Detection of Neuroendocrine Tumour of Sphenoid Sinus on the Gallium-68 DOTATATE PET/CT: A Rare Entity

@#Neuroendocrine tumours (NETs) are a category of neoplasm that is characterised by its phenotypic and heterogeneity. The occurrence of this type of neoplasm in the nasal cavity and paranasal sinuses is extremely rare accounting for only 0.2-0.8% of all cancers. NET tends to expresses somatostatin receptors (SSTR) and owning to this unique characteristic, molecular imaging has been able to detect these tumours using radiolabelled somatostatin analogue agent. Gallium-68 (Ga-68) DOTATATE PET/CT is an example of SSTR imaging and has been shown to be of importance in the assessment and staging of NET. We present a case of a rare sphenoid sinus NET in a 45-year-old gentleman whom initially presented with persistent left eye pain which led to visual loss. We described the utilization of Ga-68 DOTATATE PET/CT in the diagnosis and staging of this patient which in turn dictated treatment approach.

The objective assessment of the effects on cognition functioning among military personnel exposed to hypobaric-hypoxia: A pilot fMRI study

@#Objective: To identify regions of the brain affected during cognitive working memory during tasks to assess attention, planning and decision making among military aviation personnel who have chronic intermittent exposure to high altitude environment. Method: A case-control study was conducted in the Universiti Putra Malaysia among eight military personnel, four of whom had chronic intermittent exposure to high altitude training. They were divided into two groups, chronic intermittent exposure group (CE) (n=4) and a control group (n=4). They underwent a task-based functional magnetic resonance imaging (fMRI) that utilised spatial working memory task to objectively evaluate the neural activation in response to the Tower of London paradigm. Each correct answer was given a score of one and the maximum achievable score was 100%. Results: A consecutive dichotomised group of CE (4/8) and control (4/8) of age-matched military aviation personnel with a mean age of 37.23±5.52 years; showed significant activation in the right middle frontal gyrus (MFG). This in turn was positively correlated with response accuracy. A significant difference in the response accuracy was noted among both the groups at p<0.05. Conclusion: At the minimum results of power analysis of this preliminary fMRI study, our group of aviation personnel who had chronic intermittent exposure to hypobaric hypoxic environment, did not have any significant decrease in cognitive function namely attention, decision-making and problem solving compared to controls during a working memory task

Mapping 18F-Fluorodeoxyglucose Metabolism Using PET/CT for the Assessment of Treatment Response in Non-Small Cell Lung Cancer Patients Undergoing Epidermal Growth Factor Receptor Inhibitor Treatment: A Single-Centre Experience

Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of nonsmall cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR) inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response (CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic treatment response of NSCLC towards EGFR inhibitor treatment.

relationship between abdominal aortic calcification and cardiac abnormalities in hemodialysis patients

Background: abdominal aortic calcification [AAC] is a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality

Aim of the work: this study was conducted to investigate the association of abdominal aortic calcification with cardiac abnormalitiesin hemodialysispatient [HD]

Methods: this cross-sectionalobservational study wasperformed on 90 patients [50 males and 40 females]with chronic kidney disease, stage 5 [CKD]of varying etiologies from hemodialysis unit at Al-Hussein UniversityHospital. They wereundergoing regularhemodialysis for more than 6 monthes.Laboratory investigations were done including liver function tests, kidney function tests,complete blood count [CBC],C-reactive protein [CRP], fasting and random blood glucose,lipid profile, calcium, phosphorus,calcium phosphate productandparathormone[PTH].In addition, Echocardiography and X-ray plain radiography were determined

Results: out of 90 HD patients, 37 patients [41.1 %] had valvular calcification, all of them [41.1 %] had aortic valve calcifications and AAC score exceeded 6. Only 7 patients [7.8%] had mitral valve calcifications. Moreover, cases with mitral valve calcifications had aortic valve calcification and AAC score above 12. Seven patients [7.8 %] had mildaortic regurgitation [AR] and 4 patients [4.44%] had aortic stenosis

