Objectives
To evaluate the diagnostic performance of DCE MRI and DWI in the assessment of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with muscle-invasive ...bladder cancer (MIBC).
Methods
This prospective study included 90 patients with MIBC who finished NAC. Two radiologists independently assessed MRI for the determination of semi-quantitative parameters (wash-in rate and wash-out rate) and apparent diffusion coefficient (ADC) value. The correlation between pCR and wash-in rate, wash-out rate, ADC value were analyzed. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for detecting pCR. Inter-reader agreement was assessed using the ICC statistics.
Results
On cystectomy specimens, pCR was confirmed in (43.3%, 39/90). pCR is negatively correlated with wash-out rate (
r
= − 0.701,
p
= 0.01) and ADC value (
r
= − 0.621,
p
= 0.01). ADC value is positively correlated with wash-out rate (
r
= 0.631,
p
= 0.001). The diagnostic accuracy of ADC value (cut-off value: 0.911 × 10
−3
mm
2
/s) and wash-out rate (cut-off value: 0.677 min
−1
) in the identification of pCR was (92% for reader 1, 91% for reader 2), and (90% for reader 1, 88% for reader 2), respectively. The sensitivity, specificity for predicting pCR using ADC value + washout rate cut off values were 95.4%, 97.7% for reader 1, and 96%, 97% for reader 2, respectively. AUC was 0.981 for reader 1, 0.971 for reader 2. The overall reproducibility of the mean ADC value and wash out rate was excellent (ICC = 0.83–0.90). The ICC values for the mean ADC value, washout rate was 0.89 (95% CI 0.84–0.89) and 0.87 (95% CI 0.86–0.91), respectively.
Conclusion
Semi-quantitative parameter (wash-out) derived from DCE-MRI and ADC has the potential to assess the tumor’s complete pathologic response. The two parameters using together can offer the best possibility to identify complete response to NAC in MIBC.
Acanthospermum hispidum DC (Asteraceae), a traditional medicinal plant, plays a role as an alternative remedy for various diseases, such as bacterial and viral infections, jaundice, malaria, fever, ...gastrointestinal disorders, headache, convulsions, and snake bites. Flavonoids, alkaloids, saponins, tannins, terpenes, steroids, and cardioactive glycosides are the distinct classes of metabolites in the plant. Although A. hispidum was suggested as a promising antitumor phytomedicine, no studies identified its potential cytotoxic components. In this study, the cytotoxic compounds of A. hispidum were isolated using chromatographic techniques guided by in vitro MTT cytotoxicity assay against selected cancer cell lines; breast cancer (MCF7), colorectal adenocarcinoma (HT29), and hepatoblastoma (HepG2). The selective index (SI) was assessed on MRC5 (Normal human fetal lung fibroblast) cell line. The dichloromethane fraction (DCM) showed remarkable cytotoxic activity against MCF7 and HT29 (%Cell viability; 46.15 and 60.5, respectively). Hence, the main bioactive fraction from DCM was purified to afford two phytosterols; stigmasterol (1) and β-sitosterol (2), which were identified by 1-D and 2-D NMR spectroscopy. Cytotoxic evaluation of 1 and 2 revealed that β-sitosterol showed better selective cytotoxicity against MCF7 and HT29 (IC50 4.07 μg/mL, SI 2.63; IC50 4.52 μg/mL, SI 2.37) compared to stigmasterol (IC50 5.43 μg/mL, SI 1.38; IC50 4.21 μg/mL, SI 1.78), respectively. Bioinformatic assessments of drug-likeness and ADMET properties demonstrated that most criteria were obeyed by the investigated compounds except for their poor solubility, which recommended the preparation of special dosage forms, such as nanoformulation to enhance their oral bioavailability. Swiss Target prediction indicated that nuclear receptors represent the main target class (40%). Whereas caspase-3 stimulant activity (a key enzyme in apoptosis) was predicted by the PASS prediction tool as a potential anticancer mechanism. Our study suggests A. hispidum as a potential source of bioactive phytosterols and as a chemopreventive medicinal plant.
Background
COVID-19 pneumonia is responsible for the latest pandemics. Chest computed tomography (CT) scan is known to be an essential tool for diagnosis of COVID-19. In this research, the ...relationship between on-admission chest CT severity score, capillary blood oxygen saturation level, and laboratory inflammatory markers results in patients with SARS-COV-2 pneumonia was investigated.
Methods
This prospective analytical study was conducted in COVID-19 isolation unit, Zagazig University Hospitals, from 1st to end of April 2021. Adult patients with COVID-19 infection were included. Chest CT scan was performed for all patients, and CT severity score was computed. The initial capillary oxygen saturation was also assessed at the time of admission. The information was gathered and analyzed.
