bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Susceptibility Weighted Imaging (SWI) in Comparison to Magnetic Resonance Angiography in Assessment of the Intra-Arterial Thrombus in Patients with Acute Ischemic Stroke
Authors: Ismaeel Gehan Mohamed Mohamed , Khater Nivan Hany Ahmed , Barakat Mai Mokhtar Kamal
Published: November 2024

Background

Stroke occurs when the blood supply to the brain is cut off, usually due to a blood vessel burst or being blocked by a clot. This reduces the supply of oxygen and nutrients, causing brain tissue damage. The effects of a stroke depend on which part of the brain is injured. For this purpose, thrombus assessment in patients with acute stroke is of major clinical relevance since the location of the thrombus may determine the therapeutic decision.

Aim of the Work

Aim of study is to assess the role of susceptibility weighted imaging in assessment of intra-arterial thrombus in correlation with MRA and basic stroke protocol in patients with acute ischemic stroke.

Patients and Methods

This study is a cross-sectional study was conducted at Ain Shams University Hospitals at Radiology department. Our study included thirty patients with acute stroke symptoms in less than 24 hours of symptoms onset. The main source of data for this study was the prospectively conducted scans and clinical history of the patients referred to the MRI section of the department of Radiology, Ain Shams University Hospitals for doing MRI stroke protocol with addition of SWI sequence from November 2022 to June 2023.

Results

Thirty patients complaining of acute stroke symptoms in less than 24 hours of symptoms onset. Every single one of them went through MRI stroke protocol assessment and SWI sequence was added. So, SVS and TOF MRA were able to detect intra-arterial thrombus in acute stroke patients by 90 % and 95 %, respectively. There was no statistically significant difference in the rates of detection of intra-arterial thrombosis by SWI and MRA in patients with acute ischemic stroke (P = 0.57). The sensitivity of SWI for detection the intra-arterial thrombus in relation to MRA in MCA is 90%, in ACA and PCA is 100%, ICA is 66.7%. While specificity of SWI in relation to MRA in MCA is 80%, in PCA, ACA and ICA are 100%. The accuracy of SWI in assessment of intra-arterial thrombus in comparison to MRA in MCA is 94%, PCA 100%, ICA 95% and ACA 100%. The length of thrombus in SWI (lengthof SVS) could be measured ranging between 0.5-3.5 cm.

Conclusion

The SWI sequence needs to be incorporated into SWI stroke protocol for evaluating patients who have recently suffered an acute stroke as MRA and SWI techniques complement each other for visual detection of the occluded vessel. SWI has reasonable sensitivity, specificity and accuracy in the assessment of intra-arterial thrombosis in relation to MRA in patient of acute ischemic stroke. The „susceptibility sign' has a high sensitivity for diagnosing acute intracranial vascular blockage location and its extent in all major intracranial arteries. Also, it can be used in measuring the length of the intra-arterial thrombus over TOF MRA which cannot entirely demarcate thrombus length.
Correlations between Maximum Standardized Uptake Value Measured via 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Clinical Variables and Biochemical Indicators in Adult Lymphoma
Authors: Gawdat Ghada Nabil Anwar , Rashad Amany Mohamed , Elsamad Amr Mahmoud Abd , El-Metwally El-Diasty Shaimaa
Published: November 2024

Background

Lymphoma comprises a histological heterogeneous group of cancers derived from the cells of the immune system manifested as enlargement and proliferation of lymph nodes or secondary lymphoid tissues. Earlier, the imaging evaluation and follow-up of non-Hodgkin’s lymphoma patients were based solely on findings at contrast-enhanced CT. Fortunately, 18F- fluorodeoxyglucose (18F -FDG) positron emission tomography (PET)/computed tomography is gaining popularity for evaluating patients with non-Hodgkin lymphomas (NHLs) lymphoma and has proven to be more sensitive and specific than contrast-enhanced CT for evaluating nodal and extra-nodal lymphomatous involvement.

Main body of Abstract

18 F-FDG PET/CT and the maximum standardized uptake value (SUV max) is currently used for the diagnosis and initial staging of NHLs. The potential usefulness of (SUV max) in NHL cases and the significance of correlations between SUV max and various indicators arc currently unknown. The aim of the current study was to investigate whether the (SUV max) measured by 18 F -FDG PET/CT could discriminate between aggressive and indolent (NHLs) including different pathological subtypes and analyze the correlations between the SUV max and other important parameters. A study was conducted among newly diagnosed 60 adult NHL patients confirmed by biopsy, pretreatment 18F-FDG PET/CT scans, and a complete medical record were retrospectively enrolled in the study including evaluation of various clinical variables; clinical stage, pathological subtype, international Prognostic Index (IPI) score as well as lactate dehydrogenase (LDH) value and then correlated with SUV max of the biopsy site on PET/CT. The area under the ROC curve for examining the accuracy of SUV max regarding distinguishing between aggressive and indolent NHLs was 0.85 and a cutoff value of > 7.7 yielded a sensitivity of 90 % and specificity of 73 %. The SUV max mean ± SD of aggressive NHL was significantly higher than that of the indolent NHL (P < 0.001). The SUV max of the biopsy site was strongly positively correlated with IPI score and clinical staging (P = 0.001), but it was not significantly correlated with LDH (P > 0.05).

