Role of surveillance CT in detection of pre-clinical relapse in patients with B-cell iymphoma: a retrospective study

Background: with the evolution of curative treatment regimen, the rate of complete remission achieved in patients with diffuse aggressive non-Hodgkin lymphoma is continuously rising. It is achievable at the end of primary treatment in about 60-80%. On the other hand relapse is very common in the 1[st] two years after end of primary treatment in diffuse large B-cell lymphoma [DLBCL] and follicular lymphoma, that is to say, about 20-25% of patients relapse after complete response. Use of routine surveillance imaging for relapse detection is still an area of controversy. Evidence is still lacking to support the utility of routine imaging [namely CT scan] in detection of pre-clinical relapse in diffuse aggressive non-Hodgkin lymphoma [NHL]. This work aims at adding further evidence to the pool of studies available in the literature which might encourage, or disapprove the rule of CT as a routine imaging procedures in lymphoma patients who achieved CR

Objectives: I. to clarify whether surveillance CT scan has a significant role in early detection of asymptomatic relapse in B-Cell lymphoma patients. II. To assess the contribution of image-based relapse detection to the overall survival of B-Cell lymphoma patients

Design: this is a retrospective cohort study in which 50 Patients with B-Cell lymphoma diagnosed between 2014 and 2016 were selected from the PACS of Radiology Department at Ain Shams University Hospitals. Age ranges between 20 and 70 year-old. All diagnoses were confirmed by histopathology studies. All patients underwent treatment and follow-up strategy as planned by their treating oncologist/hematologist, after which they entered CR or SD according to IWG Cheson criteria of treatment response. Disease progression was retrospectively reviewed over a period of 6 months up to 2 years. Surveillance CT scan was performed on the neck, chest, abdomen and pelvis on each of the planned follow-up visits. Relapses were defined as "asymptomatic" if there were no reported symptoms and a normal examination was recorded

Results: the most common cause of relapse detection was patient-reported symptoms alone [41%] or in combination with abnormal blood tests and/or physical examination [23%]. Routine imaging was responsible for relapse detection in 27% of the patients. The unadjusted median OS for patients with imaging-detected relapse was 90 months versus 38 months for patients non imaging-detected relapse [P = 0.0008]. Although surveillance imaging proved no significance in detection of pre-clinical relapse, our regression analysis showed that it remained significantly associated with reduced risk of death

Conclusion: clinical symptoms remain the leading factor in diagnosing recurrent lymphoma in the era of modern imaging, and this study questions the clinical relevance of current practice. A possible survival advantage was seen for patients with image-detected relapse

Antikeratin antibodies [AKAS]: Usefulness in differentiation between rheumatoid arthritis and hepatitis C virus associated arthritis

Among the different clinical disorders associated with hepatitis C virus [HCV] infection, articular involvement is a frequent complication. Symmetric polyarthritis associated with HCV infection frequently displays a rheumatoid arthritis [RA] like clinical picture. Thus, differentiating patients with HCV related symmetric polyarthritis from patients with RA represents both a diagnostic and a therapeutic challenge. Our aim was to investigate whether antikeratin antibodies [AKAs] could be useful markers in differentiating patients with rheumatoid arthritis [RA]; from patients with hepatitis C virus [HCV,] associated polyarthritis who are seropositive for rheumatoid factor [RF]. Serum AKAs were determined in two groups of patients; all were RF seropositive. Group [I]: 25 patients with HCV associated symmetric polyarthralgia or arthritis: Group [II]: 25 patients with RA [ACR revised criteria for diagnosis of RA, 1988]. Fifteen healthy individuals, age and sex matched, served as controls. AKAs were tested using an indirect immunofluorescence technique with 1:10 serum dilution. The study revealed that AKAs were detected in 15/25 [60%] patients with true RA and in only 3/25 [12%] patients with HCV associated arthritis [p<0.0001]. AKAs were not found in the sera of the healthy controls. AKAs can be useful markers in differentiating patients with true RA from those with HCV arthritis

Misoprostol for prevention of postpartum haemorrhage: a prospective clinical trial

