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OBJECTIVE Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. METHODS The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. RESULTS SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9–1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0–1.02, adjusted p = 0.02). CONCLUSIONS In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.

AIM To study the incidence, extent and fate of uterine ischaemia as one of the forms of non-target embolisation following uterine artery embolisation (UAE), as detected on immediate post-embolisation and contrast-enhanced magnetic resonance imaging (MRI) examinations at the 3-month follow-up. MATERIALS AND METHODS A retrospective study was undertaken comprising 43 women (mean age: 44.8 ± 3.79 years). MRI was performed before, immediately after (within 6 h), and 3 months after successful UAE. Areas of uterine ischaemia were identified on immediate post-embolisation MRI as regions of newly developed (compared to pre-embolisation MRI) absent enhancement within the uterus not corresponding to the location of the leiomyoma. The volume of the ischaemic region was calculated using the formula (height × length × width × 0.523). RESULTS Uterine ischaemia was encountered in 29 patients (67.44%). The mean volume of the ischaemic region immediately after UAE was 29.29 ± 19.15 ml (range: 7.36–87.71 ml). At 3-month follow-up, it was 0.35 ± 0.95 ml (range: 0–3.5 ml) with 25 (86%) patients showing complete resolution of the ischaemia. The mean reduction in the volume of the ischaemic region at the 3-month follow-up was 98.24 ± 5.72% (range: 72–100%). This volume reduction was statistically significant (p CONCLUSION Uterine ischaemia as a form of non-target embolisation following UAE might be encountered in up to two thirds of patients. These ischaemic areas are significantly reduced at the 3-month follow-up with up to 86% of cases showing complete reversibility of the ischaemia.

Aims/Introduction To study the epidemiology, genetic landscape and causes of childhood diabetes mellitus in the State of Qatar. Materials and methods All patients (aged 0–18 years) with diabetes mellitus underwent biochemical, immunological and genetic testing. American Diabetes Association guidelines were used to classify types of diabetes mellitus. The incidence and prevalence of all the different types of diabetes mellitus were calculated. Results Total number of children with diabetes mellitus was 1,325 (type 1 n = 1,096, ≥1 antibody; type 2 n = 104, type 1B n = 53; maturity onset diabetes of the young n = 20; monogenic autoimmune n = 4; neonatal diabetes mellitus n = 10;, syndromic diabetes mellitus n = 23; and double diabetes mellitus n = 15). The incidence and prevalence of type 1 diabetes were 38.05 and 249.73 per 100,000, respectively, and for type 2 were 2.51 and 23.7 per 100,000, respectively. The incidence of neonatal diabetes mellitus was 34.4 per 1,000,000 live births, and in indigenous Qataris the incidence was 43.6 per 1,000,000 live births. The prevalence of type 1 diabetes and type 2 diabetes in Qatari children was double compared with other nationalities. The prevalence of maturity onset diabetes of the young in Qatar was 4.56 per 100,000. Conclusions This is the first prospective and comprehensive study to document the epidemiology and genetic landscape of childhood diabetes mellitus in this region. Qatar has the fourth highest incidence of type 1 diabetes mellitus, with the incidence and prevalence being higher in Qatari compared with non‐Qatari. The prevalence of type 2 diabetes mellitus is also higher in Qatar than in Western countries. The incidence of neonatal diabetes mellitus is the second highest in the world. GCK is the most common form of maturity onset diabetes of the young, and a large number of patients have type 1B diabetes mellitus., This is the first comprehensive, prospective study from the Middle East North Africa region to systematically study the causes of diabetes in every child in the State of Qatar. The State of Qatar has the fourth highest incidence of type 1 diabetes in the world. The incidence of type 2 diabetes is much higher in Qatar than in Western countries. Both type 1 and type 2 diabetes are more common in the Qatari population than the non‐Qatari population. Mutations in GCK were the most common cause of maturity onset diabetes of the young, and mutations in the PTF1A and INS genes were the most common cause of neonatal diabetes in this population.

Objectives Children with antibody positive type 1 diabetes mellitus (type 1 diabetes) are at an increased risk of developing celiac disease (CD) which suggests a common autoimmune basis with both high-risk human lymphocyte antigen (HLA) and non-HLA factors playing a role in the pathophysiology. We aim to describe the prevalence, immune profile, and clinical characteristics of children with CD who have type 1 diabetes mellitus in Qatar. Methods All children (aged 0–18 years) attending a regional diabetes clinic with antibody positive type 1 diabetes were screened for CD. Measurement of tissue transglutaminase IgA and IgG as well as anti-endomysial antibody, was done, clinical details about the birth history, family history of diabetes and CD, age of onset, and ethnicity were collected. Results Out of the 1,325 children with antibody positive type 1 diabetes, 54 were identified to have CD on screening and then confirmed on small bowel biopsy. The prevalence of CD in the type 1 diabetes childhood population in Qatar is 4.07%. CD and type 1 diabetes were more prevalent in the Qatari children (n=32) as compared to non-Qatari (n=22) and occurred mostly in the age group 6–10 years. The most common type 1 diabetes antibodies in children with CD were glutamic acid decarboxylase and insulin autoantibody. Twelve subjects were asymptomatic for CD symptoms and picked up only on screening. Conclusions The prevalence of CD in children with type 1 diabetes in Qatar is comparable to reports from around the world. Many children were asymptomatic and thus routine screening is recommended.

Aim of the work: To investigate the potential association of protein programmed death 1 (PD-1) serum level and its gene expression inrecent onset systemic lupus erythematosus (SLE) patients and study its association with the disease activity. Patients and methods: The study included 80 recently diagnosed SLE patients and 80 healthy controls. SLE disease activity index (SLEDAI) was assessed. The serum level of soluble (sPD-1) was assessed by enzyme linked immunosorbent assay (ELISA) and its gene expression level was evaluated by real time-polymerase chain reaction (RT-PCR). Results: They were 68 females and 12 males (F: M 5.7:1) with age 30.8 ± 8.7 years and disease duration of 3.2 ± 1.7 months. The sPD-1 and PD-1 gene expression level (folds) were significantly elevated in patients (1280.6 ± 1448.1 pg/ml and 0.3 ± 0.06 folds) than controls (109.1 ± 11.9 pg/ml and 0.03 ± 0.008 folds) (p

Background A growing body of evidence suggested that uric acid (UA) may contribute in the pathways underlying osteoarthritis (OA) pathogenesis; however, studies that investigated the relationship between UA and OA emerged inconclusive results. The purpose of the study was to explore the association of serum uric acid (sUA) levels with clinical severity, radiological severity of knee osteoarthritis (KOA) based on Kellgren-Lawrence (KL) grading system, and MRI changes in non-gouty patients. Results WOMAC scores: pain, stiffness, function, and total score are significantly higher in H-sUA group than L-sUA group (p = 0.004, p = 0.019, p = 0.018, p = 0.008 respectively). Joint space width (JSW) is significantly narrower in H-sUA group than L-sUA group (p = 0.013). H-sUA group had more frequent KL grade 4 (p < 0.001), osteophytes grade 4 (p < 0.001), focal bone erosion (p < 0.001), bone marrow lesions (p = 0.023), and synovitis (p = 0.011) than L-sUA group. Female KOA patients in H-sUA group had significantly higher pain, stiffness, and function and total WOMAC scores than L-sUA group (p = 0.003, p = 0.015, p = 0.008, p = 0.004), more frequently had KL grade 4 and osteophytes grade 4 (p = 0.003, p < 0.001), significantly narrower JSW (p = 0.016), more frequently show focal bone erosion (p = 0.002), bone marrow lesions (p = 0.019), and synovitis (p = 0.004) than L-sUA group. In regression analysis, female sex (p = 0.035), duration of KOA (p = 0.031), and sUA level (p = 0.025) were associated with KL severity. For female patients with KOA, KL severity is associated with duration of KOA (p = 0.045) and sUA (p = 0.009). Conclusion Higher sUA level is associated with higher clinical severity, higher radiographic KL grades, and more frequent MRI findings in patients with primary KOA patients. Our results also indicated that sUA level was significantly associated with KOA severity in female patients, but not in male patients. More studies are warranted to explore whether the two conditions exist simultaneously or there is a direct causal relationship between the two conditions.