Short Conclusion

18F-FDG PET/CT may yield reliable measurements of tumor proliferation, and an SUV max > 7.7 suggesting that SUV max was a useful predictor of diagnosis and may distinguish between aggressive and indolent newly diagnosed NHLs in adults, SUV max correlates with IPI score and clinical staging. SUV max doesn’t correlate to LDH.
Quantitative Assessment of Myocardial Viability and Ischemia in Patients with Coronary Artery Disease by Dobutamine Stress CMR Feature Tracking
Authors: Ibrahim Ghada Samir , Ibrahim Ahmed Samir , AbdelDayem Emad Hamid , El Mozy Wessam Emam , Abbas Sherif Nabil
Published: November 2024

Assessment of myocardial ischemia and viability is now mandatory for treatment decisions in patients with coronary artery disease (CAD). The high subjectivity of the noninvasive imaging tools such as dobutamine stress cardiovascular magnetic resonance (DS-CMR) in viability and ischemia assessment and late gadolinium enhancement (LGE) in scar transmurality detection, as well as the risks imposed by the contrast administration in patients with renal affection, paved the way for the evolution of more objective and safer techniques. Strain analysis provides quantifiable measurable values of the degree of myocardial deformation. Feature tracking-cardiac magnetic resonance (FT-CMR) is a novel strain analysis technique that uses only routinely acquired cine images in strain analysis. Our study aimed to assess the quantitative ability of the CMR-FT in assessment of myocardial ischemia and viability in patients with CAD. We investigated 20 patients (n = 320 myocardial segments), known or suspected CAD. DS-CMR and LGE were used to identify the viable non-ischemic, ischemic and non-viable myocardial segments. Then calculations of the rest segmental radial (Err), circumferential (Ecc) and longitudinal (Ell) strain were done by manual contouring of endocardial and epicardial borders using Segment Software.

Results

Based on the results of both DS-CMR and LGE of the 320 myocardial segments, 210 segments were defined as viable non-ischemic (remote), 71 segments were viable ischemic and 39 segments were non- viable. Rest segmental Ecc, Err and Ell values were statistically significantly reduced in the non-viable (mean± SD = -3.98 ± 5.08%, 12.26 ± 12.62% and -7.39 ± 7.05%, respectively) compared to both viable groups, p < 0.001. Furthermore, segmental Ecc and Err significantly differentiated between non-ischemic and ischemic group (mean± SD = -18.60 ± 7.09% vs -13.49 ± 8.53% and 44.09 ± 20.38% vs 32.21 ± 16.92% respectively), p1<0.001. However, Ell was weak to find a statistical significance between them, despite showing lower values in the ischemic group (mean± SD = -16.17 ± 8.86% vs -15.27 ± 9.82%, p = 0.741).

Conclusions

FT-CMR strain analysis can provide a more objective metric in myocardial strain analysis to differentiate between viable and non-viable as well as ischemic and non-ischemic myocardial segments. Therefore, such technique has a promising objective role in ischemia and viability assessment in conjunction with CMR or even may replace it in the future.
Comparative Study between MRI and Ultrasound in Articular Affection of Rheumatoid Arthritis
Authors: Gamal Noha , Shalaby Mennatallah H , Majeed Monir Abdul , Fadel Islam Y
Published: November 2024

Background

The earlier investigations showed that ultrasound had a moderate degree of accuracy in identifying and foretelling rheumatoid arthritis complications at various stages of the disease.

Objective

Evaluation of the accuracy of ultrasound imaging in comparison to MRI as a cheap method using non ionizing radiation in assessment of the rheumatoid arthritis patients.

Methods

During this study, 20 patients with clinically and laboratory proven rheumatoid arthritis were enrolled after consenting of them and subjected to ultrasound and MRI examination to compare between them in prediction of synovitis, tenosynovitis, joint effusion, bone marrow oedema, bone erosion and power Doppler activity.

Results

MRI was more accurate than ultrasound in assessment of bone marrow edema. On the other hand and as regard Doppler activity, ultrasound was more accurate than MRI. Finally, no differences were detected between both modalities in detection of synovitis, tenosynovitis, joint effusion and bone erosion.

Conclusion

Since MRI was more accurate than ultrasound in assessing bone marrow edoema, ultrasound and MRI complement one another in the assessment of articular affection in rheumatoid arthritis. On the other hand, ultrasonography was more accurate than MRI in terms of Doppler activity. Eventually, no variations in the detection of synovitis, tenosynovitis, joint effusion, and bone erosion were found between them.
The Role of Ultrasound in the Diagnosis of Hirshsprung Disease in Infants
Authors: Georgy Magy Nabil Labib , Guirguis Mounir Sobhy , Mohamed Niazi Gamal Eldin , Zaky Marwa Mohammed
Published: November 2024

Background

Hirschsprung disease (HD) is a relatively common cause of intestinal obstruction in newborn infants. It is characterized by the absence of ganglion cells in the distal bowel, which begins at the level of the internal anal sphincter and extends proximally for varying distances. The absence of ganglion cells has been attributed to the failure of migration of neural crest cells and for many years contrast enema was used for diagnosis and the pathognomonic finding of Hirschsprung disease is the transition zone between the normal and the aganglionic bowel.

Objective

To evaluate the accuracy of real time ultrasound in the diagnosis of Hirschsprung disease in infants in comparison to fluoroscopy and biopsy results.

