Role of positron emission tomography/computed tomography [PET/CT] in detection of bone metastases

Background and Aim of the Work: Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques which fuse morphological and functional data are the most sensitive and specific, and positron emission tomography [PET]/computed tomography imaging will almost become increasingly important in this regard We tried to assess the efficacy of fluorine-18 fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography [PET/CT] [[18] F-FDG-PET/CT] scan in detecting bone metastases among various primary malignancies. In order to detect accuracy of fused PET/CT in the initial detection and characterization of osseous metastases compared to isolated PET and CT with contrast

Patients and methods: The study included thirty patients [with a mean age = 27] with various primary malignancies [pathologically proven] to whom PET/CT was done. In this study population, a detailed retrograde lesion based analysis was performed for a total of 80 detected bone lesions on PET, CT and fused PET/CT images. Sensitivity, specificity, PPV and NPV of each modality were calculated. Stastical analysis of the lesions were performed to study the relationship between the lesion's SUV and its corresponding morphologic pattern on CT and to set a reliable SUVmax cut-off value that can predict the presence of malignant lesion

Results: The calculated fused PET/CT sensitivities and specificities in various malignancies ranged from 95.2% to 99.6% and 75% to 100%, respectively

The combined PET/CT has significantly improved the low CT sensitivity [especially in lymphoma] as well as both separate CT and PET specificities [using SUVmax of 3 as a cut off value for malignant osseous lesions]

Conclusion: Detection of early bone marrow infiltration not apparent on CT, resolution of metabolic activity before definite signs of complete healing on CT, detection of missed sclerotic metastases on PET due to their relatively low metabolic activity, detection of intra and extra osseous recurrence and differentiation of benign from malignant bone lesions

Prevalence of cytoinegalovirus [CMV] infection among neonatal intensive care unit [NICU] and healthcare workers

CMV is the most common cause of congenital and perinatal infection, most infections are asymptomatic at birth but later on develop handicaps, mainly neurological disturbances. The aim of the present work is to study the prevalence of CMV infection in NICU, to detect possible nosocomial transmission of CMV infection and determine possible risk factors for neonatal CMV infection. This study was carried on 175 neonates in NICU and 19 employees in the same unit. All members of the study were investigated for serum CMV-IgG and IgM by ELISA and CMV - DMA by PCR. The overall prevalence of CMV was 12.57%, 10 [5.71%] had congenital infection, while 12 cases [6.86%] had perinatal infection. In neonates with congenital CMV infection, the prevalence of breast milk feeding, congenital anomalies and blood transfusion were 80%, 30% and 60%, respectively. In neonates with perinatal CMV infection the prevalence of breast milk feeding, congenital anomalies and blood transfusion were 75%, 16.67% and 50%, respectively. On the other hand from the 19 employees, 2 [10.53%] were CMV-DNA positive by PCR, none of them was CMV-IgM positive and all of them were CMV-IgG positive. The risk factors related to CMV infection among neonates in NICU were, low birth weight, congenital anomalies and breast milk feeding, while CMV infection among employee was related to blood transfusion and employment period. In our results there was no statistical correlation between neonates in NICU and employee in the same unit. CMV infections are of more prevalence in premature and low birth weight neonates in NICU. No evidence of nosocomial CMV transmission to employee in NICU

Some epidemmiological aspects of patients with end stage renal diseases

This study was carried out to describe the end stage renal disease [ESRD] among Egyptian patients and to identify the possible risk factors of their disease. A case-control study was conducted with two control groups [patient or hospital control group and normal community control group] compared with ESRD cases on hemodialysis. The study revealed that hypertension followed by obstructive uropathy are the leading causes of ESRD. Conducting the multiple logistic regression analysis, the following factors were found to act independently as risk factors for ESRD in the following order of importance: Past history of hypertension, family history of renal failure, past history of renal pain, smoking, urban origin of birth, past history of renal or urinary stones, past history of schistosomiasis, the presence of a near-by residential factory and past history of frequent hospitalization. A quality of life score has been invented

Childhood diabetes in alexandria: mode of presentation and progress

This study was designed to characterize clinical and autoimmune features in all children with newly diagnosed IDDM diagnosed between 1994 and 1998 as well as to follow up their clinical progress. The study was performed on all newly diagnosed children with IDDM presented to the Alexandria University Children's Hospital between 1994 and 1998 [60 children]. After the primary diagnosis and management, the patients were followed up every 2-3 months in the IDDM clinic. The details of any medical problem during the period of study were recorded during the visits. A questionnaire was completed for each newly diagnosed child. This questionnaire was divided into 4 sections and focused on demographic and family characteristics, family history of diabetes, previous medical history of the child and manifestations before diagnosis. Details of clinical and laboratory data at diagnosis were recorded. The clinical features evaluated were the duration of symptoms before admission to the hospital. All blood samples were obtained before initiation of insulin therapy to measure blood glucose, hemoglobin A[1c], venous blood gases, serum electrolytes and ketones. During each clinic visit, the children were examined with emphasis on nutritional and growth data and their anthropometric measurements recorded. The height standard deviation score, body mass indices and growth velocity per year were calculated and recorded. Hemoglobin A[1c] was estimated every clinic visit. Hormonal evaluation for all children included measurement of free thyroxine [FT4], and IGF-1. The results included family history of autoimmune diseases, symptoms occurring within 3 months prior to diagnosis. Polyuria was the most common presenting symptom present in 87%, followed by fatigue/lethargy/malaise [53%], febrile illness [23%], nausea and vomiting [20%], and abdominal pain [15%]. Secondary nocturnal enuresis occurred in [23%]. Mumps was reported in 2 children while chicken pox was reported in 1 child 3-5 weeks before diabetes was diagnosed. The plasma glucose level was 22.3 +/- 5.6 mmol/L, it was related neither to age nor to duration of symptoms. The HbA[1c] concentration was 15.5 +/- 2.9%. Levels of HbA[1c] were correlated with serum glucose concentration. The frequency of DKA, its degree at presentation and associated biochemical changes is presented. As regards the progress of the disease, insulin was withdrawn in two of the 60 children in whom remission lasted 6 and 14 weeks respectively. The risk of readmission was 0.2 per patient during the first year and 0.12 during the second year. Re-admission for poor glycemic control was more common in young children. Children with good glycemic control had better linear growth compared to those with bad glycemic control. With follow up, 3 children developed hypothyroidism, 1 developed vitiligo, 1 developed chronic active hepatitis, 2 developed significant proteinuria. One child died of hepatorenal failure at the age of 5 years. In conclusion, children diagnosed as having diabetes below 5 years seem to present acutely and have highest risk of developing hypoglycemia during the first year after diagnosis