Background: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that is considered the most common liver disease all over the world. It causes metabolic and hepatic damage that can progress to cirrhosis and hepatocellular carcinoma. Objective: Our research pointed to study the preventive effects of canagliflozin (CANA) or atorvastatin (ATO) on dexamethasone-induced hepatic steatosis and dyslipidemia. Methods: Animals were grouped as; control group; DEX group; ATO/DEX-treated group; CANA/DE-treated group and ATO+CANA/DEX-treated group. Results: Significant elevations in GSH, SOD and CAT activities, while high significant decreases in serum GOT, GPT, ALP, urea, blood glucose, CK-MB, LDH, T.G, T.C, MDA and P.C levels were demonstrated in treated groups as compared to DEX group in the experimental periods. Also, significant reductions in SGPT, SGPT, ALP, CK-MB, LDH, T.C and T.G levels were detected in CANA/DEX group as compared to ATO/DEX group. All these results were confirmed with histopathological findings where the severe damages and fatty degeneration in both kidney and liver tissues developed by dexamethasone administration resolved by administration of atorvastatin alone or better with Canagliflozin. Conclusion: These results indicate that canagliflozin was as effective as atorvastatin or combination of both in reducing dyslipidemia and hepatic steatosis. The antioxidant and hypolipidemic effects of canagliflozin may be responsible for the beneficial effects.

Objective Approximately 30% of lung cancer patients develop central airway obstruction (CAO) that remarkably shortens survival. There is little data about the benefits of stenting within this heterogeneous patient group. Our objective was to review their overall survival (OS) and their risk of hospitalization versus patients who did not have lesions requiring stent placement. Methods We retrospectively reviewed charts of 171 non-small cell lung cancer (NSCLC) patients who underwent bronchoscopy in the University of Cincinnati Cancer Center from the year 2011 to 2013. Twenty-five patients with advanced lung cancer were evaluated by interventional pulmonology service for endobronchial stent placement for CAO. Eight patients did not require placement of a stent and 17 had obstructive lesions that required stenting by interventional pulmonology. Results Demographical parameters such as age and gender did not have a significant impact on the risk of hospitalization or OS of both groups of patients, however, those whose lesions did not mandate stent placement had significantly lower odds of hospitalization compared to patients with CAO requiring a stent (OR: 15.913, 95% CI: 1.211-209.068, P = 0.0352). Patients with advanced NSCLC and CAO that required stent placement had an OS of 13.9 m [3.9-19.9 m] compared to an OS of 23.9 m for patients with CAO not requiring a stent. We found out that patients with less severe CAO have lower odds of hospitalization and better OS compared to patients with CAO mandating stent placement. Conclusion CAO patients with interventional pulmonology (IP) evaluation and management in addition, may have improved OS suggesting that IP consultation might offer both improvement in quality of life and overall survival to patients with advanced NSCLC and CAO. .

Background: Three-dimensional (3D) visualization systems, also known as heads-up systems, are now available for eye surgery and as with every new device there is need for a specific evaluation. Objectives: The aim of this study was to compare the efficiency, surgical comfort, and safety of a 3D visualization system to a standard binocular microscope (BM) in routine ophthalmologic procedures. Method: After a 4-week training period, a 3D visualization system (Ngenuity, Alcon®) available in one of the Robert Debré Hospital Ophthalmology Departments’ operating rooms was compared to a standard BM (OPMI LUMIRA 700, Zeiss®), in the process of a call for new device evaluation. From December 2017 to March 2018, 5 surgeons and their respective residents were asked to fill in a questionnaire for all procedures. Before the surgery, the surgeon recorded: (i) the type of surgery (cataract [PK], retinal detachment [RD], epiretinal membrane peeling [ERM], macular hole, vitreous haemorrhage [VH]), (ii) the type of visualization system chosen (3D or BM), and (iii) the estimated surgical risk (low, intermediate, or high grade). At the end of the procedure, the primary surgeon recorded the remaining parameters, including: (i) surgery duration, (ii) intraoperative complications, (iii) percentage of endoillumination for posterior segment surgeries, (iv) status of the operator (senior or resident) and operator switch if necessary (senior only, resident only, or resident with help of the senior), and rated: (i) the visual comfort (low, normal, excellent), (ii) the operative fluency (low, normal, excellent), (iii) backaches (none, low, moderate, important), and (iv) headaches (range from 0 to 10). Age and sex were collected retrospectively. The procedures performed with 3D and BM were subsequently compared using univariate (χ2, Fisher, Wilcoxon) and multivariate analysis (generalized linear model), allowing us to identify parameters independently associated with PK surgery duration. Results: A total of 102 valid questionnaires, relative to 73 PK and 29 vitreoretinal procedures, respectively, were analysed. As regards PK (3D, n = 25 vs. BM, n = 48), the mean age, sex ratio, surgical risk, intraoperative complications (1/25 vs. 4/48), visual comfort, backaches, and headaches were similar between the two systems. The use of 3D allowed faster PK surgeries (16.44 ± 4.36 vs. 21.44 ± 7.50 min; p = 0.007) and slightly enhanced the operative fluency. In vitreoretinal surgeries (3D, n = 14 vs. BM, n = 15), no obvious differences between the two visualization systems were observed, although the use of the 3D system was found to slightly decrease the operative fluency. Parameters independently associated with PK surgery duration were 3D visualization (β = –4.4 ± 1.4; p = 0.002), high preoperative surgical risk (β = 6.2 ± 2.4; p = 0.012), intraoperative complications (β = 8.7 ± 2.6; p = 0.001), and surgeon status (β = –4.4 ± 1.3; p = 0.001) in univariate and multivariate analysis. Conclusions: 3D visualization can be safely used in routine practice. It slightly improves the operative fluency, allowing faster PK surgery.

Simple Summary Despite the impressive progress in the treatment of triple-negative breast cancer (TNBC), oncologists still face several provocative clinical scenarios in daily practice where clear evidence-based recommendations are lacking, and expert opinion is of utmost importance. In an attempt to seek guidance for these controversial topics in TNBC management, a consensus recommendations session for TNBC was held during the 12th round of the Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020. This special session convened a multidisciplinary committee of 35 panellists who specialize in breast cancer care from 13 countries. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials. Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when >= 75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.