Main body of Abstract

From September 2019 to February 2023 a diagnostic Ultrasound study was carried at pediatric radiology unit, Ain Shams university hospitals on infants with clinically suspecting Hirschsprung disease and the results compared to gastrografin enema using fluoroscopy while we were blinded with results, 30 patients met all inclusion and exclusion criteria were included in the study then the results were compared to the biopsy results. The study showed that there was no statistically significant difference between ultrasound and gastrografin enema in the diagnosis of Hirschsprung disease (p value = 1) with an overall kappa measure of agreement of 0.73, a sensitivity of ultrasound was 87.5%, the specificity was 85.7% and the accuracy of ultrasound was 86.7% and when ultrasound results were compared to biopsy results, the sensitivity was 97.8 %, the specificity was 50% and the accuracy was 88.9%. The results of gastrografin enema when compared to biopsy results were nearly the same as ultrasound results.

Conclusion

Ultrasound showed good performance in differentiating HD from other causes of chronic constipation and had excellent congruence with contrast enema. It may be an alternative screening method for HD after using it in a large group of patients with suspecting Hirschsprung disease.
Comparison of 21 Gauge vs 25 Gauge Needles in US Guided Fine-Needle Aspiration Cytology of Thyroid Nodules
Authors: Ghazy Mohamed Shaker , Sayam Omnia Ahmed , Saad El-din Somaia Ahmed , Hatata Mahmoud Ibrahim
Published: November 2024

Background

Thyroid nodules are frequent among the general population. Ultrasound is the most commonly used imaging technique in the evaluation of thyroid nodules, Fine needle cytology (FNC) has been routinely used as the baseline investigation for diagnosis of nodular thyroid disease. Its advantages include minimal invasion and high sensitivity, specificity, and accuracy.

Objective

Our aim is to compare the sample adequacy of FNA sample obtained by 21 gauge needle versus 25 gauge needle, aiming to improve the overall quality of FNC and hence better evaluation of thyroid nodules avoiding repeating FNC and unnecessary thyroidectomies.

Patients and Methods

Our study was conducted on 22 adult patients with thyroid nodules, whose ages range between 17 and 68 years old and were referred to undergo FNA procedures.

Results

22 patients with thyroid nodules were included in this study, the mean of Mayers score was 4.23 ± 2.18 and ranged from 1 to 8, while most of patients were adequate by (72.73%). Regarding the difference between two groups in Mayers score & adequacy, there was no statistically significant difference between the two groups in Mayers score nor adequacy (as P-value >0.05).

Conclusion

In conclusion concerning the diagnostic accuracy either 21- or 25-gauge needles can be used. We recommend using 21 gauge needles for markedly calcified nodules, because 25-gauge needles bend more easily in such cases.
Value of Breast Elastography in Evaluation of Breast Masses on Screening Ultrasound
Authors: Youssef Martina Youssef Abdo , Ali Souzan Bahig , El-Aassar Maha Mahmoud , Mohamed Asmaa Magdy
Published: November 2024

Background

Breast cancer is a global health burden and a leading cause of death in females worldwide, breast cancer alone accounts for 25% of all cancer cases and 15% of all cancer death among females. Its high incidence has led to improve patient's mortality rate. Breast cancer is the most common female neoplasm (31% of tumors in females), and the second-leading cause of death among women.

Objective

To evaluate the additional value of Elastography as complementary to conventional US in breast masses found on screening US.

Methods

The study was performed prospectively between August 2022 and January 2023 at Ain Shams University hospitals at diagnostic radiology department in 30 consecutive female patients who met all the inclusion criteria with no exclusion criteria.

Results

A total of 30 patients were included in our study with a mean age of 39.40 years (range 17 - 79 years). On Histopathological Evaluation, 9 (30%) lesions were malignant and 21(70%) were benign. The calculated sensitivity of Semiquantitative Elastography was 100%, specificity was 95.2% and the total accuracy was 96.7%. The PPV & NPV were 90% & 100% respectively. In our study, the best cut off value for Strain Ratio to differentiate between benign and malignant breast entities was found to be at 3.6 level (AUC, 0.984). It allowed significant differentiation between benign and malignant lesions (p < 0.001). Which considering lesions with a Strain Ratio ≤ 3.6 as benign and lesions with a Strain Ratio > 3.6 as malignant.

Conclusion

Breast Ultrasound Elastography is a useful imaging modality resulting in increase specificity and sensitivity in diagnosing different breast lesions. Breast Elastography provides useful information about distinguishing benign and malignant lesions. Thus, consideration of lesion stiffness could increase positive predictive values and reduce unnecessary benign biopsies and render better diagnostic results.
Role of MR Cholangiopancreatography in the Diagnosis of Various Pediatric Hepatic and Pancreatobiliary Diseases
Authors: Nassar Nasma Mohamed , Mohammad Shaimaa Abdelsattar , Salah Shaymaa Hassan Mohamed
Published: November 2024

Objective

The aim was to determine the role of MR cholangiopancreatography in the diagnosis of various hepatic and pancreatobiliary diseases in children and to correlate the MR imaging findings with the clinical data, laboratory results and the findings of the available other imaging modalities.

