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Background: Dyslipidemia is one of the main modifiable risk factors for cardiovascular diseases, which accounts for one third of total deaths worldwide. Statin is considered the cornerstone therapy for treating dyslipidemic patients. H1 Cardiac magnetic resonance spectroscopy (MRS) is a special non-invasive, non-irradiating method for assessing myocardial lipid content in vivo in both health and disease. Aim: To compare dyslipidemic patients and healthy individuals, and to detect the efficacy of statin on the myocardial lipid content in dyslipidemic patients to detect if there will be changes 6 months after starting statin therapy. Methods: Laboratory lipid profile and myocardial lipid content had been measured by H1 MRS in thirty dyslipidemic patients and fifteen healthy matched age and sex individuals as a control group, then dyslipidemic patients were followed up 6 months after statin therapy at Cardiovascular Medicine and Radiology departments; Mansoura University Hospitals, Dakahlia Governorate, Egypt, during the period from January 2020 to October 2022. Results: A total of thirty dyslipidemic patients were screened for lipid profile, myocardial lipid content by H1 MRS; 56.67% were male, with a mean age of 49 ± 9.19 years, and compared with fifteen healthy matched age and sex individuals as a control group. Laboratory lipid profile, and triglyceride lipid concentration by MRS were significantly higher in dyslipidemic group before initiating statin therapy compared to control group (p value, 0.001, 0.019 respectively). Median LDL levels were 161.10 ± 30.28 mg/dl before the start of statin therapy and were 114.27 ± 48.33 mg/dl after statin therapy (p < 0.001). There was a statistically significant reduction in triglyceride lipid concentration in dyslipidemic patients after 6 months of statin therapy: from 0.011 (0.001–0.55 (mmol/l), to 0.0025 (0.001–0.04 mmol/l) with a p value < 0.001. Conclusions: Increased myocardial lipid content as measured by magnetic resonance spectroscopy was demonstrated in dyslipidemic patients in our study that decreased after 6 months of statin therapy. [ABSTRACT FROM AUTHOR]

Background: The staging and management of patients with breast cancer are significantly influenced by the pathological state of the axillary lymph nodes (ALN). Thus, it is very desirable to have a differential diagnosis of metastatic ALN. Purpose: The aim of this research is to assess the effectiveness of non-invasive ALN staging using PEM versus traditional breast mammography and ultrasound in patients presenting with early-stage breast cancer. This study focuses on determining if PEM can reliably stage ALNs and potentially eliminate the need for more invasive methods. Methods: In a study involving 94 breast cancer patients, PEM was used to assess ALNs. The nodes were visually evaluated for positive or negative uptake, and further categorized as non-specific, indeterminate, or malignant based on their maximum uptake values. This classification was then compared with histopathological results. Results: There were a total of 94 breast cancer patients; the results from PEM demonstrated an ALN detection sensitivity of 83.3%. The specificity of PEM in this context was found to be 98.08%, and the overall accuracy rate was 91.49%. Additionally, the Positive Predictive Value (PPV) was calculated to be 97.2%, and the Negative Predictive Value (NPV) was 87.9%. Conclusions: The initial study has shown encouraging outcomes in terms of accurate lymph node assessment. [ABSTRACT FROM AUTHOR]