Large brain arteriovenous malformations (AVMs) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged Gamma Knife radiosurgery (VSGR) has been developed for the treatment of large AVMs to increase the efficacy and improve safety of treatment of these lesions. The aim of this study was to assess the efficacy and safety of VSGR technique for the treatment of large brain AVMs.The study included patients treated by VSGR between May 2009 and July 2015. All patients had large AVMs (10 mL). There were 29 patients.Twenty-four patients completed radiographic follow-up, with 15 obliteration cases (62.5%). A total of 56 sessions were performed. The mean AVM volume was 16 mL (range, 10.1-29.3 mL). The mean prescription dose was 18 Gy (range, 14-22 Gy). The mean follow-up duration was 43 months (range, 21-73 months). One patient died during follow-up of an unrelated cause. Two patients had hemorrhage during follow-up. Symptomatic edema developed in 5 patients (17%). The factors affecting obliteration were smaller total volume, higher dose/stage, nondeep location, compact AVM, AVM score3,18 Gy dose, and15 mL total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (P = 0.012). T2 image changes were affected by Spetzler-Martin grade ≥3 (P = 0.013) and AVM score ≥3 (P = 0.014).VSGR provides an effective and safe treatment option for large brain AVMs. Smaller AVM volume is associated with higher obliteration rate.

Background Atrial fibrillation represents a common complication after coronary artery bypass and valvular surgery, although it is a benign arrhythmia it may contribute to the morbidity, high cost and prolonged ICU stay. Objectives The purpose of this study is to investigate and analyze the incidence and risk factors associated with postoperative atrial fibrillation (POAF) and its impact on intensive care unit (ICU) and postoperative hospital stay in patients undergoing coronary artery bypass graft surgeries (CABG) at Ain Shams University hospitals using the medical records of patients who underwent(CABG) surgeries from July 2018 to July 2019. Patients and Methods Our study was conducted in Ain Shams University hospitals from July 2018 to July 2019. This study was a retrospective non randomized on total 660 patients who undergone isolated Coronary artery bypass graft surgeries (CABG) during this period, of them we targeted 100 cases who developed POAF after surgery. Results Our results show that age, history of hypertension,smoking,history of renal impairment and recent myocardial infarction were all predictors of atrial fibrillation after cardiac surgery. POAF developed more frequent in patients who had larger left atrium diameter and lower ejection fraction. Our present results indicate that there is significant association between longer bypass and cross clamping time and development of POAF. We also found that patients who had postoperative lower serum potassium experienced more frequent POAF than who had normal potassium levels. In our study, we found that use of preoperative beta blocking drugs reduces risk of developing POAF. Early electrocardiographic ischemic postop. changes was also associated with high risk to develop POAF. No significant relation between use of intra-aortic balloon pump and development of POAF. Also, no significant relation between POAF and development of stroke or thromboembolic manifestations as POAF is usually self limiting,transient and resolves spontaneously in most of cases. Conclusion The current study found that low ejection fraction, dilated left atrium, hypertension, smoking, old age, male gender, prolonged bypass time, prolonged cross clamping time, renal impairment, previous myocardial infarction, ungrafted dominant right coronary artery, low temperatures on bypass, early ischemic changes postoperative, hypokalemia, use of adrenaline and nor adrenaline, all of these factors were a significant predictors for development of atrial fibrillation after cardiac surgery.

To describe the clinical features, epidemiology, autoantibody status, HLA haplotypes and genetic mechanisms of type 1 diabetes mellitus (T1DM). Patients (0–18 years) with diabetes were recruited. Clinical data was collected, autoantibodies and c-peptide were measured. Whole Genome Sequencing was performed. Genomic data analysis was compared with the known genes linked with T1DM and HLA alleles were studied. 1096 patients had one or more antibody positivity. The incidence of T1DM in 2020 was 38.05 per 100,000 children and prevalence was 249.73. GADA was the most common autoantibody followed by IAA. Variants in GSTCD, SKAP2, SLC9B1, BANK1 were most prevalent. An association of HLA haplotypes DQA1*03:01:01G (OR = 2.46, p value = 0.011) and DQB1*03:02:01G (OR = 2.43, p value = 0.022) was identified. The incidence of T1DM in Qatar is the fourth highest in the world, IA2 autoantibody was the most specific with some patients only having ZnT8 or IA2 autoantibodies thus underlining the necessity of profiling all 4 autoantibodies. The genes associated with T1DM in the Arab population were different from those that are common in the Caucasian population. HLA-DQ was enriched in the Qatari patients suggesting that it can be considered a major risk factor at an early age.

Context Idiopathic type 1 diabetes is characterized by the absence of autoantibodies and the underlying mechanisms are not clear. Objective We aimed to study the epidemiology, describe the clinical characteristics, and report results of genetic studies in pediatric patients with idiopathic type 1 diabetes. Methods This was a prospective study of type 1 diabetes patients attending Sidra Medicine from 2018 to 2020. Autoantibodies (GAD65, IAA, IA-2A, and ZnT8) were measured and genetic testing was undertaken in patients negative for autoantibodies to rule out monogenic diabetes. Demographic and clinical data of patients with idiopathic type 1 diabetes were compared with patients with autoimmune type 1 diabetes. Results Of 1157 patients with type 1 diabetes, 63 were antibody-negative. Upon genome sequencing, 4 had maturity onset diabetes of the young (MODY), 2 had Wolfram syndrome, 1 had H syndrome, and 3 had variants of uncertain significance in MODY genes; 53 patients had idiopathic type 1 diabetes. The most common age of diagnosis was 10 to 14 years. C-peptide level was low but detectable in 30 patients (56.6%) and normal in 23 patients (43.4%) The average body mass index was in the normal range and 33% of the patients had a history of diabetic ketoacidosis (DKA). Conclusion Four percent of the children had idiopathic type 1 diabetes. There were statistically significant differences in the C-peptide level and insulin requirement between the 2 groups. DKA was less common in the idiopathic group. Mutations in MODY genes suggest the importance of autoantibody testing and genetic screening for known causes of monogenic diabetes in idiopathic type 1 diabetes. The mechanism of idiopathic type 1 diabetes is unknown but could be due to defects in antibody production or due to autoantibodies that are not yet detectable or discovered.

The current published literature regarding the role of hip arthroscopy in the diagnosis and management of post-traumatic hip pain is still limited. Therefore, we conducted the present prospective study to determine the value of hip arthroscopy in the diagnosis and management of various causes of hip pain after traumatic conditions. The present study included a prospective cohort of 17 patients with symptomatic post-traumatic hip pain. It was conducted between July 2013 and May 2018. The mean age was 22 (19–29) years and the mean follow-up was 24 (r: 7–36) months. Prior to surgery, every eligible patient underwent assessment of functional status using the Modified Harris Hip Score, Oxford hip score (OHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. All patients underwent arthroscopic management for their diagnosed pathologies. The most commonly encountered diagnosis was labral tear (58.8%), followed by ligamentum teres tear (35.3%) and loose intra-articular fragments (29.4%). In addition, 52.9% of the patients had associated CAM lesion and 11.8% had associated Pincer lesion. The mHSS, OHS and WOMAC score showed significant improvement in the post-operative period (P