Patients and Methods

The present study retrospectively included 83 patients, with signs and symptoms denoting hepatic and pancreatobiliary abnormalities, who underwent paired radiological examination using US and MRI. MRCP examinations are coronal 3D fast spin-echo HR MRCP sequence, as well as axial and coronal T2-weighted fast spin-echo and fat-suppressed sequence images, axial DWI using a multi-slice single-shot echo-planar imaging sequence and ADC maps in gray scale. Agreement between US and MRI was done as regards identification of individual radiological abnormalities, diagnostic accuracy of US vs. MRI as gold-standard modality for detection of IHBRD and EHBRD was tested, and also diagnostic accuracy of US and MRI versus final (gold-standard) diagnosis was calculated.

Result

MRCP was found to have significantly higher diagnostic accuracy when compared to ultrasound (90.2%, 41.0%) respectively, especially in detection of pancreatic lesions (p-value <0.0001). Although there was good agreement between US and MR as regards detection of IHBRD and EHBRD, it was found that the US had a sensitivity of 69%, specificity of 90%, predictive value of positive test of 81%, predictive value of negative test of 82% for diagnosis of IHBRD and had sensitivity of 64%, specificity of 100%, predictive value of positive test of 100%, predictive value of negative test of 81%, when contrasted versus MRI as the gold-standard test.

Conclusion

MRCP have a higher diagnostic accuracy compared to US in detecting various hepatic and pancreatobiliary disease in children, especially in diagnosis of pancreatic diseases.
Assessment of Treatment Response in Patient of HCC by ADC Histogram Post-TACE in Correlation with Modified RECIST
Authors: Azzab Enas Ahmed , Mohammed Marwa Sayed , El-Rahman Ali El Saied Abd , Desouky Rania Mostafa Mahmoud El
Published: November 2024

Background

Hepatocellular carcinoma (HCC) is the fifth most common cancers worldwide, and has a poor prognosis unless treated. Trance arterial chemoembolization is promising treatment option for patients with liver HCC who are not eligible for surgery.

Objective

The aim of this study is assessment pre & post TACE imaging based on histogram analysis for predicting response of the treatment in patients diagnosed with hepatocellular carcinoma (HCC).

Patients and Methods

This work was a prospective study conducted on 30 patients with HCC; to assess therapeutic response of HCC cases after TACE by ADC histogram in comparison to mRECIST to evaluate its role in detecting treatment response /residual tumor.

Results

According to CART test, out of 30 patients, 12 (40%) showing a Complete response, indicating a favorable outcome where the treatment successfully reduced the tumor burden, 14 patients (46.67%) demonstrated a Partial response, suggesting a significant reduction in tumor size or overall improvement in disease status as well as 4 patients (13.33%) had a Stable response, indicating that their disease remained relatively stable without significant progression or regression. So, There is a statistically significant correlation between the responses categorized the mRECIST methods and CART test (P = 0.013).

Conclusion

changes in mean ADC and ADC kurtosis, as a measure of change in tissue heterogencity, can be used as quantitative values to assess post TACE treatment response in patient with well-circumscribed HCC.
Magnetic Resonance Imaging in Evaluation of Cystic Renal Masses Using Bosniak Classification Version 2019
Authors: Ahmed Samar Ahmed Abdallah , Kotb Mohamed , Madkour Sherihan Said , Hussein Rasha Salah Eldin
Published: November 2024

Background

Cystic renal lesions are very commonly encountered at abdominal imaging. Most lesions are asymptomatic and incidentally found. When a confident diagnosis cannot be rendered, incidental renal masses are considered indeterminate and typically are furtherly evaluated with CT or MRI using Bosniak classification that is specifically designed to evaluate them.

Objective

To assess MRI in evaluation of cystic renal masses using Bosniak classification version 2019 to stratify the risk of malignancy in correlation to histo-pathological analysis.

Patients and Methods

This was a cross sectional study that included 60 patients who were diagnosed to have cystic renal lesion either outpatients or referred from the urology department at Ain Shams University Hospitals to the radiodiagnosis department For pelvi-abdominal MRI examination. An acceptance from the ethical committee of the Radiology Department and the ethical Committee of faculty of medicine - Ain Shams University hospitals was obtained to use the data stared on PACs system With the patient’s consent waived. All patients gone through MR assessment utilizing 1.5 T machine (inginea Philips).

Results

From our study simple renal cyst (bosniak I) were the most common benign lesion and Cystic renal masses classified as Bosniak IV were the most common malignant lesion. After exclusion of benign causes 17 cases were included in histopathology. Clear cell Renal cell carcinomas were the most common finding and we correlate Histopathology with MRI results and It shows high significant relation between Bosniak classification and histopathology.

Conclusion

Bosniak classification version 2019 has high sensitivity and specifity in correlation to histopathology.
Comparison between Digital Breast Tomosynthesis and Digital Mammography in the Assessment of Breast Cancer across Dense and Nondense Breast
Authors: Abdelrahman Sanaa Hussein , Nasr Merhan Ahmed , Hanna Chris Nabil
Published: November 2024

Background

Women's breast cancer is considered a serious public health issue. throughout the world. For asymptomatic women, digital mammography is the primary imaging modality used for breast cancer screening. It also has been shown to reduce breast cancer mortality. Digital breast tomosynthesis provides better detection of the abnormalities especially in females with dense breasts

Aim

to evaluate the impact of digital breast tomosynthesis (DBT) in comparison to digital mammography (DM) in improving the detection and characterization of breast cancer across the dense and non-dense breasts (according to BI-RADS Atlas) in correlation with ultrasound and histopathology.

