Background: CHOP regimen was the standard treatment for patients with diffuse large and mixed cells Non-Hodgkin's lymphoma (NHL) even in comparison with second and third generation regimen. Recently Rituximab –CHOP is considered the standard treatment for aggressive B-cell NHL while CHOP (alone) is so for aggressive T-cell NHL, yet more than one study investigates another regimen which is VACOP-B and some showed its superiority over CHOP. Prior to the introduction of Rituximab, we used VACOP-B in the treatment of high &intermediate grade NHL in adult Iraqi patients as an alternative to CHOP.
Patients and Methods:We performed a prospective analysis of 20 adult patients who, between April 2000 and October2005, received VACOP-B chemotherapy for high and intermediate grade NHL. The weekly regimen consisted of: doxorubicin50 mg/m2 i.v. weeks 1,3,5,7,9,11; cyclophosphamide350 mg/m2 i.v. weeks 1, 5, 9; etoposide 100mg/m2iv, weeks 3,7,11; vincristine1.4 mg/m2 i.v. (2 mg max.) weeks 2, 4, 6, 8, 10;bleomycin 10 mg/m2 i.v.(max. 15 mg) weeks 2,4, 6,8, 10; methotrexate12.5 mg intratheical was given in selected patients.; prednisolone 60mg p.o.daily for 2 weeks, reduced to 60 mg every other day for 10weeks.The patients treated were aged 25-50 years, 8(40%) had high grade (Working Formulation )NHL; 12 (60%) had intermediate grade NHL;seventeen patients(85%) had Stage III/IV disease; and 3 (15%) had stage II,bone marrow involvement seen in 3(15%)patients .patients distribution regarding age adjusted international prognostic index(aaIPI)was 8(40%)with aaIPI 0,1and 12(60%)with 2,3. Follow-up time from completion of VACOP-B chemotherapy ranged from 6 months to 40 months (median 22).
Results: VACOP-B induced a complete response (CR) and partial response (PR) in 70% and 15% respectively, whilst one patient had no response to treatment and died due to progression of the disease, 2 patients died due to treatment related toxicity. The three year disease free survival (DFS) was 78%, where 4 patients relapsed, one of them in the central nervous system. This study showed 3-year overall survival (OS) 100% for those with a IPI 0-1and 48% for those with aa IPI 2-3. Tolerance to treatment was measured by WHO toxicity scores. The hemoglobin (Hb) toxicity median score for all patients was grade 1 (Hb 9.5-10.9 g/dl), and the white cell count (WCC), toxicity score was grade 2(WCC 2.0-2.9 x 109/1). No platelet toxicity was observed. Ten per cent of patients suffered grade 3 severity infections requiring antibiotics and there was two treatment related death.
Conclusions: VACOP-B chemotherapy is an effective regimen for high and intermediate grade NHL, with an encouraging result in patients with aaIPI 0, 1. although chemotherapy was given weekly, the tolerance to treatment was acceptable. Studies comparing VACOP-B vs. CHOP chemotherapy to decide the exact role of the first in treating high grade &intermediate grade NHL, in the absence of Rituximab, are still needed.
We describe here a case of a 70 yr old man with long-standing rheumatoid arthritis who presented with low grade fever, fatigue, loss of appetite and weight, bluish discoloration of the fingers and patches of gangrenous skin on the fingers. There was intense pain in the fingers which prevented him from sleep. Along with these symptoms he developed loss of sensation in the dorsum of left foot, then left foot drop. We give below full account of the case and review of the causes of vasculitis. We want to emphasize on the importance of identifying vasculitis as one of the complications of rheumatoid arthritis and intensive treatment of this complication, as it is a life-threatening complication.
