocognitive functioning remains unclear.

Objectives

To explore whether cognitive and affective empathy are associated with the neurocognitive functioning in SCZ.

Methods

Fifty-eight outpatients with stable SCZ completed the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

Better affective and cognitive empathy correlated with better performance in the ST (less hesitations and less errors). Patients with better cognitive empathy performed better in the MCST (more categories achieved; P = 0.029) and in the LDST (more substitutions per minute; P = 0.031).

Conclusions

Our results bolster support for the presence of an association between NF and the decreased cognitive and affective empathy in schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P6-12-05: Impact of the Middle East unrest on management of breast cancer – A single institution experience

King Fahad University Hospital of Dammam (KFHU) is a major referral teaching Hospital in the Eastern province in Saudi Arabia. With permission, The Breast Division at KFHU accepts expatriate patients for treatment of breast cancer free of charge. Between Jan 2010 and June 2015 the unit has received 435 new and previously treated breast cancer patients, 35% of them were expatiates. We have noticed that most of these patients had an out of their hand delay in initiating either their investigations for a breast lump or start of active treatment; this has resulted in less than optimum prognosis in many cases. We reported that 75% of these patients had an average of 6-19 months delay before they presented for investigations of a breast mass, 25% had received previous irregular treatment and did not complete their management due to war unrest and travelling. More than 70% of patients who needed radiotherapy did not receive it due to unavailability of treatment facility. Conclusion: In spite of the dramatic improvement in diagnosing early breast cancer, after the wide spread of screening programs in the last decade, we are faced again with recent increase in advanced presentations and poor outcome due to war unrest. With the expected increase in the number of similar cases we think that this category of patients should be addressed as a special category.

Citation Format: Khalifa A, Abdul-Hadi M, Al-Haddad H, Abu-Rida L. Impact of the Middle East unrest on management of breast cancer – A single institution experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-05.

Highly Electrically Conducting Glass-Graphene Nanoplatelets Hybrid Coatings

Hybrid coatings consisting of a heat resistant Y2O3-Al2O3-SiO2 (YAS) glass containing 2.3 wt % of graphene nanoplatelets (GNPs) were developed by flame spraying homogeneous ceramic powders-GNP granules. Around 40% of the GNPs survived the high spraying temperatures and were distributed along the splat-interfaces, forming a percolated network. These YAS-GNP coatings are potentially interesting in thermal protection systems and electromagnetic interference shields for aerospace applications; therefore silicon carbide (SiC) materials at the forefront of those applications were employed as substrates. Whereas the YAS coatings are nonconductive, the YAS-GNP coatings showed in-plane electrical conductivity (∼10(2) S·m(-1)) for which a low percolation limit (below 3.6 vol %) is inferred. Indentation tests revealed the formation of a highly damaged indentation zone showing multiple shear displacements between adjacent splats probably favored by the graphene sheets location. The indentation radial cracks typically found in brittle glass coatings are not detected in the hybrid coatings that are also more compliant.

Social Network and Health Researchers and Professionals Mobility in Africa: Lessons Learned from AFRICA BUILD Project

OBJECTIVE

Promote mobility between South-South and South-North for improving level of researchers, staff and students through a platform.

METHODS

The methodology is based a filling of a questionnaire about offer or demand. Material is composed a computer connected Internet.

RESULT

we registered about 203 demands and 31 offers from partners.43 mobilities were executed completely.

CONCLUSION

The results indicate a real need of mobility for researchers and health professionals in Africa. The important number of mobility demands made by external researchers and professionals (from outside the AFRICA BUILD Consortium) may be constrained by the difficulty to find adequate funding.

Laparoscopic common bile duct exploration

BACKGROUND

Laparoscopic common bile duct exploration (LCBDE) is a safe and effective single-stage treatment for choledocholithiasis in the elective setting. The outcomes after LCBDE in the emergency setting are unknown. The aim of this study was to compare the outcomes following elective and emergency LCBDE for choledocholithiasis.

METHODS

Details of all patients who underwent LCBDE for choledocholithiasis between August 2003 and August 2013 were analysed retrospectively. The primary outcome measure was common bile duct (CBD) stone clearance rate. Secondary outcome measures were conversion rate, morbidity, mortality and length of hospital stay.