Results
A total number of 305 COVID-19 patients were involved in the study with the following data: age, gender, presence of co morbidities, capillary blood oxygen saturation, laboratory tests including absolute lymphocytic count, CRP, D-dimer and ferritin levels, as well as chest CT severity score. Based on chest CT severity score, we found that 110 cases (36.1%) were mild, 163 cases (53.4%) were moderate, and 32 cases (10.5%) were severe, with significant male predominance among moderate and severe cases. The initial measurements of blood oxygen saturation values revealed that mean blood oxygen saturation was 95.6% among mild to moderate cases and 85.4% among severe cases. Furthermore, there was a high statistically significant negative correlation between chest CT severity score and absolute lymphocytic count of studied cases, while there was a statistically significant positive correlation with D-dimer, CRP and ferritin levels.
Conclusions
CT scans can help clinicians in developing a management strategy and serve as a predictor of illness severity and possible outcomes. In individuals with COVID-19 infection, the severity of a chest CT scan is positively correlated to inflammatory markers and oxygen demand.
Background: This study aims to investigate the analgesic efficacy of ketamine and neostigmine as adjuvants to local anesthetic in ultrasound-guided Serratus anterior plane block for patients ...undergoing Modified Radical Mastectomy.
Methods: Ninety female patients aged 20-65 who were scheduled for a modified radical mastectomy under-combined general anesthesia and preoperative Serratus Anterior Plane Block were included. Three local anaesthetic mixtures were used, either 30 ml bupivacaine 0.25% + 1 ml ketamine (50 mg) (Group K) or 30 ml bupivacaine 0.25% + 1 ml neostigmine (500 μg) (Group N) or 30 ml bupivacaine 0.25% + 1 ml normal saline (Group S). The first 24 hours of postoperative morphine consumption was set as the primary outcome
Results: the 24 hr postoperative morphine consumption median was 3.0 (0.0-9.0) for group (S), 1.5 (0.0-4.0) for group (N) and 0.0 (0.0-4.0) mg for group (K) with statistical significant (P value 0.045). The first postoperative analgesic request was insignificant between group (K), group (N) and group (S) was (6.14 ± 5.17), (6.67 ± 3.18) and (5.89 ± 4.4 hr), respectively. The Intraoperative Fentanyl consumption showed a significant reduction in group (N) and group (K) (111.67 ± 30.64 and 110.00 ± 20.34, respectively) compared to group (S) (131.67 ± 42.51 μg). The numerical rating scale did not differ between study groups except at 8
th
and 16
th
hrs. Postoperatively.
Conclusion: The addition of 50 mg ketamine to 0.25% bupivacaine during preoperative ultrasound-guided SAPB combined with GA in female patients undergoing modified radical mastectomy decreased the 24 hr postoperative morphine consumption and the intraoperative fentanyl requirements while adding 500 µg neostigmine decreased the intraoperative fentanyl requirements.
Clinical trial registration: The study was registered at clinicaltrials.gov (NCT 04544228).
To depict the spectrum of rheumatoid arthritis (RA) in Egypt in relation to other universal studies to provide broad-based characteristics to this particular population. This work included 10,364 ...adult RA patients from 26 specialized Egyptian rheumatology centers representing 22 major cities all over the country. The demographic and clinical features as well as therapeutic data were assessed. The mean age of the patients was 44.8 ± 11.7 years, disease duration 6.4 ± 6 years, and age at onset 38.4 ± 11.6 years; 209 (2%) were juvenile-onset. They were 8750 females and 1614 males (F:M 5.4:1). 8% were diabetic and 11.5% hypertensive. Their disease activity score (DAS28) was 4.4 ± 1.4 and health assessment questionnaire (HAQ) 0.95 ± 0.64. The rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were positive in 73.7% and 66.7% respectively. Methotrexate was the most used treatment (78%) followed by hydroxychloroquine (73.7%) and steroids (71.3%). Biologic therapy was received by 11.6% with a significantly higher frequency by males vs females (15.7% vs 10.9%,
p
= 0.001). The least age at onset, F:M, RF and anti-CCP positivity were present in Upper Egypt (
p
< 0.0001), while the highest DAS28 was reported in Canal cities and Sinai (
p
< 0.0001). The HAQ was significantly increased in Upper Egypt with the least disability in Canal cities and Sinai (
p
= 0.001). Biologic therapy intake was higher in Lower Egypt followed by the Capital (
p
< 0.0001). The spectrum of RA phenotype in Egypt is variable across the country with an increasing shift in the F:M ratio. The age at onset was lower than in other countries.
Background: Despite the availability of HIV/AIDS voluntary counselling and testing services in Omdurman Teaching Hospital, the level of uptake remains low, and the prevalence of HIV/AIDS in Sudan is ...still high. This situation suggests that there may be some underlying factors, such as patients’ attitudes toward the services provided, that are affecting their willingness to access them. Therefore, this study aimed to assess the attitude of patients attending HIV/AIDS voluntary counselling and testing services in Omdurman Teaching Hospital, Sudan.
Methods: A descriptive hospital-based study was conducted at Omdurman Teaching Hospital, Sudan. All patients attending HIV/AIDs counseling and voluntary services center were invited to participate in this study, and of the 200 invited, 150 patients participated with a response rate of 75%. Data were collected using a structured interview questionnaire and then analyzed by SPSS (version 23).