Hypertension is identified as one of the most significant risk factors for cardiovascular diseases (CVDs). There is growing evidence showing that oxidative stress plays a major role in hypertension. Increased production of reactive oxygen species and decrease bioavailability of antioxidant have been demonstrated in experimental and human hypertension. The present study was directed to determine the beneficial effect of the antioxidant vitamin C in patients with essential hypertension treated with the calcium channel blocker (amlodipine) or with the angiotensin converting enzyme inhibitor (enalapril). Ninety six patients (50 females and 46 males) with essential hyp
... Show MoreThe utilization of targeted therapy for programmed death ligand 1 (PD‑L1) has emerged as a prominent focus in contemporary clinical trials, particularly in the context of immune checkpoint inhibitors. The prognostic significance of the expression of PD‑L1 in invasive mammary cancer remains a subject of discussion in clinical oncology, requiring further exploration, despite its recognition as a biomarker for responsiveness to anti‑PDL1 immunotherapy. The present study was conducted to investigate the immunohistological expression of PD‑L1 in women with triple‑negative breast cancer (TNBC), with a particular focus for searching for the associated clinical and pathological characteristics. The present retrospective study examined the
... Show MoreThe power of the state in Iraq has been influenced by legitimacy, which may have resembled the belt of transmission, affecting the rule of law and social cohesion. The emergence of the political system may have come about as a result of balancing the competing forces within society today as a basis for collective action. The country's march in Iraq was not a result of a series of gradual transitions such as the established ones. For almost a century, there was an extraordinary succession of succession. At each of the three stages of the state there was an internal or external change. They change or disintegrate and others appear. Social and economic conditions may change or the society is exposed to external invasion or our ideas are imp
... Show MoreOtitis media with effusion (OME) is a common disease especially among young children (before school age) and it is one of the common causes of acquired hearing loss in childhood. Pediatric patients with OME are usually undernourished. The purpose of this study is to determine whether the serum levels of trace elements (zinc, copper, magnesium, iron) have a role in the development of OME in children. This study carried out on 55 children and subdivided them into two groups. Group 1 (patient group) consist of 30 children suffering from OME and group 2 (control group) included 25 apparently healthy children. Serum levels of zinc, copper, magnesium and iron were measured for both groups. Comparison the results between the two groups showed t
... Show MoreBackground: Optimal root canal retreatment was required safe and efficient removal of filling material from root canal. The aim of this in vitro study was to compare the efficacy of reciprocating and continuous motion of four retreatment systems in removal of root canal filling material. Materials and Methods: Forty distal roots of the mandibular first molars teeth were used in this study, these roots were embedded in cold clear acrylic,roots were instrumented using crown down technique and rotary ProTaper systemize Sx to size F2 ,instrumentation were done with copiousirrigation of 2.5% sodium hypochlorite and 17% buffered solution of EDTA was used as final irrigant followed by distilledwater, roots were obturated with AH26 sealer and Prota
... Show MoreBanking reforms in many countries have focused on the efficiency enhance of the banking sector, including Iraq, in terms of indicative steps based on recommendations, policies and standards developed by international organizations, foremost of which are Basel III. In this paper, it has tried to highlight the reforms in Basel III and the impact of these reforms on the stability of the banking system in Iraq. As the research derives its importance from the idea that the sound banking system consists of a group of banks capable of employing their assets and obligations efficiently in financial intermediation and enjoying financial solvency. The stability of the banking system is an important factor in achieving the leading role of t
... Show MoreBackground: Information concerning the maximum bite force in human population is important to clinical orthodontics. Additionally, the influence of bite force on the vertical stability of any treatment result is important. The new position of the dentition should be compatible with the dynamics of the muscular and occlusal forces in all planes. This study was conducted to 1) to measure and compare maximum bite force, body height and weight among normal occlusion and malocclusion groups (cl I,cl II,cl III) in both gender 2) to evaluate the correlation between bite force and craniofacial morphology, body height and weight. Materials and Methods: The sample consists of 100 Iraqi adult subjects aged 18-25 years. It was classified in to four gr
... Show MoreThe Wang-Ball polynomials operational matrices of the derivatives are used in this study to solve singular perturbed second-order differential equations (SPSODEs) with boundary conditions. Using the matrix of Wang-Ball polynomials, the main singular perturbation problem is converted into linear algebraic equation systems. The coefficients of the required approximate solution are obtained from the solution of this system. The residual correction approach was also used to improve an error, and the results were compared to other reported numerical methods. Several examples are used to illustrate both the reliability and usefulness of the Wang-Ball operational matrices. The Wang Ball approach has the ability to improve the outcomes by minimi
... Show MoreBackground: All diseases concerning bone destruction such as osteoporosis and periodontal diseases share common pattern in which the osteoclast cells are absolutely responsible for bone resorption that occurred when osteoclast activity exceeds osteoblast activity. Osteoprotegrin (OPG) considered as novel soluble decoy receptor known as “bone protector†since it prevents extreme bone resorption through inhibition of differentiation and activity of osteoclast by competing for binding site. It binds to receptor activator of nuclear factor kappa-B ligand (RANKL) and prevent its interaction with receptor activator of nuclear factor kappa-B (RANK), thus inhibits osteoclast formation. TNF-α is a pro-inflammatory cytokines having
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