RESULTS

Some 215 consecutive patients (57 male; median age 65 (range 14-92) years) underwent LCBDE. Some 121 procedures were performed electively and 94 as an emergency. Forty-five patients (48 per cent) presented with obstructive jaundice or cholangitis in the emergency LCBDE group compared with 15 (12·4 per cent) in the elective group (P < 0·001). The CBD stone clearance rate was similarly high in both groups (96 versus 96·7 per cent respectively; P = 0·557). There were no significant differences in conversion rate (6 versus 4·1 per cent), morbidity (5 versus 6·6 per cent), mortality (2 versus 0 per cent) or median length of stay (3 days) between groups. Two patients died, both following emergency LCBDE.

CONCLUSION

LCBDE can be performed safely and effectively in both elective and emergency settings.

Predictors of quality of life among multiple sclerosis patients: a comprehensive analysis

BACKGROUND AND PURPOSE

Multiple sclerosis (MS) is a debilitating neurological disease of young people with substantial consequences on patients' quality of life (QOL). A variety of QOL instruments have been used to evaluate the efficacy of treatments. However, no study assessed the role of the different demographic, clinical, physical, social, economic and psychological parameters in the perception of patients with MS of their QOL.

METHODS

Two-hundred and one consecutive patients attending outpatient clinics were prospectively studied and objectively assessed using Expanded Disability Status Scale (EDSS), 8-m walk test, and Symbol Digit Modality Test. Patients completed the following questionnaires: MS QOL-54, Hamilton Depression Rating Scale, Fatigue Severity Scale, Brief Pain Inventory Average Pain Score, Drug Side-Effects Severity Scale, Social Support, Religiosity, Physiotherapy and Exercise, and Socioeconomic Profile. Overall, QOL, physical (PHCS) and mental (MHCS) health composite scores were computed as outcome measures from MSQOL-54.

RESULTS

Depression, social support, religiosity, education years and living area predicted overall QOL by linear regression (R(2) = 0.43). Unemployment and absence of fatigue correlated with poor and good QOL, respectively. Fatigue, pain, depression, EDSS, social support, MS type and anti-cholinergic treatment predicted PHCS (R(2) = 0.81). Fatigue, pain, depression, education years and social support predicted MHCS (R(2) = 0.70).

CONCLUSION

The QOL in patients with MS is not solely determined by physical disability, but rather by the level of social support, living area, depression, level of education, employment, fatigue and religiosity. Accordingly, we suggest that these should be evaluated in every patient with MS as they may be modified by targeted interventions.

DNA-Based Data Encryption and Hiding Using Playfair and Insertion Techniques

In this paper, we propose a novel algorithm to communicate data securely. The proposed technique is a composition of both encryption and data hiding using some properties of Deoxyribonucleic Acid (DNA) sequences. Hence, the proposed scheme consists mainly of two phases. In the first phase, the secret data is encrypted using a DNA and Amino Acids-Based Playfair cipher. While in the second phase the encrypted data is steganographically hidden into some reference DNA sequence using an insertion technique.The proposed algorithm can successfully work on any binary data since it is actually transformed into a sequence of DNA nucleotides using some binary conversion rule. Subsequently, these nucleotides are represented as an amino acids structure in order to pass through the specially designed Playfair Cipher and encrypt it into another DNA sequence. Then, this encrypted DNA data is randomly inserted into some reference DNA sequence to produce a faked DNA sequence with the encrypted data hidden. In order to recover the embedded secret data, the receiver can carry out the inverse process with the help of the both the secret key and the reference DNA sequence.

Biomedical and Health Informatics Education and Research at the Information Technology Institute in Egypt

During the last decade, Egypt has experienced a revolution in the field of Information and Communication Technology (ICT) that has had a corresponding impact on the field of healthcare.

Since 1993, the Information Technology Institute (ITI) has been leading the development of the Information Technology (IT) professional training and education in Egypt to produce top quality IT professionals who are considered now the backbone of the IT revolution in Egypt. For the past five years, ITI has been adopting the objective of building high caliber health professionals who can effectively serve the ever-growing information society.

Academic links have been established with internationally renowned universities, e.g., Oregon Health and Science University (OHSU) in US, University of Leipzig in Germany, in addition those with the Egyptian Fellowship Board in order to enrich ITI Medical Informatics Education and Research.

The ITI Biomedical and Health Informatics (BMHI) education and training programs target fresh graduates as well as lifelong learners. Therefore, the program’s learning objectives are framed within the context of the four specialization tracks: Healthcare Man- agement (HCM), Biomedical Informatics Research (BMIR), Bioinformatics Professional (BIP), and Healthcare Professional (HCP). The ITI BMHI research projects tackle a wide-range of current chal- lenges in this field, such as knowledge management in healthcare, providing tele-consultation services for diagnosis and treatment of infectious diseases for underserved regions in Egypt, and exploring the cultural and educational aspects of Nanoinformatics.