Material & Method

This study included 100 female patients according to our inclusion criteria. All patients performed full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) were classified according to breast density. To establish a correlation between mammographic findings and cancer diagnosis, high-resolution ultrasound (HHUS) and DBT were used following FFDM as the primary imaging modality. The cancer diagnosis was subsequently confirmed by histopathology.

Results

The current study was based on histopathology as a reference standard, This was correlated with the final diagnosis; the diagnostic indices of mammography at the whole group were a sensitivity of 73.9%, a specificity of 74.3%, a positive predictive value (PPV) 84.2%, a negative predictive value (NPV) of 60.5%, and a diagnostic accuracy of 74%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 88.6%, a PPV of 94.2%, an NPV of 100%, and a diagnostic accuracy of 96%. In patients with dense breasts Radiology ACR (c and d), 78% of cases had changed their BI-RADS scoring with the addition of tomosynthesis. However, in 54% of individuals with non-dense breast ACR (a and b), the addition of DBT to FFDM changed the BIRADS score. Our results showed that 100% of lesions detected by tomosynthesis were malignant tumors.

Conclusion

We conclude that DBT exceeded Mammography in terms of sensitivity, specificity, and diagnostic accuracy at all breast densities, particularly dense breasts. This is because DBT enables more accurate identification and characterization of breast lesions, which reduces the number of recalled cases and negative biopsies.
Antenatal Ultrasound Measurement of Fetal Abdominal Subcutaneous Tissue Thickness as a Predictor of Fetal Birth Weight
Authors: Shawky Abdeltawab Taha Shoeib Sherouk Ahmed , Sakr Hossam Moussa , Mohammed Hesham Salah
Published: November 2024

Objectives

To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by transabdominal ultrasound and birth weight measured immediately after delivery and to obtain cut-off values for FASTT to predict small and large for gestational age babies in the Egyptian population.

Background

Fetal weight estimation is a crucial part of antenatal and intrapartum care as it forms the basis for decision making in obstetric care. Various studies compared the accuracy of different ultrasound fetal weight estimation formulas to determine the most accurate one, but current evidence still indicates significant error levels. FASTT measurement can be used to improve ultrasonographic fetal weight assessment reducing potential perinatal complications associated with small and large for gestational age fetuses.

Patients and Methods

A prospective cohort study conducted in Ain Shams University Hospitals on 86 pregnant women with normal singleton pregnancies between 24 and 40 weeks of gestation. FASTT was measured in millimeters at the anterior third of the abdominal circumference and birth weight was recorded immediately after delivery.

Results

This study concluded that FASTT showed high statistically significant correlation with EFW by Hadlock formula IV (1985) (r = 0.624, p- value = <0.001) and BW (r = 0.749, p- value = <0.001). FASTT showed higher sensitivity (84.09%) than specificity (64.29%) as a predictor of both SGA and LGA, but it showed higher sensitivity and specificity in LGA (sensitivity 100%, specificity 97.5%) compared to SGA (sensitivity 81.1%, specificity 73.5%). The best cut-off value of FASTT for LGA was 7.1 mm and that of SGA was 4.9 mm. No statistically significant correlation was found between FASTT and any of the maternal age, fetal gender or mode of delivery.

Conclusion

FASTT can be used as a predictor for birth weight; it is a better indicator of LGA than SGA. FASTT can be incorporated into fetal weight estimation formulas as a method to increase their accuracy especially at birth weight extremes. A study on a larger scale of Egyptian population should be conducted to generate fetal weight estimation formulas based on the Egyptian ethnicity to be the reference for medical practice in Egypt.
Repetitive Transcranial Magnetic Stimulation as a Modality of Treatment in Patients with Fibromyalgia
Authors: Sebaie Mona Abdallah El , Ahmed Sahar Fathi , Nassef Marwa Abdelaziz , Abd rabbo Rawan Mohammed El Shahat
Published: November 2024

Background

Fibromyalgia is a common musculoskeletal condition affecting around 1–3% of the general population worldwide. It is defined as a complex chronic disorder characterized by widespread musculoskeletal pain and tenderness, often accompanied by additional features including fatigue, sleep disturbance and cognitive dysfunction and is associated with co-occurring health issues including mood disorders.

Aim of the Work

The aim of this study is to evaluate the role of repetitive transcranial magnetic stimulation (rTMS) in treatment of fibromyalgia.

Patients and Methods

The study was conducted on 30 primary fibromyalgia patients according to American college of rheumatology criteria (ACR) 2010 criteria 20 of which were subjective to repetitive transcranial magnetic stimulation (rTMS) and 10 subjected to Sham stimulation (placebo) as a control group.

Results

As regards the quality of life assessment after rTMS sessions, there was a highly statistically significant difference in feel good and work missed scores by FIQ being lower in cases group compared to control group with p-values 0.008 and 0.003 respectively. Also there was a statistically significant difference as regards physical impairment, anxiety and depression scores by FIQ being lower in cases group compared to control with p-values 0.013, 0.022 and 0.037 respectively. On comparing the control and cases groups regarding anxiety and depression using HADS questionnaire after rTMS sessions, there was a statistically significant difference in depression score as it was lower in cases group compared to control group with p- value 0.024. Regarding fatigue assessment after rTMS sessions, there was a highly statistically significant difference between both groups as regards energy/fatigue, general health and health change scores being higher in cases group compared to control group with p-values 0.004, 0.005 and 0.009 respectively. Also, there was a statistically significant difference regarding emotional well-being score which was higher in cases group compared to control group with p-value 0.012. Upon correlating age and BMI with the studied parameters among the cases group, our results showed a positive correlation between age and pain score by FIQ (r 0.049, p 0.028), But, there was no correlation between BMI and other studied parameters.

