Can dynamic contrast enhanced magnetic resonance imaging change treatment planning in endometrial carcinoma?

AbstractPurposeTo detect the diagnostic accuracy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the assessment of myometrium and cervix infiltration and lymph node (L.N) status in patients with endometrial carcinoma.Patients and methodsForty patients with pathologically proven endometrial carcinoma underwent preoperative MRI assessment in the National Cancer Institute, Cairo University, Egypt over three years from 2009 to 2012. Every case had one stage for the T2 weighted images (T2 WIs) alone and another stage for the combined T2 and DCE images according to the revised international federation of gynecology and obstetrics (FIGO) classification. The pathological findings after surgery were the reference standard.ResultsThe sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of T2 WIs in detection of deep myometrial invasion were 80%, 72%, 70%, 84% and 79%, respectively and 87%, 90%, 85%, 92% and 87%, respectively for DCE-MRI. For cervical infiltration, T2 WIs showed 78.5%, 88%, 73%, 90.5% and 82.5%, respectively while DCE-MRI showed 92%, 97%, 92%, 97% and 95%, respectively. T2 WIs and DCE-MRI had 100% sensitivity and 85% specificity for the detection of L.N metastasis.ConclusionDCE-MRI can accurately detect invasion of the myometrium and cervix in cases of endometrial carcinoma

Accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance: Experience from the National Cancer Institute, Cairo University, Egypt

Aim: To evaluate the accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance. Patients and methods: 85 cases of FNAC of bone lesions were included. Sixty two procedures were performed by the radiologist and 23 procedures by the histopathologists. The aspirates were immediately fixed in 95% ethanol alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. Diagnosis was established in 81 cases (95.3%), classified into 3 categories: (1) positive for malignant cells (57.6%); (2) suspicious for malignant cells (10.6%); and (3) benign, borderline or inflammatory lesions (27.1%). Cytology findings were compared with subsequent available histology. Results: The overall accuracy was 91%. The 49 cases diagnosed as malignant by cytology were all correct. FNAC could differentiate various giant cell rich lesions and round cell malignancies as Ewing’s sarcoma, myeloma and NHL. Uncommon bone lesions as chordoma and MFH were also correctly diagnosed. Cytological diagnosis of benign and borderline lesions was made in 23 patients. The authors encountered difficulties diagnosing a case of MFH that was reported as osteosarcoma and a case of metastasis that was reported as chondrosarcoma. Conclusion: FNAC of bone lesions is a simple, safe and accurate diagnostic technique for diagnosis of bone lesions especially when other diagnostic modalities are unavailable

Soluble and membranous endothelial protein C receptor in systemic lupus erythematosus patients: Relation to nephritis

Aim of the work: To investigate the role of endothelial protein C receptor (EPCR) (membrane and soluble forms) as a biomarker of lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients and to study its relation to the prognosis and response to treatment. Patients and methods: The study included 30 SLE patients and 30 matched healthy volunteers as well as 10 renal biopsies from surgical nephrectomy as a control for membranous (mEPCR) examination. SLE disease activity index-2000 and damage index were assessed. Serum sEPCR was measured. Renal expression of mEPCR was analyzed. All patients were reassessed after 3 months. Results: Patients were 26 females and 4 males with a mean age of 29.6 ± 10.04 years and disease duration of 4.4 ± 3.5 years. Their mean SLEDAI was 13.9 ± 9.9 and damage index 1 ± 1.5. Serum levels of sEPCR were significantly higher in patients with LN (19.9 ± 5.7 ng/ml) than those without (8.95 ± 4.2 ng/ml) and controls (5.3 ± 2.6 ng/ml)(p < 0.001). SLE patients with cutaneous vasculitis (n = 9) had significantly higher sEPCR levels than those without (18.1 ± 7.8 vs 10.2 ± 5.2 ng/ml)(p = 0.02). There was a significant correlation between sEPCR percentage of change and of SLEDAI-2k with and without LN (p < 0.01 and p < 0.05). A significant difference was observed in sEPCR according to the prognosis and treatment response after 3 months. mEPCR stained positively in glomeruli and tubules of LN patients with no relation to histopathological grading. Conclusion: sEPCR plays a role in the pathogenesis, is related to a bad prognosis and poor response to treatment in LN. mEPCR was not related to LN grading. Keywords: Lupus nephritis, Systemic lupus erythematosus, Soluble and membranous EPCR, ELIS, AImmunohistochemistr

Evaluation of endothelial protein C receptor in patients with systemic lupus erythematosus: correlation with disease activity and lupus nephritis

Introduction Systemic lupus erythematous (SLE) is a systemic, multifaceted inflammatory disease with clinical manifestations is protean and follows a relapsing and remitting course. Lupus Nephritis (LN) is one of the most frequent and serious manifestation. Endothelial protein C receptor (EPCR) is a transmembrane receptor that is shed into soluble form (sEPCR) in inflammatory status. It is demonstrated as a part of the pathobiology of the SLE disease. Aim of the work To assess correlation of sEPCR level in SLE patients to the disease activity in these patients and to relate sEPCR to LN. Patients and methods Serum level of sEPCR using enzyme-linked immunosorbent assay (ELISA), chemical and immunological markers of SLE were measured in 30 SLE patients and 30 age and sex matched apparently healthy controls. SLE patients were subgrouped into 20 patients without LN and 10 with LN. Disease activity was assessed using SLE Disease Activity Index (SLEDAI). Results A significantly higher sEPCR level was found on comparing SLE patients to controls with statistically highly significant difference (z = 4.8, P < 0.001). Moreover, there was a significantly higher sEPCR level on comparing SLE patients with LN to those without LN with statistically highly significant difference (z = 3.9, P < 0.001). Serum sEPCR had a highly significant positive correlation with SLEDAI in SLE patients (r = 0.66, P < 0.01). Conclusion sEPCR has a possible role in the pathogenesis of SLE and particularly LN diseases, reflecting disease activity in SLE patients

Determinants of Obtaining COVID-19 Vaccination among Health Care Workers with Access to Free COVID-19 Vaccination: A Cross-Sectional Study

Introduction: Despite global efforts to contain the illness, COVID-19 continues to have severe health, life, and economic repercussions; thus, maintaining vaccine development is mandatory. Different directions concerning COVID-19 vaccines have emerged as a result of the vaccine&rsquo;s unpredictability. Aims: To study the determinants of the attitudes of healthcare workers (HCWs) to receiving or refusing to receive the vaccine. Methods: The current study adopted an interviewed questionnaire between June and August 2021. A total of 341 HCWs currently working at Assiut University hospitals offered to receive the vaccine were included. Results: Only half of the HCWs (42%) accepted the COVID-19 vaccine. The most common reason that motivated the HCWs was being more susceptible than others to infection (71.8%). On other hand, the common reasons for refusing included: previously contracted the virus (64.8%); did not have time (58.8%); warned by a doctor not to take it (53.8%). Nearly one-third of nonaccepting HCWs depended on television, the Internet, and friends who refused the vaccine for information (p &lt; 0.05). In the final multivariate regression model, there were six significant predictors: sex, job category, chronic disease, being vaccinated for influenza, and using Assiut University hospital staff and the Ministry of Health as sources of information (p &lt; 0.05). Conclusion: Misinformation and negative conceptions are still barriers against achieving the desired rate of vaccination, especially for vulnerable groups such as HCWs