Since 2006, ITI has been positively contributing to de- velop the discipline of BMHI in Egypt in order to support improved healthcare services .

Biomedical and health informatics education and research at the Information Technology Institute in Egypt

OBJECTIVES

During the last decade, Egypt has experienced a revolution in the field of Information and Communication Technology (ICT) that has had a corresponding impact on the field of healthcare. Since 1993, the Information Technology Institute (ITI) has been leading the development of the Information Technology (IT) professional training and education in Egypt to produce top quality IT professionals who are considered now the backbone of the IT revolution in Egypt. For the past five years, ITI has been adopting the objective of building high caliber health professionals who can effectively serve the ever-growing information society.

METHODS

Academic links have been established with internationally renowned universities, e.g., Oregon Health and Science University (OHSU) in US, University of Leipzig in Germany, in addition those with the Egyptian Fellowship Board in order to enrich ITI Medical Informatics Education and Research.

RESULTS

The ITI Biomedical and Health Informatics (BMHI) education and training programs target fresh graduates as well as life-long learners. Therefore, the program's learning objectives are framed within the context of the four specialization tracks: Healthcare Management (HCM), Biomedical Informatics Research (BMIR), Bioinformatics Professional (BIP), and Healthcare Professional (HCP). The ITI BMHI research projects tackle a wide-range of current challenges in this field, such as knowledge management in healthcare, providing tele-consultation services for diagnosis and treatment of infectious diseases for underserved regions in Egypt, and exploring the cultural and educational aspects of Nanoinformatics.

CONCLUSION

Since 2006, ITI has been positively contributing to develop the discipline of BMHI in Egypt in order to support improved healthcare services.

Mathematical modeling of aeration efficiency and dissolved oxygen provided by stepped cascade aeration

Mathematical modeling has been a vital tool in the field of environmental engineering. Various models have been developed to simulate the level of aeration efficiency (AE) provided by different aerating structures to raise levels of dissolved oxygen (DO) in streams; one of which is the stepped cascade structure. Three models developed by Gameson et al. WRL, and Nakasone, in addition to Qual2k, a computer program for stream modeling, have been used in this research; values of AEs obtained have been compared to those computed using DO measured from a built model at a WWTP. A stepped cascade structure was installed with different heights to aerate five flowrates with different levels of COD. An adjustment has been made to the Nakasone model to test the effect of pollutant load on the amount of aeration that could be reached. Values of AEs computed using the Gameson model were 30%, 39.5%, and 40% for cascade heights (H(d)) 45, 60, and 75 cm respectively for the five flowrates (q) that ranged from 21-66 m³/hr. Values of AEs from WRL model were 32.8%, 42%, and 43% consequently. Values of AEs from Nakasone model ranged from 4.6-7.5%, 6-10%, and 7.6-12% respectively. For the adjusted Nakasone model, values of AEs ranged from 3.2-4.9%, 3.3-5.3%, and 4.1-6.7% respectively. Finally, the AEs computed using the values of downstream DO generated by Qual2k ranged from 4-18%, 2-15%, and 2.5-5.1% correspondingly. Around 80% of the downstream DO values computed using the Nakasone and adjusted Nakasone model were closer to those measured in the field, thus more reliable in cascade design.

Biosimilars: opinion of an expert panel in the Middle East

BACKGROUND

Several biotechnology-derived drugs are reaching the end of their patent lives. As a result, so-called biosimilar products are in development, and a few have already gained approval in Europe and other countries such as the USA. Biosimilars, unlike generic versions of conventional drugs, are not identical to their reference product, and their production is complex and sensitive to even slight changes in the manufacturing and storage process. Therefore, the registration of these products requires more stringent evaluation than that for conventional generics.

METHODS AND SCOPE

A consensus group of experts from the Near and Middle East discussed the currently available guidelines for registration of biosimilars--including those produced by the European Medicines Agency (EMEA)--and their application in this region. To inform this report, a literature search was also conducted on PubMed in January 2008, using the search terms 'biosimilar' and 'follow-on biologic'. This paper provides an overview of the issues in the development and registration of biosimilars, a description of the EMEA guidelines and the recommendations of the consensus group for the registration of biosimilars in the Middle East.

FINDINGS

Because of the complex nature of biosimilars and their potential immunogenicity, these products cannot undergo the abbreviated approval process used for generic agents. Instead demonstration of their quality, safety and efficacy, in comparison with their reference biological product, is required.