Conclusion: AAC precedes the occurrence of cardiac abnormalities in HD patients and has been shown to have significant prognostic significance for cardiovascular events and mortality

Vulnerable plaque detection: the role of 18-fluorine fluorodeoxyglucose in identifying high risk patients

Positron emission tomography computed tomography [PET-CT] is a combined functional and structural multi modality imaging tool that can be utilized to detect vulnerable and atherosclerotic plaques. In this study we observe the prevalence of active and calcified plaques in selected arteries during whole-body [18]F-FDG PET-CT and correlate the findings with risk factors in developing coronary artery disease. There was a significant relationship between patients with high body mass index and vulnerable plaques. We concluded that [18]F-FDG PET-CT can be utilized in detecting focal high FDG uptake within vascular plaque in early recognition of high risk patients having vascular accidents

Household survey of container-breeding mosquitoes and climatic factors influencing the prevalence of Aedes aegypti (Diptera: Culicidae) in Makkah City, Saudi Arabia

<p><b>OBJECTIVE</b>To investigate the prevalence of container breeding mosquitoes with emphasis on the seasonality and larval habitats of Aedes aegypti (Ae. aegypti) in Makkah City, adjoining an environmental monitoring and dengue incidence.</p><p><b>METHODS</b>Monthly visits were performed between April 2008 and March 2009 to randomly selected houses. During each visit, mosquito larvae were collected from indoors and outdoors containers by either dipping or pipetting. Mosquitoes were morphologically identified. Data on temperature, relative humidity, rain/precipitations during the survey period was retrieved from governmental sources and analyzed.</p><p><b>RESULTS</b>The city was warmer in dry season (DS) than wet season (WS). No rain occurred at all during DS and even precipitations did fall, wetting events were much greater during WS. Larval survey revealed the co-breeding of Aedes, Culex and Anopheles in a variety of artificial containers in and around homes. 32 109 larvae representing 1st , 2nd, 3rd, and 4th stages were collected from 22 618 container habitats. Culicines was far the commonest and Aedes genus was as numerous as the Culex population. Ae. aegypti larval abundance exhibited marked temporal variations, overall, being usually more abundant during WS. Ten types of artificial containers were found with developing larvae. 70% of these habitats were located indoors. 71.42% of indoor containers were permanent and 28.58% was semi-permanent during WS. Cement tanks was the only container type permanent during DS. Ae. aegypti larval indices (CI, HI, BI) recorded were greater during WS.</p><p><b>CONCLUSIONS</b>Taken together, these results indicate a high risk of dengue transmission in the holy city.</p>

study of knowledge, attitude, practice towards epilepsy among relative of epileptic patients in Khartoum state

People with epilepsy are suffering from a lot of un tolded negative impacts on their lives; due to misunderstanding of the disease and from the associated stigma. The objective of this study is to assess the knowledge, attitude, and practice among relatives of Sudanese epileptic patients seen in Sheik Mohamed Kheir Neurological clinic and Elshaab Teaching Hospital. This is a descriptive cross- sectional community based study, 313 respondents were included, the duration of the study was from November 2008 to June 2009. Most of the respondents knew the disease, and had witnessed an attack. One third mentioned a brain lesion as the underlying cause of epilepsy. Most of the respondents mentioned loss of consciousness as the major symptom. More than two thirds mentioned that it is not contagious. Most of the respondents claimed that it can be controlled, and two thirds preferred medical treatment. The study revealed that half of the respondents had shown favourable attitudes and practice. The study revealed that the level of knowledge, attitude, and practice towards epilepsy needs community educational programmes to fill the gaps, and minimize the stigma

role of angiogenesis assessment in the prognosis of breast carcinoma and in the evaluation of the therapeutic effect of "shark care" drug as an angiogenesis inhibitor