Conclusion

rTMS was more effective than sham stimulation in improving quality of life, anxiety and depression when patients were assessed approximately 3 weeks after therapy. But, it was not effective concerning pain improvement.
Incidence of Multidrug Resistant Organisms and Adequacy of Empiric Antibiotic Treatment in Hospitalized Patients with Sepsis at Ain Shams University Hospital
Authors: El-Sayed Ashraf M , Ali-eldeen Fatma A , Mubarak Hend , Ali Yasmeen M , Abousenna Ahmed M
Published: November 2024

Background

Bloodstream infections (BSIs) are the most severe infections that cause the highest mortality rate, especially in patients admitted to the intensive care unit (ICU). The nightmare of the rising numbers of multidrug-resistant organisms (MDROs) requires the implementation of effective Antibiotic stewardship programs (ASPs). However, this should be preceded by making available evidence-based knowledge regarding the local antimicrobial resistance pattern, which is fundamental.

Objective

Is to determine the prevalence of MDROs and to measure the adequacy of the empirical Anti-Microbial Therapy (EAMT) in adult patients with sepsis hospitalized at Ain Shams University Hospitals (ASUHs) ICUs.

Patients & Methods

This was a prospective cohort study carried out on hospitalized adult patients with evidence of BSI admitted at ICUs of ASUH by +ve blood culture and sensitivity results. 276 patients were included in the study during the period from December 1st 2022 till may 30th 2023.

Results

In 276 patients, our study showed male to female ratio 1:1.1, Community acquired infections account for 34.8%, while healthcare associated infections account for 65.2% of total cases. The primary source of BSI was identified in only 62% of cases; the most prevalent cause was UTI in 29.1%, and pneumonia in 16.6% of total cases with identified source. Prevalence of MDROs was 88.8% among all the studied patients, Klebsiella spp. was the most prevalent among isolated organisms in 30.8% of total cases, and adequacy of EAMT was achieved in only 40.9% of total cases. Mortality rate within 2 weeks was 23.2%, and long hospital stay > 2weeks noticed in 54.3% of the studied patients and only 22.5% of patients improved and discharged from ICU.

Conclusion

MDROs are a public health threat and their prevalence is rising over the past few years, effective ASPs are mandatory to combat that threat and improve the adequacy of EAMT.
Characteristics and Outcome of Primary Budd Chiari Syndrome due to Myeloproliferative Disorder in Egyptian Patients, A Single Center Study
Authors: Ibrahim Amany Ahmed , Mubarak Hend , Ganzoury Ahmed El , Hassan Sarah , Hakeem Emad Abdel
Published: November 2024

Background

Budd–Chiari syndrome (BCS) is a rare life-threatening disorder caused by obstruction of the hepatic venous outflow tract at any level between the small hepatic veins and the right atrium, hence also known as hepatic venous outflow tract obstruction (HVOTO). Primary BCS is often related to multiple thrombophilic conditions, including primary myeloproliferative disorders.

Aim of the Work

The present study aimed to assess characteristics of Primary Budd Chiari syndrome due to Myeloproliferative disorder in Egyptian patients and the outcome of the radiologic endovascular intervention (TIPS or angioplasty)

Patients and Methods

This was a retrospective cohort study that was carried out in The Tropical Medicine department, at Ain Shams University Hospitals. A total of 37 patients were enrolled, including 12 males and 25 females, with an age of 15-49 years (mean: 32 years) with primary BCS and MPDs during the interval between January 2006 and March 2023.

Results

JAK2 was positive in 64.9% of BCS patients, more in ET patients. ET was more frequent in BCS due to MPDs. Furthermore, these results validate routine inclusion of JAK2V617F in the diagnostic workup of BCS. Rate of stent occlusion was high 33.3% due MPDs thrombophilic burden nature.

Conclusion

MPDs are major aetiology of BCS. TIPS placement is an effective treatment for portal hypertension, but in any case, long-term high intensity anticoagulation treatment is essential in order to prevent recurrent thrombosis.
Prognostic Value of CLIF-C of Score in Patients with ACLF (Acute on Top of Chronic Liver Cell Failure)
Authors: Abdelhamid Khalaf Mohamed Salaheldin , Elgazar Ahmed Hussein Abdelhamid , Alfeqy Israa Mohamed Mohamed
Published: November 2024

Background

ACLF is a major cause of mortality in patients with cirrhosis and chronic liver disease worldwide. An international consensus definition for ACLF is currently lacking and thus there is heterogeneity in how these patients are identified and subsequently managed in different settings. Whilst it is clear that early diagnosis, prevention of precipitating factors, and aggressive ICU care with organ support improves prognosis; treatment for ACLF is currently broadly restricted essentially to supportive care.

Objective

To evaluate the prognostic accuracy of CLIF-C ACLF score in determining short-term (28-day) mortality in patients with acute on top of chronic liver cell failure presented to Ain Shams University Hospitals.