CONCLUSIONS

The consensus group recommended the implementation of the EMEA guidelines as the basis of Regional guidelines for the registration of biosimilars in the Near and Middle East. Registration would, therefore, require demonstration of the robustness of the manufacturing process and quality-control methods, the comparability of pharmacokinetics, pharmacodynamics, efficacy and safety between the biosimilar and reference product and plans for post-marketing surveillance of the long-term risks and immunogenicity of new biosimilars.

Results of trastuzumab targeted therapy in metastatic breast cancer (MBC): The Sultanate of Oman experience 2002–2006

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Background: The first random study of incidence of Her-2 over expression among Omani breast cancer patients was carried out by the Medical Oncology Department, the Royal Hospital in 2001. The incidence was reported as 40% (higher than international published figures). The Herceptest was routinely performed on all new patients for a whole year (2004) and the incidence was found to be 36%. Trastuzumab was approved for use in the Sultanate of Oman in 2002, since then a total of 26 patients with metastatic breast cancer received Trastuzumab, the results are presented. Methods: Prospective, single arm, single centre experience. Patients with confirmed metastatic breast cancer (at presentation or after adjuvant treatment), HER-2 positive (+++ by Herceptest, or FISH positive), age > 18, ECOG PS ≤ 2, LVEF = 50% and adequate renal & liver function, were included. Treatment consisted of trastuzumab as single agent or in combination with chemotherapy as indicated. A loading dose of 8mg/kg was followed by 6mg/kg q3 weeks. The endpoints were response rate (RR) progression free survival (PFS) and survival (OS). Results: a total of 26 patients were included between October 2002-October 2006, median age was 45.5years (27–60), 12 patients presented with metastasis at first presentation and 14 had metastatic disease 6 months or more after finishing adjuvant chemotherapy. The median number of received cycles was 10 (range 4–30), the overall response rate was 77% (54% CR and 23% PR), the median survival 15 months (range 4–36m), median Time to Progression 9m (range 4–33m). Six patients (23%) developed brain metastasis while on herceptin. There were 8 events (disease related deaths) during the study period. Conclusions: The incidence of Her-2 +ve breast cancer in Omani patients is slightly higher than the reported figures in international studies. The response to trastuzumab in metastatic disease is comparable to other similar studies.

No significant financial relationships to disclose.

Evaluation of endocytoscopy in the surveillance of patients with Barrett's esophagus

BACKGROUND AND STUDY AIMS

Surveillance for patients with Barrett's esophagus is time consuming and subject to sampling error. Guided biopsies from neoplastic areas invisible on conventional endoscopy may increase effectiveness of surveillance examination. We assessed the accuracy of endocytoscopy in correlation with histology.

METHODS

We analyzed 166 biopsy sites from 16 patients (13 male, mean age 62.1 years), without visible lesions, who presented for Barrett surveillance. Endocytoscopy images were recorded from pre-marked areas in the Barrett's segment using magnification x 1125 or x 450. Biopsies were taken from the same area to allow precise comparison with histology. Image sequences of each area were individually and blindly reviewed by a pathologist and a gastroenterologist. Major outcome variables included image quality, identification of neoplastic characteristics, and accuracy of endocytoscopy.

RESULTS

Adenocarcinoma was histologically diagnosed in 4.2% of biopsy sites, high grade intraepithelial neoplasia (HGIN) in 16.9%, and low grade intraepithelial neoplasia (LGIN) in 12.1 %. Adequate assessment of endocytoscopy images was impossible in 49% of the pre-marked areas with magnification x 450 and in 22% with magnification x 1125. At most, 23% of images with lower magnification were interpretable to identify characteristics of neoplasia, and 41% with higher magnification. Interobserver agreement was fair at best (kappa from < 0 to 0.45). Positive and negative predictive values for HGIN or cancer were 0.29 and 0.87, respectively, for magnification x 450 and 0.44 and 0.83, respectively, for magnification x 1125.

CONCLUSION

When not supported by macroscopic evidence, endoscopic histology using endocytoscopy lacks sufficient image quality to be currently of assistance in identifying neoplastic areas.

