Issue 36Issue No. 36, May 2021
Electronic ISSN 2521-3881
Issue No. 36 - May 2021
7-13 Epidemiological study of Helicobacter pylori infection and its association with gastric carcinogenesis

Boura Hasna1, Essaidi Imane1,6, Bounder Ghizlane1, Jouimyi Mohamed Reda1, Majd Abdeljabbar4, Jouhadi Hassan5, Badre Wafa3, Benomar Hakima2, Zerouali khalid6, Maachi Fatima1

1 Laboratory of Helicobacter Pylori and Gastric Pathologies, Pasteur institute of morocco, Casablanca 20360, Morocco.
2 Laboratory of Histo-Cytopathology, Pasteur institute of morocco, Casablanca 20360, Morocco
3 Gastroenterology Department, IbnRochd University Hospital Center, Casablanca 20360, Morocco
4 Regional Transfusion Center of Casablanca. Morocco.
5 Oncology Department, IbnRochd University Hospital Center, Casablanca 20360, Morocco
6 Faculty of Medicine of Casablanca,IbnRochd University Hospital Center, Hassan II University, Casablanca, Morocco.


Introduction: Helicobacter pylori (H.pylori) infection is recognized as a worldwide problem, mainly in developing countries where infection reaches 80% of the population. H.pylori is associated with various gastric diseases, mainly, many benign, premalignant and malignant lesions of the gastric mucosa. The aim of our study was to determine the prevalence of H.pylori infection and to highlight the determinants of the infection as well as the gastric lesions associated with this bacterium in a Moroccan population.


Patients and Methods: A total of 162 asymptomatic subjects collected from Casablanca blood transfusion, and 254 patients suffering from various gastric lesions collected from gastroenterology and oncology services of the IbnRochd CHU, were targeted typing of gastric lesions and H.pylori status were performed by Histological examination and ELISA test.


Results: Our results showed a high prevalence of H. pylori infection in asymptomatic and gastric diseases patients. We noticed that the worsening of gastric lesions related to H.pylori infection increases with age, and it was influenced bytobacco consumption and the living area.


Conclusion: Our study showed that gastric cancer was more occurred in rural areas than in urban areas.It is necessary to update the recommendations regarding diagnosis, treatment of H. pylori infection and follow-up of the patients to avoid the evolution of simple chronic gastritis to gastric cancer.


Keywords: Helicobacter pylori, gastric carcinogenesis, prevalence.


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2 14-20

Evaluation of the salivary glutaredoxin-1 levels in oral lichen planus and oral squamous cell carcinoma


Maryam Amirchaghmaghi1, Zohreh Dalirsani1, Ala Ghazi1, Leila Vazifeh Mostaan2, Seyed Isaac Hashemy3, Mohammad Taghi Shakeri4, Fatemeh Cheshomi5

1 Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
5 General Dentist, Mashhad, Iran


Background: Glutaredoxin-1, as a component of antioxidant system, plays a crucial role in pathogenesis of some cancers and pre-malignant lesions. The aim of this study is to assess salivary levels of glutaredoxin-1 in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) patients compared with healthy controls.


Methods and Materials: This cross-sectional study was conducted on 28 OLP patients, 20 OSCC cases, and 40 healthy subjects. Their salivary glutaredoxin-1 was assessed by the enzyme-linked immunosorbent assay (ELISA).


Results: Regarding the glutaredoxin-1 level, there was no significant difference between the three studied groups (p=0.073); however, the salivary glutaredoxin-1 levels were higher in the healthy subjects than the OLP and OSCC patients. Among OSCC patients, the salivary glutaredoxin-1 levels were significantly higher in the males (p=0.03). According to glutaredoxin-1 levels, the difference between keratotic and non-keratotic OLP lesions were not significant (p=0.98). Furthermore, there was no significant difference between various clinical manifestations and grades of OSCC, (p=0.08, p=0.56, respectively).