OBJECTIVERecurrent or residual adenomas are frequently treated with Gamma Knife radiosurgery (GKRS). The most common complication after GKRS for pituitary adenomas is hypopituitarism. In the current study, the authors detail the timing and types of hypopituitarism in a multicenter, international cohort of pituitary adenoma patients treated with GKRS.METHODSSeventeen institutions pooled clinical data obtained from pituitary adenoma patients who were treated with GKRS from 1988 to 2016. Patients who had undergone prior radiotherapy were excluded. A total of 1023 patients met the study inclusion criteria. The treated lesions included 410 nonfunctioning pituitary adenomas (NFPAs), 262 cases of Cushing’s disease (CD), and 251 cases of acromegaly. The median follow-up was 51 months (range 6–246 months). Statistical analysis was performed using a Cox proportional hazards model to evaluate factors associated with the development of new-onset hypopituitarism.RESULTSAt last follow-up, 248 patients had developed new pituitary hormone deficiency (86 with NFPA, 66 with CD, and 96 with acromegaly). Among these patients, 150 (60.5%) had single and 98 (39.5%) had multiple hormone deficiencies. New hormonal changes included 82 cortisol (21.6%), 135 thyrotropin (35.6%), 92 gonadotropin (24.3%), 59 growth hormone (15.6%), and 11 vasopressin (2.9%) deficiencies. The actuarial 1-year, 3-year, 5-year, 7-year, and 10-year rates of hypopituitarism were 7.8%, 16.2%, 22.4%, 27.5%, and 31.3%, respectively. The median time to hypopituitarism onset was 39 months.In univariate analyses, an increased rate of new-onset hypopituitarism was significantly associated with a lower isodose line (p = 0.006, HR = 8.695), whole sellar targeting (p = 0.033, HR = 1.452), and treatment of a functional pituitary adenoma as compared with an NFPA (p = 0.008, HR = 1.510). In multivariate analyses, only a lower isodose line was found to be an independent predictor of new-onset hypopituitarism (p = 0.001, HR = 1.38).CONCLUSIONSHypopituitarism remains the most common unintended effect of GKRS for a pituitary adenoma. Treating the target volume at an isodose line of 50% or greater and avoiding whole-sellar radiosurgery, unless necessary, will likely mitigate the risk of post-GKRS hypopituitarism. Follow-up of these patients is required to detect and treat latent endocrinopathies.

Chlorpromazine (CPZ) is an antipsychotic phenothiazine which is still commonly prescribed though it causes idiosyncratic toxicity such as cholestasis. CPZ toxicity mechanisms involve oxidative stre...

Background: With antiprogrammed death receptor-1 (anti-PD-L1) therapy, a recent meta-analysis reported higher incidence of cutaneous, endocrine and gastrointestinal complications especially with dual anti-PD-L1 immunotherapy (IMM). Methods: Our primary outcome was assessment of all cardiotoxicity grades in IMM compared with different treatments, thus a systemic review and a meta-analysis on randomized clinical trials (RCTs) were done. Results: We included 11 RCTs with 6574 patients (3234 patients in IMM arm vs 3340 patients in the other arm). Three non-small-cell lung cancer RCTs, seven melanoma RCTs and only one prostatic cancer RCT met the inclusion criteria. There were five RCTs that compared monoimmunotherapy to chemotherapy “(n = 2631 patients)”. No difference exists in all cardiotoxicity grades or high-grade cardiotoxicity (p > 0.05). Lung cancer exhibited a higher response rate and lower mortality in IMM. Conclusion: There was no reported statistically significant cardiotoxicity associated with anti-PD/PD-L1 use. Lung cancer subgroups showed better response and survival rates.

Introduction The difference in the amount of orthodontic-induced external root resorption (OIERR) of endodontically treated teeth (ETT) compared with vital pulp teeth (VPT) treatment is controversial. This systematic review and meta-analysis assessed the available evidence regarding OIERR of ETT compared with VPT. Methods PubMed, Scopus, MEDLINE, Web of Science, and Cochrane databases were searched up to May 2018 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and the risk of bias was assessed using the Risk of Bias In Non-randomised Studies of Interventions tool (Cochrane Bias Methods Group, Odense, Denmark). Weighted means of OIERR in ETT and VPT were calculated using a fixed effects model, and a random effects model was used to assess the significance of treatment effects. Results Eight studies were identified, from which 7 were included in the meta-analyses. The funnel plot of the random effects model exhibited a symmetrical distribution, which indicates no publication bias of the included studies. Because of the significant heterogeneity between studies, a random effects model was used. Significantly less OIERR for ETT was identified compared with their contralateral VPT. Conclusions Endodontic treatment does not seem to increase OIERR.

Objectives: Numerous studies addressed the effect of statin on cancer patients. The aim of this study is to define the effect of statin administration with chemotherapy on the patients’ outcomes. Methods: We retrospectively researched the database of the University of Cincinnati cancer to identify lung cancer patients who received statins (S+, n=41) during their treatment in our institute. We also, retrieved data for contemporaneously treated patients who did not receive statins (S-, n=159) as a control arm. Clinico-demographical data and overall survival (OS) were analyzed using Pearson’s Chi-square (χ2) test and Kaplan-Meier survival curves with Log-rank test. Adjustment using Cox proportional hazard ratios (HR) were done based on (age, gender, race and stage) to identify effect of statins on their outcomes. Results: The median age for S+ was 64y (IQR; 55-69) and 71.2% of the patients were white. Histopathology was 55.4% and 31.7% for adenocarcinoma and squamous cell carcinoma, respectively. Fifty-six percent were stage IV in each study arm and the median OS was14.9 m. Median OS was insignificantly lower in S–ve arm (13.7 vs 15.6 months; P=0.652, HR=0.91, 95%CI 0.52-1.57). Our results show that after different types of adjustments, S+ did not show survival advantage (P>0.05) compared to the control arm. Conclusion: While showing an increase in overall survival in patients with advanced lung cancer, the results of this study did not reach statistical significance. This could be due for the small sample size of this retrospective study.

Objectives: The purpose of this work was to determine the dimensions of CFA before the birth of the deep thigh artery, describe the mode of termination of the CFA, search for CFA collaterals, and describe the anatomical variations of the CFA. Methodology: This was a prospective study conducted at the Anatomy Laboratory of the Faculty of Medicine and Odonto-Stomatology of Bamako. CFA arteries of 12 fresh corpses of adults include 9 men and 3 women. A total of 24 CFA arteries were dissected and photographed. Results: The mean length of CFA was 50.9 ± 12.55 mm (range: 31 and 93 mm). Its average diameter was 9.12 ± 1.17 mm (range: 7 and 12 mm). In 70.83%, the CFA artery ended without any particularity. There was 29.17% anatomic variation in the CFA termination mode. The CFA divided into 3 branches (trifurcation) in 25%. The 3 branches were in 20.83%, the FS and a common core to LFCA and AQ; in 4.17%, they were the SFA, the DFA and the MFCA. In 4.17%, it divided into 4 branches which are: the SFA, the DFA, the MFCA and a common core to QA and LFCA. The CFA gave as collateral: circumflex superficial iliac artery in 22 cases (91.67%), superficial epigastric artery in 19 cases (79.17%), upper external pudendal artery in 20 cases (83.33%), and lower external pudendal artery in 14 cases (58.33%). We noted in our series 9 anatomical variations at the collateral level of the CFA or 37.5%. The CFA gave birth to the following branches: the MFCA in 4 cases or 16.67%, the LFCA in 1 case or 4.17%, the QA in 1 case or 4.17%, and a common core to the QA and LFCA in 3 cases or 12.5%. Conclusion: The length of CFA is important. The variations of CFA are frequent and important to know in clinical and surgical practice.