Background: Adnexal masses (AMs) are prevalent, leading to a substantial clinical effort including imaging for diagnosis, surgery, and pathology. Aim of the study: The goal of this research was to evaluate the reliability of the Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) scale for diagnosing the sonographically indeterminate adnexal masses and to discriminate between malignant and benign ones using the O-RADS MRI scoring system. Methods: This study included 72 cases with indeterminate adnexal masses in any age group. We excluded patients with previous history of operated adnexal lesion and patients who had contraindications for MRI as pacemakers or iron clips. Results: Based on O-RADS MRI score, 44.4% of masses were diagnosed as O-RADS II indicating that they were almost certainly benign, 11.1% as O-RADS III indicating low risk malignancy, 8.3% as O-RADS IV indicating intermediate risk malignancy and 36.1% were diagnosed as O-RADS V indicating high risk malignancy. O-RADS MRI score for malignancy gave sensitivity of 92.31% (95%CI 63.97–99.81), specificity of 82.61% (95%CI 61.22–95.05), PPV of 75% (95%CI 54.84–88.11) and NPV of 95% (95%CI 74.12–99.21) with an overall accuracy of 86.11% (95%CI 70.50–95.33). Conclusions: The O-RADS MRI score has excellent accuracy and validity in determining whether an AM is malignant or benign. Using this score in clinical practice may enable a tailored, patient-centered approach for masses that are sonographically indeterminate, avoiding unnecessary surgery, and in certain cases allows less extensive surgery, or even fertility preservation when appropriate. [ABSTRACT FROM AUTHOR]

Background: An inflammatory disorder known as trigger finger (TF) results in pain in the proximal and distal palm and digit, as well as restricted movement and diminished function. Physiotherapists use a specific treatment called dry needling (DN) to reduce musculoskeletal pain and assist patients with mobility restriction. Objectives: This study aimed to examine the effectiveness of DN on quality of life in patients suffering from trigger finger. Methods: Forty patients, ranging in age from 45 to 75, were randomized into one of two groups in this Prospective pre and post-test, single-blind parallel group randomized controlled trial. Twenty patients were assigned to the intervention group, which included traditional physiotherapy splinting and ultrasound (ultrasonic dosage was 3MHz, the intensity of 0.5 W/cm2, and the duty cycle 50%. Duration: 5 minutes) as well as to DN upon a nodule at the proximal end of the 1st annular (A1) pulley as well as the discrepancy that existed between the flexor tendon's diameter along with its sheath at the metacarpal head. Twenty patients were assigned to the control group, which consisted of traditional treatment alone, twice weekly, for a total of ten sessions over five weeks. The trial evaluated the quality of life, severity of pain, and hand grip strength using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), visual analogue scale, and Camry dynamometer respectively two times, beforetreatment and after 10 treatment sessions. Results: Within-group analysis using MANOVA demonstrated a significant decline in VAS (p = 0.001) and a significant improvement in quality of life (p = 0.001) and hand grip strength (p = 0.001). Regarding between group comparison using MANOVA there was significant improvement in favor of the DN intervention (p = 0.001) for all measured variables. Conclusions: A 5-week dry needling approach with a traditional physiotherapy program was effective in improving in quality of life, pain intensity, and hand grip strength in patients with trigger finger, emphasizing it as the better option. Trial registration: Clinical Trial. Gov, NCT05671523. Registered 14 December 2022. [ABSTRACT FROM AUTHOR]

Background: Predictions about the hospital course of the coronavirus disease 2019 (COVID-19) patients are of paramount value. This research was designed to validate 4C mortality and CT severity scores (CT-SS) as prognostication tools of mortality and detect their relations among patients with COVID-19 who are hospitalized. The identification of other potential mortality risk factors was also evaluated. Methods: Two hundred and ninety-six confirmed COVID-19 adult cases were prospectively included. They were allocated into 3 groups according to severity; 78 in moderate group, 97 in severe group, and 121 patients in critical group. Patient demographics, clinical characteristics, co-morbidities, lines of treatment, 4C mortality score and CT severity score were assessed upon admission. Results: The study revealed that 90% and 84.3% sensitivities were observed for 4C mortality and CT-SS respectively as predictors of mortality. Significant correlation between both scores (r = 0.6. p = 0.0001) was detected. Multivariate analysis identified 6.9-fold increased risk of mortality for the patients with 4C mortality score > 9.5 (p = 0.001). CT-SS > 12, age ≥ 60, male gender, hypertension and diabetes mellitus were also found as significant independent factors associated with increased mortality. Conclusions: Both of 4C mortality score and CT-SS have a high sensitivity as a risk-stratification scores with a considerable correlation. In addition, they represent the most independent risk factors associated with mortality in comparison to other clinical or laboratory indices. [ABSTRACT FROM AUTHOR]