Conclusion: Salivary glutaredoxin-1 levels were lower in OLP and OSCC patients compared to the normal volunteers; therefore the role of glutaredoxin-1 in the pathogenesis of these diseases could be proposed.

Keywords: Oral squamous cell carcinoma, Oral lichen planus, Glutaredoxin, Saliva


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3 21-29 Assessment of cosmesis and quality of life and their correlation using novel, validated methods in breast cancer patients who had undergone breast conservation therapy

G Karunanidhi1, Chandramouli R2, K Dharanipragada3, P Penumadu4, J Das5

1 Department of Radiation oncology, Regional Cancer Centre (RCC), JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Puducherry, India
2 Department of Radiation oncology, RCC, JIPMER, Puducherry, India
3 Department of General Surgery, JIPMER, Puducherry, India
4 Department of Surgical oncology, RCC, JIPMER, Puducherry, India
5 5Department of Radiation oncology, RCC, JIPMER, Puducherry, India


Purpose: To assess cosmesis [Breast Cancer Conservation Treatment. Cosmetic Results (BCCT.CORE) software] & QOL [EORTC QLQ (Quality of Life Questionnaire)-C30, BR23 questionnaires] using objective methods & to correlate effect of cosmesis on QOL (Quality of life) in breast cancer patients post BCT (Breast conservation therapy) using a cross-sectional observational study from a tertiary hospital.


Materials and Methods: Cosmesis & QOL had been assessed in all biopsy-proven adult patients of unilateral breast cancer, who had undergone BCT with minimum three months post-BCT & three months post last adjuvant chemotherapy cycle, whichever is delivered last (with just hormonal therapy or followup remaining based on hormone receptor status). Pearson chi-square & Kendall correlation Tau-b tests had been used for testing association between Cosmesis & QOL. Variation of QOL scores between Cosmetic groups had been assessed using Mann-Whitney U-test.

Results: Cosmesis was Excellent/Good in 60.4 % of patients. 58.4 % of patients had Excellent/Good Quality of Life. Cosmesis & QOL had a positive correlation (intermediate strength) [Kendall correlation factor-0.484]. QOL-Global scale had better median scores in Excellent/ Good cosmetic group when compared to Fair/Poor group, while for functional & symptomatic scales, contrary had been true. Difference of median-scores between the two groups hadn′t been statistically significant in five aspects - being upset over hair loss (p-0.09), sexual-enjoyment (p-0.33), nausea-vomiting (p-0.29), constipation (p- 0.32) & diarrhea (p-0.72).


Conclusions: About 2/3rds of patients post-BCT had Excellent/Good Cosmesis & Excellent/Good QOL. Every measure taken before, during & post-BCT to improve Cosmesis might result in better QOL. Future studies must use more accurate three-dimensional methods to assess Cosmesis & its effect on QOL.

Keywords: Breast cancer, Breast conservation therapy, Cosmetic outcome, Quality of life, BCCT.CORE software, EORTC QLQ-C30/BR23.


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4 30-35

Factors influencing Quality of life in Moroccan patients with cancer: A monocentric Prospective study.


Ismail Essadi1,2,3, Mohamed Kaakoua1,2,3, Issam Lalya2,3, Fatima Ezzahra Bejjou3, Mohamed Zyani3,4, Rhizlane Belbaraka3,4,5

1 Medical Oncology, Ibn Sina Military Hospital, Marrakesh, Morocco
2 Radiation Oncology, Ibn Sina Military Hospital, Marrakesh, Morocco
3 Faculty of Medicine and Pharmacy Mohamed VI, Caddy Ayyad University, Marrakesh, Morocco
4 Internal Medicine , Ibn Sina Military Hospital, Marrakesh, Morocco
5 Medical Oncology, Mohamed VI University Hospital, Marrakesh, Morocco


Background: Cancer as a chronic and serious disease affects the quality of life (QoL) of patients, which has increasingly become a major challenge at the heart of cancer management. The purpose of our study was to define the most involved factors in the degradation of QoL in cancer patients.