KRAS is the most commonly mutated oncogene in NSCLC and development of direct KRAS inhibitors has renewed interest in this molecular variant. Different KRAS mutations may represent a unique biologic context with different prognostic and therapeutic impact. We sought to characterize genomic landscapes of advanced, KRAS-mutated non–small cell lung cancer (NSCLC) in a large national cohort to help guide future therapeutic development. Molecular profiles of 17,095 NSCLC specimens were obtained using DNA next-generation sequencing of 592 genes (Caris Life Sciences) and classified on the basis of presence and subtype of KRAS mutations. Co-occurring genomic alterations, tumor mutational burden (TMB), and PD-L1 expression [22C3, tumor proportion score (TPS) score] were analyzed by KRAS mutation type. Across the cohort, 4,706 (27.5%) samples harbored a KRAS mutation. The most common subtype was G12C (40%), followed by G12V (19%) and G12D (15%). The prevalence of KRAS mutations was 37.2% among adenocarcinomas and 4.4% in squamous cell carcinomas. Rates of high TMB (≥10 mutations/Mb) and PD-L1 expression varied across KRAS mutation subtypes. KRAS G12C was the most likely to be PD-L1 positive (65.5% TPS ≥ 1%) and PD-L1 high (41.3% TPS ≥ 50%). STK11 was mutated in 8.6% of KRAS wild-type NSCLC but more frequent in KRAS-mutant NSCLC, with the highest rate in G13 (36.2%). TP53 mutations were more frequent in KRAS wild-type NSCLC (73.6%). KRAS mutation subtypes have different co-occurring mutations and a distinct genomic landscape. The clinical relevance of these differences in the context of specific therapeutic interventions warrants investigation.

BACKGROUND Glomus Jugulare tumors are benign but locally aggressive ones that represent a therapeutic challenge. Previous studies about the use of Gamma Knife Radiosurgery (GRS) in those tumors have documented good results that needed larger number of patients and longer follow up periods to be confirmed. MATERIAL AND METHODS Between August 2001 and December 2017, 70 patients with glomus jugulare tumors were treated at the Gamma Knife Center, Cairo. They were 46 females and 24 males. The mean age was 48 years (16–71 years). Nineteen of these patients were previously operated, 5 were partially embolized, 3 underwent embolization and subsequent surgery and 43 had gamma knife as their primary treatment. Volume-staged gamma knife radiosurgery was used in 10 patients and single-session in 60 patients, with a total of 86 sessions. The mean target volume was 12.7 cm3 (range 0.2 to 34.5 cm3). The mean tumor volume was 15.5 cm3 (range 0.2 to 105 cm3). The mean prescription dose was 14.5 Gy (range 12 to 18 Gy). RESULTS The mean follow up period was 60 months (range 18 to 206 months), and by the time of the data analysis, two of the patients were dead (66 and 24 months after GK treatment). The tumor control was 98.6% (69/70). Thirty-two tumors became smaller and 37 were unchanged. The symptoms improved in 36 patients, were stable in 32 patients, and worsened in 2 patients who developed a transient facial palsy and worsened hearing. Symptomatic improvement began before any reduction in tumor volume could be detected, where the mean time to clinical improvement was 7 months whereas the mean time to tumor shrinkage was 18 months. CONCLUSION This study about the long term follow up of the GKR for the intracranial glomus jugulare tumors confirmed that this is a highly effective and safe treatment. This data shows that the clinical improvement is not correlated with the radiological volume reduction.

In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.

Digital, Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics — from epidemiology, awareness, care and treatment to public health policies and leadership — that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD., Ciencias Médicas y de la Salud

Introduction: Sudan, especially Eastern States are very poor areas at great risk of endemic and communicable diseases particularly tuberculosis. The reasons for the spread and transmission of this disease include medical, economical and geographical issues, besides Sudan’s location in the middle of nine countries in East Africa, its boundaries were affected by free movement, high number of conflicts displaced peoples from boarders’ countries, high illiteracy rates, limited financial resources and shortages in medical services. Objectives: This project is conducted to implement a new developed system for eliminating Tuberculosis infections among eastern Sudanese populations focusing on the eradication of multidrug resistant Mycobacterium tuberculosis including novel methods for the targeted delivery of new therapeutic drugs. Conceptual Methodology: Strategies adopted in this work are proposed to increase access includes to communicable and economic factors. Disease Survey and Laboratorial Investigation for Multi Drug Resistant bacterial strains confirmation. Medical Assessment of TB Patients to facilitate improved efficiencies through metric measurement and enable patients’ relationship management. Established a national level policy of treatment, vaccination and prevention. Administering regular evaluation of the disease situation and control.Results: Implementation outcomes includes the conceptual framework for this project were informed by a combination of the general program logic model, the health system framework of the World Health Organization, WHO, the pillars of the Sudan health agenda, and the framework of the Strategic Elimination Plan. It is assumed that the reduction of TB burden at the national level (long-term output or impact) is preceded by improved case-finding and case-holding practices (short-term output). Impact outcome of the project is derived from the observation that tuberculosis is much more common at the boarders than center of Sudan where no adequate clinical services are available. It is conceivable that, although outbreaks may occur periodically, the control of disease might be easier to overcome than direct medication.Conclusion: A major success of the project accomplishment, is the stimulation of the implementation strategy development for elimination and eradication of Tuberculosis in Sudan with a view to bring diagnostic and surveillance issues much higher up according to the implementation research agenda especially for those areas explored with similar national and international research projects, reports and technical initiatives.

THE STUDY evaluated different extracts of Spirulina platensis using acetone, methanol, ethanol as well as water solvents for their antioxidant and antidiabetic potential. The results showed that all S. platensis extracts exhibited antioxidant activity by using DPPH (2, 2-Diphenyl-1-picrylhydrazyl), reducing power and total antioxidant capacity assays; in addition to their antidiabetic activity which was dependent on the used solvent. Among the tested extracts, S. platensis methanolic extract exhibited the highest antioxidant activity for all the tested assays and the maximum inhibitory effects for α-amylase (96.46 %) and α-glucosidase (97.42 %) diabetic enzymes. Spirulina methanolic extract showed no toxicity on normal cell lines using MTT assay. Gas chromatography–mass spectrometry (GC-MS) analysis of the methanolic extract revealed the presence of different bioactive compounds mainly phytol, 1-monolinoleoylglycerol trimethylsilyl ether, cholestan-3-ol, 2-methylene- (3β,5α) and fatty acids. These compounds might be acted synergistically to exert their obtained antioxidant and antidiabetic activity. For the in vivo study, administration of S. platensis methanolic extract (at 15 and 10 mg/Kg body weight (BW) caused antihyperglycemic activity by reducing the elevated blood glucose level. A remarkable decrease in different liver, kidney functions and hyperlipidemia related to diabetes were also detected. Furthermore, the methanolic extract treatment increased the body weight, total protein, albumin and hemoglobin levels as compared with the alloxan induced diabetic rats. Furthermore, treatment of diabetic rats with the extract improved liver and pancreas histopathological disorders related to diabetes. These results recommended using S. platensis methanolic extract in developing medicinal preparations for treatment of diabetes and its related symptoms.

