Background
Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5–3% of childhood carcinomas in the United States and Europe. We aimed to identify the risk of a ...second malignancy among pediatric thyroid cancer survivors.
Methods
The cohort analysis consisted of pediatric cancer patients aged less than 20 years, diagnosed with a primary thyroid cancer, identified by site code ICD-0-3: C739, and reported to the SEER 9 database between 1973 and 2013. They were followed up until December 31, 2013; the end of the study period, or up to death if earlier.
Results
Out of 1769 patients diagnosed primarily with thyroid carcinoma, 42 patients had a total of 45 incidences of subsequent malignancies. The mean age of patients at the initial diagnosis of thyroid cancer was 16 years. Females (90.5%) had a significantly higher incidence of second malignancies (SM) than males (9.5%). The overall Standardized Incidence Ratio (SIR) of SM in the study patients was higher than expected (SIR = 1.48). Some specific sites showed significantly higher incidences: the salivary glands (SIR = 33.95), the gum and other parts of the mouth excluding the lips, tongue, salivary glands and floor of the mouth (SIR = 24.53)*** and the kidneys (SIR = 5.72). The overall risk of SM in patients who had received radioactive iodine was higher than expected (SIR = 4.41). The cumulative incidence of SM after treatment of thyroid cancer in children increases steadily over 40 years (11.92%).
Conclusions
Race, gender, histological subtypes, and radioactive iodine are potentially significant prognostic factors for the development of SM among pediatric thyroid cancer survivors. Identification of underlying mechanisms that raise the risk of SM is important for both treatment and follow-up strategies.
Adrenocortical carcinoma (ACC) is a rare, aggressive endocrine neoplasm. Complete surgical resection is the single most important treatment. Most available information has been learned from ...experience with its more frequent adult counterpart. In this study, we assessed the features and survival outcome of patients with ACC at Children's Cancer Hospital Egypt (CCHE). Patients diagnosed at CCHE between July 2007 and November 2016 were followed up on until November 2018. Patients with stages I and II were operated upon, while stages III and IV had received combinations of doxorubicin, etoposide, platinol, and mitotane (DEPM) beside the attempt to conduct surgery when feasible. Data belonging to 18 patients (7 men and 11 women) were analyzed; median age at diagnosis was 48.5 months. Sixteen patients had presented with secreting tumors. Six patients were diagnosed with stage I disease; four with stage II; three with stage III; and five with stage IV carcinoma. By the end of this study, 10 patients have survived; five-year overall survival of 66.3%. Surviving patients were all of stage I or II diseases and were all in remission. Seven patients who did not survive died due to tumor progression, while one patient died after chemotherapy. The prognosis of ACC is essentially dependent on a successful complete resection of the tumor and thus on the initial tumor stage. The mitotane and DEP protocols may help control tumor growth in the advanced stages for only short periods.
Key points
Initial stage and resectability are the main indicators of outcomes in adrenocortical carcinoma.
Chemotherapeutic agents used in developed countries did not achieve the same outcomes.
Further molecular-pharmacology differentiation is needed for various ethnic populations.
Purpose
The purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region.
Methods
All diabetic patients attending the general ophthalmology clinics ...(Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders. Adjudication by a consultant was done when needed.
Results
Out of 11,033 screened patients, 10,811 had a gradable fundus photograph in at least one eye and were included. The numbers of cases in groups 1, 2 and 3 were 3940, 2826, and 4045, respectively. Males represented 38.35% of the cases. Mean age was 55 ± 12.63. For the whole sample, groups 1, 2 and 3, the DR prevalence was 32.49, 46.4%, 29.13%, and 21.29%, respectively. The prevalence of proliferative DR (grade R4) was 6.16%, 11.83%, 5.02%, and 1.45%, respectively, and of referable maculopathy (Grade M2) was 19.95%, 31.42%, 15.92%, and 11.59%, respectively.
In univariate analysis, older age, higher random blood glucose, and longer DM duration were associated with a higher risk of both DR and referable diabetic maculopathy. This association was maintained in multivariate analysis for the high random blood glucose level and the longer duration of DM (but not for the older age).
Conclusion
A significantly higher prevalence of DR, grades R4 and M2 was found in the hospital-recruited patients than in diabetics from the local communities.
Graphical abstract
In this paper, we contrast the usage of two deep-learning approaches for the automatic grading of diabetic retinopathy (DR) and diabetic macular edema (DME) in retinal fundus photographs using a ...relatively small novel dataset. We developed a telemedicine system to collect and humanly grade 11,109 diabetic patients. The certified graders annotated the level of DR as well as the existence of a referable DME in the macula-centered fundus images only. We use EfficientNet to build an AI-based model for both problems. To examine the transfer learning validity, the model was trained on an external dataset (EyePacs) and then finetuned on the egyptian data for the DR and DME grading problems. Firstly, we use the macula-centered images only in fine-tuning. Secondly, we use optic-disc-centered images in addition to macula-centered images. We obtained the labels for the optic-disc-centered images directly from the corresponding macula-centered labels as weak labels. Then, both types of images are used in fine-tuning. We found an increase in the DR performance using the second approach in both accuracy and quadratic weighted kappa(QWK). Notably, QWK increased from 90.23% to 91.3% using additional weakly labeled optic-disc-centered fundus images.