Materials and Methods: We conducted a prospective, mono-centric, qualitative and descriptive study carried out within the medical oncology department of the Ibn Sina Military Hospital spread over six months between January and June 2019.

Results: Of the 100 patients included, 58% were male with a median age of 54.42 years. 90% were married, 39% were illiterate and 43% were retired while 99% of patients had social coverage. Breast cancer was the most common in 29%. More than 54% of the patients included had localized cancer while 38% were metastatic. The Pain was estimated to be greater than or equal to six on the Visual Analog Scale (VAS) in 23%. In 78% of the cases, chemotherapy was indicated in these patients and treatment with psychotropic drugs was initiated only in 2% of the patients. The analytical study showed that most of the patients had a slightly degraded QoL 63% with a large participation of the psychic dimension, followed by the physical and spiritual dimension while the socioeconomic dimension came last. It was established a clear correlation between the QoL and certain socio-demographic factors (sex, marital status, level of education), and significant correlation with some factors related to the disease (a type of cancer, stage, and treatment received).

Conclusion: We tried to assess the impact of cancer and to identify factors affecting the QoL of patients to guide the establishment of the support structure and accompanying devices.

Keywords: Quality of life, Cancer, Factors

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5 36-41 Similarities and disparities in cancer burden among Arab world females

Layth Mula-Hussain1, Zineb Benbrahim2, Ghada M. Kunter3 Zeinab Elsayed4, Nahla Gafer5, Alyaa Mula-Hussain6, Loma Al-Mansouri7, Saif Alizzi8, Abdul-Rahman Jazieh9

1 College of Medicine - Ninevah University, Mosul, Iraq; Faculty of Medicine -University of Ottawa, Ottawa - Ontario, Canada.
2 Faculty of Medicine and Pharmacy Fez - Université Sidi Mohamed Ben Abdellah, Fez - Morocco.
3 Jasper Cancer Center, Jasper GA - USA.
4 Jasper Cancer Center, Jasper GA - USA.
5 Radiation and Isotope Centre, Khartoum - Sudan.
6 MacEwan University, Edmonton AB - Canada.
7 College of Medicine - University of Basra, Basra - Iraq.
8 Eastwood Medical Clinic, Edmonton - Alberta, Canada.
9 Cincinnati Cancer Advisors, Cincinnati - Ohio, USA.


Introduction: Cancer is the leading cause of increased morbidity and mortality worldwide. This work aims to study the Arab-world females' cancers (AFCs), the similarities and disparities from epidemiological, economic and development-indices points of view.

Patients and Methods: Descriptive - Analytical review of the 2018 Global Cancer Observatory concerning AFCs. Data on various cancers were compiled and compared among the countries in the regions and the world females' cancers (WFCs)

Results: A total estimate of 227,494 new AFCs; 2.64% of WFCs, with an average crude incidence rate of 111.7* and an age-standardized rate of 134.5*, compared to 228* and 182.6* of WFCs, respectively. Death cases estimated to be 122,903; 2.95% of WFCs, with an average crude mortality rate of 60.3* and age-standardized rate of 75.4*, compared to 110.2* and 83.1* of WFCs, respectively. Five-year prevalent cases were 530,735; 2.33% of WFCs, with an average proportion of 260.5*, compared to 603.5* of WFCs. Mortality to Incidence Ratio was 0.54 (range 0.36 - 0.80), compared to 0.58, 0.52, 0.49 in the medium human development index, upper-middle-income countries and world countries, respectively. */100,000 population

Conclusion: Despite the demographic and cultural similarities among the Arab communities, there are apparent disparities in AFCs. A systematic approach is required to address these remarkable differences in cancer ranking and rates among Arab countries themselves and when compared to other world groups and nations.

Keywords: Cancer, Arab-world Females

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6 45-52 Can Albumin Bilirubin Ratio and Inflammatory Prognostic Index Be A New Marker Determining Survival in Metastatic Pancreatic Cancer?