To evaluate the efficacy of 600 mcg misoprostol, given orally in management of the third stage of labor to minimize blood loss in the early postpartum hours. Prospective controlled trial. Kasr El-Aini Hospital. Women who were in labor between 36 to 42 weeks were divided into two groups, each including one hundred women Group A: Received no postpartum medications. Group B: Received misoprostol 600 micrograms [3tb.] orally postpartum. There were statistically significant differences in the mean duration of the third stage of labor, blood pressure and pulse between the control and misoprostol groups. A lager number of patients in the control group had bleeding from 500-1000 ml however, there was no significant difference in lab results between both groups within the first 6 hours postpartum. Oral misoprostol is effective in prevention of postpartum haemorrhage. The exact dose should be further investigated

Maternal mortality in Kasr EL Aini Hospital: Eleven years experience

To estimate the maternal mortality rate in Kasr AL Aini hospital, Cairo University, Egypt over eleven years duration to suggest different strategies to maternal mortality. Materials and Retrospective analysis of the mortality the period between 1992 to 2003. WE divide the duration of study into three periods as prophylactic were started in the second period and continued during the third period. The number of maternal deaths in the 1st period [1992-1995] was 61 with maternal mortality ratio [MMR] of 207 per 100,000 live births, while in the 2nd period [1997-2000] the number of maternal deaths was 43 with MMR of 118. Finally in the 3rd period [2001-2003] the number of maternal deaths was 37 with MMR of 97.1. Comparison between maternal mortality in 1st period and 3rd period was statistically significant. Relative risk was 2.39 [95% CI 1.56-3.71] [p = 0.000015]. The main causes of maternal mortality were postpartum hemorrhage, complications of sever hypertensive disorders, anesthetic complications and rheumatic heart diseases. Maternal deaths occurred in most of cases in late pregnancy and labor mostly due to postpartum hemorrhage and sever hypertensive disorders during pregnancy. Maternal mortality involves complex mixture clinical, infrastructural and social causes and requires a multifaceted approach, however it can effectively avoided and prevented through improving antenatal care, emergency obstetric services and reform of internship training program.

Leptin, insulin sensitivity and TNF as parameters for metabolic changes in chronic heart failure with and without cardiac cachexia

Background: The development of cachexia is a particular predictor of adverse prognosis in chronic heart failure [CHF]. Less is known about anabolic metabolism in CHF. Leptin -the hormone product of obesity gene has been shown to inhibit food intake, increase energy expenditure and fat oxidation. Insulin sensitivity and secretion is related to leptin. Leptin has been reported also to stimulate proliferation of CD4 T cells and increases cytokine production. The study aimed to investigate leptin. Insulin sensitivity and tumor necrosis factor-alpha [TNF-alpha] in chronic heart failure with and without cachexia

Methods: We studied 31 male patients with CHF, mean age [59.87 +/- 6.91 years], mean New York Heart Association Functional Class [2.52 +/- 0.81], mean left ventricular ejection fraction [LVEF] [0.33+0.08] and 13 male healthy control subjects, mean age [59.87 +/- 6.91]. Of the CHF patients, 14 were cachectic [cCHF] with non-oedematous weight loss >7.5% over at least6 months and 17 non-cachectic. Serum insulin was measured by enzyme immunoassay, insulin sensitivity was assessed by intravenous glucose tolerance. Serum leptin and TNF were meas ured using commercially available ELISA kit

Results: Compared with the healthy control subjects, patients had elevated levels of leptin, fasting insulin and TNF-alpha [P<0.001], with reduced insulin sensitivity [P<0.001]. Both ncCHF and cCHF subgroups had higher leptin and TNF levels than the control group [P<0.001]. The cCHF subgroup-compared with ncCHF subgroup-showed reduced leptin and fasting insulin levels [P<0.001 and P<0.01] respectively and elevated TNF-alpha levels [P<0.001]. In both patients and control subjects there was a positive correlation between leptin and fasting insulin levels [r=0.59, P<0.001 and r=0.54, P<0.05] respectively. The relative risk of incidence of cCHF in NYHA Functional class [I and II] versus NYHA Functional class [III and IV] was 0.427 [P<0.05]

Conclusion: CHF is hyperleptinaemic state and is associated with decreased insulin sensitivity and elevated fasting plasma insulin levels. The state of cardiac cachexia is associated with higher TNF-alpha levels and more worse NYHA Functional Class. Leptin and TNF-alpha may be valid targets for novel therapeutic interventions in patients with CHF