Background: One of the most frequent reasons for gynecologic imaging is adnexal masses. The aim of the study is to assess the diagnostic performance of ultrasonography in the identification of ambiguous adnexal masses using the O-RADS US scoring system. Methods: This study included 108 cases and involved females with indeterminate adnexal masses, with any age group who were sent to the diagnostic ultrasonography department for evaluation of a worrisome adnexal mass lesion. We excluded patients who refused the examination despite informed discussion with the sonographer and patients with a previous history of operated adnexal lesion. Results: Based on the O-RADS US score, more than half masses (52.8%) were diagnosed as O-RADS 3, which is low-risk malignant, and 47.2% were diagnosed as O-RADS 4, being intermediate-risk malignant. Regarding US O-RADS categorization in relation to the reference results by pathology, 57 lesions were categorized as O-RADS 3 by the US, and 18 of them was diagnosed as malignant according to pathology. Out of 51 lesions categorized as O-RADS 4 by the US, 30 were diagnosed as benign by pathology. At cutoff 4, the O-RADS US score for malignancy gave a sensitivity of 93.13% (95% CI 25.13–80.78), specificity of 66.72% (95% CI 34.49–76.81), PPV of 93.18% (95% CI 26.07–58.16), and NPV of 75.42% (95% CI 52.13–81.17) with an overall accuracy of 92.56% (95% CI 38.10–72.06). Conclusions: In order to distinguish between benign and malignant neoplastic lesions, the US O-RADS classification system is a crucial non-invasive diagnostic tool for suspected ovarian tumors. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-associated cardiomyopathy is a well-known cardiotoxicity of contemporary cancer treatment. As cancer outcomes improve, cardiovascular disease has become a leading cause of morbidity and mortality among cancer survivors. The objective of this study was to evaluate the role of CMR in the detection of early cardiotoxic changes and in the identification of patients at risk of developing CTRCD. Patients and methods: Fifty patients diagnosed breast cancer examined by echocardiography and cardiac MRI before the start of chemotherapeutic regimen followed by 2 and 4 months post-chemotherapy. Results: By echocardiography, all measures were within normal range at the start and at the first follow-up. Twenty (40%) patients show decreased LVEF at second follow-up reaching up to 50% with milder affection of the other parameters. CMR examination shows decreased LVF at second and third follow-up (p = 0.005). There was significant elevation of T2 value for 10 patients at first follow-up (p value 0.04) and for 22 patients at second follow-up (p value 0.01) in correlation with baseline. The T1 mapping and ECV showed elevation at first and second follow-up as compared to baseline (p = < 0.05). Conclusion: T1 and T2 mapping is superior to echocardiography in early detection of the cardiotoxic effects of chemotherapy applied for breast cancer patients and can guide the management and patient lifestyle. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic retinopathy (DR) is still a leading cause of blindness. The role of miRNAs in diabetic retinopathy still needs more research. We aimed at validating the role of circulating miRNAs: 21,181C and 1179 in early detection, dynamic monitoring, and management of DR. Methods: Whole blood samples were collected from 180 diabetic patients and 60 normal individuals as control. The diabetic patients were subdivided into 60 subjects without retinopathy, 60 with non-proliferative diabetic retinopathy (NPDR), and 60 with proliferative diabetic retinopathy (PDR). Gene expression of miR-21, miR-181c, and miR-1179 were estimated in each sample using two-step reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Results: MicroRNA 181c and miRNA 1179 were significantly higher among PDR group compared to NPDR,W DM and control groups, while no significant difference was detected regarding miRNA 21. The areas under the receiver operating characteristic (ROC) curves of the validated two-serum miRNAs were 0.983 and 0.927 respectively. Combination of miRNA 1179 and miRNA 21 improved the accuracy rate to 90%. Combination of miR-181c and miR-1179 possessed high ability to discriminate between PDR and NPDR with an accuracy rate of 100%. Conclusion: MicroRNAs play a role in pathogenesis of diabetic retinopathy. In our study, miR-181c and miR-1179 were significantly high in PDR patients compared to NPDR and controls hence can be used to anticipate and follow up the progression. MicroRNA antagonists or mimics can be tried as new medications to modify DR by reducing the rate of progression, and subsequent blindness. [ABSTRACT FROM AUTHOR]