Ferhat Ekinci1, Dilek Sari2, Cumali Çelik1, Ahmet Dirican1, Atike Pinar Erdogan1, Gamze Göksel1

1 Celal Bayar University, Medical Oncology Department, Manisa, Turkey
2 Celal Bayar University, Internal Medicine Department, Manisa, Turkey


Introduction: The main purpose of our study is to analyze the predictive and prognostic value of inflammatory prognostic index (IPI (using albumin, CRP, neutrophils and lymphocytes) and albumin / bilirubin ratio in metastatic pancreatic cancer patients in addition to other markers currently used.

Materials and Methods: Medical records of patients with pancreatic cancer treated in Celal Bayar University Medical Faculty Hospital Medical Oncology Clinic between February 2012 and April 2020 were retrospectively reviewed. Clinicopathologic variables such as age, gender, performance status (PS), treatments, histopathology type, localization of metastasis, comorbidity were recorded by an electronic medical record system. Patients performance status were recorded according to the Eastern Cooperative Oncology Group (ECOG). A total of 110 pancreatic cancer patients were reviewed. The IPI was calculated as C-reactive protein x NLR (neutrophil/lymphocyte ratio)/serum albumin. Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors.

Results: Median OS of all patients was 6 months. The NLR cut off value we calculated was 3,47. The median OS of 47 (49,4%) patients was 8 months (95 % cl. 8,673- 15,383) with NLR < 3,47 and median OS of 48 (50,6%) patients was 4 months (95 % cl. 4,221-7,523) with NLR = 3,47 (P: 0,001). The cut off value calculated for the IPI was 0,79. The median OS of 24 (25,8 %) patients was 8 months (95 % cl. 7,475-18,814) with IPI < 0,79 and median OS of 69 (74,2 %) patients was 5 months (95 % cl. 5,774-9,580) with IPI = 0,79 (P: 0,047). The ABR cut off value we calculated was 5,23. The median OS of 45 (47,3 %) patients was 4 months (95 % cl. 8,879- 15,174) with ABR = 5,23 and median OS of 50 (42,7 %) patients was 9 months (95 % cl. 4,015-7,585) with ABR < 5,23 (p<0.001) (Figure 1). According to this analyses, presenting with jaundice, peritoneum metastasis, CA- 19.9 and LDH values higher than cut off, high NLR, high IPI and high ABR were also significantly associated with OS. In multivariate analyses, ABR was an independent prognostic factor in PC. Patients with high ABR (> 5,23) had increases in the risk of death compared with those with low ABR (< 5,23) (HR, 0,305; 95 % CI, 0,176-0,531; p: 0.000). Alongside ABR, CA-19.9 (HR, 2,300; 95 % CI, 1,111-4,764; p: 0,025) and LDH (HR, 3,348; 95 % CI, 1,792-6,253; p: 0.000) were an independent prognostic factor in PC.

Conclusion: In this study, we demonstrated that both IPI and ABR, which were not evaluated in PC before, are non-invasive, cheap, accessible, and easily formulated parameters in determining the prognosis. Especially the fact that ABR is an independent prognostic indicator in multivariate analysis makes it stronger. Although we are aware that our study is retrospective, we hope that the reliability of these scores will increase if it is done with more patient series and if it is done multicenter.

Keywords: Pancreatic cancer, IPI scoring, Overall survival, Neutrophil/lymphocyte ratio, Inflammation mediators, C-reactive protein, Albumin, Bilirubin.

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7 53-59 Incidence and Trends of Liver Cancer in the Gulf Cooperation Council States, 1998-2012

Saleh Al-Othman1, Amal Al-Madouj1, Ali Al-Zahrani1

1 Gulf Centre for Cancer Control and Prevention, King Faisal Special Hospital and Research Centre, Riyadh, Saudi Arabia.


Background: Liver cancer has been identified as the fifth most common cancer in males and ninth in females in the Gulf Cooperation Council (GCC) States. Taking into consideration that GCC states have comparable cultural and demographic backgrounds, this study aimed to examine the trends and patterns of liver cancer cases in the GCC states and to compare these with other regions.