Background Osteoporosis is a common complication of ankylosing spondylitis (AS) even in the early stages of disease; however, previously published studies have demonstrated large discrepancies in the reported incidence of osteoporosis, based on measurement of bone mineral density (BMD). The aim of the present study was to compare bone quality using trabecular bone score (TBS) between AS patients and healthy controls and to evaluate factors associated with TBS in patients with AS. Results Ankylosing spondylitis patients had significantly lower BMD and T score at the neck of femur and lower total hip BMD than controls (BMD p = 0.010 and 0.032 respectively), (T score p = 0.006 and p = 0.025 respectively). The mean TBS was significantly lower in AS patients than in controls (p < 0.001). Lumbar spine TBS was directly correlated with BMI (p = 0.029) and BMD at the neck of femur (p = 0.016) and BMD of total hip (p = 0.007) while inversely correlated with the Bath AS Metrology Index (BASMI) (p = 0.026), the modified Stoke AS Spinal Score (mSASS) (p = 0.029), ESR (p = 0.031), and CRP (p = 0.033). Conclusion TBS evaluation detected lower bone quality in the lumbar spine in patients with AS when compared with matched controls, while lumbar BMD failed to identify it. These findings encourage the use of TBS as a beneficial tool to recognize the risk of axial osteoporosis as early as possible in AS patients. Also, we recommend its use for regular follow up of drug treatment for those patients.

Child abuse leads to substantial health problems and is extremely worrisome to the pediatric medical community. The child presented in our case was a victim of severe physical abuse leading to rhabdomyolysis, AKI, subsequently requiring renal replacement therapy. The objective of this case is to raise awareness and advise checking renal function, CK and myoglobin in bruised children subjugated to physical abuse. Child abuse leading to severe decline in renal function is rare and needs to be recognized in a timely manner and adequately treated.

Background: Diabetic Retinopathy (DR) is one of the long-term complications of Diabetes Mellitus (DM) and constitutes the leading cause of blindness in working-age individuals. Prolactin (PRL) is a peptide hormone that is linked with lactation but many studies have demonstrated that PRL could have protective value against DR. Aim: To evaluate the role of prolactin in pathophysiology of DR. Methods: This study is designed to find an association between PRL level and DR. In this case-control study, a total of 300 subjects were recruited to participate in the study, 150 subjects apparently healthy as control group and other 150 patients were diagnosed with type 2 DM who were classified into diabetic patients with DR (75) and diabetic patients without DR (75). Serum PRL was measured by autoanalyzer (TOSOH AIA system), HbA1c was measured by another automated chemical analyzer (Cobas c system). Statistical analysis was performed using SPSS version 21 using an independent samples T-test and Pearson's correlation. Results: Independent samples of T-test analysis show a significant decrease in PRL level in the diabetic patients with DR in comparison to the diabetic patients without DR (p˂0.05). Person's correlation revealed that there was an insignificant correlation between PRL level with duration of DM and patients age. Conclusion: These findings suggest that low PRL level might be associated with DR.

Background: pregnancy represents an important challenge in the female's life that she needs close observation during it and also needs counseling by her physician about the changes that are going through her body in this stressful period. Aim of the Work: the purpose of our study was to detect the changes that occur in the women's eyes during pregnancy and postpartum period regarding intraocular pressure and refraction. Patients and Methods: we studied 40 pregnant healthy women whose ages ranged from 18 to 35 years and we exclude any ocular diseases such as keratoconus, amblyopia or diabetic retinopathy. We measured the intraocular pressure using a Goldmann applanation tonometer, best corrected visual acuity using the Snellen's chart and k reading using autorefractor-keratometer. Results: we found that the IOP decreases only in the 3rd trimester with more decrease in women with multiple fetuses and multiple pregnancies. We found that the BCVA decreases only in the 2nd and 3rd trimesters. We also found that the K reading increases only in the 2nd and 3rd trimesters. Intraocular pressure, best corrected visual acuity and k reading returned to the normal values after delivery. Conclusion: the physiologic changes that occur in the women's eyes during pregnancy and postpartum period are usually marked in second and third trimester; this is because at this period, hormonal activity is at its peak, and however these changes are transient because several weeks postpartum, all hormonal activities return to their prenatal levels.

Background Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management. Objective To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice. Methods This study was opened to centers of the International Gamma Knife Research Foundation (IGKRF). Data collected included patient characteristics, clinical symptoms at the time of SRS, radiosurgery dosimetric data, imaging response, clinical evolution, and survival. Actuarial analyses of tumor responses were performed. Results Seventy-six patients from 8 IGKRF centers were identified. Median follow-up from the second SRS was 51.7 mo. Progression after the first SRS occurred at a median of 43 mo. Repeat SRS was performed using a median dose of 12 Gy. Actuarial tumor control rates at 2, 5, and 10 yr following the second SRS were 98.6%, 92.2%, and 92.2%, respectively. Useful hearing was present in 30%, 8%, and 5% of patients at first SRS, second SRS, and last follow-up, respectively. Seventy-five percent of patients reported stable or improved symptoms following the second SRS. Worsening of facial nerve function attributable to SRS occurred in 7% of cases. There were no reports of radionecrosis, radiation-associated edema requiring corticosteroids, radiation-related neoplasia, or death attributable to the repeat SRS procedure. Conclusion Patients with progressing VS after radiosurgery can be safely and effectively managed using a second SRS procedure.

Objectives To evaluate and categorize the survival benefit of tricyclic antidepressants (TCAs) in lung cancer patients based on systematic computational drug repositioning data. Methods Data were retrospectively extracted from the medical records of non-small cell lung cancer (NSCLC) patients from the University of Cincinnati Cancer Medical Center database. Patients receiving antidepressants during their course of anti-cancer treatment were compared with those without antidepressants. Data were analyzed using Kaplan–Meier survival curves with the log-rank test, and overall survival (OS) was calculated from the date of diagnosis until last follow-up or death. Results The median OS at 2 and 5 years for patients on antidepressants was 20.3 months (54.7% and 42%) vs 44.3 months (47.6% and 43.2%), which was not significant. The median OS for patients receiving TCAs, selective serotonin reuptake inhibitors, and other antidepressants was 3.17 months, 31.33 months, and 18.50 months, respectively. Conclusion We found no significant survival benefit for TCA use in combination with anti-cancer agents in NSCLC patients.

INTRODUCTION Stenting has advanced the treatment of coronary artery disease, with angiography being historically the gold standard to assure adequate stent deployment. However, intravascular imaging modalities including intravascular ultrasound and optical coherence tomography have shown high rates of inadequate stent deployment in angiographically optimized stents. The association of malapposition with adverse clinical outcomes remains controversial. Areas covered: The definition, types, and risk factors for metallic stent malapposition, the natural history, and significance of stent strut malapposition and its correlation with short- and long-term outcomes were reviewed. Expert commentary: Using intravascular imaging, acute stent strut malapposition is very common, occurring in >75% in some studies. Malapposition may be a result of inadequate stent deployment technique or the atherosclerotic process itself. The preponderance of available data suggests that acute malapposition is not associated with worsened outcomes. Late acquired malapposition may be associated with a relatively increased event rate for stent thrombosis and myocardial infarction but the increased risk is quite small (

Aim of the Study: Description of the results of using the stapler based ileal neobladders for reconstruction after radical cystectomy in a subset of patients in the National Cancer Institute of Cairo University in Egypt in terms of functional outcome and patient satisfaction.Patients and Methods: In 2014, A prospective interven-tional study was carried out in the National Cancer Institute involving 29 patients with bladder cancer who met the criteria for neobladder reconstruction after radical cystectomy for whom a modified Y shaped ileal neobladder was created after tumor exanteration aiming at exploring functional outcomes and patient satisfaction rates for a period of one year in such a group of patients compared to other published reconstructive options.Results: The mean value of maximum neobladder capacity was 445ml, the mean pressure at maximum neobladder capacity was 22cm H2O and the mean post-voiding urine residual was about 20ml. By 6 months' post operatively, about 85% of the cases expressed having a good quality of life evidenced by satisfaction about their body image, daily maintenance and general satisfaction.Conclusion: Orthotopic neobladder reconstruction using the Y (Fontana) ileal neobladder can be considered as a simple and practical solution for neobladder reconstruction after radical cystectomy in Egyptian bladder cancer patients.