There is still uncertainty about angiogenesis as a prognostic factor in breast cancer. To evaluate the prognostic value of microvascular density [MVD] in breast carcinoma and soluble vascular cell adhesion molecule-1 [sVCAM-1], leptin, estradiol and total testosterone as angiogenic markers. Efficacy of shark care drug was assessed by patient's overall survival. 30 premenopausal breast cancer patients [group II] and 15 controls [group I]. Group II was subgrouped into 15 patients receiving chemotherapy alone [IIA] and 15 patients receiving chemotherapy + shark care drug [IIB]. After modified radical mastectomy, microvessels were counted by staining tissues for factor VIII. For surrogate markers, enzyme-linked immunosorbant assay or radiommunoassay kits were used. A high MVD was found only in areas of carcinoma. MVD and sVCAM-1 correlated significantly with each other and with lymph node involvement. After the follow-up, all subgroup IIB patients were alive compared to 66.6% of subgroup IIA [p=0.02]. A high MVD may be a poor prognostic marker of breast carcinoma and a target for antiangiogenic therapy sVCAM-1 is useful for diagnosis and for monitoring response to therapy. Chemotherapy + shark care drug seem to ameliorate the outcome of these patients

Selective criteria of diagnostic modalities in acute stroke

Diffusion weighted MRI [DWI] scans are very sensitive and specific for the detection of hyperacute and acute infarctions, having a sensitivity of 88%-100% and a specificity of 86%-100%. However, they have certain limitations such as in severely ill patients, artifacts or sometimes unavailability in an emergency. In the current era of thrombolytic therapy, rapid identification of the presence and extent of ischemia is essential. Hence, exploitation of CT perfusion can be helpful in such cases. To identify proper modality in cases of acute stroke in order to set selective criteria for each modality. Showed that both CT perfusion and MRI diffusions are usually complementary to each others as regards identification of the stroke. We can suggest a simple algorithm to choose the proper modality for each patient

Evaluation of the role of her-2/neu and matrix metalloproteinase-9 in breast cancer patients

The search for a simple, sensitive test to reliably determine prognosis and predict response to therapy in patients with cancer is an important area of translational research. The Her-2/neu oncogene and its receptor protein overexpression are indicators of more aggressive form of breast cancer. Her-2/neu overexpression was involved in cell differentiation, proliferation, migration and carcinogenesis. The main target of this study is to investigate the possible correlation between tissue Her-2/neu, serum Her-2/neu extracellular domain [ECD] and MMP-9. The impact of the assayed parameters on the disease free survival [DFS] in breast cancer patients will also investigated after one year of follow up. Serum was collected from 33 breast cancer patients and 10 healthy volunteers. Serum Her-2/neu ECD was detected by enzyme linked Immunosorbent assay [ELISA] and serum MMP-9 was detected by enzyme Immunoassay [EIA]. Patients were reevaluated after one year of follow up to detect disease relapse. Positive correlation between expression of Her-2/neu in the primary tumor tissue and the circulating serum Her-2/neu ECD was detected. Serum Her-2/neu ECD was more sensitive in predicting disease free survival than tissue Her-2/neu. Positive correlation between expression of Her-2/neu in the primary tumor and serum MMP-9 was also observed. In contrast, negative correlation between circulating serum Her-2/neu ECD and serum MMP-9 was detected in patients with tissue positive Her-2/neu. We also observed that MMP-9 was a good monitoring factor for the chemotherapy response. We concluded that serum Her-2/neu ECD might be a good prognostic parameter in addition to tissue Her-2/neu and MMP-9 might be the member of MMPs family that responsible for the shedding of the ECD of Her-2/neu receptor

Levels of 5-hydroxyindoleacetic acid, Gamma-aminobutyric acid and Nitric oxide metabolites in cerebrospinal fluid of Egyptian women suffering of Fibromyalgia