Materials and Methods: The data were obtained from the Gulf Centre for Cancer Control and Prevention, which has maintained its database for GCC states since 1998. In total, 8,012 primary liver cancer cases were recorded for 15 years, from 1998 to 2012. Demographic information and cancer data for all cases were reviewed and analyzed, including sex, age, nationality, histological type and staging. Trends in the frequency of cases, agespecific incidence and stage at diagnosis were presented and compared for three periods (1998-2002, 2003-2007 and 2008-2012) for the six GCC countries.

Results: The trends show a balanced decrease in the number of liver cancer cases between 1998 and 2012. Over one-third of patients who presented were diagnosed with advanced liver cancer; however, 45.4% of the cases were left unknown.

Conclusion: While the Gulf countries have achieved some success in reducing the number of liver cancer cases, there is a clear defect in the documentation of the cancer staging in some countries, and more effort is needed to improve early diagnosis.

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8 60-66 Review Article | Abscopal Effect: An Old Concept with a New Horizon

Ahmed Nadeem Abbasi1, Agha Muhammad Hammad Khan1, Muhammad Atif Mansha2, Fatima Shaukat1, Rabia Tahseen1

1 Section of Radiation Oncology, Department of Oncology, The Aga Khan University, Karachi, Pakistan
2 Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan


Abstract : Abscopal effect is defined as a phenomenon where radiation delivery at one site induces shrinkage of disease at a distant site, outside the radiation field. Although it is an old concept but with recent advancements in the fields of diagnostic and therapeutic oncology, this effect has gained popularity and nowadays has become an area of interest for the researchers. With the current success of immunotherapy, there is robust and interesting data looming to evaluate potential synergistic effect of radiation coupled with immunotherapy to attain abscopal effect. Our article highlights background, mechanism and a brief literature review for abscopal response in conjunction with immunotherapy.

Keywords: Abscopal Effect, Radiation, Immunotherapy, Personalized Medicine

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9 67-71 Review Article | Therapeutic Potential of Ecdysteroids and Steroidal Alkaloids on Solid Cancers.

Catriona Cutajar1, Mariah Farrugia1, Jean-Calleja Agius1, Pierre Schembri Wismayer1

1 Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, MSD2080, Malta


Abstract: Cancer is the second most common cause of death globally. Common modalities of treatment include surgery, chemotherapy, radiotherapy and lately immunotherapy. Different steroidal agents have also been identified as therapeutics for solid cancers, often as part of chemotherapy regimens. This review will specifically focus on steroidal alkaloids and ecdysteroids, which are different types of steroids originating from plants and arthropods respectively. These have been proven to show anti-cancer effects through several methods, including inhibition of proliferation and increasing apoptosis in cancer cells. Synthetic steroids are also used as chemotherapy adjuvants. By increasing our knowledge and understanding of these compounds, further studies can be carried out which may lead to clinical trials. This may enable a potential alternative to current therapies used as cancer treatment today, and may help improve the standard of care.

Keywords: ecdysteroids, therapeutic, cancer, steroidal alkaloids, steroids, treatment.

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10 72-75 Case Report: Chest wall resection in locally advanced or recurrent breast cancer - series of three cases

Suhaildeen Kajamohideen1, Balasubramanian Venkitaraman1, Sathyanarayanan M Shivkumaran1, Prithviraj Premkumar1

1 Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Chennai


Background: The usefulness of chest wall resection in breast cancer is poorly defined as extensive surgical resection is seen inappropriate, as it is regarded as harbinger of systemic disease. We report our experience of chest wall resection in recurrent or locally advanced breast cancers.