Carcinoembryonic antigen, alpha-fetoprotein, and prostate-specific antigen in the sera of industrial workers exposed to phenol, formaldehyde, urea, and mixed vapors

Exposure to certain industrial agents has been thought to have carcinogenic potential, both for employees who work closely with agents and for the general population that comes into contact with them. The objective of the present study is to evaluate the changes at the cellular level or at the level of cellular metabolism products present in the biological fluid, and to detect early stages of the carcinogenic process resulting from the exposure of industrial environmental hazards. Carcinoembryonic antigen (CEA), alpha-fetoproteins (AFP), and prostate-specific antigen (PSA) were measured in sera of workers (n = 51), who were divided into 4 groups: group I, workers exposed to phenol; group II, workers exposed to formaldehyde; group III, workers exposed to urea; and group IV, workers exposed to mixed vapor, plus a reference control healthy group (n = 15). The results showed that 75% of the workers exposed to phenol, 75% of the workers exposed to urea, 83.3% of workers exposed to formalin, and 92.3% of the workers exposed to mixed vapors had raised values of serum CEA (S-CEA) above normal value of the control group. Also, 23% of workers exposed to mixed vapors, 44% of workers exposed to formalin, 50% of workers exposed to phenol, and 62.5% of workers exposed to urea had raised values of serum AFP (S-AFP) above normal value of control group. Finally, 16.6% of workers exposed to phenol, 23% of workers exposed to mixed vapors, and 33.3% of workers exposed to formalin had raised values of serum PSA (S-PSA) above the normal value of control group; there were no raised values of S-PSA in workers exposed to urea. No significant difference was found in the activities of AST and ALT in group I, but a highly significant increase was found in the AST activities for groups II and IV and the ALT activities for groups III and IV. A significant difference was found in the activity of ALT in group II and in AST for group III. There was no significant difference in the levels of albumin in groups I, II, and III, whereas albumin levels were significantly decreased in group IV. No significant change was found in the level of urea and creatinine in all groups except for group III, where serum levels of creatinine were significantly decreased. From our findings, we concluded that S-CEA can be used as an important prognostic screening marker for early prediction for malignancy, and for management of workers with lung cancer who are exposed to the environmental hazards in industrial factories. Furthermore, S-AFP can be used also as a biomarker if it is carried out and correlated with S-CEA.

Comparative evaluation of the nuclear matrix protein, fibronectin, urinary bladder cancer antigen and voided urine cytology in the detection of bladder tumors

PURPOSE

We evaluate the diagnostic efficacy of nuclear matrix protein-22 (NMP22, Matritech, Newton, Massachusetts), fibronectin and urinary bladder cancer antigen (UBC, IDL Biotech, Borlange, Sweden) compared with voided urine cytology in the detection of bladder cancer.

MATERIALS AND METHODS

A total of 168 patients provided a single voided urine sample for NMP22, fibronectin an ideal monoclonal for urinary bladder cancer and cytology before cystoscopy. Cystoscopy was done for all patients as the reference standard for identification of bladder cancer. Biopsy of any suspicious lesion was performed for histopathological examination. Of the 168 cases 100 were histologically diagnosed as bladder cancer, whereas the remaining 68 had benign urological disorders. A group of 47 healthy volunteers were also enrolled in this study. Voided urine was evaluated by NMP22, fibronectin and UBC, and their values were expressed relative to mg. creatinine.

RESULTS

The optimal threshold values for NMP22, fibronectin and UBC were calculated by receiver operator characteristics curves as 27 units per mg. creatinine, 198 mg./mg. creatinine and 13 ng./mg. creatinine, respectively. The levels and positive rates of the 3 parameters were significantly higher in the malignant group compared to either the benign group or normal controls. Of the entire group NMP22, fibronectin and UBC were positive in 93.2%, 91% and 68.2%, respectively in bladder cancer cases with positive cytology. Moreover, these positive rates were significantly higher in bilharzial bladder cancer cases (58.8%, 67.5%, 58.8%, respectively) compared to nonbilharzial cases (35.6%, 36.3%, 31.1%). Overall sensitivity and specificity were 85% and 91.3% for NMP22, 83% and 82.6% for fibronectin, 67% and 80.8% for UBC and 44% and 100% for voided urine cytology. Combined sensitivity of voided urine cytology with the 3 biomarkers together was higher than either combined sensitivity of voided urine cytology with 1 of the biomarkers or than that of the biomarker alone.

CONCLUSIONS

Our data indicate that NMP22 and fibronectin had superior sensitivities compared to UBC and voided urine cytology, while NMP22 and voided urine cytology had the highest specificities. The combined use of markers increased the sensitivity of cytology from 44% to 95.3%. The higher sensitivities of markers in bilharzial than nonbilharzial bladder cancer highlight their clinical use in screening patients with urinary bilharziasis.