Methods

This was a retrospective cohort study that was carried out in Ain Shams university hospitals (Tropical Medicine Department, Intermediate Care unit). 70 patients (47 males, 23 females) were studied in retrospective manner in the period from 12/2019 to 12/2021 in the form of collecting records of patients with Acute on top of Chronic liver cell failure ACLF to evaluate the prognostic value of CLIF C ACLF score in patients with ACLF to predict the 28 day mortality.

Results

CLIF-C ACLF score has shown better accuracy in predicting short term 28 day mortality for patients with ACLF compared with all other tested prognostic scores for chronic liver disease in patients with ACLF, especially for ACLF grade 3.

Conclusion

ACLF-specific scores could significantly predict in-hospital mortality of patients with ACLF. However, CLIF-C ACLF and Child-Pugh class C were superior to other scores as they could significantly and independently predict in- hospital mortality. Cirrhosis patients who were hospitalized due to acute liver decompensation with or without ACLF had a high short-term mortality rate. The CLIF-C ACLF score demonstrated the best accuracy in predicting the prognosis of ACLF patients. The prognosis of AD patients was poorer than that of other populations.
Characteristics and Outcomes of Hepatocellular Carcinoma in Patients with C-Viral Chronic Liver Disease and Non-Viral Chronic Liver Disease
Authors: Hamed Mostafa , Fawzy Montasser Iman M , Salah-Eldin Manar Mohamed , Hassan Raesa Sayed
Published: November 2024

Background

Hepatocellular carcinoma (HCC) is the primary liver cancer derived from hepatocytes and accounts for 85–90% of all primary liver cancers, It is the 5th commonest cancer in men and the 7th commonest cancer in women overall in the world. However, it is the third commonest cause of cancer-related death worldwide, exceeded only by cancers of the lung and stomach.

Aim

The aim of the work is to compare characteristics, behavior and outcomes of Hepatocellular carcinoma (HCC) in patients with viral and non-viral chronic liver disease.

Patients and Methods

It is a retrospective cohort study In Tropical Medicine department and HCC clinic at Ain Shams University Hospitals. (from 2015 to 2020), divided to 2 groups according to the aetiology of their chronic liver disease : Group 1n = 35: patients with HCC on top of viral chronic liver disease (due to viral C). Group 2n=28: patients with a HCC on top of non-viral chronic liver disease Further stratification of both groups according to BCLC was done.

Results

This study showed male predominance in both group, viral group is 30 (85.7%) and female 5 (14.3%) with mean age 58.77 ± 7.47 and in non viral group male predominance 18 (64.3%) and female10 (35.7%) with mean age of 48.07 ± 14.42 years' old. There was statistical significance difference between the two groups regarding one year survival 6 patients died in non viral (21.4%) while 16 patients died in viral groups (45.7%). There was statistical significant difference between viral group (n = 35) and non viral groups(n = 28) as regards overall survival, which was higher in non viral groups with mean (11.46) month.

Conclusion

Non-viral chronic liver disease patients with hepatocellular carcinoma (HCC) have less-severe liver dysfunction at HCC diagnosis and better overall survival compared to counterparts with viral chronic liver disease patients (HCV). Further studies on large number of patients are needed.
Type I interferon biomarker in idiopathic inflammatory myopathies: associations of Siglec-1 with disease activity and treatment response
Authors: Kamperman Renske G , Veldkamp Saskia R , Evers Sanne W , Lim Johan , van Schaik Ivo , van Royen-Kerkhof Annet , van Wijk Femke , van der Kooi Anneke J , Jansen Marc , Raaphorst Joost
Published: November 2024

Objectives

Novel biomarkers are needed to guide therapy in idiopathic inflammatory myopathies (IIM). Expression of Siglec-1, a type I interferon biomarker, was examined in adult patients with IIM in relation to disease activity and treatment response.

Methods

We analyzed PBMC samples from 19 newly diagnosed adult IIM patients who participated in a phase-2 pilot study on efficacy of intravenous immunoglobulin (IVIG) monotherapy, and from 9 healthy controls. Siglec-1 expression on monocytes was measured by flow cytometry before and after treatment, and was evaluated in relation to IIM subtype, physician global activity (PhGA) scores, manual muscle strength (MMT) and the total improvement score (TIS).

Results

Diagnoses included dermatomyositis (DM; n = 9), immune-mediated necrotizing myopathy (IMNM; n = 5), non-specific/overlap myositis (NSM/OM; n = 4) and antisynthetase syndrome (ASyS; n = 1). All patients showed increased Siglec-1 expression at baseline. Relative median fluorescence intensity of Siglec-1 was highest in patients with DM. After 9 weeks, follow-up samples were available for 15 patients of whom 10 patients showed a decline in Siglec-1 expression. In DM, Siglec-1 correlated with disease activity (MMT; rs = −0.603, P = 0.013 and PhGA; rs = 0.783, P < 0.001) and with the TIS (rs = −0.786, P = 0.036).