Case Presentation: We reviewed our institute records for chest wall resection in locally advanced or locally recurrent breast cancers from 2016 - 2018. There were 3 cases of chest wall resection for carcinoma breast. 1 for recurrent breast cancer and 2 for locally advanced breast cancer after neoadjuvant chemotherapy. Preoperative symptoms were ulceration in recurrent tumor, pain and mass in other. One patient needed Lattismus dorsi (LD) myocutaneous flap and one required a free flap. One underwent LD muscle flap. Mean postop stay were 8 days. One patient required redo flap surgery for partial flap necrosis.

Conclusion: Full thickness chest wall resection is relatively safe procedure with acceptable morbidity and can be considered in carefully selected patients.

Keywords: Breast carcinoma-Chest wall recurrence- Chest wall resection-chest wall reconstruction.

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11 76-78 Primary Enteric Adenocarcinoma Lung with Mesenchymal Epithelial Transition Factor Amplification: A Case Report

Saumya Shukla1, Rahul Kumar Pandey1, Nuzhat Husain1, Anand Srivastava2

1 Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
2 Department of Respiratory Medicine, King George′s Medical University, Lucknow Uttar Pradesh, India.


Introduction: Primary enteric adenocarcinoma (PEAC) of the lung is a rare variant characterized by the presence of colorectal adenocarcinoma like components. A rare case of PEAC of lung with over-expression of mesenchymal epithelial transition factor (MET) receptor tyrosine kinase protein is being presented.

Case Presentation: A 75-year old female presented with chest pain, cough, hemoptysis and fever for 2 months duration. Computerized tomography (CT) scan revealed a spiculated mass in left upper lobe of lung. A needle core biopsy was performed. The histopathological examination revealed a tumor composed of tall columnar cells with vesicular nuclei arranged in an acinar and glandular formation with luminal necrosis. On immunostaining, cytokeratin 7, thyroid transcription factor 1 and CDX-2 were positive. Based on the morphological and immunostaining profile a diagnosis of PEAC of the lung was rendered. Ancillary testing for driver mutations revealed over expression of c-MET while epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangement and C-ros oncogene 1, receptor tyrosine kinase (ROS 1) were negative.

Discussion: PEAC of the lung which was first described by Tsao and Fraser, is an uncommon variant and rarely harbors any driver mutations. MET over expression is present in 3-7% cases of lung adenocarcinoma and is indicative of aggressive tumor behavior. Colo-rectal adenocarcinomas with MET amplification have poor overall survival. The histogenesis of PEAC may be implicated to the dysregulation of MET pathway. Targeted therapy using MET inhibitors in cases that have MET amplification has predictive implications.

Conclusion: This is a rare case of PEAC with c-MET over expression. The MET axis that is implicated in pathogenesis of colonic adenocarcinomas might also be the molecular pathway for the development of PEAC.

Keywords: Primary enteric adenocarcinoma lung, c-MET amplification

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12 79-81 Case Report: Malignant Transformation of Juvenile Recurrent Respiratory Papillomatosis

Haziq Ghufran Muhammad Fauzi1, Avatar Singh Mohan Singh1, Hiya Boro1, Suhana Abdul Rahim1, Lina Ling Chooi1, Viji Ramasamy1, Nur Hidayati Mohamad Pakarul Razy2, Irfan Mohamad3

1 Department of Otorhinolaryngology, Taiping Hospital, 34000 Taiping, Perak, Malaysia
2 Department of Pathology, Taiping Hospital, 34000 Taiping, Perak, Malaysia
3 Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kota Bharu, Kelantan, Malaysia


Abstract: Malignant transformation of recurrent respiratory papillomatosis (RRP) is a rare entity occurring in only less than 5% of patients with RRP. The risk of transformation can arise even in the absence of risk factors such as smoking and radiation. We describe a patient with juvenile RRP diagnosed since childhood, who suffered malignant transformation into a squamous cell carcinoma after 29 years.

Keywords: Recurrent respiratory papillomatosis; laryngeal neoplasms; squamous cell carcinoma; human papilloma-virus.

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