Background and aims: Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. Methods: A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). Results: The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. Conclusion: The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients. [ABSTRACT FROM AUTHOR]

Background: Given the burden and poor outcome of end-stage renal disease in sickle cell disease (SCD), early markers of sickle cell nephropathy (SN) are desirable. Disordered angiogenesis underlies many complications of SCD. We aimed to determine the relationship between serum FMS-like tyrosine kinase-1 (sFLT-1) and other biomarkers of renal damage for the early diagnosis of SN. Methods: Forty-seven SCD patients and 49 healthy controls were enrolled. Microalbuminuria was determined in patient urine samples. Blood samples were tested for sFLT-1, serum creatinine, and various hemolysis and inflammation markers. Peripheral blood monocyte expression of sFLT-1 was measured using real-time polymerase chain reaction (PCR). Results: The serum level of sFLT-1 (pg/ml) in SCD patients was higher than controls (median/range/IQR = 142/ 60-1300/61 pg/ml vs. 125/ 110-187/52 pg/ml, respectively) ( p = 0.006). Median (range) of sFLT-1 level was higher in SCD patients with microalbuminuria compared to SCD patients with normoalbuminuria, 185 (140-1300) vs. 125 (60-189) mg/g, respectively) ( p = 0.004). There was a significant positive correlation between serum sFLT-1 and microalbuminuria, lactate dehydrogenase (LDH), and indirect bilirubin ( r = 0.59, 0.39, 0.30, and p = <0.001, 0.007, 0.041, respectively). sFLT-1 sensitivity in early detection of renal affection in SCD was 93.6 %, while specificity was 68.6 %. Finally, peripheral blood monocytes (PBM) sFLT-1 expression was significantly higher in SCD patients compared to controls ( p = 0.05). Conclusions: sFLT-1 may contribute to pathogenesis of albuminuria in SCD patients and constitute a novel renal biomarker of SN. [ABSTRACT FROM AUTHOR]

Background: Localized scleroderma (morphea) is characterized by hardening and thickening of the dermis due to excessive collagen deposition. A decreased number of CD34+ cells and an increased number of Factor XIIIa+ cells are seen in the affected skin. The flashlamp pulsed dye laser (FLPDL) has been used in the treatment of localized morphea with promising results. Objective: The purpose of this study was to evaluate the therapeutic effectiveness of the pulsed dye laser in localized scleroderma and to assess its effect on CD34+ cells, Factor XIIIa+ cells, and blood vessels. Study Design: Thirty patients with plaque morphea were treated with a FLPDL (585 nm wavelength, 450 μs pulse duration). Fluence ranged from 7.5 to 8.5 J/cm. Sessions were performed biweekly for a maximum of 6 months. Clinical, histopathologic, and immunohistochemical assessments were performed. Results: Patients showed varying degrees of improvement of indurated skin. There was no worsening or further improvement at the treated sites during the follow-up assessments at 3, 6, and 12 months. An increased number of CD34+ cells were found in both the upper and the lower dermis, and a decreased number of Factor XIIIa+ cells were found in the lower dermis. Conclusion: The FLPDL is effective in the treatment of morphea, as confirmed by the changes in the pathologic tissue and levels of CD34+ and Factor XIIIa+ cells. [ABSTRACT FROM AUTHOR]