Metastatic prognosis in uveal melanoma is assessed by gene expression profiling (GEP) testing of the tumor cells, usually obtained by fine needle aspiration (FNA). GEP has demonstrated high accuracy in distinguishing class I and II tumors, both having different metastatic potential. Transcriptomic studies identified distinct mutations including somatic mutations in GNAQ and GNA11, detected in more than 80%, and contribute to the upregulation of the mitogen-activated protein kinase (MAPK) pathway and the development of uveal melanoma (UM). The role of these mutations in treatment selection and possible benefit from targeted therapy are somewhat unclear. However, until the discovery of novel agents, local versus systemic therapies remain options for treatment that can still be considered for disease control in certain cases. We report a series of patients with metastatic UM with distinct mutational profiles. One had significant liver metastases with proven GNQ-209P mutation on tissue biopsy while peripheral blood molecular profiling did not show these mutations. The other three cases had no GNQ-209P mutation. All cases received nab-paclitaxel (Abraxane) as a treatment drug, and we record their responses to treatment and their molecular-profiling results.

Three cases from 2 institutions are presented in which patients developed asystole and/or severe bradycardia following the use of regadenoson for myocardial perfusion imaging (MPI), potential causes are posited, and directed therapy is suggested. The first case is that of an 81-year-old man with

// Nagla Abdel Karim 1 , James Schuster 2 , Ihab Eldessouki 1 , Ola Gaber 1 , Tariq Namad 3 , Jiang Wang 4 , Changchun Xie 5 and John C. Morris 1 1 Vontz Center for Molecular Studies, University of Cincinnati, Cincinnati, OH 45219, USA 2 University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA 3 Military Hospital of Mohammed V, Department of Medical Oncology, Quartier Irfane, Rabat 10080, Morocco 4 UC Health University Hospital, Department of Pathology and Laboratory Medicine, Cincinnati, OH 45219, USA 5 Division of Biostatistics and Bioinformatics, Department of Environmental Health, Cincinnati, OH 45267, USA Correspondence to: Ola Gaber, email: gaberoa@ucmail.uc.edu Keywords: chemotherapy; lung cancer; non-small cell lung cancer; sarcomatoid Received: October 10, 2017 Accepted: November 19, 2017 Published: December 18, 2017 ABSTRACT Objectives: To review the outcomes of treatment in patients with pulmonary sarcomatoid carcinoma (PSC) treated at the University of Cincinnati Medical Center (UCMC). Results: There was no significant difference in survival of patients treated with chemotherapy alone (median, 256 days) compared to patients not undergoing treatment (median, 205.5 days). Patients who underwent surgery and adjuvant chemotherapy showed a trend in improvement of survival (median, 457.6 days). Patients requiring only surgery had the longest OS of 713.5 days. Conclusions: Systemic chemotherapy alone did not improve survival in patients with PSC. Surgery provides the greatest overall survival benefit and adjuvant chemotherapy may also improve survival. Methods: From 2000 to 2014, twenty-five patients with pathologically confirmed PSC were treated at UCMC. The outcomes were retrospectively analyzed by treatment with overall survival (OS) as the endpoint.

A 65-year-old with non-small cell lung cancer developed autoimmune haemolytic anaemia while receiving pembrolizumab containing chemoimmunotherapy. Initially thought to be due to pembrolizumab induced haemolysis, he was treated with steroids, and pembrolizumab was held. Haemolysis was refractory to steroids and blood was observed to agglutinate in cold room temperatures. Cold agglutinins in high titre and monoclonal serum IgM kappa protein were detected. Bone marrow biopsy showed marginal zone lymphoma confirming low grade B-cell lymphoma causing cold agglutinin disease. B-cell depletion by rituximab stopped haemolysis, and pembrolizumab was safely continued for lung cancer.

Introduction Quadrilateral plate fractures constitute one of the most challenging components of acetabular fractures. The objective of this study is to describe and evaluate the novel technique of buttress screw fixation of the quadrilateral plate component of the acetabular fractures. Patients & methods Forty cases of acetabular fracture with associated quadrilateral plate component were included in the study. Mean age was 35 years (range, 16 − 68 years), with a mean follow-up 16.4 months (range, 9 − 36 months). Fixation of the quadrilateral plate was achieved by one or more buttress screws. The screws were inserted through the reconstruction plate, and placed close to the edge of the pelvic brim. To effectively achieve the 3-point fixation principle, the screw was inserted through the plate hole then outside the bone rubbing on the pelvic surface of the quadrilateral plate. Results Anatomical reduction of the quadrilateral plate component of the fractures was achieved in all but one patient. The modified Merle D’Aubigne and Postel score was excellent in 13 cases, good in 23 cases, fair in three cases, and poor in one case. No screw displacement or failures were observed during follow-up evaluation. No major complications related to this technique were observed in this series. Conclusion Buttress screw fixation of the quadrilateral plate fracture component in associated acetabular fractures is a safe and effective technique for reduction and fixation of these challenging fractures with no major complications related to this novel technique.

Pulmonary sarcomatoid carcinoma (PSC) is a high-grade NSCLC characterized by poor prognosis and resistance to chemotherapy. Development of targeted therapeutic strategies for PSC has been hampered because of limited and inconsistent molecular characterization.Hybrid capture-based comprehensive genomic profiling was performed on DNA from formalin-fixed paraffin-embedded sections of 15,867 NSCLCs, including 125 PSCs (0.8%). Tumor mutational burden (TMB) was calculated from 1.11 megabases (Mb) of sequenced DNA.The median age of the patients with PSC was 67 years (range 32-87), 58% were male, and 78% had stage IV disease. Tumor protein p53 gene (TP53) genomic alterations (GAs) were identified in 74% of cases, which had genomics distinct from TP53 wild-type cases, and 62% featured a GA in KRAS (34%) or one of seven genes currently recommended for testing in the National Comprehensive Cancer Network NSCLC guidelines, including the following: hepatocyte growth factor receptor gene (MET) (13.6%), EGFR (8.8%), BRAF (7.2%), erb-b2 receptor tyrosine kinase 2 gene (HER2) (1.6%), and ret proto-oncogene (RET) (0.8%). MET exon 14 alterations were enriched in PSC (12%) compared with non-PSC NSCLCs (∼3%) (p0.0001) and were more prevalent in PSC cases with an adenocarcinoma component. The fraction of PSC with a high TMB (20 mutations per Mb) was notably higher than in non-PSC NSCLC (20% versus 14%, p = 0.056). Of nine patients with PSC treated with targeted or immunotherapies, three had partial responses and three had stable disease.Potentially targetable GAs in National Comprehensive Cancer Network NSCLC genes (30%) or intermediate or high TMB (43%,10 mutations per Mb) were identified in most of the PSC cases. Thus, the use of comprehensive genomic profiling in clinical care may provide important treatment options for a historically poorly characterized and difficult to treat disease.