Fibromyalgia [FM] is a complex chronic disorder predominately affects women. The lack of objective analytical image for diagnosis and prognosis of FM attract many investigators to evaluate the neuroendocrine changes in body fluids that may be related to the pathophysiology of FM. To compare the levels of 5-hydroxyindoleacetic acid [5-HIAA, serotonin metabolite], gamma-aminobutyric acid [GABA] and nitric oxide [NO] metabolites in cerebrospinal fluid [CSF] of normoglycemic women suffering of FM with those of control group. In addition, levels of insulin, insulin like growth factor-1 [IGF-1], cortisol, 5-hydroxytryptamine [5-HT, serotonin], GABA, and NO metabolites were determined in serum of FM patients compared to control group. Moreover, the correlations between all the studied parameters were performed. The present study showed altered serum levels of insulin and cortisol in normoglycemic women suffering of FM [n=15] compared to those of control group [n=15]. However, the data did not find significant differences between serum levels of IGF-1 in women suffering of FM and those in healthy women. Cortisol levels in FM sera were inversely correlated with the number of tender points [r=-0.76, p<0.001]. Also, negative correlation was observed between serum IGF-1 levels and age of FM patients [r=-0.63, p< 0.05]. Low levels of serum 5-HT and CSF 5-HIAA were also noticed among women suffering of FM. A decrement of both serum and CSF levels of GABA in those patients compared to controls was detected. Furthermore, there was a positive correlation between serum GABA levels and serum cortisol levels [r=0.61, p< 0.05], and between CSF GABA and 5-HT [r=0.56, p< 0.05]. However, CSF GABA levels were negatively correlated with age of women suffering of FM. These findings may clarify the significant role of GABA in the pathogenesis of FM. A higher serum and CSF levels of NO metabolites were detected in FM patients than in control group. In addition, serum levels of NO metabolites were correlated with those levels in CSF [r=0.63, p< 0.05]. The involvement of NO in pain process was revealed by a strong correlation between serum and CSF levels of NO metabolites with the number of tender points [r=0.91, p< 0.001; r=0.73, p< 0.01 respectively]. Also, by a negative correlation between serum levels of NO metabolites and serum cortisol levels [r=0.70, p< 0.01] in FM patients. The changes in the levels of studied hormones and neurotransmitters in women suffering of FM support the hypothesis of neuroendocrine involvement in FM pathogenesis. The current study suggested that GABA and NO may play a role in modulating FM. Alterations of their levels in serum and CSF of women suffering of FM and their correlations with age, number of tender points and/ or cortisol may confirm this suggestion. Accordingly, this investigation recommended the examination of GABAergic agents, NO synthase [NOS] inhibitors, or antioxidants for therapy of various symptoms in women suffering of FM. Furthermore, our study may find utility of these neurotransmitters as possible markers of FM, but this study warrant more investigations to confirm these findings

role of fibronectin and TNF-alpha in early detection of diabetic nephropathy

Diabetes mellitus is a major health problem in large areas of the world. Diabetic nephropathy has become the major cause of end-stage renal disease [ESRD] [Kikkawa R. et al., 2003]. In this work, we study the role of measuring of TNF- alpha and fibronectin for possible early detection of diabetic nephropathy. This study was carried out on 45 individuals. It included 15 apparently normal healthy individuals [group I], 15 patients with NIDDM less than 5 years duration [group II], 1.5 patients with NIDDM more than 10 years duration [group III]. All individuals were thoroughly examined clinically including careful general, heart, chest and abdominal examination as well as neurological examination, fundus examination. ECG and US examination was done for all patients. All individuals were investigated with complete urine analysis, urine culture, fasting and 2 hrs postprandial blood glucose, kidney function tests, glycated hemoglobin [HbA1c], microalbumin [Albumin / creatinine ratio [ACR]]. Plasma fibronectin and TNF- alpha were done for all patients, fibronectin and TNF-alpha were markedly elevated in group III. We concluded that measurement of plasma fibronectin and TNF-alpha level may be used as marker for follow-up reflecting vascular endothelial changes in the course of diabetic nephropathy