Conclusion

Siglec-1 was increased in treatment-naive IIM patients and showed a decline after IVIG monotherapy. In DM, Siglec-1 expression correlated with relevant clinical measures. This underlines the dynamic role of type I IFN in IIM and the biomarker potential of Siglec-1, in particular in DM. These findings should be further validated in larger cohorts with longer follow-up.
Corporate governance, meritocracy, and careers
Authors: Pagano Marco , Picariello Luca
Published: November 2024

Firms may pursue non-meritocratic promotion policies at the cost of lower profitability, if they yield private benefits of control. Corporate governance standards that limit these private benefits favor meritocratic promotions and therefore encourage workers’ skill acquisition. Managerial incentive pay has ambiguous effects on workers’ skill acquisition: it fosters the supply of skilled labor, while reducing firms’ willingness to promote skilled workers to managerial positions. Social welfare increases with the share of meritocratic firms, but not necessarily with governance standards: small reforms generate losers and gainers, and may on balance lower welfare, while drastic enough reforms can generate Pareto improvements.
A preliminary study of threat-anticipatory responding in Latina youth: associations with age, anxiety, and cortical thickness
Authors: Mullins Jordan L , Abend Rany , Michalska Kalina J
Published: November 2024

Variation in prefrontal cortex neuroanatomy has been previously associated with elevated physiological responses to anticipated aversive events. The extent to which such associations extend beyond the specific ecology of treatment-seeking youth from upper-middle socioeconomic backgrounds is unknown. The current study tests the replicability of neuroanatomical correlates of anticipatory responding and the moderating roles of age and anxiety severity in a community sample of Latina girls, a historically underrepresented group exhibiting high levels of untreated anxiety. Forty pre-adolescent Latina girls (MAge = 10.01, s.d. = 1.25, range = 8–12 years) completed a structural magnetic resonance imaging scan. Participants also completed a differential threat and safety learning paradigm, during which skin conductance and subjective fear responding were assessed. Anxiety severity was assessed via the Screen for Child Anxiety Related Emotional Disorders. Ventromedial prefrontal cortex thickness was associated with reduced physiological responsivity to anticipated threat. Age- and anxiety-dependent associations emerged between dorsomedial prefrontal cortex thickness and individual differences in subjective fear responding to anticipated threat. This preliminary study extends work on neuroanatomical contributions to physiological threat responsivity to a community sample of Latina youth and highlights potential considerations for early identification efforts in this population when threat neurocircuitry is still developing.
The plurality and contexts of research quality notions
Authors: Langfeldt Liv , Steffy Kody James
Published: November 2024

Whereas research quality is a key concern in research policy, it is often handled as unitary and rarely interrogated. This paper explores variations in what researchers perceive to characterize the research they value the highest and aims to understand the different sites where research quality notions are formed. Based on a large researcher survey, we find both commonalities and differences across disciplines. Notions appear to vary systematically by researcher’s organizational type, their interaction with clients and practitioners, and their reliance on outside infrastructure and multidisciplinary research. For example, those affiliated with research institutes are more prone than those at universities to value societal impact as a characteristic of the best research. In conclusion, quality notions appear to reflect a multitude of organizational sites, and disciplines account for only part of the variation. Hence, a more nuanced understanding of the plurality and origins of research quality notions is needed.
Sexual function following risk-reducing salpingo-oophorectomy: a prospective cohort study
Authors: von Kartaschew Åsa Ehlin , Hirschberg Angelica Lindén , Gemzell-Danielsson K , Flöter Rådestad Angelique
Published: November 2024

Background

Increased access to and indications for genetic testing will lead to more women undergoing risk-reducing salpingo-oophorectomy (RRSO), with a potential impact on sexual function.

Aim

Our objective was to prospectively investigate (1) sexual function in women with pathogenic variant (PV) in BRCA1/2 genes, before and 1 year after RRSO, and to compare with a healthy age-matched control group and (2) to study if testosterone levels correlate with sexual functioning after RRSO.

Methods

A prospective observational follow-up study of 43 BRCA1/2-PV carriers planned for RRSO and 73 healthy-age matched controls. Data including personal medical history, the Female Sexual Function Index (FSFI) and blood samples for analysis of testosterone by tandem mass spectrometry and free androgen index (FAI) were collected before and 1 year after surgery or at inclusion (controls).

Outcomes

Sexual function and testosterone levels following RRSO.

Results

Median age in the RRSO group was 42 years at baseline, 55.8% were premenopausal and 53.5% had a history of breast cancer. The RRSO group had significantly lower median FSFI total score (P < .001), lower scores of all 6 FSFI domains (P < .001), as well as a higher proportion of female sexual dysfunction (FSD) (P < .001) compared to the control group at 1 year after surgery. In the RRSO group, users of menopausal hormone therapy (MHT) had a significantly higher median FSFI total score compared with the nonusers both at baseline (P = .023) and follow-up (P = .010). The proportion of FSD was significantly higher in the non-MHT group at both baseline (P = .041) and follow-up (P = .009). FAI was significantly lower in the RRSO group when compared to the controls at 1-year follow-up (P = .041); however, no significant correlations between testosterone levels and FSFI scores were found.

Clinical implications

The results highlight the need to counsel BRCA1/2-PV carriers before RRSO and offer a structured follow-up and support addressing sexual function and impact of MHT use.

Strengths and Limitations

The main strength of this study is its prospective design with age-matched controls. Limitation is a small sample size.

Conclusion

Our findings show that sexual function deteriorated 1 year after RRSO independent of testosterone levels, and the proportion with impaired sexual function was higher compared to healthy age-matched controls.