Uterine perforation is a serious complication after insertion of an intrauterine device (IUD). We report the case of a 34-year-old woman receiving in consultation for abdominal pain. In the interrogation there was a notion of IUD insertion for about a week. The gynecological examination did not find the thread of IUD and the ultrasound performed did not visualize an IUD. Radiography of the abdomen without preparation highlighted a compatible intrapelvic foreign thing like an IUD. The diagnosis of pelvic inflammatory disease by uterine perforation by an IUD was thus retained. We suggest in case of suspicion of uterine radio paque IUD perforation achieving radiography when the abdominal pelvic ultrasound is normal.

Advanced non-small cell lung cancer (NSCLC) is a complex disease comprising molecularly distinct tumor types, each with a unique biology that is becoming increasingly better characterized. The aim of this review is to present an optimized treatment schema and the accompanying diagnostic testing approach for patients with advanced NSCLC. There are a number of therapies currently approved for patients with advanced NSCLC, including agents that target particular oncogenic drivers, as well as immune checkpoint blockers (ICBs) that elicit an antitumor response. Identification of genetic alterations (e.g., epidermal growth factor receptor, anaplastic lymphoma kinase, reactive oxygen species proto-oncogene 1, B-Raf proto-oncogene) or programmed cell death ligand-1 expression levels in NSCLC requires diligent molecular testing at initial diagnosis and, in some cases, at disease progression to ensure the most efficacious treatment is delivered. Accurate molecular diagnostic testing, along with the careful selection of currently approved targeted agents, ICBs, or systemic chemotherapy, provides therapy that is personalized according to patients’ needs to achieve the best possible outcome. Enrollment in clinical trials that further the development of tailored therapies is highly recommended at all stages of treatment.Implications for PracticeTargeted therapies and immune checkpoint blockers provide effective and tailored options for patients with non-small cell lung cancer. Careful molecular analysis of tumor samples is necessary to identify the genetic alterations that are present, to ensure that each patient receives the most efficacious treatment for their specific tumor type. Personalized therapy provides each patient with the best probability for prolonged survival. Enrolling patients in clinical trials should be the first consideration before making each treatment decision.

BACKGROUND About 20% of intracranial cavernous malformations (CM) occur in the brainstem. The greatest risk of brainstem CM is hemorrhage which can be devastating and even fatal in this location. The optimal management for these lesions would naturally be microsurgical resection. However, surgery in this location is associated with significant morbidity and mortality. Gamma knife radiosurgery provides a safer alternative. The purpose of this study is to investigate the efficacy of gamma knife radiosurgery for brainstem CM in preventing bleeding, as well as, assess safety with regards to radiation-induced complications. Additionally, we aimed to evaluate the feasibility and safety of volume-staged gamma knife radiosurgery for larger CM in the brainstem. MATERIAL AND METHODS Between September 2007 and August 2017, 48 patients with brainstem CM were treated by gamma knife. Thirty-two patients were available for follow up of at least one year. A total of 33 lesions were treated (one patient had two brainstem CM). Twenty-eight patients had at least one hemorrhagic event before radiosurgery. The patients underwent 40 gamma knife sessions. These included 28 single sessions (including two sessions for same patient for 2 different lesions in pons). Five patients had volume-staged gamma knife treatments due to the large size of the CM. The median total CM volume/lesion was 0.8 cc (0.1–30.4 cc), while the median target volume/session was 1 cc (0.1–11.5 cc). The median prescription dose was 12 Gy (10–14 Gy). RESULTS The mean follow up after treatment was 40 months (12–95 months). The annual hemorrhage rate (AHR) before gamma knife radiosurgery was 25.5%. After treatment there were a total of 5 hemorrhagic events with an overall AHR of 4.5%. Three hemorrhagic events occurred in the first 2 years after treatment with an AHR of 2.7% and 2 events more than 2 years after treatment with an AHR of 2.2%. No hemorrhagic events occurred among the patients treated by volume-staged radiosurgery. Clinical improvement was observed in 15 (46.9%) patients. Temporary adverse radiation events developed in 6 patients (19%). CONCLUSION Gamma knife radiosurgery provides an effective and safe treatment alternative to surgery for brainstem CM. Volume-staged gamma knife radiosurgery for brainstem CM appears to be a viable option for larger CM.

The incidence of renal cell carcinomas in adults ranges has been increasing over the past decades in both men and women. Once the incidence was 2.9%, now is reported to have increased to 3%–5% with male predominance according to the most recent reports of cancer statistics. The disease typically describes a group of different histopathological subtypes; the most common is clear cell carcinoma which accounts for 70%–80% of the diagnosed cases, while papillary renal cell carcinoma and chromophobe types represent 20% and 5%, respectively. In 1996, the renal cell carcinomas Heidelberg classification was introduced by Delahunt et al. It divides renal cell tumors into benign and malignant parenchymal neoplasms, excluding Wilm’s tumor and secondary metastases and limiting each subcategory to the most commonly documented genetic abnormalities, if applicable. In this report, we discuss a case of metastatic type I papillary renal cell carcinoma treated with the anti-vascular endothelial growth factor receptor sunitinib and showing marked long-term clinical response. Through this case, we highlight the importance of re-classifying papillary renal cell carcinoma subtypes to prioritize the clinical management of these cases.

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF. Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

Background: Anti-PD/PD-L1-targeted immunotherapy is associated with remarkably high rates of durable clinical responses in patients across a range of tumor types, although their high incidence of skin, gastrointestinal, and endocrine side effects with their use. The risk of pneumonitis associated with checkpoint inhibition therapy is not well described. Methods: A systematic review of the literature was conducted on randomized clinical trials (RCTs) comparing anti-PD/PD-L1 mono-immunotherapy (IMM) to chemotherapy (CTH) protocols in cancer patients. The primary endpoint was the pneumonitis rate in IMM compared to CTH. Secondary endpoints were (I) high-grade pneumonitis rate in IMM compared to CTH and (II) tumor response rate, progression-free survival (PFS), and overall survival (OS) between IMM and CTH. Random model and leave-one-out-analysis were performed. Results: Thirteen RCTs studying 7,246 patients were included; 3,704 (51.12%) patients in the IMM arm and 3,542 (48.88%) patients in the chemotherapy arm. Seven non-small cell lung cancer (NSCLC) RCTs were included with 4,164 patients; 2,101 in the IMM arm and 2,063 patients in the CTH arm. Three RCTs were on melanoma patients (n=1,390). Nine RCTs compared mono-immunotherapy to CTH [docetaxel in 5 studies (38.5%), platinum-based in 2 studies (15.4%), dacarbazine in 1 study (7.7%) and everolimus in 1 study]. Both high-grade and all-grade pneumonitis were higher among patients in the IMM arm when compared to the CTH arm (OR =4.39, 95% CI: 1.65–11.69, P=0.003 and OR =2.46, 95% CI: 1.29–4.6, P=0.007). Tumor response rate was significantly better in the immunotherapy arm (OR =2.31, 95% CI: 1.62–3.29, P