Results: The findings revealed that many patients (92%) have a positive attitude toward HIV voluntary counselling and testing and believed that the shared information is informative and influential. It was also observed that 80% of the patients who received counselling had lower levels of social and psychological stress and stigma.
Conclusion: The study highlighted the positive attitude of patients to utilize HIV/AIDS voluntary counselling and testing services which reduces the social and psychological stresses and stigma among HIV patients. Females and Muslim patients had a positive attitude.
Early childhood is an age at risk of anaemia and its deleterious consequences. In Sudan, there is limited evidence on the prevalence and determinant of anaemia in under-five children. This study was ...conducted in Sudan to assess the prevalence of anaemia in children and to identify its determinants.
We conducted a household survey involving children aged 6 months to 5 years in November 2016. A representative population was sampled across rural, urban and camps settlements across 18 states in Sudan. We used a pre-designed questionnaire data collection. Haemoglobin (Hb) level and malaria infection were checked. In this cross-sectional study, we dichotomized the outcome variable and performed logistic regression analyses.
A total of 3094 children under 5 years enrolled in the study, 1566 (50.6%) of them were female and 690 (22.3%) of them were under 2 years old. Anaemia prevalence in the whole cohort (6 months - < 5 years) was 49.4% and the mean haemoglobin concentration was 108.1 (standard deviation (SD): 15.4) g/L. The prevalence in younger (6 months - < 2 years) children (61.9%) was higher than in older (2 - < 5 years) children (45.6%) (p < 0.001). Severe anaemia (Hb < 70 g/L) prevalence in the whole population was 1.6%. Age (Odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.75-2.90, p < 0.001), type of place of residence (OR 0.37, 95%CI 0.18-0.74, p = 0.005), maternal anaemia (OR 1.74, 95%CI 1.39-2.17, p < 0.001), and malaria infection (OR 2.82, 95%CI 1.56-5.11, p < 0.001) were the identified predictors of anaemia in the whole cohort. In younger children, only the economic class was an anaemia predictor, with a lower anaemia risk among the rich wealth class (OR 2.70, 95%CI 1.29-5.62, p = 0.008). However, in older children, three anaemia predictors were identified. These are maternal anaemia (OR 1.79, 95%CI 1.40-2.28, < 0.001), malaria infection (OR 2.77, 95%CI 1.48-5.21, p = 0.002), and type of residency (where camps' residents were less likely affected with anaemia than rural children (OR 0.38, 95%CI 0.17-0.87, p = 0.022)).
About half of the under-5 children in Sudan are anaemic, with worse prevalence in younger children. Efforts targeted at improving socio-economic status, decreasing maternal anaemia and childhood malaria infection may mitigate this alarming trend.
Formerly management of malignant tumors of lower limb was mainly through amputation. After advancement in neoadjuvant chemo-radiotherapy, saving the limb through lower limb-sparing surgery became the ...main line for management. Different regional techniques are used for perioperative pain control in limb-sparing surgeries. One of these techniques is lumbar paravertebral block. It is a regional technique that provides ipsilateral analgesia resulting in somatic and sympathetic blockade in a continuous dermatomal manner.
The study included 60 cancer patients scheduled for lower limb sparing surgeries. Patients were randomly allocated into two groups to receive either lumbar paravertebral block Group P with 25 ml of Bupivacaine 0.25%, with adrenaline 1:200,000 or general anesthesia Group C.
There was a statistically significant decrease in hemodynamics values for Group P compared to Group C at most of the study times. Intraoperative fentanyl consumption was lower in Group P compared to Group C (107.1 ± 22.89 ug versus 233.43 ± 49.29 ug), respectively. VAS scores were lower for Group P compared to Group C with lower postoperative morphine consumption in Group P compared to Group C (8.65 ± 3.57 mg versus 16 ± 3.15 mg) respectively.
Ultrasound guided paravertebral block can be used as an effective perioperative analgesic modality for cancer patients undergoing lower limb sparing surgeries.
This study aims to study the discharging process to verify the influence of geometry modifications and heat transfer flow (HTF) patterns on the performance of a vertical triplex-tube latent heat ...container. The phase change material (PCM) is included in the middle tube, where the geometry is modified using single or multi-internal frustum tubes instead of straight tubes to enhance the discharging rate. The effects of the HTF flow direction, which is considered by the gravity and opposite-gravity directions, are also examined in four different cases. For the optimal geometry, three scenarios are proposed, i.e., employing a frustum tube for the middle tube, for the inner tube, and at last for both the inner and middle tubes. The effects of various gap widths in the modified geometries are investigated. The results show the advantages of using frustum tubes in increasing the discharging rate and reducing the solidification time compared with that of the straight tube unit due to the higher natural convection effect by proper utilization of frustum tubes. The study of the HTF pattern shows that where the HTF direction in both the inner and outer tubes are in the gravity direction, the maximum discharging rate can be achieved. For the best configuration, the discharge time is reduced negligibly compared with that for the system with straight tubes which depends on the dimensions of the PCM domain.
PDF
